Objective To find the clinical and histopathological predictive factors for lateral lymph node ( LN ) metastasis in thyroid papillary microcarcinoma( PTMC ).Methods From January 2007 to December 2010,141 patients with PTMC underwent central and lateral LN dissections were enrolled in the study.The data from the cases were analyzed retrospectively to determine the predictive factors for lateral LN metastasis.Results Among the aforementioned cases,37 cases ( 26.2％ ) were PTMC with the presence of multifocality,24 ( 16.9％ ) Hashimoto thyroiditis,84 ( 59.6％ ) central LN metastasis,56 ( 39.7％ ) lateral LN metastasis.Multifocality,central LN metastasis,underlying Hashimoto thyroiditis,and upper pole location were significantly related to lateral LN metastasis in univariate analysis( P＜0.05 ).These four factors were also found to be independent predictive factors for lateral LN metastasis in multivariate analysis( P＜0.05 ).9(6.4％ ) of there patients were found to show skip metastasis in which there was lateral LN metastasis but no central LN metastasis.The upper pole location was statistically significantly associated with skip metastasis.Conclusions Patients with multifocality,central LN metastasis,underlying Hashimoto thyroiditis,and upper pole location should be paid more attention to the status of lateral LN.Skip metastasis occurs in a minority of patients with PTMC.Even if there is no central LN metastasis,patients with upper pole lesion should be searched carefully for the lateral cervical LN metastasis.

Objective To explore the effect of different hemostatic methods on ovarian function in la-paroscopic ovarian endometriosis cyst enucleation. Methods 200 cases of stage I and II ovarian endometriosis cyst admitted to our hospital from Jan. 2012 to Apr. 2014 were selected. All patients underwent conventional la-paroscopic ovarian endometrial endometriosis cyst enucleation. According to intraoperative hemostasis methods, patients were divided into 3 groups: suture group (n=70), electric coagulation group (n=70), and ultrasonic scalpel group (n=60). Follicle-stimulating hormone (FSH) and antibody forming cells (AFC) on admission and at 1, 3, 6, and 12 months after surgery were recorded. Peak systolic blood flow of ovarian stromal artery (PSV) was also observed. Results FSH for all the three groups were improved compared with that on admission, and the difference had statistical significance (P<0.05). FSH for the suture group was significantly lower than that in the electric coagulation group and ultrasound knife group at 1, 3, 6, and 12 months after operation. The difference had statistical significance (P<0.05). AFC at one month after surgery had no statistical significance between the 3 groups (P>0.05). however, AFC of the suture group at 3, 6, and 12 months after surgery was significantly im-proved compared with those of the the electric coagulation group and ultrasound knife group. The difference had statistical significance (P<0.05). Vaginal type B ultrasonic examination after operation showed that PSV of the su-ture group was higher than that of the electric coagulation group and ultrasound knife group at the second menstru-ation and at the 6-month menstruation after surgery. The difference of PSV between the 3 groups had statistical significance (P<0.05). Conclusion Compared electric coagulation hemostasis and ultrasonic scalpel hemostasis, the suture method can reduce damage of ovarian function in patients with ovarian endometriosis cyst, which is worth to promote.

Objective:To observe the effect of early goal directed sedation (EGDS) on cerebral oxygen metabolism in patients with acute brain injury.Methods:A prospective cohort study was conducted. A total of 108 patients with acute brain injury admitted to the intensive care unit (ICU) of the Third Medical Center of the PLA General Hospital from January 2015 to December 2019 were enrolled. According to the patient's condition, dexmedetomidine contraindication and tolerance, and combined with the wishes of patients' families, they were divided into EGDS group and on-demand sedation group. Routine treatments such as surgery, mechanical ventilation, dehydration and reduction of intracranial pressure with mannitol, hemostasis or antiplatelets therapy were given according to the patient's condition. All patients were continuously given sufentanil by intravenous infusion for analgesia. Patients in the EGDS group were sedated by continuously intravenous infusion of dexmedetomidine (0.2-0.7 μg·kg -1·min -1) for 72 consecutive hours. Patients in the on-demand sedation group received intravenous bolus of propofol (0.5-1.0 mg/kg) when treatments were interfered due to agitation. Hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), intracranial pressure (ICP)], sedation indexes [bispectral index (BIS)], severity indexes [acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS)] and cerebral oxygen metabolism indexes [jugular venous blood lactate (Lac), jugular venous oxygen saturation (SjvO 2), cerebral arterial oxygen content (CaO 2), cerebral extraction rate of oxygen (CERO 2), cerebral arteriovenous blood oxygen content difference (a-vDO 2)] were compared between the two groups before sedation and at 24, 48 and 72 hours of sedation. Results:① Among the 108 patients, 3 patients with cerebral hemorrhage received secondary surgery or had worsening of cerebral hernia were excluded. 105 patients were enrolled in the study, including 54 patients in the EGDS group and 51 patients in the on-demand sedation group. There were no statistically significant differences in gender, age, type of craniocerebral injury, GCS score, proportion of mechanical ventilation and operation ratio between the two groups. ② Compared with before sedation, Lac, CERO 2 and a-vDO 2 of both groups gradually reduced over time of sedation while SjvO 2 and CaO 2 were gradually higher. Those changes were more quickly in the EGDS group, Lac, SjO 2, CERO 2 and a-vDO 2 significantly improved at 24 hours of sedation compared with those before sedation. Above indexes at 72 hours of sedation in the EGDS group were obviously better than those in the on-demand sedation group [Lac (mmol/L): 1.81±0.31 vs. 2.19±0.12, SjvO 2: 0.714±0.125 vs. 0.683±0.132, CaO 2 (mL/L): 201.21±15.25 vs. 179.65±14.07, CERO 2: (27.87±3.66)% vs. (33.00±2.58)%, a-vDO 2 (mL/L): 44.32±5.68 vs. 48.57±8.22, all P < 0.05]. ③ Compared with before sedation, HR, MAP and ICP decreased in the two groups over time while CPP, BIS and GCS score showed increasing trend, especially more quickly in the EGDS group, HR at 24 hours of sedation, MAP, CPP, BIS and GCS score at 48 hours significantly improved as compared with those before sedation. Hemodynamics and sedation related parameters and GCS score at 72 hours of sedation in the EGDS group were significantly better than those in the on-demand sedation group [HR (bpm): 70.69±7.80 vs. 79.85±9.77, MAP (mmHg, 1 mmHg = 0.133 kPa): 84.23±8.76 vs. 89.97±9.48, ICP (mmHg): 14.23±8.76 vs. 15.97±9.48, BIS: 60.56±24.58 vs. 56.86±33.44, GCS score: 8.06±3.63 vs. 7.86±2.98, all P < 0.05]. The APACHE Ⅱ scores were significantly reduced at 72 hours of sedation in both groups as compared with those before sedation, while there was no statistical difference between the two groups. Conclusion:Compared with the on-demand sedation, EGDS could reduce cerebral oxygen metabolism, improve the coma degree, and reduce the severity of the disease in patients with acute brain injury.

Objective:To explore the clinical significance of biopsy pathological examination of cervical cytology negative, high-risk human papillomavirus (HPV) positive.Methods:The pathological data of cervical biopsy in 220 patients with cytological negative, HPV16/18 positive or interval of 1 year other 12 high-risk HPV (12HR-HPV) lasting positive for more than 1 year from January 2014 to May 2019 were retrospectively analyzed.Results:Of 220 patients, there were 3 cases with adenocarcinoma, 18 cases with CINⅢ, 18 cases with CINⅡ, 69 cases with CINⅠ, 47 cases with condyloma-like lesions, 65 cases of chronic inflammation.Among 36 cases of high-grade squamous intraepithelial lesions, there were 35 cases with HPV16/18 positive, accounting for about 15.91%(35/220), and only 1 case of other 12 high-risk HPV was continuously positive for more than one year, accounting for 0.45%(1/220).Conclusion:Cervical cytological screening may appear false negative, high-risk HPV typing examination may be more able to detect cervical intraepithelial lesions, for cytological negative, high-risk HPV positive, especially HPV16/18 positive, immediate referral colposcopy can reduce the missed diagnosis of cervical high-grade squamous intraepithelial lesions and even cancerous.

Gut microbiota is involved in maintaining intestinal homeostasis. The bidirectional communication between intestinal flora and brain can also be conducted through the neuro-immune-endocrine network, namely, the "microbiota-gut-brain axis". A number of studies have shown that the "microbiota-gut-brain axis" disorder plays an important role in the occurrence, development and prognosis of some cerebrovascular diseases, such as cerebral small vessel disease and stroke. This article introduces the latest research progress of the relationship between gut microbiota and cerebrovascular diseases, so as to provide more ideas and options for the treatment of cerebrovascular diseases.

Objective To establish evaluation of ozagrel sodium by weighted TOPSIS method so as to provide a reference for improving the rational use of ozagrel sodium.Methods Based on the drug instructions,guidelines,relevant literatures and Delphi method,the evaluation criteria for the clinical rationality of ozagrel sodium were formulated.Attribute hierarchical model(AHM)was used to assign weights to the indicators,the weighted TOPSIS method was employed to analyze and evaluate the rationality of 108 patients that discharged from the Third People's Hospital of Henan Province from January 2021 to April 2022.Results The reponse rates of two rounds of expert advice questionnaires were 100％,the authoritative coefficients(Cr)were 0.85,0.83(＞0.70),and the experts fully affirmed the items of the standard.Among the 108 cases evaluated,37 cases(34.26％)were judged to be reasonable,52 cases(48.15％)were judged to be basically reasonable and 19 cases(17.59％)were judged to be unreasonable.The main unreasonable problems were manifested in indications,the timing of administration,drug course and monitoring of efficacy and laboratory parameters.Conclusion The method of DUE of ozagrel sodium based on weighted TOPSIS is more comprehensively and intuitively.The application of ozagrel sodium in the hospital is relatively standardized,but there are problems in the course of medication,indications,and timing of administration.So it is necessary to promote the rational use by strengthening the cooperation between pharmacists and physicians,and improving pharmaceutical intervention.

Objective:To evaluate the effect of lower limb neuromuscular electrical stimulation (NMES) on mechanical ventilation patients in intensive care unit (ICU).Methods:Databases including the Cochrane Library, PubMed, Web of Science, Embase, SinoMed, CNKI, VIP and Wanfang database were searched from inception to May 2021. Randomized controlled trails (RCT) about the influence of NMES of lower limbs in patients with mechanical ventilation in ICU were collected. Routine rehabilitation measures were implemented in the control group, while the combination of routine rehabilitation and NMES on the lower limbs was implemented in the observation group. The literature screening, data extracting, and bias risk assessment of included studies were conducted independently by two reviewers. RevMan 5.3 software was used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 8 RCT were eventually enrolled. The literature quality evaluation results showed that 1 study was grade A and 7 studies were grade B, suggesting that the quality of the included literature was relatively high. The Meta-analysis results showed that NMES in the lower extremities could effectively shorten the duration of mechanical ventilation in ICU patients [standardized mean difference ( SMD) = -0.51, 95% confidence interval (95% CI) was -0.72 to -0.31, P < 0.000 01], increase the maximum inspiratory pressure [MIP; mean difference ( MD) = 14.19, 95% CI was 9.30 to 19.09, P < 0.000 01], and improve the functional status of critically ill patients [functional status score for ICU (FSS-ICU); MD = 10.44, 95% CI was 3.12 to 17.77, P = 0.005] with statistically significances. However, there were no significant advantages in increasing the Medical Research Council (MRC) score ( MD = 2.13, 95% CI was -1.38 to 5.63, P = 0.23), reducing ICU mortality [relative risk ( RR) = 0.80, 95% CI was 0.51 to 1.24, P = 0.31], shortening length of ICU stay ( MD = -0.54, 95% CI was -3.67 to 2.59, P = 0.74), and the combined effect was not statistically significant. Funnel plot based on the duration of mechanical ventilation showed that the distribution of included articles was basically symmetrical, and no publication bias was detected. Conclusions:NMES of the lower limbs can not only shorten the ventilation duration effectively, but also improve the MIP and functional status of mechanically ventilated patients in ICU. However, it has no significant effect on the MRC score, ICU mortality and length of ICU stay of patients with mechanical ventilation. In the future, high-quality, large sample size and multi-center RCT are needed to verify the effects of NMES.