Multilayer Perceptron-Based Real-Time Intradialytic Hypotension Prediction Using Patient Baseline Information and Heart-Rate Variation.

Intradialytic hypotension (IDH) is a common side effect that occurs during hemodialysis and poses a great risk for dialysis patients. Many studies have been conducted so far to predict IDH, but most of these could not be applied in real-time because they used only underlying patient information or static patient disease information. In this study, we propose a multilayer perceptron (MP)-based IDH prediction model using heart rate (HR) information corresponding to time-series information and static data of patients. This study aimed to validate whether HR differences and HR slope information affect real-time IDH prediction in patients undergoing hemodialysis. Clinical data were collected from 80 hemodialysis patients from 9 September to 17 October 2020, in the artificial kidney room at Yeungnam University Medical Center (YUMC), Daegu, South Korea. The patients typically underwent hemodialysis 12 times during this period, 1 to 2 h per session. Therefore, the HR difference and HR slope information within up to 1 h before IDH occurrence were used as time-series input data for the MP model. Among the MP models using the number and data length of different hidden layers, the model using 60 min of data before the occurrence of two layers and IDH showed maximum performance, with an accuracy of 81.5%, a true positive rate of 73.8%, and positive predictive value of 87.3%. This study aimed to predict IDH in real-time by continuously supplying HR information to MP models along with static data such as age, diabetes, hypertension, and ultrafiltration. The current MP model was implemented using relatively limited parameters; however, its performance may be further improved by adding additional parameters in the future, further enabling real-time IDH prediction to play a supporting role for medical staff.

Electrocardiogram Fiducial Point Detector Using a Bilateral Filter and Symmetrical Point-Filter Structure.

The characteristics or aspects of important fiducial points (FPs) in the electrocardiogram (ECG) signal are complicated because of various factors, such as non-stationary effects and low signal-to-noise ratio. Due to the various noises caused by the ECG signal measurement environment and by typical ECG signal deformation due to heart diseases, detecting such FPs becomes a challenging task. In this study, we introduce a novel PQRST complex detector using a one-dimensional bilateral filter (1DBF) and the temporal characteristics of FPs. The 1DBF with noise suppression and edge preservation preserves the P- or T-wave whereas it suppresses the QRS-interval. The 1DBF acts as a background predictor for predicting the background corresponding to the P- and T-waves and the remaining flat interval excluding the QRS-interval. The R-peak and QRS-interval are founded by the difference of the original ECG signal and the predicted background signal. Then, the Q- and S-points and the FPs related to the P- and T-wave are sequentially detected using the determined searching range and detection order based on the detected R-peak. The detection performance of the proposed method is analyzed through the MIT-BIH database (MIT-DB) and the QT database (QT-DB).

Mass Infection Analysis of COVID-19 Using the SEIRD Model in Daegu-Gyeongbuk of Korea from April to May, 2020.

BACKGROUND: The novel coronavirus (coronavirus disease 2019 [COVID-19]) outbreak began in China in December last year, and confirmed cases began occurring in Korea in mid-February 2020. Since the end of February, the rate of infection has increased greatly due to mass (herd) infection within religious groups and nursing homes in the Daegu and Gyeongbuk regions. This mass infection has increased the number of infected people more rapidly than was initially expected; the epidemic model based on existing studies had predicted a much lower infection rate and faster recovery. METHODS: The present study evaluated rapid infection spread by mass infection in Korea and the high mortality rate for the elderly and those with underlying diseases through the Susceptible-Exposed-Infected-Recovered-Dead (SEIRD) model. RESULTS: The present study demonstrated early infection peak occurrence (-6.3 days for Daegu and -5.3 days for Gyeongbuk) and slow recovery trend (= -1,486.6 persons for Daegu and -223.7 persons for Gyeongbuk) between the actual and the epidemic model for a mass infection region compared to a normal infection region. CONCLUSION: The analysis of the time difference between infection and recovery can help predict the epidemic peak due to mass (or normal) infection and can also be used as a time index to prepare medical resources.

Adolescent overweight and obesity and the risk of papillary thyroid cancer in adulthood: a large-scale case-control study.

This study aimed to investigate the association between adolescent overweight and obesity and PTC risk in adulthood. We conducted a case-control study in the Republic of Korea with 1,549 PTC patients and 15,490 controls individually matched for age and sex. We estimated body mass index (BMI) at age 18 years from self-reported weight at this age. Compared with BMI < 23.0 at age 18 years, BMI ≥ 25.0 at age 18 years was associated with higher PTC risk (odds ratio [OR] = 4.31, 95% confidence interval [CI]: 3.57, 5.22). The association between BMI ≥ 25.0 at age 18 years and PTC risk was stronger among men (OR = 6.65, 95% CI: 4.78, 9.27) than among women (OR = 3.49, 95% CI: 2.74, 4.43), and stronger among individuals with current BMI ≥ 25.0 (OR = 8.21, 95% CI: 6.34, 10.62) than among those with current BMI < 25.0 (OR = 2.21, 95% CI: 1.49, 3.27). Among PTC patients, BMI ≥ 25.0 at age 18 years was associated with extra-thyroidal extension and T stage ≥2, but not with N stage ≥1 or BRAFV600E mutation. Adolescent overweight and obesity was associated with higher risk of PTC in adulthood. Our results emphasise the importance of weight management in adolescence to decrease the PTC risk.

Vital Block and Vital Sign Server for ECG and Vital Sign Monitoring in a Portable u-Vital System.

An important function in the future healthcare system involves measuring a patient's vital signs, transmitting the measured vital signs to a smart device or a management server, analyzing it in real-time, and informing the patient or medical staff. Internet of Medical Things (IoMT) incorporates information technology (IT) into patient monitoring device (PMD) and is developing traditional measurement devices into healthcare information systems. In the study, a portable ubiquitous-Vital (u-Vital) system is developed and consists of a Vital Block (VB), a small PMD, and Vital Sign Server (VSS), which stores and manages measured vital signs. Specifically, VBs collect a patient's electrocardiogram (ECG), blood oxygen saturation (SpO2), non-invasive blood pressure (NiBP), body temperature (BT) in real-time, and the collected vital signs are transmitted to a VSS via wireless protocols such as WiFi and Bluetooth. Additionally, an efficient R-point detection algorithm was also proposed for real-time processing and long-term ECG analysis. Experiments demonstrated the effectiveness of measurement, transmission, and analysis of vital signs in the proposed portable u-Vital system.

Indocyanine green as a near-infrared fluorescent agent for identifying parathyroid glands during thyroid surgery in dogs.

BACKGROUND: Surgical procedures involving the thyroid gland require identification of the parathyroid glands. Indocyanine green (ICG) is a near-infrared (NIR) fluorescent contrast agent used for a variety of procedures such as intraoperative angiography, extrahepatic cholangiography, and lymph node mapping. In this study, we used a canine model to evaluate ICG for NIR fluorescent imaging of the parathyroid gland. METHODS: Three dogs were used for the study. The dogs were administered general anesthesia, and after surgical dissection, each dog received a series of intravenous ICG doses ranging from 12.5 to 100 µg/kg ICG. The excitation light source used to illuminate the operating field was a NIR laser (λ = 785 nm). Intravascular ICG fluorescence (λ = 835/45 nm) was recorded using a charge-coupled device that employed optical filtering to block ambient and laser light. Fluorescent imaging was assessed after injection of each dose of ICG. RESULTS: NIR fluorescent imaging visualized the parathyroid glands. The intensity curves showing the peak and plateau of fluorescence are similar regardless of the concentration of ICG. The time to peak fluorescent intensity was 50.2 ± 2.0 s after injection of ICG. Taking into consideration background fluorescent intensity, the estimated optimal dose of ICG was 18.75 µg/kg. At 106.7 ± 5.8 s, the parathyroid glands lost much of their fluorescence, although they remained sufficiently fluorescent to be distinguishable. There was a positive correlation of fluorescent intensity with ICG dose escalation up to 25 µg/kg. CONCLUSIONS: ICG NIR fluorescent imaging was useful in detecting the parathyroid glands of dogs. By allowing detection of parathyroid glands, the current technique shows promise for use by endocrine surgeons performing thyroidectomies.

A prospective, randomized, controlled trial of the postoperative analgesic effects of spraying 0.25 % levobupivacaine after bilateral axillo-breast approach robotic thyroidectomy.

BACKGROUND: Robotic thyroidectomy (RoT) is frequently performed due to its excellent cosmesis and recovery features. However, postoperative pain in the operating field after RoT remains a concern due to extensive tissue dissection and tension during the operation. The aim of this study was to evaluate the anterior chest pain and the effect of levobupivacaine spraying on postoperative pain control after bilateral axillo-breast approach (BABA) RoT. METHODS: We randomized 55 adult patients scheduled for BABA RoT into the control group (group C, n = 27) or the levobupivacaine group (group L, n = 28). At the end of surgery, patients in groups C and L were sprayed with the same volume (30 ml) of normal saline and 0.25 % levobupivacaine, respectively, on the flap dissection area. Pain scores, the consumption of patient-controlled analgesia (PCA), and other adverse effects were assessed at 1, 6, 24, and 48 h postoperatively. RESULTS: Patients in group L showed lower pain scores than those of group C at 1 h (50 [0-100] vs. 80 [20-100]; p = 0.004), 6 h (30 [0-90] vs. 70 [30-90]; p < 0.001), 24 h (30 [0-80] vs. 50 [10-80]; p = 0.016) and 48 h (10 [0-80] vs. 30 [10-80]; p < 0.001) postoperatively. PCA consumption of group L was less than that of group C at 6, 24, and 48 h after surgery. There were no significant differences in postoperative nausea-vomiting, headache, or dizziness. Local anesthetic-related adverse effects were not reported. CONCLUSION: Levobupivacaine spray on the operative field at the end of BABA RoT reduced postoperative pain and PCA consumption without adverse events.

A multi-institutional study of the prevalence of BRCA1 and BRCA2 large genomic rearrangements in familial breast cancer patients.

BACKGROUND: Large genomic rearrangements (LGRs) in the BRCA1/2 genes are frequently observed in breast cancer patients who are negative for BRCA1/2 small mutations. Here, we examined 221 familial breast cancer patients from 37 hospitals to estimate the contribution of LGRs, in a nationwide context, to the development of breast cancer. METHODS: Direct sequencing or mutation scanning followed by direct sequencing was performed to screen small mutations. BRCA1/2 small mutation-negative patients were screened for the presence of LGRs using a multiple ligation-dependent probe amplification (MLPA) assay. RESULTS: Using a combined strategy to detect the presence of small mutations and LGRs, we identified BRCA1/2 small mutations in 78 (35.3%) out of 221 familial breast cancer patients and BRCA1 LGRs in 3 (2.1%) out of 143 BRCA1/2 small mutation-negative patients: the deletion of exons 11-13, the deletion of exons 13-15, and whole gene deletion of exons 1-24. The novel deletion of exons 11-13 is thought to result from a non-homologous recombination event mediated by a microhomology sequence comprised of 3 or 4 base pairs: c.3416_4357 + 1863delins187 (NG_005905.2: g.33369_44944delins187). CONCLUSIONS: In this study, we showed that LGRs were found in 3.7% (3/81) of the patients who had mutations in BRCA1 or BRCA2, and 7.5% (3/40) of patients with mutations in BRCA1. This suggests that the contribution of LGRs to familial breast cancer in this population might be comparable to that in other ethnic populations. Given these findings, an MLPA to screen for mutations in the BRCA1 gene is recommended as an initial screening test in highly selective settings.

A multi-institutional study on the association between BRCA1/BRCA2 mutational status and triple-negative breast cancer in familial breast cancer patients.

Triple-negative breast cancer (TNBC) accounts for 12-24 % of all breast cancers. Here, we studied 221 familial breast and/or ovarian cancer patients from 37 hospitals using a comprehensive approach to identify large genomic rearrangements (LGRs) as well as sequence variants, and investigated the association between BRCA1/2 mutational status and TNBC. We performed direct sequencing or mutation scanning followed by direct sequencing. Then, 143 BRCA1/2 mutation-negative patients were screened for LGRs. In this study, the prevalence of BRCA1/2 mutations was high (36.9 %). The prevalence of BRCA1 mutations was similar to that of BRCA2 mutations: 49.4 versus 50.6 %, respectively. TNBC was diagnosed in 35.2 % of BRCA1/2 mutation carriers and 57.1 % of BRCA1 mutation carriers. Conversely, two-thirds of TNBC patients carried BRCA1/2 mutation(s), and about half were BRCA1 mutation carriers. When stratified by the mutated gene, TNBC prevalence in BRCA1 mutation carriers was significantly lower when there was a family history of ovarian cancer. Our multinomial logistic regression model demonstrated that no single factor was sufficient, and at least two factors, such as a patient with family history of both breast cancer and ovarian cancer or a patient diagnosed at a relatively young age (<40 years) with a TNBC phenotype, are necessary to indicate BRCA1/2 genetic testing in this population. Our results suggest that TNBC is a strong predictor for the presence of a BRCA1 mutation in this population, but additional risk factors should also be evaluated to ascertain a 10 % or higher prior probability of BRCA1/2 mutation testing.

Thyroid "atypia of undetermined significance" with nuclear atypia has high rates of malignancy and BRAF mutation.

BACKGROUND: "Atypia of undetermined significance" (AUS) in the Bethesda System for Reporting Thyroid Cytopathology is a heterogeneous category for cases that cannot be easily classified into benign, suspicious, or malignant. This study evaluated whether cytomorphology-based subcategorization could better predict the malignancy risk in cases designated as AUS, and how the subcategories correlated with BRAF mutation status in thyroid fine-needle aspirates (FNA). METHODS: Of 3589 cases of thyroid FNA diagnosed at the authors' institution in Seongnam, Korea, from January 2010 to December 2011, 331 cases of AUS were reviewed and subcategorized based on cytomorphological features, including nuclear atypia (NA), microfollicle formation (MF), Hürthle cell change (HC), and others (O). The malignancy rate of each subcategory was calculated using cases with histologic follow-up. Pyrosequencing was conducted to detect BRAF mutations. RESULTS: Malignancy was histologically proven in 23.3% (77 of 331) of cases diagnosed as AUS. In cytomorphology-based subcategories, the rate of malignancy was 30.8% (66 of 214) for AUS-NA, 14.5% (8 of 55) for AUS-O, 4.8% (2 of 42) for AUS-MF, and 5% (1 of 20) for AUS-HC. The BRAF V600E mutation was found in 40% (48 of 120) of AUS-NA, 30.8% (4 of 13) of AUS-HC, 6.7% (1 of 15) of AUS-O, and 2.8% (1 of 35) of AUS-MF. CONCLUSIONS: The AUS-NA subcategory was associated with the highest risk of malignancy and the greatest frequency of BRAF V600E (substitution of valine to glutamic acid at position 600) mutation. These findings suggest that subcategorization of AUS by cytomorphology and BRAF V600E mutation status is important for predicting the risk of malignancy.

Prospective randomized controlled trial on the use of flexible reinforced laryngeal mask airway (LMA) during total thyroidectomy: effects on postoperative laryngopharyngeal symptoms.

BACKGROUND: Sore throat, hoarseness, dysphagia, and cough are common laryngopharyngeal discomforts after thyroidectomy. The incidence and severity of laryngopharyngeal symptoms after the use of a flexible reinforced laryngeal mask airway (LMA) were compared with those that occur after the use of a plain endotracheal tube in patients after thyroidectomy. METHODS: Seventy-six patients scheduled for total thyroidectomy were randomized into a plain endotracheal tube group (group E) or a flexible reinforced LMA group (group L). Total intravenous anesthesia (propofol and remifentanil) was used for maintenance of anesthesia. Hemodynamic variables were recorded during induction of anesthesia. The incidence and severity (100-point numerical rating scales) of laryngopharyngeal symptoms, including sore throat, hoarseness, dysphagia, and cough, were assessed at 1, 24, and 48 h after surgery. RESULTS: All patients were placed successfully with an endotracheal tube or a flexible reinforced LMA. The postoperative incidence and severity of sore throat (25 vs. 33 at 24 h, p = 0.035, 17 vs. 28 at 48 h, p = 0.017; 50 [0-100] vs. 80 [20-100] at 1 h, p = 0.002; 30 [0-80] vs. 50 [0-100] at 24 h, p < 0.001; 0 [0-40] vs. 30 [0-90] at 48 h, p < 0.001) and hoarseness were lower in group L than in group E. At 48 h postoperatively, dysphagia (p = 0.005) and cough (p = 0.028) occurred less frequently in group L than in group E patients. CONCLUSION: A flexible reinforced LMA placed during surgery decreases the incidence and severity of laryngopharyngeal symptoms and is a feasible anesthetic tool compared with a conventional endotracheal tube for thyroidectomy.

Use of spiral computed tomography volumetry for determining the operative approach in patients with Graves' disease.

BACKGROUND: The purposes of the present study were to assess (1) the correlation between the weight of the postoperative thyroid specimen and the spiral computed tomography (CT) volumetry results of the thyroid gland in patients with Graves' disease, and (2) the utility of CT volumetry for determining the operative approach. METHODS: From 2009 to 2010, a total of 56 patients with Graves' disease underwent total or subtotal thyroidectomy. An enhanced spiral CT was taken in all patients prior to the operation. From 2.5 mm-thick slices of the thyroid gland, the surface area was calculated to measure the volume of the thyroid gland. The glandular volume was compared to the weight of the postoperative thyroid specimen. RESULTS: A total of 42 and 14 patients underwent total and subtotal thyroidectomy, respectively. The mean weight of the postoperative thyroid specimen was 43.9 ± 33.4 g, and the mean volume obtained by CT volumetry was 44.2 ± 32.8 mL. A good correlation was observed between the weight of the postoperative thyroid specimen and the volume calculated by CT (r = 0.98, p < 0.001). When 100 mL was set as the higher cut-off value of the thyroid volume for minimally invasive thyroid surgery, the estimated blood loss showed a significant difference between the >100 mL and the ≤100 mL groups (608.3 ± 540.8 vs. 119.7 ± 110.4 mL; p = 0.036). CONCLUSIONS: Spiral CT volumetry may be used to measure the thyroid volume reliably in patients with Graves' disease. For cases in which surgery is indicated in patients with Graves' disease, CT volumetry provides useful information from which to determine the operative approach. One hundred milliliter or less of thyroid volume in CT volumetry is recommended to perform minimally invasive thyroid surgery.

Robotic thyroidectomy by bilateral axillo-breast approach: review of 1,026 cases and surgical completeness.

BACKGROUND: Good postoperative and excellent cosmetic results have been achieved with bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT). This study was performed to analyze the surgical outcomes and evaluate the surgical completeness and safety of BABA RoT. METHODS: Between February 2008 and February 2012, a total of 1026 cases of BABA RoT were performed. The clinicopathologic characteristics, operation types, and postoperative outcomes of patients were analyzed. RESULTS: Of the 1026 cases analyzed, 968 cases were a malignant tumor and 58 cases were benign thyroid disease. Mean operating times for BABA total RoT with central lymph node dissection included 38 ± 13 min (range 20-90 min) of working space creation and 75 ± 26 min (range 25-175) of console time. Among the 872 patients who underwent total thyroidectomy with central lymph node dissection, transient hypoparathyroidism occurred in 39.1 %, transient vocal cord palsy occurred in 14.2 %, and permanent hypoparathyroidism and permanent vocal cord palsy occurred in 1.5 % and 0.2 % of patients, respectively. The median stimulated thyroglobulin (Tg) level of patients after their first radioactive iodine therapy was 0.4 ng/mL, with 65.1 % of patients having a stimulated Tg level of <1.0 ng/mL. The median suppressed Tg level at 3 postoperative months of patients without radioactive iodine therapy was <0.1 ng/mL, with 99.4 % of patients showing a suppressed Tg level of< 1.0 ng/mL. There was no recurrence or mortality after a median follow-up of 23 months. CONCLUSIONS: BABA RoT is a safe and effective method that provides good surgical completeness and has low rates of postoperative complications and recurrence.

Ipsilateral and contralateral central lymph node metastasis in papillary thyroid cancer: patterns and predictive factors of nodal metastasis.

BACKGROUND: The aims of this study were to evaluate the rate and risk factors of ipsilateral and contralateral central lymph node (CLN) metastases in patients with papillary thyroid cancer (PTC). METHODS: A total of 161 patients who underwent total thyroidectomy with prophylactic CLN dissection (CLND) to treat PTC were enrolled. RESULTS: Of 134 total cases excluding tumors located in the isthmus and bilateral lobes, 72 cases (53.7%) involved CLN metastases. Tumor size, age, and sex were found to be predictive of ipsilateral CLN metastasis and the rate of ipsilateral CLN metastasis in tumors > 1 cm was 59.6%. Contralateral CLN metastases were more prevalent only in tumors that already had ipsilateral CLN metastases (27.3%, p = .002). CONCLUSIONS: It is suggested that risk factors of ipsilateral and contralateral CLN metastases should be considered while planning the extent of CLND in patients with clinically node-negative and unilateral PTC upon preoperative ultrasonography.

Surgical completeness of total thyroidectomy using harmonic scalpel: comparison with conventional total thyroidectomy in papillary thyroid carcinoma patients.

PURPOSE: THE AIM OF THIS STUDY WAS TO COMPARE THE SURGICAL COMPLETENESS AND OUTCOME OF TOTAL THYROIDECTOMY IN TWO PATIENT GROUPS: One treated by harmonic scalpel (HS) and one by conventional total thyroidectomy (CT). METHODS: Between March 2006 and December 2007, 104 patients had total thyroidectomy by HS and 108 patients underwent CT. We analyzed clinicopathological characteristics and stimulated serum thyroid-stimulating hormone (TSH), thyroglobulin (Tg), and anti-Tg antibodies at the time of ablation for both groups. RESULTS: Compared with the CT group, the HS group had shorter operating time and hospital stays and reduced postoperative drainage. At postsurgical ablation, mean serum TSH was 80.47 ± 21.77 mU/L in the HS group and 69.74 ± 21.17 mU/L in the CT group, with significant between-group differences (P < 0.001). Mean serum Tg levels after TSH stimulation were 1.57 ± 3.17 and 3.95 ± 10.14 ng/mL in the HS and CT groups, respectively, with significant between-group differences (P = 0.028). CONCLUSION: Total thyroidectomy with an HS is a relatively safe and effective technique for use in patients with PTC. The HS provides surgical completeness and has a beneficial effect on successful ablation.

Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma.

BACKGROUND: Robotic operations have enabled a safer and more meticulous approach to thyroidectomy with the notable benefit of improved cosmesis and decreases in postoperative pain and swallowing discomfort. The aim of this study was to document the early surgical outcomes of robotic thyroidectomy in patients with papillary thyroid carcinoma (PTC) by comparing it with conventional open thyroidectomy. METHODS: From October 2007 to September 2008, 458 patients with PTC underwent thyroidectomy at the Yonsei University Health System. Of these patients, 266 patients were in the conventional open group and 192 patients were in the robotic group. These 2 groups were compared retrospectively with respect to clinicopathologic characteristics and surgical outcomes. RESULTS: The mean follow-up period was 29.1 months. Mean tumor size, incidence of capsular invasion, multiplicity, and central nodal metastasis showed no significant difference between the 2 groups. Total thyroidectomy was performed more frequently in the open group. In terms of operation times, the robotic group had a significantly greater length of time for total thyroidectomy and subtotal thyroidectomy. The total number of retrieved central lymph nodes was greater in the open group (5.7 vs 4.6, P = .004). The 2 groups showed no differences in intraoperative and postoperative complications. The postoperative serum thyroglobulin levels were similar in both groups (0.25 vs 0.22 ng/mL, P = .648) and 2-year follow-up sonography of 433 patients revealed no recurrences. No abnormal I(131) uptake was observed in whole-body scans in either group. CONCLUSION: Robotic thyroidectomy was similar to conventional open thyroidectomy in terms of early surgical outcomes but offers advantages. We conclude that robotic thyroidectomy offers a safe, feasible alternative to conventional open thyroidectomy in patients with PTC.

Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients.

OBJECTIVE: To confirm the merits of robotic thyroid surgery by comparing the surgical outcomes of robotic-assisted and conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. BACKGROUND: Robot-assisted surgical techniques are widely utilized, and substantially, overcome the limitations of conventional endoscopic surgery. Furthermore, recently, robotic procedures were introduced to the thyroidectomy field. METHODS: From November 2001 to July 2009, 1150 patients with PTMC underwent endoscopic thyroidectomy using a gasless, trans-axillary approach. Of these patients, 580 underwent a robotic procedure (the robotic group; RG) and 570 a conventional endoscopic procedure (the conventional endoscopic group; EG). These 2 groups were retrospectively compared in terms of their clinicopathologic characteristics, early surgical outcomes, and surgical completeness. RESULTS: Total thyroidectomy was performed more frequently in the RG. Although mean operation times were not statistically different, the mean number of central nodes retrieved was greater in the RG than in the EG. Mean tumor size were not significantly different in the 2 groups, but the RG showed more frequent central node metastasis and capsular invasion. Tumor and nodal statuses in the RG were more advanced than in the EG. Regarding postoperative complications, transient hypocalcemia was more frequent in the RG, but other complication frequencies were not significantly different in the 2 groups. Postoperative serum thyroglobulin levels were similar in 2 groups, and short-term follow-up (1 year) revealed no recurrence by sonography and no abnormal uptake during radioactive iodine therapy in either group. CONCLUSIONS: The application of robotic technology to endoscopic thyroidectomy could overcome the limitations of conventional endoscopic surgery during the surgical management of PTMC.

Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up.

PURPOSE: This study was undertaken to document the short-term clinical efficacy of arthroscopic pullout suture repair in treating posterior root tears of the medial meniscus. METHODS: From March 2004 to August 2006, 26 patients (27 knees) with posterior root tears of the medial meniscus were treated with arthroscopic pullout suture repair surgery by the senior author. Of these, 20 consecutive patients (21 knees) with a minimum of 2 years' follow-up treated by arthroscopic pullout suture repair were analyzed. Clinical results by use of the Lysholm knee and Hospital for Special Surgery scores and radiographic grade were evaluated, both preoperatively and at final follow-up. In addition, the second-look arthroscopic findings for 10 knees were analyzed. RESULTS: A radiographic evaluation using the criteria of Kellgren and Lawrence at final follow-up showed an increase in radiographic grade by 1 grade in only 1 knee. On the second-look arthroscopies performed in 10 knees (47.6%), all repaired menisci had healed completely without additional chondral lesions in the knee. The mean Hospital for Special Surgery scores improved from 61.1 preoperatively to 93.8 at final follow-up (P < .0001), and the mean preoperative Lysholm knee scores improved from 57.0 to 93.1 at final follow-up (P < .0001). Retear was found in 1 knee at the 6-month follow-up, and reoperation was performed with the same procedure used for the index surgery. CONCLUSIONS: Arthroscopic pullout suture repair is an effective treatment for alleviating meniscal symptoms in patients with a symptomatic posterior root tear of the medial meniscus with degenerated articular cartilage of less than grade III. In addition, no discernable degenerative arthritic changes were found in terms of radiographic features with our limited short-term follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Radial tears in the roots of the posterior horns of both the medial and lateral menisci combined with anterior cruciate ligament tear: a case report.

We report a rare case of radial tears in the roots of the posterior horns of both the medial and lateral menisci associated with a chronic anterior cruciate ligament tear. Treatment included an arthroscopic pullout suture combined with anterior cruciate ligament reconstruction. At the 3-year postoperative follow-up, a second-look arthroscopic examination showed the posterior horns of both menisci to be well healed on the tibia. Manual knee laxity tests were negative and no side-to-side difference was detected by a KT-1000 arthrometer. The patient was able to perform outdoor activities without residual symptoms.

COMP-Angiopoietin-1 ameliorates surgery-induced ischemic necrosis of the femoral head in rats.

INTRODUCTION: Ischemic necrosis of the femoral head (INFH) can lead to loss of femoral head architecture and deformity. Moreover, the process of bone healing is intimately associated with angiogenesis. We considered that COMP-Ang1 (an angiogenic factor) might preserve femoral head structure and facilitate bone repair. METHODS: INFH was induced in the femoral head of rats by dissecting the cervical periosteum and placing a ligature tightly around the femoral neck. Two weeks later, COMP-Ang1 was injected directly into infarcted areas. Rats were divided into the following groups; 1) the sham-operated group (the sham group), 2) the bovine serum albumin-injected group (the BSA group), and 3) the COMP-Ang1-injected group (the COMP-Ang1 group) (n=20/group). At 8 weeks post-surgery animals were sacrificed and radiologic and histomorphometric assessments were performed. RESULTS: Radiographs obtained at 8 weeks post-surgery showed better preservation of femoral head architecture in the COMP-Ang1 group than in the BSA group. Histological findings and immunostainings of endothelial cells for factor VIII revealed that COMP-Ang1 group animals showed higher levels of vascularity in the secondary ossification center of infarcted femoral heads. CONCLUSIONS: When INFH was surgically induced in rats, an intraosseous injection of COMP-Ang1 preserved the trabecular framework of the osseous epiphysis and prevented femoral head deformities by promoting angiogenesis and bone remodeling.