Preoperative Imaging in Cochlear Implants Lee, Andrew Y; Lee, Diana Y; Saunders, James E
Otology & neurotology,
2024-Apr-01, Letnik:
45, Številka:
4
Journal Article
Recenzirano
To determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) in cochlear implant candidates.
Retrospective case review.
Tertiary referral hospital.
A total of 207 ...cochlear implanted patients with CT and/or MRI.
N/A.
Age versus abnormal radiologic findings, imaging abnormality versus postoperative outcomes, postoperative outcomes versus electrode design, Cambridge Cochlear Implant Protocol (CCIP) status for imaging abnormalities, sensitivity and specificity of CT and MRI for round-window/cochlear occlusion, and MRI for incomplete partitions.
A total of 207 patients with CT, MRI, or both were reviewed retrospectively. Less than half (15.5%) of CT scans had findings that might affect surgical intervention compared with 5.9% of MRI. No significant difference was found between children and adults for relevant imaging abnormalities (grade 4 or higher) with either CT (p = 0.931) or MRI (p = 0.606). CCIP status correlated with cochlear abnormalities (p = 0.040); however, only 46.2% of radiographic abnormalities on CT would be identified by these criteria. For detecting cochlear occlusion requiring surgical intervention, the sensitivity and specificity for CT were 40% (4 of 10; 95% confidence interval CI, 12.16-73.76) and 95.73% (95% CI, 91.40-98.27), respectively. For MRI, the sensitivity and specificity were 33.33% (1 of 3; 95% CI, 0.84-90.57) and 96.97% (63 of 65; 95% CI, 89.32-99.63), respectively. There was no difference for postoperative AzBio scores for higher-grade imaging abnormalities (p = 0.6012) or for electrode designs (p = 0.3699).
Significant radiographic abnormalities were relatively uncommon in cochlear implant patients on either CT or MRI at our single-center institution. If present, abnormal imaging findings rarely translated to management changes. CCIP status does not reliably predict which patients are likely to have abnormalities. Both MRI and CT have low sensitivity for round-window or cochlear occlusion, but detection likely leads to changes in surgical management.
Bronchial thermoplasty is a treatment for asthma. It is currently unclear whether its histopathological impact is sufficiently explained by the proportion of airway wall that is exposed to ...temperatures necessary to affect cell survival.Airway smooth muscle and bronchial epithelial cells were exposed to media (37-70°C) for 10 s to mimic thermoplasty.
we developed a mathematical model of airway heat distribution post-thermoplasty.
we determined airway smooth muscle mass and epithelial integrity pre- and post-thermoplasty in 14 patients with severe asthma.
airway smooth muscle and epithelial cell number decreased significantly following the addition of media heated to ≥65°C.
simulations showed a heterogeneous heat distribution that was amplified in larger airways, with <10% of the airway wall heated to >60°C in airways with an inner radius of ∼4 mm.
at 6 weeks post-thermoplasty, there was an improvement in asthma control (measured
Asthma Control Questionnaire-6; mean difference 0.7, 95% CI 0.1-1.3; p=0.03), airway smooth muscle mass decreased (absolute median reduction 5%, interquartile range (IQR) 0-10; p=0.03) and epithelial integrity increased (14%, IQR 6-29; p=0.007). Neither of the latter two outcomes was related to improved asthma control.Integrated
and
modelling suggest that the reduction in airway smooth muscle post-thermoplasty cannot be fully explained by acute heating, and nor did this reduction confer a greater improvement in asthma control.
Transcriptomic profiling can shed light on the biology of small-cell bladder cancer (SCBC), nominating biomarkers, and novel therapeutic targets.
Sixty-three patients with SCBC had small-cell ...histology confirmed and quantified by a genitourinary pathologist. Gene expression profiling was performed for 39 primary tumor samples, 1 metastatic sample, and 6 adjacent normal urothelium samples (46 total) from the same cohort. Protein levels of differentially expressed therapeutic targets, DLL3 and PDL1, and also CD56 and ASCL1, were confirmed by IHC. A SCBC PDX model was utilized to assess
efficacy of DLL3-targeting antibody-drug conjugate (ADC).
Unsupervised hierarchical clustering of 46 samples produced 4 clusters that correlated with clinical phenotypes. Patients whose tumors had the most "normal-like" pattern of gene expression had longer overall survival (OS) compared with the other 3 clusters while patients with the most "metastasis-like" pattern had the shortest OS (
= 0.047). Expression of DLL3, PDL1, ASCL1, and CD56 was confirmed by IHC in 68%, 30%, 52%, and 81% of tissue samples, respectively. In a multivariate analysis, DLL3 protein expression on >10% and CD56 expression on >30% of tumor cells were both prognostic of shorter OS (
= 0.03 each). A DLL3-targeting ADC showed durable antitumor efficacy in a SCBC PDX model.
Gene expression patterns in SCBC are associated with distinct clinical phenotypes ranging from more indolent to aggressive disease. Overexpression of
mRNA and protein is common in SCBC and correlates with shorter OS. A DLL3-targeted ADC demonstrated
efficacy superior to chemotherapy in a PDX model of SCBC.
There is growing evidence that inflammation is an important mediator of pathophysiology in bipolar disorder. The omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) metabolic pathways ...participate in several inflammatory processes and have been linked through epidemiologic and clinical studies to bipolar disorder and its response to treatment. We review the data on PUFAs as biomarkers in bipolar disorder and n-3 PUFA used as treatment for bipolar disorder.
PubMed and CINAHL were searched for articles on PUFA and bipolar disorder published in the English language through November 6, 2013, with an updated search conducted on August 20, 2015. Keywords searched included omega 3 fatty acids and bipolar disorder, omega 3 fatty acids and bipolar mania, omega 3 fatty acids and bipolar depression, omega 3 fatty acids and mania, omega 3 fatty acids and cyclothymia, omega 3 fatty acids and hypomania, fatty acids and bipolar disorder, essential fatty acids and bipolar disorder, polyunsaturated fatty acids and bipolar disorder, DHA and bipolar disorder, and EPA and bipolar disorder.
Studies selected measured PUFAs as biomarkers or introduced n-3 PUFA as treatment.
We identified 17 relevant human clinical articles that either compared PUFA levels between a bipolar disorder group and a control group or used a PUFA intervention to treat depression or mania in bipolar disorder. Human studies suggest low n-3 red blood cell PUFA concentrations and correlations with clinical severity in studies of plasma concentrations in symptomatic bipolar disorder. Results of published n-3 PUFA dietary supplementation trials for bipolar disorder indicate efficacy in treatment for mania or depression in 5 of 5 open-label trials, efficacy in treatment of depression in 1 of 7 randomized controlled trials, and a signal for treatment of depression in 1 meta-analysis.
Biomarker studies of PUFA and treatment studies of n-3 PUFA in bipolar disorder show promise for indicating a way forward in the study of PUFA in bipolar disorder. Investigation of the intake and metabolism of the n-3 and n-6 PUFA when supplementation is provided in treatment trials might offer clues for identification of when and how PUFA may be important for treatment in bipolar disorder.
T follicular helper (Tfh) cells are required to develop germinal center (GC) responses and drive immunoglobulin class switch, affinity maturation, and long-term B cell memory. In this study, we ...characterize a recently developed vaccine platform, nucleoside-modified, purified mRNA encapsulated in lipid nanoparticles (mRNA-LNPs), that induces high levels of Tfh and GC B cells. Intradermal vaccination with nucleoside-modified mRNA-LNPs encoding various viral surface antigens elicited polyfunctional, antigen-specific, CD4
T cell responses and potent neutralizing antibody responses in mice and nonhuman primates. Importantly, the strong antigen-specific Tfh cell response and high numbers of GC B cells and plasma cells were associated with long-lived and high-affinity neutralizing antibodies and durable protection. Comparative studies demonstrated that nucleoside-modified mRNA-LNP vaccines outperformed adjuvanted protein and inactivated virus vaccines and pathogen infection. The incorporation of noninflammatory, modified nucleosides in the mRNA is required for the production of large amounts of antigen and for robust immune responses.
ObjectiveThis study examined the association between candidate psychosocial and lifestyle variables and the trajectories of clinically significant anxiety and depressive symptoms from entry to ...completion of first-year university.DesignA longitudinal cohort studyParticipantsFirst-year undergraduate studentsMethodsWe analysed the responses of 1686 first-year undergraduate students attending Queen’s University who completed electronic surveys at both the beginning and completion of their academic year. Predictors of change in positive anxiety and depressive symptom screens (based on exceeding validated symptom threshold scores) were identified using logistic regression.ResultsIncreased university connectedness reduced the odds of emergent significant depressive and anxiety symptoms in healthy students and increased the odds of recovery in students who screened positive at the start of university. Students who screened positive for depression or anxiety at university entry were less likely to recover if they had a lifetime history of internalising disorders. Healthy students who increased their drug use over their first year had higher odds of developing significant levels of both anxiety and depressive symptoms by completion of the academic year.ConclusionsModerate to severe levels of anxiety and depressive symptoms are common among students at entry to university and persist over the first year. University connectedness may mitigate the risk of persistent or emergent symptoms, whereas drug use appears to increase these risks. Findings have implications for university well-being initiatives.
Objective. This study was designed to determine: (1) the prevalence of elevated blood lead (BPb) levels (BPb greater than or equal to 10 mug/dL) in Chicago suburban children attending Pediatric ...Practice Research Group practices at 12 and 24 months of age, and (2) the efficacy of the Centers for Disease Control and Prevention (CDC) and Illinois lead exposure risk assessment questions. Methods. Parents bringing their 1- and 2-year-old children for health supervision visits at pediatric practices completed questionnaires. BPb levels were drawn on children. Both questionnaire and an analyzable BPb level were obtained on 1393 subjects (79.2%). Results. Only 2.1% of our sample had a venous BPb level greater than or equal to 10 mug/dL (0.48 mumol/L); no subjects had a level greater than or equal to 30 mug/dL (1.45 mumol/L). The CDC risk assessment questions had a sensitivity of .69 and specificity of .70. Due to the low prevalence of elevated BPb levels in this sample, CDC and Illinois screening strategies had high negative predictive values (.99) and low positive predictive values (.05 and .04, respectively). However, some of the subjects with BPb levels greater than or equal to 10 mug/dL were not at high risk by CDC and Illinois screening questions; 9 of 29 subjects with elevated lead levels (31%) did not respond affirmatively to any CDC risk assessment questions. The question best predicting an elevated BPb was the determination that the house the child lives in was built before 1960 (sensitivity = .83, specificity = .67). This question is not currently included in CDC or Illinois screening strategies. Screening based on the single question "Was your house built before 1960?" would have missed only five (17%) of the children with BPb levels greater than or equal to 10 mug/dL. Three of these five children were among the 17.1% of 1-year-olds and 26.3% of 2-year-olds in our sample who had moved. Conclusions. In this sample, children living in houses built before 1960 should be considered at high risk for high-dose lead exposure. Due to the high mobility of our sample, phrasing the question to include lifetime exposure (ie, Has your child ever lived in a house built before 1960?) should also be considered. Selective BPb testing of high-risk children in low-prevalence suburban areas using this question would miss few children with elevated BPb. Useful risk assessment questions in other areas and other populations may differ. Pediatrics 1994;93:164-171; lead, children, screening, risk assessment, lead poisoning.
Weather information is widely available across many media platforms, including televisions, computers, smartphones, and tablets. In addition to weather forecast information, people are seeking and ...using a variety of weather information sources that provide them with current conditions and include tools such as satellite images and weather radar displays. However, little is known about how individuals use and perceive information from weather radar displays, despite the existence of radar since the 1940s. This study is a novel exploration of how Tampa Bay area residents use radar and identifies several important factors that influence how useful radar is perceived to be as a decision-making tool. It also investigates what information radar users find most important when choosing to view a radar display, as well as what electronic sources are used most often to access weather radar. The final goal of this study is to identify which activities motivate a Tampa Bay resident to view weather radar. Data were collected using an online survey instrument. This study finds that survey respondents in the Tampa Bay area frequently view a weather radar display and find it to be a very useful tool. Respondents who reported greater accuracy for the location of precipitation on a radar display were more likely to rate the radar display as being more useful. The majority of respondents indicate they use a smartphone device to view radar most often and that participating in outdoor activities was an important motivator for using radar.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Computer tomography has been described for the detection and characterization of different thoracic neoplastic diseases in dogs, both primary and metastatic. Its use and availability in veterinary ...medicine are rapidly increasing in the clinical setting, particularly in referral practices. Due to the cross-sectional nature of this modality, CT is particularly useful in the assessment of complex anatomical regions, such as the thoracic cavity. In this review, the most common applications of thoracic CT for the diagnosis and staging of different neoplastic processes in dogs are highlighted.
Background Despite the epidemiological associations between psychological stress, depression, and increased cardiovascular disease risk, no studies have examined the relation between naturally ...occurring psychosocial stressors and directly measured microvascular function in adults with major depressive disorder ( MDD ). We tested the hypothesis that young adults with MDD exposed to everyday psychosocial stressors would exhibit more severe impairments in endothelium-dependent dilation ( EDD ) compared with: (1) healthy nondepressed adults ( HCs ); and (2) adults with MDD without acute psychosocial stress exposure. Methods and Results Twenty HCs (22±1 years) and 23 otherwise healthy adults with MDD (20±0.3 years) participated in the study. Participants completed a psychosocial experiences survey to document their exposure to any of 6 stressors over the preceding 24 hours (eg, arguments, work stressors). Red cell flux (laser Doppler flowmetry) was measured during graded intradermal microdialysis perfusion of acetylcholine (10
to 10
mol/L). EDD was expressed as a percentage of maximum vascular conductance (flux/mm Hg). Multiple linear regression was used to determine the associations between stress, EDD , and MDD . Adults with MDD reported a greater number and severity of psychosocial stressors compared with HCs (all P<0.05). EDD was blunted in adults with MDD ( HCs : 91±2 versus MDD : 74±3%; P<0.001). Exposure to any stressor was related to more severe impairments in EDD in patients with MDD (no stressor: 81±3 versus 1+ stressors: 69±5%; P=0.04) but not in HCs ( P=0.48). Conclusions These data indicate that exposure to everyday psychosocial stressors is associated with greater impairments in endothelial function in patients with MDD , suggesting a potential mechanistic link between daily stress and depression in increased cardiovascular risk.
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