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Objective:To investigate the relationship of HRAS gene mutation and lymph node metastasis and ultrasonographic characteristics in differentiated thyroid carcinoma (DTC).Methods:The clinical data of 162 patients with DTCs who underwent thyroidectomy and confirmed by postoperative pathological examination in Beijing Friendship Hospital from January 2014 to February 2019 were retrospectively analyzed. There were 139 patients with papillary thyroid carcinoma (PTC group) and 23 patients with follicular thyroid carcinoma (FTC group); the PTC were further classified as classic variant of papillary thyroid carcinoma (CVPTC, n=34), follicular variant of papillary thyroid carcinoma (FVPTC, n=36) and tall cell variant (TCV, n=69). Tissue HRAS mutation frequency was detected in 162 DTC patients and 19 patients with follicular adenoma (FA); blood HRAS mutation frequency was detected in 195 healthy subjects. The correlation between HRAS mutation (IVS1-82del gctgggcctggg) and cervical lymph node metastasis was analyzed, and the ultrasonographic characteristics of DTC patients were also analyzed. Results:The frequency of HRAS mutation in DTC patients was higher than that in healthy controls[37.0%(60/162) vs. 26.2%(51/195), χ2=4.538, P=0.03], while there was no significant difference between FTC and FA [39.1%(9/23) vs. 5/19, χ2=0.769, P=0.38]. In DTC patients there was no significant difference in cervical lymph node metastasis between HRAS mutation group and wild type group [57.3% (43/75) vs. 42.6% (32/75), χ2=1.898, P=0.16]. Among CVPTC, FVPTC and TCV patients, the rates of cervical lymph node metastasis were 7/12, 8/14 and 48.0% (12/25) in HRAS mutation group, while those were 50.0% (11/22), 40.9% (9/22) and 43.1% (19/44) in wild-type group, respectively (χ2=1.009, P=0.98).There were 9 patients with HRAS mutation in FTC group, and the cervical lymph node metastasis in mutation group and wild-type group was 5/9 and 4/14, respectively ( P=0.38). The ultrasonographic characteristics of PTC patients with HRAS mutation were more likely to have clear boundaries [66.7%(34/51) vs. 42.0%(37/88); χ 2=7.833, P<0.01] and not close to the membrane[84.3%(43/51) vs. 65.9%(58/88);χ2=5.506, P=0.02]. Conclusion:DTC patients are more likely to have HRAS (IVS1-82del gctgggcctggg) mutation, and the ultrasonic characteristics of DTC patients with HRAS mutation are likely to have clear boundaries and be not close to the membrane.
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Objective:To explore the application effect of dysphagia rehabilitation pathway nursing in patients with dysphagia after stroke.Methods:Eighty patients with dysphagia after stroke who were admitted to the hospital from October 2019 to April 2020 were enrolled as the research objects. They were divided into observation group and control group by random number table method, 40 cases in each group. The control group was given routine nursing intervention, while observation group was given dysphagia rehabilitation pathway nursing on basis of control group. The swallowing function, serum ALBumin (ALB), subcutaneous fat, weight, incidence of aspiration pneumonia and nutrition deficiency were compared between the two groups at admission, after 2 weeks and 4 weeks of intervention.Results:After 2 weeks of intervention, the number of cases with normal swallowing function in observation group was significantly more than that in control group (15, 30 vs 7, 21) ( χ2 value was 4.013, 4.381, P<0.05). After 4 weeks of intervention, number of cases with abnormal swallowing function in observation group was less than that in control group (2 vs 9) ( χ2 value was 5.165, P<0.05). After 4 weeks of intervention, level of plasma ALB and TSF, and weight in the observation group were significantly higher than those in the control group [(39.46±2.84)g/L, (19.28±2.20)mm, (19.28±2.20) kg vs (31.71±2.59)g/L, (17.06±2.35)mm, (62.48±4.29)kg]( t value was 12.752, 4.362, 2.317, P<0.05), while incidence rates of aspiration pneumonia and nutrition deficiency were significantly lower than those in control group [12.50% (5/40), 2.50% (1/40) vs 32.50% (13/40), 32.50% (13/40)] ( χ2 value was 4.588, 12.468, P<0.05). Conclusion:Application of dysphagia rehabilitation pathway nursing in patients with dysphagia after stroke can significantly promote the recovery of swallowing function, improve their nutrition status, and reduce incidence of aspiration pneumonia and nutrition deficiency.
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Objective To investigate the correlation of BRAF mutation frequency with cervical lymph node metastasis ,and to compare the ultrasonic characteristics in patients with BRAF mutation in papillary thyroid carcinoma ( PTC) different subtypes . Methods The tumor samples were collected from 139 PTC patients who underwent thyroidectomy . And they were classified by histological subtype into 3 groups:classic variant of papillary thyroid carcinoma (CVPTC) group( 34 cases) ,follicular variant of papillary thyroidcarcinoma (FVPTC) group(36 cases) ,tall cell variant (TCV) group(69 cases) . The BRAF mutation frequency and the correlation with cervical lymph node metastasis among 3 groups were analyzed , then the ultrasonic characteristics with BRAF mutation in PTC different subtypes were compared . Results①The frequency of BRAF mutation was statistically significant different in different subtypes( χ2 =6 .390 , P =0 .041) ,and the frequency in TCV was 86 .9％ . There was also a statistical difference between BRAF mutation frequency and cervical lymph node metastasis among three subtypes ( χ2 = 13 .106 , P =0 .041) .②There was no statistically significant difference among the three groups in nodule number ,echo level , internal structure ,boundary ,crossbar ,morphology and acoustic halo of patients with BRAF mutation ( P >0 .05) . ③ A single factor analysis was performed for the ultrasonographic characteristics of patients with BRAF mutation ,and there were significant statistical differences among the 3 groups in calcification type (χ2 = 21 .7 , P = 0 .001 ) and close to the envelope (χ2 = 7 .726 , P = 0 .021 ) . ④ Multivariate logistic regression showed that BRAF mutation was an independent influence factor affecting the calcification type of different histological subtypes in PTC patients.Conclusions ①BRAF mutation is correlated with cervical lymph node metastasis in different PTC subtypes . ② BRAF mutation is an independent influence factor affecting the morphology type of different calcification subtypes in PTC . The CVPTC group is mainly microcalcification ,and the TCV group is mainly macrocalcification .
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Objective To analyze thyroid papillary carcinoma (PTMC) neck lymph node metastasis (LNM) related factors,and further to explore the diagnostic value of ultrasonography in LNM.Methods A retrospective analysis of 384 cases of patients with PTMC confirmed by pathology and ultrasonic data were performed,according to the presence of cervical lymph node metastasis,they were divided into transfer group (116 cases) and nontransfer group (268 cases).Analysis was made to summarize the clinical and sonographic features of the two groups.Chi-square test and the multi-factor Logistic regression analysis were used to study the risk factors.Results ①The single factor analysis of sonographic features showed that the factors of gender (X 2 = 3.893,P = 0.048),age (P = 0.001),tumor diameter (P = 0.008), boundary(X 2 =6.327,P =0.012),acoustic halo (X2 = 15.562,P =0.001),and place (X 2 =9.441 ,P =0.024) were statistical different between the two groups;②Multiariable Logistic regression analysis showed that:patient age,tumor diameter,and acoustic halo were independent risk factors for PTMC neck lymph node metastasis,if Logistic model was used to predict the probability P =0.50 as a threshold,its accuracy was 74.2%,and the area under the ROC curve was 0.744.Conclusions Patients with age ≤ 45 years, tumor diameter ≥ 0.7 cm,located in the lower pole,boundary with uneven acoustic halo,were prone to LNM,and easy to Ⅵ area,suggest preventive cleaning lymph node in central region.
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Objective To assess the relationship between pulse wave velocity(PWV) and carotid atherosclerosis by UltraFast imaging.Methods 476 cases from Medical Examination Center of Beijing Friendship Hospital were enrolled in this study.According to intima-media thickness(IMT) of carotid artery,all subjects were divided into two groups:IMT without thickening group (G0) of 283 cases and IMT thickening group (G1) of 193 cases.Through UltraFast imaging,carotid artery PWV was measured,including the PWV at the beginning of the systole(BS) and the PWV at the ending of the systole(ES).Carotid IMT and plaque situation were recorded under gray-scale ultrasound.BS and ES were compared between the two groups.Spearman rank correlation was used to analyse the correlation between IMT of carotid artery and BS,between IMT of carotid artery and ES.Two independent samples t test to compare BS,ES between the two groups.Results BS of G1 and G0 were (6.03 ± 1.33)m/s and (5.51 ± 1.13)m/s,t =-4.571,P =0.000;ES of G1 and G0 were (8.42 ± 2.13)m/s and (7.34 ± 2.02) m/s,t =5.619,P =0.000.BS and ES of G1 were larger those of G0 respectively.BS (r =0.192,P =0.000) and ES (r =0.249,P =0.000) were correlated with the IMT of carotid artery.Conclusions Ultrafast imaging technique can quickly measure the carotid artery PWV.BS and ES of carotid artery can be quick,convenient,safe,noninvasive parameters for evaluating carotid atherosclerosis.
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ObjectiveTo assessment the value of strain ratio(SR) in differentiating benign and malignant breast lesions of BI-RADS Ⅳ diagnosed by conventional ultrasound.MethodsElastosonography was performed on 64 patients with breast lesions of BI-RADS Ⅳ diagnosed by conventional ultrasound.SR (strainnormal neighboring tissues /strainbreast lesion) was calculated by the software equipped with the ultrasonic machine.Pathology of the lesions after biopsy or operation was considered as standard,SRs of benign and malignant breast lesions were compared with independent-samples t test.The diagnostic value of SR was evaluated by receiver operating characteristic (ROC) curve analysis.Results SRs of 34 benign breast lesions and 30 malignant breast lesions were 2.85 ± 1.30 and 5.03 ± 2.50 respectively,there was significant difference between them( t =- 4.29,P =0.000).Area under the curve of diagnosing benign and malignant of breast lesions was 0.875 for SR( P ＜0.0001).If the cut-off point of SR was 3.26,the sensitivity in differentiating breast lesions was 83.33％,while the specificity was 82.35％.Conclusions SR is a helpful elasticity parameter for differentiating benign and malignant breast lesions of BI-RADS Ⅳ diagnosed by conventional ultrasound.
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Objective To evaluate hepatic perfusion assessed by contrast-enhanced ultrasonography (CEUS) for predicting cirrhosis accurately and non-invasively.Methods Forty patients with cirrhosis and twenty-five healthy controls were given CEUS examination,and time-intensity curves were drawn as the regions of interest located in liver parenchyma by using QLAB analyzing soft.The parameters of the two groups as follows:intensity of arterial perfusion (Iap),intensity of total perfusion of liver parenchyma (Ipeak),intensity of portal venous perfusion (Ipp),the ratio of portal venous perfusion and total perfusion (Ipp/Ipeak) were compared by independent-samples t test,and the diagnostic value of parameters were analyzed by receiver operating characteristic (ROC) curve.Resnlts Iap was bigger,while Ipp,Ipp/Ipeak were smaller in patients than that in controls( P ＜0.001 ).But there was no significant difference on Ipeak between the two groups.When Iap,Ipp,Ipp/Ipeak were used for the diagnosis of cirrhosis,the sensitivity were 67.3 ％,92.7％,96.4％ and the specificity were 80.0％,96.0％,92.3％,respectively.Conclusions CEUS can reflect the changes of the blood perfusion of cirrhotic liver.CEUS parameters Iap,Ipp,Ipp/Ipeak are significant different between the two groups and can be the non-invasive diagosis parameters of cirrhosis.
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Objective To evaluate the value of contrast-enhanced uhrasound(CEUS)for liver fibrosis.Methods Ninty-two chronic hepatitis B patients with histology diagnosis and fifteen health control were detected by CEUS,dynamic images and the time-intensity curve were analyed.Results Hepatic veinartery transit(HV-ATT)became shorter in the early hepatic cirrhosis patients [(7.5±2.1)s]compared to the control[(11.8±2.7)s].However,there was no difference between the fibrosis patients [(13.0±2.2)s]and the control.Furthermore,HV-ATT of the fibrosis patients with S1 to S3 stage were(11.7±2.7)s(S1),(11.8±3.0)S(S2),(11.8±2.3)s(S3)without significant difference.Conclusions CEUS is valuable in diagnosing earlier hepatic cirrhosis,but not fibrosis.
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Objective To evaluate the efficacy and feasibility of ultrasound-guided percutaneous microwave ablation for peripheral lung cancer. Methods Seventeen patients with peripheral lung cancer (23 nodules) were treated with ultrasound-guided microwave ablation. The microwave energy was initially set at 60 W for 100s, and then at 30~40 W for 300~600 s. The treatment was conducted by using multiple simultaneously-powered antennas in lesions ≥3 cm in diameter. Results After the treatment, all the nodules were decreased in size and the blood flow signals inside the nodule disappeared (14 nodules) or weakened (9 nodules). Enhanced CT scanning revealed no enhancement in 16 nodules and partial enhancement in 7. Repeated biopsy in 4 patients showed a complete tumor necrosis. Clinical symptoms disappeared in 8 patients and subsided in 9 patients 1 month after treatment. Follow-up observations in 15 patients for 6~47 months (mean, 23 months) showed 9 survivors, without serious complications. Conclusions Ultrasound-guided percutaneous microwave ablation is an effective, safe, and feasible method for treating peripheral lung cancer.