Unsuspected Hyoid Bone Fracture Following a Sport Laryngeal Trauma

A years old man sustained a fracture of the hyoid bone following closed neck injury while weight lifting in the gym Though commonly occurring in association of other neck fractures of the laryngeal skeleton the fracture was isolated Isolated hyoid bone fractures resulting from trauma other than strangulation are very rare and occur more frequently in young men more than in women These fractures are usually managed conservatively with good results as indeed our case wa

Coarse Grained Density Functional Theories for Metallic Alloys: Generalized Coherent Potential Approximations and Charge Excess Functional Theory

The class of the Generalized Coherent Potential Approximations (GCPA) to the Density Functional Theory (DFT) is introduced within the Multiple Scattering Theory formalism for dealing with, ordered or disordered, metallic alloys. All GCPA theories are based on a common ansatz for the kinetic part of the Hohenberg-Kohn functional and each theory of the class is specified by an external model concerning the potential reconstruction. The GCPA density functional consists of marginally coupled local contributions, does not depend on the details of the charge density and can be exactly rewritten as a function of the appropriate charge multipole moments associated with each lattice site. A general procedure based on the integration of the 'qV' laws is described that allows for the explicit construction the same function. The coarse grained nature of the GCPA density functional implies great computational advantages and is connected with the O(N) scalability of GCPA algorithms. Moreover, it is shown that a convenient truncated series expansion of the GCPA functional leads to the Charge Excess Functional (CEF) theory [E. Bruno, L. Zingales and Y. Wang, Phys. Rev. Lett. {\bf 91}, 166401 (2003)] which here is offered in a generalized version that includes multipolar interactions. CEF and the GCPA numerical results are compared with status of art LAPW full-potential density functional calculations for 62, bcc- and fcc-based, ordered CuZn alloys, in all the range of concentrations. These extensive tests show that the discrepancies between GCPA and CEF are always within the numerical accuracy of the calculations, both for the site charges and the total energies. Furthermore, GCPA and CEF very carefully reproduce the LAPW site charges and the total energy trends.Comment: 19 pages, 11 figure

Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

Iatrogenic Impairment of Hearing During Surgery for Acoustic Neuroma

Isolated or combined labyrinthine, neural, and vascular damage account for failure to preserve hearing during removal of acoustic neuromas. However, the specific mechanisms of auditory impairment remain unclear unless surgical maneuvers can be related to peri- and postoperative hearing on the basis of intraoperative monitoring of auditory function. Among the different auditory monitoring techniques, recording of cochlear nerve action potentials (CNAPs) from the intracranial portion of the nerve has proven particularly useful for identifying the mechanisms of iatrogenic auditory injury. The present investigation analyzes intra- and postoperative auditory impairment in relation to surgical steps in a group of 38 subjects with acoustic neuroma (size ranging from 5 to 24 mm) undergoing removal via a retrosigmoid approach. Coagulation close to the cochlear nerve, drilling of the internal auditory canal, and removal of the intrameatal portion of the acoustic neuroma have prove to be the most critical surgical steps in hearing preservation. Changes were correlated with intra- and extrameatal tumor size, the relationship between the internal auditory canal and vestibule, and internal auditory canal enlargement, anatomic involvement of the cochlear nerve, preoperative auditory level, and ABR and ENG test findings. Changes in CNAP morphology and latency are detailed, and mechanisms of injury are analyzed and discussed as a function of these variables

Intraoperative Monitoring for Hearing Preservation and Restoration in Acoustic Neuroma Surgery

The present article reports on our experience with hearing preservation during 158 acoustic neuroma (AN) operations via the retrosigmoid-transmeatal (RS-TM) approach with the aid of intraoperative auditory monitoring. Several auditory monitoring methods are described. Of these, the bipolar cochlear nerve action potential (CNAP) was found to be the most helpful in preserving hearing. Of 106 patients with useful hearing preoperatively, more than 50% had useful hearing after surgery. Electrical auditory brainstem responses were useful in the placement of an auditory brain stem implant (ABI) in 4 patients with neurofibromatosis type 2 (NF2). All 4 reported speech perception benefit and use their ABIs regularly in their lives. It is our firm belief that intraoperative auditory monitoring has a pivotal role in the preservation and restoration of hearing in AN surgery

Advantages of the Retrosigmoid Approach in Auditory Brain Stem Implantation

From April 1997 to December 1999, six patients (five men and one woman), ranging in age from 22 to 37 years with neurofibromatosis type 2 (NF2) were operated on via the classic retrosigmoid-transmental (RS-TM) approach for removal of a vestibular schwannoma (VS) (tumor size from 12 to 40 mm) and for auditory brain stem implantation (ABI). After tumor removal, the floor of the lateral recess of the fourth ventricle and the convolution of the dorsal cochlear nucleos were reached, and the ABI was inserted. More recently, an ABI was implanted via the retrosigmoid approach in a 4-year-old boy with a cochlear malformation (common cavity) associated with cochlear nerve aplasia. Electrically evoked auditory brain stem responses (EABRs) and neural response telemetry (NRT) were performed to verify the correct positioning of the inserted electrodes. No major complications related to ABI were observed. ABI has been activated to date in five of the NF2 patients. Auditory sensations with various numbers of electrodes were evoked in all patients. We consider the RS-TM approach the route of choice for ABI insertion in patients with NF2 and good hearing, offering a chance of hearing preservation, and in patients with complete cochlear ossification, severe head trauma and cochlear fracture, or nerve disruption, or a combination of these. A new indication for ABI implantation via the RS approach is presented by patients with bilateral cochlear nerve aplasia

Synthesis and in-vitro pharmacological evaluation of new 5-HT1A receptor ligands containing a benzotriazinone nucleus

n order to identify selective ligands for the 5-HT1A subtype receptor, the microwave-assisted synthesis and the binding assays on the 5-HT1A, 5-HT2A and 5-HT2C receptors of new benzotriazinone derivs. were reported. Conventional and microwave heating of the reactions were compared. Good yields and short reaction times were the main advantages of our synthetic route. More active compds. were selected and further evaluated for their binding affinities on D1, D2 dopaminergic and a1, a2 adrenergic receptors. The 3-(2-(4-(naphthalen-1-yl)piperazin-1-yl)ethyl)benzo[d][1,2,3]triazin-4(3H)-one I with Ki = 0.000178 nM was the most active and selective deriv. for the 5-HT1A receptor with respect to other serotonin receptors and the most selective deriv. compared to dopaminergic and adrenergic receptors