Browse publications by year: 2006

Vessel density ratio: A novel approach to identify "culprit" coronary lesion by spiral computed tomography

Chin BS, Ong TK, Seyfarth TM, Liew CK, Chan WL, Rapaee A, et al.

J Comput Assist Tomogr, 2006 7 18;30(4):564-8.
PMID: 16845284

BACKGROUND AND OBJECTIVE: We hypothesized that a "culprit" lesion in acute coronary syndrome (ACS) should have low overall vessel lumen and plaque density on multidetector computed tomography-assisted coronary angiography (MDCTA) because of lower calcification and the presence of occlusive thrombus. However, thrombi and calcification both can themselves blur the demarcation between vessel wall and lumen. If we calculated a "vessel density ratio" (VDR) obtained by measuring the mean density of contrast-enhancement within a region of interest (ROI), which includes the vessel wall, lumen, plaque, and thrombus, and comparing that with the aortic root mean density acting as a reference point, this ratio may be more convenient, standardized, and reproducible to test the feasibility of VDR in identifying "culprit" lesions in ACS.
METHODS: Sixty-four patients-21 exertional angina; 17 unstable angina/non-ST elevation myocardial infarction (NSTEMI); 26 ST elevation myocardial infarction (STEMI)-provided 188 diseased segments on conventional angiography. All underwent MDCTA within a week of angiography. ROI was mapped out from maximum intensity projections of diseased segments in planar view.
RESULTS: One hundred seventy-four segments were evaluated. Patients who presented with ACS (STEMI and unstable angina/non-ST elevation myocardial infarction) had lower mean VDR compared to patients with exertional angina (0.58 vs. 0.66 vs. 0.81; P < 0.001). Culprit lesions in ACS patients also had the lowest mean VDR when compared to nonculprit lesions and lesions in patients without ACS (0.51 vs. 0.68 vs. 0.81; P < 0.001).
CONCLUSIONS: VDR is a new, convenient, and standardized approach in identifying "culprit" lesions by MDCTA.

MeSH terms: Acute Disease; Analysis of Variance; Contrast Media; Female; Humans; Iohexol; Male; Middle Aged; Severity of Illness Index; Syndrome; Coronary Angiography; Tomography, Spiral Computed*
Computed tomographic morphometry of thoracic pedicles: safety margin of transpedicular screw fixation in malaysian malay population

Liau KM, Yusof MI, Abdullah MS, Abdullah S, Yusof AH

Spine (Phila Pa 1976), 2006 Jul 15;31(16):E545-50.
PMID: 16845341

A cross-sectional study of thoracic pedicle morphometry (T1-T12) of 180 Malaysian Malay patients obtained from computed tomographic scan.

MeSH terms: Adult; Aged; Bone Screws*; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Safety; Sex Characteristics; Thoracic Vertebrae/radiography*; Thoracic Vertebrae/surgery*; Tomography, X-Ray Computed*; Asian Continental Ancestry Group*
Multiresolution wavelet analysis for efficient analysis, compression and remote display of long-term physiological signals

Khuan LY, Bister M, Blanchfield P, Salleh YM, Ali RA, Chan TH

Australas Phys Eng Sci Med, 2006 Jun;29(2):216-28.
PMID: 16845928

Increased inter-equipment connectivity coupled with advances in Web technology allows ever escalating amounts of physiological data to be produced, far too much to be displayed adequately on a single computer screen. The consequence is that large quantities of insignificant data will be transmitted and reviewed. This carries an increased risk of overlooking vitally important transients. This paper describes a technique to provide an integrated solution based on a single algorithm for the efficient analysis, compression and remote display of long-term physiological signals with infrequent short duration, yet vital events, to effect a reduction in data transmission and display cluttering and to facilitate reliable data interpretation. The algorithm analyses data at the server end and flags significant events. It produces a compressed version of the signal at a lower resolution that can be satisfactorily viewed in a single screen width. This reduced set of data is initially transmitted together with a set of 'flags' indicating where significant events occur. Subsequent transmissions need only involve transmission of flagged data segments of interest at the required resolution. Efficient processing and code protection with decomposition alone is novel. The fixed transmission length method ensures clutter-less display, irrespective of the data length. The flagging of annotated events in arterial oxygen saturation, electroencephalogram and electrocardiogram illustrates the generic property of the algorithm. Data reduction of 87% to 99% and improved displays are demonstrated.

MeSH terms: Algorithms*; Computer Graphics*; Data Display*; Data Interpretation, Statistical; Database Management Systems; Monitoring, Physiologic/methods*; Sensitivity and Specificity; Signal Processing, Computer-Assisted; User-Computer Interface*; Reproducibility of Results; Databases, Factual; Information Storage and Retrieval/methods*; Telemedicine/methods*; Data Compression/methods*
Mating behaviors of the proboscis monkey (Nasalis larvatus)

Murai T

Am J Primatol, 2006 Aug;68(8):832-7.
PMID: 16847976 DOI: 10.1002/ajp.20266

The mating behaviors of the proboscis monkey were observed in a riverine forest along a tributary of the Kinabatangan River, Sabah, Malaysia, for a period of 30 months. Solicitation for copulation was initiated frequently by males and occasionally by females. Most copulations involved only one mount; however, some multiple-mount copulations were observed and a maximum of six mounts per copulation were recorded. The mean duration of mounts was about 27 sec. Nonsexual mounts (female-female, female-juvenile/infant, juvenile-juvenile, and juvenile-infant) were also observed. Female-female mounts occurred shortly after failed solicitations toward males were observed. Harassment by juveniles and/or infants was observed during copulation; however, these harassments apparently did not interfere with copulation. Sexual swelling was evident in 77.4% of copulating females, with copulating subadult females showing the most distinct swelling.

MeSH terms: Animals; Female; Genitalia, Female/anatomy & histology; Malaysia; Male; Sexual Behavior, Animal*; Colobinae/anatomy & histology; Colobinae/physiology*
Feral cats and risk for Nipah virus transmission

Epstein JH, Abdul Rahman S, Zambriski JA, Halpin K, Meehan G, Jamaluddin AA, et al.

Emerg Infect Dis, 2006 Jul;12(7):1178-9.
PMID: 16848051
MeSH terms: Animals; Cats/virology*; Chiroptera/virology; Malaysia; Nipah Virus/isolation & purification*; Henipavirus Infections/transmission*; Henipavirus Infections/virology*
Improving diagnostic quality of MR images through controlled lossy compression using SPIHT

Choong MK, Logeswaran R, Bister M

J Med Syst, 2006 Jun;30(3):139-43.
PMID: 16848126

This paper attempts to improve the diagnostic quality of magnetic resonance (MR) images through application of lossy compression as a noise-reducing filter. The amount of imaging noise present in MR images is compared with the amount of noise introduced by the compression, with particular attention given to the situation where the compression noise is a fraction of the imaging noise. A popular wavelet-based algorithm with good performance, Set Partitioning in Hierarchical Trees (SPIHT), was employed for the lossy compression. Tests were conducted with a number of MR patient images and corresponding phantom images. Different plausible ratios between imaging noise and compression noise (ICR) were considered, and the achievable compression gain through the controlled lossy compression was evaluated. Preliminary results show that at certain ICR's, it becomes virtually impossible to distinguish between the original and compressed-decompressed image. Radiologists presented with a blind test, in certain cases, showed preference to the compressed image rather than the original uncompressed ones, indicating that under controlled circumstances, lossy image compression can be used to improve the diagnostic quality of the MR images.

MeSH terms: Algorithms; Magnetic Resonance Imaging/methods*; Radiology/methods*; Data Compression/methods*
Mode choice model for vulnerable motorcyclists in Malaysia

Ibrahim Sheikh AK, Radin Umar RS, Habshah M, Kassim H, Stevenson M, Ahmed H

Traffic Inj Prev, 2006 Jun;7(2):150-4.
PMID: 16854709

In developing countries, motorcycle use has grown in popularity in the past decades. Commensurate with this growth is the increase in death and casualties among motorcyclists in these countries. One of the strategic programs to minimize this problem is to reduce motorcyclists exposure by shifting them into safer modes of transport. This study aims to explore the differences in the characteristics of bus and motorcycle users. It identifies the factors contributing to their choice of transport mode and estimates the probability that motorcyclists might change their travel mode to a safer alternative; namely, bus travel.

MeSH terms: Adolescent; Adult; Age Factors; Choice Behavior*; Data Collection; Female; Humans; Income; Malaysia; Male; Middle Aged; Motorcycles*; Sex Factors; Time Factors; Transportation*; Wounds and Injuries/prevention & control*; Logistic Models; Motor Vehicles
Increased energy intake for preterm infants with (or developing) bronchopulmonary dysplasia/ chronic lung disease

Lai NM, Rajadurai SV, Tan KH

Cochrane Database Syst Rev, 2006.
PMID: 16856077

Preterm infants with bronchopulmonary dysplasia/chronic lung disease have nutritional deficits that may contribute to short and long term morbidity and mortality. Increasing the daily energy intake for these infants may improve their respiratory, growth and neurodevelopmental outcomes.

MeSH terms: Bronchopulmonary Dysplasia/diet therapy*; Bronchopulmonary Dysplasia/physiopathology; Energy Intake*; Child Development; Chronic Disease; Humans; Infant, Newborn; Respiration
Safety and efficacy of rapid dose administration of quetiapine in bipolar mania

Hatim A, Habil H, Jesjeet SG, Low CC, Joseph J, Jambunathan ST, et al.

Hum Psychopharmacol, 2006 Jul;21(5):313-8.
PMID: 16856220

In this open-label pilot study, 20 adult patients hospitalized for acute bipolar mania received oral quetiapine as a single evening dose of 200 mg on day 1, increased by 200 mg/day on days 2, 3, and 4 until 800 mg/day taken in 2 divided doses on day 4. From day 5 onward, patients received a flexible total dose of 400-800 mg/day until completion of 3 weeks of treatment. Safety and tolerability were assessed by adverse-event (AE)-related dropouts in week 1, incidence of AEs including EPS, changes in electrocardiogram, and vital signs. Efficacy was assessed using the YMRS, PANSS, and CGI scales. Nineteen of 20 patients (95%) completed the quetiapine rapid titration during week 1. Significant improvement was observed in YMRS, PANSS, and CGI Severity of Illness scores by day 5, and was maintained throughout the study. A reduction of > or = 50% in YMRS score was achieved by 75% of patients by day 7, and maintained to day 21. Overall, 20% of patients discontinued due to AEs. Agitation was the most common cause of AE-related study discontinuation. Thirty-five per cent of patients required dose adjustment due to AEs after rapid dose administration was completed. Most patients tolerated rapid titration of quetiapine to 800 mg/day by day 4 of therapy, with a significant improvement in manic symptoms by day 7 of treatment.

MeSH terms: Quetiapine Fumarate; Adult; Bipolar Disorder/drug therapy*; Dibenzothiazepines/administration & dosage*; Dibenzothiazepines/adverse effects; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Evaluation; Female; Humans; Male; Middle Aged; Pilot Projects; Severity of Illness Index; Time Factors; Antipsychotic Agents/administration & dosage*; Antipsychotic Agents/adverse effects; Treatment Outcome
Determination of organochlorine and pyrethroid pesticides in fruit and vegetables using solid phase extraction clean-up cartridges

Sharif Z, Man YB, Hamid NS, Keat CC

J Chromatogr A, 2006 Sep 15;1127(1-2):254-61.
PMID: 16857206

A method to determine six organochlorine and three pyrethroid pesticides in grape, orange, tomato, carrot and green mustard based on solvent extraction followed by solid phase extraction (SPE) clean-up is described. The pesticides were spiked into the sample prior to analysis, extracted with ethyl acetate, evaporated and reconstituted with a solvent mixture of acetone:n-hexane (3:7). Three different sorbents (Strong Anion Exchanger/Primary Secondary Amine (SAX/PSA), Florisil and C18) were used for the clean-up step. Pesticides were eluted with 5mL of acetone:n-hexane (3:7, v/v) and determined by gas chromatography and electron-capture detection (GC-ECD). SAX/PSA was the sorbent, which provided chromatograms with less interference and the mean recoveries obtained were within 70-120% except for captafol. The captafol recoveries for grape were within acceptable range with C18 clean-up column.

MeSH terms: Chromatography, Gas/instrumentation; Chromatography, Gas/methods*; Chemical Fractionation/methods; Fruit/chemistry*; Hydrocarbons, Chlorinated/analysis*; Pesticides/analysis*; Pyrethrins/analysis*; Vegetables/chemistry*
The effect of Piper betle and Psidium guajava extracts on the cell-surface hydrophobicity of selected early settlers of dental plaque

Razak FA, Othman RY, Rahim ZH

J Oral Sci, 2006 Jun;48(2):71-5.
PMID: 16858135

The adhesion of early settlers of dental plaque to the tooth surface has a role in the initiation of the development of dental plaque. The hydrophobic surface properties of the bacteria cell wall are indirectly responsible for the adhesion of the bacteria cell to the acquired pellicle on the tooth surfaces. In this study, the effect of aqueous extract of two plants (Psidium guajava and Piper betle) on the cell-surface hydro-phobicity of early settlers of dental plaque was determined in vitro. Hexadecane, a hydrocarbon was used to represent the hydrophobic surface of the teeth in the oral cavity. It was found that treatment of the early plaque settlers with 1 mg/ml extract of Psidium guajava reduced the cell-surface hydrophobicity of Strep. sanguinis, Strep. mitis and Actinomyces sp. by 54.1%, 49.9% and 40.6%, respectively. Treatment of these bacteria with the same concentration of Piper betle however, showed a comparatively lesser effect (< 10%). It was also observed that the anti-adhesive effect of the two extracts on the binding of the early plaque settlers to hexadecane is concentration dependent.

MeSH terms: Actinomyces/drug effects; Actinomyces/physiology; Analysis of Variance; Bacterial Adhesion/drug effects*; Dental Plaque/microbiology*; Plant Extracts/pharmacology*; Streptococcus sanguis/drug effects; Streptococcus sanguis/physiology; Surface Properties/drug effects; Psidium*; Piper betle*; Streptococcus mitis/drug effects; Streptococcus mitis/physiology; Dental Pellicle/microbiology; Hydrophobic and Hydrophilic Interactions
Heat treatment of unclarified Escherichia coli homogenate improved the recovery efficiency of recombinant hepatitis B core antigen

Ng MY, Tan WS, Abdullah N, Ling TC, Tey BT

J Virol Methods, 2006 Oct;137(1):134-9.
PMID: 16860402

Heat precipitation procedure has been regularly incorporated as a selective purification step in various thermostable proteins expressed in different hosts. This method is efficient in precipitation of most of the host proteins and also deactivates various host proteases that can be harmful to the desired gene products. In this study, introduction of heat treatment procedure in the purification of hepatitis B core antigen (HBcAg) produced in Escherichia coli has been investigated. Thermal treatment of the cell homogenate at 60 degrees C for 30 min prior to subsequent clarification steps has resulted in 1.4 times and 18% higher in purity and recovery yield, respectively, compared to the non-heat-treated cell homogenate. In direct capture of HBcAg by using anion-exchangers from unclarified feedstock, pre-conditioning the feedstock by heat treatment at 60 degrees C for 45 min has increased the recovery yield of HBcAg by 2.9-fold and 42% in purity compared to that treated for 10 min. Enzyme-linked immunosorbent assay (ELISA) analysis showed that the antigenicity of the core particles was not affected by the heat treatment process.

MeSH terms: Cell Fractionation/methods*; Escherichia coli/genetics; Escherichia coli/metabolism*; Fermentation; Hot Temperature*; Hepatitis B Core Antigens/isolation & purification*; Chemical Precipitation; Recombinant Proteins/isolation & purification
Random amplified polymorphic DNA analysis of genetically modified organisms

Yoke-Kqueen C, Radu S

J Biotechnol, 2006 Dec 15;127(1):161-6.
PMID: 16860900

Randomly amplified polymorphic DNA (RAPD) was used to analyzed 78 samples comprises of certified reference materials (soya and maize powder), raw seeds (soybean and maize), processed food and animal feed. Combination assay of two arbitrary primers in the RAPD analysis enable to distinguish genetically modified organism (GMO) reference materials from the samples tested. Dendrogram analysis revealed 13 clusters at 45% similarity from the RAPD. RAPD analysis showed that the maize and soybean samples were clustered differently besides the GMO and non-GMO products.

MeSH terms: Zea mays/genetics*; Food Analysis/methods; Polymorphism, Genetic; Reference Values; Soybeans/genetics*; Random Amplified Polymorphic DNA Technique*; Plants, Genetically Modified/genetics*; Food, Genetically Modified*
Melatonin in mood disorders

Srinivasan V, Smits M, Spence W, Lowe AD, Kayumov L, Pandi-Perumal SR, et al.

World J Biol Psychiatry, 2006;7(3):138-51.
PMID: 16861139

The cyclic nature of depressive illness, the diurnal variations in its symptomatology and the existence of disturbed sleep-wake and core body temperature rhythms, all suggest that dysfunction of the circadian time keeping system may underlie the pathophysiology of depression. As a rhythm-regulating factor, the study of melatonin in various depressive illnesses has gained attention. Melatonin can be both a 'state marker' and a 'trait marker' of mood disorders. Measurement of melatonin either in saliva or plasma, or of its main metabolite 6-sulfatoxymelatonin in urine, have documented significant alterations in melatonin secretion in depressive patients during the acute phase of illness. Not only the levels but also the timing of melatonin secretion is altered in bipolar affective disorder and in patients with seasonal affective disorder (SAD). A phase delay of melatonin secretion takes place in SAD, as well as changes in the onset, duration and offset of melatonin secretion. Bright light treatment, that suppresses melatonin production, is effective in treating bipolar affective disorder and SAD, winter type. This review discusses the role of melatonin in the pathophysiology of bipolar disorder and SAD.

MeSH terms: Antidepressive Agents/therapeutic use; Bipolar Disorder/diagnosis; Bipolar Disorder/drug therapy; Bipolar Disorder/physiopathology*; Circadian Rhythm/drug effects; Circadian Rhythm/physiology; Depressive Disorder, Major/diagnosis; Depressive Disorder, Major/drug therapy; Depressive Disorder, Major/physiopathology; Depressive Disorder/diagnosis; Depressive Disorder/drug therapy; Depressive Disorder/physiopathology*; Humans; Melatonin/blood*; Melatonin/therapeutic use; Phototherapy; Biomarkers/blood; Seasonal Affective Disorder/diagnosis; Seasonal Affective Disorder/physiopathology; Treatment Outcome; Sleep Disorders, Circadian Rhythm/diagnosis; Sleep Disorders, Circadian Rhythm/drug therapy; Sleep Disorders, Circadian Rhythm/physiopathology
Unusual origin of radial collateral artery noted in quadrangular space syndrome

Mohandas Rao KG, Bhat SM, Vollala VR

J Chin Med Assoc, 2006 Jun;69(6):276-7.
PMID: 16863014

In this paper, an unusual origin of the radial collateral artery of the arm is reported. The radial collateral artery in one of the cadavers dissected by us originated from the posterior circumflex humeral artery. The importance of this abnormal origin of the radial collateral artery from the posterior circumflex humeral artery in quadrangular space syndrome is discussed.

MeSH terms: Arm/blood supply*; Humans; Humerus/blood supply; Male; Middle Aged; Nerve Compression Syndromes/pathology*; Nerve Compression Syndromes/surgery; Radial Artery/abnormalities*
Opposing trends in incidence of esophageal squamous cell carcinoma and adenocarcinoma in a multi-ethnic Asian country

Fernandes ML, Seow A, Chan YH, Ho KY

Am J Gastroenterol, 2006 Jul;101(7):1430-6.
PMID: 16863543

To describe the incidence trends in esophageal squamous cell carcinoma (SCC) and adenocarcinoma among the three major ethnic groups in Singapore from 1968 to 2002.

MeSH terms: Adenocarcinoma/ethnology*; Adenocarcinoma/epidemiology; Adult; Carcinoma, Squamous Cell/ethnology*; Carcinoma, Squamous Cell/epidemiology; China/ethnology; Esophageal Neoplasms/ethnology*; Esophageal Neoplasms/epidemiology; Female; Humans; India/ethnology; Malaysia/ethnology; Male; Middle Aged; Registries; Risk Factors; Sex Factors; Singapore/epidemiology; Incidence; Linear Models
Corneal elevation indices in normal and keratoconic eyes

Fam HB, Lim KL

J Cataract Refract Surg, 2006 Aug;32(8):1281-7.
PMID: 16863962 DOI: 10.1016/j.jcrs.2006.02.060

PURPOSE: To determine an index that distinguishes keratoconus and keratoconus-suspect eyes from normal eyes with Orbscan (Bausch & Lomb) corneal elevation maps.
SETTING: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, and iLaser Centre, Island Hospital, Penang, Malaysia.
METHODS: In this initial phase of this multicenter nonrandomized retrospective study, 1 eye of 166 normal subjects, 15 keratoconus patients, and 11 keratoconus suspects was examined at 1 clinic. The anterior best-fit sphere (BFS), posterior BFS, anterior elevation, posterior elevation, and maximum and minimum keratometries were analyzed. Two indices with the highest sensitivity and specificity classifying these conditions were identified using receiver operating characteristic curves. These 2 indices were evaluated in a subsequent validation study using 1 eye of 221 normal subjects, 43 keratoconus patients, and 23 keratoconus suspects from another clinic.
RESULTS: The anterior elevation and anterior elevation ratio (anterior elevation ratio = anterior elevation/anterior BFS) best classified the different groups. An anterior elevation ratio of 0.5122 mm or less had 99% sensitivity and 95.2% specificity while a ratio 16.5 mum or less had 80.1% sensitivity and 80.8% specificity in discriminating normal eyes from keratoconus and keratoconus suspects. The results were similar in the validation study. In addition, these anterior elevation and anterior elevation ratio cutoff values had high sensitivity and specificity in identifying keratoconus suspects from normal eyes in the validation study.
CONCLUSION: Anterior corneal elevation parameters are clinically relevant measures for detecting keratoconus and suspected keratoconus eyes.

MeSH terms: Adult; Anthropometry; Cornea/pathology*; Female; Humans; Keratoconus/diagnosis*; Male; Models, Biological; Refraction, Ocular; Refractometry; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Visual Acuity
Fulltext Aggressive giant cell tumour of bone

Faisham WI, Zulmi W, Halim AS, Biswal BM, Mutum SS, Ezane AM

Singapore Med J, 2006 Aug;47(8):679-83.
PMID: 16865207

The surgical treatment of Stage III or aggressive giant cell tumour of the bone, whether to perform intralesional or en-bloc resection, remains controversial. The aim of this study is to identify the effectiveness of en-bloc resection for local control and final oncological outcome of the disease.

MeSH terms: Adult; Bone Neoplasms/diagnosis; Bone Neoplasms/pathology; Bone Neoplasms/surgery*; Female; Humans; Lung Neoplasms/drug therapy; Lung Neoplasms/secondary; Male; Middle Aged; Neoplasm Staging; Prognosis; Retrospective Studies; Treatment Outcome*; Carcinoma, Giant Cell/diagnosis; Carcinoma, Giant Cell/drug therapy; Carcinoma, Giant Cell/pathology; Carcinoma, Giant Cell/surgery*; Disease Progression
Fulltext Femoral overgrowth following plate fixation of the fractured femur in children

Sulaiman AR, Joehaimy J, Iskandar MA, Anwar Hau M, Ezane AM, Faisham WI

Singapore Med J, 2006 Aug;47(8):684-7.
PMID: 16865208

The purpose of this study is to determine the overgrowth phenomenon of the affected femur following plate fixation of femoral fractures in children.

MeSH terms: Adolescent; Child; Cross-Sectional Studies; Female; Femoral Fractures/surgery*; Femur/injuries; Femur/surgery*; Fracture Fixation, Internal/adverse effects*; Humans; Male; Postoperative Complications; Postoperative Period; Tomography, Emission-Computed
Fulltext Prognostic factors of differentiated thyroid cancer patients in Hospital Universiti Sains Malaysia

Voralu K, Norsa'adah B, Naing NN, Biswal BM

Singapore Med J, 2006 Aug;47(8):688-92.
PMID: 16865209

The aim of this study was to identify the prognostic factors that influence the survival of differentiated thyroid cancer patients treated at Hospital Universiti Sains Malaysia (HUSM).

MeSH terms: Adult; Female; Hospitals, University; Humans; Malaysia; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Risk Factors; Thyroid Neoplasms/diagnosis*; Thyroid Neoplasms/mortality*; Thyroid Neoplasms/pathology; Proportional Hazards Models; Survival Analysis; Risk Assessment

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