Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic

Sound influence on vestibulo-spinal control

It has been known for a long time that the application of intense acoustic stimuli to the ear can induce reflex muscle responses. The classic physiology describes reflex responses of neck muscles aimed at turning the head towards the source of acoustic stimuli. It is well known Tullio phenomenon (1929) which is a rare but remarkable clinical entity consisting of a rotatory vertigo and unsteadiness evoked by extremely loud sounds (ipsilateral nystagmus ). The link between the vibratory energy and the vestibular response takes place in the saccule which is located between choclea and utriculus on one side and semicircular canals on the other side. The acoustic stimulation induces movements of the stapes footplate which excite macular receptors of the sacculus, due to their close proximity. Therefore, acoustic stimulation activates the vestibulo-spinal pathway by stimulating saccular maculae EMG/ABR recording from ipsi SCM showes a P13/N23 biphasic complex

Vestibular rehabilitation in whiplash injuries

Whiplash injury can be defined as a non-contact rapid acceleration-deceleration head-neck trauma during which the kinematics of the cervical spine are completely disrupted. Because of the impact a sudden violent head retro-flexion is followed by an as much as violent head antero-flexion. The therapy influenced Tonic muscles by increasing labyrinthine percentage and induced a reduction in activity of Phasic muscles by decreasing Somatosensorial and Visive Percentag

The MCS (mechanic, cybernetics and synergetics) method in vestibular rehabilitation

Vertigo and dizziness are conscious symptoms and the disturbances are not disequilibrium or nystagmus but the consciousness of disequilibrium and nystagmus. Thus physical rehabilitation must not only be pointed to resolution of objective disorder but it must be aimed to resolution of subjective consciousness of the disorder itself. MCS is the achronimus of mechanic , cybernetics and synergetics. We said that to prepare a particular protocol of treatment is necessary to have in mind a particular model of the Equilibrium system. Under a mechanic point of view we can consider the Equilibrium function as the result of the sum of these reflexes, the contemporary but distinct activation of some or all of these reflexes, according to the need: gaze, standing, walking. Under a cybernetics point view all the structures, peripheral and central, that contribute to the BOR and BSR constitute a system. A System is a network of different structures interconnected , interacting to reach a common goal. In this case the goal is human balance. The structures that provide the BOR and the BSR consitute the so-called Equilibrium System. Lackner remembered that the so-called vestibular nuclei are real polisensorial relays and that they are not only correlated to the activity of the vestibule. Thus it is uncorrected to define those nuclei as vestibular nuclei. They are true Balance nuclei that act together cerebellum and reticular formations to provide the sub-cortical component of human Equilibrium. Under the neurophysiological point of view the Equilibrium system (ES) is the Vestibular system. In order to reduce misinterpretation we prepose to refer to the Equilibrium System comprehending also the vestibular part of informations and reflexes. Synergetics model is based on the papers of Haken. He proposed his model to simplify complex functions such as macroeconomics processes, some physics phenomena such as clouds formation and many other complex phenomena. He proposed that every phenomenon, every function, is the macroscopic result of microscopic arrangements of the components that acts together to produce the phenomenon itself (that is to perform the function). By this point of view a system can be subdivided into different functional levels. Each lower, microscopic, level is directly communicating and interconnected with the upper, macroscopic, level.</p

Distortion-product otoacoustic emission: early detection in deferoxamine induced ototoxicity

Objective. Deferoxamine therapy in lifelong transfusion-dependent anaemias, as beta-thalassemia major, is associated with an increased risk of ototoxic changes. With increasing survival rates, prevention and/or early detection of ototoxicity are important for providing management options. The predictive value of pure-tone audiometry in early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions appear to be more sensitive to cochlear insult than the conventional pure-tone audiometry. The aim of our study was to compare the efficacy of otoacoustic emissions (distortion-product otoacoustic emissions) with that of pure-tone audiometry as method of audiological monitoring. Methods. Baseline audiometric (0.25–8 kHz) and otoacoustic emission testing (distortion-product otoacoustic emissions) was conducted in a group of patients with beta-thalassemia major, 60 of whom met the criteria for inclusion in the study. Comparisons were performed between baseline measurements and those recorded after 20 months. Distortion-product otoacoustic emissions were obtained as DP-grams. The DP-gram amplitude was determined for each child. Results. Threshold changes from baseline were found to be statistically significant from 4 to 8 kHz in 68.4% of the subjects (P &lt; 0.01). Distortion-product otoacoustic emissions demonstrated a significant threshold shift and a decreased amplitude in the frequencies &gt;3 kHz (P &lt; 0.05). Furthermore, DP-gram amplitude also reduced significantly at 3 kHz (P &lt; 0.05) without any similar change in pure-tone audiometry. Conclusions. As ototoxicity screening tool DP-gram was extremely sensitive and superior to pure-tone audiometry. Their use is recommended for regular monitoring of cochlear function, aiming in prevention of permanent damage

Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations

Patients with multiple sclerosis (MS) frequently report symptoms related to vestibular disorders in the course of their disease. At present, the fundamental tests assessing vestibulospinal involvement are posturography and vestibular evoked myogenic potentials (VEMPs). While posturography cannot be performed in every subject requiring minimal stance control, VEMPs do not require any specific skill on the part of the subjects and they may be investigated in all patients able to sit. VEMPs were recorded for 40 patients (17 men, 23 women; mean age 38 years, range 17-71 years) fulfilling diagnostic criteria of clinically defined MS, by means of rarefaction clicks, recording modulation of sterno-cleido-mastoideus tonic contraction saccule-mediated modulation. VEMPs were found to be abnormal in 28 of 40 patients. In 18 of the cases the VEMPs were asymmetric, i.e., had a prolonged latency on one side. In six cases latency was increased on both sides (mean delay 4.1 ms). In four subjects VEMPs were absent on one side. C oncordance with clinical findings of presence/absence of brainstem involvement was found in 55% and with MRI findings in 65% of the cases. A bnormal VEMPs indicated brainstem dysfunction in four patients (10%) with normal MRI and no specific clinical signs

Aging and vestibular system: specific tests and role of melatonin in cognitive involvement

Balance disorders are frequent with aging. They are particularly important because they decrease social autonomy of the aged subjects and they often provoke falls. The cause is always multifactorial. There is evidence that aging affects multiple sensory inputs, as well as the muscoloskeletal system and central nervous system ability to perform sensorimotor integration. For the evaluation of decreased balance skills in elderly, a specific questionnaire has been prepared, in order to identify high risk of falling called falling risk inventory (FRI) questionnaire, and a complex psycho-sensory-motor test has been studied by means of posturography, in order to detect specific vestibular impairment. Regarding ethiopathogenesis of balance disorders in aged subjects, because the decline of behavioral and cognitive performances are due also to decline of biological rhythm control, the role of melatonin (the hormone regulating circadian rhythms, being strictly connected with cerebellar function, and it is well known that cerebellum acts in elderly both at motor and cognitive regulation. The goals of the present paper are: (i) To present a self-administered FRI questionnaire aimed at identifying possible causes of falls and quantifying falling risk in aged. (ii) To validate posturography as a specific test to investigate vestibular involvement in elderly in correlation with FRI. (iii) To present a complex behavioral test (NT) aimed at evaluating both spatial orientation and spatial memory in elderly, factors involved into the genesis of complex dizziness and unsteadiness. (iv) To evaluate the role of melatonin in cognitive involvement in dizzy, old subjects due to the functional correlations between circadian rhythms, cerebellum balance disturbances and cognitive disorders. General conclusions are: FRI correlates with falling risk. Posturography identifies specific vestibular impairments correlated to balance disorders and elderly falls. Spatial orientation is altered in about 40% of dizzy patients but no significant differences are revealed in melatonin rhythm. Spatial memory is highly altered only in subjects with inversion of circadian melatonin rhythm it is possible to hypothesize that the alteration of the normal circadian melatonin rhythm plays some role in the genesis of dizziness in a subpopulation of patients

A Novel autosomal dominant non-syndromic deafness locus (DFNA48) maps to 12q13-q14 in a large Italian family

Non-syndromic hearing loss is the most common sensory disorder in humans; 15%–20% of cases are transmitted as a dominant trait (NSDA) with 40 loci having been mapped and 16 genes having been identified. Here, we report the mapping of a novel NSDA locus, DFNA48, to chromosome 12q13-q14 in a large multigenerational Italian family. A maximum lod score of 3.31 was obtained with marker D12S83, whereas markers D12S347 and D12S1703 defined a region of approximately 18 cM. Positional candidate genes are being screened for deafnesscausing mutations

Translating epithelial mesenchymal transition markers into the clinic: Novel insights from proteomics

The growing understanding of the molecular mechanisms underlying epithelial-to-mesenchymal transition (EMT) may represent a potential source of clinical markers. Despite EMT drivers have not yet emerged as candidate markers in the clinical setting, their association with established clinical markers may improve their specificity and sensitivity. Mass spectrometry-based platforms allow analyzing multiple samples for the expression of EMT candidate markers, and may help to diagnose diseases or monitor treatment efficiently. This review highlights proteomic approaches applied to elucidate the differences between epithelial and mesenchymal tumors and describes how these can be used for target discovery and validation

Translating epithelial mesenchymal transition markers into the clinic: Novel insights from proteomics

International audienceThe growing understanding of the molecular mechanisms underlying epithelial-to-mesenchymal transition (EMT) may represent a potential source of clinical markers. Despite EMT drivers have not yet emerged as candidate markers in the clinical setting, their association with established clinical markers may improve their specificity and sensitivity. Mass spectrometry-based platforms allow analyzing multiple samples for the expression of EMT candidate markers, and may help to diagnose diseases or monitor treatment efficiently. This review highlights proteomic approaches applied to elucidate the differences between epithelial and mesenchymal tumors and describes how these can be used for target discovery and validation