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

A Clinical Application of the Bone Structure Index

It has been recently estimated that about 30% of women and 20% of men over 50 will develop osteoporosis, a disease characterized by decreasing bone strength. Although low bone mineral density is generally associated with higher fracture risk, the spatial arrangement of the trabecular structure is a second key factor of bone resistance [1] and about 40-60% of the fractures affect people that can be considered at moderate risk on the basis of densitometry (DXA) assessment alone [2, 3]. Hence the need to develop innovative and low-cost diagnostic methods that can be used together with the consolidated systems. The recently introduced Bone Structure Index (BSI) gives an indication of the quality of the bone structure: it measures the weight-bearing capacity of the bone structure, evaluated from simulated application of loads on a virtual biopsy of the patient. The bone structure images are acquired by planar radiograms in the proximal epiphysis of the three central proximal phalanges of the non-dominant hand, a peripheral site of the human body [4-7]. In this work, we describe a recent application of the BSI in a clinical setting

Tracking ground state Ba+ ions in an expanding laser–plasma plume using time-resolved vacuum ultraviolet photoionization imaging

We report results from a study of the integrated column density and expansion dynamics of ground-state-selected Ba+ ions in a laser–plasma plume using a new experimental system—VPIF (vacuum-ultraviolet photoabsorption imaging facility). The ions are tracked by recording the attenuation of a pulsed and collimated vacuum ultraviolet beam, tuned to the 5p–6d inner-shell resonance of singly ionized barium, as the expanding plasma plume moves across it. The attenuated beam is allowed to fall on a CCD array where the spatial distribution of the absorption is recorded. Time-resolved ion velocity and integrated column density maps are readily extracted from the photoionization images

Flight Tests, Performances and Flight Certification of a Twin-Engine Light Aircraft

This paper deals with flight test activities performed on P2006T, a twin-engine light aircraft recently designed and produced by Tecnam. Research activities and flight tests have been conducted during the flight certification of P2006T for the normal category under CS-23. All the acquired data and flight results presented have been focused on both aircraft certification and on aircraft performances, stability and flight qualities measurement. The data have been acquired through a light, accurate and reliable flight instrumentation available at DIAS (Department of Aerospace Engineering). Some flight data about aircraft leveled speed, stall speed, climb characteristics and ground performances (take-off and landing) will be presented. After preliminary flight tests, winglets have been designed and added to the final configuration in order to obtain good climb performances also in OEI (One Engine Inoperative) conditions. Accurate stall tests have been performed in all configurations and influence of both entry-rate and load factor on stall speed have been highlighted. Excellent ground performances have been measured with short take-off and landing distances compared with similar airplanes. All measured flight performances can be considered very good for this aircraft category and have been used to demonstrate aircraft safety and to obtain CS23 certification

Real time control of curved laser welding processes by cellular neural networks (CNN): first results

In the last decades the laser beam welding (LBW) has outclassed older welding techniques in the industrial scenario. Despite the improvement in welding technology, sophisticated methods of fault detection are not commonly used in commercially available equipments yet. A recent analysis of process images have revealed the possibility to build up a real time closed loop control system. By the use of image based quality features, a feedback signal can be provided to maintain the process in the desired state. The development of the presented visual control system has been focused on the adjustment of the laser power according to the detection of the so called full penetration hole. Due to the high dynamics of the laser welding, a fast real time image processing with controlling rates in the multi kilo Hertz range is necessary to have a robust feedback control. In this paper an algorithm for the real time control of welding processes is described. It has been implemented on the Eye-RIS v1.2, a visual system which mounts a cellular structure. By applying this algorithm in real time applications, controlling rates of about 7 kHz can be reached. In the following some real time control results are also described

Immunization status of internationally adopted children in Rome, Italy

Aims: International adoption medicine is a relatively new specialty in pediatrics that has emerged to address the specific health care needs of internationally adopted children in high‑income countries. This study ascertains the seroprotection rate for vaccine‑preventable diseases, especially against pneumococcal diseases.Patients and Methods: We evaluated 67 internationally adopted children that reached the International Adoption Unit of Bambino Gesù Children’s Hospital, Rome‑Italy. We collected demographic information, data from preadoption immunization records, results of laboratory testing for immunity to vaccine‑preventable diseases (tetanus, pneumococcus, hepatitis B, hemophilus influenzae type b (Hib), measles), as well as results of screening for HIV, hepatitis C, quantiferon, immunological and nutritional status.Results: For children that had received ≥3 vaccine doses of tetanus, overall protection was 94% of 31 vaccinated children; with 1–2 vaccine doses for hepatitis B and Hib respectively, protection was 45% of 29 vaccinated children and 63% of 8 vaccinated children, respectively. For children with one or more doses of measles vaccine, protection was 63% of 32 vaccinated children. Regarding pneumococcus vaccine (documented for eight children), 88% of children with one or more doses of vaccine had developed protective immunity.Conclusions: International adoptees without a valid vaccine record need to undergo a complete schedule in accordance with their age and should receive all the vaccines in the adoptive country’s schedule.Key words: And pneumococcal immunization, immigrant children, internationally adopted children, vaccination statu