Almost γ

In this paper, a new class of functions called almost γ-continuous is introduced and their several properties are investigated. This new class is also utilized to improve some published results concerning weak continuity [6] and γ-continuity [2]

On the δ

In this paper, we define and investigate the δ-continuous retraction and the δ-continuous fixed point property. Theorem 1 of Connell [11] and Theorem 3.4 of Arya and Deb [2] are improved

Management of idiopathic epistaxis in adults: what's new? [Il trattamento dell’epistassi idiopatica nell’adulto: cosa c’è di nuovo?]

L’epistassi è uno dei disturbi più comuni per il quale il paziente si rivolge spesso al pronto soccorso. Questa revisione della letteratura sipropone di valutare sistematicamente e criticamente gli studi scientifici riguardo il trattamento dell’epistassi idiopatica al fine di ottenere utili spunti per la pratica clinica. La ricerca è stata eseguita nei database elettronici: PubMed, Embase, Cochrane e Central. I criteri di inclusione sono stati: studi clinici controllati retrospettivi o prospettici o randomizzati o studi su modelli animali che includevano i risultati nella gestione dell’epistassi idiopatica. Sono stati individuati 23 articoli che soddisfano i criteri di inclusione. Il tamponamento nasale rappresenta ancora l’approccio di prima linea all’epistassi, anche se è evidente dalla letteratura che sia il meno efficace ma il più associato a ricoveri ospedalieri di maggior durata rispetto alla chirurgia endoscopica basata sull’elettrocoagulazione. In conclusione appare sempre più evidente che la cauterizzazione dovrebbe essere l’approccio di prima linea per l’alto tasso di costo-efficacia e il basso rischio di complicanze. Tuttavia, ulteriori ricerche urgenti sono necessarie per validare l’efficacia dei nuovi biomateriali nel trattamento dell’epistassi.Epistaxis is one of the most common complaints presenting to emergency departments. The aim of this study is to systematically review and critically evaluate the evidence relating to treatment of idiopathic epistaxis for guiding best practice. A comprehensive review of the English language literature was performed using PubMed, Embase, Cochrane Library and Central electronic databases. The inclusion criteria were: retrospective or prospective or randomised controlled clinical trials which included outcomes in the management of idiopathic epistaxis. Twentythree articles met inclusion criteria and were reviewed. Nasal packing still represents the first-line approach to epistaxis, although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective and associated with more admissions and longer hospital stays than endoscopic electrocoagulation-based management of epistaxis. In conclusion, cauterisation should be the first-line approach for its high cost-effectiveness rate and low risk of complications. Further research is urgently needed to assess the efficacy of new biomaterials

Multidisciplinarity in Transition Pathways for Patients With Kidney Disease: The Current State of Play

In the field of medical care, successful transition from pediatric-centered to adult-oriented healthcare can provide a sense of continuity in the development of youth, and prepare them to accept responsibility for and manage their own chronic kidney condition in complete autonomy. The so-called transition process requires the presence of some basic aspects: a multidisciplinary team, which acts as a bridge between child and adult services; a comprehensive clinical, cognitive, psychological, and social change for the young people; the involvement of family and caregivers. Within the framework of transition and chronicity during the developmental age, we selected international papers explaining models which agreed on some important steps in the transition process, although many differences can be observed between different countries. In fact, in Europe, the situation appears to be heterogeneous as regards certain aspects: the written transition plan, the educational programmes, the timing of transfer to adult services, the presence of a transition coordinator, a dedicated off-site transition clinic. We then analyzed some studies focusing on patients with renal diseases, including the first to contain a standardized protocol for transition which was launched recently in the USA, and which seems to have already achieved important positive, although limited, results. In Italy, the issue of transition is still in its infancy, however important efforts in the management of chronic kidney disease have already been initiated in some regions, including Emila Romagna, which gives us hope for the future of many young people

Palatal surgery in a transoral robotic setting (TORS): preliminary results of a retrospective comparison between uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP) and barbed repositioning pharyngoplasty (BRP)

Negli ultimi anni si è diffusa lopinione che la chirurgia multilivello nel trattamento della sindrome delle apnee ostruttive garantisca risultati pià soddisfacenti. Lobiettivo del nostro lavoro è quello di confrontare tre tecniche palatali associate alla TORS: luvulopalatofaringoplastica (UPPP), lexpansion sphincter pharyngoplasy (ESP) e la barbed repositioning pharingoplasty (BRP). Trenta pazienti, trattati con TORS, tonsillectomia e settoturbinoplastica e chirurgia palatale sono stati retrospettivamente studiati. I seguenti valori pre e post-operatori sono stati presi in considerazione: AHI, ESS, VAS per la valutazione del dolore, tempi operatori palatali, data di dimissione e complicanze (tipi ed incidenza). Sia la BRP che lESP hanno garantito dei valori postoperatorio di AHI inferiori rispetto allUPPP con un maggior tasso di successo chirurgico. Dallaltra parte non è stato possibile dimostrare una superiorità della BRP sullESP. I tempi operatori più lunghi sono stati registrati nel gruppo ESP mentre i più brevi sono stati riscontrati nel gruppo BRP. Riassumendo, ESP e BRP sono risultate più efficaci dellUPPP in un setting robotico multilivello. Inoltre, essendo una tecnica rapida, di facile apprendimento e dal basso tasso di complicanze, la BRP si presenta come una valida opzione chirurgica nel trattamento dellOSAS

Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation

La decannulazione è sempre stata considerata una procedura con un certo grado di rischio, specie nei pazienti con ridotti diametri delle via aeree, come nel caso della sindrome delle apnee ostruttive (OSA). Presentiamo 4 casi nei quali la chirurgia robotica transorale (TORS) ha permesso un appropriato management di pazienti tracheotomizzati da divers mesi. Gli obiettivi del nostro lavoro sono: 1. Dimostrare come il team otorinolaringoiatrico possa favorire il riconoscimento di pazienti ad alto rischio di decannulazione inefficace e 2. Evidenziare il ruolo nella TORS nel trattamento dellipertrofia della base della lingua, responsabile dellostruzione delle vie aeree superiori. Dalla nostra esperienza la TORS appare una tecnica efficace nella decannulazione di pazienti affetti da ipertrofia della base della lingua e da epiglottide flottante

Acquired nasopharyngeal stenosis correction using a modified palatal flaps technique in obstructive sleep apnea (OSA) patients

Background: Acquired nasopharyngeal stenosis is a rare and heterogeneous pathological condition that has different causes, generally resulting as a complication of a pharyngeal surgery, especially in patients affected by obstructive sleep apnea (OSA). Different approaches have been proposed for the treatment of nasopharyngeal stenosis but a unique and standardized management has not yet been presented. The aim of our paper is to evaluate the efficacy of our surgical technique, describing its steps and results with the aim to consider it as a possible solution for the treatment of this condition. Methods: This is a retrospective cohort study. Eight patients (mean age 27.25 years old (yo), range 8–67 yo; Male/Female ratio 4/4; mean body mass index (BMI) 26.1) affected by OSA (mean apnea hypopnea index (AHI) before OSA surgery was 22.1) and acquired nasopharyngeal stenosis as a consequence of different pharyngeal surgeries were treated with our modified approach in the Department of Otolaryngology, Morgagni Pierantoni Hospital, Forlì, Italy. Resolution of stenosis and complication rate were the main outcome measures. Results: Complete resolution of the stenosis was achieved in all cases and no complications were recorded at three weeks, six months, and 2 years follow-up. Conclusions: Our technique appears to be a promising method for the management of nasopharyngeal stenosis in OSA patients. However, further studies comparing different techniques and reporting on larger series and longer follow up time are needed to prove the efficacy of the proposed technique

Trans-oral robotic surgery for the management of oropharyngeal carcinomas: A 9-year institutional experience

Trans-oral robotic surgery (TORS) has changed surgical management of patients with oropharyngeal squamous cell carcinomas (OPSCC). In this study we present surgical and oncologic outcomes of patients with oropharyngeal squamous cell carcinomas, treated using TORS, with and without an adjuvant therapy. Sixty patients with oropharyngeal squamous cell carcinomas treated with TORS between January 2008 and December 2017 have been retrospectively evaluated considering clinicopathologic features, disease characteristics, adjuvant treatments and oncological outcomes. TORS was performed for OPSCC to the base of tongue in 41.7%, tonsils in 46.7%, soft palate and posterior pharyngeal wall in 3.3% and 5%, respectively. Neck dissection was performed in 43.3% of patients. Management strategies included surgery alone in 30%, TORS and adjuvant radiotherapy in 33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year overall survival of the total group was 77.6%, the 5-year disease-free survival rate was 85.2%, and the 5-year local recurrence-free survival rate was 90.6%. Finally, in selected patients TORS appears to yield similar oncologic outcomes and functional outcomes to traditional techniques and non-operative treatment with a possible benefit on long-term quality of life. The future offers exciting opportunities to combine TORS and radiotherapy in unique ways. However, further research is urgently needed to clarify the indications for adjuvant therapy following TORS resections

Features of Mild-to-Moderate COVID-19 Patients with Dysphonia

Introduction To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients. Methods The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and non-dysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis. Results A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (p=0.022). The proportion of smokers was significantly higher in the dysphonic group (p=0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with non-dysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain and nasal obstruction was higher in dysphonic group compared with non-dysphonic group. There were significant associations between the severity of dysphonia, dysphagia and cough. Conclusion Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than non-dysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation