ObjectivesDifferentiation of benign and malignant changes in lymph nodes is extremely important. We aimed to identify the ultrasound and clinical diagnostic criteria permitting this differentiation.MethodsClinical and ultrasound data were collected at Beijing Friendship Hospital from May 2019 to November 2020. Univariate and multivariate analysis were performed using statistical methods, and a mathematical model was established to evaluate benign and malignant lymph nodes.ResultsA total of 1343 LNs (person) with US‐guided core needle or fine needle biopsy (CNB or FNB) were evaluated in the analysis. Variables with a high predictive power were sex (odds ratio, OR: 3.360, p<0.001), short diameter (OR: 4.660, p<0.001), short/long diameter (S/L) ratio (OR: 1.515, P=0.007), border (OR: 1.626, p=0.002), cortex echogenicity (OR: 2.089, P<0.001), fusion (OR: 2.313, p=0.002), vascularity (peripheral vascularity, OR: 3.424, p<0.001; mixed vascularity, OR: 4.127, p<0.001), and medical history (fever/local pain, OR: 0.316, p<0.001; tumor history in the drainage area, OR: 4.595, p<0.001; both, OR: 5.554, p<0.001). The cut-off score on receiver operating characteristic (ROC) curve analysis using these eight variables was 2.5. The largest area under the ROC curve (Az) value was 82.3% (95% confidence interval (CI), 0.805–0.851), and the sensitivity (79.4%), specificity (72.3%), and accuracy (74.8%) were higher than those for nearly all the single indices.ConclusionThe model of combination of ultrasound and clinical symptoms can preliminarily evaluate the benign and malignant of lymph nodes.

目的:分析探讨浅表转移性淋巴结及淋巴瘤的声像图特点,以提高超声诊断准确率.方法:选取医院收治的136例(138枚)浅表转移性淋巴结及淋巴瘤(除甲状腺癌外)患者,依据病理结果将其分为淋巴瘤组(39例,40枚)和转移组(97例,98枚),所有患者均在放化疗前经超声诊断并采集声像图,分析其临床和声像图特点,包括是否合并临床症状和(或)体征、淋巴结大小、形状、边缘、淋巴结门回声、皮质回声、内部回声、有无钙化及血流模式.结果:淋巴瘤组出现临床症状和(或)体征、可触及肿块及发热的比例高于转移组,差异有统计学意义(x2=18.816,x2=8.166,x2=4.957;P<0.05);淋巴瘤组较转移组的淋巴结长径更大,差异有统计学意义(t=1.678,P<0.05).两组形态不规则、淋巴结门样血流、周边血流、网格样改变及部分极低回声或条索样改变以及回声不均匀比较,差异均有统计学意义(x2=15.971,x2=8.530,x2=10.344,x2=43.488,x2=32.137;P<0.05).在纳入的可疑超声征象中,网格样改变、部分极低回声或条索样改变较好的提示为淋巴瘤;而回声不均匀、形态不规则提示为转移性淋巴结.结论:淋巴瘤的声像图特点与转移性淋巴结存在差异,常规超声对鉴别浅表转移性淋巴结及淋巴瘤有一定临床意义.

Oral anticoagulants(OAC)are the first choice for patients with atrial fibrillation to prevent stroke /systemic embolism. However,anticoagulation and hemorrhage risk coexist,among which intracranial hemorrhage(ICH)is the most severe complication with the highest mortality rate.After ICH occurs in patients with atrial fibrillation,whether and when to restart anticoagulation is debated.Balancing the risk and benefit of stroke and re-hemorrhage is a huge challenge in clinical practice.

With the development of society, the elderly population and prevalence of cardiovascular diseases in china is increasing in a growing number day by day. Hypertension, diabetes and dyslipidaemias are independent risk factors of cardiovascular events. The regulation of INR is important to guide treatment in atrial fibrillation patients. However, elderly especially very elderly are excluded from most of large clinical trials, so the targets of cardiovascular risk factors in elderly are complex and controversial. Elderly related cardiovascular risk factors are reviewed as follows.