Objective:To analyze the association between thyroglobulin antibody (TgAb) and differentiated thyroid cancer (DTC) metastases detected by post-radioactive iodine (RAI) therapy scan, when stimulated thyroglobulin (sTg) <1 μg/L.Methods:A total of 314 (68 males, 246 females, age (44.5±12.5) years) post-thyroidectomy DTC patients whose sTg <1 μg/L between March 2013 and May 2017 in Henan Cancer Hospital were enrolled retrospectively. Patients underwent 131I whole-body planar imaging ( 131I-WBS) and SPECT/CT imaging 5 d after 131I administration. Iodine avid metastases were compared between TgAb-positive group and TgAb-negative (TgAb<4 kU/L) group. Logistic regression analysis was conducted to assess odds ratio ( OR) for iodine avid metastases in each subgroup (Q1: 4 kU/L≤TgAb≤9.27 kU/L; Q2: 9.27 kU/L101.43 kU/L) of TgAb-positive patients, with the TgAb-negative patients as the reference. χ2 test was used to analyze the data. Results:Iodine avid metastases were found in 16.9% (53/314) of DTC patients and were more frequently in TgAb-positive group with TgAb>26.75 kU/L than TgAb-negative group (26.0%(19/73) vs 13.7%(23/168); χ2=5.382, P=0.02). Most metastases (92.5%, 49/53) occurred in cervical and mediastinal lymph nodes. The OR for iodine avid metastases was obviously high in TgAb-positive patients with 26.75 kU/L

Objective:To investigate the diagnostic efficacy of 99Tc m-MIBI SPECT dual-phase imaging combined with rapid parathyroid hormone detection in thyroid cancer with suspected parathyroid mass. Methods:Data of 76 cases of thyroid cancer with suspected cervical parathyroid gland tumors receiving colorectal ultrasonography or CT examination in Thyroid Surgery Department of the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. Blood samples were taken before surgery to detect parathyroid hormone. Parathyroid hormone was quickly detected after clamping the tumor blood vessels during surgery. Based on the postoperative pathological results, the sensitivity, specificity, accuracy and consistency of various diagnostic methods were evaluated. The ROC curve was drawn by measuring the value of the parathyroid gland concentration after reduction of the tumor blood vessels by clamping the tumor.Results:The sensitivity and accuracy of the 99Tc m-MIBI SPECT dual-phase imaging combined with the rapid detection of parathyroid hormone in diagnosis of suspected parathyroid tumors were (96.5%, 93.4%) better than the 99Tc m-MIBI SPECT dual-phase imaging methods (77.6%, 78.9%) and intraoperative rapid detection methods (86.2%, 82.8%) , and had a high consistency with the results of pathological examination, Kappa value of 0.81. The combined detection rate of suspected parathyroid tumors was significantly higher than that of 99Tc m-MIBI SPECT dual-phase imaging and rapid intraoperative detection, but there was no significant difference between 99Tc m-MIBI SPECT dual-phase imaging and intraoperative rapid detection. The area under the ROC curve of the reduction ratio a value after clamping the blood vessels of the tumor was 0.774, and the standard error was 0.073. The difference was statistically significant ( P<0.001,95% CI:0.631-0.918) . According to the results obtained by the ROC, the index (sensitivity + specificity-1) was plotted on the ordinate and a was the abscissa. The maximum value of the Jordan index was 0.584. The a value corresponding to this point was 0.52. 0.52 is the DCP value. The corresponding sensitivity, specificity, accuracy was 86.2%,72.2%,and 82.9%. Conclusion:99Tc m-MIBI SPECT dual-phase imaging combined with rapid parathyroid hormone detection during surgery has good diagnostic value for thyroid cancer with suspected parathyroid mass, and is completely consistent with pathological diagnosis.

Objective To evaluate the clinical effect of alveolar bone augmentation by applying autogenous tooth bone graft material to patients with alveolar bone deficiency in orthodontic treatment. Methods Four patients with a stable periodontal condition managed with fixed orthodontic treatment were included, and the number of graft sites was 17. Cone beam computed tomography (CBCT) showed labial alveolar bone deficiency. The treatment plan included extraction, and the extracted teeth were used to prepare autogenous tooth bone material. The alveolar bone width was measured at the same site at multiple heights prior to operation and at 3 and 6 months post-operation.Results The alveolar bone width was higher at both 3 and 6 months post-operatively (P ＜ 0.05) than that pre-operatively. The alveolar bone width at 6 months post-operation was lower than that at 3 months post-operation (P ＜ 0.05). Conclusion Applying autogenous tooth bone graft material to patients with alveolar bone deficiency in orthodontic treatment can expand the range of tooth movement and result in good clinical outcomes.

Objective: To assess value of immediate postoperative intravesical instillation of pirarubicin after transurethral resection (TURBT)of non-muscle invasive bladder cancer. Methods: 484 patients diagnosed with non-muscle-invasive bladder cancer admitted to the Second Affiliated Hospital of Kunming Medical University were divided into two groups after transurethral resection of bladder tumor. 285 patients received postoperative intravesical instillation of pirarubicin within 6 hours after the surgery, 199 patients received first instillation of pirarubicin at 10 days after the surgery, after that, all the patients received routine bladder perfusion chemotherapy. Patients who received intravesical instillation of pirarubicin within 6 hours were defined as immediate intravesical instillation group and the other patients as the control group. Based on the European Organisation for Research and Treatment of Cancer risk tables, scores of recurrence and progression of patients were calculated and then stratified into risk groups accordingly. Recurrence and progression rates of the immediate intravesical instillation group were analyzed and then compared with the corresponding reference of the risk tables. Results: The 1-year and 5-year recurrence rate of patients with EORTC table scoring 0 in the immediate intravesical instillation group were significantly lower than that of the EORTC reference group (5.3% and 14.0% vs 15.0% and 31.0%, P<0.05). 1-year recurrence free rate between the immediate intravesical instillation group and the control group in patients scoring 1-4 was significantly different (81.3% vs 76.7%, P=0.014). However, 1-year recurrence free rate of the immediate intravesical instillation group was comparable with that of the control group in patients scoring 5-9, 10-17(P>0.05), which is quite close to the EORTC reference. The probability rates of 1-year and 5-year progression of the 285 patients who received immediate intravesical instillation group did not show significant difference with the EORTC reference. On multivariate analysis, previous recurrence, tumor grade G2-3, tumor multiplicity, delay of immediate intravesical instillation were independent risk factors of recurrence(P<0.05). Conclusions With the help of EORTC recurrence risk table stratifying the patients into different risk groups, our study showed that delay of immediate postoperative intravesical instillation of chemotherapy after TURBT was an independent risk factor of post-surgery recurrence of tumor. Moreover, patients with EORTC scoring 1-4 might obtain greatest benefits.

Objective To analyze and explore the clinical value of CYP2C19 genetic polymorphism in the treatment of refractory gastroesophageal reflux disease.Methods The CYP2C19 genetic polymorphism was detected and analyzed in 198 RGERD patients.According to genotyping,the patients were divided into extensive metabolism and poor metabolism.Each patient was filled in RDQ and LA Classification(from A to D) by endoscopy before and after 8 weeks of PPI treatment.Results There were 160 cases in EM group,mean age 53.23-± 14.52 years old.There were 38 cases in PM group,mean age 52.11 ± 12.13 years old.And all patients were treated with omeprazole 20 mg (twice daily).The mean score of RDQ in the PM group was significantly decreased after 8 weeks,and the esophageal mucosal lesion was significantly improved by endoscopy(P ＜ 0.05),but there was no significant difference in EM group with RDQ and LA (P ＞ 0.05).Conclusion The RGERD patients with poor metabolism group of CYP2C19 using proton pump inhibitors can achieve better efficacy.Theoretically,increasing the PPI dose can achieve the desired effect in the patients of EM group.So the clinician can be based on metabolic typing to achieve individualized medication and rationalization of medication.

Objective To investigate the treatment outcome of patients with localized soft tissue sarcoma (STS) and related prognostic factors,with a focus of the role of postoperative radiotherapy in the treatment of STS.Methods A retrospective analysis was performed for the clinical data of 203 STS patients who underwent organ preservation surgery in Fudan University Shanghai Cancer Center from July 2000 to July 2010.Of all the patients,76(37.4％) received adjuvant radiotherapy,which was delivered via anterior-posterior parallel opposed fields at a dose of 45-70 Gy.The Kaplan-Meier method was used to calculate survival rates,the log-rank test was used for survival difference analysis,and the Cox proportional hazards model was used for multivariate analysis.Results The follow-up rate was 100％.The 5-year overall survival (OS) rate,local failure-free survival rate,and distant metastasis-free survival rate were 69.1％,69.2％,and 68.0％,respectively.The multivariate analysis showed that pathological subtype,tumor size,resection margin status,and postoperative radiotherapy were influencing factors for OS.Among these factors,postoperative radiotherapy was associated with a significantly reduced risk of local recurrence in STS patients (HR=0.327,95％ CI 0.177-0.605,P=0.000) and a significantly increased OS rate (HR=0.489,95％ CI 0.266-0.897,P=0.021).Conclusions Postoperative radiotherapy can reduce local recurrence and improve OS in patients with localized STS,and further studies are needed to clarify its role.

Objective To study the influence of hierarchical psychological nursing on anxiety, depression, 5-hydroxytryptamine (5-HT) and Galanin (GAL) of patients with gastroesophageal reflux disease. Methods A total of 238 gastroesophageal reflux disease patients were divided into study group( n=119) and control group( n=119) by random number table. Two groups of patients were given the same routine care. Based on this, patients in the control group were given conventional psychological nursing, the study group were given hierarchical psychological nursing. SAS and SDS were used to evaluate the two group patients mental status before and after different mental care. Enzyme linked immunosorbent assay ( ELISA) was used to evaluate the contents of 5-HT and GAL of the two groups.Results After 4 weeks of hierarchical psychological nursing, SAS and SDS scores of the study group were (41.47±9.37) and (42.13±12.36). Those scores of the control group were (45.68±14.81) and (48.15±14.21). The differences were significant (t=2.62,3.49;P<0.05). After 4 weeks of hierarchical psychological nursing, 5-HT and GAL contents of the study group were (166.05±63.66) ng/ml and (23.18±8.74)pg/ml. Those contents of the control group were (146.30±63.75)ng/ml and (25.45± 9.03)pg/ml. The differences were significant (t=2.39,1.97;P<0.05).Conclusions Hierarchical psychological nursing can decrease anxiety and depression of patients with gastroesophageal reflux disease and help the contents of GAL and 5-HT return to normal level gradually. It is worthy of clinical promotion and popularization.

Objective Proximal humerus fracture is the most common upper-arm osteoporotic fracture in elderly patients and the result of treatment directly affects the physiological function of the shoulder .This article discusses the clinical effect of the locking proximal humeral plate ( LPHP) combined with anti-osteoporosis drugs in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients . Methods This study included of 47 elderly osteoporotic patients with comminuted proximal humerus fractures treated from April 2009 to March 2012 and with complete follow-up data.According to the Neer classification , the patients were divided into groups A (LPHP treatment, n=23, including 13 cases of three-part fractures and 10 cases of four-part fractures) and B (LPHP+anti-osteoporosis drugs, n=24, including 13 cases of three-part fractures and 11 cases of four-part fractures). Results All the patients were followed up for 14 to 38 (mean 23.6) months.The postoperative healing time was significantly shorter in group B than in group A ([96.57 ±2.59]d vs [115.91 ±2.73]d, P<0.05), and the excellence rate was remarkably higher in B than in A (91.7%vs 78.3%,P<0.05). Conclusion With the advantages of short healing time and high excellence rate , LPHP+anti-os-teoporosis drugs is superior to simple LPHP in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients.

Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.

Objective To investigate the application of CT in the diagnosis of cardiac lipoma.Methods Retrospective analysis of 6 patients with cardiac lipoma confirmed by operation and pathology was done. Four patients had singles slice electron beam CT plain and contrast and movie scan. Two patients had 64-slice CT plain and enhanced scan. Results (1) One patient was isolated intracavitary lipoma in the right artium, 1 patient was isolated intrapericardial lipoma and 4 patients were intramural lipomas. Of the 4 intramural lipoma, 2 were infiltrative lipomas located in the left ventricle wall or the right ventricle and septum, 2 patients were isolated in the atrio-ventricular septums. (2) CT and three-dimensional reconstruction could depict the location, shape, size, margin and characteristic fat density of lipoma,indicating the diagnosis and classifications. The displacement of coronary artery, pulmonary inflammation and effusions of pericardium and pleural cavity could also be revealed. Conclusion Cardiac lipoma can be accurately diagnosed and classified by CT.