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Purpose: To summarize the published literature on thermal ablation for primary hyperparathyroidism (PHPT) and to evaluate the effectiveness and safety of thermal ablation as a novel treatment strategy. Materials and methods: Two authors carried out the literature search using four databases independently, including PubMed, Embase, Cochrane, and Web of Science. The meta-analysis included prospective and retrospective data that compared post-ablative outcomes to pre-ablative values. The primary outcomes were parathyroid hormone (PTH), serum calcium and volume of the parathyroid gland (VPG). Results: From the 184 original articles, five studies (4 retrospective studies and 1 prospective study) examining 84 patients met the inclusion criteria. The meta-analysis showed significant reduction of PTH at 3 (standardized mean difference (SMD) ¼ À1.09, 95% confidence index (CI) ¼ À1.42 to À0.76, p < 0.001) and 6 months (SMD ¼ À1.13, 95% CI ¼ À1.46 to À0.80, p < 0.001) after thermal ablation. Serum calcium level was significantly reduced at 3 (mean difference (MD) ¼ À0.31, 95% CI ¼ À0.50 to À0.12, p ¼ 0.001) and 6 months (MD ¼ À0.31, 95% CI ¼ À0.46 to À0.17, p < 0.001) after thermal ablation. There was no significant difference between pre-ablative VPG and that of 6 months after ablation (MD ¼ À0.30, 95% CI ¼ À0.70 to 0.09, p ¼ 0.13). The most common complications were transient dysphonia and subcutaneous edema. No major complications or death occurred. Conclusion: Thermal ablation is effective and safe for treatment of PHPT. PTH and calcium levels were reduced significantly at 3 and 6 months after thermal ablation.

Background. The association between lipoprotein-associated phospholipase A2 (Lp-PLA2) and stroke risk is inconsistent. We conducted a meta-analysis to determine whether elevated Lp-PLA2 is a risk factor for stroke. Methods. Studies were included if they reported Lp-PLA2 mass and/or activity levels and adjusted risk estimates of stroke. The primary outcome was overall stroke incidence. The combined results were shown as relative risks (RRs) with 95% confidence intervals (CI) for per 1 standard deviation (SD) higher value of Lp-PLA2 and the highest versus lowest Lp-PLA2 category. Results. Twenty-two studies involving 157,693 participants were included for analysis. After adjusting for conventional risk factors, the RRs for overall stroke with 1 SD higher Lp-PLA2 activity and mass were 1.07 (95% CI 1.02–1.13) and 1.11 (95% CI 1.04–1.19), respectively. The RRs of ischemic stroke with 1 SD higher Lp-PLA2 activity and mass were 1.08 (95% CI 1.01–1.15) and 1.11 (95% CI 1.02–1.22), respectively. When comparing the highest and lowest levels of Lp-PLA2, the RRs of stroke for Lp-PLA2 activity and mass were 1.26 (95% CI 1.03–1.54) and 1.56 (95% CI 1.21–2.00), respectively. Finally, when comparing the highest and lowest levels of Lp-PLA2, the pooled RRs of ischemic stroke for Lp-PLA2 activity and mass were 1.29 (95% CI 1.07–1.56) and 1.68 (95% CI 1.12–2.53), respectively. Conclusions. Elevated baseline Lp-PLA2 levels, detected either by activity or mass, are associated with increased stroke risk.

PurposeTo evaluate diagnostic performance and safety of ultrasound-guided needle biopsy in the diagnosis of peripheral pulmonary nodules (PPLs) ≤ 2 cm, and the influence factors of sample adequacy and safety.Materials and Methods194 patients (99 men, 95 women; mean age, 56.2 ± 13.7 years) who received biopsy for PPLs ≤ 2 cm between January 2014 to January 2019 were included. Variables including patient demographics, lesion location, lesion size, presence of lesion necrosis, presence of emphysema on CT, patient position, biopsy needle size and number of needle passes were recorded. Univariate analysis and multivariate logistic regression analysis were performed to explore the influence factor of sample adequacy and safety.ResultsBiopsy specimens were adequate for diagnosis in 161/194 (83%) cases; the diagnostic accuracy was 81.4% (158/194). The overall complication rate was 8.8% (17/194), including pneumothorax, hemoptysis and pleural effusion, which occurred in 2.1% (4/194), 5.2% (10/194), and 1.5% (3/194) of patients, respectively. The incidence of pneumothorax in the 16-gauge-needle group were significantly higher than that of the 18-gauge-needle group (5.6% vs 0%, P=0.018). Adequate sampling of 16-gauge and 18-gauge needles were achieved in 90.3%(65/72) and 78.7%(96/122) cases, respectively. Multivariate logistic regression analysis revealed needle size (16-gauge vs 18-gauge) was an independent influence factors of sample adequacy (P=0.015, odds ratio=3.419). A receiver operating characteristic curve was plotted and the area under the curve was 0.774.ConclusionUS-guided percutaneous needle biopsy is a feasible and safe technique for small PPLs ≤ 2 cm. Needle size is an independent influence factor of sample adequacy and post-procedure pneumothorax. Sixteen-gauge needle has the advantage of achieving adequate sample for pathological analysis, though the risk of pneumothorax should be alerted.

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BackgroundPediatric allergic rhinoconjunctivitis has become a public concern with an increasing incidence year by year. Conventional subcutaneous immunotherapy (SCIT) has long treatment time, high cost and poor compliance. The novel immunotherapy significantly shortens the course of treatment by directly injecting allergens into cervical lymph nodes, which can perform faster clinical benefits to children.ObjectiveBy comparing with SCIT, this study aimed to evaluate the long-term efficacy and safety of intra-cervical lymphatic immunotherapy (ICLIT).MethodsThis is a prospective randomized controlled study. A total of 50 allergic rhinoconjunctivitis children with dust mite allergy was randomly divided into ICLIT group and SCIT group, receiving three cervical intralymphatic injections of dust mite allergen or three years of subcutaneous injection, separately. Primary outcomes included total nasal symptom scores (TNSS), total ocular symptom scores (TOSS), total symptom scores (TSS), total medication scores (TMS), and total quality of life score. Secondary outcomes included pain perception and adverse reactions during treatment. Other secondary outcome was change in Dermatophagoides pteronyssinus (Derp) and Dermatophagoides farina (Derf) -specific IgE level.ResultsBoth groups had significantly decreased TNSS, TOSS, TSS, TMS, and total quality of life score after 36 months of treatment (p&lt;0.0001). Compared with SCIT, ICLIT could rapidly improve allergic symptoms (p&lt;0.0001). The short-term efficacy was consistent between the two groups (p=0.07), while the long-term efficacy was better in SCIT group (p&lt;0.0001). The pain perception in ICLIT group was lower than that in SCIT group (p&lt;0.0001). ICLIT group was safer. Specifically, the children had only 3 mild local adverse reactions without systemic adverse reactions. The SCIT group had 14 systemic adverse reactions. At last, the serum Derp and Derf-specific IgE levels in ICLIT and SCIT groups decreased 3 years later (p&lt;0.0001).ConclusionICLIT could ameliorate significantly the allergic symptoms in pediatric patients with an advantage in effectiveness and safety, besides an improved life quality including shortened period of treatment, frequency of drug use and pain perception.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR1800017130.