Factors Affecting the Extrusion Rate of Ventilation Tubes

ObjectivesThe objective of this study was to determine the various factors that affect the extrusion rate of ventilation tubes (VTs), including the nature of the middle ear effusion.MethodsA retrospective chart review of 82 pediatric patients (177 ears) who received VT insertion surgery under general anesthesia was carried out to evaluate the relationship between various factors and the VT extrusion rate. The factors we analyzed included age, gender, the adenoid size, the amount and content of the middle ear effusion after myringotomy, bleeding events, associated adenoidectomy and the findings of the tympanic membrane status, the tympanometry and the audiometry of the air bone gap.ResultsThe mean extrusion time was 254 days (range, 11 to 809 days). The patients with no history of previous VT insertion had a longer extrusion time (mean, 279 days) than did the patients who had undergone previous VT insertion (mean, 203 days). The patients with serous effusion had the shortest extrusion time (mean, 190 days) as compared to those patients with glue (273 days) and pus (295 days) effusions. Other factors had no statistical significant relationship with the extrusion time.ConclusionThe mean VT extrusion time was 254 days. The VT extrusion time was significantly related to the characteristics of the middle ear effusion and a history of previous VT insertion. Thus, the nature of middle ear effusion can provide a clinical clue to predict the VT extrusion time

Efficacy of Central Neck Dissection for Clinically Node-Negative Papillary Thyroid Carcinoma: Propensity Scoring Matching

Objectives: The utility of prophylactic central neck dissection (pCND) for papillary thyroid carcinoma (PTC) is still controversial. Although the procedure may reduce locoregional recurrence, it is associated with a high rate of postoperative complications. The aim of this study was to evaluate the role of pCND in patients with PTC.Materials and Methods: From January 1995 to April 2011, the records of 477 patients who underwent total thyroidectomy with or without pCND for clinically node-negative PTC measuring < 4 cm were retrospectively reviewed. Of these, 341 patients had undergone pCND with total thyroidectomy and 136 patients did not undergo pCND. The clinicopathologic characteristics, surgical outcomes, complications, recurrence, and survival were analyzed using propensity score matching, using age, sex, tumor size, extrathyroidal extension, and radioactive iodine ablation as covariates to minimize selection bias.Results: At baseline, there was no significant difference in sex, age, and multiplicity and bilaterality of the cancer between the two groups. However, extrathyroidal extension was more common and tumor size larger in patients who underwent pCND. For the propensity score-matched analysis, two matched groups, each comprising 135 patients, were generated. After propensity score matching, the significant differences observed at baseline between the two groups disappeared. The postoperative complication rate did not differ between the two groups. Recurrence occurred in 4 patients (2.96%) who had undergone pCND and in 2 patients (1.48%) who did not undergo pCND (P = 0.684). The recurrence-free survival curves did not differ between the two groups.Conclusion: The efficacy of pCND in total thyroidectomy for clinically node-negative PTC is limited, and pCND is not recommended for these patients

Clinical Analysis of Acinic Cell Carcinoma in Parotid Gland

ObjectivesAcinic cell carcinoma (AciCC) is a rarely encountered malignancy in parotid gland. Because AciCC is rare and was recently recognized as the entity of malignancy, AciCC has been difficult to study. We aimed to analyze the diagnosis and treatment experience for this malignancy in our hospital.MethodsWe retrospectively reviewed medical records of the 20 patients with AciCC of parotid gland diagnosed from 1990 to 2009. The preoperative computed tomography scan, preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section results were compared with the final diagnosis. The survival and recurrence were analyzed with the cancer stages and treatment modalities.ResultsThere were 10 males and 10 females, with a mean age of 44.4 years, ranging 8-77 years. The AJCC tumor stage distributions of the patients were 70%, 15%, and 15% for stages I, II, and IV, respectively. The sensitivity of FNAC and intraoperative frozen section was 26.7% and 50.0% respectively. The 10-year survival rate was 90.9% with a mean follow-up of 111 months, ranging 17-251 months. The 10-year disease free survival rate was 74.2% and the mean duration of recurrence from initial surgery was 92.3 months.ConclusionAciCC of the parotid gland is a rare malignancy that has features of less aggressive behavior, and good prognosis. Intraoperative frozen section examination may be helpful in the diagnosis of AciCC of the parotid gland because of the low sensitivity of preoperative computed tomography scan and FNAC. Surgery with adjuvant postoperative radiotherapy is satisfactory for disease control

Robotic and Endoscopic Thyroid Surgery: Evolution and Advances

To minimize surgical morbidity and neck scarring, minimally invasive thyroidectomy and robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular or transoral approaches have been developed over the past 20 years. In this article, we review the evolution of robotic and endoscopic thyroid surgery and recent advances. Among remote access approaches, the gasless transaxillary approach, bilateral axillo-breast approach, postauricular facelift approach, and transoral vestibular approach are in common use today. Each procedure has its own advantages and disadvantages. Therefore, we need to understand these advantages and limitations, and to select the appropriate method for each patient. The most significant advantage of remote access thyroidectomy is its excellent cosmesis. The complication rate is similar in patients undergoing a remote access approach and those undergoing conventional surgery if the former is performed by experienced surgeons. Operative time is significantly longer in remote access thyroidectomy. In conclusion, remote access thyroidectomy is feasible and its outcomes are comparable to those of conventional transcervical thyroidectomy in highly selected patients

Assessment of Water Quality and Thermal Stress for an Artificial Fish Shelter in an Urban Small Pond during Early Summer

: This study evaluated water quality variations in an artificial deep pool (ADP), which is an underground artificial structure built in a shallow pond as a fish shelter. The water temperature, pH, dissolved oxygen (DO), and electrical conductivity (EC) were measured on an hourly basis in the open space and inside the ADP, and a phenomenological study was performed, dividing seasons into normal and rainy seasons and environments into stagnant and circulating conditions. The results showed that the water quality parameters inside the ADP exhibit lower fluctuations and diurnal variations compared with the open space. On average, the water temperature inside the ADP is lower than outside it by 1.7–3.7 °C in stagnant conditions, and by 0.6–0.7 °C in circulating conditions during early summer. Thermal stratification occurs inside the ADP but is temporarily disturbed due to the mixing from the forced circulation and the rainwater input through rainfall events. The ADP provided a constant and optimal water temperature for living and spawning for bitterling (i.e., 15.0–21.0 °C), which dominated in experimental pond during spring to summer. Most importantly, the ADP was able to significantly reduce the thermal stress of the fish in the study site, and as a result, the bitterling, a cool water fish species, could successfully become dominant. Finally, the deployment of the ADP appears to provide a practical alternative for effective fishery resources management to improve species diversity and fish communities in an artificial freshwater ecosystem (garden pond, park pond, other artificial wetlands, etc.)

Prey Survival and Vulnerability of Juvenile Rhynchocypris oxycephalus in Juvenile Fish Shelters under Predation by Korean Native Piscivorous Fish (Coreoperca herzi)

The aim of this study was to evaluate the newly-developed juvenile fish shelter (JFS) for its ability to increase prey survival and to improve species diversity in a freshwater ecosystem. An experiment was performed in an outdoor large-scale mesocosm three times from 2011 to 2012 by comparing the responses to adjustment as a function of the volume of JFS in the control and experimental groups. Analysis results of the environmental monitoring over three periods indicated only minor differences in the physicochemical characteristics of the water quality and phyto- and zoo-plankton biomass, thereby enabling a comparative analysis of the feeding ecology. However, the water temperature exhibited large fluctuations, ranging from 16.4 to 27.6 °C, and high water temperature conditions (Period 1, 25.6 ± 2.0 °C) enhanced the predation activity of the piscivorous fish Coreoperca herzi (C. herzi, size 89 ± 4 mm). Statistically, the survival rates of the prey fish, Rhynchocypris oxycephalus (R. oxycephalus, size 29 ± 1 mm), with JFSs were greater by 35.9%–46.7%, and improved as the patch volume of JFS increased. Based on both experimental observations and statistical analysis, the JFS developed in this study could reduce the chances of predator–prey encounters, minimize prey vulnerability, and thereby increase prey survival rates

Analysis of the Association between Female Medical History and Thyroid Cancer in Women: A Cross-Sectional Study Using KoGES HEXA Data

The purpose of this study was to evaluate the association between female medical history and thyroid cancer. Methods: Data from the Korean Genome and Epidemiology Study were collected from 2004 to 2016. Among a total of 1303 participants with thyroid cancer and 106,602 control (non-thyroid cancer) participants, the odds ratios (ORs) with 95% confidence intervals (CIs) of hysterectomy, oophorectomy, use of oral contraceptives, and number of children were evaluated. Results: The adjusted OR of hysterectomy for thyroid cancer was 1.73 (95% CI = 1.48–2.01, p < 0.001) in the minimally adjusted model. The adjusted ORs for thyroid cancer were 1.89 (95% CI = 1.06–3.37, p = 0.031), 0.89 (95% CI = 0.83–0.94, p < 0.001), and 0.85 (95% CI = 0.73–0.99, p = 0.040) for bilateral oophorectomy, number of children, and use of oral contraceptives, respectively, in the fully adjusted model. In the subgroup analysis, the adjusted ORs of bilateral oophorectomy were significant in the younger age (OR = 3.62, 95% CI = 1.45–9.03, p = 0.006), while the number of children was significant in the older age (OR = 0.86, 95% CI = 0.80–0.93, p < 0.001). Conclusions: The ORs of hysterectomy and bilateral oophorectomy were significantly higher in the thyroid cancer group in the younger age group. The adjusted ORs of the number of children were significantly low in the older age group