International consensus (ICON) on treatment of Ménière's disease

Objective: To present the international consensus for recommendations for Ménière's disease (MD) treatment. Methods: Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work. Results: The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option

Imaging of non-operated cholesteatoma: Clinical practice guidelines

SummaryMiddle ear cholesteatoma is an aggressive form of chronic otitis media requiring surgical therapy. The surgical strategy depends on the location of the lesion, its extensions to the middle ear and mastoid, the anatomical conformation of the tympanomastoid cavities and the health status of the patient (as well as his or her interest in aquatic leisure activities). For several years, imaging of the ear has been a routine test in the preoperative work-up of the disease. National guidelines for the topic “Imaging of non-operated middle ear cholesteatoma” were prepared in October 2010, for the annual congress of the French Society of Otolaryngology Head and Neck Surgery (SFORL), by a panel of experts from the SFORL, represented by the French Association of Otology and Neuro-otology (AFON), and the French Radiological Society (SFR), represented by the French Society of Head and Neck Imaging (CIREOL). These guidelines are presented in the present article

Complicanze infettive locali precoci e tardive nella chirurgia otologica

La via retroauricolare rappresenta l’approccio di scelta nel trattamento dell’otite media cronica. Nelle procedure “sporche” l’incidenza della complicanza infettiva locale è del 10%. Il presente studio analizza le infezioni del sito chirurgico dopo la chirurgia dell’otite media cronica e ne investiga i potenziali fattori predittivi. Il presente studio, dal design osservazionale prospettico, ha incluso pazienti affetti da otite media cronica e candidati alla chirurgia mediante approccio retroauricolare. Sono state definite precoci le complicanze postoperatorie insorte entro i 30 giorni e tardive quelle insorte oltre i 30 giorni. Sono stati analizzati i dati di 102 pazienti. Sono stati registrati 4 casi (3,9%) di infezione precoce, per la quale è stata evidenziata un’associazione significativa con l’antibioticoterapia preoperatoria, l’orecchio in fase secernente all’esame otoscopico preoperatorio, una classe III (contaminato) nella classificazione delle ferite chirurgiche, indice NNIS (National Nosocomial Infection Surveillance) >1 e assunzione di antibiotici per OS nel postoperatorio. Sono state inoltre registrate 7 complicanze tardive (7,1%), occorse fra i 90 e i 160 giorni dall’intervento, significativamente correlate alla presenza di otorrea nei sei mesi precedenti la chirurgia, una durata del tempo chirurgico inferiore o uguale a 60 minuti, una tecnica aperta e all’uso della colla di fibrina. L’infezione del sito chirurgico sembra essere associata ai fattori correlati allo stato infiammatorio dell’orecchio medio al momento della chirurgia nelle infezioni precoci e all’infiammazione cronica nelle infezioni tardive

Reduction of Hydrophilic Ubiquinones by the Flavin in Mitochondrial NADH:Ubiquinone Oxidoreductase (Complex I) and Production of Reactive Oxygen Species†

ABSTRACT: NADH:ubiquinone oxidoreductase (complex I) from bovine heart mitochondria is a complicated, energy-transducing, membrane-bound enzyme that contains 45 different subunits, a non-covalently bound flavin mononucleotide, and eight iron-sulfur clusters. The mechanisms of NADH oxidation and intramolecular electron transfer by complex I are gradually being defined, but the mechanism linking ubiquinone reduction to proton translocation remains unknown. Studies of ubiquinone reduction by isolated complex I are problematic because the extremely hydrophobic natural substrate, ubiquinone-10, must be substituted with a relatively hydrophilic analogue (such as ubiquinone-1). Hydrophilic ubiquinones are reduced by an additional, non-energy-transducing pathway (which is insensitive to inhibitors such as rotenone and piericidin A). Here, we show that inhibitor-insensitive ubiquinone reduction occurs by a ping-pong type mechanism, catalyzed by the flavin mononucleotide cofactor in the active site for NADH oxidation. Moreover, semiquinones produced at the flavin site initiate redox cycling reactions with molecular oxygen, producing superoxide radicals and hydrogen peroxide. The ubiquinone reactant is regenerated, so the NADH:Q reaction becomes superstoichiometric. Idebenone, an artificial ubiquinone showing promise in the treatment of Friedreich’s Ataxia, reacts at the flavin site. The factors which determine the balance of reactivity between the two sites of ubiquinone reduction (the energy-transducing site and the flavi

The Earth: Plasma Sources, Losses, and Transport Processes

This paper reviews the state of knowledge concerning the source of magnetospheric plasma at Earth. Source of plasma, its acceleration and transport throughout the system, its consequences on system dynamics, and its loss are all discussed. Both observational and modeling advances since the last time this subject was covered in detail (Hultqvist et al., Magnetospheric Plasma Sources and Losses, 1999) are addressed