Surgical Management of Retraction Pockets: Does Mastoidectomy have a Role?

Abstract Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. Results This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (p > 0.5). Conclusion Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets

Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment

Objective: The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy. Materials and methods: A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior–inferior quadrant filling completely the middle ear. The follow-up in the following 6 months included an audiogram every month. Results: The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB. After the failed treatment the mean PTA was 59.6 dB. The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy. The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p<0.01). A significant difference (p<0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit. Conclusions: Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery

Acceptability of HPV Vaccination in Young Students by Exploring Health Belief Model and Health Literacy

Evidence on the human papillomavirus (HPV) vaccine shows that it is effective in reducing the burden of HPV-related diseases. For more than 15 years the HPV vaccine has been offered free of charge in Italy to girls from the age of 12. Over time, the free offer of the HPV vaccine has also been extended to boys and to young adults at risk of developing HPV lesions. Despite the HPV vaccine's effectiveness and availability, vaccination coverage is low in Italy, with a reported value of 46.5% in 2020. Furthermore, in the southern administrative regions, vaccination coverage is even lower than national values, with 25.9% coverage in Sicily. A cross-sectional study was conducted among university and high school students in the Palermo area (Sicily, Italy) in order to identify the determinants of HPV vaccination adherence by using a questionnaire that investigated factors of HPV vaccine practice. The study explored the behavioral attitude by using the Health Belief Model (HBM), and also used the SILS test and the METER test to investigate the level of health literacy (HL). Overall, 3,073 students were enrolled, and less than a third reported they had completed the vaccination schedule (n = 925, 30.1%). Multivariable analysis showed that the factors directly associated with the adherence to HPV vaccination were female sex (OR = 4.43, p &lt; 0.001), high HBM total score (OR = 4.23, p &lt; 0.001), good HL level (OR = 1.26, p = 0.047), parents (OR = 1.78, p = 0.004), general practitioner (OR = 1.88, p = 0.001), and educational material provided by public vaccination services (OR = 1.97, p = 0.001) as HPV vaccine information sources. Further health-promotion programs focused on improving HL and perception of the HPV vaccine's benefits should be implemented in order to achieve the desirable 95% vaccination coverage

Microalgae biomass concentration and reuse of water as new cultivation medium using ceramic membrane filtration

The aim of this study is to advance means for microalgae dewatering with the simultaneous reuse of water as new cultivation medium, specifically through ceramic membrane filtration. Three algae, namely, Spirulina platensis, Scenedesmus obliquus, and Chlorella sorokiniana were tested by filtering suspensions with four ceramic membranes having nominal pore sizes of 0.8 μm, 0.14 μm, 300 kDa, 15 kDa. The observed flux values and organic matter removal rates were related to the membrane pore size and cake layer properties, with some differences in productivity between algae types, likely due to cell size and shape. Interestingly, similar near steady-state fluxes (70-120 L m-2h-1) were measured using membranes with nominal pore size above 15 kDa, suggesting the dominance of cake layer filtration independently of the initial flux. Virtually complete algae cells rejections and high nutrient passage (&gt;75%) were observed in all combinations. When the permeate streams were used as media for new growth cycles of the various algae, no or little growth was observed with Spirulina p., while Chlorella s. (permeate from 300 kDa membrane) and especially Scenedesmus o. (permeate from 0.14 μm membrane) showed the fastest growth rates, almost comparable to those observed with ideal fresh media

All-in-One Mesh Hernioplasty: A New Procedure for Inguinal Hernia Repair

Since the 1970s, when biocompatible meshes were introduced with the consequent decrease of recurrence, one of the priorities in inguinal hernia surgery was that of minimizing postoperative chronic pain. All technical variations, proposed during the past years in order to improve patient’s comfort, reported a variable incidence of chronic neuralgia. The procedure we describe, applicable to all cases of primary inguinal hernia, employs a smaller pre-cut single mesh that covers all weak areas of the inguinal canal and is enveloped in a fibro-cremasteric sheath, avoiding contact of the prosthesis with neural structures. The new procedure, already performed on 250 patients, aims to improve patients’ comfort and to reduce the incidence of chronic neuralgia

Concentration of phycocyanin and coffee extracts in aqueous solutions with osmotically-assisted membrane distillation

Osmotic membrane distillation (OMD) is a dewatering process that exploits combined temperature and osmotic pressure gradients to drive water vapor fluxes under mild operation conditions. In this study, the feasibility of OMD is evaluated for the concentration of phycocyanin and coffee extract solutions, with the goal to safeguard the quality of the extracts. Different feed solution temperatures were studied, namely, 35 °C, 45 °C, 55 °C, while keeping a concentration of 4 M CaCl2 in the extraction solution. The target concentration factor was set to 4, equivalent to a water recovery rate of 75 %. The results suggest that a temperature equal to or below 45 °C should be chosen for the concentration of phycocyanin to prevent degradation and to minimize fouling, while higher temperatures may be used for the recovery of the coffee extract. The combined gradients provided water fluxes around or above 4 L m−2h−1 with both extracts under relatively mild conditions, even at high concentration factors. Qualitative membrane fouling inspection was corroborated by estimating the fraction of productivity lost due to fouling, which was larger for higher feed temperatures and for the phycocyanin extracts, and had values between roughly 20 and 70 %. Results also suggest that the quality of the extracts was maintained, based on the measured purity and content of the target compounds in the concentrated solutions. Specifically, no trace of extraneous compounds was found, and no salt passage was observed from the extraction solution to the feed solution, suggesting that OMD has the potential to concentrate sensitive components

Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study.

The aim of this study was to verify the efficacy and the safety of transtympanic dexamethasone to treat sudden sensorineural hearing loss as first and single drug method. Considering ethical implication of performing a mininvasive procedure on middle ear, we matched such proposed treatment with systemic prednisone administration that represents the widest adopted protocol. Randomized prospective study was conducted. The inclusion criterion was a sudden sensorineural hearing loss of at least 30 dB across three contiguous frequencies over a period of 24 h. Group A received transtympanic steroid injections; Group B received oral administration of steroids. 25 patients were treated with transtympanic therapy whereas 21 underwent systemic treatment. The mean of initial PTA was 59 dB for the whole series: 65 dB for group A and 51 dB for group B. The recovery better than 10 dB was obtained in 80% of patients of group A and in 17 81% of patients of group B, with a total of 80.5%. The mean relative gain in PTA was 41.16% in the group A and 44.7% in the group B. In the frequencies tested (0.5, 1, 2, and 4 kHz) PTA improvements after transtympanic treatment were higher than after systemic treatment, but these differences were not statistically significant (P = 0.61). Both transtympanic and systemic treatment had similar clinical recovery times. This prospective randomized clinical study showed good result in terms of hearing recovery, better than the expected results of the simple observation without treatment. We can consider transtympanic administration as a first line treatment, because of the statistical analysis confirmed similar results with systemic therapy, reducing possible side effects of systemic drug administration. The delay of treatment does not influence the outcome, allowing treating patients within 10 days of onset

ONIX: Open Radio Network Information eXchange

While video-on-demand still takes up the lion's share of Internet traffic, we are witnessing a significant increase in the adoption of mobile applications defined by tight bit rate and latency requirements (e.g., augmented/virtual reality). Supporting such applications over a mobile network is very challenging due to the unsteady nature of the network and the long distance between the users and the application back-end, which usually sits in the cloud. To address these and other challenges, like security, reliability, and scalability, a new paradigm termed multi-access edge computing (MEC) has emerged. MEC places computational resources closer to the end users, thus reducing the overall end-to-end latency and the utilization of the network backhaul. However, to adapt to the volatile nature of a mobile network, MEC applications need real-time information about the status of the radio channel. The ETSI-defined radio network information service (RNIS) is in charge of providing MEC applications with up-to-date information about the radio network. In this article, we first discuss three use cases that can benefit from the RNIS (collision avoidance, media streaming, and Industrial Internet of Things). Then we analyze the requirements and challenges underpinning the design of a scalable RNIS platform, and report on a prototype implementation and its evaluation. Finally, we provide a roadmap of future research challenges

Cat-Owner Relationship and Cat Behaviour : Effects of the COVID-19 Confinement and Implications for Feline Management

The aim of this study was to explore the effects of the Italian COVID-19 lockdown on the cat-owner relationship and on cat behaviour. In order to do so, we used a questionnaire to obtain information on the owner and cat's demographics, living environment, cat behaviour, and possible changes in some aspects of the cat-owner relationship. The questionnaire was distributed online when the lockdown was still ongoing and was completed by 548 cat owners, mainly women. Our findings suggest that the greater amount of time that owners spent at home with their cats, as a consequence of the social restrictions, had a positive effect on the owner's perception of their relationship with their cat (e.g., higher frequency of interaction, greater emotional closeness, reduced perceived costs of caring for the cat). Similarly, the lockdown seemed to have improved the welfare of many cats, as suggested by the positive changes in many of their behaviours, even for those cats with pre-existing behavioural problems. Overall, our findings suggest that the lockdown provided many cats with a more thriving physical and social environment. They also highlight the need to reconsider some cat management practices commonly implemented in non-exceptional circumstances. The restrictive measures implemented to stem the spread of COVID-19 abruptly changed the lives of many cats and their owners. This study explored whether the lockdown in Italy affected the cat-owner relationship, as well as cat behaviour and welfare. A survey that included questions on owner and cat's demographics, living environment, cat behaviour and a modified version of the Cat/Dog Relationship Scale (C/DORS) was distributed online during the lockdown and was completed by 548 cat owners, mainly women (81.6%). With regard to the C/DORS subscales, both emotional closeness and cat-owner interactions increased during confinement, as opposed to a reduction in perceived costs. The effect of the type of job, family role and owner's age on the C/DORS scores suggests that the relationship improved for those owners that, due to the lockdown, increased the time spent with their cats. For 58.8% of respondents, their cat's general behaviour did not change, but when changes occurred, they were mostly positive (20.4%). Attention-seeking and demanding behaviours were the most increased during lockdown (25.7%). Cats with pre-existing problematic behaviours tended to either remain stable or improve during confinement. The overall positive effects of lockdown-related environmental changes on a cat's behaviour suggest that some aspects of commonly implemented cat management practices should be revised to improve cat welfare in normal circumstances