The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children.

BACKGROUND AND OBJECTIVES: Based on our previous single-center study on optimization of treatment of chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) in children using a noninvasive system approach to lower the necessity of antibiotics, analgesic use, and surgical interventions, we proceeded to perform a multicenter investigation in an outpatient setting. The purpose of the previous prospective study in 2013-2015 was to compare outcomes in the treatment of COME and AH using the noninvasive multimodal integrative method (IM) versus conventional treatment practice (COM). MATERIALS AND METHODS: In this paper, we retrospectively analyze the data of patients treated with the integrative method between 2017 and 2020 in a multicenter setting and compared the outcomes with data from 2013-2015 in order to evaluate generalizability. In both periods, all eligible and willing participants were included and treated with the IM protocol under real-life conditions. The treatment involved pneumatization exercises, education, an antiallergic diet, nasal hygiene, useful constitutional therapy, and thermal interventions (P.E.A.N.U.T.). A total of 48 versus 28 patients, aged 1-8, were assessed, presenting with COME and AH, with moderate to severe hearing impairment at entry. RESULTS: The significant improvement found in both audiometric measures (intact hearing) and tympanometric measures (normal A-type curve) was similar in both datasets with respect to conventional treatment. The new data confirms that the P.E.A.N.U.T. method results in a significant reduction of antibiotics, analgesic use, and surgical interventions. CONCLUSION: In this multicenter trial, we confirm the effectiveness of the noninvasive system approach for the treatment of COME in lowering the need for antibiotics and analgesic use and elective surgery. This could be especially important with respect to a generally observed increase in antibiotic resistance. The method is easy to perform in different clinical settings and is effective, safe, and well-tolerated.

Germanium in the soil-plant system-a review.

Germanium (Ge) is widespread in the Earth's crust. As a cognate element to silicon (Si), Ge shows very similar chemical characteristics. Recent use of Ge/Si to trace Si cycles and changes in weathering over time, growing demand for Ge as raw material, and consequently an increasing interest in Ge phytomining have contributed to a growing interest in this previously rather scarcely considered element in geochemical studies. This review deals with the distribution of Ge in primary minerals and surface soils as well as the factors influencing the mobility of Ge in soils including the sequestration of Ge in secondary mineral phases and soil organic matter. Furthermore, the uptake and accumulation of Ge in plants and effects of plant-soil relationships on the availability of Ge in soils and the biogeochemical cycling of Ge are discussed. The formation of secondary soil minerals and soil organic matter are of particular importance for the concentration of Ge in plant-available forms. The transfer from soil to plant is usually low and shows clear differences between species belonging to the functional groups of grasses and forbs. Possible uptake mechanisms in the rhizosphere are discussed. However, the processes that are involved in the formation of plant-available Ge pools in soils and consequently its biogeochemical cycling are not yet well understood. There is, therefore, a need for future studies on the uptake mechanisms and stoichiometry of Ge uptake under field conditions and plant-soil-microbe interactions in the rhizosphere as well as the chemical speciation in different plant parts.

Automatic determination of 3D orientations of fossilized oyster shells from a densely packed Miocene shell bed.

Shell beds represent a useful source of information on various physical processes that cause the depositional condition. We present an automated method to calculate the 3D orientations of a large number of elongate and platy objects (fossilized oyster shells) on a sedimentary bedding plane, developed to support the interpretation of possible depositional patterns, imbrications, or impact of local faults. The study focusses on more than 1900 fossil oyster shells exposed in a densely packed Miocene shell bed. 3D data were acquired by terrestrial laser scanning on an area of 459 m2 with a resolution of 1 mm. Bivalve shells were manually defined as 3D-point clouds of a digital surface model and stored in an ArcGIS database. An individual shell coordinate system (ISCS) was virtually embedded into each shell and its orientation was determined relative to the coordinate system of the entire, tectonically tilted shell bed. Orientation is described by the rotation angles roll, pitch, and yaw in a Cartesian coordinate system. This method allows an efficient measurement and analysis of the orientation of thousands of specimens and is a major advantage compared to the traditional 2D approach, which measures only the azimuth (yaw) angles. The resulting data can variously be utilized for taphonomic analyses and the reconstruction of prevailing hydrodynamic regimes and depositional environments. For the first time, the influence of possible post-sedimentary vertical displacements can be quantified with high accuracy. Here, the effect of nearby fault lines-present in the reef-was tested on strongly tilted oyster shells, but it was found out that the fault lines did not have a statistically significant effect on the large tilt angles. Aside from the high reproducibility, a further advantage of the method is its non-destructive nature, which is especially suitable for geoparks and protected sites such as the studied shell bed.

Integrative versus Conventional Therapy of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children: A Prospective Observational Study.

BACKGROUND: Chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) are common entities in the pediatric population. The conventional treatment approach (conventional medicine; COM) involved mainly surgery after a period of close observation. In this study, we aimed to introduce an integrative, non-invasive approach (integrative medicine; IM) for COME, AH, and associated episodes of recurrent acute otitis media, and compared outcomes with conventional treatment. METHODS: We conducted a prospective, non-randomized study in an integrative primary care pediatric practice and a conventional pediatric otolaryngological clinic, where treatment modality was determined by patient preference. Out of a total 101 patients aged 1-8 years, integrative therapy was chosen by 46, and conventional treatment by 55. All patients had COME and AH diagnosed by an otolaryngologist and had moderate to severe hearing impairment. COM treatment was based on close observation over time, nasal decongestants and surgical intervention. In contrast, the IM involved a complex personalized approach with non-invasive interventions, non-allopathic medications, diet and patient education. RESULTS: The number of surgical interventions (adenoidectomy, pressure-equalization tube insertion, myringotomy) was significantly less in the IM cohort (1 of 28 vs. 15 of 35 in the COM group, p < 0.001). The frequency of antibiotic use was significantly less in the IM group (p < 0.001). The frequency of analgesic use was also significantly less in the IM group (p = 0.029). Improvement in tympanometric measures (normal A-type curve) was higher in IM patients compared to expected spontaneous remission during the observation period. Improvement in audiometric measures (intact hearing) of IM patients was also higher than expected compared to spontaneous remission during the observation period. CONCLUSION: Compared to conventional treatment, integrative treatment of patients with COME and AH showed significantly lower invasive surgical intervention rates and significantly decreased antibiotic and analgesic use. The integrative treatment was effective, safe and well tolerated.

Effects of intercropping of oat (Avena sativa L.) with white lupin (Lupinus albus L.) on the mobility of target elements for phytoremediation and phytomining in soil solution.

This study aims to investigate how intercropping of oat (Avena sativa L.) with white lupin (Lupinus albus L.) affects the mobile fractions of trace metals (Fe, Mn, Pb, Cd, Th, U, Sc, La, Nd, Ge) in soil solution. Oat and white lupin were cultivated in monocultures and mixed cultures with differing oat/white lupin ratios (11% and 33% lupin, respectively). Temporal variation of soil solution chemistry was compared with the mobilization of elements in the rhizosphere of white lupin and concentrations in plant tissues. Relative to the monocrops, intercropping of oat with 11% white lupin significantly increased the concentrations of Fe, Pb, Th, La and Nd in soil solution as well as the concentrations of Fe, Pb, Th, Sc, La and Nd in tissues of oat. Enhanced mobility of the mentioned elements corresponded to a depletion of elements in the rhizosphere soil of white lupin. In mixed cultures with 33% lupin, concentrations in soil solution only slightly increased. We conclude that intercropping with 11% white lupin might be a promising tool for phytoremediation and phytomining research enhancing mobility of essential trace metals as well as elements with relevance for phytoremediation (Pb, Th) and phytomining (La, Nd, Sc) in soil.