Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients

Background: The aim of this study was to evaluate the ability of intraoperative neuromonitoring in reducing the postoperative recurrent laryngeal nerve palsy rate by a comparison between patients submitted to thyroidectomy with intraoperative neuromonitoring and with routine identification alone. Methods: Between June 2007 and December 2012, 2034 consecutive patients underwent thyroidectomy by a single surgical team. We compared patients who have had neuromonitoring and patients who have undergone surgery with nerve visualization alone. Patients in which neuromonitoring was not utilized (Group A) were 993, patients in which was utilized (group B) were 1041. Results: In group A 28 recurrent laryngeal nerve injuries were observed (2.82%), 21 (2.11%) transient and 7 (0.7%) permanent. In group B 23 recurrent laryngeal nerve injuries were observed (2.21%), in 17 cases (1.63%) transient and in 6 (0.58%) permanent. Differences were not statistically significative. Conclusions: Visual nerve identification remains the gold standard of recurrent laryngeal nerve management in thyroid surgery. Neuromonitoring helps to identify the nerve, in particular in difficult cases, but it did not decrease nerve injuries compared with visualization alone. Future studies are warranted to evaluate the benefit of intraoperative neuromonitoring in thyroidectomy, especially in conditions in which the recurrent nerve is at high risk of injury. Keywords: Neuromonitoring, Recurrent laryngeal nerve, Thyroidectom

Il cgml: una soluzione basata su xml per la rappresentazione di mappe vettoriali su dispositivi mobili

L’evoluzione tecnologica dei dispositivi mobili, in termini di potenza di calcolo, capacità di visualizzazione e memorizzazione, e il proliferare di sistemi di connessione a banda larga su rete locale wireless (WiFi) e cellulare (UMTS), permette la gestione di dati complessi quali le mappe vettoriali e l’accesso ai Location Based Service (LBS) per mezzo di un telefono cellulare o un palmare. L’uso di linguaggi XML nel settore dei LBS condiziona la struttura delle funzionalità e dei dati ma garantisce l’interoperabilità dei servizi. Un esempio è il linguaggio GML (Geographic Markup Language) standard de facto nello scambio dei dati tra sistemi GIS e nella rappresentazione dell’informazione geografica. Il GML non è orientato alla rappresentazione di mappe vettoriali, è quindi necessario trasformarlo in un altro linguaggio XML, ad esempio il linguaggio grafico SVG (Scalable Vector Graphics). Per evitare la separazione tra il dato geografico (GML) e la sua visualizzazione (Mobile SVG) ma usando comunque le mappe vettoriali su dispositivi mobili, abbiamo definito il cGML (compact Geographic Markup Language). La rappresentazione di un dato tramite cGML è una mappa vettoriale e come tale può essere utilizzata nella presentazione grafica, ma allo stesso momento è anche un contenitore di insiemi di dati geo-riferiti, omogenei per semantica, utilizzabili in elaborazioni locali sul dispositivo mobile.Enhanced mobile device performances, in terms of CPU power, memory capacity, display capabilities and adoption of wideband connectivity based on local wireless (WiFi) and cellular (UMTS) networks, bring interactive mapping and access to Location Based Services (LBS) to mobile phones and PDAs. The use of XML language in the LBS influences data structure, functionalities and performances; although it could be time and memory expensive, it guarantees service interoperability. The GML language (Geographic Markup Language) is "de facto" standard in data exchanging between Geographic Information Systems. The GML has not been designed to represent vector map: it has to be transformed into another XML language, for example the graphical-oriented XML language Mobile SVG. To avoid the separation between the geographic data (GML) and its visualization (Mobile SVG), keeping vector mapping on mobile devices, we have designed the cGML (compact Geographic Markup Language). The data encoded using cGML is a vector map, so that it can be used in the graphic representation, but at the same time it is a container of geographical related data set, homogenous for semantic and usable in local processing on the mobile device

The cgml: a xml language for mobile cartography

Increasing processing power and storage capabilities encourage systematic adoption of high-end mobile devices, such as programmable cellular phones and wireless-enabled PDA to implement new exciting applications. The performances of modern mobile devices are bringing innovative scenarios, based on position awareness and ambient intelligence paradigms. The market is moving from old 'Wireless Applications' approach to Mobile Computing, which aims to exploit mobile host capabilities. This paper presents the compact Geographic Markup Language (cGML), an XML-based language defined to enable design and development of LBS applications specific for mobile devices, and an example of client-server architecture using it

Compact gml: merging mobile computing and mobile cartography

The use of portable devices is moving from "Wireless Applications", typically implemented as browsing-on-the-road, to "Mobile Computing", which aims to exploit increasing processing power of consumer devices. As users get connected with smartphones and PDAs, they look for geographic information and location-aware services. While browser-based approaches have been explored (using static images or graphics formats such as Mobile SVG), a data model tailored for local computation on mobile devices is still missing. This paper presents the Compact Geographic Markup Language (cGML) that enables design and development of specific purpose GIS applications for portable consumer devices where a cGML document can be used as a spatial query result as well

A metabolomic approach to animal vitreous humor topographical composition: A pilot study

The purpose of this study was to evaluate the feasibility of a 1H-NMR-based metabolomic approach to explore the metabolomic signature of different topographical areas of vitreous humor (VH) in an animal model. Five ocular globes were enucleated from five goats and immediately frozen at 280uC. Once frozen, three of them were sectioned, and four samples corresponding to four different VH areas were collected: the cortical, core, and basal, which was further divided into a superior and an inferior fraction. An additional two samples were collected that were representative of the whole vitreous body. 1H-NMR spectra were acquired for twenty-three goat vitreous samples with the aim of characterizing the metabolomic signature of this biofluid and identifying whether any site-specific patterns were present. Multivariate statistical analysis (MVA) of the spectral data were carried out, including Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), and Partial Least Squares Discriminant Analysis (PLS-DA). A unique metabolomic signature belonging to each area was observed. The cortical area was characterized by lactate, glutamine, choline, and its derivatives, N-acetyl groups, creatine, and glycerol; the core area was characterized by glucose, acetate, and scyllo-inositol; and the basal area was characterized by branched-chain amino acids (BCAA), betaine, alanine, ascorbate, lysine, and myo-inositol. We propose a speculative approach on the topographic role of these molecules that are mainly responsible for metabolic differences among the as-identified areas. 1H-NMR-based metabolomic analysis has shown to be an important tool for investigating the VH. In particular, this approach was able to assess in the samples here analyzed the presence of different functional areas on the basis of a different metabolite distribution.The purpose of this study was to evaluate the feasibility of a 1H-NMR-based metabolomic approach to explore the metabolomic signature of different topographical areas of vitreous humor (VH) in an animal model. Five ocular globes were enucleated from five goats and immediately frozen at -80°C. Once frozen, three of them were sectioned, and four samples corresponding to four different VH areas were collected: the cortical, core, and basal, which was further divided into a superior and an inferior fraction. An additional two samples were collected that were representative of the whole vitreous body. 1H-NMR spectra were acquired for twenty-three goat vitreous samples with the aim of characterizing the metabolomic signature of this biofluid and identifying whether any site-specific patterns were present. Multivariate statistical analysis (MVA) of the spectral data were carried out, including Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), and Partial Least Squares Discriminant Analysis (PLS-DA). A unique metabolomic signature belonging to each area was observed. The cortical area was characterized by lactate, glutamine, choline, and its derivatives, N-acetyl groups, creatine, and glycerol; the core area was characterized by glucose, acetate, and scyllo-inositol; and the basal area was characterized by branched-chain amino acids (BCAA), betaine, alanine, ascorbate, lysine, and myo-inositol. We propose a speculative approach on the topographic role of these molecules that are mainly responsible for metabolic differences among the as-identified areas. 1H-NMR-based metabolomic analysis has shown to be an important tool for investigating the VH. In particular, this approach was able to assess in the samples here analyzed the presence of different functional areas on the basis of a different metabolite distribution. © 2014 Locci et al

A Fatal Case of Metastatic Pulmonary Calcification during the Puerperium

We present an unusual case of a fatal respiratory failure in a young woman developed two weeks after she gave birth at home. Circumstantial and clinical features of the case were strongly suggestive for a ‘classical’ septic origin of the respiratory symptoms. Autopsy, together with histopathological and immunohistochemical analyses allowed demonstrating a massive calcium redistribution consisting of an important osteolysis, especially from cranial bones and abnormal accumulation in lungs and other organs. Such physiopathology was driven by a primary hyperparathyroidism secondary to a parathyroid carcinoma as demonstrated by immunohistochemistry. This very rare case is furthermore characterised by a regular pregnancy course, ended with the birth of a healthy new-born. A complex interaction between pregnancy physiology and hyperparathyroidism might be hypothesised, determining the discrepancy between the relative long period of wellness and the tumultuous cascade occurred in the puerperium

Fear of the COVID-19 and medical liability. Insights from a series of 130 consecutives medico-legal claims evaluated in a single institution during SARS-CoV-2-related pandemic

Objectives: The aim of the current work was to evaluate the frequency and the type of cases of medical liability from a single center in the first ten months of the pandemic as well as to identify critical issues associated with the organization of public health during the coronavirus disease 2019 pandemic. Methods: We compared 130 cases evaluated for medical liability from March 2020 to January 2021 and compared with 159 cases from March 2019 to January 2020. The cases were divided in four pre-established groups: surgical error, diagnostic/therapeutic errors and nosocomial diseases, delays, and problems related to assistance. Results: Analysis showed a significant increase in cases due to delay in treat-ment/hospitalization and shortages in health care of non-autonomous patients [χ2 (1, N = 289) = 5.6746, p = 0.02]. Conclusions: The work showed an increase in medical/legal cases regarding non-COVID-19 emergencies in which the outcome is related to the time of treatment and/or arrival at the hospital. There was also a rise in complaints of deficits in supervision and care for non-autonomous patients. Despite the persistence of preventive measures for the current pandemic, measures should be taken to improve health care in these categories of patients

Postmortem Ocular Findings in the Optical Coherence Tomography Era: A Proof of Concept Study Based on Six Forensic Cases

Postmortem analysis of the ocular globe is an important topic for forensic pathology and transplantology. Although crucial elements may be gathered from examining cadaveric eyes, the latter do not routinely undergo in-depth analysis. The paucity of quantitative and objective data that are obtainable using current, invasive necroscopic techniques is the main reason for the limited interest in this highly specialized procedure. The aim of the current study is to describe and to object for the first time the postmortem ocular changes by mean of portable optical coherence tomography for evaluating ocular tissues postmortem. The design involved the postmortem analysis (in situ, and without enucleation) of 12 eyes by portable spectral-domain Optical Coherence Tomography. The scans were performed, in corneal, retinal and angle modality at different intervals: <6 h, 6th, 12th, and 24th hour and after autopsy (25th–72nd hour). The morphological changes in the cornea, sclera, vitreous humor and aqueous humor were easy to explore and objectify in these tissues in first 72 h postmortem. On the other hand, the “in situ” observation of the retina was difficult due to the opacification of the lenses in the first 24 h after death

Forensic NMR metabolomics: one more arrow in the quiver

Introduction: NMR metabolomics is increasingly used in forensics, due to the possibility of investigating both endogenous metabolic profiles and exogenous molecules that may help to describe metabolic patterns and their modifications associated to specific conditions of forensic interest. Objectives: The aim of this work was to review the recent literature and depict the information provided by NMR metabolomics. Attention has been devoted to the identification of peculiar metabolic signatures and specific ante-mortem and post-mortem profiles or biomarkers related to different conditions of forensic concern, such as the identification of biological traces, the estimation of the time since death, and the exposure to drugs of abuse. Results and Conclusion: The results of the described studies highlight how forensics can benefit from NMR metabolomics by gaining additional information that may help to shed light in several forensic issues that still deserve to be further elucidated