Clinical study of preoperative fT4/fT3 quotient and thyroid function test in distinguishing benign from malignant thyroid nodules

Objective:To analyze the clinical and pathological characteristics of thyroid nodules and to explore the related risk factors of malignant thyroid nodules.Methods: According to the criteria of inclusion and exclusion, a total of 283 patients with thyroid nodules during January 2015 and December 2017 were divided into benign group (benign nodule,n =172) and malignant group (malignant nodule,n = 111) based on postoperative histopathological results. The age, sex, serum thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), thyroid stimulating hormone (TSH), free thyroxine (fT4), free three iodine thyroxine (fT3) and fT4/ fT3 ratio were subjected to univariate analysis, and the risk factors of malignant thyroid nodule were screened by multivariate logistic regression analysis.Results:Univariate analysis showed that age, TgAb, fT4 (P < 0.05) and fT4/ fT3 quotient (P < 0.01) were significantly different between the two groups. The fT4/fT3 quotient is a risk factor of malignant nodules. Multivariate logistic regression analysis indicated that the risk factors of malignant thyroid nodule were age (0R: 0.934,95% CI:0.911-0.957), TgAb(0R: 2.069,95% CI: 1.008-4.247) and fT4 (0R: 1.206,95% CI: 1.038-1.401).Conclusion: The fT4/fT3 quotient has important diagnostic value in differentiating benign and malignant thyroid nodules. When fT4 / fT3 > 3, it increases the risk of malignancy. The age, TgAb and fT4 are independent risk factors for malignant thyroid nodule, which is of great value in distinguishing benign from malignant thyroid nodules.

Real Time Ultrasound Elastography for the Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

Differential value of shear wave velocity(SWV)in nodules quantitatively determined by ARFI for benign and malignant thyroid nodules

Objective: To study the differential value of shear wave velocity (SWV) in nodules quantitatively determined by acoustic radiation force impulse (ARFI) for benign and malignant thyroid nodules. Methods: Patients who were diagnosed with thyroid nodules in the People's Hospital of Hai'an County between June 2014 and February 2017 were selected and divided into those with benign thyroid nodules and malignant thyroid nodules according to the biopsy results. Before biopsy, the ARFI ultrasonic elastography was performed to measure SWV, and the biopsy tissue was collected after biopsy to determine the expression of proliferation molecules and invasion molecules. Results: The SWV of malignant thyroid nodules was significantly higher than that of benign thyroid nodules;P53, CyclinG2, E-cadherin, TIMP1 and TIMP3 mRNA expression in malignant thyroid nodules were significantly lower than those in benign thyroid nodules while FOXA1, Survivin, XIAP, Twist and Vimentin mRNA expression were significantly higher than those in benign thyroid nodules;P53, CyclinG2, E-cadherin, TIMP1 and TIMP3 mRNA expression in malignant thyroid nodules with high SWV were significantly lower than those in malignant thyroid nodules with low SWV while FOXA1, Survivin, XIAP, Twist and Vimentin mRNA expression were significantly higher than those in malignant thyroid nodules with low SWV. Conclusion: The SWV of malignant thyroid nodules significantly increases and is closely related to the abnormal proliferation and invasion of cancer cells.

Perithyroidal hemorrhage caused by hydrodissection during radiofrequency ablation for benign thyroid nodules:Two case reports

BACKGROUND Hydrodissection is a widely used technique during radiofrequency ablation(RFA)for benign thyroid nodules.Although it could effectively avoid thermal injury to the surrounding critical structures and achieve complete treatment,routine operation of the remaining needle could cause perithyroidal hemorrhage.In this report,we present 2 cases of perithyroidal hemorrhage during RFA caused by a hydrodissection needle,which have not been reported before.CASE SUMMARY A 21-year-old female and a 45-year-old male were admitted for RFA for benign thyroid nodules.Considering that their nodules were adjacent to the recurrent laryngeal nerve,the needle used for hydrodissection was placed and remained between the dorsal capsule of the lateral lobe and the recurrent laryngeal nerve.During the procedure,active bleeding near the needle appeared on ultrasonography(US).Although moderate pressure was quickly applied to the neck for several minutes,contrast-enhanced US(CEUS)still showed an active hemorrhage.A radiofrequency electrode was placed at the bleeding point under the guidance of CEUS to stop the bleeding,and the procedure was finally confirmed to be successful by CEUS,without other complications.CONCLUSION Hydrodissection during RFA of benign thyroid nodules was associated with a risk of perithyroidal hemorrhage.The timely recognition of this acute hemorrhage could help in the timely control of the bleeding,and CEUS-guided ablation of the bleeding point could be useful.

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% - 75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 - 400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

Difference in microvascular structure between benign and malignant pulmonary nodules and its relationship with CT enhancement

Objective： To investigate the enhancement basis and the mechanisms of solitary pulmonary nodules （SPNs） by comparing the differences in microvascular structure between benign and malignant lesions. Methods： Dynamic contrast-enhanced CT scan was performed on 53 patients with SPNs （diameter〈3 cm, 38 peripheral lung cancers, 5 hamartomas, 10 inflammatory lesions） using a Siemens Plus S or a Marconi MX8000 multi slices spiral CT scanner. The time-attenuation curves were interpreted. The microvascular density （MVD） and the continuity of the microvessels＇ basemental membrane in the dissected specimens were observed with the ABC （avldin-biotin complex） immuno-histochemical method in all patients. Results ：The CT enhancement values of lung cancer （49.05± 16.08 HU） and inflammatory lesions （49.59±21.30 HU） were significantly higher than those of hamartoma （8.98±4.56 HU） t=7.48, P〈0.051 t=8.35, P〈0.05）. But the enhancement of lung cancer was similar to that of inflammatory lesions （t=0.76, P±0. 05）. The time attenuation curve of inflammatory lesions tended to increase faster and reached a higher peak compared to the lung cancer, and both of them maintained a high plateau after crossing. The hamartoma showed a slight increase in the time-attenuation curve and demonstrated a lowplateau curve. The MVD of SPNs was positively correlated with CT enhancement （r=0. 8051）. The microvascular counts of peripheral lung cancer （48.45±10. 09） and inflammatory lesions （49. 60±19. 94） were significantly higher than those of hamartoma （8.70±7. 30） （t=11. 64, P〈0.001, t=6. 09, P〈0. 001 ）, but no significant difference was found between lung cancer and inflammatory lesions （t= -0.26, P=0.799）. There was no difference in the continuity of basement membrane between nodules with anen haneement less than 30 HU and those with an enhancement higher than 30HU （X^2=3. 13, P〉0.05 ）. Conclusion： The microvascular counts mainly contribute to the enhancement value of SPNs. The basement membrane is not related to nodule enhancement, but it might influence the pattern of the time-attenuation curve.

Correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes

Objective: To study the correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes. Methods: Patients with thyroid nodules who underwent ultrasonography in this hospital between March 2015 and February 2017 were selected, and the tissue properties were judged according to the results of fine needle aspiration biopsy;ultrasonic elastography was done to measure the strain rate ratio, and the fluorescence quantitative PCR reaction was performed to determine the mRNA expression of oncogenes and angiogenesis genes. Results: The strain rate ratio of malignant thyroid nodules was greatly lower than that of benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules were greatly lower than those in benign thyroid nodules whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were greatly higher than those in benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules with low strain rate ratio were greatly lower than those in malignant thyroid nodules with high strain rate ratio whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were higher than those in malignant thyroid nodules with high strain rate ratio. Conclusion: The increase in ultrasonic elastography strain rate ratio of malignant thyroid nodules is closely related to the changes in the expression of oncogenes and angiogenesis genes.

Correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes

Objective: To study the correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes. Methods: Patients with thyroid nodules who underwent ultrasonography in this hospital between March 2015 and February 2017 were selected, and the tissue properties were judged according to the results of fine needle aspiration biopsy;ultrasonic elastography was done to measure the strain rate ratio, and the fluorescence quantitative PCR reaction was performed to determine the mRNA expression of oncogenes and angiogenesis genes. Results: The strain rate ratio of malignant thyroid nodules was greatly lower than that of benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules were greatly lower than those in benign thyroid nodules whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were greatly higher than those in benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules with low strain rate ratio were greatly lower than those in malignant thyroid nodules with high strain rate ratio whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were higher than those in malignant thyroid nodules with high strain rate ratio. Conclusion: The increase in ultrasonic elastography strain rate ratio of malignant thyroid nodules is closely related to the changes in the expression of oncogenes and angiogenesis genes.

Pathological and Clinical Correlation European Union-Thyroid Imaging Reporting and Data System (EU-TIRADS) Classification of Thyroid Nodules in Two University Hospitals in Cotonou

Introduction: Since its creation in 2017 by the European community, the EU-TIRADS classification has enjoyed an excellent reputation in several countries around the world. Indeed, several studies conducted in these countries testify to the effectiveness of this tool for the management of nodular thyroid pathology. However, in Benin, the contribution of this classification has not yet been evaluated. It is therefore to overcome this inadequacy that we undertook this study. Objective: Participate in improving the diagnostic and therapeutic management of thyroid nodules at the CNHU HKM in Cotonou and at the CHUZ in Suru-Léré. Methods: This is a cross-sectional study with retrospective data collection spread over a period of 3 years 5 months, from January 2019 to May 2022 and carried out jointly in the Endocrinology Metabolism Nutrition and ORL-CCF departments of the CNHU HKM of Cotonou and in the ORL-CCF department of the CHUZ of Suru-Léré. The study population consisted of patients who consulted the University Clinic of Endocrinology Metabolism Nutrition, the University Clinic of ORL-CCF of the CNHU-HKM and the University Clinic of ORL-CCF of the CHUZ of Suru-Léré for thyroid nodule and who have had surgery. The study data was collected from patients hospitalization records using a survey form. Results: On ultrasound, according to the EU-TIRADS classification, 56.8% of nodules presented a low risk of malignancy (EU-TIRADS 3) compared to respectively 19.8%;23% and 2.5% of nodules with zero (EU-TIRADS 2), intermediate (EU-TIRADS 4) and high (EU-TIRADS 5) risk of malignancy. Regarding the performance of this classification, it is sensitive in 37.5% of cases and has a specificity of 78.5% with a PPV (Positive Predictive Value) and a NPV (Negative Predictive Value) respectively of 6.6 % and 91.6%. Furthermore, the bivariate correlations revealed that the size of the nodule was significantly associated with the malignancy of the nodule (p = 0.014) and the calculated value of the Yule’s Q coefficient (0.375) reflects a moderate intensity of the connection between the EU-TIRADS and histology. Conclusion: the EU-TIRADS classification, due to its excellent NPV, is of great interest for the management of thyroid nodules at the CNHU-HKM of Cotonou and at the CHUZ of Suru-Léré. In view of this, particular emphasis must be placed on its regular and rigorous use.

The Diagnostic Value of Color Doppler Ultrasound and Grey Scale Sonography in Predicting the Malignancy of Thyroid Nodules

Retrospective study was done at KAUH to determine the sonographic characteristics in predicting the malignancy of thyroid nodules. The sample was 120 patients consisting of 70 benign nodules and 50 malignant nodules. Out of 120 patients, 106 (88.3%) female and 14 (11.7%) male patients. Out of 106 female patients, 64 (91.45) had benign and 42 had malignant thyroid nodules. Out of 14 (11.7) male patients, 6 had benign and 8 had malignant thyroid nodules. The youngest patient in our study was 31 years and the oldest patient was 76 years. The common range of patients age was ≥ 60 years and consisting of twenty (28.6%) benign thyroid nodules and fourteen (28%) malignant thyroid nodules. The majority of patients’ age group with malignant thyroid nodules were between 50 - 60 years and consisting of twenty (40%) malignant nodules. In our study, according to the result of gray scale and color Doppler ultrasonography, hypo-echogenicity, solid echo structure, micro-calcification and intra-nodular vascularity were the significant characteristics of malignancy in nodules with sensitivity (72%, 74%, 48% and 88% respectively), specificity (66%, 63%, 94% and 69% respectively), PPV (60%, 59%, 86% and 67% respectively) and NPV (77%, 77%, 72% and 89% respectively).

Correlation of BRD4 and Skp2 expression levels in ultrasound-guided thyroid nodule fine needle aspiration biopsy tissue with the pathological features of nodules

Objective:To study the correlation of bromodomain-containing protein 4(BRD4)and S-phase kinase-associated protein 2(Skp2)expression levels in ultrasound-guided thyroid nodule fine needle aspiration biopsy tissue with the pathological features of nodules.Methods:The tissues obtained in ultrasound-guided thyroid nodule fine needle aspiration biopsy in our hospital between March 2015 and March 2018 was selected and divided into malignant group and benign group according to the pathological results,and the expression levels of BRD4,Skp2,proliferation genes and angiogenesis genes were detected.Results:The BRD4 and Skp2 mRNA expression in thyroid nodules of the malignant group were significantly higher than those of the benign group,and the BRD4 and Skp2 mRNA expression in the malignant group of thyroid nodules with TNM III-IV,capsular invasion and lymph node metastasis were significantly higher than those in the thyroid nodules with TNM I-II,without capsular invasion and without lymph node metastasis;cyclin D1(CCND1),β-catenin,proliferation cell nuclear antigen(PCNA),vascular endothelial growth factor(VEGF),endothelial cell specific molecule-1(ESM-1),Survivin and cyclooxygenase 2(COX2)mRNA expression in thyroid nodules of the malignant group were obviously higher than those of the benign group and positively correlated with BRD4 and Skp2 while cyclin G2(CCNG2)and endostatin(ES)mRNA expression were significantly lower than those of the benign group and negatively correlated with BRD4 and Skp2.Conclusion:The high expression of BRD4 and Skp2 in malignant thyroid nodules is correlated with the pathological changes and can change the expression of proliferation genes and angiogenesis genes.

Complications Following Radiofrequency Ablation of Benign Thyroid Nodules： A Systematic Review

Objective： This systematic review examined whether radiofrequency ablation （RFA） is a sate treatment modality for benign thyroid nodules （BTNs）. Data Sources： PubMed, Embase, and the Cochrane Library database were searched for articles that （a） targeted human beings and （b） had a study population with BTNs that were confirmed by fine-needle aspiration cytology and/or core needle biopsy. Study Selection： Thirty-two studies relating to 3409 patients were included in this systematic review. Results： Based on literatures, no deaths were associated with the procedure, serious complications were rare, and RFA appears to be a sale and well-tolerated treatment modality. However, a broad spectrum of complications offers insights into some undesirable complications, such as track needle seeding and Hornet syndrome. Conclusions： RFA appears to be a safe and well-tolerated treatment modality for BTNs. More research is needed to characterize the complications of RFA for thyroid nodules.

Evaluation of Diagnostic Efficiency of Ultrasound Features on Malignant Thyroid Nodules in Chinese Patients

Background： The aim of this study was to evaluate the efficacy of ultrasonic features in predicting the malignancy of thyroid nodules in a group of Chinese patients. Methods： In all, 762 patients with thyroid nodules （424 malignant and 338 benign） underwent ultrasound （US） check and surgery between March 2011 and July 2014 at Peking University First Hospital were identified. Univariate and receiver operating characteristic （ROC） analyses were performed to calculate the sensitivity, specificity, negative and positive predictive values of each US feature, and the accuracy of their combinations lbr prediction of malignancy. Results： Patients with malignant nodules were younger and without obvious risk history than those in the benign group （P 〈 0.001, P = 0.93 ）. No individual US sign was fully predictive of a malignant lesion. The Youden indexes of irregular margins and hypoechogenicity were the first and second highest in all US features, which were 51.9% and 45.2%, respectively. The sensitivity of solid components （89.7%） and hypoechogenicity （89.2%） and the specificity of taller-than-wide shape （98.5%） and microcalcifications （90.6%） were the first and second highest in all US features. Intranodular flow on a color Doppler examination was a weak predictor of malignancy. Under ROC analysis excepting intranodular flow, the 95% confidence interval （C1） of areas under tile curves of hypoechogenicity and irregular margins with any one of the US features were overlapped that of five-feature combinations （95% CI： 0.850 0.901）. Conclusions： We should be alert with taller-than-wide shape and microcalcifications, lntranodular flow was a weak predictor of malignancy. According to Youden indexes and ROC analysis, irregular margins and hypoechogenicity combined with solid component or taller-than-wide shapes or microcalcifications have a high predicative value for malignant thyroid nodules in Chinese patients.

Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update

Pancreatic ductal adenocarcinoma is the most common malignant tumor of the pancreas. The remaining pancreatic tumors are a diverse group of pancreatic neoplasms that comprises cystic pancreatic neoplasms, endocrine tumors and other uncommon pancreatic tumors. Due to the excellent soft tissue contrast resolution, magnetic resonance imaging(MRI) is frequently able to readily separate cystic from noncystic tumors. Cystic tumors are often easy to diagnose with MRI; however, noncystic non-adenocarcinoma tumors may show a wide spectrum of imaging features, which can potentially mimic ductal adenocarcinoma. MRI is a reliable technique for the characterization of pancreatic lesions. The implementation of novel motionresistant pulse sequences and respiratory gating techniques, as well as the recognized benefits of MR cholangiopancreatography, make MRI a very accurate examination for the evaluation of pancreatic masses. MRI has the distinctive ability of non-invasive assessment of the pancreatic ducts, pancreatic parenchyma, neighbouring soft tissues, and vascular network in one examination. MRI can identify different characteristics of various solid pancreatic lesions, potentially allowing the differentiation of adenocarcinoma from other benign and malignant entities. In this review we describe the MRI protocols and MRI characteristics of various solid pancreatic lesions. Recognition of these characteristics may establish the right diagnosis or at least narrow the differential diagnosis, thus avoiding unnecessary tests or procedures and permitting better management.

Comparison of three mathematical prediction models in patients with a solitary pulmonary nodule

Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.

Extrathyroidal Implantation of Thyroid Hyperplastic/neoplastic Cells after Endoscopic Thyroid Surgery

Objective To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapies. Methods A systematic search of literature from the PubMed database was conducted for identifying eligible studies on implantation of thyroid hyperplastic or neoplastic cells after endoscopic thyroid surgery. Results Overall, 5 reported cases on patients suffering from endoscopic thyroid surgery with implantation of thyroid hyperplastic or neoplastic cells were included in the systematic review. Conclusions Unskilled surgeons, rough intraoperative surgical treatment, scarification or rupture of tumor, contamination of instruments, chimney effect, aerosolization of tumor cells may be associated with the implantation after endoscopic thyroidectomy. To minimize the risk of such complication, we should be more meticulous and strict the endoscopic surgery indications.

Intratumoral Bacteria Dysbiosis Is Associated with Human Papillary Thyroid Cancer and Correlated with Oncogenic Signaling Pathways

Emerging evidence suggests that microbial dysbiosis plays vital roles in many human cancers.However,knowledge of whether the microbial community in thyroid tumor is related to tumorigenesis remains elusive.In this study,we aimed to explore the microbial community in thyroid tissues and its contribution to papillary thyroid cancer(PTC).In parallel,we performed microbial profiling and transcriptome sequencing in the tumor and adjacent normal tissues of a large cohort of 340 PTC and benign thyroid nodule(BTN)patients.Distinct microbial signatures were identified in PTC,BTN,and their adjacent nontumor tissues.Intra-thyroid tissue bacteria were verified by means of bacteria staining,fluorescence in situ hybridization,and immunoelectron microscopy.We found that 17 bacterial taxa were differentially abundant in PTC compared with BTN,which included enrichment in PTC of the pathobionts Rhodococcus,Neisseria,Streptococcus,Halomonas,and Devosia,and depletion of the beneficial bacteria Amycolatopsis.These differentially abundant bacteria could differentiate PTC tumor tissues(PTC-T)from BTN tissues(BTN-T)with an area under the curve(AUC)of 81.66%.Microbial network analysis showed increased correlation strengths among the bacterial taxa in PTC-T in comparison with BTN-T.Immunefunction-corresponding bacteria(i.e.,Erwinia,Bacillus,and Acinetobacter)were found to be enriched in PTC with Hashimoto’s thyroiditis.Moreover,our integrative analysis revealed that the PTC-enriched bacteria had a positive association with key PTC-oncogenic pathway-related genes,including BRAF,KRAS,IRAK4,CTNNB1,PIK3CA,MAP3K7,and EGFR.In conclusion,our results suggest that intratumor bacteria dysbiosis is associated with the thyroid tumorigenesis and oncogenic signaling pathways of PTC.

Bethesda System for Reporting Thyroid Cytopathology:A three-year study at a tertiary care referral center in Saudi Arabia

AIM To stratify the malignancy risks in thyroid nodules in a tertiary care referral center using the Bethesda system. METHODS From January, 2012 to December, 2014, a retrospective analysis was performed among 1188 patients(15-90 years) who had 1433 thyroid nodules and fine-needle aspiration at Prince Sultan Military Medical City, Saudi Arabia. All thyroid cyto-pathological slides and ultra sound reports were reviewed and classified according to the Bethesda System for Reporting Thyroid Cytopathology. Age, gender, cytological features and histological types of the thyroid cancer were collected from patients' medical chart and cytopathology reports. RESULTS There were 124 total cases of malignancy on resection, giving an overall surgical yield malignancy of 33.6%.Majority of the thyroid cancer nodules(n = 57, 46%) in Bethesda VI category followed by Bethesda IV(n = 25, 20.2%). Almost 40% of the cancer nodules in 31-45 age group in both sex. Papillary thyroid carcinoma(PTC) was the most common form of thyroid cancer among the study population(111, 89.6%) followed by 8.9% of follicular thyroid carcinoma(FTC), 0.8% of medullary carcinoma and 0.8% of anaplastic carcinoma. Among the Bethesda IV category 68% thyroid nodules were PTC and 32% FTC. CONCLUSION The malignancy values reported in our research were constant and comparable with the results of other published data with respect to the risk of malignancy. Patients with follicular neoplasm/suspicious for follicular neoplasm and suspicious of malignancy categories, total thyroidectomy is indicted because of the substantial risk of malignancy.

甲状腺结节超声恶性危险分层指南对甲状腺乳头状癌的诊断价值:C-TIRADS与ATA指南比较

目的探讨甲状腺结节超声恶性危险分层中国指南(C-TIRADS)和美国甲状腺协会(ATA)指南对甲状腺乳头状癌(PTC)的诊断价值。资料与方法回顾性收集2019年7月—2021年5月联勤保障部队第九〇九医院甲状腺结节术后且有明确病理结果的259例患者(339个结节),分为甲状腺良性结节组150例(210个结节)和PTC组109例(129个结节),分析两组一般资料和结节声像图特征,分别用两种指南对结节进行分类并与手术病理结果进行对照,绘制受试者工作特征曲线评价两种指南对PTC的诊断价值。结果两组恶性声像图特征中,实性、边缘模糊/不规则或甲状腺外侵犯、垂直位、低或极低回声、微钙化差异有统计学意义(χ^(2)=123.67、132.71、103.82、4.58、137.93,P均<0.05),以PTC组多见;与C-TIRADS不同,ATA指南对61个结节(61/339,17.99%)分类不明确;C-TIRADS和ATA指南的曲线下面积分别为0.952(0.924~0.972)、0.942(0.911~0.964),差异无统计学意义(Z=0.943,P=0.346);两者的最佳截断值为4b类和高度可疑,C-TIRADS的敏感度最高[0.930(120/129)比0.822(106/129)],ATA指南的特异度最高[0.857(180/210)比0.943(198/210)],差异均有统计学意义(χ^(2)=6.99、8.57,P均<0.01),两组准确度[0.885(300/339)比0.897(300/339)]差异无统计学意义(χ^(2)=0.24,P=0.622)。结论C-TIRADS和ATA指南对PTC均有很高的诊断效能,但C-TIRADS适用于所有甲状腺结节的声像图表现,且受超声医师临床经验影响小,更易在临床推广使用。

从肝脾论治甲状腺良性结节研究进展

甲状腺结节为常见的内分泌系统疾病,多为良性结节。西医对于甲状腺结节缺乏有效的治疗措施,对于部分病情严重的患者可进行手术治疗,但相关并发症较多。中医认为,甲状腺结节的发生与患者情志失调密切相关,而情志畅达与肝脏气机调畅密切相关,患者情志抑郁可致肝气郁结,日久使得脾胃生化功能失调,肝郁脾虚则水液输布失常,痰气瘀结于颈前而发为“瘿病”,因此,从疏肝理气、健脾利水、化痰消瘀为基本原则,治疗甲状腺结节能取得良好的效果。