Evaluating the effectiveness of prophylactic central neck dissection with total thyroidectomy for cN0 papillary thyroid carcinoma: An updated meta-analysis.

BACKGROUND: The effectiveness of prophylactic central neck dissection (pCND) following total thyroidectomy (TT) in patients with clinical node-negative (cN0) papillary thyroid carcinoma (PTC) is still controversial. The aim of this meta-analysis is to evaluate the outcome of pCND and to provide quantitative evidence. METHOD: A detailed literature search of PubMed, EMBASE, ClinicalTrails.gov and Cochrane Library electronic databases for articles published up to October 2016 was carried out. This meta-analysis was performed by the random method (Mantel-Haenszel) model. Locoregional recurrence (LRR) and surgical complications were analyzed. RESULTS: Twenty-two studies comparing pCND + TT (combined) and TT alone in cN0 PTC patients were analyzed. A total of 6930 cases were enrolled, including 2381 cases in the combined group and 4009 cases in the TT-alone group. Compared with TT alone, patients in the combined group showed a significantly lower rate of overall LRR (OR = 0.66, 95% CI = 0.48-0.89) and central compartment recurrence (OR = 0.40, 95% CI = 0.22-0.73). There was no statistical difference in the rate of lateral compartment recurrence. However, the combined group showed a significantly higher rate of temporary and permanent hypoparathyroidism (OR = 2.28, 95% CI = 1.92-2.27/OR = 1.84, 95% CI = 1.15-2.95) and temporary recurrent laryngeal nerve injury (LNR) (OR = 1.53, 95% CI = 1.08-2.16). There was no statistical difference in the rate of permanent LNR, hematoma, hemorrhage or wound infection. CONCLUSIONS: This meta-analysis revealed that pCND with TT was a significantly efficient way to reduce the risk of LRR. However, pCND + TT increased the incidence rate of temporary and permanent hypoparathyroidism and temporary LNR.

[Dynamic observation on ultrasonographic image during chemotherapy of hepatic cystic echinococcosis and a proposal for ultrasonic classification].

OBJECTIVE: To submit a proposal for the classification of ultrasonographic image in patients with hepatic cystic echinococcosis, on the basis of characteristic and distribution of ultrasonic image of hydatid cysts in cases and systematic observation on dynamic changes of sonographic image under treatment with emulsion albendazole and in relation to clinical efficacy. METHODS: The ultrasonic image of 645 cysts in 497 cases with liver cystic echinococcosis was classified. The distribution of different types of image in patients was analyzed. A comparative analysis of correspondence between the sonographic type and clinical efficacy was made in association with the rule of changes in ultrasonic features during chemotherapy. RESULTS: The ultrasonographic image of hydatid cysts was divided into six types. The distribution of ultrasonic types in patients reflected the process of natural evolution of cysts in human bodies. The dynamic change of ultrasonic image during treatment was identical with the natural evolution process of hydatid cysts. CONCLUSION: The proposal for ultrasonographic classification submitted reflects a long evolutionary process from growth to death of hydatid cysts in human body. The dynamic change of hydatid cysts during chemotherapy indicated that the effect of drug has accelerated this process. Therefore this classification may be applied in diagnosis and to judge the chemotherapeutic efficacy of cystic echinococcosis.

[Premature ovarian failure treated with acupoint catgut implantation and artificial periodic therapy: a randomized controlled trial].

OBJECTIVE: To compare the difference in the clinical efficacy on premature ovarian failure (POF) between the acupoint catgut implantation combined with artifical periodic therapy and the simple artificial periodic therapy and explore its effect mechanism. METHODS: Sixty-five patients of POF were randomized into the two groups. In a western medication group, 32 cases were treated with the artificial periodic therapy with the oral administration of medroxyprogesterone acetate tablets. In a catgut implantation + western medication group, 33 cases were treated with the acupoint catgut implantation combined with artificial periodic therapy. The acupoints of Neiguan (PC 6), Zusanli (ST 36), Guanyuan (CV 4) and Sanyinjiao (SP 6) were selected. The treatment was lasted for half a year and the follow-up visit was for another half a year in the two groups. Kupperman index was used to assess the improvements in the clinical symptoms. The levels of serum sexual hormones such as follicle stimulating hormone (FSH) and estradiol (E2) were evaluated of the patients in the two groups before and after treatment. The efficacy was compared between the two groups. RESULTS: The scores of the clinical symptoms were all significantly improved after treatment and in the follow-up in the two groups (P < 0.01, P < 0.05). In the 6-month follow-up visit after treatment, the result in the catgut implantation + western medication group was better than that in the western medication group (8.17 +/- 1.19 vs 13.68 +/- 1.08, P < 0.01). FSH was reduced after treatment in the two groups (all P < 0.01) and E2 was increased (all P < 0.05). The curative and remarkably effective rates were 75.8% (25/33) and 81.8% (27/22) after treatment and in the follow-up visit in the catgut implantation + western medication group, which were better than 67.9% (19/28) and 53.6% (15/28) in the western medication group separately (P < 0.05, P < 0.01). CONCLUSION: The acupoint catgut implantation combined with artificial periodic therapy achieve the remarkable improvements in the clinical symptoms of POF in the patients and the better results as compared with the simple western medication therapy. The combined therapys efficacy is stable and the long-term efficacy is apparently superior. The effect mechanism is related to the improvements in the serum sexual hormone levels.