Objective: To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC). Methods: The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81st Military Hospital of People's Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results: Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM (P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM (P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95%CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95%CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95%CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions: NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

甲状腺癌(thyroid carcinoma,TC)是头颈部最常见的内分泌系统实体恶性肿瘤之一,发病率近年呈快速增长趋势.根据美国国立癌症研究所(SEER)数据库统计,2018年全球新发TC约为567000例,位列所有常见癌症发病率的第9位,并以每年5.1％的速度持续增长[1].甲状腺乳头状癌(papillary thyro id carcinoma,PTC)是TC中最常见的病理分型,占全部甲状腺恶性肿瘤的90％以上[2].也是30岁以下女性发病率最高的恶性肿瘤,男女发病比例为1:2.7[3].我国近十年间PTC发病率涨幅显著,2013年以来90％以上的新增TC患者为PTC[4].肿瘤常继发于慢性炎症和基因突变,而慢性炎症又可导致机体内微环境改变、诱导基因突变、诱发肿瘤.BRAFV600E突变是目前PTC中最常见的遗传学事件,是促进PTC侵袭和转移的分子基础之一[5].PTC虽然是多种因素共同作用的结果,预后亦受多种因素影响,但是炎症、BRAFV600E突变和PTC三者之间联系十分密切,结合文献分析如下.

目的 研究BRAFV600E突变与中性粒细胞/淋巴细胞计数比值(NLR)的相关性及其对甲状腺微小乳头状癌(PTMC)中央区淋巴结转移(CLNM)的影响.方法 150例cN0期PTMC患者术中均行预防性中央区淋巴结清扫术;根据术前外周静脉血血常规计算NLR,Ventana免疫组化检测术后病理标本BRAFV600E突变情况;采用交互作用相对超额危险度、归因比以及协同指数分析BRAFV600E突变和炎症指标间的交互作用.结果 不存在BRAFV600E突变且NLR<2.5的PTMC患者CLNM转移比例最低(P<0.05);而存在BRAFV600E突变且NLR≥2.5的PTMC患者CLNM比例明显高于仅存在BRAFV600E突变或NLR≥2.5及不存在BRAFV600E突变且NLR<2.5的患者(P<0.05).BRAFV600E和NLR交互作用分析显示RERI=4.987(0.159～11.011),AP=0.497(0.199～0.802),SI=2.313(1.502～4.605).结论 BRAFV600E突变和NLR具有明显交互作用,两者具有协同作用,促进了PTMC患者CLNM.

脑干出血具有起病急、病情重、病情进展迅速的特点,多在1～2d内死亡,预后不良,死亡率高[1-3],因为脑干是生命的中枢所在,且包涵大量神经核团和纤维结构,几乎参与中枢神经系统的所有重要功能[4].过去认为桥脑出血手术风险高,救治成功率低[5-7],随着显微外科技术的发展,有文献报道采用微创手术治疗脑干出血取得了满意的效果[8-11].我科近期收治1例脑干出血患者,在神经电生理监测(neurophysiological monitoring,NPM)下行微创血肿清除术,治疗效果良好,现报告如下.

结合临床工作经验,设计头皮脑电图电极定位装置,探讨头皮脑电图确定电极位置的更优方法.该装置确定电极位置用时短,方法简单,步骤精炼,定位准确,被医务人员和受检者普遍接受.