Objective To assess the clinical value of a nomogram model constructed by the authors in predicting recurrent laryngeal nerve(RLN)injury after thermal ablation for secondary hyperparathyroidism(SHPT).Methods The clinical data of a total of 102 patients with end-stage renal disease SHPT,who received thermal ablation at the Yulin Municipal First People's Hospital of China from May 2019 to January 2024,were retrospectively analyzed.According to whether RLN injury occurred or not after thermal ablation,the patients were divided into RLN injury group(n=24)and non-RLN injury group(n=78).The clinical data were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for RLN injury.R language was used to construct a visualization nomogram according to the variables of the logistic regression model.The receiver operating characteristic(ROC)curve was used to evaluate the discrimination of the nomogram model.Hosmer-Lemeshow test and calibration curve were used to evaluate the goodness of fit and the calibration of the nomogram model.Results Superior gland ablation(OR=8.784,95％ CI:2.056-37.521,P=0.003),total parathyroid gland volume(OR=1.684,95％CI:1.167-2.430,P=0.005),thermal ablation energy(OR=1.132,95％ CI:1.016-1.261,P=0.025)were the independent risk factors for RLN injury after thermal ablation(all P＜0.05).Based on the above 3 risk factors,a nomogram model used for predicting the risk of RLN injury was established.The area under ROC curve(AUC)was 0.868,and the Hosmer-Lemeshow test showed that the degree of fit was good(P=0.769).The calibration curve indicated that the calibration curve basically coincided with the ideal curve.Conclusion Superior gland ablation,total parathyroid gland volume,and thermal ablation energy are the independent risk factors for RLN injury after thermal ablation in patients with end-stage renal disease SHPT.The nomogram model constructed based on the above mentioned three factors can effectively predict RLN injury.

Purpose To investigate the risk factors of severe hypocalcemia after ultrasound-guided thermal ablation for secondary hyperparathyroidism.Materials and Methods A retrospective case-control study was used to study 91 patients with uremia complicated with secondary hyperparathyroidism in the First People's Hospital of Yulin from May 2019 to May 2023.All patients underwent ultrasound-guided thermal ablation and were divided into severe hypocalcemia group(SH)and non-SH group according to postoperative blood calcium levels.The difference of clinical data between the two groups was compared,and the independent risk factors of SH were investigated by multivariate Logistic regression analysis.Results A total of 317 glands were ablated in 49 cases of microwave ablation and 42 cases of radiofrequency ablation.SH occurred in 57 cases(62.64%)after ablation.The comparison of clinical data between the two groups showed that there were significant differences in the preoperative intact parathyroid hormone(iPTH),decline rate of iPTH 1 d,preoperative serum alkaline phosphatase,the proportion of parathyroid glands≥4 and the total gland volume between the two groups(all P<0.05).Receiver operating characteristic curve analysis was used to obtain the best cut-off point of iPTH 1 d decline rate,the result was 74.59%,the area under the curve was 0.866(95%CI 0.787-0.945)(P<0.05),the sensitivity was 84.2%,and the specificity was 78.1%.Multivariate Logistic regression analysis showed that preoperative alkaline phosphatase(OR=1.015,95%CI 1.005-1.025,P=0.030)and decline rate of iPTH 1 d≥74.59%(OR=30.423,95%CI 5.938-155.858,P<0.001)and parathyroid glands≥4(OR=4.355,95%CI 1.027-18.469,P=0.046)were independent risk factors for postoperative SH(all P<0.05).Conclusion Preoperative alkaline phosphatase and decline rate of iPTH 1 d≥74.59%and the number of parathyroid glands≥4 are independent risk factors for SH after thermal ablation.

Objective To observe the risk factors of recurrence after ultrasound-guided thermal ablation for treating uremia secondary hyperparathyroidism(SHPT).Methods Totally 59 patients with uremia SHPT who underwent ultrasound-guided thermal ablation were enrolled,including 23 cases with(relapse group)and 36 without SHPT recurrence(non relapsed group).Clinical data were compared between groups,univariate and multivariate logistic regression analysis were performed to screen independent risk factors of SHPT recurrence.Results There were significant differences of serum free thyroxine(FT4),urea,intact parathyroid hormone(iPTH)1 day after ablation,1 day decrease rate of iPTH,the maximum diameter of the largest nodule,ablation time,total ablation energy,energy to volume ratio and the proportion of 1 day decrease rate of iPTH≤90%between groups(all P＜0.05).Higher urea,lower energy to volume ratio and 1 day decrease rate of iPTH≤90%were all independent risk factors of SHPT recurrence(all P＜0.05).Conclusion Higher urea,lower energy to volume ratio and 1 day decrease rate of iPTH≤90%were independent risk factors of recurrence after ultrasound-guided thermal ablation for treating uremia SHPT.

Objective: To evaluate the effectiveness and safety of the endoscope combined with microscope for the microvascular decompression in hemifacial spasm. Methods: A total of 26 patients underwent endoscope combined with microscopic facial nerve microvascular decompression through retrolabyrinthine approach from January 2013 to December 2016 were retrospectively reviewed in Ear Institute, Shanghai Jiaotong University School of Medicine. Among them, 9 were male and 17 were female, with a mean age of (51.9±11.4) years;15 cases of left side and 11 of right side patients were followed up for 1-3 years. The pre-and post-operative Cohen Classification was used for hemifacial spasm, House-Brackmann Grade for facial nerve function, hearing level and complication rates were reviewed. SPSS 19.0 software was used to analyze the data. Results: All 26 patients were operated successfully. No recurrence was seen during 1-3 year follow-up. Post-operative Cohen Grade were as follows: 25 cases with Cohen Grade I and 1 case with Cohen Grade II. The difference in Cohen grade between pre-and post-operative was statistically significant (Z=-4.87, P<0.01). Post-operative facial nerve function was satisfactory in all patients (House-Brackmann Grade I-II in all patients). No hearing loss was observed. No facial paralysis and other lower cranial nerve dysfunction were observed. No postoperative complications such as cerebrospinal fluid leakage occurred. Conclusions Using an angled endoscope combined with microscope in microvascular decompression in hemifacial spasmis is safe and effective.

Clinical efficacy of liver lesion with the treatment of reduced glutathione and ademetionine was analyzed retrospectively. 83 patients were randomly divided into two groups based on the application of preventive hepatopro-tective drug. Control group was treated with reduced glutathione intravenous drip infusion once a day ( n =40 ) , while treatment group with reduced glutathione and ademetionine(Transmetil) once a day(n=43). After 12 days, the clinical efficacy of treatment group was better than that of control group. Total response rate was 95. 35% for treatment group, much better than that of control group(80. 00%). There was significant difference between two groups ( P<0.05 ) . Reduced glutathione and ademetionine are more effective in the treatment of chemotherapeutics-induced liver lesion than only with reduced glutathione.

Objective To explore the value of readout segmentation of long variable echo-trains (RESOLVE) in the differentiation of prostate cancer from benign prostatic hyperplasia (BPH).Methods Seventy two consecutive patients with suspected prostate cancer were evaluated by 3.0 T MR examination (RESOLVE sequence included,b values=0 and 800 s/mm2) were included in our retrospective study.All the patients had ultrasound guided systemic biopsy with histopathological diagnosis.The patients were divided into group A (23 prostate cancer cases with total 43 malignant lesions) and group B (49 BPH cases with total 64 benign lesions).Two radiologists who were blinded to the clinical data quantitatively analyzed the ADC values of suspicious lesions independently.Inter-reader agreement for ADC values was assessed with Bland and Altman test,and the intra-class correlation coefficient (ICC).Difference of ADC values in two groups was assessed by student's t test.Receiver operating characteristic curve (ROC) was used to determine the best predictor and cutoff value.Results A total of 107 lesions (43 malignant and 64 benign) were identified in 72 patients.ICC was 0.976,P＜0.01.The mean ADC value of prostate cancer is lower than BPH (t=19.223,P＜0.01),(0.74±0.12) × 10 3 and (1.21±0.12) × 10-3mm2/s respectively.Diagnostic cut-off point was 0.946× 10-3mm2/s,diagnostic sensitivity 95.3 ％ (41/43),specificity 98.4％ (63/64),accuracy 97.2％ (104/107).Conclusion RESOLVE ADC value is valuable in the differential diagnosis of prostate cancer and BPH.