Reduce Recurrence Rates Research Articles

Adjuvant Radiation Sparing after Neoadjuvant Chemotherapy and TORS in Selected HPV-Positive Oropharyngeal Cancer.

Transoral robotic surgery (TORS) has shown promising results in treating human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), and there has been increasing interest in incorporating neoadjuvant chemotherapy (NCT) prior to TORS. This study aimed to assess the feasibility and safety of sparing adjuvant RT following NCT and TORS. A retrospective cohort study included consecutive patients with HPV-positive OPSCC who underwent NCT followed by TORS without adjuvant RT. Disease-free survival (DFS) was the primary outcome. Pattern of recurrence (local, regional, and distant), salvage treatment outcomes, and predictors of tumor recurrence were also assessed. A total of 84 patients were included in the analysis. No patients died during the study period. DFS rates (95% Confidence Interval, CI) at 1, 2, and 3 years were 92.8% (87.4-98.5), 87.0% (79.7-94.9), and 84.4% (76.0-93.8), respectively. Local, regional, and distant recurrence rates were 7.0%, 9.5%, and 3.6%, respectively. Salvage treatment achieved a 100% salvage rate. Predictors of tumor recurrence included the number of positive lymph nodes (hazard ratio: 2.66; 95% CI: 1.19-5.92) and clinical stage III at diagnosis (hazard ratio: 7.65; 95% CI: 1.97-29.7). Recommendation of adjuvant treatment based on pathologic adverse features appears to be associated with favorable outcomes in selected HPV-positive OPSCC cases treated with NCT and TORS. Future studies should focus on refining criteria for recommending adjuvant RT to further reduce recurrence rates and minimize treatment-related toxicity, contributing to personalized treatment strategies for HPV-related OPSCC. 4 Laryngoscope, 2024.

Early results of an orthoplastic multidisciplinary approach to diabetic foot ulcer soft tissue reconstruction.

Diabetic foot ulcer (DFU) is a common complication in patients with diabetes. With current treatment, only two-thirds of patients heal, with a median duration of 3-6 months. Hard-to-heal DFUs are a major source of morbidity and mortality. Improving wound healing via soft tissue reconstruction may be the key to improving clinical outcomes. Thus, the Diabetic Limb Salvage (DLS) service in Sengkang General Hospital, Singapore, was established to provide patients with a streamlined, one-stop, comprehensive service dedicated to DFU soft tissue reconstruction. The reconstruction was carried out using secondary closure, skin grafting, local flaps or free flaps, depending on the severity of the wound and patient suitability. This study aims to audit the early outcomes of the DLS service. Patients with DFUs treated by the DLS service were compared with patients with DFUs treated prior to the launch of the DLS service (control). Outcomes including major and minor amputation rates, wound healing rate, mortality and DFU recurrence rates were analysed statistically. A total of 103 patients took part in the study (50 in the DLS service cohort and 50 in the control cohort). There was no significant difference in demographics, comorbidities and wound profiles between the two cohorts. All (100%) patients in the DLS service cohort received soft tissue reconstruction versus only 13% in the control group. The DLS service cohort had a significantly higher healing rate (96% versus 68%, respectively), shorter healing duration (77±30 days versus 111±43 days, respectively), reduced major amputation rate (0% versus 9%, respectively), and reduced recurrence rate (6% versus 25%, respectively) compared with the control cohort within the one-year follow-up. The findings of this study showed that an orthoplastic multidisciplinary approach focused on DFU soft tissue reconstruction improved wound healing rates, shortened healing duration and, as a result, lowered amputation rates and reduced recurrence.

Patient reported outcomes and decision regret scores in redo-paraesophageal hernia repair.

Recurrent paraesophageal hernia (PEH) repair presents significant technical challenges, with limited data weighing the benefit to the operative risk. This study aims to describe our experience with recurrent PEH repair, including long-term surgical and patient reported outcomes(PROs). We conducted a retrospective review of recurrent PEH repairs from June 2018-March 2023 using our institutional database. A blinded review of post-operative imaging was conducted to assess for recurrence. Quality of life (QOL) and decision regret were measured using the GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire and Decision Regret Scale (DRS) at maximum follow up. Eighty-eight patients underwent recurrent PEH repair at our institution for PEH, classified as type II (13.6%), type III (72.7%) and type IV (13.6%). There was significant heterogeneity in operative techniques used: one-third of patients had mesh placed at the hiatus, 11.4% had a Collis gastroplasty, and one-third of patients underwent fundoplication. Intraoperative complications included gastric (5.7%), esophageal (2.3%), vascular (1.1%) and pulmonary (1.1%) injuries. Follow up was available for 73 patients with median follow up of 35.2months. Of patients with radiographic follow up, 20 (35.7%) had a radiographic recurrence: 12 (21.4%) were 2-5cm and 8 (14.3%) were > 5cm. Patients reporting PROs (53 patients; 60.2%) reported low symptom severity (mean GERD-HRQL 13.1 ± 12) and low decision regret (mean DRS 13.3 ± 19.4) with 75.5% scoring in the lowest quartile (DRS < 25). Radiographic recurrence was associated with worse QOL (p < 0.05), but no significant difference in decision regret (p = 0.125). We found significant heterogeneity amongst recurrent PEH repair techniques with continued high recurrence rate during follow up. Radiographic recurrence was correlated with worse QOL, yet patients reported low symptom severity and low decision regret, suggesting continued value in these challenging operations. Future studies should aim to identify more effective techniques to reduce recurrence rates in this patient population.

Comparing the efficacy of linovera spray plus hydrocortisone cream for breast cancer patients undergoing conformal radiotherapy

BackgroundBreast cancer is one of the most prevalent malignancies globally, with a significant proportion of patients undergoing radiotherapy, a crucial treatment modality that substantially reduces recurrence rates. However, radiotherapy is often complicated by dermatological adverse effects ranging from mild erythema to severe dermal burns. Despite various interventions aimed at mitigating skin toxicities, the efficacy of hyperoxygenated fatty acids (HOFA) in this context remains underexplored. ObjectiveTo evaluate the effectiveness of topical HOFA (Linovera spray) in preventing radiotherapy-induced skin reactions in breast cancer patients undergoing conformal radiotherapy. MethodsThis prospective, randomized, controlled trial enrolled post-partial mastectomy breast cancer patients indicated for conformal radiotherapy targeting lymph node levels and the supraclavicular region, with dosages of 45–50 Gy and a 60 Gy tumor bed boost. Patients with active skin diseases or sensitivity to the study spray were excluded. The intervention group applied hydrocortisone ointment and Linovera spray twice daily to the treatment site, while the control group used only hydrocortisone ointment. Skin reactions were graded using the validated Global Skin Reaction Classification and assessed during radiotherapy weeks 3 and 5. ResultsAll 60 randomized patients (intervention n = 24, control n = 28) developed radiation dermatitis. By week 5, the intervention group showed a statistically significant reduction in dermatitis severity versus controls (p = 0.04). Dermatitis grades also significantly worsened within both groups from week 3–5 (all p < 0.001). ConclusionWhile HOFA-based moisturizers did not statistically impact overall incidence or severity, marginal benefits were observed with prolonged Linovera spray plus hydrocortisone use versus hydrocortisone alone by week 5. Further research is warranted to explore HOFA's potential skin-protective effects.

A 10-year retrospective study of 43 female patients presenting with idiopathic granulomatous mastitis

Background: Idiopathic Granulomatous Mastitis (IGM) is a rare inflammatory breast condition affecting middle aged women. IGM typically presents as a unilateral, painful and challenging-to-treat breast mass, with a high recurrence rate. Common treatments include corticosteroids and antibiotics, with surgical excision reserved for resistant cases. However, the absence of a standardized treatment protocol leads to variability in management across different settings and providers. Methods: We present a case series of 43 patients diagnosed with IGM at a community hospital in New York, aiming to facilitate early recognition and treatment of this rare condition. This study identifies risk factors and reviews best practices in imaging and treatment, emphasizing the importance of considering IGM in the differential diagnosis, particularly in cases of recurrent disease. Results: The sample comprised 43 patients with an average age of 34.65 years, 31 (72%) of whom were Hispanic. The most commonly reported symptoms were pain, mass, erythema, and swelling. In all cases, IGM was confirmed by histopathological examination. Treatment modalities included incision and drainage (I and D), corticosteroids, antibiotics, methotrexate and surgical intervention. Conclusions: IGM is a rare condition often mistaken for breast cellulitis, abscess or carcinoma. Maintaining a high index of suspicion is crucial, particularly in Hispanic women who may be at increased risk. Histopathological diagnosis is essential to prevent unnecessary surgical interventions and antibiotic use, thereby reducing recurrence rates. Early initiation of corticosteroids or alternatives like methotrexate can optimize patient outcomes and reduce healthcare costs.

Role of tranexamic acid as an adjunctive for chronic sub dural hematoma for early resolution and reduced recurrence rate: a prospective case-control study

Background: Literature shows the effective use of tranexamic acid to reduce CSDH either as a primary treatment or as an adjunctive treatment. However, literature lacks conclusive evidence on the use of tranexamic acid for CSDH. There are not many Indian studies also on this subject. This study was aimed at finding the effectiveness of tranexamic acid in reducing the recurrence rate following surgery and early resolution. Methods: From May 2023 to May 2024, single centric case control study was done in a tertiary care center (Government Mohan Kumaramangalam medical college hospital, Salem) in Southern India. All patients with chronic subdural hematoma with Markwalder grading 2-4 and grade 1 with midline shift more than 1 cm were included in the study. Patients with severe cardio-cerebrovascular disease, patients with allergy to tranexamic acid and patients not willing to participate were excluded from the study. Tranexamic acid was given at a dose of 500 mg twice a day for 10 days. Patients were allocated into two groups: group A: where tranexamic acid was used, group B: where tranexamic acid was not used. Results: The mean duration of hospital stay was lesser in tranexamic acid group (p&lt;0.005). The mean SDH thickness was lesser at 4th and 8th week in tranexamic acid group (p&lt;0.005). Recurrence rate was lesser in tranexamic acid group at three months (p&gt;0.05). Conclusions: This study of patients with CSDH showed that the adjunctive use of TXA after burr-hole drainage is effective in achieving resolution of CSDH through faster hematoma reduction. TXA may have a favorable effect in reducing recurrence and can be administered safely in selected patients.

Short-term incremental prednisone therapy in patients with serologically active clinically quiescent lupus nephritis: a retrospective observational study

ObjectiveThis study investigated whether short-term incremental prednisone therapy decreases the risk of relapse without increasing adverse events (AEs) in patients with serologically active, clinically quiescent lupus nephritis (LN).MethodsAfter standardized treatment, 153 patients with serologically active, clinically quiescent LN were included. Clinical data were retrospectively reviewed. The patients were divided into two groups: the control group (n = 58) received prednisone or prednisone and immunosuppressant maintenance therapy, the prednisone increment group (n = 95) received additional prednisone doses of up to 10 mg/day as maintenance therapy, which were then gradually reduced back to the original dose at 3 months. Lupus activity, renal involvement, and AEs during follow-up in the two groups were analyzed within 18 months.ResultsNo significant differences in sex, age, disease course, maintenance treatment composition, or laboratory tests between the two groups were observed, except for serum complement C3 levels, which were significantly lower in patients in the prednisone increment group than in controls (P = 0.025). The prednisone increment group had significantly lower recurrence rates than the control group (P = 0.002), with only 3 patients (5.2%) in the prednisone increment group and 24 patients (25.3%) in the control group experiencing relapse. Renal recurrence was significantly lower in the prednisone increase group (P = 0.013). Nine AEs occurred in the prednisone-modulated group and 11 AEs occurred in controls, with infection being the main cause for both groups.ConclusionShort-term incremental prednisone therapy is safe in reducing recurrence rates in serologically active and clinically quiescent patients with LN.Key pointsIncremental prednisone is safe and effective for patients with serologically active clinically quiescent LN.

Unleashing the potential of Genistein and its derivatives as effective therapeutic agents for breast cancer treatment.

Breast cancer remains one of the leading causes of cancer-related deaths among women worldwide. Genistein (Gen), a phytoestrogen soy isoflavone, has emerged as a promising agent in the prevention and treatment of breast cancer due to its ability to function as a natural selective estrogen receptor modulator (SERM). This review explores the multifaceted mechanisms through which Gen and its derivatives exert their anticancer effects, including modulation of the PI3K/Akt signaling pathway, regulation of apoptosis, inhibition of angiogenesis, and impacts on DNA methylation and enzyme functions. We discuss the dual roles of Gen in both enhancing and inhibiting estrogen receptor (ER)-dependent pathways., highlighting its complex interactions with ERα and ERβ. Furthermore, the review examines the synergistic effect of combining Gen with conventional chemotherapeutic agents such as doxorubicin, cisplatin, and selenium, as well as other natural compounds like lycopene. Clinical studies suggest that while isoflavones may not significantly influence breast cancer progression in general, the high consumption of soy isoflavones is associated with reduced recurrence rates in breast cancer survivors. Importantly, Gen's ability to modulate key signaling pathways and enhance the efficacy of existing treatments improves its potential as a valuable adjunct in breast cancer therapy. In conclusion, Gen and its derivatives offer a novel and promising approach for treatment of breast cancer. Continued research into their mechanisms of action and clinical applications will be essential in optimizing their therapeutic potential and translating these findings into effective clinical interventions.

Experience of using robot-assisted (da Vinci) operations in the treatment of common endometriosis

Background. Currently, genital endometriosis is considered as one of the most severe conditions in women of reproductive age, which has detrimental consequences for social, professional and psychological functioning. It ranks third in the structure of gynecological diseases after inflammatory diseases of the female reproductive system and uterine fibroids. Because of this, it acquires a more pronounced social significance and ceases to be only a medical problem. Aim. To study the results of surgical treatment of patients with severe forms of genital endometriosis using the da Vinci surgical robotic complex.Materials and methods. A retrospective analysis of the treatment results of 51 patients operated on at the N.I. Pirogov National Medical and Surgical Center for the period from January 2015 to July 2024, who underwent robot-assisted (da Vinci) operations for deep endometriosis involving neighboring organs. The duration of surgery and hospital stay, the amount of blood loss, the frequency of intra- and postoperative complications, the clinical course of the disease in the long-term postoperative period, the frequency of detection of residual infiltration in the postoperative period, and the implementation of reproductive plans were analyzed.Results. The duration of the surgical intervention was 220.8 ± 21.87 minutes. The postoperative bed-day was 6.9 ± 1.5 bed days. The average blood loss was 160.2 ± 67.58 ml. There were no intraoperative complications. Postoperative complications accounted for 7.8 %. Residual infiltration occurred in 11.7 % of cases. 94.1 % of the patients had no clinical symptoms of endometriosis in the long-term postoperative period. The pregnancy rate was 31.9 %.Conclusion. Surgical treatment of deep endometriosis using da Vinci surgical robotic complex in the amount of radical removal of endometrioid infiltrate has a positive effect on both the clinical course of the disease and the reproductive potential of a woman. Real-time fluorescence navigation has demonstrated additional imaging capabilities in robotic surgery for deep endometriosis, potentially increasing the radicalism of surgical treatment of infiltrating endometriosis and may lead to a reduction in recurrence rates.

Examining the standalone efficacy and safety of tranexamic acid in chronic subdural hematoma: a comprehensive review and meta-analysis

BackgroundChronic subdural hematoma (CSDH) is an important medical condition characterized by the accumulation of blood in the subdural space. Several methods have been explored, including surgical intervention and administration of tranexamic acid, which is a conservative treatment option. This meta-analysis aimed to assess the effectiveness and safety of tranexamic acid in CSDH management.MethodsA systematic literature search was performed according to the PRISMA and MOOSE guidelines. This study included cohort and randomized controlled trials involving adults with chronic subdural hematoma (CSDH) who were treated with intravenous tranexamic acid. The primary outcome measures were recurrence and adverse events.ResultsSix studies encompassing 2024 participants were included. Studies have shown that tranexamic acid reduced recurrence rates (OR, 0.32; 95% CI: 0.27–0.38, p = 0.16; I2 = 0%), although the result was non-significant. However, the analysis of adverse events indicated a moderate level of heterogeneity (OR, 1.14; 95% CI: 0.60–2.15, p = 0.07; I2 = 57%), suggesting a potential safety concern.ConclusionIn conclusion, this meta-analysis suggests tranexamic acid (TXA) may reduce chronic subdural hematoma (CSDH) recurrence, though significance varied across studies. Adverse effects with TXA were similar to controls. Larger trials are needed to confirm TXA’s role in CSDH management.

Bioelectrical stimulation therapy for muscle injuries in aerobics athletes

This article aims to explore the recovery effect of the bioelectrical stimulation therapy on muscle injuries in aerobics athletes. Non-invasive medical techniques are adopted to activate muscle tissue through electrical currents, promoting muscle contraction ability and functional recovery. This article selects 100 aerobics athletes with muscle injuries through questionnaire surveys and interviews. The Modulo Plus electrical stimulation device is used, and personalized treatment plans are set. Muscle changes before and after treatment are monitored using electromyography and ultrasound technology. In the single-blind experiment, in the fourth week, the pain score of the experimental group decreases to 2.4 points; the functional recovery score increases to 75.2 points; the flexibility measurement reaches 19.2 cm. In the case-control study, the bioelectrical stimulation therapy cures all athletes in the sixth week, exceeding the conventional therapy’s 35 patients, and has a lower recurrence rate. In the cohort study, athletes who use the bioelectrical stimulation therapy for a long time have a shorter average recovery time of 15.3 days and a recurrence rate of 16%. In the muscle recovery experiment, in the eighth week after treatment, the electromyographic activity level of the experimental group increases to 58.6 μV; the muscle thickness increases to 4.3 mm; the echo intensity increases to 63.1 dB; the fatigue characteristic score drops to 2.1. These data indicate that the bioelectrical stimulation therapy has significant effects in reducing pain, promoting functional recovery, improving flexibility, shortening recovery time, and reducing recurrence rates and pain scores, thereby providing an effective treatment option for the recovery of muscle injuries in aerobics athletes.

Retrograde Middle Meningeal Artery Embolization through Mini Craniotomy for Subdural Hematoma Evacuation: A Technical Note.

This report introduces a novel surgical technique for middle meningeal artery embolization (MMAE) during a mini-craniotomy for subdural hematoma (SDH) evacuation. A patient with multiple health issues presented with a 14 mm right subacute SDH. During surgery, the MMA was retrogradely catheterized and embolized using Onyx 18. This approach, combining MMAE with hematoma evacuation, resulted in successful resolution of the SDH without complications. The procedure offers a more efficient workflow by integrating 2 interventions into 1, potentially reducing recurrence rates of SDH.

Optimal Timing for Corticosteroid Therapy in Idiopathic Granulomatous Mastitis: A Retrospective Analysis Highlighting Early Intervention Efficacy.

Idiopathic granulomatous mastitis (IGM) is a chronic breast condition known for its aggressive nature and tendency for persistence and recurrence. Steroids are commonly used as the first-line treatment for IGM, but issues such as the optimal timing, and duration of treatment remain debated. We retrospectively analyzed 343 IGM cases treated at the Third People's Hospital of Chengdu from September 2012 to September 2023. Based on inclusion and exclusion criteria, a total of 188 patients were included in the study. Patients were categorized into lump (78 cases), abscess (81 cases), and sinus tract stages (29 cases) according to their initial diagnosis upon admission. Prednisolone was initiated at 0.75 mg/kg/day, and after effective treatment, the dosage was adjusted by 5-10 mg weekly, followed by a maintenance dose of 2.5-5 mg/day. Clinical characteristics, treatment responses, adverse effects, recurrence rates, and follow-up data were assessed. The median duration of prednisone treatment in our study was 87 days (range, 21-281 days). Positive response rates to prednisolone were 78.2% in the lump stage, 60.5% in the abscess stage, and 62.1% in the sinus tract stage. Continuing low-dose prednisone for 3 months post-effective treatment reduced recurrence rates and side effect risks. Weight gain was the most common side effect (39.36%). Early steroid therapy, especially in the lump stage, demonstrated superior efficacy. Following a regimen of starting with a full dose, tapering slowly, and maintaining a low dose for around 3 months steroids treatment is recommended to minimize recurrence rate and adverse effects.

Oncological and Surgical Outcomes of Oncoplastic Reduction Mammoplasty: A Single-centre Retrospective Study.

Breast-conserving surgery is the preferred treatment for early-stage breast cancer but can often result in unsatisfactory cosmetic outcomes. Oncoplastic surgery aims to improve both oncologic and aesthetic outcomes by combining local excision with plastic surgery techniques. Using breast reduction techniques in breast cancer treatment has been shown to allow for wider margins of excision, leading to enhanced oncological safety and reduced recurrence rates without causing significant asymmetry. This study aimed to analyze the surgical and oncological outcomes of a large cohort of patients undergoing oncoplastic reduction mammoplasty (ORM). A retrospective analysis of postoperative surgical and oncological outcomes of all patients who underwent ORM at a single center between January 2018 and December 2023 was performed. Preoperative patient characteristics, operative and post-operative outcomes were recorded and analyzed. A total of 67 patients that underwent oncologic breast reduction were included in the final analysis - representing a total of 71 ORM, with a mean (SD) age of 53.1 (10.5) years and a mean (SD) BMI of 28.8 (5.9) kg/m2 A superomedial pedicle-based technique was the most frequently used (36.6%), followed by inferior pedicle-based technique (28.1%). A complication rate of 18.3% on the ipsilateral side was observed. Salvage surgery was necessary in five cases (7.0%) due to positive margins - with one patient (1.4%) requiring margin expansion surgery and four (5.6%) a completion mastectomy. This monocentric retrospective study shows that ORM is safe, with a complication rate on par with conventional breast reduction and offers satisfactory oncological outcomes.

Validation of a breast cancer assay for radiotherapy omission: an individual participant data meta-analysis.

There are currently no molecular tests to identify individual breast cancers where radiotherapy (RT) offers no benefit. Profile for the Omission of Local Adjuvant Radiotherapy (POLAR) is a 16-gene molecular signature developed to identify low risk cancers where RT will not further reduce recurrence rates. An individual participant data meta-analysis was performed in 623 cases of node-negative ER+/HER2-negative early breast cancer enrolled in three RT randomized trials for whom primary tumor material was available for analysis. A Cox proportional hazards model on time to locoregional recurrence (LRR) was used to test the interaction between POLAR score and RT. 429 (69%) patients' tumors had a high POLAR score and 194 (31%) had a low score. Patients with high POLAR score had, in the absence of RT, a 10-year cumulative incidence of LRR: 20% (15%-26%) vs 5% (2%-11%) for those with a low score. Patients with a high POLAR score had a large benefit from RT (hazard ratio [HR] for RT vs no RT: 0.37 [0.23-0.60], p < .001). In contrast, there was no evidence of benefit from RT for patients with a low POLAR score (HR: 0.92 [0.42-2.02], p = .832). The test for interaction between RT and POLAR was statistically significant (p = .022). POLAR is not only prognostic for locoregional recurrence but also predictive of benefit from radiotherapy in selected patients. Patients ≥ 50 years with ER+/HER2-negative disease and a low POLAR score could consider omitting adjuvant RT. Further validation in contemporary clinical cohorts is required.

Current Applications of Raman Spectroscopy in Intraoperative Neurosurgery.

Neurosurgery demands exceptional precision due to the brain's complex and delicate structures, necessitating precise targeting of pathological targets. Achieving optimal outcomes depends on the surgeon's ability to accurately differentiate between healthy and pathological tissues during operations. Raman spectroscopy (RS) has emerged as a promising innovation, offering real-time, in vivo non-invasive biochemical tissue characterization. This literature review evaluates the current research on RS applications in intraoperative neurosurgery, emphasizing its potential to enhance surgical precision and patient outcomes. Following PRISMA guidelines, a comprehensive systematic review was conducted using PubMed to extract relevant peer-reviewed articles. The inclusion criteria focused on original research discussing real-time RS applications with human tissue samples in or near the operating room, excluding retrospective studies, reviews, non-human research, and other non-relevant publications. Our findings demonstrate that RS significantly improves tumor margin delineation, with handheld devices achieving high sensitivity and specificity. Stimulated Raman Histology (SRH) provides rapid, high-resolution tissue images comparable to traditional histopathology but with reduced time to diagnosis. Additionally, RS shows promise in identifying tumor types and grades, aiding precise surgical decision-making. RS techniques have been particularly beneficial in enhancing the accuracy of glioma surgeries, where distinguishing between tumor and healthy tissue is critical. By providing real-time molecular data, RS aids neurosurgeons in maximizing the extent of resection (EOR) while minimizing damage to normal brain tissue, potentially improving patient outcomes and reducing recurrence rates. This review underscores the transformative potential of RS in neurosurgery, advocating for continued innovation and research to fully realize its benefits. Despite its substantial potential, further research is needed to validate RS's clinical utility and cost-effectiveness.

RAI therapy in low-risk papillary thyroid cancer: recurrence reduction and long-term outcomes in the Turkish population

PurposePapillary thyroid cancer (PTC) is the most common thyroid malignancy, characterized by its slow progression and favorable prognosis. This study re-evaluates the efficacy of radioactive iodine (RAI) therapy versus no RAI in low-risk PTC patients following total thyroidectomy.MethodsA retrospective analysis was conducted on 588 patients treated between 2010 and 2016 at a major tertiary center in Turkey. Patients were divided into two cohorts: those receiving total thyroidectomy (TT) with high-dose RAI (100 mCi) and those receiving TT alone. A matched cohort of 138 patients per group was analyzed to minimize bias.ResultsFollow-up data indicated that at 24 months, the RAI group demonstrated a higher percentage of excellent treatment responses (86%) compared to the non-RAI group (74%). Long-term follow-up showed that 99.3% of the RAI group achieved no evidence of disease (NED), versus 90.6% in the non-RAI group. Recurrence rates were significantly lower in the RAI group (1%) compared to the non-RAI group (5.8% with a > 2.0 ng/ml cut-off for biological events).ConclusionIn summary, the findings from this study underscore the efficacy of RAI therapy in reducing recurrence rates and enhancing long-term disease control in low-risk papillary thyroid cancer patients. While total thyroidectomy alone is effective, the addition of RAI therapy provides a marked improvement in treatment responses and reduces the risk of disease recurrence. This indicates that personalized treatment plans incorporating RAI may offer significant advantages in managing low-risk PTC.

Conservative Decompression in the Management of Odontogenic Keratocysts: Case Report

Aims: This study aims to assess the effectiveness of decompression as a conservative treatment for odontogenic keratocysts (OKCs), with emphasis on reducing recurrence rates, decreasing lesion size, and preserving adjacent anatomical structures. Additionally, it explores the combination of decompression with enucleation and other therapies to minimize recurrence risks. Presentation of Case: This is a case study focusing on conservative management of OKCs using decompression, with enucleation performed when necessary. A 15-year-old male patient with a mandibular OKC underwent decompression under local anesthesia. Preoperative radiographic evaluations were followed by aspirate puncture and placement of a thoracic drain to facilitate lesion size reduction. The patient was monitored over six months, with radiographic exams every 60 days to assess cyst shrinkage. Discussion: The patient showed a significant reduction in lesion size following decompression, allowing for easier enucleation while preserving the bone cortex. A review of the literature supports decompression as an effective treatment; however, recurrence rates remain problematic when performed without adjunctive therapies. Combining decompression with enucleation resulted in lower recurrence rates and improved long-term outcomes. Conclusion: Decompression is a promising conservative approach for managing OKCs, particularly when combined with enucleation and adjunctive treatments. This approach reduces lesion size and preserves critical structures, although recurrence remains a concern. Long-term follow-up and further research on recurrence mechanisms are essential to improving outcomes for patients treated with decompression for OKS.

Orbital Langerhans Cell Histiocytosis: A Systematic Review of 228 Cases.

Orbital Langerhans cell histiocytosis (LCH) is an extremely rare disorder, and widely different manifestations often make it diagnostically challenging. The variability of symptoms - from common presentations, such as eyelid swelling and exophthalmos, to very atypical symptoms, like headaches and diplopia - frequently results in delayed diagnosis and mismanagement. This systematic review aims to describe in detail the clinical presentation, diagnostic approaches, treatment modalities, and outcomes of orbital LCH. This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were conducted in PubMed and Scopus up to August 2024. Synthesis of data involved 228 patients from 18 studies. Extracted data included study design, sample size, patient demographics (age, gender, ethnicity), clinical presentation, diagnostic criteria, treatment modalities, follow-up duration, recurrence rates, and complications. The review found that orbital LCH mostly affects subjects with a mean age of 8.5 years (SD ± 7.1 years), indicating that a greater number of subjects are from younger populations, with 152 males (66.7%) and 76 females (33.3%). The most common presenting symptom was eyelid swelling, reported in 108 patients (47.4%), often serving as the initial sign prompting further investigation, exophthalmos was observed in 95 patients (41.7%), indicating more significant orbital involvement, and palpable mass was detected in 80 patients (35.1%). Imaging played a critical role in the diagnosis, with CT or MRI revealing lytic lesions in nearly all cases (99%). Histopathology confirmed LCH with CD1a and S-100 proteins serving as hallmark markers of LCH. Treatment strategies for orbital LCH varied depending on the extent of disease, patient characteristics, and institutional practices. Surgical intervention was the most common treatment modality, used in 136 patients (59.6%), and it was very effective in localized disease. Radiation therapy was employed in 68 patients (29.8%), often as an adjunct to surgery or as a primary treatment for residual or inoperable disease. Chemotherapy was administered to 85 patients (37.3%), especially those with multisystem involvement. Observation and follow-up were employed in selected cases, particularly those with solitary or asymptomatic lesions, allowing for the possibility of spontaneous regression. Although the remission rate was high, at 79.8%, there was a recurrence in 14.9% of the patients, thus requiring close follow-up. Diabetes insipidus was a complication, and it was also a pointer to multisystem involvement. Orbital LCH is a diagnosis that requires a multidisciplinary approach for accurate diagnosis and effective management, with individualized treatment guided by advanced imaging and molecular markers. Further studies are needed to refine treatment protocols in an attempt to reduce recurrence rates.

Thulium laser en bloc resection reduces recurrence rates in NMIBC patients with tumor diameters ≥3cm compared to transurethral resection: a non-randomized controlled study

PurposeThe advantages of en bloc resection of bladder tumors (ERBT) over transurethral resection of bladder tumors (TURBT) in terms of patient prognosis are not yet clear, and there are some technical limitations. We aimed to compare the tumor recurrence in non-muscle invasive bladder cancer (NMIBC) patients with tumor diameter ≥ 3 cm undergoing either TURBT or thulium laser ERBT.MethodsThe patients included were those diagnosed with NMIBC based on pathological confirmation and underwent TURBT or modified thulium laser ERBT in the Department of Urology at Tongji Hospital from 2019 to 2024. The patients’ medical records were meticulously collected and postoperative follow-up was diligently conducted by trained personnel. Recurrence-free survival curves were generated utilizing the Kaplan–Meier method, and group comparisons were performed using the log-rank trend test. To minimize biases, we employed stratified survival analysis, alongside univariate and multivariate Cox regression analysis.ResultsThis study included a total of 396 patients with NMIBC, with 214 undergoing TURBT and 182 undergoing ERBT. For all patients, there was no significant difference (P = 0.180) in RFS between the TURBT and ERBT groups. For patients with tumor diameter ≥ 3 cm, stratified analysis revealed that the RFS of the ERBT group was significantly better than that of the TURBT group (P = 0.033). However, in patients with tumor diameter < 3 cm, there was no significant difference (P = 0.150) between the two groups. Univariate (HR: 0.52, 95% CI 0.28–0.96, P = 0.036) and multivariate (HR: 0.49, 95% CI 0.25–0.93, P = 0.031) Cox analyses revealed that ERBT was an independent protective factor for recurrence in NMIBC patients with tumor diameter ≥3cm.ConclusionThis study found that thulium laser ERBT may offer advantages in managing NMIBC patients with tumor diameters ≥ 3 cm. This could potentially drive the clinical application of thulium laser ERBT.Trial registrationProtocol was registered at Chinese Clinical Trial Register (ChiCTR) with number ChiCTR2000035407 on 12 August 2020.