Summary:The simultaneous occurrence of parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma is exceptionally rare. Herein, we present an uncommon case in which the right malignant parathyroid lesion was 99mTc-MIBI-negative and the contralateral benign parathyroid lesion was 99mTc-MIBI-positive, which was confirmed by pathological examination postoperatively. In addition, we performed bilateral internal jugular venous sampling of PTH (IJ PTH), and the results showed that the IJ PTH was higher on the side of 99mTc-MIBI-negative lesion than on the other side. These findings suggest that 99mTc-MIBI-negative lesions with ipsilateral high IJ PTH should be highly suspected of parathyroid carcinoma in the setting of patients with two suspicious parathyroid lesions detected by cervical ultrasonography or computed tomography. No germline mutations associated with hereditary endocrine tumors were identified by whole-exome sequencing. Learning points:Parathyroid carcinoma can appear negative on 99mTc-sestamibi scintigraphy; therefore, comprehensive evaluation with both ultrasound and computed tomography is essential. In cases with discordant imaging and multiple lesions, bilateral internal jugular venous parathyroid hormone sampling serves as a decisive adjunct to guide en bloc resection when carcinoma is suspected. Preoperative evaluation for concurrent thyroid nodules is recommended during parathyroid surgery planning to avoid the need for secondary neck procedures.

Parathyroid carcinoma (PC) and atypical parathyroid tumor (APT) are rare malignant lesions characterized by high recurrence and metastasis rates, and accurate preoperative diagnosis remains a clinical challenge. The purpose of this study was to explore the diagnostic value of preoperative grayscale ultrasound combined with shear wave elastography (SWE) for such lesions. In this retrospective case-control study, patients with primary hyperparathyroidism and suspicious parathyroid abnormality on ultrasonography were recruited. All the lesions were assessed by SWE before surgery. Sonographic features and SWE performance along with demographic and related clinical parameters between PC/APT and PA groups were analyzed. This study included 21 patients with PC or APT matched to 84 patients with PA who underwent parathyroid surgery. The best subset selection method and multiple logistic regression analysis identified the sonographic features of intra-nodal fibrous bands and the ratio of mean shear wave velocity in tumor (SWVmean)/shear wave velocity in thyroid parenchyma (SWVth) as independent factors for PC/APT prediction (odds ratio [OR] = 38.536, 95

For the wear of rolling bearings, this paper establishes a wear model of angular contact ball bearings based on the proposed static mechanics of rolling bearings, kinematics of rolling bearings and Archard's wear theory, studies the wear of bearings, and analyses the effects of rotational speed, load and structural parameters on the wear of bearings. The results show that: the inner ring of the bearing is uniformly worn and the depth of wear is larger than the outer ring; the depth of wear of the inner ring of the bearing increases with the increase of rotational speed, the load has a certain effect on the depth of wear, the depth of wear increases with the increase of axial load; the structural parameters of the bearings have a certain effect on the wear, the depth of wear of the inner ring decreases with the increase of the radius of curvature of the internal grooves, the radius of curvature of the internal grooves has a small effect on the outer ring wear, and the selection of appropriate structural parameters can effectively reduce the wear of the bearings, the wear of the bearings can be reduced. Selection of appropriate structural parameters can effectively attenuate the wear.

Ectopic parathyroid carcinoma (EPC) is a rare clinical entity with multiple diagnostic pitfalls, making surgical cures challenging. We assessed the clinicopathological spectrum and outcome of EPCs. In this retrospective cohort study, 24 EPCs were identified from 133 PC patients treated at a tertiary referral center. The relationship between clinicopathological findings and locations was analyzed. The locations of EPCs were predominantly intrathyroidal (62.5

Purpose Accurate preoperative localization of tumor-bearing lesions is crucial for the successful surgical management of suspected recurrent parathyroid carcinoma. The purpose of this study was to evaluate the diagnostic value of 99m-technetium-labeled methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) and cervical ultrasound, individually and in combination, for preoperative localization of recurrent/metastatic lesions. We also analyzed the value of 99mTc-MIBI SPECT/CT in detecting ectopic lesions in patients with suspected recurrent parathyroid carcinoma. Methods Twenty-nine patients with suspected recurrent parathyroid carcinoma were included in this retrospective cohort study. Patients underwent preoperative 99mTc-MIBI SPECT/CT and cervical ultrasound. The reference standard was postsurgical histopathology. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy of the two diagnostic modalities alone and in combination were analyzed. Results Of the 29 patients, histopathological results revealed 48 metastases/recurrent lesions in 26 patients. The diagnostic value of 99mTc-MIBI SPECT/CT, cervical ultrasound, and the two modalities in combination were compared for the 27 patients who underwent new cervical surgery. Patient-level analysis of the combined use of 99mTc-MIBI SPECT/CT and cervical ultrasound had the highest sensitivity (100.00%) and accuracy (96.30%). At the lesion level, 99mTc-MIBI SPECT/CT had the highest specificity and PPV, at 100.00% respectively, whereas the combined use of 99mTc-MIBI SPECT/CT and cervical ultrasound had the highest sensitivity, at 97.62%. Moreover, 99mTc-MIBI SPECT/CT detected six ectopic lesions, and five of them showed increased 99mTc-MIBI uptake. Conclusions The combined use of 99mTc-MIBI SPECT/CT and cervical ultrasound is the most efficient strategy in the diagnosis of parathyroid carcinoma relapse, whereas 99mTc-MIBI SPECT/CT is the preferred method for localizing and analyzing cervical and extra-cervical lesions before the new surgery.

BACKGROUND:According to published guidelines, gynecologic surgical patients should be stratified into different risk level groups to receive prophylaxis for venous thromboembolism (VTE), but the applicability of available risk assessment models (RAMs) in common gynecologic surgical patients remained to be confirmed. We aimed to validate the use of the Caprini RAM and gynecologic Caprini (G-Caprini) RAM for assessing postoperative VTE risk in gynecologic surgical patients.METHODS:The database of a randomized controlled trial (RCT) was used to select patients who underwent gynecologic surgeries for benignant and malignant diseases in five institutions in China between 2011 and 2018. The Caprini RAM version recommended by the American College of Chest Physicians (ACCP) was adopted. Participants were divided into four risk levels based on the Caprini and G-Caprini scores. For each risk level group, the incidence of VTE was calculated. The correlation between VET incidence and risk levels was assessed by Spearman's rank correlation coefficient (RS) value.RESULTS:As a result, 800 patients in the data base were analyzed with an overall VTE incidence of 5.8%. Caprini RAM showed that the percentage of patients at very low risk, low risk, moderate risk, and high risk were 0%, 4.3%, 44.4%, and 51.4%, respectively, and the VTE incidence was 2.9%, 2.3%, and 9.0%, respectively. RS value between the risk stratification and VTE incidence was 0.500 (P=0.667). G-Caprini RAM showed that the percentage of patients at very low risk, low risk, moderate risk, and high risk were 7.8%, 28.0%, 32.0%, and 32.3%, respectively, and the VTE incidence was 0.0%, 2.9%, 2.3%, and 9.0%, respectively. RS value between the risk stratification and VTE incidence was 1.000 (P<0.01).CONCLUSIONS:The G-Caprini RAM was as suitable as the Caprini RAM for VTE risk assessment in gynecologic surgical patients. The gynecologic model has the advantages of ease of use and more accurate identification of low-risk groups.

Aim Intrathyroidal parathyroid adenoma (IPA) is rare and may easily be mistaken for thyroid nodule in ultrasonography. The aim of this study was to investigate the characteristic features of IPA and explore the value of preoperative and intraoperative ultrasound in the diagnosis and localization of IPA. Methods 13 of 216 patients who were found to have intrathyroidal parathyroid lesions underwent parathyroidectomy in our hospital because of PHPT. According to the relationship between parathyroid adenoma and thyroid gland, parathyroid adenoma was divided into extra-thyroid type or intra-thyroid type (partial or complete) and the results were compared with surgical and histopathological reports as gold standard. The sonographic features of intrathyroidal parathyroid lesions were analyzed retrospectively. Results A total of 12 intrathyroidal lesions showed profoundly hypoechoic solid nodules with well-defined border, abundant blood flow and polar feeding vessels originating from the superior or inferior thyroid artery (92.3%, 12/13). These nodules were finally confirmed as IPA (or IPAC) after surgery. Polar feeding vessel was not detected in one case of parathyroid hyperplasia confirmed by pathology (7.7%, 1/13). 12 cases were diagnosed and localized on ultrasonography before operation and 10 cases were localized on Tc-99m MIBI SPECT/CT. Conclusions The color Doppler ultrasound findings of IPA were confirmed as profoundly hypoechoic nodules with clear boundary and abundant internal blood flow. The presence of polar feeding vessels which originate from thyroid artery were identified as characteristic features of US for IPA. Preoperative and intraoperative ultrasound could be helpful in the localization and treatment of intrathyroidal parathyroid diseases.

Abstract Background Primary hyperparathyroidism (PHPT) results from an excess of parathyroid hormone (PTH) produced from an overactive parathyroid gland. The study aimed to explore the sonographic features of parathyroid adenomas and assess the diagnostic performance of ultrasonography (US) and Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid adenomas. Methods A total of 107 patients were enrolled in this retrospective study who had PHPT and underwent parathyroidectomy. Of the 107 patients, 97 performed US and Tc-99m MIBI SPECT/CT examinations for preoperative localization of parathyroid nodules. The sensitivity and accuracy of each modality were calculated. Results In this study, residual parathyroid sign and polar vascular sign were identified as characteristic US features of parathyroid adenomas. These manifestations were closely related to the size of the abnormal parathyroid lesions. Among the 108 parathyroid nodules from 97 patients with PHPT, the sensitivity and accuracy of US for locating the parathyroid nodules were significantly higher than those of Tc-99m MIBI SPECT/CT (93.0% vs. 63.0% and 88.0% vs. 63.0% respectively; χ2 = 26.224, 18.227 respectively, P < 0.001). The differences between US + Tc-99m MIBI SPECT/CT and Tc-99m MIBI SPECT/CT-alone were statistically significant (χ2 = 33.410, 21.587 respectively, P < 0.001), yet there were no significant differences in the sensitivity or accuracy between US + Tc-99m MIBI SPECT/CT and US-alone (χ2 = 0.866, 0.187 respectively, P = 0.352 and 0.665). Conclusions US shows significantly better sensitivity and accuracy for localization of parathyroid adenomas than Tc-99m MIBI SPECT/CT. However, US combined with Tc-99m MIBI SPECT/CT is of great clinical value in the preoperative localization of parathyroid nodules in patients with PHPT.

目的 分析原发性甲状旁腺功能亢进症(PHPT)甲状旁腺病变声像图特征.方法 对临床诊断为PHPT的107例患者术前采集超声图像,以手术切除后病理作为金标准,探讨PHPT的声像图特征.结果 对术后病理明确诊断为甲状旁腺病变的107个结节绘制ROC曲线,曲线下面积分别为0.670和0.675,与0.05相比有统计学差异(P=0.005、0.001),故当结节最大直径≤1.55 cm时,残余甲状旁腺征预测甲状旁腺病变的灵敏度和特异度分别为63.0％和63.9％;当结节最大直径≥1.35 cm时,极性供支血管征预测甲状旁腺病变的灵敏度和特异度分别为79.0％和55.6％;当两种征象同时显示时,联合灵敏度和特异度分别为92.2％和35.5％.结论 残余甲状旁腺征及极性供支血管征是PHPT时甲状旁腺病变的特征性的声像图改变,且此两种征象的显示与甲状旁腺病变的大小密切相关.

探讨颈动脉粥样硬化斑块患者采用超声超微血管成像(SMI)技术检测斑块内新生血管形成的临床价值.选取经彩色多普勒颈动脉超声检查确诊的100例颈动脉粥样硬化患者作为研究对象,所有纳入对象均接受SMI、超声造影(CEUS)检查,以CEUS检查结果作为判断标准,计算SMI检测结果与CEUS结果的一致性.颈动脉彩色多普勒超声检出低回声斑块的平均厚度为(3.22±1.07)mm,平均斑块长度为(11.60±3.31)mm;混合回声斑块的平均厚度为(3.50±1.21)mm,平均斑块长度为(17.32±4.16)mm;SMI技术检出分级与CEUS分级的一致性kappa值为0.516,P=0.000;Spearman R=0.704,P=0.000;SMI技术检出分级与CEUS分级具有较高的一致性和相关性.SMI技术检测颈动脉粥样硬化斑块内新生血管形成与CEUS结果具有较高的一致性和相关性,可以作为一种无创、快速、方便的检测手段应用于临床.

PURPOSE:To explore the application value of SMI scoring assignment method combined with 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) in differentiating benign and malignant thyroid nodules.METHODS:According to the 2017 ACR TI-RADS classification, the enrolled nodules were divided into 3 points group, 4 points group, 5 points group, 6 points group and≥7 points group. The nodules were assigned scores according to the echocity of the nodules and the microvessels detected by SMI and their distribution patterns based on ACR TI-RADS. Accompany with the scores increased or decreased after assignment, the thyroid nodules were re-grouped.RESULTS:The AUC after the scores assignment is better than before (Z = 3.881, P < 0.001). The specificity, positive predictive value and accuracy after score assigned are better than those of before (Z = 8.323, P < 0.001; Z = 8.619, P < 0.001; Z = 5.345, P < 0.001), there is no statistical difference in sensitivity before and after score assigned (Z = -0.513, P = 0.60), and the negative predictive value before assigned score is better than that of after (Z = -3.826, P < 0.001).CONCLUSION:The diagnostic efficacy after scoring was better than that of before.

目的 探讨剪切波弹性成像(SWE)技术评价糖尿病周围神经病变(DPN)患者胫神经改变的价值.方法 选取30例临床诊断为2型糖尿病伴周围神经病变患者[DPN(+)组]、30例2型糖尿病不伴周围神经病变患者[DPN(-)组]及30名健康志愿者(对照组),应用二维超声及SWE测量并比较3组双下肢远端胫神经横截面积(CSA)及弹性模量均值(Emean).分析2型糖尿病患者胫神经CSA、运动神经传导速度(MCV)及DPN(+)组患者疼痛视觉模拟量表(VAS)评分与Emean的相关性.绘制Emean诊断DPN的ROC曲线.结果 3组间胫神经CSA、Emean总体差异有统计学意义(P均＜0.01),两两比较差异均有统计学意义(P均＜0.01).2型糖尿病患者胫神经CSA与Emean呈正相关(r=0.64,P＜0.05),胫神经MCV与Emean呈负相关(r=-0.70,P＜0.05);DPN(+)组患者VAS与Emean呈正相关(r=0.82,P＜0.05).胫神经Emean诊断2型糖尿病患者DPN最佳截断值为47.4 kPa,敏感度为94.2％,特异度为80.0％.结论 2型糖尿病患者胫神经硬度增加;弹性模量值可作为诊断DPN的参考指标.

Objective:To explore the value characteristics of preoperative and intra-operative ultrasound in the diagnosis and treatment of parathyroid adenoma,and to further clarify the value of ultrasound in the diagnosis and treatment of parathyroid adenoma.Method:A total of 62 cases of parathyroid adenoma confirmed by postoperative pathology from March 2016 to November 2017 were collected, and the pre-operative ultrasound parameters were analyzed;and 26 cases were detected by intra-operative ultrasound.Result:In 62 cases of parathyroid adenoma, 58 cases of parathyroid adenoma were diagnosed by ultrasound before operation,and the sensitivity was 93.54%. Among the 26 cases,the lesions of 24 cases were detected by intra-operative ultrasound,and the sensitivity was 92.31%.Conclusion:Preoperative ultrasonography has a high diagnostic value for the qualitative diagnosis and location diagnosis of parathyroid adenoma, and intra-operative ultrasound can help to detect lesions quickly and safely, which is of great significance to shorten the operation time and improve the safety of operation. It is an important development space of ultrasound in the diagnosis and treatment of parathyroid glands.

ObjectivesTwo-dimensional (2D) shear wave elastography (SWE) can measure the elasticity of skeletal muscle, tendons, and ligaments. Three-dimensional (3D) SWE has been used to detect breast cancer but has not been applied to the musculoskeletal system. This study aimed to investigate whether 3D SWE could be used in skeletal muscles in vivo. MethodsThe study enrolled 20 healthy volunteers at Beijing Chaoyang Hospital from August to October 2016. Two-dimensional and 3D SWE scans were used to measure the Young modulus of the flexor carpi radialis in the relaxed state. Longitudinal and transverse scanning was performed. Data were analyzed by a 1-way analysis of variance/least significant difference post hoc test, a paired t test, and Bland-Altman plots. ResultsThe participants included 10 male and 10 female volunteers with a mean ageSD of 25 +/- 5 years. The Young modulus did not differ between 3D and 2D SWE for the sagittal plane (longitudinal scanning, 34.9 +/- 5.7 versus 32.7 +/- 5.2 kPa; P=.096) or transverse plane (transverse scanning, 9.1 +/- 2.1 versus 9.2 +/- 1.6 kPa; P=.877). The Young modulus did not differ between sagittal, transverse, and coronal planes for 3D SWE longitudinal scanning (34.9 +/- 5.7, 34.3 +/- 5.8, and 34.8 +/- 5.9 kPa, respectively; P=.936) or 3D SWE transverse scanning (9.1 +/- 2.0, 9.1 +/- 2.1, and 8.8 +/- 2.1 kPa; P=.838). However, the Young modulus for each individual plane (sagittal, transverse, or coronal) differed significantly between longitudinal and transverse scanning (P<.001). ConclusionsBoth 2D SWE and 3D SWE are suitable techniques for clinical use, depending on the examiner's experience/preference. However, 3D SWE provides a multiplanar/multislice view that better illustrates the spatial characteristics of muscle tissue. Three-dimensional SWE may be a new method for fully visualizing the musculoskeletal system.

Objective To explore the value of ultrasound-guided biopsy(USGB)in diagnosing benign or malignant masses.Methods The clinical and pathological dates were retrospectively analyzed from 343 patients who had underwent USGB for suspected malignant masses in our hospital. The success rate of USGB,sensitivity,specificity,misdiagnostic rate,missed diagnostic rate,positive predict value,negative predict value,Youden index(YI),positive likelihood rate,negative likelihood rate and Kappa value were calculated.Results A total of 343 lesions in 343 cases,325 lesions were definitely diagnosed and the success rate of USGB was 94.75%(325/343).Confirmed by postoperative pathology,202 lesions were diagnosed as malignant and 141 as benign.10 lesions were misdiagnosed,14 lesions were missed diagnosed,and the accuracy was 93.00%(319/343). The sensitivity,specificity,misdiagnostic rate,missed diagnostic rate,positive predict value,negative predict value,YI,positive likelihood rate and negative likelihood rate of USGB were 93.07%(188/202),92.91%(131/141),7.09%(10/141),6.93%(14/202),94.95%(188/198),90.34%(31/145),85.98%,13.12 and 0.07,respectively.The consistency of USGB and gold standard was great(Kappa=0.86).Conclusion USGB has significant value in clinical diagnosis and guiding treatment,with high puncture success rate,high accuracy in diagnosis and great consistency with gold standard.

Background: Superb microvascular imaging (SMI) for depiction of microvascular flow in thyroid nodules was compared with color/power Doppler imaging (CDI/PDI) and contrast-enhanced ultrasonography (CEUS). In addition, the diagnostic performance of conventional ultrasound combined with SMI for differentiating benign and malignant thyroid nodules was evaluated. Methods: Preoperative conventional ultrasound consisting of gray-scale ultrasonography and CDI/PDI, followed by SMI and CEUS, was used to record 52 thyroid nodules. Two radiologists analyzed the gray-scale ultrasound signs and nodules' microvascular flow patterns to differentiate between benign (n = 13) and malignant nodules (n = 39). Results: SMI was significantly more effective in the detection of microvascular flow signals than CDI/PDI. In malignant nodules, SMI depicted the presence of incomplete surrounding periphery microvasculature and of disordered heterogeneous internal microvasculature. Benign nodules showed complete surrounding periphery microvasculature (ring sign) and homogeneity internal branching. The accuracies of conventional ultrasound combined with CDI/PDI, SMI, or CEUS for predicting malignancy were 67.31, 86.54, and 92.31%, respectively. The accuracy of SMI differed significantly from CDI/PDI (P = 0.012), but not from CEUS (P = 0.339). Conclusions: Microvascular flow and vessel branching in the peripheral and internal microvasculature of thyroid nodules is depicted with greater detail and clarity with SMI compared with conventional ultrasound. SMI offers a safe and low-cost alternative to CEUS for differentiating between benign and malignant thyroid nodules.

Objective To compare the difference between color Doppler flow imaging (CDFI) and superb microvascular imaging (SMI) in the evaluation of vascular grading and the display rate of vascular in papillary thyroid carcinoma (PTC).Methods Between June 2015 and December 2015 in Beijing Chaoyang Hosptial,50 patients with 61 thyroid nodules were detected by ultrasonography,and pathologic types were confirmed as PTC.CDFI and SMI were used to evaluation the same nodule respectively according to Adler's grading criteria.The different flow characteristics were analyzed by the x2 test.Results In CDFI,the vascular grading of 33 patients were 0 ～ Ⅰ and these of 28 patients were Ⅱ ～Ⅲ by CDFI.In SMI,the vascular grading of 6 patients were 0 ～ Ⅰ and these of 55 patients were Ⅱ ～Ⅲ by SMI.There was a significant difference between CDFI and SMI for vascular grading (x2=27.475,P ＜ 0.01).In CDFI,50 patients with PTC showed punctiform and rod-like flow signals,and 5 patients showed more detail internal small branches by CDFI.In SMI,42 patients with PTC showed punctiform and rod-like flow signals,and 17 patients showed more detail internal small branches.There was a significant difference between CDFI and SMI about the display rate of vascular (x2=7.011,P ＜ 0.01).Conclusions Compared with CDFI,SMI is highly improved blood flow sensitivity.It can provide more detail internal small branches in PTC.The characteristics of vascular distribution are similar to strengthening mode of contrast-enhanced ultrasound in PTC,therefore,SMI is worth to further research.

OBJECTIVE To investigate the association between the prevalence of varicocele and benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) in elder man in China. METHODS A total of 831 BPH/LUTS outpatients who were 40 years or older were recruited. The patients' age, total prostatic volume (TPV), International Prostate Symptom Score, total prostate-specific antigen, nocturia, and body mass index were recorded. The presence and grade of varicocele were diagnosed by physical examination in combination with scrotal color Doppler. RESULTS The total prevalence of varicocele was 53.0%. The prevalence values of varicoceles in patients were 40-49, 50-59, 60-69, 70-79 years old, and 80 or above were 43.0%, 42.4%, 54.0%, 59.5%, and 64.0%, respectively. When comparing with varicocele grade, TPV (P = .002) was found to be significantly different. Nocturia frequencies increased significantly in patients with varicocele (P < .01). There were no difference in terms of International Prostate Symptom Score, total prostate-specific antigen, and body mass index between patients with no varicocele and with grades 1, 2, and 3 varicoceles (P > .05). CONCLUSION For elderly patients, the prevalence of varicocele shows an increasing trend with aging. Higher-grade varicoceles are associated with higher TPV and nocturia levels. Varicocele, which may be a factor that affects BPH/LUTS, cannot be overlooked. (C) 2016 Elsevier Inc.