Objective:To investigate the value of the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS), real-time ultrasound elastography (RTE), and contrast-enhanced ultrasound (CEUS), individually and in combination, in the diagnosis of TBSRTC Ⅲ-Ⅴ thyroid nodules.Methods:A retrospective analysis was performed on 106 patients with TBSRTC Ⅲ-Ⅴ thyroid nodules who were pathologically diagnosed by fine needle aspiration cytology at Bao Ji People's Hospital between February 2022 and December 2023. All patients were assessed using ACR TI-RADS grading, RTE, and CEUS, with postoperative pathological diagnosis serving as the gold standard. The diagnostic effectiveness of ACR TI-RADS, RTE, and CEUS, individually and in combination, for TBSRTC Ⅲ-Ⅴ thyroid nodules was analyzed using the receiver operating characteristic (ROC) curve.Results:There were statistically significant differences in nodule size, blood supply, and proportion of TBSRTC Ⅲ-Ⅴ nodule between the two groups ( χ2 = 4.67, 42.56, 26.09, all P < 0.05), while there was no statistical significance in other general data (all P > 0.05). Of the 106 patients with TBSRTC Ⅲ-Ⅴ nodules, 69 patients were diagnosed with malignant nodules and 37 with benign nodules. The area under the curve (95% CI) of ACR-TIRADS, RTE, and CEUS in identifying malignant nodules were 0.860 [95% CI (0.779-0.920)], 0.712 [95% CI (0.616-0.796)], and 0.788 [95% CI (0.698-0.862)], respectively, with sensitivities of 85.51%, 66.67%, and 73.91%, respectively and specificities of 86.49%, 75.68%, and 83.78%, respectively. The Youden indices were 0.719, 0.423, and 0.577, respectively. Among the three diagnostic methods, ACR TI-RADS had the highest diagnostic efficiency, while RTE had the lowest. Pairwise comparisons in ROC analysis revealed statistically significant differences between ACR TI-RADS and RTE, ACR TI-RADS and CEUS, as well as RTE and CEUS ( Z = 4.22, 3.02, 2.78, all P < 0.05). The ACR TI-RADS + RTE + CEUS combination had the highest sensitivity, specificity, Youden index, and AUC (95% CI) values: 94.20%, 89.19%, 0.834, and 0.917 (95% CI: 0.847-0.962). The RTE + CEUS combination had the lowest values: 76.81%, 78.38%, 0.552, and 0.776 (95% CI: 0.685-0.851). The pairwise comparison results in the ROC curve revealed that significant differences were observed between ACR TI-RADS + RTE and RTE + CEUS, ACR TI-RADS + RTE and ACR TI-RADS + RTE + CEUS, ACR TI-RADS + CEUS and ACR TI-RADS + RTE + CEUS, RTE + CEUS and ACR TI-RADS + RTE + CEUS, and ACR TI-RADS + CEUS and RTE + CEUS ( Z = 3.13, 2.40, 2.16, 4.07, 3.32, all P < 0.05). However, there was no significant difference between ACR TI-RADS + RTE and ACR TI-RADS + CEUS in ROC analysis ( Z = 0.06, P > 0.05). Conclusion:The combined utilization of ACR TI-RADS, RTE, and CEUS offers enhanced information on thyroid nodules, encompassing malignant risk stratification, nodular elasticity, and contrast agent perfusion, thereby aiding in improving the diagnostic precision of TBSRTC Ⅲ-Ⅴ malignant nodules.

Objective To investigate the effect of remimazolam combined with esmketamine adjuvant medicines on anaesthetic effect and mental symptom in puerperae undergoing cesarean section.Methods Ninety-six full-term puerperae during cesarean section under combined spinal-epidural anesthe-sia,aged 24-38 years,BMI 24-35 kg/m2,ASA physical status Ⅰ or Ⅱ.All the puerperae were divided into three groups using random number table:remimazolam combined with esketamine group(group RK),esketamine group(group K),and control group(group C),32 puerperae in each group.After the delivery of the fetus,puerperae in group RK were given intravenous injection of remimazolam 0.1 mg/kg,and then intravenous pumping of estaketamine 0.25 mg/kg which was diluted to 20 ml with normal saline(finished in 30 minutes),puerperae in group K were given intravenous pumping of estaketamine 0.25 mg/kg which was diluted to 20 ml with normal saline(finished in 30 minutes),puerperae in group C were given the same dose of normal saline.All puerperae were given PCIA after operation.The anesthetic effect from the fetus de-livery to the end of operation were recorded(grade Ⅰ,no pain;grade Ⅱ,slight pain;grade Ⅲ,with sig-nificant pain).The adverse reactions such as hypertension,tachycardia,and mental symptoms(nystagmus,dizziness,nightmares and hallucinations)during surgery were recorded.The score of Edinburgh postpartum depression scale(EPDS)and incidence of postpartum depression(PPD)at 1 week and 4 weeks after sur-gery were recorded.Results Compared with group C,the proportion of grade Ⅰ anesthetic effect in groups,RK and K was significantly increased,and the proportion of grade Ⅲ anesthetic effect was signifi-cantly decreased(P＜0.05),the EPDS score and the incidence of PPD were significantly decreased at 1 week and 4 weeks after surgery(P＜0.05).Compared with group K,the incidence of mental symptoms during surgery in group RK was significantly decreased(P＜0.05),EPDS score was significantly decreased at 1 week and 4 weeks after surgery(P＜0.05).There were no significant differences in the in-cidences of hypertension,tachycardia between the three groups.Conclusion Remimazolam combined with esketamine for cesarean section can improve the anesthetic effect during surgery,reduce the incidence of in-traoperative mental sympton,decrease the postpartum EPDS score,optimize postpartum depression.

Objective To compare the value of two-dimensional high-frequency ultrasound, acoustic pulsed radiant force imaging (ARFI)-acoustic palpation tissue quantification (VTQ) technology, and strain elastography alone and their combination in diagnosis of benign and malignant thyroid micronodules. Methods A retrospective analysis was conducted in 99 patients (107 thyroid micro-solid nodules with diameters ≤ 10.0 mm) who were treated at Baoji People's Hospital in Shaanxi Province from June 2021 to June 2023. All patients underwent two-dimensional high-frequency ultrasound, ARFI-VTQ technology, and strain elastography to obtain ultrasound data scores and data. Using biopsy and surgical pathology as the diagnostic "gold standard", the diagnostic efficacy of the three ultrasound methods alone and their combination was compared for thyroid micro-nodules. Results A total of 62 patients (68 nodules) underwent fine-needle aspiration biopsy (FNAB), and 37 patients (39 nodules) underwent surgery. Among 107 thyroid micro-nodules, 45 were diagnosed as malignant, and 62 as benign. Significant differences were observed between malignant micro-nodules and benign micro-nodules in terms of internal echo (isoechoic and hyperechoic echo, very hypoechoic and hypoechoic echo), boundary, microcalcification, aspect ratio >1, blood supply, and resistance index (RI) of the artery (P < 0.05). When the critical value of the C-TIRADS score for diagnosing thyroid micro-nodules using two-dimensional high-frequency ultrasound was ≥ 2 points (C-TIRADS 4b), the diagnostic sensitivity was 73.33%, specificity was 79.03%, and the area under the curve (AUC) was 0.762[95%CI, 0.670 to 0.839]. In ARFI-VTQ technology, the SWV values ranged from 0.52 to 7.55 m/s, with an average of (2.62 ± 0.61) m/s. The mean SWV of malignant micro-nodules was (5.24±2.23) m/s, which was higher than (2.11±0.70) m/s of benign micro-nodules (t=10.258, P < 0.05). When the critical SWV value was 3.19 m/s, the diagnostic sensitivity was 77.78%, specificity was 80.65%, and the AUC (95%CI) was 0.792(95%CI, 0.703 to 0.865). In strain elastography, when the critical score was ≥3, the diagnostic sensitivity was 75.56%, specificity was 77.42%, and the AUC (95%CI) was 0.765 (95%CI, 0.673 to 0.841). Combined detection of the three methods showed that there were 44 positive micro-nodules, 63 negative micro-nodules, the diagnostic sensitivity was 93.33%, specificity was 96.77%, and the AUC (95%CI) was 0.951 (95%CI, 0.891 to 0.983). There was statistical significance in the diagnostic efficacy of combined application compared with that of 2D high-frequency ultrasonography, ARFI-VTQ technology and strain-elasticity imaging alone (Z=4.861, 4.393, 4.842, P < 0.05). Conclusion The combination of two-dimensional high-frequency ultrasound, ARFI-VTQ technology, and strain elastography can improve the diagnostic accuracy of benign and malignant thyroid micro-nodules.

Objective To investigate the effect of esketamine combined with ropivacaine in patients with cesarean section undergoing patient-controlled epidural analgesia (PCEA). Methods A total of 76 full-term pregnant women who delivered cesarean section under combined lumbo-epidural anesthesia were selected, and randomly divided into group K (esketamine) and group C (control), with 38 cases in each group. Group K was given analgesic pump formula (esketamine 50 mg+ ropivacaine 200 mg), group C was given analgesic pump formula (ropivacaine 200 mg). Numerical pain scores (NRS) at rest and activity (hip flexion) were observed in two groups at 6, 12, 24, 36 and 48 h after surgery. The 40-item Recovery Quality Scale (QoR-40) scores was compared between the two groups. The occurrence of postoperative adverse reactions was compared between the two groups. Results The NRS scores of the group K were significantly lower than that of the group C at rest 24, 36 and 48 hours after operation (P < 0.05); the NRS scores of the group K were significantly lower than that of the group C at 12, 24, 36 and 48 h after operation (P < 0.05). The QoR-40 scores of the group K were significantly higher than that of the group C at 1 day and 2 days after operation (P < 0.05). The incidence of postoperative chills, nausea and vomiting in the group K was significantly lower than that in the group C (P < 0.05). Conclusion Esketamine combined with ropivacaine for PCEA after cesarean section can optimize analgesic effect, reduce adverse reactions and improve recovery quality.

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Objective: To explore the relationship between the tumor necrosis factor receptor superfamily members 11A (TNFRSF11A) and 11B (TNFRSF11B) gene polymorphisms and the outcome of hepatitis C virus (HCV) infection. Methods: In this case-control study, 749 cases of persistent HCV infection, 494 cases of spontaneous clearance and 1 486 control subjects were included from 2008 to 2016. TaqMan-MGB probe method was used to detect the genotype of TNFRSF11A rs1805034 and TNFRSF11B rs2073617. The genotypes distribution of the two single nucleotide polymorphisms (SNP) were analyzed in different populations. Results: Co-dominant model showed that individuals carrying the rs2073617 CC genotype were prone to have chronic HCV infection, compared with individuals carrying the rs2073617 TT genotype (OR=1.517, 95%CI: 1.055-2.181, P=0.024). Recessive model results showed that individuals carrying rs2073617 CC genotype were more likely to develop chronic HCV infection compared with individuals carrying rs2073617 TT or TC genotype (OR=1.435, 95%CI: 1.033-1.996, P=0.032). Additive model showed that the risk for chronic HCV infection increased with the increase of the number of rs2073617 C alleles (OR=1.204, 95%CI: 1.013-1.431, P=0.035). Conclusion The genetic polymorphism of TNFRSF11B rs2073617 might be related with the chronicity of HCV infection.

Objective: To investigate the tumor necrosis factor receptor superfamily 1B gene (TNFRSF1B) polymorphism in relation to the outcomes of hepatitis C virus (HCV) infection. Methods: One thousand six hundred and forty-five cases without HCV infection, 545 cases with HCV clearance, and 783 cases with chronic HCV infection were enrolled. TaqMan probe method was used to investigate genotype rs1061622 (T > G) and rs1061624 (G > A). Two single nucleotide polymorphisms (SNPs) sites were genotyped and haplotypes were constructed to evaluate their relation with the outcome of HCV infection. Results: Logistic regression analysis showed that there was no relation to the two SNPs with HCV infection susceptibility and chronicity (P > 0.05). Haplotype analysis showed that carrier TA had an increased susceptibility to HCV infection [adjusted odds ratio (OR) = 1.15, 95% confidence interval (CI): 1.01 to 1.30, P = 0.038)]. Carrier TA and GG haplotypes were conducive to chronic HCV infection (adjusted OR = 1.28, 95% CI: 1.08 to 1.53, P = 0.006; OR = 1.31, 95% CI: 1.03 to 1.66, P = 0.026). Conclusion The combinational effects of rs1061622 and rs1061624 in TNFRSF1B gene may increase the risk of HCV chronicity and infection.

Objective:To explore the expression of IL-22 in the patients with rheumatoid arthritis,and to define the clinical sig-nificance of IL-22 cells for RA. Methods: A total of 50 RA patients, 15 OA patients and 15 healthy controls were enrolled. The proportion of Th22 cells in peripheral blood and synovial fluid( SF) of RA patients was detected by flow cytometry;the levels of IL-22 in serum and synovial fluid of RA patients were detected by ELISA. The clinical parameters of disease activity were assessed including ESR,RF,CRP,DAS28,anti CCP and the degree of bone erosions determined by X-rays. Pearson correlation analysis,t test and Kruskal-Wallis H test were used for statistical analysis. Results:The proportion of Th22 cells in RA patients was higher than that of OA patients (t=2. 290 ,P=0. 021) and healthy controls(t=2. 524,P=0. 015). IL-22 levels in RA patients were higher than that of OA patients (t=2. 560,P=0. 014) and healthy controls(t=2. 768,P=0. 009). IL-22 in the RF positive group were higher than that of RF negative group(t=2. 322,P=0. 035). IL-22 in the anti-CCP antibody positive group were higher than that of anti-CCP antibody negative group (t=2. 504,P=0. 015). The levels of IL-22 were correlated positively with ESR,RF,DAS28(r=0. 312,0. 314,0. 332,P<0. 05). The levels of IL-22 were increased gradually along with the aggravation of bone erosions. There were statistical significant difference among different X-ray stagings(H=9. 14,χ20.05(3)=7. 81,H> χ20.05(3),P<0. 05). Serum IL-22 levels in the RA patients with joint effusion were higher than that of without(t=2. 587,P=0. 012). The levels of IL-22 in SF were higher than that in serum(t=2. 668,P=0. 011),and had no correlation with the proportion of Th22 cells in SF. Conclusion: The expression of IL-22 in serum and joint effusion of RA patients increase. The level of IL-22 may be useful marker for assessment of disease activity and finding of bone erosions. Therapeutic targeting of IL-22 may be valuable for the intervention of RA.