Concurrent Hearing and Genetic Screening of 180,469 Neonates with Follow-up in Beijing, China.

Concurrent hearing and genetic screening of newborns is expected to play important roles not only in early detection and diagnosis of congenital deafness, which triggers intervention, but also in predicting late-onset and progressive hearing loss and identifying individuals who are at risk of drug-induced HL. Concurrent hearing and genetic screening in the whole newborn population in Beijing was launched in January 2012. This study included 180,469 infants born in Beijing between April 2013 and March 2014, with last follow-up on February 24, 2018. Hearing screening was performed using transiently evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR). For genetic testing, dried blood spots were collected and nine variants in four genes, GJB2, SLC26A4, mtDNA 12S rRNA, and GJB3, were screened using a DNA microarray platform. Of the 180,469 infants, 1,915 (1.061%) were referred bilaterally or unilaterally for hearing screening; 8,136 (4.508%) were positive for genetic screening (heterozygote, homozygote, or compound heterozygote and mtDNA homoplasmy or heteroplasmy), among whom 7,896 (4.375%) passed hearing screening. Forty (0.022%) infants carried two variants in GJB2 or SLC26A4 (homozygote or compound heterozygote) and 10 of those infants passed newborn hearing screening. In total, 409 (0.227%) infants carried the mtDNA 12S rRNA variant (m.1555A>G or m.1494C>T), and 405 of them passed newborn hearing screening. In this cohort study, 25% of infants with pathogenic combinations of GJB2 or SLC26A4 variants and 99% of infants with an m.1555A>G or m.1494C>T variant passed routine newborn hearing screening, indicating that concurrent screening provides a more comprehensive approach for management of congenital deafness and prevention of ototoxicity.

Cost-effectiveness analysis of neonatal hearing screening program in China: should universal screening be prioritized?

BACKGROUND: Neonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China. METHODS: A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces. RESULTS AND DISCUSSION: A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs. CONCLUSIONS: Universal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.

New-onset COVID-19-related diabetes: an early indicator of multi-organ injury and mortally of SARS-CoV-2 infection.

Objective: The pandemic of 2019 coronavirus (SARS-CoV-2) disease (COVID-19) has imposed a severe public health burden worldwide. Most patients with COVID-19 were mild. Severe patients progressed rapidly to critical condition including acute respiratory distress syndrome (ARDS), multi-organ failure and even death. This study aims to find early multi-organ injury indicators and blood glucose for predicting mortality of COVID-19. Methods: Fasting blood glucose (FBG) ≥7.0 mmol/L for two times during hospitalization and without a history of diabetes were defined as new-onset COVID-19-related diabetes (CRD). Indicators of injuries for multiple organs, including the lung, heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting death. Results: A total of 120 patients with a severity equal to or greater than Moderate were hospitalized. After excluding patients with history of diabetes, chronic heart, kidney, and liver disease, 69 patients were included in the final analysis. Of the 69 patients, 23 were Moderate, 20 were Severe, and 26 were Critical (including 16 deceased patients). Univariable analysis indicated that CRD, lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with death. Multivariable analysis indicated that CRD was an independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Abnormal glucose homeostasis or CRD occurred earlier than other indicators for predicting poor outcomes. Indicators of multiple organ injury were in parallel with the expression patterns of ACE2 (the SARS-CoV-2 receptor) in different organs including pancreatic islet. Conclusions: New-onset COVID-19-related diabetes is an early indicator of multi-organ injury and predictor for poor outcomes and death in COVID-19 patients. As it is easy to perform for clinical practices and self-monitoring, glucose testing will be helpful for predicting poor outcomes to facilitate appropriate intensive care.

Pulse transit time for quantifying inspiratory effort in patients with obstructive sleep apnea.

OBJECTIVES: To investigate the feasibility of pulse transit time (PTT) as a quantitative measure of inspiratory effort in patients with obstructive sleep apnea (OSA). METHODS: Nineteen moderate to severe OSA patients were included to undergo overnight polysomnography simultaneously with esophageal pressure (P(es)) and PTT. The quantitative relationships between the size of P(es) variations (ΔP(es)) and PTT variations (ΔPTT) on a breath-by-breath basis in obstructive apneas were assessed. RESULTS: A total of 19,833 breaths from 6,087 obstructive apneas were analyzed. There were good correlations with r = 0.779 ± 0.095 (mean ± SD) between ΔP(es) and ΔPTT based on overnight sleep. The correlation coefficients for supine and lateral position were of the approximated magnitude (r = 0.783 ± 0.060 and 0.757 ± 0.106, respectively), whereas they were lower in rapid eye movement (REM) sleep (r = 0.564 ± 0.140) compared with non-rapid eye movement (NREM) sleep (r = 0.787 ± 0.071). In NREM sleep, the regression lines of ΔPTT against ΔP(es) were plotted with intercepts (5.1 ± 2.1 ms) and slopes (0.35 ± 0.08 ms·cm H(2)O(-1)). CONCLUSIONS: PTT showed good ability in detecting changes of inspiratory effort in overnight sleep and was proved to be a clinically useful method in quantifying increases in inspiratory effort in NREM sleep. Hence, PTT has prospects to become an alternative to P(es) in respiratory sleep studies.

Gender Differences in Patients With COVID-19: Focus on Severity and Mortality.

Objective: The recent outbreak of Novel Coronavirus Disease (COVID-19) is reminiscent of the SARS outbreak in 2003. We aim to compare the severity and mortality between male and female patients with COVID-19 or SARS. Study Design and Setting: We extracted the data from: (1) a case series of 43 hospitalized patients we treated, (2) a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and (3) data of 524 patients with SARS, including 139 deaths, from Beijing in early 2003. Results: Older age and a high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. Age was comparable between men and women in all data sets. In the case series, however, men's cases tended to be more serious than women's (P = 0.035). In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015). Conclusion: While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age.

[Anatomical study of auditory brainstem implantation through retrosigmoid approach].

OBJECTIVE: To provide anatomic data for auditory brainstem implantation (ABI) through the retrosigmoid approach. METHODS: Simulated operations were performed on 30 web adult head specimens and the structure around the foramen of luschka was observed. Both microscope and endoscope were employed. RESULTS: (1)The bony window, the most adjacent but not overlapping with sigmoid sinus, was a circle with a radius of 20 mm. Its center was located behind midpoint of the line from parietal notch to mastoid apex with a distance of (26.42 +/- 1.29) mm. The distance between bony window and transverse sinus, mastoid apex, foramen of luschka, jugular foramen, posterior edge of internal auditory meatus and root entry zone of the IX cranial nerve were (22.45 +/- 1.41) mm, (35.51 +/- 1.65) mm, (43.86 +/- 2.20) mm, (16.56 +/- 1.64) mm, (15.01 +/- 0.63) mm and (46.27 +/- 1.70) mm respectively; (2) The foramen of luschka can be spotted by using microscope or endoscope, especially 30 degrees angled endoscope. By this way, we could obtain a more distinct visual field without over-retraction of cerebellum and achieve the goal of minimally invasive surgery. The distance between the foramen of luschka and internal acoustic porus was (15.01 +/- 0.53) mm; (3) The foramen of luschka lies in the triangle formed by flocculus and root entry zone of glossopharyngeal nerve and rostral margin of biventer lobule. Choroids plexus acts as a direct landmark. the length of lateral recess was (17.53 +/- 1.03) mm. The distance between acoustic tubercle and the foramen of luschka and the root of cochlea never was (16.52 +/- 1.67) mm and (13.77 +/- 1.66) mm respectively. CONCLUSION: Adjustment of the angle of skull bone window and clarification of cerebellopontine angle are the keys to positioning the foramen of luschka. The usage of 30 degrees angled endoscope can identify the angle are the keys to positioning the foramen of luschka. The usage of 30 degrees angled endoscope can identify the foramen of luschka more accurately and expose the operation area more clearly.

[Comparison study between clinical diagnosis and experimental diagnosis of fungal sinusitis].

OBJECTIVE: To compare the differences between clinical diagnosis and laboratory diagnosis of fungal sinusitis. METHODS: One hundred cases of fungal sinusitis were reviewed in this study. The clinical characters including symptoms, physical signs, images and intraoperative signs were the main aspects of clinical diagnosis. The results of clinical diagnosis, pathology, direct observation of the nasal and sinus samples with microscope and the fungal culture were compared. RESULTS: The numbers of fungal ball, allergic fungal sinusitis, acute fulminant invasive fungal sinusitis, and chronic invasive fungal sinusitis were 82, 10, 6, and 2 respectively. The positive rates of clinical diagnosis, pathology, direct observation with microscope and the fungal culture were 95%, 61%, 78%, and 74% respectively. There was significant difference among the positive rates of above methods (P < 0. 01). CONCLUSION: Clinical diagnosis can be used as the preliminary method for fungal sinusitis diagnosis. The demonstrative diagnosis needs to combine all above methods. The culture was the main method for confirm the types of pathogenic fungus.

Effects of delayed brain-derived neurotrophic factor application on cochlear pathology and auditory physiology in rats.

BACKGROUND: The development and maintenance of spiral ganglion cells (SGCs) appear to be supported by neurotrophins. Removal of this support leads to their gradual degeneration. Intracochlear infusion with neurotrophins can provide trophic support to SGCs in animal deafness models if given shortly after deafening. However, it is not known whether delayed intervention will provide similar protection, which might be clinically relevant. The present research was conducted to determine the effects of brain-derived neurotrophic factor (BDNF) administration on the capacity of the peripheral processes to resprout. METHODS: The left cochlea of 20 profoundly deafened rats, which were divided into 2 groups equally, was implanted with an electrode and drug-delivery system 30 days after deafening. Either BDNF or artificial perilymph (AP) was delivered continuously for 28 days. Electrically evoked auditory brainstem responses (EABRs) were recorded during the period. SGC body and peripheral process density were measured. RESULTS: The EABR thresholds of AP increase continually. Those of BDNF increase slowly at the beginning then decrease, and were significantly less than those of the AP group from day 14 to 28 (P < 0.01). In terms of SGC and peripheral process density, the difference between the treated and control ears of BDNF group was clearly significant (P < 0.01), but not in AP group (P > 0.05). Analysis of the left cochlea between the two groups demonstrated that SGC/peripheral process density of the BDNF group was significantly greater than that of the AP group. Finally, a functional formula was developed relating the last EABR threshold and SGC density and process density, which was as follows: T = 466.184 - 2.71 (F.B.L). CONCLUSIONS: Under the conditions of delayed intervention following 30 days after deafening in rats, it can be concluded that BDNF enhances SGC bodies and peripheral processes survival after differentiation and so improves auditory sensitivity. SGC peripheral processes influence the auditory sensitivity.

[Quality of life after cochlear implantation in postlingually deaf adults].

OBJECTIVE: To evaluate the quality of life after cochlear implantation in adult cochlear implant recipients and to assess the applicability of Nijmegen Cochlear implant Questionnaire (NCIQ). METHODS: Thirty-two postlingually deaf patients, 19 males and 13 females, underwent cochlear implantation with the age at operation of 35.27 (18-66) during the period from 1996 to the end of 2006. NCIQ was used to investigate the application of the equipment, hearing ability, and emotional exchange ability. RESULTS: All of the patients used their cochlear implants for 16 h every day on average with an experience in using such implant of more than 6 months. Improvement was seen in sound recognition, speech recognition, confidence, daily life, social exchange, and emotional behavior ability at different degrees. The improvement of confidence was very obvious. The speech communication ability of those with a hearing deprivation time longer than 5 years was lower than that of those with a shorter hearing deprivation time. Age and educational level did not influence the efficiency. CONCLUSION: Cochlear implantation is a cost effective intervention in the postlingually deaf adults. NCIQ test can be used to evaluate the quality of life among postlingually deaf adult cochlear implant recipients in China.

[Concerns about vertigo].

Vertigo is an erroneous perception of movement resulted from the disorder of spatial orientation. The diagnosis and treatment of vertigo is complexand it is urgent to pay more attention on the research in this disease and standardize the management protocol.

Isobaric tag for relative and absolute quantitation-based comparative proteomic analysis of human pathogenic Prototheca zopfii genotype 2 and environmental genotype 1 strains.

BACKGROUND/PURPOSE: Prototheca species are ubiquitous achlorophyllic microalgae belonging to the family Chlorellaceae, which can cause a wide range of infections in humans and animals. Mainly in individuals with immunologic defects or trauma, Prototheca spp. can cause even lethal diseases. However, the exact pathogenic mechanism of Prototheca in causing disease remains largely unknown. To investigate the differences between pathogenic and nonpathogenic Prototheca spp. genotypes on proteome level, a nonpathogenic Prototheca zopfii genotype 1 strain, isolated from cow manure, and a human pathogenic P. zopfii genotype 2, isolated from human granulomatous lymphadenitis, were studied. METHODS: Differentially expressed proteins between the two genotypes were quantified by isobaric tag for relative and absolute quantitation-based quantitative proteomics, using liquid chromatography-tandem mass spectrometry. RESULTS: A total of 245 proteins were identified from the proteomic analysis after data filtering to eliminate low-scoring spectra. Among these, 35 proteins that displayed a significant (p<0.05) 1.5-fold change were considered as differentially expressed proteins. CONCLUSION: The differentially expressed proteins were associated with suppressed energy production and conversion, carbohydrate transport and metabolism, and enhanced translation in the genotype 2 strain, and are thus potentially relevant in the pathogenic mechanism of P. zopfii genotype 2, but need further investigation.

Anatomic structural study of cerebellopontine angle via endoscope.

BACKGROUND: Minimally invasive surgery in skull base relying on searching for possible anatomic basis for endoscopic technology is controversial. The objective of this study was to observe the spatial relationships between main blood vessels and nerves in the cerebellopontine angle area and provide anatomic basis for lateral and posterior skull base minimally invasive surgery via endoscopic retrosigmoid keyhole approach. METHODS: This study was conducted on thirty dried adult skulls to measure the spatial relationships among the surface bony marks of posterior cranial fossa, and to locate the most appropriate drilling area for retrosigmoid keyhole approach. In addition, we used 10 formaldehyde-fixed adult cadaver specimens for simulating endoscopic retrosigmoid approach to determine the visible scope. RESULTS: The midpoint between the mastoid tip and the asterion was the best drilling point for retrosigmoid approach. A hole centered on this point with the 2.0 cm in diameter was suitable for exposing the related structures in the cerebellopontine angle. Retrosigmoid keyhole approach can decrease the pressure on the cerebellum and expose the related structures effectively which include facial nerve, vestibulocochlear nerve, trigeminal nerve, glossopharyngeal nerve, vagus nerve, accessory nerve, hypoglossal nerve, anterior inferior cerebellar artery, posterior inferior cerebellar artery and labyrinthine artery, etc. CONCLUSIONS: Exact location on endoscope retrosigmoid approach can avoid dragging cerebellum during the minimally invasive surgery. The application of retrosigmoid keyhole approach will extend the application of endoscopic technology.

[Development of cognition, communication, and vocalization in hearing impaired infants fitted with hearing aids].

OBJECTIVE: To study the characteristics of development of cognition, communication, and vocalization in congenitally hearing impaired infants with hearing aids. METHODS: Hearing aids were fitted to 39 congenitally hearing impaired infants: 20 of them were fitted with the hearing aids before the age of 8 months (Group A), and 19 of them after the age of 8 months (Group B). Digital video camera was used to record the action, communication, and vocalization of the children. RESULTS: The time needed to be adaptable to the hearing aids of Group A was (0.5+/-0.2) months, significantly shorter than that of Group B [(2.2+/-0.3) months, P<0.01]. The time needed to establish communication by eyes was (0.6+/-0.2) months in Group A, significantly shorter than that in Group B [(2.3+/-0.5) months, P<0.01]. The time needed to present canonical babbling, communication by pointing behaviors, and meaningful words of Group A were (15.0+/-1.8) months, (12.1+/-2.1) months, and (17.3+/-2.2) months respectively, all stigmatically shorter than those of Group B [(23.2+/-8.0) months, (16.1+/-4.5) months, and (32.6+/-10.9) months respectively, all P<0.05)]. However, the time needed to present pre-canonical babbling of Group A was (4.3+/-0.5) months, not significantly different from that of Group B [(4.8+/-0.6) months, P>0.05]. CONCLUSION: Using the hearing aids early and validly helps acquire good development of cognizance and speech in hearing impaired infants.

Retinal Vascular Morphological Changes in Patients with Extremely Severe Obstructive Sleep Apnea Syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) has been shown to generate hypertension and endothelial dysfunction. Retinal vessel is the only vessel that can be observed directly and noninvasively; retinal vascular abnormalities can serve as a predictive marker for the occurrence, clinical course, and prognosis of cardiovascular and cerebrovascular diseases. The objective of this study was to identify the effect of OSAS severity on the morphological changes of retinal vessels. METHODS: Adult patients complained of snoring were included in this study. The patients' general information, polysomnography, and fundus photography parameters including central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) were collected. Patients were divided into four groups according to their apnea-hypopnea index (AHI) results: Group I, AHI ≤5/h; Group II, 5/h < AHI ≤30/h; Group III, 30/h < AHI ≤60/h; and Group IV, AHI> 60/h. RESULTS: A total of 133 patients were included in this study with 111 males (83.5%) and 22 females (16.5%). Mean age was 41.6 ± 9.9 years, and the mean body mass index was 28.1 ± 4.0 kg/m2. AHI ranged between 0 and 130.8/h with a mean of 39.1 ± 30.7/h. There were 24, 34, 35, and 40 patients in Group I, Group II, Group III, and Group IV, respectively. Significant differences were found for AHI (F = 388.368, P< 0.001), minimal pulse oxygen saturation (F = 91.902, P< 0.001), and arousal index (F = 31.014, P< 0.001) among four groups; no significant differences were found for CRAE (F = 0.460, P = 0.599) and CRVE (F = 0.404, P = 0.586) among groups; there were significant differences for AVR between Group I and Group IV (63.6 ± 5.1% vs. 67.2 ± 5.5%, P = 0.010) Group II and Group IV (64.5 ± 6.0% vs. 67.2 ± 5.5%, P = 0.030), and Group III and Group IV (64.7 ± 4.1% vs. 67.2 ± 5.5%, P = 0.043). A main group-by-AHI effect was found on the AVR: patients with higher AHI showed higher AVR results (r = 0.225, P = 0.009). Multivariate logistic regression analysis was used for multi-variable factors. A group-by-age effect was found on the AVR: younger patients showed higher AVR results (ß = -0.001, P = 0.020). CONCLUSIONS: This study indicated that increased AVR of retinal vessel can be observed in extremely severe OSAS patients. For patients with OSAS, retinal vascular abnormalities may become an early indication for further cardiovascular abnormalities.

Intranasal application of Epstein-Barr virus/lipoplex to abrogate eosinophillia in murine model of allergic rhinitis.

BACKGROUND: Currently anti-inflammatory therapy with steroids for allergic rhinitis need long-term repeated administration, although it is effective. Gene therapy is being suggested to substitute it. The aim of this study was to investigate nonviral vector mediated exogenous gene expression in COS-7 cells in vitro and the effect of intranasal mouse interleukin (mIL)-12 transgene expression on allergen induced eosinophil infiltration of nasal mucosa in a murine model of allergic rhinitis. METHODS: In vitro COS-7 cells were infected with Epstein-Barr virus (EBV)/lipoplex. The expression of IL-12 p70 in cell culture supernatant was examined by enzyme-linked immunosorbent assay (ELISA). In mice with ovalbumin (OVA) induced allergic rhinitis, EBV/lipoplex was administered by nasal drops before OVA challenge once a day from day 1 to day 10. The expression of IL-12 mRNA and protein, the change of eosinophil count in nasal mucosa and serum total IgE were measured 24 hours after the last challenge. RESULTS: EBV/lipoplex could effectively transfect COS-7 cells. The expression of IL-12 p70 in cell culture supernatant was significantly more than in blank control. IL-12 via EBV plasmid vector transduction could be overexpressed in vivo. In pGEG.mIL-12 treated models, the nasal mucosa revealed a high level of widespread mIL-12 transduction by immunohistochemistry and in situ hybridization. Histological evaluation revealed marked suppression of eosinophil infiltration in nasal mucosa. The eosinophil count in allergic rhinitis group [(26.5 +/- 9.8)/high-power field (HPF)] was significantly increased over control group [(0.40 +/- 0.52)/HPF] (F = 56.94, P < 0.01), while the count in IL-12 gene therapy group [(4.60 +/- 2.63)/HPF] was significantly less than that of allergic group (F = 56.9, P < 0.01). Serum total IgE between in gene therapy mice [(88.83 +/- 6.71) ng/ml] and allergic rhinitis mice [(103.1 +/- 5.7) ng/ml] showed a significant difference (F = 1216, P < 0.05). CONCLUSIONS: Nonviral EBV plasmid vector, pGEG.mIL-12 was able to overexpress exogenous gene both in vitro and in murine nasal mucosa in vivo. IL-12 overexpression via EBV/lipoplex could stem allergen induced eosinophil infiltration in nasal mucosa in murine models of allergic rhinitis, which may suggest a new cytokine immunogenetic therapy for allergic rhinitis.

[Histopathologic study of the ethmoid bone in chronic sinusitis].

OBJECTIVE: To investigate the histopathologic study of the ethmoid bone in chronic sinusitis (CRS) and the role of bone pathology in the pathogenesis of CRS. METHODS: Specimens of mucosa of ethmoid sinus with bone were collected during operation from 40 patients with CRS, 25 males and 15 females, aged 44.8, and specimens of mucosa of ethmoid sinus were collected from 16 patients with other otorhinolaryngologic diseases, 9 males and 7 females, aged 40.9 during operation. The specimens underwent HE, tartrate-resistant acid phosphatase, alkaline phosphatase, and Van Gieson staining so as to obtain the scores of nasal mucosa inflammation, pathology of mucoperiosteum and bone, and activity of bone remodeling. RESULTS: The average score of mucosal inflammation of the CRS group was 2.30 +/- 0.88, significantly higher than that of the control group (1.38 +/- 0.81, P = 0.004). The score of mucoperiosteum and bone pathology of the CRS group was 1.65 +/- 0.84, significantly higher than that of the control group (1.00 +/- 0.73, P = 0.004). The score of bone remodeling activity of the CRS group was 2.15 +/- 0.74, significantly higher than that of the control group (1.56 +/- 0.63, P = 0.007). In the CRS patients, the score of mucosal inflammation was not significantly correlated with the mucoperiosteum and bone pathology (R = 0.047, P = 0.772), and the activity of bone remodeling (R = 0.021, P = 0.897). CONCLUSION: The ethmoid bone of CRS patients shows marked fibrosis, bone remodeling, structure of woven bone, and pathologic changes similar to those of chronic osteomyelitis, especially bone absorption, new bone formation, etc.

Three-dimensional Evaluation of Nasal Surgery in Patients with Obstructive Sleep Apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway. The effectiveness of nasal surgery has been discussed in several studies and shows a promising growing interest. In this study, we intended to evaluate the effects of nasal surgery on the upper airway dimensions in patients with OSA using three-dimensional (3D) reconstruction of cone-beam computed tomography (CT). METHODS: Twelve patients with moderate to severe OSA who underwent nasal surgery were included in this study. All patients were diagnosed with OSA using polysomnography (PSG) in multi sleep health centers associated with Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary and the Partners Health Care from May 31, 2011 to December 14, 2013. The effect of nasal surgery was evaluated by the examination of PSG, subjective complains, and 3D reconstructed CT scan. Cross-sectional area was measured in eleven coronal levels, and nasal cavity volume was evaluated from anterior nasal spine to posterior nasal spine. The thickness of soft tissue in oral pharynx region was also measured. RESULTS: Five out of the 12 patients were successfully treated by nasal surgery, with more than 50% drop of apnea-hypopnea index. All the 12 patients showed significant increase of cross-sectional area and volume postoperatively. The thickness of soft tissue in oral pharynx region revealed significant decrease postoperatively, which decreased from 19.14 ± 2.40 cm 2 and 6.11 ± 1.76 cm 2 to 17.13 ± 1.91 cm 2 and 5.22 ± 1.20 cm 2 . CONCLUSIONS: Nasal surgery improved OSA severity as measured by PSG, subjective complaints, and 3D reconstructed CT scan. 3D assessment of upper airway can play an important role in the evaluation of treatment outcome.

Clinical features of probable severe acute respiratory syndrome in Beijing.

AIM: To summarize clinical features of probable severe acute respiratory syndrome (SARS) in Beijing. METHODS: Retrospective cases involving 801 patients admitted to hospitals in Beijing between March and June 2003, with a diagnosis of probable SARS, moderate type. The series of clinical manifestation, laboratory and radiograph data obtained from 801 cases were analyzed. RESULTS: One to three days after the onset of SARS, the major clinical symptoms were fever (in 88.14% of patients), fatigue, headache, myalgia, arthralgia (25-36%), etc. The counts of WBC (in 22.56% of patients) lymphocyte (70.25%) and CD3, CD4, CD8 positive T cells (70%) decreased. From 4-7 d, the unspecific symptoms became weak; however, the rates of low respiratory tract symptoms, such as cough (24.18%), sputum production (14.26%), chest distress (21.04%) and shortness of breath (9.23%) increased, so did the abnormal rates on chest radiograph or CT. The low counts of WBC, lymphocyte and CD3, CD4, CD8 positive T cells touched bottom. From 8 to 16 d, the patients presented progressive cough (29.96%), sputum production (13.09%), chest distress (29.96%) and shortness of breath (35.34%). All patients had infiltrates on chest radiograph or CT, some even with multi-infiltrates. Two weeks later, patients' respiratory symptoms started to alleviate, the infiltrates on the lung began to absorb gradually, the counts of WBC, lymphocyte and CD3, CD4, CD8 positive T cells were restored to normality. CONCLUSION: The data reported here provide evidence that the course of SARS could be divided into four stages, namely the initial stage, progressive stage, fastigium and convalescent stage.

Comparisons between neural response imaging thresholds, electrically evoked auditory reflex thresholds and most comfortable loudness levels in CII bionic ear users with HiResolution sound processing strategies.

CONCLUSIONS: The data collected in this study indicated that first Neural Response Imaging (NRI) thresholds had a better correlation with HiResolution most comfortable loudness (M) levels than tNRI thresholds. Electrically evoked auditory reflex thresholds (EARTs) had a higher correlation with HiResolution M levels than tNRI thresholds and a lower correlation than first NRI thresholds. NRI is a very useful method for programming the cochlear implants of young children who cannot demonstrate a reliable judgment of loudness. OBJECTIVE: To investigate how HiResolution sound processing, designed to deliver high-rate stimuli, relates to EARTs and electrically evoked compound action potential measurements produced by low-rate stimuli. MATERIAL AND METHODS: Nine profoundly hearing-impaired children and adults aged 6-29 years participated in the study. NRI responses were elicited using pulse trains consisting of biphasic pulses at a pulse width per phase of 32 micros delivered at a frequency of 30 Hz using SoundWave programming software. Stimuli were delivered to the odd electrodes (1, 3, 5, 7, 9, 11, 13 and 15) along the array. tNRI (NRI threshold) and first NRI thresholds were recorded for each stimulating electrode. "Speech bursts" stimuli used in EARTs recording were delivered to four electrodes at a time and stapedial reflexes were recorded from the impedance bridge. The M levels used were those used by each patient in their everyday HiResolution programs. RESULTS: For 8 patients (53 stimulating electrodes) the correlation between tNRI threshold and M level was r=0.675 (p=0.000) and that between first NRI thresholds and M level was r=0.741 (p=0.000). On average the M-level value was 20 CU (Current Unit) lower than the first NRI threshold value and 12 CU higher than the tNRI threshold value. The M-level patterns across the electrode array overall were similar to the tNRI or first NRI threshold patterns. For 7 patients (112 stimulating electrodes) the correlation between EART and M levels was r=0.710 (p=0.000). On average the EART value was 14 CU higher than the M-level value.