In this study, a nomogram was established and validated by assessing the risk factors for the development of pulmonary metastases in patients with non-papillary thyroid carcinoma (NPTC) and was used to predict the risk of developing pulmonary metastases. Demographic and clinicopathological variables of patients with NPTC from 2010 to 2015 in the Surveillance, Epidemiology, and End Results database were retrospectively analyzed, and independent risk factors were identified using χ² tests and full subset regression analysis. Based on this, a nomogram was developed and validated for predicting the risk of pulmonary metastasis in patients with NPTC. The predictive performance of the nomogram was calculated using the consistency index, and the clinical application value of the nomogram was evaluated using calibration curve and decision curve analyses. In addition, risk stratification of patients with NPTC based on these results was performed to facilitate early diagnosis and treatment of patients with pulmonary metastases in the clinic. Data from 1435 patients with NPTC were used for the analysis based on the inclusion and exclusion criteria. Statistical analysis yielded a high risk of pulmonary metastasis in patients with older age, high T-stage, poorly differentiated, undifferentiated thyroid carcinoma, follicular thyroid carcinoma (NOS), and the presence of other distant metastases. We further developed a nomogram with a consistency index of 0.898 (95% confidence interval: 0.880–0.920) in the training cohort and 0.895 (95% confidence interval: 0.862–0.927) in the validation cohort. The calibration curve and decision curve analyses also demonstrated the strong reliability and accuracy of this clinical prediction model. In this study, a nomogram was constructed to accurately identify patients with NPTC at a high risk of pulmonary metastasis, which will help clinicians in personalized decision-making.

Background: This study was conducted to develop nomograms and validate them by assessing risk factors for the development of central lymph node metastasis (CLNM) in patients with solitary papillary thyroid carcinoma of the isthmus (PTCI) for predicting the probability of CLNM. Methods: Demographic and clinicopathological variables of patients with solitary papillary thyroid carcinoma (PTC) from May 2018 to May 2023 at the First Hospital of Shanxi Medical University were retrospectively analyzed, and the lobar group and the isthmus group were divided according to tumor location. Patients with the same sex, age difference of less than 3 years, and equal gross tumor diameter were selected from the lobar group and compared with the paraisthmic tumor group. Independent risk factors were determined using univariate and multivariate logistic regression analysis. On this basis, clinical predictive nomograms were developed and validated. Results: Clinical data from 326 patients with solitary PTCI and 660 cases of solitary lobar PTC were used for analysis in our study. The incidence of solitary tumors CLNM located in the median isthmus, paracentral isthmus, and lobes was 69.8%, 40.9%, and 33.6%, respectively. Statistical analysis revealed that gender, age, isthmus location, maximum nodal diameter, the presence of possible CLNM in advance on preoperative ultrasound, chronic lymphocytic thyroiditis, and the lymphocyte/monocyte ratio were independent risk factors for preoperative CLNM in patients with solitary PTCI. Age, isthmus location, chronic lymphocytic thyroiditis, gross tumor diameter, presence of intraoperative extrathyroidal extension, and presence of metastasis in the Delphian lymph node on frozen section were independent risk factors for intraoperative CLNM. The concordance indices of nomograms for preoperative and intraoperative are 0.871 and 0.894 in the training set and 0.796 and 0.851 in the validation set, calibration curve and decision curve analysis also demonstrated the strong reliability and clinical applicability of this clinical prediction model. Conclusion: In this study, we concluded that solitary PTCI is more aggressive compared to solitary lobar PTC, and we constructed nomograms and risk stratification to accurately identify patients with solitary PTCI who are at high risk of developing CLNM, which will help clinicians in personalized decision making.

Participants: This study enrolled 294 patients admitted to the Thyroid Surgery Department of the First Hospital of Shanxi Medical University between April and July 2024. Patients were randomly assigned to either the control group (145 patients) or the experimental group (149 patients). Interventions: The control group received traditional adhesive tape fixation for drains, while the experimental group utilized a newly developed fixation patch combined with a unique "C" and "S" fixation method. Both groups employed vertical negative pressure drainage. Specific Objectives or Hypotheses: The aim of this study was to assess the clinical effectiveness and patient satisfaction with a novel surgical drain fixation patch and method in the context of thyroid surgery. The hypothesis was that the novel fixation patch and method would reduce drain-related adverse events, improve patient comfort, and increase patient satisfaction. Outcomes: The experimental group exhibited significantly lower rates of drain-related adverse events, including displacement, infection, and leakage, compared to the control group (3.40% vs 53.10%, P < 0.05). Additionally, patients in the experimental group reported lower neck/throat pain scores (mean score: 0.84 vs 1.40 in the control group, P < 0.05) and experienced no drain pulling pain (0% vs 1.16% in the control group, P < 0.05). Furthermore, the need for patch replacements was virtually eliminated in the experimental group (0% vs 70.86% in the control group, P < 0.05). Patient satisfaction with the fixation method was significantly higher in the experimental group (83.3% vs 46.9% in the control group, P < 0.05). Randomization: Patients were randomly assigned to the control and experimental groups, ensuring the fairness and reliability of the study.

Background: Complications significantly impact the prognosis and healthcare burden of hospitalized patients, making early identification of high-risk individuals crucial. While nutritional and metabolic status are influencing factors, existing tools struggle to provide an integrated assessment. The Triglyceride-Cholesterol-Body weight Index (TCBI) is a novel indicator that concurrently reflects both nutritional and metabolic status, yet its value in predicting in-hospital complications remains unclear. Methods: This observational study leveraged large-scale, multicenter real-world data, enrolling 8,288 eligible hospitalized patients. Demographic information, anthropometric measurements, laboratory results, and clinical outcomes were collected. Due to its skewed distribution, TCBI was analyzed using its natural logarithm-transformed value (TCBI-LN) and categorized into quartiles (Q1-Q4). The primary outcome was the occurrence of complications during hospitalization. Univariate analysis was used to compare inter-group differences. Multivariate logistic regression models were employed to analyze the independent association between TCBI-LN and complication risk. Restricted cubic splines were applied to explore the dose-response relationship. The robustness and generalizability of the association were assessed through subgroup analyses and interaction tests. We further compared five nested logistic regression models incorporating TCBI, its individual components, and existing indices (PNI and TyG) using AUC, NRI, IDI, AIC, and BIC, and performed causal mediation analysis to examine whether complications mediated the associations of TCBI with length of stay (LOS) and hospital cost. Results: Complications occurred in 403 patients (4.9%). Patients with complications had significantly lower TCBI-LN levels compared to those without (6.83 ± 0.71 vs. 7.10 ± 0.83, P < 0.001). Multivariate logistic regression analysis revealed that a higher TCBI-LN remained independently associated with a lower risk of complications even after adjusting for multiple potential confounders, including age, sex, body mass index, disease type, comorbidities, and related prognostic factors (adjusted OR = 0.707, 95% CI: 0.553–0.930, P = 0.012). Restricted cubic spline analysis suggested a linear inverse correlation between TCBI-LN and complication risk. Subgroup analyses indicated that the protective association of TCBI-LN was statistically significant in males, patients aged < 65 years, those with a body mass index < 18.5 or ≥ 24 kg/m², and malnourished patients. No significant interactions were observed across all subgroups (P for interaction > 0.05). A risk stratification cutoff was determined based on the Youden index. The complication rate was significantly higher in the high-risk group (6.3%) compared to the intermediate- (5.1%) and low-risk groups (2.9%). In model comparison, adding TCBI-LN to a clinical model significantly improved AUC, NRI and IDI, and the model combining TCBI-LN with PNI and TyG provided the best overall performance. Mediation analysis indicated that TCBI-LN shortened LOS predominantly through reducing in-hospital complications and partially attenuated its direct cost-increasing effect. Conclusion: In a large-scale cohort study of hospitalized patients, lower TCBI-LN levels were independently associated with a higher risk of in-hospital complications, and this association was generalizable across different patient subgroups. As a composite index easily derived from routine laboratory tests, TCBI may serve as a practical tool for early identification of patients at high risk for in-hospital complications and ultimately improve clinical outcomes.

Background The aim of this study was to evaluate independent predictors of prognosis in patients with mixed medullary and follicular cell carcinoma (MMFCC) and to establish the novel prognostic nomograms in the academic community for 3-, 5-, and 10 year CSS and OS in patients with MMFCC. Methods Demographic information, clinicopathological characteristics, treatment information, and survival status information of 200 patients with MMFCC and 6615 patients with medullary thyroid carcinoma (MTC) from 2000 to 2020 in the SEER database were retrospectively analyzed. Independent predictors of prognosis in MMFCC patients were derived using univariate and multivariate Cox regression analyses after relevant comparisons based on pathologic typing. On this basis, we developed and validated clinical prognostic nomograms and risk-stratified the patient population. Results In this study, the clinical information of 200 patients with MMFCC was compared with that of 5947 patients with MTC (NOS) and 668 patients with MTC with amyloid stroma, and there was a significant difference in the relevant variables among the three, with the CSS being 88.5%, 87.5%, and 90.9%, and the OS being 76.5%, 75.4%, and 83.8%. Univariate and multivariate Cox regression analyses yielded that age at diagnosis, presence of distant metastases, thyroidectomy scope, and lymph node dissection status were significantly correlated with the prognosis of patients (P < 0.05), and were independent predictors of CSS and OS for patients with MMFCC, and the Kaplan–Meier survival curves plotted by these factors demonstrated their predictive power for the prognosis of patients with MMFCC. The concordance index of the prognostic nomograms of CSS and OS established on this basis was 0.838 and 0.794, respectively, and the time-dependent area under curve, calibration curve, and decision curve analysis curve showed that the model had good discriminative ability, accuracy, and clinical applicability. Conclusions In this study, we concluded that there are large differences between MMFCC and MTC in terms of demographic information, clinicopathological characteristics, treatment information, and survival status information, and we constructed the novel prognostic nomograms for 3-, 5-, and 10 year CSS and OS for patients with MMFCC with risk stratification, which will help clinicians to develop individualized protocols for their postoperative treatments and follow-ups.