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Silvia Ottaviani,1,2 Eleonora Rondanina,1,2 Floriana Arnone,3 Virna Brucato,3 Roberto Campigli,3 Massimo Della Bona,3 Luca Tagliafico,1,2 Ennio Ottaviani,4 Alessio Nencioni,1,2 Fiammetta Monacelli1,2 1Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy; 2IRCCS Ospedale Policlinico San Martino, Genoa, Italy; 3ASL5 Ospedale San Bartolomeo, Sarzana, Italy; 4Department of Mathematics (DIMA), University of Genoa, Genoa, 16132, ItalyCorrespondence: Fiammetta Monacelli, Dipartimento di Medicina Interna e Specialità Mediche (D.I.M.I.) - Università degli Studi di Genova, Viale Benedetto XV, 6, Genova, GE, 16132, Italy, Tel/Fax +39-010-353-7545, Email fiammetta.monacelli@unige.itPurpose: In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale.Patients and methods: The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale.Results: Within the population, 152 subjects (48%) developed PU at different levels of severity. The results showed that age, Braden scale (subscales of mobility and friction/shear), Barthel scale, Mini Nutritional Assessment, hemoglobin, and albumin are predictors associated with the development of PU (AUC 85%). The result is an improvement over the use of the Braden scale alone (AUC 75%). Regarding the identification of predictive factors for PU severity, 4AT also emerges as potentially relevant.Conclusion: Assessing the subject’s nutritional status, physical performance, and functional autonomies enables the effective integration of the Braden scale in identifying patients most susceptible to developing PU. Our findings support the integration of a comprehensive set of methodologically robust frailty determinants into traditional risk assessment tools. This integration reflects the mutual interplay between patients’ frailty, skin frailty, and PU development in very old hospitalized patients.Keywords: chronic wounds, nutrition, pressure injury, health analytics, precision medicine, chronic diseases

Purpose: Nowadays, several efficacious biologic drugs are used for severe asthma with or without chronic rhinosinusitis with nasal polyps (CRSwNP). However, it has been observed that not all comorbid patients (asthma/CRSwNP) receiving biologic treatment for asthma experience satisfactory control of both conditions equally., Methods: We selected 20 patients who had both severe asthma and comorbid CRSwNP under biological treatment with benralizumab, omalizumab or mepolizumab with adequate control of asthma but inadequate control of nasal symptoms. Patients were switched to dupilumab and outcomes were evaluated at baseline (T0), at 3 months (T1), at 6 months (T2), at 12 months (T3) and finally at 18 months (T4). Data were collected at each time point including blood tests measuring eosinophil levels and total IgE, SNOT22, ACT, NPS score, rhinomanometry, olfactory testing, and nasal cytology., Results: The results showed an overall improvement in all the outcomes. Peripheral eosinophilia was observed consistently with existing literature. All patients registered an improvement in sinonasal outcomes, while only one patient had a worsening of asthma. Three patients interrupted the therapy due to various causes: poor asthma control, onset of psoriasis and thrombocytopenia., Conclusions: The response to a biologic treatment for CRSwNP control may be heterogenous and it seems that patients may benefit from switching improving control in equal measure in the upper and lower airway. Further studies to explore the endotype/phenotype which best fits with each biologic are mandatory to personalize the therapy., (© 2024. The Author(s).)

Introduction: The impairment of the sense of smell is often related to chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP, CRSsNP). CRSwNP is a frequent condition that drastically worsens the quality of life of those affected; it has a higher prevalence than CRSsNP. CRSwNP patients experience severe loss of smell with earlier presentation and are more likely to experience recurrence of their symptoms, often requiring revision surgery., Methods: The present study performed a multicentric data collection, enrolling 811 patients with CRS divided according to the inflammatory endotype (Type 2 and non-Type 2). All patients were referred for nasal endoscopy for the assessment of nasal polyposis using nasal polyp score (NPS); Sniffin' Sticks olfactory test were performed to measure olfactory function, and SNOT-22 (22-item sinonasal outcome test) questionnaire was used to assess patients' quality of life; allergic status was evaluated with skin prick test and nasal cytology completed the evaluation when available., Results: Data showed that Type 2 inflammation is more common than non-type 2 (656 patients versus 155) and patients suffer from worse quality of life and nasal polyp score. Moreover, 86.1% of patients with Type 2 CRSwNP were affected by a dysfunction of the sense of smell while it involved a lesser percentage of non-Type 2 patients. Indeed, these data give us new information about type-2 inflammation patients' characteristics., Discussion: The present study confirms that olfactory function weights on patients' QoL and it represents an important therapeutic goal that can also improve patients' compliance when achieved. In a future - and present - perspective of rhinological precision medicine, an impairment of the sense of smell could help the clinician to characterize patients better and to choose the best treatment available., 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., (© 2023 Macchi, Giorli, Cantone, Carlotta Pipolo, Arnone, Barbone, Bertazzoni, Bianchini, Ciofalo, Cipolla, De Massimi, De Vita, Di Lieto, Ghidini, Govoni, Gramellini, Maselli Del Giudice, Ottaviano, Seccia, Sireci, Sollini, Staffieri, Gallo, Heffler, Mantia, De Corso, Canevari, Lombardo, Malvezzi, Orietti, Pasquini, Presutti and Monti.)

Needle artifacts pose a major limitation for MRI-guided interventions, as they impact the visually perceived needle size and needle-to-target-distance. The objective of this agar liver phantom study was to establish an experimental basis to understand and reduce needle artifact formation during MRI-guided abdominal interventions. Using a vendor-specific prototype fluoroscopic T1-weighted gradient echo sequence with real-time multiplanar acquisition at 1.5 T, the influence of 6 parameters (flip angle, bandwidth, matrix, slice thickness, read-out direction, intervention angle relative to B 0 ) on artifact formation of 4 different coaxial MR-compatible coaxial needles (Nitinol, 16G-22G) was investigated. As one parameter was modified, the others remained constant. For each individual parameter variation, 2 independent and blinded readers rated artifact diameters at 2 predefined positions (15 mm distance from the perceived needle tip and at 50% of the needle length). Differences between the experimental subgroups were assessed by Bonferroni-corrected non-parametric tests. Correlations between continuous variables were expressed by the Bravais-Pearson coefficient and interrater reliability was quantified using the intraclass classification coefficient. Needle artifact size increased gradually with increasing flip angles (p = 0.002) as well as increasing intervention angles (p < 0.001). Artifact diameters differed significantly between the chosen matrix sizes (p = 0.002) while modifying bandwidth, readout direction, and slice thickness showed no significant differences. Interrater reliability was high (intraclass correlation coefficient 0.776-0.910). To minimize needle artifacts in MRI-guided abdominal interventions while maintaining optimal visibility of the coaxial needle, we suggest medium-range flip angles and low intervention angles relative to B 0 ., (© 2021. The Author(s).)

Incidentally diagnosed, asymptomatic, paranasal fungus ball might occasionally undergo spontaneous healing. Accurate preoperative workup may avoid unnecessary surgical or anesthesiological procedures., Competing Interests: None declared., (© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Objective: Comorbidity in psychiatric patients has been widely examined in the literature, enucleating the role in misinterpretation of symptom's root in a multi-disease background, as well as the impact on the quality of life, outcome, and health-care effects. This research aimed to examine, in an Italian population of psychiatric patients, the diagnostic continuum in the context of lifetime psychiatric comorbidity, assessing possible differences related to the onset disorder., Method: A retrospective analysis of medical records of 458 subjects, in which various psychiatric diagnoses were represented and categorized in 16 nosographic classes, was conducted., Results: Results showed that "Bipolar disorder" (22.06%) was the most frequent diagnosis, "Eating disorder" had the earliest age onset (Mean age years = 16 ± 1.41), and "Schizophrenia" showed the longest disease duration (Mean years = 24.20±12.76). Moreover, 54,4% of the final sample presented at least one psychiatric comorbidity in disease history, while "Other personality disorders" was the most comorbidity-associated diagnosis, representing 29% of all the cases with more than 3 past diagnoses. Heterotypic transition was observed in fairly all considered onset diagnoses, exception made for "Schizophrenia" with 75% of the subjects showing homotypic progression., Conclusions: Our results suggest a tendency to make multiple diagnoses over psychiatric patients' lifetime in the majority of cases, often escaping from the original onset nosographic domain. More generally, our findings agree with a broad consensus that describes psychiatric symptomatic dimensions rather overlapped and correlated with each other, leading to a more transdiagnostic clinical approach., Competing Interests: Competing interests: None., (© 2020 Giovanni Fioriti Editore s.r.l.)

Purpose: Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients., Methods: One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions., Results: The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment., Conclusions: The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%.

Functional Endoscopic Sinus Surgery (FESS) is a common day surgery technique for upper airway disorders. Hyaluronic acid (HA) is a fundamental component of the human connective tissue. HA may exert reparative, anti-inflammatory and immune-modulating activities. Recently, a new intranasal HA formulation has been proposed: a supramolecular system containing lysine hyaluronate, thymine and sodium chloride (T-LysYal®). This randomized study investigated whether intranasal T-LysYal® (RinoLysYal®, Farmigea, Italy) was able to reduce symptom severity, endoscopic features, and nasal cytology in 83 patients (49 males and 34 females mean age 45.4±6.2 years) treated with FESS. All patients were treated with isotonic saline solution for 4 weeks, and a sub-group (active group) was also treated with intranasal T-LysYal®. Patients were visited at baseline, after treatment, and after 4-week follow-up. Intranasal T-LysYal® treatment significantly reduced the quote of patients with symptoms, endoscopic features, and inflammatory cells in comparison to isotonic solution. In conclusion, the present study demonstrates that intranasal T-LysYal® is able to significantly improve patients after FESS and its effect is long lasting.

Background: Fat is theoretically the ideal implant for vocal fold augmentation because it is soft, easily available and biocompatible. However, reabsorption is a frequent cause of long-term failure., Objective: We prospectively tested Coleman's "lipostructure" technique used for facial recontouring in the treatment of glottic incompetence., Study Design and Setting: Fourteen patients (aged 18-74 years, mean 48) with breathy dysphonia secondary to laryngeal hemiplegia (7) or anatomical defects (7) underwent vocal fold lipoinjection. Fat harvested by liposuction was centrifuged, and the fat cell layer injected into the vocalis muscle. The patients underwent pre- and postoperative videolaryngostroboscopy, maximum phonation time (MPT) measurements, GRBAS perceptual evaluations, and Voice Handicap Index (VHI) self-assessments., Results: Voice quality improved soon after surgery and remained stable over 3-26 months (mean 10.6), being confirmed by the GRBAS, MPT and VHI evaluations ( P < 0.005). The results were best in the seven patients with paralytic dysphonia., Conclusion: Lipostructure is a valuable technique for voice rehabilitation in glottic incompetence.

This prospective randomized trial compares the results of i.v. omeprazole and i.v. ranitidine in 45 patients admitted as an emergency with an endoscopic diagnosis of bleeding duodenal ulcer. The patients were randomized to receive i.v. omeprazole, 40 mg bolus followed by 80 mg/day by continuous infusion for 3 days (group A), or ranitidine 50 mg i.v. bolus followed by 400 mg/day i.v., continuous infusion for 3 days (group B). Follow-up endoscopy on day 4 demonstrated successful therapy, except when more than 4 units of blood/day had to be transfused to maintain hemoglobin level above 10 g/l. Bleeding stopped in 20/21 patients in group A (95.2%), and in 17/24 patients in group B (70.80%) (p < 0.05). From the results of the study, it can be concluded that intravenous omeprazole seems to be effective in the control of bleeding duodenal ulcer.