Comparison of endoscopic versus focused parathyroidectomy in surgical management of single-gland primary hyperparathyroidism: a randomized clinical trial.

BACKGROUND: Over recent years, various advanced minimally invasive techniques have been developed for parathyroidectomy, and there was a universal acceptance of these less invasive procedures by surgeons. This study is designed to compare overall outcomes between endoscopic versus focused, single gland parathyroidectomy using intraoperative rapid parathyroid hormone (ioPTH) changes under general anesthesia in primary hyperparathyroidism (PHPT) patients. METHOD: In this randomized clinical trial, 96 patients diagnosed with PHPT were randomly assigned into two groups endoscopic and focused parathyroidectomy. Baseline clinical and demographical data were collected along with perioperative features. The success rate was evaluated based on ioPTH changes. RESULTS: The ioPTH levels after five minutes in the endoscopic group were significantly lower than the focused group (P = 0.005). The success rate for endoscopic and the focused method was 95.3% and 77.1% during the first five minutes (P = 0.013) and 100% in both groups after ten minutes. A decrease in parathyroid hormone levels was significant in each group but not between each other. Postoperative calcium levels were significantly lower in the focused method (P = 0.042). The focused group also had a significantly shorter operation time than the endoscopic group (P < 0.001). Patient satisfaction with cosmetic outcome was significantly higher in the endoscopic group compared to the focused group. CONCLUSION: The endoscopic technique was superior to the unilateral focused neck exploration parathyroidectomy in the management of single-gland PHPT. Influencing aspects included higher postoperative calcium levels, more rapid success achievement, and satisfactory cosmetic outcomes in the endoscopic group. However, patient selection and accurate adenoma localization are vital in this method.

System dynamics modeling of lake water management under climate change.

Lake Urmia, the twentieth largest lake in the world, is the most valuable aquatic ecosystem in Iran. The lake water level has decreased in recent years due to human activities and climate change. Several studies have highlighted the significant roles of climatic and anthropogenic factors on the shrinkage of the lake. Management policies for water resources harvesting must be adopted to adapt to climate change and avoid the consequent problems stemming from the drought affecting Lake Urmia, and rationing must be applied to the upstream water demands. This study analyzes strategies and evaluates their effectiveness in overcoming the Urmia Lake crisis. Specifically, system dynamics analysis was performed for simulating the water volume of Lake Urmia, and the Hadley Centre coupled model was applied to project surface temperature and precipitation for two future periods: 2021-2050 and 2051-2080. Six management scenarios were considered for decreasing the allocation of agricultural water demand corresponding to two options: (1) one-reservoir option (Bukan reservoir only), and (2) six-reservoir option. The net inflow of Urmia Lake was simulated for the two future periods with the IHACRES model and with artificial neural network models under the six management scenarios. The annual average volumes of Lake Urmia would be 30 × 109 and 12 × 109 m3 over the first and second future periods, respectively, without considering the management scenarios. The lake volumes would rise by about 50% and 75% for the first and second periods, respectively under the management scenarios that involve strict protective measures and elimination of the effect of all dams and their reservoirs. Implementing strict measures would increase the annual average lake volume to 21 × 109 m3 in the second period; yet, this volume would be less than the long-term average and strategic volume. The human water use would be completely eliminated under Scenario 6. Nevertheless, Lake Urmia would experience a considerable loss of storage because of drought.

Dietary diversities score and anthropometric characteristics in Iranian elementary school children.

Dietary diversity scoring is a good method to assess quality of individual's diet. The study aimed to investigate the association between dietary diversity and body mass index among elementary school students in the south of Tehran, Iran. This cross-sectional study was conducted on elementary school students, age range of 7-12 years old, in 2015. Data were collected using a personal information questionnaire and three 24-h recall questionnaires. Dietary diversity score was calculated from the number of food groups in these questionnaires. A total of 536 students, 258 (48.1%) female and 278 (51.9%) male, were recruited in the study. The mean age of the students was 9.43 ± 1.73 years. Seafood consumption was more frequent and beans was lower frequent in students at higher BMI (≥95th percentile) than the other children (34% vs 25% and 71% vs 83%, respectively, p<0.05). However, the statistical analysis failed to find significant relationships between children's body mass index (BMI) with consumption of diary, vegetable, fruits, protein, fat, and junk food intake. The association between children's BMI with seafood and beans consumption confirmed in multivariate analysis (OR= 1.50 and 0.52, respectively, p<0.05). The study finding showed that seafood and beans consumption may influence on elementary student BMI.