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In this meta-analytic study, we investigated the effects of mobile devices on student achievement in science, mathematics and reading in grades K-12. Based on our inclusion criteria, we searched the ERIC and PsycINFO databases and identified 14 peer-reviewed research articles published between 2010 and 2014. We identified the device type, subject area, intervention language, grade level, study design and implementer (i.e., of the intervention) as potential moderator variables that may influence student achievement in the targeted content areas. We followed a three-level meta-analytic procedure to estimate the overall effect of these variables and explain the variation in outcomes. The results suggest that use of mobile devices in teaching yielded higher achievement scores than traditional teaching in all subject areas. With regard to the analysis of moderator variables, the results suggest that using mobile devices in reading is significantly more effective than doing so in mathematics.

This study was carried out to investigate fruit yield and quality characteristics among new nectarine cultivars grown in the eastern Mediterranean region of Turkey. 'Gardeta', 'Gartario', and 'Garofa' nectarine cultivars were cultivated on 'GN15' rootstock. The flowering stage, fruit set percentage, yield, and fruit quality properties of these cultivars were investigated between 2018 and 2021. During the study, chill requirements ranged between 391 and 600 chilling hours and between 207 and 361 chill units in the area, and huge values were obtained for the average initial fruit set above 60% and the final fruit set above 45%. 'Gardeta' had the highest cumulative yield per tree (80.15 kg tree-1) and cumulative yield per hectare (133.04 tons ha-1). The fruit size, Total Soluble Solids (TSS) content, and fruit coloration were homogeneously distributed in all three cultivars. In addition, the Flowering (F) and Initial Fruit Set (IFS) characters were negatively correlated with Fruit Weight (FW), Fruit Length (FLE), and Fruit Diameter (FD). As a result, the 'Gardeta' was found remarkable with late flowering, the highest yield, and superior fruit quality characteristics such as size, red skin color, and high TSS/total acidity values in the eastern Mediterranean region of Turkey. In addition, the date of Full Flowering (FF) and Fruit Firmness (FF) were negatively correlated with fruit Skin color L* (SL), C (SC), and h° (SH) variables. The results demonstrated that the new nectarine cultivars used here showed changes in yield parameters and fruit quality attributes depending on the genotypic and environmental effects. [ABSTRACT FROM AUTHOR]

Nowadays, there is considerable interest in plants such as hawthorn that have a rich source of secondary metabolites (volatile and phenolic compounds) in their leaves, with beneficial effects on health. This study investigated the Volatile Compounds (VCs), total phenolic content, and antioxidant activities of Sultan hawthorn leaves collected at three different times based on fruit maturity stages (immature, mature, and over-mature). Our main goal was to determine whether the volatile profile, total phenolic content, and antioxidant activity would change depending on the leaf collection time. A total of 78 VCs were identified in the leaves, 11 of which were for the first time. With the progress in fruit maturity, the levels of most VCs varied, the phenolic content and antioxidant activity increased, and acidity decreased. Benzaldehyde and α-farnesene were the principal VCs accounting for 61% of total VCs identified in leaf at the overmature stage. The principal component analysis successfully separated volatile compounds in hawthorn leaves along the fruit maturity stages. For the first time, the present study provided a general overview of the secondary metabolites in leaves from Sultan hawthorn cultivar along fruit maturity stages. The hawthorn leaf collected at the overmature fruit stage proved to have high potential in secondary metabolites and antioxidant capacity. [ABSTRACT FROM AUTHOR]

Tubers of the tuberous orchids have been collected for centuries, and used for medicinal purposes as well as in beverage and ice-cream industry. These orchids (Sahlep orchids) cannot be propagated vegetatively as they generally do not yield more than one tuber in a year. Seeds do not have microscopic endosperms; they have quite small chance of germination and successful establishment. These orchids are not cultivated and are usually collected from natural populations. Therefore, they are under threat of extinction and thus are placed under protection worldwide with national and international treaties. In this study, specimens of the threatened orchid taxa Ophrys sphegodes subsp. mammosa (Desf.) Soo ex E. Nelson orchid, were stimulated to grow tuber twice in a single vegetation period. Plants' ability to develop new tubers was tested and a new propagation method was proposed for the first time worldwide. Plants harvested at the beginning, middle, and end of flowering period were re-planted. It was observed that the plants harvested at early flowering were able to develop new tubers when they were re-planted in their original places. At the end of their annual life cycle, the number of tubers that were produced by the plants harvested at the three subsequent harvest periods were 2.21, 2.10, and 1.04. Quality of the tubers of the 2nd harvest was also tested in this study to use them as propagation material for the subsequent season, and positive outcomes were achieved. According to the present findings, growth of two tubers in a single vegetation period was achieved for the first time. Possible sustainable cultivation of Sahlep orchids was proved by this new propagation method. [ABSTRACT FROM AUTHOR]

Apricot (Prunus armeniaca L.) is a species particularly prone to erratic fruit set, and its flower bud drop has been repeatedly reported in different cultivars and growing conditions. A number of potential causes have been explored, but a clear main cause remains elusive. In this study, fruit set was determined for 11 apricot cultivars ('Precoce de Tyrinthe', 'Feriana', 'Beliana', 'Priana', 'Bebeco', 'Early Kishinewski', 'Precoce de Colomer', 'Canino', 'Silistre Rona', 'Rouge de Sernhac' and 'Tokaloglu') grown on the coast of the Mediterranean region of Turkey from 2006 to 2008. Trees budded on apricot seedlings and planted 6x6 m in 1997. On four branches of each tree randomly selected from all four directions, blossom number, percentage of initial and final fruit set, and yield per tree were determined during the experimental period. Fruit set differed significantly depending on year and cultivar. Based on three-year averages, percentage of fruit set was highest on 'Tokaloglu' (14%), followed by 'Beliana' (8.8%) and 'Precoce de Tyrinthe' (8.2%). The lowest fruit set (2.3%) was in 'Early Kishinewski' and 'Canino'. High yields per tree were found in Tokaloglu' (29.1 kg), 'Precoce de Tyrinthe' (29.0 kg), 'Rouge de Sernhac' (27.9 kg), and 'Beliana' (23.0 kg). 'Tokaloglu', 'Beliana', 'Precoce de Tyrinthe', and 'Rouge de Sernhac' cultivars showed good performance for both fruit set and yield per tree under subtropical climate conditions. However, findings of this study also suggested that fruit set and fruit drops in apricots should be assessed together with total yield amounts by years. The influence of the cultivar on fruit yield was more determinant than the seasonal effect. [ABSTRACT FROM AUTHOR]

Selecting within local pomegranate accessions is the main method used to identify new cultivars. Total of 76 pomegranate accessions from Hatay, Turkey, were collected and their morpho-pomological and chemical characteristics were determined. The results showed that there was significant diversity among the accessions in terms of fruit quality parameters. Several accessions were notable for their various characteristics. For example, 'Eksi 5', 'Eksiliknar', 'Kara Mehmet 1', 'Lifani 5' and 'Eksi 3' accessions could be used for extracted aril and juice as they had dark red arils and juice, good taste, and large arils. In addition, the sweet accessions 'Tatlı 3', 'Tatlı 13', and 'Tatlı 16' with soft seeds, rosy peel, and red aril colors were very promising for fresh consumption. Our study demonstrated that there was great morpho-pomological variability among the local pomegranates grown in eastern Mediterranean region of Turkey, making them a valuable genetic source for incorporation into potential breeding programs, especially for different fruit quality characteristics. [ABSTRACT FROM AUTHOR]

This study was conducted to assess the influence of different salinity and irrigation water treatments on the growth and development of sweet basil (Ocimum basilicum L.). Five salinity levels (0.4, 1.00, 2.50, 4.00 and 8.00 dSm-1) and three different irrigation water regimes (80, 100, 120% of full irrigation) were applied in a factorial design with three replications. Dry root weight, aerial part dry weight and aerial part/root ratio were determined and evaluated as experimental parameters at the end of growing period. Results revealed significant decreases in yields with increasing salinity levels. However, basil managed to survive high salt stress. With increasing salinity levels, decreases in growth were higher in roots than in leaves. Changes in the amount of irrigation water also significantly affected the evaluated parameters.

Aim: The tubercle of Zuckerkandl (TZ) is considered to be the fusion point of the ultimabranchial body and the median thyroid body. We aimed to evaluate the frequency of TZ and its relationship with other anatomical variations and recurrent laryngeal nerve (RLN) paralysis., Material and Methods: Data regarding the thyroid lobe and RLN of patients with thyroidectomy between June 2016 and December 2019 were retrospectively evaluated. TZ is classified according to its dimensions as follows: category 0; invisible, category 1; thickening only the lateral to thyroid lobe, category 2; ≤1 cm, and category 3; >1 cm. Categories 2 and 3 were accepted as TZ., Results: In 627 patients, 1011 necks and thyroid lobes were evaluated. TZ was found as 58.9% in categories 0 and 1, 18.7% in category 2%, and 22.4% in category 3. In the presence of TZ, the RLN was located posteromedially in 95.2% and laterally in 4.8%. RLN entrapment in the Berry ligament region was significantly higher in categories 2 and 3 compared to category 1 (25.4% vs. 28% vs. 17.3% and p < 0.0001). There was no significant difference in RLN paralysis based on the presence and size of TZ or the relationship between RLN and TZ., Conclusion: TZ is not rare and can be observed in 41.1% of thyroid lobes. It should be noted that the likelihood of RLN entrapment in the Berry region is higher in categories 2 and 3. Therefore, performing TZ dissection without applying traction to the thyroid lobe and mapping RLN could contribute to better RLN preservation., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Objectives: The incidence of papillary thyroid cancer (PTC) is increasing, and due to the favorable postoperative survival rates, the extent of surgery should be carefully determined, and complications during the operation should be avoided. The recurrent laryngeal nerve (RLN) divides the right paratracheal lymph node (RPTLN) into anteromedial and posterolateral compartments due to its anatomical course on the right and left sides of the neck, and the posterolateral lymph nodes are in close proximity to the RLN. Due to the risk of this complication, in this study, we aimed to determine the risk factors for the development of right paratracheal posterolateral lymph node (RPTPLLN) metastasis in PTC., Methods: Between 2013 and 2022, patients who underwent central neck dissection (CLND) or central and lateral neck dissection due to the presence of PTC in the right lobe of the thyroid gland were included in the study. Descriptive data, along with preoperative imaging findings and postoperative pathology findings, were retrospectively evaluated., Results: The data of 55 patients who met the criteria were statistically analyzed. Of these patients, 24 (43.6%) were male and 31 (56.4%) were female. The mean age was 47.9±17.5 years (range: 16-81). The mean tumor size was 2.17±1.43 cm (range: 0.4-7.0). RPTPLLN was observed in 13 patients (23.6%). Univariate analysis revealed that extrathyroidal extension (p=0.008), lymphovascular invasion (p=0.044), presence of right paratracheal anteromedial (RPTAMLN) metastasis (p=0.001), and presence of left paratracheal metastasis (p=0.049) were statistically significant factors. However, in the multivariate analysis, only the presence of RPTAMLN was determined to be a significant variable (p=0.035)., Conclusion: In patients undergoing surgery for PTC, the risk of metastasis in the RPTPLLN should be considered higher when there is metastasis in the RPTAMLN. We believe that formal dissection of the RPTLN should be considered for optimal evaluation in patients with tumors in the right lobe where central dissection is planned. Posterolateral dissection (PLD) should be routinely performed in the presence of clinical lymph nodes in the RPTAMLN. When a decision cannot be made, PLD may not be performed if the anteromedial tissue is examined with frozen pathology and the result is negative., Competing Interests: No conflict of interest was declared by the authors., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Objectives: Thyroglossal cysts (TGCs) usually present during childhood and before the age of 30, however, they can also be seen in adults, even in advanced age. Nodular thyroid disease is also common in adults. In the literature, there is an ongoing debate regarding the differences in clinical presentation, gender, and postoperative recurrence of TGC between children and adults. In this study, we aimed to process the data of adult patients who underwent surgery for TGC in our clinic, along with the data on concurrent thyroid disease and thyroid surgery., Methods: The data of patients over 18 years old who were operated on for TGC at the General Surgery Clinic of Sisli Hamidiye Etfal Training and Research Hospital between 2018 and 2024 were retrospectively evaluated., Results: A total of 16 patients with a mean age of 43.94±12.98 (21-67) years, were included in the study (11 F/5 M). The diagnosis of TGC was made in 12 patients (75%) by ultrasonography (USG), in 1 patient (6.25%) by computed tomography, in 1 patient (6.25%) by magnetic resonance imaging (MRI), and in 2 patients (12.5%) incidentally intraoperatively. 13 patients (81.25%) underwent the Sistrunk procedure, and 3 patients (18.75%) underwent cyst excision. Among the 16 TGC patients, papillary thyroid cancer in the cyst was detected in one patient (6.25%) preoperatively. During preoperative evaluation, nodular thyroid disease was found in 12 patients (75%). Of these, papillary thyroid cancer was detected in 3 patients (18.75%) preoperatively. Of the TGC group, 3 (18.75%) underwent thyroidectomy for thyroid malignancy, and five (31.25%) underwent additional thyroid surgery for nodular thyroid disease. The patients were followed for a mean of 22.63±18.32 months (3-67 months), and no recurrence of TGC was observed during the follow-up period., Conclusion: In patients with TGC, thyroid diseases and the requirement for thyroidectomy due to benign or malignant thyroid disease are not uncommon. Patients with TGC should be evaluated for thyroid disease before surgical treatment. While the Sistrunk procedure is the standard surgical technique in the treatment of TGC, in adults, if the cyst terminates below the hyoid bone, total cyst excision without removing the central portion of the hyoid bone may be sufficient., Competing Interests: No conflict of interest was declared by the authors., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Hyperthyroidism is a clinical condition that develops due to the excessive production and secretion of thyroid hormones by the thyroid gland, leading to an elevated concentration of thyroid hormones in tissues. Hyperthyroidism is characterized by low TSH and elevated T3 and/or T4, with the most common causes being Graves' disease, toxic multinodular goiter, and solitary toxic adenoma. T3 is the peripherally active form of thyroid hormone, affecting nearly each tissue and system. The most prominent aspects of hyperthyroidism are related to the cardiovascular system. The treatment of hyperthyroidism includes three options: antithyroid drugs (ATDs), radioactive iodine therapy (RAI), and surgery. Among these treatment modalities, surgery is considered as the most effective one. For patients who are candidates for surgery, preoperative preparation is required to ensure that the thyroidectomy can be performed under optimal conditions. Preoperative preparation should be a combination therapy aimed at preventing the synthesis, secretion, and peripheral effects of thyroid hormones from the thyroid gland. Medications that can be used in this treatment include thionamides, beta-blockers, iodine, corticosteroids, cholestyramine, perchlorate, lithium, and therapeutic plasma exchange. These treatment options can be combined based on the patient's condition. While it is recommended that patients be made euthyroid through preoperative antithyroid treatment to prevent the feared complication, which is the thyroid storm, the supporting evidence is limited. Preoperative treatment does not prevent against thyroid storm whether the patient is euthyroid or hyperthyroid during surgery. Whether surgery should be delayed until biochemical euthyroidism is achieved in hyperthyroid patients remains a topic of debate. Recent studies suggest that thyroidectomy can be safely performed during the hyperthyroid phase by experienced anesthesiologists and surgeons without precipitating thyroid storm or increasing intraoperative and postoperative complications. Although achieving the euthyroid state before surgery is ideal in hyperthyroid patients, it is not always possible. Factors such as allergies to medications, drug side effects, treatment-resistant disease, patient noncompliance, and the urgency of definitive treatment are critical in determining whether hyperthyroidism can be controlled preoperatively. When surgery is necessary in hyperthyroid patients without achieving euthyroidism, the patient's overall condition and comorbidities should be evaluated together by the anesthesiologist, surgeon and endocrinologist, with particular attention to stabilizing the cardiovascular system. We believe that in hyperthyroid patients who are cardiovascularly stable during the hyperthyroid phase, thyroid surgery may not need to be delayed and can be performed safely., Competing Interests: The authors have no conflicts of interest to declare., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Purpose: The anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its anatomical variations, retrospectively., Methods: The patients with primary thyroidectomy between January 2016 and December 2019 were enrolled. The effect of age, gender, surgical intervention, neuromonitorisation type, central neck dissection, postoperative diagnosis, neck side, extralaryngeal branching, non-RLN, relation of RLN to inferior thyroid artery (ITA), grade of Zuckerkandl tubercle on vocal cord paralysis (VCP) were investigated., Results: This study enrolled 1070 neck sides. The extralaryngeal branching rate was 35.5%. 45.9% of RLNs were anterior and 44.5% were posterior to the ITA, and 9.6% were crossing between the branches of the ITA. The rate of total VCP was 4.8% (transient:4.5%, permanent: 0.3%). The rates of total and transient VCP were significantly higher in extralaryngeal branching nerves compared to nonbranching nerves (6.8% vs. 3.6%, p = 0.018; 6.8% vs. 3.2%, p = 0.006, respectively). Total VCP rates were 7.2%, 2.5%, and 2.9% in case of the RLN crossing anterior, posterior and between the branches of ITA, respectively (p = 0.003). The difference was also significant regarding the transient VCP rates (p = 0.004). Anterior crossing pattern increased the total and transient VCP rates 2.8 and 2.9 times, respectively., Conclusion: RLN crossing ITA anteriorly and RLN branching are frequent anatomical variations increasing the risk of VCP in thyroidectomy that cannot be predicted preoperatively. This study is the first one reporting that the relationship between RLN and ITA increased the risk of VCP., (© 2024. The Author(s).)

Trastuzumab emtansine (T-DM1) was the first and one of the most successful antibody-drug conjugates (ADC) approved for treating refractory HER2-positive breast cancer. Despite its initial clinical efficacy, resistance is unfortunately common, necessitating approaches to improve response. Here, we found that in sensitive cells, T-DM1 induced spindle assembly checkpoint (SAC)-dependent immunogenic cell death (ICD), an immune-priming form of cell death. The payload of T-DM1 mediated ICD by inducing eIF2α phosphorylation, surface exposure of calreticulin, ATP and HMGB1 release, and secretion of ICD-related cytokines, all of which were lost in resistance. Accordingly, ICD-related gene signatures in pretreatment samples correlated with clinical response to T-DM1-containing therapy, and increased infiltration of antitumor CD8+ T cells in posttreatment samples was correlated with better T-DM1 response. Transforming acidic coiled-coil containing 3 (TACC3) was overexpressed in T-DM1-resistant cells, and T-DM1 responsive patients had reduced TACC3 protein expression whereas nonresponders exhibited increased TACC3 expression during T-DM1 treatment. Notably, genetic or pharmacologic inhibition of TACC3 restored T-DM1-induced SAC activation and induction of ICD markers in vitro. Finally, TACC3 inhibition in vivo elicited ICD in a vaccination assay and potentiated the antitumor efficacy of T-DM1 by inducing dendritic cell maturation and enhancing intratumoral infiltration of cytotoxic T cells. Together, these results illustrate that ICD is a key mechanism of action of T-DM1 that is lost in resistance and that targeting TACC3 can restore T-DM1-mediated ICD and overcome resistance., Significance: Loss of induction of immunogenic cell death in response to T-DM1 leads to resistance that can be overcome by targeting TACC3, providing an attractive strategy to improve the efficacy of T-DM1., (©2024 The Authors; Published by the American Association for Cancer Research.)

Background: Postoperative nausea and vomiting (PONV) is a frequent adverse effect following laparoscopic sleeve gastrectomy. Palonosetron with a standard dosing (75 μg) schedule has been questioned due to its low efficiency in obese patients. This study aimed to investigate the effectiveness and safety of the body weight-based dosing of palonosetron in managing PONV following laparoscopic sleeve gastrectomy., Methods: A single-center, prospective, double-blinded randomized study was conducted between August 2021 and December 2021. Patients who underwent laparoscopic sleeve gastrectomy were prospectively recruited in the study. One hundred patients were randomly divided into palonosetron (Group P) and ondansetron (Group O). The demographic and clinical variables were recorded. The primary outcome of the study was the incidence of PONV between the two groups during the hospitalization. The secondary outcomes were the number of rescue anti-emetic and analgesic medications and the Functional Living Index-Emesis scores., Results: There were 50 patients in each group (Group P and Group O). There were significant differences in the scores of POVN, nausea, and vomiting favoring Group P. In Group P, the rate of patients using rescue anti-emetics was significantly lower. The incidence of complete response and proportion of patients with higher Functional Living Index-Emesis scores were significantly higher in patients using palonosetron., Conclusions: The use of palonosetron significantly reduced the incidence of PONV following laparoscopic sleeve gastrectomy. There was a significant improvement in the scores of Functional Living Index-Emesis in patients using palonosetron.

In endocrine pathology, frozen section (FS) examination is most commonly used for the intraoperative evaluation of thyroid and parathyroid tumors, as well as cervical lymph nodes. In the past, frozen section was considered a fundamental tool in thyroid surgery. However, with advancements in preoperative ultrasound and fine-needle aspiration biopsy (FNAB), there have been increasing queries about its routine use due to the improved preoperative diagnosis. Nowadays, while the use of FS during thyroidectomy has decreased, it is still used as an additional method for different purposes intraoperatively. FS may not always provide definitive results. If FS will alter the surgical plan or extent, it should be applied. Routine FS is not recommended for evaluating thyroid nodules. But in addition to FNAB, if FS results may change the operation plan or extent, they can be utilized. FS should not be applied for thyroid lesions smaller than 1 cm, and the entire lesion should not be frozen for FS. For the assessment of thyroid nodules, the use of FS is recommended based on the Bethesda categories of FNAB. In Bethesda I category nodules, FS may contribute to distinguishing between malignant and benign lesions and guide surgical treatment. In Bethesda II nodules, where the malignancy rate is low, the performance of FNAB and FS can be compared, but it's not recommended due to the lack of a significant contribution to the surgical strategy. The sensitivity of FS in Bethesda III and IV nodules is low; its contribution to the diagnosis is limited, and it does not provide an apparent benefit to treatment; therefore, it is not recommended. In Bethesda V nodules, FS can effectively confirm the malignancy diagnosis, contribute to the surgical strategy, and reduce the possibility of completion thyroidectomy, and accordingly, it is recommended for use. Nonetheless, in Bethesda V nodules with a benign FS report, the malignancy rate remains high, so it should not be used to rule out malignancy. In Bethesda VI nodules, the performance of FS is lower or comparable to FNAB and does not significantly contribute to the treatment strategy; hence, it is not recommended. Particularly in patients with papillary thyroid cancer, intraoperative FS can be effective in detecting extrathyroidal extension and can assist the surgeon in determining the extent of thyroid surgery and central neck dissection. FS has high sensitivity and specificity in evaluating the lymphatic status of the central region intraoperatively and can be used to determine the extent of central compartment node dissection. During thyroidectomy, FS examination can be used in recognizing parathyroid tissue and distinguishing it from fatty tissue, thymus, thyroid, lymph nodes, especially in differentiating metastatic lymph nodes., Competing Interests: None declared., (© Copyright 2023 by The Medical Bulletin of Sisli Etfal Hospital.)

Objectives: Unilateral or bilateral prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) is still controversial. We aimed to evaluate the risk factors for contralateral paratracheal lymph node metastasis and whether CND might be performed unilaterally., Methods: Prospectively collected data of patients who underwent bilateral CND and lateral neck dissection (LND) with thyroidectomy due to PTC with lateral metastases, between January 2012 and November 2019, were evaluated retrospectively. The patients were divided into two groups according to the presence (Group 1) and absence (Group 2) of metastasis in the contralateral paratracheal region.A total of 42 patients (46 ±15.7 years) were operated. In the contralateral paratracheal region, Group 1 (35.7%) had metastases, while Group 2 (64.3%) had no metastases. In groups 1 and 2, metastasis rates were 100% vs 77.8% (p=0.073), 46.7% vs 18.5% (p=0.078), and 80% vs 40.7% (p=0.023) for the ipsilateralparatracheal, prelaryngeal and pretracheal lymph nodes, respectively.The number of metastatic lymph nodes in the central region was significantly higher in Group 1 compared to Group 2 as; 10.7±8.4 vs. 2.6±2.4 (p=0.001) in bilateral central region material; 8.3±7.4 vs. 2.9±2.7 (p=0.001) in lateral metastasis with ipsilateral unilateral central region; 3.8±3.4 vs. 1.9±1.9 (p=0.023) in ipsilateralparatracheal area; and 3.7±4.6 vs. 0.6±0.9 (p=0.001) in pretracheal region, respectively. However, no significant difference was found regarding the prelaryngeal region material (0.9±1.8 vs. 0.2±0.4 (p=0.71))., Results: >2 metastatic central lymph nodes in unilateral CND material (AUC: 0.814, p<0.001, J=0.563) can estimate contralateral paratracheal metastasis with 93% sensitivity, 63% specificity, while >2 pretracheal metastatic lymph nodes (AUC: 0.795, p<0.001, J: 0.563) can estimate contralateral paratracheal metastasis with 60% sensitivity and 96.3% specificity., Conclusion: In patients with lateral metastases, the rate of ipsilateralparatracheal metastasis is 85%, while the rate of contralateral paratracheal metastasis is 35.7%. The number of ipsilateral central region or pretracheal lymph node metastases may be helpful in predicting contralateral paratracheal lymph node metastases. Notably, unilateral CND may be performed in the presence of ≤ 2 metastases in the ipsilateral central region., Competing Interests: None declared., (© Copyright 2023 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: In thyroid surgery, both the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) should be preserved for maintaining the vocal cord functions. We aimed to evaluate whether EMG of the CTM applied after the superior pole dissection provided additional informative data to the IONM via ETT or not, regarding the EBSLN function., Methods: The prospectively collected data of the patients, who have undergone thyroidectomy with the use of IONM for the exploration of both the RLN and EBSLN between October 2016 and March 2017, were evaluated retrospectively. Patients over 18 years of age with primary thyroid surgery for malignant or benign thyroid disease, and whom were applied CTM EMG with a needle electrode after the completion of thyroidectomy were included in the study. In the study, each neck side was evaluated as a separate entity considering the EBSLN at risk., Results: The data of 41 patients (32 female, 9 male) (mean age, 46.7 + 9.1; range, 22-71) were evaluated. Sixty seven EBSLNs out of 26 bilateral and 15 unilateral interventions were evaluated. With EBSLN stimulation after the superior pole dissection, positive glottic EMG waveforms via ETT were obtained in 45 (67.2%) out of 67, and the mean glottic amplitude value was 261 + 191 μV (min-max: 116-1086 μV). Positive EMG responses via the CTM EMG were achieved from all of the 67 EBSLNs (100%) with stimulation using a monopolar probe at the most cranial portion above the area of divided superior pole vessels. The mean value of CTM amplitudes via CTM EMG obtained with EBSLN stimulation was 5268 + 3916 μV (min-max:1215 -19726 μV). With EBSLN stimulation, the mean CTM EMG amplitude was detected significantly higher than the mean vocal cord amplitude (p<0.0001). The CTM EMG provided more objective quantifiable data regarding the EBSLN function (100% vs 67,2%, p<0.001)., Conclusion: In addition to the IONM via ETT, intraoperative post-dissection CTM EMG via needle electrode is a safe, simple and applicable method that may provide significant additional informative data to IONM with ETT by obtaining and recording objective quantitative data related to the EBSLN function., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Aygun, Unlu, Kostek, Caliskan, Isgor and Uludag.)

Objective: Our goal in this study is to analyze the correlation between papillary thyroid cancer (PTC) with elevated thyroid-stimulating hormone (TSH) levels and deficiency of vitamin D., Methods: Patients who underwent thyroidectomy, also with available vitamin D test results preoperatively, were included in the study. The patients were separated into two different categories as having papillary thyroid carcinoma (Group 1), benign diseases (Group 2). According to the TSH (mUI/mL) level and vitamin D values, patients were categorized into four quarters., Results: Preoperatively, TSH level (mean±SDmUI/mL) was higher in Group 1 (2.04±1.55) compared to Group 2 (1.82±1.94) significantly (p=0.029). Preoperatively, vitamin D levels (mean±SD) were higher in Group 1 (15.88±10.88) than in Group 2 (12.94±10.26) significantly (p=0.011). There was no significant difference between Group 1 and Group 2 according to the vitamin D deficiency (65.5%, 72.8%; respectively (p=0.472)). When categorized with reference to pre-operative vitamin D levels, the proportion of patients in Group 2 and Category 1 was higher significantly (p=0.031)., Conclusion: Although the pre-operative TSH level was significantly higher in papillary thyroid carcinoma than benign thyroid diseases, the categorical distributions of the patients according to the TSH value were similar and the TSH values overlapped. Pre-operative mean vitamin D levels were similar in both PTC and benign thyroid disease groups so PTC was not associated with vitamin D deficiency., Competing Interests: No conflict of interest was declared by the authors., (© Copyright 2023 by Istanbul Provincial Directorate of Health.)

Objectives: Lateral lymph node metastasis (LLNM) in papillary thyroid cancer (PTC) determines the extent of surgery to be performed and the prognosis of the disease. In this study, we aimed to evaluate the clinicopathological risk factors affecting the development of LLNM., Methods: We retrospectively evaluated the demographic and clinicopathological data of 346 cases with PTC who were operated in our clinic between May 2012 and September 2020. The patients were divided into 2 groups as patients with LLNM (Group 1) and without LLNM (Group 2)., Results: Thirty-six (10.4%) patients out of 346 patients with PTC had LLNM. A statistically significant difference was found between Group 1 and Group 2 regarding the male gender (M/F: 38.9% vs. 21.6%; p=0.020), tumor size (2.30±1.99 cm vs. 1.31±1.40 cm; p=0.000), lymphovascular invasion (69.4 vs. 20.6%; p=0.000), multicentricity (69.4% vs. 35.5%; p=0.000), multifocality (p=0.000), aggressive variant (22.2% vs. 9.4%; p=0.000), extrathyroidal extension (50% vs. 16.1% p=0.000), central lymph node metastasis (CLNM) rates (75% vs. 6.5%; p=0.000), and ≥3 cm lymph node metastasis (48.5% vs. 0%, p=0.000), distant metastasis (2.1% vs. 0%, p=0.000), respectively. Multivariance analysis determined the presence of CLNM as an independent risk factor for the development of LLNM., Conclusion: The presence of CLNM in patients with PTC was determined as an independent risk factor for the development of LLNM. Although there has been increasing debate about prophylactic central neck dissection (pCND) in LLNM, pCND should still be considered in these patients as the rate of CLNM is high in patients with LLNM. CLNM might be a reference for surgeons to determine the extent of surgery. In addition, the presence of CLNM is important for close follow-up for the early detection of LLNM recurrence., Competing Interests: None declared., (©Copyright 2023 by The Medical Bulletin of Sisli Etfal Hospital.)

Thyroid nodules are common and the prevalence varies between 4 and 7% by palpation and 19-68% by high-resolution USG. Most thyroid nodules are benign, and the malignancy rate varies between 7 and 15% of patients. Thyroid nodules are detected incidentally during clinical examination or, more often, during imaging studies performed for another reason. All detected thyroid nodules should be evaluated clinically. The main test in evaluating thyroid function is thyroid stimulating hormone (TSH). If the serum TSH level is below the normal reference range, a radionuclide thyroid scan should be performed to determine whether the nodule is hyperfunctioning. If the serum TSH level is normal or high, ultrasonography (US) should be performed to evaluate the nodule. US is the most sensitive imaging method in the evaluation of thyroid nodules. Computed tomography (CT) and magnetic resonance imaging are not routinely used in the initial evaluation of thyroid nodules. There are many risk classification systems according to the USG characteristics of thyroid nodules, and the most widely used in clinical practice are the American Thyroid Association guideline and the American College of Radiology Thyroid Imaging Reporting and Data System. Fine needle aspiration biopsy (FNAB) is the gold standard method in the evaluation of nodules with indication according to USG risk class. In the cytological evaluation of FNAB, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the most frequently applied cytological classification. TBSRTC is a simplified, 6-category reporting system and was updated in 2023. The application of molecular tests to FNAB specimens, especially those diagnosed with Bethesda III and IV, is increasing to reduce the need for diagnostic surgery. Especially in Bethesda III and IV nodules, different methods are applied in the treatment of nodules according to the malignancy risk of each category, these are follow-up, surgical treatment, radioactive iodine treatment, and non-surgical ablation methods., Competing Interests: None declared., (©Copyright 2023 by The Medical Bulletin of Sisli Etfal Hospital.)