近年来,由于甲状腺癌的发病率越来越高,世界各地的学者开始更多地关注甲状腺癌,对其发病机制、疾病演变及转归预后都进行了探索研究。其中基因分子领域的研究成为热点,如抗鼠科肉瘤病毒癌基因同源物B1（BRAF）突变和端粒酶逆转录酶（TERT）启动子突变等,但目前相关研究尚不成熟,仍有很多问题及挑战亟待解决。本文从基因分子学理论出发,探究BRAF突变在甲状腺乳头状癌的治疗、复发、死亡率及预后评估中的应用价值,以及BRAF突变与TERT启动子突变在甲状腺癌中的相互联系与影响,以供相关学者了解该领域的现状,为今后进一步研究提供一个大致的方向。

Purpose: To evaluate the prognostic value of maximum standardized uptake values (SUVmax) measured in the primary lesion and axillary lymph nodes (ALN) by pretreatment fluorine-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) in patients with breast cancer.Methods: We systematically searched PubMed, Embase, and the Cochrane Library. The primary prognosis endpoint was event-free survival (EFS), and the secondary endpoint was overall survival (OS). The pooled hazard ratio (HR) was estimated by using random-effects model according to the results of heterogeneity.Results: Fifteen eligible studies with 3574 breast cancer patients were included. For EFS, patients with higher primary SUV(max )showed a poorer survival prognosis with pooled HR of 1.96 (95% confidence interval (CI) 1.40-2.73). The combined HR of high SUVmax in ALN and ALN-to-primary SUVmax ratio (N/T ratio) were 1.89 (95% CI 0.70-5.07) and 2.06 (95% CI 0.59-7.21), respectively. In analyzing invasive ductal carcinoma (IDC) patients, the pooled HR was 1.91 (95% CI 1.40-2.64). For OS, the pooled HR of SUVmax in primary lesion and ALN were 0.64 (95% CI 0.23-1.84) and 1.09 (95% CI 0.07-16.53), respectively.Conclusions: Our meta-analysis suggested that patients with high primary SUVmax may experience a higher risk for recurrence or a poor progression. Moreover, the SUVmax of F-18-FDG showed a significant prognostic value in IDC patients.

抑郁症是常见的精神障碍疾病,其中约30%的患者对标准的抗抑郁药物治疗无明显缓解,这种情况被称为难治性抑郁症,其神经生物学机制尚不清楚。神经影像技术可无创探究脑结构、功能和代谢的变化,被逐渐应用于难治性抑郁症的神经生物学机制研究,并发现额叶-边缘系统重要脑区的结构、功能和代谢的异常。本文就难治性抑郁症的神经影像学研究最新进展进行综述,为进一步研究难治性抑郁症的神经生物学机制提供思路及客观影像学依据。

Depression is the leading cause of disability around the world, but little is known about its pathology. Currently, the diagnosis of depression is made based on clinical manifestations, with little objective evidence. Magnetic resonance imaging (MRI) has been used to investigate the pathological changes in brain anatomy associated with this disorder. MRI can identify structural alterations in depressive patients in vivo, which could make considerable contributions to clinical diagnosis and treatment. Numerous studies that focused on gray and white matter have found significant brain region alterations in major depressive disorder patients, such as in the frontal lobe, hippocampus, temporal lobe, thalamus, striatum, and amygdala. The results are inconsistent and controversial because of the different demographic and clinical characteristics. However, some regions overlapped; thus, we think that there may be a "hub" in MDD and that an impairment in these regions contributes to disease severity. Brain connections contain both structural connections and functional connections, which reflect disease from a different view and support that MDD may be caused by the interaction of multiple brain regions. According to previous reports, significant circuits include the frontal-subcortical circuit, the suicide circuit, and the reward circuit. As has been recognized, the pathophysiology of major depressive disorder is complex and changeable. The current review focuses on the significant alterations in the gray and white matter of patients with the depressive disorder to generate a better understanding of the circuits. Moreover, identifying the nuances of depressive disorder and finding a biomarker will make a significant contribution to the guidance of clinical diagnosis and treatment.

Depression is the leading cause of disability around the world, but little is known about its pathology. Currently, the diagnosis of depression is made based on clinical manifestations, with little objective evidence. Magnetic resonance imaging (MRI) has been used to investigate the pathological changes in brain anatomy associated with this disorder. MRI can identify structural alterations in depressive patients in vivo, which could make considerable contributions to clinical diagnosis and treatment. Numerous studies that focused on gray and white matter have found significant brain region alterations in major depressive disorder patients, such as in the frontal lobe, hippocampus, temporal lobe, thalamus, striatum, and amygdala. The results are inconsistent and controversial because of the different demographic and clinical characteristics. However, some regions overlapped; thus, we think that there may be a "hub" in MDD and that an impairment in these regions contributes to disease severity. Brain connections contain both structural connections and functional connections, which reflect disease from a different view and support that MDD may be caused by the interaction of multiple brain regions. According to previous reports, significant circuits include the frontal-subcortical circuit, the suicide circuit, and the reward circuit. As has been recognized, the pathophysiology of major depressive disorder is complex and changeable. The current review focuses on the significant alterations in the gray and white matter of patients with the depressive disorder to generate a better understanding of the circuits. Moreover, identifying the nuances of depressive disorder and finding a biomarker will make a significant contribution to the guidance of clinical diagnosis and treatment.

Objectives The aim of this meta-analysis was to evaluate the accuracy of F-18-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients. Methods PubMed, Embase, the Cochrane Library (Central), and the Web of Science (SCI-Expanded) were systematically searched to identify pertinent studies. The methodologic quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. The Spearman correlation coefficient was used to explore the existence of a threshold effect. Heterogeneity was assessed by the likelihood ratio I-2 index. Results The pooled values calculated with a mixed-effects model for the sensitivity, specificity and diagnostic odds ratio with 95% confidence intervals were 81.9% (76.0-86.6%), 79.3% (72.1-85.1%) and 17.35 (10.98-27.42), respectively. Conclusions F-18-FDG PET/CT has a moderate accuracy in predicting the pathological response during the early process of NAC in breast cancer patients. To increase the role of F-18-FDG PET/CT in monitoring the therapy response, future prospective studies are needed to explore how chemotherapy regimens and different subtypes affect the levels of glucose metabolism.

Purpose: To detect biophysical abnormalities in patients with postmedication treatment-resistant depression (TRD) with magnetization transfer imaging.Materials and Methods: This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Participants included 69 patients with major depressive disorder (MDD) (30 with TRD; 39 with nonTRD) and 41 healthy control subjects. Age and sex were examined with one-way analysis of variance and x2 tests and were well matched among the three groups. Wholebrain voxel-based analysis was used to compare the magnetization transfer ratio (MTR) between the three groups. Regional MTR values were used to analyze the correlations with symptom severity and illness duration.Results: MTR differences were identified in the bilateral precentral gyrus, left cerebellum posterior lobe, left middle occipital lobe, left precuneus, and left temporal lobe among the three groups. Relative to patients with non-TRD, those with TRD had significantly lower MTR in the task-positive network regions, including the bilateral precentral gyrus and left middle occipital lobe, and had lower MTR in the default mode network regions, including the left precuneus and left temporal lobe. Regional MTRs were not associated with symptom severity or illness duration.Conclusion: These results suggest that treatment resistance in patients with MDD may be mediated by macromolecular abnormalities in the task-positive and default mode functional networks.

BackgroundAccurate clinical staging of mediastinal lymph nodes of patients with lung cancer is important in determining therapeutic options and prognoses. We aimed to compare the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) in detecting mediastinal nodal metastasis of lung cancer.MethodsRelevant studies were systematically searched in the MEDLINE, EMBASE, PUBMED, and Cochrane Library databases. Based on extracted data, the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR) with individual 95% confidence intervals were calculated. In addition, the publication bias was assessed by Deek's funnel plot of the asymmetry test. The potential heterogeneity was explored by threshold effect analysis and subgroup analyses.ResultsForty-three studies were finally included. For PET/CT, the pooled sensitivity and specificity were 0.65 (0.63-0.67) and 0.93 (0.93-0.94), respectively. The corresponding values of DWI were 0.72 (0.68-0.76) and 0.97 (0.96-0.98), respectively. The overall PLR and NLR of DWI were 13.15 (5.98-28.89) and 0.32 (0.27-0.39), respectively. For PET/CT, the corresponding values were 8.46 (6.54-10.96) and 0.38 (0.33-0.45), respectively. The Deek's test revealed no significant publication bias. Study design and patient enrollment were potential causes for the heterogeneity of DWI studies and the threshold was a potential source for PET/CT studies.ConclusionBoth modalities are beneficial in detecting lymph nodes metastases in lung cancer without significant differences between them. DWI might be an alternative modality for evaluating nodal status of NSCLC.

18F-氟代脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)是目前正电子药物中临床应用最广泛的显像剂,但其在前列腺癌、脑肿瘤、肝癌、肺癌等方面的应用存在一定的局限性。胆碱作为磷脂的前体,是合成细胞膜的必需成分。肿瘤细胞迅速增殖,细胞膜生物合成活动增加,胆碱激酶活性增强,胆碱摄取量增加,这是11C或18F标记的胆碱可以作为正电子发射计算机断层显像（positron emission tomography/computed tomography,PET/CT）显像剂的基本原理。在临床应用中,胆碱PET/CT能大大弥补18F-FDG PET/CT在某些肿瘤应用中的不足,提高诊断肿瘤的准确性。该文旨在总结11C/18F-胆碱PET/CT在肿瘤诊断中的价值。