Early efficacy of radiofrequency ablation for multifocal T1N0M0 papillary thyroid carcinoma: a multicenter study

OBJECTIVES

This study aimed to assess the efficacy and safety of radiofrequency ablation (RFA) for multifocal papillary thyroid carcinoma (M-PTC) and compare these outcomes with those for unifocal papillary thyroid carcinoma (U-PTC).

METHODS

This retrospective multicenter study included 465 patients (367 women and 98 men) who underwent RFA for either U-PTC (411 patients) or M-PTC (54 patients) between May 2015 and October 2022. Patients were followed up at 1, 3, 6, and 12 months post-RFA, then every 6 months in the second year, and annually thereafter. After 1:1 propensity score matching (PSM), local tumor progression rate (LTP), tumor volume, volume reduction rate (VRR), tumor complete response rate (CDR), and complications were evaluated and compared between the M-PTC and U-PTC groups during the follow-up period.

RESULTS

The median follow-up time was 23 months. The median follow-up time for the U-PTC and M-PTC groups was 23 months and 23.5 months, respectively. The overall local tumor progression rate was 0.9% (4/465), and the overall complication rate was 0.6% (3/465). After PSM, no significant differences were observed between the U-PTC and M-PTC groups regarding tumor volume (p = 0.377), VRR (p = 0.151), CDR (50% vs. 44.2%, p = 0.556), or LTP (1.9% vs. 0%, p = 0.556). Additionally, the complication rates were not significantly different between the groups (1.03% vs. 2.5%, p = 0.343).

CONCLUSION

After adequate preoperative evaluation, RFA is an effective and safe treatment for appropriately selected patients with M-PTC, with a prognosis similar to that of U-PTC.

The clinical value of Delphian and pre-tracheal lymph nodes in predicting lateral lymph nodes metastasis of papillary thyroid carcinoma

BACKGROUND

Occult lymph node metastasis of papillary thyroid carcinoma is common. However, whether undergoing prophylactic lateral lymph node dissections is still controversial. This cross-sectional study with large cohort of patients aims to investigate the clinical value of Delphian and pre-tracheal lymph node in predicting lateral lymph node metastasis of papillary thyroid carcinoma.

MATERIALS AND METHODS

A retrospective analysis was conducted on 865 papillary thyroid carcinoma patients with Delphian and pre-tracheal lymph node data who underwent thyroidectomy plus central and lateral lymph node dissection. Data on clinicopathological characteristics were collected. Subsequently, a predictive model was established based on the results of the univariate and multivariate analyses.

RESULTS

The rates of Delphian and pre-tracheal lymph node metastasis and lateral lymph node metastasis were 54.7% and 39.1%, respectively. Having ≥ 3 or 1-2 Delphian and pre-tracheal lymph node metastasis dramatically increased the risk of lateral lymph node metastasis (OR = 8.5, 95% CI 5.3-13.4 and OR = 3.9, 95% CI 2.7-5.7, respectively). The upper tumour had a 3.7 times higher risk of lateral lymph node metastasis than other locations. Patients ≤ 42 years or tumour size >8 mm had a higher risk of lateral lymph node metastasis.

CONCLUSIONS

Delphian and pre-tracheal lymph node metastasis was associated positively with the risk of lateral lymph node metastasis. For patients without clinical lateral lymph node metastasis, the Delphian and pre-tracheal lymph node could be considered to harvest as the first step in a thyroidectomy to facilitate further conduct of the operation.

Impact of parathyroid gland classification on hypoparathyroidism following total thyroidectomy with central neck dissection for differentiated thyroid cancer

OBJECTIVE

To assess the impact of parathyroid gland (PG) classification on hypoparathyroidism incidence following total thyroidectomy (TT) with central neck dissection (CND) in patients with differentiated thyroid carcinoma (DTC).

METHODS

In this prospective cohort study, adult patients with DTC who underwent TT with CND between 2021 and 2023 were enrolled, with a maximum follow-up duration of 32 months. A simplified PG classification system was employed, categorizing glands into four distinct types: tightly connected, loosely connected, non-connected, and thymic. The intraoperative frequency of each PG type was recorded based on this classification. Parathyroid hormone (PTH) levels were routinely tested 1 day, 1 month, 6 months and 1 year after surgery. The association between PG classification and the incidence of postoperative hypoparathyroidism was then systematically analysed.

RESULTS

Among 135 patients with DTC (mean age: 48.50 ± 10.52 years; 101 women), 62 patients (45.93%) developed hypoparathyroidism on postoperative day 1 (POD1), while 14 patients (10.37%) experienced hypoparathyroidism on postoperative month 1 (POM1). All patients exhibited PTH normalization within six months, with no permanent hypoparathyroidism cases. A total of 532 PGs were identified: 264 (49.62%) were tightly connected, 150 (28.20%) loosely connected, 95 (17.86%) non-connected, and 23 (4.32%) thymic. The highest prevalence of hypoparathyroidism on POD1 was observed in patients with four tightly connected PGs (p < 0.001). Patients with four tightly connected PGs had a significantly greater incidence of hypoparathyroidism than those with none (p = 0.024). Regression analysis revealed that each additional tightly connected PG increased the risk of hypoparathyroidism by 1.38 times (p = 0.019). Tightly connected PGs demonstrated predictive value for POD1 hypoparathyroidism (AUC = 0.604, cut-off: two tightly connected glands). In contrast, thymic PGs did not provide a protective effect.

CONCLUSION

PG classification may serve as a valuable tool for surgeons in intraoperative parathyroid preservation and the prediction of postoperative hypoparathyroidism in patients with DTC. Notably, DTC patients with more than two tightly connected PGs are at an elevated risk of developing temporary hypoparathyroidism, emphasizing the importance of meticulous parathyroid preservation during surgical procedures.

Comparison of US-guided thermal ablation and surgery for papillary thyroid cancer: a systematic review and meta-analysis

OBJECTIVE

We conducted the systematic review and meta-analysis to comprehensively compare ablation and surgery in terms of effectiveness, safety and multiple factors affecting life quality of patients with papillary thyroid cancer (PTC).

METHODS

PubMed, Embase, Scopus, Web of Science and EBSCO were searched for relevant studies published between January 1980 and September 2023. Two reviewers independently extracted data according to the PRISMA recommendations and assessed the quality of each study with the Cochrane Risk of Bias Tool. Pooled analyses were performed using random or fixed-effects models, as appropriate.

RESULTS

A total of 4829 patients with PTC from 19 eligible studies were included. Through the meta-analysis, similar tumor progression (OR: 1.07; 95% CI 0.78, 1.48; p = 0.66) and recurrence-free survival (OR: 0.86; 95% CI, 0.55, 1.34; p = 0.50) were found between the patients undergoing ablation and those undergoing surgery. More strikingly, the lower risk of major complications (OR: 0.31; 95% CI 0.24, 0.41; p < 0.001), the shorter hospital stay (MD = 3.67 d; 95% CI, -4.89, -2.44; p < 0.001), the abbreviated procedure time (MD: -66.33 min, 95% CI, -77.08, -55.59; p < 0.001), the less intraoperative blood loss (MD: -27.43 ml, 95% CI, -34.60, -20.27; p < 0.001) and the lower treatment cost (MD: -860.42 USD, 95% CI, -1008.03, -712.81; p < 0.001) were noticed in ablation techniques compared to surgical operation. Thermal ablation has shown multiple advantages by virtue of its percutaneous puncture compared with surgical resection.

CONCLUSION

As an effective, safe, minimally invasive and economical modality, thermal ablation might be a promising alternative to existing PTC management options.

Radical Resection of Differentiated Thyroid Cancer in Elderly Patients: Evaluation of the Efficacy of the Immunocolloidal Gold Strip Method Combined with Nanocarbon Negative Imaging Tracing Technology for Parathyroid Gland Imaging

OBJECTIVE

Extant imaging methods used for the proper identification of the parathyroid glands to prevent post-operative hypothyroidism associated with the resection of differentiated thyroid cancer (DTC) are limited by factors such as low specificity, high cost, and technical complexity. This study, therefore, sought to investigate the efficacy of the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during radical resection of DTC in elderly patients.

METHODS

A total of 100 elderly patients with DTC were enrolled and randomly divided into two groups: the control group and the observation group. The control group underwent conventional radical thyroidectomy with bilateral cervical lymph node dissection, while the observation group received the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during the surgery. The baseline characteristics, intraoperative findings, postoperative parathyroid hormone (PTH), and serum calcium levels, as well as postoperative complications, were compared between the two groups.

RESULTS

There were no significant differences in age, gender, body mass index, comorbidities, or smoking history between the two groups. The observation group had a significantly higher number of parathyroid glands identified during surgery compared with the control group. The postoperative PTH and serum calcium levels at postoperative days 1 and 3 and at 6 months were significantly higher in the observation group than those in the control group. The incidence of postoperative hypoparathyroidism was significantly lower in the observation group.

CONCLUSION

The immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology is effective in identifying and preserving parathyroid glands during radical resection of DTC in elderly patients.

ITGA3-MET interaction promotes papillary thyroid cancer progression via ERK and PI3K/AKT pathways

BACKGROUND

Studies have examined the role of integrin α3 (ITGA3) in papillary thyroid carcinoma (PTC). However, the functional and molecular mechanism by which ITGA3 is involved in the progression of PTC remains poorly understood.

METHODS

To investigate the role of ITGA3 in PTC, raw PTC transcriptome data underwent comprehensive bioinformatics analyses, including differential expression, co-expression network, and enrichment analyses. ITGA3 expression was validated via immunohistochemistry and western blotting in PTC tissues. Cell functional assays and xenograft models assessed PTC cell behaviour. The potential mechanisms of ITGA3 were elucidated using bioinformatics analyses, western blotting, co-immunoprecipitation, and immunofluorescence. Finally, integration of ITGA3 expression with clinical parameters enabled nomogram construction for precise prediction of cervical lymph node metastasis (CLNM) in PTC.

RESULTS

ITGA3 was upregulated in PTC and associated strongly with CLNM (79.5% vs. 53.84%, p = 0.016). ITGA3 expression enhanced PTC proliferation and migration in vitro and in vivo via cooperating with the MET protein tyrosine kinase, followed by phosphorylation of MET at Tyr1234/1235, and activation of ERK and PI3K/AKT signaling pathways. Furthermore, upregulation ITGA3 reduced phosphorylation at FAK-Tyr397 and Src-Tyr416 in PTC cells. Finally, a nomogram combining ITGA3 expression and clinical parameters for predicting CLNM was constructed and validated, achieving a ROC curve AUC of 0.719, suggesting potential application for PTC diagnosis.

CONCLUSIONS

ITGA3 promotes PTC cell proliferation and migration by cooperating with MET to activate MET-ERK and MET-PI3K-AKT signalling. ITGA3-MET cooperation may serve as a potential therapeutic target.

Effects of using app-based interventions on quality of life among breast cancer patients: a systematic review with meta-analysis

BACKGROUND

Application-based interventions have gradually emerged as potential tools for improving the health status of cancer patients. However, the conclusions of existing studies on the effectiveness of app-based intervention in managing breast cancer symptoms vary.

METHODS

This study systematically searched the PubMed, Web of Science, Scopus, Cochrane Library, and EMBASE databases from the inception of each database to October 25, 2024. Two researchers independently screened studies, extracted data, and evaluated the quality using the Cochrane Risk of Bias Tool. Data analysis was performed using RevMan 5.3 software, and the effect size was expressed as the standardized mean difference (SMD).

RESULTS

Of 16 included randomized controlled trials, meta-analysis results indicated that, compared to usual care, app-based interventions significantly improved breast cancer patients' quality of life (14 studies, SMD = 0.84, 95%CI = 0.48 - 1.19, p < 0.00005, I2 = 90%, GRADE = low), and positively alleviated physical pain and anxiety (5 studies, SMD = - 0.60, 95%CI = -0.92 to -0.29, p = 0.0002, I2= 56%, GRADE = very low; 3 studies, SMD = -0.75, 95% CI = -1.40 to -0.09, p = 0.03, I2= 86%, GRADE = very low). However, no statistically significant differences were observed in improving fatigue (3 studies, SMD = 0.18, 95%CI = - 0.05 - 0.42, p = 0.13, I2 = 0%) and depression (2 studies, SMD = -0.65, 95%CI = - 2.12 - 0.82, p = 0.38, I2 = 96%).

CONCLUSION

Application-based interventions can significantly improve the quality of life of breast cancer patients, effectively relieve pain, and reduce anxiety.

Breast cancer survivors' perceptual map of breast reconstruction appearance outcomes

Purpose

It is often hard for patients to articulate their expectations about breast reconstruction appearance outcomes to their providers. Our overarching goal is to develop a tool to help patients visually express what they expect to look like after reconstruction. We aim to comprehensively understand how breast cancer survivors perceive diverse breast appearance states by mapping them onto a low-dimensional Euclidean space, which simplifies the complex information about perceptual similarity relationships into a more interpretable form.

Approach

We recruited breast cancer survivors and conducted observer experiments to assess the visual similarities among clinical photographs depicting a range of appearances of the torso relevant to breast reconstruction. Then, we developed a perceptual map to illuminate how breast cancer survivors perceive and distinguish among these appearance states.

Results

We sampled 100 photographs as stimuli and recruited 34 breast cancer survivors locally. The resulting perceptual map, constructed in two dimensions, offers valuable insights into factors influencing breast cancer survivors' perceptions of breast reconstruction outcomes. Our findings highlight specific aspects, such as the number of nipples, symmetry, ptosis, scars, and breast shape, that emerge as particularly noteworthy for breast cancer survivors.

Conclusions

Analysis of the perceptual map identified factors associated with breast cancer survivors' perceptions of breast appearance states that should be emphasized in the appearance consultation process. The perceptual map could be used to assist patients in visually expressing what they expect to look like. Our study lays the groundwork for evaluating interventions intended to help patients form realistic expectations.

Endothelial cell supplementation promotes xenograft revascularization during short-term ovarian tissue transplantation

The ischemic/hypoxic window after Ovarian Tissue Transplantation (OTT) can be responsible for the loss of more than 60 % of follicles. The implantation of the tissue supplemented with endothelial cells (ECs) inside dermal substitutes represents a promising strategy for improving graft revascularization. Ovarian biopsies were partly cryopreserved and partly digested to isolate ovarian ECs (OVECs). Four dermal substitutes (Integra®, made of bovine collagen enriched with chondroitin 6-sulfate; PELNAC®, composed of porcine collagen; Myriad Matrix®, derived from decellularized ovine forestomach; and NovoSorb® BMT, a foam of polyurethane) were compared for their angiogenic bioactive properties. OVECs cultured onto the scaffolds upregulated the expression of angiogenic factors, supporting their use in boosting revascularization. Adhesion and proliferation assays suggested that the most suitable scaffold was the bovine collagen one, which was chosen for further in vivo experiments. Cryopreserved tissue was transplanted onto the 3D scaffold in immunodeficient mice with or without cell supplementation, and after 14 days, it was analyzed by immunofluorescence (IF) and X-ray phase contrast microtomography. The revascularization area of OVECs-supplemented tissue was doubled (7.14 %) compared to the scaffold transplanted alone (3.67 %). Furthermore, tissue viability, evaluated by nuclear counting, was significantly higher (mean of 169.6 nuclei/field) in the tissue grafted with OVECs than in the tissue grafted alone (mean of 87.2 nuclei/field). Overall, our findings suggest that the OVECs-supplementation shortens the ischemic interval and may significantly improve fertility preservation procedures.

Matrix-designed bright near-infrared fluorophores for precision peripheral nerve imaging

The FDA's recent approval of pafolacianine, the first molecular targeted contrast agent for fluorescence-guided surgery (FGS), signifies a remarkable milestone in precision medicine. This advance offers new hope for cancer patients by enabling guided removal of cancerous tissues, where completed surgical removal remains a consistent challenge without real-time intraoperative guidance. For optimal surgical outcomes, delicate nerve tissues must be preserved to maintain patient quality of life. Despite advances in the clinical translation pipeline, the development of clinically viable nerve-specific contrast agents for FGS remains a significant challenge. Herein, a medicinal chemistry-based matrix design strategy was applied to effectively generate a synthetic roadmap permitting management of nerve-specificity within the near-infrared (NIR) oxazine fluorophore family. Many of these newly developed fluorophores demonstrated robust nerve-specificity and superior safety profiles, while also offering spectral profiles that are compatible with the clinical surgical FGS infrastructure. Notably, improving observed brightness in vivo enabled exceptional visibility of buried nerve tissue, a priority during surgical procedures. Critically, the lead probe showed a large dosage safety window capable of generating substantial contrast at doses 100x lower than the maximum tolerated dose. Following clinical translation, such NIR nerve-specific fluorophores stand poised to significantly improve outcomes for surgical patients by improving identification and visualization of surface and buried nerve tissues in real time within the surgical arena.

Therapeutic potential of Da Cheng Qi Decoction and its ingredients in regulating ferroptosis via the NOX2-GPX4 signaling pathway to alleviate and predict severe acute pancreatitis

OBJECTIVE

This study aimed to elucidate the protective effects of Da Cheng Qi Decoction (DCQD) on severe acute pancreatitis (SAP) by targeting ferroptosis in pancreatic acinar cells and to establish a predictive signature and nomogram for acute pancreatitis (AP) risk assessment.

METHODS

We utilized microarray analysis to delineate gene expression patterns among 32 healthy controls and 87 AP patients stratified by severity. Employing SAP models and NOX2-deficient cells, we investigated the molecular underpinnings of ferroptosis. The impact of DCQD and the ferroptosis inhibitor Fer-1 on gene expression, oxidative stress, and inflammation was assessed. Machine learning algorithms identified differentially expressed genes (DEGs) sensitive to DCQD, SAP, and ferroptosis (DSNFGs), which were validated across multiple datasets. A predictive nomogram integrating DSNFGs was developed, and single-cell analysis provided a comprehensive view of the cellular dynamics.

RESULTS

The microarray analysis revealed upregulation of NOX2 and downregulation of GPX4 in AP, with expression patterns correlating with disease severity. DCQD ameliorated SAP-induced pancreatic acinar cell damage and ferroptosis by reducing inflammatory markers and enhancing GPX4 expression. NOX2 knockout mitigated ferroptosis in SAP models, suggesting a key role in the disease process. DCQD and Fer-1 differentially regulated the expression of ferroptosis-related genes, reduced reactive oxygen species (ROS) and high-mobility group box 1 (HMGB1) levels, and suppressed the inflammatory response in a SAP mouse model. The HPLC analysis of DCQD constituents indicated eight components (aloe-emodin, rhein, emodin, chrysophanol, naringin, hesperidin, magnolol, and honokiol) with the capacity to modulate ferroptosis. Venn analysis identified 48 DSNFGs, with a subset of five genes demonstrating significant predictive value. The developed nomogram, based on LASSO regression, showed high accuracy in validation cohorts. Single-cell RNA sequencing (scRNA-seq) and CellChat analysis uncovered heterogeneity and cell-cell communication networks in the pancreas during recovery from pancreatitis, implicating several signaling pathways.

CONCLUSION

DCQD and its eight ingredients exert its protective effect in SAP by inhibiting ferroptosis through the NOX2/GPX4 pathway. The DCQD-SAP-ferroptosis-related signature and nomogram offer a novel tool for AP risk assessment, prognosis prediction, and personalized therapeutic strategies in SAP management.

Anaplastic thyroid cancer: Genetic roles, targeted therapy, and immunotherapy

Anaplastic thyroid cancer (ATC) stands as the most formidable form of thyroid malignancy, presenting a persistent challenge in clinical management. Recent years have witnessed a gradual unveiling of the intricate genetic underpinnings governing ATC through next-generation sequencing. The emergence of this genetic landscape has paved the way for the exploration of targeted therapies and immunotherapies in clinical trials. Despite these strides, the precise mechanisms governing ATC pathogenesis and the identification of efficacious treatments demand further investigation. Our comprehensive review stems from an extensive literature search focusing on the genetic implications, notably the pivotal MAPK and PI3K-AKT-mTOR signaling pathways, along with targeted therapies and immunotherapies in ATC. Moreover, we screen and summarize the advances and challenges in the current diagnostic approaches for ATC, including the invasive tissue sampling represented by fine needle aspiration and core needle biopsy, immunohistochemistry, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. We also investigate enormous studies on the prognosis of ATC and outline independent prognostic factors for future clinical assessment and therapy for ATC. By synthesizing this literature, we aim to encapsulate the evolving landscape of ATC oncology, potentially shedding light on novel pathogenic mechanisms and avenues for therapeutic exploration.

The Abelson kinase and the Nedd4 family E3 ligases co-regulate Notch trafficking to limit signaling

Precise output from the conserved Notch signaling pathway governs a plethora of cellular processes and developmental transitions. Unlike other pathways that use a cytoplasmic relay, the Notch cell surface receptor transduces signaling directly to the nucleus, with endocytic trafficking providing critical regulatory nodes. Here we report that the cytoplasmic tyrosine kinase Abelson (Abl) facilitates Notch internalization into late endosomes/multivesicular bodies (LEs), thereby limiting signaling output in both ligand-dependent and -independent contexts. Abl phosphorylates the PPxY motif within Notch, a molecular target for its degradation via Nedd4 family ubiquitin ligases. We show that Su(dx), a family member, mediates the Abl-directed LE regulation of Notch via the PPxY, while another family member, Nedd4Lo, contributes to Notch internalization into LEs through both PPxY-dependent and -independent mechanisms. Our findings demonstrate how a network of posttranslational modifiers converging at LEs cooperatively modulates Notch signaling to ensure the precision and robustness of its cellular and developmental functions.

Comparing the effectiveness of Rosuvastatin and Atorvastatin on changes in LDL, TG and HDL: A systematic review and meta-analysis

AIM

Elevated levels of LDL and triglycerides, along with low levels of HDL, are key contributors to cardiovascular disease. If the increase of harmful fats is prevented, it will be a great step towards the prevention of diseases. The two drugs atorvastatin and rosuvastatin are the most commonly used drugs to reduce LDL and triglycerides and increase HDL in patients. The present study aimed to compare the effectiveness of Rosuvastatin and Atorvastatin on changes in LDL, TG and HDL using a systematic review and meta-analysis method.

MATERIALS AND METHODS

The present study was conducted on the basis of the protocol of systematic review and meta-analyses. The ISI, Cochrane Library, Google Scholar, PubMed, Scopus, and Elsevier databases were independently searched by two researchers using Mesh keywords in different regions of the world during 2003 to 2025. Data was analyzed using the STATA software.

KEY FINDINGS

Effectiveness of Atorvastatin on the reduction of LDL was 51.49 mg/dl (42.75-60.23 %, CI =95 %) versus Rosuvastatin with a reduction of 55.66 mg/dl (46.32-65 and CI =95 %). The effectiveness of Atorvastatin on the rise of HDL was 1.85 mg/dl (-3.23-0.46 and CI =95 %) versus Rosuvastatin with a rise of 3.87 mg/dl (2.08-5.66 and CI =95 %); and the effectiveness of atorvastatin on the reduction of TG was 24.76 mg/dl (18.14-31.88 and CI = 95 %) versus the effectiveness of Rosuvastatin with a reduction of 31.98 mg/dl (24. 41-39.55 and CI = 95 %).

SIGNIFICANCE

According to research results, Rosuvastatin was better than Atorvastatin and decreased triglyceride and LDL and increased HDL in all cases.

Noncommunicable disease syndemic among the general population in Iran: a cross-sectional study

Objectives

This study aims to investigate the status of the NCD syndemic among individuals over 25 in all provinces of Iran.

Methods

This study was based on a national survey. Using a systematic cluster random sampling framework, 26,707 participants were selected from all 31 Iranian provinces. The data were analyzed for descriptive statistics by gender and age, followed by principal component analysis and logistic regression, using R software for the statistical analysis.

Results

There was an interaction between diabetes mellitus and cardiovascular diseases, in their association with healthy life lost due to disability in the Iranian adult population. Additionally, there was a clustering of diabetes mellitus and cardiovascular diseases, partly due to the shared specific causes such as obesity, hypertension, shared baseline features, and poverty.

Conclusions

The syndemic analysis showed that social inequalities in diabetes and cardiovascular disease arise not only from exposure levels but also from varying vulnerabilities and disease outcomes. Iran's health policy should prioritize reducing these health inequalities.

Revisiting low complications of VICRYL mesh in breast reconstruction: Insights from an updated systematic review

Background

Alloplastic breast reconstruction continues to be the most prevalent breast reconstruction performed in the United States. Plastic surgeons are challenged to recreate the breast footprint after the ablative surgeon's mastectomy. Mesh augmentation has emerged as a valuable tool in controlling implant migration. Several soft tissue support breast meshes have been introduced, each characterized by a different risk profile, cost, and associated complications.

Objectives

This manuscript presents a comprehensive systematic review, with updated data over the last decade, of the use of a resorbable and less costly VICRYL (Ethicon, Somerville, NJ, USA) mesh in breast reconstruction after mastectomy.

Methods

The authors conducted a systematic review of the use of VICRYL mesh in breast reconstruction using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors queried five databases. Data was collected using a standardized form and underwent review using set inclusion and exclusion criteria. The primary outcome variable was reconstructive failure, with secondary outcomes including seroma, hematoma, skin necrosis, and infection.

Results

A total of 693 articles were found after the multi database search. Forty articles met inclusion criteria. Following full text review, six articles analyzing 511patients were included. VICRYL mesh was utilized in 711 breast reconstructions, of which 5% were complicated by reconstructive failure (confidence interval (CI): 4.75-5.25%); 1.6% by seroma (CI: 1.53-1.67%); 3.33% by infection (CI: 3.14-3.52%); 1.83% by hematoma (CI: 1.71-1.95%); and 6.33% by skin necrosis (CI: 6.03-6.63%).

Conclusion

VICRYL mesh repeatedly demonstrates low reconstructive failure in breast reconstruction with an acceptable complication profile.

Pathogenesis, attenuation, and treatment strategies for keloid management

Keloid is an outcome of abnormal cellular response in the wound healing process with excessive fibroblast and collagen deposition in the dermal layer of the skin. It is characterized by a scar showing fibrous outgrowth that grows beyond the original boundaries of the wound. Thus, it is cosmetically and functionally disturbing to the patient. Keloidal development depends on various patient and environmental factors, possibly initiating abnormal wound healing. Due to abnormal wound healing, various aberrant cellular responses are observed during keloid development, like delayed inflammatory response, increased growth factors, varied cytokine level, decreased apoptosis, increased angiogenesis, and imbalanced proteinases. Bacteria and the immune system also play a role in keloid development. Advancements like single-cell RNA sequencing and transcriptomics studies have led to a better understanding of pathogenesis. In line with the complex pathogenesis, the later part of the review covers a detailed analysis of various treatment options employed for keloid, which includes silicone-based topical therapy, drug-based therapy, invasive approach (surgery), and minimally invasive therapies (radiation, laser therapy, and cryotherapy). The advantages and limitations of individual and combination therapies are also discussed. Keloids tend to re-occur after treatment; hence, follow-up is very important, making keloid treatment a complex procedure. Novel therapeutics in keloid have advantages like better efficacy of drugs, less pain, self-administration, and fewer side effects. A few nanotherapeutics advancements, such as microneedles, nanoparticles, liposomes, and exosomes, are discussed in the review.

Three-dimensional breast imaging using Artificial-Intelligence-Based Automatic Measurement System

Background

Three-dimensional (3D) image technology in breast measurement requires exploration. We aimed to evaluate a new automatic breast measurement system based on artificial intelligence (AI).

Methods

This prospective controlled study included all-women patients who underwent breast reconstruction from January to May 2022. Patients underwent 3D scanning before breast reconstruction. Two doctors performed the measurements twice through AI and manual measurements on the 3D images, respectively. The measurement results of bilateral breast width, convexity, height, volume, and measurement time were recorded. Consistency analyses were performed.

Results

Fifty-eight patients (116 breasts) were recruited. For the left breasts, AI and manual measurements showed excellent consistency (intra-class correlation coefficients (ICC) = 0.81) in width measurements, moderate consistency (ICC = 0.59) in height measurements, excellent consistency (ICC = 0.87) in convexity measurements, and good consistency (ICC = 0.74) in volume measurements. For the right breasts, the width consistency was excellent (ICC = 0.93), height consistency was good (ICC = 0.65), convexity consistency was excellent (ICC = 0.94), and volume consistency was excellent (ICC = 0.85). The Bland-Altman curves also showed that the measurement results were comparable and few outliers were detected. AI average measurement time (compared to manual measurements) was significantly shorter (40.65 ± 1.51 s vs. 610.47 ± 18.74 s; p < 0.001).

Conclusion

The AI-based 3D breast measurement system showed high accuracy, better reproducibility, and significantly shortened the measurement time, which could help guide surgical management.

Diagnostic performance of dual-energy computed tomography in detecting anterior cruciate ligament injuries: a systematic review and meta-analysis

OBJECTIVE

Anterior cruciate ligament (ACL) injuries are common and lead to significant physical limitations. While MRI is the diagnostic gold standard, its use is restricted in acute trauma cases due to contraindications and longer imaging times. Dual-energy computed tomography (DECT) has emerged as a potential alternative. This meta-analysis evaluates the diagnostic accuracy of DECT for ACL injuries.

MATERIALS AND METHODS

Following PRISMA guidelines, a comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and Embase for studies published up to June 2024. Studies that provided diagnostic accuracy data for DECT in ACL ruptures were included. Metrics of diagnostic accuracy were aggregated using a bivariate random effects model.

RESULTS

The meta-analysis, which included five studies with a total of 191 patients, found that DECT had a pooled sensitivity of 88.1% (95% CI, 78.0-93.9%) and a specificity of 82.0% (95% CI, 62.0-92.7%) for diagnosing ACL ruptures, with an AUC of 0.92 (95% CI, 0.72-0.96). For complete ruptures, sensitivity was 83.2% (95% CI, 68.2-92.0%), and specificity was 94.9% (95% CI, 92.2-96.7%), with an AUC of 0.96 (95% CI, 0.81-0.98). In acute/subacute settings, sensitivity was 89.4% (95% CI, 76.8-95.6%), and specificity was 82.1% (95% CI, 56.2-94.2%), with an AUC of 0.93 (95% CI, 0.71-0.97).

CONCLUSION

Our findings suggest that DECT is a valuable diagnostic tool for ACL injuries, particularly as an adjunct or alternative when MRI is unavailable or contraindicated, enabling timely and accurate diagnosis.

Development of a prediction model for ctDNA detection (Cir-Predict) in breast cancer

PURPOSE

The detection of circulating tumor DNA (ctDNA) is a valuable method to predict the risk of recurrence and to detect real-time gene changes. The amount of ctDNA is affected by many factors. Moreover, the detection rate of ctDNA varies from report to report.

METHODS

The present study evaluated differentially expressed genes using a DNA microarray assay for gene expression in tumors with and without detected ctDNA and constructed a prediction model for the detectability of ctDNA in breast tumor tissues. The model, named Cir-Predict, consisted of 126 probe sets (111 genes) and was constructed in a training set of breast cancer patients (n = 35) and validated in a validation set (n = 13).

RESULTS

The accuracy, sensitivity, and specificity in training and validation sets were over 90%, and Cir-Predict was significantly associated with ctDNA detection independently of the other conventional clinicopathological parameters in training and validation sets (P < 0.001, P = 0.014, respectively). Cir-Predict (+) was significantly associated with worse recurrence-free survival (P = 0.006). Pathway analysis revealed that nine pathways including tight junction and cell cycle tended to be related to ctDNA detectability.

CONCLUSION

Cir-Predict not only provides information useful for breast cancer treatment, but also helps the understanding of the mechanism by which ctDNA is detected.

Prevalence of Silicone Lymphadenopathy in Women with Breast Implants: A single-center retrospective study

Introduction

Silicone lymphadenopathy (SLA) is a known finding after breast implant surgery. The prevalence of SLA is unknown and therefore its clinical implications are unclear. To make a statement about the clinical importance of SLA, more knowledge on its prevalence is necessary. This study aimed to provide details of SLA prevalence in a single-center.

Methods

This single-center retrospective cohort collected all breast radiology reports from breast or axillary ultrasound (US) and breast MRI exams between 2010 and 2020. These reports were screened for the presence of implant rupture (IR) and/or SLA.

Results

Overall, 1,217 women with silicone breast implants (SBIs) were included over 10 years. This resulted in 1,345 US and 900 MRI reports. In this cohort, 47 women (3.86%) had SLA with intact SBIs, 136 women (11.18) had IR, and 24 (1.97%) had SLA with IR. The sensitivity for IR on US and MRI were 76.2% and 91.7%, respectively. The specificity was 53.8% for IR on US and 66.7% on MRI. These calculations were based on the imaging results of patients whose implants were removed in the MUMC+.

Conclusion

This retrospective cohort provides a single-center ten-year representation of diagnostic imaging of patients with breast implants. The prevalence of SLA in this cohort of women with breast implants is 5.83%. IR increases the risk of developing SLA; however, it can also occur in women with intact SBIs. To our knowledge, this is the first study to report on the prevalence of SLA in patients with SBIs.

Breast implant silicone exposure induces immunogenic response and autoimmune markers in human periprosthetic tissue

Silicone-based breast implants are commonly used, but there are concerns about their long-term safety. While implantation results in the formation of a periprosthetic tissue that isolates the implant from the rest of the host body, silicone can leak and reach surrounding tissues. We combined histological analysis and gene expression profiling (RNA sequencing) of samples from human patients with silicone breast implants with different fillers (silicone or serum), surface topographies and/or shell rupture, and performed systematic cross-comparisons. Our study shows that exposure to silicone gel filler, even in clinically asymptomatic cases, induces an immune response. This response includes the expression of markers associated with various autoimmune diseases. This study provides the first biological evidence of an association between silicone implants and autoimmune markers, highlighting the need for further research and stricter implant safety regulations. We suggest that implant design factors, such as filler type and surface texture, may influence the inflammatory response. Re-evaluation of existing clinical trials is warranted to investigate the association between implant characteristics and potential health risks.

Nomogram using bi-modal imaging for predicting low-level HER2 expression status in breast cancer

OBJECTIVE

To develop and validate a nomogram based on ultrasound and mammographic imaging features for predicting human epidermal growth factor receptor 2-low (HER2-low) expression status in breast cancer.

METHODS

Patients with HER2-negative breast cancer (n = 316) were retrospectively recruited and randomized into training (n = 221) and validation (n = 95) cohorts. Patients were categorized into HER-low and HER2-zero expression groups. Ultrasound and mammography images were collected. Univariate and multivariate analyses were used to identify independent risk factors for HER-low expression status in the training cohort. A predictive nomogram model was developed and validated in the validation cohort. The calibration, discrimination, and clinical net benefit of the nomogram model were assessed using calibration curves, receiver operating characteristic curves, and decision curve analyses, respectively. A Kaplan-Meier curve was drawn, and the log-rank test was used to compare progression-free survival of the two groups of patients.

RESULTS

A longer diameter, tumor margin that was not circumscribed in ultrasound and mammography images, posterior acoustic shadowing, and a higher maximum elasticity were independent predictors of HER2-low expression status; thus, they were incorporated into the nomogram model. The area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.783 in the training cohort. The nomogram also showed good discrimination in the validation cohort (AUC = 0.810), and good calibration efficiency in both cohorts. Decision curve analysis indicated that the nomogram was clinically useful. The log-rank test result revealed a significant difference in progression-free survival. HER2-low expression correlated with improved breast cancer prognosis.

CONCLUSION

This nomogram may provide reference for selecting candidates for appropriate management.

Long-term outcomes of volume de-escalation for breast nodal irradiation

INTRODUCTION

NCCN recommendations suggest irradiating chest wall/breast only + regional node irradiation (RNI) of the undissected axillary levels for node-positive breast cancer (BC) patients. We retrospectively analyzed a cohort of node-positive BC patients who received adjuvant radiotherapy (RT) with a volume de-escalation at the level of axillary nodes.

MATERIAL AND METHODS

We conducted a retrospective analysis of node-positive BC patients treated with adjuvant RT administered following a conventional fractionation schedule using a 3D-conformal technique to the chest wall or breast and only the IV axillary level. The primary endpoint of the study was disease free survival (DFS). Secondary endpoints included loco-regional control (LRC), and Overall Survival (OS). Toxicity was documented according to the Radiation Therapy Oncology Group (RTOG) criteria.

RESULTS

A total cohort of 343 patients was analyzed. Loco-regional recurrence occurred in 100 (29.1%). The 5- and 10-year Kaplan-Meyer curves for DFS were 81.4% (95% CI: 79.3%-83.5%) and 60.9% (95% CI: 57.6%-64.5%), respectively. Multivariate Cox analysis confirmed that lymph node ratio (HR = 9.76, 95% CI: 3.12-30.53, p = 0.0001), Luminal B subtype (HR = 2.03, 95% CI: 1.26-3.29, p = 0.004), and triple-negative subtype (HR = 2.70, 95% CI: 1.22-5.99, p = 0.01) were significant predictors of poor DFS. Lymphedema in the ipsilateral arm was reported in 32 (9.3%) patients, primarily Grade 1 or 2.

CONCLUSIONS

Improved patients' selection and a broader use of systemic therapy could make de-escalation a feasible option. However, this approach should be avoided in patients with extensive nodal involvement, specific molecular subtypes, or comorbidities that prevent the use of chemotherapy.

IHC4 and COMBINE scores for enhanced prognostic stratification in HR+/HER2- breast cancer patients after neoadjuvant chemotherapy

BACKGROUND

The prognostic value of pathological complete response (pCR) in HR+/HER2- breast cancer patients following neoadjuvant chemotherapy (NAC) is limited, as many of these patients achieve long-term survival regardless of pCR status. The effectiveness of current tools-residual cancer burden (RCB), the Miller-Payne (MP) score, CPS-EG score and the immunohistochemical 4 (IHC4)-in this subgroup remains uncertain. In this study, we validated the prognostic role of these approaches and developed a COMBINED score capable of more accurately stratifying patients into distinct risk groups, effectively identifying low-risk patients with favorable outcomes who may be suitable for treatment de-escalation.

METHODS

This study retrospectively analyzed 601 HR+/HER2- breast cancer patients at Sun Yat-sen Memorial Hospital who did not achieve pCR following NAC. Patients were stratified using the IHC4, RCB, MP, CPS-EG, and a novel COMBINE score (integrating CPS-EG and IHC4). Survival outcomes, including disease-free survival (DFS) and overall survival (OS), were evaluated using Kaplan-Meier analysis and Cox regression, with time-dependent ROC and concordance index (C-index) calculations to assess prognostic performance.

RESULTS

The IHC4 and CPS-EG scores outperformed the RCB and MP scores in predicting DFS and OS for non-pCR HR+/HER2- patients. The COMBINE score further enhanced prognostic accuracy, stratifying patients into four risk groups with significant differences in 5-year DFS (96.5% for low-risk vs. 55.1% for high-risk) and OS (100% for low-risk vs. 63.4% for high-risk). The COMBINE score consistently demonstrated superior AUC and C-index values compared to the CPS-EG and IHC4 scores individually at all time points (all p-values < 0.05).

CONCLUSION

The IHC4 score adds prognostic value beyond the CPS-EG score in HR+/HER2- breast cancer patients post-NAC. The COMBINE score, integrating both systems, offers superior prognostic stratification, highlighting the importance of combining clinical staging with tumor biology. Future studies with independent datasets are needed to validate these findings. This study provides valuable insights for optimizing treatment decisions in HR+/HER2- breast cancer.

Role of imaging based response assesment for adapting neoadjuvant systemic therapy for breast cancer: A systematic review

PURPOSE

The objective of this systematic review is to investigate the role of imaging in response monitoring during neoadjuvant systemic therapy (NST) for breast cancer and assess whether treatment modifications based on imaging response are implemented in clinical practice.

METHODS

A systematic review was conducted, analyzing five clinical practice guidelines and 147 clinical trial publications involving NST for breast cancer. The snowballing technique was employed, using a "start set" of clinical guidelines to trace relevant trials. Additionally, a PubMed search was conducted to identify trials published between 2023-2024. The review analyzed the use of imaging modalities, timing, and response criteria, and whether escalation, de-escalation, or change of treatment occurred based on imaging response.

RESULTS

Imaging was utilized in 81 % (119/147) of the trials, with ultrasound, MRI, and mammography being the most frequently employed modalities. Mid-treatment imaging was applied in 56 % (83/147) of the trials. However, only 15 % (22/147) of the trials implemented treatment modifications based on imaging response, highlighting the limited application of imaging response-guided therapy. No standardized imaging protocols or consistent response-guided treatment strategies were identified across the trials or clinical practice guidelines, with considerable variability in imaging methods, timing, and response criteria.

CONCLUSION

This systematic review underscores the critical need for standardized imaging protocols, response assessment criteria and image-guided treatment decisions. It is therefore evident that imaging for response monitoring during treatment should preferably be performed within clinical trials.

Rare pancreatic cystic neoplasms: A pictorial review

Since rare pancreatic cystic tumors may differ from common pancreatic cystic neoplasms in terms of treatment plan and prognosis, the differential diagnosis of these diseases is clinically relevant. Various imaging tests play an important role in the differential diagnosis of rare cystic pancreatic tumors, but accurately distinguishing these diseases solely on the basis of imaging findings is challenging. The purpose of this pictorial review is to present CT and in particular MR imaging features of rare pancreatic cystic tumors and discuss potential elements for differential diagnosis.

Chinese Association of Ultrasound in Medicine and Engineering, Superficial Organs and Peripheral Vessels Committee Expert Consensus on Selected Common Clinical Issues in Parathyroid Ultrasound (2024 Edition)

Parathyroid ultrasound is widely used in clinical practice and plays a crucial role in the diagnosis and treatment of parathyroid diseases. Nevertheless, ultrasound physicians frequently encounter a number of challenges and doubts in their professional practice. For this reason, Superficial Organs and Peripheral Vessels Committee of Chinese Association of Ultrasound in Medicine and Engineering has formulated the expert consensus on certain common clinical problems of parathyroid ultrasound based on the current research progress and clinical experience, in order to guide the clinical practice. This consensus describes in detail the diagnostic and interventional common problems of parathyroid ultrasound and provides in-depth discussion on related contents.

Advances in abiotic tissue-based biomaterials: A focus on decellularization and devitalization techniques

This Review explores the growing and diversifying field of tissue-derived abiotic constructs for tissue engineering applications, with main focus on decellularization and devitalization techniques and principles. Acellular fractions derived from biological tissues, such as the extracellular matrix (ECM), have long been considered a valuable approach for the generation of numerous scaffolds and more complex constructs. The removal of the cellular content has been considered essential to prevent the development of adverse immunological reactions. Nevertheless, the discovery of promising features of certain cellular components has sparked interest in the use of inactivated or devitalized cellular fractions for several applications, particularly in regenerative medicine and inflammation control. Devitalization has been described for several clinical applications, but remains poorly explored in terms of in vitro constructs compared to decellularization methods currently available. In this review, we present and critically evaluate a spectrum of approaches for the decellularization of whole-organs and in vitro constructs, and the most prevalent devitalization techniques, with a discussion on their implications on scaffolds composition, structure, and potentially therapeutic properties. Processing methodologies to achieve optimal cell-based abiotic materials and approaches for their effective characterization are described and discussed. The application of these materials in healthcare, with most focus on regenerative approaches and including examples of commercially available products, is also addressed.

Prediction of BRAF and TERT status in PTCs by machine learning-based ultrasound radiomics methods: A multicenter study

Background

Preoperative identification of genetic mutations is conducive to individualized treatment and management of papillary thyroid carcinoma (PTC) patients. Purpose: To investigate the predictive value of the machine learning (ML)-based ultrasound (US) radiomics approaches for BRAF V600E and TERT promoter status (individually and coexistence) in PTC.

Methods

This multicenter study retrospectively collected data of 1076 PTC patients underwent genetic testing detection for BRAF V600E and TERT promoter between March 2016 and December 2021. Radiomics features were extracted from routine grayscale ultrasound images, and gene status-related features were selected. Then these features were included to nine different ML models to predicting different mutations, and optimal models plus statistically significant clinical information were also conducted. The models underwent training and testing, and comparisons were performed.

Results

The Decision Tree-based US radiomics approach had superior prediction performance for the BRAF V600E mutation compared to the other eight ML models, with an area under the curve (AUC) of 0.767 versus 0.547-0.675 (p < 0.05). The US radiomics methodology employing Logistic Regression exhibited the highest accuracy in predicting TERT promoter mutations (AUC, 0.802 vs. 0.525-0.701, p < 0.001) and coexisting BRAF V600E and TERT promoter mutations (0.805 vs. 0.678-0.743, p < 0.001) within the test set. The incorporation of clinical factors enhanced predictive performances to 0.810 for BRAF V600E mutant, 0.897 for TERT promoter mutations, and 0.900 for dual mutations in PTCs.

Conclusion

The machine learning-based US radiomics methods, integrated with clinical characteristics, demonstrated effectiveness in predicting the BRAF V600E and TERT promoter mutations in PTCs.

Using ICG to Streamline Perforator Selection in DIEP Flap Reconstruction: Retrospective cohort study of outcomes in our first one hundred flaps

The use of indocyanine green in conjunction with near infra-red fluoroscopy as an adjunct to the clinical assessment of tissue perfusion is now well established.1-3 Its intraoperative use in breast reconstruction with deep inferior epigastric (DIEP) flaps has been described since 2009.4-6 Fat necrosis is commonly encountered in the recovery period. This study reports on our step-by-step practical technique of using indocyanine green (ICG) to streamline perforator choice intraoperatively during DIEP flap raising for breast reconstruction and our rates of fat necrosis (8%) and flap survival (100%) within the first 100 flaps in our regional reconstruction unit. We discuss the benefits and pitfalls of using ICG fluoroscopy at various stages of breast reconstruction with free DIEP flaps. This study has been reported using the STROBE guidelines.

Prolactin as a novel biomarker in malignancy

Apart from lactation, prolactin is engaged in a wide range of physiological activities and mostly generated by lactotroph cells in the anterior pituitary. Among these actions are metabolic, immunological, and reproductive ones. Prolactin acts through the binding of the hormone to its receptor, PRLR. Among organs in which this receptor is found include the liver, adipose tissue, immunological cells, and the central nervous system. Because of its control of glucose and lipid metabolism, adipogenesis, and leptin production, prolactin is a fundamental component in the control of metabolism. It is responsible for maintaining energy homeostasis during critical physiological states such as increasing immune cell diversity and proliferation. However, elevated levels of prolactin have been linked to exacerbated autoimmune diseases. An association has been established between the hormone prolactin and the development and progression of a number of malignancies, including breast, ovarian, prostate, and hepatic cancers. Investigations are now being conducted to determine the diagnostic and therapeutic potential of prolactin. The objective of this review is to investigate the various functions that prolactin serves, as well as the ways in which high or low amounts of the hormone influence certain cancers.

Single-Cell RNA Sequencing Reveals the Immune Landscape of Granulomatous Mastitis

Granulomatous mastitis (GM) is a form of non-lactational breast inflammation that is closely associated with autoimmune processes, however its underlying pathogenesis remains elusive. In this study, we employed single-cell RNA sequencing (scRNA-seq) to conduct a comparative analysis of GM lesion tissues versus normal breast tissues, thereby unveiling the immune profile of GM tissues. Our investigation centered on T and NK cells, macrophages, epithelial cells, and endothelial cells. Notably, we observed a substantial infiltration of immune cells in GM tissues, accompanied by immune disorders, an elevation in Th1 cell counts, enrichment of the toll-like receptor (TLR) pathway, and upregulation of various factors including interferon-γ (IFN-γ), C-C motif chemokine ligand 3 (CCL3), CCL4, chemokine (C-X-C motif) ligand (CXCL) 13, CD69, signal transducer and activator of transcription 1 (STAT1), and heat shock protein family A member 1A (HSPA1A). Furthermore, the macrophage subpopulations in GM tissues exhibited a transition to a pro-inflammatory phenotype, enriched for pathways such as interferon-γ (IFN-γ), IFN-α, interleukin-6/janus kinase/signal transducer and activator of transcription 3 (IL-6/JAK/STAT3), and tumor necrosis factor-α/nuclear factor-κB (TNF-α/NF-κB). Mammary luminal cells demonstrated an impaired estrogenic profile yet displayed upregulation of prolactin downstream signaling pathways, namely the JAK/STAT and mitogen-activated protein kinase (MAPK) pathways. Additionally, vascular endothelial cells were found to recruit immune cells and exhibited a prominent angiogenic profile in GM tissues. Cellular interaction analysis unveiled an intricate network of interactions between mesenchymal and immune cells. This study provides a comprehensive immune landscape of granulomatous mastitis and offers some potential therapeutic targets for the disease.

Early readmission after adrenalectomy for pheochromocytoma. A retrospective study

PURPOSE

Adrenalectomy for pheochromocytoma (PHEO) presents a significant challenge due to the high incidence of early hospital readmission (ER). This study evaluated the incidence and risk factors of ER for PHEO within 30 days of adrenalectomy.

METHODS

A retrospective analysis of 346 patients > 18 years with unilateral PHEO who underwent adrenalectomy between September 2012 and September 2024. The patients were categorised into ER (n = 49) and no ER (n = 297) groups. Logistic regression analyses were performed to predict risk factors for ER.

RESULTS

The most common causes of ER were postoperative maintained hypotension (42.9%), bleeding (6.1%), ileus (24.5%), wound infection (4.1%), hyperkalemia (8.2%), pneumonia (2%), intra-abdominal abscess (2%), acute MI (4.1%), and colonic injury (6.1%). Most postoperative complications were Clavien-Dindo grade II (n = 40, 81.6%). Two perioperative deaths (4%) occurred in the ER group. Logistic regression showed that low body mass index (OR 0.849, 95% CI, 0.748-0.964; p = 0.012), tumor size < 5 cm (OR 0.096, 95% CI, 0.030-0.310; p < 0.001), and low ASA (OR 0.435, 95% CI, 0.249-0.761; p = 0.003) were associated with risk reduction for ER while malignancy (OR 5.302, 95% CI, 1.214-23.164; p = 0.027), open approach(OR 12.247, 95% CI, 5.227-28.694; p < 0.001), and intraoperative complications (OR 19.149, 95% CI, 7.091-51.710; p < 0.001) were associated with risk increase of ER.

CONCLUSION

Postoperatively maintained hypotension and ileus were the most common causes of ER. Low body mass index, tumour size < 5 cm, and low ASA were risk reductions for ER, while malignancy, open approach, and intraoperative complications were the independent risk increase factors.

Clinical effect of using a lower limb warming blanket combined with dexmedetomidine to prevent postoperative delirium and shivering in elderly patients undergoing spinal surgery

OBJECTIVE

To observe the clinical effect of using a lower limb warming blanket combined with dexmedetomidine (DEX) to prevent postoperative delirium (POD) and shivering in elderly patients undergoing spinal surgery.

METHODS

A total of 160 elderly patients undergoing posterior spinal surgery under general anesthesia were selected and divided into a control group (group N), heating group (group T), DEX group (group D) and heating combined with DEX group (group TD), with 40 patients in each group. The intraoperative anesthesia dosage, changes in body temperature and heart rate at different time points (T1-T6) were compared, as well as the occurrence of postoperative shivering and POD in different groups.

RESULTS

During the entire procedure, the anesthesia dosage was lower in groups D and TD than in groups N and T (p < 0.05). The body temperature of groups N and D exhibited a downwards trend, which decreased significantly at T2. At T2-T4, the heart rate of groups D and TD was lower than that of groups N and T (p < 0.05).

CONCLUSION

Using a lower limb heating blanket combined with DEX can effectively reduce the incidence of POD and postoperative shivering in elderly patients undergoing spinal surgery.

Retrospective analysis of robotic versus laparoscopic surgery in the treatment of giant pheochromocytoma and paraganglioma

To compare the safety and effectiveness of robot-assisted laparoscopic surgery and traditional laparoscopic surgery in the treatment of giant pheochromocytomas and paragangliomas (PPGL). A retrospective analysis was conducted using the data of patients who underwent surgery at our institution between January 2013 and November 2023 and whose postoperative pathological examination confirmed PPGL (n = 84). Patients were divided into the robot-assisted (n = 33) and laparoscopic (n = 51) groups. Baseline data and intraoperative and postoperative recovery conditions of the two groups were compared. There was no significant difference in the baseline data between the two groups. The time to resume food intake in the robot-assisted group was shorter than that in the laparoscopic group [2 (1-2) vs. 3 (2-3) days, p < 0.001], and the incidence of postoperative morbidity was also lower (15.2% vs. 43.1%, p = 0.009); however, operating room time was longer [265 (240-370) vs. 245 (205-297.5) min, p = 0.039], and overall hospitalization costs were higher [80336.38 (72,014.3-101,555.39) vs. 60,102.13 (43,059.205-88085.35) CNY, p = 0.003]. This study results indicate that robot-assisted laparoscopic surgery has a lower postoperative complication rate and faster postoperative gastrointestinal function recovery. However, the surgery is costlier and operating room time is longer than with traditional laparoscopic surgery. Robotic surgery can be considered for giant PPGL if the patient's financial condition permits.

A comprehensive overview of ovarian cancer stem cells: correlation with high recurrence rate, underlying mechanisms, and therapeutic opportunities

Ovarian cancer is one of the most lethal gynecological malignancies, with a recurrence rate of 70-80%, particularly in patients diagnosed at advanced stages (stage III or IV), where the five-year survival rate falls below 30%. A key driver of this recurrence is the presence of cancer stem cells (CSCs), which exhibit resistance to chemotherapy and possess the capacity for self-renewal, plasticity, and tumor regeneration. The tumor microenvironment (TME) plays a crucial role in maintaining ovarian cancer stem cells (OCSCs) by providing nutrient and oxygen gradients, extracellular matrix (ECM) interactions, immune cell modulation, and support from cancer-associated fibroblasts (CAFs). CAFs secrete growth factors, cytokines, and ECM components that create a pro-tumorigenic niche, promoting CSC maintenance, invasion, and chemoresistance. Additionally, dysregulation of critical signaling pathways, including WNT, NOTCH, PI3K/AKT/mTOR, TGF-β, JAK/STAT, Hedgehog, NF-κB, and Hippo, supports CSC stemness, plasticity, maintenance, and adaptability, thereby increasing their survival and progression. Numerous inhibitors targeting these pathways have shown promise in preclinical studies. This review discusses the molecular mechanisms underlying CSC-mediated recurrence in ovarian cancer and highlights emerging therapeutic strategies. Particular emphasis is placed on the potential of combination therapies involving routine platinum or taxane based regimens with OCSC inhibitors to overcome chemoresistance, reduce recurrence rates, and improve survival outcomes for patients with advanced-stage ovarian cancer.

Allele frequency in thyroid cancer: mechanisms, challenges, and applications in cancer therapy

Allele Frequency (AF) is the percentage of sequence reads with a specific mutation relative to the read depth at that locus, reflecting the proportion of gene mutation. This review explores the AF characteristics of different mutations in thyroid cancer, investigating their connection with tumor features and clinical characteristics. BRAF mutation AF is associated with tumour malignancy and prognosis, exhibiting a relatively low peak value. TERT mutations in AF are associated with invasive characteristics, and the combination between BRAF and TERT mutations AF improved the diagnostic value in identifying patients' risk of recurrence and tumour malignancy. RET mutation is frequently observed in medullary carcinoma, and RET mutation AF is associated with partial tumour characteristics. RAS mutation is prevalent in follicular tumors, but the association between RAS mutation AF and tumour characteristics is relatively weak. TP53 mutation is more frequently occurred in poorly differentiated and anaplastic carcinoma, and its AF might be associated with the dedifferentiation process. We also concentrated on the mutually exclusive and synergistic effect between different mutations. The mutation rate of TERT increases with the elevation of BRAF mutation AF. Finally, the detection and assessment of AF by NGS in clinical practice helps to provide a reference for individualised targeted therapy plans.

Survival after neoadjuvant and induction FOLFIRINOX versus gemcitabine-nab-paclitaxel in patients with resected localised pancreatic adenocarcinoma: an international multicentre study

BACKGROUND

It remains unclear whether there is a difference in overall survival (OS) benefit between (m)FOLFIRINOX and gemcitabine-nab-paclitaxel as preoperative regimens for localised pancreatic adenocarcinoma. This study aimed to investigate the outcome of patients with resected localised pancreatic adenocarcinoma following (m)FOLFIRINOX versus gemcitabine-nab-paclitaxel.

METHODS

International multicentre retrospective study (16 centres, 8 countries, 3 continents), including consecutive patients after pancreatic resection for localised pancreatic adenocarcinoma following 2-6 months preoperative (m)FOLFIRINOX or gemcitabine-nab-paclitaxel (2010-2018). Primary endpoint was OS from start of preoperative chemotherapy. Cox regression analysis was performed to investigate the association of the preoperative chemotherapy regimen with OS, adjusted for confounders at diagnosis.

RESULTS

Overall, 935 patients were included after resection of localised pancreatic adenocarcinoma following preoperative (m)FOLFIRINOX (65%) or gemcitabine-nab-paclitaxel (35%). Preoperative chemotherapy regimen (m)FOLFIRINOX was not associated with OS (HR = 0.83 [95% CI 0.64-1.08]), compared to gemcitabine-nab-paclitaxel. Interaction analysis showed stronger effect of (m)FOLFIRINOX in patients with a lower (i.e., non-elevated/marginally elevated) serum CA19-9 at diagnosis (pinteraction = 0.032).

CONCLUSION

This international study found no OS benefit of preoperative (m)FOLFIRINOX in patients with resected localised pancreatic adenocarcinoma compared to gemcitabine-nab-paclitaxel.

Hypoparathyroidism After Total Thyroidectomy: A Population-Based Analysis of California Databases

INTRODUCTION

Postthyroidectomy hypoparathyroidism is common and usually managed as an outpatient. A better understanding of patients at risk for an emergency department (ED) visit can improve health-care utilization and patient care.

METHODS

The California Cancer Registry and Health Care Access and Information Databases were linked to identify patients who underwent a thyroidectomy for thyroid cancer 2005-2018 and had an ED visit for hypoparathyroidism within 2 y of surgery. Cumulative incidence and multivariable Cox proportional hazards models were used to identify factors associated with an ED visit.

RESULTS

Among 41,502 thyroidectomy patients, 588 (1.42%) presented to the ED for hypoparathyroidism, with a median time between thyroidectomy and first ED visit of 4 ds. Two-year cumulative incidence was highest for women (1.56%), Hispanic patients (2.04%), younger adults aged 18-40 y (1.97%), higher Charlson comorbidity index score (2.43%), lowest neighborhood socioeconomic status quintile (1.97%), patients with >4 lymph nodes removed (2.04%), and patients not seen at an American College of Surgeons Committee on Cancer site (1.60%). Multivariable analysis revealed several factors associated with an increased risk of hypoparathyroidism, including female gender (hazard ratio [HR] 1.67, 95% confidence interval [CI] = 1.32-2.10), Hispanic ethnicity (HR 1.41, 95% CI = 1.16-1.71), a higher Charlson comorbidity index score (≥2 = HR 1.91 [95% CI = 1.46-2.51]), and patients with >4 lymph nodesremoved (HR 1.70 [95% CI = 1.43-2.01]).

CONCLUSIONS

ED visits for postthyroidectomy hypoparathyroidism are uncommon, but usually occurs shortly after surgery. Most risk factors identified are not modifiable, but they help identify high-risk patients who could benefit from targeted postoperative care (programs) to reduce unplanned ED visits.

Multimodal ultrasound radiomics model combined with clinical model for differentiating follicular thyroid adenoma from carcinoma

OBJECTIVE

This study aimed to develop a nomogram integrating radiomics features derived from contrast-enhanced ultrasound (CEUS) and B-mode ultrasound (B-US) with clinical features to improve preoperative differentiation between follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA). Accurate preoperative diagnosis is critical for guiding appropriate treatment strategies and reducing unnecessary interventions.

METHODS

We retrospectively included 201 patients with histopathologically confirmed FTC (n = 133) or FTA (n = 68). Radiomics features were extracted from B-US and CEUS images, followed by feature selection and machine-learning model development. Five models were evaluated, and the one with the highest area under the curve (AUC) was used to construct a radiomics signature. A Clinical Risk model was developed using statistically significant clinical features, which outperformed the conventional Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in both training and test groups. The radiomics signature and Clinical Risk model were integrated into a nomogram, whose diagnostic performance, calibration and clinical utility were assessed.

RESULTS

The Clinical Risk model achieved superior diagnostic performance compared to the C-TIRADS model, with AUCs of 0.802 vs. 0.719 in the training group and 0.745 vs. 0.703 in the test group. The nomogram further improved diagnostic efficacy, with AUCs of 0.867 (95% CI, 0.800-0.933) in the training group and 0.833 (95% CI, 0.729-0.937) in the test group. It also demonstrated excellent calibration. Decision curve analysis (DCA) also indicated that the nomogram showed good clinical utility.

CONCLUSION

By combining CEUS and B-US radiomics features with clinical data, we developed a robust nomogram for distinguishing FTC from FTA. The model demonstrated superior diagnostic performance compared to existing methods and holds promise for enhancing clinical decision-making in thyroid nodule management.

CLINICAL TRIAL NUMBER

Not applicable.

Mitigating complications rate in parotid gland tumor surgery by reconstruction technique with SurgiMend®: a retrospective, single-center, observational study on 300 consecutive patients

BACKGROUND

Salivary gland tumors have an incidence of 1 out of 100,000 people every year, representing 2-4 % of the head and neck tumors. Consensually, radical surgery is the choice in parotid tumors. Despite improvements in surgical and anatomy-preserving strategies, several complications exist in this surgery. Frey Syndrome is caused by an aberrant regeneration of parasympathetic nerve fibers of the auriculotemporal nerve after parotidectomy.

PURPOSE

The purpose of the present study was to compare the surgical complication rate differences between patients undergone parotid gland tumor surgery with reconstruction performed by traditional methods (Group A), and by SurgiMend (Group B).

STUDY DESIGN, SETTING, AND SAMPLE

The clinical, surgical, and monitoring data of 300 consecutive patients operated at our Institution between 2017 and 2020 were assessed for statistical deductive purposes, shaping a cohort retrospective monocentric observational study.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE/MAIN OUTCOME VARIABLE

The primary outcome variable was the rate of Frey Syndrome. Secondary outcomes were the other complication rates, including surgical site infections, dehiscence, hypertrophic scars, seromas, hematomas, and temporary and permanent facial nerve palsy.

ANALYSES

To conduct the statistical study, we used descriptive and deductive analyses. We employed the Fisher's Exact test for both analyses. All statistical tests were "two-tailed", and significance was set to an α-error <0.05. Statistical differences between groups A and B on the categorical postoperative complications were investigated for deductive purposes.

RESULTS

This study demonstrated the SurgiMend reconstruction to be significantly associated with a lower rate of Frey Syndrome and hypertrophic scar for parotid gland tumor surgery.

CONCLUSION

and relevance: Our study, through sustained and homogeneous follow-up on patients with benign tumors of the parotid gland, associated with a large, representative, and homogeneous sample, allows us to assert the genuineness and reliability of the minor Frey Syndrome and hypertrophic scars rates for benign parotid tumor surgery.

Impact of en bloc extended R0 resections on oncological outcome of locally advanced adrenocortical carcinoma

In locally advanced adrenocortical carcinoma (ACC) (ENSAT stage III - S-III) R0 surgery, involving en bloc extended resections, is the only potential curative treatment. We evaluated oncological outcomes and complications rate in S-III patients who underwent extended resection in comparison with stage I/II (S-I/II). Among 1098 adrenalectomies over 27 years (1997 -2024) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV and not-multivisceral resections in S-III patients. Forty-eight patients met the inclusion criteria: 6 S-I (12.5%), 36 S-II (75%) and 6 S-III (12.5%) patients. The latter patients' cohort underwent multivisceral en bloc resections (3 total nephrectomies, one renal vein thrombectomy, one splenopancreasectomy associated with total nephrectomy, left hemicolectomy and omentectomy, one liver S6-S7-S8 resection). Open adrenalectomy was scheduled in all S-III patients. Minimally-invasive approach was scheduled in 21 (50%) S-I/II patients. Conversion to open adrenalectomy was registered in 5 out these 21 patients. Locoregional and distant disease recurrences were registered in 19% of S-I/II vs 33.3% of S-III patients and 28.6% of S-I/II vs 66.7% of S-III patients, respectively (p = 0.420, p = 0.064). Postoperative complications were observed in 21.4% of S-I/II patients and 16.7% of S-III patients (p = 0.788). Kaplan-Meier DFS and OS curves were comparable among the two groups (p = 0.255, p = 0.459, respectively). After univariable analysis, hyperfunction and chemotherapy were significantly associated with locoregional disease recurrence (p = 0.02, p = 0.04, respectively). OS and DFS of S-III ACC patients undergoing extended en bloc R0 resections were comparable to those of S-I/II patients, without increased postoperative morbidity.

Unraveling the clinical impact of differential DNA methylation in PDAC: A systematic review

INTRODUCTION

Despite significant efforts to improve clinical outcomes, pancreatic ductal adenocarcinoma (PDAC) has a high mortality rate. The poor prognosis associated with this disease is multifactorial and associated with a highly variable genetic profile associated with its pathogenesis. Epigenetic modifications including DNA methylation further affect the expression of genetic material. However, there is no comprehensive understanding of the clinical impact of DNA methylation in PDAC.

METHODS

A systematic literature review was registered on the International Prospective Register of Systematic Reviews database (CRD42023451955) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic search was conducted using the following databases: CINAHL Plus, Cochrane Library, Embase, Web of Science, Ovid Medline, and Google Scholar. Inclusion criteria included studies of patients with a PDAC diagnosis and information regarding genes or CpG sites that potentially affect diagnosis, prognosis, or survival of PDAC.

RESULTS

The initial search retrieved 2402 articles, and 423 duplicates were excluded. After exclusion criteria was applied, 19 studies were included. The most common genes recorded as affecting tumor pathogenesis were SFRP1 (n = 3/19, 15.7 %) and NPTX2 (n = 2/19, 10,5 %). Studies indicated that hypermethylation of SFRP1 and NPTX2 were associated with poor prognosis.

CONCLUSIONS

PDAC is associated with a range of epigenetic modifications. Methylation of specific genes related to PDAC may influence survival and prognosis and be a therapeutic target. Individual patient epigenetic analysis may be a future direction in directing PDAC treatment and prognosis.

Robotic Approach to Surgery for Pheochromocytoma in Children: A Case Series

Pheochromocytoma is a rare disease in children with incidence of reported as 1 in 10 million children. There are few reported series with clinical follow-up published in literature from the Indian subcontinent; none has reported minimally invasive operation for pheochromocytoma and long-term outcome. These children present with symptoms secondary to increased catecholamine secretion from the adrenal pheochromocytes, of which hypertension is the most common and can be life threatening. Although hypertension in children is almost always secondary to a hidden disease, children with pheochromocytoma may be treated for a while before diagnosis is established. Surgical excision of the tumor is the treatment. Preoperative assessment can be challenging as 10% of the cases may be syndromic with bilateral tumors and associated with multiple endocrine neoplasia. The preoperative stabilization of the child with alpha antagonists, fluid replacement, and beta-blockers are the mainstay of preoperative preparation. Intraoperative disasters are well known in the absence of adequate preparation. Conventional procedure has been the standard surgical approach. Minimally invasive surgery (MIS) in children for pheochromocytoma is evolving. We report a series of five children treated over 5 years by the minimally invasive approach with follow-up details for this period. This study confirms the efficacy of MIS approach in treatment of pheochromocytoma and its ability to produce reliable results in the long term.

Adrenal Surgery: Open, Laparoscopic, and Robotic Approaches

Adrenal surgery is an established, critical tool in the management of various adrenal gland pathologies. Complete or partial adrenalectomy is employed to manage both benign lesions and malignant tumors. Beyond a technical understanding of surgical and anatomic principles, an understanding of adrenal endocrine function is essential for all surgeons who care for patients with adrenal pathologies. In this article, we provide an overview of adrenal surgery, discussing key anatomic and functional considerations, various surgical approaches, perioperative management strategies, and potential complications.

PERSPECTIVE: Challenging preoperative α-blockade in phaeochromocytoma surgery: beyond tradition, towards 'safer surgery'

The rarity of phaeochromocytomas has left a gap in evidence supporting guideline recommendations for preoperative α-blockade dose-escalation. Despite recent studies questioning its efficacy, randomized-controlled trials (RCTs) are warranted before considering omitting preoperative α-blockade dose-escalation. Through an online survey, opinions on the ideal study design for this future RCT were gathered from specialists involved in phaeochromocytoma management in the Netherlands. Responses from 23 physicians suggest a non-inferiority-designed RCT that only excludes patients with severe comorbidities and incorporates clinical outcome measures as most suitable design. The survey furthermore revealed diverse opinions regarding study design and perioperative threats, emphasizing the importance of an inclusive, multidisciplinary approach in future research.

A New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps

BACKGROUND

 Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps.

METHODS

 A retrospective medical record study involving all patients who underwent bilateral or bipedicled robotic DIEP (rDIEP) or standard DIEP (sDIEP) flap harvest between July 2021 and September 2022. Outcomes included abdominal wall morbidity, total operative time, length of stay (LOS), and complications.

RESULTS

 Forty-seven patients were included (48 sDIEP flaps, 46 rDIEP flaps) with no significant difference in patient characteristics. Fascial incision length in the rDIEP group was shorter (4.1 vs. 11.7 cm, p < 0.001). Mesh reinforcement of the abdominal wall was used in 13/24 sDIEP and none in rDIEP patients (p < 0.001). Operative time was longer in the rDIEP cohort (739 vs. 630 minutes, p = 0.013), although subanalysis showed no difference in the second half of the cohort. The average robotic dissection time was 135 minutes, which decreased significantly with the surgeon's experience. There were no intraoperative complications from using the robot. LOS was shorter with rDIEP but not statistically significant (3.9 vs. 4.3 days, p = 0.157).

CONCLUSION

 This study represents the most extensive cohort analysis of bilateral rDIEP flap harvest, offering a comprehensive comparison to traditional sDIEP. The initial results underscore the viability of robotic techniques for flap harvesting, highlighting potential advantages including reduced fascial incision length and decreased abdominal disruption. Furthermore, using robotics may obviate the necessity for fascial reinforcement with mesh.

Navigating skeletal wellness after breast cancer

Breast cancer is the leading cause of death in the female population. Hormone receptor-positive cancers are usually treated with surgery in combination with endocrine therapy. The latter is known to lower estrogen levels, contributing, therefore, to loss of bone density (BMD) and higher risk of fracture. Bone-modifying agents (BMAs) can regulate the bone-related adverse effects of cancer treatment. In premenopausal women, intravenous zoledronate effectively prevents bone loss. However, the evidence regarding its ability to reduce disease recurrence remains inconclusive. In postmenopausal women, denosumab demonstrates the most substantial evidence for fracture prevention, supported by one well-powered randomized controlled trial, but has not been shown to confer anticancer benefits. While bisphosphonates effectively prevent and reduce clinical vertebra fractures, their impact on overall fracture risk is unclear. In clinical practice, management of bone health in this group of patients starts with stratification for the risk of fracture. This can be done using the FRAX algorithm; measurements of bone mineral density can help to optimize stratification for individuals at higher fracture risk. Caution is advised when interpreting the results, as the FRAX algorithm has been considered to underestimate the true fracture risk in this population, given that the algorithm has not been adjusted for the effect of anti-cancer agents. Nowadays, clodronate, ibandronate, and zoledronic acid are recommended for bone protection in this group of patients, while denosumab is not. Further research is required to highlight the optimal BMA according to patient characteristics.

Primary Hypercortisolism

Primary hypercortisolism, commonly known as Cushing's syndrome, is an endocrine disorder characterized by excessive cortisol production by the adrenal glands, independent of adrenocorticotropic hormone stimulation. This disorder presents with a wide range of clinical manifestations, including metabolic, cardiovascular, and psychological disturbances, making its diagnosis and management complex. This document aims to provide a detailed review of primary hypercortisolism, including its pathophysiology, clinical presentation, diagnostic approaches, and treatment modalities. Special attention is given to the molecular mechanisms underlying cortisol overproduction, differential diagnosis from other forms of Cushing's syndrome, and the challenges posed by this condition in clinical practice.