Objective To analyze the risk factors of permanent hypoparathyroidism(pHPP)after total thyroidectomy in patients with thyroid cancer and establish a nomogram prediction model.Methods A total of 245 patients with thyroid cancer who received total thyroidectomy in our hospital were enrolled between January 2020 and January 2024.According to presence or absence of postoperative pHPP,patients were divided into the pHPP group and the non-pHPP group.The influencing factors of postoperative pHPP in patients with thyroid cancer were analyzed by univariate and multivariate Logistic regression analysis.The nomogram prediction model for postoperative pHPP in patients with thyroid cancer was constructed and varified,and efficiency of the model was evaluated.Results In 245 patients with thyroid cancer,the incidence of pHPP within 6 months after surgery was 10.20%(25/245).Univariate analysis showed that there were significant differences in tumor size,surgical method,central lymph node dissection,use of nano carbon tracer,envelope invasion,parathyroid excision by mistake,Hashimoto thyroiditis,serum calcium and parathyroid hormone at 1 d after surgery between the two groups(P＜0.05),but there were no significant differences in gender,age,smoking,drinking,extraglandular invasion,parathyroid autologous transplantation,preoperative vitamin D or serum phosphorus at 1 d after surgery between the two groups(P＞0.05).Multivariate analysis showed that maximum tumor diameter≥4 cm,routine and open total thyroidectomy,central lymph node dissection,no use of nano carbon tracer and parathyroid excision by mistake were all independent risk factors for postoperative pHPP in patients with thyroid cancer(P＜0.05).Results of nomogram prediction model showed that C-index was 0.921,the corrected curve was close to ideal curve,and AUC of nomogram model for predicting postoperative pHPP was 0.926(95%CI:0.871-0.981).Conclusion The nomogram prediction model constructed based on independent risk factors of postoperative pHPP has good predictive efficiency in patients with thyroid cancer.

Objective To explore the effect of artificial pleural effusion combined with radiofrequency ablation in patients with phrenic top liver cancer.Methods A total of 92 patients with liver tumors at top of the diaphragm were prospectively selected and divided into the control group(46 cases,radiofrequency ablation)and the observation group(46 cases,radiofrequency ablation+artificial pleural effusion)by the random number table method.Clinical outcomes one month after treatment,time to first surgical ablation,serum alpha-fetoprotein(AFP)levels and complications before treatment and one month after treatment were compared.Both groups were followed up for 2 years after the operation,and survival conditions of patients were compared.Results Enhanced MRI or enhanced CT at 1 month after surgery in the 2 groups showed that the complete tumor ablation rate was lower in the control group than that in the observation group(76.09%vs.93.48%,P＜0.05).The surgical ablation time of the observation group was shorter than that of the control group[(9.64±1.22)min vs.(11.15±1.47)min,P＜0.05].The survival rates were higher in the observation group than those in the control group at 1 year(82.61%vs.58.70%)and 2 years(71.74%vs.47.83%)after treatment(P＜0.05).Serum AFP levels decreased in both groups after treatment,and those were lower in the observation group than those in the control group(P＜0.05).The total complication rate of the observation group was lower than that of the control group(8.70%vs.23.91%,P＜0.05).The follow-up period of 92 patients ranged from 7 to 29 months,with a mean of(20.17±4.61)months.The local tumor progression rate was higher in the control group than that in the observation group during the follow-up period(36.96%vs.10.87%,P＜0.05).Conclusion Artificial pleural effusion combined with radiofrequency ablation can effectively improve the clinical efficacy and survival rate of patients with liver cancer,reduce the level of serum AFP and decrease the occurrence of complications.

Objective To investigate the therapeutic effect of Sheng Mai San mixed Jiawei Sheng Xian Tang on patients with heart failure with reduced ejection fraction(HFrEF)of Qi deficiency blood stasis type,and its impact on the immune inflammatory response of patients.Methods Ninety patients with HFrEF of Qi deficiency blood stasis type were selected and divided into two groups according to the treatment plan.Patients of the conventional group(42 cases)took sacubitril/valsartan sodium tablets orally.Patients of the combined group(48 cases)were treated with Sheng Mai San combined with Jiawei Sheng Xian Tang on the basis of the conventional group,one dose per day,and divided it in two servings used in the morning and evening.The symptoms of the patients were evaluated by using traditional Chinese medicine(TCM)syndrome score before and after the treatment respectively.Echocardiography technology was used to measure the left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF).Enzyme-linked immunosorbent assay was used to detect pentaggrin 3(PTX3),tumor necrosis factor-α(TNF-α),galectin-3(Gal-3),interleukin(IL)-8,IL-6,IL-33 and angiotensin Ⅱ(Ang Ⅱ).N-terminal pro-brain natriuretic peptide(NT-proBNP)was detected by immunofluorescence analysis.The therapeutic effect was evaluated based on the symptoms and the New York Heart Association(NYHA)cardiac function classification in the United States.Results After treatment,the levels of TCM syndrome scores,LVEDD,TNF-α,PTX3,IL-8,IL-6,IL-33,NT-proBNP,Gal-3 and AngⅡ decreased in both groups,and those in the combined group were lower than those in the conventional group(P＜0.05).The LVEF increased,and which were higher in the combined group than those of the conventional group(P＜0.05).After the treatment,the total effective rate of the combined group was higher than that of the conventional group(P＜0.05).Conclusion The Sheng Mai San mixed Jiawei Sheng Xian Tang as adjuvant therapy can effectively reduce the levels of immune inflammatory cytokines in HFrEF patients of Qi deficiency blood stasis type,improve their clinical symptoms and enhance therapeutic effect.

Objective To explore the clinical efficacy of erigeron breviscapus injection combined with atorvastatin calcium in patients with acute ischemic stroke(AIS)and its impact on systemic inflammatory markers.Methods A total of 151 AIS patients diagnosed and treated from January 2020 to December 2022 were selected and divided into the control group(n=75)and the study group(n=76)by random number method.The control group was given oral atorvastatin calcium treatment,and the study group was additionally treated with erigeron breviscapus injection on this basis.Before treatment,7 d and 14 d after treatment,neurological function[National Institutes of Health Stroke Scale(NIHSS)],motor function[Fugl-Meyer Assessment(FMA)],activities of daily living[Barthel Index(ADL)]and systemic inflammatory markers such as tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin(IL)-6,lymphocytes(LYM),white blood cells(WBC),neutrophils(NEU)and platelets(PLT)were evaluated.Efficacy evaluation was conducted after 14 days of treatment.The adverse reactions of patients during the treatment period were recorded for safety assessment.Results The NIHSS score,TNF-α,CRP,IL-6,WBC,NEU and PLT levels were lower in the study group than those in the control group after 7 d and 14 d treatment,and decreased with the increase of treatment time(P＜0.05).After 7 d and 14 d treatment,FMA score,ADL score and LYM level were higher in the study group than those in the control group,and increased with the prolongation of treatment time(P＜0.05).TNF-α,CRP,IL-6,WBC,NEU and PLT were positively correlated with NIHSS score,and negatively correlated with FMA score and ADL score.LYM was negatively correlated with NIHSS score,and positively correlated with FMA score and ADL score(P＜0.05).The total effective rate was higher in the study group than that of the control group(P＜0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P＞0.05).Conclusion After the combined treatment of AIS with erigeron breviscapus injection and atorvastatin calcium,the systemic inflammatory level of patients decreases significantly,the curative effect is good and the safety is high.

Objective To observe the effect of Magu Xujin capsule on clinical symptoms and bone metabolism after intramedullary nail fixation of proximal humerus fracture.Methods Eighty-two patients with proximal humeral fractures treated with intramedullary nailing were randomly divided into two groups,with 41 cases in each group.The conventional group was given routine anti-swelling and pain-relieving symptomatic treatment after surgery,while the experimental group was given Magu Xujin capsules(2 capsules each time,3 times a day,for 8 consecutive weeks)on the basis of the conventional group.Changes in shoulder joint circumference difference,shoulder joint pain score,Neer shoulder joint function score and callus growth score were compared between the two groups.The serum levels of osteocalcin(BGP),N-terminal osteocalcin(N-MID),bone morphogenetic protein 2(BMP-2)and blood calcium were detected by enzyme-linked immunosorbent assay.The occurrence of complications and adverse reactions was analyzed in the two groups.Results Changes of shoulder joint circumference difference at 3,5,7 and 14 days after surgery were lower than those at 1 day after surgery in both groups,and changes of the shoulder joint circumference difference were smaller in the experimental group at 3,5,7 and 14 days after surgery than those in the conventional group(P＜0.01).The shoulder joint pain scores in both groups at 3,5,7 and 14 days after surgery and at 4 and 8 weeks were lower than those at 1 day after surgery,and the score was lower in the experimental group than that in the conventional group(P＜0.01).The serum levels of BGP,N-MID,BMP-2 and blood calcium in both groups at 4 and 8 weeks after surgery were higher than those before surgery(P＜0.05),and the levels in the experimental group were higher than those in the conventional group(P＜0.05).The Neer scores in both groups at 4 and 8 weeks after surgery were higher than those before surgery(P＜0.05).The Neer score and callus growth score at 4 and 8 weeks after surgery were higher in the experimental group than those in the conventional group(P＜0.05).In the conventional group,there were two cases of delayed fracture healing and one case of soft tissue infection after surgery.No adverse reactions occurred in either group.Conclusion Magu Xujin capsules can promote the reduction of swelling after intramedullary nail fixation surgery for proximal humeral fractures,alleviate shoulder joint pain,improve bone metabolism and promote the recovery of shoulder joint function.

Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2(Lp-PLA2)and homocysteine(Hcy)combined with white matter hyperintensities(WMH)for cognitive impairment in patients with cerebral small vessel disease(CSVD).Methods A total of 240 patients with CSVD were selected.According to the Montreal Cognitive Assessment(MoCA)scale,all subjects were divided into the non-cognitive impairment group(MoCA≥26 points,120 cases)and the cognitive impairment group(MoCA＜26 points,120 cases).Paraventricular white matter high signal(PWMHs)and deep white matter high signal(DWMHs)were scored by Fazekas scale.The sum of the two parts was the total score,and the severity of DWMHs was graded by the score.The basic information,serum Lp-PLA2,Hcy level and severity of WMH were compared between the two groups.Logistic regression was applied to analyze influencing factors of cognitive impairment in CSVD patients.The predictive value of serum level of Lp-PLA2 and Hcy and WMH for cognitive impairment in CSVD patients was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the non-cognitive impairment group,patients of the cognitive impairment group were older,had higher serum levels of Lp-PLA2 and Hcy,and had more severe of WMH(P＜0.05).Results of Logistic regression analysis showed that serum Lp-PLA2,Hcy levels and severity of WMH were influencing factors for cognitive impairment of patients with CSVD(P＜0.05).The results of ROC curve analysis showed that the area under the curve of serum Lp-PLA2,Hcy level combined with severity of WMH predicting cognitive impairment in patents with CSVD was 0.812,the sensitivity was 81.7%and the specificity was 71.7%(P＜0.05).Conclusion Patients with cognitive impairment caused by CSVD have higher serum levels of Lp-PLA2 and Hcy,and more severe WMH.The combination of the three has a relatively high predictive value for cognitive impairment in patents with CSVD.

Objective To investigate the clinical efficacy of Jiawei Tai Yuan Yin combined with allylestradiol tablets for the treatment of early threatened abortion complicated by subchorionic hematoma(SCH).Methods A total of 120 patients with early threatened miscarriage combined with SCH were selected and divided into the observation group(Jiawei Tai Yuan Yin+allylestradiol tablets,60 cases)and the control group(allylestradiol tablets,60 cases)according to the treatment regimen.Seven days was one course of treatment,and both groups of patients were treated for two courses.Changes of traditional Chinese medicine(TCM)syndrome score before treatment and 14 days after treatment,clinical efficacy,SCH area,the ratio of SCH area to gestational sac area,vaginal bleeding(duration and volume),the miscarriage rate in the early stage of pregnancy,the ratio of auxiliary T cells to inhibitory T cells(Th/Ts)and the level of carbohydrate antigen 125(CA125)were observed.Results After 14 days of treatment,TCM syndrome scores,SCH area,the ratio of SCH area to gestational sac area,the Th/Ts ratio and the CA125 level were decreased in the two groups,and those of the observation group were lower than those of the control group(P＜0.05).After 14 days of treatment,the total effective rate was higher in the observation group than that of the control group(P＜0.05).During the treatment period,the duration of vaginal bleeding,the amount of vaginal bleeding and the miscarriage rate in the early stage of pregnancy were lower in the observation group than those in the control group(P＜0.05).Conclusion The combination of Jiawei Tai Yuan Yin and allylestradiol tablets can effectively treat early threatened miscarriage with SCH,thereby reducing the miscarriage rate in early pregnancy.

Objective To analyze the global burden of disease and cross-national imbalances of tracheal,bronchial and lung cancer from 1990-2021 and to further predict changes up to 2040.Methods Age-standardised incidence rate(ASIR),prevalence rate(ASPR),mortality rate(ASMR),disability-adjusted life years rate(ASDR)and 95%confidence interval(95%UI)were extracted from GHDx.The official data platform of the institute for health metrics and evaluation(IHME)and the source of data were the Global Burden of Disease Study 2021(GBD 2021)for global burden of disease of trachea,bronchus and lung cancer.The estimated annual percentage change(EAPC)was calculated to describe the prevalence at global,regional and national levels,to understand the differences in diseases at different gender,age and socio-demographic index(SDI)levels,and to explore the overall situation through cluster analysis,cross-country health inequality analysis and to predict the future prevalence up to 2040 through Nordpred model.Results Globally,the ASIR for tracheal,bronchial and lung cancer fluctuated slightly from 1990 to 2009,and began to decline rapidly after 2009,with an ASIR of 26.42/100 000 in 2021.ASPR showed an increasing and then decreasing trend,reaching a peak in 2011,with a peak of 37.28/100 000 in 2021,while the ASMR and the ASDR showed a general decreasing trend.Tracheal,bronchial and lung cancer diseases showed the highest disease burden in men,those aged 65-74 and in countries and regions with high SDI.ASDR burden showed significant inequalities globally,with a significant positive correlation between ASDR and SDI,mainly concentrated in countries and regions with high SDI,and the unequal burden of ASDR for tracheal,bronchial and lung cancer decreases over time.Predictive analyses found that the number of new cases,current cases,deaths and disability-adjusted life years(DALY)for tracheal,bronchial and lung cancer were expected to increase through 2040,whereas ASIR,ASPR,ASMR and ASDR were projected to decrease each year.Conclusion The overall burden of tracheal,bronchial and lung cancer has declined globally from 1990 to 2021,but with demographic and regional differences.The actual number of cases will continue to climb in the future,despite the continuing decline in age-specified rates,and disease prevention and control will need to focus on growth trends and equity in resource allocation.

Objective To explore the influencing factors of compliance with new oral anticoagulants(NOACs)in elderly patients with nonvalvular atrial fibrillation(NVAF)and its correlation with social support.Methods The clinical data of 126 patients with NVAF treated by NOACs in Lu 'an People's Hospital of Anhui Province from January 2022 to January 2024 were selected by convenient sampling method.General data of patients were collected.According to Morisky medication compliance scale,patients were divided into two groups:the good compliance group(n=74)and the poor compliance group(n=52).Social support was investigated by Social Support Rating Scale(SSRS).General data of patients were compared between the good compliance group and the poor compliance group.The relationship between medication compliance and social support was analyzed by Pearson correlation.Multivariate Logistic regression was used to analyze the influencing factors of patient medication compliance.Results There were statistically significant differences in educational level,the proportion of patients with anxiety and depression,CHA2DS2-VASc score,HAS-BLED score and SSRS score between the good compliance group and the poor compliance group(P＜0.05).The results of the correlation analysis showed that the medication compliance of patients was positively correlated with objective support(r=0.461),subjective support(r=0.432),support utilization(r=0.323)and SSRS score(r=0.596,P＜0.05).The results of multivariate Logistic regression analysis showed that low educational level,accompanied by anxiety,low HAS-BLED and SSRS scores were risk factors for poor medication compliance in elderly NVAF patients(P＜0.05).Conclusion Improving the social support level of elderly patients with NVAF is conducive to the formation of good medication compliance.

Sleep-related breathing disorders(SBDs)are a group of disorders characterized by abnormal breathing patterns during sleep,with obstructive sleep apnea(OSA)being the most common type.Pulmonary hypertension(PH)is characterized pathophysiologically by pulmonary vasoconstriction and vascular remodeling,with initial clinical diagnosis typically relying on echocardiography.SBDs and PH have a bidirectional relationship in many aspects,with shared pathophysiological mechanisms such as hypoxia,inflammation and oxidative stress being common.The percentage of sleep time with nocturnal oxygen saturation＜0.90(T90)can assess the risk of pulmonary hemodynamic and right ventricular function deterioration in OSA patients,but this indicator still has limitation in clinical application.Currently,there is limited domestic research on the bidirectional relationship between SBDs and PH in China.This article reviews the bidirectional relationship between SBDs and PH in terms of epidemiology,potential mechanisms,screening and treatment.It also analyzes the relevance of OSA and PH based on current domestic and international clinical studies,providing a theoretical basis for further exploration of these two diseases.