Objective To investigate the value of TI-RADS for sonographic diagnosis of papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) and to evaluate the sonographic findings of FTC compared to PTC.Methods The clinical and sonographic data of 363 cases of pathology confirmed thyroid nodules were retrospectively analyzed.The thyroid nodules were classified by TI-RADS grading criteria,the accuracy of TI-RADS and sonographic findings between FTC and PTC was analyzed.Results In 363 thyroid nodules,114 cases were confirmed as benign lesions;249 cases were confirmed as carcinomas,including 50 FTC cases and 199 PTC cases.The sensitivity,specificity,PPV,NPV,and accuracy of PTC were 97.0％ (193/199),85.1％ (97/114),91.9％ (193/210),85.8％ (97/113),95.7％ (290/303) respectively.The sensitivity,specificity,PPV,NPV,and accuracy of FTC were 97.0％(193/199),85.1％ (97/114),91.9％ (193/210),85.8％ (97/113),95.7％ (290/303) respectively.There were significant differences of nodule size,shape,margin,echogenecity,calcification,halo and flow between FTC group and PTC group (P ＜ 0.05).Conclusion TI-RADS has higher value in the sonographic diagnosis of PTC than that of FTC.FTC are greatly different from PTC in many sonographic findings making it less valuable for the diagnosis of FTC.

As important Internet users, college students need to establish good cyber ethics to promote healthy development of the Internet and meet the needs of their own growth. The characteristics of college students' cyber ethics include hierarchy, self-discipline, orientation and particularity. Self-respect and respect for others;hon-est and trustworthy;fair and mutual benefit;attention to public welfare and participation;patriotic, studious, cre-ate a harmonious network should be college students' network moral norms.

Objective:To explore the subjective well-being and its influencing factors of female elderly in ur-ban community in Shandong province. Methods: Used the multi-stage stratified sampling method to extract 449 elderly women in 6 communities of 18 cities in Shandong Province. The basic situation and Subjective well-being of their were investigated by using the self-designed questionnaire and Memorial University of Newfoundland Scale of Happiness ( MUNSH) . Results:The economic situation, the number of children, living conditions, self-care ability, chronic disease severity, and other variables have a significant effect on the subjective well-being of fe-male elderly. Conclusions:To improve the economic situation of the urban community elderly women, pay atten-tion to their physical and mental health level, improve the pension and health insurance system, intensify the con-struction of old-age care institutions, playing the roles of family, children, society in the network to support the community elderly women society, can significantly improve the community elderly women′s subjective well-be-ing.

Objective:To retrospectively analyze the early mortality and related risk factors in adult patients with maintenance hemodialysis (MHD).Methods:Adult MHD patients from 2008 to 2018 were enrolled and divided into training data group and validation data group. In training data group, multivariate logistic regression was used to analyze the risk factors of early death within 120 days after hemodialysis and establish a prediction model. The receiver operating characteristic (ROC) curve was applied to evaluate the prediction ability of the model.Results:A total of 4 885 patients were included. The cumulative mortality within 120 days was 20.97/100 person years, and that within 365 days was 12.25/100 person years. A total of 3 603 patients in the training data group were analyzed. The following risk factors were correlated with early mortality (all P<0.05), including age at start of dialysis over 60 years old ( OR=1.792), non-chronic glomerulonephritis ( OR=2.214), cardio-cerebrovascular disease ( OR=2.695), plasma albumin less than 35 g/L ( OR=1.358), platelet count less than 120×10 9/L ( OR=2.194), serum creatinine less than 600 μmol/L ( OR=1.652), blood urea nitrogen over 30 mmol/L ( OR=1.887), blood phosphorus less than 1.13 mmol/L ( OR=1.783), pulse pressure over 55 mmHg(1 mmHg=0.133 kPa) ( OR=1.656), low density lipoprotein less than 1.5 mmol/L ( OR=1.873), and blood calcium over 2.5 mmol/L ( OR=1.876). Risk prediction model was established. The other 1 282 cases in the validation data group were verified. The area under ROC curve was 0.810, with sensitivity 85.7%, and specificity 62.5%. Conclusion:The mortality rate of adult MHD patients within 120 days after dialysis is high. The established prediction model can effectively predict the risk of early death.

D ue to the negative autopsy and w ithout cardiac structural abnorm alities, unexpected sudden cardiac death (U SC D ) is alw ays a tough issue for forensic pathological expertise. U SC D m ay be asso-ciated w ith parts of fatal arrhythm ic diseases. T hese arrhythm ic diseases m ay be caused by disorders of cardiac ion channels or channel-related proteins. C aveolin can com bine w ith m ultiple m yocardial ion channel proteins through its scaffolding regions and plays an im portant role in m aintaining the depolar-ization and repolarization of cardiac action potential. W hen the structure and function of caveolin are af-fected by gene m utations or abnorm al protein expression, the functions of the regulated ion channels are correspondingly im paired, w hich leads to the occurrence of m ultiple channelopathies, arrhythm ia or even sudden cardiac death. It is im portant to study the effects of caveolin on the functions of ion channels for exploring the m echanism s of m alignant arrhythm ia and sudden cardiac death.

Objective T o explore the genetic variation sites of caveolin (C A V ) and their correlation w ith sudden unexplained death (SU D ).Methods The blood sam ples w ere collected from SU D group (71 cases), coronary artery disease (C A D ) group (62 cases) and control group (60 cases), respectively. T he genom e D N A w ere extracted and sequencing w as perform ed directly by am plifying gene coding region and exon-intron splicing region of CAV1 and CAV3 using PC R . T he type of heritable variation of CVA w as con-firm ed and statistical analysis w as perform ed. Results A total of 4 variation sites that m aybe significa-tive w ere identified in SU D group, and tw o w ere new found w hich w ere CAV1: c.45C>T (T 15T ) and CAV1:c.512G>A (R 171H ), and tw o w ere SN P loci w hich w ere CAV1:c.246C>T (rs35242077) and CAV3:c.99C>T (rs1008642) and had significant difference (P<0.05) in allele and genotype frequencies betw een SU D and control groups. Forem entioned variation sites w ere not found in C A D group. Conclu-sion T he variants of CAV1 and CAV3 m ay be correlated w ith a part of SU D group.

PURPOSE: The significance of neuroendocrine differentiation (NED) in gastric carcinoma (GC) is controversial, leading to ambiguous concepts in traditional classifications. This study aimed to determine the prognostic threshold of meaningful NED in GC and clarify its unclear features in existing classifications. MATERIALS AND METHODS: Immunohistochemical staining for synaptophysin, chromogranin A, and neural cell adhesion molecule was performed for 945 GC specimens. Survival analysis was performed using the log-rank test and univariate/multivariate models with percentages of NED (PNED) and demographic and clinicopathological parameters. RESULTS: In total, 275 (29.1%) cases were immunoreactive to at least 1 neuroendocrine (NE) marker. GC-NED was more common in the upper third of the stomach. PNED, and Borrmann's classification and tumor, lymph node, metastasis stages were independent prognostic factors. The cutoff PNED was 10%, beyond which patients had significantly worse outcomes, although the risk did not increase with higher PNED. Tumors with ≥10% NED tended to manifest as Borrmann type III lesion with mixed/diffuse morphology and poorer histological differentiation; the NE components in this population mainly grew in insulae/nests, which differed from the predominant growth pattern (glandular/acinar) in GC with <10% NED. CONCLUSIONS: GC with ≥10% NED should be classified as a distinct subtype because of its worse prognosis, and more attention should be paid to the necessity of additional therapeutics for NE components.
Adenocarcinoma ; Chromogranin A ; Classification ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Neural Cell Adhesion Molecules ; Prognosis ; Stomach ; Stomach Neoplasms ; Synaptophysin

Objective To analyze and summarize the cases of pregnancy on maintenance hemodialysis (MHD),and review the literature.Methods Seven cases of pregnancy and childbirth in patients on MHD in the First Affiliated Hospital of Zhejiang University from Jan 2009 to Dec 2017 were analyzed,and the literature about pregnancy in patients on MHD reported in Pubmed and Web of Science database was retrieved.Both maternal and fetal outcome were studied.Results There are seven pregnant MHD patients in this center,among whom six patients went through a smooth pregnancy and one patient had intra-uterine fetal death at 14 weeks of pregnancy.The six patients had preterm labor.Among six fetuses,four grew in good health and developed well,one had physical development retardation and one had heart malformation at born.In the literature,169 cases reported pregnant patients and 182 fetuses were evaluated,of which 145 live infants were delivered,79.67％ overall fetal survival rate,with gestational age of (32.94±3.34) weeks.In 164 delivered fetuses,147 were preterm labor (89.63％).The weight of live births was (1824±609) g.There were no maternal deaths.Fetal survival rate was zero in ＜ 20 weeks of gestational age,20-24 weeks was 14.29％,25-27 weeks was 45.45％,≥28 weeks was 94.44％.The fetal survival rate was higher in pregnant woman receiving hemodialysis≥28 hours weekly compared to women receiving ＜ 16 hours weekly (92.31％ vs 52.94％,P=0.02).Conclusions There are still a very high matemal and fetal complication rate in hemodialysis patients,especially in fetus.Gestational age≥28 weeks has a high fetal survival rate.Intensive dialysis during pregnancy may benefit higher fetal survival rate.

Objective To explore the application value of Thyroid Imaging Reporting and Data System ( TI?RADS) stratification in diagnosing thyroid nodules in respect of the effect of age and gender. Methods A total of 684 patients with thyroid nodules, including 118 males and 566 females, were stratified into subgroups according to their age and gender, and the results of TI?RADS evaluation were compared with their pathological diagnosis. Results The sensitivity, specificity, and AUC of TI?RADS grading for malignant thyroid nodules in the males was 84.7%, 66.7%, and 0.803 (95% CI 0.709?0.897), respectively. In the females, the sensitivity and specificity were 80. 8% and 65. 0%, respectively, with an AUC of 0.812 (95% CI 0.758?0.849). There was no statistically significant difference between genders when using TI?RADS to determine the nature of thyroid nodules ( P>0.05) . In the patients aged 26?35 years, the sensitivity, specificity and AUC of TI?RADS classification for malignant thyroid nodules were 85.4%, 90.0%, and 0.915 (95% CI 0.818?0.987), respectively. In the patients aged 36?45 years, the sensitivity and specificity of TI?RADS classification for malignant thyroid nodules were 84. 4% and 78. 1%, respectively, with an AUC of 0. 898 ( 95% CI 0. 842?0. 953 ) . In the patients aged 46?55 years, the corresponding parameters were 79.7%, 71.4% and AUC 0.822 (95% CI 0.789?0.925), respectivey, while in those aged 56?65 years, the corresponding data were 75.6%, 60.0%, and AUC 0.729 (95% CI 0.576?0.785), respectively. The ROC curve of patients aged 56?65 years was statistically significantly different from those of patients aged 26?35, 36?45 and 46?55 years ( P<0.05 for all) . Conclusions Patient gender has no significant effect on the results of TI?RADS classification, but age of the patients does. The age factor should be considered during ultrasound diagnosis of thyroid nodules using TI?RADS classification.

Objective To explore the application value of Thyroid Imaging Reporting and Data System ( TI?RADS) stratification in diagnosing thyroid nodules in respect of the effect of age and gender. Methods A total of 684 patients with thyroid nodules, including 118 males and 566 females, were stratified into subgroups according to their age and gender, and the results of TI?RADS evaluation were compared with their pathological diagnosis. Results The sensitivity, specificity, and AUC of TI?RADS grading for malignant thyroid nodules in the males was 84.7%, 66.7%, and 0.803 (95% CI 0.709?0.897), respectively. In the females, the sensitivity and specificity were 80. 8% and 65. 0%, respectively, with an AUC of 0.812 (95% CI 0.758?0.849). There was no statistically significant difference between genders when using TI?RADS to determine the nature of thyroid nodules ( P>0.05) . In the patients aged 26?35 years, the sensitivity, specificity and AUC of TI?RADS classification for malignant thyroid nodules were 85.4%, 90.0%, and 0.915 (95% CI 0.818?0.987), respectively. In the patients aged 36?45 years, the sensitivity and specificity of TI?RADS classification for malignant thyroid nodules were 84. 4% and 78. 1%, respectively, with an AUC of 0. 898 ( 95% CI 0. 842?0. 953 ) . In the patients aged 46?55 years, the corresponding parameters were 79.7%, 71.4% and AUC 0.822 (95% CI 0.789?0.925), respectivey, while in those aged 56?65 years, the corresponding data were 75.6%, 60.0%, and AUC 0.729 (95% CI 0.576?0.785), respectively. The ROC curve of patients aged 56?65 years was statistically significantly different from those of patients aged 26?35, 36?45 and 46?55 years ( P<0.05 for all) . Conclusions Patient gender has no significant effect on the results of TI?RADS classification, but age of the patients does. The age factor should be considered during ultrasound diagnosis of thyroid nodules using TI?RADS classification.