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mTOR-Inhibition and also COVID-19 in Elimination Transplant Individuals: Focus on Lung Fibrosis.
With the success of modeling can be judged by the behaviors,pathomorphology,and neuroelectricity of the animals.These findings may inform further studies on the mechanisms of early-stage type 2 DPN and its interventions.Objective To investigate the magnetic resonance imaging(MRI)findings of ovarian thecomas and improve the accuracy of preoperative MRI diagnosis of the disease.Methods A retrospective analysis of 48 patients with ovarian thecoma confirmed by operation and pathology was performed.According to the maximum diameter,the lesions were divided into≥5 cm and less then 5 cm groups and analyzed in terms of location,size,shape,boundary,cystic necrosis,T1WI/T2WI signals,DWI characteristics,enhancement features,and pelvic effusion.The diagnostic score was evaluated by MRI(the highest score was 6 points).Results All the 48 lesions were single.In the≥5 cm group(n=39),the tumor boundary was clear in 37 cases and unclear in 2 cases;necrosis was found in 35 cases;T1WI showed equal signals in 23 cases and equal low signals in 16 cases;T2WI showed equal signals in 7 cases,equal low signals in 23 cases,and slightly higher signals in 9 cases;DWI showed high signals in 23 cases and mixed high signals in 16 cases;dynamic enhanced sc levels was significantly higher than that of patients without cystic lesions(χ2=5.847,P=0.016;contingency coefficeient=0.330).Conclusions Large ovarian thecomas have high or mixed high signals on DWI;they are often accompanied by pelvic fluid and cystic necrosis,and the cystic necrosis is common and has small involvement.For small ovarian thecomas,DWI often reveals high signals,and cystic necrosis is rare.MRI score evaluation combined with patient's age and other factors is helpful to improve the accuracy of preoperative diagnosis.Objective To assess the diagnostic value of dual energy pulmonary perfusion imaging(DEPI)for pulmonary embolism.Methods The clinical data of 87 patients with suspected pulmonary embolism who had received DEPI between August 2017 and July 2018 in Jiaxing Second Hospital were retrospectively analyzed.With the findings of CT pulmonary angiography(CTPA)as the reference standard and with patients and pulmonary lobes as evaluation units,respectively,a diagnostic test was performed to calculate the diagnostic coincidence rate,sensitivity,specificity,positive predictive value,negative predictive value,Youden index,positive likelihood ratio,negative likelihood ratio,and Kappa coefficient value for the diagnosis of DEPI and CTPA.Results The coincidence rate,sensitivity,specificity,positive predictive value,negative predictive value,Youden index,positive likelihood ratio,and negative likelihood ratio were 85.06%,88.41%,72.22%,92.42%,61.90%,0.61,3.18,and 0.16,respectively,when applying the patients as evaluation units.When the pulmonary lobes were invoked as evaluation units,the above-mentioned indexes were 89.57%,76.80%,96.82%,93.20%,88.02%,0.74,24.15,and 0.24,respectively.The diagnostic results of DEPI and CTPA had a good and excellent consistency,respectively(Kappa value=0.571,0.765).Conclusions DEPI has high accuracy,sensitivity,and specificity in the detection of pulmonary embolism.The combination of DEPI with CTPA can simultaneously obtain the anatomical structure and functional information images,greatly improving the diagnostic accuracy for pulmonary embolism.Thus,it can be used as the preferred examination for patients with clinically suspected pulmonary embolism.Objective To explore the value of contrast-enhanced ultrasound(CEUS)in the detection of peripheral nerve crush injury.Methods Thirty New Zealand white rabbits were randomly divided into normal control group and sciatic nerve crush injury group(which included 3-day,2-week,4-week,and 8-week groups after operation).The morphological structure and blood perfusion of the injured sciatic nerves were detected by high-frequency ultrasound,power Doppler ultrasound(PDUS),CEUS,and histopathology.Results Conventional ultrasound revealed that the internal diameter of nerves showed no significant difference between the 8-week group and the control group [(1.14±0.15)mm vs.(0.92±0.11)mm;t=4.72,P=0.86].Analysis of nerve blood perfusion showed that PDUS had a high sensitivity in displaying fine blood flow signal inside the injured nerve in the acute stage of inflammation(3-day group)but not good enough in the 4-and 8-week groups.CEUS could clearly show the microcirculation perfusion in the 3-day,2-week,4-week,and 8-week groups,and analyses of the area under the curve,the peak time,and the peak intensity showed that the nerve blood perfusion increased significantly 3 days after operation and then decreased gradually.Histopathological examination showed that the median cumulative OD value was 12 035.6(10 566.3,14 805.8)8 weeks after operation,which was still significantly lower than that 18 784.8(15 904.5,21 103.5)in the normal control group(H=6.10, P=0.0003).Conclusions Conventional high-frequency ultrasound and PDUS can not adequately evaluate the microcirculation perfusion in different periods after nerve injury.CEUS can quantitatively evaluate the microvascular perfusion of injured nerve at any period and provide more information for indirect evaluation of nerve regeneration.Objective To evaluate the factors affecting health-related quality of life (HRQoL) of patients with thyroid papillary microcarcinoma (PTMC) after ultrasound-guided radiofrequency ablation (RFA).Methods The clinical data of 100 patients with PTMC who underwent reexamination after RFA in the Ultrasound Department of our center from October to December 2019 were retrospectively analyzed.Demographic information was collected.SF-36 and Thyroid Cancer-specific Health-related Quality of Life Questionnaire scales were used to assess patients' quality of life and thyroid-related specific symptoms.The SF-36 scale includes two general domains including physical component summary (PCS) and mental component summary (MCS).The impacts of demographic characteristics and thyroid-related symptoms after RFA on PCS and MCS scores were further analyzed.Results Univariate analysis and correlation analysis showed that the PCS scores in quality of life of PTMC patients were related to sex, neuromuscular, voice, concentration, sympat-guided RFA were female gender, psychological burden, lack of attention, and symptoms in neuromuscular system and throat/mouth.Therefore, preoperative explanations should be made according to the relevant symptoms that the patients may report, and psychological interventions should be offered after RFA to improve the quality of life of PTMC patients after treatment.Objective To establish a predictive model for central compartment lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC).Methods We retrospectively evaluated patients with histologically confirmed PTC treated in Chinese PLA General Hospital between January 2018 and January 2019.Totally 855 patients undergoing thyroidectomy with central lymph node dissection were enrolled in this study (577 in the training cohort and 278 in the validation cohort).The clinical manifestations of the patients and the ultrasound features of the tumors were recorded.To predict the probability of CLNM,we developed the clinical-ultrasound model with significant factors selected by the stepwise logistic regression.The Akaike Information Criterion (AIC) was use to select the optimal model,and the area under the curve (AUC) and the calibration curves were used to evaluate the performance of the prediction model.Results Multivariate analysis showed that sex (P2 cm (P=0.008),multifocality (P=0.029),microcalcification (P=0.019),diffused distribution of microcalcifications (P=0.001),and vascularity levels 2-3 (P=0.002) were effective for CLNM prediction.The model based on the clinical and ultrasound features showed good performance in both training cohort with AUC of 0.78 (95%CI0.74-0.82) and validation cohort with AUC of 0.70 (95%CI0.67-0.76).Conclusions A quantitative model of CLNM in PTC patients was established based on the risk factors.According to the model,central lymph node dissection is recommended for PTC patients with high scores.Objective To evaluate the diagnostic value of contrast-enhanced ultrasound(CEUS)in thyroid extrathyroidal extension(ETE)of papillary thyroid carcinoma(PTC).Methods Totally 172 PTC patients(184 thyroid nodules)were examined by conventional ultrasound(US)and CEUS before operation.Sonographic features of thyroid nodules and the relationship between nodules and thyroid capsule were retrospectively evaluated.The diagnostic efficacy of these two methods for ETE was compared,and the effect of nodule enhancement level on the diagnosis of ETE was analyzed.Results The sensitivity,specificity,and accuracy of CEUS were 78.9%,89.4% and 84.2% in diagnosing ETE,while those of US were 60.0%,86.2%,and 73.4%,respectively.Among them,the sensitivity(P=0.000)and accuracy(P=0.009)of CEUS in diagnosing ETE were significantly higher than those of US,but there was no statistically significant difference in specificity(P=0.375).The area under the receiver operator characteristic curve of CEUS(0.84)was significantly larger than that of US(0.73)(Z=2.24,P=0.01).The diagnostic value of CEUS in ETE was related to the enhancement level of nodules.The sensitivity,specificity,and accuracy of CEUS in the diagnosis of ETE were highest in hypo-enhanced nodules,followed by hyper-enhanced nodules and the iso-enhanced nodules.Conclusion CEUS has higher performance than US in detecting ETC of PTC.Objective To evaluate the role of nutritional intervention during concurrent chemoradiotherapy (CCRT) for esophageal cancer and investigate the incidence and risk factors of skeletal muscle loss after CCRT.Methods The clinical data of patients with esophageal cancer who underwent CCRT in our center from April 2017 to November 2019 were retrospectively collected.The CT images before and after CCRT were analyzed.The incidence of skeletal muscle loss,changes in nutritional indicators,and chemoradiotherapy delay were recorded,and the risk factors associated with declined skeletal muscle index (SMI) were analyzed.Results In the nutritional intervention group,the average daily energy intake per person in the oral nutritional supplement (ONS) subgroup,parenteral nutrition (PN) subgroup,and ONS+PN subgroup were (273.5±252.8), (310.6±311.2),and (745.3±637.8) kcal (1 kcal=4.1868 kJ),respectively,and the difference was statistically significant (F=5.870,P=0.005).After CCRT,the incidence of sarcopenia was 40.3% (n=40) inP less then 0.001),and nutritional intervention (P=0.014) at baseline had significant effects on the decrease of SMI in patients with esophageal cancer after radiotherapy and chemotherapy.Conclusions Nutrition intervention can reduce the incidence of delayed chemoradiotherapy during esophageal cancer CCRT and reduce skeletal muscle loss.The decline of SMI is mainly related to the T stage,N stage,and nutrition intervention at baseline.Objective To investigate the clinical features and treatments of programmed death-1(PD-1)inhibitors-induced bullous pemphigoid(BP).Methods The clinicopathological and immunohistological data of patients with PD-1 inhibitors-induced BP from Peking Union Medical Collage Hospital and reported in the literature were retrospectively analyzed.Results Totally 21 cases(15 males and 6 females)were enrolled.The average age was(70.9±9.7)years(56-86 years).The most common primary malignancies were melanoma(38.10%)and lung cancer(33.33%).The average duration from onset of PD-1 inhibitors treatment to diagnosis of BP was(49.1±23.7)weeks.Typical dermatopathological features were sub-epidermal blisters(76.19%)with infiltration of eosinophils(88.24%).Direct immunofluorescence features were linear deposition of complement C3(95%)and IgG(75%)in the basement membrane zone.Anti-BP180-NC16A antibodies were positive in most cases(84.21%).Patients were mainly treated with systemic corticosteroids,whereas biologics such as rituximab and omazumab were also effective.
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