Surgery, selective radioiodine therapy and thyroid stimulating hormone suppressive therapy are the standard treatment modalities for differentiated thyroid cancer (DTC). After therapy, most DTC patients could get good prognosis. However, some patients with distant metastasis lose the ability to concentrate radioiodine at early time or during the treatment, and develop radioiodine-refractory DTC (RAIR-DTC). These patients progress quickly and have high mortality. Looking for effective treatments for these patients has been the hot spot in research of thyroid carcinoma. In this paper, we summarized the recent advances in the diagnosis and treatment of RAIR-DTC, hoping to early identify these patients and buy time for early intervention of other possible beneficial treatments such as targeted therapy and radiotherapy.

The expression and function of NIS are the prerequisites of radioactive iodine ( RAI ) treatment for DTC, which in turn determine the iodine uptake and outcome in DTC patients. Studies for the factors that might influence the function of NIS for the development of redifferentiation therapy should be conducted in conjunction with the individualized course of treatment in DTC patients having poor iodine up?take in their thyroid tumors. This review summarizes the factors that influence the function and expression of NIS in these patients.

Recent studies on the role of viable myocardium in revascularization are hot spots.The definition of viable myocardium,multimodality imaging in the assessment of myocardial viability,Meta analyses related to the value of viable myocardium in revascularization,prospective randomized trials,and factors affecting the prognosis of patients after revascularization are reviewed in this article.

Objective To evaluate the impact of low-dose 131I therapy and high-dose 131I therapy on the clinical outcome in PTC patients coexisting with Hashimoto's thyroiditis (HT).Methods A total of 140 non-distant metastatic PTC patients (16 males,124 females,age range:16-66 years) from July 2010 to December 2014 were enrolled in this retrospective study.Patients concurrent with HT (n=84,group A) were divided into low-dose group (1 110 MBq,n=56,group A1) and high-dose group (5 550 MBq,n=28,group A2) according to 131I ablation dose.Patients without HT (n =56) were enrolled as control group (group B),and received 1 110 MBq of 131I.The thyroid remnant ablation outcome was evaluated according to 131I diagnostic whole-body scan (Dx-WBS),neck ultrasonography (US),serum Tg and TgAb level 6-8 months after 131I ablation therapy.The successful ablation rates were compared by x2 test.Kruskal-Wallis rank sum test was also used.Results There were no significant differences among the 3 groups in terms of both clinicopathological features and postoperative remnant thyroid (H:0.203-2.944,x2:0.271-0.970,all P＞0.05).When negative Dx-WBS and US were deemed as successful ablation criterion,complete ablation rate was found significantly more in group B (94.6％,53/56) than that in group A1 (82.1％,46/56;x2=4.264,P＜0.05),but no significant difference was found between group A2 (85.7％,24/28) and group A1 (x2 =0.318,P＞0.05).When combining negative sTg (sTg＜1 μg/L,TgAb＜46 kU/L) with the above 2 criterions to assess remnant ablation outcome,group B also had a higher successful rate to achieve complete ablation (85.7％,48/56) compared with group A1 (75.6％,34/45),but without statistical significance (x2=2.978,P＞0.05),and no difference was observed between group A2 (12/15) and group A1 (x2=1.320,P＞ 0.05).Conclusion Non-distant metastatic PTC patients coexisting with HT has undesirable 131I ablation outcome compared with those without HT,increasing 131I dose is unhelpful to enhance efficiency of remnant ablation for PTC patients with HT.

PurposeCurrent conventional imaging methods X-ray, CT, MRI and ultrasound for rheumatic diseases are mostly local site imaging, rather than systemic display, thus is difficult to show the whole picture of the diseases, this study aims to explore the18F-FDG PET/CT findings of rheumatic diseases and its preliminary clinical value. Materials and Methods18F-FDG PET/CT imaging findings and clinical data of 18 patients with rheumatic diseases confirmed by clinical diagnosis were retrospectively analyzed, and 18F-FDG uptake of lesions was observed.Results Among all the 18 patients with rheumatic diseases: four cases were with rheumatoid arthritis (RA), 5 cases with takayasu arteritis (TA), 2 cases with adult onset Still’s disease (AOSD), 1 case with polymyalgia rheumatica (PMR) and 6 cases with ankylosing spondylitis (AS). Findings of PET/CT: RA showed increased FDG uptake in multiple bigger joints such as shoulder joint, elbow, hip, wrist joint, and part palm finger joints, with no bone abnormalities in CT; TA displayed as diffusely increased uptake of FDG the aorta and its major branches vascular wall while CT showed multiple arterial wall irregular thickening with dot or strip calcification, and in one case, the vascular wall FDG uptake decreased obviously after one year treatment, the SUVmax of left clavicle dropped from 6.8 to 3.2; AOSD showed diffusely increased FDG uptake in spleen and bone marrow, while CT had no obvious spleen and bone abnormalities; PMR showed increased uptake of FDG in the atlantoaxial joint, shoulder joint, sternoclavicular joint, hip joint, pubic symphysis, ischial tuberosity and lesions around lumbar spinous process; only 1 case of 6 AS patients showed left acetabular articular surface hyperplasia and sclerosis with increased FDG uptake, while CT showed spinal multiple vertebral bone hyperplasia and sclerosis as bamboo change in all of 6 AS cases, with normal FDG metabolism. Conclusion18F-FDG PET/CT is helpful for the diagnosis of rheumatic diseases, because it can be used to display the lesion extent, reflect its activity, and also to evaluate the effect of the treatments.

Objective To explore the relationship between the proliferation of neural stem cells (NSCs)and the expression of β-catenin protein in neonate rats with hypoxic ischemic brain damage (HIBD) after hyperbaric oxygen (HBO) therapy. Methods One hundred and eighty Sprague-Dawley rats aged 7 days were randomly divided into a normal control group (CON) , a HIBD model group and a HBO treatment group. The HIBD model was induced using Rice's method. Beginning 3h after the HIBD, HBO was administered to the HBO treatment group at 2 atmospheres for 60 min, once daily for 7 days. The HIBD model group was not given any treatment. The expression of nestin/β-catenin protein in the subventricular zone of the ischemic brain was double-stained for immunofluorescence and analyzed by confocal scanning microscopy dynamically at 3 hours, 21 hours, and then on the 3rd, 5th, 7th and 14th day of HBO therapy. The expression of whole cell β-catenin and nuclear β-catenin protein in the left brain were also examined by Western blotting at these 6 time points. Linear correlation was used to analyze the correlation between β-catenin and nestin protein. Results The expression of β-catenin protein in NSCs increased initially at the 21st hour after HBO therapy in the model group and the HBO group as compared with the normal control group.β-catenin protein in the model group reached a higher level, though there was no significant difference between model group and the HBO group. At the 5th day of HBO therapy β-catenin protein in the HBO group had reached a significantly higher level than in the model group. At the 14th day the average expression of β-catenin in the HBO group began to decrease. The expression of nestin protein began to increase 21 hours after HBO therapy began, and it peaked at the 7th day of HBO therapy and then decreased. In the HBO group the increase in nestin protein was linearly correlated with that of β-catenin protein. The whole cell β-catenin protein and β-catenin nucleic protein readings increased initially by the 21st hour of HBO therapy and by the 5th day were significantly higher than the levels in the model group. Conclusion HBO treatment is capable of stimulating the proliferation of NSCs in HIBD neonate rats.The proliferation of NSCs is correlated with the activation of β-catenin protein.

Objective To investigate the surgical techniques of the modified presigmoid trans-partial bony labyrinth approach and the advantages in exposure of the petroclival region and in treat the lesion of this area.Methods By simulate the modified presigmoid trans-partial bony labyrinth approach in 15 adult cadaveric heads with the aid of an operating microscope and record important structures in the petroclival region.Results The petroclival region,the posterior cavernous sinus,Meckel cave,the vertebral-basilar artery,the anterior inferior cerebellar artery,the superior cerebellar artery,ipsilateral Ⅲ-Ⅹ cranial nerve nere fully exposured and contralateral Ⅵ cranial nerve were fully exposured.The range of presigmoid exposure was (19.41 ± 1.58)mm,the exposurein of inferior temporal was (14.18 ± 1.88) nun,the maximum exposure angle of slope center depression was (60.54 ± 6.93) °,the depth of operation was (55.87 ± 4.34) mm.Conclusion The advantages of the modified presigmoid trans-partial bony labyrinth approach can earn enough exposures of deep part of petroclival region and posterior part of cavernous sinus,improved petroclival exposure,multiple axes of visualization,preservation of hearing and facial nerve function,and early devascularization of the tumor.

Objective:To investigate the relation between the angiotensinⅡ(AngⅡ)levels in thoracic aorta and plasma and atherosclerosis(AS).Methods:Totally40healthy male Wistar rats were randomly divided into4groups(n=10).Four different feeding methods,including normal diet,high lipid,high lipid+vitamin D overload,and high lipid+vitamin D over-load+endothelium injury,were used for inducing AS in rats.The thickness of intima was taken as the index of AS severity, radio-immunity analysis was used to assay AngⅡin each group in thoracic aorta and plasma.Results:Only rats in high lipid diet group did not develop AS plaque;high lipid+vitamin D only resulted in AS fibrous plaque with VSMC proliferation;high lipid+vitamin D+endothelium injury formed ripe AS plaque.The thickness of intima and AngⅡof thoracic aorta in-creased gradually compared with control group(P

Objective To elucidate the CT characteristics and pathology of acute miliary pulmonary tuberculosis (AMPT). Methods The CT features of AMPT in 25 cases were analyzed retrospectively, and the CT features in HIV-seronegative and HIV-seropositive patients were compared by 2-sided exact propability Chi-square test. Two lung specimens were inflated and fixed by Heitzman's method. HRCT scans, gross specimen section (80-150 μm) and histologic section (5 μm) were performed on dry lung specimens and CT-pathologic correlation was conducted. The distribution of micronodules in the secondary lobule on HRCT and pathology in one specimen was evaluated by Chi-square test. Results Twenty five patients with AMPT were included in this study, including 11 HIV-seropositive patients and 14 HIV-seronegative patients. HRCT showed diffuse micronodules randomly distributed throughout both lungs in 25 patients, and ground-glass opacity (17 patients)was the predominant complicated finding. Coalescence of nodules and consolidation in HIV-seropositive patients (5 and 6 patients) were markedly higher than that in HIV-seronegative patients (none). In lung specimens, most nodules located in the lung parenchyma between the central bronchovascular bundle and the perilobular structures (792 and 560 nodules), which located in the interlobular septum pathologically. The distribution of micronodules in the secondary lobule showed on HRCT (1060 nodules)and pathology(864 nodules) was not significantly difference(x2=2.814,P＞0.05). HRCT showed ground-glass opacities when ARDS occured, which were pulmonary edema,inflammation and hyaline membrane on alveolar wall pathologically. Conclusions The HRCT characteristic of nodule distribution in AMPT is random. ARDS should be suspected when diffuse ground-glass opacities appear on HRCT.

Objective To investigate the relationship between V-raf murine sarcoma viral oncogene homolog B1 (BRAF)v600E mutation and radioactive iodine (RAI) uptake in distant metastases from papillary thyroid cancer(PTC).Methods From January 2011 to December 2012,40 PTC patients (21 males,19 females,average age 39.8 years) with distant metastases were recruited and divided into mutation group and wild group according to the BRAFv600E mutation in primary lesions.The clinical,pathological and serological differences were compared between the two groups.The relationship between BRAFv600E mutation and RAI uptake capability in distant metastases from PTC,as well as its relationship with Tg change after 131I treatment were investigated.Statistical analysis was performed with two-sample t test,x2 test or Fisher exact test.Results The BRAFv600E mutation rate was 30.0％ (12/40) in patients with metastases from PTC.There was no significant difference in clinical,pathological and serological features between mutation group (n =12) and wild group (n=28; t:from-0.533 to 1.728,x2:from-1.951 to 1.088,all P＞0.05).Twelve PTC patients had no RAI uptake in the distant metastases,of which 10 belonged to mutation group (83.3％,10/12) and 2 belonged to wild group (7.1％,2/28; x2=19.734,P＜0.05).BRAFv600E mutation group was more likely to have no RAI uptake in the distant metastases.Tg change after 131I treatment in 30 patients were analyzed.In the wild group,Tg level decreased in 66.7％ (14/21) patients,stabilized in 19.0％ (4/21)and increased in 14.3％ (3/21)patients.While there was no decrease of Tg in the mutation group (0/9).Two patients had increased Tg level and 7 patients (with no RAI uptake) kept stable in mutation group.Conclusions Due to poor RAI uptake capability in PTC patients with BRAFv600E mutation,both primary and metastatic sites may have poor response to 131I treatment.Molecular detection of BRAFv600E mutation might be helpful for choosing PTC with distant metastases and predicting the effect of 131 I treatment.