Proposal of a timing strategy for cholesteatoma surgery during the COVID-19 pandemic.

The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold's abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 sub-groups based on disease severity. Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic

SARS-CoV-2 tracheitis in laryngectomised patients: A consecutive case-series study

Key points SARS-CoV-2 is a possible cause of acute severe tracheitis in laryngectomees. In our series, the clinical picture was characterized by a haemorrhagic tracheitis with a slow resolution pattern. We observed a histological pattern of erosive inflammation of the respiratory epithelium. Planned tracheo-bronchoscopy and tracheal toilettes are recommended to prevent critical obstruction of the airway, which can be fatal in patients with associated impairment of lung function caused by SARS-CoV-2 infection. The present cases highlight the need for close interdisciplinary working and communication in the management of airway complications of COVID-19 infection

Endoscopic Middle Ear Surgery: Tips and Pearls

Program Description: Middle ear surgery can generally be performed with the aid of an operating microscope. However, under a potentially minimally invasive trans-canal approach, it is very difficult to operate on several sites using a microscope alone unless the surrounding bone is removed and retro-auricular approaches are performed. Such sites may include the epitympanum as well as the inferior and posterior parts of the mesotympanum. Although it has been more than 15 years since the introduction of operative endoscopy to middle ear surgery there is still a very limited role for the endoscope in the surgical management of middle ear disease across the globe. There are several possible reasons for that, such as the current idea of a limited and marginal role for endoscopes in middle ear surgery, a potentially long learning curve through the hassles and tribulations of adapting newer techniques and newer instrumentation, and some resistance, especially with otologists who are very comfortable with the use of microscopes. The operating microscope provides a very good quality magnified image in a straight line, however, the surgeon\u2019s field of view is limited to the narrowest segment of the ear canal when using a transcanal approach. On the other hand, endoscopes also provide a magnified vision that enables the ability to change rapidly from a close-up to a wide angle view, just by going closer or by withdrawing the instrument. Further, it provides an all-round vision to the surgeon who can rotate angled endoscopes to visualize the deep and hidden structures. In this miniseminar, we are going to discuss, with the help of very nice quality surgical movies, endoscopic anatomic dissection images and videos, virtual reality objects and also augmented reality capability the current techniques for endoscopic middle ear dissection, and surgical management of several middle ear diseases, such as tympanic membrane perforations, cholesteatomas, ossicular chain reconstruction and also stapedotomies, all performed with endoscopes discussing and commenting the equipment needed, surgical indications, also showing the potential advantages and disadvantages of the procedures, postoperative care and results and some interesting tips and pearls regarding this new way to surgically manage middle ear diseases. Educational Objectives: 1) Learn and review the endoscopic anatomy of the middle ear, discussing anatomic landmarks. 2) Identify the actual indications and limitations of this minimally invasive approach. 3) Describe and demonstrate step-wise endoscopic middle ear approaches for several diseases of this area

Endoscopic Ear Surgery: Tips and Pearls

Program Description: Endoscopic ear surgery (EES) is a current hot topic in our specialty; however, it is not entirely correct to introduce EES as \u201cnew.\u201d Although not new, it is clear that during the past few years, endoscopes have proven to be safe and effective instruments to manage ear diseases in a minimally invasive way, preserving important anatomic structures, allowing functional approaches to well-known conditions. Moreover, endoscopes have provided a better view and understanding of traditional middle ear anatomy and physiology, allowing new landmarks, novel concepts of tissue preservation, ventilation routes, and management of other conditions within the middle ear and beyond. Educational Objectives: (1) Describe the endoscopic anatomy of the middle and inner ears, discussing the concepts of related physiology. (2) Examine totally endoscopic and combined surgical approaches to middle ear conditions, discussing the possible advantages and disadvantages. (3) Present the instruments needed, system setup, surgical skills, learning curve, and also some important tips and pearls to surgeons to start doing endoscopic ear surgery

Endoscopic Middle Ear Surgery: Tips and Pearls

Program Description: We are going to discuss, with excellent quality presentations, high-definition surgical movies, endoscopic anatomic dissection images, virtual reality, and augmented reality, the current techniques of endoscopic middle ear surgery, discussing and commenting on the equipment needed, surgical indications, potential advantages and disadvantages, postoperative care, results, and some tips and pearls. Educational Objectives: 1) Learn and review the endoscopic anatomy of the middle ear, discussing the important endoscopic anatomic landmarks and showing new endoscopic anatomical findings. 2) Identify the actual indications and limitations of this minimally invasive approach. 3) Describe and demonstrate stepwise endoscopic middle ear approaches for several diseases of this area

Regional Genetic Structure in the Aquatic Macrophyte Ruppia cirrhosa Suggests Dispersal by Waterbirds

The evolutionary history of the genus Ruppia has been shaped by hybridization, polyploidisation and vicariance that have resulted in a problematic taxonomy. Recent studies provided insight into species circumscription, organelle takeover by hybridization, and revealed the importance of verifying species identification to avoid distorting effects of mixing different species, when estimating population connectivity. In the present study, we use microsatellite markers to determine population diversity and connectivity patterns in Ruppia cirrhosa including two spatial scales: (1) from the Atlantic Iberian coastline in Portugal to the Siculo-Tunisian Strait in Sicily and (2) within the Iberian Peninsula comprising the Atlantic-Mediterranean transition. The higher diversity in the Mediterranean Sea suggests that populations have had longer persistence there, suggesting a possible origin and/or refugial area for the species. The high genotypic diversities highlight the importance of sexual reproduction for survival and maintenance of populations. Results revealed a regional population structure matching a continent-island model, with strong genetic isolation and low gene flow between populations. This population structure could be maintained by waterbirds, acting as occasional dispersal vectors. This information elucidates ecological strategies of brackish plant species in coastal lagoons, suggesting mechanisms used by this species to colonize new isolated habitats and dominate brackish aquatic macrophyte systems, yet maintaining strong genetic structure suggestive of very low dispersal.Fundacao para a Cincia e Tecnologia (FCT, Portugal) [PTDC/MAR/119363/2010, BIODIVERSA/0004/2015, UID/Multi/04326/2013]Pew FoundationSENECA FoundationMurcia Government, Spain [11881/PI/09]FCT Investigator Programme-Career Development [IF/00998/2014]Spanish Ministry of Education [AP2008-01209]European Community [00399/2012]info:eu-repo/semantics/publishedVersio

Senescence in dahlia flowers is regulated by a complex interplay between flower age and floret position

Mechanisms regulating flower senescence are not fully understood in any species and are particularly complex in composite flowers. Dahlia (Dahlia pinnata Cav.) florets develop sequentially, hence each composite flower head includes florets of different developmental stages as the whole flower head ages. Moreover, the wide range of available cultivars enables assessment of intraspecific variation. Transcriptomes were compared amongst inner (younger) and outer (older) florets of two flower head ages to assess the effect of floret vs. flower head ageing. More gene expression, including ethylene and cytokinin pathway expression changed between inner and outer florets of older flower heads than between inner florets of younger and older flower heads. Additionally, based on Arabidopsis network analysis, different patterns of co-expressed ethylene response genes were elicited. This suggests that changes occur in young inner florets as the whole flower head ages that are different to ageing florets within a flower head. In some species floral senescence is orchestrated by the plant growth regulator ethylene. However, there is both inter and intra-species variation in its importance. There is a lack of conclusive data regarding ethylene sensitivity in dahlia. Speed of senescence progression, effects of ethylene signalling perturbation, and patterns of ethylene biosynthesis gene expression differed across three dahlia cultivars (‘Sylvia’, ‘Karma Prospero’ and ‘Onesta’) suggesting differences in the role of ethylene in their floral senescence, while effects of exogenous cytokinin were less cultivar-specific

Dissecting the Role of Mesenchymal Stem Cells in Idiopathic Pulmonary Fibrosis:Cause or Solution

Idiopathic pulmonary fibrosis (IPF) is one of the most aggressive forms of idiopathic interstitial pneumonias, characterized by chronic and progressive fibrosis subverting the lung’s architecture, pulmonary functional decline, progressive respiratory failure, and high mortality (median survival 3 years after diagnosis). Among the mechanisms associated with disease onset and progression, it has been hypothesized that IPF lungs might be affected either by a regenerative deficit of the alveolar epithelium or by a dysregulation of repair mechanisms in response to alveolar and vascular damage. This latter might be related to the progressive dysfunction and exhaustion of the resident stem cells together with a process of cellular and tissue senescence. The role of endogenous mesenchymal stromal/stem cells (MSCs) resident in the lung in the homeostasis of these mechanisms is still a matter of debate. Although endogenous MSCs may play a critical role in lung repair, they are also involved in cellular senescence and tissue ageing processes with loss of lung regenerative potential. In addition, MSCs have immunomodulatory properties and can secrete anti-fibrotic factors. Thus, MSCs obtained from other sources administered systemically or directly into the lung have been investigated for lung epithelial repair and have been explored as a potential therapy for the treatment of lung diseases including IPF. Given these multiple potential roles of MSCs, this review aims both at elucidating the role of resident lung MSCs in IPF pathogenesis and the role of administered MSCs from other sources for potential IPF therapies