HucMSCs Delay Muscle Atrophy After Peripheral Nerve Injury Through Exosomes by Repressing Muscle-Specific Ubiquitin Ligases.

Cell therapy based on mesenchymal stem cells (MSCs) alleviate muscle atrophy caused by diabetes and aging; however, the impact of human umbilical cord mesenchymal stem cells on muscle atrophy following nerve injury and the underlying mechanisms remain unclear. In this study, we evaluated the therapeutic efficacy of human umbilical cord MSCs (hucMSCs) and hucMSC-derived exosomes (hucMSC-EXOs) for muscle atrophy following nerve injury and identified the underlying molecular mechanisms. Sciatic nerve crush injury in rats and the induction of myotubes in L6 cells were used to determine the ameliorating effect of hucMSCs and hucMSC-EXOs on muscle atrophy. Q-PCR and Western blot analyses were used to measure the expression of muscle-specific ubiquitin ligases Fbxo32 (Atrogin1, MAFbx) and Trim63 (MuRF-1). Dual-luciferase reporter gene experiments were conducted to validate the direct binding of miRNAs to their target genes. Local injection of hucMSCs and hucMSC-EXOs mitigated atrophy in the rat gastrocnemius muscle following sciatic nerve crush injury. In vitro, hucMSC-EXOs alleviated atrophy in L6 myotubes. Mechanistic analysis indicated the upregulation of miR-23b-3p levels in L6 myotubes following hucMSC-EXOs treatment. MiR-23b-3p significantly inhibited the expression of its target genes, Fbxo32 and Trim63, and suppressed myotube atrophy. Notably, an miR-23b-3p inhibitor reversed the inhibitory effect of miR-23b-3p on myotube atrophy in vitro. These results suggest that hucMSCs and their exosomes alleviate muscle atrophy following nerve injury. MiR-23b-3p in exosomes secreted by hucMSCs contributes to this mechanism by inhibiting the muscle-specific ubiquitination ligases Fbxo32 and Trim63.

Platelet-rich plasma-derived exosomes enhance mesenchymal stem cell paracrine function and nerve regeneration potential.

BACKGROUND: Peripheral nerve injury (PNI) presents a significant clinical challenge, leading to enduring sensory-motor impairments. While mesenchymal stem cell (MSC)-based therapy holds promise for PNI treatment, enhancing its neurotrophic effects remains crucial. Platelet-rich plasma-derived exosomes (PRP-Exo), rich in bioactive molecules for intercellular communication, offer potential for modulating cellular biological activity. METHODS: PRP-Exo was isolated, and its impact on MSC viability was evaluated. The effects of PRP-Exo-treated MSCs (MSCPExo) on Schwann cells (SCs) from injured sciatic nerves and human umbilical vein endothelial cells (HUVECs) were assessed. Furthermore, the conditioned medium from MSCPExo (MSCPExo-CM) was analyzed using a cytokine array and validated through ELISA and Western blot. RESULTS: PRP-Exo enhanced MSC viability. Coculturing MSCPExo with SCs ameliorated apoptosis and promoted SC proliferation following PNI. Similarly, MSCPExo-CM exhibited pro-proliferative, migratory, and angiogenic effects. Cytokine array analysis identified 440 proteins in the MSCPExo secretome, with 155 showing upregulation and 6 showing downregulation, many demonstrating potent pro-regenerative properties. ELISA confirmed the enrichment of several angiotrophic and neurotrophic factors. Additionally, Western blot analysis revealed the activation of the PI3K/Akt signaling pathway in MSCPExo. CONCLUSION: Preconditioning MSCs with PRP-Exo enhanced the paracrine function, particularly augmenting neurotrophic and pro-angiogenic secretions, demonstrating an improved potential for neural repair.

Effects of Platelet-Rich Plasma-Derived Exosomes on Proliferation and Migration of Tendon Stem/Progenitor Cell.

Objective To investigate the effects of platelet-rich plasma-derived exosomes (PRP-Exos) on the proliferation and migration of tendon stem/progenitor cell (TSPC). Methods PRP-Exos were extracted through the combination of polymer-based precipitation and ultracentrifugation.The morphology,concentration,and particle size of PRP-Exos were identified by transmission electron microscopy and nanoparticle tracking analysis.The expression levels of surface marker proteins on PRP-Exos and platelet membrane glycoproteins were determined by Western blot analysis.Rat TSPC was extracted and cultured,and the expression of surface marker molecules on TSPC was detected using flow cytometry and immunofluorescence staining.The proliferation of TSPC influenced by PRP-Exos was evaluated using CCK-8 assay and EdU assay.The effect of PRP-Exos on the migration of TSPC was evaluated by cell scratch assay and Transwell assay. Results The extracted PRP-Exos exhibit typical saucer-like structures,with a concentration of 4.9×1011 particles/mL,an average particle size of (132.2±56.8) nm,and surface expression of CD9,CD63 and CD41.The extracted TSPC expressed the CD44 protein.PRP-Exos can be taken up by TSPC,and after co-cultured for 48 h,concentrations of 50 and 100 µg/mL of PRP-Exos significantly promoted the proliferation of TSPC (both P<0.001),with no statistical difference between the two concentrations (P=0.283).Additionally,after co-cultured for 24 h,50 µg/mL of PRP-Exos significantly promoted the migration of TSPC (P<0.001). Conclusion Under in vitro culture conditions,PRP-Exos significantly promote the proliferation and migration of rat TSPC.

Clinical value of three-dimensional ultrasonography in the morphologic evaluation of rotator cuff tear: a prospective study.

OBJECTIVE: To study the clinical value of three-dimensional ultrasonography (3D-US) in the morphological evaluation of rotator cuff tears (RCTs). METHODS: Based on previously published literature, RCT patterns in our study were divided into crescent, L-shaped with the remnant tendon retracted to the anterior rotator cuff (aL-shaped), L-shaped with the remnant tendon retracted to the posterior rotator cuff (pL-shaped), T-shaped (a tear pattern that is a combination of aL-shaped and pL-shaped), U-shaped, and massive type. Two radiologists prospectively assessed the tear patterns using 3D-US as well as magnetic resonance imaging (MRI) and compared these results using arthroscopy to calculate diagnostic accuracy. RESULT: Fifty-two patients (52 shoulders) were enrolled. The overall diagnostic accuracy of 3D-US in evaluating RCT patterns (82.7%, 43/52; 95% CI: 72.1-93.3%) was significantly higher (p = 0.008) than that of the MRI (57.7%, 31/52; 95% CI: 45.8-73.4%). The accuracy of 3D-US was higher than that of MRI for most types of tears (crescent: 95.0% vs. 55.0%, aL-shaped: 83.3% vs. 77.8%, pL-shaped: 50.0% vs. 25.0%, T-shaped: 75.0% vs. 0.0%, and massive type: 80.0% vs. 100.0%). The accuracies of 3D-US with respect to evaluation by the two radiologists were 84.6% (44/52) and 76.9% (40/52), and there was substantial agreement evident (κ = 0.709). The time taken by the two radiologists to reconstruct the 3D-US images and evaluate the tear pattern was < 5 min. CONCLUSION: The 3D-US can be used for the preoperative evaluation of RCT patterns, and thus be useful for the correct selection of the surgical repair technique for RCTs. KEY POINTS: • Few studies have been found exploring the value of 3D-US for the morphological evaluation of RCTs and correlated with the arthroscopic findings. • Based on previous studies on the morphological classification, anterior L shape (aL-shaped), and posterior L shape (pL-shaped) were used for the first time to describe the torn patterns of RCT.

The value of combined ultrasound contrast arthrography and subacromial-subdeltoid bursography for detecting and differentiating the rotator cuff tear subtypes in patients with the uncertain rotator cuff tear.

OBJECTIVES: In this study, ultrasound (US) contrast arthrography and subacromial-subdeltoid bursography with the contrast agent of SonoVue were performed to evaluate their value for detecting and differentiating the rotator cuff tear (RCT) subtypes in patients with the uncertain RCT. METHODS: A total of 102 patients with the clinically suspected RCTs in the orthopedic clinic were prospectively recruited and underwent conventional high-frequency US for the category of undoubted full-thickness RCT, uncertain RCT, and intact rotator cuff. Among these patients, the patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. The arthroscopic findings were used as the gold standard in this study. RESULTS: After the conventional US screening, 62 patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. All the US contrast arthrography and subacromial-subdeltoid bursography were successfully performed and no severe side effects were observed in all the patients. For full-thickness tears, the sensitivity and specificity of the combined US contrast arthrography and subacromial-subdeltoid bursography were 94.7% (CI: 0.72-1.0) and 81.4% (CI: 0.66-0.91), respectively, and for articular-side tears 100% (CI: 0.51-1) and 100% (CI: 0.92-1), respectively, and for the bursal-side tears 84.6% (CI: 0.54-0.97) and 97.9% (CI: 0.88-1.0), respectively. The main inconsistency between the contrast-enhanced US and arthroscopy was that 7 patients with arthroscopic proved concurrent articular- and bursal-side tears were indicated as full-thickness RCTs on contrast-enhanced US. CONCLUSIONS: Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs. CLINICAL RELEVANCE STATEMENT: When conventional high-frequency US has some difficulty in differentiating the full-thickness from partial-thickness RCTs, combined US contrast arthrography and subacromial-subdeltoid bursography could be used to improve the detection accuracy of RCT subtypes. KEY POINTS: • This is the first study by injection of the US contrast agent SonoVue into the shoulder joint cavity and subacromial-subdeltoid bursa for the detection and differentiation of the RCT subtypes among the people with the uncertain RCT by conventional US screening. • The SonoVue was injected into the glenohumeral joint cavity under US guidance to differentiate the full-thickness RCTs from partial-thickness RCTs. • Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs.

Optimal thyrotropin level for low-risk papillary thyroid carcinoma after ultrasound-guided radiofrequency ablation.

PURPOSE: Maintaining an optimal thyroid stimulating hormone (TSH) level is important in the postoperative management of papillary thyroid carcinoma (PTC). However, there is little evidence for TSH target levels in patients undergoing radiofrequency ablation (RFA). This study aimed to determine the optimal TSH level for management in low-risk patients who underwent RFA. METHODS: This retrospective propensity score-matched cohort study included patients with low-risk PTC who underwent RFA from January 2014 to December 2018. The patients were categorized into two groups based on the range of TSH levels: low (≤2 mU/L) and high (>2 mU/L) TSH levels. Local tumor progression and disease-free survival (DFS) were compared between the low TSH and high TSH groups, using propensity score analyses based on patient- and tumor-level characteristics. Univariate analyses were performed to select risk factors for tumor progression. RESULTS: Overall, our study included 516 patients with low-risk PTC who underwent RFA with a long-term follow-up of 5-years. During follow-up, the overall incidence rate of local tumor progression was 4.8% (25/516), with no significant difference between the matched groups (7/106 [6.6%] vs. 5/53 [9.4%], p = 0.524). DFS did not differ between the two groups (p = 0.5). Moreover, TSH level was not regarded as a significant predictor of tumor progression after Cox analysis; primary tumor size was the only relevant risk factor. CONCLUSION: This large propensity-matched study revealed no association between TSH levels and tumor progression. Thus, for patients with low-risk PTC who underwent RFA, the optimalTSH level is recommended at the euthyroid range.

[Human Platelet-Rich Plasma-Derived Exosomes Promote the Proliferation of Schwann Cells Cultured in Vitro].

Objective To investigate the effect of human platelet-rich plasma-derived exosomes(PRP-exos)on the proliferation of Schwann cell(SC)cultured in vitro. Methods PRP-exos were extracted by polymerization-precipitation combined with ultracentrifugation.The morphology of PRP-exos was observed by transmission electron microscopy,and the concentration and particle size distribution of PRP-exos were determined by nanoparticle tracking analysis.Western blotting was employed to determine the expression of the marker proteins CD63,CD81,and CD9 on exosome surface and the platelet membrane glycoprotein CD41.The SCs of rats were isolated and cultured,and the expression of the SC marker S100ß was detected by immunofluorescence staining.The fluorescently labeled PRP-exos were co-cultured with SCs in vitro for observation of their interaction.EdU assay was employed to detect the effect of PRP-exos on SC proliferation,and CCK-8 assay to detect the effects of PRP-exos at different concentrations(0,10,20,40,80,and 160 µg/ml)on SC proliferation. Results The extracted PRP-exos appeared as uniform saucer-shaped vesicles with the average particle size of(122.8±38.7)nm and the concentration of 3.5×1012 particles/ml.CD63,CD81,CD9,and CD41 were highly expressed on PRP-exos surface(P<0.001,P=0.025,P=0.004,and P=0.032).The isolated SCs expressed S100ß,and PRP-exos could be taken up by SCs.PRP-exos of 40,80,and 160 µg/ml promoted the proliferation of SCs,and that of 40 µg/ml showed the best performance(all P<0.01). Conclusions High concentrations of PRP-exos can be extracted from PRP.PRP-exos can be taken up by SCs and promote the proliferation of SCs cultured in vitro.

Value of Conventional Ultrasound-based Scoring System in Distinguishing Adenomatous Polyps From Cholesterol Polyps.

BACKGROUND AND AIM: Ultrasound has increased the detection of gallbladder polyps, but it has limitations in evaluating the nature of gallbladder polyps, especially the maximum size of 1.0 to 1.5 cm. We assessed the value of ultrasound scoring system based on independent predictive parameters in distinguishing adenomatous polyps from cholesterol polyps with the maximum size of 1.0 to 1.5 cm. MATERIALS AND METHODS: We enrolled 163 patients with gallbladder polyps (1.0 to 1.5 cm) who underwent ultrasonography and cholecystectomy. Ultrasound image characteristics were compared between cholesterol polyps and adenomatous polyps in the training cohort from April 2018 to January 2020. An ultrasound scoring system was constructed in the training cohort, and its diagnostic performance was evaluated in the validation cohort from February 2020 to February 2021. RESULTS: Maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot were significantly different between cholesterol polyps and adenomatous polyps in the training cohort ( P <0.05). The independent predictive parameters for adenomatous polyps were lower height/width ratio, presence of vascularity and absence of hyperechoic spot. The total score was as follows: (height/width ratio, <0.9=4, ≥0.9=0) + (vascularity, present=3, absent=0) + (hyperechoic spot, absent=2, present=0). The sensitivity, specificity and accuracy of ultrasound scoring system ≥5 for diagnosis of adenomatous polyps in the validation cohort were 73.33%, 80.49%, and 78.57%, respectively. CONCLUSIONS: The ultrasound scoring system aids in distinguishing adenomatous polyps from cholesterol polyps, and effectively decreasing unnecessary cholecystectomy.

Contrast-enhanced ultrasound is a reliable and reproducible assessment of necrotic ablated volume after radiofrequency ablation for benign thyroid nodules: a retrospective study.

PURPOSE: To investigate the intra- and inter-observer reliability and agreement of contrast-enhanced ultrasound (CEUS) in measuring ablated volume (Va) after radiofrequency ablation (RFA) for benign thyroid nodules. MATERIALS: This retrospective study evaluated 65 patients with 74 benign thyroid nodules who underwent RFA. Patients were followed up at 1, 3, 6, and 12 months and every 12 months thereafter. Two independent observers measured the Va using CEUS during the same follow-up visit. The intra- and inter-observer reliability was assessed using intraclass correlation coefficient (ICC) with 95% confidence interval. The Bland-Altman analysis was used to evaluate the inter-observer agreement, which was expressed as a mean difference with 95% limit of agreement (LOA). RESULTS: No significant difference was found in Va measurements by the two observers with a mean follow-up time of 41.17 ± 16.80 months (all p > 0.05). The intra- and inter-observer reliability were both excellent (ICC >0.90) at each follow-up period. The 95% LOA became wider over the follow-up period. The smallest 95% LOA was found at 1 month with a LOA from 0.8117 to 1.122, and the largest 95% LOA was from 0.5694 to 1.343 at 36 months. CONCLUSIONS: CEUS could provide a reliable and reproducible assessment of Va after RFA for benign thyroid nodules. In clinical post-ablation follow-up, the irregular morphology of ablated area and the variation by different observers could not affect the assessment of Va by CEUS.

Clinical Application of C-TIRADS Category and Contrast-Enhanced Ultrasound in Differential Diagnosis of Solid Thyroid Nodules Measuring ≥1 cm.

BACKGROUND The aim of this study was to investigate the performance of Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) category combined with contrast-enhanced ultrasound (CEUS) in diagnosing thyroid cancer. MATERIAL AND METHODS From October 2020 to March 2021, 116 thyroid nodules from 113 patients who underwent conventional ultrasound and CEUS examinations at the General Hospital of Northern Theater Command were reviewed. In the conventional ultrasound examination, thyroid nodules were categorized by C-TIRADS. The nodules were reclassified based on CEUS scoring, then a combined diagnosis was made. The pathological results were taken as the criterion standard. To compare the diagnostic performance of the 3 methods according to the receiver operating characteristic curves produced for thyroid nodules. RESULTS After chi-square test, the 7 characteristics of enhancement patterns, internal homogeneity, wash-in, wash-out, ring enhancement, morphology, and contrast agent retention characteristics (CAR) were statistically different between malignant and benign tumors; A high diagnostic performance was demonstrated by C-TIRADS combined with CEUS in diagnosing thyroid cancer. The area under the curve (AUC), the sensitivity, and the specificity of C-TIRADS combined with CEUS for diagnosing thyroid cancer were 0.918 (95% CI: 0.852-0.961), 80.9% (95% CI: 69.1-89.8%), and 90.6% (95% CI: 79.3-96.9%), respectively. The AUC of C-TIRADS alone was significantly lower than that of C-TIRADS combined with CEUS (P=0.0056), while there was no significant difference between CEUS and C-TIRADS combined with CEUS (P=0.59). CONCLUSIONS The combined method of C-TIRADS and CEUS, with reduced rate of thyroid nodule biopsy and clinical application value, has higher diagnostic accuracy than the single diagnosis method.

Differential diagnosis and feature visualization for thyroid nodules using computer-aided ultrasonic diagnosis system: initial clinical assessment.

BACKGROUND: To assess the diagnostic efficacy of the computer-aided ultrasonic diagnosis system (CAD system) in differentiating benign and malignant thyroid nodules. METHODS: The images of 296 thyroid nodules were included in validation sets. The diagnostic efficacy of the CAD system was compared with that of junior physicians and senior physicians, as well as that of the combination diagnosis of the CAD system with junior physicians. The diagnostic efficacy of the CAD system for different sizes of thyroid nodules was compared. RESULTS: The diagnostic sensitivity and accuracy of the CAD system were higher than those of junior physicians (83.4% vs. 72.2%, 73.0% vs. 69.6%), but the diagnostic specificity of the CAD system was lower than that of junior physicians (62.1% vs. 66.9%). The diagnostic accuracy of the CAD system was lower than that of senior physicians (73.0% vs. 83.8%). However, the combination diagnosis of the CAD system with junior physicians had higher accuracy (81.8%) and AUC (0.842) than those of either the CAD system or junior physicians alone, and comparable diagnostic performance with those of senior physicians. The Kappa was 0.635 in the combination diagnosis of the CAD system with junior physicians, showing good consistency with the pathological results. The accuracy (76.4%) of the CAD system was the highest for nodules of 1-2 cm. CONCLUSION: The CAD system can effectively assist physicians to identify malignant and benign thyroid nodules, reduce the overdiagnosis and overtreatment of thyroid nodules, avoid unnecessary invasive fine needle aspiration, and improve the diagnostic accuracy of junior physicians.

Targeting Diagnosis of High-Risk Papillary Thyroid Carcinoma Using Ultrasound Contrast Agent With the BRAFV600E Mutation: An Experimental Study.

OBJECTIVE: High-risk papillary thyroid carcinoma (PTC) patients with BRAF mutation have lymph node and distant metastases and poor prognosis. Therefore, this study aims to develop a targeted ultrasound contrast agent for the BRAFV600E mutation to screen high-risk PTC at early stage. METHODS: The targeted lipid nanobubbles carrying BRAFV600E antibody were prepared using thin film hydration-sonication and avidin-biotin binding methods. The physicochemical properties and stability of the targeted nanobubbles were detected by transmission electron microscopy, atomic force microscopy, and confocal laser scanning microscopy. The target binding abilities of the targeted nanobubbles in the PTC cells (B-CPAP) overexpressed mutant BRAFV600E were evaluated by immunofluorescence staining, quantitative real-time polymerase chain reaction, western blot, and fluorescence microscopy. After PTC tumor models overexpressed mutant BRAFV600E were established, the enhanced images of targeted lipid nanobubbles and untargeted lipid nanobubbles on PTC tumors in nude mice were observed using contrast-enhanced ultrasound imaging. RESULTS: The targeted lipid nanobubbles revealed uniform, round morphology, and good stability with a nanoscale size. Besides, BRAFV600E monoclonal antibody was observed to be combined on the surface of lipid nanobubbles. Furthermore, the targeted nanobubbles had a good targeting diagnosis ability in PTC cells with BRAFV600E overexpression. Moreover, the targeted nanobubbles had better ultrasound enhancement and peak intensity of the time-intensity curve (P < .001) in PTC tumors with BRAFV600E overexpression as compared to the untargeted lipid nanobubbles. CONCLUSION: The targeted lipid nanobubbles carrying BRAFV600E antibody could be regarded as a potential targeted ultrasound contrast agent for the diagnosis of high-risk PTC.

Greater protein quality of an egg breakfast may be inadequate to induce satiety during weight loss, compared with a cereal breakfast of equal protein quantity.

We compared the effects of consuming egg-breakfast of superior protein quality to cereal-breakfast of similar energy density and protein quantity, but lower protein quality. Two, two-week randomised crossover clinical trials included 30 otherwise healthy women with overweight or obesity. Subjects received counselling to follow a reduced-calorie diet. Under supervision, participants consumed either breakfast for one-week then crossed over to the opposite breakfast. Experiment-1 outcome variables included post-breakfast appetite hormones, glucose and insulin, subjective markers of satiety and energy intake at lunch and dinner. In Experiment-2, an appealing food (brownies) was included in lunch. Following the breakfasts, Experiment-1 showed no significant differences in outcome variables. In Experiment-2, the egg-breakfast increased fullness (p = 0.038), but lunch-time energy intake was not different. If these findings apply to other breakfasts, it suggests that in comparing two breakfasts with similar protein quantity, the greater protein quality of a breakfast may not be adequate to induce satiety.

Fe-Ion-Catalyzed Synthesis of CdSe/Cu Core/Shell Nanowires.

CdSe/Cu core/shell nanowires (NWs) are successfully synthesized by a wet chemical method for the first time. By utilizing the solution-liquid-solid (SLS) mechanism, CdSe NWs are fabricated by Bi seeds, which act as catalysts. In the subsequent radial overcoating of the Cu shell on the CdSe NWs, Fe ions have been proven to be an indispensable and efficient catalyzer. The thickness of the Cu shell could be well controlled in the range of 3 to 6 nm by varying the growth temperature (from 300 to 360 °C). Our synthetic strategy pioneers a new possibility for the controlled synthesis of semiconductor-metal heterostructure NWs (especially for II-VI semiconductors), such as CdS/Cu, ZnS/Au, and ZnO/Ag, which had broad application prospects in photoconductors, thin-film transistors, and light-emitting diodes. Theoretically, electrons flow from a higher Fermi-level material to the bottom Fermi-level at the metal-semiconductor heterojunction interface, which aligns the Fermi level and establishes the Schottky barrier. It leads to excess negative charges in metals and excess positive charges in semiconductors. Therefore, those effective electron traps reduce the probability of photogenerated electron-hole pair recombination efficiently, which has been widely applied in solar cells, sensors, photocatalysis, and energy storage. The breakthrough and innovation of this synthesis method have opened up a new synthetic route with a mild reaction environment, low energy consumption, and convenience.

New Simple Ultrasound-Guided Transforaminal Injection in Patients With Radiculopathy in the Lower Cervical Spine: A Computed Tomography-Controlled Study.

OBJECTIVES: To evaluate the feasibility of a new simple ultrasound-guided transforaminal injection in patients with cervical radiculopathy. METHODS: Ultrasound scans of the neck in a plastic model and in 5 unaffected participants were first performed to identify the intervertebral foramen. Then ultrasound-guided transforaminal injections were performed in 20 patients with radiculopathy in the lower cervical spine, and computed tomography was used to verify the accuracy. Complications, the visual analog score, and the neck disability index were assessed at 1 and 3 months after the injection. RESULTS: Computed tomography confirmed that the needle tip was correctly placed in the intervertebral foramen in 88.5% (23 of 26) of injections. No immediate or short-term complications were observed in all patients. The visual analog score and neck disability index at 1 and 3 months were significantly lower than those before the injection (both P < .0001). CONCLUSIONS: Ultrasound may be a feasible and accurate method to guide cervical transforaminal injection.

Papillary thyroid carcinoma: an ultrasound-based nomogram improves the prediction of lymph node metastases in the central compartment.

OBJECTIVES: To develop a nomogram based on postoperative clinical and ultrasound findings to quantify the probability of central compartment lymph node metastases (CLNM). METHODS: A total of 952 patients with histologically confirmed papillary thyroid carcinoma (PTC) were included in this retrospective study and assigned to three groups based on sex and age. The strongest predictors for CLNM were selected according to ultrasound imaging features, and an ultrasound (US) signature was constructed. By incorporating clinical characteristics, a predictive model presented as a nomogram was developed, and its performance was assessed with respect to calibration, discrimination and clinical usefulness. RESULTS: Predictors contained in the nomogram included US signature, US-reported LN status and age. The US signature was constructed with tumour size and microcalcification. The nomogram showed excellent calibration in the training dataset, with an AUC of 0.826 (95% CI, 0.765-0.887) for male patients, 0.818 (95% CI, 0.746-0.890) for young females and 0.808 (95% CI, 0.757-0.859) for elder females. For male and young female patients, application of the nomogram to the validation cohort revealed good discrimination, with AUCs of 0.813 (95% CI, 0.722-0.904) and 0.814 (95% CI, 0.712-0.915), respectively. Conversely, for elderly female patients, the nomogram failed to show good performance with an AUC of 0.742 (95% CI, 0.661-0.823). CONCLUSION: This ultrasound-based nomogram may serve as a useful clinical tool to provide valuable information for treatment decisions, especially for male and younger female patients. KEY POINTS: • Age, gender, US-reported LN status and US signature were the strongest predictors of CLNM in PTC patients and informed the development of a predictive nomogram. • Microcalcification was the strongest predictor in the US signature, as CLMN was identified in approximately 92% of patients characterised by diffuse microcalcification. • Stratified by sex and age, this nomogram achieved good performance in predicting CLNM, especially in male and young female patients. This prediction tool may be useful as an imaging marker for identifying CLNM preoperatively in PTC patients and as a guide for personalised treatment.

Inter-observer reliability in ultrasound measurement of benign thyroid nodules in the follow-up of radiofrequency ablation: a retrospective study.

PURPOSE: To investigate the inter-observer reliability of ultrasound (US) measurement in volume and volume reduction rate (VRR) of benign thyroid nodules during the follow-up of radiofrequency ablation (RFA). MATERIALS: This retrospective study evaluated 76 patients with 88 benign thyroid nodules who underwent RFA. Two independent observers performed the US measurements during the same follow-up visit. The Bland-Altman analysis was used to evaluate the inter-observer reliability of volume and VRR (logarithmic transformation). The mean difference and 95% limits-of-agreement (LOA) were obtained after antilogarithm. RESULTS: No significant differences were found in the volume and VRR measurements during a mean follow-up time of 35.52 ± 12.82 months. After antilogarithms, the mean difference of volume was 0.9961, 0.9987, 1.0016, 0.9972, 0.9977 and 0.9969 at 1, 3, 6, 12, 24 and 36 months, respectively. The 95% LOA of volume became wider over the follow-up period, and the largest one was between 0.8471 and 1.1733 at 36 months. The 95% LOA of VRR became narrower over the follow-up period, and the largest one was between 0.9541 and 1.0469 at 1 month. The incidence of regrowth was 20.45% and the largest 95% LOA of regrowth nodules was between 0.9028 and 1.284 at 12 months. At the same follow-up period, VRR had a narrower 95% LOA than volume. Compared with volume ≥10 ml, nodules <10 ml revealed a larger 95% LOA in both the volume and VRR. CONCLUSION: The inter-observer reliability of the US measurements of benign thyroid nodules during the follow-up period of RFA was acceptable. The variation by different observers could not affect the evaluation of efficacy.

Factors associated with health-related quality of life in papillary thyroid microcarcinoma patients undergoing radiofrequency ablation: a cross-sectional prevalence study.

PURPOSE: To explore the association of demographic characteristics, clinical symptoms and the fear of the disease progression factors with the physical and mental summary components of the health-related of life (HRQoL) of the papillary thyroid microcarcinoma (PTMC) patients undergoing radiofrequency ablation (RFA). METHODS: 123 PTMC survivors undergoing RFA were enrolled in this study from October 2019 to March 2020. Demographic, clinical symptoms and the fear of the disease progression data were collected. SF-36, THYCA-QoL and FoP-Q-SF were used to evaluate the HRQoL of patients, clinical symptoms and the fear of disease progression. A multivariate regression model was performed to evaluate the association between the independent variable and the HRQoL variable. RESULTS: The average self-reported HRQoL score was 81.17 ± 15.48 for the PCS and 73.40 ± 18.03 for the MCS. The multivariate linear regression model shows that the factors related to a poorer PCS were dependent for the female patients, the symptoms of neuromuscular and the throat/mouth, the fear of disease progression; the psychological disorder, symptoms of throat/mouth, inability to concentrate were related to worse scores for the MCS. The condition that was most strongly related to a poorer HRQoL (in both PCS and MCS) was the fear of their physical health. CONCLUSIONS: The factors related to significantly worse HRQoL scores across PCS and MCS for PTMC survivors include the female gender, the symptoms of neuromuscular and the throat/mouth, the psychological disorder, inability to concentrate, and the fear of their own physical health. Identification, management, and prevention of these factors are critical to improving the HRQoL of patients.

Efficacy and safety of ultrasonography-guided radiofrequency ablation for the treatment of T1bN0M0 papillary thyroid carcinoma: a retrospective study.

Purpose: To evaluate the efficacy and safety of ultrasonography (US)-guided radiofrequency ablation (RFA) for treating low-risk T1bN0M0 papillary thyroid cancer (PTC).Methods: This retrospective study was approved by the ethics committee of the Chinese People's Liberation Army General Hospital (S2019-211-01). Sixty-six patients with T1bN0M0 PTC (14 men and 52 women with a mean age of 41.0 ± 9.2 years [range, 21-61 years]), who were not eligible for or refused surgery, were included in our study. RFA was performed with the moving-shot technique, and the ablation area exceeded the tumor edge by at least 3 mm. US (including contrast-enhanced) was performed before RFA; 1, 3, and 6 months after RFA, and every 6 months thereafter. US-guided core-needle biopsy was performed 3 or 6 months after ablation to rule out recurrence.Results: The technical success rate was 100%, and there were no major complications. The tumor volume decreased significantly; the volume reduction rate (VRR) was 99.11 ± 2.44% (range, 92.62-100%) at the final follow-up with 38 tumors (57.6%) disappearing. Significant decreases in the VRR were found at every other follow-up visit before 18 months (p < .01). Technique efficacy was obtained in 64/66 (97.0%) patients over 20.5 ± 7.4 months follow-up. Malignant cells were confirmed in 2 ablation zones (3.0%), and cervical lymph node metastasis was detected in 1 patient (1.5%). These patients underwent additional RFA and achieved good results.Conclusion: RFA may be considered a safe and effective modality for the management of T1bN0M0 PTC in select patients.

Solid benign thyroid nodules (>10 ml): a retrospective study on the efficacy and safety of sonographically guided ethanol ablation combined with radiofrequency ablation.

Background: Image-guided radiofrequency ablation (RFA) of large solid benign thyroid nodules (BTNs) usually require a high amount of energy. Injection of ethanol into a benign thyroid nodule before RFA can lower the procedural time and patient discomfort.Objective: To investigate the efficacy and safety of ethanol ablation (EA) combined with RFA in the treatment of solid BTNs (>10 ml) and to compare this modified method with RFA treatment alone.Methods: A total of 366 nodules in 366 patients were treated from June 2017 to Mar. 2018, 76 (M:F = 32:44, age 46 ± 14 years) were treated with EA + RFA and 290 (M:F = 99:191, age 49 ± 14 years) were treated with RFA. 44 patients (44 nodules) of each group formed a matched cohort after adjustment with propensity score matching. The average time, energy and power of the RFA procedure were retrospectively compared between the two groups. The postoperative nodule volume reduction ratio (VRR), compressive symptoms, cosmetic concerns, comprehensive satisfaction score, thyroid function and complications were retrospectively compared within and between the two groups after 6 months after treatment.Results: No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. The mean RFA time (454.7 s (interquartile range (IQR), 290.8-589.0 s vs. 796.0 s (IQR, 554.0-976.30 s), p < .001), energy (3.69 ± 1.99 kJ vs. 5.10 ± 2.15 kJ, p = .009) and power (6.17 ± 1.38 W vs. 7.21 ± 1.29 W, p < .001) in the EA + RFA group were significantly lower than those in the RFA group. Mean nodule reduction at 6 months in the EA + RFA group and in the RFA group was 69.81 ± 11.48% vs. 67.43 ± 12.13% (10-30 ml, p = .454) and 62.75 ± 11.41% vs. 59.82 ± 10.53% (>30 ml, p = .456), respectively. The Medium nodules shrunk more than the large nodules (all p < .001), and the pressure symptoms and cosmetic signs significantly improved in the large nodules in both groups (all p < .05). Patients in the EA + RFA group had the highest satisfaction.Conclusions: EA combined with RFA shortened the ablation time of RFA, reduced the total energy and power required and improved patient satisfaction. This modified RFA approach may be considered a low-risk and high-efficacy alternative to treat solid BTNs greater than 10 ml in size.