Bell's palsy: Symptoms preceding and accompanying the facial paresis

This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy

3D curved multiplanar cone beam CT reconstruction for intracochlear position assessment of straight electrodes array. A temporal bones and patients study

A retrospective review of post-op cone beam CT (CBCT) of 8 adult patients and 14 fresh temporal bones that underwent cochlear implantation with straight flexible electrodes array was performed to determine if the position of a long and flexible electrodes array within the cochlear scalae could be reliably assessed with CBCT. An oto-radiologist and two otologists examined the images and assessed the electrodes position. The temporal bone specimens underwent histological analysis for confirm the exact position. The position of the electrodes was rated as scala tympani, scala vestibule, or intermediate position for the electrodes at 180°, 360° and for the apical electrode. In the patient group, for the electrodes at 180° all observers agreed for scala tympani position except for 1 evaluation, while a discrepancy in 3 patients both for the 360° and for the apical electrode assessment were found. In five temporal bones the evaluations were in discrepancy for the 180° electrode, while at 360° a disagreement between raters on the scalar positioning was seen in six temporal bones. A higher discrepancy between was found in assessment of the scalar position of the apical electrode (average pairwise agreement 45.4%, Fleiss k = 0.13). A good concordance was found between the histological results and the consensus between raters for the electrodes in the basal turn, while low agreement (Cohen’s k 0.31, pairwise agreement 50%) was found in the identification of the apical electrode position confirming the difficulty to correct identify the electrode position in the second cochlear turn in temporal bones. In conclusion, CBCT is a reliable radiologic exam to correctly evaluate the position of a lateral wall flexible array in implanted patients using the proposed imaging reconstruction method, while some artefacts impede exact evaluation of the position of the apical electrode in temporal bone and other radiological techniques should be preferred in ex vivo studies

Provoked Vestibulodynia and Topical Treatment: A New Option

Background: Provoked vestibulodynia is commonly associated with dyspareunia and affects 7% to 15% of women. This pathology has major implications on sexual function and quality of life, and several types of treatments are available for its management. However, a consensus has not been reached concerning the best treatment of vulvar pain. The aim of this study was to assess the efficacy and safety of a brand-new product, the vulvar emulgel Meclon (R) Lenex, for the management of provoked vestibulodynia and non-infective vulvitis. Methods: This was a monocentric, prospective, randomized, double-blind and placebo-controlled study. We enrolled 40 women with provoked vestibulodynia; 20 patients received Meclon (R) Lenex, whereas the remaining received a placebo. Each woman was assessed subjectively (through questionnaires) and objectively by evaluating vaginal and vulvar symptoms (Friedrichs criteria and Marinoff dyspareunia grade). We evaluated efficacy, safety, compliance and tolerability of the brand-new product vulvar gel Meclon (R) Lenex in provoked vestibulodynia. Results: After administration of Meclon (R) Lenex, we evaluated all parameters of the Friedrichs criteria (burning, dyspareunia, erythema, vulvar pain at the 5 o'clock position and 7 o'clock position), as well as the levels of Marinoff dyspareunia. The active treatment showed to be statistically significantly effective (p value <= 0.05) in reducing all symptoms of Friedrichs criteria, vulvar pain and Marinoff dyspareunia. Conclusion: This prospective study showed that Meclon (R) Lenex vulvar emulgel revealed an excellent tolerability and compliance, demonstrating to be a safe and effective option in the treatment of provoked vestibulodynia and non-infective vulvitis

Lactobacillus (L.) acidophilus, L. plantarum, L. rhamnosus and L. reuteri Cell-Free-Supernatants inhibit Candida parapsilosis pathogenic potential upon infection of vaginal epithelial cells monolayer and in a transwell co-culture system in vitro.

Vulvovaginal candidiasis (VVC) is a common clinical condition with symptoms and signs of vaginal inflammation in the presence of Candida species. At least one episode of VVC is experienced in up to 75% of women in the reproductive age group during their lifetime, and 5-8% of such women suffer from the chronic form. Most cases of VVC are still caused by C. albicans; however, the incidence of VVC cases by non-albicans (NAC) species, such as C. parapsilosisis, is continuously increasing. Despite the prevalence of VVC from NAC, to date little is known on these species, and almost nothing on the mechanisms that trigger the VVC. Lactobacillus spp. are the most represented microorganisms in the vaginal microbiota of healthy women. Here, cell-free supernatants (CFS) obtained from L. acidophilus, L. plantarum, L. rhamnosus, L. reuteri were assessed for their effect on C. parapsilosis virulence traits. Moreover, we assessed if such effect persists even after removal of the CFS (CFS-preincubation effect). Moreover, a transwell co-culture system was employed, by which the relevant antifungal effect was shown to be attributable to the compounds released by Lactobacilli. Our results suggests that Lactobacilli can work: a) by reducing C. parapsilosis virulence traits, as indicated by the reduced fungal proliferation, viability and metabolic activity and b) by improving epithelial resistance to the fungus. Overall, these data suggest that, in the context of vaginal microbiota, the Lactobacilli may play a role in preventing the onset of mucosal C. parapsilosis infection

Distinctive physiological muscle synergy patterns define the Box and Block Task execution as revealed by electromyographic features

Stroke survivors experience muscular pattern alterations of the upper limb that decrease their ability to perform daily-living activities. The Box and Block test (BBT) is widely used to assess the unilateral manual dexterity. Although BBT provides insights into functional performance, it returns limited information about the mechanisms contributing to the impaired movement. This study aims at exploring the BBT by means of muscle synergies analysis during the execution of BBT in a sample of 12 healthy participants with their dominant and non-dominant upper limb. Results revealed that: (i) the BBT can be described by 1 or 2 synergies; the number of synergies (ii) does not differ between dominant and non-dominant sides and (iii) varies considering each phase of the task; (iv) the transfer phase requires more synergies. Clinical Relevance— This preliminary study characterizes muscular synergies during the BBT task in order to establish normative patterns that could assist in understanding the neuromuscular demands and support future evaluations of stroke deficit

Ricostruzione multiplanare 3D di immagini cone beam per lidenficazione della posizione degli impianti cocleari. Studio su ossi temporali e pazienti impiantati

Questo studio riporta unanalisi retrospettica delle immagini cone beam CT effettuate su 8 pazienti adulti sottoposti ad impianto cochleare MedEl flex 28 e su 14 ossi temporali impiantati con lo stesso tipo di array portaelettrodi. Lo scopo dello studio é di determinare laffidabilità della metodica cone beam CT nella valutazione della posizione intracocleare degli elettrodi in impianti che si posizionano lungo la parete laterale del lume cocleare, quindi non perimodiolari la cui posizione é più facilmente identificabile. Un otoradiologo e due otologi hanno analizzato le immagini e assegnato la posizione per ciascun elettrodo localizzato nella regione dei 180° e dei 360° del primo giro cocleare e per lelettrodo apicale scegliendo tra scala timpanica, vestibulare o posizione intermedia Lanalisi istologica ha successivamente confermato lesatta posizione negli ossi temporali. Nel gruppo dei pazienti per lelettrodo a 180° i tre esperti concordavano sulla posizione in scala timpanica in tutti eccetto un paziente, mentre una discordanza nella valutazione era presente in 3 pazienti per gli elettrodi a 360° e per gli elettrodi apicali. Negli ossi temporali in 5 casi era presente una discordanza per lelettrodo a 180°, mentre a 360° sei valutazioni erano discordanti tra i valutatori. Una disdcordanza tra le valutazioni più elevata veniva trovata per la la posizione dellelettrodo apicale (concordanza valutatori 45.4%, Fleiss k = 0,13). Un buon grado di concordanza veniva trovato tra i risultati istologici e le valutazioni tra i valutatori per gli elettrodi localizzati nel giro basale; un grado più basso esisteva per la posizione degli elettrodi apicali (concordanza valutatori 50%, Cohens k = 0,31) confermando la difficoltà nella corretta valutazione della posizione degli elettrodi nella regione più apicale negli ossi temporali. In conclusione, le immagini cone beam postoperatorie analizzate con la metodica della ricostruzione multiplanare 3D rappresentano una metodica affidabile per lo studio della posizione intracocleare degli elettrodi a posizionamento laterale nei pazienti impiantati. La corretta identificazione del posizionamento dellelettrodo piu apicale risulta difficile su osso temporale per la presenza di un artefatto più importante o per la minore resistenza delle strutture della parete laterale della coclea (legamento spirale, membrane basilare) nel preparato istologico (osso temporale fresco/congelato) che è responsabile di un maggior numero di traslocazioni dalla rampa timpanica alla rampa vestibolare e di localizzazioni intermedie più difficilmente interpretabili

High-quality CMOS compatible n-type SiGe parabolic quantum wells for intersubband photonics at 2.5-5 THz

A parabolic potential that confines charge carriers along the growth direction of quantum wells semiconductor systems is characterized by a single resonance frequency, associated to intersubband transitions. Motivated by fascinating quantum optics applications leveraging on this property, we use the technologically relevant SiGe material system to design, grow, and characterize n-type doped parabolic quantum wells realized by continuously grading Ge-rich Si1-x Ge x alloys, deposited on silicon wafers. An extensive structural analysis highlights the capability of the ultra-high-vacuum chemical vapor deposition technique here used to precisely control the quadratic confining potential and the target doping profile. The absorption spectrum, measured by means of Fourier transform infrared spectroscopy, revealed a single peak with a full width at half maximum at low and room temperature of about 2 and 5 meV, respectively, associated to degenerate intersubband transitions. The energy of the absorption resonance scales with the inverse of the well width, covering the 2.5-5 THz spectral range, and is almost independent of temperature and doping, as predicted for a parabolic confining potential. On the basis of these results, we discuss the perspective observation of THz strong light-matter coupling in this silicon compatible material system, leveraging on intersubband transitions embedded in all-semiconductor microcavities

Non-hormonal strategies for managing menopausal symptoms in cancer survivors: an update

Vasomotor symptoms, particularly hot flushes (HFs), are the most frequently reported symptom by menopausal women. In particular, for young women diagnosed with breast cancer, who experience premature ovarian failure due to cancer treatments, severe HFs are an unsolved problem that strongly impacts on quality of life. The optimal management of HFs requires a personalised approach to identify the treatment with the best benefit/risk profile for each woman. Hormonal replacement therapy (HRT) is effective in managing HFs but it is contraindicated in women with previous hormone-dependent cancer. Moreover, many healthy women are reluctant to take HRT and prefer to manage symptoms with non-hormonal strategies. In this narrative review, we provide an update on the current available non-oestrogenic strategies for HFs management for women who cannot, or do not wish to, take oestrogens. Since isoflavones have oestrogenic properties and it is not known if they can be safely consumed by women with previous hormonedependent cancer, they were excluded. Selective serotonin reuptake inhibitors/selective serotonin-norepinephrine reuptake inhibitors, as well as other neuroactive agents, some herbal remedies and behavioural strategies are considered

A fast and long-lived outflow from the supermassive black hole in NGC 5548

Supermassive black holes in the nuclei of active galaxies expel large amounts of matter through powerful winds of ionized gas. The archetypal active galaxy NGC 5548 has been studied for decades, and high-resolution X-ray and UV observations have previously shown a persistent ionized outflow. An observing campaign in 2013 with six space observatories shows the nucleus to be obscured by a long-lasting, clumpy stream of ionized gas never seen before. It blocks 90% of the soft X-ray emission and causes simultaneous deep, broad UV absorption troughs. The outflow velocities of this gas are up to five times faster than those in the persistent outflow, and at a distance of only a few light days from the nucleus, it may likely originate from the accretion disk.Comment: 25 pages, 8 figures. This is the author's version of the work. It is posted here by permission of the AAAS for personal use, not for redistribution. The definitive version was published in Science, electronically available at Science Express (June 19, 2014). For a brief video explaining the key results of this paper, please visit http://www.issibern.ch/teams/ngc5548/?page_id=2