S Berrettini

Università di Pisa, Pisa, Tuscany, Italy

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Publications (136)189.17 Total impact

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    ABSTRACT: To evaluate the long-term stability of intratympanic steroids and investigate the 'real' impact of sudden sensorineural hearing loss on patients.
    The Journal of laryngology and otology. 08/2014; 128(8):669-73.
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    ABSTRACT: In this study, we performed a complete histologic analysis of constructs based on large diameter ( > 100 μm) poly-L-lactic acid (PLLA) microfibers obtained via dry-wet spinning and rat Mesenchymal Stromal Cells (rMSCs) differentiated towards the osteogenic lineage, using acrylic resin embedding.In many synthetic polymer-based microfiber meshes, ex post processability of fiber/cell constructs for histologic analysis may face deterring difficulties, leading to an incomplete investigation of the potential of these scaffolds. Indeed, while polymeric nanofiber (fiber diameter = tens of nanometers)/cell constructs can usually be embedded in common histologic media and easily sectioned, preserving the material structure and the antigenic reactivity, histologic analysis of large polymeric microfiber/cell constructs in the literature is really scant. This affects microfiber scaffolds based on FDA-approved and widely used polymers such as PLLA and its copolymers. Indeed, for such constructs, especially those with fiber diameter and fiber interspace much larger than cell size, standard histologic processing is usually inefficient due to inhomogeneous hardness and lack of cohesion between the synthetic and the biological phases under sectioning.In this study, the microfiber/MSC constructs were embedded in acrylic resin and the staining/reaction procedures were calibrated to demonstrate the possibility of successfully employing histologic methods in tissue engineering studies even in such difficult cases. We histologically investigated the main osteogenic markers and extracellular matrix molecules, such as alkaline phosphatase, osteopontin, osteocalcin, TGF-β1, Runx2, Collagen type I and the presence of amorphous, fibrillar and mineralized matrix. Biochemical tests were employed to confirm our findings. This protocol permitted efficient sectioning of the treated constructs and good penetration of the histologic reagents, thus allowing distribution and expression of almost all the tested molecules to be revealed. Our results demonstrated that it is possible to perform histologic analyses of large-diameter PLLA-based microfiber scaffold/MSC constructs that face the failure of standard histologic procedures.
    Biomedical Materials 07/2014; 9(4):045007. · 2.92 Impact Factor
  • Maria Palmieri, Francesca Forli, Stefano Berrettini
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    ABSTRACT: Objective: To investigate the improvement in different skills following cochlear implantation (CI) in deaf children with additional disabilities (AD), and present an overview of the different outcome measures and the corresponding tests used. Methods: The MEDLINE and Embase databases were searched for studies published in English, Italian, French, German, Spanish or Dutch, up to 4 December 2013, including studies published ahead of print. The search was directed toward studies with a clear diagnosis of additional disability. Only studies including a comparison with pre-CI data of the same group or with post-CI performance of a control group were retained. Two reviewers independently assessed methodological quality and extracted data from the studies by means of forms. Because of the heterogeneity of the study groups and the reported outcome measures, meta-analysis was not possible. Data were collected in tables and described by means of a structured review. Results: The initial search yielded 464 unique studies, of which 41 met the inclusion criteria. These studies show that children with AD improve on average in most of the outcome measures, although often to a lesser degree and more slowly than their peers with cochlear implants and no AD. However, in cases of mild AD, they may reach similar skills to normally developing peers. Many receive measurable benefit from CI that adds to their quality of life. Conclusions: There is a need for alternative tools for measuring those outcomes that are difficult to quantify. Early implantation appears to be beneficial and, over the last 13 years, the mean average age of CI in children with AD decreased from 45 to 30 months. There is ample consensus that cognitive and global developmental levels have significant implications for expectation of benefit and are accurate predictors of certain outcomes.
    Hearing, Balance and Communication. 03/2014; 12(1).
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    ABSTRACT: In this communication, we introduce boron nitride nanotube (BNNT)-functionalised muscle cell/microfibre mesh constructs, obtained via tissue engineering, as a three-dimensional (3D) platform to study a wireless stimulation system for electrically responsive cells and tissues. Our stimulation strategy exploits the piezoelectric behaviour of some classes of ceramic nanoparticles, such as BNNTs, able to polarize under mechanical stress, e.g. using low-frequency ultrasound (US). In the microfibre scaffolds, C2C12 myoblasts were able to differentiate into viable myotubes and to internalize BNNTs, also upon US irradiation, so as to obtain a nanotech-assisted 3D in vitro model. We then tested our stimulatory system on 2D and 3D cellular models by investigating the expression of connexin 43 (Cx43), as a molecule involved in cell crosstalk and mechanotransduction, and myosin, as a myogenic differentiation marker. Cx43 gene expression revealed a marked model dependency. In control samples (without US and/or BNNTs), Cx43 was upregulated under 2D culture conditions (10.78 ± 1.05-fold difference). Interactions with BNNTs increased Cx43 expression in 3D samples. Cx43 mRNA dropped in 2D under the ‘BNNTs + US’ regimen, while it was best enhanced in 3D samples (3.58 ± 1.05 vs 13.74 ± 1.42-fold difference, p = 0.0001). At the protein level, the maximal expressions of Cx43 and myosin were detected in the 3D model. In contrast with the 3D model, in 2D cultures, BNNTs and US exerted a synergistic depletive effect upon myosin synthesis. These findings indicate that model dimensionality and stimulatory regimens can strongly affect the responses of signalling and differentiation molecules, proving the importance of developing proper in vitro platforms for biological modelling. Copyright © 2014 John Wiley & Sons, Ltd.
    Journal of Tissue Engineering and Regenerative Medicine 03/2014; · 4.43 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the presence of mitochondrial DNA (mtDNA) alterations and metabolic dysfunctions in patients with presbyacusis, and to discover correlations between presbyacusis and the degree of hearing loss and mitochondrial damage. Seventy patients with presbyacusis were examined, including 40 Egyptian patients and 30 Italian patients. Forty eight normal subjects were included as control group, including 24 Egyptians and 24 Italians. There was no common point mutation, and A1555G, A3243G, A7445G not were detected in any patients or controls. Haplogroup U was significantly common in patients in comparison to controls. Mutation of antioxidant genes (GSTT1, GSTM1) were significantly present in only Italian patients compared to Italian controls.
    Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 02/2014; 34(1):54-61. · 0.79 Impact Factor
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    ABSTRACT: Functional Transcranial Doppler ultrasonography (fTCD) was used to investigate the effects of early acoustic deprivation and subsequent reafferentation on cerebral dominance for language in deaf children provided with Cochlear Implantation (CI). Twenty children with CI (13 in right ear and 7 in left ear) and 20 controls matched for age, sex and handedness were administered a fTCD animation description task. Left hemisphere dominance for language with comparable mean Laterality Indexes (LIs) was found in children with CI and controls; right-ear implanted subjects showed cerebral activation controlateral to implanted ear more frequently than left-ear implanted ones. Linguistic proficiency of CI recipients was below age expectation in comparison to controls; language scores did not significantly differ between children with left and right LI, whereas both age and side of implantation were significantly related to language outcome. Theoretical implication and potential clinical application of fTCD in CI management are discussed.
    Brain and Language 01/2014; 129C:1-6. · 3.39 Impact Factor
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    ABSTRACT: We have evaluated neuropsychic development in 70 normal schoolchildren in an area of severe endemic goitre and cretinism in the Central Apennines (Montefeltro). In each subject we have studied auxological, psychometric and audiometric parameters, together with tympanograms and stapedial reflexograms. Auxological data were in the normal range, as were the stapedial reflexograms and tympanograms. On the contrary, 54.8% of the sample performed below the 25th percentile in psychometric tests (Raven test PM-47), being also 22.8% below the 5th percentile. Audiometric data showed a neurological hearing impairment in 3.1% of the children tested, as compared with 0.28% in the area of Pisa. These data point out that an impairment of central nervous system function still persists in this area of severe endemic goitre.
    Minerva endocrinologica 01/2014; 14(2):99-103. · 1.40 Impact Factor
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    ABSTRACT: Abstract Congenital Cytomegalovirus (CMV) infection affects many organs: reticuloendothelial and central nervous system are particularly involved. Congenital CMV infection is the leading cause of nongenetic sensorineural hearing loss. Hearing impairment can be present at birth or it can occur months or even years after birth. It is as well an important risk factor for antenatal stillbirth, preterm birth and SGA (Small for Gestational Age) condition. For these reasons we should early identify congenital CMV infection investigating at least at risk newborns such as preterm or SGA babies given that a simple and standardized method for a large scale screening program is lacking. In our study we found an association between congenital CMV infection and preterm births (3.03 %) and with SGA condition (3.7 %). Consequently routine CMV urine detection should be performed at least in all babies born before 37 weeks of gestational age and in term SGA newborns.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 12/2013; · 1.36 Impact Factor
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    ABSTRACT: In this paper we investigated a novel and non-invasive approach for an endogenous osteoblast stimulation mediated by boron nitride nanotubes (BNNTs). Specifically, following the cellular uptake of the piezoelectric nanotubes, cultures of primary human osteoblasts (hOBs) were irradiated with low frequency ultrasound (US), as a simple method to apply a mechanical input to the cells loaded with BNNTs. This in vitro study was aimed at investigating the main interactions between hOBs and BNNTs and to study the effects of the 'BNNTs + US' stimulatory method on the osteoblastic function and maturation.A non-cytotoxic BNNT concentration to be used in vitro with hOB cultures was established. Moreover, investigation with transmission electron microscopy/electron energy loss spectroscopy (TEM/EELS) confirmed that BNNTs were internalized in membranal vesicles. The panel of investigated osteoblastic markers disclosed that BNNTs were capable of fostering the expression of late-stage bone proteins in vitro, without using any mineralizing culture supplements. In our samples, the maximal osteopontin expression, with the highest osteocalcin and Ca(2+) production, in the presence of mineral matrix with nodular morphology, was observed in the samples treated with BNNTs + US. In this group was also shown a significantly enhanced synthesis of TGF-β1, a molecule sensitive to electric stimulation in bone. Finally, gene deregulations of the analyzed osteoblastic genes leading to depletive cellular effects were not detected. Due to their piezoelectricity, BNNT-based therapies might disclose advancements in the treatment of bone diseases.
    Nanotechnology 10/2013; 24(46):465102. · 3.84 Impact Factor
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    A Martini, R Bovo, P Trevisi, F Forli, S Berrettini
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    ABSTRACT: A cochlear implant (CI) is a partially implanted electronic device that can help to provide a sense of sound and support speech to severely to profoundly hearing impaired patients. It is constituted by an external portion, that usually sits behind the ear and an internal portion surgically placed under the skin. The external components include a microphone connected to a speech processor that selects and arranges sounds pucked up by the microphone. This is connected to a transmitter coil, worn on the side of the head, which transmits data to an internal receiver coil placed under the skin. The received data are delivered to an array of electrodes that are surgically implanted within the cochlea. The primary neural targets of the electrodes are the spiral ganglion cells which innervate fibers of the auditory nerve. When the electrodes are activated by the signal, they send a current along the auditory nerve and auditory pathways to the auditory cortex. Children and adults who are profoundly or severely hearing impaired can be fitted with cochlear implants. According to the Food and Drug Administration, approximately 188,000 people worldwide have received implants. In Italy it is extimated that there are about 6-7000 implanted patients, with an average of 700 CI surgeries per year. Cochlear implantation, followed by intensive postimplantation speech therapy, can help young children to acquire speech, language, and social skills. Early implantation provides exposure to sounds that can be helpful during the critical period when children learn speech and language skills. In 2000, the Food and Drug Administration lowered the age of eligibility to 12 months for one type of CI. With regard to the results after cochlear implantation in relation to early implantation, better linguistic results are reported in children implanted before 12 months of life, even if no sufficient data exist regarding the relation between this advantage and the duration of implant use and how long this advantage persists in the subsequent years. With regard to cochlear implantation in children older than 12 months the studies show better hearing and linguistic results in children implanted at earlier ages. A sensitive period under 24-36 months has been identified over which cochlear implantation is reported to be less effective in terms of improvement in speech and hearing results. With regard to clinical effectiveness of bilateral cochlear implantation, greater benefits from bilateral implants compared to monolateral ones when assessing hearing in quiet and in noise and in sound localization abilities are reported to be present in both case of simultaneous or sequential bilateral implantation. However, with regard to the delay between the surgeries in sequential bilateral implantation, although benefit is reported to be present even after very long delays, on average long delays between surgeries seems to negatively affect the outcome with the second implant. With regard to benefits after cochlear implantation in children with multiple disabilities, benefits in terms of speech perception and communication as well as in quality of the daily life are reported even if benefits are slower and lower in comparison to those generally attained by implanted children without additional disabilities. Regarding the costs/efficacy ratio, the CI is expensive, in particular because of the cost of the high technological device, long life support, but even if healthcare costs are high, the savings in terms of indirect costs and quality of life are important. The CI, in fact, has a positive impact in terms of quality of life.
    Minerva pediatrica 06/2013; 65(3):325-339. · 0.64 Impact Factor
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    ABSTRACT: IMPORTANCE The unpredictability of idiopathic sudden sensorineural hearing loss (ISSNHL) presents a challenge to preventive care. Our study confirms the potentially important role of the 3-T magnetic resonance imaging (MRI), and in particular of the 3-dimensional fluid-attenuated inversion-recovery (3D-FLAIR) sequence, in the diagnosis and prognosis of ISSNHL to guide medical treatment. OBJECTIVE To confirm the diagnostic, clinical, and prognostic role of 3D-FLAIR MRI in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). DESIGN, SETTING, AND PATIENTS Retrospective study in a tertiary referral center with a consecutive sample of 23 patients diagnosed as having unilateral ISSNHL from January 2010 to March 2011. EXPOSURES Patients underwent 3D-FLAIR MRI at 3 T to evaluate ISSNHL, and the MRI images were compared with those belonging to a random group of 20 age-matched healthy patients. MAIN OUTCOMES AND MEASURES Precontrast and postcontrast high-intensity 3D-FLAIR MRI findings in patients with ISSNHL and the correlation with clinical findings. RESULTS Thirteen patients showed high-intensity signals in the affected inner ear on precontrast and postcontrast 3D-FLAIR MRI (57%). From the analysis of different MRI sequences, we posited 3 radiologic patterns likely correlated with mild hemorrhage, acute inflammation, and presence or absence of blood-labyrinth or nerve barrier (BLB) breakdown. Hypersignal on 3D-FLAIR MRI was positively associated with pretreatment hearing loss (P = .04) and presence of vertigo (P = .04). A strict correlation also existed between distribution of the signal (vestibule, semicircular canals) and clinical features (vertigo) (P = .04). CONCLUSIONS AND RELEVANCE Use of 3D-FLAIR MRI at 3 T may contribute to the elucidation of pathologic conditions in the inner ears of patients with ISSNHL and provide new radiologic indicators (mild hemorrhage, acute inflammation, presence or absence of BLB breakdown) that might assume the role of prognostic factors.
    JAMA otolaryngology-- head & neck surgery. 05/2013; 139(5):456-64.
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    ABSTRACT: The traditional bone tissue engineering approach exploits mesenchymal stem cells (MSCs) to be seeded once only on 3D scaffolds, hence differentiated for a certain period of time and resulting in a homogeneous osteoblast population at the endpoint. However, after achieving terminal osteo-differentiation, cell viability is usually markedly compromised. On the other hand, naturally occurring osteogenesis results from the coexistence of MSC progenies at distinct differentiative stages in the same microenvironment. This diversification also enables long-term viability of the mature tissue. We report an easy and tunable in vitro method to engineer simple osteogenic cell niches in a biomimetic fashion. The niches were grown via periodic re-seeding of undifferentiated MSCs on MSC/scaffold constructs, the latter undergoing osteogenic commitment. Time-fractioning of the seeded cell number during differentiation time of the constructs allowed graded osteogenic cell populations to be grown together on the same scaffolds (i.e., not only terminally differentiated osteoblasts). In such cell-dynamic systems, the overall differentiative stage of the constructs could also be tuned by varying the cell density seeded at each shot. In this way, we generated two different biomimetic niche models able to host good reservoirs of pre-osteoblasts and other osteo-progenitors after 21 culture days. At that time, the niche type resulting in 40.8% of immature osteogenic progenies and only 59.2% of mature osteoblasts showed calcium content comparable to the constructs obtained with the traditional culture method (i.e., 100.03 ± 29.30 vs. 78.51 ± 28.50 pg/cell, respectively; p = n.s.), the latter colonized only by fully differentiated osteoblasts showing exhausted viability. This assembly method for tissue-engineered constructs enabled a set of important parameters, such as viability, colonization and osteogenic yield of the MSCs to be balanced on 3D scaffolds, thus achieving biomimetic in vitro models with graded osteogenicity, which are more complex and reliable than those currently used by tissue engineers.
    Tissue Engineering Part C Methods 03/2013; · 4.64 Impact Factor
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    ABSTRACT: Vocal load plays a significant role in the aetiology of voice disorders and influences the response to treatment. For this reason, many researchers have focused their attention on how a voice is used, especially when vocal load is increased, during working hours for instance. The majority of studies in this regard have been performed by recording vocal parameters for brief periods with the aid of microphones. The first devices produced recorded only a few parameters and for relatively short periods of time, and since microphones were used there was a problem with both privacy and background noise such as the inclusion of voices from nearby people. Recently, microprocessors that can monitor a voice for an entire day have been developed; these use miniaturised accelerometers as vocal sensors. The latest commerciallyavailable version is the Ambulatory Phonation Monitor (APM) (KayPENTAX, Lincoln Park, NJ, USA) which can record several vocal parameters for over 18 hours and supply a series of graphic representations of the variations in these parameters during the recording period. In particular, the APM permits recording vocal load by measuring the cycle dose and distance dose, and evaluates vocal intensity (dB sound pressure level [SPL]), fundamental frequency and total phonation time. This report describes the APM, the use of an accelerometer as a vocal sensor, the importance of its calibration and the parameters it records. In particular, details are given on phonation time, variations in frequency, vocal intensity, phonation density and vocal dose. The role of the APM in voice studies is also described, in addition to its potential clinical applications as demonstrated by the few reports available in the literature. We also discuss our experience with the device in groups of euphonic and dysphonic elementary school teachers.
    Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 02/2013; 33(1):49-55. · 0.79 Impact Factor
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    ABSTRACT: In this investigation, we report on 4 patients affected by incomplete partition type I submitted to cochlear implant at our institutions. Preoperative, surgical, mapping and follow-up issues as well as results in cases with this complex malformation are described. The cases reported in the present study confirm that cochlear implantation in patients with incomplete partition type I may be challenging for cochlear implant teams. The results are variable, but in many cases satisfactory, and are mainly related to the surgical placement of the electrode and residual neural nerve fibres. Moreover, in some cases the association of cochlear nerve abnormalities and other disabilities may significantly affect results.
    Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 02/2013; 33(1):56-62. · 0.79 Impact Factor
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    Dataset: CLIN. 1
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    ABSTRACT: OBJECTIVE:: A growing number of studies on deaf children with cochlear implant (CI) document a significant improvement in receptive and expressive language skills after implantation, even if they show language delay when compared with normal-hearing peers. Data on language acquisition in CI Italian children are still scarce and limited to only certain aspects of language. The purpose of this study is to prospectively describe the trajectories of language development in early CI Italian children, with particular attention to the transition from first words to combinatorial speech and to acquisition of complex grammar in a language with rich morphology, such as Italian. DESIGN:: Six children, with profound prelingual deafness, provided with CI, between 16 and 24 months of age were prospectively assessed and followed over a mean period of up to 34.8 months postimplant. During follow-up, each child received between four to five individual language evaluations through a combination of indirect procedures (parent reports of early lexical and grammar development) and direct ones (administration of standardized receptive and expressive language tests with Italian norms and collection of spontaneous language samples). RESULTS:: In relation to chronological age, the acquisition of expressive vocabulary was delayed. However, considering the duration of hearing experience, most CI participants showed an earlier start and faster growth of expressive rather than receptive vocabulary in comparison with typically developing children. This quite atypical result persisted right up until the end of the follow-up. The acquisition of expressive grammar was delayed relative to chronological age, though all but one CI participant achieved the expected grammar level after approximately 3 years of CI use. In addition, the rate of grammar acquisition was not homogeneous during development, showing two different paces: one comparable with normal hearing in the transition from holophrastic to primitive combinatorial speech and a much slower one to attain more advanced levels of morphosyntactic control. CONCLUSION:: From a rehabilitative viewpoint, our results suggest the importance of implementing rehabilitation in lexical comprehension, even when expressive vocabulary appears to be within normal range. Moreover, assessment of language acquisition in CI Italian children should focus on those grammar aspects that are more vulnerable to early acoustic deprivation (such as free and bound morphology) to ensure enhanced language therapy planning.
    Ear and hearing 01/2013; 34(3):e28-e37. · 2.06 Impact Factor
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    ABSTRACT: Lymphomas represent the second most frequent malignant tumor (incidence 2.5%) in the head and neck region. Non-Hodgkin lymphomas (NHLs) present with cervical lymph node involvement, but in 40% extranodal site could be primary involved: nasopharynx, the lacrimal sac, the temporal bone, or the others areas. NHLs of the ear are rarely reported. In this report, we described a patient with primary NHL of the external ear canal who was successfully treated with surgical excision and chemotherapy.
    Case reports in otolaryngology. 01/2013; 2013:138397.
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    ABSTRACT: Salivary gland tumors are rare. The majority of these tumors are benign and about 70% are pleomorphic adenomas (PA). Nasopharynx is an unusual site for the PA tumor. Only six cases are presented in the literature from 1990 to 2011. The diagnosis of this disease is linked to the sum of imaging tests, clinical and histological study of the mass of the above. The radiologic features of noninvasion of surrounding structures give the first clue to the benign lesion. From the review of the literature and our experience is identified as the gold standard in surgical treatment for this condition. Thanks to the endoscopic surgery, we can perform a complete resection of the lesion without damaging adjacent structures. We presented a case of pleomorphic adenoma of nasopharynx with literature review.
    Case reports in otolaryngology. 01/2013; 2013:712873.
  • Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 10/2012; 37(5):415-21. · 1.87 Impact Factor
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    ABSTRACT: Precise knowledge of the expression and distribution of extracellular matrix (ECM) molecules and osteochondrogenic markers helps target the proper in vitro regeneration of novel ossicular chain (OC) replacements via tissue engineering (TE). We performed an extensive histologic analysis of human ear ossicles in healthy adults. A variety of OC prostheses are currently available, but extrusion of synthetic devices still represents an important clinical phenomenon. TE is a novel discipline combining stem cells, bioresorbable biomaterials, and stimulatory factors for the development of new living tissues in vitro, which might offer forefront opportunities to otologic surgery. However, to drive stem cell differentiation correctly, the final tissue target must be accurately known. Malleus, incus, and stapes were collected from cadaveric temporal bones. TE PORPs were obtained via osteodifferentiation of human mesenchymal stromal cells on polymeric scaffolds. Histochemical and immunohistochemical analyses were performed to detect ECM molecules and osteochondrogenic markers. Malleus and incus showed the same histologic tissue type, with similar levels of expression and distributions for both ECM molecules and osteochondrogenic markers, whereas the stapes showed self-standing histologic patterns. In TE PORPs, mesenchymal ECM synthesis and early stage development of ossification sites could be observed, highlighting good cellular integration with the scaffold biomaterial. Detailed morphologic study of the ossicles provides data related to tissue dynamics involved in their development, defining features of tissue differentiation and maturation. Such findings underpin the future development of biomimetic ossicular replacement, data that can guide tissue-engineered ossiculoplasty.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 10/2012; 33(8):1458-68. · 1.44 Impact Factor

Publication Stats

805 Citations
189.17 Total Impact Points

Institutions

  • 1986–2014
    • Università di Pisa
      • • Department of Translational Research on New Technologies in Medicine and Surgery
      • • Department of Biology
      • • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
  • 2013
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 2012
    • Azienda Ospedaliero Universitaria Careggi
      Firenzuola, Tuscany, Italy
    • Azienda Ospedaliero-Universitaria Pisana
      Pisa, Tuscany, Italy
  • 2011
    • Scuola Superiore Sant'Anna
      • Institute of Management
      Pisa, Tuscany, Italy