目的 探讨超声对肿块型浆细胞性乳腺炎(PCM)与浸润性导管癌(IDC)的鉴别诊断价值.方法 回顾性分析行超声检查并经病理穿刺证实为肿块型PCM的51例病例的超声特征,并将其与同期的103例IDC病例进行对比分析.结果 根据BI-RADS分类,51例肿块型PCM病例中,27例判为2～3类,24例判为4类,诊断准确率为52.9％;103例IDC病例中,95例判为4a～5类,8例判为3类,诊断准确率为92.2％;肿块型PCM在纵横比＞0.8、周围呈高回声晕、后方回声衰减、钙化灶、血流2～3级的检出率均低于IDC(P＜0.05);而在肿块内部回声不均匀、形态不规则、边缘不光整、腋窝肿大淋巴结的检出率则无明显差别(P＞0.05),其中肿块型PCM的边缘毛刺蟹足征、异常肿大淋巴结检出率均低于IDC(P＜0.05).结论 超声对肿块型PCM与IDC具有一定的鉴别诊断价值,充分认识两者的声像图特征,并结合患者的病史及临床表现,可提高肿块型PCM的诊断准确率.

以南方丘陵红壤区典型小流域为例,构建了基于R语言的流域非点源颗粒态磷污染指数并进行应用.结果表明,(1)流域土壤侵蚀模数在0.7～15244.2t/(km2·a)之间,超出南方丘陵红壤区容许土壤侵蚀量的区域占流域面积59％;平均非点源颗粒态磷产生强度为0.86kg/hm2,超出非点源磷流失阈值的区域占流域面积14％.流域侵蚀等级以微、轻度为主,但中度及以上强度区域以较小的面积(7.2％)贡献了较大比例的流域侵蚀产生量(35％)和输出量(43％)、以及非点源颗粒态磷输出量(31％).(2)识别的关键源区占流域面积14％,贡献了65％和58％的侵蚀土壤和颗粒态磷输出负荷;主要分布在近河道的坡地(＜25°,水文距离≤800m),林地、耕地、园地是主要土地利用类型组成.(3)过量施肥导致的土壤磷素富集、强降雨条件下低丘缓坡地带的高易蚀性是关键源区形成的主因.研究进一步对关键源区进行分类分区,提出了以水土保持、配方施肥、工程治理为核心的非点源颗粒态磷污染治理组合措施.研究为丘陵红壤区流域非点源颗粒态磷污染的防治提供了较为系统完善的思路.

目的 研究复发性流产(RSA)患者不同妊娠时期的子宫动脉血流搏动指数(PI)和阻力指数(RI)以指导临床治疗.方法 198例患者依据RSA的主要病因分为4组:自身免疫性疾病组、易栓症组、多囊卵巢综合征组、甲状腺疾病组,于妊娠7、12、24、32周监测子宫动脉血流阻力,并随访母胎结局.结果 198例患者中,不良妊娠结局75例.发生不良妊娠结局的患者各时期的子宫动脉PI及RI在不同病因组间差异无统计学意义(P>0.05);不同病因组间不良妊娠结局患者妊娠7、32周时的子宫动脉PI及RI均显著高于同组正常妊娠结局患者,差异有统计学意义(P<0.05);自身免疫性疾病组中,发生不良妊娠结局的患者各时期的子宫动脉PI及RI均显著高于本组正常妊娠结局患者,差异有统计学意义(P<0.05).结论 RSA患者在妊娠7、32周时的子宫动脉PI及RI与妊娠结局有关,但与母体病因无关.自身免疫性疾病的RSA患者妊娠早、中、晚期的PI及RI与妊娠结局有关.妊娠期间的子宫动脉PI及RI可用来预测不良妊娠结局.

目的 探讨超声应变弹性成像技术中的弹性评分及应变比值(SR)对乳腺影像报告和数据系统(BI-RADS)4类结节级别调整的诊断价值.方法 收集200个常规超声BI-RADS分级诊断为BI-RADS 4类结节行应变弹性成像,获得弹性评分值和SR,并计算出两者的良恶性界值,联合这两项指标,对结节的分级重新调整.以病理结果 为金标准,分别比较常规超声BI-RADS分类、弹性评分、SR及三者联合对该组乳腺结节良恶性的诊断价值.结果 恶性病变弹性评分明显高于良性病变,差异有统计学意义(Z=-7.237,P<0.05).良性病变SR明显高于恶性病变,差异有统计学意义(Z=-7.152,P<0.05).弹性评分和SR联合常规超声BI-RADS分类联合诊断该组乳腺结节的良恶性AUC为0.9,与单独运用常规超声BI-RADS分类、弹性评分、SR诊断该组乳腺结节良恶性的AUC相比,差异均有统计学意义(P<0.05).结论 应变弹性技术中的弹性评分及SR能够定性及半定量评价组织的相对硬度,将两者与常规超声乳腺BI-RADS分类联合,可以提高乳腺BI-RADS 4类结节的诊断效能.

In this systematic review and meta-analysis, we aimed to determine the risk factors associated with neck hematoma requiring surgical re-intervention after thyroidectomy. We systematically searched all articles available in the literature published in PubMed and CNKI databases through May 30, 2017. The quality of these articles was assessed using the Newcastle-Ottawa Quality Assessment Scale, and data were extracted for classification and analysis by focusing on articles related with neck hematoma requiring surgical re-intervention after thyroidectomy. Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Of the 1028 screened articles, 26 met the inclusion criteria and were finally analyzed. The factors associated with a high risk of neck hematoma requiring surgical re-intervention after thyroidectomy included male gender (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.60–2.17, P < 0.00001), age (MD: 4.92, 95% CI: 4.28–5.56, P < 0.00001), Graves disease (OR: 1.81, 95% CI: 1.60–2.05, P < 0.00001), hypertension (OR: 2.27, 95% CI: 1.43–3.60, P = 0.0005), antithrombotic drug use (OR: 1.92, 95% CI: 1.51–2.44, P < 0.00001), thyroid procedure in low-volume hospitals (OR: 1.32, 95% CI: 1.12–1.57, P = 0.001), prior thyroid surgery (OR: 1.93, 95% CI: 1.11–3.37, P = 0.02), bilateral thyroidectomy (OR: 1.19, 95% CI: 1.09–1.30, P < 0.0001), and neck dissection (OR: 1.55, 95% CI: 1.23–1.94, P = 0.0002). Smoking status (OR: 1.19, 95% CI: 0.99–1.42, P = 0.06), malignant tumors (OR: 1.00, 95% CI: 0.83–1.20, P = 0.97), and drainage used (OR: 2.02, 95% CI: 0.69–5.89, P = 0.20) were not significantly associated with postoperative neck hematoma. Conclusion: We identified certain risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy, including male gender, age, Graves disease, hypertension, antithrombotic agent use, history of thyroid procedures in low-volume hospitals, previous thyroid surgery, bilateral thyroidectomy, and neck dissection. Appropriate intervention measures based on these risk factors may reduce the incidence of postoperative hematoma and yield greater benefits for the patients.

目的 探讨BRAF V600E基因突变检测对甲状腺微小癌的诊断价值.方法 分层比较BRAF V600E突变基因检测对甲状腺微小癌与非微小癌的诊断效率,并比较两组基因表达的差异.结果 BARF V600E基因突变率随TI-RADS分类级别的增加而增加,BARF V600E基因突变检测在微小癌组较非微小癌组的敏感性及特异性差异无统计学意义(P=0.279,P=0.052).无论甲状腺微小癌与非微小癌,还是甲状腺微小癌中直径大于等于0.5 cm与小于0.5 cm者,BRAF V600E突变率均差异无统计学意义(P=0.279,P=0.687).结论 BRAF V600E突变基因检测对微小癌具有同等的敏感性及特异性.

目的 探讨优化TI-RADS系统对甲状腺结节的诊断价值.方法 回顾分析941例患者的资料,分析其1174个甲状腺结节的超声特征,筛选有价值的征象纳入TI-RADS系统,并研究其价值.结果 将筛选的甲状腺恶性结节预测因子纳入TI-RADS系统,检测诊断灵敏度、特异度、阳性预测值、阴性预测值分别为72.8％、88.3％、78.3％、84.9％,ROC曲线下面积为0.857.该系统诊断大小>1 cm结节准确性更高.结论 优化后TI-RADS系统对于甲状腺良恶性结节的诊断价值更高,且对>1 cm的结节更敏感.

*Correspondence: Guoqiang Su, Department of Surgical Oncology, The First Affiliated Hospital, Xiamen University, No.55 Zhenhai Road, Xaimen 361003, China, Tel: 865922137310; Fax: 865922137189; E-mail: suguoqiang66@163.com Zhibin Li, Epidemiology Research Unit, The First Affiliated Hospital, Xiamen University, No.55 Zhenhai Road, Xiamen 361003, China, Tel: +86-5922137364; Fax: +86-592-2137557; E-mail: zhibinli33@hotmail.com Received Date: 25 Oct 2018 Accepted Date: 26 Nov 2018 Published Date: 30 Nov 2018 Citation: Su J, Zeng C, Fan C, Li Z, Su G. Evaluation of Parallel Diagnostic Test Combining BRAF V600E Mutation with TI-RADS on Thyroid Nodules. Clin Oncol. 2018; 3: 1553. Copyright © 2018 Zhibin Li and Guoqiang Su. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research Article Published: 30 Nov, 2018

Purpose: To evaluate the clinicopathological features, patterns of distant metastases, and survival outcome between stage IV male breast cancer (MBC) and female breast cancer (FBC).Methods: Patients diagnosed with stage IV MBC and FBC between 2010 and 2013 were included using the Surveillance, Epidemiology, and End Results program. Univariate and multivariate Cox regression analyses were used to analyze risk factors for overall survival (OS).Results: A total of 4997 patients were identified, including 60 MBC and 4937 FBC. Compared with FBC, patients with MBC were associated with a significantly higher rate of estrogen receptor-positive, progesterone receptor-positive, unmarried, lung metastases, and a lower frequency of liver metastases. Univariate and multivariate analyses showed no significant difference in OS between MBC and FBC. In the propensity score-matched population, there was also no difference in survival between MBC and FBC. Multivariate analysis of MBC showed that OS was longer for patients aged 50-69 years and with estrogen receptor positive disease.Conclusions: There was no significant difference in survival outcome between stage IV MBC and FBC, but significant differences in clinicopathological features and patterns of metastases between the genders. (C) 2017 Elsevier Ltd. All rights reserved.

目的：探讨甲状腺滤泡癌(follicular thyroid carcinoma，FTC)的超声声像图特征。方法：选取笔者所在医院2005年1月-2015年7月行手术切除并经病理检查证实为甲状腺滤泡癌且资料完整的31例患者超声声像图、临床及病资料进行回顾性分析。结果：31例患者，超声共检出33个病灶。超声提示，腺瘤病灶16个(42.42%)，恶性15个(36.36%)。结论：甲状腺滤泡癌多为低回声结节，内部回声不均，可伴有液化，钙化形式多样，可有小液性区且结节周边有不规则或不完整声晕，局部血流信号杂乱且较丰富。

Gastric cancer is the fourth most common type of malignant tumor, with a poor prognosis. Focal adhesion kinase (FAK) mediates the crosslink of intracellular signaling networks, playing a key role in cell migration and invasion. The aim of the present study was to investigate the effects of FAK interference on the proliferation ability, invasion and metastasis of gastric cancer cells. The FAK-RNAi lentiviral vector was infected into SGC7901 gastric cancer cells in order to observe the in vivo situations of tumor growth and metastasis before and after the FAK interference. The growth of SGC7901 gastric cancer cells in the interference group was significantly inhibited compared with that of the negative control (P<0.05) and the blank control groups (P<0.05), and the FAK expression significantly decreased (P<0.05). The in vitro invasion and metastasis experiments showed that the cell invasion and metastasis abilities of the interference group significantly decreased when compared with those of the negative control (P<0.05) and blank control groups (P<0.05). In the nude mouse subcutaneous tumor transplantation model, the mean ± standard deviation tumor weight of the interference group (1.474±0.9840 g) was lower than that of the negative control (3.134±0.3299 g) and blank control (2.68±0.12 g) groups (P<0.05). In the nude mice, the liver and peritoneal metastasis rates of the interference group were significantly lower than those of the negative control (P<0.05) and the blank control groups (P<0.05), and the FAK mRNA of the interference group significantly reduced (P<0.05). In conclusion, FAK interference could effectively suppress the proliferation, invasion and metastasis of transfected SGC7901 gastric cancer cells, and could inhibit the growth and distant metastasis of gastric cancer in nude mice.

Alloreactive memory T cells are major barriers to transplantation acceptance due to their capacity to accelerate rejection. Here, we investigated the effects of combined treatment with arsenic trioxide (As(2)O(3)) and blocking monoclonal antibodies (mAb) against CD154 and LFA-1 (anti-CD154/LFA-1) on graft survival as well as changes in pathology and immunological responses in mice with adoptively transferred allo-primed T cells. The mean survival time (MST) for the cardiac allografts in recipient mice receiving the combination of As(2)O(3) and anti-CD154/LFA-1 was significantly longer (>113.7days) compared to those receiving anti-CD154/LFA-1 (23.2days), As(2)O(3) (12.5days) alone or no treatment (5.5days). This combined strategy distinctly inhibited lymphocyte infiltration in grafts, proliferation of splenic T cells and the generation of memory T cells in spleens. Moreover, the combined treatment caused the significant down-regulation of IL-2 and IFN-γ accompanied by increased expression of TGF-β and regulatory T cells (Tregs) in spleens, which led to long-term cardiac allograft survival in recipient mice. These results highlight the potential application of As(2)O(3) and its contribution in combination therapy with antibody blockade to delay rejection by memory T cells.

Objective To evaluate the clinical value of three-dimensional ultrasonography(3DUS)in the diagnosis of fetal malformation.Methods A total of 1 510 fetuses between 20-39 weeks of gestation were examined with two-dimensional ultrasound(2DUS)and 3DUS and were followed up after delivery.Results 32 fetuses of those 1 510 fetuses with malformations in 3DUS and 2DUS scanning and were followed up,confirmed after delivery.The sensibility and specificity of 2DUS are 93.8%and 99.9%respectively,while combination scanning 3DUS and 2DUS can make final diagnosis to all fetuses.Conclusion 3DUS can offer more plentiful diagnostic information,and association application 3DUS and 2DUS provides important information in diagnosing fetal malformation.

Objective To investigate clinical value of color Doppler ultrasound in the diagnosis and treatment of different types of Budd-Chiari Syndrome. Methods Totally, 106 patients to be suspected Budd-chiari syndrome(BCS) clinically and 30 healthy adults were examined with color Doppler ultrasound, The characteristic patterns of abnormal vessels and hemodynamics were observed, compared with DSA and followed up after interventional therapy . Results (1) Ninety cases were diagnosed by color Doppler ultrasound, in which 89 cases were confirmed by the "gold standard" DSA. The sensitivity of color Doppler ultrasound was 97.8%, specificity was 82.4%, accuracy was 95.3%, false positive rate was 17.7% , and false negative rate 2.3%. (2)When compared with the control group, color Doppler imaging showed local high-speed blood flow in patients with stenosis of the inferior vena cava(IVC), but color flow signal was not detected in the cases with IVC obstruction, who had hepatic veins (HV)dilation with slowed blood flow and collateral flow in the liver, as well as decreased velocity of blood flow in portal vein. (3)After interventional treatment, the diameter and blood flow of the involved IVC returned normal and the size and shape of stent were detected clearly.The velocity of blood flow was increased in both the HV and portal veins. IVC and HV blood flow recovered in the cases underwent surgical operation, or graft bypass was detected in IVC with normal blood flow signals. Conclusion Color Doppler ultrasound is useful in the diagnosis of BCS, correlated well with DSA. Therefore, it can be an ideal method in the diagnosis and follow up patients with BCS.

OBJECTIVE:To study the changes in morphology of liver and spleen and hemodynamics of the patients with Budd-Chiari syndrome (BCS) after interventional treatment.METHODS:The dimensions of liver and spleen were detected by routine ultrasonography in 30 normal control subjects and 256 BCS patients before and after inventional therapy. Color duplex sonography was employed to measure the hemodynamic changes.RESULTS:Compared with the control group, BCS patients before interventional therapy showed obvious liver and spleen enlargements (P<0.005), specially the caudate lobe of the liver (P<0.001), which were significantly reduced 7 days after interventional treatment (P<0.005), but the spleen was still larger than that of the control group (P<0.005) even till 6 months after the therapy. Color Doppler flow imaging (CDFI) revealed local high-speed blood flow in patients with stenosis of the inferior vena cave (IVC), but color flow was not detected in patients with IVC obstruction, who had hepatic vein dilation (P<0.005) with slowed blood flow and collateral formation of in the liver, as well as decreased velocity of blood flow in the portal vein. After interventional treatment, the diameter of the involved IVC increased with blood flow restoration and the size and shape of the stent were detected clearly. The velocity of blood flow was increased in both the hepatic and portal veins (P<0.005).CONCLUSION:Interventional therapy can relieve obstruction of blood flow in the liver and improve the hemodynamics of patients with BCS.

我院自1997年9月至2001年2月共收治慢性布加综合征(Budd-Chiari syndrome,BCS)合并下腔静脉血栓形成的患者11例,现报告如下.

Objective To investigate the therapy of Bubb-Chiari syndrome(BCS) due to membranous obstruction of the hepatic veins(MOHV).Method One patient with membranous obstruction of middle hepatic vein was treated with percutaneous transhepatic hepatovenography(PTHV) under ultrasound guidance, and then percutaneous transluminal angioplasty(PTA) and stent placement of the hepatic vein were undergone under DSA guidance. Balloon was placed at orifice of middle hepatic vein in the inferior vena cava(IVC) to avoid movement of stent in hepatic vein.Result PTA and stent placement were successful,and his symptoms and signs disappeared during a follow-up period of 3 years.Conclusion The interventional therapy is safe and effective to BCS due to MOHV.

Objective　To explore the relationship between the type of disease of the inferior vena cava (IVC) in patients with BCS and endovasculer stent. Methods　186 cases with BCS were treated with PTA＆PTSA,and they were depended on the following principle: ①Diameter of stent graft was 1.0cm bigger than enlarged site of the IVC . ② In the cases with thrombosis in the IVC ,two stents were used ,one pressed the thrombus in the IVC ,the other enlarged the injured site . ③The improved stents were used to avoid to obstruct the entrance of hepatic veins. Results　In 186 cases with BCS ,PTA was performed in 149 cases， PTSA was performed in 48 cases，11 cases had various complication. The therapy was successfully in the others during follow-up from 1 to 10 years. Conclusion　It was satisfied to choice different stent in treatment of BCS according to different type of the IVC injury.

肝破裂在各种腹部损伤中的发生率为15%～20%，而其中伴发肝内胆管损伤而引起肝内胆瘘是诊断处理中十分棘手的问题，从1995年起我院应用胆总管注水诊治肝内胆瘘5例。报告如下。