Lay San Lim

Background: Locally advanced thyroid cancer is associated with a poor prognosis and high surgical morbidity. This study evaluated the feasibility and outcomes of neoadjuvant treatment including targeted therapy with locoregional interventions. Methods: We retrospectively analyzed 17 patients with locally advanced thyroid cancer who received neoadjuvant treatment, including tyrosine kinase inhibitors (TKIs), transarterial embolization (TAE), and radiofrequency ablation (RFA), either alone or in combination. The primary outcome was the proportion of patients who proceeded to R0 or R1 surgical resection following neoadjuvant treatment. Secondary outcomes included tumor response assessed using the Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, and changes in surgical morbidity evaluated using the MGH/MEEI–MSK–MD Anderson surgical morbidity complexity score (MMM score) and the Invasive Thyroid Class. Results: Five patients (29%) achieved R0/R1 resection, including four with R0 resection. Most patients demonstrated reduced tumor burden and surgical complexity, as reflected by improvements in the MMM score and the Invasive Thyroid Class. The objective response rate was 47% and the 12-month progression-free survival rate was 58.2%. Conclusion: Neoadjuvant treatment may improve tumor downstaging and surgical feasibility in selected patients with initially unresectable thyroid cancer. Further prospective studies are required to validate these findings.

Objective This study aimed to evaluate the feasibility of muscle ultrasonography (US) as a diagnostic tool for assessing sarcopenia in patients with Parkinson’s disease (PD) to facilitate early detection and intervention to help prevent falls and enhance quality of life.Methods This prospective single-center study evaluated the diagnostic accuracy of US for identifying sarcopenia, using the Asian Working Group for Sarcopenia 2019 criteria as the reference. A total of 85 patients with PD, were recruited between June 2022 and August 2024, consisting of 31 individuals in the sarcopenic group and 54 in the nonsarcopenic group. We compared muscle thickness (MT), cross-sectional area (CSA), and shear wave velocity of the rectus femoris (RF), anterior tibialis (AT), and biceps brachii (BB) between the two groups. Statistical analyses included univariate analysis, correlation analysis, and binary logistic regression to develop a prediction model for sarcopenia.Results The sarcopenic group exhibited lower MTBB, MTAT, and CSAAT than the nonsarcopenic group (all p<0.05). MTBB, CSABB, and CSAAT were significantly correlated with the appendicular skeletal muscle mass index and functional measures (all p<0.05). The prediction model, which included age, body mass index, and MTBB as predictors, achieved an area under the curve of 0.857, with a sensitivity of 80.6% and a specificity of 79.6%.Conclusion US is a reliable and effective diagnostic tool for assessing sarcopenia in patients with PD, providing a practical approach for early identification of this condition.

Background: Papillary thyroid microcarcinoma (PTMC) is associated with certain features that carry an increased risk of local recurrence, underscoring the importance of preoperative risk assessment. This study investigated the clinicopathological factors associated with high-risk lymph node metastasis (HRLNM) and patient outcomes. HRLNM is defined as ≥5 metastatic lymph nodes and/or lateral neck metastasis. Methods: We conducted a retrospective review of 985 patients with PTMC who underwent thyroidectomy at the Kaohsiung Chang Gung Memorial Hospital from 2013 to 2022. Results: Among the 985 patients, 100 (10.2%) had lymph node metastasis (LNM), and 27% of these were classified as having HRLNM. Male sex (OR 3.61, p = 0.04) and extranodal extension (OR 3.76, p = 0.043) were independent predictors of HRLNM. Patients with LNM exhibited lower rates of excellent treatment response (75% vs. 87%, p = 0.001), higher recurrence rates (9.0% vs. 0.6%, p = 0.001), and an increased risk of distant metastasis (2.0% vs. 0%). Recurrence-free survival (RFS) was significantly shorter in patients with LNM (120.9 vs. 198.6 months, p < 0.001). Although HRLNM showed a trend toward reduced RFS (113.5 vs. 124.6 months, p = 0.177), its impact on long-term survival remains uncertain. Conclusions: Male sex and extranodal extension were significant risk factors for HRLNM in patients with PTMC. These findings highlight the need for individualized risk stratification to guide treatment strategies and improve patient outcomes.

Objective To investigate shoulder function and muscle alterations in patients with Parkinson’s disease (PD) and determine their associations with spinopelvic parameters and clinical status.Methods This prospective cohort study included 62 PD patients, divided into postural instability and gait difficulty (PIGD) (n=30) and non-PIGD (n=32) groups, as well as 35 controls. The American Shoulder and Elbow Surgeons (ASES) score, shoulder range of motion (ROM), and shoulder muscle stiffness were assessed for each group. Clinical demographics, PD severity, and shoulder-related parameters were extracted and analyzed.Results Compared with the control group, the PIGD group had significantly lower total and subscored ASESs (all p<0.05). Compared with the controls, both the PIGD and non-PIGD groups demonstrated reduced abduction and forward flexion (all p<0.05). Compared with the non-PIGD group and the control group, the PIGD group also presented decreased external rotation (all p<0.05). Infraspinatus muscle stiffness was greater in the PIGD group than in the control group (p=0.012). Correlation analysis revealed that shoulder condition was significantly associated with PD severity and the PIGD score, whereas muscle stiffness was linked to spinopelvic alignment and the PIGD score. Various clinical factors, including PD severity, the PIGD score, the tremor score, and spinopelvic alignment, were significantly correlated with shoulder ROM.Conclusion PD patients experience shoulder dysfunction in various ways, including decreased ASES scores, limited ROM, and increased shoulder muscle stiffness. Our study highlighted the impact of PD motor subtype, disease severity, and spinopelvic alignment on the development of shoulder dysfunction, offering deeper insights into the pathophysiological basis of shoulder disorders in PD.