OBJECTIVE To investigate the pertinency between acute physiology and chronic health evaluation Ⅱ scores(APACHEⅡ)and nosocomial infection.METHODS The clinical data from 1 007 ICU patients were evaluated with APACHEⅡ scores system,and made a prospective survey of nosocomial infection.RESULTS Along with the increase in APACHEⅡ scores,nosocomial infection rate and mortality showed rising trend and they were in linear relationship.CONCLUSIONS APACHEⅡ scores system not only can appraise the degrees of severity of illness,evaluate medical treatment,and estimate the prognosis,but also forecast nosocomial infection.

Objective: To investigate the clinicopathologic and molecular features of the rare cribriform morular variant of papillary thyroid carcinoma (CMV-PTC). Methods: The clinicopathologic data of 10 patients with CMV-PTC were retrospectively reviewed. Immunohistochemical (IHC) staining was done using LSAB method. DNA sequencing for APC were applied using Sanger method. BRAF V600E mutation was examined using ARMS method. The cytological, morphological, IHC and molecular features were analyzed. Results: All patients were female at an average age of 27 years old. The tumors were mostly located in the right lobe of thyroid. Fine needle aspiration cytology was performed in three patients; two were diagnosed as suspicious for PTC and one as PTC. Nine tumors presented as solitary nodule and two as multiple nodules in both lobes. Infiltration was demonstrated in three cases. The average size was 2.6 cm. The neoplastic cells were arranged in papillary, cribriform, solid and glandular patterns, with rare or without colloid inside the lumen. The number of morula varied, ranging from zero to many. The neoplastic cells were variably enlarged, showing round, oval or spindle shape. Nuclear irregularity was identified as irregular membrane, nuclear grooves or pseudoinclusion, but no typical ground glass feature. Peculiar nuclear clearing could be observed in the morular cells. IHC staining showed the neoplastic cells were negative for thyroglobulin and p63, but positive for TTF1, cytokeratin 19 and estrogen receptor. Diffuse staining with cytokeratin was seen in the neoplastic cells and the morula. Specific cytoplasmic and nuclear staining of β-catenin was seen in the neoplastic cells but not the morula. Ki-67 proliferation index was 1%-30%. No recurrence or metastasis was observed. One patient was demonstrated to harbor both somatic and germline mutations of the APC gene, who was found to have adenomatous polyposis and her mother died of colonic carcinoma. No BRAF V600E mutation was detected. Conclusions CMV-PTC is rare and shows atypical cytological and clinicopathological features, and it is easily misdiagnosed.TG, TTF1, ER and β-catenin are specific IHC markers for CMV-PTC. The morula is negative for cytokeratin 19, in contrast to squamous metaplasia. Although CMV-PTC has indolent clinical behavior, a definite diagnosis is necessary to rule out the possibility of APC gene mutation and related extra-thyroidal neoplasm, such as FAP and Gardner syndrome.

Objective　To evaluate the diagnostic value of superb microvascular imaging(SMI) in cervical artery dissection.Methods　A total of 42 patients with cervical artery dissection diagnosed by the Department of Neurology of our hospital from June 2017 to June 2021 were collected to evaluate the consistency of SMI and CTA/MRA+DSA in the diagnosis of cervical artery dissection,and to compare the accuracy and sensitivity of SMI.Results　Among 42 patients,the positive rate of cervical artery dissection with ultrasonography,SMI,CTA or MRA and DSA were 42.8 %（18/42）,90.4% （38/42） and 92.6%（39/42） respectively.The DSA mostly showed the line-like sign(n=19,48.7%); Ultrasonography and SMI mostly showed the intramural hematoma.SMI and CTA/MRA+DSA showed the good consistency in the diagnosis of cervical artery dissection（Kappa=0.340，P=0.056).Superb microvascular imaging was superior to ultrasonography in the detection of cervical artery dissection（Kappa=5.895，P=0.015）.The area under the ROC superb microvascular imaging diagnosis of cervical artery dissection was 0.966.It is suggested that superb microvascular imaging has high accuracy in diagnose cervical artery dissection.Conclusion　Superb microvascular imaging has high clinical value in the diagnosis of various types of cervical artery dissection.