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Identify the critical points that lead to recurrences and lack of radicality in endolymphatic sac tumors (ELSTs). Retrospective case study and review of the literature. Tertiary referral center. Thirteen cases of ELST were included in the study and their preoperative, intraoperative and postoperative data were analyzed and compared to a review of the literature. Therapeutical. Prevalence of recurrent and residual tumors, comparison to the literature and analysis of ELST characteristics. Diagnosis was made 26 ± 17 months after the onset of symptomatology, and an ELST was preoperatively suspected in only six cases. At the time of surgery, 10 patients suffered from hearing loss. Preoperative symptoms or audiometry could not predict labyrinth infiltration, although speech discrimination scores were significantly associated with labyrinth infiltration (p = 0.0413). The labyrinth was infiltrated in 8 cases (57.1%), and in 7 cases (46.7%) the tumor eroded the carotid canal, whereas 6 cases (40%) presented an intradural extension. A gross total resection was achieved in 11 cases. There were two residual tumors, one of which because of profuse bleeding, and one recurrence (23.1%). A mean of 22.8% of recurrent or residual tumors are described in the literature based on 242 published cases, in more than half of the cases as a consequence of subtotal tumor resection (STR). Recurrence derives mostly from the difficulty to identify the extension of the tumor due to the extensive bone infiltration. Accurate diagnosis and correct preoperative planning, with embolization when possible, will facilitate surgery and avoid STR due to intraoperative bleeding. Long follow-ups are important in order to avoid insidious recurrences.

Objectives: To assess the validity of the subtotal petrosectomy (STP) technique in problematic cases of cochlear implant (CI) surgery, and review indications, outcomes, and related controversies. Study Design: This is a retrospective review of data from a private quaternary referral center of otology and skull base surgery. Patients and Methods: A review of patients who underwent CI with STP (STP-CI) as the leading approach was performed. Demographics, indications, surgical details, and main outcomes were evaluated. The surgeries performed were usually single-stage procedures encompassing a comprehensive mastoidectomy, blind sac closure of the external auditory canal (EAC), and mastoid obliteration with autologous fat. Results: A total of 107 cases were included. Mean follow-up was 7.1 years (range 1–13 years). The most frequent indication for STP-CI was chronic otitis media with/without cholesteatoma (32.7%), followed by open mastoid cavity (26.1%), and cochlear ossification (17.7%). Other difficult conditions where STP facilitates successful implantation include inner-ear malformations, temporal-bone trauma, unfavorable anatomic conditions, and revision surgery. A planned staged procedure was performed in 3 cases. The rate of major complications was 5.6% (n = 6). Three patients developed postauricular wound dehiscence which eventually resulted in device extrusion. No cases of recurrent/entrapped cholesteatoma, EAC breakdown, or meningitis were encountered. This is the largest single-center series of STP-CI reported in the literature. Conclusions: When CI is intended in technically challenging cases or associated with a high risk of complications, STP is effective and reliable. Safe implantation and excellent long-term outcomes can be achieved provided surgical steps are properly followed. Single-stage procedures can be performed in most cases, even when there is active middle-ear disease.

Invasive alien species threaten biodiversity and ecosystem structure and functioning, but incomplete assessments of their origins and temporal trends impair our ability to understand the relative importance of different factors driving invasion success. Continuous time-series are needed to assess invasion dynamics, but such data are usually difficult to obtain, especially in the case of small-sized taxa that may remain undetected for several decades. In this study, we show how micropaleontologic analysis of sedimentary cores coupled with radiometric dating can be used to date the first arrival and to reconstruct temporal trends of foraminiferal species, focusing on the alien Amphistegina lobifera and its cryptogenic congener A. lessonii in the Maltese Islands. Our results show that the two species had reached the Central Mediterranean Sea several decades earlier than reported in the literature, with considerable implications for all previous hypotheses of their spreading patterns and rates. By relating the population dynamics of the two foraminifera with trends in sea surface temperature, we document a strong relationship between sea warming and population outbreaks of both species. We conclude that the micropaleontologic approach is a reliable procedure for reconstructing the bioinvasion dynamics of taxa having mineralized remains, and can be added to the toolkit for studying invasions., peer-reviewed

Large deposits of gypsum accumulated in the marginal basins of the Mediterranean Sea during the Messinian Salinity Crisis. These form the marginal portions of the Mediterranean Salt Giant (MSG) that also occupies the deep, central Mediterranean basins. Although the marine, evaporitic origin of the MSG is undisputed, the analysis of gypsum fluid inclusions and of gypsum-bound water (d18OH2O and dDH2O) suggest that marginal basin gypsum formed from low- to moderate-salinity water masses (5 - 60 ‰), rather than from high-salinity brines (130 - 320 ‰), as expected during the evaporation of seawater. We present a new set of water isotope and fluid inclusion salinity data that extends the low salinity signature of gypsum to include five Mediterranean Sea marginal basins: Caltanissetta Basin (Sicily), Sorbas Basin (Spain), Piedmont Basin and Vena del Gesso Basin (northern Italy) and Catanzaro Trough (Southern Italy). With a simple geochemical model we explore the salinity-d18OH2O-dDH2O evaporation path and the 87/86Sr and d34SSO4 composition of the Mediterranean Sea subject to a variety of evaporation conditions and mixing ratios with continental runoff. This approach suggests that evaporation and mixing with continental runoff - including freshwater transiting via the Paratethys - cannot lead to the observed geochemical signature of MSC gypsum deposits. An alternative process that decouples the saturation state with respect to gypsum from salinity must have been active. We are exploring the possibility that the biogeochemical sulfur cycle leads to spatially and temporally localized gypsum supersaturation conditions via the production of SO42- by the oxidation and disproportionation of reduced sulfur compounds.

The fresh new cores 3AGN2S02 and 3AGN2S04 located in the deformed foredeep of the Gela Thrust System, locally known as Caltanissetta Basin, represent an opportunity for a better comprehension of the Messinian events, as well as for the reconstruction of the Sicilian evaporitic Basin architecture. The entire ‘early Messinian stage’ (7.2-5.96Ma) preceding the Messinian Salinity Crisis (MSC) has been already investigated in the Caltanissetta Basin. Even though the Tripoli Formation and ‘Calcare di Base’ (‘CdB’) have been widely studied for a long period of time, many aspects remain unclear. The ‘CdB’ has been commonly considered to represent the first evaporitic unit of the Messinian succession in Sicily. Different ages obtained in the underlying Tripoli deposits from various Sicilian outcrops display a diachronous onset of the MSC (Rouchy & Caruso, 2006). However, Manzi et al. (2011) propose an alternative interpretation for the ‘CdB’, suggesting that it does not belong exclusively to the onset of the MSC, but it is made of three carbonate facies belonging to different MSC stages. A detailed sedimentological, geochemical and petrographic study of the two cores allowed us to evidence the paleoceanographic changes that affected the central Mediterranean Sea during the transition from marine to restricted conditions, up to the onset of the MSC, and to observe the differences between the marginal and the deep basins of the Caltanissetta Basin, enhanced by the ongoing regional tectonics. Facies characterization made it possible to confirm the nature of the sediments of the cores, reflecting distinct depositional environments. A lithological transition passing from the Tripoli Formation to the complex ‘CdB’ carbonates alternating with shales is observed (3AGN2S04). This CdB appears to be laterally equivalent to gypsum and salts at site 3AGN2S02. In the brecciated facies of the ‘CdB’, evaporite pseudomorphs are also present, implying early stage diagenesis. Furthermore, our analyses gave us insights of strong oscillations in hypersaline conditions with freshwater inputs controlled by Milankovitch’s cycles. Moreover, the 3AGN2S04 core is characterized by the repetition of sedimentary successions due to the later development of a thrust system, which can be an important hint concerning the morphological and structural evolution of the Caltanissetta Basin. These new data are fundamental for stratigraphic reconstructions, comparing them with the already well-calibrated reference section of Falconara-Gibliscemi but also with other outcrops located in the various depocenters of the Caltanissetta Basin. The local transition from the uppermost part of the Tripoli cycles to the ‘CdB’ reflects the worsening of the marine connections, implying that during late Messinian broadly constant stressed environmental conditions existed in the central Mediterranean shelves. We conclude that since the onset of the MSC, marine inputs were not important enough to balance the effects of the climate fluctuations and the evaporation/precipitation budget in the individualized semi-closed settings.

In the eastern Mediterranean Sea, the early Holocene was characterized by major climatic and oceanographic changes that led to the formation of the last sapropel (S1) between 10.8 and 6.1 kyr cal. BP. These hydrographic changes might have altered the water exchange between the eastern and western Mediterranean sub-basins through the Strait of Sicily, but the existing evidences are inconclusive. In the present study we show new evidence from sediment core NDT-6-2016 located at the western flank of the Sicily channel, a key location to monitor the surface/intermediate water exchange between the two Mediterranean sub-basins. We perform paleo-hydrographic reconstructions based on planktic foraminifera ecology for the last 15 kyr cal. BP, including the S1 deposition interval. In addition, δ18O measurements in both Globigerina bulloides and Globigerinoides ruber and also major elements analyses in bulk sediment are presented. Our results show that significant changes in surface water properties occurred in W-Sicily characterized by a strong contrast in the seasonal hydrographic conditions during the S1 interval. This study proposes that the oceanographic changes in the eastern Mediterranean associated with the surface freshening promoted by the African monsoon likely triggered a restricted water exchange through the Strait of Sicily. This situation led to limited influence of the surface Atlantic waters into the studied area that favored the development of intense summer stratification and vertical winter mixing. This situation changed at about 7 kyr cal. BP when a decrease in the summer stratification probably reflected the influence of the eastward path of the surface Atlantic Waters. This situation would suggest a reinforcement of the water exchange through the Strait of Sicily that marked the end of the extreme conditions that prevailed in the eastern Mediterranean during the S1 formation.

Radiofrequency cavity is one of the most critical and complicated components in a cyclotron. Dee voltage of radiofrequency cavity accelerates charged particles to achieve required energy. Peak voltage of Dee is the key parameter of an radiofrequency cavity. Balanced Dee voltage is very important for effective beam cantering and beam extracting. An X-ray measurement has been made to calibrate and verify the peak voltage of Dee in a low-power ( 20 kW) test. The X-ray measurement for radiofrequency cavity was designed by means of bremsstrahlung. A suitable shielding cover was chosen for radiofrequency cavity and the X-ray measurement design was demonstrated according to the theory of photon transmission. Finally, the peak voltage of Dee was obtained at the power of 10-20 kW and the balance of Dee voltage was verified.

A detailed biostratigraphical and cyclostratigraphical study provided the opportunity of cycle-by-cycle correlations between sections from the marginal and deep areas of the Caltanissetta Basin (Sicily), and the northern Calabrian Rossano Basin. All the sections were compared with the Falconara-Gibliscemi composite section. We present new mineralogical and geochemical data on the transition from Tripoli to Calcare di Base (CdB), based on the study of several field sections. The outcrops display good record of the paleoceanographical changes that affected the Mediterranean Sea during the transition from slightly restricted conditions to the onset of the Mediterranean Salinity Crisis (MSC). This approach permitted to better constrain depositional conditions and highlighted a new palaeogeographical pattern characterized by separated sub-basins. The sedimentological and geochemical parameters of these basins introduced a different and diachronous response to the global constraints of the MSC. Our preliminary results display already evidences of paleoenvironmental changes: (1) a lithological transition passing from the Tripoli’s triplet (grey marls, reddish laminites and diatomites) to the complex carbonates of CdB; (2) the appearance of evaporite pseudomorphs implying early stage diagenesis; (3) the presence of sulphur-rich deposits involving process of bacterial sulphate reduction. The local transition from the uppermost part of the Tripoli cycles to the CdB reflects the worsening of the marine connections, leading to the individualisation of semi-closed settings where the marine inputs were not great enough to balance the effects of the climate fluctuations and especially of the evaporation/precipitation budget.

The Messinian Salinity Crisis (MSC) is a prominent and still misunderstood event that influenced the Mediterranean basin in the late Miocene leaving behind a Salt Giant (SG) widespread all over the Mediterranean basin. More than 90% of the Messinian Evaporitic deposits are located offshore with reduced access via boreholes, and thus has been studied mainly by seismic imaging. Onshore-Offshore should be considered a key for a better understanding and answering some of the controversies on the MSC.The Balearic Promontory (BP) contains a series of small perched basins presently lying at different water depths, stepped from the present-day coastline down to the deep basin. These topographic lows trapped sedimentary series up to 500m thick, interpreted as MSC in age.The reduced tectonic movements in the BP since the late Miocene (Messinian) till recent days, favored the conservation of the MSC records in this area. Moreover, recent studies revealed the presence of a Salt layer in the Central Mallorca Depression (CMD).Considering: 1- the bathymetry of the BP, classified as an intermediate perched basin; 2- the distribution of the MSC records accumulated in a series of sub-basins more or less connected between each other; 3- the geometries of the evaporitic formations, provided by how these records appear on the seismic data; this might recall similarities between the BP records (especially the ones in the CMD) and the MSC reference records outcropping in Sicily (especially in the Caltanissetta Basin).We perform seismic interpretation of a wide seismic reflection dataset in the study area with the aim of refining the mapping of the Messinian evaporites covering the study area. Four seismic units were identified in the BP based on their seismic facies and their seismo-stratigraphic position. We try to match up these units to the consensus Messinian 3-stages chrono-stratigraphic model proposed during the CIESM in 2008.We also attempt to find similarities in geometries, facies and distribution of the MSC between the sub-basins of the BP and those described in the Sicilian sub-basins.

Large deposits of gypsum accumulated in the marginal basins of the Mediterranean Sea during the Messinian Salinity Crisis. These form the marginal portions of the Mediterranean Salt Giant (MSG) that also occupies the deep, central Mediterranean basins. Although the marine, evaporitic origin of the MSG is undisputed, the analysis of gypsum fluid inclusions and of gypsum-bound water (d18OH2O and dDH2O) suggest that marginal basin gypsum formed from low- to moderate-salinity water masses (5 - 60 ‰), rather than from high-salinity brines (130 - 320 ‰), as expected during the evaporation of seawater. The formation of low-salinity gypsum poses a fundamental geochemical problem: how can gypsum saturation conditions be met in marginal basins if evaporation does not concentrate marine water to high salinity? In other words, can gypsum saturation be attained by adding Ca2+ and/or SO42- ions rather than by extracting water? We are exploring two geochemical scenarios to explain this phenomenon: (1) the addition of Ca2+ and SO42- to marginal basins by continental runoff, and (2) the non-steady state addition of SO42- to marginal basins via the biogeochemical oxidation of reduced sulfur. Both scenarios may lead - at least theoretically - to the decoupling of saturation state from salinity that is suggested by gypsum geochemical signatures.

Sulfur is a key element to understand ocean biogeochemical processes. Since decades, numerous studies have explained sulfur isotopic variations registred in the geological record as reflecting changes in continental sulfur inputs, biogeochemical recycling of sulfur and the relative proportion of oxidized (gypsum) vs reduced (e.g. pyrite) sulfur burial fluxes. Geochemical and petrographic studies have showed that these processes were active during the formation of the Mediterranean Salt Giant (MSG), a giant salt deposit formed at the end of the Messinian period (5.9-5.33 Ma) following the restriction of hydrological exchanges between the Mediterranean Sea and the Atlantic Ocean. To date, the biogeochemical sulfur cycle during the formation of the MSG has been investigated by analyzing the sulfur and oxygen isotope composition (δ34S and δ18O, respectively) of the sulfate ion in gypsum accumulated in the deep and marginal Mediterranean basins. In the uppermost gypsum layers (Upper Gypsum unit), significantly higher δ18O isotopic ratios (averaging at 12,7‰) than Messinian marine values suggest implications of microbial sulfate reduction activity followed by complete re-oxidation of sulfide back to sulfate in evaporated marine waters. Nevertheless, these different microbial processes can overprint each other δ34S and δ18O isotopic signatures and could have been provoked by various type of microbial metabolisms, involving different hydrological and environmental conditions. Here we present for the first time a multiple sulfur isotope (δ34S, Δ33S, Δ36S) investigation of samples from the well-known sections of Vena del Gesso (Apennines) and Pollenzo (Piedmont basin) in order to identify and understand how microbial mechanisms were coupled during the MSG formation. We designed a simple steady-state, three-box model representing the analysed S-bearing fractions (SO42-, S0, FeS2) and the different hydrological and biogeochemical S fluxes involved in marginal basin S-cycling. This system of 18 equations allows us to explain the strong isotopic variations we measured (-40.2 to 25.4‰ in δ34S, -0.001 to 0.160‰ in Δ33S and -1.79 to 0.001 in Δ36S‰) as produced by a huge variability in sulfate reduction activity reflecting fluctuations in the availability of organic matter. Moreover, our results, with relatively high λ33net (0.513 to 0.516) suggest than more than 90% of the hydrogen sulfide produced was re-oxidized by disproportionation reactions. Large, cyclic fluctuations of the Mediterranean hydrological cycle, and the presence of easily accessible S-compounds with a variety of oxidation states, makes the MSG a key system to understand the dynamics of the S biogeochemical cycle in the geological past.

Objective We present an extremely rare report of congenital cholesteatoma (CC) in identical twins with atypical location. Methods Two consecutive cases of CC in identical twins from diagnosis to treatment and a literature review are presented. Results The twin children presented to our otology and lateral skull base clinic with different clinical picture. Both underwent thorough audiological workup and imaging and early surgical intervention. The 6-year follow-up of these two children has been uneventful with no recurrence of disease and hearing restoration. Conclusion Multiple theories exist to explain this rare pathology. Modified Levenson’s criteria define it as white mass behind intact tympanic membrane. Atypical location of CC with recurrent otitis media is not uncommon; hence, further study is required. To our best knowledge, this is the second reported occurrence in identical twins but first report with differential presentation and atypical location in both cases.

Lead (Pb) has been regarded as a very toxic element that poses a serious threat to biota. A mesocosm experiment is performed to assess the influence of Pb on meiofaunal (metazoans within 45-500 µm) and benthic foraminiferal (protozoans) communities. To this end, sediments bearing such communities are incubated in mesocosms, exposed to different levels of Pb in seawater, and monitored for up to eight weeks. Concentrations of Pb below 1 ppm in water do not promote a significant increase of this metal in sediments. Relatively high concentrations of Pb seem to affect meiofaunal and benthic foraminiferal communities by reducing their richness or diversity, and the abundance of the most sensitive taxa. The mesocosm approach can be considered an effective method to document the responses of meiofaunal and benthic foraminiferal communities to various kinds and concentrations of pollutants over time. This approach allows the evaluation of dose-response relationships, validates the outcomes of field studies, and possibly confirms the sediment quality guidelines and thresholds. This article is protected by copyright. All rights reserved.

Reimbursement by payers (policy makers and budget holders) is critical for the uptake and use of new diabetes technologies. The purpose of this article is to describe the different reimbursement pathways that exist for new diabetes technologies in five selected European countries using examples of recent reimbursement decisions. Countries can be grouped into one of three categories: “top-down” (where reimbursement decisions are usually made by policy makers, eg, France), “bottom-up” (where reimbursement decisions are usually made by budget holders, eg, Italy and Spain) and “mixed” (where reimbursement decisions can be made by both policy makers and budget holders, eg, Germany and England). Whatever category a specific country falls into will have different implications from a market access perspective.

To evaluate incidence, demographics, surgical, and radiological correlates of incomplete and false tract electrode array insertions during cochlear implantation (CI). To evaluate outcomes in patients with incomplete electrode insertion (IEI). Retrospective analysis. Otology and skull base center. Charts of 18 patients (19 ears) with incomplete or false tract insertions of the electrode array were evaluated who underwent CI, with at least 1 year follow-up (from 470 cases). Demographic findings, etiologies, pre-operative radiologic findings, operative records, post-operative plain radiographic assessment for extent of electrode insertion, and switch-on mapping were evaluated. Audiological outcomes were evaluated using maximum and last recorded vowel, word, sentence, and comprehension scores for patients with IEI. Incidence of insertional abnormalities was 4.25% with 17 instances of incomplete and 2 cases of insertion into superior semicircular canal. Mean age and duration of deafness were 55.18 ± 4.62 and 22.12 ± 5.71 years. Etiologies in the IEI group were idiopathic, otosclerosis, meningitis, chronic otitis media (COM), temporal bone fractures, and Neurofibromatosis-2. 29.4% cases had cochlear luminal obstruction. Mean radiological and active electrophysiological length of insertion was 20.49 ± 0.66 and 19.49 ± 0.88 mm, respectively. No significant correlation was observed between audiological outcomes and insertional length except in time to achieve maximum word scores (p = 0.04). Age at implantation had significant correlations with last recorded word and comprehension scores at mean follow-up of 42.9 months, and with time to achieve maximum auditory scores. IEI during cochlear implantation using straight electrodes can occur with or without cochlear luminal obstruction. Age plays an important role in the auditory rehabilitation in this patient subset.

Planktonic foraminiferal biostratigraphy and isotope stratigraphy analyses of Turonian-Maastrichtian deposits have been carried out in the western part of the Kopet-Dagh Basin. The identification of the planktonic foraminiferal assemblages has led to the recognition of twelve Upper Cretaceous zones (Helvetoglobotruncana helvetica Zone to the Contusotruncana contusa-Abathomphalus mayaroensis zone) from the Tethyan realm. The obtained stable carbon isotope profile correlates with other reference curves, revealing many Late Cretaceous events including the Hitchwood, Navigation, Light Point, East Cliff, White Fall, Late Campanian Event (LCE), Campanian-Maastrichtian Boundary Event (CMBE), Middle Maastrichtian Event (MME) and KPg Events (KPgE). The Turonian-Maastrichtian deposits of the studied area represent severe changes in sedimentation rate and several hiatuses and condensed intervals, which mostly coincide with lithological boundaries. The data indicate a general shallowing -upwards in association with the Late Cretaceous tectonics of the Kopet-Dagh Basin. The reconstruction of the age model allows a discussion of the results in terms of changes in palaeoenvironmental conditions (eutrophic vs. oligotrophic).

Cholesteatomas in children have a more aggressive growth pattern compared to adults, which leads to a higher incidence of both residual and recurrent disease. A staged canal wall-up or a canal wall-down tympanomastoidectomy (CWUT and CWDT, respectively) is selected depending on the extent of the disease and condition of the middle ear (ME) cleft and mastoid. Endoscopic ear surgery (EES) has been recently introduced as an adjuvant tool for the treatment of this pathology even in the pediatric population. Objectives To analyze long term outcomes of CWUT and CWDT in the pediatric population, focusing on residual and recurrence rates of cholesteatoma and hearing results. A literature review including cases treated with EES were discussed. Material and methods Pediatric patients treated for cholesteatoma involving both the ME and mastoid with a follow-up (FU) of at least 4 years were retrospectively analyzed in a quaternary referral center for otology and lateral skull base surgery. Patients were grouped according to the surgical technique (CWUT versus CWDT). Rates of residual and recurrent cholesteatoma after each surgical technique were reported and compared. Mean Air-Bone Gap (ABG) of 0.5-1-2-4 KHz was measured and reported before the first surgery and at the last post-operative FU. Results Two-hundred and thirty-six cases fulfilled our inclusion criteria. The mean FU was 100.4 ± 44.2 months (median 89 months). One-hundred and five (44.5%) cases underwent a CWUT, whereas 131 (55.5%) a CWDT. A second stage surgery was performed in 73.5% of CWUT and 58.7% of CWDT. Among the CWUT group, residual cholesteatoma occurred in 22 (21%) ears and recurrence in 24 (22.9%). Patients undergoing CWDT showed lower rates of both residual and recurrent cholesteatoma (7.6% and 2.3%, respectively). ABG improvement was noted for both groups, even though CWUT showed better post-operative hearing results. Conclusions The CWDT technique offers a definite surgical therapy, with minimal residual and recurrence rates and audiological results comparable to the CWUT technique. EES must still prove its added benefit or equivalence to pure microscopic approaches.

Objectives To evaluate the long-term surgical outcomes of cochlear implantation (CI) in chronic otitis media (COM) with cholesteatoma and open cavities using subtotal petrosectomy (STP). To review device explantation (DE) patients and reimplantation considerations. Study design Retrospective review. Setting Otology and skull base center. Patients and methods Charts of 35 patients (36 ears) with COM with cholesteatoma, including open cavities, who underwent CI were reviewed for surgical outcomes and DE. Patient demographics, pathologies, previous surgeries, staging of implantation, salient intraoperative findings at the time of implantation and follow-up were evaluated. Details of patients with DE were evaluated for cause, operative findings, and reimplantation considerations. Results Mean age of patients was 65.94 years. Nineteen open cavities, 11 primary cholesteatomas, 3 petrous bone cholesteatomas, and 3 atelectatic middle ears represented the pathologies with 31 patients of CI with concurrent STP and 5 patients where implantation was staged. The mean follow-up was 7.16 years ranging from 2 to 13 years. Four patients (11%) had DE due to extrusion and cavity infection with three reimplanted in same or contralateral ear. All explantations occurred within 24 months of primary implantation. No residual or recurrent cholesteatoma was observed in any of the patients during follow-up. Conclusion CI is feasible in COM with cholesteatoma and open cavities with the use of STP and single-stage implantation can be performed in the absence of purulence. Despite low risk of residual cholesteatoma post meticulous disease removal, risk of DE remains, particularly in open cavity patients, and is higher than standard implantation. Reimplantation is often possible with careful considerations.

Objectives 1) To review the surgical and auditory outcomes and complications of cochlear implantation in cases with cochlear ossification. 2) To evaluate association between the extent and etiology of ossification to outcomes. Study design Retrospective study. Setting Otology and skull base surgery center. Subjects and methods Charts of 40 patients (42 ears) with cochlear ossification undergoing cochlear implantation were reviewed. Demographic features, operative findings, auditory outcomes, and complications were analyzed. Operative findings included extent of cochlear ossification, extent of drilling required to obtain patent cochlear lumen, approach (posterior tympanotomy/subtotal petrosectomy), electrode insertion (partial/complete, scala tympani/vestibuli), and complications. Auditory outcomes were assessed over a 4-year follow-up period using vowel, word, sentence, and comprehension scores. Patients were divided into groups (otosclerotic/non-otosclerotic and round window/basal turn ossification) for comparison of auditory outcomes. Outcomes were compared with 60 randomly identified controls (adults with postlingual deafness) who underwent implantation with no cochlear ossification. Results The median age and duration of deafness of patients was 54.39 and 27.15 years, respectively. Etiology of cochlear ossification was otosclerosis in 23 of 42 ears and mixed in 19 of 42 ears (chronic otitis media, temporal bone fractures, idiopathic, meningitis, Cogan's syndrome) with exclusive round window involvement in 54.7% of cases and the rest having partial or complete basal turn ossification. 59.5% ears underwent subtotal petrosectomy for implantation. Three patients underwent scala vestibuli insertion and five had incomplete electrode insertion. Auditory outcomes were comparable in otosclerotic and non-otosclerotic cases and in round window and basal turn ossification cases. No significant differences were observed in auditory scores when compared with controls with no ossification. Conclusions Cochlear implantation in cochlear ossification is feasible despite surgical challenges and modifications. Auditory outcomes in basal turn ossification appear to be comparable to cases with no ossification with extent of ossification having no significant association with outcomes.

A multi-scale analysis of sedimentary carbonate facies and post-sedimentary diagenetic features of the Calcare di Base Formation, the precursor to evaporites in Upper Messinian successions of Northern Calabria and Central Sicily, has revealed their microbial bio-mediated origin. Massive to laminated microbial boundstones represent the most common sedimentary facies forming flat to low relief cm to m scale stromatolitic and thrombolitic bodies. The fabric of the micrite varies from peloidal to aphanitic, and almost always preserves filamentous bacteria which characterized the original microbial mat. The mat was dominated by sulphur-oxidizing bacteria belonging to the Thiotrichaceae, but there is evidence for a more complex community with sulphate- and/or nitrate-reducing bacteria, all being responsible for the mediation of the carbonate precipitation. Microbial boundstones are rich in pseudomorphs of Ca-sulphate and halite, which formed during the deposition of the microbial carbonate. Layers of primary gypsum are interbedded locally with carbonates suggesting the presence of restricted marine conditions. The stable O and C isotopic composition of the carbonates, that vary from dolomite to aragonite and calcite, suggests a complex interplay between arid to humid climatic changes, expressed cyclic interbedding of the carbonate with marl-marlstone. Later diagenetic events mainly consist of phreatic meteoric recrystallization and cementation. Although considered as diachronous, the microbial carbonates can be mapped out over a distance of more than 500 km across southern Italy; this indicates near-constant environmental conditions upon the central Mediterranean shelf at the beginning of the salinity crisis. Deposition of the extensive subaqueous microbial deposit that largely comprises the Calcare di Base is envisaged to have taken place across a shallow to moderate depth platform with local slopes into deeper water areas, where some resedimentation occurred.

Objectives 1) To review the surgical and auditory outcomes in patients of cochlear implantation in otosclerosis. 2) To review complications and postimplantation facial nerve stimulation (FNS). 3) To compare the auditory outcomes between patients displaying cochlear ossification to the nonossified ones. Study design Retrospective study. Setting Quaternary Otology and Skull base surgery center. Subjects and methods Charts of 36 patients (38 ears) with otosclerosis undergoing cochlear implantation were reviewed from the cochlear implant database. Demographic features, operative findings, auditory outcomes, and postimplantation FNS were analyzed. Operative findings included extent of cochlear ossification, approach (posterior tympantomy/subtotal petrosectomy), electrode insertion (partial/complete, scala tympani/vestibuli), and complications. All the patients underwent implantation using straight electrodes. Auditory outcomes were assessed over a 4-year follow-up period using vowel, word, sentence, and comprehension scores. Patients were divided into two groups (with and without cochlear ossification) for comparison of auditory outcomes. Results The mean age and duration of deafness of patients was 59.72 and 28.9 years respectively. Twenty-three of 38 ears had cochlear ossification, with exclusive round window involvement in 60% of the patients, with the rest having partial or complete basal turn ossification. 36.8% ears underwent subtotal petrosectomy for cochlear ossification. One patient underwent scala vestibuli insertion and two had incomplete electrode insertion. Patients with no ossification had no intra or postoperative complications. One patient had bilateral FNS managed by alterations in programming strategy. Auditory outcomes in patients without any ossification were better than in patients with ossification, though statistically insignificant in most parameters. Conclusion Cochlear implantation in otosclerosis provides good auditory outcomes, despite high incidence of cochlear ossification. Patients of FNS can be managed by alterations in programming strategy, without affecting auditory outcomes.

Objectives/Hypothesis To describe the technique of subtotal petrosectomy (STP), to analyze the outcomes, and to review the literature Study Design A retrospective review. Methods Four hundred sixty cases of STP performed for various indications were included in the study, which was conducted at a quaternary referral center for otology and skull base surgery. Surgical and audiological parameters, and complications were evaluated. Our results were compared with the existing literature on the subject. Results Two hundred ninety-seven (64.6%) patients had been subjected to multiple surgeries before an STP was performed. The most common indication for STP was recurrent chronic otitis with or without cholesteatoma, with 165 (35.9%) patients. Difficult cases of cochlear implantation, temporal bone fractures, and class B3 tympanomastoid paragangliomas were the next most common indications, with 91 (19.8%), 43 (9.4%), and 38 (8.3%) cases, respectively. The median follow-up of the patient pool was 36 ± 19 months. Recidivism and postauricular wound fistula were the most common complications, seen in five (1.1%) patients each. This series of STP is the largest reported in the literature Conclusions STP is a very useful and safe surgical tool in the management of a variety of problematic situations in otology, as it offers the possibility of a definitive cure by offering radical clearance. This procedure can be combined safely with hearing implantation procedures. Level of Evidence 4. Laryngoscope, 127:2833–2842, 2017

International audience; The Messinian Salinity Crisis (MSC) is a controversial geological event that influenced the Mediterranean Basin in the late Miocene leaving behind a widespread Salt Giant. Today, more than 90% of the Messinian evaporitic deposits are located offshore, buried below the Plio-Quaternary sediments and have thus been studied mainly by marine seismic reflection imaging. Onshore-offshore records’ comparisons and correlations should be considered a key approach to progress in our understanding of the MSC.This approach has however not been widely explored so far. Indeed, because of the erosion on the Messinian continental shelves and slopes during the MSC, only few places in the Mediterranean domain offers the opportunity to compare onshore and offshore records that have been preserved from erosion. In this paper, we compare for the first time the MSC records from two basins that were lying at intermediate water depths during the MSC and in which salt layers emplaced in topographic lows: the Central Mallorca Depression (CMD) in the Balearic Promontory, and the Caltanissetta Basin (CB) in Sicily. The reduced tectonic movements in the CMD since the late Miocene (Messinian) till recent days, favored the conservation of most of the MSC records in a configuration relatively close to their original configuration, thus allowing a comparison with the reference records outcropping in Sicily. We perform seismic interpretation of a wide seismic reflection dataset in the study area with the aim of refining the mapping of the Messinian units covering the Balearic Promontory (BP) and restituting their depositional history based on a detailed comparison with the Messinian evaporitic units of the Sicilian Caltanissetta Basin. We discuss how this history matches with the existing 3-stages chrono-stratigraphic model. We show that the Messinian units of Central Mallorca Depression could be an undeformed analog of those outcropping on-land in the Sicilian Caltanissetta Basin, thus questioning the contemporaneous onset of the salt deposition on the Mediterranean scale. We show a change in seismic facies at a certain range of depth between stage 1 MSC units, and wonder if this could reflect the threshold/maximum depth of deposition of bottom growth PLG selenites passing more distally to pelagic snowfall cumulate gypsum. Moreover, we confirm that PLG could be deposited in water depths exceeding 200m.

To investigate the surgical and audiological outcomes of an installation of a bone-anchored hearing system (BAHS) procedure without tissue reduction using Ponto implants and abutments. Retrospective consecutive case series. Forty-nine patients, 18 years or older and eligible for treatment with a bone-anchored hearing system with tissue preservation surgery, were included in the study. Following a systematic scheme for medical outcomes, we collected the data regarding surgical intervention, quality of life (GBI), skin and soft tissue reactions (Holgers grading system), pain and numbness (VAS). Hearing performance (aided thresholds and speech recognition in noise) was recorded in 20 patients. No implants were lost, skin, and soft tissue reactions were mild in 96 % of the all visits. Quality of life (GBI) generally improved in the aided condition compared to prior to implantation. Audiologically, 100 % of the 20 patients examined showed improvement of speech reception and sound field thresholds comparing aided to unaided. An average improvement of 33 dB on PTA was recorded. The study, presenting data on a large population, treated with tissue preservation and modern titanium implants, shows that this treatment is a viable solution that results in fewer complications, high degree of predictability and good audiological results.

To reduce the secondary emission yield of an RF window ceramic so as to suppress the occurrence of a multipactor, we propose coating the window with a titanium nitride (TiN) film by atomic layer deposition. We investigate two groups of samples with film thicknesses of 56 and 8 nm, respectively, to analyze the composition and optimize the coating thickness of the TiN film on the ceramic. For the first group of samples (56 nm films), x-ray photoelectron spectroscopy (XPS) results show that the film can be divided into three mixed layers: a top layer composed of TiOxNy and TiO2; a middle layer consisting of TiN, TiOxNy, TiO2, and TiC; and a bottom layer called a diffusion layer, formed by decreasing TiN, TiOxNy, TiO2, TiC, and increasing A l 2 O 3 as the ceramic is approached. The depth of this bottom layer is ∼8 nm. Two more films (8 nm films) in the second group of samples were grown on a 96 ceramic and silicon to determine the sheet resistance, those on silicon is ∼1 kΩ/□ as measured by spectroscopic ellipsometry. According to the XPS results of the two 8 nm films, the content of TiOxNy and TiO2 increased while TiN content decreased in the film on 96 ceramic, compared to the film on silicon. Therefore, the 8 nm film is suitable for use as a coating for the RF window to weaken the multipactor effect and lower conductivity. To test the film performance, an RF ceramic window is coated with an 8 nm TiN film. Low-power measurements show that, within a frequency of 100 MHz, the 8 nm film on the RF ceramic window has a negligible effect on its transmission characteristics. 8 kW RF power tests indicate that the film coating can significantly improve the power transmission, anti-multipaction, and stability of the RF window.

This work deals with Messinian deposits belonging to the Neogene infill of the Rossano and Belvedere Basins, respectively developed along the fore-arc and the back-arc areas of the north Calabria accretionary wedge. The main goal is to characterize the carbonate and evaporitic sedimentation during the Messinian Salinity Crisis, in the general framework of the basin architecture and the interplay between eustatic vs tectonic controlled sea-level variations. Fieldwork integrated with seismic lines and well logs interpretations led to the revision of the general stratigraphy of the basins and the proposal of a new sequential stratigraphic model driven by cyclic sea-level variations. Each cycle, repeated at least two times during the Messinian Salinity Crisis time frame, begins with a relative sea-level fall responsible for the emplacement of prograding wedges composed of terrigenous and evaporitic deposits that, subsequently, evolve in the deposition of primary basin-fill evaporites. This phase is followed by open marine transgression due to relative sea-level rise that terminates the evaporite formation and predates the development of microbial dominated carbonate platforms associated with shallow-water evaporites. Both basins experienced intense tectonic activity during the Messinian, which could be responsible for huge basinward sediments exportation and fast decreasing in the accommodation space. However, this did not substantially influence the development of the systems tracts that, considering the basinal architecture, have been mainly controlled by eustatic sea-level variations. In fact, two major sea-level drops associated with basin restriction and aridity (cold) conditions seem to have caused the origin of two main evaporitic units as basin-fill evaporites, while consequent sea-level rises and less stressed condition, account for two carbonate units with limited evaporites and terrigenous deposition.

Cognitive dysfunctions are a common clinical feature of schizophrenia and represent important indicators of outcome among patients who are affected. Therefore, a randomized, controlled, monocentric, single-blind trial was carried out to compare two different rehabilitation strategies adopted for the restoration and recovery of cognitive functioning of residential patients with schizophrenia. A sample of 110 residential patients were selected and, during the experimental period, a group of 55 patients was treated with sets of domain-specific exercises (SRT+CRT), whereas an equal control group was treated with sets of non-domain-specific exercises (SRT+PBO) belonging to the Cogpack® software. The effects on the scores (between T0 and T1) of the variables treatment and time and of the interaction time X treatment were analyzed: for the total BACS, the main effect of the between-factors variable treatment is statistically significant (F=201.562 P=0.000), as well as the effect of the within-factors variable “time” (F=496.68 P=0.000).The interaction of these two factors is also statistically significant (F=299.594 P=0.000). The addition of cognitive remediation therapy (CRT) to a standard treatment of metacognitive training (MCT) resulted in a significant improvement in global neurocognitive functioning and has reported positive effects with regard to the strengthening of verbal and working memory, selective and sustained attention at T1. A relevant result is the statistically significance of “time X treatment” for all the tests administered: we can assume that the domain-specific cognitive training amplifies the effects of SRT, as the primary and secondary goals of the present study were achieved.

At the Istituto Nazionale di Fisica Nucleare – Laboratori Nazionali del Sud (INFN-LNS) the beam commissioning of the high intensity Proton Source (PS-ESS) and the Low Energy Beam Transport (LEBT) line for the European Spallation Source (ESS) has been completed. The official project schedule was satisfied and the packaging for the shipment to Lund will shortly begin. Due to the high flexibility of the magnetic system, and to the innovative approach developed for the commissioning, we were able to test a huge amount of configurations (more than 400˙000). The optimum source configuration that satisfy all requirements at the same time has been identified. The source is able to produce a stable total current between 40 and 125 mA (90 mA requested) through an 8 mm extraction aperture, with a proton fraction of up to 87% (75% requested). At the end of the LEBT the beam characteristics fully satisfy the ESS requirements: more than 70 mA of proton beam with 99% normalized beam emittance of 2.25 π.mm.mrad have been transported with intra pulse current fluctuation below ±1.5% (

Current ICT infrastructures are characterized by increasing requirements of reliability, security, performance, availability, adaptability. A relevant issue is represented by the scalability of the system with respect to the increasing number of users and applications, thus requiring a careful dimensioning of resources. Furthermore, new security issues to be faced arise from exposing applications and data to the Internet, thus requiring an attentive analysis of potential threats and the identification of stronger security mechanisms to be implemented, which may produce a negative impact on system performance and scalability properties. The paper presents a model-based evaluation of scalability and security tradeoffs of a multi-service web-based platform, by evaluating how the introduction of security mechanisms may lead to a degradation of performance properties. The evaluation focuses on the OPENNESS platform, a web-based platform providing different kind of services, to different categories of users. The evaluation aims at identifying the bottlenecks of the system, under different configurations, and assess the impact of security countermeasures which were identified by a thorough threat analysis activity previously carried out on the target system. The modeling activity has been carried out using the Stochastic Activity Networks (SANs) formalism, making full use of its characteristics of modularity and reusability. The analysis model is realized through the composition of a set of predefined template models, which facilitates the construction of the overall system model, and the evaluation of different configuration by composing them in different ways.

Objective 1. To analyze the surgical outcomes in the management of petrous apex cholesterol granulomas (PACG) with a brief literature review.2. To evaluate the importance of wait-and-scan management option. Study design Retrospective review. Setting Quaternary referral center for otology and skull base surgery. Subjects and methods Charts of 55 patients with at least 12 months of follow-up were analyzed for demographic, clinical, audiometric, and radiological features. Patients were divided into surgical group (SG) (n = 31) and wait-and-scan (n = 24) (WS) group. Surgical approach was chosen as per hearing status and PACG extension and relation to nearby neurovascular structures and included either drainage by transmastoid-infralabyrinthine approach (TM-IL)/transcanal-infracochlear approach (TC-IC) or resection by infratemporal fossa type B approach (ITF-B). The combination of ITF-B with trans-otic (TO) approach or TO approach solely was used in unserviceable hearing cases. Postoperative outcomes and complications were evaluated in SG. Results Postoperative symptom relief was observed in 24 patients (77.4%). Diplopia and paresthesia recovered in each case and improvement in headache, dizziness, tinnitus, and hearing loss was observed in 87.1% cases. Serviceable hearing was preserved in 24 of 26 cases. Postoperative complication rate was 32.2% including incidences of profound hearing loss, facial nerve paresis, carotid artery injury and intraoperative CSF leaks. Revision surgery was required in 3 (9.6%) cases, after TM-IL approach. Conclusion Surgical drainage is preferable to more aggressive resection procedures, with the latter reserved for recurrent lesions or lesions with severe hearing loss/involvement of critical neurovascular structures. ITF-B approach provides adequate cyst and neurovascular control for resection, while avoiding brain retraction. An initial wait-and-scan approach can be used in most patients where symptoms and imaging justify so.

A detailed study of the marine sediments collected on the inner shelf of some of the selected areas of the central Mediterranean Sea has been carried out in order to verify the presence of exotic benthic foraminiferal species. Since 2000, the coastal marine environments of the Pelagian Islands and of Sicily (central Mediterranean) have been increasingly colonized by exotic species (i.e. fishes and algae) originating both from the Atlantic Ocean and the Red Sea. The studied areas (Pelagian Islands and SE Sicily) are located in the middle of the Mediterranean Sea. Therefore, they represent an ideal place to understand how exotic species, coming from different Oceans, may have colonized ecological niches in the Mediterranean Sea. The objective of this study is to evaluate the colonization of benthic foraminiferal species which have migrated from the Atlantic Ocean and the Red Sea into the Mediterranean. The study shows that two species of Amphistegina ( lessonii and lobifera ) have massively colonized the Pelagian Islands. Furthermore, two ecomorphotypes of Amphistegina ( A . cf. lessonii and A . cf. papillos a), never described up to now, have been found attached to exotic green algae, of Indo-Pacific origin. In the study area, Amphisteginids are so abundant that they can account for up to 90% of the total assemblage. In addition to Amphistegina , other exotic benthic foraminifera, such as Amphisorus hemprichii , have colonized the central Mediterranean Sea. The migration might have been through the Suez Canal, as a Lessepsian invasion. Alternatively, other species, such as Sorites orbiculus might have colonized the Mediterranean Sea from the Atlantic Ocean, migrating through the Gibraltar gateway and/or from the Red Sea, via the Suez Canal.

Sr isotope records from marginal marine basins track the mixing between seawater and local continental runoff, potentially recording the effects of sea level, tectonic, and climate forcing in marine fossils and sediments. Our 110 new Sr-87/Sr-86 analyses on oyster and foraminifera samples from six late Miocene stratigraphic sections in southern Turkey, Crete, and Sicily show that Sr-87/Sr-86 fell below global seawater values in the basins several million years before the Messinian Salinity Crisis, coinciding with tectonic uplift and basin shallowing. 87Sr/86Sr from more centrally located basins (away from the Mediterranean coast) drop below global seawater values only during the Messinian Salinity Crisis. In addition to this general trend, 55 new Sr-87/Sr-86 analyses from the astronomically tuned Lower Evaporites in the central Apennines (Italy) allow us to explore the effect of glacio-eustatic sea level and precipitation changes on Sr-87/Sr-86. Most variation in our data can be explained by changes in sea level, with greatest negative excursions from global seawater values occurring during relative sea level lowstands, which generally coincided with arid conditions in the Mediterranean realm. We suggest that this greater sensitivity to lowered sea level compared with higher runoff could relate to the inverse relationship between Sr concentration and river discharge. Variations in the residence time of groundwater within the karst terrain of the circum-Mediterranean region during arid and wet phases may help to explain the single (robust) occurrence of a negative excursion during a sea level highstand, but this explanation remains speculative without more detailed paleoclimatic data for the region.