Is sudden deafness in non-diabetic patients affected by their glycosylated hemoglobin levels?

OBJECTIVE: Though the incidence of sudden sensorineural hearing loss (SSNHL) is relatively low, the disorder has a major impact on the quality of life of patients. Identifying biological markers for the disease will be useful, especially in resource-scarce areas. Our study aims to evaluate the correlation between the degree of hearing impairment and glycosylated hemoglobin (HbA1c) in patients with SSNHL. PATIENTS AND METHODS: One hundred and thirty-eight patients with SSNHL and no history of diabetes were included in this study. The intravenous HbA1c content before treatment was correlated with the pure tone audiogram (PTA) average as per the criteria for SSNHL. Spearman correlation and the Receiver Operating Characteristic (ROC) curve were used to determine the HbA1c levels of the study participants. The critical value of HbA1c and its diagnostic implications for assessing the degree of hearing impairment in patients with SSNHL were noted. RESULTS: There was a significant positive correlation between HbA1c and PTA in patients with SSNHL (p<0.05). In addition, the best HbA1c cutoff value for screening and referring an individual for a detailed audiometric evaluation of hearing impairment was 5.550%, as indicated by the ROC curve. CONCLUSIONS: The level of HbA1c in the circulation may affect the onset, duration, and progression of SSNHL. The same parameter may be used as a diagnostic and prognostic indicator for this condition.

Diagnostic potential of urinary monocyte chemoattractant protein-1 for Alzheimer's disease and amnestic mild cognitive impairment.

BACKGROUND AND PURPOSE: The chemokine monocyte chemoattractant protein-1 (MCP-1) is involved in the pathogenesis of Alzheimer's disease (AD). This study aimed to investigate whether urinary MCP-1 can distinguish patients with AD, patients with amnestic mild cognitive impairment (aMCI) and cognitively normal (CN) subjects. METHODS: A total of 754 participants, including 97 patients with AD, 50 patients with aMCI and 84 age- and sex-matched CN controls as well as a cohort of 523 CN subjects of different ages, were enrolled from five hospitals located in different areas of China. Urinary MCP-1 levels were determined using enzyme-linked immunosorbent assays. The correlations between urinary MCP-1 levels and cognition test scores or age were analysed. The optimal diagnostic sensitivity and specificity were determined using receiver operating characteristic curve analysis. RESULTS: In the cohort of CN subjects of different ages, urinary MCP-1 levels increased with ageing and were correlated with age. The urinary MCP-1 levels were higher in females than in males. In the cohort composed of patients with AD, aMCI and age- and sex-matched CN controls, urinary MCP-1 levels were significantly higher in patients with AD and aMCI than in CN controls. There were no differences in urine MCP-1 levels between the AD group and the aMCI group. The urinary MCP-1 levels were correlated with the Mini-Mental State Examination scores and age, and were able to differentiate patients with AD and aMCI from CN subjects. CONCLUSIONS: Urinary MCP-1 is a potential biomarker for the diagnosis of AD and aMCI.

[Clinical application of the dynamic adenoidal hypertrophy ratio in the evaluation of illness severity in children with OSAHS].

Objective:To evaluate application value of the dynamic adenoidal/hypertrophy (A/N) ratio in children with OSAHS by analyzing the correlation between the A/N ratio at the different respiratory phases and the index of polysomnography.Method:Fifty-one childrens, with simple hypertrophic adenoids, were diagnosed as OSAHS. Magnetic resonance imaging (MRI) with respiratory gating technology were used to scan the upper airway of children during sleep at the early, middle and end phases of respiratory cycle, and measure adenoidal hypertrophy ratio in different respiratory phases. The correlation analysis was performed between the A/N ratio in different respiratory phases and the index of polysomnography (AHI and LaSO2). Finally, via ROC curve and Kappa analysis, the critical value and diagnosis accordance rate of A/N ratio in illness severity evaluation of children with OSAHS were confirmed.Result:At the 6 respiratory phases, the A/N ratios showed significantly positive correlations with AHI (All P< 0.01). There was a highest coefficient between the end-expiratory A/N ratio and AHI (r= 0.559 4). In addition, the optimal cut-off point of A/N ratio between slight-moderate and severe OSAHS was 0.834. The diagnosis accuracies of the end-expiratory A/N ratio in severe and slight moderate OSAHS were 81% and 84%, respectively.Conclusion:MRI with respiratory gating technology obtaining dynamic A/N ratio might be an important method of imaging diagnosis of children OSAHS, and the end expiratory A/N ratio is expected to become a classification index of slight moderate and severe children OSAHS.

The role of middle calyx puncture in percutaneous nephrolithotomy: relative factors and choice considerations.

Percutaneous nephrolithotomy (PCNL) is a well established procedure for management of renal calculi. It is generally believed that the access to the renal pelvic system via the desired calyx is the most crucial step during the whole procedure. The adequacy of the access directly influences the success and complication rates of PCNL. Traditionally, a lower pole access was routinely performed for less complication. Upper calices are also preferred for access in a given condition with large and complex calculi. However, the middle calices access is seldom selected. In aim to provide the reader some advantages of middle pole approach and a broaden horizon in determining the strategy of renal puncture, the present review describes the anatomical basis of the percutaneous tract. It provides a literature review of the success rate and efficiency of middle calyx access alone with the advantage of this approach, especially in dealing with large and complex stones.

p75NTR ectodomain is a physiological neuroprotective molecule against amyloid-beta toxicity in the brain of Alzheimer's disease.

In Alzheimer's disease (AD), neurodegenerative signals such as amyloid-beta (Aß) and the precursors of neurotrophins, outbalance neurotrophic signals, causing synaptic dysfunction and neurodegeneration. The neurotrophin receptor p75 (p75NTR) is a receptor of Aß and mediates Aß-induced neurodegenerative signals. The shedding of its ectodomain from the cell surface is physiologically regulated; however, the function of the diffusible p75NTR ectodomain (p75ECD) after shedding remains largely not known. Here, we show that p75ECD levels in cerebrospinal fluid and in the brains of Alzheimer's patients and amyloid-beta precursor protein (APP)/PS1 transgenic mice were significantly reduced, due to inhibition of the sheddase-tumor necrosis factor-alpha-converting enzyme by Aß. Restoration of p75ECD to the normal level by brain delivery of the gene encoding human p75ECD before or after Aß deposition in the brain of APP/PS1 mice reversed the behavioral deficits and AD-type pathologies, such as Aß deposit, apoptotic events, neuroinflammation, Tau phosphorylation and loss of dendritic spine, neuronal structures and synaptic proteins. Furthermore, p75ECD can also reduce amyloidogenesis by suppressing ß-secretase expression and activities. Our data demonstrate that p75ECD is a physiologically neuroprotective molecule against Aß toxicity and would be a novel therapeutic target and biomarker for AD.

Clinical and vascular laboratory determinants for outcome after infrainguinal atherectomy.

Three surgeons performed 180 atherectomy procedures in 161 patients using the Transluminal Extraction Catheter in 144 and the Auth Rotablator in 36. The primary patency rate was 55% at 1 year and 46% at 2 years, and failure was caused by stenosis in 28 (15.6%) and occlusion in 61 (33.7%) limbs. Multivariate Cox regression analysis showed significantly better outcome if the indication was claudication, the lesion was short or there was associated stenting. Vascular laboratory surveillance was performed in 93 limbs in 83 patients. Cox regression analysis in this subgroup also showed a significant relationship between outcome and the maximum peak systolic velocity from a duplex scan at the last study performed. Receiver operating characteristics curves showed that a raised maximum peak systolic velocity best predicted late failure (sensitivity 84%, specificity 66% for > 200 cm/s; sensitivity 72%, specificity 84% for > 250 cm/s); the velocity ratio at the stenosis to that in the segment above or the resting ankle/brachial pressure index were less predictive. For 50 procedures studied in the vascular laboratory which remained successful to the end of the study, maximum peak systolic velocities were > 250 cm/s from the first postoperative study, suggesting residual stenosis in 6%, or increased to become > 250 cm/s by the last study, suggesting recurrent stenoses in 12%. For 43 procedures which were studied and later failed, velocities were > 250 cm/s from the first test in 26% or increased to > 250 cm/s by the last test before failure in 40%. Vascular laboratory surveillance helps to predict outcome after atherectomy. Failure may be a result of residual disease from the time of the procedure or from restenosis. The apparent high incidence of clinically manifest or developing stenoses raises doubts as to the benefit of atherectomy over balloon dilatation alone.

Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux.

PURPOSE: Patterns of flow in superficial and deep veins and outward flow in medial calf perforators were studied by duplex ultrasonography scanning in 1653 lower limbs in 1114 consecutive patients. This study compares results in 776 limbs with primary uncomplicated varicose veins with those in 166 limbs with the complications of lipodermatosclerosis or past venous ulceration. METHODS: Duplex scanning determined whether superficial and deep veins were occluded or showed reflux and whether outward flow occurred in medial calf perforators with calf muscle contraction. RESULTS: Two proximal deep veins were occluded. When limbs with primary uncomplicated varicose veins, lipodermatosclerosis, or past ulceration were compared, superficial reflux alone was seen in 55%, 39%, and 38%, deep reflux alone was seen in 2%, 7%, and 8%, and combined superficial and deep reflux was seen in 18%, 34%, and 48%, respectively. Superficial reflux affected the long saphenous system alone in 58%, 57%, and 40%, the short saphenous system alone in 18%, 18%, and 26%, and both the long and short saphenous systems in 24%, 25%, and 34%, respectively. Limbs with ulceration more frequently showed superficial reflux (p < 0.05), and all limbs with complications more frequently showed short saphenous reflux (p < 0.05) and deep reflux (p < 0.01) specifically in the posterior tibial veins (p < 0.01). Outward flow was seen in medial calf perforators in 57%, 67%, and 66%, respectively; it occurred more frequently in all limbs with complications (p < 0.05). Isolated outward flow in perforators without superficial or deep reflux was seen in 10%, 10%, and 2%, respectively. CONCLUSIONS: Most limbs with complications had superficial reflux either alone or combined with deep reflux, and few had deep reflux alone. Reflux was more frequent in posterior tibial veins for limbs with complications compared with those with uncomplicated primary varicose veins. Outward flow in perforators was common in limbs with complications and with uncomplicated primary varicose veins, but isolated outward flow in perforators was uncommon. Treatment directed to the superficial veins alone may be sufficient for most patients with complications.