Energy based vessel sealing devices in thyroid surgery: A systematic review to clarify the relationship with recurrent laryngeal nerve injuries

Background and objectives: The principal complications associated with thyroid surgery consist in postoperative recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, intra-operative and post-operative hemorrhage. In this paper, structured as a literature review, we describe the current knowledge and the technical improvements currently employed in the field of thyroid surgery, focusing on the contribution of energy based devices in relation with the reduction of the operating time and the odds of possible complication. Materials and methods: a relevant systematic literature search on Pubmed was carried out including works from 2004 through 2019, selecting studies providing information on the energy based devices employed in surgeries and statistic data concerning RNL (transient and permanent) injury and operative time. Results: Nineteen studies were reviewed, dealing with 4468 patients in total. The operative variables considered in this study are: employed device, number of patients, pathological conditions affecting the patients, surgical treatment, RNL injury percentage and the operating time, offering an insight on different patient conditions and their relative operative outcomes. A total of 1843 patients, accounting to the 41.2% of the total pool, underwent the traditional technique operation, while 2605 patients (58.3%) were treated employing the energy based devices techniques. Thyroidectomy performed by approaches different from traditional (for example robotic, MIVAT (Mini Invasive Video Assisted thyroidectomy)) were excluded from this study. Conclusions: The energy-based vessel sealing devices in study, represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in the thyroidal surgery scenario, granting a reduction in operating time while not increasing RNL injury rates. According to this information, a preference for energy based devices techniques might be expressed, furthermore, a progressively higher usage rate for these devices is expected in the near future

Management of bile duct injuries after cholecystectomy: Therapeutic approach and examination of possible sources of error. Report of 2 cases

Background: Bile duct injuries is the primary concern of general surgeons during and after cholecystectomy, with an incidence ranging from 0.08% to 0.4%. Through the description of two cases we intend to discuss the management of most frequent types of bile duct injuries after cholecystectomy and examine some possible sources of error. Case reports: We have treated 2 cases previously operated by other surgical teams. Case report 1: patient undergoing laparoscopic cholecystectomy with lesion of the main bile duct, treated with its reconstruction with positioning of a T-drainage tube. Case report 2: patient with jaundice previously treated for incarcerated incisional hernia and gallbladder stones. We verified the presence of a stenosis of the main bile duct which was resolved with the positioning of a T-tube drainage Discussion: Many descriptions and classifications regarding iatrogenic lesions of the bile duct after cholecystectomy have been described, although some of them represent a good guide on the surgical approach to be adopted, but the surgical skills possessed by the operator remain the most important variables Conclusions: All possible precautions must be considered in order to avoid the possibility of damaging the biliary tree. In our opinion an anterograde approach during cholecystectomy offers greater safety

Strangulated hiatal hernia remains a challenge in surgical emergency: Literature review and our experience

Introduction. Upside-down stomach (UDS) is the rarest type of hiatal hernia (<5%). It is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. It is a very rare condition and it is associated with a risk of incarceration as well as volvulus development. All of these complications represent true emergencies as life-threatening conditions. Material & methods. Case 1: A 62-year-old woman with an incarcerated and ischemic paraesophageal hiatal hernia with a stomach perforation. A total gastrectomy was performed with a Roux en-Y esophago-jejunostomy. The patient was discharged after 15 days without any complication. Case 2: A 84-year-old woman with the evidence at the computer tomography scan all of her stomach and parts of her jejunum and pancreas were drawn into the hernia sac herniated in her thorax. An exploratory laparotomy was performed which showed edematous intraperitoneal portion of the pyloric antrum, a total gastrectomy was performed and Roux en-Y esophago-jejunostomy was performed. The patient was placed in the intensive care unit, where she was instable and she developed sepsis. She died on 7th postoperative day. Case 3: A 76-year-old man presented in our department as emergency with the diagnosis of an incarcerated and ischemic paraesophageal hiatal hernia. An exploratory laparotomy was performed which showed an incarcerated and strangulated hiatal hernia. A section of the cardias and the body of the stomach was performed. The patient was placed in the intensive care unit, where he was instable and he developed sepsis which caused his death. Discussion. Surgery for incarcerated paraesophageal hernia or upside-down stomach has to be performed emergently as incarceration can become irreversible and severe bleeding can occur due to distension and vascular dilation. Moreover, ischemia and gastric perforation are on the verge. However, there are no clear evidence or existing guidelines on the management of acute paraesophageal hernia or upside-down stomach. In our literature review we analyzed clinical case reports and case series studies of strangulated hiatal hernia published between 2013 and 2019 published in PubMed. Conclusion. Management of strangulated hiatal hernia remains a challenge in general surgery. Open approach is suggested for unstable patients and an emergent laparoscopic reduction and repair is reasonable in stable patients

Speaker-independent emotion recognition exploiting a psychologically-inspired binary cascade classification schema

In this paper, a psychologically-inspired binary cascade classification schema is proposed for speech emotion recognition. Performance is enhanced because commonly confused pairs of emotions are distinguishable from one another. Extracted features are related to statistics of pitch, formants, and energy contours, as well as spectrum, cepstrum, perceptual and temporal features, autocorrelation, MPEG-7 descriptors, Fujisakis model parameters, voice quality, jitter, and shimmer. Selected features are fed as input to K nearest neighborhood classifier and to support vector machines. Two kernels are tested for the latter: Linear and Gaussian radial basis function. The recently proposed speaker-independent experimental protocol is tested on the Berlin emotional speech database for each gender separately. The best emotion recognition accuracy, achieved by support vector machines with linear kernel, equals 87.7%, outperforming state-of-the-art approaches. Statistical analysis is first carried out with respect to the classifiers error rates and then to evaluate the information expressed by the classifiers confusion matrices. © Springer Science+Business Media, LLC 2011

EVALITA Evaluation of NLP and Speech Tools for Italian - December 17th, 2020

Welcome to EVALITA 2020! EVALITA is the evaluation campaign of Natural Language Processing and Speech Tools for Italian. EVALITA is an initiative of the Italian Association for Computational Linguistics (AILC, http://www.ai-lc.it) and it is endorsed by the Italian Association for Artificial Intelligence (AIxIA, http://www.aixia.it) and the Italian Association for Speech Sciences (AISV, http://www.aisv.it)