Search

Background Endoscopic thyroidectomy offers excellent cosmetic outcomes, but requires a period of time for surgeons to become proficient. We examined the learning curve for the first 100 cases experienced by a single surgeon using a video-assisted neck surgery (VANS) subclavian approach. Methods We retrospectively studied 100 patients (99 women, 1 man; mean age, 36.2 years) with both benign and malignant thyroid diseases treated between 2016 and 2020. Results Preoperative diagnosis was papillary thyroid carcinoma (PTC) in 36 cases and other (non-PTC) in 64 cases. All patients underwent lobectomy, with unilateral central node dissection added for patients with PTC. Mean operative time was 125 min for non-PTC cases and 129 min for PTC cases (p = 0.43), with blood loss of 33.8 ml and 7.6 ml, respectively (p = 0.01). Recurrent laryngeal nerve paralysis (RNP) was observed in 12 patients (12%) and hemorrhage in 2 patients (2%). Comparing the first 30 cases with the last 70 cases, no significant differences in operative time or blood loss were evident, although tumor size of non-PTC cases was significantly greater among later cases (32.4 mm vs. 39.5 mm, p = 0.039). RNP was significantly decreased in later cases (26.7% vs. 5.7%, p = 0.003). Multivariate analysis revealed tumor size as a significant risk factor for increased blood loss, and increased experience correlated significantly with the decrease in RNP. Conclusions In VANS, a certain surgical level was reached after experiencing 30 cases.

Prospective trials of active surveillance (AS) have shown low rates of progression in low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0). However, the significance of multifocality as a prognostic factor remains controversial. Data from 571 patients (mean age, 53.1 years; 495 females) who underwent AS were reviewed. PTMC was unifocal in 457 patients (80.0%) and multifocal in 114 patients (20.0%), with 2–5 lesions each (261 tumors in total). Tumor progression was defined as tumor size enlargement ≥ 3 mm and/or development of clinically evident lymph node metastasis (LNM). After a mean duration of AS of 7.6 years, 53 patients (9.3%) showed tumor enlargement and 8 patients (1.4%) developed LNM. The 10-year progression rate was 13.1%. Age, sex, and calcification pattern did not differ significantly between uni- and multifocal diseases. However, anti-thyroglobulin antibody and/or anti-thyroid peroxidase antibody was more frequently positive with multifocal PTMCs (46.7%) than with unifocal disease (34.4%, p = 0.024). Patients with uni- and multifocal disease showed no significant differences in 10-year rate of tumor enlargement (11.4% vs. 14.8%), LNM development (1.1% vs. 2.4%), or progression (12.4% vs 15.9%). Multivariate analysis of predictors for progression showed multifocality was not a significant risk factor (odds ratio, 1.45; 95% confidence interval, 0.79–2.54; p = 0.22). Eventually, 9 patients (7.9%) with multifocal PTMCs underwent surgery and 7 needed total thyroidectomy, although 7 still showed T1N0M0 low-risk cancer. Even patients with multiple PTMCs (T1amN0M0) are good candidates for AS. Many patients can avoid total thyroidectomy and subsequent surgical complications.

Non-alcoholic steatohepatitis (NASH) is a progressive subtype of non-alcoholic fatty liver disease (NAFLD) that is closely related to cardiovascular disease (CVD). Nitric oxide (NO) plays a critical role in the control of various biological processes. Dysfunction of the NO signaling pathway is associated with various diseases such as atherosclerosis, vascular inflammatory disease, and diabetes. Recently, it has been reported that NO is related to lipid and cholesterol metabolism. Chronic NO synthase (NOS) inhibition accelerates NAFLD by increasing hepatic lipid deposition. However, the detailed relationship between NO and abnormal lipid and cholesterol metabolism in NAFLD/NASH has not been completely explained. We aimed to determine the effects of NOS inhibition by N omega-nitro-L-arginine methyl ester hydrochloride (L-NAME), a NOS inhibitor, on NASH and CVD via lipid and cholesterol metabolism.Stroke-prone spontaneously hypertensive rats were fed a high-fat and high-cholesterol diet for 8 weeks and administered L-NAME for the last 2 weeks. Following blood and tissue sampling, biochemical analysis, histopathological staining, quantitative RT-PCR analysis, and western blotting were performed.L-NAME markedly increased hepatic triglyceride (TG) and cholesterol levels by promoting TG synthesis and cholesterol absorption from the diet. L-NAME increased the mRNA levels of inflammatory markers and fibrotic areas in the liver. Cholesterol secretion from the liver was promoted in rats administered L-NAME, which increased serum cholesterol. L-NAME significantly increased the level of oxidative stress marker and lipid deposition in the arteries.NOS inhibition simultaneously aggravates NASH and atherosclerosis via hepatic lipid and cholesterol metabolism.

Parathyroid tumors (PTs) are sometimes difficult to diagnose because they are small and have a low-velocity blood flow, which can be missed by current imaging modalities. PTs consist of parathyroid adenoma (PA), parathyroid cyst, and parathyroid carcinoma (PC). Detective flow imaging (DFI) is a new imaging technology that displays a low-velocity blood flow. Herein, we report two cases in which DFI was useful for the diagnosis of PTs. One case consisted of a PA and a parathyroid cyst in close proximity, and the other was a PC. To the best of our knowledge, this is the first report to demonstrate the usefulness of DFI in the diagnosis of PTs.

Prospective trials of active surveillance (AS) have shown low rates of progression in low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0). However, the significance of multifocality as a prognostic factor remains controversial.Data from 571 patients (mean age, 53.1 years; 495 females) who underwent AS were reviewed. PTMC was unifocal in 457 patients (80.0%) and multifocal in 114 patients (20.0%), with 2-5 lesions each (261 tumors in total). Tumor progression was defined as tumor size enlargement ≥ 3 mm and/or development of clinically evident lymph node metastasis (LNM).After a mean duration of AS of 7.6 years, 53 patients (9.3%) showed tumor enlargement and 8 patients (1.4%) developed LNM. The 10-year progression rate was 13.1%. Age, sex, and calcification pattern did not differ significantly between uni- and multifocal diseases. However, anti-thyroglobulin antibody and/or anti-thyroid peroxidase antibody was more frequently positive with multifocal PTMCs (46.7%) than with unifocal disease (34.4%, p = 0.024). Patients with uni- and multifocal disease showed no significant differences in 10-year rate of tumor enlargement (11.4% vs. 14.8%), LNM development (1.1% vs. 2.4%), or progression (12.4% vs 15.9%). Multivariate analysis of predictors for progression showed multifocality was not a significant risk factor (odds ratio, 1.45; 95% confidence interval, 0.79-2.54; p = 0.22). Eventually, 9 patients (7.9%) with multifocal PTMCs underwent surgery and 7 needed total thyroidectomy, although 7 still showed T1N0M0 low-risk cancer.Even patients with multiple PTMCs (T1amN0M0) are good candidates for AS. Many patients can avoid total thyroidectomy and subsequent surgical complications.

The mechanomyogram (MMG) is a signal measured by various vibration sensors for slight vibrations induced by muscle contraction, and it reflects the muscle force during electrically induced-contraction or until 60%-70% maximum voluntary contraction, so the MMG is considered an alternative and novel measurement tool for muscle strength. We simultaneously measured the MMG and muscle force in the gastrocnemius (GC), vastus intermedius (VI), and soleus (SOL) muscles of rats. The muscle force was measured by attaching a hook to the tendon using a load cell, and the MMG was measured using a charged-coupled device-type displacement sensor at the middle of the target muscle. The MMG-twitch waveform was very similar to that of the muscle force; however, the half relaxation time and relaxation time (10%), which are relaxation parameters, were prolonged compared to those of the muscle force. The MMG amplitude correlated with the muscle force. Since stimulation frequencies that are necessary to evoke tetanic progression have a significant correlation with the twitch parameter, there is a close relationship between twitch and tetanus in the MMG signal. Therefore, we suggest that the MMG, which is electrically induced and detected by a laser displacement sensor, may be an alternative tool for measuring muscle strength.

Single crystals of Fe1-xCoxTe0.85 have been synthesized successfully with x = 0, 0.02, 0.03, 0.05 and 0.10. The cobalt can be substituted for the iron site as Fe1-xCoxTe0.85 up to a solubility limit of x = 0.10, above which an impurity phase was observed. We obtained the intrinsic susceptibilities of these samples by Honda-Owen plot. The antiferromagnetic transition temperature decreases from about 70 K (x = 0) to 34 K (x = 0.05) with increasing the Co substitution level. Superconductivity was not discovered in this series, but a spin-glass like behavior was observed in 5 % substituted sample.

Intrinsic spin susceptibility of the novel layered superconducting and magnetic system Fe1+δTe1−xSex was investigated by means of the magnetization measurements in comparing with the 125Te NMR Knight shift 125K. The macroscopic uniform susceptibility in Fe1+δTe1−xSex consists of the itinerant magnetization originated in the Fe(1) site, localized one in the Fe(2) site and the ferromagnetic‐like impurity which is frequently sandwiched by the thin film‐like single crystals. Unlike the macroscopic magnetization, Knight shift 125K is mainly attributed to the itinerant magnetism of the Fe(1) site, which is important for the superconductivity and the magnetism in the Fe1+δTe1−xSex system. The magnetic susceptibility estimated in the high‐field region agrees well with 125K. The uniform susceptibility of the superconducting Fe1+δTe1−xSex gradually decreases with decreasing temperature in the normal state accompanied by the growth of antiferromagnetic spin afluctuations.

Macroscopic physical properties of the novel layered superconducting system ${\text{Fe}}_{1+\ensuremath{\delta}}{\text{Te}}_{1\ensuremath{-}x}{\text{Se}}_{x}$ were investigated by means of magnetic-susceptibility, electric resistivity, and heat-capacity measurements. In addition to the substitution effect of the Te site, intercalated excess irons would suppress the bulk superconductivity. We have also performed $^{125}\text{T}\text{e}$ and $^{77}\text{S}\text{e}$ NMRs on a single crystal of ${\text{Fe}}_{1.04}{\text{Te}}_{0.67}{\text{Se}}_{0.33}$ with the highest superconducting transition temperature ${T}_{\text{c}}\ensuremath{\sim}14\text{ }\text{K}$. In the superconducting state, the spin part of Knight shifts for both $H\ensuremath{\parallel}a$ and $H\ensuremath{\parallel}c$ are suppressed, and the nuclear-spin-lattice relaxation rate $1/{T}_{1}$ shows the power-law like behavior without any coherent peaks, indicating the nodal spin-singlet superconductivity. In the normal state, $1/{T}_{1}T$ is enhanced by antiferromagnetic spin fluctuations with decreasing temperature. The superconductivity in ${\text{Fe}}_{1+\ensuremath{\delta}}{\text{Te}}_{1\ensuremath{-}x}{\text{Se}}_{x}$ is realized in the vicinity of the magnetic quantum phase transition and is possibly mediated by the growth of the antiferromagnetic spin fluctuations.

The spin-fluctuation effect in the Se-substituted single crystalline Fe 1+δ Te 1- x Se x ( x = 0, 0.05, 0.12, 0.20, 0.30, 0.33, 0.45, and 0.48; 0≤δ≤0.12) and the polycrystalline Fe 1.11 Se has been studied by the measurements of the X-ray diffraction, the magnetic susceptibility under high magnetic fields and the electrical resistivity under magnetic fields up to 14 T. The samples with x = 0.05, 0.12, 0.20, 0.30, 0.33, 0.45, and 0.48 show superconducting transition temperatures in the ranger of 10–14 K. We obtained their intrinsic susceptibilities by the Honda–Owen method. A nearly linear-in- T behavior in magnetic susceptibility of Se-rich superconducting samples was observed, indicating the antiferromagnetic spin fluctuations have a strong link with the superconductivity in this series. The upper critical field µ 0 H c2 orb for T →0 was estimated to exceed the Pauli paramagnetic limit. The Kadowaki–Woods and Wilson ratios indicate that electrons are strongly correlated in this system. Furthermore, the s...