Volume 105 · Issue 14 · 2025

Cancer-associated thrombosis is one of the most dangerous complications of plasma cell neoplasms. The occurrence of thrombotic events can disrupt treatment plans, compromise patients′ quality of life, and even threaten their lives, which presents significant challenges in clinical management. Given the adverse impacts, the accurate identification of risk factors and the appropriate application of thromboprophylaxis are of great importance. This paper will discuss the epidemiology, risk assessment, and stratified thromboprophylaxis of thrombotic events in plasma cell neoplasms, with the aim of drawing clinicians′ attention to this common complication and promoting the overall management of plasma cell tumor-related thrombotic diseases.

Obstructive sleep apnea (OSA) is a common chronic disease closely associated with various complications during the perioperative period, such as respiratory failure, hypertension, coronary artery ischemia, arrhythmia, stroke, etc. In recent years, with the increasing prevalence of OSA, the incidence of OSA in patients undergoing surgery has also been increasing. Screening, diagnosis, and treatment of OSA before surgery can help to reduce surgical related complications. At the same time, the management of patients with OSA during the perioperative period also has its own characteristics. In order to enhance the awareness of relevant physicians towards patients with OSA, improve perioperative management of such patients, and thereby reduce perioperative risks, the consensus expert group on perioperative management of adult patients combined with OSA searched and scientifically evaluated domestic and foreign guidelines and clinical research literature, then formulated this expert consensus. The consensus includes early identification of OSA in patients undergoing general anesthesia and monitoring anesthesia, preoperative preparation and intraoperative and postoperative management of OSA patients, etc., in order to provide reference for perioperative management of such patients.

In recent years, the incidence of thyroid tumor has risen significantly, and thyroid cancer has emerged as one of the most common malignant tumors in the head and neck region. Surgery remains the primary treatment for thyroid tumors, but postoperative dyspnea still occurs occasionally and becomes a serious complication. Although its incidence is relatively low, the underlying causes are complex, and severe cases can be life-threatening. Currently, there are no standardized perioperative protocols or guidelines available, either domestically or internationally. To address this gap, the Head and Neck Tumor Specialty Committee of Chinese Pharmaceutical Education Association, the Thyroid Cancer Specialty Committee of China Anti-cancer Association, the Head and Neck Surgery Group of the Otorhinolaryngology Society of the Chinese Medical Doctor Association, and the Thyroid Disease Specialty Committee of the Sichuan Medical Association convened a multidisciplinary panel of over 90 experts from different fields including head and neck surgery, thyroid surgery, general surgery, otolaryngology surgery, oncologic surgery, and anesthesiology. Through a systematic literature review, evidence appraisal, and multiple rounds of expert discussions, a consensus was reached on the etiology, monitoring, assessment, and management of postoperative dyspnea in thyroid tumor patients. This expert consensus comprises 17 key recommendations, aiming to provide scientific reference and standardized guidance for clinical practice.

To explore the relationship between sleep quality and the risk of all-cause mortality based on a large-scale prospective cohort of elderly people aged 60 and above in Shanghai community.

In 2019, 17 948 community elderly people aged 60 and above were recruited to participate in the Shanghai Community Elderly Cohort. Baseline information of cohort members was collected through face-to-face questionnaires, and sleep information during the most recent month was collected using the Pittsburgh Sleep Quality Index (PSQI) scale. The association between sleep quality and risk of all-cause mortality was analyzed using multifactorial Cox regression models. Restricted cubic spline (RCS) model was used to analyze the relationship between sleep duration and all-cause mortality risk.

A total of 16 271 individuals were included in the analysis, aged (68.4±5.9) years, 46.25% (n=7 525) were males, and after a mean follow-up of 4.49 years, 700 deaths were observed. Using a sleep duration of 6 to<7 h/d as a reference, the risk of all-cause mortality was increased for sleep duration<6 h/d (HR=1.51, 95%CI: 1.01 to 2.26), and the risk of all-cause mortality was also increased for sleep durations of 7 to <8, 8 to <9, and ≥9 h/d, with HR (95%CI) of 1.40 (1.08 to 1.82), 1.51 (1.16 to 1.96) and 2.08 (1.58 to 2.73), respectively. The associations of PSQI score, self-reported sleep quality, time to sleep score, sleep efficiency, sleep disorder score, number of hypnotic medications used per week, daytime dysfunction score, and length of daytime naps with the risk of all-cause mortality were not statistically significant (all P>0.05). Analysis of the RCS model showed that sleep duration was associated with the risk of all-cause mortality in a "J" pattern, with the lowest risk at 7 h/d of sleep duration (P for nonlinear=0.048). Above a sleep duration of 7 h/d, the risk of all-cause mortality increased by 22% for each 1 h/d increase in sleep duration, with an HR (95%CI) of 1.22 (1.13 to 1.31).

There is a J-shaped association between daily hours of sleep and risk of all-cause mortality among elderly people aged 60 and above in the Shanghai community, and the elderly who slept 7 hours per night have the lowest risk of all-cause mortality.

To explore the immediate antihypertensive efficacy of continuous positive airway pressure (CPAP) overnight manual pressure titration (OMPT) in patients with obstructive sleep apnea (OSA) complicated with hypertension, and the influencing factors related to antihypertensive efficacy.

A total of 88 patients diagnosed with OSA complicated with hypertension who were admitted to the Third Hospital of Hebei Medical University from September 2022 to October 2023 due to nocturnal sleep snoring and breath-holding were retrospectively enrolled. All patients were treated with CPAP OMPT during polysomnography (PSG). Based on the immediate antihypertensive effect after CPAP OMPT treatment (changes in blood pressure within 15 minutes before and after treatment), patients were divided into the significant decrease group [group A, systolic blood pressure (SBP) decreased by ≥5 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure (DBP) decreased by ≥3 mmHg] and the non-decrease group (group N, SBP decreased by <5 mmHg or DBP decreased by <3 mmHg). The demographic characteristics of the two groups was compared, as well as the differences in apnea-hypopnea index (AHI), time for pulse oxygen saturation<90% [T (SpO₂<90%)], oxygen desaturation index (ODI), lowest SpO₂ during sleep (LSpO₂), mean SpO₂ during sleep (MSpO₂). A multivariate logistic regression model was used to analyze the factors associated with the improvement of blood pressure by CPAP OMPT.

A total of 88 patients with OSA complicated with hypertension were included, with 77 males and 11 females, and aged (46.5±13.2) years. There were 33 cases in group A and 55 cases in group N. CPAP OMPT had a significant effect on immediate blood pressure reduction in 37.5% of patients with OSA complicated with hypertension; there were no significant differences in age, gender composition, neck circumference, history of diabetes mellitus, history of coronary heart disease, and history of hyperlipidemia between the two groups (all P>0.05). After CPAP OMPT treatment, the change values of LSpO₂ and MSpO₂ [M (Q₁, Q₃)] in group A were higher than those in group N [17.0% (9.0%, 22.0%) vs 8.0%(5.0%, 15.0%), 4.0%(1.0%, 7.0%) vs 2.0%(1.0%, 4.0%), both P<0.05]. The change values of AHI, ODI and T (SpO₂<90%) in group A were lower than those in group N [(-59.5±26.2) vs (-43.7±25.3) episodes/h, -52.7(-64.1, -31.0) vs -32.0(-54.0, -12.8) episodes/h, -75.8(-148.6, -9.8) vs -12.0(-82.9, -2.6) min, all P<0.05]. The results of multivariate logistic regression model analysis indicated that the change of LSpO₂ was positively associated with the improvement of blood pressure by CPAP OMPT, with an OR value (95%CI) of 1.086 (1.010-1.167).

CPAP OMPT has a significant immediate antihypertensive effect on 37.5% of patients with OSA complicated with hypertension. The change values in LSpO₂ before and after CPAP OMPT treatment is positively associated with blood pressure improvement.

To analyze the maternal and neonatal outcomes of obstructive sleep apnea hypopnea syndrome (OSAHS) during pregnancy with different severity levels.

Pregnant women who visited the obstetrics outpatient clinic at Peking University People′s Hospital with suspected OSAHS symptoms such as nocturnal snoring from January 2021 to May 2024 and completed home sleep apnea monitoring (HSAT) were retrospectively included. Based on the apnea-hypopnea index (AHI), participants were divided into three groups, the non-OSAHS group (AHI<5/h), mild OSAHS group (5/h≤AHI<15/h), and moderate-to-severe OSAHS group (AHI≥15/h). Differences in maternal and neonatal outcomes were compared including hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), gestational age at delivery, neonatal birth weight, Apgar score, and the ratio of placental weight to birth weight among the three groups.

A total of 506 pregnant women, aged (33.7±4.3) years were included in the analysis, with 268 in the non-OSAHS group, 188 in the mild OSAHS group, and 50 in the moderate-to-severe OSAHS group. Statistically significant differences were observed among the three groups in pre-pregnancy and pregnancy body mass index (BMI), neck circumference, pregestational diabetes mellitus (PGDM), minimum percutaneous oxygen saturation, AHI, and oxygen desaturation index (ODI) (all P<0.05). Pre-pregnancy BMI [(28.0±4.9), (30.9±4.7) vs (25.4±5.1) kg/m²] and BMI at HSAT monitoring [(30.1±4.5), (31.8±6.5) vs (27.2±4.4) kg/m²], neck circumference [(36.7±2.8), (38.5±3.0) vs (35.3±2.5) cm], AHI [M(Q₁,Q₃)][7.9 (6.0, 10.7), 22.5 (18.3, 30.9) vs 1.8 (1.0, 3.8)/h], and ODI [7.8 (6.2, 11.1), 21.4 (17.7, 28.4) vs 2.1 (1.0, 3.8)/h] of mild OSAHS group and moderate-to-severe OSAHS group were all higher than those in the non-OSAHS group (all P<0.05). Differences in HDP, GDM, Apgar score at 5 min, and the ratio of placental weight to birth weight were statistically significant among the three groups (all P<0.05). The proportion of GDM [24.4% (11/45) vs 10.6% (26/245)] and the ratio of placental weight to birth weight [(0.19±0.04) vs (0.18±0.03) g] were both higher in the moderate-to-severe OSAHS group than those in the non-OSAHS group; and the gestational age at delivery [(37.4±2.2) vs (38.1±2.2) weeks], neonatal birth weight [(2, 961.2±769.8) vs (3, 088.8±680.9) g], and Apgar score at 5 min [(9.7±1.5) vs (10.0±0.3)] were all lower than those in the non-OSAHS group (all P<0.05).

Compared to the non-OSAHS group, pregnant women with moderate-to-severe OSAHS have a higher proportion of HDP and GDM, earlier gestational age at delivery, an increased ratio of placental weight to birth weight and lower neonatal birth weight.

To construct and validate a prediction model for treatment failure in peritoneal dialysis associated peritonitis (PDAP).

A total of 211 PDAP patients who were admitted to Jiangsu University Affiliated Hospital from January 1, 2013 to December 31, 2023 were selected as the modeling group and 72 PDAP patients who were admitted to Nanjing First Hospital from January 1, 2015 to December 31, 2019 were selected as the verification group. Based on the modeling group data, univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were used to screen variables. Logistic regression was used to construct the model, and then a nomogram was developed. Receiver operating characteristic (ROC) curves, calibration curves and decision curves (DCA) were used to evaluate the model efficiency and clinical applicability.

A total of 283 PDAP patients (148 males and 135 females) aged (51.1±12.5) years were included. Based on the modeling group data, univariate analysis identified factors affecting the failure of PDAP treatment, including dialysis age, positive ascites culture, albumin, glucose and triglycerides. LASSO regression screened 5 non-zero coefficient indicators, including dialysis age, positive ascites culture, total bilirubin, albumin and triglycerides. Based on the Z-test results of the product under the curve (Z=2.258, P=0.024), the optimal LASSO regression screening variables were selected to establish the model. Multivariate LASSO-logistic regression showed that independent risk factors for PDAP treatment failure included dialysis age (OR=1.011, 95%CI: 1.001-1.022, P=0.034), positive ascites culture (OR=2.605, 95%CI: 1.082-6.272, P=0.033), total bilirubin (OR=1.336,95%CI: 1.143-1.563, P<0.001), albumin (OR=0.880, 95%CI: 0.822-0.943, P<0.001) and triglycerides (OR=1.678, 95%CI: 1.260-2.235, P<0.001). The area under the ROC curve of the model in the modeling group and validation group were 0.765 (95%CI: 0.698-0.833) and 0.794 (95%CI: 0.693-0.896), respectively. In addition, the two sets of calibration curves and decision curves indicated good model consistency and clinical practicality.

The factors of PDAP treatment failure include dialysis age, positive ascites culture, total bilirubin, albumin and triglycerides. The prediction model established based on the above indicators had good prediction accuracy and clinical practicality.

To explore the impact of sleeve gastrectomy and Roux-en-Y gastric bypass on bone marrow adipose tissue (BMAT) in patients with metabolic syndrome.

A total of 82 patients with metabolic syndrome who underwent bariatric metabolic surgery at the Department of Bariatric and Metabolic Surgery in Beijing Friendship Hospital from January 2022 to October 2023 were conducted retrospectively. Patients who received SG and RYGB were divided into the SG group and RYGB group, respectively. Bone marrow fat fraction (BMFF) of T₉-L₁ was measured using the MRI iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification (IDEAL-IQ) sequence. The changes of body weight, body mass index (BMI), lipid metabolism index and BMFF before and after operation were compared between the two groups. Pearson correlation analysis was used to evaluate the correlation between BMFF changes and body weight, BMI and lipid metabolism index.

The age of the 82 patients was (34.8±8.6) years, with 19 males (23.2%). There were 51 patients in the SG group (62.2%) and 31 in the RYGB group (37.8%). The weight, BMI, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and BMFF were all decreased one year after surgery in metabolic syndrome patients, while the high-density lipoprotein cholesterol (HDL-C) increased compared with preoperative levels (all P<0.05). The decreases of TC, TG and LDL-C in SG group were lower than those in RYGB group (all P<0.05). There was no statistical difference in the decreases of weight, BMI, HDL-C and BMFF after surgery between two groups (all P>0.05). BMFF changes before and after surgery were positive correlated with changes in body weight (r=0.765, 0.753, 0.801) and BMI (r=0.697, 0.646, 0.797) in the whole patients, SG and RYGB groups (all P<0.05).

BMFF in patients with metabolic syndrome decreases after bariatric and metabolic surgery. BMFF changes are similar after different surgical methods, and positively correlated with body weight and BMI changes.

To observe the clinical efficacy of spinal cord stimulation (SCS) in treating lower extremity peripheral arterial disease (PAD).

A retrospective analysis was conducted on the clinical data of patients diagnosed with lower extremity PAD at Nanjing Hospital of Nanjing Medical University from October 2021 to August 2024. Patients were divided into SCS group and control group based on whether they underwent SCS implantation surgery. Propensity score matching (PSM) was applied to match the two groups. The numeric rating scale (NRS) score, Pittsburgh sleep quality index (PSQI), perfusion index (PI), and skin blood flow (SkBF) were recorded at pre-treatment (T₀), 7 days (T₁), 1 month (T₂), 3 months (T₃), 6 months (T₄), and 1 year (T₅) post-treatment, and adverse reactions and complications were also reviewed after treatment. Repeated measures analysis of variance (ANOVA) was used to compare the therapeutic effects between the two groups at different time points before and after treatment.

A total of 46 patients were included, with 23 patients in the SCS group [14 males and 9 females, aged (63.3±7.6) years], and 23 patients in the control group [13 males and 10 females, aged (62.0±8.5) years]. There were no statistically significant differences in general clinical characteristics, or in pre-treatment NRS score [(7.9±1.0) vs (8.3±1.0) scores], PSQI [16.4±1.3) vs (16.9±1.2) scores], PI [(0.32±0.12) vs (0.29±0.08)], and SkBF [(28.65±6.39) vs (30.48±4.77) perfusion units] between the SCS group and the control group (all P>0.05). Repeated measures ANOVA showed that at different follow-up time points, the NRS score and PSQI in the SCS group were lower than those in the control group (all P_groupP<0.05), while the PI and SkBF were higher than those in the control group (all P_groupP<0.05). Additionally, within the SCS group, post-treatment NRS score and PSQI were lower than those at T₀ (all P_time<0.05), and the PI and SkBF were higher than those at T₀ (all P_time<0.05). None of the patients experienced severe adverse reactions related to SCS, and no deaths occurred.

SCS is effective in treating lower extremity PAD, as it can relieve pain, improve sleep quality, and enhance microcirculation.

The data of 298 patients with auditory neuropathy (AN) who underwent genetic testing in Chinese PLA General Hospital from August 2015 to June 2024 were retrospectively reviewed, and 12 cases (4.0%) carried pathogenic glucose-6-phosphate dehydrogenase (G6PD) gene mutations were enrolled. Among them, 11 patients were from Guangxi. There were 11 cases (9 males and 2 females) that showed symptoms of G6PD deficiency, and 10 cases had neonatal hyperbilirubinemia. The audiological characteristics of the 12 patients were typical AN manifestations, with the age of onset of hearing loss of 0 (0, 1) month, and 11 cases were classified as infant AN. Genetic analysis of the 12 patients identified four G6PD mutation, with the c.1388G>A pathogenic mutation being the most prevalent (8/12). Additionally, three deafness-associated genes, including GJB2, AIFM1, and STRC were identified. The current study indicates that there are regional differences in the distribution of G6PD gene variation in AN, predominantly in the AN population of Guangxi. The potential mechanisms of hearing loss may be related to neonatal hyperbilirubinemia, genetic factors and others.

This study investigated the characteristic changes of brain function in children with Tourette syndrome (TS) based on resting-state functional MRI (rs-fMRI) and their correlation with the Yale Global Tic Severity Scale (YGTSS) scores. A total of 19 children diagnosed as TS at the Department of Pediatrics in China-Japan Friendship Hospital from October 2021 to April 2023 were enrolled prospectively as the TS group, and 20 healthy children matched for age and gender were field recruited from the community as the control group. All participants underwent head rs-fMRI scans, and regional homogeneity (ReHo) and amplitude of low-frequency fluctuations (ALFF) values were calculated. YGTSS scores were assessed for the TS group. Pearson correlation analysis and Spearman correlation analysis were used to evaluate the correlation between ReHo, ALFF and YGTSS scores. Receiver operating characteristic (ROC) curves were plotted and area under the curve (AUC) was calculated to evaluate the efficacy of brain function parameters related to YGTSS score in diagnosing TS. The TS group included 19 patients, and aged (8.5±2.6) years, including 13 males (68.4%). The control group included 20 children, and aged (5.5±1.8) years, including 7 males (35.0%). In the TS group, the ReHo values in the left lentiform nucleus gray matter, left occipital lobe fusiform gyrus, right occipital lobe medial gyrus, and right frontal lobe paracentral lobule white matter were lower than those in the control group. The ReHo values in the pons and right cerebellar tonsil region, as well as the ALFF values in the right lingual gyrus, were higher than those in the control group (all P<0.01). The ReHo values in the right frontal lobe paracentral lobule, right occipital lobe medial gyrus, and left occipital lobe fusiform gyrus were positively correlated with vocal frequency (r=0.466, 0.576, 0.491) and intensity (r=0.498, 0.593, 0.609); the ReHo values in the right occipital lobe medial gyruss (r=0.615) and left occipital lobe fusiform gyrus (r=0.661) were positively correlated with the number of vocal tics (all P<0.05). The AUC (95%CI) for discriminating TS based on the ReHo values in the right frontal lobe paracentral lobule, right occipital lobe medial gyrus, and left occipital lobe fusiform gyrus were 0.890 (0.774-1.000), 0.863 (0.745-0.982), and 0.858 (0.760-0.988), respectively, with no statistically significant differences in the efficacy of these 3 ReHo values for discriminating TS (all P>0.05). Children with TS have characteristic brain function changes, and there is a correlation between the characteristic brain regions of MRI brain function changes and vocal tic symptoms.

This study aimed to explore the surgical strategies and outcomes of petrosal bone cholesteatoma (PBC) surgery under ear endoscope. A retrospective analysis was conducted on the clinical data of PBC patients who underwent endoscopic surgery for PBC and were followed-up for≥1 year at West China Hospital, Sichuan University, from January 2017 to January 2024. The characteristics of the lesions, surgical procedures, and prognoses were evaluated. A total of seven patients were included, consisting of four males and three females, with 28-59 (36.4±11.0) years. According to the Sanna classification, four cases were classified as supralabyrinthine type and three as massive type, and all were managed with endoscopic resection. No facial nerve transposition was performed in any patient during surgery. Comparison of preoperative and postoperative facial nerve function based on the House-Brackman (HB) grading system showed that facial nerve function was preserved in five patients postoperatively; one patient was grade Ⅳ preoperatively and grade Ⅴ postoperatively, and one patient was grade Ⅵ preoperatively and remained grade Ⅵ postoperatively. Four patients had severe conductive or mixed hearing loss preoperatively, with the labyrinth preserved during surgery and one-stage ossicular reconstruction for hearing improvement; three patients had extreme sensorineural hearing loss preoperatively, with the labyrinth resected during surgery and no hearing reconstruction performed. Two patients experienced transient and minor cerebrospinal fluid otorrhea, which was resolved before discharge. All patients had dry ears within two months postoperatively, with one case of recurrence diagnosed at an external institution one year postoperatively. The endoscopic approach is feasible and appears beneficial in reducing trauma and recurrence rates in PBC surgery.

This paper reports a case of pulmonary sarcoidosis presented by bilateral subpleural multifocal consolidation. The patient, a 59-year-old female, went to Qingdao Municipal Hospital on August 22, 2021 due to "cough and expectoration for more than 3 months". The patient coughed and coughed a little white sticky sputum. Chest CT showed bilateral subpleural multifocal consolidation, accompanied by mediastinal lymph node enlargement and interlobular septal thickening. Considering that the inflammation may be large and the anti-infective treatment effect is not good, ultrasound-guided transbronchial needle aspiration biopsy was performed. No pathological evidence of infection and tumor was found, and no obvious abnormalities were found in alveolar lavage fluid related examinations. To further confirm the diagnosis, CT-guided percutaneous lung biopsy was performed. The pathology showed granulomatous inflammation of lung tissue. Comprehensive clinical, imaging and pathological manifestations, the diagnosis was pulmonary sarcoidosis. After methylprednisolone treatment and gradual reduction, the clinical symptoms and chest CT of the patient improved compared with before. Follow-up until November 2024, the patient had no symptoms such as cough and expectoration, and his condition was stable.

POEMS syndrome is a rare plasma cell disease, which is mainly manifested by multiple neuropathy, clonal plasma cells, sclerosing bone lesions, organ enlargement, endocrine lesions, and elevated vascular endothelial growth factor. The diagnosis is based on a combination of clinical and laboratory judgments, and risk factors include hypoalbuminemia, older age, pleural effusion, pulmonary hypertension, and decreased glomerular filtration rate. The treatment is mainly to remove cloned plasma cells. Patients suitable for transplantation are the first choice for sequential autologous hematopoietic stem cell transplantation after induction, and no consolidation or maintenance treatment may be given after transplantation. Patients who were not suitable for transplantation entered maintenance therapy after 8 to 12 courses of chemotherapy. This article reviews the clinical manifestations, diagnosis and treatment of POEMS syndrome.

Stanford aortic dissection type A (TAAD) is a high morbidity and fatality vascular surgical disease. Its prevention and treatment have always been the focus and difficulty in the medical field. Previous studies have suggested that the maximum diameter of the ascending aorta after TAAD based on CT angiography (CTA) is an independent risk factor for TAAD, but the reliability of this conclusion remains controversial. In recent years, many more accurate imaging evaluation indicators of TAAD are emerging constantly. This paper summarizes and summarizes various existing imaging parameters related to the course of TAAD, in order to provide a reference for the assessment of the risk of TAAD.

A 7-year-old child went to the Department of Ophthalmology, Beijing Tongren Hospital affiliated to Capital Medical University because she "consciously lost sight in her left eye for 4 months", without strabismus, amblyopia and nystagmus. The child was delivered naturally at term, denied the history of hypoxia and trauma, and had no other systemic diseases. His mother was healthy during pregnancy and denied the history of special drug use. Deny that relatives have a history of similar diseases and familial genetic diseases.

The patient, a 56-year-old female, was seen at Beijing Tongren Hospital affiliated to Capital Medical University in November 2024 due to "7-month visual loss in her left eye". Seven months before admission, the patient found that the left fundus occupied space in the local hospital due to the decreased visual acuity of his left eye, but no definite diagnosis and treatment was given. Further diagnosis and treatment in a higher-level hospital was recommended. Past history: 15 years of hypertension, 15 years of diabetes, after resection of thyroid tumor (pathology suggests papillary thyroid carcinoma).