Shaving Papillary Thyroid Carcinoma Involving Functioning Recurrent Laryngeal Nerve: Safety of Incomplete Tumor Resection and Nerve Sparing.

BACKGROUND: Whether to sacrifice or spare the recurrent laryngeal nerve (RLN) when papillary thyroid carcinoma (PTC) involves a functioning RLN remains controversial. Oncological outcomes after shaving PTC with gross remnant on the RLN have been rarely reported. The objective of this study was to evaluate the oncological outcomes of patients who underwent shaving of a PTC from the RLN, leaving a gross residual tumor with the intent of vocal function preservation. METHODS: A retrospective, cohort study was conducted in 47 patients who were determined to have PTC invasion of the RLN via intraoperative inspection and underwent tumor shaving with macroscopic remnant (R2 resection) less than 1 cm in length and 4 mm in thickness. Median follow-up period was 93 (range, 60-215) months. The primary endpoint was the recurrence-free survival and the progression-free survival. Secondary endpoints were biochemical outcomes (serum thyroglobulin) and vocal cord function. RESULTS: Of the 47 patients, five (10.6%) patients showed recurrence (central neck, 3; lateral neck, 2) without death or distant metastasis. The RLN was resected along with the tumor in one (2.1%) patient who presented with progression of the residual tumor. Postoperative temporary vocal cord paralysis occurred in six (12.8%) patients without permanent cases. The final nonstimulated serum thyroglobulin was 0.7 ± 1.8 ng/ml. CONCLUSIONS: Shaving a tumor from a RLN with gross residual disease may be considered an alternative strategy to preserve vocal function when complete tumor resection with nerve preservation is impossible in patients with PTC invading a functioning RLN.

Peri-articular injections of local anaesthesia can replace patient-controlled analgesia after total knee arthroplasty: a randomised controlled study.

PURPOSE: In recent years, there has been an increasing interest in peri-articular injections (PAI) to control post-operative pain after total knee arthroplasty (TKA). Previous studies have evaluated the effect of PAI using multimodal analgaesic protocols, but the concomitant use of patient-controlled analgesia (PCA) may has masked the genuine effects of PAI. We investigated the efficacy of PAI compared with PCA and determined whether conventional PCA can be effectively replaced with PAI after TKA. METHODS: Eighty patients undergoing unilateral TKA were randomised into two groups. The PCA group consisted of patients who used PCA after surgery, while the PAI group included patients who did not use PCA post-operatively but were given PAI during surgery. We measured changes in visual analogue scale (VAS) scores, straight leg raising (SLR), range of motion (ROM) and consumption of antiemetics or analgaesics. RESULTS: Pain levels in the PAI group were significantly lower than in the PCA group during two weeks post-operatively (p < 0.05).; functional recovery in the SLR test showed no difference between groups (p > 0.05).; mean ROM showed no difference; (p > 0.05) and there was no difference in the number of patients who needed additional analgaesics. However, antiemetic use was significantly lower for the PAI group (p < 0.05). CONCLUSIONS: PAI offered improved pain control and minimal side effects compared with PCA. Thus, PAI can replace conventional PCA for controlling post-operative pain after TKA.

Synthesis of multi-walled carbon nanotube-Ag-nanoparticles composite nanomaterials using proton beam irradiation.

A new synthetic route for decorating carbon nanotubes (MWCNTs) with silver nanoparticles by proton beam irradiation at room temperature is presented. Pristine- and surface-modified MWCNTs were comparatively utilized for the preparation of MWCNT-Ag-nanoparticles nanohybrid. Silver nanoparticles on the surfaces of MWCNTs were produced in situ without any additional reducing reagents, and more importantly, all the solutions were aqueous phase-based. The surfaces of MWCNTs were functionalized with thiol groups using several steps, which included an oxidation step. The silver nanocrystals on the surface-modified MWCNTs were spherical and -4 nm in diameter. Thiolated MWCNTs were well decorated with Ag nanoparticles, whereas pristine MWCNTs were not.

Bidirectional meta-Kronecker factored optimizer and Hausdorff distance loss for few-shot medical image segmentation.

To increase the accuracy of medical image analysis using supervised learning-based AI technology, a large amount of accurately labeled training data is required. However, the supervised learning approach may not be applicable to real-world medical imaging due to the lack of labeled data, the privacy of patients, and the cost of specialized knowledge. To handle these issues, we utilized Kronecker-factored decomposition, which enhances both computational efficiency and stability of the learning process. We combined this approach with a model-agnostic meta-learning framework for the parameter optimization. Based on this method, we present a bidirectional meta-Kronecker factored optimizer (BM-KFO) framework to quickly optimize semantic segmentation tasks using just a few magnetic resonance imaging (MRI) images as input. This model-agnostic approach can be implemented without altering network components and is capable of learning the learning process and meta-initial points while training on previously unseen data. We also incorporated a combination of average Hausdorff distance loss (AHD-loss) and cross-entropy loss into our objective function to specifically target the morphology of organs or lesions in medical images. Through evaluation of the proposed method on the abdominal MRI dataset, we obtained an average performance of 78.07% in setting 1 and 79.85% in setting 2. Our experiments demonstrate that BM-KFO with AHD-loss is suitable for general medical image segmentation applications and achieves superior performance compared to the baseline method in few-shot learning tasks. In order to replicate the proposed method, we have shared our code on GitHub. The corresponding URL can be found: https://github.com/YeongjoonKim/BMKFO.git .

Detectable depth of unexposed parathyroid glands using near-infrared autofluorescence imaging in thyroid surgery.

Background: Near-infrared light can penetrate the fat or connective tissues overlying the parathyroid gland (PG), enabling early localization of the PG by near-infrared autofluorescence (NIRAF) imaging. However, the depth at which the PG can be detected has not been reported. In this study, we investigated the detectable depth of unexposed PGs using NIRAF during thyroidectomy. Materials and methods: Fifty-one unexposed PGs from 30 consecutive thyroidectomy patients, mapped by an experienced surgeon (K.D. Lee) with the use of NIRAF imaging, were included. For NIRAF detection of PGs, a lab-built camera imaging system was used. Detectable depths of the unexposed PGs were measured using a Vernier caliper. The NIRAF images were classified as faint or bright depending on whether a novice could successfully interpret the image as showing the PG. Data on variables that may affect detectable depth and NIRAF intensity were collected. Results: Detectable depth ranged between 0.35 and 3.05 mm, with a mean of 1.23 ± 0.73 mm. The average NIRAF intensity of unexposed PGs was 3.13 au. After dissection of the overlying tissue, the intensity of the exposed PG increased to 4.88 au (p < 0.001). No difference in NIRAF intensity between fat-covered (3.27 ± 0.90 au) and connective tissue-covered PGs (3.00 ± 1.23 au) was observed (p = 0.369). PGs covered by fat tissue (depth: 1.77 ± 0.67 mm) were found at deeper locations than those covered by connective tissue (depth: 0.70 ± 0.21 mm) (p < 0.001). The brightness of images of the faint group (2.14 ± 0.48 au) was on average 1.24 au lower than that of the bright group (3.38 ± 1.04 au) (p = 0.001). A novice successfully localized 80.4% of the unexposed PGs. Other variables did not significantly affect detectable depth. Conclusion: Unexposed PGs could be mapped using NIRAF imaging at a maximum depth of 3.05 mm and an average depth of 1.23 mm. A novice was able to localize the PGs before they were visible to the naked eye at a high rate. These results can be used as reference data for localization of unexposed PGs in thyroid surgery.

Formation of flower-like Ag colloids using pulsed proton beam.

A new solution phase method is presented for the synthesis of "flower-like" silver nanomaterials using a pulsed proton beam irradiation process at room temperature. It was observed that the morphology of the prepared silver crystals was easily controlled by varying the number of exposures to the pulsed proton beam. The synthesized flower-like silver nanocrystals exhibited excellent surface enhanced Raman scattering (SERS) signals, which were attributed to the rough microstructures on the surface of the synthesized Ag crystals.

Controlling the shapes and electrical conductivities of polyaniline-wrapped MWCNTs.

Nanocomposites of carbon nanotubes with polyaniline (PANI) constitute promising conducting nanomaterials, due to their ease of synthesis, electrical conductivity, and environmental stability. Variously shaped multi-walled carbon nanotube (MWCNT)-PANI nanocomposites were synthesized, and their electrical conductivities were compared. This study shows that new synthetic methods were able to control the shapes and electrical conductivities of MWCNT-PANI nanocomposites. The shapes of the MWCNT-PANI nanocomposites were changed by altering the reactant concentrations and the sequence of adding the initiator, ammonium persulfate (APS). The use of surface-modified MWCNTs instead of pristine MWCNTs is also an important factor determining the shapes of the nanocomposites. It was found that the electrical conductivity is strongly dependent on the shape and PANI content. The electrical conductivities of the MWCNT-PANI nanocomposites increased when the PANI/MWCNT ratio was decreased. The nanocomposites were characterized via field emission transmission electron microscopy (FE-TEM), Fourier-transform infrared (FT-IR) and ultraviolet-visible (UV-Vis) spectroscopy, and elementary analysis of the MWCNT-PANI nanocomposites.

Asymmetry of the "strongest" OHO hydrogen bond, in the monoanion of (+/-)-alpha,alpha'-di-tert-butylsuccinate.

The large pK(a) difference between first and second deprotonations of (+/-)-alpha,alpha'-di-tert-butylsuccinic acid has been interpreted as evidence for a short, strong intramolecular hydrogen bond in the monoanion. Incorporation of (18)O into one carboxyl group allows investigation of the symmetry of the H-bond in solution by the method of isotopic perturbation. Relative to the intrinsic (18)O-induced isotope shift at the carboxyl carbon, as measured in the diacid, an additional isotope shift of 8 ppb in methanol, 14 ppb in acetone, and 5 ppb in THF is observed for potassium hydrogen (+/-)-alpha,alpha'-di-tert-butylsuccinate-(18)O. This increase indicates that the ion exists as an equilibrating pair of interconverting tautomers and not as a single symmetric resonance hybrid. The X-ray crystal structures of the tetrapropylammonium, tetrabutylammonium, tetrabutylphosphonium, magnesium, and calcium hydrogen (+/-)-alpha,alpha'-di-tert-butylsuccinate salts show a remarkably short O-O distance of 2.41 A, consistent with a strong hydrogen bond. However, the dicesium salt of the (+/-)-alpha,alpha'-di-tert-butylsuccinate dianion also shows the short O-O distance of 2.41 A, so this cannot be taken as evidence for a strong hydrogen bond in the monoanion. Moreover, the two O-H distances in the monoanions are unequal, and the hydrogen bond is asymmetric in these crystals. It is concluded that there is no evidence for any special stabilization associated with symmetric H-bonds. The large Delta pK(a) difference is therefore not due to any feature of the H-bond itself but is attributed to the electrostatic repulsion between the carboxylates in the dianion, which is relieved in the monoanion by inserting a proton between the carboxylates.

anti-9,10-Di(1-naphth-yl)anthracene pyridine disolvate.

In the title compound, C(34)H(22)·2C(5)H(5)N, there is a crystallographic inversion center in the middle of the anthracene ring system. The dihedral angle between the mean planes of the anthracene and naphthalene ring systems is 83.96 (4)°. The crystal structure is stabilized by weak inter-molecular C-H⋯N and C-H⋯π inter-actions.

Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty in Young Asian Patients Less than 60 Years of Age: A Minimum 5-Year Follow-up.

PURPOSE: The purpose of this study was to evaluate the efficacy of unicompartmental knee arthroplasty (UKA) in young active Asian patients by analyzing clinical outcomes, complications and survival rates. MATERIALS AND METHODS: Eighty-two knees were evaluated with a minimum follow-up of 5 years after Oxford phase 3 UKA in patients less than 60 years of age at the time of surgery. Their mean age was 54.7 years (range, 44 to 59 years). The mean follow-up period was 8.9 years (range, 5.3 to 12 years). Kaplan-Meier survivorship analysis was used to estimate implant survival. RESULTS: Including 3 bearing dislocations, 1 medial tibial collapse and 1 lateral osteoarthritis, the total complication rate was 6.1% (5/82). Of the 3 cases of bearing dislocation, 2 cases were resolved by replacing with a thicker bearing and 1 case was converted to total knee arthroplasty (TKA) due to repeated dislocation. The two knees with a medial tibial collapse and a lateral osteoarthritis were converted to TKA. The 10-year cumulative survival rate using Kaplan-Meier survival method was 94.7% (95% confidence interval: 88.7%-100%). CONCLUSIONS: Oxford medial UKA was reliable and effective in young active Asian patients providing good clinical results and survival rate in the mid-term follow-up.

Size and shape-tuned overgrowth on Au nanorods regulated by polyallylamine.

Au nanorods prepared by a photochemical method were used as seeds for the overgrowth of thin shell of gold by using a mild reducing agent, ascorbic acid at ambient conditions. The overgrowth rate along different crystal facets of the starting gold nanorods was regulated by the addition of polyallylamine. The shape of the resulting gold nanorods was different from the naturally overgrown Au nanorods without any additives.

Errata to "Coronal Alignment of the Lower Limb and the Incidence of Constitutional Varus Knee in Korean Females".

[This corrects the article on p. 49 in vol. 27, PMID: 25750894.].

Coronal alignment of the lower limb and the incidence of constitutional varus knee in korean females.

PURPOSE: In total knee arthroplasty (TKA), it is important to restore neutral mechanical alignment. The purpose of this study was to assess whether the lower limb alignment is neutral in healthy Korean females and investigate the incidence of constitutional varus knees among them. MATERIALS AND METHODS: Weight-bearing full-leg standing radiographs were obtained from 118 healthy females between the ages of 20 to 39 years. One radiologist and two orthopaedic surgeons measured the hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), and femoral anatomic mechanical angle (FAMA) on the radiographs and compared with the traditional gold standard HKAA of 0°, MPTA of 3° varus, and FAMA of 6°. RESULTS: The interobserver reliability of the three independent observers was high (p<0.001). The HKAA of the study subjects (1.35°±2.04°) was significantly different from the standard HKAA of 0° (p<0.001), but no statistically significant difference was observed in the MPTA (-3.18°±1.61°) and FAMA (5.99°±0.70°) from the standard values (p=0.083 and p=0.887, respectively). The incidence of constitutional varus alignment was 20.34%. CONCLUSIONS: In Korean females, the mechanical axis of the lower limb was not neutral and the incidence of constitutional varus alignment was slightly higher than that in Western females. We believe that these findings should be taken into consideration in planning reconstructive surgery of the knee, such as TKA, unicompartmental knee arthroplasty, and high tibial osteotomy.

Equilibrium constants and alkylation kinetics of two lithium enolates/LiHMDS mixed aggregates in THF.

[reaction: see text] Mixed aggregates between lithium enolates and lithium hexamethyldisilazide (LiHMDS) have been studied in THF using UV-vis spectroscopy. The equilibrium constants (K(agg)) between monomeric LiEn and monomeric LiHMDS are 760 and 560 M(-1) when LiEn are LiSIBP and LiBnPAT, respectively. The alkylation kinetics of the reactions with benzyl bromide were studied at 25 degrees C. The rate constants for the mixed aggregates, k(Mixed), are substantially smaller than those of the monomeric enolates.

Size-controlled synthesis of Pd nanomaterials via proton beam irradiation.

We present a facile one-pot synthetic route for the production of palladium nanoparticles via a simple proton beam irradiation process at room temperature. The synthesis of size-controlled palladium nanostructures was realized just by changing the mean current of the proton beam and by controlling the molar concentration ratios of surfactants to Pd precursors in an aqueous phase-based solution without the addition of any harsh reductants. As the beam current was increased under the same Pd ion concentration conditions, the average diameter of the prepared Pd nanoparticles tended to be decreased. We also found that the size of the synthesized Pd nanocrystals was decreased as the molar ratio of surfactants to palladium ion was increased.

Photophysical properties of near-infrared-emitting Ln(III) complexes with 1-(9-Anthryl)-4,4,4-trifluoro-1,3-butandione (Ln = Nd and Er).

We report the synthesis and photophysical properties of Nd(III) and Er(III) complexes with 1-(9-anthryl)-4,4,4-trifluoro-1,3-butandione (9-ATFB). The complexes of [Nd(9-ATFB)4]- and [Er(9-ATFB)4]- produced sensitized near-infrared (NIR) luminescence via the excitation of anthracene. This suggests that the intramolecular energy transfer occurred from the singlet excited state of anthracene to the resonance levels of the metal ions, since the phosphorescence of anthracene is forbidden under normal conditions. The observed quantum yield of the visible luminescence showed that the energy transfer is more efficient for [Nd(9-ATFB)4]- than for [Er(9-ATFB)4]-. The lifetimes of the NIR luminescence of the complexes were in the microsecond range. The quantum yields of the sensitized NIR of the complexes were estimated using the lifetime and the energy-transfer quantum yield.

Basicity of a stable carbene, 1,3-di-tert-butylimidazol-2-ylidene, in THF.

The basicity of 1,3-di-tert-butylimidazol-2-ylidene (1) was measured in THF against three hydrocarbon indicators. Both ion pairs and free ions were found and the corresponding equilibrium constants were measured. Homoconjugation was not found in either THF or DMSO. The carbene is effectively more basic in DMSO by several pK units, probably because of hydrogen bonding of 1-H(+) to DMSO. Model ab initio computations are consistent with these results.

Aggregation and reactivity of the dilithium and dicesium enediolates of 1-naphthylacetic acid.

UV-vis spectra of the dilithium, 1-Li, and dicesium, 1-Cs, enediolates of alpha-naphthylacetic acid show no systematic change with concentration in dilute THF solution, but addition of small amounts of HMPA causes a bathochromic shift in the spectrum of 1-Li. These results indicate that these salts are aggregated and that HMPA breaks up the aggregates of 1-Li. The quantitative effect of small increments of HMPA indicates that 1-Li is a dimer. Alkylation reactions of 1-Cs show half-order kinetics in enediolate indicating that this salt is also dimeric but that the small amount of monomer in equilibrium is the actual reactant. Alkylation of 1-Li, however, is much slower and shows first-order kinetics interpreted as a direct reaction of the dimer; the amount of monomer in this case is too small to compete. A solution of 1-Li in THF containing 10% HMPA is much more reactive in alkylation than 1-Li alone and the first-order dependence in 1-Li is now interpreted as reaction of the monomer. Compound 1-Li is found to form a mixed aggregate with LDA, a finding that has possible synthetic significance since enediolates used in syntheses are frequently prepared using LDA. Structures of these compounds are suggested based on model ab initio computations.