Objective To evaluate the performance of ultrasonography (US) for the preoperative staging of papillary thyroid carcinoma (PTC). Methods One hundred and twenty-one patients with cytologically proven PTC were prospectively collected. Patients were recruited at the Chinese Academy of Medical Sciences Cancer Hospital from January 2014 to November 2014. Preoperative US was performed for the evaluation of primary tumor size, extrathyroidal extension and neck lymph node metastasis according to the 6th UICC TNM staging system. Results The sensitivity, specificity, positive predictive value (PPV) and negative predicative value (NPV) of US in predicting extrathyroidal extension were 89.6%(60/67), 72.2%(39/54), 80.0%(60/75), 84.8%(39/46), respectively. The accuracies of preoperative US for T1, T2, T3, T4 stage were 75.0%(36/48), 100%(1/1), 81.9%(59/72), 0, respectively. The sensitivity, specificity, PPV, and NPV of US in predicting neck lymph node metastasis were 47.5%(29/61), 90.0%(54/60), 82.9%(29/35), 62.8%(54/86), respectively. Conclusion Ultrasonography is a feasible tool for preoperative staging of PTC and is helpful for accurate prediction of extrathyroidal tumor extension and lateral neck lymph node metastasis.

Objective To describe the clinical and imaging manifestations of patients with synovitis acne pustulosis hyperostosis osteomyelitis (SAPHO) syndrome,and to analyze the diagnostic importance of different clinical and imaging manifestations for SAPHO syndrome. Methods Seventeen patients (7 males and 10 females) with SAPHO syndrome were recruited in this study.Age ranged from 36 to 67 years with a mean age of (48 ± 8) years. All patients fulfilled the diagnostic criteria of Benhamou. Serum HLA B27 antigen records were reviewed for all patients. Imaging data of the abnormal bone sites were collected by conventional radiograph in all patients,CT in 13 patients as well as MR in 3 patients.Average time to take for a definite diagnosis of the syndrome was 3.7 years (ranged from O.5 to 13 years).Results Serum HLA B27 antigen was positive in all patients. Both skin and bone abnornalities were found in all patients.Ten patients had skin palmoplantar pustulosis and two patients had acne. Involving sites of bone and joints include sacroiliac joints,anterior chest and limbs.Sacroiliac joints were asymmetrically involved with imaging features in all patients.Eight patients exhibited anterior chest wall involvement. Five patients had osteomyelitis at limbs. For all images of 17 patients,CT was superior to conventional radiography in detecting abnormal changes of bone erosion and soft tissue swelling.MR imaging was able to depict edema changes that was not detectable by CT and radiography.Conclusion SAPHO syndrome is a rare disease,but for patients with skin and bone-joint abnormalities,especially with skin palmoplantar pustulosis,acne as well as with imaging features at the sacroiliac joint and anterior chest wall,SAPHO syndrome should be taken into a diagnostic consideration.

Objective To analyze the cause of missing diagnosis for vertebral fracture on lateral chest radiography. Methods Lateral chest radiographies of 1638 hospitalized patients (871 males and 767 females) were retrospectively reviewed for identifying vertebral fractures. Their ages ranged from 50 to 91 years with the mean of 63.5 years. Complains and application for chest radiography in all patients were not related to osteoporosis and vertebral fracture. Vertebral fracture and fracture severity were evaluated using Genant's semiquantitative visual method, taking approximately a 20%-25% vertebral height reduction as mild grade,26%-40% as moderate grade and 41% or greater as severe grade. Evaluation results of the vertebral fracture, original X-ray reports, as well as medical records were compared for further analysis. Results Eighty-four in 1638 patients showed vertebral fractures on the lateral chest radiographies. Of them,vertebral fractures were reported in 30 cases and 54 patients were not reported on their original X-ray reports. There were 63 vertebral fractures in 54 un-reported patients, most of which were single fracture (75% or 47/63). Grade Ⅰ fracture accounted for 54% (34/63), Grade Ⅱ fracture 33% (21/63), while 13% presented grade Ⅲ fracture (8/63). In all 84 patients with vertebral fractures, only 5 cases (6%)underwent dual energy X-ray absorptiometry (DXA) measurement, 5 cases ( 6% ) were recorded to have vertebral fractures on the medical papers, as well as 15 cases ( 18% ) were prescribed drugs related to the osteoporosis when discharged from hospital All drugs prescribed for the 15 patients were limited only to calcium. Conclusions More attention should be paid to osteoporosis by doctors including radiologists.Vertebral fracture on lateral chest radiography should be completely diagnosed, which is helpful for both prevention and treatment.

Objective To analyze the sonographic ifndings of large adrenal cortical adenoma. Methods The sonographic characteristics of thirteen cases of large adrenal cortical adenoma (diameter≥4.0 cm) which were diagnosed by surgery from January 2006 to August 2012 were retrospectively reviewed. Results In all cases, the adenomas had distinct margins. The mean size of lesions was (5.5±1.6) cm, ranging from 4.0 cm to 8.8 cm. On echotexture, three lesions were homogeneous and the remaining ten lesions were heterogeneous. In addition, seven contained hypoechoic nodules and hyperechoic septum, three had anechoic area, three had extremely hyperechoic area with acoustic shadow, and two had patchy hyperechoic area. On Doppler, most lesions had no lfow signal. Conclusions Large adrenal adenomas have complete capsule and heterogeneous internal echoes with septum, calciifcation, necrosis and hemorrhages. These characteristics are less frequently seen incommon adrenal adenoma, therefore may be helpful in recognition of large adrenal adenoma in clinical practice.

Objective To analyze indications,complications and outcomes of amputation.Methods A total of 15 patients undergone amputation in field or at tent hospital were collected for analy-zing injury severity,place where amputation was done,whether open or closed amputation and stitch re-moval time. Results There were 9 males and 6 females.at an average age of 32 years(11-51years).There were 16 amputations including Gustilo IIIB in 2 patients, Gustilo IIIC in 9 and Tscheme Ⅲin 5 according to Gustiln classification or Tscheme classification.Four patients who received amputation in field or at tent hospital developed infection and had to receive amputation again at a higher level on the limb and drainage of open wounds because of a higher infection rate due to the amputation location.Ten patients received first amputation at higher levels with open wound at station hospital but only 2 manifested infected incision.High level amputation with one stage closure was done in 1 patient who was infected and suppurated after operation and even developed bacteremia. Conclusions Infection rate following am-putation 4n field and tent clinics is rather higher,so secondary open amputations should be performed at a higher level as soon as possible.One-time and high-level open amputation plays an important role in treat-ment of severe lower limb injuries following earthquake.

Objective ToexplorethevalueofspectralCTimaginginmultiGparameterquantitativeanalysisoflungcancerwithdifferent pathologicaltypes.Methods SpectralCTimagesof72patientswithlungcancerprovedbypathologywereanalyzed,includingadenocarcinoma (ADC)in44cases,squamouscellcarcinoma(SQCC)in23casesandsmallcelllungcancer(SCLC)in5cases.Theslopeof40－100keVspectralattenuationcurve(λH),effectiveatomicnumber(EffectiveGZ),Calciumconcentration,hydroxyapatite(HAP)concentration, normalizediodineconcentration(NIC)and Waterconcentration were measuredandcomparedrespectively.The O n eG W a y analysisof variance (ANOVA ) was used and a value of P＜0.05 was considered statistically significant.Results (1 )O n plain C T ,there were statisticallysignificantdifferencesinEffectiveGZandλHamongthreeGdiseasegroups(F＝3.423,P＝0.04,F＝3.476,P＝0.038,respectively). (2)IncontrastGenhancedarterialphase,theWaterconcentrationandλHshowedstatisticallysignificantdifferencesamongthreegroups (F＝6.303,P＝0.003,F＝5.833,P＝0.005,respectively).(3)Invenousphase,thedifferenceinNICandλH wasstatisticallysignificant amongthegroups(F＝3.974,P＝0.023,F＝6.766,P＝0.002,respectively).(4)Apairwisecomparisonshowedtherewerestatistically significantdifferencesinallquantitativeparametersofspectralCTbetweenADCandSQCCgroups.ROCcurveanalysisshowedthat thosequantitativeparametersinvenousphaseappearedtohavehighdiagnosticefficiencyindifferentiatingADCfromSQCC,especiallyfor theλHinVP,withaAUCof0.754,sensitivityof79.5%,specificityof69.6%andthresholdvalueof1.78.Conclusion CTSpectral multiGparameterimagingprovidesanewsupplementarymethodforpreoperativediagnosisofADCandSQCC,andλHinvenousphase hasthehighestvalueindifferentiatingADCfromSQCC.

BACKGROUND:Persistent hyperglycemia has been identified as promoting neurovascular dysfunction,leading to irreversible endothelial dysfunction,increased neuronal apoptosis,oxidative stress and inflammation.These changes in combination or alone lead to microvascular and macrovascular lesions as well as progressive neuropathy.Noncoding RNAs may provide a new strategy for understanding the etiology,pathogenesis and treatment of the disease. OBJECTIVE:To review the role and mechanism of noncoding RNAs in the occurrence and development of diabetic peripheral neuropathy by reviewing relevant literature at home and abroad,in order to provide new ideas and approaches for noncoding RNAs in the prevention,diagnosis and treatment of diabetes neuropathy. METHODS:CNKI and PubMed were retrieved for relevant literature published from database inception to 2022.The key words were"noncoding RNA;lncRNA;miRNA;diabetes peripheral neuropathy;expression profile"in Chinese and English,respectively.The retrieved documents were summarized and analyzed,and 61 articles were finally selected for further review. RESULTS AND CONCLUSION:(1)Noncoding RNA plays a key role in the pathophysiological process of diabetic peripheral neuropathy.Among the most widely studied regulatory noncoding RNA species,there are long noncoding RNAs,circular RNAs and microRNAs.(2)Through the regulation of noncoding RNAs,the activation or inhibition of related cell pathways,inflammatory genes and downstream-related cytokines will inhibit cell apoptosis,improve inflammation,and thus change the expression of target genes to participate in the process of diabetic neuralgia.(3)Although many microRNAs and long noncoding RNAs have been found to participate in diabetic peripheral neuropathy,the mechanisms of many noncoding RNAs are unclear,and the same noncoding RNAs may play different roles in different modes.Therefore,it is necessary to further study their action modes in disease etiology and pathology,thereby clarifying their role in the pathogenesis of diabetic peripheral neuropathy.However,the criteria for evaluating noncoding RNA activity have not yet been established,and further research is needed on which specific noncoding RNAs play a dominant regulatory role.(4)MicroRNAs,long noncoding RNAs and their target genes can regulate progressive neuropathy,which are expected to become new targets for the clinical prevention and treatment of diabetic peripheral neuropathy and new biomarkers for the development and prognosis of diabetic peripheral neuropathy.

BACKGROUND:Allogeneic hematopoietic stem cell transplantation is an effective and even the only way to cure various hematological diseases,but the short-term mortality rate is relatively high after transplantation. OBJECTIVE:To investigate the risk factors affecting the overall survival of patients with hematological diseases in the short term(within 100 days)after allogeneic hematopoietic stem cell transplantation,so as to reduce mortality and effectively prevent related risks in the short term(within 100 days)after allogeneic hematopoietic stem cell transplantation. METHODS:Clinical data of 585 patients with hematological diseases who underwent allogeneic hematopoietic stem cell transplantation at the Hematopoietic Stem Cell Transplantation Center of First Affiliated Hospital of Zhengzhou University from January 1,2018 to June 30,2021 were retrospectively analyzed.The risk factors that affected overall survival within 100 days after allogeneic hematopoietic stem cell transplantation were explored. RESULTS AND CONCLUSION:A total of 585 patients with hematologic diseases underwent allogeneic hematopoietic stem cell transplantation.92 patients died within 100 days after transplantation,with a mortality rate of 15.7%(92/585).The median age of death cases was 26.5 years old(1-56 years),and the median survival time of death cases was 48 days(0-97 days).Univariate analysis exhibited that age≥14 years old,acute graft-versus-host disease,grade IV acute graft-versus-host disease,bacterial bloodstream infection,as well as carbapenem-resistant organism bloodstream infection,were risk factors for overall survival within 100 days after allogeneic hematopoietic stem cell transplantation(P<0.05).Multivariate regression analysis showed that age≥14 years old,grades Ⅲ-Ⅳ acute graft-versus-host disease,bacterial bloodstream infection,and carbapenem-resistant organism bloodstream infections were independent risk factors for overall survival(within 100 days)in patients after allogeneic hematopoietic stem cell transplantation.Hazard ratios were 1.77(95%CI 1.047-2.991),7.926(95%CI 3.763-16.695),2.039(95%CI 1.117-3.722),and 3.389(95%CI 1.563-7.347),respectively.In conclusion,all-cause mortality rate after allogeneic hematopoietic stem cell transplantation is relatively high in the short term.A timely diagnosis and effective treatment of bacterial bloodstream infection and acute graft-versus-host disease are essential to improving allogeneic hematopoietic stem cell transplantation outcomes.

Objective: To analyze the feature of breast complex cystic masses and to classify it at ultrasonography (US), which applied to the Breast Imaging Reporting and Data System (BI-RADS) categories 4a to 4c with pathological results as the golden standards. Methods: The ultrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features: type 1 [thick wall and (or) thick septa (> 0.5 mm)], type 2 (one or more intra-cystic masses), type 3 (mixed cystic and solid components with cystic components more than 50%) and type 4 (mixed cystic and solid components with solid components more than 50%). Positive values (PPVs) were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses (lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc.) with malignant correlation. Results: There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 (17.3%) were classified as type Ⅰ, 18 (22.2%) as type Ⅱ, 18 (22.2%) as type Ⅲ, and 31 (38.3%) as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ, type Ⅱ, Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively (P=0.040). In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI≥0.7 and presence of abnormal axillary nodes assessment had a high probability of malignancy (P=0.030, 0.038, <0.001 and 0.025, respectively). Conclusion Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.