Artificial intelligence assisted diagnosis of early tc markers and its application.

Thyroid cancer (TC) is a common endocrine malignancy with an increasing incidence worldwide. Early diagnosis is particularly important for TC patients, because it allows patients to receive treatment as early as possible. Artificial intelligence (AI) provides great advantages for complex healthcare systems by analyzing big data based on machine learning. Nowadays, AI is widely used in the early diagnosis of cancer such as TC. Ultrasound detection and fine needle aspiration biopsy are the main methods for early diagnosis of TC. AI has been widely used in the detection of malignancy in thyroid nodules by ultrasound images, cytopathology images and molecular markers. It shows great potential in auxiliary medical diagnosis. The latest clinical trial has shown that the performance of AI models matches with the diagnostic efficiency of experienced clinicians, and more efficient AI tools will be developed in the future. Therefore, in this review, we summarized the recent advances in the application of AI algorithms in assessing the risk of malignancy in thyroid nodules. The objective of this review was to provide a data base for the clinical use of AI-assisted diagnosis in TC, as well as to provide new ideas for the next generation of AI-assisted diagnosis in TC.

Application of thyroglobulin and anti-thyroglobulin antibody combined with emission computed tomography in the adjuvant diagnosis of differentiated thyroid carcinoma.

PURPOSE: Thyroid nodules are a kind of common endocrine system disease, with approximately 5% of them developing into malignant lesions, the most common of which belong to differentiated thyroid carcinoma (DTC). Accurate differential diagnosis using reliable methods and targeted treatment of benign and malignant thyroid nodules are of great significance to improve patient outcomes. This study mainly investigates the diagnostic value of thyroglobulin (Tg) and anti-thyroglobulin antibody (anti-TgAb) combined with emission computed tomography (ECT) in the adjuvant diagnosis DTC. METHODS: All the data of 387 histopathologically diagnosed DTC patients (observation group) and 151 patients with nodular goiter (control group) admitted between June 2019 and June 2021 were collected and retrospectively analyzed. Serum Tg and anti-TgAb levels were detected in all subjects. In addition, all patients in the observation group underwent thyroid ECT, and the results were compared with the pathological findings. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic performance of Tg, TgAb and thyroid ECT, either alone or in combination, in patients with thyroid cancer (TC). RESULTS: The consistency test showed that Tg (Kappa-value = 0.370) and anti-TgAb (Kappa-value = 0.393) had generally consistent efficiency with pathological findings in the diagnosis of DTC; ECT (Kappa-value = 0.625) and the combined diagnosis of the three (Kappa-value = 0.757) showed higher consistency than the pathological diagnosis, of which the combined diagnosis contributed to an even higher consistency. The combined diagnosis of Tg, anti-TgAb, and thyroid ECT outperformed either of these alone in DTC diagnosis, with a sensitivity of 91.5%, a specificity of 86.1%, and an accuracy of 90%. CONCLUSIONS: The combination of Tg. anti-TgAb, and RNI can effectively improve the diagnostic accuracy of DTC and reduce the missed diagnosis rate, which has important reference significance for clinical diagnosis and treatment of TC.

MRI-Based Artificial Intelligence in Rectal Cancer.

Rectal cancer (RC) accounts for approximately one-third of colorectal cancer (CRC), with death rates increasing in patients younger than 50 years old. Magnetic resonance imaging (MRI) is routinely performed for tumor evaluation. However, the semantic features from images alone remain insufficient to guide treatment decisions. Functional MRIs are useful for revealing microstructural and functional abnormalities and nevertheless have low or modest repeatability and reproducibility. Therefore, during the preoperative evaluation and follow-up treatment of patients with RC, novel noninvasive imaging markers are needed to describe tumor characteristics to guide treatment strategies and achieve individualized diagnosis and treatment. In recent years, the development of artificial intelligence (AI) has created new tools for RC evaluation based on MRI. In this review, we summarize the research progress of AI in the evaluation of staging, prediction of high-risk factors, genotyping, response to therapy, recurrence, metastasis, prognosis, and segmentation with RC. We further discuss the challenges of clinical application, including improvement in imaging, model performance, and the biological meaning of features, which may also be major development directions in the future. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.

Hypoxia-responsive circRNAs: A novel but important participant in non-coding RNAs ushered toward tumor hypoxia.

Given the rapid developments in RNA-seq technologies and bioinformatic analyses, circular RNAs (circRNAs) have gradually become recognized as a novel class of endogenous RNAs, characterized by covalent loop structures lacking free terminals, which perform multiple biological functions in cancer genesis, progression and metastasis. Hypoxia, a common feature of the tumor microenvironments, profoundly affects several fundamental adaptive responses of tumor cells by regulating the coding and non-coding transcriptomes and renders cancer's phenotypes more aggressive. Recently, hypoxia-responsive circRNAs have been recognized as a novel player in hypoxia-induced non-coding RNA transcriptomics to modulate the hypoxic responses and promote the progression and metastasis of hypoxic tumors. Moreover, via extracellular vesicles-exosomes, these hypoxia-responsive circRNAs could transmit hypoxia responses from cancer cells to the cells of surrounding matrices, even more distant cells of other organs. Here, we have summarized what is known about hypoxia-responsive circRNAs, with a focus on their interaction with hypoxia-inducible factors (HIFs), regulation of hypoxic responses and relevance with malignant carcinoma's clinical features, which will offer novel insights on the non-coding RNAs' regulation of cancer cells under hypoxic stress and might aid the identification of new theranostic targets and define new therapeutic strategies for those cancer patients with resistance to radiochemotherapy, because of the ubiquity of tumoral hypoxia.

Apatinib vs Placebo in Patients With Locally Advanced or Metastatic, Radioactive Iodine-Refractory Differentiated Thyroid Cancer: The REALITY Randomized Clinical Trial.

IMPORTANCE: Patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) have a poor prognosis and limited treatment options. OBJECTIVE: To assess the efficacy and safety of apatinib, a highly selective vascular endothelial growth factor (VEGFR-2) inhibitor, in patients with progressive locally advanced or metastatic RAIR-DTC. DESIGN, SETTING, AND PARTICIPANTS: This randomized, double-blind, placebo-controlled, phase 3 trial (Efficacy of Apatinib in Radioactive Iodine-refractory Differentiated Thyroid Cancer [REALITY]) was conducted in 92 patients with progressive locally advanced or metastatic RAIR-DTC between February 17, 2017, and March 2, 2020, at 21 sites within China, and the data cutoff date for this analysis was March 25, 2020. INTERVENTIONS: Patients were randomly assigned (1:1) to apatinib, 500 mg/d, or placebo. Patients who developed progression while receiving placebo were allowed to cross over to apatinib. MAIN OUTCOMES AND MEASURES: The primary end point was investigator-assessed progression-free survival (PFS). Secondary end points included overall survival, objective response rate (ORR), disease control rate (DCR), duration of response, time to objective response, and safety. Intention-to-treat analyses were performed to evaluate efficacy. RESULTS: Of the 92 patients included in the trial, 56 were women (60.9%); mean (SD) age at baseline was 55.7 (10.6) years. Patients were randomized to the apatinib (n = 46) or placebo (n = 46) group. The median follow-up duration was 18.1 (IQR, 12.7-22.2) months. The median PFS was 22.2 (95% CI, 10.91-not reached) months for apatinib vs 4.5 (95% CI, 1.94-9.17) months for placebo (hazard ratio, 0.26; 95% CI, 0.14-0.47; P < .001). The confirmed ORR was 54.3% (95% CI, 39.0%-69.1%) and the DCR was 95.7% (95% CI, 85.2%-99.5%) in the apatinib group vs an ORR of 2.2% (95% CI, 0.1%-11.5%) and DCR of 58.7% (95% CI, 43.2%-73.0%) in the placebo group. The median overall survival was not reached for apatinib (95% CI, 26.25-not reached) and was 29.9 months (95% CI, 18.96-not reached) for placebo (hazard ratio, 0.42; 95% CI, 0.18-0.97; P = .04). The most common grade 3 or higher-level treatment-related adverse events in the apatinib group were hypertension (16 [34.8%]), hand-foot syndrome (8 [17.4%]), proteinuria (7 [15.2%]), and diarrhea (7 [15.2%])-none of which occurred in the placebo group. CONCLUSIONS AND RELEVANCE: The REALITY trial met its primary end point of PFS at the prespecified interim analysis. Apatinib showed significant clinical benefits in both prolonged PFS and overall survival with a manageable safety profile in patients with progressive locally advanced or metastatic RAIR-DTC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03048877.

Exosomal circular RNA hsa_circ_007293 promotes proliferation, migration, invasion, and epithelial-mesenchymal transition of papillary thyroid carcinoma cells through regulation of the microRNA-653-5p/paired box 6 axis.

Circular RNAs (circRNAs) or exosomes have been reported to exert key regulatory and/or communication functions in human cancer. Nevertheless, current literature on the effects of exosomal circRNAs on tumor invasion and metastasis in thyroid cancer is incomplete. The role of tumor-derived exosomes in driving in vitro papillary thyroid carcinoma (PTC) progression and metastasis requires further investigation. In our study, Exosomes were harvested from PTC patient serum and PTC cell culture medium. Gene expression analysis in PTC cell lines and exosomes was performed with quantitative reverse-transcription polymerase chain reaction. Transwell, wound healing, Western blot assays, and the cell counting kit-8 were applied for functional analysis. Dual-luciferase reporter assay was used to examine the interaction between hsa_circ_007293 (circ007293), microRNA (miR)-653-5p, and paired box 6 (PAX6). Results showed that circ007293 was enriched in exosomes derived from PTC patient serum and cell culture media. Moreover, circ007293 could enter PTC cells through exosomes, and exosomal circ007293 promoted PTC cell epithelial-mesenchymal transition, invasion, migration, and proliferation. circ007293 knockdown reversed the malignant phenotype of PTC cells in vitro. Additionally, circ007293 could competitively bind with miR-653-5p to regulate PAX6 expression. Notably, miR-653-5p overexpression or PAX6 inhibition suppressed the malignant effects of exosomal circ007293. These results evidenced that exosomal circ007293 induced EMT and augmented the invasive and migratory abilities of PTC cells via the miR-653-5p/PAX6 axis, suggesting that it may serve as a promising biomarker for cancer progression.

Activation of the TGF-ß1/Smad signaling by KIF2C contributes to the malignant phenotype of thyroid carcinoma cells.

Kinesin family member 2C (KIF2C) has been identified as a potential oncogene in various types of human cancers; however, the role of KIF2C in thyroid cancer has not yet been elucidated. Quantitative real-time polymerase chain reaction and western blotting were employed for gene expression analysis. Cell Counting Kit-8 and ethynyl-2'-deoxyuridine assays were performed to examine cell proliferation. Cell migration and invasion were assessed by wound-healing and transwell invasion assays. Results showed that KIF2C expression was upregulated in thyroid carcinoma cell lines. In addition, upregulation of KIF2C promoted the proliferation, migration, and invasion of thyroid carcinoma cells, while downregulation of KIF2C exerted the opposite effects. Overexpression of KIF2C induced the activation of transforming growth factor-ß1 (TGF-ß1)/Smad signaling in thyroid carcinoma cells. However, inhibition of TGF-ß1/Smad signaling through silencing TGF-ß1 attenuated the promoting effects of KIF2C overexpression on the malignant phenotype of thyroid carcinoma cells. Besides, overexpression of TGF-ß1 suppressed the inhibitory effect of KIF2C knockdown on the proliferation and metastasis of thyroid carcinoma cells. In conclusion, our findings demonstrated that KIF2C contributed to the malignant phenotype of thyroid carcinoma cells by inducing the activation of TGF-ß1/Smad signaling, thus uncovering a novel mechanism for thyroid carcinoma progression.

Application of Pet-CT Fusion Deep Learning Imaging in Precise Radiotherapy of Thyroid Cancer.

This article explores the value of wall F-FDG PET/Cr imaging in the diagnosis of thyroid cancer, studies its ability to distinguish benign and malignant thyroid lesions, and seeks ways to improve the accuracy of diagnosis. The normal control group selected 40 patients who came to our center for physical examination. In the normal control group, the average value of the standard uptake value of both sides of the thyroid was used as the SUV of the thyroid gland and the highest SUV value of the patient's lesion (SUV max) represented the SUV of the lesion. After injection of imaging agent 18F-FD1G, routine imaging was performed at 1h, time-lapse imaging was performed at 2.5 h, and the changes with conventional imaging were compared to infer the benign and malignant lesions. We used SPSS software to carry out statistical analysis, respectively, carrying out analysis of variance, paired t-test, independent sample t-test, and linear correlation analysis. In the thyroid cancer group, 87.5% of the delayed imaging SUV was higher than the conventional imaging SUV, while 83.33% of the benign disease group had a lower SUV than the conventional imaging SUV. 18F-FDG PET/CT imaging has higher sensitivity and specificity for the diagnosis of recurrence or metastasis in patients with Tg positive. However, it has lower sensitivity and specificity for the diagnosis of 131I-Dx-WBS negative DTC and 18F-FDG PET/CT. The specificity increases with the increase of serum Tg level. The above results confirm that 18F-FDG PET/CT imaging is of great significance for the diagnosis of recurrence or metastasis in patients; with PET/CT imaging, the results changed 16.13% of the Tg-positive and 131I-Dx-WBS negative DTC patients' later treatment decision. The decision-making and curative effect evaluation have certain value.

Silencing of AHNAK2 restricts thyroid carcinoma progression by inhibiting the Wnt/ß-catenin pathway.

AHNAK nucleoprotein 2 (AHNAK2) has been proposed to have an oncogenic role in various human cancers. However, the functional role of AHNAK2 in thyroid carcinoma (TC) progression has never been explored. In this study, quantitative real-time polymerase chain reaction and western blot were conducted to evaluate the expression of genes. The functional role of AHNAK2 was elucidated by cell count kit-8, colony-forming assay, wound-healing assay, and Transwell invasion assay. We found that AHNAK2 was highly expressed in thyroid carcinoma, and it was tightly correlated with the pathological stage in TC. The mRNA and protein levels of AHNAK2 were increased in TC cells. Silencing of AHNAK2 restricted the proliferation, metastasis, and epithelial-mesenchymal transition (EMT) of TC cells. AHNAK2 silencing inhibited the protein expression of ß-catenin and cyclin D1, and AHNAK2 overexpression had the opposite effects. Moreover, LiCl or ICG-001 exposure counteracted the effects of AHNAK2 silencing or upregulation on malignant phenotypes of TC cells. In conclusion, the knockdown of AHNAK2 restrained the proliferation, metastasis, and EMT of TC cells by inhibiting the Wnt/ß-catenin pathway, providing a new potential mechanism of AHNAK2 in understanding the oncogenesis and progression of TC.

Overexpression of serum lncRNA-ABHD11-AS1 as poor prognosis of patients with papillary thyroid carcinoma.

This paper was aimed at exploring the correlation of long non-coding RNA (lncRNA)-ABHD11 Antisense RNA1 (ABHD11-AS1) with the poor prognosis of patients with papillary thyroid carcinoma (PTC) and at investigating its effects on the survival of PTC cells. Serum was respectively collected from 64 PTC patients who were admitted to our hospital (PTC group) and from 50 healthy controls who underwent physical examinations (HC group) both from April 2011 to April 2015. The expression levels of ABHD11-AS1 in the serum were detected, and the values of it for diagnosis and prognosis (5-year follow-ups) were analyzed. The knockdown and overexpression models of ABHD11-AS1 in were constructed to explore the effects of the models on their proliferation, cycles and apoptosis. According to the data, the expression levels of serum ABHD11-AS1 in the PTC patients were remarkably higher than those in the healthy controls, and the area under the curve (AUC) for distinguishing the patients from the controls was 0.920. In the analysis of prognosis, the levels in patients with a poor prognosis were remarkably higher than those in patients with a good prognosis. According to the curves of overall survival rates (OSRs), the high levels of ABHD11-AS1 were remarkably correlated with the poor prognosis (a lower 5-year OSR). COX analysis showed that TNM staging, lymph node metastasis and ABHD11-AS1 were the independent prognostic factors of PTC patients. In the cell experiments, knocking down ABHD11-AS1 remarkably inhibited PTC cells from proliferation, arrested them in G0/G1 phase, and induced their apoptosis, negatively affecting their survival indices. Overexpressing this RNA had positive effects on the survival indices. Taken together, high levels of serum ABHD11-AS1 are related to the poor prognosis of PTC patients, and knocking down its expression can inhibit the survival of PTC cells.

Incidental detection of primary hepatocellular carcinoma on 18F-prostate-specific membrane antigen-1007 positron emission tomography/computed tomography imaging in a patient with prostate cancer: A case report.

RATIONALE: Prostate-specific membrane antigen positron emission tomography-computed tomography (F-PSMA-1007 PET/CT) imaging is an emerging method for the diagnosis of prostate cancer (PC), but its efficiency in detecting other accompanying diseases has rarely been investigated. PATIENT CONCERNS: A 77-year-old man presented with a complaint of bone pain throughout his entire body lasting for 2 weeks. Routine preoperative whole-body bone scanning revealed multiple osteogenic metastases. His alpha-fetoprotein and prostate-specific antigen levels were 108.2 ng/mL and 53.32 ng/mL, respectively. F-PSMA-1007 PET/CT imaging revealed high tracer uptake in the primary lesion in the liver and the peripheral zone of the prostate. DIAGNOSES: Due to the results from imaging and pathological examinations, a diagnosis of PC with multiple bone metastases accompanied by primary hepatocellular carcinoma was made. INTERVENTIONS: Taking into consideration the patient's age, interventional therapy was performed for the liver lesion, whereas the prostate and bone lesions were treated with endocrine therapy. OUTCOMES: The patient recovered well and was discharged uneventfully postoperatively. The patient was also doing well at the 6-month follow-up. LESSONS: PSMA-PET/CT imaging results must be interpreted cautiously when the uptake of PSMA increases in a single lesion instead of the most common sites of PC metastasis. Pathological examination of the suspected lesions is also recommended.

Development of a generalized model for kidney depth estimation in the Chinese population: A multi-center study.

PURPOSE: To establish an accurate and reliable equation for kidney depth estimation in adult patients from different Chinese geographical regions. METHOD: This multicenter study enrolled Eastern Asian Chinese patients with abdominal PET/CT scans at 26 imaging centers from six macro-regions across China in 3 years. Age, gender, height, weight, primary disease and its extent on PET scans of the participants were collected as potential predictive factors. Kidney depth on CT, defined as the average of the vertical distances from the posterior skin to the farthest anterior and closest posterior surfaces of each kidney, was measured as the standard reference. The new kidney depth model was constructed using a multiple regression model, and its performance was compared to those of three established models by computing the absolute value of estimation errors in comparison with CT-measured kidney depth. RESULTS: A total of 2502 patients were enrolled and classified into training (n=1653) and testing (n = 849) subsets. In the training subset, two kidney depth models were constructed: Left (cm): 0.013×age+0.117×gender-0.044×height+0.087×weight+7.951, Right (cm): 0.005×age+0.013×gender-0.035×height+0.082×weight+7.266 (weight: kg, height: cm, gender = 0 if female, 1 if male). In the testing subset, one-way analysis of variance showed that the estimation errors of the new models did not significantly differ among the 6 regions. Bland-Altman analysis determined that new equations had lower estimated biases (left: 0.039 cm, right: 0.018 cm) compared with other existing models. CONCLUSION: The new equations were highly accurate for kidney depth estimation in adults from all over China, with lower estimation errors compared to other established models.

LncRNA PVT1 Acts as a Tumor Promoter in Thyroid Cancer and Promotes Tumor Progression by Mediating miR-423-5p-PAK3.

INTRODUCTION: Thyroid cancer (TC) is an endocrine tumor whose risk of onset has been rising, so the deep understanding of its molecular mechanism helps formulate new treatment strategies. METHODS: This paper was aimed at exploring the regulatory mechanism of long non-coding RNA (LncRNA) plasmacytoma variant translocation 1 (PVT1) in TC. The expression of PVT1, miR-423-5p and p21-activated kinase 3 (PAK3) in TC tissues and cell lines was detected by real-time PCR. PAK3 levels were detected by Western blot. Regulatory relationships between target genes and the proliferation, invasion and apoptosis of cells and genes were analyzed. RESULTS: PVT1 and PAK3 upregulated while miR-423-5p downregulated in the tissues and cell lines. PVT1 downregulation inhibited TC cells from malignantly proliferating and invading, and promoted their apoptosis. PVT1 specifically regulated miR-423-5p, and its overexpression could weaken the anti-tumor effect of this miR on TC cells. In addition, miR-423-5p directly targeted PAK3, and knocking down its expression could weaken the inhibitory effect of PAK3 downregulation on TC progression. Besides, PVT1 acted as a competitive endogenous RNA to sponge this miR and thus regulate PAK3 expression. DISCUSSION: In conclusion, PVT1 can mediate the molecular mechanism of the miR-423-5p-PAK3 axis regulatory network on regulating TC, so it is a new direction of treating the disease.

HORMAD2 methylation-mediated epigenetic regulation of gene expression in thyroid cancer.

This study is aimed to investigate the methylation level of candidate genes and its impact on thyroid carcinoma (THCA) development. Infinium Human Methylation 450 BeadChip Arrays by Illumina (Illumina HM450K) was the most popular CpG microarray platform widely used in biological and medical research. The methylation level of differentially expressed genes and their corresponding CpG sites were analysed by R programme. The expression of HORMAD2 was evaluated by qRT-PCR and Western blot, while the methylation level was examined via methylation-specific PCR. Cell viability, metastasis, cell cycle and apoptosis were detected by MTT assay, transwell and wound healing assay and flow cytometry, respectively, after treatment with 5-aza-2'-deoxycytidine (5-Aza). Tumour formation assay was used to analyse thyroid tumour growth in nude mice in vivo. The methylation levels of all 116 differentially expressed genes were analysed. HORMAD2 was significantly hypermethylated and its mRNA expression was inhibited in THCA cells. After treatment with 5-Aza, HORMAD2 expression was up-regulated in THCA cells and its overexpression can suppress thyroid cancer cell viability, mobility and invasiveness remarkably. Up-regulation of HORMAD2 in THCA cells could prolong G0/G1 phase and shorten S phase to impede cell mitosis as well as promote thyroid cancer cells apoptosis. Furthermore, tumour formation assay showed that increased HORMAD2 level impeded tumour growth in vivo. Hypermethylation of HORMAD2 could induce THCA progression, while hypomethylation of HORMAD2 retard cell growth and mobility and facilitate apoptosis through increasing its mRNA expression.

LncRNA TNRC6C-AS1 regulates UNC5B in thyroid cancer to influence cell proliferation, migration, and invasion as a competing endogenous RNA of miR-129-5p.

To investigate the biological functions and regulatory mechanism of lncRNA TNRC6C-AS1 in thyroid cancer (TC). TNRC6C-AS1, miR-129-5p, and UNC5B expression levels were investigated by qRT-PCR and Western blot. CCK-8 assay was conducted to determine cell proliferation, while transwell assay was for inspection of cell migration and invasion. Through bioinformatic analysis, the interactions among TNRC6C-AS1, miR-129-5p, and UNC5B were predicted. Dual luciferase reporter gene assay and RNA pull-down assay confirmed the predicted target relationships. Tumor xenograft assay was applied to inspect the effect of TNRC6C-AS1 downregulation on TC development in vivo. TNRC6C-AS1 and UNC5B were overexpressed, while miR-129-5p was underexpressed in TC tissues and cells. TNRC6C-AS1/UNC5B downregulation and miR-129-5p overexpression could suppress proliferation, migration, and invasion of TC cells as well as inhibit tumorigenesis in vivo. MiR-129-5p targeted TNRC6C-AS1 and UNC5B in TC cells; and UNC5B expression was downregulated by knocking down TNRC6C-AS1, which competitively bound with miR-129-5p. Downregulation of TNRC6C-AS1 restrained TC development by knocking down UNC5B through upregulating the expression of miR-129-5p.

Case report of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography imaging of a patient with multiple endocrine gland metastases from small cell lung cancer.

Synchronous multiple endocrine gland metastasis caused by small cell lung cancer (SCLC) is rare. A patient was investigated for primary cancer because of suspected brain metastasis on computed tomography (CT). Baseline 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT was positive in the lung and multiple endocrine glands (right thyroid, right breast, pancreatic body, right adrenal gland, and left ovary). Histopathology confirmed small cell lung cancer. The patient's symptoms were alleviated after chemotherapy and brain radiotherapy. Follow-up PET-CT revealed that some of the lesions had disappeared and some had reduced in size. This rare case of multiple endocrine gland metastases from SCLC suggests that whole body PET-CT is a useful tool to detect rare/asymptomatic metastases.

Discriminant function analysis of the occurrence risk of abnormal electrocardiogram in thyroidectomized differentiated thyroid carcinoma patients with short-term overt hypothyroidism.

OBJECTIVES: The common form and risk factors of electrocardiogram (ECG) abnormality in thyroidectomized differentiated thyroid carcinoma (DTC) patients with short-term overt hypothyroidism were investigated and some discriminant formulas for forecasting the occurrence of abnormal ECG in this specific population were deduced in this study. METHODS: A total of 260 thyroidectomized DTC patients were retrospectively reviewed, 67 of whom had abnormal ECG and 193 normal ECG after short-term (3 weeks) levothyroxine (L-T4) withdrawal. One-way ANOVA, Spearman's rank correlation analysis and discriminant function analysis were performed using data from these DTC patients. RESULTS: A flat or inverted T wave in inferior myocardial and left ventricular wall leads was the most common abnormal ECG finding in short-term overt hypothyroidism. Statistical analyses showed that age, interval, TSH-end (The serum hormothyrin level at the end of L-T4 withdrawal for 3 weeks), and TSH-vel (The average ascending velocity of serum hormothyrin level during L-T4 withdrawal for 3 weeks) were statistically significant and positively correlated with the occurrence of abnormal ECG. Meanwhile, TSH-vel showed the highest correlation coefficient (r = 0.358, p = 0.000). The formulas, especially deduced from age, interval and TSH-vel, could discriminate patients with abnormal ECG or not as high as 77.6 and 70.5%, respectively (resubstitution accuracy: 72.3%). CONCLUSION: The thyroidectomized DTC patients undergoing short-term L-T4 withdrawal before their first radioiodine ablative therapy, who had one or more of the above-mentioned risk factors, are likely to show abnormal ECG findings. The formulas from discriminant function analysis may be helpful for predicting patients with abnormal ECG with short-term L-T4 withdrawal and allow appropriate medical intervention beforehand.

A Chinese patient with pusher syndrome and unilateral spatial neglect syndrome.

OBJECTIVE: To observe clinical manifestations, behavioral characteristics, and effects of rehabilitation on a patient with pusher syndrome and unilateral spatial neglect caused by right thalamic hemorrhage. METHODS: Assessment of pusher syndrome was made by the Scale for Contraversive pushing (SCP), and unilateral spatial neglect syndrome was diagnosed using line cancellation, letter and star cancellation, line bisection tests and copy and continuation of graphic sequence test. Behavioral therapy, occupational therapy, reading training and traditional Chinese medicine methods were adopted for treatment of pusher syndrome and unilateral spatial neglect. RESULTS: The patient showed typical pusher syndrome and unilateral spatial neglect symptoms. The pusher syndrome and unilateral spatial neglect symptoms were significantly improved following rehabilitation treatments. CONCLUSIONS: Pusher syndrome and unilateral spatial neglect syndrome occurred simultaneously after right thalamic hemorrhage. Early rehabilitation therapy can reduce the symptoms of pusher syndrome and unilateral spatial neglect syndrome and improve motor function.

Sex determination from the mandibular ramus flexure of Koreans by discrimination function analysis using three-dimensional mandible models.

It has been known that mandible ramus flexure is an important morphologic trait for sex determination. However, it will be unavailable when mandible is incomplete or fragmented. Therefore, the anthropometric analysis on incomplete or fragmented mandible becomes more important. The aim of this study is to investigate the sex-discriminant potential of mandible ramus flexure on the Korean three-dimensional (3D) mandible models with anthropometric analysis. The sample consists of 240 three dimensional mandibular models obtained from Korean population (M:F; 120:120, mean age 46.2 y), collected by The Catholic Institute for Applied Anatomy, The Catholic University of Korea. Anthropometric information about 11 metric was taken with Mimics, anthropometry libraries toolkit. These parameters were subjected to different discriminant function analyses using SPSS 17.0. Univariate analyses showed that the resubstitution accuracies for sex determination range from 50.4 to 77.1%. Mandibular flexure upper border (MFUB), maximum ramus vertical height (MRVH), and upper ramus vertical height (URVH) expressed the greatest dimorphism, 72.1 to 77.1%. Bivariate analyses indicated that the combination of MFUB and MRVH hold even higher resubstitution accuracy of 81.7%. Furthermore, the direct and stepwise discriminant analyses with the variables on the upper ramus above flexure could predict sex in 83.3 and 85.0%, respectively. When all variables of mandibular ramus flexure were input in stepwise discriminant analysis, the resubstitution accuracy arrived as high as 88.8%. Therefore, we concluded that the upper ramus above flexure hold the larger potentials than the mandibular ramus flexure itself to predict sexes, and that the equations in bivariate and multivariate analysis from our study will be helpful for sex determination on Korean population in forensic science and law.

Effects of siRNA targeting c-Myc and VEGF on human colorectal cancer Volo cells.

c-Myc and vascular endothelial growth factor (VEGF) genes are frequently deregulated and overexpressed in this malignancy, and strategies designed to inhibit c-Myc and VEGF expression in cancer cells may have considerable therapeutic value. In the present study, we design and use short interfering RNA (siRNA) to inhibit c-Myc and VEGF expression in colorectal cancer Volo cells and validate their effects on cell proliferation, cell cycle, apoptosis, and cell metastasis. Upon transient transfection with plasmid-encoding siRNA, it was found that expression of c-Myc and VEGF was significantly downregulated in siRNA-transfected cells and the downregulation of c-Myc and VEGF inhibited cell growth and induced apoptosis and metastasis of Volo cells. c-Myc and VEGF downregulation also increased cell population in the G0-G1 phase. In conclusion, the specific siRNA efficiently silenced the expression of c-Myc and VEGF, further suppressed the cell proliferation, triggered cell apoptosis, and inhibited cell invasiveness of colorectal cancer Volo cells.