Objective:To explore the clinical efficacy and safety of different surgical procedures of Mayo level Ⅳ inferior vena cava tumor thrombus(IVC-TT).Methods:The clinical and pathological data of 36 patients with Mayo level Ⅳ tumor thrombus were collected in three large clinical centers in China, including 18 cases in PLA General Hospital, 7 cases in Nanfang Hospital, and 11 cases in Renji Hospital. There were 25 males and 11 females.The median age was 56.5 years (53-67 years old). The average body mass index was 24.18±2.55 kg/m 2. The average diameter of renal tumors was 8.24±3.25 cm. The average length of inferior vena cava tumor thrombus was 12.89±2.50 cm. Mayo level Ⅳ tumor thrombus were divided into level Ⅳa and level Ⅳb (301 classification) based on the criterion of whether the proximal end of the thrombus has invaded the right atrium. Among them, level Ⅳa patients underwent robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass(CPB-free group, 6 cases). Level Ⅳb patients underwent robot-assisted inferior vena cava thrombectomy with cardiopulmonary bypass(CPB group, 12 cases) or cardiopulmonary bypass with deep hypothermic circulatory arrest assisted inferior vena cava thrombectomy(CPB/DHCA group, 18 cases). The baseline data of the three groups of patients were comparable. The perioperative results and long-term survival data after surgery were compared with different surgical methods for grade Ⅳcancer thrombosis. Results:All operations were successfully completed. Compared with the CPB group, the CPB-free group had a shorter first portal blocking time[17.5(15-36)min vs. 36.5(12-102)min, P=0.044], less intraoperative bleeding [2 350(1 000-3 000)ml vs. 3 500 (1 500-12 000)ml, P=0.043] and a lower allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 185(700-5 800)ml, P=0.049]. Compared with the CPB/DHCA group, the CPB-free group had an advantage in reducing intraoperative allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 700(1 200-10 000)ml, P=0.003]. There were no significant differences between groups in terms of duration of surgery and postoperative hospital stay. Among the 36 patients in this group, 23(64%) developed major complications (level Ⅲ or above), including 9 (25%) grade Ⅲ, 12 (33%) grade Ⅳ, and 2 (6%) grade Ⅴ. The CPB-free group had a relatively low complication rate of grade Ⅳ or above [ 17% (1/6) vs.42% (5/12) vs.44% (8/18)]. There were no statistical differences in median progression-free survival (16.4 vs.12.3 vs.18.0 months, P=0.695) and overall survival (30.1 vs.30.2 vs.37.7 months, P=0.674) between the groups. Conclusions:Robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass has the advantages of short ischemia time of organs, less intraoperative bleeding, and low incidence of major complications, which can be used as a safe and feasible surgical strategy for selected level Ⅳ tumor thrombus.

OBJECTIVES: The energy consumption process of cochlea and neural signal transduction along the auditory pathway are highly dependent on blood oxygen supply. At present, it is under debate on whether the obstructive sleep apnea syndrome (OSAS) would affect the auditory function since the patients suffer from low oxygen saturation. Moreover, it is difficult to detect the functional state of auditory in less severe stage of OSAS. Recently, speech-evoked auditory brainstem response (speech-ABR) has been reported to be a new electrophysiological tool in characterizing the auditory dysfunction. The aim of the present study is to evaluate the auditory processes in adult patients with mild and moderate OSAS by speech-ABR. METHODS: An experimental group of 31 patients with mild to moderate OSAS, and a control group without OSAS diagnosed by apnea hypopnea index in polysomnogram were recruited. All participants underwent otologic examinations and tests of pure-tone audiogram, distortion product otoacoustic emissions, click-evoked auditory brainstem response (click-ABR) and speech-ABR, respectively. RESULTS: The results of pure-tone audiogram, distortion product otoacoustic emissions, and click-ABR in OSAS group showed no significant differences compared with the control group (P>0.05). Speech-ABRs for OSAS participants and controls showed similar morphological waveforms and typical peak structures. There were significant group differences for the onset and offset transient peaks (P < 0.05), where OSAS group had longer latencies for peak V (6.69± 0.33 ms vs. 6.39±0.23 ms), peak C (13.48±0.30 ms vs. 13.31±0.23 ms), and peak O (48.27±0.39 ms vs. 47.60± 0.40 ms) compared to the control group. The latency of these peaks showed significant correlations with apnea hypopnea index for peak V (r=0.37, P=0.040), peak C (r=0.36, P=0.045), as well as peak O (r=0.55, P=0.001). CONCLUSION: These findings indicate that some auditory dysfunctions may be present in patients with mild and moderate OSAS, and the damages were aggravated with the severity of OSAS, which suggests that speech-ABR may be a potential biomarker in the diagnosis and evaluation at early stage of OSAS.
Adult ; Anoxia ; Apnea ; Auditory Pathways ; Cochlea ; Diagnosis ; Evoked Potentials, Auditory, Brain Stem ; Humans ; Oxygen ; Polysomnography ; Signal Transduction ; Sleep Apnea, Obstructive

The maximum length sequence (m-sequence) has been successfully used to study the linear/nonlinear components of auditory evoked potential (AEP) with rapid stimulation. However, more study is needed to evaluate the effect of the m-sequence order in terms of the noise attenuation performance. This study aimed to address this issue using response-free electroencephalogram (EEG) and EEGs with nonlinear AEPs. We examined the noise attenuation ratios to evaluate the noise variation for the calculations of superimposed averaging and cross-correlation, respectively, which constitutes the main process in the deconvolution method using the dataset of spontaneous EEGs to simulate the cases of different orders (order 5 to 12) of m-sequences. And an experiment using m-sequences of order 7 and 9 was performed in true cases with substantial linear and nonlinear AEPs. The results demonstrate that the noise attenuation ratio is well agreed with the theoretical value derived from the properties of m-sequences on the random noise condition. The comparison of waveforms for AEP components from two m-sequences showed high similarity suggesting the insensitivity of AEP to the m-sequence order. This study provides a more comprehensive solution to the selection of m-sequences which will facilitate the feasible application on the nonlinear AEP with m-sequence method.

[ABSTRACT]OBJECTIVETo investigate the relationships between electrophysiological characteristic of speech evoked auditory brainstem response and Mandarin phonetically balanced maximum, so as to provide more clues for the mechanism of speech cognitive behavior. METHODSThe speech discrimination scores were obtained by Mandarin phonemic-balanced monosyllable lists via speech audiometric software in forty-one ears of normal hearing adults. Their s-ABRs were recorded with speech syllables da with the intensity of phonetically balanced maximum (PBmax). The electrophysiological characteristic of s-ABR, as well as the relationships between PBmax and s-ABR parameters including latency in time domain, fundamental frequency (F0) and first formant (F1) in frequency domain were analyzed statistically.RESULTS While divided the subjects into three groups by PBmax1= 100%, 100%

Objective To investigate the effectiveness of intratympanic dexamethasone injection as a protec-tion agent against cisplatin ototoxicity.Methods Fifty five healthy guinea pigs were randomly divided into four groups.The guinea pigs groups received (group I)0.9% NaCl solution(16 ml/kg)intraperitoneally (IP),(group II)dexamethasone (10 mg/ml)intratympanically(IT),(group III)cisplatin (16 mg/kg)only intraperitoneally(IP) and (group IV)dexamethasone (10 mg/ml)IT followed after 1h by 16 mg/kg cisplatin.Before and 7 days following injections,the ototoxic effect was measured with auditory brainstem response(ABR).The contents of malondiade-hyde(MDA)and activities of superoxide dismutase(SOD)were also measured.Results ABR thresholds before and after dosing were 28.50±4.74,29.00±3.94 dB nHL and 28.67±5.82,31.33±5.81 dB nHL in group I and group II,respectively,with no significant differences (P>0.05).The contents of MDA and activities of SOD were 2.01 ±0.07 mmol/L ,234.10±13.09 U/ml and 2.06±0.09 mmol/L,233.20±13.24 U/ml in the group I and group II, respectively,with no significant differences (P>0.05).ABR thresholds after dosing were 55.33±4.81,and 40.67 ±3.72 dB nHL in the group III and group IV,which were significantly increased,but ABR thresholds in the group IV were significantly lower than that in the group III (P<0.05).The contents of MDA were 5.74±0.17,3.51± 0.18 mmol/L in the group III and group IV,which were significantly increased.SOD activities were 107.90 ± 14.21,and 162.70±11.25 U/ml,which significantly decreased.Nevertheless,in the group IV dexamethasone rela-tively reduced the contents of MDA(P<0.001)while increased the activities of SOD(P<0.001)compared with group III.Conclusion Intratympanic dexamethasone injection presents as an effective treatment modality to prevent cisplatin ototoxicity without any ototoxic effect.

OBJECTIVE: To investigate the effectiveness of cisplatin on the expressions of Bcl-2 and Bax in cochlea and spiral ganglion cells (SGC) of guinea pigs. METHOD: Twenty guinea pigs were randomly divided into cisplatin (n = 10) and control groups (n = 10). Cisplatin group were administrated with a dose of intraperitoneal injection of 16 mg/kg, while the control group were received intraperitoneal injection of normal saline as placebo. Before and 7 days following injections, the ototoxic effect was measured with distortion product otoacoustic emission (DPOAE). Bcl-2, Bax in cochlea were detected by Western Blot. Immunohistochemical staining was used to detect the protein levels of Bcl-2 and Bax in spiral ganglion cells. RESULT: In control and cisplatin group, Bcl-2 protein levels were 0.727 8 ± 0.016 9 and 0.467 6 ± 0.020 1, Bax protein levels were 0.384 8 ± 0. 0217 and 0.735 6 ± 0.022 3 in cochlea respectively, both P < 0.01. In Control and cisplatin group, the grey values of Bcl-2 in SGC were 99.00 ± 2.42 and 149.80 ± 2.37 respectively, the grey values of Bax were 154.50 ± 2.80 and 104.50 ± 3.09 respectively, both P < 0.05. CONCLUSION Decreased expression of Bcl-2 and increased expression of Bax may be involved in cisplatin-induced apoptosis in cochlea and SGC of guinea pigs.
Animals ; Apoptosis ; Cisplatin ; pharmacology ; Cochlea ; metabolism ; Guinea Pigs ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Spiral Ganglion ; drug effects ; metabolism ; bcl-2-Associated X Protein ; metabolism

Objective To investigate the relationships between electrophysiological characteristic of speech evoked auditory brainstem response(s-ABR) and Mandarin phonetically balanced maximum(PBmax) at different hearing impairment,so as to provide more clues for the mechanism of speech cognitive behavior.Method Forty-one ears in 41 normal hearing adults (NH),thirty ears in 30 conductive hearing loss patients(CHL) and twenty-seven ears in 27 sensorineural hearing loss patients(SNHL) were included in present study.The speech discrimination scores were obtained by Mandarin phonemic-balanced monosyllable lists via speech audiometric software.Their s-ABRs were recorded with speech syllables /da/ with the intensity of phonetically balanced maximum (PBmax).The electrophysiological characteristic of s-ABR,as well as the relationships between PBmax and s-ABR parameters including latency in time domain,fundamental frequency(F0) and first formant(F1) in frequency domain were analyzed statistically.Results All subjects completed good speech perception tests and PBmax of CHL and SNHL had no significant difference (P ＞ 0.05),but both significantly less than that of NH (P ＜ 0.05).While divided the subjects into three groups by 90％ ＜ PBmax ≤ 100％,80％ ＜ PBmax ≤ 90％ and PBmax ≤ 80％,the results showed that all subjects decreased amplitudes of Fo and F1,and increased latency of feature peaks as PBmax reduced.In the same PBmax group,latency of feature peaks increased and amplitudes of Fo and F1 decreased from SNHL,CHL to NH.All subjects showed strongest significant positive correlation between amplitudes of F0 and F1 with PBmax respectively,as well as significant negative correlation between latencies of all the feature peaks with PBmax.A stepwise regression analysis equation displayed that the sum of latencies of peak A and F,and amplitudes of F0 and F1 attributed to PBmax reached 76％,and their beta coefficient decreased from amplitudes of F0 and amplitudes of F1,latencies of peak F to latencies of peak A.Conclusions These electrophysiological characteristics of s-ABR showed closely and stably associated with Mandarin monosyllable discriminative abilities at different hearing impairment.Some electrophysiological characteristics such as amplitudes of Fo and F1,latencies of peak F and A may play more important roles in speech recognition assess,which may be applied combined or separately to further investigation of speech perception and temporal processing abilities.

OBJECTIVE: To investigate the relationships of electrophysiological characteristics between speech evoked auditory brainstem response (s-ABR) and auditory mismatch negativity (MMN), so as to provide more clues for the mechanism of speech cognitive behavior. METHOD: Thirty-three ears in 33 normal hearing adults were included in this study. Their s-ABR were recorded with speech syllables /da/ at 80 dB HL intensity. Meanwhile, two MMNs were recorded with 1 kHz frequency deviant extent and 40 dB intensity deviant extent in them. The electrophysiological characteristics of s-ABRs and MMNs, as well as the relationships of MMN latencies between s-ABR parameters including latencies in time domain, fundamental frequency(F0) and first formants(F1) in frequency domain were analyzed statistically. RESULT: MMN latency of frequency deviance showed a negative correlation tendency with s-ABR transient components, and it showed a positive trend with sustained components of s-ABR. While MMN latency of intensity deviance showed a positive correlation with s-ABR latency of peak V, A and D respectively, and it negatively showed a correlation with s-ABR latency of other peak s and amplitude of F0 and FI respectively. Only the s-ABR latency of peak F and MMN latency of frequency deviance, and the F0 amplitude of s-ABR and MMN latency of intensity deviance were moderate correlation statistically. CONCLUSION It was probably the neurons of frequency deviant MMN unmatched the characteristics of frequency with the neurons of s-ABR transient component, but well matched the characteristics of frequency with the neurons of s-ABR sustained component. Similarly, the neurons of intensity deviant MMN probably matched the characteristics of intensity with neurons of different components of s-ABR or not. These results may formed as a valuable clue for further investigation of speech perception and temporal processing abilities.
Acoustic Stimulation ; Adult ; Evoked Potentials, Auditory, Brain Stem ; Humans ; Speech ; Speech Perception

Objective To evaluate the therapeutic efficacy of intratympanic dexamethasone injections combined with prednisone in patients with idiopathic sudden sensorineural hearing loss. Methods A total of 71 patients diagnosed with sudden hearing loss were treated with intratympanic dexamethasone injections plus prednisone (B group) or prednisone alone (A group). Hearing was evaluated by pure tone audiogram performed before initial treatment and at 4 weeks following the final treatment. Results The total recovery rate after the treatment was 81.8% in the B group and 55.3% in the A group. The diflference between two groups was statistically significant (P < 0.05). Conclusion The present study suggests that sudden sensorineural hearing loss patients treated with intratympanic dexamethasone combined with prednisone have a higher likelihood of hearing recovery than those treated with prednisone alone.

OBJECTIVE: To evaluate effectiveness of endoscopic tragus cartilage-perichondrium in the treatment of large tympanic membrane perforations. METHOD: Patients with large tympanic membrane perfortations who had underwent cartilage-perichondrium myringoplasty were retrospectively retrieved from our department. Those with a follow-up of equal to or greater than 12 months after surgery were included in the study. Hearing test results were reported using a four-frequency air conduction and bone-air conduction gap. Patients were labeled as treatment success if the tympanic membrane was intact without lateralization or anterior blunting after surgery. RESULT: Of the 35 patients with large tympanic membrane perforations treated by endoscopic tragus cartilage-perichondrium, 33 (94.3%) were treatment success. There was no graft lateralization, anterior blunting, neocholesteatoma, and sensorineural hearing loss in these patients after surgery. The air conduction and bone-air conduction gap before surgery in the study cohort were (43.8 ± 5.7) dB and (28.5 ± 3.1) dB, respectively. Postoperative air conduction and bone-air conduction gap of the cohort were (31.4 ± 6.4) dB HL and (16.2 ± 4.1) dB, respectively. The postoperative air conduction and bone-air conduction gap decreased significantly after surgery (P < 0.01). Overall postoperative air-bone gap in 27 of the 35 patients (77%) were less than 20 dB after surgery. CONCLUSION Endoscopic cartilage-perichondrium myringoplasty is an effective procedure in the treatment of large tympanic membrane perforations.
Bone Conduction ; Cartilage ; Cohort Studies ; Ear Auricle ; Endoscopy ; Hearing ; Hearing Tests ; Humans ; Myringoplasty ; Postoperative Period ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; Tympanic Membrane Perforation ; surgery ; Tympanoplasty