[Ultrasonographic assessment and differentiation of spontaneous degenerating cystic thyroid nodules and papillary thyroid carcinomas].

Objective: To analyze the features of degenerating cystic thyroid nodules (DCTN) on conventional ultrasound and contrast-enhanced ultrasound (CEUS), and to explore the differentiation between DCTN and papillary thyroid carcinomas (PTC). Methods: A total of 46 DCTN (39 cases, including 12 males and 27 females, with an age range of 25 to 76 years) and 36 PTC (32 cases, including 8 males and 24 females, with an age range of 23 to 68 years) diagnosed via fine- needle aspiration (FNA) or surgery from February 2019 to January 2020 in the First Affiliated Hospital of Nanchang University were enrolled. The size, shape, margin, echogenicity, presence of shadowing, calcification and vascularity of DCTN and PTC were retrospectively evaluated, and 28 DCTN and 30 PTC underwent CEUS were separately analyzed and compared.The t test, χ² test or Fisher's exact test were implemented to compare the features of ultrasound among the two groups. The binary Logistic regression test was performed to determine whether the feature whose difference was statistically significant was an independent predictive risk factor. Results: A univariate analysis indicated that DCTN more frequently showed wider-than-tall shapes, marked hypoechogenicity, well-defined margin and no or dot-lined enhancement (wider-than-tall shapes: 36 vs. 17, χ2=8.511; well-defined margin: 30 vs. 15, χ2=4.523; marked hypoechogenicity: 27 vs. 9, χ2=9.310; no or dot-lined enhancement: 24 vs. 3, χ2=33.369; all P＜0.05). A multivariate analysis demonstrated that wider-than-tall shapes, well-defined margin and marked hypoechogenicity were independent predictors for DCTN (OR values were 5.204, 3.134 and 5.042, P values were 0.003, 0.031, and 0.003, respectively). Among 28 DCTN, 15 showed a decrease in mean maximum diameter (24.3±11.4 mm) with a mean time span of (18.6±10.5) months between the presence and absence of suspicious ultrasound features. Conclusions: Compared with PTC, DCTN shows the ultrasound characteristics of wider-than-tall shapes, well-defined margin, marked hypoechogenicity and no or dot-lined enhancement pattern. Ultrasound follow-up can help to identify spontaneous DCTN.

A service evaluation of an occupational health Covid-19 referral pathway.

BACKGROUND: A rapid management referral pathway was established by a private UK occupational health (OH) provider to offer assessments and advice on managing individual risk relating to Covid-19 in the workplace. AIMS: The aim of this service evaluation was to assess the utilization and effectiveness of the pathway in supporting referrers during a pandemic. METHODS: Referrals between March-August 2020 were analysed by date and industry to assess service utilization. A survey was sent to a convenience sample of referrers throughout this period, requesting feedback on whether the report led to a change in how the worker was managed, and whether it increased referrer confidence in managing the worker. RESULTS: Five hundred and seventy referrals were made, predominantly from wholesale and retail; professional, scientific and technical; and food and drink production. There was a small peak of referrals from manufacturing in April and a larger peak in July-August from wholesale and retail, and food and drink production. Of 166 surveys sent, 58 were completed (35% response rate). In 71% of cases, referrers indicated that the report led to change in how the worker was managed, and in 86% of cases, referrers reported being more confident in managing the worker. CONCLUSIONS: The pathway was well-utilized. OH assessments and advice have an important role to play in a pandemic, with useful impact on how workers are managed and how confident managers feel in managing workers.

Sentinel approach to detect emerging causes of work-related respiratory diseases.

BACKGROUND: The world of work is continually changing, and this could result in new and emerging risks being introduced, including those that may cause work-related respiratory diseases (WRRD). AIMS: To describe recently emerging and new cases of WRRD and the relevant methodology using data in a national occupational respiratory disease surveillance scheme in the UK. METHODS: Incident cases of respiratory diseases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) between January 2015 and December 2017 were included. Potentially emerging respiratory hazards manifesting in SWORD data were identified with the following hierarchical approach: (i) new respiratory disease not previously associated with work, (ii) specific exposure/agent not previously associated with WRRD and (iii) industry and/or occupation not previously associated with WRRD. RESULTS: A total of 1215 cases of WRRD were reported to SWORD between January 2015 and December 2017. No new WRRD were identified. Thirteen potentially emerging causes of occupational asthma were identified, including exposures to agents such as ninhydrin. Four potential new causes were identified for interstitial pneumonia, which included wood and brass dust. Two potentially emerging causes of WRRD were identified for inhalational accidents (green coffee and nitrocellulose), hypersensitivity pneumonitis (diphenylmethane diisocyanate and salami mould), rhinitis (morphine and Amaranthus quitensis) and sarcoidosis (prions and horses). CONCLUSIONS: Continuous monitoring and reporting of any new work-related disease is a critical function of any occupational disease reporting scheme. Potential emerging causes of work-related health risks have been identified by using a simple and systematic way of detecting emerging causes of WRRDs.

Differential reporting of work-related mental ill-health in doctors.

BACKGROUND: Evidence suggests that the medical profession is reluctant to report mental ill-health despite its high prevalence. AIMS: To compare differential reporting patterns in the incidence of work-related mental ill-health (WRMIH) affecting doctors with selected comparison occupational groups, as determined by surveillance by general practitioners (GPs), specialist psychiatrists and occupational physicians (OPs). METHODS: New cases of medically reported WRMIH were reported prospectively between 2006 and 2009 by GPs, psychiatrists and OPs as part of The Health and Occupation Research (THOR) network. For GP and psychiatry reporting schemes, incidence rates (IRs) for doctors, nurses, teachers, corporate managers and protective service workers were calculated using information from the Labour Force Survey as the denominator. In OP surveys, participating reporters provided denominator information to calculate IRs for doctors, nurses and teachers. RESULTS: Average annual IRs expressed per 100000 person/years employed as reported by GPs, psychiatrists and OPs, respectively, were: doctors (309, 971, 430), nurses (891, 208, 670), teachers (1040, 136, 210) and for GPs and psychiatrists, respectively, were: protective service workers (1432, 721) and corporate managers (428, 90). Psychiatrists reported a higher incidence of WRMIH in doctors, whereas GPs reported higher incidences of WRMIH in other occupations (chi-squared test, P < 0.001). CONCLUSIONS: The distribution of the incidence of new cases reported across different schemes suggests a differential reporting pattern of WRMIH in doctors. The higher IR for doctors in psychiatrist-reported WRMIH could be due to factors such as disease severity and bypassing formal referral channels.

EELAB: an innovative educational resource in occupational medicine.

BACKGROUND: Postgraduate education, training and clinical governance in occupational medicine (OM) require easily accessible yet rigorous, research and evidence-based tools based on actual clinical practice. AIMS: To develop and evaluate an online resource helping physicians develop their OM skills using their own cases of work-related ill-health (WRIH). METHODS: WRIH data reported by general practitioners (GPs) to The Health and Occupation Research (THOR) network were used to identify common OM clinical problems, their reported causes and management. Searches were undertaken for corresponding evidence-based and audit guidelines. A web portal entitled Electronic, Experiential, Learning, Audit and Benchmarking (EELAB) was designed to enable access to interactive resources preferably by entering data about actual cases. EELAB offered disease-specific online learning and self-assessment, self-audit of clinical management against external standards and benchmarking against their peers' practices as recorded in the research database. The resource was made available to 250 GPs and 224 occupational physicians in UK as well as postgraduate OM students for evaluation. RESULTS: Feedback was generally very favourable with physicians reporting their EELAB use for case-based assignments. Comments such as those suggesting a wider range of clinical conditions have guided further improvement. External peer-reviewed evaluation resulted in accreditation by the Royal College of GPs and by the Faculties of OM (FOM) of London and of Ireland. CONCLUSIONS: This innovative resource has been shown to achieve education, self-audit and benchmarking objectives, based on the participants' clinical practice and an extensive research database.

[The value of fractionated exhaled nitric oxide in the diagnosis of asthma-chronic obstructive pulmonary disease overlap syndrome].

Objective: To explore the diagnostic value of fractionated exhaled nitric oxide (FeNO) measurement in patients with asthma-chronic obstructive pulmonary disease(COPD) overlap syndrome (ACOS). Methods: Eighty-one patients with ACOS, 76 patients with asthma, 82 patients with COPD and 39 healthy non-smoking subjects were recruited in the study. Naku Lun breath analyzer was used to measure the level of FeNO in the 4 groups. Pulmonary function was also measured. The ROC curve was used to differentiate ACOS from patients with COPD. The correlation between FeNO and lung function was analyzed with Pearson correlation analysis. Results: The levels of FeNO in asthmatic group, COPD group, ACOS group and healthy group were (102.3±8.2)×10(9,) (23.7±0.6)×10(9,) (50.2±3.2)×10(9,) and (18.5±7.1)×10(9) respectively. Among the former 3 groups, the differences of FeNO were statistically significant (P<0.05). FeNO>29×10(9) was the best cutoff point to differentiate ACOS from COPD; the sensitivity was 80%, specificity was 73%, positive predictive value was 75%, and negative predictive value and accuracy was 79% and 77%. There was no correlation between FeNO and FEV(1)% or FEV(1)/FVC in ACOS, COPD and asthma groups (r=0.12, 0.11, P>0.05; r=0.11, 0.03, P>0.05; r=0.06, 0.08, P>0.05). Conclusion: FeNO is a good marker to help clinicians differentiate ACOS from COPD. FeNO>29×10(9) was the best cutoff point for the identification of patients with ACOS from COPD.

[Diagnosis and treatment of orbit solitary fibrous tumor: a report of 4 cases].

OBJECTIVE: To investigate the diagnosis, treatment and prognosis of orbital solitary fibrous tumor. METHODS: Clinical data of 4 cases with orbital solitary fibrous tumor from January 2001 to June 2014 in the Second Affiliated Hospital of Xi'an Jiaotong University was retrospectively analyzed and the image, pathologic and immunohistochemical findings were reviewed. RESULTS: In the 4 cases, 3 were males and 1 was female, aged from 48 to 67 years. The main symptoms were unilateral progressive proptosis, orbital tumor and decreased vision. Two cases involved the left orbit and 2 in right. The locations of the tumor were in the lateral (2 cases) or inferior orbit (2 cases). Encapsulated smooth round shadow was shown in imaging examination and a homogeneous enhancement strengthening was seen by CT scanning. All cases underwent surgical resection and the removed tumors, appeared as round or irregular oval with fibrous capsule, were 1.5-5.0 cm in size. Three cases were pathological benign and 1 was malignant. Microscopically, the tumors were composed of a large number of spindle tumor cells and varying amounts of interstitial collagen deposition and angiogenesis. There was no atypia in benign tumor, while there was atypia in malignant tumor. Moreover, the tumor was invasive, capsuleless and shown hyperplasia area by light microscope in the case with malignant disease. CD34 and Vimentin were positive in 4 cases and Bcl-2 positive in 2 cases by immunohistochemistry staining. One patient with malignant pathology showed strong positive staining of Ki-67 (>70%) and died of tumor recurrence 10 months after he received the second operation. No metastasis or recurrence occurred by a follow-up of 2 months to 5 years in other 3 cases. CONCLUSIONS: Orbital SFT is characteristic of unilateral progressive proptosis in symptom. Imaging examination is an important diagnostic tool and a complete surgical resection of the tumor is the primary treatment method. Diagnosis depends on pathological and immunohistochemical staining. Malignant transformation may be occurred from benign lesion, hence postoperative follow-up is essential for confirmed patients.(Chin J Ophthalmol, 2016, 52: 268-272).

TRAF2 is an NF-κB-activating oncogene in epithelial cancers.

Aberrant nuclear factor (NF)-κB activation is frequently observed in human cancers. Genome characterization efforts have identified genetic alterations in multiple components of the NF-κB pathway, some of which have been shown to be essential for cancer initiation and tumor maintenance. Here, using patient tumors and cancer cell lines, we identify the NF-κB regulator, TRAF2 (tumor necrosis factor (TNF) receptor-associated factor 2), as an oncogene that is recurrently amplified and rearranged in 15% of human epithelial cancers. Suppression of TRAF2 in cancer cells harboring TRAF2 copy number gain inhibits proliferation, NF-κB activation, anchorage-independent growth and tumorigenesis. Cancer cells that are dependent on TRAF2 also require NF-κB for survival. The phosphorylation of TRAF2 at serine 11 is essential for the survival of cancer cells harboring TRAF2 amplification. Together, these observations identify TRAF2 as a frequently amplified oncogene.