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OBJECTIVES: To assess the effect of the position of the SS on CI regarding the ability to perform posterior tympanotomy, round window visibility, and mastoid pneumatization. MATERIALS AND METHODS: This is a prospective study, including 65 adult patients with CI performed at our center during 2017. We used 3 methods to assess SS position using a computed tomography (CT) scan. Lee’s line passing through the tympanic segment of the facial nerve. Park’s line passing through the facial nerve and round window membrane. Our proposed method using a parallel line from the external auditory canal and passing through the facial nerve. Relation to mastoid pneumatization on CT and to intraoperative round window visibility were assessed in relation to intraoperative position of the SS. RESULTS: The method by Park et al. was statistically significant (p

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.

In this paper, a complete three-dimensional (3D) RF model of the cyclotron coaxial resonator—including the coaxial sliding shorts, the “Liner” vacuum chamber, the coupler, the trimmer, and the high RF voltage “Dee” structures—has been developed. An eigenmode analysis was used to simulate the tuning of the resonator in the operating frequency range of 15–48 MHz obtained by two movable sliding shorts and a trimmer. A driven analysis has been performed in order to compute the |S11| parameter (or impedance matching) of the cavity excited by a movable coaxial power coupler. The numerical simulations have been performed using the different peculiarities of two commercial tools, COMSOL Multiphysics and CST microwave studio. Experimental validation of the developed model is presented. The evidence of an unwanted electric field component, orthogonal to the accelerating field, was discovered and a mitigation is also proposed. The impact of the proposed modification was evaluated by using a 3D beam dynamics code under development in the framework of the Superconducting Cyclotron upgrade ongoing at INFN-LNS.

Unmanned aerial vehicles (UAVs) are autonomous devices employed as data collectors in precision agriculture to support a large number of applications. These UAVs gather data from on-the-ground wireless sensor networks, especially in scenarios that lack any kind of fixed communication infrastructure or where the available infrastructure does not fit the application requirements. Sensors on the ground can store sensing data, and in scenarios that do not require a real-time observation and analysis of the data, like in smart farming, a drone can be used maybe once or two times each day to collect and report the data to a command-and-control center that use them directly, without any other infrastructure (cloud or edges). In this article, we study analytically how close the drone, that uses a LoRa radio, needs to fly over the sensors to collect data with a given quality of data collection. This can be used to properly spacing the sensors on the field at deployment time, to select among different type of drones, and to properly solve some tradeoff related to field size vs autonomy of the drones and the path used by the latter when collecting the data.

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.

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.

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.

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.

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

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.

The Internet of Things (IoT) paradigm poses a great variety of application domains where million of devices work uninterruptedly to improve some aspect of our lives. To support the continuous execution of the applications working on the devices, energy harvesting systems enable to extract the energy found naturally in the environment (for instance from the sun or from the wind) and convert it into energy able to either sustain the device’s operation and recharge its batteries which, in conjunction with an appropriate scheduling strategy, led to the device to an electrically sustainable state (i.e. an energy-neutral state). Most of the works found in literature oriented to achieve energy neutrality are however evaluated by means of simulation which means that, in spite of precisely modeling hardware features and energy productions, lack of the realism that we find in a real deployment. A minor part of the works are based on a real deployment but do not share the collected data that permit to replicate the analysis. With this purpose in mind, in this article we describe a testbed designed for outdoor monitoring purposes in the IoT context, equipped with several sensors for weather conditions monitoring and with a solar panel to provide application lifetimes potentially infinite. The testbed was deployed on the roof of a building and it executed uninterruptedly an application able to generate a dataset with the collected information over a period of more than two months. This dataset has been online published to be used for different researching purposes, as for instance, prediction models of the energy production.

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.

Scheduling tasks appropriately in an IoT device powered by multiple energy-harvesting sources is a challenging problem. In this paper, we model this problem, and we present a scheduling algorithm that optimally sets the overall node power consumption based on the utility, and on the energy required by tasks. The algorithm schedules high-level tasks, it uses the weather forecast informations available at the beginning of each scheduling period (typically a day), and the level of the battery, to define an optimal schedule. The main goal is to find a schedule that is energy neutral on average, over a period longer than the single scheduling window, for example a week. We test our scheduler on a simulated platform with the same specs of an Arduino node, equipped with a small (portable) solar panel, and attached to a small wind turbine. We see from the simulations that the scheduler performs as expected and that the utility of the scheduling improves as the error between the expected forecast and the real harvested energy is reduced.

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.

Background Safe and effective insulin therapy for diabetes mellitus requires initial dose titration and regular adjustments based on blood glucose (BG) monitoring. Our objective was to explore the use of BG measurement in phase-III clinical studies of insulin analogs. These studies provide safety and efficacy information for regulatory authorities and are the basis for insulin analog regulatory approval. Methods A systematic review of phase-III studies of rapid-acting insulin analogs (insulin lispro, insulin aspart and insulin glulisine) and pre-mixed insulin analogs (biphasic insulin aspart and insulin lispro mix) was conducted. Studies were identified using manufacturers’ databases. Search for reports was performed in Medline and registry of clinical trials (clinicaltrials.gov). The European Medicines Agency was contacted to provide Clinical Study Reports. Results Forty-five studies were included. Regular BG measurements were reported in 100 % of the studies and were performed by either self-monitoring of blood glucose (SMBG) alone in 84 %, laboratory alone in 7 %, and both SMBG and laboratory in 9 % of studies. In total, 93 % of the studies reported SMBG. Most studies (91 %) reported insulin therapy adjustments based on BG measurements. Conclusions The findings suggest that BG monitoring and specifically SMBG are co-dependent technologies with insulin analogs. BG measurement is used in most phase-III registration studies for establishing safe and efficacious insulin administration and is recommended in the insulin labels. The indispensable role of SMBG in treatment of insulin-dependent patients should receive attention from health care payers to assess and reimburse SMBG along with insulin to avoid adverse events from inappropriate insulin administration and associated costs.

The Electron Cyclotron Resonance Ion Sources (ECRISs) development is strictly related to the availability of new diagnostic tools, as the existing ones are not adequate to such compact machines and to their plasma characteristics. Microwave interferometry is a non-invasive method for plasma diagnostics and represents the best candidate for plasma density measurement in hostile environment. Interferometry in ECRISs is a challenging task mainly due to their compact size. The typical density of ECR plasmas is in the range 10(11)-10(13) cm(-3) and it needs a probing beam wavelength of the order of few centimetres, comparable to the chamber radius. The paper describes the design of a microwave interferometer developed at the LNS-INFN laboratories based on the so-called "frequency sweep" method to filter out the multipath contribution in the detected signals. The measurement technique and the preliminary results (calibration) obtained during the experimental tests will be presented.

Underwater communications through acoustic modems rise several networking challenges for the Underwater Acoustic Sensor Networks (UASN). In particular, opportunistic routing is a novel but promising technique that can remarkably increase the reliability of the UASN, but its use in this context requires studies on the nature of mobility in UASN. Our goal is to study a real-world mobility dataset obtained from the Argo project. In particular, we observe the mobility of 51 free-drifting floats deployed on the Mediterranean Sea for approximately one year and we analyze some important properties of the underwater network we built. Specifically, we analyze the contact-time, inter- contact time as well density and network degree while varying the connectivity degree of the whole dataset. We then consider three known routing algorithms, namely Epidemic, PROPHET and Direct Delivery, with the goal of measuring their performance in real conditions for USAN. We finally discuss the opportunities arising from the adoption of opportunistic routing in UASN showing that, even in a very sparse and strongly disconnected network, it is still possible to build a limited but working networking framework.

Purpose The objective of this study was to assess the usefulness of low-dose intratympanic gentamicin administration in patients with Meniere's disease (MD). Materials and Methods We carried out a retrospective review of the charts of 55 patients with definite MD in accordance with the AAO-HNS (American Academy of Otolaryngology–Head and Neck Surgery) Diagnostic Scale who were treated at Gruppo Otologico (Piacenza, Rome, Italy). The treatment protocol consisted of 3 intratympanic injections of gentamicin at a 12-hour interval between each administration. Results Results were resumed in accordance with AAO-HNS criteria and showed complete control of vertigo spells in 60% (class A), good control in 16% (class B), moderate control in 4% (class C), poor control in 16% (class D), and no control in 4% (class E) of the patients. Audiological assessment showed unchanged thresholds in 61%, improvement in 22%, and worsening in 17% of the cases. Conclusion Administration of gentamicin is a good alternative to medical and surgical procedures in the treatment of intractable MD. One-day treatment allows for adequate control of vertigo attacks without compromising hearing and quality of life and with reduced costs.

Glomus tympanicum tumour is one of the commonest neoplasms of the middle ear. It is more common in females. The most common presenting symptom is pulsatile tinnitus. A retrotympanic mass is found in the middle ear in all the cases. Computed tomography (CT) scan is the investigation of choice, however in difficult cases magnetic resonance imaging (MRI) can be helpful. Surgery is regarded as the gold standard of treatment in spite of the fact that radiation therapy has also been advocated in the literature. In this series 17 cases of glomus tympanicum treated at Gruppo Otologico Piacenza – Rome (Italy) were analysed retrospectively. A simple and safe technique has been described. All the cases were female and treated by surgery. The tumour was removed completely in all the cases and the ossicular chain kept intact. Recurrence was encountered in only one case after nine years. Surgical removal of the tumour is recommended as the treatment of choice with the following advantages: complete removal, a low complication rate, a low recurrence rate, acceptable hearing level and minimum morbidity.

Mobile Social Networks represent a convergence between mobile communications and service-oriented paradigms, which are supported by the large availability and heterogeneity of resources and services offered by recent mobile devices. In particular, the service-oriented nature of MSN is in the capability of sharing resources and services among devices that lie in proximity and that opportunis- tically interact. Service discovery is thus of primary importance to sustain the most intimate mechanisms of MSN. Despite of their centrality, studies on service discovery in MSN are still in their youth. We contribute to frame the results achieved so far and to identify some possible perspectives of the research in this field, by giving a transversal review of the scientific outcomes in the different steps of service discovery, namely advertisement, query, selection and access.

The SPES project is the new Radioactive Ion Beam facility under construction at the Laboratori Nazionali of Legnaro, Italy. In this framework, the realization of a new RFQ Beam Cooler (RFQBC) is in progress. This device allows to improve the quality of the low energy ion beams produced by the ISOL technique, granting a reduction of transverse emittance and energy spread. The RFQBC is an electromagnetic apparatus operating with oscillating electric fields needed to confine the very low energy (eV) ions (Q=1+) which lose both the longitudinal and transversal momentum by making collisions with lighter atoms of the so called buffer gas (He). This process provides the reduction of the transversal emittance up to 10 times of the initial value and it keeps the energy dispersion within 2-3 eV. The electromagnetic design of the RFQ section and the electrostatic layout of the injection and extraction regions have been done. The beam dynamics study is going on by means of dedicated codes which allow to take into account the interaction of the ions with the buffer gas needed to cool the beams. The RF group of LNS Catania is involved in the design of the RF system (500W) providing the oscillating high voltage (up to 3 kV) at frequency which varies in the range of 1-30 MHz. The preliminary design of the device started in 2011 in the framework of REGATA experiment of the 5 th scientific committee of INFN and it is carrying on within the COOLBEAM experiment.

Prospective Study of Glomus Jugulare and Tympanicum Tumors: Clinical Findings, Surgical Approach and Outcomes, Short-Term Follow-Up: A Clinical Perspective Facial canal paragangliomas are rare and by definition they arise from the paraganglia along the vertical portion of facial canal. We report a case of a facial canal paragangliomas with extension into the internal auditory canal. This report describes for the first time this avenue of extension of facial canal paragangliomas.

The distributed gradient protocol is a common building block to perform several tasks in a wireless sensor network. The gradient calculates the minimum hop-distances between each sensor and a specified set of anchor sensors. This calculation is performed using a distributed greedy forwarding of messages in the network. Several virtual localization protocols use gradients to compute the virtual coordinates of the sensors. The quality of these coordinate systems depends on the relation between the value of the gradient and the real geographic distances between sensors. In this paper a formal proof of such relation is provided in the case of dense sensor networks with homogeneous sensor communication range r. The minimum-hop distances between a sensor and an achor is bounded to be in a range defined by two geographic distances. The size of this range decreases with increasing density of the network and it is equal to the maximum resolution (the communication range r) when the density is high enough.

Underwater Sensor Networks (USN) are used for harsh oceanographic missions where human operation is dangerous or impossible. Localization is essential for USNs. It is required for data tagging, node tracking and position-based routing algorithms. Localization is challenging because Global Positioning System(GPS) is not available in underwater; at the same time, existing GPS-less schemes based on fixed landmarks have high communication cost. Such cost is critical in Mobile Underwater Sensor Networks (MUSN), since sensor nodes drift with the ocean currents, thus requiring continuous refresh. In this paper, we propose a multi-stage localization scheme using mobile beacons. The beacons periodically ascent and descent in the water column. When they resurface, they receive new GPS coordinates. Then, they dive to the level of the underwater sensors to advertise these coordinates. In turn, localized sensors become proxy beacons and propagate their own coordinates, etc. This iterative, multi-stage localization is the major innovation of this paper. The goal is to localize the nodes with the smallest number of beacons using proxies instead, yet achieving an adequate accuracy. The major benefit is the reduction in operating costs. Mobility is a critical factor in determining performance. In this paper, performance (i.e., the percentage of localized nodes during a cycle, accuracy, delay and communication cost) is tested in a simulation scenario based on a realistic mobility model. The "Meandering Current Mobility with Surface Effect" (MCM-SE) model - a composite model combining surface and subsurface currents.

We consider the problem of routing with guaranteed de- livery in wireless sensor networks where physical locations of the sensors are not known. We propose a naming proto- col which defines a 2-dimensional coordinate system and a routing protocol (Ibrid) which ensures guaranteed delivery of packets. We show by means of simulation that in realis- tic settings where the network includes voids and obstacles, Ibrid finds routess hortest than those obtained with existing geographic routing algorithms over physical coordinates.

A novel routing protocol for wireless, mobile ad hoc networks is presented. This protocol incorporates features that enhance routing reliability, defined as the ability to provide almost 100% packet delivery rate. The protocol is based on a virtual structure, unrelated to the physical network topology, where mobile nodes are connected by virtual links and are responsible for keeping physical routes to their neighbors in the virtual structure. Routes between pairs of mobiles are set up by using information to translate virtual paths discovered in the virtual structure. Route discovery and maintenance phases of the protocol are based on unicast messages travelling across virtual paths, with sporadic use of flooding protocol. Most flooding is executed in the background using low priority messages. The routing protocol has been evaluated and compared with the Dynamic Source Routing protocol and with the Zone Routing Protocol by means of simulation.

Wireless ad hoc networks are generally characterised by random node locations and multi-hop routes. A quantitative knowledge of the relation between hop count and Euclidean distance could provide a better understanding of important network parameters such as end-to-end delay, power consumption along the route, and node localisation. In this paper, we present an analytic approach to capture the statistics on hop count for a given source-to-destination Euclidean distance in a greedy routing approach. We also show that, for a given hop count, the bounds on Euclidean distance can be computed from the distribution characteristics of per-hop progress.

To report our personal experience in the surgical treatment of cholesteatoma in children with Down syndrome.Retrospective study.Tertiary care otology and skull base centers.Nine patients with Down syndrome were surgically treated for cholesteatoma. Two patients had bilateral disease, resulting in a total of 11 ears surgically treated.A canal-wall-up mastoidectomy was performed in two ears; in eight of the ears, a canal-wall-down mastoidectomy was carried out and a modified Bondy procedure was performed in one ear.Residual cholesteatoma was found in one ear after the canal-wall-up mastoidectomy and recurrent cholesteatoma developed in another ear, also after canal-wall-up mastoidectomy. The recurrence required conversion to canal-wall-down mastoidectomy. One patient developed a perforation of the neotympanic membrane that had to be revised.Cholesteatoma in children with Down syndrome is a challenging entity for the otologic surgeon. Otolaryngologists should always suspect a cholesteatoma in each child with Down syndrome presenting warning symptoms such as otorrhea and hearing loss. If there is any doubt on inspection, further imaging studies (high-resolution computed tomography) are necessary. To the best of our knowledge, the current study is the first report to document the surgical treatment of cholesteatoma in subjects with Down syndrome.

From January 2000 the beam delivered from a superconducting ECR source [1] has been injected through the axial beam line in the K-800 superconducting cyclotron [2]. Along the axial hole the beam is bunched by the Axial Buncher, placed at 1/2 meter from the median accelerator plane of the cyclotron. In addition, along the injection line, to vary the duty cycle of the injected beam, a Low Energy Chopper is positioned. In the near future LNS has to deliver beam bunches as short as 500 ps FWHM with a separation time of 100–200 ns. This will be accomplished by a new beam chopping system, the Chopper 500. It will be installed along the cyclotron extraction beam line instead of the H. E. Chopper [3] and, together with the buncher should ensure these performances. A description and status report of the axial buncher, chopper 500 and low energy chopper is presented.