Objective To summarize the progress of the application of ultrasound-guided thermal ablation for treatment of papillary thyroid microcarcinoma (PTMC). Methods The relevant literatures of thyroid nodules treated by ultrasound-guided thermal ablation were reviewed by adopting the methods of literature review. Results In conditions of grasping the therapeutic indication strictly and evaluating preoperative various aspects sufficiently, it reveals a certain feasibility and validity applying ultrasound-guided thermal ablation in the treatment of PTMC classified in the low-risk group. Conclutions Possessing the advantages of minimal invasive techniques, low-risks, beauty and rapidness, ultrasound-guided thermal ablation might be recommended as an alternative to a low-risk PTMC patient who is at high risk in general anaesthesia operation or intolerant to open operation.
ObjectiveTo explore the role of preoperative evaluation indicators for decision-making on treatment modalities in papillary thyroid microcarcinoma (PTMC) with intermediate- and high-risk. MethodThe recent pertinent literatures on studies of risk factors influencing PTMC were collected and reviewed. ResultsThe surgical treatment was advocated for the PTMC with intermediate- and high-risk. However, the intraoperative surgical resection range and the postoperative prognosis of patients were debated. The malignancy of cell puncture pathology was a key factor in determining the surgical protocol. The patients with less than 45 years old at surgery, male, higher body mass index, higher serum thyrotropin level, and multifocal and isthmic tumors, and nodule internal hypoecho, calcification, unclear boundary, and irregular morphology by ultrasound, as well as mutations in BRAFV600E and telomerase reverse transcriptase gene were the risk factors for preoperative evaluation of PTMC with intermediate- and high-risk. ConclusionsAccording to a comprehensive understanding of preoperative risk factors for PTMC with intermediate- and high-risk, it is convenient to conduct an accurate preoperative evaluation and fully grasp the patients’ conditions. Clinicians should formulate individualized surgical treatment plans for patients based on preoperative assessment and their own clinical experiences.
ObjectiveTo investigate the condition of neck lymph node metastasis and related factors in thyroiditis coexisting thyroid cancer, and make clear the indication of neck lymph node dissection. MethodsA retrospective cohort study was conducted with the clinical data of 147 patients with thyroiditis coexisting thyroid cancer who underwent radical resection of thyroid cancer (total thyroidectomy or subtotal thyroidectomy) and neck lymph node dissection, including age, gender, tumor size, number of focuses, and lymph node metastasis. Results Among 147 patients, 65 patients with neck lymph node metastasis (44.22%), central cervical lymph node metastasis rate was 36.05% （53/147）， which was higher than that of lateral lymph node metastasis rate (20.41%, 30/147), Plt;0.05. Neck lymph node metastasis rate was correlated with patient’s gender and tumor size （Plt;0.05）, while it was not correlated with patient’s age and number of focuses (Pgt;0.05). ConclusionCentral neck lymph node metastasis rate is higher in patients with thyroiditis coexisting thyroid cancer, then routine prophylactic central neck lymph node dissection is significant. Patient’s gender and tumor size are correlated with neck lymph node metastasis. When tumor is larger or in male, ipsilateral lymph node dissection should be considered to done.
ObjectiveTo summarize the research progress of related genes in Hashimoto’s thyroiditis with papillary thyroid carcinoma.MethodLiteratures about Hashimoto’s thyroiditis with papillary thyroid carcinoma were reviewed by searching the literatures in domestic and foreign database.ResultsIn recent years, the incidence of Hashimoto’s thyroiditis with thyroid carcinoma (especially papillary thyroid carcinoma) was on the increase, the two might have the same molecular pathology mechanism.ConclusionThere is a close association between Hashimoto’s thyroiditis and papillary thyroid carcinoma, the common molecular genetic changes suggest that Hashimoto’s thyroiditis may have a correlation with papillary thyroid carcinoma.
ObjectiveTo explore the value of ultrasound-guided core needle biopsy (CNB) in diagnosis of thyroid nodules. MethodsThe clinical data of 347 patients with thyroid nodules who underwent ultrasoundguided CNB were retrospectively analyzed, and the results of CNB pathology were compared with postoperative wax pathology results. ResultsAll patients completed CNB successfully and satisfaction rate for tissue samples was 100%. After CNB, local hematoma occurred in two cases and relieved by conservative therapy. The CNB pathology results of 347 cases of patients were as follows: 117 cases were malignancy, including papillary thyroid cancer in 115 cases, undifferentiated adenocarcinoma in 1 case, and squamous cell carcinoma in 1 case; 230 cases were benign, including thyroiditis in 53 cases, and nodular goiter in 141 cases, adenoma in 16 cases, and nodular goitre coexisting thyroiditis in 20 cases. In 132 cases of patients underwent surgery including 113 cases of malignancy and 19 cases of benign disease, the CNB pathology results in 127 cases were consistent with postoperative wax pathology results and false negative occurred in 5 cases. The diameter of thyroid nodules were not more than 0.5 cm in 4 cases, 0.5-1.0 cm in 59 cases, 1-2 cm in 46 cases, and more than 2 cm in 23 cases, and the accuracy rate of CNB pathology results was 75.0%（3/4）, 98.3%（58/59）, 97.8%（45/46）, and 91.3%（21/23）, respectively, which was the highest in 0.5-2.0 cm. The accuracy, sensibility, specificity, positive predictive value, negative predictive value, failure rate, and misdiagnosis rate of ultrasound-guided CNB for differential diagnosis of thyroid malignant nodules from benign nodules were 96.21% (127/132), 95.76% (113/118), 100% (14/14), 1 (113/113), 0.74 (14/19), 4.24%(5/118), and 0 (0/14), respectively. ConclusionUltrasound-guided CNB has important value on differential diagnosis of thyroid nodules, and important guiding significance on treatment of thyroid diseases.
ObjectiveTo summarize the characteristics of cervical lymph node metastasis (LNM) in the papillary thyroid carcinoma (PTC) coexisting with Hashimoto thyroiditis (HT). MethodThe literatures related to cervical LNM of PTC coexisting with HT in recent years were collected and summarized. ResultsCompared with the PTC patients without HT, the more enlarged lymph nodes could be detected, and the cervival central LNM rate was lower, but there was still controversy about cervival lateral LNM in the patients with PTC coexisting with HT. The male, young, large tumor diameter, extraglandular invasion, multifocal cancer, BRAF gene mutation, and higher thyroid peroxidase antibody and thyroglobulin antibody levels, as well as the ultrasound features such as thyroid nodule aspect ratio >1, extremely low echo, calcification, and lymph node calcification, liquefaction, and disappearance of hilar lymph nodes could be used to evaluate the risk factors of cervical LNM for the patients with PTC coexisting with HT. ConclusionsFrom the results of this review, it is suggests that the rate of central LNM is lower in patients with PTC coexisting with HT, but the status of LNM in the cervical lateral region remains to be explored. The relevant risk factors in combination with ultrasonic characteristics could help evaluate cervical lymph node status, could provide basis for early detection of metastatic lymph nodes and the formulation of individualized surgical plans, and improve the prognosis of patients.
Detection and classification of malignant arrhythmia are key tasks of automated external defibrillators. In this paper, 21 metrics extracted from existing algorithms were studied by retrospective analysis. Based on these metrics, a back propagation neural network optimized by genetic algorithm was constructed. A total of 1,343 electrocardiogram samples were included in the analysis. The results of the experiments indicated that this network had a good performance in classification of sinus rhythm, ventricular fibrillation, ventricular tachycardia and asystole. The balanced accuracy on test dataset reached up to 99.06%. It illustrates that our proposed detection algorithm is obviously superior to existing algorithms. The application of the algorithm in the automated external defibrillators will further improve the reliability of rhythm analysis before defibrillation and ultimately improve the survival rate of cardiac arrest.
Acute respiratory distress syndrome (ARDS) is a serious threat to human life and health disease, with acute onset and high mortality. The current diagnosis of the disease depends on blood gas analysis results, while calculating the oxygenation index. However, blood gas analysis is an invasive operation, and can’t continuously monitor the development of the disease. In response to the above problems, in this study, we proposed a new algorithm for identifying the severity of ARDS disease. Based on a variety of non-invasive physiological parameters of patients, combined with feature selection techniques, this paper sorts the importance of various physiological parameters. The cross-validation technique was used to evaluate the identification performance. The classification results of four supervised learning algorithms using neural network, logistic regression, AdaBoost and Bagging were compared under different feature subsets. The optimal feature subset and classification algorithm are comprehensively selected by the sensitivity, specificity, accuracy and area under curve (AUC) of different algorithms under different feature subsets. We use four supervised learning algorithms to distinguish the severity of ARDS (P/F ≤ 300). The performance of the algorithm is evaluated according to AUC. When AdaBoost uses 20 features, AUC = 0.832 1, the accuracy is 74.82%, and the optimal AUC is obtained. The performance of the algorithm is evaluated according to the number of features. When using 2 features, Bagging has AUC = 0.819 4 and the accuracy is 73.01%. Compared with traditional methods, this method has the advantage of continuously monitoring the development of patients with ARDS and providing medical staff with auxiliary diagnosis suggestions.