ObjectiveTo explore the clinical characteristics, diagnosis and treatment of ectopic thyroid gland (ETG) so as to reduce the misdiagnosis and improper treatment.
MethodsAccording to the patients who were definitely diagnosed ETG by pathology from 2002 to 2010 in our hospital, their clinical and pathological data were retrospectively analyzed.
ResultsThere were 14 patients, 4 cases of male and 10 cases of female. Five patients had clinical symptoms. Eight cases were diagnosed before operation and six cases were diagnosed by pathology after operation. There were 4 cases were malignancy and 10 were benign. Three cases of differentiated ectopic thyroid carcinoma patients and 1 normal position's thyroid had papillary carcinoma patient accepted TSH suppression treatment after operation, 4 benign patients and 1 ectopic thyroid medullary carcinoma patient accepted levothyroxine substitution treatment after operation, and the other 5 benign patients did not accept any treatment after operation. Nine patients who accepted follow-up in 1-10 years had orthobiosis, and the malignancy patients without recurrence and metastasis.
ConclusionsETG usually reveal no any special clinical features. For any masses from root of tongue to mediastinum, especially cervical masses, should be carefully check whether there are thyroid in normal position, and to exclude ETG. The color Doppler ultrasound, thyroid radioactive scanning, thyroid function tests, computed tomography, and fine needle aspiration cytology are all important examination measures. Due to the ETG may occur the same lesions as the normal position's thyroid, so once it is be definitly diagnosed, the treatment should be based on patient's age, position, size, and type of ETG, and nature of the lesions to select follow-up observation, operative treatment, levothyroxine replacement or therapeutic inhibition of TSH, and 131I therapy.
ObjectiveTo observe and analyze the correlations between aqueous humor cytokine concentrations and disorganization of retinal inner layers (DRIL), as well as postoperative visual acuity, in patients with idiopathic epiretinal membrane (iERM). MethodsA prospective clinical study. From November 2022 to October 2024, 40 eyes of 40 patients diagnosed with iERM at Ophthalmology Center of Zhejiang Provincial People's Hospital (Affiliated People's Hospital) underwent cataract surgery alone or combined with pars plana vitrectomy (iERM group) were enrolled; 19 eyes of 19 patients undergoing cataract surgery alone during the same period served as the control group. All eyes underwent best-corrected visual acuity (BCVA) testing and swept-source optical coherence tomography (SS-OCT). BCVA was assessed using a logarithmic visual acuity chart and converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Central macular thickness (CMT) was measured using SS-OCT. The iERM group was further subdivided into DRIL-positive and DRIL-negative subgroups (21 eyes and 19 eyes, respectively), based on the presence or absence of DRIL. Aqueous humor samples were collected preoperatively from eyes in both the iERM and control groups. Concentrations of transforming growth factor (TGF)-β1, TGF-β2, TGF-β3, platelet-derived growth factor (PDGF)-AB, hepatocyte growth factor, fibroblast growth factor, vascular endothelial growth factor-A (VEGF-A), placental growth factor (PLGF), glial cell line-derived neurotrophic factor (GDNF), intercellular adhesion molecule-1 (ICAM-1), angiopoietin (Ang)-1, Ang-2, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured. Follow-up examinations using the same equipment and methods were performed at 1 month postoperatively. Aqueous cytokine levels were compared between the iERM group, control group, DRIL-positive subgroup, and DRIL-negative subgroup. Correlations between aqueous cytokine levels in the iERM group and BCVA or CMT were also analyzed. Intergroup comparisons utilized the Mann-Whitney U test; correlations between variables were assessed using Spearman's rank correlation analysis. ResultsCompared to the control group, the iERM group exhibited significantly higher aqueous concentrations of TGF-β1, TGF-β3, PDGF-AB, PLGF, GDNF, ICAM-1, Ang-1, and TNF-α (P＜0.05). Compared to the DRIL-negative subgroup, the DRIL-positive subgroup showed significantly elevated aqueous concentrations of TGF-β3, PDGF-AB, PLGF, GDNF, ICAM-1, Ang-1, Ang-2, TNF-α, and IL-6 (P＜0.05). Significant differences were observed in logMAR BCVA (P=0.028) and CMT (P＜0.001) within the iERM group between preoperative and 1-month postoperative measurements. LogMAR BCVA differed significantly between the DRIL-positive and DRIL-negative subgroups (P=0.048). Correlation analysis revealed that baseline aqueous levels of VEGF-A and IL-6 in eyes with DRIL were positively correlated with postoperative BCVA (r=0.324, 0.452; P=0.042, 0.003). No significant correlation was found between CMT and any cytokine (P＞0.05). ConclusionsAqueous humor cytokines are closely associated with DRIL in iERM patients. IL-6 and VEGF-A may serve as potential predictive biomarkers for early postoperative visual recovery.
Objective To study the ectopic osteogenesis and vascularization ofthe tissue engineered bone promoted by an artificial bone composite that consists of coral hydroxyapatite (CHA), 1,25-(OH)2 D3, human marrow stromal osteoblast (hMSO), and human umbilical vein endothelial cell (hUVEC).Methods After the isolation and the culture in vitro, hMSO and hUVEC were obtained. Then, hMSO (5×105/ml) and hUVEC (2.5×105/ml) were seeded at a ratio of 2∶1 onto the CHA scaffolds coated with 1,25-(OH)2 D3 (the experimental group) or onto the CHA scaffolds without 1,25-(OH)2 D3 (the control group). The scaffolds were culturedin vitro for 3 days, and then the scaffolds were implanted into the pockets that had beenmade on the backs of 18 nude mice. Then, 6 of the mice were implanted with one experimental engineered bone bilaterally; another 6 mice were implanted with onecontrol engineered bone bilaterally; the remaining 6 mice were implanted with one experimental engineered bone and one control engineered bone on each side. At4, 8 and 12 weeks after operation, the retrieved scaffolds and cells were examined by the nake eye and histology as well as by the scanning electron microscopy. The quantitative assessment of the newly-formed bone and the quantitative analysis of the newly-formed blood vessels were performed. Results The evaluationsby the histology revealed that at 4 weeks the original bone tissues grew into the scaffolds in all the groups, but significantly more newly-formed bone tissuesand newly-formed blood vessels were found in the experimental group. At 12 weeks the newly-formed bone tissues were found in all the groups, but there was a typical bone unit found in the experimental group. There was a significantly smaller amount of capillary vessels in the control group than in the experimental group at all the time points. The evaluations by the scanning electron microscopy revealed that at 4 weeks in the experimental group there were great amounts of extracelluar matrix that embedded the cells, and plenty of capillary vessels were found on the surface of the implanted bone materials and some of them grew into the materials; however, in the control group there was a smaller amount of capillary vessels although much extracelluar matrix was still found there. At 8 weeks sarciniform osteoids were found on some of the implanted materials, with much extracelluar matrix and many newly-formed capillary vessels in the experimental group; however, in the control group there were fewer capillary vessels and lower degrees of the bone maturity. The quantitative assessment of the newly-formed bone showed that the newformed bones were 3.1±0.52 in the experimental group but2.30±0.59 in the control group at 8 weeks (Plt;0.05), and 4.63±0.55 vs. 3.53±0.62 at 12 weeks. There was a significant difference at these two time points between the two groups (Plt;0.05). The quantitative analysis of the newly-formed blood vessels showed that the vascular areas were 28.74％±7.81％i n the experimental group but 19.52％±4.57% in the control group at 4 weeks (Plt;0.05), and 24.66％±7.38％ vs. 1784%±5.22% at 12 weeks. There was a significant difference at these two time points between the two groups (Plt;0.05). Conclusion 1,25-(OH)2 D3 as an active factor can increase the interaction between hMSO and hUVEC, and thus promote the ectopic osteogenesis and vascularization in the tissue engineered bone.
Objective To analyze the effectiveness of conservative medical treatments for ectopic pregnancy (EP): methotrexate (MTX) + mifepristone + Ectopic Pregnancy II decoction (EP-II) vs. methotrexate + mifepristone. Methods A total of 95 patients with EP in Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University from January 2009 to January 2011 were randomly divided into two groups: 45 patients in the experimental group were treated with MTX, mifepristone and EP II decoction, while the other 50 patients in the control group were treated with MTX and mifepristone. The effectiveness of the two groups was analyzed with SPSS 13.0 software. Results There were significant differences in the time of serum β-HCG return to normal (16.13±8.13 ds vs. 22.05±7.15 ds, Plt;0.05), time of EP mass absorption (30.46±7.56 ds vs. 39.99±18.26 ds, Plt;0.05) and tubal patency rate (80% vs. 75%, Plt;0.05) between the two groups. But there were no significant differences in effective rate (95.56%, 43/45 vs. 94%, 47/50, χ2=0.0809, Pgt;0.05) and side effects. Conclusion The combination of methotrexate, mifepristone and EP II decoction for ectopic pregnancy is more effective than mifepristone and methotrexate in coordinately killing the embryo, shortening the time of serum β-HCG return to normal and the time of EP mass absorption, and improving the function of oviducts.
Objective To study the method of reinnervation after ectopic transplantation of the gracilis muscle in rats. Methods Sixty healthy male rats (age, 8 months; weight, 400-500 g) were randomly divided into 3 groups: the control group, the motor reinnervation group, and the sensory reinnervation group. The right gracilis of the rat was cut off, and the muscle was transplanted to the left leg. In the control group, no reinnervation was performed on the obturator nerve; in the sensory reinnervation group, the obturator nerve was coapted with the recipient saphenous nerve; in the motor reinnervation group, the obturator nerve was coapted with the femoral nerve motor branch. After 25 weeks, the weight of the muscle was measured, and the histological examination was performed. Results Atrophy of the gracilis was found to be a dominant effect in the control group, where the weight of the muscle was 204.0±15.3 mg. In the motor reinnervation group, the weight ofthemuscle was 394.8±12.9 mg, and in the sensory reinnervation group, it was 389.2±13.5 mg, with no significant difference between the two groups (P＞0.05). The weight of the muscle in the motor reinnervation group and in the sensory reinnervation group was significantly greater than that in the control group (P＜0.05).The tissue observation revealed that the nerve axon was diffusedin the motor reinnervated group, with no nerve endplates found. The motor nervereinnervated flaps showed the viable axons out to the motor endplates. The histological examination revealed evidence of reinnervation. Conclusion The motor or sensory nerve anastomosis after the ectopic transplantation of the skeletal muscle can prevent the atrophy of the muscle and restorepart of the nerve function.
Objective To observe the change of retinal artery angle in eyes with idiopathic epiretinal membrane (ERM) and to analyze the relationship between retinal artery angle, ERM classification based on optical coherence tomography (OCT), and visual acuity. MethodsA retrospective cross-sectional clinical study. A total of 187 eyes in 187 patients diagnosed with monocular idiopathic ERM (IERM group) in Department of Ophthalmology of Zhejiang Provincial People's Hospital and the Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou from November 2018 to January 2023 were included in the study. The contralateral healthy eyes were included as the control group. All patients underwent best corrected visual acuity (BCVA), fundus photography, spectral-domain OCT, OCT angiography (OCTA) and axial length (AL) measurement. BCVA examination was performed using the standard logarithmic visual acuity chart, which was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The foveal avascular zone (FAZ) area was measured by OCTA. The central macular thickness (CMT) was measured by spectral domain OCTaccording to the grading criteria of ectopic inner foveal layer (EIFL) was divided into stages 1 to 4 with 42, 45, 62, and 38 eyes, and the IERM group was subdivided into stage 1, stage 2, stage 3, and stage 4 groups accordingly. Image J was used to measure the retinal artery angle and the 1/2 retinal artery angle on fundus images. Multiple linear regression analysis was used to analyze the correlation between BCVA and artery angle, 1/2 artery Angle, CMT, FAZ area and AL. ResultsCompared with the control group, eyes in IERM group had worse BCVA (t=9.727), thicker CMT (t=12.452), smaller FAZ area (t=－14.329), smaller artery angle (t=－9.165) and smaller 1/2 artery angle (t=－9.549). The differences were statistically significant (P＜0.001). With the increase of IERM stage, the artery angle and 1/2 artery angle decreased significantly (F=21.763, 12.515; P＜0.001). There was no significant difference in artery angle and 1/2 artery angle between stage 1 group and stage 2 group, and 1/2 arterial angle between stage 2 group and stage 3 group (P＞0.05). There were significant differences in artery angle and 1/2 artery angle between the other groups (P＜0.05). There were significant differences in CMT and logMAR BCVA among different classification subgroups in IERM groups (P＜0.05). There was no significant difference in FAZ area between grade 3 group and grade 4 group (P＞0.05). There were significant differences in FAZ area between the other groups (P＜0.05). Correlation analysis showed that decreased artery angle (P=0.013) and increased CMT (P＜0.001) were associated with decreased BCVA. ConclusionsCompared with healthy eyes, the artery angle decreases significantly with the increase of ERM stage. Decreased retinal artery angle is associated with decreased visual acuity in IERM eyes.
Objective To study the effect of motor nerve implantation after ectopic transplantation of skeletal muscle on nerve regeneration in rat. Methods Sixty Sprague-Dewley male 8 monthold rats were randomly divided into 3 groups: control group,in situ implantation group and ectopic transplantation group. In control group, obturator nerve controlling right gracilis was cut off. In in situ implantation group, the right gracilis was cut off and replanted to its original site, and the obturator nerve was implanted to the muscle. In ectopic transplantation group, the right gracilis was cut off and transplanted to the muscle of the left leg, and the obturator nerve was implanted to the muscle. After 25 weeks, the neurophysiological information was collected through electromyography and the weight of the muscle was measured. Results The potentialwithout control of the nerve existed in control group. There were no significant differences in latency, amplitude and conduct velocity betweenin situ implantation group and ectopic transplantation group(Pgt;0.05).The atrophy of gracilis was dominant incontrol group, the weight of the muscle was 158.0±19.3 mg. The weights of the muscle were 509.6±14.5 mg in ectopic transplantation group and 516.8±12.7 mg in in situ mplantation group, showing no significant difference (P＞0.05). The weights of the muscle in in situ implantation and ectopic transplantation group were larger than that in control group, showing significant difference(P＜0.05). Conclusion Motor nerve implantation after ectopic transplantation of skeletal muscle could prevent the atrophy of the muscle and resume partial function of nerve.
Objective To observe the change of sino-atrial nodal tissue structure and ectopic pacing function after xenogenic sino-atrial nodal tissue transplanted into left ventricular wall, so as to provide new ideas for the treatment of sick sinus syndrome and severe atrioventricular block. Methods Seventy healthy rabbits were selected, male or female, and weighing 1.5-2.0 kg. Of them, 42 were used as reci pient animals and randomly divided into sham operation group, warm ischemia transplantation group, and cold ischemia transplantation group (n=14), the other 28 were used as donors of warm ischemia and cold ischemia transplantation groups, which were sibl ing of the recipients. In recipients, a 6-mm-long and about 2-mm-deep incision was made in the vascular sparse area of left ventricular free wall near the apex. In sham operation group, the incision was sutrued directly by 7-0 Prolene suture; in cold ischemia transplantation group, after the aortic roots cross-clamping, 4 ℃ cold crystalloid perfusion fluid infusion to cardiac arrest, then sinoatrial node were cut 5 mm × 3 mm for transplantation; in warm ischemia transplantation group, the same size of the sinus node tissue was captured for transplantation. After 1, 2, 3, and 4 weeks, 3 rabbits of each group were harvested to make bradycardia by stimulating bilateral vagus nerve and the cardiac electrical activity was observed; the transplanted sinus node histology and ultrastructural changes were observed.? Results? Thirty-six recipient rabbits survived (12 rabbits each group). At 1, 2, 3, and 4 weeks after bilateral vagus nerve stimulation, the cardiac electrical activity in each group was significantly slower, and showed sinus bradycardia. Four weeks after operation the heart rates of sham operation group, warm ischemia, and cold ischemia transplantation group were (81.17 ± 5.67), (82.42 ± 7.97), and (80.83 ± 6.95) beats/ minute, respectively; showing no significant difference among groups (P gt; 0.05). And no ectopic rhythm of ventricular pacing occurred. Sino-atrial nodal tissue survived in 6 of warm ischemic transplantation group and in 8 of cold ischemia transplantation group; showing no significant difference between two groups (P gt; 0.05). Two adjacent sinoatrial node cells, vacuole-l ike structure in the cytoplasm, a few scattered muscle microfilaments, and gap junctions between adjacent cells were found in transplanted sinus node. Conclusion The allograft sinus node can survive, but can not play a role in ectopic pacing.
Objective To investigate the ectopic bone formation of the chitosan/phosphonic chitosan sponge combined with human umbil ical cord mesenchymal stem cells (hUCMSCs) in vitro. Methods Phosphorous groups were introduced in chitosan molecules to prepare the phosphonic chitosan; 2% chitosan and phosphonic chitosan solutions were mixed at a volume ratio of 1 ∶ 1 and freeze-dried to build the complex sponge, and then was put in the simulated body fluid for biomimetic mineral ization in situ. The hUCMSCs were isolated by enzyme digestion method from human umbil ical cord and were cultured. The chitosan/phosphonic chitosan sponge was cultured with hUCMSCs at passage 3, and the cell-scaffoldcomposite was cultured in osteogenic medium. The growth and adhesion of the cells on the scaffolds were observed by l ight microscope and scanning electron microscope (SEM) at 1 and 2 weeks after culturing, respectively. The cell prol iferation was detected by MTT assay at 1, 2, 3, 4, 5, and 6 days, respectively. Bilateral back muscles defects were created on 40 New Zealand rabbits (3-4 months old, weighing 2.1-3.2 kg, male or female), which were divided into groups A, B, and C. In group A, cellscaffold composites were implanted into 40 right defects; in group B, the complex sponge was implanted into 20 left defects; and in group C, none was implanted into other 20 left defects. The gross and histological observations were made at 4 weeks postoperatively. Results The analysis results of phosphonic chitosan showed that the phosphorylation occurred mainly in the hydroxyl, and the proton type and chemical shifts intensity were conform to its chemical structure. The SEM results showed that the pores of the chitosan/phosphonic chitosan sponge were homogeneous, and the wall of the pore was thinner; the coating of calcium and phosphorus could be observed on the surface of the pore wall after mineral ized with crystal particles; the cells grew well on the surface of the chitosan/phosphonic chitosan sponge. The MTT assay showed that the chitosan/phosphonic chitosan sponge could not inhibit the prol iferation of hUCMSCs. The gross observation showed that the size and shape of the cell-scaffold composite remained intact and texture was toughened in group A, the size of the complex sponge gradually reducedin group B, and the muscle defects wound healed with a l ittle scar tissue in group C. The histological observation showed that part of the scaffold was absorbed and new blood vessels and new bone trabeculae formed in group A, the circular cavity and residual chitosan scaffolds were observed in group B, and the wound almost healed with a small amount of lymphocytes in group C. Conclusion The chitosan/phosphonic chitosan sponge has good biocompatibil ity, the tissue engineered bone by combining the hUCMSCs with chitosan/phosphonic chitosan sponge has the potential of the ectopic bone formation in rabbit.
