Rate Of Palsy Research Articles

Increasing Incidence of Facial Nerve Disorders in the United States from 2007 to 2022.

Incidence data on Facial Nerve Disorders (FND) and Bell's palsy are currently limited. Prior epidemiological studies have estimated the incidence rate of Bell's palsy to be between 11 and 53/100,000 individuals, although the most cited incidence data are from single regions or municipalities, many of which are outdated from several decades ago. This was a retrospective cohort study of US adults from 2007 to 2022 using the Merative™ Marketscan® Research Databases. Trends in the incidence of FND were described overall and by specific sociodemographic groups, including age, sex, region, and insurance plan type. Chi-squared and simple logistic regression analyses were performed. From 2007 to 2022, the total adult incidence of all FND was 30.5/100,000, and the total incidence of Bell's palsy alone was 24.5/100,000. Over the study period, there was a significant annual increase of 2.1 cases of FND/100,000 adults (95% Confidence Interval [CI] 1.8, 2.3; p < 0.001), and a significant total increase of 1.5 cases of Bell's palsy/100,000 adults (95% CI 1.2, 1.7; p < 0.001). The total incidence of FND was higher in males (33.1/100,000) than in females (28.4/100,000, p < 0.001), and greater in older age groups (p < 0.001). Additionally, the incidence of FND varied significantly by region (p < 0.001) and insurance plan type (p < 0.001). This study provides up-to-date incidence rates for Bell's palsy and facial nerve disorders, based on national administrative claims data. Incidence rates of FND and Bell's palsy alone have been increasing in the United States from 2007 to 2022. III Laryngoscope, 2025.

Comparing C3, 4, and 5 nerve root block and interscalene with intermediate cervical plexus block in diaphragmatic motion for clavicle surgery

Regional anesthesia is a popular method for surgical anesthesia in clavicular surgery. Selective blocking of the cervical 3, 4, and 5 nerve roots shows promise in clavicle surgery, with its fast onset, good anesthesia and less complications, necessitating evaluation of its impact on diaphragmatic function. The purpose of this study is to examine the safety of C3, 4, and 5 nerve root block for its application in clavicle surgery. We conducted a pragmatic, randomized trial to evaluate the effect of C3, 4, and 5 nerve root block as compared with interscalene with intermediate cervical plexus block in diaphragmatic motion. This study involved forty patients undergoing right clavicle surgery. Patients were assigned in a 1:1 ratio to either a C345 nerve root block (administered with 2, 3, and 5 ml of 0.5% ropivacaine) or an interscalene with intermediate cervical plexus block (ISB + ICPB, each receiving 10 ml of 0.5% ropivacaine). Diaphragmatic kinetics were quantitatively assessed using sonographic techniques. The primary outcome was the incidence of complete hemi-diaphragmatic paralysis, observed at 30 min post-blockade. Secondary outcomes included the rate of complete hemi-diaphragmatic paralysis at 15 min and the degree of diaphragmatic motion restoration at 2, 4, 6, and 8 h post-blockade, onset time of block, motor block score in upper extremity, and adverse events. Results showed that only one patient (5%) in the C345 group vs. fifteen (75%) in the ISB + ICPB group experienced complete hemi-diaphragmatic paralysis at 30 min during deep breathing (P = 0.001). No patients in the C345 group, compared to five (25%) in the ISB + ICPB group exhibited paradoxical movement at 30 min during voluntary sniffing (P = 0.0471). Additionally, the C345 group demonstrated significantly greater diaphragmatic motion and upper limb strength restoration at all measured intervals post-blockade. Moreover, faster onset time and less adverse events were observed in the C345 group vs. in the ISB + ICPB group. Benefit from low volume of local anesthetics, the C345 nerve root block not only significantly reduces the incidence of complete hemi-diaphragmatic paralysis but also facilitates better recovery from diaphragmatic paralysis compared to the ISB + ICPB. It can be inferred that C345 is a more beneficial anesthesia method for early recovery of clavicular patients.Trial registration number: ChiCTR2300078283 04/12/2023.

Comparison of glucocorticoids combined with antiviral drugs versus glucocorticoids alone in the management of Bell's Palsy: A systematic review and meta-analysis of randomized clinical trials.

This study aimed to compare the efficacy of glucocorticoids combined with antiviral drugs (GA) versus glucocorticoids alone (GO) in the treatment of Bell's Palsy. According to the PRISMA2020 guidelines, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for English articles from their inception to August 10, 2023, and performed a secondary search on October 31, 2024. Studies describing the efficacy of (GA) for Bell's Palsy versus (GO). Patient demographics, cure rates, and results of subgroup analysis were collected. Stata 17.0 was used to perform the calculation and to draw relevant meta-analysis pictures. RevMan 5.4 was used to determine the source of bias and to summarize the risk of bias. Heterogeneity was assessed using Q-tests and I2 statistics. A total of 10 RCTs enrolling 2893 participants were finally included in the meta-analysis. The treatment rate in the group of GA and the group of GO was 88.7% and 83.2%, respectively. The difference in the treatment rate between the two groups for Bell's Palsy was significant (relative risk (RR)=1.09, 95% confidence interval (CI)=1.03-1.15), and significant heterogeneity was (I2=63.6%, p=0.003<0.1). This review suggests that GA may be an effective treatment for Bell's palsy. Compared with GO, GA can improve the cure rate of Bell's palsy.

Impact of intraoperative recurrent laryngeal nerve monitoring on minimally invasive esophagectomy outcomes for esophageal cancer: a meta-analysis of case-control studies.

Esophagectomy and lymphadenectomy for esophageal cancer carry an inherent risk of recurrent laryngeal nerve (RLN) injury. Intraoperative nerve monitoring (IONM) may help prevent RLN damage, though evidence on its effectiveness is still limited. This systematic review and meta-analysis (SRMA) evaluate the feasibility and efficacy of IONM during minimally invasive esophagectomy (MIE) for esophageal cancer. This SRMA followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, with a registered protocol on PROSPERO (CRD42022367916). Two independent authors conducted a comprehensive literature search across multiple databases, screening studies on MIE for esophageal cancer using IONM. Case-control studies were included, focusing on the RLN palsy (RLNP) rate as the primary outcome. A total of 11 studies involving 1907 patients (IONM group: 752 patients; non-IONM group: 1155 patients) were included in the SRMA. IONM significantly reduced the incidence of RLNP (OR = 0.47, P < 0.001). Length of hospital stay (LOHS) and lower respiratory tract infection (LRTI) rates were significantly reduced with IONM use. No significant differences were observed in anastomotic leak, chylothorax, total number of lymph nodes dissected, operation time, aspiration rates, or intraoperative blood loss. The pooled sensitivity and specificity of IONM for detecting RLN injury were 83.3% and 81%, respectively. IONM during MIE significantly reduces the incidence of RLNP, postoperative LRTI, and shortens the LOHS, without adding operative risks. Further research is needed to evaluate its long-term survival benefits and cost-effectiveness.

Superior Vena Cava Isolation With Cryoballoon in AF Ablation: Randomized CAVAC AF Trial.

Superior vena cava (SVC) has been considered a specific trigger in atrial fibrillation development. We investigated the efficacy and safety of combining cryoballoon pulmonary vein isolation (PVI) with SVC ablation compared with PVI alone in 100 patients with paroxysmal or non-long-standing persistent atrial fibrillation. Patients were randomly assigned to either the PVI+SVC ablation group or the PVI-only group. Each patient was given a mobile device to record a daily ECG and detect atrial tachyarrhythmias. The primary end point, freedom from any atrial tachyarrhythmia recurrence between 91 and 365 days post-catheter ablation, did not significantly differ between the 2 groups (62.9% versus 72%; P=0.41). However, the PVI+SVC group exhibited higher rates of phrenic nerve paralysis (20.8% versus 6%; P=0.003) and transient sinus node injury (18.8% versus 0%; P=0.001) compared with the PVI-only group. The median burden of atrial tachyarrhythmia showed no significant difference (P=0.91). The addition of SVC ablation to PVI did not enhance freedom from atrial tachyarrhythmia at 12 months, and it led to increased complications. These findings do not support the routine inclusion of SVC ablation in cryoballoon procedures for first-time catheter ablation in patients with paroxysmal or non-long-standing persistent atrial fibrillation.

Current Trends in Deep Plane Neck Lifting: A Systematic Review.

The aging neck is a prevalent aesthetic concern, with over 160,000 neck procedures performed in 2020. It is characterized by increased soft tissue laxity and displacement of cervical structures. While nonsurgical interventions like cryoablation and laser resurfacing show promise, their variable responses highlight the necessity for surgical solutions. Traditional neck lifts address superficial structures but often neglect the subplatysmal plane. Recently, deep plane neck lifts have gained attention for addressing deeper anatomical structures. This paper systematically reviews the literature on subplatysmal modifications in cervicoplasty, aiming to clarify the risks and benefits of these evolving surgical techniques. On February 20, 2024, a systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines was performed. MEDLINE, PubMed, Cochrane, and Scopus databases were searched for terms related to neck rejuvenation. Independent reviewers screened titles, abstracts, and full texts, including all relevant studies. Data extracted included patient numbers, procedures, outcomes, and complications. From an initial 771 articles, 57 studies encompassing 8648 patients met inclusion criteria. The most commonly altered anatomical structures during "deep plane" neck lift (DPNL) were the submandibular gland (69.9%), digastric muscles (58.6%), and subplatysmal fat (48.6%). Postoperative complications were reported in 59.6% of studies, with nerve palsy (0.2%-12%) and hematoma (0.2%-4%) being most common. Aesthetic outcomes were less frequently reported (56% of studies); patient satisfaction ranged from 81.6% to 98.6%, while objective measures were reported in only 12% of studies. Recent surveys indicate a growing concern over excess laxity under the chin, with patients increasingly seeking neck rejuvenation. Our review found that DPNL techniques vary widely, with the submandibular gland and digastric muscles being the most frequently altered structures. Despite a general lack of standardized outcome measures, patient satisfaction was high. However, DPNL showed a higher rate of postoperative nerve palsy compared to traditional neck lift. Overall, while DPNL demonstrates potential aesthetic benefits, the increased risk necessitates thorough patient counseling and further studies for standardization and comparison.

The parathyroid glands identification of carbon nanoparticles via preoperative injection in reoperation of recurrent benign multinodular goiter.

Benign multinodular goiter (BMNG) can grow very large and cause compression symptoms, making the operation procedure difficult. However, the recurrence rate of BMNG ranges from 3% to 43%. Reoperative thyroid surgery for BMNG is uncommon and can result in a high rate of complications, including hypoparathyroidism and recurrent laryngeal nerve palsy. Carbon nanoparticles (CNs) have been widely used as a protective agent for the parathyroid gland and as a tracer agent in central lymph node dissection. However, the protection effect of CNs in redoing BMNG has not been well illustrated. This study investigates whether CNs could protect parathyroid glands (PGs) during reoperation for patients with BMNG. BMNG patients who previously underwent thyroidectomy and received reoperation between January 2019 and January 2022 were retrospectively recruited. The Dunhill approach was employed for all patients. The patients were divided into two groups: the CNs group, who received injection CNs injection 1 hour before the operation (n = 24), and the control group, who underwent thyroid surgery without CNs injection (control group, n = 25). The numbers of PGs preserved in situ, autotransplantation, the accidental removal of the PGs, and the parathyroid hormone level were recorded and analyzed. The results revealed that more PGs were preserved in situ in the CNs group compared to the control group (3.25±0.15 vs 2.60±0.16, P=.007). Moreover, fewer PGs were subjected to autotransplantation and were accidentally discovered in the specimen in the CNs group compared to the control group. Patients who had CNs injection exhibited a lower rate of transient (5/24 vs. 13/25, P=.024) and permanent hypoparathyroidism (2/24 vs. 9/25, P=.020) compared to the control group.

The impact of anesthesia instruments and drugs on the occurrence of vocal cord injury, systematic review and meta-analysis.

This study extensively examined common complications related to anesthesia drugs and equipment on vocal cords. It also delved into factors such as smoking, anesthesia duration and anesthesia induction methods. Overall, the research aimed to pinpoint influential factors for creating a general anesthesia protocol with minimal post-operative complications. We searched PubMed, Scopus, Web of Science, and Google Scholar for studies concerning the impact of anesthesia drugs and equipment on the vocal cord, until May 2023. after screening and reviewing of full text, the characteristics of the study including sample size, age, dosage or size of anesthesia drugs and equipment, Duration of intervention, Adverse effects, and Maintenance of adverse effects, were extracted. The quality assessment was done using the Newcastle-Ottawa scale and the Jadad Scale. Our review included 39 studies from 1983 to 2023. The most frequent VCAEs were cough‎ (39.17%; CI = 9.84-68.51)‎, hoarseness (‎35.32%; CI = 25.04-45.60)‎, and erythema (35.09%; CI=-4.84-75.02). VC paralysis was relatively less frequent (‎4.16%; CI = 2.90-5.43)‎. Meta-regression showed no difference in the frequency of VCAEs with or without single-lung ventilation and smoking. However, the duration of procedure was shown to be affecting three outcomes; the duration shorter than 120min is associated with lower rates of granuloma (2.74% vs. 44.30%; p < 0.05) and higher rates of cough (48.89% vs. 15.91%; p < 0.05) and VC paralysis (42.86% vs. 0.12%; p < 0.05). The overall outcomes were not affected. The most common anesthesia-related VCAEs are cough, erythema, and dysphagia, while serious complications like vocal cord hematoma and paralysis are rare. Also surgery duration significantly influences VCAE occurrence.

Recurrent laryngeal nerve lymph node dissection with subcomplete sealing using advanced bipolar energy device in minimally invasive esophagectomy.

Recurrent laryngeal nerve (RLN) palsy is a complication that must be avoided during esophagectomy. While RLN injury is thought to be caused by thermal spread from electric devices, electric devices are useful to avoid bleeding. When dissecting lymph nodes around RLNs, to seal small vessels, we use subcomplete technique with advanced bipolar. We describe our surgical technique, termed the subcomplete sealing technique, in RLN lymph node dissection. The first step is to perform blunt dissection with forceps on both sides of the esophageal branch near the right RLN. A distance of at least 2 mm from the RLN was preferred. Sealing with advanced bipolar often causes tissue shrinkage, pulling the RLN near the device. To prevent this, sealing should be stopped before reaching completion. Although the sealing was not complete, it was sufficient to seal the small vessels. After subcomplete sealing, the sealed tissues were dissected using laparoscopic scissors. The lymph nodes around left RLN are dissected in the same manner. A total of 76 patients received esophagectomy with the subcomplete technique. Grade IIIa RLN palsy occurred in three cases (3.95%). Over Grade IIIb RLN palsies did not occur. This subcomplete sealing technique can assist surgeons in performing RLN lymph node dissection without bleeding and increasing the rate of RLN palsy.

Commercial hybrid graft versus traditional arch replacement with frozen elephant trunk: A multi-institutional comparison

ObjectiveTraditional total arch replacement with frozen elephant trunk requires 2 separate grafts in the descending thoracic aorta and arch, and frequently requires a graft-to-graft anastomosis, which is prone to bleeding. The Thoraflex (Terumo Aortic) device treats the arch and descending thoracic aorta in a single device but has not been compared directly to traditional total arch replacement with frozen elephant trunk and has not been studied in a real-world context in the United States. MethodsA consecutive sample of total arch replacement with frozen elephant trunk patients across 5 different institutions between January 2018 and January 2024, identified 438 patients of which 83 out of 438 (18.9%) had a Thoraflex device. Propensity score matching in a 1:2 ratio identified 166 well-matched controls. Groups were compared across perioperative outcomes. ResultsOne hundred forty out of 438 (32%) patients presented with acute type A dissection, 112 out of 438 (26%) had an aneurysm, and 87 out of 438 (20%) had chronic dissection with a previous proximal repair. One hundred thirty-two out of 438 (30%) underwent surgery on an emergency or emergency/salvage basis. Median (interquartile range [IQR]) crossclamp times in the Thoraflex and traditional matched groups were 71 (IQR, 48-105) and 82 (IQR, 62-123), respectively, (P = .012). Total circulatory arrest times were 19 minutes (IQR, 13-32 minutes) and 23 minutes (IQR, 17-37 minutes), respectively (P = .009). Total procedure times were 6.1 hours (IQR, 5.2-7.3 hours) and 6.8 hours (IQR, 5.7-8.2 hours), respectively (P = .012). The operative mortality, stroke, and paralysis rates were 11 out of 83 (13%), 16 out of 83 (19%), and 4 out of 83 (5%), respectively, in the Thoraflex group and were not significantly different than matched controls. ConclusionsThe Thoraflex hybrid device facilitates shorter crossclamp and circulatory arrest times for arch replacement, with similar observed mortality and stroke rates compared with matched controls.

Demographic toxicology of insect growth regulators on the nontarget ectolarval parasitoid Habrobracon hebetor

Habrobracon hebetor Say (Hymenoptera: Braconidae) is one of the most important parasitoids of many pyralid moths, including the olive leaf moth, Palpita unionalis Hubner (Lepidoptera: Pyralidae). The widespread use of insecticides threatens natural enemies. Assessing the side effects of insecticides on nontarget organisms supports the rational use of insecticides during field application. The present study evaluates the lethal and sublethal effects of three insect growth regulators (IGRs), novaluron, methoxyfenozide, and pyriproxyfen, on P. unionalis and the demographic toxicology of these IGRs on its parasitoid H. hebetor. The LC50 values of these IGRs on P. unionalis were 0.97, 0.176, and 0.00009 ppm, respectively, indicating that pyriproxyfen was the most toxic. When H. hebetor adults were exposed to these LC50 levels under laboratory conditions to determine possible side effects. The IGRs did not affect the paralysis and parasitism rates of the parasitoid nor the sex ratio of its offspring. IGR treatments slightly reduced hatching rates and immature survival by 15–25%, indicating moderate effects on the early developmental stages of H. hebetor. The longevity and fecundity of treated females were each reduced to < 50% of their respective values in untreated females. Additionally, some demographic parameters of the parasitoid were significantly affected by the IGRs. Nevertheless, despite these observed effects, the positive net reproductive rate (R0 > 0) and intrinsic rate of increase (rm > 1) of H. hebetor indicated an exponential population increase that reflects the compatibility of the IGRs with the parasitoid. Our results demonstrated that the tested IGRs could be categorized as relatively harmless compounds to the parasitoid. Following these laboratory assessments, field studies will be required to confirm the effects of the tested IGRs on H. hebetor as well as other nontarget organisms.

Enhancing Global Poliomyelitis Surveillance Performance is Crucial for Eradication Efforts

Background: Poliomyelitis remains a significant public health challenge, with global efforts focused on its eradication. One critical strategy in this endeavor is the implementation of an acute flaccid paralysis (AFP) surveillance system, which is essential for early detection and response to poliovirus transmission. Specific Background: Despite the system's importance, there is limited evaluation of its performance, particularly in regions like Diyala province, Iraq. Knowledge Gap: Previous studies have not adequately assessed the AFP surveillance performance indicators specific to this region, necessitating a comprehensive analysis. Aims: This study aimed to evaluate the performance indicators of the AFP surveillance system in Diyala province during 2021, utilizing established World Health Organization (WHO) standards. Results: The cross-sectional study analyzed data from seven primary health care centers. Key findings revealed a Non-Polio Acute Flaccid Paralysis rate of 5.11 per 100,000 children under 15 years. Performance indicators included 100% reporting completeness, 95% timeliness of notification and investigation, and 97% stool quality for laboratory analysis. Furthermore, 97.3% of specimens reached the national laboratory within three days, demonstrating high operational efficiency. Novelty: This study is one of the first to provide a detailed evaluation of the AFP surveillance system in Diyala province, highlighting areas of strength and compliance with WHO targets. Implications: The findings underscore the effectiveness of the AFP surveillance system in this region, suggesting that its continued implementation can significantly contribute to the global eradication efforts of poliomyelitis while also serving as a model for similar evaluations in other regions. Highlights: High reporting completeness and timeliness in AFP surveillance. Non-Polio AFP rate exceeds WHO targets, indicating effective monitoring. Study supports global efforts toward poliomyelitis eradication. Keywords: Poliomyelitis, Acute Flaccid Paralysis, Surveillance System, Performance Indicators, Iraq

Outcomes of a modified technique of partial parotidectomy and novel parotid tumour position classification from a single surgeon prospective database.

Conservative parotidectomy for benign tumours reduces facial nerve palsy, without increasing local recurrence. We report a modified technique of partial parotidectomy and using a novel description of tumour position, explore relationships between tumour position and histological margins, facial nerve palsy and local recurrence. A prospectively collected single surgeon parotidectomy database was analysed, including tumour location (superficial/deep lobe; central/peripheral) and outcomes. A partial parotidectomy identified the facial nerve and the proximal portion of its branches with a macroscopically clear resection margin. Mean follow up was 5.9 years for pleomorphic adenomas. Three hundred and three patients underwent parotidectomy; 257 (84.8%) were superficial and 46 (15.2%) deep lobe. Tumour position was recorded in 291: 236 (81.1%) were peripheral tumours and 55 (18.9%) central. Histological margin involvement was similar in central and peripheral tumours, both overall and for superficial and deep lobe tumours, but was commoner in central deep lobe tumours, (P = 0.003). Temporary partial facial nerve palsy occurred in 21 (6.9%), with one permanent partial nerve palsy (0.3%). Deep lobe tumours and total parotidectomy were associated with facial nerve palsy (P = 0.01). Facial nerve monitoring reduced the risk of palsy (P < 0.01). Local recurrence of pleomorphic adenomas was uncommon, occurring in 3 (2.0%) of 151 patients. This series confirms the safety and adequacy of more conservative partial parotidectomy for benign tumours, highlighting most tumours are peripheral, but not more prone to histological margin involvement or local recurrence, and with routine intraoperative facial nerve monitoring, is achieved with low facial nerve palsy rates.

A prospective observational study on the anatomical variations of recurrent laryngeal nerve and its application in the prevention of injury during thyroid surgery in a tertiary care centre

BackgroundThyroid gland is the largest and most vascular structure among the endocrine glands. The recurrent laryngeal nerve and the superior laryngeal nerve are closely related to the thyroid gland; these nerves control voice and are vital in breathing. Anatomical preservation of the recurrent laryngeal nerve (RLN) is the gold standard in thyroid surgery. Visual identification of RLN has decreased the rates of permanent RLN palsy during thyroid and parathyroid operations. Prior knowledge about the branching patterns will help in predicting and preventing injury to the nerve during thyroid surgery.Aim and objectivesThe aim of the study is to observe the terminal branching pattern of recurrent laryngeal nerve before its entry into the larynx.MethodsAn observational study with 50 participants who fulfilled the inclusion and exclusion criteria were enrolled in the study. After a complete evaluation and pre-anaesthetic checkup, the patients were operated and intraoperative findings of RLN branching were recorded and compared for the study.ResultsIn our study, out of the 50 patients who underwent thyroid surgery during the course of the study, right-sided RLN branching was demonstrated in 25 patients (21 right hemithyroidectomy and 4 total thyroidectomy). Ten patients had RLN bifurcation, 7 had trifurcation, 5 had numerous branches, and 3 with no branching pattern were noted. Similarly, out of 29 patients (25 left hemithyroidectomy and 4 total thyroidectomy) in whom left-sided RLN branching was studied, bifurcation was seen in 10 patients, trifurcation in 12 patients, and multiple branching was observed in 7.ConclusionThe anatomical variations seen in RLN may increase the risk of vocal cord palsy due to its injury. Anatomical variations are categorized according to the original direction of the RLN and the number of terminal branches in the larynx. This classification aids in the identification and preservation of its branches, hence facilitating a safer thyroidectomy.

Implication of surgical loupes on complications following thyroidectomy: a meta-analysis.

To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy. PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024. Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests. The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = - 0.87 [(- 1.58, - 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) = - 0.31 [(- 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) = - 0.34 [(- 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) = - 0.85 [(- 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group. Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes. 3a.

Single-Port da Vinci Robot-Assisted Cervical Esophagectomy: How to Do It.

Minimally invasive esophagectomies, including robot-assisted procedures, have demonstrated superiority over traditional open surgery. Despite the prevalence of transhiatal and transthoracic approaches, cervical access is less common in minimally invasive esophageal surgery. Advancements in robotic systems, such as the da Vinci Single Port (SP), enable controlled transcervical extrapleural mediastinoscopic access, potentially reducing pulmonary complications and extending surgical options to patients with comorbidities. The da Vinci SP robot-assisted cervical esophagectomy (SP-RACE) employs an SP and laparoscopic approach, demonstrating feasibility with comparable lymphadenectomy and recurrent nerve palsy rates to transthoracic methods. This technique, performed for the first time in Europe at the University Hospital Mainz, involves a transcervical SP phase that allows for effective mediastinal dissection and esophageal mobilization. Despite technical challenges due to limited space, robotic systems enhance controlled access and eliminate arm collision. The da Vinci SP platform's advantages include improved triangulation, fewer interferences, and better control of instruments in confined spaces. This novel approach shows promise for patients with high esophageal tumors and those unsuitable for transthoracic surgery, warranting further investigation into its clinical utility and reproducibility.

Central Neck Dissection in Papillary Thyroid Carcinoma: Benefits and Doubts in the Era of Thyroid Lobectomy.

Surgery is still the main line of treatment for papillary thyroid cancer (PTC) with a current trend for de-intensified treatment based on an excellent prognosis. The role of a routine prophylactic central neck dissection (PCND) is still debated as its impact on oncologic outcomes has never been cleared by a randomized clinical trial. In this study, we aimed to report our long-standing experience in PCND and its potential contemporary role in the treatment of PTC. A retrospective institutional review was performed on all patients who underwent operation for PTC including PCND between 1998 and 2021. The primary outcomes were the rate of central lymph node metastases (CLNMs), cancer recurrence and incidence of complications. Survivals were analyzed using the Kaplan-Meier estimator and Cox proportional hazard models. A total of 657 patients were included in this study with a median follow-up of 78 months (48-114 months). Two hundred and one patients presented occult CLNMs (30.6%). The presence of a pathological node represented the unique reason for a completion thyroidectomy and I131 therapy in 12.5% of the population. Age lower than 55 years, microscopic or macroscopic extra-thyroid extension (ETE) and multifocality were independent factors predicting CLNMs. The rate of recurrence in the whole population was 2.7% (18 patients). Five-year and ten-year disease-free survival (DFS) was 96.5% (94.7-97.7) and 93.3% (90.3-95.5), respectively. Two patients relapsed in the central neck compartment (0.3%). Age (>55 years), pathological staging (pT) and extranodal extension (ENE) were independent factors associated with a worse DFS. The rate of temporary and permanent vocal fold palsy was 12.8% and 1.8%, respectively, and did not depend on the type of surgical procedure performed. Hypoparathyroidism was temporary in 42.2% and permanent in 11.9% of the patients. A sub-analysis upon cT1b-T2 patients treated primarily with thyroid lobectomy and ipsilateral PCND demonstrated a 2.6% rate of permanent hypoparathyroidism. PCND allows for a high disease-free survival and a proper selection of patients needing adjuvant treatment, in particular, those treated with a unilateral procedure. On the other hand, bilateral approach is burdened by a not-neglectable rate of permanent hypoparathyroidism.

Efficacy and safety of atrial fibrillation ablation in patients with aged 80 years or older.

Atrial fibrillation (AF) is the most common cardiac arrhythmia observed in the elderly. Its prevalence rises with age, particularly in individuals over 80 years old. While catheter ablation has emerged as a first line therapy for the patients with symptomatic AF, evidence on its application in elderly patients remains controversial. This study aimed to assess safety and efficacy outcomes of AF ablation in patients aged ≥ 80 years.Consecutive 1327 patients who underwent a first pulmonary vein isolation (PVI) for AF were retrospectively analyzed. Patients aged ≥ 80 years (elderly group, n = 107) were compared with patients aged < 80 years (younger group, n = 1220). At 1-year follow-up, there was no significant difference in AF free rate between the elderly and the younger group (72.0% vs. 73.9%, P = 0.786). Regarding major complications, the elderly patients had a greater incidence of periprocedural stroke (1.9% vs. 0.1%, P = 0.018). The rates of cardiac tamponade, phrenic palsy, and vascular complications were not significantly different between the 2 groups.PVI for AF is effective in patients aged ≥ 80 years with a similar success rate, but periprocedural stoke risk was higher compared to the younger population.

Network Pharmacology Analysis and Retrospective Cohort Study Revealing the Effect of Qingyi Decoction on Intestinal Paralysis in Patients with Severe Acute Pancreatitis.

Intestinal dysfunction plays an important role in the clinical progress and prognosis of severe acute pancreatitis (SAP). Qingyi decoction (QYD) has shown beneficial effects on intestinal function recovery, but the prevention actions of the QYD on intestinal paralysis and its mechanism have not been fully explored. The possible molecular mechanism was unraveled by network pharmacology, including active ingredients and potential target prediction, as well as GO, KEGG, and REATCOME pathway enrichment analyses. The potential interactions between the main active ingredients of the QYD and core genes were explored by molecular docking. A retrospective cohort study on 137 patients with SAP from Tianjin Nankai Hospital was conducted to evaluate the preventive effect of QYD on intestinal paralysis. A total of 110 active ingredients in QYD were screened out, and 37 key targets were predicted by network pharmacology. GO, KEGG, and REATCOME enrichment analyses showed that bioinformatics annotation of the hub genes was mainly involved in intestinal epithelial functions and inflammatory response pathways. The main components of QYD possessed good affinity with IL-6, TNF, CASP3, CXCL8, and CRP by molecular docking. Patients who used QYD plus usual care seemed to have fewer intestinal paralysis rates, lower risk of renal insufficiency, ARDS and blood purification therapy, and shorter hospital and ICU stays. The multivariable regression analyses indicated that the mode of nasogastric and enemas administration of QYD (P = 0.010) and timely intervention with QYD (P = 0.045) were the independent protective factors for intestinal paralysis prevention in patients with SAP. In conclusion, QYD can be used as an effective adjuvant procedure to prevent the occurrence and development of intestinal paralysis in patients with SAP. The mechanisms may be involved in the anti-inflammatory response and maintenance of intestinal epithelial function.

Bell's palsy and COVID-19: A cohort study with historical rate comparison

IntroductionDuring the SARS-CoV-2 pandemic, immune-mediated neurological events have been described in patients vaccinated against the virus or who have overcome the disease. Among these events is Idiopathic peripheral facial palsy or Bell’s palsy. ObjectivesTo study the incidence of Bell's Palsy in the ENT emergency department of a tertiary hospital in Catalonia during the SARS-CoV-2 pandemic. MethodsRetrospective historical cohort comparison study of patients diagnosed with Bell's palsy between January 2018 and December 2021. Crude incidence rates were calculated as the total number of events divided by person time at risk per 100.000 person-years. Observed (2020, 2021) and historical (2018, 2019) rates were compared using standardized incidence rates with corresponding 95% confidence intervals. ResultsOf the total number of ENT emergency department visits from 2018 to 2021 (22.658), there were 247 cases of Bell's palsy. The incidence rate of Bell's palsy in the pre-pandemic group was 12,2 and 10,9 per 100.000 person-years for 2018 and 2019, respectively. The 2020 standardized incidence rate of Bell's palsy was 0,70 [95% CI 0,49–1,01] and 1,25 [95% CI 0,93–1,67] for 2021. No significant differences were evident between the two groups. ConclusionIn our cohort, no association was found between vaccination or COVID-19 infection and the development of Bell's Palsy.