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Bagnasco D, Nicola S, Testino E, Brussino L, Pini L, Caminati M, Piccardo F, Canevari RF, Melissari L, Ioppi A, Guastini L, Lombardi C, Milanese M, Losa F, Robbiano M, De Ferrari L, Riccio AM, Guida G, Bonavia M, Fini D, Balbi F, Caruso C, Paggiaro P, Blasi F, Heffler E, Paoletti G, Canonica GW, Senna G, Passalacqua G. Long-Term Efficacy of Mepolizumab at 3 Years in Patients with Severe Asthma: Comparison with Clinical Trials and Super Responders. Biomedicines 2023; 11:2424. [PMID: 37760865 PMCID: PMC10525371 DOI: 10.3390/biomedicines11092424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/23/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
The efficacy mepolizumab in severe asthmatic patients is proven in the literature. Primarily to study the effect of mepolizumab on exacerbations, steroid dependence, and the continuation of efficacy in the long term. Secondarily to evaluate the effect of the drug on nasal polyps. Analyzing data from SANI (Severe Asthma Network Italy) clinics, we observed severe asthmatic patients treated with mepolizumab 100 mg/4 weeks, for a period of 3 years. 157 patients were observed. Exacerbations were reduced from the first year (-84.6%) and progressively to 90 and 95% in the second and third ones. Steroid-dependent patients decreased from 54% to 21% and subsequently to 11% in the second year and 6% in the third year. Patients with concomitant nasal polyps, assessed by SNOT-22, showed a 49% reduction in value from baseline to the third year. The study demonstrated the long-term efficacy of mepolizumab in a real-life setting.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Stefania Nicola
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy (L.B.)
| | - Elisa Testino
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Luisa Brussino
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy (L.B.)
| | - Laura Pini
- Respiratory Medicine Unit, ASST—“Spedali Civili” of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Marco Caminati
- Department of Medicine, University of Verona, 37134 Verona, Italy; (M.C.); (G.S.)
| | - Federica Piccardo
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Rikki Frank Canevari
- ENT Department, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (R.F.C.); (L.G.)
| | - Laura Melissari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Alessandro Ioppi
- ENT Department, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (R.F.C.); (L.G.)
| | - Luca Guastini
- ENT Department, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (R.F.C.); (L.G.)
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, 25124 Brescia, Italy;
| | - Manlio Milanese
- Department of Respiratory Diseases, S. Corona Hospital, ASL2, 17027 Pietra Ligure, Italy;
| | - Francesca Losa
- UO Allergology and Clinical Immunology, ASST Mantova, 46100 Mantova, Italy;
| | - Michela Robbiano
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Laura De Ferrari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Giuseppe Guida
- Department of Clinical and Biological Science, University of Torino, 10043 Orbassano, Italy;
| | - Marco Bonavia
- Department of Rehabilitation Pulmonology, Hospital Ge-Arenzano, ASL3, 16149 Genoa, Italy;
| | - Donatella Fini
- Department of Pneumologiy, Hospital Sarzana (SP), 19125 La Spezia, Italy;
| | - Francesco Balbi
- Department of Pneumologiy, Hospital Imperia, 18100 Imperia, Italy;
| | - Cristiano Caruso
- Department of di Medical and Surgical Science, Fondation Universitary Policlinic A. Gemelli IRCCS, University Cattolica Sacro Cuore, 20123 Rome, Italy;
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, Internal Medicine Department, Fondation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Enrico Heffler
- Unit of Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Italy; (E.H.); (G.P.); (G.W.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Giovanni Paoletti
- Unit of Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Italy; (E.H.); (G.P.); (G.W.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Giorgio Walter Canonica
- Unit of Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Italy; (E.H.); (G.P.); (G.W.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37134 Verona, Italy; (M.C.); (G.S.)
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
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Mocellin D, Ioppi A, Gaglio G, Pennacchi A, Bertolini M, Tirrito A, Guastini L, Bagnasco D, Passalacqua G, Peretti G, Canevari FRM. Severe chronic rhinosinusitis treated with dupilumab, a real-life analysis of early effectiveness. Eur Rev Med Pharmacol Sci 2023; 27:7324-7336. [PMID: 37606141 DOI: 10.26355/eurrev_202308_33304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The present study evaluated the safety and efficacy of dupilumab in severe uncontrolled type 2 chronic rhinosinusitis with nasal polyps (CRSwNP). PATIENTS AND METHODS A retrospective analysis was conducted on a cohort of adult patients affected by severe CRSwNP treated with dupilumab. Maxillofacial computed tomography, evaluation of blood eosinophils and serum IgE levels, measurement of nasal polyp score (NPS), smell identification test (SSIT-16), sinonasal outcome test-22 (SNOT-22) and asthma control test (ACT) were performed. Follow-up was conducted at 2 weeks, and at 1, 3, and 6 months. Adverse events and the efficacy of treatment were monitored. RESULTS 23 patients were enrolled. After 15 days, scores of the SNOT-22, NPS and SSIT-16 significantly improved. These outcomes were also maintained after 1, 3, and 6 months (p < 0.001). At this latter follow-up time, SNOT-22 showed a change of -33.10 (p < 0.001), NPS -3.36 (p < 0.001) and SSIT-16 +5.60 (p < 0.001). In all, 26.1% of patients experienced early minor complications. CONCLUSIONS In the present study, dupilumab was effective in the treatment of severe uncontrolled CRSwNP, demonstrating a quick significant improvement in both questionnaires and endoscopic evaluation. Only minor complications were observed.
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Affiliation(s)
- D Mocellin
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Carobbio ALC, Cheng Z, Gianiorio T, Missale F, Africano S, Ascoli A, Fragale M, Filauro M, Marchi F, Guastini L, Mora F, Parrinello G, Canevari FRM, Peretti G, Mattos LS. Electric Bioimpedance Sensing for the Detection of Head and Neck Squamous Cell Carcinoma. Diagnostics (Basel) 2023; 13:2453. [PMID: 37510197 PMCID: PMC10377945 DOI: 10.3390/diagnostics13142453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The early detection of head and neck squamous cell carcinoma (HNSCC) is essential to improve patient prognosis and enable organ and function preservation treatments. The objective of this study is to assess the feasibility of using electrical bioimpedance (EBI) sensing technology to detect HNSCC tissue. A prospective study was carried out analyzing tissue from 46 patients undergoing surgery for HNSCC. The goal was the correct identification of pathologic tissue using a novel needle-based EBI sensing device and AI-based classifiers. Considering the data from the overall patient cohort, the system achieved accuracies between 0.67 and 0.93 when tested on tissues from the mucosa, skin, muscle, lymph node, and cartilage. Furthermore, when considering a patient-specific setting, the accuracy range increased to values between 0.82 and 0.95. This indicates that more reliable results may be achieved when considering a tissue-specific and patient-specific tissue assessment approach. Overall, this study shows that EBI sensing may be a reliable technology to distinguish pathologic from healthy tissue in the head and neck region. This observation supports the continuation of this research on the clinical use of EBI-based devices for early detection and margin assessment of HNSCC.
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Affiliation(s)
- Andrea Luigi Camillo Carobbio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", 35128 Padua, Italy
| | - Zhuoqi Cheng
- Maersk Mc-Kinney Moller Institute, University of Southern Denmark, 5230 Odense, Denmark
| | - Tomaso Gianiorio
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Molecular and Translational Medicine, University of Brescia, 25125 Brescia, Italy
- Department of Head & Neck Oncology & Surgery, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066 Amsterdam, The Netherlands
| | - Stefano Africano
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Luca Guastini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | | | - Frank Rikki Mauritz Canevari
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genova, Italy
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Missale F, Bugatti M, Marchi F, Mandelli GE, Bruni M, Palmerini G, Monti M, Bozzola AM, Arena G, Guastini L, Boggio M, Parrinello G, Peretti G, Vermi W. The prometastatic relevance of tumor-infiltrating B lymphocytes in laryngeal squamous cell carcinoma. Clin Transl Immunology 2023; 12:e1445. [PMID: 37122496 PMCID: PMC10131296 DOI: 10.1002/cti2.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives Laryngeal squamous cell carcinomas (LSCCs) typically have an excellent prognosis for stage I tumors but a significant risk of locoregional and distant recurrence for intermediate to advanced disease. This study will investigate the clinical relevance of the tumor microenvironment in a large cohort of treatment-naïve patients affected by stage II-IV LSCC. Methods Whole slide-based digital pathology analysis was applied to measure six immune cell populations identified by immunohistochemistry (IHC) staining for CD3, CD8, CD20, CD66b, CD163 and CD38. Survival analysis was performed by Cox proportional hazards models and unsupervised hierarchical clustering using the k-means method. Double IHC staining and in-situ hybridisation by RNAscope allowed further analysis of a protumoral B cell population. Results A cohort of 98 patients was enrolled and analysed. The cluster of immune-infiltrated LSCCs demonstrated a significantly worse disease-specific survival rate. We also discovered a new association between high CD20+ B cells and a greater risk of distant recurrence. The phenotypic analysis of infiltrating CD20+ B cells showed a naïve (BCL6-CD27-Mum1-) regulatory phenotype, producing TGFβ but not IL10, according to an active TGFβ pathway, as proved by positive pSMAD2 staining. Conclusion The identification of regulatory B cells in the context of LSCC, along with the activation of the TGFβ pathway, could provide the basis for new trials investigating the efficacy of already available molecules targeting the TGFβ pathway in the treatment of LSCC.
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Affiliation(s)
- Francesco Missale
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
- Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van LeeuwenhoekNederlands Kanker InstituutAmsterdamThe Netherlands
| | - Mattia Bugatti
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | | | - Maria Bruni
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
| | | | - Matilde Monti
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Anna M Bozzola
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
| | - Giorgio Arena
- ENT DivisionUniversity of Easter Pidmont – AOU Maggiore della Carità di NovaraNovaraItaly
| | - Luca Guastini
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | | | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - William Vermi
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
- Unit of PathologyASST Spedali Civili di BresciaBresciaItaly
- Department of Pathology and ImmunologyWashington University School of MedicineMOSt. LouisUSA
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Azam MA, Sampieri C, Ioppi A, Benzi P, Giordano GG, De Vecchi M, Campagnari V, Li S, Guastini L, Paderno A, Moccia S, Piazza C, Mattos LS, Peretti G. Videomics of the Upper Aero-Digestive Tract Cancer: Deep Learning Applied to White Light and Narrow Band Imaging for Automatic Segmentation of Endoscopic Images. Front Oncol 2022; 12:900451. [PMID: 35719939 PMCID: PMC9198427 DOI: 10.3389/fonc.2022.900451] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/26/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Narrow Band Imaging (NBI) is an endoscopic visualization technique useful for upper aero-digestive tract (UADT) cancer detection and margins evaluation. However, NBI analysis is strongly operator-dependent and requires high expertise, thus limiting its wider implementation. Recently, artificial intelligence (AI) has demonstrated potential for applications in UADT videoendoscopy. Among AI methods, deep learning algorithms, and especially convolutional neural networks (CNNs), are particularly suitable for delineating cancers on videoendoscopy. This study is aimed to develop a CNN for automatic semantic segmentation of UADT cancer on endoscopic images. Materials and Methods A dataset of white light and NBI videoframes of laryngeal squamous cell carcinoma (LSCC) was collected and manually annotated. A novel DL segmentation model (SegMENT) was designed. SegMENT relies on DeepLabV3+ CNN architecture, modified using Xception as a backbone and incorporating ensemble features from other CNNs. The performance of SegMENT was compared to state-of-the-art CNNs (UNet, ResUNet, and DeepLabv3). SegMENT was then validated on two external datasets of NBI images of oropharyngeal (OPSCC) and oral cavity SCC (OSCC) obtained from a previously published study. The impact of in-domain transfer learning through an ensemble technique was evaluated on the external datasets. Results 219 LSCC patients were retrospectively included in the study. A total of 683 videoframes composed the LSCC dataset, while the external validation cohorts of OPSCC and OCSCC contained 116 and 102 images. On the LSCC dataset, SegMENT outperformed the other DL models, obtaining the following median values: 0.68 intersection over union (IoU), 0.81 dice similarity coefficient (DSC), 0.95 recall, 0.78 precision, 0.97 accuracy. For the OCSCC and OPSCC datasets, results were superior compared to previously published data: the median performance metrics were, respectively, improved as follows: DSC=10.3% and 11.9%, recall=15.0% and 5.1%, precision=17.0% and 14.7%, accuracy=4.1% and 10.3%. Conclusion SegMENT achieved promising performances, showing that automatic tumor segmentation in endoscopic images is feasible even within the highly heterogeneous and complex UADT environment. SegMENT outperformed the previously published results on the external validation cohorts. The model demonstrated potential for improved detection of early tumors, more precise biopsies, and better selection of resection margins.
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Affiliation(s)
- Muhammad Adeel Azam
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Claudio Sampieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Pietro Benzi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giorgio Gregory Giordano
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marta De Vecchi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Valentina Campagnari
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Shunlei Li
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Luca Guastini
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Missale F, Ioppi A, Ascoli A, Camerino PL, Camillo Carobbio AL, Larghi M, Castello EM, Guastini L, Peretti G, Criminelli D, Parrinello G, Bagnasco D, Mauritz Canevari FR. Cerebrospinal Fluid Leak Repair: Usefulness of Intrathecal Fluorescein for Correct Topographic Identification of the Skull Base Defects. World Neurosurg 2022; 160:e267-e277. [PMID: 34999266 DOI: 10.1016/j.wneu.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the management of cerebrospinal fluid (CSF) leak, the identification of the exact discharge spot is paramount. This process can represent a challenge for the radiologist and the surgeon. In the present study, we analyzed a series of patients affected by endonasal CSF leak who underwent endoscopic surgical reconstruction aided by the use of ITF. The purpose of this work is to assess the efficacy of intraoperative ITF in addition to computed tomography (CT) and magnetic resonance imaging for correct topographic localization of the CSF leak. METHODS Eighty-three patients were enrolled in the study. The main outcome was the concordance between the supposed radiologic defect site and the actual one seen intraoperatively. Recurrence-free survival was evaluated as secondary outcome. RESULTS ITF better defined the defect site, allowing a change in the treatment in 21 patients (25.3%), in whom nonconcordance was observed between the suspected radiologic site and the actual surgical site. Good agreement was found between the specific topographic localization (κ = 0.737; P < 0.0001), whereas fair agreement was observed considering the side of the defect (κ = 0.362; P = 0.0009) and correct identification of multiple sites (κ = 0.044; P = 0.666). The 10-year 96% estimate of recurrence-free survival confirmed the correct repair of the fistula site in most cases. CONCLUSIONS Our data show the usefulness and safety of intraoperative ITF for management of patients affected by endonasal CSF leak. ITF improved the topographic diagnosis of the leak site, ensuring the best target reconstruction and very low recurrence rate.
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Affiliation(s)
- Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alessandro Ioppi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Paola Lovino Camerino
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Andrea Luigi Camillo Carobbio
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Section of Otorhinolaryngology, Head and Neck Surgery-Azienda Ospedaliera di Padova, University of Padua, Padua, Italy
| | - Marco Larghi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | | | - Luca Guastini
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | | | | | - Diego Bagnasco
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Allergy and Respiratory Diseases, DIMI Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Frank Rikki Mauritz Canevari
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
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Azam MA, Sampieri C, Ioppi A, Africano S, Vallin A, Mocellin D, Fragale M, Guastini L, Moccia S, Piazza C, Mattos LS, Peretti G. Deep Learning Applied to White Light and Narrow Band Imaging Videolaryngoscopy: Toward Real-Time Laryngeal Cancer Detection. Laryngoscope 2021; 132:1798-1806. [PMID: 34821396 PMCID: PMC9544863 DOI: 10.1002/lary.29960] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess a new application of artificial intelligence for real-time detection of laryngeal squamous cell carcinoma (LSCC) in both white light (WL) and narrow-band imaging (NBI) videolaryngoscopies based on the You-Only-Look-Once (YOLO) deep learning convolutional neural network (CNN). STUDY DESIGN Experimental study with retrospective data. METHODS Recorded videos of LSCC were retrospectively collected from in-office transnasal videoendoscopies and intraoperative rigid endoscopies. LSCC videoframes were extracted for training, validation, and testing of various YOLO models. Different techniques were used to enhance the image analysis: contrast limited adaptive histogram equalization, data augmentation techniques, and test time augmentation (TTA). The best-performing model was used to assess the automatic detection of LSCC in six videolaryngoscopies. RESULTS Two hundred and nineteen patients were retrospectively enrolled. A total of 624 LSCC videoframes were extracted. The YOLO models were trained after random distribution of images into a training set (82.6%), validation set (8.2%), and testing set (9.2%). Among the various models, the ensemble algorithm (YOLOv5s with YOLOv5m-TTA) achieved the best LSCC detection results, with performance metrics in par with the results reported by other state-of-the-art detection models: 0.66 Precision (positive predicted value), 0.62 Recall (sensitivity), and 0.63 mean Average Precision at 0.5 intersection over union. Tests on the six videolaryngoscopies demonstrated an average computation time per videoframe of 0.026 seconds. Three demonstration videos are provided. CONCLUSION This study identified a suitable CNN model for LSCC detection in WL and NBI videolaryngoscopies. Detection performances are highly promising. The limited complexity and quick computational times for LSCC detection make this model ideal for real-time processing. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Muhammad Adeel Azam
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Stefano Africano
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Vallin
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Davide Mocellin
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Marco Fragale
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Luca Guastini
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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8
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Mattos LS, Acemoglu A, Geraldes A, Laborai A, Schoob A, Tamadazte B, Davies B, Wacogne B, Pieralli C, Barbalata C, Caldwell DG, Kundrat D, Pardo D, Grant E, Mora F, Barresi G, Peretti G, Ortiz J, Rabenorosoa K, Tavernier L, Pazart L, Fichera L, Guastini L, Kahrs LA, Rakotondrabe M, Andreff N, Deshpande N, Gaiffe O, Renevier R, Moccia S, Lescano S, Ortmaier T, Penza V. μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery. Front Robot AI 2021; 8:664655. [PMID: 34568434 PMCID: PMC8455830 DOI: 10.3389/frobt.2021.664655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project μRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond μRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated μRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.
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Affiliation(s)
| | | | | | - Andrea Laborai
- Department of Otorhinolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Brahim Tamadazte
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS, Paris, France
| | | | - Bruno Wacogne
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France.,Centre Hospitalier Régional Universitaire, Besançon, France
| | - Christian Pieralli
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Corina Barbalata
- Mechanical and Industrial Engineering Department, Louisiana State University, Baton Rouge, LA, United States
| | | | | | - Diego Pardo
- Istituto Italiano di Tecnologia, Genoa, Italy
| | - Edward Grant
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, United States
| | - Francesco Mora
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | | | - Giorgio Peretti
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | - Jesùs Ortiz
- Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kanty Rabenorosoa
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | | | - Lionel Pazart
- Centre Hospitalier Régional Universitaire, Besançon, France
| | - Loris Fichera
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Luca Guastini
- Clinica Otorinolaringoiatrica, IRCCS Policlinico San Martino, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | - Lüder A Kahrs
- Department of Mathematical and Computational Sciences, University of Toronto, Mississauga, ON, Canada
| | - Micky Rakotondrabe
- National School of Engineering in Tarbes, University of Toulouse, Tarbes, France
| | - Nicolas Andreff
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | | | - Olivier Gaiffe
- Centre Hospitalier Régional Universitaire, Besançon, France
| | - Rupert Renevier
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Sara Moccia
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sergio Lescano
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comte, CNRS, Besançon, France
| | - Tobias Ortmaier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Garbsen, Germany
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9
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Filauro M, Vallin A, Fragale M, Sampieri C, Guastini L, Mora F, Peretti G. Office-based procedures in laryngology. ACTA ACUST UNITED AC 2020; 41:243-247. [PMID: 33372918 PMCID: PMC8283403 DOI: 10.14639/0392-100x-n0935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022]
Abstract
Objective Development of transnasal fiberoptic laryngoscopy, integration of an operative channel (OC), the advent of high-definition television imaging, with improvements in laser technology, cleared the way for office-based laryngology. Three treatment categories can be identified: bioendoscopy-guided biopsy; laryngeal injection; laser-assisted surgery. Methods 26 patients underwent OBPs at the Otolaryngology Clinic of IRCCS Policlinico San Martino, Genoa, Italy. Sixty-eight procedures were performed: 60 for recurrent respiratory papillomatosis (RRP), 5 for unilateral vocal fold paralysis (UVFP) and 3 for glottic leukoplakias. Neoblucaine 5% was administrated through the operative channel, for local anaesthesia. All procedures were carried out with the physician standing behind the patient. Narrow band imaging (NBI – Olympus Medical) or i-scan (Pentax Medical) were used to enhance the accuracy of the biopsy thanks to identification of atypical vascular patterns. Laryngeal injections were made using a 25G flexible needle. Opera Evo (Quanta system IEC/EN 60825-1:2007) is a hybrid fibre laser that is used for “blanching” and vaporisation of RRP lesions and to treat selected leukoplakias that were previously biopsied. Conclusions No major complications occurred during the procedures.
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Affiliation(s)
- Marta Filauro
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Italy
| | - Alberto Vallin
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Claudio Sampieri
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Luca Guastini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
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10
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Acemoglu A, Peretti G, Trimarchi M, Hysenbelli J, Krieglstein J, Geraldes A, Deshpande N, Ceysens PMV, Caldwell DG, Delsanto M, Barboni O, Vio T, Baggioni S, Vinciguerra A, Sanna A, Oleari E, Camillo Carobbio AL, Guastini L, Mora F, Mattos LS. Operating From a Distance: Robotic Vocal Cord 5G Telesurgery on a Cadaver. Ann Intern Med 2020; 173:940-941. [PMID: 32658568 DOI: 10.7326/m20-0418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Alperen Acemoglu
- Istituto Italiano di Tecnologia, Genoa, Italy (A.A., J.K., A.G., N.D., P.M.C., D.G.C., L.S.M.)
| | - Giorgio Peretti
- University of Genoa - IRCCS San Martino Hospital, Genoa, Italy (G.P., A.L.C., L.G., F.M.)
| | - Matteo Trimarchi
- University Vita Salute Milano - IRCCS San Raffaele Hospital, Milan, Italy (M.T., A.V., A.S., E.O.)
| | | | - Jan Krieglstein
- Istituto Italiano di Tecnologia, Genoa, Italy (A.A., J.K., A.G., N.D., P.M.C., D.G.C., L.S.M.)
| | - Andre Geraldes
- Istituto Italiano di Tecnologia, Genoa, Italy (A.A., J.K., A.G., N.D., P.M.C., D.G.C., L.S.M.)
| | - Nikhil Deshpande
- Istituto Italiano di Tecnologia, Genoa, Italy (A.A., J.K., A.G., N.D., P.M.C., D.G.C., L.S.M.)
| | | | - Darwin Gordon Caldwell
- Istituto Italiano di Tecnologia, Genoa, Italy (A.A., J.K., A.G., N.D., P.M.C., D.G.C., L.S.M.)
| | - Marco Delsanto
- Vodafone Italia, Milan, Italy (J.H., M.D., O.B., T.V., S.B.)
| | - Ottavia Barboni
- Vodafone Italia, Milan, Italy (J.H., M.D., O.B., T.V., S.B.)
| | - Tommaso Vio
- Vodafone Italia, Milan, Italy (J.H., M.D., O.B., T.V., S.B.)
| | | | - Alessandro Vinciguerra
- University Vita Salute Milano - IRCCS San Raffaele Hospital, Milan, Italy (M.T., A.V., A.S., E.O.)
| | - Alberto Sanna
- University Vita Salute Milano - IRCCS San Raffaele Hospital, Milan, Italy (M.T., A.V., A.S., E.O.)
| | - Elettra Oleari
- University Vita Salute Milano - IRCCS San Raffaele Hospital, Milan, Italy (M.T., A.V., A.S., E.O.)
| | | | - Luca Guastini
- University of Genoa - IRCCS San Martino Hospital, Genoa, Italy (G.P., A.L.C., L.G., F.M.)
| | - Francesco Mora
- University of Genoa - IRCCS San Martino Hospital, Genoa, Italy (G.P., A.L.C., L.G., F.M.)
| | - Leonardo S Mattos
- Istituto Italiano di Tecnologia, Genoa, Italy (A.A., J.K., A.G., N.D., P.M.C., D.G.C., L.S.M.)
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11
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Vicini C, Cammaroto G, Meccariello G, Iannella G, Fragale M, Cacco T, Sampieri C, Guastini L, Castello E, Parrinello G, De Vito A, Gulotta G, Visconti IC, Abita P, Pelucchi S, Bianchi G, Melegatti MN, Garulli G, Bosco F, Gennaiotti A, Berrettini S, Magnani M, Troncossi M, Peretti G. Overview of different modified full-face snorkelling masks for intraoperative protection. Acta Otorhinolaryngol Ital 2020; 40:317-324. [PMID: 32970047 PMCID: PMC7726642 DOI: 10.14639/0392-100x-n0841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has caused significant impact on healthcare systems worldwide. The rate of infected healthcare workers is > 10% in Italy. Within this dramatic scenario, the development of new personal protective equipment (PPE) devices is mandatory. This study focuses on validation of modified full-face snorkel masks (MFFSM) as safe and protective equipment against SARS-CoV-2 infection during diagnostic and therapeutic procedures on the upper aerodigestive tract. METHODS Five different MFFSM were tested during otolaryngological surgery and in anaesthesia procedures. Data were collected through an online survey to assess the feedback of operators. pO2 and pCO2 monitoring values during procedures were recorded in selected cases. RESULTS All five MFFSM tested were easy to use and gave all operators a sound "feeling" of protection. All clinicians involved had common agreement regarding safety and the user-friendly format. CONCLUSIONS In the future, specific development of different type of masks for protection in the operating room, intensive care units and/or office will be possible as a joint venture between clinicians and developers. Goals for clinicians include better definition of needs and priorities, while developers can devote their expertise to produce devices that meet medical requirements.
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Affiliation(s)
- Claudio Vicini
- Department of Head-Neck Surgery, AUSL Romagna, Italy - Ear Nose Throat (ENT) Unit of Forlì and Faenza, University of Ferrara and Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, AUSL Romagna, Italy - Ear Nose Throat (ENT) Unit of Forlì and Faenza, University of Ferrara and Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, AUSL Romagna, Italy - Ear Nose Throat (ENT) Unit of Forlì and Faenza, University of Ferrara and Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giannicola Iannella
- Department of Head-Neck Surgery, AUSL Romagna, Italy - Ear Nose Throat (ENT) Unit of Forlì and Faenza, University of Ferrara and Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Tommaso Cacco
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Claudio Sampieri
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Luca Guastini
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Eolo Castello
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery AUSL Romagna, Italy - Ear Nose Throat (ENT) Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | - Pietro Abita
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, Italy
| | - Stefano Pelucchi
- Otolaryngology Head and Neck Surgery, University Hospital of Ferrara, Italy
| | - Giulia Bianchi
- Otolaryngology Head and Neck Surgery, University Hospital of Ferrara, Italy
| | | | - Gianluca Garulli
- Minimally Invasive General and Thoracic Surgery Unit, AUSL Romagna, Italy - Ceccarini Hospital, Riccione, Italy
| | - Filippo Bosco
- Department of Anesthesia and Intensive Care, Cisanello Hospital, University Hospital of Pisa, Italy
| | - Alessandro Gennaiotti
- Department of Anesthesia and Intensive Care, Cisanello Hospital, University Hospital of Pisa, Italy
| | - Stefano Berrettini
- Otolaryngology Head and Neck Surgery, Cisanello Hospital, University Hospital of Pisa, Italy
| | - Massimo Magnani
- Department of Head-Neck Surgery AUSL Romagna, Italy; Ear Nose Throat (ENT) Unit, Bufalini Hospital, Cesena, Italy
| | - Marco Troncossi
- Department of Industrial Engineering, University of Bologna, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
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12
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Cheng Z, Carobbio ALC, Soggiu L, Migliorini M, Guastini L, Mora F, Fragale M, Ascoli A, Africano S, Caldwell DG, Canevari FRM, Parrinello G, Peretti G, Mattos LS. SmartProbe: a bioimpedance sensing system for head and neck cancer tissue detection. Physiol Meas 2020; 41:054003. [PMID: 32325435 DOI: 10.1088/1361-6579/ab8cb4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study presents SmartProbe, an electrical bioimpedance (EBI) sensing system based on a concentric needle electrode (CNE). The system allows the use of commercial CNEs for accurate EBI measurement, and was specially developed for in-vivo real-time cancer detection. APPROACH Considering the uncertainties in EBI measurements due to the CNE manufacturing tolerances, we propose a calibration method based on statistical learning. This is done by extracting the correlation between the measured impedance value |Z|, and the material conductivity σ, for a group of reference materials. By utilizing this correlation, the relationship of σ and |Z| can be described as a function and reconstructed using a single measurement on a reference material of known conductivity. MAIN RESULTS This method simplifies the calibration process, and is verified experimentally. Its effectiveness is demonstrate by results that show less than 6% relative error. An additional experiment is conducted for evaluating the system's capability to detect cancerous tissue. Four types of ex-vivo human tissue from the head and neck region, including mucosa, muscle, cartilage and salivary gland, are characterized using SmartProbe. The measurements include both cancer and surrounding healthy tissue excised from 10 different patients operated on for head and neck cancer. The measured data is then processed using dimension reduction and analyzed for tissue classification. The final results show significant differences between pathologic and healthy tissues in muscle, mucosa and cartilage specimens. SIGNIFICANCE These results are highly promising and indicate a great potential for SmartProbe to be used in various cancer detection tasks.
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Affiliation(s)
- Zhuoqi Cheng
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
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13
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Fantoni M, Ricci F, Del Borgo C, Izzi I, Damiano F, Moscati AM, Marasca G, Bevilacqua N, Del Forno A, Narciso P, Colaiacomo M, Armignacco O, Ccrasari G, Pauluzzi S, Francisci D, Tersigni I, Fabrizi P, Consorte A, Parruti G, Tacconi L, Vetica A, Pizzigallo E, Barberio A, Caterini A, Guastini L, Vullo V, Santopadre P, Pompei A, Matarazzo F, Natalini-Raponi G, Marani-Toro G, Tarquini P, Lauria F, Sciotti M, Mariani A. Multicentre Study on the Prevalence of Symptoms and Symptomatic Treatment in HIV Infection. J Palliat Care 2019. [DOI: 10.1177/082585979701300203] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the prevalence and intensity of symptoms and the use of drugs for symptom control among all HIV-infected patients reporting to the outpatient clinics or wards of 15 clinical centres in central Italy, recording clinical and epidemiological data on three consecutive days. A total of 1128 patients were observed and tabulated. Their most frequent symptoms were asthenia (55%), anorexia (34%), cough (32%), pain (29%), and fever (29%). Opioid analgesics were used in 3% of these patients and non-opioid analgesics in 13%. A large majority of HIV-infected patients presented with symptoms regardless of the stage of their disease. Pain was present in fewer than one third of patients but nonetheless seemed to be undertreated. Pain was more frequent and more intense among intravenous drug users. Based on our study, a greater effort to control symptoms in HIV patients seems to be warranted.
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Affiliation(s)
- Massimo Fantoni
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Ricci
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Cosmo Del Borgo
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Immacolata Izzi
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Fernando Damiano
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna M. Moscati
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Marasca
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Nazario Bevilacqua
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Del Forno
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
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Deshpande N, Peretti G, Mora F, Guastini L, Lee J, Barresi G, Caldwell DG, Mattos LS. Design and Study of a Next-Generation Computer-Assisted System for Transoral Laser Microsurgery. OTO Open 2018; 2:2473974X18773327. [PMID: 30480214 PMCID: PMC6239143 DOI: 10.1177/2473974x18773327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To present a new computer-assisted system for improved usability, intuitiveness, efficiency, and controllability in transoral laser microsurgery (TLM). Study Design Pilot technology feasibility study. Setting A dedicated room with a simulated TLM surgical setup: surgical microscope, surgical laser system, instruments, ex vivo pig larynxes, and computer-assisted system. Subjects and Methods The computer-assisted laser microsurgery (CALM) system consists of a novel motorized laser micromanipulator and a tablet- and stylus-based control interface. The system setup includes the Leica 2 surgical microscope and the DEKA HiScan Surgical laser system. The system was validated through a first-of-its-kind observational study with 57 international surgeons with varied experience in TLM. The subjects performed real surgical tasks on ex vivo pig larynxes in a simulated TLM scenario. The qualitative aspects were established with a newly devised questionnaire assessing the usability, efficiency, and suitability of the system. Results The surgeons evaluated the CALM system with an average score of 6.29 (out of 7) in ease of use and ease of learning, while an average score of 5.96 was assigned for controllability and safety. A score of 1.51 indicated reduced workload for the subjects. Of 57 subjects, 41 stated that the CALM system allows better surgical quality than the existing TLM systems. Conclusions The CALM system augments the usability, controllability, and efficiency in TLM. It enhances the ergonomics and accuracy beyond the current state of the art, potentially improving the surgical safety and quality. The system offers the intraoperative automated scanning of customized long incisions achieving uniform resections at the surgical site.
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Affiliation(s)
- Nikhil Deshpande
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Francesco Mora
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Luca Guastini
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Jinoh Lee
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Giacinto Barresi
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Darwin G Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
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Moccia S, Vanone GO, Momi ED, Laborai A, Guastini L, Peretti G, Mattos LS. Learning-based classification of informative laryngoscopic frames. Comput Methods Programs Biomed 2018; 158:21-30. [PMID: 29544787 DOI: 10.1016/j.cmpb.2018.01.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/18/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Early-stage diagnosis of laryngeal cancer is of primary importance to reduce patient morbidity. Narrow-band imaging (NBI) endoscopy is commonly used for screening purposes, reducing the risks linked to a biopsy but at the cost of some drawbacks, such as large amount of data to review to make the diagnosis. The purpose of this paper is to present a strategy to perform automatic selection of informative endoscopic video frames, which can reduce the amount of data to process and potentially increase diagnosis performance. METHODS A new method to classify NBI endoscopic frames based on intensity, keypoint and image spatial content features is proposed. Support vector machines with the radial basis function and the one-versus-one scheme are used to classify frames as informative, blurred, with saliva or specular reflections, or underexposed. RESULTS When tested on a balanced set of 720 images from 18 different laryngoscopic videos, a classification recall of 91% was achieved for informative frames, significantly overcoming three state of the art methods (Wilcoxon rank-signed test, significance level = 0.05). CONCLUSIONS Due to the high performance in identifying informative frames, the approach is a valuable tool to perform informative frame selection, which can be potentially applied in different fields, such us computer-assisted diagnosis and endoscopic view expansion.
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Affiliation(s)
- Sara Moccia
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy; Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.
| | - Gabriele O Vanone
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Elena De Momi
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Andrea Laborai
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Luca Guastini
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
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Moccia S, De Momi E, Guarnaschelli M, Savazzi M, Laborai A, Guastini L, Peretti G, Mattos LS. Confident texture-based laryngeal tissue classification for early stage diagnosis support. J Med Imaging (Bellingham) 2017; 4:034502. [PMID: 28983494 DOI: 10.1117/1.jmi.4.3.034502] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/12/2017] [Indexed: 12/24/2022] Open
Abstract
Early stage diagnosis of laryngeal squamous cell carcinoma (SCC) is of primary importance for lowering patient mortality or after treatment morbidity. Despite the challenges in diagnosis reported in the clinical literature, few efforts have been invested in computer-assisted diagnosis. The objective of this paper is to investigate the use of texture-based machine-learning algorithms for early stage cancerous laryngeal tissue classification. To estimate the classification reliability, a measure of confidence is also exploited. From the endoscopic videos of 33 patients affected by SCC, a well-balanced dataset of 1320 patches, relative to four laryngeal tissue classes, was extracted. With the best performing feature, the achieved median classification recall was 93% [interquartile range [Formula: see text]]. When excluding low-confidence patches, the achieved median recall was increased to 98% ([Formula: see text]), proving the high reliability of the proposed approach. This research represents an important advancement in the state-of-the-art computer-assisted laryngeal diagnosis, and the results are a promising step toward a helpful endoscope-integrated processing system to support early stage diagnosis.
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Affiliation(s)
- Sara Moccia
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy.,Istituto Italiano di Tecnologia, Department of Advanced Robotics, Genoa, Italy
| | - Elena De Momi
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy
| | - Marco Guarnaschelli
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy
| | - Matteo Savazzi
- Politecnico di Milano, Department of Electronics, Information, and Bioengineering, Milan, Italy
| | - Andrea Laborai
- University of Genoa, Department of Otorhinolaryngology, Head, and Neck Surgery, Genoa, Italy
| | - Luca Guastini
- University of Genoa, Department of Otorhinolaryngology, Head, and Neck Surgery, Genoa, Italy
| | - Giorgio Peretti
- University of Genoa, Department of Otorhinolaryngology, Head, and Neck Surgery, Genoa, Italy
| | - Leonardo S Mattos
- Istituto Italiano di Tecnologia, Department of Advanced Robotics, Genoa, Italy
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Mattos LS, Caldwell DG, Peretti G, Mora F, Guastini L, Cingolani R. Microsurgery robots: addressing the needs of high-precision surgical interventions. Swiss Med Wkly 2016; 146:w14375. [PMID: 27878799 DOI: 10.4414/smw.2016.14375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Robotics has a significant potential to enhance the overall capacity and efficiency of healthcare systems. Robots can help surgeons perform better quality operations, leading to reductions in the hospitalisation time of patients and in the impact of surgery on their postoperative quality of life. In particular, robotics can have a significant impact on microsurgery, which presents stringent requirements for superhuman precision and control of the surgical tools. Microsurgery is, in fact, expected to gain importance in a growing range of surgical specialties as novel technologies progressively enable the detection, diagnosis and treatment of diseases at earlier stages. Within such scenarios, robotic microsurgery emerges as one of the key components of future surgical interventions, and will be a vital technology for addressing major surgical challenges. Nonetheless, several issues have yet to be overcome in terms of mechatronics, perception and surgeon-robot interfaces before microsurgical robots can achieve their full potential in operating rooms. Research in this direction is progressing quickly and microsurgery robot prototypes are gradually demonstrating significant clinical benefits in challenging applications such as reconstructive plastic surgery, ophthalmology, otology and laryngology. These are reassuring results offering confidence in a brighter future for high-precision surgical interventions.
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Peretti G, Piazza C, Penco S, Santori G, Del Bon F, Garofolo S, Paderno A, Guastini L, Nicolai P. Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers. Head Neck 2016; 38:1107-12. [DOI: 10.1002/hed.24424] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Sara Penco
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics; University of Genoa; Genoa Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Sabrina Garofolo
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
| | - Luca Guastini
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Genoa; Genoa Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Brescia; Brescia Italy
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Garofolo S, Piazza C, Del Bon F, Mangili S, Guastini L, Mora F, Nicolai P, Peretti G. Intraoperative Narrow Band Imaging Better Delineates Superficial Resection Margins During Transoral Laser Microsurgery for Early Glottic Cancer. Ann Otol Rhinol Laryngol 2014; 124:294-8. [DOI: 10.1177/0003489414556082] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The high rate of positive margins after transoral laser microsurgery (TLM) remains a matter of debate. This study investigates the effect of intraoperative narrow band imaging (NBI) examination on the incidence of positive superficial surgical margins in early glottic cancer treated by TLM. Methods: Between January 2012 and October 2013, 82 patients affected by Tis-T1a glottic cancer were treated with TLM by type I or II cordectomies. Intraoperative NBI evaluation was performed using 0-degree and 70-degree rigid telescopes. Surgical specimens were oriented by marking the superior edge with black ink and sent to a dedicated pathologist. Comparison between the rate of positive superficial margins in the present cohort and in a matched historical control group treated in the same way without intraoperative NBI was calculated by chi-square test. Results: At histopathological examination, all surgical margins were negative in 70 patients, whereas 7 had positive deep margins, 2 close, and 3 positive superficial margins. The rate of positive superficial margins was thus 3.6% in the present group and 23.7% in the control cohort ( P < .001). Conclusion: Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation during TLM for early glottic cancer.
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Affiliation(s)
- Sabrina Garofolo
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Stefano Mangili
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Luca Guastini
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
| | - Francesco Mora
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Italy
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Guastini L, Matos L, Deshpande N, Ortiz J, Mora F, Peretti G. Redesign of the Microsurgical Interface with a Novel, Computer-Assisted “Virtual Microscope” System in Laser Phonomicrosurgery. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: (1) Augment surgeon skills through gesture scaling and magnified visualization. (2) Eliminate extensive training using intuitive stylus-based manipulation. (3) Perform active constraints intraoperative planning assisting the surgeon. Methods: The virtual microscope elements system are: Motorized Micromanipulator, Graphics Stylus with Tablet, Virtual Microscope (VM), Configuration Interface (CI). The apparatus has been implemented and tested between July and December 2013 by resident surgeons and medical students. The surgeon performs the surgical tasks in the VM interface, consisting of modified head-mount display and HD cameras attached to a microscope. The CI includes different categories: in-surgery messages, choosing assistive features, system configuration, etc. The assistive features in the VM include: Precise aiming and incision with laser, defining virtual scan patterns allowing incision and ablation planning for automatic execution, defining regions where the laser is active (safe area), or inactive (dangerous area). The apparatus was compared with the state-of-the-art Lumenis AcuBlade (AB) interface. Average path outcome measurements following error and statistical subjective evaluations of usability were made. Results: The average path following error (root mean square error value) was 0.25 mm while maximum error was 0.66 mm. VM is more accurate and superior to AB, which provided values of 0.51 mm and 1.20 mm, respectively, in earlier trials. The subjective evaluations of usability gave a score of 88.3 for the VM. Earlier trials with AB provided a score of 65.56. VM interface is simple, usable, easy to learn, and appropriate. Conclusions: The VM was created to provide improved precision, safety, and better ergonomics for microsurgery procedures. The system provides enhanced 3D visualization and allows delicate maneuvers.
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Mattos LS, Deshpande N, Barresi G, Guastini L, Peretti G. A novel computerized surgeon-machine interface for robot-assisted laser phonomicrosurgery. Laryngoscope 2014; 124:1887-94. [DOI: 10.1002/lary.24566] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/25/2013] [Accepted: 12/12/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Leonardo S. Mattos
- Department of Advanced Robotics; Istituto Italiano di Tecnologia; Genoa Italy
| | - Nikhil Deshpande
- Department of Advanced Robotics; Istituto Italiano di Tecnologia; Genoa Italy
| | - Giacinto Barresi
- Department of Advanced Robotics; Istituto Italiano di Tecnologia; Genoa Italy
| | - Luca Guastini
- Department of Otorhinolaryngology; University of Genoa; Genoa Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology; University of Genoa; Genoa Italy
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Mora R, Mora F, Crippa B, Santomauro V, Guastini L, Peretti G. Ribosomal therapy in patients with pharyngolaryngeal reflux. Acta Otolaryngol 2012; 132:651-6. [PMID: 22497598 DOI: 10.3109/00016489.2011.652310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Our data confirm the induction of specific and nonspecific immune responses of the upper respiratory tract mucosa and the consequent improvement of its physiology, through an oral ribosomal therapy in patients with pharyngolaryngeal reflux disease (PLRD). OBJECTIVES The aim of this study was to investigate the efficiency and applicability of oral ribosomal immunotherapy in adult patients with PLRD. METHODS One hundred adult patients with PLRD were enrolled. The patients were equally divided, at random, into two groups (A and B): group A patients underwent ribosomal prophylaxis with Immucytal® (one tablet daily, 8 days a month for 3 months), while group B received a placebo (same dosage for the same period). At the beginning, at the end, and 6 months after the beginning of the therapy, all patients underwent medical history, ENT examination, nasal-pharynx-laryngoscopy with optic fiber, plasma levels of immunoglobulins class E, A, G, M, subjective assessment of symptoms on a 10 cm visual analog scale (VAS), reflux symptoms index, and reflux finding score. RESULTS At the end and 6 months after the beginning of the treatment, all the patients in group A presented a significant (p < 0.05) improvement of almost all the different items analyzed.
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Affiliation(s)
- Renzo Mora
- ENT Department, University of Genoa, Italy.
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Mora R, Salzano FA, Mora F, Guastini L. Outcomes of uvulopalatopharyngoplasty with harmonic scalpel after failure of continuous positive airway pressure in sleep apnea syndrome. Acta Otolaryngol 2012; 132:299-304. [PMID: 22201296 DOI: 10.3109/00016489.2011.637178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Our data highlight that uvulopalatopharyngoplasty (UPPP) with harmonic scalpel (HS) is a reliable treatment in selected patients affected by obstructive sleep apnea (OSA) and users of continuous positive airway pressure (CPAP). OBJECTIVES The aim of this paper was to verify the efficacy and applicability of UPPP with HS in the treatment of patients affected by OSA and users of CPAP. METHODS A total of 21 patients with a retropalatal obstruction and users of CPAP underwent UPPP with HS and were evaluated (before and 6 months after surgery) using the apnea/hypopnea index (AHI); oxygen desaturation index ≥4% (ODI(4)); Epworth Sleepiness Scale (ESS); snoring level (SL); subjective assessment of the postoperative pain on postoperative days 1, 3, and 10; and number of days until return to solid food. RESULTS Six months after surgery: AHI decreased significantly (p < 0.05) from 31.8 ± 2.83 to 9.0 ± 0.68; ODI(4) was 2.1 ± 0.4 vs a preoperative value of 24.0 ± 1.9; ESS scores were also significantly decreased (p < 0.05) from 14.0 ± 3.7 to 4.7 ± 2.2; SL was significantly lower (p < 0.05) 1.6 ± 0.3 vs 7.9 ± 0.8. Postoperatively, patients experienced lower levels of pain and the median of time to return to normal diet was 3 days.
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Affiliation(s)
- Renzo Mora
- ENT Department, University of Genoa, Italy.
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Fiocchi A, Omboni S, Mora R, Macchi A, Nespoli L, Arrigoni S, Guastini L, Castelnuovo P, Graziani D, Marcassa S. Efficacy and safety of ribosome-component immune modulator for preventing recurrent respiratory infections in socialized children. Allergy Asthma Proc 2012; 33:197-204. [PMID: 22525398 DOI: 10.2500/aap.2012.33.3516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Attending day care is associated with recurrent respiratory infections (RRIs) and asthma. Ribosomal immunotherapy may confer protection against RRIs in children. This study was designed to assess the efficacy of a ribosome-component immune modulator (RCIM) as preventive treatment of respiratory infections in socialized children aged ≤5 years, with or without a history of frequent RRI. In a multicenter, Italian, randomized, double-blind, placebo-controlled, parallel-group study, 164 socialized day care center children (mean age, 3.8 ± 1.1 years) were treated with RCIM or placebo for 6 months and followed-up for additional 6 months. Outcomes are presented for the intent-to-treat population. In socialized children with five or less RRIs (n = 95; 49 RCIM and 46 placebo, group A) the duration of the infectious episodes was significantly shorter with RCIM than with placebo (6 months, 3.7 ± 2.1 versus 4.5 ± 1.9 days, p = 0.040; 12 months, 3.6 ± 2.0 versus 4.7 ± 2.5 days, p = 0.015). The proportion of patients reporting no respiratory infectious episodes with RCIM at 6 and 12 months was also significantly larger in group A (20.4% versus 4.4% placebo; p = 0.028). No such differences were found in children with more than five RRIs in the preceding year (n = 63; 32 RCIM and 31 placebo, group B). In all children, general well-being improved significantly more under RCIM than under placebo (11.6 ± 1.8% versus 10.2 ± 1.8%; p = 0.002). No statistically significant between-treatment differences were observed for other end points. Both treatments were similarly well tolerated. Six-month treatment with RCIM effectively prevented the 12-month risk of RRIs in children <5 years old and with five or less RRIs in the preceding year.
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Affiliation(s)
- Alessandro Fiocchi
- Department of Child and Maternal Medicine, Fatebenefratelli/Melloni University Hospital, Milan, Italy.
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Mora R, Crippa B, Cervoni E, Santomauro V, Guastini L. Acoustic features of voice in patients with severe hearing loss. J Otolaryngol Head Neck Surg 2012; 41:8-13. [PMID: 22498262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate changes in the acoustic features of voice in patients with sensorineural hearing loss. DESIGN Thirty male patients, between 35 and 53 years of age with postlingual bilateral symmetric severe sensorineural hearing loss, were included (group A). As a control group (group B), 30 normal-hearing male adults, aged 38 to 51 years, were identified. SETTING ENT Department, University of Genoa (Italy). METHODS Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the Multidimensional Voice Program (Kay Elemetrics) in all subjects. MAIN OUTCOME MEASURES The parameters estimated were the average of fundamental frequency (F0), jitter percent (jitter), shimmer, noise to harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voicelessness (DUV), degree of voice breaks (DVB), and peak amplitude variation (vAm). RESULTS Compared to the control group, in group A, the following acoustic parameters presented a statistically significantly higher value (p < .05) of F0 (137.2 Hz vs 120.0 Hz), jitter (1.93% vs 0.67%), shimmer (6.67% vs 3.81%), NHR (0.19 vs 0.10), SPI (12.9 vs 8.76), DVB (2.12% vs 0.01%), DUV (9.53% vs 0.51%), and vAm (23.12 % vs 12.06%). In group A, F0 was also significantly higher in the balanced sentences (126 Hz vs 111 Hz). CONCLUSIONS This study demonstrates that hearing loss affects voice production by changing its parameters, especially in subjects with marked hearing loss.
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Affiliation(s)
- Renzo Mora
- ENT Department, University of Genoa, Genoa, Italy.
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Mora R, Mora E, Salzano FA, Guastini L. Audiometric Characteristics in Patients with Noise-Induced Hearing Loss after Sodium Enoxaparin Treatment. Ann Otol Rhinol Laryngol 2012; 121:85-90. [DOI: 10.1177/000348941212100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The aim of this study was to evaluate the effect of sodium enoxaparin treatment on patients with noise-induced hearing loss. Methods: Sixty patients with noise-induced hearing loss were included and randomly divided into two numerically equal groups. Group A underwent therapy with sodium enoxaparin for 10 days, followed by an additional 10 days of treatment after 10 days of no treatment. Group B received placebo as a control. Before treatment, at the end of treatment, and 2 months after the end of treatment, all patients underwent evaluation by laboratory tests, pure tone audiometry, transient evoked otoacoustic emissions (TEOAEs) testing, distortion product otoacoustic emissions (DPOAEs) testing, and auditory brain stem response testing. Results: In contrast to group B, at the end of the treatment in group A pure tone audiometry showed a significant (p < 0.05) improvement of the audiometric thresholds at 0.5, 1, 2, 4, and 8 kHz. Depending on the air and bone conduction thresholds, TEOAEs and DPOAEs, which had previously been absent, were evoked at the frequencies examined. These improvements were confirmed at last follow-up. We found no significant differences in auditory brain stem responses or laboratory results. Conclusions: These preliminary data encourage further studies to collect additional evidence on the effect of sodium enoxaparin in preventing the development of noise-induced hearing loss.
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Abstract
CONCLUSIONS Stapedotomy is, in our opinion, the technique of choice in stapes surgery. The precision of this technique allows clinicians to perform the surgical procedure in day surgery under local anesthesia. OBJECTIVES There is a strong emphasis on increasing the number of elective day surgery cases, especially in the patients' best interest, as it decreases the likelihood of late cancellation and hospital-acquired morbidity. A prospective study was performed to determine whether stapes surgery for otosclerosis could be performed safely in an outpatient setting. METHODS We present a series of stapes surgery cases for otosclerosis performed on a day-case basis. We performed a classic stapedotomy in 9 patients, a reverse classic step stapedotomy in 2 patients, a partial reverse classic step stapedotomy in 11 patients, and a hemi-stapedectomy in two patients. RESULTS Three of 24 patients (12.5%) treated with classic stapedotomy, 1 patient with partial reverse classic step stapedotomy, and 1 patient with hemi-stapedectomy were formally admitted to the hospital after surgery (length of stay, 23 h). The indications were vertigo (two patients) and asthenia (one patient). These patients were treated under general anesthesia. Two of these patients resided more than 250 km away from the hospital.
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Abstract
CONCLUSIONS In our experience, the technique described can be applied independently according to the specific patient's anatomy and disease, allowing simple, easy, and safe identification of the anterior ethmoidal artery (AEA). OBJECTIVES The aim of this study was to provide the anatomic rationale for endoscopic cauterization of the AEA and to present our surgical approach to AEA in the treatment of severe nasal bleeding. METHODS A retrospective study reviewed 300 endoscopic transnasal AEA cauterizations, over a 20-year period from 1991 to July 2010, at the Instituto Felippu, Sao Paolo, Brazil. All surgeries were carried out under general anesthesia and with the help of a rigid 30° endoscope. RESULTS The AEA was identified in all the patients treated. In 299 patients we found the AEA located at the level of the horizontal portion of the frontal bone into the anterior ethmoidal canal; in 88 (29.4%) of these patients the canal bone was partially open and in 211 (70.6%) it was completely closed. In only one patient, we found a dehiscent AEA. No patients presented short-term failure and/or long-term failure.
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Ralli G, Ruoppolo G, Mora R, Guastini L. Deleterious sucking habits and atypical swallowing in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol 2011; 75:1260-4. [PMID: 21802155 DOI: 10.1016/j.ijporl.2011.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 07/01/2011] [Accepted: 07/02/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the possible correlation between otitis media with effusion, bad sucking habits and atypical swallowing in children affected by otitis media with effusion. METHODS 65 children, aged from 7 to 12 years, observed in the ENT Department of the "La Sapienza" University of Rome, were enrolled in the study group (group A). All children were affected by otitis media with effusion for more than 3 months. As control group, 60 healthy children, aged from 7 to 12 years were identified (group B). All the children underwent medical history, with evaluation of the sucking habits, ENT examination, tympanometry, orthodontic examination and evaluation of swallowing. In the orthodontic examination the variables analyzed were: maximum mouth opening, right and left mandibular lateral movements and mandibular protrusion. Atypical swallowing was considered to occur when lip activity produced strong tension in the perioral musculature, and/or the tip of the tongue was placed or pushed against the anterior teeth during swallowing. RESULTS In the group A, atypical swallowing was found in 33/65 subjects out of the 65 children (50.7%). In the control group (group B) 16/60 children (26.6%) showed atypical swallowing. Compared with group B, deleterious sucking habits were significantly higher (p<0.05) in the study group (28/65 vs. 12/60). In both the study and control group, deleterious sucking habits were present in almost all children with atypical swallowing (28/33 in group A and 12/16 in group B). CONCLUSIONS Our data suggest a correlation between otitis media with effusion, deleterious sucking habits and prevalence of atypical swallowing.
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Prevete N, Salzano FA, Rossi FW, Rivellese F, Dellepiane M, Guastini L, Mora R, Marone G, Salami A, De Paulis A. Role(s) of formyl-peptide receptors expressed in nasal epithelial cells. J BIOL REG HOMEOS AG 2011; 25:553-564. [PMID: 22217988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chronic rhinosinusitis is one of the most frequent chronic diseases in humans. Little is known about stimuli initiating tissue remodeling process that determines the morphological expression of the disease. N-formyl peptide receptors (FPRs) are innate immunity receptors important in tissue remodeling of gastric and intestinal epithelium. The expression and functions of FPRs in nasal epithelial cells were examined to evaluate whether they could be important in the remodeling of nasal mucosa. The aim of this study is to examine FPR expression in a nasal epithelial cell line (RPMI-2650) at mRNA and protein levels. To determine whether FPRs were functional, chemotaxis experiments were carried out. In addition the effects of FPRs agonists on the expression (PCR and ELISA) of VEGF-A and TGF-beta, two key mediators of tissue remodelling, were examined. Here we demonstrate that RPMI-2650 express FPR and FPRL2, but not FPRL1. fMLP, a bacterial product active on FPR, and uPAR(84-95), an inflammatory mediator agonist for FPRL2, stimulated migration of nasal epithelial cells. fMLP and uPAR(84-95) induce expression and secretion of VEGF-A and TGF-beta. Our results suggest a possible mechanisms initiating tissue remodeling observed during chronic rhinosinusitis. This study provides further evidence that FPRs play a more complex role in human pathophysiology than bacterial recognition.
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Affiliation(s)
- N Prevete
- Department of Clinical Immunology and Allergy, University of Naples Federico II, Naples, Italy.
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Guastini L, Crippa B, Mora F, Salzano FA, Mora R, Santomauro V. Water-Soluble Coenzyme Q10 in Chronic Hearing Loss. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811416318a202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Q-TER is a multicomposite water-soluble formulation of CoQ10; in particular, Q-TER consists of a mixture of maltodextrin, acting as a carrier, of CoQ10 molecules of sucrester, which serves as bioactivator. The purpose of this study was to evaluate the efficiency of Q-TER in subjects with chronic sensorineural hearing loss. Method: A total of 80 patients affected by chronic sensorineural hearing loss were included. The patients were divided, at random, into 2 numerically equal groups (A and B). Group A underwent therapy with Q-TER, 160 mg, once a day for 30 days; group B received placebo, once a day for 30 days. Results: Before, at the end, and 6 months after the end of the treatment, all patients underwent: pure tone audiometry, transient evoked otoacoustic emissions (TEAOE) and otoacoustic products of distortion (DPOAE), auditory brainstem response and speech audiometry. Compared with group B, at the end of the treatment in group A the pure tone audiometry showed a significant ( P < .05) improvement of the audiometric thresholds at the 1.000, 2.000, 4.000, and 8.000 Hz. This improvement was confirmed by the data obtained with the speech audiometry and in the last check. We found no significant differences in the others parameters and in group B. Conclusion: It is quite early to be enthusiastic. There must be more studies with controlled results. However, this kind of therapy for chronic hearing loss seems to be interesting, especially to stop hearing decay. It is also remarkable that good results are found one month after the beginning of the treatment.
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Guastini L, Crippa B, Mora F, Salzano FA, Mora R, Santomauro V. Acoustic Features of Voice in Patients with Snoring. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415823a444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Determine whether the acoustic characteristics of snoring sounds differed between 30 simple male adult snorers (group A) and 30 healthy adult male subject (group B) by using a multidimensional voice program (MDVP), which is a commonly used computer program that analyzes various aspects of voice. Method: Group A patients presented a Friedman tongue position grade I, tonsil size 2 to 3, a body mass index of 15. Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the MDVP; evaluation of voice handicap index (VHI) was done too. Results: Compared with control group, in group A: the acoustic parameters presented a statistically significantly higher value ( P < .05) of fundamental frequency (158.2 Hz vs 120.2 Hz), jitter (2.03 % vs 0.66 %), shimmer (6.54 % vs 3.77 %), NHR (0.24 vs 0.11), SPI (13.7 vs 8.71), DVB (2.23 % vs 0.12 %), DUV (9.31 % vs 0.54 %) and vAm (22.09 % vs 11.13 %), according to the degree of hearing loss; VHI had a mean value of 66 (vs 37 of group B). Conclusion: The study indicates that snoring affects voice production by changing its acoustic parameters. A voice analysis program MDVP can be used for snoring sound analysis as a noninvasive procedure for examination of sleep-related breathing disorders.
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Mora R, Salami A, Salzano FA, Guastini L, Dellepiane M. Electronystagmography in the Diagnosis of Central Vertigo. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415823a245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Determine the efficacy and applicability of electronystagmography (ENG) testing in the differential diagnosis between peripheral and central vertigo, through the visual-vestibular interaction test, in patients with vertigo. Method: Patients were submitted to ENG recording. Patients sat on a rotatory chair, which was placed in the middle of a rotary rotatory cylindrical chamber. The rotatory chamber was driven by a direct current engine, which turned it clockwise and counterclockwise, and its internal area was covered with 32 black vertical contrast. Results: All patients underwent rotatory vestibular stimulation by Stop test (VOR), optokinetic stimulation (OKN), and contemporary rotatory vestibular and optokinetic stimulation (VVOR). Our experiences highlight as normal that subjects and/or patients affected by peripheral vertigo present a VVOR nystagmus homodirectional to optokinetic nystagmus; patients affected by central vertigo present a VVOR nystagmus homodirectional to vestibular-ocular-reflex (VOR). In healthy patients, VVOR nystagmus is always homodirectional to OKN and indicates the optokinetic system prevalence on VOR. Conclusion: The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification, and highlights a CNS disease. Our data highlight the role of ENG in the diagnosis between peripheral and central vertigo.
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Guastini L, Crippa B, Mora F, Dellepiane M, Mora R, Santomauro V. Harmonic Scalpel in the Treatment of Snoring. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415823a51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The Ultracision Harmonic Scalpel (HS) is an ultrasonic cutting and coagulating surgical device. The mechanism of the HS is based on transforming electrical energy into mechanical movement of 55.5 kHz frequency. This work aims to report our 4 years’ experience with HS in the treatment of snoring (uvulopalatopharyngoplasty). Method: Specific handpieces shaped like hook and blade were preferred. After tonsillectomy, 2 incisions, were made on each side of the lateral margin of the uvula, with upward direction. Thereafter, an excision of the redundant mucosa of each posterior arch and subsequent creation of neouvula by a partial uvulectomy was done. Results: In all the patients treated, the HS allowed rapid intraoperative management with a precise and safe cut: the HS provided excellent control without side effects on the adjacent structures and postoperative complications. Compared with other techniques (laser, cold knife dissection, etc) HS’s group experienced shorter operation time, lesser blood loss, fewer days of hospitalization, lower postoperative pain, and improvement of voice quality. No complications with regard to hemostasis or other major complication (temporary velopharyngeal insufficiency, bleeding, globus sensation, etc) were noted in the HS group. Conclusion: Our experience highlights that the use of HS in uvulopalatopharyngoplasty confers some advantages over conventional methods: its use led to diminished bleeding, shorter operation time, lesser pain, better wound healing in the postoperative period, and reduction of snoring and improvement of voice quality.
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Abstract
CONCLUSION These preliminary data show a decrease in nasal tactile sensitivity and point out interesting aspects of the nasal chronic inflammatory condition in allergic rhinitis. OBJECTIVES The aim of this study was to evaluate the effects of allergic rhinitis on nasal tactile sensitivity during the intercritical period. METHODS A total of 70 patients aged between 18 and 67 years (average 42 years), with a positive history of allergy caused by seasonal outdoor allergens, were included (group A). Patient outcome was assessed by the nasal monofilament test: a set of 20 Semmes-Weinstein monofilaments was used to detect nasal sensitivity for both nasal cavities. The sensitivity threshold was recorded as the minimum monofilament size with which patients could detect at least two of three stimuli. RESULTS When compared to the control group (group B), subjects in group A required a significantly (p < 0.05) higher stimulus to trigger a touch response in the monofilament test, for both the inferior (195.1 ± 0.39 mg vs 67.7 ± 0.19 mg) and middle turbinate (108.7 ± 0.23 mg vs 67.7 ± 0.19 mg).
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Abstract
INTRODUCTION The aim of this study was to evaluate the efficiency of sulphurous thermal water in the treatment of chronic rhinosinusitis (CRS). METHODS Eighty patients with CRS were included and randomly assigned into two groups. Patients underwent a 12-day course of warm vapour inhalations and nasal irrigations with sulphurous thermal water in group A, and a physiological solution in group B. RESULTS Compared with group B, in group A the results were as follows: serum concentration of IgE was significantly lower (p<0.05) 12 days (76.27+26.3 mg/dl vs. 97.44±45.4) and 3 months after the beginning of the treatment (75.48+26.1 mg/dl vs. 98.37±41.4); IgA titers were not significantly higher 12 days (231.09±120.3 mg/dl vs. 220.44+114.4 mg/dl) and 3 months after the beginning of the treatment (235.44±118.5 mg/dl vs. 214.51±111.8 mg/dl); VAS scores were significantly (p<0.05) improved at 12 days (1.7+0.18 vs. 6.9±0.51) and 3 months after the start (1.8+0.22 vs. 7.1±0.59); NMIT was normal at 12 days (11.54±1.59 min vs. 17.38+1.83 min) and 3 months after the beginning of the treatment (11.46+2.07 min vs. 17.43±2.01 min); total nasal resistances were significantly (p<0.05) decreased at 12 days and 3 months. CONCLUSION Our results indicate the efficiency and applicability of sulphurous thermal water in the treatment of CRS.
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Salami A, Mora R, Crippa B, Gentile R, Dellepiane M, Guastini L. Potential nerve damage following contact with a piezoelectric device. Ann Otol Rhinol Laryngol 2011; 120:249-54. [PMID: 21585155 DOI: 10.1177/000348941112000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the study was to assess the extent of the potential nerve damage following prolonged contact with a piezoelectric device. METHODS The study was conducted with 30 patients; all of the patients had cervical metastatic lymph nodes at levels II, III, and IV (N2b) and a negative evaluation for metastatic disease (MO). The patients underwent radical neck dissection. After its skeletonization, the spinal nerve was exposed directly to ultrasonic activation with a piezoelectric device for various times (5, 10, and 20 seconds) and with different inserts (OP3 insert and OT7 insert). The axonal damage was graded from 0 to 3 as follows: 0, no damage; 1, minor axonal damage; 2, severe axonal damage but not covering the entirety of the nerve fascicles; 3, severe axonal damage covering the entirety of the nerve fascicles. RESULTS Histologic examination showed no evidence of damage to the perineurium and axons after 5 and 10 seconds of exposure to ultrasonic activation with each insert. CONCLUSIONS Our histologic data highlight the selective action of the piezoelectric device, which reduces the risk of accidental nerve damage in otolaryngological bone surgery.
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Affiliation(s)
- Angelo Salami
- Department of Otorhinolaryngology, University of Genoa, Italy
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Abstract
CONCLUSION These findings provide the basis for understanding the duration of the effect after the last use of the drug and encourage a larger clinical trial to collect additional evidence on the effect of coenzyme Q10 (CoQ10) in preventing the development of hearing loss in subjects with presbycusis. OBJECTIVES The aim of this study was to evaluate the long-term effects of a water-soluble formulation of CoQ10 (Q-TER) in subjects with presbycusis. METHODS Sixty patients with presbycusis were included and divided at random into three numerically equal groups. For 30 days, group A underwent therapy with Q-TER, group B underwent therapy with vitamin E, and group C received placebo. Before, at the end, and 6 months after the end of the treatment, all patients underwent evaluation of pure tone audiometry, transient evoked otoacoustic emissions and otoacoustic products of distortion, auditory brainstem response, and speech audiometry. RESULTS Compared with group B, at the end of the treatment in group A the pure tone audiometry showed a significant (p < 0.05) improvement of the audiometric thresholds at 1000, 2000, 4000, and 8000 Hz. This improvement was confirmed by the speech audiometry and last check. We found no significant differences in the other parameters and in group C.
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Mirisola V, Mora R, Esposito AI, Guastini L, Tabacchiera F, Paleari L, Amaro A, Angelini G, Dellepiane M, Pfeffer U, Salami A. A prognostic multigene classifier for squamous cell carcinomas of the larynx. Cancer Lett 2011; 307:37-46. [PMID: 21481529 DOI: 10.1016/j.canlet.2011.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/28/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
Survival after diagnosis of laryngeal cancer has not improved over the last 20 years. Selection of patients for radio- and chemotherapy or surgery or follow-up strategies based on a prognostic classifier could improve survival without unduly extending radical surgery. We performed microarray gene expression analysis and developed a four-gene classifier for laryngeal cancer using Prediction Analysis of Microarray and leave-one-out cross validation. A four-gene classifier containing the non-coding gene H19, the histone HIST1H3F and the two small nucleolar RNAs, SNORA16A and SNORD14C was developed that assigns cases to low and high risk classes. The high risk class has a relative risk of 6.5 (CI=1.817-23.258, Fisher exact test p<0.0001). The maternally imprinted gene H19 is the top classifier gene.
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Affiliation(s)
- Valentina Mirisola
- Integrated Molecular Pathology, National Cancer Research Institute, Genova, Italy
| | - Renzo Mora
- ENT Department, University of Genova, Italy
| | | | | | - Flavia Tabacchiera
- Integrated Molecular Pathology, National Cancer Research Institute, Genova, Italy
| | - Laura Paleari
- Integrated Molecular Pathology, National Cancer Research Institute, Genova, Italy
| | - Adriana Amaro
- Integrated Molecular Pathology, National Cancer Research Institute, Genova, Italy
| | - Giovanna Angelini
- Integrated Molecular Pathology, National Cancer Research Institute, Genova, Italy
| | | | - Ulrich Pfeffer
- Integrated Molecular Pathology, National Cancer Research Institute, Genova, Italy.
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Nola G, Guastini L, Crippa B, Deiana M, Mora R, Ralli G. Vestibular evoked myogenic potential in vestibular neuritis. Eur Arch Otorhinolaryngol 2011; 268:1671-7. [DOI: 10.1007/s00405-011-1592-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 03/16/2011] [Indexed: 10/18/2022]
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Graviero G, Guastini L, Mora R, Salzano G, Salzano FA. The role of three-dimensional CT in the evaluation of nasal structures and anomalies. Eur Arch Otorhinolaryngol 2011; 268:1163-1167. [PMID: 21431952 DOI: 10.1007/s00405-011-1575-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 03/08/2011] [Indexed: 11/25/2022]
Abstract
Traditionally, computed tomography (CT) is the primary radiographic method to analyze the morphology of the craniofacial bones: Because of the many overlapping anatomical structures, it is difficult and sometimes impossible to evaluate craniofacial bones three-dimensionally (3D) with these images. For this reason, the aim of this paper has been to evaluate and demonstrate the importance of CT scans integrated by three-dimensional reconstructions (3D-CT) volume rendering imaging for the accurate understanding of the nasal pyramid morphology in the evaluation of patients submitted to secondary rhinoseptoplasty. Twenty patients enrolled for a secondary rhinoseptoplasty, underwent a preoperative evaluation through 3D-CT volume rendering imaging. This technique allowed a prefect reconstruction of the nasal structures at the level of the valve, as well as the medial and lateral walls of the nasal fossa in all of its components (bone and cartilage). In our experience, the 3D-CT volume rendering imaging studies improve the preoperative evaluation of structures and anomalies which are hard to evaluate by the anterior rhinoscopy and/or nasal endoscopy: alar and lateral cartilages, interdomal distance, tip morphology, valvular configuration, loss of bone-cartilaginous substance, etc. All of these points are important during the preoperative planning of secondary rhinoseptoplasty.
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Affiliation(s)
| | - Luca Guastini
- ENT Department, University of Genoa, Via dei Mille 11/9, 16147, Genoa, Italy
| | - Renzo Mora
- ENT Department, University of Genoa, Via dei Mille 11/9, 16147, Genoa, Italy.
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Crippa B, Salzano FA, Mora R, Dellepiane M, Salami A, Guastini L. Comparison of postoperative pain: piezoelectric device versus microdrill. Eur Arch Otorhinolaryngol 2011; 268:1279-82. [PMID: 21327729 DOI: 10.1007/s00405-011-1520-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
Piezosurgery® is a recently developed system for cutting bone with microvibrations. The objective of this study was to compare the severity of pain over the first 10 postoperative days in a group of 70 patients who underwent intact canal wall mastoidectomy, with the piezoelectric device, and to compare the results with traditional method by means of microdrill (70 patients). The subjective perception of pain was evaluated on a scale from 0 to 10, such that 0 represented no pain and 10 represented maximum pain; the severity was recorded as null when the score was 0; slight, when it was 1-4; moderate, when it was 5-7; or severe, when it was 8-10. Compared with microdrill, the patients that underwent surgery with the piezoelectric device showed a significant (P < 0.05) lower postoperative pain on day 1 (52 vs. 26 patients presented a slight pain, 12 vs. 37 presented a moderate pain, and 6 vs. 7 presented a severe pain) and day 3 (68 vs. 44 patients presented a slight pain, 2 vs. 23 presented a moderate pain, and 0 vs. 3 presented a severe pain). These results highlight as the piezoelectric device is a safe and minimally invasive tool.
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Affiliation(s)
- Barbara Crippa
- ENT Department, University of Genoa, Via dei Mille 11/9, 16147, Genoa, Italy
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Abstract
CONCLUSION Although older people varied widely in tactile sensitivity, our results show that tactile thresholds increased with age. OBJECTIVES The aim of this study was to evaluate the effects of aging on nasal tactile sensitivity. METHODS A total of 160 healthy patients aged between 50 and 90 years were included. According to their age, patients were divided into groups (A, B, C, D, E, F, G, and H). From the age of 50, each group included subjects with an age range of 5 years (i.e. group A, 50-55 years; group B, 56-60 years, etc.). Each patient's outcome was assessed through the nasal monofilament test: a set of 20 Semmes-Weinstein monofilaments was used to detect nasal sensitivity for both nasal cavities. The sensitivity threshold was recorded as the minimum monofilament size from which patients could detect at least two of three stimuli. RESULTS In groups D (66-70 years), E (71-75 years), F (76-80 years), G (81-85 years), and H (86-90 years) a significantly (p < 0.05) higher stimulus (171.1 ± 0.34 mg vs 67.7 mg, 167.01 ± 0.31 mg 67.7 mg, 166.54 ± 0.28 mg 67.7 mg, 201.24 ± 0.43 mg 67.7 mg, 165,87 ± 0.27 mg 67.7 mg) was required to trigger a touch response in the monofilament test.
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Abstract
CONCLUSIONS We can consider the micropulse program as the best level of safety that should be used in all cases of piezoelectric stapedotomy. OBJECTIVES The aim of this study was to describe the importance of a micropulse program in determining the success of piezoelectric stapedotomy. METHODS A total of 112 patients (group A) affected by primary otosclerosis underwent piezoelectric stapedotomy for otosclerotic stapes fixation. A specific operative program was created to perforate the stapes footplate: this program makes it possible to perforate the footplate of the stapes with a predetermined and non-modifiable temporization. Before and 1 year after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, and auditory brainstem response. Results were compared with those obtained from 30 patients who underwent piezoelectric stapedotomy without the specific operative program (group B). RESULTS At 1 year after surgery, with regard to the pure-tone audiometry test, all patients had an air-bone gap (ABG) reduction: no worsening of the bone conduction and no postoperative sensorineural hearing loss were found. In group A, there was a closure of the ABG within 10 dB in all patients.
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Abstract
CONCLUSION For otologic revision surgery, the advantage of the piezoelectric device appears real because it is possible to perform a 'blind' cutting of bone with fewer precautions necessary for soft tissues such as the facial nerve, lateral sinus, and dura mater. OBJECTIVES The aim of this study was to determine the efficiency of the piezoelectric device in revision surgery for chronic otitis media. METHODS A total of 30 patients had revision mastoidectomy with previous canal wall up mastoidectomy. The piezoelectric device was used in all intraoperative steps. Before surgery and 1 month and 1 year after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording. RESULTS The piezoelectric device provided effective cutting, with excellent control and without side effects on the adjacent structures of the middle and inner ear (lateral sinus, facial nerve, and/or dura mater). Postoperatively, all patients had an uneventful recovery with no evidence of audiovestibular deficit or side effects. Among 30 cases followed for 1 year, 29 (97%) maintained a dry and safe ear. Intermittent otorrhea with perforation of the tympanic membrane occurred in one patient (3%).
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Salami A, Mora R, Dellepiane M, Manini G, Santomauro V, Barettini L, Guastini L. Water-soluble coenzyme Q10 formulation (Q-TER(®)) in the treatment of presbycusis. Acta Otolaryngol 2010; 130:1154-62. [PMID: 20443731 DOI: 10.3109/00016481003727590] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONCLUSION These preliminary data are encouraging for a larger clinical trial to collect additional evidence on the effect of Q-TER(®) in preventing the development of hearing loss in subjects with presbycusis. OBJECTIVES The purpose of this study was to evaluate the efficiency and applicability of a water-soluble formulation of CoQ10 (Q-TER(®)) in subjects with presbycusis. METHODS A total of 60 patients with presbycusis were included and divided into three numerically equal groups. Group A underwent therapy with Q-TER(®), 160 mg, once a day for 30 days; group B underwent therapy with vitamin E (50 mg), once a day for 30 days; group C received placebo, once a day for 30 days. Before and at the end of the treatment, all patients underwent pure tone audiometry, transient evoked otoacoustic emissions, otoacoustic products of distortion, auditory brainstem response, and speech audiometry. RESULTS Compared with group B, at the end of the treatment in group A the liminar tonal audiometry showed a significant improvement of the air and bone thresholds at the 1000 (14/20 vs 9/20), 2000 (14/20 vs 7/20), 4000 (15/20 vs 6/20), and 8000 Hz (13/20 vs 5/20). We found no significant differences in the other parameters and in group C.
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Mora R, Jankowska B, Guastini L, Santomauro V, Dellepiane M, Crippa B, Salami A. Computerized voice therapy in hypofunctional dysphonia. J Otolaryngol Head Neck Surg 2010; 39:615-621. [PMID: 20828528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to analyze the efficiency and applicability of the Kay CSL 4500 system with the Sona-Speech II software model 3650 (Kay Pentax, Lincoln Park, NJ) in the voice therapy of patients affected by hypofunctional dysphonia. DESIGN The study evaluated the effect of visual biofeedback, obtained with the Sona-Speech II software, on dysphonia associated with hypofunction dysphonia. SETTING The study was conducted with 40 male adults affected by hypofunctional dysphonia in the Otolaryngology Department of the University of Genoa (Italy) between April 2008 and April 2009. METHODS Before, at the end of, and 3 months after voice therapy, all subjects underwent an otolaryngology visit, videostroboscopy, and voice analysis through the Multi-Dimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) as an evaluation of nasal resonance and the Voice Handicap Index (VHI). Each cycle of rehabilitation was characterized by 30 daily consecutive sessions, each for 25 minutes. During each session, the patient was asked to perform specific computer exercises. MAIN OUTCOME MEASURES The following acoustic parameters were estimated: average of fundamental frequency, percentage of jitter, shimmer, noise to harmonics ratio, voice turbulence index, soft phonation index, degree of voicelessness, degree of voice breaks, and peak amplitude variation. RESULTS Our data showed significant (p < .05) improvements in acoustic and other parameters in the patients submitted to voice therapy. CONCLUSIONS Our preliminary results suggest the applicability and efficiency of the Kay CSL 4500 system in association with the Sona-Speech II software model 3650 in a voice therapy program.
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Affiliation(s)
- Renzo Mora
- Otolaryngology Department, University of Genoa, Genoa, Italy.
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Pfeffer U, Dellepiane M, Mirisola V, Esposito A, Guastini L. A Prognostic Multigene Classifier for Larynx Carcinoma. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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