Development of Assessment Tool for Psychological Effect of Thyroid Cancer Screening

Background: Nation cancer screening program is provided to all population who reached a certain age in Korea. Also individualized cancer screening also widely conducted in private screening units. The harms associated with cancer screening have rarely been reported. Moreover there have been few studies on the psychological effects associated with cancer screening. Aim: This study aimed to evaluate the psychological effects occurring in thyroid cancer screening which is frequently conducted in Korea. We evaluate the validity and reliability of developing measuring tools. Methods: The psychological effects on cancer screening were classified into 3 domains (quality of life, stress response and anxiety) through the review of previous studies and expert discussion. Four assessment tools were selected for measuring quality of life (WHOQOL-BREF), stress level (PSS, SRI), anxiety level (GAD-7). We conducted 2-step of survey. First step was conducted on the day of cancer screening. And second step survey was conducted after reporting cancer screening results. Inclusion criteria of participation is subjects who received thyroid cancer screening for the first time or who has not had thyroid cancer screening for the past 3 years. Based on the survey results, the final assessment tool for psychological effect of thyroid cancer screening was developed through the second expert meeting. The final assessment tool was verified the reliability and the validity through 2-step surveys before and after screening. Results: The new Assessment tool for Psychological Effect of Cancer Screening (APECS) was developed in 4 domains (quality of life, stress-anxiety level, stress responses, and thyroid cancer screening related psychological problems). A total of 143 patients were surveyed on the day of thyroid cancer screening using the developed assessment tool. Second survey was conducted for 99 patients who visited the hospital for counseling the screening results. Test-retest reliability showed high internal consistency with 0.859, P < 0.001, and Cronbach's alpha showed high value with 0.918 in all domains. The reliability of the stress-reaction level domain was the highest in the all domains (0.878). Factor analysis identified 5 factors, including quality of life, stress-anxiety level/response, and thyroid cancer screening–related psychological problems domain were combined. Conclusion: Both of reliability and validity of the newly developed assessment tool for psychological effect of thyroid cancer screening were measured high in all domains. In the future, a strategy for minimizing psychological harms could be suggested from the results of a large scale survey with the new assessment tool on the psychological impact of thyroid cancer screening.

Malignant fibrous histocytoma of the heart presenting as right ventricular outflow tract obstruction: a case report

Primary malignant fibrous histocytoma (MFH) of the heart is extremely rare. Herein, we report the case of a 17-year-old woman with a primary MFH in the right ventricular outflow tract, presenting with increasing dyspnea on exertion. Wide excision of the tumor, including part of the pulmonary artery and pulmonary valve, was performed under cardiopulmonary bypass. Her postoperative recovery was uneventful.

Profile of cytokine expression in nasopharyngeal carcinomas: a distinct expression of interleukin 1 in tumor and CD4+ T cells

Nasopharyngeal carcinoma (NPC) is an epithelial cancer that is causally associated with Epstein-Barr virus (EBV) infection. NPC tumor biopsies are characterized histopathologically by an abundant infiltration of nonmalignant lymphocytes. We analyzed the expression of various cytokines in NPC tissues to investigate the interaction of the infiltrating lymphocytes and tumor cells. Analysis using reverse transcriptase-PCR revealed the expression of a panel of cytokines in the NPC biopsies: interleukin (IL)-1alpha, IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-10, IFN-gamma, tumor necrosis factor-alpha, transforming growth factor-beta, and IL-1 receptor types I and II. Elevated expression of IL-1alpha and IL-1beta was observed in primary tumors and NPC metastases compared to control tissues. Interestingly, this increased expression correlated with the EBV-encoded viral IL-10 transcript. To determine which cells were responsible for producing IL-1, we determined the cellular constituents of NPC biopsies by immunoflow cytometric analysis. On the basis of data from these analyses, the three major specific cell populations, epithelial cells, CD4+ T cells, and CD8+ T cells, were selected from five NPC tumors using specific, antibody-coated paramagnetic beads. Reverse transcriptase-PCR of RNA from these fractionated cells showed that transcripts of IL-1alpha and IL-1beta were present not only in the malignant epithelial cells but also in CD4+ T cells infiltrating the tumor, a finding confirmed by immunohistochemical staining. We hypothesize that the unusual synthesis of IL-1alpha and IL-1beta by EBV-positive epithelial cells as well as by CD4+ T cells might contribute to lymphocyte infiltration and/or tumor growth during NPC development.

[Fractal dimension analysis of the surface EMG]

Fractal analysis is a new method for biomedical signal processing. Present research on surface EMG and its parameterization method were introduced in this paper. Experiments were performed on three conditions: (1) different muscle contraction degree, (2) different static load, (3) different motion pattern. Problems and prospects in engineering application were also discussed here.

Proteoglycans synthesized by smooth muscle cells derived from monkey (Macaca nemestrina) aorta

Smooth muscle cells derived from monkey aorta were cultured in medium with [35S]sulfate and [3H]glucosamine as labeling precursors. Proteoglycans in the medium and in 4 M guanidine HCl extracts of the cell layer were purified by DEAE-Sephacel and molecular sieve chromatography. Both preparations contained a predominant, large chondroitin sulfate proteoglycan (Kav = 0.30 on Sepharose CL-2B) with glycosaminoglycan chains of Mr approximately 43,000 average containing a ratio of 6-sulfate to 4-sulfate of approximately 2. Approximately 7 and 27% of the 3H label in this proteoglycan were present in N-linked and O-linked oligosaccharides, respectively. Reaggregation experiments indicated that a large proportion of these proteoglycans can form link protein-stabilized aggregates. The medium fraction also contained a smaller dermatan sulfate proteoglycan (Kav = 0.67 on Sepharose CL-2B) with glycosaminoglycan chains of Mr approximately 43,000 containing a ratio of 6-sulfate to 4-sulfate of about 0.5. This proteoglycan contained approximately the same percentage of N-linked oligosaccharides as the chondroitin sulfate proteoglycan, but few or no O-linked oligosaccharides. A smaller dermatan sulfate proteoglycan with a single chain was present only in the cell layer. Additionally, small amounts of heparan sulfate proteoglycans were synthesized by the cells.

[Detection of minimal residual disease after allogeneic bone marrow transplantation in chronic myeloid leukemia]

OBJECTIVE

To detect minimal residual disease (MRD) after allogeneic bone marrow transplantation (allo-BMT) in chronic myeloid leukemia (CML).

METHODS

M-bcr/abl mRNA was assayed by reverse transcriptase polymerase chain reaction (RT-PCR) in bone marrow cells from 46 successfully sibling marrow engrafted CML patients.

RESULTS

About 70% of the patients achieved genetic complete remission in 3 months post allo-BMT. Four patients were M-bcr/abc mRNA positive at 1.5 to 2 months post allo-BMT and turned to be negative at 3 to 9 months post allo-BMT. One patient was still M-bcr/abl(+) after disease-free survival(DFS) for more than 6 years, while another one was M-bcr/abl(-) after DFS for more than 4 years.

CONCLUSION

RT-PCR is so far the most sensitive method for MRD detection in CML, but its limitation should not be ignored.

Precision Measurement of Reactor Antineutrino Oscillation at Kilometer-Scale Baselines by Daya Bay

We present a new determination of the smallest neutrino mixing angle θ_{13} and the mass-squared difference Δm_{32}^{2} using a final sample of 5.55×10^{6} inverse beta-decay (IBD) candidates with the final-state neutron captured on gadolinium. This sample is selected from the complete dataset obtained by the Daya Bay reactor neutrino experiment in 3158 days of operation. Compared to the previous Daya Bay results, selection of IBD candidates has been optimized, energy calibration refined, and treatment of backgrounds further improved. The resulting oscillation parameters are sin^{2}2θ_{13}=0.0851±0.0024, Δm_{32}^{2}=(2.466±0.060)×10^{-3}  eV^{2} for the normal mass ordering or Δm_{32}^{2}=-(2.571±0.060)×10^{-3}  eV^{2} for the inverted mass ordering.

Radiomics nomogram: distinguishing benign and malignant pure ground-glass nodules based on dual-layer spectral detector CT

AIM

To investigate the value of the combined model based on spectral quantitative parameters, radiomics features, imaging and clinical features to distinguish the benign and malignant pure ground-glass nodules (pGGNs).

MATERIALS AND METHODS

A retrospective analysis of 113 patients with single pGGNs who underwent non-contrast enhancement examination of the chest on dual-layer spectral detector CT (SDCT) with two weeks before surgery was performed in our hospital. These patients were randomized into training and testing cohorts. Regions of interest based on the conventional 120 kVp poly energetic image of SDCT were outlined. Then the optimal features were extracted and selected to construct radiomic model. A combined model combining vacuole sign, electron density (ED) value and the rad score of radiomics model was built by logistic regression analysis. A nomogram was built in a training cohort and the performance of the models was evaluated in the training and testing cohorts by receiver operating characteristic curves, calibration curves and decision curve analysis.

RESULTS

ED value [Odds Ratio (OR):1.100; 95% confidence interval (CI):1.027-1.166)] and vacuole sign (OR:3.343; 95% CI:0.881-12.680) were independent risk factors for the malignant pGGNs in the training cohort. A combined model was constructed using radiomics features, ED value and vacuole sign. And the AUC was 0.910 (95% CI, 0.825-0.997) and 0.850 (95% CI, 0.714-0.981) in the training and testing cohorts, respectively.

CONCLUSION

The combined model based on SDCT has high specificity and sensitivity for distinguishing the benign and malignant pGGNs, suggesting the model can further improve diagnostic performance, and using a nomogram is helpful for individualized predictions.

[Early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency]

Objective: To examine the early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency. Methods: This is a retrospective cohort study. The clinical data of 124 patients with BAV insufficiency who underwent aortic valve repair from January 2017 to June 2023 in the Department of Cardiovascular Surgery at Fuwai Hospital were analyzed retrospectively. There were 117 males and 7 females with an age of (38.1±12.7) years (range: 14 to 65 years). Depending on whether the aortic sinus was replaced or not, surgical approaches were divided into valve sparing root replacement (reimplantation, remodeling, modified remodeling) and isolated aortic valve repair (annuloplasty, isolated aortic valve leaflet repair). Perioperative and follow-up data were collected. Kaplan-Meier method was used to plot the curves of survival rate, free recurrence rate of massive aortic valve insufficiency and free re-operation rate, and Log-rank test was used for comparison between groups. Results: Among the surgeries, there were 47 cases of reimplantation, 8 cases of remodeling, 8 cases of modified remodeling, 48 cases of aortic annuloplasty (external annuloplasty in 22 cases, CV-0 annuloplasty in 26 cases), and 13 cases of isolated leaflet repair. Leaflet plication was the most used leaflet repair technique, used in 103 patients. The cardiopulmonary bypass time was (133.7±56.9) minutes (range: 48 to 461 minutes), and aortic cross-clamp time was (103.8±47.8) minutes (range: 25 to 306 minutes), with no surgical mortality. All patients underwent outpatient or telephone follow-up. The cumulative follow-up time was 340.3 person-years and the mean follow-up time was (M (IQR)) 34.0 (25.5) months (range: 3 to 76 months). The 5-year survival rate was 98.4%, the 5-year freedom from significant insufficiency rate was 93.4% and the 5-year freedom from aortic valve reoperation rate was 95.6%. The subgroup analysis revealed a significantly better freedom from the significant insufficiency rate in the aortic valve annular reduction group compared to the non-reduction group (P<0.01). Conclusions: Aortic valve repair in patients with bicuspid aortic insufficiency could obtain steady early to mid-term outcomes. Aortic annuloplasty can reduce the risk of recurrent aortic valve insufficiency in patients undergoing aortic repair.

Zinc is a mixed antagonist of homomeric rho 1 gamma-aminobutyric acid-activated channels

The transition metal Zn2+ is differentially distributed in the central nervous system, where it is proposed to be a neuromodulator. One of the documented effects of Zn2+ is the antagonism of gamma-aminobutyric acid (GABA)-mediated synaptic inhibition. This antagonism is presumed to result from a direct interaction of Zn2+ with the GABA receptor/ionophore complex, although the characteristics of Zn2+ sensitivity are dependent on the particular GABA subunit combination. In this study, we examined the effects of Zn2+ on homomeric rho 1 GABA-activated channels expressed in Xenopus oocytes. Zn2+ was found to be a mixed antagonist of these recombinant rho 1 GABA receptors. The antagonism was predominantly competitive at low Zn2+ concentrations (< or = 100 microM), whereas at high Zn2+ concentrations (> 100 microM) a noncompetitive antagonism was apparent. Evidence is presented showing that the antagonism was not due to an interaction of GABA and Zn2+ in solution but, rather, resulted from interactions of these two ligands with the GABA-activated channel. A mechanism is proposed for Zn(2+)-mediated antagonism in which GABA and Zn2+ bind to distinct sites on the GABA complex. The apparent mixed antagonism may arise from different Ki values for the binding of Zn2+ to non-agonist-bound or agonist-bound receptors. However, two distinct Zn2+ binding sites, one competitive and one noncompetitive, could also give rise to the dual antagonism.

Successful management of perforating injury of right atrium by chest tube

Tube thoracostomy is an invasive procedure caring about 1% complication rate. Most confronted complications include diaphragm or lung laceration [1-3], damage to intrabdominal organ, intercostal artery bleeding and unilateral pulmonary edema. Here we present another rare complication of perforation of the right atrium which occurred in a patient with rheumatic heart disease (RHD) who had received mitral valve replacement (MVR) and tricuspid annuloplasty. Severe tricuspid regurgitation (TR) with huge right atrium was noted. Chest tube was inserted for pleural effusion drainage. The lesion was proved to be in the right atrium by echocardiography and computerized tomography three days later. The penetrated hole was repaired with bovine pericardium patch with minimal blood loss. This case attests to the extreme caution warranted when performing tube thoracostomy in patient with huge cardiomegaly.