[Comparison and analysis of ophthalmic resources and service ability in Shanxi Province in 2014 and 2021].

Objective: To compare and analyze the ophthalmic resources and service ability in Shanxi Province in 2014 and 2021, and to provide reference for the development planning of ophthalmology and eye care. Methods: In this cross-sectional study, a questionnaire survey was conducted among all ophthalmic institutions registered in the health administrative department in 11 cities of Shanxi Province by the end of 2014 and 2021 by using the National Ophthalmology Competency Resource Questionnaire (compiled by the Medical Administration and Hospital Authority of the National Health and Wellness Commission). The basic situations of ophthalmic institutions in 2014 and 2021, as well as the human resources, ophthalmic equipment configuration, technology and medical service capabilities, were recorded and compared. The chi-square test was used for statistical analysis. Results: A total of 270 questionnaires for 2014 were collected from 270 ophthalmic institutions, and 292 questionnaires for 2021 from 292 ophthalmic institutions. The institution categories in 2014 (197 general hospitals, 31 eye hospitals and 42 others) were statistically different from those in 2021 (182 general hospitals, 45 eye hospitals and 65 others) (P<0.05). The proportion of doctors with senior titles in ophthalmic institutions increased from 25.5% (346/1 358) in 2014 to 41.7% (580/1 391) in 2021, the proportion of senior technicians increased from 9.4% (14/148) to 25.3% (110/435), the proportion of doctors with junior titles decreased from 42.1% (572/1 358) to 26.5% (369/1 391), and the proportion of junior technicians decreased from 45.3% (67/148) to 39.1% (170/435). There was a significant difference in the distribution of professional titles between doctors and technicians in ophthalmic institutions (P<0.05). The number of doctors (130 to 28), nurses (152 to 50), technicians (33 to 11) and full-time optometrists (44 to 12) in the first-class ophthalmic institutions decreased, the increase of equipment with the ophthalmic A-ultrasound scan system, fundus camera and coherent optical tomography system (35.1%, 28.9% and 25.4%; P<0.05) ranked the top three, and the increase of performing the phacoemulsification procedure, intraocular lens implantation, intravitreal injection and iris surgery (30.2%, 24.7% and 20.7%; P<0.05) ranked the top three in 2021 as compared to 2014. Conclusions: The resources and service ability of ophthalmology in Shanxi Province developed in 2021 in comparison with 2014. However, there were some problems, such as changes in the type and structure of eye institutions, unreasonable proportions of professional titles, insufficient human resources in primary ophthalmic institutions, and slow improvement in the allocation of ophthalmology equipment and technical capabilities.

[Correlations between the average Young's modulus and histopathological characteristics of papillary thyroid carcinoma].

Objective: To explore the histopathological factors affecting the stiffness of papillary thyroid carcinoma (PTC). Methods: Ninety-six patients with PTC confirmed by surgery and pathology in Shanxi Bethune Hospital from January 2019 to December 2020 were selected, including 101 nodules. Two-dimensional ultrasound and shear-wave elastography (SWE) were performed before surgery and the average Young's modulus (Emean) of PTC nodules were measured. Histopathological examinations on the nodules were conducted after surgery to decide the lesion size, number of lesions, calcification type, presence or absence of capsular and extracapsular invasion, degree of fibrosis, microvessel density, and number of tumor cells. The correlations between the lesion size, degree of fibrosis, microvessel density, and number of tumor cells and the Emean were analyzed. The Emeans of nodules with different numbers of lesions, presence or absence of capsular and extracapsular invasion, and different pathological calcification types were compared. The multiple linear regression analysis was used to evaluate the histopathological factors influencing the Emean. Results: The ranges of the lesion sizes, degrees of fibrosis, microvascular density, numbers of tumor cells, and the Emeans of the 101 investigated PTC nodules were (1.29±0.95) cm, (30.64±18.37)%, (101.64±30.7) vessels per high power field, (373.52±149.87) cells per high power field, and (36.47±19.62) kPa, respectively. Correlation analysis showed that the lesion size of PTC and the degree of fibrosis were positively correlated with the Emean (r=0.660, P＜0.001; r=0.789, P＜0.001), while the microvessel density was negatively correlated with the Emean (r=-0.198, P=0.047). The Emean of the group with capsular and extracapsular invasion was higher than that of the group without (P=0.014). There were statistical differences in the Emeans among different types of pathological calcification (P＜0.001). The multiple linear regression analysis showed that the lesion size (ß=0.325, P＜0.001), degree of fibrosis (ß=0.563, P＜0.001), psammoma bodies (ß=0.177, P=0.001), stromal calcification (ß=0.164, P=0.003), and mixed calcification of both psammoma bodies and stroma (ß=0.163, P=0.003) were independent influencing factors for the Emean. The degree of fibrosis had the greatest impact on the Emean. Conclusions: The Emean of PTC lesions was correlated with the histopathological characteristics of PTC. The lesion size, degree of fibrosis, and calcification had significant impact on the Emean, among which the degree of fibrosis had the greatest impact.

[Value of shear wave elastrography image classification in the diagnosis of breast masses].

Objective: To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions. Methods: A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results: The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01). Conclusion: The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

[The role of Th1/Th2 cells imbalance in the pathogenesis of secretory otitis media].

Objective:The aim of this study is to explore the role of Th1/Th2 cells imbalance in the pathogenesis of secretory otitis media. Method:Ninety secretory otitis media patients were enrolled in observation group. According to medical history, they were divided into acute and chronic group. In addition, 90 healthy volunteers during the same period were selected as the control group. The levels of Th1-type cytokines IFN-γ, Th2-type cytokines interleukin-4 (IL-4) and IFN-γ/IL-4 in peripheral blood were compared between observation group and control group. Compare with acute and chronic secretory otitis media patients IFN-γ, IL-4, IFN-γ/IL-4 levels as well as the compare with middle ear effusion and peripheral blood sIFN-γ, IL-4, IFN-γ/IL-4 levels in observation group. Result:The level of IFN-γ, IL-4 and IFN-γ/IL-4 in the peripheral blood in the observation group were higher than those of the control group (P<0.05). The levels of IFN-γ, IL-4 and IFN-γ/IL-4 in the peripheral blood of patients in the chronic group were higher than those in the acute group. There was no significant difference in IL4, IFN-γ/IL-4 levels between the observation group and the middle ear effusion (P>0.05), IFN-γ levels in peripheral blood were lower than those of the middle ear effusion IFN-γ (P<0.05). Conclusion:Abnormal IFN-γ, IL-4 levels of the peripheral blood and the middle ear effusion have some relationship with secretory otitis media, and Th1/Th2 imbalance may be a risk factor for secretory otitis media.