Outcomes of Minimally Invasive Thyroid Surgery - A Systematic Review and Meta-Analysis

Purpose: Conventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy. Methods: A systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques. Results: Out of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques. Conclusions: This is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy

Hydrogen generation from hydrazine on N4 moieties graphene embedded by vanadium metal, DFT calculation

In this article, the catalytic effect of the VN4 on graphene has been studied for the decomposition of hydrazine (N2H4) with Density Functional Theory (DFT) calculations using DFT-D3 in the method of Grimme. The adsorb energy, a Bader charge transfer, charge density difference, and partial density of states were examined. Hydrazine decomposition is investigated in two different ways; the N[sbnd]N bond cleavage for N2H4→NH2+NH2 reaction and the N[sbnd]H bond cleavage for N2H4→N2H3+H to produce hydrogen production. According to our result, the gauche conformer of hydrazine is the most stable formation on the modified graphene surface. The interaction of hydrazine molecule with the surface is chemical adsorption through adding V impurity. The N[sbnd]N bond split for V embedded surface has lower activation energy than that of the N[sbnd]H bond cleavages. It is promising to investigate hydrogen generation from hydrazine on the high-performance graphene-like catalyst

Hydrazine decomposition on nickel-embedded graphene

*Akça, Aykan ( Aksaray, Yazar )In this article, the catalytic effect of the Ni-embedded graphene has been investigated for hydrazine (N2H4) decomposition reaction through Density Functional Theory (DFT) calculations with Grimme-D2 dispersion correction. Nickel embedded graphene systems are expected to be much cheaper than pristine nickel surfaces in the future because of relatively few numbers of Ni atom usage, experimentally synthesizable, and limit the Ni usage. The transformation of N2H4 has been taken into account in two different ways. The first way is sequential N–H and, the second one is the N–N bond cleavage from the gauche conformation which is the most stable conformation in gas phase and sole conformation observed on the Ni site. According to our findings, ·NH2 formation breaking the N–N bond in hydrazine has lower activation energy than hydrogen abstraction from hydrazine. The difficulty of breaking N–H bonds stems from the spatial accumulation of negative and positive charges, so it causes a mismatch between hydrogen atoms and negatively charges carbon atoms. NH3 formation pathway through the interaction of N2Hx (x = 1 → 4) species with co-adsorbed ·NH2 radicals is accompanied by much lower activation barriers and highly exothermic. Nevertheless, metal-embedded graphene systems are promising materials for hydrazine dehydrogenation and can be tailored to have more efficient charge distributio

Prognostic features and survival of inoperable hepatocellular carcinoma in Turkish patients with cirrhosis

Background: Primary hepatocellular carcinoma (HCC) is common in Turkey and its prognosis is poor. In the current study the authors analyzed the prognostic factors and survival in Turkish patients with inoperable HCC with cirrhosis

Successful Radiofrequency Ablation of Atrial Flutter Causing Hemodynamic Instability in a Patient with Recent Myocardial Infarction

Atrial flutter (AFL) is a common arrhythmia which may decrease cardiac output and may cause embolic events. Direct current (DC) cardioversion, medical cardioversion and radiofrequency (RF) ablation are therapeutic options, but over all RF ablation therapy has the longest event free period. Although development of AFL after myocardial infarction is quite common it may spontaneously recover or results in atrial fibrillation. Herein we report a patient with medical and electrical cardioversion resistant AFL which developed in the early post- myocardial infarction period causing hemodynamic instability, who was successfully treated with RF catheter ablation

Adjuvant chemoradiation or patients wit adenocarcinoma of the pancreas: an expirence of single institute

Only a small percentage of patients with pancreatic cancer have limited disease suitable for curative resection. Even with surgery, patients often have poor long-term survival due to relapse of the disease. There are controversies about the adjuvant treatment of these patients. We reported the survival of resected pancreatic cancer from a single institute. About 128 consecutive patients who had complete resection of the pancreatic ductal adenocarcinoma were evaluated, retrospectively. Chemoradiotherapy (45 Gy plus 5-fluorouracil) was given to 63 patients. Fifty-five patients declined to take chemoradio-therapy or with poor performance status were observed without additional treatment. Eight patients took only chemotherapy and two patients took only radiotherapy. The median survival of chemoradiotherapy group was significantly higher than the observation group (13 months vs. 4 months, respectively; P < 0.001). In multivariate analyses the most important factors improving survival were the application of chemoradiation (P < 0.001), low-level serum LDH (P = 0.026), good performance status (P = 0.033) and low serum CA19-9 (P = 0.037). Although adjuvant chemoradiotherapy has a significant survival benefit when compared with the observation group, the survival data are still poor for pancreatic cancer. Therefore, we need more effective additional or adjuvant treatment modalities

Effectiveness of topical ciclosporin A treatment after excision of primary pterygium and limbal conjunctival autograft

Aim: To study the efficacy and safety of topical ciclosporin A (CsA) as an adjunctive therapy after surgical treatment of primary pterygium including excision and limbal conjunctival autograft (LCA) with respect to postoperative pain and complications