A Propensity Score Matching Study Between Microwave Ablation and Radiofrequency Ablation in Terms of Safety and Efficacy for Benign Thyroid Nodules Treatment.

Background: Large benign thyroid nodules often lead to cosmetic problems and compression on trachea. Thermal ablation is an effective method for benign thyroid nodules treatment. Among all the thermal ablation techniques, microwave and radiofrequency are frequently used energy sources. However, treatment outcomes of the two ablation types have not been compared in detail. Therefore, we conducted this study aiming for comparing the safety and efficacy of the two ablation techniques in benign thyroid nodules treatment. Methods: Information was retrospectively collected from patients with benign thyroid nodules, who received radiofrequency ablation or microwave ablation between January 1, 2018, and December 31, 2019, in a main hospital in South China. Patients were divided into microwave ablation group and radiofrequency ablation group according to the techniques applied. A propensity score matching was performed to balance the baseline indexes between the two groups. We also recorded and analyzed the operative variables including operative duration, intraoperative blood loss, hospitalization time, and overall costs. Postoperative quality of life, volume reduction rates, and complication rates were routinely evaluated during the follow-up by asking patients to fulfil questionnaires at the 1st, 3rd, 6th, 12th, and 18th postoperative month. Results: A total of 943 patients receiving microwave ablation or radiofrequency ablation in the years of 2018 and 2019 met our inclusion criteria. After 1:1 propensity score matching, 289 pairs of patients were matched. There was no significant difference between the two groups in operative duration, intraoperative blood loss, hospitalization time, overall cost, quality of life scores, complication rates or volume reduction rates. Conclusion: There was no significant difference between microwave and radiofrequency ablation in terms of safety and efficacy. Both of the two techniques` are ideal therapeutic methods in benign thyroid nodules treatment. Registration number: ChiCTR2000034764.

Percutaneous transhepatic cholangioscopic lithotripsy using soft fiber-optic choledochoscope.

Many patients with intrahepatic cholelithiasis need surgical treatment during their life. For patients with hepatolithiasis, conventional therapy methods suggest partial hepatectomy or hepatic transplantation, while both kinds of surgery carry a considerable risk and trauma. Under such conditions, percutaneous transhepatic cholangioscopic lithotripsy provides an alternative method for hepatolithiasis treatment. Conventional rigid choledochoscope applied in percutaneous transhepatic cholangioscopic lithotripsy often lack sufficient flexibility for complete intrahepatic bile duct inspection. In this article, we report a case of one patient with complex hepatolithiasis and choledocholithiasis who received percutaneous transhepatic cholangioscopic lithotripsy using the newly-developed soft fiber-optic choledochoscope. This treatment represents a safe and effective outcome. We came to the conclusion that soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy seems a promising treatment option for selected patients with hepatolithiasis, especially for those who cannot accept conventional methods.

Application of indocyanine green in the parathyroid detection and protection: Report of 3 cases.

BACKGROUND: It was thought that identifying the parathyroid gland during surgery was difficult for surgeons. It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the intrinsic fluorescence via imaging technology. In this case reports, a newly-invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid gland and evaluate the vascularization of parathyroid. CASE PRESENTATION: From July 1st to August 8st, 2018, 3 patients underwent total thyroidectomy in Zhuhai People's Hospital. The 3 subjects were recruited into our research. Indocyanine green angiography was performed on all the three participants. By ICG angiography, parathyroid glands were identified and protected. In the 3 patients, postoperative PTH levels were in the normal range. No one of them developed transient hypoparathyroidism. CONCLUSIONS: This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism.

Research on indocyanine green angiography for predicting postoperative hypoparathyroidism.

BACKGROUND: It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, the intrinsic fluorescence of the parathyroid has been found. There is some evidence supporting that new equipment can detect fluorescence via imaging technology. In this study, a newly invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid glands and evaluate the vascularization of the parathyroid. The report is as follows. METHODS: From 1 May to 8 August 2018, 26 patients underwent total thyroidectomy in Zhuhai People's Hospital and were recruited into our research. All identified parathyroid glands were scored visually from grade 0 to grade 2 according to the vascularity of the parathyroid before ICG angiography was performed. After ICG angiography, parathyroid glands were scored from score 0 to score 2 according to the FI. RESULTS: Visual scores were significantly higher than ICG angiography scores. In the 22 patients with at least one parathyroid gland with an ICG score of 2, postoperative PTH levels were in the normal range. In the four patients with no parathyroid gland with an ICG score of 2, two of them developed transient hypoparathyroidism, with recovery on POD 7 for the first patient and after 3 months for the second one. CONCLUSION: This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative hypoparathyroidism. Registration number: ChiCTR1800016864.

Application of a Fluorescence Imaging System with Indocyanine Green to Protect the Parathyroid Gland Intraoperatively and to Predict Postoperative Parathyroidism.

INTRODUCTION: Identifying the parathyroid gland during surgery may be difficult for surgeons. It is critical for them to be able to locate it during thyroidectomy or parathyroidectomy because of the significant function of the parathyroid in the calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the fluorescence via imaging technology. In this study, a newly invented intraoperative fluorescence imaging system and indocyanine green (ICG) dye were applied to detect the parathyroid glands and evaluate the vascularization of the parathyroid. METHODS: From 1 May to 8 August 2018, 26 patients underwent total thyroidectomy in Zhuhai People's Hospital. These 26 subjects were recruited in our research. All identified parathyroid glands were scored visually from grade 0 to grade 2 according to the vascularity of the parathyroid before ICG angiography was performed. After ICG angiography, the parathyroid glands were scored from 0 to 2 according to the fluorescence intensity (FI). RESULTS: Visual scores were significantly higher than ICG angiography scores. In the 22 patients with at least one parathyroid gland with an ICG score of 2, postoperative parathyroidism (PTH) levels were in the normal range. Of the four patients with no parathyroid gland with an ICG score of 2, two developed transient hypoparathyroidism, with recovery on postoperative day (POD) 7 for the first patient and after 3 months for the second. CONCLUSION: This study has shown that a fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism. TRIAL REGISTRATION: Chinese Clinical Trial Registry no. ChiCTR1800016864.

A propensity score matching study between ultrasound-guided percutaneous microwave ablation and conventional thyroidectomy for benign thyroid nodules treatment.

PURPOSE: Our study aims to compare ultrasound (US)-guided percutaneous microwave ablation (PMWA) and conventional thyroidectomy in benign thyroid nodules (BTN) treatment. MATERIALS AND METHODS: From December 2015 to December 2017, a total of 280 patients with at least one benign thyroid nodule were studied retrospectively, including 156 patients treated with US-guided PMWA and 124 patients treated with conventional thyroidectomy. Propensity score matching was performed to decrease the confounding bias due to retrospective assignment and to balance the pre-operation data of the two groups. A total of 106 pairs (1:1) was created. The operation time, intraoperative blood loss, postoperative hospitalization time, serum levels of interleukin (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) 12 h after operation and postoperative complications incidence rate were compared between the two groups. The volume reduction ratio was calculated in the US-guided PMWA group at 1, 3, 6 and 12 months after treatment. Registration number: ChiCTR1800015531. RESULTS: Significant differences were found between the two groups in levels of CRP, IL-6, and TNF-α after the operation； there were significant differences between the two groups in intraoperative blood loss, operation time, postoperative hospitalization time and postoperative complications rate. The volume reduction ratio at 1, 3, 6 and 12 months after treatment was 15.2%, 47.6%, 67.2% and 79.6%, respectively. CONCLUSIONS: Our study demonstrated that US-guided PMWA is characterized by a definite therapeutic success rate, good cosmetic effect, slight injury and rapid recovery. US-guided PMWA is an effective technique for benign thyroid nodules treatment．.

DNA methyltransferases contribute to the fungal development, stress tolerance and virulence of the entomopathogenic fungus Metarhizium robertsii.

DNA methylation is an important epigenetic mark in mammals, plants, and fungi and depends on multiple genetic pathways involving de novo and maintenance DNA methyltransferases (DNMTases). Metarhizium robertsii, a model system for investigating insect-fungus interactions, has been used as an environmentally friendly alternative to chemical insecticides. However, little is known concerning the molecular basis for DNA methylation. Here, we report on the roles of two DNMTases (MrRID and MrDIM-2) by characterizing ΔMrRID, ΔMrDIM-2, and ΔRID/ΔDIM-2 mutants. The results showed that approximately 71, 10, and 8% of mC sites remained in the ΔMrRID, ΔMrDIM-2, and ΔRID/ΔDIM-2 strains, respectively, compared with the wild-type (WT) strain. Further analysis showed that MrRID regulates the specificity of DNA methylation and MrDIM-2 is responsible for most DNA methylation, implying an interaction or cooperation between MrRID and MrDIM-2 for DNA methylation. Moreover, the ΔMrDIM-2 and ΔRID/ΔDIM-2 strains showed more defects in radial growth and conidial production compared to the WT. Under ultraviolet (UV) irradiation or heat stress, an obvious reduction in spore viability was observed for all the mutant strains compared to the WT. The spore median lethal times (LT50s) for the ΔMrDIM-2 and ΔRID/ΔDIM-2 strains in the greater wax moth, Galleria mellonella, were decreased by 47.7 and 65.9%, respectively, which showed that MrDIM-2 is required for full fungal virulence. Our data advances the understanding of the function of DNMTase in entomopathogenic fungi, which should contribute to future epigenetic investigations in fungi.