Introduction: Permanent hypoparathyroidism is a recognized complication of total thyroidectomy, with an estimated incidence of 10.47%. Standard treatment involves supplementation with calcium and activated vitamin D. However, some patients remain refractory to conventional therapy and fail to achieve normocalcemia. During pregnancy, significant physiological changes occur in calcium-regulating hormones. Notably, the placenta increases the production of parathyroid hormone-related peptide (PTHrP), which acts as a calcitropic hormone, mimicking the effects of parathyroid hormone. Case: A 38-year-old female with a history of total thyroidectomy 14 years ago for follicular thyroid carcinoma presented with permanent hypoparathyroidism. Her condition was refractory to high-dose replacement therapy, which included calcium carbonate 3 g BD, alfacalcidol 4 mcg ON, calcitriol 1 mcg BD, and cholecalciferol 100,000 IU OD. Despite compliance, her serum calcium levels fluctuated between 1.7 and 1.93 mmol/L, necessitating intermittent intravenous calcium infusions. Laboratory investigations showed a phosphate level of 1.63 mmol/L and 24-hour urine calcium of 4.81 mmol/L. Her thyroid function remained stable on levothyroxine 150 mcg daily (T4: 12.0 pmol/L; thyroid-stimulating hormone: 2.93 mIU/L). While off-label use of teriparatide was being considered, she became pregnant. As the pregnancy progressed, her calcium levels stabilized. Calcitriol was discontinued at 26 weeks’ gestation when her calcium reached 2.5 mmol/L. By 30 weeks, the alfacalcidol dose was reduced to 3.5 mcg daily, with cholecalciferol dosing reduced to 50,000 IU OD. Her corrected calcium levels remained between 2.4 and 2.6 mmol/L until delivery. Similar reduction in supplementation requirements was noted during her previous pregnancy. Conclusion Elevated PTHrP during pregnancy likely contributed to improved calcium homeostasis by increasing maternal bone resorption and enhancing placental calcium transfer. This case underscores the necessity of individualized, dynamic adjustments to calcium and vitamin D therapy based on rigorous biochemical monitoring for pregnant patients with hypoparathyroidism.
Female ; Pregnancy ; Hypoparathyroidism ; Placenta

Introduction: Hypernatremia is a common yet high-mortality electrolyte disorder. The hypothalamus maintains water homeostasis via thirst sensation and arginine vasopressin (AVP) secretion. Hypothalamic tumors, such as gliomas, can progressively destroy these osmoregulatory centres, leading to “malignant” hypernatremia (>180 mmol/L). We report a case of life-threatening hypernatremia in a patient with a progressive hypothalamic glioma, exploring its complex pathophysiology. Case: A 41-year-old female with a progressive high-grade hypothalamic glioma and persistent hydrocephalus presented with generalized weakness, reduced oral intake, and dehydration. Her initial Glasgow Coma Scale was E4V3M6. Laboratory investigations revealed malignant hypernatremia (serum sodium 209 mmol/L) and a serum osmolarity of 441 mOsm/kg. Despite life-threatening dehydration (urea 26.2 mmol/L, creatinine 343 umol/L), she was still able to deceptively produce urine output of 400 mL/day with a concentrated urine osmolarity of 890 mOsm/kg. A 1 mcg IV desmopressin trial reduced urine output to 60 mL/day and serum sodium by 10 mmol/L within 14 hours, confirming relative AVP deficiency. The patient’s malignant hypernatremia was gradually corrected to 168 mmol/L over 1 week (8–12 mmol/L/day) using controlled intravenous hydration. However, her condition deteriorated due to hospital-acquired infection, and she succumbed 10 days after admission. Conclusion This case underscores several critical learning points for managing hypothalamic emergencies. First, hypothalamic tumors can reset the osmostat or destroy osmoregulatory centres, causing adipsic AVP deficiency. Second, clinicians must be alert to “masked polyuria” where severe hypovolemia reduces the glomerular filtration rate, causing urine output to appear “normal” despite underlying AVP deficiency. This state of “relative polyuria” is a hallmark of hypothalamic hypernatremia, thus indicating that a normal urine output does not rule out AVP deficiency. While desmopressin is indicated, its use in adipsic patients demands strict fluid titration to prevent iatrogenic hyponatremia. Rapid hypotonic correction carries a proven risk of cerebral oedema, and sodium measurement accuracy varies significantly across laboratory methods in extreme ranges.
Hypernatremia ; Hypothalamic Neoplasms

In recent years, with the rapid development of artificial intelligence technology, the application of deep learning in the field of pathology has been continuously expanding. Particularly, the rise of multimodal data fusion methods has opened up new technical paths for the precise diagnosis, prognosis assessment, and individualized treatment of tumors. By integrating multi-level and multi-source data such as clinical information, pathological omics, molecular omics, and imaging omics, deep learning models can identify potential associated features and key biological mechanisms that are difficult to reveal by a single modality, thereby significantly improving the accuracy of disease classification and the scientific nature of risk stratification. This article systematically reviews the research progress of multimodal data fusion methods based on deep learning in the field of pathology in recent years, focuses on sorting out different types of fusion strategies, evaluates their advantages and challenges in practical clinical applications, and looks forward to future development trends.

OBJECTIVE: To construct and validate a prognostic prediction model for children with sepsis using the Phoenix sepsis score (PSS). METHODS: A retrospective case series study was conducted to collect clinical data of children with sepsis admitted to the pediatric intensive care unit (PICU) of the Affiliated Hospital of Guizhou Medical University from January 2022 to April 2024. The data included general information, the worst values of laboratory indicators within the first 24 hours of PICU admission, PSS score, pediatric critical illness score (PCIS), and the survival status of the children within 30 days of admission. The statistically significant indicators in univariate Logistic regression analysis were included in multivariate Logistic regression analysis to screen the risk factors affecting the prognosis of children with sepsis and construct a nomogram model. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive performance of the model. The Bootstrap method was used to perform 1 000 repeated sampling internal verification and draw the calibration curve of the model. RESULTS: A total of 199 children with sepsis were included, of which 32 died and 167 survived 30 days after admission. In the univariate Logistic regression analysis, shock, white blood cell count (WBC), international normalized ratio (INR), lactic acid (Lac), PSS score, and PCIS score were identified as statistically significant predictors. These variables were then included in the multivariate Logistic regression analysis, which demonstrated that shock [odds ratio (OR) = 4.258, 95% confidence interval (95%CI) was 1.049-17.288], WBC (OR = 1.124, 95%CI was 1.052-1.210), and PSS score (OR = 1.977, 95%CI was 1.298-3.012) were independent risk factors for mortality in pediatric patients with sepsis (all P < 0.05). A nomogram model was constructed based on these three risk factors, with the model equation as follows: -4.809+1.449×shock+0.682×PSS score+0.117×WBC. The calibration curve results showed that the model's predictions were highly consistent with the actual observations. The ROC curve showed that when the Youden index of the prediction model was 0.792, the sensitivity and specificity were 90.6% and 88.6%, respectively, and the area under the curve (AUC) was 0.957 (95%CI was 0.930-0.984), which was higher than the AUC of shock, WBC, and PSS score alone (0.808, 0.667, 0.908, respectively). CONCLUSIONS Shock, WBC, and PSS score have demonstrated certain predictive value for mortality in children with sepsis. The nomogram model based on the above indicators has important clinical significance for evaluating the prognosis and guiding treatment of children with sepsis.
Humans ; Sepsis/diagnosis* ; Prognosis ; Retrospective Studies ; Logistic Models ; Intensive Care Units, Pediatric ; Nomograms ; Child ; ROC Curve ; Risk Factors ; Male ; Female ; Child, Preschool ; Infant

Hepatitis E is the liver inflammation caused by a hepatitis E virus infection.Immunocompetent patients with acute hepatitis E can spontaneously clear the infection,whereas immunosuppressed patients may not be able to clear the hepatitis E virus infection and develop chronic hepatitis.Most patients with hepatitis E are asymptomatic and present only with mild and persistent liver function abnormalities.This article reports a case of hepatitis E in an immunocompetent adult with elevated aminotransferases as the main manifestation.Hepatic fibrosis was detected by hepatic puncture biopsy.This report aims to remind other physicians to evaluate liver fibrosis when encountering acute hepatitis E,especially in patients with chronic liver disease.
Adult ; Humans ; Acute Disease ; Hepatitis E/complications* ; Liver Cirrhosis/etiology*

BACKGROUND:Percutaneous retrograde screws and minimally invasive percutaneous plates are extensively used in the treatment of unilateral pubic ramus fractures.However,the above internal fixations have the disadvantages of mistakenly penetrating the hip joint and damaging the medial pelvic trophoblastic artery.A new type of retrograde superior pubic ramus intramedullary nail offers advantages,such as fewer radiographic exposures and shorter surgery times,but the validation of the biomechanical properties of the three endoprostheses is lacking.OBJECTIVE:To compare the biomechanical differences post-treatment of upper and lower pubic ramus fractures using percutaneous retrograde screws,minimally invasive percutaneous plates,and retrograde superior pubic ramus intramedullary nail under various conditions through finite element analysis.METHODS:Pelvic CT data were collected from one volunteer and imported into Mimics 20,Geomagic Wrap 2021,and SolidWorks 2019 to create geometric models of three types of internal fixation for treating unilateral pubic ramus fractures:hollow screw group,plate group,and intramedullary nail group.Each model was imported into Ansys 2022 software,where it was set up in vertical,book-opening,and shear conditions for preprocessing and calculation to compare and analyze the mechanical stability of the implants.RESULTS AND CONCLUSION:(1)In vertical conditions,the biomechanical stability of the hollow screw treatment for unilateral pubic fractures was superior to that of the steel plate and intramedullary nail,with the smallest peak stress in the implant,which was four times lower compared to the other two groups.(2)In book-opening conditions,the steel plate treatment for unilateral pubic fractures showed better biomechanical stability,particularly in reducing stress at the fracture ends of the upper pubic branch,with stress values five times higher in the other two groups.(3)In shear conditions,the intramedullary nail treatment for unilateral pubic fractures exhibited good biomechanical stability,maintaining the best pelvic displacement,with a 25％greater displacement observed in the other two groups.(4)These findings reveal the biomechanical differences of different implants:the peak stress of implants is the smallest under vertical working conditions with percutaneous retrograde screws.Minimally invasive percutaneous plates reduce the stress at the broken end of superior pubic branch under open-book working condition.Retrograde superior pubic ramus intramedullary nail of superior pubic branch maintains pelvic displacement under shear working condition.The surgeon can combine the biomechanical differences of the implants with the actual situation of pubic injury in clinical practice to make the best implant treatment.

Histological staining is the basis of pathological analysis,but the traditional staining method relies on chemical reagents,which not only consumes a lot of resources,but also causes harm to the environment and human health.In recent years,with the rapid development of deep learning technology,virtual staining technology,as a new method,is expected to effectively replace and supplement the traditional histological staining methods.It uses neural networks to analyze unstained tissue images,generate digital images that are highly similar to chemical staining effects,and even realize the mutual conversion between different staining modes,reducing the laboratory's dependence on chemical reagents and providing sustainable research programs.In this paper,the basic principles of virtual staining and its potential applications in histopathology are introduced in detail,and the current challenges and future research directions are discussed.

Objective:To explore the acupoint selection law of acupuncture and moxibustion in the treatment of broca aphasia after stroke.Methods:RCT articles about acupuncture and moxibustion treatment for broca aphasia after stroke were retrieved from CNKI, VIP, Wanfang Data, China Medical Journal Full-text Database, SinoMed, PubMed, Web of Science and Embase database from the establishment of the databases to May 31, 2024. Excel 2021, SPSS Statistics 27.0, SPSS Modeler 18.0 and Cytoscape 3.9.1 software were used to analyze the frequency of acupoint, clustering, association rules and core co-occurrence network.Results:A total of 87 articles were included, involving 100 acupuncture and moxibustion prescriptions and 101 acupoints/acupoint area, involving 6 types, including Lianquan (CV 23) (35 times), Jinjin (EX-HN12) (35 times) and Yuye (EX-HN13) (34 times). The selected acupoints were mainly distributed in the head, face, neck and lower limbs, and the meridians were mainly Governor Vessel and Conception Vessel; the specific acupoints were mainly original acupoints, followed by collaterals acupoints, and scalp acupuncture was used most frequently in special acupuncture (88 times). According to the clustering analysis of high-frequency acupoints/acupoint area, there were five effective groups, such as "Jinjin (EX-HN12)-Yuye (EX-HN13)-Lianquan (CV 23)-Baihui (GV 20)-Yamen (GV 15)". The core co-occurrence network analysis showed that the acupoints used most frequently were Lianquan (CV 23) and Jinjin (EX-HN12), and the highest correlation between the two acupoints was Jinjin (EX-HN12)-Yuye (EX-HN13).Conclusions:Acupuncture and moxibustion for the treatment of broca aphasia after stroke is often based on "awakening the brain as the outline, benefiting the marrow as the foundation, and resuscitation". Under the guidance of the theory of Zang-fu meridians and collaterals, through dredging the meridians and collaterals, tonifying the brain and opening and closing the sound, the recovery of language function can be achieved.

Objective:To systematically analyze the impact of various physician payment methods on medical service delivery behavior and outcomes.Methods:Based on the scoping review method,2 255 documents related to"physician","compensation","payment method",and"physician behavior"were retrieved from Web of Science,CNKI,VIP,and WanFang databases,and finally 70 studies were included based on scientific screening standards and process.Results:Fee-for-service encourages physicians to deliver an adequate volume of services but is susceptible to overtreatment;salary and capitation assist in controlling costs but can lead to insufficient service provision;the advantages of DRG/DIP in the quantity and quality of medical services weaken as the patient's condition worsens.Mixed payment methods can effectively balance the quantity and cost of medical services,while pay-for-performance is generally outstanding in improving quality.Conclusions:It is difficult for a single payment method to achieve the optimization of medical service delivery behavior and outcomes.A mixed payment system that integrates multiple payment methods with quality incentives must be established urgently.At the same time,it is recommended to deepen the reform of the mechanism for converting medical insurance balance into physician compensation,fully implement the allocation autonomy of public hospitals,and accelerate the establishment of a mixed physician payment method that is coordinated with medical insurance payment and performance appraisal.

Aim To investigate the neuroprotective effect of dioscin(DIO)on hippocampal neurons(HT22)after oxygen glucose deprivation/reoxygen-ation(OGD/R)and its possible mechanism.Methods HT22 cells were treated with 0,2.5,5,10,20,40,80,160,and 320 mg·L-1DIO for 24 h,and the cell proliferation rate was detected by CCK-8 method.The concentration that was non-toxic to HT 2 2 cells was se-lected for subsequent experiments.After OGD for 2 h,HT22 cells were randomly divided into the OGD/R group,1.25,2.5,and 5 mg·L-1DIO group,and posi-tive control group.HT22 cells were taken as the con-trol group.After drug intervention for 24 h,the cell proliferation rate was detected by CCK-8 method;the LDH release was detected by colorimetry;the cell ap-optosis rate was detected by TUNEL method;the ex-pression of proteins related to PARP-1/AIF pathway and caspase pathway was detected by Western blot.Results DIO intervention significantly upregulated the expression of AIF protein in mitochondria and PAR protein in nucleus of HT22 cells after OGD/R,and sig-nificantly downregulated the release of LDH,neuronal apoptosis rate,total protein expression of AIF and PAR,PARP-1,AIF in nucleus and protein expression of PAR protein in mitochondria,while the expression of Bax and caspase-3 proteins was not significantly differ-ent from that in the OGD/R group.Conclusion DIO can alleviate the apoptosis of HT22 cells induced by OGD/R by regulating the expression and translocation of proteins related to the PARP-1/AIF pathway,thus playing a neuroprotective role.