Objective:To explore the risk factors of central lymph node metastasis (CLNM) in Hashimoto thyroiditis (HT) patients with thyroid micropapillary carcinoma (PTMC), and formulate a reasonable range of lymph node.Methods:Retrospective analysis of 448 cases of PTMC admitted to the People′s Hospital of Inner Mongolia Autonomous Region from September 2018 to September 2021 including 94 males and 354 females, with a male female ratio of 1.00∶3.77, all patients aged 21 to 82 years old, with the average of (46.9 ± 11.0) years old. According to whether Hashimoto thyroiditis (HT) is combined, it is divided into HT-PTMC group ( n=142) and non HT-PTMC group ( n=306).Single factor analysis and multiple factor analysis were used to explore whether the clinicopathological characteristics of patients such as gender, age, tumor diameter, number of lesions (single/multiple lesions), presence of capsule invasion, pretracheal/paratracheal lymph nodes, delphian lymph nodes, and lateral cervical lymph nodes were related to lymph node metastasis in the central region. SPSS 20.0 software was used for statistical analysis and logistic regression equation was established, The mathematical model was used to evaluate the predictive value of diagnosis and treatment. Results:There were significant differences between HT-PTMC group and non HT-PTMC group in terms of age, sex, metastasis of anterior laryngeal lymph nodes and lateral cervical lymph nodes ( P<0.05). Univariate analysis showed that tumor diameter, number of lesions, capsule invasion, calcification, lateral cervical lymph node metastasis were correlated with CLNM in HT-PTMC patients ( P<0.05). Multivariate logistic regression analysis showed that tumor diameter increase and capsule invasion were independent risk factors for CLNM ( P<0.05). Logistic regression mathematical model was established according to the above independent risk factors: (Y=-1.974+ 0.191 × Tumor diameter+ 1.139 × The area under the ROC curve for predicting CLNM in HT-PTMC patients was 0.669 (95% CI: 0.571- 0.766). When taking the maximum Jordan index, the sensitivity of prediction was 0.460, and the specificity was 0.859. Conclusions:For PTMC patients with HT, there is evidence that the tumor diameter increases or the capsule is invaded, and the risk of lymph node metastasis in the central region is increased. Preventive lymph node dissection in the central region is recommended.

Exosomes are small vesicles with a diameter of about 40-160 nm actively secreted by cells. They participate in a variety of pathophysiological processes and are closely related to the occurrence and development of diseases. As a newly carrier of intercellular communication and circulating biomarkers of disease diagnosis and prognosis, exosomes have attracted great attention for their potential clinical applications. However, many aspects such as exosome biogenesis, targeted transport, and mechanism of action are still unclear. This paper focuses on the exosome biogenesis, summarizes the exosome biogenesis pathways, and describes relevant molecular modulation mechanisms of importance. And this review provides a theoretical basis for disease treatment based on regulating exosome production.

Objective To evaluate the curative effect of Huoxue-Xiaozhi capsule on non-alcoholic fatty liver disease (NAFLD). Methods A total of 100 patients with NAFLD who met the inclusion criteria were divided into 2 groups with 50 patients in each group by random number table method. The treatment group was treated with Huoxue-Xiaozhi capsule, while the control group was treated with Compound Methionine Choline Tablets. Both groups were treated for 8 weeks. The ALT, AST, γ-GT (γ- glutamyltranspeptidase ), ALP (alkaline phosphatase, alkaline phosphate) were detected by automatic blood biochemical analyzer. The serum high sensitivity-C reactive protein (hs-CRP) and Homocysteine (Hcy) were detected by supplementary detection method. The serum IL-18 was detected by ELISA method, and liver imaging was performed before and after treatment. The symptoms and signs were evaluated, and clinical efficacy was evaluated. Results The total effective rate was 90.0％ (45/50) in the treatment group and 74.0％ (37/50) in the control group. The difference between the two groups was statistically significant (Z=-2.328, P=0.020 ). After treatment, the serum hs-CRP (2.4 ± 2.9 mg/L vs. 3.6 ± 2.8 mg/L, t=2.105), Hcy (11.2 ± 5.5 μmol/L vs. 13.9 ± 6.4 μmol/L, t=2.262), IL-18 (690.6 ± 61.3 ng/L vs. 775.4 ± 60.5 ng/L, t=6.962) in the treatment group were significantly lower than those in the control group (P<0.05 or P<0.01). After treatment, the improvement of hypochondriac lump, sallow complexion, dark complexion and hypochondriac dull pain in the treatment group were superior to those in the control group (Z values were -2.563, -2.788, -2.780, -2.220 respectively, all Ps<0.05 ). The Serum ALT, AST,γ-GT and ALP levels were significantly lower than those of the control group (t values were 18.820, 19.811, 10.221 and 3.248 respectively, all Ps<0.001 ). Conclusions The Huoxue-Xiaozhi capsule can improve the liver function and reduce the levels of serum hs-CRP, HCY and IL-18, and its curative effect of NAFLD.

Objective To observe the clinical therapeutic effect of Xiaozhong Sanjie prescription combined with Huayu powder external application for treatment of patients with nodular goiter (NG) and approach its mechanism. Methods A prospective randomized controlled study was conducted, including 128 patients who were definitely diagnosed as NG and admitted into Affiliated Hospital of Qinghai University from September 2014 to December 2016, and they were divided into a control group and a traditional Chinese medicine (TCM) treatment group by random number table method, 64 cases in each group. The control group received follow up observation; the TCM group was treated by Xiaozhong Sanjie prescription (the ingredients: rhizoma sparganii 15 g, zedoary 10 g, fritillary bulb 15 g, prunella vulgaris 20 g, bupleurum 6 g, dried tangerine 10 g, oyster 20 g, fructus aurantii 10 g, radix glycyrrhizae 5 g) in the mean time combined with Huayu powder (the ingredients: borneol 10 g, prunella vulgaris 20 g, pinellia ternata 15 g, oyster 15 g, radix curcumae 15 g, rhubarb 15 g); the ingredients of the prescription were immersed in water and decocted to form a decoction, a dose 400 mL daily, 200 mL taken orally in the morning and 200 mL in the evening after meal; the powder ingredients were mixed and stirred thoroughly with Chinese rice wine or vinegar (10 mL) to form a paste which was put uniformly flat onto a gauze about 15 cm in length and 1 cm in thickness, roasted by infrared lamp, as the paste temperature was lowered to body temperature, it was attached on the goiter skin of neck, then fixed by bandage before sleep to the next morning, afterwards the paste was removed and nodular skin washed, the length of external application being guaranteed to be over 4 hours a day; in the event when skin red swelling or pruritus occurred, promethazine should be used or the duration of application was shortened. Fifteen days constituted one therapeutic course, and after consecutive 3 courses of treatment, the therapeutic effects in the two groups were observed. Before and after treatment in the two groups, the changes of thyroid nodular size and TCM syndrome score were observed, meanwhile the thyroid functional index levels of serum vascular endothelial growth factor (VEGF), insulin-like growth factor Ⅰ(IGF-Ⅰ) and transforming growth factor-β1 (TGF-β1) were detected by enzyme-linked immunosorbent assay (ELISA). Results After treatment for 45 days, compared with control group, the thyroid nodule in TCM treatment group was significantly shrunken (mm: 8.75±3.41 vs. 15.89±4.51, P < 0.05) , and TCM syndrome score in TCM treatment group was significantly lowered (20.35±4.83 vs. 35.53±6.71, P < 0.05); before and after admission in the two groups, the thyroid function indexes of thyrotropic-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) were in the normal range, and there were no statistical significant differences between the two groups (all P > 0.05); the levels of serum VEGF, IGF-I were reduced in the TCM treatment group [VEGF (ng/L): 27.52±8.35 vs. 33.08±9.57, IGF-Ⅰ (μg/L): 24.12±6.74 vs. 35.57±11.39], TGF-β1 was increased in the TCM treatment group (ng/L: 363.67±97.83 vs. 225.87±47.71), and the differences were statistically significant (all P < 0.05). Conclusions Xiaozhong Sanjie decoction combined with Huayu powder external application can inhibit the levels of VEGF, IGF-Ⅰ and elevate the TGF-β1 level that possibly the mechanism of the combined therapy to shrink the thyroid nodule size.

Objective To compare the effect of three-point positioning method and traditional puncture method in patients with arteriovenous fistula in hemodialysis.Methods A total of 800 hemodialysis patients with malignant tumor of urinary system in our hospital were divided into three-point positioning method group (observation group) and traditional puncture method group (control group), with 400 cases in each group.All the puncture was performed by the senior nurses with color Doppler, and vein intima thickness of artery fistula before puncture and 60 times after puncture were observed, puncture failure rate, incidence of venous fistula aneurysm, arteriovenous fistula stenosis and satisfaction were compared.Results There was no significant difference in vein intima thickness of artery fistula(P<0.05);The effect degree of vein intima thickness of artery fistula in the observation group after treatment was significantly lower than that of the control group, and the difference was statistically significant(P<0.05);The puncture failure rate, incidence of arteriovenous fistula aneurysm, and arteriovenous fistula stenosis rate in the observation group after 60 times puncture were significantly lower than that in the control group, and the differences were statistically significant(P<0.05);The satisfaction in the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05).Conclusion Three-point positioning puncture combined with losartan has significant effect for arteriovenous fistula patients with the malignant tumor of urinary system, and it can effectively prolong longevity of vascular puncture, and reduce complications of vascular with fistula.

Objective To compare the effect of three-point positioning method and traditional puncture method in patients with arteriovenous fistula in hemodialysis.Methods A total of 800 hemodialysis patients with malignant tumor of urinary system in our hospital were divided into three-point positioning method group (observation group) and traditional puncture method group (control group), with 400 cases in each group.All the puncture was performed by the senior nurses with color Doppler, and vein intima thickness of artery fistula before puncture and 60 times after puncture were observed, puncture failure rate, incidence of venous fistula aneurysm, arteriovenous fistula stenosis and satisfaction were compared.Results There was no significant difference in vein intima thickness of artery fistula(P<0.05);The effect degree of vein intima thickness of artery fistula in the observation group after treatment was significantly lower than that of the control group, and the difference was statistically significant(P<0.05);The puncture failure rate, incidence of arteriovenous fistula aneurysm, and arteriovenous fistula stenosis rate in the observation group after 60 times puncture were significantly lower than that in the control group, and the differences were statistically significant(P<0.05);The satisfaction in the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05).Conclusion Three-point positioning puncture combined with losartan has significant effect for arteriovenous fistula patients with the malignant tumor of urinary system, and it can effectively prolong longevity of vascular puncture, and reduce complications of vascular with fistula.

Objective:To explore the status quo of self-stigma in diabetic patients and analyze its correlation with self-compassion.Methods:In this cross-sectional study, from December 2020 to January 2021, totally 240 diabetic patients admitted at the Department of Endocrinology in two ClassⅢ Grade A hospitals in Hangzhou, Zhejiang Province were selected by convenient sampling and investigated with the general information questionnaire, Self-Stigma Scale (SSS) , and Self-Compassion Scale (SCS) . Hierarchical regression analysis was used to explore the relationship between self-stigma and self-compassion in diabetic patients. A total of 240 questionnaires were issued, and 225 valid questionnaires were recovered. The effective response rate was 93.75% (225/240) .Results:The total SSS score of the 225 diabetic patients was (56.47±16.72) , and the average score of all items was (2.01±0.60) ; the total SCS score was (86.46±12.79) , and the average score of all items was (3.33±0.49) . Pearson correlation analysis showed that the total SSS score of diabetic patients was negatively correlated with the total SCS score ( P < 0.01) . Hierarchical regression analysis revealed that self-compassion was an influencing factor of self-stigma in diabetic patients ( P< 0.01) , which could independently explain 13.1% of self-stigma (Δ R2=0.131, P<0.001) . Conclusions:Self-stigma of diabetic patients is at a moderate level, and self-compassion is an influencing factor of self-stigma of diabetic patients. Nursing staff can reduce patients ' self-stigma by improving their self-compassion.

This paper summarizes the definition, evaluation tools, influencing factors, and cultivation strategies of moral sensitivity in nursing students, so as to provide reference for moral education of nursing students in China.

Objective To observe the effects of Siweiyuganzi prescription on anti-peroxidation and blood lipid levels in experimental rats with hyperlipidemia. Methods Sixty male Sprague-Dawley (SD) rats were divided into normal control group, hyperlipidemia model group, Xuezhikang group, Siweiyuganzi prescription large, medium and small dose group according to the random number table method, with 10 rats in each group. The hyperlipidemia rat model was established by intragastric feeding with high fat emulsion everyday 10 mL·kg-1·d-1; normal saline 10 mL/kg was given to the normal control group, twice a day by intragastric feeding; 3 dosages of Siweiyuganzi suspended fluid 12.8, 6.4, 4.3 g·kg-1·d-1 intragastric administrations were given to Siweiyuganzi prescription large, medium and small dose groups respectively; Xuezhikang suspended fluid 0.3 g·kg-1·d-1 was given to Xuezhikang group intragastrically;the same volume of normal saline was given to hyperlipidemia model group. After 4 weeks, the level changes of blood lipid, serum superoxide dismutase (SOD), malonaldehyde (MDA), hydroxymethylglutaryl Coenzyme A (HMG-CoA) were observed. Results Compared to those in the normal control group, the levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), MDA, content and positive expression of HMG-CoA, alanine aminotransferase (ALT) were all higher in hyperlipidemia model group [TG (mmol/L): 6.59±0.72 vs. 4.32±0.36, TC (mmol/L): 7.10±0.25 vs. 5.98±0.40, LDL-C (mmol/L): 4.18±1.30 vs. 2.33±0.35, MDA (μmol/L): 26.05± 5.99 vs. 10.08±1.98, HMG-CoA content (ng/L): 54.60±2.90 vs. 48.73±3.09, HMG-CoA positive expression in liver tissue:(57.80±12.30)% vs. (22.00±4.92)%, ALT (U/L): 106.83±15.75 vs. 81.97±13.18]; SOD and high-density lipoprotein cholesterol (HDL-C) in hyperlipidemia model group were significantly decreased [SOD (kU/L): 295.47±37.51 vs. 345.13±19.76, HDL-C (mmol/L): 2.32±0.49 vs. 4.84±0.45, both P < 0.05]. Compared with the hyperlipidemia model group, the TG, TC, LDL-C, MDA, contents and positive expression of HMG-CoA in each group were significantly reduced, and the SOD and HDL-C were obviously increased, and the changes in the Siweiyuganzi high dose group were more significant than those of the Siweiyuganzi middle-and low-dose groups [TG (mmol/L): 4.70±0.46 vs. 5.40±0.31, 5.70±0.41, TC (mmol/L): 5.80±0.23 vs. 6.14±0.20, 6.56±0.32, LDL-C (mmol/L): 2.56±0.45 vs. 2.93±0.33, 3.28±0.32, HDL-C (mmol/L): 4.58±0.28 vs. 3.89±0.30, 3.59±0.08, SOD (kU/L): 381.45±20.68 vs. 360.60±30.16, 325.49±32.13, MDA (μmol/L): 16.98±5.39 vs. 17.89±5.37, 21.03±6.01, HMG-CoA content (ng/L): 50.58±0.77 vs. 52.16±0.66, 52.90±0.91, HMG-CoA positive expression in liver tissue: (27.90±6.03)% vs. (32.20±7.00)%, (43.00±8.39)%, all P < 0.05]. In the normal control group, there were positive cells scattered in the central vein area and loosely distributed around the portal area in the rat liver; in the hyperlipidemia model group, the positive cells were increased in the central vein area and the cells in relatively great number were seen around the portal area. While the positive cells in Xuezhikang group and in the high, medium and low dose Siweiyuganzi groups were decreased. Conclusion Siweiyuganzi prescription can regulate the levels of blood lipids, prevent and treat the lipid peroxidation caused by hyperlipidemia, and inhibit excessive expression of HMG-CoA in experimental rats with hyperlipidemia.