Teaching in schools of specialization: problems and the possible solutions

Teaching of anatomy in post-graduate schools that request it is particularly difficult for the number of hours available, the need not to repeat arguments already addressed in the degree course in medicine, to stimulate the interest of doctors in training and provide anatomical knowledge which are not detached from the clinical practice. To overcome these difficulties we have used in the teaching of anatomy of the post-graduate schools of the neurological-neurosurgical areas and of laryngology-phoniatry a didactic approach, which illustrate, verified for its effectiveness with an evaluation questionnaire submitted to the doctors in training at the end of the course. The essential points of the teaching are: monographic lectures on topics of anatomy related to the clinical field of specific specialization. Treatment of the subjects starting from neurological syndromes or complex brain functions of clinical relevance the understanding of which involves learning of a set of anatomical structures (eg language and cranial nerve, paralytic syndromes associated of the cranial nerves etc).The educational cycle is completed inviting the doctors to present to colleagues and to the professor the anatomical correlates of a published case report, provided to them at the end of the lesson. The teaching of the anatomy that we have illustrated is different from that which is evident from the texts available of clinical neuroanatomy, which treated anatomy of brain regions or of functional systems and reported medical cases that seek to exercise the clinical reasoning ,which purpose is not relevant to the teaching of anatomy .In conclusion even if our didactic approach is limited to some medical specializations and tested on a small number of doctors in training we suggest it as an alternative way to teach anatomy in postgraduate schools

The incidence of vestibular neuritis in Italy

ObjectiveThis study aims to estimate the incidence of Vestibular neuritis (VN) in three different districts in Italy, its epidemiological features, and the prevalence of comorbidities associated with it. MethodsAn observational prospective study of 198 patients referred to ENT departments in Siena, Grosseto, and Cuneo was carried out over a 2-year period. Each patient underwent a complete otoneurologic examination in the first 48 h from the onset of symptoms and a brain MRI in the early stages of the disease. The follow-up lasted for 1 year. ResultsThe total VN incidence rate of the three municipalities was 48.497 (95% CI: 48.395-48.598) and its standardized value was 53.564 (95% CI: 53.463-53.666). The total VN incidence rate for the whole sample (municipality and district of the three centers) was 18.218 (95% CI: 18.164-18.272), and its standardized value was 20.185 (95% CI: 20.129-20.241). A significant difference was highlighted between patients living in the city compared to those living in the surrounding area (p < 0.000), this may be due to the ease of reaching the otoneurological referral center. ConclusionThe total incidence rate for the three municipalities was 48.497. This result is higher than previously reported studies

Valutazione della funzione post-operatoria del nervo faciale dopo exeresi di schwannoma vestibolare nella Neurofibromatosi tipo 2.

Introduzione: analizzare la funzione del nervo facciale dopo resezione completa di schwannoma vestibolare (VS) in pazienti con diagnosi di Neurofibromatosi tipo 2 (NF2). Analisi e Metodi: analisi retrospettiva dei dati nei pazienti NF2 trattati chirurgicamente in Francia. Risultati: 102 pazienti sono stati inclusi nella nostra analisi retrospettiva. 10 sono stati operati bilateralmente. Tutti i pazienti sono stati sottoposti ad intervento chirurgico di resezione completa di schwannoma vestibolare, controllato con esame radiologico post-operatorio MRI. Il 42% dei pazienti operati aveva uno schwannoma vestibolare di stadio 3 e il 58% di stadio 4. Il 72% dei soggetti aveva una funzione pre-operatoria del nervo faciale grado 1 secondo la classificazione di House-Brackmann (HB) e solo il 42% aveva una normale funzione post-operatoria. I pazienti che hanno eseguito anastomosi VII-XII nervo cranico con interposizione sono stati esclusi dallo studio. Il tasso di mortalità perioperatoria è stata dell'1,4% (2 pazienti). Tre pazienti (2,5%) sono stati ri-operati per la comparsa di un ematoma post-operatorio e 2 (1,67%) presentavano un deficit dei nervi misti; uno di loro ha eseguito tracheostomia post-operatoria e sono stati inseriti in 5 (4,16%) pazienti shunts ventricolo peritoneale (VP) per idrocefalo post-operatorio e 7 (6%) presentavano fuga di fluido cerebro spinale (CSF). Conclusioni: Con l’arrivo di nuove tecniche di trattamento e con l’obiettivo di preservare e mantenere una buona qualità di vita nei pazienti con NF2, lo scopo di questa chirurgia è oggi quello dell’exeresi dei VS non più totale ma parziale al fine di conservare il funzionamento del nervo faciale. Il presente studio illustra l'alto costo funzionale di resezione completa del tumore in questi pazienti, anche in un team esperto e di sostenitori per la chirurgia sub-totale e con trattamenti combinati

Coping Strategies of Healthcare Professionals with Burnout Syndrome: A Systematic Review

Background and Objectives: To evaluate the efficacy of coping strategies used to reduce burnout syndrome in healthcare workers teams. Materials and Methods: We used PubMed and Web of Science, including scientific articles and other studies for additional citations. Only 7 of 906 publications have the appropriate inclusion criteria and were selected. A PRISMA 2020 flow diagram was used. Results: The most common coping strategies that the literature studies showed were efficient, in particular social and emotional support, physical activity, physical self-care, emotional and physical distancing from work. Coping mechanisms associated with less burnout were also physical well-being, clinical variety, setting boundaries, transcendental, passion for one’s work, realistic expectations, remembering patients and organizational activities. Furthermore, it was helpful to listen to the team’s needs and preferences about some types of training. Conclusion: We suppose that the appropriate coping strategies employed in the team could be useful also in the prevention of psychological suffering, especially in contexts where working conditions are stressful. Studies about coping strategies to face burnout syndrome in healthcare workers should be increased

The functional head impulse test: preliminary data

The functional head impulse test is a new test of vestibular function based on the ability to recognize the orientation of a Landolt C optotype that briefly appears on a computer screen during passive head impulses imposed by the examiner over a range of head accelerations. Here, we compare its results with those of the video head impulse test on a population of vestibular neuritis patients recorded acutely and after 3\ua0months from symptoms onset. The preliminary results presented here show that while both tests are able to identify the affected labyrinth and to show a recovery of vestibular functionality at 3\ua0months, the two tests are not redundant, but complementary

Relief of nasal symptoms in obstructive rhinopathy with and without rhinosinusitis, with the silsos® hyper medical device. A randomized, double-blind, active comparator (saline)-controlled clinical trial

BACKGRoUND. Nasal obstruction is a primary symptom of common upper respiratory tract disorders, including common cold and acute and chronic rhinosinusitis with/without nasal polyposis. In patients affected by sinonasal diseases, transudation and edema are reported to increase and thicken the periciliary layer impairing the mucociliary clearance (MCC) and/or the mucociliary transport time (MCTt) which are preventative mechanisms against the deposition of inhaled, pro-inflammatory particulate matter as well as the harboring of infections at the level of paranasal sinuses. In clinical practice and in several nasal affections nasal saline solutions are always recommended for the cleansing of nasal cavities and relieving nasal symptoms. MATERiAl AND METHoDs. A randomized, double-blind, active comparator (isotonic, nasal saline solution) controlled, parallel study was conducted to evaluate the safety and the efficacy of SILSOS hyper (a new Medical Device - MD - composed of the synergistic association of the patented silver salt Silver Sucrose Octasulfate and Potassium Sucrose Octasulfate) in patients suffering from obstructive rhinopathy, with nasal obstruction/congestion of moderate severity persistent since at least 10 days in advance of recruitment with/without rhinosinusitis. At baseline (T0), ten days (T10) and twenty days (T20) after saline or SILSOS treatment, study participants were evaluated subjectively with VAS and SNOT-22, and objectively by Active Anterior Rhinomanometry (AAR) and MCC/MCTt determination by means of the charcoal+3% saccharine test. All the patients were followed-up 30 days after the end of the treatment by a phone interview aimed to evaluate the long term effectiveness of the treatment. REsUlTs. All the 50 enrolled outpatients (aged 18-70 years) completed the study. The AAR analysis showed that whereas saline resulted ineffective on improving inspiratory and expiratory flow at any study timepoint, MD patients progressively and significantly (p<0.05) ameliorated in expiratory flow, at T0-T10 as well over the whole study period (T0-T20). Considering MCC and MCTt determination, no improvement in MCTt was observed over the 20 days study period. As the MCC is concerned, the mean values significantly improved at T20 (p<0.0001) in both groups, but the ΔT0-T20 was 4.12 minutes in the MD group and 2.64 minutes in the control group. This difference has to be considered clinically significant. MD showed a continuous VAS total and mean score improvement along all time-intervals, resulting superior to saline at T10-T20 (p<0.001 vs p<0.05 in saline). Nasal obstruction was back 30 days after the end of treatment in both the groups, but in saline patients only it was judged as moderate/severe. The symptom was present in only 3 patients from the MD group, and reported to be in a mild form. CoNClUsioN. The obtained results show that only the MD has added to the mechanical action of removal of secretions a specific decongestant and antiseptic effect lasting longer after the end of the treatment. In view of its natural decongestant activity and of its hydrating effects, SILSOS hyper could help to fluidize thick mucus, improve respiration and promote resolution of symptoms, preventing pathogens adhesion to nasal mucos

Proteomic investigation of dermal fibroblasts isolated from affected and unaffected skin samples from patients with limited cutaneous systemic sclerosis: 2 distinct entities?

Objective. To identify using proteomic analysis the proteins of altered abundance in the affected and unaffected limited cutaneous systemic sclerosis (lcSSc) skin fibroblasts. Methods. Excision biopsies (3 mm) were obtained from the affected and unaffected skin of 5 patients with lcSSc. Dermal fibroblasts were isolated enzymatically. Two-dimensional gel electrophoresis was used to separate and define proteins in affected and unaffected fibroblast lysates. Proteins of altered abundance were identified by mass spectrometry. Differences among skin samples were confirmed also by immunohistochemistry (IHC) and by quantitative real-time PCR (qRT-PCR) for type I collagen (Col-1) and vimentin (VIM). Results. Proteomic analysis revealed different expressions of proteins involved in cytoskeleton organization (27%), extracellular matrix remodeling (11%), response to oxidative stress (22%), energy metabolism (19%), protein metabolism (5%), cellular homeostasis (5%), signal transduction (3%), and protein transcription, synthesis, and turnover (8%). IHC analysis showed that SSc-affected epidermis is thickened and the dermis is strongly reactive to Col-1 and VIM (typical markers of activated myofibroblasts) compared to SSc-unaffected skin, whose stainings are comparable to those of control healthy skin. Overexpression of Col-1 and VIM mRNA levels in affected lcSSc fibroblasts compared to unaffected lcSSc ones was confirmed by qRT-PCR. Conclusion. Consistent with previous studies, these findings are important for 2 reasons: First, because they reveal the opposite behavior of dermal fibroblasts in the unaffected and affected skin areas of the same patient with lcSSc; second, because they demonstrate the histological/histochemical similarities between unaffected skin from patients with lcSSc and healthy control skin

A comparative study on oxidative stress role in nasal breathing impairment and obstructive sleep apnoea syndrome

Obstructive sleep apnoea syndrome (OSAS) is a sleep disorder that leads to metabolic abnormalities and increased cardiovascular risk. This study aimed to define the expression and clinical significance of biomarkers involved in oxidative stress in patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in three groups of subjects. The study involved the recruitment of three groups of subjects, 10 patients with obstructive sleep apnoea syndrome with AHI > 30; 10 patients suffering from snoring at night with AHI 0.05). There were significant differences in AHI among the three groups of patients (p 0.05) between the levels of biomarkers of oxidative stress in the three populations studied. The results of our study show that the nose can play a role in the pathogenesis of OSAS through the production of biomarkers of oxidative stress

Bellussi, L

Obstructive sleep apnoea syndrome (OSAS) is a disorder that leads to metabolic abnormalities and increased cardiovascular risk. The aim of this study was to identify early laboratory markers of cardiovascular disease through analysis of oxidative stress in normal subjects and patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in 20 adult patients with OSAS and a control group of 20 normal subjects. Laboratory techniques for detecting and quantifying free radical damage must be targeted to assess the pro-oxidant component and the antioxidant in order to obtain an overall picture of oxidative balance. No statistical differences in age, sex distribution, or BMI were found between the two groups (p>0.05). There were significant differences in the apnoea/hypopnoea index (AHI) between OSAS patients and the control group (p<0.05). Statistically significant differences in isoprostane, advanced oxidation protein products (AOPP) and non-protein bound iron (NPBI) levels were found between the study and control groups. No significant difference in the levels of thiol biomarkers was found between the two groups. The main finding of the present study was increased production of oxidative stress biomarkers in OSAS patients. The major difference between thiols and other oxidative stress biomarkers is that thiols are antioxidants, while the others are expressions of oxidative damage. The findings of the present study indicate that biomarkers of oxidative stress in OSAS may be used as a marker of upper airway obstructive episodes due to mechanical trauma, as well as a marker of hypoxaemia causing local oropharyngeal inflammation

Apremilast interferes with the TGFβ1-induced transition of human skin fibroblasts into profibrotic myofibroblasts : in vitro study

Objectives. Fibroblast-to-myofibroblast transition and extracellular matrix overproduction represent progressive events in chronic inflammatory and fibrotic diseases, in which TGF beta 1 is one of the key mediators. Phosphodiesterase 4 (PDE4) acts as a proinflammatory enzyme through the degradation of cyclic adenosine monophosphate and it is overexpressed in skin fibroblasts. The study investigated how apremilast (a PDE4 inhibitor) interferes with the intracellular signalling pathways responsible for the TGF beta 1-induced fibroblast-to-myofibroblast transition and profibrotic extracellular matrix protein synthesis. Methods. Cultured human skin fibroblasts were stimulated with TGF beta 1 (10 ng/ml) alone or combined with apremilast (1 and 10 mu M) for 4, 16 and 24h. Other aliquots of the same cells were previously stimulated with TGF beta 1 and then treated with apremilast (1 and 10 mu M) for 4, 16 and 24h, always under stimulation with TGF beta 1. Gene and protein expression of aSMA, type I collagen (COL1) and fibronectin were evaluated, together with the activation of small mothers against decapentaplegic 2 and 3 (Smad2/3) and extracellular signal-regulated kinase (Erk1/2) proteins. Results. Apremilast reduced the TGF beta 1-induced increase in alpha SMA, COL1 and fibronectin gene expression at 4 and 16 h, and protein synthesis at 24 h of treatment in cultured fibroblasts, even for cells already differentiated into myofibroblasts by way of a previous stimulation with TGF beta 1. Apremilast inhibited the TGF beta 1-induced Smad2/3 and Erk1/2 phosphorylation at 15 and 30 min. Conclusion. Apremilast seems to inhibit in vitro the fibroblast-to-myofibroblast transition and the profibrotic activity induced by TGF beta 1 in cultured human skin fibroblasts by downregulating Smad2/3 and Erk1/2 intracellular signalling pathways