In recent years， the incidence of papillary thyroid carcinoma （PTC） in China has increased significantly. Thus， it is necessary to standardize the procedures of diagnosis， treatment and follow-up. Thyroid Center of the Third Affiliated Hospital of Sun Yat-sen University （consisted of Department of Ultrasound， Department of Thyroid and Breast Surgery， Department of Otolaryngology Head and Neck Surgery， Department of Endocrinology， Department of Nuclear Medicine， Department of Medical Oncology， Department of Pathology， and Department of Radiology） referred to the 2015 American Thyroid Society guidelines for the diagnosis and treatment of adult thyroid nodules and differentiated thyroid cancer， the 2021 Chinese society of clinical oncology thyroid guidelines， China Anti-Cancer Association guidelines for holistic integrative management of thyroid cancer （2022 version） combined with clinical front-line work experience， aimed at the pre-operative diagnosis process of papillary thyroid cancer， fine needle aspiration pathology reporting standards， the indications and complication of radical treatments such as open surgery， endoscopic surgery， thermal ablation treatment for newly diagnosed PTC， the standards and processes of ¹³¹I treatments with intents of thyroid clearance， adjuvant therapy， and focal cleaning treatment， postoperative dynamic evaluation， and TSH inhibition treatment， etc.， and finally built the integrated diagnosis and treatment path of PTC （initial treatment）. Hereby we released this guideline.

Objective To investigate the relationship between thyroid hormones levels and frailty in patients with type 2 diabetes mellitus （T2DM）. Methods Data were obtained from a cross-sectional study， which was a follow-up of the METAL study （a 5-year community-based follow-up study on risk factors for chronic complications of diabetes） conducted from April to June 2023. The study included 897 adult patients with T2DM from 11 communities in Shanghai. The degree of frailty was assessed using the frailty phenotypes， which included weight loss， fatigue， reduced physical activity， decreased walking speed， and reduced grip strength. General information of participants was recorded， and the levels of thyroid hormones [free triiodothyronine （FT₃）， free thyroxine （FT₄）， and thyroid-stimulating hormone （TSH）] and thyroid antibodies [thyroglobulin antibody （TgAb） and thyroid peroxidase antibody （TPOAb）] were measured. Multivariate logistic regression analysis was used to examine the relationship between thyroid hormone levels and frailty phenotype. Results After adjusting for age， gender， body mass index （BMI）， smoking status， presence of hypertension or heart failure， duration of diabetes and glycated hemoglobin （GHbA_1c）， multivariate logistic regression analysis showed that FT₃ levels was the protective factor with weight loss （OR = 0.71， 95% CI 0.51-0.99） and low grip strength （OR = 0.61， 95% CI 0.43-0.86） （all P < 0.05）. Conclusions FT₃ levels are negatively correlated with weight loss and low grip strength in patients with T2DM， suggesting that low FT₃ levels may be associated with an increased risk of frailty in this population.

ObjectiveTo investigate the mechanism of thymosin β10 gene （TMSB10） promoting the progression of papillary thyroid carcinoma （PTC）. Methods The Gene Expression Profiling Interactive Analysis （GEPIA） database was used to analyze highly expressed genes in PTC and their expression levels across different T and N stages. Real-time quantitative PCR （qRT-PCR） was employed to detect the differential expression of TMSB10 in the human thyroid follicular epithelial cell line Nthy-ori 3-1 and PTC cell lines （BCPAP, TPC-1, KTC-1, BHT101）. Western blot was used to measure the expression differences of TMSB10 protein in each group. Short hairpin （sh） RNA sequences （sh-TMSB10-NC, sh-TMSB10-1, sh-TMSB10-2 vectors） were constructed in 293T cells and transfected into TPC-1 and BCPAP cells to knock down TMSB10 expression， which was validated by qRT-PCR. Cell proliferation was assessed using the Cell Counting Kit-8 （CCK-8） assay, and cell invasion ability was measured using the Transwell assay. Results GEPIA database analysis revealed that TMSB10 was highly expressed in PTC, with statistically significant differences across different T and N stages （all P < 0.05）. Compared to Nthy-ori 3-1 cells, TMSB10 was highly expressed in PTC cell lines, with statistically significant differences （all P < 0.05）. The proliferation and invasion abilities of the sh-TMSB10-1 and sh-TMSB10-2 groups were significantly reduced compared to the sh-TMSB10-nc group （P < 0.05）. Conclusions TMSB10 is highly expressed in PTC, which enhances the proliferation and invasion abilities of PTC cells, promoting its progression.

Objective To evaluate the efficacy and safety of Chaihu Shugan Powder in the treatment of Hashimoto’s thyroiditis. Methods Randomized controlled trials of Chaihu Shugan Powder in the treatment of Hashimoto’s thyroiditis were searched from China Knowledge Network， VIP Database， Wanfang Database， China Biomedical Literature Database， PubMed， Embase and Cochrane Library from date of database inception until October， 2024. Meta-analysis was performed using RevMan 5.3. Results A total of 9 literatures were included， involving 671 patients with Hashimoto’s thyroiditis. Meta-analysis showed that Chaihu Shugan Powder could improve the clinical effectiveness rate of Hashimoto’s thyroiditis [RR （95%CI） =1.21 （1.13， 1.30）]， reduce the levels of thyroid peroxidase antibody [TPO-Ab， SMD （95%CI） =-1.61 （-2.28， -0.94）]， decrease the level of thyroglobulin antibody [TgAb， SMD （95%CI） =-1.28 （-1.70， -0.86）]， reduce traditional Chinese medicine syndrome score [MD （95%CI） =-6.15 （-6.69， -5.61）]， improve function of thyroid [TSH： MD （95%CI） =-0.83 （-1.57， -0.09）， FT₃： MD （95%CI） =0.64 （0.12， 1.16）， FT₄： MD （95%CI） =2.31 （0.70， 3.92）] and reduce the level of inflammatory factor interleukin-23 [IL-23， SMD （95%CI） =-1.92 （-2.29， -1.54）]. In addition， compared with the control group， Chaihu Shugan Powder did not increase the incidence of adverse reactions. Conclusion Chaihu Shugan Powder is an effective and safe treatment for Hashimoto’s thyroiditis， but further research and verification is needed.

Objective To investigate the application effect of the modified in situ parathyroid preservation technique in transoral vestibular endoscopic radical thyroidectomy for thyroid cancer. Methods A retrospective analysis was carried out on 105 patients who underwent transoral vestibular endoscopic radical thyroidectomy for thyroid cancer at Shenzhen People’s Hospital from January 2020 to January 2024. The control group received traditional in situ preservation or autotransplantation of the inferior parathyroid glands， while the observation group underwent the modified in situ parathyroid preservation technique. The therapeutic effects of the two groups were compared. Results All surgeries were successfully completed in both groups. Preoperative serum calcium and parathyroid hormone （PTH） levels showed no significant differences between the observation and control groups （all P >0.05）. At 24 hours postoperatively， the serum calcium in the observation group was （2.3±0.1） mmol/L， significantly higher than （2.2±0.1） mmol/L in the control group （t = -5.43， P < 0.01）. The PTH levels in the observation group were 18.2 （5.3，28.0） pg/mL， compared to 20.8 （6.8， 27.1） pg/mL in the control group， with no significant difference between the two groups （t = -0.48， P > 0.05）. The blood calcium level in the observation group were higher than those in the control group 24 h after bilateral thyroidectomy combined with central lymph node dissection （P < 0.05）. The incidence of transient hypoparathyroidism was 36.7% （18/49） in the observation group and 50.0% （28/56） in the control group.At 6 weeks postoperatively， the PTH recovery rate in the observation group was 72.2% （13/18）， while the control group had a PTH recovery rate of 68.2% （15/22）. The difference in PTH recovery rates between the two groups was not statistically significant （P > 0.05）. Conclusion In transoral vestibular endoscopic radical thyroidectomy for thyroid cancer， the modified in situ parathyroid preservation technique can prevent hypoparathyroidism and contribute to the improvement of postoperative outcomes for patients.

For well-differentiated and early-stage thyroid cancer， conventional treatment options such as surgery， thyroid-stimulating hormone suppression therapy， and radioactive iodine therapy can usually significantly extend patients’ overall survival and progression-free survival， with prognosis approaching that of the general population. In contrast， for advanced or undifferentiated thyroid cancer that cannot be surgically resected or is unresponsive to radioactive iodine treatment， systemic therapy is typically required. Traditional cytotoxic chemotherapy or external radiation therapy has limited efficacy in these patients. Over the past decade， targeted therapies for thyroid cancer have undergone rapid development. Despite these treatments yielding promising results， many patients with advanced thyroid cancer ultimately experience disease progression due to acquired resistance. In this paper， we summarize the mechanisms of resistance to targeted drugs in thyroid cancer and explore strategies to overcome resistance， aiming to provide reference for future clinical practice in targeted therapy and guide directions for subsequent research.

Differentiated thyroid carcinoma （DTC） is the most common type of thyroid malignancy， with a high incidence of regional lymph node metastasis. Accurate diagnosis of lymph node metastasis is crucial for determining appropriate treatment strategies. Fine-needle aspiration （FNA） is an important method for evaluating the nature of thyroid nodules and lymph node metastasis. In recent years， the detection of thyroglobulin （Tg） levels in FNA washout fluid has received widespread attention as a supplementary tool for cytological examination. FNA-Tg can increase the detection rate of cytology- negative lymph node metastasis， with high sensitivity and specificity. Combined with other diagnostic methods such as serology examination and imaging analysis， it can further enhance diagnostic value. However， there is currently a lack of standardized procedures for FNA-Tg operation and specimen handling. The methodological and interpretative standards for quantitative Tg have not been established. And it is still controversial whether various factors， such as thyroid hormone replacement therapy， Tg autoantibodies， and residual thyroid tissue， affect the results of FNA-Tg. This article reviews the current status and dilemma of the application of FNA-Tg testing in neck lymph nodes to provide a reference for the clinical application of FNA-Tg testing in the diagnosis of lymph node metastasis in DTC.

Insomnia is a common sleep disorder that significantly impacts daily functioning and overall health. Traditional treatments， including Cognitive Behavioral Therapy for Insomnia （CBT-I） and pharmacotherapy， are widely used； however， anesthesiology， as an emerging treatment modality， has shown promising potential due to its precise drug management and unique technical advantages. Anesthesiologists can offer personalized treatments using sedative-hypnotic drugs and nerve block techniques， particularly for chronic and refractory insomnia. Innovations such as propofol， dexmedetomidine， and stellate ganglion block have been shown to regulate sleep architecture， improve sleep quality， and quickly reverse sleep deprivation， breaking the vicious cycle of insomnia. Despite these promising results， challenges remain， including technical complexity， the need for standardized protocols， and long-term efficacy evaluation. In the future， with the standardization of anesthetic techniques， multidisciplinary collaboration， and the integration of emerging technologies， anesthesiology is expected to play a greater role in insomnia treatment.

Objective To categorize civil servants’ sleep beliefs and their effects on sleep quality to inform tailored interventions. Methods A total of 507 employed civil servants from Guangzhou were selected and surveyed using the Dysfunctional Beliefs and Attitudes about Sleep Scale （DBAS-16）， Pittsburgh Sleep Quality Index （PSQI）， and Self-Rating Anxiety Scale （SAS）. Latent profile analysis was conducted on cadres’ sleep belief types based on the DBAS-16， and regression mixture analysis was used to explore the factors influencing cadres’ sleep quality and the moderating role of sleep beliefs. Results Analysis identified three sleep belief types: Good Sleep Beliefs （15.2%）， Consequence Bias （57.0%）， and High Worry-Exaggerated Consequences （27.8%）. Significant differences in gender， PSQI， SAS， and stress scores were noted across types（all P < 0.05）. Anxiety and night shifts significantly affected the sleep quality of the High Worry-Exaggerated Consequences type， but not for Good Sleep Beliefs. Conclusion There is heterogeneity in the sleep beliefs of cadres， and sleep beliefs moderate the impact of anxiety and night work on sleep quality， those with fewer biased beliefs are less affected.

Objective To evaluate the effect of dexmedetomidine on postoperative sleep quality and complications in women undergoing elective cesarean delivery. Methods 180 women undergoing elective cesarean delivery were selected and randomly divided into the dexmedetomidine group （group D） and control group （group C）， 90 cases in each group. Dexmedetomidine 0.5 μg/kg（group D） or 10 mL of 0.9% sodium chloride injection was pumped within 15 min after fetal extraction. Maternal sleep status was assessed by Pittsburgh Sleep Quality Index （PSQI） and Insomnia Severity Index （ISI） for 24 h， 48 h postoperatively and 1 day before discharge. Maternal resting pain and activity-induced pain at 24 h and 48 h postoperatively were recorded by visual analog score （VAS） in both groups. Other perioperative complications of labor were recorded. Results The PSQI scores and ISI scores of the women in group D were lower than those of the women in group C at 24 h， 48 h after surgery and 1 day before discharge （all P < 0.05）. The incidence of severe sleep disorders and insomnia at 24 h postoperatively was lower in group D than that in group C （P = 0.031 and P =0.021）. The women in group D had less resting pain and activity-induced pain at 24 h and 48 h postoperatively， and the number of postoperative PCEA compressions was also lower （all P < 0.05）. The incidence of postoperative nausea and vomiting， itchy skin complications was lower in group D. The time to first postoperative activity， the length of postoperative hospital stay was shorter， degree of satisfaction during hospitalization was higher， and the incidence of depression at 6 weeks postpartum was also lower （all P < 0.05）. Conclusion Dexmedetomidine improves sleep quality after cesarean delivery， reduces postoperative pain and complications.

Objective To explore the risk factors for coronary artery disease （CAD） in patients with obstructive sleep apnea （OSA） and to establish a clinical risk prediction model based on the systemic inflammatory response index （SIRI） and to validat its effectiveness. Methods OSA patients suspected of CAD who underwent coronary angiography or coronary CT angiography at the First Affiliated Hospital of Xinjiang Medical University between April 2020 and December 2023 were enrolled. Patients were divided into CAD and non-CAD groups based on the degree of coronary artery stenosis. Variable were screened using LASSO regression and multifactor logistic regression， and a nomogram was constructed. The discrimination and calibration of the prediction model were evaluated and validated using receiver operating characteristic （ROC） curves， calibration curves， and Hosmer-Lemeshow test. The clinical effectiveness of the prediction model was assessed using decision curve analysis （DCA）. Results Multivariate logistic regression results indicated the following factors for CAD in OSA patients （all P < 0.05）： age≥50 years（OR=1.947 （95% CI 1.277-2.969））， hypertension （OR=2.462 （95% CI 1.612-3.761））， diabetes （OR=2.003 （95% CI 1.313-3.057））， low-density lipoprotein cholesterol （LDL-C） ≥2.6 mmol/L （OR=1.793 （95% CI 1.176-2.735））， apnea-hypopnea index （AHI） ≥30 times/hour （OR=2.425 （95% CI 1.500-3.920））， and SIRI ≥0.84 （OR=2.240 （95% CI 1.463-3.428））. A nomogram was constructed based on these factors. The area under the ROC curve （AUC） for the prediction model was 0.721 （95% CI 0.673-0.770） in the training set and 0.750 （95% CI 0.678-0.820） in the validation set. Calibration curves and the Hosmer-Lemeshow test indicated good agreement between predicted and actual outcomes （training set： χ ² = 7.924， P = 0.542； validation set： χ ² = 12.304， P = 0.197）. DCA demonstrated the clinical utility of the prediction model. Conclusion A risk prediction model incorporating age， hypertension， diabetes， LDL-C， AHI， and SIRI has potential clinical value for predicting CAD in OSA patients.

ObjectiveTo evaluate the clinical application value of non-contact vital signs monitoring in patients with chronic obstructive pulmonary disease （COPD）， analyze the correlation between multi-dimensional vital signs parameters and disease severity， and explore their application value in COPD monitoring. Methods A total of 55 COPD patients treated at the Tianhe Campus of the Third Affiliated Hospital of Sun Yat-sen University from March 2021 to October 2023 were enrolled. All patients underwent deployment of a novel non-contact vital signs monitoring system and completed standardized pulmonary function assessments. Clinical baseline data were collected， and nocturnal physiological signals were recorded， with core monitoring indicators including heart rate variability （HRV）， respiratory characteristics， and sleep structure. Based on pulmonary function assessments， patients were categorized into mild， moderate， severe， and very severe groups. The mild cases were classified as the non-severe group， while the moderate， severe， and very severe cases were combined into the severe group. Intergroup differences were compared， a risk model was constructed， and the efficacy of each parameter in assessing COPD severity was analyzed using receiver operating characteristic （ROC） curves. Results Significant differences were observed among the mild， moderate， severe， and very severe cases in terms of gender， age， body mass index （BMI）， forced expiratory volume in the first second （FEV₁）， forced vital capacity （FVC）， and FEV₁/FVC ratio （all P < 0.05）. Significant differences were also found between the two groups in total cardiac energy， total cardiac energy baseline value， sympathetic nerve tension index， sympathetic nerve tension baseline value， vagal nerve tension index， and vagal nerve tension baseline value （ all P < 0.05）， with these indicators showing an increasing trend as disease severity worsened. No significant differences were observed in autonomic nerve balance and autonomic nerve balance baseline value between the groups （all P > 0.05）. HRV had a notable impact on COPD severity. The vagal nerve tension index， total cardiac energy baseline value， light sleep duration， and long-term baseline respiratory parameters demonstrated high efficacy in diagnosing disease severity， with areas under the ROC curve （AUC） values of 0.892， 0.886， 0.800， and 0.733， respectively. Conclusions Non-contact continuous vital signs monitoring is feasible in the management of COPD. Indicators such as HRV， light sleep duration， and long-term baseline respiratory rate hold significant clinical value in the monitoring and assessment of COPD patients.

Obstructive sleep apnea （OSA） exhibits a high prevalence during pregnancy and serves as an independent risk factor for hypertensive disorders during pregnancy， preeclampsia， and gestational diabetes mellitus. Moreover， it readily leads to various adverse pregnancy outcomes， such as preterm birth and low birth weight. Timely treatment plays a crucial role in improving OSA during pregnancy and may even reverse adverse pregnancy outcomes. Positive airway pressure （PAP） is the preferred treatment for OSA， and its application in pregnant patients is increasingly receiving attention. This review provides a comprehensive review of the current status of positive airway pressure （PAP） therapy for obstructive sleep apnea （OSA） during pregnancy， delving into the positive impacts of PAP on alleviating OSA symptoms during pregnancy， controlling the progression of gestational hypertension and hyperglycemia， and improving biomarkers in the body. The aim is to enhance the awareness of clinical practitioners towards the diagnosis and treatment of OSA during pregnancy and to provide reference for clinical treatment.

Sleep is a basic need for human life-sustaining activities， and sleep quality is closely related to human health. With the rapid changes in the global climate， an increasing number of studies have found that climate change has an important impact on sleep quality of human beings， and this impact is a complex process involving multiple interacting factors. Climate factors affect human physiology and the comfort of the sleep environment， which then affects the sleep quality of individuals. This article reviews domestic and international studies on the effects of climate factors such as temperature， humidity， air pressure， oxygen content and light on sleep quality， and analyse the mechanism of climate change on sleep quality， with the purpose of providing reference for the clinical treatment of sleep disorders.