Smoker's paradox in ST-elevation myocardial infarction: Role of inflammation and platelets.

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Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study)

Background Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence.Methods Patients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed.Results Eight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex (P < 0.001), older age (P < 0.001), higher BMI (P = 0.021), unilateral lateral neck dissection (P < 0.001), drain placement (P = 0.007), and shorter operative times (P < 0.001) were found to be independent risk factors for cervical haematoma.Conclusions Based on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery

Will new technologies be able to reduce the rate of post-operative hypoparathyroidism in thyroid surgery?

Hypoparathyroidism is the most frequent complication in thyroid surgery. Technology improvements in medical field tends to help reducing complication in surgery and in recent years fluorescence-guided surgery technology has been largely developed and has been used in many different surgical fields. In endocrine surgery a recent but actively researched field is near infrared fluorescence imaging and several groups have each detailed their methodology and reported on the observed utility of their approach. Overall fluorescence-guided surgery has been shown to assist in lowering the postoperative hypoparathyroidism in thyroid surgery. The objective of the current review is to give an overview of the different fluorescence imaging techniques and applications in order demonstrate the value of fluorescence imaging in protecting parathyroid glands during thyroid surgery

Electrocardiographic Changes and False-Positive Troponin I in a Patient with Acute Cholecystitis

Cardiac troponins are the most sensitive and specific serum markers of myocardial cell injury, but they can also arise without apparent cardiac injury. Besides, acute cholecystitis may be associated with nonspecific ST-T wave changes in electrocardiography (ECG). The signs and symptoms of gallbladder and heart disease may overlap, which can make diagnosis difficult. We describe the case of a 75-year-old woman with clinical features suggestive of acute cholecystitis associated with transient ST segment elevation and elevated troponin I that, after extensive workup, did not seem to be attributable to myocardial ischemia or any other acute cardiac problem, but were exclusively related to cholecystitis. We show that cholecystitis with gallbladder distension can be the sole cause of pathological ECG changes and an increased troponin I level; this should be considered when evaluating patients with similar presentations

Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands

Fluorescence imaging is a well-known method for both the in vivo and in vitro identification of specific cells or tissues. This imaging tool is gaining importance in the intraoperative detection and preservation of parathyroid glands during endocrine surgery owing to the intrinsic properties of parathyroid tissue. The aim of this paper is to provide an overview of the basics of the technology, its history, and the recent surgical intraoperative applications of near-infrared imaging methods. Moreover, a literature review of the utilization of fluorescence devices in thyroid surgery suggests that the use of near-infrared imaging seems to be beneficial in reducing postoperative hypoparathyroidism, which is one of the most frequent complications of thyroid surgery

Managing a heterogeneous scientific computing cluster with cloud-like tools: ideas and experience

Obtaining CPU cycles on an HPC cluster is nowadays relatively simple and sometimes even cheap for academic institutions. However, in most of the cases providers of HPC services would not allow changes on the configuration, implementation of special features or a lower-level control on the computing infrastructure, for example for testing experimental configurations. The variety of use cases proposed by several departments of the University of Torino, including ones from solid-state chemistry, computational biology, genomics and many others, called for different and sometimes conflicting configurations; furthermore, several R&D activities in the field of scientific computing, with topics ranging from GPU acceleration to Cloud Computing technologies, needed a platform to be carried out on. The Open Computing Cluster for Advanced data Manipulation (OCCAM) is a multi-purpose flexible HPC cluster designed and operated by a collaboration between the University of Torino and the Torino branch of the Istituto Nazionale di Fisica Nucleare. It is aimed at providing a flexible and reconfigurable infrastructure to cater to a wide range of different scientific computing needs, as well as a platform for R&D activities on computational technologies themselves. We describe some of the use cases that prompted the design and construction of the system, its architecture and a first characterisation of its performance by some synthetic benchmark tools and a few realistic use-case tests

Managing a heterogeneous scientific computing cluster with cloud-like tools: ideas and experience

Obtaining CPU cycles on an HPC cluster is nowadays relatively simple and sometimes even cheap for academic institutions. However, in most of the cases providers of HPC services would not allow changes on the configuration, implementation of special features or a lower-level control on the computing infrastructure, for example for testing experimental configurations. The variety of use cases proposed by several departments of the University of Torino, including ones from solid-state chemistry, computational biology, genomics and many others, called for different and sometimes conflicting configurations; furthermore, several R&D activities in the field of scientific computing, with topics ranging from GPU acceleration to Cloud Computing technologies, needed a platform to be carried out on. The Open Computing Cluster for Advanced data Manipulation (OCCAM) is a multi-purpose flexible HPC cluster designed and operated by a collaboration between the University of Torino and the Torino branch of the Istituto Nazionale di Fisica Nucleare. It is aimed at providing a flexible and reconfigurable infrastructure to cater to a wide range of different scientific computing needs, as well as a platform for R&D activities on computational technologies themselves. We describe some of the use cases that prompted the design and construction of the system, its architecture and a first characterisation of its performance by some synthetic benchmark tools and a few realistic use-case tests

On Integration and Validation of a Very Low Complexity ATC UWB System for Muscle Force Transmission

The thresholding of Surface ElectroMyoGraphic (sEMG) signals, i.e., Average Threshold Crossing (ATC) technique, reduces the amount of data to be processed enabling circuit complexity reduction and low power consumption. This paper investigates the lowest level of complexity reachable by an ATC system through measurements and in-vivo experiments with an embedded prototype for wireless force transmission, based on asynchronous Impulse-Radio Ultra Wide Band (IR-UWB). The prototype is composed by the acquisition unit, a wearable PCB 23 34 mm, which includes a full custom IC integrating a UWB transmitter (chip active silicon area 0.016 mm , 1 mW power consumption), and the receiver. The system is completely asynchronous, it acquires a differential sEMG signal, generates the ATC events and triggers a 3.3 GHz IR-UWB transmission. ATC robustness relaxes filters constraints: two passive first order filters have been implemented, bandwidth from 10 Hz up to 1 kHz. Energy needed for the single pulse generation is 30 pJ while the whole PCB consumes 5.65 mW. The pulses radiated by the acquisition unit TX are received by a short-range and low complexity threshold-based 130 nm CMOS IR-UWB receiver with an Ultra Low Power (ULP) baseband unit capable of robustly receiving generic quasi-digital pulse sequences. The acquisition unit have been tested with 10 series of in vivo isometric and isotonic contractions, while the transmission channel with over-the-air and cable measurements obtained with a couple of planar monopole antennas and an integrated 0.004 mm transmitter, the same used for the acquisition unit, with realistic channel conditions. The entire system, acquisition unit and receiver, consumes 15.49 m

Preliminary experience with the EleVision IR system in detection of parathyroid glands autofluorescence and perfusion assessment with ICG

Background: Postoperative hypoparathyroidism remains the most frequent complication of neck endocrine surgery. In order to reduce the incidence of this feared complication, several systems for imaging of near infrared autofluorescence (NIRAF) have been invented to help surgeons identify parathyroid glands (PTGs) and evaluate their vascularization. We evaluated the efficacy of the EleVision IR system in thyroid and parathyroid surgery. Methods: We used the EleVision IR system in 25 patients who underwent thyroid/parathyroid surgery or both at our institution between December 2020 and July 2021. At various stages of the surgery, the surgeon first looked for PTGs with the naked eye and then completed the visual inspection with NIRAF imaging. We then compared both the naked eye and NIRAF-supported PTGs detection rates. At the end of surgery, we performed indocyanine green angiography of PTGs in 17 patients. Results: In total, we identified 80% of PTGs: 65% with the naked eye only and additional 15% with the assistance of the EleVision IR system. 14 of 17 patients evaluated by ICG angiography had at least one well-vascularized PTG. Only one of these patients (a case of subtotal parathyroidectomy for tertiary hyperparathyroidism) developed symptomatic postoperative hypocalcemia despite a normal parathormone level. The three other patients had at least one remaining moderately-vascularized PTG and only one patient developed transient postoperative hypoparathyroidism. Conclusion: We concluded that EleVision IR provides an efficient support for identification and evaluation of PTGs, and may be of great assistance in endocrine surgery. The images are easy to interpret even for less experienced surgeons thanks to the different types of color visualization and the possibility to measure the relative fluorescence intensity of PTGs and surrounding tissues.</p