A Retrospective Multicentre Cohort Review of Patient Characteristics and Surgical Aspects versus the Long-Term Outcomes for Recipients of a Fully Implantable Active Middle Ear Implant

OBJECTIVE: To summarise treatment outcomes compared to surgical and patient variables for a multicentre recipient cohort using a fully implantable active middle ear implant for hearing impairment. To describe the authors' preferred surgical technique to determine microphone placement. STUDY DESIGN: Multicentre retrospective, observational survey. SETTING: Five tertiary referral centres. PATIENTS: Carina recipients (66 ears, 62 subjects) using the current Cochlear® Carina® System or the legacy device, the Otologics® Fully Implantable Middle Ear, with a T2 transducer. METHODS: Patient file review and routine clinical review. Patient outcomes assessed were satisfaction, daily use and feedback reports at the first fitting and ≥12 months after implantation. Descriptive and statistical analysis of correlations of variables and their influence on outcomes was performed. Independently reported preferred methods for microphone placement are collectively summarised. RESULTS: The average implant experience was 3.5 years. Satisfaction increased significantly over time (p < 0.05). No correlation with covariates examined was observed. Feedback significantly decreased over time, showing a significant correlation with microphone location, primary motivation, gender, age at implantation, and contralateral hearing aid use (p < 0.05). Patient satisfaction was inversely correlated with reports of system feedback (p < 0.05). The implantable microphone was most commonly on the posterior inferior mastoid line, in 42/66 (65%) cases, correlating with less likelihood for feedback and consistent with author surgical preference. CONCLUSION: Carina recipients in this study present as satisfied consistent daily users with very few reports of persistent feedback. As microphone location is an influencing factor, a careful surgical consideration of microphone placement is required. The authors prefer a posterior inferior mastoid line position whenever possible

Historical assumptions of lymphadenectomy

Abstract: The role of lymphadenectomy for the treatment of gastric cancer is still very much open to debate. Consequently, Japanese, European and American surgeons perform different typologies of lymphadenectomy because of the absence of randomized clinical trials confirming the superiority of extended lymphadenectomy over less invasive surgery. In Japan, D2 lymphadenectomy has been considered as the gold standard for advanced gastric carcinoma for many years. Although numerous European studies have been conducted in an attempt to find differences between D1 and D2 lymphadenectomy, none has succeeded to date. The decision to wait for results attesting to the fact that D2 guarantees a better outcome than D1 resulted in a long delay in the implementation of D2 as the gold standard treatment in Europe. In the U.S., the study by Macdonald et al. established D1 lymphadenectomy followed by chemoradiotherapy as the treatment of choice for advanced cancer, whereas D2 is officially indicated as the gold standard in the most recent European guidelines [the Italian Research Group for Gastric Cancer (GIRGC), German, British, ESSO]. Interestingly, European guidelines for lymphadenectomy are not based on evidence-based medicine but rather on the experience of the most important centers involved in the treatment of gastric cance

Aseismic creep and gravitational sliding on the lower eastern flank of Mt. Etna: Insights from the 2002 and 2022 fault rupture events between Santa Venerina and Santa Tecla

Fault creep along the lower eastern flank of Mt. Etna volcano has been documented since the end of the 19th century and significantly contributes to the surface faulting hazard in the area. On 29 October 2002, during a seismic swarm related to dyke intrusions, two earthquakes caused extensive damage and surface faulting in an area between the Santa Venerina and Santa Tecla villages. On the same day after the two earthquakes, an episodic aseismic creep occurred along the Scalo Pennisi Fault close to the Santa Tecla coastline. On 8 February 2022, during another aseismic creep event along the Scalo Pennisi Fault, we observed the reopening of the pre-existing 2002 ground ruptures mostly as pure dilational fractures. We mapped the 2002 and 2022 surface ruptures, and collected data on displacement, length, and pattern of ground breaks. Ground ruptures affected structures located along the activated fault segments, including roads, walls and buildings. The 2002 surface faulting propagation can be ascribed to a sliding of the Mt. Etna eastern flank toward the SE, as also suggested by the related shallow seismicity, and InSAR and geodetic data between 2002 and 2005. For the 2022 event, differential InSAR data, acquired in both descending and ascending views, allowed us to decompose Line of Sight (LOS) displacement into horizontal and vertical components. We detect a ~ 700 long and ~ 500 m wide deformation zone with a downward and eastward motion (max displacement ~1,5 cm) consistent with a normal fault. We inverted the InSAR–detected surface deformation using a uniform-slip fault model and obtained a shallow detachment for the causative fault, located at ~300 m depth, within the volcanic pile. This is the first in-depth study along the Scalo Pennisi Fault to suggest a shallow faulting that accommodates Mt. Etna E flank gravitational sliding

Conversion surgery for gastric cancer: A cohort study from a western center

Background: Advanced unresectable gastric cancer has a dismal prognosis. The aim of this study was to evaluate the short- and long-term outcomes of patients who underwent induction chemotherapy ± gastrectomy for advanced gastric cancer. Material and methods: All patients referred to our center with a clinical diagnosis of unresectable locally advanced or stage IV gastric adenocarcinoma between April 2005 and August 2016 were included in the study. Cox regression was performed to find independent prognostic factor among the considered variable. Results: The cohort included 73 patients: 16 had best supportive care, 35 chemotherapy alone and 22 chemotherapy plus radical surgery. Thirty-three patients underwent surgery after chemotherapy. Twenty-two patients had R0 surgery, while the remaining 11 had only an exploratory procedure. Nine patients (40.9%) underwent gastrectomy plus hyperthermic intraperitoneal chemotherapy. Three patients out of 22 developed postoperative complications with a Clavien-Dindo grade above 2. Median survival was 50 months for patients who had chemotherapy plus surgery while it was 14 and 3 for those who had chemotherapy alone and best supportive care, respectively (p < 0.0001). Cox regression analysis performed on the whole cohort identified only radical conversion surgery as an independent factor positively associated with survival (HR 0.12, 95% CI 0.05–0.29, p < 0.0001). Conclusion: Conversion gastrectomy, when R0 could be achieved, is associated with long survivals and it is the most important prognostic factor in patients with advanced gastric cancer. Further studies are needed to define the ideal patient who can really benefit from this treatment

Preoperative Mapping of the Sensorimotor Cortex: Comparative Assessment of Task-Based and Resting-State fMRI

<div><p>Resting state fMRI (rs-fMRI) has recently been considered as a possible complement or alternative to task-based fMRI (tb-fMRI) for presurgical mapping. However, evidence of its usefulness remains scant, because existing studies have investigated relatively small samples and focused primarily on qualitative evaluation. The aim of this study is to investigate the clinical usefulness of rs-fMRI in the context of presurgical mapping of motor functions, and in particular to determine the degree of correspondence with tb-fMRI which, while not a gold-standard, is commonly used in preoperative setting. A group of 13 patients with lesions close to the sensorimotor cortex underwent rs-fMRI and tb-fMRI to localize the hand, foot and mouth motor areas. We assessed quantitatively the degree of correspondence between multiple rs-fMRI analyses (independent-component and seed-based analyses) and tb-fMRI, with reference to sensitivity and specificity of rs-fMRI with respect to tb-fMRI, and centre-of-mass distances. Agreement with electro-cortical stimulation (ECS) was also investigated, and a traditional map thresholding approach based on agreement between two experienced operators was compared to an automatic threshold determination method. Rs-fMRI can localize the sensorimotor cortex successfully, providing anatomical specificity for hand, foot and mouth motor subregions, in particular with seed-based analyses. Agreement with tb-fMRI was only partial and rs-fMRI tended to provide larger patterns of correlated activity. With respect to the ECS data available, rs-fMRI and tb-fMRI performed comparably, even though the shortest distance to stimulation points was observed for the latter. Notably, the results of both were on the whole robust to thresholding procedure. Localization performed by rs-fMRI is not equivalent to tb-fMRI, hence rs-fMRI cannot be considered as an outright replacement for tb-fMRI. Nevertheless, since there is significant agreement between the two techniques, rs-fMRI can be considered with caution as a potential alternative to tb-fMRI when patients are unable to perform the task.</p></div

Activation volumes (calculated over the corresponding anatomical masks), overlap sensitivity (α) and specificity (β) of resting-state fMRI (rs-fMRI) with respect to task-based fMRI (tb-fMRI), obtained with AMPLE thresholds.

<p>Sign ‘-’ denotes unavailable maps; ‘- - ’ denotes unavailable α and β calculation due to lack of tb-fMRI map (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0098860#pone-0098860-t002" target="_blank">Table 2</a>); aROI: seed-based analysis using anatomical ROI, fROI: seed-based analysis using functional ROI, ICA: independent-component analysis.</p

Example of direct comparison between the thresholds chosen by two operators and the thresholds determined by AMPLE.

<p>Concordance between task-based (tb-fMRI, in green) and resting-state (rs-fMRI, in red) fMRI maps computed with aROI. Overlap sensitivity (α) and specificity (β) of rs-fMRI with respect to tb-fMRI are reported. a) For case 1 mapping of the hand area with AMPLE was satisfactory and aROI sensitivity increased with respect to the operator-dependent threshold. b) For case 9 mapping of the foot area with AMPLE was good with tb-fMRI, while with aROI the paracentral lobule was not activated and aROI sensitivity decreased with respect to the operator-dependent threshold. c) In case 8 mapping of the mouth area with AMPLE was successful with both tb-fMRI and rs-fMRI and results were similar to those obtained with the operator-dependent threshold. Images are shown in neurological convention (left is left) and MNI coordinates are reported on top of each slice.</p

Summary of administered tasks, quality of motor performance and available functional maps.

<p>Good denotes satisfactory and symmetrical performance, failed denotes inability to tap using all fingers, weaker denotes ability to tap but more slowly or with smaller movements. Superscript ‘*’ indicates that the patient did not tap but counted by finger extension; ‘#’ indicates that the patient performed the task well with the affected hemisoma but had plegic contralateral hand since birth; ‘√’ and ‘-’ respectively denote maps that were deemed satisfactory and unusable; n.a. indicates not available; task-based fMRI (tb-fMRI); aROI: seed-based analysis using anatomical ROI; fROI: seed-based analysis using functional ROI; ICA: independent-component analysis; electro-cortical stimulation (ECS) responses.</p