Do low preoperative vitamin D levels reduce the accuracy of quick parathyroid hormone in predicting postthyroidectomy hypocalcemia?

BACKGROUND: Although some studies have suggested that low preoperative 25-hydroxyvitamin D (25-OHD) levels may increase the risk of hypocalcemia and decrease the accuracy of single quick parathyroid hormone in predicting hypocalcemia after total thyroidectomy, the literature remains scarce and inconsistent. Our study aimed to address these issues. METHODS: Of the 281 consecutive patients who underwent a total/completion total thyroidectomy, 244 (86.8 %) did not require any oral calcium and/or calcitriol supplements (group 1), while 37 (13.2 %) did (group 2) at hospital discharge. 25-OHD level was checked 1 day before surgery, and postoperative quick parathyroid hormone (PTH) was checked at skin closure (PTH-SC). Postoperative serum calcium was checked regularly. Hypocalcemia was defined by the presence of symptoms or adjusted calcium of /=15 ng/mL via bootstrapping. RESULTS: Preoperative 25-OHD level was not significantly different between groups 1 and 2 (13.1 vs. 12.5 ng/mL, p = 0.175). After adjusting for other significant factors, PTH-SC (odds ratio 2.49, 95 % confidence interval 1.52-4.07, p /=15 ng/mL (0.880 vs. 0.850, p = 0.61) CONCLUSIONS: Low 25-OHD was not a significant factor for hypocalcemia and did not lower the accuracy of quick PTH in predicting postthyroidectomy hypocalcemia.published_or_final_versio

Does using an energized device in open thyroidectomy reduce complications?

BACKGROUND: Although using energy devices during open thyroidectomy might shorten the procedure time compared with the conventional technique, its effect on procedure-related complications remains unclear and controversial. In an era of cost containment, we aimed to compare the rate of procedure-related complications (particularly vocal cord palsy and hypoparathyroidism) between patients who underwent thyroidectomy using reusable ultrasonic shears and those who did not. METHODS: Of 508 eligible patients, 237 (46.7%) underwent thyroidectomy using the SonoSurg (reusable ultrasonic shears; SonoSurg group) and 271 (53.3%) underwent thyroidectomy using the conventional technique (suture ligation and clips; conventional technique group). The reusable shears were autoclaved at the end of each procedure and replaced after every 20 cases. To evaluate the effect of the ultrasonic shears on procedure-related complications, the patient characteristics and outcomes were compared between the 2 groups. RESULTS: In the SonoSurg group, the total operating time (60 min versus 105 min, P < 0.001) and temporary (12.4% versus 25.5%, P = 0.009) and permanent hypoparathyroidism (1.9% versus 9.8%, P = 0.003) rates were significantly less than those in the conventional technique group. The permanent vocal cord palsy rate was similar (P = 0.262). On multivariate analysis, using the reusable shears (odds ratio 0.163; 95% confidence interval 0.047-0.570; P = 0.005) and parathyroid autotransplantation of at least 1 gland (odds ratio 0.370; 95% confidence interval 0.146-0.943; P = 0.037) were the 2 independent variables for permanent hypoparathyroidism after completion/total thyroidectomy. CONCLUSIONS: Using the reusable shears during open thyroidectomy was significantly associated with a shortened operating time and lower permanent hypoparathyroidism rate, although the vocal cord palsy rate remained similar.link_to_subscribed_fulltex

Epidemiological and clinical characteristics of patients with anti-interferon-gamma autoantibodies associated with opportunistic infections in Hong Kong

OS185: Oral Session - Immunity and immunogenetics of infections in immunocompromised hosts - no. OS090

Epidemiology, Seroprevalence, and Clinical Manifestations of Immunodeficiency due to Autoantibody Against Interferon Gamma in Hong Kong

Poster presentation: Infectious Diseases: no. P137-0079Introduction/Project Objectives: Patients with adult-onset immunodeficiency due to autoantibodies against interferon gamma (anti-IFN-γ autoantibodies) may develop disseminated and/or recurrent opportunistic infections, including non-tuberculous mycobacteriosis, non-typhoidal salmonellosis, burkholderiosis, penicilliosis, and herpes zoster. While the condition appears to be especially common among Asians, including Chinese residents in Hong Kong, Taiwan, and mainland China, the seroprevalence rate of anti-IFN-γ autoantibodies among these populations is unknown. Moreover, the full spectrum of infective and non-infective clinical manifestations of this immuondeficiency syndrome is not fully understood. This retrospective case-control analysis aimed to investigate the epidemiology, seroprevalence rate, and clinical manifestations of this emerging immunodeficiency syndrome in Hong Kong. Methods: This study was approved by the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster. Archived serum samples from subjects aged ≥18 years, with or without opportunistic infections, were tested by a screening enzyme immunoassay and an IFN-γ spiking assay for the presence of anti- IFN-γ autoantibodies. The patients' clinical data were retrieved from the Hospital Authority Electronic Patient Record (ePR) system and entered into a predesigned database. Comparisons between patient groups were evaluated by the Chi-square test (categorical variables) and Mann-Whitney U-test (continuous variables). All statistical analyses were performed using SPSS18.0 for Windows. P<0.05 was considered statistically significant. Results: 3198 serum samples from 3198 patients were tested. Overall, anti-IFN-γ autoantibodies were detected in 34 serum samples (34/3198, 1.1%) in the screening enzyme immunoassay. These included 11 patients with opportunistic infections including non-tuberculous mycobacteriosis, penicilliosis, non-typhoidal salmonellosis, burkholderiosis, and/or herpes zoster (11/133, 8.3%), 4 subjects aged >65 years without these opportunistic infections (4/783, 0.5%), 14 patients with autoimmune diseases without these opportunistic infections (14/753, 1.9%), and 5 patients with chronic HBV/HCV infection without these opportunistic infections (5/764, 0.7%). The seroprevalence rate of anti-IFN-γ autoantibodies in subjects without opportunistic infections was ~1%, which was significantly lower than that of patients with opportunistic infections (8.3%, P<0.001). Some patients with high-titer serum neutralizing anti-IFN-γ autoantibodies also developed reactive (Sweet's syndrome and lobular panniculitis) and infective dermatoses. Anti-IFN-γ autoantibodies were strongly associated with HLA-DR*15:02/16:02 and HLA-DQ*05:01/05:02 among the affected patients. Conclusions: These findings helped to optimize the diagnostic and treatment protocols for this emerging immunodeficiency syndrome. Routine screening for anti-IFN-γ autoantibodies in asymptomatic patients is unlikely warranted. A working algorithm for the diagnosis and treatment of patients with dermatoses associated with anti-IFN-γ autoantibodies was established. Our non-laborious screening enzyme immunoassay could be adopted by clinical laboratories

Firm networking and bribery in China: assessing some potential negative consequences of firm openness

Economic openness, both in terms of increased international trade exposure and enhanced inter-firm networking, has been a key element of China’s economic emergence since the implementation of market reforms and the "opening-up policy" over 30 years ago. Unfortunately, these changes have also coincided with the increased incidence of bribery and corruption. Both in general, and in the specific context of China, research on the relationship between a firm’s tendency toward openness and its propensity to engage in bribery is scarce. This study seeks to fill this gap based on empirical evidence provided by a large sample of Chinese firms. The findings of the study reveal that firms’ increased networking and openness tend to occur contemporaneously with greater bribery and corruption. We suggest that this may be due to the misuse of guanxi-based networks that coincide with the presence of firms’ open network strategies, heightened by the potential loss of resource and capability heterogeneity (and hence reduced competitive advantages) in the context of openness. We further find that firms paying bribes do so as an attempt to overcome unnecessary bureaucratic processes and ineffective institutional support that might tend to hinder their development.Fang Huang and John Ric