| Background and Objective Thyroid nodules is a common clinical disease,multiple epidemiological investigation showed that the positive rate is only 3-7% by using conventional palpate Thyroid nodule detection.With the development of imaging technology,the detected rate increased to 20-76% by using the high-frequency ultrasound.In recent years,researches found that metabolic syndrome is a risk factor for thyroid nodules.At present,most scholars divided the thyroid nodules into cystic,solid and cystic,single and multiple,benign and malignant.Most thyroid nodules are benign,only about 5% are malignant,the current treatment for malignant nodules is mainly through surgery.For the benign nodules,the majority of patients still have a positive request of treatment,the traditional treatment is percutaneous interstitial injection of ethanol dispersion guided by ultrasound which often exist defects of ethanol dispersion uneven and the degree of hardening inconsistencies;In addition,the flow of ethanol is poorly controlled,and is easy to leak around the nodules lead to chemical adhesion.Surgical treatment indications of benign thyroid nodules are narrow,only is used in the tumor in the sternum or mediastinal and oppressive symptoms,postoperative bleeding prone,infection,recurrent laryngeal nerve injury,parathyroid injury,hypothyroidism and other complications,are often not accepted by patients.Drug therapy is TSH inhibition therapy,but some researchers believe that L-thyroxine can not significantly inhibit thyroid nodules,its effectiveness is controversial.Radioactive iodine is mainly used for the treatment of benign thyroid nodules with autonomic intake with hyperthyroidism,and there is still a risk of hypothyroidism after treatment.Therefore,a new method is urgently to be found for the treatment of thyroid benign nodules.Thermal ablation,as a new minimally invasive technique,is more suitable for lung,liver,kidney,pancreas,breast,uterus and other substantive organ cancer treatment,but for the treatment of superficial organ lesions is still rare.In recent years,researchers have begun to try to use ultrasound-guided thermal ablation techniques for the treatment of thyroid neoplasms.Thermal ablation mainly includes radiofrequency ablation(RFA),laser ablation(LAT)and microwave ablation(MWA).The common principle is the use of heat to make the lesion cells degeneration and coagulation necrosis,necrotic tissue gradually absorbed by the body,so as to achieve the purpose of destroying the lesion.Studies have confirmed that radiofrequency ablation of thyroid tumors susceptible to current interference,blood perfusion and other effects,and laser ablation is caused less damage,therefore,limit its further clinical applications.Microwave ablation is the microwave energy changed into heat mediated by ultrasound,thus leading to destroy the lesion tissue,which is used for liver and kidney tumors,uterine fibroids,etc.In recent years,although the studies show that microwave ablation area is large,not vulnerable to blood flow perfusion.there is little research on the treatment of thyroid nodules by microwave ablation.However,microwave ablation is becoming a new treatment of benign thyroid nodules which is worth exploring.In this study,benign thyroid nodules were screened by fine-needle aspiration biopsy(FNAB)guided by ultrasound.The ablation of nodules was performed by microwave ablation.The changes of biochemical,nodular size and complications were observed before and after treatment.Furthermore,we explore whether there is mutual influence in the metabolic indicators and the thyroid related indicators in the treatment of nodules.It aims to clarify the efficacy,safety and specificity of microwave ablation in the treatment of thyroid nodules,and provide effective clinical evidence for the new treatment of benign thyroid nodules in order to achieve good therapeutic prospects.Methods Forty-five patients(63)with thyroid benign nodules diagnosed by FNAB screening(TI-RADS class 1-3,Bethesda class II)were enrolled in the Department of Endocrinology,Xinqiao Hospital,Third Military Medical University from April 2016 to August 2016,MWA followed up for 3 months after treatment and data were analyzed..The following evaluation was made:(1)Overall evaluation: The efficacy of MA was evaluated by comparing the change of nodal meridian,volume and blood flow signal,thyroid related index and complication before and after treatment.(2)Subgroup evaluation: according to the difference of internal echo in tubercle(In the FNAB screening on the basis of benign nodules were divided into cystic,cystic,solid)nodules,thyroid-related indicators were compared after treatment to explore the differences in the treatment of different properties of MA;(3)influencing factors: the metabolic factors and the thyroid related indicators affected curative effect were compare.Result 1.Comparison of the efficacy of MWA in the treatment of benign thyroid nodules The results showed that the nodule volume continued to shrink after microwave ablation,and the volume was significantly reduced after 1 month,and 3 month later,the average volume reduction rate reached 71.60%,which was statistically significant(P <0.0001).CDFI showed a significant reduction in 1 day after intraoperative or marginal blood flow(P <0.001),and 52.46% of tuberculous blood flow disappeared in 3 month later after the treatment.There was no significant difference in thyroid function and thyroid autoantibody before and after operation.All patients in the microwave ablation process are able to tolerate complete treatment.intraoperative pain(31.1%),voice hoarse(20%),bleeding(20%),and most of the symptoms within 24 hours after surgery are moderated,and 1 patient Postoperative 2 month cases of hissing symptoms were completely relieved.The whole process has not been specially treated.2.Comparison of the results of subgroups of thyroid benign nodules treated by MWA MWA posterior capsule solid nodules,solid nodules and cystic nodules between the average volume reduction rate was statistically significant,including cystic nodules narrowing the most significant(P <0.0001);the nodules were also analyzed(P <0.0001),but nodules with a volume of <1 ml were slightly increased after ablation.3.Evaluation of influencing factors The effects of age and metabolic factors on the treatment of thyroid benign nodules were compared.The results showed that with the increase of ALT,AST,TC and CREA value,the change of nodule volume(volume change rate)was smaller,but HDL-C,FT4 and TT4 were positively correlated with volume change rate,there was no significant correlation between blood pressure and blood glucose at the end of follow-up.Conclusion In summary,MWA,as a thermal ablation techniques for the treatment of thyroid benign nodules showed a clear efficacy and safety.MWA treatment showed a certain degree of superiority for the cystic solid nodules;and for small volume of thyroid nodules,especially the volume of <1ml nodules,MWA treatment ablation may exceed the nodules if necessary to select LAT.Pain,bleeding are common complications in the treatment of MWA,because of its self-limiting and follow-up observation;more serious complications is nerve damage,if the operation is reasonable,strictly follow the treatment norms,and combined with ultrasound-guided positioning accuracy,the incidence was significantly lower,and we also need to pay attention to the location near the nerve nodules,the release of energy as far as possible to avoid the nerve,considering incomplete ablation.Blood lipid,liver and kidney function damage and TSH can reduce the volume of benign thyroid nodules after negative intervention,thus affecting the efficacy of MWA.Therefore,MWA treatment of benign thyroid nodules has a good clinical prospects.Background thiazolidinediones(TZDs)reduce blood glucose primarily by increasing insulin sensitivity in peripheral tissues without producing hypoglycemia.These agents have been widely used in patients with diabetes mellitus(DM).pioglitazone has been shown to prevent both progression to diabetes and major cardiovascular events or even nonalcoholic steatohepatitis,indicating a broader prospect for its clinical applications.However,Whether the antidiabetic drug pioglitazone increases bladder cancer risk has been debated for many years.A series of recent large population studies obtained conflicting results.Objective To seek the reasons of the debate on this subject,we conducted stratified analyses to analyze potential confounders causing the discordant outcomes of previous studies.Data Sources Embase,Pub Med,Web of Science,Cochrane Central Register of Controlled Trials,and Clinical Trials.gov from inception to Jan 5,2017.Study Selection All studies(observational [OB] and randomized controlled trials [RCTs])related to pioglitazone and cancers in diabetic patients were included.Data Extraction and Synthesis Three reviewers performed the literature search,data extraction,and quality assessment of the studies.Main Outcomes and Measures Primary analyses examined whether the associations between pioglitazone use and bladder cancer risk varied by study design(i.e.,study type,adjustment factors,intervention measures,comparator agents,follow-up duration,and study population).Secondary analyses assessed the relationship between pioglitazone use and other cancer risks.Results 2,764,731 participants from OB studies and 9,999 from RCTs were identified for analyses regarding bladder cancer risk with pioglitazone.For OB studies,the pooled OR of bladder cancer risk at the global level was 1.15(95% CI,1.07-1.24;P<0.001).The potential confounders stratified analysis revealed that study type,adjustment for age/sex,treatment duration,cumulative dose,agents used in control group,mean period of follow-up and study population region might contribute to the discordant outcomes.For population regions,pioglitazone increased bladder cancer risk in European populations(OR,1.20;95% CI,1.08-1.32;P<0.001)but not in American(OR,1.03;95% CI,0.88-1.21;P=.68)and Asian(OR,1.16;95% CI,0.96-1.40;P=0.12)populations.Furthermore,in American and Asian regions,the results were also negative after stratifying by potential confounders(P>0.05).In European region,the stratified results were positive(P<0.05)except for subgroups unadjusted for age/sex and smoking,short treatment duration and follow-up,and rosiglitazone use in the control group(P>0.05).For OB studies plus RCTs,all results were similar to those reported in OB studies.In addition,pioglitazone was associated with increased risks of prostate and pancreatic cancer(P<0.05)and decreased risks of liver and brain cancer(P<0.05).Conclusions and Relevance The bladder cancer risk with pioglitazone use needs to be considered according to different population regions,it may be present in the European but not in American and Asian populations.In Europe,patients who with longer treatment duration(>12 months)or larger cumulative dose(>28,000 mg)require more attention,and the long-term effects(?3.6 years)of pioglitazone need to be aware of.In addition,future related studies should adjust for age/sex and smoking and adopt non-specific agents in the control group.Furthermore,pioglitazone use may also relate to other cancers. |
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