Objective:To investigate the influencing factors of ultrasonic missed diagnosis of kidney neoplasm.Methods:The clinical data of 2 033 patients pathologically diagnosed with kidney neoplasm after operation and with complete medical record in Shanxi Province Cancer Hospital from January 2013 to October 2021 were retrospectively analyzed. Preoperative ultrasound diagnosis, clinical data, CT/magnetic resonance imaging (MRI) were analyzed, and ultrasound missed diagnosis rate was calculated. Chi-square test and multivariate logistic regression were used to analyze the influencing factors of ultrasonic missed diagnosis of kidney neoplasm mainly based on the anatomic characteristics of neoplasm.Results:The ultrasonic missed diagnosis rate of kidney neoplasm was 1.87% (38/2 033), among which the ultrasonic missed diagnosis rate of renal parenchymal neoplasm was 1.33% (25/1 874) and the ultrasonic missed diagnosis rate of renal pelvis neoplasm was 8.18% (13/159). The results of multivariate logistic regression analysis showed that the patients' body mass index (BMI) ≥ 24 kg/m 2 ( OR = 2.805, 95% CI 1.030-7.641), the small lesion ( OR = 0.425, 95% CI 0.293-0.617), the lesion located on the left kidney ( OR = 0.307, 95% CI 0.113-0.834), the lesion located on the body ( OR = 0.344, 95% CI 0.124-0.956 compared to lesions in the upper pole of the kidney; OR = 0.239, 95% CI 0.069-0.834 compared to lesions in the lower pole of the kidney) and the lesion located on the dorsal side ( OR = 0.409, 95% CI 0.172-0.970) were independent influencing factors for ultrasound missed diagnosis of renal parenchymal neoplasms (all P < 0.05). Patients with BMI ≥ 24 kg/m 2 ( OR = 10.464, 95% CI 1.042-105.087), concurrent ureteral or (and) bladder urothelial carcinoma ( OR = 32.937, 95% CI 4.017-270.063), and small lesion size ( OR = 0.216, 95% CI 0.081-0.577) were independent influencing factors for ultrasound missed diagnosis of renal pelvis neoplasms (all P < 0.05). Conclusions:Obesity, small focus, focus on the left kidney, focus on the body, and focus on the back may be the main reasons for ultrasonic missed diagnosis of renal parenchymal neoplasms. Obesity, concurrent ureteral or/and bladder urothelial carcinoma and small lesions may be the main reasons for ultrasonic missed diagnosis of renal pelvis neoplasms.

【Objective】 To conduct the laboratory quality assessment between 12 blood stations in Hebei province, analyze the results and explore the accuracy and comparability of testing, so as to improve the level of testing ability and quality management. 【Methods】 With reference to the external quality assessment rules of National Center for Clinical Laboratories and combined with the instructions of quality assessment samples, daily testing process of the laboratories were assessed. The quality indicators include blood cell count (WBC, RBC, Hb, HCT, MCV, MCH, MCHC and PLT), biochemical items (TP) and coagulation parameters (FIB and FⅧ). 【Results】 There are still problems in laboratories in terms of personnel operation, instrument maintenance and the impact of different reagent batches, especially in biochemical items and coagulation parameters. The pass rate of biochemical items was the lowest, only 72.75%, and that of blood cell count was the highest, reaching 98.75%. 【Conclusion】 With the progress of the project, the quality monitoring level of daily blood sampling tests in the quality control laboratory of each blood station has been improved. However, it is still necessary for each laboratory to improve the testing ability and quality management to a higher level in Hebei.

Objective:To observe the clinical efficacy and safety of decitabine combined with low-dose cytarabine in treatment of high-risk myelodysplastic syndrome.Methods:The data of 47 newly treated MDS patients who had high-risk or above scores according to revised international prognostic scoring system (IPSS-R) in the Affiliated Hospital of Qingdao University from January 2016 to September 2018 were retrospectively analyzed. The patients were divided into decitabine combined with low-dose cytarabine group (15 cases) and decitabine group (32 cases). The clinical efficacy and adverse reactions in two groups were compared.Results:After 4 courses of treatment, the bone marrow remission rate, partial remission rate and hematologic remission rate was 20.0% (3/15), 6.7% (1/15), and 13.3% (2/15), respectively in decitabine combined with low-dose cytarabine group, and was 28.1% (9/32), 3.1% (1/32), and 9.4% (3/32), respectively in decitabine group, and there were no statistically differences of both groups (both P > 0.05). The overall response rate in decitabine combined with low-dose cytarabine group was higher than that in decitabine group [93.3% (14/15) vs. 62.5% (20/32), P = 0.037], and the complete remission rate in decitabine combined with low-dose cytarabine group was higher than that in decitabine group [53.3% (8/15) vs. 21.9% (7/32), P = 0.046]. The 1-year overall survival (OS) rate of decitabine combined with low-dose cytarabine group was 86%; and the median OS time of decitabine combined with low-dose cytarabine group was 24 months (95% CI 15.5-32.5 months), which was higher than that of decitabine group (20 months), but there was no statistically significant difference ( χ2 = 0.058, P = 0.810). The incidence of grade Ⅲ-Ⅳ bone marrow suppression and infection in decitabine combined with low-dose cytarabine group was higher than that in decitabine group, but there were no statistically significant differences of both groups (both P > 0.05). Grade Ⅲ-Ⅳ bone marrow suppression and infection were commonly found within the first 2 courses of treatment in decitabine combined with low-dose cytarabine group, and the adverse reactions gradually decreased in the subsequent treatment. Conclusions:Decitabine combined with low-dose cytarabine can achieve better remission rate and prolong survival time for MDS patients with high-risk and above. There is no significant increase in the incidence of grade Ⅲ-Ⅳ bone marrow suppression and infection. For high-risk MDS patients who are not suitable or unable to receive hematopoietic stem cell transplantation, it can be the preferred option.

The "three eye-needling" technique is one of the important component of's three needling therapy, mainly used for the treatment of eye disorders such as optic atrophy, macular pigment degeneration, myopia, hyperopia, strabismus, amblyopia, diplopia, glaucoma, cataract, etc. In the paper,'s "three eye-needling" technique is explored, including the keys of manipulation, operation procedure and basic skills. This technique is particularly for "mind regulation", focusing on tranquilizing, observing and concentrating the mind. The precise selection of point is the basic requirement, the technique for fixing, pressing and pricking are the most important link. The needle insertion with one hand is adopted with gentle rotation manipulation. Mind regulation, point selection and specific operation are coordinated with each other to bring the function of "three eye-needling" technique into play and achieve better therapeutic effects.

Primary hepatic lymphoma (PHL) is an extremely rare disease without any unified diagnostic criterion.The symptoms are usually nonspecific.Liver biopsy remains the most valuable tool for diagnosis of PHL.The predominant histology of PHL is diffuse large B-cell lymphoma.The therapeutic modalities are variable,including surgery,chemotherapy,radiotherapy,or combination of the various processes.This article described a 33-year-old man with diffuse large B-cell PHL who was treated at the Affiliated Cancer Hospital of Shanxi Medical Univeitity Blood Disease Diagnosis and Treatment Center in February 2014.The patient benefited from eight-cycle chemotherapy.At present,the patient is disease-free and undergoes regular follow-up.

Objective To evaluate the ultrasonographic features of enlarged central lymph nodes in thyroid microcarcinoma and its clinical significance.Methods The data of 422 cases of thyroid microcarcinoma in Shanxi Medical University Affiliated Tumor Hospital from January 2014 to December 2014 was investigated retrospectively.For the enlarged central lymph nodes,the results of ultrasonography,intraoperative detection and surgical pathology were compared,and the ultrasound characteristics of enlarged lymph nodes were assessed.Results In 422 cases of thyroid microcarcinoma,128 cases of central compartment lymphadenopathy were identified,including 276 nodes detected by preoperative ultrasound.The ultrasonic characteristics of central lymph nodes included hypo-echoic (98.6％,272/276),L/T ≥ 2 (63.8％,176/276),absence of echogenic hilus (72.1％,199/276),poor blood supply (91.7％,253/276).Surgery detected 978 paratracheal lymph nodes,and 522 nodules were ≤ 5.0 mm in diameter (53.4％).Among 422 patients,100 cases with paratracheal lymph nodes were confirmed by pathology (23.7％).Preoperative ultrasound undetected pretracheal and prelaryngeal lymph nodes,and surgery detected 51 nodes,including 30 nodules ≤ 5.0 mm in diameter (58.8％) and 5 nodules ＞ 10.0 mm in diameter (9.8％),of whom 7 cases with pretracheal and prelaryngeal lymph nodes were identified by pathology.Conclusions Preoperative ultrasound was prone to undetected,which may be involved with the deep location,the smaller diameter and complicated anatomy.The present findings emphasize that a negative US does not obviate the need for careful exploration of the central compartment to minimize the risk of persistent or recurrent local disease.The sonographer should be familiar with the status of central lymph node metastasis and ultrasonic features.The sonographer also should expand the area of the initiative while detect the central compartment lymphadenopathy,which is important guiding for surgical removal of thyroid cancer and lymph node metastasis.

Objective To analyze the ultrasound features of ultrasonograpy-false-positive benign thyroid nodules in 37 cases. Methods With pathology results as the golden standard, thirty-seven patients with forty-six nodules were misdiagnosed as thyroid cancer by ultrasonography. The pre-operative diagnosis of ultrasonography were retrospectively reviewed and analyzed. Results Among forty-six thyroid nodules, twenty-one nodules had a diameter of 10.0 mm or smaller, while the other twenty-five nodules had a diameter of larger than 10.0 mm. In all forty-six thyroid nodules, the pre-operative ultrasonography found the majority of nodules with 3 or more than 3 malignant signs. The forty-six thyroid nodules showed solid (89.1%, 41/46), cystic-solid (10.9%, 5/46), marked hypoechogencity (87.0%, 40/46), ill-defined margin (56.5%, 26/46), calcification (76.1%, 35/46),microcalcification and macrocalcification), and taller-than-wide shape (30.4%, 14/46). The thyroid imaging reporting and data system (TI-RADS) lexicon was introduced to describe the lesions:forty-one nodules were categorized as TI-RADS 4c and 5 nodules were categorized as TI-RADS 5. On histology, these misdiagnosed thyroid nodules revealed severe fibrosis, hyalinization and calcification. The ultrasonic images were complicated and difficult to be differentiated from thyroid cancer. Conclusion Benign thyroid nodules with fibrosis, hyalinization, hemorrhage and calcification will lead tothe significant change on lesions' morphology, echo intensity and internal structure. When the benign and malignant signs ultrasound co-existed in a single thyroid nodule, benign thyroid nodules might be easily misdiagnosed as thyroid cancer.

Objective To explore the efficacy of hormone replacement therapy (HRT) for rheumatoid arthritis (RA).Methods The literature about HRT in the treatment of rheumatoid arthritis were searched.Eleven papers were subjected to a Meta-analysis and a heterogeneity test was conducted to evaluate the efficacy of HRT.Results HRT reduced the level of erythrocyte sedimentation rate (ESR) in RA patients (P=0.016),the SMD was-0.22(-0.40,-0.04); improved bone mineral density (BMD) in RA patients (P=0.022),the WMD was 2.83(0.41,5.26); decreased clinical parameters for disease activity evaluations of RA patients (P=0.048),the SMD was-0.19 (-0.38,0.00); decreased the level of C-reactive protein (CRP) in RA patients,the SMD was-0.08 (-0.37,0.21),but the difference was not statistically significant (P=0.591).Conclusion The findings from this Meta-analysis indicate that HRT can reduce the ESR level,improve clinical indexes and improve BMD level of RA patients.HRT may suppress disease activity and osteoporosis of RA patients,so it may be used as an auxiliary therapy in the treatment of RA.

Objective To observe the ultrasonographic features of primary female genital system lymphoma and its histopathological characteristics.Methods Sonographic appearances and histopathological characteristics of 14 patients who were pathologically comfirmed as primary female genital system lymphoma were reviewed.Results Fourteen patients underwent ultrasonography and 15 lesions were found,6 cases of which were found in the ovary and cervix separately,3 cases in the uterine body.Among the lesions detected,10 of which respectively represents extremely low echo and homogeneous internal echo,all lymphomas had posterior enhancement.The margins were most frequently circumcribed (13/15),5numbers primary lymphomas of the ovary were mostly elliptical in shape,while 5 numbers of cervix tumors showed the shape of lobular,all of the tumors in the uterine body showed diffuse symmetrical enlargement without disruption of the endometria.Color Doppler imaging showed hypervascularity in most tumors(13/15).The pathological examination showed that all tumors were non-Hodgkin lymphoma diffuse B-cell type.Conclusions Primary female genital system lymphoma has some ultrasonic features,including extremely low echo,homogeneous echo and posterior enhancement.Final diagnosis depends on the histopathology.

Objective To analyze imageology appearance and clinical characteristics of the cystic and solid breast carcinoma.Methods Features of MRI and B-type ultrasonic inspection of 26 patients with the cystic and solid breast carcinoma pathologically confirmed (15 patients with mucinous carcinoma,6 patients with intracystic papillary carcinoma,5 patients with squamous cell carcinoma of the breast) were retrospectively reviewed.Results In terms of clinical appearance,the incidence of the squamous cell breast carcinoma with an average age of 70.1 years old was larger than in youth,while mucinous carcinoma with an average age of 67.7 years old and intracystic carcinoma of breast with an average age of 55.1 years old were contrary.The squamous cell breast carcinoma developed more quickly than mucinous carcinoma and intracystic carcinoma of breast.The squamous cell breast carcinoma often occurred around mammilla (4/5),while the mucinous carcinoma and intracystic papillary carcinoma often occurred upper outer quadrant of breast,which was similar with other breast cancer.The average size of 49.6 mm in the squamous cell breast carcinoma was largest than the average size of 25.1 mm in mucinous carcinoma and the average size of 35.2 mm in intracystic papillary carcinoma.The malignant degree of squamous cell breast carcinoma was higher than mucinous carcinoma and intracystic papillary carcinoma,which intended to occur lymph node metastasis and skin infiltration.The diagnosis probability of mucinous carcinoma was smaller than intracystic papillary carcinoma through preoperative puncture,while squamous cell breast carcinoma was larger.On the MRI imageology appearance,both types of breast cancer had the same shape of rotundity or lobulated.The tumors were low signal on T1WI and partially high signal on T2WI,which were circular enhancement after enhancement.However,the edge of mucinous carcinoma and squamous cell breast carcinoma was rougher than intracystic papillary carcinoma compared with squamous cell breast carcinoma.The bursa wall of mucinous carcinoma was more uniformity,while papillary soft tissue image can be found in intracystic papillary carcinoma,which was enhanced significantly after enhancement.In terms of ultrasonic sound (US),there were low echo signal and high echo signal on the back of tumor compared with other breast tumor.There were shadow beside mucinous carcinoma.Squamous cell breast carcinoma was rich in blood supply,while mucinous carcinoma and intracystic papillary carcinoma were opposite.Conclusion Histological type of cystic and solid breast carcinoma is complex,but the appearances of MRI and US have some characteristics.Histological type and the range of disease could be guessed through the combination of preoperative puncture and clinical appearance,which plays an important role in operation mode and treatment guidance.