Background
This study compared the surgical outcomes of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) in papillary thyroid cancer (PTC).
...Methods
The TOETVA and TORT groups comprised 119 and 121 patients between November 2016 and May 2022. Clinico‐surgical outcomes and operation times were retrospectively reviewed.
Results
The TORT group showed a higher number of retrieved central compartment lymph nodes, shorter hospital stays, and lower pain score after 48 h than the TOETVA group. No significant difference was observed in the other postoperative complications, including permanent vocal cord palsy. Total operation, working space creation, and endoscopic or robotic surgery times of the TORT group were longer than those of the TOETVA group.
Conclusions
TORT and TOETVA are feasible and safe. TORT may have some advantages, such as central compartment node dissection, shorter hospital stays, and pain score after 48 h in PTC, despite a longer operative time.
Background
The failure to preserve parathyroid function in patients who have undergone total thyroidectomy is of major concern, because hypocalcemia is difficult to prevent and remains a common ...postoperative complication. Here, we describe procedures designed to preserve the vasculature supplying the parathyroid glands and examine both recent outcomes and retrospective reports of results obtained prior to the application of these preservation techniques.
Methods
Our technique for preserving parathyroid function during thyroidectomy was adopted in 2009 and involves separating a relatively long segment of a vessel distally from the thyroid gland. We reviewed the medical records of 1,411 patients who underwent total thyroidectomy, with or without lateral neck dissection, at the Samsung Medical Center from January 2006 through June 2014 to determine outcomes. Patients were divided into three groups according to the time period during which the surgery took place: Group A, 2006–2008 (before the vasculature-preserving technique was applied); Group B, 2009–2011 (the time when the technique was first adopted); and Group C, 2012–2014 (more recent results of the technique). We analyzed the incidence of hypoparathyroidism in the three groups, as well as risk factors that influenced its development.
Results
The rates of transient and permanent hypoparathyroidism in Group A were 25.4 and 4.3 %, respectively. However, the incidence of hypoparathyroidism decreased significantly over time after the vasculature-preserving procedure was adopted. Transient hypoparathyroidism developed in 4.8 % of Group C patients, and only four (0.7 %) of the 565 patients in this group required calcium supplementation, despite the fact that a greater number of patients were included who underwent total thyroidectomy combined with lateral neck dissection. Although female sex and lateral neck dissection tended to increase the rate of transient hypoparathyroidism, multivariate analysis showed that the vasculature-preserving procedure was the only significant risk factor related to postoperative hypoparathyroidism.
Conclusion
The blood flow of the final branch to the parathyroid gland is mostly in the lateral-to-medial direction; therefore, mobilization and preservation of the vessels lateral to the gland is essential to prevent devascularization of the parathyroid gland.
Recent studies have shown remarkable success in image-to-image translation for two domains. However, existing approaches have limited scalability and robustness in handling more than two domains, ...since different models should be built independently for every pair of image domains. To address this limitation, we propose StarGAN, a novel and scalable approach that can perform image-to-image translations for multiple domains using only a single model. Such a unified model architecture of StarGAN allows simultaneous training of multiple datasets with different domains within a single network. This leads to StarGAN's superior quality of translated images compared to existing models as well as the novel capability of flexibly translating an input image to any desired target domain. We empirically demonstrate the effectiveness of our approach on a facial attribute transfer and a facial expression synthesis tasks.
A good image-to-image translation model should learn a mapping between different visual domains while satisfying the following properties: 1) diversity of generated images and 2) scalability over ...multiple domains. Existing methods address either of the issues, having limited diversity or multiple models for all domains. We propose StarGAN v2, a single framework that tackles both and shows significantly improved results over the baselines. Experiments on CelebA-HQ and a new animal faces dataset (AFHQ) validate our superiority in terms of visual quality, diversity, and scalability. To better assess image-to-image translation models, we release AFHQ, high-quality animal faces with large inter- and intra-domain differences. The code, pretrained models, and dataset are available at https://github.com/clovaai/stargan-v2.
Perovskite materials have garnered significant attention over the past decades due to their applications, not only in electronic materials, such as dielectrics, piezoelectrics, ferroelectrics, and ...superconductors but also in optoelectronic devices like solar cells and light emitting diodes. This interest arises from their versatile combinations and physiochemical tunability. While strain engineering is a recognized powerful tool for tailoring material properties, its collaborative impact on both oxides and halides remains understudied. Herein, strain engineering in perovskites for energy conversion devices, providing mutual insight into both oxides and halides is discussed. The various experimental methods are presented for applying strain by using thermal mismatch, lattice mismatch, defects, doping, light illumination, and flexible substrates. In addition, the main factors that are influenced by strain, categorized as structure (e.g., symmetry breaking, octahedral distortion), bandgap, chemical reactivity, and defect formation energy are described. After that, recent progress in strain engineering for perovskite oxides and halides for energy conversion devices is introduced. Promising methods for enhancing the performance of energy conversion devices using perovskites through strain engineering are suggested.
Oxide and halide perovskites play a key role in various energy conversion devices such as piezoelectric devices, catalysts, light emitting diodes, and photodetectors. This review covers the latest studies on strain engineering in both oxide and halide perovskites for energy conversion devices. The work provides a new insight that can lead breakthroughs for high performance energy conversion devices.
A polar conductor, where inversion symmetry is broken, may exhibit directional propagation of itinerant electrons, i.e., the rightward and leftward currents differ from each other, when time-reversal ...symmetry is also broken. This potential rectification effect was shown to be very weak due to the fact that the kinetic energy is much higher than the energies associated with symmetry breaking, producing weak perturbations. Here we demonstrate the appearance of giant nonreciprocal charge transport in the conductive oxide interface, LaAlO
/SrTiO
, where the electrons are confined to two-dimensions with low Fermi energy. In addition, the Rashba spin-orbit interaction correlated with the sub-band hierarchy of this system enables a strongly tunable nonreciprocal response by applying a gate voltage. The observed behavior of directional response in LaAlO
/SrTiO
is associated with comparable energy scales among kinetic energy, spin-orbit interaction, and magnetic field, which inspires a promising route to enhance nonreciprocal response and its functionalities in spin orbitronics.
IMPORTANCE: Data on P2Y12 inhibitor monotherapy after short-duration dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention are limited. OBJECTIVE: To determine ...whether P2Y12 inhibitor monotherapy after 3 months of DAPT is noninferior to 12 months of DAPT in patients undergoing PCI. DESIGN, SETTING, AND PARTICIPANTS: The SMART-CHOICE trial was an open-label, noninferiority, randomized study that was conducted in 33 hospitals in Korea and included 2993 patients undergoing PCI with drug-eluting stents. Enrollment began March 18, 2014, and follow-up was completed July 19, 2018. INTERVENTIONS: Patients were randomly assigned to receive aspirin plus a P2Y12 inhibitor for 3 months and thereafter P2Y12 inhibitor alone (n = 1495) or DAPT for 12 months (n = 1498). MAIN OUTCOMES AND MEASURES: The primary end point was major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke) at 12 months after the index procedure. Secondary end points included the components of the primary end point and bleeding defined as Bleeding Academic Research Consortium type 2 to 5. The noninferiority margin was 1.8%. RESULTS: Among 2993 patients who were randomized (mean age, 64 years; 795 women 26.6%), 2912 (97.3%) completed the trial. Adherence to the study protocol was 79.3% of the P2Y12 inhibitor monotherapy group and 95.2% of the DAPT group. At 12 months, major adverse cardiac and cerebrovascular events occurred in 42 patients in the P2Y12 inhibitor monotherapy group and in 36 patients in the DAPT group (2.9% vs 2.5%; difference, 0.4% 1-sided 95% CI, –∞% to 1.3%; P = .007 for noninferiority). There were no significant differences in all-cause death (21 1.4% vs 18 1.2%; hazard ratio HR, 1.18; 95% CI, 0.63-2.21; P = .61), myocardial infarction (11 0.8% vs 17 1.2%; HR, 0.66; 95% CI, 0.31-1.40; P = .28), or stroke (11 0.8% vs 5 0.3%; HR, 2.23; 95% CI, 0.78-6.43; P = .14) between the 2 groups. The rate of bleeding was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (2.0% vs 3.4%; HR, 0.58; 95% CI, 0.36-0.92; P = .02). CONCLUSIONS AND RELEVANCE: Among patients undergoing percutaneous coronary intervention, P2Y12 inhibitor monotherapy after 3 months of DAPT compared with prolonged DAPT resulted in noninferior rates of major adverse cardiac and cerebrovascular events. Because of limitations in the study population and adherence, further research is needed in other populations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02079194
Global soil nitrogen (N) cycling remains poorly understood due to its complex driving mechanisms. Here, we present a comprehensive analysis of global soil δ15N, a stable isotopic signature indicative ...of the N input–output balance, using a machine‐learning approach on 10,676 observations from 2670 sites. Our findings reveal prevalent joint effects of climatic conditions, plant N‐use strategies, soil properties, and other natural and anthropogenic forcings on global soil δ15N. The joint effects of multiple drivers govern the latitudinal distribution of soil δ15N, with more rapid N cycling at lower latitudes than at higher latitudes. In contrast to previous climate‐focused models, our data‐driven model more accurately simulates spatial changes in global soil δ15N, highlighting the need to consider the joint effects of multiple drivers to estimate the Earth's N budget. These insights contribute to the reconciliation of discordances among empirical, theoretical, and modeling studies on soil N cycling, as well as sustainable N management.
The stable N isotope (δ15N) has emerged as a useful tool for integrating N cycling processes into a single metric. Early studies hold that climatic conditions predominantly control soil δ15N and N cycling, whereas our comprehensive analysis reveals prevalent joint effects of climatic conditions, plant N‐use strategies, soil properties, and other natural and anthropogenic forcings on global soil δ15N. Considering the joint effects of multiple drivers is critical for better understanding and assessing the Earth's N balance.
Receptor-interacting protein kinase-3 （RIP3 or RIPK3） is an essential part of the cellular machinery that executes ＂programmed＂ or ＂regulated＂ necrosis. Here we show that programmed necrosis is ...activated in response to many chemotherapeutic agents and contributes to chemotherapy-induced cell death. However, we show that RIP3 expres- sion is often silenced in cancer cells due to genomic methylation near its transcriptional start site, thus RIP3-depen- dent activation of MLKL and downstream programmed necrosis during chemotherapeutic death is largely repressed. Nevertheless, treatment with hypomethylating agents restores RIP3 expression, and thereby promotes sensitivity to chemotherapeutics in a RIP3-dependent manner. RIP3 expression is reduced in tumors compared to normal tissue in 85% of breast cancer patients, suggesting that RIP3 deficiency is positively selected during tumor growth/develop- ment. Since hypomethylating agents are reasonably well-tolerated in patients, we propose that RIP3-deficient cancer patients may benefit from receiving hypomethylating agents to induce RIP3 expression prior to treatment with con- ventional chemotherapeutics.
Ruthenium (Ru) is the most widely used metal as an electrocatalyst for nitrogen (N2) reduction reaction (NRR) because of the relatively high N2 adsorption strength for successive reaction. Recently, ...it has been well reported that the homogeneous Ru‐based metal alloys such as RuRh, RuPt, and RuCo significantly enhance the selectivity and formation rate of ammonia (NH3). However, the metal combinations for NRR have been limited to several miscible combinations of metals with Ru, although various immiscible combinations have immense potential to show high NRR performance. In this study, an immiscible combination of Ru and copper (Cu) is first utilized, and homogeneous alloy nanoparticles (RuCu NPs) are fabricated by the carbothermal shock method. The RuCu homogeneous NP alloys on cellulose/carbon nanotube sponge exhibit the highest selectivity and NH3 formation rate of ≈31% and −73 μmol h−1 cm−2, respectively. These are the highest values of the selectivity and NH3 formation rates among existing Ru‐based alloy metal combinations.
An atomic‐scale homogeneous alloy of immiscible metals is first implemented in electrocatalytic nitrogen reduction (NRR) by a unique carbothermal shock method. Atomic‐scale mixing of ruthenium and copper facilitates pivotal reaction steps in NRR, showing high selectivity and formation rate to ammonia. This paves the way for developing numerous potential homogeneous alloys of immiscible metal combinations for future efficient NRR electrocatalysts.
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