Cochlear implantation in single-sided deafness: a single-center experience of 138 cases

OBJECTIVES

Assess the outcomes in patients who underwent cochlear implant (CI) for single-sided deafness (SSD).

METHODS

All patients affected by SSD who underwent CI at Gruppo Otologico, Piacenza, from October 2012 to May 2022 with at least 6 months of follow-up were selected in the study group. The analysis included subjective and objective measures performed pre-operative and up to 24 months after surgery. Hearing threshold on both sides was evaluated with a weighted four-frequency average (PTA [0.5 kHz + 1 kHz + 2 kHz + 4 kHz]/4) on pure tone audiometry and speech audiometry (Speech Discrimination Score, SDS). The Speech Spatial and Qualities of Hearing scale (SSQ Questionnaire) for binaural hearing benefits and sound localization, the Tinnitus Handicap Inventory Questionnaire (THI) and Dizziness Handicap Inventory Questionnaire (DHI) were used for subjective assessment.

RESULTS

Data from 138 patients, 69 males and 69 females, (mean age 49 years, range 17-77 years) underwent CI for SSD were examined. Single-sided hearing deprivation average before undergoing CI surgery was 2.5 years (range 3 months-35 years). There was a significant reduction of THI and DHI scores compared to pre-operative scores alongside a referred improvement in social, physical, and emotional well-being through the SSQ questionnaire.

CONCLUSIONS

To the best of our knowledge, this paper descried the largest cohort of SSD who underwent CI in a single institution. According to our findings CI in patients affected by SSD represents a valuable tool for an overall improvement of tinnitus and dizziness but also quality of life, after at least 6 months of follow-up. Further studies are desirable to improve rehabilitation pathways and possibly set new standards of care of this condition.

Quality Evaluation of Fresh Pasta Fortified with Sourdough Containing Wheat Germ and Wholemeal Semolina

Pasta is a staple food in the Mediterranean diet, primarily manufactured with two essential ingredients, semolina and water; nowadays, it is often supplemented with functional ingredients. In this work, a sourdough obtained with wheat germ and wholemeal semolina was used, in order to improve sensorial and nutritional properties of fresh pasta, to prevent lipids oxidation, and to improve the shelf life. Three different formulations were prepared, a first one using semolina, a second one with raw wheat germ, wholemeal semolina, and semolina, and the last one with semolina and sourdough. The study highlighted the improved nutritional properties of pasta with sourdough (reduced phytic acid content, higher antioxidant activity and phenolic content). Proteins, ashes, dietary fibers, lipids, and tocols (vitamin E) increased in pasta with wheat germ and wholemeal semolina, and with sourdough. The amount of tocols decreased in pasta samples after cooking, except for the β-tocopherol in sourdough pasta, the amount of which remained high, surprisingly. Lipase and lipoxygenase enzymes likely decreased as an effect of the pasteurization process. The NMR analysis showed that lipid oxidation was higher in semolina pasta than in pasta with wheat germ, most likely due to the protective effect of antioxidants deriving from wheat germ.

From Hop to Beer: Influence of Different Organic Foliar Fertilisation Treatments on Hop Oil Profile and Derived Beers' Flavour

Foliar fertilisation is known to influence the physiological response of Humulus lupulus (hop plants), but its effect on the flavour profile of beer still has to be investigated. By comparing the effects of four fertilisation treatments, this study aims at determining whether different foliar fertilisation treatments have a significant impact on hop plants' aromatic quality and that of the beer produced. Hop cones harvested from each experimental treatment were brewed to obtain five single dry-hopped beers, which were subsequently analysed. Gas chromatography-mass spectrometry (GC-MS) and electronic nose (Cyranose 320) analyses were performed on the hop cones, while headspace solid-phase microextraction-gas chromatography-mass spectrometry HS-SPME-GC-MS, electronic nose and sensory analyses were carried out on the beers produced. The analyses not only allowed for a differentiation between the hops from the four fertilisation treatments and the control but also enabled a differentiation between the beers produced for their identification. Sensory evaluation revealed consumer preferences regarding the dry-hopped beers analysed, evidencing their distinctive features, including significant differences in both aroma and flavour.

In Vivo and In Vitro Starch Digestibility of Fresh Pasta Produced Using Semolina-Based or Wholemeal Semolina-Based Liquid Sourdough

The use of wholemeal flour and sourdough fermentation in different food matrices has received considerable attention in recent years due to its resulting health benefits. In this study, a semolina-based and a wholemeal semolina-based sourdough were prepared and added to the formulation of gnocchetti-type fresh pasta. Four types of gnocchetti were made, using semolina plus semolina-based sourdough (SS), semolina plus wholemeal semolina-based sourdough (SWS), semolina alone (S), and semolina plus wholemeal semolina (WS). The latter two were used as controls. The digestibility of starch was studied both in vitro and in vivo, and the glycemic response (GR) and glycemic load (GL) were determined. Starch digestibility, both in vivo and in vitro, was higher in wholemeal semolina than semolina pasta and the resulting GR values (mg dL⁻¹ min⁻¹) were also higher (2209 and 2277 for WS and SWS; 1584 and 1553 for S and SS, respectively). The use of sourdough significantly reduced the rapidly digestible starch (RDS) content and increased the inaccessible digestible starch (IDS) content. The addition of sourdough to the formulation had no effect on the GR values, but led to a reduction of the GL of the pasta. These are the first data on the GR and GL of fresh pasta made with sourdough.

Surgery of the lateral skull base: a 50-year endeavour

Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

Fresh Pasta Manufactured with Fermented Whole Wheat Semolina: Physicochemical, Sensorial, and Nutritional Properties

Fresh pasta (SP) was prepared by mixing semolina with liquid sourdough, whole wheat semolina based, and the effects of sourdough inclusion were evaluated against a control sample (CP) prepared using semolina and whole wheat semolina. Physicochemical, nutritional, and sensorial analyses were performed on pasteurized fresh pasta, before and after cooking. The optimum cooking time was not affected by whole wheat sourdough, whereas differences were found in color, firmness, and cooking loss. Changes of in vitro digested starch fractions in SP pasta were affected by a higher cooking loss. Overall, SP samples were characterized by improved nutraceutical features, namely higher content of free essential amino acids and phenolic compounds, lower phytic acid content, and higher antioxidant activity. Sensory analyses (acceptability and check-all-that-apply (CATA) tests) showed significantly higher scores for the SP, and the differences were enhanced when the consumers were informed about the product composition and how it was manufactured. Consumers checked for more positive sensory parameters for the SP than the CP.

Filament identification in wide-angle high speed imaging of the mega amp spherical tokamak

A new tomographic inversion technique is presented for the identification of plasma filaments in wide-angle visible camera data. The technique works on the assumption that background subtracted images of filaments can be represented as a superposition of uniformly emitting magnetic equilibrium field lines. A large collection of equilibrium magnetic field lines is traced and projected onto the camera field of view and combined to form a geometry matrix describing the coordinate transformation from magnetic field aligned coordinates to image pixel coordinates. Inverting this matrix enables the reprojection of the emission in the camera images onto a field aligned basis, from which filaments are readily identifiable. The inversion is a poorly conditioned problem which is overcome using a least-squares approach with Laplacian regularization. Blobs are identified using the "watershed" algorithm and 2D Gaussians are fitted to get the positions, widths, and amplitudes of the filaments. A synthetic camera diagnostic generating images containing experimentally representative filaments is utilized to rigorously benchmark the accuracy and reliability of the technique. 74% of synthetic filaments above the detection amplitude threshold are successfully detected, with 98.8% of detected filaments being true positives. The accuracy with which filament properties and their probability density functions are recovered is discussed, along with sources of error and methods to minimize them.

Effect of liquid sourdough technology on the pre-biotic, texture, and sensory properties of a crispy flatbread

The present study compared liquid sourdough technology with baker's yeast leavening when applied to the production of a semolina-based crispy flatbread. Following in vitro starch digestion, the results revealed the sourdough leavened flatbread to contain a lower percentage of rapidly digestible starch (16%), higher amounts of slowly digestible starch (27%) and inaccessible digestible starch (4.1%) compared with the baker's yeast leavened flatbread (20, 20, and 2.4%, respectively), making the former nutritionally healthier. The sourdough leavened bread was crispier, stiffer and more solid, as shown by texture analyses, although Raman spectroscopy revealed no differences in the crystallinity status of starch. The descriptive analyses show that the use of sourdough enhances the positive sensory traits, as rated by the consumer panel scores (6.08 vs. 5.56). In summary, the results indicate that the implementation of sourdough technology in the production of flat crispy breads could confer economic advantages to this product.

Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas

OBJECTIVE

To analyze the long term outcomes after surgery in tympanomastoid paragangliomas.

STUDY DESIGN

Retrospective study.

METHODS

The charts of 145 patients with tympanomastoid paragangliomas managed between 1988 and 2013 were reviewed. The clinical features, audiological data, pre- and postoperative notes were noted. The tumors were staged according to the modified Fish and Mattox classification. The surgical approaches for all patients were formulated according to the surgical algorithm developed at our center.

RESULTS

34 (23.5%), 46 (31.7%), 22 (15.2%), 18 (12.4%) and 25 (17.2%) patients were diagnosed to have TMP class A1, A2, B1, B2 and B3 tumors respectively. Gross tumor resection was achieved in 141 (97.2%) patients. The facial nerve was uncovered in four patients and infiltrated in three. The cochlea was found eroded in seven cases. The mean follow-up was 48.4 months. Recurrence was seen in one patient (0.7%). In the cases where the facial nerve was preserved (n=143), the nerve function was graded as HB grade 1 in 138 patients (97%). Postoperatively, the mean AC showed an improvement in all categories except in class B2 and B3, which corresponds to the classes that include patients who underwent subtotal petrosectomy.

CONCLUSION

We report the long term surgical outcomes in tympanomastoid paragangliomas in the largest series published till date. It is possible to completely eradicate all types of tympanomastoid paragangliomas with minimum sequelae by choosing the correct surgical approach to achieve adequate exposure for individual tumor classes as described in our classification and algorithm.

LEVEL OF EVIDENCE

IIb.

Impact of cholesterol lowering treatment on plasma kynurenine and tryptophan concentrations in chronic kidney disease: relationship with oxidative stress improvement

BACKGROUND AND AIM

Tryptophan (Trp) degradation via indoleamine (2,3)-dioxygenase (IDO), with consequent increased in kynurenine (Kyn) concentrations, has been proposed as marker of immune system activation. Oxidative stress (OS) might contribute to the pro-inflammatory state in chronic kidney disease (CKD) through the activation of NF-kB, with consequent activation and recruitment of immune cells.

METHODS AND RESULTS

Serum concentrations of Trp and Kyn, oxidative stress indices malondialdehyde (MDA) and allantoin/uric acid (All/UA) ratio and anti-oxidant amino acid taurine were measured in 30 CKD patients randomized to 40 mg/day simvastatin (group 1), ezetimibe/simvastatin 10/20 mg/day (group 2) or ezetimibe/simvastatin 10/40 mg/day (group 3) and treated for 12 months. Baseline Kyn and Kyn/Trp ratio were higher in CKD patients vs. healthy controls (1.67 ± 0.62 μmol/L vs 1.25 ± 0.40 μmol/L, p < 0.01 and 0.036 ± 0.016 vs 0.023 ± 0.010, p < 0.001 respectively). Both Kyn and Kyn/Trp ratio significantly decreased after cholesterol lowering treatment, to values comparable with healthy controls after one year treatment (1.67 ± 0.62 μmol/L vs 1.31 ± 0.51 μmol/L, p < 0.0001 and 0.036 ± 0.016 vs 0.028 ± 0.012 p < 0.0001, respectively). This was paralleled by a significant decrease in MDA (218 ± 143 nmol/L vs 176 ± 123 nmol/L, p < 0.01) and All/UA ratio (1.47 ± 0.72 vs 1.19 ± 0.51, p < 0.01) in CKD patients.

CONCLUSIONS

Amelioration of both oxidative and inflammation status after cholesterol lowering treatment in CKD might be mediated by restoration of antioxidant taurine concentrations during therapy (from 51.1 ± 13.3 μmol/L at baseline to 63.1 ± 16.4 μmol/L, p < 0.001 by ANOVA), suggesting that improvement of both oxidative and inflammation status in CKD patients could be explained, at least partly, by the cholesterol lowering effects.

Regular cigarette smoking influences the transsulfuration pathway, endothelial function, and inflammation biomarkers in a sex-gender specific manner in healthy young humans

Cigarette smoking (CS) is the primary cause of preventable morbidity and mortality. Abundant clinical evidence suggests that CS is more harmful to women; however, the mechanisms responsible for these differences are not yet known. CS alters endothelial function, the redox state, inflammation, and global DNA methylation, which is associated with one-carbon metabolism and the transsulfuration pathway. However, it is not known whether the previously identified alterations are sex-gender related. Healthy adult men and oral contraceptive-free women with regular menstrual cycles were enrolled; women were examined during the follicular phase. Men had higher plasma levels of uric acid, total bilirubin, homocysteine, glutamylcysteine, total glutathione, cysteinylglycine; had more monocytes and released more TNF-alpha from human monocytes derived macrophages (hMDMs), but they had fewer platelets and lower levels of DNA methylation, and their hMDMs released less TNF-alpha after LPS stimulation. MDA, taurine, cysteine, arginine, ADMA, and SDMA were not different. CS decreased global DNA methylation more in women and increased the platelet, monocyte, and lymphocyte counts and the homocysteine, arginine, and ADMA levels only in women, whereas increased the neutrophil and eosinophil counts only in men. Additionally, CS reduced the sex-gender differences in total bilirubin, basal and LPS-induced TNF-alpha release, total glutathione, and glutamylcysteine, leaving unchanged cysteinylglycine, taurine, SDMA, MDA, and cysteine. These data suggest that cardiovascular risk factors seem to come earlier in young healthy female smokers than in young healthy male smokers, supporting the greater alarmism regarding the effects of CS in women and providing a basis for understanding the sex-gender differences. These results also suggest that cessation programs targeting women are needed.