Late manifestation of bilateral laryngeal nerve palsy after thyroidectomy

Respiratory distress is a feared complication after thyroid surgery. Differential diagnosis includes bilateral recurrent laryngeal nerve palsy (BRLNP), local hematoma, vocal cord edema and laryngeal trauma. BRLNP results from intraoperative irritation without physical injury (neurapraxia), or intraoperative partial or complete transsection (axonotmesis and neurotmesis, respectively) of the recurrent laryngeal nerve (RLN). RLN palsy typically manifests immediately in the postoperative course. However, in rare cases there is a delayed, progressive development of BRLNP, potentially leading to respiratory failure in emergency setting weeks after initial surgery. Herein we report on a patient developing massive respiratory distress secondary to BRLNP 5 weeks after thyroidectomy for massive goiter. With the current tendency to decrease the length of hospital stay after thyroid surgery, late onset palsy of the RLN should be included into the differential diagnosis for acute respiratory distress in patients with recent history of thyroid surgery

Acupuncture for Relief of Gag Reflex in Patients Undergoing Transoesophageal Echocardiography—A Protocol for a Randomized Placebo-Controlled Trial

Background: Gagging during transesophageal echocardiography examination (TEE) can be distressing and even dangerous for patients. The needling of acupuncture point CV24 was described to be effective in reducing the gag reflex during TEE in patients with ischemic stroke or transient ischemic attack. Methods: We describe a proposal for a prospective, randomized, patient, practitioner and assessor-blinded, single-center trial with two arms/groups; real acupuncture will be compared to placebo acupuncture. A total of 60 (30 per group) patients scheduled for elective TEE in order to exclude a cardiac embolic source, endocarditis or for valve failure evaluation will be recruited according to patients’ selection criteria and receive either indwelling fixed intradermal needles at acupoints CV24 and bilateral PC6 or placebo needles at the same areas. Patients, the practitioners who will perform the TEE procedure, and the assessor of the outcome measures will be unaware of the group’s (real or placebo) allocation. Results: The primary outcome is the intensity of gagging, measured using verbal rating scale (VRS-11) from 0 = no gagging to 10 = intolerable gagging. Secondary outcomes include the incidence of gagging, the use of rescue medication, patients’ satisfaction with relief of unwanted side effects during TEE procedure, success of patients’ blinding (patients’ opinion to group allocation), heart rate and oxygen saturation measured by pulse oxymetry. Conclusions: To study the effects of acupuncture against gagging during TEE, we test the needling of acupoints CV24 and PC6 bilaterally. A placebo acupuncture is used for the control group. Trial registration number: NCT NCT0382142

Are Temporal and Tonal Musical Skills Related to Phonological Awareness and Literacy Skills? – Evidence From Two Cross-Sectional Studies With Children From Different Age Groups

Temporal and spectral auditory processing abilities are required for efficient and unimpaired processing of speech and might thus be associated with the development of phonological and literacy skills in children. Indeed, studies with unselected children have found links between these basic auditory processing abilities and the development of phonological awareness, reading, and spelling. Additionally, associations between the processing of temporal or spectral/tonal information in music and phonological awareness/literacy have been reported, but findings concerning relations between music processing and spelling are rather sparse. To gain more insights into the specific, potentially age-dependent relevance of various temporal (e.g., rhythm, tempo) and tonal (e.g., pitch, melody) musical subdomains for phonological awareness and literacy, we adapted five music-processing tasks (three temporal, two tonal) for use with tablet computers and used them in two cross-sectional studies with German children from two age groups: Study 1 was conducted with preschool children (about 5 years of age; without formal reading and spelling instruction) and focused on associations between music processing and phonological awareness. In Study 2, third-graders (about 8 years of age) were investigated concerning relations between music processing, phonological awareness, reading comprehension, and spelling. In both studies, rhythm reproduction and pitch perception turned out to be significant predictors of phonological awareness in stepwise regression analyses. Although various associations between music processing and literacy were found for third-graders in Study 2, after phonological awareness was accounted for, only rhythm reproduction made a unique contribution to literacy skills, namely, to alphabetic spelling skills. Hence, both studies indicate that temporal (i.e., rhythm reproduction) and spectral/tonal (i.e., pitch perception) musical skills are distinctly and uniquely related to phonological awareness in children from different age groups (preschool vs. Grade 3). The finding that rhythm reproduction, an auditory temporal processing skill integrating perceptual and motor aspects of rhythm processing, was especially tightly linked to phonological awareness and literacy corroborates other findings on associations between rhythm processing and literacy development and is of interest from the viewpoint of current theories of developmental dyslexia. The potential relevance of our results for applied research concerning early diagnosis and training of literacy-related skills is discussed

Late manifestation of bilateral laryngeal nerve palsy after thyroidectomy

Respiratory distress is a feared complication after thyroid surgery. Differential diagnosis includes bilateral recurrent laryngeal nerve palsy (BRLNP), local hematoma, vocal cord edema and laryngeal trauma. BRLNP results from intraoperative irritation without physical injury (neurapraxia), or intraoperative partial or complete transsection (axonotmesis and neurotmesis, respectively) of the recurrent laryngeal nerve (RLN). RLN palsy typically manifests immediately in the postoperative course. However, in rare cases there is a delayed, progressive development of BRLNP, potentially leading to respiratory failure in emergency setting weeks after initial surgery. Herein we report on a patient developing massive respiratory distress secondary to BRLNP 5 weeks after thyroidectomy for massive goiter. With the current tendency to decrease the length of hospital stay after thyroid surgery, late onset palsy of the RLN should be included into the differential diagnosis for acute respiratory distress in patients with recent history of thyroid surgery

Mode competition in broad-ridge-waveguide lasers

The lateral brightness achievable with high-power GaAs-based laser diodes having long and broad waveguides is commonly regarded to be limited by the onset of higher-order lateral modes. For the study of the lateral-mode competition two complementary simulation tools are applied, representing different classes of approximations. The first tool bases on a completely incoherent superposition of mode intensities and disregards longitudinal effects like spatial hole burning, whereas the second tool relies on a simplified carrier transport and current flow. Both tools yield agreeing power-current characteristics that fit the data measured for 5 to 23 µm wide ridges. Also, a similarly good qualitative conformance of the near and far fields is found. However, the threshold of individual modes, the partition of power between them at a given current, and details of the near and far fields show differences. These differences are the consequence of a high sensitivity of the mode competition to details of the models and of the device structure. Nevertheless, it can be concluded concordantly that the brightness rises with increasing ridge width irrespective of the onset of more and more lateral modes. The lateral brightness 2W · mm¯¹ 1mrad¯¹ at 10MW · cm¯²2 power density on the front facet of the investigated laser with widest ridge (23 µm) is comparable with best values known from much wider broad-area lasers. In addition, we show that one of the simulation tools is able to predict beam steering and coherent bea

Mode competition in broad-ridge-waveguide lasers

The lateral brightness achievable with high-power GaAs-based laser diodes having long and broad waveguides is commonly regarded to be limited by the onset of higher-order lateral modes. For the study of the lateral-mode competition two complementary simulation tools are applied, representing different classes of approximations. The first tool bases on a completely incoherent superposition of mode intensities and disregards longitudinal effects like spatial hole burning, whereas the second tool relies on a simplified carrier transport and current flow. Both tools yield agreeing power-current characteristics that fit the data measured for 5 to 23 µm wide ridges. Also, a similarly good qualitative conformance of the near and far fields is found. However, the threshold of individual modes, the partition of power between them at a given current, and details of the near and far fields show differences. These differences are the consequence of a high sensitivity of the mode competition to details of the models and of the device structure. Nevertheless, it can be concluded concordantly that the brightness rises with increasing ridge width irrespective of the onset of more and more lateral modes. The lateral brightness 2W · mm¯¹ 1mrad¯¹ at 10MW · cm¯²2 power density on the front facet of the investigated laser with widest ridge (23 µm) is comparable with best values known from much wider broad-area lasers. In addition, we show that one of the simulation tools is able to predict beam steering and coherent beam

Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences and Countermeasures.

Circadian (∼ 24 hour) timing systems pervade all kingdoms of life, and temporally optimize behaviour and physiology in humans. Relatively recent changes to our environments, such as the introduction of artificial lighting, can disorganize the circadian system, from the level of the molecular clocks that regulate the timing of cellular activities to the level of synchronization between our daily cycles of behaviour and the solar day. Sleep/wake cycles are intertwined with the circadian system, and global trends indicate that these too are increasingly subject to disruption. A large proportion of the world's population is at increased risk of environmentally-driven circadian rhythm and sleep disruption, and a minority of individuals are also genetically predisposed to circadian misalignment and sleep disorders. The consequences of disruption to the circadian system and sleep are profound and include myriad metabolic ramifications, some of which may be compounded by adverse effects on dietary choices. If not addressed, the deleterious effects of such disruption will continue to cause widespread health problems; therefore, implementation of the numerous behavioural and pharmaceutical interventions that can help restore circadian system alignment and enhance sleep will be important

A MODEST review

We present an account of the state of the art in the fields explored by the research community invested in 'Modeling and Observing DEnse STellar systems'. For this purpose, we take as a basis the activities of the MODEST-17 conference, which was held at Charles University, Prague, in September 2017. Reviewed topics include recent advances in fundamental stellar dynamics, numerical methods for the solution of the gravitational N-body problem, formation and evolution of young and old star clusters and galactic nuclei, their elusive stellar populations, planetary systems, and exotic compact objects, with timely attention to black holes of different classes of mass and their role as sources of gravitational waves. Such a breadth of topics reflects the growing role played by collisional stellar dynamics in numerous areas of modern astrophysics. Indeed, in the next decade, many revolutionary instruments will enable the derivation of positions and velocities of individual stars in the Milky Way and its satellites and will detect signals from a range of astrophysical sources in different portions of the electromagnetic and gravitational spectrum, with an unprecedented sensitivity. On the one hand, this wealth of data will allow us to address a number of long-standing open questions in star cluster studies; on the other hand, many unexpected properties of these systems will come to light, stimulating further progress of our understanding of their formation and evolution.Comment: 42 pages; accepted for publication in 'Computational Astrophysics and Cosmology'. We are much grateful to the organisers of the MODEST-17 conference (Charles University, Prague, September 2017). We acknowledge the input provided by all MODEST-17 participants, and, more generally, by the members of the MODEST communit

The Value of Environmental and Health Claims on New Legume Products: A Non-Hypothetical Online Auction

Legumes are valued in agricultural systems, as they can contribute to a more sustainable land use. However, their economic value is low. Despite health and environmental benefits, marketers struggle to communicate the worth of legumes to consumers. We evaluate the worth of health and, in particular, environmental claims that would spread consumers’ awareness of ecological advantages. Utilizing a large consumer sample, we execute binding online auctions. Comparing claim-treated and untreated subjects (between design), we model the price premium that potential customers are willing to pay (WTP) for having pasta in a legume instead of a wheat version. We find that claims may increase the WTP, however, a mix of environmental and health claims is superior to individual claims. Effect sizes suggest that the mix of claims increases the WTP by roughly 35% (20 cents). The link of WTP and food attitudes, such as concern for health in eating habits or social reservations towards legumes, varies depending on whether the green-pea or chickpea pasta was evaluated. A critical perception of legumes’ association with flatulence reduces the WTP. Developing the online auction may enable researchers to increase the external validity of consumer samples. We discuss implications for researchers and marketers