Step-by-step iconographic description of a prolonged but still favourable course of orbital cellulitis in a child with acute rhinosinusitis: an iconographic case study

Orbital cellulitis is an infrequent complication of acute ethmoiditis possibly leading to life- or visual-threatening complications. Despite its natural history is well known, its clinical evolution may widely vary among patients, and even in the most favourable cases long-term sequelae may persist. We here provide a step-by-step iconographic description of a periorbital and orbital cellulitis occurring in a child with ipsilateral acute rhinosinusitis. Our report shows that an unusual long-term evolution of periorbital and orbital cellulitis is possible also in apparently favourable cases

Lung involvement in "stable" undifferentiated connective tissue diseases: a rheumatology perspective

Previous studies of the occurrence of interstitial lung disease (ILD) in undifferentiated connective tissue diseases (UCTD) were conducted in patients admitted to Respiratory Medicine Units. The aim of the present prospective study was to investigate lung involvement in UCTD patients admitted to a Rheumatology Unit. Eighty-one consecutive UCTD patients were enrolled in the study. Each patient underwent history and physical examination, routine laboratory investigations, antinuclear antibody (ANA) profiling, B-mode echocardiography, and lung function study according to previously reported methods. Lung high resolution computed tomography (HRCT) was performed in patients who provided informed consent. Six patients (7.4%) had a history of grade II dyspnea. Three of them had a DLCO ranging from 42 to 55% of the predicted value; and a HRCT-documented ILD with a non-specific interstitial pneumonia (NSIP) pattern. Symptoms in the other three patients were due to cardiac disease. None of the 75 asymptomatic patients, had relevant findings at physical examination, 26/75 had a DLCO <80% (<70% in 10 cases). Of these, 3 of the 30 patients who underwent lung HRCT were affected by NSIP-ILD. Six of the 81 enrolled were affected by ILD, which was symptomatic in three patients. A higher percentage of patients had a reduced DLCO. The latter finding may reflect a preradiographic ILD or a preechocardiographic pulmonary vascular disease

Development of novel nano-structured materials for Enhanced Raman Spectroscopies: an insight in SERS and TERS applications

Owing to their ultrahigh selectivity and sensitivity, the plasmon-enhanced Raman spectroscopies (PERS) methods have emerged as diverse and exciting cutting-edge techniques for the investigation of biosystems at nanometric scales in air or water environments. By exploiting the plasmonic properties of noble metal nanoparticles, the PERS methods enable to remove the main obstacle of the Raman spectroscopy represented by the small Raman cross- section. Among them, the Surface Enhanced Raman Spectroscopy (SERS) is certainly the most important in terms of the number of applications in many fields of science (physics, chemistry, and biomedicine). One of the interesting features of the SERS is that the huge amplification of inelastic Raman photons can reach up to 12 orders of magnitude allowing even the detection at single-molecule level. In addition, the strong distance dependence of the plasmonic near-field effect (∼ 10-20 nm) makes effective the SERS only for molecules in proximity to metal-nanostructured surfaces and, thus, suitable not only for the bio-analysis of membranes but also for the surface characterization in science materials. Anyway, beyond the high sensitivity, the limitation of the SERS is represented by the diffracted-limited spatial resolution. A significant improvement is given by the modern tip-enhanced Raman spectroscopy (TERS) technique. By combining the high resolution of scanning-probe microscope (SPM) technology and the sensitivity of SERS, TERS is capable to correlate topographical and chemical information of a sample at nanoscale level. In fact, the Raman signal coming from the probed molecules is strongly enhanced via SERS effect when they are in proximity of the apex of a metalized or metallic SPM tips. Moreover, the scattering efficiency of TERS signal is greatly increased when the metal surface of the probe is nano-structured. The spatial resolution of TERS signals is mainly ruled by the tip-radius, which is typically of few tens of nanometers, therefore allowing to reach a lateral resolution in the range of 10-50 nm, far beyond the diffraction limit. Anyway, the development of reliable and effective plasmonic devices for SERS and TERS applications represents the major obstacle towards a wider diffusion of TERS/SERS as powerful analytical tools in material science and life science. In the case of TERS, the main technological challenge is based on the fabrication of metal nano-structures on the tip. Compared to SERS substrates that are produced on large-area surfaces, the sub-micron dimensions of the tip apex make the nano-structuring task more tricky. In this frame, the current thesis work aims to present a novel and versatile method for the preparation of appropriate AFM-TERS tips and SERS substrates. The innovative approach is based on the application of a radio-frequency discharge produced by an inductively coupled plasma (ICP) on commercial Ag-covered AFM probes. The plasma treatment produces an intriguing metallic porous nanotexture resembling a coral-like structure. The so-produced probes have been characterized by showing an amplification up to six orders of magnitude and a spatial resolution down to 10 nm, which render these devices particularly attractive for nanometer chemical characterization. In addition, this method has been successfully implemented for the fabrication of broad-band SERS-active platforms. This protocol has shown to be effective to produce substrates that can amplify the Raman signal up to seven orders of magnitude. Finally, another method for the fabrication of SERS substrates, based on the self-assembly of block copolymer (BCP) loaded with Ag-NPs, is proposed. The sensitivity of the so-prepared substrates has been tested by revealing the over-expression of target proteins in membranes of cancer cells

Feasibility of SERS-Active Porous Ag Substrates for the Effective Detection of Pyrene in Water

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous pollutants that are typically released into the environment during the incomplete combustion of fossil fuels. Due to their relevant carcinogenicity, mutagenicity, and teratogenicity, it is urgent to develop sensitive and cost-effective strategies for monitoring them, especially in aqueous environments. Surface-enhanced Raman spectroscopy (SERS) can potentially be used as a reliable approach for this purpose, as it constitutes a valid alternative to traditional techniques, such as liquid and gas chromatography. Nevertheless, the development of an SERS-based platform for detection PAHs has so far been hindered by the poor adsorption of PAHs onto silver-and gold-based SERS-active substrates. To overcome this limitation, several research efforts have been directed towards the development of functionalized SERS substrates for the improvement of PAH adsorption. However, these strategies suffer from the interference that functionalizing molecules can produce in SERS detection. Herein, we demonstrate the feasibility of label-free detection of pyrene by using a highly porous 3D-SERS substrate produced by an inductively coupled plasma (ICP). Thanks to the coral-like nanopattern exhibited by our substrate, clear signals ascribable to pyrene molecules can be observed with a limit of detection of 23 nM. The observed performance can be attributed to the nanoporous character of our substrate, which combines a high density of hotspots and a certain capability of trapping molecules and favoring their adhesion to the Ag nanopattern. The obtained results demonstrate the potential of our substrates as a large-area, label-free SERS-based platform for chemical sensing and environmental control applications

A simple and reliable approach for the fabrication of nanoporous silver patterns for surface-enhanced Raman spectroscopy applications

The fabrication of plasmonic nanostructures with a reliable, low cost and easy approach has become a crucial and urgent challenge in many fields, including surface-enhanced Raman spectroscopy (SERS) based applications. In this frame, nanoporous metal films are quite attractive, due to their intrinsic large surface area and high density of metal nanogaps, acting as hot-spots for Raman signal enhancement. In this paper, we report a detailed study on the fabrication of nanoporous silver-based SERS substrates, obtained by the application of two successive treatments with an Inductively Coupled Plasma (ICP) system, using synthetic air and Ar as feeding gases. The obtained substrates exhibit a quite broad plasmonic response, covering the Vis–NIR range, and an enhancement factor reaching 6.5 ×107, estimated by using 4-mercaptobenzoic acid (4-MBA) as probe molecule at 532 nm. Moreover, the substrates exhibit a quite good spatial reproducibility on a centimeter scale, which assures a good signal stability for analytical measurements. Globally, the developed protocol is easy and cost effective, potentially usable also for mass production thanks to the remarkable inter-batches reproducibility. As such, it holds promise for its use in SERS-based sensing platforms for sensitive detection of targets molecules

Nanoporous silver films produced by solid-state dewetting for SERS applications

Detection of analytes in aqueous solution with high specificity and sensitivity is of paramount importance in many fields of science, ranging from biomedicine, environmental control, and food quality assessment. Surface-enhanced Raman scattering (SERS) has proven to be a cutting-edge analytical technique for this purpose, by combining the high selectivity of Raman features with the high sensitivity deriving from the plasmonic amplification of Raman signals. Herein, we report a facile and quite effective approach to fabricate large-area Ag-based SERS substrates, exhibiting a porous, coral-like nanotexture. Due to their intrinsic large surface-area and high hot-spot density, the produced substrates appear quite promising for the detection of analytes at trace levels. The nanoporous substrates are produced by Solid-State Dewetting (SSD) of thin Ag-films. In particular, ~30 nm thickness Ag-films are first deposited on glass coverslips by magnetron sputtering. Then, marked roughening is induced by exposing the films to an Inductively Coupled Plasma (ICP) discharge, using synthetic air as feeding gas. The performances of our SERS substrates are characterized in terms of morphology and enhancement factor using CV as probe molecule

CT Navigation-Assisted Transfacial Removal of Parotid Stones: Does It Work?

Background/Objectives: The failure rate of minimally invasive surgical approaches to parotid stones is about 10%, primarily due to the presence of large, impacted, or unpalpable deep stones. When stones are palpable and exceed 7 mm in size, a combined transfacial and sialendoscopic approach offers a safe and effective surgical option, while unpalpable and impacted stones located in the parenchyma, not visible or accessible through sialendoscopy, can be treated with a CT-guided transfacial approach. Methods: Twenty-two patients (three females, mean age 53 years, range 32–73 years) underwent CT navigation-assisted transfacial removal of unpalpable and impacted parotid stones at the Department of Otolaryngology and Head and Neck Surgery of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan between 2017 and 2024. Results: The mean size of the stones was 7.4 mm (range 4–14 mm), while the mean depth of stones, calculated as the distance from the skin surface, was 8.7 mm (range 4–14 mm). Stones were removed successfully in all but five patients (77% success rate). Failure of the procedure was significantly associated (p &lt; 0.05) with the depth of the stone (&gt;12 mm); in all these cases, patients were treated immediately by means of traditional parotidectomy. Conclusions: The CT-navigation-assisted transfacial approach can be considered a safe, reliable, and efficacious option for the treatment of difficult unpalpable parotid stones, impacted and deeply located in the gland parenchyma. Stones deeper than 10 mm can be more effectively treated by means of traditional parotidectomy if extracorporeal lithotripsy is not available

Nasopharyngeal fiberendoscopy in children: A survey of current Italian pediatric otolaryngological practices

Background: Nasopharyngeal fiberendoscopy (NFE) is the gold standard diagnostic procedure for adenoidal disease, but there is no consensus concerning the optimal technical approach. The aim of this study was to investigate the attitudes of Italian otolaryngologists towards diagnostic NFE in children, and the most widely used methods. Methods: Nine hundred randomly selected members of the two largest Italian otolaryngological scientific societies were e-mailed an anonymous web-based questionnaire containing 29 multiple-choice items regarding their opinions about, and use of NFE in children. Results: Questionnaires were returned by 764 clinicians (84.9 %). About 75 % declared they used NFE, but 35 % said they preferred alternative diagnostic methods. Most of the respondents considered NFE safe, but more than 80 % judged it to be poorly or only fairly well tolerated. Almost all declared that they generally use flexible, small-diameter instruments, with the patient seated on a chair or a parent's lap; 65 % use gentle restraining methods. Fewer than 50 % reported using a standardised hypertrophy grading system. Conclusion: Italian otolaryngologists have a generally positive attitude towards using NFE in children. However, some have reservations, and there was no unanimous agreement concerning how it should be done. Given the medical advantages of NFE, it is essential to clarify the many still controversial aspects of the procedure by means of comparative studies and educational programmes

Outpatient Ductal Steroid Irrigations as an Adjuvant Treatment to Sialendoscopy in Recurrent Inflammatory Obstructive Sialadenitis

The aim of this study is to retrospectively investigate the effectiveness of outpatient ductal steroid irrigations (DSIs) as an adjuvant treatment in recurrent inflammatory obstructive sialadenitis (RIOS). A retrospective chart review of prospectively recruited RIOS patients was randomly assigned to group A (i.e., interventional sialendoscopy) or group B (i.e., interventional sialendoscopy with outpatient DSIs). The statistical analysis detected any postoperative difference between groups in terms of the number and severity (attested by 0–10 VAS pain) of episodes of swelling. Interventional sialendoscopy and DSIs were effective and well tolerated in all 122 patients, and a significantly reduced number of salivary gland swelling episodes (p-value = 0.01) was documented in group B compared to group A at any follow-up assessment. When the specific aetiology was considered, repeated DSIs were more effective than interventional sialendoscopy alone in patients with type 1 or 3 stenoses and in those without mucous plugs. Our results confirm the safety and effectiveness of interventional sialendoscopy (both as a single-modality and a multimodal approach) in a large series of adult patients with RIOS at short-, medium-, and long-term analyses. The superiority of a combined therapeutic protocol, with a positive effect still detectable 12 months after the end of the treatment, was attested as well