BackgroundThe value of prophylactic central neck dissection (PCND) for papillary thyroid carcinoma (PTC) with clinically evident lateral cervical lymph node metastases (cN1b) remains unclear. Therefore, a systematic review and meta-analysis was conducted to assess the efficacy and safety of PCND.MethodsA comprehensive systematic search was conducted on PubMed, Web of Science, Cochrane library and Embase databases up to September 2021 to identify eligible studies. Controlled clinical trials assessing therapeutic effects and safety of PCND for cN1b PTC patients were included. The risk of bias for each cohort study was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcomes were indexes related to the locoregional recurrence (LRR) and surgical complications. Review Manager software V5.4.0 was used for statistical analysis. A fixed effects model was adopted for the data without heterogeneity, otherwise a random effects model was used.ResultsWe included 4 retrospective cohort studies, which comprised 483 PTC patients. There was no statistically significant difference in the central neck recurrence (CNR) (10.2% vs. 3.8%, relative risk (RR) = 1.82; 95%CI 0.90–3.67; P = 0.09), lateral neck recurrence (LNR) (5.1% vs. 7.7%, RR = 0.47; 95% CI 0.13–1.74; P = 0.26), and overall recurrence (OR) (18.9% vs. 16.9%, RR = 0.77; 95%CI 0.34–1.76; P = 0.54), between LND + PCND group and LND group. Simultaneously, PCND increased the risk of permanent hypoparathyroidism (11.4% vs. 4.5%, RR = 2.70, 95%CI 1.05–6.94; P = 0.04) and overall complications (17.0% vs. 5.3%, RR = 3.28; 95%CI 1.37–7.86; P = 0.008).ConclusionsThis meta-analysis showed that PCND did not have any advantage in preventing LRR for cN1b PTC. Meanwhile, PCND may result in the increased rate of surgical complications. However, the current evidence is limited and more clinical trials are still needed to further clarify the true role of PCND.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, CRD42021281825.
This study aimed to explore the changes in calcium transient in the development of heart failure and the effects of levosimendan (LeV) on intracellular calcium dynamics. Cultured neonatal rat ventricular myocytes were divided into four groups: normal, norepinephrine (NE) only (10 mmol/L), NE + LeV1 (0.1 mmol/L), and NE + LeV2 (1 mmol/L). The calcium transients of the myocytes loaded with Fluo-3/AM were observed using a laser scanning confocal microscope. Compared with the control group, the calcium wave in the NE group dispersed, propagated slowly, and exhibited dyssynchrony of Ca 2+ release. Norepinephrine accelerated the beating rate of the cultured myocytes, decreased the systolic peak Ca 2+ , and increased the time to peak (Ttp) and decay time (Tau) of calcium transient. Levosimendan increased the synchrony of calcium transient, and reduced Ttp and Tau. In contrast, LeV did not affect the beating rate and systolic peak Ca 2+ . Both NE-only-and LeV-treated groups did not affect resting Ca 2+ and calcium transient amplitude of the myocytes. The currents from L-type calcium channel currents did not differ among the groups. Both NE and LeV shortened the action potential duration, but the effect of the latter was more serious than that of the former. Western blot results showed that the sarco/endoplasmic reticulum Ca 2+ -ATPase 2 (SERCA2) expression decreased in the NE group but increased in the LeV groups. The sodium-calcium exchanger 1 (NCX1) expression increased in the NE group but decreased in the LeV groups. Long-term exposure to NE decreased myocardial contractility by reducing the peak Ca 2+ of calcium transient and by prolonging and disrupting the conduction of calcium waves. Levosimendan elicits a positive inotropic effect by accelerating the velocity of calcium signal propagation and synchronizing calcium release without increasing calcium influx.
For HER2-positive metastatic breast cancer patients with the brain involved at initial diagnosis, there was no standard regimen before 2022 when the HER2CLIMB trial published its final overall survival analysis, and the prognosis is relatively poor under the current treatment strategy. We herein reported a case of a female patient who was initially diagnosed with HER2-positive metastatic breast cancer with brain metastases, receiving pyrotinib and trastuzumab-based systematic therapy after palliative craniocerebral radiotherapy as the first-line systematic therapy. During the treatment, the tumor lesions showed obvious regression, and chemotherapy drugs were gradually removed from the regimen. The patient continued receiving trastuzumab and pyrotinib for HER2-targeted therapy. She had achieved more than 26 months of progression-free survival and the disease was stable during the evaluation in April 2022. Radiotherapy followed by dual HER2-targeted therapy of macromolecular monoclonal antibodies trastuzumab and micromolecular TKI pyrotinib plus chemotherapy could be an alternative option for this subtype of patients and need to be further verified by future clinical trials.
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