Long-Term Oncological Outcome Comparison between Intermediate- and High-Dose Radioactive Iodine Ablation in Patients with Differentiated Thyroid Carcinoma: A Propensity Score Matching Study.

BACKGROUND: Radioactive iodine (RAI) ablation is recommended for most patients with differentiated thyroid carcinoma (DTC) after total thyroidectomy (TT). We aimed to compare long-term outcomes between intermediate-dose (100 mCi) and high-dose (150 mCi) RAI ablation therapy in patients with DTC using propensity score matching analysis. METHODS: This was a retrospective study of 1448 patients with DTC who underwent RAI ablation after TT. Propensity score matching was performed using the extent of operation, tumor size, extrathyroidal extension, multifocality, lymphatic invasion, vascular invasion, perineural invasion, number of positive lymph nodes (LNs), ATA risk stratification system, T stage, N stage, TNM stage, preoperative serum Tg and TgAb levels, and post-RAI serum Tg and TgAb levels. RESULTS: Recurrence rates in the intermediate- and high-dose groups were 3.1% and 5.6%, respectively. After propensity score matching, LN ratio >0.22 (HR, 2.915; 95% CI, 1.228-6.918; p=0.015) and serum Tg >10 ng/mL after RAI (HR, 3.976; 95% CI, 1.839-8.595; p < 0.001) were significant predictors of recurrence. Kaplan-Meier analysis showed no significant difference in DFS before or after propensity score matching (p=0.074 and p=0.378, respectively). CONCLUSIONS: Intermediate-dose RAI ablation for the adjuvant treatment of DTC is sufficient as compared to high-dose RAI ablation. Further prospective or multicenter studies should be conducted to clarify the prognosis of intermediate-dose RAI ablation.

Viscum album extract (Helixor-M) treatment for thoracic duct injury after modified radical neck dissection: a case report.

Chyle leakage after modified radical neck dissection is a rare condition that could be occasionally life-threatening if untreated. We report the first case of successful management of a thoracic duct injury using Viscum album extract (Helixor-M). A 54-year-old woman diagnosed with papillary thyroid cancer of the right lobe of the thyroid with metastasis to cervical lymph node levels II-VI, bilaterally, underwent total thyroidectomy and modified radical neck dissection. Three days postoperatively, the surgical team identified a thoracic duct injury due to drainage of chyle from the Jackson-Pratt drain inserted in the right side of the patient`s neck. Various medical treatments (octreotide, withdrawal of enteral feeding, and total parenteral nutrition) and surgical treatments [lymphatic ligation of cervical lymph node level IV and negative pressure wound therapy (vacuum-assisted closure)] were performed, but the drainage persisted. Viscum album extract (Helixor-M) was then injected through the drain. The dose of Viscum album extract was increased while being cautious of its adverse effects, such as nausea, vomiting, erythema, induration at the injection site, and flu-like symptoms. The injection was effective in stopping the drainage and the patient's condition improved, without recurrence. The patient was discharged on the 64th postoperative day without any further complications. Our results suggest that treatment of thoracic duct injury after neck surgery with Viscum album extract (Helixor-M) may be a novel, less invasive alternative approach to treat cases resistant to standard treatments.

The long-term risk of lymphoma and skin cancer did not increase after topical calcineurin inhibitor use and phototherapy in a cohort of 25,694 patients with vitiligo.

BACKGROUND: Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. OBJECTIVE: To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. METHODS: A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. RESULTS: During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. LIMITATIONS: Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. CONCLUSION: The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.

In vivo gastric residence and gastroprotective effect of floating gastroretentive tablet of DA-9601, an extract of Artemisia asiatica, in beagle dogs.

OBJECTIVE: DA-9601, an extract of Artemisia asiatica containing eupatilin and jaceosidin as active compounds, has been prescribed to treat gastritis in Asia. In recent times, sustained-release, floating gastroretentive (GR) tablets of DA-9601 are available on the market. In the present study, the physical properties and in vitro drug release profile, in vivo gastric residence time, and gastroprotective effect of GR tablet were compared to those of immediate release (IR) tablets of DA-9601. METHOD: In vitro buoyancy behavior (floating lag time and duration) and release profile of eupatilin were assessed in acidic medium. The in vivo intragastric behaviors of the barium sulfate-loaded IR and GR tablets were evaluated in beagle dogs by radiographic studies. Local gastroprotective effect was compared in an experimentally induced gastric lesion in beagle dogs after oral administration of IR (three times per day) or GR (twice daily) tablets for 15 days. RESULTS: Upon contact with gastric juice, a low-density floating tablet (apparent density of 0.93 g/cm(3)) was buoyant on the medium and was upheld for 14 hours, providing sustained drug release profile, whereas the IR tablet disintegrated within 10 minutes, showing complete drug release within 2 hours. In vivo radiographic studies showed that the GR tablet was retained for >4 hours in the stomach. Both DA-9601 formulations remarkably alleviated gastric mucosal injury compared to placebo group, when observed by gastric endoscopy. CONCLUSION: Twice-daily GR tablets exhibited a prolonged gastric residence time and a remarkable mucosal restoration effect in animal models. Therefore, the GR system of DA-9601 could be a substitute dosage form for the treatment of gastritis, while reducing the dosing frequency and thus improving patient compliance.

The mediating effect of caregiver burden on the caregivers' quality of life.

[Purpose] Quality of life (QoL) can be closely related to caregiver burden, which may be a potential mediating effect on the relationships among stroke patient caregivers. This study investigated the predictors of caregiver's QoL based on patient and caregiver characteristics, with caregiver burden as a mediator. [Methods] This study was conducted using surveys, a literature review, and interviews. Survey data were collected from 238 subjects, who were diagnosed with stroke, and their family caregivers from October 2013 to April 2014. [Results] Caregiver health status, income, spouses caring for patients, and duration of hospitalization were identified as significant predictors of caregivers' QoL with a mediating effect of caregiver burden. The time spent on caregiving per day and patient education level were the only direct predictors of caregivers' QoL. [Conclusion] The responsibility of caring for patients with stroke, in particular for a spouse, must be administered by means of a holistic family-centered rehabilitation program. In addition, financial support and availability of various health and social service programs must be comprehensively provided in order to maintain caregivers' well-being.

Ameliorating the effect of astragaloside IV on learning and memory deficit after chronic cerebral hypoperfusion in rats.

Astragaloside IV (AS-IV) has been reported to have a prominent antioxidant effect and was proposed as a promising agent for the prevention of neurodegenerative disorders accompanied by cognitive impairment. The present study investigated the ameliorating effect of AS-IV on learning and memory deficits induced by chronic cerebral hypoperfusion in rats. Rats were treated with two doses of AS-IV (10 and 20 mg/kg, i.p.) daily for 28 days starting from the 5th week after permanent bilateral common carotid artery occlusion. AS-IV treatment (at dose of 20 mg/kg) significantly improved the spatial learning and memory deficits assessed using the Morris water maze test in rats with chronic cerebral hypoperfusion. AS-IV significantly attenuated neuronal apoptosis as well as the levels of superoxide dismutase and lipid peroxidation markers, including malondialdehyde and 4-hydroxy-2-nonenal, in the hippocampus. AS-IV also significantly reduced 8-hydroxy-2'-deoxyguanosine expression, a maker of oxidative DNA damage, while significantly inhibited the astrocyte and microglia activation in the hippocampus. The results indicate that AS-IV has therapeutic potential for the prevention of dementia caused by cerebral hypoperfusion and suggest that the ameliorating effect of AS-IV on learning and memory deficits might be the result of suppressing neuronal apoptosis and oxidative damage in the hippocampus.

Endoscopic thyroid surgery via a breast approach: a single institution's experiences.

BACKGROUND: Thyroid carcinoma in young women is rapidly increasing, and cosmesis plays an important role in thyroid operations. Various endoscopic thyroid surgery approaches have been performed, and their application has recently been extended. We performed endoscopic thyroid surgeries via a breast approach since 1999. Herein, we evaluate the safety of this approach and identify the outcomes for differentiated thyroid carcinoma. METHODS: A total of 452 consecutive patients with thyroid and parathyroid disease underwent endoscopic thyroidectomy via a breast approach at Uijeongbu St. Mary's Hospital between November 1999 and December 2012. The inclusion criteria for endoscopic thyroidectomy included a benign tumour less than 4 cm in diameter, malignant thyroid nodules less than 2 cm, and no evidence of lymph node metastasis or local invasion. We analysed the clinicopathologic data and surgical factors of this approach. RESULTS: The mean age of the patients was 38.4 ± 10.6 years (range 11-73 years). The mean tumour size was 2.12 ± 1.17 cm (range 0.1-4 cm). The final tumour pathologies included papillary carcinoma (n = 120), follicular carcinoma (n = 8), nodular hyperplasia (n = 266), follicular adenoma (n = 43), and Hüthle cell adenoma (n = 4). The mean postoperative hospital stay was 3.8 ± 1.3 days (range 1-17 days). Temporary and permanent hypoparathyroidism requiring calcium and vitamin D supplementation developed in 32 (7.1%) and 4 (0.9%) patients, respectively. Transient vocal cord paresis occurred in 20 (4.4%) patients. CONCLUSIONS: For patients with benign and low-risk malignant thyroid disease, endoscopic thyroidectomy via a breast approach is a safe, feasible, and minimally invasive surgical method with minimal complications.

Observed chemical characteristics of long-range transported particles at a marine background site in Korea.

Deokjeok Island is located off the west coast of the Korean Peninsula and is a suitable place to monitor the long-range transport of air pollutants from the Asian continent. In addition to pollutants, Asian dust particles are also transported to the island during long-range transport events. Episodic transport of dust and secondary particles was observed during intensive measurements in the spring (March 31-April 11) and fall (October 13-26) of 2009. In this study, the chemical characteristics of long-range-transported particles were investigated based on highly time-resolved ionic measurements with a particle-into-liquid system coupled with an online ion chromatograph (PILS-IC) that simultaneously measures concentrations of cations (Li+, Na , NH4+, K+, Ca2+, Mg2+) and anions (F-, C1-, NO3-, SO42-). The aerosol optical thickness (AOT) distribution retrieved by the modified Bremen Aerosol Retrieval (M-BAER) algorithm from moderate resolution imaging spectroradiometer (MODIS) satellite data confirmed the presence of a thick aerosol plume coming from the Asian continent towards the Korean peninsula. Seven distinctive events involving the long-range transport (LRT) of aerosols were identified and studied, the chemical components of which were strongly related to sector sources. Enrichment of acidic secondary aerosols on mineral dust particles, and even of sea-salt components, during transport was observed in this study. Backward trajectory, chemical analyses, and satellite aerosol retrievals identified two distinct events: a distinctively high [Ca2++Mg2]/[Na+] ratio (>2.0), which was indicative of a preprocessed mineral dust transport event, and a low [Ca2++Mg2+]/[Na+] ratio (<2.0), which was indicative of severe aging of sea-salt components on the processed dust particles. Particulate C1- was depleted by up to 85% in spring and 50% in the fall. A consistent fraction of carbonate replacement (FCR) averaged 0.53 in spring and 0.55 in the fall. Supporting evidences of C1- enrichment on the marine boundary layer prior to a dust front were also found. Supplemental materials are available for this article. Go to the publisher's online edition of the Journal of the Air & Waste Management Association for sector and air mass classifications of clean and LRT cases.

Analysis of tofisopam in human serum by column-switching semi-micro high-performance liquid chromatography and evaluation of tofisopam bioequivalency.

A rapid and sensitive column-switching semi-micro HPLC method is described for the direct analysis of tofisopam in human serum. The sample (100 microL) was directly injected onto the precolumn (Capcell Pak MF Ph-1), where unretained proteins were eluted to waste. Tofisopam was then eluted into an enrichment column using 13% acetonitrile in 50 mM phosphate buffer (pH 7.0) containing 5 mM sodium octanesulfonate and subsequently into the analytical column using 43% acetonitrile in 0.1% phosphoric acid containing 5 mM sodium octanesulfonate. The detection limit (2 ng/mL), good precision (CV < or = 4.2%) and speed (total analysis time 24 min) of the present method were sufficient for drug monitoring. This method was successfully applied to a bioequivalence test of two commercial tofisopam tablets.