A variety of electromyography (EMG) recording methods were reported during intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery. This study compared two surface recording methods that were obtained by electrodes on endotracheal tube (ET) and thyroid cartilage (TC). This study analyzed 205 RLNs at risk in 110 patients undergoing monitored thyroidectomy. Each patient was intubated with an EMG ET during general anesthesia. A pair of single needle electrode was inserted obliquely into the TC lamina on each side. Standard IONM procedure was routinely followed, and EMG signals recorded by the ET and TC electrodes at each step were compared. In all nerves, evoked laryngeal EMG signals were reliably recorded by the ET and TC electrodes, and showed the same typical waveform and latency. The EMG signals recorded by the TC electrodes showed significantly higher amplitudes and stability compared to those by the ET electrodes. Both recording methods accurately detected 7 partial loss of signal (LOS) and 2 complete LOS events caused by traction stress, but only the ET electrodes falsely detected 3 LOS events caused by ET displacement during surgical manipulation. Two patients with true complete LOS experienced temporary RLN palsy postoperatively. Neither permanent RLN palsy, nor complications from ET or TC electrodes were encountered in this study. Both electrodes are effective and reliable for recording laryngeal EMG signals during monitored thyroidectomy. Compared to ET electrodes, TC electrodes obtain higher and more stable EMG signals as well as fewer false EMG results during IONM.

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In the recent environmental protection the reverse logistics of the used product is one of the most important research topics. The reverse logistics is the process flow of usedproducts that are collected to be reproduced so that they can be sold again to customers after some processing. We propose a multi-objective hybrid genetic algorithm (mo-hGA) combined with Fuzzy Logic Controller (FLC) for efficiently dealing with multi-objective reverse logistics network (mo-RLN) problem. The aim of this paper is firstly to formulate mo-RLN model, and secondly to optimize it by mo-hGA method proposed with reusable system configuration. In particular two objective functions to be minimized total costs of mo-RLN, (i.e. fixed opening cost, transportation cost and inventory cost) and also minimized delivery tardiness in all periods are considered in the model. We will clear each objective function (i.e. total costs and total delivery tardiness), computational time and number of Pareto solutions with LINGO, pri-awGA (priority-based GA with adaptive weight approach) and mo-hGA proposed with numerical examples. For demonstrating the effectiveness of the proposed model, we evaluate with the numerical examples and simulate it with a bottles distilling/sale company as a case study in Busan, Korea. Keywords Multi-objective reverse logistics network (mo-RLN). Pri-awGA (priority-based GA with adaptive weight approach). Multi-objective hybrid genetic algorithm (mo-hGA). Fuzzy logic controller (FLC)

ImportanceIdentification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery.ObservationThis narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF)—both label free and in combination with indocyanine green—based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery.Conclusions and RelevanceEmerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.

The authors measured the diameters of vessels around the surgical plane of tonsillectomy to investigate an anatomical basis to reduce hemorrhage. Thirty tonsils removed from 15 adult cadavers with the mean age of 56 years (range 44-71 years) at the time of death were studied. Calibration of the vessels across the tonsillar capsule was performed at the 1-mm intracapsular, capsular, and 1-mm extracapsular plane as artery and vein, respectively. The average diameter of the arteries was 73.0 +/- 33.1 mum at the 1-mm intracapsular plane, 94.7 +/- 33.5 mum at the capsular plane, and 139.5 +/- 51.2 mum at the 1-mm extracapsular plane. For the veins, it was 62.9 +/- 38.7 mum at the 1-mm intracapsular plane, 86.8 +/- 50.4 mum at the capsular plane, and 133.6 +/- 78.6 mum at the 1-mm extracapsular plane. The diameters of the vessels at the 1-mm intracapsular plane were significantly smaller than those at the capsular plane (P < 0.01), and likewise the diameters of the vessels at the capsular plane were significantly smaller than those at the 1-mm extracapsular plane (P < 0.01). The result of this study on the diameter of the vessels across the tonsillar capsule could be considered to be an important factor providing an anatomical rationale for a change in recommendation leading to safer tonsillectomies that minimize vascular injury.