Publications by authors named "Daqi Zhang"

81 Publications

Drawbacks of neural monitoring troubleshooting algorithms in transoral endoscopic thyroidectomy.

Langenbecks Arch Surg 2021 Jul 15. Epub 2021 Jul 15.

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, China.

Introduction: The application of intraoperative neural monitoring (IONM) trouble-shooting algorithms procedures in transoral endoscopic thyroidectomy vestibular approach (TOETVA) was investigated.

Methods: Loss of signal (LOS) is defined as a loss of the primary electromyographic (EMG) normal biphasic waveform with reduced amplitude response to less than 100μV with a stimulation level intensity of 1-2mA. A systematic review of the IONM system at LOS was covered methodically: (i) correct endotracheal tube verification, (ii) stimulation of the recurrent laryngeal nerve (RLN) at entry point, (iii) ipsilateral or contralateral vagal nerve (VN) stimulation, and (iv) laryngeal twitch (LT).

Results: The function of 223 nerves at risk (NAR) was recorded with IONM. Twenty-seven (12%) NAR experienced a suspected LOS. LT could not be appreciated. In 15/27 (55%) cases, the application of the IONM trouble-shooting algorithm revealed upward displacement of the EMG tube (all orotracheal intubations). In 9 (4%) NAR, VN stimulation was not accomplished. In detail, there were n.5 left and n. 4 right VNs. Two VNs were ipsilateral, and 7 VNs contralateral. For EMG tube displacement, because the oral/nasal area is included in the aseptic field, it is less possible to re-check by the laryngoscope or fiberscope.

Conclusions: A limit for applying the IONM trouble-shooting algorithm to TOETVA is determined by (a) inability to appreciate the LT, (b) difficulty in stimulating the ipsilateral and contralateral VN, and (c) remodeling EMG endotracheal tube position. A modified IONM trouble-shooting algorithm for TOETVA is proposed.
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http://dx.doi.org/10.1007/s00423-021-02217-6DOI Listing
July 2021

Analysis and outcomes of wrong site thyroid surgery.

BMC Surg 2021 Jun 4;21(1):281. Epub 2021 Jun 4.

Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.

Background: In thyroid surgery, wrong-site surgery (WSS) is considered a rare event and seldom reported in the literature.

Case Presentation: This report presents 5 WSS cases following thyroid surgery in a 20-year period. We stratified the subtypes of WSS in wrong target, wrong side, wrong procedure and wrong patient. Only planned and elective thyroid surgeries present WSS cases. The interventions were performed in low-volume hospitals, and subsequently, the patients were referred to our centres. Four cases of wrong-target procedures (thymectomies [n = 3] and lymph node excision [n = 1] performed instead of thyroidectomies) and one case of wrong-side procedure were observed in this study. Two wrong target cases resulting additionally in wrong procedure were noted. Wrong patient cases were not detected in the review. Patients experienced benign, malignant, or suspicious pathology and underwent traditional surgery (no endoscopic or robotic surgery). 40% of WSS led to legal action against the surgeon or a monetary settlement.

Conclusion: WSS is also observed in thyroid surgery. Considering that reports regarding the serious complications of WSS are not yet available, these complications should be discussed with the surgical community. Etiologic causes, outcomes, preventive strategies of WSS and expert opinion are presented.
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http://dx.doi.org/10.1186/s12893-021-01247-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176686PMC
June 2021

Chloropicrin alternated with dazomet improved the soil's physicochemical properties, changed microbial communities and increased strawberry yield.

Ecotoxicol Environ Saf 2021 Sep 1;220:112362. Epub 2021 Jun 1.

Institute of Plant Protection, Chinese Academy of Agricultural Sciences, Beijing 100193, China; State Key Laboratory for Biology of Plant Disease and Insect Pests, Beijing 100193, China. Electronic address:

Chloropicrin (Pic) and dazomet (DZ) are effective soil fumigants that are often used to reduce soil-borne pathogens that would otherwise reduce crop yield. As Pic is scheduled to be banned, we investigated whether its consumption could be halved by alternating it with DZ. We observed that Pic alternated with DZ increased the soil NH-N content by 28.74-47.07 times, increased available potassium content by 40.80%-46.81% and increased electrical conductivity by 39.23%-85.81%. It generally improved the soil's physicochemical properties. High-throughput DNA sequencing showed that Pic alternated with DZ changed the taxonomic diversity of bacteria and fungi by increasing the relative abundance of Bacillus and Firmicutes, and by decreasing Proteobacteria, Acidobacteria and Sphingomonas. Moreover, Pic alternated with DZ can inhibit key soil pathogens by more than 90% and significantly increased strawberry yield by 78.22%-116.12%. In terms of strawberry production, we recommend using DZ in the first year and Pic in the second year. Our results showed significant ecological benefit and yield benefit when Pic consumption was halved by alternating it with DZ.
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http://dx.doi.org/10.1016/j.ecoenv.2021.112362DOI Listing
September 2021

An Improved Recurrent Laryngeal Nerve-Monitoring Device: Technical Note for NIM Vital™.

Surg Technol Int 2021 Jun 3;38. Epub 2021 Jun 3.

Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy.

A new device for monitoring the laryngeal nerves during thyroid surgery has been developed. NIM Vital™ (Medtronic Xomed, Inc., Jacksonville, FL, USA) incorporates (a) a new wireless design, (b) NIM NerveTrendTM (Medtronic Xomed) EMG reporting, (c) intelligent noise-reduction technology that suppresses artifacts, (d) smart troubleshooting pop-up alerts, and (e) NIM Nervassure ™ (Medtronic Xomed) for continuous monitoring. This device offers enhanced stability and flexibility for both intermittent and continuous laryngeal nerve monitoring. The new NIM NerveTrend ™ EMG reporting makes it possible to track the recurrent laryngeal nerve condition throughout a procedure, even when using intermittent nerve monitoring. During both continuous and intermittent monitoring, green, yellow and red status bars provide visual information and associated tones provide audible cues, making it easy to monitor nerve function and interpret EMG trends. This new tool for laryngeal nerve monitoring has the potential to augment nerve dissection during surgery. Measurements of long-term outcome are needed to establish their efficacy.
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June 2021

C2 Xplore® for Intermittent and Continuous Laryngeal Nerve Monitoring: Technical Note.

Surg Technol Int 2021 05 27;38. Epub 2021 May 27.

Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy.

Due to the direct anatomical relationship between the recurrent laryngeal nerve (RLN) and the thyroid gland, the function and anatomical integrity of the RLN is fundamentally at risk in every thyroid operation. While a RLN morbidity rate of less than 5% is achieved in specialized clinics, the morbidity rates are significantly higher in non-specialized centers. Thus, the aim is to reduce the complication rate by establishing standardized interventions. Exact knowledge of the anatomical course of the RLN, the nerve-sparing dissection technique and the supportive use of intraoperative neuro-monitoring (IONM) to identify anatomical variations are the basis for nerve-sparing surgery. We tested the new C2 Xplore® system (inomed Medizintechnik GmbH, Emmendingen, Germany) as a tool for performing intermittent and continuous laryngeal nerve monitoring during thyroid surgery. The C2 Xplore® helps to enhance surgeon-IONM interaction, and provides comprehensive digital EMG documentation with EMG quantification. EMG artifacts are removed. Image quality and EMG feedback are highly acceptable for intraoperative monitoring. The C2 Xplore® system does not have a deleterious impact on the proper function of other surgical instruments. C2 Xplore® is effective for intraoperative monitoring, optimizing RLN dissection, and supporting surgical deliberations, and for forensic use and research. A step-by-step C2 Xplore® procedure is described.
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May 2021

Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery.

Surg Technol Int 2021 05 27;38. Epub 2021 May 27.

Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy.

Introduction: Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerød, Denmark).

Methods: Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves' disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection).

Results: Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed.

Conclusion: This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.
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May 2021

Proprieties of adhesive surface arrays to thyroid cartilage for recurrent laryngeal nerve monitoring.

Ann Transl Med 2021 Apr;9(8):690

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China.

Background: To investigate the optimal placement and size of adhesive thyroid cartilage electrodes (ATCEs) placed on the thyroid cartilage in porcine models for evaluating recurrent laryngeal nerve function compared with the other 3 recording electrode types.

Methods: Four Meishan piglets were used for this study. The electromyogram (EMG) signal stability was detected by intraoperative nerve monitoring (IONM). Best location and size of ATCEs were detected, and the EMG signals from each were compared. Latency data were tested by stimulating the different nerve points, and 6 manipulations of the trachea and endotracheal tube (ET) were applied to test the stability of EMG signals. ET electrodes, needle electrodes, and transcutaneous recording electrodes were simultaneously tested with comparison to ATCEs.

Results: The optimal placement locations and sizes of ATCEs were determined. The amplitudes and latencies recorded from the ATCEs were consistent with those of the ET electrodes. More anti-interference was observed with the ATCEs than with the ET electrodes in surgical manipulations. ATCEs could be used during intermittent and continuous monitoring in similar fashion to ET electrodes and needle electrodes.

Conclusions: ATCEs had consistent monitoring function with ET electrodes and needle electrodes. Feasibility, EMG stability, and optimal location and size of ATCEs for IONM were resolved. The EMG profiles from the ATCEs were more stable during surgical manipulations.
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http://dx.doi.org/10.21037/atm-21-1229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106000PMC
April 2021

Correction to: Posture and dysphonia associations in patients undergoing total thyroidectomy: stabilometric analysis.

Updates Surg 2021 May 11. Epub 2021 May 11.

Division for Otorhinolaryngology, Department of Adult and Development Age Human Pathology "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy.

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http://dx.doi.org/10.1007/s13304-021-01077-5DOI Listing
May 2021

Bio-activation of soil with beneficial microbes after soil fumigation reduces soil-borne pathogens and increases tomato yield.

Environ Pollut 2021 Aug 14;283:117160. Epub 2021 Apr 14.

Institute of Plant Protection, Chinese Academy of Agricultural Sciences, Beijing, 100193, China; Beijing Innovation Consortium of Agriculture Research System, Beijing, 100029, China. Electronic address:

Soil-borne diseases have become increasingly problematic for farmers producing crops intensively under protected agriculture. Although soil fumigants are convenient and effective for minimizing the impact of soil-borne disease, they are most often detrimental to beneficial soil microorganisms. Previous research showed that bio-activation of soil using biological control agents present in biofertilizers or organic fertilizers offered promise as a strategy for controlling soil-borne pathogens when the soil was bio-activated after fumigation. Our research sought to determine how bio-activation can selectively inhibit pathogens while promoting the recovery of beneficial microbes. We monitored changes in the soil's physicochemical properties, its microbial community and reductions in soil-borne pathogens. We found that the population density of Fusarium and Phytophthora were significantly reduced and tomato yield was significantly increased when the soil was bio-activated. Soil pH and soil catalase activity were significantly increased, and the soil's microbial community structure was changed, which may have enhanced the soil's ability to reduce Fusarium and Phytophthora. Our results showed that soil microbial diversity and relative abundance of beneficial microorganisms (such as Sphingomonas, Bacillus, Mortierella and Trichoderma) increased shortly after bio-activation of the soil, and were significantly and positively correlated with pathogen suppression. The reduction in pathogens may have been due to a combination of fumigation-fertilizer that reduced pathogens directly, or the indirect effect of an optimized soil microbiome that improved the soil's non-biological factors (such as soil pH, fertility structure), enhanced the soil's functional properties and increased tomato yield.
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http://dx.doi.org/10.1016/j.envpol.2021.117160DOI Listing
August 2021

Association Between the Presence of Female-Specific Tumors and Aggressive Clinicopathological Features in Papillary Thyroid Cancer: A Retrospective Analysis of 9,822 Cases.

Front Oncol 2021 11;11:611471. Epub 2021 Mar 11.

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China.

Objective: To investigate the association between the presence of female-specific tumors and aggressive clinicopathological features in papillary thyroid cancer (PTC).

Methods: This study retrospectively analyzed 9,822 female cases between June 2008 and December 2017. Odds ratios and corresponding 95% confidence intervals were calculated. Findings were stratified by age and body mass index (BMI) in different models.

Results: 1443/9822 (14.7%) patients with PTC had a female-specific tumor. Presence of a benign breast mass was an independent risk factor for a primary PTC lesion > 1 cm in diameter (adjusted OR = 1.446, 95% CI 1.136-1.840, = 0.003), but a protective factor against extrathyroidal extension of PTC (adjusted OR = 0.650, 95%CI 0.500-0.845, = 0.001). Presence of a benign uterine mass was an independent risk factor for multifocal PTC (adjusted OR = 1.305, 95%CI 1.113-1.531, = 0.001). Analyses stratified by age and BMI revealed the presence of a benign breast mass was an independent risk factor for a primary PTC lesion > 1 cm in diameter in patients aged <36 years (adjusted OR = 1.711, 95% CI 1.063-2.754, = 0.027), and a protective factor against extrathyroidal extension of PTC in patients aged ≥36 - <42 years (OR adjusted = 0.533, 95% CI 0.302-0.941, = 0.030) or with a BMI ≥ 23.4 kg/m (BMI ≥ 23.4 to < 25.7 kg/m, adjusted OR = 0.441, 95% CI 0.246-0.792, = 0.006; BMI ≥25.7 kg/m, adjusted OR = 0.558, 95% CI 0.315-0.998, = 0.045). Presence of a benign uterine mass was an independent risk factor for multifocal PTC in patients aged ≥49 years (adjusted OR = 1.397, 95% CI 1.088-1.793, = 0.009) or with a BMI <21.5 kg/m (OR adjusted = 1.745, 95% CI 1.214-2.509, = 0.003).

Conclusion: The presence of a benign breast mass was an independent risk factor for a primary PTC lesion > 1 cm in diameter and a protective factor against extrathyroidal extension of PTC, while the presence of a benign uterine mass was an independent risk factor for multifocal PTC. Data from this study may help surgeons propose more personalized treatment plans when encountering patients with PTC and female-specific benign tumors.
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http://dx.doi.org/10.3389/fonc.2021.611471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006326PMC
March 2021

Correction to: Efficacy and acceptability of the S1P receptor in the treatment of multiple sclerosis: a meta-analysis.

Neurol Sci 2021 May;42(5):2155

Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, 570100, People's Republic of China.

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http://dx.doi.org/10.1007/s10072-021-05137-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182864PMC
May 2021

Tensile strength analysis of automatic periodic stimulation for continuous intraoperative neural monitoring in a piglet model.

Sci Rep 2021 Mar 15;11(1):5898. Epub 2021 Mar 15.

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.

Continuous intraoperative neural monitoring (C-IONM) during thyroid surgery is a useful tool for preventing recurrent laryngeal nerve (RLN) injury. The present study aims to analyze the tensile strength tolerance of C-IONM electrodes on the vagal nerve (VN). A C-IONM wire was enclosed in a hand-held tensile testing system. The probe displacement on the VN was continuously monitored by positioning a second probe far-up/proximally in a piglet model, and an automatic periodic stimulation (APS) accessory was used. The 3-mm and 2-mm APS accessory has a mean tensile strength of 20.6 ± 10 N (range, 14.6-24.4 N) and 11.25 ± 8 N (range, 8.4-15.6 N), respectively (P = 0.002). There was no difference between bilateral VNs. The mean amplitude before and during electrode displacement was 1.835 ± 102 μV and 1.795 ± 169 μV, respectively (P = 0.45). The mean percentage of amplitude decrease on the electromyography (EMG) was 6.9 ± 2.5%, and the mean percentage of latency increase was 1.9 ± 1.5%. No significant amplitude reduction or loss of signal (LOS) was observed after > 50 probe dislocations. C-IONM probe dislocation does not cause any LOS or significant EMG alterations on the VN.
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http://dx.doi.org/10.1038/s41598-021-84988-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960733PMC
March 2021

Prevention of non-recurrent laryngeal nerve injury in robotic thyroidectomy: imaging and technique.

Surg Endosc 2021 Aug 15;35(8):4865-4872. Epub 2021 Mar 15.

Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma, China-Japan Union Hospital Of Jilin University, Changchun, 130000, People's Republic of China.

Introduction: The aim of this report was to summarize observations, evaluate the feasibility, provide detailed information concerning proper techniques, and address limitations for non-recurrent laryngeal nerve (NRLN) dissection and release during the robotic bilateral axillo-breast approach (BABA) for thyroidectomy.

Materials And Methods: The BABA approach was used in two cases of thyroidectomy in the setting of NRLN. Preoperative CT imaging findings suggesting the aberrant anatomy are reviewed and technical planning, inclusive of intraoperative nerve monitoring, was employed. Intraoperative videos with narrative discussion of technique for safe dissection are provided, along with supplementary video of additional technical guidance.

Results: In both cases, the NRLNs were identified, dissected, and preserved. We dissected the proximal segment of each NRLN to its origin. We determined that the use of only the NRLN proximal to distal robotic dissection jeopardized the nerve. The BABA approach with the Type I NRLN is similar to the dissection of the recurrent laryngeal nerve (RLN) in transoral thyroidectomy. Due to interference with endoscopic viewing caused by the thyroid cartilage, the Type I NRLN is more challenging to manage both at the laryngeal entry point and its origin from the vagus nerve (VN). For the Type II NRLN, it is essential to identify its point of origin and the reflection of the nerve from the VN. Therefore, modification of nerve dissection to mirror open surgery with bidirectional nerve dissection assisted in avoidance of traction injury to the nerve.

Conclusions: We presented a video, a detailed description of methods, and discussed limits for NRLN management in robotic BABA. This report included (i) a description of the aberrant anatomy and CT scans to inform surgeons of the possible NRLN locations, (ii) a description of a technique for using the nerve monitor in the robotic surgeries, and (iii) a description of the techniques used to isolate and protect the NRLN during the robotic surgery. In robotic BABA, our NRLN-sparing technique and degree included mainly a multi-directional nerve dissection (i.e., medial-grade, later-grade approach together with proximal to/from distal) using athermal technique. The NRLN-sparing technique is predominantly carried out in an anterior dissection plane.
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http://dx.doi.org/10.1007/s00464-021-08421-1DOI Listing
August 2021

Pictorial essay of vestibular incision outcomes from transoral endoscopic thyroidectomy.

Langenbecks Arch Surg 2021 Mar 15. Epub 2021 Mar 15.

Division of thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China.

Purpose: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a new treatment option for patients with selected thyroid disease requiring surgery. The aim of this pictorial essay is to illustrate the healing outcomes of the vestibular incisions.

Methods: TOETVA patients were recruited at two Centers in China and Italy. TOETVA is initiated with one 10-20-mm median incision in the center of the oral vestibule 10 mm above the inferior labial frenulum, and two 5-mm lateral incisions, just below the lower lip near the labial commissure. Healing of the vestibular incision was monitored through serial photographs 1, 3, 7, 30, and 90 days after surgery. Outcomes were evaluated by Landry's score, time to healing, issues affecting wound outcomes, scar, fibrin, granulation, necrotic tissue formation, and infections.

Results: Results of TOETVA were monitored in 52 patients. There were no postoperative infections. All lateral incisions demonstrated favorable surgical outcomes. Landry's criteria scores indicated worse outcomes for the median incisions vs. the lateral ones (p<0.05). Median incisions healed well in 65.4% of patients, but 34.6% of patients had visible scars from the median incision 90 days after surgery. Eight (15.4%) had cicatricial diathesis, seven (13.5%) experienced displacement of the stitches, and three (5.8%) developed synechia with gingiva. When the central vestibular incision was <10mm from the gingiva, patients tended to form synechia (60%). There were no significant differences in wound healing between the Chinese and Italian patients.

Conclusions: Knowledge of vestibular incision healing is essential to provide practical TOETVA clinical guide and to define optimal outcomes evaluation for transoral surgeons. Vestibular wound problems were confined only to the central incision.
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http://dx.doi.org/10.1007/s00423-021-02124-wDOI Listing
March 2021

The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery.

Gland Surg 2021 Jan;10(1):143-153

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China.

Background: Injuries to the external branches of the superior laryngeal nerve (EBSLN) are difficult to identify during thyroidectomy. Monitoring the low amplitudes of the EBSLN during surgery has proven to be complicated. Therefore a new parameter, the area under the waveform (AUW), was designed to improve monitoring efficiency. The aim of this study was to determine the effectiveness of using AUW to monitor the EBSLN during thyroidectomy.

Methods: A total of 927 patients and 927 recurrent laryngeal nerves (RLN) and EBSLNs who underwent monitored unilateral thyroidectomy were included. Standardized intraoperative neuromonitoring procedures were followed. RLN injuries were confirmed using stroboscopic laryngoscopy after surgery. EBSLN injuries were identified by means of observing changes in cricothyroid muscle (CTM) twitches when stimulated. Amplitude and AUW changes were assessed using statistical analysis. The correlations between AUW and amplitude were verified using the ratio of the two parameters to determine any decreases that were observed in the number of nerve injury cases. The receiver operating characteristic (ROC) curve was used to estimate the prediction of nerve injury.

Results: The overall injury rates of the RLN and EBSLN were 3.56% and 2.05%, respectively. The AUW for the RLN and EBSLN presented linear correlations with amplitude. In the RLN injury cases, no significant difference was observed between the two parameters (P>0.05). In the cases with EBSLN injuries, the AUW decreased 64.5%±14.1%, on average, which was a greater decrease compared to that observed for amplitude 49.7%±22.2% (P<0.0001). The summary of the EBSLN injury prediction included, amplitude AUW, AUC: 0.918 0.994; P<0.0001, and Youden's index: 31.54% 49.58%.

Conclusions: The AUW demonstrated consistency with the change in amplitude, and the observed changes were significant. The use of the AUW allowed successful predictions for both RLN and EBSLN nerve injuries. Also, the sensitivity of AUW was greater than amplitude for predicting EBSLN injuries.
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http://dx.doi.org/10.21037/gs-20-570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882319PMC
January 2021

Efficacy and acceptability of the S1P receptor in the treatment of multiple sclerosis: a meta-analysis.

Neurol Sci 2021 May 1;42(5):1687-1695. Epub 2021 Feb 1.

Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, 570100, People's Republic of China.

Background And Objective: Sphingosine-1-phosphate (S1P) receptors are extensively used in the treatment of multiple sclerosis (MS). However, the optimal therapeutic role of S1P in MS patients has still remained elusive. This network meta-analysis (NMA) systematically evaluated the efficacy and acceptability of S1P receptors, as disease-modifying drugs, in the treatment of patients with MS, so as to find out the most appropriate therapeutic strategy and provide a reliable basis for the prescription of S1P drugs for patients with MS.

Methods: We conducted a systematic review and NMA to compare the efficacy and acceptability of S1P receptors for treating MS patients. Randomized controlled trials (RCTs), which were published until May 2020, were retrieved from the PubMed, Cochrane Library, Embase, and ClinicalTrials.gov databases. The primary outcome in this study was the treatment efficacy for the S1P receptor for MS patients, in terms of decrease in annualized relapse rate. The secondary outcomes were adverse events leading to discontinuation of a study, such as an unfavorable or unintended sign/symptom. Outcomes were appraised using a random effects model expressed as standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs), respectively, and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities for hierarchical clustering of interventions.

Results: A total of 13 RCTS were included, which enrolled 10,554 patients. The results of NMA showed that Fingolimod, Laquinimod, Siponimod, Ozanimod, Amiselimod, and Ponesimod were superior to placebo in terms of reducing the annualized relapse rate of MS patients. Regarding efficacy, the best and worst treatments were Amiselimod (0.4 mg; SUCRA 8.1%) and placebo (SUCRA 90.5%), respectively. As for acceptability, the best and worst interventions were Ozanimod (1 mg; SUCRA 20.4%) and Ponesimod (40 mg; SUCRA 96.0%), respectively. The comparison-adjusted funnel plots of annualized relapse rate and side effects in the included studies revealed that there was no significant funnel plot asymmetry CONCLUSIONS: This NMA indicated that Amiselimod (0.4 mg) is the most effective treatment strategy as a S1P receptor for MS patients. However, the abovementioned findings need to be further confirmed in the next researches.
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http://dx.doi.org/10.1007/s10072-021-05049-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043952PMC
May 2021

Iron Metabolism and Ferroptosis in Epilepsy.

Front Neurosci 2020 8;14:601193. Epub 2020 Dec 8.

Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.

Epilepsy is a disease characterized by recurrent, episodic, and transient central nervous system (CNS) dysfunction resulting from an excessive synchronous discharge of brain neurons. It is characterized by diverse etiology, complex pathogenesis, and difficult treatment. In addition, most epileptic patients exhibit social cognitive impairment and psychological impairment. Iron is an essential trace element for human growth and development and is also involved in a variety of redox reactions in organisms. However, abnormal iron metabolism is associated with several neurological disorders, including hemorrhagic post-stroke epilepsy and post-traumatic epilepsy (PTE). Moreover, ferroptosis is also considered a new form of regulation of cell death, which is attributed to severe lipid peroxidation caused by the production of reactive oxygen species (ROS) and iron overload found in various neurological diseases, including epilepsy. Therefore, this review summarizes the study on iron metabolism and ferroptosis in epilepsy, in order to elucidate the correlation between iron and epilepsy. It also provides a novel method for the treatment, prevention, and research of epilepsy, to control epileptic seizures and reduce nerve injury after the epileptic seizure.
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http://dx.doi.org/10.3389/fnins.2020.601193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793792PMC
December 2020

Multi-Encapsulation Combination of O/W/O Emulsions with Polyurea Microcapsules for Controlled Release and Safe Application of Dimethyl Disulfide.

ACS Appl Mater Interfaces 2021 Jan 22;13(1):1333-1344. Epub 2020 Dec 22.

Institute of Plant Protection, Chinese Academy of Agricultural Sciences, Beijing 100193, China.

Dimethyl disulfide (DMDS), a promising alternative fumigant, has been highly desirable for excellent management of soil pests and diseases. However, high volatility and moderate toxicity of this sulfide limit its application. To address these issues, a novel controlled release formulation of DMDS was proposed employing multiple emulsions and polyurea microcapsules ([email protected]). The successful combination of the two technologies was revealed by confocal laser scanning microscopy, scanning electron microscopy, thermogravimetric analysis, and Fourier transform infrared. According to the multiple encapsulation structure, the encapsulation efficiency decreased by only 3.13% after thermal storage, compared with a 15.21% decrease of microcapsules made with only a monolayer film. [email protected] could effectively control the release of active ingredient, which increased applicator and environmental safety during application. Moreover, it could be facilely used by spraying and drip irrigation instead of a special fumigation device. The innovative formulation exhibited better control efficacy on soil pathogens ( spp. and spp.) and root-knot nematodes ( spp.) than DMDS technical concentration (DMDS TC). In addition, it did not inhibit seed germination after 10 days when the plastic film was removed from the fumigated soil. This method appears to be of broad interest for the development of safe and handy fumigant application.
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http://dx.doi.org/10.1021/acsami.0c16613DOI Listing
January 2021

Electronic Raman Scattering in Suspended Semiconducting Carbon Nanotube.

J Phys Chem Lett 2020 Dec 7;11(24):10497-10503. Epub 2020 Dec 7.

Beijing National Laboratory for Molecular Sciences, Key Laboratory for the Physics and Chemistry of Nanodevices, State Key Laboratory of Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China.

The electronic Raman scattering (ERS) features of single-walled carbon nanotubes (SWNTs) can reveal a wealth of information about their electronic structures. Previously, the ERS processes have been exclusively reported in metallic SWNTs (M-SWNTs) and attributed to the inelastic scattering of photoexcited excitons by a continuum of low-energy electron-hole pairs near the Fermi level. Therefore, the ERS features have been thought to appear exclusively in M-SWNTs but not in semiconducting SWNTs (S-SWNTs), which are more desired in many application fields such as nanoelectronics and bioimaging. In this work, the experimental observation of the ERS features in suspended S-SWNTs is reported, the processes of which are accomplished via the available high-energy electron-hole pairs. The excitonic transition energies with an uncertainty in the order of ±1 meV can be directly obtained via the ERS spectra, compared to a typical uncertainty of ±10 meV in conventional electronic spectroscopies. The ERS features can facilitate further systematic studies on the properties of SWNT, both metallic and semiconducting, with defined chirality.
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http://dx.doi.org/10.1021/acs.jpclett.0c03320DOI Listing
December 2020

Organic fertilizer improves soil fertility and restores the bacterial community after 1,3-dichloropropene fumigation.

Sci Total Environ 2020 Oct 18;738:140345. Epub 2020 Jun 18.

Institute of Plant Protection, Chinese Academy of Agricultural Sciences, Beijing 100193, China; Beijing Innovation Consortium of Agriculture Research System, Beijing 100029, China. Electronic address:

Although fumigants can effectively control soil-borne diseases they are typically harmful to beneficial microorganisms unless methods are developed to encourage their survival after fumigation. The soil fumigant 1,3-dichloropropene (1,3-D) is widely used because of its effective management of pathogenic nematodes and weeds. After fumigation with 1,3-D, Bacillus subtilis and Trichoderma harzianum fertilizer (either singularly or together) or humic acid were added to soil that had been used to produce tomatoes under continuous production for >20 years. We evaluated changes to the soil's physicochemical properties and enzyme activity in response to these fertilizer treatments, and the effects of these changes on beneficial bacteria. Fertilizer applied after fumigation increased the content of ammonium nitrogen, nitrate nitrogen, available phosphorus, available potassium and organic matter, and it promoted an increase in pH and electrical conductivity. The activity of urease, sucrase and catalase enzymes in the soil increased after fumigation. Taxonomic identification of bacteria using genetic analysis techniques showed that fertilizer applied after fumigation increased the abundance of Actinobacteria and the relative abundance of the biological control genera Sphingomona, Pseudomonas, Bacillus and Lysobacter. The abundance of these beneficial bacteria increased significantly when B. subtilis and T. harzianum were applied together. These results showed that fertilizer applied after fumigation can increase the abundance of beneficial microorganisms in the soil within a short period of time, which improved the soil's fertility, ecological balance and potentially crop quality and yield.
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http://dx.doi.org/10.1016/j.scitotenv.2020.140345DOI Listing
October 2020

Outcomes following minimally invasive imagine-guided percutaneous ablation of adrenal glands.

Gland Surg 2020 Jun;9(3):859-866

Unità Operativa di Radiologia, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Whilst surgery represents the gold standard for the treatment of adrenal primary malignant tumors, metastatic involvement of the adrenal glands is generally approached conservatively; however, surgery for local control has been controversial, and several reports have described the utility of surgical removal in terms of prolonged survival in selected patients. Different techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser induced thermal therapy (LITT), cryoablation (CRA), and chemical ablation, are employed in percutaneous image-guided ablation for primary and metastatic malignancies of the adrenal glands, in case of patients with multiple comorbidities or who refuse surgery. Technical success, clinical success and safety were analysed and discussed in this systematic review. Tumor size was found a significant determinant for local disease control; histology of the primary malignancy and coexistence of tumor elsewhere were correlated with prognosis. These procedures resulted to be feasible and safe, with hypertensive crisis representing the most common complication. Although there is lack of evidence in the literature concerning outcomes compared with surgery, percutaneous ablation may represent a useful therapeutic option for controlling unresectable adrenal metastases, offering patients opportunities for improved survival.
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http://dx.doi.org/10.21037/gs.2020.03.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347819PMC
June 2020

Posture and dysphonia associations in patients undergoing total thyroidectomy: stabilometric analysis.

Updates Surg 2020 Dec 11;72(4):1143-1149. Epub 2020 Jul 11.

Division for Otorhinolaryngology, Department of Adult and Development Age Human Pathology "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy.

The aim of this study is the analysis of postural changes of patients affected by vocal disorders post-thyroidectomy, in the absence of post-operative organ damage, through a stabilometry analysis, evaluating the effectiveness of a speech-language intensive treatment in phoniatric and postural quality recovery. 260 patients with vocal dysfunction after surgery without iatrogenic damage were enrolled. 130 patients were subject to post-surgical logopedic rehabilitative training (Group A); other 130 patients were not subject to any post-surgical treatment (Group B). For all patients, vocal and stabilometric parameters were evaluated before and after 2 days and 1 month from surgery. Vocal parameters evaluated were Voice Handicap Index-10, Maximum Phonation Time and objective evaluation of voice with Multidimensional Voice Program (MDVP). Stabilometric parameters evaluated were Sway area (mm) and Sway velocity (mm/s) in firm surface and foam pad with eyes opened and closed. Regarding the stabilometric parameters, Group A obtained a statistically significant recovery of the correct posture statistically significant compared to Group B, after a month of speech therapy. Vocal parameters (VHI, MPT, MDVP) were statistically different between the two groups (p < 0.05), with a better improvement in Group A. Thanks to our study, we have shown that a logopedic rehabilitation therapy in patients with dysfunctional post-thyroidectomy dysphonia improves both the vocal and postural outcomes.
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http://dx.doi.org/10.1007/s13304-020-00844-0DOI Listing
December 2020

A Randomized Comparison of Carbon Nanoparticles in Endoscopic Lymph Node Dissection Via the Bilateral Areola Approach for Papillary Thyroid Cancer.

Surg Laparosc Endosc Percutan Tech 2020 Aug;30(4):291-299

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma.

Objective: We assess the value of carbon nanoparticles (CNP) staining in patients undergoing endoscopic thyroidectomy and central compartment lymph node (CLN) dissection via the bilateral areola approach [endoscopic thyroidectomy via bilateral areola approach (ETBAA)].

Methods: This was a prospective randomized study. Three hundred two consecutive early-stage thyroid cancer patients eligible for ETBAA were recruited at the Division of Thyroid Surgery, China-Japan Union Hospital, Jilin University, China. CLN were mapped and retrieved under the guidance of stained or unstained CNP. The location, detection rates, positive nodes, and number of stained lymph nodes were compared.

Results: ETBAA patients were randomly divided into a CNP group (n=152) and a control group (n=150). In the CNP group, the imaging of lymphatic flow could be observed in 1016 (95.9%) lymph nodes, whereas 43 (4.1%) were unstained. The mean number of stained lymph nodes in each procedure was 6.68 (range, 3 to 12). The total number of dissected lymph nodes was 1059 in the CNP group and 872 in the control group (P=0.00). There was a significant difference of inadvertent parathyroidectomy between the 2 groups: 0.5% versus 3.9% in lobectomy (P=0.035) and 0.6% versus 5.2% in total thyroidectomy (P=0.012). However, the rates of hypoparathyroidism were not significantly different (P>0.05). There were no cases of CNP-related adverse effects.

Conclusions: The lymphatic navigation by CNP increases the number of detected CLN without the involvement of radioactive isotopes. However, CNP did not lower hypocalcemia, did not improve parathyroid hormone range, and there was no significant difference in the percentage of metastatic lymph nodes between the 2 groups.
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http://dx.doi.org/10.1097/SLE.0000000000000793DOI Listing
August 2020

Biochar mitigates the negative effect of chloropicrin fumigation on beneficial soil microorganisms.

Sci Total Environ 2020 Oct 2;738:139880. Epub 2020 Jun 2.

Institute of Plant Protection, Chinese Academy of Agricultural Sciences, Beijing 100193, China. Electronic address:

Chloropicrin (CP) is the most commonly used soil fumigant worldwide. Although CP effectively controls soilborne pathogens, it is also detrimental to beneficial soil microorganisms unless measures can be put in place to protect them from the effects of fumigation. In this study, we evaluated the ability of biochar made from the invasive weed Eupatorium adenophorum to mitigate the effects of CP fumigation on beneficial species. Our results showed that the addition of biochar to the soil effectively reduced the detrimental effects of CP on beneficial species and their ecological functions. Biochar added to CP-fumigated soil shortened the time to 28-84 days for microbial diversity and nitrogen cycle functions to be restored to unfumigated levels. At the same time, the inorganic nitrogen (NH-N, NO-N) content and NO production potential level in CP-fumigated soil returned to unfumigated levels relatively quickly, which showed that nitrogen metabolism improved with the addition of biochar. The mitigation effect of biochar in CP-fumigated soil was more evident at higher biochar amendment rates. Our results suggest that the addition of biochar to CP-fumigated soil significantly reduced the impact of CP on beneficial species and their ecological functions, and significantly shortened the time for beneficial species to recover to pre-fumigation levels. Field research is required to determine biochar's ability to mitigate the impact of CP and other fumigants on beneficial species and to quantify its benefits on crop quality and yield.
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http://dx.doi.org/10.1016/j.scitotenv.2020.139880DOI Listing
October 2020

Recurrent laryngeal nerve management in transoral endoscopic thyroidectomy.

Oral Oncol 2020 09 8;108:104755. Epub 2020 Jun 8.

Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address:

Introduction: The mechanism of recurrent laryngeal nerve (RLN) injury was investigated during a TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA).

Methods: The function of 185 nerves at risk (NAR) was recorded with intermitted intraoperative neural monitoring (I-IONM). The RLN electromyography (EMG) was delineated during: (a) a pre-dissection vagal nerve stimulation; (b) a RLN stimulation at initial visualization; (c) at nerve dissection; and (d) at the final verification of the entire RLN route. The location, genesis, segmental or diffuse and the outcomes of RLN injuries were catalogued.

Results: Twelve nerves (6.4%) lost the EMG signal and the incidences of temporary and permanent RLN dysfunction were 5.9% and 0.5%. A disrupted point (type 1 injury) could be identified in 7/12 nerves (58%). Five (42%) nerve injuries were classified as global (type 2). Of the seven type 1 injuries, 3 lesions occurred at the RLN laryngeal entry point during the nerve identification. Four type 1 injuries were at the distal 1 cm of the RLN course and during the early nerve dissection. No proximal (>2 cm) injuries occurred. The mechanisms of the injuries were thermal (58%) during the energy-based device use at the ligament of Berry dissection or at the dividing small branches of the inferior thyroid artery. Two (16%) traction injuries occurred during the early nerve dissection. In 2 cases we could not elucidate the mechanism of RLN injury (16%) and 1 injury (8%) was caused by the connective tissue constricting band of. The thermal RLN lesions had longer recovery times.

Conclusions: The RLN palsy occurs in TOETVA, even when combined with an endoscopic magnification, IONM, early nerve identification, cranial to caudal dissection and top-down view. The thermal RLN injury was the most frequent cause and all injuries occurred at the distal RLN course.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104755DOI Listing
September 2020

Consequences of Trocar Dynamics on Mental Nerve in Transoral Thyroidectomy.

Surg Laparosc Endosc Percutan Tech 2020 Aug;30(4):305-311

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, People's Republic of China.

Background: Mental nerve (MN) injuries are reported during transoral endoscopic thyroidectomy vestibular approach. Effect of trocar insertion and position on MN are examined in the present study.

Materials And Methods: Ten millimeter incision was made at the center of the lower lip oral vestibule. Two 5 mm lateral incisions of the lower lip oral vestibule were made at the junction between the incisor and the canine. These 2 lateral incisions were high, just below the edge of lower lip. Nine pigs (18 MN) were randomly divided into 3 groups and MN dissection was performed. The angle between the lateral ports and median line were changed between 15 and 45 degrees among 3 groups and effect on MN was examined.

Results: During dissection when insertion and other ports are in neutral position visual inspection of MNs did not reveal any compression bilaterally. The distance between MN and the ports was 18.2±2.1 mm (16.3 to 21.2 mm). In group I and group II, MNs have no compression by the lateral trocars. In group III (45 degrees), left MNs were all compressed. Two MNs (66.7%) were compressed on the right side. The MN was compressed at its ramification.

Conclusions: The results of the present experimental study, endorse the suggested medial and lateral vestibular incisions for transoral endoscopic thyroidectomy vestibular approach. However, during dynamic modification of the lateral port position/angle, MN compression was observed when the angle was >45 degrees.
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http://dx.doi.org/10.1097/SLE.0000000000000795DOI Listing
August 2020

Single port transoral thyroidectomy.

Gland Surg 2020 Apr;9(2):159-163

Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy.

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http://dx.doi.org/10.21037/gs.2020.01.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225491PMC
April 2020

Platysmal Lineaments of the Neck With Emphasis on Endoscopic Endocrine Surgery.

Surg Laparosc Endosc Percutan Tech 2020 Aug;30(4):300-304

KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Korea.

Background: In endoscopic neck endocrine surgery, the subplatysmal plane is an anatomic key structure that must be identified and preserved, to progress with the dissection. We define the prevalence of platysma, in the intermediate plane of the anterior cervical region, and evaluate potential statistical correlations with clinical and pathologic variables.

Materials And Methods: The study included patients who had thyroid surgery. Morphologies, asymmetry, and patterns of the platysma were described. The analysis of the different considered variables was quantitative and qualitative, using multiple data reports.

Results: A total of 23 men and 90 women, aged 19 to 70 (median 41±19) years constituted the study cohort. Their neck circumference and height were 388.5±45 mm (334 to 479 mm) and 200±30 mm (160 to 270 mm), respectively. The hemi-platysmal muscle was bilaterally identified in 109 (96.4%). The mean platysmal thickness was 2.7±1.7 mm (range: 0.7 to 8.2 mm). The intermediate plane between the platysmal muscles was classified into 4 types, depending on the muscle features in the midline: Type A: the left and right platysmal fibers were interlaced with each other in the midline (7%); type B: the platysmal fibers were disconnected by <1 cm (27%); type C: between 1 and 3 cm (52%); and type D separated >3 cm (14%).

Conclusions: We provide descriptive characteristics of the cervical platysma. A better understanding of the anatomic variability in cervical platysma may be useful in performing a more accurate dissection in endoscopic endocrine neck surgery.
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http://dx.doi.org/10.1097/SLE.0000000000000792DOI Listing
August 2020

Strategies for superior thyroid pole dissection in transoral thyroidectomy: a video operative guide.

Surg Endosc 2020 08 7;34(8):3711-3721. Epub 2020 May 7.

Division of Thyroid Surgery, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma, China-Japan Union Hospital Of Jilin University, 126 Xiantai Blvd, Changchun city, Jilin province, People's Republic of China.

Background: The dissection of the superior thyroid gland pole is challenging when using the in TransOral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) due to (a) the cranio-caudal approach, (b) cranial-caudal view, and (c) the restriction of maneuverability inside the narrow neck air pocket.

Methods: In this paper and operative video guide, a series of TOETVA's tips and tricks are presented with an emphasis on the strategies for a safe approach to the superior thyroid gland pole structures.

Results: Management of the upper thyroid pole structures includes: (a) use of a 5 mm/30°-45° endoscope; (b) retraction ports up to the limit of the lower jaw edge; (c) lateral retraction of 1/3 of the cranial strap muscles; (d) isthmectomy; (e) cutting the sternothyroid muscle cranially for 1 cm; (f) retraction of the thyroid upwards and laterally; (g) monitoring the external branch of the superior laryngeal nerve, and (h) sealing individual vessel branches.

Conclusion: Access to the superior thyroid pole space through the TOETVA approach presents some challenges, particularly when accessing thyroid vessels or nodules located or displaced more cranially. Strategies that enhance a critical view of the superior thyroid gland structures can protect them from damage and have the potential to improve the safety of the TOETVA and decrease potential conversion rates.
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http://dx.doi.org/10.1007/s00464-020-07577-6DOI Listing
August 2020

Continuous Neural Monitoring in Endoscopic Thyroidectomy: Feasibility Experimental Study for Transcutaneous Vagal Nerve Stimulation.

J Laparoendosc Adv Surg Tech A 2020 Oct 24;30(10):1095-1101. Epub 2020 Mar 24.

Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, China.

Adoption of continuous intraoperative neural monitoring (C-IONM) in endoscopic thyroid surgery is limited due to the uneasy application of C-IONM electrode. Feasibility for transcutaneous vagal nerve stimulation was tested. Vagus nerve (VN) and recurrent laryngeal nerve (RLN) were mapped and stimulated in different neck sites by (1) transcutaneous monopolar intermitted stimulation; (2) prototype for continuous transcutaneous stimulating electrodes (TSEs), that is, suction ball C-IONM electrode remodeled; (3) stimulation subsequently to neck CO insufflation; (4) direct stimulation of surgical exposed nerves. Electromyographic (EMG) parameters were compared. Six anterior neck locations evoked EMG signals of VNs and RLNs. Location Nos. 3 and 6 according to our scheme were over the VNs, confirmed by ultrasonography and subsequent dissection. Other locations did not correspond to nerves sites. Transcutaneous thresholds were higher than surgical exposed ones to produce a consistent and satisfactory EMG response. TSE recorded solely in location No. 5 with amplitude values 256-9 μV. It was not possible to stimulate and monitor the RLN and VN after neck CO insufflation. Transcutaneous C-IONM is unfeasible for endoscopic thyroidectomy.
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http://dx.doi.org/10.1089/lap.2020.0073DOI Listing
October 2020
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