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Chen PP, Zhang X, Ye H, Chen D. Effects of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat in patients who underwent thyroidectomy: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e38235. [PMID: 38758857 PMCID: PMC11098170 DOI: 10.1097/md.0000000000038235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND This randomized controlled trial aimed to evaluate the efficacy of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat (POST) after general anesthesia in patients who underwent thyroidectomy. METHODS Patients who underwent elective thyroidectomy were randomly divided into the intravenous dexamethasone group (group A) and budesonide inhalation combined with intravenous dexamethasone group (group B). All patients underwent general anesthesia. The incidence and severity of POST, hoarseness, and cough at 1, 6, 12, and 24 hours after surgery were evaluated and compared between the 2 groups. RESULTS There were 48 and 49 patients in groups A and B, respectively. The incidence of POST was significantly lower at 6, 12, and 24 hours in group B than that in group A (P < .05). In addition, group B had a significantly lower incidence of coughing at 24 hours (P = .047). Compared with group A, the severity of POST was significantly lower at 6 (P = .027), 12 (P = .004), and 24 (P = .005) hours at rest, and at 6 (P = .002), 12 (P = .038), and 24 (P = .015) hours during swallowing in group B. The incidence and severity of hoarseness were comparable at each time-point between the 2 groups (P > .05). CONCLUSION Preoperative inhaled budesonide combined with intravenous dexamethasone reduced the incidence and severity of POST at 6, 12, and 24 hours after extubation compared with intravenous dexamethasone alone in patients who underwent thyroidectomy. Additionally, this combination decreased the incidence of postoperative coughing at 24 hours.
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Affiliation(s)
- Ping-Ping Chen
- Department of Gastrointestinal Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Xing Zhang
- Department of Thyroid and Breast Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Hui Ye
- Department of Anesthesiology, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Dan Chen
- Department of Gastrointestinal Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
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Tang N, Wang Y, Miao J, Zhao Y, Cao Y, Sun W, Zhang J, Sui H, Li B. Potential pharmacological mechanisms of tanshinone IIA in the treatment of human neuroblastoma based on network pharmacological and molecular docking Technology. Front Pharmacol 2024; 15:1363415. [PMID: 38533261 PMCID: PMC10964018 DOI: 10.3389/fphar.2024.1363415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Tanshinone IIA (Tan-IIA) is the main bioactive component of Chinese herbal medicine salvia miltiorrhiza (Danshen). Sodium sulfonate of Tan-IIA is widely used in the treatment of cardiovascular and cerebrovascular diseases. Tan-IIA also has inhibitory effects on tumor cells such as gastric cancer, but its therapeutic effect and mechanism on human neuroblastoma have not been evaluated, so its pharmacological mechanism is systematically evaluated by the combined method of network pharmacology and molecular docking. PharmMapper and SwissTargetPrediction predicted 331 potential Tan-IIA-related targets, and 1,152 potential neuroblastoma-related targets were obtained from GeneCards, DisGeNET, DrugBank, OMIM and Therapeutic Target databases (TTD), 107 common targets for Tan-IIA and neuroblastoma. Through gene ontology (GO) functional annotation, Kyoto Encyclopedia of Genes and Genomesa (KEGG) pathway enrichment, protein-protein interaction (PPI) network and cytoHubba plug-in, 10 related signal pathways (Pathways in cancer, PI3K-Akt signaling pathway, Prostate cancer, etc.) and 10 hub genes were identified. The results of molecular docking showed that Tan-IIA could interact with 10 targets: GRB2, SRC, EGFR, PTPN1, ESR1, IGF1, MAPK1, PIK3R1, AKT1 and IGF1R. This study analyzed the related pathways and targets of Tan-IIA in the treatment of human neuroblastoma, as well as the potential anticancer and anti-tumor targets and related signaling pathways of Tan-IIA, which provides a reference for us to find and explore effective drugs for the treatment of human neuroblastoma.
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Affiliation(s)
- Ning Tang
- Department of Integrative Medicine, Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, China
| | - Yan Wang
- Department of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Jiarui Miao
- Department of Acupuncture and Massage, Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, China
| | - Yang Zhao
- Department of Integrative Medicine, Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, China
| | - Yue Cao
- Department of Integrative Medicine, Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, China
| | - Wentao Sun
- Department of Acupuncture and Massage, Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, China
| | - Jingke Zhang
- Department of Integrative Medicine, Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, China
| | - Hua Sui
- Department of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Bing Li
- Department of Integrative Medicine, Liaoning University of Traditional Chinese Medicine Xinglin College, Shenyang, China
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Braafladt SM, Baumgartner TC, Allison HR, Blumenthaler AN, Ritter HE, Mariash CN, Elfenbein DM, McDow AD. Outcomes of Preoperative Medical Therapy for Thyroidectomy in Autoimmune Thyroid Disease. J Surg Res 2024; 295:318-326. [PMID: 38061236 DOI: 10.1016/j.jss.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/28/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Thyroidectomy provides definitive treatment for autoimmune thyroid disease (AITD) often resulting in improved quality of life. Historically, patients with AITD undergoing thyroidectomy have increased rates of postoperative hypoparathyroidism and recurrent laryngeal nerve palsy. We investigated the outcomes of preoperative medications in patients with AITD undergoing thyroidectomy. METHODS We performed a retrospective analysis of patients who underwent thyroidectomy for AITD at a single institution from 2015 to 2021. Surgical outcomes and perioperative laboratory values were analyzed by type of AITD and type of preoperative medical treatment: none, saturated solution of potassium iodide (SSKI), corticosteroids, or both SSKI and corticosteroids. RESULTS A total of 123 patients underwent thyroidectomy for AITD and were included in analysis: 50 received no preoperative medications, 40 received SSKI, 20 received corticosteroids, and 13 received both. Seventy-six patients had Graves' disease and 47 had Hashimoto's thyroiditis. There were no significant differences in blood loss, operative time, wound complications, hematoma, or recurrent laryngeal nerve injury for patients treated with preoperative corticosteroids compared to those who were not. Patients who received corticosteroids and patients with Graves' disease more commonly had at least one instance of hypocalcemia postoperatively (P < 0.01, P = 0.01), although only on postoperative day 1 was mean calcium < 8.5 mg/dL. There was no difference in rate of transient or permanent hypoparathyroidism. CONCLUSIONS Patients who received corticosteroids preoperatively had no increased risk of complications. They did have mildly lower calcium levels in the early postoperative period, although no difference in hypoparathyroidism. Further exploration is warranted to investigate the impact of preoperative corticosteroids on operative difficulty, quality of life, and autoantibody clearance.
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Affiliation(s)
- Signe M Braafladt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Hannah R Allison
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alisa N Blumenthaler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hadley E Ritter
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cary N Mariash
- Division of Endocrinology and Metabolism, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dawn M Elfenbein
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Alexandria D McDow
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Zheng XG, Wang MZ, Wang F, He D. The Impact of Glucocorticoid Treatment on Hypocalcemia Following Thyroid Surgery: A Systematic Review and Meta-Analysis. Endocr Res 2024; 49:77-85. [PMID: 38078858 DOI: 10.1080/07435800.2023.2293103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/05/2023] [Indexed: 04/24/2024]
Abstract
Patients undergoing thyroidectomy often develop hypocalcemia. While there is evidence suggesting that the prophylactic administration of dexamethasone in patients undergoing thyroidectomy can reduce the risk of postoperative complications including nausea, vomiting, and pain, it remains uncertain as to whether such treatment has a similar impact on hypocalcemia risk. Here, randomized controlled trials (RCTs) focused on comparing the risk of postoperative hypocalcemia in thyroidectomy patients that either were or were not administered a single preoperative dose of dexamethasone were systematically evaluated. These RCTs were identified by searching the Medline, PubMed, Embase, and Cochrane Library for all relevant publications as of April 2023. Primary study outcomes included biochemical hypocalcemia and symptomatic hypocalcemia incidence within 24 h after thyroidectomy, while the incidence of permanent hypocalcemia was a secondary outcome in this analysis. Random-effects models were used for all comparisons in this meta-analysis. In total, 8 RCTs enrolling 1666 patients were incorporated when conducting this meta-analysis. Relative to placebo control treatment, dexamethasone administration was associated with significant reductions in the rates of postoperative symptomatic hypocalcemia (OR = 0.40; 95%CI 0.16-1.00; p = 0.050) and biochemical hypocalcemia (OR = 0.34;95%CI 0.14-0.83; p = 0.020 (p < 0.05). No differences were detected between these groups with respect to the incidence of permanent hypocalcemia, and no trials revealed any evidence of glucocorticoid-associated complications. Significant heterogeneity was detected among studies, but the exclusion of any single study did not significantly alter study outcomes. The present pooled analyses suggested that one preoperative dexamethasone dose was sufficient to reduce the odds of thyroidectomy patients developing biochemical or symptomatic hypocalcemia within 24 h after the procedure. The prophylactic administration of steroids was both safe and effective, suggesting that it warrants consideration as a component of routine clinical care. However, additional prospective work will be vital to validate the efficacy of dexamethasone as a means of preventing objective hypocalcemia in this patient population.
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Affiliation(s)
- Xiao Gang Zheng
- Jinhua maternal and child health Hospital - Breast and thyroid surgery, Jinhua, China
| | - Ming Zheng Wang
- Jinhua Municipal Central Hospital FFFC - Breast and thyroid surgery, Jinhua, China
| | - Fan Wang
- Jinhua maternal and child health Hospital - Breast and thyroid surgery, Jinhua, China
| | - Dan He
- Jinhua maternal and child health Hospital - Breast and thyroid surgery, Jinhua, China
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Zhao ZM, Zhang CD. A commentary on 'Perioperative versus postoperative calcium and vitamin D supplementation to prevent symptomatic hypocalcemia after total thyroidectomy: a randomized placebo controlled trial'. Int J Surg 2023; 109:2133-2134. [PMID: 37288589 PMCID: PMC10389490 DOI: 10.1097/js9.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/09/2023]
Affiliation(s)
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital, China Medical University, Shenyang, People’s Republic of China
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Koh ES, Chen FR, Chen S, Quan T, Leung KL, Yang J. The Effects of Chronic Steroid Use on Postoperative Complications Following Thyroidectomy. World J Surg 2023; 47:995-1002. [PMID: 36622436 DOI: 10.1007/s00268-023-06903-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients undergoing thyroidectomy are sometimes on chronic steroids for underlying disease. This study examined the postoperative risk profile of thyroidectomy patients on chronic steroids. METHODS Patients in the National Surgical Quality Improvement Program (NSQIP) database who underwent thyroidectomy were sorted by presence or absence of chronic steroid use. Clinicodemographics, comorbidities, and postoperative complications were recorded and compared between the two. Univariate and multivariate analyses compared the groups and calculated odds ratios (OR). RESULTS We identified 42,857 patients. 41,903 (97.8%) patients were not on chronic steroids, while 954 (2.2%) were. Most underwent total thyroidectomy (18,748, 43.75%) or total lobectomy (16,323, 38.09%). Following univariate and multivariate analyses, patients on chronic steroids had increased risk of postoperative bleeding and transfusions (OR = 0.375, p = 0.046, 95% CI 0.223-0.988), open wound infection (OR = 0.226, p < 0.001, 95% CI 0.117-0.437), pulmonary embolism (OR = 0.312, p = 0.034, 95% CI 0.106-0.918), and ventilator use > 48 h (OR = 0.401, p < 0.008, 95% CI 0.205-0.785). CONCLUSIONS Chronic steroid use prior to thyroidectomy is an independent risk factor for multiple postoperative complications, namely postoperative bleeding and transfusions, open wound infection, pulmonary embolism, and ventilator use over 48 h. Patients on chronic steroids should be medically optimized before thyroidectomy to reduce the risk of potentially life-threatening complications.
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Affiliation(s)
- Elizabeth S Koh
- Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA.
| | - Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sophia Chen
- Department of Otolaryngology Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Karen L Leung
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Jason Yang
- Department of Otolaryngology Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA, USA
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg 2022; 276:e141-e176. [PMID: 35848728 DOI: 10.1097/sla.0000000000005522] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. BACKGROUND Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. METHODS Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.
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Kane EG, Lee K, Balasubramanian S. Key Issues in Use of Prophylactic Steroids to Prevent Hypocalcemia and Voice Dysfunction After Thyroidectomy. JAMA Otolaryngol Head Neck Surg 2022; 148:493. [PMID: 35357401 DOI: 10.1001/jamaoto.2022.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth Grace Kane
- University of Liverpool, United Kingdom.,Liverpool University Foundation Trust Hospitals, United Kingdom
| | | | - Sabapathy Balasubramanian
- University of Sheffield, United Kingdom.,Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
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Dhahri AA, Rao A, Ahmad R. Key Issues in Use of Prophylactic Steroids to Prevent Hypocalcemia and Voice Dysfunction After Thyroidectomy-Reply. JAMA Otolaryngol Head Neck Surg 2022; 148:493-494. [PMID: 35357408 DOI: 10.1001/jamaoto.2022.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Ahsan Rao
- Cambridge University Hospital, United Kingdom
| | - Raheel Ahmad
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
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