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Background: Transoral robotic thyroidectomy has gained popularity as a promising approach for thyroid surgery owing to its improved cosmetic outcomes. The objective of this retrospective study was to describe the surgical and safety outcomes of 1,000 consecutive transoral robotic thyroidectomy cases., Methods: 1,000 consecutive patients who underwent transoral robotic thyroidectomy for thyroid disease were reviewed at a large metropolitan tertiary hospital (Seoul, Korea) between September 2012 and March 2022., Results: The study comprised 1,000 patients (815 women), with 891 cancer cases. Lobectomy was the most common procedure (89.4%), followed by total thyroidectomy (9.8%) and isthmusectomy (0.8%), and their respective mean total operative times were 173.8 ± 36.2, 236.8 ± 50.5, and 107.5 ± 19.8 minutes. An obvious learning curve was noted. The respective postoperative pain scores on postoperative days 0, 1, and 2 were 4.6 ± 1.3, 3.1 ± 0.8, and 2.5 ± 0.8. The mean postoperative hospital stay duration was 2.6 ± 0.9 days. Complications occurred in 3.6% of cases, including oral wound infection, skin flap burn, bleeding, chyle leakage, transient and permanent mental nerve injury, and transient and permanent recurrent laryngeal nerve injury. Transient hypoparathyroidism occurred in 4.1% of total thyroidectomy cases. Thirty-seven patients (4.2%) underwent additional radioactive iodine therapy. The median follow-up period was 39 months, and there were no cases of recurrence., Conclusions: Under the expertise of an experienced surgeon, transoral robotic thyroidectomy results in favorable cosmetic outcomes, tolerable postoperative pain, and acceptable complication rates in carefully selected patients., Competing Interests: Conflict of Interest/Disclosure None reported., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Acute bronchiolitis is a common cause of hospitalization during infancy that carries significant morbidity and mortality rates., Purpose: This study compared the efficacy of different treatment modalities for infants with bronchiolitis in terms of hospital stay and clinical severity scores., Methods: The PubMed database was searched for relevant studies. Eligibility criteria included double-blind randomized controlled trial design, assessment of the effect of treatment on bronchiolitis in infants under 2 years of age, and publication in English from inception through July 31, 2020. The primary efficacy outcome was the length of hospital stay, while the secondary outcome was the clinical severity score. The standardized treatment effect and standard error of the effect size were calculated., Results: We identified 45 randomized controlled trials of 24 pairwise comparisons. These 45 trials included 5,061 participants and investigated 13 types of interventions (12 active, 1 placebo). Inhalation therapy with epinephrine (standard mean difference [SMD], -0.41; 95% confidence interval [CI], -0.8 to -0.03) and hypertonic saline (SMD, -0.29; 95% CI, -0.55 to -0.03) reduced the length of hospital stay compared with normal saline. Hypertonic saline was the most effective at improving the clinical severity score (SMD, -0.52; 95% CI, -0.95 to -0.10)., Conclusion: Inhalation therapy with epinephrine and hypertonic saline reduced the length of hospital stay and the clinical severity of bronchiolitis among infants under 2 years of age.

Purpose: To investigate the association between metabolic syndrome and perirenal fat stranding (PRFS), which is defined as linear or curvilinear soft tissue densities in the perirenal fat on computed tomography (CT)., Material and Methods: Adults who had abdominal CT for health screening at a single institution between October 2022 and March 2023 were included retrospectively. Two radiologists assessed the extent of PRFS for each CT and graded it as absent, mild/moderate, and severe. Logistic regression analyses were used to investigate the associations between PRFS and metabolic syndrome-related factors, as well as age and gender., Results: Among 701 participants (mean age, 56.8 years ± 9.7; 336 women and 365 men), 87 (12.4%) had mild (n = 80) or moderate (n = 7) PRFS. None had severe PRFS. The presence of PRFS was independently associated with higher body mass index (odds ratio [OR], 2.561 and 9.842 for overweight and obese, respectively; p ≤ 0.001), elevated blood pressure with or without anti-hypertensive medication (OR, 2.232; p = 0.015), anti-diabetic medication (OR, 3.129; p < 0.001), and lipid-lowering medication (OR, 1.919; p = 0.019), older age (OR, 4.545 and 9.109 for 50-59 years and ≥ 60 years, respectively; p ≤ 0.002), and male gender (OR, 10.065; p < 0.001). Sixty three of 87 (72.4%) participants with PRFS had metabolic syndrome, while 265 of 614 (43.2%) participants without PRFS did (p < 0.001)., Conclusion: Incidental mild or moderate PRFS may be associated with the presence of metabolic syndrome or related disorders in otherwise healthy adults., Competing Interests: Declarations Conflict of interests The authors have no relevant financial or non-financial interests to disclose. Ethical approval Institutional Review Board approval was obtained and the requirement for written informed consent was waived., (© 2024. Italian Society of Medical Radiology.)

Background: We present the initial outcomes of transoral robotic parathyroidectomy (TORP) using the transoral vestibular approach in patients with primary hyperparathyroidism (PHPT)., Method: A retrospective case series analysis was performed on patients diagnosed with PHPT between October 2016 and July 2019 who underwent transoral robotic surgery for parathyroidectomy., Results: Thirteen patients (five males and eight females) successfully underwent TORP at our institution from October 2016 to July 2019. Eight patients underwent TORP alone, and five underwent TORP combined with transoral robotic thyroidectomy for papillary thyroid carcinoma. No intra- or postoperative complications were observed. Serum levels of parathyroid hormone, total calcium, and ionized calcium decreased to normal postoperatively and continued to decrease during the follow-up period., Conclusion: This study suggests that TORP holds promise for the treatment of patients with PHPT with the advantages of the robotic procedure, including dynamic visualization and meticulous dissection., Competing Interests: Declaration of competing interest Dawon Park: The first author has no conflict of interest to disclose and did not receive any funding for this study. Hyewon Cho: The first author has no conflict of interest to disclose and did not receive any funding for this study. Eunbee Lee: The co-author has no conflict of interest to disclosure and did not receive any funding for this study. Moon Young Oh: The co-author has no conflict of interest to disclosure and did not receive any funding for this study. Young Jun Chai: The co-author has no conflict of interest to disclosure and did not receive any funding for this study. Kwangsoon Kim: The corresponding author has no conflict of interest to disclosure and did not receive any funding for this study. Hoon Yub Kim: The corresponding author is a consultant for Medtronic., (Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.)

Background: We investigated the correlation between urine VOC metabolites and airway function in children exposed to anthropogenic volatile organic compounds (VOCs), notable pollutants impacting respiratory health., Methods: Out of 157 respondents, 141 completed skin prick tests, spirometry, IOS, and provided urine samples following the International Study of Asthma and Allergies in Childhood (ISAAC)-related questions. Allergic sensitization was assessed through skin prick tests, and airway functions were evaluated using spirometry and impulse oscillometry (IOS). Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) was recorded and FEV1/FVC ratio was calculated. Airway mechanics parameters including respiratory resistance at 5 Hz (Rrs5) mean respiratory resistance between 5 Hz and 20 Hz (Rrs5-20), were also recorded. Urine concentrations of metabolites of benzene, ethylbenzene, toluene, xylene, styrene, formaldehyde, carbon-disulfide were analyzed by gas chromatography/tandem mass spectroscopy., Results: The median age at study participation was 7.1 (SD 0.3) years. Muconic acid (benzene metabolites) and o-methyl-hippuric acid (xylene metabolites) above medians were associated with a significant increase in Rrs5 (muconic acid: aβ = 0.150, p  = .002; o-methyl-hippuric acid: aβ = 0.143, p  = .023) and a decrease in FEV1/FVC (o-methyl-hippuric acid: aβ = 0.054, p  = .028) compared to those below median. No associations were observed for Rrs5-20 and FEV1 between the groups categorized as above and below the median (all parameter p values > .05)., Conclusions: Elevated levels of benzene and xylene metabolites were associated with a significant increase in Rrs5 and a decrease in FEV1/FVC, related to increased resistance and restrictive lung conditions compared to individuals with concentrations below the median.

The purpose of this study was to investigate the hierarchical organization of digit force production and its effect on stability and performance during the simulated archery task. The simulated archery shooting task required the production of a prescribed level of force in virtual space with the left hand and an equivalent force with all 4 fingers of right hand. A single trial had 2 phases, including static force production as aiming in archery and quick force release to shoot the virtual arrow. The timing of the force release was determined by the participant's choice or response to the external cue. The coordination indices, that is, the synergy index, of force stabilization were quantified in 2 hierarchies by decomposing the variance components. The accuracy and precision of the hit position of the virtual arrow were calculated as performance-related indices. The results confirmed that the precision, that is, reproducibility, of the performance was greater when the force release time was determined by the self-selected time, suggesting the beneficial effect of the anticipatory mechanism. There was a distinct synergistic organization of digit forces for the stabilization of net forces in both bimanual and multifinger levels, which was especially correlated with the precision of performance.

Robotic adrenalectomy (RA) has gained significant popularity in the management of adrenal gland diseases. We report our experience at a single tertiary institution and evaluate the safety and surgical outcomes of RA. The data of 122 consecutive patients who underwent RA from October 2009 to December 2022 at Korea University Anam Hospital (Seoul, Korea) were reviewed. There were no perioperative complications. Clinicopathological features and surgical outcomes were retrospectively analyzed through complete chart reviews. Noteworthy findings include the influence of sex, tumor size, and body mass index on operation time, with the female and small tumor groups exhibiting shorter operation times (P = 0.018 and P = 0.009, respectively). Pheochromocytoma was identified as a significant independent risk factor for a longer operation time in the multivariate analysis [odds ratio (OR), 3.709; 95% confidence interval (CI), 1.127-12.205; P = 0.031]. A temporal analysis revealed a decreasing trend in mean operation times across consecutive groups, reflecting a learning curve associated with RA adoption. RA is a safe and effective operative technique alternative to laparoscopic adrenalectomy that has favorable surgical outcomes and enhances the convenience of the operation., (© 2024. The Author(s).)

Background: Transoral robotic thyroidectomy (TORT) has proven to be a safe and effective procedure with favourable surgical and cosmetic outcomes, but its application in completion thyroidectomy procedures remains to be established. In this study, the authors present our experience with completion TORT, assessing its surgical feasibility and efficacy. between February 2017 and August 2023., Methods: The authors conducted a retrospective analysis of consecutive patients who underwent completion TORT after an initial TORT procedure between February 2017 and August 2023., Results: A total of 10 patients (three males and seven females) were included in the study, with a mean age of 42.2±13.5 years. The indications for completion thyroidectomy included five cases of aggressive initial lesions and five cases of metachronous papillary thyroid carcinoma detected in the remnant lobe. The median interval between the initial and completion TORT procedures was 6.5 months. Flap dissection time showed no significant difference between the initial TORT and completion TORT operations (43.3±7.5 vs. 36.2±11.2, P =0.125). However, the mean console time (127.9±42.6 vs. 86.4±26.3 min, P =0.019) and mean total operation time (206.7±65.9 vs. 146.0±34.9 min, P =0.021) were significantly longer during the initial TORT procedure than during the completion TORT procedure. Two patients experienced transient hypoparathyroidism, which resolved within four weeks postoperatively. No other complications, such as vocal cord palsy, mental nerve injury, or bleeding, were observed. The median follow-up period was 21.5 months, and no recurrences were detected in any of the patients., Conclusions: Our study demonstrates that re-do TORT is feasible, showing excellent cosmetic results and minimal adverse effects. Completion TORT may be considered a viable option for selected patients who require completion thyroidectomy after an initial TORT procedure., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

In this study, we tested several hypotheses related to changes in motor unit activation patterns after warm-up exercise. Fifteen healthy young men participated in the experiment and the main task was to produce voluntary torque through the elbow joint under the isometric condition. The experimental conditions consisted of two directions of torque, including flexion and extension, at two joint angles, 10° and 90°. Participants were asked to increase the joint torque to the maximal level at a rate of 10% of the maximum voluntary torque. The warm-up protocol followed the ACSM guidelines, which increased body temperature by approximately 1.5°C. Decomposition electromyography electrodes, capable of extracting multiple motor unit action potentials from surface signals, were placed on the biceps and triceps brachii muscles, and joint torque was measured on the dynamometer. The mean firing rate and the recruitment threshold of the decomposed motor units were quantified. In addition, a single motor unit activity from the spike train was quantified for each of five selected motor units. The magnitude of joint torque increased with the warm-up exercise for all the experimental conditions. The results of the motor unit analyses showed a positive and beneficial effect of the warm-up exercise, with an increase in both the mean firing rate and the recruitment threshold by about 56% and 33%, respectively, particularly in the agonist muscle. Power spectral density in the gamma band, which is thought to be the dominant voluntary activity, was also increased by the warm-up exercise only in the high threshold motor units., Competing Interests: The authors declare no conflict of interest., (Copyright: © Academy of Physical Education in Katowice.)

Background: The urinary levels of volatile organic compound (VOC) metabolites provide individual exposure levels compared to data obtained by measuring these compounds in ambient air. We aimed to investigate the association between personal urinary concentrations of VOC metabolites and symptoms of atopic dermatitis in schoolchildren., Methods: Nine urinary VOC metabolites were analyzed from urine samples of 149 children. Diagnosis of atopic dermatitis was determined using standardized questionnaires. Pediatricians visited the schools and rated the severity of symptoms using the SCORing Atopic Dermatitis (SCORAD) in all children., Results: Forty-five children (30.2%) had atopic dermatitis based on the International Study of Asthma and Allergies in Childhood (ISAAC) results and 35 children (23.8%) had symptoms of atopic dermatitis with positive SCORAD index values (defined as SCORAD ≥ 5). Children with benzylmercapturic acid detected in personal urines were associated with presence of atopic dermatitis and positive SCORAD index values. Children in the highest quartile of mandelic acid concentration were associated with presence of atopic dermatitis and positive SCORAD results., Conclusion: Personal exposure to VOCs, as indicated by urinary levels of VOC metabolites, was associated with presence of atopic dermatitis and the SCORAD index value., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2022 The Korean Academy of Medical Sciences.)

Mechanochromic smart membranes capable of optical modulation have great potential in smart windows, artificial skins, and camouflage. However, the realization of high-contrast optical modulation based on light scattering activated at a low strain remains challenging. Here, we present a strategy for designing mechanochromic scattering membranes by introducing a Young's modulus mismatch between the two interdigitated polydimethylsiloxane phases with weak interfaces in a periodic three-dimensional (3D) structure. The refractive index-matched interfaces of the nanocomposite provide a high optical transparency of 93%. Experimental and computational studies reveal that the 3D heterogeneity facilitates the generation of numerous nanoscale debonds or "nanogaps" at the modulus-mismatching interfaces, enabling incident light scattering under tension. The heterogeneous scatterer delivers both a high transmittance contrast of >50% achieved at 15% strain and a maximum contrast of 82%. When used as a smart window, the membrane demonstrates effective diffusion of transmitting sunlight, leading to moderate indoor illumination by eliminating extremely bright or dark spots. At the other extreme, such a 3D heterogeneous design with strongly bonded interfaces can enhance the coloration sensitivity of mechanophore-dyed nanocomposites. This work presents insights into the design principles of advanced mechanochromic smart membranes.

Background: Precise dissection with hemostasis while preserving important structures is critical in thyroid surgeries. In this study, we tested the safety of the Hemostatix Shaw scalpel (HSS) around the recurrent laryngeal nerve (RLN) in porcine models., Methods: Four piglets were used to obtain continuous intraoperative neuromonitoring data. The HSS was applied at various distances from the RLN, with various temperature settings. Monopolar electrosurgical pencil and Harmonic scalpel were also tested for comparison., Results: The use of HSS did not show adverse electromyographic (EMG) events when activated at 3- and 5-mm distances from the RLN. At a 1-mm distance, adverse event was observed at 300 °C after 2 seconds of activation. At 210 °C, adverse event was observed when the instrument was directly adjacent to the RLN. For comparison, an electrosurgical pencil, set at coagulation mode (25W), showed an irreversible adverse EMG event during 5 seconds of activation at 1-mm distance from the RLN. Harmonic ACE+, activation power at level 5, was also applied in one RLN and reversable adverse EMG event was observed at <0.1-mm (contact) distance after 3 seconds of activation., Conclusions: The safety distance of the HSS was 3 mm for the 300 °C setting and >1 mm for the 210 °C setting in the swine models in this study. Surgeons must understand the specific characteristics of various energy devices and apply them appropriately for safe operation., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-336). RPT serves as an unpaid editorial board member of Gland Surgery from September 2020 to August 2022. RPT reports that he is a consultant for Medtronic and Hemostatix. HYK reports that he is a consultant for Medtronic. The other authors have no conflicts of interest to declare., (2020 Gland Surgery. All rights reserved.)

Background: Transoral robotic thyroidectomy (TORT) for differentiated thyroid carcinoma is increasing in popularity. However, studies are limited to small tumors. This study aimed to compare the outcomes of TORT for papillary thyroid carcinomas smaller than 1 cm and 1 cm or larger., Methods: The study analyzed 269 patients with papillary thyroid carcinoma who underwent TORT at Korea University Hospital, Korea between January 2001 and December 2017. Surgical outcomes and postoperative complications were compared., Results: Group 1 (tumor < 1 cm) had 215 patients, and group 2 (tumor ≥ 1 cm) had 54 patients. The majority of the patients underwent lobectomy (95.8% in group 1 and 87.0% in group 2; p = 0.339) and unilateral central neck dissection (96.3% in group 1 and 88.9% in group 2; p = 0.024). The two groups did not differ significantly in terms of gender, age, body mass index, thyroiditis status, Da Vinci model. or operative procedure. The majority of the tumors in group 1 (73%) had T1a staging, whereas the majority of the tumors in group 2 were stage T1b or T3a (44.4% in each group; p = 0.000). Most of the patients in group 1 had N0 staging (59.1%), whereas most of the patients in group 2 had N1a staging (55.6%; p = 0.026). The mean operative time was significantly longer in group 2 (198.0 ± 34.2 min in group 1 vs. 215.7 ± 49.3 min in group 2; p = 0.015). The two groups did not differ significantly regarding length of stay, postoperative pain score, or thyroglobulin level. No patients experienced locoregional or distant recurrence. No statistically significant difference in overall complications was observed (p = 0.214)., Conclusions: Transoral robotic thyroidectomy is a safe and effective procedure and may be a feasible option for patients with papillary thyroid carcinomas larger than 1 cm.

Background: We evaluated the outcomes of patients with papillary thyroid carcinoma (PTC) who underwent transoral robotic thyroidectomy (TORT)., Methods: We retrospectively analyzed the perioperative outcomes of 200 patients (170 women and 30 men) with PTC who underwent TORT at a single center between March 2016 and February 2018., Results: There were 182 and 13 cases of lobectomy and total thyroidectomy, respectively, with corresponding mean operative times of 200.6 ± 31.2 and 265.7 ± 63.0 minutes. On average, 5.6 ± 3.45 lymph nodes were retrieved per patient. There were 12 cases of perioperative morbidity. No conversion to endoscopic or conventional open surgery was noted. In a subgroup analysis for predictors of difficult TORT, patient sex was the only factor showing a significant operative time difference between a difficult and a nondifficult thyroidectomy., Conclusion: TORT can be performed safely in patients with PTC without serious complications., (© 2020 Wiley Periodicals, Inc.)

Background: Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation. Transoral robotic thyroidectomy (TORT) can be done either using just two robot arms for instruments and an extra one for the endoscopic camera, or using three robot arms for instruments (third arm through axila) and an additional arm for the camera., Pros of Additional Axillary Arm for Tort: The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue. The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation. Ultimately, these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups., Cons of Additional Axillary Arm for Tort: One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar. Another issue to consider is the cost. In some places, robotic surgery operation fee varies with the number of arms used during the operation. Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction., Conclusion: TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors., Competing Interests: Hoon Yub Kim: The corresponding author is a consultant for Medtronic., (© 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.)

Objectives/hypothesis: Obesity is an increasing health concern worldwide. It has been associated with perioperative complications that could affect patient outcomes. Our aim was to compare surgical outcomes in obese and nonobese patients after transoral robotic thyroid (TORT) surgery., Study Design: Retrospective cohort study., Methods: A total of 304 consecutive patients who underwent TORT between January 2012 to December 2017 were included in the study. Patients were divided into two groups according to their body mass index (BMI): BMI < 30 kg/m 2 and BMI ≥30 kg/m 2 . Patient demographics, operative extent, pathological data, surgical outcomes, and postoperative complications were included and analyzed. A χ 2 test was used to compare categorical variables, and a Student t test was used to compare changes of continuous variables between groups. Statistical significance was conferred by a two-tailed P value of ≤.05., Results: There were 290 patients in the non-obese group and 14 patients in the obese group. There was no statistically significant difference between the two groups in terms of patient demographics, operative procedure, or pathological characteristics. The only statistically significant difference was for lymph node dissection (P = .012); however, for both groups, unilateral central node dissection was the most common procedure. There was also no statistically significant difference found for operative time, length of stay, pain score, or postoperative complications including TORT-specific complications such as oral commissure tear and general complications such as recurrent nerve injury., Conclusions: This initial experience shows that TORT appears to be a safe and feasible option for obese patients pursuing scarless thyroid surgery., Level of Evidence: NA Laryngoscope, 130:1343-1348, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Transoral vestibular approach endoscopic thyroidectomy has gained popularity worldwide because it avoids a cutaneous incision. Some surgeons have expressed reservations about operating with only 2 instruments in the endoscopic technique, and some therefore utilize an axillary incision as an adjunct to facilitate dissection. The Intuitive da Vinci single port robotic system offers the potential to overcome this limitation without an axillary incision., Methods: In this study, the Intuitive da Vinci single port robotic surgical system was used to perform transoral thyroidectomy on 2 human cadavers., Results: A total thyroidectomy was performed in 2 cadavers using the da Vinci single port (SP) robot via transoral vestibular technique. The dissections were performed with removal of the thyroid gland and preservation of the recurrent laryngeal nerves and parathyroid glands., Conclusion: In our evaluation, transoral vestibular approach robotic thyroidectomy using the Intuitive da Vinci SP system facilitated dissection without the need for an axillary incision., (© 2019 Wiley Periodicals, Inc.)

The advancement of minimally invasive surgery in the field of endocrine surgery over the last 2 decades has fostered the attempt of natural orifice transluminal endoscopic surgery (NOTES) for thyroidectomy and parathyroidectomy via oral incisions. This technically demanding surgery is currently being evaluated in a number of specialised centres. The procedure has gained popularity worldwide and is performed in more than 50 centres. By retrieving information from published or presented articles and direct personal communications, this study reports several issues to enable and optimise correct patient and surgeon candidacy, present the advantages and prevent novel complications under the standards of open thyroid surgery. Not all patients are eligible for the transoral approach. Transoral endoscopic and robotic procedures were described and critically analysed in this study., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Backgrounds/aims: Perioperative surgical site infection (SSI) remains a morbid complication even in successful surgical procedures. We encountered an unusual experience of a methicillin-resistant Staphylococcus aureus (MRSA)-related SSI outbreak in our hospital; therefore, we conducted an epidemiologic analysis to determine the origin of SSIs due to MRSA., Methods: Among 102 consecutive patients who underwent hepatobiliopancreatic operations, SSIs occurred in eight cases. Infection surveillance regarding the operative environment was carried out. We analyzed the possible risk factors for this infectious outbreak in our institution., Results: Patients with SSI tended to be older ( p =0.293), had variable operation fields ( p =0.020), more cancer-related operation ( p =0.003), less laparoscopic surgery ( p =0.007), performed in operation room 1 ( p =0.004), prolonged operation time ( p <0.001) and had longer hospital stays ( p =0.002). After propensity score (PS) matching, there was the only significant difference in the participation of surgeon D as a second assistant ( p =0.001) between the SSI and non-SSI group. After PS matching, surgeon D as a second assistant was the only significant risk factor for MRSA SSI in the univariate ( p =0.001) and multivariate analysis ( p =0.004, hazard ratio=25.088, 95% confidence interval=2.759-228.149)., Conclusions: Outbreak of SSIs occurred due to transmission of MRSA from a surgeon to patients despite the standard regulation of infection control. These SSIs were associated with an excessive incidence of surgeon's nasal and hand carriage of the MRSA strain identified in the surgeon via cultures. We recommend the preoperative regular nasal and hand screening for MRSA among surgeons.

Thymic stromal lymphopoietin (TSLP) plays an important role in the differentiation and proliferation of Th2 cells, resulting in eosinophilic inflammation and numerous allergic diseases. Baicalein (1), a major component of Scutellaria baicalensis, was found to be the first small molecule to block TSLP signaling pathways. It inhibited effectively eosinophil infiltration in house dust mite-induced and ovalbumin-challenged mouse models. Structure-activity relationship studies identified compound 11a, a biphenyl flavanone analog, as a novel human TSLP inhibitor for the discovery and development of new anti-allergic drugs.

Background: Transoral approach for thyroidectomy draws attention recently among the thyroid surgeons, with the merits of cosmetic outcomes and minimal flap dissection. The aim of this study is to demonstrate the details and the steps of transoral robotic thyroidectomy., Methods: We made three incisions in the gingival-buccal sulcus for three 8-mm intraoral ports: one inverted U-shaped 1-cm midline incision approximately 2 cm above the frenulum, and two 0.5-cm lateral incisions near the commissure of lips. An additional 8-mm axilla port was inserted for countertraction and later drain insertion., Results: Right thyroid lobectomy, ipsilateral central neck dissection, and left thyroid lobectomy were performed with preserving recurrent laryngeal nerves and parathyroid glands. There was no development of transient or permanent hypoparathyroidism, vocal cord palsy, postoperative bleeding, or surgical site infection., Conclusion: Transoral robotic total thyroidectomy and ipsilateral central neck dissection using the da Vinci Xi Surgical System are feasible and safe., (© 2019 Wiley Periodicals, Inc.)

Transoral robotic thyroidectomy (TORT) is well consistent with the primary goal of remote-access thyroid surgery, which is to avoid a visible cervical scar. Additionally, the extent of transoral thyroidectomy dissection is less than that of other remote-access surgical procedures. Owing to these merits of the transoral approach, several institutions around the world are now performing this procedure. Since transoral thyroidectomy is performed in a confined, narrow space, and is characterized by a close distance from the ports to the working space, more benefits can be derived from multiarticulation of robotic instruments. Especially when performing left lobectomy by TORT, the surgeon can use right-handed robotic instruments over the thyroid cartilage with the merits of multiarticulation. In this study, we present our unique procedure of left lobectomy by TORT in detail., Competing Interests: CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

Transoral approach for thyroidectomy recently gains a lot of attention among the thyroid surgeons, with the merits of cosmetic outcomes and minimal flap dissection. We've successfully introduced the robotic surgical system to the transoral approach for thyroidectomy. For transoral robotic thyroidectomy, we made 3 incisions in the gingival-buccal sulcus for three intraoral ports. An additional axilla port was inserted for counter-traction and later drain insertion. Herein, our unique procedures of transoral robotic thyroidectomy (TORT) are described in the treatment of a patient with papillary thyroid carcinoma., (Copyright © 2019 The Journal of Minimally Invasive Surgery.)

Purpose: An oxaliplatin-based regimen is the most common adjuvant chemotherapy for patients with stage II/III colorectal cancer, but many patients experience dose reduction or early termination of chemotherapy due to side effects. We conducted this study to verify the range of reduction with oncologic safety., Methods: Patients with stage II/III colorectal cancer who received adjuvant FOLFOX chemotherapy were enrolled in this study. The total amount of oxaliplatin administered per patient was calculated as a percentile based on 12 cycles of full-dose FOLFOX as a standard dose. The cutoff values showing significant differences in survival were calculated, and the clinicopathologic outcomes of patient groups classified by the value were compared., Results: Among a total of 611 patients, there were 107 stage II patients, and 504 stage III patients. At 60% of the standard dose of oxaliplatin, the patients in the dose reduction group were older (62 years vs . 58 years, P = 0.003), had lower body mass index (BMI) (23.1 kg/m 2 vs . 24.0 kg/m 2 , P = 0.005), and were more exposed to neoadjuvant treatment (18.0% vs . 9.1%, P = 0.003) in comparison to the standard group. At 60% of the standard dose, there were no significant differences in 5-year disease-free survival (DFS) and overall survival (OS) between the 2 groups (5-year DFS: 73.5% vs . 74.2%, P = 0.519; 5-year OS: 71.9% vs . 81.5%, P = 0.256, respectively)., Conclusion: Patients with old age, low BMI, and more frequent exposure to neoadjuvant treatment tended to show lower compliance with chemotherapy. More than 60% dose should be administered to patients with stage II/III colorectal cancer as adjuvant chemotherapy to achieve acceptable oncologic outcomes., Competing Interests: CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

In mammals, the increased secretion of arginine-vasopressin (AVP) (antidiuretic hormone) and oxytocin (natriuretic hormone) is a key physiological response to hyperosmotic stress. In this study, we examined whether chronic hyperosmotic stress weakens GABA(A) receptor-mediated synaptic inhibition in rat hypothalamic magnocellular neurosecretory cells (MNCs) secreting these hormones. Gramicidin-perforated recordings of MNCs in acute hypothalamic slices prepared from control rats and ones subjected to the chronic hyperosmotic stress revealed that this challenge not only attenuated the GABAergic inhibition but actually converted it into excitation. The hyperosmotic stress caused a profound depolarizing shift in the reversal potential of GABAergic response (E(GABA)) in MNCs. This E(GABA) shift was associated with increased expression of Na(+)-K(+)-2Cl(-) cotransporter 1 (NKCC1) in MNCs and was blocked by the NKCC inhibitor bumetanide as well as by decreasing NKCC activity through a reduction of extracellular sodium. Blocking central oxytocin receptors during the hyperosmotic stress prevented the switch to GABAergic excitation. Finally, intravenous injection of the GABA(A) receptor antagonist bicuculline lowered the plasma levels of AVP and oxytocin in rats under the chronic hyperosmotic stress. We conclude that the GABAergic responses of MNCs switch between inhibition and excitation in response to physiological needs through the regulation of transmembrane Cl(-) gradients.

Objective: To determine the prevalence of systemic damage in Korean patients with systemic lupus erythematosus (SLE) and to elucidate associations between possible risk factors and the presence of damage., Methods: The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to quantify systemic damage in 588 patients who were enrolled consecutively at the Hospital for Rheumatic Diseases, Seoul, South Korea. The frequencies and means of each variable were compared using the chi-square test or Student t test between the presence and absence of damage. Multivariate models were used to investigate the relationship between possible risk factors (age, disease duration, and use of intravenous cyclophosphamide) and the presence of damage., Results: Among the 588 patients, 244 (41.5%) exhibited damage at a mean of 54 months after onset of disease. The musculoskeletal (14.3% of patients) and renal (13.3%) systems were involved most frequently, followed by neuropsychiatric (10.7%), ocular (4.6%), and pulmonary (4.1%) system involvement. The presence of damage was associated with higher age, longer disease duration, and a high frequency of intravenous cyclophosphamide use., Conclusion: Systemic damage in at least one of the items of the SDI was present in 41.5% of our Korean patients with SLE, this damage being significantly more prevalent in patients who were older, had longer disease duration, and received more intravenous pulses of cyclophosphamide.