Tinnitus revival during COVID‑19 lockdown: how to deal with it?

To the Editor, The novel Coronavirus Disease, officially designated as COVID-19 by the WHO, is a serious issue for public health. To contain the COVID-19, the Italian Government stated on March 9th 2020 the prohibition of any movement throughout the national area unless for work/health reasons and the obligation to remain as much as possible inside one’s own home. With the start of the so-called “Phase Two” on May 4th 2020, circulation within the same region was allowed again, due to the progressive slowdown of the outbreak. Therefore, since lockdown measures were relaxed and access to the emergency room or ENT clinic became less worrying for patients, specialists of Otolaryngology Units in Bari (Italy) observed an increase in the amount of subjects complaining of the revival of intense tinnitus. We attempt in this letter to focus on patients affected by chronic subjective tinnitus, that already had a diagnosis and self-stabilized without a massive treatment. Research studies have reported tinnitus wide impact on quality of life of subjects experiencing it, involving their emotional state, concentration and sleep quality; at this regard, Tinnitus Handicap Inventory (THI) is a self-reported tool regularly used to quantify the grade of perceived handicap as slight (0–16), mild (18–36), moderate (38–56), severe (58–76) or catastrophic (78–100) on the basis of 25 questions [1]. During the past 2 weeks, we have collected data from 16 patients among our population of chronic sufferers: THI observed was moderate in 62.5% and severe in 18.75% of cases, catastrophic in 12.5% and mild in 6.25% of subjects. Interestingly, the grade of handicap resulted increased by one-level in 12 out of 16 patients (75%); in particular, THI shifted from mild to moderate in 9 patients and from moderate to severe in 3 patients. As shown in the literature, tinnitus generation, maintenance and recrudescence are still debated. A cortical reorganization secondary to sensory deprivation has been proposed as one on the most frequent cause of tinnitus [2]. The avoidance of silence and acoustic masking have been proposed as effective measures to overcome sensory deprivation and increase masking of the symptom [3]. It is reasonable to think that, during the lockdown, the absence of environmental masking sounds from everyday life may have enhanced the tinnitus perception. Furthermore, proneness to worry and incoming stress during pandemic could be included as further potential risk factors for tinnitus worsening. As proficiently reviewed in a recent work [4], some internet/smartphone-based applications provide in tinnitus patients adequate counseling and interactive information together with sound therapy. As brain networks implicated in adaptive responses to sound stimuli and to worry are shared in many cases, an early decrease of anxiety status may release neural resources crucial for tinnitus habituation/distress perception [5]. In general, interactive platforms have been widely implemented during lockdown period due to the forced lack of real personal and working relationships; since smart-working seems to be successful for future plans, the development of smart applications and mobile services in the health care field may be promising in terms of cost-effectiveness, tolerability and simplicity of use

Engineering geological 3D modeling and geotechnical characterization in the framework of technical rules for geotechnical design: the case study of the Nola’s logistic plant (southern Italy)

model is an essential step to optimize costs of the construction and limit risks from failure or damage due to unforeseen ground conditions. The modeling of ground conditions is a challenging issue to be tackled especially in the case of geological units with complex geometries and spatially variable geotechnical properties. In such a direction, coupled geological and geotechnical criteria are usually adopted to define engineering geological units. These concepts are considered by the current technical rules for geotechnical design such as the Eurocode 7 and in the national regulations which have followed it, known in Italy as “Norme Tecniche per le Costruzioni (NTC).” Notwithstanding this advanced regulatory framework, no comprehensive indications on methodological approaches were given for the 3D engineering geological modeling and geotechnical characterization of a design and construction site. In this paper, the case study of the highly heterogeneous and heteropic pyroclastic-alluvial stratigraphic setting of the Nola plain (Campania, southern Italy) characterizing the site of the Nola’s logistic plant is dealt with. The approaches are based on the engineering geological modeling analysis of a high number of stratigraphic, laboratory and in situ geotechnical data, collected for the design of the plant, and the use of a specialized modeling software providing advanced capabilities in spatial modeling of geological and geotechnical information, as well as in their visual representation. The results obtained, including also the analysis of statistical variability of geotechnical properties and the identification of representative geotechnical values, can be potentially considered a methodological approach, consistent with the current technical rules for geotechnical design as well as with fundamental concepts of engineering geological modeling and mapping

Common features between neoplastic and preneoplastic lesions of the biliary tract and the pancreas

The bile duct system and pancreas show many similarities due to their anatomical proximity and common embryological origin. Consequently, preneoplastic and neoplastic lesions of the bile duct and pancreas share analogies in terms of molecular, histological and pathophysiological features. Intraepithelial neoplasms are reported in biliary tract, as biliary intraepithelial neoplasm (BilIN), and in pancreas, as pancreatic intraepithelial neoplasm (PanIN). Both can evolve to invasive carcinomas, respectively cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC). Intraductal papillary neoplasms arise in biliary tract and pancreas. Intraductal papillary neoplasm of the biliary tract (IPNB) share common histologic and phenotypic features such as pancreatobiliary, gastric, intestinal and oncocytic types, and biological behavior with the pancreatic counterpart, the intraductal papillary mucinous neoplasm of the pancreas (IPMN). All these neoplastic lesions exhibit similar immunohistochemical phenotypes, suggesting a common carcinogenic process. Indeed, CCA and PDAC display similar clinic-pathological features as growth pattern, poor response to conventional chemotherapy and radiotherapy and, as a consequence, an unfavorable prognosis. The objective of this review is to discuss similarities and differences between the neoplastic lesions of the pancreas and biliary tract with potential implications on a common origin from similar stem/progenitor cells

Design of a tuned vbration absorber (TVA) for applications in transport engineering

The control of the response to tonal excitations or to broadband stochastic disturbances of a stiffened cylinder is investigated through the use of a Tuned Vibrating Absorber (TVA). In particular, the study considered both a purely passive device (Mechanical) and a semi-active one with shunt circuit (Electro-Mechanical) to evaluate the efficiencies and differences

Design, Manufacture and Measurement of three Permanent Magnet Dipoles for FASER Experiment

FASER, the ForwArd Search ExpeRiment, is designed to search for new, yet undiscovered, light and weakly-interacting particles and study the interactions of high-energy neutrinos. Three dipoles, one 1.5 m-long and the other two 1.0 m-long each, installed upstream of the ATLAS experiment at CERN, are required to achieve sufficient separation of pairs of oppositely charged, high-energy Standard Model particles originating from decays of new physics particles. The dipoles have an aperture of 200 mm in diameter and a required magnetic field at the centre ≥ 0.55 T. Due to tight space constraints, a design based on permanent magnet technology was proposed. This paper describes the design, manufacturing, assembly and magnetic measurement of these large Halbach array dipoles

Experimental study of graphene and carbon nanotubes thermal sensing properties

Today there are several new and interesting Nano-particle materials on the market providing good electrical conductivity. Examples are carbon Nano-tubes and different versions of graphene derivatives, often provided as powder. In particular, the materials available were Multi-Walled Carbon Nanotubes in Epoxy matrix and Reduced Graphene Oxide (rGOH). An initial literature survey underlined the lack of measurements and information about the conductivity of these materials during heating up or curing. This work is part of a larger project aiming at producing ”sensing structural composite material”, i.e. a composite material with integrated Nanoparticles, as eg. Carbonnano-tubes or graphene, working as sensors reporting the status of the material during heating up, curing and/or tensioning. The principal results concerns the evaluation of the specific conductivity during heating for both materials (rGOH and MWCNT in Epoxy Matrix) with the realization of an experimental model for the gradient of the specific conductivity with temperature. The linearity underlines the possibility of using the properties of these materials to create sensors, not only for strain (with the advantage of high Gauge Factors), but also for temperature

Passive noise control oriented design of aircraft headrests

Two Passive Noise Control (PNC) concepts were numerically evaluated in terms of their impact on the Sound Pressure Level (SPL) perceived by passengers of an aircraft flight. A concept was based on the shape optimization of the headrests, whereas the second one was based on the adoption of a high absorbing material, i.e. a nanofiber textile, to improve the acoustic performances of the headrests. To this aim, an aircraft seat was modelled with the Boundary Element Method (BEM) and loaded with a spherical distribution of monopole sources surrounding the seat. Different configurations of headrest shape and covering textiles were then compared in terms of the SPL calculated at passengers’ ears. The work shows how an acoustic-oriented design of the aircraft headrests could achieve an average SPL reduction for passengers up to 3 dBA

Projection to Latent Spaces Disentangles Pathological Effects on Brain Morphology in the Asymptomatic Phase of Alzheimer's Disease

Alzheimer’s disease (AD) continuum is defined as a cascade of several neuropathological processes that can be measured using biomarkers, such as cerebrospinal fluid (CSF) levels of Aβ, p-tau, and t-tau. In parallel, brain anatomy can be characterized through imaging techniques, such as magnetic resonance imaging (MRI). In this work we relate both sets of measurements and seek associations between biomarkers and the brain structure that can be indicative of AD progression. The goal is to uncover underlying multivariate effects of AD pathology on regional brain morphological information. For this purpose, we used the projection to latent structures (PLS) method. Using PLS, we found a low dimensional latent space that best describes the covariance between both sets of measurements on the same subjects. Possible confounder effects (age and sex) on brain morphology are included in the model and regressed out using an orthogonal PLS model. We looked for statistically significant correlations between brain morphology and CSF biomarkers that explain part of the volumetric variance at each region-of-interest (ROI). Furthermore, we used a clustering technique to discover a small set of CSF-related patterns describing the AD continuum. We applied this technique to the study of subjects in the whole AD continuum, from the pre-clinical asymptomatic stages all the way through to the symptomatic groups. Subsequent analyses involved splitting the course of the disease into diagnostic categories: cognitively unimpaired subjects (CU), mild cognitively impaired subjects (MCI), and subjects with dementia (AD-dementia), where all symptoms were due to AD

Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based on Patient Demographics.

Purpose:To evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures. Methods:We retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid or Medicare vs private), smoking history, employment status, and history of surgery to determine which demographic factors led to an increased risk of elective case cancellation. Results:Patients who canceled were significantly older (46.5 years vs 41.5 years, t = 2.432, P = .015) than those who do not. In addition, current smokers (22.5% vs 10.9%, χ2 = 10.85, P = .001), patients with Medicare or Medicaid versus private insurance (16.7% vs 10.0%, χ2 = 5.35, P = .021), non-English-speaking patients (29.5% vs 11.6%, χ2 = 11.43, P = .001), and patients without a history of surgery requiring anesthesia (18.8% vs 9.6%, χ2 = 9.96, P = .002) were all more likely to cancel. When all studied variables were examined in a logistic regression analysis, of the above demographic variables, only insurance status was no longer significant, given its correlation with age and language. Conclusions:Increased age (≥46.5 years), non-English speaking, smoking, lack of a history of surgery requiring anesthesia, and Medicaid or Medicare insurance were found to contribute to an increased risk of elective orthopaedic surgery cancellation. Level of Evidence:Level III, case-control study