Objectives: Multinodular goiter is the most common thyroid disease in Mongolia. Recent guidelines suggest that a nodule without clinical symptoms should be treated with watchful waiting however, some patients require treatment because of cosmetic problems or symptoms. The main treatment remainssurgical resection, however, minimally invasive alternatives are being investigated. Ethanol ablation (EA), laser ablation, microwave ablation, and radiofrequency ablation (RFA) are safe and effective techniques for the treatment of nodular goiter. This retrospective review evaluates two widely used methods of ablation in Mongolia, ethanol ablation (EA) methods and RFA. Our objective is to compare volume reduction of single-session EA and RFA for thyroid nodules of different compositions and sizes. Materials and Methods: This retrospective study was approved by the Research Ethics Committee of the Mongolian National University of Medical Sciences and informed consent was obtained from all patients before EA and RFA. From January 2019 to January 2020, 50 patients with nodular goiter who underwent RFA (mean age 45.74 ±12.45 years) and 50 patients treated with sonography (US)-guided EA (mean age 36.52 ±9.61 years) were enrolled in this study. Nodules were assessed prior to treatment and at 1, 3, 6, and 12 months follow-up. Nodule volume, symptomatic and cosmetic assessmentscores were recorded at each time point. The primaryendpoint was the volume reduction ratio (percentage) at 1, 3, 6, and 12-month follow-ups. Secondary endpoints included therapeutic success rate, improvement of symptoms and cosmetic problems, and a number of major complications. Results: For the primary outcome of nodule volume reduction, in the RFA and EA groups, the absolute volume reductions at the 12-month follow-up were 62.8±13.2% (50) and 55.8±0.0% (n = 50) respectively. The treatment outcomes are summarized in Tables 3, 4, 5, and 6 and Figures 1, 2, 3, 4, 5, and 6. In RFA group, the mean volume reductions at the 1, 3, 6 and 12-month follow-ups were 33.0±11.0% (n = 50), 44.7± 17.0% (n = 50), 57.3± 14.7% (n = 50), and 62.8± 13.2% (n = 50), respectively. In EA group, the mean volume reductions at the 1, 3, 6 and 12-month follow-ups were 18.3±0.0% (n = 50), 30.5±0.0% (n = 50), 42.5±0.0% (n = 50), and 55.8±0.0% (n = 50), respectively. Conclusion: The purpose of this article is to review the current evidence relating to image-guided ablation of thyroid disease with a focus on clinical outcomes and complication rates for patients treated with this minimally invasive approach. EA may be appropriate as the first-line treatment modality for cystic thyroid nodules, which has comparable therapeutic efficacy to, but is less expensive than, RF ablation.
Background and Aims: Myocardial Injury after Noncardiac Surgery (MINS) is a broader term that includes not only perioperative myocardial infarction but also other prognostically significant myocardial injuries due to ischemia, within 30 days after noncardiac surgery. Annually, around 1 million patients who undergo noncardiac surgery worldwide die during the first 30 days following surgery. The incidence of MINS is around 5-8%, with the majority occurring in the first two days after surgery. A recent study showed a potential positive effect of Dabigatran to prevent major vascular complications among patients with MINS. However, there is no evidence whether any drug may reduce the incidence of MINS after orthopedic surgeries. Our study aims to assess the efficacy of dabigatran to prevent MINS in a high cardiovascular risk population Methods: This study will be a single-center randomized, two-arm (1:1 ratio), active-controlled and double-dummy, phase II trial. We will study 264 adults in total, age in range of 45 to 75 years and high cardiovascular risk associated with Framingham risk score higher than 20% and scheduled to undergo elective orthopedic surgery which requires a hospitalization for more than 24 hours. Patients which troponin measurement keeps negative after surgery will be randomly assigned (1:1) to receive dabigatran 150mg twice daily or enoxaparin daily, 6 hours after surgery for seven days. The primary outcome will be the incidence of MINS as ascertained by the difference in troponin (troponin delta) greater than 14ng/L in the perioperative period, after randomization. Secondary outcomes will be 30-day mortality, major thromboembolic complications, and severe bleeding complications Discussion: This clinical trial will be the first to assess the efficacy and the safety of dabigatran to prevent MINS. Given MINS is estimated to affect every year about 8 million patients worldwide and is associated with cardiovascular complications and death after surgery, we believe this trial will provide relevant data to clinical practice and future research directions.
Objectives: To assess the efficacy and safety of thyroid radiofrequency (RF) ablation for benign thyroid nodules for a 24 months period. Methods: From 2019 to 2021, 485 nodules were from 183 patients (mean age 47.7 ± 11.2) who met eligibility criteria were enrolled from participants. At pre-ablation, the median volume was 0.371 mL (CI 95 %; 0.289 -0.513). For 1, 3, 6, 12 and 24 months after treatment, 485 lesions, consisting of 258 (27 %) solid, 108 (11.3 %) predominantly solid, 47 (4.9 %) cystic, 25 (2.6 %) predominantly cystic and 47 (4.9 %) sponge were followed. RFA treatment was performed using two standard techniques (trans isthmic and moving-shot) and an RFA V-1000 cooling system. For 24 months, nodule size reduction was assessed. Results: At pre-ablation, the median volume was 0.371 mL (CI 95 % 0.289 -0.513). For 1, 3, 6, 12 and 24 months after treatment, median volume reduction was 0.263 (CI 95 %; 0.205 -0.325 p < 0.000), 0.163 (CI 95 %; 0.124 -0.218 p < 0.000), 0.153 (CI 95 %; 0.074 -0.194 p < 0.000), 0.148 (CI 95 %; 0.046 -0.150 p < 0.000), and 0.062 (CI 95 %; 0.006 -0.111 p < 0.000) respectively. Median volume statistically decreased significantly p = 0.000. Both mean symptom and cosmetic scores showed significant improvements (p < 0.001). All complications were also evaluated during the followup. Conclusion: Thyroid RF ablation is an effective and safe treatment modality in patients with benign thyroid nodules. RF ablation may be as effective as surgery if it is performed by experienced physicians in optimally selected patients.
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