Objective To analyze the overall deployment of Class-A large medical equipments in China.Methods Data of Class A large medical equipments deployed from 2007 to 2015 were collected and classified regionally,for the purpose of measuring the overall deployment,growth level and plan performance.Results There were 403 large medical equipments in China,a rapid rise of deployment,yet still far below developed countries in terms of per capita deployment.Regional differences were significant.With PET-CT as an example,the plan performance in the east(92.19%)was much higher than the west of China(68.57%);plan performance of Class-A equipments was better,conducive to regulating the increase and distribution.Conclusions The deployment level of Class-A equipments in China is low in general,and calls for better regulation regardless of the planning and management progress.

[Summary] Riedel thyroiditis is an extremely rare form of thyroiditis, the etiologic mechanism remains obscure. It often onsets insidiously and has non-specific clinical manifestations, most of the patients visit doctor because of goiter and clinical manifestation caused by involvement of the surrounding tissue and organs, histopathological examination is the gold standard for diagnosis. Riedel thyroiditis can be easily confused with the other common thyroiditis and thyroid malignant tumor due to lack of understanding of Riedel thyroiditis. Thyroid isthmus wedge resection is recommended if symptoms of oppression are obvious, glucocorticoid or tamoxifen treatment can be used after the operation if Riedel thyroiditis still progresses. Here we present a case of Riedel thyroiditis with diagnosis and treatment in order to call attention to the diagnosis and treatment of this disease.

Objective To provide anatomic evidence for chock-block technique used for acromioplasty.Methods Thirty cadaveric specimens of intact shoulder fixed by formaldehyde solution were used for this anatomic study.They were chosen from 15 males and 15 females and from 17 left and 13 right sides.First the specimens were dissected for observation of general morphology of the acromion.According to the Bigliani's classification,the acromions were sorted in morphology as type Ⅰ (flat),type Ⅱ (curved) and type Ⅲ (hooked).The shortest distance from the acromion to the humeral head (A-H) was measured.Then the location of subacromial impingement was observed and the thickness of the anterolateral angle was measured preoperatively.At last,acromioplasty using the chock-block technique was performed in the acromions of types Ⅱ and Ⅲ.Postoperatively,the distance A-H and the thickness of the anterolateral angle were measured again for comparison with the preoperative values.Results According to the Bigliani's classification,7 acromions were type Ⅰ,13 type Ⅱ and 10 type Ⅲ.Subacromial impact occurred only in the anterior acromions of types Ⅱ and Ⅲ.The distance A-H was 0.670 ± 0.035 cm in type Ⅰ acromions,significantly longer than the preoperative values of type Ⅱ (0.506 ±0.029 cm) and type Ⅲ (0.334 ±0.023 cm) (P ＜ 0.05),but showed no significant differences from the postoperative values of type Ⅱ (0.692 ±0.025 cm) and type Ⅲ (0.699 ±0.024 cm) (P ＞ 0.05).The anterolateral angular thickness of type Ⅰ acromions was O.413 ± 0.015 cm,significantly thinner than the preoperative values of type Ⅱ (0.607 ±0.014 cm) and type Ⅲ (0.623 ±0.025 cm) (P ＜ 0.05),but showed no significant differences from the postoperative values of type Ⅱ (0.414±0.035 cm) and type Ⅲ (0.412±0.033 cm) (P＞ 0.05).Conclusion The chock-block technique used for acromioplasty is effective because it can enlarge the supraspinatus outlet and deter impingement.

Objective To analyze the CT features of solitary pulmonary nodules(SPN) in patients with malignant tumor with the aim of improving its diagnosis and differential diagnosis in this special background .Methods From May 2014 to De-cember 2018, the CT data of 76 pathologically confirmed SPNs in patients with malignant tumor were retrospectively analyzed . The CT features of SPNs, including density, morphology and change of peripheral lung field and adjacent structures, were mainly analyzed.The characteristics of different types of nodules and their differences were summarized .Results Among the 76 SPNs, there were 41(53.9％) primary lung cancers, 14(18.5％) metastatic tumors, and 21(27.6％) benign lesions(in-cluding 12 inflammatory nodules, 7 tuberculous nodules and 2 benign tumors).Of all nodules, there were 57(75％) solid nodules, including 23(40.4％) primary lung cancers which mainly manifested as nodules with rough margin , close to adjacent vessel and bronchus and usually had internal or edge features(19, 82.6％), 14(24.6％) metastatic tumors which mainly showed as round or oval, homogeneous density, smooth margin nodules(12, 85.7％), and 18(31.6％) inflammatory nodules which mainly showed as lesions with rough and blurred margin accompanied by peripheral patch or fibrosis (14, 77.8％). There were 19(25％) sub-solid nodules, including 18(94.7％) primary lung cancers, which mainly manifested as nodules with heterogeneous density and clear border(14, 77.8％).There was only 1(5.3％) sub-solid inflammatory nodule.Conclu-sion The pathological nature of SPNs in patients with malignant tumors is various .Understanding their CT characteristics is helpful for diagnosing and differentiating and providing useful information for further treatment .

Objective To obverse the changes ofmacular choroidal thickness (CT) in patients with mild to moderate Alzheimer's disease (AD).Methods This was a case-control study.Twenty-one patients with mild to moderate AD confirmed by Neurology Department of Jinhua Central Hospital from November 2016 to June 2018 and 21 age-matched control subjects were concluded in the study.There was no significant difference in age (t=0.128),intraocular pressure (t=0.440) and axial length (t=1.202) between the two groups (P＞0.05).There was significant difference in mini-mental state examination score (t=8.608,P＜0.05).CT was measured by OCT with enhanced depth imaging technique in the subfoveal choroid,at 0.5 mm and 1.0 mm from the center of the fovea nasal (NCT0.5,1.0mm),temporal (TCT0.5,1.0mm),superior (SCT0.5,1.0mm),and inferior (ICT0.5,1.0mm).Independent-samples t test was used to compare the results obtained from these two groups.Results SFCT (t=2.431),NCT0.5,1.0 mm (t=3.341,2.640),TCT0.5,1.0 mm (t=3.340,2.899),SCT0.5.1.0 mm (t=3.576,3.751) and ICT0.5 (t=2.897,2.903) were significantly thinner in AD eyes than those in control eyes.Conclusion Compared with healthy subjects,patients with mild to moderate AD showed a significant reduction in CT.

This study preliminarily discussed the TCM syndrome types of myasthenia gravis (or flaccidity) and its treatments and prescriptions through consensus method,providing evidence and level revision of the recommended expert consensus of myasthenia gravis in TCM clinical practice guideline.Literatures over TCM syndrome types,symptoms,therapeutic regime,medication and acupuncture were involved in the syndrome analysis of myasthenia gravis through literature retrieval.The common clinical syndromes were outputted by mentioned rate.Ten first-rate hospitals were finally included,such as The Affiliated Hospital of Changchun University of Traditional Chinese Medicine,Dongfang Hospital of Beijing University of Chinese Medicine,Guangdong Province Traditional Chinese Medical Hospital and Affiliated Hospital of Anhui University of Traditional Chinese Medicine.Twelve experts in aggregate were confirmed to participate in the discussion for the identification of the TCM syndrome types,treatments and prescriptions of myasthenia gravis.As a result,five TCM syndrome types,such as syndrome of spleen and stomach qi deficiency,syndrome of spleen-kidney deficiency,deficiency syndrome of both qi and yin,syndrome of deficiency and sinking of qi,were confirmed;while five therapeutic regimes were approved,including reinforcement of qi,tonification of spleen and stomach,tonification of spleen and kidney qi,tonification of qi and yin,the supplement of qi and restoration of yang for ascending qi collapse.In addition,five prescriptions were supported by the experts,such as Bu Zhong Yi Qi (BZYQ) decoction,BZYQ decoction combined with You Gui pills,BZYQ decoction combined with Sheng Mai powders and Sheng Xian decoction.In conclusion,the expert consensus method for the screen of TCM syndrome types of myasthenia gravis embodied the conception of literature research based on the clinical practice combined with the scientific methods in conformity with the current research approaches to TCM syndrome types.

Objective: To investigate the diagnostic and predictable value of the levels of serum Trx (S-Trx), urinary Trx (U-Trx) and S-Trx/U-Trx ratio in acute pyelonephritis of children. Methods: A total of 120 children with urinary tract infection were divided into APN group (67 cases) and non-APN group (53 cases).In addition, 67 children with APN were assigned to severe group (23 cases)and non-severe group (44 cases). The leves of serum C-reactive protein(CRP), precalcitonin(PCT), cystatin C (CysC), Trx (S-Trx) and urinary β₂-microglobulin(β₂-MG), neutrophill gelatinase-related apolipoprotein (NGAL), Trx (U-Trx) were collected. Besides, the ratio of S-Trx/U-Trx was also counted. The diagnostic and predictable value of each index were determined by receiver operating characteristic (ROC). Results: Serum PCT, S-Trx, urinary β₂-MG, NGAL, U-Trx was markedly increased and S-Trx/U-Trx ratio was obviously decreased in the APN group compared to that of the non-APN group (P<0.05). Moreover, S-Trx, urinary NGAL, U-Trx was significantly increased and S-Trx/U-Trx ratio was significantly decreased in the severe group compared to that of the non-severe group (P<0.05). Both in APN group or severe APN group, S-Trx and U-Trx displayed significantly positive correlation (P<0.05). The results from ROC demonstrated that AUC were 0.960, and optimal cut-off value were 16.17 μg/L of U-Trx diagnostic APN in children, with a specificity and sensitivity of 94.34% and 92.54%, respectively. The optimal cut-off value was 1.29.AUC of S-Trx/U-Trx 0.960 predicted the severe of APN in children, with a specificity and sensitivity of 81.82% and 82.61%, respectively. Conclusions U-Trx is useful for diagnostic APN in children, S-Trx/U-Trx is an independent predictor of the severe APN.

The detection rate of multifocal / multicentric breast cancer (MMBC) is increasing, and the local treatment of MMBC is attracting more attention. Relevant research focuses on the selection of surgical methods, the application of radiotherapy, and the feasibility of local ablation. Currently, due to the high rate of local recurrence in breast conserving surgery, most Chinese doctors recommend mastectomy to patients with MMBC. Recent studies have shown that with the development of imaging technology, surgical techniques, accurate judgment of the resection margin, the emergence of new therapeutic drugs and the improvement of the accuracy of radiotherapy, for eligible patients with MMBC, breast conserving surgery did not increase the local recurrence rate while ensuring negative margin and cosmetic results. Whether patients with MMBC must receive adjuvant radiotherapy after mastectomy is controversial, with some evidence suggesting that MMBC may increase the risk of local recurrence and should be an important consideration for radiotherapy, and there is also evidence that the local recurrence rate of MMBC was higher regardless of the type of surgery. In general, the local treatment modality for MMBC is essentially the same as that for unifocal breast cancer, but more prospective studies are needed for further evaluation.

The detection rate of multifocal / multicentric breast cancer (MMBC) is increasing, and the local treatment of MMBC is attracting more attention. Relevant research focuses on the selection of surgical methods, the application of radiotherapy, and the feasibility of local ablation. Currently, due to the high rate of local recurrence in breast conserving surgery, most Chinese doctors recommend mastectomy to patients with MMBC. Recent studies have shown that with the development of imaging technology, surgical techniques, accurate judgment of the resection margin, the emergence of new therapeutic drugs and the improvement of the accuracy of radiotherapy, for eligible patients with MMBC, breast conserving surgery did not increase the local recurrence rate while ensuring negative margin and cosmetic results. Whether patients with MMBC must receive adjuvant radiotherapy after mastectomy is controversial, with some evidence suggesting that MMBC may increase the risk of local recurrence and should be an important consideration for radiotherapy, and there is also evidence that the local recurrence rate of MMBC was higher regardless of the type of surgery. In general, the local treatment modality for MMBC is essentially the same as that for unifocal breast cancer, but more prospective studies are needed for further evaluation.

Objective:To investigate the correlation between systemic immune inflammatory index (SII) and other metabolic indicators and diabetic epiretinal membranes (dERM).Methods:A retrospective case-control study. From March 2022 to July 2023, 81 patients (81 eyes) with dERM in Department of Ophthalmology, Affiliated Jinhua Hospital of Zhejiang University of Medicine School diagnosed by fundus screening were included in the study. A total of 81 patients (81 eyes) with diabetes who were matched in age, gender, and duration of diabetes and had no dERM or diabetic macular edema in both eyes during fundus screening were selected as the control group. All patients underwent optical coherence tomography (OCT) examination and laboratory tests for peripheral blood neutrophil, lymphocyte, platelet counts, serum albumin, blood lipids, uric acid, and glycosylated hemoglobin (HbA1c). SII was calculated. Random urine samples were collected for urinary albumin/creatinine ratio (ACR) testing. The OCT device's own analysis software obtained the macular volume coefficient, including central foveal thickness (CMT), macular volume, and average macular thickness. The macular volume coefficient, SII, serum albumin, blood lipids, uric acid, HbA1c, and ACR between the two groups were compared using paired t tests or Mann-Whitney U tests. Conditional logistic regression analysis was performed to evaluate the risk factors for dERM; Spearman correlation test was used to analyze the correlation between CMT, SII, ACR, disorganization of retinal inner layers (DRIL), intraretinal cyst (IRC), and hyper-reflective foci (HRF) in patients with dERM. Results:There were significant differences in CMT, macular volume, average macular thickness, SII, serum albumin, and ACR between the dERM group and the control group ( Z=-7.234, -6.306, -6.400, -3.063, -2.631, -3.868; P<0.05). Conditional logistics regression analysis showed that high SII [odds ratio (OR)= 3.919, 95% confidence interval ( CI) 1.591-9.654, P=0.003] and ACR ( OR=4.432, 95% CI 1.885-10.420, P=0.001) were risk factors for dERM. Spearman correlation analysis showed that HRF, IRC, DRIL were positively correlated with CMT ( Rs=0.234, 0.330, 0.248; P=0.036, 0.003, 0.026); HRF was positively correlated with SII and ACR ( Rs=0.233, 0.278; P=0.036, 0.012). Conclusion:Elevated SII and ACR are independent risk factors for the occurrence of dERM.