Efficacy of postoperative radioactive iodine therapy for patients with low and intermediate risk papillary thyroid carcinoma.

PURPOSE: This study aimed to evaluate the efficacy of postoperative radioactive iodine (RAI) and its impact on recurrence rates and survival benefits in low- to intermediate-risk papillary thyroid carcinoma (PTC). METHODS: This retrospective study involved the examination of 1286 patients diagnosed with low- to intermediate-risk PTC who underwent total thyroidectomy with or without neck dissection, supplemented with postoperative RAI therapy or not between the years 2000 and 2021. RESULTS: From the patient pool, 589 (45%) were classified as low-risk and 697 (55%) as intermediate-risk according to the 2015 American Thyroid Association guidelines. Among the low-risk group, 375 (63.7%) underwent postoperative RAI, while in the intermediate-risk group, 566 (82.2%) underwent the procedure. The overall survival and disease-free survival rates were not statistically different between the groups that received RAI and those that did not, in both the low- and intermediate-risk categories. In a subgroup analysis, within the intermediate-risk category, postoperative RAI was significantly correlated with decreased recurrence in two subgroups: patients over 55 years with pN1b disease (hazard ratio 0.043, 95% confidence interval 0.004-0.500, p = 0.012) and patients over 55 years with five or more metastatic lymph nodes (hazard ratio 0.060, 95% confidence interval 0.005-0.675, p = 0.023). CONCLUSION: Our findings suggest that, while post-total thyroidectomy RAI does not substantially influence recurrence or survival rates in most low-risk and intermediate-risk PTC patients, it may be beneficial in specific subgroups, particularly patients over 55 with pN1b disease or those presenting with five or more metastatic lymph nodes.

Contemporary Review of Idiopathic Sudden Sensorineural Hearing Loss: Management and Prognosis.

Sudden sensorineural hearing loss (SSNHL) is a rapid decline in auditory function that needs urgent medical management. Although etiologic factors, including viral infections, autoimmune diseases, and vascular issues, contribute to the understanding of SSNHL, the condition remains unclear in most cases. Systemic steroids are often used as the first-line treatment because they reduce inner ear inflammation; however, there remains numerous discussions about the effectiveness of alternative treatments. To predict hearing recovery is crucial in patients' counseling with factors, including delayed treatment, vertigo, and other health conditions, which indicate poor prognosis. Herein, we review contemporary research on the treatment approaches and outcome predictions of SSNHL to establish important guidelines for physicians in evaluating and treating patients with SSNHL.

Antibiotic Sensitivity and Nasal Microbiome in Patients with Acute Bacterial Rhinosinusitis.

OBJECTIVES: Acute rhinosinusitis (ARS) is a common upper respiratory tract infection that is mostly of viral origin. However, little is known about the nasal microbiome profile at presentation and the changes caused by antibiotics in acute bacterial rhinosinusitis (ABRS). METHODS: This was a prospective single-center study. Overall, 43 ARS patients were screened and were assessed with the symptom questionnaires, nasal endoscopy, and Water's view. Five healthy subjects were recruited as controls. Middle meatal mucus samples were obtained using a cotton swab (for bacterial culture and antimicrobial susceptibility testing) and the suction technique (for 16S rRNA sequencing). After 1 week of antibiotic use (amoxicillin with clavulanic acid), we enrolled 13 patients with ABRS with positive isolates and middle meatal samples for 16S rRNA sequencing were obtained again. RESULTS: Overall, we demonstrated a significantly lower abundance of the Lactobacillaceae family in ABRS patients than in healthy controls. Resistant ABRS had different characteristics of middle meatal microbiomes when compared to sensitive ABRS as follows: (1) lower proportion of lactic acid bacteria, (2) increased pathogens such as Rhodococcus sp., Massila sp., Acinetobacter sp., and H. influenza, and (3) increased beta diversity. However, no remarkable changes were observed in the middle meatal microbiome after antibiotic use. CONCLUSION: We showed the roles of Lactobacillaceae in ABRS, and Acinetobacter and Massilia in case of amoxicillin resistance. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1081-1088, 2024.

Ganoderma lucidum Extract Reduces Insulin Resistance by Enhancing AMPK Activation in High-Fat Diet-Induced Obese Mice.

Ganoderma lucidum is used widely in oriental medicine to treat obesity and metabolic diseases. Bioactive substances extracted from G. lucidum have been shown to ameliorate dyslipidemia, insulin resistance, and type 2 diabetes in mice via multiple 5' AMP-activated protein kinase (AMPK)-mediated mechanisms; however, further studies are required to elucidate the anti-obesity effects of G. lucidum in vivo. In this study, we demonstrated that 3% G. lucidum extract powder (GEP) can be used to prevent obesity and insulin resistance in a mouse model. C57BL/6 mice were provided with a normal diet (ND) or a high-fat diet (HFD) supplemented with 1, 3, or 5% GEP for 12 weeks and the effect of GEP on body weight, liver, adipose tissue, adipokines, insulin and glucose tolerance (ITT and GTT), glucose uptake, glucose-metabolism related proteins, and lipogenesis related genes was examined. GEP administration was found to reduce weight gain in the liver and fat tissues of the mice. In addition, serum parameters were significantly lower in the 3% and 5% GEP mice groups than in those fed a HFD alone, whereas adiponectin levels were significantly higher. We also observed that GEP improved glucose metabolism, reduced lipid accumulation in the liver, and reduced adipocyte size. These effects may have been mediated by enhanced AMPK activation, which attenuated the transcription and translation of lipogenic genes such as fatty acid synthase (FAS), stearoyl-CoA desaturase 1 (SCD1), and sterol regulatory element-binding protein-1c (SREBP1c). Moreover, AMP-activated protein kinase (AMPK) activation increased acetyl-CoA carboxylase (ACC), insulin receptor (IR), IR substrate 1 (IRS1), and Akt protein expression and activation, as well as glucose transporter type 1/4 (GLUT1/4) protein production, thereby improving insulin sensitivity and glucose metabolism. Together, these findings demonstrate that G. lucidum may effectively prevent obesity and suppress obesity-induced insulin resistance via AMPK activation.

The association of albuminuria, arterial stiffness, and blood pressure status in nondiabetic, nonhypertensive individuals.

OBJECTIVE: Although several studies have reported an association between microalbuminuria and pulse wave velocity in patients with hypertension or diabetes, there have been no reports of their significance in apparently healthy individuals. METHODS: Microalbuminuria and brachial-ankle PWV (baPWV) were investigated in a sample of 3826 nonhypertensive, nondiabetic individuals (3598 men, mean age 50 ± 11.3 years) at Kangbuk Samsung Health Promotion Center between 2006 and 2009. The patients were classified into two groups according to urinary albumin-creatinine ratio (UACR) in morning urine specimens: normoalbuminuria (<30 µg/mg) and microalbuminuria (30-300 µg/mg). RESULTS: The prevalence of prehypertension (preHT) and microalbuminuria was 52.5 and 4%, respectively. Abnormal baPWV and microalbuminuria each has unfavorable cardiometabolic profile. The absolute values of baPWV were correlated with those of UACR (r = 0.220, P < 0.001). In multivariate regression analysis, the microalbuminuria group showed an independent association of increasing baPWVs irrespective of potential confounders, compared with the normoalbuminuria group (standard ß = 0.049, P < 0.001). In the subspecified analyses, category III (preHT + normoalbuminuria) and IV (preHT + microalbuminuria) had higher odds ratio (ORs) [95% confidence interval (CI)] for the abnormal baPWV group, compared with category I (normal BP + normoalbuminuria) [2.345 (2.010-2.735) and 3.822 (2.367-6.171), respectively]. CONCLUSION: These findings demonstrate epidemiologic evidence for an independent association between arterial stiffness and microalbuminuria, indices of subclinical target organ damage in nonhypertensive, nondiabetic individuals, which suggests the possibility of a similar pathophysiologic mechanism involved in these two indices of subclinical target organ damage.