OBJECTIVES:To investigate the effects of thalidomide in preventing disease relapse with 'zero' glucocorticoids (GCs) usage in IgG4-related disease (IgG4-RD). METHODS:This was a multicentre, randomised, double-blinded, placebo-controlled study, in which eligible patients in disease active status were randomised into 2 groups (group 1: GCs+Thalidomide; group 2: GCs+Placebo) at a 1:1 ratio. The primary outcome of this trial was the disease relapse rate at month 12, whereas the secondary outcomes were the disease remission rate at month 12 and the incidence of adverse events (AEs). RESULTS:A total of 60 patients were randomised, and 57 patients (GCs+Thalidomide: 29; GCs+Placebo: 28) finished the study per protocol. The relapse rates of the GCs+Thalidomide and GCs+Placebo groups at month 12 were 13.8% and 67.8%, respectively. A 100% response rate was observed in both treatment group, while the remission rates of the GCs+Thalidomide and GCs+Placebo groups were 75.8% and 32.1%, respectively. In total. 49 AEs were recorded in 35 participants, in which 4 were graded as moderate, and 45 were graded as mild. The risk-benefit analysis based on the evaluation of rates of disease relapse and moderate AEs within the 12-month follow-up showed a NNT (number needed to treat) of 2 and a NNH (number needed to harm) of 8 for thalidomide treatment. CONCLUSIONS:Thalidomide can effectively prevent relapse in IgG4-RD outweighing its side effects, which indicating that thalidomide can be a potential safe therapeutic option for disease relapse prevention in parallel with steroid sparing in IgG4-RD.

AIM:The continuous update of international guidelines and enhanced availability of biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have made a significant impact on the diagnosis and treatment of early rheumatoid arthritis (ERA). This study aims to systematically evaluate the current treatment strategies and outcomes within a large-scale cohort of patients with ERA. METHODS:Data from the Chinese Registry of Rheumatoid Arthritis (CREDIT), a large multicenter Chinese registry of RA, were collected to analyze temporal trends in clinical profiles, therapeutic strategies, and treatment outcomes among patients with ERA. RESULTS:From November 2016 to October 2023, A total of 2722 patients with follow-up information for 6 months were included. The use of methotrexate (MTX) increased annually and has become the predominant DMARD as the initial treatment. Following initial therapy, 1059 (38.9%) patients achieved the therapeutic target of low disease activity and remission. Age ≥ 50 years (adjusted OR 0.70 [95% CI 0.59-0.83]; p < 0.001), high baseline disease activity (adjusted OR 0.48 [95% CI 0.41-0.57]; p < 0.001), csDMARD monotherapy other than MTX (adjusted OR 0.55 [95% CI 0.41-0.73]; p < 0.001), and the use of b/tsDMARDs without a csDMARD combination (adjusted OR 0.57 [95% CI 0.36-0.87]; p = 0.011) were associated with lower target attainment rates. For patients who did not achieve the treatment target after initial therapy, the use of b/tsDMARDs increased after 2020, although the extent of therapeutic escalation remained suboptimal. CONCLUSION:Treatment of patients with ERA in China has become more standardized. Adherence to guideline-directed therapeutic regimens has emerged as a significant determinant of therapeutic target achievement. The increased prevalence of b/tsDMARDs would benefit more patients in ameliorating the disease.

Nodal marginal zone B-cell lymphoma(NMZL),the least common subtype of marginal zone lymphoma,represents a low-grade malignancy arising from the marginal zone of lymph node follicles,composed of small B-cells with an inert non-Hodgkin lymphoma nature.It accounts for 1.5% to 1.8% of all non-Hodgkin lymphomas and 10% of all marginal zone lymphomas.The low incidence and lack of typical clinical and pathological features pose a challenge to the diagnosis and clinical management of NMZL.In this article,we reported the diagnosis and treatment of a case of NMZL located in the parapharyngeal space of the left neck and reviewed the relevant literature from both domestic and international sources.We summarized the clinical manifestations,histopathological features,immunohistochemical characteristics,imaging features,diagnosis and treatment modalities,and prognosis of NMZL.

ABSTRACT:Research on IgG4-related disease (IgG4-RD), an autoimmune condition recognized to be a unique disease entity only two decades ago, has processed from describing patients' symptoms and signs to summarizing its critical pathological features, and further to investigating key pathogenic mechanisms. Challenges in gaining a better understanding of the disease, however, stem from its relative rarity-potentially attributed to underrecognition-and the absence of ideal experimental animal models. Recently, with the development of various high-throughput techniques, "omics" studies at different levels (particularly the single-cell omics) have shown promise in providing detailed molecular features of IgG4-RD. While, the application of omics approaches in IgG4-RD is still at an early stage. In this paper, we review the current progress of omics research in IgG4-RD and discuss the value of machine learning methods in analyzing the data with high dimensionality.

ObjectivesThis study aimed at identifying risk factors for the incidence of interstitial lung disease in patients with rheumatoid arthritis (RA-ILD) by a systematic review and meta-analysis.MethodsInformation sources: studies published by March 2021 were searched in PubMed, Web of Science, MEDLINE, EMBASE, Cochrane Library and Scopus databases.Eligibility criteria: cohort studies or nested case-control studies that reported OR or HR of risk factors for RA-ILD were included. Two researchers independently screened the studies and extracted data.Synthesis of results: the relative risks (RRs) were introduced to measure the association across studies.Risk bias: quality assessments of included studies were performed using the Newcastle-Ottawa Scale. Based on the result of heterogeneity, the random-effects model or fixed-effects model was chosen in the meta-analysis. Furthermore, a sensitivity analysis was conducted to identify the origins of heterogeneity, and publication bias was evaluated for the factors with no less than five included studies by funnel plots and Egger’s test.ResultsAmong 3075 identified articles, 12 studies met the inclusion criteria. 17 risk factors were included in the meta-analysis. Male (RR 1.94, 95% CI 1.33 to 2.85, p<0.001), elder age (>60 years, RR 1.42, 95% CI 1.05 to 1.94, p=0.02), older RA onset age (RR 1.05, 95% CI 1.01 to 1.10, p=0.02), smoking (RR 1.37, 95% CI 1.09 to 1.71, p=0.006), lung complications (RR 2.72, 95% CI 1.24 to 5.95, p=0.01), rheumatoid nodule (RR 1.85, 95% CI 1.36 to 2.51, p<0.001), leflunomide usage (RR 1.41, 95% CI 1.02 to 1.96, p=0.04) were identified as risk factors of RA-ILD.ConclusionPhysicians should be aware that patients with RA with the above risk factors are likely to develop RA-ILD, and perform close ILD screening during follow-ups so that the patients can be early diagnosed and treated, and achieve improved prognosis.

BackgroundThere is no study focusing on noninvasive predictors for the efficacy of sintilimab (anti-PD-1) plus IBI305 (a bevacizumab biosimilar) treatment in advanced hepatocellular carcinoma (HCC). MethodA total of 33 patients with advanced HCC were prospectively enrolled and received sintilimab plus IBI305 treatment from November 2018 to October 2019. Baseline characteristics including clinical data, laboratory data, and tumor features based on pretreatment CT/MR were collected. Meanwhile, pretreatment contrast-enhanced ultrasound (CEUS) for target tumor was performed and quantitative parameters were derived from time-intensity curves (TICs). A nomogram was developed based on the variables identified by the univariable and multivariable logistic regression analysis. The discrimination, calibration, and clinical utility of the nomogram were evaluated. ResultsTumor embolus and grad ratio were significant variables related to the efficacy of sintilimab plus IBI305 strategy. The nomogram based on these two variables achieved an excellent predictive performance with an area under curve (AUC) of 0.909 (95% CI, 0.813-1). A bootstrapping for 500 repetitions was performed to validate this model and the AUC of the bootstrap model was 0.91 (95% CI, 0.8-0.98). The calibration curve and decision curve analysis (DCA) showed that the nomogram had a good consistency and clinical utility. ConclusionsThis study has established and validated a nomogram by incorporating the quantitative parameters of pretreatment CEUS and baseline clinical characteristics to predict the anti-PD-1 plus anti-VEGF treatment efficacy in advanced HCC patients.

Purpose: To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves' ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment. Methods: Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2-weighted, fat-suppressed fast spin echo imaging (T2WI-fs) and T1-weighted, fat-suppressed, contrast-enhanced fast spin echo imaging (T1WI-fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non-effective group. Independent t-test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t-test was used to compare SIR and T of LPS muscle before and after treatment. Then cut-off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed. Results: Sixty-two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non-effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI-fs and T1WI-fs + C decreased after treatment in the effective group (P-T2 < 0.001, PT1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non-effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non-effective treatment group on T1WI-fs + C (P < 0.001). SIR of LPS muscle on T1WI-fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840). Conclusion: In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy.

Studies have confirmed the involvement of a variety of lymphocyte subsets, including type 2 helper T lymphocytes (Th2) and IgG4 + B lymphocytes, in the pathogenesis of IgG4-related disease (IgG4-RD). Those lymphocytes contribute to the major pathogenetic features of IgG4-RD. However, they are not the only cellular components in the immunoinflammatory environment of this mysterious disease entity. Recent studies have suggested that various non-lymphocytic components, including macrophages and fibroblasts, may also play an important role in the pathogenetic process of IgG4-RD in terms of contributing to the chronic and complex progress of the disease. Therefore, the potential role of non-lymphocyte in the pathogenesis of IgG4-RD is worth discussing.

OBJECTIVES:To investigate the landscape of T-B cell interaction, immune receptor profiles and effects of different types of immune responses in the involved tissues of IgG4-RD.METHODS:Single cell RNA sequencing, bulk sample RNA sequencing, immune receptor repertoire analysis (both BCR and TCR), multi-color flow cytometry, and in-vitro assays with model cells (e.g. EBV-immortalized B cells from IgG4-RD patient) and histologic methods were applied to investigate the immunopathological features of IgG4-RD from multiple aspects.RESULTS:Ectopic germinal center formation was observed in IgG4-RD patients at advanced disease stage, and a large part of B cells in involved tissue were germinal center B cell-like. Germinal center reaction in IgG4-RD led to the irregularities of both TCR and BCR clones in the involved tissues, and limited clonal overlaps among different samples. Enhanced Th1- and Th2-type responses were observed in involved tissues of IgG4-RD and patients with both increased Th1- and Th2-type response related cell subsets possessed more severe inflammatory indices. Analyses to the origin of IGHG4 transcripts in IgG4-RD indicated that IgG4 could be switched from IgM directly, or from other IgG subclasses. In vitro assays with EBV-immortalized B cells, fibroblasts and epithelial cells revealed the effects of Th1-type and Th2-type responses on germinal center reaction, ectopic expression of MHC-II molecules, and formation of tertiary lymphoid structures.CONCLUSIONS:Synergistic effects of Th1- and Th2-type responses were involved in the pathogenesis of IgG4-RD via their influences on both acute inflammatory processes and the chronicity and complexity of IgG4-RD.

This prospective study was aimed at assessing the value of nomograms based on conventional and contrast-enhanced ultrasound (CEUS) features in the pre-operative diagnosis of sonographically indeterminate/suspicious lymph node metastasis (LNM) in patients with differentiated thyroid carcinoma (DTC). A total of 72 cervical LNs from 47 patients with DTC from January to June 2018 were included in the primary data set, and 30 LNs from 15 patients with DTC from July to August 2018 were included in the external validation data set. The LNs of the included patients were preoperatively evaluated by conventional ultrasound (US) and CEUS. Each included LN was labeled by puncture localization with carbon nanoparticle suspension injection (Canalin) under US guidance and dissected separately to ensure the one-to-one correspondence between ultrasonic features and pathology status. Univariate logistic regression analysis was used to identify risk factors for LNM. A nomogram was used to construct a prediction model for cervical metastatic LNs. Round shape, absence of hilar structure, peripheral or mixed blood flow and centripetal or mass enhancement were risk factors for lymph node metastases. The area under the receiver operating characteristic curve of the nomogram model based on conventional US and CEUS features was 0.93 (95% confidence interval: 0.872-0.985), which was superior to that of the nomogram based on conventional US features(0.85, 95% confidence interval: 0.707-0.989). CEUS features can provide incremental benefit in the diagnosis of LNM among DTC cohorts. Nomograms based on conventional US and CEUS features can predict LN status with high accuracy.

动脉粥样硬化是一种缓慢进行性的血管炎症性病变.越来越多的研究表明长链非编码RNA(lncRNA)作为竞争性内源RNA(ceRNA)与微小RNA(miRNA)结合,通过ceRNA网络调控靶基因信使RNA(mRNA)分子的表达水平和功能,在动脉粥样硬化的病理生理过程中发挥重要作用.lncRNA、miRNA和mRNA之间的互作调控机制复杂.本文综述了lncRNA-miRNA-mRNA调控网络在动脉粥样硬化发病机制中的调控关系,阐述该调控网络在内皮细胞功能障碍、血管平滑肌细胞表型转化、巨噬细胞激活以及脂质代谢异常等病变中的重要作用,为动脉粥样硬化临床诊疗提供新思路.

We provide a case report of two thyroid nodules in an 8-year-old girl, which revealed malignant ultrasonographic findings and which were confirmed as ectopic thymic tissue by total thyroidectomy. The ultrasound presentations of intrathyroidal thymus glands were similar to those of the malignant thyroid nodules. In addition, in this case, there were two ectopic thymus lesions in the thyroid gland, which undoubtedly increased the difficulty of diagnosis. The occurrence of multiple ectopic thymic lesions in the thyroid gland was different from previous reports. Therefore, clinicians should take into consideration this rare entity, and should not mistake it as a thyroid neoplasm; moreover, they should not perform extensive thyroid resection.

Objectives:This study was designed to investigate the distribution of the independent parameters of PET and MR in tumour differentiation and staging and to evaluate the diagnostic efficiency of the independent parameters and combined model of PET/MR in the tumour differentiation of head and neck squamous cell carcinoma (HNSCC).Methods:The patients with the preliminary diagnosis of HNSCC were included and underwent the integrated PET/MR The parameters included the diffusion-weighted imaging, dynamic contrast enhancement and PET. The correlations between different parameters and the distribution in groups of tumour differentiation and staging were analysed. The combined model was established with complementary PET/MR parameters. The diagnostic efficiency of the independent parameters and combined model in the tumour differentiation were analysed by receiver operating characteristic curve.Results:The correlations between the parameters of dynamic contrast enhancement and PET were most significant. There were significant differences between the well-differentiated group and the moderately/poorly differentiated group in terms of the mean values of apparent diffusion coefficient (ADC) and standardised uptake value (SUV) (p < 0.05). The distributions among different tumour stage groups were not statistically different in all the parameters. The diagnostic efficiency of tumour differentiation increased in the order of Kepmean, SUVmean, ADCmean, and the combined model.Conclusions:Compared with the independent parameter, the combination of multiple parameters with PET/MR can further improve the diagnostic performance of tumour differentiation in HNSCC.

BACKGROUND:To analyze the diagnostic value of ultrasound-guided fine-needle aspiration (FNA) biopsy for lymph nodes with short-axis diameters ≤1 cm and to investigate whether the short-axis diameter influences the results of FNA biopsy. METHODS:The cytological results of ultrasound-guided FNA lymph node biopsies in 1,242 cases treated at our hospital between December 2015 and June 2017 were retrospectively analyzed. The results were compared with the final diagnostic results of the cases (988 cases had core-needle biopsies, and 254 cases were followed-up for more than six months) to explore the diagnostic value of ultrasound-guided FNA for small lymph nodes. RESULTS:The sensitivities, specificities and accuracies of ultrasound-guided FNA were 99.6%, 99.5% and 99.5% for small lymph nodes with short-axis diameters ≤1 cm and 97.2%, 94.4% and 96.4% for lymph nodes with short-axis diameters >1 cm, respectively. No significant differences were detected between the two groups (P>0.05). Lymph nodes with short-axis diameters ≤1 cm were divided into three groups according to the following diameters: 0.7 cm ≤ short-axis diameter ≤1 cm, 0.5 cm ≤ short-axis diameter <0.7 cm, and short-axis diameter <0.5 cm. The sensitivities of ultrasound-guided FNA for these three groups were 99.6%, 99.5% and 98.0% respectively; the specificities were 99.5%, 99.0% and 98.0%, respectively; and the accuracies were 99.8%, 99.3% and 99.0%, respectively. The differences in accuracy between the three groups were significant (P<0.05), while the differences in sensitivity and specificity were not significant (P>0.05). CONCLUSIONS:The diagnostic results of ultrasound-guided FNA for small lymph nodes are not affected by the short-axis diameter. For lymph nodes with short-axis diameters ≤1 cm, the accuracy decreases as the short-axis diameter decreases, but FNA still has a high diagnostic accuracy for these small lymph nodes.

BACKGROUND The incidence rate of renal cell carcinoma (RCC) has gradually increased worldwide over the past decade. Targeted therapy is the primary method for treating metastatic renal cell carcinoma (mRCC), and the development of thyroid dysfunction is one of the most common adverse reactions of this treatment. Therefore, this study aimed to assess the value of sonography in monitoring the morphology and functions of the thyroid in metastatic renal cell carcinoma patients treated with targeted drugs. METHODS In total, 37 patients from September 2016 to April 2019 with clinically confirmed mRCC that were treated with targeted drugs (19 with sunitinib and 18 with sorafenib) were enrolled in this study. The enrolled patients were divided into the hypothyroidism group and the non-hypothyroidism groups according to the changes in the serum concentration of the thyroid-stimulating hormone (TSH) during the treatment period. The serum concentrations of free triiodothyronine (FT3), free thyroxine (FT4), and TSH were measured by the Roche method before and after treatment. Simultaneously, the major axis, transverse diameter, and anteroposterior diameter of the bilateral lobes and isthmus of the thyroid gland were measured by ultrasound, and every thyroid volume was calculated. The changes in the thyroid volume, the thyroid volume change rate, and the homochronous serum concentration of TSH, FT3, FT4 in the hypothyroidism group, and the non-hypothyroidism group were then compared to assess the value of using sonography for monitoring the changes of thyroid morphology and functions. RESULTS In total, 20 patients had hypothyroidism (hypothyroidism group), while 17 patients did not have hypothyroidism (non-hypothyroidism group). The thyroid volumes in both groups decreased gradually after targeted therapy. In the 1st, 2nd, 3rd, 4th, 5th, 6th, 9th, and 12th month after the treatment, the rate of change in thyroid volume in the hypothyroidism group (n=20) was 0.84 (0.47)%, 3.36 (1.34)%, 6.95 (1.42)%, 8.57 (1.66)%, 9.15 (0.55)%, 10.40 (1.12)%, 13.30 (1.53)%, and 14.15 (1.85)%, respectively. In the non-hypothyroidism group (n=17), the thyroid volume change rates were 0.25 (0.11)%, 3.00 (1.81)%, 3.9 (0.75)%, 5.09 (1.81)%, 6.72 (1.81)%, 6.90 (1.35)%, 9.90 (1.35)%, and 10.60 (1.79)%, respectively. There were significant differences in the rate of change in thyroid volume between the hypothyroidism and non-hypothyroidism group after treatment (F =490.804, P=0.000). When the thyroid volume change rate reached 8.5%, the sensitivity, specificity, and accuracy of using ultrasound in evaluating the occurrence of hypothyroidism were 70.3%, 94.1%, and 75.0%, respectively. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.845. CONCLUSIONS Using ultrasound as a tool can precisely detect the reduction of thyroid volume induced by targeted drugs used in mRCC therapy. For mRCC patients treated with targeted drugs, the degree of thyroid volume reduction in patients with hypothyroidism is higher than those without hypothyroidism. Furthermore, the rate of thyroid volume change in patients with mRCC can indirectly monitor the changes in thyroid function after a targeted treatment in these patients. The degree of thyroid volume reduction of 8.5% was relatively sensitive, specific, and accurate for the diagnosis of hypothyroidism.

Purpose: To examine the prognostic value of a machine learning model trained with pretreatment MRI radiomic features in the assessment of patients with nonmetastatic nasopharyngeal carcinoma (NPC) who are at risk for 3-year disease progression after intensity-modulated radiation therapy and to explain the radiomics features in the model. Materials and Methods: A total of 277 patients with nonmetastatic NPC admitted between March 2008 and December 2014 at two imaging centers were retrospectively reviewed. Patients were allocated to a discovery or validation cohort based on where they underwent MRI (discovery cohort, n = 217; validation cohort, n = 60). A total of 525 radiomics features extracted from contrast material-enhanced T1- or T2-weighted MRI studies and five clinical features were subjected to radiomic machine learning modeling to predict 3-year disease progression. Feature selection was performed by analyzing robustness to resampling, reproducibility between observers, and redundancy. Features for the final model were selected with Kaplan-Meier analysis and the log-rank test. A support vector machine was used as the classifier for the model. To interpret the pattern learned from the model, Shapley additive explanations (SHAP) was applied. Results: The final model yielded an area under the receiver operating characteristic curve of 0.80 in both the discovery (95% bootstrap confidence interval: 0.80, 0.81) and independent validation (95% bootstrap confidence interval: 0.73, 0.89) cohorts. Analysis with SHAP revealed that tumor shape sphericity, first-order mean absolute deviation, T stage, and overall stage were important factors in 3-year disease progression. Conclusion: These results add to the growing evidence of the role of radiomics in the assessment of NPC. By using explanatory techniques, such as SHAP, the complex interaction of features learned by the model may be understood. (C) RSNA, 2019

Objective: To compare the efficiency of saline irrigation, antibiotics irrigation and high-concentration antibiotics perfusion with tube drainage in the treatment of infectious effusion. Methods: Clinical and sonographic features of abdominal and pelvic infectious effusion of 64 patients with malignant tumor collected from September 2013 to September 2017 were retrospectively analyzed. The changes of effusion size and temperature, catheterization time were evaluated in saline irrigation group and antibiotics irrigation group. The catheterization time was compared between antibiotics irrigation group and high-concentration antibiotics perfusion group. Results: The effective rates of the saline irrigation group and the antibiotics irrigation group were 68.6% and 86.8%, respectively, and the times of catheterization were 11.9±8.4 days and 7.8±4.8 days, respectively, with significantly statistical difference (both P<0.05). However, the effective rates of the antibiotics irrigation group and the high concentration antibiotic perfusion group were 86.8% and 100.0%, respectively (P=0.067), while the times of catheterization were 7.8±4.8 days and 3.6±3.1 days, respectively (P<0.001). Conclusion: The antibiotic irrigation with tube drainage, especially the high concentration perfusion is more effective than saline in the treatment of abdominal and pelvic infection effusion.

引起浅表淋巴结病变的因素较多,肿瘤、炎症、结核等多种疾病均可以引起浅表淋巴结肿大,淋巴结良恶性的判断对临床治疗方案的选择具有重要的指导作用.超声是浅表淋巴结检查的首选方法,近年来出现的超声造影及弹性成像技术能够使淋巴结内的微血管显示的更加清晰,使淋巴结的硬度可视化,可以更加直观地评估淋巴结内的血流灌注特点和硬度特征,可使超声对浅表淋巴结病变诊断的准确性得到进一步提高.本文旨在综述超声造影及弹性成像在浅表淋巴结病变诊断中的应用.

靶向治疗是转移性肾癌(mRCC)的主要治疗方法之一,该方法通过靶向药物作用于特定的靶点、信号通路,抑制肿瘤细胞生长和增殖,进而发挥抗肿瘤作用.目前治疗mRCC的靶向药物包括酪氨酸激酶抑制剂(TKI)类药物和雷帕霉素靶蛋白(MTOR)抑制剂类药物.治疗mRCC的靶向药物在拮抗血管内皮细胞生长因子受体(VEGFR)的同时,也进一步破坏了甲状腺内毛细血管网的完整性,甲状腺会出现不同程度的缺血、坏死,进而导致甲状腺功能减退、腺体萎缩.超声可以显示甲状腺的形态和功能,功能正常与功能异常甲状腺的超声图像特征不同.本文围绕治疗mRCC的靶向药物的作用机制、靶向药物对甲状腺功能的影响、超声对甲状腺形态和功能的检测价值作一综述.

韧带纤维瘤病是一种比较罕见的交界性肿瘤,来源于筋膜或肌腱膜组织者多见,其特点主要是局部浸润、破坏性生长和易复发[1].该病因局部侵袭生长导致组织重构,挤压破坏重要的结构和器官[1-2].该病发病率占所有肿瘤的0.03％,并且占所有软组织肿瘤的不足3％,国外文献报道该病发病率仅为(2～4)/100万[1].国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院收治1例回肠末端韧带纤维瘤病患者,因乙状结肠癌进行检查时偶然发现该病,现报道如下.