Volume Reduction Rate Research Articles

Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts.

This study compared ethanol ablation (EA) with the Sistrunk operation (SO) with regard to feasibility, treatment efficacy, and cost-effectiveness. The goal was to evaluate whether EA could replace SO as a primary treatment modality for thyroglossal duct cysts (TGDCs). This retrospective case-control study included patients with TGDCs who were treated with either EA or SO between 2016 and 2022. The primary outcome variables evaluated were treatment efficacy (as measured by the volume reduction rate [VRR] and treatment success rate), complications, and cost-effectiveness. A total of 72 patients were enrolled, with 33 in the EA group and 39 in the SO group. The procedure or operation times for the EA and SO groups were 9 and 82 minutes, respectively (P<0.001). At the final follow-up appointment, the VRR was 94.1% for the EA group and 100.0% for the SO group (P<0.001). Treatment success was achieved for 32 patients (97.0%) in the EA group and for all 39 patients (100.0%) in the SO group (P=0.458). The overall complication rates were 0.0% and 17.9% in the EA and SO groups, respectively (P=0.013). The total costs, including all treatment procedures and follow-up ultrasound examinations, were $485 and $1,081.7 for the EA and SO groups, respectively (P<0.001). EA demonstrates superiority over SO in terms of feasibility, safety, and costeffectiveness, while maintaining comparable treatment efficacy. Despite the need for multiple treatment sessions in approximately one-quarter of patients, EA can serve as a primary treatment modality for selected patients with TGDCs, supplanting SO.

Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction.

In general, flap volume decreases over time and further in the case of a denervated muscle flap. In our institution, dynamic reconstruction, including functional muscle flaps, has been used to aid functional recovery in the past 6 years. This study aimed to determine the effect of volume change of the fat and muscular sections of reconstructed tongue flaps after motor nerve reinnervation in dynamic total tongue reconstruction using 3-dimensional measurement and analysis. A retrospective chart review was performed on 21 patients who underwent total tongue reconstruction using an anterolateral thigh free flap from 2015 to 2020. The fat and muscle volumes of the flap were measured using computed tomography data obtained before surgery (T0), 2 weeks after surgery (T1), and 6 months after surgery (T2) using a 3-dimensional rendering software. Among the 21 patients that underwent tongue reconstruction, 10 underwent dynamic reconstruction, whereas 11 underwent conventional reconstruction using a fasciocutaneous flap. T2 volume compared with T1 was 69.08% in the conventional reconstruction group, and the fat and muscle portions in the dynamic reconstruction group were 77.04% and 69.06%, respectively. No significant difference was noted in the volume change between the 2 groups. After dynamic tongue reconstruction, the muscular volume of the flap had similar volume reduction rate as the fat volume. The dynamic reconstruction was effective not only for functional muscle transfer but also for maintaining the volume of the reconstructed muscle flap.

Volume reduction rate's predictors after radiofrequency ablation of benign thyroid nodules. a single-centre analysis

Volume reduction rate's predictors after radiofrequency ablation of benign thyroid nodules. a single-centre analysis

Comparison of the effectiveness of lauromacrogol injection for ablation and microwave ablation in the treatment of predominantly cystic thyroid nodules: a multicentre study

PurposeTo compare the therapeutic efficacy and safety of microwave ablation (MWA) and lauromacrogol injection for ablation (LIA) for benign predominantly cystic thyroid nodules.Materials and methodsIn this retrospective study, 85 patients with predominantly cystic thyroid nodules (PCTNs) who underwent microwave ablation (MWA) or lauromacrogol injection for ablation (LIA) between June 2019 and August 2022 at three hospitals were included in our research. Forty-six patients were treated with microwave ablation, and thirty-nine patients were treated with lauromacrogol injection for ablation. The baseline characteristics, nodal volume, volume reduction rate (VRR), and incidence of postoperative complications were compared between these two groups.ResultsAfter treatment, there were significant differences in the thyroid nodule volume and the volume reduction rate (VRR) at different follow-up times between the groups (p < 0.001). There were no significant differences in the nodal volume or the volume reduction rate (VRR) between the MWA group and the LIA group at 1, 3, 6, and 12 months (p > 0.05). Of note, no serious intraoperative or postoperative complications occurred in the corresponding group.ConclusionMWA and LIA are very effective and safe strategies for the treatment of predominantly cystic thyroid nodules. However, LIA is more advantageous in that it is less expensive and has a shorter length of hospital stay than MWA.

Initial ablation radio predicting volume reduction from microwave ablation of benign thyroid nodules.

Our research sought to investigate the relationship between initial ablation ratio (IAR) and internal composition of benign thyroid nodules treated by microwave ablation (MWA). Patients who underwent MWA at the Affiliated Hospital of Jiangsu University from January 2018 to December 2022 were enrolled in our research. All the patients were followed up for at least one year. We analyzed the relationship between IAR at 1 month of solid nodules (solid >90%), predominantly solid nodules (90% >solid > 75%), mixed solid alongside cystic nodules (75% >solid > 50%) as well as volume reduction rate (VRR) at 1, 3, 6 and 12 months follow-up. The mean IAR of the solid nodules (solid >90%) was 94.32±7.87%,#x0025;, that of the predominantly solid nodules (90% >solid > 75%) and mixed solid alongside cystic nodules (75% >solid > 50%) were 86.51±6.66% and 75.19±4.97%,#x0025;, respectively. Almost all the thyroid nodules were significantly decreased in size after MWA. After 12 months of MWA treatment, the average volume of the aforementioned thyroid nodules decreased from 8.69±8.79 to 1.84±3.11 ml, 10.94±9.07 to 2.58±3.34 ml, 9.92±6.27 to 0.25±0.42 ml, respectively. The mean symptom and cosmetic scores of the nodules showed significant (p < 0.000) improvement. The rates of the complications or side effects of MWA against the above-mentioned nodule types were 8.3% (3/36), 3.2% (1/31) and 0% (0/36), respectively. The application of the IAR to quantify the success rate of thyroid nodule microwaves in the short term demonstrated that IAR was related to the internal components of the nodule. Although the IAR was not high when the thyroid component was mixed solid and cystic nodules (75% >solid > 50%), the final therapeutic effect was still satisfactory.

Long-term efficacy of microwave ablation for multifocal papillary thyroid microcarcinoma: a 5-year follow-up study.

Microwave ablation (MWA) has achieved excellent long-term efficacy in treating unifocal papillary thyroid microcarcinoma (UPTMC). The therapeutic effect of this treatment on multifocal papillary thyroid microcarcinoma (MPTMC) is unknown. Therefore, we evaluated the long-term efficacy of MWA for low-risk MPTMC and to provide evidence-based medicine for the revision of clinical guidelines. This study included 66 MPTMC patients with a total of 158 lesions, all of whom received MWA. We collected and retrospectively analyzed the patients' follow-up data before MWA, at 1, 3, 6, and 12 months posttreatment and every 6 months thereafter until 5 years posttreatment. We evaluated the MWA complication rate, technical success rate (TSR), lesion volume reduction rate (VRR), and complete disappearance rate (CDR) during follow-up and in those patients with tumor progression and delayed surgery. After 60 months of follow-up, all 158 lesions disappeared in 66 patients, and the volume was reduced from 43.82 mm3 to 0.00 mm3. The TSR and VRR were both 100%. The CDRs at 1 year, 2 years, and 3 years were 57.59%, 93.67%, and 100%, respectively. The complication rate was 3.03% (2/66), and the incidence of tumor progression was 3.03% (2/66), including one new intrathyroidal lesion and one cervical lymph node metastasis (LNM). These lesions were retreated with MWA, and the lesions disappeared during the follow-up period. Ultrasound-guided MWA for low-risk MPTMC is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance (AS). This study concludes that ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance. • Ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective. • During 5 years of follow-up, multifocal papillary thyroid microcarcinoma patients treated with microwave ablation had a favorable prognosis. • To provide evidence-based medicine for the revision of clinical guidelines.

Prediction of ablation zone disappearance after microwave ablation for the patients with papillary thyroid microcarcinoma using nomograph.

To construct a prognostic nomogram to predict the ablation zone disappearance for patients with papillary thyroid microcarcinoma (PTMC) after microwave ablation (MWA). From April 2020 to April 2022, patients with PTMC who underwent MWA treatment were collected retrospectively. Ultrasound (US) or contrast-enhanced ultrasound (CEUS) was performed at 1 day, 1, 3, 6, 12, 18 and 24 months after MWA to observe the curative effect after ablation. The volume, volume reduction rate (VRR) and complete disappearance rate of the ablation zone at each time point were calculated. Univariate and multivariate logistic regression analysis were used to determine the prognostic factors associated with the disappearance of the ablation zone after MWA, and the nomogram was established and validated. 72 patients with PTMCs underwent MWA were enrolled into this study. After MWA, no tumor progression (residual, recurrence or lymph node metastasis) and major postoperative complications occurred. The ablation zone in 28 (38.89%) patients did not completely disappear after MWA in the follow-up period. Three variables, including age (odds ratio [OR]: 1.216), calcification type (OR: 12.283), initial maximum diameter (OR: 2.051) were found to be independent prognostic factors predicting ablation zone status after MWA by multivariate analysis. The above variables and outcomes were visualized by nomogram (C-index=0.847). MWA was a safe and effective treatment for PTMC. Older patients with macrocalcification and larger size PTMCs were more unlikely to obtain complete disappearance of ablation zones. Incomplete disappearance of ablation zone was not related to recurrence.

Thyroid artery embolization of large solitary symptomatic benign thyroid nodules through transradial approach.

This study investigated the efficacy and safety of transradial access (TRA) thyroid artery embolization (TAE) for patients with large solitary symptomatic benign thyroid nodules. Six patients with a total of six nodules (three men and three women; mean age, 36.3 years; age range, 23-45 years) underwent TRA TAE between October 2021 and June 2022 and were subsequently followed up three months later, and their cases were retrospectively reviewed. The associated complications were recorded during and after TRA TAE. The volume change and nodule-related symptom score on a 10-cm visual analogue scale (VAS) between baseline, 1- and 3-month follow-up was analyzed using Wilcoxon signed-rank test. The technical success rate of the TRA TAE was 100% without conversion to transfemoral access. The mean volume of the nodules decreased between baseline (84.1 mL; range, 46.1-170.5 mL), 1-month (38.8 mL; range, 17.6-91.5 mL; P=0.028) and 3-month (14.8 mL; range, 3.95-26.4 mL; P=0.068) at follow-up after TRA TAE. The mean volume reduction rate was 54.9% (range, 45.2-71.8%) at 1-month follow-up and 81.8% (range, 62.0-92.0%) at 3-month follow-up. The VAS score was reduced at 1-month (P=0.028) and at 3-month follow up (P=0.068). Radial artery spasm (n=1) was noted during TRA TAE, and neck pain (n=5) and voice change (n=1) occurred within 1 week after the procedure and resolved with conservative treatment. No major complications were reported. TRA TAE may be a promising alternative therapy for the management of large solitary thyroid nodules.

A comparison of the 2 thermal ablation procedures for the management of benign thyroid nodules.

In recent years, ultrasound (US)-guided thermal ablation techniques have come to the fore as minimally invasive alternatives to surgery. The purpose of this study was to assess the effectiveness and safety of radiofrequency ablation or microwave ablation procedures in patients with benign thyroid nodules. This retrospective and single-centre study consisted of 55 patients and 62 benign thyroid nodules that were treated either with radiofrequency ablation (RFA) or microwave ablation (MWA) in our hospital between January 2020 and March 2022. All the patients were at high risk for surgery or with symptomatic TNs and who refused surgery. The TNs diagnosed as benign from the fine-needle aspiration biopsy were evaluated in terms of volume reduction, symptom, and cosmetic scores. In addition, these 2 treatment modalities were compared to each other. Out of 55 patients, 44 (80%) were female and were aged between 24 and 97 years with a median age of 50 years. RFA was applied to 54.5% (n = 30) of the participants, and MWA was applied to 46.5% (n = 25). The volume reduction rate (VRR) after RFA and MWA at the first month was 63.4 ± 14.2 and 65.7 ± 13, respectively. No significant difference was detected between the 2 groups in terms of VRR (p = 0.51). In addition, the mean symptom and cosmetic scores decreased significantly in both procedures, and there was a significant difference due to the symptom score change in the RFA group compared to the MWA group. Of all the patients, one patient experienced haematoma in the RFA, and one patient had transient voice change in the MWA group. No life-threatening complications were noted. In the treatment of benign symptomatic thyroid nodules, both RFA and MWA are options worthy of consideration in terms of efficacy and safety.

Suppression of volume expansion in Sn-M (M= Cu, Mn, Ni) alloy anode materials for sodium ion battery

Sn shows high volume expansion corresponding to its high capacity, hindering cycle performance. To resolve the problem, studies are being conducted on alloying metal elements with the Sn anode. For an overall analysis or optimization of various alloying conditions, atomistic simulations are used to investigate the atomic scale structural evolution in Sn anodes during Na infusion.In the present study, we choose Cu, Mn, and Ni as candidate metal elements for alloying, considering the conditions of metal elements. Then, the clustering behavior of metal elements as sodium infuses into Sn-M (M = Cu, Mn, Ni) alloy is investigated using an atomistic simulation. We find that Sn-M alloy is stable in an amorphous solid solution, and as Na atoms infuse, a phase transformation occurs such that M elements are separated out, forming M clusters and a NaxSn amorphous phase, which eventually causes a reduction in volume. Finally, a diffusion simulation is also conducted for Na infusion into spherical Sn-M nanoparticles, to see if the alloying element decreases the Na diffusion rate severely. The comparison of volume reduction and Na infusion rate suggests that Cu is the best alloying element for the Sn base alloy anode materials.

Comparison of microwave alone and combined with ethanol ablation for different types of benign mixed thyroid nodules.

To evaluate the efficacy and safety of microwave ablation (MWA) plus ethanol ablation (EA) for different types of benign mixed thyroid nodules. A total of 81 patients with 81 benign mixed thyroid nodules were enrolled into the study; 39 were divided to the MWA group and 42 to the combined group (MWA combined with EA). Nodule ablation rate, volume reduction rate (VRR) and surgical complications of all patients were analyzed before and after treatment. The mean ablation rate were 86.49 ± 6.68% and 90.09 ± 5.79% in the microwave and combined groups respectively, and the ablation rate of nodule decreased as the nodule volume increased. For nodules ≥15 ml in volume, the mean ablation rate of the combined group was higher than that of the microwave group (all P < 0.05). The mean VRR at 12 months postoperatively was 89.58 ± 4.32% in the microwave group and 92.92 ± 3.49% in the combined group, showing statistical significantly different between both arms (P = 0.001). The combined group decreased in volume more significantly than the microwave group for nodules with 20-50% or 50-80% cystic proportions or >15 ml in volume (all P < 0.05). The complication rate was 23.08% and 2.38% respectively. MWA combined with EA is more effective than MWA for treating mixed thyroid nodules. MWA combined with EA may be the first approach for nodules with >20% cystic proportions or volume >15 ml.

Outcomes of transarterial embolization for large symptomatic focal nodular hyperplasia in 17 pediatric patients.

To evaluate the safety and the long-term outcomes of transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus N-Butyl cyanoacrylate (NBCA) in the treatment of children with large symptomatic focal nodular hyperplasia (FNH). This is a retrospective case serial study. Children (aged <18 years) with FNH were treated. Indications for TAE were patients who were presenting with FNH related abdominal pain and the maximum diameter of FNH is more than 7cm, and who were not candidates for surgical treatment. Technical success, adverse events, symptoms relief rate, and changes in the lesion size after TAE were evaluated. Between January 2003 and February 2018, 17 pediatric patients were included. Technical success was achieved in all patients. Mean follow-up was 67.5 months. All patients had complete resolution of abdominal symptom. The mean largest diameter of the lesions decreased from 10.5cm to 1.9cm (P<0.01). The mean volume reduction rate was 96.9%. The complete resolution of the FNH was observed in 16 patients. No further therapy was needed for all patients. TAE with LBE plus NBCA appears to be a safe and effective treatment in pediatric patients with large symptomatic FNH. It could be considered as the first-line treatment for symptomatic large FNH.

A prospective study to assess for the prognostic value of tumour volume reduction rate in head and neck cancer, during definitive chemo-radiation in a tertiary care hospital.

Tumour volume (TV) is an important factor influencing Radiation therapy(RT) outcome of patients. Logically, total dose and its fractionation should be tailored to the initial number of tumor cells which strongly correlated with tumor volume (TV) rather than to the tumor diameter or stage T. Aims and objectives: To assess tumour volume reduction rate weekly in patients with biopsy proven head and neck cancers treated with definitive chemo-radiation ant to correlate with histology haemoglobin and BMI . Methods and Materials: All oral cavity, oropharyngeal, hypopharyngeal, nasopharyngeal, and laryngeal cancer patients meeting inclusion criteria were included after obtaining informed written consent. All patients received definitive chemoradiation with weekly CT scanning of head and neck for the assessment of tumour and nodal volume response to chemoradiation. Tumour volume was contoured every week on CT scanning images. Tumour volume response rate (TVRR) was calculated. Results: Fourty patients were recruited. Most tumours were MDSCC accounting for 55%. Phase 1 TVRR was marginal which steeply increase 3rd week onwards during chemoradiation. In the phase 2, TVRR increased markedly. The mean TVRR on week 7 for WDSCC, MDSCC and PDSCC were 14.38 ± 7.01%, 15.01 ± 7.95% and 19.82 ± 10.44% respectively. The maximum TVRR was observed on the 7 th week of treatment which is the last week of treatment period. Patients with PDSCC had higher TVRR . Conclusion: Our study demonstrated TVVR increased markedly third week onwards and it was found to be maximum at 7th week .

Comparison of the Efficiency of Radiofrequency and Microwave Ablation Methods in the Treatment of Benign Thyroid Nodules

To compare the efficacy of two thermal ablation techniques (radiofrequency vs microwave ablation) in the treatment of benign thyroid nodules. A total of 80 patients with 80 nodules underwent thermal ablation of thyroid nodules with either radiofrequency ablation (RFA) (23 females and14 males; mean age 41±9years) or microwave ablation (MWA) (28 females and 15 males; mean age 45±11years). Ultrasound assessments were made at the 1st, 3rd, 6th, and 12th months after the ablation procedure. The mean initial volume of the nodules (RFA: 15.6mL [min 2.5-max 74]; MWA: 40mL [min 2-max 205]) was statistically significantly different (P<.001). The following were the volume reduction rates of nodules at 1, 3, 6, and 12months, respectively: after RFA: 46.8±13.5%, 62.9±13.6%, 71.6±11.9%, and 77.9±10.3%. After MWA: 38.7±12.5%, 54±15.3%, 59.6±12.5%, and 65±11.3%. For all months, volume reduction rates in the RFA group were significantly higher than those in the MWA group (P<.05). One patient treated by RFA reported an abscess formationand another patient treated by RFA had a self-limiting hematoma, whorecovered without any further treatment. Also, in the MWA group, one patient had abscess formation and another patient had transient recurrent nerve paralysis, who recovered with appropriate treatment. Both methods are effective in treating benign thyroid nodules;however, RFA provides a better volume reduction.

Influence factors and nomogram for volume reduction rate in benign thyroid nodule after thermal ablation

Background Thermal ablation is a minimally invasive and safe treatment for benign thyroid nodules, and the volume reduction rate (VRR) of nodule is a primary clinical efficacy indicator. Purpose To screen factors influencing VRR in benign thyroid nodules after thermal ablation and establish a predictable nomogram. Materials and methods This retrospective study enrolled 238 patients with benign thyroid nodules who underwent thermal ablation between January 2016 and September 2021. Clinical information and imaging characteristics in routine ultrasound (US) and contrast-enhanced ultrasound (CEUS) were evaluated. Factors influencing the VRR ≥75% were screened using multivariate logistic regression, and a predictable nomogram was established. Results At the 12-month follow-up, the VRR of nodule was 77.0 ± 20.6% (18.4–100%). Seven factors influencing the VRR ≥75.0% were identified: echogenicity, component, calcification, enhancement degree, enhancement defect, ring enhancement, and energy of ablation. A nomogram was established based on the above factors, and the predictive ability of the model was confirmed by internal validation with 1000 bootstrap repetitions. The area under the receiver-operating characteristic curve (AUC) of the model was 0.926, and the calibration curve and decision curve analysis (DCA) revealed that this model demonstrated predictive ability. Conclusion Seven factors influencing VRR in benign thyroid nodules after thermal ablation were screened out in the present study and used to establish a nomogram to predict the probability of VRR ≥75% at the 12-month follow-up. It would be beneficial to make personalized medical decisions to trigger thermal ablation in patients with benign thyroid nodules.

Changes of cortical gray matter volume during development: a Human Connectome Project study.

We assessed changes in gray matter volume of 35 cerebrocortical regions in a large sample of participants in the Human Connectome Project-Development (n = 649, 6-21 yr old, 299 males and 350 females). The same protocol for MRI data acquisition and processing was used for all brains. Volumes of individual areas were adjusted for estimated total intracranial volume and linearly regressed against age. We found changes of volume with age that were distinct among areas and consistent between sexes, as follows: 1) the overall cortical volume decreased significantly with age; 2) the volumes of 30/35 areas also decreased significantly with age; 3) the volumes of the hippocampal cortex (hippocampus, parahippocampal, and entorhinal) and that of pericalcarine cortex did not show significant age-related changes; and 4) the volume of the temporal pole increased significantly with age. The rates of volume reduction with age did not differ significantly between the two sexes, except for areas of the parietal lobe where males showed statistically significantly higher volume reduction with age than females. These results, obtained from a large sample of male and female participants, and acquired and processed in the same way, confirm previous findings, offer new insights into region-specific age-related changes in cortical brain volume, and are discussed in the context of the hypothesis that reduction in cortical volume may be partly due to a background, low-grade chronic neuroinflammation inflicted by common viruses residing latently in the brain, notably viruses of the human herpes family.NEW & NOTEWORTHY We report mixed effects of age on cortical gray matter volume during development in a large sample of 649 participants studied in an identical manner (6-21 yr old, 299 males, 350 females). Volumes of 30/35 cortical areas decreased with age, temporal pole increased, and pericalcarine and hippocampal cortex (hippocampus, parahippocampal, and entorhinal) did not change. These findings were very similar in both sexes and provide a solid base for assessing region-specific cortical changes during development.

Low-dose fractionated radiotherapy combined with neoadjuvant chemotherapy for T3-4 nasopharyngeal carcinoma patients: Preliminary results of a phase II randomized controlled trial.

6049 Background: Over 70% of NPC patients were local advanced NPC (LANPC). The 5-year local recurrence-free survival rate is only 70% in T3-4 patients. Neoadjuvant chemotherapy (NACT) followed with concurrent chemoradiotherapy (CCRT) was recommended for LANPC patients. Low-dose fractionated radiotherapy (LDFRT), which is &lt; 100cGy, induces enhanced cell killing by the hyper-radiation sensitivity phenomenon and potentiates effects of chemotherapy. The synergy of LDFRT and NACT has not been used in the clinical practice and few studies focused on it. A single arm study found the ORR of primary site was improved to 90% for head and neck squamous carcinoma patients treated with LDFRT and NACT. Our previous study found the ORR of lymph nodes was higher in LDFRT group for high-risk LANPC patients. However, another study showed there was no significant difference between LDFRT and control group for LANPC patients. So, we aimed to investigate the potential efficacy of this novel neoadjuvant therapy for T3-4 NPC patients. Methods: 60 pathological confirmed T3-4 (UICC/AJCC8th) NPC patients were prospectively enrolled in our study. They were randomly assigned to two groups. For the LDFRT group, the patients received 3 cycles of NACT (docetaxel 75mg/m2 D1, cisplatin 80mg/m2 D1) with LDFRT, and followed with CCRT. LDFRT was delivered as 50cGy per fraction twice a day to primary site on D1,2 for each cycle of NACT. The patients in the control group only received NACT and followed with CCRT. All the patients underwent IGRT. RECIST criteria and CTCAE 5.0 was used to evaluate the ORR and toxicity at post-NACT and the completion of CCRT. Results: from Feb 2022 to Dec 2022, 60 T3-4 NPC patients were included, and 30 patients for each group. For the primary site, the median volume reduction rate and the ORR after NACT was significantly improved in LDFRT group (69.27% vs 40.10%, p&lt; 0.001;93.33% vs 73.33%, p= 0.038). For the median volume reduction rate of primary site and lymph node, it was also obviously improved in LDFRT group (86.59% vs 55.43%, p&lt; 0.001). Though there was a tendency of ORR improvement in LDFRT group, but no significant difference (96.67% vs 83.33%, p= 0.195). After the completion of CCRT, the median volume reduction rate of primary site had an increased tendency in LDFRT group (96.16% vs 88.3%, p= 0.065), but the ORR had no statistical significance (LDFRT group: CR 45.8%, PR 54.2%; control group: CR 37.5%, PR 62.5%). For the toxicity, the incidence of grade 3-4 adverse events had no difference between two groups ( p= 0.786). No grade 5 adverse events occurred. Conclusions: LDFRT combined with NACT could obviously improve the median volume reduction rate and ORR of primary tumor for T3-4 NPC patients, and the toxicity was similar and tolerable. The novel treatment could be a promising strategy to improve treatment response, and needed to be confirmed further. Clinical trial information: NCT05503914 .

Impact of the introduction of minimally invasive treatments of the thyroid (MITT) for benign thyroid nodules in an Italian hospital: a cost-minimization analysis.

Prevalence of thyroid nodules is high in the adult population, approaching 60% in women and older people. Most thyroid nodules are benign and asymptomatic. However, a not negligible part of them causes compressive symptoms and/or cosmetic concerns and need to be treated. In the last two decades, minimally-invasive treatments of the thyroid (MITT) have been proposed in routine clinical practice as a reliable cost-effective alternative to surgery in patients with symptomatic benign thyroid nodules (SBTNs). To perform a cost-minimization analysis comparing direct, indirect and intangible costs of radiofrequency (RFA) and laser thermal ablation (LTA) with traditional surgery in patients with SBTNs. Data of patients treated by MITT for SBTNs from October 1st 2019 to September 30th 2022 in a single Italian tertiary Center were analyzed. Costs were compared to those of traditional surgery reported in the 2022 Associazione Medici Endocrinologi Guidelines on the Management of SBTNs. In the study lapse, 157 MITT of SBTNs were performed in 148 patients, 114 females and 34 males (mean age: 59 yrs; median age: 57 yrs). Before MITT, the mean thyroid nodule volume was 19 ml; 1 year after MITT, volume reduction rate >50% and symptom relief were achieved in 89% and 93% of patients, respectively. No major complications occurred. Adding up pre-operative, operative and post-operative costs, total direct costs per single procedure are the following: 1361.43 € for LTA when using one optic fiber; 1761.43 € for LTA when using two optic fibers; 1968.53 € for RFA; 3338.39 € for hemithyroidectomy plus isthmectomy; 4034.99 € for total thyroidectomy. Surgery was impactful on direct-i.e., preoperative, operative and postoperative-costs, due to longer operating room occupation time and hospital stay. Overall, a total saving for the Italian National Health Service of 285,377.15 € has been obtained treating the 148 patients by MITT instead of surgery. Likewise, MITT was advantageous also for indirect costs-i.e., those related to "loss of productivity" caused by time off work due to hospital stay and recovery time-, for both the self-employed workers and the Government, the latter saving 53,838.50 € overall. Finally, intangible costs, related to patients' quality of life-e.g., residual surgical scar, stress related to general anesthesia, convalescence, and life-long intake of L-Thyroxine replacement therapy-were all in favor of MITT. This real-life cost-minimization analysis demonstrates that LTA and RFA are safe and cost-effective procedures for the treatment of SBTNs. In our 3 years experience, adding the savings of 285,377.15 € for direct costs to those of 53.838,50 € for indirect costs, in total 339,215.65 € were saved. The saving concern patients, the National Health System and the Government.

Ultrasound-Guided Radiofrequency Ablation versus Thyroidectomy for the Treatment of Benign Thyroid Nodules in Elderly Patients: A Propensity-Matched Cohort Study.

Ultrasound-guided radiofrequency ablation has been recommended as an alternative to surgery for benign thyroid nodules. However, little is known about the benefit from the application of radiofrequency ablation for benign thyroid nodules in elderly patients. The purpose of this study was to compare the clinical outcomes of radiofrequency ablation versus thyroidectomy for elderly patients with benign thyroid nodules. This retrospective study evaluated 230 elderly patients (60 years of age or older) with benign thyroid nodules treated with radiofrequency ablation (R group, n = 49) or thyroidectomy (T group, n = 181). Complications, thyroid function, and treatment variables, including procedural time, estimated blood loss, hospitalization, and cost, were compared after propensity score matching. The volume, volume reduction rate, symptoms, and cosmetic score were also evaluated in the R group. After 1:1 matching, each group had 49 elderly patients. The rate of overall complications and hypothyroidism was 26.5% and 20.4% in the T group, respectively, but these complications were totally absent from the R group (P < .001, P = .001). Patients in the R group had a significantly shorter procedural time (median, 4.8 versus 95.0 minutes, P < .001) and lower cost (US $1979.02 versus US $2208.80, P = .013) than those treated by thyroidectomy. After radiofrequency ablation, the volume reduction rate was 94.1%, and 12.2% of nodules had completely disappeared. The symptom and cosmetic scores were both significantly reduced at the last follow-up. Radiofrequency ablation could be considered as a first-line treatment for elderly patients with benign thyroid nodules.

Short-term follow-up pilot study of sole middle meningeal artery embolization for chronic subdural hematoma: influence of internal architecture on the radiological outcomes.

To identify prognostic factors with emphasis on chronic subdural hematoma (CSDH) architecture that determines short-term outcome of middle meningeal artery embolization (MMAE). Consecutive CSDH patients treated by MMAE (November 2019 and March 2022) were retrospectively analyzed. Four architectures were analyzed: homogeneous, laminar, separated, and trabecular types. Predictor variables from baseline CT were correlated with radiological endpoint (≥ 50% of hematoma volume reduction), time to reach the endpoint, and rate of volume reduction. Study included 50 patients with 56 CSDHs (median age [first quartile, Q1; third quartile, Q3] 70.5 [60, 78.3] years; 36 were men). Separated type reached the endpoint at a lower rate on both bivariate (p = 0.02) and multivariate Cox model (0.034). Kaplan-Meier curves demonstrated that the median [Q1, Q3] time for 50% of the hematomas to reach the endpoint was 5 [4, 8], 4 [3, 5], 15 [15, 15], and 11 [4, 19] weeks for homogeneous, laminar, separated, and trabecular types, respectively. Linear mixed-effect model demonstrated a significant variation in the slope of hematoma volume reduction that was - 4.16 (95% confidence interval [CI] - 5.4, - 2.9), - 6.7 (95% CI - 8.35, - 5.1), - 2.03 (95% CI - 4.14, 0.08), and - 5.06 (95% CI - 6.8, - 3.32) ml per week for homogeneous, laminar, separated, and trabecular subtypes, respectively. Separated CSDH is a poor prognostic type in achieving radiological endpoint and a slower rate of volume reduction. While, homogeneous and laminar types reached the endpoint faster than separated and trabecular types on short-term follow-up.