Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury

BACKGROUND: There is currently a lack of consensus to support the proper timing for postoperative laryngoscopy that is reliable to diagnose recurrent laryngeal nerve palsy (RLNP) after thyroid surgery. The purpose of this study was to investigate the impact of different time intervals of fiber-optic nasolaryngoscopy (FNL) on the diagnosis of RLNP. METHOD: FNL was performed postoperatively at day 0 (T1), at second day post-op (T2), and +2 weeks (T3). For patients with RLNP, repeated examinations were performed at +2 (T4), +6 (T5), and +12 months (T6). RESULTS: Four hundred thirty-four patients appear for postoperative FNL, providing 825 nerves at risk. Permanent RLNP occurred in 0.7%, temporary RLNP in 6.7%. RLNP rate was 6.4% at T1, 6.7% at T2, 4.8% at T3, 2.5% at T4, 0.8% at T5, and 0.7% at T6. Full recovery of vocal cord function was confirmed after rehabilitation in 87.5% of cases at T5 and 89% in T6. T2 was significantly superior to T3 in terms of diagnosis of RLNP (P < 0.05). Of patients at T2, 10.7% did not see any reason to FNL because of their normal voice register. CONCLUSION: FNL is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord motility with great and significant variability of results. Second day post-op inspection of the larynx (T2) is suggested. Symptomatic voice assessment is insufficient

Prognostic value of the Sinonasal Outcome Test 22 (SNOT-22) in chronic rhinosinusitis

Studi in letteratura hanno evidenziato che il punteggio basale del Sinonasal Outcome Test 22 (SNOT-22) influenza l\u2019outcome chirurgico nella rinosinusite cronica (CRS) ed hanno suggerito che un approccio SNOT-22-mediato potrebbe migliorare la comprensione delle aspettative dei pazienti dopo il trattamento. Il presente studio mirava a verificare questa ipotesi in una popolazione italiana di CRS. In 457 pazienti con CRS, trattati con chirurgia endoscopica endonasale dopo fallimento della terapia medica massimale, sono stati calcolati la percentuale di raggiungimento della differenza minima clinicamente rilevabile (MCID) e la percentuale di miglioramento relativo dopo l\u2019intervento chirurgico. Inoltre, \ue8 stato studiato l\u2019impatto di diversi fattori sul punteggio dello SNOT-22 preoperatorio e postoperatorio. Il miglioramento dei sintomi si \ue8 verificato nella maggior parte dei pazienti ed era direttamente proporzionale alla SNOT-22 basale. Il 79,7% dei pazienti ha raggiunto l\u2019MCID e la percentuale di miglioramento relativo \ue8 stata del 50,1%. Le implicazioni psicologiche e sociali hanno influenzato significativamente i punteggi dello SNOT-22. Un\u2019analisi di regressione multipla ha mostrato che la storia di precedenti interventi chirurgici, asma, score endoscopico preoperatorio e SNOT-22 basale hanno statisticamente predetto il punteggio dello SNOT-22 postoperatorio (R2 = 0,229). Sottoporre i pazienti con CRS a SNOT-22 prima dei trattamenti chirurgici potrebbe quindi aiutare ad informarli sui probabili esiti, sebbene sia fortemente influenzato dalla percezione individuale. Sono necessari ulteriori studi per identificare un set efficace di parametri soggettivi e oggettivi per la valutazione dei risultati.Previous studies have highlighted that baseline Sinonasal Outcome Test 22 (SNOT-22) score affects surgical outcomes in chronic rhinosinusitis (CRS) and suggested that a SNOT-22- based approach might ameliorate patients\u2019 understanding of expectations after treatment. Our study aimed at verifying this hypothesis in an Italian CRS population. In 457 CRS patients treated with endoscopic sinus surgery after failure of maximal medical therapy, the percentage of achieving a minimal clinically important difference (MCID) and the percentage of relative improvement after surgery were calculated. Moreover, the impact of several factors on preoperative and postoperative SNOT-22 score was investigated. Symptom improvement occurred in the majority of patients and was directly proportional to baseline SNOT-22. 79,7% of patients achieved the MCID and the percentage of relative improvement was 50,1%. Psychological and social-functioning implications significantly affected SNOT-22 scores. Multiple regression analysis showed that history of previous surgery, asthma, preoperative endoscopic and SNOT-22 scores predicted the postoperative SNOT-22 score (R2 = 0,298). Submitting CRS patients to SNOT-22 prior to surgical treatments might help to inform about probable outcomes, although it is strongly influenced by individual perception. Further studies are needed to identify an effective set of subjective and objective parameters for evaluation of outcomes

Does Kinesiophobia Mediate the Relationship between Pain Intensity and Disability in Individuals with Chronic Low-Back Pain and Obesity?

Individuals suffering from chronic low-back pain and obesity face severe physical and functional limitations. According to the fear-avoidance model, kinesiophobia might play a crucial role in the relationship between pain intensity and disability. Thus, the purpose of this study was to verify the role of kinesiophobia as a mediator in the association between pain intensity and disability in individuals with both chronic low-back pain and obesity. A total of 213 individuals with chronic low-back pain and obesity were included in the study. The level of kinesiophobia, pain intensity and disability were all assessed using self-reported questionnaires. We verified through a simple mediation analysis that kinesiophobia partially mediated the association between pain intensity and disability in our sample. According to our findings, we emphasize the crucial role of kinesiophobia as a psychological factor that should be addressed in chronic low-back pain rehabilitative protocols to reduce disability in individuals with obesity

precision mathematics and approximation mathematics the conceptual and educational role of their comparison

The relationship between applied and pure mathematics is of utmost concern for Klein. Examples from Volume III of his "Elementarmathematik" illustrate how, starting from an intuitive and sometimes practical approach, Klein develops abstract concepts working in rich "mathematical environments". The examples concern the concept of empirical function and its comparison with an idealised curve, point sets obtained through circular inversion that lead to compare rational numbers and real numbers, and the "continuous" transformation of curves with the help of a point moving in space

Sleep disturbances and sleep disorders as risk factors for chronic postsurgical pain: A systematic review and meta-analysis

This systematic review and meta-analysis aimed at evaluating the role of sleep disturbances and sleep disorders in influencing presence and intensity of chronic postsurgical pain (CPSP). We included cohort studies which enrolled adults, assessed sleep disturbances or disorders before surgery, measured pain intensity, presence of pain, or opioid use at least three months after surgery. Eighteen studies were included in a narrative synthesis and 12 in a meta-analysis. Sleep disturbances and disorders were significantly related to CPSP, with a small effect size, r = 0.13 (95% CI 0.06–0.20). The certainty of evidence was rated low due to risk of bias and heterogeneity. In subgroup analyses the above association was significant in studies that used pain intensity as the outcome, but not in those that used presence of pain; in studies on patients who underwent total knee arthroplasty or other surgeries, but not in those on patients who had breast cancer surgery or total hip arthroplasty; in the single study that assessed insomnia and in studies that assessed sleep disturbances as predictors. A meta-regression showed that the follow-up length was positively associated with the overall estimate. Our findings suggest that presurgical sleep disturbances and disorders should be evaluated to detect patients at risk for CPSP. Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=27265

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity