自发性甲状腺皱缩结节与甲状腺乳头状癌的超声鉴别诊断研究

目的探究自发性甲状腺皱缩结节常规超声和超声造影检查下(contrast-enhanced ultrasound,CEUS)的表现特点,并与甲状腺乳头状癌(papillary thyroid carcinomas,PTC)进行鉴别诊断。方法回顾性分析2019年2月至2020年1月于南昌大学第一附属医院就诊且经细针穿刺(fine-needle aspiration,FNA)细胞学或术后病理证实的39例自发性甲状腺皱缩结节患者(46个结节,即皱缩结节组),其中男12例,女27例,年龄25~76 岁,以及同时期经术后病理确诊的PTC患者中随机选取32例(36个癌灶,即PTC组),其中男8例,女24例,年龄23~68 岁。比较2组病变的大小、形状、边界、回声、钙化、血流信号等常规超声表现,其中28个皱缩结节及30个PTC在FNA或术前行CEUS检查,分析比较2组在增强模式下的表现。采用两独立样本t检验、χ2检验或Fisher精确检验比较2组的超声表现,差异有统计学意义者行二元Logistic回归检验是否为独立预测风险因素。结果单变量分析示皱缩结节组与PTC组相比,更常表现纵横比<1、边界清晰、极低回声以及无或点线状增强方式,差异有统计学意义(纵横比<1者∶36比17,χ2 =8.511;边界清晰:30比15,χ2 =4.523;极低回声:27比9,χ2=9.310;无或点线状增强方式:24比3,χ2 =33.369;P值均<0.05),多变量Logistic回归分析示结节纵横比<1、边界清晰及极低回声为皱缩结节的独立风险预测因子(OR值分别为5.204、3.134和5.042,P值分别为0.003、0.031和0.003)。其中15个皱缩结节从良性表现至首次可疑恶性的时间跨度为(18.6±10.5)个月,初始最大长径缩小(24.3±11.4)mm。结论皱缩结节相较于PTC超声检查中更常表现为纵横比<1、边界清晰、极低回声和无或点线状增强方式。结合随访过程中患者历史超声检查有助于诊断。     

中文版嗓音疲劳指数量表在职业用声者嗓音疲劳评估中的应用

目的 探索中文版嗓音疲劳指数量表(VFI)在职业用声者嗓音疲劳(VF)评估中的应用.方法 观察组为因嗓音疲劳就诊的职业用声者120例,对患者进行电子喉镜内镜窄带成像技术(NBI)检查,填写中文版VFI量表调查问卷.观察组根据电子喉镜NBI下检查再次分组慢性喉炎组(A组)、声带小结组(B组)、声带肿物组(C组).对照组为...     

Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types

Objective: To compare the cytological findings of hypoechoic thyroid nodules with intranodular vascular pattern (pattern II) obtained by two different needles (Neolus 25 gauge, Chemil, Wenzhou, China vs Yale Spinal 25 gauge, Becton Dickinson, Madrid, Spain) in euthyroid patients and to evaluate their cost-effectiveness. Methods: From January 2001 to December 2003, 480 euthyroid patients with a hypoechoic thyroid nodule pattern II were referred for US-FNAC. The nodules were alternatively evaluated by Neolus or by Yale Spinal with the stylet (YS+) or without the stylet (YS−), in order to evaluate if the cytological results could be due to the presence of the stylet or to the different length of the two needles. For each nodule two passes were performed and the material was obtained by capillary action. Material was smeared on slides, fixed, and stained by Papanicolaou techniques. Cytological specimens were evaluated in blind by the same experienced cytopathologist. Results: Inadequate cytological specimens because of blood contamination were present in 30 (18.7%) samples by Neolus needle and in 22 (13.8%) by YS− compared to only 5 (3.1%) by YS+. In 6 (20%) cases of the 30 repeated US-FNAC by Neolus and in 4 (18%) of the 22 US-FNAC by YS−, material remained inadequate for diagnosis because of blood contamination. All the five repeated samples obtained by YS+ became adequate for diagnosis and resulted benign nodules. Direct costs of US-FNAC procedure are currently Э 72.30 including cytological examination. The cost of Neolus and Yale needles is Э 0.19 and Э 3.0, respectively. The estimated total cost to obtain a cytological diagnosis by a Neolus needle (160 + 30 repeated US-FNAC) was Э 13809.2 vs Э 12919.5 by Yale Spinal needle (160 + 5 repeated US-FNAC). Conclusion: This study demonstrates that the use of Yale Spinal needles greatly reduces inadequate cytological specimens, and therefore limits both direct and indirect costs.     

甲状腺良性结节微波消融术中喉返神经及旁腺保护措施与解剖基础

目的 探讨超声引导下微波消融术治疗甲状腺良性结节过程中对喉返神经及甲状旁腺的损伤保护措施及其解剖基础。方法 选取2017年1月到2019年6月行1射频消融治疗的甲状腺疾病患者52例,观察术后结节大小、血流信号变化、甲状腺激素水平、并发症发生情况等。结果 术后超声随访结节的体积较治疗前不同程度缩小(P<0.05)。结论 加强隔离带技术可以有效保护喉返神经及甲状旁腺,降低损伤风险。     

敲除NIPBL基因可下调小鼠骨髓间充质干细胞增殖及成骨分化能力

文题释义： NIPBL基因：其编码的蛋白Delangin通过调控cohesin蛋白加载到DNA上,所以又名粘连蛋白加载因子(cohesin loading factor)。它还能调控多个基因的表达,也与基因修复有关。在研究德朗热综合征致病机制过程中,NIPBL基因最受人关注。 德朗热综合征：是以身材矮小、骨骼发育、智力低下和特殊面容为主要特征的遗传性疾病,患病率为1∶10 000- 1∶30 000,它的发病机制主要与7个基因(NIPBL、SMC1A、SMC3、BRD4、HDAC8、RAD21、ANKRD11)突变密切相关,确定NIPBL基因是否突变在德朗热综合征诊断中被作为首要检测指标。 背景：德朗热综合征是一种多系统发育缺陷的遗传性疾病,NIPBL是其主要致病基因。 目的：探讨NIPBL基因对骨髓间充质干细胞增殖及成骨分化能力的影响。 方法：采用NIPBL-Loxp小鼠与Cre小鼠构建NIPBL基因缺陷杂合子小鼠模型(NIPBL^+/-)并将其作为实验组,野生型(NIPBL^+/+)小鼠作为对照组,分离培养两组小鼠骨髓间充质干细胞,传至第3代时采用CCK-8法比较两组细胞增殖能力,然后进行成骨诱导培养比较两组细胞成骨分化能力。 结果与结论：①实验组骨髓间充质干细胞的增殖能力低于对照组(P < 0.05);②成骨诱导第7天,实验组细胞碱性磷酸酶活力明显低于对照组(P < 0.05);③成骨诱导后,实验组Runx2、OCN基因及其蛋白的表达水平低于对照组(P < 0.05);④成骨诱导第21天,茜素红染色后倒置显微镜下观察对照组较实验组可见更多的红色钙结节;⑤结果提示,敲除NIPBL基因降低了骨髓间充质干细胞的增殖、成骨分化能力。 ORCID: 0000-0001-7493-4402(林明) 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Clinicopathologic significance of mitotic arrest defective protein 2 overexpression in hepatocellular carcinoma

Mitotic arrest defective protein 2 (MAD2) gene plays a central role in the mitotic checkpoint. Elevated MAD2 expression was observed in a number of human malignancies; its role in the development of hepatocellular carcinoma is still not understood and is controversial. The purpose of this study was to investigate the clinicopathologic significance of MAD2 expression in hepatocellular carcinoma. The MAD2 protein and its messenger RNA levels were measured in hepatocellular carcinomas, high-grade dysplastic nodules, and their paired nontumorous liver tissues by quantitative real-time polymerase chain reaction, Western blot, and immunohistochemistry. The results showed that MAD2 at both messenger RNA and protein levels was overexpressed in 8 of 9 high-grade dysplastic nodules and in 51 of 58 hepatocellular carcinomas, including 12 of 14 unifocal small hepatocellular carcinomas. There was a tendency for MAD2 expression to increase in the process of this multistep carcinogenesis. A significantly high tumor MAD2 immunostaining was associated with the progression of histologic grade and the overall low survival. In conclusion, MAD2 is overexpressed frequently in hepatocellular carcinoma, including high-grade dysplastic nodules and early-stage small hepatocellular carcinoma, indicating that overexpression of MAD2 plays a role in the development and progression of hepatocellular carcinoma. It may be an early event in hepatocarcinogenesis and could be used as a potential prognostic indicator.     

恶性孤立性肺结节诊断与治疗

肺部结节发病总体呈增长趋势.肺结节按密度分为纯毛玻璃样结节、部分实性结节和实性结节,按良恶性分为良性肺结节和恶性肺结节.恶性孤立性肺结节以早期肺腺癌为主.对于部分液体活检及肺活检诊断为早期肺癌的患者以手术治疗为主;不能手术的早期肺癌患者可考虑体部立体定向放疗;对于诊断不清的患者,应根据生长的速度、影像学资料、高危险因素给予定期随访.随访过程中如发现肺结节体积增大、密度增强应给予手术治疗.     

99TcmO-4甲状腺静态显像及SPECT/CT同机融合显像对甲状腺"冷结节"良恶性鉴别的诊断价值

目的 探讨99TcmO-4甲状腺静态显像及SPECT/CT同机断层融合显像对甲状腺"冷结节"良恶性鉴别的诊断价值.方法 选取2014年1月至2016年12月99TcmO-4甲状腺静态显像显示为冷结节的患者60例,行SPECT/CT同机断层融合显像,所有患者均行甲状腺手术或穿刺取活检确诊.结果 甲状腺断层融合显像提示冷结节病灶呈低密度35例,等或稍低密度25例,病灶边缘清晰33例,边缘模糊27例,有明显粗大钙化15例,未见明显钙化45例,结节直径大于等于2cm 13例,结节直径小于2cm 47例.等或稍低密度、边缘模糊、无明显粗大钙化灶结节为恶性结节的可能性偏高,低密度结节、边缘清晰、可见粗大钙化灶冷结节为良性结节的可能性偏低,差异均具有统计学意义.结论 99TcmO-4甲状腺静态显像显示冷结节患者,行SPECT/CT同机断层融合显像对鉴别结节良恶性的诊断准确性有很大提高.     

人参皂苷Rb1对体外培养人脂肪干细胞增殖与成骨分化的影响

背景：脂肪干细胞成骨分化受多种因素的影响,中药成骨诱导活性因子在脂肪干细胞研究中有重要意义。 目的：观察人参皂苷Rb1在体外培养条件下对人脂肪干细胞增殖和成骨分化的影响。 方法：体外分离培养人脂肪干细胞,传至第3代后,按2×10³/孔接种至96孔板,分别加入0.5,1.0,2.0,4.0,6.0 μmol/L人参皂苷Rb1培养基200 μL进行培养;设立对照组,仅加入等量普通DMEM培养基。采用XTT比色法测定大鼠脂肪干细胞的生长增殖曲线。通过碱性磷酸酶试剂盒测定细胞碱性磷酸酶活性,放射免疫法检测骨钙素含量,茜素红染色观察钙化结节形成能力。 结果与结论：0.5 μmol/L人参皂苷Rb1可明显促进人脂肪干细胞增殖;随着人参皂苷Rb1浓度的增加,促细胞增殖活性降低,6.0 μmol/L人参皂苷Rb1表现为明显的抑制细胞增殖作用。人参皂苷Rb1呈剂量依赖性促进人脂肪干细胞碱性磷酸酶活性和骨钙素表达。4.0,6.0 μmol/L人参皂苷Rb1诱导钙化结节形成能力优于0.5,1.0和2.0 μmol/L人参皂苷Rb1,对照组人脂肪干细胞未见钙化结节形成。提示人参皂苷Rb1在一定浓度范围内对体外培养条件下的人脂肪干细胞具有促生长增殖作用,但在高浓度时,人参皂苷Rb1对人脂肪干细胞的成骨分化具有促进作用,因此可作为一种良好的成骨诱导活性因子。     

Combination of Radiological and Gray Level Co-occurrence Matrix Textural Features Used to Distinguish Solitary Pulmonary Nodules by Computed Tomography

The objective of this study was to investigate the method of the combination of radiological and textural features for the differentiation of malignant from benign solitary pulmonary nodules by computed tomography. Features including 13 gray level co-occurrence matrix textural features and 12 radiological features were extracted from 2,117 CT slices, which came from 202 (116 malignant and 86 benign) patients. Lasso-type regularization to a nonlinear regression model was applied to select predictive features and a BP artificial neural network was used to build the diagnostic model. Eight radiological and two textural features were obtained after the Lasso-type regularization procedure. Twelve radiological features alone could reach an area under the ROC curve (AUC) of 0.84 in differentiating between malignant and benign lesions. The 10 selected characters improved the AUC to 0.91. The evaluation results showed that the method of selecting radiological and textural features appears to yield more effective in the distinction of malignant from benign solitary pulmonary nodules by computed tomography.