RESUMEN
Background Microwave ablation (MWA) is currently under preliminary investigation for the treatment of multifocal papillary thyroid carcinoma (PTC) and has shown promising treatment efficacy. Compared with surgical resection (SR), MWA is minimally invasive and could preserve thyroid function. However, a comparative analysis between MWA and SR is warranted to draw definitive conclusions. Purpose To compare MWA and SR for preoperative US-detected T1N0M0 multifocal PTC in terms of overall and 1-, 3-, and 5-year progression-free survival rates and complication rates. Materials and Methods In this retrospective study, 775 patients with preoperative US-detected T1N0M0 multifocal PTC treated with MWA or SR across 10 centers between May 2015 and December 2021 were included. Propensity score matching (PSM) was performed for patients in the MWA and SR groups, followed by comparisons between the two groups. The primary outcomes were overall and 1-, 3-, and 5-year progression-free survival (PFS) rates and complication rates. Results After PSM, 229 patients (median age, 44 years [IQR 36.5-50.5 years]; 179 female) in the MWA group and 453 patients (median age, 45 years [IQR 37-53 years]; 367 female) in the SR group were observed for a median of 20 months (range, 12-74 months) and 26 months (range, 12-64 months), respectively. MWA resulted in less blood loss, shorter incision length, and shorter procedure and hospitalization durations (all P < .001). There was no evidence of differences in overall and 1-, 3-, or 5-year PFS rates (all P > .05) between MWA and SR (5-year rate, 77.2% vs 83.1%; P = .36) groups. Permanent hoarseness (2.2%, P = .05) and hypoparathyroidism (4.0%, P = .005) were encountered only in the SR group. Conclusion There was no evidence of a significant difference in PFS rates between MWA and SR for US-detected multifocal T1N0M0 PTC, and MWA resulted in fewer complications. Therefore, MWA is a feasible option for selected patients with multifocal T1N0M0 PTC. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.
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Microondas , Neoplasias de la Tiroides , Humanos , Femenino , Adulto , Persona de Mediana Edad , Microondas/uso terapéutico , Estudios Retrospectivos , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/cirugía , Hospitalización , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugíaRESUMEN
Cardiac fibrosis is a common pathological manifestation in multiple cardiovascular diseases and often results in myocardial stiffness and cardiac dysfunctions. LncRNA (long noncoding RNA) participates in a number of pathophysiological processes. However, its role in cardiac fibrosis remains unclear. The purpose of this study was to investigate the role and molecular mechanism of MetBil in regulating cardiac fibrosis. Our data showed that METTL3 binding lncRNA (MetBil) was significantly increased both in fibrotic tissue following myocardial infarction (MI) in mice and in cardiac fibroblasts (CFs) exposed to TGF-ß1 (20 ng/mL) or 20% FBS. Overexpression of MetBil augmented collagen deposition, CF proliferation and activation while silencing MetBil exhibited the opposite effects. Importantly, heterozygous knockout of MetBil alleviated cardiac fibrosis and improved cardiac function after MI. RNA pull-down and RNA-binding protein immunoprecipitation assay showed that METTL3 is a direct downstream target of MetBil; consistently, MetBil and METTL3 were co-localized in both the nucleus and cytoplasm of CFs. Interestingly, MetBil regulated METTL3 expression at protein level, but not mRNA level, in ubiquitin-proteasome pathway. Enforced expression of METTL3 canceled the antifibrotic effects of silencing MetBil reflected by increased collagen production, CF proliferation and activation. Most notably, the m6A-modified fibrosis-regulated genes mediated by METTL3 are profoundly involved in the regulation of MetBil in the cardiac fibrosis following MI. Our study reveals that MetBil as a novel regulator of fibrosis promotes cardiac fibrosis via interacting with METTL3 and regulating the expression of the methylated fibrosis-associated genes, providing a new intervening target for fibrosis-associated cardiac diseases.
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Cardiopatías , Infarto del Miocardio , ARN Largo no Codificante , Ratones , Animales , ARN Largo no Codificante/genética , Infarto del Miocardio/metabolismo , Fibrosis , Metiltransferasas/genética , Metiltransferasas/metabolismo , Colágeno/genética , Colágeno/metabolismoRESUMEN
BACKGROUND: Ku70 participates in several pathological processes through mediating repair of DNA double-strand breaks. Our previous study has identified a highly conserved long noncoding RNA cardiac ischemia reperfusion associated Ku70 interacting lncRNA (CIRKIL) that was upregulated in myocardial infarction. The study aims to investigate whether CIRKIL regulates myocardial ischemia/reperfusion (I/R) through binding to Ku70. METHODS: CIRKIL transgenic and knockout mice were subjected to 45-minute ischemia and 24-hour reperfusion to establish myocardial I/R model. RNA pull-down and RNA immunoprecipitation assay were used to detect the interaction between CIRKIL and Ku70. RESULTS: The expression of CIRKIL was increased in I/R myocardium and H2O2-treated cardiomyocytes. Overexpression of CIRKIL increased the expression of γH2A.X, a specific marker of DNA double-strand breaks and aggravated cardiomyocyte apoptosis, whereas knockdown of CIRKIL produced the opposite changes. Transgenic overexpression of CIRKIL aggravated cardiac dysfunction, enlarged infarct area, and worsened cardiomyocyte damage in I/R mice. Knockout of CIRKIL alleviated myocardial I/R injury. Mechanistically, CIRKIL directly bound to Ku70 to subsequently decrease nuclear translocation of Ku70 and impair DNA double-strand breaks repair. Concurrent overexpression of Ku70 mitigated CIRKIL overexpression-induced myocardial I/R injury. Furthermore, knockdown of human CIRKIL significantly suppressed cell damage induced by H2O2 in adult human ventricular cardiomyocytes and human induced pluripotent stem cell-derived cardiomyocytes. CONCLUSIONS: CIRKIL is a detrimental factor in I/R injury acting via regulating nuclear translocation of Ku70 and DNA double-strand breaks repair. Thus, CIRKIL might be considered as a novel molecular target for the treatment of cardiac conditions associated with I/R injury.
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Enfermedad de la Arteria Coronaria , Células Madre Pluripotentes Inducidas , Infarto del Miocardio , Isquemia Miocárdica , Daño por Reperfusión Miocárdica , ARN Largo no Codificante , Animales , Apoptosis , Enfermedad de la Arteria Coronaria/metabolismo , ADN/metabolismo , Humanos , Peróxido de Hidrógeno/toxicidad , Células Madre Pluripotentes Inducidas/metabolismo , Ratones , Ratones Noqueados , Infarto del Miocardio/metabolismo , Isquemia Miocárdica/metabolismo , Daño por Reperfusión Miocárdica/metabolismo , Miocitos Cardíacos/metabolismo , ARN Largo no Codificante/genética , ARN Largo no Codificante/metabolismo , ReperfusiónRESUMEN
OBJECTIVE: To evaluate the complications associated with microwave ablation (MWA) in treating persistent/recurrent hyperparathyroidism (HPT) post-surgical or ablative treatments. MATERIALS AND METHODS: From January 2015 to December 2022, 87 persistent/recurrent HPT patients (primary HPT [PHPT]: secondary HPT [SHPT] = 13:74) who underwent MWA after surgical or ablative treatment were studied. Grouping was based on ablation order (initial vs. re-MWA), prior treatment (parathyroidectomy [PTX] vs. MWA), and etiology (PHPT vs. SHPT). The study focused on documenting and comparing treatment complications and analyzing major complication risk factors. RESULT: Among the 87 patients, the overall complication rate was 17.6% (15/87), with major complications at 13.8% (12/87) and minor complications at 3.4% (3/87). Major complications included recurrent laryngeal nerve (RLN) palsy (12.6%) and Horner syndrome (1.1%), while minor complications were limited to hematoma (3.4%). Severe hypocalcemia noted in 21.6% of SHPT patients. No significant differences in major complication rates were observed between initial and re-MWA groups (10.7% vs. 13.8%, p = 0.455), PTX and MWA groups (12.5% vs. 15.4%, p = 0.770), or PHPT and SHPT groups (15.4% vs. 13.5%, p > 0.999). Risk factors for RLN palsy included ablation of superior and large parathyroid glands (>1.7 cm). All patients recovered spontaneously except for one with permanent RLN palsy in the PTX group (2.1%). CONCLUSION: Complication rates for MWA post-surgical or ablative treatments were comparable to initial MWA rates. Most complications were transient, indicating MWA as a viable and safe treatment option for persistent/recurrent HPT patients.
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Técnicas de Ablación , Hiperparatiroidismo Secundario , Ablación por Radiofrecuencia , Humanos , Microondas/efectos adversos , Técnicas de Ablación/efectos adversos , Ablación por Radiofrecuencia/efectos adversos , Hiperparatiroidismo Secundario/cirugía , Parálisis/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Notwithstanding a plethora of observational studies, the causal implications of obesity, encompassing both body mass index (BMI) and waist circumference (WC), as well as type 2 diabetes (T2D), and lifestyle factors, in relation to the vulnerability to low back pain (LBP), remain enigmatic. AIMS: This study was designed to investigate the related causal associations DESIGN: A two-sample Mendelian randomization (MR) analysis. SETTINGS: By utilizing genetic variants associated with pertinent factors gleaned from genome-wide association studies (GWASs), We extracted independent genetic variants about exposures such as BMI, WC, T2D, smoking, alcohol consumption, and coffee intake from published GWASs, ensuring their genome-wide significance. PARTICIPANTS/SUBJECTS: The GWASs were selected from the most up-to-date and largest publicly accessible databases. METHODS: The summary data concerning LBP emanated from a GWAS of European cases and controls, which was based on the esteemed MRC-IEU (Medical Research Council Integrative Epidemiology Unit) consortium. RESULTS: Heightened body mass index and waist circumference exhibited odds ratios of 1.003 (95% confidence interval [CI] = 1.002-1.004, p < 0.001) and 1.003 (95% CI = 1.002-1.004, p < 0.001) for LBP, respectively, per each standard deviation (SD) increase. As for smoking initiation and every SD increase in the frequency of alcohol intake, the odds ratios were 1.002 (95% CI = 1.001-1.003, p = 0.003) and 1.002 (95% CI = 1.000-1.003, p = 0.011), respectively, for LBP. Conversely, an increased log odds ratio for T2D, and prevalence of coffee intake, divulged no discernible causal effects on the risk of LBP. CONCLUSION: This study provides suggestive evidence to support the causal involvement of obesity, smoking, and the frequency of alcohol intake in the development of LBP, which suggests that implementing measures to mitigate these risk factors may aid in preventing LBP.
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Índice de Masa Corporal , Estudio de Asociación del Genoma Completo , Estilo de Vida , Dolor de la Región Lumbar , Humanos , Factores de Riesgo , Estudio de Asociación del Genoma Completo/métodos , Diabetes Mellitus Tipo 2/epidemiología , Análisis de la Aleatorización Mendeliana/métodos , Obesidad/complicaciones , Obesidad/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for T1N0M0 multifocal (≤ 3) papillary thyroid carcinoma (PTC). METHODS: This was a retrospective study, and patients who underwent MWA for multifocal (≤ 3) PTC were reviewed between October 2016 and December 2020. After ablation, the changes in tumor size and volume, as well as the rate of technical success, tumor disappearance, disease progression, and complications were assessed. RESULTS: There were a total of 57 cases enrolled in the present study, which included 18 males and 39 females. The mean age was 44 ± 11 years (22-66 years); the mean follow-up time was 18 ± 11 months (6-48 months). Complete ablation was achieved in all enrolled cases. Therefore, the technical success rate was 100%. Due to expanding ablation, the MD and volume of the ablation zone, as well as the VRR, increased at the 1st and 3rd months after ablation and decreased at 12 and 18 months after ablation (p < 0.05 for all). The total complete tumor disappearance rate was 43.9% (25/57), including 54% (24/44) in the T1a subgroup vs. 7.7% (1/13) in the T1b subgroup (p = 0.003). The total disease progression rate was 7% (4/57), including 9.1% (4/44) in the T1a subgroup vs. 0% (0/13) in the T1b subgroup (p = 0.142). The overall complication rate was 5.3% (3/57), including 6.8% (4/44) in the T1a subgroup vs. 0% (0/13) in the T1b subgroup (p = 0.206). CONCLUSION: This preliminary study indicates that MWA is a safe and effective treatment for T1N0M0 multifocal (≤ 3) PTC. KEY POINTS: ⢠MWA is a promising alternative method for T1N0M0 multifocal (≤ 3) PTC.
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Ablación por Catéter , Neoplasias de la Tiroides , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Cáncer Papilar Tiroideo/cirugía , Estudios Retrospectivos , Microondas/uso terapéutico , Resultado del Tratamiento , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Progresión de la Enfermedad , Ablación por Catéter/métodosRESUMEN
OBJECTIVES: Microwave ablation (MWA) has been widely used for unifocal papillary thyroid carcinoma (U-PTC) and has recently been preliminarily used in multifocal papillary thyroid carcinoma (M-PTC). However, the efficacy and safety of MWA for M-PTC have not been investigated in large samples. The aim of the present study was to evaluate the efficacy and safety of MWA for M-PTC and compare them with MWA for U-PTC. MATERIALS AND METHODS: This retrospective multicentre study enrolled 504 patients (376 females) who underwent MWA for U-PTC (340 cases) or M-PTC (164 cases) from Jan 2015 to Dec 2020. The median age of the patients was 43 years (age range, 20-80 years). Propensity score matching (PSM) was used to balance the baseline characteristics between M-PTC group and U-PTC group. The tumour progression, tumour disappearance, and complication rates were compared between the two groups. RESULTS: The complete ablation was achieved in all enrolled cases in one session. According to the statistical results, no significant differences were shown in tumour progression-free survival (p = 0.29) or cumulative tumour progression rate (6.7% vs. 4.3%, p = 0.33) between the M-PTC and U-PTC groups during the follow-up time. However, the tumour disappearance rate in the M-PTC group was lower in the U-PTC group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the M-PTC group (p < 0.001). The complication rate showed no significant difference (3.0% vs. 4.9%, p = 0.571). CONCLUSIONS: MWA is an effective and safe treatment for selected patients with M-PTC, and the prognosis is similar to that of U-PTC. CLINICAL RELEVANCE STATEMENT: The present study provided evidence that compared with unifocal papillary thyroid cancer, microwave ablation could also treat multifocal T1N0M0 papillary thyroid cancer safely with similar clinical outcome, which could promote the application of minimally invasive treatment for papillary thyroid cancer. KEY RESULTS: ⢠Microwave ablation for multifocal and unifocal T1N0M0 papillary thyroid carcinoma had similar tumour progression rates after propensity score matching (6.7% vs. 4.3%, p = 0.33). ⢠The tumour disappearance rate in the multifocal group was lower than that in the unifocal group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the multifocal group (p < 0.001). ⢠Tumour size, number, and location were not risk factors for tumour progression in the multifocal papillary thyroid cancer group.
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Carcinoma Papilar , Neoplasias de la Tiroides , Femenino , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Estudios Retrospectivos , Resultado del Tratamiento , Microondas/uso terapéutico , Carcinoma Papilar/cirugía , Carcinoma Papilar/patologíaRESUMEN
PURPOSE: To study the feasibility, safety, and effectiveness of microwave ablation (MWA) in patients with multifocal papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS: This retrospective study included patients who underwent MWA for multifocal PTMC (number of nodules ≤3). A total of 44 patients were included, and the mean age was 43 years (SD ± 11). After ablation, progression-free survival (PFS) at 6, 12, 24, 36, and 48 months; disease progression; change in tumor size and volume; tumor disappearance rate; and adverse events (AEs) were assessed, and the feasibility, safety, and effectiveness of MWA for PTMC were evaluated on the basis of statistical analysis. RESULTS: The median follow-up period was 18 months (interquartile range, 12-33 months). The PFS rates at 6, 12, 24, 36, and 48 months were 100.0%, 96.4%, 96.4%, 70.3%, and 52.7%, respectively. The disease progression rate was 11.4% (5 of 44 patients). The maximum diameter (MD) and volume of the ablation zone were larger at the 3-month follow-up than before ablation (median MD, 13.0 vs 7.0 mm; P < .001; median volume, 503.8 vs 113.0 mm3; P < .001). Subsequently, the tumors exhibited a reduction in both size and volume after 18 months (median MD, 4.0 vs 7.0 mm; P = .04; median volume, 12.6 vs 113.0 mm3; P = .055). At the end of the follow-up period, the complete response rate was 59% (26 of 44 patients). The overall AE rate was 6.8%. CONCLUSIONS: MWA is a feasible treatment for PTMC (number of nodules ≤3), and this study preliminarily demonstrated the safety and effectiveness of this technique.
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Microondas , Neoplasias de la Tiroides , Humanos , Adulto , Estudios Retrospectivos , Microondas/efectos adversos , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Progresión de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: To study the safety of improved hydrodissection based on the periparathyroidal fascial space during microwave ablation (MWA) for secondary hyperparathyroidism (SHPT). MATERIALS AND METHODS: Data from 337 patients (162 males and 175 females; mean age, 50.8 ± 12.8 [range, 16-84] years) who underwent MWA for SHPT were retrospectively reviewed. Among them, 177 patients underwent traditional hydrodissection (traditional group) and 160 patients underwent improved hydrodissection based on periparathyroidal fascial spaces (improved group). Safety enhancement was analyzed by comparing the complications between the two groups. The characteristics of the hydrodissected fascial spaces, complications, and the follow-up results were recorded. The baseline data, clinical parameters, laboratory indices and characteristics of SHPT lesions were analyzed to assess the risk factors associated with hoarseness. RESULTS: Hydrodissection was successfully performed in all the enrolled patients according to the protocol. Six periparathyroid fascial spaces were hydrodissected, depending on the location of the SHPT lesions. The incidence of hoarseness due to recurrent laryngeal nerve injury, the most common complication of thermal ablation for SHPT lesions, was lower in the improved group than in the traditional group (6.9% vs. 13.0%, p = 0.044). The median hoarseness recovery time in the improved group was shorter than that in the traditional group (2 vs. 6 months, p < 0.001). There was no difference in technical efficiency between the two groups (improved group vs. traditional group: 75.0% vs. 70.6%; p > 0.05). CONCLUSIONS: Compared with traditional hydrodissection, improved hydrodissection based on periparathyroidal fascial spaces could enhance safety during MWA for SHPT.
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Técnicas de Ablación , Hiperparatiroidismo Secundario , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Ablación/métodos , Ronquera/complicaciones , Hiperparatiroidismo Secundario/cirugía , Microondas/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , Adolescente , Adulto Joven , Anciano , Anciano de 80 o más AñosRESUMEN
OBJECTIVES: To study the efficacy and safety of an improved hydrodissection protocol based on the perithyroidal fascial space during microwave ablation for papillary thyroid carcinoma (PTC). METHODS: The data of 341 patients (94 men and 247 women, median age 41 years old, 25%-75% interquartile range 34-53 years old, nodule maximum diameter 0.2-1.9 cm) who underwent microwave ablation for PTC were retrospectively reviewed. Among them, 185 patients underwent traditional hydrodissection and served as a control group, and 156 patients underwent improved hydrodissection based on perithyroidal fascial spaces, constituting the improved group. Improvements in safety were analyzed by comparing complications between the two groups. The characteristics of hydrodissected spaces, complications, and follow-up results were recorded. RESULTS: Hydrodissection was successfully performed in all enrolled patients according to the protocol. The incidence of hoarseness caused by recurrent laryngeal nerve injury, the most common complication in thermal ablation of thyroid nodules, was significantly lower in the improved group than in the control group (1.9% vs. 8.1%, p = 0.021). The median hoarseness recovery time in the improved group was shorter than that in the control group (2 months vs. 3 months, p = 0.032). During follow-up, no local recurrence was encountered in either group. The tumor disappearance rate was not significantly different between the two groups (69.9% vs. 75.7%, p = 0.228). CONCLUSIONS: Improved hydrodissection based on perithyroidal fascial spaces had better protective effects than traditional hydrodissection.
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Microondas , Neoplasias de la Tiroides , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Cáncer Papilar Tiroideo/cirugía , Estudios Retrospectivos , Microondas/uso terapéutico , Ronquera , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the health-related quality of life (HRQoL) of patients with T1N0M0 papillary thyroid carcinoma (PTC) who underwent microwave ablation (MWA) and those who underwent total thyroidectomy (TT). MATERIALS AND METHODS: From February 2018 to February 2022, 180 T1N0M0 PTC patients were enrolled in present study, including 90 in the MWA group and 90 in the TT group, respectively. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL) were completed by patients to evaluate their HRQoL scores. RESULTS: According to the results of the EORTC-QLQ-C30, there was a significant difference in the scores of global health, physical, emotional, etc. between the two groups, which indicated that the quality of life in these items in the MWA group was better than those in the TT group (all p < 0.05). According to the results of the THYCA-QoL, all items had significant differences between the two groups except for headache, which demonstrated the thyroid-specific quality of life was higher in the MWA group than in the TT group (all p < 0.05). CONCLUSION: Ultrasound (US)-guided MWA offers a significant advantage in HRQoL over TT in T1N0M0 PTC patients, which provides an important reference for MWA as an alternative strategy to TT.
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Neoplasias de la Tiroides , Tiroidectomía , Humanos , Calidad de Vida , Cáncer Papilar Tiroideo/cirugía , Microondas/uso terapéutico , Neoplasias de la Tiroides/cirugíaRESUMEN
Objective: To study the current status of non-suicidal self-injury (NSSI) incidents among middle school students in Chengdu during the COVID-19 epidemic and to explore the mechanism of action of depression on the relationship between family environment and NSSI. Methods: Data were obtained from the Chengdu Positive Child Development (CDPD) cohort. In June and July 2020, after primary and secondary schools were reopened after the closure due to the COVID-19 epidemic, on-site questionnaire surveys were conducted with the Deliberate Self-Harm Inventory (DSHI), the Chinese Family Assessment Instrument (C-FAI), and Center for Epidemiologic Studies Depression Scale for Children (CES-DC), thereby obtaining the data of 3595 middle school students. Two-sample t-test and χ 2 test were used to compare the incidence of NSSI among middle school students of different grades and genders, and the Model 58 test of the SPSS PROCESS component was used to analyze the mediating effect of gender-mediated depression. Results: 1) The incidence of NSSI among middle school students in Chengdu during the COVID-19 epidemic was 49.67%. The incidence of NSSI among ninth-graders (80.70%) was significantly higher than those of the eighth graders (33.82%) and seventh graders (32.32%), and the incidence of NSSI among female middle school students (54.75%) was significantly higher than that of male students (44.52%). 2) Family environment ( r=0.34, P<0.001) and depression ( r=0.50, P<0.001) were positively correlated with NSSI. 3) Depression partially mediated the effect of family environment on NSSI, with the mediating effect accounting for 64.64% of the total effect. Compared with that of male students, the positive predictive effect between family environment and depression and that between depression and NSSI in female middle school students were more significant. Conclusion: During the COVID-19 pandemic, middle school students in Chengdu had a high incidence of NSSI, which indicates that the family environment should be improved, more attention should be given to gender differences, and early screening and intervention for depression should be strengthened to reduce the incidence of NSSI.
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COVID-19 , Conducta Autodestructiva , Niño , Humanos , Masculino , Femenino , Depresión/epidemiología , Pandemias , Conducta Autodestructiva/epidemiología , COVID-19/epidemiología , Estudiantes , Factores de RiesgoRESUMEN
Background Microwave ablation (MWA) has attracted interest as a minimally invasive treatment for papillary thyroid carcinoma (PTC). However, comparisons between MWA and surgical resection (SR) in the management of T1N0M0 PTC are rare. Purpose To compare the technical effectiveness, disease progression, and complications of MWA and SR for solitary T1N0M0 PTC. Materials and Methods This retrospective study was conducted in a single center. A total of 1029 patients with T1N0M0 PTC treated with either MWA or SR from January 2015 to May 2021 were studied and divided into two groups according to treatment modality. Propensity score matching and inverse probability of treatment weighting were used to control for confounding factors. Disease progression was analyzed in T1N0M0 PTCs as well as T1a and T1b subgroups by using Kaplan-Meier curves and Cox proportional hazards regression models. Results A total of 404 patients (mean age, 43 years ± 12 [SD]; 289 women; 337 with T1a PTC) underwent MWA, and 625 (mean age, 46 years ± 12; 495 women; 521 with T1a PTC) underwent SR. During the follow-up (median, 25 months; IQR, 7-61 months), there was no evidence of differences regarding disease progression in T1N0M0 (4.0% vs 4.0%; P = .97), T1a (3.4% vs 3.8%; P = .89), or T1b PTCs (6.8% vs 5.0%; P = .72). Compared with SR, MWA resulted in less blood loss (2 mL vs 10 mL) and a shorter procedure time (23 minutes vs 72 minutes) (both P < .001). The rate of major complications was 5.4% (19 of 350 patients) in the MWA group and 6.3% (22 of 350 patients) in the SR group (P = .75). Permanent hoarseness only occurred in the SR group (1.7%; P = .03). Conclusion For T1a and T1b solitary T1N0M0 papillary thyroid carcinomas, there was no evidence of differences regarding disease progression and major complications between microwave ablation and surgical resection. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by vanSonnenberg and Simeone in this issue.
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Ablación por Catéter , Neoplasias de la Tiroides , Adulto , Ablación por Catéter/métodos , Progresión de la Enfermedad , Femenino , Humanos , Microondas/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the clinical outcomes between microwave ablation (MWA) and parathyroidectomy (PTX) for the treatment of primary hyperparathyroidism (pHPT). MATERIALS AND METHODS: This retrospective study enrolled 212 patients with pHPT treated by either MWA (MWA group) or PTX (PTX group) from January 2015 to October 2020. The baseline data were balanced through propensity score matching. Clinical cure was evaluated by the Kaplan-Meier method and compared between the MWA and PTX groups. The risk factors related to persistent or recurrent pHPT were screening out using a Cox proportional hazards regression model. RESULTS: After propensity score matching, a total of 174 patients were enrolled in the present study, with 87 patients in each group. During the follow-up period (median, 28.5 months), there were no differences between the two groups regarding the clinical cure (hazard ratio, 1.71; 95% confidence interval: 0.81-3.62; p = .155), persistent pHPT rate (13.8% vs. 10.3%, p = .643), recurrent pHPT rate (6.9% vs. 3.4%, p = .496), or major complications (6.9% vs. 3.4%, p = .496). MWA resulted in a shorter procedure time (30 min vs. 60 min), smaller incision length (0.1 cm vs. 7 cm) and slightly higher costs (25745 CNY vs. 24111 CNY) (all p < .001). High levels of preoperative intact parathyroid hormone (p = .01) and multiple pHPT nodules (p < .001) were independent risk factors for recurrent and persistent pHPT in the two groups. CONCLUSION: MWA and PTX have comparable clinical outcomes for pHPT. MWA has a shorter procedure time and smaller incision length. KEY POINTS: ⢠There were no differences in terms of clinical cure, persistent pHPT, recurrent pHPT, or major complications between MWA and PTX in the treatment of pHPT. ⢠MWA is minimally invasive and results in a shorter procedure time. ⢠Multiple nodules and high levels of iPTH were the independent risk factors for recurrent and persistent pHPT.
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Hiperparatiroidismo Primario , Paratiroidectomía , Estudios de Cohortes , Humanos , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/cirugía , Microondas/uso terapéutico , Estudios RetrospectivosRESUMEN
Myocardial ischemia-reperfusion (I/R) injury is a pathological process characterized by cardiomyocyte apoptosis, which leads to cardiac dysfunction. Increasing evidence shows that abnormal expression of long noncoding RNAs (lncRNAs) plays a crucial role in cardiovascular diseases. In this study we investigated the role of lncRNAs in myocardial I/R injury. Myocardial I/R injury was induced in mice by ligating left anterior descending coronary artery for 45 min followed by reperfusion for 24 h. We showed that lncRNA KnowTID_00006395, termed lncRNA-6395 was significantly upregulated in the infarct area of mouse hearts following I/R injury as well as in H2O2-treated neonatal mouse ventricular cardiomyocytes (NMVCs). Overexpression of lncRNA-6395 led to cell apoptosis and the expression change of apoptosis-related proteins in NMVCs, whereas knockdown of lncRNA-6395 attenuated H2O2-induced cell apoptosis. LncRNA-6395 knockout mice (lncRNA-6395+/-) displayed improved cardiac function, decreased plasma LDH activity and infarct size following I/R injury. We demonstrated that lncRNA-6395 directly bound to p53, and increased the abundance of p53 protein through inhibiting ubiquitination-mediated p53 degradation and thereby facilitated p53 translocation to the nucleus. More importantly, overexpression of p53 canceled the inhibitory effects of lncRNA-6395 knockdown on cardiomyocyte apoptosis, whereas knockdown of p53 counteracted the apoptotic effects of lncRNA-6395 in cardiomyocytes. Taken together, lncRNA-6395 as an endogenous pro-apoptotic factor, regulates cardiomyocyte apoptosis and myocardial I/R injury by inhibiting degradation and promoting sub-cellular translocation of p53.
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Daño por Reperfusión Miocárdica , ARN Largo no Codificante , Animales , Apoptosis , Proteínas Reguladoras de la Apoptosis/metabolismo , Proteínas Reguladoras de la Apoptosis/farmacología , Peróxido de Hidrógeno/farmacología , Infarto/patología , Ratones , Ratones Noqueados , Daño por Reperfusión Miocárdica/metabolismo , Miocitos Cardíacos , ARN Largo no Codificante/genética , ARN Largo no Codificante/metabolismo , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/metabolismoRESUMEN
OBJECTIVE: To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for T1N0M0 papillary thyroid carcinoma (PTC) with capsular invasion (CI). METHODS: The data of 69 T1N0M0 PTC with CI underwent MWA from August 2015 to January 2020 were retrospectively analyzed. All PTC nodules were pathologically confirmed by fine needle aspiration (FNA). The extended ablation was performed in all cases, that is, the ablation zone completely covered the tumor and extended the tumor edge by at least 2 mm. The strategy of fluid isolation was successfully applied before and during ablation. The strategy of multiple point ablation was applied. After ablation, the changes in tumor size at different time points, local recurrence, new lesions, lymph node metastasis (LNM), and complications were evaluated and recorded. The technical feasibility, technical success rate, and safety were analyzed. RESULTS: Based on the contrast-enhanced ultrasound results, complete ablation has been achieved in all enrolled cases after ablation. The mean maximum tumor diameter and the mean volume of PTC nodules before ablation were 0.84 ± 0.39 cm (range, 0.3-2 cm) and 0.26 ± 0.35 ml (range, 0.01-1.72 ml) respectively. The mean follow-up time was 26 ± 10 months (range, 9-48 months). Nodules in 47 cases (68.1%) completely disappeared in the follow-up period. No local recurrence was detected. The incidence of new lesions and LNM was 4.3% (3/69) and 4.3% (3/69) respectively. Further ablations have been successfully employed for all of the new lesions and LMN. Light voice changes (2.9%, 2/69) were the only major complication, which was relieved within 6 months after MWA. The sizes of the ablation zone increased firstly within 6 months after MWA compared with the pretreatment tumor size (p < 0.05). Twelve months later, the sizes were smaller than those before MWA (p < 0.05 for all). CONCLUSIONS: MWA is an effective, safe, and feasible method in treating T1N0M0 PTC with CI.
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Carcinoma Papilar , Neoplasias de la Tiroides , Carcinoma Papilar/cirugía , Humanos , Microondas/uso terapéutico , Estudios Retrospectivos , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Resultado del TratamientoRESUMEN
Background Microwave ablation (MWA) and radiofrequency ablation (RFA) have recently attracted interest as minimally invasive treatment modalities for papillary thyroid carcinoma (PTC). However, the ablation outcomes of T1N0M0 PTC are not well characterized. Purpose To evaluate the efficacy and safety of thermal ablation (MWA or RFA) of solitary T1N0M0 PTC in patients who were ineligible for (due to presence of comorbid cardiovascular disease, renal failure, other malignancy, etc) or who refused surgery. Materials and Methods This was a retrospective multicenter study of 847 patients (660 women) who underwent thermal ablation for PTC (673 T1a, 174 T1b) between March 2015 and March 2020; of these patients, 645 underwent MWA and 202 underwent RFA. The mean age of patients was 46 years ± 11 (standard deviation) (age range, 18-81 years); the mean follow-up time was 22 months ± 13 (range, 6-60 months). Changes in tumor size and volume and the rates of technical success, tumor disappearance, disease progression, and complications were assessed. Results The technical success rate was 100%. Relative to preablation measurements, the maximum diameter and volume of the ablation zone increased during the 1st month after ablation (P < .001), whereas there was no difference by the 3rd month; subsequently, the tumors showed reduction in size at 6, 9, and 12 months (all P < .001). Complete disappearance of tumors occurred in 68% of patients (577 of 847; 69% [466 of 673] in the T1a group vs 64% [111 of 174] in the T1b group; P < .001). The postablation disease progression rate was 1.1% (nine of 847 patients; 0.9% [six of 673 patients] in the T1a group vs 1.7% [three of 174 patients] in the T1b group; P = .54). The overall complication rate was 3.4% (29 of 847 patients; 2.7% [18 of 673 patients] in the T1a group vs 6.3% [11 of 174 patients] in the T1b group; P = .02). Conclusion This multicenter study provided evidence that thermal ablation is an effective and safe treatment option in selected -patients with solitary T1N0M0 papillary thyroid carcinoma. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baek and Cho in this issue.
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Microondas/uso terapéutico , Ablación por Radiofrecuencia , Cáncer Papilar Tiroideo/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , China , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Cáncer Papilar Tiroideo/patologíaRESUMEN
BACKGROUND: To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for papillary thyroid carcinoma (PTC) close to the thyroid capsule. METHODS: The data of 106 cases who underwent thermal ablation from June 2014 to September 2020 were retrospectively analyzed. The mean follow-up time was 25 ± 11 months (range, 9-48 months). The strategy of fluid isolation was successfully applied in all cases, and all PTC nodules underwent extended ablation. The technical feasibility, technical success rate, and safety were analyzed. Changes in tumor size at different time points after MWA were evaluated. RESULTS: According to the contrast-enhanced ultrasound results after ablation, MWA has been successfully applied in all enrolled cases. The capsular ablation has also been achieved for all cases. Nodules in 71 cases (70.0%) completely disappeared in the follow-up period. No local recurrence was detected. The incidence of lymph node metastasis and new tumors was 1.9% (2/106) respectively. Light voice changes were the only complication, with a rate of 5.7% (6/106), which were relieved within 6 months after MWA. The size of the ablation zone increased firstly in 6 months after MWA compared with the pretreatment tumor size (p < 0.05). At 12, 18, 24, 30, 36 and 42 months after MWA, the ablation zone shrank and the sizes were smaller than the tumor size before MWA (p < 0.05 for all). CONCLUSIONS: MWA is an effective, safe, and feasible method in treating PTC close to the thyroid capsule.
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Carcinoma Papilar , Neoplasias de la Tiroides , Carcinoma Papilar/cirugía , Estudios de Factibilidad , Humanos , Microondas/uso terapéutico , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: To assess the feasibility, efficacy, and safety of ultrasound (US)-guided microwave ablation (MWA) for the treatment of papillary thyroid cancer (PTC) located in the thyroid isthmus. MATERIALS AND METHODS: Thirty-four patients (mean age, 43 ± 11 years; 26 women) with isthmic PTC treated with MWA between June 2014 and September 2020 were included in this retrospective study. The follow-up time after MWA was 17 ± 9 months (range, 8-50 months). Changes in thyroid function, parathyroid function, and tumor size were evaluated, along with the rates of tumor disappearance and complications. RESULTS: The treatment was technically feasible and successfully completed in all 34 patients (100%). Measures of thyroid function (i.e. serum triiodothyronine, free thyroxine, and thyrotropin) and parathyroid function (i.e. serum calcium and intact parathyroid hormone) showed no changes from pretreatment levels at 1, 3, and 6 months after MWA (p > 0.05 for all). Tumor size was found to be increased at 1 and 3 months after MWA compared with before MWA (p < 0.05). However, the tumor sizes measured at 6, 9, 12, and 18 months after MWA were smaller than the pretreatment sizes (p < 0.05 for all). In 24 cases (70.6%), the tumors completely disappeared on US examination. Five cases (2.9%) experienced side effects from MWA treatment, but no major or minor complications were recorded. CONCLUSION: The results of this study demonstrate that US-guided MWA is a feasible, effective, and safe treatment option for selected patients with PTC located in the thyroid isthmus.
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Microondas , Neoplasias de la Tiroides , Adulto , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Cáncer Papilar Tiroideo , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of primary hyperparathyroidism (pHPT). METHOD: This retrospective study included 104 pHPT patients treated by MWA or RFA between January 2015 and March 2020 in four centers. The clinical outcomes including effectiveness and complications were compared between the two groups. Ablation cure was defined as the reestablishment of normal values of serum calcium and intact parathyroid hormone (iPTH) at least more than 6 months. Clinical cure was defined as the reestablishment of normal values of serum calcium and iPTH throughout the entire follow-up period. RESULTS: A total of 77 patients underwent MWA (mean age, 55.5 ± 16.4 years) and 27 underwent RFA (mean age, 58.9 ± 15.6 years). During the follow-up (median, 18.7 months in the MWA group; 12 months in the RFA group), no difference was observed between ablation cure rates (88.3% vs. 88.9%, p = 1.000), clinical cure rates (87.0% vs. 82.3%, p = .880), recurrent pHPT (5.2% vs. 3.7%, p = .447), persistent pHPT (11.7% vs. 11.1%, p = 1.000) and complication rate (9.1% vs. 3.7%, p = .677). A maximum diameter less than 0.7 cm was an independent prognostic factor of uncured pHPT in ablation (hazard ratio, 0.1; 95% confidence interval: 0.02, 0.54; p = .007). Major complication - voice change encountered in five patients (6.5%) in the MWA group and in one patient (3.7%) in the RFA group. CONCLUSION: Both RFA and MWA are safe and effective techniques for patients with pHPT, with comparable clinical outcomes.