BACKGROUND In recently diagnosed patients with thyroid cancer,papillary thyroid cancer(PTC),as the most common histological subtype,accounts for 90%of all cases.Although PTC is known as a relatively adolescent maligna...BACKGROUND In recently diagnosed patients with thyroid cancer,papillary thyroid cancer(PTC),as the most common histological subtype,accounts for 90%of all cases.Although PTC is known as a relatively adolescent malignant disease,there still is a high possibility of recurrence in PTC patients with a poor prognosis.Therefore,new biomarkers are necessary to guide more effective stratification of PTC patients and personalize therapy to avoid overtreatment or inadequate treatment.Accumulating evidence demonstrates that microRNAs(miRNAs)have broad application prospects as diagnostic biomarkers in cancer.AIM To explore novel markers consisting of miRNA-associated signatures for PTC prognostication.METHODS We obtained and analyzed the data of 497 PTC patients from The Cancer Genome Atlas.The patients were randomly assigned to either a training or testing cohort.RESULTS We discovered 237 differentially expressed miRNAs in tumorous thyroid tissues compared with normal tissues,which contained 172 up-regulated and 65 downregulated miRNAs.The evaluation of differently expressed miRNAs was conducted using our risk score model.We then successfully generated a fourmiRNA potential prognostic signature[risk score=(-0.001×hsa-miR-181a-2-3p)+(0.003×hsa-miR-138-5p)+(-0.018×hsa-miR-424-3p)+(0.284×hsa-miR-612)],which reliably distinguished patients from high and low risk with a significant difference in the overall survival(P<0.01)and was effective in predicting the five-year disease survival rate with the area under the receiver operating characteristic curve of 0.937 and 0.812 in the training and testing cohorts,respectively.Additionally,there was a trend indicated that high-risk patients had shorter relapse-free survival,although statistical significance was not reached(P=0.082)in our sequencing cohort.CONCLUSION Our results indicated a four-miRNA signature that has a robust predictive effect on the prognosis of PTC.Accordingly,we would recommend more radical therapy and closer follow-ups for highrisk groups.展开更多
BACKGROUND Papillary thyroid cancer(PTC)is one of the well-differentiated thyroid tumors.Cutaneous metastasis from differentiated thyroid cancers occurs in<1%of primary thyroid carcinomas but produces the worst sur...BACKGROUND Papillary thyroid cancer(PTC)is one of the well-differentiated thyroid tumors.Cutaneous metastasis from differentiated thyroid cancers occurs in<1%of primary thyroid carcinomas but produces the worst survival prognosis.The multi-targeting tyrosine kinase inhibitor anlotinib has been approved to treat refractory advanced non-small-cell lung cancer as well as advanced soft-tissue and clear cell sarcomas in China.CASE SUMMARY In a patient with scalp metastasis caused by PTC,thyroid and skull metastasis tumor sizes were significantly reduced after a trial of neoadjuvant anlotinib therapy for 3 cycles.Anlotinib maintenance medication after thyroidectomy further reduced the metastatic skull tumor size thereby preventing the requirement for craniotomy.CONCLUSION The outcome of the present trial confirmed the potential of anlotinib therapy to treat scalp metastasis induced by PTC and point the way for the treatment of similar diseases in the future.展开更多
BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and t...BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and the scope of lymph node dissection,ultimately improving patient prognosis.AIM To explore the diagnostic value of fine-needle aspiration of thyroglobulin(FNATg)combined with ultrasound(US)-guided fine-needle aspiration cytology for cervical lymph node metastasis in thyroid carcinoma.METHODS We enrolled 209 pathologically confirmed thyroid carcinoma patients who visited our hospital between Jan 2017 and Dec 2020.Patients were tentatively diagnosed with cervical lymph node enlargement using preoperative US.They underwent US-guided fine-needle aspiration cytology and FNA-Tg.The value of single and combined application of the two methods for the diagnosis of cervical lymph node metastasis was calculated.The factors affecting FNA-Tg for diagnosis were analyzed using univariate and multivariate methods.RESULTS FNA-Tg values were significantly higher among patients with positive cervical lymph node metastasis.The sensitivity and specificity of US-guided fine-needle aspiration cytology,FNA-Tg,and US-guided fine-needle aspiration cytology+FNA-Tg were 85.48%and 90.59%,83.06%and 87.06%,and 96.77%and 91.76%,respectively.The area under the receiver operating characteristic curve for USguided fine-needle aspiration cytology,FNA-Tg,and the two combined,was 0.880,0.851,and 0.943,respectively.A long diameter/short diameter ratio<2,an insufficient number of acquired cells,a low serum thyroglobulin level,and an absence of typical metastatic US features increased the risk of cervical lymph node metastasis in thyroid carcinoma patients misdiagnosed using FNA-Tg.CONCLUSION The diagnostic value of FNA-Tg for detecting cervical lymph node metastasis is not high;however,combined with US-guided fine-needle aspiration cytology,it is significantly improved.展开更多
<strong>Background:</strong> We aimed to investigate the ability of carbon nanoparticles to identify parathyroid glands with vasculature during thyroid surgery. <strong>Material and methods:</stro...<strong>Background:</strong> We aimed to investigate the ability of carbon nanoparticles to identify parathyroid glands with vasculature during thyroid surgery. <strong>Material and methods:</strong> Totally 42 patients with various thyroid diseases were selected for the prospective research of carbon nanoparticle injection used in thyroidectomy. Another 42 patients without receiving carbon nanoparticle injection were selected as the control group. All cases underwent total or subtotal bilateral thyroidectomy. Before the ligation of the superior and inferior poles of the thyriod lobes, 0.1 mL of a carbon nanoparticle suspension was injected into the two poles. Important tissues such as the recurrent laryngeal nerve, parathyroid gland with blood supply and the inferior thyroid artery were identified and protected. <strong>Results:</strong> The parathyroid glands with vasculature were not stained and thus remained the primary color in all cases, while abnormal thyroid tissues were stained black. After 5 minutes, thyroid lobes were injected with the carbon nanoparticle suspension and the original color of parathyroid glands was unchanged. Even the parathyroids with blood supply can be identified and protected. The number of parathyroid glands for autotransplantation was one in the test group and six in the control group. At one day after the thyroid surgery, hypocalcemia became detectable in four patients of the test group and in five of the control group. Twenty-four instances of hypoparathyroidism occurred at 1 day after surgery in the control group, while ten instances in the test group. <strong>Conclusion:</strong> Intraoperatvie carbon nanoparticle suspension injection is an effective and safe technique for guiding thyroid surgery. The carbon nanoparticle suspension plays an important role in identifying the vasculatural parathyroid glands, while protecting the physiologic function of the parathyroid glands during surgery.展开更多
BACKGROUND In recent years,studies have found that the occurrence and development of diabetic cardiomyopathy(DCM)is closely related to an increase in polyadenosine diphosphate-ribose polymerase-1(PARP-1)activity.PARP-...BACKGROUND In recent years,studies have found that the occurrence and development of diabetic cardiomyopathy(DCM)is closely related to an increase in polyadenosine diphosphate-ribose polymerase-1(PARP-1)activity.PARP-1 activation could be involved in the pathophysiological process of DCM by promoting oxidative stress,the inflammatory response,apoptosis and myocardial fibrosis.AIM To investigate the mechanism of liraglutide in improving myocardial injury in type 2 diabetic rats,further clarified the protective effect of liraglutide on the heart,and provided a new option for the treatment of DCM.METHODS Forty healthy male SD rats aged 6 wk were randomly divided into two groups,a normal control group(n=10)and a model group(n=30),which were fed an ordinary diet and a high-sugar and high-fat diet,respectively.After successful modeling,the rats in the model group were fed a high-glucose and high-fat diet for 4 wk and randomly divided into a model group and an intervention group(further divided into a high-dose group and a low-dose group).The rats were fed a high-glucose and high-fat diet for 8 wk and then started drug intervention.Blood samples were collected from the abdominal aorta to detect fasting blood glucose and lipid profiles.Intact heart tissue was dissected,and its weight was used to calculate the heart weight index.Haematoxylin and eosin staining was used to observe the pathological changes in the myocardium and the expression of PARP-1 in the heart by immunohistochemistry.RESULTS The body weight and heart weight index of rats in the model group were significantly increased compared with those in the normal control group,and those in the intervention group were decreased compared with those in the model group,with a more obvious decrease observed in the high-dose group(P<0.05).In the model group,myocardial fibers were disordered,and inflammatory cells and interstitial fibrosis were observed.The cardiomyopathy of rats in the intervention group was improved to different degrees,the myocardial fibers were arranged neatly,and the myocardial cells were clearly striated;the improvement was more obvious in the high-dose group.Compared with the normal control group,the expression of PARP-1 in myocardial tissue of the model group was increased,and the difference was statistically significant(P<0.05).After liraglutide intervention,compared with the model group,the expression of PARP-1 in myocardial tissue was decreased,and the reduction was more obvious in the high-dose group(P<0.05)but still higher than that in the normal control group.CONCLUSION Liraglutide may improve myocardial injury in type 2 diabetic rats by inhibiting the expression of myocardial PARP-1 in a dose-dependent manner.展开更多
BACKGROUND Obesity is a state in which excess heat is converted into excess fat,which accumulates in the body and may cause damage to multiple organs of the circulatory,endocrine,and digestive systems.Studies have sho...BACKGROUND Obesity is a state in which excess heat is converted into excess fat,which accumulates in the body and may cause damage to multiple organs of the circulatory,endocrine,and digestive systems.Studies have shown that the accumulation of abdominal fat and mesenteric fat hypertrophy in patients with obesity makes laparoscopic surgery highly difficult,which is not conducive to operation and affects patient prognosis.However,there is still controversy regarding these conclusions.AIM To explore the relationship between body mass index(BMI)and short-term prognosis after surgery for colorectal cancer.METHODS PubMed,Embase,Ovid,Web of Science,CNKI,and China Biology Medicine Disc databases were searched to obtain relevant articles on this topic.After the articles were screened according to the inclusion and exclusion criteria and the risk of literature bias was assessed using the Newcastle-Ottawa Scale,the prognostic indicators were combined and analyzed.RESULTS A total of 16 articles were included for quantitative analysis,and 15588 patients undergoing colorectal cancer surgery were included in the study,including 3775 patients with obesity and 11813 patients without obesity.Among them,12 articles used BMI≥30 kg/m^(2)and 4 articles used BMI≥25 kg/m^(2)for the definition of obesity.Four patients underwent robotic colorectal surgery,whereas 12 underwent conventional laparoscopic colorectal resection.The quality of the literature was good.Meta-combined analysis showed that the overall complication rate of patients with obesity after surgery was higher than that of patients without obesity[OR=1.35,95%CI:1.23-1.48,Z=6.25,P<0.0001].The incidence of anastomotic leak after surgery in patients with obesity was not significantly different from that in patients without obesity[OR=0.99,95%CI:0.70-1.41),Z=-0.06,P=0.956].The incidence of surgical site infection(SSI)after surgery in patients with obesity was higher than that in patients without obesity[OR=1.43,95%CI:1.16-1.78,Z=3.31,P<0.001].The incidence of reoperation in patients with obesity after surgery was higher than that in patients without obesity;however,the difference was not statistically significant[OR=1.15,95%CI:0.92-1.45,Z=1.23,P=0.23];Patients with obesity had lower mortality after surgery than patients without obesity;however,the difference was not statistically significant[OR=0.61,95%CI:0.35-1.06,Z=-1.75,P=0.08].Subgroup analysis revealed that the geographical location of the institute was one of the sources of heterogeneity.Robot-assisted surgery was not significantly different from traditional laparoscopic resection in terms of the incidence of complications.CONCLUSION Obesity increases the overall complication and SSI rates of patients undergoing colorectal cancer surgery but has no influence on the incidence of anastomotic leak,reoperation rate,and short-term mortality rate.展开更多
BACKGROUND Multiple endocrine neoplasia type 1(MEN1)is a rare hereditary tumor syndrome inherited in an autosomal dominant manner and presents mostly as parathyroid,endocrine pancreas(such as gastrinoma)and anterior p...BACKGROUND Multiple endocrine neoplasia type 1(MEN1)is a rare hereditary tumor syndrome inherited in an autosomal dominant manner and presents mostly as parathyroid,endocrine pancreas(such as gastrinoma)and anterior pituitary tumors.At present,papillary thyroid carcinoma(PTC)and nodular goiter are not regarded as components of MEN1.CASE SUMMARY A 35-year-old woman presented with MEN1 accompanied by coinstantaneous PTC and nodular goiter.The pathological diagnosis was PTC with cervical lymph node metastasis,nodular goiter,parathyroid cyst and adenomatoid hyperplasia.Genetic testing was performed and a MEN1 gene mutation was detected.The patient underwent unilateral lobectomy of the thyroid gland and surgical removal of the parathyroid tumors.At 18 mo of follow-up,ultrasonic examination of the neck showed no abnormality.Serum calcium and parathyroid hormone levels were normal.No new MEN1-associated tumors were detected.CONCLUSION The role of inactivating mutations of MEN1 gene in tumorigenesis of PTC and/or nodular goiter remains to be determined by more case reports and further research.展开更多
BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants hav...BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.展开更多
BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the ...BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the individual tumor and the degree of hypercalcemia.CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC.All three patients had hypercalcemia,consisting of a high serum calcium level and a high level of parathyroid hormone that was>2-fold(even>30-fold)of the normal upper limit.The ultrasonographic findings of the parathyroid gland showed that the glands were all>30 mm,and the internal echo was uneven.All patients underwent surgery.PC in three cases was confirmed by routine histopathology and immunohistochemistry.CONCLUSION As clinical signs and laboratory results are nonspecific,it is difficult to diagnose PC preoperatively,so imaging examinations are often needed.展开更多
Objective:Large volume radiological text data have been accumulated since the incorporation of electronic health record(EHR)systems in clinical practice.We aimed to determine whether deep natural language processing a...Objective:Large volume radiological text data have been accumulated since the incorporation of electronic health record(EHR)systems in clinical practice.We aimed to determine whether deep natural language processing algorithms could aid radiologists in improving thyroid cancer diagnosis.Methods:Sonographic EHR data were obtained from the EHR database.Pathological reports were used as the gold standard for diagnosing thyroid cancer.We developed thyroid cancer diagnosis based on natural language processing(THCaDxNLP)to interpret unstructured sonographic text reports for thyroid cancer diagnosis.We used the area under the receiver operating characteristic curve(AUROC)as the primary metric to measure the performance of the THCaDxNLP.We compared the performance of thyroid ultrasound radiologists aided with THCaDxNLP vs.those without THCaDxNLP using 5 independent test sets.Results:We obtained a total number of 788,129 sonographic radiological reports.The number of thyroid sonographic data points was 132,277,18,400 of which were thyroid cancer patients.Among the 5 test sets,the numbers of patients per set were 439,186,82,343,and 171.THCaDxNLP achieved high performance in identifying thyroid cancer patients(the AUROC ranged from 0.857–0.932).Thyroid ultrasound radiologists aided with THCaDxNLP achieved significantly higher performances than those without THCaDxNLP in terms of accuracy(93.8%vs.87.2%;one-sided t-test,adjusted P=0.003),precision(92.5%vs.86.0%;P=0.018),and F1 metric(94.2%vs.86.4%;P=0.007).Conclusions:THCaDxNLP achieved a high AUROC for the identification of thyroid cancer,and improved the accuracy,sensitivity,and precision of thyroid ultrasound radiologists.This warrants further investigation of THCaDxNLP in prospective clinical trials.展开更多
Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immed...Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immediate surgery for patients with low risk PTMC.With decreased doubts about the safety and validity due to evidence from a large number of studies,the AS approach has become increasingly popular worldwide.However,Chinese thyroid surgeons still lag behind other countries in their knowledge of clinical practices and research related to AS.To promote the implementation of AS in China,thyroid surgeons should understand the implications,advantages,and disadvantages of management approaches for AS,and should also consider the willingness of Chinese patients,the impact on the medical billing system,and the enthusiasm of doctors.Thus,a management approach for AS based on the Chinese population should be developed to reduce the risk of disease progression and enhance patient adherence.Herein,we summarize the recent research achievements and deficiencies in AS approaches,and describe the initial experiences regarding AS in the Chinese population,in order to assist Chinese thyroid surgeons in preparing for AS management in the era of PTMC precision medicine.展开更多
BACKGROUND Diabetic nephropathy(DN)is the main cause of chronic kidney disease and endstage renal disease worldwide.Although available clinical trials have shown that endothelin receptor(ER)antagonists may be a novel ...BACKGROUND Diabetic nephropathy(DN)is the main cause of chronic kidney disease and endstage renal disease worldwide.Although available clinical trials have shown that endothelin receptor(ER)antagonists may be a novel and beneficial drug for DN,no consistent conclusions regarding their sufficient effectiveness and safety for patients with DN have been presented.AIM To assess the effectiveness and safety of ER antagonists among patients with DN.METHODS The EMBASE,PubMed,MEDLINE,Cochrane,and ClinicalTrials.gov databases were searched without any language restrictions.Relative risks with 95%confidence intervals(CIs)for dichotomous data and mean differences or standardized mean difference with 95%CIs for continuous data were calculated using Review Manager 5.3 software.Publication bias was assessed using Egger’s test with Stata/SE software.RESULTS We enrolled seven studies with six data sets and 5271 participants.The ER antagonists group showed a significantly greater reduction in albuminuria and more patients with 40%reduction in urinary albumin-to-creatinine ratio than the control group(P<0.0001 and P=0.02,respectively).Subgroup analysis for reductions in estimated glomerular filtration rate(eGFR)showed that for the middle-dosage subgroup,the ER antagonists group exhibited lower eGFR reduction than the control group(P<0.00001;mean difference,0.7095%CI:0.66,0.74).Moreover,significant reductions in systolic and diastolic blood pressure were observed in the invention group.CONCLUSION ER blockades combined with angiotensin converting enzyme inhibitor/angiotensin II type 1 receptor blockers may be an effective treatment to lower blood pressure and reduce proteinuria in DN with declined eGFR.However,attention should be given to adverse events,including cardiac failure,anemia,and hypoglycemia,as well as serious adverse events.展开更多
Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patien...Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.展开更多
BACKGROUND Secondary malignancy of the thyroid occurs infrequently and mainly originates from malignant tumors of the kidney,gastrointestinal tract,lungs,breast,and skin.The correct diagnosis is important but difficul...BACKGROUND Secondary malignancy of the thyroid occurs infrequently and mainly originates from malignant tumors of the kidney,gastrointestinal tract,lungs,breast,and skin.The correct diagnosis is important but difficult.Importantly,there are major differences in the treatment of primary and metastatic thyroid cancer,which has a significant impact on prognosis and survival.Therefore,how to diagnose thyroid metastasis(TM)correctly before surgery is a major concern for surgeons.CASE SUMMARY We report a 38-year-old woman who presented with palpable cervical lymph nodes after breast cancer(BC)surgery 2 years ago.Ultrasonography and computed tomography revealed thyroid nodules with irregular margins and enlarged cervical lymph nodes.Biopsy was performed for the right largest cervical lymph node,and immunohistochemical analysis revealed negativity for thyroglobulin,estrogen receptor,and progestin receptor and positive for human epidermal growth factor receptor 2.The diagnosis was TM from BC with cervical lymph node metastasis.Total thyroidectomy with bilateral central and lateral neck lymph node dissection was performed.After a 5-mo follow-up,no recurrence or novel distant metastasis was identified.CONCLUSION TM from BC is a rare secondary malignancy.Broad differential diagnosis by biopsy and immunohistochemical analysis needs to be considered.展开更多
BACKGROUND Spontaneous rupture and hemorrhage of renal angiomyolipoma(RAML)is a lifethreatening clinical emergency.When it occurs during pregnancy,it is compared to a"bomb explosion,"which makes the diagnosi...BACKGROUND Spontaneous rupture and hemorrhage of renal angiomyolipoma(RAML)is a lifethreatening clinical emergency.When it occurs during pregnancy,it is compared to a"bomb explosion,"which makes the diagnosis and treatment more challenging.An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure,which is always preferred for pregnant women.Currently,cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare,as is the diagnostic value and characteristics of ultrasound.The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis.In this study,we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics.CASE SUMMARY A 38-year-old woman in her 19 th wk of pregnancy(G2 P1)was referred to our clinic for a sudden,persistent pain on the left side of the waist.She had not undergone any previous related abdominal examination.Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area.The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound.Her left-side waist pain continued to be intense.Subsequently,she underwent computed tomography,which led to the same diagnosis.Based on many factors,the patient underwent left nephrectomy after the induction of labor.The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.CONCLUSION Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.展开更多
The effect and mechanism of phenylacetic acid on the proliferation of pancreatic carcinoma cells were investigated in cultured pancreatic carcinoma BXPC-3 cells by means of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltet...The effect and mechanism of phenylacetic acid on the proliferation of pancreatic carcinoma cells were investigated in cultured pancreatic carcinoma BXPC-3 cells by means of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and flow cytometry assay.The results show that the treatment of pancreatic carcinoma cells with phenylacetic acid significantly inhibited the cell proliferation in time-dependent and dose-dependent manners.The proliferation of BXPC-3 cells was inhibited at the stage of S phase,the cells at the end stage of S phase were accumulated abundantly,and thus DNA synthesis could not be accomplished entirely.In addition,the expression of adenosine deaminases acting on RNA(ADARs) mRNA in BXPC-3 cells and pancreatic carcinoma specimen were detected by RT-PCR.Having been treated with phenylacetic acid,ADAR2 mRNA in BXPC-3 cells was significantly decreased,the differences were of statistical significance(P<0.01).Taken together,these results suggest that phenylacetic acid may likely regulate the proliferation of pancreatic carcinoma cells through the regulation of ADAR2 mRNA expression.展开更多
Parathyroid carcinoma is an extremely rare malignant tumor,composed primarily of vacuolated principal cells,but may also be composed of eosinophils.The exact etiology and pathogenesis of parathyroid carcinoma is unkno...Parathyroid carcinoma is an extremely rare malignant tumor,composed primarily of vacuolated principal cells,but may also be composed of eosinophils.The exact etiology and pathogenesis of parathyroid carcinoma is unknown,and head and neck radiation exposure,chronic stimulation from renal failure,and familial syndromes can lead to the development of parathyroid carcinoma.Most parathyroid carcinoma is difficult to distinguish from benign HPT and is often diagnosed only when there is a recurrence of hypercalcemia several years later,which can manifest as weight loss,extreme fatigue,anorexia,and muscle atrophy.At present,surgical resection remains the primary treatment.In this case,the patient underwent initial surgery for primary hyperparathyroidism and was subsequently diagnosed with parathyroid carcinoma.During the 8 years of follow-up,the patient underwent 7 surgeries in combination with radiation therapy,chemotherapy and targeted medications.Although the neck tumor was cured,the patient died of complications related to hypercalcemia.We will review the literature on the combination of surgery,radiotherapy,chemotherapy,and targeted drug therapy in order to improve the diagnosis and treatment of parathyroid carcinoma.展开更多
BACKGROUND: Transjugular intrahepatic portosystemic shunt(TIPS) and open splenectomy and esophagogastric devascularization(OSED) are widely used to treat patients with portal hypertension and recurrent variceal bleedi...BACKGROUND: Transjugular intrahepatic portosystemic shunt(TIPS) and open splenectomy and esophagogastric devascularization(OSED) are widely used to treat patients with portal hypertension and recurrent variceal bleeding(PHRVB). This study aimed to compare the effectiveness between TIPS and OSED for the treatment of PHRVB.METHODS: The data were retrospectively retrieved from 479 cirrhotic patients(Child-Pugh A or B class) with PHRVB, who had undergone TIPS(TIPS group) or OSED(OSED group) between January 1, 2010 and October 31, 2014.RESULTS: A total of 196 patients received TIPS, whereas 283 underwent OSED. Within one month after TIPS and OSED, the rebleeding rates were 6.1% and 3.2%, respectively(P=0.122). Significantly lower incidence of pleural effusion,splenic vein thrombosis, and pulmonary infection, as well as higher hepatic encephalopathy rate, shorter postoperative length of hospital stay, and higher hospital costs were observed in the TIPS group than those in the OSED group. During the follow-up periods(29 months), significantly higher incidences of rebleeding(15.3% vs 4.6%, P=0.001) and hepatic encephalopathy(17.3% vs 3.9%, P=0.001) were observed in the TIPS group than in the OSED group. The incidence of instent stenosis was 18.9%. The survival rates were 91.3% in the TIPS group and 95.1% in the OSED group. The long-term liver function did not worsen after either TIPS or OSED.CONCLUSION: For the patients with liver function in the Child-Pugh A or B class, TIPS is not superior over OSED in terms of PHRVB treatment and rebleeding prevention.展开更多
Background:Accumulating data have suggested that long non-coding RNAs(lncRNAs)play important roles in regulating tumor cell growth.This study was designed to investigate the role of SNHG16 in hep-atocellular carcinoma...Background:Accumulating data have suggested that long non-coding RNAs(lncRNAs)play important roles in regulating tumor cell growth.This study was designed to investigate the role of SNHG16 in hep-atocellular carcinoma(HCC).Methods:SNHG16 expression was detected with real-time polymerase chain reaction(PCR).The cut-offvalue of SNHG16 for tumor-free survival(TFS)was determined with receiver operating characteristic curve analysis.Small interfering RNA was used to inhibit the expression of SNHG16 in HCC cell lines.The biologic behavior of HCC cell was determined with cell viability assay and Transwell assay in vitro.The potential predictive value of SNHG16 on prognosis was analyzed by Kaplan-Meier curves and Cox proportional hazards regression model.Results:SNHG16 expression was upregulated in tumor tissues and HCC cell lines.High expression of SNHG16 was associated with tumor recurrence and poor prognosis after surgery.Multivariate analysis revealed that SNHG16 was an independent prognostic factor for poor recurrence-free survival.Moreover,inhibition of SNHG16 in HepG2,Hep3B,and BEL-7402 cells significantly reduced cell invasiveness and proliferation.Mechanistic analyses indicated that the ECM-receptor interaction pathway was remarkably activated by SNHG16.Conclusions:SNHG16 might be a promising biomarker for predicting tumor recurrence in HCC patients after surgery and a potential therapeutic target for HCC.展开更多
基金Supported by the Foundation of Wenzhou Municipal Science and Technology Bureau,No.Y20190209 and No.Y2020739the Hospital Research Incubation Program,No.FHY2019075。
文摘BACKGROUND In recently diagnosed patients with thyroid cancer,papillary thyroid cancer(PTC),as the most common histological subtype,accounts for 90%of all cases.Although PTC is known as a relatively adolescent malignant disease,there still is a high possibility of recurrence in PTC patients with a poor prognosis.Therefore,new biomarkers are necessary to guide more effective stratification of PTC patients and personalize therapy to avoid overtreatment or inadequate treatment.Accumulating evidence demonstrates that microRNAs(miRNAs)have broad application prospects as diagnostic biomarkers in cancer.AIM To explore novel markers consisting of miRNA-associated signatures for PTC prognostication.METHODS We obtained and analyzed the data of 497 PTC patients from The Cancer Genome Atlas.The patients were randomly assigned to either a training or testing cohort.RESULTS We discovered 237 differentially expressed miRNAs in tumorous thyroid tissues compared with normal tissues,which contained 172 up-regulated and 65 downregulated miRNAs.The evaluation of differently expressed miRNAs was conducted using our risk score model.We then successfully generated a fourmiRNA potential prognostic signature[risk score=(-0.001×hsa-miR-181a-2-3p)+(0.003×hsa-miR-138-5p)+(-0.018×hsa-miR-424-3p)+(0.284×hsa-miR-612)],which reliably distinguished patients from high and low risk with a significant difference in the overall survival(P<0.01)and was effective in predicting the five-year disease survival rate with the area under the receiver operating characteristic curve of 0.937 and 0.812 in the training and testing cohorts,respectively.Additionally,there was a trend indicated that high-risk patients had shorter relapse-free survival,although statistical significance was not reached(P=0.082)in our sequencing cohort.CONCLUSION Our results indicated a four-miRNA signature that has a robust predictive effect on the prognosis of PTC.Accordingly,we would recommend more radical therapy and closer follow-ups for highrisk groups.
文摘BACKGROUND Papillary thyroid cancer(PTC)is one of the well-differentiated thyroid tumors.Cutaneous metastasis from differentiated thyroid cancers occurs in<1%of primary thyroid carcinomas but produces the worst survival prognosis.The multi-targeting tyrosine kinase inhibitor anlotinib has been approved to treat refractory advanced non-small-cell lung cancer as well as advanced soft-tissue and clear cell sarcomas in China.CASE SUMMARY In a patient with scalp metastasis caused by PTC,thyroid and skull metastasis tumor sizes were significantly reduced after a trial of neoadjuvant anlotinib therapy for 3 cycles.Anlotinib maintenance medication after thyroidectomy further reduced the metastatic skull tumor size thereby preventing the requirement for craniotomy.CONCLUSION The outcome of the present trial confirmed the potential of anlotinib therapy to treat scalp metastasis induced by PTC and point the way for the treatment of similar diseases in the future.
基金Supported by The Research and Development Project of Science and Technology of Chengde City,No.201706A046.
文摘BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and the scope of lymph node dissection,ultimately improving patient prognosis.AIM To explore the diagnostic value of fine-needle aspiration of thyroglobulin(FNATg)combined with ultrasound(US)-guided fine-needle aspiration cytology for cervical lymph node metastasis in thyroid carcinoma.METHODS We enrolled 209 pathologically confirmed thyroid carcinoma patients who visited our hospital between Jan 2017 and Dec 2020.Patients were tentatively diagnosed with cervical lymph node enlargement using preoperative US.They underwent US-guided fine-needle aspiration cytology and FNA-Tg.The value of single and combined application of the two methods for the diagnosis of cervical lymph node metastasis was calculated.The factors affecting FNA-Tg for diagnosis were analyzed using univariate and multivariate methods.RESULTS FNA-Tg values were significantly higher among patients with positive cervical lymph node metastasis.The sensitivity and specificity of US-guided fine-needle aspiration cytology,FNA-Tg,and US-guided fine-needle aspiration cytology+FNA-Tg were 85.48%and 90.59%,83.06%and 87.06%,and 96.77%and 91.76%,respectively.The area under the receiver operating characteristic curve for USguided fine-needle aspiration cytology,FNA-Tg,and the two combined,was 0.880,0.851,and 0.943,respectively.A long diameter/short diameter ratio<2,an insufficient number of acquired cells,a low serum thyroglobulin level,and an absence of typical metastatic US features increased the risk of cervical lymph node metastasis in thyroid carcinoma patients misdiagnosed using FNA-Tg.CONCLUSION The diagnostic value of FNA-Tg for detecting cervical lymph node metastasis is not high;however,combined with US-guided fine-needle aspiration cytology,it is significantly improved.
文摘<strong>Background:</strong> We aimed to investigate the ability of carbon nanoparticles to identify parathyroid glands with vasculature during thyroid surgery. <strong>Material and methods:</strong> Totally 42 patients with various thyroid diseases were selected for the prospective research of carbon nanoparticle injection used in thyroidectomy. Another 42 patients without receiving carbon nanoparticle injection were selected as the control group. All cases underwent total or subtotal bilateral thyroidectomy. Before the ligation of the superior and inferior poles of the thyriod lobes, 0.1 mL of a carbon nanoparticle suspension was injected into the two poles. Important tissues such as the recurrent laryngeal nerve, parathyroid gland with blood supply and the inferior thyroid artery were identified and protected. <strong>Results:</strong> The parathyroid glands with vasculature were not stained and thus remained the primary color in all cases, while abnormal thyroid tissues were stained black. After 5 minutes, thyroid lobes were injected with the carbon nanoparticle suspension and the original color of parathyroid glands was unchanged. Even the parathyroids with blood supply can be identified and protected. The number of parathyroid glands for autotransplantation was one in the test group and six in the control group. At one day after the thyroid surgery, hypocalcemia became detectable in four patients of the test group and in five of the control group. Twenty-four instances of hypoparathyroidism occurred at 1 day after surgery in the control group, while ten instances in the test group. <strong>Conclusion:</strong> Intraoperatvie carbon nanoparticle suspension injection is an effective and safe technique for guiding thyroid surgery. The carbon nanoparticle suspension plays an important role in identifying the vasculatural parathyroid glands, while protecting the physiologic function of the parathyroid glands during surgery.
基金Supported by Shanxi Provincial Natural Science Foundation,No.201701D121159Shanxi Provincial Health and Family Planning Commission,No.2014016Health Commission of Shanxi Province,No.2019020.
文摘BACKGROUND In recent years,studies have found that the occurrence and development of diabetic cardiomyopathy(DCM)is closely related to an increase in polyadenosine diphosphate-ribose polymerase-1(PARP-1)activity.PARP-1 activation could be involved in the pathophysiological process of DCM by promoting oxidative stress,the inflammatory response,apoptosis and myocardial fibrosis.AIM To investigate the mechanism of liraglutide in improving myocardial injury in type 2 diabetic rats,further clarified the protective effect of liraglutide on the heart,and provided a new option for the treatment of DCM.METHODS Forty healthy male SD rats aged 6 wk were randomly divided into two groups,a normal control group(n=10)and a model group(n=30),which were fed an ordinary diet and a high-sugar and high-fat diet,respectively.After successful modeling,the rats in the model group were fed a high-glucose and high-fat diet for 4 wk and randomly divided into a model group and an intervention group(further divided into a high-dose group and a low-dose group).The rats were fed a high-glucose and high-fat diet for 8 wk and then started drug intervention.Blood samples were collected from the abdominal aorta to detect fasting blood glucose and lipid profiles.Intact heart tissue was dissected,and its weight was used to calculate the heart weight index.Haematoxylin and eosin staining was used to observe the pathological changes in the myocardium and the expression of PARP-1 in the heart by immunohistochemistry.RESULTS The body weight and heart weight index of rats in the model group were significantly increased compared with those in the normal control group,and those in the intervention group were decreased compared with those in the model group,with a more obvious decrease observed in the high-dose group(P<0.05).In the model group,myocardial fibers were disordered,and inflammatory cells and interstitial fibrosis were observed.The cardiomyopathy of rats in the intervention group was improved to different degrees,the myocardial fibers were arranged neatly,and the myocardial cells were clearly striated;the improvement was more obvious in the high-dose group.Compared with the normal control group,the expression of PARP-1 in myocardial tissue of the model group was increased,and the difference was statistically significant(P<0.05).After liraglutide intervention,compared with the model group,the expression of PARP-1 in myocardial tissue was decreased,and the reduction was more obvious in the high-dose group(P<0.05)but still higher than that in the normal control group.CONCLUSION Liraglutide may improve myocardial injury in type 2 diabetic rats by inhibiting the expression of myocardial PARP-1 in a dose-dependent manner.
文摘BACKGROUND Obesity is a state in which excess heat is converted into excess fat,which accumulates in the body and may cause damage to multiple organs of the circulatory,endocrine,and digestive systems.Studies have shown that the accumulation of abdominal fat and mesenteric fat hypertrophy in patients with obesity makes laparoscopic surgery highly difficult,which is not conducive to operation and affects patient prognosis.However,there is still controversy regarding these conclusions.AIM To explore the relationship between body mass index(BMI)and short-term prognosis after surgery for colorectal cancer.METHODS PubMed,Embase,Ovid,Web of Science,CNKI,and China Biology Medicine Disc databases were searched to obtain relevant articles on this topic.After the articles were screened according to the inclusion and exclusion criteria and the risk of literature bias was assessed using the Newcastle-Ottawa Scale,the prognostic indicators were combined and analyzed.RESULTS A total of 16 articles were included for quantitative analysis,and 15588 patients undergoing colorectal cancer surgery were included in the study,including 3775 patients with obesity and 11813 patients without obesity.Among them,12 articles used BMI≥30 kg/m^(2)and 4 articles used BMI≥25 kg/m^(2)for the definition of obesity.Four patients underwent robotic colorectal surgery,whereas 12 underwent conventional laparoscopic colorectal resection.The quality of the literature was good.Meta-combined analysis showed that the overall complication rate of patients with obesity after surgery was higher than that of patients without obesity[OR=1.35,95%CI:1.23-1.48,Z=6.25,P<0.0001].The incidence of anastomotic leak after surgery in patients with obesity was not significantly different from that in patients without obesity[OR=0.99,95%CI:0.70-1.41),Z=-0.06,P=0.956].The incidence of surgical site infection(SSI)after surgery in patients with obesity was higher than that in patients without obesity[OR=1.43,95%CI:1.16-1.78,Z=3.31,P<0.001].The incidence of reoperation in patients with obesity after surgery was higher than that in patients without obesity;however,the difference was not statistically significant[OR=1.15,95%CI:0.92-1.45,Z=1.23,P=0.23];Patients with obesity had lower mortality after surgery than patients without obesity;however,the difference was not statistically significant[OR=0.61,95%CI:0.35-1.06,Z=-1.75,P=0.08].Subgroup analysis revealed that the geographical location of the institute was one of the sources of heterogeneity.Robot-assisted surgery was not significantly different from traditional laparoscopic resection in terms of the incidence of complications.CONCLUSION Obesity increases the overall complication and SSI rates of patients undergoing colorectal cancer surgery but has no influence on the incidence of anastomotic leak,reoperation rate,and short-term mortality rate.
文摘BACKGROUND Multiple endocrine neoplasia type 1(MEN1)is a rare hereditary tumor syndrome inherited in an autosomal dominant manner and presents mostly as parathyroid,endocrine pancreas(such as gastrinoma)and anterior pituitary tumors.At present,papillary thyroid carcinoma(PTC)and nodular goiter are not regarded as components of MEN1.CASE SUMMARY A 35-year-old woman presented with MEN1 accompanied by coinstantaneous PTC and nodular goiter.The pathological diagnosis was PTC with cervical lymph node metastasis,nodular goiter,parathyroid cyst and adenomatoid hyperplasia.Genetic testing was performed and a MEN1 gene mutation was detected.The patient underwent unilateral lobectomy of the thyroid gland and surgical removal of the parathyroid tumors.At 18 mo of follow-up,ultrasonic examination of the neck showed no abnormality.Serum calcium and parathyroid hormone levels were normal.No new MEN1-associated tumors were detected.CONCLUSION The role of inactivating mutations of MEN1 gene in tumorigenesis of PTC and/or nodular goiter remains to be determined by more case reports and further research.
文摘BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.
文摘BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the individual tumor and the degree of hypercalcemia.CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC.All three patients had hypercalcemia,consisting of a high serum calcium level and a high level of parathyroid hormone that was>2-fold(even>30-fold)of the normal upper limit.The ultrasonographic findings of the parathyroid gland showed that the glands were all>30 mm,and the internal echo was uneven.All patients underwent surgery.PC in three cases was confirmed by routine histopathology and immunohistochemistry.CONCLUSION As clinical signs and laboratory results are nonspecific,it is difficult to diagnose PC preoperatively,so imaging examinations are often needed.
基金This work was supported by the National Natural Science Foundation of China(Grant No.31801117 to Dr.X.Li and 82073287 to Dr.Zhang)the Program for Changjiang Scholars and Innovative Research Team in University in China(Grant No.IRT_14R40 to Dr.K.Chen)the Chinese National Key Research and Development Project(Grant No.2018YFC1315601).
文摘Objective:Large volume radiological text data have been accumulated since the incorporation of electronic health record(EHR)systems in clinical practice.We aimed to determine whether deep natural language processing algorithms could aid radiologists in improving thyroid cancer diagnosis.Methods:Sonographic EHR data were obtained from the EHR database.Pathological reports were used as the gold standard for diagnosing thyroid cancer.We developed thyroid cancer diagnosis based on natural language processing(THCaDxNLP)to interpret unstructured sonographic text reports for thyroid cancer diagnosis.We used the area under the receiver operating characteristic curve(AUROC)as the primary metric to measure the performance of the THCaDxNLP.We compared the performance of thyroid ultrasound radiologists aided with THCaDxNLP vs.those without THCaDxNLP using 5 independent test sets.Results:We obtained a total number of 788,129 sonographic radiological reports.The number of thyroid sonographic data points was 132,277,18,400 of which were thyroid cancer patients.Among the 5 test sets,the numbers of patients per set were 439,186,82,343,and 171.THCaDxNLP achieved high performance in identifying thyroid cancer patients(the AUROC ranged from 0.857–0.932).Thyroid ultrasound radiologists aided with THCaDxNLP achieved significantly higher performances than those without THCaDxNLP in terms of accuracy(93.8%vs.87.2%;one-sided t-test,adjusted P=0.003),precision(92.5%vs.86.0%;P=0.018),and F1 metric(94.2%vs.86.4%;P=0.007).Conclusions:THCaDxNLP achieved a high AUROC for the identification of thyroid cancer,and improved the accuracy,sensitivity,and precision of thyroid ultrasound radiologists.This warrants further investigation of THCaDxNLP in prospective clinical trials.
基金The work was supported by grants from the National Natural Science Foundation of China(Grant No.81760142)the Construction Project of Clinical Research Centre of General Surgical Disease in Yunnan Province(Grant No.2X2019-03-03)the“Ten Thousand People Plan”of Yunnan ProvinceMedical Experts Project(Grant No.RLCRC20210412).
文摘Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immediate surgery for patients with low risk PTMC.With decreased doubts about the safety and validity due to evidence from a large number of studies,the AS approach has become increasingly popular worldwide.However,Chinese thyroid surgeons still lag behind other countries in their knowledge of clinical practices and research related to AS.To promote the implementation of AS in China,thyroid surgeons should understand the implications,advantages,and disadvantages of management approaches for AS,and should also consider the willingness of Chinese patients,the impact on the medical billing system,and the enthusiasm of doctors.Thus,a management approach for AS based on the Chinese population should be developed to reduce the risk of disease progression and enhance patient adherence.Herein,we summarize the recent research achievements and deficiencies in AS approaches,and describe the initial experiences regarding AS in the Chinese population,in order to assist Chinese thyroid surgeons in preparing for AS management in the era of PTMC precision medicine.
文摘BACKGROUND Diabetic nephropathy(DN)is the main cause of chronic kidney disease and endstage renal disease worldwide.Although available clinical trials have shown that endothelin receptor(ER)antagonists may be a novel and beneficial drug for DN,no consistent conclusions regarding their sufficient effectiveness and safety for patients with DN have been presented.AIM To assess the effectiveness and safety of ER antagonists among patients with DN.METHODS The EMBASE,PubMed,MEDLINE,Cochrane,and ClinicalTrials.gov databases were searched without any language restrictions.Relative risks with 95%confidence intervals(CIs)for dichotomous data and mean differences or standardized mean difference with 95%CIs for continuous data were calculated using Review Manager 5.3 software.Publication bias was assessed using Egger’s test with Stata/SE software.RESULTS We enrolled seven studies with six data sets and 5271 participants.The ER antagonists group showed a significantly greater reduction in albuminuria and more patients with 40%reduction in urinary albumin-to-creatinine ratio than the control group(P<0.0001 and P=0.02,respectively).Subgroup analysis for reductions in estimated glomerular filtration rate(eGFR)showed that for the middle-dosage subgroup,the ER antagonists group exhibited lower eGFR reduction than the control group(P<0.00001;mean difference,0.7095%CI:0.66,0.74).Moreover,significant reductions in systolic and diastolic blood pressure were observed in the invention group.CONCLUSION ER blockades combined with angiotensin converting enzyme inhibitor/angiotensin II type 1 receptor blockers may be an effective treatment to lower blood pressure and reduce proteinuria in DN with declined eGFR.However,attention should be given to adverse events,including cardiac failure,anemia,and hypoglycemia,as well as serious adverse events.
基金supported by Improving the Ability of Diagnosis and Treatment of Difficult Diseases (ZLYNXM202009)。
文摘Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.
文摘BACKGROUND Secondary malignancy of the thyroid occurs infrequently and mainly originates from malignant tumors of the kidney,gastrointestinal tract,lungs,breast,and skin.The correct diagnosis is important but difficult.Importantly,there are major differences in the treatment of primary and metastatic thyroid cancer,which has a significant impact on prognosis and survival.Therefore,how to diagnose thyroid metastasis(TM)correctly before surgery is a major concern for surgeons.CASE SUMMARY We report a 38-year-old woman who presented with palpable cervical lymph nodes after breast cancer(BC)surgery 2 years ago.Ultrasonography and computed tomography revealed thyroid nodules with irregular margins and enlarged cervical lymph nodes.Biopsy was performed for the right largest cervical lymph node,and immunohistochemical analysis revealed negativity for thyroglobulin,estrogen receptor,and progestin receptor and positive for human epidermal growth factor receptor 2.The diagnosis was TM from BC with cervical lymph node metastasis.Total thyroidectomy with bilateral central and lateral neck lymph node dissection was performed.After a 5-mo follow-up,no recurrence or novel distant metastasis was identified.CONCLUSION TM from BC is a rare secondary malignancy.Broad differential diagnosis by biopsy and immunohistochemical analysis needs to be considered.
文摘BACKGROUND Spontaneous rupture and hemorrhage of renal angiomyolipoma(RAML)is a lifethreatening clinical emergency.When it occurs during pregnancy,it is compared to a"bomb explosion,"which makes the diagnosis and treatment more challenging.An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure,which is always preferred for pregnant women.Currently,cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare,as is the diagnostic value and characteristics of ultrasound.The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis.In this study,we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics.CASE SUMMARY A 38-year-old woman in her 19 th wk of pregnancy(G2 P1)was referred to our clinic for a sudden,persistent pain on the left side of the waist.She had not undergone any previous related abdominal examination.Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area.The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound.Her left-side waist pain continued to be intense.Subsequently,she underwent computed tomography,which led to the same diagnosis.Based on many factors,the patient underwent left nephrectomy after the induction of labor.The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.CONCLUSION Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.
基金Supported by the National Natural Science Foundation of China(Nos.30801354 and 30970791)the Jilin Provincial Science & Technology Department,China(No.20080154)
文摘The effect and mechanism of phenylacetic acid on the proliferation of pancreatic carcinoma cells were investigated in cultured pancreatic carcinoma BXPC-3 cells by means of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and flow cytometry assay.The results show that the treatment of pancreatic carcinoma cells with phenylacetic acid significantly inhibited the cell proliferation in time-dependent and dose-dependent manners.The proliferation of BXPC-3 cells was inhibited at the stage of S phase,the cells at the end stage of S phase were accumulated abundantly,and thus DNA synthesis could not be accomplished entirely.In addition,the expression of adenosine deaminases acting on RNA(ADARs) mRNA in BXPC-3 cells and pancreatic carcinoma specimen were detected by RT-PCR.Having been treated with phenylacetic acid,ADAR2 mRNA in BXPC-3 cells was significantly decreased,the differences were of statistical significance(P<0.01).Taken together,these results suggest that phenylacetic acid may likely regulate the proliferation of pancreatic carcinoma cells through the regulation of ADAR2 mRNA expression.
基金This research was funded by National Natural Science Foundation of China(Grant Number:81760142)the High-level Health Talents Project of Yunnan Provincial(Grant Number:H-2017036).
文摘Parathyroid carcinoma is an extremely rare malignant tumor,composed primarily of vacuolated principal cells,but may also be composed of eosinophils.The exact etiology and pathogenesis of parathyroid carcinoma is unknown,and head and neck radiation exposure,chronic stimulation from renal failure,and familial syndromes can lead to the development of parathyroid carcinoma.Most parathyroid carcinoma is difficult to distinguish from benign HPT and is often diagnosed only when there is a recurrence of hypercalcemia several years later,which can manifest as weight loss,extreme fatigue,anorexia,and muscle atrophy.At present,surgical resection remains the primary treatment.In this case,the patient underwent initial surgery for primary hyperparathyroidism and was subsequently diagnosed with parathyroid carcinoma.During the 8 years of follow-up,the patient underwent 7 surgeries in combination with radiation therapy,chemotherapy and targeted medications.Although the neck tumor was cured,the patient died of complications related to hypercalcemia.We will review the literature on the combination of surgery,radiotherapy,chemotherapy,and targeted drug therapy in order to improve the diagnosis and treatment of parathyroid carcinoma.
文摘BACKGROUND: Transjugular intrahepatic portosystemic shunt(TIPS) and open splenectomy and esophagogastric devascularization(OSED) are widely used to treat patients with portal hypertension and recurrent variceal bleeding(PHRVB). This study aimed to compare the effectiveness between TIPS and OSED for the treatment of PHRVB.METHODS: The data were retrospectively retrieved from 479 cirrhotic patients(Child-Pugh A or B class) with PHRVB, who had undergone TIPS(TIPS group) or OSED(OSED group) between January 1, 2010 and October 31, 2014.RESULTS: A total of 196 patients received TIPS, whereas 283 underwent OSED. Within one month after TIPS and OSED, the rebleeding rates were 6.1% and 3.2%, respectively(P=0.122). Significantly lower incidence of pleural effusion,splenic vein thrombosis, and pulmonary infection, as well as higher hepatic encephalopathy rate, shorter postoperative length of hospital stay, and higher hospital costs were observed in the TIPS group than those in the OSED group. During the follow-up periods(29 months), significantly higher incidences of rebleeding(15.3% vs 4.6%, P=0.001) and hepatic encephalopathy(17.3% vs 3.9%, P=0.001) were observed in the TIPS group than in the OSED group. The incidence of instent stenosis was 18.9%. The survival rates were 91.3% in the TIPS group and 95.1% in the OSED group. The long-term liver function did not worsen after either TIPS or OSED.CONCLUSION: For the patients with liver function in the Child-Pugh A or B class, TIPS is not superior over OSED in terms of PHRVB treatment and rebleeding prevention.
基金supported by grants from Science and Tech-nology Projects of Medicine and Health in Zhejiang Province(2020383364)Natural Science Foundation of Zhejiang Province(LY21H160055).
文摘Background:Accumulating data have suggested that long non-coding RNAs(lncRNAs)play important roles in regulating tumor cell growth.This study was designed to investigate the role of SNHG16 in hep-atocellular carcinoma(HCC).Methods:SNHG16 expression was detected with real-time polymerase chain reaction(PCR).The cut-offvalue of SNHG16 for tumor-free survival(TFS)was determined with receiver operating characteristic curve analysis.Small interfering RNA was used to inhibit the expression of SNHG16 in HCC cell lines.The biologic behavior of HCC cell was determined with cell viability assay and Transwell assay in vitro.The potential predictive value of SNHG16 on prognosis was analyzed by Kaplan-Meier curves and Cox proportional hazards regression model.Results:SNHG16 expression was upregulated in tumor tissues and HCC cell lines.High expression of SNHG16 was associated with tumor recurrence and poor prognosis after surgery.Multivariate analysis revealed that SNHG16 was an independent prognostic factor for poor recurrence-free survival.Moreover,inhibition of SNHG16 in HepG2,Hep3B,and BEL-7402 cells significantly reduced cell invasiveness and proliferation.Mechanistic analyses indicated that the ECM-receptor interaction pathway was remarkably activated by SNHG16.Conclusions:SNHG16 might be a promising biomarker for predicting tumor recurrence in HCC patients after surgery and a potential therapeutic target for HCC.
