Analgesic effects of pectoserratus plane block and intermediate cervical plexus block for transaxillary endoscopic thyroidectomy: a prospective randomized controlled trial.

BACKGROUND: Transaxillary endoscopic thyroidectomy (TAET) is favored for its favorable cosmetic outcomes and the preservation of anterior cervical function. Despite these benefits, postoperative analgesia has traditionally relied on pharmacological interventions, and regional anesthetic procedures may be an alternative method. This study aimed to evaluate the efficacy of an ultrasound-guided pectoserratus plane block (PSPB) combined with an intermediate cervical plexus block (ICPB) for TAET. METHODS: Forty patients undergoing TAET were randomized into two groups: the nerve block group (N.=20) received ultrasound guided PSPB with 20 ml of 0.375% ropivacaine and ICPB with 8 mL of 0.3% ropivacaine, while the control group (N.=20) received no block. The primary outcome was the Visual Analog Scale (VAS) scores for postoperative neck and axillary pain at different time points (1, 6, 12, 24 h) during rest and movement post-TAET. The secondary outcomes included intraoperative remifentanil consumption, incidence of postoperative nausea and vomiting (PONV), number of remedial analgesic requirements, and patient satisfaction postoperatively. RESULTS: Compared to the control group, patients in the nerve block had significantly lower VAS scores of the neck and axilla whether at rest or movement, and 1, 6, 12, and 24 h postoperatively (P<0.0125). The nerve block group showed higher patient satisfaction (P<0.001). No difference was observed in intraoperative remifentanil consumption, need for rescue analgesics, or other adverse effects 48 h postoperatively. CONCLUSIONS: Ultrasound-guided PSPB with ICPB significantly alleviated postoperative pain and improved patient satisfaction with TAET.

A novel nomogram for identifying high-risk patients among active surveillance candidates with papillary thyroid microcarcinoma.

Objective: Active surveillance (AS) has been recommended as the first-line treatment strategy for low-risk (LR) papillary thyroid microcarcinoma (PTMC) according to the guidelines. However, preoperative imaging and fine-needle aspiration could not rule out a small group of patients with aggressive PTMC with large-volume lymph node micro-metastasis, extrathryoidal invasion to surrounding soft tissue, or high-grade malignancy from the AS candidates. Methods: Among 2,809 PTMC patients, 2,473 patients were enrolled in this study according to the inclusion criteria. Backward stepwise multivariate logistic regression analysis was used to filter clinical characteristics and ultrasound features to identify independent predictors of high-risk (HR) patients. A nomogram was developed and validated according to selected risk factors for the identification of an HR subgroup among "LR" PTMC patients before operation. Results: For identifying independent risk factors, multivariable logistic regression analysis was performed using the backward stepwise method and revealed that male sex [3.91 (2.58-5.92)], older age [0.94 (0.92-0.96)], largest tumor diameter [26.7 (10.57-69.22)], bilaterality [1.44 (1.01-2.3)], and multifocality [1.14 (1.01-2.26)] were independent predictors of the HR group. Based on these independent risk factors, a nomogram model was developed for predicting the probability of HR. The C index was 0.806 (95% CI, 0.765-0.847), which indicated satisfactory accuracy of the nomogram in predicting the probability of HR. Conclusion: Taken together, we developed and validated a nomogram model to predict HR of PTMC, which could be useful for patient counseling and facilitating treatment-related decision-making.

Comparisons of different approaches and incisions of thyroid surgery and selection strategy.

To date, the traditional open thyroid surgery via a low collar incision remains the standard approach for patients undergoing thyroidectomy. However, this conventional approach will inevitably leave patients a neck scar and even cause a variety of complications such as paresthesia, hypesthesia, and other uncomfortable sensations. With the progress in surgical techniques, especially in endoscopic surgery, and the increasing desire for cosmetic and functional outcomes, various new approaches for thyroidectomy have been developed to avoid or decrease side effects. Some of these alternative approaches have obvious advantages compared with traditional surgery and have already been widely used in the treatment of thyroid disease, but each has its limitations. This review aims to evaluate and compare the different approaches to thyroidectomy to help surgeons make the proper treatment strategy for different individuals.

High throughput sequencing revealed enhanced cell cycle signaling in SLE patients.

The multi-system involvement and high heterogeneity of systemic lupus erythematosus (SLE) pose great challenges to its diagnosis and treatment. The purpose of the current study is to identify genes and pathways involved in the pathogenesis of SLE. High throughput sequencing was performed on the PBMCs from SLE patients. We conducted differential gene analysis, gene ontology (GO) analysis, kyoto encyclopedia of genes and genomes (KEGG) analysis, and quantitative real-time PCR (qRT-PCR) verification. Protein-protein interaction (PPI) analysis, alternative splicing analysis, and disease correlation analysis were conducted on some key pathogenic genes as well. Furthermore, si-CDC6 was used for transfection and cell proliferation was monitored using a cell counting kit-8 (CCK-8) assay. We identified 2495 differential genes (1494 upregulated and 1001 downregulated) in SLE patients compared with healthy controls. The significantly upregulated genes were enriched in the biological process-related GO terms of the cell cycle, response to stress, and chromosome organization. KEGG enrichment analysis revealed 7 significantly upregulated pathways including SLE, alcoholism, viral carcinogenesis, cell cycle, proteasome, malaria, and transcriptional misregulation in cancer. We successfully verified some differential genes on the SLE pathway and the cell cycle pathway. CDC6, a key gene in the cell cycle pathway, had remarkably higher MXE alternative splicing events in SLE patients than that in controls, which may explain its significant upregulation in SLE patients. We found that CDC6 participates in the pathogenesis of many proliferation-related diseases and its levels are positively correlated with the severity of SLE. Knockdown of CDC6 suppressed the proliferation of Hela cells and PBMCs from SLE patients in vitro. We identified SLE-related genes and their alternative splicing events. The cell cycle pathway and the cell cycle-related biological processes are over-activated in SLE patients. We revealed a higher incidence of MXE events of CDC6, which may lead to its high expression in SLE patients. Upregulated cell cycle signaling and CDC6 may be related to the hyperproliferation and pathogenesis of SLE.

Optimization-Based Post-Training Quantization With Bit-Split and Stitching.

Deep neural networks have shown great promise in various domains. Meanwhile, problems including the storage and computing overheads arise along with these breakthroughs. To solve these problems, network quantization has received increasing attention due to its high efficiency and hardware-friendly property. Nonetheless, most existing quantization approaches rely on the full training dataset and the time-consuming fine-tuning process to retain accuracy. Post-training quantization does not have these problems, however, it has mainly been shown effective for 8-bit quantization. In this paper, we theoretically analyze the effect of network quantization and show that the quantization loss in the final output layer is bounded by the layer-wise activation reconstruction error. Based on this analysis, we propose an Optimization-based Post-training Quantization framework and a novel Bit-split optimization approach to achieve minimal accuracy degradation. The proposed framework is validated on a variety of computer vision tasks, including image classification, object detection, instance segmentation, with various network architectures. Specifically, we achieve near-original model performance even when quantizing FP32 models to 3-bit without fine-tuning.

Extremely Sparse Networks via Binary Augmented Pruning for Fast Image Classification.

Network pruning and binarization have been demonstrated to be effective in neural network accelerator design for high speed and energy efficiency. However, most existing pruning approaches achieve a poor tradeoff between accuracy and efficiency, which on the other hand, has limited the progress of neural network accelerators. At the same time, binary networks are highly efficient, however, a large accuracy gap exists between binary networks and their full-precision counterparts. In this article, we investigate the merits of extremely sparse networks with binary connections for image classification through software-hardware codesign. More specifically, we first propose a binary augmented extremely pruning method that can achieve ~98% sparsity with small accuracy degradation. Then we design the hardware architecture based on the resulting sparse and binary networks, which extensively explores the benefits of extreme sparsity with negligible resource consumption introduced by binary branch. Experiments on large-scale ImageNet classification and field-programmable gate array (FPGA) demonstrate that the proposed software-hardware architecture can achieve a prominent tradeoff between accuracy and efficiency.

Retraction: MicroRNA-497 inhibits thyroid cancer tumor growth and invasion by suppressing BDNF.

[This retracts the article DOI: 10.18632/oncotarget.13747.].

Toward Accurate Binarized Neural Networks With Sparsity for Mobile Application.

While binarized neural networks (BNNs) have attracted great interest, popular approaches proposed so far mainly exploit the symmetric sign function for feature binarization, i.e., to binarize activations into -1 and +1 with a fixed threshold of 0. However, whether this option is optimal has been largely overlooked. In this work, we propose the Sparsity-inducing BNN (Si-BNN) to quantize the activations to be either 0 or +1, which better approximates ReLU using 1-bit. We further introduce trainable thresholds into the backward function of binarization to guide the gradient propagation. Our method dramatically outperforms the current state-of-the-art, lowering the performance gap between full-precision networks and BNNs on mainstream architectures, achieving the new state-of-the-art on binarized AlexNet (Top-1 50.5%), ResNet-18 (Top-1 62.2%), and ResNet-50 (Top-1 68.3%). At inference time, Si-BNN still enjoys the high efficiency of bit-wise operations. In our implementation, the running time of binary AlexNet on the CPU can be competitive with the popular GPU-based deep learning framework.

[Retracted] Silencing NOB1 enhances doxorubicin antitumor activity of the papillary thyroid carcinoma in vitro and in vivo.

Following the publication of this paper, it was drawn to the Editors' attention by a concerned reader that certain of the western blotting assay data shown in Figs. 2 and 5, and the tumour images shown in Fig. 6A, were strikingly similar to data appearing in different form in other articles by different authors. Owing to the fact that the contentious data in the above article had already been published elsewhere, or were already under consideration for publication, prior to its submission to Oncology Reports, the Editor has decided that this paper should be retracted from the Journal. After having been in contact with the authors, they agreed with the decision to retract the paper. The Editor apologizes to the readership for any inconvenience caused. [the original article was published in Oncology Reports 33: 1551-1559, 2015; DOI: 10.3892/or.2015.3730].

Prednisolone induces sleep disorders via inhibition of melatonin secretion by the circadian rhythm in zebrafish.

Prednisolone (PN) is a glucocorticoid (GC) analog that is clinically used to treat allergic inflammation and autoimmune diseases. However, the long-term use of GC-like drugs results in many side effects, among which sleep disorders caused by PN have attracted much attention. Many studies have showed that GCs indirectly cause sleep disorders by disrupting the circadian rhythm of the peripheral biological clock. However, the detailed mechanism of this effect in zebrafish remains unclear. In the present study, we aimed to study the pharmacology and toxicology of PN by analyzing the sleep phenotype and internal circadian oscillation of zebrafish. Exposure of zebrafish to PN resulted in decreased melatonin secretion and shortened sleep time. Additionally, analysis of the internal circadian rhythm of the zebrafish revealed that the expression of per and cry was significantly upregulated, resulting in a significant delay in the phase of the zebrafish behavioral rhythm. A dual-luciferase reporter assay further revealed that PN repressed per2 and cry1aa expression via the GC receptor (GR), which inhibited aanat2 expression. This caused a decrease in melatonin secretion and led to sleep disorders. The findings of this study highlight the mechanisms underlying the effects of GCs on sleep.

Isolation, purification, gene cloning and expression of antifungal protein from Bacillus amyloliquefaciens MG-3.

The antifungal protein MG-3A was isolated from Bacillus amyloliquefaciens MG-3, and was purified and identified. The results showed that antifungal protein MG-3A was likely a serine protease with a molecular weight of ~48 kDa. The serine protease exhibited a broad antifungal spectrum and effectively extended the shelf-life of loquat fruit up to 25 d. The antifungal protein MG-3A showed good stabilities to temperature, pH and protease K. Primers were designed according to the mass spectrum of antifungal protein and the comparison with proteins in the NCBI database. The serine protease gene MG-3A from B. amyloliquefaciens genome was isolated and cloned using PCR. The prokaryotic expression plasmid pET28a-MG-3A was constructed and used to express the antimicrobial protein in vitro. The SDS-PAGE results showed that the recombinant protein expressed in Escherichia coli BL21 (DE3) was highly soluble. Affinity chromatography was used to purify the recombinant protein and its antifungal activity was evaluated.

Supraclavicular Approach of Lobectomy Improves Quality of Life for Patients With Unilateral Papillary Thyroid Microcarcinoma: A Prospective Cohort Study.

Objective: Postoperative neck symptoms, including pain, swelling, uncomfortable feelings during swallowing, and incision adhesion formation, are common in patients after lobectomy through the traditional middle neck approach. A new unilateral supraclavicular approach is proposed to protect the anterior cervical region and reduce related complications. The aim of this study is to investigate the efficacy, safety, and advantages of the supraclavicular approach in lobectomy for unilateral papillary thyroid microcarcinoma (PTMC). Methods: Two hundred sixty-three patients were recruited into either a conventional middle group (CM) or a new supraclavicular (NS) group. Clinicopathological features, surgically related variables, and postoperative symptoms were recorded. Quality of life (QOL) of all patients was assessed by the 12-item short-form health survey (SF-12) and thyroid cancer-specific QOL (THYCA-QoL) questionnaire in 3 and 12 months. Results: There were no statistically significant differences in clinicopathological features (including sex, age, multifocality, extrathyroidal extension, histological variants, largest tumor diameter, Hashimoto's thyroiditis, metastasized central lymph node, removed central lymph node, surgeon, BRAF mutation, and follow-up duration), hospitalization (including hospital cost, surgery time, and blood loss during surgery), and complications between the two groups. Patients who underwent lobectomy through the NS approach had significantly better SF-12 physical, mental, and THYCA-QoL than the CM group patients in both 3 and 12 months (all p < 0.001). Moreover, the NS group had a shorter hospitalization time. Conclusion: In conclusion, the NS approach for lobectomy is a safe and effective method for reducing postoperative symptoms and increasing QOL in patients with unilateral PTMC in both 3 and 12 months' follow-up.

Unsupervised Network Quantization via Fixed-Point Factorization.

The deep neural network (DNN) has achieved remarkable performance in a wide range of applications at the cost of huge memory and computational complexity. Fixed-point network quantization emerges as a popular acceleration and compression method but still suffers from huge performance degradation when extremely low-bit quantization is utilized. Moreover, current fixed-point quantization methods rely heavily on supervised retraining using large amounts of the labeled training data, while the labeled data are hard to obtain in the real-world applications. In this article, we propose an efficient framework, namely, fixed-point factorized network (FFN), to turn all weights into ternary values, i.e., {-1, 0, 1}. We highlight that the proposed FFN framework can achieve negligible degradation even without any supervised retraining on the labeled data. Note that the activations can be easily quantized into an 8-bit format; thus, the resulting networks only have low-bit fixed-point additions that are significantly more efficient than 32-bit floating-point multiply-accumulate operations (MACs). Extensive experiments on large-scale ImageNet classification and object detection on MS COCO show that the proposed FFN can achieve about more than 20× compression and remove most of the multiply operations with comparable accuracy. Codes are available on GitHub at https://github.com/wps712/FFN.

Modeling and Optimization of Electrostatic Film Actuators Based on the Method of Moments.

Electrostatic film actuators represent a promising new approach to drive a soft robot, but they lack a comprehensive model to link the design parameters and actuation performance, making actuator design and parameter optimization challenging. To solve this problem, we build a mathematical model based on the method of moments by assuming that each electrode consists of a large number of line charges. This model can directly deduce fluctuation in thrust and adhesive forces during actuator movement, as well as the distribution of electric potential and field strength, for analysis and optimization. It consumes shorter computing time and fewer computing resources, but with comparable accuracy, in comparison with previous indirect means. It is validated by results from both previous studies and on-site experiments. Based on this model, we generate numerous values of actuator output force for different structural parameters. By analyzing the tendency, we summarize a parameter optimization workflow and write an open-sourced program as an example to facilitate the parameter selection for actuator design starting from scratch.

Predictive Factors of Central-Compartment Lymph Node Metastasis for Clinical N0 Papillary Thyroid Carcinoma With Strap Muscle Invasion.

Background: Papillary thyroid carcinoma (PTC) patients with anterior extrathyroidal extension (ETE) involving the strap muscle have a relatively better prognosis than those with posterior gross ETE involving the recurrent laryngeal nerve. Whether prophylactic central-compartment lymph node dissection (CLND) should be performed in PTCs with only strap muscle invasion (SMI) is still unclear. Methods: A retrospective cohort study was conducted in clinical N0 (cN0) PTC patients with SMI who underwent thyroid surgery from 2009 to 2017. A total of 152 patients were included, and predictive factors of central-compartment lymph node metastasis (CLNM) were determined. Results: Among the 281 PTCs patients with SMI, 152 (51.1%) did not clinically present with lymph node metastasis. Microscopic CLNM was identified in 77 (50.7%) cN0 PTC patients with SMI. According to the univariate and multivariate analyses, male patients and those aged <40 years were more likely to be diagnosed with CLNM than female patients and those aged >40 years (odds ratio [OR] = 6.22 [95% confidence interval (CI), 1.43-27.10], p = 0.02 vs. OR = 9.94 [95% CI, 2.79-35.44], p = 0.00). The CLNM positive rate of male patients aged <40 years was 87.5%, while that for female patients aged ≥55 years was 23.8%. However, risk factors associated with large-volume CLNM were not identified because of the small number of patients. Conclusions: Taken together, nearly half of PTC patients with SMI did not clinically present with lymph node metastasis. Male sex and patients aged <40 years were identified as the predictive factors of CLNM in cN0 PTCs with SMI. Hence, the results of this single-center study raise the possibility that prophylactic CLND may be more often considered for younger male PTC patients with SMI.

Impact of Gross Strap Muscle Invasion on Outcome of Differentiated Thyroid Cancer: Systematic Review and Meta-Analysis.

Background: Gross strap muscle invasion (gSMI) in patients with differentiated thyroid cancer (DTC) was defined as high-risk recurrent group in the 2015 American Thyroid Association guidelines. However, controversy persists because several studies suggested gSMI had little effect on disease outcome. Herein, a systematic review and meta-analysis was conducted to investigate impact of gSMI on outcome of DTC. Methods: A systematic search of electronic databases (PubMed, EMBASE, Cochrane Library, and MEDLINE) for studies published until February 2020 was performed. Case-control studies and randomized controlled trials that studied the impact of gSMI on outcome of DTC were included. Results: Six studies (all retrospective studies) involving 13,639 patients met final inclusion criteria. Compared with no extrathyroidal extension (ETE), patients with gSMI were associated with increased risk of recurrence (P = 0.0004, OR, 1.46; 95% CI: 1.18-1.80) and lymph node metastasis (LNM) (P < 0.00001, OR 4.19; 95% CI: 2.53-6.96). For mortality (P = 0.34, OR 1.47; 95% CI: 0.67-3.25), 10 year disease-specific survival (P = 0.80, OR 0.91; 95% CI: 0.44-1.88), and distant metastasis (DM) (P = 0.21, OR 2.94; 95% CI: 0.54-15.93), there was no significant difference between gSMI and no ETE group. In contrast with maximal ETE(extension of the primary tumor to the trachea, esophagus, recurrent laryngeal nerve, larynx, subcutaneous soft tissue, skin, internal jugular vein, or carotid artery), patients with gSMI were associated with decreased risk of recurrence (P < 0.0001, OR, 0.58; 95% CI: 0.44-0.76), mortality (P = 0.0003, OR 0.20; 95% CI: 0.08-0.48), LNM (P = 0.0003, OR 0.64; 95% CI: 0.50-0.81), and DM (P = 0.0009, OR 0.28; 95% CI: 0.13-0.59). Conclusions : DTC patients with gSMI had a higher risk of recurrence and LNM than those without ETE. However, in contrast with maximal ETE, a much better prognosis was observed in DTC patients with only gSMI.

Endophytic Bacillus amyloliquefaciens YTB1407 elicits resistance against two fungal pathogens in sweet potato (Ipomoea batatas (L.) Lam.).

The endophytic Bacillus amyloliquefaciens YTB1407 was previously reported to promote the growth of sweet potato (Ipomoea batatas cv. Yanshu 25). Here, we demonstrate in both in vitro and pot trial assays that pre-treatment with YTB1407 suspension could enhance resistance against root rot disease and black rot disease, caused by Fusarium solani Mart. Sacc. f. sp. batatas McClure and Ceratocystis fimbriata Ell. & Halst on sweet potato, respectively. When seedlings were infected with fungal pathogens at 10 days post irrigation, pre-treatment with YTB1407 suspension decreased these pathogens and YTB1407 bacterial biomass in sweet potato roots. The pre-treatment activated the expression of salicylic acid (SA)-responsive PR-1 gene, raised SA content, and reduced hydrogen peroxide (H2O2) in the host to resist F. solani, while it enhanced the expression levels of SA-responsive NPR1 and PR1 genes and increased SA content to resist C. fimbriata. The disease resistance control effect initiated by pre-treatment with YTB1407 for root rot pathogen (F. solani) was better than for black rot pathogen (C. fimbriata). The results indicated that Bacillus amyloliquefaciens YTB1407 played a pivotal role in enhancing resistance to two fungi pathogens in sweet potato, through production of some antifungal metabolites to decrease infection in the early stage as well as induction of SA-dependent systemic resistance.

Clinical and Ultrasonic Risk Factors for Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis.

Background: Clinical and ultrasonic risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid microcarcinoma (PTMC) are not well-defined. Herein, a systematic review and meta-analysis was conducted to investigate clinicopathologic and ultrasonic risk features for LLNM in PTMC. Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) for studies published until April 2019 was performed. Case-control studies and randomized controlled trials that studied clinical and ultrasonic risk factors of LLNM in PTMC were included. Results: Fourteen studies (all retrospective studies) involving 43,750 patients met final inclusion criteria. From the pooled analyses, younger age<45 (OR, 1.55; 95% CI, 1.16-2.07; P = 0.003), male patients (OR, 1.94; 95% CI, 1.55-2.42; P < 0.00), extrathyroidal extension (OR, 3.63; 95% CI, 2.28-5.77; P <0.00), tumor multifocality (OR, 2.24; 95% CI, 1.53-3.28; P <0.00), tumor > 0.5 cm (OR, 2.24; 95% CI, 1.53-3.28; P < 0.00), central lymph node metastasis (OR, 5.61; 95% CI, 4.64-6.79; P < 0.00), >25% tumor contact with thyroid capsule (OR, 6.66; 95% CI, 1.96-22.65; P = 0.002), tumor calcification (OR, 2.90; 95% CI, 1.71-4.93; P < 0.00), upper tumor (OR, 3.18; 95% CI, 2.23-4.55; P < 0.00) were significantly associated with increased risk of LLNM in PTMC, while Hashimoto's thyroiditis and other ultrasonic features (solid tumor, hypoechoic tumor, smooth margin, and taller than wide tumor) were not significantly associated with LLNM in PTMC. Conclusions: Our analysis identified several clinicopathologic and ultrasonic factors associated with LLNM in PTMC. This finding highlights the need for a cautious and frequent postoperative surveillance of the lateral neck in high-risk PTMC patients. Moreover, high-risk ultrasonic features also need to be considered during selection of PTMC for active surveillance.

Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases.

Background: Lateral lymph node metastasis (LLNM) is associated with distant metastasis, locoregional recurrence and cancer-specific mortality, although the prevalence of LLNM among patients with papillary thyroid microcarcinoma (PTMC) is relatively low. The potential benefits and risks of routine lateral level V dissection (LVD) for PTMC with LLNM have not been previously investigated. Methods: A total of 6,880 consecutive PTMC patients who underwent initial surgery at the First Hospital of Jilin University from January 2009 to July 2017 were retrospectively analyzed. A total of 252 N1b PTMC patients were enrolled in our study. Results: The overall and occult metastasis rates in level V lymph nodes were 21.4 and 6.4%, respectively. Patients with N1b PTMC who received LVD did not show a significantly lower disease-free survival (DFS) than that of patients who did not receive LVD [hazard ratio = 1.11 (CI 0.38-3.21); p = 0.85]. Meanwhile, LVD simultaneously increased the hospital stay and cost (p = 0.03; 0.02). Multivariate logistic regression analysis revealed that 3-level simultaneous metastasis in the lateral neck was an independent risk factor for level V metastasis [odds ratio = 8.6 (CI 1.42-51.72); p = 0.02]. Conclusions: Because of the low metastasis rate in level V lymph nodes, the lack of benefit for recurrence, the longer hospital stay and the higher cost associated with LVD, N1b PTMC patients without clinical level V metastasis may not need to undergo routine dissection. Prophylactic LVD may be recommended only for patients with N1b PTMC with 3-level simultaneous metastasis.

Predictive Factors of Recurrence for Multifocal Papillary Thyroid Microcarcinoma With Brafv600e Mutation: A Single Center Study of 1,207 Chinese Patients.

Background: The American Thyroid Association (ATA) guidelines risk stratify Brafv600e mutated multifocal papillary thyroid microcarcinoma (BMPTMC) into different recurrence risk groups by the extent of extrathyroidal extension (ETE). These findings and modifications for BMPTMC need to be verified in additional studies. Methods: A retrospective cohort study was conducted in BMPTMC patients who underwent total thyroidectomy (TT) and central lymph node dissection (CLND) from 2008 to 2013. Overall, 1,207 patients were included, and predictive factors were identified by univariate and multivariate analysis over a mean 7.5-year follow up. Results: BMPTMC with ETE to capsule shows the same recurrence rate (3.8%) with intrathyroidal BMPTMC. Moreover, BMPTMC with ETE only to strap muscle, which belongs to high-risk group according to ATA guideline, shows relatively lower recurrence rate (13.3%) compared with some intermediate risk categories such as cN1 and >5 pN1. Multivariate analysis using a Cox proportional hazards regression model shows that total tumor diameter (TTD) is associated with significantly higher recurrence for BMPTMC with or without other risk factors (Hazard Ratio (HRO) = 9.86 [95%CI 5.35-18.20], p = 0.00; HRO = 2.32 [95%CI 1.12-4.85], p = 0.02; respectively), while Hashimoto thyroiditis (HT) is found to be protective against the recurrence (HRO = 0.51 [95%CI 0.33-0.79], p = 0.00; HRO = 0.47 [95%CI 0.25-0.89], p = 0.02; respectively). Conclusions: Taken together, capsular ETE and gross ETE to the strap muscles did not have the expected significant influence on recurrence for Chinese BMPTMC patients who underwent TT and CLND. Rather than the extent of ETE, TTD and the lack of HT were identified as predictors for recurrence among BMPTMC with or without other risk factors (vascular invasion, cN1, pN1>5, pN1>3 cm).