Vertical saccades during horizontal head impulses: a sign of posterior semicircular canal hypofunction

Objective

We describe an uncharacteristic vestibular-ocular reflex (VOR) pattern, studied by video head impulse tests (VHIT) in patients suffering from unilateral isolated posterior semicircular canal (PSC) hypofunction. In these patients, we found an upward sliding of the eyes, followed by an oblique downward catch-up saccade during horizontal head impulse to the healthy side.

Methods

We present a retrospective study of all VHIT exams presenting isolated PSC hypofunction between May 2020 and November 2022.

Results

We found 37 patients, which led to the discovery of such incongruent eye movement in 19 cases; their gain data are shown and compared to the remaining 18 cases in which such an anomaly was absent. A control group of 31 healthy subjects was recruited to define the reference criteria for VHIT gain values. The correlation between the amplitude of the vertical saccade and the relative functional imbalance of the vertical semicircular canals was studied.

Conclusions

We have observed that in approximately half of the subjects with isolated CSP deficiency, there is a VOR anomaly. A possible pathophysiological explanation of the unbalanced effect of vertical semicircular canal stimulation of a labyrinth during horizontal head thrust toward the opposite side is proposed. The planar incongruity of the response of the VOR described here appears more evident at the onset of the CSP deficit. Current VHIT systems do not detect this incongruent eye reflex. They can lead to an error in gain evaluation (pseudo-deficit) of the lateral semicircular canal of the healthy side and problems in performing the test (trace rejected). In the future, software for VHIT should take into account the possibility of non-coplanar ocular responses to cephalic stimuli.

Phenotypes and clinical subgroups in vestibular migraine: a cross-sectional study with cluster analysis

OBJECTIVE

The aim of this multicentric cross-sectional study was to collect phenotypes and clinical variability on a large sample of 244 patients enrolled in different university centers in Italy, trying to differentiate subtypes of VM.

BACKGROUND

VM is one of the most frequent episodic vertigo characterized by a great clinical variability for duration of attacks and accompanying symptoms. Diagnosis is based only on clinical history of episodic vertigo in 50% of cases associated with migrainous headache or photo/phonophobia.

METHODS

We enrolled in different university centers 244 patients affected by definite VM according to the criteria of the Barany Society between January 2022 and December 2022. An audiometric examination and a CNS MRI were performed before inclusion. Patients with low-frequency sensorineural hearing loss were not included, as well as patients with an MRI positive otherwise that for microischemic lesions. Patients were asked to characterize vestibular symptoms choosing among (multiple answers were allowed): internal vertigo, dizziness, visuo-vestibular symptoms/external vertigo; onset of vertigo and duration, neurovegetative, and cochlear accompanying symptoms (hearing loss, tinnitus, and fullness during attacks) were collected as well as migrainous headache and/or photo/phonophobia during vertigo; autoimmune disorders were also analyzed. A bedside examination was performed including study of spontaneous-positional nystagmus with infrared video goggles, post head shaking ny, skull vibration test, and video head impulse test.

RESULTS

We included 244 subjects, 181 were females (74.2%). The age of onset of the first vertigo was 36.6 ± 14.5 while of the first headache was 23.2 ± 10.1. A positive correlation has been found between the first headache and the first vertigo. The mean duration of vertigo attacks was 11 ± 16 h. We carried on a cluster analysis to identify subgroups of patients with common clinical features. Four variables allowed to aggregate clusters: age of onset of vertigo, duration of vertigo attacks, presence of migrainous headache during vertigo, and presence of cochlear symptoms during vertigo. We identified 5 clusters: cluster 1/group 1 (23 subjects, 9.4%) characterized by longer duration of vertigo attacks; cluster 2/group 2 (52 subjects, 21.3%) characterized by absence of migrainous headache and cochlear symptoms during vertigo; cluster 3/group 3 (44 subjects, 18%) characterized by presence of cochlear symptoms during vertigo but not headache; cluster 4/group 4 (57 subjects, 23.4%) by the presence of both cochlear symptoms and migrainous headache during vertigo; cluster 5/group 5 (68 subjects, 27.9%) characterized by migrainous headache but no cochlear symptoms during vertigo.

CONCLUSION

VM is with any evidence a heterogeneous disorder and clinical presentations exhibit a great variability. In VM, both symptoms orienting toward a peripheral mechanism (cochlear symptoms) and central ones (long lasting positional non-paroxysmal vertigo) may coexist. Our study is the first published trying to characterize subgroups of VM subjects, thus orienting toward different pathophysiological mechanisms.

Ammonia gas sensors based on undoped and Ca-doped ZnO nanoparticles

Due to its large use in different industrial sectors, high toxicity, and corrosion, the demand for sensing techniques towards ammonia gas has become urgent. In this study we report on the sensing performances of a conductometric sensor for NH3 gas based on Ca-doped ZnO nanoparticles with different calcium concentrations (0, 1, and 3 at%) synthesized using the sol-gel process under supercritical dry conditions of ethanol. All samples were characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and Fourier-transform infrared (FTIR) spectroscopy. Pure and Ca-doped ZnO are polycrystalline and well crystallized in the hexagonal wurtzite structure. TEM images revealed that pure ZnO is composed of spherical particles with dimensions in the nanometer range. Larger particles were observed after the incorporation of Ca ions. The average crystallite size, estimated by the Williamson-Hall method, was 43, 80, and 96 nm for pure, Ca-1 at% and Ca-3 at%, respectively. Furthermore, FTIR spectroscopy was used to prove the formation of ZnO and the incorporation of calcium ions in the Ca-doped ZnO samples. The gas sensing performances towards ammonia gas clearly ameliorated after the addition of Ca ions in the ZnO structure. The gas response to NH3, R0/Rg, of the 1% Ca-doped ZnO sensor reached a value of 33 for 4000 ppm of ammonia at T = 300 °C with good selectivity compared to other gases such as CO, CO2, and NO2. The response and recovery times were 5 s and 221 s, respectively. The reported good sensing performances indicate the potential application of Ca-doped ZnO as a sensor material for ammonia detection.

The Role of Nasal Cytology and Serum Atopic Biomarkers in Paediatric Rhinitis

A Nasal Provocation Test allows the differentiation of allergic and non-allergic rhinitis, but it is difficult and expensive. Therefore, nasal cytology is taking hold as an alternative. We carried out a cross-sectional study, including 29 patients with persistent rhinitis according to ARIA definition and negative skin prick tests. Nasal symptoms were scored from 0 to 5 using a visual analogue scale, and patients underwent blood tests to investigate blood cell count (particularly eosinophilia and basophilia), to analyze serum total and specific IgE and eosinophil cationic protein (ECP), and to perform nasal cytology. We performed a univariate logistical analysis to evaluate the association between total serum IgE, serum eosinophilia, basophils, and ECP and the presence of eosinophils in the nasal mucosa, and a multivariate logistic model in order to weight the single variable on the presence of eosinophils to level of the nasal mucosa. A statistically significant association between serum total IgE levels and the severity of nasal eosinophilic inflammation was found (confidence interval C.I. 1.08-4.65, odds ratio OR 2.24, p value 0.03). For this reason, we imagine a therapeutic trial with nasal steroids and oral antihistamines in patients with suspected LAR and increased total IgE levels, reserving nasal cytology and NPT to non-responders to the first-line therapy.

COVID-19 Smell Impairment and Crosstalk with Hypoxia Physiology

Since its apomorphic appearance in 2019, severe acute respiratory syndrome Coronavirus type 2 (SARS-CoV-2) nowadays circulates as a plesiomorphic human virus in several synapomorphic variants. The respiratory tract is the most important site of infection, the viral effects in the lungs are well described, and more than half of the patients could develop shortness of breath and dyspnea and require ventilatory support. The physiological sign of this condition is the decrease in the partial pressure of oxygen in the blood, leading to acute hypoxia, which could be a factor in the disease. In severe patients, we recorded several physiological parameters: breath frequency (BF), partial pressure of oxygen in the blood (pO2), partial pressure of carbon dioxide in the blood (pCO2), hemoglobin (Hb), heart rate (HR), and blood pressure in correlation with the olfactory threshold. We found significant correlations between reduced olfactory threshold with pO2 and hemoglobin levels, changes in heart rate, and increased HR and pCO2. These results suggest that COVID-19 causes an impaired sense of smell that decreases in threshold corresponding to the disease severity.

Unmasking the 'Asymptomatic' COVID-19: A Nose Question

The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has high infectivity, often masked by asymptomatic carriers, which allows it to spread rapidly and become a pandemic. Attempts to slow the pandemic at this stage depend on the ability to unmask asymptomatic carriers. The rapid diagnosis of active coronavirus disease 2019 (COVID-19) infection is one of the cornerstones of pandemic control, as the nasal cavity is the main gateway for SARS-CoV-2 entry and altered sense of smell is a feature of the current virus. In the present study, we therefore tested the olfactory threshold coupled with heart–lung parameters in subjects undergoing traditional molecular testing, resulting in a significantly different score between asymptomatic subjects and healthy controls. In total, 82% of asymptomatic positives showed olfactory impairment; of these, 46% had severe hyposmia and 7% had anosmia, while in the control 9% had severe hyposmia and 0% had anosmia, respectively, which agrees with heart rate, breathing rate, and blood pressure parameter variations. The olfactory test coupled with physiological parameters may help to identify asymptomatic people. In conclusion, our results suggest that most asymptomatic individuals could be unmasked by mass olfactory rapid threshold screening and then referred to traditional slower diagnostic tests.

Effect of tonsillectomy in a child with obesity and obstructive sleep apnea: A case report and review of the literature

Obstructive sleep apnea (OSA) is an increasingly recognized disorder in children. Adenotonsillectomy is the primary surgical treatment for OSA in children with adenotonsillar hypertrophy (ATH). We present the case of an obese 4-year-old boy hospitalized for severe desaturation during sleep and severe ATH. Nasal steroid therapy proved ineffective with persistent symptoms. Polygraphy documented severe OSA with an apnea-hypopnea index (AHI) equal to 11. Tonsillectomy resulted in prompt symptom improvement and a substantial reduction of the AHI (2.2). In this case, tonsillectomy alone resulted effective in treating OSA, despite obesity. We concluded that the presence of obesity should not postpone/exclude surgical treatment of preschool children for whom ATH is the most important cause of OSA.

Electrophysiological and olfactometric evaluation of long-term COVID-19

COVID-19 is a public health emergency with cases increasing globally. Its clinical manifestations range from asymptomatic and acute respiratory disease to multiple organ dysfunction syndromes and effects of COVID-19 in the long term. Interestingly, regardless of variant, all COVID-19 share impairment of the sense of smell and taste. We would like to report, as far as we know, the first comprehensive neurophysiological evaluation of the long-term effects of SARS-CoV-2 on the olfactory system with potential-related neurological damage. The case report concerns a military doctor, with a monitored health history, infected in April 2020 by the first wave of the epidemic expansion while on military duty in Codogno (Milan). In this subject, we find the electrophysiological signal in the periphery, while its correlate is absent in the olfactory bulb region than in whole brain recordings. In agreement with this result is the lack of metabolic signs of brain activation under olfactory stimulation. Consequently, quantitative and qualitative diagnoses of anosmia were made by means of olfactometric tests. We strongly suggest a comprehensive series of olfactometric tests from the first sign of COVID-19 and subsequent patient assessments. In conclusion, electrophysiological and metabolic tests of olfactory function have made it possible to study the long-term effects and the establishment of neurological consequences.

MRI With Intratympanic Gadolinium: Comparison Between Otoneurological and Radiological Investigation in Menière's Disease

Objectives/hypothesis: To compare findings obtained using both magnetic resonance imaging plus intratympanic gadolinium and audiovestibular testing for Menière's disease.

Study design: Retrospective cohort study.

Methods: Patients with definite unilateral Menière's disease (n = 35) diagnosed according to 2015 Barany Criteria were included. Three-dimensional real inversion recovery (3D-real-IR) MRI was executed 24 h after intratympanic gadolinium injection to assess the presence and degree of endolymphatic hydrops. Pure tone audiometry, bithermal caloric test, head impulse test, ocular, and cervical VEMPs using air-conducted sound were performed to evaluate the level of hearing and vestibular loss. The results were compared to verify precision of the method in providing correct diagnoses.

Results: Different degrees of endolymphatic hydrops were observed in the MRI of the cochlea and vestibule in the affected ears of Menière's disease patients, even though it was impossible to radiologically distinguish the two otolithic structures separately. The correlation between the degree of linked alterations between instrumental and MRI testing was statistically significant. In particular, an 83% correspondence with audiometry, a 63% correspondence for cVEMPs and 60% correspondence for cVEMPs were seen. While for HIT the accordance was 70 and 80% for caloric bithermal test.

Conclusions: MRI using intratympanic gadolinium as a contrast medium has proved to be a reliable and harmless method, even though there is an objective difficulty in disclosing macular structures. The study revealed that there is no complete agreement between instrumental values and MRI due to the definition of the image and fluctuation of symptoms. The present work highlights the greater (but not absolute) sensitivity of otoneurological tests while MRI, although not yet essential for diagnosis, is certainly important for understanding the disease and its pathogenic mechanisms.

Congenital Hairy Polyp Causing Severe Upper Airway Obstruction in a Newborn: A Case Report

Patient: Female, newborn

Final Diagnosis: Congenital hairy polyp

Symptoms: Cyanosis • respiatory distress

Medication: —

Clinical Procedure: —

Specialty: Oncology • Otolaryngology

Otitis media with effusion: The role of Helicobacter Pylori in its pathogenesis

BACKGROUND

Otitis Media with Effusion (OME) is the most common disease of the middle ear. Different factors play a role in its pathogenesis, such as viral and bacterial infections, allergy, morphological and functional changes of nasal passage, Eustachian Tube (ET), and cleft palate. This study aims to investigate the Helicobacter Pylori presence in middle ear effusions from patients with OME through RT-PCR and compare our results with results from other published articles.

METHODS

The study was carried out from October 2007 to February 2009, in the Department of Otorhinolaryngology of SS. Annunziata Hospital, Chieti, Italy. 132 consecutive patients with OME were included in the study. Fluid in the middle ear was assessed for the presence of Helicobacter Pylori through RT-PCR.

RESULTS

132 consecutive patients with OME were included in the study. The patients were between ages 8 and 78 (median 50); 62 were males (47%), 70 were females (53%), and 53 patients had bilateral OME (40%). 185 samples were collected from 132 patients. Of the 185 samples taken from the ear, 21 (11.35%) were not adequate for the correct execution of the DNA extraction procedure. The remaining 167 samples, subjected to RT-PCR, did not show in any case an increase in fluorescence linked to the FAM fluorophore, thus demonstrating the complete absence of Helicobacter Pylori.

CONCLUSION

Based on the results obtained, we can affirm that although a third of the cases of OME is correlated to the presence of reflux, Helicobacter Pylori does not seem to play any role in the pathophysiology of OME as it cannot be found in endo-tympanic exudate.

Recurring paroxysmal positional vertigo: evaluation of the vascular factor

To evaluate the effective incidence of vascular factor in the recurrence of benign paroxysmal positional vertigo (BPPV), we studied 50 subjects, 32 affected by idiopathic recurrent BPPV (study group) and 18 healthy subjects (control group). All subjects underwent complete otoneurological balance and haemodynamic evaluation by extracranial colour-coded duplex sonography (ECCS) of vertebral arteries (VA) with indication of arterial flow in ml/min, and retinal fluorangiography (FAG). The ECCS of 19 patients (59.3%) within the study group presented a reduction in vertebral arterial flow, exceeding the limits established by normative values (< 100 ml/min). In all cases, the same side was affected by BPPV, emphasised by vertebral hypoperfusion. The remaining 13 patients (40.6%) showed an arterial vertebral flow entirely within the normative values. The FAG excluded qualitative alterations of the cerebral microcirculation. The ECCS demonstrated that 59.3% of the study group showed a significant reduction in vertebral arterial flow ipsilateral to the semicircular canal affected by BPPV. This increased to 68.75% when the flow difference (D) between both the vertebral arteries were considered and reached 71.8% when vascular risk factors were evaluated. We conclude that reduced perfusion of the vestibular structures makes an already critical situation even more difficult, which can eventually develop into labyrinth suffering. The absence of fluorangiographic signs suggests that the labyrinthine neuroepithelium is much more sensitive to hypoperfusion than the retina. We hypothesise that this ischaemic situation could degenerate utricular macula, otolith detachment, leading to the development of recurrent BPPV. This risk situation for the labyrinth can also be revealed by the evaluation of three parameters: presence of vascular risk factors, reduction of vertebral flow < 100 ml/min and the difference in flow between the 2 vertebral arteries > 29 ml/min.

Smell and Taste in Severe CoViD-19: Self-Reported vs. Testing

One of the most striking reported symptoms in CoViD-19 is loss of smell and taste. The frequency of these impairments and their specificity as a potential central nervous system function biomarker are of great interest as a diagnostic clue for CoViD-19 infection as opposed to other similar symptomatologic diseases and because of their implication in viral pathogenesis. Here severe CoViD-19 was investigated by comparing self-report vs. testing of smell and taste, thus the objective severity of olfactory impairment and their possible correlation with other symptoms. Because a significant discrepancy between smell and taste testing vs. self-report results (p < 0.001) emerges in our result, we performed a statistical analysis highlighting disagreement among normosmia (p < 0.05), hyposmia, severe hyposmia, and anosmia (p < 0.001) and, in hypogeusia and severe hypogeusia, while no differences are observed in normogeusia and ageusia. Therefore, we analyzed the olfactory threshold by an objective test revealing the distribution of hyposmic (34%), severe hyposmic (48%), and anosmic (13%) patients in severe CoViD-19. In severe CoViD-19 patients, taste is lost in 4.3% of normosmic individuals, 31.9% of hyposmic individuals, 46.8% of severe hyposmic individuals, and 17% of anosmic individuals. Moreover, 95% of 100 CoViD-19 patients objectively tested were affected by smell dysfunction, while 47% were affected by taste dysfunction. Furthermore, analysis by objective testing also highlighted that the severity of smell dysfunction in CoViD-19 subjects did not correlate with age and sex. In conclusion, we report by objective testing that the majority of CoViD-19 patients report severe anosmia, that most of the subjects have olfactory impairment rather than taste impairment, and, finally, that the olfactory impairment correlate with symptom onset and hospitalization (p < 0.05). Patients who exhibit severe olfactory impairment had been hospitalized for about a week from symptom onset; double time has taken place in subjects with normosmia. Our results may be limited by the relatively small number of study participants, but these suggest by objective testing that hyposmia, severe hyposmia, and anosmia may relate directly to infection severity and neurological damage. The smell test assessment could be a potential screening symptom that might contribute to the decision to test suspected cases or guide quarantine instructions, further therapeutic approach, and evaluation of neurological damage.

Left atrial remodeling after Mitraclip implantation

Objective

Changes in left atrial (LA) size and function are associated with major adverse cardiovascular outcomes such as atrial fibrillation, heart failure, stroke, and death. Reverse LA remodelling occurs after successful surgical mitral valve repair for severe MR. Changes in LA volumes after MV repair have reported in several studies. However, LA data are limited in the setting of transcatheter repair.

Materials an methods

From November 2016 to July 2018, clinical and echocardiographic data of 42 patients with mitral regurgitation who underwent Mitraclip implantation in our division were evaluated for LA function: LA global longitudinal strain (LA GLS); LAESV (Left atrial end-systolic volume), LAEDV (Left atrial end-diastolic volume); LA emptying Fraction at baseline, at 1 month, at 6 months and 1 year of follow up were assessed. The variation of continuous variables was evaluated using a student T test for paired data or the Wilcoxon matched-pair signed rank test when appropriate. The categorical variables between two groups were evaluated using the chi-square test (χ2). P values &lt;0.05 were considered significant.

Results

The etiology of the mitral regurgitation was primary in 33,3% and secondary in 66,7% of the included patients. The MR degree was 3+ in 21,4% of patients and 4+ in 78,6%. When compared to baseline at 6 months and 1 year a statistically significant reduction was observed for both LAESV (p&lt;0.001) and LAEDV (p&lt;0.001). At 6 months, compared to baseline, the LA GLS reached statistic relevance (p 0.05) with a significant improvement at 1 year (p 0.001). Finally, we did not find significant differences in LA emptying fraction at different time point analyzed.

Conclusions

A successful MitraClip procedure can reverse the process of LA remodeling within 12 months, and this can be detected by Two-dimensional speckle tracking echocardiography (2D STE) through an improvement in the LA reservoir function. These data generate the hypothesis that the GLS, compared to conventional echocardiographic parameters, represents an advanced method that quantify atrial function in Mitraclip implanted patients.

Funding Acknowledgement

Type of funding source: Public hospital(s)

A new pharmacological approach based on remdesivir aerosolized administration on SARS-CoV-2 pulmonary inflammation: A possible and rational therapeutic application

The new zoonotic coronavirus (SARS-CoV-2) responsible for coronavirus disease (COVID-19) is a new strain of coronavirus not previously seen in humans and which appears to come from bat species. It originated in Wuhan, Hubei Province, China, and spread rapidly throughout the world, causing over 5,569,679 global cases and 351,866 deaths in almost every country in the world, including Europe, particularly Italy. In general, based on existing data published to date, 80.9% of patients infected with the virus develop mild infection; 13.8% severe pneumonia; 4.7% respiratory failure, septic shock or multi-organ failure; 3% of these cases are fatal. Critical patients have been shown to develop acute respiratory distress syndrome (ARDS) and hospitalization in intensive care units. The average age of patients admitted to hospital is 57-79 years, with one third half with an underlying disease. Asymptomatic infections have also been described, but their frequency is not known. SARS-CoV-2 transmission is mainly airborne from one person to another via droplets. The data available so far seem to indicate that SARS-CoV-2 is capable of producing an excessive immune reaction in the host. The virus attacks type II pneumocytes in the lower bronchi through the binding of the Spike protein (S protein) to viral receptors, of which the angiotensin 2 conversion enzyme (ACE2) receptor is the most important. ACE2 receptor is widely expressed in numerous tissues, including the oropharynx and conjunctiva, but mostly distributed in ciliated bronchial epithelial cells and type II pneumocytes in the lower bronchi. The arrival of SARS-CoV-2 in the lungs causes severe primary interstitial viral pneumonia that can lead to the "cytokine storm syndrome", a deadly uncontrolled systemic inflammatory response triggered by the activation of interleukin 6 (IL-6), whose effect is extensive lung tissue damage and disseminated intravascular coagulation (DIC), that are life-threatening for patients with COVID-19. In the absence of a therapy of proven efficacy, current management consists of off-label or compassionate use therapies based on antivirals, antiparasitic agents in both oral and parenteral formulation, anti-inflammatory drugs, oxygen therapy and heparin support and convalescent plasma. Like most respiratory viruses can function and replicate at low temperatures (i.e. 34-35 °C) and assuming viral thermolability of SARS-CoV-2, local instillation or aerosol of antiviral (i.e. remdesivir) in humid heat vaporization (40°-41 °C) in the first phase of infection (phenotype I, before admission), both in asymptomatic but nasopharyngeal swab positive patients, together with antiseptic-antiviral oral gargles and povidone-iodine eye drops for conjunctiva (0,8-5% conjunctival congestion), would attack the virus directly through the receptors to which it binds, significantly decreasing viral replication, risk of evolution to phenotypes IV and V, reducing hospitalization and therefore death.

Double-Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo

OBJECTIVES/HYPOTHESIS

The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the forced prolonged position (FPP).

STUDY DESIGN

Double-blind, randomized controlled trial.

METHODS

Two hundred twenty-one patients with unilateral LC-BPPV met the inclusion criteria for a multicentric study. Patients were randomly assigned to treatment by FPP (116 subjects) or sham treatment (105 subjects). Subjects were followed up at 24 hours with the supine roll test by blinded examiners.

RESULTS

Among the sample, 67.4% and 32.6% of the patients showed respectively geotropic and apogeotropic variant of LC-BPPV. At the 24-hour follow-up, the effectiveness of FFP compared to the sham maneuver was, respectively, 57.8% versus 12.4% (P < .0001) in the total sample, 76.9% versus 11.3% (P < .0001) in the geotropic variant group, and 60.5% versus 17.6% (P = .0003) in the apogeotropic variant group, including resolution or transformation to geotropic variant.

CONCLUSIONS

FPP proved highly effective compared to the sham maneuver. The present class 2 study of the efficacy of the FPP changes the level of recommendation of the method for treating LC-BPPV into a strong one.

LEVEL OF EVIDENCE

2 Laryngoscope, 131:E1296-E1300, 2021.

Menière's disease patients improve specific posturographic parameters following diagnostic intratympanic injection

PURPOSE

Evaluation of specific computerized posturographic parameters in patients with Menière's disease (MD) following the intratympanic injection of gadolinium, a contrast agent, used in radiological diagnosing.

MATERIALS AND METHODS

We have observed 12 adult patients with unilateral Menière's Disease subjected to inner ear magnetic resonance imaging (MRI) examination after intratympanic gadolinium injection (ITG). The diagnoses have been performed according to the guidelines of the American Academy of otolaryngology. Before and after 24 h the ITG, all patients were subjected to the clinical evaluation and computerized posturography (CP), in 4 conditions depending on open/closed eyes and with/without foam cushion under feet.

RESULTS

After ITG, in the affected ear the MRI confirmed the endolymphatic hydrops revealing a thin or even disappeared perilymphatic space. The statokinesigram showed improvement of stability only with closed eyes on a foam cushion. The CP performed 24 h after the contrast intratympanic injection showed a significant reduction of Path Length and Confidence Ellipse Area, due to an improvement of vestibular function on static balance. This improvement could be directly dependent to intratympanic pressure modification mediated by volume of contrast liquid, by "columella effect".

CONCLUSIONS

This study demonstrates the absence of vestibular damage in patients undergoing intratympanic gadolinium infiltration and confirms the relationship between intratympanic pressure and vestibular stability modifications providing positive evidences for an applicative use of CP as a functional assessment to better address diagnosis and follow-up in MD patients treated with intratympanic injections.

α-MoO3 nanostructure on carbon cloth substrate for dopamine detection

Orthorhombic molybdenum oxide (α-MoO₃) nanostructures were deposited on the surface of carbon cloth (CC) as a flexible and high conductive scaffold by reactive RF magnetron sputtering technique. Structure and morphology of the as prepared molybdenum coated carbon cloth (MoO₃CC) were thoroughly characterized with field emission scanning electron microscopy, x-ray diffraction, energy dispersive x-ray and Raman spectroscopy. Benefiting from high surface area and superior conductivity of CC as well as electrocatalytic activity of α-MoO₃ nanostructures, an electrochemical sensor was fabricated. The electrochemical behavior of this new sensor toward determination of dopamine was studied in detail by cyclic voltammetry, amperometry (AM) and square wave voltammetry (SWV). Results reported here reveal that using SWV not only enhances the sensitivity of sensors to dopamine by more than 14 times compared to AM, but also offers higher linear dynamic range (1-700 μM compared to 5-550 μM). Limit of detection, for signal to noise ratio 3, was calculated to be 0.48 μM. Applicability of the proposed sensor for measurement of dopamine in real samples, like urine and pharmaceutical formulation, was also evaluated that concluded to satisfactory results.

Manganese Doped Hydroxyapatite Nanoparticles Based Enzyme-Less Electrochemical Sensor for Detecting Hydroquinone

Manganese (Mn) doped hydroxyapatite (HA) nanoparticles were synthesized by a simple microwave irradiation method and characterized using XRD, SEM, micro-Raman, FTIR, XPS and vibrating sample magnetometer (VSM) methods. The as prepared 3 M% Mn doped HA (3 M% Mn-HA) nanoparticles modified glassy carbon electrode (GCE) showed an excellent electrocatalytic activity towards the oxidation of hydroquinone (HQ). The electrochemical studies demonstrated that the 3 M% Mn-HA nanoparticles modified GCE detects HQ linearly over a wide concentration range of 1.0×10^-8 to 1.6×10^-4 M with the lowest detection limit of 11 nM at neutral pH (7.0) in PBS. Furthermore, Mn-HA modified GCE exhibited an excellent stability, reproducibility and anti-interference ability against a number of potential electroactive species and metal ions and proved to be useful for the estimation of the HQ in tap water and industry waste water with satisfactory recovery.

High performance acetone sensor based on γ-Fe2O3/Al-ZnO nanocomposites

Ternary nanocomposites made of γ-iron oxide and aluminum-doped zinc oxide (γ-Fe₂O₃/Al-ZnO NCs), with different metal oxides ratio (0%-100%) were prepared through a solvothermal sol-gel process. The synthesized materials were characterized by x-ray diffraction, UV-vis spectroscopy, photoluminescence (PL), scanning electron microscope and BET analysis. Characterization results demonstrated that the ternary γ-Fe₂O₃/Al-ZnO NCs are mainly constituted by γ-Fe₂O₃ and Al-ZnO individual phases, while structural and physical properties like surface area, pore size, optical band gap, PL and electrical conductivity were deeply affected by the composition of nanocomposite. The synthesized γ-Fe₂O₃/Al-ZnO NCs were employed to prepare conductometric gas sensors, then their sensing performances toward acetone were also investigated. Results revealed enhanced sensing performance of nanocomposites than both pure γ-Fe₂O₃ and Al-ZnO phases. In particular, the γ-Fe₂O₃(33%)/Al-ZnO based gas sensor showed the best sensing properties, like a high response of R _air/R _gas = 29, a short response time of 3 s, in addition to an improved selectivity toward acetone versus ethanol at an operating temperature of 200 °C. Overall, ternary γ-Fe₂O₃/Al-ZnO NCs appear to be promising for the development of conductometric acetone sensors.

Assessment of the effect of mesoglycan in the treatment of audiovestibular disorders of vascular origin

It is a well-known fact that inner ear diseases are often caused by microcirculatory disorders, and the recent literature is oriented towards investigations into the relationship between the cardiovascular system and cochleovestibular illness with related classical symptoms: tinnitus, hearing loss, and vertigo or instability. These symptoms, and particularly the vertigo, may be the alarm signal of microcirculatory disorders of the labyrinth or vertebrobasilar circulation so as to represent a possible symptom of posterior circulation stroke. The treatment aimed at correcting the haemodynamic and metabolic imbalance, generated by the cochleovestibular microcirculatory disorders, with drugs that act on the vessel wall being very useful, both alone and in combination with other treatment protocols. This is a multicenter retrospective observational study conducted in 40 neurootological laboratories with 873 patients with cardiovascular risk factors suffering from tinnitus, instability or peripheral vertigo alone or in combination with one another treated for the first time with mesoglycan. The data collected showed that the treatment with mesoglycan, irrespective of the type of vascular risk factor, is not only well tolerated but also significantly and objectively improves the cochleovestibular symptoms and the quality of life of patients suffering from tinnitus, peripheral vertigo and instability.

A water-filled garment to protect astronauts during interplanetary missions tested on board the ISS

As manned spaceflights beyond low Earth orbit are in the agenda of Space Agencies, the concerns related to space radiation exposure of the crew are still without conclusive solutions. The risk of long-term detrimental health effects needs to be kept below acceptable limits, and emergency countermeasures must be planned to avoid the short-term consequences of exposure to high particle fluxes during hardly predictable solar events. Space habitat shielding cannot be the ultimate solution: the increasing complexity of future missions will require astronauts to protect themselves in low-shielded areas, e.g. during emergency operations. Personal radiation shielding is promising, particularly if using available resources for multi-functional shielding devices. In this work we report on all steps from the conception, design, manufacturing, to the final test on board the International Space Station (ISS) of the first prototype of a water-filled garment for emergency radiation shielding against solar particle events. The garment has a good shielding potential and comfort level. On-board water is used for filling and then recycled without waste. The successful outcome of this experiment represents an important breakthrough in space radiation shielding, opening to the development of similarly conceived devices and their use in interplanetary missions as the one to Mars.

Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects

Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined "episodic symptoms which may be associated with migraine." The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.

Concanavalin a and Wheat Germ Agglutinin Receptors in the Ascitic Fluid of Rat Hepatomas

The presence of glycopeptide lectin receptors in the ascitic fluid of rats bearing Novikoff or AS-30D hepatoma was investigated. Macrosialoglycopeptides, resistant to pronase digestion, were partially purified from the ascitic fluid of hepatoma-bearing rats by gel filtration on Sephadex G-50. A macrosialoglycopeptide fraction, isolated from the ascitic fluid of rats bearing the Novikoff hepatoma, possessed potent concanavalin A (Con A) receptor activity. This fraction possessed higher Con A receptor activity than did the comparable macrosialoglycopeptide fraction from the ascitic fluid of rats bearing the AS-30D hepatoma; this observation is in agreement with the Con A-induced agglutination properties of these 2 hepatoma cell lines and with the Con A receptor activities of the glycopeptides released from the surface of the hepatoma cells by papain digestion. Rat blood serum contained a comparable macrosialoglycopeptide fraction, which possessed weak Con A receptor activity. The macrosialoglycopeptide fractions from the ascitic fluid of hepatoma-bearing rats possessed wheat germ agglutinin receptor activity. However, this activity was also present in normal rat serum. These results suggest that glycopeptides present on the surface of Novikoff hepatoma cells are shed into the ascitic fluid and may be distinguished from components in normal serum by their Con A receptor activity.

Behavior of A Cell Line Derived from A Mouse Submaxillary Adenocarcinoma during the Initial 480 Days in Vitro

A cell line was established from a transplantable adenocarcinoma, containing viral particles of the A and B type, derived from a tumor appearing spontaneously in the submaxillary region of a male mouse of the C3H/He strain. This line, after 480 days in vitro, did not change the original epithelial-like morphology, the viral expression, the membrane immunofluorescence and the degree of agglutination by various plant lectins. After 208 days of culture, the presence of up to 3 pairs of metacentric chromosomes appeared in about 55% of the cells. However, this change in the chromosomal pattern was not sufficient, at least within the limits of our observation, to modify significantly the other parameters investigated, with the possible exception of the oncogenicity, which showed a modest decrease after 296 days of culture.

Diagnosis of a neonatal ophthalmic discharge, Ophthalmia neonatorum, in the molecular age: investigation for a correct therapy

An early double case of acute Ophthalmia neonatorum in 3-day-old twins is reported. Culture of eye swabs showed a wide bacterial polymorphism, in which common bacteria, such as Klebsiella pneumoniae, Streptococcus pneumoniae, Corynebacterium ulcerans and other Enterobacteriaceae, coexisted with atypical Mycoplasmataceae and Chlamydiaceae from resident cervical-vaginal maternal microbiota. The neonates were in an apparently healthy state, but showed red eyes with abundant greenish-yellow secretion, mild chemosis and lid edema. The maternal cervical-vaginal ecosystem resulted differently positive to the same common cultivable, atypical bacteria culturally and molecularly determined. This suggested a direct maternal-foetal transmission or a further foetal contamination before birth. An extended culture analysis for common bacteria to atypical ones was decisive to describe the involvement of Mycoplasmas (M. hominis and U. urealyticum) within the scenario of the Ophthalmia neonatorum in a Caucasian couple. The introduction of a routine PCR molecular analysis for Chlamydiaceae and N. gonorrhoeae allowed to establish which of these were present at birth, and contributed to determine the correct laboratory diagnosis and to define an adequate therapeutic protocol obtaining a complete resolution after one year for culture and atypical bacteria controls. This study suggests to improve the quality of laboratory diagnosis as unavoidable support to a correct clinical diagnosis and therapy, in a standardized modality both for swabbing and scraping, to check the new-born microbial programming starting in uterus, overtaking the cultural age to the molecular age, and to revise the WHO guidelines of SAFE Strategy for trachoma eye disease, transforming it into SAFES Strategy where the S letter is the acronym of Sexual ecosystem and behavioural valuation/education.

Tracking areal lithium densities from neutron activation - quantitative Li determination in self-organized TiO2 nanotube anode materials for Li-ion batteries

Nanostructuring of electrode materials is a promising approach to enhance the performance of next-generation, high-energy density lithium (Li)-ion batteries. Various experimental and theoretical approaches allow for a detailed understanding of solid-state or surface-controlled reactions that occur in nanoscaled electrode materials. While most techniques which are suitable for nanomaterial investigations are restricted to analysis widths of the order of Å to some nm, they do not allow for characterization over the length scales of interest for electrode design, which is typically in the order of mm. In this work, three different self-organized anodic titania nanotube arrays, comprising as-grown amorphous titania nanotubes, carburized anatase titania nanotubes, and silicon coated carburized anatase titania nanotubes, have been synthesized and studied as model composite anodes for use in Li-ion batteries. Their 2D areal Li densities have been successfully reconstructed with a sub-millimeter spatial resolution over lateral electrode dimensions of 20 mm exploiting the ⁶Li(n,α)³H reaction, in spite of the extremely small areal Li densities (10-20 μg cm^-2 Li) in the nanotubular active material. While the average areal Li densities recorded via triton analysis are found to be in good agreement with the electrochemically measured charges during lithiation, triton analysis revealed, for certain nanotube arrays, areas with a significantly higher Li content ('hot spots') compared to the average. In summary, the presented technique is shown to be extremely well suited for analysis of the lithiation behavior of nanostructured electrode materials with very low Li concentrations. Furthermore, identification of lithiation anomalies is easily possible, which allows for fundamental studies and thus for further advancement of nanostructured Li-ion battery electrodes.

Synthesis, characterization and electrochemical properties of 5-aza[5]helicene-CH2O-CO-MWCNTs nanocomposite

In this study, we report the preparation of a novel nanocomposite, 5-aza[5]helicene-CH₂O-CO-MWCNTs, obtained by grafting the 5-aza[5]helicene moiety on the surface of multi-walled carbon nanotubes (MWCNTs). Thermogravimetry (TGA), Fourier transform-infrared spectroscopy (FTIR), ultraviolet (UV), and photoluminescence (PL) measurements provided evidence that the organic moiety is covalently grafted to the MWCNTs. The 5-aza[5]helicene-CH₂O-CO-MWCNTs nanocomposite was utilized to fabricate modified commercial screen-printed carbon electrodes. Its electrochemical behavior was studied in neutral buffer solution in the presence of ferricyanide and hydroquinone (HQ). Finally, the electrochemical sensing of epinephrine in the presence of ascorbic acid by using the linear sweep voltammetry (LSV) technique was investigated. Results have demonstrated the enhanced electrocatalytic activity and excellent ability of the 5-aza[5]helicene-CH₂O-CO-MWCNTs-modified electrode in the separation between the anodic peaks of epinephrine (EP) and ascorbic acid (AA), even in the presence of a high amount of AA, with a detection limit (S/N = 3) of 5 μmol l^-1.

Investigations on the effect of gamma-ray irradiation on the gas sensing properties of SnO2 nanoparticles

In recent years, SnO2 nanoparticles (NPs) have been subjected to various modifications in order to improve their performance in sensing and other applications. Here, we report the synthesis of SnO2 NPs by microwave irradiation, and subsequent exposure to gamma (γ) radiation at different doses (0-150 kGy) to induce desirable physico-chemical properties. The irradiated samples were characterized by x-ray powder diffraction (XRD), transmission electron microscopy (TEM and HR-TEM), and photoluminescence (PL) to evaluate the effect of γ-ray irradiation on their morphology and microstructure. The results revealed that the bulk crystal structure remained unchanged after irradiation, while the existence of defects and a damaged over-layer have been confirmed by PL and HR-TEM respectively. The influence of γ-irradiation on the electrical and CO sensing characteristics was also investigated in the temperature range between 150 and 400 °C. γ-irradiated SnO2 NP based resistive sensors showed better CO sensing characteristics (i.e. higher response and lower working temperature) compared to non-irradiated SnO2. Upon optimizing the γ-ray dose irradiation level and working temperature, a ten-fold enhancement in the response to CO has been achieved (R/R 0 = 12 to 50 ppm of CO in air) in 50 kGy irradiated SnO2 NP based sensors operating at 150 °C. A possible mechanism for the enhanced sensing performance of γ-irradiated SnO2 NPs has been proposed.

Single-Blind Evaluation of Post-Tonsillectomy Pain Treatment with an Eutectic Mixture of Local Anesthetics

The efficacy of an eutectic mixture of local anesthetics (lidocaine and prilocaine) in ointment for topical use (EMLA) in the treatment of post-tonsillectomy pain in both pediatric and adult patients was evaluated. Ninety patients affected by recurring tonsillitis and refractory to antibiotic therapy were submitted to tonsillectomy by dissection. Of the ninety patients 45 random subjects received topical treatment and the remaining 45 did not receive any treatment in the emptied tonsillar compartment. Pain intensity was evaluated at 3, 6 and 9 hours after surgical treatment using a visual subjective evaluation scale (VAS for adults and FES for children). The percentage of adults who referred pain of minor intensity was greater in the treated patients than in the controls: 51.4% vs 14.3% (p<0.001) at the third hour, 71.4% vs 2.9% (p<0.001) at the sixth hour and 88.6% vs 14.3% (p<0.001) at the ninth hour. In the pediatric groups, 80.0% of the treated subjects referred moderate pain at the third hour, compared to 40% of the control group. At the ninth hour all children (100%) referred moderate pain compared to 20% of the control group. No treated patient required analgesic therapy during the post-operative observation period. The application of EMLA in the compartment after tonsillectomy determined an extremely significant reduction of postoperative pain in terms of intensity and duration.

Ultrastructural regenerating features of nasal mucosa following microdebrider-assisted turbinoplasty are related to clinical recovery

BACKGROUND

The nasal mucosa plays a key role in conditioning the inhaled air and in regulating the immune response. These functions led many authors to recommend mucosal sparing techniques for the surgical management of inferior turbinate hypertrophy. However, the histological modifications of chronic diseases retain the inflammatory activity and prevent the nasal physiology restoration. It has been proved that the basal cells of the nasal mucosa are able to proliferate and to repair after cold-knife incision. The aim of this study was to demonstrate that the healing process after removal of the inferior turbinate mucosa with cold techniques results in a complete structural restoration.

METHODS

A prospective study was performed in 18 patients who underwent Microdebrider inferior turbinoplasty (cold technique). Subjective and objective improvement of nasal patency was evaluated with visual analogue scale, rhinomanometry, videoendoscopy and mucociliary transport test. Pre- and post-operative biopsy specimens were taken from 7 patients to evaluate the healing process. Two samples were taken from two healthy patients as control. The specimens were processed for transmission electron microscopy analysis.

RESULTS

Videoendoscopy showed reduction of lower turbinate after surgery. Nasal patency augmented and no adverse consequences were observed. After 4 months the nasal mucosa showed normal appearance, with restoration of the pseudostratified ciliated pattern, intercellular connections and normal cellular morphology. Fibrosis and submucosal edema disappeared. At longer time after operation (4 years) clinical improvement was confirmed.

CONCLUSIONS

The total removal of the nasal mucosa with cold techniques results in a complete restoration of the normal structure and permanent resolution of the chronic inflammation typical of hypertrophic rhinopathy.

A comparison of the ethanol sensing properties of α-iron oxide nanostructures prepared via the sol-gel and electrospinning techniques

Haematite (α-Fe2O3) nanostructures were synthesized via a Pechini sol-gel method (PSG) and an electrospinning (ES) technique. Their texture and morphology were investigated by scanning and transmission electron microscopy. α-Fe2O3 nanoparticles were obtained by the PSG method, whereas fibrous structures consisting of interconnected particles were synthesized through the ES technique. The crystallinity of the α-Fe2O3 nanostructures was also studied by means of x-ray diffraction and Raman spectroscopy. Gas-sensing devices were fabricated by printing the synthesized samples on ceramic substrates provided with interdigitated Pt electrodes. The sensors were tested towards low concentrations of ethanol in air in the temperature range (200-400 °C). The results show that the α-Fe2O3 nanostructures exhibit somewhat different gas-sensing properties and, interestingly, their sensing behaviour is strongly temperature-dependent. The availability of active sites for oxygen chemisorption and the diffusion of the analyte gas within the sensing layer structure are hypothesized to be the key factors responsible for the different sensing behaviour observed.

A novel disposable electrochemical sensor for determination of carbamazepine based on Fe doped SnO2 nanoparticles modified screen-printed carbon electrode

An effective strategy to fabricate a novel disposable screen printing carbon electrode modified by iron doped tin dioxide nanoparticles for carbamazepine (CBZ) detection has been developed. Fe-SnO2 (Fe=0 to 5 wt.%) NPs were synthesized by a simple microwave irradiation method and assessed for their structural and morphological changes due to Fe doping into SnO2 matrix by X-ray diffraction and scanning and transmission electron microscopy. The electrochemical behaviour of carbamazepine at the Fe-SnO2 modified screen printed carbon electrode (SPCE) was investigated by cyclic voltammetry and square wave voltammetry. Electron transfer coefficient α (0.63) and electron transfer rate constant ks (0.69 s(-1)) values of the 5 wt.% Fe-SnO2 modified SPCE indicate that the diffusion controlled process takes place on the electrode surface. The fabricated sensor displayed a good electrooxidation response towards the detection of CBZ at a lower oxidation potential of 0.8 V in phosphate buffer solution at pH7.0. Under the optimal conditions, the sensor showed fast and sensitive current response to CBZ over a wide linear range of 0.5-100 μM with a low detection limit of 92 nM. Furthermore, the practical application of the modified electrode has been investigated by the determination of CBZ in pharmaceutical products using standard addition method.

Sr- and Ni-doping in ZnO nanorods synthesized by a simple wet chemical method as excellent materials for CO and CO2 gas sensing

In this study, the effect of Sr- and Ni-doping on the microstructural, morphological and sensing properties of ZnO nanorods has been investigated.

Engineering of carbon based nanomaterials by ring-opening reactions of a reactive azlactone graphene platform

A reactive azlactone-based graphene nanoplatform was successfully synthesized by the ligation of azido-azlactone with alkyne-terminated graphene via Cu(I)-catalyzed cycloaddition. The reactive azlactone rings, grafted on graphene sheets, were subjected to highly efficient ring-opening reactions with functionalized primary amine derivatives incorporating an aminosilane coupling agent or a biological fragment.