Search

BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions, and even distal, medium vessel occlusions. A distal, medium vessel has a tortuous course and thinner wall compared to large arteries, making it more susceptible to damage. Here, we review the treatment strategies for arterial perforation during mechanical thrombectomy, and we report the case of a patient treated with gelfoam embolization. CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia. The initial National Institutes of Health Stroke Scale score was 15. Computed tomography (CT) and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion. During endovascular mechanical thrombectomy, arterial rupture occurred. The patient’s vital signs were stable, but delayed angiography showed persistent active bleeding. Therefore, selective embolization of the injured artery was performed using gelfoam. Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis. A localized subarachnoid hemorrhage (SAH) was confirmed on a follow-up CT scan. A repeated CT scan after 12 d showed resolution of the SAH, and rebleeding did not occur. CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal, medium vessel perforation.

Ischemic stroke results from arterial occlusion and can cause irreversible brain injury. A non-human primate (NHP) model of ischemic stroke was previously developed to investigate its pathophysiology and for efficacy testing of therapeutic candidates; however, fine motor impairment remains to be well-characterized. We evaluated hand motor function in a cynomolgus monkey model of ischemic stroke. Endovascular transient middle cerebral artery occlusion (MCAO) with an angiographic microcatheter induced cerebral infarction. In vivo magnetic resonance imaging mapped and measured the ischemia-induced infarct lesion. In vivo diffusion tensor imaging (DTI) of the stroke lesion to assess the neuroplastic changes and fiber tractography demonstrated three-dimensional patterns in the corticospinal tract 12 weeks after MCAO. The hand dexterity task (HDT) was used to evaluate fine motor movement of upper extremity digits. The HDT was modified for a home cage-based training system, instead of conventional chair restraint training. The lesion was localized in the middle cerebral artery territory, including the sensorimotor cortex. Maximum infarct volume was exhibited over the first week after MCAO, which progressively inhibited ischemic core expansion, manifested by enhanced functional recovery of the affected hand over 12 weeks after MCAO. The total performance time decreased with increasing success rate for both hands on the HDT. Compensatory strategies and retrieval failure improved in the chronic phase after stroke. Our findings demonstrate the recovery of fine motor skill after stroke, and outline the behavioral characteristics and features of functional disorder of NHP stroke model, providing a basis for assessing hand motor function after stroke.

A hybrid composite of silver nanoparticles (AgNPs) and porous silicon microparticles (pSiMPs) was developed and applied for the computed tomography (CT) scanning of the lungs as an image-guided localization agent. We confirmed the grafting of AgNPs on oxidized pSiMPs template using various analytical equipment, including a scanning electron microscope (SEM), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), and energy-dispersive X-ray spectroscopy (EDS). The hybrid composite showed a high CT contrast intensity (>1000 HU) that enabled us to produce and view images of the lungs. In addition, it showed the ability to maintain a strong CT signal at the injected area of the rabbit's lungs, up to an hour, without spreading. The lack of toxicity and immune response indicated that the composite could be fully utilized as a new image-guided localization agent of CT scans for lung cancer surgery.

The function of microglia/macrophages after ischemic stroke is poorly understood. This study examines the role of microglia/macrophages in the focal infarct area after transient middle cerebral artery occlusion (MCAO) in rhesus monkeys. We measured infarct volume and neurological function by magnetic resonance imaging (MRI) and non-human primate stroke scale (NHPSS), respectively, to assess temporal changes following MCAO. Activated phagocytic microglia/macrophages were examined by immunohistochemistry in post-mortem brains (n=6 MCAO, n=2 controls) at 3 and 24 hours (acute stage), 2 and 4 weeks (subacute stage), and 4, and 20 months (chronic stage) following MCAO. We found that the infarct volume progressively decreased between 1 and 4 weeks following MCAO, in parallel with the neurological recovery. Greater presence of cluster of differentiation 68 (CD68)-expressing microglia/macrophages was detected in the infarct lesion in the subacute and chronic stage, compared to the acute stage. Surprisingly, 98~99% of transforming growth factor beta (TGFβ) was found co-localized with CD68-expressing cells. CD68-expressing microglia/macrophages, rather than CD206+ cells, may exert anti-inflammatory effects by secreting TGFβ after the subacute stage of ischemic stroke. CD68+ microglia/macrophages can therefore be used as a potential therapeutic target.

Rationale: Sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotid artery (ICA) caused by traumatic vessel injury is rare, and rarer is a concomitant carotid-cavernous fistula (CCF). In particular, delayed subarachnoid hemorrhage (SAH) due to pseudoaneurysm rupture has not been reported to-date in literature. Here, we report a case of sphenoid sinus pseudoaneurysm with CCF presenting with delayed SAH. Patient concerns: A 73-year-old man presented with traumatic brain injury due to motorcycle accident. Diagnoses: Twenty-four days after admission, the patient's neurological status suddenly deteriorated. Brain computed tomography (CT) showed acute SAH along interhemispheric cisterns and suprasellar intracerebral hematoma. Brain CT angiography and digital subtraction angiography revealed giant sphenoid sinus pseudoaneurysm with CCF and the daughter sac of the pseudoaneurysm extended to the intracranial part via fracture in the superior wall of the sphenoid sinus. Interventions: As the sphenoid sinus pseudoaneurysm and CCF shared one rupture point, endovascular treatment with intraarterial approach using coil and liquid embolic material by balloon assisted technique was performed simultaneously. Outcomes: The origin of the pseudoaneurysmal sac and CCF was sufficiently blocked after injection of liquid embolic material and the lesions completely resolved immediately after endovascular treatment. Lessons: Sphenoid sinus pseudoaneurysm and CCF rarely occur following head trauma through a series of processes involving fracture of the lateral wall of the sphenoid sinus and ICA cavernous segment injury. Sphenoid sinus pseudoaneurysm may present as SAH through intracranial rupture with concomitant superior wall fracture of the sphenoid sinus. Therefore, early diagnosis using CT or magnetic resonance angiography and appropriate treatment through understanding the disease mechanism is necessary.

The neurovascular unit (NVU) comprises multiple types of brain cells, including brain endothelial cells, astrocytes, pericytes, neurons, microglia, and oligodendrocytes. Each cell type contributes to the maintenance of the molecular transport barrier and brain tissue homeostasis. Several disorders and diseases of the central nervous system, including neuroinflammation, Alzheimer’s disease, stroke, and multiple sclerosis, have been associated with dysfunction of the NVU. As a result, there has been increased demand for the development of NVU in vitro models. Here, we present a three-dimensional (3D) immortalized human cell-based NVU model generated by organizing the brain microvasculature in a collagen matrix embedded with six different types of cells that comprise the NVU. By surrounding a perfusable brain endothelium with six types of NVU-composing cells, we demonstrated a significant impact of the 3D co-culture on the maturation of barrier function, which is supported by cytokines secreted from NVU-composing cells. Furthermore, NVU-composing cells alleviated the inflammatory responses induced by lipopolysaccharides. Our human cell-based NVU in vitro model could enable elucidation of both physiological and pathological mechanisms in the human brain and evaluation of safety and efficacy in the context of high-content analysis during the process of drug development.

The non-autoclave curing technique with vacuum bag only (VBO) prepreg has been conceived as a cost-effective manufacturing method for producing high-quality composite part. This study demonstrated the feasibility of improving composite part’s performances and established the effective mitigation strategies for manufacturing induced defects, such as internal voids and surface porosity. The experimental results highlighted the fact that voids and surface porosity were clearly dependent on the resin viscosity state at an intermediate dwell stage of the curing process. Thereafter, the enhancement of resin flow could lead to achieving high quality parts with minimal void content (1.3%) and high fiber fraction (53 vol.%). The mechanical testing showed comparable in-plane shear and compressive strength to conventional autoclave. The microscopic observations also supported the evidence of improved interfacial bonding in terms of excellent fiber wet-out and minimal void content for the optimized cure cycle condition.

This study investigates the impact behavior of fiber-metal laminates (FMLs) (Carbon FMLs and Glass FMLs), which were fabricated by using high-stiffness steel, carbon prepreg, and glass prepreg through autoclave molding. The mechanical behavior of the FMLs was evaluated by performing tensile, compressive, in-plane shear, and low-velocity impact tests. Drop-weight impact tests were conducted to induce cracking of the FMLs, and the crack initiation along with crack propagation behavior of the different laminate sequences ([0/0], [0/90], [0/90/0], [90/0/90] and [0/90/90/0]) were also studied. The results show that the fabricated FMLs have higher strength and stiffness than conventional FMLs. Their impact strengths increased, and weights decreased simultaneously. The absorption energy was proportional to the crack length that was induced by the low-velocity impact. Moreover, it was found that the fiber orientation mainly affected the direction of crack propagation in the FMLs. This investigation facilitates the design of high-stiffness and lightweight FMLs for automotive parts.

The hole-drilling technique of hybrid GLARE laminate described herein utilizes conventional high-speed steel cobalt and carbide tools with two cutting parameters such as feed rate and cutting speed. The selection of the optimal cutting parameters is important when drilling multi-layered material because each constituent material in the GLARE laminate requires a different set of cutting parameters. The parametric influences on thrust force, torque, surface qualities and delamination extent were experimentally evaluated. In addition, the mechanical model for predicting the critical thrust force at the onset of delamination was established based on classical bending theory and the mechanics of GLARE laminate. The analytical findings were consistent with the delamination extent quantitatively measured by ultrasonic inspection. The carbide produces better hole quality and size tolerance compared to the HSS-Co. Furthermore, feed rate is considered to significantly impact the indentation over the uncut thickness of the material, resulting in a greater influence on delamination onset at the metal-prepreg interface. The faster penetration of the cutting tool through the work-piece due to the increase of the feed rate increases the hole deflections and vibrations in the cutting tool causing higher circularity errors. Compared to the feed rate, the cutting speed effect is relatively insignificant.

Mechanical modeling of fiber-reinforced plastics to predict nonlinear mechanical behavior along the off-axis direction is very complex due to tension–compression asymmetry. This study aimed aims to develop a generalized constitutive model for different types of unidirectional and woven composites, considering tension–compression asymmetry in various deformation ranges from elastic to plastic, and finally to failure. To capture the asymmetry effectively, a new multivariable plastic model was proposed with additional dilatational components and different elastic moduli for tension and compression. Finally, asymmetric failure criteria and a damage evolution law were introduced for strength prediction. The proposed model was implemented in a finite element analysis software via a user material subroutine, and experimentally validated in terms of off-axis tension and compression tests in various loading directions. The experimental results were accurately predicted using a multi-parameter plastic model in this study compared to previous other models with few parameters.

Mesothelial cyst of the spleen is a developmental disorder. Previous reports have elaborated on the radiological features of splenic mesothelial cysts as being unilocular with a smooth and well-defined margin. However, due to its rarity, it is unclear whether these characteristics are representative and specific for the diagnosis of mesothelial cysts. Herein, this case report presents an atypical case of splenic mesothelial cyst mimicking a malignant tumour, especially splenic metastasis in a 66-year-old woman with ascending colon cancer. Due to an overlapping imaging finding of hypodense splenic lesions, and considering the clinical history, a mesothelial cyst that developed as a multilocular hypodense mass from an ill-defined small nodule was inevitably misdiagnosed as metastasis. Although rare, it is important to consider the possibility of mesothelial cyst in a patient with multilocular hypodense lesions of the spleen.

The effects of cure temperatures on the thermal, physical and mechanical characteristics of two types of thermosetting structural epoxy film adhesives were determined in detail. The aim of this paper is to assess the effect of cure temperatures (82–121 °C) on the degree of cure of the two adhesives and the relevant void formations that need to be addressed in bonded part production and repair. Two thermal parameters were used to characterize the advancement of the reaction, such as degree of cure and glass transition temperature. The joint properties with respect to the cure temperatures were characterized by void content and bond-line thickness measurements and lap shear strength tests. Experimental results presented that all lap shear strengths were well within minimum shear strength (29 MPa) required by the specification of the film-type adhesive. However, the lap shear strength testing after aging at 82 °C and 95%R.H for 1000 h showed that the improved durability when the adhesive is cured at ...

We study the Josephson effect of a $\rm{T_1 F T_2}$ junction, consisting of spin-triplet superconductors (T), a weak ferromagnetic metal (F), and ferromagnetic insulating interfaces. Two types of the triplet order parameters are considered; $(k_x +ik_y)\hat{z}$ and $k_x \hat{x}+k_y\hat{y}$. We compute the current density in the ballistic limit by using the generalized quasiclassical formalism developed to take into account the interference effect of the multilayered ferromagnetic junction. We discuss in detail how the current-phase relation is affected by orientations of the d-vectors of superconductor and the magnetizations of the ferromagnetic tunneling barrier. General condition for the anomalous Josephson effect is also derived.

To assess hyperacute focal cerebral ischemia in rats on 3.0-Tesla diffusion-weighted imaging (DWI), we developed a novel voxel-wise lesion segmentation technique that overcomes intra- and inter-subject variation in apparent diffusion coefficient (ADC) distribution. Our novel technique involves the following: (1) intensity normalization including determination of the optimal type of region of interest (ROI) and its intra- and inter-subject validation, (2) verification of focal cerebral ischemic lesions at 1 h with gross and high-magnification light microscopy of hematoxylin-eosin (H&E) pathology, (3) voxel-wise segmentation on ADC with various thresholds, and (4) calculation of dice indices (DIs) to compare focal cerebral ischemic lesions at 1 h defined by ADC and matching H&E pathology. The best coefficient of variation was the mode of the left hemisphere after normalization using whole left hemispheric ROI, which showed lower intra- (2.54 ± 0.72%) and inter-subject (2.67 ± 0.70%) values than the original. Focal ischemic lesion at 1 h after middle cerebral artery occlusion (MCAO) was confirmed on both gross and microscopic H&E pathology. The 83 relative threshold of normalized ADC showed the highest mean DI (DI = 0.820 ± 0.075). We could evaluate hyperacute ischemic lesions at 1 h more reliably on 3-Tesla DWI in rat brains.

Tenosynovial giant cell tumor of diffuse type is a locally aggressive neoplasm that most commonly arises in the lower extremities. Herein, we report for the first time a case of an extra-articular tenosynovial giant cell tumor of diffuse type in the temporal region with brain parenchymal invasion. Imaging studies revealed an intracranial expansile mass in the temporal bone without involvement of the temporomandibular joint. The unusual location of the tumor without involvement of the joint and the presence of brain parenchymal invasion made this case challenging to diagnose.

In the automotive industry, being lightweight has become an important design factor with the enhancement of environmental regulations. As a result, many studies on the application of composite materials are in progress. Among them, interest in carbon materials, such as carbon sheet molding compound (C-SMC) and carbon-fiber-reinforced plastic (CFRP), which have excellent strength and stiffness, is increasing. However, CFRP is a material that makes it difficult to secure economic feasibility due to its relatively high manufacturing costs and limited mass production, despite its excellent mechanical strength and durability. As a result, many studies have been conducted on C-SMC as an alternative carbon composite material that can be easily mass-produced. In this regard, this study intended to conduct a study on evaluating the fatigue strength of C-SMC and CFRP among mechanical properties due to the lack of clear failure criteria for fatigue design. We investigated the tensile and fatigue strengths of C-SMC and CFRP, respectively. In the case of C-SMC, the mechanical strength tests were conducted for two different width conditions to evaluate the cutting effect and the machining methods to assess the effects of the edge conditions. To evaluate the fatigue failure assessment criteria, the stiffness drop and elastic modulus degradation criteria were applied for each fatigue test result from the C-SMC and CFRP. The results confirmed that the rationality of the failure criteria in terms of the stiffness drop and the application of the fatigue life prediction of C-SMC based on elastic modulus degradation demonstrated promising results.

Rationale: Traumatic arteriovenous fistulas (AVFs) of the pelvis are uncommon and present with a variety of clinical manifestations; their detection may be difficult. An endovascular approach is usually the first choice of treatment, because surgical intervention is complicated due to the location of the lesions. Patient concerns: A 68-year-old man was admitted with severe pelvic pain following a fall. Diagnosis: A pelvic bone fracture (Young and Burgess Classification, lateral compression type II) was revealed on pelvic computed tomography (CT), while a pelvic sidewall hematoma, unaccompanied by any vascular injury, was detected on multidetector CT. Interventions: Pelvic angiography revealed an AVF between the internal iliac artery and vein, which was undetected by MDCT. The AVF was successfully treated using transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA). Outcomes: The patient recovered well and was discharged 4 weeks later. No complications were noted at the 8-month follow-up. Lessons: AVF may occur as a complication of blunt pelvic bone fracture. A high index of suspicion, angiography, and prompt diagnosis resulted in the successful management of our patient who presented with risk factors. Furthermore, TAE using NBCA enables a minimally invasive and effective treatment of traumatic pelvic AVF.

Central venous stenosis is a relatively common complication in hemodialysis patients; however, jugular venous reflux (JVR) and increased intracranial pressure are rare, and associated progressive visual disturbance was reported in only a few cases. Here, we report a case of JVR with visual disturbance and increased intracranial pressure. Notably, the MRI was accompanied by a dilatation of the superior ophthalmic vein, which was mistaken for a cavernous sinus dural arteriovenous fistula (CSdAVF). The patient had JVR on time-of-flight MR angiography (TOF-MRA) and severe stenosis of the left brachiocephalic vein on conventional angiography. After balloon angioplasty for central venous stenosis, he was discharged after improvement of his visual disturbance. Although JVR due to central venous stenosis and CSdAVF might show similar symptoms, treatment plans are different. Therefore, it is important to distinguish radiologically based on a thorough review of MRI and TOF-MRA and confirm the central venous stenosis on cerebral angiography for the accurate diagnosis.

A fully differential RC calibrator for accurate cut-off frequency of a programmable channel selection filter is proposed. The proposed RC calibrator consists of an RC timer, clock generator, synchronous counter, digital comparator, and control block. To verify the proposed RC calibrator, a six-order Chebyshev programmable low-pass filter with adjustable 3 dB cut-off frequency, which is controlled by the proposed RC calibrator, was implemented in a 0.18-mm CMOS technology. The channel selection filter with the proposed RC calibrator draws 1.8 mA from a 1.8 V supply voltage and the measured 3 dB cut-off frequencies of the channel selection LPF is controlled accurately by the RC calibrator.

Aim of the paper is to find how the acoustic and vibration responses of rectangular carbon-fiber-reinforced plastic (CFRP) plates is changed by the various orientation of fiber in a CFRP plate. First, the vibration and acoustic response of the CFRP plate excited by a concentrated harmonic force along with the natural vibration were evaluated theoretically. The theoretical solutions were verified by comparing with numerical simulations, which were conducted using commercial software. Second in order to confirm the numerical solutions, the experimental works were performed with three CFRP plates having different fiber orientation of 0°, 45°, and 90°. Finally the influence of fiber orientation on vibration and acoustics was investigated in CFRP plates.

Although early diffusion lesion reversal after recanalization treatment of acute ischaemic stroke has been observed in clinical settings, the reversibility of lesions observed by diffusion-weighted imaging remains controversial. Here, we present consistent observations of sustained diffusion lesion reversal after transient middle cerebral artery occlusion in a monkey stroke model. Seven rhesus macaques were subjected to endovascular transient middle cerebral artery occlusion with in-bore reperfusion confirmed by repeated prospective diffusion-weighted imaging. Early diffusion lesion reversal was defined as lesion reversal at 3 h after reperfusion. Sustained diffusion lesion reversal was defined as the difference between the ADC-derived pre-reperfusion maximal ischemic lesion volume (ADCD-P Match) and the lesion on 4-week follow-up FLAIR magnetic resonance imaging. Diffusion lesions were spatiotemporally assessed using a 3-D voxel-based quantitative technique. The ADCD-P Match was 9.7 ± 6.0% (mean ± SD) and the final infarct was 1.2–6.0% of the volume of the ipsilateral hemisphere. Early diffusion lesion reversal and sustained diffusion lesion reversal were observed in all seven animals, and the calculated percentages compared with their ADCD-P Match ranged from 8.3 to 51.9% (mean ± SD, 26.9 ± 15.3%) and 41.7–77.8% (mean ± SD, 65.4 ± 12.2%), respectively. Substantial sustained diffusion lesion reversal and early reversal were observed in all animals in this monkey model of transient focal cerebral ischaemia.

A CMOS millimeter-wave (mmWave) downconversion mixer with a local-oscillator (LO) buffer is proposed for wireless Gb/s data-transfer enabling systems, such as 5G systems. To obtain high linearity at low supply voltages, the proposed mmWave downconversion mixer adopts an on-chip transformer-based topology. In order to achieve differential to single-ended conversion and IF output matching, while maintaining a high linearity performance, the proposed mmWave downconversion mixer incorporates an active balun with common-source and common-drain configurations employing common-mode noise and third-order intermodulation distortion cancellations. The proposed downconversion mixer with active balun and LO buffer was implemented using a 65-nm CMOS process and it draws 18 mA from a 1 V supply voltage. It demonstrates a gain greater than 5.6 dB, noise figure less than 10.9 dB, and third-order output intercept point more than 12.4 dBm, in the band from 57 to 66 GHz.

The study aimed to establish a staining method that could delineate the macroscopic lesion boundary of a hyperacute infarction depicted by diffusion-weighted MRI (DWI) and to validate the infarction boundary by comparing different staining methods.Thirteen rats with 1 -h middle cerebral artery (MCA) infarction were included. Five different staining methods (Hematoxylin and eosin (HE), Nissl, 2,3,5-triphenyltetrazolium hydrochloride (TTC), microtubule associated protein 2 (MAP2), and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) stains) were used to identify whether the hyperacute infarction could be histopathologically identified. Dice indices were compared to evaluate similarities in the lesion area ascertained by DWI and the staining methods. Through macroscopic lesion delineation, each region was subdivided into abnormal regions in all three stains (ROIMean Dice indices of the HE stain were significantly higher than those of the Nissl- and MAP2-stained specimens (0.83 ± 0.052, 0.58 ± 0.107, and 0.56 ± 0.059, respectively; p = 0.000). Grading scores for ROIs in the DWI abnormal lesions varied by region: ROIHE stain allowed for the macroscopic delineation of the 1 h DWI-abnormal lesions, while MAP2 and Nissl stains could only partially depict lesions.

Predicting the mechanical behavior of adhesives is important, because adhesives strongly influence the strength and reliability of adhesive–adherend structures. Herein, we report a simulation of the mechanical behavior of an adhesive, including its failure strength, using Schapery's nonlinear viscoelastic model. A detailed derivation of the nonlinear viscoelastic model for 3D implementation in finite-element software is presented. Experimental procedures for obtaining the model parameters from dynamic mechanical testing of lap-joint specimens are detailed. Strain-rate dependent failure criterion was employed using the shift factor and experimental lap shear tests at different strain rates to calculate the failure strain at different temperature. Then, the mechanical behavior of the adhesive in the adhesive joint at different rates and temperatures until its failure was simulated and compared with experiments, demonstrating the validity of the current approach.

Rationale: Schwannomas involving the thyroid gland are very rare and only a few cases have been reported in the literature. However, previous reports did not distinguish between thyroid bed schwannomas and intrathyroidal schwannomas. Here, we report a thyroid bed schwannoma mimicking a malignant thyroid nodule and review the literature on thyroid bed schwannomas. Patient concerns: A 33-year-old woman presented at our hospital with mild neck swelling. Diagnosis: Thyroid ultrasound revealed a well-defined, oval-shaped, markedly hypoechoic solid nodule with echogenic foci suggesting macro- and microcalcifications in the left thyroid gland. The lesion was considered a “highly suspicious” intrathyroidal nodule, based on the guidelines for the assessment of thyroid nodules. Fine needle aspiration was performed twice, but the cytological results were nondiagnostic. Interventions: Left thyroidectomy was performed, and schwannoma of the thyroid bed was confirmed on histopathologic analysis. Outcomes: The patient was in a stable condition after surgery, and the thyroid function test results were within the normal range. Lessons: Diagnosis of a schwannoma of the thyroid bed is challenging because its incidence is extremely low, and it is often misdiagnosed as an intrathyroidal nodule on ultrasonography. Therefore, it is advisable to adopt a diagnostic strategy to perform additional core needle biopsy in cases of thyroid nodules with nondiagnostic fine needle aspiration results and to consider the location of the lesion more carefully to determine the suitable therapy.