Temporal changes in foveal contour after macular hole surgery

BACKGROUND

To investigate the changes in inner foveal contour after surgery for macular hole (MH) and its clinical implications.

METHODS

This retrospective observational case series included 66 eyes from 66 patients who underwent surgery for MH. Notching of tissue was defined as an abrupt alteration in the inner contour of the parafoveal tissue based on postoperative optical coherence tomography (OCT) image. The distance between the parafoveal edges of the outer plexiform layer (OPL) was defined as the inter-OPL distance. The inter-OPL distance was divided into nasal, temporal, superior, and inferior lengths. The difference in the lengths of each direction between the early and late postoperative period was compared between directions with and without notching.

RESULTS

The early and late postoperative examination was performed at 4.6±2.9 weeks and 6.2±0.6 months, respectively. Notching of tissue was noted in 54 eyes (81.8%). In 53 eyes with a measurable inter-OPL distance, the notching of tissue was noted in 45 eyes (84.9%) regardless of preoperative MH size. The mean amount of foveal tissue elongation that occurred during the designated period was 104.6±68.8 and 78.4±72.9 μm in the directions with and without the notching of tissue (P<0.001), respectively.

CONCLUSIONS

The changes in the inner foveal contour, including notching of tissue and elongation of foveal tissue, were noted in the majority of eyes after MH surgery. Notching of tissue on OCT image could be a clinical marker for the development of foveal tissue elongation after MH surgery.

Sex differences in remifentanil requirements for preventing cough during anesthetic emergence

PURPOSE

Target-controlled infusion (TCI) of remifentanil can suppress coughing during emergence from general anesthesia; nevertheless, previous studies under different clinical conditions recommend significantly different effective effect-site concentrations (effective Ce) of remifentanil for 50% of patients (EC₅₀). The differences among these studies include type of surgery and patient sex. In recent years, study of sex differences in regards to anesthetic pharmacology has drawn greater interest. Accordingly, we attempted to determine the effective Ce of remifentanil for preventing cough for each sex under the same clinical conditions.

MATERIALS AND METHODS

Twenty female and 25 male ASA physical status I-II grade patients between the ages of 20 and 46 years who were undergoing thyroidectomy were enrolled in this study. The effective Ce of remifentanil for preventing cough was determined for each sex using the isotonic regression method with a bootstrapping approach, following Dixon's up-and-down method.

RESULTS

Isotonic regression with a bootstrapping approach revealed that the estimated EC₅₀ of remifentanil for preventing coughing during emergence was significantly lower in females {1.30 ng/mL [83% confidence interval (CI), 1.20-1.47 ng/mL]} than in males [2.57 ng/mL (83% CI, 2.45-2.70 ng/mL)]. Mean EC₅₀ in females was also significantly lower than in males (1.23±0.21 ng/mL vs. 2.43±0.21 ng/mL, p<0.001). Mean arterial pressure, heart rate, and respiratory rate over time were not significantly different between the sexes.

CONCLUSION

When using remifentanil TCI for cough prevention during anesthetic emergence, patient sex should be a considered for appropriate dosing.

Tetrathiafulvalene as an electron acceptor for positive charge induction on the surface of silver nanoparticles for facilitated olefin transport

Tetrathiafulvalene (TTF), a well-known electron donor, can also behave as an electron acceptor after being adsorbed on the surface of silver nanoparticles (Ag NPs), thereby inducing a partial positive charge on the Ag NPs surface. The Ag NPs activated by TTF help propylene transport much faster than propane, i.e., facilitated olefin transport, resulting in extremely high separation performance for propylene-propane mixtures.

ATM-mediated phosphorylation of the chromatin remodeling enzyme BRG1 modulates DNA double-strand break repair

ATP-dependent chromatin remodeling complexes such as SWI/SNF (SWItch/Sucrose NonFermentable) have been implicated in DNA double-strand break (DSB) repair and damage responses. However, the regulatory mechanisms that control the function of chromatin remodelers in DNA damage response are largely unknown. Here, we show that ataxia telangiectasia mutated (ATM) mediates the phosphorylation of BRG1, the catalytic ATPase of the SWI/SNF complex that contributes to DSB repair by binding γ-H2AX-containing nucleosomes via interaction with acetylated histone H3 and stimulating γ-H2AX formation, at Ser-721 in response to DNA damage. ATM-mediated phosphorylation of BRG1 occurs rapidly and transiently after DNA damage. Phosphorylated BRG1 binds γ-H2AX-containing nucleosomes to form the repair foci. The Ser-721 phosphorylation of BRG1 is critical for binding γ-H2AX-containing nucleosomes and stimulating γ-H2AX formation and DSB repair. BRG1 binds to acetylated H3 peptides much better after phosphorylation at Ser-721 by DNA damage. However, the phosphorylation of Ser-721 does not significantly affect the ATPase and transcriptional activities of BRG1. These results, establishing BRG1 as a novel and functional ATM substrate, suggest that the ATM-mediated phosphorylation of BRG1 facilitates DSB repair by stimulating the association of this remodeler with γ-H2AX nucleosomes via enhancing the affinity to acetylated H3. Our work also suggests that the mechanism of BRG1 stimulation of DNA repair is independent of the remodeler's enzymatic or transcriptional activities.

Olefin separation via charge transfer and dipole formation at the silver nanoparticle–tetracyanoquinoid interface

Charge transfer and dipole formation at silver nanoparticle–tetracyanoquinoid takes place in the solid-state membrane, forming an unprecedented, highly olefin permselective facilitated transport membrane with a mixed gas selectivity of over 100 for a propylene–propane mixture. This provides a potential alternative to the highly energy-intensive cryogenic distillation process for olefin/paraffin separation.

Right adrenal venography findings correlated with C-arm CT for selection during C-arm CT-assisted adrenal vein sampling in primary aldosteronism

PURPOSE

This study was designed to evaluate retrospectively the efficacy of C-arm CT to confirm right adrenal vein catheterization during adrenal vein sampling (AVS) and to correlate adrenal venography findings with C-arm CT and/or biochemical results for right adrenal vein selection.

METHODS

Forty-two consecutive primary aldosteronism patients (M:F = 21:21; age: 29-70 years) underwent C-arm CT assisted sequential AVS. After catheterization of right adrenal vein, C-arm CT was performed to confirm catheter position. Catheter was repositioned when right adrenal gland was not opacified. Radiological images, medical records, and biochemical results were reviewed for technical/biochemical success rates and complications. Right adrenal venography findings of pinnate pattern, visualization of renal capsular vein, and retroperitoneal vein other than renal capsular vein were correlated with C-arm CT and/or biochemical results for right adrenal vein selection.

RESULTS

Both the technical and biochemical success of AVS was achieved in 40 patients (95.2%). C-arm CT failed due to catheter instability in one, and adrenal/vena cava cortisol gradient was <3 in one patient. Catheter was repositioned in four patients (9.5%) according to C-arm CT findings. Right adrenal venography finding of renal capsular vein significantly correlated with C-arm CT and/or biochemical results (100%) for right adrenal vein selection (p = 0.011, χ(2) test), whereas pinnate pattern (p = 0.099) and other retroperitoneal veins (p = 0.347) did not. There was no procedure-related complication.

CONCLUSIONS

C-arm CT increases confidence of right adrenal vein catheterization during AVS. Visualization of renal capsular vein on adrenal venography suggests right adrenal vein catheterization and C-arm CT may not be required.

Inhibition of matrix metalloproteinases expression in human dental pulp cells by all-trans retinoic acid

All-trans retinoic acid (ATRA) inhibits matrix metalloproteinase (MMP)-2 and MMP-9 in synovial fibroblasts, skin fibroblasts, bronchoalveolar lavage cells and cancer cells, but activates MMP-9 in neuroblast and leukemia cells. Very little is known regarding whether ATRA can activate or inhibit MMPs in human dental pulp cells (HDPCs). The purpose of this study was to determine the effects of ATRA on the production and secretion of MMP-2 and -9 in HDPCs. The productions and messenger RNA (mRNA) expressions of MMP-2 and -9 were accessed by gelatin zymography and real-time polymerase chain reaction (PCR), respectively. ATRA was found to decrease MMP-2 level in a dose-dependent manner. Significant reduction in MMP-2 mRNA expression was also observed in HDPCs treated with 25 µmol⋅L(-1) ATRA. However, HDPCs treated with ATRA had no effect on the pattern of MMP-9 produced or secreted in either cell extracts or conditioned medium fractions. Taken together, ATRA had an inhibitory effect on MMP-2 expression in HDPCs, which suggests that ATRA could be a candidate as a medicament which could control the inflammation of pulp tissue in vital pulp therapy and regenerative endodontics.

Partial posterior hyaloidectomy for macular disorders

PURPOSE

To evaluate the effect of partial posterior hyaloidectomy (PPH) in preventing iatrogenic retinal breaks related to the induction of a posterior vitreous detachment (IPVD).

METHODS

Fifty-nine patients who necessitated IPVD for an epiretinal membrane or macular hole were included in this prospective, interventional case series. Extensive removal of vitreous gel, close to the retina, was conducted before IPVD under 23 G (gauge)-vitrectomy system. The PPH involved the limited extent of IPVD and limited removal of the outermost vitreous cortex to an area slightly beyond the margin of the temporal major vascular arcade. The incidence of retinal breaks related to the surgery was compared with 57 eyes that had undergone conventional 23-G total vitrectomy accompanied by extensive IPVD using χ(2)-test.

RESULTS

Patients were followed-up for a mean of 14.3 months (6-30 months) after the surgery. The incidence of peripheral retinal breaks after the PPH was 3.4% (2/59 eyes), which was significantly lower than that in the eyes that underwent conventional 23 G vitrectomy (15.8%, 9/57 eyes, P=0.023) for the same disorders that required an IPVD. No patient complained of postoperative floaters, postoperatively.

CONCLUSIONS

PPH would be an efficient procedure to prevent iatrogenic peripheral retinal breaks related to an IPVD.

Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma

PURPOSE

The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT).

PATIENTS AND METHODS

A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30-50 Gy (median 37.5 Gy) in 2-5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the ≥ grade 2 GD toxicity were investigated.

RESULTS

Endoscopic findings showed erosive gastritis in 14 patients (16 %), gastric ulcers in 8 patients (9 %), erosive duodenitis in 15 patients (17 %), and duodenal ulcers in 14 patients (16 %). Grade 2 toxicity developed in 19 patients (21 %) and grade 3 toxicity developed in 8 patients (9 %). V25 for stomach and V35 for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for ≥ grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9 % for V25 ≤ 6.3 % and 57.1 % for V25 > 6.3 %. The duodenal toxicity rate at 6 months was 9.4 % for V35 ≤ 5.4 % and 45.9 % for V35 > 5.4 %. By multivariate analysis including the clinical factors, V25 for stomach and V35 for duodenum were the significant factors.

CONCLUSION

EGD revealed that GD toxicity is common following RT for HCC. V25 for the stomach and V35 for the duodenum were the significant factors to predict ≥ grade 2 GD toxicity.

Distribution of the Vasotocin Subtype Four Receptor (VT4R) in the Anterior Pituitary Gland of the Chicken, Gallus gallus, and its Possible Role in the Avian Stress Response

The neurohormone arginine vasotocin (AVT) in non mammalian vertebrates is homologous to arginine vasopressin (AVP) in mammals. Its actions are mediated via G protein-coupled receptors that belong to the vasotocin/mesotocin family. Because of the known regulatory effects of nonapeptide hormones on anterior pituitary functions, receptor subtypes in that family have been proposed to be located in anterior pituitary cells. Recently, an avian vasotocin receptor subtype designated VT4R has been cloned, which shares 69% sequence homology with a human vasopressin receptor, the V1aR. In the present study, a polyclonal antibody to the VT4R was developed and validated to confirm its specificity to the VT4R. The antibody was used to test the hypothesis that the VT4R is present in the avian anterior pituitary and is specifically associated with certain cell types, where its expression is modulated by acute stress. Western blotting of membrane protein extracts from pituitary tissue, the use of HeLa cells transfected with the VT4R and peptide competition assays all confirmed the specificity of the antibody to the VT4R. Dual-labelling immunofluorescence microscopy was utilised to identify pituitary cell types that contained immunoreactive VT4R. The receptor was found to be widely distributed throughout the cephalic lobe but not in the caudal lobe of the anterior pituitary. Immunoreactive VT4R was associated with corticotrophs. Approximately 89% of immunolabelled corticotrophs were shown to contain the VT4R. The immunoreactive VT4R was not found in gonadotrophs, somatotrophs or lactotrophs. To determine a possible functional role of the VT4R and previously characterised VT2R, gene expression levels in the anterior pituitary were determined after acute immobilisation stress by quantitative reverse transcriptase-polymerase chain reaction. The results showed a significant increase in plasma corticosterone levels (three- to four-fold), a significant reduction of VT4R mRNA and an increase of VT2R mRNA (P < 0.05) in acutely immobilised chicks compared to controls. The data suggest a role of the VT4R in the avian stress response.

Translationally controlled tumour protein is associated with podocyte hypertrophy in a mouse model of type 1 diabetes

AIMS/HYPOTHESIS

Translationally controlled tumour protein (TCTP) is thought to be involved in cell growth by regulating mTOR complex 1 (mTORC1) signalling. As diabetes characteristically induces podocyte hypertrophy and mTORC1 has been implicated in this process, TCTP may have a role in the pathogenesis of diabetes-induced podocyte hypertrophy.

METHODS

We investigated the effects and molecular mechanisms of TCTP in diabetic mice and in high glucose-stimulated cultured podocytes. To characterise the role of TCTP, we conducted lentivirus-mediated gene silencing of TCTP both in vivo and in vitro.

RESULTS

Glomerular production of TCTP was significantly higher in streptozotocin induced-diabetic DBA/2J mice than in control animals. Double-immunofluorescence staining for TCTP and synaptopodin revealed that podocyte was the principal cell responsible for this increase. TCTP knockdown attenuated the activation of mTORC1 downstream effectors and the overproduction of cyclin-dependent kinase inhibitors (CKIs) in diabetic glomeruli, along with a reduction in proteinuria and a decrease in the sizes of podocytes as well as glomeruli. In addition, knockdown of TCTP in db/db mice prevented the development of diabetic nephropathy, as indicated by the amelioration of proteinuria, mesangial expansion, podocytopenia and glomerulosclerosis. In accordance with the in vivo data, TCTP inhibition abrogated high glucose-induced hypertrophy in cultured podocytes, which was accompanied by the downregulation of mTORC1 effectors and CKIs.

CONCLUSIONS/INTERPRETATION

These findings suggest that TCTP might play an important role in the process of podocyte hypertrophy under diabetic conditions via the regulation of mTORC1 activity and the induction of cell-cycle arrest.

TRAIL promotes caspase-dependent pro-inflammatory responses via PKCδ activation by vascular smooth muscle cells

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is best known for its selective cytotoxicity against transformed tumor cells. Most non-transformed primary cells and several cancer cell lines are not only resistant to death receptor-induced apoptosis, but also subject to inflammatory responses in a nuclear factor-κB (NF-κB)-dependent manner. Although the involvement of TRAIL in a variety of vascular disorders has been proposed, the exact molecular mechanisms are unclear. Here, we aimed to delineate the role of TRAIL in inflammatory vascular response. We also sought possible molecular mechanisms to identify potential targets for the prevention and treatment of post-angioplastic restenosis and atherosclerosis. Treatment with TRAIL increased the expression of intercellular adhesion molecule-1 by primary human vascular smooth muscle cells via protein kinase C (PKC)δ and NF-κB activation. Following detailed analysis using various PKCδ mutants, we determined that PKCδ activation was mediated by caspase-dependent proteolysis. The protective role of PKCδ was further confirmed in post-traumatic vascular remodeling in vivo. We propose that the TRAIL/TRAIL receptor system has a critical role in the pathogenesis of inflammatory vascular disorders by transducing pro-inflammatory signals via caspase-mediated PKCδ cleavage and subsequent NF-κB activation.

Nanoporous graphene oxide thin films from nanohybrid multilayers

We report on the preparation and characterization study of new nanoporous reduced graphene oxide (rGO) film fabricated from electrostatic layer-by-layer assembly of gold nanoparticles (gold-NPs) and rGO. Well distributed gold-NPs in multilayer film means that the gold-NPs can be readily dissolved by the addition of cyanide ions, which allows for a direct and precise comparison of the porosity of multilayer thin films based on rGO under the presence and absence of the gold-NPs. In addition, the LbL assembly methods offers the big advantages of possibilities in mass production and 2-dimensional nano-objects based film prepared from large size substrates. We expect that this demonstration offers a new route to introduce nanopore into multilayer thin films and opens up the possibility of building more complex functional multicomponent nanoporous structure consisting of 2-dimensional nano-objects, which are believed to be useful for nanodevice systems.

Carbon decorative coatings by dip-, spin-, and spray-assisted layer-by-layer assembly deposition

We performed a comparative surface analysis of all-carbon nano-objects (multiwall carbon nanotubes (MWNT) or graphene oxide (GO) sheets) based multilayer coatings prepared using three widely used nanofilm fabrication methods: dip-, spin-, and spray-assisted layer-by-layer (LbL) deposition. The resultant films showed a marked difference in their growth mechanisms and surface morphologies. Various carbon decorative coatings were synthesized with different surface roughness values, despite identical preparation conditions. In particular, smooth to highly rough all-carbon surfaces, as determined by atomic force microscopy (AFM) and scanning electron microscopy (SEM), were readily obtained by manipulating the LbL deposition methods. As was confirmed by the AFM and SEM analyses, this finding indicated the fundamental morphological evolution of one-dimensional nano-objects (MWNT) and two-dimensional nano-objects (GO) by control of the surface roughness through the deposition method. Therefore, an analysis of the three LbL-assembly methods presented herein may offer useful information about the industrial use of carbon decorative coatings and provide an insight into ways to control the structures of multilayer coatings by tuning the morphologies of carbon nano-objects.

Dopamine and mesotocin neurotransmission during the transition from incubation to brooding in the turkey

We investigated the neuroendocrine changes involved in the transition from incubating eggs to brooding of the young in turkeys. Numbers of mesotocin (MT; the avian analog of mammalian oxytocin) immunoreactive (ir) neurons were higher in the nucleus paraventricularis magnocellularis (PVN) and nucleus supraopticus, pars ventralis (SOv) of late stage incubating hens compared to the layers. When incubating and laying hens were presented with poults, all incubating hens displayed brooding behavior. c-fos mRNA expression was found in several brain areas in brooding hens. The majority of c-fos mRNA expression by MT-ir neurons was observed in the PVN and SOv while the majority of c-fos mRNA expression in dopaminergic (DAergic) neurons was observed in the ventral part of the nucleus preopticus medialis (POM). Following intracerebroventricular injection of DA or oxytocin (OT) receptor antagonists, hens incubating eggs were introduced to poults. Over 80% of those injected with vehicle or the D1 DA receptor antagonist brooded poults, while over 80% of those receiving the D2 DA receptor antagonist or the OT receptor antagonist failed to brood the poults. The D2 DA/OT antagonist groups also displayed less c-fos mRNA in the dorsal part of POM and the medial part of the bed nucleus of the stria terminalis (BSTM) areas than did the D1 DA/vehicle groups. These data indicate that numerous brain areas are activated when incubating hens initially transition to poult brooding behavior. They also indicate that DAergic, through its D2 receptor, and MTergic systems may play a role in regulating brooding behaviors in birds.

Association between interleukin-3 gene polymorphism and acute rejection after kidney transplantation

BACKGROUND

Acute rejection (AR) after kidney transplantation resulting from alloimmune responses has a negative effect on graft survival. AR is mainly caused by T-cell immune responses activated by cytokines, including interleukin (IL)-2, -4, and -7. Many reports have shown that single nucleotide polymorphisms (SNPs) of these cytokines can affect the occurrence of AR. IL-3, which is secreted by activated T cells, can mediate AR. Our study sought to investigate the association between SNPs of the IL3 gene and the occurrence of an AR episode (ARE).

METHODS

We analyzed 3 SNPs of IL3 (rs181781, rs2073506, and rs40401) among 330 renal recipients, 60 of whom had developed an ARE. SNPs of the IL3 gene, including 1 exonic SNP (rs40401) and 2 regulatory thought to be promoter SNPs (rs181781 and rs2073506).

RESULTS

The genotypes of 60 ARE subjects and the 270 patients without AR demonstrated a significant relationship between genotype frequencies and the SNPs. The occurrence of an ARE was associated with rs181781 (P = .041, dominant model), rs2073506 (P = .009, codominant 1 model; P = .003, dominant model), and rs40401 (P = .014, recessive model). Among haplotypes, AAT showed a significant association with ARE. (P = .0033).

CONCLUSION

Our results suggest that IL3 gene polymorphisms were associated with this event.

Effects of nicotine on apoptosis in human gingival fibroblasts

AIM

Cigarette smoke is a complex mixture of more than 4700 chemical compounds including free radicals and oxidants and it is a world widely known problem to health. Nicotine is the major compound of tobacco and known as the cause of gingivitis and periodontitis. It induces intracellular oxidative stress recognized as the important agent in the damage of biological molecules. The aim of this study is to clarify the cytotoxic pathway of nicotine in human gingival fibroblasts (HGFs).

METHODS

Human gingival fibroblasts stimulated by nicotine were used as an in vitro model. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to detect cell viability and reactive oxygen species (ROS) generation was assessed with 2,7-dichlorofluoroscein diacetate (DCF-DA). Morphological change was detected by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP) nick end labelling (TUNEL) assay, stained with 4,6-diamidino-2-phenylindole (DAPI). To delineate the roles of extracellular signal-regulated kinase (ERK), P38 and c-Jun N-terminal kinase (JNK), Western blot and caspase-3 (CASP3) activity assay were performed.

RESULTS

Exposure of the human gingival fibroblasts to nicotine reduced cell viability by time and dose dependent and increased the generation of ROS. It also showed morphological evidence of increased apoptosis, resulted in transient activation of JNK and ERK concomitant with activation of P38, and stimulated apoptosis as evidenced by CASP3 activation and Poly ADP ribose polymerase (PARP) cleavage.

CONCLUSION

These results suggest that nicotine induces apoptosis through the ROS generation and CASP3 dependent pathways in HGFs.

Multicenter study of robotic thyroidectomy: short-term postoperative outcomes and surgeon ergonomic considerations

BACKGROUND

Robotic thyroidectomy (RT) has recently emerged as a viable approach to thyroid surgery, resulting in better functional and cosmetic outcomes than afforded by open thyroidectomy (OT). The present multicenter study assessed the perioperative outcomes of RT and compared physician perspectives on the musculoskeletal ergonomic parameters associated with OT, endoscopic thyroidectomy (ET), and RT.

MATERIALS AND METHODS

We reviewed the medical records of 2014 consecutive patients who underwent RT, conducted by 7 surgeons, at 4 centers between October 2007 and June 2010. Patient characteristics, perioperative clinical results, complications, and pathologic outcomes were analyzed. Moreover, surgeons were surveyed to gather data on musculoskeletal discomfort experienced during OT, ET, and RT.

RESULTS

Of the 2014 patients, 740 underwent total and 1274 subtotal thyroidectomy. Mean tumor diameter was 0.8 cm, and the mean number of retrieved central lymph nodes was 4.5 ± 3.9 (range 0-28). The rates of permanent recurrent laryngeal nerve injury and permanent hypocalcemia were 0.4 and 0.05%, respectively. Neck and/or back pain after OT, ET, and RT was experienced by 100, 85.7, and 28.6% of surgeons, respectively. When surgeons ranked the operative approaches in decreasing order of associated pain, 57.1% indicated ET > OT > RT, 28.6% selected OT > ET > RT, and 14.3% responded ET > RT > OT.

CONCLUSION

RT is a feasible and safe procedure that may facilitate radical cervical lymph node dissection. Moreover, for surgeons, the RT resulted in less musculoskeletal discomfort than did OT or ET. A larger prospective study, with a longer follow-up, is needed to determine whether RT offers real benefits for both patients and surgeons.