Risk Factors for Transient Hypoparathyroidism after Total Thyroidectomy: Insights from a Cohort Analysis.

Background: Transient hypoparathyroidism (TH) is the main post-thyroidectomy complication, significantly impacting surgical outcomes, hospitalization length, and perceived perceived quality of life understood as mental and physical well-being. This study aims to identify possible associated risk factors. Methods: We analyzed 238 thyroidectomies (2020-2022), excluding instances of partial surgery, primary hyperparathyroidism, neck irradiation history, and renal failure. The variables considered were as follows: demographics, histology, autoimmunity, thyroid function, pre- and postoperative Vitamin D levels (where available), type of surgery, number of incidentally removed parathyroid glands (IRP), and surgeons' experience (>1000 thyroidectomies, <500, in training). Univariate analysis applied: χ2, Fisher's exact test for categorical variables, and Student's t-test for continuous variables. Subsequently, logistic multivariate analysis with stepwise selection was performed. Results: Univariate analysis did not yield statistically significant results for the considered variables. The 'No Complications' group displayed a mean age of 55 years, whereas the TH group showed a mean age of 51 (p-value = 0.055). We considered this result to be marginally significant. Subsequently, we constructed a multivariate logistic model. This model (AIC = 245.02) indicated that the absence of incidental parathyroidectomy was associated with the age class >55 years, presenting an odds ratio (OR) of 9.015 (p-value < 0.05). Simultaneously, the age class >55 years exhibited protective effects against TH, demonstrating an OR of 0.085 (p-value < 0.01). Similarly, the absence of incidental parathyroidectomy was found to be protective against TH, with an OR of 0.208 (p-value < 0.01). Conclusions: Multivariate analysis highlighted that having "No IRP" was protective against TH, while younger age was a risk factor. Surgeon experience does not seem to correlate with IRP or outcomes, assuming there is adequate tutoring and a case volume close to 500 to ensure good results. The effect of reimplantation has not been evident in transient hypoparathyroidism.

The Role of "Critical" Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules.

Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5-15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to 2022, 298 BIII nodules were enrolled for thyroidectomy (79 malignancies). We evaluated ultrasonographic data: hechogenicity, intralesional vascularization, spiculated margins, micro-calcifications, "taller than wide" shape, extra-thyroidal growth, size increase, as well as their association with histology. We also evaluated if the ultrasound reassessment modified the strategy. Results: Spiculated margins and microcalcification were significantly correlated with malignancy risk. Spiculated margins showed a specificity of 0.95 IC95% (0.93-0.98); sensitivity 0.70 IC95% (0.59-0.80). Microcalcifications showed a sensitivity of 0.87 CI95% (0.80-0.94); specificity 0.75 CI95% (0.72-0.83). The presence of these signs readdressed the strategy in 76/79 cases Then, the indication for surgery was appropriate in 75% of cases. Conclusions: Microcalcifications and spiculated margins should be routinely sought during a final ultrasound reassessment in BIII nodules. These signs allowed for a modification of the strategy in favor of surgery in 96% of the cases that were not otherwise referred to surgery. The importance of integrating ultrasound and cytology in the evaluation of BIII thyroid nodules is confirmed. Reassessment with ultrasound of BIII nodules allowed for a redirection of the surgical choice.

Influence of Operational Strategies for the Recovery of Magnesium Hydroxide from Brines at a Pilot Scale.

The continuous depletion of minerals caused by land mining and the increase in their demand have pushed the development of novel sustainable technological processes for mineral recovery from unconventional sources. In this context, magnesium (Mg) has gained considerable attention for its peculiar properties and high relevance of its compounds, such as magnesium hydroxide, Mg(OH)2. In the present work, the influence of several operating conditions on the Mg(OH)2 precipitation process was thoroughly investigated by adopting a novel multiple feed-plug flow reactor. The influence of (i) initial Mg2+ concentrations in the feed stream; (ii) brine and alkaline flow rates; and (iii) the product recycling strategy (seeded crystallization) was considered. The results marked the possibility of improving sedimentation and filterability properties of Mg(OH)2 suspensions by adopting the recycling strategy to overcome industrial issues associated with the production of Mg(OH)2 suspensions using NaOH solutions.

A Novel Ionic Exchange Membrane Crystallizer to Recover Magnesium Hydroxide from Seawater and Industrial Brines.

A novel technology, the ion exchange membrane crystallizer (CrIEM), that combines reactive and membrane crystallization, was investigated in order to recover high purity magnesium hydroxide from multi-component artificial and natural solutions. In particular, in a CrIEM reactor, the presence of an anion exchange membrane (AEM), which separates two-compartment containing a saline solution and an alkaline solution, allows the passage of hydroxyl ions from the alkaline to the saline solution compartment, where crystallization of magnesium hydroxide occurs, yet avoiding a direct mixing between the solutions feeding the reactor. This enables the use of low-cost reactants (e.g., Ca(OH)2) without the risk of co-precipitation of by-products and contamination of the final crystals. An experimental campaign was carried out treating two types of feed solution, namely: (1) a waste industrial brine from the Boleslaw Smialy coal mine in Laziska Górne (Poland) and (2) Mediterranean seawater, collected from the North Sicilian coast (Italy). The CrIEM was tested in a feed and bleed modality in order to operate in a continuous mode. The Mg2+ concentration in the feed solutions ranges from 0.7 to 3.2 g/L. Magnesium recovery efficiencies from 89 up to 100% were reached, while magnesium hydroxide purity between 94% and 98.8% was obtained.