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Intraoperative neuromonitoring versus optical magnification in the prevention of recurrent laryngeal nerve injury in thyroid surgery: a prospective randomized study
Full text linkBackground
Although a standardized technique in thyroid surgery, still a certain percentage of both early and late complications is reported and undoubtedly the recurrent laryngeal nerve (RLN) paralysis remains the most fearful. Thus, different technological innovations have been introduced over the last decades with the aim to guarantee major accuracy and decrease the risk of severe complications. Intraoperative neuromonitoring (IONM) and optical magnification (OM) facilitate dissection and increase the surgeon’s precision. The aim of our study is to compare these two techniques in terms of complications rate especially in the incidence of RLN paralysis during thyroid surgery.
Materials and Methods
In our prospective randomized longitudinal study, from October 2018 to February 2020 total thyroidectomy was performed in a population of 100 consecutive patients that was divided into 2 groups of 50 patients. In the first group (OM - Optical Magnification), only surgical binocular loupes (2.5x-4.5x) were used as an aid in the RLN identification and dissection, while in the second group (IONM – Intraoperative Neuromonitoring) was adopted only the NIM in intermittent modality. The preoperative assessment included either indirect laryngoscopy or fibrolaringoscopy and all the patients had normal vocal cord motility. Written informed consent was obtained and thyroid surgery was performed by the same experienced surgeons of the team. Exclusion criteria were previous thyroid surgery, lobectomy, neck irradiation, concomitant parathyroidectomy, lymph node dissection, minimally invasive procedures such as MIVAT, TOETVA. The follow-up period was 6 months. No cases of mortality were reported in our series.
Results
The two groups were homogeneous in distribution of age, sex and type of thyroid disease at the admission. No statistically significant differences in the presence of hyperfunction or thyroiditis was shown. In the IONM group, the most relevant data was the presence of 2 cases of bilateral RLN paralysis that needed immediate airway management and intensive care unit transfer of the patients. However, the two transients bilateral RLN paralysis in the IONM Group (4%) versus none in the OM Group (0%) were not statistically significant (p>0.05). Furthermore, statistically relevant data was found regarding the duration of the operation, transient hypocalcemia and the length of hospitalization (p<0.05). The duration of the operation seemed to be significantly shorter in the OM Group (median 80 vs 100 minutes, p<0.05). With regard in the length of hospital staying, there was a statistically significant difference in favor of the OM Group (median 2 vs 4 days, p<0.05). Nevertheless, the OM group reported a 4-fold higher risk developing transient hypocalcemia than the IONM group (OR 3.78, Adj OR 4.11, p=0.01). In addition, the multivariate analysis adjusted by group and gender documented a relevant difference regarding the transient postoperative dysphonia with the males having a 5-fold higher risk developing transient dysphonia than the females (Adj OR 5.19, 95% IC 0.99-27.18, p=0.05). A collateral data of our study was the finding of occult carcinomas in relation to the histological report and cytological examination for each group (90% and 80% of incidence rate in OM and IONM group respectively) and the presence of overall histological carcinomas in the OM group was statistically significant (p<0,05). Finally, no significant difference was found regarding definitive hypoparathyroidism and in the follow-up at six months after surgery all patients were found with preserved vocal cord motility and no cases of hypocalcemia or hypoparathyroidism were detected.
Conclusion
To our knowledge, this is the first study in the literature that directly compares the use of IONM with OM alone in the prevention of RLN injuries. The risk of recurrent complications in both methods remains comparable and the 2 cases of RLN paralysis in the IONM group of our series are not statistically significant. While the OM is advantageous for the accurate identification, isolation and dissection of the RLN, the IONM allows intraoperative assessment of the nerve integrity and functionality and can add greater confidence to the surgeon, especially if less experienced. In our opinion the two techniques can be considered a valid alternative in thyroid surgery, at least in highly specialized endocrine-surgical centers, and their simultaneous application provides better outcomes. A new multicenter study with a larger cohort of patients and using the IONM in continuous modality could certainly provide us further information
Pelvic floor anatomy
No full textThe pelvis is a complex structure made up of bones, muscles, ligaments, and fascia and con- tains organs such as the bladder, urethra, uterus, prostate, and rectum. The pelvic floor is separated into three compartments (anterior, middle, and posterior) and consists of muscles and connective tissue that work as a coordinated system to sup- port the organs and to prevent dysfunctions.
This chapter attempts to provide an essential description of those structures and organs of pel- vic floor that contribute to the complex mecha- nism of anal continence. The pelvic cavity, the anterior and middle compartment of the pelvic floor, and the ischioanal fossae are anatomic structures beyond the scope of this section.
Fecal incontinence is described mostly as a disorder of the posterior compartment of pelvic floor, managed traditionally by colorectal sur- geons. Therefore, in order to make easier to understand the physiology of continence mecha- nism, we concentrated our attention to the ana- tomical aspects regarding the muscles of pelvic floor and the structure of the anorectum
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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