AIM: To analyze the changes of retinal structure and function before and after panretinal photocoagulation(PRP)in patients with proliferative diabetic retinopathy(PDR).METHODS: Prospective study. Totally 98 cases(98 eyes)of PDR patients who underwent PRP in Eye Hospital of Wenzhou Medical University from January 2022 to May 2023 were included. Optical coherence tomography angiography(OCTA)was used to detect central retinal thickness(CRT), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), foveal avascular zone(FAZ), deep vascular complex(DVC)blood flow density, superficial vascular complex(SVC)blood flow density before and at 1 wk, 1 and 3 mo after PRP. During the follow-up, 1 eye underwent vitrectomy, 2 eyes were lost to follow-up, and finally 95 eyes completed 1 a follow-up, with a loss rate of 3%. According to the visual prognosis at 1 a after treatment, the patients were divided into two groups: 73 eyes in good prognosis group and 22 eyes in poor prognosis group(including 9 eyes of visual disability and 13 eyes of visual regression). The changes in retinal structure and function before and after PRP treatment were compared between the two groups of patients, and the receiver operating characteristic(ROC)curve and decision curve were used to analyze the predictive value of retinal structure and function for PDR treatment.RESULTS: There were statistical significant differences in PDR staging, CRT, CMT, SFCT, DVC blood flow density, and SVC blood flow density between the two groups of patients before treatment(all P<0.05). At 1 wk, 1 and 3 mo after treatment, the FAZ area of both groups decreased compared to before treatment, while the blood flow density of DVC and SVC increased compared to before treatment(both P<0.05). However, there was no significant difference in the blood flow density of FAZ, DVC, and SVC between the two groups at 1 wk, 1 and 3 mo after treatment(all P>0.05). The CRT, CMT and SFCT of the two groups at 1 wk after treatment were higher than those before treatment(all P<0.05), but there were no significant differences between the two groups(all P>0.05). The CRT, CMT and SFCT at 1 and 3 mo after treatment were lower than those at 1 wk after treatment and before treatment in both groups. The CRT, CMT and SFCT in the poor prognosis group at 3 mo after treatment were higher than those at 1 mo after treatment, and were higher than those in the good prognosis group(all P<0.05). ROC analysis showed that, at 3 mo after laser treatment in PDR patients, the area under the curve of the CRT, CMT, and SFCT alone or in combination after treatment for 1 a was 0.788, 0.781, 0.783, and 0.902, respectively, and the combined prediction value was better(P<0.05). Decision curve analysis showed that the combined detection of CRT, CMT, and SFCT in PDR patients at 3 mo after treatment can improve the predictive value of visual prognosis.CONCLUSION: The optimal time for retinal structure and function recovery in PDR patients after PRP treatment is between 1 wk and 1 mo. OCTA measurement of CRT, CMT, and SFCT at 3 mo after treatment can predict the visual prognosis during the 1 a treatment period.

Objective:To determine the clinical factors affecting Central lymph node metastases (CLNM) of single Papillary thyroid carcinoma (PTC). To predict the value of age for CLNM under different genders and the status of Hashimoto’s thyroiditis (HT) .Methods:The clinical data of 4 115 patients with PTMC (≤10.0 mm) and 664 patients with PTC (> 10.0 mm) in Hangzhou First People’s Hospital affiliated to Westlake University Medical School from Jan. 2010 to Aug. 2023 were retrospectively analyzed, and the independent risk factors of PTMC and PTC CLNM were identified by univariate and multivariate logistic regression analysis. According to different gender and HT status, the patients were divided into male group, female group, HT group and non-HT group. The optimal age threshold and diagnostic efficacy of CLNM in each subgroup were determined by Receiver operating characteristic area under the curve (AUC) .Results:The proportion of CLNM in 3451 PTMCs and 664 PTCs was 27.2% (937/3451) and 58.9% (391/664) ( χ2=256.565, P<0.050), respectively. Univariate and multivariate regression analysis showed that larger tumor ( OR 1.230), male ( OR 2.085), older age ( OR 0.960) and HT ( OR 0.697) were independent predictors of the occurrence of CLNM in PTMC. Only male ( OR 1.460) and older ( OR 0.963) PTC were independently associated with CLNM. Subgroup analysis showed that the age-predicted AUC of CLNM in male, HT and non-HT patients in PTC were higher than that of PTMC, which were 0.642-0.689 and 0.635-0.659, respectively. The age thresholds of female, HT and non-HT subgroups in PTC were lower than those in PTMC, which were 38.5 to 39.5 years old and 41.5 to 42.5 years old, respectively. Conclusions:Larger tumor, male, older patients and HT can independently predict the risk of CLNM in PTMC, while only male and older people can independently predict the risk of CLNM in PTC. There are certain differences in the age of CLNM occurrence between PTMC and PTC patients with different genders and HT combination status. It is of great significance to correctly understand these differences for providing personalized clinical treatment.

Objective:To explore the diagnostic efficacy of enhanced CT value in central lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT) .Methods:The 209 central lymph nodes of 209 patients with PTC confirmed by surgery and pathology were retrospectively analyzed, and they were divided into HT group and non-HT group, including 77 lymph nodes (52 negative and 25 positive) in the HT-PTC group and 132 lymph nodes (74 negative and 58 positive) in the non-HT group. The CT values of lymph nodes were measured on enhanced CT images, and the optimal thresholds and corresponding sensitivity and specificity of enhanced CT values in the two groups were analyzed by the receiver operating characteristic curve.Results:The enhanced CT values of metastatic lymph nodes in the two groups were (103.2±21.1) Hu and (101.9±25.4) Hu, respectively ( t=0.23, P>0.05), and the enhanced CT values of benign lymph nodes were (72.0±15.8) Hu and (68.5±10.9) Hu, respectively ( t=-1.38, P>0.05). The area under the curve of enhanced CT values in the HT group and non-HT group were 0.882 and 0.918, respectively, and the optimal thresholds were 78.8 Hu and 74.7 Hu, respectively, with corresponding sensitivity of 92.0% and 91.4%, and specificity of 67.3% and 77.0%, respectively, for the diagnosis of CLNM in the two groups. Conclusion:The enhanced CT value has high and similar diagnostic efficiency for CLNM in HT group and non-HT group, providing a theoretical basis for the early clinical development of individualized treatment plans.

Objective:To investigate the predictive value of dual-phase enhanced CT for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) .Methods:The CT data of 220 central lymph nodes in 182 cases of PTMC confirmed by surgery and pathology were retrospectively analyzed. The lymph nodes were divided into 0.3 cm-0.4 cm group, 0.4 cm-0.5 cm and ≥ 0.5 cm groups according to the size of them. The CT values of arterial phase and venous phase of lymph nodes were measured, respectively. The distribution of dual-phase CT values of lymph nodes in the three groups was analyzed by t test. The optimal threshold values of dual-phase enhanced CT values of lymph nodes in each group were obtained by receiver operating characteristic (ROC) . Results:The area under ROC curve of arterial phase CT in predicting CLNM was 0.717, 0.707 and 0.761, the optimal threshold was 71.4Hu, 63.3Hu and 72.9Hu, and the sensitivity and specificity were 50.0% and 92.3%, 63.6% and 81.0%, 52.4% and 82.9%, respectively. The area under the ROC curve of venous phase CT value in predicting CLNM was 0.744, 0.729, and 0.662, the optimal thresholds were 71.1 HU, 80.3 HU, and 61.3 HU, and the sensitivity and specificity were 52.8% and 87.2%, 54.2% and 86.7%, 82.6% and 46.7%, respectively. The sensitivity and specificity of dual-phase combined CT values in predicting CLNM in 3 groups were 44.1% and 94.7%, 50.0% and 88.1%, 52.4% and 85.4%, respectively.Conclusion:Dual-phase enhanced CT can effectively predict central lymph node metastasis of PTMC, and the combination of the two can further improve the specificity of predicting CLNM and provide an important basis for reducing unnecessary surgical trauma.

OBJECTIVE To study the quality grade stand ard of the premature Forsythia suspensa . METHODS A total of 138 batches of premature F. suspensa were collected from the main producing areas of F. suspensa in China. According to 2020 edition of Chinese Pharmacopoeia ，the contents of impurities ，moisture，ethanol-soluble extract ，volatile oil ，forsythin and forsythoside A in the premature F. suspense were determined ，and the qualified samples were screened. AHP-PCA mixed weighting method was used to give comprehensive weight to the indicators （except for the limit of impurity ）. The comprehensive score of the samples was calculated. The suggestions on the quality grade division of premature F. suspensa were put forward according to cluster analysis of K-mean value. RESULTS & CONCLUSIONS The contents of impurities ，moisture，ethanol-soluble extract ，volatile oil ，forsythin and forsythoside A in the premature F. suspense were 0-7.80％，1.60％-8.18％，13.13％-61.60％，0.21％-3.47％，0.02％-2.15％ and 0.79％-14.04％，respectively；average contents of them were 1.24％，4.97％，34.88％，2.01％，0.42％，6.86％，respectively. Totally 47 batches of 138 batches were qualified in all indexes. It is suggested that the quality grade of the premature F. suspense can be divided into three grades ：in first grade of F. suspense ，the contents of volatile oil ，forsythin，forsythoside A ， ethanol-soluble extract and moisture were ≥2.40％，≥0.59％，≥8.34％，≥38.66％ and ≤4.99％，respectively；in second grade of F. suspense ，the contents of above indicators were ≥2.26％，≥0.41％，≥7.47％，≥32.58％ and ≤5.33％，respectively；in third grade of F. suspense ，the contents of above indicators were ≥2.15％，≥0.32％，≥4.60％，≥31.52％ and≤7.23％，respectively.

Objective:To investigate ultrasonographic manifestations of gonococcal infections of the penile skin and accessory glands in men, and to assess their clinical significance.Methods:From January 2014 to January 2021, male patients with gonococcal infections of the penile skin and accessory glands were collected from Department of Dermatology, Changshu No.1 People′s Hospital. The diagnosis had been confirmed by laboratory examinations, and these patients had not received relevant treatment. The real-time ultrasound imaging system SIEMENS ACUSON X300 was used to examine the penile skin and accessory gland lesions infected with Neisseria gonorrhoeae, with the probe frequency ranging from 7.5 to 15 MHz. Patients with tubular anechoic fluid-filled areas on the high-frequency ultrasound images received a single dose of intramuscular ceftriaxone (1 g) ; those with oval-shaped anechoic fluid-filled areas on the high-frequency ultrasound images received incision and drainage followed by intramuscular injection of ceftriaxone at a dose of 1 g once a day for 5 consecutive days; those with hypoechoic or mixed echoic areas on the high-frequency ultrasound images received intramuscular injection of ceftriaxone at a dose of 1 g once a day for 5 consecutive days, and if the nodules did not regress after 1-month treatment, local resection would be performed. One month after the treatment, the patients were followed up, and the efficacy was evaluated. Results:A total of 32 male patients with gonococcal infections of the penile skin and accessory glands were collected. They were aged 28.54 ± 3.27 years, all had a history of non-marital sexual contact, and the duration from non-marital sexual contact to the onset of symptoms was 4.45 ± 1.03 days. The disease course was 8.64 ± 1.87 days. Lesions were all solitary, and located at the external urethral meatus in 16 cases (50.00%) , at the glans penis in 7 cases (21.88%) , beside the foreskin frenulum in 5 cases (15.62%) , and at the penile raphe in 4 cases (12.50%) . Sixteen patients (50.00%) presented with sinus-like lesions, 9 (28.13%) with abscesses, 7 (21.87%) with nodules, and all had tenderness on palpation. High-frequency ultrasound examination showed tubular anechoic fluid-filled areas in 16 cases (50.00%) , oval-shaped anechoic fluid-filled areas in 7 cases (21.88%) , hypoechoic areas in 5 cases (15.62%) , and mixed echoic areas in 4 cases (12.50%) . Gonococcal infections involved the cavernous body of the urethra in 16 cases (50.00%) , cavernous body of the penis in 5 cases (15.62%) , and subcutaneous tissue of the penis in 11 cases (34.38%) . After the treatment, all the patients were cured.Conclusion:High-frequency ultrasound can be used in the assessment of skin lesions and selection of treatment regimens for male patients with gonococcal infections of the penile skin and accessory glands.

Objective:To investigate the value of CT tumor-thyroid marginal contact range (MCR) for predicting capsular invasion and cervical lymph node metastasis in papillary thyroid carcinoma (PTC) with a diameter>1.0 cm and papillary thyroid microcarcinomas (PTMC) with a diameter ≤ 1.0 cm, and to evaluate the diagnostic efficacy of direct CT signs for lymph node metastasis.Methods:The CT data of 148 patients with PTC (>1.0 cm) and 193 patients with PTMC confirmed by surgery and pathology were retrospectively analyzed from January 2017 to April 2020 at Hangzhou First People′s Hospital. MCR was evaluated based on CT images and classified as<1/4 tumor circumference or ≥1/4 tumor circumference. Direct CT signs of cervical lymph nodes were observed, including cystic change, microcalcification, hyperenhancement, short/long diameter≥0.5, clustered lymph nodes or central area turbidity. The difference in the distribution of MCR between PTC (>1.0 cm) and PTMC was compared using the χ 2 test, and the efficiency of MCR and direct CT signs for diagnosing capsular invasion and lymph node metastasis was calculated using the pathological results as the gold standard. Results:In 148 PTC (>1.0 cm) and 193 PTMC patients, the pathological results showed capsular invasion in 88.5% (131/148) and 57.0% (110/193), and lymph node metastasis in 71.6% (106/148) and 44.0% (85/193), respectively. In PTC (>1.0 cm) patients, MCR≥1/4 tumor circumference was more common in patients with capsular invasion (χ2=22.211, P<0.001) and lymph node metastasis (χ2=4.746, P=0.029), and the corresponding sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 84.7% (111/131) and 64.7% (11/17), 83.0% (88/106) and 33.3% (14/42), respectively. In PTMC patients, MCR≥1/4 tumor circumference was more common in patients with capsular invasion (χ2=66.066, P<0.001) and lymph node metastasis (χ2=5.343, P=0.021), and its sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 87.3% (96/110) and 69.9% (58/83), 71.8% (61/85) and 44.4% (48/108), respectively. The sensitivity and specificity of direct CT signs for diagnosing lymph node metastasis in PTC (>1.0 cm) and PTMC were 89.6% and 73.8%, 69.4% and 76.9%, respectively. Conclusions:Both direct CT signs and MCR ≥ 1/4 tumor circumference can predict cervical lymph node metastasis in PTC patients, and the former had higher sensitivity and specificity. MCR≥1/4 tumor circumference has high efficiency for predicting capsular invasion in PTC patients.

Objective:To investigate the predictive value of lymph node size for ipsilateral central lymph node metastasis (ICLNM) of papillary thyroid microcarcinoma (PTMC) in CT examination.Methods:The CT data of 229 patients with single PTMC admitted to the Department of Oncology, Hangzhou First People’s Hospital, Affiliated to Zhejiang University School of Medicine from Jan. 2018 to Jun. 2019 were retrospectively analyzed. All cases were confirmed by surgery and pathology. The ipsilateral central lymph nodes were divided into <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group according to their maximun diameters, and the distribution difference of positive and negative ICLNM among the three groups were observed and analyzed by χ 2 test. Results:In 229 PTMCs, the proportion of positive and negative ICLNM were 29.69% (68/229) and 70.31% (108/155) , respectively. Positive ICLNM in <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group accounted for 11.43% (16/140) , 64.29% (36/56) and 81.82% (27/33) , respectively. When 0.2 cm and 0.4 cm were used as the threshold to determine positive ICLNM, the values of χ 2 and P between groups were 87.663 and <0.001. The sensitivity and specificity of diagnosing lymph node metastasis were 79.75% (63/79) and 82.67% (124/150) , 34.18% (27/79) and 96% (144/150) , respectively. The proportions of high enhancement, calcification and cystic degeneration were 3.2% (5/155) , 0.7% (1/155) and 0 (0/155) , respectively. Conclusions:In CT examination of patients with PTMC, the diameter of lymph nodes less than 0.2 cm highly indicates negative ICLNM. The proportion of positive ICLNM increased with increasing lymph node diameter, and the diameter of lymph nodes less than 0.4 cm highly indicates positive ICLNM.

Objective: This study amis to evaluate the effect of resilience group counseling based on Achieving Success Everyday(ASE) group counseling model on mental health promotion of junior high school students. Methods: An experimental design of 2 (experimental group/control group)×3(pre-test/post-test/follow-up test) was adopted to conduct resilience group counseling for junior high school students in a school in southern Xinjiang (8 weeks, once a week, each activity lasts for 60-90 min), followed by a detailed analysis of intervention effect. Results: After intervention, scores of resilience, goal focus, emotional control, family support, interpersonal assistance, core self-evaluation, coping styles and positive coping in intervention group increased significantly(t=8.93, 3.78, 6.62, 3.17, 6.13, 5.18, 4.01, 2.91, P<0.01). The scores of mental health and negative coping significantly decreased (t=-4.24, -3.01, P<0.01) and was lower than control group(t=-2.58, -3.11, P<0.05). The scores of resilience, goal focus, interpersonal assistance, core self-evaluation, coping styles and positive coping were significantly higher than those of the control group(t=3.88, 2.84, 3.18, 4.19, 3.68, 2.49, P<0.01). The results of the follow-up test showed that the scores of resilience and goal concentration, emotional control, positive cognition, family support, interpersonal assistance, core self-evaluation and positive coping were still significantly higher than those of the pretest(t=5.69, 3.50, 2.26, 2.80, 2.64, 4.13, 3.39, 2.13, P<0.05), and the scores of mental health were still significantly lower than the pretest(t=-4.62, P<0.01). Conclusion Mental resilience group counseling based on ASE model can effectively improve students’ mental health level, and at the same time, it shows positive effect on improving core self-evaluation and coping styles.

Objective:To investigate the value of CT enhancement degree in diagnosing cervical lymph node metastasis of papillary thyroid carcinoma (PTC) .Methods:CT data of 535 neck lymph nodes with pathological diagnosis in 251 cases were retrospectively analyzed. The ratio and difference between the density of CT enhancement and plain scan were calculated. Mann-Whitney test was used to analyze the distribution of ratio and difference in lymph node metastasis group and non-metastasis group. The optimal thresholds of ratio and difference in the two groups were obtained by receiver operating characteristic (ROC) curve analysis.Results:535 cervical lymph nodes including 271 in metastatic group and 264 in non-metastatic group. The ratios of two groups were 2.30 (2.04, 2.76) and 1.66 (1.51, 1.81) ( Z=-16.94, P<0.05) respectively, and the differences were 58 (49, 76) Hu and 31 (22, 36) Hu ( Z=-18.045, P<0.05) respectively. When the ROC area under curve of ratio and difference between the two groups were 0.923 and 0.951 respectively, the optimal thresholds were 1.93 and 39.5Hu respectively. The sensitivity and specificity of diagnosing lymph node metastasis were 84.9% and 87.1%、91.5% and 86.0%respectively.The sensitivity and specificity of combination of the two diagnosing lymph node metastasis were 82.3% and 91.7%. Conclusions:The ratio of enhancement and plain scan density ≥1.93 and the difference ≥39.5Hu have a high diagnostic efficiency for cervical lymph node metastasis of PTC. The specificity of the two is similar, but the latter has higher sensitivity. The combination of the two can significantly improve the specificity, thereby reducing unnecessary surgical trauma.