Quality of Life After Robotic Thyroidectomy by a Gasless Unilateral Axillary Approach

Background

Robotic thyroidectomies have been safely performed with early surgical outcomes comparable to conventional cervical thyroidectomies. However, health-related quality of life (HRQOL) after robotic thyroidectomy has not yet been evaluated. The aim of this study was to compare HRQOL of patients who underwent robotic thyroidectomy with that of those who received conventional thyroidectomy.

Methods

We conducted a cross-sectional study in 111 patients who underwent either robotic thyroidectomy (44 patients) via a gasless unilateral axillary approach, or conventional cervical thyroidectomy (67 patients), for papillary thyroid carcinoma (PTC). HRQOL of patients was assessed using two questionnaires, the University of Washington Quality of Life (UW-QOL) questionnaire for patients with head and neck cancer, and the Quality of Life-Thyroid Version (QOL-TV), which was specifically designed for thyroid cancer patients. The survey using the questionnaires was performed 1 year after surgery at a routine outpatient clinic follow-up.

Results

There was no difference in UW-QOL scores between the two groups for any factor other than neck appearance and physical composite score, which were higher in the robotic group. Humor (mood) and anxiety, emotional measures of UW-QOL, were selected by patients in both groups as being their most significant issue during the preceding 7 days. There was no between-group difference in the four QOL-TV domains (physical, psychological, social, and spiritual well-being).

Conclusions

Patients who underwent robotic thyroidectomy reported a higher score for satisfaction with neck appearance compared to patients receiving conventional cervical thyroidectomy. However, the overall HRQOL of patients in the robotic and conventional groups was similar.     

Clinical Outcomes in Patients with Non-Diagnostic Thyroid Fine Needle Aspiration Cytology: Usefulness of the Thyroid Core Needle Biopsy

Background

Patients with non-diagnostic thyroid fine needle aspiration cytology (FNAC) results undergo repeat FNAC or core needle biopsy (CNB) for definite diagnosis or surgical resection, or are followed up by clinical and ultrasound surveillance. We aimed at evaluating the risk of malignancy in patients with non-diagnostic FNACs and their clinical outcomes according to the follow-up modality.

Methods

We retrospectively reviewed 1,496 (8.8 %) cases with a non-diagnostic result on a first aspiration among 17,045 thyroid FNACs performed between October 2008 and August 2012. Of the non-diagnostic FNACs, 389 patients underwent a second FNAC; 125, CNB; and 89, thyroidectomy by clinical indication. The remaining patients were clinically followed up.

Results

The rate of a second non-diagnostic result was significantly higher on repeat FNAC than on CNB (33.2 vs. 2.4 %; p < 0.001). There was no significant difference in the malignancy risk among patients initially non-diagnostic, twice non-diagnostic, and thrice or more non-diagnostic, nor did this differ from the rate following CNB. No further malignancy was found in cases with ≥2 non-diagnostic CNBs. The malignancy risk was 51 % in those who underwent thyroidectomy. The sensitivity for detecting malignancy was 65 and 70 % for repeat FNACs and first CNBs, respectively, with no false positives seen in either test.

Conclusions

Approximately one-third of repeat FNACs after an initial non-diagnostic aspirate are non-diagnostic on repeat examination, and the malignancy risk may not reduce following repetitively non-diagnostic FNACs. However, a single CNB may be enough to exclude malignancy risk for patients with a non-diagnostic aspirate.     

The Use of Absorbable Interceed® Pouch with Double‐Layer Skin Closure for Partial Defect of Breast

Generally, a partial breast defect can be covered with surrounding breast tissue. However, when the tumor is located in the upper central and inner quadrant, simple closure with breast tissue is insufficient because rotation of breast tissue is difficult in this location. We introduce a surgical technique using an absorbable Interceed^® pouch with double‐layer skin closure for a remnant defect. A total of 43 patients with breast cancer underwent conventional breast‐conserving surgery, following which an Interceed^® pouch with double‐layer skin closure was applied for a remnant defect of the breast. Patients assessed their own cosmetic outcomes based on a four‐point scoring system. The mean age of the patients and their mean body mass index were 51.2 years and 23.1 kg/m², respectively. Cosmetic outcomes were self‐reported to be excellent in 13 cases (30.2%), good in 26 cases (60.5%), fair in three cases (7.0%), and poor in one case (2.3%). Postoperative complications occurred in two cases (4.6%). In conclusion, a use of an absorbable Interceed^® pouch with double‐layer skin closure is a simple, feasible, ancillary surgical technique to correct an upper central and inner quadrant breast defect without significant complications.     

Blood lead and cadmium levels and renal function in Korean adults

Background

The objective of this study was to evaluate the associations of blood lead and cadmium levels with estimated glomerular filtration rate (eGFR) and proteinuria in Korean adults.

Methods

This was a cross-sectional study based on the Korea Nation Health and Nutrition Examination Survey (KNHANES) to analyze the association of blood lead and cadmium levels with renal dysfunction and urine protein excretion. We defined renal dysfunction as eGFR < 60 ml/min/1.73 m², as measured by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and proteinuria as positive urine dip-stick result.

Results

Blood lead and cadmium levels were significantly increased in the renal dysfunction group compared with the normal renal function group. Lead levels were significantly higher in the proteinuria group than in the group with no proteinuria. There were no differences in cadmium levels according to the amount of proteinuria. Multivariate logistic regression analysis adjusted for age and sex demonstrated higher lead and cadmium levels in the renal dysfunction group than in the group with normal renal function [odds ratio (OR) 1.344, 95 % confidence interval (CI) 1.157–1.162, P < 0.05; OR 1.467, 95 % CI 1.077–1.999, P < 0.05, respectively]. For proteinuria, the fully adjusted ORs comparing the highest versus the lowest lead and cadmium quartiles were 1.22 (95 % CI 1.00–1.50) and 0.51 (95 % CI 0.24–1.08), respectively, showing no significance. For reduced eGFR, the fully adjusted ORs comparing the highest versus the lowest lead and cadmium quartiles were 1.23 (95 % CI 0.98–1.53) and 1.93 (95 % CI 1.39–2.67), respectively, showing the significant association between lead and cadmium levels and renal function. The risk of having reduced eGFR for individuals in the highest quartiles of both lead and cadmium levels in blood was greater than for those in the highest quartile of blood level of lead or cadmium only.

Conclusion

The CKD-EPI equation showed that blood lead and cadmium levels were associated with renal dysfunction in the Korean adult population. This finding has significant implications for environmental institutional strategies regarding heavy metal exposure.     

Anti-arthritis effects of (E)-2,4-bis(p-hydroxyphenyl)- 2-butenal are mediated by inhibition of the STAT3 pathway

Background and Purpose

Products of Maillard reactions between aminoacids and reducing sugars are known to have anti-inflammatory properties. Here we have assessed the anti-arthritis effects of (E)-2,4-bis(p-hydroxyphenyl)-2-butenal and its possible mechanisms of action.

Experimental Approach

We used cultures of LPS-activated macrophages (RAW264.7 cells) and human synoviocytes from patients with rheumatoid arthritis for in vitro assays and the collagen-induced arthritis model in mice. NO generation, iNOS and COX2 expression, and NF-κB/IKK and STAT3 activities were measured in vitro and in joint tissues of arthritic mice, along with clinical scores and histopathological assessments. Binding of (E)-2,4-bis(p-hydroxyphenyl)-2-butenal to STAT3 was evaluated by a pull-down assay and its binding site was predicted using molecular docking studies with Autodock VINA.

Key Results

(E)-2,4-bis(p-hydroxyphenyl)-2-butenal (2.5–10 μg·mL⁻¹) inhibited LPS-inducedNO generation, iNOS and COX2 expression, and NF-κB/IKK and STAT3 activities in macrophage and human synoviocytes. This compound also suppressedcollagen-induced arthritic responses in mice by inhibiting expression of iNOS and COX2, and NF-κB/IKK and STAT3 activities; it also reduced bone destruction and fibrosis in joint tissues. A pull-down assay showed that (E)-2,4-bis(p-hydroxyphenyl)-2-butenal interfered with binding of ATP to STAT3. Docking studies suggested that (E)-2,4-bis(p-hydroxyphenyl)-2-butenal bound to the DNA-binding interface of STAT3 possibly inhibiting ATP binding to STAT3 in an allosteric manner.

Conclusions and Implications

(E)-2,4-bis(p-hydroxyphenyl)-2-butenal exerted anti-inflammatory and anti-arthritic effects through inhibition of the NF-κB/STAT3 pathway by direct binding to STAT3. This compound could be a useful agent for the treatment of arthritic disease.     

Efficacy of gastro-retentive forms of ecabet sodium in the treatment of gastric ulcer in rats

The purpose of the present study is to investigate the influence of gastric retention of ecabet sodium (ECS) on its mucoprotective effect in rat ulcer models. Mini-tablets containing 9 mg ECS were prepared using the direct compression method. The release rates of ECS mini-tablets were controlled by the amount and viscosity grade of hydroxypropylmethyl cellulose incorporated. Gastric retention of ECS mini-tablets after oral administration to rats was visually confirmed using a fluorescence imaging system. Because ECS mini-tablets exhibited size-dependent gastric retention, their gastric retention time was prolonged as the release rate decreased. In the in vivo efficacy study, gastro-retentive dosage forms of ECS did not influence the mucoprotective effect in the immediate irritation model but enhanced the effect in the delayed irritation model compared with ECS suspension. This finding indicates that the duration of the mucoprotective effect of ECS can be extended by the employment of gastro-retentive dosage formulations and provides a rationale for development of ECS gastro-retentive dosage forms.