Objective To assess the value of multimodal ultrasonography for diagnosing thyroid nodules—atypia of undetermined significance (AUS) of thyroid imaging reporting and data system (TI-RADS) categories 3 to 5. Methods A total of 90 AUS thyroid nodules in TI-RADS 3-5 categories from 88 patients underwent conventional ultrasonography, ultrasound elastography, superb microvascular imaging, and multimodal ultrasonography at the same time. With fine needle aspiration biopsy results as the gold standard, the methods were compared in terms of the sensitivity, specificity, accuracy, false positive rate (FPR), false negative rate (FNR), and area under the receiver operating characteristic curve (AUC) for diagnosing thyroid nodules. Results There were no significant differences between patients with benign and those with malignant thyroid nodules in terms of sex, age, and nodule locations (all P > 0.05), but the proportion of thyroid nodules ≤ 1 cm in diameter was significantly higher for malignant thyroid nodules than for benign thyroid nodules (χ²=9.610, P=0.002). Compared with benign nodules, malignant nodules were significantly more frequent to have low-level echoes or very low-level echoes, a blurred margin, a vertical diameter/horizontal diameter ratio of > 1, and microcalcifications or no calcifications (all P < 0.05). An ultrasound elastography score of ≥ 3 and type III vascularity on superb microvascular imaging indicated a higher possibility of malignant thyroid nodules (both P < 0.001). The multivariable logistic regression analysis showed that the size, echogenicity, margin, and vertical diameter/horizontal diameter ratio, and superb microvascular imaging type of thyroid nodules were not significant markers for benign or malignant thyroid nodules (all P > 0.05), while microcalcifications/no calcifications and an ultrasound elastography score of ≥ 3 were independent risk factors for malignant AUS nodules (both P < 0.05). The diagnostic sensitivity, specificity, accuracy, FPR, and FNR of conventional ultrasonography for AUS nodules were 91.30%, 71.40%, 62.70%, 28.60%, and 8.70%, respectively; the values for ultrasound elastography were 85.50%, 66.70%, 52.20%, 33.30%, and 14.50%, respectively; the values for superb microvascular imaging were 66.70%, 76.20%, 42.90%, 23.80%, and 33.30%, respectively; and the values for multimodal ultrasonography were 75.20%, 92.50%, 67.70%, 24.80%, and 7.50%, respectively. For distinguishing between benign and malignant AUS nodules, the AUC values of conventional ultrasonography, ultrasound elastography, superb microvascular imaging, and multimodal ultrasonography were 0.866, 0.745, 0.774, and 0.918, respectively. Conclusion Multimodal ultrasonography shows better diagnostic efficacy for AUS nodules of TI-RADS 3-5 compared with conventional ultrasonography, ultrasound elastography, and superb microvascular imaging, which can facilitate the malignancy risk stratification and management of AUS thyroid nodules.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

【Objective】 To explore and evaluate the application of blood intelligent management platform (scheme) based on the Internet of Things(IoT)in the clinical blood management for hospitals. 【Methods】 Based on radio frequency identification technology (RFID), smart blood refrigerators, IoT blood shipping containers, automated blood bank systems, smart blood management software, etc. were developed and integrated as an IoT blood intelligent management platform (scheme). The blood storage, management software and hardware systems were organically combined, and the blood storage equipment was moved forward to the clinical departments to solve the concerns of clinicians. 【Results】 The in-depth integration of IoT technology, RFID and refrigeration technology has built an RFID-based IoT blood management solution, which integrates blood storage, transfusion, and quality control management, also realizes the entire process of supervision and traceability of clinical blood transfusion. The forward movement of blood bank to the clinical departments and the implementation of electronic cross-matching streamlined and optimized the clinical blood flow. The waiting time of patient′s for blood transfusion was shortened from (40±10) min to less than 2 min. The whole process of cold chain logistics ensured the storage quality of blood products issued, so that the clinical departments can return the untransfused blood and Blood Transfusion Department can reissue it to other hospitals. 【Conclusion】 IoT blood intelligent management based on RFID realizes the intelligent management of clinical blood transfusion and blood information traceability. The forward movement of blood bank to the clinical departments improves the efficiency of clinical blood transfusion, avoids the waste of blood source, and ensures the safety of blood transfusion. It is worth promoting in the whole process of blood transfusion.

Thyroid nodules are extremely common. Ultrasonography is the most effective imaging modality to diagnose and differentiate thyroid nodules. There are many versions of thyroid image reporting and data system(TI-RADS) evaluated by ultrasound, but some classification system indexes are complicated and clinical application is chaotic. In 2017, the American College of Radiology (ACR) published white papers that introduced a TI-RADS classification system based on conventional ultrasound to reduce the dependence on operators and facilitate communication with physicians. The purpose of the ACR TI-RADS is to establish the risk classification system for managing thyroid nodules and guide the physicians to make professional judgments. The ACR TI-RADS risk classification system is interpreted in this article, including the development, overview and feature categories of ACR TI-RADS, and authors′ experiences in clinical application.

Objective To investigate the value of ultrasound in differential diagnosis of benign and malignant thyroid lesions with rimlike peripheral calcification.Methods Seventy-three patients of thyroid nodules with rimlike peripheral calcification were analyzed retrospectively.All cases were confirmed by surgery and pathology.The efficacy of sonographic features on diagnosis of thyroid nodules was analyzed.Results Among 73 patients,58 (58/73,79.45％) were benign and 15 (15/73,20.55％) were malignant.Among the sonographic features mentioned,the mean size,margin,internal echo and presence of halo showed no significant differences between malignant and benign nodules (all P＞0.05).Proportion of thyroid nodules coexisting with nodular goiter,irregular thickness and interruption of rimlike peripheral calcification had significant differences between malignant and benign nodules (all P＜0.05).The sensitivity,specificity,positive predictive value and negative predictive value of coexisting with nodular goiter for diagnosing benign nodules were 77.59％ (45/58),60.00％ (9/15),88.24 ％ (45/51),40.91％ (9/22),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of irregular thickness for diagnosing malignant nodules were 53.33 ％ (8/15),87.93％ (51/58),53.33％ (8/15),87.93％ (51/58),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of interruption of rimlike peripheral calcification for diagnosing malignant nodules were 73.33％ (11/15),68.97％ (40/58),37.93％ (11/29),90.91％ (40/44),respectively.Conclusion Ultrasonography is helpful to diagnosis of thyroid nodules with rimlike peripheral calcification.Irregular thickness and interruption of calcification are associated with malignancy.

Objective To explore value of detecting fetal thymus size with the thymic-thoracic ratio (TT-ratio).Methods Prenatal ultrasonography examinations were performed on totally 317 normal singleton healthy pregnancies from 18 to 39 gestational weeks.The normal thymus of fetus were observed on the three-vessel-trachea (3VT) view.The anteroposterior diameter of the thymus (T1) was measured between the anterior border of the aortic arch and posterior border of sternum.The intrathoracic mediastinal diameter (T2) was measured between the anterior border of thoracic vertebral body and posterior border of sternum.The TT-ratio was then calculated as the ratio of T1 to T2.Scatter plot between TT-ratio and gestational age was drawn.And the Spearman regression analysis was performed.Results The thymus of fetus was shown as an irregular homogenous structure in the anterior mediastinum on the 3VT view.The mean TT-ratio was 0.45± 0.03.There was no correlation between TT-ratio and gestation (rs =0.06,P=0.29).Conclusion Prenatal ultrasound can display the thymus obviously.TT-ratio could be applied to assess the fetal thymus size,which can provides clinical basis for the detection of absent or hypoplastic thymus in fetus.

OBJECTIVETo investigate the characteristics,diagnosis and therapy of post-biopsy renal artery pseudoaneurysm in children and to study the clinical value of arterial embolization for traumatic renal hemorrhage when conservative treatment failed.

METHODData were compiled from medical records of a child in whom renal artery pseudoaneurysm occurred after biopsy in the Provincial Hospital Affiliated to Shandong University , and the related literature was reviewed to analyze the diagnosis and treatment of such pseudoaneurysm.

RESULTA 13-year-old boy had gross hematuria, aggravated dysuria and decreased hemoglobin 10 days after percutaneous renal biopsy. Hb decreased from 110 g/L on the first day after admission to 92 g/L on the 4th day, 83 g/L on the 7th day and the minimum to 74 g/L at the 8th day after admission. Ultrasound showed solid echogenic mass in the right renal pelvis as well as the bladder. Color Doppler ultrasound shows the red and blue rotation of blood flow in the polar capsule under the right kidney. Contrast-enhanced CT in the arterial phase showed a 0.5 cm sized renal mass with a strongly enhanced dot in the lower pole of the right kidney, suggesting a renal artery pseudoaneurysm. Haemostatic, supplement of red blood cells and blood volume and other integrative treatment of hematuria were applied for seven days, but his gross hematuria continued to be worsened. He was diagnosed as pseudoaneurysm by digital subtraction angiography (DSA) on the 19th day after renal biopsy. Superselective renal artery embolization using micro-coils and gelatin sponge particles was performed, and the blood clots were cleaned under cystoscope. Macro-haematuria and dysuria disappeared after the interventional treatment. Retrieval of reports on post-biopsy renal artery pseudoaneurysm in children by using "pseudoaneurysm, child" as the search term showed report of one case from the Chinese CNKI database and 3 cases from the PubMed database. The underlying disease was Henoch-Schonlein purpura nephritis in 3 cases and Sneedon syndrome in 1 case; clinical manifestation of gross haematuria was present in 4 cases, lumbago or pain at the site of the puncture in 2 cases, dysuria in 1 case, and fever in 2 cases.

CONCLUSIONThe post-biopsy renal artery pseudoaneurysm in children is often manifested as gross hematuria, lumbago, pain at the site of the puncture, fever and dysuria, DSA can be used for definite diagnosis and the interventional treatment is effective.

Adolescent ; Aneurysm, False ; therapy ; Angiography, Digital Subtraction ; Biopsy ; Embolization, Therapeutic ; Hematuria ; Hemorrhage ; Humans ; Kidney ; blood supply ; pathology ; Kidney Diseases ; diagnosis ; Male ; Nephritis ; Renal Artery ; pathology

PurposeTo explore the value of ultrasound radio frequency technique in the quantitative evaluation of common carotid artery intima-media thickness (IMT) and elasticity change in patients with dyslipidemia, and to discuss the influence of high density lipoprotein cholesterol (HDL-C) upon carotid artery structure and elasticity function. Materials and Methods A hundred and fifty patients with abnormal serum lipid were selected as case group and further divided into three groups: group A--50 patients with hyperlipidemia and high HDL-C, group B--50 patients with hyperlipidemia and normal HDL-C, group C--50 patients with hyperlipidemia and low HDL-C. Meanwhile, 50 healthy people were enrolled in the study as control group (group D). The ultrasound radio frequency-data technique was employed to analyze the influence of hyperlipidemia and HDL-C upon IMT, CC,β, PWV and AIx.Results The IMT,β, PWV and AIx in group B were higher than those in group D, but group B had lower CC (the differences with statistic significance,t=5.141, 4.219, 4.898, 4.142 and-3.758,P<0.01). Compared with group A, group B had higher IMT,β, PWV and AIx and lower CC (the differences with statistic significance,t=3.425, 2.807, 2.913, 2.209 and-2.091,P<0.05 orP<0.01). Compared with group B, group C had higher IMT,β, PWV and AIx and lower CC (the differences with statistic significance,t=4.937, 2.195, 3.337, 2.067 and-3.049, P<0.05 orP<0.01). Group A had higher IMT and PWV than group D (the differences with statistic significance,t=2.236 and 2.407,P<0.05), but CC,β, and AIx showed no difference between group A and group D (t=-1.693, 1.845 and 1.967,P>0.05). In patients with hyperlipidemia, the increase of HDL-C led to the reduction of the common carotid artery IMT and wall stiffness and the increase of elasticity and vice versa.Conclusion The ultrasound radio frequency technique could measure the real-time common carotid artery IMT and elasticity automatically and accurately, thus provides reliable quantitative index for the evaluation of early artery structure and change of function in lipid lowering therapy.

OBJECTIVETo explore the value of the strain means of the quantitative parameters of organization diffusion in determining the degree of liver fibrosis.

METHODSA total of 130 patients with chronic hepatitis B were examined for quantitative analysis of organization diffusion before liver biopsy to analyze the performance of the strain means in liver fibrosis of different degrees. All the cases were confirmed by pathology.

RESULTSThe strain means differed significantly between different stages of liver fibrosis. Using the best cut-off values of 116.2, 111.4, 101.6 and 97.5 for diagnosis of S≥1, S≥2, S≥3 and S=4, the diagnostic sensitivities were 91.2%, 90.8%, 95.8% and 89.7%, with specificities of 90.4%, 98.6%, 93.8% and 95.6% and accuracies of 90.6%, 94.7%, 95.5% and 91.8%, respectively.

CONCLUSIONThe strain mean can provide specific numerical indicators to determine the degree of liver fibrosis.

Biopsy ; Diffusion ; Hepatitis B, Chronic ; Humans ; Liver Cirrhosis ; diagnosis ; Sensitivity and Specificity

Objective To explore the value of the strain means of the quantitative parameters of organization diffusion in determining the degree of liver fibrosis. Methods A total of 130 patients with chronic hepatitis B were examined for quantitative analysis of organization diffusion before liver biopsy to analyze the performance of the strain means in liver fibrosis of different degrees. All the cases were confirmed by pathology. Results The strain means differed significantly between different stages of liver fibrosis. Using the best cut-off values of 116.2, 111.4, 101.6 and 97.5 for diagnosis of S≥1, S≥2, S≥3 and S=4, the diagnostic sensitivities were 91.2%, 90.8%, 95.8% and 89.7%, with specificities of 90.4%, 98.6%, 93.8% and 95.6% and accuracies of 90.6%, 94.7%, 95.5% and 91.8%, respectively. Conclusion The strain mean can provide specific numerical indicators to determine the degree of liver fibrosis.