Comparative efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma: Systematic review including traditional pooling and Bayesian network meta-analysis.

PURPOSE: To compare the efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma, using a systematic review including traditional pooling and Bayesian network meta-analysis. MATERIALS AND METHODS: A comprehensive literature search in PubMed, EMBASE, and the Cochrane Library databases identified retrospective studies evaluating the tumor volume change after different thermal ablation or conventional surgery. Studies from the date of their inception to January 6, 2024, were included. A review of 4463 potential papers, including a full-text review of 23, identified 10 eligible papers covering a total of 2658 patients for meta-analysis. The tumor volume change over a 12-month follow-up was compared between different thermal ablations. Tumor diameter change, complications, recurrence, operation and hospitalization time were evaluated by network meta-analysis. RESULTS: Based on the traditional frequentist approach, the overall pooled estimates for the standardized mean difference (SMD) in tumor volume change of radiofrequency ablation (RFA), laser ablation (LA), and microwave ablation (MWA) were 1.38 (95 % credibility interval (CI), 0.62-2.13), 1.94 (95%CI, 0.78-3.10) and 1.38 (95%CI, 1.01-1.75), respectively. Based on the Bayesian network meta-analysis, in examining the surface under the cumulative ranking area (SUCRA) ranking, RFA (SUCRA, 76.6), MWA (SUCRA, 66.6), and LA (SUCRA, 39.8) were identified as the three interventions that were associated with the greatest reduction in risk for complications compared with conventional surgery (CS), with RFA (SUCRA, 76.6) being ranked as the highest in safety. MWA, SMD 4.43 [95%CI, 2.68-6.17], RFA SMD 4.24 [95 % CI, 1.66-6.82], and LA SMD 4.24 [95 % CI, 1.48-7.00] were associated with the shorter operation time compared with CS. LA SMD 4.61 [95 % CI, 1.79-7.44] and MWA SMD 3.07 [95 % CI, 1.32-4.83] were associated with the shorter hospitalization time compared with CS, with LA (SUCRA, 86.5) yielding the highest ranking. MWA was associated with a reduced risk for tumor recurrence RR 0.02 [95 % CI, -0.44-0.49], compared with CS. CONCLUSION: We conducted a comprehensive review of the published literature on the effectiveness and safety of different thermal ablation techniques and conventional surgery for papillary thyroid microcarcinoma. Important research gaps persist due to a lack of long-term data and high-quality randomized controlled trials (RCTs).

Five-year follow-up results of thermal ablation for benign thyroid nodules: Systematic review and meta-analysis.

OBJECTIVES: Confidence in long-term treatment results of thermal ablation for benign thyroid nodules (BTNs) is required in comparison with surgery. The objective of this meta-analysis is to report 5-year follow-up results of thermal ablation for BTNs. METHODS: Ovid PUBMED, COCHRANE, and EMBASE databases were searched through Feb 30, 2023, for studies reporting outcomes in patients with BTNs treated with thermal ablation and followed up for about 5 years. Pooled volume reduction rates (VRRs) at 6, 12, 24, 36, 48, and 60 months after thermal ablation were assessed. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines. RESULTS: Five studies, involving 939 patients, met the inclusion criteria through database searches. 137 patients experienced local nodules recurrence during a mean pooled 59.25-month follow-up. Seventeen of them proved to be non-benign. Fifty of all patients with nodules regrowth had a secondary surgery, while 35 had a secondary thermal ablation. The pooled mean major complication rate was 7.70 %, with no patient experiencing life-threatening or delayed complications. CONCLUSIONS: Thermal ablation is an excellent local nodules control method in patients with BTNs, and results in a clinically significant and long-lasting volume reduction of BTNs. The risk of regrowth and needing retreatment was lower after thermal ablation.

Three-year follow-up results of radiofrequency ablation for low-risk papillary thyroid microcarcinomas: Systematic review and meta-analysis.

OBJECTIVES: Confidence in long-term treatment results of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) is required in comparison with surgery and active surveillance (AS). The objective of this meta-analysis is to report more than three years of follow-up results of radiofrequency ablation for PTMCs. METHODS: Ovid PUBMED, COCHRANE, and EMBASE databases were searched through Nov 19, 2023, for studies reporting outcomes in patients with PTMC treated with radiofrequency ablation and followed up for more than 3 years. The standard mean difference of the tumor volume before and after therapy, tumor recurrence, lymph node (LN) metastasis, distant metastasis, complications, and the pooled volume reduction rates (VRRs) at 1, 3, 6, 12, 24, 36, and 48 months after radiofrequency ablation were assessed. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines. RESULTS: Eight studies, involving 2131 patients, met the inclusion criteria through database searches. The overall VRR was 99.81 % (95 % CI: 99.68, 99.95) in the last follow-up. During a mean pooled follow-up of 46.59 months, 69 patients experienced local PTMC recurrence, with 8 cases within the ablation area. Additionally, 44 patients were diagnosed with newly discovered PTMC, and 17 patients exhibited lymph node metastases. Among the patients with PTMC recurrence, 3 were under active surveillance while 59 underwent additional RFA. The pooled mean complication rate was 2.80 %, with no instances of life-threatening or delayed complications. CONCLUSIONS: Radiofrequency ablation proves to be an effective local tumor control method for low-risk PTMC patients, resulting in clinically significant and enduring volume reduction. The rate of regrowth and retreatment requirement post-RFA was notably lower, positioning RFA as a compelling alternative to existing treatment options.

Efficacy of ultrasound in the treatment of osteoarthritis of the knee.

OBJECTIVE: To investigate the effect of ultrasound in the treatment of osteoarthritis of the knee. METHODS: Eighty-seven out- and in-patients with osteoarthritis of the knee (15 men and 72 women) underwent ultrasonic therapy from February to October 2010. The patients were randomly assigned to an ultrasound group (Group A) and a placebo group (Group B). Group A was offered ultrasonic therapy while Group B underwent mock treatment. The visual analogue scale (VAS) and Lequesne scores of the two groups before and after treatment were compared. The data were analyzed by normal distribution, Student's t-test and the rank sum test. The means during and after treatment of the VAS and Lequesne efficacy index of the treatment group were calculated and plotted on a bar graph. RESULTS: Single sample analysis of Groups A and B showed VAS efficacy index: mean = 0.3640, P= 0.000; Lequesne efficacy index, median = 0.3080, P= 0.000, and mean = 0.1000, P= 0.000; Lequesne efficacy index, mean = 0.0364, P= 0.024, respectively. Independent samples t test and rank sum test showed significant differences between the two groups, namely P= 0.000 for both the VAS and Lequesne curative effect indexes. The means of the VAS efficacy index of the treatment group increased during and after treatment. The means of the Lequesne efficacy index of the treatment group showed no apparent decrease by 28 days after treatment. CONCLUSION: Ultrasound treatment significantly alleviates joint symptoms, relieving joint swelling, increasing joint mobility and reducing inflammation, in osteoarthritis patients.

Effects of air traffic geometry on pilots' conflict detection with cockpit display of traffic information.

OBJECTIVE: This experiment attempted to identify the features of air traffic geometry that would influence the difficulty and biases of pilots' conflict detection using a cockpit display of traffic information (CDTI). BACKGROUND: There was previously no systematic study on effects of such features on conflict detection using the CDTI. METHOD: Twenty-four pilots viewed dynamic encounters between their own aircraft and an intruder aircraft on a simulated CDTI; difficulty was varied by the intruder aircraft's distance and time to closest point of approach (CPA), relative speed, miss distance at CPA, approach side, and conflict angle. Participants estimated the intruder's location at, and its time to, CPA. Effects on three estimation error measures were explored: intruder's miss distance at CPA, orientation at CPA, and time to CPA. RESULTS: (a) Estimation errors increased with slower speeds, longer times to CPA, and longer distances to CPA and with longer miss distances at CPA; (b) the best performance occurred at a conflict angle of 90 degrees; (c) there was a bias to judge conflicts to be more risky than was actually the case; and (d) there was a "distance-over-speed" bias, such that two aircraft farther apart and converging rapidly were perceived as less risky than when they were closer to each other and converging at a slower rate, despite identical time to CPA. CONCLUSION: Pilots' conflict detection with CDTI was subject to various errors and biases, which has important safety implications. APPLICATION: The design of procedures, displays, and decision support tools for the free flight environment needs to take these human performance limitations into account.

Effects of conflict alerting system reliability and task difficulty on pilots' conflict detection with cockpit display of traffic information.

A total of 24 pilots viewed dynamic encounters between their own aircraft and an intruder aircraft on a 2-D cockpit display of traffic information (CDTI) and estimated the point and time of closest approach. A three-level alerting system provided a correct categorical estimate of the projected miss distance on 83% of the trials. The remaining 17% of alerts were equally divided between misses and false alarms, of large and small magnitude. Roughly half the pilots depended on automation to improve estimation of miss distance relative to the baseline pilots, who viewed identical trials without the aid of automated alerts. Moreover, they did so more on the more difficult traffic trials resulting in improved performance on the 83% correct automation trials without causing harm on the 17% automation-error trials, compared to the baseline group. The automated alerts appeared to lead pilots to inspect the raw data more closely. While assisting the accurate prediction of miss distance, the automation led to an underestimate of the time remaining until the point of closest approach. The results point to the benefits of even imperfect automation in the strategic alerts characteristic of the CDTI, at least as long as this reliability remains high (above 80%).

Pilot maneuver choice and workload in free flight.

Two experiments examined pilots' maneuver choice and visual workload in a free-flight simulation. In Experiment 1, 12 pilots flew a high-fidelity flight simulator with a cockpit display of traffic information and maneuvered to avoid traffic in a simulated free-flight environment. Pilots' choices reflected a preference to make vertical rather than lateral avoidance maneuvers and to climb rather than descend. Pilots avoided both complex maneuvers and airspeed maneuvers. The data were modeled in terms of how pilots traded off factors related to safety, efficiency, mental effort, and prior habits. In Experiment 2, 10 pilots flew the same maneuvers as the pilots in Experiment 1 but followed ATC instructions rather than using the CDTI. The CDTI in Experiment 1 occupied 25% of the pilots' visual attention. A comparison of scanning with Experiment 2 suggested that the CDTI pulled visual attention away from the outside world, but this attention diversion did not leave pilots vulnerable to missing traffic not annunciated on the CDTI. Actual or potential applications of the results include understanding the safety implications of presenting traffic displays in the cockpit, and the impact of pilot maneuver preferences on airspace procedures.