ABSTRACT
Active surveillance, as a first-line treatment strategy for low-risk papillary thyroid microcarcinoma, has been recommended by guidelines worldwide. However, active surveillance has not been widely accepted by doctors and patients in China. In view of the huge challenges faced by active surveillance, doctors should improve their understanding of the "low risk" of papillary thyroid micropapillary cancer, identify some intermediate or high-risk cases, be familiar with the criteria and methods of diagnosis for disease progression, and timely turn patients with disease progression into more active treatment strategies. By analyzing the long-term cost-effectiveness of active surveillance, it is clear that medical expense is only one cost form of medical activities, and the health cost (thyroid removal and surgical complications) paid by patients due to"over-diagnosis and over-treatment" is the most important. Moreover, the weakening of the patients' social function caused by surgical procedures is a more hidden and far-reaching cost. The formulation of health economic policies (including medical insurance) should promote the adjustment of diagnosis and treatment behavior to the direction which is conducive to the long-term life and treatment of patients, improving the overall health level of society and reducing the overall cost. At the same time, doctors should stimulate the subjective initiative of patients, help them fully understand the impact of various treatment methods on their psychological and physical status, support patients psychologically, and strengthen their confidence in implementing active surveillance. By strengthening multi-disciplinary treatment team and system support, doctors can achieve risk stratification of papillary thyroid microcarcinoma, accurate judgment of disease progress, timely counseling for psychological problems, and long-term adherence to active surveillance. Improving the treatment level of advanced thyroid cancer is the key point of improve the prognosis. It is important to promote the development of active surveillance for low-risk papillary thyroid microcarcinoma. In the future, it is necessary to carry out multi-center prospective research and accumulate research evidence for promoting the standardization process of active surveillance. Standardized active surveillance will certainly benefit specific papillary thyroid microcarcinoma patients.
Subject(s)
Humans , Thyroidectomy/methods , Prospective Studies , Watchful Waiting/methods , Thyroid Neoplasms/pathology , Disease Progression , Thyroid Cancer, Papillary/surgeryABSTRACT
Objective: To compare the clinical effects of endoscopic thyroidectomy using a modified gasless transsubclavian approach and the traditional neck approach for unilateral papillary thyroid carcinoma (cN0). Methods: The clinical data of 135 patients with cN0 papillary thyroid carcinoma who underwent unilateral thyroidectomy in the Department of Thyroid Surgery, the First Hospital of Jilin University from October 2020 to November 2022 were retrospectively analyzed. There were 37 males and 98 females, aging (43.2±8.8) years (range: 21 to 59 years). There were 51 cases using the modified gasless transsubclavian approach (TS group) and 84 cases using the traditional neck approach (TN group). Comparative analyses were performed between the operative results of the 2 groups by t-test, Wilcoxon rank sum test, and χ2 test. Results: All endoscopic operations were successfully completed without conversion to the traditional neck approach. Compared to the TN group, the TS group had a longer operation time (M(IQR)) (73.5 (22.5) minutes vs. 90.0 (30.0) minutes, Z=-5.831, P<0.01), more postoperative drainage (60 (25) ml vs. 95 (45) ml, Z=-6.275, P<0.01), higher hospitalization costs (22 687 (3 488) yuan vs. 26 652 (2 431) yuan, Z=-6.944, P<0.01), and a higher rate of parathyroid autotransplantation (15.5% (13/84) vs. 60.8% (31/51), χ2=29.651, P<0.01). There was no significant difference in the total exposure rate of the central compartment, postoperative hospitalization time, the number of dissected lymph nodes, the number of metastatic lymph nodes, C-reactive protein ratio before and after operation, and preoperative and postoperative parathyroid hormone (all P>0.05). Conclusions: Endoscopic thyroidectomy using the modified gasless transsubclavian approach is safe for cN0 papillary thyroid carcinoma, with longer operating time, more postoperative drainage, higher hospitalization costs, and moredifficulty in preserving the inferior parathyroid gland in situ compared to traditional open surgery.
ABSTRACT
Objective To assess the role of microRNA-9 in bone marrow mesenchymal stem cells differentiating into neurons and research the role of gene modification in spinal cord injury treatment.Methods Adherent culture was used to isolate and culture rat bone marrow mesenchymal stem cells (MSCs); microRNA-9-1 lentiviral vector was constructed.Acute spinal cord injury (SCI) models were established in 84 adult SD rats at T10/11 level according to the improved Allen's method; then,they were randomly divided into control group,MSCs group and miRNA group (n=28).One week after SCI,the rats of MSCs group were treated with MSCs implantation,and the rats of miRNA group were treated with MSCs-transfected microRNA-9-1 lentiviral vector; while rats of the control group only received the same amount of physical saline in the same region.The neurological functions were evaluated by using Basso-Beattie-Bresnahan (BBB) scale 1 and 3 days,and 1,2,4,6,8 and 12 weeks after SCI.The immunoreactivity of neuro filament 200 (NF-200) and glial fibrillary acidic protein (GFAP) was measured,and the percentage of positive response area was assayed and compared between groups.Results Four weeks after cell transplantation,statistical difference of BBB scale scores was noted between each two groups; the scores of miRNA group were significantly higher than those of the MSCs group and control group (P＜0.05).The immunohistochemistry staining indicated that the expression of NF-200 was significantly more intense and the expression of GFAP was significantly weaker in miRNA group than those of the other two groups (P＜0.05).Conclusion MicroRNA-9 may play an important role in bone marrow mesenchymal stem cells differentiating into neurons,and possess effects on repairing injured spinal cord and promoting functional recovery through promoting axonal regeneration and reducing the number of reactive glial cells in the spinal cord injury site.