Hipertiroidismo como manifestación de la enfermedad trofoblástica gestacional: a propósito de un caso

Gestational trophoblastic disease (GTD) is a group of tumours caused by the hyperproliferation of trophoblast cells and is noted for its overproduction of hCG. Among its manifestations, there may be hyperthyroidism, due to the stimulating activity of hCG on TSH receptors. In most cases it is only a biochemical hyperthyroidism, with its presentation as symptomatic hyperthyroidism being much less frequent. We report the case of a patient with GTD, who at diagnosis presented with symptomatic hyperthyroidism. Treatment included surgical evacuation of the hydatidiform mole, as well as a beta-blocker and antithyroid drug treatment to relieve the symptoms.     

超声引导下甲状腺结节细针穿刺术的个人学习曲线初步研究

目的探讨超声引导下无负压甲状腺细针穿刺细胞学（US-FNAC）的学习曲线规律及其影响因素。 方法收集分析2017年6月至2018年月6月西安交通大学医学院附属陕西省肿瘤医院由同一医师完成的135例US-FNAC患者的操作耗时及临床病例资料，将患者按手术先后分9组（A~I组），每组15例定为一手术阶段后进行两两对比分析，比较各阶段的操作耗时、并发症及操作无效率。根据得出结果将135例患者分为前、中、后（X、Y、Z）3组，比较组间差异，进一步验证结果。 结果在A组至I组进行两两对比统计学分析得出，在A~D组间操作耗时均存在统计学差异（均P<0.05），在D组与E组间出现转折即两组比较差异无统计学意义（P=0.561），而E~I组间差异均无统计学意义（均P>0.05）。X、Y、Z 3组比较中，X组操作耗时明显长于Y组和Z组［分别为（6.23±1.38）min、（3.47±0.45）min、（3.21±0.45）min］，X组与Y组和Z组差异均有统计学意义（t=18.07、23.15，均P<0.05），Y、Z两组对比无显著差异（t=1.92，P=0.067）。随着操作例数的增加，并发症及无效操作的发生率逐渐降低。 结论对于期望熟练掌握US-FNAC技术的超声医师，遵循对操作的全面认知和科学操作步骤，在指导下开展45例左右的US-FNAC后，可望快速安全越过学习曲线转折点。     

基于Faster-RCNN的肺结节检测算法

针对目前的肺结节检测中存在的个体差异、同病异影、同影异病的问题,提出一种大样本条件下的基于Faster-RCNN的肺结节检测算法,对比研究目前的深度学习模型的适应性,给出一种通用的随着样本数量增加肺结节检测率持续提升的策略。首先搭建深度学习的软硬件环境,设置影像数据接口与Faster-RCNN的网络接口匹配;然后搭建Faster-RCNN的单类分类网络,并对网络结构的参数进行调整优化;最后用包含2 000例病人的肺结节数据集,通过不同的卷积神经网络模型 (包括ZF和VGG),计算CT图像在各自模型中的特征。对测试结果进行分析评估,分别统计其漏检率、检测准确率,并探讨不同训练数量和数据增广类型对最终检测准确率的影响。最终ZF模型的检测准确率为90.82%,准确率的波动方差为13.30%;VGG模型的检测准确率为87.02%,准确率的波动方差为37.10%。ZF模型的波动方差小,检测精确度高,综合考虑,ZF模型对肺结节的检测效果优于VGG模型的检出效果。所提出的肺结节检测技术具有良好的理论价值和工程应用价值。     

Large cutaneous epithelioid angiomatous nodules in a patient with nephrotic syndrome: A case report

BACKGROUND Cutaneous epithelioid angiomatous nodules(CEAN) are rare, benign, vascular lesions characterized by benign proliferation of endothelial cells with prominent epithelioid features, which can be easily confused with benign and malignant vascular tumors. However, the etiology of CEAN remains unclear, and no association with infection, trauma, or immunosuppression has been described.This case study indicated that CEAN is closely related to the patient’s impaired immune status and may be induced by cyclosporine.CASE SUMMARY A 19-year-old boy with nephrotic syndrome(NS) developed large CEAN on the left foot during treatment for NS. He had repeated relapses of edema in the past 6 years and different types of immunosuppressants were administered including methylprednisolone, mycophenolate mofetil, tacrolimus and cyclosporine;the dosages of these drugs were frequently adjusted. The patient had been receiving cyclosporine and methylprednisolone for 7 mo before he developed CEAN.Cyclosporine was discontinued due to its side effects on skin. After cessation of cyclosporine and 16 mo follow-up, the nodules gradually disappeared without any other treatment for the CEAN.CONCLUSION Impaired immune status is proposed to be a risk factor for CEAN, which may be induced by cyclosporine.