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Canine vector-borne diseases (CVBDs) pose a global threat to both canine and public health. This study evaluates the prevalence of Anaplasma spp., Ehrlichia spp., Borrelia burgdorferi sensu lato (s.l.), Rickettsia conorii , and Dirofilaria immitis in domestic dogs in Liguria, north-west Italy, a region where data were lacking. From 2013 to 2023, 8584 blood samples from shelter (74%) and owned dogs (26%) were submitted to the Istituto Zooprofilattico Sperimentale of Piemonte, Liguria and Valle d'Aosta (IZSPLV) for serological testing (indirect immunofluorescence and/or rapid immunochromatographic tests). Overall, 18.8% (95% CI: 18.0-19.7) of the dogs tested positive for at least one pathogen, with positivity against R. conorii antigen being the most frequently recorded (24.4%, 95% CI: 23.3-25.5). Lower prevalence levels were observed for Anaplasma spp. (1.82%, 95% CI: 1.47-2.23), Ehrlichia spp., (1.25%, 95% CI: 0.97-1.60), B. burgdorferi s.l. (0.22%, 95% CI: 0.11-0.39), and D. immitis (0.84%, 95% CI: 0.65-1.06). Positive cases for all pathogens increased over time, with prevalence differing significantly between owned and shelter dogs. Topographical factors, land use, and monthly relative humidity appeared to influence the positivity in the dogs. These results update the epidemiology of the investigated CVBDs in Liguria, indicating a widespread exposure to Rickettsia spp. among local dogs.

Background: Psychiatric patients may refer to concepts neither medically accepted nor easily understood to describe their experiences when seeking medical care. These concepts may lie outside the clinician's cultural references and consequently hinder the diagnostic consultation. In the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the clinical instrument Cultural Formulation Interview (CFI) was included. The CFI aims to facilitate the gathering and synthesis of culturally relevant clinical information. The notion of Cultural Concepts of Distress (CCD) was also introduced in DSM-5. The CCD include the subterms of the cultural syndrome, cultural explanation, and cultural idiom of distress. No previous study has used CFI for conceptualizing a cultural notion as a CCD. This study aimed to approach the cultural notion of being a highly sensitive person (HSP) in patients with bipolar disorder (BD) by applying the CFI. The cultural notion of HSP has garnered great interest globally, although scientific evidence is limited. No direct correlation between BD and HSP was hypothesized before or during the study process., Methods: In this case study, three patients with BD who reported being HSP were interviewed using the CFI. Furthermore, the applicability of the CCD was examined based on the outcomes of the CFI using an interpretive approach., Results: All three patients reported that the CFI facilitated the clinical consultation, and in one of the cases, it may also have increased the treatment engagement. Based on the synthesis of the CFI outcomes in these illustrative cases, HSP could be understood as a cultural syndrome, a cultural explanation, and a cultural idiom of distress., Conclusion: By applying a person-centered perspective, CFI was used for the conceptualization of a cultural notion as a CCD (i.e., HSP in our study). Moreover, the cases highlight the complexity of illness insight in BD as a medical phenomenon when patients' illness perspectives are taken into consideration. Future studies need to further examine the clinical relevance of the CFI in the management of BD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ioannou, Olsson, Bakken Wold, Dellepiane and Steingrímsson.)

Background: The treatment of multisystem inflammatory syndrome in children unresponsive to first-line therapies (IVIG and/or steroids) is challenging. The effectiveness of IL-1 receptor antagonist, anakinra, is debated., Patients and Methods: We conducted an anonymous retrospective multicenter study on MIS-C patients treated with anakinra in Italy from January 2020 to February 2021. Our study outcomes included the percentage of patients who required further therapeutic step-up, the percentage of patients who experienced fever resolution within 24 h and a reduction of CRP by half within 48 h, and the percentage of patients who developed Coronary Artery Anomalies (CAA) during follow-up., Results: 35 cases of MIS-C were treated in 10 hospitals. Of these, 13 patients started anakinra while in the ICU, and 22 patients started anakinra in other wards. 25 patients (71.4%) were treated with corticosteroids at a starting dose 2-30 mg/Kg/day plus IVIG (2 g/Kg), 10 patients (28.6%) received only corticosteroids without IVIG. Anakinra was administered intravenously to all patients in Group A (mean dose 8 mg/Kg/day), and subcutaneously in Group B (mean dose 4 mg/Kg/day). Only two patients required further treatment step-up and no patients developed CAA after receiving anakinra. The most commonly observed side effect was an increase in ALT, occurring in 17.1% of patients., Conclusions: In this retrospective cohort of severe MIS-C patients treated with anakinra we report favorable clinical outcomes with a low incidence of side effects. The simultaneous use of steroids ± IVIG in these patients hinders definitive conclusions regarding the need of IL-1 inhibition in MIS-C treatment., Competing Interests: GF is a consultant for SOBI, GS and MM received an unrestricted educational Grant from SOBI, for a project not related to MIS-C. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Licciardi, Covizzi, Dellepiane, Olivini, Mastrolia, Lo Vecchio, Monno, Tardi, Mauro, Alessio, Filocamo, Cattalini, Taddio, Caorsi, Marseglia, LaTorre, Campana, Simonini, Ravelli and Montin.)

Antimicrobial resistance is one of the most challenging public health problems worldwide, and integrated surveillance is a key aspect in a One Health control strategy. Additionally, Salmonella is the second most common zoonosis in Europe. We aimed to investigate the circulation of Salmonella strains and their related antimicrobial resistance in human, environmental, and wild boar samples from the northwest of Italy, from 2018 to 2020, to obtain a more comprehensive epidemiological picture. Salmonella Typhimurium 1,4,[5],12:i:-, S. Veneziana and S. Newport were the most common serotypes occurring in humans, the environment, and wild boar, respectively. Antimicrobial resistance was rather common in Salmonella isolates, with those from human displaying the highest degree of resistance against sulfadiazine−sulfamerazine−sulfamethazine (>90% of resistance). Moreover, resistance against azithromycin were exclusively observed in environmental samples, while only 7.7% (95% CI = 1.6−20.8) of wild boar isolates experienced resistance against trimethoprim−sulfamethoxazole. Multidrug resistance concurrently involved up to seven antimicrobial classes in human isolates, including third-generation cephalosporins and fluoroquinolones. Salmonella Typhimurium in humans and serotypes Goldcoast and Rissen from environmental sources showed the highest levels of resistance. This study shows diverse antimicrobial resistance patterns in Salmonella strains isolated from different sources and gives a broad picture of antimicrobial resistance spread in wild animals, humans, and the environment.

The wild boar is an important natural reservoir for the zoonotic transmission of the hepatitis E virus (HEV) around the world. In particular, HEV genotypes 3 and 4 are an emerging problem in industrialized countries, as the number of wild boars has increased, and their territory is ever closer to farms and populated areas. This study describes the HEV prevalence and geographic circulation among wild boar populations in the Ligurian region (Italy) during the period 2019-2022. Liver samples from 849 wild boars were analyzed for HEV RNA using real-time RT-PCR; positive samples were then subjected to sequencing and phylogenetic analysis. Overall, 6.7% of the wild boars were positive for HEV RNA; however, in the last two years, the percentage of positive animals almost doubled. Phylogenetic analysis showed that wild boar HEV sequences belonged to genotype 3 and clustered within subtypes 3a and 3c, and, for the first time in Italy, subtypes 3b and 3m were identified. Interestingly, 13 sequences could not be assigned to a recognized subtype. Furthermore, the results showed different circulations of identified subtypes across the territory. These findings increase the knowledge of HEV-3 heterogeneity in Italy and describe the role of wild boars in maintaining an active viral circulation in the environment.

Clinical examination (CE) and musculoskeletal ultrasound (MSUS) of ten joints (knee, ankle, wrist, elbow, II-MCP) and their extra-articular (EA) compartments (tendons and bursae) were performed on 35 consecutive patients with active juvenile idiopathic arthritis (JIA) (active group) to test how the extension of MSUS examinations to EA changes the concordance between MSUS and CE. The overall concordance between CE and MSUS, measured with Cohen's Kappa ( k ), was moderate (k = 0.43); the addition of EA MSUS increased the concordance in all joints, with the exclusion of II-MCP (k = 0.49). In the ankle and wrist, the k increase was relevant (k from 0.13 to 0.27 and 0.11 to 0.41). In the active group patients, we observed 44 subclinical synovitis; the number of subclinical synovitis per patient was correlated with JADAS-27 ( p = 0.03) and was higher in a control group composed of 15 patients with persistent disease remission (1.3 vs. 0.4 p = 0.03). Our results show that EA compartments should always be evaluated during MSUS. Furthermore, we demonstrate a moderate concordance between CE and MSUS in JIA; the finding of subclinical synovitis is common in patients with active diseases and is related to disease activity.

The COVID-19 pandemic has caused societal restrictions and public fear which may have impacted the pattern of seeking psychiatric care. There has generally been a decrease in the numbers seeking acute psychiatric care. It is important to investigate which groups seeking psychiatric treatment have decreased in number. The aim of our investigation was to identify which groups have a changed pattern in acute psychiatric service utilization during the first two waves of the COVID-19 pandemic. The study investigated changes in the rate and pattern of visits and hospital admissions for psychiatric disorders at a large Swedish hospital. A register-based study was conducted using administrative data on adult psychiatric emergency department visits (PEVs) and hospital admission rates. Data during the first two COVID-19 waves were compared to corresponding control periods in 2018-2019. Furthermore, a survey was performed among patients visiting the Psychiatric Emergency Department on their views of COVID-19 and acute psychiatric care. During the COVID-19 periods, PEVs were reduced overall by 16 and 15% during the first and second wave, respectively ( p < 0.001 in both cases), while the rate of admissions remained unaltered. PEVs were significantly reduced for most psychiatric diagnosis subgroups except for patients with schizophrenia and other related psychotic disorders as well as for those who required ongoing outpatient care. Most of the survey respondents disagreed that the pandemic affected their visit and about a quarter thought a video call with a doctor could have replaced their visit. In conclusion, there was a significant reduction in overall PEVs during both COVID-19 waves but this did not affect the numbers requiring admission for psychiatric inpatient care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hamlin, Ymerson, Carlsen, Dellepiane, Falk, Ioannou and Steingrimsson.)

Hard ticks' geographical distribution and abundance are influenced by wildlife population. This work presents the results of the identification of ticks retrieved from wild animals in the framework of a Regional Plan of Monitoring and Surveillance of Wildlife health. The frequency of distribution of ticks in different hosts and their geographical patterns were also investigated. Ticks were collected from game animals ( Sus scrofa , Capreolus capreolus , Dama dama , and Rupicapra rupicapra ) during two hunting seasons (2018-2019 and 2019-2020) in the four provinces of the Liguria region in northwest Italy. In the same period, ticks were also collected from carcasses of Vulpes vulpes , Canis lupus , Meles meles , and Asio otus received for necropsy. Tick species were identified according to taxonomic keys. A total of 819 ticks, removed from 259 animals, were found and identified. Overall, Ixodes ricinus was the dominant species (62.6%), followed by Dermacentor marginatus (24.5%), Rhipicephalus sanguineus s.l. (12.5%), Haemaphysalis punctata (0.2%), and Ixodes hexagonus (0.1%). I. ricinus was also the prevalent species in roe deer and in fallow deer and the only species collected from the three wolf carcasses examined. In contrast, D. marginatus was the dominant species in S. scrofa . This last tick species was also more frequent in one province (Imperia), whereas Ixodes spp. were more common in another one (Savona). Wild animals proved to be useful for characterizing and monitoring tick population.

Cadmium (Cd 2+ ) is regarded as one of the most toxic heavy metals, which can enter the food chain through environmental contamination and be bioaccumulated. Its exposure in Ligurian wild boars was monitored between 2016-2020 and revealed high level of this heavy metal in different provinces. In one of these polluted area, 21 wild boars were additionally sampled and the relationship between hepatic and renal Cd 2+ concentration suggested that majority of these animals presented chronic intoxication. Cd 2+ exposure of wild boar might lead to an immunosuppression status, thus in vitro experiments on wild boar monocyte-derived macrophages (moMФ) were carried out. Effects of Cd 2+ scalar doses were evaluated through viability and adsorption assays, ELISA, qPCR. Moderate doses of this environmental pollutant (20 μM) were absorbed by moMФ, with subsequent reduction of their viability. This heavy metal did not trigger release of either IFN- β, anti-inflammatory or pro-inflammatory cytokines by moMФ, instead 24 h treatment with 20 μM of Cd 2+ resulted in down-regulated expression of TNF-α, IL-12p40, several TLRs, CD14, MD2, BD2, MyD88, p65, and NOS2. The results of our monitoring activity suggested that wild boar can be useful to monitor environmental exposure of this heavy metal and can help in understanding the type of contamination. In addition, in vitro experiments on wild boar moMФ revealed that Cd 2+ exposure negatively affected the immune function of these cells, likely leading to increased susceptibility to infection., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Background: MIS-C is a potentially severe inflammatory syndrome associated with SARS-CoV-2 exposure. Intravenous immunoglobulin (IVIG) is considered the first-tier therapy, but it implies infusion of large fluid volumes that may worsen cardiac function. Patients and Methods: Since April 2020, we have developed a treatment protocol that avoids the infusion of IVIG as first-line therapy in the early phase of MIS-C. In this study, we retrospectively analyzed a cohort of consecutive patients treated according to this protocol between 01/04/2020 and 01/04/2021. Results: In the last year, 31 patients have been treated according to the protocol: 25 with high-dose pulse MP (10 mg/kg) and 6 with 2 mg/kg. 67.7% of the patients responded to the initial treatment, while the others needed a step-up, either with Anakinra (25.8%) or with MP dose increase (6.5%). IVIG was administered in four patients. Overall, only one patient (3.2%) needed ICU admission and inotropic support; one patient developed a small coronary artery aneurysm. Conclusions: Timely start of MP therapy and careful fluid management might improve the outcomes of MIS-C patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Licciardi, Baldini, Dellepiane, Covizzi, Mogni, Pruccoli, Orsi, Rabbone, Parodi, Mignone and Montin.)

Ataxia-telangiectasia (A-T) is a multisystem disorder caused by biallelic pathogenic variants in the gene encoding A-T mutated (ATM) kinase, a master regulator of the DNA damage response (DDR) pathway. Most A-T patients show cellular and/or humoral immunodeficiency that has been associated with cancer risk and reduced survival, but NK cells have not been thoroughly studied. Here we investigated NK cells of A-T patients with a special focus on the NKG2D receptor that triggers cytotoxicity upon engagement by its ligands (NKG2DLs) commonly induced via the DDR pathway on infected, transformed, and variously stressed cells. Using flow cytometry, we examined the phenotype and function of NK cells in 6 A-T patients as compared with healthy individuals. NKG2D expression was evaluated also by western blotting and RT-qPCR; plasma soluble NKG2DLs (sMICA, sMICB, sULBP1, ULBP2) were measured by ELISA. Results showed that A-T NK cells were skewed towards the CD56 neg anergic phenotype and displayed decreased expression of NKG2D and perforin. NKG2D was reduced at the protein but not at the mRNA level and resulted in impaired NKG2D-mediated cytotoxicity in 4/6 A-T patients. Moreover, in A-T plasma we found 24-fold and 2-fold increase of sMICA and sULBP1, respectively, both inversely correlated with NKG2D expression. Overall, NK cells are disturbed in A-T patients showing reduced NKG2D expression, possibly caused by persistent engagement of its ligands, that may contribute to susceptibility to cancer and infections and represent novel targets for therapeutic interventions., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Intentional poisoning represents a serious risk to domestic and wild animals, and it can be an environmental and human health issue as well . This paper is a retrospective study, which covers a decade, based on animal poisoning cases and poisoned baits that were submitted for diagnostic examinations to the Veterinary Medical Research Institute for Piedmont, Liguria and the Aosta Valley (IZS-PLVA) in Liguria region. All data were collected through a passive surveillance system introduced in Italy by a decree of the Ministry of Health in January 2009. 43.2% of the animal poisoning cases were confirmed by toxicological analysis, whereas toxic agents were detected in 31.1% of the baits. The most affected animal species were dogs and cats, followed by synanthropic birds,. Only 4% of the total poisoning events analysed involved wild animals and cases of livestock poisoning were minimal. An increased number of cases in January, March, April and August was noticed, but no seasonal trend was detected. The most affected areas were the ones with the highest level of urbanization and population density. The major cause of the poisonings and the most common substances detected in the examined baits were anticoagulants whereas cholinesterase inhibitors, organochlorine pesticides and carbamates were detected in a minor number of cases. This study raises concerns about deliberate animal poisoning in ligurian region and highlights the necessity to fight this phenomenon as it endangers animals, humans and environment., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Salmonella spp. is an important zoonotic agent. Wild boars might host this pathogen in the intestinal tract and might represent a risk for Salmonella spp. transmission to humans. Wild boars are widely spread in Liguria, due to the environmental characteristics of the region. The aim of the study was the isolation, typing, and investigation of antimicrobial susceptibility of the isolated strains of Salmonella spp. During the 2013-2017 hunting seasons, 4335 livers of wild boars were collected and analyzed for the presence of Salmonella spp. A total of 260 strains of Salmonella spp. were isolated and characterized, with a prevalence of 6%. The isolated strains belonged to all six Salmonella enterica subspecies. Most of them were identified as Salmonella enterica subs. enterica of which 31 different serotypes were identified. The dominating serotype identified was S. Enteritidis. The antimicrobial resistance profiles of the isolated strains were analyzed against sixteen molecules. Of the isolated strains, 94.6% were resistant to at least one of the tested antimicrobials. This study showed the circulation of resistant Salmonella spp. strains in the wild boar population living in this area of Italy, underling the potential risk for these animals to disseminate this pathogen and its antimicrobial resistances.

Yersinia enterocolitica ( Ye ) is a very important zoonosis andwild boars play a pivotal role in its transmission. In the last decade, the wild boar population has undergone a strong increase that haspushed them towards urbanized areas, facilitating the human-wildlife interface and the spread of infectious diseases from wildlife to domestic animals and humans. Therefore, it is important to know the serotype, antimicrobial resistance and presence of pathogenicity genes of Yersinia enterocolitica ( Ye ) isolated in species. From 2013 to 2018, we analyzed the liver of 4890 wild boars hunted in Liguria region; we isolated and serotyped 126 Ye positive samples. A decisive role in the pathogenicity is given by the presence of virulence genes; in Ye isolated we found ystB (~70%), ymoA (45.2%), ail (43.6%) and ystA (~20%). Moreover, we evaluated the susceptibility at various antimicrobic agents (Ampicillin, Chloramphenicol, Enrofloxacin, Gentamicin, Kanamycin, Trimethoprim-Sulfamethoxazole, Sulfisoxazole, Ceftiofur and Tetracycline). The antibiotic resistance was analyzed, and we found a time-dependent increase. It is important to shed light on the role of the wild boars as a reserve of potentially dangerous diseases for humans, and also on the antibiotic resistance that represents a public health problem.

Background: Acute/subacute haematogenous osteomyelitis (AHOM/SAHOM) are potentially devastating diseases. Updated information about the epidemiology, management and outcome of AHOM/SAHOM is needed to minimize the risk of complications and sequelae., Methods: A multicenter study was performed to evaluate retrospectively the management and outcome of AHOM/SAHOM in Italy. Data from children aged >1 month, and hospitalized between 2010 and 2016, in 19 pediatric centers, were analyzed., Results: 300 children with AHOM and 98 with SAHOM were included. Median age was 6.0 years (IQR: 2.0-11.0). No clinical difference was observed with the exception of fever at onset (63.0% vs. 42.9%; P < 0.0001), and a more common spinal involvement in SAHOM (6.7% vs 20.4%; P < 0.001). Fifty-Eight Staphylococcus aureus strains were isolated; 5 (8.6%) were MRSA. No Kingella kingae infection was documented. No different risk for complication/sequela was observed between AHOM and SAHOM (38.3% vs. 34.7%; OR:0.85; 95%CI: 0.53-1.38; P = 0.518). Duration and type of antibiotic therapy were not associated with risk of complication/sequelae., Conclusion: AHOM and SAHOM displayed some differences, however occurrence and risk factors for complications and sequelae are similar, and the same empiric treatment might be recommended.

The advent of low cost scanning devices and the improvement of multi-view stereo techniques have made the acquisition of 3D geometry ubiquitous. Data gathered from different devices, however, result in large variations in detail, scale, and coverage. Registration of such data is essential before visualizing, comparing and archiving them. However, state-of-the-art methods for geometry registration cannot be directly applied due to intrinsic differences between the models, e.g., sampling, scale, noise. In this paper we present a method for the automatic registration of multi-modal geometric data, i.e., acquired by devices with different properties (e.g., resolution, noise, data scaling). The method uses a descriptor based on Growing Least Squares, and is robust to noise, variation in sampling density, details, and enables scale-invariant matching. It allows not only the measurement of the similarity between the geometry surrounding two points, but also the estimation of their relative scale. As it is computed locally, it can be used to analyze large point clouds composed of millions of points. We implemented our approach in two registration procedures (assisted and automatic) and applied them successfully on a number of synthetic and real cases. We show that using our method, multi-modal models can be automatically registered, regardless of their differences in noise, detail, scale, and unknown relative coverage.

Background: Mood Spectrum Self Report (MOODS-SR) is an instrument that assesses mood spectrum symptomatology including subthreshold manifestations and temperamental features. There are different versions of the MOODS-SR for different time frames of symptom assessment: lifetime (MOODS-LT), last-month and last-week (MOODS-LW) versions., Objective: To evaluate the psychometric properties of the MOODS-LT the MOODS-LW., Methods: The reliability of the MOODS-LT and MOODS-LW was evaluated in terms of internal consistency and partial correlations among domains and subdomains. The known-group validity was tested by comparing out-patients with bipolar disorder (n=27), unipolar depression (n=8) healthy controls (n=68). The convergent and divergent validity of MOODS-LW were evaluated using the Montgomery Åsberg Depression Rating Scale (MADRS), the Young-Ziegler Mania Rating Scale (YMRS) in outpatients as well the General Health Questionnaire (GHQ-12) in healthy controls., Results: Both MOODS-LT and MOOODS-LW showed high internal consistency with the Kuder-Richardson coefficient ranging from 0.823 to 0.985 as well as consistent correlations for all domains and subdomains. The last-week version correlated significantly with MADRS (r= 0.79) and YMRS (r=0.46) in outpatients and with GHQ-12 (r= 0.50 for depression domain, r= 0.29 for rhythmicity) in healthy controls., Conclusion: The Swedish version of the MOODS-LT showed similar psychometric properties to other translated versions. Regarding MOODS-LW, this first published psychometric evaluation of the scale showed promising psychometric properties including good correlation to established symptom assessment scales. In healthy controls, the depression and rhythmicity domain scores of the last-week version correlated significantly with the occurrence of mild psychological distress.

The projection of a photographic data set on a 3D model is a robust and widely applicable way to acquire appearance information of an object. The first step of this procedure is the alignment of the images on the 3D model. While any reconstruction pipeline aims at avoiding misregistration by improving camera calibrations and geometry, in practice a perfect alignment cannot always be reached. Depending on the way multiple camera images are fused on the object surface, remaining misregistrations show up either as ghosting or as discontinuities at transitions from one camera view to another. In this paper we propose a method, based on the computation of Optical Flow between overlapping images, to correct the local misalignment by determining the necessary displacement. The goal is to correct the symptoms of misregistration, instead of searching for a globally consistent mapping, which might not exist. The method scales up well with the size of the data set (both photographic and geometric) and is quite independent of the characteristics of the 3D model (topology cleanliness, parametrization, density). The method is robust and can handle real world cases that have different characteristics: low level geometric details and images that lack enough features for global optimization or manual methods. It can be applied to different mapping strategies, such as texture or per-vertex attribute encoding.

Chronic rhinosinusitis is one of the most frequent chronic diseases in humans. Little is known about stimuli initiating tissue remodeling process that determines the morphological expression of the disease. N-formyl peptide receptors (FPRs) are innate immunity receptors important in tissue remodeling of gastric and intestinal epithelium. The expression and functions of FPRs in nasal epithelial cells were examined to evaluate whether they could be important in the remodeling of nasal mucosa. The aim of this study is to examine FPR expression in a nasal epithelial cell line (RPMI-2650) at mRNA and protein levels. To determine whether FPRs were functional, chemotaxis experiments were carried out. In addition the effects of FPRs agonists on the expression (PCR and ELISA) of VEGF-A and TGF-beta, two key mediators of tissue remodelling, were examined. Here we demonstrate that RPMI-2650 express FPR and FPRL2, but not FPRL1. fMLP, a bacterial product active on FPR, and uPAR(84-95), an inflammatory mediator agonist for FPRL2, stimulated migration of nasal epithelial cells. fMLP and uPAR(84-95) induce expression and secretion of VEGF-A and TGF-beta. Our results suggest a possible mechanisms initiating tissue remodeling observed during chronic rhinosinusitis. This study provides further evidence that FPRs play a more complex role in human pathophysiology than bacterial recognition.

Piezosurgery® is a recently developed system for cutting bone with microvibrations. The objective of this study was to compare the severity of pain over the first 10 postoperative days in a group of 70 patients who underwent intact canal wall mastoidectomy, with the piezoelectric device, and to compare the results with traditional method by means of microdrill (70 patients). The subjective perception of pain was evaluated on a scale from 0 to 10, such that 0 represented no pain and 10 represented maximum pain; the severity was recorded as null when the score was 0; slight, when it was 1-4; moderate, when it was 5-7; or severe, when it was 8-10. Compared with microdrill, the patients that underwent surgery with the piezoelectric device showed a significant (P < 0.05) lower postoperative pain on day 1 (52 vs. 26 patients presented a slight pain, 12 vs. 37 presented a moderate pain, and 6 vs. 7 presented a severe pain) and day 3 (68 vs. 44 patients presented a slight pain, 2 vs. 23 presented a moderate pain, and 0 vs. 3 presented a severe pain). These results highlight as the piezoelectric device is a safe and minimally invasive tool.

Survival after diagnosis of laryngeal cancer has not improved over the last 20 years. Selection of patients for radio- and chemotherapy or surgery or follow-up strategies based on a prognostic classifier could improve survival without unduly extending radical surgery. We performed microarray gene expression analysis and developed a four-gene classifier for laryngeal cancer using Prediction Analysis of Microarray and leave-one-out cross validation. A four-gene classifier containing the non-coding gene H19, the histone HIST1H3F and the two small nucleolar RNAs, SNORA16A and SNORD14C was developed that assigns cases to low and high risk classes. The high risk class has a relative risk of 6.5 (CI=1.817-23.258, Fisher exact test p<0.0001). The maternally imprinted gene H19 is the top classifier gene., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Concurrent chemoradiotherapy has become the standard of care for patients with inoperable squamous cell head and neck carcinoma. More recently, induction chemotherapy has been adopted as an approach in the management of these patients. We report the results of a phase II trial associating induction chemotherapy and concomitant chemoradiotherapy in a series of patients with inoperable squamous cell head and neck cancer. Twenty-nine patients with advanced squamous cell carcinoma ineligible for surgery were enrolled. Induction chemotherapy with docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) every 21 days was administered for two cycles. Radiotherapy followed the induction phase. During radiotherapy, docetaxel was administered weekly at the dose of 33 mg/m(2) . Primary end point of the study was feasibility of treatment. Six (18%) patients failed to conclude the treatment schedule. Although response rates in evaluable patients were very high (disease control rate >90%), toxicities were a matter of concern. The reported treatment schedule proved infeasible. However, some modifications in ancillary therapies aimed at exploiting its efficacy could make it practicable., (© 2010 Blackwell Publishing Ltd.)

Conclusion: These findings provide the basis for understanding the duration of the effect after the last use of the drug and encourage a larger clinical trial to collect additional evidence on the effect of coenzyme Q10 (CoQ10) in preventing the development of hearing loss in subjects with presbycusis., Objectives: The aim of this study was to evaluate the long-term effects of a water-soluble formulation of CoQ10 (Q-TER) in subjects with presbycusis., Methods: Sixty patients with presbycusis were included and divided at random into three numerically equal groups. For 30 days, group A underwent therapy with Q-TER, group B underwent therapy with vitamin E, and group C received placebo. Before, at the end, and 6 months after the end of the treatment, all patients underwent evaluation of pure tone audiometry, transient evoked otoacoustic emissions and otoacoustic products of distortion, auditory brainstem response, and speech audiometry., Results: Compared with group B, at the end of the treatment in group A the pure tone audiometry showed a significant (p < 0.05) improvement of the audiometric thresholds at 1000, 2000, 4000, and 8000 Hz. This improvement was confirmed by the speech audiometry and last check. We found no significant differences in the other parameters and in group C.

Objectives: The aim of the study was to assess the extent of the potential nerve damage following prolonged contact with a piezoelectric device., Methods: The study was conducted with 30 patients; all of the patients had cervical metastatic lymph nodes at levels II, III, and IV (N2b) and a negative evaluation for metastatic disease (MO). The patients underwent radical neck dissection. After its skeletonization, the spinal nerve was exposed directly to ultrasonic activation with a piezoelectric device for various times (5, 10, and 20 seconds) and with different inserts (OP3 insert and OT7 insert). The axonal damage was graded from 0 to 3 as follows: 0, no damage; 1, minor axonal damage; 2, severe axonal damage but not covering the entirety of the nerve fascicles; 3, severe axonal damage covering the entirety of the nerve fascicles., Results: Histologic examination showed no evidence of damage to the perineurium and axons after 5 and 10 seconds of exposure to ultrasonic activation with each insert., Conclusions: Our histologic data highlight the selective action of the piezoelectric device, which reduces the risk of accidental nerve damage in otolaryngological bone surgery.

This paper describes a new motorized laser micromanipulator created for computer-assisted laser laryngeal microsurgeries. This new device is based on a single tip/tilt fast steering mirror driven by a parallel kinematics mechanism, which is shown to improve previous laser micromanipulator designs by offering highly accurate motorized laser aiming control from a small, simple, and robust system created for real operating settings. The integration of this new device to a previously developed assistive surgical system is also described, including the new calibration model implemented to enable precise laser beam control from the live microscope video displayed on a computer screen. High system accuracy is demonstrated by the results of trajectory following experiments, which reveal an average RMSE of only 0.06 mm over an 8.5 mm diameter circular path. These numbers are also shown to favorably compare to those obtained with a traditional laser micromanipulator, evidencing a 70% error reduction when using the new system. In addition, experiments under higher optical magnification (40× instead of 16×) demonstrate even better accuracy results, proving the new system is highly scalable and indicating it has the potential to greatly improve laser microsurgery quality and safety.

This research investigates the impact of three different control devices and two visualization methods on the precision, safety and ergonomics of a new medical robotic system prototype for assistive laser phonomicrosurgery. This system allows the user to remotely control the surgical laser beam using either a flight simulator type joystick, a joypad, or a pen display system in order to improve the traditional surgical setup composed by a mechanical micromanipulator coupled with a surgical microscope. The experimental setup and protocol followed to obtain quantitative performance data from the control devices tested are fully described here. This includes sets of path following evaluation experiments conducted with ten subjects with different skills, for a total of 700 trials. The data analysis method and experimental results are also presented, demonstrating an average 45% error reduction when using the joypad and up to 60% error reduction when using the pen display system versus the standard phonomicrosurgery setup. These results demonstrate the new system can provide important improvements in terms of surgical precision, ergonomics and safety. In addition, the evaluation method presented here is shown to support an objective selection of control devices for this application.

Conclusion: Although older people varied widely in tactile sensitivity, our results show that tactile thresholds increased with age., Objectives: The aim of this study was to evaluate the effects of aging on nasal tactile sensitivity., Methods: A total of 160 healthy patients aged between 50 and 90 years were included. According to their age, patients were divided into groups (A, B, C, D, E, F, G, and H). From the age of 50, each group included subjects with an age range of 5 years (i.e. group A, 50-55 years; group B, 56-60 years, etc.). Each patient's outcome was assessed through the nasal monofilament test: a set of 20 Semmes-Weinstein monofilaments was used to detect nasal sensitivity for both nasal cavities. The sensitivity threshold was recorded as the minimum monofilament size from which patients could detect at least two of three stimuli., Results: In groups D (66-70 years), E (71-75 years), F (76-80 years), G (81-85 years), and H (86-90 years) a significantly (p < 0.05) higher stimulus (171.1 ± 0.34 mg vs 67.7 mg, 167.01 ± 0.31 mg 67.7 mg, 166.54 ± 0.28 mg 67.7 mg, 201.24 ± 0.43 mg 67.7 mg, 165,87 ± 0.27 mg 67.7 mg) was required to trigger a touch response in the monofilament test.

Conclusions: We can consider the micropulse program as the best level of safety that should be used in all cases of piezoelectric stapedotomy., Objectives: The aim of this study was to describe the importance of a micropulse program in determining the success of piezoelectric stapedotomy., Methods: A total of 112 patients (group A) affected by primary otosclerosis underwent piezoelectric stapedotomy for otosclerotic stapes fixation. A specific operative program was created to perforate the stapes footplate: this program makes it possible to perforate the footplate of the stapes with a predetermined and non-modifiable temporization. Before and 1 year after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, and auditory brainstem response. Results were compared with those obtained from 30 patients who underwent piezoelectric stapedotomy without the specific operative program (group B)., Results: At 1 year after surgery, with regard to the pure-tone audiometry test, all patients had an air-bone gap (ABG) reduction: no worsening of the bone conduction and no postoperative sensorineural hearing loss were found. In group A, there was a closure of the ABG within 10 dB in all patients.

Purpose: The aim of this study has been to compare the Harmonic Scalpel (HS) and the "cold knife" dissection in the treatment of snoring by uvulopalatopharyngoplasty (UPPP)., Materials and Methods: The investigation included 40 adult males with snoring. Patients were assigned to two homogeneous groups (A and B) and UPPP was performed using HS or "cold knife" dissection in groups A and B, respectively. Before and 6 months after surgery, each patient was studied using the apnea-hypopnea index and a visual analogue scale of snore levels. Postoperative assessment of pain was evaluated on postoperative days 1 and 10. All the patients underwent to a perioperative evaluation concerning the duration of surgical dissection, the amount of intraoperative blood loss and days of hospitalization., Results: In group A, the HS provided excellent control without side effects on the adjacent structures and postoperative complications. Harmonic Scalpel's group experienced shorter operation time, lesser blood loss, fewer days of hospitalization and lower postoperative pain., Conclusions: The use of the HS in UPPP is safe and confers some advantages over conventional methods of UPPP: its use led to diminished bleeding, shorter operation time, lesser pain, and better wound healing in the postoperative period., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Piezosurgery is a recently developed system for cutting bone with microvibrations. The objectives of the present study were to report our experience with the piezoelectric device in the intact canal mastoidectomy, and to compare the results with traditional method by means of microdrill. A non-randomized controlled trial was undertaken on 60 intact canal wall mastoidectomy performed using the piezoelectric device (30 patients) or the microdrill (30 patients). Before 1 month and 1 year after surgery, all the patients underwent the following instrumental examinations: otomicroscopic evaluation of the tympanic membrane and external auditory duct, bone conduction threshold audiometry, tympanometry, transient-evoked otoacoustic emissions with linear click emission, distortion product otoacoustic emissions, auditory brainstem response (ABR) by MK 12-ABR screener with natus-ALGO2e (Amplifon, Milan, Italy), and electronystamographic recording. The piezoelectric device is proved to be effective in sclerotic and pneumatic mastoid, with an excellent control and without side effects on the adjacent structures of the middle and inner ear (lateral sinus, facial nerve, and/or dura mater). The operation time has been the same as compared with microdrill, and the average hospital stay was significantly (p < 0.05) shorter. Postoperatively, all patients had uneventful recovery with no evidence of audiovestibular deficit or side effects. Our experience highlights the safety of the piezoelectric device on the anatomic structures of the middle and inner ear, and demonstrates its efficiency in terms of cutting precision and healing process.

Conclusion: These preliminary data are encouraging for a larger clinical trial to collect additional evidence on the effect of Q-TER(®) in preventing the development of hearing loss in subjects with presbycusis., Objectives: The purpose of this study was to evaluate the efficiency and applicability of a water-soluble formulation of CoQ10 (Q-TER(®)) in subjects with presbycusis., Methods: A total of 60 patients with presbycusis were included and divided into three numerically equal groups. Group A underwent therapy with Q-TER(®), 160 mg, once a day for 30 days; group B underwent therapy with vitamin E (50 mg), once a day for 30 days; group C received placebo, once a day for 30 days. Before and at the end of the treatment, all patients underwent pure tone audiometry, transient evoked otoacoustic emissions, otoacoustic products of distortion, auditory brainstem response, and speech audiometry., Results: Compared with group B, at the end of the treatment in group A the liminar tonal audiometry showed a significant improvement of the air and bone thresholds at the 1000 (14/20 vs 9/20), 2000 (14/20 vs 7/20), 4000 (15/20 vs 6/20), and 8000 Hz (13/20 vs 5/20). We found no significant differences in the other parameters and in group C.

Piezosurgery is an ultrasound instrument (24.7-29.5 kHz) that is able to cut the bone without necrosis and nonmineralized tissue damage. The aim of this work has been to determine the applicability and efficiency of the piezoelectric device in the excision of symptomatic ear osteomas. 10 patients affected by osteoma of the external auditory canal (EAC) (6 right, 4 left) were enrolled. Patients underwent excision of the EAC osteoma through a transcanal approach, with the piezoelectric device. Before and 6 months after surgery, all the patients underwent pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording. The piezoelectric device provided excellent control without side effects on the adjacent structures of the external, middle and inner ear. The piezoelectric device is a new bony scalpel using the microvibrations at ultrasonic frequency so that soft tissue (nerve, vessel, dura mater, skin, etc.) will not be damaged even on accidental contact with the cutting tip. A feature of the piezoelectric device is its good manageability, which makes it easy for a well-trained otologic surgeon to create a straight osteotomy line: this renders the piezoelectric device suitable for bone surgery and for removal osteomas of the EAC.

Objective: The aim of this study was to analyze the efficiency and applicability of the Kay CSL 4500 system with the Sona-Speech II software model 3650 (Kay Pentax, Lincoln Park, NJ) in the voice therapy of patients affected by hypofunctional dysphonia., Design: The study evaluated the effect of visual biofeedback, obtained with the Sona-Speech II software, on dysphonia associated with hypofunction dysphonia., Setting: The study was conducted with 40 male adults affected by hypofunctional dysphonia in the Otolaryngology Department of the University of Genoa (Italy) between April 2008 and April 2009., Methods: Before, at the end of, and 3 months after voice therapy, all subjects underwent an otolaryngology visit, videostroboscopy, and voice analysis through the Multi-Dimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) as an evaluation of nasal resonance and the Voice Handicap Index (VHI). Each cycle of rehabilitation was characterized by 30 daily consecutive sessions, each for 25 minutes. During each session, the patient was asked to perform specific computer exercises., Main Outcome Measures: The following acoustic parameters were estimated: average of fundamental frequency, percentage of jitter, shimmer, noise to harmonics ratio, voice turbulence index, soft phonation index, degree of voicelessness, degree of voice breaks, and peak amplitude variation., Results: Our data showed significant (p < .05) improvements in acoustic and other parameters in the patients submitted to voice therapy., Conclusions: Our preliminary results suggest the applicability and efficiency of the Kay CSL 4500 system in association with the Sona-Speech II software model 3650 in a voice therapy program.

Conclusion: For otologic revision surgery, the advantage of the piezoelectric device appears real because it is possible to perform a 'blind' cutting of bone with fewer precautions necessary for soft tissues such as the facial nerve, lateral sinus, and dura mater., Objectives: The aim of this study was to determine the efficiency of the piezoelectric device in revision surgery for chronic otitis media., Methods: A total of 30 patients had revision mastoidectomy with previous canal wall up mastoidectomy. The piezoelectric device was used in all intraoperative steps. Before surgery and 1 month and 1 year after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording., Results: The piezoelectric device provided effective cutting, with excellent control and without side effects on the adjacent structures of the middle and inner ear (lateral sinus, facial nerve, and/or dura mater). Postoperatively, all patients had an uneventful recovery with no evidence of audiovestibular deficit or side effects. Among 30 cases followed for 1 year, 29 (97%) maintained a dry and safe ear. Intermittent otorrhea with perforation of the tympanic membrane occurred in one patient (3%).

An automated auditory brainstem response (AABR) method, the Maico MB-11 with BERAphone, has been developed for hearing screening in newborns. The aim of this study was to test the validity of this automated ABR screening method in a multistage newborn hearing screening (NHS). We applied a "five level" protocol using transient evoked otoacoustic emission (TEOAE), AABR-MB-11 with BERAphone and conventional auditory brainstem response (ABR). TEOAE, AABR, and conventional ABR testing were performed by ENT specialists experienced in neonatal screening techniques. Among the 8,671 newborns tested (males 3,889; females 4,782), only 42 newborns were lost to follow-up and the final false-positive rate was of 0.03%. Our experience highlights that for the neonatal period, conventional auditory brainstem response is the most reliable method for assessing the hearing level and minimizing the false-positive rate. Although AABR (performed by ENT specialists experienced in neonatal screening techniques) is easy to use, fast and with a good compliance, the device is unable to provide accurate and certain diagnosis on the degree of hearing loss to allow a proper treatment.

The aim of this study was to evaluate the efficacy of an oral ribosomal immunotherapy in the management of children with recurrent acute adenoiditis (RAA). 60 children with RAA were included and randomly assigned into two groups (group A and B). Group A children underwent ribosomal prophylaxis, while group B received a placebo. Before, at the end and 6 months after start of the therapy, children underwent medical history, ENT examination, plasma levels of immunoglobulins class E, A, G, M (IgE, IgA, IgG, IgM), tympanometry, active anterior rhinomanometry and VAS scores by children' parents. After the treatment and at the end of the study, in the group A, the serum concentration of IgE was significantly (P < 0.05) lower than in group B (77.34 +/- 6.23 vs. 95.49 +/- 7.07 mg/dl; 74.82 +/- 6.26 vs. 94.44 +/- 7.44 mg/dl), IgA titers were significantly (P < 0.05) higher than in group B (312.04 +/- 18.41 vs. 213.20 +/- 11.82; 309.07 +/- 18.33 vs. 211.73 +/- 11.54 mg/dl) as well as serum concentration of IgG (1401.12 +/- 118.81 vs. 1101.81 +/- 109.64 mg/dl; 1412.19 +/- 116.43 vs. 1144.06 +/- 103.58 mg/dl). At the end of the study, comparison between the two groups showed, in group A: 77% of children (n = 23), versus 23% (n = 7) of group B, with a type A tympanogram; significant (P < 0.05) nasal flow decrease at the rhinomanometric measures; VAS scores were significantly (P < 0.05) improved (1.8 +/- 0.22 vs. 5.1 +/- 0.59) and frequency, severity and social impact of RAA episodes were significantly (P < 0.05) lower than group B. Our results show the therapeutic effectiveness of this approach in the prophylaxis of recurrent acute adenoiditis.

Objective: Piezosurgery is a recently developed system for cutting bone without necrosis and nonmineralized tissues damage. The aim of this work has been to test Piezosurgery as a new bony scalpel in nasal surgery., Methods: In this nonrandomized study, we have performed Piezosurgery in the excision of malignant nasal tumors through a paralateronasal approach. We have used Piezosurgery on 10 patients affected by nasal adenocarcinoma. The piezoelectric device uses low-frequency ultrasonic waves (24.7-29.5 kHz); the applied power can be modulated between 2.8 and 16 W and is programmed in accordance to the density of the bone. The equipment consists of 2 hand pieces, 2 inserts, and 2 peristaltic pumps; the microvibrations that are created in the piezoelectric hand piece cause the inserts to vibrate linearly between 60 and 210 mum., Results: In all the patients, Piezosurgery provided excellent control without bleeding and harming effects on the adjacent structures. No patients experienced adverse effects., Conclusion: Piezosurgery is a new and revolutionary osteotomy technique using the microvibrations of scalpels at ultrasonic frequency, so that soft tissue will not be damaged even upon accidental contact with the cutting tip. The safety of Piezosurgery as regards soft tissues was confirmed. No adverse effects were detected during unintentional contact with the tumor, nerve, vessel, and mucoperiosteum; this renders the piezoelectric device ideal for this application., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to present our experiences and results of stapedotomy performed with and without the piezoelectric device., Design: The article evaluates and compares the use of the piezoelectric device in performing primary stapedotomy in patients affected by otosclerosis with the traditional method of microdrilling., Setting: The study was conducted with 100 patients in the Department of Otolaryngology of the University of Genoa (Italy), between January 2007 and January 2008., Methods: A prospective, randomized, controlled trial was undertaken on 100 stapedotomy patients performed using the piezoelectric device (50 patients) or the microdrill (50 patients)., Main Outcome Measures: Before surgery and at 1 and 12 months afterward, all patients underwent the following: otomicroscopic evaluation of the external and middle ear, pure-tone audiometry, tympanometry, transient evoked otoacoustic emissions, distortion product otoacoustic emissions, and auditory brainstem response., Results: All patients treated with the piezoelectric device had an air-bone gap reduction, with a closure of the air-bone gap within 10 dB; 44 (88%) patients who underwent traditional surgery had an air-bone gap reduction, with a closure of the air-bone gap within 10 dB., Conclusion: All of our postoperative data confirm the safety of the device on the anatomic structures of the middle and inner ear and demonstrate the efficacy of the piezoelectric device in terms of safety, cutting precision, and protection of anatomic structures and its applicability to stapedotomy.

Objective: The aim of this study was to demonstrate that binocular flash-induced nystagmus (B-FIN) can be evoked in humans., Design: The study evaluated the presence of B-FIN by stimulation with a stroboscopic flash., Setting: The study was conducted with 12 healthy patients in the Otorhinolaryngology Department of the University of Genoa (Italy), between April 2008 and January 2009., Methods: Patients underwent binocular flashing light stimulation, in the dark, by stroboscopic flash presented through a photostimulator at frequencies of 4.7 and 7.69 cycles/second for 120 seconds, with their eyes covered by a homogeneous field hollow opal hemisphere. The photostimulator was placed in three different positions with respect to the anterior-posterior axis: 0 degrees, 45 degrees to the right, and 45 degrees to the left., Main Outcome Measures: Eye movements were recorded by electronystagmography (ENG). ENG recording started 30 seconds before the stimulation and stopped 60 seconds after the end of the luminance stimuli to test the presence of flash induced after nystagmus (FIAN)., Results: B-FIN was clearly evoked from 10 of the 12 healthy adults, whereas FIAN was evoked from 4 of the 12 subjects. The best stimulation of B-FIN was obtained through an intermittent luminance stimulus presented at a frequency of 4.7 cycles/second and the photostimulator placed at 0 degrees to the optic axis., Conclusions: Our investigation demonstrates that B-FIN can be evoked in humans and its possible value in the differential diagnosis between central and peripheral vertigo.

Introduction: The aim of this study was to evaluate the efficiency of sulphurous thermal water in the treatment of chronic rhinosinusitis (CRS)., Methods: Eighty patients with CRS were included and randomly assigned into two groups. Patients underwent a 12-day course of warm vapour inhalations and nasal irrigations with sulphurous thermal water in group A, and a physiological solution in group B., Results: Compared with group B, in group A the results were as follows: serum concentration of IgE was significantly lower (p<0.05) 12 days (76.27+26.3 mg/dl vs. 97.44±45.4) and 3 months after the beginning of the treatment (75.48+26.1 mg/dl vs. 98.37±41.4); IgA titers were not significantly higher 12 days (231.09±120.3 mg/dl vs. 220.44+114.4 mg/dl) and 3 months after the beginning of the treatment (235.44±118.5 mg/dl vs. 214.51±111.8 mg/dl); VAS scores were significantly (p<0.05) improved at 12 days (1.7+0.18 vs. 6.9±0.51) and 3 months after the start (1.8+0.22 vs. 7.1±0.59); NMIT was normal at 12 days (11.54±1.59 min vs. 17.38+1.83 min) and 3 months after the beginning of the treatment (11.46+2.07 min vs. 17.43±2.01 min); total nasal resistances were significantly (p<0.05) decreased at 12 days and 3 months., Conclusion: Our results indicate the efficiency and applicability of sulphurous thermal water in the treatment of CRS.

This study wants to show the effects of active middle frequency sonar on a selected group of Italian Navy divers. Ten male divers with normal hearing were exposed to active sonar of the Italian Navy for more than 100 exposures, each of at least 1-h duration, in the course of 6 months. Before, at the end, and six months after the end of noise exposure, we performed pure-tone audiometry, Carhart test, Peyser test, thresholds of discomfort test (TDT), tympanometry, transient evoked otoacoustic emissions (TEOAE), distortion product otoacoustic emissions (DPOAE), and auditory brainstem response (ABR). At the end of the noise exposure, the audiological tests showed a worsening of the mean air and bone audiometric thresholds at the 2,000 (1/10), 4,000 (7/10), and 8,000 Hz (6/10); a fail status of the TEOAE and DPOAE, which were previously present, in all the divers; temporary threshold shift, at the Peyser test, in 9/10 divers; discomfort for pulse tone presented at the TDT test, in all the divers; no post exposure significant differences at the Carhart and ABR tests, in any of the divers. Six months after the end of noise exposure, all the divers presented a complete recovery of their audio-vestibular functions. Our results show the temporary negative effects of repeated and lasting exposure to active sonar (Hull MF) on the divers; the last control demonstrate the absence of permanent noise-induced hearing loss in divers exposed to active sonar.

This paper presents the design, implementation and control of a novel robotic system for assistive laser phonomicrosurgeries. The goals here are to improve the precision, the controllability, the safety and the ergonomics of traditional transoral laser laryngeal surgeries. Successful steps achieved by the developed system in those directions are presented here, including the design, control and characterization of a novel laser micromanipulator system. Such system is shown to achieve very fast (181mm/s) and accurate (1µm resolution) laser beam aiming within an 11×11mm target area. The design and implementation of a high-level control system for safe operation of the new laser phonomicrosurgery equipment is also described in this paper. This controller runs on a personal computer, offering a comfortable and safe surgical environment for the surgeon. In addition, it implements safe teleoperation by allowing the definition of safe and exclusion zones for surgical laser aiming. Automation of ablation procedures is also implemented on this high-level controller and described here. This feature adds an extra level of safety for phonomicrosurgeries by allowing the precise execution of surgical plans defined by the surgeon.

Objective: Piezosurgery is an ultrasound instrument (24.7-29.5 kHz) capable of cutting bone without necrosis and nonmineralized tissue damage. The aim of this work has been to determine the time required for a well-trained surgeon to perform otological surgery with the piezoelectric device., Study Design: Case series with planned data collection. Sixty-three patients affected by otosclerosis and 63 by chronic otitis media were enrolled. For each disease, patients were divided into three numerically equal groups, with each group assigned to a well-trained otological surgeon. Patients underwent stapedotomy (n = 63) and intact canal wall tympanoplasty (n = 63) with the piezoelectric device., Setting: ENT Department, University of Genoa (Italy)., Subjects and Methods: We recorded "skin-to-skin" operation time, surgical success, surgical complication, and hospital stay duration. Before and one year after surgery, all patients underwent pure-tone audiometry, tympanometry, recording of transient-evoked otoacoustic emission, recording of distortion product otoacoustic emission, auditory brainstem response, and electronystamographic recording., Results: In each surgical technique, the piezoelectric device provided excellent control without side effects on the adjacent structures of the middle and inner ear., Conclusion: The piezoelectric device is a new bony scalpel that uses microvibrations at ultrasonic frequency so that soft tissue (nerve, vessel, dura mater, etc) will not be damaged even on accidental contact with the cutting tip. A feature of the piezoelectric device is its good manageability, which makes it easy for a well-trained otological surgeon to create a straight osteotomy line without any learning period: this renders the piezoelectric device suitable for bone surgery.

The aim of this study was to evaluate changes in acoustic features of speech and voice after uvulopalatopharyngoplasty (UPPP) with the Harmonic Scalpel (HS), using the multidimensional voice program (MDVP) in conjunction with other tests. Before and 6 months after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with MDVP in all the patients, as an evaluation of nasal resonance (trough the Glatzel and the Gutzmann tests), speech articulation and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks and peak amplitude variation. Six months after surgery, improvements in all the acoustic parameters, in nasalance and VHI were achieved. In our experiences UPPP, with the HS, improves speech and voice in patients affected by snoring and/or obstructive sleep apnea syndrome.

The aim of this study was to evaluate changes in acoustic features of speech after tonsillectomy and to establish concepts of patient management and rational therapeutic approach. Before and 1 month after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with Multi-Dimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) in all the patients, as an evaluation of nasal resonance, speech articulation, and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter percent, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks, and peak amplitude variation. Our data showed that 1 month after tonsillectomy, improvements in all the acoustic parameters, a subjective decrease of hypernasality, and an improvement of speech articulation and VHI were achieved. These data suggest the reduction of the nasal resonance and highlight the role of tonsillectomy in the improvement of voice and speech quality. Furthermore, tonsillectomy should be performed before consideration of pharyngeal flap surgery. Our results highlight that objective evaluation of speech and voice helps the specialist to improve patient management and avoid unnecessary and dangerous surgical procedures.

Objective: To compare the microscopic and macroscopic effects of radiofrequency, high-frequency, and electrocautery therapies with partial inferior turbinotomy in the treatment of nasal obstruction caused by inferior turbinate hypertrophy., Design: Nonrandomized controlled trial., Setting: Department of Otolaryngology-Head and Neck Surgery, University of Genoa., Patients: The study included 80 patients affected by nasal obstruction from hypertrophied inferior turbinates., Interventions: Homogeneous patient groups A, B, C, and D underwent radiofrequency, high-frequency, and electrocautery treatments and partial inferior turbinotomy, respectively, to surgically reduce hypertrophied inferior turbinates., Main Outcomes Measures: Prior to surgery and at 7-day and 2-month follow-up evaluations, patients' outcomes were assessed via visual analogue scale, nasal endoscopy, nasal monofilament test, nasal mucociliary transport time (NMTT), anterior active rhinomanometry, and histologic examination of microbiopsy specimens from the inferior turbinate mucosa., Results: Compared with groups A, B, and C 2 months after surgery, group D showed a lower subjective assessment of symptoms score, normal NMTT (vs an increase in all other groups), lower stimulus to trigger a touch response at monofilament test (vs hyposensitivity in the other groups), and absence of histologic changes., Conclusions: To our knowledge, no one has previously performed comparative studies to conclusively demonstrate which surgical technique is ideal. Our results show that the partial inferior nasal turbinotomy is the best method of treatment because it most effectively maintains satisfactory nasal physiologic integrity without damaging nasal mucosa or underlying nerves.

Background: The aim of this study was to evaluate changes in acoustic features of voice after septoplasty and to establish concepts of patient management and a rational therapeutic approach., Material/methods: Before and one month after surgery, phonetically balanced sentences and sustained vowels a, e, and i were recorded and digitalized with MDVP (Multi Dimensional Voice Program, Kay Elemetrics) in all patients for an evaluation of nasal resonance, voice handicap index (VHI), and active anterior rhinomanometry. These parameters were estimated: average fundamental frequency (Fo), jitter percent, shimmer, noise-to-harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voicelessness (DUV), degree of voice breaks (DVB), and peak amplitude variation (vAm)., Results: One month after surgery the data showed an improvement in all the acoustic parameters and a normalization of nasalance., Conclusions: The results highlight the impact of septoplasty on nasalance and voice. In selected cases, such as severe nasal septum deviation, the decision to perform septoplasty depends on its potential effect on speech and respiratory function. An objective evaluation of voice and nasalance helps the specialist in the management of these patients.