RESUMO
Objective: To observe the effect of surgical procedures and general anesthesia exposure (<2 h) in early childhood on neurodevelopmental outcomes in school-age. Methods: A total of 147 children aged 6-12 years old, who received surgery under general anesthesia (<2 h) at the age of 0-2 years in Children's Hospital of Nanjing Medical Universityfrom June 2009 to December 2012 were retrospectively enrolled in this study (from June 2018 to December 2021) as exposure group, including 76 males and 71 females, with a mean age of (8.8±1.6) years. All the cases were divided into single-exposure group (n=65) and multiple-exposure group (≥2 times, n=82) according to different times of anesthesia exposure. According to the cohort of exposure group, 160 healthy children of the same age with no history of surgery under general anesthesia were recruited from the community from June 2018 to December 2021 as the control group, including 87 males and 73 females, and aged (8.6±1.9) years. A variety of standardized neurological tests including Wechsler intelligence scale for children fourth edition (WSC-â £), integrated visual and auditory continuous performance test (IVA-CPT), Swanson Nolan and Pelham, version â £ (SNAP-â £), children sensory integration capacity development rating scale (CSIC), and social living ability scale were performed in all subjects by a child health specialist who failed to know the details. The primary outcome was the full-scale IQ (FSIQ) in WISC-â £, and the secondary outcomes were IVA-CPT, SNAP-â £, CSIC, and social living ability scale. Results: The FSIQ of single-exposure, multiple-exposure and control groups was 105.4±14.1, 100.9±10.2 and 103.6±13.5, respectively, with no statistically significant difference (F=2.37, P=0.095). The FSIQ of different first age exposure groups (aged 0-6 months, 7-12 months and 1-2 years) was 99.8±10.2, 104.5±10.5 and 104.4±14.5, respectively, with no statistically significant difference (F=2.39, P=0.095). The FSIQ of different exposure duration groups (0-59 min, 60-119 min and control group) was 102.8±11.3, 103.0±13.7 and 103.6±13.5, respectively, with no statistically significant difference (F=0.13, P=0.882). As for the secondary outcomes, the scores of visual persistence quotient in single-exposure, multiple-exposure and control groups were 94.8±10.5, 94.0±10.9 and 100.6±17.7, with a statistically significant difference (F=6.96, P=0.001). In terms of locomotion in social living ability scale, the score of the three groups was 10.0±0.2, 10.2±0.6 and 10.4±0.7, respectively, with a statistically significant difference (F=10.61, P<0.001), but all were within the standard range. Conclusions: The surgical procedures and general anesthesia exposure within 2 hours in early childhood has no effect on the overall FSIQ in school age, but has a slight impacts on the visual persistence quotient of IVA-CPT and the locomotion score of social living ability scale.
Assuntos
Anestesia Geral , Desenvolvimento Infantil , Masculino , Criança , Feminino , Humanos , Pré-Escolar , Estudos Retrospectivos , Escalas de Wechsler , Anestesia Geral/efeitos adversosRESUMO
AIM: To investigate the value of the qualitative and quantitative features of Virtual Touch imaging quantification (VTIQ) shear-wave elastography in the characterisation of breast lesions. MATERIALS AND METHODS: Conventional ultrasound (US) and VTIQ were performed in 148 solid breast lesions in 148 women. During qualitative analysis, patterns of VTIQ were categorised into two patterns, 1 and 2. During quantitative analysis, the mean SWV (SWVmean) and the maximum SWV (SWVmax) of each lesion were used. The sensitivity, specificity, and the areas under the receiver operating characteristic (ROC) curve (Az value) were calculated for conventional US, VTIQ, and combined conventional US and VTIQ. RESULTS: Malignant lesions were more likely to show VTIQ pattern 2 than the benign lesions (p<0.001). There was no significant difference in the Az values between SWVmean (0.907) and SWVmax (0.902; p=0.572). There was no significant difference in the Az values between the VTIQ pattern (0.884) and SWVmax (p=0.572). The combined conventional US and VTIQ pattern carried a similar Az value (0.949) as compared with the combined conventional US and SWVmax, which yielded an Az value of 0.952 (p=0.683). CONCLUSION: The combination of either VTIQ pattern or SWVmax and conventional US may be helpful in the characterisation of benign and malignant breast lesions.
Assuntos
Doenças Mamárias/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Ultrassonografia Mamária/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Adulto JovemRESUMO
AIM: To determine the interobserver variability of experienced radiologists in evaluating the number of suspicious lymph nodes (LNs) seen on axillary ultrasound (AUS) examination, and to evaluate the effects of clinicopathological features on the discordance. MATERIAL AND METHODS: A prospective non-randomised triple-blind study was conducted from July 2016 to December 2017 at Shanghai Ruijin Hospital. Three experienced radiologists performed AUS on 462 patients (469 axillae) with invasive breast cancer independently and assessed the number of abnormal LNs during the real-time AUS examination. Interobserver agreement was determined according to the kappa statistic. RESULTS: The mean numbers of metastatic LNs on final histology study were 0.35, 0.98, 3.05 and 4.70 for patients with 0, 1, 2 and >2 abnormal nodes on preoperative AUS. When the cut-off (the number of abnormal LNs seen on AUS was >1) at which the maximal sum of sensitivity and specificity for diagnosis of ≥3 tumour-involved LNs was achieved was applied, the Az values ranged from 0.776 to 0.811. When the number of abnormal LNs was grouped into two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS), good interobserver agreement (kappa: 0.601-0.687) was found, and disagreement between the radiologists was more frequently found in patients with T2-stage tumour and in those with one or two tumour-involved nodes. CONCLUSION: Abnormal LN count according to two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS) was a feasible method with good accuracy and high repeatability to select patients with heavy nodal disease in the post-Z0011 trial era.
Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/patologia , Competência Clínica , Metástase Linfática/diagnóstico por imagem , Ultrassonografia Mamária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Variações Dependentes do Observador , Estudos ProspectivosRESUMO
AIM: To identify the differences between ultrasound (US) features of parathyroid carcinoma (PC) and benign parathyroid (BP) lesions in patients with primary hyperparathyroidism (PHPT). MATERIAL AND METHODS: Twenty-one patients with PC and 64 consecutive patients with BP, whose diagnoses were confirmed at surgery, were enrolled from January 2013 to December 2018. The US features, demographic, clinical, and biochemical characteristics of the two groups were compared retrospectively. RESULTS: There are no significant differences between the patients with PC and BP regarding mean age or mean ionized calcium levels but differences were seen in sex distribution and mean parathyroid hormone (PTH) levels. On US imaging, PC significantly exhibited higher incidences of larger size and higher depth/width (D/W) ratio, heterogeneous echotexture, irregular shape, non-circumscribed margin, intra-nodular calcifications, indistinct border, cystic change, and the presence of suspicious lymph nodes compared to BP lesions. CONCLUSION: Preoperative ultrasonography is helpful to differentiate PC and BP. Patients with PC are differentiated from BP by their sex distribution, mean PTH levels, and major US characteristics: larger size, higher D/W ratio, heterogeneous echotexture, irregular shape, non-circumscribed margin, indistinct border, intra-nodular calcifications, cystic change, and the presence of suspicious lymph nodes.
Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Carcinoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças das Paratireoides/diagnóstico por imagem , Doenças das Paratireoides/cirurgia , Neoplasias das Paratireoides/cirurgia , Cuidados Pré-Operatórios , Estudos RetrospectivosRESUMO
AIM: To compare the diagnostic efficacy of the maximal, minimal, and mean pulsatility index (PI) and resistance index (RI) and determine which should be utilized in the evaluation of thyroid nodules. MATERIALS AND METHODS: A total of 224 consecutive patients with thyroid nodules were included in this prospective study. Doppler signals from three different nodular arteries were obtained and six Doppler parameters were used for final analysis: maximal PI (PImax), minimal PI (PImin), mean PI (PImean), maximal RI (RImax), minimal RI (RImin), and mean RI (RImean). RESULTS: Eighty-five patients had malignant and 139 cases had benign thyroid nodules. All three sets of PI and RI parameters were significantly higher in malignant than in benign thyroid nodules (p = 0.000 for all). The area under the receiver operating characteristic (ROC) curve (Az) of PImax was significantly higher than that of PImin (p = 0.046) and higher than that of PImean (p = 0.161). The Az value of RImax was higher than that of RImean and RImin; however, the differences were not significant (p = 0.403, and p = 0.058, respectively). The Az values of the three sets of PI parameters (PImax, PImin, and PImean) were significantly higher than those of the corresponding sets of RI parameters (p = 0.005, p = 0.003, and p = 0.003, respectively). CONCLUSION: Maximal pulsed Doppler parameters should be utilized in the evaluation of thyroid nodules. PI parameters were superior to the RI parameters in determining malignant nodules.