二维和彩色多普勒超声在鉴别甲状腺节良恶性实性结诊断中的效果

探究二维和彩色多普勒超声在鉴别甲状腺节良恶性实性结诊断中的效果。方法:此次研究以70名患者作为观察样本,所选患者必须符合此次纳入标准,病例相关数据时间段始于2020年2月,结束于两年后的1月,每一位受试者均接受二维和彩色多普勒超声检查,对其良恶性分布特点、诊断敏感度等进行比较。结果:在二维和彩色多普勒超声的诊断准确率情况对比方面,二维超声组良性结节和恶性结节诊断准确率分别为(69.76%)、(66.66%),二维和彩色多普勒超声组良性结节和恶性结节诊断准确率分别为(97.67%)、(92.59%),二维和彩色多普勒超声组诊断准确率明显高于二维超声组,有统计学意义(P<0.05);在二维超声征象检出情况比较方面,良性结节中边界清晰、微钙化、低回声、形态规则、结节囊实质检出概率分别为(90.00%)、(6.66%)、(6.66%)、(86.66%)、(93.33%),恶性结节中边界清晰、微钙化、低回声、形态规则、结节囊实质检出概率分别为(0.00%)、(50.00%)、(44.44%)、(0.00%)、(11.11%),有统计学意义(P<0.05);在彩色多普勒超声诊断良恶性结节的血流分型比较方面,良性结节中,30例I型、5例II型、1例III型,恶性结节中1例I型、12例II型、8例III型,有统计学意义(P<0.05);结论:将二维与彩色多普勒超声进行结合在甲状腺结节患者的诊断中,能够有效的提升良恶性结节诊断准确率,同时提升在良性结节中个情况的检出率,血型分型效果较佳,值得参考。

超声弹性成像技术对慢性淋巴细胞性甲状腺炎结节的鉴别诊断价值

目的探讨分析超声弹性成像技术对慢性淋巴细胞性甲状腺炎(CLT)结节的鉴别诊断价值。方法回顾性分析北京积水潭医院住院手术治疗的84例CLT合并甲状腺实性结节患者的临床资料。结节112个,经病理证实合并良性结节41个,合并恶性结节患者71个。患者术前行常规超声和超声弹性成像检查,分析2种检查方式对CLT合并微小结节的诊断价值。结果常规超声诊断敏感性为74.65%,特异性为63.41%,准确率为70.54%;采用超声弹性评分法诊断敏感性为87.32%,特异性为85.37%,准确率为86.61%;常规超声联合超声弹性评分诊断敏感性为94.37%,特异性为97.56%,准确率为95.54%;超声弹性应变率比值诊断敏感性为83.10%、特异性为90.24%、准确率为85.71%。采用ROC曲线分析超声弹性评分和弹性应变率比值对良恶性结节的诊断价值,结果显示,超声弹性评分诊断曲线下面积为0.872,弹性应变率比值诊断曲线下面积为0.922。结论超声弹性成像可反映甲状腺结节硬度,其中弹性评分和弹性应变率比值有较高的诊断价值,在实际工作中可联合运用超声弹性成像技术和常规超声检查,以提高CLT患者合并甲状腺结节的鉴别诊断准确率。

甲状腺腺瘤与单发结节性甲状腺肿的超声诊断价值

本文通过对健康体检中所发现的42例甲状腺腺瘤及37例单发结节性甲状腺肿的声像图及彩色多普勒血流显像(CDFI)进行分析,旨在探讨超声对两种疾病的鉴别诊断,进一步提高诊断的符合率.

高频超声与彩色多普勒诊断甲状腺结节的影像学特征及价值分析

目的探讨高频超声与彩色多普勒的影像学特征及其在甲状腺结节诊断中的应用价值,以便尽早采取相应的防治措施。方法选取诸城中医医院2019年10月至2020年10月收治的117例甲状腺结节患者进行回顾性分析,根据结节性质将其分为甲状腺良性结节组63例、甲状腺恶性结节组54例。两组患者均行高频超声与彩色多普勒检查,比较两组患者高频超声声像图特点、血流分布等级、血流参数、高频超声与彩色多普勒超声诊断结果的符合率、高频超声良/恶性结节图像差异。结果与甲状腺恶性结节组进行比较,甲状腺良性结节组行高频超声检查后所显示的以下声像图特征均有不同之处,如结节结构(囊性或海绵状、囊实性复合、实性或几乎完全实性)、结节回声(无回声、高回声或等回声、低回声、极低回声)、结节形态(纵横比<1、纵横比≥1)、结节边缘(光滑或模糊、分叶或不规则、腺体外侵犯)、结节钙化灶(无或大彗星尾、粗钙化、边缘钙化、星点状钙化)等方面经比较,差异有统计学意义(P<0.05);甲状腺恶性结节组在不同的血流分布等级中的2、3级占比高于甲状腺良性结节组;恶性结节组血流收缩期峰值流速(PSV)、阻力指数(RI)值均比良性结节组高(均P<0.05);高频超声诊断符合率为87.18%、彩色多普勒超声诊断符合率为88.03%,经比较,差异无统计学研究意义(P>0.05)。结论高频超声与彩色多普勒超声检查在良性、恶性甲状腺结节患者的诊断中可显示不同的血流特征,高频超声与彩色多普勒均有较高的诊断价值,可根据临床医师及患者实际情况选择合适的检查方式进行诊断。

小白鼠甲状腺神经节的形态学观察

应用镀银、硫堇及HE染色法和石蜡连续切片,可见不同鼠龄小白鼠甲状腺内侧缘上端与喉肌之间存在有类似典型的植物性神经节结构。此外,节的附近偶有散在的单个神经节细胞。神经节的位置、数量及大小个体不一,节的外面通常具有结缔组织的被膜,膜的胶原纤难向节内延伸成网、基质内有神经节细胞、神经胶质细胞和毛细血管。此外,尚有穿过节的有髓神经纤维等。神经节细胞散在分布,但以节的边缘为多,为多极神经元,胞体卵圆或不规则,尼氏小体呈细颗粒状,边缘较多,神经原纤维纤细世网。细胞核偏位,大而圆,染色质稀少呈空泡状,核仁明显,1—2个,此外核内尚有数个染色质聚集的不规则小块。幼龄小鼠可见双核神经节细胞。胞体外围有卫星细胞(被囊细胞)形成的被囊。神经节附近有甲状腺动脉、静脉主干同时出现,并显示为神经通路上(或稍偏离)之膨大结构,由其分出节前纤维进入节内,与神经节细胞形成突触。神经节内有错综交织的节前、后纤维及树突形成的神经网。研究表明小白鼠甲状腺附近存在有副交感神经节,其节后纤维分布有待进一步研究。

原发性甲状腺副神经节瘤附1病例

1病例资料患者,女性,54岁,3年前发现左侧颈前部有1块约花生米大小肿物,未系统诊治,查体：左侧颈前部可触及1枚肿物,约15mm×12mm×8mm,在全麻下行左侧叶甲状腺及峡部切除术,术野止血,逐层缝合腺体、皮下层及皮肤,包扎术毕。手术过程顺利。术后切口愈合良好,无红肿,无渗出,如期出院,建议定期复查甲功并随访。

应用AchE法对小白鼠甲状腺神经节及其节后纤维分布的观察

本文应用Koelle的整块组织染色显示乙酰胆碱酯酶(AchE)方法,对存在于小白鼠甲状腺和喉肌间的甲状腺神经节的性质,及其后纤维的分布进行了研究。实验结果显示甲状腺神经节和节前、节后纤维均呈AchE阳性反应,证明小白鼠甲状腺神经节为副交感神经节,其节后纤维大部分进入喉肌,小部分进入甲状腺,有的甲状腺滤泡间存在有丰富的AchE阳性反应的节后纤维及其末梢。

用甲状腺全切术治疗双侧结元节性甲状腺肿的疗效观察

目的 :探讨用甲状腺全切术治疗双侧结元节性甲状腺肿的临床效果。方法 :对2008年7月~2012年5月期间我院收治的50例双侧结元节性甲状腺肿患者的临床资料进行回顾性研究。我们对这50例患者均进行了双侧甲状腺全切手术治疗。结果 :在这50例患者中,有6例患者在术后出现了声音嘶哑的现象,经治疗后痊愈,且未出现后遗症;有5例患者在术后2天出现了暂时性的低钙症状。这50例患者均在术后长期口服甲状腺素,均未发生甲状腺素缺乏的情况。结论 :对于年龄在40岁以上、存在多处双侧甲状腺结节性肿大,且结节直径在30mm以上的患者,我们应尽量使用甲状腺全切手术对其进行治疗。在进行手术时,我们应谨慎操作,以防损伤患者的喉返神经等重要组织。该方法值得在临床上推广使用。

用甲状腺全切术治疗双侧结元节性甲状腺肿的疗效分析

目的探究用甲状腺全切术治疗双侧结元节性甲状腺肿的临床疗效。方法选取60例双侧结元节性甲状腺肿患者,对其临床资料回顾分析。结果有6例患者在术后出现了声音嘶哑的现象,经治疗后痊愈,且未出现后遗症;这60例患者均在术后长期口服甲状腺素,均未发生甲状腺素缺乏的情况。结论对于年龄>45岁,且双侧甲状腺处伴有较多的肿大结节(直径>25 mm)的患者,应给予患者甲状腺全切术进行治疗。手术时,应谨慎操作,防止损伤喉返神经等重要神经和周围组织血管。

甲状腺原发性副神经节瘤1例

1病例报告患者,女,55岁,因＂发现颈部无痛性肿块4d＂于2012年5月入院,既往有高血压病史4年,无甲状腺疾病家族史。体检：右侧甲状腺可触及一约3cm×3cm大小圆形肿块,质中等、无压痛,随吞咽上下活动。甲状腺功能检查显示甲状腺球蛋白：32.12ng/ml（13.16-24.19ng/ml）。

Ultrasound features of extranodal extension in the metastatic cervical lymph nodes of papillary thyroid cancer:a case-control study

Objective：Extranodal extension in cervical lymph nodes is an important risk factor for the progression and prognosis of papillary thyroid cancer.The purpose of this study was to identify the common and characteristic preoperative ultrasonography features that are associated with the pathologic extranodal extension of metastatic papillary thyroid carcinoma.Methods：We retrospectively assessed and compared clinicopathologic and ultrasound features between 60 papillary thyroid cancer patients with extranodal extension and 120 control patients with papillary thyroid cancer without extranodal extension.Results：With respect to the pathological N stage and clinicopathologic features,N1b stage papillary thyroid carcinomas were more frequently found in patients who were extranodal extension-positive,in comparison with those who were extranodal extension-negative（78.3%vs.63.3%,P=0.043）.Extranodal extension was detected most frequently in level VI cervical lymph nodes（48.7%）.In our univariate analysis of patients with papillary thyroid carcinoma,cervical lymph nodes with extranodal extension showed higher incidences of node matting,microcalcification,cystic area,aspect ratio＆lt;2,and larger diameter than those without extranodal extension（all P〈0.05）.Our multivariate analysis demonstrated that node matting and cystic area were independent risk factors for the presence of extranodal extension[odds ratio（OR）：4.751,95%confidence interval（CI）：1.212~18.626,P=0.025;OR：2.707,95%CI：1.127~6.502,P=0.026].Conclusions：Common ultrasound features may indicate the presence of extranodal extension in patients with metastatic cervical lymph nodes of papillary thyroid carcinoma.

Iodothyronine deiodinase gene analysis of the Pacific oyster Crassostrea gigas reveals possible conservation of thyroid hormone feedback regulation mechanism in mollusks

Iodothyronine deiodinase catalyzes the initiation and termination of thyroid hormones(THs) effects, and plays a central role in the regulation of thyroid hormone level in vertebrates. In non-chordate invertebrates, only one deiodinase has been identified in the scallop C hlamys farreri. Here, two deiodinases were cloned in the Pacific oyster C rassostrea gigas( Cg Dx and C g Dy). The characteristic in-frame TGA codons and selenocysteine insertion sequence elements in the oyster deiodinase c DNAs supported the activity of them. Furthermore, seven orthologs of deiodinases were found by a tblastn search in the mollusk Lottia gigantea and the annelid C apitella teleta. A phylogenetic analysis revealed that the deiodinase gene originated from an common ancestor and a clade-specific gene duplication occurred independently during the differentiation of the mollusk, annelid, and vertebrate lineages. The distinct spatiotemporal expression patterns implied functional divergence of the two deiodinases. The expression of C g Dx and Cg Dy was influenced by L-thyroxine T4, and putative thyroid hormone responsive elements were found in their promoters, which suggested that the oyster deiodinases were feedback regulated by TH. Epinephrine stimulated the expression level of C g Dx and Cg Dy, suggesting an interaction effect between different hormones. This study provides the first evidence for the existence of a conserved TH feedback regulation mechanism in mollusks, providing insights into TH evolution.

Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules

Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.

Characterization of the Xenopus homolog of animmediate early gene associated with cell activation: sequence analysis and regulation of its expression by thyroid hormone during amphibian metamorphosis

The complex transformation of a tadpole to a frogduring amphibian development is under the control of thyroid hormone (T3). T3 is known to regulate gene transcription through its nuclear receptors. We have previouslyisolated many genes which are up-regulated by T3 in theintestine of Xenopus laevis tadpoles. We have now cloneda full- length cDNA for one such gene (IU12). Sequenceanalysis shows that the IU12 cDNA encodes a plasmamembrane protein with 12 transmembrane domains andhomologous to a mammalian gene associated with cell activation and organ development. Similarly, we have foundthat IU12 is activated during intestinal remodeling whenboth cell death and proliferation take place. Furthermore,IU12 is an early T3-response gene and its expression in theintestine during T3-induced metamorphosis mimics thatduring normal development. These results argue for a roleof IU12 in the signal transduction pathways leading to intestinal metamorphosis.

ANALYSIS OF EFFICACY IN TREATMENT OF LOW-RISK WELL-DIFFERENTIATED THYROID CANCER WITHOUT CERVICAL LYMPH NODE INVOLVEMENT: 42 CASES REPORT

Objective To assess the more appropriate surgical treatment for low-risk group differentiated thyroid cancer. Methods A total of 42 low-risk patients with DTC, according to the AMES system (male, n = 6; female, n = 36) , were chosen for total thyroidectomy or subtotal thyroidectomy with center compartment lympha-dectomy. Results Nineteen patients had cervical lymph node involvement. Two patients had recurrent nerve injured. One patient had hypoparathyroidism. There were no mortality or local lymph recurrent up to present. Conclusion Total thyroidectomy or subtotal thyroidectomy with prophylactic center compartment lymphadectomy is an appropriate approach for the treatment of low-risk group differentiated thyroed cancer, to prevent recurrent and improve life quality.

Correlation between thyroid function and nodular goiter accompanied with gallstone

Objective： The purpose of the study wass to explore the correlation between thyroid function and nodular goiter accompanied with gallstone. Methods： We collected 120 cases about nodular goiter accompanied with gallstone and 128 cases about nodular goiter and establish 50 healthy control groups. Detected t level of hyrotropic hormone （TSH）, total triio- dothyronine （TT3）, total thyroxine in the peripheral venous blood of these cases in the three groups by using electrochemilu- minescenca immunoassay, measure level of total cholesterol （TC）, high-density tipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol （LDL-C） and total bile acid （TBA） levels by using enzymic method, and observed the changes of thyroid function and blood lipid among the three groups. Results： The serum TT3 level in nodular goiter accompanied with gallstone group and the nodular goiter group was significantly lower than that in control group （P 〈 0.01）, and TSH level in the nodular goiter accompanied with gallstone group is significantly higher than that in control group （P 〈 0.01）, There were no statistical significance about difference of TT4 level among the three groups （P 〉 0.05）. Accordingly, TC and LDL-C level in nodular goiter accompanied with gallstone group was significantly higher than that in nodular goiter and control group （P 〈 0.01）, while TBA level in nodular goiter accompanied with gallstone group was significantly lower than that in simple nodular goiter group and control group （P 〈 0.01）. There was no statistical significance about difference of TC and LDL-C level between simple nodular goiter group and control group （P 〉 0.05）. The HDL-C level in nodular goiter accompanied with gallstone group and control group was higher than that in simple nodular goiter group （P 〈 0.01）. Conclusion： The originating etiologic factor of nodular goiter accompanied with gallstone may be related to that the decreased TT3 induced sub-clinical hypothyroidism.

Diagnostic value of computed tomography(CT) histogram analysis in thyroid benign solitary coarse calcification nodules

This study was to investigate the diagnostic value of the computed tomography（CT） histogram in thyroid benign solitary coarse calcification nodules（BSCNs）. A total of 89 thyroid solitary coarse calcification nodules（coarse calcification ≥5 mm, no definite soft tissue around calcification） confirmed either by surgery or histopathological examination in 86 cases enrolled from January 2009 to December 2015 were evaluated. These included 56 BSCNs and 33 malignant solitary coarse calcification nodules（MSCNs）. Overall, 27 cut-off values were calculated by N（4≤N≤30） times of 50 Hounsfield units（HU） in the range of 200 to 1500 HU, and each cut-off value and the differences in the corresponding area percentages in the CT histogram were recorded for BSCN and MSCN. The optimal cut-off value and the corresponding area percentage were established by receiver operating characteristic（ROC） curve analysis. In the 19 groups with an ROC area under curve（AUC） of more than 0.7, at a cut-off value of 800 HU and at an area percentage of no more than 93.8%, the ROC AUC reached the maximum of 0.79, and the accuracy, sensitivity, and specificity were 75.3%, 80.4%, and 66.7%, respectively. At a cut-off value of 1050 HU and at an area percentage of no more than 93.6%, the accuracy, sensitivity, and specificity were 71.9%, 60.7%, and 90.9%, respectively. At a cut-off of 1150 HU and area of no more than 98.4%, the accuracy, sensitivity, and specificity were 70.8%, 57.1%, and 93.9%, respectively. At a cut-off of 600 HU and area of no more than 12.1%, the accuracy, sensitivity, and specificity were 61.8%, 39.3%, and 100.0%, respectively. Compared with the cut-off value of 800 HU and an area percentage of no more than 93.8%, the sensitivity of cut-off values and minimum areas of 1050 HU and 93.6%, of 1150 HU and 98.4%, and of 600 HU and 12.1%, was gradually decreasing; however, their specificity was gradually increasing. This can provide an important basis for reducing the misdiagnosis and unnecessary surgical trauma.

Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes

The cytology of 130 indeterminate nodules （Thy 3） was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a （atypical features） and Thy 3f （follicular lesion） categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonogrephy （US）, semi-quantitative elastography-US （USE）, contrast-enhanced US （CEUS）, and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgically- treated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a （26%） and Thy 3f （14%） nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f （29%） than in Thy 3a （3%） nodules （P=0.01）. The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules （P=0.04）. Receiver-operating characteristic （ROC） analysis was used to obtain cut-off values from US （score）, USE （ELX 2/1 strain index）, and CEUS （time-to- peak index and peak index） data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is 〉2, ELX 1/2 strain index 〉1, time-to-peakindex 〉1, and peak index 〈1. In a sub-group of 24 revised nodules （12 Thy 3a and 12 Thy 3f） with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values （83% and 100%, respectively） for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.

Introduction to Quick and Surround Needling Method for Nodular Goiter

Clinically guided by the holistic concept of traditional Chinese medicine and in combination with four diagnostic methods and pattern identification, quick and surround puncture is used for treating nodular goiter, fully displaying the practical application value of the special acupuncture therapy.

Clinical and laboratory characteristics of patients having amyloidogenic transthyretin deposition in osteoarthritic knee joints

Objective： Our aim was to investigate clinical and laboratory characteristics of osteoarthritic patients who had amyloid deposition in their knee joints. Methods： Synovial membranes were obtained from 36 patients with knee osteoarthritis （OA） who underwent joint replacement surgery. From this sample, the diagnosis of amyloid was deter- mined by Congo red staining, which demonstrated apple-green birefringence under a polarized microscope. All syn- ovial membranes were immunohistochemically characterized for the expressions of amyloid immunoglobulin light chain （AL-K and AL-,k）, serum amyloid-A （SAA）, amyloidogenic transthyretin （ATTR）, and amyloidogenic 152- microglobulin （A152M）. Matrix-assisted laser desorption-ionizaton/time of flight mass spectrometry （MALDI-TOF MS） was used to analyze transthyretin （TTR） isoforms in the serum of each patient. Results： Nine cases （25%） were found to be amyloid-positive. Immunohistochemicaliy, eight cases （88.9%） had ATTR deposition, and one sample （11.1%） was shown to be AL-K-positive. MALDI-TOF MS identified that the TTR in the serum of the patients was unmodified wild-type TTR, TTR-Cys-S-S-Cys, and TTR-Cys-S-S-CysGly. The age at surgery and the disease duration were sig- nificantly higher in the ATTR-positive group than in the ATTR-negative group. Knee score and function score were significantly lower in the ATTR-positive group than in the ATTR-negative group. Conclusions： Amyloid deposition in synovial membranes of OA patients was found to be ATTR and AL-K. TTR in the serum of the patients was unmodified wild-type TTR together with two isoforms. The high age at surgery, long disease duration, and a deteriorated knee function were associated with ATTR amyloid deposition in the osteoarthritic knee joints.