改良喉部分切除术治疗声门型喉癌的疗效分析

目的 探讨保留甲状软骨的喉部分切除术在治疗声门型喉癌中的可行性及其手术效果.方法 回顾性分析1999年1月至2009年1月收治的声门型喉癌患者128例,术中肉眼和病理证实甲状软骨内膜无癌细胞侵犯或甲状软骨局灶性破坏无需大范围切除的T2-3期病例,采用病例对照研究方法,按部位相同、TNM分期相同,年龄相差≤10岁,1∶1配对.研究组为保留甲状软骨的喉部分切除术患者,共64例,其中T2N038例,T2N16例,T2N21例,T3N0 17例,T3N12例;对照组为传统喉部分切除术患者,共64例,TNM分期同研究组.比较两组患者生存率、局部控制率和总拔管率.结果 研究组3年及5年累积生存率分别为89.8％,84.3％,对照组分别为91.5％,85.4％,两组比较差异无统计学意义（x2=1.687,P＞0.05）;研究组局部控制率为91.7％（55/60）,对照组为93.2％（55/59）,两组比较差异无统计学意义（x2=0.103,P＞ 0.05）;研究组总拔管率为98.3％（59/60）,对照组为89.8％（53/59）,两组比较差异有统计学意义（x2=4.933,P＜ 0.05）.结论 对于T2期和部分T3期声门型喉癌患者的治疗,与传统喉部分切除术式相比,保留甲状软骨的喉部分切除术在保证彻底切除肿瘤、保留足够安全缘的同时,保留了喉功能,其术后拔管率高,并发症发生率低,有助于改善喉癌患者术后的生活质量.     

右美托咪啶滴鼻用于甲状腺手术的临床观察

目的 观察右美托咪啶滴鼻对全凭静脉麻醉下甲状腺手术术后镇痛效果.方法 60例择期行甲状腺手术的女性患者,按机械抽样法随机分成两组,每组30例.Ⅰ组麻醉诱导前给予右美托咪啶1μg/kg滴鼻,Ⅱ组麻醉诱导前同量氯化钠注射液滴鼻,开皮前10 min氟比洛芬酯100 mg静脉注射.行气管插管全凭静脉麻醉,术后1,2,4,6,8,12,24 h用视觉模拟量表（VAS）评价手术部位的疼痛,布氏舒适量表（BCS）评价咳嗽时疼痛,并记录不良反应.结果 Ⅰ组术后1,2,4,6,8,12h的VAS评分明显低于Ⅱ组,差异有统计学意义（P＜0.05）;Ⅰ组术后1,2,4,6,8h的BCS评分高于Ⅱ组,差异有统计学意义（P＜0.05）;Ⅰ组术后恶心、头晕发生例数低于Ⅱ组（8例比14例、6例比14例）,差异有统计学意义（P＜0.05）;Ⅱ组有8例患者术后12h内追加镇痛药物,明显高于Ⅰ组（0例）,差异有统计学意义（P＜0.05）.结论 在全凭静脉麻醉下甲状腺手术患者给予右美托咪啶1μg/kg滴鼻联合氟比洛芬酯超前镇痛可达到满意的术后镇痛效果,且降低了术后恶心及头晕的发生率,提高了患者术后舒适度.     

南京市1854名放射工作人员甲状腺功能分析

目的通过对放射工作人员血清中三碘甲状腺原氨酸（TT3）、甲状腺素（讯）、促甲状腺激素（TSH）检查结果的分析,了解放射工作人员甲状腺功能情况,以便改进防护措施,减少电离辐射损伤,为保障放射工作人员的健康提供依据。方法选择南京市2012年共1854名放射工作人员甲状腺功能检查结果,按性别、年龄、工龄、吸烟、饮酒和在岗状况分组后进行比较分析。结果TT3水平女性低于男性,差异有统计学意义（P〈0．01）,而TSH水平女性高于男性,差异有统计学意义（P〈0．05）。TT3、TT4随着工龄、饮酒和岗位状况的变化呈下降趋势,而TSH呈上升趋势,其他分组无明显变化规律。结论长期低剂量电离辐射对放射工作人员甲状腺功能有一定影响,同时生活中不良嗜好也可能对甲状腺功能产生一定的影响,应该进一步加强放射防护措施,并且改变不良的生活方式。     

甲状腺腺叶切除术对甲状腺结节的治疗价值评析

目的：分析甲状腺腺叶切除术对甲状腺结节的治疗价值。方法：选取我院甲状腺结节患者80例,收治时间在2011年3月至2014年5月期间,并将甲状腺结节患者随机分为两组(观察组和对照组),对照组患者采用甲状腺全切术治疗,观察组患者采用甲状腺腺叶切除术治疗。结果：观察组患者治疗后的并发症发生率7.50%显著低于对照组患者并发症发生率37.50%,观察组患者平均费用（7123.07±133.45)元、术中出血量（67.09±8.37)ml、手术平均时间（108.26±2.37)min、术后住院时间（6.15±2.22)天显著优于对照组（P＜0.05）。结论;甲状腺腺叶切除术对甲状腺结节具有较高的治疗价值。     

肠内营养对肠瘘非甲状腺疾病综合征病人甲状腺功能的作用研究

目的:肠瘘病人容易发生非甲状腺疾病综合征(NTIS),探讨肠内营养(EN)治疗对肠瘘合并NTIS病人甲状腺功能的作用. 方法:回顾性分析80例肠瘘合并NIIS并接受EN治疗的病人,统计纳入病人住院期间甲状腺功能和其他实验室指标的变化. 结果:80例病人EN支持治疗后,66例NTIS病情缓解,14例未缓解,有效率82.50％.多变量Cox比例风险模型表明,从入院到开始接受全量EN治疗的时间为NTIS获得缓解的独立风险因素. 结论:EN治疗有助于缓解肠瘘病人NTIS的症状.     

Long-term exposure of European flounder (Platichthys flesus) to the flame-retardants tetrabromobisphenol A (TBBPA) and hexabromocyclododecane (HBCD)

Tetrabromobisphenol A (TBBPA) and hexabromocyclododecane (HBCD) are widely used flame retardants that have increasingly been found as contaminants in the aquatic environment. In the present study, European flounder (Platichthys flesus) were chronically exposed to TBBPA; (105 days) and HBCD (78 days), in a wide range including environmentally relevant concentrations. TBBPA was administered via the water, whereas HBCD was administered in food and sediment, or in sediment alone. Chemical analysis of muscle showed an average increase in internal concentrations of approximately two orders of magnitude for both compounds tested. Animals exposed to HBCD via sediment alone (8000 microg/g total organic carbon, TOC) showed a proportional increase of alpha-HBCD in muscle compared to animals exposed via food and sediment. In both studies, exposure to the test compounds did not affect general health and toxicity parameters (behavior, survival, growth rate, relative liver and gonad weight). Hepatic microsomal enzyme activities (TBBPA: EROD; HBCD: EROD, PROD, and BROD) were not induced by any of the tested chemicals. Aromatase activity in male gonads showed a mild increase with rising TBBPA levels. There were no morphological and immunohistochemical indications for increased production of the yolk precursor protein vitellogenin (VTG) in animals exposed to TBBPA and HBCD; immunochemical analysis of plasma VTG levels showed no dose response in animals exposed to TBBPA. In animals exposed to TBBPA, levels of the thyroid hormone thyroxin (T(4)) increased with internal concentrations of the test compound, possibly indicating competition of TBBPA for plasma protein binding. Triiodothyronin (T(3)) levels were not affected and histology showed no signs of altered thyroid gland activity. Other organs investigated (liver, gills, kidney, skin, and gonads) revealed no histological changes related to TBBPA or HBCD exposure. Overall, the present results indicate limited endocrine effects of these widely used flame retardants in a test species representative of European estuaries at environmentally relevant exposure levels and at internal levels up to 4300 ng TBBPA/g wet weight, and 446 microg HBCD/g lipid weight in flounder muscle.     

食道癌贲门癌患者术前术后的甲状腺激素的变化及临床意义

本文总结了30例食道癌贲门癌患者术前术后的甲状腺激素水平监测结果,并将对照组与术前患者的甲 状腺激素对比和术前术后患者的甲状腺激素水平对比,前者结果为:T_3、T_4均降低,rT_3值升高;后者结果是:术后T_3降低,rT_3升高,T_4、TSH变化无显著性.因此,作者认为食道癌贲门癌患者手术前后的甲状腺激素的变化,可作为判断病情、疗效、治疗方案是否合理及估计预后的辅助指标.     

Preoperative comprehensive malignancy risk estimation for thyroid nodules: Development and verification of a network-based prediction model

BackgroundIn order to avoid excessive treatment of thyroid nodules in the clinic, it is necessary to find a simple and practical analysis method to comprehensively and accurately reflect benign or malignant thyroid nodules. This study aimed to construct and validate a comprehensive and reliable network-based predictive model using a variety of imaging and laboratory criteria for thyroid nodules to stratify the risk of malignancy prior to surgery.MethodsWe retrospectively analyzed data from patients who underwent surgical treatment for thyroid nodules at the Thyroid and Breast Diagnosis and Treatment Center of Weifang Hospital of Traditional Chinese Medicine between January 2018 and December 2020. Binary logical regression analysis was performed to predict whether nodules were malignant or benign. The developmental dataset included 457 patients (January 2018–December 2020). The validation set included separate data points (n = 225, January 2018–December 2020).ResultsIn this study, criteria that showed significant predictive value for malignant nodules included TI-RADS: 4b (p = 0.065); Bethesda IV, Bethesda V, Bethesda VI (P < 0.0001); BRAF^V600E mutation (P < 0.0001); Calcitonin>5 pg/ml (p = 0.0037); and FNA-Tg>30 ng/ml (p = 0.0003). A 10-grade risk scoring system was developed. The risk of malignancy risk ranged from 2.06% to 100% and was positively associated with increasing risk grade. The areas under the receiver-operating characteristic curve of the development and validation sets were 0.972 and 0.946, respectively.ConclusionA simple, comprehensive and reliable web-based predictive model was designed using a variety of imaging and laboratory criteria to stratify thyroid nodules by probability of malignancy.     

Efficacité et tolérance de la radiothérapie externe pour les patients atteints d'une récidive d'un carcinome différencié de la thyroïde

PurposeRadiation therapy is often the last resource treatment for cervical relapse in iodine refractory differentiated thyroid cancer. We present locoregional control data in patients with cervical relapse treated with curative intent radiation therapy with or without concomitant carboplatin.Material and methodsThis monocentric retrospective study gathered data on patients with differentiated thyroid carcinoma – vesicular or papillary – in relapse after thyroidectomy who received a curative intent cervical radiation therapy. Locoregional progression free survival (LRPFS), progression free survival (PFS), overall survival (OS) were gathered as well as acute and chronic adverse events assessed with the CTCAE v4.ResultsThirty-nine patients were consecutively included between 2005 and 2019. The median follow-up was 36.6 months. Fifteen patients (38%) had a locoregional relapse, locoregional control at 2 years was 66.7%. The median LRPFS was 48 months [32.9–not reached] and the median overall survival 49 months [38.8–not reached]. In multivariate analysis, initial incomplete resection was associated with poorer OS (HR: 24.39 [3.57–166.78], P = 0.00113) and LRPFS (HR: 33.91 [4.46–257.61], P = 0.00066), extra nodal spread was associated with poorer LRPFS (HR: 13.45 [1.81–99,76], P = 0.011). ECOG performance status was associated with OS (HR: 5.11 [1.57–16.66], P = 0.00688). Carboplatin association with radiation therapy was not associated with improved survivals (OS: P = 0.34, LRPFS: P = 0.84). The rate of acute grade 3 toxicities was 14%.ConclusionSalvage cervical radiation therapy was associated with a locoregional control of 66.7% at 2 years with a reasonable toxicity rate. Carboplatin association with radiation therapy did not improve locoregional control nor overall survival in comparison with radiotherapy alone.     

Synergistic Effects of High-dose Soybean Intake with Iodine Deficiency, but Not Sulfadimethoxine or Phenobarbital, on Rat Thyroid Proliferation

The specificity and dose dependence of the synergistic effects of soybean intake with iodine deficiency on the induction of thyroid proliferation were investigated in female F344 rats. In the first experiment, rats were divided into 6 groups, each consisting of 5 annuals, and fed a basal diet containing 20% gluten, an iodine-deficient basal diet alone or an iodine-deficient diet containing 0.2%, 1.0%, 5.0% or 25% defatted soybean for 5 weeks. Soybean feeding synergistically induced thyroid hyperplasias with iodine deficiency only at the 25% dose. In the second experiment, rats were also divided into 6 groups, each consisting of 5 animals, and fed a basal diet, a diet containing 20% defatted soybean, 0.025% Sulfadimethoxine (SDM), 20% defatted soybean+0.025% SDM, 0.05% phenobarbital (PB) or 20% defatted soybean+0.05% PB for 5 weeks. The SDM treatments significantly (P<0.05-0.01) increased the thyroid weights, but this increase rate was less prominent in the SDM+soybean group than in the SDM alone group. The PB treatment was also associated with a tendency for increase in thyroid weight, but again this was smaller in the PB+soybean group than in the PB alone group. Although the SDM or PB treatments reduced the serum triiodothyronine and thyroxine levels and consequently increased the serum thyroid-stimulating hormone (TSH) levels, the soybean feeding did not affect or rather attenuated these changes. Our results clearly indicate that soybean feeding does not synergistically enhance the effects of SDM or PB on the rat thyroid. Thus it can be concluded that soybean intake specifically interacts with iodine deficiency in induction of thyroid proliferative lesions in rats, only at high doses.