To investigate the ultrasonographic and clinicopathological features of follicular thyroid cancer (FTC).

Seventeen patients diagnosed with FTC in the Ultrasonography Department of Nanjing Gaochun people′s Hospital between June 15, 2019 and December 31, 2022 were included to summarize the characteristics of ultrasonography, histopathology and gene testing results after fine needle aspiration cytology (FNAC) examination.

The lesions in 17 patients had an average length diameter of (31.23±15.44)mm. Uneven echo and no microcalcification were visible on ultrasound. The maximum diameter of the mass exceeded than 25 mm in 76.47% (13/17) of the patients, 88.24% (15/17) of the patients could see the blood signal in the mass, 70.59% (12/17) of the patients had sparse blood signal, and 82.35% (14/17) of the patients had no surrounding sound halo. The patients received a focal elastic imaging score of (2.53±0.76) points. Histopathological findings revealed that the mass had invaded the capsule and extended outside of the capsule in each case. Immunohistochemical analysis showed that all instances were positive for thyroid transcription factor 1 (TTF) and negative for calcitonin. Nine individuals had the post FNAC gene mutation detection, while the B-Raf proto-oncogene serine/threonine kinase (BRAF) mutation was negative. In these patients, 6 patients had telomerase reverse transcriptase (TERT) gene mutation detection, of which 5 were positive.

Postoperative pathological examination is considered the gold standard for the diagnosis of FTC. However, the combination of FNAC and TERT detection can enhance the preoperative diagnostic accuracy of FTC.

To explore the diagnostic features of clear cell type oxyphilic adenoma of salivary gland in retroauricular lymph nodes.

The clinical and pathological data of a patient with clear cell type oxyphilic adenoma of salivary gland in retroauricular lymph node admitted to the Department of Otorhinolaryngology, the 928th Hospital of the Joint Support Force on January 21, 2022 were retrospectively analyzed, and the diagnostic characteristics were summarized combined with literature.

A 15-year-old female patient presented with a mass behind her left ear 3 years ago, whose size initially was like a " peanut" and subsequently enlarged to the size of a " quail egg". Physical examination found that the neoplasm was under the subcutaneous layer of the left ear, medium in texture, clear in boundary, and average in motion. Color Doppler ultrasound showed a solid mass, about 3.3 cm×2.8 cm in size, with clear boundary and uneven internal echo. There were no abnormalities in the bilateral parotid glands and thyroid glands. Chest and abdominal CT examinations showed no abnormalities. During the operation, it was found that the mass was located in the subcutaneous lymph node group behind the ear, about 0.5 cm away from the left parotid gland. Postoperative pathological examination showed that the tumor size was 4.0 cm×3.2 cm×2.6 cm, with a gray-red and yellow-white surface, irregular oval, complete capsule, a gray-yellow and gray-white section, and soft texture. HE staining showed eosinophilic epithelial cells with dense acinar proliferation, clear cells and foamy cells within the fibrous capsule, with residual lymphoid tissue space at the edge of the capsule. The nuclei of the tumor cells were centrally located, with few nucleoli and rare mitotic figures. The cytoplasm was abundant. Immunohistochemical staining showed positive for broad-spectrum cytokeratin (CK), a small amount of high weight molecular cytokeratin (HCK), and low weight molecular cytokeratin (LCK), while negative for P63, S-100, smooth muscle actin (SMA), Vimentin, renal cell carcinoma (RCC) marker, thyroglobulin (TG), P53, estrogen receptor (ER), progesterone receptor (PR), carcinoembryonic antigen (CEA), discovered on GST-1 protein (Dog-1), human epidermal growth factor receptor 2 (Her-2), carbohydrate antigen 125 (CA125), thyroid transcription factor-1 (TTF-1). The Ki-67 nucleoprotein positive rate was 1%-2%. The pathological diagnosis was a clear cell type oxyphilic adenoma of salivary gland in retroauricular lymph nodes.

The oxyphilic adenoma can occur in the lymph nodes located behind the ear, which may be related to heterotopic salivary glands in lymph nodes. It displays younger age and cell hyaline degeneration when compared to primary oncocytoma in the salivary gland. The clinical signs, histological traits, and immunohistochemical properties of this tumor must be meticulously coupled to make a diagnosis.

To explore the diagnostic characteristics of invasive stratified mucin-producing carcinoma (ISMC).

Retrospective analysis and a study of the literature were performed on the clinical data of a female cervical cancer with ISMC who was admitted to the Department of Gynecology at the Affiliated Hospital of Jining Medical University on September 9, 2021.

In a nearby hospital, the patient′s cervical cancer screening revealed human papilloma virus (HPV) 33 is positive, while thin-prep cytology test (TCT) showed atypical adenosine cells with no apparent significance. The cervix was big and firm, with a diameter of about 3 cm×4 cm, according to the gynecological examination. A cervical space-occupying lesion was discovered on a full-body CT scan of the abdomen, and a cervical biopsy revealed squamous cell carcinoma. After a transabdominal radical excision of cervical cancer, postoperative pathology reported a 2 cm×2 cm×1 cm ISMC that had infiltrated the wall of the cervical canal, and affected nerves. In the vascular canal, a tumor thrombus was discovered. P16(+ ), P63(+ ), cytokeratin 5/6 (CK5/6)(+ ), CK7(+ ), and nuclear proliferation-associated index (Ki-67) (+, >75%) were all detected by immunohistochemical labeling.

It′s simple to mistake ISMC for cervical squamous cell cancer. It was possible to distinguish between the two by using immunohistochemical staining.

To explore the clinical and imaging features of diabetic striatopathy(DS).

The clinical and imaging data of a patient with recurrent DS who was admitted to Department of Neurology of Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine on November 12, 2020, were analyzed retrospectively, and the literature was reviewed to summarize the disease's clinical and imaging features.

An eldly female patient was admitted for a 2 d dance-like movement on the left side of her upper limb. At the time of admission, the random venous glucose level was 38.62 mmol/L. Cranial CT revealed a high density shadow in the right basal ganglia, while cranial MRI revealed a high signal intensity in the right striatum on T₁WI, with no obvious abnormal signal on susceptibility weighted imaging (SWI). Insulin hypoglycemic therapy, fluid rehydration, electrolyte correction, and other symptomatic treatments such as anti-platelet aggregation, lipid-stabilizing plaque, improving circulation, nourishing brain cells, and regulating blood pressure were administered to the patient. A week later, blood glucose control had stabilized, and a cranial MRI revealed that the high signal intensity of the right striatum T₁WI had been reduced, and the symptoms had been improved. One month after discharge, the patient was readmitted to the hospital due to involuntary writhing of the left lower limb. A re-examination of the cranial MRI revealed a high T₁WI signal in the right striatum, a slight increase in blood glucose with high inflammatory markers, and infection of both lungs. After receiving hypoglycemic and anti-infection treatment, the patient′s lower limb symptoms resolved.

Patients with subacute unilateral dance-like dyskinesia, poorly controlled diabetes, contralateral striatum high density shadow, and T₁WI high signal on cranial CT and MRI should be evaluated for DS. Infection can also cause disease recurrence, and the imaging manifestations of the disease are reversible to some extent.

To explore the feasibility of utlizing ultrasonography in evaluating the level of clinical pain in patients with gout in the first metatarsophalangeal joint.

From March 2022 to April 2023, the clinical and ultrasound data of 109 gout patients treated at the Gout Department of Affiliated Hospital of Qingdao University, were evaluated retrospectively. Patients were separated into 4 groups based on their pain intensity: no pain (n=25), mild pain (n=25), moderate pain (n=31), and severe pain (n=28). The ANOVA or Kruskal-Wallis H test was used to compare measurement data differences between groups. The Chi-square test or Fisher exact probability approach was used to examine differences in count data between groups. To compare rank data, the Kruskal-Wallis H test was utilized. Spearman correlation analysis was used to examine the relationship between pain level and ultrasonic characteristics. The Kappa consistency test and intra-class correlation coefficient (ICC) were used to assess the consistency of ultrasound image assessment among radiologists.

All 109 patients were male, with an average age of (44.62±14.91) years old. Among the 4 groups, clinical stage (χ²=76.31, P<0.01), number of tophus-positive cases (χ²=14.39, P<0.01), number of tophi (H=55.39, P<0.01), color Doppler (CD) signal in the synovium (H=15.49, P<0.01), CD signal in tophi (H=11.26, P<0.05) and total CD signal score (H=20.64, P<0.01) were statistically different. CD signal of the synovium (r=0.30, P<0.01), CD signal of the tophi(r=0.35, P<0.01), and the total CD signal score (r=0.43, P<0.01) were positively correlated with the pain intensity.

Gout patients′ pain can be accurately assessed using color Doppler ultrasound. Color Doppler signals in synovium and tophi are connected to patients′ pain level. Blood flow signal grading should be provided in ultrasonography reports to help with clinical staging and treatment decision-making.

To investigate the value of radiomics nomogram based on coronary CT angiography (CCTA) in differential diagnosis of vulnerable plaques in patients with coronary artery disease (CAD).

From January 2018 to December 2022, 93 CAD patients who had undergone CCTA scans at the Affiliated Cardiovascular Hospital of Shanxi Medical University with complete data were enrolled. There were 95 non-calcified plaques, including 43 vulnerable plaques and 52 stable plaques. In an 8: 2 ratio, the lesions were randomly separated into a training set (n=76) and a testing set (n=19). To choose radiomics features appropriate for a CCTA-image-based radiomics signature, the Mann-Whitney U test, the correlation coefficient approach, and least absolute shrinkage and selection operator (LASSO) were used, and a radiomics score (Radscore) was created. Using clinical data and CCTA findings, a clinical model was constructed. Subsequently, the separate clinical parameters and Radscore were integrated to create a radiomics nomogram. The receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis were used to evaluate the performance of the radiomics signature, clinical model, and nomogram.

Finally, 13 best features with non-zero coefficients were selected. In the training and test sets, the AUC of the nomogram model combined with Radscore and clinical variables were 1.000 and 0.922, sensitivity were 1.000 and 1.000, specificity were 1.000 and 0.800, and accuracy were 1.000 and 0.895, respectively. The calibration curve demonstrated good agreement between expected and actual results. The decision curve analysis revealed that the nomogram had greater clinical application value compared to the clinical model.

Combined with clinical factors and imaging features, the radiomics nomogram can accurately and objectively identify vulnerable plaques, and has good diagnostic performance, which can be used to guide clinical decision-making.

To explore the construction of automatic classification model for the diagnosis of colorectal polyp based on deep learning.

From January 2018 to January 2023, 957 colonoscopy images were collected at 3 endoscopy centers in Suzhou (537 at Changshu NO.1 People′s Hospital, 359 at Changshu Hospital of Traditional Chinese Medicine, and 61 at the First Affiliated Hospital of Soochow University), by using various image enhanced endoscopy (IEE) techniques. Based on pathological features, these images were classified into normal group, hyperplastic polyps group, and adenomatous polyps group. By using the DenseNet-121, EfficientNet, ResNet101, and ResNet50 convolutional neural network (CNN) frameworks, deep learning models were constructed and tested against the performance of endoscopists with varied experience levels in terms of accuracy, recall rate, precision, F1 score, and time taken to read images.

EfficientNet outperformed the other models, with a 0.961 accuracy, 0.968 recall rate, 0.959 precision, and 0.962 F1 score. In terms of image reading time, all models significantly outperformed endoscopists, completing automatic diagnostic tasks in an average time of (4.08±0.63) seconds compared to the average time of (291.10±17.68) seconds required by endoscopists, showing a statistical difference (t=-36.22, P<0.01). The EfficientNet pretrained model, after transfer learning, was named " EffiPolypNet". It misclassified a few adenomatous polyps but achieved an accuracy of 0.90 and an AUC of 0.98. Visualization using t-distributed stochastic neighbor embedding (t-SNE) revealed semantic feature overlaps between adenomatous and hyperplastic polyps, which could account for the misclassifications. Gradient-weighted class activation mapping (Grad-CAM) and Shapley additive explanations (SHAP) elucidated the key image regions and relative importance of features in the model′s decision-making process.

The EffiPolypNet model outperformed other IEE techniques in categorizing the nature of colorectal polyps, offering efficient and dependable support for optical diagnosis in colonoscopy.

To explore the ultrasonographic features of fetal right aortic arch (RAA) in the first trimester.

The echocardiographic data of 12 fetuses with RAA in the first trimester who underwent standard fetal ultrasound examination and were confirmed by follow-up at Laizhou Maternal and Child Health Hospital from April 2019 to July 2022 were retrospectively analyzed, and the ultrasonic diagnostic characteristics of fetal RAA in the first trimester were summarized.

Twelve instances of RAA were observed. Among these, 8 cases were isolated RAA, and 4 cases presented with other intracardiac and extracardiac abnormalities. Three cases underwent genetic testing, 2 cases of which resulted in normal results, and 1 case of which revealed a confirmed 22q11 microdeletion. By using three vessels and trachea (3VT) view, the aortic arch of the 12 cases was located to the right of the trachea, and the distance between the ductus arteriosus and the aortic arch of the 9 cases was widened. Nine cases combined RAA with U-shaped vascular rings created by the malformed left subclavian artery and the left ductus arteriosus. Three fetal RAA cases with mirror branches on the brachiocephalic arteries (1 case without ductus arteriosus, 1 case with left ductus arteriosus, and 1 case with right ductus arteriosus) did not develop vascular rings. Two cases revealed a single artery arch (the aortic arch), while 1 case revealed the right " V" sign by using 3VT view. Eleven cases showed increased angle between aortic arch and aortic ascendens in the left ventricular outflow tract (LVOT) view of non-standard. Eight of the 12 cases were confirmed by fetal echocardiogram in the second trimester and postnatal echocardiography, and 4 cases were confirmed by autopsy.

Fetal RAA has the characteristic ultasonographic appearances in the first trimester. It is of great significance to grasp the prenatal ultrasonographic features for the early detection and diagnosis of fetal RAA.

To investigate the ultrasonic diagnostic characteristics of persistent median artery and median nerve double branch variation.

Retrospective analysis of the clinical and ultrasound image characteristics of 7 patients with persistent median artery and median nerve double branch variation treated at Ultrasound Department of the Affiliated Hospital of Jining Medical University between January 1, 2018, and December 31, 2022 was performed. Three of them were found surgically. The ultrasonic diagnostic characteristics of the persistent median artery and median nerve double branch variation were summarized.

The majority of the 7 patients′ clinical complaints were forearm or wrist pain and discomfort, frequently accompanied with radial finger numbness. The ultrasonic diagnostic characteristics were as follows: the forearm showed abnormal pulsating tubular anecho, accompanied by the median nerve, the median nerve changed into two bundles of hypoecho, and there was an independent hyperechoic outer nerve membrane, both of which entered the carpal tunnel in parallel, and the median nerve entrapment can be seen in the carpal tunnel, and the anteroposterior diameter of the compression site was 1.6 mm-1.9 mm, and the proximal middle nerve was swollen and enlarged, and the anteroposterior diameter increased to 2.8 mm-3.5 mm. Surgery on 3 patients revealed different degrees of median nerve entrapment in the carpal tunnel and confirmed that the median nerve had swollen during the procedure. The forearm segment was split into two branches that entered the carpal tunnel with the permanent median artery.

Ultrasound examination of the persistent median artery and double branches of the median nerve has clear diagnostic characteristics, which has important guiding significance for clinical diagnosis.

To investigate the prenatal ultrasonic diagnostic features of amniotic band syndrome (ABS) in early pregnancy.

The prenatal ultrasound data of a case of a 13⁺⁶-week-old fetus with ABS, who was confirmed by induced abortion at the Ultrasound Department of Laizhou Maternity and Child Healthcare Hospital on January 7, 2020, were retrospectively analyzed, and the literature was reviewed.

The prenatal ultrasonic diagnostic features of ABS in early pregnancy included limited movement of the left upper limb and feet of the fetus, absence of the right upper limb. In the amniotic cavity multiple slender linear echoes of the amniotic band and the contiguous amniotic sheets were detected, which were connected to the ends of the left finger and both toes respectively.

Grasping the prenatal ultrasonographic features of ABS in the first trimester may be helpful in improving the eally detection and diagnosis.

To explore the diagnostic characteristics of anti-dipeptidyl-peptidase-like protein 6 (DPPX) antibody associated encephalitis.

A retrospective analysis was conducted on the past and current clinical data of a patient with serum anti-DPPX antibody positive admitted to the Neurology Department of Inner Mongolia Baogang Hospital on June 25, 2021. The diagnostic characteristics of anti-DPPX antibody related encephalitis were summarized and relevant literatures were reviewed.

The patient, a 53 year old male, was hospitalized due to progressive blindness in the right eye for 10 days. Ophthalmic examination showed that the pupils of both sides had unequal sizes, 3.0 mm on the left side and 4.0 mm on the right side, and the direct and indirect light reflection of right eye disappeared. Light perception of right eye disappeared, and the vision of the left eye was 0.4. The fundus, macular area and fundus fluorescein showed no abnormality. Visual evoked response in the right eye was not elicited. No new infarctions or occupying lesions were found on cranial MRI. The dynamic electroencephalogram was generally normal. Serum anti-DPPX antibody + + (diluted at 1∶20 titers), all other N-methyl-D-aspartic acid (NMDA) receptors encephalitis antibodies were negative. The remaining items of the cerebrospinal fluid examination were generally normal. During hospitalization, nutritional nerve therapy was given, and after 6 days of hospitalization, the lower field of vision and light perception recovered and there was a sense of light. The discharge diagnosis was anti-DPPX antibody encephalitis. The patient was admitted to the hospital for treatment on March 8, 2018 due to left limb strength. At the time of admission, a neurological examination showed that the left limb strength was level 4, with reduced pain sensation in the left upper limb and negative results on other examinations. Complete cranial MRI showed no new infarctions. Neck MRI showed a intramedually mass at the C5/6 level of the neck, diagnosed as astrocytoma. No special treatment was given, and only self rehabilitation exercise was performed. In March 2020, the left limb strength and sensation fully returned to normal.

The patient with anti-DPPX antibody encephalitis in this case started with weak unilateral limb strength, and both clinical symptoms showed varying degrees of self relief, further proving that the disease may exhibit self-limiting characteristics.

To explore diagnostic features of Kawasaki disease shock syndrome (KDSS) complicated with reversible splenial lesion syndrome (RESLES).

The clinical data of a pediatric patient with KDSS complicated with RESLES diagnosed in Women and Children′s Hospital, Qingdao University in May 25, 2022 were retrospectively analyzed. The diagnostic features of KDSS with RESLES were summarized and relevant literatures were reviewed.

The 11-year-old boy was admitted to hospital because of dizziness, fever for 2 days and delirium once. On admission, his blood pressure was normal, but his cervical lymph nodes were enlarged, and he had positive neck resistance. In terms of laboratory tests, C-reactive protein level and erythrocyte sedimentation rate increased while serum sodium level decreased. Following admission, he was treated with anti-infection and nerve nourishment medications. On the third day, conjunctival congestion, rashes, bayberry tongue, red lip chapping, red swelling of hands and feet were appeared, which were associated with Kawasaki disease (KD). MRI of the head showed the splenium of the corpus callosum with slightly decreased T₁ and slightly increased T₂ signals in the pressure area, with high signal intensity on DWI. Based on these findings, he was diagnosed with RESLES. On the fourth day, hypotension was observed. Meanwhile, ultrasonography revealed that the motion of the left ventricular wall of the heart was slightly diminished, with multiple serosal effusions. KDSS was diagnosed and treated with dobutamine to raise blood pressure and glucocorticoid for anti-inflammatory, and fluid for resuscitation, after which shock was reversed and KD-related symptoms gradually faded within ten days. On the 14th day, cranial MRI revealed that the aberrant signal had disappeared. Literatures were searched from CNKI, Wanfang, VIP and PubMed databases until December 31, 2023, and a total of 14 literatures were retrieved, including 12 foreign literatures and 2 Chinese literatures. A total of 19 children were reported, of which 2 were Chinese. One was definitely reported to have hypotension.

KD complicated with RESLES is rare in children, the clinical symptoms are varied and atypical, the corpus callosum injury is reversible, and the prognosis is good after active treatment. Increasing awareness of this condition can improve physicians′ diagnostic abilities and provide early standardized treatment for the patient.

To investigate the association between serum potassium/hypokalemia and electrocardiographic left ventricular hypertrophy (ECG-LVH) in patients with hypertension or primary aldosteronism (PA).

A retrospective analysis was performed in 1 107 patients with hypertension admitted to the Hypertension Center of Xinjiang Uygur Autonomous Region People′s Hospital between January 2010 and January 2014, who underwent standardized PA screening and simultaneously measured blood potassium and electrocardiogram, and 177 patients were diagnosed with PA. Logistic regression analysis was used to evaluate the association between serum potassium/hypokalemia and ECG-LVH in patients with hypertension or PA. Area under the operating characteristic curve (AUC) was used to assess the accuracy of serum potassium/hypokalemia to predict the ECG-LVH risk.

Serum potassium (OR=0.482, P=0.033) and hypokalemia (OR=1.819, P=0.033) were respectively associated with ECG-LVH, independent of blood pressure, renin activity, and aldosterone-to-renin. And in PA patients, these associations were significantly independent of systolic blood pressure [(OR=0.070, P=0.004) and (OR=6.472, P=0.007)], respectively. Moreover, serum potassium can screen for ECG-LVH risk with AUCs of 0.607 and 0.784 in patients with hypertension or PA. When serum potassium <3.28 mmol/L in patients with PA, the predict value of ECG-LVH risk were high, with sensitivity and specificity of 71.4% and 89.6%, respectively.

Both serum potassium and hypokalemia are independently associated with ECG-LVH, regardless in patients with hypertension or PA. Especially in patients with PA, hypokalemia is associated with cardiac hypertrophy.

To explore the diagnostic characteristics of contrast-enhanced ultrasound for endoleak and left perirenal hematoma after endovascular repair of abdominal aortic aneurysm.

Retrospective analysis of the clinical information of a patient with endoleak and left perirenal hematoma following endovascular repair of abdominal aortic aneurysm at the Cardiovascular Surgery Department of the Air Force Medical Center on May 6, 2022 was performed. The advantages of contrast-enhanced ultrasound in the diagnosis of endoleak were discussed, supported by relevant literature.

A 54 year old male patient was admitted with complains of intermittent chest tightness, shortness of breath, and discomfort that had been present for 1 year and worsened for 1 week. Two years ago, the patient was found to have abdominal aortic aneurysm and underwent endovascular aneurysm repair. The general condition of the patient was poor after surgery. Conventional ultrasound showed aneurysmal dilatation of the abdominal aorta with stent echo, while color Doppler ultrasound showed red and blue vortex signals within the aneurysm. There was a hypoechoic mass in the left kidney, and color Doppler showed no obvious blood flow signal in it. Ultrasound contrast examination revealed that no obvious microbubbles entered the left perirenal mass. A microbubble entered the upper half of the perivascular mass around the left lateral wall at the upper end of the abdominal aortic stent and returned to the stent on the right lateral wall. Left perirenal hematoma detected on ultrasound, but no visible signs of ongoing bleeding. Active leakage (I a type endoleak) was visible in the tumor body following stenting for abdominal aortic aneurysm. Abdominal CT indicated the formation of an intramural hematoma at the aneurysm site, with encapsulated fluid accumulation in the left posterior kidney behind the peritoneum (considered a hematoma). The position of the sent was normal, and no abnormal density shadow was found.

For patients with endoleak after endovascular aneurysm repair, contrast-enhanced ultrasound can observe the endoleak site in real time, which makes up for the shortcomings of conventional ultrasound and the lack of dynamic monitoring of enhanced CT, and provides accurate and effective imaging basis for the diagnosis of endoleak.