Papillary thyroid carcinoma (PTC) has a relatively good prognosis, yet there are some invasive PTC cases with worse clinicopathological features and poor outcome. Cancer-associated fibroblasts (CAFs) play an important role in cancer invasion and metastasis. This study aimed to investigate the expression of marker proteins of CAFs in PTC and their correlations with clinicopathological features through immunohistochemistry. The medical records of 125 PTC patients were reviewed in this study, whose specimens were retrieved for immunohistochemistry. Four CAFs marker proteins, FAP fibroblast activated protein (FAP), α-smooth muscle actin (α-SMA), Vimentin and platelet-derived growth factor receptor-α(PDGFR-α), were stained and scored. Then, statistical analyses were performed. The immunoreactivity scores of FAP and α-SMA correlated with tumor size, BRAF mutation, extrathyroidal, invasion, pathological subtype, lymph node metastasis and ATA risk stratification. Moreover, binary logistic regression analysis and receiver operating characteristic curves showed that high FAP and α-SMA immunoreactivity scores were risk factors for extrathyroidal invasion, BRAF mutation, multi-focality and lymph node metastasis (especially N1b) with good sensitivity and accuracy in prediction. A better performance was found in FAP than α-SMA. Strong expressions of CAFs were risk factors for worse thyroid cancer clinicopathological features. FAP was the better CAFs marker for PTC.

Osseous metastasis (OM) is the second most common site of thyroid cancer distant metastasis and presents a poor prognosis. Accurate prognostic estimation for OM has clinical significance. Ascertain the risk factors for survival and develop an effective model to predict the 3-year, 5-year overall survival (OS) and cancer-specific survival (CSS) for thyroid cancer patients with OM. We retrieved the information of patients with OMs between 2010 and 2016 from the Surveillance, Epidemiology, and End Result Program. The Chi-square test, and univariate and multivariate Cox regression analyses were performed. Four machine learning (ML) algorithms, which were most commonly used in this field, were applied. A total of 579 patients having OMs were eligible. Advanced age, tumor size ≥ 40 mm, combined with other distant metastasis were associated with worse OS in DTC OMs patients. Radioactive iodine (RAI) significantly improved CSS in both males and females. Among four ML models [logistic regression, support vector machines, extreme gradient boosting, and random forest (RF)], RF had the best performance [area under the receiver-operating characteristic curve: 0.9378 for 3-year CSS, 0.9105 for 5-year CSS, 0.8787 for 3-year OS, 0.8909 for 5-year OS]. The accuracy and specificity of RF were also the best. RF model shall be used to establish an accurate prognostic model for thyroid cancer patients with OM, not only from the SEER cohort but also intended for all thyroid cancer patients in the general population, which may be applicable in clinical practice in the future.

OBJECTIVE:The objective was to evaluate the impacts of different reconstruction methods [filtered back projection (FBP) and ordered subset expectation maximization (OSEM)] and different filters (Butterworth filter and Gaussian filter) on the image quality in cadmium-zinc-telluride (CZT)-based single photon emission computed tomography (SPECT)/computed tomography (CT) pulmonary perfusion imaging. METHODS:A combinations including FBP with Butterworth filter, OSEM with Butterworth filter (OSEM + Butterworth filter ), and OSEM with Gaussian filter (OSEM + Gaussian filter) were used during SPECT image reconstruction. Visual and quantitative parameters [root mean square (RMS) noise, contrast and contrast-to-noise ratio (CNR)] were used to evaluate image quality. RESULTS:The OSEM + Gaussian filter had better RMS noise and CNR than those of the FBP + Butterworth filter or OSEM + Butterworth filter, while the OSEM + Butterworth filter had the best contrast. The highest visual scores were obtained by OSEM + Gaussian filter ( P  < 0.0001). In the lesion size <2 cm group, the contrast ( P < 0.01) and visual scores ( P < 0.001) of OSEM + Butterworth filter were better than those of the other two groups. In the lesion size ≥2 cm group, the RMS noise and visual scores of OSEM + Gaussian filter were better than those of the other two groups. CONCLUSION:In CZT SPECT/CT pulmonary perfusion imaging, this study recommended the clinical use of the OSEM + Gaussian filter combination for reconstruction in both conventional and larger lesions, the OSEM + Butterworth filter image postprocessing method might be advantageous in small lesions.

INTRODUCTION:The objective of this study is to evaluate the benefits of radioactive iodine (RAI) treatment and the risk of second primary malignancy (SPM) in RAI-treated patients.MATERIAL AND METHODS:The cohort for this analysis consisted of individuals diagnosed with a first primary differentiated thyroid carcinoma (DTC), reported by the Surveillance, Epidemiology, and End Results (SEER) database in 1988-2016. Overall survival (OS) difference was estimated by Kaplan-Meier curves and log-rank test, and hazard ratios (HR) were obtained by Cox proportional-hazards model to evaluate the association between RAI and SPM.RESULTS:Among 130,902 patients, 61,210 received RAI and 69,692 did not, and a total of 8604 patients developed SPM. We found that OS was significantly higher in patients who received RAI than in those who did not (p < 0.001). DTC survivors treated with RAI had increased risk of SPM in females (p = 0.043), particularly for SPM occurring in the ovary (p = 0.039) and leukaemia (p < 0.0001). The risk of developing SPM was higher in the RAI group than in the non-RAI group and the general population, and the incidence increased with age.CONCLUSIONS:Increased risk of SPM occurs in female DTC survivors treated with RAI, which become more obvious with increasing age. Our research findings were beneficial to the formulation of RAI treatment strategies and the prediction of SPM for patients with thyroid cancer of different genders and different ages.

Abstract Background This study aimed to develop and validate an AI (artificial intelligence)-aid method in myocardial perfusion imaging (MPI) to differentiate ischemia in coronary artery disease. Methods We retrospectively selected 599 patients who had received gated-MPI protocol. Images were acquired using hybrid SPECT-CT systems. A training set was used to train and develop the neural network and a validation set was used to test the predictive ability of the neural network. We used a learning technique named “YOLO” to carry out the training process. We compared the predictive accuracy of AI with that of physician interpreters (beginner, inexperienced, and experienced interpreters). Results Training performance showed that the accuracy ranged from 66.20% to 94.64%, the recall rate ranged from 76.96% to 98.76%, and the average precision ranged from 80.17% to 98.15%. In the ROC analysis of the validation set, the sensitivity range was 88.9 ~ 93.8%, the specificity range was 93.0 ~ 97.6%, and the AUC range was 94.1 ~ 96.1%. In the comparison between AI and different interpreters, AI outperformed the other interpreters (most P-value < 0.05). Conclusion The AI system of our study showed excellent predictive accuracy in the diagnosis of MPI protocols, and therefore might be potentially helpful to aid radiologists in clinical practice and develop more sophisticated models.

Background:Blunt chest trauma patients with pulmonary contusion are susceptible to pulmonary complications, and severe cases may develop respiratory failure. Some studies have suggested the extent of pulmonary contusion to be the main predictor of pulmonary complications. However, no simple and effective method to assess the severity of pulmonary contusion has been available yet. A reliable prognostic prediction model would facilitate the identification of high-risk patients, so that early intervention can be given to reduce pulmonary complications; however, no suitable model based on such an assumption has been available yet.Methods:In this study, a new method for assessing lung contusion by the product of the three dimensions of the lung window on the computed tomography (CT) image was proposed. We conducted a retrospective study on patients with both thoracic trauma and pulmonary contusion admitted to 8 trauma centers in China from January 2014 to June 2020. Using patients from 2 centers with a large number of patients as the training set and patients from the other 6 centers as the validation set, a prediction model for pulmonary complications was established with Yang's index and rib fractures, etc., being the predictors. The pulmonary complications included pulmonary infection and respiratory failure.Results:This study included 515 patients, among whom 188 developed pulmonary complications, including 92 with respiratory failure. Risk factors contributing to pulmonary complications were identified, and a scoring system and prediction model were constructed. Using the training set, models for adverse outcomes and severe adverse outcomes were developed, and area under the curve (AUC) of 0.852 and 0.788 were achieved in the validation set. In the model performance for predicting pulmonary complications, the positive predictive value of the model is 0.938, the sensitivity of the model is 0.563 and the specificity of the model is 0.958.Conclusions:The generated indicator, called Yang's index, was proven to be an easy-to-use method for the evaluation of pulmonary contusion severity. The prediction model based on Yang's index could facilitate early identification of patients at risk of pulmonary complications, yet the effectiveness of the model remains to be validated and its performance remains to be improved in further studies with larger sample sizes.

Purpose. Quantitative scintigraphy to evaluate salivary gland function changes in patients with differentiated thyroid cancer (DTC) after iodine-131 (131I) treatment. Methods. A total of 458 patients with DTC grouped by sex and age were included. Salivary gland scintigraphy was performed to evaluate salivary gland function before and after 131I treatment. The uptake fraction (UF), uptake index (UI), and excretion fraction (EF) of two pairs of parotid glands and submandibular glands were measured and compared. The Chi-square test was conducted according to function impairment count. Results. Salivary gland function in different age groups and sexes were quite different, especially for women <55 years old, who had decreased UF, UI, and EF of all four glands without basal injury. The secretion or uptake function of some salivary glands with basic function impairment before 131I treatment was increased after iodine treatment. Only a small percentage of males showed reduced functional parameters after several treatments. The most significant difference in the count of impairment for the four salivary glands were the first and third examinations, which was more evident in women. The submandibular gland had the most significant reduction in uptake. Conclusion. Changes in salivary gland function are more common in young females being treated for DTC. Impairment of salivary gland function is correlated with the number of treatments and the cumulative dose of 131I. Some salivary gland functions impaired before 131I treatment were enhanced in the early treatment.

Background This study aim to evaluate surgical procedures for titanium plate internal fixation of costal cartilage fractures with displacement or nonunion. Methods From January 2019 to October 2020, 13 patients with costal cartilage fractures were treated with titanium plate internal fixation in the thoracic surgery department of the Shanghai Sixth People’s Hospital. Pain severity scale scores and respiratory function were evaluated preoperatively and postoperatively. All the patients had a 6-month follow-up for treatment evaluation. Results The mean hospital length of stay was 10.7 days. A statistically significant difference ( P < 0.05) was found between preoperative and postoperative pain severity scores (7.69 vs. 5.00). VC (24.6% vs. 44.5%) and FEV1 (25.3% vs. 44.0%) were also significantly different before operation and after operation ( P < 0.05). At follow-up, healing of the nonunion or fracture was confirmed in all the cases. Conclusion The rigid titanium plate application ensured a safe and easy management of costal cartilage fractures and nonunion with a good prognosis as compared with other methods.

Abstract Purpose The objective of this study is to evaluate the benefits of radioactive iodine (RAI) treatment and the risk of second primary malignant (SPM) in RAI treated patients. Methods The cohort for this analysis consisted of individuals diagnosed with a first primary differentiated thyroid carcinoma (DTC), reported by SEER database in 1988–2016. Overall survival (OS) difference was estimated by Kaplan–Meier curves and Log-Rank test, and hazard ratios (HR) was obtained by cox proportional hazard model to evaluate the association between RAI and SPM. Standardized incidence ratios (SIR) were calculated to assess cancer incidence in relation to RAI and no-RAI groups and the general population. Results Among 130,902 patients, 61,210 received RAI and 69,692 did not and a total of 8,604 patients developed SPM. We found that OS was significantly higher in patients who received RAI than those who did not (P < 0.001). DTC survivors treated with RAI had increased risk of SPM in females (6.27% versus 5.97%, P = 0.043), particularly for SPM occurred in ovary (RAI group: 0.17%, no-RAI group: 0.12%, P = 0.039) and leukemia (RAI group: 0.22%, no-RAI group: 0.12%, P < 0.0001). In addition, RAI group in all age subgroups demonstrated higher SPM incidence than no-RAI group, and the incidence increased with age. Patients with primary thyroid cancer had a 16% elevated risk of developing SPM in all sites (SIR:1.16), 243% elevated risk in salivary glands (SIR:3.43), 119% elevated risk in kidneys (SIR:2.19), and 46% elevated risk in hematopoietic System (SIR:1.46). In general, the risk of developing SPM was higher in RAI group than in no-RAI group and general population. Conclusions Increased risks of SPM occur in female DTC survivors treated with RAI, which become more obvious with age increasing. Our research findings were beneficial to the formulation of radioactive iodine treatment strategies and the prevention of secondary tumors for patients with thyroid cancer of different genders and different ages.

Rib fracture is the most common injury in chest trauma. Chest wall stabilization (CWS) has been employed in China for 10 years and has been recognized as a safe and practical technique for rib fracture therapy. A survey entitled "Surgical Treatment for Rib Fractures" was launched at the beginning of 2018 showing that 95.6% of the hospitals surveyed performed CWS in over 30,000 cases in the past 2 years. Despite the large volume of CWS performed in China, we discovered the following characteristics: lack of large-scale clinical research, and standardized recognition of surgical indications, high costs incurred for surgical consumables, and undefined professional standard. We revealed that most of the researches on CWS in China have room for improvement. The Shanghai Sixth People's Hospital has conducted a series of CWS researches in patients with multi-rib fractures whose results showed shorter therapeutic time, pain reduction, lower morbidity, and improvement in lung function. Consequently, we formulated our own surgical indications for CWS. Thoracoscopic-assisted minimally invasive CWS surgery had been conducted in several hospitals in China. Undoubtedly, the continuous improvement of equipment and surgical techniques will inevitably lead to its further development. Researches on materials with superior absorbability or tissue compatibility have been successfully conducted in China. However, the lack of multi-center and large-sample randomized controlled trials has been one of the key factors that hampered the accurate evaluation of CWS. Accordingly, a nationwide study entitled "Evaluation of the effectiveness of surgical fixation of multiple rib fractures-a multi-center and ambispective cohort study" was initiated in June 2018. It is believed that the result of this research would considerably improve and enrich the clinical evidence on CWS in rib fracture patients.

肋骨骨折在胸部创伤中较为常见，占胸部创伤的55%[1]。其常见的致伤原因为交通伤、坠落伤、挤压伤、直接暴力伤等。连枷胸是较为严重的肋骨骨折类型，在胸部钝性伤中占10%~15%，病死率为16%~20%[2]。肋骨骨折的治疗可分为保守治疗和手术治疗。大多数肋骨骨折患者可以通过非手术治疗获得痊愈。本文对两种肋骨骨折治疗方法的优缺点以及手术内固定治疗的研究进展综述如下。

目的 探讨可吸收肋骨钉与记忆合金接骨板内固定两种方法治疗多发性肋骨骨折的效果.方法 回顾性分析2009年1月至2014年1月在上海市第六人民医院胸外科行手术内固定的胸部外伤致多根多处肋骨骨折患者321例的临床资料,其中可吸收肋骨钉组70例,其中男62例、女8例,年龄(48.54±9.74)岁;记忆合金接骨板组251例,其中男187例、女64例,年龄(51.44±10.22)岁.分析两组患者疗效差异.结果 两组患者术前疼痛评分(7.74±0.89 vs.7.66±0.92)、术后疼痛评分(3.80±0.79 vs.3.82±0.85),术后胸腔引流时间[(6.00±2.84)d vs.(5.68±2.98)d]差异均无统计学意义(P＞0.05).记忆合金接骨板组住院时间[(20.06±7.39)d vs.(17.77±7.68)d],及手术时间(101.29±30.67)min vs.(71.95±29.50) min]均短于可吸收肋骨钉组,且差异有统计学意义(P＜0.05).术后3个月随访复查胸部X线,两组患者骨折再移位差异无统计学意义.结论 可吸收肋骨钉与记忆合金接骨板均是治疗多发性肋骨骨折较理想的术式,记忆合金接骨板手术操作更为简单,可吸收肋骨钉手术无需在体内留置金属内固定装置,但固定强度较接骨板略差,应根据情况选择合适的内固定方法.