Estimating the risk of completion total thyroidectomy using real-world data to guide initial surgical decision-making for patients with clinical low-risk papillary thyroid carcinoma

Background:Continuing controversy exists in diferent guidelines’recommendations regarding whether total thyroidectomy(TT)or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma(PTC).Diverse perceptions of the risk of completion TT after lobectomy are the main debate between guidelines and institutions.Methods:Patients who underwent thyroidectomy and prophylactic central lymph node dissection for≤4 cm PTC(January 2007 to December 2020)by high-volume surgeons were included.Patients with preoperatively known highrisk characteristics or suspicious bilateral multifocality were excluded.The pathological fndings were defned as the risk stratifcations of completion TT from low to high to evaluate which initial surgical procedure could allow more patients to meet the criteria of optimal surgical extent.Results:Of 4965 consecutive patients met lobectomy criteria as the initial operation.Aggressive histological subtypes were found in 2.5%of patients,T3b disease in 1.1%,T4 disease in 3.1%,LNs involved≤5 in 29.5%,LNs involved>5 in 3.1%,and incidental bilateral multifocality in 7.9%.According to our defned risk stratifcation system,TT and lobectomy would be considered the optimal initial procedure in 12.0%and 67.2%PTC patients with a tumor≤1 cm and 28.7%and 36.6%in the 1-4 cm groups in our real-world cohort,respectively.Conclusion:Lobectomy alone,as an initial procedure,could allow more low-risk PTC patients with a tumor either≤1 cm or 1-4 cm to achieve the optimal surgical extent.Moreover,surgeons should balance the high-risk characteristics and complication risks during surgery to re-evaluate surgical decision-making.

A Heterozygous Phospholamban Variant(p.R14del)Leads to Left Ventricular Involvement and Heart Failure Phenotypes in Arrhythmogenic Right Ventricular Cardiomyopathy

This study aimed to determine the prevalence and clinical features of Arrhythmogenic Right Ventricular Cardiomyopathy(ARVC)caused by pathogenic mutations in the Phospholamban(PLN)gene.The study included 170 patients who had a confrmed diagnosis of ARVC and underwent PLN genetic screening using next-generation sequencing.The fndings of this study provide valuable insights into the association between PLN mutations and ARVC,which can aid in the development of more efective diagnostic and treatment strategies for ARVC patients.Out of the patients evaluated,six had a rare pathogenic mutation in PLN with the same p.R14del variant.Family screening revealed that heterozygous carriers of p.R14del exhibited a defnite ARVC phenotype.In clinical studies,individuals with the p.R14del mutation experienced a similar rate of malignant arrhythmia events as those with classic desmosome mutations.After adjusting for covariates,individuals with PLN mutations had a two point one seven times greater likelihood of experiencing transplant-related risks compared to those who did not possess PLN mutations(95%CI 1.08–6.82,p=0.035).The accumulation of left ventricular fat and fbers is a pathological marker for ARVC patients with p.R14del mutations.In a cohort of 170 Chinese ARVC patients,three point fve percent of probands had the PLN pathogenic variant(p.R14del)and all were female.Our data shows that PLN-related ARVC patients are at high risk for ventricular arrhythmias and heart failure,which requires clinical diferentiation from classic ARVC.Furthermore,carrying the p.R14del mutation can be an independent prognostic risk factor in ARVC patients.