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 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 clinical characteristics and pathogenic mutations of propionic acidemia.Methods:Clinical data of two patients with propionic acidemia admitted to the Obstetrics and Gynecology Hospital of Nanjing Medical University from May 2017 to June 2018 were collected. Genomic DNA was extracted from the peripheral blood of the patients and their parents. Inherited disease panel based on Ion Torrent semiconductor sequencing technology was performed to detect gene mutations, and those with suspected pathogenic mutations were verified by Sanger sequencing. Descriptive statistical analysis was used for data analysis.Results:Case 1 was suspected of sepsis and admitted to the Obstetrics and Gynecology Hospital of Nanjing Medical University due to "drowsiness and milk rejection" on the second day after birth. Tandem mass spectrometry suggested the level of propionyl carnitine and its ratios to acetylcarnitine and free carnitine were increased. Urine gas chromatography-mass spectrometry showed elevated 3-hydroxypropionic acid and methylcitric acid. Genetic analysis revealed that the infant carried c.331C>T (p.R111X)/c.1228C>T (p.R410W) compound heterozygous mutations in the PCCB gene. The infant was diagnosed with propionic acidemia and treated with a special diet with an L-Carnitine supplement but died of sudden coma and vomiting without precipitating factors at three months of age. Case 2 presented with sudden vomiting, drowsiness, and anergia on the admission at five-months old. Tandem mass spectrometry showed increased propionyl carnitine level and its ratios. Compound heterozygous mutations of c.146delG (p.G49EfsX16)/c.1253C>T (p.A418V) in the PCCB gene were identified in the patient, of which c.146delG (p.G49EfsX16) was a de novo mutation and was evaluated as a pathogenic mutation. The patient was on a special diet with an L-Carnitine supplement, but with disobedience. Followed up to the age of three years and eight months, the child was severely underdeveloped. Conclusions:Neonates with clinically suspected sepsis may have propionic acidemia, and tandem mass spectrometry and genetic testing should be performed as soon as possible to confirm or rule out the diagnosis. Further investigations on the pathogenesis and function of the new mutation are still needed.

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: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.

Objective:To investiqate the clinical and CT features of anaplastic thyroid carcinoma.Methods:The clinical and CT data of 23 anaplastic thyroid carcinoma patients were retrospectively analyzed, mainly including gender, age, chief complaint, and CT signs such as tumor size, distribution status, morphology, calcification, necrosis, peripheral invasion, lymph node metastasis and lung metastasis.Results:Among 23 cases of ATC, the ratio of male to female was 7∶16. 21 cases (91.3%) had hoarseness or cervical mass, 8 cases (34.8%) had rapid enlargement of tumor size, 6 cases (26.1%) with lesion in unilateral lobe, 8 cases (34.8%) in unilateral lobe + isthmus, 9 cases (39.1%) in bilateral lobe + isthmus, diameter of tumors was (6.1 ± 1.7) cm, 20 cases (87.0%) had irregular shape of tumors. 16 cases (69.6%) with rough calcification, 17 cases (73.9%) with extensive necrosis, 15 cases (65.2%) with tracheoesophageal groove extension, 18 cases (78.3%) with cervical lymph node metastasis, 8 cases (34.8%) with lung metastasis, 16 cases (69.6%) with trachea invasion, 7 cases (30.4%) with common carotid artery invasion, and 10 cases (43.5%) with internal jugular vein invasion.Conclusions:The clinical features include elderly women patients, big tumors size, rapid enlargement of tumor size, CT signs include irregular shape, coarse calcification, extensive necrosis, tracheoesophageal groove extension, cervical lymph node metastasis, lung metastasis and invasion of trachea, common carotid artery and internal jugular vein. These features have great value in the diagnosis of ATC and evaluation of peripheral structure invasion, cervical lymph node metastasis and distant metastasis.

Clinical final examination is an important link in the standardized training of residents in dermatology and quantification of evaluation indicators is one of the important parameters. In this study, the scores of clinical examinations of six candidates who participated in standardized training of residents in dermatology of Sun Yat-Sen University in June 2019 were taken as examples to explore the quantitative indicators of standardized and multi-station clinical final examinations. The indicators contained four stations and five links: skin pathological reading, skin biopsy, medical history collection and physical examination, medical record writing, and comprehensive questioning, which covered the main contents of the standardized training outline of residents in dermatology. Each evaluation indicator was refined and quantified. Finally, heuristic ideas were put forward, including a wider range of standardized and multi-station clinical examinations, introduction of new examination places, and utilization of information technology.

Taking the course's characteristics and advantages into account, this study explores the systematic implementation of standardized teaching rounds in the clinical probation sessions of the Dermatology and Venereology course , and evaluates its effect by analyzing the cases of 125 medical students from grade 2015 of Sun Yat-sen University . The results showed that the implementation of standardized teaching rounds has positive effect on the course.