Cu nanoparticles grafting on the surface of ZnO nanostructures to boost the porosity and surface area for effective removal of manganese ions from aqueous solutions.

Designing highly adsorptive materials for wastewater treatment via facile approaches is still challenging. To boost the recovery of heavy metals from wastewater, surface and structure modification are considered a successful route. Herein, we report the design of ZnO nanoparticles by a simple thermal decomposition method followed by grafting Cu nanoparticles (Cu NPs) over the ZnO surface. Cu/ZnO was prepared with different Cu ratios, 0.01 and 1%. It was found that incorporating Cu into ZnO improved the porosity and surface area of ZnO. The adsorption ability of Cu/ZnO compared with bare ZnO was studied towards removing manganese ions from wastewater. The effects of several parameters, such as pH, temperature, contact time, and initial ion concentrations, were studied. The maximum removal of manganese was found at pH 2, 20 °C after 60 min in the presence of 1 g/L adsorbent. The role of Cu grafted on the surface of ZnO was discussed. The rates of adsorption were found to follow the pseudo-second-order model. The results showed better fitting to Freundlich isotherm. The thermodynamic study revealed that the sorption process is spontaneous, exothermic, and favorable at low temperatures. The free energy (ΔG°), enthalpy (ΔH°), and entropy (ΔS°) changes were calculated to predict the nature of adsorption.

The Use of Photoactive Polymeric Nanoparticles and Nanofibers to Generate a Photodynamic-Mediated Antimicrobial Effect, with a Special Emphasis on Chronic Wounds.

This review is concerned with chronic wounds, with an emphasis on biofilm and its complicated management process. The basics of antimicrobial photodynamic therapy (PDT) and its underlying mechanisms for microbial eradication are presented. Intrinsically active nanocarriers (polydopamine NPs, chitosan NPs, and polymeric micelles) that can further potentiate the antimicrobial photodynamic effect are discussed. This review also delves into the role of photoactive electrospun nanofibers, either in their eluting or non-eluting mode of action, in microbial eradication and accelerating the healing of wounds. Synergic strategies to augment the PDT-mediated effect of photoactive nanofibers are reviewed.

Photoactive electrospun cellulose acetate/polyethylene oxide/methylene blue and trilayered cellulose acetate/polyethylene oxide/silk fibroin/ciprofloxacin nanofibers for chronic wound healing.

This study aimed to synthesize cellulose acetate (CA)-based electrospun nanofibers as drug delivery dressings for chronic wound healing. For the first time, CA was blended with polyethylene oxide (PEO) using acetone and formic acid. Methylene blue (MB) was incorporated into monolayered random CA/PEO nanofibers. They had a diameter of 400-600 nm, were hydrophilic, and generated reactive oxygen species upon irradiation. Thus, they mediated antimicrobial photodynamic inactivation (aPDI) against isolated biofilm-forming Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Bacterial survival, biofilm mass, and produced pyocyanin of the treated groups declined by 90%, 80%, and 3 folds, respectively. On the other hand, ciprofloxacin (Cipro) was loaded into an innovative trilayered aligned nanofiber consisting of CA/PEO surrounding a blank layer of silk fibroin. Cipro and MB release followed the Korsmeyer-Peppas model. An infected diabetic wound mouse model was established and treated with either MB-aPDI or Cipro. A combined therapy group of MB-aPDI followed by Cipro was included. The combined therapy showed significantly better results than monotherapies delineated by elevation in re-epithelization, collagen deposition, CD34, and TGF-ß expression, along with a decline in CD95+ cells. This study deduced that drug-loaded CA electrospun nanofibers might be exploited in multimodal chronic wound healing.

Transaxillary gasless robotic thyroidectomy: a single surgeon's experience in North America.

OBJECTIVE: To describe a robotic technique for transaxillary gasless thyroidectomy with the addition of intraoperative peripheral nerve monitoring in the surgical management of thyroid disease. DESIGN: Prospective study. SETTING: Academic institution. PATIENTS: Fifty patients underwent robotic transaxillary thyroidectomy from September 1, 2009, to August 31, 2010. All the patients underwent preoperative and postoperative direct laryngoscopy. The patients' demographic information, operative times, complications, postoperative hospital stay, and the surgeon's learning curve were evaluated. MAIN OUTCOME MEASURES: Feasibility of the robotic approach, patient and gland characteristics, operative time, and complications. RESULTS: Thirty-nine females and 11 males with a mean age of 48.2 (age range, 13-76) years were included in the study. A total of 37 surgical procedures were lobectomies, and 13 were total or near-total thyroidectomies. The mean nodule size (range) was 24.9 (10-72) mm. The mean operative time (range) was 122.5 (81-280) minutes, mean docking time (range) was 10.1 (6-15) minutes, and mean console time (range) was 55.5 (10-140) minutes. Mean blood loss (range) was 25 (10-100) mL. There were no conversions to conventional open surgery. One patient developed transient radial nerve neuropathy that resolved spontaneously. There were no other postoperative complications. In addition, there was no evidence of vocal cord palsy or paresis on postoperative laryngoscopy. All the patients were discharged home within 24 hours. Subjectively, the cosmetic results were considered excellent owing to the hidden anatomical location of the incision site. CONCLUSIONS: We have demonstrated the technique to be feasible, safe, and applicable for patients with thyroid disease. We believe that the use of robotic technology for endoscopic thyroid surgical procedures could overcome the limitations of conventional endoscopic surgical procedures in the surgical management of thyroid disease. To our knowledge, this is the first reported large series using this novel technique in the United States.

Robotic-assisted transaxillary parathyroidectomy of an atypical adenoma.

The advancement of minimally invasive surgical technologies over the past several years has led to improved surgical outcomes and greater patient satisfaction. Particularly for patients undergoing parathyroidectomies, endoscopic surgeries resulted in smaller surgical scars when compared with the open approach. Early endoscopic methods, however, were still restricted in their ability to provide adequate dexterity, two-dimensional views of the operative field; and while smaller than open surgeries, still left the presence of a small cervical scar. The limitations of endoscopic surgery led to application of the da Vinci S surgical robot system (Intuitive Surgical, Sunnyvale, CA, USA) and a novel transaxillary approach for parathyroidectomy. This surgical technique and approach is ideal for patients with primary hyperparathyroidism. This case report demonstrates that parathyroidectomy with en bloc thyroid lobectomy for atypical parathyroid adenomas using robotic- assisted transaxillary surgery is safe and feasible.

Burkitt-like lymphoma arising in the thyroid gland.

INTRODUCTION: Primary Burkitt lymphoma of the thyroid gland is exceptionally rare. This highly aggressive, potentially curable malignancy arises from B cells. It presents as a rapidly expanding thyroid mass causing compressive symptoms. This article reports a very rare occurrence of Burkitt-like lymphoma in the thyroid, a variant of Burkitt lymphoma. METHODS: A 60-year-old white female developed a rapidly expanding thyroid mass associated with airway compression and difficulty in swallowing. RESULTS: Fine needle aspiration and cytometry studies established the diagnosis of lymphoma. The patient underwent an incisional neck biopsy which confirmed the final diagnosis according to the latest World Health Organization criteria. It was successfully treated with 1 cycle of appropriate therapeutic chemotherapy. CONCLUSION: In patients with lymphoma diagnosed on fine needle aspiration, an incisional thyroid and bone marrow biopsies are required to aid in the diagnosis and assure the appropriate chemotherapy protocol.

Robotic-assisted laparoscopic wedge resection of a gastric leiomyoma with intraoperative ultrasound localization.

Gastric leiomyoma is a rare gastric neoplasm that traditionally has been resected for negative margins using an open approach. The laparoscopic approach may also treat various gastric tumors without opening the gastric cavity. Robotic surgery was developed in response to the limitations and drawbacks of laparoscopic surgery. Herein, we describe a case of robotic-assisted laparoscopic wedge resection of a gastric leiomyoma. A 63-year-old male complaining of abdominal pain was found to have an incidental 3 cm antral mass on an abdominal CT. Endoscopy with endoscopic ultrasound (EUS) confirmed a submucosal mass. Biopsy of the lesion was consistent with a leiomyoma. The DaVinci robotic system was used for partial gastrectomy and reconstruction, with the addition of intraoperative ultrasound to localize the lesion intraoperatively. Pathological examination of the resected mass confirmed a diagnosis of leiomyoma with negative margins. There were no intraoperative or postoperative complications. The patient was discharged home on the second postoperative day. Intraoperative endoscopic ultrasound is a safe technique that may improve the success rate of surgery by confirming the location of the lesion. Robotic assistance in gastric resection offers an easy minimally invasive approach to such tumors. This approach can achieve adequate surgical margins and lead to short hospital stays.

A case report of intraoperative endoscopic ultrasound during robotic assisted Heller myotomy for severe esophageal achalasia.

Esophageal achalasia is the best described primary esophageal motility disorder. Endoscopic ultrasound (EUS) is considered a useful adjunct for grading and establishing the prognosis of these patients. Recent experience using Da Vinci robotic assisted myotomy has demonstrated that this is a safe and effective approach of treatment. The benefit of magnification and three dimensional imaging helps prevent esophageal perforation and identify residual circular muscle fibers. This paper reports the relative efficacy and safety of intraoperative ultrasound during robotic assisted myotomy in a patient with severe achalasia. Intraoperative esophageal endoscopic ultrasound is a safe technique that may improve the success rate of surgery by confirming the adequacy of myotomy, thereby decreasing the likelihood of recurrent symptoms.

Recurrent laryngeal nerve: significance of the anterior extralaryngeal branch.

INTRODUCTION: Recognition of extralaryngeal branching of the recurrent laryngeal nerve (RLN) is crucial, because inadvertent operative division may lead to significant postoperative morbidity. The purpose of this study was to examine the incidence of extralaryngeal bifurcation of the RLN and to demonstrate the location of the motor fibers within the branches of the RLN. METHODS: Prospective study on 99 patients over 1 year with operative data collected on the branching of a total of 137 RLNs. Operative data obtained included the type of operation, incidence of nerve bifurcation, the distance from the inferior border of the cricothyroid to the point of bifurcation, and the location of the motor fibers to the intrinsic muscles of the larynx within the branches of the RLN. RESULTS: The RLN was seen intra-operatively in all patients. A total of 137 (right 69, left 68) RLNs in 99 patients undergoing thyroidectomy (total 29; hemi 51), parathyroidectomy (16) and central lymph node dissection (3) were studied. Overall, 46 RLNs (34%) bifurcated prior to entry into the larynx. These bifurcations occurred on the right in 27 (59%) and left 19 (41%). Bilateral bifurcation occurred in 12 (27%) of the 44 patients who underwent bilateral dissections. The median branching distance from the cricothyroid membrane on the right was 8.3 ± 2.5 mm, and on the left was 7.5 ± 1.8 mm. In all bifurcated RLNs, the motor fibers to the vocal cords were located exclusively in the anterior branches. CONCLUSION: Extralaryngeal bifurcation was found in 34% of the RLNs in this case series. The motor fibers of RLN are located in the anterior branch while the posterior branch is only sensory in function. Great caution is, therefore, required after the presumed identification of the RLN to ensure there is no unidentified anterior branch. Identification of the anterior branch may lead to decreased risk of postoperative nerve injury.

Detection and prevention of impending brachial plexus injury secondary to arm positioning using ulnar nerve somatosensory evoked potentials during transaxillary approach for thyroid lobectomy.

Robotic assisted surgery is becoming widely used for procedures such as radical prostatectomy. The use of robotic assisted surgery to perform partial and complete thyroidectomies using a transaxillary approach is being investigated in patient populations who wish to avoid a conspicuous cervical scar. Patient positioning for this approach as well as retraction during exposure has the potential to result in postoperative brachial plexopathy similar to what is seen in other types of surgery. We report the use of ulnar nerve somatosensory evoked potentials (SSEPs) to detect and prevent positional related neuropathy in the first pediatric patient in the world to undergo this procedure. We conclude that upper extremity SSEPs should be routinely performed during robotic assisted thyroidectomy.

Black thyroid associated with thyroid carcinoma.

Objective. Black thyroid is a rare pigmented change seen almost exclusively in patients upon minocycline ingestion, and the process has previously been thought to be generally benign. There have been 61 reported cases of black thyroid. We are aware of 13 cases previously reported in association with thyroid carcinoma. This paper reports six patients with black thyroid pigmentation in association with thyroid carcinoma. Design. The medical records of six patients who were diagnosed with black thyroid syndrome, all of whom underwent thyroid surgery, were reviewed. Data on age, gender, race, preoperative fine needle aspiration biopsy (FNA), thyroid function levels, and pathology reports were collected. Main Outcome. The mean age was 60 years. There were 5 females, 4 of whom were African American. All patients were clinically and biochemically euthyroid. Black pigmentation was not diagnosed in preoperative FNA, and only one patient had a preoperative diagnosis of papillary thyroid carcinoma. The other patients underwent surgery and were found to have black pigmentation of the thyroid associated with carcinoma. Conclusions. FNA does not diagnose black thyroid, which is associated with thyroid carcinoma. Thyroid glands with black pigmentation deserve thorough pathologic examination, including several sections of each specimen.

Primary peripheral nerve sheath tumors of the thyroid gland.

BACKGROUND: Primary peripheral nerve sheath tumors (PNSTs) of the thyroid gland are exceptionally rare tumors that usually present as asymptomatic neck nodules in adults. This article presents a literature review of these tumors. SUMMARY: PNSTs of the thyroid can be classified into benign and malignant. Only three cases of malignant PNSTs have been reported. Benign PNSTs of the thyroid include neurofibromas and schwannomas. Only two cases of isolated neurofibroma of the thyroid have been reported. Schwannomas are typically benign, slow-growing tumors that originate from neuronal schwann cells, with a clinical picture depending on the anatomic size and site. Pathologically, schwannomas are classified into Antoni A and Antoni B. Only 17 cases of schwannomas of the thyroid exist in literature to date. CONCLUSIONS: Schwannomas of the thyroid gland are extremely rare and usually asymptomatic. Complete surgical resection is mandatory for care.

Plasmacytoma in the thyroid.

OBJECTIVE: The paper presents a case of plasmacytoma unexpectedly found in a goiter. PATIENT MATERIAL AND METHODS: The patient presented with compressive symptoms, including dyspnea and dysphagia and had no documented prior history of multiple myeloma. Physical examination revealed thyromegaly with no specific nodule. Computerized tomographic (CT) scan of the neck and chest showed diffuse homogenous enlargement of both the thyroid lobes extending into the mediastinum. Total thyroidectomy was done because of the compressive symptoms. RESULTS: Pathology revealed evidence of fibrosis surrounding small nodules of residual follicles with massive infiltration by plasma cells. The pathologic diagnosis was plasmacytoma. CONCLUSION: Plasmacytoma should be added to the list of causes of diffuse thyromegaly.