Objective To explore the application value of ultrasound microvascular imaging combined with shear wave elastography in differentiating thyroid ultrasound image reporting and data system(TI-RADS)4 benign and malignant thyroid nodules.Methods Totally 114 thyroid nodules diagnosed as ACR TI-RADS 4 in Hangzhou traditional Chinese medicine hospital from November 2021 to December 2022 were retrospectively selected.All nodules were examined by ultrasound microvascular imaging and shear wave elastography,and compared with the surgical pathological results to evaluate the diagnostic efficacy of microvascular imaging,shear wave elastography and the combination of the two.Results Among 114 cases of thyroid TI-RADS type 4 nodules,35 cases were benign nodules,79 cases were malignant nodules.The microvascular pattern of malignant nodules was mainly concentrated and interrupted sign and perforator sign.The Emax value of shear wave elastography was statistically significant in differentiating benign from malignant nodules,and the SWE Emax value of malignant nodules was greater than 41.6kPa(P<0.05).The sensitivity,specificity and accuracy of ultrasound microvascular imaging combined with shear wave elastography in the diagnosis of thyroid TI-RADS 4 nodules were 96.20%,65.72%and 86.84%,respectively,and the area under curve(AUC)was 0.810.The sensitivity and accuracy were higher than those of single diagnosis mode,and the difference was statistically significant(P<0.05).Conclusion Ultrasound microvascular imaging combined with shear wave elastography can improve the diagnostic efficiency of benign and malignant thyroid TI-RADS 4 nodules with high diagnostic sensitivity and accuracy,which is helpful for the noninvasive differential diagnosis of such nodules and avoids some unnecessary needle biopsy.

Objective:To analyze the types of genetic variants and clinical characteristics of three Chinese pedigrees affected with Hereditary coagulation factor Ⅶ (FⅦ) deficiency.Methods:Three pedigrees who had visited the First Affiliated Hospital of Wenzhou Medical University between December 2021 and October 2022 were selected as the study subjects. Prothrombin time (PT), activated partial thromboplastin time (APTT) and FⅦ activity (FⅦ: C) were measured in the three probands and their pedigree members. All exons and their flanking sequences were analyzed by direct sequencing, and candidate variants were verified by reverse sequencing. The corresponding variant loci in the family members were also analyzed. ClustalX-2.1-win was used to analyze the conservation of the variant loci. Varcards and Spcards online software was used to predict the pathogenicity of the variants. Pymol software was used to analyze the changes in protein structure and molecular forces.Results:Three cases of hereditary FⅦ deficiency were found to have decreased FⅦ: C, prolonged PT and normal APTT. Genetic analysis identified a total of four genetic variants, and all three probands had harbored compound heterozygous variants of the F7 gene, including p. Cys389Gly and p. His408Gln in proband 1, p. Cys389Gly and IVS6+ 1G>T in proband 2, and IVS6+ 1G>T and IVS1a+ 5G>A in proband 3. Conservation analysis showed that both the p. Cys389 and p. His408 loci are highly conserved among orthologous species. Analysis with Varcards and Spcards software showed that these variants were pathogenic. Protein modeling analysis showed that the p. Cys389Gly and p. His408Gln variants may result in altered protein structures and changes in hydrogen bonds. Conclusion:The clinical manifestations of the three FⅦ-deficient probands may be attributed to the compound heterozygous variants of p. Cys389Gly/p.His408Gln, p. Cys389Gly/ⅠⅤS6+ 1G>T and ⅠⅤS6+ 1G>T/ⅠⅤS1a+ 5G>A of the F7 gene. The combination of the three compound heterozygous variants was unreported previously.

Objective: To prospectively evaluate the outcomes of ultrasound (US)-guided radiofrequency ablation (RFA) in tertiary hyperparathyroidism (THPT). Materials and Methods: Patients with THPT underwent RFA between September 2017 and January 2022. Laboratory parameters, including serum intact parathyroid hormone (iPTH) levels, were monitored for 48 months after RFA and compared with the levels at baseline. Complications related to RFA and changes in hyperparathyroidism-related clinical symptoms were recorded before and after RFA. Results: A total of 42 patients with THPT were recruited for this study. Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. All complications resolved within 6 months of ablation without medical intervention, except in 10.5% (4/38) patients with permanent hypocalcemia. The overall symptom recovery rate was 58.8% (10/17). The severity scores for bone pain, arthralgia, and itchy skin associated with hyperparathyroidism improved after treatment (P < 0.05). Conclusion US-guided RFA is an effective and safe alternative to surgery in the treatment of patients with TPTH and improves hyperparathyroidism-related clinical symptoms.Keywords: Ultrasound; Radiofrequency ablation; Te

Objective:To explore the risk factors of subsyndromal delirium (SSD) after cardiac surgery in adults and construct a risk model.Methods:The convenience sampling method was used to select 620 adult patients undergoing cardiac surgery admitted to the Surgical Intensive Care Unit (SICU) of Zhejiang Provincial People's Hospital from January 1, 2017 to December 31, 2018 as the research object. Patients with postoperative SSD were included in the SSD group, and patients without postoperative SSD were included in the non-SSD group. The preoperative, intraoperative and postoperative clinical data and various indicators of all patients were recorded in detail. Through univariate analysis and binary Logistic regression analysis, the risk factors of SSD after cardiac surgery in adults were explored, and the risk model function was constructed.Results:A total of 569 cases were included in the study. Among them, 399 cases of postoperative subdelirium did not occur (non-SSD group) , 170 cases of postoperative subdelirium occurred (SSD group) , and the incidence of SSD was 29.9%. Univariate analysis found that the influencing factors of adult SSD after cardiac surgery were age, emergency surgery, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, aortic occlusion time, deep hypothermia circulatory arrest time, intraoperative plasma transfusion, SICU stay time and the use of dexmedetomidine, and the differences between the two groups were statistically significant ( P<0.05) . The binary Logistic regression analysis found that age>76 years [odds ratio ( OR) =4.332, 95% confidence interval ( CI) : (2.103, 8.965) , P<0.001], emergency surgery [ OR=3.453, 95%CI: (1.143, 7.534) , P<0.05], APACHEⅡ score> 15 [ OR=5.453, 95% CI: (1.453, 9.536) , P<0.001], deep hypothermia circulatory arrest time > 34.2 min [ OR=2.132, 95% CI: (1.053, 5.532) , P<0.05] and SICU stay time > 50.0 h [ OR=1.675, 95% CI: (0.832, 5.233) , P<0.05] were independent risks of SSD after cardiac surgery in adults, and the use of dexmedetomidine [ OR=1.536, 95% CI: (0.763, 4.862) , P<0.05] was a protective factor. Conclusions:Age > 76 years, emergency surgery, APACHE Ⅱ score > 15, deep hypothermia circulatory arrest time > 34.2 min, and SICU stay time >50.0 h are independent risk factors for SSD after cardiac surgery in adults, and the use of dexmedetomidine can reduce the occurrence of SSD.

Objective: To analyze the risk factors for large renal hematoma caused by percutaneous renal biopsy (PRB) in order to provide evidence for early clinical prevention and Effective nursing. Methods: The data of 707 patients who underwent PRB in nephrology department in Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to January 2017 were retrospectively identified. Demographic and clinical data were collected, including general status (gender, age, body mass index, histological diagnosis, associated diseases), laboratory indexes and related examination during PRB (serum creatinine, estimated glomerular filtration rate, creatinineclearance rate, serumuricacid, serumalbumin, hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, kidney size), blood pressure(history of hypertension, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure before PRB). Univariable logistic regression analysis, linear diagnosis, factor analysis, multivariable logistic regression analysis and receiver operating characteristic curve (ROC curve) were used to assess risk factors. Results: Over the period, 707 native kidney biopsies were performed. Hematoma occurred in 609 biopsies (86.1%), including 558 minorhematomacases (78.9%), 51 largehematoma cases (7.2%), no severe complications were observed. Univariable logistic regression analysis of risk factors in 51 patients with large hematoma after PRB found that there were significant differences in renal tubulointerstitial fibrosis, crescents > 25%, serum creatinine, history of hypertension, systolic blood pressure, diastolic blood pressure and mean arterial pressure before PRB (P< 0.05). Compared with the non-hematoma/minor-hematoma group, the blood pressure before PRB increased significantly in large hematoma group (OR=1.414, 95%CI=1.007-1.985, P=0.045) . More patients with a history of hypertension in large hematoma group (OR=1.997, 95% CI=0.995-4.009, P=0.052) .The area under the ROC curve for predicting large hematoma after PRB was 0.634 for blood pressure before PRB and history of hypertension, the Youden index was 0.27. The blood pressure before PRB and hypertension history were used to predict the formation of large hematoma separately, and the Youden index was 0.28 vs. 0.22 (P> 0. 05). Conclusions History of hypertension and blood pressure before PRB were independent risk factors for large renal hematoma after PRB.Patients with history of hypertension were more likely to develop large hematoma than those with no history of hypertension, and those with higher blood pressure before PRB were more likely to develop large hematoma. The history of hypertension and the blood pressure before PRB have certain effect in predicting the formation of large hematoma after PRB. Each of them have a certain predictive effect on the formation of largehematoma after PRB, and the prediction effect trend of blood pressure before PRB is slightly better than that of history of hypertension.

In March 2017, a severely burned male patient aged 36 years with hypovolemic shock was admitted to our hospital. The patient received large quantities of antibiotics and blood products and repeated skin graft after admission, and then he suffered wound errhysis and throat congestion. The patient was healthy before without family history of bleeding or thrombosis disease. Laboratory tests showed that prothrombin time and activated partial coagulation time were remarkably prolonged, blood coagulation factor Ⅴ activity was extremely low, and the result of qualitative test of coagulation factor inhibitor was positive. Acquired blood coagulation factor Ⅴ deficiency was diagnosed. After application of dexamethasone (5 mg, twice per day) and infusion of fresh frozen plasma, blood coagulation indicators of patients recovered in 4 days, the result of qualitative test of coagulation factor inhibitor was negative, and bleeding symptoms were improved.

Objective To explore the guiding role of double volume reconstruction (DVRT) in interventional embolization of intracranial aneurysms. Methods Ninety?six cases of subarachnoid hemorrhage with 115 aneurysms underwent total cerebrovascular angiography and interventional endovascular embolization of intracranial aneurysms in our hospital from January 2017 to December 2017 were retrospectively analyzed. They were randomly divided into observation group (n=48) and control group (n=48) according to random number method. In the control group, guided by the results of 2D?DSA and 3D?DSA 3D reconstruction, the aneurysm neck and tumor were fully exposed with the optimal position. the responsible aneurysms were performed with the interventional endovascular embolization. The operators finished the embolization According to the size and shape of aneurysms and the operative experience. In the observation group, the operators could speculate the embolization density of aneurysms by using the data of 3D reconstruction and digital subtraction reconstruction and adjusted the surgical plan to make the aneurysms had been completely embolized. The baseline data, treatment status, adverse cerebrovascular reaction and recurrence rate of aneurysms were compared between the two groups. All patients in the two groups were operated by Deputy chief surgeons or above of the neurosurgery department. The comparison of the counting data were tested by χ2. The measured data conformed to normal distribution were tested by independent sample t. Results Statistically, There was no significant differences in baseline data including sex, age, blood glucose, blood pressure and cerebral atherosclerosis between the two groups (P>0.05). Comparing the responsible aneurysms in different positions and sizes, the differences was not statistically significant (P>0.05).There was no statistically significant differences in the dosage of contrast media and the cost of operation between the two groups (P>0.05). The radiation dose and operation time in the observation group were smaller and shorter than those in the control group, but there was no statistical differences between the two groups (P<0.05). Statistically, The incidence of rerupture of aneurysm and thrombosis in the observation group was significantly lower than that in the control group (P<0.05). and The incidence of cerebral infarction and the recurrence rate of aneurysm in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in sex, age, blood glucose, blood pressure and cerebral atherosclerosis between the two groups (P>0.05).There was no significant difference in the location and size of responsible arterial tumors (χ2=0.148, P=0.929).There was no significant difference in the dosage of contrast agent and the cost of operation between the two groups (t=-0.769, 0.225; P>0.05). The radiation dose and operation time were (479.81 ± 51.21)mGy, (103.52 ± 10.18) minin the observation group and (511.95 ± 53.26)mGy, (114.60 ± 9.51)min in the control group. The difference was statistically significant (t=-1.376,-2.516; P<0.05).There were 1 case of rerupture of aneurysm in the observation group, 4 cases in the control group;There were 0 cases of thrombus, respectively, 3 cases in the control group. The difference was statistically significant (χ2=11.748, 4.256; P<0.05).There were 0 cases postoperative cerebral infarction occurred in the observation group, and aneurysm recurrence in 1 case. Four cases postoperative cerebral infarction occurred in the control group, and aneurysm recurrence in 3 cases, respectively. The difference was statistically significant (χ2=5.719, 10.811; P<0.05). Conclusions The clinical effect of interventional embolization of intracranial aneurysms under the guidance of double volume reconstruction is remarkable, and the effect of interventional embolization and the relationship with the peripheral vessels can be clearly demonstrated. It can reduce the incidence of adverse cerebral vascular reactions and the recurrence rate of aneurysms and reduce the intraoperative risk. It is worthy to be popularized in interventional embolization of intracranial aneurysms and follow?up after operation.

Objective Toexplorethevalueofdualvolumereconstructionininterventionalembolizationofwideneckedintracranial aneurysms.Methods Theclinicalandimagingdataof30patientswithintracranialwideneckaneurysmrupturedwerecollectedfrom June2016toDecember2017intheMeizhouPeople’sHospital.Thetreatmentoftheintracranialwideneckedaneurysm,theposition andopeningofthestentreleasing,therelatedcomplications,andfollow-upreviewafter6monthswereretrospectivelyanalyzed.Results Ofthe30patients,therewere35aneurysms(4 multipleaneurysms),inwhich26caseswerestentsassisted,with26stentsimplanted, and4caseswereballoonassisted.3D-DSAwasperformedimmediatelyafteroperationandevaluatedbydualvolumereconstructionon AdvantageWorkstation (AW)postprocessing workstation.(1)26casesofdenseembolism ofaneurysmswithouttumorneckor tumorresidual(86.7%),3casesofaneurysmcervicalresidual(10%)and1casesoftumorresidual(0.33%);(2)26stentswithaccurate locationsandcompletereleases(100%).(3)2caseswithvasospasmandstentthrombosisduringoperation,and1casewithsecond aneurysmruptureduringoperation.(4)DSAreexaminationsinhalfayearafteroperations:3casesrecurred (11.5%)inthe26cases ofdenseembolism;theresidualin2casesincreasedin4ofaneurysmalneckresidualand2oftumorresidual,andtherestremained;26stentsstayedinthesamepositionandthestentsin3caseswerenarrowed.2D-DSA,3D-DSAanddualvolumereconstructioncould clearlyshowthedegreeofembolizationofaneurysmsin20cases(66.7%),25cases(83.3%)and30cases(100%),respectively.The degreeofembolizationofaneurysmswassignificantlydifferentinthreeimagingmethods(P＜0.05).Conclusion Intheprocessof interventionalembolizationforintracranialwideneckedaneurysm, doublevolumereconstructioncanbeusedtoshowtheeffectof embolization,thelocationofthestentandtherelationshipwith theneckoftheaneurysm,whichprovidesanassessmentofthe situationofaneurysmembolism,thedevelopmentoftheauxiliarystentandtheobjectivefortheselectionofthesurgicalstrategy.

Objective To explore the feasibility of tracking migration and distribution of SD-rat adipose derived stem cells (ADSCs) labeled with Polyethylene Glycol/Polyehthyleneimine modified superparamagnetic iron oxide (PEG/PEI-SPIO) in rats with chronic cerebral ischemia using MRI.Methods Thirty female SD rats underwent permanent occlusion of bilateral common carotid arteries 6 months were divided into PEG/PEI-SPIO labeled group and unlabeled group (each n =15).Labeled or unlabeled ADSCs suspension was injected into the right ventricle of rats in two groups,respectively.MR scans were performed at the 7th,14th and 21st day after transplantation for each 5 rats.T2 value of T2mapping sequence in hippocampus,cortex and cerebellum were measured.Then the rats were scarified,and the brains were obtained,and Prussia dyeing was performed.Under high magnification,blue dye cells at each time points and brain area were counted.T2 values and blue dye cells were statistically analyzed.Results Class round hypointensity areas were detected in temporol-parietal cortex and hippocampus in both groups on T2WI,T2* WI and SWI.T2 value of the right temporolparietal cortex and hippocampus in the labeled group was shorter than those of the unlabeled group on the 14th day after transplantation (P=0.013,0.045).T2 value of the right temporol-parietal cortex in the labeled group was shorter than that of the unlabeled group on the 21st day after transplantation (P=0.007).The number of blue dye cell of the right temporol-parietal cortex on the 14th and 21th day,hippocampus on the 14th day in the labeled group were more than those of the unlabeled group after transplantation (P=0.029,0.032,0.043).Conclusion ADSCs labeled with PEG/PEI-SPIO transplanted into lateral ventricle of SD rat could migrate to the damaged areas caused by chronic cerebral ischemia.It is possible to use quantitative MRI to track migration and distribution of ADSCs labeled with PEG/PEI-SPIO in rat brain.

Objective To investigate the relationship between MRI and pathological features of uterine carcinosarcoma(UCS).Methods 13 cases of UCS which were confirmed by surgery and pathology were collected,MRI plain scan and enhanced scan were carried on all of the patients,the pathological tissue was got after operation for conventional HE and immunohistochemical staining.The MRI representation and pathological tissue composition of all the 13 cases were analyzed and summarized.Results 8 cases were occurred in uterine body,3 cases were in the cervix and 2 were involving the uterine body and cervix at the same time.The MRI manifestations of them were enlarged uterine size with irregular masses showed,intermediate or hypointensity intensity signal on T1 weighted and hyperintensity or intermediate intensity signal on T2 weighted,necrosis and cystic lesions were showed in 5 cases,2 cases hemorrhage were displaied which showed hyperintensity signal on T1 weighted,4 cases were endometrial thickening,all of the cases were heterogeneous enhancement;the pathological showed different proportion of carcinorma and sarcoma were visible in all the 13 cases of UCS.Conclusion UCS has complex components histopathologically,including both carcinoma tissue and sarcoma tissue.The heterogeneous signal of cystic degeneration,necrosis and hemorrhage within tumor in MRI could help the diagnosis of UCS.