Papillary thyroid microcarcinoma(PTMC),which lacks lymph node metastasis,distant metastasis,extra-thyroid invasion,high-risk subtypes,and invasion of the trachea or recurrent laryngeal nerve,may be classified as low-risk PTMC based on clinical assessment.Surgical intervention such as lobectomy or total thyroidectomy is the primary treatment modality for PTMC.This study comprised 124 patients who underwent conformal thyroidectomy and revealed that this innovative surgical approach yielded long-term oncological outcomes comparable to those who received lobectomy or total thyroidectomy.The surgical intervention may play a significant role in the comprehensive management of PTMC,while the implementation of PTMC precision medicine necessitates the utilization of genetic testing,molecular typing,and other advanced technologies to detect early-stage high-risk factors like lymph node microinvasion and integrate biology-based surgery concept for optimal outcomes.

Objective:To investigate the predictive value of platelet aggregation rate for early neurological deterioration (END) after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS).Methods:Consecutive patients with AIS received IVT at the Department of Neurology, Haikou Hospital Affiliated to Xiangya School of Medical, Central South University from November 2020 to July 2023 were retrospectively included. The maximum platelet aggregation rate (MAR) was measured using the PL-12 multi-parameter platelet function analyzer. END was defined as an increase of ≥4 from baseline in the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after IVT. The demographic, baseline data, laboratory findings, and imaging results between the END and non-END groups were compared, and the dynamic changes in MAR induced by arachidonic acid (AA) and adenosine diphosphate (ADP) before, immediately after, and 2 h after IVT were observed. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of MAR for END at different time points. Results:A total of 300 patients were included, aged 64.88±8.82 years, with a median baseline NIHSS score of 11 (interquartile range, 8-15) and the onset-to-needle time was 172.03±53.96 min. Among them, 66 patients (22.0%) developed END. The MAR-AA and MAR-DP levels before, immediately after, and 2 h after IVT in the END group were significantly higher than those in the non-END group (all P<0.05). Multivariate logistic regression analysis showed that MAR-AA (odds ratio 1.098, 95% confidence interval 1.039-1.161; P<0.001) and MAR-ADP (odds ratio 1.100, 95% confidence interval 1.038-1.167; P<0.001) at 2 h after IVT were the independent risk factors for END. ROC curve analysis shows that MAR-AA and MAR-ADP before, immediately after, and 2 h after IVT had good predictive value for END. Among them, the area under the curve corresponding to MAR-AA and MAR-ADP at 2 h after IVT was the largest, with values of 0.745 and 0.710, respectively. The optimal cutoff value of MAR-AA was 39.28%, and the sensitivity and specificity for predicting END were 74.2% and 76.1%, respectively. The optimal cutoff value of MAR-ADP was 43.35%, and the sensitivity and specificity for predicting END were 69.7% and 66.2%, respectively. Conclusion:The MAR measured by PL-12 is closely associated with the risk of END in patients with AIS after IVT treatment, and has good predictive value for END.

Objective:To explore the structural alterations in functional brain areas of patients with diabetic peripheral neuropathy (DPN) using voxel-based morphometry (VBM), and to investigate the abnormal region of grey matter and its distribution in DPN.Methods:A total of 124 patients with DPN and 88 patients with type 2 diabetes without DPN (NDPN) diagnosed in Haikou Hospital and the First Affiliated Hospital of Guangdong Pharmaceutical University from June 2019 to December 2020 were selected as the study subjects, and 40 healthy volunteers matched with gender and age were included as the control group.All subjects underwent whole-brain MRI examination, and 3D-T1WI data were collected for post-processing and analysis based on voxel morphological analysis.Results:Compared with NDPN patients, decreased gray matter volume in DPN patients was observed in the bilateral anterior central gyrus and thalamus, with statistical signifcant difference ( P<0.05), and there was no significant difference between the two sides ( P>0.05). Compared with healthy control group, decreased gray matter volume in DPN was observed in the the bilateral anterior central gyrus, central posterior gyrus, superior frontal gyrus and thalamus, with statistical signifcant difference ( P<0.05) and there was no significant difference between the two sides ( P>0.05). Conclusions:DPN patients also have decreased volumes of the brain greymatter, suggesting that the occorrence of DPN patients may be caused by the of injury of central structure.

Objective:To investigate the predictive value of platelet reactivity for early neurological deterioration (END) in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke within 48 h of onset admitted to the Department of Neurology, the Affiliated Haikou Hospital of Xiangya School of Medicine, Central South University from January 2017 to March 2019 were enrolled prospectively. Aspirin was taken on the day of admission, and the platelet aggregation rate was detected using a PL-11 Platelet Function Analyzer 7 d after taking it. END was defined as the National Institutes of Health Stroke Scale (NHISS) score at any time point within 7 d after admission increased by ≥2 or the motor function item score increased by ≥1 from baseline. The demographics, baseline data, imaging examination and laboratory findings of patients in the END and non-END groups were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of platelet aggregation rate for END. Results:A total of 230 patients were included in the study. They aged 63.24±9.75 years, 126 were females (51.4%). The median baseline NIHSS score was 6 (interquartile range, 4-10). The median time from onset to admission was 15 h (interquartile range, 9-28 h). There were 54 patients (23.5%) in the END group and 176 (76.5%) in the non-END group. There were significant differences in arachidonic acid-induced maximum platelet aggregation ratio (MAR-AA), epinephrine-induced maximum platelet aggregation ratio (MAR-EPI) and collagen-induced maximum platelet aggregation ratio (MAR-COL) between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that MAR-AA (odd ratio [ OR] 1.165, 95% confidence interval [ CI] 1.091-1.243; P<0.001) and MAR-EPI ( OR 1.035, 95% CI 1.006-1.067; P=0.023) were the independent risk factors for END in patients with acute ischemic stroke. ROC curve analysis showed that MAR-AA had good predictive value for END, and the area under the curve was 0.775 (95% CI 0.707-0.843; P<0.001). The optimal cut-off value was 21.80%. The sensitivity and specificity of MAR-AA for predicting END were 72.2% and 77.3%, respectively. Conclusions:The platelet function measured by PL-11 is closely related to the risk of END in patients with acute ischemic stroke. It has a better predictive value for END.

Objective To investigate the changes of soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) and omentin-1 in patients with H-type hypertension complicated with acute ischemic stroke, and to analyze the correlation of sLOX-1 and omentin-1 levels with the severity and prognosis of the disease.Methods Totally 136 patients with H-type hypertension complicated with acute ischemic stroke from February2017 to May 2018 were selected as observation group, and 136 non-acute ischemic stroke patients with H-type hypertension in the same period as the control group. The patients of observation group were divided into mild, moderate and severe sub-groups according to NIHSS score, and they were also divided into good prognosis group and poor prognosis group based on modified RANKIN scale (mRS) score. The serum sLOX-1 and omentin-1 levels were detected, and the correlation of sLOX-1 and omentin-1 levels with severity and prognosis of disease was analyzed. Results The serum sLOX-1 level of the observation group was higher, but the serum omentin-1 level lower than that of control group (P < 0.05). With the severity of the disease, the serum sLOX-1 level increased, but the serum omentin-1 level decreased (P < 0.05). The serum sLOX-1 level of good prognosis group was significantly lower, whereas the serum omentin-1 level significantly higher than that of poor prognosis group (P < 0.05). sLOX-1 was positively correlated with NIHSS score and mRS score, while omentin-1 was negatively correlated with NIHSS score and mRS score (P < 0.05). Conclusions The levels of serum sLOX-1 and omentin-1 are closely related to the severity and prognosis of patients with H-type hypertension complicated with acute ischemic stroke, which could be used as markers for evaluating the severity and prognosis of the patients.

Objective To investigate the risk factors of cognitive impairment associated with early post－acute stroke seizures (EPASS). Methods One hundred and sixty－eight eligible patients were recruited in the study. Patients were divided into cognitive impairment group and non－cognitive disorder group according to MMSE. General clinical data, severity of the stroke, location and extent of infarction, characteristics of epileptic seizures were compared between the two groups. Multivariate Logistic regression analysis was utilized to investigate the independent risk factors of EPASS related cognitive impairment. Results Multivariate logistic regression analysis showed that moderate to severe stroke (OR=4.386, P=0.006), cortical infarction (OR=6.430, P=0.012), general tonic clonic seizure (OR=8.189, P=0.004), seizure frequency≥1 time per day (OR=12.818, P＜0.001) were the independent risk factors for cognitive impairment in EPASS. Conclusions Patients with moderate to severe stroke, cortical infarction, general tonic clonic seizure and seizure frequency≥1 time per day may have a higher risk of cognitive impairment.

Objective To study the effect of citicoline on mild cognitive impairment MCI) in pa tients with middle cerebral artery stenosis (MCAS).Methods Eighty-six MCAS patients with MCI were divided into citicoline group (n=44) and control group (n=42).The patients in citicoline group were treated with citicoline (0.2 g,3 times a day) for 6 months on the basis of conventional treatment.Cerebrovascular reserve,PI,BHI and Vm between the two groups were compared by transcranial Doppler ultrasonography after treatment.MCI between the two groups was assessed according to the MoCA after treatment.Results The rate of cerebrovascular reserve,PI,BHI and Vm were significantly higher in citicoline group than in control group (13.59％± 1.16％ vs 7.61％±1.12％,P＜0.01;0.51±0.16 vs 0.58±0.12,P＜0.05;1.36±0.08 vs 0.74±0.11,P＜ 0.01;32.63％ ±2.32％ vs 16.92％ ± 1.68％,P＜0.05).The total MoCA score,attention,language,visuospatial and executive function,abstract,naming,orientation and memory were significantly higher in citicoline group than in control group (P＜0.01).Conclusion Early citicoline treatment can improve cerebrovascular reserve and alleviate MCI in MCAS patients.

Objective To investigate the risk factors of progressive motor deficit (PMD) in patients with acute middle cerebral artery occlusion (MCAO) beyond thrombolysis time.Methods The clinical data of 123 patients with acute MCAO beyond thrombolysis time,admitted to our hospital from March 2015 to March 2017,were analyzed retrospectively.According to whether patients having National Institute of Health Stroke Scale (NIHSS) scores increased＞2 within 5 d of admission and continued for 24 h,these patients were divided into two groups:PMD group and non-PMD group.Single factor analysis was performed on all clinical parameters that might influence PMD;in addition,the influencing factors of PMD were analyzed by multiple factor Logistic regression analysis.Results Fifty-one patients (41.5％) had PMD and 72 patients (58.5％) did not have PMD.Single factor analysis showed that the differences of randomized blood glucose level,ratio of patients with PH2 type hemorrhagic transformation,intracurricular infarct pattern,radiation crown infarct and collateral circulation pathway between the PMD group and the non-PMD group were statistically significant (P＜0.05).Multiple factor Logistic regression analysis showed that ratio of patients with PH2 type hemorrhagic transformation,radiation infarct site,internal watershed infarct model and collateral circulation pathway were significantly correlated to PMD (OR=2.857,95％CI:1.037-7.869,P=0.042;OR=2.585,95％CI:1.219-5.481,P=0.013;OR=2.876,95％CI:1.327-6.232,P=0.007;OR=2.332,95％CI:1.120-4.867,P=).024).Conclusion PH2 type hemorrhagic transformation,corona radiate infarct,intemal watershed infarct model and insufficient collateral circulation pathway are the important risk factors of PMD in patients with acute MCAO beyond thrombolysis time.

Objective To investigate effects of N-acetylcysteine (NAC) on changes of the behavior and the monoamine neurotransmitters in prefrontal cortex (PFC), striatum (ST), amygdala (AM) and hippocampus (HIP) in rat model of chronic unpredictable stress (CUS), and to explore the possible mechanisms related to the NAC. Methods Thirty-two male Sprague-Dawle (SD) rats were divided into CUS group, fluoxetine group (FLX), NAC group and control group (n=8 for each group). Rats in CUS group, NAC group and FLX group were all fed alone and received CUS for 6 weeks to establish CUS model. Rats in NAC group and FLX group were given NAC and FLX by daily intragastric administration respectively during the last 3 weeks, while rats in CUS group and control group were given the same volume of solvent. Behavioral assessment including weight measurement, sucrose water consumption test, and opened field test were used for evaluation before and after CUS, and before and after intervention. The concentrations of the monoamine neurotransmitters (NE, DA, 5-HT) in PFC, ST, AM and HIP were measured with Coul array HPLC. Results (1) There were more increases in weight gain, sucrose consumption, and distance of horizontal moving and number of up-right, while the number of feces was less, after intervention in control group, NAC group and FLX group than those of CUS group (P<0.05). (2) Neurotransmitters including NE, DA and 5-HT were significantly decreased in PFC, ST, AM and HIP in CUS group compared with that of control group (P<0.05). The monoamine neurotransmitter (NE, DA and 5-HT) were significantly increased in the brain region (PFC, ST, AM and HIP) in NAC group and FLX group than those of CUS group (P < 0.05). Conclusion NAC and fluoxetine can effectively improve the depressive behavior of the CUS rats, increase the contents of monoamine neurotransmitters including NE, DA and 5-HT in PFC, AM, ST and HIP brain regions.

Objective To study the effects of mild hypothermia on cognitive function , synapsinⅠexpression and synaptic ultrastructure of hippocampus in epileptic rats induced by global cerebral ischemia. Methods Forty-eight male SD rats were randomly divided into control (NC) group, sham-operated (Sham) group, normothermic epilepsy (NT) group and mild hypothermic epilepsy (HT) group. The model of postischemic audio-genetic seizure was established by chest compression. Hypothermia intervention was given to HT group. Immunocytochemistry was conducted to detect the expressions of synapsin I in hippocampus at days 1 , 3, 14. the synaptic ultrastructure and cognitive function were respectively observed by electron microscope and Morris water maze. Results Compared with NC and Sham group, the expression of synapsinI in NT group was decreased, the escape latency was prolonged and across platform number decreased (P < 0.05). The synapses were decreased in number, and mitochondria was viewed swelling, synaptic membranes unclear, myelin fractured. Compared with NT group, the expression of synapsinⅠin HT group had no obvious change in 24 h but was significantly increased in days 3 and 14 (P < 0.01); The escape latency was decreased and the number of cross platform increased (P < 0.01); Synaptic structure was clear, with interface growing and postsynaptic density thickened. Conclusion Mild hypothermia may improve the cognitive function of the epileptic rats induced by global cerebral ischemia by upregulating the expression of synapsinⅠand alleviating the damage of synaptic structure.