International journal of surgery最新文献

The expression of human epidermal growth factor receptor 2 (HER2) is a critical biomarker for guiding precision therapy in HER2-positive cancers. However, conventional diagnostic approaches are invasive and fail to resolve the spatiotemporal heterogeneity of HER2 expression. Molecular imaging using HER2-targeted probes provides a noninvasive alternative, enabling quantitative assessment of HER2 status at the whole-body level. This capability supports critical clinical needs including early molecular subtyping, sensitive detection of metastases, and dynamic monitoring of treatment response. This review focuses on the rational design and engineering strategies of emerging HER2-targeted probes, highlighting key advances in probe architecture and functional optimization. We systematically evaluate how optimization strategies improve imaging contrast, metabolic stability, and targeting specificity. Despite considerable preclinical progress, the widespread clinical translation of these probes remains challenged by issues in scalable manufacturing, reproducible quality control, and regulatory validation. Addressing these application barriers represents a critical objective for future research to fully realize the potential of HER2-targeted molecular imaging in precision oncology.

Objective: To evaluate the Allium stent's efficacy as a curative treatment for benign ureteral strictures, bridging the gap between endoscopic management and surgical reconstruction.

Methods: A retrospective analysis was conducted on 101 patients with benign ureteral strictures treated with Allium stents (2018-2024). Inclusion criteria were benign strictures and complete follow-up data. Treatment success was defined as hydronephrosis improvement, symptom resolution, stability of renal function, and absence of reintervention for at least 12 months postremoval. Outcomes were assessed via ultrasonography at 3-month intervals.

Results: The overall curative success rate was 63.36% (64/101), with a median follow-up of 22.5 months (range: 12-50 months). Etiologies included ureteral stones (56.94%), anastomotic strictures (30.69%), polyps (9.9%), and Retroperitoneal Fibrosis (6.95%). A significantly lower success rate was observed in the >2 cm group compared to the ≤2 cm group (48.84% vs. 74.14%, P = 0.01). Multivariate analysis identified anastomotic stricture (OR = 0.347, 95% CI: 0.041-2.886) and stricture length (OR = 0.255, 95% CI: 0.064-0.898) as independent predictors of success. For strictures ≤2 cm, optimal outcomes occurred with 12-24 months' stent retention (92.86% success).

Conclusion: The Allium stent demonstrated satisfactory curative potential for benign ureteral strictures (63.36% curative success rate), particularly in shorter strictures. Etiology and stricture length were independent predictors of success. Twelve to twenty-four months appears as the optimal indwelling duration, offering a viable minimally invasive alternative to reconstruction surgery.

Background: In recent decades, thermal ablation (TA) has gained acceptance as an effective and safe treatment for benign thyroid nodules (BTNs). However, despite its increasing popularity, the indications and techniques of TA for BTNs lack a unified standard, resulting in differences in treatment outcomes. In particular, the current guidelines and consensus statements adopt indications based on surgical criteria, which focus on larger BTNs with symptoms or cosmetic concerns. However, these indications may not adequately demonstrate the advantages of TA, as it is a fundamentally distinct therapeutic approach. To establish novel and specific indications for TA in BTNs and to standardize the use of this technique, a panel of experts issued the current expert consensus.

Materials and methods: Based on a systematic review of the literature and clinical experience, the drafting group developed preliminary recommendations on TA for BTNs. A multidisciplinary panel of 30 experts with specific competence and expertise in TA for thyroid nodules reviewed, rated, and revised these recommendations through multiple rounds of the modified Delphi method.

Results: Twenty-six recommendations on TA for BTNs were proposed in the present consensus, covering indications and contraindications, physician training suggestions, preablation preparation, technical procedures, complications, efficacy assessment, follow-up strategies, and postablation management.

Conclusion: The present consensus emphasizes the indication of TA for BTNs and outlined the technique details and periablation management. The implementation of this consensus is expected to standardize treatment practices, enhance patient outcomes, and shape future research and policy developments in the management of BTNs.

Background: The rising incidence of thyroid nodules has led to increased referrals under the 2-week wait pathway, despite a low malignancy rate. This places pressure on healthcare systems. We developed a multidisciplinary one-stop thyroid clinic (OSTC) to streamline diagnostics and improve patient experience.

Methods: The OSTC was established in three phases: incorporating real-time ultrasound-guided fine needle aspiration (FNA), rapid on-site evaluation (ROSE) of cytology, and same-day multidisciplinary team (MDT) decision-making. Patients referred with thyroid nodules underwent clinical, biochemical, radiological, and cytological assessment, with results and management plans delivered on the same day. Data on demographics, investigations, cytology, surgery, histology, and follow-up were collected prospectively from January 2022 to October 2023. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) was used to evaluate implementation.

Results: A total of 508 patients were assessed; 81% were female with a median age of 51 years. FNA was performed in 46% of cases. ROSE reduced non-diagnostic (Thy1) cytology from 16% to 5%. About 62% of patients received a definitive management plan on the same day; 29% were referred for surgery, and 10% were diagnosed with thyroid cancer. The non-attendance rate in OSTC was significantly lower (1. 6%) than standard clinics (12. 4%; P < 0. 0001). Same-day MDT review facilitated prompt decisions and reduced diagnostic delays. RE-AIM evaluation confirmed wide reach, improved diagnostic yield, team-wide adoption, efficiency, and sustainability.

Conclusion: The OSTC model delivers faster, more accurate thyroid nodule assessment with reduced appointment burden and improved diagnostic yield. It is a reproducible and cost-effective model that supports NHS priorities and enhances patient-centered care.