Data-Driven Virtual Sensing for Electrochemical Sensors.

In recent years, the application of machine learning for virtual sensing has revolutionized the monitoring and management of information. In particular, electrochemical sensors generate large amounts of data, allowing the application of complex machine learning/AI models able to (1) reproduce the measured data and (2) predict and manage faults in the measuring sensor. In this work, data-driven models based on an autoregressive model and an artificial neural network have been identified and used to (i) evaluate sensor redundancy and (ii) predict and manage faults in the context of electrochemical sensors for the measurement of ethanol. The approach shows encouraging results in terms of both performance and sensitivity analyses, allowing for the reconstruction of the values measured by two sensors in a series of six sensors with different dopant levels and to reproduce their values after a fault.

Bonebridge® bone conduction implant. Hearing outcomes and quality of life in patients with conductive/mixed hearing loss.

PURPOSE: The aim of this study was to analyze the hearing outcomes and quality of life in a series of 52 patients affected by conductive or mixed hearing loss and treated with Bonebridge®. METHODS: 52 of 71 patients implanted with Bonebridge® between October 2012 and January 2022, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000 Hz, the SRT50% and the World Recognition Score at an intensity of 50 dB with and without the implant. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was employed to assess the quality of life of patients. RESULTS: The liminal tone audiometry (free field) pure tone average for air conduction after 6 months with the implant was 35.12 dB, obtaining a mean gain of 31.83 dB. With Bonebridge®, the mean SRT was 34.17 dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50 dB. The world recognition score at 50 dB changed from 11% without the implant to 85% with it. We observed one case of implant failure and one case of implant exposure. The APHAB questionnaire showed an improvement after implantation in practically all the subscales. CONCLUSIONS: The hearing outcomes and the subjective benefits reported by patients obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent method for the rehabilitation of patients with conductive and mixed hearing loss, showing a low rate of complications.

Analysis of the lockdown effects due to the COVID-19 on air pollution in Brescia (Lombardy).

SARS-CoV-2 virus (COVID-19) pandemic has impacted several countries, with also some differences at local levels. When lockdown restrictions were imposed, the concentrations of some air pollutants were reduced, as reported in some other cities in the world. This was often considered a positive by-product of the pandemic. However, often literature reporting the connection of air quality (AQ) and lockdown, suffers of limited and incomplete data analysis, not considering, for example, some confounding factors. This work presents a methodology, and the results of its application, to assess the impact of pandemic restrictions on AQ (in particular nitrogen oxides, NO2 and particulate matter, PM10) in spring 2020 in Brescia, located in one of the most affected areas in terms of virus diffusion and in one of the most polluted areas in Europe (Po Valley, Italy). In particular, the proposed methodology integrates data and AQ modelling simulations to distinguish between the changes in the PM10 and NO2 pollutants concentration that occurred due to the restriction measures and due to other factors, like spatial-temporal characteristics (for example the seasonality), meteorological factors, and governmental actions that were introduced in the past to improve the air quality. Results show that NO2 is strongly dependent to traffic emission. On the contrary, although the expected decrease in PM10 concentrations, the results highlight that the reduction of transport emission would not help to avoid severe air pollution, due to the other pollution sources that contribute to its origin. The results presented for the first time in this work are of particular interest because they may be used as a basis to investigate in more details the sources that can impact on the air quality in Brescia, with the aim to propose effective measures able to reduce it.

Sensitization profile in patients with respiratory allergic diseases: differences between conventional and molecular diagnosis (a cross-sectional study).

BACKGROUND: Component-resolved diagnosis (CRD) allows to identify single molecular allergen components, and constitutes a routine practice in many allergy units. However, skin prick test (SPT) remains the technique of choice in many otorhinolaryngology departments, thus increasing the risk of using inadequate immunotherapies in patients with respiratory allergies. This study aimed to compare sensitization profiles determined by SPT and CRD in patients with respiratory allergy, and to explore the relationship between sensitization and type and severity of the respiratory disease. METHODS: Cross-sectional, multicenter study of patients admitted to the Otorhinolaryngology Department due to symptoms of respiratory allergy. Extracts from various house dust mites, pollens, and molds were tested by SPT, whereas IgE against the corresponding antigens were measured by CRD. RESULTS: The analysis included 101 patients. The sensitization profile obtained by SPT had low agreement with that of CRD, particularly to dust mite allergens (Dermatophagoides sp.) and pollens (Plantago lanceolata, Olea europaea, and Cupressus sempervirens). While SPT did not show any significant relationship between sensitization and type/severity of the respiratory disease, CRD allowed to associate Der p 1, Der f 1 and Lep d 2 sensitizations with asthma, and Der p 2, Der f 2 and Lep d 2 sensitizations with more severe symptoms of allergic rhinitis. CONCLUSIONS: Compared with SPT, CRD enables to describe a more accurate sensitization profile and to identify associations between symptoms and specific antigens. The routine use of CRD in an otorhinolaryngology setting may benefit the management of patients with respiratory allergy.Trial registration IB 3108/15 (Retrospectively registered).

Survival and complications after carotid resection for head and neck squamous cell carcinoma: A systematic review and pooled analysis.

OBJECTIVE: The aim of this study is to analyze oncologic outcomes and complications rate after common or internal carotid artery (CCA/ICA) resection for head and neck squamous cell carcinoma (HNSCC). METHODS: This study was conducted in conformity with the PRISMA statement. A systematic review and pooled analysis was performed for overall survival (OS), disease specific survival (DSS) (primary outcomes), and perioperative death rate (secondary outcome). RESULTS: A total of 276 patients (males: 76.7%, n = 191/249) with a median age of 59 years (n = 239/276; 95% CI 55.0-61.7) who underwent CCA/ICA resection for HNSCC were included. The median follow-up time was 11 months (n = 276). Estimated pooled OS rates (95% CI) at 1 and 2 years were 52.7% (46.9-59.2) and 29.8% (24.3-36.5), respectively. The median OS (95% CI) was 14 months (12-17). Estimated pooled DSS rates (95% CI) at 1 and 2 years were 58.6% (52.7-65.2) and 34.6% (28.5-41.9), respectively. The median DSS (95% CI) was 16 months (14-19). The perioperative death rate was 6.9% (n = 19/276). CONCLUSIONS: CCA/ICA resection should be considered as a treatment option for accurately selected patients. Multicentric prospective studies are recommended to develop a predictive score guiding the decision-making process.

Pulse transit time as a measure of respiratory effort under noninvasive ventilation.

Among the respiratory events that may occur during nocturnal noninvasive ventilation (NIV), differentiating between central and obstructive events requires appropriate indicators of respiratory effort. The aim of the present study was to assess pulse transit time (PTT) as an indicator of respiratory effort under NIV in comparison with oesophageal pressure (P(oes)). During wakefulness, PTT was compared to P(oes) during spontaneous breathing and under NIV with or without induced leaks in 11 healthy individuals. In addition, the contribution of PTT versus P(oes) to differentiation of central from obstructive respiratory events occurring under NIV during sleep was evaluated in 10 patients with obesity hypoventilation syndrome (OHS). From spontaneous breathing to NIV without leaks, respiratory effort decreased significantly whereas, with increasing level of leaks, there was a significant increase in respiratory effort. Changes in PTT accurately reflected changes in P(oes). In OHS patients during nocturnal NIV, intraclass correlation coefficients between P(oes) and PTT were 0.970 for total number of events and 0.970 for percentage of central events. PTT accurately reflects the unloading of respiratory muscles induced by NIV and the increase in respiratory effort during leaks. PTT during sleep is also useful to differentiate central from obstructive respiratory events occurring under NIV.

Combined Approach for Giant Temporal Meningoencephalocele.

Introduction: To present a complex case of giant meningoencephalocele after a canal wall down mastoidectomy and describe our preferred approach to repair meningoencephalic herniation of the temporal bone. Case Report: A 20-year-old patient, who had previously undergone type III tympanoplasty with total ossicular reconstruction prosthesis for an attic cholesteatoma, presents with clinical and imaging features compatible with the diagnosis of a giant temporal meningoencephalocele. We performed a combined approach -transmastoid plus minicraniotomy- to repair the skull base defect. A multilayer reconstruction of the defect with septal cartilage and temporal fascia was performed. After a 48 months follow-up, the patient remains symptom free without signs of tissue herniation. Conclusions: Transmastoid plus minicraniotomy combined approach is a safe and feasible technique in case of large and anterior skull base defects with low surgical morbidity, allowing a safe and multilayered reconstruction, even in the context of a simultaneous active chronic otitis media.

The "Kite-t-FAMMIF": A Novel Technique for Reconstruction of Extensive Soft Palate Resection.

Total soft palate reconstruction is a challenge for the head and neck surgeon. Velopharyngeal incompetence resulting from soft palate resection impairs both speech and swallowing and significantly affects the quality of life of the patients. Radial forearm free flap is the reconstructive technique most used worldwide, but it requires microsurgical skills, is associated with high donor site morbidity, and shrinks during the healing process, especially after adjuvant radiotherapy. We present a novel technique using a single "kite-shaped" tunnelized-facial artery myomucosal island flap (t-FAMMIF) and report very favorable functional outcomes. Three patients in whom a kite-shaped flap was used to reconstruct a total soft palate defect after squamous cell carcinoma resection were included. In two of them, the resection included both tonsils due to cancer spreading to the tonsillar fossae. The mucosal and muscular sides of a single t-FAMMIF flap were able to restore the oral and nasal lining of the palate, respectively, without the need to fold the flap. All patients were able to tolerate an oral soft diet 10 days after surgery. No complications were detected. A complete mucosalization on the nasal lining was observed by video-endoscopy 3 weeks after surgery. No case of shrinking of the flap was observed during the follow-up, and speech and swallowing functions were not impaired after complete wound healing. Kite-shaped t-FAMMIF represents an excellent and feasible reconstructive option for extensive postablative soft palate defects.

Neck glomangiomyoma: A case report and literature review.

Glomus tumors are rare and the hand is classically the most commonly affected site. The present study performed a literature review on the topic and reported on an unusual case of neck glomangiomyoma in a female adult patient. A 31-year-old woman presented with a 4-year history of a growing submandibular tumor with localized non-irradiated pain. A previous fine needle aspiration biopsy had suggested a glomus tumor, and immunohistochemical analysis showed positive staining for smooth muscle actin, H-caldesmon, muscle-specific actin and collagen type IV. The MRI revealed a well-defined nodular lesion measuring 38x28x33 mm. The patient underwent surgery with no complications. After the histopathological examination and immunohistochemical staining, a diagnosis of glomangiomyoma was established. Glomangiomyomas are extremely rare but should be considered in the differential diagnosis of an adult presenting with a neck mass and localized tenderness, especially if no other risk factors for head and neck tumors are present.

The greatest air quality experiment ever: Policy suggestions from the COVID-19 lockdown in twelve European cities.

COVID-19 (Coronavirus disease 2019) hit Europe in January 2020. By March, Europe was the active centre of the pandemic. As a result, widespread "lockdown" measures were enforced across the various European countries, even if to a different extent. Such actions caused a dramatic reduction, especially in road traffic. This event can be considered the most significant experiment ever conducted in Europe to assess the impact of a massive switch-off of atmospheric pollutant sources. In this study, we focus on in situ concentration data of the main atmospheric pollutants measured in twelve European cities, characterized by different climatology, emission sources, and strengths. We propose a methodology for the fair comparison of the impact of lockdown measures considering the non-stationarity of meteorological conditions and emissions, which are progressively declining due to the adoption of stricter air quality measures. The analysis of these unmatched circumstances allowed us to estimate the impact of a nearly zero-emission urban transport scenario on air quality in 12 European cities. The clearest result, common to all the cities, is that a dramatic traffic reduction effectively reduces NO2 concentrations. In contrast, each city's PM and ozone concentrations can respond differently to the same type of emission reduction measure. From the policy point of view, these findings suggest that measures targeting urban traffic alone may not be the only effective option for improving air quality in cities.

An integrated air quality forecast system for a metropolitan area.

Air quality forecasting is an important issue in environmental research, due to the effects that air pollutants have on population health. To deal with this topic, in this work an integrated modelling system has been developed to forecast daily maximum eight hours ozone concentrations and daily mean PM10 concentrations, up to two days in advance, over an urban area. The presented approach involves two steps. In the first step, artificial neural networks are identified and applied to get point-wise forecasting. In the second step, the forecasts obtained at the monitoring station locations are spatially interpolated all over the domain using the cokriging technique, which allows to improve the spatial interpolation in the absence of densely sampled data. The integrated modelling system has been then applied to a case study over Northern Italy, performing a validation over space and time for the year 2004 and analyzing if the limit values for the protection of human health set by the European Commission are respected. The presented approach represents a fast and reliable way to provide decision makers and the general public with air quality forecasting, and to support prevention and precautionary measures.

Minimizing external indirect health costs due to aerosol population exposure: a case study from Northern Italy.

Environmental Agencies require Decision Support Systems, in order to plan Air Quality Policies considering the cost of emission reduction measures and the human health effects (with related social costs). The use of Decision Support Systems is also useful to spread information to general public, explaining the effectiveness of proposed air quality plans. In this paper, a multi-objective approach to control PM10 concentration at a regional level is presented. The problem considers both the internal costs (due to the implementation of emission reduction measures) and the external costs (due to population exposure to high PM10 concentrations). To model PM10 concentrations, a single surrogate model is used for the entire domain, allowing the implementation of a very efficient optimization procedure. The surrogate model is derived through a set of 10 simulations, performed using a Chemistry Transport Model fed with different emission reduction scenarios. The methodology is applied to Northern Italy, a region affected by very high PM10 concentrations that exceed the limit values specified by the EU legislation.

Middle turbinate mucosal flap: Low-morbidity option in the management of skull base defects.

BACKGROUND: To describe the low morbidity of middle turbinate mucosal flap (MTMF) to repair anterior skull base defects. METHODS: Skull base endonasal endoscopic surgeries performed at a tertiary hospital between 2015 and 2018 were analyzed. Patients were divided into two groups according the existence or not of a significant intraoperative cerebrospinal fluid (CSF) leak. In Group 1 (n = 28), gasket seal and a pedicled endonasal flap were used to repair the defect: 13 nasoseptal flaps (NSF), 8 inferolateral wall flaps (ILF), and 7 MTMF. In Group 2 only an endonasal flap was used: 9 NSF, 4 ILF, and 18 MTMF. Surgical and recovery time were analyzed (Student's t test). Our favorite surgical technique is described. RESULTS: Fifty-nine patients were included. Average surgical time was 27.7, 41.6, and 11.3 min for NSF, ILF, and MTMF, respectively. MTMF showed a faster recovery. CONCLUSION: MTMF is a safe reconstructive option for anterior skull base defects.

Head and Neck Manifestations of Granulomatosis with Polyangiitis: A Retrospective analysis of 19 Patients and Review of the Literature.

Introduction Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis characterized by a necrositing granulomatous inflammation of the upper and lower respiratory tracts and focal/proliferative glomerulonephritis. In more than 70% of the cases, the presenting symptoms are head and neck manifestations that are often misdiagnosed as infectious or allergic in etiology. Objective The present study provides an analysis of head and neck manifestations in a series of patients diagnosed with GPA. It also evaluates their medical and surgical treatment and provides a review of the relevant literature. Methods A retrospective analysis of 19 patients diagnosed with GPA at a public tertiary care hospital between 2006 and 2017 was performed. Results A total of 19 patients were included in the present study, and 16 of them presented head and neck manifestations. Sinonasal symptoms were the most common, affecting 56% of the patients, followed by laryngotracheal (31.25%) and ear (25%) symptoms. In 7 patients, sinonasal symptoms were the first manifestation of the disease (43.75%). Four patients underwent surgery at some stage of the disease. Conclusions Head and neck involvement is common in GPA and may stand for the first or the only manifestation of the disease. The otolaryngologists play a central role in the diagnosis and long-term treatment of these patients, and they have to keep this pathology in mind when treating patients with ENT symptoms that do not respond as expected to the treatment.

Identification of Factors Related to Cases of Benign Paroxysmal Positional Vertigo Refractory to Canalicular Repositioning Maneuvers and Evaluation of the Need for Magnetic Resonance Imaging in their Management: Retrospective Analysis of a Series of 176 Cases.

Introduction Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo, and, in most cases, it presents a favorable prognosis. The treatment is based on a series of specific canalicular repositioning maneuvers that offer an efficacy close to 100%. Despite this, there are cases that are refractory to treatment, with the persistence of the vertigo symptoms. Objectives The objective of the present paper is to analyze the factors associated with an increased risk of refractory BPPV and the importance of nuclear magnetic resonance in the study of these patients. Methods We retrospectively reviewed the cases of 176 patients diagnosed with BPPV in our center. We divided them into two groups: responders and non-responders to the treatment, and analyzed the possible risk factors associated with a higher risk of refractory vertigo. Fischer exact test was used. Results We found 11 cases refractory to treatment; all of them underwent magnetic resonance imaging (MRI) with gadolinium according to our protocol. Of these, four had an otoneurologic background or pathology, and two other patients presented a multicanal involvement. The difference between the two groups was statistically significant ( p < 0.05). Conclusion Otoneurologic background and multicanal involvement were associated with a higher risk of refractory BPPV. When dealing with a BPPV with persistent symptomatology/nystagmus or with early relapse after an initial improvement, other entities that enter into the differential diagnosis must always be considered. We consider it essential to perform an MRI with gadolinium to rule out cases of BPPV that have a central cause.

Hearing outcomes of the active bone conduction system Bonebridge® in conductive or mixed hearing loss. / Resultados auditivos del sistema activo de conducción ósea Bonebridge® en hipoacusias conductivas o mixtas.

OBJECTIVE: The active transcutaneous bone conduction implant Bonebridge®, is indicated for patients affected by bilateral conductive/mixed hearing loss or unilateral sensorineural hearing loss, showing hearing outcomes similar to other percutaneous bone conduction implants, but with a lower rate of complications. The aim of this study was to analyze the hearing outcomes in a series of 26 patients affected by conductive or mixed hearing loss and treated with Bonebridge®. METHODS: 26 of 30 patients implanted with Bonebridge® between October 2012 and May 2017, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000Hz, the SRT50% and the percentage of correct answers at an intensity of 50dB with and without the implant. RESULTS: "Pure tone average" with the implant was 34.91dB showing an average gain of 33.46dB. Average SRT 50% with the implant was 34.33dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50dB. The percentage of correct answers at 50dB changed from 11% without the implant to 85% with it. We only observed one complication consisting of an extrusion of the implant in a patient with a history of 2 previous rhytidectomies. CONCLUSIONS: The hearing outcomes obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent alternative in the treatment of conductive or mixed hearing loss, and with a lower rate of complications.

Safe use of systemic bevacizumab for respiratory recurrent papillomatosis in two children.

Recurrent respiratory papillomatosis can be a devastating condition for a child, with severe consequences. Currently, there is no proven successful medical treatment. We describe the use of systemic bevacizumab to treat two children affected by aggressive recurrent respiratory papillomatosis. Respiratory symptoms and quality of life improved dramatically in both patients, without observing any toxicity. The only complication was mild proteinuria. Systemic bevacizumab is a promising adjuvant treatment in aggressive recurrent respiratory papillomatosis in children. It is effective and well tolerated. Further studies are needed to establish the optimal dosing frequency and duration of therapy. Laryngoscope, 129:1001-1004, 2019.

Design and validation of a multiphase 3D model to simulate tropospheric pollution.

This work presents the Transport and Chemical Aerosol Model (TCAM) formulation and its validation in the frame of CityDelta-CAFE project. TCAM is a 3D eulerian multiphase model simulating tropospheric secondary pollution at mesoscale. It is included in the GAMES (Gas Aerosol Modelling Evaluation System) modelling system, designed to support the analysis of secondary pollution dynamics and to assess the impact of emission control strategies. The presented validation assessment has been performed in the frame of the CityDelta II project over the Milan domain and concerns both gas and aerosol 1999 simulations. Ozone, nitrogen oxides and aerosol computed and observed patterns have been compared and analysed by means of statistical indicators showing high model performances for both winter and summer pollution regimes.

A non-linear optimization programming model for air quality planning including co-benefits for GHG emissions.

This paper introduces the MAQ (Multi-dimensional Air Quality) model aimed at defining cost-effective air quality plans at different scales (urban to national) and assessing the co-benefits for GHG emissions. The model implements and solves a non-linear multi-objective, multi-pollutant decision problem where the decision variables are the application levels of emission abatement measures allowing the reduction of energy consumption, end-of pipe technologies and fuel switch options. The objectives of the decision problem are the minimization of tropospheric secondary pollution exposure and of internal costs. The model assesses CO2 equivalent emissions in order to support decision makers in the selection of win-win policies. The methodology is tested on Lombardy region, a heavily polluted area in northern Italy.