Bilateral osseous stenosis of the internal auditory canal: case report

Osteomas as well as exostoses of the internal auditory canal are rare, benign, usually slow-growing lesions. The most common localizations of these temporal bone lesions are the mastoid cortex and the external auditory canal. A rare case is reported of bilateral osseous stenosis of the internal auditory canal, in the absence of clinical (auditory, vestibular and facial nerve) symptoms. In the absence of auditory, vestibular and/or facial nerve symptoms, long-term follow-up should be assessed; surgical intervention may be warranted only if symptoms are present

Malignant otitis externa in the antibiotic resistance era: key to successful treatment

Malignant otitis externa in the antibiotic resistance era: key to successful treatment. Objective: Malignant otitis externa (MOE) is a rare aggressive, necrotizing infection of the external auditory canal and the temporal bone. MOE may have a poor prognosis when it is not treated promptly and adequately. It is most commonly reported in males, older individuals, patients with diabetes, or patients that are immunocompromised. Pseudomonas aeruginosa is the main pathogenic agent involved. This study aimed to evaluate a clinical series of patients with MOE and discuss the current literature on the topic. Methodology: This retrospective study included 8 patients with MOE that were evaluated and treated, medically and/ or surgically, at the University Hospital of Ferrara between January 2012 and December 2016. We retrieved data from medical records on the clinical history, imaging, and treatment. Results: In all cases, a microbiological examination disclosed the presence of P. aeruginosa. The infection was eventually controlled in all cases, after a median of 6 months of therapy. All patients were followed-up for an average of 12 months after infection resolution. Conclusion: Currently, no specific guidelines for MOE treatment are available in the literature. Based on our findings, we proposed a diagnostic and therapeutic flow-chart for managing this infection

Assessment of benefit of advanced inflammatory bowel disease training: Challenges and solutions

BACKGROUND: Advanced inflammatory bowel disease (IBD) fellowships are available for gastroenterologists who wish to increase their expertise in complex IBD. However, little is known about the outcomes of such training. The aims of this study were to assess clinical and academic outcomes following advanced training in IBD. METHODS: We surveyed gastroenterologists who completed advanced IBD fellowships and compared competency and outcomes to gastroenterologists focusing in IBD who completed gastroenterology training alone. Participants completed a survey via REDCap. Continuous variables were compared using the Wilcoxon rank-sum test. Categorical variables were compared using chi-square or Fisher\u27s exact tests. RESULTS: A total of 104 physicians participated in the study. IBD fellowships were completed by 31 physicians (30%), of whom 29 (94%) felt their training was excellent. Management of complicated IBD (84%), research mentoring (74%), and career mentoring (71%) were felt to contribute most highly to professional development. Compared to non-advanced trained physicians, advanced trained physicians expressed higher levels of comfort with management of IBD during pregnancy ( CONCLUSIONS: This study suggests there may be clinical benefit to advanced IBD training. Importantly, this study identified that there are also unique challenges to the assessment of clinical competency in IBD training. Efforts by the IBD community to establish a registry of advanced trainees and improve competency assessments are needed

Sindrome di charge: risultati a lungo termine della riabilitazione audiologica

Obiettivo del presente lavoro è valutare i risultati della riabilitazione audiologica su un gruppo, numericamente consistente, di bambini affetti da sindrome di CHARGE. Lo studio è stato eseguito retrospettivamente, utilizzando il database dei pazienti pediatrici, presso l’Audiologia dell’Azienda Ospedaliero-Universitaria di Padova e di Ferrara. Sono stati individuati 31 bambini in totale, che hanno presentato diversi gradi di disabilità uditiva associata alla sindrome di CHARGE. La valutazione audiologica è stata eseguita utilizzando i potenziali evocati uditivi (ABR) e/o l’elettrococleografia, oppure le tecniche di audiometria infantile (VRA o play audiometry). Sono stati valutati anche i risultati percettivi, in termini di capacità di comunicazione e linguaggio espressivo. Sono quindi stati studiati gli effetti della riabilitazione uditiva (con apparecchio acustico o impianto cocleare) e in particolare lo sviluppo del linguaggio nel corso di un lungo follow-up. Gli esiti degli interventi riabilitativi sono risultati diversi in relazione alle eterogenee e spesso gravi disabilità associate alla sindrome di CHARGE (ad esempio, ritardo di sviluppo psico-fisico, gravi disturbi visivi concomitanti, disfunzioni uditive retrococleari per neuropatia uditiva/dissincronia associata). Anche dopo lungo follow-up, lo sviluppo del linguaggio è risultato gravemente compromesso nella maggior parte dei casi, suggerendo quindi la necessità di sviluppare modalità di comunicazione alternative in questo gruppo di piccoli Pazienti. L’identificazione precoce della sordità neurosensoriale e l’accurata pianificazione di trattamenti riabilitativi mirati, è in ogni caso fondamentale nei bambini con sindrome di CHARGE

Sustainable exploitation of residual cynara cardunculus l. To levulinic acid and n-butyl levulinate

Hydrolysis and butanolysis of lignocellulosic biomass are efficient routes to produce two valuable bio-based platform chemicals, levulinic acid and n-butyl levulinate, which find increasing applications in the field of biofuels and for the synthesis of intermediates for chemical and pharmaceutical industries, food additives, surfactants, solvents and polymers. In this research, the ac-id-catalyzed hydrolysis of the waste residue of Cynara cardunculus L. (cardoon), remaining after seed removal for oil exploitation, was investigated. The cardoon residue was employed as-received and after a steam-explosion treatment which causes an enrichment in cellulose. The effects of the main reaction parameters, such as catalyst type and loading, reaction time, temperature and heat-ing methodology, on the hydrolysis process were assessed. Levulinic acid molar yields up to about 50 mol % with levulinic acid concentrations of 62.1 g/L were reached. Moreover, the one-pot bu-tanolysis of the steam-exploded cardoon with the bio-alcohol n-butanol was investigated, demon-strating the direct production of n-butyl levulinate with good yield, up to 42.5 mol %. These results demonstrate that such residual biomass represent a promising feedstock for the sustainable production of levulinic acid and n-butyl levulinate, opening the way to the complete exploitation of this crop

Reconstructive Options after Oncological Rhinectomy: State of the Art

Background: The nose is a central component of the face, and it is fundamental to an individual's recognition and attractiveness. The aim of this study is to present a review of the last twenty years literature on reconstructive techniques after oncological rhinectomy. Methods: Literature searches were conducted in the databases PubMed, Scopus, Medline and Google Scholar. "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" for scoping review was followed. Results: Seventeen articles regarding total rhinectomy reconstruction were finally identified in the English literature, with a total of 447 cases. The prostheses were the reconstructive choice in 213 (47.7%) patients, followed by local flaps in 172 (38.5%) and free flaps in 62 (13.8%). The forehead flap (FF) and the radial forearm free flap (RFFF) are the most frequently used flaps. Conclusions: This study shows that both prosthetic and surgical reconstruction are very suitable solutions in terms of surgical and aesthetic outcomes for the patient

Human papillomavirus 9-valent vaccine for cancer prevention: a systematic review of the available evidence.

In 2014, the Food and Drug Administration approved a new human papillomavirus 9-valent vaccine (9vHPV), targeting nine HPV types: HPV types 6, 11, 16, and 18, which are also targeted by the quadrivalent HPV vaccine (qHPV), plus five additional high cancer risk HPV types (HPV types 31, 33, 45, 52, and 58). The aim of the current study was to systematically retrieve, qualitatively and quantitatively pool, as well as critically appraise all available evidence on 9vHPV from randomized controlled trials (RCTs). We conducted a systematic review of the literature on 9vHPV efficacy, immunogenicity and safety, as well as a systematic search of registered, completed, and ongoing RCTs. We retrieved and screened 227 records for eligibility. A total of 10 publications reported on RCTs' results on 9vHPV and were included in the review. Sixteen RCTs on 9vHPV have been registered on RCT registries. There is evidence that 9vHPV generated a response to HPV types 6, 11, 16 and 18 that was non-inferior to qHPV. Vaccine efficacy against five additional HPV type-related diseases was directly assessed on females aged 16-26 years (risk reduction against high-grade cervical, vulvar or vaginal disease = 96·7%, 95% CI 80·9%-99·8%). Bridging efficacy was demonstrated for males and females aged 9-15 years and males aged 16-26 years (the lower bound of the 95% CIs of both the geometric mean titer ratio and difference in seroconversion rates meeting the criteria for non-inferiority for all HPV types). Overall, 9vHPV has been proved to be safe and well tolerated. Other RCTs addressed: 9vHPV co-administration with other vaccines, 9vHPV administration in subjects that previously received qHPV and 9vHPV efficacy in regimens containing fewer than three doses. The inclusion of additional HPV types in 9vHPV offers great potential to expand protection against HPV infection. However, the impact of 9vHPV on reducing the global burden of HPV-related disease will greatly depend on vaccine uptake, coverage, availability, and affordability