The Laryngoscope, Год журнала: 2025, Номер unknown
Опубликована: Май 27, 2025
Язык: Английский
Thyroid, Год журнала: 2025, Номер unknown
Опубликована: Янв. 21, 2025
Objectives: Cytologically indeterminate thyroid nodules (Bethesda class III or IV) carry a 10-40% risk of malignancy. Diagnostic lobectomies are frequently performed but negative surgeries incur unnecessary costs on the healthcare system, potential complications, and impacts quality life. Molecular tests (MTs) have been developed to reduce surgeries. However, well-validated, high-performance MTs often expensive, their cost-effectiveness has not studied in Asian population. This study evaluates rate surgery setting without MT (our current practice) introducing commercially available for management cytologically modernized city Asia. Methods: Management decisions outcomes consecutive Bethesda IV tertiary endocrine center Hong Kong were evaluated. Costs health service provided by public which covers >90% city, retrieved. A decision tree model was compare avoiding practice versus routine from provider's perspective. In our practice, available, patients with received either upfront lobectomy, repeat fine needle aspiration cytology (FNAC), active surveillance. Results: Over 4-year period, 2157 FNACs performed. After exclusion, 1957 analyzed, 18.6% IV. Thirty-six percent these surgery, 28% having malignancy final pathology, that is, 72% unnecessary. Routine could 82 surgeries/year, 26% more than practice. resulted an incremental ratio dollar (HKD) 49,102 (US [USD] 6314) per surgery. Sensitivity analysis showed test cost contributed significantly ratio. Lowering commercial price below HKD 8044 (USD 1031) would render cost-saving. Conclusion: Currently, high is being nodules. effective reducing at higher cost. will become cost-saving if be lowered.
Язык: Английский
Процитировано
4
Pituitary, Год журнала: 2023, Номер 26(4), С. 319 - 332
Опубликована: Май 20, 2023
Diagnostic delay is high in acromegaly and leads to increased morbidity mortality. The aim of this study systematically assess the most prevalent clinical signs, symptoms comorbidities at time diagnosis.A literature search (in PubMed, Embase Web Science) was performed on November 18, 2021, collaboration with a medical information specialist.Prevalence data (presenting) diagnosis were extracted synthesized as weighted mean prevalence. risk bias assessed for each included using Joanna Briggs Institute Critical Appraisal Checklist Studies Reporting Prevalence Data.Risk heterogeneity 124 articles. Clinical signs highest prevalence were: acral enlargement (90%), facial features (65%), oral changes (62%), headache (59%), fatigue/tiredness (53%; including daytime sleepiness: 48%), hyperhidrosis (47%), snoring (46%), skin (including oily skin: 37% thicker 35%), weight gain (36%) arthralgia (34%). Concerning comorbidities, patients more frequently had hypertension, left ventricle hypertrophy, dia/systolic dysfunction, cardiac arrhythmias, (pre)diabetes, dyslipidemia intestinal polyps- malignancy than age- sex matched controls. Noteworthy, cardiovascular comorbidity lower recent studies. Features that often led typical physical (acral enlargement, prognatism), local tumor effects (headache visual defect), diabetes, thyroid cancer menstrual disorders.Acromegaly manifests itself but also wide variety common emphasizing recognition combination these key establishing diagnosis.
Язык: Английский
Процитировано
27
Frontiers in Endocrinology, Год журнала: 2023, Номер 14
Опубликована: Авг. 11, 2023
Background Published data on the relationship between polycystic ovary syndrome (PCOS) and thyroid dysfunction are sparse confusing. Objective To comprehensively review available in literature regarding PCOS function, its abnormalities. Methods Nine main areas of interest were identified analyzed according to evidence: 1) Evaluation function for diagnosis; 2) Epidemiology function/disorders patients with PCOS, vice versa; 3) Experimental supporting PCOS; 4) Effects features, 5) Effect alterations cardiometabolic risk women 6) abnormalities reproductive outcomes 7) Relationship function/abnormalities who undergoing fertility treatment; 8) treatments diseases 9) function. An extensive search specific keywords was performed articles published from 1970 March 2023 using PubMed Web Science. Data reported a narrative fashion. Results is diagnosis exclusion which possible only after excluding disorders that mimic phenotype, including dysfunctions. However, tests cutoff values used this not specified. Many experimental clinical suggest perturbations PCOS. Direct unequivocal evidence effects features lacking. High thyroid-stimulating hormone levels subclinical hypothyroidism may be associated significant worsening several intermediate endpoints Thyroid worsen outcomes, especially treatment. date, there no demonstrating efficacy medications Lifestyle modification changes, metformin, vitamin D seem improve general population. Conclusion closely related, their coexistence identify higher metabolic risk. Regular screening thyroid-specific autoantibodies particularly before during pregnancy, highly recommended.
Язык: Английский
Процитировано
21
Nature Reviews Endocrinology, Год журнала: 2024, Номер 20(12), С. 715 - 728
Опубликована: Авг. 16, 2024
Язык: Английский
Процитировано
9
EDPACS, Год журнала: 2024, Номер 69(10), С. 1 - 29
Опубликована: Авг. 2, 2024
This study presents a comprehensive bibliometric and content analysis of scholarly articles exploring the intersection information systems marketing strategy. Leveraging Web Science Core Collection database, research employed rigorous search strategy using key terms such as "information systems" "marketing strategy." After initially identifying over 2,000 sources, final dataset 124 peer-reviewed studies from management business domains was meticulously selected for analysis. The identifies seven trends within strategy, with particular focus on evolving impact remote work. Special attention is dedicated to authentic applications in shaping dynamics. study's novelty lies its extensive examination, offering fresh insights guiding future directions. By significantly contributing understanding advancement this field, underscores complex interplay between contemporary organizational contexts.
Язык: Английский
Процитировано
7
The Journal of Clinical Endocrinology & Metabolism, Год журнала: 2023, Номер 108(11), С. 2759 - 2771
Опубликована: Май 18, 2023
Abstract Over the past 3 decades, advances in molecular genetics of thyroid cancer (TC) have been translated into diagnostic tests, prognostic markers, and therapeutic agents. The main drivers differentiated TC pathogenesis are single-point mutations gene fusions components Mitogen-activated protein kinase (MAPK) phosphoinositide-3-kinase-protein B/Akt (PI3K/Akt) pathways. Other important genetic alterations more advanced types include TERT promoter, TP53, EIF1AX, epigenetic alterations. Using this knowledge, several tests developed for cytologically indeterminate nodules. Currently, commercially available use including a DNA/RNA-based test (ThyroSeq v.3), an RNA-based (Afirma Gene Sequencing Classifier), hybrid DNA/miRNA test, ThyGeNEXT/ThyraMIR. These mostly used to rule out malignancy Bethesda III IV nodules because they all high sensitivities negative predictive values. Their common use, predominantly United States, has resulted significant reduction unnecessary surgeries benign Some these also provide information on underlying TC; may support decision making initial management planning, although practice not yet widely adopted. More importantly, testing is essential patients with disease before using specific mono-kinase inhibitors (eg, selpercatinib RET-altered TC) drugs ineffective absence target. This mini-review discusses utilization data clinical different situations.
Язык: Английский
Процитировано
13
Life, Год журнала: 2023, Номер 13(6), С. 1292 - 1292
Опубликована: Май 31, 2023
A widely discussed topic in the pathophysiology of thyroid nodules is role obesity, a state that leads to increased systemic inflammatory markers. Leptin plays vital forming and cancer through several mechanisms. Together with chronic inflammation, there an augmentation secretion tumor necrosis factor (TNF) cytokine interleukin 6 (IL-6), which contributed development, progression metastasis. In addition, leptin exerts modulatory action growth, proliferation invasion carcinoma cell lines via activating various signal pathways, such as Janus kinase/signal transducer activator transcription, mitogen-activated protein kinase (MAPK) and/or phosphoinositide 3-kinase (PI3K)/protein B (Akt). Through proposed mechanisms, aberrant endogenous estrogen levels have been suggested play development both benign malignant nodules. Metabolic syndrome triggers by stimulating angiogenesis due hyperinsulinemia, hyperglycemia dyslipidemia. Insulin resistance influences distribution structure blood vessels. growth 1 (IGF-1) insulin affect regulation expression genes differentiation cells. TSH can promote pre-adipocytes mature adipocytes but also, presence insulin, possesses mitogenic properties. This review aims summarize underlying mechanisms explaining obesity discuss potential clinical implications.
Язык: Английский
Процитировано
10
Frontiers in Endocrinology, Год журнала: 2024, Номер 15
Опубликована: Май 28, 2024
Introduction Fine needle aspiration (FNA) is the gold standard method recommended in diagnosis of thyroid nodules. Bethesda IV cytology results are identified 7-9% nodules investigated through FNA, with reported malignancy rate a wide range 10-40%. The treatment either surgical or risk additional molecular testing before surgery. However, large number belonging to this category (60-80%) observed be benign after excision, which can put patient at unnecessary morbidity. This study aimed assess diagnostic performance conventional ultrasound, ACR TI-RADS score and elastography cases on FNA. Methods We evaluated ninety-seven consecutive FNA by using B-mode qualitative strain shear-wave (Hitachi Preirus Machine, Hitachi Inc., Japan Aixplorer Mach 30 Supersonic Imagine, Aix-en-Provence, France) all were classified according system. Conventional ultrasound was used categorize as potentially malignant based following features: hypoechogenicity, inhomogeneity, taller than shape, irregular margins, presence microcalcifications, an interrupted capsule suspicious cervical lymph nodes. Elastography increased stiffness for malignancy. Results considered pathology diagnosis, finding that 32 out 97 carcinomas (33%) 65 (67%). group included twenty non-invasive follicular neoplasm papillary-like nuclear features (NIFTP). Finally, we compared data results, showed nineteen presented (p=0.0002). On found microcalcifications (p=0.007), hypoechogenicity margins (p=0.006) distinguish between statistical significance. Discussion Integrating parameter evaluation sensitivity 90.62% detecting cancer (p=0.006). conclude elastographic addition high improves detection cytology.
Язык: Английский
Процитировано
4
International Journal of Molecular Sciences, Год журнала: 2023, Номер 24(20), С. 15131 - 15131
Опубликована: Окт. 13, 2023
The incidence of thyroid nodules (TNs) is estimated at 36.5% and 23% in females males, respectively. A single nodule usually detected during ultrasound assessment patients with symptoms dysfunction or neck mass. TNs are classified as benign tumours (non-malignant hyperplasia), neoplasms (e.g., adenoma, a non-invasive follicular tumour papillary nuclear features) malignant carcinomas (follicular cell-derived C-cell derived). differential diagnosis based on fine-needle aspiration biopsies cytological (which burdened the bias subjectivity). Raman spectroscopy (RS) laser-based, semiquantitative technique which shows for oscillations many chemical groups one label-free measurement. RS, through content, gives insight into tissue state which, turn, allows differentiation disease basis spectral characteristics. purpose this study was to report if RS could be useful TN. Web Science, PubMed, Scopus were searched from beginning databases up end June 2023. Two investigators independently screened key data using terms “Raman spectroscopy” “thyroid”. From 4046 records found initially, we identified 19 studies addressing applying technique. lasers used included 532, 633, 785, 830, 1064 nm lines. investigations performed cellular and/or level, well serum samples. accuracy carcinoma detection approx. 90%. Furthermore, medullary, can 100% accuracy. These results might biased low numbers cases some research overfitting models reference method. main biochemical changes observe malignancies follows: increase protein, amino acids (like phenylalanine, tyrosine, tryptophan), nucleic acid content comparison non-malignant TNs. Herein, present review literature application This seems have powerful potential diagnosis.
Язык: Английский
Процитировано
9
Scientific Reports, Год журнала: 2024, Номер 14(1)
Опубликована: Июнь 21, 2024
With an increasing prevalence of thyroid nodules globally, this study investigates the potential correlation between use Bluetooth headsets and incidence nodules, considering cumulative effects non-ionizing radiation (NIR) emitted by these devices. In study, we analyzed 600 valid questionnaires from WenJuanXing platform using Propensity Score Matching (PSM) XGBOOST model, supplemented SHAP analysis, to assess risk nodules. PSM was utilized balance baseline characteristic differences, thereby reducing bias. The model then employed predict factors, with efficacy measured area under Receiver Operating Characteristic (ROC) curve (AUC). analysis helped quantify explain impact each feature on prediction outcomes, identifying key factors. Initially, underwent processing, resulting in a matched dataset 96 cases for modeling analysis. AUC value reached 0.95, demonstrating high accuracy differentiating nodule risks. revealed age daily headset usage duration as two most significant factors affecting risk. Specifically, longer durations were strongly linked increased developing indicated outcomes. Our highlighted relationship prolonged risk, emphasizing importance health impacts modern technology, especially devices like that are frequently used daily. Through precise predictions variable our research provides scientific basis formulation public policies personal habit choices, suggesting attention should be paid life reduce Future further investigate biological mechanisms consider additional influencing offer more comprehensive guidance preventive measures.
Язык: Английский
Процитировано
3