Hasil untuk "Surgery"

Giorgio Chiesa, Rossella Borra, Vittorio Lauro et al.

This paper presents a comprehensive workflow for generating and validating a synthetic dataset designed for robotic surgery instrument segmentation. A 3D reconstruction of the Da Vinci robotic arms was refined and animated in Autodesk Maya through a fully automated Python-based pipeline capable of producing photorealistic, labeled video sequences. Each scene integrates randomized motion patterns, lighting variations, and synthetic blood textures to mimic intraoperative variability while preserving pixel-accurate ground truth masks. To validate the realism and effectiveness of the generated data, several segmentation models were trained under controlled ratios of real and synthetic data. Results demonstrate that a balanced composition of real and synthetic samples significantly improves model generalization compared to training on real data only, while excessive reliance on synthetic data introduces a measurable domain shift. The proposed framework provides a reproducible and scalable tool for surgical computer vision, supporting future research in data augmentation, domain adaptation, and simulation-based pretraining for robotic-assisted surgery. Data and code are available at https://github.com/EIDOSLAB/Sintetic-dataset-DaVinci.

Monika Gandhi, Rashpal Singh Gill, Aishwarya Sharma et al.

Background: Proper pain control before subarachnoid block (SAB) is must in proximal femur fractures as patients cannot tolerate movement due to severe pain. This study compares ultrasound-guided fascia iliaca compartment block (USG-FICB) with femoral nerve block (USG-FNB) for pre-SAB analgesia. Materials and Methods: Ninety patients scheduled for elective femur fracture surgery under SAB were randomly divided. Group FICB received 25 ml of 0.25% bupivacaine and Group FNB got 15 ml. Pain was assessed using Numerical Rating Scale (NRS) scale. Time for first rescue dose, side effects, and patient satisfaction also noted. Results: Both groups had similar baseline NRS. Group FICB showed faster pain relief and better positioning comfort during SAB (NRS 3.00 vs. 4.28 P = 0.001). Time to first rescue analgesia was more in FICB (4.67 vs. 2.71 h P = 0.001). Satisfaction scores were also higher. Hemodynamics stayed stable, and adverse events were rare. Conclusion: USG-FICB is more effective than USG-FNB in controlling pain before SAB in femur fracture surgery.

Hanyi Zhang, Kaizhong Deng, Zhaoyang Jacopo Hu et al.

Radioguided surgery, such as sentinel lymph node biopsy, relies on the precise localization of radioactive targets by non-imaging gamma/beta detectors. Manual radioactive target detection based on visual display or audible indication of gamma level is highly dependent on the ability of the surgeon to track and interpret the spatial information. This paper presents a learning-based method to realize the autonomous radiotracer detection in robot-assisted surgeries by navigating the probe to the radioactive target. We proposed novel hybrid approach that combines deep reinforcement learning (DRL) with adaptive robotic scanning. The adaptive grid-based scanning could provide initial direction estimation while the DRL-based agent could efficiently navigate to the target utilising historical data. Simulation experiments demonstrate a 95% success rate, and improved efficiency and robustness compared to conventional techniques. Real-world evaluation on the da Vinci Research Kit (dVRK) further confirms the feasibility of the approach, achieving an 80% success rate in radiotracer detection. This method has the potential to enhance consistency, reduce operator dependency, and improve procedural accuracy in radioguided surgeries.

Michele Campigotto, Francesca Priotto, Cinzia Francesca Tonello et al.

<b>Background and Clinical Significance</b>: Orofacial granulomatosis is a rare but often disabling condition potentially associated with inflammatory bowel disease (IBD). Pathogenesis is not well understood, and no disease-specific approved treatment exists to date. <b>Case Presentation</b>: A 26-year-old woman with pan-enteric Crohn’s disease developed buccal swelling and deep oral ulcers histologically confirmed as associated orofacial granulomatosis. Multiple therapies were attempted during her life, including systemic steroids and immunomodulator drugs as Thalidomide, Adalimumab, and Ustekinumab in combination with topical steroid injections and Cyclosporin application, with no or minimal benefit. Only Infliximab showed good efficacy, but it was suspended due to side effects. Following secondary loss of response to Ustekinumab, compassionate treatment with Upadacitinib, a recently developed oral Jak-1 selective inhibitor, resulted in the complete resolution of the oral ulcers. Moreover, after the 12-week induction phase and the transition to 30 mg/daily maintenance dosage, the oral disease remained controlled. Due to the clinical recurrence of Crohn’s disease, Vedolizumab was added as associated treatment, resulting in complete clinical benefit after six months of follow-up. <b>Conclusions</b>: This is a unique case of orofacial granulomatosis associated with pan-enteric Crohn’s disease successfully treated with Upadacitinib. More data are needed to explore its potential benefits in this clinical condition.

Alessandro Marquis, Jonathan Olivier, Tavya G. R. Benjamin et al.

<b>Background/Objectives:</b> Focal therapy (FT) for prostate cancer (PCa) is an alternative to radical treatments that aims to balance cancer control and quality of life preservation in well-selected patients. Understanding its general principles and outcomes is key for its widespread adoption and proper implementation. <b>Methods</b>: The International Consultation on Urological Diseases nominated a committee to review the literature on FT for PCa. A comprehensive PubMed search was conducted to identify articles focused on the different aspects of FT, including patient selection, imaging techniques, treatment modalities, cancer control and safety outcomes, integration with other approaches and future perspectives. <b>Results</b>: FT for PCa was introduced in the 1990s with cryotherapy and high-intensity focused ultrasound (HIFU) as pioneering modalities. Though initially guided by transrectal ultrasound (TRUS) and large biopsy templates, FT implementation expanded significantly with the advent of multiparametric magnetic resonance imaging (MRI) and the validation of the index lesion concept. Appropriate patient selection is key for FT and relies on prostate-specific antigen (PSA) metrics, MRI findings and targeted biopsy information. Multiple energy sources are now available, each with specific technical characteristics. Cancer control rates vary by energy modality, tumor characteristics, and institutional experience, demonstrating comparable outcomes to radical treatments in well-selected patients. The safety profile is excellent, with high rates of urinary continence and sexual function preservation. Post-treatment surveillance integrates PSA measurements, imaging, and histological assessment. Future directions for further FT adoption include the availability of long-term data, protocol standardization and technological improvements to enhance patient selection and treatment planning and delivery. <b>Conclusions</b>: FT is a valuable therapeutic option for selected patients with localized PCa, demonstrating promising oncological outcomes and better functional preservation compared to radical treatments. Understanding its principles and technical aspects is essential for offering comprehensive PCa care.

Zefeng Shen, Liye Tao, Yali Wang et al.

Abstract The development of primary liver cancer (hepatocellular carcinoma [HCC] and intrahepatic cholangiocarcinoma [ICC]) is linked to its physical microenvironment, particularly extracellular matrix (ECM) stiffness. Potential anticancer strategies targeting ECM stiffness include prevention/reversal of the stiffening process and disruption of the response of cancer cells to mechanical signals from ECM. However, each strategy has limitations. Therefore, the authors propose integrating them to maximize their strengths. Compared with HCC, ICC has a stiffer ECM and a worse prognosis. Therefore, ICC is selected to investigate mechanisms underlying the influence of ECM stiffness on cancer progression and application of the integrated anticancer strategy targeting ECM stiffness. In summary, immunofluorescence results for 181 primary liver cancer tissue chips (ICC, n = 91; HCC, n = 90) and analysis of TCGA mRNA‐sequencing demonstrate that ECM stiffness can affect phenotypes of primary liver cancers. The YAP1/ABHD11‐AS1/STAU2/ZYX/p‐YAP1 pathway is a useful entry point for exploration of specific mechanisms of mechanical signal conduction from the ECM in ICC cells and their impact on cancer progression. Moreover, a synergistic anticancer strategy targeting ECM stiffness (ICCM@NPs + siABHD11‐AS1@BAPN) is constructed by integrating ECM softening and blocking intracellular mechanical signal transduction in ICC and can provide insights for the treatment of cancers characterized by stiff ECM.

Tiancheng Liu, Tiancheng Liu, Sishi Huang et al.

BackgroundAnatomic basal segmentectomy is often regarded as a complex procedure, particularly in the presence of complex anatomical variations.Case reportHerein, we present a case of a 55-year-old female patient diagnosed with invasive lung adenocarcinoma. Three-dimensional computed tomography bronchography and angiography (3D-CTBA) displayed a unique combined variation in the basal segment of right lower lobe (RLL): The medial basal subsegmental bronchi (BX7a+BX7t) originated from both the anterior and posterior segmental bronchi; The medial basal subsegmental arteries emanated from the anterior and posterior basal segmental arteries; The medial anterior segmental vein shared a trunk with both the anterior basal and lateral basal subsegmental veins. With precise preoperative planning, thoracoscopic anterior basal segmentectomy was successfully executed.ConclusionThis case again highlights the importance of 3D-reconstruction in pulmonary segmentectomy. Detailed understanding of anatomic features of segmental bronchi and vessels is imperative for those with complex anatomical variations.

Ehsan Nasiri, Long Wang

In laparoscopic robot-assisted minimally invasive surgery, the kinematic control of the robot is subject to the remote center of motion (RCM) constraint at the port of entry (e.g., trocar) into the patient's body. During surgery, after the instrument is inserted through the trocar, intrinsic physiological movements such as the patient's heartbeat, breathing process, and/or other purposeful body repositioning may deviate the position of the port of entry. This can cause a conflict between the registered RCM and the moved port of entry. To mitigate this conflict, we seek to utilize the interaction forces at the RCM. We develop a novel framework that integrates admittance control into a redundancy resolution method for the RCM kinematic constraint. Using the force/torque sensory feedback at the base of the instrument driving mechanism (IDM), the proposed framework estimates the forces at RCM, rejects forces applied on other locations along the instrument, and uses them in the admittance controller. In this paper, we report analysis from kinematic simulations to validate the proposed framework. In addition, a hardware platform has been completed, and future work is planned for experimental validation.

Peter N. Taylor, Yujiang Wang, Callum Simpson et al.

Magnetic resonance imaging (MRI) is a crucial tool to identify brain abnormalities in a wide range of neurological disorders. In focal epilepsy MRI is used to identify structural cerebral abnormalities. For covert lesions, machine learning and artificial intelligence algorithms may improve lesion detection if abnormalities are not evident on visual inspection. The success of this approach depends on the volume and quality of training data. Herein, we release an open-source dataset of preprocessed MRI scans from 442 individuals with drug-refractory focal epilepsy who had neurosurgical resections, and detailed demographic information. The MRI scan data includes the preoperative 3D T1 and where available 3D FLAIR, as well as a manually inspected complete surface reconstruction and volumetric parcellations. Demographic information includes age, sex, age of onset of epilepsy, location of surgery, histopathology of resected specimen, occurrence and frequency of focal seizures with and without impairment of awareness, focal to bilateral tonic-clonic seizures, number of anti-seizure medications (ASMs) at time of surgery, and a total of 1764 patient years of post-surgical follow up. Crucially, we also include resection masks delineated from post-surgical imaging. To demonstrate the veracity of our data, we successfully replicated previous studies showing long-term outcomes of seizure freedom in the range of around 50%. Our imaging data replicates findings of group level atrophy in patients compared to controls. Resection locations in the cohort were predominantly in the temporal and frontal lobes. We envisage our dataset, shared openly with the community, will catalyse the development and application of computational methods in clinical neurology.

Joschka Haltaufderheide, Stefanie Pfisterer-Heise, Dawid Pieper et al.

Background: Robot-assisted surgery has been widely adopted in recent years. However, compared to other health technologies operating in close proximity to patients in a vulnerable state, ethical issues of robot-assisted surgery have received less attention. Against the background of increasing automation that are expected to raise new ethical issues, this systematic review aims to map the state of the ethical debate in this field. Methods: A protocol was registered in the international prospective register of systematic reviews (PROSPERO CRD42023397951). Medline via PubMed, EMBASE, CINHAL, Philosophers' Index, IEEE Xplorer, Web of Science (Core Collection), Scopus and Google Scholar were searched in January 2023. Screening, extraction, and analysis were conducted independently by two authors. A qualitative narrative synthesis was performed. Results: Out of 1,723 records, 66 records were included in the final dataset. Seven major strands of the ethical debate emerged during analysis. These include questions of harms and benefits, responsibility and control, professional-patient relationship, ethical issues in surgical training and learning, justice, translational questions, and economic considerations. Discussion: The identified themes testify to a broad range of different and differing ethical issues requiring careful deliberation and integration into the surgical ethos. Looking forward, we argue that a different perspective in addressing robotic surgical devices might be helpful to consider upcoming challenges of automation.

Tejas Vyas, Mohsena Chowdhury, Xiaojiao Xiao et al.

Mitral Transcatheter Edge-to-Edge Repair (mTEER) is a medical procedure utilized for the treatment of mitral valve disorders. However, predicting the outcome of the procedure poses a significant challenge. This paper makes the first attempt to harness classical machine learning (ML) and deep learning (DL) techniques for predicting mitral valve mTEER surgery outcomes. To achieve this, we compiled a dataset from 467 patients, encompassing labeled echocardiogram videos and patient reports containing Transesophageal Echocardiography (TEE) measurements detailing Mitral Valve Repair (MVR) treatment outcomes. Leveraging this dataset, we conducted a benchmark evaluation of six ML algorithms and two DL models. The results underscore the potential of ML and DL in predicting mTEER surgery outcomes, providing insight for future investigation and advancements in this domain.

Zhang Y, Wang H, Yang J et al.

Yating Zhang,1 Hongyan Wang,1 Jie Yang,2 Sanchun Wang,1 Weifang Tong,1 Bo Teng1 1Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China; 2Department of Neurology, the First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of ChinaCorrespondence: Bo Teng, Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun, Jilin Province, 130000, People’s Republic of China, Email tengbo1975@163.comPurpose: This investigation sought to elucidate the genetic underpinnings that connect obesity indicators, circulating blood lipid levels, adipokines levels and obstructive sleep apnea syndrome (OSAS), employing a bidirectional two-sample Mendelian randomization (MR) analysis that utilizes data derived from extensive genome-wide association studies (GWAS).Methods: We harnessed genetic datasets of OSAS available from the FinnGen consortium and summary data of four obesity indices (including neck circumference), seven blood lipid (including triglycerides) and eleven adipokines (including leptin) from the IEU OpenGWAS database. We primarily utilized inverse variance weighted (IVW), weighted median, and MR-Egger methods, alongside MR-PRESSO and Cochran’s Q tests, to validate and assess the diversity and heterogeneity of our findings.Results: After applying the Bonferroni correction, we identified significant correlations between OSAS and increased neck circumference (Odds Ratio [OR]: 3.472, 95% Confidence Interval [CI]: 1.954– 6.169, P= 2.201E-05) and decreased high-density lipoprotein (HDL) cholesterol levels (OR: 0.904, 95% CI: 0.858– 0.952, P= 1.251E-04). Concurrently, OSAS was linked to lower leptin levels (OR: 1.355, 95% CI: 1.069– 1.718, P= 0.012) and leptin receptor levels (OR: 0.722, 95% CI: 0.530– 0.996, P= 0.047). Sensitivity analyses revealed heterogeneity in HDL cholesterol and leptin indicators, but further multiplicative random effects IVW method analysis confirmed these correlations as significant (P< 0.05) without notable heterogeneity or horizontal pleiotropy in other instrumental variables.Conclusion: This investigation compellingly supports the hypothesis that OSAS could be a genetic predisposition for elevated neck circumference, dyslipidemia, and adipokine imbalance. These findings unveil potential genetic interactions between OSAS and metabolic syndrome, providing new pathways for research in this domain. Future investigations should aim to delineate the specific biological pathways by which OSAS impacts metabolic syndrome. Understanding these mechanisms is critical for developing targeted prevention and therapeutic strategies.Keywords: sleep disorders, metabolic syndrome, causal inference, GWAS

A. S. Zoricheva, E. A. Zvonova, L. S. Agapova et al.

INTRODUCTION. The current cell-based cartilage repair methods, such as autologous chondrocyte transplantation, are not sufficiently effective, and the surgery is painful and traumatic. Therefore, there is a need for a more effective cell therapy product with a minimally invasive surgical procedure for its implantation into the patient.AIM. This study aimed to develop a manufacturing technology for the production of an autologous cell-based medicinal product (CBMP) comprising three-dimensional structures (3D-spheroids) based on chondrocytes isolated from the patient’s cartilage tissue, as well as to evaluate its clinical efficacy.MATERIALS AND METHODS. Autologous chondrocytes isolated from the patient’s cartilage biopsy were propagated in monolayer culture to obtain the required number of cells. Subsequently, the chondrocytes were cultivated on plates with a non-adhesive coating to form 3D spheroids. All CBMP production steps were performed under aseptic conditions in cell culture isolators. The authors used phase-contrast microscopy and immunohistochemical staining with specific fluorescence-labelled antibodies to characterise chondrocyte phenotypes at different stages of cultivation. Genetic stability was controlled by karyotyping. The efficacy of Easytense® was evaluated in a clinical trial using specialised functional tests and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. The primary efficacy endpoint was a change in the overall score on the Knee Injury and Osteoarthritis Outcome Score (KOOS).RESULTS. A manufacturing technology without using animal sera, growth factors, cytokines, or other additives was developed for the production of the autologous CBMP Easytense®. Karyological data confirmed that the chondrocytes retained genetic stability for 3 passages in monolayer culture. When cultured as 3D spheroids, the chondrocytes produced cartilage extracellular matrix proteins (type II collagen, aggrecan), thus acquiring the ability to repair damaged cartilage. The clinical trial demonstrated a statistically significant improvement in knee cartilage 12 months after the transplantation of 3D spheroids derived from autologous chondrocytes. The mean change in the overall KOOS score was 23.8±15.9.CONCLUSIONS. The clinical trial results indicate that Easytense® is highly effective for cartilage repair. Based on these results, the CBMP has been granted marketing authorisation and introduced into clinical practice in the Russian Federation. Easytense® has the potential to replace endoprosthetics and expensive surgeries abroad.

Dong Wang, Wenzhe Chen, Jiali Chen et al.

In individuals afflicted with hemophilia, characterized by a deficiency of coagulation factor VIII (FVIII), the occurrence of spontaneous recurrent intra-articular hemorrhage precipitates the emergence of hemophilic arthropathy (HA). Although clotting factor replacement therapy reduces joint bleeding clinically, clotting factors need to be injected frequently due to the rapid diffusion of the drug. Hence, a novel drug delivery approach may be developed to improve the drug therapy. Platelet-derived extracellular vesicles (PEVs) are known to possess anti-inflammatory and hemostatic properties and could be used as a potential HA therapy. In this study, we constructed a PEV-LS@FVIII nanotherapeutic system by combining thioketal (TK), liposomes (LS), and FVIII to form the LS@FVIII complexes, and then hybridizing PEV with LS@FVIII. Our results demonstrated that PEV-LS@FVIII could efficiently facilitate FVIII delivery and specifically target the injured knee joint. Both in vitro and in vivo studies showed a reduction in the M1 phenotype of macrophages and an enhancement of the M2 phenotype, compared to FVIII free control. Furthermore, PEV-LS@FVIII appeared to alleviate HA-induced cartilage damage. In conclusion, our findings demonstrate that PEV-LS@FVIII could delay the progression of HA by targeting bleeding joints, modulating macrophage polarization to suppress inflammation, and mitigating cartilage damage.

Ollie Thakar

We introduce a new method of detecting when the fundamental group of a Dehn surgery on a knot admits a left-ordering, a method which is particularly useful for 2-bridge knots. As an illustration of this method, we show that all Dehn surgeries on the knot $6_2$ with slope in the interval $(-4, 8)\cap\mathbb{Q}$ have left-orderable fundamental groups by exhibiting a family of hyperbolic $\widetilde{PSL}(2,\mathbb{R})$-representations of the knot complement group.

Vitorino Modesto dos Santos, Lister A. Modesto dos Santos, Laura Campos-Modesto et al.

Lymphadenopathy related to vaccination has been reported as an adverse effect of mRNA-based COVID-19 vaccines. Most cases are regional lymph nodes near of injection site, with mild-moderate 18 F-fluorodeoxyglucose uptake on positron emission tomography. We report a middle-aged Brazilian man with mesenteric lymphadenitis manifested five days after the third dose of the Pfizer-BioNTech mRNA-based vaccine against COVID-19. The patient had no known risk factors and evolved with rapid clinical improvement. The imaging findings, laboratory determinations, histopathological and microbiological evaluations raised doubts about the hypothesis of an eventual adverse effect of the vaccine. The aim is to call attention to possible rare reactions of SARS-CoV-2 vaccinations.

Harshini Suresh Kumar, Edwina N. Barnett, John L. Fowlkes et al.

ABSTRACT Diabetes is a chronic metabolic disorder that can lead to diabetic myopathy and bone diseases. The etiology of musculoskeletal complications in such metabolic disorders and the interplay between the muscular and osseous systems are not well understood. Exercise training promises to prevent diabetic myopathy and bone disease and offer protection. Although the muscle‐bone interaction is largely biomechanical, the muscle secretome has significant implications for bone biology. Uncoupling effects of biophysical and biochemical stimuli on the adaptive response of bone during exercise training may offer therapeutic targets for diabetic bone disease. Here, we have developed an in vitro model to elucidate the effects of mechanical strain on myokine secretion and its impact on bone metabolism decoupled from physical stimuli. We developed bone constructs using cross‐linked gelatin, which facilitated osteogenic differentiation of osteoprogenitor cells. Then muscle constructs were made from fibrin, which enabled myoblast differentiation and myotube formation. We investigated the myokine expression by muscle constructs under strain regimens replicating endurance (END) and high‐intensity interval training (HIIT) in hyperglycemic conditions. In monocultures, both regimens induced higher expression of Il15 and Igf1, whereas END supported more myoblast differentiation and myotube maturation than HIIT. When co‐cultured with bone constructs, HIIT regimen increased Glut4 expression in muscle constructs more than END, supporting higher glucose uptake. Likewise, the muscle constructs under the HIIT regimen promoted a healthier and more matured bone phenotype than END. Under static conditions, myostatin (Mstn) expression was significantly downregulated in muscle constructs co‐cultured with bone constructs compared with monocultures. Together, our in vitro co‐culture system allowed orthogonal manipulation of mechanical strain on muscle constructs while facilitating bone‐muscle biochemical cross‐talk. Such systems can provide an individualized microenvironment that allows decoupled biomechanical manipulation, help identify molecular targets, and develop engineered therapies for metabolic bone disease. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

I. A. Filatova, Yu. P. Kondratieva, I. M. Mohammad et al.

Purpose: to evaluate the effectiveness of surgical treatment of the floppy eyelid syndrome. Material and methods. The clinical group consisted of 23 patients (46 eyes) with the floppy eyelid syndrome (16 men and 4 women), ave. aged 46,0 ± 2.6 years. Of these 20 patients underwent surgery for floppy eyelid syndrome by vertical and horizontal shortening of the upper eyelid with or without correction of blepharoptosis. The observation period ranged from 1 month to 10 years. Fragments resected during the operation were subjected to histological examination. Results. A histological study revealed a reduced quantity or absence of elastin in the tarsal plate, destruction of collagen fiber beams, malformation of hair follicles accompanied by moderate chronic inflammation, In the postoperative period, the complaints caused by involuntary ectropion of the upper eyelid disappeared in all patients, the palpebral fissures became maximally symmetric. Conclusion. Surgeries performed by our technologies result in the best possible anatomical arrangement of the upper eyelid within a single-stage procedure.

Meihua Jin, Ahreum Jang, Chae A Kim et al.

Objective: This study evaluated the efficacy of antithyroid drugs (ATDs) and risk factors associated with the recurrence of Graves’ hyperthyroidism using a comprehensive retrospective cohort. Methods: We included 1829 patients newly diagnosed with Graves’ hyperthyroidism, with sufficient follow-up data. Clinical outcomes of the patients and risk factors associated with recurrence-free survival, including the changes in thyrotropin receptor antibody, were evaluated. Results: The median age of the patients was 44.5 years, and 69% were female. Among the patients, 1235 had a chance to withdraw ATD after a median of 23 (interquartile range (IQR) 17.0–35.5) months of treatment. The first remission rate was 55.6% during a median of 72.7 months of follow-up. After the first recurrence, 95% of patients underwent the second course of ATD treatment for a median of 21 .1 (IQR 14.8–31.7) months, and the remission rate was 54.1%. During a median of 67 months of follow-up, 7.7% of patients underwent surgery, and 10.5% underwent radioac tive iodine therapy. Approximately 30% were still on ATD therapy for recurrent disease or prolonged lowdose maintenance. Younger age (<45 years), male sex, and fluctua ting or smoldering of TRAb levels were independent risk factors of the first recurrenc e after ATD treatment. Conclusions: ATD treatment is an acceptable option for the initial treatment of Graves’ hyperthyroidism as well as for recurrent disease. The optimal treatment period for ATD treatment needs to be determined using the individual risk factors of recurrence.