[Effects of surgical procedures and general anesthesia exposure within 2 hours in early childhood on neurodevelopmental outcomes in school-age]

Objective: To observe the effect of surgical procedures and general anesthesia exposure (<2 h) in early childhood on neurodevelopmental outcomes in school-age. Methods: A total of 147 children aged 6-12 years old, who received surgery under general anesthesia (<2 h) at the age of 0-2 years in Children's Hospital of Nanjing Medical Universityfrom June 2009 to December 2012 were retrospectively enrolled in this study (from June 2018 to December 2021) as exposure group, including 76 males and 71 females, with a mean age of (8.8±1.6) years. All the cases were divided into single-exposure group (n=65) and multiple-exposure group (≥2 times, n=82) according to different times of anesthesia exposure. According to the cohort of exposure group, 160 healthy children of the same age with no history of surgery under general anesthesia were recruited from the community from June 2018 to December 2021 as the control group, including 87 males and 73 females, and aged (8.6±1.9) years. A variety of standardized neurological tests including Wechsler intelligence scale for children fourth edition (WSC-Ⅳ), integrated visual and auditory continuous performance test (IVA-CPT), Swanson Nolan and Pelham, version Ⅳ (SNAP-Ⅳ), children sensory integration capacity development rating scale (CSIC), and social living ability scale were performed in all subjects by a child health specialist who failed to know the details. The primary outcome was the full-scale IQ (FSIQ) in WISC-Ⅳ, and the secondary outcomes were IVA-CPT, SNAP-Ⅳ, CSIC, and social living ability scale. Results: The FSIQ of single-exposure, multiple-exposure and control groups was 105.4±14.1, 100.9±10.2 and 103.6±13.5, respectively, with no statistically significant difference (F=2.37, P=0.095). The FSIQ of different first age exposure groups (aged 0-6 months, 7-12 months and 1-2 years) was 99.8±10.2, 104.5±10.5 and 104.4±14.5, respectively, with no statistically significant difference (F=2.39, P=0.095). The FSIQ of different exposure duration groups (0-59 min, 60-119 min and control group) was 102.8±11.3, 103.0±13.7 and 103.6±13.5, respectively, with no statistically significant difference (F=0.13, P=0.882). As for the secondary outcomes, the scores of visual persistence quotient in single-exposure, multiple-exposure and control groups were 94.8±10.5, 94.0±10.9 and 100.6±17.7, with a statistically significant difference (F=6.96, P=0.001). In terms of locomotion in social living ability scale, the score of the three groups was 10.0±0.2, 10.2±0.6 and 10.4±0.7, respectively, with a statistically significant difference (F=10.61, P<0.001), but all were within the standard range. Conclusions: The surgical procedures and general anesthesia exposure within 2 hours in early childhood has no effect on the overall FSIQ in school age, but has a slight impacts on the visual persistence quotient of IVA-CPT and the locomotion score of social living ability scale.

Virtual touch imaging quantification shear-wave elastography for breast lesions: the diagnostic value of qualitative and quantitative features

AIM

To investigate the value of the qualitative and quantitative features of Virtual Touch imaging quantification (VTIQ) shear-wave elastography in the characterisation of breast lesions.

MATERIALS AND METHODS

Conventional ultrasound (US) and VTIQ were performed in 148 solid breast lesions in 148 women. During qualitative analysis, patterns of VTIQ were categorised into two patterns, 1 and 2. During quantitative analysis, the mean SWV (SWVmean) and the maximum SWV (SWVmax) of each lesion were used. The sensitivity, specificity, and the areas under the receiver operating characteristic (ROC) curve (Az value) were calculated for conventional US, VTIQ, and combined conventional US and VTIQ.

RESULTS

Malignant lesions were more likely to show VTIQ pattern 2 than the benign lesions (p<0.001). There was no significant difference in the Az values between SWVmean (0.907) and SWVmax (0.902; p=0.572). There was no significant difference in the Az values between the VTIQ pattern (0.884) and SWVmax (p=0.572). The combined conventional US and VTIQ pattern carried a similar Az value (0.949) as compared with the combined conventional US and SWVmax, which yielded an Az value of 0.952 (p=0.683).

CONCLUSION

The combination of either VTIQ pattern or SWVmax and conventional US may be helpful in the characterisation of benign and malignant breast lesions.

Interobserver variability between experienced radiologists in evaluating the number of abnormal lymph nodes seen on preoperative axillary ultrasound

AIM

To determine the interobserver variability of experienced radiologists in evaluating the number of suspicious lymph nodes (LNs) seen on axillary ultrasound (AUS) examination, and to evaluate the effects of clinicopathological features on the discordance.

MATERIAL AND METHODS

A prospective non-randomised triple-blind study was conducted from July 2016 to December 2017 at Shanghai Ruijin Hospital. Three experienced radiologists performed AUS on 462 patients (469 axillae) with invasive breast cancer independently and assessed the number of abnormal LNs during the real-time AUS examination. Interobserver agreement was determined according to the kappa statistic.

RESULTS

The mean numbers of metastatic LNs on final histology study were 0.35, 0.98, 3.05 and 4.70 for patients with 0, 1, 2 and >2 abnormal nodes on preoperative AUS. When the cut-off (the number of abnormal LNs seen on AUS was >1) at which the maximal sum of sensitivity and specificity for diagnosis of ≥3 tumour-involved LNs was achieved was applied, the Az values ranged from 0.776 to 0.811. When the number of abnormal LNs was grouped into two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS), good interobserver agreement (kappa: 0.601-0.687) was found, and disagreement between the radiologists was more frequently found in patients with T2-stage tumour and in those with one or two tumour-involved nodes.

CONCLUSION

Abnormal LN count according to two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS) was a feasible method with good accuracy and high repeatability to select patients with heavy nodal disease in the post-Z0011 trial era.

Maximal, minimal, and mean pulsed Doppler parameters: which should be utilized in the diagnosis of thyroid nodules?

AIM

To compare the diagnostic efficacy of the maximal, minimal, and mean pulsatility index (PI) and resistance index (RI) and determine which should be utilized in the evaluation of thyroid nodules.

MATERIALS AND METHODS

A total of 224 consecutive patients with thyroid nodules were included in this prospective study. Doppler signals from three different nodular arteries were obtained and six Doppler parameters were used for final analysis: maximal PI (PImax), minimal PI (PImin), mean PI (PImean), maximal RI (RImax), minimal RI (RImin), and mean RI (RImean).

RESULTS

Eighty-five patients had malignant and 139 cases had benign thyroid nodules. All three sets of PI and RI parameters were significantly higher in malignant than in benign thyroid nodules (p = 0.000 for all). The area under the receiver operating characteristic (ROC) curve (Az) of PImax was significantly higher than that of PImin (p = 0.046) and higher than that of PImean (p = 0.161). The Az value of RImax was higher than that of RImean and RImin; however, the differences were not significant (p = 0.403, and p = 0.058, respectively). The Az values of the three sets of PI parameters (PImax, PImin, and PImean) were significantly higher than those of the corresponding sets of RI parameters (p = 0.005, p = 0.003, and p = 0.003, respectively).

CONCLUSION

Maximal pulsed Doppler parameters should be utilized in the evaluation of thyroid nodules. PI parameters were superior to the RI parameters in determining malignant nodules.

Updated analysis of studies on the cytotoxic T-lymphocyte-associated antigen-4 gene A49G polymorphism and Hashimoto's thyroiditis risk

Published data on the association between the cytotoxic T-lymphocyte-associated antigen-4 gene A49G polymorphism and the risk for Hashimoto's thyroiditis (HT) are inconclusive. A meta-analysis was performed to derive a more precise estimation. Published case-control studies in English or Chinese were identified. In total, 24 studies with 2295 cases and 4521 controls were investigated. A random-effect model was performed irrespective of between-study heterogeneity. Study quality was assessed in duplicate, and subgroup analyses were conducted by ethnicity or age. Overall, the 49G allele was associated with an increase in HT risk [odds ratio (OR) = 1.31; 95% confidence interval (95%CI) = 1.17-1.47; P < 0.00001]. In a subgroup analysis by ethnicity, comparison of allele 49G with 49A generated a 27% increased risk among East Asians (OR = 1.48; 95%CI = 1.24-1.76; P < 0.00001) and whites (OR = 1.27; 95%CI = 1.12-1.44; P = 0.0002). We also found an increased risk among adults (OR = 1.31; 95%CI = 1.17-1.47; P < 0.00001) but not among children (OR = 1.44; 95%CI = 0.75-2.79; P = 0.27), possibly owing to the small sample sizes in children. No publication biases were observed. This meta-analysis suggested that the cytotoxic T-lymphocyte-associated antigen-4 gene 49G allele was associated with an increased HT risk, especially in adults.