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OBJECTIVE To investigate the diagnostic efficacy of serum calcitonin(Ctn)in medullary thyroid cancer(MTC),the correlation between preoperative serum Ctn and clinicopathological features,and the risk factors affecting the progression of MTC disease during follow-up.METHODS The clinical data of 50 patients admitted to the Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine from 2011 to 2022 were systematically reviewed,the ROC curve calculated the diagnostic efficacy of Ctn and CEA levels on MTC,and the risk factors for lymph node metastasis in the central region of MTC were analyzed in univariate and multivariate,and the survival curve without disease progression was drawn to predict risk factors.RESULTS The ROC curve yields the preoperative cut-off value of Ctn was 23.81 pg/ml and the cut-off value of CEA was 3.035 ng/ml for the diagnosis of MTC.The age of disease,tumor diameter,and preoperative serum Ctn and CEA levels in MTC patients were higher than those in non-MTC patients.Ctn≥289.62 pg/ml was an independent risk factor for central lymph node metastasis in MTC.The survival curve showed that invasion of the capsule,central region metastasis,and TNM stage above T2 were risk factors for predicting disease progression(P<0.05).Patients with MTC who have disease progression have higher preoperative Ctn.CONCLUSION Serum Ctn has important clinical value in the differential diagnosis,preoperative evaluation and postoperative follow-up of MTC.
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Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d<DOT≤15.0 d), Q 3 (15.0 d<DOT≤27.0 d) and Q 4 (DOT>27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%<breast milk intake ratio≤50%), medium-ratio breastfeeding group (50%<breast milk intake ratio≤75%) and high-ratio breastfeeding group (breast milk intake ratio>75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.
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To investigate the effectiveness and safety of ultrasound-guided microwave ablation (MWA) in treatment of primary hyperparathyroidism (PHPT). A total of 12 PHPT patients with parathyroid adenoma were treated with MWA in Nanjing University of Chinese Medicine Affiliated Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to February 2021. The patients were followed up once every 3 months for 3-12 months. Levels of serum parathyroid hormone (PTH), calcium and phosphorus were detected before and 20 min, 4h and 1day after ablation, and during follow-up period. The volume and volume reduction rate of parathyroid lesion were compared before the treatment and at the end of follow-up. The technical and clinical success of MWA were assessed as well. At the end of follow-up, median serum PTH [66.60 (42.21,80.03) ng/L vs.169.90 (89.01,396.50) ng/L] and calcium [2.39 (2.32,2.49) mmol/L vs. 2.75 (2.57,2.96) mmol/L] levels in 12 patients decreased significantly (all P<0.05). A complete response in terms of PTH and calcium levels was achieved in 6 of the 12 patients, while 4 of the patients had slightly elevated PTH levels just above the upper limit of normal reference range, and 2 of the patients remained abnormal PTH and calcium levels. The clinical cure rate was 50%. The volumes of all lesion after ablation were significantly decreased ( P<0.05), with the technical success rate reaching 92.3%. No serious complications were observed. Ultrasound-guided MWA, thus, is safe and effective in the treatment of PHPT.
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Objective To compare the clinical value of ultrasonic elastography ( UE) and three common ultrasonic features in diagnosing papillary thyroid carcinoma ( PTC).Methods From January 2012 to December 2017,the clinical data of 105 cases with PTC which were confirmed by postoperative pathologic examination and 20 cases with benign thyroid nodules (BTN) in the Integration of Chinese and Western Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine were analyzed retrospectively.The UE and common ultrasonic features comprising a taller -than-wide shape,irregular margins and microcalcifications were analyzed.The sensitivity, specificity and area under curve ( AUC) of PCT dingnosis with two different ultrasonic parameters are calculated. Results Based on surgical pathology ,the diagnostic sensitivity of irregular boundary is the highest amony the three paraneters of ordinary ultrasound.Although an irregular margin showed higher sensitivity than taller -than -wide shape and microcalcifications with 71.42% vs.59.04% vs.60.00%,but there was no statistically significant difference (χ2 ＝4.3,P＝0.116).There was also no statistically significant difference in specificity (χ2 ＝0.134,P＝0.935). The diagnostic efficiency of UE was higher than taller -than-wide shape (Z＝3.046,P＝0.002),irregular margin (Z＝2.962,P＝0.003) as well as microcalcifications (Z＝3.942,P＝0.000),the difference was statistically signifi-cant(P＜0.05).The diagnostic efficiency of UE was higher than the combined three common ultrasonic features together (Z＝3.125,P＝0.001).Conclusion UE score shows a higher diagnostic efficiency ,easy to perform, indicating the important application value in preoperative diagnosis of PTC ,and is worthy of promoting in clinic.
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Objective@#To compare the clinical value of ultrasonic elastography (UE) and three common ultrasonic features in diagnosing papillary thyroid carcinoma (PTC).@*Methods@#From January 2012 to December 2017, the clinical data of 105 cases with PTC which were confirmed by postoperative pathologic examination and 20 cases with benign thyroid nodules (BTN) in the Integration of Chinese and Western Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine were analyzed retrospectively.The UE and common ultrasonic features comprising a taller-than-wide shape, irregular margins and microcalcifications were analyzed.The sensitivity, specificity and area under curve (AUC) of PCT dingnosis with two different ultrasonic parameters are calculated.@*Results@#Based on surgical pathology, the diagnostic sensitivity of irregular boundary is the highest amony the three paraneters of ordinary ultrasound.Although an irregular margin showed higher sensitivity than taller-than-wide shape and microcalcifications with 71.42% vs.59.04% vs.60.00%, but there was no statistically significant difference (χ2=4.3, P=0.116). There was also no statistically significant difference in specificity (χ2=0.134, P=0.935). The diagnostic efficiency of UE was higher than taller-than-wide shape (Z=3.046, P=0.002), irregular margin(Z=2.962, P=0.003) as well as microcalcifications(Z=3.942, P=0.000), the difference was statistically significant(P<0.05). The diagnostic efficiency of UE was higher than the combined three common ultrasonic features together (Z=3.125, P=0.001).@*Conclusion@#UE score shows a higher diagnostic efficiency, easy to perform, indicating the important application value in preoperative diagnosis of PTC, and is worthy of promoting in clinic.