Protocol design and current status of CLIVIT: a randomized controlled multicenter relevance trial comparing clips versus ligatures in thyroid surgery

BACKGROUND: Annually, more than 90000 surgical procedures of the thyroid gland are performed in Germany. Strategies aimed at reducing the duration of the surgical procedure are relevant to patients and the health care system especially in the context of reducing costs. However, new techniques for quick and safe hemostasis have to be tested in clinically relevance randomized controlled trials before a general recommendation can be given. The current standard for occlusion of blood vessels in thyroid surgery is ligatures. Vascular clips may be a safe alternative but have not been investigated in a large RCT. METHODS/DESIGN: CLIVIT (Clips versus Ligatures in Thyroid Surgery) is an investigator initiated, multicenter, patient-blinded, two-group parallel relevance randomized controlled trial designed by the Study Center of the German Surgical Society. Patients scheduled for elective resection of at least two third of the gland for benign thyroid disease are eligible for participation. After surgical exploration patients are randomized intraoperatively into either the conventional ligature group, or into the clip group. The primary objective is to test for a relevant reduction in operating time (at least 15 min) when using the clip technique. Since April 2004, 121 of the totally required 420 patients were randomized in five centers. DISCUSSION: As in all trials the different forms of bias have to be considered, and as in this case, a surgical trial, the role of surgical expertise plays a key role, and will be documented and analyzed separately. This is the first randomized controlled multicenter relevance trial to compare different vessel occlusion techniques in thyroid surgery with adequate power and other detailed information about the design as well as framework. If significant, the results might be generalized and may change the current surgical practice

Scaling the state: Egypt in the third millennium BC

Discussions of the early Egyptian state suffer from a weak consideration of scale. Egyptian archaeologists derive their arguments primarily from evidence of court cemeteries, elite tombs, and monuments of royal display. The material informs the analysis of kingship, early writing, and administration but it remains obscure how the core of the early Pharaonic state was embedded in the territory it claimed to administer. This paper suggests that the relationship between centre and hinterland is key for scaling the Egyptian state of the Old Kingdom (ca. 2,700-2,200 BC). Initially, central administration imagines Egypt using models at variance with provincial practice. The end of the Old Kingdom demarcates not the collapse, but the beginning of a large-scale state characterized by the coalescence of central and local models

Audiovisual prosody of uncertainty. An overview

The goal of this work is to give an overview of research conducted in the field of audiovisual prosody and uncertainty. We refer to previous studies investigating the relevance of prosodic cues for both the production and perception of uncertainty in natural conversation. Afterwards, we present our own experiments dealing with the role of prosodic cues of uncertainty and also of context for pragmatic focus interpretation. In a next step we discuss which role uncertainty plays for humanmachine communication. In this context we summarise our own studies on the modelling and perception of uncertainty in speech from an articulatory speech synthesizer. We assume that speech synthesis systems with highly variable speech can help to improve human-machine communication

Mono- and binuclear molybdenum and tungsten complexes containing asymmetric bridging ligands: effects of ligand conjugation and conformation on metal-metal interactions

This article does not have an abstract

Mono-and bunuclear molybdenum complexes incorporating 4-(4-hydroxyphenyl) pyridine: metal-metal interactions across an asymmetric bridging ligand

Localization versus delocalization: in the binuclear asymmetric Mo complex 1, a facile one-electron reduction with cobaltocene is sufficient to convert a system with localized electrons to one with delocalized electrons. Whereas according to the EPR spectrum the unpaired electron in the 17e-16e complex 1 is localized at the Mo center coordinated to N, in the 17e-17e diradical 1- a rapid site exchange of the two unpaired electrons occurs for which a rate of 4 × 107 Hz was determined. L* = hydro-tris(3,5-dimethylpyrazolyl)borate

Aromatase deficiency confers paradoxical postischemic cardioprotection

The\ conventional view is that estrogen confers female cardioprotection. Estrogen synthesis depends on androgen availability, with aromatase regulating conversion of testosterone to estradiol. Extragonadal aromatase expression mediates estrogen production in some tissues, but a role for local steroid conversion has not yet been demonstrated in the heart. This study's goal was to investigate how aromatase deficiency influences myocardial function and ischemic resilience. RT-PCR analysis of C57Bl/6 mouse hearts confirmed cardiac-specific aromatase expression in adult females. Functional performance of isolated hearts from female aromatase knockout (ArKO) and aromatase wild-type mice were compared. Left ventricular developed pressures were similar in aerobic perfusion, but the maximal rate of rise of ventricular pressure was modestly reduced in ArKOhearts (3725 ± 144 vs. 4272 ± 154 mm Hg/sec, P < 0.05). After 25 min of ischemia, the recovery of left ventricular developed pressure was substantially improved in ArKO (percentage of basal at 60 min of reperfusion, 62 ± 8 vs. 30± 6%; P < 0.05). Hypercontracture was attenuated (end diastolic pressure, 25 ±5 vs. 51 ± 1 mm Hg; P < 0.05), and lactate dehydrogenase content of coronary effluent was reduced throughout reperfusion in ArKO hearts. This was associated with a hyperphosphorylation of phospholamban and a reduction in phosphorylated Akt. Immediately after reperfusion, ArKO hearts exhibited increased incidence of ventricular premature beats (194 ± 70 vs. 46 ± 6, P < 0.05). These observations indicate more robust functional recovery, reduced cellular injury, and modified cardiomyocyte Ca handling in aromatase-deficient hearts. Our findings indicate that androgen-to-estrogen conversion may be of pathophysiologic importance to the heart and challenge the notion that estrogen deficiency is deleterious. These studies suggest the possibility that aromatase suppression may offer inotropic benefit in the acute ischemia/reperfusion setting with appropriate arrhythmia management