Search

Progress in high-energy physics has been closely tied to the development of high-performance electromagnetic calorimeters. Recent experiments have demonstrated the possibility to significantly accelerate the development of electromagnetic showers inside scintillating crystals typically used in homogeneous calorimeters based on scintillating crystals when the incident beam is aligned with a crystallographic axis to within a few mrad. In particular, a reduction of the radiation length has been measured when ultrarelativistic electron and photon beams were incident on a high-Z scintillator crystal along one of its main axes. Here, we propose the possibility to exploit this physical effect for the design of a new type of compact e.m. calorimeter, based on oriented ultra-fast lead tungstate (PWO-UF) crystals, with a significant reduction in the depth needed to contain electromagnetic showers produced by high-energy particles with respect to the state-of-the-art. We report results from tests of the crystallographic quality of PWO-UF samples via high-resolution X-ray diffraction and photoelastic analysis. We then describe a proof-of-concept calorimeter geometry defined with a Geant4 model including the shower development in oriented crystals. Finally, we discuss the experimental techniques needed for the realization of a matrix of scintillator crystals oriented along a specific crystallographic direction. Since the angular acceptance for e.m. shower acceleration depends little on the particle energy, while the decrease of the shower length remains pronounced at very high energy, an oriented crystal calorimeter will open the way for applications at the maximum energies achievable in current and future experiments. Such applications span from forward calorimeters, to compact beam dumps for the search for light dark matter, to source-pointing space-borne γ-ray telescopes, to decrease the size and the cost of the calorimeter needed to fully contain e.m. showers initiated by GeV to TeV particles.

The first search for ultra-rare K+ decays into the π+e+e−e+e− final state is reported, using a dataset collected by the NA62 experiment at CERN in 2017–2018. An upper limit of 1.4×10−8 at 90% CL is obtained for the branching ratio of the K+→π+e+e−e+e− decay, predicted in the Standard Model to be (7.2±0.7)×10−11. Upper limits at 90% CL are obtained at the level of 10−9 for the branching ratios of two prompt decay chains involving pair-production of hidden-sector mediators: K+→π+aa, a→e+e− and K+→π+S, S→A′A′, A′→e+e−.

Rapid local adaptation frequently occurs during the spread of invading species. It remains unclear, however, how consistent, and therefore potentially predictable, such patterns of local adaptation are. One approach to this question is to measure patterns of local differentiation in functional traits and plasticity levels in invasive species in multiple regions. Finding consistent patterns of local differentiation in replicate regions suggests that these patterns are adaptive. Further, this outcome indicates that the invading species likely responds predictably to selection along environmental gradients, even though standing genetic variation is likely to have been reduced during introduction. We studied local differentiation in the invasive annual plant Erodium cicutarium in two invaded regions, California and Chile. We collected seeds from across strong gradients in precipitation and temperature in Mediterranean-climate parts of the two regions (10 populations per region). We grew seeds from maternal families from these populations through two generations and exposed the second generation to contrasting levels of water and nutrient availability. We measured growth, flowering time and leaf functional traits across these treatments to obtain trait means and plasticity measures. We found strong differentiation among populations in all traits. Plants from drier environments flowered earlier, were less plastic in flowering time and reached greater size in all treatments. Correlations among traits within regions suggested a coordinated evolutionary response along environmental gradients associated with growing season length. There was little divergence in traits and trait intercorrelations between regions, but strongly parallel divergence in traits within regions. Similar, statistically consistent patterns of local trait differentiation across two regions suggest that local adaptation to environmental gradients has aided the spread of this invasive species, and that the formation of ecotypes in newly invaded environments has been relatively consistent and predictable.

Abstract A sample of 2.8 × 104 K + → π + μ + μ − candidates with negligible background was collected by the NA62 experiment at the CERN SPS in 2017–2018. The model-independent branching fraction is measured to be (9.15 ± 0.08) × 10 −8, a factor three more precise than previous measurements. The decay form factor is presented as a function of the squared dimuon mass. A measurement of the form factor parameters and their uncertainties is performed using a description based on Chiral Perturbation Theory at O $$ \mathcal{O} $$ (p 6).

This review aims to draw attention to the multiple ipsilateral otic capsule dehiscences (OCDs), which may cause therapeutic failure in operated patients. A series of six severely disabled patients with symptoms and signs consistent with a superior semicircular canal dehiscence (SSCD) diagnosis, confirmed by a high-resolution CT scan, is presented here. Five of the patients underwent surgery, and in four of the cases, the postoperative results were poor and/or disappointing. The ethical principles underlying modern medicine encourage medical staff to learn from past experience even when the results are modest despite the accuracy of the treatment applied to a patient. Consequently, we reviewed the radiological records of symptomatic and asymptomatic patients diagnosed or referred to our center for confirmation over the past 5 years to determine the incidence of multiple OCD in this population. Multiple localizations of suspected OCD in the ipsilateral ear did not appear to be rare and were found in 29 of 157 patients (18.47%) in our retrospective review using high-resolution thin-sliced CT scans. The decision to perform surgery for a documented symptomatic superior SSCD should be made with caution only after ruling out concomitant lesser-known variants of OCD in the ipsilateral ear.

Parasitic plants may indirectly modify arthropod community structure by inducing resistance/susceptibility in host plants. In the Atacama Desert, the mistletoe Tristerix aphyllus initiates cascading effects on its cactus host, Echinopsis chiloensis, inducing susceptibility to stem‐borer beetles, whose brood chambers are colonized by a diverse arthropod community.We evaluated whether those cascading effects initiated by Tristerix generate a positive or negative feedback loop on this parasitic plant. A positive or negative feedback loop would occur if the mistletoe‐elicited indirect effects on arthropod community result in increased or decreased mistletoe fitness, respectively. Specifically, by way of field sampling, experimental manipulation of number of brood chambers, and structural equation modelling, we assessed the indirect impact of number of brood chambers on Tristerix fitness mediated by its influence on the abundance of arthropod trophic guilds (omnivores, nectarivores, herbivores and predators).We found that the number of brood chambers had a positive indirect effect on mistletoe fitness, likely mediated by the increased abundance of nectarivores. The number of brood chambers was positively associated with the abundance of predators, nectarivores and herbivores. However, nectarivores were the only trophic guild showing a positive association with both number of brood chambers and Tristerix fitness.This positive feedback loop, together with the known pattern of specific disperser‐mediated cyclic reinfection of cacti by Tristerix, would indicate that mistletoe infection may ultimately threaten cactus survival. [ABSTRACT FROM AUTHOR]

A search for the K+→μ−νe+e+ decay, forbidden within the Standard Model by either lepton number or lepton flavour conservation depending on the flavour of the emitted neutrino, has been performed using the dataset collected by the NA62 experiment at CERN in 2016–2018. An upper limit of 8.1×10−11 is obtained for the decay branching fraction at 90% CL, improving by a factor of 250 over the previous search.

A novel irradiation platform for preclinical proton therapy studies foresees proton imaging for accurate setup and treatment planning. Imaging at modern synchrocyclotron-based proton therapy centers with high instantaneous particle flux is possible with an integration mode setup. The aim of this work is to determine an object’s water-equivalent thickness (WET) with a commercially available large-area CMOS sensor. Image contrast is achieved by recording the proton energy deposition in detector pixels for several incoming beam energies (here, called probing energies) and applying a signal decomposition method that retrieves the water-equivalent thickness. A single planar 114 mm × 65 mm CMOS sensor (49.5 µm pixel pitch) was used for this study, aimed at small-animal imaging. In experimental campaigns, at two isochronous cyclotron-based facilities, probing energies suitable for small-animal-sized objects were produced once with built-in energy layer switching and the other time, using a custom degrader wheel. To assess water-equivalent thickness accuracy, a micro-CT calibration phantom with 10 inserts of tissue-mimicking materials was imaged at three phantom-to-detector distances: 3 mm, 13 mm, and 33 mm. For 3 mm and 13 mm phantom-to-detector distance, the average water-equivalent thickness error compared to the ground truth was about 1% and the spatial resolution was 0.16(3) mm and 0.47(2) mm, respectively. For the largest separation distance of 33 mm air gap, proton scattering had considerable impact and the water-equivalent thickness relative error increased to 30%, and the spatial resolution was larger than 1.75 mm. We conclude that a pixelated CMOS detector with dedicated post-processing methods can enable fast proton radiographic imaging in a simple and compact setup for small-animal-sized objects with high water-equivalent thickness accuracy and spatial resolution for reasonable phantom-to-detector distances.

Abstract The mechanisms behind the unique capacity of the vine Boquila trifoliolata to mimic the leaves of several tree species remain unknown. A hypothesis in the original leaf mimicry report considered that microbial vectors from trees could carry genes or epigenetic factors that would alter the expression of leaf traits in Boquila. Here we evaluated whether leaf endophytic bacterial communities are associated with the mimicry pattern. Using 16S rRNA gene sequencing, we compared the endophytic bacterial communities in three groups of leaves collected in a temperate rainforest: (1) leaves from the model tree Rhaphithamnus spinosus (RS), (2) Boquila leaves mimicking the tree leaves (BR), and (3) Boquila leaves from the same individual vine but not mimicking the tree leaves (BT). We hypothesized that bacterial communities would be more similar in the BR–RS comparison than in the BT–RS comparison. We found significant differences in the endophytic bacterial communities among the three groups, verifying the hypothesis. Whereas non-mimetic Boquila leaves and tree leaves (BT–RS) showed clearly different bacterial communities, mimetic Boquila leaves and tree leaves (BR–RS) showed an overlap concerning their bacterial communities. The role of bacteria in this unique case of leaf mimicry should be studied further.

Abstract Background Since late 2019, a severe acute respiratory syndrome, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread with overwhelming speed causing over 214 million confirmed infections and more than 4.5 million deaths worldwide. In this framework, Italy had the second highest number of SARS-CoV-2 infections worldwide, and the largest number of deaths. A global effort of both the scientific community and governments has been undertaken to stem the pandemic. The aim of this paper is to perform a narrative review of the Italian contribution to the scientific literature regarding intensive care management of patients suffering from COVID-19, being one of the first western countries to face an outbreak of SARS-CoV-2 infection. Main body We performed a narrative review of the literature, dedicating particular attention and a dedicated paragraph to ventilatory support management, chest imaging findings, biomarkers, possible pharmacological interventions, bacterial superinfections, prognosis and non-clinical key aspects such as communication and interaction with relatives. Conclusions Many colleagues, nurses and patients died leaving their families alone. To all of them, we send our thoughts and dedicate these pages.

Urban conservation and (re)development can be conflicting or balanced. Governments' dual role in conserving cultural heritage and promoting development makes balancing the urban conservation – (re)development relationship a dynamic process. After coding the policy documents issued by China's governments from 1906 to 2023 with the conceptual framework of layering, the following conclusions are drawn: (1) core policies promote the development of the policy system; (2) policy evolution of heritage conservation is categorized into five phases and policy objects evolved from heritage conservation to institutional and capacity construction; (3) the layering of instruments and actors is analyzed in terms of changes to the layering approach, audience, and structure; (4) the dynamic relationship between urban conservation and development can be explained by the time-lag of heritage conservation policy-making in relation to the urban development stages and the gap between policy goals and implementation; (5) the evolution of heritage conservation policies with urban development stages is categorized as drift, stagnation, hysteresis, and adjustment connected with policy goal conversions. This research argues that the earlier friction between urban conservation and development shifted to a mutually beneficial convergence, but that balancing urban conservation and development is challenging in the context of power decentralization and pro-growth ideology. [ABSTRACT FROM AUTHOR]

Abstract The NA62 experiment reports the branching ratio measurement BR K + → π + ν ν ¯ = 10.6 − 3.4 + 4.0 stat ± 0.9 syst × 10 − 11 $$ \mathrm{BR}\left({K}^{+}\to {\pi}^{+}\nu \overline{\nu}\right)=\left({10.6}_{-3.4}^{+4.0}\left|{}_{\mathrm{stat}}\right.\pm {0.9}_{\mathrm{syst}}\right)\times {10}^{-11} $$ at 68% CL, based on the observation of 20 signal candidates with an expected background of 7.0 events from the total data sample collected at the CERN SPS during 2016–2018. This provides evidence for the very rare K + → π + ν ν ¯ $$ {\pi}^{+}\nu \overline{\nu} $$ decay, observed with a significance of 3.4σ. The experiment achieves a single event sensitivity of (0.839 ± 0.054) × 10 −11, corresponding to 10.0 events assuming the Standard Model branching ratio of (8.4 ± 1.0) × 10 −11. This measurement is also used to set limits on BR(K + → π + X), where X is a scalar or pseudo-scalar particle. Details are given of the analysis of the 2018 data sample, which corresponds to about 80% of the total data sample.

Desert shrubs are keystone species for plant diversity and ecosystem function. Atriplex clivicola and Atriplex deserticola (Amaranthaceae) are native shrubs from the Atacama Desert that show contrasting altitudinal distribution (A. clivicola: 0–700 m.a.s.l.; A. deserticola: 1500–3000 m.a.s.l.). Both species possess a C4 photosynthetic pathway and Kranz anatomy, traits adaptive to high temperatures. Historical records and projections for the near future show trends in increasing air temperature and frequency of heat wave events in these species’ habitats. Besides sharing a C4 pathway, it is not clear how their leaf-level physiological traits associated with photosynthesis and water relations respond to heat stress. We studied their physiological traits (gas exchange, chlorophyll fluorescence, water status) before and after a simulated heat wave (HW). Both species enhanced their intrinsic water use efficiency after HW but via different mechanisms. A. clivicola, which has a higher LMA than A. deserticola, enhances water saving by closing stomata and maintaining RWC (%) and leaf Ψmd potential at similar values to those measured before HW. After HW, A. deserticola showed an increase of Amax without concurrent changes in gs and a significant reduction of RWC and Ψmd. A. deserticola showed higher values of Chla fluorescence after HW. Thus, under heat stress, A. clivicola maximizes water saving, whilst A. deserticola enhances its photosynthetic performance. These contrasting (eco)physiological strategies are consistent with the adaptation of each species to their local environmental conditions at different altitudes.

We present a multi-stage and multi-resolution deformable image registration framework for image-guidance at a small animal proton irradiation platform. The framework is based on list-mode proton radiographies acquired at different angles, which are used to deform a 3D treatment planning CT relying on normalized mutual information (NMI) or root mean square error (RMSE) in the projection domain. We utilized a mouse X-ray micro-CT expressed in relative stopping power (RSP), and obtained Monte Carlo simulations of proton images in list-mode for three different treatment sites (brain, head and neck, lung). Rigid transformations and controlled artificial deformation were applied to mimic position misalignments, weight loss and breathing changes. Results were evaluated based on the residual RMSE of RSP in the image domain including the comparison of extracted local features, i.e. between the reference micro-CT and the one transformed taking into account the calculated deformation. The residual RMSE of the RSP showed that the accuracy of the registration framework is promising for compensating rigid (>97% accuracy) and non-rigid (∼95% accuracy) transformations with respect to a conventional 3D-3D registration. Results showed that the registration accuracy is degraded when considering the realistic detector performance and NMI as a metric, whereas the RMSE in projection domain is rather insensitive. This work demonstrates the pre-clinical feasibility of the registration framework on different treatment sites and its use for small animal imaging with a realistic detector. Further computational optimization of the framework is required to enable the use of this tool for online estimation of the deformation. [ABSTRACT FROM AUTHOR]

The article discusses the European Association of Cardiothoracic Surgeons' perspective on the future of robotic cardiac surgery in Europe. It highlights the evolution of robotic surgical systems in reducing invasiveness and improving outcomes for procedures like coronary artery bypass grafting and mitral valve repair. The text emphasizes the potential benefits of robotic surgery, such as reduced complications, shorter recovery times, and enhanced precision, while also addressing challenges related to training, innovation, and regulatory requirements. The authors advocate for the integration of robotics in cardiac surgery to enhance patient safety, minimize morbidity, and improve postoperative outcomes, emphasizing the importance of structured training programs and collaboration with industry partners. [Extracted from the article]

OBJECTIVES Left ventricular assist device (LVAD) therapy has evolved from a short-term bridge-to-transplant strategy into a long-term and often chronic therapy due to long waiting times for heart transplantation and application as destination therapy. Consequently, patients are at risk of developing complications necessitating LVAD exchange. The aim of this study is to assess patient outcomes after LVAD exchange. METHODS Patients who underwent LVAD exchange between January 2010 and December 2022 were included. Logistic and cox regression analyses were used to identify potential risk factors for short and long-term adverse events, respectively. Survival after exchange was assessed using Kaplan–Meier estimates. RESULTS Sixty-one patients underwent a total of 80 LVAD exchanges. Most frequently observed short-term complications were pulmonary infections (16.3%) and right heart failure (16.3%). Exit-site infections (34.7%) and device malfunctions (25.3%) were the most often observed long-term complications. HeartWare ventricular assist device as index device was associated with a higher risk of right heart failure [hazard ratio 6.42, 95% confidence interval (CI) 1.80–22.90] and respiratory failure (hazard ratio 7.81, 95% CI 1.95–31.23) compared to HeartMate II and HeartMate 3. Survival was 83% (95% CI 75.5–95.3%) at 1 year and 67% (95% CI 53.9–84.7%) at 6 years after exchange. After 5 years, 25.0% was transplanted, 23.8% had undergone a re-exchange and 32.5% was alive without new intervention. CONCLUSIONS Although LVAD exchange can be performed with a relatively low mortality, other post-operative adverse events are common. Patients with the HeartWare ventricular assist device as index device may be at higher risk of developing right heart failure and respiratory failure after exchange. [ABSTRACT FROM AUTHOR]

Urban Living Labs are open innovation ecosystems that integrate research and innovation activities within urban communities. However, while solutions co‐created and tested in the Urban Living Labs must be contextualized and tailored to each city's uniqueness, broader impact requires generalization and systematic replication across geographical, institutional, and sectoral boundaries. This article examines nine Living Labs in European coastal cities, identifying several barriers and drivers for mainstreaming and upscaling solutions to increase climate resilience through the Living Lab Integrative Process. Our analysis focuses on three main categories. First, social and cultural aspects highlighted include stakeholder engagement and awareness, communication, and dissemination. Second, we assess institutional and political aspects, such as silos, bureaucracy, and resources. Last, we investigate technical factors as knowledge and experience, technical and internal capacity, data availability and accessibility, climate‐related policies and actions, and long‐term perspective. The results suggest that while some barriers and drivers are common across the cases, providing generalizable patterns, there are also specific differences requiring tailored solutions at the local scale. Nonetheless, the diversity in drivers indicates the potential for sharing knowledge across cases to translate, embed, and scale solutions, enhancing the transition toward climate resilience. Learning and innovation in real‐life contexts are fundamental in the Living Lab approach, and our findings demonstrate that cross‐case learning can enhance an iterative process of contextualizing and generalizing innovative climate solutions. [ABSTRACT FROM AUTHOR]

Abstract Aims Left ventricular assist device therapy has become the cornerstone in the treatment of end‐stage heart failure and is increasingly used as destination therapy next to bridge to transplant or recovery. HeartMate 3 (HM3) and HeartWare (HVAD) are centrifugal continuous flow devices implanted intrapericardially and most commonly used worldwide. No randomized controlled trials have been performed yet. Analysis based on large registries may be considered as the best alternative but has the disadvantage of different standard of care between centres and missing data. Bias is introduced, because the decision which device to use was not random, even more so because many centres use only one type of left ventricular assist device. Therefore, we performed a propensity score (PS)‐based analysis of long‐term clinical outcome of patients that received HM3 or HVAD in a single centre. Methods and results Between December 2010 and December 2019, 100 patients received HVAD and 81 patients HM3 as primary implantation at the University Medical Centre Utrecht. We performed PS matching with an extensive set of covariates, resulting in 112 matched patients with a median follow‐up of 28 months. After PS matching, survival was not significantly different (P = 0.21) but was better for HM3. The cumulative incidences for haemorrhagic stroke (P = 0.01) and pump thrombosis (P = 0.02) were significantly higher for HVAD patients. The cumulative incidences for major bleeding, ischaemic stroke, right heart failure, and driveline infection were not different between the groups. We found no interaction between the surgeon who performed the implantation and survival (P = 0.59, P = 0.78, and P = 0.89). Sensitivity analysis was performed, by PS matching without patients on preoperative temporary support resulting in 74 matched patients. This also resulted in a non‐significant difference in survival (P = 0.07). The PS‐adjusted Cox regression showed a worse but non‐significant (P = 0.10) survival for HVAD patients with hazard ratio 1.71 (95% confidence interval 0.91–3.24). Conclusions Survival was not significantly different between both groups after PS matching, but was better for HM3, with a significantly lower incidence of haemorrhagic stroke and pump thrombosis for HM3. These results need to be interpreted carefully, because matching may have introduced greater imbalance on unmeasured covariates. A multicentre approach of carefully selected centres is recommended to enlarge the number of matched patients.

Abstract A search for the K + → π + X decay, where X is a long-lived feebly interacting particle, is performed through an interpretation of the K + → π + ν ν ¯ $$ {\pi}^{+}\nu \overline{\nu} $$ analysis of data collected in 2017 by the NA62 experiment at CERN. Two ranges of X masses, 0–110 MeV/c 2 and 154–260 MeV/c 2, and lifetimes above 100 ps are considered. The limits set on the branching ratio, BR(K + → π + X), are competitive with previously reported searches in the first mass range, and improve on current limits in the second mass range by more than an order of magnitude.

Searches for lepton number violating K+→π−e+e+ and K+→π−π0e+e+ decays have been performed using the complete dataset collected by the NA62 experiment at CERN in 2016–2018. Upper limits of 5.3×10−11 and 8.5×10−10 are obtained on the decay branching fractions at 90% confidence level. The former result improves by a factor of four over the previous best limit, while the latter result represents the first limit on the K+→π−π0e+e+ decay rate.

ObjectiveThis report is a case series of patients with findings suspicious for a labyrinthine dehiscence syndrome not previously described in the medical literature. We describe the clinical and test findings in 16 patients with CT findings suspicious for dehiscence of the ampullated end of the horizontal semicircular canal at the tympanic segment of the facial nerve.Study DesignObservational case series.SettingNeurotology vestibular referral center.PatientsTo be included in this study the patients were seen at our center in 2019 and had a high-resolution CT scan with a collimation of 0.6 mm. Patients who were identified as having findings suspicious for dehiscence of bone where the facial nerve crosses the ampullated end of the horizontal semicircular canal (HSC-FND) were identified and further analyzed.InterventionsCase series retrospective record review of patient symptoms, physical findings, audiometry, vestibular testing, and CT scans was performed. CT findings of other dehiscent sites were noted. A comparison to surgically treated perilymph fistula (PLF) patients of the same period was performed.Main Outcome MeasuresHistory and physical exam were reviewed for auditory symptoms, vestibular symptoms, and exacerbating factors. and. Audiometry and vestibular testing were reviewed to determine which tests were most likely to be abnormal. CT scans were independently graded according to degree of suspicion for HSC-FND. Finally, patients with HSC-FND as the sole dehiscence identified were compared to those who had HSC-FND plus other dehiscent sites (HSC-FND+O) and to the group of surgically treated PLF patients.ResultsOf 18 patients, 16 met inclusion criteria. Nine (56%) of those suspicious for HSC-FND had dehiscences in other parts of the labyrinth. Additional dehiscent sites included: six superior semicircular canal dehiscences (SSCD), two cochlear facial dehiscences and one cochlear carotid dehiscence. The most common auditory symptoms were autophony followed by tinnitus and aural fullness. The most common vestibular symptoms were pulsion sensation (feeling of being pushed to one side) followed by vertigo spells. The most common exacerbating factors for vertigo were straining, and sound. The most commonly abnormal vestibular test was nasal Valsalva testing, which was positive in all but one patient. Anamnesis and examination observations were similar in both groups, but the HSC-FND group were less likely to demonstrate a caloric weakness or an abnormal ECOG compared to the HSC-FND+O group. Of note, cVEMP was more often found to have lower thresholds in the HSC-FND group compared to the HSC-FND+O group. An example case is highlighted. Comparison to the PLF patients revealed statistically significant difference in the presenting symptoms of autophony, fullness and pulsion sensation. When comparing testing, HSC-FND patients were more likely to have an abnormal cVEMP and PLF patients were more likely to have asymmetric hearing. The incidence of bilateral disease was also more common among the HSC-FND patients than the PLF patients.ConclusionsA new labyrinthine dehiscence has been described to occur where the tympanic segment of the facial nerve crosses over the ampullated end of the horizontal semicircular canal. HSC-FND patients can present in a similar manner as HSC-FND+O patients with similar test findings except as mentioned above. The identification of one dehiscence such as SSCD does not preclude the presence of another dehiscence such as HSC-FND. HSC-FND could be the source of persistent symptoms post SSCD surgery as illustrated in the case presented. HSC-FND patients seem to identify themselves compared to PLF patients by a much more likely presenting symptoms of autophony, fullness, pulsion, abnormal cVEMP, bilaterality of disease, and symmetric hearing.