Clinical characteristics and survival outcomes in patients with primary ovarian carcinoid: A historical cohort study.

INTRODUCTION: Primary ovarian carcinoids are extremely rare ovarian tumors, and there is limited data available on their clinical characteristics and survival outcomes. MATERIAL AND METHODS: We conducted a historical cohort study of 56 patients to investigate their clinical characteristics. The overall survival, disease-specific survival, recurrence-free survival, and potential prognostic factors of these patients were also evaluated. RESULTS: The median age of these patients was 42.0 years (range: 20-71). The average mass and carcinoid size was 7.3 and 0.4 cm, respectively. Elevated tumor marker levels and ascites were observed in 15 and 10 patients, respectively. In 98.2% of the patients, tumors were confined to the ovary, while only one had metastatic disease. Surgery was the mainstay therapy: 37.5% of the patients underwent unilateral salpingo-oophorectomy, 25.0% underwent hysterectomy with bilateral salpingo-oophorectomy, 21.4% underwent ovarian cystectomy, 10.7% underwent comprehensive staging surgery, and 5.4% underwent bilateral salpingo-oophorectomy. Appendectomy and lymphadenectomy were performed in eight and five patients, respectively, but none showed tumor involvement. Chemotherapy was the only adjuvant treatment utilized, and was administered in four patients. Pathological analysis showed that strumal carcinoid was the most predominant subtype, occurring in 66.1% of the patients. The Ki-67 index was reported in 39 patients, 30 of which had an index of no more than 3%, with a maximum of only 5%. Only one relapse occurred after the initial treatment, and that patient experienced recurrences on two occasions, maintaining stable disease after surgery and octreotide therapy. After a median follow-up of 3.6 years, 96.4% of the patients achieved no evidence of disease, while 3.6% were alive with the disease. The 5-year recurrence-free survival rate was 97.9% and no death occurred. No risk factors for recurrence-free survival, overall survival, or disease-specific survival were identified. CONCLUSIONS: The Ki-67 indices were extremely low and prognoses were excellent in patients with primary ovarian carcinoids. Conservative surgery, especially unilateral salpingo-oophorectomy, is preferred. Individualized adjuvant therapy may be considered for patients with metastatic diseases.

Quantifying the Influence of Factors on the Accuracy of Speech Perception in Mandarin-Speaking Cochlear Implant Patients.

Rehabilitation of hearing perception in cochlear implant (CI) patients is a challenging process. A comprehensive analysis of the characteristics of hearing rehabilitation in Mandarin-speaking CI patients was conducted. We measured the aided hearing threshold (AHT) and the speech perception accuracy (SPA) and collected clinical data. A total of 49 CI patients were included. Significant linear relationships existed between the AHT and SPA. The SPA increased by about 5-7% when the AHT decreased by 5 dB. An apparent individual difference in the SPA was observed under the same AHT, which in some patients was lower than the reference value fitted by the regression model. The timing of both of cochlear implantation and rehabilitation training was found to lead to significant improvement in SPA. The SPA increases by 2.1-3.6% per year of cochlear implantation and 0.7-1.5% per year of rehabilitation training. The time of auditory deprivation can significantly reduce the SPA by about 1.0-1.6% per year. The SPA was still poor in some CI patients when the hearing compensation seemed satisfying. Early cochlear implantation and post-operative rehabilitation are essential for recovery of the patient's SPA if the indications for cochlear implantation are met.

[The value of threshold of neural response telemetry on the prediction of behavioral audiometry threshold after cochlear implantation patients].

Objective:To explore the feasibility of using the threshold of neural response telemetry（NRT） to guide postoperative machine adjustment by analyzing the regularity and correlation between the threshold of subjective behavior test and NRT in cochlear implant patients with normal cochlear morphology and inner ear malformation. Methods:Thirty cochlear implant patients with normal cochlear morphology and 12 cochlear implant patients with inner ear malformation were selected for NRT test and subjective behavior test, respectively. Electrode 1 representing high frequency, electrode 11 representing medium frequency and electrode 22 representing low frequency were selected to analyze the correlation between NRT threshold and T value and C value. Results:The mean NRT threshold values of the cochlear normal group and the inner ear malformation group were both greater than T value, close to and slightly smaller than C value. The T value, C value and NRT threshold of the inner ear malformation group were slightly higher than those of the cochlear normal group. The NRT thresholds of high, middle and low frequency bands were significantly correlated with C and T values in the normal cochlear group and the inner ear malformation group. Compared with the normal cochlear group, the regression coefficients B of NRT threshold and T value in the high, medium and low frequency groups were 20.90%, 3.02%, 9.68%, and the K coefficients were 13.01%, 3.92%, 5.28%. The regression coefficients B of NRT threshold and C value of the two groups were 15.74%, 2.51%, 0.53%, and K were 14.44%, 0.24%, 4.09%, respectively. It can be seen that the correlation between NRT threshold and T value and C value of the two groups was significantly different in the high frequency band, but similar in the low and middle frequency band. Conclusion:The NRT threshold is significantly correlated with the threshold of subjective behavior test. The linear regression equation obtained can be used to guide the cochlear implant tuning machine, especially for the high frequency band T and C values of patients with inner ear malformation implantation. Different regression equations should be used to estimate the T and C values of patients with normal cochlea, so as to obtain more accurate T and C values.

Comparison of clinical outcome between endoscopic and postauricular incision microscopic type-1 tympanoplasty.

BACKGROUND: Microscopic type-1 tympanoplasty (T1T) is a classical method for the treatment of chronic otitis media. However, it has its limitations. The development of otoendoscopy provided a new method for T1T. OBJECTIVE: To investigate the difference between endoscopic T1T and microscopic T1T. MATERIAL AND METHODS: Seventy-four patients who underwent T1T were evaluated retrospectively. About 52 cases underwent endoscopic T1T, and 22 cases accepted microscopic T1T. Parameters including operative duration, incision size, graft site, duration of postoperative hospitalization, visual analog scale (VAS) score, complications, hearing improvement, and expenses were compared. RESULTS: Operative duration of endoscopic T1T (47.0 ± 8.2 min) was shorter than microscopic T1T (58.0 ± 9.3 min) (p < .05). The VAS score under endoscopic T1T (1.5 ± 0.2) was lower than microscopic T1T (5.6 ± 0.4) (p < .05). There was no complication during endoscopic T1T, but damage to the chorda tympani nerve (one case) was noted for microscopic T1T. There was no difference in hearing improvement between endoscopic (15.0 ± 1.5 dB) and microscopic T1T (16.0 ± 1.1 dB). Duration of postoperative hospitalization and expenses were lower for endoscopic T1T. CONCLUSIONS AND SIGNIFICANCE: Endoscopic T1T is a minimally invasive surgery with similar graft success rate, comparable hearing improvement, fast recovery, low cost, and high patient satisfaction compared to microscopic T1T.

Clinical effects of acupuncture for diabetic peripheral neuropathy.

OBJECTIVE: To observe the clinical effects of acupuncture for diabetic peripheral neuropathy. METHODS: Totally 65 patients were randomly divided into a treatment group of 32 cases and a control group of 33 cases. On the basis of conventional treatment of diabetes, acupuncture was used in the treatment group, and inositol was orally administered in the control group. During a 3-month treatment, changes in the symptoms were observed. RESULTS: In the treatment group, 16 cases were markedly relieved, 12 cases improved, and 4 cases failed, with a total effective rate of 87.5%. In the control group, 7 cases were markedly relieved, 14 cases improved and 12 cases failed, with a total effective rate of 63.6%. There was a significant difference in the total effective rate between the 2 groups (P < 0.05). CONCLUSION: Acupuncture may show good effects for diabetic peripheral neuropathy.

Complex responses of spring alpine vegetation phenology to snow cover dynamics over the Tibetan Plateau, China.

Snow cover dynamics are considered to play a key role on spring phenological shifts in the high-latitude, so investigating responses of spring phenology to snow cover dynamics is becoming an increasingly important way to identify and predict global ecosystem dynamics. In this study, we quantified the temporal trends and spatial variations of spring phenology and snow cover across the Tibetan Plateau by calibrating and analyzing time series of the NOAA AVHRR-derived normalized difference vegetation index (NDVI) during 1983-2012. We also examined how snow cover dynamics affect the spatio-temporal pattern of spring alpine vegetation phenology over the plateau. Our results indicated that 52.21% of the plateau experienced a significant advancing trend in the beginning of vegetation growing season (BGS) and 34.30% exhibited a delaying trend. Accordingly, the snow cover duration days (SCD) and snow cover melt date (SCM) showed similar patterns with a decreasing trend in the west and an increasing trend in the southeast, but the start date of snow cover (SCS) showed an opposite pattern. Meanwhile, the spatial patterns of the BGS, SCD, SCS and SCM varied in accordance with the gradients of temperature, precipitation and topography across the plateau. The response relationship of spring phenology to snow cover dynamics varied within different climate, terrain and alpine plant community zones, and the spatio-temporal response patterns were primarily controlled by the long-term local heat-water conditions and topographic conditions. Moreover, temperature and precipitation played a profound impact on diverse responses of spring phenology to snow cover dynamics.

[A novel technique for simultaneous multi-gene mutation screening in 225 patients with nonsyndromic hearing loss].

OBJECTIVE: Using simultaneous multi-gene mutation screening to investigate the new method molecular epidemiological basis of 225 patients with nonsyndromic hearing loss in Tianjin, and verifying the for simultaneous multi-gene mutation screening. METHODS: Two hundred and twenty-five patients with severe non-syndromic deafness from Tianjin CDPF and Association of the Deaf were included in the study. The single nucleotide polymorphisms scan, (SNPscan) technique was used for screening the 115 spots mutations in three common deafness-related genes (GJB2, SLC26A4, mtDNA 12S rRNA) of patients with nonsyndromic hearing loss in Tianjin. We verified the results by Sanger sequencing. RESULTS: Among the 225 patients, there were 111 cases of deafness caused by mutation (49.3%). Using this method, up to 50% of the patients in our study were identified to have hereditary HL caused by mutations in the three genes. 56 patients with the GJB2 mutations were detected (24.9%), including 30 cases of homozygous mutations (13.3%), 26 patients (11.6%) of compound heterozygous mutations, and 21 cases (9.33%) of single heterozygous mutations. 50 patients with the SLC26A4 mutations were detected (22.2%), including 22 cases of homozygous mutations(9.8%), 28 patients (12.4%) of compound heterozygous mutations, and 22 cases (9.8%) of single heterozygous mutations. mtDNA 12S rRNA A1555G mutation was detected in 5 patients (2.2%). mtDNA 12S rRNA 1494C>T mutation was not detected. We verified the results by Sanger sequencing. The accuracy of the sequencing results was 100%. The SNPscan cost eight hours and 160 yuan (each sample). CONCLUSIONS: Applying SNPscan technology can be accurate, rapid and cost-effective diagnostic screening in patients with hearing loss for etiology investigation. It is expected to become an effective means of large-scale genetic testing for hereditary deafness.

[Evaluation of the injured range of vestibular superior and inferior nerves in sudden deafness patients with vertigo using video head impulse test].

OBJECTIVE: To discuss the video head impulse tests (vHIT) application values in assessment of the vestibular nerves, function in sudden deafness patients with vertigo. METHODS: There were 60 cases (120 ears) of healthy volunteers as control group, and 182 cases (182 ears) of sudden deafness with vertigo patients as study group. The study group received vHIT and caloric test, and the control group received vHIT. Functions of vestibular superior and inferior nerves were analyzed by the gains of vHIT and the nystagmus, s unilateral weakness of caloric test, with SPSS17.0 software. RESULTS: The values of vHIT-G of the six semicircular canals in the control group were normal distribution and no statistical significance among them (F = 0.005, P = 1.000). The vHIT-G averages of both sides of anterior, horizontal and posterior semicircular canals were (15.20 ± 11.00) %, (15.30 ± 13.30) %, and (15.15 ± 14.72) % respectively. In the study group, the vHIT-G of the affected side were (21.73 ± 14.84) %, (21.20 ± 28.24) %, and (19.22 ± 23.50) %, with normal distribution, and in which statistical significance was detected comparing with those in the control group (P < 0.05). The positive rates were 26.9% (49/182) in vHIT, 70.3% (128/182) in caloric test. Significant difference (P < 0.05) was observed between vHIT and caloric test examined by chi-square test. According to the results of vHIT, there were 15 cases (8.2%) damaged vestibular superior and inferior nerves areas, 19 cases (10.4%) damaged the superior vestibular nerve area, and 15 cases (8.2%) damaged the inferior vestibular nerve area. In combination with caloric test results, it was shown that there were 29 cases (15.9%) damaged vestibular superior and inferior nerves areas, 101 cases (55.5%) damaged the superior vestibular nerve area, and 1 case (0.5%) damaged the inferior vestibular nerve area. CONCLUSIONS: vHIT can assess the function of six semicircular canals and illustrate high frequency of vestibular nerves. Caloric test combined with vHIT have more advantages to comprehensive assess vestibular damage of sudden deafness patients with vertigo.

[Multi-center study on the treatment of sudden deafness accompanied with tinnitus].

OBJECTIVE: To investigate the clinical characteristics and the effects of different drug therapies in patients of sudden deafness accompanied with tinnitus. METHODS: The international standardized clinical research methods, the unified design and program were used in the study. The patients of sudden deafness accompanied with tinnitus, aged between 18 to 65 years old, were recruited, whose duration was less than two weeks with no medication. The patients were divided into four types according to the hearing curve: type A was acute sensorineural hearing loss in low tone frequencies, type B was acute sensorineural hearing loss in high tone frequencies, type C was acute sensorineural hearing loss in all frequencies and type D was total deafness. Each type had four different treatment programs, based on the unified designed randomized table. RESULTS: A total of 1024 cases with single side sudden deafness were recruited in the study by 33 hospitals in China from August 2007 to October 2011. Among the 1024 cases, 922 cases were accompanied with tinnitus (90.04%). By classification of audiogram, among the 922 cases, 169 cases were type A (82.44%), 127 cases were type B (90.07%), 370 cases were type C (92.04%), and 256 cases were type D (92.75%). The tinnitus mostly was persistent and low tone tinnitus. The degree of the tinnitus was mostly 2-3 grade. The curative effects of different types were analyzed, type A had the highest rate of 96.18%, type C was 87.75%, type B was 81.51%, and type D had the lowest rate of 75.32%. Significant difference of curative rate between different types was detected (χ² = 125.33, P = 0.000). There had no significant difference between the four different treatment groups (all P > 0.05). CONCLUSIONS: In the cases with single side sudden deafness accompanied with tinnitus, the type in low tone frequencies has the best curative effect, followed by the type in all frequencies. The type in high tone frequencies and the total deafness type have poor curative results. The steroid plays a good effect in the treatment.

[Analysis of the dysfunction frequency and characteristics of semicircular canal in benign paroxysmal positional vertigo].

OBJECTIVE: To assess the characteristics of the dysfunction of semicircular canal in benign paroxysmal positional vertigo and the relationship with the ectopic otoconia. METHODS: There were 214 patients with benign paroxysmal positional vertigo (BPPV), including 107 cases of posterior semicircular canal canalithiasis (PSC-Can) 80 cases of horizontal semicircular canal canalithiasis (HSC-Can), 27 cases of horizontal semicircular canal cupulolithiasis (HSC-Cup). One hundred and ninety (88.8%) patients were accompany with relevant diseases while 24 (11.2%) cases were not. They accepted low, middle and high frequency vestibular function tests, including caloric test (CT), head shaking test (HST) and video head impulse test (vHIT) respectively. The parameters of the unilateral weakness (UW), head shaking nystagmus (HSN) and video head impulse test gain (vHIT-G) were observed. Patients classified into three groups (PSC-Can, HSC-Can, HSC-Cup) according to the involvement semicircular canal. The results of the three tests were analyzed with SPSS16.0 software. RESULTS: The positive cases of the three tests were vHIT: 15 (7.0%), HST: 52 (24.3%), CT: 152 (71.0%), a statistically significant difference (P < 0.05) was found between the three tests. When compared the Caloric Test, HST and vHIT between the BPPV patients with and without relevant diseases, there were no significant differences (P > 0.05). The variance without statistical significance (P > 0.05) was showed between three tests' results in each groups, it was also showed that the variance between the three groups in each tests reached no statistical significance (P > 0.05). The test of affected side UW between PSC-Can, HSC-Can and HSC-Cup showed the variance without statistical significance (F = 0.970, P = 0.383). CONCLUSIONS: The lesion of semicircular canals has the same etiological factors with the utricle pathological change in benign paroxysmal positional vertigo, and the dysfunction mostly happens in low frequency range of semicircular canal frequency band. The ectopic otoconia is not the main etiological factors for that. HST and vHIT of middle and high frequency can not be ultimately used for the screening test evaluating due to the semicircular canal function in BPPV.

[Analysis of directional preponderance of caloric test in evaluation of vestibular dynamic compensation].

OBJECTIVE: To analyze the value of directional preponderance (DP) in vestibular dynamic compensation evaluation. METHODS: One hundred fifty-five patients with sudden deafness accompanied vertigo were asked to accept routine vestibular tests including the spontaneous nystagmus (SN) and caloric test with video-nystagmography. DP, SN and unilateral weakness (UW) were selected as the observation parameters. Then the correlation analysis between DP, SN, UW and course of disease were investigated respectively. The change characteristic of the three parameters was also analyzed in the course of vestibular compensation. RESULTS: Of the 155 patients, there were negative correlations between SN, DP and course of disease (r(s) = -0.386, r(s) = -0.424, P < 0.05), positive correlation between SN and DP (r(s) = 0.543, P < 0.05), but no correlation between UW and course of disease (r(s) = 0.004, P > 0.05), and also positive correlation (r(s) = 0.274, P < 0.05) between DP and UW. According to three parameters were positive or negative, three main groups (DP+UW+SN+, DP+UW+SN- and DP-UW+SN-) in DP, UW, SN. The course of disease in three main groups was positively skewed distribution. Median was 6 days, 10 days and 20 days respectively. Through Kruskal-Wallis Test, chi(2) = 24.63, P < 0.05, there was statistical significance among the above three main groups. CONCLUSIONS: DP keeps on changing in the acute stage, static and dynamic compensation stage of peripheral vestibular disease. This indicates that DP can be considered as an objective evaluation index of vestibular dynamic compensation and as a guidance of the vestibular rehabilitation evaluation.

[Mutation analysis of Cx26 gene in Chinese hereditary nonsyndromic deafness sufferers].

OBJECTIVE: To analyze the mutations in the code region of Cx26 gene in Chinese hereditary nonsyndromic hearing impairment (NSHI) sufferers. METHODS: Thirty-three cases (29 cases in the families of 8 students who were picked out from the Deafness and Muteness School of Tianjin, 2 cases as control and 2 normal cases of genetic counseling) were included in this study. The blood samples were obtained to distill the DNA templates. Using polymerase chain reaction (PCR), the code region of Cx26 gene was amplified. The mutations were screened by restriction endonucleases fingerprinting-single strand conformation polymorphism (REF-SSCP). Afterwards we inspected the polymorphous changes or mutations of these segments with DNA sequence. RESULTS: There were 30 cases with the nucleotide changes in the Cx26 code region. The rate was 90.9% (30/33). Eight kinds of mutations were found, 79G-->A, 109G-->A, 161A-->T, 235delC, 240G-->A, 341A-->G, 571T-->C and 608T-->C. 161A-->T, 240G-->A and 571T-->C were detected primarily. There were 3 cases with 235delC in 22 deafness sufferers and the rate was 13.64% (3/22). CONCLUSIONS: The 235delC of Cx26 gene is the main mutation in Chinese NSHI sufferers, and in NSHI cases many polymorphous changes exist.