Ultrasound and clinical factors predicting central lymph node metastases in patients with unilateral multifocal papillary thyroid carcinoma.

OBJECTIVE: This retrospective study involving a large dataset of unilateral multifocal papillary thyroid carcinoma (UM-PTC) sought to identify factors that predict central lymph node metastases (CLNM) in patients. METHODS: We identified a cohort of 158 patients who underwent cervical ultrasonography followed by UM-PTC diagnosis based on postoperative pathology. The relationship between CLNM and UM-PTC clinical ultrasound features was evaluated using univariate and multivariate analyses. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of total tumor diameter (TTD) to predict CLNM. RESULTS: Among the 158 UM-PTC patients, the incidence of CLNM was 29.7% (47/158). Univariate and multivariate analyses revealed that a number of similarity of sonographic features (NSSF) ≥4 (odds ratio [OR] = 11.335, 95% confidence interval [CI]: 3.95-32.50, p = 0.000), microcalcifications (OR = 3.54, 95% CI: 1.30-9.70, p = 0.014), a TTD of ≥2 cm (OR = 4.48, 95% CI: 1.62-12.34, p = 0.004), number of nodules ≥3 (OR = 13.17, 95% CI: 3.24-53.52, p = 0.000), and Lateral cervical lymph node metastasis (LLNM) (OR = 5.57, 95% CI: 1.59-19.48, p = 0.007) were independently associated with CLNM in UM-PTC. ROC curve analysis revealed that the TTD cut-off of 1.795 cm had a sensitivity of 0.723 and a specificity of 0.676 for predicting CLNM. CONCLUSIONS: Patients with UM-PTC are at high risk of CLNM. NSSF ≥4, microcalcifications, TTD of ≥2 cm, LLNM, and a number of nodules ≥3 were independently associated with CLNM. Our data show that ultrasound may guide surgical decisions in the treatment of UM-PTC.

Ultrasonic features of automated breast volume scanner (ABVS) and handheld ultrasound (HHUS) combined with molecular biomarkers in predicting axillary lymph node metastasis of clinical T1-T2 breast cancer.

Background: In the post-American College of Surgeons Oncology Group Z0011 trial era, clinicians are attempting to preoperatively evaluate axillary lymph node (ALN) status using ultrasound. However, the value of preoperative ultrasound examination remains uncertain. The study aimed to investigate the ultrasonic features of automated breast volume scanner (ABVS) and handheld ultrasound (HHUS), in combination with molecular biomarkers, to predict the risk of ALN metastasis (ALNM) in clinical T1-T2 breast cancer. Methods: A retrospective case-control analysis was conducted on 168 patients with clinical T1-T2 breast cancer at Peking University First Hospital between January 2013 and August 2021. Preoperative ABVS and HHUS examinations were performed. According to the pathology results of the ALN, patients were divided into metastatic and nonmetastatic groups. Logistic regression analyses were used to analyze the ultrasonic characteristics of ABVS and HHUS on clinical T1-T2 breast cancer, and molecular biomarkers were incorporated to predict the risk of ALNM. Results: Of the 168 patients, 88 (52.4%) had ipsilateral ALNM while 80 (47.6%) had no ipsilateral ALNM. The univariate analysis showed that shorter tumor-skin distance (P=0.011), the Adler blood flow grade of II-III (P=0.014), and larger tumor size on ABVS (P<0.001) were associated with ALNM. The multivariate logistic analysis showed that these three risk factors, including the tumor-skin distance [odds ratio (OR) =0.279; P=0.024], the Adler blood flow grade (OR =2.164; P=0.046), and the tumor size on ABVS (OR =1.033; P=0.002), were independent predictive parameters. Conclusions: The tumor-skin distance, tumor size on ABVS, and Adler blood flow grade have diagnostic value for ALNM in clinical T1-T2 breast cancer.

Contrast-enhanced ultrasound evaluation of renal perfusion before angioplasty and its predictive value for hypertension.

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is a common disease in the elderly population. OBJECTIVE: The aim was to develop a contrast-enhanced ultrasound (CEUS)-based model for predicting post-angioplasty improvement in hypertension in patients with severe ARAS. METHODS: Thirty-five patients with severe ARAS (⩾ 70%) were included in this study, and 42 renal arteries received percutaneous transluminal renal arterial stenting. An optimal integral formula was developed from pre-interventional color-coded duplex sonography (CCDS) and CEUS parameters using least absolute shrinkage and selection operator (LASSO) regression and receiver operating characteristic (ROC) curve analysis. A model for predicting short-term hypertension improvement was established using the integral formula and clinical risk factors. Bootstrapping was used for internal validation. RESULTS: Two integral formulas, LASSO.CCDS and LASSO.CEUS, were established. ROC curves of the two integral formulas showed that LASSO.CEUS was the better formula for predicting hypertension improvement (AUC 0.816, specificity 78.6%). Univariate and multivariate regression analyses showed that duration of hypertension (OR 0.841, P= 0.027), diabetes (OR = 0.019, P= 0.010), and LASSO.CEUS (OR 7.641, P= 0.052) were predictors of short-term hypertension improvement after interventional therapy. Using LASSO.CEUS combined with clinical risk factors, the following prediction model was established: logit (short-term improvement in hypertension) = 1.879-0.173 × hypertension duration - 3.961 × diabetes + 2.034 × LASSO.CEUS (AUC 0.939). CONCLUSIONS: The model established using CEUS parameters and clinical risk factors could predict hypertension improvement after interventional therapy, but further research and verification are needed.

Comparison of the diagnostic performance and clinical role of different ultrasound-based thyroid malignancy risk stratification systems for medullary thyroid carcinoma.

Background: This study sought to investigate the applicability of different ultrasound (US) thyroid risk stratification systems in diagnosing medullary thyroid carcinoma (MTC) and determining the need for biopsy. Methods: In total, 34 MTC nodules, 54 papillary thyroid carcinoma (PTC) nodules, and 62 benign thyroid nodules were examined in this study. All the diagnoses were histopathologically confirmed postoperatively. All the thyroid nodule sonographic features were recorded and categorized by 2 independent reviewers according to the Thyroid Imaging Reporting and Data System (TIRADS) of the American College of Radiology (ACR), the American Thyroid Association (ATA) guidelines, the European Thyroid Association (EU) TIRADS, the Kwak-TIRADS, and the Chinese TIRADS (C-TIRADS). The sonographic differences and risk stratifications of the MTCs, PTCs, and benign thyroid nodules were analyzed. The diagnostic performance and recommended biopsy rates for each classification system were evaluated. Results: The risk stratifications of MTCs were all higher than the benign thyroid nodules (P<0.01) and lower than PTCs (P<0.01) with each classification system. Hypoechogenicity and malignant marginal features were independent risk factors for identifying malignant thyroid nodules, and the area under the receiver operating characteristic curve (AUC) for identifying MTCs was lower than that for identifying PTCs (0.873 vs. 0.954, respectively). The AUCs, sensitivity, specificity, positive predictive values, negative predictive values, and accuracy values of the 5 systems for MTC were all lower than those for PTC. The best cut-off values for diagnosing MTC were TIRADS (TR) 4 in the ACR-TIRADS, intermediate suspicion in the ATA guidelines, TR 4 in EU-TIRADS, and TR 4b in both the Kwak-TIRADS and the C-TIRADS. The Kwak-TIRADS had the highest recommended biopsy rate for MTCs (97.1%), followed by the ATA guidelines, the EU-TIRADS (88.2%), the C-TIRADS (85.3%), and the ACR-TIRADS (79.4%). Conclusions: The US-based thyroid malignancy risk stratification systems analyzed in this study were able to satisfactorily identify MTC and recommend biopsy, but the diagnostic performance of these systems for MTC was not as good as that for PTC.

Value of High-Frequency Ultrasonography in the Qualitative and Semi-Quantitative Assessment of Immunoglobulin G4-Related Submandibular Sialadenitis.

OBJECTIVE: To assess the value of high-frequency ultrasonography in the evaluation of immunoglobulin G4-related submandibular sialadenitis (IgG4-SS). METHODS: Thirty-four submandibular glands in 17 patients with IgG4-SS were retrospectively enrolled, as well as 34 submandibular glands in 17 healthy control subjects. Qualitative ultrasonic features including submandibular gland size, border, echogenicity, and vascularity were reviewed. Two different scoring systems (0-16 and 0-48, respectively) were used for semi-quantitative analysis of imaging features. Comparison of both qualitative and semi-quantitative ultrasonic analysis were made between patients with IgG4-SS and healthy controls. Spearman correlation was used to explore relationships between variables. RESULTS: The submandibular glands with IgG4-SS presented with enlarged size, rough border, increased vascularity, and abnormal echogenicity (All P < .05). The most common echogenicity pattern for IgG-SS was diffuse hypoechoic foci pattern (44.1%), followed by superficial hypoechoic pattern (20.6%), tumor-like pattern (14.7%), and diffuse hypoechogenicity pattern (11.8%). Most IgG4-SS glands presented linear hyperechogenicity in parenchyma (91.2%). Based on both scoring system, scores of IgG4-SS were significantly higher than those of the controls (All P < .05). Association analysis of both scoring systems showed positive correlation of scores with vascularity in the gland parenchyma (All P < .05). CONCLUSION: The ultrasonic features of IgG4-SS comprise enlarged gland, rough border, increased vascularity, and abnormal echogenicity, which correlate with its pathological characteristics. The most common echogenicity pattern for IgG4-SS was diffuse hypoechoic foci pattern. Semi-quantitative analysis systems could be useful in the assessment of IgG4-SS. Ultrasound is a potential, valuable, and non-invasive tool for the diagnosis and evaluation of IgG4-SS.

Diagnostic Value of Ultrasound Elastography in the Differentiation of Breast Invasive Ductal Carcinoma and Ductal Carcinoma In situ.

BACKGROUND: Ultrasound elastography (US-E) has been shown superior to the conventional US in diagnosing benign and malignant breast lesions. In contrast, the role of US-E in the differentiation of breast invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) has been poorly described. OBJECTIVE: This study was designed to examine the diagnostic value of US-E in the differentiation of IDC and DCIS. METHODS: Medical records of all patients who underwent preoperative US-E evaluation and were diagnosed with IDC or DCIS at our hospital from April-December 2019 were retrieved and analyzed. Those who had prior surgical treatment, chemotherapy or radiotherapy were excluded. RESULTS: Twenty women with DCIS and 111 women with IDC were included in this study. There were no significant differences in age, maximum lesion diameter and tumor volume between the two groups. While shear wave velocity (SWV) inside the lesion and in the surrounding tissue, strain ratio and tumor area ratio were not substantially different between the two groups, SWV at the edge of the lesion was significantly higher in IDC cases, which had an AUC value of 0.66 with a sensitivity of 65.8% and a specificity of 60.0% for the differential diagnosis of IDC and DCIS. CONCLUSION: Edge SWV is significantly higher in IDC than that in DCIS, which had a moderate diagnostic value for the differentiation of IDC and DCIS, similar to the performance of diffusion-weighted magnetic resonance imaging as reported in the literature. In terms of cost-effectiveness, US-E could be very useful while waiting for further evaluations to determine whether US-E combined with other diagnostic modalities improves the diagnostic performance.

Microbubble contrast agent SonoVue: An efficient medium for the preoperative lymphatic mapping of thyroid carcinoma.

Objective: To assess the value of microbubble contrast agent SonoVue in the thorough preoperative lymphatic mapping of patients with thyroid carcinoma, including the lymphatic drainage region, the detection of sentinel lymph node (SLN), and the diagnosis of lymph node metastasis (LNM). Materials and methods: 55 patients with 62 thyroid malignancies proved by surgical pathology (59 papillary thyroid carcinomas and three medullary thyroid carcinomas) who underwent preoperative lymphatic contrast-enhanced ultrasound (LCEUS) with microbubble contrast agent SonoVue were enrolled. All LNM were confirmed by pathology. The location of thyroid lesions, ultrasonic features of lymph nodes, lymphatic drainage region, and detection of SLN were assessed. The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value and accuracy) of different parameters for the LNM diagnosis was calculated. Results: SonoVue effectively demonstrated the lymphatic drainage region for all enrolled thyroid carcinomas. The most common lymphatic drainage region for thyroid carcinomas was region VI (93.55%), followed by region III (62.90%), region IV (48.39%) and region II (4.84%). When divided by the lesion location, the most common lymphatic drainage regions for the nodule in isthmus, superior lobe and inferior lobe of the thyroid were region VI, region III, and region VI respectively. SLN was detected in 96.77% (60/62) of cases. The two cases without SLN demonstration had pathologically proven LNM. The most common sonographic sign of LNM was perfusion defect (54.17%). The diagnostic accuracy of SonoVue in central and lateral compartment LNM was 86.67% and 91.67%, respectively. Conclusion: Microbubble contrast agent SonoVue is a valuable imaging contrast medium for thorough preoperative lymphatic mapping in patients with thyroid carcinoma, including the lymphatic drainage region, the detection of SLN, and the diagnosis of LNM. LCEUS with SonoVue alone has limitations of false negatives when there is lymphatic vessel obstruction and may need to be combined with other ultrasound modalities.

The value of ultrasound elastography combined with multi-parameters in the diagnosis of BI-RADS 4 breast lesions.

BACKGROUND: Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%) in the global cancer statistics 2020. OBJECTIVE: To evaluate the diagnostic value of ultrasound elastography combined with multi-parameters in differentiating category 4 benign and malignant lesions in the breast imaging reporting and data system (BI-RADS). METHODS: This study retrospectively analyzed 206 patients (213 breast lesions) who visited the Department of Breast Surgery and underwent a breast core needle biopsy in the Department of Ultrasound in Peking University First hospital from April to December 2019. The shear wave velocity (SWV) values were collected at the following locations by virtual touch tissue imaging quantification (VTIQ): breast lesion interior, breast lesion margin, surrounding glands, and surrounding fat. Simultaneously, the strain ratio (SR) of breast lesions to glands and the area ratio (AR) of breast lesions were collected under strain elastography and a two-dimensional ultrasound mode. RESULTS: Univariate analysis found that the SWV value, measured by ultrasound elastography parameters, and the AR between the elasticity and the two-dimensional ultrasound breast lesions showed statistical differences when differentiating benign and malignant lesions (p< 0.05). Binary logistic regression analysis found that the SWV values of the lesion interior and the surrounding glands were statistically significant. The joint predictors were calculated and analyzed by Receiver Operating Characteristic (ROC), and it was found that the joint predictors and the SWV values of the lesion interior have great diagnostic value. The cut-off value, sensitivity and specificity of the joint predictor and the SWV value of the lesion interior were > 3.65, 88.35% and 76.36% and > 5.55 m/s, 79.61% and 82.73%, respectively. CONCLUSIONS: Ultrasound elastography combined with multi-parameters has good diagnostic value in differentiating BI-RADS 4 breast lesions.

Impacts of COVID-19 on Chinese nationals' tourism preferences.

This paper examines the impacts of COVID-19 on Chinese nationals' tourism preferences. Employing a mixed-method research design, two rounds of nation-wide online surveys were conducted, one in February 2020 when COVID-19 cases started to peak in China and another one in June 2020 when COVID-19 was a global pandemic; both survey studies were accompanied with semi-structured in-depth interviews and altogether 37 interviews were conducted in two stages. Based on both quantitative survey data and qualitative interview data, the research identified that: 1) COVID-19 significantly reduced Chinese nationals' preferences to travel to countries with high infection numbers, and geographically faraway, administratively and culturally distant outbound destinations; 2) Chinese nationals reduced their preferences in all travel modes and most of the tourism forms, but most of them would prefer nature-based, rural, and cultural destinations after COVID-19; and 3) shortened trips in short travel distance are preferred after COVID-19. The findings offer rich insights and practical implications for governments, industry organisations, and tourism operators to formulate tourism recovery strategies toward Chinese tourists.

Zoledronate-induced acute anterior uveitis: a three-case report and brief review of literature.

PURPOSE: This three-case report aims to highlight the ocular adverse effects induced by bisphosphonate therapy and to call clinicians' attention. METHODS: Three cases of acute anterior uveitis secondary to the initial dose of zoledronate infusion were reported with focus on their symptoms, treatment regimens, and outcomes. A review of published reports provided a basis for discussion. RESULTS: Three cases of acute anterior uveitis were either bilateral or unilateral. They demonstrated typical manifestations of bisphosphonate-induced acute anterior uveitis such as eye pain, blurred vision, conjunctival and ciliary hyperemia, keratic precipitates, and flare in the anterior chamber. After topical corticosteroid-containing comprehensive treatments, these symptoms resolved completely without any vision loss and long-term sequelae. CONCLUSIONS: Acute anterior uveitis may be part of the acute phase reaction induced by zoledronate. Patients should be informed of its symptoms in advance and be monitored closely during and after administration. Clinicians should have a good awareness of the zoledronate-associated acute anterior uveitis and to treat it in a prompt and appropriate manner.

Value of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Papillary Thyroid Carcinoma Invasiveness.

OBJECTIVE: To evaluate the diagnostic performance of preoperative contrast-enhanced ultrasound (CEUS) in the detection of extracapsular extension (ECE) and cervical lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) and the added value of CEUS in the evaluation of PTC invasiveness to conventional ultrasound (US). MATERIALS AND METHODS: A total of 62 patients were enrolled retrospectively, including 30 patients with invasive PTCs (Group A, ECE or LNM present) and 32 patients with non-invasive PTCs (Group B). All patients underwent US and CEUS examinations before surgery. US and CEUS features of PTCs and lymph nodes were compared between groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US, CEUS, and the combination of the two in the detection of ECE and LNM of PTCs were calculated. Logistic regression was used to analyze relationships between variables. RESULTS: The PTC size was larger in group A on both US and CEUS (P = 0.001, P = 0.003). More PTCs showed hyper-enhancement in group A (P = 0.013) than in group B. More PTCs had >25% contact between PTC and the thyroid capsule and discontinued capsule on US and CEUS (all P < 0.05) in group A than in group B. More absent hilum and calcification of lymph nodes were observed in group A (both P < 0.05) than in group B on US. More centripetal perfusion and enlarged lymph nodes were observed in group A (both P < 0.05) than in group B on CEUS. CEUS alone and US combined with CEUS manifested higher diagnostic accuracy (79.0%) than US alone (72.6%) in the detection of ECE. The combination of US and CEUS manifested the highest diagnostic accuracy (95.2%) than CEUS alone (90.3%) and US alone (82.2%) in the detection of LNM. Diagnoses of ECE and LNM by the combination of US and CEUS were independent risk factors for PTC invasiveness [odds ratio (OR) = 29.49 and 97.20, respectively; both P = 0.001]. CONCLUSION: CEUS or US combined with CEUS is recommended for the detection of PTC ECE, while the combination of US and CEUS is most recommended for LNM detection. CEUS plays an essential role in the preoperative evaluation of PTC invasiveness.

Evolution of international tourist flows from 1995 to 2018: A network analysis perspective.

Tourist arrivals and tourism revenues have been extensively studied to evaluate international tourist flows, whereas the structure and evolution of these flows have received less attention. Based on international tourist arrival data from 221 countries/regions during the period 1995-2018, this study applies network analysis to explore the structure and evolution of international tourist flows, and the roles and functions of countries/regions in the international tourist flow network. The results of this study reveal that the network density of international tourist flows is increasing. Countries/regions in Europe, East Asia and North America generally occupy a significantly important position within the international tourist flow network, especially Germany and China. Those geographically close countries/regions demonstrate the same or similar roles and positions in international tourism. This study has significant implications for tourist destination management and marketing.

Contrast-Enhanced Ultrasound Evaluation of Renal Blood Perfusion Changes After Percutaneous Transluminal Renal Angioplasty and Stenting for Severe Atherosclerotic Renal Artery Stenosis.

This study used contrast-enhanced ultrasound (CEUS) to evaluate changes in renal cortical blood perfusion after percutaneous transluminal renal angioplasty and stenting (PTRAS) for severe renal artery stenosis (RAS) (≥70%). CEUS was performed in 21 patients with 24 severe RASs that underwent PTRAS. Renal cortical perfusion was quantitatively evaluated by comparing time intensity curve (TIC) parameters for SonoVue (Bracco, Milan, Italy) contrast enhancement, including peak intensity (PI), time to peak (TTP), mean transmit time (MTT), curve ascending slope (S), area under the curve (AUC), AUC-wash-in and AUC-wash-out. The parameters PI, TTP, MTT and S differed significantly between the pre-intervention and post-intervention TIC analysis (p < 0.05). Of the 24 pre-intervention curve appearances, 58.3% (14/24) improved after operation. The PI difference correlated positively with the estimated glomerular filtration rate difference (r = 0.433, p < 0.05). In conclusion, changes in some ultrasound perfusion parameters on CEUS and the shape of the TIC can be used to quantitatively and intuitively evaluate renal cortical blood perfusion change after PTRAS.

Real-time ultrasound elastography evaluation of achilles tendon properties in patients with mild hemiplegic stroke after rehabilitation training.

OBJECTIVE: This study aims to evaluate the Achilles tendon's properties after rehabilitation training in patients with stroke using real-time ultrasound elastography. METHODS: A total of 24 patients with mild hemiplegic stroke in the past 6 to 12 months and unilateral lower limb movement disorder were prospectively enrolled. All patients accepted 9-week rehabilitation training with the same schema. The 2-dimensional elastography and real-time elastography findings in the impaired and contralateral normal Achilles tendon were measured at pretraining and at 3, 6, and 9 weeks after training, which included tendon length, thickness, elasticity score (grade 1-3), and strain ratio of fat to tendon. The functional properties, which include the 10-meter walk test and timed up-and-go scores, were evaluated before and after the 9-week training. RESULTS: The impaired Achilles tendon had a longer length (P = .002), lower frequency of grade 1 (P = .012), and lower strain ratio (P = .009) than the contralateral tendon before training. The impaired tendons at the third, sixth, and ninth weeks after training were compared to ones before training, respectively, which revealed shorter length, increased frequency of grade 1, and increased strain ratio. The first statistically significant changes in the length were observed at the sixth week, while such changes in elasticity score and strain ratio were observed at the ninth week. CONCLUSIONS: Two-dimensional elastography and real-time elastography can provide valuable imaging markers for quantitatively evaluating the Achilles tendon's properties after rehabilitation training in patients with stroke.

Imaging and Screening of Thyroid Cancer.

Ultrasound is the first-line diagnostic tool for diagnosis of thyroid diseases. The low aggressiveness of many thyroid cancers coupled with high sensitivity of sonography can lead to cancer diagnosis and treatment with no effect on outcomes. Ultrasound is recognized as the most important driver of thyroid cancer overdiagnosis. Ultrasound should not be used as a general screening tool and should be reserved for patients at high risk of thyroid cancer and in the diagnostic management of incidentally discovered thyroid nodules. With prescreening risk stratification and application of consensus criteria for nodule biopsy, the value of the diagnostic ultrasound can be maximized.

[Early age-related macular degeneration treated with emayaoling acupuncture technique: a randomized controlled trial].

OBJECTIVE: To compare the differences in the clinical therapeutic effects on early age-related macular degeneration (AMD) in the treatment between emayaoling acupuncture technique and regular acupuncture. METHODS: A total of 110 patients of AMD were randomized into an observation group (55 cases, 73 eyes) and a control group (55 cases, 76 eyes). In the observation group, acupuncture was applied at Cuanzhu (BL 2) and Yiming (EX-HN 14). The needles were retained for 30 min. Additionally, Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23) were stimulated with quick needling technique. Emayaoling needling technique was applied. The needle was rotated with the thumb and index finger of the puncture hand, forward and backward. The strong and large amplitude were given when the thumb moved forward, and while, the week and small amplitude required when moving backward. The gentle movement was required in the entire procedure. In the control group, the point selection was same as the observation group. The points were stimulated with regular technique. The needle retaining time was same as the observation group. The treatment was given once every two days in the two groups and for 3 months continuously. The visit was followed up for 3 months. Before and after treatment, as well as at follow-up, the eyesight, the effect on macular area and the macular retinal structure [the macular nerve fiber layer (MNFL), retinal neurepithelium layer (RNL), pigment epithelium and choroid capillary composite lay (PECCL)] were evaluated separately. RESULTS: 1. After treatment and at follow-up, the eyesight was improved as compared with that before treatment in the two groups, indicating the significant difference (both P<0.05). The differences in comparison before and after treatment, and in comparison of the follow-up with that before treatment, were improved in a larger amplitude in the observation group as compared with the control group, indicating the significant difference (both P<0.05). 2. Regarding the therapeutic effects on macular area, after treatment and at follow-up, the total effective rates were 83.6% (61/73) and 86.3% (63/73) in the observation group and were 63.2% (48/76) and 67.1% (51/76) in the control group separately. The results in the observation group were higher than those in the control group, indicating the significant difference between the two groups (both P<0.05). 3. Regarding the macular retinal structure, after treatment and at follow-up, the levels of MNFL, RNL and PECCL were all reduced as compared with those before treatment, indicating the significant difference (all P<0.05). After treatment and at follow-up, the levels of MNFL, RNL and PECCL in the observation group were all lower than those in the control group, indicating the significant difference (all P<0.05). CONCLUSION: The emayaoling acupuncture technique achieves better clinical therapeutic effects on treatment of early AMD as compared with the regular acupuncture.

[Ultrasound-guided core needle biopsy on the thyroid nodules: the adequacy and the predicting factors for the nodule management].

OBJECTIVE: To explore the adequacy of the initial ultrasound-guided core needle biopsy (CNB) on the thyroid nodules and the potential factors for predicting the management of the nodules. METHODS: Retrospectively collected the subjects who underwent the CNB on the thyroid nodules within one year, with the inclusion criteria: (1) initial CNB on the thyroid nodules, (2) underwent the ultrasound scanning 1 month before the biopsy. The following data were recorded, which were the patient's age, sex, the lesion's sonographic findings (size, number, content, margin, echo, calcification, and internal vascularity), and histopathology. The CNB pathological diagnostic criterion was set up referring to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC). RESULTS: One hundred and fifty-seven patients with 162 nodules were enrolled, and the adequacy of the CNB was 97.5% (158/162, 95%CI 93.8%-99.3%). Referring to the BSRTC, of all the 153 nodules with determined management, 64 (64/153, 41.8%, 95%CI 34.0%-49.6%) were to be followed up only, and 89 (89/153, 58.2%, 95%CI 50.4%-66.0%) were to be undergone nodule excision. Three of the sonographic findings, including lesion margin, echogenicity, and internal vascularity, were significantly associated with the management of the nodules (P < 0.05), and the internal vascularity and margin were demonstrated as the independent factors for predicting the nodule excision by using the logistic regression model (Odds Ratio = 2.942, 2.767, P < 0.05). Only one case of moderate localized hematoma was observed in this series. CONCLUSION: As long as the specification of biopsy operation and pathology interpretation, the procedure of CNB on the thyroid nodules is safe with high adequacy as well. The sonographic margin and internal vascularity of the lesion are the independent factors for predicting the nodule excision.

[Logistic regression analysis of clinical and ultrasonic features of breast nodules].

OBJECTIVE: To create a breast nodule estimation model based on grayscale and color Doppler ultrasonography using Logistic regression that can screen out the specific features for distinguishing breast malignancy from benignancy. METHODS: From July, 2009 to May, 2010, 217 patients were enrolled in the study in peking university first hospital. Clinical data and ultrasonic features were evaluated in 219 breast nodules of 217 patients confirmed by surgical pathology. Logistic regression model was established to screen out significant ultrasonic indexes for differentiating breast malignancy from benignancy. A receiver operating characteristics curve was made to assess diagnostic value of the Logistic regression model. Correlation was analyzed between the Logistic regression model and surgical pathology. RESULTS: Logistic regression model: Logit(p) = -16.884 + 0.037 × age + 3.228 × longitudinal-transverse axis ratio + 1.412 × border + 2.663 × halo + 1.813 × microcalcium + 1.157 × resistance index + 2.204 × enlarged axillary lymph node (χ(2) = 167.107, P = 000). The areas of ROC curve for probability and identification of breast malignant and benign nodule were 0.948 and 0.882 respectively. Diagnostic sensitivity, specificity and accuracy were 91.6%, 84.9% and 88.9%. Logistic regression model positively correlated with surgical pathology (r = 0.768, P = 0.000). CONCLUSION: Our Logistic regression model can effectively differentiate malignant breast nodules from benign and can identify the ultrasonic features associated with breast cancer.