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Background Recently, adhesive skin electrodes have been reported to be useful for recording electromyographic signals from intrinsic laryngeal muscles for intraoperative neuromonitoring in thyroid surgery and have shown good results compared to existing recording methods. In this study, we investigated the optimal attachment location of adhesive skin electrodes for intraoperative neuromonitoring in both porcine models and human cases. Methods Attachment locations were divided vertically into upper, middle, and lower locations and horizontally into medial and lateral locations to determine the optimal location of placing adhesive skin electrodes preclinically in four porcine models. This study included a total of 78 patients who underwent thyroidectomy under intraoperative neuromonitoring with adhesive skin electrodes. Sixteen patients were monitored using both adhesive skin electrodes and an electromyographic endotracheal tube. Two pairs of skin electrodes were attached to the level of the thyroid cartilage lamina. Evoked electromyographic data, including data on mean amplitude and latency, obtained by stimulating the recurrent laryngeal nerve and vagus nerve, were collected. Results Lateral attachment of adhesive skin electrodes showed significantly higher evoked amplitudes than medial attachment in both animal models and human patients. In cases where skin electrodes and an electromyographic endotracheal tube were used together, the electromyographic endotracheal tube showed a significantly higher amplitude than skin electrodes, and laterally attached skin electrodes showed a significantly higher amplitude than medially attached skin electrodes. Conclusion Intraoperative neuromonitoring using adhesive skin electrodes was feasible in both animal models and human patients. We suggest that it would be better to attach adhesive skin electrodes to the lateral side of the thyroid cartilage lamina. Lateral attachment closer to the cricoarytenoid joint may be better for measuring muscle movement around the cricoarytenoid joint.

Branchial cleft cysts are the most common lateral neck mass, and usually have well-delineated cystic structures under ultrasonography. Ultrasonography and fine needle aspiration cytology is very helpful during preoperative diagnosis. However, these cysts may occur in unusual locations and have a sonographic morphology similar to malignant thyroid neoplasm. A 61-year-old woman presented with thyroid nodules, and ultrasonography revealed a 0.8-cm, hypoechoic, solid nodule with microcalcifications in the right lobe of thyroid in the lower portion. Postoperative histopathological examination revealed the 0.8-cm hypoechoic nodule to be a branchial cleft cyst. In addition, concurrent medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) were found. Herein, we present a rare case of branchial cleft cyst mimicking malignant thyroid neoplasm concurrent with medullary and PTC.

Objectives. Facial nerve monitoring (FNM) can be used to identify the facial nerve, to obtain information regarding its course, and to evaluate its status during parotidectomy. However, there has been disagreement regarding the efficacy of FNM in reducing the incidence of facial nerve palsy during parotid surgery. Therefore, instead of using electromyography (EMG) to identify the location and state of the facial nerve, we applied an intraoperative neuromonitoring (IONM) system using a surface pressure sensor to detect facial muscle twitching. The objective of this study was to investigate the feasibility of using the IONM system with a surface pressure sensor to detect facial muscle twitching during parotidectomy.Methods. We evaluated the stimulus thresholds for the detection of muscle twitching in the orbicularis oris and orbicularis oculi, as well as the amplitude and latency of EMG and the surface pressure sensor in 13 facial nerves of seven rabbits, using the same stimulus intensity.Results. The surface pressure sensor detected muscle twitching in the orbicularis oris and orbicularis oculi in response to a stimulation of 0.1 mA in all 13 facial nerves. The stimulus threshold did not differ between the surface pressure sensor and EMG.Conclusion. The application of IONM using a surface pressure sensor during parotidectomy is noninvasive, reliable, and feasible. Therefore, the IONM system with a surface pressure sensor to measure facial muscle twitching may be an alternative to EMG for verifying the status of the facial nerve.

Objective This study aimed to demonstrate the usefulness of an attachable magnetic nerve stimulator for preservation of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. Methods We retrospectively analyzed 120 female patients, of which 60 underwent thyroidectomy with an attachable magnetic nerve stimulator (magnetic group) and the remaining 60 underwent thyroidectomy with a conventional method without EBSLN identification (control group). For both groups, objective and subjective voice parameters were investigated on the day before surgery and at 2 weeks and 2 months after surgery. Results In the magnetic group, a magnetic nerve stimulator was used to ligate only the site without cricothyroid muscle (CTM) twitching, and thyroid surgery was successfully performed without damage to the EBSLN. In the control group, objective voice parameters, including fundamental frequency, voice range profile (VRP), highest VRP (VRP-H), and maximal phonation time, and the subjective thyroidectomy-related voice questionnaire score were significantly decreased at 2 months after surgery compared to preoperative values. Compared to the control group, the magnetic group did not show a significant decrease in the objective VRP and VRP-H at 2 months after surgery. Conclusion The use of metallic surgical instruments with an attachable magnetic nerve stimulator may provide surgeons with real-time feedback on CTM twitching feedback and EBSLN status. Compared to direct EBSLN identification during thyroidectomy, this is a simple, easy, and noninvasive method for EBSLN preservation that is useful, especially for less-experienced surgeons.

Salivary gland dysfunction is a common symptom that occurs after menopause. This study was performed to investigate the mechanism of salivary gland dysfunction to confirm the relationship between ferroptosis and salivary gland dysfunction by ovariectomy. Forty-eight female rats were randomly divided into four groups (12 rats in each group). Histology, real time PCR, western blot, immunohistochemistry, electron microscopy, cytosolic iron assay, and salivary function were analyzed. Human salivary gland tissue analysis was also done. Lipogenesis and lipid deposition in the submandibular gland tissue occurred after ovariectomy. ROS generation, MDA+HAE was increased and GPX4 activity was decreased and in the OVX group compared to the CON group. Iron deposition in the submandibular gland tissue was increased in the OVX group. Submandibular gland fibrosis was increased and saliva secretion was decreased in the OVX group. In human submandibular gland analysis, lipid and iron deposition was also increased in the postmenopause group. This is the first in vivo study in which salivary gland dysfunction is associated with the ferroptosis in postmenopausal animal model. Increased lipid and iron deposition in normal submandibular gland tissues of postmenopausal women can suggest that the salivary gland dysfunction after menopause may be associated with the ferroptosis.

There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p

Inflammasomes are cytosolic, multiprotein complexes that act at the frontline of the immune responses by recognizing pathogen- or danger-associated molecular patterns or abnormal host molecules. Mesenchymal stem cells (MSCs) have been reported to possess multipotency to differentiate into various cell types and immunoregulatory effects. In this study, we investigated the expression and functional regulation of NLR Family Pyrin Domain Containing 3 (NLRP3) inflammasome in human umbilical cord blood-derived MSCs (hUCB-MSCs). hUCB-MSCs expressed inflammasome components that are necessary for its complex assembly. Interestingly, NLRP3 inflammasome activation suppressed the differentiation of hUCB-MSCs into osteoblasts, which was restored when the expression of adaptor proteins for inflammasome assembly was inhibited. Moreover, the suppressive effects of MSCs on T cell responses and the macrophage activation were augmented in response to NLRP3 activation. In vivo studies using colitic mice revealed that the protective abilities of hUCB-MSCs increased after NLRP3 stimulation. In conclusion, our findings suggest that the NLRP3 inflammasome components are expressed in hUCB-MSCs and its activation can regulate the differentiation capability and the immunomodulatory effects of hUCB-MSCs. [BMB Reports 2020; 53(6): 329-334].

Background and objectivesFTY720 ((2-amino-2-)2-[4-octylphenyl]ethyl)-1,3-propanediol) is an Food and Drug Administration (FDA)-approved immunomodulatory drug for treating multiple sclerosis. It inhibits lymphocyte egression from lymphoid tissues by downregulating sphingosine-1 phosphate receptor (S1PR). To date, there has been no study on the effects of FTY720 on the chronic stage of the complex regional pain syndrome (CRPS) rodent model, despite its antiallodynic effect in previous studies. Thus, the aim of this study is to investigate the effect of FTY720 in a chronic stage of the CRPS mouse model.MethodThe authors used a mouse model of CRPS, involving tibia fracture/cast immobilization, to test the efficacy of intrathecal FTY720 (2.5 or 25 ng daily; 6 days) or vehicle during the chronic (7 weeks after fracture) stage of CRPS.ResultsIntrathecal recombinant FTY720 administration was antiallodynic in the chronic stage of the CRPS mouse model, and such an effect of FTY720 developed by modulating astrocyte activation in the spinal cord. Additionally, according to the in vitro data, the FTY720 treatment inhibited S1P-induced increase in the nitric oxide production and suppression of the NF-κB pathway, by inhibiting the phosphorylation of NF-κB/p65 in astrocytes without toxic effect on astrocytes.ConclusionCollectively, these results demonstrate that intrathecally administered FTY720 attenuates mechanical allodynia in the chronic stage of the CRPS mouse model.

Hyperthyroidism is often observed in postmenopausal women due to conditions such as thyroiditis and toxic nodular goiter, Grave’s disease or thyroid stimulating hormone suppressive therapy for treating differentiated thyroid carcinoma (DTC). However, the effect of such hormonal changes on skeletal muscles in females remain unclear. Therefore, this study aimed to observe the effects of hyperthyroidism on the skeletal muscle of ovariectomized rats. We randomly divided female Sprague-Dawley rats into sham-operated (Sham), ovariectomized (OVX), and levothyroxine-treated ovariectomized groups (OVX+LT4). Levothyroxine was administered intraperitoneally at 0.3 mg/kg, daily for six weeks. Protein synthesis was increased after ovariectomy whereas protein synthesis was suppressed and protein degradation was increased in response to levothyroxine treatment. However, there was no difference in lean mass between the two groups. Collagen I levels were similar between the Sham and OVX groups, but were significantly decreased in the OVX+LT4 group. The mRNA levels of matrix metalloproteinase (MMP) ‐2 and ‐9 were similar between the Sham and OVX groups but were upregulated in the OVX+LT4 group. After ovariectomy, mitochondrial biogenesis and dynamics were changed; these changes were exacerbated in hyperthyroidism. Our findings indicate that in postmenopausal rats with hyperthyroidism, the progression of muscle weakness occurs through impaired regulation of signaling pathways related to extracellular matrix homeostasis, protein turnover, and mitochondrial quality.

The alterations of the extracellular matrix (ECM) in lamina propria of the vocal folds are important changes that are associated with decreased vibrations and increased stiffness in aging vocal fold. The aim of this study was to investigate the differences in gene expression of lamina propria using next generation sequencing (NGS) in young and aging rats and to identify genes that affect aging-related ECM changes for developing novel therapeutic target molecule. Among the 40 genes suggested in the NGS analysis, voltage-gated calcium channels (VGCC) subunit alpha1 S (CACNA1S), VGCC auxiliary subunit beta 1 (CACNB1), and VGCC auxiliary subunit gamma 1 (CACNG1) were increased in the lamina propria of the old rats compared to the young rats. The synthesis of collagen I and III in hVFFs decreased after si-CACNA1S and verapamil treatment. The expression and activity of matrix metalloproteinases (MMP)-1 and -8 were increased in hVFFs after the treatment of verapamil. However, there was no change in the expression of MMP-2 and -9. These results suggest that some calcium channels may be related with the alteration of aging-related ECM in vocal folds. Calcium channel has promising potential as a novel therapeutic target for the remodeling ECM of aging lamina propria.

Objectives The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. Methods We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. Results The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. Conclusion Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.

Several exercise methods, such as the Shaker exercise, tongue press exercise, chin tuck against resistance (CTAR) exercise, and submandibular push exercise, have been introduced to strengthen the muscles involved in swallowing. In this study, we compared the effectiveness of the CTAR, submandibular push, and Shaker exercises for the induction of selective supra- and infrahyoid muscle contractions using surface electromyography (EMG). This study is a prospective non-randomized controlled study. Twenty-five healthy subjects and 20 patients experiencing swallowing difficulty were enrolled. During the three different types of exercises, the root mean square (RMS) values of the sternocleidomastoid (SCM), suprahyoid (anterior belly of the digastric and mylohyoid muscles), and infrahyoid (sternothyroid and thyrohyoid muscles) muscles were analyzed using surface EMG. Differences in the activity of swallowing muscles among the three different exercises were analyzed using one-way repeated measured analysis of variance. In terms of both the maximum and mean RMS values of the suprahyoid muscle, the submandibular push exercise showed a larger RMS value than the CTAR and Shaker exercises in healthy subjects (p p

The aim of this study was to observe the effects of oligonol on submandibular gland dysfunction in ovariectomized rats. We randomly divided female Sprague-Dawley rats into sham-operated, ovariectomized, and oligonol-treated ovariectomized groups. Oligonol was intraperitoneally administered at 30 mg/kg daily for six weeks. Lipogenesis increased after the ovariectomy while fatty acid oxidation increased and intracellular triglyceride levels decreased in response to oligonol treatment. Submandibular gland fibrosis characterized by collagen type I accumulation was observed in the ovariectomized group. However, oligonol markedly reduced fibrosis to a level comparable to that observed in the sham group. Aquaporin 1 and glucose transporter 4 were downregulated in the ovariectomized group. Nevertheless, both factors were significantly upregulated by oligonol treatment. However, aquaporin 5 was significantly downregulated in the oligonol treatment group. Our findings indicate that oligonol protects against damage in postmenopausal rat salivary glands.

This study analyzed the prognostic significance of clinico-pathologic factors, including the number of metastatic lymph nodes (LNs) and lymph node ratio (LNR), in patients with papillary thyroid carcinoma (PTC), and attempted to construct a disease recurrence prediction model using machine learning techniques. We retrospectively analyzed clinico-pathologic data from 1040 patients diagnosed with PTC between 2003 and 2009. We analyzed clinico-pathologic factors related to recurrence through logistic regression analysis. Among the factors that we included, only sex and tumor size were significantly correlated with disease recurrence. Parameters such as age, sex, tumor size, tumor multiplicity, ETE, ENE, pT, pN, ipsilateral central LN metastasis, contralateral central LNs metastasis, number of metastatic LNs, and LNR were input for construction of a machine learning prediction model. The performance of five machine learning models related to recurrence prediction was compared based on accuracy. The Decision Tree model showed the best accuracy at 95%, and the lightGBM and stacking model together showed 93% accuracy. Among those factors mentioned above, LNR and contralateral LN metastasis were used as important features in all machine learning prediction models. We confirmed that all machine learning prediction models showed an accuracy of 90% or more for predicting disease recurrence in PTC. LNR and contralateral LN metastasis were used as important features for constructing a robust machine learning prediction model. In the future, we have a plan to perform large-scale multicenter clinical studies to improve the performance of our prediction models and verify their clinical effectiveness.

BACKGROUND: Metastatic lymph nodes are occasionally found in suprasternal lymph nodes in patients with papillary thyroid cancer (PTC). However, limited studies have examined these lymph nodes thus far. Therefore, we investigated the frequency and risk factors of suprasternal lymph node metastasis in patients with PTC and lateral cervical lymph node metastasis. METHODS: A total of 85 patients with cN1b PTC underwent total thyroidectomy, central neck dissection, and ipsilateral selective neck dissection including suprasternal lymph node dissection. We analyzed the correlation between suprasternal lymph node metastasis and sex, age, tumor characteristics, and cervical lymph node metastasis status. RESULTS: Eleven (12.9%) patients had pathological suprasternal lymph node metastasis. Suprasternal lymph node metastasis was associated with tumors located in the inferior pole of the thyroid gland and level IV lymph node metastasis (P=0.005 and 0.014, respectively). Receiver operating characteristic curve analysis indicated that two or more level IV metastatic lymph nodes had the best predictive value for suprasternal lymph node metastasis (P

Various materials can be used for injection laryngoplasty. Autologous materials are immunologically safe compared to other non-autologous materials, so they do not cause foreign body reactions or chronic inflammation. However, there is a disadvantage that it requires general anesthesia compared to commercialized products. The autologous materials currently used in clinical practice are fat and cartilage. Fat has an advantage because it has excellent viscoelasticity, but it has a disadvantage of having resorption. There is a disadvantage in that it is difficult to predict the clinical outcome after fat injection due to various resorption rates. Cartilage is not a popular method, but it has the advantage of lasting long-term effects with a single injection.

Mesenchymal stem cells (MSCs) have been spotlighted in the field of cell therapies as a promising tool for the treatment of intractable inflammatory diseases. However, their therapeutic potency still shows a gap between preclinical and clinical settings, and distinctive characteristics of specific tissue-derived MSCs and definitive ways to maximize their beneficial functions have not been fully elucidated yet. We previously identified the unique MSCs population from human palatine tonsil (TMSCs) and revealed their superior properties in proliferation and ROS regulation. Based on these findings, we explored further characteristics of TMSCs particularly focused on immunomodulatory function. We found the merit of TMSCs as a therapeutic agent that retains favorable MSCs properties until relatively late passages and revealed that pre-treatment of TNF-&alpha, can enhance the immunomodulatory abilities of TMSCs through the upregulation of the PTGS2/PGE2 axis. TMSCs primed with TNF-&alpha, effectively restrained the proliferation and differentiation of T lymphocytes and macrophages in vitro, and more interestingly, these TNF-&alpha, licensed TMSCs exhibited significant prophylactic and therapeutic efficacy in a murine model of autoimmune-mediated acute colitis via clinical and histopathological assessment compared to unprimed na&iuml, ve TMSCs. These findings provide novel insight into the optimization and standardization of MSCs-based anti-inflammatory therapies, especially targeting inflammatory bowel disease (IBD).

IntroductionSystemic histaminergic activity is elevated in patients with diabetes mellitus. There are a few studies suggesting that histamine is implicated in the pathogenesis of diabetes, but the exact role of histamine in the development of diabetic retinopathy is unclear. The aim of this study was to investigate the role of histamine receptor H4 (HRH4) in the regulation of retinal pigment epithelium (RPE)-derived pro-angiogenic and anti-angiogenic factors under diabetic conditions.Research design and methodsThe levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), histamine and histidine decarboxylase (HDC) in the serum and vitreous samples of patients with diabetes were compared with those of patients without diabetes. The effect of hyperglycemia on expression levels of HRH4, VEGF, IL-6 and pigment epithelium-derived factor (PEDF) in the RPE was determined. The role of HRH4 in high glucose-induced regulation of VEGF, IL-6 and PEDF in ARPE-19 cells and the underlying regulatory mechanism were verified using an RNA interference-mediated knockdown study.ResultsThe serum and vitreous levels of VEGF, IL-6, histamine and HDC were more increased in patients with diabetic retinopathy than in patients without diabetes. HRH4 was overexpressed in RPE both in vitro and in vivo. Histamine treatment upregulated VEGF and IL-6 and downregulated PEDF expression in ARPE-19 cells cultivated under hyperglycemic conditions. Hyperglycemia-induced phosphorylation of p38 and subsequent upregulation of VEGF and IL-6 and downregulation of PEDF were dampened by small interfering RNA-mediated knockdown of HRH4 in ARPE-19 cells.ConclusionsTaken together, HRH4 was a critical regulator of VEGF, IL-6 and PEDF in the RPE under hyperglycemic conditions and the p38 mitogen-activated protein kinase pathway mediated this regulatory mechanism.

Mesenchymal stromal cells (MSCs) from various sources exhibit different potential for stemness and therapeutic abilities. Recently, we reported a unique MSCs from human palatine tonsil (TMSCs) and their superior proliferation capacity compared to MSCs from other sources. However, unique characteristics of each MSC are not yet precisely elucidated. We investigated the role of stanniocalcin-1 (STC1), an anti-oxidative hormone, in the functions of TMSCs. We found that STC1 was highly expressed in TMSC compared with MSCs from bone marrow or adipose tissue. The proliferation, senescence and differentiation of TMSCs were assessed after the inhibition of STC1 expression. STC1 inhibition resulted in a significant decrease in the proliferation of TMSCs and did not affect the differentiation potential. To reveal the anti-oxidative ability of STC1 in TMSCs themselves or against other cell types, the generation of mitochondrial reactive oxygen species (ROS) in TMSC or ROS-mediated production of interleukin (IL)-1&beta, from macrophage-like cells were detected. Interestingly, the basal level of ROS generation in TMSCs was significantly elevated after STC1 inhibition. Moreover, down-regulation of STC1 impaired the inhibitory effect of TMSCs on IL-1&beta, production in macrophages. Taken together, these findings indicate that STC1 is highly expressed in TMSCs and plays a critical role in proliferating and ROS-regulatory abilities.

We developed a new exercise method called the submandibular push exercise that can strengthen the suprahyoid muscle by inducing only the motion of the hyoid bone without neck flexion. In this study, we aimed to investigate and compare the muscle activity of the suprahyoid and infrahyoid muscles in the course of performing three different swallowing exercises. Twenty healthy participants and fifteen patients with dysphagia were recruited. Each participant consecutively performed three exercises: Shaker, CTAR, and submandibular push exercises. To investigate muscle activation, surface electromyography was performed on the suprahyoid, infrahyoid, and SCM muscles, during the exercises. Root mean square (RMS) was measured. In healthy participants, the submandibular push exercise showed a significantly higher RMS value in the suprahyoid and infrahyoid muscles than the Shaker and CTAR exercises using repeated ANOVA with Tukey's post hoc test (p p

Fillers are products that fill the space in soft tissues of the human body and actively used in the various medical fields. Unfortunately, most of the cost-effective commercially available fillers are synthetic and have limitations in terms of their biocompatibility. Here, we evaluated the possible application of decellularized xenogenic cartilage as a long-lasting material for soft tissue augmentation and compared it with two commercially available fillers Artesense (polymethylmethacrylate microspheres) and Radiesse (calcium hydroxyapatite [CaHa]). To do so, porcine auricular cartilage was harvested, followed by freezing and grinding of the tissue into flakes. Then, we used 1% Triton X-100 to decellularize the flakes. We then, respectively, injected 0.1 cc of each material (decellularized xenogenic cartilage, Radiesse, and Artesense) into the subcutaneous layer at three different sites per subject in 12 Sprague-Dawley rats, and evaluated the inflammatory cell infiltration and foreign body reactions of each. Our data indicate that the infiltration of giant cells in the injection area was significantly lower in the decellularized xenogenic cartilage injection group than that in the Radiesse and Artesense injection groups. Further, we observed some neutrophil infiltration in the xenogenic cartilage and Artesense injection groups at 1 month, but these levels were much lower at 3 months (comparable to the Radiesse injection group). Thus, decellularized xenogenic cartilage may have a distinct advantage in terms of biocompatibility compared with other commercial injectable long-lasting fillers, making it one of the most feasible, natural, and cost effective materials in the market. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2708-2715, 2018.

As tissue engineering and regenerative medicine have evolved recently, stem cell therapy has been investigated in the field of impaired wound healing. Several studies have reported that mesenchymal stem cells derived from various tissues including bone marrow and adipose tissue can exert the regenerative efficacy in the wound healing. Previously, we have demonstrated the isolation and characterization of tonsil-derived mesenchymal stem cells (TMSCs) with excellent proliferative property. In the present study, we aimed to evaluate the regenerative efficacy of TMSCs in the wound healing process. Two distinct cutaneous surgical defects were generated in the dorsum of mice. Each wound was treated with TMSCs or phosphate-buffered saline (PBS), respectively. After sacrifice, the skin and subcutaneous tissues around the surgical defect were harvested and assessed for inflammation, re-epithelialization, dermal regeneration, and granulation tissue formation. The administration of TMSCs into wound beds significantly promoted the repair of surgical defects in mice. Especially, TMSCs efficiently contributed to the attenuation of excessive inflammation in the surgical lesion, as well as the augmentation of epidermal and dermal regeneration. To elucidate the underlying mechanisms, TMSCs were analyzed for their potency in immunomodulatory ability on immune cells, stimulatory effect on the proliferation of keratinocytes, and fibroblasts, as well as the regulation of fibroblast differentiation. TMSCs inhibited the non-specific or T-cell-specific proliferation of peripheral blood mononuclear cells, as well as the M1 polarization of macrophage-like cells. Moreover, TMSCs augmented the proliferation of skin-constituting fibroblasts and keratinocytes while they suppressed the differentiation of fibroblasts into myofibroblasts. Taken together, our findings demonstrate the regenerative potential of TMSCs in wound healing process through the regulation on inflammation, proliferation, and remodeling of various skin cells, implying that TMSCs can be a promising alternative for wound repair.

// Gi Cheol Park 1,* , Ji Min Kim 2,* , Hee-Young Park 2 , Ji Min Han 3 , Sung-Chan Shin 2 , Jeon Yeob Jang 4 , Dawoon Jung 2 , In Joo Kim 5 , Jin-Choon Lee 6 and Byung-Joo Lee 2 1 Department of Otorhinolaryngology – Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea 2 Department of Otorhinolaryngology – Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea 3 Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea 4 Department of Otorhinolaryngology - Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea 5 Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea 6 Department of Otorhinolaryngology – Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Korea * The first two authors have equally contributed to this paper Correspondence to: Byung-Joo Lee, email: // Keywords : aging, thyroid, cold exposure, rat, Gerotarget Received : May 18, 2017 Accepted : July 26, 2017 Published : August 03, 2017 Abstract Thyroid function decreases and cold exposure response becomes impaired with increasing age. We investigated the age-related changes in thyroid structure and function and cold-induced changes in the thyroid activity of aging rats. Thirty-two male Sprague–Dawley rats were randomly divided into four groups (8 rats per group): young (7 months) and old (22 months) groups exposed to room temperature and cold stress. The active follicle ratio and serum free T3, T4 and TSH, and TSH receptor (TSHR) concentrations in the thyroid tissues of the rats from each group were compared. At room temperature, old rats had significantly lower active follicle ratio and free T3 and T4 concentrations than young rats. Furthermore, old rats displayed higher TSH level than young. Exposure to cold temperature led to significantly increased active colloid ratio and free T3 and T4 concentrations among old rats, but no significant differences were found among young rats. Additionally, no significant changes in the TSH and TSHR levels were observed after cold exposure in both young and old rats. Old rats have lower thyroid function than young rats under normal temperature. Aging rats are more susceptible to cold stress than young rats, and cold-induced thyroid activation occurs independently of TSH. We investigated the age-related changes in the thyroid structure and function and cold-induced changes in the thyroid activity of aging rats. Aging rats have structurally less active thyroid follicles and functionally lower thyroid hormone levels than young rats. Furthermore, old rats are more susceptible to cold stress than young rats, and cold-induced thyroid activation occurs independently of TSH.

Thyroid gland vasculature has a distinguishable characteristic of endothelial fenestrae, a critical component for proper molecular transport. However, the signaling pathway that critically governs the maintenance of thyroid vascular integrity, including endothelial fenestrae, is poorly understood. Here, we found profound and distinct expression of follicular epithelial VEGF-A and vascular VEGFR2 that were precisely regulated by circulating thyrotropin, while there were no meaningful expression of angiopoietin-Tie2 system in the thyroid gland. Our genetic depletion experiments revealed that VEGFR2, but not VEGFR3, is indispensable for maintenance of thyroid vascular integrity. Notably, blockade of VEGF-A or VEGFR2 not only abrogated vascular remodeling but also inhibited follicular hypertrophy, which led to the reduction of thyroid weights during goitrogenesis. Importantly, VEGFR2 blockade alone was sufficient to cause a reduction of endothelial fenestrae with decreases in thyrotropin-responsive genes in goitrogen-fed thyroids. Collectively, these findings establish follicular VEGF-Avascular VEGFR2 axis as a main regulator for thyrotropindependent thyroid angiofollicular remodeling and goitrogenesis.

Objective Currently, various tools have been introduced for the assessment of vocal fold vibration: laryngeal videolaryngoscopy (LV), videokymography (VKG), high speed videoendoscopy (HSV), digital videokymography (DKG), and 2D scanning videokymography (2D VKG). Among these, the authors have recently designed a dual modality examination system using LV and 2D VKG for more detailed information regarding the vibrations of the vocal folds. The clinical availability of this hybrid system offers medical imaging departments a range of potential advantages in the evaluation of vocal fold vibration. The obvious benefit of simultaneous acquisition is the improved integration of information that allows not only optimal anatomic localization, but also physical movement patterns. Other advantages include the lessened inconvenience to patients due to no longer requiring repeated examinations and shortening the examination time, and increased profitability. The purpose of study was to identify the efficacy of real-time dual examination of two different modalities for the evaluation of vocal fold vibration in human subjects and vocal fold vibration simulator. Methods One vocally healthy subject and three patients with vocal fold nodules, a vocal cyst, and vocal fold paralysis took part in this study. The vibratory patterns of the vocal folds were visualized using simultaneous real-time examination of two different modalities. Additionally, qualitative and quantitative analyses of the dual LV and 2D VKG images were performed. Results Real-time dual examination using a two modality system provided high definition images of the vibratory movements of the vocal folds. By assessing the obtained images, we confirmed that the dual modality examination method was useful in the evaluation of pathologic vibratory patterns, even in non-periodic phonation. Conclusion The present system might improve the understanding of the processes of vocal fold vibration and make a contribution to pathologic voice research, as well as clinical practice.

The thyroidectomy-related voice questionnaire (TVQ) is an efficient screening tool for detecting postoperative vocal dysfunction. The aim of this study was to confirm the significance of the preoperative TVQ score in thyroid surgery.We examined 180 women who underwent total thyroidectomy with central lymph node dissection from March 2014 to May 2016. Based on the preoperative TVQ score, participants were categorized under "normal" (TVQ score5) and "abnormal" (TVQ score ≥5) groups. The laryngoscopic examination and acoustic analysis were performed and the TVQ score assessed before and after surgery (2 weeks, 2 months, and 8 months).In the normal group, the TVQ score increased up to 2 months postoperatively and had decreased at 8 months postoperatively but was significantly higher than the preoperative TVQ score. In the abnormal group, the TVQ score increased up to 2 months postoperatively but had recovered similar to the preoperative TVQ score 8 months postoperatively. The preoperative TVQ score in the abnormal group moderately correlated with the final TVQ score; however, the preoperative TVQ score in the normal group did not correlate with the TVQ score 8 months postoperatively.During preoperative patient counseling, it is important to explain that voice changes without vocal cord palsy may occur postoperatively and that it may take a long time to resolve, particularly in patients with a normal preoperative TVQ score.

Purpose To evaluate the findings of postnatal ophthalmological examinations in patients diagnosed with cataracts by prenatal fetal sonography. Methods We retrospectively identified patients diagnosed with fetal cataract without other ocular abnormalities using antenatal ultrasound. We analyzed data including the patients' family history, the presence of metabolic or systemic disease-associated cataracts, gestational age at diagnosis, fetal sonography reports, and the results of postnatal ophthalmological examinations. Results In total, eight patients were diagnosed with cataracts by prenatal fetal ultrasonography, and all these patients showed mild to severe degrees of cataract after birth. Patients showed hyperechoic opacity of the lens in the available images. The mean gestational age at diagnosis was 26 ± 3 weeks (range, 22-28 weeks), and three patients (37.5%) had a family history of congenital cataract. All patients, except one patient who had patent ductus arteriosus, showed no systemic abnormalities associated with cataracts on postnatal evaluation. Six (75.0%) were diagnosed with bilateral cataracts after birth, and of these, two patients had been diagnosed with unilateral left cataract prenatally. Postnatal ophthalmological examination revealed that all patients showed opacities involving the nucleus of the lens and three patients (37.5%) had associated abnormalities of microcornea or microphthalmia, which were not diagnosed antenatally. Conclusion In all our subjects, the lens opacities on prenatal fetal sonography were diagnosed postnatally as cataracts involving the nucleus. A careful postnatal examination is essential to detect the presence of associated ocular abnormalities such as microcornea and/or microphthalmia and cataract in the contralateral eye in patients with congenital cataract.

To date and to the best of our knowledge, there have been limited studies on the risk factor of clavicle fracture combined with congenital muscular torticollis (CMT), despite it being the most common fracture in newborns. So, the aim of this study was to investigate the risk factors associated with clavicular fracture combined with CMT, and its effect on prognosis. In this study, a total of 134 infants with CMT were included. The risk factors associated with clavicular fracture combined with CMT were analyzed. To analyze the correlation between the clinical parameters and the clavicular fracture in patients with CMT, demographic data, such as body weight at birth, maternal age, gender, gestational age, delivery method, sternocleidomastoid (SCM) thickness of ipsilateral side, its ratio between the ipsilateral and contralateral side, and the first visitation date after birth were evaluated. In the results of this study, the clavicular fracture was found in 15 of 134 patients with CMT (19%). In multivariate logistic analysis, the body weight at birth was the only significant parameter for predicting clavicular fracture in patients with CMT (p-value

Introduction: An isolated injury to the tibial division is rare among compressive sciatic neuropathy. To date, isolated injury to the tibial division of the sciatic nerve after self-massage of the gluteal muscle has not been reported. Here, we report a case of compressive sciatic neuropathy diagnosed after self-massage of the gluteal muscle using magnetic resonance image (MRI) and ultrasound images and its associated therapeutic process. Patient concerns: A 50-year-old woman presented right lower extremity pain for the past 7 days. Diagnosis: Electrophysiological findings were consistent with right tibial neuropathy proximal to the branch to hamstring muscles. However, T2-weighted MRI showed high signal intensity and swelling in the right sciatic nerves from the superior gemellus level to the quadratus femoris level. After considering both radiologic and electrophysiological findings, the patient was diagnosed with an isolated injury to the tibial division of the right sciatic nerve. Interventions: The patient agreed to an ultrasound-guided perineural steroid injection upon receiving detailed explanation of the procedure. Outcomes: After the injection, there was significant improvement in pain. Conclusion: Therefore, in making a diagnosis of sciatic neuropathy, it may be important to find the lesion via MRI than relying solely on the patient's history or electrophysiologic study.

Objectives The role of sex hormones for voice changes in men and women is presently unknown. To determine the effect of sex hormone on the vocal fold, changes of the extracellular matrix (ECM) in vocal fold lamina propria were assessed in orchiectomized (ORX) and ovariectomized (OVX) rats. Methods Male and female Sprague-Dawley rats were divided into sham-operated control male (CON-ORX), ORX, sham-operated female (CON-OVX), and OVX rats. Histological changes and expression of ECM-related genes in lamina propria of the vocal fold were evaluated at 4 and 12 weeks after surgery. Results Testosterone and estradiol levels decreased in the ORX and OVX groups, respectively. ORX groups did not have significant changes compared with CON-ORX groups. However, the expression of hyaluronic acid (HA) was decreased in the OVX group compared with the CON-OVX group. The expression of collagen I in OVX was lower than in the CON-OVX group. Collagen III levels were elevated at 4 weeks in the OVX group, but collagen III levels were diminished at 12 weeks in the OVX group. Expression of elastin in the ECM was less dense in the OVX group compared with controls. The expression MMP-1 and MMP-9 showed significantly increase in the OVX group compared to the CON-OVX group. Conclusion No changes of the ECM-related genes in the vocal fold lamina propria were observed in ORX groups with reduced testosterone. However, changes of several ECM-related genes were observed in OVX groups with decreased estrogen. These results indicate that the vocal fold is an estrogen-sensitive target organ and that decreased estrogen, not testosterone, can affect the expression of several ECM-related molecules of vocal fold. Level of evidence NA Laryngoscope, 130:732-740, 2020.

Objectives/Hypothesis High-mobility group box 1 (HMGB1) is a chromatin-binding protein located in the cell nucleus. Following injury, immunocompetent cells secrete HMGB1 to the extracellular milieu under the stimulation of proinflammatory cytokines. Extracellular HMGB1 acts a danger signal that instigates the innate immunity and tissue repair. We previously reported HMGB1 in the vocal fold extracellular compartment between day 3 and day 7 following surgical injury. In this study, we further investigated the cell source of HMGB1 and the relationship of proinflammatory cytokine expression and HMGB1 translocation in wounded vocal folds. Study Design Prospective animal study. Methods Bilateral vocal fold injury was performed on 122 Sprague-Dawley rats. An additional 18 rats served as uninjured controls. Animals were sacrificed at multiple time points up to 4 weeks after surgery. Immunohistochemical costaining was performed to identify the cell source of HMGB1. Cell markers ED1, fibroblast-specific protein 1 (FSP1), and alpha smooth muscle actin (α-SMA) were used to identify macrophages, fibroblasts, and myofibroblasts, respectively. Enzyme-linked immunosorbent assays were performed to measure cytokine levels of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in vocal fold tissue. Results Costaining of HMGB1 was strong with ED1 and FSP1 but was minimal with α-SMA in injured vocal folds. Compared to uninjured controls, IL-1β and TNF-α expression increased significantly the first 2 days after injury. Conclusions Macrophages and fibroblasts were a major cell source of vocal fold HMGB1. Translocation of HMGB1 may be an active response to the early accumulation of IL-1β and TNF-α in the wounded vocal folds. Level of Evidence NA Laryngoscope, 2016

Background The Korean Society of Thyroid Head and Neck Surgery established a nationwide multicenter registry of anaplastic thyroid carcinoma (ATC) and evaluated the prognostic factors and treatment outcomes of ATC. Methods The present study enrolled 329 patients who were diagnosed with ATC between January 2000 and December 2012 at 19 medical centers in Korea. Survival outcomes were evaluated according to various clinical factors and treatments. Results Multivariate analysis identified age ≥70 years old, the presence of initial clinical symptoms, distant metastasis, and treatment modality as significant risk factors (p

Objectives To clarify the anatomical distribution of the lingual artery in normal adult subjects through histopathologic evaluations. Methods Eighteen healthy cadaveric tongues were used to produce 8 paraffin-embedded tissue sections each. Length from midline raphe, depth from dorsum of tongue and the whole transverse length tongue were measured. The lateral distance, depth, and proportion of lateral distance of deep lingual artery were determined from tip to base of tongue gradually. Lateral distance is length from median raphe to the center of deep lingual artery lumen. Depth is vertical distance from dorsal surface of tongue to the center of deep lingual artery. Proportion of lateral distance is obtained by dividing lateral distance with transverse length from median raphe to lateral border of tongue. The degree of symmetry between right and left sides and the difference between selected spots were evaluated. Results Right and left sides of the lingual artery were symmetric. The lingual artery was lateralized as it run posterior. The lingual artery runs gradually deeper from the surface as it goes near the base of tongue. Both length and depth of the lingual artery gradually increased between 0%-75% of the mobile tongue, but 75%-100% zone of the lingual artery showed no significant difference. There was no anastomosis between right and left side of the lingual arteries. The lingual artery was located within 50% of the transverse length of tongue from median raphe. Conclusion The present study reveals 3-dimensional information on the anatomical distributions of the lingual artery in normal adult subjects. These findings gives us beneficial information about the handling of the lingual artery during oral and base of tongue-related surgery.

Objectives/Hypothesis Office-based biopsy (OBB) is widely used to diagnose suspicious laryngeal lesions. However, its routine use is still controversial and the algorithm for clinical strategy is not concrete. We tried to evaluate the accuracy of OBB as a diagnostic tool for laryngeal malignancy. Methods Medical data of 581 patients undergoing OBB were reviewed. Diagnostic values of OBB were analyzed for malignancy and malignancy/premalignancy. False negative rates (FNRs) were analyzed according to subsites, lesion sizes, and morphology. Results The collection rate of adequate specimens was 99.1%, and there were no complications during OBB. The false omission rates for malignancy of benign lesion; mild, moderate, and severe dysplasia; and carcinoma in situ (CIS) were 5.1%, 11.9%, 14.3%, 50.0%, and 100.0%, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy in OBB were 78.2%, 100.0%, 100.0%, and 87.3%, respectively. Those for malignancy/premalignancy in OBB were 88.2%, 86.7%, 85.7%, and 89.1%, respectively. The high FNRs were reported in glottis lesions (27.0%) and small lesions below 1 cm (27.5%). Morphologically fungating lesions showed low FNR (9.1%) compared to nonfungating ones. Conclusion Office-based biopsy could be used as an initial diagnostic tool for laryngeal malignancy for early detection and avoidance of general anesthesia. However, operative re-biopsy should be considered when severe dysplasia or CIS were reported in OBB, or when the lesions are clinically suspicious for malignancy. Level of Evidence 4. Laryngoscope, 2016

Background/Aims: The purpose of this study was to compare the diagnostic validity of two-dimensional (2D) and three-dimensional (3D) ultrasonography (US) when predicting the extrathyroidal extension of papillary thyroid cancer. Methods: All 2D data were interpreted in real time and 3D data were stored, rendered using tomographic ultrasound imaging (TUI), and then reviewed retrospectively. Results: Extrathyroidal extension was present in 17 papillary thyroid cancers(24.3%) on pathology reports. The presence of contact was significantly associated with extrathyroidal extension on both 2D and 3D US (p = 0.007 and p = 0.003), and the sensitivity and specificity were not significantly different between 2D and 3D US (p = 1.000 and p = 0.754). The coexistence of protrusion and contact was not significantly associated with extrathyroidal extension on either 2D or 3D sonogram. Conclusions: Three-dimensional images rendered with TUI algorithms alone do not seem to be markedly superior to real-time 2D US in predicting the extrathyroidal extension of papillary thyroid cancer.

Background:The high failure rate after surgical repair of massive rotator cuff tears is a consistent problem.Purpose:To evaluate the clinical and radiological outcomes of arthroscopic rotator cuff repair with bone marrow stimulation and patch augmentation in patients with massive rotator cuff tears.Study Design:Cohort study; Level of evidence, 3.Methods:This study included 21 patients who underwent bone marrow stimulation and patch augmentation (group 1) and 54 patients who underwent conventional repair (group 2) for massive rotator cuff tears. Postoperative clinical outcomes were evaluated based on visual analog scale (VAS) for pain, simple shoulder test (SST), University of California, Los Angeles (UCLA), Constant, and American Shoulder and Elbow Surgeons (ASES) scores at baseline, 1 year postoperatively, and final follow-up. Anatomic outcomes were evaluated by using postoperative magnetic resonance imaging at 1 year after surgery.Results:No significant differences in demographic characteristics and baseline data were observed between groups 1 and 2. Clinical symptoms were significantly improved at the final follow-up in both groups ( P < .001). At the final follow-up, no significant differences were found in VAS pain ( P = .676), SST ( P = .598), UCLA ( P = .100), Constant ( P = .469), or ASES ( P = .880) scores. However, the retear rate was lower in group 1 (4/21, 19.0%) than in group 2 (25/54, 46.3%) ( P = .036), and the medial-row failure rate (type 2 retears) was much lower in group 1 (0/4, 0%) than in group 2 (18/25, 72.0%) ( P = .014).Conclusion:Concomitant bone marrow stimulation and patch augmentation significantly reduced retear and medial-row failure rates in the arthroscopic repair of massive rotator cuff tears.

Background and Objectives We evaluated the feasibility of using optical coherence tomography (OCT), to identify microscopic extrathyroidal extension (mETE) in ex vivo thyroidectomy specimens of patients who underwent thyroidectomy for the treatment of papillary thyroid carcinoma (PTC). Methods A total of 170 ex vivo OCT images of the tumor, were acquired just after completion of thyroidectomy in 17 patients. The OCT images of each patient were separately evaluated by two blinded investigators, and the outcomes were compared with the histopathology reports. Results The sensitivity and specificity of mETE identification from the OCT images were 81.4% and 86.0%, respectively, for the first investigator, and 82.9% and 87.0%, respectively, for the second investigator. Substantial agreement between the investigators was verified by Cohen's κ (Cohen's κ = 0.772). Conclusion In this preliminary study of a limited series of ex vivo thyroidectomy specimens, we verified the feasibility of OCT as a method of identifying mETE in patients with PTC. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc.

Conclusion Loco-regional recurrence-free survival was significantly decreased in the papillary thyroid cancer patients with > 6 metastatic lymph nodes and a lymph node ratio > 0.22. Also, the risk of lung metastasis was significantly increased in cases with bilateral neck node metastases. Objective This study focused on the metastatic lymph node status of the lateral neck compartment to understand its prognostic significance for loco-regional recurrence and distant metastasis. Methods Between January 2004 and December 2009, 1040 patients were diagnosed with papillary thyroid cancer and underwent treatment. Results In a multivariate analysis, sex, the number of metastatic lymph nodes, and the lymph node ratio was significantly associated with loco-regional recurrence. The sensitivity/specificity of > 6 metastatic lymph nodes for predicting recurrence was 64.0%/69.7%. The 5-year loco-regional recurrence-free survival of patients with 0-6 metastatic lymph nodes and > 6 metastatic lymph nodes were 93.4% and 79.2%, respectively. The 5-year loco-regional recurrence-free survival of patients with a lymph node ratio ≤ 0.22 and a lymph node ratio > 0.22 were 97.1% and 78.8%, respectively. In the multivariate analysis, only bilateral neck node metastases were significantly associated with lung metastasis.

Background Radiofrequency ablation (RFA) is an emerging minimally invasive treatment modality of benign thyroid nodule and limited small papillary thyroid cancer. Among the RFA related complications, the recurrent laryngeal nerve (RLN) damage is one of the most concerned complications. To reduce the RLN injury during RFA, we developed a RFA device with intraoperative neuromonitoring system (IONM) to detect recurrent laryngeal nerve. Furthermore, to avoid a use of EMG tube requiring general anesthesia, we developed an accelerometer sensor that can be attached on the anterior neck skin. In this study, we examined the feasibility of neuromonitoring system to detect RLN during RFA in thyroid gland. Methods Three beagles (six thyroid glands) underwent the RFA under general anesthesia. Tip of the RF electrode acted as a neurostimulator probe and its location was ultrasonographically monitored. Stimulation current was set based on NIM-Response 3.0 system. During the procedure, nervemonitoring was performed simultaneously using NIM® standard EMG reinforced tube, needle electrode and accelerometer. Results When the tip of the RF electrode was placed near the tracheoesophageal groove, RLN was successfully identified with EMG tube, needle electrode and accelerometer sensor. After RFA near the tracheoesophageal groove, nerve injury was detected in EMG tube, needle electrode and accelerometer sensor. Conclusion Neuromonitoring system to detect RLN using RF electrode was feasible in the animal study. Like both EMG tube and needle electrode, the accelerometer sensor can detect laryngeal muscle twitching during RLN stimulation. Accelerometer sensor for detecting RLN is expected to make the RFA procedure safer without any invasive monitoring system.

To evaluate the correlation between indirect magnetic resonance (MR) arthrographic imaging findings and the clinical symptoms and prognosis of patients with frozen shoulder. Indirect MR arthrography was performed for 52 patients with primary frozen shoulder (mean age 55.1 ± 9.0 years) and 52 individuals without frozen shoulder (mean age 53.1 ± 10.7 years); capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were evaluated. Clinical symptom severity was assessed using the Visual Analogue Scale for Pain (VAS Pain), simple shoulder test (SST), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM). At 6-month follow-up, we evaluated whether MR arthrography findings correlated with the clinical symptoms and prognosis. Capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were significantly greater in the patient group than in the controls (p

Background The purpose of this study was to present our focus on the lymph node status in the central compartment and evaluate the relevant factors and disease recurrence. Methods Between January 2004 and December 2009, 1040 patients were diagnosed with papillary thyroid carcinoma (PTC) and underwent surgery. Results The number of metastatic lymph nodes was a significant predictor for recurrence conferring a hazard ratio of 1.36 (confidence interval = 1.103–1.680; p = .004). The receiver operating characteristic (ROC) curve was calculated to determine the cutoff number of lymph nodes that predicted recurrence with the highest sensitivity and specificity (area under the ROC curve, 0.794; SE, 0.077; p = .001). The sensitivity/specificity of >3 metastatic lymph nodes for predicting recurrence was 63.6%/77.0%, respectively. Conclusion The number of metastatic lymph nodes in the central compartment was a statistical significant predictive factor associated with disease recurrence. Further study is required to confirm the relationship between the number of lymph nodes and disease recurrence. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Purpose: To investigate a sequential chronological change in tip cells during the development of the retinal vasculature in newborn mice. Materials and Methods: Newborn C57BL/6 mice were used for this study. To elucidate the patterns in the developing retinal vasculature, histology, and immunohistochemistry—antiplatelet endothelial cell adhesion molecule-1, anticollagen type IV, isolectin IB4—were performed on sections of mouse retina on postnatal days (P)-4, -8, and -12. Staining patterns of isolectin IB4-stained arterial and venous tip cells were compared in retinal wholemounts, in which the numbers and characteristics of tip cells were compared between arteries and veins on P-4, -6, and -8. In addition, vascular densities and branching patterns were compared between arterial and venous vascular forefront areas. Results: Tip cells in the superficial vascular plexus were observed until P-8. The number of tip cells was highest on P-6, decreasing dramatically from P-6 to P-8 (P-4, 165.2 ± 10.1, n = 17; P-6, 183.8 ± 19.4, n = 15; P8, 21.4 ± 6.4, n = 15) (p < 0.05, respectively, t-test). There was a greater number of tip cells in veins versus arteries on P-4 and P-6 (P-4, 91.0 ± 9.2 veins versus 74.2 ± 10.4 arteries; P-6, 104.0 ± 10.2 veins versus 79.8 ± 11.3 arteries) (p < 0.05, respectively). Arterial tip cells had thinner and longer sprouts compared with venous tip cells (basal thickness: 15.7 ± 8.7 veins versus 9.9 ± 3.5 μm arteries) (length, 20.3 ± 9.1 veins versus 37.1 ± 13.2 μm arteries on P-4) (p < 0.05, respectively). Vessel areas and densities of vascular branch points were significantly higher around veins compared to arteries (vessel areas: 58.9 ± 1.2% veins versus 40.8 ± 1.9% arteries; vascular branch points, 1371.9 ± 136.7/mm2 veins versus 1046.7 ± 175.5/mm2 arteries) (p < 0.05, respectively). Conclusion: The number of tip cells increased to a greater extent in the superficial vascular plexus of veins versus arteries until P-6. Consequently, there are more vessel areas and vascular branch points near retinal veins versus arteries. Arterial tip cells are longer and thinner than the shorter and thicker venous tip cells.

Ocular chemical damage may induce limbal vessel ischemia and neovascularization, but the pathophysiology of the disease is not completely known. To observe changes in blood vessels after alkaline burn, we monitored the anterior segment and choroidal vasculature using a photoacoustic microscope (OR-PAM). We were able to observe not only the iris blood vessels but also the choroidal vessels under the sclera, which were difficult to be observed with conventional photographs. After alkali burning, we observed neovascularization and limbal ischemia and successfully tracked changes in vasculature during the 7-day healing process. We also used the RANdom SAmple Consensus (RANSAC) method to segment the abnormally generated blood vessels in the cornea by detecting the eyeball surface and successfully visualize the distance from each PA signal to the center of the eye. We believe that photoacoustic imaging has an important potential to reveal the pathophysiology of limb ischemia and neovascularization.

Objectives Current preoperative diagnosis of thyroid nodules remains imperfect despite recent advances in cytopathology and molecular diagnostics. False-positivity in preoperative fine needle aspiration cytology (FNAC) may lead to overtreatment of patients, including total thyroidectomy, and sometimes to lawsuits for misdiagnosis and malpractice. In this study, we analyzed clinical characteristics and pathologic findings in patients with false-positivity for papillary thyroid carcinoma (PTC) in FNAC. Methods We retrospectively reviewed permanent pathology results from 3788 patients who underwent thyroid surgery. Among them, 48 patients had lesions that were deemed suspicious or positive (Bethesda class V or VI) for PTC in preoperative FNAC. We reviewed clinic-pathologic data, radiologic findings and surgical planning in these patients. Results The prevalence of pathologic thyroiditis was significantly higher among patients with false-positive FNAC results than in those with confirmed PTC (54.2% versus 9.2%, P < 0.001). The analysis of the permanent pathology reports showed that 26 patients had chronic lymphocytic thyroiditis and 22 patients had no evidence of thyroiditis. Among the patients without pathologic thyroiditis, 19 patients (86.4%) had nodular hyperplasia and 3 (13.6%) had follicular adenoma, while among the patients with pathologic thyroiditis, 7 (26.9%) had no nodule, 14 (53.8%) had nodular hyperplasia, 2 (7.7%) had hyalinized nodules, 2 (7.7%) had follicular adenoma, and 1 (3.8%) had a hyalinizing trabecular tumor. In 42 patients, the extent of surgery (total thyroidectomy or hemithyroidectomy) was to be determined according to intraoperative frozen section biopsy results. Among them, 4 (10.5%) had inconclusive frozen section results, and 38 (90.5%) had benign results on frozen section. Conclusions Patient counseling about the possibility of false-positivity is still important. And the presence of thyroiditis might create confusion in the interpretation of cytopathologic results. This article is protected by copyright. All rights reserved.

We developed a technique for preparing harvested cartilage that creates finer, more uniform pieces by freezing with liquid nitrogen and grinding with a mortar and pestle. Herein, we report the application of this new technique for intracordal cartilage injection.Experimental study.Human cartilage was obtained from surgical cases. In the standard method, harvested cartilage was prepared with scissors and a knife. In the experimental group, harvested cartilage was frozen with liquid nitrogen and ground with a mortar and pestle.It took an average of 60 minutes to manipulate cartilage using the standard technique, whereas it took an average of 10 minutes using the freezing and grinding method (P0.001). The average size of cartilage flakes generated by the standard and new techniques were 727 and 48.6 μm, respectively. The cartilage flakes produced using scissors and a knife were able to pass through a 19-gauge needle, whereas those created using the freezing and grinding method were able to pass through a 24-gauge needle.Using the freezing and grinding method, cartilage was broken into fine, uniform pieces that could pass through a 24-gauge needle. This new technique will facilitate the production of commercial cartilage material for intracordal injection.