Fluorescence imaging to visualize the recurrent laryngeal nerve during thyroidectomy procedures: analysis of 65 cases and 81 nerves.

BACKGROUND: Recurrent laryngeal nerve (RLN) injury after thyroidectomy is relatively common. Locating the RLN prior to thyroid dissection is paramount to avoid injury. We developed a fluorescence imaging system that permits nerve autofluorescence. We aimed to determine the sensitivity and specificity of fluorescence imaging at detecting the RLN relative to thyroid and other background tissue and compared it to white light. METHODS: In this prospective study, 65 patients underwent thyroidectomy from January to April 2022 (16 bilateral thyroid resections) using white and fluorescent light. Fluorescence intensity [relative fluorescence units (RFU)] was recorded for RLN, thyroid, and background. RFU mean, minimum, and maximum values were calculated using Image J software. Thirty randomly selected pairs of white and fluorescent light images were independently reviewed by two examiners to compare RLN detection rate, number of branches, and length and minimum width of nerves visualized. Parametric and nonparametric statistical analysis was performed. RESULTS: All 81 RNLs observed were visualized more clearly under fluorescence (mean intensity, µ = 134.3 RFU) than either thyroid (µ = 33.7, p < 0.001) or background (µ = 14.4, p < 0.001). Forest plots revealed no overlap between RLN intensity and that of either other tissue. Sensitivity and specificity for RLN were 100%. All 30 RLNs and all 45 nerve branches were clearly visualized under fluorescence, versus 17 and 22, respectively, with white light (both p < 0.001). Visible nerve length was 2.5 × as great with fluorescence as with white light (µ = 1.90 vs. 0.76 cm, p < 0.001). CONCLUSIONS: In 65 patients and 81 nerves, RLN detection was markedly and consistently enhanced with autofluorescence neuro-imaging during thyroidectomy, with 100% sensitivity and specificity.

Targeted delivery of nuclear targeting probe for bladder cancer using cyclic pentapeptide c(RGDfK) and acridine orange.

PURPOSE: Both cyclic pentapeptide c(RGDfK) and acridine orange (AO) exhibit antitumor effects and cell permeability. This study aimed to evaluate the nuclear targeting efficiency and safety of the nuclear targeting probe for bladder cancer (BCa) synthesized by c(RGDfK) and AO. METHODS: The nuclear targeting probe AO-(cRGDfK)2 was synthesized from AO hydrochloride, azided c(RGDfK), and a near-infrared skeleton synthesized via click chemistry reactions. The effect of the AO-(cRGDfK)2 probe on cell viability was assessed in BCa 5637 cells. The tumor cell targeting efficacy of the AO-(cRGDfK)2 probe was evaluated in BCa cells in vitro and in tumor-bearing mice in vivo. Nuclear-specific accumulation of fluorescence probe in BCa tumor cells was evaluated using laser scanning confocal microscopy (LSCM). Hematoxylin and eosin staining was performed to detect histopathological changes in the spleen, heart, liver, and kidney. RESULTS: The AO-(cRGDfK)2 probe did not cause a significant reduction in cell viability. LSCM analysis showed that AO-(cRGDfK)2 exhibited nuclear-specific ambulation in BCa cells and was not accumulated in 293T cells. Also, this probe efficiently targeted tumor cells in the serum and urine samples. In vivo imaging system of tumor-bearing mice showed that ~ 80% percent of fluorescence signal was accumulated in the tumor sites. The probe did not change histopathology in the heart, liver, spleen, and kidney in tumor-bearing mice after the 21-day treatment. CONCLUSIONS: The AO-(cRGDfK)2 probe exhibited nuclear-specific accumulation in BCa cells without cytotoxicity, which provides an innovative alternative to improve anticancer therapy for BCa.

Combined spinal and general anesthesia attenuate tumor promoting effects of surgery. An experimental animal study.

Background: Radical prostatectomy, a standard management approach for localized Prostate Cancer (PC), may cause a stress response associated with immune modulating effects. Regional anesthesia was hypothesized to reduce the immune effects of surgery by minimizing the neuroendocrine surgical stress response, thus mitigating tumor cells dissemination. Our primary objective was to investigate whether the use of spinal blocks attenuates PC tumor cells dissemination on an animal model. We also assessed the number of circulating NK cells and the amount of inflammatory and anti-inflammatory cytokines. Materials and methods: A subcutaneous tumor model, with PC-3M cell line transfected with a luciferase-producing gene (PC-3M-luc-C6) was used. After proper tumor establishment and before tumors became metastatic, animals were submitted to tumor excision surgeries under general or combined (general and spinal) anesthesia. A control group was only anesthetized with general anesthesia. Results: The subcutaneous tumor model with PC-3M-luc-C6 cells was effective in causing distant metastasis after 35 days. The number of circulating tumor cells increased in animals that underwent surgery under general anesthesia alone compared to the group submitted to combined anesthesia. Interleukin 6 levels were different in all groups, with increase in the general anesthesia group. Conclusion: Our results suggest that combination of spinal and general anesthesia may attenuate the suppression of innate tumor immunity and it might be related to a reduction in the neuroendocrine response to surgery. Institutional protocol number: Animal Ethics Committee 1332/2019.

Accuracy of a handheld 3D imaging system for child anthropometric measurements in population-based household surveys and surveillance platforms: an effectiveness validation study in Guatemala, Kenya, and China.

BACKGROUND: An efficacy evaluation of the AutoAnthro system to measure child (0-59 months) anthropometry in the United States found 3D imaging performed as well as gold-standard manual measurements for biological plausibility and precision. OBJECTIVES: We conducted an effectiveness evaluation of the accuracy of the AutoAnthro system to measure 0- to 59-month-old children's anthropometry in population-based surveys and surveillance systems in households in Guatemala and Kenya and in hospitals in China. METHODS: The evaluation was done using health or nutrition surveillance system platforms among 600 children aged 0-59 months (Guatemala and Kenya) and 300 children aged 0-23 months (China). Field team anthropometrists and their assistants collected manual and scan anthropometric measurements, including length or height, midupper arm circumference (MUAC), and head circumference (HC; China only), from each child. An anthropometry expert and assistant later collected both manual and scan anthropometric measurements on the same child. The expert manual measurements were considered the standard compared to field team scans. RESULTS: Overall, in Guatemala, Kenya, and China, for interrater accuracy, the average biases for length or height were -0.3 cm, -1.9 cm, and -6.2 cm, respectively; for MUAC were 0.9 cm, 1.2 cm, and -0.8 cm, respectively; and for HC was 2.4 cm in China. The inter-technical errors of measurement (inter-TEMs) for length or height were 2.8 cm, 3.4 cm, 5.5 cm, respectively; for MUAC were 1.1 cm, 1.5 cm, and 1.0 cm, respectively; and for HC was 2.8 cm in China. For intrarater precision, the absolute mean difference and intra-TEM (interrater, intramethod TEM) were 0.1 cm for all countries for all manual measurements. For scans, overall, absolute mean differences for length or height were 0.4-0.6 cm; for MUAC were 0.1-0.1 cm; and for HC was 0.4 cm. For the intra-TEM, length or height was 0.5 cm in Guatemala and China and 0.7 cm in Kenya, and other measurements were ≤0.3 cm. CONCLUSIONS: Understanding the factors that cause the many poor scan results and how to correct them will be needed prior to using this instrument in routine, population-based survey and surveillance systems.

Three-dimensional vs two-dimensional laparoscopic gastric bypass for manual gastrojejunal anastomosis: A prospective and randomized trial.

OBJECTIVE: The objective of this study was to compare the total procedure time and task-specific execution time in gastric bypass using a three-dimensional (3D) versus two-dimensional (2D) imaging system. MATERIALS AND METHODS: This study was a prospective and randomized clinical trial. Forty obese patients were randomized into two groups: gastric bypass with 3D imaging system or with conventional 2D system. The primary endpoint was operative time during manual gastrojejunal anastomosis. Data collection was carried out on demographics, comorbidities, operative time in three stages, and complications. The same surgeon performed all surgeries. Two patients were excluded because technical issues were encountered for viewing their videos during the trial. RESULTS: A total of 20 patients in the Laparoscopic Gastric Bypass (LGB) 3D group and 18 in the LGB 2D group were analyzed. There were no significant differences in the pre-operative data. The average procedure time was 16.5 min lower in the 3D group versus the 2D group. Execution time for specific tasks was not statistically significant, except for the gastrojejunal anastomosis, which is routinely performed as a manual anastomosis in our surgery group. There was no complication intra- or post-operative. CONCLUSIONS: The use of a 3D imaging system for laparoscopic gastric bypass was associated with a shorter total operative time, especially for the hand-sewn gastrojejunal anastomosis, compared with the 2D imaging system. OBJETIVO: Comparar el tiempo total del procedimiento y de tareas específicas en bypass gástrico laparoscópico (BGL) utilizando sistemas de imagen 3D y 2D.

MÉTODO: Estudio prospectivo, aleatorizado, con 40 pacientes obesos divididos en dos grupos: BGL 2D o 3D. El objetivo principal fue medir el tiempo al realizar la gastroyeyunoanastomosis manual. La recolección de datos incluyó comorbilidad, demografía, tiempo operatorio en tres fases (formación de reservorio, gastroyeyunoanastomosis y yeyunoyeyunoanastomosis) y complicaciones posoperatorias. El mismo cirujano realizó los procedimientos. Se excluyeron dos pacientes por incapacidad para abrir el video. RESULTADOS: Se analizaron 20 pacientes en el grupo 3D y 18 en el grupo 2D. No hubo diferencias significativas en los datos preoperatorios. El tiempo promedio del procedimiento fue menor en el grupo 3D que en el 2D en 16,5 minutos. El tiempo de ejecución para realizar tareas solo fue significativo al realizar la gastroyeyunoanastomosis. No hubo ninguna complicación intraoperatoria ni posoperatoria. CONCLUSIONES: El uso de un sistema de imagen 3D se asoció con un menor tiempo quirúrgico total, en especial para la gastroyeyunoanastomosis manual, en comparación con el sistema de imagen 2D.