目的 探讨超声引导下射频消融(US-RFA)治疗不同大小甲状腺良性结节(BTN)的有效性及安全性.方法 回顾性分析52例患者85个BTN,根据初始直径大小将结节分为＜2 cm组(A组)、2～4 cm组(B组)及≥4 cm组(C组),计算结节消融前及消融后1、3、6、12、24、36个月最大径、体积、体积减小率(VRR),记录美容评分及并发症发生情况.结果 术后3个月时A组VRR大于C组(P＜0.05),术后6～36个月时A、B组VRR均大于C组(P＜0.05),随访期间A、B组VRR无统计学意义(P＞0.05);B组和C组在术后12个月美容评分明显改善(P＜0.05),差异有统计学意义;3组间并发症发生率及结节复发率无统计学意义(P＞0.05).结论 US-RFA是BTN的有效微创治疗手段,术后6个月可作为评估消融疗效的时间节点,结节初始最大径＜4 cm者体积缩小更显著,结节初始最大径≥2 cm者美容症状改善明显.

Doxorubicin (Dox) is a widely used clinical drug whose cardiotoxicity cannot be ignored. Pyroptosis (inflammatory cell death) has gradually gained attention in the context of Dox-induced cardiotoxicity. In addition to the inhibition of platelet activation by ticagrelor, little is known about its other pharmacological effects. Glycogen synthase kinase 3β (GSK-3β) has been shown to contribute to the pathological process of pyroptosis, but whether it is related to the potential role of ticagrelor is unclear. In this study, we investigated the effects of ticagrelor on Dox-induced pyroptosis in cardiomyocytes. Rats were treated with ticagrelor (7.5 mg/kg, i.g.) 1 h before intravenous injection of Dox (2.5 mg/kg), once every 3 days, six times in total. Hearts were collected for histochemical analysis and western blot detection 8 weeks after the last administration. Ticagrelor was shown to significantly improve cardiac function by inhibiting GSK-3β/caspase-1/GSDMD activation. In vitro experiments were conducted using rat cardiac myocytes (RCMs) and rat embryonic cardiac-derived H9c2 cells. Pretreatment with ticagrelor (10 μm) significantly inhibited Dox (1 μm)-induced hypertrophy and reversed the upregulation of GSDMD-NT expression. We showed that ticagrelor suppressed the activation of Akt caused by Dox in the heart tissue as well as in RCMs/H9c2 cells caused by Dox. When GSK-3β expression was absent in H9c2 cells, the inhibitory effect of ticagrelor on Dox-induced caspase-1/GSDMD activation was weakened. These data showed that ticagrelor reduced Dox-induced pyroptosis in rat cardiomyocytes by targeting GSK-3β/caspase-1.

目的 通过常规超声联合S-detect及超声弹性成像技术对甲状腺良恶性结节进行诊断,分析联合应用是否可提高诊断甲状腺良恶性结节的诊断效能.方法 采用常规超声、S-detect、超声弹性成像方法依次对2021年1—8月在河南省肿瘤医院就诊并诊断为甲状腺结节的203例患者(273个甲状腺结节)进行良恶性鉴别,以病理结果为金标准,评价不同方法对甲状腺良恶性结节的应用诊断价值.结果 常规超声、S-detect、超声弹性成像、常规超声+S-detect、常规超声+弹性成像及三者联合诊断甲状腺良恶性结节的敏感性分别为88.67％、97.64％、79.71％、98.58％、95.28％、94.81％;特异性分别为90.16％、78.68％、86.88％、75.40％、83.60％、90.16％;准确性分别为89.01％、93.40％、81.31％、93.40％、92.67％、93.77％,常规超声、S-detect、弹性成像、常规超声+S-detect、常规超声+弹性成像及三者联合与病理结果比较,一致性检验Kappa值分别为0.713、0.801、0.553、0.796、0.789、0.826.结论 常规超声分别联合S-detect及超声弹性成像诊断甲状腺结节时均具有较高诊断效能,三者联合应用时进一步提高了诊断效能.

目的 探讨经典型甲状腺乳头状癌(C-PTC)及滤泡亚型甲状腺乳头状癌(FV-PTC)的超声声像图特征及其与颈部淋巴结转移(CLNM)的相关性.方法 共238个结节纳入分析,其中C-PTC122个、FV-PTC116个,分析两组患者的临床与超声特征,以及其与颈部淋巴结转移的相关性.结果 C-PTC与FV-PTC在性别、结节形态、纵横比、微钙化、结节最大径线、被膜外侵犯以及颈部淋巴结转移方面具有差异(P＜0.05).多因素Logistic回归分析显示,对于C-PTC,侵犯被膜是CLNM的独立危险因素;对于FV-PTC,最大径线(≥10 mm)和侵犯被膜是CLNM的独立危险因素,年龄≥45岁是CLNM的保护因素.结论 C-PTC与FV-PTC在临床与超声特征上有所不同,在颈部淋巴结转移上有明显差异,C-PTC较FV-PTC更容易发生CLNM,在临床治疗和后期监测中应警惕其淋巴结转移风险.

目的 探讨超声造影联合空心针组织穿刺活检评估浸润性乳腺癌患者腋窝前哨淋巴结(sentinel lymph node,SLN)转移的价值.方法 120例浸润性乳腺癌患者行乳腺癌根治术前均行常规超声及超声造影检查,记录SLN数目及超声造影增强模式,对超声造影检出SLN者行超声引导下空心针组织穿刺活检;乳腺癌根治术中行SLN活检.以SLN组织活检病理检查结果为金标准,评估超声造影、超声造影联合空心针组织穿刺活检诊断腋窝SLN转移的价值.结果 120例患者超声造影检出SLN共158枚,手术组织病理检查证实发生转移57枚,未转移101枚.超声造影表现为均匀增强96枚,不均匀增强57枚,微弱增强或无增强5枚.超声造影诊断腋窝SLN转移62枚,未转移96枚.超声造影联合空心针组织穿刺活检诊断腋窝SLN转移49枚,未转移109枚.以SLN组织活检病理检查结果为金标准,超声造影诊断腋窝SLN转移的灵敏度为78.95％,特异度为83.17％,阳性预测值为72.58％,阴性预测值为87.50％,准确率为81.65％;超声造影联合空心针穿刺活检诊断腋窝SLN转移的灵敏度为85.96％,特异度为100％,阳性预测值为100％,阴性预测值为92.66％,准确率为94.94％.结论 超声造影联合空心针组织穿刺活检在浸润性乳腺癌患者腋窝SLN转移诊断中具有较高价值.

目的 对比2020甲状腺结节超声恶性危险分层中国指南(C-TIRADS)与2017年美国放射学会(ACR)规范化的"甲状腺影像报告和数据系统"(TI-RADS)在甲状腺结节的诊断价值.方法 回顾性分析235例甲状腺结节的临床资料,对所有纳入研究的结节的声像图资料分别使用C-TIRADS和ACR TI-RADS指南进行评估,以病理结果为金标准构建ROC曲线,并比较C-TIRADS和ACR TI-RADS在甲状腺结节诊断中的效能.结果 C-TIRADS和ACR TI-RADS指南诊断甲状腺结节的曲线下面积分别为0.889、0.856,二者差异有统计学意义(P=0.03);C-TIRADS指南在甲状腺结节诊断中的灵敏度、特异度分别为:78.46％、87.62％,ACR TI-RADS指南甲状腺结节诊断中的灵敏度、特异度分别为89.23％、64.76％,差异均具有统计学意义(P＜0.05);C-TIRADS指南及ACR TI-RADS指南的准确性分别为82.55％、78.29％,差异无统计学意义(P=0.245).结论 在甲状腺结节诊断中,C-TIRADS指南具有更高的特异度,ACR TI-RADS具有更高的灵敏度.

目的:探讨基于深度学习模型的超声人工智能辅助诊断技术(S-Detect技术)在甲状腺结节诊断中的临床应用价值.方法:选取2019年10月至2020年5月在河南省肿瘤医院治疗并行超声检查的甲状腺结节患者(共183例患者,183个病灶),分别由超声医生及S-Detect技术对其超声声像图特征进行分析,比较二者对不同超声特征诊断的一致性,并以病理结果为金标准,评估S-Detect技术在甲状腺结节鉴别诊断中的临床应用价值.结果:183例甲状腺结节经病理证实良性68例,恶性115例,S-Detect技术对本组数据诊断的敏感性、特异性、准确率分别为84.35％、86.76％、85.25％;高年资医师组诊断的敏感性、特异性、准确率分别为90.43％、92.65％、91.26％,低年资医师组诊断的敏感性、特异性、准确率分别为76.52％、82.35％、78.69％,在可以评估的5个超声声像图特征中,结节成分、回声及纵横比3个指标超声医师与S-Detect诊断的一致性较高,结节形状及边缘2个指标超声医师与S-Detect诊断的一致性较差.结论:基于深度学习模型的S-Detect技术诊断甲状腺结节的准确率较高,有助于提高低年资医师诊断的准确性.

Objective:To explore the diagnostic value of C-TIRADS combined with artificial intelligence-assisted diagnosis S-Detect technology in the differential diagnosis of thyroid nodules.Methods:A total of 237 thyroid nodules patients (237 thyroid nodules)with ultrasound examination and definitive pathologic results in Henan Cancer Hospital from April to September 2020 were retrospectively analyzed. The nodules were diagnosed according to C-TIRADS guidelines, and then by S-Detect technology combined with C-TIRADS guidelines. The ROC curve was plotted with the pathological results as the gold standard, and the area under the ROC curve, sensitivity, specificity and accuracy of the diagnosis results between the two groups were compared.Results:Among the 237 thyroid nodules, 105 were benign and 132 were malignant.The area under the ROC curve of C-TIRADS diagnosis alone and C-TIRADS diagnosis combined with artificial intelligence were 0.869 and 0.942 respectively, the difference between the two groups was statistically significant (χ 2=36.11, P<0.001); When Category 4A was used as the cutoff value of benign and malignant differential diagnosis, the specificity and accuracy of C-TIRADS classification of artificial intelligence-assisted diagnosis was significantly higher than that of C-TIRADS alone, and the difference was statistically significant(83.81% vs 47.62%, 90.72% vs 75.53%, all P<0.05). Conclusions:C-TIRADS combined with artificial intelligence-assisted diagnosis S-Detect technology has a high efficiency in the diagnosis of thyroid nodules and can improve the specificity and accuracy of thyroid nodules diagnosis and reduce unnecessary biopsy.