George Shiyao He

Introduction: Definitive second‐line treatment for pediatric Graves' disease (GD) includes radioiodine ablation (RAI) or thyroidectomy. The current treatment practice in pediatric GD patients is a contentious issue as the decision to consider either of the treatment options depends on preferences of patients, physicians, and access to surgical care and radioactive iodine treatment. This systematic review and meta‐analysis were performed to compare the cure and relapse rates of RAI versus surgery as definitive therapy in children with Graves' Disease. Methods: A comprehensive search on Cochrane library, Embase, PUBMED, MEDLINE (via Pubmed), and ClinicalTrials.gov for English articles published on definitive treatment of GD in children since 1985 to 2023 was performed. The data were extracted and meta‐analyzed for efficacy and safety outcomes, risk of bias (ROB), and certainty of evidence summated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) instrument. Results: Twenty‐nine (26 retrospective and 3 prospective) studies with a total of 1861 children and a mean age of 13.15 years with a mean follow up of 8 years were evaluated in the systematic review. Among these, 1061 children received RAI therapy, whereas 800 underwent thyroidectomy and were evaluated in the pooled analysis. 755 were excluded as details pertaining to definite treatment was not available. Studies were of low to moderate risk of bias. The pooled analysis suggests that RAI had significantly lower cure rate in children compared to children who underwent thyroidectomy (RR 0.89; 95% CI 0.81–0.99; p = 0.03). In subgroup analysis of patients from 19 studies who underwent surgery, total thyroidectomy (2%) was more effective than subtotal thyroidectomy (13%) in preventing recurrent hyperthyroidism ( p = 0.001; moderate quality evidence). Hypothyroidism rates after RAI and surgery were similar (RR 0.97; 95% CI 0.67–1.40; p = 0.88). There were no significant adverse outcomes reported such as secondary malignancy or quality of life after RAI. Following TT, adverse effects seen were permanent hypoparathyroidism (0.6%) and temporary recurrent laryngeal nerve palsy (5.1%). Conclusion: Thyroidectomy appears to be more effective than RAI in effecting cure in Graves' disease in children following failed remission with antithyroid medication therapy. However, access to thyroidectomy may not be universally available and RAI is an option in these children.

Background/Objectives: Synchronous ipsilateral supraclavicular lymph node metastases (sISLMs) in breast cancer are rare and associated with poor prognosis. The optimal locoregional treatment strategy remains unclear, particularly regarding the role of supraclavicular lymph node dissection (SLND). Methods: We conducted a systematic review and network meta-analysis, including studies published up to end December 2023, to compare the outcomes of SLND combined with radiotherapy (RT) and systemic therapy (ST), SLND with ST alone, and ST alone, using RT + ST as the reference. Results: Ten studies involving 3346 patients were included for overall survival (OS) analysis, and six studies were included for disease-free survival (DFS). SLND + RT + ST showed similar OS and DFS compared to RT + ST. Sensitivity analyses revealed that SLND limited to level V improved OS (HR: 0.47, 95% CI: 0.29–0.77), while more extensive dissections (level V+) worsened outcomes (HR: 1.41, 95% CI: 1.10–1.80). Conclusions: These findings suggest that selective SLND may benefit certain patients, but broader application should be approached with caution pending results from future randomized trials.

Background: Hyaluronic acid has gained widespread attention for its potential role in sinonasal surgery, especially functional endoscopic sinus surgery (FESS), due to its wound healing and anti‐inflammatory properties. However, clinical evidence on its efficacy remains inconclusive. This meta‐analysis aims to clarify the efficacy of hyaluronic acid in improving both objective and subjective outcomes after sinonasal surgery.Methods: Two blinded reviewers searched PubMed, Embase, and Scopus databases, then selected randomized controlled trials (RCTs) on hyaluronic acid use in sinonasal surgery compared to routine post‐operative care. The risk of bias was graded using the Cochrane Risk of Bias 2 (RoB 2) tool. Data was analyzed using random‐effects models to pool risk ratios for dichotomous outcomes and the ratio of means (RoM) for continuous outcomes. Publication bias was assessed via funnel plots and the trim‐and‐fill method.Results: From 244 records, 15 RCTs—13 on FESS and two on septoplasty and inferior turbinoplasty—were selected, with 789 participants. Meta‐analysis for the 13 studies on FESS was performed. Hyaluronic acid significantly reduced synechiae formation (relative risk [RR] 0.65, 95% confidence interval [CI] 0.44–0.94), improved epithelialization (RR 0.48, 95% CI 0.27–0.86), and decreased post‐operative edema (RR 0.70, 95% CI 0.50–0.97) compared to routine post‐FESS care. All included studies had a low to moderate risk of bias, and there was no substantial publication bias. There were no adverse events reported.Conclusions: Hyaluronic acid dressings are safe and may reduce synechiae, edema, and improve epithelialization after sinonasal surgery. Hyaluronic acid may be considered as an adjunct after FESS to optimize post‐operative outcomes.

Background: In recent years, Artificial Intelligence (AI) has shown transformative potential in advancing breast cancer care globally. This scoping review seeks to provide a comprehensive overview of AI applications in breast cancer care, examining how they could reshape diagnosis, treatment, and management on a worldwide scale and discussing both the benefits and challenges associated with their adoption. Methods: In accordance with PRISMA-ScR and ensuing guidelines on scoping reviews, PubMed, Web of Science, Cochrane Library, and Embase were systematically searched from inception to end of May 2024. Keywords included “Artificial Intelligence” and “Breast Cancer”. Original studies were included based on their focus on AI applications in breast cancer care and narrative synthesis was employed for data extraction and interpretation, with the findings organized into coherent themes. Results: Finally, 84 articles were included. The majority were conducted in developed countries (n = 54). The majority of publications were in the last 10 years (n = 83). The six main themes for AI applications were AI for breast cancer screening (n = 32), AI for image detection of nodal status (n = 7), AI-assisted histopathology (n = 8), AI in assessing post-neoadjuvant chemotherapy (NACT) response (n = 23), AI in breast cancer margin assessment (n = 5), and AI as a clinical decision support tool (n = 9). AI has been used as clinical decision support tools to augment treatment decisions for breast cancer and in multidisciplinary tumor board settings. Overall, AI applications demonstrated improved accuracy and efficiency; however, most articles did not report patient-centric clinical outcomes. Conclusions: AI applications in breast cancer care show promise in enhancing diagnostic accuracy and treatment planning. However, persistent challenges in AI adoption, such as data quality, algorithm transparency, and resource disparities, must be addressed to advance the field.

Background Current guidelines on the management strategy for patients with asymptomatic severe aortic stenosis (AS) remain unclear. This uncertainty stems from the lack of data regarding the natural history of these patients. To address this gap, we performed a systematic review and meta-analysis examining the natural history of asymptomatic severe AS patients receiving conservative treatment. Methods The PubMed, Cochrane, and Embase databases were searched from inception to 24 January 2024 using the keywords “asymptomatic” AND “aortic” AND “stenosis”. We included studies examining patients with asymptomatic severe AS. In interventional trials, only data from conservatively managed arms were collected. A one-stage meta-analysis was conducted using individual patient data reconstructed from published Kaplan–Meier curves. Sensitivity analysis was performed for major adverse cardiovascular outcomes in patients who remained asymptomatic throughout follow-up. Results A total of 46 studies were included (n = 9545). The median time to the development of symptoms was 1.11 years (95% CI 0.90–1.53). 49.36% (40.85–58.59) of patients who were asymptomatic had suffered a major adverse cardiovascular event by 5 years. The median event-free time for heart failure hospitalization (HFH) was 5.50 years (95% CI 5.14–5.91) with 36.34% (95% CI 33.34–39.41) of patients experiencing an HFH by year 5. By 5 years, 79.81% (95% CI 69.26–88.58) of patients developed symptoms (angina, dyspnoea, syncope and others) and 12.36% (95% CI 10.01–15.22) of patients died of cardiovascular causes. For all-cause mortality, the median survival time was 9.15 years (95% CI 8.50–9.96) with 39.43% (CI 33.41–36.40) of patients dying by 5 years. The median time to AVR was 4.77 years (95% CI 4.39–5.17), with 52.64% (95% CI 49.85–55.48) of patients requiring an AVR by 5 years. Conclusion Our results reveal poor cardiovascular outcomes for patients with asymptomatic severe AS on conservative treatment. A significant proportion eventually requires an AVR. Further research is needed to determine if early intervention with AVR is more effective than conservative treatment.

Background: The risk of skin cancer is determined by environmental factors like ultraviolet radiation (UVR), personal habits like time spent outdoors and genetic factors. This review aimed to survey existing studies in gene–environment (GxE) interaction on skin cancer risk, and report on GxE effect estimates.Methods: We searched Embase, Medline (Ovid) and Web of Science (Core Collection) and included only primary research that reported on GxE on the risk of the three most common types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Quality assessment followed the Newcastle–Ottawa Scale. Meta‐analysis was not possible because no two studies examined the same interaction. This review was registered on PROSPERO (CRD42021238064).Results: In total 260 records were identified after exclusion of duplicates. Fifteen studies were included in the final synthesis—12 used candidate gene approach. We found some evidence of GxE interactions with sun exposure, notably, with MC1R, CAT and NOS1 genes in melanoma, HAL and IL23A in BCC and HAL and XRCC1 in SCC.Conclusion: Sun exposure seems to interact with genes involved in pigmentation, oxidative stress and immunosuppression, indicating that excessive UV exposure might exhaust oxidative defence and repair systems differentially, dependent on genetic make‐up. Further research is warranted to better understand skin cancer epidemiology and develop sun exposure recommendations. A genome‐wide approach is recommended as it might uncover unknown disease pathways dependent on UV radiation.