Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients

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

Management of patients with chronic rhinosinusitis and nasal polyposis in Italy: expert opinion on the diagnostic-therapeutic approach (La gestione del paziente con rinosinusite cronica e poliposi nasale in Italia: expert opinion sul percorso diagnostico-terapeutico)

Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses; it can be characterized by nasal polyposis (CRSwNP) in up to 30% of cases. CRSwNP is frequently associated with bronchial asthma and patients affected show a greater severity of clinical disease with a significantly worse quality of life. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the increase of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target inflammatory molecules are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. The correct definition of the target patient, the type of biological drug to be used and the timing of intervention are crucial to guarantee a personalized therapy and optimize the cost/effectiveness of the treatment. A panel of Italian pneumologists, allergologists, immunologists and ear, nose and throat specialists discussed in a series of virtual expert meetings the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, the constant dialogue between doctor and patient, the organization in networks and the use of registries as strategies to implement the management of CRSwNP patients, to reach the personalization of the treatment and the best use of the biological drug(s)

Fetal MRI prior to intrauterine surgery of open neural tube defects: What does the radiologist need to know

: The management of myelomeningocele study trial showed significant prognostic improvement in fetal repair before 26 weeks of gestation. Hence, surgery in utero represents the best treatment option for open-neural tube defects (NTDs). Fetal surgery of open-NTDs has specific inclusion and exclusion criteria, which can be adequately studied with fetal MRI. The main concern: the spine (spinal defects other than Myelomeningocele and Myeloschisis, the level of the lesion higher than T1 or lower than S1 and the degree of kyphosis ≥ 30°), the skull/brain (no cerebellum herniation and Chiari II malformation and the presence of any intracranial abnormality unrelated to open NTDs), the uterus (cervix length less than 2 cm, multiple gestations and placental and uterine abnormalities) and any other fetal abnormality not attributed to spinal defect. In this review, we describe the fundamental role of fetal MRI in supporting therapeutic decisions in pre-surgery intrauterine planning through the accurate and comprehensive description of findings, providing a proposal of a structured report. In addition, we describe how post-surgical MRI is important in investigating the effectiveness of surgery and detecting repairing complications

Characterization of 150 μm\mu m thick silicon microstrip prototype for the FOOT experiment

International audienceThe goals of the FOOT (FragmentatiOn Of Target) experiment are to measure the proton double differential fragmentation cross-section on H, C, O targets at beam energies of interest for hadrontherapy (50–250 MeV for protons and 50–400 MeV/u for carbon ions), and also at higher energy, up to 1 GeV/u for radioprotection in space. Given the short range of the fragments, an inverse kinematic approach has been chosen, requiring precise tracking capabilities for charged particles. One of the subsystems designed for the experiment will be the MSD (Microstrip Silicon Detector), consisting of three x-y measurement planes, each one made by two single sided silicon microstrip sensors. In this document, we will present a detailed description of the first MSD prototype assembly, developed by INFN Perugia group and the subsequent characterization of the detector performance. The prototype is a wide area(∼ 100 cm$^{2}$) single sensor, 150 μm thick to reduce material budget and fragmentation probability along the beam path, with 50 μm strip pitch and 2 floating strip readout approach. The pitch adapter to connect strips with the readout channels of the ASIC has been implemented directly on the silicon surface. Beside the interest for the FOOT experiment, the results in terms of cluster signal, signal-to-noise ratio, dynamic range of the readout chips, as well as long-term stability studies in terms of noise, are relevant also for other experiments where the use of thin sensors is crucial

Characterization of 150 μm thick silicon microstrip prototype for the FOOT experiment

International audienceThe goals of the FOOT (FragmentatiOn Of Target) experiment are to measure the proton double differential fragmentation cross-section on H, C, O targets at beam energies of interest for hadrontherapy (50–250 MeV for protons and 50–400 MeV/u for carbon ions), and also at higher energy, up to 1 GeV/u for radioprotection in space. Given the short range of the fragments, an inverse kinematic approach has been chosen, requiring precise tracking capabilities for charged particles. One of the subsystems designed for the experiment will be the MSD (Microstrip Silicon Detector), consisting of three x-y measurement planes, each one made by two single sided silicon microstrip sensors. In this document, we will present a detailed description of the first MSD prototype assembly, developed by INFN Perugia group and the subsequent characterization of the detector performance. The prototype is a wide area(∼ 100 cm$^{2}$) single sensor, 150 μm thick to reduce material budget and fragmentation probability along the beam path, with 50 μm strip pitch and 2 floating strip readout approach. The pitch adapter to connect strips with the readout channels of the ASIC has been implemented directly on the silicon surface. Beside the interest for the FOOT experiment, the results in terms of cluster signal, signal-to-noise ratio, dynamic range of the readout chips, as well as long-term stability studies in terms of noise, are relevant also for other experiments where the use of thin sensors is crucial

The representation of the onset of the Covid-19 pandemic and the consequent lockdown in Italy: A psychosocial research by SPS, Studio di Psicosociologia of Rome

A fine febbraio 2020, in SPS4ci siamo chiesti quali fossero i vissuti evocati dalla pandemia Covid-19 in esordio, e quali fatti “derivassero” da tali vissuti. A tal fine abbiamo interpellato 419 persone, tra l’1 marzo e il 5 maggio 2020. Il corpus raccolto è stato analizzato con l’Analisi Emozionale del Testo (AET). Si ipotizzava che la pandemia avesse destrutturato le modalità abituali di rapporto, e pensavamo stessero emergendo dimensioni relazionali inedite. I nostri dati dicono che l’individualismo abituale, di avida competitività, è in crisi. In risposta alla destrutturazione dello schema relazionale amico/nemico, alla base della socialità, è emerso un nuovo individualismo. La rappresentazione del pericolo insito nel contagio pandemico ci ha reso, tutti, potenzialmente nemici gli uni degli altri. Tutti siamo vissuti come potenzialmente nemici di tutti, a meno di non essere dichiaratamente malati. I malati, di contro, non sono vissuti come nemici: sono un’alterità scissa, relegata in un altrove lontano da chi è “sano”. Le cure, nel lockdown, erano confinate nell’ospedale, caratterizzate dall’isolamento, dall’emergenza, dalla morte esperita nel peggiore dei modi. L’altrove è stato reificato in un ospedale diventato sintomatico del fallimento del sistema sanitario. Si è costituito un “noi” qui insieme, sani e maniacalmente felici, e un “loro”contagiati, dannati, isolati e “altrove”. Internet, consentendo vicinanza senza contatto, è diventata un nuovo contesto di socialità. Ha permesso di ridiventare umani, ovvero amici, a meno che non si dimostri il contrario. Ma la nuova amicalità è fondata sulla scissione dall’altro dannato: la coppia malato/curante, e tutti gli esclusi, per diverse motivazioni, dalla protezione del lockdown. Dalla nuova socialità è escluso anche il vissuto dello stare chiusi in casa con gli abituali conviventi, dove emerge la violenza delle relazioni familiari obbligate. Si evidenziano altri esclusi dal noi maniacalmente amicale: gli anziani che non usano internet e che più di tutti rischiano di morire. C’è poi una cultura che, entro il fallimento delle relazioni sociali abituali, sottolinea l’impotenza delle istituzioni (politiche, sanitarie, mediatiche etc.) nella contingenza pandemica. Infine, c’è una cultura pre-lockdown, fatta della paura che porterà a scegliere l’isolamento. Manca, nei dati, il mondo produttivo, che non ha ritrovato, per gli interpellati dalla ricerca –nel periodo di tempo da noi considerato –un codice emozionale condiviso che potesse raccogliersi in un cluster. La ricerca aveva anche un obiettivo di intervento: quello di creare un contesto in cui l’evento pandemia potesse essere interpretato, entro un setting di partecipazione. Oltre a effettuare una pubblicazione rapida dei dati, intendiamo promuovere gruppi di discussione su internet con i partecipanti. La creazione di un contesto di condivisione è anche un motivo dell’alto numero di Autori.At the end of February 2020, in SPS2we asked ourselves what were the experiences evoked by the Covid-19 pandemic in its debut, and what facts “derived”from these experiences. To this end, we interviewed 419 people, between 1 March and 5 May 2020. The collected corpus was analyzed through the Emotional Text Analysis (AET). It was assumed that the pandemic had deconstructed the usual ways of relating, and we thought that new relational dimensions were emerging. Our data show that habitual individualism, of greedy competitiveness, is in crisis. A new individualism has emerged in response to the deconstruction of the friend/foerelational schema, at the basis of sociality. The representation of the danger inherent in the pandemic contagion has made us all potentially enemies of each other. We have all lived as potentially enemies of all, unless we are admittedly sick. The sick, on the other hand, are not experienced as enemies: they are a split otherness, relegated to an elsewhere far from those who are “healthy”. Duringthe lockdown, treatments were confined to the hospital, characterized by isolation, emergency, death experienced in the worst way. The othernesswas reified in a hospital that became symptomatic of the failure of the health system. A “we”has formed here together, healthy and maniacally happy, and a “them”infected, damned, isolated and “elsewhere”. The Internet, by allowing contactless proximity, has become a new context of sociality. It has allowed us to become human again, or friends, unless proven otherwise. But the new friendship is based on the split from the damned other: the sick/caring couple, and all those excluded, for various reasons, from the protection of the lockdown. The experience of being closed at home with the usual cohabitants is also excluded from the new sociality, where the violence of forced family relationships emerges. There are others excluded from a maniacally friendlyus: the elderly who do not use the internet and who most of all risk dying. There is also a culture that, within the failure of habitual social relations, underlines the powerlessness of institutions (political, health, media, etc.) in the pandemic contingency. Finally, there is a pre-lockdown culture, made up of fear that will lead to chooseisolation. In the data, the productive world is missing, which for those interviewed by the research did not find -in the period of time we considered -a shared emotional code that could be gathered in a cluster. The research also had an intervention objective: to create a context in which the pandemicevent could be interpreted, within a setting of participation. In addition to publishing the data quickly, we intend to promote discussion groups onthe internet with participants. The creation of a sharing context is also areason for the high number of Author

The Drift Chamber detector of the FOOT experiment: Performance analysis and external calibration

The study that we present is part of the preparation work for the setup of the FOOT (FragmentatiOn Of Target) experiment whose main goal is the measurement of the double differential cross sections of fragments produced in nuclear interactions of particles with energies relevant for particle therapy. The present work is focused on the characterization of the gas-filled drift chamber detector composed of 36 sensitive cells, distributed over two perpendicular views. Each view consists of six consecutive and staggered layers with three cells per layer. We investigated the detector efficiency and we performed an external calibration of the space–time relations at the level of single cells. This information was then used to evaluate the drift chamber resolution. An external tracking system realized with microstrip silicon detectors was adopted to have a track measurement independent on the drift chamber. The characterization was performed with a proton beam at the energies of 228 and 80 MeV. The overall hit detection efficiency of the drift chamber has been found to be 0.929±0.008 , independent on the proton beam energy. The spatial resolution in the central part of the cell is about 150±10 μ m and 300±10 μ m and the corresponding detector angular resolution has been measured to be 1.62±0.16 mrad and 2.1±0.4 mrad for the higher and lower beam energies, respectively. In addition, the best value on the intrinsic drift chamber resolution has been evaluated to be in the range 60−100 μ m. In the framework of the FOOT experiment, the drift chamber will be adopted in the pre-target region, and will be exploited to measure the projectile direction and position, as well as for the identification of pre-target fragmentation events