La diagnosi audiologica precoce dell’ipoacusia dell’età pediatrica

Nell’ambito delle ipoacusie infantili permanenti, la diagnosi audiologica precoce rappresenta il presupposto per l’attivazione di un adeguato programma abilitativo, in modo da prevenire o limitare i noti effetti che la deprivazione uditiva determina sullo sviluppo del linguaggio e delle abilità cognitive nel bambino. Nella diagnosi audiologica possono riconoscersi schematicamente tre fasi: l’identificazione dei soggetti a rischio, la definizione dei caratteri dell’ipoacusia, la verifica dell’appropriatezza della diagnosi stessa e dell’abilitazione. La strategia ed i metodi della diagnosi audiologica sono ben definiti e prevedono l’integrazione dei dati provenienti dai metodi obiettivi, con quelli clinici e comportamentali. A fronte di una sostanziale efficacia delle procedure e di un diffuso consenso sul loro impiego e sulla loro interpretazione, esistono varie criticità rispetto al conseguimento di tale obiettivo, che saranno affrontate in questo lavoro

CaloCube: a novel calorimeter for high-energy cosmic rays in space

In order to extend the direct observation of high-energy cosmic rays up to the PeV region, highly performing calorimeters with large geometrical acceptance and high energy resolution are required. Within the constraint of the total mass of the apparatus, crucial for a space mission, the calorimeters must be optimized with respect to their geometrical acceptance, granularity and absorption depth. CaloCube is a homogeneous calorimeter with cubic geometry, to maximise the acceptance being sensitive to particles from every direction in space; granularity is obtained by relying on small cubic scintillating crystals as active elements. Different scintillating materials have been studied. The crystal sizes and spacing among them have been optimized with respect to the energy resolution. A prototype, based on CsI(Tl) cubic crystals, has been constructed and tested with particle beams. Some results of tests with different beams at CERN are presented.Comment: Seven pages, seven pictures. Proceedings of INSTR17 Novosibirs

Completare l’adattamento degli apparecchi acustici entro 1 mese dall’identificazione dell’ipoacusia di un bambino

Grazie al perfezionamento delle procedure diagnostiche e alla diffusione dei programmi di screening uditivo neonatale, la diagnosi di ipoacusia può essere posta con estrema tempestività rispetto ad un passato non troppo lontano. Diventa pertanto fondamentale giungere dalla diagnosi alla corretta applicazione dell’apperecchio acustico in tempi rapidi, in modo da ripristinare la funzione uditiva e consentire lo sviluppo del linguaggio. L’intervento abilitativo precoce di protesizzazione acustica o l’eventuale successiva applicazione dell’impianto cocleare offrono l’opportunità di un regolare sviluppo delle vie uditive centrali e delle aree cerebrali deputate alla ricezione dell’informazione sonora nonchè delle relative connessioni con le aree motorie e articolatorie. L’obiettivo di questo articolo è presentare i risultati di un’analisi strategica che prenda in considerazione i punti di forza, i punti di debolezza, le opportunità e i rischi del percorso clinico da seguire per ottenere un’amplificazione precoce in tutti i casi di ipoacusia bilaterale permanente dell’età pediatrica. L’analisi è centrata sulla realtà italiana ed è parte del progetto CCM 2013 finanziato dal Ministero della Salute “Programma regionale di identificazione, intervento e presa in carico precoci per la prevenzione dei disturbi comunicativi nei bambin con deficit uditivo”

Raccomandazioni per perfezionare i programmi regionali di screening uditivo neonatale universale in Italia

L’obiettivo dello screening uditivo neonatale universale è di ottenere una diagnosi precoce di ipoacusia congenita. Non appena confermata la perdita uditiva, è necessario intervenire dal punto di vista riabilitativo. Nell’ambito del progetto del Ministero della Salute CCM 2013 “Programma regionale di identificazione, intervento e presa in carico precoci per la prevenzione dei disturbi comunicativi nei bambini con deficit uditivo” un gruppo di professionisti appartenenti a centri di terzo livello con un programma regionale di screening uditivo neonatale, ha analizzato i limiti e i punti di forza dell’attuale impostazione dei programmi regionali di screening uditivo neonatale mediante l’analisi SWOT e la realizzazione di una matrice TOWS. Alcune criticità sono rappresentate dalla copertura dello screening e dal numero di persi allo screening. Sono state sviluppate raccomandazioni volte a migliorare l’efficacia di tali programmi. Sono emerse la necessità di una regolamentazione uniforme dei programmi di screening a livello regionale e nazionale, e il bisogno di ricevere informazioni e formazione aggiornate, di alta qualità, e condivise per familiari e operatori

A Multicenter Clinical Evaluation of Data Logging in Cochlear Implant Recipients Using Automated Scene Classification Technologies

Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by recipients by means of objective tools. The Nucleus 6 sound processor features a data logging system capable of real-time recording of CI use in different acoustic environments and under various categories of loudness levels. In this study, we report data logged for the different scenes and different loudness levels of 1,366 CI patients, as recorded by SCAN. Monitoring device use in cochlear implant recipients of all ages provides important information about the listening conditions encountered in recipients' daily lives that may support counseling and assist in the further management of their device settings. The findings for this large cohort of active CI users confirm differences between age groups concerning device use and exposure to various noise environments, especially between the youngest and oldest age groups, while similar levels of loudness were observed

CaloCube: an innovative homogeneous calorimeter for the next-generation space experiments

The direct measurement of the cosmic-ray spectrum, up to the knee region, is one of the instrumental challenges for next generation space experiments. The main issue for these measurements is a steeply falling spectrum with increasing energy, so the physics performance of the space calorimeters are primarily determined by their geometrical acceptance and energy resolution. CaloCube is a three-year R&D project, approved and financed by INFN in 2014, aiming to optimize the design of a space-born calorimeter. The peculiarity of the design of CaloCube is its capability of detecting particles coming from any direction, and not only those on its upper surface. To ensure that the quality of the measurement does not depend on the arrival direction of the particles, the calorimeter will be designed as homogeneous and isotropic as possible. In addition, to achieve a high discrimination power for hadrons and nuclei with respect to electrons, the sensitive elements of the calorimeter need to have a fine 3-D sampling capability. In order to optimize the detector performances with respect to the total mass of the apparatus, which is the most important constraint for a space launch, a comparative study of different scintillating materials has been performed using detailed Monte Carlo simulation based on the FLUKA package. In parallel to simulation studies, a prototype consisting in 14 layers of 3 x 3 CsI(Tl) crystals per layer has been assembled and tested with particle beams. An overview of the obtained results during the first two years of the project will be presented and the future of the detector will be discussed too

Cell-derived extracellular vesicles can be used as a biomarker reservoir for glioblastoma tumor subtyping

Glioblastoma (GBM) is one of the most aggressive solid tumors for which treatment options and biomarkers are limited. Small extracellular vesicles (sEVs) produced by both GBM and stromal cells are central in the inter-cellular communication that is taking place in the tumor bulk. As tumor sEVs are accessible in biofluids, recent reports have suggested that sEVs contain valuable biomarkers for GBM patient diagnosis and follow-up. The aim of the current study was to describe the protein content of sEVs produced by different GBM cell lines and patient-derived stem cells. Our results reveal that the content of the sEVs mirrors the phenotypic signature of the respective GBM cells, leading to the description of potential informative sEV-associated biomarkers for GBM subtyping, such as CD44. Overall, these data could assist future GBM in vitro studies and provide insights for the development of new diagnostic and therapeutic methods as well as personalized treatment strategies

Divergent Genomic and Epigenomic Landscapes of Lung Cancer Subtypes Underscore the Selection of Different Oncogenic Pathways during Tumor Development

For therapeutic purposes, non-small cell lung cancer (NSCLC) has traditionally been regarded as a single disease. However, recent evidence suggest that the two major subtypes of NSCLC, adenocarcinoma (AC) and squamous cell carcinoma (SqCC) respond differently to both molecular targeted and new generation chemotherapies. Therefore, identifying the molecular differences between these tumor types may impact novel treatment strategy. We performed the first large-scale analysis of 261 primary NSCLC tumors (169 AC and 92 SqCC), integrating genome-wide DNA copy number, methylation and gene expression profiles to identify subtype-specific molecular alterations relevant to new agent design and choice of therapy. Comparison of AC and SqCC genomic and epigenomic landscapes revealed 778 altered genes with corresponding expression changes that are selected during tumor development in a subtype-specific manner. Analysis of >200 additional NSCLCs confirmed that these genes are responsible for driving the differential development and resulting phenotypes of AC and SqCC. Importantly, we identified key oncogenic pathways disrupted in each subtype that likely serve as the basis for their differential tumor biology and clinical outcomes. Downregulation of HNF4α target genes was the most common pathway specific to AC, while SqCC demonstrated disruption of numerous histone modifying enzymes as well as the transcription factor E2F1. In silico screening of candidate therapeutic compounds using subtype-specific pathway components identified HDAC and PI3K inhibitors as potential treatments tailored to lung SqCC. Together, our findings suggest that AC and SqCC develop through distinct pathogenetic pathways that have significant implication in our approach to the clinical management of NSCLC

Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation