Serum lipid metabolism characteristics and potential biomarkers in patients with unilateral sudden sensorineural hearing loss.

BACKGROUND: Glycerophospholipids (GPLs) are essential for cell membrane structure and function. Sphingomyelin and its metabolites regulate cell growth, apoptosis, and stress responses. This study aimed to investigate lipid metabolism in patients experiencing sudden sensorineural hearing loss across all frequencies (AF-SSNHL). METHODS: The study included 60 patients diagnosed with unilateral AF-SSNHL, among whom 30 patients had a level of hearing improvement ≥ 15 dB after 6 months of follow-up. A propensity score-matched (2:1) control group was used. Liquid chromatography‒mass spectrometry based untargeted lipidomics analysis combined with multivariate statistics was performed to investigate the lipids change. The "lipidome" R package and weighted gene co-expression network analysis (WGCNA) were utilised to assess the lipids' structural features and the association between lipids and hearing. RESULTS: Lipidomics successfully differentiated the AF-SSNHL group from the control group, identifying 17 risk factors, mainly including phosphatidylcholine (PC), phosphatidylethanolamine (PE), and related metabolites. The ratios of lysophosphatidylcholine/PC, lysophosphatidylethanolamine/PE, and lysodimethylphosphatidylethanolamine/PE were upregulated, while some glycerophospholipid (GPL)-plasmalogens were downregulated in the AF-SSNHL group, indicating abnormal metabolism of GPLs. Trihexosylceramide (d34:1), PE (18:1e_22:5), and sphingomyelin (d40:3) were significantly different between responders and nonresponders, and positively correlated with hearing improvement. Additionally, the results of the WGCNA also suggested that partial GPL-plasmalogens were positively associated with hearing improvement. CONCLUSION: AF-SSNHL patients exhibited abnormally high blood lipids and pronounced GPLs metabolic abnormalities. Sphingolipids and GPL-plasmalogens had an association with the level of hearing improvement. By understanding the lipid changes, clinicians may be able to predict the prognosis of hearing recovery and personalize treatment approaches.

HMGB1 accumulation in cytoplasm mediates noise-induced cochlear damage.

Damage-associated molecular pattern molecules (DAMPs) play a critical role in mediating cochlear cell death, which leads to noise-induced hearing loss (NIHL). High-mobility group box 1 (HMGB1), a prototypical DAMP released from cells, has been extensively studied in the context of various diseases. However, whether extracellular HMGB1 contributes to cochlear pathogenesis in NIHL and the potential signals initiating HMGB1 release from cochlear cells are not well understood. Here, through the transfection of the adeno-associated virus with HMGB1-HA-tag, we first investigated early cytoplasmic accumulation of HMGB1 in cochlear hair cells after noise exposure. We found that the cochlear administration of HMGB1-neutralizing antibody immediately after noise exposure significantly alleviated hearing loss and outer hair cells (OHCs) death induced by noise exposure. In addition, activation of signal transducer and activators of transcription 1 (STAT1) and cellular hyperacetylation were verified as potential canonical initiators of HMGB1 cytoplasmic accumulation. These findings reveal the adverse effects of extracellular HMGB1 on the cochlea and the potential signaling events mediating HMGB1 release in hair cells, indicating multiple potential pharmacotherapeutic targets for NIHL.

Epidemiology and Association Rules Analysis for Pulmonary Tuberculosis Cases with Extrapulmonary Tuberculosis from Age and Gender Perspective: A Large-Scale Retrospective Multicenter Observational Study in China.

Background: Tuberculosis (TB), a multisystemic disease with protean presentation, remains a major global health problem. Although concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) cases are commonly observed clinically, knowledge regarding concurrent PTB-EPTB is limited. Here, a large-scale multicenter observational study conducted in China aimed to study the epidemiology of concurrent PTB-EPTB cases by diagnostically defining TB types and then implementing association rules analysis. Methods: The retrospective study was conducted at 21 hospitals in 15 provinces in China and included all inpatients with confirmed TB diagnoses admitted from Jan 2011 to Dec 2017. Association rules analysis was conducted for cases with concurrent PTB and various types of EPTB using the Apriori algorithm. Results: Evaluation of 438,979TB inpatients indicated PTB was the most commonly diagnosed (82.05%) followed by tuberculous pleurisy (23.62%). Concurrent PTB-EPTB was found in 129,422 cases (29.48%) of which tuberculous pleurisy was the most common concurrent EPTB type observed. The multivariable logistic regression models demonstrated that odds ratios of concurrent PTB-EPTB cases varied by gender and age group. For PTB cases with concurrent EPTB, the strongest association was found between PTB and concurrent bronchial tuberculosis (lift = 1.09). For EPTB cases with concurrent PTB, the strongest association was found between pharyngeal/laryngeal tuberculosis and concurrent PTB (lift = 1.11). Confidence and lift values of concurrent PTB-EPTB cases varied with gender and age. Conclusions: Numerous concurrent PTB-EPTB case types were observed, with confidence and lift values varying with gender and age. Clinicians should screen for concurrent PTB-EPTB in order to improve treatment outcomes.

Differential weighting of temporal envelope cues from the low-frequency region for Mandarin sentence recognition in noise.

BACKGROUND: Temporal envelope cues are conveyed by cochlear implants (CIs) to hearing loss patients to restore hearing. Although CIs could enable users to communicate in clear listening environments, noisy environments still pose a problem. To improve speech-processing strategies used in Chinese CIs, we explored the relative contributions made by the temporal envelope in various frequency regions, as relevant to Mandarin sentence recognition in noise. METHODS: Original speech material from the Mandarin version of the Hearing in Noise Test (MHINT) was mixed with speech-shaped noise (SSN), sinusoidally amplitude-modulated speech-shaped noise (SAM SSN), and sinusoidally amplitude-modulated (SAM) white noise (4 Hz) at a + 5 dB signal-to-noise ratio, respectively. Envelope information of the noise-corrupted speech material was extracted from 30 contiguous bands that were allocated to five frequency regions. The intelligibility of the noise-corrupted speech material (temporal cues from one or two regions were removed) was measured to estimate the relative weights of temporal envelope cues from the five frequency regions. RESULTS: In SSN, the mean weights of Regions 1-5 were 0.34, 0.19, 0.20, 0.16, and 0.11, respectively; in SAM SSN, the mean weights of Regions 1-5 were 0.34, 0.17, 0.24, 0.14, and 0.11, respectively; and in SAM white noise, the mean weights of Regions 1-5 were 0.46, 0.24, 0.22, 0.06, and 0.02, respectively. CONCLUSIONS: The results suggest that the temporal envelope in the low-frequency region transmits the greatest amount of information in terms of Mandarin sentence recognition for three types of noise, which differed from the perception strategy employed in clear listening environments.

The prevalence and risks of major comorbidities among inpatients with pulmonary tuberculosis in China from a gender and age perspective: a large-scale multicenter observational study.

In clinical practice, PTB patients have concurrent many types of comorbidities such as pneumonia, liver disorder, diabetes mellitus, hematological disorder, and malnutrition. Detecting and treating specific comorbidities and preventing their development are important for PTB patients. However, the prevalence of most comorbid conditions in patients with PTB is not well described. We conducted a large-scale, multicenter, observational study to elucidate and illustrate the prevalence rates of major comorbidities in inpatients at 21 hospitals in China. The 19 specific comorbidities were selected for analysis in this patient cohort, and stratified the inpatient cohort according to age and gender. A total of 355,929 PTB inpatients were included, with a male:female ratio of 1.98 and the proportion of ≥ 65 years PTB inpatients was the most. Approximately 70% of PTB inpatients had at least one defined type of comorbidity. The prevalence of 19 specific comorbidities in inpatients with PTB was analyzed, with pneumonia being the most common comorbidity. The prevalence of most comorbidities was higher in males with PTB except thyroid disorders, mental health disorders, etc. The prevalence of defined most comorbidities in patients with PTB tended to increase with increasing age, although some specific comorbidities tended to increase initially then decrease with increasing age. Our study describes multiple clinically important comorbidities among PTB inpatients, and their prevalence between different gender and age groups. The results will enhance the clinical aptitude of physicians who treat patients with PTB to recognize, diagnose, and treat PTB comorbidities early.

Transcriptomic Analysis Reveals an Altered Hcy Metabolism in the Stria Vascularis of the Pendred Syndrome Mouse Model.

Purpose: Slc26a4-/- mice exhibit severer defects in the development of the cochlea and develop deafness, while the underlying mechanisms responsible for these effects remain unclear. Our study was to investigate the potential mechanism linking SLC26A4 deficiency to hearing loss. Materials and Methods: RNA sequencing was applied to analyze the differential gene expression of the stria vascularis (SV) from wildtype and Slc26a4-/- mice. GO and KEGG pathway analysis were performed. Quantitative RT-PCR was applied to validate the expression of candidate genes affected by Slc26a4. ELISA and immunofluorescence technique were used to detect the homocysteine (Hcy) level in serum, brain, and SV, respectively. Results: 183 upregulated genes and 63 downregulated genes were identified in the SV associated with Slc26a4 depletion. Transcriptomic profiling revealed that Slc26a4 deficiency significantly affected the expression of genes associated with cell adhesion, transmembrane transport, and the biogenesis of multicellular organisms. The SV from Slc26a4-/- mice exhibited a higher expression of Bhmt mRNAs, as well as altered homocysteine (Hcy) metabolism. Conclusions: The altered expression of Bhmt results in a dramatic change in multiple biochemical reactions and a disruption of nutrient homeostasis in the endolymph which may contribute to hearing loss of Slc26a4 knockout mouse.

Graphene Assisted in the Analysis of Coumarins in Angelicae Pubescentis Radix by Dispersive Liquid-Liquid Microextraction Combined with 1H-qNMR.

The content of active components in traditional Chinese medicine is relatively small, and it is difficult to detect some trace components with modern analytical instruments, so good pretreatment and extraction are very important in the experiment. Graphene was introduced by a dispersive liquid-liquid microextraction method based on solidification of floating organic drop (DLLME-SFO) with graphene/1-dodecyl alcohol used as the extractant, and this method, combined with quantitative proton nuclear magnetic resonance spectroscopy (1H-qNMR), was used to simultaneously qualitative and quantitative osthole, columbianadin and isoimperatorin in Angelicae Pubescentis Radix. In this experiment, a magnetic stirrer was used for extraction, all NMR spectra were recorded on a Bruker Advance III 600 MHz spectrometer with dimethyl sulfoxide-d6 (DMSO-d6) as deuterated solvent and pyrazine as the internal standard. The influencing factors and NMR parameters in the extraction process were investigated and optimized. In addition, the methodology of the established method was also examined. The quantitative signals of osthole, columbianadin and isoimperatorin were at a chemical shift of δ6.25-δ6.26 ppm, δ6.83-δ6.85 ppm, and δ6.31-δ6.32 ppm. The linear ranges of osthole, columbianadin and isoimperatorin were all 0.0455-2.2727 mg/mL, and R2 were 0.9994, 0.9994 and 0.9995, respectively. The limits of detection of osthole, columbianadin and isoimperatorin were 0.0660, 0.0720, 0.0620 mg, and the limits of quantification of osthole, columbianadin and isoimperatorin were 0.2201, 0.2401, 0.2066 mg/mL. The solution had good stability and repeatability within 24 h. The recoveries of osthole, columbianadin and isoimperatorin were 102.26%, 99.89%, 103.28%, respectively. The established method is simple and easy to operate, which greatly reduces the cumbersome pretreatment of samples and has high extraction efficiency.

Extraction and Analysis of Six Effective Components in Glycyrrhiza uralensis Fisch by Deep Eutectic Solvents (DES) Combined with Quantitative Analysis of Multi-Components by Single Marker (QAMS) Method.

Deep eutectic solvents (DESs) are green organic solvents that have broad prospects in the extraction of effective components of traditional Chinese medicine. This work employed the quantitative analysis of multi-components by a single marker (QAMS) method to quantitatively determine the six effective components of glycyrrhizic acid, liquiritin, isoliquiritin apioside, liquiritigenin, isoliquiritin, and glycyrrhetinic acid in Glycyrrhiza uralensis, which was used for comprehensive evaluation of the optimal extraction process by DESs. First, Choline Chloride: Lactic Acid (ChCl-LA, molar ratio 1:1) was selected as the most suitable DES by comparing the extraction yields of different DESs. Second, the extraction protocol was investigated by extraction time, extraction temperature, liquid-to-material ratio, molar ratio, and ultrasonic power. The Box-Behnken design (BBD) combined with response surface methodology (RSM) was used to investigate the optimal DES conditions. The result showed that the best DES system was 1.3-butanediol/choline chloride (ChCl) with the molar ratio of 4:1. The optimal extraction process of licorice was 20 mL/g, the water content was 30%, and the extraction time was 41 min. The comprehensive impact factor (z) was 0.92. At the same time, it was found that the microstructure of the residue extracted by the eutectic solvent was more severely damaged than the residue after the traditional solvent extraction through observation under an electron microscope. The DES has the characteristics of high efficiency and rapidity as an extraction solution.

Effects of SoundBite Bone Conduction Hearing Aids on Speech Recognition and Quality of Life in Patients with Single-Sided Deafness.

Objectives: To analyze the clinical application of SoundBite bone conduction hearing aids by assessing the improvement of speech recognition and the scores of the benefit scale questionnaire for patients with single-sided deafness (SSD). Design: Nine patients aged 24 to 61 years with SSD for more than 3 months were enrolled in this study. The patients could understand and repeat Mandarin and have good compliance with the study. The measurements were evaluated before and after one month of wearing hearing aids using the pure tone audiometry threshold, speech recognition in quiet and in noise, and the Glasgow Benefit Inventory (GBI) benefit scale score. Results: Pure tone audiometry results showed that the average hearing threshold of good ears and bad ears was 11.4 ± 2.6 dB HL and 89.9 ± 6.4 dB HL, respectively. The average hearing threshold of bad ears after wearing hearing aids was 23.5 ± 9.0 dB HL. Statistical analysis showed that the hearing improvement for the bad ears after wearing hearing aids was significant. The speech audiometry results showed that the disyllable word recognition score of the bad ears in quiet increased significantly at 50 dB SPL by 40 ± 12 percentage points and at 65 dB SPL by 71 ± 15 percentage points. As for the speech recognition in noise, when the signal sound came from the bad ear side and the noise from the good ear side (SSSDNAH), the speech recognition score (SRS) significantly increased by 17 ± 6 and 9 ± 4 at a signal-to-noise ratio (SNR) of -2 dB and -5 dB, respectively, after wearing the hearing aids. When the signal sound came from the front of the patient and the noise from the bad ear side (S0NSSD), the SRS scores were reduced by 5 ± 5 and 7 ± 5 percentage points at SNR equal to -2 dB and -5 dB, which was significantly different from that before wearing the hearing aids. When the signal and noise both came from the front of the patients (S0N0), the SRS was not significantly increased by 5 ± 4 percentage points at SNR equal to -2 dB compared to before wearing hearing aids. However, the SRS was significantly increased by 5 ± 2 percentage points at SNR equal to -5 dB compared to before wearing hearing aids. The average total GBI score was 31 ± 12 for the nine patients, with an average score of 32 ± 10, 31 ± 8, and 30 ± 7 for general conditions, social support, and physical health, respectively. The results of the questionnaires showed that patients' quality of life was improved after wearing SoundBite bone conduction hearing aids. Conclusions: SoundBite bone conduction hearing aids are a good choice for patients with SSD, as it could improve the speech recognition ability of patients both in a quiet and noisy environment and improves the quality of life after wearing hearing aids.

Differences in Clinical Characteristics and Brain Activity between Patients with Low- and High-Frequency Tinnitus.

This study was aimed at delineating and comparing differences in clinical characteristics and brain activity between patients with low- and high-frequency tinnitus (LFT and HFT, respectively) using high-density electroencephalography (EEG). This study enrolled 3217 patients with subjective tinnitus who were divided into LFT (frequency < 4000 Hz) and HFT (≥4000 Hz) groups. Data regarding medical history, Tinnitus Handicap Inventory, tinnitus matching, and hearing threshold were collected from all patients. Twenty tinnitus patients and 20 volunteers were subjected to 256-channel EEG, and neurophysiological differences were evaluated using standardized low-resolution brain electromagnetic tomography (sLORETA) source-localized EEG recordings. Significant differences in sex (p < 0.001), age (p = 0.022), laterality (p < 0.001), intensity (p < 0.001), tinnitus type (p < 0.001), persistent tinnitus (p = 0.04), average threshold (p < 0.001), and hearing loss (p = 0.028) were observed between LFT and HFT groups. The tinnitus pitch only appeared to be correlated with the threshold of the worst hearing loss in the HFT group. Compared with the controls, the LFT group exhibited increased gamma power (p < 0.05), predominantly in the posterior cingulate cortex (PCC, BA31), whereas the HFT group had significantly decreased alpha1 power (p < 0.05) in the angular gyrus (BA39) and auditory association cortex (BA22). Higher gamma linear connectivity between right BA39 and right BA41 was observed in the HFT group relative to controls (t = 3.637, p = 0.027). Significant changes associated with increased gamma in the LFT group and decreased alpha1 in the HFT group indicate that tinnitus pitch is crucial for matching between the tinnitus and control groups. Differences of band frequency energy in brain activity levels may contribute to the clinical characteristics and internal tinnitus "spectrum" differences.

Rosiglitazone Improves Glucocorticoid Resistance in a Sudden Sensorineural Hearing Loss by Promoting MAP Kinase Phosphatase-1 Expression.

In this study, we investigated the role of MAP kinase phosphatase-1 (MKP-1) and rosiglitazone (RSG) in glucocorticoid resistance and glucocorticoid sensitivity, respectively, using a guinea pig model of lipopolysaccharide- (LPS-) induced sudden sensorineural hearing loss (SSHL). The pigs were divided into control, LPS, LPS+dexamethasone (DEX), LPS+RSG, and LPS+DEX+RSG groups. Their hearing was screened by auditory brainstem response measurement. Immunofluorescence staining was used to identify the location of MKP-1 in the inner ear. The expression levels of MKP-1 and the related proteins in the inner ear were detected using western blotting. The morphological changes in the cochlea were observed via hematoxylin-eosin staining. Severe hearing loss was observed in the LPS group, as opposed to the protection from hearing loss observed in the LPS+DEX+RSG group. A positive correlation was observed between MKP-1 expression levels and protection from hearing loss. RSG and DEX synergistically influenced inner ear inflammation. In conclusion, resistance of LPS-induced SSHL guinea pig models to glucocorticoids may result from impaired MKP-1 function in inner ear tissues, induced by glucocorticoids, impairing the inhibition of inflammation. Our findings present novel targets to develop potential therapeutics to treat inflammatory diseases of the inner ear.

A preliminary study on time-compressed speech recognition in noise among teenage students who use personal listening devices.

OBJECTIVE: To compare speech perception obtained with different time compression rates in teenagers that do or do not use personal listening devices (PLDs). DESIGN: Teenagers in a high school were recruited to complete questionnaires reporting their recreational noise exposure using PLDs. The dose of individual recreational noise exposure was calculated. The individuals with the most and least doses of recreational noise were selected and grouped into PLD users and non-PLD users. Normal rate and time-compressed (60% and 70%) speech recognition in quiet and noisy conditions was measured. STUDY SAMPLE: PLD user and non-PLD user group each included 20 participants. RESULTS: ANOVA analysis showed that the effect of group, background, compression rate, and interactions between any two factors are significant. Post hoc analysis showed that the speech recognition scores with normal rate in quiet and noise and those obtained from time-compressed speech in the quiet condition were not significantly different between PLD users and non-PLD users. However, differences in the time-compressed speech recognition scores (60% and 70%) in noisy conditions between the two groups were statistically significant. CONCLUSIONS: The fast-speed speech recognition in noise decreased significantly in PLD users compared with that in non-PLD users selected by extreme entertainment exposure.

Recent advances in glyphosate biodegradation.

Glyphosate has emerged as the most widespread herbicide to control annual and perennial weeds. Massive use of glyphosate for decades has resulted in its ubiquitous presence in the environment, and poses a threat to humans and ecosystem. Different approaches such as adsorption, photocatalytic degradation, and microbial degradation have been studied to break down glyphosate in the environment. Among these, microbial degradation is the most effective and eco-friendly method. During its degradation, various microorganisms can use glyphosate as a sole source of phosphorus, carbon, and nitrogen. Major glyphosate degradation pathways and its metabolites have been frequently investigated, but the related enzymes and genes have been rarely studied. There are many reviews about the toxicity and fate of glyphosate and its major metabolite, aminomethylphosphonic acid. However, there is lack of reviews on biodegradation and bioremediation of glyphosate. The aims of this review are to summarize the microbial degradation of glyphosate and discuss the potential of glyphosate-degrading microorganisms to bioremediate glyphosate-contaminated environments. This review will provide an instructive direction to apply glyphosate-degrading microorganisms in the environment for bioremediation.

Comparison of Acceptable Noise Level Generated Using Different Transducers and Response Modes.

The acceptable noise level (ANL) was defined by subtracting the background noise level (BNL) from the most comfortable listening level (MCL) (ANL = MCL - BNL). This study compared the ANL obtained through different methods in 20 Chinese subjects with normal hearing. ANL was tested with Mandarin speech materials using a loudspeaker or earphones, with each subject tested by himself or by the audiologist. The presentation and response modes were as follows: (1) loudspeaker with self-adjusted noise levels using audiometer controls (LS method); (2) loudspeaker with the subject signaling the audiologist to adjust speech and noise levels (LA method); (3) earphones with self-adjusted noise levels using audiometer controls (ES method); and (4) earphones with the subject signaling the audiologist to adjust speech and noise levels (EA method). ANL was calculated from three measurements with each method. There was no significant difference in the ANL obtained through different presentation modes or response modes sound. The correlations between ANL, MCL, and BNL obtained from each two methods were significant. In conclusion, the ANL in normal-hearing Mandarin listeners may not be affected by presentation modes such as a loudspeaker or earphones nor is it affected by self-adjusted or audiologist-adjusted response modes. Earphone audiometry is as reliable as sound field audiometry and provides an easy and convenient way to measure ANL.

The Relative Weight of Temporal Envelope Cues in Different Frequency Regions for Mandarin Sentence Recognition.

Acoustic temporal envelope (E) cues containing speech information are distributed across the frequency spectrum. To investigate the relative weight of E cues in different frequency regions for Mandarin sentence recognition, E information was extracted from 30 contiguous bands across the range of 80-7,562 Hz using Hilbert decomposition and then allocated to five frequency regions. Recognition scores were obtained with acoustic E cues from 1 or 2 random regions from 40 normal-hearing listeners. While the recognition scores ranged from 8.2% to 16.3% when E information from only one region was available, the scores ranged from 57.9% to 87.7% when E information from two frequency regions was presented, suggesting a synergistic effect among the temporal E cues in different frequency regions. Next, the relative contributions of the E information from the five frequency regions to sentence perception were computed using a least-squares approach. The results demonstrated that, for Mandarin Chinese, a tonal language, the temporal E cues of Frequency Region 1 (80-502 Hz) and Region 3 (1,022-1,913 Hz) contributed more to the intelligence of sentence recognition than other regions, particularly the region of 80-502 Hz, which contained fundamental frequency (F0) information.

Effects of Various Extents of High-Frequency Hearing Loss on Speech Recognition and Gap Detection at Low Frequencies in Patients with Sensorineural Hearing Loss.

This study explored whether the time-compressed speech perception varied with the degree of hearing loss in high-frequency sensorineural hearing loss (HF SNHL) individuals. 65 HF SNHL individuals with different cutoff frequencies were recruited and further divided into mildly, moderately, and/or severely affected subgroups in terms of the averaged thresholds of all frequencies exhibiting hearing loss. Time-compressed speech recognition scores under both quiet and noisy conditions and gap detection thresholds within low frequencies that had normal thresholds were obtained from all patients and compared with data from 11 age-matched individuals with normal hearing threshold at all frequencies. Correlations of the time-compressed speech recognition scores with the extents of HF SNHL and with the 1 kHz gap detection thresholds were studied across all participants. We found that the time-compressed speech recognition scores were significantly affected by and correlated with the extents of HF SNHL. The time-compressed speech recognition scores also correlated with the 1 kHz gap detection thresholds except when the compression ratio of speech was 0.8 under quiet condition. Above all, the extents of HF SNHL were significantly correlated with the 1 kHz gap thresholds.

The Importance of Acoustic Temporal Fine Structure Cues in Different Spectral Regions for Mandarin Sentence Recognition.

OBJECTIVES: To study the relative contribution of acoustic temporal fine structure (TFS) cues in low-, mid-, and high-frequency regions to Mandarin sentence recognition. DESIGN: Twenty-one subjects with normal hearing were involved in a study of Mandarin sentence recognition using acoustic TFS. The acoustic TFS information was extracted from 10 3-equivalent rectangular bandwidth-wide bands within the range 80 to 8858 Hz using the Hilbert transform and was assigned to low-, mid-, and high-frequency regions. Percent-correct recognition scores were obtained with acoustic TFS information presented using one, two, or three frequency regions. The relative weights of the three frequency regions were calculated using the least-squares approach. RESULTS: Results indicated that the mean percent-correct scores for sentence recognition using acoustic TFS were nearly perfect for stimuli with all three frequency regions together. Recognition was approximately 50 to 60% correct with only the low- or mid-frequency region but decreased to approximately 5% correct with only the high-frequency region of acoustic TFS. The mean weights of the low-, mid-, and high-frequency regions were 0.39, 0.48, and 0.13, respectively, and the difference between each pair of frequency regions was statistically significant. CONCLUSION: The acoustic TFS cues in low- and mid-frequency regions convey greater information for Mandarin sentence recognition, whereas those in the high-frequency region have little effect.

First-referral presentations of patients with benign paroxysmal positional vertigo who were negative on positional testing and who lacked nystagmus.

The aim of the present study was to explore the demographic, clinical, and pathogenetic features; and treatment outcomes of patients with benign paroxysmal positional vertigo (BPPV) who were negative upon positional testing at their first referral. A total of 133 patients presented with histories of BPPV but were negative, in our hands, upon positional testing. Patients were told to cease taking vestibular suppressant medication (if any) and were to return for re-examination when positional vertigo symptoms recurred. If BPPV was diagnosed, the appropriate repositioning maneuver was applied and patients were re-examined weekly until the characteristic nystagmus and vertigo disappeared. Follow-up was performed 1 week, 4 weeks, 3 months, 6 months, and 1 year after diagnosis. The 133 patients were compared with a group of 250 patients with typical BPPV. Sixty-five of the 133 patients (termed the n-BPPV group) were subsequently identified with typical BPPV. Such diagnoses were made within 10 days of the first referral in 37 (56.9%) cases. Patients of the n-BPPV group had a longer duration of the last episode of vertigo than did others (39.7 ± 38.4 vs. 26.1 ± 36.7 days, p < 0.001), and a higher proportion used vestibular suppressant medication prior to first referral (75.4 vs. 54.8%, p = 0.003). The n-BPPV and typical BPPV patients responded similarly to treatment and exhibited similar recurrence rates. BPPV patients who were negative upon positional testing at first referral were quite common, accounting for 26% of all typical BPPV patients. No significant difference in either treatment outcome or recurrence rate was evident between n-BPPV and typical BPPV positions. Positional vertigo and nystagmus are not always present as BPPV progresses.

A new strategy for difficult airway management with visual needle cricothyroidotomy: a manikin study.

BACKGROUND: Conventional needle cricothyroidotomy uses blind manipulation. We investigated the feasibility and efficiency of a new visually guided needle cricothyroidotomy technique. METHODS: A 0.9-mm microimaging fiber was delivered into a 14G needle to develop a visual puncture system. 10 inexperienced physicians were randomly assigned to perform 10 repeated needle cricothyroidotomy in each group with both conventional method and visual puncture in a manikin. Tracheal lumen puncture time and number of procedure-related complications were recorded. RESULTS: Under visual guidance, the needle successfully reached the tracheal lumen. The anatomy of the upper and lower airways was acquired by further advancing the microimaging fiber into the tracheal lumen of the visual group. The tracheal lumen puncture time was significantly less in the visual group than in the conventional group (3.85 ± 1.54 vs. 9.84 ± 1.08 seconds, P < .001). Damage to the posterior tracheal wall was not observed in the visual group; however, 21% of manikins in the conventional group had procedure-related complications. CONCLUSIONS: Our results demonstrate that visual needle cricothyroidotomy is feasible, and may lead to a decrease in procedure time and procedure-related complications compared to the conventional procedure. In addition, this strategy may also provide useful information for diagnostic purposes; therefore, visual needle cricothyroidotomy may be a new strategy for the management of difficult airways in future care.