Thyroid nodule is a common diseases of neck,which property is usually identified by ultrasound examination.Color doppler ultrasonography can reflect the distribution of blood vessels and blood flow within the nodules.And with development of new technologies,three-dimensional ultrasound increase the accuracy of identification.Three-dimension power doppler ultrasound (3D-PDUS) can reflect blood flow information within the nodule space,which is more accurate than two-dimensional ultrasound and it can be used to evaluate the blood flow in nodules qualitatively and quantitatively,provide a new reference for clinical diagnosis of thyroid nodule.

The non-cancer-cell component of the tumor microenvironment in hepatocellular carcinoma (HCC) has drawn the attention of the researchers because of its relative stability of the genome.The composition and characteristics of the tumor microenvironment and the composition of the tumor microenvironment in hepatocellular carcinoma were introduced in this article.Besides,the recent studies about the non-cancer-cell component of the tumor microenvironment in HCC were reviewed from three aspects..The exosomes,the chemokines and the local conditions without biological activity.The application of non-cancer-cell in interventional treatment in the future was also discussed.

Objective To explore ultrasound performances and misdiagnostic causes of aggressive fibromatosis (AF).Methods Ultrasound performance and misdiagnostic causes of 45 patients (47 tumors) with AF confirmed by histopathology were analyzed retrospectively.Results Of 45 patients,ultrasound showed lesions of varying size,and the maximum diameter of 36 masses (36/47,76.60％) were more than 3 cm;37 masses (37/47,78.72％) were irregular pale leaf;45 masses (45/47,95.74％) had no complete capsule;45 masses (45/47,95.74％) were shown as interogeneous internal echo mixed with hyperechoic area in the hypoechoic internal;29 cases were diagnosed correctly,16 cases were misdiagnosed,the diagnostic accordance rate was 64.44％ (29/46).Conclusion AF has certain ultrasonic characteristics.Combined with the patient's medical history and physical sign,ultrasound can significantly improve the preoperative detection rate and diagnostic accuracy of AF.

Objective To explore the clinical application value of ultrasound-guided intrahepatic biliary puncture combined with internal double biliary stenting under DSA in elderly patients with malignant hilar biliary obstruction (MHBO).Methods Totally 108 elderly MHBO patients received interventional treatment were analyzed retrospectively.Half of patients were treated with ultrasound-guided intrahepatic biliary puncture (ultrasound group),and another 54 patients were treated with DSA intrahepatic biliary puncture (DSA group).After successful puncture,the patients received percutaneous transhepatic cholangial drainage (PTCD) with 4 methods under DSA guidance,namely internal double biliary stenting,contralateral external PTCD with single biliary stenting,complete external PTCD and external PTCD on the dominant side.The recent complications of intrahepatic biliary puncture at two groups and the curative effect with four methods were observed.Results The frequency of intrahepatic biliary puncture,the dosage of contrast agent,the incidence of pain at the puncture point and hemobilia in ultrasound group were all lower than those in DSA group (all P＜0.05),the successful rate of intrahepatic biliary puncture in first time was significantly higher compared with DSA group (P＜0.05).The liver function indicators at 14 days postoperation and total bilirubin at 21 days postoperation had statistical differences between any two biliary drainage methods (all P＜ 0.05).Conclusion Ultrasound-guide intrahepatic biliary puncture combined with internal double biliary stenting under DSA can significantly benefit elderly patients with MHBO.

Objective To explore the value of interventional therapy in unruptured intracranial aneurysms combined with brain arteriovenous malformations (BAVM).Methods Data of 23 patients with unruptured aneurysms combined with BAVM were retrospectively analyzed.All patients were treated with interventional embolization,and the embolization methods were choosen according to the Redekop classification.The proximal or distal hemodynamic aneurysms were embolized with coils,and the intranidal aneurysms were embolized with Onyx.The outcome was assessed by the Glasgow outcome score (GOS) one week after treatment.DSA scan was used to observe whether there was recurrence during 3-6 months after embolization.Results Totally there were 36 aneurysms in 23 patients,including 8 intranidal aneurysms,16 proximal flow-related aneurysms,11 distal flow-related aneurysms and 1 unrelated aneurysm.Embolizations of 16 proximal hemodynamic aneurysms and l0 distal hemodynamic aneurysms were done with coils.And embolization of 8 intranidal aneurysms were done with Onyx.One distal hemodynamic aneurysm was not embolized due to the difficulty of embolization and the regular shap of aneurysm;and the patient died of cerebral hernia caused by intracranial hemorrhage on the sixth day after embolization.Because it was more suitable for surgical clipping,1 unrelated hemodynamic aneurysm was not embolized.In 23 cases,BAVM were completely embolized in 7 cases and incompletely embolized in 16 cases.A week after operation,the GOS score were 5 in 19 cases and 4 in 3 cases.The GOS score was not evaluated in the dead case.Except for 1 cases of death,the other 22 cases were followed up after embolization.No recurrence and intracranial hemorrhage occurred.Conclusion Interventional treatment of unruptured intracranial aneurysms combined with BAVM is safe and effective.Making treatment plan according to the hemodynamic characteristics of lesions and completely embolizing all lesions to prevent postoperative bleeding is helpful to improve the prognosis of patients.

Objective To explore the techniques and strategies for the retrieval of the retractable inferior vena cava filter (IVCF).Methods Celect IVCF retrieval was not removed successfully with Gtünther Celect recovery device in 9 cases and exchange-wire-loop removal of inferior vena cava filter method were applicated.Results The longest implanted time of 9 patients was 142 days,the shortest implanted time was 37 days,and the average time was (88.67±33.85)days.Eight fil ters were successfully removed and one failed due to severe bending of inferior vena cava.Filter retrieval rate was 88.89％ (8/9).The average retrieval time was (69.89± 12.12)min (57-162 min).No perforation of the wall and contrast agent were found in all patients after the inferior vena cava angiography.Conclusion For the retrieval of the hook heavily atta ched to the IVCF,the retrieval technique of using the exchange wire into the loop method can effectively improve the retrieval rate and has a certain clinical value.

Objective To analyze the safety and clinical efficacy of three types stents of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of cirrhosis with portal hypertension.Methods Totally 1 086 patients with cirrhotic portal hypertension underwent TIPS for the first time.All patients were divided into bare stent group (group A),covered stent-group (group B) and combined stents group (group C).The rates of symptom improvement,shunt insufficiency,re bleeding,survival and major complications in 2 years after TIPS were analyzed and compared.Results Totally 1 690 stents were placed in 1 086 patients.The overall technical success rate was 100％;2.53％ (10/396) emergency patients dead due to uncontrolled gastrointestinal bleeding,and 2.78％ (11/396) emergency patients,0.84％ (5/593) bleeding stopped patients dead with acute liver funtional failure.In 2-year following-up,the overall survival rate of group A,group B,group C were 83.78％ (186/222),88.36％ (281/318),96.34％ (526/546),and the difference was statistical significant (x2=4.15,P=0.04).The shunt insufficiency rates of group A,group B,group C were 39.64％ (88/222),22.33％ (71/ 318),11.17％ (61/546),and the difference was statistical significant (x2 =4.15,P=0.04),The rates of rebleeding of group A,group B,group C were 31.53％ (70/222),16.89％ (54/318),7.14％ (39/546),and the difference was statis tical significant (x2 =9.91,P=0.01).The rates of hepatic encephalopathy of group A,group B,group C were 21.62％ (48/222),22.96％ (73/318),19.23％ (105/546),and the difference had no statistical significant (x2 =1.00,P=0.06).Conclusion TIPS is an effective way to relieve portal hypertension and complications in patients with cirrhosis.The safety and clinical efficacy can be improved by 8 mm shunt with double stent technique.

Objective To investigate the application value of prophylactic bilateral uterine artery catheterization and embolization in treatment of patients with pernicious placenta previa and accreta.Methods Data of 16 patients with pernicious placenta previa and accreta who underwent prophylactic bilateral uterine artery catheterization and uterine artery embolization and cesarean section were retrospectively analyzed.The amount of intraoperation blood loss,the amount of blood transfusion,cesarean hysterectomy rate,fluoroscopy operative time,radiation dose,complications and neonatal outcome were recorded.Results The technical success rate of the combined treatment was 93.75％ (15/16).The mean amount of blood loss was (1 575.00 ± 1 040.83)ml.The mean amount of blood transfusion was (3.44 ± 2.34)U leukoreduced red blood cells.The mean fluoroscopy operative time and radiation dose before delivery were (0.89±0.24)min and (7.17 ± 2.12)mGy.One newborn was diagnosed as severe asphyxia.The mean Apgar score of another 15 newborns was (9.38± 0.89) at 5 min after birth.One patient underwent hysterectomy due to postpartum hemorrhage complicated with disseminated intravascular coagulation.Buttock pain was found in 2 cases.Conclusion Prophylactic bilateral uterine artery catheterization and embolization can be used for the treatment of pernicious placenta previa and accreta.The combined treatment can control postpartum hemorrhage during placental dissection and reduce transfusion requirements and hysterectomy rate with few minor complications and low radiation exposure dose.

Objective To explore the application value of coaxial semi automatic biopsy gun in the biopsy of small pulnonary nodules.Methods A retrospective analysis was performed on 40 patients with small pulmonary nodules who underwent CT guided percutaneous pulmonary nodules biopsy.Taking postoperative pathology diagnosis or imaging follow-up results as gold standard,the accuracy,specificity,sensitivity,intraoperative complications and puncture techniques of biopsy were analyzed.Results All operations were successfully completed.There were 29 malignant lesions and 11 benign lesions confirmed by postoperative pathology diagnosis or imaging follow-up results.The sensitivity,specificity,accuracy rate of puncture biopsy in diagnosis of malignant small pulmonary nodules was 89.65％ (26/29),100％ (11/11),92.50％ (37/40).The main complications were pneumothorax and local hemorrhage.Conclusion Percutaneous biopsy of small pulmonary nodules using coaxial semi-automatic biopsy gun has high accuracy,specificity and sensitivity,is a safe and effective method.

Objective To evaluate two methods measuring alveolar bone loss by micro computed tomography (micro-CT)based on periodontitis model in mice.Methods The silk ligatures were tied around the right maxillary second molars of mice to induce periodontitis model.The right half maxillaries of mice model were harvested for micro-CT analysis.Three dentists were recruited for the measurement with two different methods:Modified tomography (T) method and reconstruction (R) method.Accuracy and consistency of each method were estimated by standard deviation (SD).Results The SDs of R method managed by the same operator (measurement for 3 times) or different operators (3 operators) were 34.87μm and 35.67 μm respectively,while that of T method was 7.82 μm and 14.24 μm respectively.The SDs of T method were significantly lower than those of R method (both P＜0.05).Conclusion T method is more accurate and consistent than R method for evaluating alveolar bone loss in mice periodontitis model.