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

Actinobacteria isolated from subterranean and cultural heritage: implications for biotechnology

Due to their extraordinary properties, Actinobacteria can thrive in extreme environments, such as limestone caves, lava tubes and stone monuments. They grow forming microbial mats and speleothems on the walls and ceilings of caves, ranging from extensive coatings to small colonies (Riquelme et al. 2015). Their colour includes yellow, tan, orange, grey, pink and white. Recently, we have found abundant yellow and white-coloured bacterial mats coating the cave walls and secondary mineral deposits (speleothems) of lava tubes from La Palma Island, Canary Islands, Spain (Gonzalez-Pimentel et al. 2018) and Mount Etna in Catania (Sicily, Italy). Field Emission Scanning Electron Microscopy (FESEM) of the coloured microbial mats revealed abundant Actinobacteria-like cells, including a variety of filaments and spore structures with smooth surface ornamentation or profuse surface appendages. The DNA-/RNA-based analyses confirmed that these microbial mats are mainly composed of metabolically active Actinobacteria (Gonzalez-Pimentel et al. 2018). It is well known that Actinobacteria, mainly isolated from marine and soil ecosystems, are an important source of bioactive compounds, with Streptomyces ranking first with a huge number of bioactive secondary metabolites (Guo et al. 2015). These compounds, not only produced by Streptomyces but also by Bacillus, are very important to the industrial sector, such as pharmacology, biofuel and food industries, as well as to the conservation of stone cultural heritage, due to their antimicrobial properties (Silva et al. 2017). In the last decades, these sectors have intensified demands for exploring novel eco-friendly bioactive compounds, which stresses the need to investigate new groups of Actinobacteria from underexplored habitats. Yet, Actinobacteria from caves have not been the target of intensive screening for bioactive secondary metabolites. Hence, Actinobacterial-like microbial mats were collected and isolated from lava tubes in La Palma and Mount Etna to investigate their biotechnological potential. The screening of antimicrobial activity was based both on culture-dependent techniques using the agar diffusion assay and on metagenomics. Our study has showed that the strain Streptomyces sp. MZ0467C isolated from La Palma lava tube has antimicrobial activity against Microbacterium, Rhodococcus, Arthrobacter, Kocuria, Sphingomonas and Paenibacillus due to its ingenious adaptations and metabolic strategies to survive under extreme environmental conditions. This demonstrates that Actinobacteria from subterranean environments are promising sources of antibacterial compounds with interest for cultural heritage conservation

The iatrogenic costs of NSAID therapy: A population study

Objective. To estimate the iatrogenic costs of nonsteroidal antiinflammatory drug (NSAID) treatment from the perspective of the Italian National Health Service. Methods. We conducted a retrospective cohort study using the primary and secondary care claims data registered in the regional health service database in the Friuli-Venezia Giulia (Italy). The study cohort comprised all persons (265,114) who received at least one prescription for any NSAID between August 1996 and July 1998. The outcomes of interest were the costs of medical interventions for upper gastrointestinal disorders following NSAID treatment (i.e., prescriptions for gastroprotective drugs, hospitalizations, and outpatient diagnostic procedures). Results. The study population received a total of 660,311 NSAID prescriptions for a cost of 6,587,533 Euros (ε) (ε0.53 per treatment day). The cost of medical interventions for gastrointestinal events added 58% to the cost of NSAID therapy (ε0.31 per NSAID treatment day, up to 64% directly attributable to NSAID use). The iatrogenic costs were generated by 12.4% of the patients, 77% of whom had a positive history of gastrointestinal disorders and 82% of whom were older than 50 years. Co-prescriptions for gastroprotective drugs accounted for 78.6% of the overall iatrogenic costs. The iatrogenic costs did not differ between cyclooxygenase (COX) nonselective and COX-2 preferential drugs within strata of age and prior history of gastrointestinal disorders, but were significantly higher for the parenteral NSAIDs than the oral or rectal formulations. Conclusions. In Italy, the iatrogenic costs of NSAID therapy add 58% to the cost of NSAID treatment; most of the cost is generated by co -prescriptions of gastroprotective drugs to elderly NSAID users or patients with a history of gastrointestinal disorders

Comparing extrapolations of the coronal magnetic field structure at 2.5 solar radii with multi-viewpoint coronagraphic observations

The magnetic field shapes the structure of the solar corona but we still know little about the interrelationships between the coronal magnetic field configurations and the resulting quasi-stationary structures observed in coronagraphic images (as streamers, plumes, coronal holes). One way to obtain information on the large-scale structure of the coronal magnetic field is to extrapolate it from photospheric data and compare the results with coronagraphic images. Our aim is to verify if this comparison can be a fast method to check systematically the reliability of the many methods available to reconstruct the coronal magnetic field. Coronal fields are usually extrapolated from photospheric measurements typically in a region close to the central meridian on the solar disk and then compared with coronagraphic images at the limbs, acquired at least 7 days before or after to account for solar rotation, implicitly assuming that no significant changes occurred in the corona during that period. In this work, we combine images from three coronagraphs (SOHO/LASCO-C2 and the two STEREO/SECCHI-COR1) observing the Sun from different viewing angles to build Carrington maps covering the entire corona to reduce the effect of temporal evolution to ~ 5 days. We then compare the position of the observed streamers in these Carrington maps with that of the neutral lines obtained from four different magnetic field extrapolations, to evaluate the performances of the latter in the solar corona. Our results show that the location of coronal streamers can provide important indications to discriminate between different magnetic field extrapolations.Comment: Accepted by A&A the 20th of May, 201

On the Absorption of X-rays in the Interstellar Medium

We present an improved model for the absorption of X-rays in the ISM intended for use with data from future X-ray missions with larger effective areas and increased energy resolution such as Chandra and XMM, in the energy range above 100eV. Compared to previous work, our formalism includes recent updates to the photoionization cross section and revised abundances of the interstellar medium, as well as a treatment of interstellar grains and the H2molecule. We review the theoretical and observational motivations behind these updates and provide a subroutine for the X-ray spectral analysis program XSPEC that incorporates our model.Comment: ApJ, in press, for associated software see http://astro.uni-tuebingen.de/nh