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  • 2022 Volume 32 Issue 04
    Published: 16 July 2022
      
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    2022, 32(04): 1.
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  • Influence factors of ultrasoundguided microwave ablation for benign cystic solid thyroid nodules#br#
    LIU Hongyan1, XU Yongqiang1, LI Xiaolong2, SUN Liping1,2
    2022, 32(04): 277-282.
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    ［Abstract］Objective： To evaluate the influence factors of ultrasound (US)guided percutaneous microwave ablation (MWA) for benign cystic solid thyroid nodules. Methods： From January 2020 to June 2021, a total of 160 patients with benign cystic solid thyroid nodules were included. All patients underwent USguided percutaneous MWA. Each patient was followed up at the 6month after treatment. According to the nodule volume reduction rate (VRR), VRR≥ 50% was defined as significant effective group (122 cases) and VRR<50% as nonsignificant effective group (38 cases). Univariate analysis and multivariate analysis were used to evaluate the factors influencing the VRR of thyroid nodules. Results： Univariate analysis showed that features such as gender, age, body mass index (BMI), nodule size, maximum nodule diameter, nodule morphology, blood flow, and aspect ration were not significantly associated with VRR<50% (all P>0.05). For nonsignificant effective group, nodules located in the risk triangle, nodules being calcified, and proportion of cystic components＜50% were lower than those in the significant effective group (all P<0.05). Based on multivariate analysis, the features of nodule located in risk triangle（OR=26.076,95% CI: 6.983~97.424,P<0.001） and proportion of cystic components＜50%（OR=18.690,95% CI: 5.412~64.605,P＜0.001）were independent risk factors influencing the effect of MWA on benign cystic solid thyroid nodule. The logistic regression equation was established as follows: M=-3.855+(3.261×nodule located in risk triangle)+(2.928×proportion of cystic components＜50%). The associated sensitivity was 78.9% (30/38), specicity was 95.1% (116/122), accuracy was 91.3% (146/160). Conclusion：USguided percutaneous MWA is an effective and safe technique for the treatment of benign cystic solid thyroid nodules. It can significantly reduce the volume of thyroid nodules. The proximity of nodules to the risk triangle and proportion of cystic components＜50% may affect the efficacy of MWA in the treatment of benign cystic solid thyroid nodules.
  • ultrasound parameters in the central region of thyroid nodules in the differential diagnosis of benign and malignant nodules
    2022, 32(04): 283-287.
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    Objective:To investigate the clinical significance of combined shear wave elastography (SWE) parameters and quantitative analysis parameters of contrastenhanced ultrasound (CEUS) in the differential diagnosis of benign and malignant thyroid nodules. Methods: A total of 71 patients with malignant thyroid nodules and 65 patients with benign thyroid nodules who underwent auxiliary diagnosis in the ultrasound department of Taicang First People′s Hospital from January 2019 to January 2021 were selected. All patients underwent SWE and CEUS. The differences in twodimensional ultrasonographic appearance of benign and malignant nodules, SWE and CEUS parameters in the central area were analyzed.Logistic regression model was used to screen the parameters for judging malignant nodules in SWE and CEUS, the receiver operator characteristic (ROC) curve was drawn using pathological diagnosis as the gold standard, and the area under the curve (AUC) was calculated,and the predictive value of each factor and combined diagnosis of malignant thyroid nodules was analyzed.Results: The twodimensional ultrasonography of benign and malignant thyroid nodules had significant differences in morphology, margin, aspect ratio and microcalcification, and there were differences in central area Emin, Emean, Emax, Peak and AUCt of benign and malignant thyroid nodules (P<0.001). Logistic regression results showed that Emax and Peak entered the regression equation. The ROC curve results showed that among the SWE parameters, the area under the Emax curve was the largest and had the highest diagnostic performance, while Peak was the best diagnostic index in the CEUS parameters, and the AUC value of Emax and Peak in the diagnosis of malignant thyroid nodules was 0.837, which was greater than that of either SWE or CEUS alone.Conclusion:The diagnostic value of Emax and Peak in the central area of thyroid nodules is higher than that of other single parameters, and it has certain guiding significance for the noninvasive examination and diagnosis of thyroid nodules in clinical practice.
  • Effects of preoperative ultrasound-guided and intraoperative carbon nanoparticles injection on lymph node clearance of papillary thyroid carcinoma#br#
    ZHOU Zhengguo1, LIU Niu1, DING Qianshan1, CHEN Chen2, REN Ming2, HE Ling2, XU Kun2
    2022, 32(04): 288-291.
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    Objective： To investigate effects of preoperative ultrasound guidance and intraoperative injection of carbon nanoparticles on lymph node clearance of thyroid papillary carcinoma. Methods： The clinical data of 162 patients undergoing thyroid papillary carcinoma surgery in our hospital were retrospectively analyzed, including 59 patients in the preoperative ultrasound guided group and 103 patients in the intraoperative carbon nano injection group. The number of dissected lymph nodes and the number of detected metastatic lymph nodes in the two groups were analyzed . Results： The numbers  of lymph node clearance, metastasis lymph node detection,<5 mm lymph node clearance,<5 mm metastasis lymph node detection,>5 mm lymph node clearance,>5 mm metastasis lymph node detection, lymph node clearance in central region, the central transfer lymph node detection, lateral neck lymph node clearance， lateral neck metastasis lymph node detection in preoperative ultrasound guided group were higher than those in intraoperative injection group (P<0.05 and P＜0.001).Conclusion：Compared with intraoperative injection group, preoperative ultrasoundguided carbon nanoparticles injection exents better lymph node clearance rate.
  • The role of ACRTIRADS category in predicting cervical lymph node metastasis
    FAN Xing1, ZHENG Kun1, CHEN Wenying2, GU Jun2
    2022, 32(04): 292-296，305.
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    ［Abstract］Objective： To investigate the value of ACR TIRADS categories in predicting cervical lymph node metastasis in thyroid papillary carcinoma (PTC)patients with Hashimoto′s thyroiditis(HT). Methods： A retrospective analysis was performed in 271 PTC patients with HT. They were divided into metastasis group and nonmetastasis group according to the presence or absence of cervical lymph node metastasis. The differences of preoperative ultrasonography between the two groups were compared, then Kwak TIRADS and ACR TIRADS categories were graded according to the ultrasonography features. Binary logistic regression analysis was performed to determine the independent predictors of cervical lymph node metastasis. The ROC curve was drawn to evaluate the diagnostic efficiency of each factor. Results： Age, sex, maximum diameter, aspect ratio, and ACR TIRADS score were correlated with cervical lymph node metastasis in PTC patients with HT (all P<0.05). Binary logistic regression analysis showed that maximum diameter, ACR TIRADS score and aspect ratio>1 were independent factors for predicting cervical lymph node metastasis（OR=1.169,1.392,2.765, all P<0.05）. The area under ROC curve (AUC) of the combined prediction model was 0.887 (95% CI： 0.849-0.925), the sensitivity and specificity were 86.2% and 75.0%, respectively. Conclusion：ACR TIRADS score is the independent predictor of cervical lymph node metastasis in PTC patients with HT. The combined prediction model can provide some imaging references for clinical treatment.
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    2022, 32(04): 297-305.
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    2022, 32(04): 306-317.
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    2022, 32(04): 318-325.
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    2022, 32(04): 326-331,349.
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  • Inhibition of liver lipid deposition by exosomes derived from hepatocytes in mice with nonalcoholic fatty liver
    WU Yanshuang1, WANG Yanjin1, YANG Fuji1, YAN Yongmin1,2
    2022, 32(04): 332-337.
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    ［Abstract］Objective： To investigate the effect of exosomes derived from hepatocytes(LO2-Ex) on liver lipid deposition in mice with nonalcoholic fatty liver induced by highfat diet. Methods： Normal human hepatocyte line LO2 cells were cultured and LO2-Ex was extracted by ultracentrifugation. The particle size and concentration of exosomes were measured by nanosight nanoparticle analysis system, the morphology of exosomes was observed by transmission electron microscope, and the markers of exosomes were detected by Western blotting. C57BL/6 male mice were fed with highfat diet for 10 weeks to establish the mice model of nonalcoholic fatty liver. From the 11th week, LO2-Ex was injected into the caudal vein continuously for 4 weeks, and the liver tissue was collected after 4 weeks, the liver tissue structure was observed by HE staining, the liver index(liver mass / net weight) was calculated, the lipid deposition in the liver was detected by oil red O staining, and the collagen deposition in the liver was observed by Sirius red staining. Results： LO2-Ex, a particle size of about 120 nm, has a lipid bilayer structure characteristic of exosomes. It expresses exosome specific proteins CD9 and TSG101, but does not express Calnexin. Compared with the model group, the liver surface of mice in LO2-Ex group were ruddy, delicate and shiny. LO2Ex can reduce the weight of mice and improve the liver index of mice. HE staining, oil red O staining and Sirius red staining showed that LO2-Ex reduced vacuolar degeneration, fat deposition and collagen deposition in liver tissues. Conclusion：LO2-Ex can inhibit lipid deposition in liver tissues and inhibit the progression of nonalcoholic fatty liver in mice.
  • Expression of lncRNA HMGA1P4 in hepatocellular carcinoma and its correlation with the regulation of miR-4436a
    ZHANG Yun,SHI Jian
    2022, 32(04): 338-344.
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    ［Abstract］Objective： To investigate the expression and clinical significance of long non-coding RNA (lncRNA) HMGA1P4 in hepatocellular carcinoma (HCC) tissues, and verify the regulatory mechanism of HMGA1P4 and miR4436a and its influence on the migration and invasion ability of hepatocellular carcinoma cell line. Methods： qRT-PCR was utilized to detect the expression of HMGA1P4 and miR4436a in hepatocellular carcinoma tissue microarrays; the correlation between HMGA1P4 expression in hepatocellular carcinoma tissues and the clinical pathological parameters or prognosis of patients was analyzed; the influence of HMGA1P4 and miR-4436a on the migration and invasion ability of the HepG2 cell line was verified by the transwell experiment; the regulatory relationship between HMGA1P4 and miR-4436a was verified by the dual luciferase report experiment.Results： HMGA1P4 was abnormally highly expressed in hepatocellular carcinoma tissues,whereas the expression of miR4436a was downregulated in hepatocellular carcinoma tissues; the abnormally high expression of HMGA1P4 was associated with lymph node metastasis, TNM staging, recurrence, serum γ-GGT levels, PD-L1, EGFR and CTLA-4 status, and among TNM Ⅰ-Ⅳ, TNM Ⅰ, TNM Ⅱ staging hepatocellular carcinoma patients, the overall survival rate and recurrence-free survival of hepatocellular carcinoma patients with high HMGA1P4 expression was significantly lower than low expression group. The high expression of HMGA1P4 was an independent risk factor for the poor prognosis of hepatocellular carcinoma patients.Transwell experiment revealed that downregulation of miR-4436a could reverse the inhibitory effect of HMGA1P4 silencing-mediated hepatocellular carcinoma cell migration and invasion,the dual luciferase report experiment showed that HMGA1P4 could regulate miR-4436a.Conclusion：The abnormally high expression of HMGA1P4 promotes the malignant biological behavior and poor prognosis of hepatocellular carcinoma. HMGA1P4 can promote the migration and invasion of hepatocellular carcinoma cells by regulating miR-4436a.
  • Application of ultrasound-guided fascia iliaca block combined with lumbar anesthesia in closed reduction and internal fixation for intertrochanteric fractures in elderly patients
    ZHU Juan, MA Peng, JIANG Peng
    2022, 32(04): 345-349.
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    ［Abstract］Objective： To investigate the effect of ultrasound-guided supra-inguinal fascia iliaca block combined with lumbar anesthesia on closed reduction and internal fixation for intertrochanteric fractures in elderly patients. Methods： From September 2019 to September 2021, 60 elderly patients with intertrochanteric fracture who received closed reduction of proximal femoral anti-rotation intramedullary nail fixation in our hospital were enrolled and randomly divided into observation group(ultrasoundguided fascia iliaca block combined with lumbar anesthesia, 30 cases) and control group(lumbar anesthesia alone, 30 cases).General conditions, hemodynamic indexes (mean arterial pressure and heart rate), inflammatory cytokine (CRP and IL-6), visual analogue scale(VAS), postoperative intensification of analgesia and incidence of anesthesia related complications in 2 groups were recorded. Results： The average arterial pressure and heart rate of the observation group were lower than those of the control group in the position of lumbar anesthesia (both P<0.05). The levels of CRP and IL-6 of 1d after operation in both groups were higher than that before operation (P<0.05), while the levels of CRP and IL-6 of 1d after operation in the observation group was lower than those in the control group (both P<0.05).VAS of the observation group at lumbar anesthesia position, 12 h, 24 h and 48 h postoperation were significantly lower than those of the control group(both P<0.05). The time of the first postoperative intensive analgesia in the observation group was significantly longer than that in the control group (P<0.05), and the utilization rate of postoperative intensive analgesic drugs in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in the incidence of anesthesia related complications between the two groups (P>0.05).Conclusion：Ultrasound-guided suprainguinal fascia iliaca block combined with lumbar anesthesia for closed reduction and internal fixation in elderly patients with intertrochanteric fracture could reduce pain during lumbar anesthesia position, stabilize perioperative vital signs, reduce inflammatory cytokine, provide effective postoperation analgesia, and do not increase anaesthesia related adverse reactions.
  • Risk factors of postoperative noncurative resection for early gastroesophageal junction cancer after endoscopic submucosal dissection
    HUANG Xiaojie1, LIN Xiaolu2, LIANG Wei2, LIN Ying2, CHENG Hui2, YANG Shijie2,LIN Haining2, ZHENG Weiping1, DENG Wanyin2
    2022, 32(04): 350-354.
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    ［Abstract］Objective： To investigate the risk factors of noncurative resection of earlystage gastroesophageal junction (GEJ) cancer after endoscopic submucosal dissection (ESD). Methods： A total of 114 patients with early GEJ cancer who underwent ESD in the Digestive Endoscopy Center of Fujian Provincial Hospital from October 2016 to September 2020 were selected and divided into the curative resection group and the noncurative resection group, according to the postoperative pathological examination results. The gender, age, tumor diameter, tumor morphology, pathological type, depth of invasion and whether there was ulcer, etc. were compared between the two groups. Logistic regression analysis was used to figure out the related factors that may be associated with non-curative resection. Spearman correlation analysis was performed between the number of independent risk factors and the rate of noncurative resection. Results： There were no significant differences between the two groups in terms of gender, age, lesion shape, lesion location, deep cystic gastritis and background mucositis(all P>0.05), while tumor diameter, submucosal infiltration, ulcer, pathological type and submucosal fibrosis were signifcantly different(all P<0.05). Logistic analysis showed that tumor diameter(>2 cm), submucosal infiltration, ulcer and undifferentiated carcinoma are independent risk factors for noncurative resection of early GEJ cancer. The number of independent risk factors was correlated with the incidence of postoperative noncurative resection (rs=0.492, P<0.01), the more risk factors, the higher non-curative resection rate. Conclusion：Tumor diameter (>2 cm), submucosal infiltration, ulcer and undifferentiated carcinoma are independent risk factors for noncurative resection after ESD for earlystage GEJ cancer; the greater the number of risk factors, the higher the propotion of noncurative resection.
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    2022, 32(04): 355-358.
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    2022, 32(04): 359-362.
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