OBJECTIVE To investigate the ultrasound characteristics of category 4 thyroid nodules in the Chinese version of the Thyroid Imaging Reporting and Data System(C-TI-RADS),and to analyze the value of ultrasonography combined with elastography scoring in the correction of nodule properties.METHODS Data from 80 patients with 105 nodules from April 2020 to December 2023 were retrospectively analyzed.Fine-needle aspiration biopsy or surgical pathology was used as the gold standard.The Kappa test was employed to evaluate diagnostic consistency,while the receiver operating characteristic(ROC)curve was utilized to assess the differentiation and accuracy of the diagnostic methods.RESULTS Sixty-eight malignant nodules and 37 benign nodules were confirmed by surgical pathology or puncture biopsy.After enhancement by ultrasonography,the percentage of malignant nodules with low intensity,centripetal enhancement,inhomogeneous enhancement,blurred boundary of enhanced nodules,enlarged enhanced nodules,and irregular enhanced nodules was significantly higher than that of the benign group,while the percentage of circumferential enhancement was lower than that of the benign group(P<0.05).The overall compliance rate of ultrasonography scoring in diagnosing C-TI-RADS category 4 thyroid nodules was 83.81%(88/105),and when compared with the pathological gold standard,the Kappa value was 0.644.The ROC curve analysis showed that the sensitivity of ultrasonography scoring in diagnosing benign and malignant nodules was 84.51%,the specificity was 82.35%,the correctness index was 0.669,the negative likelihood ratio was 0.188,and the positive likelihood ratio was 4.789.The overall compliance rate of elastography score in diagnosing C-TI-RADS category 4 thyroid nodules was 85.71%(90/105),and when compared with the pathological gold standard,the Kappa value was 0.689.The ROC curve analysis revealed that the sensitivity of elastography score in diagnosing benign and malignant nodules was 88.24%,the specificity was 81.08%,the correctness index was 0.693,the negative likelihood ratio was 0.145,and the positive likelihood ratio was 4.664.Ultrasonography enhancement features,along with the combination of ultrasonography score and elastography score,had an AUC=0.922(0.876-0.968),with an accuracy of 92.91%,demonstrating a strong ability to identify truly malignant nodules versus benign nodules.CONCLUSION Ultrasonography combined with elastography scoring is valuable in the correction of C-TI-RADS category 4 nodules in the thyroid gland and helps to improve diagnostic accuracy.

Objective To investigate the risk factors for postoperative pulmonary embolism in patients with spontaneous cerebral hemorrhage,and construct and verify the nomogram model.Methods A retrospective cohort study was conducted on 558 patients admitted in the First Affiliated Hospital of Chongqing Medical University and the Three Gorges Hospital Affiliated to Chongqing University.And 393 of them who hospitalized from January 2015 to January 2021 were assigned into a modeling group,and the other 165 patients from February 2021 to January 2023 into a validation group.Univariate and multivariate stepwise logistic regression analyses were used to screen out the risk factors associated with pulmonary embolism after spontaneous cerebral hemorrhage surgery.Then a nomogram model was build based on these factors and verified.Results Based on age,blood loss,Glasgow coma scale(GCS)score,surgical treatments,levels of fibrin degradation products,D-dimer and hemoglobin,plasma osmolality,and deep vein thrombosis,a risk model of pulmonary embolism was built.Receiver operating characteristic(ROC)curve analysis showed the model had good discriminability for the presence of pulmonary embolism,and the area under the curve(AUC)value was 0.908.Hosmer-Lemeshow goodness-fit test indicated that the model had a good fit to the verification set(Chi-square=14.805,df=8,P=0.063),the correction curve was close to the ideal curve,and the prediction probability of the model was close to the actual occurrence probability,suggesting the model having good accuracy.Decision curve analysis revealed that the established nomogram model can get benefits under a large range of threshold probabilities.Conclusion We develop a prediction model for postoperative pulmonary embolism in patients with spontaneous cerebral hemorrhage after surgical treatment,which shows good prediction performance in both the training and validation groups,and can be used for accurate,prompt and quick identification for the occurrence of pulmonary embolism in clinical practice.

Objective To study the expression of HPV、p16 and Her-2 in the squamous cell cervical carcinoma and its chnical significance. Methods Expression of HPV16/18、p16, and C-erbB-2 and the amplification of Her-2 gene were examined using situ hybridization technique,SP immunohistochemistry,and FISH imaging analysis system in 60 cases of cervical cancer, 61 cases of CIN, and 21 cases of normal cervical tissue,respectively.Results The positive rates of HPV16/18 and p16 in the normal tissue,CIN Ⅰ -Ⅱ,CINⅢ and the squamous cell cervical carcinoma were gradually increased, they wereo (0/21),9.68 ％ (3/31),46.67 ％ (14/30),71.67 ％ (43/60);0 (0/21),19.35 ％ (6/31),93.33 ％ (28/30),96.67 ％ (58/60),respectively,and there were significant differences among the groups (P＜0.05),but no significant difference was found between the normal tissue and the CIN Ⅰ - Ⅱ. The positive rates of Her-2 and Her-2 in the CIN Ⅲ and the carcinoma were 13.33 ％ (4/30),31.67 ％ (19/60),3.33 ％ (1/30),21.67 ％ (13/60),respectively,but in the normal group and the CIN Ⅰ - Ⅱ wereo,and the differences between the carcinoma group and the CIN group,the carcinoma group and the normal group were significant(P＜0.05).The expression of Her-2 and the amplification of Her-2 were closely related to the stage, degree of differentiation and metastasis of lymph node in the squamous cell cervical carcinoma (P＜0.05). Conclusion The infection of HPV is one of thetriggers for the squamous cell cervical carcinoma.The expression of p16 and the amplification of Her-2 may be closely correlated with tumor development and high expression of p16 and Her-2 indicates poor prognosis.

Objective To investigate the expression of EGFR, Her-2 and TOPO Ⅱ in esophageal canceration course, analyze the correlation between the expression and clinical pathological parameters and the correlation of the three genes. Methods EGFR, Her-2 and TOPO Ⅱ were detected by Tissue microarray technology and Envision immunohistochemistry method in 107 cases of esophageal carcinoma, including normal esophageal epithelium, esophageal intraepithelial neoplasia and esophageal squamous cell carcinoma. Results The positive expression rates of EGFR and TOPO Ⅱ display an improving trend from normal esophageal epithelium, intraepithelial neoplasia to carcinoma (P =0.031) in the above four groups. The positive expression rates of EGFR were 8.41 %, 7.94 %, 27.27 %, 50.47 %, and TOPO Ⅱ were 3.74 %, 4.76 %, 20.45 %, 43.93 %. Furthermore, the expression showed gradually incresing with histological grades advance (P =0.009). There was no correlation between EGFR or TOPO Ⅱ and gender, age, lymph node or distant metastasis (P >0.05). There was a positive correlation between EGFR and TOPO Ⅱ (r 1=0.410, P <0.05). There were no significance of Her-2 protein expression among the three groups(P >0.05), no correlation was obtained between Her-2 and gender, age, the depth of invasion or lymph node metastasis (P >0.05), no relationship between Her-2 and EGFR or TOPO Ⅱ either. Conclusion EGFR and TOPO Ⅱ are closely related to the occurrence and development of esophageal squamous cell carcinoma, their expressions all make a qualitative change in the esophageal high-grade intraepithelial neoplasia. The role of Her-2 in the development of esophageal squamous cell carcinoma is still not definite in Shanxi province.

Objective To investigate the role of cell cycle regulatory protein CDK4,p18,p19 in the genesis and development of esophageal squamous cell carcinoma (SCC).Methods Tissue microarray and immunohistochemical method (Envision) were used to detect the protein expression of CDK4,p18,p19 in 120 cases of esophageal tissues.The results were statistically analyzed.Results The positive rate of CDK4 protein expression in normal esophageal epithelium was low [28.3 % (34/120)],it increased in esophageal intraepithelial neoplasia [32.5 % (39/120)],and it was high in esophageal SCC [84.2 % (101/120)],which increased with the degree of SCC differentiation decreasing gradually.There was significant differences between the SCC and normal esophageal epithelium or esophageal intraepithelial neoplasia (x2= 76.004,P ＜0.05; x 2= 65.897,P ＜ 0.05).The expression of CDK4 in group with lymphatic metastasis [93.88 % (46/49)]was higher than without it [71.43 % (55/71)] (x2= 5.860,P ＜ 0.05).The positive rates of p18,p19 protein expression in normal esophageal epithelium were high [34.2 % (41/120),29.2 % (35/120)],it decreased in esophageal intraepithelial neoplasia [19.2 % (23/120),15.0 % (1 8/120)] (x 2= 134.481,P ＜ 0.05; x 2 = 141.376,P ＜ 0.05),but it were high in esophageal SCC [63.3 % (76/120) and 61.7 % (74/120)] which decreased with the degree of SCC differentiation gradually increased.There were significant differences between the normal esophageal epithelium and esophageal intraepithelial neoplasia,esophegeal intraepithelial neoplasia and SCC,normal esophageal epithelium and SCC (p 18:x 2 = 6.903,48.296,20.429,P ＜ 0.05; p1 9:x2 = 6.998,55.276,25.565,P＜ 0.05).CDK4 protein expression was correlated with both p18 and p19 (r =0.696,0.630,P ＜0.05),and there was significant positive correlation between the protein expression of p18 and p19 (r =0.833,P ＜0.05).Conclusion Cell cycle regulatory gene CDK4,p18,p19 get involved in the genesis and development of esophageal squamous cell carcinoma.Their protein expressions are closely related to canceration of esophageal epithelium.

Objective To investigate the expressions of p16, cyclinD1 protein in esophageal squamous cell carcinoma and its clinic significance. Methods The expressions of p16 and cyclinD1 protein in 55 esophageal carcinoma cases were detected by immunohistochemical technique. Results The positive expression of p16 protein in 55 patients was 49.1%(27/55). The loss of p16 protein was significantly related to lymph node metastasis (P ＜0.05), and the positive expression of p16 had the higher five-year survival rate.Conversely, the positive expression of cyclinD1 in 55 patients was 74.5 % (41/55), and had the lower five-year survival rate compared to the negative expression cases. Conclusion Loss of p16 protein in human ESCC is a frequent event and correlates significantly with the lymph node metastasis. The loss of p16 and the over expression of cyclinD 1 in esophageal carcinoma may serve as a risk prognosis factors.

Objective To investigate the relationship and clinicopathologic significance between the expression of CD95,CD44V6 and metastasis of axillary lymph node in breast cancer.Methods Immunohistochemistry was used to detect the expression of CD95 and CD44V6 in 101 cases of breast cancer, in which, 40 cases without metastasis in axillary lymph node were detected MCK expression by IHC. The results were analyzed statistically. Results 9 cases of breast cancer with lymph node micrometastasis were observed by IHC in 40 cases without metastasis in axillary lymph node by microscope. The expression of CD95, CD44V6 in lymph node metastasis group was similar as in lymph node micrometastasis group. There was significant difference of CD95 expression between those with lymph node metastasis and those without. The positive rate of CD95 and the high expression of CD44V6 in the cases that the tumor size was over 2 cm were significandy higher than in the cases that the tumor size was less than 2 cm (P<0.05). Conclusion Detection of the expression of CD95, CD44V6 in breast cancer may be helpful to predict the lymph node micrometastasis and provide more dependable evidence for judging prognosis and selecting treatment prescription clinically.

Objective To explore expression and clinical value of VEGF-C and p63 in early esophageal carcinoma and intraepithelial neoplasia. Methods 146 cases were randomized into normal esophageal mucosa, low level intraepithelial tumor, high level intraepithelial tumor and early esophageal carcinoma. The expression of VEGF-C and p63 were detected by using the immunohistochemistry dyeing.Results The expression of VEGF-C immunohistochemistry dyeing had statistical differences among different levels(X~2= 47.455, P <0.001). Normal esophageal mucosa v.s. high level intraepithelial tumor (X~2=36.721, P <0.001), Normal esophageal mucosa v.s. early esophageal carcinoma (X~2=26.483, P <0.001), low level intraepithelial tumor v.s. high level intraepithelial tumor(X~2= 10.025, P<0.0083), low level intraepithelial tumor v.s. early esophageal carcinoma(X~2=16.734, P<0.001). There was a significant correlation between pathological classification and the expression amount of VEGF-C (r = 0.462, P <0.001). The expression of p63 had statistical differences among different levels(X~2=28.962, P <0.05). There was a significant difference on normal esophageal mucosa comparing with low level, high level intraepithelial tumor or early esophageal carcinoma (X~2=12.735, P =0.005, X~2=20.421, P<0.001, X~2=20.854, P<0.001). There was a significant correlation between pathological classification and the expression of p63 (r= 0.272, P<0.05). Conclusion There is a significant correlation in the express of either VEGF-C or p63 comparing with either intraepithelial tumor or early esophageal carcinoma. It may be an early warning indicator.