Complete bilateral central neck dissection should be considered for isthmic PTC because of the high rate of bilateral central lymph node metastasis, especially to pretracheal and bilateral paratracheal lymph nodes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E412-E416, 2016.

Background The aim of this study was to evaluate the feasibility, safety, and early surgical outcomes of transoral thyroidectomy and to compare robotic and endoscopic procedures. Methods A total of 37 patients underwent robotic (23 cases) or endoscopic (14 cases) transoral thyroidectomy. We compared the outcomes of the two procedures. Results Of the 37 patients, 2 were converted to the robotic facelift approach as a result of an intraoperative CO2 embolism and inability to remove the tumor. The mean operative time was 172.8 ± 37.5 minutes. Transient recurrent laryngeal nerve palsy occurred in one case, and transient hypoparathyroidism in two cases. Most of patients were satisfied with the postoperative cosmesis. There were no significant differences between the robotic and endoscopic procedures, except for operative time, which was significantly longer in the robotic group. Conclusion Robotic and endoscopic transoral thyroidectomies are both feasible and safe in appropriate patients.

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Background Epidemiological studies have suggested an association between selenium (Se) and diabetes mellitus (DM). However, different studies have reported conflicting results. Therefore, we performed a comprehensive meta-analysis to clarify the impact of Se on DM. Methods We searched the PubMed database for studies on the association between Se and DM from inception to June 2018. Results Twenty articles evaluating 47,930 participants were included in the analysis. The meta-analysis found that high levels of Se were significantly associated with the presence of DM (pooled odds ratios [ORs], 1.88; 95% confidence interval [CI], 1.44 to 2.45). However, significant heterogeneity was found ( I 2 =82%). Subgroup analyses were performed based on the Se measurement methods used in each study. A significant association was found between high Se levels and the presence of DM in the studies that used blood (OR, 2.17; 95% CI, 1.60 to 2.93; I 2 =77%), diet (OR, 1.61; 95% CI, 1.10 to 2.36; I 2 =0%), and urine (OR, 1.49; 95% CI, 1.02 to 2.17; I 2 =0%) as samples to estimate Se levels, but not in studies on nails (OR, 1.24; 95% CI, 0.52 to 2.98; I 2 =91%). Because of significant heterogeneity in the studies with blood, we conducted a sensitivity analysis and tested the publication bias. The results were consistent after adjustment based on the sensitivity analysis as well as the trim and fill analysis for publication bias. Conclusion This meta-analysis demonstrates that high levels of Se are associated with the presence of DM. Further prospective and randomized controlled trials are warranted to elucidate the link better.

We investigated the cardiovascular complications and mortality rates of patients with diabetes in South Korea. The rates of hospitalization due to cardiovascular complications and mortality were analyzed using the Korean National Health Insurance Service-National Sample Cohort. From 2006 to 2015, the rates of hospitalization due to major cardiovascular complications decreased, while those due to heart failure (from 72 to 146 and 124 to 161 per 10,000 men and women, respectively) and peripheral artery disease (from 39 to 55 and 19 to 35 per 10,000 men and women, respectively) increased. In the period 2007 to 2015, the mortality rates for cancer, cerebrovascular disease, diabetes, heart disease, and hypertensive disease all decreased. However, the mortality rate for pneumonia increased. We observed a continuous reduction in cardiovascular complications and mortality in adults with diabetes. However, with the increase in some diabetes complications, more efforts are needed to prevent diabetes complications.

Body mass index (BMI) has limited accuracy for predicting cardiovascular diseases (CVD) and is not capable of identifying sarcopenic obesity, the combination of sarcopenia (an age-associated decline in muscle mass and physical function) and obesity. To overcome this, the z-score of the log-transformed A Body Shape Index (LBSIZ) was recently introduced as a measure of obesity using waist circumference, height, and weight. We aimed to investigate the association of LBSIZ with sarcopenic obesity and CVD, and propose appropriate cut-off values using the National Health and Nutrition Examination Survey 1999–2016 data. Of 92,062 participants, 40,468 adults (≥20 years) were included. Overall area under curve (AUC) of LBSIZ was 0.735 (95% confidence interval [CI]: 0.716–0.754) for sarcopenic obesity, and 0.695 (95% CI: 0.687–0.703) for CVD. The subgroup analysis of ethnicity/race showed similar results. Waist circumference (WC), BMI, conicity index, body roundness index (BRI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), new BMI, and waist to height ratio (WHtR) showed a negative association with sarcopenic obesity, while LBSIZ and conicity index showed a positive association. The AUC of LBSIZ was significantly higher for sarcopenic obesity than that of conicity index (p < 0.001). The AUC of LBSIZ was significantly higher for CVD than those of parameters including WC, BMI, BRI, CUN-BAE, new BMI, and WHtR (p < 0.001). The AUC for conicity index alone was comparable to that of LBSIZ for CVD. Overall LBSIZ cut-off was 0.35 for both sarcopenic obesity (sensitivity, 65.3%; specificity, 71.5%) and CVD (sensitivity, 63.3%; specificity, 66.6%). These results may be useful not only to identify sarcopenic obesity, but also to conduct CVD risk assessment in the clinical setting.

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Body mass index (BMI) and waist circumference (WC) have limitations in stratifying cardio-metabolic risks. Another obesity measure, A Body Shape Index (ABSI), has been introduced but its applicability remains limited. To address this, the z-score of the log-transformed ABSI (LBSIZ) was recently developed. This study aimed to examine the ability of LBSIZ, compared to that of WC and BMI, to predict cardiovascular disease (CVD) risk. The study included 8,485 participants aged 40–69 years (mean age = 52.1) who were followed for 10 years and recruited from the Korean Genome and Epidemiology Study, a population-based cohort study. The area under the curve was 0.635 (95% confidence interval [CI]: 0.614–0.657) for LBSIZ, 0.604 (95%CI: 0.580–0.627) for WC, and 0.538 (95%CI: 0.514–0.562) for BMI. The AUC of the Framingham risk score (FRS) was 0.680 (95%CI: 0.659–0.701) in comparison. When we added LBSIZ to the model, the integrated AUC significantly improved from 0.680 to 0.692 (95%CI: 0.672–0.713; p value, 0.033), whereas there were no changes with BMI (AUC, 0.678; 95%CI: 0.656–0.699) or WC (AUC, 0.679; 95%CI: 0.658–0.701). In the multivariate Cox regression analysis, LBSIZ but not BMI or WC showed a significant hazard ratio of CVD event compared to 1st decile of each parameter. In the restricted cubic spline regression, BMI and WC showed an overall J-shaped relationship with CVD events whereas LBSIZ showed a linear relationship. LBSIZ is strongly associated with CVD risk and should predict CVD risk better than BMI and WC in the general population.