Purpose
In 2016, the European Laryngological Society (ELS) proposed a classification for vascular changes occurring in glottic lesions as visible by narrow band imaging (NBI), based on the dichotomic ...distinction between longitudinal vessels (not suspicious) and perpendicular ones (suspicious). The aim of our study was to validate this classification assessing the interobserver agreement and diagnostic test performance in detecting the final histopathology.
Methods
A retrospective study was carried out by reviewing clinical charts, preoperative videos, and final pathologic diagnosis of patients submitted to transoral microsurgery for laryngeal lesions in two Italian referral centers. In each institution, two physicians, independently re-assessed each case applying the ELS classification.
Results
The cohort was composed of 707 patients. The pathologic report showed benign lesions in 208 (29.5%) cases, papillomatosis in 34 (4.8%), squamous intraepithelial neoplasia (SIN) up to carcinoma in situ in 200 (28.2%), and squamous cell carcinoma (SCC) in 265 (37.5%). The interobserver agreement was extremely high in both institutions (
k
= 0.954,
p
< 0.001 and
k
= 0.880,
p
< 0.001). Considering the diagnostic performance for identification of at least SIN or SCC, the sensitivity was 0.804 and 0.902, the specificity 0.793 and 0.581, the positive predictive value 0.882 and 0.564, and the negative predictive value 0.678 and 0.908, respectively.
Conclusion
The ELS classification for NBI vascular changes of glottic lesions is a highly reliable tool whose systematic use allows a better diagnostic evaluation of suspicious laryngeal lesions, reliably distinguishing benign ones from those with a diagnosis of papillomatosis, SIN or SCC, thus paving the way towards confirmation of the optical biopsy concept.
Rhinogenic headache (RH) is a widespread pain syndrome but its pathogenesis and treatment are still unclear. Some authors recognize a correlation between RH and mucosal contact points or some other ...sinonasal anatomical variations. The authors conducted a retrospective case-control study to analyze the correlation between radiological findings and clinical symptoms.One hundred-nineteen adults with Para-Nasal Sinuses Computed Tomography (PNS-CT) scans were included: 64 patients who have originally undergone PNS-CT scan as part of rhinogenic headache workup (Group A), and 55 controls in whom PNS-CT scans were obtained for other purposes (Group B). All subjects were asked to report their symptoms using a headache scoring system. PNS-CT scans of all subjects were analyzed for presence of mucosal contact points, middle turbinate concha bullosa (MTCB) and frontoethmoidal cells.The most common anatomical abnormality found in our series was MTCB, reported in 60.9% of patients in Group A and 41.8% of those in Group B. A statistically significant prevalence was found in Group A compared to Group B regarding the presence of MTCB (P = 0.037) and Type II (P = 0.016) and Type III (P = 0.039) frontoethmoidal cells. No statistically significant difference (P >0.05) was found between Group A and Group B regarding the presence of mucosal contact points at each site.Multiple anatomical variations in nasal and paranasal sinuses may cause a rhinogenic headache with different characteristics. Some of these, such as concha bullosa of middle turbinate or type II and III Kuhn cells, have shown a significant association with rhinogenic headache. No statistically significant association was found between presence of headache and mucosal contact points and type I and IV frontal cells. These findings can be very helpful for the surgeons that want to deal with the treatment of RH.
This study was designed to prospectively evaluate the role of nebulized hyaluronic acid (HA) given for 10 days/mo over 3 months as adjunct treatment to minimize symptoms and preventing exacerbation ...of chronic rhinosinusitis (CRS).
Thirty-nine eligible patients were randomized to receive nebulized 9-mg sodium hyaluronate nasal washes plus saline solution (21 patients) or 5 mL of saline alone (18 patients), according to an open-label, parallel-group design, with blind observer assessment. A questionnaire about main CRS discomfort and nasal endoscopy for mucous discharge and/or mucosal edema of nasal cavities was used to assess primary outcomes of treatments. Secondary outcome measures included side effects and satisfaction.
HA significantly improved quality of life in CRS patients according to the CRS questionnaire (16± 3.72 versus 11.52 ± 4.28; p < 0.001), contrary to saline group scores (18.92 ± 3.09 versus 18.21 ± 3.21; p = 0.55). The HA group showed significantly reduced osteomeatal edema (2.42 versus 1.52; p < 0.001) and secretions (0.95 versus 0.42; p < 0.001), whereas there was no statistically significant difference in the saline group. The compliance to the treatment was similar in both groups and no side effects were recorded.
The results of this study suggested that intermittent treatment with topical 9-mg sodium hyaluronate plays a role in minimizing symptoms and could prevent exacerbations of CRS.
Infection of the skin-muscle flap is one of the most severe risks of cochlear implantation. The aim of this paper is to describe a novel and minimally invasive procedure to avoid cochlear implant ...(CI) extrusion.
A 79-year-old woman with severe comorbidities developed a pressure injury of the skin-muscle flap overlying the CI receiver/stimulator (R/S) nine years after surgery. Skin thinning and failure of conventional pressure injury management led the patient to a high risk of CI extrusion. Therefore, she underwent a single procedure of autologous fat grafting under local anesthesia to increase scalp thickness and vascularization over the CI R/S.
Within one month, complete healing of the pressure injury was observed, and the patient was able to safely use her CI. No further signs of infection and skin deterioration were detected at the 15-months follow-up.
Fat grafting has been proven to promote neoangiogenesis and tissue regeneration. To the best of our knowledge, this is the first report of fat grafting utilized in the skin-muscle flap area to avoid incipient CI R/S extrusion.
The described case demonstrates the efficacy of this salvage procedure to avoid major surgery and the additional costs related to CI reimplantation.
This paper represents an overview on activities done in real Smart Cities scenarios using IoT Technologies for Intelligent Transportation Systems (ITS). Nowadays, there are several use cases related ...to IoT for ITS, such as connected and autonomous vehicles, cooperative transportation networks and smart roads in order to improve data propagation, create heterogeneous connectivity and low latency applications in high capacity environments. ITS techniques can be also applied on logistics, so accuracy on delivery and timing can be improved consider all the involved ecosystems, baseline and standardized architectures in interconnected Smart Cities for future development and integration. Secure correlations between vehicles and smart roads can optimize road safety and traffic flow, reduce incidents, avoid congestions etc. These technologies comprise also V2X (Vehicle to Everything). In this scenario, the cloud-based LoRa (Long Range) and mesh networks technologies, can play an important role for the propagation of intelligent sensed data and localization. The Smart Roads scenario is considered as one of the most attractive field in a Smart City environment. The right choice on technology, delay and frequency represents an important factor to be considered for standardization and engineering activities.
Several free flaps are nowadays available for functional reconstruction after hemi-glossectomy in head and neck oncologic surgery. Radial forearm free flap (RFFF) and anterolateral thigh (ALT) have ...been played a workhorse role until recent years, when other valuable options such as Medial Sural Artery Perforator (MSAP) flap and Profunda Artery Perforator (PAP) flap demonstrated to be suitable contenders and are increasingly taken into account. This study aims to investigate the preference of the donor site in the light of esthetical and functional outcomes.
The participants attended a one-to-one interview with a surgeon explaining a standardized head and neck oncological procedure requiring a soft tissue reconstruction. The donor site preference in terms of esthetical, functional and overall outcomes among these four flap options was investigated.
Univariable and multivariable analysis were performed comparing the donor site preference between the two most widespread free flap RFFF vs ALT. Subsequently, the analysis was performed comparing RFFF, ALT, MSAP and PAP.
The study illustrated that a diverse group of patients exhibits similarly diverse preferences and expectations. As we observe a shift in the age distribution of patients with OSCC from the fifth-sixth decade towards the two extremes, and an increased incidence in the female population, it becomes essential to enhance reconstructive options provided to patients. This ensures that, while maintaining an equivalent functional outcome, we maximize patient satisfaction to the fullest extent possible.
•We are witnessing an epidemiological change in patients affected by head and neck cancer.•Several reconstructive options involving free flaps are nowadays available.•The preference of the donor site in the light of esthetical and functional outcomes in a heterogeneous cohort has yet to be investigated.•A diverse group of patients exhibits similarly diverse preferences and expectations.•Improving the reconstructive options provided allows to maximizes patient satisfaction to the fullest extent possible.
Taormina: A LoRa-based localization scheme for smart road scenarios Mazzola, Francesco; Giglio, Stefano; Brincat, Alberto ...
2021 International Conference on Electrical, Computer, Communications and Mechatronics Engineering (ICECCME),
2021-Oct.-7
Conference Proceeding
Accurate localization of people and assets is crucial in several application scenarios including smart roads. In this paper the Taormina localization scheme is presented which uses information ...collected by a LoRa network. More specifically the objective of Taormina is to accurately identify the location of a vehicle, equipped with a LoRa node, travelling along a known path which is divided into segments of length equal to or shorter than the desired accuracy. Values of the RSSI measured by the LoRa gateways are collected and used to characterize each of the above segments. The node that wants to be located periodically transmits LoRa messages. The LoRa gateways evaluate the corresponding RSSIs and use such values to identify the segment where the vehicle is currently located. Therefore, in Taormina localization is addressed as a classification problem. Early results demonstrate that Taormina can deliver the target localization accuracy with high probability.
Background
Rhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in ...breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures.
Methods
For 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1 year.
Results
The results at 1 year showed high rates of improvement in tip definition (mean, 7.9 ± 2.4) and nasal tip only evaluation (mean, 6.5 ± 3.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2 ± 3.2), nostril symmetry (mean, 4.5 ± 4.1), and tip projection (mean, 5.8 ± 2.9).
Conclusions
This simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips.
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