Metastatic Lymph Node Ratio of Central Neck Compartment Has Predictive Values for Locoregional Recurrence in Papillary Thyroid Microcarcinoma

ObjectivesThis study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma.MethodsAfter reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR.ResultsThe MLNR showed a predictive significance for the locoregional recurrence (P<0.05). Most recurrences were occurred in the lateral neck (n=12, 80%) with a median interval of 20 months. The lowest cutoff value of the MLNR for a meaningful separation of disease recurrence was 0.44 (hazard ratio, 8.86; 95% confidence interval, 1.49 to 52.58; P=0.001).ConclusionWhen the MLNR is higher than 0.44, there is an increased risk of locoregional recurrence mostly in the lateral neck. Therefore, MLNR of the central neck in a permanent or frozen biopsy may be helpful in decision making in the extent of thyroidectomy and/or the need for contralateral central neck lymph nodes dissection.     

Trajectories of sleep quality during the first three years after breast cancer diagnosis

ObjectiveTo identify trajectories of sleep quality up to three years after breast cancer diagnosis and to assess differences in characteristics of patients across distinct trajectories.MethodsA total of 458 breast cancer patients underwent a neurological evaluation before treatment and at one and three years after diagnosis. Clinical data were obtained throughout the follow-up. Anxiety and depression were evaluated at baseline, using the Hospital Anxiety and Depression Scale. In all sessions of follow-up, sleep quality was assessed using the Pittsburgh Sleep Quality Index. Model-based clustering was used to identify groups of patients with homogeneous variation in sleep quality.ResultsWe identified three trajectories of variation in sleep quality, named “low” (LSQ), “medium” (MSQ), and “high sleep quality” (HSQ). Women in the HSQ trajectory presented good sleep quality during the three years. LSQ and MSQ trajectories were characterized by poor sleep quality during the whole period, although during the first year the latter depicted a significant deterioration of sleep quality and the former a significant improvement. Patients included in the LSQ trajectory were more likely to have clinically significant anxiety and depression at baseline. The two trajectories with worse sleep quality were associated with neuropathic pain three years after cancer diagnosis.ConclusionsThis study provides a model for describing the variation in sleep quality during the first three years after breast cancer diagnosis, based on three main trajectories. Further studies are needed understanding the heterogeneity of the individual trajectories within each of these major patterns of variation.     

~1H-MRS对肺癌脑转移瘤患者放疗疗效的评价

目的:通过测量肺癌脑转移瘤瘤体放射治疗前后MRS代谢物浓度,探讨1 H-MRS代谢物浓度的变化对肺癌脑转移瘤放疗疗效评价的价值。方法:选取经临床及影像学证实的原发性肺癌脑转移患者,患者于放疗前、后均行MRI增强扫描及MRS。将放疗后脑转移瘤的代谢物浓峰比值Cho/Cr、Cho/NAA行配对t检验,同时在治疗前后对肺癌脑转移患者进行Karnofsky(卡氏,KPS,百分法)功能状态评分,将放疗前后脑转移瘤瘤体代谢物比值的变化与KPS评分的变化进行相关性分析。结果:放疗前后转移瘤各峰比值的差值(d)为1.92±0.58,通过对d行正态性检验,2组间差异具有统计学意义(P=0.020 7)。结论:1 H-MRS可定量评估肺癌脑转移患者的治疗效果,对其疗效判定有一定的参考价值。     

Application of Various Additional Imaging Techniques for Thyroid Ultrasound: Direct Comparison of Combined Various Elastography and Doppler Parameters to Gray-Scale Ultrasound in Differential Diagnosis of Thyroid Nodules

This study was conducted to evaluate the role in the differential diagnosis of thyroid nodules of various elastographic and Doppler parameters when added to gray-scale ultrasonography (US). One-hundred seventy-one thyroid nodules (63 malignant, 108 benign) in 169 patients were included. Elastography (strain and shear wave elastography) and Doppler (power Doppler, superb microvascular imaging and microflow imaging) images of the same thyroid nodule were obtained using a single US machine. The diagnostic performance parameters of gray-scale US with and without elastography and those of Doppler US were calculated and compared. The specificity, positive predictive value and accuracy of gray-scale US were significantly higher than those of US combined with elastographic parameters (all p values?<?0.05). The area under the receiver operating characteristic curve for gray-scale US was 0.877, significantly higher than that for US combined with elastography patterns, shear wave elastography ratio (all p values?<?0.05) and Doppler parameters. Adding additional imaging modalities such as elastography and Doppler does not improve the diagnostic performance of gray-scale US in differentiating thyroid nodules.     

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts

BackgroundBasal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking.ObjectivesTo evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts.MethodsA retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence.ResultsOf the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types.Study limitationsRetrospective nature of the study.ConclusionThe present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.     

结直肠癌肝转移局部治疗的研究进展

结直肠癌是常见的消化道恶性肿瘤，易发生肝转移。外科手术切除肝转移病灶是重要治疗方法之一。随着临床诊疗技术的进步，介入治疗、放射治疗等方法已成为结直肠癌肝转移的重要治疗手段。本文将对结直肠癌肝转移局部治疗的研究进展进行综述。     

AP-4在恶性肿瘤中的表达和意义

恶性肿瘤是以细胞增殖和转移为特点的一大类疾病，其发生、发展与多基因、多因素的调节有关。激活蛋白4（AP-4）作为转录因子AP家族的一员，在多种恶性肿瘤中呈过表达，通过识别和结合CAGCTG序列调控靶基因表达，参与恶性肿瘤细胞凋亡、增殖、血管生成、转移、DNA修复等的调节。本文就AP-4的作用途径及其在胃癌、结直肠癌等恶性肿瘤中的表达和意义作一综述。     

乳腺浸润性小叶癌的临床病理特征、诊疗现状及展望

乳腺癌是目前全球范围内发病率最高的恶性肿瘤，且组织学类型多样。乳腺浸润性小叶癌（ILC）是第二大常见浸润性乳腺癌组织学亚型（占5%~15%），近三十年来其发病率有所升高。E-钙黏蛋白表达缺失是乳腺ILC最主要的分子特征，可导致细胞间缺乏黏附性、肿瘤呈特殊弥漫性浸润生长，这给临床查体及影像学检查带来了一定挑战。尽管多数乳腺ILC患者激素受体呈阳性表达、对内分泌治疗反应良好，但也存在内分泌治疗耐药问题。此外，近年研究证实乳腺ILC患者预后并非如既往研究报道的那样良好，仅基于肿瘤分期及分子分型的治疗原则似乎并不完全适用于乳腺ILC，可能有必要将其作为独立的临床实体行进一步研究。本文主要综述了乳腺ILC的流行病学及临床特征、病理学及分子特征、诊断、治疗、预后、未来治疗方向等，以供临床医师更好地了解并优化乳腺ILC的临床诊断和个体化治疗参考。