Objective To investigate the value of CT signs in combination with clinical materials of papillary thyroid carcinoma (PTC) to predict the central lymph node metastasis (CLNM).Methods This article reviewed the CT signs and clinical materials of 366 patients with surgically and pathologically verified PTC.The single factor and multi-factor logistic regression analyses were performed on the relation of tumor position,thyroid marginal contact,calcification,plain scan border,border after enhancement,diameter,age and sex with CLNM.Results Among the 366 patients with PTC,the number of patients with positive CLNM and negative CLNM was 155 and 211 respectively.The single factor and multi-factor logistic regression analysis indicated that the thyroid marginal contact,diameter,age and sex were related with CLNM,and the more common patients diagnosed with CLNM had the following features:thyroid marginal contact,a diameter ＞1.0 cm,age ＜45 years and males (P＜ 0.05).Among the single risk factors,the tumor position,calcification,plain scan border and border after enhancement were unrelated with CLNM (P＞0.05).Conclusion The thyroid margin contact,diameter＞l.0 cm,age＜45 years and males are independent risk factors in diagnosis of positive CLNM.

0.05). After the treatment the level of ?bl, ?bh, ?p of treated group degraded obviously (P

Objective To expound the mechanism and the clinical features of Tong-Du-Huo-Luo exercise in treating ankylosing spondylitis.Methods Besides taking SASP per os,the patients in treatment group did Tong-Du-Huo-Luo exercise twice daily. Patients in control group took SASP only.The patients in both groups had accepted the treatments for 6 months.Results Compared with western medicine treatment,the Tong-Du-Huo-Luo exercise can bring better effects on ability of expanding chest,finger-floor distance,pulvinar-wall distance,and improving the results of Schober test and blood sedimentation test.Conclusions Tong-Du-Huo-Luo exercise is an effective method in treating ankylosing spondylitis patients.

Objective To investigate the diagnostic value of hyperenhancement sign on ultrasound,CT and their combination in diagnosis of thyroid benign and malignant nodules.Methods The contrast-enhanced ultrasound and enhanced CT datas of 172 thyroid nodules in 144 cases confirmed by operation and pathology were retrospectively analyzed,including 97 benign nodules and 75 malignant nodules.According to the degree of enhancement,these nodules were divided into iso-or low-enhancement and hyperenhancement.The distributions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules,adenomatoid lesions and nodular goiters were analyzed,followed byx2 test for statistical analysis.Results In 172 thyroid nodules,the proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules were 53.6％(52/97) and 20.0％(15/75)(x2＝20.090,P＜0.05),34.0％ (33/97) and 4.0％ (3/75) (x2＝23.033,P＜0.05),31.0％ (30/97) and 0％ (0/75) (x2＝28.096,P＜0.05),respectively.Their sensitivity and specificity of diagnosing benign nodules were 53.6％ (52/97) and 80.0％ (60/75),34.0％ (33/97) and 96％ (72/75),30.9％ (30/97) and 100％ (75/75),respectively.The proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in adenomatoid lesions and nodular goiters were 96.9％(31/32) and 32.3％(21/65)0x2＝35.946,P＜0.05),65.6％(21/32) and 18.5％(12/65)(x2＝21.250,P＜0.05),65.6％(21/32) and 13.8％ (9/65)(x2＝26.912,P＜0.05).Their sensitivity and specificity of diagnosing adenomatoid lesions were 96.9％(31/32) and 67.7％(44/65),65.6％(21/32) and 81.5％(53/65),65.6％(21/32) and 87.2％(56/65).Conclusions Ultrasound hyperenhancement,CT hyperenhancement for diagnosing thyroid benign nodules are of significant value.Especially for adenomatoid nodules,ultrasound hyperenhancement has a higher sensitivity,while CT hyperenhancement has a higher specificity.Their combination can further improve the diagnostic specificity,thus reducing the unnecessary surgical trauma.

Objective To evaluate the effectiveness of a newly designed modular flexible ureteroscope with holmium laser lithotripsy for the treatment of renal calculi based. Methods 40 patients were treated with modular flexible ureteroscopic lithotripsy (German Polydiagnost) with holmium laser. 40 patients were treated by traditional flexible ureteroscopic lithotripsy. Their therapeutic effects were compared. Results For modular flexible ureteroscopic lithotripsy group, 37 patients underwent successful operation, with lithotripsy with operation time of (86.0 ± 34.4) min and postoperative hospital stay of (5.3 ± 1.6) days. No severe complication including ureteral perforation, high fever or severe bleeding occurred. One month after the operation, KUB and B-ultrasonography showed complete stone free in 35 patients. Residual calculi (0. 4 cm in diameter) in the calyces were found in 2 patients. Medication and postural drainage therapy were applied. Two weeks later , KUB and B-ultrasonography showed that the residual stones have been removed completely. There was no significant differences in stone size , operation time, rate of calculus clearance, the incidence of postoperative complications, operating time and duration of postoperative hospitalization between the traditional flexible ureteroscopic lithotripsy group and modular ureteroscopic lithotripsy group. Conclusions The modular flexible ureteroscope is effective and safe in treating reanl calculi. It has similar surgical efficacy as traditional flexible ureteroscope , but is more costly effective in terms of maintenance costs.

Objective To analyze CT characteristics of patients with primary parathyroid hyperplasia ( PPH) , parathyroid adenoma ( PA) , atypical parathyroid adenoma ( APA) , and parathyroid carcinoma ( PC) and to evaluate the value of CT in the diagnosis and differential diagnosis of primary hyperparathyroidism ( PHPT ) . Methods CT scan of 134 pathologically proved PHPT patients with complete clinical and laboratory data were retrorespectively analyzed .The similarities and differences of CT features in patients with PPH , PA, APA and PC were studied.Results Among 140 lesions in the 134 patients, 130 cases had solitary parathyroid mass and 4 cases had 10 parathyroid masses , including 22 lesions in 17 patients with PPH, with the diameter ranging from 0.6 cm to 2.8 cm(1.2 ±0.6)cm, 106 lesions in 105 patients with PA, with the diameter ranging from 0.3 cm to 3.2 cm (1.1 ±0.6)cm, 10 lesions in 10 patients with APA, with the diameter ranging from 0.9 cm to 3.3 cm(2.6 ± 0.6)cm, and 2 lesions in 2 patients with PC, with the diameter ranging from 2.1 cm to 3.0 cm(2.6 ±0.6)cm. 124 lesions were located in tracheo-esophageal groove or at the side of trachea on CT .The boundaries between the parathyroid and thyroid gland were low density .3 lesions did not appear .9 lesions were located at the area over the manubrium sterni among 13 lesions which were ectopic.CT images showed round (29.9%,41/137), oval (38.0%,52/137), triangular(19.7%, 27/137), and cylindrical(12.4%,17/137) tumors in 137 lesions.The density of lesions were 30-66 Hu(45.0 ±12.3)Hu on non-enhanced CT scan, and 59-209 Hu(121.8 ±32.7)Hu on enhanced scan .Different pathological lesions had no statistical difference on location ( left upper , left lower , right upper, right lower, ectopic)(χ2 =15.839), linear low density sign(χ2 =1.896), shape(χ2 =10.945), non-enhanced CT(χ2 =0.915) or enhancement CT(χ2 =6.165)(P>0.05).Different pathological lesions had statistical significance on sizes(χ2 =18.395, P<0.05).The diameter of APA-PC was bigger than that in PH-PA.99 lesions exhibited homogeneous enhancement , and 38 lesions exhibited heterogeneous enhancement .The necrosis rate of APA-PC was more than that of PH-PA(χ2 =7.929, P<0.05).Conclusions The lesions origi-nate from parathyroid if they are located in tracheo-esophageal groove or at the side of trachea with hyperparathy-roidism.Multiple lesions help in PH diagnosis .Large size and necrosis in lesions imply APA or PC .The location (left upper, left lower, right upper, right lower, ectopic), shape, density and the degree of enhancement of the lesions have not specificity for diagnosis of PHPT .

Objective To assess the value of computed tomgraphy (CT)in differential diagnosis between medullar thyroid carcinoma (MTC)and papillary thyroid carcinoma (PTC).Methods CT findings of 20 lesions in 16 MTC patients and 35 lesions in 35 PTC patients were retrospectively analyzed.All patients were confirmed by pathology exam.We investigated the shape,location,bitten cookie sign,calification and lymph node metastasis between the two groups of patients to summarize the sensitivity and specificity of regular shape for MTC or lesions located in lower thyroid lobe,bitten cookie sign,lymph node metastasis for PTC.Results Regular shape was more common in MTC patients than in PTC patients (X2=5.815,P=0.016),with sensitivity and specificity of 55％ and 77.1％ respectively.Lesions were located at lower thyroid(X2=10.732,P=0.001),bitten cookie sign(X2=18.832,P=0.000)and lymph node metastasis (X2=4.377,P=0.036)was significantly more common in PTC patients than in MTC patients,with sensitivity and specificity of 40％ (14/35)and 100％ (16/16),80％ (28/35)and 80％ (16/20),and 68.6％(24/35)and 62.5％(10/16)respectively.Calcification was not significantly different between MTC and PTC patients (X2=0.550,P=0.458).Conclusions CT plays an important role in differential diagnosis between MTC and PTC.Regular shape is helpful for the diagnosis of MTC.Leisions located at lower thyroid,with bitten cookie sign and lymph node metastasis are conductive to the diagnosis of PTC.

Objective To discuss the predictive value of multiple ultrasonic features combination in diagnosis of thyroid papillary carcinoma (PTC) more than 1.0 cm in diameter. Methods The ultrasonic features of 258 PTC nodules from 251 patients and 207 nodular goiter (NG) nodules from 190 patients in the First People′s Hospital of Hangzhou were retrospectively analyzed. All the nodules were confirmed by pathological examination after surgery. The ultrasonic features included the shape of nodules, internal echo,anteroposterior/transverse diameter ratio (A/T), and microcalcification. The χ2 test was used to analyze the differences of ultrasonic features between PTC and NG. Multi-variate analyses (Logistic regression) was used to analyze the predictive risk ultrasonic features of PTC. The sensitivity and specificity of ultrasonic features were analyzed based on the gold standard of pathological results. Results There were significantly differences between 258 PTC nodules and 207 NG nodules in irregular shape, hypoechogenicity,A/T > 1 and microcalcification (χ2 values were 121.511, 105.411, 41.483, 121.072, all P < 0.01). The results of Logistic regression showed that irregular shape, hypoechogenicity, A/T>1 and microcalcification were risk ultrasonic features of PTC. And their OR values were 5.013 (95%CI 2.919-8.610), 5.811 (95%CI 3.411-9.901), 15.399 (95%CI 7.576-31.301), 4.141 (95%CI 1.687-10.164) respectively. The sensitivity and specificity of single ultrasonic feature were 26.0%-79.5% and 71.5%-96.1%; the sensitivity and specificity of two ultrasonographic features combination were 11.2%-57.0% and 92.3%-99.0%; and the sensitivity and specificity of three or four ultrasonographic features combination were 8.1%-31.8% and 99.0%-99.5%.Conclusions Irregular shape, hypoechogenicity, A/T> 1 and microcalcification of thyroid neoplasm are important ultrasonic features of PTC. Although the sensitivity of single ultrasonic feature in diagnosing PTC is higher than that of multiple features combination, it has a lower specificity. Therefore, combination of multiple ultrasonographic features can improve the specificity in diagnosing PTC and reduce the misdiagnosis of PTC.

Objective To investigate the diagnostic value of computed tomography (CT) histogram analysis for thyroid malignant solitary coarse calcification nodules (MSCN).Methods A total of 89 thyroid solitary coarse calcification nodules (coarse calcification ≥5 mm,no definite soft tissue around calcification) confirmed either by surgery or histopathological examination in 86 patients enrolled in this study from Jan.2009 to Dec.2015 were evaluated,including 33 MSCN from 32 patients and 56 benign solitary coarse calcification nodules (BSCN) from 56 patients.Overall,27 cut-off values were calculated by N (4 ≤ N ≤ 30) times of 50 Hounsfield units (HU) in the range of 200 HU to 1500 HU,and each cut-off value and the differences in the corresponding area percentages in the CT histogram were recorded for MSCN and BSCN.The optimal cut-off value and the corresponding area percentage were established by receiver operating characteristic (ROC) curve analysis.Results In the 24 groups with an ROC area under the curve (AUC) of more than 0.7,at a cut-off value of 1150 HU and at an area percentage of no less than 98.4％,the ROC AUC reached a maximum of 0.86,and the accuracy,sensitivity,and specificity were 70.8％,93.9％,and 57.1％,respectively.At a cut-off value of 450 HU and at an area percentage of no less than 46.3％,the accuracy,sensitivity,and specificity were 76.4％,48.5％,and 92.9％,respectively.At a cut-off value of 550 HU and at an area percentage of no less than 81.5％,the accuracy,sensitivity,and specificity were 75.3％,33.3％,and 100％,respectively.Conclusions In comparison with the cut-off value of 1150 HU with an area percentage of no less than 98.4％,the sensitivities for the cut-off value of 450 HU with an area percentage of no less than 46.3％ and for the cut-off value of 550 HU with an area percentage of no less than 81.5％ were lower;however,the specificities increased significantly,providing an important basis for reducing the misdiagnosis of MSCN.

Objective To investigate diagnostic value of CT signs in papillary thyroid carcinoma (PTC) by comparing CT signs of PTC with different sizes.Methods CT signs of 406 PTC from 396 patients confirmed by histology were analyzed retrospectively.Based on the largest tumor diameter,PTC were divided into 1.1-2.0 cm group,2.1-3.0 cm group and＞3.0 cm group.Distribution of irregular shape,cookie bite sign,enhanced narrow/ fuzzy and microcalcification in each group was analyzed.Results There were 318 pieces in 1.1-2.0 cm group,60 pieces in 2.1-3.0 cm group and 28 pieces in ＞3.0 cm group,respectively.The rate of irregular shape was 89.6％(285/318),75.0％(45/60) and 64.3％(18/28) in each group,the rate of cookie bite sign was 83.6％(266/318),71.7％(43/60) and 64.3％ (18/28),and enhanced narrow/fuzzy was 84％(267/318),78.3％ (47/60) and 67.9％ (19/28) in each group,and microcalcification was 35.5％ (113/318),40.0％ (24/60) and 59.3％ (16/27) in each group.The rate of irregular shape (x2=20.092,P=0.000)and cookie bite sign (x2=9.695,P=0.008)had statistical difference among the three groups,while the rate of enhanced narrow/fuzzy(x2=5.175,P=0.075)and microcalcification (x2=5.277,P=0.071) had no statistical difference among each group.Furthermore,irregular shape and cookie bite sign were compared between groups.Rate of irregular shape in 1.1-2.0 cm group and 2.1-3.0 cm (x2=9.746,P=0.002)group,1.1-2.0 cm group and ＞ 3.0 cm group (x2=15.180,P=0.000) was statistically different.Rate of cookie bite sign in 1.1-2.0 cm group and ＞3.0 cm(x2=6.560,P=-0.010)was statistically different.There was no statistical difference between other groups.Conclusions Although irregular shape,cookie bite sign,enhanced narrow/fuzzy and microcalcification are important CT signs in diagnosing PTC,distribution of different signs varies with tumor sizes.Correct identification of these differences will help to improve the accuracy of preoperative diagnosis,and reduce occurrence of misdiagnosis.