Safety of neural monitoring in thyroid surgery

During thyroid surgery, the functional integrity of the recurrent laryngeal nerve (RLN) is not only threatened by direct nerve injury resulting from accidental transection, clipping or ligation. In fact, indirect trauma, e.g. traction and compression occurring repeatedly throughout gland dissection, contribute to long-term nerve impairment. In order to avoid RLN lesions and preserve nerve function the surgeon must adhere to and comply with a strict standardized intraoperative neuromonitoring (IONM) technique to preserve results, quality and safety.IONM should be a team work between the surgeon and the anesthesiologist

Diagnostik und Therapie bei Schwindel : Interdisziplinärer Leitfaden für die klinische Praxis [Diagnosis and treatment of vertigo and dizziness : Interdisciplinary guidance paper for clinical practice. German version]

Vertigo and dizziness belong to the most common leading symptoms in clinical practice. Their differential diagnosis, however, often poses a challenge. This work aims to provide evidence-based and practice-oriented recommendations for diagnosis and treatment of vertigo and dizziness in primary care. The consensus statement of an interdisciplinary working group following a national survey among Swiss primary care physicians and neurotology specialists (neurologists, otorhinolaryngologists) is presented. The associated literature search in PubMed was conducted up to October 2024. Structured history taking and clinical neurotological examination form the basis for the differential diagnosis of the various acute (AVS), episodic (EVS), and chronic (CVS) vestibular syndromes (AVS: e.g., stroke or acute unilateral vestibulopathy; EVS: e.g., benign paroxysmal positional vertigo [BPPV], Menière's disease, vestibular migraine, vestibular paroxysmia; CVS: e.g., bilateral vestibulopathy, persistent postural perceptual dizziness). The present paper covers the following topics: i) "red flags" for a potentially dangerous cause in patients with acute vertigo/dizziness/gait and balance disorders; ii) essential clinical neurotological examination steps; iii) diagnostic and therapeutic maneuvers for posterior and lateral canal BPPV; iv) the most important therapeutic strategies for the vestibular syndromes named above; and v) the top 10 recommendations regarding history taking, diagnosis, and treatment of vertigo and dizziness in clinical practice. This review aims to serve as a clinical companion for physicians of all specialties dealing with the primary diagnosis and treatment of vertigo and dizziness

Secondary students' values and perceptions of science-related careers: responses to vignette-based scenarios

There has been concern about the attractiveness of science-based careers to many adolescent learners, and it has been suggested that school science may not always recognise or engage personal values that are important to young people in making life choices. The present study discusses interview comments made by upper secondary level students in England when 15 young people were asked to give their personal responses to brief vignettes describing scientific careers. Using an interview-about-scenarios approach, the students were asked about whether they would feel comfortable working in the scientific careers represented. The career areas were purposefully selected because they might be considered to potentially raise issues in relation to personal values or commitments that some students might hold. A range of student perceptions relating to the mooted careers were elicited (positive, negative and indifferent), but all of the participants raised issues that impacted on the acceptability or attractiveness of at least one of the mooted scientific careers, in terms of aspects of their own personal beliefs and values systems. It is recommended that teachers and career advisors should be aware of the range of value-related considerations that influence student views of science-related careers and should consider exploring aspects of science-based careers that link to values commonly shared by young people. This exploratory study also offers indications for directions for further research exploring how learners' value systems impact upon their perceptions of science and scientific work

IRIS: methodological assessment of psychopathological disease in a cohort of hirsute women.

Hirsutism in females can be a source of considerable psychological distress and a threat to female identity. The aim of our study was to evaluate a possible relationship between facial, total body hair involvement and physical, mental and social well--being during 12 months of follow--up and treatment. Both objective and subjective methods of evaluating hirsutism were used: the Ferriman-Gallwey scoring method and the questionnaires GHQ--12, PCOSQ and SF--12. The total of 469 female patients (mean age 27.61±7.63 years) was enrolled in 27 Italian centres participating in this study. Higher total body score was correlated to significant emotional discomfort. The correlation between the FG total body score, the facial score and physical/mental health was found to be significant in all the patients assessed by SF--12 questionnaire. The ongoing reduction of GHQ--12 score was found for the facial FG score at the first follow--up (T0--T1 period) and at the second one (T0--T2). No relationship was found between T1 and T2. At both six (T1) and twelve months (T2) follow--up an increase of PCOSQ score (psychological improvement) was accompanied by a concomitant reduction of the FG score (reduction of hirsutism). Physical health assessed by SF--12 questionnaire does not change at both six and twelve months' follow--up, but mental health decreased at both T1 and T2. The clinical improvement was achieved at six months regardless on treatment used and it was maintained for the next six--month's follow--up. The clinical outcome could be assessed both by Ferriman--Gallwey score both through questionnaires administrated to each patient with hirsutism. For the evaluation of psychopathological discomfort the most appropriate questionnaire was GHQ--12, because of it major sensitivity to identify the psychological discomfort in the hirsutism

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Antipsychotic dose mediates the association between polypharmacy and corrected QT interval

Antipsychotic (AP) drugs have the potential to cause prolongation of the QT interval corrected for heart rate (QTc). As this risk is dose-dependent, it may be associated with the number of AP drugs concurrently prescribed, which is known to be associated with increased cumulative equivalent AP dosage. This study analysed whether AP dose mediates the relationship between polypharmacy and QTc interval. We used data from a crosssectional survey that investigated the prevalence of QTc lengthening among people with psychiatric illnesses in Italy. AP polypharmacy was tested for evidence of association with AP dose and QTc interval using the Baron and Kenny mediational model. A total of 725 patients were included in this analysis. Of these, 186 (26%) were treated with two or more AP drugs (AP polypharmacy). The mean cumulative AP dose was significantly higher in those receiving AP polypharmacy (prescribed daily dose/defined daily dose = 2.93, standard deviation 1.31) than monotherapy (prescribed daily dose/defined daily dose = 0.82, standard deviation 0.77) (z = -12.62, p < 0.001). Similarly, the mean QTc interval was significantly longer in those receiving AP polypharmacy (mean = 420.86 milliseconds, standard deviation 27.16) than monotherapy (mean = 413.42 milliseconds, standard deviation 31.54) (z = -2.70, p = 0.006). The Baron and Kenny mediational analysis showed that, after adjustment for confounding variables, AP dose mediates the association between polypharmacy and QTc interval. The present study found that AP polypharmacy is associated with QTc interval, and this effect is mediated by AP dose. Given the high prevalence of AP polypharmacy in real-world clinical practice, clinicians should consider not only the myriad risk factors for QTc prolongation in their patients, but also that adding a second AP drug may further increase risk as compared with monotherapy

Analisi e modellizzazione dell'effetto di agrotecniche sull'altezza della pianta : il progetto MIATA

L\u2019altezza delle piante \ue8 importante per determinarne il potenziale produttivo e la suscettibilit\ue0 nei confronti di avversit\ue0 abio-tiche. Nonostante questo, i modelli disponibili la ignorano o la simulano utilizzando semplici funzioni logistiche indipendenti dai reali processi bioLsici in gioco e dalle modalit\ue0 di gestione. Il progetto MIATA, condotto da studenti del corso di Sistemi Colturali dell\u2019Universit\ue0 degli Studi di Milano, ha affrontato la problematica, fornendo soluzioni modellistiche utili sia a scopo previsionale che di supporto alla gestione