Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network meta-analysis.

OBJECTIVE: Approximately 30-50% of sudden sensorineural hearing loss (SSNHL) patients show poor response to systemic steroid therapy. Additionally, the most appropriate treatment for patients with refractory sudden sensorineural hearing loss (RSSNHL) is unknown. This study aimed to explore the best treatment for RSSNHL. DESIGN: Using a frequentist contrast-based model and PRISMA guidelines, this study compared five salvage regimes: intratympanic injection of steroids (ITS), hyperbaric oxygen (HBO) therapy, post auricle steroid injection (PSI), ITS combined with HBO therapy, and continued systemic steroids. STUDY SAMPLE: We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases for randomised controlled trials and cohort studies comparing treatment regimens for RSSNHL. RESULTS: Compared with the control group (no additional treatment), PSI and ITS demonstrated significant improvements. The mean hearing gain was greater after PSI (11.1 dB [95% CI, 4.4-17.9]) than after ITS (7.7 dB [95% CI, 4.8-10.7]). When a restricted definition of RSSNHL was used, the ITS + HBO therapy showed the largest difference in improvement for pure tone average compared with the control group (14.5 dB [95% CI, 4.2-25.0]). CONCLUSIONS: The administration of either PSI or ITS leads to the greatest therapeutic effect in patients with RSSNHL. However, a consensus on the definition of RSSNHL is needed.

Statin use reduces radiation-induced stroke risk in advanced nasopharyngeal carcinoma patients.

OBJECTIVE: This cohort study aimed to evaluate the impact of statin use on ischemic stroke risk in patients with advanced nasopharyngeal carcinoma (NPC) undergoing standard concurrent chemoradiotherapy (CCRT). METHODS: Using data from the Taiwan Cancer Registry Database, we conducted an inverse probability of treatment-weighted Cox regression analysis to examine the association between statin use during CCRT and ischemic stroke risk. RESULTS: The adjusted hazard ratio (aHR) for ischemic stroke in the statin group compared to the non-statin group was 0.70 (95 % CI: 0.54-0.92; P < 0.0107). This protective effect was observed across different statin classes, with hydrophilic statins such as pravastatin showing an aHR of 0.37 (95 % CI: 0.17-0.85) and lipophilic statins including atorvastatin displaying an aHR of 0.32 (95 % CI: 0.21-0.50) compared to non-statin use. Analysis of cumulative defined daily doses (cDDD) revealed a dose-response relationship, with lower stroke risk observed in higher quartiles of cDDD. Additionally, patients with a daily defined dose (DDD) > 1 had a reduced risk of stroke with an aHR of 0.49 (95 % CI: 0.31-0.63), while those with DDD ≤ 1 showed an aHR of 0.59 (95 % CI: 0.40-0.84). CONCLUSIONS: Our study provides evidence supporting the beneficial effects of statin use during the CCRT period in reducing radiation-induced stroke risk among patients with advanced NPC undergoing definitive CCRT. Notably, pravastatin and atorvastatin demonstrated significant reductions in stroke occurrence. Furthermore, the findings suggest a dose-response relationship, where higher cumulative doses and greater daily dose intensity of statin use were associated with a lower risk of stroke.

Functioning tailor-made 3D-printed vascular graft for hemodialysis.

BACKGROUND: The two ends of arteriovenous graft (AVG) are anastomosed to the upper limb vessels by surgery for hemodialysis therapy. However, the size of upper limb vessels varies to a large extent among different individuals. METHODS: According to the shape and size of neck vessels quantified from the preoperative computed tomography angiographic scan, the ethylene-vinyl acetate (EVA)-based AVG was produced in H-shape by the three-dimensional (3D) printer and then sterilized. This study investigated the function of this novel 3D-printed AVG in vitro and in vivo. RESULTS: This 3D-printed AVG can be implanted in the rabbit's common carotid artery and common jugular vein with ease and functions in vivo. The surgical procedure was quick, and no suture was required. The blood loss was minimal, and no hematoma was noted at least 1 week after the surgery. The blood flow velocity within the implanted AVG was 14.9 ± 3.7 cm/s. Additionally, the in vitro characterization experiments demonstrated that this EVA-based biomaterial is biocompatible and possesses a superior recovery property than ePTFE after hemodialysis needle cannulation. CONCLUSIONS: Through the 3D printing technology, the EVA-based AVG can be tailor-made to fit the specific vessel size. This kind of 3D-printed AVG is functioning in vivo, and our results realize personalized vascular implants. Further large-animal studies are warranted to examine the long-term patency.

The Risk of Ischemic Stroke in Head and Neck Cancer Patients and Those Who Were Treated with Radiotherapy: A Population-Based Cohort Study.

BACKGROUND: To investigate the standardized incidence ratios (SIR) of stroke in patients with head and neck cancer and their relationship to radiotherapy. METHODS: Patients with head and neck cancer ages 20-85 years were enrolled from 2007 to 2016 using the Taiwan Cancer Registry. The study endpoint was fatal and non-fatal ischemic stroke, ascertained by the National Health Insurance Research Database. Age- and sex-adjusted SIRs, categorized by 10-year age standardization, were used to compare the patients with head and neck cancer with a randomly selected 2,000,000 general population. We compared the risk of stroke in patients with head and neck cancer who received radiotherapy or surgery alone. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) were obtained from Cox regression analysis with competing risk. RESULTS: Among 41,266 patients (mean age, 54.1 years; men, 90.6%) in the median follow-up period of 3.9 years, 1,407 strokes occurred. Compared with the general population, the overall SIR of stroke was 1.37 (95% CI, 1.30-1.44) in patients with head and neck cancer. In patients with head and neck cancer, the fully adjusted HR of stroke in those who received radiotherapy was 0.96 (95% CI, 0.83-1.10), compared with those who received surgery alone. CONCLUSIONS: Patients with head and neck cancer had a higher risk of fatal or non-fatal ischemic stroke. The risk of stroke was not higher in patients initially treated with radiotherapy. IMPACT: Oncologists should emphasize stroke prevention in all patients with head and neck cancer, not only in those who received radiotherapy.

Association of Acute Upper Respiratory Tract Infections with Sudden Sensorineural Hearing Loss: A Case-Crossover, Nationwide, Population-Based Cohort Study.

The etiology of sudden sensorineural hearing loss (SSNHL) has been unclear until now. Understanding its potential etiology is crucial for the development of preventive medicine. In this study, we investigated the association between acute upper respiratory tract infections (URIs) and SSNHL risk. We conducted a case-crossover study by using the longitudinal health insurance database derived from the National Health Insurance Research Database in Taiwan. Individual acute URI between the case and control periods was reviewed. Multivariable conditional logistic regression models were used to estimate the adjusted odds ratios (aORs) of SSNHL risk associated with acute URIs after adjustments for potential confounders. In total, 1131 patients with SSNHL between 2010 and 2013 fulfilled our inclusion criteria and were included. The aOR (95% confidence interval [CI]) for SSNHL was 1.57 (1.20-2.05) in relation to acute URIs one month before the index date. Moreover, the aORs (95% CIs) of the female and young to middle-aged (≤65 years) populations were 1.63 (1.13-2.36) and 1.76 (1.29-2.40), respectively. In addition, the association between SSNHL and acute URIs was decreased over time. The aOR for SSNHL was 1.25 (1.01-1.56) in relation to acute URIs three months before the index date. Acute URIs increase SSNHL risk and are a potential risk factor for SSNHL. The establishment of a feasible health policy for the prevention of acute URIs is crucial for SSNHL prevention, particularly in female, and young to middle-aged populations.

Effect of betel nut chewing on the otolithic reflex system.

OBJECTIVE: This study investigated the effect of betel nut chewing on the otolithic reflex system. METHODS: Seventeen healthy volunteers without any experience of chewing betel nut (fresh chewers) and 17 habitual chewers underwent vital sign measurements, ocular vestibular-evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests prior to the study. Each subject then chewed two pieces of betel nut for 2min (dosing). The same paradigm was repeated immediately, 10min, and 20min after chewing. On a different day, 10 fresh chewers masticated chewing gum as control. RESULTS: Fresh chewers exhibited significantly decreased response rates of oVEMP (53%) and cVEMP (71%) after dosing compared with those from the predosing period. These abnormal VEMPs returned to normal 20min after dosing. In contrast, 100% response rates of oVEMP and cVEMP were observed before and after masticating chewing gum. In habitual chewers, the response rates of oVEMP and cVEMP were 32% and 29%, respectively, 20min after dosing. CONCLUSION: Chewing betel nuts induced a transient loss of the otolithic reflexes in fresh chewers but may cause permanent loss in habitual chewers. SIGNIFICANCE: Chewing betel nuts can cause a loss of otholitic reflex function. This creates a risk for disturbed balance and malfunction, for instance, during driving.

Correlations between foam posturography and vestibular-evoked myogenic potential tests in Ménière's disease.

OBJECTIVES: This study adopted foam posturography coupled with inner ear test battery including audiometry, and cervical Vestibular-Evoked Myogenic Potential (cVEMP), ocular Vestibular-Evoked Myogenic Potential (oVEMP) and Caloric tests in patients with Ménière's disease to investigate the relations between them. DESIGN: Fifty patients with unilateral definite Ménière's disease were enrolled. All patients underwent Audiometry, and Caloric, oVEMP, and cVEMP tests. In addition, posturography was also performed under 4 conditions: A (firm surface, eyes open), B (firm surface, eyes closed), C (foam pad, eyes open), and D (foam pad, eyes closed). Romberg quotient (RQ) was measured as the value from eyes closed divided by that from eyes open. RESULTS: No correlation existed between Ménière stage and RQ measured with foam pad. Mean RQ of the sway area on foam pad in Ménière's patients with abnormal oVEMPs (1.75 ± 0.95) was significantly larger than 1.20 ± 0.70 in those with normal oVEMPs. However, neither cVEMP nor Caloric test results were associated with RQ on foam pad (p > 0.05). Further, the area under the receiver operating characteristic curve of the RQ of sway area on foam pad in discrimination between normal and abnormal oVEMP test was 0.65 (95% CI, 0.51 to 0.79; p < 0.05), implying that RQ of the sway area on foam pad may serve as a significant predictor for abnormal oVEMP test. CONCLUSIONS: By removing or reducing both visual and somatosensory inputs from foam posturography, the remaining vestibular cue, represented as RQ of sway area on foam pad, may reflect utricular function.

Transgenic overexpression of heat shock protein 72 in mouse muscle protects against exhaustive exercise-induced skeletal muscle damage.

BACKGROUND/PURPOSE: Lifelong overexpression of heat shock protein (HSP) 72 in skeletal muscle is known to protect against age-related oxidative stress and muscle damage. This study aimed to ascertain whether exhaustive exercise (EE)-induced muscle fatigue and damage can be prevented by lifelong overexpression of HSP72 in skeletal muscle. METHODS: Transgenic mice heterozygous for the porcine HSP70.2 gene ([+]HSP72) and transgene-negative littermate controls ([-]HSP72) were subjected to an EE protocol. Mice were randomly divided into four groups: sedentary [-]HSP72, sedentary [+]HSP72, EE [-]HSP72, and EE [+]HSP72. Animals were killed 82 minutes after the start of EE to determine muscular levels of HSP72, serum levels of superoxide dismutase (SOD, an antioxidant enzyme) and lactate (an indicator of muscle fatigue), muscular levels of matrix metalloproteinase (an indicator of inflammatory myopathies), and muscular damage. RESULTS: During the test, the latency value for the occurrence of EE was 79-85 minutes and 100-110 minutes for [-]HSP72 and [+]HSP72 mice, respectively. After EE, [+]HSP72 mice had significantly higher serum SOD and significantly lower serum lactate, muscular matrix metalloproteinase or myeloperoxidase activity, and muscle damage compared to [-]HSP72 mice. CONCLUSION: The results suggest that HSP72 overexpression in skeletal muscle may improve muscle fatigue and damage in EE by reducing oxidative damage and phagocytic infiltration, at least in mice.

Simultaneous bilateral anterior fracture dislocation of the shoulder with neurovascular injury: report of a case.

This paper reports an unusual case of orthopedic trauma in a 29-year-old man who experienced concomitant bilateral anterior shoulder fracture dislocation with associated brachial plexus and axillary artery injury. We also highlight the mechanism underlying this rare workplace injury related to use of a forklift.