Publications by authors named "Massimo Ralli"

177 Publications

Weekly chemotherapy as first line treatment in frail head and neck cancer patients in the immunotherapy era.

J Transl Med 2021 Jul 12;19(1):303. Epub 2021 Jul 12.

Department of Clinical and Molecular Oncology, "Sapienza" University of Rome, 00185, Rome, Italy.

Objective: First-line therapy for metastatic squamous cell carcinoma of the head and neck (R/M HNSCC) has been revolutionized by the introduction of anti-checkpoint monoclonal antibodies, which have shown a significant improvement in overall survival (OS) gaining approval in a first line setting. Efficacy and safety of first-line weekly chemotherapy, compared to 3-weeks treatment, was retrospectively evaluated in a frail patient population with R/M HNSCC with the aim to evaluate its role as part of a personalized first-line approach.

Methods: A total of 124 patients with locally incurable R/M HNSCC receiving weekly (21) or three-weekly (103) chemotherapy plus cetuximab in a first line setting from December 2010 to September 2020 were retrospectively reviewed. Treatment outcomes in terms of objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and toxicities were analysed.

Results: Patients in the three-week subgroup were ECOG PS 0 (39) and 1 (64) while patients in weekly group (21) were all PS 2. No significant differences were reported in terms of age, sex, smoking and previous alcohol abuse considering the two distinct subgroups. Moreover, no statistically significant difference was found in PFS and OS between the two treatment subgroups. The response rate was 35% (36 patients) and 34% (7 patients) in three-week and weekly treatment group, respectively. Seventy patients (68%) in the three-week group experienced chemotherapy-related toxicities, predominantly G3. In the weekly group a predominantly low-grade toxicity was found in a lower number of patients (52%).

Conclusion: The weekly schedule appears to be an active and safe strategy in frail patients with R/M HNSCC. Based on these data, a weekly schedule could be considered as a first line treatment in all frail patients excluded from pembrolizumab treatment and a study on the combination of weekly chemotherapy and immunotherapy should be performed.
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http://dx.doi.org/10.1186/s12967-021-02975-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274020PMC
July 2021

Biomarkers of laryngeal squamous cell carcinoma: a review.

Ann Diagn Pathol 2021 Jul 2;54:151787. Epub 2021 Jul 2.

Surgical Sciences Department, University of Turin, Corso Dogliotti 14, 10124 Turin, Italy.

Laryngeal carcinoma is the second common malignancy of the upper aerodigestive tract after lung cancer; in most cases is a squamous cell carcinoma, whose risk factors include tobacco smoking and alcohol consumption. Despite therapeutic progress, the five-year overall survival rate for this malignancy has remained nearly 50% and many patients already present metastasis at the time of diagnosis. To date, there are no tools that predict the evolution of laryngeal carcinoma: in this light, during the last years, many studies were planned with the aim to investigate the role played by different biomarkers expressed by larynx cancer, which can help make an early diagnosis, predict disease evolution and direct therapeutic choice. This review aims to summarize these markers and correlating them with disease evolution.
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http://dx.doi.org/10.1016/j.anndiagpath.2021.151787DOI Listing
July 2021

Health and Social Inequalities in Women Living in Disadvantaged Conditions: A Focus on Gynecologic and Obstetric Health and Intimate Partner Violence.

Health Equity 2021 15;5(1):408-413. Epub 2021 Jun 15.

Primary Care Services, Eleemosynaria Apostolica, Vatican City State, Vatican City.

Gynecologic and obstetric health and intimate partner violence are particularly influenced by social determinants of health, such as poverty, low education, and poor nutritional status, and by ethnic and racial factors. In this study, we evaluated health and social inequalities of women living in disadvantaged neighborhoods in the city of Rome, Italy. The study included 128 women living in socioeconomically disadvantaged neighborhoods. For each woman, a medical record was compiled and a gynecologic examination with screening for cervical cancer was performed. Family network, risk factors for gender-based violence, and psychological abuse were also evaluated. The largest part of the sample, although had adequate schooling, was unemployed or had a low-status job; this was at the basis of intimate partner violence in about one-third of our sample. Nearly 35% of our sample was composed of pregnant women; about half of them were not assisted by the public health system for routine obstetric examinations. Common findings at gynecologic examination for nonpregnant women were infections (=18, 19.9%), pregnancy planning (=13, 13.7%), menopause management (=12, 12.6%), ovarian fibromas (=6, 6.3%), and post-partum assistance (=3, 3.2%). Screening for cervical cancer was executed in 62 women; 9 (14.5%) had low- or high-grade squamous intraepithelial lesion or cervical carcinoma. Health and social inequalities are frequent in women living in disadvantaged conditions, with serious consequences for health and quality of life of women and of their children. Prevention and treatment, especially for the most vulnerable subjects, should be a priority for the public health system.
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http://dx.doi.org/10.1089/heq.2020.0133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237099PMC
June 2021

Impact of COVID-19 pandemic on the incidence of otitis media with effusion in adults and children: a multicenter study.

Eur Arch Otorhinolaryngol 2021 Jul 4. Epub 2021 Jul 4.

Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forli, Italy.

Purpose: To compare and analyze the incidence of otitis media with effusion (OME), before and during the COVID-19-related pandemic period, to evaluate the effects of the social changes (lockdown, continuous use of facial masks, social distancing, reduction of social activities) in the OME incidence in children and adults.

Methods: The number of diagnosed OME in e five referral centers, between 1 March 2018 and 1 March 2021, has been reviewed and collected. To estimate the reduction of OME incidence in children and adults during the COVID-19 pandemic period the OME incidence in three period of time were evaluated and compared: group 1-patients with OME diagnosis achieved between 1/03/2018 and 01/03/2019 (not pandemic period). Group 2-patients with OME diagnosis achieved between 1/03/2019 and 1/03/2020 (not pandemic period). Group 3-patients with OME diagnosis achieved between 1/03/2020 and 1/03/2021 (COVID-19 pandemic period).

Results: In the non-pandemic periods (group 1 and 2), the incidence of OME in the five referral centers considered was similar, with 482 and 555 diagnosed cases, respectively. In contrast, the OME incidence in the same centers, during the pandemic period (group 3) was clearly reduced with a lower total number of 177 cases of OME estimated. Percentage variation in OME incidence between the first non-pandemic year considered (group 1) and the pandemic period (group 3) was-63, 3%, with an absolute value decrease value of-305 cases. Similarly, comparing the second non-pandemic year (group 2) and the pandemic year (group 3) the percentage variation of OME incidence was-68, 1% with an absolute value of-305 cases decreased.

Conclusions: Our findings showed a lower incidence of OME during the pandemic period compared with 2 previous non pandemic years. The drastic restrictive anti-contagion measures taken by the Italian government to contain the spread of COVID-19 could have had a positive impact on the lower OME incidence during the last pandemic year.
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http://dx.doi.org/10.1007/s00405-021-06958-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255053PMC
July 2021

Surgical Approach to Frontal and Ethmoid Sinus Osteomas: The Experience of 2 Metropolitan Italian Hospitals.

Ear Nose Throat J 2021 Jun 28:1455613211016895. Epub 2021 Jun 28.

Otolaryngology Unit, Ospedale Niguarda "Ca' Granda," Milano, Italy.

Objectives: The aim of this study was to report the surgical management experience of patients with osteomas of the frontal and ethmoid sinuses performed in 2 metropolitan Italian hospitals between 2012 and 2019.

Methods: A retrospective chart review of cases of frontal and ethmoid osteomas from the of Milan and the of Rome was performed. All patients underwent preoperative computed tomography and, when orbital or intracranial extension was suspected, magnetic resonance imaging. Surgical treatment was performed according to Chiu classification.

Results: A total of 38 cases of frontal and ethmoid sinus osteomas were included in the study; 22 patients were men and 16 were women. The mean age at diagnosis was 49 years. Seven (18.4%) patients were treated using an open approach; 3 (7.9%) patients underwent open and endoscopic approach; the remaining 28 (73.7%) patients were treated with endoscopic approach. Seven (18.4%) patients had a cerebrospinal fluid leak intraoperatively and were treated with the placement of tissue graft through the defect. The mean follow-up time was 18 months; no recurrence was observed at 12-month follow-up.

Conclusion: Osteomas of the frontal and ethmoid sinuses can be treated using different techniques, mostly endoscopically. The choice of surgical approach (endoscopic vs open) depends on the location and size of the osteoma, anatomical size, characteristic of the sinus, surgeon's experience, and available existing technical facilities. Cerebrospinal fluid leak is a possible complication of surgery.
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http://dx.doi.org/10.1177/01455613211016895DOI Listing
June 2021

Arachnoid Cysts of the Internal Auditory Canal: Multiplanar Magnetic Resonance Imaging With Audio-Vestibular Correlates.

Laryngoscope 2021 Jun 21. Epub 2021 Jun 21.

Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.

Objectives/hypothesis: To investigate prevalence, radiological characteristics, and functional correlates of arachnoid cysts (AC) of the internal auditory canal (IAC) region, including associations of nerve compression with auditory/vestibular symptoms and asymmetrical audiogram or vestibular testing.

Study Design: Retrospective study.

Methods: T2-weighted magnetic resonance imaging (MRI) studies of IACs were retrospectively analyzed from 1247 patients with asymmetric auditory or vestibular symptoms. Patients with radiological findings of AC of the IAC were identified. Multiplanar analysis was used to analyze cyst position in the IAC and assess nerve displacement or compression. Size, position, and presence of nerve compression were correlated with symptoms.

Results: Twenty-four patients had a cyst in the middle or fundus in the IAC. Diameter (P = .04) and position (P = .002) of AC were associated with symptoms. Sagittal analyses identified displacement versus compression (P = .003) more reliably than axial imaging. Symptom laterality was associated with the site of radiological abnormality. Vestibular nerve compression was associated with vertigo (P = .0001), and cochlear nerve compression was associated with auditory symptoms (P < .0001).

Conclusions: In a retrospective series of patients undergoing MRI of IACs for asymmetric auditory or vestibular impairment, clinical symptom profile correlated with blinded assessment of IAC lesions.

Level Of Evidence: 4 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29699DOI Listing
June 2021

Preoperative Multiparametric Ultrasound and Fine Needle Aspiration Cytology evaluation of parotid gland tumors: which is the best technique?

Med Ultrason 2021 Jun 10. Epub 2021 Jun 10.

Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.

Aims: To evaluate the pre-surgical diagnostic value of Multiparametric Ultrasound (MPUS) and Fine Needle Aspiration Cytology (FNAC) in differentiating parotid gland tumors, comparing the results with histology.

Materials And Methods: The study enrolled 84 patients with parotid gland lesions surgically treated in a single tertiary center and evaluated by MPUS. Each patient underwent FNAC. Histological examination was considered the gold standard.

Results: Histology identified 62 benign tumors and 22 malignancies. In the differential diagnosis between malignant and benign lesions, B-mode Ultrasound (US), Color-Doppler US, Contrast-Enhanced US (CEUS), Elastography (USE) and FNAC showed the following values of sensitivity: 82%, 81%, 86%, 77%, 73% respectively; specificity: 97%, 61%, 95%, 71%, 97% respectively; PPV: 90%, 43%, 86%, 50%, 89% respectively; NPV: 93%, 90%, 95%, 88%, 91% respectively; and accuracy: 89%, 71%, 90%, 78%, 84% re-spectively.

Conclusions: CEUS proved to be a valid and accurate method for identifying malignant tumors of parotid gland; the combination of B-mode US with CEUS showed similar diagnostic accuracy, but better sensitivity than CEUS taken alone. USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.
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http://dx.doi.org/10.11152/mu-3068DOI Listing
June 2021

Inner Ear Disorders in SCUBA Divers: A Review.

J Int Adv Otol 2021 May;17(3):260-264

Department of Surgical Sciences, University of Turin, Turin, Italy.

Self-Contained Underwater Breathing Apparatus (SCUBA) diving is a popular sport. However, improper diving may injure different organs. The majority of dive-related disorders concern otolaryngology, and may include hearing loss, tinnitus, aural fullness, disequilibrium, and vertigo. Three main inner ear pathological conditions can occur underwater: inner ear barotrauma (IEB), inner ear decompression sickness (IEDS), and alternobaric vertigo (AV). IEB results from inappropriate equalization of middle ear pressure and consequent inner ear injury produced by pressure changes within the middle ear; IEDS is characterized by the formation of gas bubbles within the vessels of the inner ear during rapid ascent; AV typically develops while ascending or performing the Valsalva maneuver and can follow asymmetrical equalization of middle ear pressure transmitted via the oval and round window membranes. The clinical pictures of these pathological conditions are partly superimposable, even if they have specific peculiarities. Before starting SCUBA diving, a fit-to-dive assessment is recommended. It should include an otolaryngologic examination with audiological assessment to evaluate nasal, middle ear, and tubal patency and to minimize the risk of IEB, IEDS, and AV. It is of utmost importance to identify individual risk factors and predisposing pathological conditions that favor inner ear injury before diving, to prevent acute events and preserve auditory and vestibular functions in SCUBA divers. This review aims to provide an overview of the pathological conditions characterized by inner ear injury in SCUBA divers, discussing their pathogenetic mechanisms, diagnostic work-up, and prevention.
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http://dx.doi.org/10.5152/iao.2021.8892DOI Listing
May 2021

Extraneural Sclerosing Perineurioma of the Tongue.

Ear Nose Throat J 2021 Jun 1:1455613211020539. Epub 2021 Jun 1.

Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

Perineurioma (PN) is an uncommon benign peripheral nerve sheath tumor. For the rarity of this tumor in the oral cavity, otolaryngologists and oral surgeons might not be familiar with this entity. Perineuriomas are typically benign and complete excision is deemed adequate management. Thus, their histological recognition is mandatory to avoid unnecessary overtreatment. We report the clinicopathologic findings of an uncommon variant, the Extraneural Sclerosing PN, in an unusual and never described site, the tongue.
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http://dx.doi.org/10.1177/01455613211020539DOI Listing
June 2021

Mediterranean Diet, Brain and Muscle: Olive Polyphenols and Resveratrol Protection in Neurodegenerative and Neuromuscular Disorders.

Curr Med Chem 2021 May 3. Epub 2021 May 3.

Institute of Biochemistry and Cell Biology, Section of Neurobiology, (IBBC-CNR), Rome. Italy.

The Mediterranean diet is worldwide recognized as a good prototype of nutrition due to the conspicuous intake of olive oil, nuts, red wine, legumes, fruit, and vegetables, all fundamental elements rich in antioxidant substances and polyphenols. Polyphenols are a wide range of phytochemicals and/or synthetic chemical compounds with proven beneficial properties for human health. In the present review, we critically summarize the well-characterized antioxidant and anti-inflammatory properties of polyphenols contained in the olives and extra virgin olive oil and of resveratrol, a non-flavonoid phenolic compound. We discussed the potential use of these polyphenols as pharmaceutical formulations for the treatment of human diseases. We also show the emerging importance of their consumption in the prevention and management of crucial neurodegenerative conditions (alcohol-related brain disorders and aging) and in neuromuscular disorders (Spinal Muscular Atrophy and Amyotrophic Lateral Sclerosis and Duchenne Muscular Dystrophy), where oxidative stress plays a predominant role.
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http://dx.doi.org/10.2174/0929867328666210504113445DOI Listing
May 2021

Cancer screenings among sexual and gender minorities by midwives' point of view.

Minerva Obstet Gynecol 2021 May 4. Epub 2021 May 4.

SITAC, Società Italiana per il Trattamento dell'Alcolismo Rome, Rome, Italy.

Background: Although women belonging to sexual and gender minorities are more at risk of gynecological and breast cancer, pieces of evidence have been provided that this population finds hardships getting involved in cancer screening programs. This happens because they tend to avoid clinical settings because of fear of discrimination, heteronormative assumptions, heterosexism, classism and homophobic slurs by healthcare professionals. On the other hand, medical programs that allow healthcare providers to have experience with LGBTQ people are scarce and there are no specific tools to assess sexual cancer risks in this population.

Methods: Studies included were obtained searching MEDLINE with keywords "lesbians", "queer women", "trans women", "LGBTQ women", "cervical cancer screening", "pap test", "oncology screening", "mammogram" and "prevention". 1577 papers were found. After filtering for species, sex, language and time range, 820 papers were left. The number of works included was 24 after title screening and 20 after abstract screening and full-text screening.

Conclusions: More research will be needed to develop tools with an inclusive, non-judgmental and open language capable of engaging the LGBTQ community. Cancer screening programs involve a large variety of healthcare providers including midwives. Midwives are multifaceted healthcare professionals whose large competence spectrum includes a variety of knowledge and skills going from antenatal care to education and research and they may efficiently provide cancer screenings. Midwives have been asking for more specialistic roles and calling for specific instruction to face the complex and ever-changing reality.
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http://dx.doi.org/10.23736/S2724-606X.21.04802-8DOI Listing
May 2021

Otolaryngology activity in two hospitals in northern and central Italy differently affected by COVID-19 pandemic.

Sci Prog 2021 Apr-Jun;104(2):36850421998487

Otolaryngology Unit, Ospedale Niguarda "Ca' Granda," Milano, Italy.

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic had a significant impact on the Italian healthcare system, although geographical differences were present; regions in northern Italy have been the most severely affected while regions in the south of the country were relatively spared. Otolaryngologists were actively involved in the management of the pandemic. In this work, we analyzed and compared the otolaryngology surgical activity performed during the pandemic in two large public hospitals located in different Italian regions. In northern Italy, otolaryngologists were mainly involved in performing surgical tracheotomies in COVID-19 positive patients and contributed to the management of these patients in intensive care units. In central Italy, where the burden of the infection was significantly lower, otolaryngologists focused on diagnosis and treatment of emergency and oncology patients. This analysis confirms the important role of the otolaryngology specialists during the pandemic, but also highlights specific differences between two large hospitals in different Italian regions.
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http://dx.doi.org/10.1177/0036850421998487DOI Listing
May 2021

Laryngeal Obstruction due to Blue Rubber Bleb Nevus Syndrome.

Ear Nose Throat J 2021 Apr 28:1455613211013078. Epub 2021 Apr 28.

Department of Oral and Maxillofacial Sciences, 9311Sapienza University of Rome, Roma, Italy.

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http://dx.doi.org/10.1177/01455613211013078DOI Listing
April 2021

Homeless Shelter Characteristics and Prevalence of SARS-CoV-2.

West J Emerg Med 2021 03 2;22(2):232-233. Epub 2021 Mar 2.

Eleemosynaria Apostolica, Primary Care Services, Vatican City State.

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http://dx.doi.org/10.5811/westjem.2020.11.50337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972400PMC
March 2021

Advanced midwifery practice: intrapartum ultrasonography to assess fetal head station and comparison with vaginal digital examination.

Minerva Obstet Gynecol 2021 Apr;73(2):253-260

Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy.

Background: Vaginal digital examination is considered the gold standard to evaluate patients during labor and delivery. However, transperineal ultrasound has been suggested as an effective tool in determining fetal head station during labor. Angle of progression (AOP), head-perineal distance (HPD) and head-symphysis distance (HSD) are reliable parameters to assess fetal head station during labor. The study aims were to evaluate how midwives can use AOP, HSD, HPD to assess the accuracy of digital vaginal exploration limited to the fetal head station.

Methods: Trained midwives for ultrasound analyses performed transperineal ultrasounds during the first stage of labor with 2D-convex probe in 62 pregnant women at term with a single fetus in cephalic presentation. Immediately before the intrapartum ultrasound, the birth attendant performed a digital examination to assess cervical dilatation and head station. The ultrasound scans were compared to the digital vaginal examination through the Tutschek's formula.

Results: AOP was wider in women who delivered vaginally without any complication if compared to "complicated delivery" group. HPD and HSD were greater in women who underwent an operative vaginal delivery or caesarean section. The vaginal exploration accuracy was 34%, but when ±1 cm was considered as tolerated, the overall accuracy was 74.19%.

Conclusions: Midwives may include ultrasounds in their clinical practice after adequate training or under the supervision of an ultrasound professional as an adjunct tool during labor to evaluate its progress and prevent any deviation from physiology.
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http://dx.doi.org/10.23736/S2724-606X.21.04687-6DOI Listing
April 2021

Alcohol Drinking, Apolipoprotein Polymorphisms and the Risk of Cardiovascular Diseases.

Curr Neurovasc Res 2021 Apr 6. Epub 2021 Apr 6.

Department of Experimental Medicine, Sapienza University of Rome, Rome. Italy.

Lipoprotein disorders are a major risk factor for atherosclerotic neuro-cardiovascular disease (ACVD) and are heavily influenced by lifestyle, including alcohol drinking. Moderate drinkers have a lower ACVD risk than abstainers because of their higher levels of high-density lipoprotein (HDL) cholesterol, an important protective factor against ACVD. On the contrary, heavy drinking increases ACVD risk. According to a large literature body, ethanol intoxication modifies lipid serum profile and induces endothelial dysfunction. Single nucleotide polymorphisms may influence the relationship between alcohol drinking, HDL cholesterol level, and atherosclerotic risk. The risk of ACVD in heavy drinkers seems enhanced in patients with apolipoprotein E4 allele, interleukin-6-174 polymorphism, and cholesteryl ester transfer protein TaqIB polymorphism. Apolipoprotein E4 is a known risk factor for ACVD, while apolipoprotein E2 has mixed effects. Therefore, even if a "protective role" may be attributed to moderate drinking, this effect cannot be extended to everyone.
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http://dx.doi.org/10.2174/1567202618666210406123503DOI Listing
April 2021

Role of Clinical-Demographic Data in Survival Rates of Advanced Laryngeal Cancer.

Medicina (Kaunas) 2021 Mar 15;57(3). Epub 2021 Mar 15.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00185 Rome, Italy.

: Laryngeal cancer is one of the most common cancers in the upper aerodigestive tract, and tobacco and alcohol habits are the most relevant risk factors. The role of these risk factors in the incidence of laryngeal carcinomas is well known, yet only a few studies have been conducted on their role as risk factors of prognosis. The aim of the study was to assess the impact of clinical-demographic data on overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) in patients with advanced-stage laryngeal cancer (Stage III-IV) who underwent total laryngectomy. : This retrospective study was carried out on patients with Stage III-IV laryngeal squamous cell carcinoma treated with total laryngectomy between 2004 and 2014. For each patient, clinical and anamnestic data were collected and collated in a database, including alcohol and smoking habits. : Considering the variable age, family history, alcohol, grading, subsite, stage, pT stage, pN stage, and adjuvant therapy, no statistical significance was found for five-year OS. Smoking was the only variable that was statistically significant ( = 0.0043). A relevant difference was noted in the five-year DFS between pN-negative and pN-positive tumors (74.3% vs. 55.26%, respectively; = 0.056), and a statistically significant difference was found between non- and ≤20 cigarettes/day smokers and heavy smokers (77.78% vs. 53.66%, respectively; = 0.021). The five-year disease-specific survival rate was 68.83%, and a significant difference was detected for the smoking and pN stage variables. Heavy smokers (43.90% died vs. 16.67% of the non- and ≤20 cigarettes/day smokers; = 0.0057) and pN-positive (42.1% died vs. 20.51% of the pN-negative patients; = 0.042) patients had a worse prognosis. : Smoking in our study was found to be an important independent risk factor for worse OS and DSS in patients with advanced laryngeal cancer.
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http://dx.doi.org/10.3390/medicina57030267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001944PMC
March 2021

Chloroquine and hydroxychloroquine ototoxicity; potential implications for SARS-CoV-2 treatment. A brief review of the literature.

Am J Otolaryngol 2020 Jul 8;42(5):102640. Epub 2020 Jul 8.

Department of Surgical Sciences, University of Turin, Turin, Italy.

Introduction: Current clinical evidences do not support any specific treatment against SARS-CoV-2. Chloroquine (CQ) and hydroxychloroquine (HCQ) are typically used in the treatment of rheumatoid arthritis, systemic lupus erythematosus and malaria; they have been considered for off-label and compassionate use in several countries against moderate to severe cases of COVID-19 and there's actually a massive demand of these two drugs. The aim of this paper is to briefly review the published literature, summarizing evidences about audiological implications after CQ and HCQ treatment.

Methods: We conducted a review of the literature on Medline and Pubmed platforms from 27th May 2020 to 30 May 2020. We combined MeSH terms of "chloroquine", "hydroxychloroquine", "ototoxicity", "hearing loss", "tinnitus", "deafness" and "hearing". Publications with relevant data were included. Selected data (authors, country and year; sample size; study design; audiological side effects) were extracted and summarized in a table.

Results: Of 45 initial studies, 14 met inclusion criteria. The authors found xix cases of HCQ ototoxicity; Tinnitus was reported in 2 cases, and it was found to be reversible or irreversible. Sensorineural hearing loss after HCQ use was reported in 7 patients; it was found to be irreversible or partially reversible after discontinuation of HCQ in 6 cases. Eight papers reporting CQ ototoxicity were; tinnitus was not reported by any authors. Sensorineural hearing loss after taking CQ was reported in 6 patients; it was found to be irreversible after discontinuation of CQ in 5 patients. One patient showed abnormal gait after a single intramuscular injection of CQ. Thirteen patients' Auditory Brainstem Response (ABR) were found to be abnormal, but they resolved after CQ discontinuation.

Conclusions: CQ and HCQ related ototoxicity is widely reported in the literature although the pathophysiological mechanism is not well known. Current data are not sufficient enough to support the use of CQ and HCQ as therapy for COVID-19, but considering the growing demand for these two drugs and the number of people around the world who have taken and will take CQ and HCQ, it must necessarily consider the clinical and social impact of long term audiological side effects.
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http://dx.doi.org/10.1016/j.amjoto.2020.102640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342085PMC
July 2020

Impact of COVID-19 pandemic on the medical activities of the Directorate of Health and Hygiene, Vatican City State.

J Intern Med 2021 07 13;290(1):213-219. Epub 2021 Mar 13.

Directorate of Health and Hygiene, Vatican City State, Italy.

Objectives: To report the changes in volume and characteristics of medical activities in the Vatican City State during COVID-19 pandemic.

Methods: Data for general / emergency procedures , specialty consultations, radiology examinations and diagnostic procedures delivered by the Directorate of Health and Hygiene of the Vatican City State were retrospectively analysed. Analysis focused on the entire year 2020 and on the lockdown period 9 March - 18 May 2020.

Results: In 2020, 73.932 procedures were performed compared to 95.218 in 2019 (-22.4%). During lockdown, general / emergency activities decreased by 61.1%, specialty consultations by 85.3%, radiology examinations by 95.8%, and diagnostic procedures by 96.5%. A decrease was found for nearly all specialties; the most affected were occupational medicine and dermatology, whilst an increase was found for legal medicine, psychiatry and angiology.

Conclusion: Medical activities of the Vatican City State have been severely impacted, especially during the first months of the pandemic. However, organizational efforts allowed rapid restoration to near-normal volumes.
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http://dx.doi.org/10.1111/joim.13251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251324PMC
July 2021

Cerebrospinal Fluid Leak During Stapes Surgery: The Importance of Temporal Bone CT Reconstructions in Oblique Anatomically Oriented Planes.

Ear Nose Throat J 2021 Feb 24:145561320984569. Epub 2021 Feb 24.

Department of Surgical, Medical and Molecular Pathology, ENT Unit I, University of Pisa, Pisa, Italy.

Stapes gusher is a massive flow of perilymph and cerebrospinal fluid leak that fills the middle ear immediately after surgical opening of the labyrinth, such as during stapedectomy. Stapes gusher usually occurs as the result of a congenital malformation that causes an abnormal communication between the perilymphatic space and the subarachnoid space involving the internal auditory canal or the cochlear duct. To date, the potential risk of stapes gusher cannot be assessed preoperatively, as there are not pathognomonic signs suggestive of this complication. However, high-resolution computed tomography scan (HRCT) of the temporal bone can provide information that may help recognizing patients at risk. Recently, an anatomic evaluation of the inner ear with oblique reformation at HRCT has been described. This reformation offers a new and more detailed topographic vision of temporal bone structures compared to the classic axial and coronal planes and may help identifying anatomical alterations otherwise not visible. In this article, we present a case of stapes gusher and the role of preoperative HRCT with oblique reformation in its prevention.
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http://dx.doi.org/10.1177/0145561320984569DOI Listing
February 2021

Orbital wall decompression in the management of Graves' orbitopathy: a systematic review with meta-analysis.

Eur Arch Otorhinolaryngol 2021 Feb 18. Epub 2021 Feb 18.

Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020, Ancona, Italy.

Purpose: To systematically review outcomes of orbital bony wall decompression for Grave's orbitopathy according to the surgical approach.

Methods: A systematic search for studies published in "Ovid MEDLINE", "Web of Science" and "Embase" of patients with surgical treatment of Grave's orbitopathy was performed. The overall postoperative change in Hertel exophthalmometry was calculated by random-effect meta-analysis model with 95% confidence interval (CI).

Results: A total of 33 studies, including 1686 patients and 2946 procedures, were included. The weighted mean Hertel value overall reduction was - 4.56 mm (95% CI - 5.05 to - 4.07 mm). According to surgical techniques the reduction was - 4.36 mm (95% CI - 5.22 to - 3.50) for infero-medial technique, - 4.88 mm (- 5.68 to - 4.08) for medial-lateral technique, - 4.32 mm (- 4.80to - 3.84) for lateral technique, - 5.45 mm (- 6.16 to - 4.74) for three-wall technique and - 3.47 mm (- 5.81 to - 1.12) for medial technique. The overall rate of new-onset of primary gaze diplopia was reported in 23 studies. The included procedures were 653 and results were heterogeneous (heterogeneity: Q = 78.8 df = 22, I2 = 72.09%, p < 0.01). The pooled proportion (95% CI) rate of new-onset of primary gaze diplopia was 12% (7-16).

Conclusion: Our metanalysis highlights that orbital bony wall decompression represents an effective surgical procedure. The three wall approach was associated with the best results in terms of exophthalmos reduction. Data suggest that an exclusive lateral approach may help to avoid the new-onset of primary gaze diplopia during the postoperative period.
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http://dx.doi.org/10.1007/s00405-021-06698-5DOI Listing
February 2021

SARS-CoV-2 seroprevalence in the Vatican City State.

Eur J Intern Med 2021 04 4;86:98-99. Epub 2021 Feb 4.

Directorate of Health and Hygiene, Vatican City State; Department of Health Care Surveillance and Bioethics, section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

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http://dx.doi.org/10.1016/j.ejim.2021.01.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859713PMC
April 2021

Homelessness and COVID-19: Leaving No One Behind.

Ann Glob Health 2021 01 27;87(1):11. Epub 2021 Jan 27.

Primary Care Services, Eleemosynaria Apostolica, Vatican City State, Italy.

The United Nations 2030 Agenda for Sustainable Development promotes the "Leaving no one behind" principle and sets goals in areas of critical importance. This principle has become extraordinarily important during the COVID-19 pandemic, and is especially relevant for fragile populations, such as people experiencing homelessness. Homeless persons live in congregate and poor hygiene settings that may favor virus transmission, often have underling physical and mental comorbidities that place them at high risk of severe forms of COVID-19, and have limited access to public healthcare and social services. In addition, the homeless are often overlooked by safety and health monitoring actions. All of these factors, taken together, place homeless persons at high risk of being left behind. It is therefore of utmost importance to put in place adequate public health measures to limit spread of infection among homeless persons, rapidly identify and isolate asymptomatic and minimally symptomatic subjects, promptly and appropriately treat positive cases, and correctly handle the entire socioeconomic environment of vulnerable people.
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http://dx.doi.org/10.5334/aogh.3186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845474PMC
January 2021

Therapeutic options in Meniere's disease: Our experience.

Am J Otolaryngol 2021 May-Jun;42(3):102939. Epub 2021 Jan 23.

Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.

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http://dx.doi.org/10.1016/j.amjoto.2021.102939DOI Listing
July 2021

Involvement of ocular surface in graft-versus-host disease: An update from immunopathogenesis to treatment.

J Cell Physiol 2021 Sep 28;236(9):6190-6199. Epub 2021 Jan 28.

Department of Sense Organs, Sapienza University of Rome, Rome, Italy.

Graft-versus-host disease is a common complication of hematopoietic stem cell transplantation and the ocular surface is a main target of inflammatory reaction.
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http://dx.doi.org/10.1002/jcp.30304DOI Listing
September 2021

The Vatican City State Internal Healthcare System Response to COVID-19 Pandemic: Prevention and Control Strategies.

Appl Health Econ Health Policy 2021 03 20;19(2):141-144. Epub 2021 Jan 20.

Directorate of Health and Hygiene, Vatican City, Vatican City State.

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http://dx.doi.org/10.1007/s40258-020-00633-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816057PMC
March 2021

Narrative review of multiparametric ultrasound in parotid gland evaluation.

Gland Surg 2020 Dec;9(6):2295-2311

Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy.

Disorders affecting parotid gland represent a heterogeneous group comprising congenital, inflammatory and neoplastic diseases which show a focal or diffuse pattern of appearance. The differentiation of neoplastic from non-neoplastic conditions of parotid glands is pivotal for the diagnostic imaging. Frequently there is evidence of overlapping between the clinical and the imaging appearance of the various pathologies. The parotid gland is also often object of study with the combination of different techniques [ultrasound-computed tomography-magnetic resonance imaging (US-CT-MRI), ex.]. Compared to other dominant methods of medical imaging, US has several advantages providing images in real-time at lower cost, and without harmful use of ionizing radiation and of contrast enhancement. B-mode US, and the microvascular pattern color Doppler are usually used as first step evaluation of parotid lesions. Elastography and contrast-enhanced US (CEUS) has opened further possible perspectives to improve the differentiation between benign and malignant parotid lesions. The characterization of the parotid tumors plays a crucial role for their treatment planning and for the prediction of possible surgical complications. We present, here an updated review of the most recurrent pathologies of parotid gland focusing on the diagnostic power of multiparametric US including CEUS and ultrasound elastography (USE); limitations, advantages and the main key-points will be presented.
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http://dx.doi.org/10.21037/gs-20-530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804540PMC
December 2020

The safety of sublingual immunotherapy, can the rare systemic reactions be prevented?

Expert Opin Drug Saf 2021 Mar 21;20(3):259-264. Epub 2021 Jan 21.

Department of Sense Organs, Sapienza University, Rome, Italy.

: The safety of subcutaneous immunotherapy (SCIT), and particularly the dramatic issue of fatal reactions, has been an obstacle that limited the implementation of a therapy with unique characteristics of action on the causes of allergy. The introduction of sublingual immunotherapy (SLIT) was aimed at solving safety problems while maintaining clinical efficacy.: For more than 20 years, SLIT has been based on allergen extracts in drops at low average doses. As evidenced by meta-analyses, the typical adverse events (AE) have consisted of local reactions in the mouth and throat. Unlike the injection route, no correlation was observed between the administered dose and AEs. The development of SLIT products in tablets, based on higher doses than drops, has somewhat changed the concept of SLIT safety. Although large trials, performed to obtain regulatory agency approval, have shown overall high safety, rare anaphylactic reactions have been described.: SLIT is globally safe, and no fatal reactions have ever been reported, but with currently available high biological potency products it is necessary to follow prudential rules, such as the administration of the first dose under medical supervision and the thorough education of patients to avoid taking of higher doses than recommended.
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http://dx.doi.org/10.1080/14740338.2021.1874917DOI Listing
March 2021

Hearing loss and dementia: radiologic and biomolecular basis of their shared characteristics. A systematic review.

Neurol Sci 2021 Feb 7;42(2):579-588. Epub 2021 Jan 7.

Neurology Department, Wayne State University, Detroit, MI, USA.

Dementia and hearing loss share radiologic and biologic findings that might explain their coexistence, especially in the elderly population. Brain atrophy has been observed in both conditions, as well as the presence of areas of gliosis. The brain atrophy is usually focal; it is located in the temporal lobe in patients with hearing loss, while it involves different part of brain in patients with dementia. Radiological studies have shown white matter hyperintensities (WMHs) in both conditions. WMHs have been correlated with the inability to correctly understand words in elderly persons with normal auditory thresholds and, the identification of these lesion in brain magnetic resonance imaging studies has been linked with an increased risk of developing cognitive loss. In addition to WMHs, some anatomopathological studies identified the presence of brain gliosis in the elderly's brain. The cause-effect link between hearing loss and dementia is still unknown, despite they might share some common findings. The aim of this systematic review is to analyze radiologic and biomolecular findings that these two conditions might share, identify a common pathological basis, and discuss the effects of hearing aids on prevention and treatment of cognitive decline in elderly patients with hearing loss.
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http://dx.doi.org/10.1007/s10072-020-04948-8DOI Listing
February 2021

Assessment of SARS-CoV-2 infection through rapid serology testing in the homeless population in the City of Rome, Italy. Preliminary results.

J Public Health Res 2020 Oct 22;9(4):1986. Epub 2020 Dec 22.

Primary Care Services, Eleemosynaria Apostolica, Vatican City State.

The development of COVID-19 pandemic has affected all segments of the population; however, it had a significant impact on vulnerable subjects, such as in people experiencing homelessness. The aim of this study was to evaluate the prevalence of COVID-19 spread in homeless persons in the city of Rome, Italy. Patients included in the study underwent a clinical evaluation and rapid antibody analysis on capillary blood for the presence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to SARS-CoV-2 virus. Symptomatic patients were not included in the screening and immediately referred to local hospitals for further evaluation. One-hundred seventy-three patients of both sexes were tested for SARS-CoV-2 infection through rapid serological test. Age range was 10-80 years; people came from 35 different countries of origin and 4 continents. Test results were negative for most patients (170-98.2%); two patients had positive IgM (1.2%) and one patient had positive IgG (0.6%). Our study is the first to evaluate the prevalence of SARS-CoV-2 infection in people experiencing homelessness in the city of Rome, Italy. Most patients were negative for COVID- 19, although several factors may have had an impact on this result, such as the exclusion of symptomatic patients, the limited sensitivity of rapid serological tests in the initial stage of infection and the prevention measures adopted in these populations. Larger studies on fragile populations are needed to prevent and intercept new clusters of infection in the upcoming months.
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http://dx.doi.org/10.4081/jphr.2020.1986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772753PMC
October 2020
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