RESUMO
Objective:To evaluate the feasibility, safety and effectiveness of the active surveillance as an alternative to surgery in patients with low-risk papillary thyroid microcarcinoma(PTMC); And to explore potential surgical indicators based on characteristics of patients and medical environment.Methods:A prospective cohort study was conducted in patients with low risk PTMC and received active surveillance management( n=98). Patient adherence, non-progression surgery rates were described, cumulative incidence of tumor growth≥3 mm and tumor volume increase≥50% under ultrasonic monitoring, as well as tumor doubling rate(TDR) were evaluated. Results:A total of 98 patients were enrolled in this prospective cohort. The median age was 39(30, 45) years, and the median baseline diameter of the index tumors was 5.0(3.8, 6.8) mm, with 63.3% of tumors being≤5 mm. After a median 22(12, 44) months follow-up, tumor size growth≥3 mm and tumor volume increase≥50% occurred in 11(11.2%) and 50(51.0%) patients, and no new lymph node metastasis, distant metastasis, and death occurred. Five cases(5.1%) required delayed surgery, and other five non-progression patients opted in surgery based on their own preferences. One patient lost to follow-up. The median post-tumor progression TDRs was significantly lower than that of pre-tumor progression TDRs [size growth per year: -0.09(-0.12, 0.48) vs 0.91(0.86, 1.25), P=0.014, n=8; volume increase per year: 0.29(-0.14, 0.70) vs 1.04(0.66, 2.17), P<0.001, n=39]. After tumor size and volume progression, 62.5% and 43.6% of tumors were remained stable or shrank, respectively. Conclusions:Actived surveillance can be considered as one of the management strategies for low-risk PTMC. Given the differences in population and clinical characteristics, it should be taken in to consideration in developing active surveillance management, such as candidate criteria, follow-up strategies, and intervention indications.
RESUMO
Objective To evaluate the clinical value of ultrasound in evaluating the wrist nerve stem.Methods The examination of the high-resolution ultrasound about normal median nerve,ulnar nerve,radial nerve in the wrist on 100 normal volunteers,the courser,shape and sonographic appearance of the nerve stem were observed,and the vertical and horizontal diameter and the area of cross-section were measured.Results (1)Ultrasound clearly showed the nerve stem arranged and organization structures around it.(2) Ultrasound entirely measured the vertical and horizontal sections of normal median nerve,ulnar nerve,radial nerve in the wrist,besides it measured various diameters and the cross-section area.By comparing the vertical diameter of MN and RN between left hand and right hand of the same sexuality,the difference had no statistical significance (P＞0.05).By comparing the various diameters of UN between left hand and right hand of females,the difference had no statistical significance (P＞0.05) By comparing the vertical diameter between left hand and right hand of male,the difference had statistical significance (P＜0.05).To compare the vertical diameter of MN,RN and UN between male and females on the same side,the difference had statistical significance (P＜0.05).To compare the CSA of MN,RN and UN between left hand and right hand of the same sexiuality,the diffevence had no statistical significance (P＞0.05);By comparing the CSA of MN,RN and UN between male and females on the same side,the diffevence had statistical significance (P＜0.05).Median nerve cross-sectional area (CSA) and weight correlation was statistically significant (P ＜ 0.05) in a straight line,no statistically significant correlation was found between age and height (P＞ 0.05).(3) High resolution ultrasound clearly showed the neural surrounding adjacent to the organizational structure,and in line with gross anatomy section.Conclusion Ultraound has a clinical evalution value for examing the wrist nerve