ObjectiveTo explore the value of active surveillance (AS) with ultrasound for papillary thyroid microcarcinoma (PTMC) tumor growth.MethodsA retrospective collection of 196 patients who underwent ultrasound-guided fine-needle aspiration biopsy at West China Hospital of Sichuan University from January 2014 to December 2018 were pathologically diagnosed as PTMC, and no cervical lymph node metastasis was found on ultrasound, and AS was performed. According to the change of the maximum diameter of the nodule, the patients were divided into the maximum diameter increase group, the maximum diameter stable group and the maximum diameter reduction group. According to the nodule volume change, the patients were divided into the volume increase group, the volume stable group and the volume reduction group. The differences in the patients’ gender, age, with Hashimoto’s thyroiditis, follow-up time, tumor size, boundary, shape, echo, aspect ratio, calcifications, multifocality, bilateral involvement, other nodule, surrounding tissues and cervical lymph nodes among the different groups were analyzed in order to clarify the related factors of tumor growth.ResultsOne hundred and ninety-six patients had ultrasound AS time ranging from 6 to 79 months with the median (quartile) time were 16.0 (10.0, 30.0) months. One hundred and seventeen patients (59.7%) were in AS for 6 to 63 months with the median (quartile) time were 13.0. (8.0, 22.0), surgical treatments were performed after termination of AS. Forty-five patients (23.0%) continued to perform AS, 34 patients (17.3%) did not continue to perform AS in West China Hospital of Sichuan University. There was no significant reduction in the maximum diameter and volume of the nodules in all cases. Among them, 9 cases (4.6%) had an increase in the maximum diameter of the nodules, and 187 cases (95.4%) had a stable maximum diameter. Forty cases (20.4%) had an increase in the volume of the nodules, and 156 cases (79.6%) had a stable volume of the nodules. Comparison of the maximum diameter change of nodules between the two groups, there was a significant difference in the age of patients (P<0.05). Comparison of the maximum volume change between the two groups, there were significant differences in age, follow-up time and initial nodule volume (P<0.05). Logistic regression analysis showed that younger age was an independent risk factor for PTMC nodule growth [OR＝0.638, 95%CI (0.601, 0.675), P＝0.015].ConclusionsYounger age is a risk factor for PTMC tumor growth. We should adopt a more active monitoring program for younger patients. The increase of PTMC tumor volume can be more easily monitored than the increase of its maximum diameter, so it can be used as an indicator to predict nodule growth at an earlier stage in AS.
ObjectiveTo summarize the research progress in the treatment of papillary thyroid microcarcinoma (PTMC) , and provide rationalized treatment strategies for patients with PTMC. MethodsRetrieved and reviewed relevant literatures about the treatment of PTMC in recent years both at home and abroad. ResultsLow-risk and high-risk PTMC differ markedly in biological characteristics and prognosis and should be treated differently. For high-risk PTMC, surgery is the primary treatment, supplemented by endocrine and radioiodine therapy. Various options are available for low-risk PTMC, including surgery, active surveillance, and ablative therapy. Surgery is the preferred option with clear efficacy and diversified surgical options. However, there are surgical risks and postoperative complications. Active surveillance avoids surgical and/or postoperative complications. Thermal ablation is minimally invasive with a low impact on thyroid function. Still, both active surveillance and thermal ablation lack the results of large samples with long-term follow-up to validate effectiveness and safety. ConclusionsStratified management should be applied to PTMC. High-risk PTMC should be treated surgically. All three treatment options of low-risk PTMC have advantages and disadvantages, which should be considered in conjunction with the patients’ wishes. After careful assessments and fully informed communications with patients, doctors and patients work together to develop a rationalized and individualized PTMC treatment strategy.
ObjectiveTo summarize the latest research progress in active surveillance of low-risk papillary thyroid microcarcinoma at home and abroad, and provide some reference for future clinical work. MethodRetrieved and reviewed relevant literatures about prospective studies on active surveillance of papillary thyroid microcarcinoma.ResultsIn recent years, the incidence of papillary thyroid microcarcinoma had increased sharply, but most of the biological activities were inert, tumor-specific mortality was very low, and only a few had progressed. For patients with papillary thyroid microcarcinoma, surgery was a safe and effective treatment method, but due to changes in the epidemiological characteristics of the disease, people were reconsidering whether there was overtreatment in patients without high-risk characteristics. Expert consensus and guidelines no matter at home or abroad mentioned that active monitoring can be considered as an alternative to surgery. For suitable patients, active monitoring might be a better choice.ConclusionsActive surveillance for low-risk papillary thyroid microcarcinoma is basically considered to be a safe and feasible treatment option, but large numbers of clinical trials are still needed to provide evidence for the conversion of conventional clinical treatment models. In the future, by more accurately assessing the tumor progression of patients with low-risk papillary thyroid microcarcinoma, active surveillance is promising to alternate surgical treatments.
Objective To evaluate the value of methylated Septin9 (mSEPT9) in the diagnosis and postoperative recurrence/metastasis monitoring of colorectal cancer. Methods A total of 76 patients with colorectal cancer who were hospitalized in Beijing Anorectal Hospital (Beijing Erlonglu Hospital) and positive for mSEPT9 before operation from January to December in 2020 were collected. Nineteen patients who were still positive for mSEPT9 at one week after operation were selected as the msept9 positive group, and 57 patients whose mSEPT9 became negative were selected as the msept9 negative group. The clinicopathological features and postoperative recurrence and metastasis of the two groups were analyzed and compared. Results There were significant differences in lymph node metastasis rate, vascular or nerve infiltration and clinical staging between the mSEPT9 positive group and the mSEPT9 negative group (P=0.024, P=0.009, P=0.009). There was no significant difference in age, gender, tumor location, degree of tumor differentiation, and tumor invasion depth (T stage), P>0.05. Two patients in the mSEPT9 positive group had liver metastases after operation, and there were no cases of metastasis or recurrence in the mSEPT9 negative group (P=0.024). Conclusion The mSEPT9 can be used as a potential tumor marker for the diagnosis of colorectal cancer and the monitoring of postoperative treatment effect, and more attention should be paid to patients who are still positive for mSEPT9 after surgery.
ObjectiveTo carry out targeted surveillance on ventilator-associated pneumonia (VAP) newly defined by the Centers for Disease Control and Prevention of the United States in 2013, and to understand its applicability and influence on the prognosis, and infection rate and risk factors of the disease.
MethodsTargeted surveillance was carried out on all patients receiving mechanical ventilation in the general ICU of our hospital between January and December 2014. VAP infection rate was studied, and patients were divided into groups based on the development of the disease. SPSS 18.0 was used for statistical analysis of the prognostic indicators.
ResultsA total of 885 patients received mechanical ventilation and were monitored, 31 of whom had VAP. The VAP case infection rate was 3.5% and its daily infection rate was 3.9‰. The results of multiple factors regression analysis showed that age (OR=1.025, P=0.025) and combining other types of hospital infection (OR=4.874, P<0.001) were independent risk factors for the development of VAP. VAP was the independent risk factor for both length of stay in the ICU and length of mechanical ventilation (P<0.001), but it was not the independent risk factor for mortality in the ICU (P=0.515).
ConclusionThe applicability of the newly defined ventilator-associated pneumonia may be under restrictions in developing countries. It may influence the outcomes of patients by prolonging the length of stay in ICU and the length of mechanical ventilation.
ObjectiveTo analyze targeted surveillance results of nosocomial infection in Neurosurgical Intensive Care Unit (ICU) and investigate the characteristics of nosocomial infection, in order to provide reference for constituting the intervention measures.
MethodsWe monitored the incidence of nosocomial infection, the application and catheter-related infection of invasive operation, and the situation of multiple resistant bacteria screening and drug resistance characteristics of each patient who stayed more than two days in neurosurgical ICU during January to December 2013.
ResultsThere were a total of 1 178 patients, and the total ICU stay was 4 144 days. The nosocomial infection rate was 4.92%, and the day incidence of nosocomial infection was 13.75‰. The nosocomial infection rate was significantly higher in January and between July and December compared with other months. Ventilator utilization rate was 9.75%; ventilator-associated pneumonia incidence density was 14.85 per 1 000 catheter-days; central line utilization rate was 28.40%; central line-associated bloodstream infection incidence density was 0.85 per 1 000 catheter-days; urinary catheter utilization rate was 97.90%; and the incidence density of catheter-associated urinary tract infection was 0.25 per 1 000 catheter-days.
ConclusionThe nosocomial infection rate has an obvious seasonal characteristic in neurosurgical intensive care unit, so it is necessary to make sure that the hospital infection control full-time and part-time staff should be on alert, issue timely risk warning, and strengthen the risk management of hospital infection.
Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+endoscopic ultrasound+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve circulating tumor DNA and radiomics for risk stratification to advance precise organ-preserving strategies.
Objective To explore the intraoperative imaging to monitor the prosthetic fixation for the total hip arthroplasty (THA) and to increasethe accuracy of the primary THA prosthetic fixation. Methods From April 2000 to August 2005, 69 patients (75 hips) underwent THA monitored by the imaging (the imaged THA group, Group I), and 72 patients (78 hips) underwent THA with the standard method (the standard THA group, Group S). There were 32 males and 37 females in Group S. The mean ages of the patients in Group I and Group S were 62.3 years and 60.5 years respectively, ranging 46-75 years in Group I and 43-75 years in Group S. Preoperative diagnoses were femoral neck fracture (Garden Ⅲ,Ⅳ) in 23 patients (23 hips) in Group I and 25 patients (25 hips) in Group S, acetabular dysplasia (Campbell Ⅰ, Ⅱ) in 9 patients (10 hips) in Group I and 11 patients (13 hips) in Grouop S, osteoarthritis in 16 patients (17 hips)in Group I and 15 patients (15 hips) in Group S, femoral head osteonecrosis (Ficat Ⅲ,Ⅳ) 15 patients (16 hips) in Group I and 17 patients (17 hips) in Group S, and rheumatoid arthritis in 6 patients (9 hips) in Group I and 4 patients (8 hips) in Group S. There were 21 hips of cement prostheses in Group I and 22 hips in Group S, 12 hips of cementless prostheses in Group I and 11 hips in Group S, 42 hips of cement and cementless prostheses in Group I and 45 hips in Group S. Group I used the standard THA and the intraoperative X-ray monitoring the prosthetic fixation in the numerical measure of abduction angle, anteversion angle, femoralneck length, and femoral offset distance. The items compared betweem Group I and Group S included incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, infection, postoperative functional recovery, and prostheric position of postoperative X-ray imaging. Results The follow-up on 62 patients in Group I and 64 patients in Group S for 6-64 months averaged 42 months revealed that there were statistically significant differences in incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, postoperative functional recovery, prosthetic position of postoperative X-ray imaging, and the Harris score between Group I and Group S one year after operation. The results of Group I were significatly better than those of Group S. Conclusion The intraoperative X-ray imaging can increase the accuracy of the THA prosthetic fixation and reduce the incidence of THA maloperation by The X-ray imaging can also be used in county hospitals if Carm fluoroscopy can be provided.
ObjectiveTo investigate the risk factors for surgical site infection (SSI) in patients after colorectal surgery, in order to provide a basis for regulation and implementation of preventive measures against SSI.
MethodsFrom February to December 2012, a targeted surveillance on surgical site infection of "colon resection" and "rectum resection" surgery patients in the Department of Gastrointestinal Surgery was carried out. We analyzed the monitoring data, and explored the occurrence of postoperative SSI. At the same time, by case-control study, both single and multiple regression logistic analyses were performed on the 12 variables such as hypertension, diabetes mellitus duration during operation, America Society of Anesthesiologists score, grade of incision and so on to analyze the risk factors for SSI.
ResultsAmong the 535 patients who underwent colorectal resections, 44 had SSI with an infection rate of 8.22%. Multiple logistic regression analysis showed that the length of hospital stay[OR=1.070,95%CI(1.033,1.109), P<0.001]and emergency surgery[OR=6.320,95%CI(1.932,20.669),P=0.002] were independent risk factors for SSI after colorectal resections.
ConclusionThere are many risk factors for SSI after colorectal surgery. Through the implementation of targeted surveillance, we can find the main risk factors, which provides a basis for the regulation and implementation of intervention measures against SSI.
