The aim of the study was to evaluate the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating thymoma from nonthymoma abnormalities in patients with myasthenia gravis (MG). A cross-sectional study of 53 patients with MG, who had undergone surgical thymectomy, was conducted at 103 Hospital (Hanoi, Vietnam) and Cho Ray Hospital (Ho Chi Minh City, Vietnam) during August 2014 and January 2017. The CT and MRI images of patients with MG were qualitatively and quantitatively (radiodensity and chemical shift ratio [CSR]) analyzed to determine and compare their ability to distinguish thymoma from nonthymoma abnormalities. Logistic regression was used to identify the association between imaging parameters (eg, CSR) and the thymoma status. The receiver operating curve (ROC) analysis was used to determine the differentiating ability of CSR and radiodensity. As results, of the 53 patients with MG, 33 were with thymoma and 20 were with nonthymoma abnormalities. At qualitative assessment, MRI had significantly higher accuracy than did CT in differentiating thymoma from nonthymoma abnormalities (94.3% vs 83%). At quantitative assessment, both the radiodensity and CSR were significantly higher for thymoma compared with nonthymoma groups ( P < .001). The ROC analysis showed that CSR had significantly higher sensitivity (Se) and specificity (Sp) than radiodensity in discriminating between the 2 groups (CSR: Se 100%, Sp 95% vs radiodensity: Se 90.9%, Sp 70%). When combining both qualitative and quantitative parameters, MRI had even higher accuracy than did CT in thymoma diagnosis ( P = .031). In conclusion, chemical shift MRI was more accurate than CT for differentiating thymoma from nonthymoma in patients with MG.
Background: Grayscale ultrasound (US) is the most common imaging modality for the assessment of thyroid nodules. Objective: This research aimed to assess the value of using the elasticity index (EI), obtained using shear wave elastography (SWE), to discriminate between malignant and benign thyroid nodules. Materials and methods: A total of 86 patients (94 distinct thyroid nodules) were operated on at Vietnam National Cancer Hospital from June 2018 to June 2019. Comparisons of the grayscale ultrasound (US) findings and the EI values between the benign and malignant groups were performed using the Chi-square test and Student’s t -test, respectively. The discrimination abilities of EI were determined through receiver operating characteristic (ROC) curve analysis, with the computation of optimal cut-off points. Results: The EI values of the benign and malignant groups were 37.6 ± 26.1 kPa and 105.4 ± 48.8 kPa, respectively. The area under the ROC curve (AUROC) value for discrimination between groups based on EI values was 0.889 when using an optimal cut-off point of 74.5 kPa, which resulted in a sensitivity of 74.3% and a specificity of 90%. Logistic multivariate regression analysis found that EI and microcalcification were significant factors for the discrimination between groups, with an odds ratio (OR): 1.487 [95% confidence interval (95% CI): 1.124–1.968, p = 0.005] and OR: 12.119 (95% CI: 2.031–72.323, p = 0.006), respectively. Combining grayscale US imaging with SWE can increase the specificity of the diagnosis but does not increase the accuracy. Conclusion: SWE can be helpful for predicting the malignancy of thyroid nodules, although the accuracy of this method is only moderate.
Mục tiêu: xác định các yếu tố có liên quan đến kết quả cắt tuyến ức điều trị bệnh nhược cơ bằng phẫu thuật nội soi lồng ngựcĐối tượng và phương pháp nghiên cứu: nghiên cứu mô tả cắt ngang trên 61 bệnh nhân nhược cơ được phẫu thuật nội soi lồng ngực (PTNSLN) cắt tuyến ức từ tháng 9 - 2008 đến tháng 1 - 2011.Kết quả: nữ chiếm 62,3%, nam: 37,7%. Tuổi trung bình là 35. Theo dõi sau mổ được 52/61=85,2%. 86,9% BN dưới 50 tuổi, 13,1% tuổi >50. Kết quả tốt (khỏi và cải thiện) là 86,5%. Kết quả tốt ở tuổi dưới 50 là 86,7% so với 85,7% tuổi trên 50, ở nữ là 93,8% cao hơn so với nam là 75%, 94,1% ở nhóm tăng sản so với 85,2% ở nhóm u và 75% ở các nhóm tổn thương khác. Kết quả tốt ở giai đoạn sớm (< 1 năm) là 86,5%, sau 1 năm là 90%Kết luận: Tuổi, giới, tổn thương mô bệnh học và thời gian theo dõi sau mổ có thể được sử dụng để tiên lượng kết quả của phẫu thuật nội soi lồng ngực cắt tuyến ức điều trị bệnh nhược cơ
Background: Systemic lupus erythematosus (SLE) is a chronic disease that causes systemic inflammation which affects multiple organs. There is no cure for SLE. Conventional treatment options include antimalarial drugs, corticosteroids, and immune suppressants, but a number of patients are resistant to treatment or suffer from severe side effects. Stem cell transplantation has been used to treat SLE for the past 2 decades. We describe the first Vietnamese patient with refractory SLE who received an autologous hematopoietic stem cell transplant. Case presentation: The patient is a woman who was diagnosed 12 years ago with systemic lupus erythematosus. She was administered corticosteroids and high-dose immunosuppressive medicines, but the condition was refractory, manifesting as severe headache, arthralgia, chronic anemia, severe Cushing's syndrome, and proteinuria. At admission, the SLEDAI score was 28 and proteinuria was 6.7g/l. She received cyclophosphamide and G-CSF for HSCT mobilization. Peripheral blood stem cells were collected and selected for CD34+ cells. Antithymocyte, cyclophosphamide, and rituximab were used in conditioning regimens. The patient was then administered a CD34+ autologous hematopoietic stem cell transfusion with a CD34+ dose of 7.93 x 106 cells/kg body weight, T and B lymphocyte purity of the graft exceeded 99.99%. Post-transplant course was favorable, the patient did not experience serious complications. Recovery of neutrophils on post-HSCT day +9 and platelet on day +12. Six months after stem cell transplantation, the patient's clinical symptoms significantly improved, the SLEDAI score dropped from 28 to 0, and the patient discontinued receiving immunosuppressive drugs. Conclusion: Autologous hematopoietic stem cell transplantation promises to be a new, effective therapeutic method that can be implemented more broadly in Vietnam for SLE patients.
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