Objective To evaluate the diagnostic performance of elastography in the diagnosis of thyroid nodules in the context of Hashimoto's thyroiditis(HT). Methods The study evaluated 43 thyroid nodules by conventional ultrasound (CU) and elastography in 38 patients co-existed with HT who were referred for operation. The patients underwent CU and elastography before operation. The sensitivity,specificity,positive and negative predictive values,and accuracy for CU,elastography,and combination of these two techniques were assessed by using histopathological results as the gold standard. Results Among these 43 thyroid nodules,pathology confirmed 29 (67.4%) malignant nodules and 14 (32.6%) benign ones. There were statistically significant differences between malignant and benign groups in features such as solid shape (96.6% vs. 64.0%;OR:15.6,95%CI:1.600-151.262,P=0.004),irregularity (90.0% vs. 42.9%;OR:11.6,95%CI:2.341-57.032,P=0.001),taller than wide shape (72.0% vs. 21.4%;OR:9.6,95% CI:2.117-43.753,P=0.002),microcalcification (69% vs. 28.6%;OR:5.6,95% CI:1.368-22.556,P=0.012) and irregular blood flow (90.0% vs. 28.6%;OR:17.3,95%CI:3.186-94.290,P=0.000). The diagnostic performance of elastography and CU was as follows:sensitivity (86.2 % vs.96.6%),specificity (71.4% vs.42.9%),positive predictive value (86.2% vs.77.8%),negative predictive value (71.4% vs.85.7%),and accuracy (81.4% vs.79.0%). The combination of these two techniques had a sensitivity of 93.1%,a specificity of 71.4%,a positive predictive value of 87.1%,a negative predictive value of 83.3%,and an accuracy of 86.0%. Conclusions Elastography has a higher specificity in the diagnosis of thyroid nodules in HT,while its sensitivity is slightly lower than that of CU. Combination of these two techniques can increase the specificity and accuracy.

The highly pathogenic avian influenza (HPAI) H5N1 virus has caused several outbreaks in domestic poultry. Despite great efforts to control the spread of this virus, it continues to evolve and poses a substantial threat to public health because of a high mortality rate. In this study, we sequenced whole genomes of eight H5N1 avian influenza viruses isolated from domestic poultry in eastern China and compared them with those of typical influenza virus strains. Phylogenetic analyses showed that all eight genomes belonged to clade 2.3.2.1 and clade 7.2, the two main circulating clades in China. Viruses that clustered in clade 2.3.2.1 shared a high degree of homology with H5N1 isolates located in eastern Asian. Isolates that clustered in clade 7.2 were found to circulate throughout China, with an east-to-west density gradient. Pathogenicity studies in mice showed that these isolates replicate in the lungs, and clade 2.3.2.1 viruses exhibit a notably higher degree of virulence compared to clade 7.2 viruses. Our results contribute to the elucidation of the biological characterization and pathogenicity of HPAI H5N1 viruses.
Animals ; China ; Influenza A Virus, H5N1 Subtype ; genetics ; isolation & purification ; pathogenicity ; Influenza in Birds ; virology ; Mice, Inbred BALB C ; Phylogeny ; Poultry

OBJECTIVETo compare clinical results of treatment of Pipkin type I and II femoral head fractures through modified Smith-Peterson(S-P) approach and modified Hardinge approach.

METHODSFrom July 2005 to July 2014, 42 patients with Pipkin type I and II femoral head fractures were treated with operation. A total of 23 patients in anterior group was treated with modified S-P approach including 17 males and 6 females with an average age of (29.3±9.4) years old, 5 cases of type I by excision of the fragement, 3 cases of type I and 15 cases of type II cases by fixation of the fragement. While a total of 19 patients in the lateral group was treated with modified Hardinge approach including 15 males and 4 females with an average age of (31.4±10.0) years old, 3 cases of type I by excision of the fragement, 4 cases of type I and 12 cases of type II by fixation of the fragement. Operative time, blood loss during operation and fracture healing time were observed and compared. The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale. The effect of hip reduction time of less than 6 h, 6 to12 h, and more than 12 h, the effect of surgery time within 24 h and more than 24 h after injury were compared.

RESULTSAll patients were followed up from 24 to 60 months with an average of(30.29±6.95) months. The operation time (61.96±12.22) min, blood loss (46.09±18.03) ml, and (74.74±10.06) min, blood loss (72.11±19.88) ml in lateral group in the anterior group were better than those of lateral group(<0.05). In anterior group, fracture healing time was(12.22±1.70) weeks, the results were excellent in 8 cases, good in 10 cases, fair in 4 cases and poor in 1 case, the excellent and good rate was 78.3%, the incidence of avascular necrosis of femoral head was 8.69%(2/23), and the incidence of heterotopic ossification was 13.04%(3/23). While in lateral group, the fracture healing time was(12.42±1.95) weeks, the results were excellent in 6 cases, good in 7 cases, fair in 3 cases and poor in 3 cases, the excellent and good rate was 68.4%, the incidence of avascular necrosis of femoral head was 10.53%(2/19), and the incidence of heterotopic ossification was 5.26%(1/19). There was no significant difference in fracture healing time, postoperative effect and postoperative complications between the anterior group and lateral group(<0.05). The effect of patients with reduction time of hip dislocation less than 12 h was significantly better than that of more than 12 h, there was no significant difference in the effect between reduction time within 6 h and 6 to 12 h. There was no significant difference in the outcome between surgical patients within 24 h and more than 24 h after injury.

CONCLUSIONSDislocated hip of Pipkin type I and II femoral head fractures should be closed reduction within 6 h. If conditions are limited, the reduction time can be accepted within 12 h. Both of modified S-P approach and modified Hardinge approach are effective in treating Pipkin type I and II femoral head fractures, and can obtain excellent outcomes. Moreover, modified S-P approach has advantage of less trauma, less blood loss, shorter operative time.

Objective To explore the ultrasound features and levels of cervical lymph node metastases in primary and recurrent/persistent papillary thyroid cancer (PTC).Methods We retrospectively analyzed the clinical data of 2181 patients who underwent cervical lymph nodes dissection for PTC from January 12015 to January 12016.Totally 418 PTC patients (with 622 lymph nodes) who met the inclusion criteria entered the final analysis.Patients who had not received any prior thyroid treatment (surgery with or without radioactive iodine) were categorized as the primary group (352 patients with 527 metastatic lymph nodes),and patients who had received prior treatment (thyroidectomy with or without radioactive iodine) for PTC were categorized as recurrent/persistent group (66 patients with 95 metastatic lymph nodes).Pathological results from lymph node dissections were used as the gold standards by means of level-to-level analysis.Results The mean of the minimum axis diameter of the lymph nodes in the primary group was (6.7±3.6)mm,and that of the recurrent/persistent group was (6.6±3.1)mm (U=0.180,P=0.857).The proportion of metastasis in the central area of primary group was 40.0%,which was significantly higher than that in the recurrent/persistent group (12.6%);the proportion of metastasis in the lateral area was 60.6% in the primary group,which was significantly lower than that in the recurrent/persistent group (87.4%)(χ=26.288,P<0.001).In lateral metastatic lymph nodes,Ⅲ level was the most common place in both groups.Level Ⅴ metastatic lymph was rare in both primary group and recurrent/persistent group.Calcifications (63.1% vs. 48.2%;χ=7.207,P=0.007) and peripheral vascularity (81.1% vs. 59.4%;χ= 16.147, P<0.001) were more common in the recurrent/persistent group.The round shape,absence of an echogenic hilum,hyperechogenicity,and cystic aspects were not significantly different between these two groups (all P>0.05).Conclusions Primary metastatic lymph nodes often occur in the central area of lymph nodes,while lateral metastatic lymph nodes are more common in recurrent/persistent PTC.For metastatic lymph nodes,calcifications and peripheral vascularity are more common in recurrent/persistent PTC.

To further evaluate the safety of ginkgo diterpene lactone meglumine injection in the clinical use in ischemic stroke patients. Clinical safety study was conducted in 82 clinical units and 6 300 cases were completed and included from June 2013 to December 2014 by using multicenter, prospective, open and uncontrolled design methods for clinical research. A total of 29 cases of adverse reactions were observed in the experiment. Adverse reaction ratio (ADR) was 0.46%, and about 86.21% (25 cases) of them was mild with transient response which could be alleviated or disappeared without intervention; about 13.79% (4 cases) was moderate, including 2 cases of headache, 1 case of dizziness and 1 case of rash; no serious adverse reactions were found. The adverse reactions occurred in this study were pre-known adverse reactions or common adverse reactions of Chinese medicine injection. The overall incidence of adverse reactions was low, and the risk was controllable.

OBJECTIVETo compare the size of papillary thyroid carcinoma on ultrasonography(US)and the actual size measured during histological examination and to discuss the potential causes of such discrepancy.

METHODSA total of 148 patients with histologically confirmed papillary thyroid carcinoma underwent thyroid surgery in our center from December 2012 to May 2013. Patients were stratified based on the size,morphology,margin,cystic component,and presence of Hashimoto's disease to compare the discrepancy of the US and pathalogical measurements.

RESULTSThe mean sizes of the nodules measured by US and pathology were(1.58±0.94)cm and(1.33±0.84)cm,respectively(P=0.000). In 70.9%(105/148)of the nodules,the sizes measured by US were larger than those measured by pathology. In 17.6%(26/148)of the nodules,the sizes measured by US were smaller than those measured by pathology. In 1.1-1.4 cm size subgroup,the difference between mean ultrasound diameter and pathologic diameter was not significant [(1.21±0.11)cm vs.(1.11±0.32)cm,P=0.062]. In 0.1-1.0 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(0.75±0.19)cm and(0.62±0.23)cm,respectively(P=0.000). In ≥1.5 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(2.48±0.70)cm and(2.03±0.81)cm(P=0.000).

CONCLUSIONSThere is a significant discrepancy between US and pathologic size measurements for papillary thyroid carcinoma. However,for nodules sized 1.1-1.4 cm,the ultrasound and pathologic measurements are more likely to be consistent.

Carcinoma ; diagnostic imaging ; pathology ; Carcinoma, Papillary ; Hashimoto Disease ; Humans ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; Ultrasonography

OBJECTIVETo evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing thyroid nodules coexisting with Hashimoto's thyroiditis (HT).

METHODSTotally 62 thyroid nodules in 48 HT patients were retrospectively analyzed. The CEUS characteristics were reviewed, and diagnostic value of enhancement pattern and peak intensity were calculated.

RESULTSPeak intensity (P=0.002) and enhancement pattern (P<0.001) differed significantly between malignant and benign thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of heterogeneous enhancement were 97.6%, 85.7%, 93.0%, 94.7%, and 93.5%, respectively. Sensitivity, specificity, PPV, NPV and accuracy of low intensity at peak time were 85.4%, 52.4%, 77.8%, 64.7%, and 74.2%, respectively.

CONCLUSIONSHeterogeneous enhancement is effective in the diagnosis of malignant thyroid nodules coexisting with HT. CEUS can improve the diagnostic accuracy in distinguishing thyroid nodules with unknown malignancy under the conventional ultrasound.

Contrast Media ; Hashimoto Disease ; Humans ; Thyroid Nodule ; diagnostic imaging ; Ultrasonography

OBJECTIVETo compare the ultrasound imaging characteristics of benign and malignant thyroid nodules on the background of Hashimoto's thyroiditis (HT).

METHODSTotally 120 consecutive patients with pathologically confirmed benign (n=60) or malignant (n=60) thyroid nodules in Peking Union Medical College Hospital since January 2013 were retrospectively analyzed, and their preoperative ultrasound images were reviewed.

RESULTSSixty cases (100%) of the malignant nodules were papillary thyroid cancers. In the benign group, 33 cases (55.0%) had nodular changes of HT, 26 (43.3%) had nodular goiter, and one (16.7%) had adenoma. Compared with the benign ones,the malignant nodules were more likely to be solid (91.7% vs. 68.3%, P=0.001), hypoechoic (96.7% vs. 48.3%, P=0.000), ill defined (95.0% vs. 41.7%, P=0.000), irregular (96.7% vs. 43.4%, P=0.000), and more easily to have such characteristics as micro-calcification (71.7% vs. 30.0%, P=0.000), absence of regular halo (96.7% vs. 65.0%, P=0.000), taller-than-wide sign (46.7% vs. 13.3%, P=0.000), and locally increased or irregular blood flow (61.7% vs. 26.7%, P=0.000).

CONCLUSIONSUltrasound has an ideal overall sensitivity in differentiating nodules on the background of HT. Solid structure, hypo-echogenicity, ill-defined margin, irregular shape, and absence of regular halo are good screening ultrasound markers. Except for the A/T≥1, the other variables have less satisfactory diagnostic specificity.

Adult ; Hashimoto Disease ; diagnostic imaging ; Humans ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms ; diagnostic imaging ; Thyroid Nodule ; diagnostic imaging ; pathology ; Ultrasonography

OBJECTIVETo evaluate the usefulness of ultrasonography in distinguishing follicular carcinoma from adenoma.

METHODSThe ultrasound data of 37 patients with histopathologically confirmed follicular carcinomas who were treated in PUMC Hospital from January 2000 to November 2012 were retrospectively studied. In addition, 74 sex-and age-matched patients with histopathologically confirmed adenomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard.

RESULTSIrregular shape (32.4% of follicular carcinoma vs 5.4% of adenoma), absence of thin halo (67.6% vs 36.5%), indistinct margin (21.6% vs 1.4%), hypoechoic appearance (64.9% vs 39.2%), punctuate calcification(40.5% vs 13.5%), absence of cystic change (78.4% vs 54.1%), and being complicated with other thyroid disease (56.8% vs 28.4%) were more frequently associated with follicular carcinoma than with benign adenoma (P<0.05). No significant difference in the echotexture and internal flow was observed between the two groups (P>0.05).

CONCLUSIONAlthough follicular carcinoma and adenoma share many sonographic features, irregular shape, absence of thin halo, indistinct margin, hypoechoic appearance, punctuate calcification, absence of cystic change, and being complicated with other thyroid disease favor a follicular carcinoma diagnosis.

Adenocarcinoma, Follicular ; diagnostic imaging ; Adenoma ; diagnostic imaging ; Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Gland ; diagnostic imaging ; Thyroid Neoplasms ; diagnostic imaging ; Ultrasonography ; Young Adult