Introduction:
Endoscopic thyroidectomy (ET) has become a well-established surgical technique that is mainly performed for benign thyroid lesions. Several endoscopic approaches are available, such as transaxillary, unilateral axillo-breast approach (UABA), modified anterior chest wall approach (MACWA), bilateral axillo-breast approach, and most recently the transoral approach and the robotic-assisted techniques. There is no recommended approach, because each approach has its own positive and negative attributes. We, herein, compare between UABA and MACWA in terms of surgical and cosmetic outcomes.
Methods:
This prospective study was conducted from April 2016 to August 2017. Forty patients with unilateral benign thyroid lesions were selected. Of them, 20 patients underwent ET using UABA, and 20 patients underwent ET using MACWA. Gas insufflation was implemented for all patients. Clinicopathologic data, surgical outcomes, and cosmetic outcomes in both groups were analyzed.
Results:
There was no significant difference between both groups in the clinicopathologic characteristics. The mean surgical time was significantly longer in the UABA group compared with the chest wall group (147.3 vs. 124.3 min). The postoperative pain scores were relatively lower in the UABA group compared with the MACWA group. We reported a higher rate of persistent paresthesia, neck contracture with swallowing discomfort, and hypertrophic scars in the MACWA group. Cosmetic satisfaction scores for patients who underwent UABA were higher than for those who underwent MACWA.
Conclusions:
Both approaches were similar in terms of safety, feasibility, and operative complications. Even though the surgical time was longer, patients who underwent the UABA reported relatively less postoperative pain, superior cosmetic results, scar perception, and patient satisfaction compared with MACWA.
Immunopatho Genesis of HCV-Related CryoglobulinemiaGlobal B-cell stimulation may be fundamental to HCV-related cryoglobulinemia, which is a consequence of chronic antigenic stimulation of the humeral immune system. It is believed that the hepatitis C virus attaches itself to B lymphocyte cells, which causes the immune system to produce auto-antibodies [6].It is suggested that a proto-oncogene named Bcl-2, when activated, increases B-cell survival by inhibiting apoptosis. This could lead to increased B-cell quantities which may lead to the increased production of auto antibodies and cryoglobulins [7]. Another possibility suggested is that the HCV E2 envelope protein binds to the cell surface glycoprotein CD81 that is present on B cells as well as on hepatocytes, thus reducing the threshold for B-cell activation. A molecular mimicry with NS5A and NS core proteins of HCV can be hypothesized, which might simulate host auto antigens resulting in B-lymphocyte activation and autoantibody production [6,7].
Groundwater in Abu Rawash area has particular importance where it is the source of water used for agricultural, domestic and industrial purposes. Nine groundwater samples from shallow wells were available during summer 2019 and were analyzed for physicochemical characteristics. The physicochemical parameters indicated that the water type is dominance of Na-K-Cl-SO4. These data has been used for preliminary evaluation of suitability of groundwater for irrigation purposes using groundwater quality indices which are irrigation water quality index IWQI, Sodium Adsorption Ratio (SAR), Residual Sodium Carbonate (RSC), and Permeability Index (PI). The average obtained values of IWQI, SAR, RSC, PI respectively were 32.91, 25.35, -31.17, and 76.55 mg/l. According to the IWQI classification, approximately 67% of the groundwater samples were served restriction with no toxicity risk for most plants, while about 33% of samples were high restriction on their use for irrigation. According to the SAR classification, approximately 44% of the groundwater samples were fairly poor, while about 56% of samples were Unsuitable on their use for irrigation. Based on the RSC and PI classification all ground water samples were more suitable for irrigation.
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