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A prospective observational study was conducted to evaluate the presence of swallowing, speech and orofacial muscle imbalance (OMI) disorders in patients with adenotonsillar hypertrophy and their regression after surgery. ENT, speech therapist and dentistry examination were conducted before and 12 months after surgery in 78 children between the ages of 2 and 12 with dysphagia, speech disorders and OMI adenotonsillar hypertrophy related with sleep-disordered breathing. Of the 78 patients enrolled, 62 underwent adenotonsillectomy, 9 adenoidectomy and 7 volume reduction of the palatine tonsils with a 12-month post-operative increase in SWAL-QOL score, weight gain, correction of ogival palate, dental crowding and tongue posture and consequent resolution of phono-articulatory disorders. All patients show an improvement in swallowing, phono-articulatory disorders’ symptoms and OMI correction at 12-month evaluation.

Background: Vedolizumab registration trials were the first to include elderly patients with moderate-to-severe ulcerative colitis (UC) or Crohn’s disease (CD), but few real-life data have been reported in this population. Aims: We investigated the effectiveness and safety of vedolizumab in matched cohorts of elderly and nonelderly UC and CD patients. Methods: The Long-term Italian Vedolizumab Effectiveness (LIVE) study is a retrospective-prospective study including UC and CD patients who started vedolizumab from April 2016 to June 2017. Elderly patients (≥65 years) were matched clinically 1:2 to nonelderly patients (18–64 years); the 2 groups were followed until drug discontinuation or June 2019. Results: The study included 198 elderly (108 UC, 90 CD) and 396 matched nonelderly patients (205 UC, 191 CD). Nonelderly UC patients had a significantly higher persistence on vedolizumab compared to elderly patients (67.6% vs. 51.4%, p=0.02). No significant difference in effectiveness was observed between elderly and nonelderly CD patients (59.4% vs. 52.4%, p=0.32). Age ≥65 years was associated with lower persistence in UC; for CD, previous exposure to anti-TNF-α agents, Charlson comorbidity index >2 and moderate-to-severe clinical activity at baseline were associated with lower persistence. There were recorded 130 adverse events, with comparable rates between the two groups. A Charlson comorbidity index >2 was associated with an increased risk of adverse events. Conclusion: Vedolizumab can be considered a safe option in elderly IBD patients. Its effectiveness in elderly UC patients may be reduced, while no age-dependent effect on effectiveness was observed in CD.

Introduction: Nasal packing is a common procedure used to ensure haemostasis after nasal surgery. Materials and Methods: A prospective, randomized, controlled and double-blinded study was conducted on 80 consecutive subjects to investigate whether using Nasal Dressing Sponge® (NDS) instead of simple Merocel® might improve patients' postoperative experience of nasal packing. Results: During the stay of the tampons no differences were noticed between the two groups as regards the postoperative pain. When it comes to pain during the packing removal, patients complained of worse symptoms in the side packed with Merocel. There was no bleeding after the removal of Merocel, whereas 5,6% patients were subject to some bleeding when NDS was removed. Conclusion: Merocel and NDS gave similar results regarding haemostatic activity. Nasal Dressing Sponge could decrease pain during the removal of the nasal pack, while it could be associated to a bigger incidence of mild bleeding after removing the pack.

In recent years, part of the scientific community has focused its attention on the involvement of the epithelial-mesenchymal trophic unit (EMTU) in mucosa remodeling, monitoring its role in chronic inflammatory lung diseases. The term EMTU is used to describe the anatomic and functional relationship between the attenuated fibroblast sheath and epithelial tissue, i.e. the signaling between epithelial cells and the underlying fibroblasts, which are in close indirect physical contact with the former. These interactions are important for many airway functions, such as differentiation during lung growth, repair of damaged tissue and regulation of inflammatory response. Several studies have indicated a key role for the EMTU in the processes that influence mucosae remodelling. These processes can be observed in different pathologies, such as asthma or chronic obstructive pulmonary disease (COPD). This review focuses on the primary role of the EMTU in mucosa remodeling, aiming to give a contribution to an issue that, if deepened may lead to more efficient treatments for the handling of chronic respiratory diseases. The close correlation between the reactivation of the EMTU in adult age and the onset of chronic diseases of the respiratory system is now widely accepted by the scientific community. It is therefore of fundamental importance to enhance our knowledge on its reactivation and the processes that lead to tissue remodeling. Pinpointing the key molecular pathways would provide new therapeutic targets for limiting the remodeling processes typical of subjects suffering from different types of airway pathologies.

Background and Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.

The obstructive sleep apnea syndrome is a chronic condition characterized by frequent episodes of collapse of the upper airways during sleep. It can be considered a multisystem disease. Among the districts involved, even the auditory system was seen to be concerned. It was enrolled a population of 20 patients after polysomnographic diagnosis of OSAS (Apnea Hypopnea Index > 10) and a control group of 28 healthy persons (Apnea Hypopnea Index < 5). Each patient has been subjected to Pure Tone Audiometry, Tympanometry, study of Acoustic Reflex, Otoacoustic Emissions and Auditory Brainstem Response. Moreover they were submitted to endoscopy of upper airway with Muller Maneuver and Epworth Sleepiness Scale (ESS). The values of ESS was 13.5 in OSAS group and 5.4 in control group. The tone audiometry is worse in all frequencies analyzed in OSAS patients, but within the normal range for both groups analyzed by 250 to 1000 Hertz. Otoacoustic emissions show a reduced reproducibility and a lower signal/ noise ratio in OSAS group (P