Objective To compare the value of fine-needle aspiration cytology (FNAC),Tg,TgAb and ultrasonography (US) for the differential diagnosis of lymph node metastasis in patients with DTC after operation and radioactive iodine remnant ablation.Methods A total of 61 DTC patients with enlarged lymph nodes detected by US or physical examination after operation and radioactive iodine remnant ablation were included.FNAC was performed on the lymph nodes under US guidance within one week and the results were compared with those of Tg,TgAb and US.Final results were confirmed by comprehensive FNAC,posttreatment whole,body scan (Rx-WBS) and clinical follow-up.x2 test and Fisher's exact test were performed.Resuits Fifty-eight DTC patients had successful FNAC results,and 40 patients were confirmed as malignant and 18 as benign after overall assessment.FNAC identified 39 malignant and 19 benign cases.The coincidence rates of FNAC with postoperative pathological diagnosis and Rx-WBS for malignant cases were 100％ (20/20) and 78.9％ (15/19),respectively.For the benign cases,the coincidence rates of FNAC with clinical follow-up and Rx-WBS were 93.3％ (14/15)and 4/4,respectively.The sensitivity,specificity and accuracy were 97.5％(39/40),100％(18/18) and 98.3％(57/58) for FNAC; 87.5％(35/40),55.6％(10/18) and 77.6％(45/58) for US; 92.5％(37/40),72.2％(13/18) and 86.2％(50/58) for Tg combined with TgAb (Tg/TgAb).The accuracy of FNAC was higher than that of US and Tg/TgAb(x2 =4.336,11.697,both P＜0.05),while US and Tg/TgAb showed no significant difference (x2 =1.450,P＞0.05).Tg/TgAb and US results were consistent in 39 cases with a diagnostic accuracy of 97.4％ (38/39) verified by FNAC,while the other 19 cases with inconsistent Tg/TgAb and US results were verified as malignant in 4 cases and benign in 15 cases.Conclusions FNAC is superior to US and Tg/TgAb in the evaluation of lymph node metastasis in DTC patients after operation and radioactive iodine remnant ablation.FNAC should be recommended particularly when Tg/TgAb and US had inconsistent results.

Objective To investigate the effects of capparis spinosa total alkaloid on type collagen (ColⅣ - ),Ⅳmatrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1) and plasminogen activator inhibitor-1 (PAI-1) in bleomycin-induced systemic sclerosis (SSc) mice; To explore the effective mechanism of capparis spinosa total alkaloid on fibrosis of SSc. Methods Totally 90 BALB/c mice were randomly divided into control group, model group, penicillamine group and capparis spinosa total alkaloid low-, medium- and high-dose group. Mice models with SSc were established by repeated local injections of bleomycin in mice back, except for the control group. Mice in medication groups received external application with capparis spinosa total alkaloid cream;mice in penicillamine group were given penicillamine for gavage; mice in the control and model group received external application without substance, one time a day, for 60 days. The contents of MMP-9, TIMP-1 and PAI-1 in serum and Col- in skin tissue were dⅣ etected respectively by ELISA after the last medication. Results Compared with the model group, the levels of MMP-9 and ratio of MMP-9/TIMP-1 markedly increased and the levels of Col-Ⅳand TIMP-1 markedly decreased in medium and high- dose of capparis spinosa total alkaloid group (P<0.05, P<0.01). But the level of PAI-1 was not influenced (P>0.05). Conclusion Capparis spinosa total alkaloid is effective in treating fibrosis of SSc by adjusting imbalance of MMP-9/TIMP-1 and decreasing expression of Col-Ⅳ.

Objective To investigate the effects of capparis spinosa total alkaloid on the pathological changes and the type Ⅲ collagen(COL?Ⅲ)expression in systemic sclerosis(SSc)mice. Methods Mice models with SSc were established by repeated local injection of bleomycin in BALB/c mice back. After administration of capparis spinosa total alkaloid ,the pathological changes of skin and lung tissue were observed ,and the COL?Ⅲ expression was detected by ELISA. Results Compared with the model group,the inflammation and fibrosis of skin and lung tissue were improved,and the level of COL?Ⅲ was markedly reduced by treatment of high dose capparis spinosa total alkaloid(P<0.05). Conclusion Cap?paris spinosa total alkaloid is effective in treating fibrosis of SSc.

Objective To analyze the clinical features of 35 cases of Kennedy's disease and the correlation be?tween clinical features and CAG repeat size to strengthen the understanding of KD and to avoid misdiagnosis and delayed diagnosis.Methods Clinical data, including clinical signs and symptoms ,serum lipid, serum sex hormone level, electro?myography, the number of CAGs and (amyotrophic lateral sclerosis muscular atrophy,ALS) rating scale were collected from 35 patients genetically diagnosed of Kennedy disease and proceed system analysis. Results Patients with KD were adult onset with the average age of (40.77 ± 8.57) years and the average confirmed course were (8.32 ± 4.17) years. Forty-two point nine percent of the patients had family history. Clinical features included medulla oblongata and spinal muscular atrophy and weakness, limbs tremor, perioral muscles twitch and endocrine function and metabolic disorders in some cases. Creatine kinase, triglyceride, low density lipoprotein, follicle estrogen and prolactin were significantly in?creased compared to healthy adults (P:0.000,0.018,0.000,0.000,0.003). The number of CAG repeat was negatively correlated with the onset age (r=-0.549, P=0.001) but not associated with the illness severity (ALS rating scale) (r=0.001, P=0.998). ALS score was negatively correlated with course of disease(r=-0.540, P=0.001).Conclusions Chinese KD pa? tients share similar clinical phenotypes with those of other races but exhibit slightly different clinical characteristics. The length of the CAG repeat influences age at onset but not the severity of disease. Severity of disease is related to the course of disease.

Objective To describe the clinical features, differential diagnosis and therapeutic method of Madras motor neuron disease (MMND) to improve the understanding of MMND. Methods We retrospectively summarized the clinical data of 3 MMND patients. and conducted the related literature review to compare the similarities and differences on clinical features between our cases and foreign MMND patients. Results Patients in the present study were adult-on?set without definite family history. The main manifestations were multiple lower cranial nerve palsies along with weakness and wasting of proximal limbs. Bifacial palsy and dysarthria were most presented in patients, while definite hearing im?pairment was rarely seen. Two patients had fasciculation and atrophy in tongue and one presented with dysphagia. Weak?ness and atrophy were more frequently presented in upper extremities than in lower limbs. All patients had signs of upper motor neuron damage. The level of creatine kinase (CK) moderately increased in one case. Electromyography (EMG) de?tected a widespread neuronal damage in all patients. MMND should be differentiated from Amyotrophic Lateral Sclerosis, Kennedy Disease and Brown–Vialetto–van Laere Syndrome. Intravenous immunoglobulin therapy showed effective in some cases to some extent. Compare to foreign MMND patients, bifacial weakness at onset was more frequently presented in our patients, but hearing impairment was absent. Conclusion The clinical features of MMND include weakness and at?rophy of limbs, involvement of facial and bulbar muscles, pyramidal dysfunction and hearing impairment. Some clinical manifestations of our patients are different from foreign MMND patient.

Objective:To investigate the preoperative diagnostic value of 99Tc m-methoxyisobutylisonitrile (MIBI) planar imaging and SPECT/CT imaging for primary hyperparathyroidism (PHPT), and analyze the relevant factors affecting the imaging results. Methods:From June 2016 to September 2019, a total of 62 patients (15 males, 47 females, age range: 27-80 years) confirmed as PHPT by postsurgical pathology in Affiliated Hospital of Qingdao University were retrospectively enrolled. The diagnostic efficacies of 99Tc m-MIBI planar imaging and SPECT/CT imaging were compared using χ2 test. The differences of preoperative serum parathyroid hormone (PTH), Ca and the maximum diameter of lesion between the positive and negative groups of planar imaging were analyzed using independent-sample t test and Mann-Whitney U test. The region of interest (ROI) method was applied to calculate the uptake ratio of lesions to normal tissues at the early phase (T/Ne) and delayed phase (T/Nd) in positive cases of planar imaging. Pearson or Spearman correlation analysis was used to evaluate the correlation of T/Ne, T/Nd with preoperative serum PTH, Ca and the maximum diameter of lesion. The receiver operating characteristic (ROC) curves of preoperative serum PTH, Ca and positive planar imaging were drawn and the cut-off values were obtained. Results:The sensitivity of planar imaging and SPECT/CT imaging was 69.35%(43/62) and 87.10%(54/62) respectively ( χ2=5.729, P=0.017). The preoperative serum PTH, Ca levels and the maximum diameter of lesion in patients with positive planar imaging (253.32(107.00, 331.70) ng/L, 2.78(2.51, 2.87) mmol/L, (2.01±0.88) mm) were higher than those with negative planar imaging ((111.86±44.29) ng/L, (2.59±0.21) mmol/L, (1.42±0.55) mm; z values: -2.802, -1.978, t=3.300, all P<0.05). T/Ne was positively correlated with preoperative serum PTH ( rs=0.511, P<0.001) and the maximum diameter of lesion ( r=0.381, P=0.012), and T/Nd was positively correlated with preoperative serum PTH ( rs=0.538, P<0.001), Ca ( rs=0.348, P=0.022) and the maximum diameter of lesion ( r=0.463, P=0.002). The area under the ROC curve between preoperative serum PTH, Ca and planar imaging was 0.725 and 0.646, respectively. Preoperative serum PTH had a better predictive value with the optimal cut-off value of 150.4 ng/L. Conclusions:Preoperative serum PTH, Ca and the maximum diameter of lesion are positively correlated with 99Tc m-MIBI uptake in PHPT patients with positive planar imaging results. When preoperative serum PTH is lower than 150.4 ng/L, planar imaging is prone to false negative. SPECT/CT imaging has a significant value in preoperative diagnosis and the combination of PTH and CT can improve the positive rate.

Objective To observe the effects of Capparis spinosa total alkaloid on vascular endothelial growth factor (VEGF),endothelin-1(ET-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels in systemic sclerosis (SSc) mouse model and explore the therapeutic mechanism of Capparis spinosa total alkaloid for the treatment of SSc. Methods A total of 90 BALB/c mice were randomly divided into blank control group,model control group,penicillamine (125 mg·kg-1) group and Capparis spinosa total alkaloid low(225 mg·kg-1),medium(450 mg·kg-1) and high(900 mg·kg-1) dose group. Except for the blank control group,SSc mouse model was established by daily subcutaneous injection of bleomycin in the back of the mice.After establishing model successfully,Capparis spinosa total alkaloid emulsifiable paste was externally applied with Capparis spinosa total alkaloid group,ground substance was externally applied to the mice in blank control group and model control groups,penicillamine was intragastrically administrated in the penicillamine group for 60 days,once daily.After the treatment,the content of VEGF in skin tissue and ET-1,sVCAM-1 in serum were measured by ELISA. Results The levels of VEGF and ET-1 were significantly decreased in Capparis spinosa total alkaloid high dose group as compared with model control group(P<0.05, P<0.01),but the content of sVCAM-1 wasn't influenced(P>0.05). Conclusion Capparis spinosa total alkaloid is effective in adjusting abnormal expression of VEGF and ET-1 in SSc mice.

Objective To evaluate the effects of capparis spinosa total alkaloid on transforming growth factor-β( TGF-β)/Smad4 signalling pathways in systemic sclerosis (SSc). Methods A total of 90 BALB/c mice were randomly divided into normal control group, model control group, penicillamine ( 125 mg·kg-1) group and Capparis spinosa total alkaloid low (225 mg·kg-1),medium (450 mg·kg-1) and high ( 900 mg·kg-1) dose group. Except for the normal control group,SSc mouse model was established by daily subcutaneous injection of bleomycin in the back of the mice.After the establishment of the model,Capparis spinosa total alkaloid emulsifiable paste was externally applied to Capparis spinosa total alkaloid group,ground substance was externally applied to the mice in normal control group and model control groups, and penicillamine was intragastrically administrated in the penicillamine group for 60 days,once daily.After the treatment,The expression of TGF-β1in skin tissue was detected by Western-blotting and the levels of actin / in receptor-like kinase / Smad4, nuclear factor-κB in skin tissue were measured by ELISA. Results The expression of TGF-β1was significantly decreased after administration of 225,450 and 900 mg·kg-1capparis spinosa total alkaloid, and the levels of ALK1 and Smad4 were significantly decreased after administration of 900 mg·kg-1capparis spinosa total alkaloid as compared with model control group (P<0.05 or P<0.01),but the content of NF-κB was not influenced (P>0.05). Conclusion Capparis spinosa total alkaloid can accommodate abnormal expression of TGF-β1/Smad4 signalling pathways in SSc.

Objective: To investigate the response to ¹³¹I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation. Methods: From May 2016 to October 2018, 108 DTC patients (28 males, 80 females, age: (45.7±10.4) years) with negative psTg who underwent ¹³¹I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled. All patients had iodine-positive lymph nodes, which were showed by SPECT/CT imaging 5-6 d after ¹³¹I treatment. The treatment response was evaluated at 6-24 month after ¹³¹I treatment. Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first ¹³¹I treatment. Independent-sample t test, χ² test and Mann-Whitney U test were used to analyze differences of factors (e.g. age, gender, extraglandular infiltration) between the 2 groups, and then multivariate logistic regression was performed to find the influence factors for treatment response. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in ¹³¹I treatment response. Results: A total of 82 patients (75.93%, 82/108) achieved ER, and 26 (24.07%, 26/108) was non-ER patients. There were significant differences in age (t=-2.540, P=0.016), extraglandular infiltration (χ²=5.764, P=0.016), T stage (χ²=19.857, P<0.001), N stage (χ²=14.145, P=0.001), risk stratification of recurrence (χ²=11.487, P=0.003), ultrasound results before ¹³¹I treatment (χ²=44.819, P<0.001), dose of the first ¹³¹I treatment (U=780.0, P=0.018), size (long diameter) of iodine-positive lymph node (U=184.0, P<0.001), and psTg level (U=776.0, P=0.037) between ER and non-ER groups. Multivariate logistic regression showed that age, size of iodine-positive lymph node and ultrasound results before ¹³¹I treatment were closely related to ¹³¹I treatment response. The odds ratio (OR) values (95% CI) were 1.123 (1.025-1.231), 4.275 (1.893-9.653) and 260.86 (8.123-8 376.764), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for non-ER were 100%(26/26), 70.73%(58/82), 77.78%(84/108), 52.00%(26/50) and 100%(58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm. Conclusion The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER. Age, ultrasound results before ¹³¹I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.