2022 Expert consensus on the use of laser ablation for papillary thyroid microcarcinoma.

OBJECTIVE: With the aim of standardizing and improving the use of ultrasound-guided PLA on PTMC, a panel of experts from China and Italy, jointly issued this expert consensus on the clinical use of PLA for low-risk PTMC. METHODS: This expert consensus was developed by Chinese and Italian experts who have specific competence and expertise in this area. An evidence-based approach combining the knowledge and practical experience of the panelists was utilized. RESULTS: Twenty-six expert consensus recommendations were developed, spanning topics including the indications and contraindications of PLA for PTMC, physician training, preoperative preparation of patients, intraoperative technical procedures, possible complications, efficacy assessment, follow-up strategy, the approach to new PTMC and metastatic lymph nodes after treatment, thyroid-stimulating hormone inhibition therapy, and quality control of the entire procedure. CONCLUSION: We summarized practical recommendations about standardized and improved PLA treatment for PTMC.

Multidisciplinary team efforts to improve the pregnancy outcome of pregnancy complicated with primary hyperparathyroidism: case series from a single hospital.

BACKGROUND: There is no consensus or management algorithm for primary hyperparathyroidism (PHPT) in pregnancy. METHODS: This study comprises a retrospective case series. From August 2014 to December 2020, 9 cases of PHPT in pregnancy were diagnosed by a multidisciplinary team (MDT) consultation center of obstetrics in our hospital. Their clinical manifestations, treatment strategies, and maternal and infant outcomes were analyzed. RESULTS: The median onset age of the patients was 32 (25 ~ 38) years. PHPT was diagnosed in two cases before pregnancy, in six cases during pregnancy and in one case postpartum. The main clinical manifestations were nausea, vomiting, and other nonspecific symptoms, with anemia as the most common maternal complication. Hypercalcemia crisis was developed in one case. The median levels of preoperative serum calcium and parathyroid hormone (PTH) were 3.08 (2.77 ~ 4.21) mmol/L and 300.40 (108.80 ~ 2603.60) pg/ml, respectively. The parathyroid ultrasonography tests were positive in eight cases and negative in one patient who had an ectopic lesion localized by 99mTc-MIBI. Parathyroidectomy was conducted in 7 cases during the 2nd trimester, including 2 patients diagnosed before pregnancy who refused surgery, 1 patient during the 1st trimester, and 1 patient postpartum, with a significant reduction in serum concentrations of calcium and PTH. A management algorithm was developed. CONCLUSION: This case series suggests that pregnant women with PHPT should be managed by MDT according to the algorithm. If PHPT is confirmed in fertile women before pregnancy, parathyroidectomy should be strongly suggested and performed. If PHPT is diagnosed during pregnancy, even in its mild form, surgical treatment, optimally during the 2nd trimester, is effective and safe for pregnancy and neonatal outcome.

Axillary Staging of Early-Stage Invasive Breast Cancer by Ultrasound-Guided Fine-Needle Aspiration Cytology: Which Ultrasound Criteria for Classifying Abnormal Lymph Nodes Should Be Adopted in the Post-ACOSOG Z0011 Trial Era?

OBJECTIVES: Ultrasound (US)-guided fine-needle aspiration cytology (FNAC) is able to identify patients with extensive node involvement before surgery. In this study, we aimed to establish the optimal US criterion to identify abnormal lymph nodes on US-guided FNAC for detection of patients with 3 or more metastatic axillary nodes. METHODS: A total of 445 axillae from 443 patients with histologically confirmed invasive breast cancer (cT1-2 cN0) were examined with US at Ruijin Hospital from August 2013 to August 2014. Ultrasound-guided FNAC was performed on suspicious nodes when the cortex was eccentrically or concentrically thickened to greater than 2 mm; 269 axillae (60.4%) met the criterion and underwent US-guided FNAC. We retrospectively analyzed the US characteristics of axillary lymph nodes, the US-guided FNAC results, and the extent of axillary nodal involvement. For diagnostic performance, the sensitivity, specificity, and receiver operating characteristic curves were obtained. RESULTS: Eighty-six patients (19.4%) were confirmed to have 3 or more positive lymph nodes by pathologic analysis. There was a significant association between the morphologic change in the most suspicious node and the extent of axillary nodal involvement (P < .001). When we applied the cutoff point (cortical thickness >3.5 mm) at which the maximal sum of sensitivity and specificity for diagnosis of 3 or more axillary lymph node metastases was achieved, we found that the sensitivity and specificity were 75.6% and 82.7%, respectively. When combining this criterion with US-guided FNAC of the most suspicious nodes, the sensitivity and specificity were 64.2% and 94.5%, and 36.1% of cases could be spared an unnecessary 1-step axillary lymph node dissection. CONCLUSIONS: Cortical thickness of greater than 3.5 mm in the most suspicious nodes is appropriately predictive of patients with 3 or more tumor-involved axillary nodes. When this criterion for US-guided FNAC was adopted, a group of patients with 1 or 2 metastatic nodes could be spared unnecessary 1-step axillary lymph node dissection.

Complete degradation of PET waste using a thermophilic microbe-enzyme system.

Enzymatic degradation has been proposed as a suitable solution for addressing PET pollution, but approximately 10 % of PET is left as nonbiodegradable. Microbes can completely degrade PET at the gram level per year. Based on the complementary benefits of microbes and enzymes, a microbe-enzyme system was created to completely degrade PET. Here, a thermophilic microbe-enzyme (TME) system composed of Bacillus thermoamylovorans JQ3 and leaf-branch compost cutinase variant (ICCG) was used to demonstrate the synergistic degradation of PET, enabling 100 % degradation of PET waste at a high PET loading level (360 g/L). Six endogenous PET hydrolases of strain JQ3 were discovered by employing an ester bond hydrolysis function-first genome mining (EGM) strategy and first successfully expressed in E. coli. These hydrolases could release TPA as the final product from PET and preferentially degraded BHET instead of MHET. Of these, carboxylesterase 39_5 and ICCG could degrade PET in a synergistic manner to generate 50 µM of TPA, which was greater than the sum of the individual treatments. Finally, the degradation pathway of the TME system was speculated to include biofilm formation, PET degradation and utilization. The successful implementation of this study rendered a scale-up degradation feasible of PET at a lower cost.

Blood flow resistance in lesion vessels and normal host vessels evaluated by pulsed Doppler ultrasound.

Blood flow rate in the microcirculation is proportional to the arteriole-venule pressure difference and inversely proportional to the blood flow resistance (BFR). Generally, the BFR studies to date have focused on using invasive methods and were carried out in non-physiological conditions. Moreover, few studies have been concerned with the relationships of BFR between the tumor vessels and the normal host vessels. The present study investigated the BFR in malignant lesion vessels, benign lesion vessels and normal host vessels in physiological conditions using pulsed Doppler ultrasound as a tool and the thyroid as a model, A total of 133 patients with thyroid nodules were included in the study. The results revealed that most of the BFR parameters were higher in malignant lesion vessels than in benign lesion vessels (P=0.001-0.029), as well as lower in normal host vessels than in malignant or benign lesion vessels (P=0.000-0.017); Low to moderate significant positive correlations of BFR between benign lesion vessels and normal host vessels were also found (r=0.358-0.480, P=0.000 for all). Finally and interestingly, low negative correlations between the malignant nodule sizes and some of the BFR parameters were revealed, though these correlations were not statistically significant (r=-0.205--0.261, P=0.108-0.211). Our results suggested that pulsed Doppler ultrasound could be successfully used to measure BFR in physiological conditions and to reveal the BFR relationship between lesion vessels and normal host vessels, as well as the relationship between the lesion sizes and the BFR.

Differences in sonographic features of papillary thyroid carcinoma between neck lymph node metastatic and nonmetastatic groups.

OBJECTIVES: The purpose of this study was to assess the differences in sonographic features of papillary thyroid carcinoma between neck lymph node metastatic and non-metastatic groups. METHODS: A total of 155 patients with 155 papillary thyroid carcinoma nodules were included and divided into two groups: with neck lymph node metastases (52 cases) and without neck lymph node metastases (103 cases). The size, shape, border, margin, halo, internal architecture, echogenicity, echo homogeneity, calcifications, and contact extent between the nodule border and thyroid capsule were evaluated by gray scale sonography, and color Doppler sonography was applied to assess the vascularization distribution and vascularization degree in the nodules. The peak systolic velocity, pulsatility index, resistive index, peak systolic velocity difference, pulsatility index difference, and resistive index difference were measured by pulsed Doppler sonography in 80 lesions. The differences in the sonographic features of papillary thyroid carcinoma between the metastatic and nonmetastatic groups were investigated. RESULTS: The differences in the size, percentage of the nodule border that contacted the thyroid capsule, calcifications, vascularization degree, and resistive index difference of the lesions were statistically significant between the metastatic and nonmetastatic groups (P < .05). CONCLUSIONS: Our findings suggest that a larger size, a greater contact percentage, combined microcalcifications and macrocalcifications, a higher blood supply, and a higher resistive index difference were significantly more common in the metastatic group compared to the nonmetastatic group.

Efficacy of Lauromacrogol Injection for Ablation of Benign Predominantly Cystic Thyroid Nodules and Related Factors: A Prospective Study.

OBJECTIVE: To prospectively evaluate the efficacy of lauromacrogol injection for ablation (LIA) of benign predominantly cystic thyroid nodules and its related factors. MATERIALS AND METHODS: A total of 142 benign predominantly cystic thyroid nodules (median volume, 12.5 mL; range, 0.4-156 mL) in 137 patients (male:female sex ratio, 36:101; mean age ± standard deviation [SD], 49 ± 13 years) were treated with LIA after being confirmed as benign via cytology. The volume reduction rate (VRR) of the nodules and cosmetic score were evaluated during follow-up at 1, 3, and 6 months after treatment and every 6 months thereafter. A VRR of ≥ 50% at the 12-month follow-up was considered to indicate effective treatment. The associations between the clinical factors and nodular ultrasound features, including the initial nodule volume, proportion of solid components, vascularity grade and ineffective treatment (VRR of < 50% at the 12-month follow-up), and regrowth were analyzed. RESULTS: All patients completed follow-up for at least 12 months. The average ± SD follow-up period was 32 ± 11 months (range, 12-54 months). The effective treatment rate was 73.2% (104/142), while the regrowth rate was 12.0% (17/142) at the last follow-up. Grade 2-3 intranodular vascularity in the solid components of the nodules was the only independent factor associated with ineffective treatment, with an odds ratio (reference category, grade 0-1) of 3.054 (95% confidence interval, 1.148-8.127) (p = 0.025). CONCLUSION: LIA is an effective treatment for predominantly cystic thyroid nodules. Grade 2-3 intranodular vascularity in the solid components of nodules is the only independent risk factor for ineffective LIA.

Long-term follow-up ultrasonography surveillance in a large cohort of patients with papillary thyroid carcinoma.

OBJECTIVE: This study aimed to investigate the predictive factors as well as the time and age course of recurrence/persistence in a large cohort of postoperative patients with papillary thyroid carcinoma (PTC) based on the long-term ultrasonography (US) follow-up data. METHODS: Between January 2007 and December 2016, 3106 patients underwent surgery for PTC and at least two postoperative US follow-up examination over more than three years. Tumor recurrence/persistence was confirmed based on the follow-up US data and histopathological results. Univariate and multivariate analyses were performed to evaluate the predictive factors of tumor recurrence/persistence. Kaplan-Meier survival analysis was used to evaluate the recurrence-/persistence-free survival curve based on the US results. RESULTS: A total of 321(10.3%) patients developed tumor recurrence/persistence during 54.3 months of mean follow-up (range 36-135 months), including 268(83.5%) cases of lymph node recurrence/persistence, 37 (11.5%) cases of non-lymph node recurrence/persistence, and 16(5%) cases of both types. Recurrence/persistence was observed using US examination at a mean interval of 23.6 ± 21.6 months (range 1-135 months) after surgery and peak incidence was observed 1-2 years after initial treatment. Younger (20-30 years old) and older (70-80 years old) patients had a higher proportion of tumor recurrence/persistence. Multifocality, advanced T and advanced N stages were independent risk factors of tumor recurrence/persistence. CONCLUSION: Tumor recurrence/persistence of PTC usually occurs during the early postoperative period. For patients with multifocal cancer, advanced T and N stage, the US surveillance examination should be cautiously performed, especially in younger and older patients.

Qualitative Evaluation of Virtual Touch Imaging Quantification: A Simple and Useful Method in the Diagnosis of Breast Lesions.

OBJECTIVE: To test the value of qualitative virtual touch imaging quantification (VTIQ) features in differentiating benign from malignant breast lesions. METHODS: From November 2016 to August 2017, 230 lesions were subjected to conventional US and virtual touch imaging quantification before biopsy. The maximum shear wave velocity (SWVmax) was measured using a standardized method. Qualitative VTIQ features, including the "stiff rim" sign and color pattern classification, were assessed according to a binary classification. The sensitivity, specificity and area under the receiver operating curve (AUC) of Breast Imaging Reporting and Data System (BI-RADS), SWVmax, qualitative VTIQ features, and combined data were compared. RESULTS: Among the 230 breast lesions, 150 were benign and 80 were malignant. Compared to the benign lesions, the malignant ones had higher SWVmax values and were more likely to show the "stiff rim" sign and VTIQ pattern 2 (P <0.001 for all). The AUC value was 0.885 for the qualitative VTIQ combination (the presence of the "stiff rim" sign and/or the display of VTIQ pattern 2), similar to that for SWVmax (P=0.472). BI-RADS combined with the qualitative VTIQ combination and with SWVmax yielded similar results, including significantly higher AUC values (P = 0.018 and 0.014, respectively), significantly higher specificities (P<0.001 for both), and nonsignificantly decreased sensitivities (P = 0.249 for both) compared to BI-RADS alone. CONCLUSION: The dual-category classification of qualitative VTIQ features according to the presence of the "stiff rim" sign and/or the classification of VTIQ pattern 2 is a simple and useful method that may be representative of quantitative VTIQ parameters in the evaluation of breast masses.

Sex-dependent changes in the skin mucus metabolome of discus fish (Symphysodon haraldi) during biparental care.

Discus fish Symphysodon spp. employs an unusual parental care where fry feed on parental skin mucus after hatching. Here, we investigated the mucus metabolites of parental and non-parental discus by using non-targeted metabolomics. Statistical analysis of the skin mucus metabolome revealed sex-dependent changes of mucus between parental and non-parental discus, as well as sex-specific differences between parental fish. Differential metabolites reflected that mucus of both parents was rich in prostaglandin A1, but only male contained more oligosaccharides (gentiobiose and D-melezitose) and nucleotides (guanine and cytosine), and only female detected more thymine. Moreover, differential metabolites revealed the metabolic status of parental discus, including the inhibition of biosynthesis of amino acids, e.g., L-phenylalanine (parents), L-aspartic acid (female) and taurine (male) and the activation of metabolism of these amino acids; the increase of metabolism of fatty acids such as α-Linolenic acid (female), arachidonic acid (female) and linoleic acid (male); the perturbation of metabolism of carbohydrate and energy including starch and sucrose metabolism (parents), ascorbate and aldarate metabolism (parents), amino sugar and nucleotide sugar metabolism (female), pentose and glucuronate interconversions (male) and glyoxylate and dicarboxylate metabolism (male). These results might suggest sex-specific metabolic changes in the skin mucus of discus fish during parental care. SIGNIFICANCE: We detected the low-molecular-weight compounds present in the parental mucus of discus fish evolving for offspring and revealed the possible metabolic changes associated with parental care. These results are helpful to gain further insights on the functional and regulatory aspects of skin mucus of discus during parental care.

Similar Reproducibility for Strain and Shear Wave Elastography in Breast Mass Evaluation: A Prospective Study Using the Same Ultrasound System.

The objective of this study was to evaluate the inter-operator reproducibility of strain elastography (SE) and shear wave elastography (SWE) in three groups: all lesions, benign lesions and malignant lesions. Ninety-one lesions from ninety-one women were examined by SE and SWE from January 2017 to December 2017 by two radiologists. The reproducibility of elastic score, SE strain ratio and SWE Young's modulus between operators was prospectively evaluated. There was good agreement on elasticity score, with κ values of 0.711, 0.640 and 0.766. The intra-class correlation coefficients of the strain ratio, mean elastic modulus (Emean), maximum elastic modulus (Emax) and elastic modulus standard deviation (Esd) ranged from 0.723-0.876, which indicated good and excellent agreement. We concluded that both SE and SWE had good reproducibility among different operators using the same probe in the same ultrasound instrument. Strain elasticity score was more consistent among operators in malignant breast tumors. There was better agreement on strain elastic ratio and shear wave elasticity among operators in benign breast lesions.

Blood perfusion of the contralateral testis evaluated with contrast-enhanced ultrasound in rabbits with unilateral testicular torsion.

The changes of blood perfusion of contralateral testis after unilateral testicular torsion remain controversial. In this study, 28 New Zealand white male rabbits were randomly divided into five groups. Group A (n = 8), the control group, underwent a sham operation on the unilateral testis without inducing testicular torsion. In groups B, C, and D (n = 5 each), unilateral testicular torsion was induced, and, after 3, 6 or 24 h, respectively, detorsion was performed. In group E (n = 5), permanent unilateral testicular torsion was applied. Contrast-enhanced ultrasound was used to observe the blood perfusion of the contralateral testis at the following stages: pre-torsion (preopration), immediately post-torsion (postopration), pre-detorsion, immediately post-detorsion, and late-stage post-detorsion (6-12 h post-detorsion in groups B-D) or at a similar time point (15-21 h post-torsion in group E). Time-intensity curves were generated, and the following parameters were derived and analyzed: arrival time, time to peak intensity, peak intensity, and half-time of the descending peak intensity. The analysis revealed that blood perfusion of the contralateral testis increased immediately after testicular torsion on the opposite side (P < 0.05), which increased with prolonged testicular torsion of the other testis. This research demonstrated that contrast-enhanced ultrasound was valuable in evaluating blood perfusion of the contralateral testis after unilateral testicular torsion.

Comparison of fine-needle aspiration and fine-needle capillary sampling of thyroid nodules: a prospective study with emphasis on the influence of nodule size.

BACKGROUND: The objective of this study was to compare the sampling efficiency of ultrasound-guided fine-needle aspiration (FNA) and fine-needle capillary (FNC) sampling in thyroid nodules, in which the authors specifically analyzed the influence of nodule size. METHODS: This study included 280 thyroid nodules in 275 consecutive patients. The nodules were divided into 4 size subgroups: ≤5.0 mm, from 5.1 to 10.0 mm, from 10.1 to 20.0 mm, and >20.0 mm. Each nodule was sampled by both FNA and FNC. The final cytopathologic findings were reported. The smears were scored and then categorized as diagnostically inadequate, adequate, or superior on the basis of 4 parameters, which included background clot or blood, the number of obtained cells, preserved tissue architecture, and cellular degeneration. RESULTS: The κ scores for agreement of the cytopathologic results between FNA and FNC sampling in the 4 size subgroups were 0.377, 0.455, 0.751, and 0.352 for nodules that measured ≤5.0 mm, from 5.1 to 10.0 mm, from 10.1 to 20.0 mm, and >20.0 mm, respectively. The proportion of nondiagnostic of FNAs was significantly lower than the proportion of nondiagnostic FNC samples in nodules that measured >20.0 mm (P = .037). Scores for the 4 diagnostic parameters were significantly greater in FNAs than in FNC samples in nodules that measured from 5.1 to 10.0 mm and >20.0 mm (all P < .05); however, similar results were not observed in the nodules that measured ≤5.0 mm or from 10.1 to 20.0 mm (all P > .05). Also, FNA yielded significantly more diagnostically superior specimens than FNC sampling in nodules that measured from 5.1 to 10.0 mm and >20.0 mm (P < .05 for both). CONCLUSIONS: The current findings indicated that FNA may be more suitable than FNC for sampling nodules that measure from 5.1 to 10.0 mm and >20.0 mm; whereas, for nodules that measure ≤5.0 mm and from 10.1 to 20.0 mm, the 2 techniques could yield specimens with similar quality.