Influence of cochlear parameters on the current practice in cochlear implantation : Development of a concept for personalized medicine.

Since the introduction of cochlear implants into clinical routine, the interest in measuring cochlear parameters, particularly the cochlear duct length (CDL) has increased, since these can have an influence on the correct selection of the electrode. On the one hand, coverage of an optimal frequency band is relevant for a good audiological result, and on the other hand, cochlear trauma due to too deep insertion or displacement of the electrode must be avoided. Cochlear implants stimulate the spiral ganglion cells (SGC). The number of SGC and particularly their distribution can also have an influence on the function of a cochlear implant. In addition, the frequency assignment of each electrode contact can play a decisive role in the postoperative success, since the frequency distribution of the human cochlea with varying CDL shows substantial interindividual differences. The aim of this work is to provide an overview of the methods used to determine the cochlear parameters as well as of relevant studies on the CDL, the number and distribution of SGZ, and the frequency assignment of electrode contacts. Based on this, a concept for individualized cochlear implantation will be presented. In summary, this work should help to promote individualized medicine in the field of cochlear implants in the future, in order to overcome current limitations and optimize audiological outcomes.

[Influence of cochlear parameters on the current practice in cochlear implantation : Development of a concept for personalized medicine. German version]. / Einfluss cochleärer Parameter auf die aktuelle Cochleaimplantatversorgung : Entwicklung eines Konzepts für die personalisierte Medizin.

Since the introduction of cochlear implants into clinical routine, the interest in measuring cochlear parameters, particularly the cochlear duct length (CDL) has increased, since these can have an influence on the correct selection of the electrode. On the one hand, coverage of an optimal frequency band is relevant for a good audiological result, and on the other hand, cochlear trauma due to too deep insertion or displacement of the electrode must be avoided. Cochlear implants stimulate the spiral ganglion cells (SGC). The number of SGC and particularly their distribution can also have an influence on the function of a cochlear implant. In addition, the frequency assignment of each electrode contact can play a decisive role in the postoperative success, since the frequency distribution of the human cochlea with varying CDL shows substantial interindividual differences. The aim of this work is to provide an overview of the methods used to determine the cochlear parameters as well as of relevant studies on the CDL, the number and distribution of SGZ, and the frequency assignment of electrode contacts. Based on this, a concept for individualized cochlear implantation will be presented. In summary, this work should help to promote individualized medicine in the field of cochlear implants in the future, in order to overcome current limitations and optimize audiological outcomes.

Estimated glomerular filtration rate progression in UK primary care patients with type 2 diabetes and diabetic kidney disease: a retrospective cohort study.

AIMS: To examine the rates of diabetic kidney disease (DKD) progression and associated factors, we undertook a study of estimated glomerular filtration rate (eGFR) in a historical cohort of UK primary care patients with type 2 diabetes mellitus (T2DM) and associated DKD from the Clinical Practice Research Datalink. METHODS: Our eligible population were patients with definitive T2DM from a recorded diagnostic code with either a diagnosis of chronic kidney disease (CKD) or renal function test values and renal abnormalities consistent with a CKD diagnosis, identified between 1 October 2006 and 31 December 2011. Only patients with albuminuria results reported in mg/l were used for the longitudinal statistical analyses of the eGFR rate of change using multilevel models. RESULTS: We identified 111,030 patients with T2DM. Among them 58.6% (95% confidence interval (CI): 58.3-58.9) had CKD and 37.2% (95% CI: 36.9-37.5%) had presumed DKD at baseline. Only 19.4% of patients had urinary albumin test results expressed as mg/l in the year prior to index date. Almost two-thirds (63.8%) of patients with T2DM and presumed DKD received prescriptions for angiotensin-converting enzyme (ACE) inhibitors or angiotensin type 1 receptor blockers (ARB) or both. Time-dependent variables that predict subsequent eGFR decline include increased albuminuria, time from index date and older age. CONCLUSION: Only a minority of diabetic patients with DKD had quantitative albuminuria assessments. The relatively low proportion of DKD patients with ACEi or ARB prescriptions suggests a gap between healthcare practice and available scientific evidence during the study period. Increased albuminuria and older age were the most consistent predictors of subsequent eGFR decline.

Inhibition of PKC beta by ruboxistaurin does not enhance the acute blood pressure response to nitroglycerin.

Ruboxistaurin is a selective protein kinase C beta inhibitor undergoing clinical investigation for treatment of diabetic microvascular complications. This study assessed a possible blood pressure (BP) interaction between ruboxistaurin and the exogenous nitric oxide donor, glyceryl trinitrate (GTN). Subjects (N=22) with chronic stable angina received placebo or ruboxistaurin 96 mg/day orally to steady state in a crossover design. Graded GTN (0, 5, 10, 20, 40, 80, and 120 microg/min) or 5% dextrose solution was then infused intravenously and BP was measured following each dose. Ruboxistaurin did not alter the slope of change in standing systolic BP (DeltasSBP/1n[GTN dose]) curve (P=0.272 analysis of covariance) or affect the DeltasSBP at the estimated GTN dose producing a 10-mm Hg reduction in sSBP from baseline on placebo (mean difference -0.9 mm Hg; 95% confidence of interval, -3.3-1.5). In conclusion, ruboxistaurin does not potentiate the acute BP-lowering effects of GTN.

Pelleted beet pulp substituted for high-moisture corn: 1. Effects on feed intake, chewing behavior, and milk production of lactating dairy cows.

The effects of increasing concentrations of dried, pelleted beet pulp substituted for high-moisture corn on intake, milk production, and chewing behavior were evaluated using eight ruminally and duodenally cannulated multiparous Holstein cows in a duplicated 4 x 4 Latin square design with 21-d periods. Cows were 79 +/- 17 (mean +/- SD) d in milk at the beginning of the experiment. Experimental diets with 40% forage (corn silage and alfalfa silage) and 60% concentrate contained 0, 6.1, 12.1, or 24.3% beet pulp substituted for high-moisture corn on a dry matter basis. Diet concentrations of neutral detergent fiber (NDF) and starch were 24.3 and 34.6% (0% beet pulp), 26.2 and 30.5% (6% beet pulp), 28.0 and 26.5% (12% beet pulp), and 31.6 and 18.4% (24% beet pulp), respectively. Increasing beet pulp in the diet caused a linear decrease in dry matter intake (DMI). Time spent eating per day and per kilogram of DMI increased, and sorting against NDF tended to increase, with added beet pulp. Substituting beet pulp for corn caused a quadratic response in milk fat yield, with the highest yield for the 6% beet pulp treatment. A tendency was detected for a similar quadratic response in 3.5% fat-corrected milk yield. Lower plasma insulin concentration may have resulted in lower body condition gain for cows fed diets with higher beet pulp concentration. Partial substitution of pelleted beet pulp for high-moisture corn decreased intake but also may have permitted greater fat-corrected milk yield.

Pelleted beet pulp substituted for high-moisture corn: 2. Effects on digestion and ruminal digestion kinetics in lactating dairy cows.

The effects of increasing concentrations of dried, pelleted beet pulp substituted for high-moisture corn on digestion and ruminal digestion kinetics were evaluated using eight ruminally and duodenally cannulated multiparous Holstein cows in a duplicated 4 x 4 Latin square design with 21-d periods. Cows were 79 +/- 17 (mean +/- SD) d in milk at the beginning of the experiment. Experimental diets with 40% forage (corn silage and alfalfa silage) and 60% concentrate contained 0, 6.1, 12.1, or 24.3% beet pulp substituted for high-moisture corn on a dry matter basis. Diet concentrations of neutral detergent fiber (NDF) and starch were 24.3 and 34.6% (0% beet pulp), 26.2 and 30.5% (6% beet pulp), 28.0 and 26.5% (12% beet pulp), and 31.6 and 18.4% (24% beet pulp), respectively. Ruminal dry matter pool decreased and NDF turnover rate increased as dietary beet pulp content increased. Potentially digestible NDF was digested more extensively and at a faster rate in the rumen with increasing beet pulp, resulting in increased total tract NDF digestibility. Passage rates of potentially digestible NDF and of indigestible NDF were not affected by treatment. True ruminal digestibility of starch decreased with increasing beet pulp substitution. This was caused by a linear increase in starch passage rate, possibly because of increasing ruminal fill, and a linear decrease in digestion rate of starch in the rumen, possibly because of reduced amylolytic enzyme activity for lower-starch diets. Although true ruminal starch digestibility decreased when more beet pulp was fed, whole tract starch digestibility was not affected because of compensatory digestion of starch in the intestines. Due to more thorough digestion of fiber in diets containing more beet pulp, whole-tract digestibility of organic matter increased linearly, and intake of digestible organic matter was not affected. Partially replacing high-moisture corn with beet pulp in low-forage diets increased fiber digestibility without reducing whole-tract starch digestibility.

Pelleted beet pulp substituted for high-moisture corn: 3. Effects on ruminal fermentation, pH, and microbial protein efficiency in lactating dairy cows.

The effects of increasing concentrations of dried, pelleted beet pulp substituted for high-moisture corn on ruminal fermentation, pH, and microbial efficiency were evaluated using eight ruminally and duodenally cannulated multiparous Holstein cows in a duplicated 4 x 4 Latin square design with 21-d periods. Cows were 79 +/- 17 (mean +/- SD) DIM at the beginning of the experiment. Experimental diets with 40% forage (corn silage and alfalfa silage) and 60% concentrate contained 0, 6.1, 12.1, or 24.3% beet pulp substituted for high-moisture corn on a DM basis. Diet concentrations of NDF and starch were 24.3 and 34.6% (0% beet pulp), 26.2 and 30.5% (6% beet pulp), 28.0, and 26.5% (12% beet pulp), and 31.6 and 18.4% (24% beet pulp), respectively. Substituting beet pulp for corn did not affect daily mean or minimum ruminal pH but tended to reduce pH range. Ruminal acetate:propionate responded in a positive exponential relationship to added beet pulp. Rate of valerate absorption from the rumen was not affected by treatment. Substituting beet pulp for corn up to 24% of diet DM did not affect efficiency of ruminal microbial protein production, expressed as microbial N flow to the duodenum as a percentage of OM truly digested in the rumen. Microbial efficiency was not correlated to mean pH or daily minimum pH. While microbial efficiency was not directly related to concentration of beet pulp fed, it was positively correlated with passage rate of particulate matter, as represented by starch and indigestible NDF, probably due to reduced turnover of microbial protein in the rumen.

Effects of pretrial milk yield on responses of feed intake, digestion, and production to dietary forage concentration.

The relationships between pretrial milk yield and effects of dietary forage-to-concentrate ratio on dry matter intake (DMI), digestion, and milk yield were evaluated using 32 Holstein cows in a crossover design with two 16-d periods. Cows were 197 +/- 55 (mean +/- SD) days in milk at the beginning of the experiment. Milk yield averaged 33.9 kg/d and ranged from 16.5 to 55.0 kg/d for the 4 d before initiation of treatments. Treatments were diets with forage-to-concentrate ratios of 67:33 and 44:56. Forages were alfalfa silage and corn silage, each at 50% of forage dry matter (DM). Neutral detergent fiber (NDF) concentrations of high-forage and low-forage diets were 30.7 and 24.3% of DM, respectively. Dry matter intake was 1.7 kg/d higher for cows fed the low-forage diet. Milk yield was 2.3 kg/d greater on low forage than on high forage, but 3.5% fat-corrected milk yield and yield of milk fat were not different between treatments. Individual DMI response to the low-forage diet relative to the high-forage diet (low-high) was positively and linearly related to pretrial fat-corrected milk yield, but fat-corrected milk yield response demonstrated a quadratic relationship with pretrial fat-corrected milk yield. Milk yield responded more positively to low forage among low- and high-producing cows than among moderate-producing cows. Energy partitioned to body reserves and to milk, and passage rate of indigestible NDF, also responded to dietary forage level in quadratic relationships with pretrial milk energy output. Individual responses of intake, production, and fiber digestion to a change in forage-to-concentrate ratio were dependent on production level.

Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation: case report.

BACKGROUND: Vertebral artery injury during posterior C1-2 transarticular screw fixation occurs in approximately 3% of patients and may remain asymptomatic or result in arteriovenous fistulae, occlusion, narrowing, or dissection of the vertebral artery, and lead to transient ischemic attacks, stroke, or death. CASE DESCRIPTION: This is the first report of a pseudoaneurysm resulting from damage to the vertebral artery during the procedure. This 31-year-old male underwent posterior C1-2 transarticular screw fixation for unstable os odontoideum. Injury to the left vertebral artery occurred while the hole for the left screw was being drilled. Temporary control of bleeding with local pressure was followed by immediate postoperative angiography that revealed a left vertebral artery pseudoaneurysm. Although the patient remained asymptomatic, therapeutic anticoagulation was instituted 6 hours postoperatively. Increasing size of the pseudoaneurysm was noted on routine follow-up angiography 4 weeks later. Endovascular occlusion of the pseudoaneurysm and left vertebral artery, with preservation of vertebrobasilar flow through the right vertebral artery, was accomplished without neurological consequence. CONCLUSIONS: Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation may be effectively treated with endovascular approaches.

Nonoperative treatment of chronic subdural hematoma.

Chronic subdural hematomas that are asymptomatic or producing only mild symptoms are occasionally found with current neuroimaging methods. Some do not progress, and spontaneous resolution can occur. In addition, successful medical treatment of more significant hematomas has been reported. The indications for nonoperative management of these lesions are reviewed in this article.

The role of craniotomy and trephination in the treatment of chronic subdural hematoma.

The treatment of chronic subdural hematoma by craniotomy was the procedure of choice in the early part of this century. It has since been replaced by less invasive techniques but retains a limited role in the management of this condition. A new procedure involving a small craniectomy and marsupialization of the hematoma cavity to the temporalis muscle is described. The results of this treatment compare favorably with the more commonly performed drainage methods.

Prophylactic antibiotics with intracranial pressure monitors and external ventricular drains: a review of the evidence.

BACKGROUND: The role of prophylactic antibiotics (PABs) in preventing infections associated with intracranial pressure (ICP) monitors and external ventricular drains (EVD) is not well defined. METHODS: This study includes an analysis of published reports and a survey of current practices regarding the use of PABs with ICP monitors and EVDs. A computerized data search and a review of the abstracts from two major national neurosurgical meetings over the past decade yielded 85 related articles. Three independent investigators, blinded to the title, author(s), institution(s), results, and conclusions of the articles used predetermined inclusion criteria to select studies for meta-analysis. Thirty-six responses were returned from 98 questionnaires (37%) mailed to university neurosurgical programs. RESULTS: Among the articles reviewed, only two studies met the predetermined inclusion criteria for the meta-analysis, and they were of insufficient size to produce statistically significant results. Among the 36 programs that responded to the survey, 26 (72%) used PABs, mainly cephalosporins (46%) and semisynthetic penicillins (38%), with ICP monitors and EVDs. Twenty-two (85%) used one drug, and 4 (15%) used two drugs. Twenty-two (61%) of the total group reported intra-institutional variation in practices among individual staff neurosurgeons. Nineteen (53%) expressed interest in a retrospective study, and 27 (75%) expressed interest in a prospective study on the role of PABs in minor neurosurgical procedures. CONCLUSION: No consensus regarding the use of PABs with ICP monitors and EVDs is noted. Randomized controlled trials of sufficiently large size with appropriate blinding are needed to address this issue.

Giant intracranial and extracranial cavernous malformation. Case report.

Massive enlargement of an extracerebral cavernous malformation and extension across tissue planes is very uncommon. The authors present the case of a 49-year-old woman with a giant cavernous malformation in the left frontotemporal area. It progressively enlarged during several decades, extended through the calvaria to the extradural space, and was surgically treated. The lesion may have originated in the soft tissue or the skull. The locations of cavernous malformations in various parts of the body are reviewed and their mechanisms of growth are discussed. Surgical excision is the treatment of choice.

Entirely intracanalicular meningioma: contrast-enhanced MR findings in a rare entity.

We report an unusual case of an entirely intracanalicular meningioma in a 51-year-old woman. Contrast-enhanced MR images showed an enhancing lesion filling the lateral portion of the left internal auditory canal. Our findings suggest that meningiomas should be considered in the differential diagnosis of entirely intracanalicular masses.

Transient enlargement of an intracranial aneurysm during pregnancy: case report.

BACKGROUND: The association of intracranial aneurysm and pregnancy is uncommon. Hemodynamic stress plays an important role in the growth of aneurysms. METHODS: The authors report the case of an enlarging cavernous carotid aneurysm in a pregnant 15-year-old young woman. RESULTS: The aneurysm was initially diagnosed prior to the patient's pregnancy by both cross-sectional imaging and cerebral angiography. Further imaging evaluation was required during pregnancy, which demonstrated significant enlargement of the aneurysm. Following delivery, the lesion decreased in size. CONCLUSIONS: We review potential factors associated with pregnancy that may increase hemodynamic stress and influence aneurysm growth. Additionally, the management of pregnancy-related intracranial aneurysms is discussed.

Delayed deterioration after head trauma due to traumatic aneurysm.

Closed head trauma is fairly common in our industrialized society. A small percentage of affected patients develop traumatic intracranial aneurysms, which rupture an average of three weeks following injury resulting in sudden neurological deterioration. The case of a patient with a traumatic aneurysm is presented. A high index of suspicion is necessary to diagnose these lesions, for which surgical treatment is recommended.

Intraparenchymal hemorrhage.

Spontaneous hemorrhage into the cerebral parenchyma accounts for 8% to 13% of all strokes. It is more common in males, in blacks, and in the elderly. Fifty percent of cases are due to the effects of chronic hypertension on intracranial perforating arteries. The basal ganglia are the most frequent site of bleeding. Lobar hematomas tend to occur in younger patients, and may be due to specific causes such as vascular malformations. Many patients will have increased intracranial pressure and will require treatment in an intensive care unit. If surgery is necessary, stereotactic aspiration and pharmaceutical clot lysis are recent developments that may be advantageous. Prognosis is related to the patient's age and neurologic condition, and to the size, location, and rapidity of formation of the hematoma.

The renin angiotensin aldosterone system and frusemide response in congestive heart failure.

1. To test the hypothesis that basal renin angiotensin aldosterone system (RAAS) activity impairs the acute natriuretic response to frusemide in patients with mild or moderate congestive heart failure (CHF), we studied eight adult volunteers with preserved renal function, stable New York Heart Association Class II or III CHF, and echocardiographic evidence of left ventricular dysfunction due to myocardial infarction, hypertension, or both causes. 2. All patients received three dosing regimens administered in random order: (a) intravenous frusemide: 40 mg bolus then 40 mg h-1 for 3 h, (b) captopril: two 12.5 mg oral doses separated by 2 h, (c) combined dosing: the first captopril dose preceded the frusemide bolus by 30 min. Sodium balance on an 80 mmol day-1 sodium diet was documented prior to each dosing regimen. Sodium excretion was quantitated in urine collected at intervals until 3.5 h after initiating drug administration. During this time, urine output was replaced intravenously with an equivalent volume of 0.45% saline. 3. Captopril significantly lowered plasma angiotensin converting enzyme (ACE) activity and plasma aldosterone concentration, and raised inulin clearance. The drug had essentially no effect on the time course of magnitude of frusemide's natriuretic effect. Maximal fractional sodium excretion during frusemide infused by itself and in combination with captopril was 24.7 +/- 1.9% vs 28.2 +/- 3.8%, respectively (difference 3.5%; 95% CI, -4.0 to 11.0%; P > 0.05). Cumulative sodium excretion ending at 3.5 h was 429 +/- 53 mmol when frusemide was given alone and 455 +/- 69 mmol when captopril was added (difference, 26 mmol; CI, -121 to 174 mmol; P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Improved HPLC-radioimmunoassay for quantifying angiotensin II in plasma.

To measure the octapeptide angiotensin II (Ang II) in plasma, we developed a sensitive, specific assay that interfaces solid-phase extraction, HPLC, and RIA. A reversed-phase HPLC system involving isocratic elution at 38 degrees C with a volatile mobile phase of acetonitrile and the ion-pairing reagent heptafluorobutyric acid produced baseline separation of angiotensin peptides. Ang II was collected as a single fraction, concentrated by evaporation to dryness, and measured by RIA after resuspension in RIA buffer. Even including column washing between sample injections to prevent carryover of plasma constituents, two plasma extracts could be processed per hour by HPLC. Assay validation experiments demonstrated < 2% cross-reactivity with Ang II-related peptides; a 75% recovery from plasma at physiological concentrations of Ang II; intra- and interassay precision (CVs) of 6.2% and 10.3%, respectively; and a lower limit of quantification of 1.3 ng/L. Two clinical protocols designed to measure plasma Ang II concentration under basal and stimulated conditions confirmed the utility of the assay.

Giant cell tumor of the calvaria in a child. Case report.

A giant cell tumor involving the vertex of the skull is described in a 3-year-old child with no history of head trauma. The mass was present approximately 4 months prior to resection. Microscopically, the lesion consisted of highly cellular tissue composed of oval to spindle-shaped stromal cells admixed with numerous multinucleated giant cells. Giant cell tumor of the skull is a rare lesion, usually involving the sphenoid or temporal bone in adults. The differential diagnosis is discussed with reference to the literature regarding giant cell lesions, especially of the cranium. The authors are unaware of previous reports of a similar lesion in this location in such a young child.