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BackgroundPatients with advanced thyroid carcinoma (TC), such as anaplastic thyroid carcinoma (ATC), poorly differentiated thyroid carcinoma (PDTC), and locally advanced papillary thyroid carcinoma (PTC), have poor prognoses and require novel treatments. Immune checkpoint (ICP) inhibitors have demonstrated encouraging and good results; nevertheless, their effect in advanced TCs remains largely unclear. Thus, we demonstrated ICP profiles and investigated their potential clinical significance.MethodsA total of 234 TC patients were involved, with 22 ATCs, 44 PDTCs, and 168 PTCs, including 58 advanced PTCs. Immunohistochemistry was performed to evaluate nine ICPs [programmed cell death ligand 1 (PDL1), Programmed cell death 1 (PD1), cytotoxic T lymphocyte-associated protein 4 (CTLA4), B and T lymphocyte attenuator (BTLA), T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), lymphocyte activation gene 3 (LAG3), V-domain immunoglobulin suppressor of T-cell activation (VISTA), B7 homolog 3 (B7-H3), and T-cell immunoglobulin and mucin domain- 3 protein (TIM3)] expression via tissue microarrays (TMAs), and clinical correlations were analyzed simultaneously.ResultsATC had the highest positive rate of ICPs among the three pathological types, as well as relatively high ICP co-expression. ATC with high expression of PDL1 positivity had a poor prognosis. Shorter survival was associated with VISTA, B7H3, TIM3, and TIGIT expression in PDTC. The greater the co-expression of these four ICPs, the poorer the prognosis in PDTC patients. VISTA and B7H3 were the two most commonly expressed ICPs in advanced PTC, both of which were linked to a poor prognosis.ConclusionsPDL1 is linked to the overall survival (OS) of ATC. A subset of PDTC is likely immunogenic with poor prognosis and co-expression of VISTA, B7H3, TIM3, and TIGIT. Furthermore, VISTA and B7H3 are prognostic biomarkers in advanced PTC. Single or combined blockade targeting these ICPs might be effective for advanced TCs in the future.

The emergent of medical science and technology has risen the minimally invasive surgery. Da Vinci Robotic Surgical Systems (RSS) is the trend at present. Compared with the past surgical methods, many studies related to RSS tend to explore postoperative outcomes and quality of life or compare the advantages and disadvantages than the other surgery. Few studies to understand the patients' willing who use RSS. This study mainly explores the patients' willingness and adopts the Technology Acceptance Model (TAM) as the theoretical foundation, and appended the trust concept to discuss. The study was a retrospective study and used a structured questionnaire to conduct a survey. The subjects included the patients with single-disease who had used RSS in a Medical Center of Southern Taiwan but excluded the patients with multiple disorder. This study conducted SPSS 22.0 and Smart PLS 2.0 software for statistical analysis, which included descriptive statistical analysis and applied Partial Least Squares (PLS) analysis to test the research model and to examine the established hypotheses. A total of 136 cases were collected in this study. Study validation was tested. Trust positively affects Perceived Usefulness (β = 0.550) and Perceived Ease of Use (β = 0.300). Perceived Ease of Use positively affects Perceived Usefulness (β = 0.188). Perceived Usefulness positively affects Attitude Toward Using (β = 0.589. Attitude Toward Using positively affects Behavioral Intention (β = 0.446. The relationship between perceived Ease of Use and Attitude toward Using was insignificant. Additionally, the relationship between Perceived Usefulness and Behavioral Intention was insignificant. In the research results, we found that patients are mostly in the middle and high age groups, and if the patient himself feels that RSS is extremely helpful to his illness, the intensity of his choice of intention will be high. In comparison, the information related to RSS has been clearly known, it does not directly affect the selection intention. According to age, most of the choices of RSS is based on safety and risk considerations, and it is beneficial to the patient himself, but RSS is also more expensive. We recommended that the government consider ββ reimbursing the RSS process in health insurance programs to meet the needs and expectations of patients.