Objective To investigate the value of contrast-enhanced ultrasound(CEUS)guided fine needle aspiration(FNA)in diagnosing the nature of type 4 thyroid nodules by thyroid imaging re-porting and data system(TI-RADS).Methods A total of 120 patients with TI-RADS type 4 thyroid nodules were selected as subjects.Sixty patients underwent CEUS-guided FNA(CEUS group),while the other 60 patients underwent conventional ultrasound-guided FNA(conventional ultrasound group).Using pathological results as the gold standard,Kappa consistency tests were used to analyze the diagnostic consistency of conventional ultrasound-guided FNA and CEUS-guided FNA for TI-RADS type 4 thyroid nodules.Results Among 120 patients with TI-RADS type 4 thyroid nodules(138 nodules),85 malignant nodules and 53 benign nodules were confirmed by pathology.In the CEUS group,there were 28 benign nodules and 42 malignant nodules(40 papillary thyroid carcino-mas and 2 medullary carcinomas).In the conventional ultrasound group,there were 25 benign nod-ules and 43 malignant nodules(39 papillary thyroid carcinomas and 4 medullary carcinomas).The false positive rate and false negative rate of conventional ultrasound-guided FNA for diagnosing malignant TI-RADS type 4 thyroid nodules were 3.62％and 5.07％,respectively.For CEUS-guided FNA,the rates were 2.17％and 2.90％,respectively.The sensitivity,specificity and accuracy of con-ventional ultrasound-guided FNA for diagnosing the nature of TI-RADS type 4 thyroid nodules were 83.72％,80.00％and 82.35％,respectively,with Kappa value of 0.627.For CEUS-guided FNA,these values were 90.48％,89.29％and 90.00％,respectively,with Kappa value of 0.793.Based on pathological examination,the diagnostic agreement rates for malignant TI-RADS type 4 thyroid nodules were 79.07％for conventional ultrasound-guided FNA and 83.33％for CEUS-guided FNA,with Kappa values of 0.719 and 0.786,respectively.Conclusion CEUS-guided FNA can provide high-resolution,real-time dynamic imaging information,thereby improving the sensitivity and specificity of diagnosing the nature of TI-RADS type 4 thyroid nodules.

OBJECTIVETo investigate the guidance role of preoperative nutritional risk screening in perioperative nutrition support for colorectal cancer patients in order to provide evidence for the rational clinical application of nutrition support.

METHODSNutritional risk screening was carried out in 290 hospitalized colorectal cancer patients from The Fourth People's Hospital of Wuxi City, Tongji Hospital of Tongji University and The Second Hospital of Soochow University with the nutritional risk screening(NSR) 2002 score summary table. Postoperative bowel function recovery and associated nutritional indices were compared between patients who received preoperative nutrition support according to the risk screening results and those who did not.

RESULTSAmong 110 patients at nutritional risk, 65 received perioperative nutrition support and had faster recovery of intestinal function [time to first flatus (2.3±0.5) d vs. (3.3±0.5) d, time to first defecation (3.5±0.5) d vs. (4.6±0.6) d, semi-fluid intake (10.1±1.2) d vs. (12.4±2.2) d], shorter postoperative stay [(15.7±1.1) d vs. (18.8±1.4) d], and higher albumin, prealbumin and transferrin [(33.2±4.5) g/L vs. (26.0±4.0) g/L, (0.28±0.05) g/L vs. (0.16±0.04) g/L, (1.92±0.33) g/L vs. (1.75±0.45) g/L] at 7-day postoperatively (all P<0.05) as compared to those without perioperative nutrition support(n=45). While among 180 cases without nutritional risk, there were no significant differences in the above indices between patients who received preoperative nutrition support and those who did not (all P>0.05).

CONCLUSIONIt is important to evaluate the nutritional risk in hospitalized patients with colorectal cancer, and to carry out nutrition support actively for those at nutritional risk.

Colorectal Neoplasms ; therapy ; Female ; Humans ; Male ; Middle Aged ; Nutrition Assessment ; Nutritional Support ; Perioperative Care ; Retrospective Studies ; Risk Assessment

Obj ective To investigate the effects of laparoscopic surgeryon coagulation func-tion in patients with gastric cancer.Methods A total of 71 patients with gastric cancer were divid-ed into laparoscopic group and laparotomy group.Levels of D-dimer (D-D)and fibrinogen (FIB), prothrombin time (PT),activated partial thromboplastin time (APTT)were detected before opera-tion,end of operation and 24 hours after operation.Prothrombin time-international normalized ratio (INR)was calculated and coagulation function was observed in both groups.Results There were no significant differences in APTT and INR before and after operation in both groups (P>0 .05 ). PT at 24 hours after operation was significantly shorter than that before operation(P<0 .05 ),but there was no significant difference between two groups (P>0 .05 ).Levels of FIB and D-D in-creased after operation,and there were significant differences between two groups (P<0 .05 ). Conclusion Blood hypercoagulability and potential thrombosis are associated with patients with la-paroscopic surgery or laparotomy surgery.Preventions during preoperative period should be conduct-ed to mitigate the effects of laparotomy surgery on coagulation function.

Objective To investigate the guidance role of preoperative nutritional risk screening in perioperative nutrition support for colorectal cancer patients in order to provide evidence for the rational clinical application of nutrition support. Methods Nutritional risk screening was carried out in 290 hospitalized colorectal cancer patients from The Fourth People′s Hospital of Wuxi City, Tongji Hospital of Tongji University and The Second Hospital of Soochow University with the nutritional risk screening (NSR) 2002 score summary table. Postoperative bowel function recovery and associated nutritional indices were compared between patients who received preoperative nutrition support according to the risk screening results and those who did not. Results Among 110 patients at nutritional risk, 65 received perioperative nutrition support and had faster recovery of intestinal function [time to first flatus (2.3 ±0.5) d vs. (3.3 ± 0.5) d, time to first defecation (3.5 ±0.5) d vs. (4.6 ±0.6) d, semi-fluid intake (10.1 ±1.2) d vs. (12.4 ± 2.2) d], shorter postoperative stay [(15.7±1.1) d vs. (18.8±1.4) d], and higher albumin, prealbumin and transferrin [(33.2±4.5) g/L vs. (26.0±4.0) g/L, (0.28±0.05) g/L vs. (0.16±0.04) g/L, (1.92±0.33) g/L vs. (1.75±0.45) g/L] at 7-day postoperatively (all P<0.05) as compared to those without perioperative nutrition support (n=45). While among 180 cases without nutritional risk, there were no significant differences in the above indices between patients who received preoperative nutrition support and those who did not (all P>0.05). Conclusion It is important to evaluate the nutritional risk in hospitalized patients with colorectal cancer , and to carry out nutrition support actively for those at nutritional risk.

Obj ective To investigate the effects of laparoscopic surgeryon coagulation func-tion in patients with gastric cancer.Methods A total of 71 patients with gastric cancer were divid-ed into laparoscopic group and laparotomy group.Levels of D-dimer (D-D)and fibrinogen (FIB), prothrombin time (PT),activated partial thromboplastin time (APTT)were detected before opera-tion,end of operation and 24 hours after operation.Prothrombin time-international normalized ratio (INR)was calculated and coagulation function was observed in both groups.Results There were no significant differences in APTT and INR before and after operation in both groups (P>0 .05 ). PT at 24 hours after operation was significantly shorter than that before operation(P<0 .05 ),but there was no significant difference between two groups (P>0 .05 ).Levels of FIB and D-D in-creased after operation,and there were significant differences between two groups (P<0 .05 ). Conclusion Blood hypercoagulability and potential thrombosis are associated with patients with la-paroscopic surgery or laparotomy surgery.Preventions during preoperative period should be conduct-ed to mitigate the effects of laparotomy surgery on coagulation function.

Objective To investigate the guidance role of preoperative nutritional risk screening in perioperative nutrition support for colorectal cancer patients in order to provide evidence for the rational clinical application of nutrition support. Methods Nutritional risk screening was carried out in 290 hospitalized colorectal cancer patients from The Fourth People′s Hospital of Wuxi City, Tongji Hospital of Tongji University and The Second Hospital of Soochow University with the nutritional risk screening (NSR) 2002 score summary table. Postoperative bowel function recovery and associated nutritional indices were compared between patients who received preoperative nutrition support according to the risk screening results and those who did not. Results Among 110 patients at nutritional risk, 65 received perioperative nutrition support and had faster recovery of intestinal function [time to first flatus (2.3 ±0.5) d vs. (3.3 ± 0.5) d, time to first defecation (3.5 ±0.5) d vs. (4.6 ±0.6) d, semi-fluid intake (10.1 ±1.2) d vs. (12.4 ± 2.2) d], shorter postoperative stay [(15.7±1.1) d vs. (18.8±1.4) d], and higher albumin, prealbumin and transferrin [(33.2±4.5) g/L vs. (26.0±4.0) g/L, (0.28±0.05) g/L vs. (0.16±0.04) g/L, (1.92±0.33) g/L vs. (1.75±0.45) g/L] at 7-day postoperatively (all P<0.05) as compared to those without perioperative nutrition support (n=45). While among 180 cases without nutritional risk, there were no significant differences in the above indices between patients who received preoperative nutrition support and those who did not (all P>0.05). Conclusion It is important to evaluate the nutritional risk in hospitalized patients with colorectal cancer , and to carry out nutrition support actively for those at nutritional risk.

Objective To analyze the clinical and pathological characteristics and its surgical management strategy for colorectal high-grade intraepithelial neoplasia (HGIN).Methods Eighty-two cases with colorectal tumors diagnosed as colorectal HGIN based on colonoscopic biopsy between January 2005 and December 2012 were enrolled in the study.The clinicopathological data of all the patients was collected and analyzed.Of the 82 cases,71 cases had radical colorectal surgery,1 cases had Miles operation after previous transanal excisions,3 had transanal local excisions,8 cases had palliative surgery.The surgical specimens were all examined pathologically and compared with the preoperative diagnosis of colonoscopic biopsy of all the patients.Results Three cases (3.7％) were pathologically diagnosed as high-grade intraepithelial neoplasia,their average diameter was 1.5 cm.The other 79 (96.3％) cases were diagnosed as adenocarcinoma,with an average diameter of 4.7 cm.The difference in tumor size was statistically significant (P ＜ 0.01).Comparison of pre-and post-operative specimens showed poor consistency,the Kappa value was O.104.Significant analysis showed a correlation between cancerous change to tumor size and depth of invasion.In the 79 cases confirmed as adenocarcinoma,liver metastasis occurred in 8 cases,regional lymph nodes metastasis in 31 cases (39.2％).Of the 33 cases with rectal tumors,30 cases (90.9％) were pathologically diagnosed as adenocarcinoma after operation.Conclusions Much attention should be payed to the pathological diagnosis in colorectal intraepithelial neoplasia,especially in the HGIN.We have found that of the cases first diagnosed as HGIN,approximately 96.3％ already have invasion adenocarcinoma.Most cases had reginonal lymph nodes metastasis.Liver metastasis had been occurred.thus active surgical measures should be taken.If the location of the tumor was not involved to anal sphincter,or cases with tumors larger than 3 cm was diagnosed,in highly suspected cases with malignant potiential,radical surgery is recommended.For tumors located at the lower rectum,the final decision should be made only after repeated endoscopic or transanal biopsy.

Objective The aim of the current study was to investigate the prognostic value of extracapsular lymph node spread in gastric cancer patients and to find correlations with clinicopathological parameters.Methods Clinicopathological data of 131 gastric cancer patients who underwent gastrectomy with lymphadenectomy were analyzed retrospectively. The number of metastatic lymph nodes with extracapsular spread were determined. Multivariate analysis was performed to find the clinical prognosis affecting extracapsular lymph node involvement. Results Seventy-eight patients (59.5%)had perigastric lymph node metastasis. Fortysix cases were detected extracapsular lymph node involvement. The 5-year cumulative survival rate for patients with extracapsular lymph node spread was 13. 5% , while 32 patients with lymph node metastasis but without extracapsular involvement had a 5-year survival rate of 39.3%. The survival rate decreased significantly with the increase of extracapsular lymph node involvement(P =0.001). Extracapsular lymph node involvement was significantly associated with the higher number of metastatic lymph nodes, the location of lymph node metastasis, tumor invasion depth and distant lymph node metastasis. In the multivariate analysis, extracapsular lymph node spread also remained as an independent prognostic factor(P =0.003). Conclusions Extracapsular lymph node involvement is a convenient and reliable prognostic index, and is an independent prognostic factor in gastric cancer patients. In future staging systems for gastric cancer, extracapsular lymph node involvement should be considered, be pathologically checked and reported in order to determine extracapsular spread status.

Objective To summarize the advances in the clinical application of the quality of life(QOL) assessment after surgery of rectal cancer. Methods　The recent literatures on the advances in the studies on the QOL assessment following the treatment of rectal cancer were reviewed. Results　After surgery of rectal cancer, the patients might suffer from short and/or long term of various complications affecting the physical, social and psychological aspects of their well-being. The QOL assessment included many aspects of the studies. Global QOL scores as measured by the specific questionnaires improved significantly after surgery. It had provided clinical evidences of therapeutic methods, operative treatment of choices and bowel reconstructed procedures for the patients with rectal cancer.Conclusion　The QOL studies after surgery for rectal cancer are of increasing importance. Apart from the improvements of the survival rates and the recurrence-free period, it is essential to provide an acceptable QOL postoperatively. The QOL assessment for the guidance of clinical treatment should be discussed routinely for a patient with potentially curable rectal carcinoma so that the excellent outcome could be achieved.