Early onset absence epilepsy of childhood: Epidemiologic data, treatment and outcome in a sample of 56 patients born between 2000 and 2018

PURPOSE

The aim of our work is to describe the characteristics of Early Onset Absence Epilepsy (EOAE) and to observe whether specific anamnestic, clinical or electroencephalographic characteristics can influence the drug sensitivity of this pathology.

METHODS

We carried out a retrospective study of patients affected by absence epilepsy with onset under four years of age, born between January 1st 2000 and December 31st 2018, who were reffered to the Regional Epilepsy Center of Spedali Civili of Brescia. We then divided the sample into three groups based on the age of onset.

RESULTS

Our sample is composed of 56 patients. Among the children with epilepsy onset under two years of age (11), all were still on therapy after three and six years of follow-up, and 64 % of them required polytherapy. Among patients with epilepsy onset between two and three years of age (24), 87 % were still on therapy after three years of follow-up and 68 % after six years of follow-up; 46 % of these subjects required polytherapy. Among patients with epilepsy onset between three and four years of age (21), 89 % were still on therapy after three years of follow-up and 38 % after six years of follow-up; 38 % of them required polytherapy.

CONCLUSIONS

We observe that patients with an earlier epilepsy onset have a worse outcome and a lower drug sensitivity. This may allow to predict in which cases it would be appropriate to maintain antiseizure therapy for a prolonged period.

The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease; a case report

Ménière's disease (MD) patients may suffer episodes of sudden falls, named Tumarkin drop attacks (DAs). This fall occurs abruptly and without warning or loss of consciousness. DAs usually aggravate the clinical picture of MD and are challenging to manage. The present report describes a case treated by cochlear implantation (CI) due to concomitant deafness and offers some clinical considerations for this condition. A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side. He suffered from intermittent attacks of vertigo, ear fullness, and tinnitus and, in the last year, had developed DAs and experienced 14 episodes in the previous six months. The preoperative category of acoustic performance was 3. The Dizziness Handicap Inventory (DHI) questionnaire showed a total score of 46, which indicated a moderate degree of disability. A CI was planned for the right side. The patient did not report any further DAs episode for two years since then. The postoperative category of acoustic performance became 11, and the postoperative DHI questionnaire showed a decrease in the total score (from 46 to 19), which indicated a mild disability. Unilateral CI effectively alleviated the DAs associated with bilateral MD. Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results.

The impact of labyrinthine magnetic resonance signal alterations on the treatment of sudden sensory-neural hearing loss

BACKGROUND

Sudden sensory-neural hearing loss (SSNHL), with positive findings on magnetic resonance imaging (MRI), possibly related to labyrinthine hemorrhage, is a rare condition and difficult to be diagnosed.

OBJECTIVES

We evaluated the role of MRI in detecting labyrinthine signal changes and the impact of these changes on the prognosis of SSNHL after the intratympanic corticosteroid injection.

METHODS

A prospective study was held between January and June 2022. We included patients who complained of SSNHL, either idiopathic (30 patients) or labyrinthine signal alterations (14 patients), as diagnosed by MRI performed 15 days after the SSNHL onset. In addition, all patients underwent a course of intratympanic prednisolone injections.

RESULTS

83.3% of the idiopathic group showed a complete or marked improvement after the intratympanic injection. Conversely, most cases of positive MR signal alterations (92.8%) had slight or poor improvement after the therapeutic course.

CONCLUSIONS

Our study revealed that MRI imaging is essential for assessing any SSNHL case. It can diagnose labyrinthine hemorrhage, whose course and prognosis differ significantly from idiopathic SSNHL.

SIGNIFICANCE

Intratympanic prednisolone injection was effective in managing idiopathic SSNHL. On the other hand, this therapeutic modality was ineffective in improving SSNHL associated with labyrinthine hemorrhage.

On the battery life of a totally implantable active middle ear device: a retrospective study in a single implanting center

BACKGROUND

Totally-implantable active middle ear devices (AMED) rely on a non-rechargeable battery encased with the implantable sound processor that needs to be replaced with a minor surgical procedure after its depletion.

OBJECTIVES

This study aimed to investigate the most significant factors affecting the implant's battery life.

MATERIALS AND METHODS

The implanted subjects (29 patients) were divided into three groups; group A with 17 patients who underwent one battery change surgery; group B with ten patients who underwent two battery changes; and group C with two patients and three surgeries. The battery life was put in correlation with several variables, including daily use and the auditory threshold.

RESULTS

The battery life ranged from 26 to 67 months, with a mean of 48.93 ± 13.47. Pearson's correlation coefficient revealed that the battery life was statistically correlated only with the mean post-implantation bone conduction thresholds (p-value <.0001).

CONCLUSIONS

Although the non-rechargeable battery system of the AMED under study overcomes the drawbacks of daily charging, it needs to be surgically changed after its depletion. The different rates of battery life were shown to mainly depend on the post-implantation BC thresholds, which in some cases showed a deterioration concerning the pre-implanting values.

Evaluation of prednisolone and prednisolone sodium succinate concentrations in human plasma and inner ear perilymph during cochlear implantation 24 h after intratympanic injection

BACKGROUND

The use of intratympanic (IT) steroids has drastically increased over the past 10-15 years to manage many otological pathologies.

OBJECTIVES

This study aimed to compare the concentrations of prednisolone and prednisolone sodium succinate (SS) in the plasma and inner ear perilymph of participants who underwent cochlear implantation 24 h after IT injection.

MATERIALS AND METHODS

It was a prospective comparative randomized study. Twenty participants received an IT injection of prednisolone SS ∼24 h before the cochlear implantation. The other five participants received an IT saline injection and represented the control group. Perilymph and blood were sampled during the cochlear implantation surgery.

RESULTS

Both prednisolone and prednisolone SS were still present in perilymph ∼24 h after the IT administration. Only prednisolone was present in the blood plasma of seven participants (35%).

CONCLUSION

IT injection of prednisolone SS resulted in high perilymph concentrations of prednisolone and prednisolone SS, which could stay in the perilymph for at least 24 h. Using a mini-endoscope during the IT injection may effectively detect barriers infront of the round window membrane, increasing the drug concentration in the inner ear.

SIGNIFICANCE

IT injection is an effective method for delivering prednisolone to the inner ear.

Proposal of a magnetic resonance imaging follow-up protocol after cholesteatoma surgery: a prospective study

BACKGROUND

Non-echo planar (EPI) diffusion-weighted (DW) MRI has become an effective tool for the follow-up after cholesteatoma surgery and decreased the rate of second-look surgeries.

OBJECTIVES

To shed light on the optimal imaging follow-up protocol to detect postoperative residual or recurrent cholesteatoma.

MATERIALS AND METHODS

64 patients were included in this prospective study. Three different surgical procedures were considered: canal-wall-up (26 patients), canal-wall-down (20 patients), and obliterative (18 patients). The imaging follow-up protocol included non-EPI DW MRI during the following postoperative periods: 1 month, 6 months, and 1, 3, 5, and 7 years after the primary surgery.

RESULTS

MRI-positive lesions were present in 18.75% of patients. 50% of the MRI-positive findings occurred at the 1-month follow-up. The other peak of MRI positivity occurred at the 3-year follow-up. The last MRI-positive finding appeared at the 5-year follow-up.

CONCLUSIONS

The timing for the imaging protocol proposed by this prospective study to detect recidivism after cholesteatoma surgery stressed the importance of performing non-EPI DW MRI for detecting residual, though rare, disease. Likewise, extending the follow-up to a least 5 years after primary surgery was also recommended to detect any recurrent cholesteatoma that would appear unlikely to be present beyond this time set.

The Use of Nanoparticles in Otoprotection

The inner ear can be insulted by various noxious stimuli, including drugs (cisplatin and aminoglycosides) and over-acoustic stimulation. These stimuli damage the hair cells giving rise to progressive hearing loss. Systemic drugs have attempted protection from ototoxicity. Most of these drugs poorly reach the inner ear with consequent ineffective action on hearing. The reason for these failures resides in the poor inner ear blood supply, the presence of the blood-labyrinthine barrier, and the low permeability of the round window membrane (RWM). This article presents a review of the use of nanoparticles (NPs) in otoprotection. NPs were recently used in many fields of medicine because of their ability to deliver drugs to the target organs or cells. The studies included in the review regarded the biocompatibility of the used NPs by in vitro and in vivo experiments. In most studies, NPs proved safe without a significant decrease in cell viability or signs of ototoxicity. Many nano-techniques were used to improve the drugs' kinetics and efficiency. These techniques included encapsulation, polymerization, surface functionalization, and enhanced drug release. In such a way, it improved drug transmission through the RWM with increased and prolonged intra-cochlear drug concentrations. In all studies, the fabricated drug-NPs effectively preserved the hair cells and the functioning hearing from exposure to different ototoxic stimuli, simulating the actual clinical circumstances. Most of these studies regarded cisplatin ototoxicity due to the wide use of this drug in clinical oncology. Dexamethasone (DEX) and antioxidants represent the most used drugs in most studies. These drugs effectively prevented apoptosis and reactive oxygen species (ROS) production caused by ototoxic stimuli. These various successful experiments confirmed the biocompatibility of different NPs and made it successfully to human clinical trials.

Thulium laser in stapedotomy surgery

BACKGROUND

Thulium laser use in stapedotomy surgery is usually associated with many doubts regarding the thermal effect on the vestibular area and the production of acoustic shock waves, which may result in permanent complications.

OBJECTIVES

We aimed to evaluate the efficacy and safety of the Thulium laser use in stapedotomy and its long-term effects on the clinical and audiological results.

MATERIAL AND METHODS

It was a retrospective randomized case-series study. We included 148 otosclerosis patients. They were divided randomly into two groups; group A (multiple shots) included 62 patients and group B (one shot with a manual perforator) included 86 patients.

RESULTS

There was a statistically significant improvement of the ABG in both groups. ABG closure (<10 dB) occurred in 87.1% of patients in group A, and 89.5% of patients in group B. Intraoperative complications were more in group B (p-value = 0.038). The postoperative complications were more in group A (p-value = .017).

CONCLUSIONS

According to our experience on a relatively large number of cases, the Thulium laser is a safe tool to be used in stapedotomy either in multiple shots or one shot with a manual perforator. It improved functional hearing efficiently without showing signs of inner ear impairment.

A Challenging Nodular Lesion of the Ear

Skin nodular lesion are really frequent, but rapidly growing ones needs to be quickly removed since they can hide really aggressive skin tumor. Among malignant lesion Merkel cell carcinoma arise. It is a rare neuroendocrine skin tumor highly aggressive, not easy to diagnose at first stage, since at first diagnosis it is already widespreading all over the body. In order to renew interest in this letal skin tumori is mandatory to remind high risk population which include elderly people, white skin, chronically exposed to UV immunocompromised. Our unhappy case was described to increase awareness on this kind of skin tumor, since new drug appeared in the market can give an hope to these patients.

Long-Term Follow-Up of the Auditory Threshold After a Fully Implantable Middle Ear Implant

A fully implantable active middle ear device has been proposed and indicated for the rehabilitation of bilateral moderate or moderate-to-severe sensorineural hearing loss, assuming it would overcome the disadvantages of a conventional hearing aid. The indications have further been extended to severe or severe-to-profound forms of hearing loss in the case of an expected limited or null efficacy of hearing aids. While the literature has highlighted several positive aspects of the device, including a better quality of life related to its invisibility, the improvement of auditory and perceptual functions has not been controlled for throughout a long period of follow-up. The present study aimed to verify the behavior of the auditory threshold, especially the bone conduction (BC) component, in the implanted ear in a group of implantees affected by initial bilateral symmetric hearing loss of different severity grades. The BC threshold was assessed preoperatively at activation and at the last follow-up (ranging from 4 to 12 years) in the implanted ear, and preoperatively and at the last follow-up in the contralateral ear, to monitor eventual deteriorated values in both ears over time. The pure tone average (PTA; 250–4,000 Hz), speech reception threshold (SRT) and the maximum word recognition score as a percentage (% WRS) and in dB HL were measured in the implanted ear to verify the efficacy of the device after the first fitting at device activation. A significant worsening of the BC threshold with respect to the baseline threshold was noticed during further follow-up. When comparing the implanted ear with the contralateral ear, a significant worsening of the bone PTA was assessed in the former with respect to the contralateral ear. Despite the worsened hearing found in the implanted ears, the beneficial gains in PTA and speech audiometry observed at the first activation remained constant at the follow-up, thus showing an extension of the efficacy of this device in aiding those with up to the most severe forms of sensorineural hearing loss.

Early non-EPI DW-MRI after cholesteatoma surgery

OBJECTIVE

Middle ear cholesteatoma may lead to the erosion of the bony structures of the temporal bone, possibly causing intra- and extracranial complications. Surgical treatment is mandatory, and due to possible residual/recurrent disease, the use of reliable diagnostic methods is essential. Our study aimed to evaluate the reliability of non-EPI DW-MRI for the follow-up of cholesteatoma after surgery.

METHODS

In a study group including 53 consecutive patients who underwent surgery for cholesteatoma at a tertiary university hospital, an imaging protocol was applied, including non-echo planar diffusion-weighted imaging magnetic resonance (MR) at 1 month after surgery and then at 6 and 12 months after surgery. Based on the combination of preoperative assessment and intraoperative findings, the study group was divided into 3 subgroups: petrous bone (PB) cholesteatoma, complicated cholesteatoma and uncomplicated cholesteatoma. PB cholesteatoma patients were treated by a subtotal petrosectomy, whereas complicated and uncomplicated cholesteatoma patients were treated either by a canal wall up procedure or a retrograde (inside-out) canal wall down technique with bone obliteration technique (BOT).

RESULTS

The results show that patients who had positive findings on non-EPI DW-MRI scans 1 month after surgery consequently underwent revision surgery during which residual cholesteatoma was noted. All the patients who displayed negative findings on non-EPI DWI-MRI scan at 1 month after surgery did not show the presence of a lesion at the 6- and 12-month evaluations. The 6 patients who displayed residual cholesteatoma at the 1-month follow-up presented dehiscence/exposure of the facial nerve canal at the primary surgery, mostly at the level of the labyrinthine segment.

CONCLUSION

Non-EPI DW-MRI is a useful and reliable tool for follow-up cholesteatoma surgery, and when applied early, as was done in the protocol proposed in the present study, this tool may be used to detect the presence of residual cholesteatoma in some patients, prompting the planning of early revision surgery.

The impact of surgical masks on the nasal function in the COVID-19 era

BACKGROUND

The Covid-19 pandemics has obliged to using different types of personal protective devices (PPD) for a prolonged time of the day, especially in the Health Centers, with preference of surgical masks (SM) during the first pandemic waves.

AIMS/OBJECTIVES

This study was designed to assess the eventual changes of the nasal respiratory condition during continuous SM wearing.

MATERIAL AND METHODS

Fourteen healthcare professionals filled a visual analogue scale (VAS) questionnaire for the detection of eventual nasal breathing impairment or symptoms. Nasal resistance and flow values were obtained via the active anterior rhinomanometry (AAR) that was performed under the basal condition, as well as immediately after wearing the surgical mask (SM) and 3 h after its continuous use.

RESULTS

The increase of inspiratory resistance was significantly correlated to the reduction of the maximum flux, when comparing SM parameters to the basal ones (r = -0.70, p < .05). At VAS evaluation, SM wearing showed to induce itching in 70% of the subjects, nasal dryness in 55%, nasal blockage in 50%, headache in 39%, watery nasal discharge in 20% and sneezing in 18%.

CONCLUSIONS AND SIGNIFICANCE

The SMs do not induce evident physiological variations of the nasal function due to a compensatory respiratory mechanism that, despite a progressive increase of nasal resistances, is not inducing significant changes of the nasal fluxes.

On the Effect of Bimodal Rehabilitation in Asymmetric Hearing Loss

BACKGROUND

Bone conductive implants (BCI) have been reported to provide greater beneficial effects for the auditory and perceptual functions of the contralateral ear in patients presenting with asymmetric hearing loss (AHL) compared to those with single-sided deafness (SSD). The aim of the study was to assess the effects of wearing a conventional hearing aid in the contralateral ear on BCI in terms of an improved overall auditory performance.

METHODS

eleven AHL subjects wearing a BCI in their worse hearing ear underwent an auditory evaluation by pure tone and speech audiometry in free field. This study group was obtained by adding to the AHL patients those SSD subjects that, during the follow-up, showed deterioration of the hearing threshold of the contralateral ear, thus presenting with the features of AHL. Four different conditions were tested and compared: unaided, with BCI only, with contralateral hearing aid (CHA) only and with BCI combined with CHA.

RESULTS

all of the prosthetic conditions caused a significant improvement with respect to the unaided condition. When a CHA was adopted, its combination with the BCI showed significantly better auditory performances than those achieved with the BCI only.

CONCLUSIONS

the present study suggests the beneficial role of a CHA in BCI-implanted AHL subjects in terms of overall auditory performance.

An objective, markerless videosystem for staging facial palsy

Purpose

To propose a new objective, video recording method for the classification of unilateral peripheral facial palsy (UPFP) that relies on mathematical algorithms allowing the software to recognize numerical points on the two sides of the face surface that would be indicative of facial nerve impairment without positioning of markers on the face.

Methods

Patients with UPFP of different House–Brackmann (HB) degrees ranging from II to V were evaluated after video recording during two selected facial movements (forehead frowning and smiling) using a software trained to recognize the face points as numbers. Numerical parameters in millimeters were obtained as indicative values of the shifting of the face points, of the shift differences of the two face sides and the shifting ratio between the healthy (denominator) and the affected side (numerator), i.e., the asymmetry index for the two movements.

Results

For each HB grade, specific asymmetry index ranges were identified with a positive correlation for shift differences and negative correlation for asymmetry indexes.

Conclusions

The use of the present objective system enabled the identification of numerical ranges of asymmetry between the healthy and the affected side that were consistent with the outcome from the subjective methods currently in use.

Revision of active middle ear implants (AMEI): causes, surgical issues and rehabilitative transition at a single implanting center

PURPOSE

To report on failures related to active middle ear implants (AMEI) surgery, within a series of subjects treated at a single Implanting Center.

METHODS

A retrospective review of 79 cases of implanted AMEI has been performed to report the failure ratio, the causes for the failure and the selected rehabilitative solution. The AMEI included 25 Vibrant Soundbridge^® (Medel, Innsbruck, Austria), 20 as round window vibroplasty (RW-VSB) for mixed hearing loss, 5 as incus-vibroplasty for sensorineural hearing loss; 7 MET/Carina^® (Cochlear, Melbourne, Australia), 2 MET for mixed and sensorineural hearing loss, 5 Carina for sensorineural hearing loss; 43 Esteem^® (EnvoyMedical, St Paul, USA) for sensorineural hearing loss; 3 Maxum^® (Ototronics, Texas, USA) for sensorineural hearing loss; 1 Codacs^® (Cochlear, Melbourne, Australia) for severe mixed hearing loss.

RESULTS

The overall complication rate affected 20% of the implanted devices, individually ranging from 6.9 to 100%. Hardware system failures were recorded in all the AMEI, ranging from 10 to 50%. The alternative auditory rehabilitation included replacement of the same system in 2 cases, use of a conventional hearing aid in 3 cases, Cochlear implantation in 4 cases and implantation in the contralateral ear in 2 cases.

CONCLUSION

The present clinical experience showed that, in spite of the successful functional rate displayed by the majority of the AMEI implantees, complications may occur to a certain percentage of cases and should prompt the professionals to select alternative solutions, starting from the (re)adoption of a conventional hearing aid and ending up to Cochlear implantation.

Bone conductive implantation in asymmetric hearing loss (AHL)

Background: Bone conductive implants (BCI) represent one possible solution for rehabilitation of single-sided deafness (SSD).Aims: The aim of the present study was to verify the efficacy of bone conduction implantation in subjects with unilateral severe-to-profound hearing loss and contralaterally impaired hearing, that is, asymmetric hearing loss (AHL), and to compare it with known BCI indications for SSD.Material and methods: Twenty-one subjects received BCI for either SSD or AHL. All of the subjects underwent a battery of audiological and subjective tests, Data were collected and statistically evaluated within and between the SSD group and the AHL group.Results: A PTA threshold gain was observed in AHL patients along with improved values in speech audiometry in quiet and noise. The two visual analogue scale evaluations (QoL and QoS) and the GBI showed significantly better scores in AHL patients compared to SSD patients.Conclusions: BCI provided improvement for auditory or speech recognition in AHL subjects, as compare to SSD. From these findings, it is possible to predict a positive role of BCI for some audiological aspects of AHL subjects that are generally not present or not detectable in SSD cases.

Rehabilitation of severe-to-profound sensorineural hearing loss with an active middle ear implant

Background: Severe-to-profound sensorineural hearing loss (spSNHL) is mostly relying on the use of a cochlear implant (CI).Aims: The present study reports on the auditory outcome from a group of subjects affected by spSNHL who received an AMEI application.Materials and methods: Nine out of 43 subjects who received a fully-implantable AMEI were initially candidated as off-label (primary off-label group or POLG). Twelve subjects showed over time a decrease in bone conduction threshold (BCT) in the operated ear (Secondary Off-Label Group or SOLG): SOLGa with no detectable BCT (9 subjects), SOLGb with residual low-frequency BCT (3 subjects). The auditory assessment included pure tone audiometry and speech audiometry in quiet and noise.Results: A significant PTA5 difference was found at activation in SOLGb group and at the last fitting in SOLGa Group in respect to the label control group. No significant difference was found between POLG group and control group. Speech audiometry in noise revealed a significant lower gain in all three groups in comparison to the control group.Conclusions: The adoption of an AMEI in unconventional indications could be beneficial also for subjects with spSNHL, although this solution can in some cases only be transient before performing CI surgery.

Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery

Introduction: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14%). In those subjects (21.7%) in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded. Discussion/Conclusion: The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI-operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.

Video Head Impulse Test in Labyrinthine Fistula due to Middle Ear Cholesteatoma

OBJECTIVES

To assess and monitor lateral semicircular canal (LSC) function over time in patients affected by chronic otitis media with cholesteatoma (CHO) complicated by fistula of LSC (LSC-F) before and after surgery using video Head Impulse Test (vHIT).

MATERIALS AND METHODS

Eight patients aged 18-67 years affected by CHO with imaging-ascertained LSC-F were included in this preliminary prospective study. The following protocol has been applied: oto-microscopic diagnosis with patient's history; computed tomography scan of the temporal bone; surgery with concomitant resurfacing of LSF-F; audiological and vestibular evaluation before surgery (T0) and at 30 days (T1), 6 months (T2), and 1 year after surgery (T3). vHIT was used to assess vestibulo-ocular reflex (VOR) in LSC.

RESULTS

None of the patients showed deterioration of bone conduction hearing levels during the different time of evaluation. Three patients showed a reduced VOR gain and catch-up saccades at T0, with VOR gain normalization at T2. This finding remained stable at the 1-year follow-up. The VOR gain in the nonaffected side generally experienced an increase, paralleled by the normalization on the affected side, with statistically significant correlation. The subjects with normal vHIT before surgery did not show any variation following surgery.

CONCLUSION

vHIT allows the assessment of LSC function in case of fistula. The adopted surgical fistula repair did not induce deterioration of the auditory or LSC function, but indeed, it could prevent worsening and help promoting recovery to the normal function.

Validation of the objective assessment of facial movement with a new software-based system

BACKGROUND

Most used subjective Unilateral Peripheral Facial Palsy (UPFP) grading systems are characterized by high variability and low reproducibility and doesn't allow a separate evaluation of single facial regions.

OBJECTIVE

To assess the reliability of a new objective method for classification of UPFP, comparing it with House-Brackmann (HB) and Sunnybrook facial grading (SFGS) systems.

METHOD

Forty-seven patients affected by UPFP of different HB grade were included. Each patient underwent a blinded examination by three different operators, via the two subjective methods (HBGS and SFGS) and a newly proposed objective one, that was obtained from a digital video-analysis, named SMART FACIAL system. Results were converted by validated conversion scales into HBGS grades and statistically compared.

RESULTS

In 87,23% (n° 41 pts) consistency was found between the grades obtained with all the three evaluation methods; in 10,41% (n°5 pts), between HBGS and SFGS grade and in 2,08% (n°1 pt) between HBGS grades and SMART-FACIAL system. Statistical analysis showed significant correlation among the three systems (p < .000).

CONCLUSIONS

The SMART FACIAL system presents high reliability also in comparison with the most frequently used subjective methods.

SIGNIFICANCE

This method represents a fast, simple and thorough way to analyze UPFP, especially during physical rehabilitation.

Transitions in auditory rehabilitation with bone conduction implants (BCI)

BACKGROUND

The bone conductive implants (BCI) are nowadays a reliable alternative for rehabilitation of specific forms of hearing loss, i.e. conductive, mixed or single sided deafness (SSD). Aims/Objective: To analyse the various factors in play when considering an auditory rehabilitation with a bone-conductive device (BCI).

MATERIALS AND METHODS

The clinical charts of subjects who underwent BCI application at the same Implanting Center from 2005 to 2018 were retrieved analysing also the reason for eventual explantation and the alternative option (transition) for hearing rehabilitation.

RESULTS

Nine BAHA Compact, 4 BAHA Intenso, 21 BAHA Divino, 3 BAHA BP100, 4 Ponto, 2 Sophono, 5 Bonebridge, 5 BAHA5 Attract; 11 BAHA5 Connect were used in 12 unilateral COM; 16 bilateral COM; 3 unilateral cholesteatoma; 6 bilateral cholesteatoma; 2 unilateral otosclerosis; 5 bilateral otosclerosis; 9 congenital malformations; 6 major otoneurosurgical procedures; 5 sudden deafness. Explantation was necessary for five subjects.

CONCLUSIONS

Middle ear pathology and sequels from surgery represent the most common reason for BCI implantation, both in unilateral and in bilateral cases. Transition from one implantable device to another one can be predictable, mostly when explantation is necessary.

SIGNIFICANCE

The role of BCI for rehabilitation in middle ear pathology may be extremely important.

Complications after round window vibroplasty

PURPOSE

To evaluate the complication rate in adult subjects with open cavities that were implanted with the Vibrant Soundbridge implant, using the round window (RW) vibroplasty procedure.

METHODS

From 2009 to 2014, 21 adult subjects with mixed hearing loss, all with sequel from open tympanoplasty surgery, underwent RW vibroplasty (RW-VPL). Surgical complications were recorded and a standard minimal approach was used as a basis for all the cases that needed revision.

RESULTS

The mean follow-up was 42 months (range 12-76). Complications occurred in nearly half of the cases and included: cable extrusion (23.8%), hardware failure (14.3%), profound hearing loss (9.5%), and inadequate RW coupling (9.5%). A minimal endaural approach (MEA) was used in the majority of the cases (86.7%), while the extended endaural approach was adopted for those patients requiring explantation with or without replacement (14.3%).

CONCLUSIONS

RW-VPL can be considered a possible option for the rehabilitation of auditory impairment derived from an open tympanoplasty procedure due to cholesteatoma. The procedure may lead to minor/major complications that may require a surgical revision. By adopting an MEA, it has been possible to manage all the situations in which functionality of the device is worth being preserved.

Ten years of active middle ear implantation for sensorineural hearing loss

OBJECTIVES

To evaluate long-term benefits of a totally implantable active middle ear implant (AMEI) that has been used in a single implanting center for over 10 years.

METHODS

Forty-one subjects who underwent implantation with an Esteem^® AMEI during a 10-years period were evaluated on the auditory benefits, as derived from pure tone and speech audiometry tests. The analysis included a comparison with a conventional hearing aid, the problematics related to the battery duration and surgical replacement and, finally, the complication rate.

RESULTS

Over 80% of the implanted subjects maintained over time a satisfactory auditory gain, ranging from 10 to over 30 dB in respect to the unaided situation, as mean at 0.5, 1, 2 and 4 kHz. In more than 60% of them, an improvement has also been found at 4 and 8 kHz. Battery duration varied according to the severity of the hearing loss and to the daily use of the device. No major post-operative complications were recorded, whilst explantation was necessary in five subjects, although none for device failure.

CONCLUSIONS

The Esteem^® can be considered a reliable device for rehabilitation of sensorineural hearing loss in alternative to conventional hearing aids.

Simultaneous Contralateral Vestibular Schwannoma and Middle Ear Paraganglioma Tumor

To the best of our knowledge, only 2 cases of a simultaneous contralateral vestibular schwannoma (VS) and middle ear paraganglioma (MEP) have previously been reported in literature. We report the third case observed in a 43-year-old male, who presented with an 11-year history of right-sided hearing loss and a 1-year history of left-sided pulsatile tinnitus. A magnetic resonance imaging (MRI) showed a VS on the right side and computer tomography (CT) identified a Fisch type A1 paraganglioma on the left side. The VS was treated using a translabyrinthine approach and the MEP was kept under radiological observation for 1 year. Due to the growth of the MEP (Fisch type A2), it was treated with excision via a retroauricular approach. Our case was very challenging because there was a different and important pathology on each side, both carrying a risk of deafness as a consequence of the disease and/or the treatments.

Human hepatocyte transplantation for liver disease: current status and future perspectives

Liver transplantation is the accepted treatment for patients with acute liver failure and liver-based metabolic disorders. However, donor organ shortage and lifelong need for immunosuppression are the main limitations to liver transplantation. In addition, loss of the native liver as a target organ for future gene therapy for metabolic disorders limits the futuristic treatment options, resulting in the need for alternative therapeutic strategies. A potential alternative to liver transplantation is allogeneic hepatocyte transplantation. Over the last two decades, hepatocyte transplantation has made the transition from bench to bedside. Standardized techniques have been established for isolation, culture, and cryopreservation of human hepatocytes. Clinical hepatocyte transplantation safety and short-term efficacy have been proven; however, some major hurdles-mainly concerning shortage of donor organs, low cell engraftment, and lack of a long-lasting effect-need to be overcome to widen its clinical applications. Current research is aimed at addressing these problems, with the ultimate goal of increasing hepatocyte transplantation efficacy in clinical applications.

A new semi-implantable middle ear implant for sensorineural hearing loss: three-years follow-up in a pilot patient's group

OBJECTIVE

The aim of this article is to report on the long-term follow-up of a new semi-implantable middle ear device utilized for restoration of moderate-to-severe sensorineural hearing loss in a first series of subjects.

METHODS

Three subjects, affected by sensorineural hearing loss, have undergone implantation of Maxum^® middle ear implant, via a transcanal approach. They all underwent an auditory assessment, paying particular attention on the pre- versus post-operative hearing levels under the unaided, best-fitted hearing aided and implant-aided conditions. The audiometric evaluation has been repeated 3 years after implantation and implemented by questionnaires aiming at the evaluation of the quality of life.

RESULTS

The post-operative hearing threshold and discrimination in quiet appear to be similar or better than those provided by conventional hearing aids, with a concomitant improvement of the subjects' quality of life. The application of the present device showed to be easy and reproducible, with no severe adverse effects recorded at the 3-years follow-up. Mild issues due to the external component were also observed, such as difficulty of keeping it continuously in place due to excess canal sweating in one subject, and a temporary loss of stability due to occurring irregularities of the external coating in another subject.

CONCLUSIONS

Long-term, preliminary data reveal that the Maxum^® device may provide equal or better functional gain and word recognition scores in quiet in patients with moderate-to-severe sensorineural hearing loss, in comparison to optimally fitted hearing aids, with a satisfactory improvement of their quality of life.

Kabat rehabilitation for Bell's palsy in the elderly

CONCLUSIONS

This study has confirmed the importance of combining the physical rehabilitation to the steroid treatment for a better outcome from BP in all age groups, especially in the old HB grade V.

OBJECTIVES

To investigate the role played by aging in the recovery rate from peripheral facial nerve palsy.

METHOD

In the present study, subjects affected by peripheral facial nerve palsy, distributed by age, were randomly assigned to medical treatment, either alone or associated with Kabat physical rehabilitation. Rate and speed of recovery were assessed in the younger and older groups. All the patients were also asked to fill in a specific questionnaire (beta FAce scale). A series of non-parametric tests (McNemar Chi-square and Chi-square) have been applied to verify the hypothesis of dependence of the final recovery level from the variables age and rehabilitation.

RESULTS

The results show that, when treated only by medical therapy, the HB V subjects showed no significant age difference in relation to the achievement of a HB Grade III (100% in the over 65, 80% in the under 65), whilst, in the HB IV subjects, the younger population showed a better recovery, with 89% of a good recovery (HB I or II). In the patients who received the combined protocol, a better recovery rate was found, both in HB IV and V subjects, and the younger population could reach a good recovery in 90% of HB V cases in respect to the older population (50%).

Delayed Effect of Active Pressure Treatment on Endolymphatic Hydrops

Objective: To identify eventual correlations between the effect of low-pressure treatment and endolymphatic hydrops in Ménière patients. Material and Methods: The study group consisted of subjects affected by definite Ménière disease (2015) and a severe degree of disability, who received a ventilation tube with or without a low-pressure treatment before undergoing a surgical procedure (vestibular neurectomy). After the placement of the ventilation tube, the subjects were either left alone with the tube or received 1 month of self-administered low-pressure therapy with a portable device. In all subjects, an electrocochleography (ECochG) was performed and specific questionnaires - Dizziness Handicap Inventory (DHI) and Functional Scale Level (FSL) - were completed before starting either arm of treatment, at the end of treatment, and then 3 and 6 months later. Results: All selected subjects presented with an ECochG pattern that was indicative of endolymphatic hydrops before starting either treatment. At the end of pressure treatment, 80% showed symptomatic improvement while maintaining the hydropic ECochG pattern. At the 3-month control stage, the hydropic pattern resulted normalized (<0.5) in all the improved subjects. Conclusions: Although 1 month of low-pressure treatment provided a positive symptomatological outcome, normalization of the hydropic ECochG parameters occurred only at a later time. Therefore, it is possible to assume that endolymphatic hydrops could be concurrent with a non-symptomatic stage of Ménière disease, and that the anti-hydropic effect of the low-pressure treatment, if any, would present with a certain delay after its completion.

Patient satisfaction after auditory implant surgery: ten-year experience from a single implanting unit center

CONCLUSIONS

The satisfaction rate of the subjects with an auditory implant appears strictly related to the resulting auditory improvement, and the surgical variables would play a prevailing role in respect to the esthetic factors.

OBJECTIVES

To assess the rate of satisfaction in subjects who underwent the surgical application of an auditory device at a single Implanting Center Unit.

METHOD

A series of validated questionnaires has been administered to subjects who underwent the surgical application of different auditory devices. The Glasgow Benefit Inventory (GBI), the Visual Analog Scale (VAS), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) have been used to compare the implanted situation with the hearing-aided one; a percutaneous bone conductive implant (pBCI) with an active middle ear implant (AMEI) on the round window in mixed hearing loss; and an invisible, fully-implantable device with a frankly and bulky semi-implantable device.

RESULTS

The mean GBI scores were higher in Vibrant Soundbridge (VSB)^® and Bonebridge^® subjects, without significant differences among the various devices. The mean VAS score increased for all the devices in comparison with the conventional hearing aid. The mean APHAB score was similarly better in the implanted condition as total and partial scores.

Cone beam computed tomography after round window vibroplasty: do the radiological findings match the auditory outcome?

CONCLUSION

The cone beam computed tomography (CBCT) imaging technique has proved to be reliable for assessing the appropriate positioning of the floating mass transducer (FMT) in the round window (RW) niche, although some parameters do not seem to be essential for achieving a satisfactory functional outcome.

OBJECTIVES

To evaluate the role that specific imaging parameters derived from CBCT of the temporal bone have for predicting the functional outcome after RW vibroplasty (RW-VP).

METHODS

CBCT imaging was carried out in a homogeneous group of patients who presented with a mixed type of hearing loss after open tympanoplasty. Three arbitrary radiological parameters were taken into account: the FMT/RW membrane contact, bony contacts of the FMT margins, and the inferior FMT tissue support. The audiological assessment took into consideration the PTA4 (500-4000 Hz), the PTA2 (125-250 Hz), and the word recognition score (WRS) in quiet and in noise.

RESULTS

One subject presented with all positive CBCT parameters and showed a good, but not the best auditory performance among the study group. In the majority of the subjects, with a satisfactory postoperative hearing improvement, at least two of the three radiological parameters were present. In comparison with the unaided condition, an improvement in both the PTA4 and PTA2 was found in all the subjects.

Bone conductive implants in single-sided deafness

CONCLUSION

Bone conduction implants (BCIs) have been shown to partially restore some of the functions lost when binaural hearing is missing, such as in subjects with single-sided deafness (SSD). The use of a single BCI needs to be recommended by a clinician based on thorough counselling with the SSD subject.

OBJECTIVES

To perform an overview of the present capabilities of BCIs for SSD and to evaluate the reliability of the audiological evaluation for assessing speech recognition in noise and sound localization cues, which are major problems related to the loss of binaural hearing.

METHODS

Nine subjects with SSD who received BCI implants underwent a preoperative audiological evaluation that included sound field speech audiometry, word recognition score (WRS) testing and sound localization testing in quiet and in noise. They were also tested for the accuracy of their directional word recognition in noise and their subjective perceptions of their hearing difficulties using the APHAB questionnaire.

RESULTS

The mean maximum accuracy of word discrimination was 65.5% in the unaided condition and 78.9% in the BCI-aided condition. Sound localization in noise was better with the BCI than in the unaided condition, especially when the stimulus and noise were presented on the same side as the implanted ear. The accuracy of directional word recognition showed an improvement with the BCI with respect to the unaided condition on the BCI side, with either the stimulus in the implanted ear and the noise in the contralateral ear or with both the stimulus and noise presented to the implanted ear.

Perceived disability from hearing and voice changes in the elderly

AIM

Dysphonia and hearing loss are underestimated conditions in the elderly, despite their significant prevalence (18% and 50%, respectively) and their sociopsychological implications. Previous studies have shown that the reason for this lack of consideration is related to the general misconception of a simple age-related issue, as well as to the reduced communication requirements of this population, which can result in infrequent requests/supply of care. The purpose of the present study was to evaluate, within an elderly population, the subjective perception of hearing and voice dysfunctions, the resulting changes in communication skills, and the perception of handicap and disability.

METHODS

Four anonymous questionnaires were administered to 400 participants (218 men, 182 women) aged older than 65 years, some of whom (276) were hospitalized and some of whom (124) were outpatients. The questionnaires consisted of questions regarding age-related changes in voice, multiple-choice questions on the qualitative characteristics of the voice, questions regarding verbo-acoustic communication (hearing), the Voice Handicap Index, and the Self Assessment of Communication regarding the perception of hearing loss-related handicap and disability. Statistical correlations were calculated for voice dysfunction between the perception of disability and the clinical assessment of voice quality obtained by the Grade, Roughness, Breathiness, Asthenia, Strain scale, and between the perception of disability and the demand for care.

RESULTS

More than half of the elderly patients reported not perceiving voice changes throughout their lives. Most of the participants were satisfied with their own voices, although 65% of them judged them to be qualitatively altered, and in 31.5% of the participants, pathology was found on phoniatric evaluation. Low scores for vocal handicap (Voice Handicap Index) were found, and the type of perceived disability was mainly physical, although the association between Voice Handicap Index scores and Grade, Roughness, Breathiness, Asthenia, Strain was statistically significant. A total of 62% of the patients perceived hearing changes over their lifetimes not related to previous ear infections, but significantly correlated with a family history of hearing problems and with the need for specialist consultations. However, the perception of hearing loss handicaps and disability showed lower mean values, showing that older patients recognized dysfunction, but did not consider it to be a disability.

CONCLUSIONS

The present study showed that, despite the relevant incidence of hearing and voice disorders among the elderly population, the implications for communication abilities seems to be underestimated. Hence, it appears to be extremely important to undergo specialist screening consultations to detect eventual voice and hearing alterations, and to correct them with appropriate therapeutic strategies.

Sucralfate modulates uPAR and EGFR expression in an experimental rat model of cervicitis

Sucralfate is a drug used in the treatment of gastric and duodenal ulcer; it is cytoprotective and able to increase the bioavailability of several growth factors, modulating the wound healing process. In this study we tested the possible therapeutic effect of Sucralfate in the treatment of ulcerative lesions occurring in uterine cervix; to investigate such effect we used an experimental rat model of cervicitis in which the uPAR and EGFR expression were evaluated. Cervicitis was induced in wild and ovariectomized Wistar female rats by an acetic acid-soaked tampon. The animals were divided into two main groups (4 and 7 days) and Sucralfate was administered topically until the day they were sacrificed. In order to distinguish physiological and drug-induced healing, quantitative and qualitative uPAR and EGFR expression were evaluated by using Western blot and Immunohistochemistry techniques. Western blot analysis demonstrated an increased expression of both receptors after 4 days from wounding in wild and ovariectomized animals. In particular in ovariectomized animals the expression of uPAR and EGFR increased after 4 days while it reduced following the administration of Sucralfate. In wild rats the same was observed for uPAR expression, while EGFR was different; in fact, its expression increased significantly at day 4 in the animals treated with the drug and only at day 7 in those untreated. Immunohistochemistry highlighted a noteworthy epithelial colocalization of EGFR and uPAR after 4 days in the animals treated with Sucralfate. We conclude that Sucralfate can promote the healing of ulcerative cervicitis and moreover, it reduces the normal healing time because of its modulatory property on uPAR and EGFR expression.

Immunomodulatory activity of shikimic acid and quercitin in comparison with oseltamivir (Tamiflu) in an in vitro model

The risk of an avian influenza pandemic has put oseltamivir (Tamiflu) in the spotlight and has given rise to rumors that shikimic acid (SK), which is used for the synthesis of Tamiflu, possesses therapeutic activity. This study was undertaken to determine whether SK, either alone or in combination with quercitin (QT) is able to modulate the release of IL-6 and IL-8 from peripheral blood mononuclear cells (PBMCs). The experiments were conducted comparing the properties of SK, both alone and in combination, with those of Tamiflu. The incubation of PBMCs with 100 nM Tamiflu or SK at two concentrations (10 nM; 100 nM) did not produce any change in IL-6 and IL-8 baseline levels (data expressed as incremental change vs. baseline). On the contrary, incubation with SK and QT at both concentrations (10 and 100 nM) produced a significant increase in the release of IL-8 as compared to other groups (4.19 +/- 0.82, SK-QT 10 nM; 3.83 +/- 1.17 SK-QT 100 nM, P < 0.05 vs. baseline 1.00 +/- 0.10, Tamiflu 100 nM 1.35 +/- 0.16, SK 10 nM 1.68 +/- 0.15 and SK 100 nM 1.80 +/- 0.48). The SK-QT combination also proved to be effective in the upregulation of IL-6 (3.08 +/- 0.46, SK-QT 10 nM; 3.60 +/- 0.74 SK-QT 100 nM, P < 0.05 vs. baseline 1.00 +/- 0.26). According to these findings SK alone is not able to modulate innate immunity in antiviral terms. However, the data show that the SK + QT combination, even at low doses, may be effective for the modulation of innate immunity.

Energy-consistent pseudopotentials for quantum Monte Carlo calculations

The authors present scalar-relativistic energy-consistent Hartree-Fock pseudopotentials for the main-group elements. The pseudopotentials do not exhibit a singularity at the nucleus and are therefore suitable for quantum Monte Carlo (QMC) calculations. They demonstrate their transferability through extensive benchmark calculations of atomic excitation spectra as well as molecular properties. In particular, they compute the vibrational frequencies and binding energies of 26 first- and second-row diatomic molecules using post-Hartree-Fock methods, finding excellent agreement with the corresponding all-electron values. They also show their pseudopotentials give superior accuracy than other existing pseudopotentials constructed specifically for QMC. Finally, valence basis sets of different sizes (VnZ with n=D,T,Q,5 for first and second rows, and n=D,T for third to fifth rows) optimized for our pseudopotentials are also presented.

Treatment with 1,25-dihydroxyvitamin D3 preserves glomerular slit diaphragm-associated protein expression in experimental glomerulonephritis

In this study, we investigated the effect of 1,25(OH)2D3 on proteinuria and on the alteration of slit diaphragm-associated proteins induced by anti-Thy 1.1 in Wistar rats. Four groups of animals were studied: group I, anti-Thy 1.1 treated rats; group II, anti-Thy1.1 treated group that at day 2, after the onset of overt proteinuria, started the treatment with 1,25(OH)2D3; group III, normal control rats injected with vehicle alone; group IV, rats that received only 1,25(OH)2D3. At day 2, in group I and II, before the administration of 1,25(OH)2D3, protein excretion was significantly increased when compared to controls. Overt proteinuria was maintained until day 14 in group I whereas in group II protein excretion was significantly reduced from day 3 to day 14. Moreover, treatment with 1,25(OH)2D3 abrogated podocytes injury, detected as desmin expression and loss of nephrin and zonula occludens-1 (ZO-1), two slit diaphragm-associated proteins, and glomerular polyanion staining, that were observed in group I. In conclusion, these results suggest that 1,25(OH)2D3 administrated with a therapeutic regiment may revert proteinuria, counteracting glomerular podocyte injury.

C-reactive protein in patients on chronic hemodialysis with different techniques and different membranes

In hemodialysis patients, C-reactive protein (CRP), an acute-phase reactant, is a sensitive and independent marker of malnutrition, anemia, and cardiovascular mortality. The aim of the present study was to evaluate CRP levels in plasma samples from long-term hemodialysis patients on different extracorporeal modalities and dialyzed with different membranes, at baseline and after 6 months. Two hundred and forty-seven patients were recruited in eight hospital-based centers. All patients had been on their dialytic modality for at least 3 months and were prospectively followed in their initial dialytic modality for 6 months. Patients were treated with conventional bicarbonate dialysis (N = 127) or hemodiafiltration (N = 120). Patients treated with conventional bicarbonate dialysis were dialyzed with different membranes: Cuprophane (N = 51), low-flux cellulose modified membrane (N = 37) and synthetic membranes (N = 39). Hemodiafiltration was performed in post-dilution mode with polysulfone (N = 66) and polyacrylonitrile (N = 54) membranes. Analysis of baseline CRP values in the clinically stable patients showed that an unexpectedly high proportion (47%) of the patients had CRP values higher than 5 mg/l (upper limit in normal subjects). The mean +/- S.D. CRP values were significantly higher (P < 0.05) in hemodiafiltration with infusion volumes < 10 l per session (14.6+/-3.1 mg/l) than in standard hemodialysis (5.1 +/- 2.1 mg/l) and hemodiafiltration with infusion volumes > 20 l per session (4.9 +/- 2.1 mg/l). These values did not significantly change after 6 months of follow-up. Concerning the membranes, the highest levels of CRP were observed in patients dialyzed with Cuprophane with a significant increase from 15.1 +/- 3.6 to 21.2 +/- 3.1 mg/l after 6 months (P < 0.05); a significant reduction of CRP levels was observed in patients dialyzed with polysulfone in the same follow-up period (from 13.5 +/- 2.9 to 8.1 +/- 2.4 mg/l; P < 0.05). The CRP increase following low volume HDF can be related to back-filtration of bacterial derived contaminants.; moreover, an important effect on CRP of the hemodialysis membrane is observed and new synthetic membranes can be used to decrease these levels.

[A glance into the mouth--dental aspects for physicians]

A glance into the mouth at the surgery occasionally confronts the general practitioner or specialist with dental aspects or issues. The nursing-bottle syndrome and injuries from accidents are frequently observed in children. In older patients, mucosal change is not a rare occurrence. A comparatively new field is halitosis and its effective and cause-related treatment.

Inhibitory activity of the white wine compounds, tyrosol and caffeic acid, on lipopolysaccharide-induced tumor necrosis factor-alpha release in human peripheral blood mononuclear cells

The objective of this study was to assess whether tyrosol and caffeic acid are able to inhibit lipopolysaccharide (LPS)-induced tumor necrosis factor (TNF)-alpha release. TNF is one of the most important cytokines involved in inflammatory reactions. The results show that both tyrosol and caffeic acid are able to inhibit LPS-induced TNF-alpha release from human monocytes, even at low doses. Their mechanisms of action are discussed and we conclude that high doses of the two compounds are not required to achieve effective inhibition of inflammatory reactions due to TNF-alpha release.

Effect of some white wine phenols in preventing inflammatory cytokine release

Some well-known antioxidant phenols present in extravirgin olive oil have also been found in white wine. Both tyrosol and caffeic acid are phenols that are present not only in extravirgin olive oil, but also in wine, especially white wine. Their antioxidant properties are well known, but their biological effects have not yet been elucidated. In a previous study we found that these substances were able to inhibit tumor necrosis factor alpha release. The present study was carried out to assess whether these compounds are able to inhibit other inflammatory cytokines, such as interleukin-1 beta and interleukin-6. The results show that low concentrations of these phenols, which can be found in the bloodstream after intake of moderate quantities of white wine, exert significant inhibitory activity on the release of several inflammatory cytokines.

Role of electronic correlation in the Si(100) reconstruction: a quantum Monte Carlo study

Recent low-temperature scanning tunneling experiments have questioned the generally accepted picture of buckled silicon dimers as the ground state reconstruction of the Si(100) surface, undermining the ability of density functional theory to accurately describe electronic correlations at surfaces. We present quantum Monte Carlo calculations on large cluster models of the surface, and conclude that buckling remains energetically favorable even when the present-day best treatment of electronic correlation is employed. The implications for experimental interpretation are discussed.