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25 August 2024, Volume 23 Issue 04 Previous Issue   

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Current status and challenges of diagnosis and treatment of hyperthyroidism in China LI Jing, SHAN Zhongyan 2024, 23 (04):  347-353.  DOI: 10.16150/j.1671-2870.2024.04.001 Abstract ( 150 )   HTML ( 10 )   PDF (1021KB) ( 61 )   In China, the clinical prevalence of hyperthyroidism is 0.78%, subclinical hyperthyroidism is 0.44%, and Graves' disease hyperthyroidism is 0.53%. Untreated hyperthyroidism and subclinical hyperthyroidism may increase the risk of atrial fibrillation, stroke, and other cardiovascular events, as well as osteoporosis and fractures. In special populations (such as pregnant women and the elderly), both the diagnosis and treatment of hyperthyroidism require special conside-rations. Although China has made some progress in the standardized diagnosis and treatment of hyperthyroidism, challenges remain. Despite established guidelines for diagnosis and differential diagnosis, clinical practice faces obstacles, notably due to limited access to thyroid radionuclide imaging and 131 iodine uptake rate in some hospitals. Additionally, the peak systolic velocity (PSV) in the thyroid obtained by thyroid ultrasound is not widely adopted. While clinical treatment methods align with international standards in China, there is a lack of specific guidelines on the initial dose and dose adjustment during the reduction period of antithyroid drugs (ATD). Currently, most clinicians follow the initial dose regimen re-commended by the guidelines established by the American Thyroid Association. Furthermore, indicators in both domestic and international guidelines for predicting adverse reactions to ATD remain unclear. During the ATD treatment of hyperthyroidism, the incidence of transient neutropenia is 1%-5%, and follow-up of baseline blood routine and liver function is ne-cessary. At present, there is a lack of monitoring frequency regulations and high-quality evidence-based medical support for above indice, and clinical practice has not yet established feasible indicators for predicting ATD adverse reactions. ATD-induced agranulocytosis is related to genetic susceptibility, age, drug type and dosage. HLA-B*27:05, HLA-B*38:02 and HLA-DRB1*08:03 on chromosome 6 in Chinese Han population may be susceptibility genes. Progress has been made in the diagnosis and treatment of thyroid associated ophthalmopathy (TAO) in China, with 36.7% of doctors adopting a multidisciplinary approach. Due to accessibility issues, less than 10% of patients receive biological agents to treat TAO, which is significantly lower than that in Western countries. Given these current status and challenges in China, further measures are necessary to improve the diagnosis and treatment of hyperthyroidism. References | Related Articles | Metrics

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Differential diagnosis and treatment of thyroid storm YAN Huixian, LÜ Chaohui 2024, 23 (04):  354-361.  DOI: 10.16150/j.1671-2870.2024.04.002 Abstract ( 90 )   HTML ( 8 )   PDF (1282KB) ( 19 )   Thyroid storm is a rare, life-threatening endocrine emergency characterized by severe clinical manifestations of thyrotoxicosis. Studies in the United States and Japan show that the annual incidence rates of hyperthyroid storm are (0.57-0.76) per 100 000 people and 0.2/100 000 people, respectively, accounting for 0.22% of all hyperthyroid patients and 5.4% of hospitalized hyperthyroid patients. Even with timely treatment, the mortality rate of patients with hyperthyroidism storm is still as high as 10%-30%; If left untreated, the mortality rate of patients may reach 90%. The misdiagnosis and missed diagnosis rate of hyperthyroidism storm in the Emergency Department is as high as 43.48%. It may be precipitated by abrupt discontinuation of antithyroid drugs or by an acute event such as infection, trauma, thyroid or nonthyroidal surgery, an acute iodine load, or parturition and other rare causes. There are currently no recognized standards or validated clinical tools for diagnosing thyroid storm. The diagnosis of thyroid storm is based upon the presence of biochemical evidence of hyperthyroidism (elevation of free T4 and/or T3 and suppression of TSH), and severe and life-threatening symptoms (hyperpyrexia, cardiovascular dysfunction, and altered mentation). BWPS has been widely used for the identification of thyroid storm for nearly 30 years. The main treatments for thyroid storm consist of symptomatic treatment and specific treatment for the thyroid gland, including removing the cause and treating complications cuse of thionamide, iodine, glucocorticoids and beta-blockers to inhibit new hormone synthesis, block the peripheral conversion of T4 to T3, inhibition of the release of thyroid hormone. If the above treatment do not improve the condition, blood purification therapy (plasmapheresis) can be tried. In addition to specific therapy directed against the thyroid, supportive therapy is essential. After active treatment, most of the status of patients with thyroid storm are improved within 1 to 2 days. After a successful rescue of thyroid storm, hyperthyroidism should be treated by radical treatment. Figures and Tables | References | Related Articles | Metrics

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Current status and challenges in ultrasound diagnosis and treatment of thyroid nodules in China ZHOU Jianqiao, ZHANG Lu, XU Shangyan 2024, 23 (04):  362-370.  DOI: 10.16150/j.1671-2870.2024.04.003 Abstract ( 77 )   HTML ( 12 )   PDF (1012KB) ( 25 )   Thyroid nodules (TNs) exhibit a high prevalence rate of 36.9% in China, with a marked preponderance in females over males, and regional variations observed. Ultrasonography (US), due to its non-invasiveness, convenience, and high sensitivity, has emerged as the primary diagnostic tool for TNs. In recent years, advancements in US diagnostic techniques have flourished, including the Thyroid Imaging Reporting and Data System (TIRADS), multimodal US, fine-needle aspiration (FNA) coupled with molecular testing, and artificial intelligence (AI). Notably, the 2020 edition of the Chinese-specific C-TIRADS system has improved diagnostic accuracy by tailoring to China's healthcare landscape. Multimodal US assessment, integrating various US techniques, has significantly enhanced diagnostic efficacy, reducing unnecessary biopsies. Molecular testing and AI-assisted diagnosis have further improved diagnostic precision; however, the generalization capabilities of AI models and their long-term clinical application efficacy remain to be validated. Ultrasound-guided interventional therapies occupy a pivotal position in TN management, including chemical ablation and thermal ablation techniques. Chemical ablation is primarily utilized for cystic-predominant nodules, whereas thermal ablation is suitable for both cystic-solid and solid nodules, with their combined application yielding optimal results. Although the application of thermal ablation in thyroid micropapillary carcinoma remains controversial, preliminary studies have demonstrated its efficacy and safety. Despite the remarkable progress in US technologies for TN diagnosis and treatment, challenges persist, including inconsistent diagnostic criteria, disparities in equipment and technical expertise across regions and hospitals, and the absence of large-scale studies on the long-term efficacy and safety of thermal ablation. Future directions encompass refining risk stratification systems, intensifying research on multimodal US assessment, enhancing the generalization capabilities of AI models, standardizing the application of molecular testing, exploring indications for ablation therapy, and establishing standardized efficacy assessments. References | Related Articles | Metrics

Academic trend at home and abroad

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Interpretation of cancer death burden data from disease surveillance sites in China from 2005 to 2020 ZHANG Xin, ZHENG Ying 2024, 23 (04):  371-377.  DOI: 10.16150/j.1671-2870.2024.04.004 Abstract ( 78 )   HTML ( 20 )   PDF (1154KB) ( 25 )   In December 2023, the Chinese Center for Disease Control and Prevention published National and subnational trends in cancer burden in China, 2005-2020: an analysis of national mortality surveillance data.on Lancet Public Health, covering the mortality rate and average years of life lost from 23 specific tumor sites in people in 31 provinces and cities across the country. The analysis suggests that in 2020, the number of deaths from cancer in China was 2.3978 million, with a mortality rate of 170.80/100 000. The top 10 tumor deaths cases are as follows: lung cancer 761,000, liver cancer 367,700, stomach cancer 291,200, colorectal cancer 182,400, esophageal cancer 173,300, pancreatic cancer 100,400, breast cancer 57,100, leukemia 54,900, cranial nerve cancer 54,200, cervical cancer 44,800, accounting for 32.0%, 15.3%, 12.1%, 7.6%, 7.2%, 4.2%, 2.4%, 2.3%, 2.3%, 1.9% of the total number of deaths due to tumors, respectively. The mortality rates were 54.57/100 000, 26.19/100 000, 20.74/100 000, 13.00/100 000, 12.34/100 000, 7.15/100 000, 4.06/100 000, 3.91/100 000, 3.86/100 000 and 3.19/100 000, respectively. In 2020, the average years of life lost (AYLL) due to cancer in China was 23.60 years, which was 3.74 years lower than that in 2015. Among them, leukemia caused an AYLL of 37.35 years, with a decrease of 13.36 years from the AYLL of 50.71 years caused by leukemia in 2005, but it was still the tumor that caused the most life loss. Prostate cancer was the tumor that caused the least AYLL. The composition of China’s cancer spectrum is changing to those in developed countries. Lung cancer, breast cancer and colorectal cancer, which are highly prevalent in developed countries, are showing an increasing disease burden trend in China. In 2020, the mortality rates of lung cancer, breast cancer and colorectal cancer all increased during this period, increasing by 78.98%, 19.41% and 47.56% respectively compared with those in 2005. GLOBOCAN2022 suggests that the top 10 cancer incidence rates in China in 2020 are lung cancer (40.8/100 000), breast cancer (33.0/100 000), thyroid cancer (24.6/100 000), liver cancer (20.1/100 000), cervical cancer (15.0/100 000), gastric cancer (13.8/100 000), prostate cancer (13.7/100 000), esophageal cancer (9.7/100 000), uterine cancer (8.7/100 000) and ovarian cancer (6.8/100 000). Five of the top 10 common cancer in China and the United States overlap, and lung cancer is the leading cause of death in both countries. Changes in the spectrum of tumor diseases have made the promotion and implementation of proven tumor prevention and control measures more urgent. Figures and Tables | References | Related Articles | Metrics

Original articles

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Analysis of incidence trend of thyroid cancer in Baoshan District, Shanghai from 2000 to 2022 ZHANG Zhiping, CAI Shilong, GENG Yanlong, LIU Shiyou 2024, 23 (04):  378-384.  DOI: 10.16150/j.1671-2870.2024.04.005 Abstract ( 22 )   HTML ( 0 )   PDF (2050KB) ( 13 )   Objective To provide a scientific basis for the prevention and control of thyroid cancer by analyzing the incidence characteristics and trends of thyroid cancer in Baoshan District, Shanghai from 2000 to 2022. Methods The thyroid cancer incidence data from the Shanghai Cancer Registry Reporting System from 2000 to 2022 were used to analyze the incidence of thyroid cancer among registered residents of Baoshan District. Indices such as crude incidence rate, age-standardized incidence rate (ASIR), cumulative incidence rate for ages 0-74, truncated rate for ages 35-64, and age-specific and gender-specific incidence rates were calculated using Excel 2013.Joinpoint 5.0.2.0 software was used to calculate the annual percentage of change (APC) and average annual percentage of change (AAPC), and to conduct trend analysis. Results Between 2000 and 2022, a total of 6 877cases of thyroid cancer were monitored and recorded in Baoshan District,with an average annual incidence rate of 33.38/100 000(ASIR of 28.77/100 000), among which the incidence rate for males was 17.54/100 000 (ASIR of 15.40/100 000), and for females was 49.87/100 000 (ASIR of 43.05/100 000);the cumulative incidence rate for the 0-74 age group was 2.16%;and the truncated rate for the 35-64 age group was 64.07/100 000. The ASIR of thyroid cancer showed an overall upward trend over the 23 years, with an AAPC of 14.51% (P<0.001). It increased rapidly from 2000 to 2017, with an APC of 20.79% (P<0.001), followed by a stabilization phase from 2017 to 2022, with an APC of -4.50% (P=0.146). The incidence rate of thyroid cancer reached two peaks in in the 30-34 and 55-59 age groups, with the incidence rates of 45.37/100 000 and 52.12/100 000, respectively. The incidence trend of all age groups showed that the average increase rate was the highest between 20 and 44 years old, with an AAPC of 17.02% (P<0.001). Conclusions The incidence of thyroid cancer in Baoshan District of Shanghai presentes a shift from a rapid to a stable trend, yet it remains at a relatively high level. There is a need for further investigation into the causes of the high incidence of thyroid cancer. The age groups of 30-34 and 55-59 should be particularly emphasized as key focus populations, and targeted prevention strategies must be developed to mitigate their risk. Figures and Tables | References | Related Articles | Metrics

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Evaluation of clinical efficacy of full field digital mammography (FFDM) used alone and in combition with digital breast tomosynthesis in diagnosis of breast cancer FU Qiuyi, ZHAN Ying, TAN Ling, ZHU Hong, ZHU Naiyi, SUN Kun, CHAI Li, CHAI Weimin 2024, 23 (04):  385-391.  DOI: 10.16150/j.1671-2870.2024.04.006 Abstract ( 46 )   HTML ( 4 )   PDF (1282KB) ( 14 )   Objective To compare the detective and diagnostic ability of full field digital mammography (FFDM) alone and digital breast tomosynthesis (DBT) combined with FFDM (FFDM+DBT) in different types of lesions. Method A total of 389 patients who underwent preoperative mammography in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 were prospectively included in this study. FFDM images and DBT images were obtained from each patient in the Combo mode. All images were interpreted by senior radiologists, who have been involved in breast imaging diagnosis for more than 10 years. Using the pathological results as the gold standard, the consistency between the imaging evaluation and the gold standard was analyzed to evaluate the differences in diagnostic efficacy between FFDM and DBT (FFDM+DBT), and the differences in diagnostic efficacy in different types of lesions. Indice of diagnostic efficacy includes sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), area under curve (AUC) receiver operating characteristic curve (ROC) for diagnosing breast cancer and overall diagnostic ability between FFDM and FFDM+DBT were compared. Results The overall diagnostic capability of FFDM+DBT was significantly improved compared with FFDM alone (P<0.000 1); the specificity, sensitivity, accuracy, PPV, and NPV of FFDM+DBT were significantly higher than FFDM alone (86.96%, 89.11%, 88.15%, 86.54%, 89.45% vs 80.19%, 87.16%, 84.05%, 83.42%, 84.53%) (P<0.05). The AUC of FFDM+DBT diagnostic ROC for breast cancer was significantly higher than FFDM alone (0.906 vs 0.869, P<0.01); the detection rate of masses by FFDM+DBT was significantly higher than that of FFDM alone (62.5% vs 46.55%, P<0.05); the detection rate of structural distortions by FFDM+DBT was significantly higher than that by FFDM alone (11.42% vs 5.17%, P<0.05). The AUC of FFDM+DBT diagnosis for malignant mass lesions was significantly higher than that of FFDM alone (0.9186 vs 0.8759, P=0.004). Conclusions Compared to FFDM FFDM+DBT examination demonstrates a superior advantage in displaying breast masses and related structural distortions, with higher diagnostic efficiency for differentiating benign and malignant breast lesions. Figures and Tables | References | Related Articles | Metrics

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Study on the Bw11 subtype caused by the 695 T>C mutation in exon 7 of the ABO blood group gene ZHOU Lihua, SHEN Ru, QU Kexuan, WANG Aihua, CHEN Youhui, YUAN Zhimin 2024, 23 (04):  392-397.  DOI: 10.16150/j.1671-2870.2024.04.007 Abstract ( 46 )   HTML ( 2 )   PDF (3257KB) ( 34 )   Objective To identify the rare ABO*BW.11/ABO*O.01.02 subtype in the Yi ethnic group in China, and to investigate the blood group serological characteristics, molecular mechanisms, and genetic background of the ABO*BW.11/ABO*O.01.02 subtype. Methods The proband was a 25-year-old pregnant woman, with ABO typing discre-pancy in routine tests on admission. Due to the inability to accurately identify the conventional ABO blood serology, exons 1-7 of the ABO gene were analyzed by sequencing using the Sanger method, and the effect of the mutation at this site on the structure and function of B glycosyltransferase was predicted using the amino acid series homology modelling of wild-type B glycosyltransferase. Results The blood group serological results of the proband and lineage were inconsistent with the typical B subtype. ABO gene sequencing unveiled a c.695T>C missense mutation in exon 7 of the ABO blood group gene in the 7 probands and family members in 4 generations, leading to the substitution of leucine by proline at position 232 of the B glycosyltransferase. Homology modeling showed that the mutation influenced the peptide and hydrogen bonds of the protein, which probably led to structural and functional alterations, diminished B-glycosyltransferase activity, and weakened expression of the B antigen. Conclusions This proband carries a point mutation in the ABO allele in exon 7 c.695T>C.P.leu 232 Pro to form the ABO*BW.11/ABO*O.01.02 subtype, and is stably inherited in multiple members of this family. Figures and Tables | References | Related Articles | Metrics

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Knocking out FLO8 gene of Candida glabrata and its effect on EPA family ZHAO Juntao, YUAN Jie, LIU Jinyan, CHEN Kezhi, XIANG Mingjie 2024, 23 (04):  398-404.  DOI: 10.16150/j.1671-2870.2024.04.008 Abstract ( 36 )   HTML ( 2 )   PDF (1587KB) ( 13 )   Objective To construct a FLO8 gene knockout strain of Candida glabrata and analyze the effect of FLO8 knockout on the expression of EPA family in Candida glabrata. Methods By fusion PCR technology, the knockout components were constructed with the genomic DNA of Candida glabrata ATCC2001 strain and the plasmid DNA with screening marker NAT as templates. The knockout components were transfected into Candida glabrataATCC2001 by lithium acetate transfection method to obtainflo8△strain. The expression of EPA1, EPA6 and EPA7 genes were detected by real-time quantitative PCR. Results The FLO8 gene knockout strain of Candida glabrata was efficiently constructed. The expression levels of EPA1, EPA6 and EPA7genes in flo8△strain were significantly lower than those in ATCC2001 strain (all P<0.001). Conclusions The gene knockout method permits rapid, easy and highly efficient generation of homozygous knockout mutations in Candida glabrata. The knockout of FLO8 gene reduced the expression of EPA family in Candida glabrata, which laid a foundation for further study on its virulence mechanism. Figures and Tables | References | Related Articles | Metrics

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The value of inflammatory cytokines（TNF-α, IL-6 and IL-8） in predicting prognosis in patients with new-onset intracerebral hemorrhage GU Tianyan, PAN Jingyu, CHEN Lin, ZOU Zhihao, SHI Qinghai 2024, 23 (04):  405-415.  DOI: 10.16150/j.1671-2870.2024.04.009 Abstract ( 66 )   HTML ( 6 )   PDF (1201KB) ( 39 )   Objective To investigate correlation of levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 in cerebrospinal fluid with the severity of the disease in patients with intracerebral hemorrhage, and to analyze the value of the cytokines for predicting prognosis of the patients. Methods A total of 40 patients with new-onset intracerebral hemorrhage, admitted to the Department of Neurosurgery of the General Hospital of Xinjiang Military Region, were collected from March 2023 to December 2023. Forty patients who underwent cerebrospinal fluid examination at the hospital due to the presence of clinical symptoms, but whose central nervous system disease was eventually excluded, served as the control group. Within 24 h of the onset of illness, the patient's cerebrospinal fluid was collected,as well as the laboratory test results. The levels of inflammatory cytokines TNF-α, IL-6, and IL-8 were measured both in serum and cerebrospinal fluid samples. Patients were divided into the mild-moderate group (GCS 9-15, n=14) and severe group (GCS 3-8, n=26) accor-ding to the Glasgow coma scale (GCS) on admission, and also were divided into ≥30mL group (n=21) and <30mL group (n=19) according to the hemorrhage volume. At 90 days after discharge, the patients with intracerebral hemorrhage were divided into a good prognosis group (GOS 4-5 points, n=18) and a poor prognosis group (GOS 1-3 points, n=22) according to the Glasgow out-come scale (GOS). Spearman correlation coefficient and Receiver operating characteristic curve (ROC) was used to analyze the value of inflammatory cytokines in serum and cerebrospinal fluid for predicting the prognosis in patients with intracerebral hemorrhage. Results Compared with the control group, TNF-α, IL-6 and IL-8 levels in serum and cerebrospinal fluid were significantly increased in the intracerebral hemorrhage (P<0.001). The levels of TNF-α, IL-6 and IL-8 in serum and cerebrospinal fluid were higher in the severe intracerebral hemorrhage group than those in the mild-moderate group (P<0.01), and all of them were negatively correlated with the GCS score (r=-0.397, P<0.05; r=-0.587, P<0.01; r=-0.615, P<0.01; r=-0.696, P<0.01; r=-0.671, P<0.01; r=-0.510, P<0.01). Compared with patients in the group of hemorrhage volume <30mL, TNF-α, IL-6 and IL-8 levels in cerebrospinal fluid of patients in the ≥30 mL group were elevated (P<0.05), and in serum only IL-6 levels were elevated (P<0.05). The levels of TNF-α, IL-6 and IL-8 in serum and cerebrospinal fluid were elevated in the poor prognosis group compared with the good prognosis group (P<0.01). The area under the curve (AUC) of single and combined detection of TNF-α, IL-6 and IL-8 in the cerebrospinal fluid of patients with cerebral hemorrhage for the first time on admission to the hospital for predicting the prognosis of patients with cerebral hemorrhage were 0.836, 0.773, 0.849, and 0.917, respectively. The AUC of single and combined tests of serum TNF-α, IL-6 and IL-8 in patients within 24 h admission for predicting the prognosis were 0.692, 0.808, 0.721 and 0.843, respectively. Conclusions TNF-α, IL-6 and IL-8 levels are elevated in the cerebrospinal fluid of patients with intracerebral hemorrhage, and they correlated with the severity of the patient's condition. In addition, the levels of these indicators in the cerebrospinal fluid detected for the first time on admission may be used to predict the prognosis 90 days after discharge. Figures and Tables | References | Related Articles | Metrics

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Study on the risk factors for persistent infection of high-risk human papillomavirus after cervical conization FU Xina, XU Xin, LI Tianjie, JIN Ying 2024, 23 (04):  416-423.  DOI: 10.16150/j.1671-2870.2024.04.010 Abstract ( 42 )   HTML ( 1 )   PDF (1060KB) ( 36 )   Objective To analyze the risk factors of persistent infection of high-risk human papillomavirus (HR-HPV) after cervical conization, so as to identify the high-risk population of residual and recurrent cervical lesions after cervical conization. Method A total of 467 patients with one more HR-HPV infection and underwent cervical conization in the outpatient clinic and ward of our hospital from January 1,2017 to May 31,2022 were collected. After cervical conization,HR-HPV-positive patients within 6 months were included in the HR-HPV persistent infection group, and HR-HPV-negative patients were included in the HR-HPV clearance group. The differences in age, menopausal status, preoperative HR-HPV infection, preoperative thinprep cytologic test (TCT), pathological grade of cervical biopsy, conization margin status, glandular involvement, and conization surgery were compared between the two groups. Among them, the age difference was processed by rank sum test, and other indicators were compared by chi-square test. Multivariate Logistic regression analysis was used to find the high risk factors for HR-HPV persistent infection after cervical conization. Result The HR-HPV clearance rate was 64.0% within 6 months after cervical conization. Patients with age ≥ 46 years old (P<0.001 ), menopause (P<0.001), preoperative infection of any type of HPV 16, HPV 52 or HPV 58 (P=0.002), preoperative multiple HPV infection (P<0.001), preoperative TCT < high grade squamous intraepithelial lesion (HSIL) (P=0.005), cervical biopsy pathology < HSIL (P=0.020), unclean margin (P=0.003), gland involvement (P=0.008) or loop electrosurgical excision procedure (LEEP) (P<0.001), had a higher probability of HR-HPV persistent infection after cervical conization. Multivariate Logistic regression analysis showed that menopause (OR=3.453, P<0.001), preoperative HR-HPV multiple infection (OR=2.683, P<0.001), preoperative TCT < HSIL (OR=1.884, P=0.015), unclean margin (OR=1.479, P=0.048) and LEEP (OR=2.330, P=0.013) were independent risk factors for HR-HPV persistent infection after cervical conization.The residual and recurrence rate of cervical lesions at 6-24 months after conization was 12.2%. Compared with HR-HPV clearance group, HR-HPV persistent infection group had a higher rate of residual and recurrent cervical lesions at 6-24 months after cervical conization (28.6% vs 3.0%, χ2=65.585, P<0.001), and the risk of HSIL was also higher (Fisher test, P=0.027). Conclusions In this study, a large sample size is included, and menopause, preoperative HR-HPV multiple infection, preoperative TCT < HSIL, unclean margin, and LEEP are identified as high-risk factors for HR-HPV persistent infection after cervical conization, and a higher risk of residual and recurrent cervical lesions (especially HSIL lesions) after cervical conization. Figures and Tables | References | Related Articles | Metrics

Review article

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Advances in the study of indications for thermal ablation therapy of thyroid nodules YANG Yixuan, ZHOU Jianqiao 2024, 23 (04):  424-429.  DOI: 10.16150/j.1671-2870.2024.04.011 Abstract ( 80 )   HTML ( 4 )   PDF (1655KB) ( 14 )   Thyroid nodules, a common endocrine tumor, have shown a significant increase in incidence globally. The total incidence rate of thyroid nodules worldwide is about 25% from 2000 to 2022, of which the incidence of malignant thyroid nodules is 4.0% to 6.5%. In recent years, the application of thermal ablation technology in the treatment of thyroid nodules has been steadily increasing, with broader indications and fewer contraindications. Thermal ablation techniques have been widely applied in the treatment of benign thyroid nodules. Studies have demonstrated that radiofrequency ablation (RFA) and microwave ablation (MWA) significantly reduce nodule volume and alleviate symptoms. For retrosternal thyroid nodules, the post-treatment volume reduction rate exceeds 90%. For calcified benign nodules, a five-year follow-up showed an average volume reduction rate of 92.95%. Studies on follicular tumors indicated that more than half of the nodules achieved a 90%-volume reduction one year after thermal ablation, with a low incidence of complications in the treatment group. In the treatment of malignant thyroid tumors, thermal ablation has shown promising results in T1aN0M0 solitary low-risk papillary thyroid microcarcinoma (PTMC), with a disease progression rate as low as 3.6%. For T1bN0M0-T2N0M0 primary solitary papillary thyroid carcinoma (PTC), the prognosis following thermal ablation is comparable to surgery, with a lower incidence of complications. In patients with multifocal PTC, the success rate of thermal ablation was 100%, with a low rate of local tumor progression during follow-up. For PTMC located in the isthmus, adjacent to the trachea, or close to the thyroid capsule, thermal ablation demonstrated similar efficacy to surgery, with lower rates of complications and recurrence. This review summarizes the current indications of thermal ablation technology in the treatment of thyroid nodules and provides a reference for clinical applications. Figures and Tables | References | Related Articles | Metrics

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Advances in study on risk factors related to cerebral microbleeds and on treatment decision-making when cerebral microbleeds merging related diseases ZHAO Lijuan, CHENG Tao, SHUI Xinjun, YUE Dongqi, QIN Shaochen, LIU Xiaoling, WANG Jiali, FU Yi 2024, 23 (04):  430-438.  DOI: 10.16150/j.1671-2870.2024.04.012 Abstract ( 70 )   HTML ( 1 )   PDF (1061KB) ( 18 )   Cerebral microbleeds， belongs to the category of cerebral small blood vessel disease， is a vascular lesion of subcortical or deep brain tissue caused by a variety of risk factors. In recent years, with the development of imaging and the wide use of antithrombotic drugs, the detection rate of cerebral microbleeds has gradually increased. Although mostly regarded as asymptomatic, cerebral microbleeds may increase the risk of cognitive dysfunction, hemorrhagic transformation after cerebral infarction, cerebral hemorrhage, etc. It is of great significance to summarize the progress of the epidemiology and related risk factors of cerebral microbleeds. Risk factors for cerebral microbleeds include genetic factors (ApoE ε4 gene (OR=2.54), NOTCH3 mutation, homozygous mutation in HTRA 1 gene, Fabry disease), advanced age and male (P=0.043), smoking (OR=5.791) and alcohol consumption (OR=7.306), hypertension (OR=1. 049), diabetes (P=0.005), dyslipidemia (P<0.05), cerebral amyloid angiopathy (OR=2.210), hyperhomocysteemia (P<0.05), hyperuricemia (OR:1. 98), renal dysfunction and dialysis (P=0.0041), critical illness (60% of patients had cerebral microhemorrhage after ECMO). Other rare risk factors include cardiac surgery, infective endocarditis, reversible posterior encephalopathy syndrome, moyamoya disease, obstructive sleep apnea syndrome, craniocerebral radiotherapy, and traumatic brain injury can all lead to the occurrence of cerebral microbleeds. At present, age, hypertension and ApoE gene polymorphism are specific risk factors for cerebral microhemorrhage. Whether other risk factors has not reached the overwhelming consensus. Cerebral microbleeds does not require treatment, but in clinical practice, patients with cerebral infarction or atrial fibrillation combined with cerebral microbleeds should be carefully considered. For patients with ischemic stroke/TIA complicated with cerebral microbleeds, antiplatelet therapy is still beneficial, and cerebral microbleeds should not be a contraindication to intravenous thrombolysis (intravenous thrombolysis, IVT) or endovascular treatment (endovascular therapy, EVT). However, for patients with high-load (>10) cerebral microbleeds, even with the IVT/EVT treatment indications, the pros and cons should also be weighed according to the patient's specific situation. For patients with atrial fibrillation complicated with cerebral microbleeds, when the number of cerebral microbleeds is larger or lesions located in the cortical areas, and the risk of cerebral microbleeds is higher, safer new anticoagulants are recommended. At present, there is no consensus between the domestic and foreign medical circles on the risk factors of cerebral microbleeds and the treatment plan and individualized intervention of ischemic stroke combined with cerebral microbleeds, and large-scale clinical studies are still needed for further exploration. Figures and Tables | References | Related Articles | Metrics

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18F-FDG PET/CT in the diagnosis and prognosis evaluation of follicular lymphoma LI Zhuohan, HUANG Xinyun, GUO Rui, LI Biao 2024, 23 (04):  439-444.  DOI: 10.16150/j.1671-2870.2024.04.013 Abstract ( 73 )   HTML ( 5 )   PDF (1006KB) ( 11 )   Follicular lymphoma (FL) is a non-Hodgkin lymphoma with complex biological properties and heterogeneous clinical manifestations. FL mainly involves lymph nodes throughout the body, and about 7% of patients in China will histologically transform into other aggressive lymphoma. Therefore, there are great differences in the treatment strategies and prognosis of patients with FL. With the development of molecular imaging technology, PET/CT fusion molecular ima-ging can not only identify small lesions in vivo more accurately, but also provide metabolic information of lesions. A number of studies and guidelines have affirmed the important value of 18F-fluorodeoxyglucose-positron emission computed tomography (18F-FDG PET/CT) image features in the whole process of FL disease diagnosis, grading and staging, evaluation of efficacy and prediction of survival outcomes. However, due to the lack of uniform standards for image scanning and threshold definition, the specific prognostic efficacy of PET/CT parameters in FL patients in different studies is still controversial. This article reviews the recent progress in early identification of high-risk follicular lymphoma patients and prognosis prediction of FL patients based on PET/CT image features at home and abroad, further affirms the value of 18F-FDG PET/CT in judging the possibility of histological transformation of FL and evaluating the survival outcome of FL patients. To assist to optimize the clinical diagnosis and treatment decisions, improve the treatment efficiency and prognosis of FL patients. Figures and Tables | References | Related Articles | Metrics

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Advances in research of radiomics and metabolomics in acute pancreatitis ZHONG Jingyu, DING Defang, XING Yue, HU Yangfan, ZHANG Huan, YAO Weiwu 2024, 23 (04):  445-451.  DOI: 10.16150/j.1671-2870.2024.04.014 Abstract ( 101 )   HTML ( 2 )   PDF (1050KB) ( 10 )   Acute pancreatitis (AP) is an acute abdominal disease that is prone to organ dysfunction, with high mortality. Timely prediction of the occurrence and development trend of the disease is the prerequisite for early treatment and intervention. Radiomics can extract quantitative features from medical images with high throughput and realize deep data mining. It can be used for the diagnosis of acute pancreatitis and prediction of severity, progression and recurrence of the disease. For the diagnosis of AP, CT radiomics can distinguish recurrent AP patients from functional abdominal pain, chronic pancreatitis, and recurrent AP patients, with an area under curve (AUC) of 0.88. For predicting AP recurrence, CT radiomics can accurately predict AP recurrence within 48 months, with an AUC of 0.93. For predicting the severity of AP, MRI radiomics can predict whether AP patients will progress to moderate to severe AP in the future, with an AUC of 0.85, which is better than clinical scoring systems. For predicting complications and progression of AP, MRI radiomics can effectively predict the occurrence of peripancreatic necrosis, with an AUC of 0.92. Metabolomics has confirmed that metabolic spectrum changes dynamically during the occurrence and development of AP. It has been reported that active metabolites can be used as early warning indicators for the diagnosis, etiology identification and severity assessment of AP. In addition, urinary metabolomics allows accurate diagnosis of AP, with an AUC of 0.91. For identifying the etiology of AP, the blood metabolomics models can identify patients with biliary AP, hyperlipidemic AP, and alcoholic AP, with AUCs of 0.89, 0.91, and 0.86, respectively. For predicting the severity of AP, the blood metabolomics models can accurately predict whether AP patients will progress to moderate to severe AP in the future, with an AUC of 0.99. The combination of the radiomics and metabolomics can complement each other's advantages and integrate multi-group data, which can jointly characterize the process and internal connections of disease occurrence and development from different levels, for achieving early warning and early intervention more effectively. References | Related Articles | Metrics

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Advances in the diagnosis of abdominal disease based on virtual monoenergetic imaging and iodine map of spectral CT ZHANG Tianyi, YAN Fuhua 2024, 23 (04):  452-456.  DOI: 10.16150/j.1671-2870.2024.04.015 Abstract ( 50 )   HTML ( 2 )   PDF (968KB) ( 8 )   Computed tomography (CT) is one of the most commonly used examination methods in clinical practice, but its resolution for soft-tissue is not high enough, making it difficult to detect and identify some lesions, and it is insufficient in quantitative assessment. The advantages of spectral CT imaging are multi-parameter, multi-dimensional and quantitative imaging, which reflects the compositional characteristics of tissues and the characteristics of blood supply. It can simulate images of a single KeV energy, through two sets of high-energy and low-energy data, namely virtual monoenergetic images (VMI). In this review, the current problems in the use of VMI and iodine maps in lesion detection and differentiating diagnosis of abdominal diseases were concluded. The progress in detection of liver and pancreas lesion were pointed out. For example, the confidence level was raised from 52.4 to 68.8 in detection of small hepatocellular carcinoma by using VMI. In the pancreas, compared with normal CT, detection rate of VMI for endocrine tumor in pancreas was raised from 84.6% to 92.3%. What’s more, in terms of differential diagnosis, there have been many advances in the research on VMI and iodine density maps, and higher efficiency in differentiating diagnosis has been obtained in the classification of kidney cyst, differentiation between small hepatocellular carcinoma and small hepatic hemangioma, and differentiation of serous and mucinous cystadenoma in pancreas. Based on current progress, the future of VMI and iodine maps in abdominal diseases is prospected. References | Related Articles | Metrics

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Teaching practice of “introduction to basic medical specialty” course based on enhancing the sense of identity of basic medical specialty DONG Zhifang, YU Huarong, YANG Mei, HE Guiqiong 2024, 23 (04):  457-460.  DOI: 10.16150/j.1671-2870.2024.04.016 Abstract ( 67 )   HTML ( 1 )   PDF (962KB) ( 5 )   Figures and Tables | References | Related Articles | Metrics