Ipsilateral Vestibular Schwannoma after Cochlear Implantation.

OBJECTIVE: The vestibular schwannoma incidence rate is approximately 4.2 per 100,000/year. Thus far, about 700,000 cochlear implantations have been performed worldwide; therefore, the occurrence of vestibular schwannoma postcochlear implantations can be assumed to be infrequent. Recent developments allow safe observation and surveillance of the implanted-side internal auditory canal (IAC) and cochlea by magnetic resonance imaging (MRI), even after cochlear implantation. Patients. A 71-year-old woman with sudden hearing loss and a contralateral vestibular schwannoma without clinical and genetic signs of neurofibromatosis type II. Intervention(s). Ipsilateral cochlear implantation and contralateral vestibular schwannoma extirpation with regular tumor follow-up. Main Outcome Measure(s). Comparison of ipsilateral pre and postcochlear implantation 3T MRI T1 GAD. RESULTS: We observed a tumor growing at the fundus of the internal auditory canal 1 year after cochlear implantation on the ipsilateral side. Although first detected after cochlear implantation beside a known vestibular schwannoma on the contralateral side, a scan slice thickness of 2 mm cannot fully exclude the preoperative persistence of a small tumor. Based on the clinical findings and after genetic exclusion of NFII, the patient was classified as a NFII mosaic type. CONCLUSION: Even after cochlear implantation, tumors in the IAC causing vertigo, facial palsy, and affecting the audiologic outcome can be detected by MRI. The MRI slice thickness used before cochlear implantation should be under 2 mm.

Hexagonal boron nitride nanoparticles trigger oxidative stress by modulating thiol/disulfide homeostasis.

BACKGROUND: Hexagonal boron nitride nanoparticles (hBN NPs) are encouraging nanomaterials with unique chemical properties in medicine and biomedical fields. Until now, the optimal hBN NP's dosage and biochemical mechanism that can be used for in vivo systems has not been fully revealed. The main aim of this article is to reveal characteristics, serum and tissue interactions and any acute cytotoxic effect of different dose of hBN NPs for the first time. METHODS: hBN NPs at concentrations varying between 50-3200 µg/kg was administered by intravenous injection to Wistar albino rats (n = 80) divided into seven dosage and control groups. Blood and tissue samples were taken after 24 hours. RESULTS: Our findings suggested that higher doses hBN NPs caused oxidative stress on the serum of rats dose-dependently. However, hBN NPs did not affect thiol/disulfide homeostasis on kidney, liver, spleen, pancreas and heart tissue of rats. Furthermore, hBN NPs increased serum disulfide formation by disrupting the thiol/disulfide balance in rats. Also, LOOH and MPO levels increased at high doses, while CAT levels decreased statistically. CONCLUSION: The results revealed that hBN NPs induce oxidative stress in a dose-dependent manner by modulating thiol/disulfide homeostasis in rats at higher concentrations.

Effect of head position on cochlear implant MRI artifact.

PURPOSE: A new generation of cochlear implant (CI) magnets and specific surgical techniques (e.g., implant positioning) has changed the relationship between a CI and magnet resonance imaging (MRI). MRI allows a pain free in vivo evaluation of the inner ear fluid state and internal auditory canal after the insertion of an electrode. The aim of this study is to evaluate how the patient's head position in the MRI scanner influences the CI magnet-related artefact. METHODS: We performed in vivo measurement of MRI artefacts at 3 T with a CI system containing a bipolar diametrical magnet. The implant magnet was positioned with a head bandage at different positions from the nasion and external auditory canal in three volunteers. We used a turbo spin echo (TSE) T2w sequence on the axial and coronal planes and observed three positions: (1) regular position, (2) chin to chest (anteflexion), and (3) hyperextension (retroflexion). RESULTS: By comparing the positions, anteflexion of the cervical spine in a chin-to-chest position allowed us to place the artefact in a more apical position from the IAC in the coronal plane. The hyperextension of the cervical spine position shifts the artefact father towards the cochlea's direction. CONCLUSION: The head's position can influence the location of MRI artefacts. In cases where the artefact diminished the IAC or cochlea, anteflexion of the cervical spine in the chin-to-chest position of the head in the MRI scanner should be attempted to allow a visualization of the IAC.

Do state-trait anxiety and previous unpleasant dental experiences predict the need for sedation in women having third molar surgery?

The aim of this study was to examine the need for sedation in women who had or had not had a previous unpleasant dental experience, and to assess possible contributory factors. The sample size required was estimated at 312 subjects. Healthy women listed for the surgical removal of third molars were asked to complete a questionnaire regarding their health, clinical and personal experience, past dental experience, result of the Indicator of Sedation Need (IOSN) scale, and of the Spielberger's State-Trait Anxiety Inventory. The participants were categorised before analysis by the nature of their previous dental experience. The number of participants who required sedation, their mean IOSN score, and the mean degree of state anxiety were significantly higher in the unpleasant experience group. The younger the patient at the time of the experience, the worse the state-anxiety (r=-0.25). The odds that sedation would be needed were 2.24 times higher in the same group. The final model correctly predicted the need for sedation in 75.3% of the cases. Healthy women having third molar surgery who had had a previous upsetting dental experience were more likely to need sedation and had worse state-anxiety than those who had not.

QT interval changes in term pregnant women living at moderately high altitude.

OBJECTIVE: This study aimed to compare the QT interval changes in women with term pregnancy living at moderately high altitude (1890 m in Erzurum, Turkey) with those of women living at sea level (31 m in Istanbul, Turkey). MATERIALS AND METHODS: One-hundred ten women (n = 55, for each group) with full-term and single child pregnancies. Two different locations in that state were selected: Istanbul, Turkey, which is at 31 m above sea level (Group 1) and Erzurum, Turkey, at 1890 m above sea level (Group 2). Physicians from the two locations participated in the study. We estimated QTc, QTc Max, QTc Min, QT, and QTcd intervals. RESULTS: Moderately high altitude group had significantly longer QT parameters (QTc, QTc Max, QTc Min, QT, and QTcd intervals) compared with sea level group (P < 0.01, for all). CONCLUSIONS: According to our results, QT interval changes occur in term pregnant women living moderately high altitude. These changes may be associated with pregnancy-related cardiovascular complications in moderately high altitude.

The efficacy of intravenous hyoscine-N-butylbromide during colonoscopy: a prospective, randomized, double-blind, placebo-controlled study.

BACKGROUND: Colonic spasm makes colonoscope advancement difficult. This prospective, randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy of hyoscine-N-butylbromide as an antispasmodic during colonoscopy. METHOD: Patients referred for elective colonoscopy were randomized into the study and placebo groups. Before the procedure, the study and placebo groups received 20 mg intra-venous hyoscine-N-butylbromide and intravenous saline solution of the same amount, respectively. Demographic and procedure--related data were recorded and compared between the groups. RESULTS: Of 198 patients referred for elective colonoscopy, 121 were included (study group = 60, placebo group = 61). No differences were observed between the study and placebo groups in terms of demographic data, pre-procedure characteristics, and colonoscopic characteristics including the cecal intubation time, total procedure time, bowel preparation, sedation doses, hemo-dynamic findings, endoscopist satisfaction, patient comfort, and polyp detection rate. The only difference was an increase in the heart rate by 32% in the study group after hyoscine-N-butyl-bromide administration (p < 0.001). CONCLUSIONS: Hyoscine-N-butylbromide did not reduce the time to reach the cecum and the total colonoscopy time, and patient and endoscopist satisfaction and polyp detection rate did not change. Furthermore, it was concluded that hyoscine-N-butylbromide can increase the risk of drug-related complications.

Value of the neutrophil-to-lymphocyte ratio in predicting post-pericardiotomy syndrome after cardiac surgery.

OBJECTIVE: Post-pericardiotomy syndrome (PPS) occurs in 10-40% of patients after cardiac surgery. PPS is considered an autoimmune phenomenon. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker that is associated with various cardiovascular diseases. Studies have reported that the NLR increases in certain autoimmune diseases. This study examined whether the NLR is helpful to predict the occurrence of PPS after elective on-pump coronary artery bypass graft (CABG) surgery. PATIENTS AND METHODS: The records of patients who underwent elective first-time on-pump CABG were reviewed retrospectively. In total, 72 patients with PPS were included in the study, and 100 patients who did not develop PPS were included as the control group. Peripheral blood samples collected preoperatively and on postoperative day 1 were used to calculate the NLR. RESULTS: No differences in preoperative white blood cell (WBC) count, neutrophil count, lymphocyte count, or NLR were observed between the patients with PPS and the control group. The WBC (p < 0.001) and neutrophil counts (p < 0.001) and NLR (p = 0.01) were significantly higher during the postoperative period in patients with PPS than in the control group. A receiver operating characteristic curve analysis showed that the postoperative NLR predicted PPS with 60% sensitivity and 59% specificity (area under the curve, 0.61; 95% confidence interval [CI], 0.51-0.70; p = 0.017), using a cut-off of 8.34. The postoperative WBC count (odds ratio [OR], 1.6; 95% CI, 1.36-2.03; p < 0.001) and NLR (OR, 3.3; 95% CI, 1.56-7.01; p = 0.002) were independently associated with PPS. CONCLUSIONS: The postoperative NLR may be useful to predict the development of PPS in patients undergoing on-pump CABG.

Role of methylprednisolone in the prevention of postpericardiotomy syndrome after cardiac surgery.

OBJECTIVE: Postpericardiotomy syndrome (PPS) occurs in 10-40% of patients after cardiac operations. Pericardial effusions and tamponade occurring > 7 days after surgery are usually related to PPS and remain an important cause of cardiac surgery-related morbidity and mortality; therefore, preventing PPS is important. Colchicine affords safe and efficacious protection against PPS and related complications. However, the roles of corticosteroids and nonsteroidal anti-inflammatory drugs in PPS prevention remains unclear. This study aimed to determine whether the intraoperative use of single-dose methylprednisolone can effectively prevent PPS. PATIENTS AND METHODS: This retrospective study included 100 patients undergoing elective coronary artery bypass grafting (CABG) who received a single intraoperative dose of 1 mg/kg methylprednisolone. A further 100 patients undergoing CABG, who were not given methylprednisolone, comprised the control group. The presence and severity of pericardial effusion was determined by echocardiography, with chest X-ray used to assess pleural effusion. RESULTS: PPS occurrence and pericardial effusion occurrence were significantly lower in patients who received methylprednisolone (p = 0.02 and p = 0.007 respectively). Although the differences were not statistically significant, pericardial and pleural effusions were more severe in the control group than in the methylprednisolone group. Logistic regression analysis demonstrated that methylprednisolone administration was independently associated with prevention of PPS (OR 0.8, 95% CI 0.25-0.91, p <  0.026). CONCLUSIONS: Intraoperative, single-dose methylprednisolone may confer protection against PPS in patients undergoing CABG.

Complexity measures from interaction structures.

We evaluate information-theoretic quantities that quantify complexity in terms of kth-order statistical dependences that cannot be reduced to interactions among k-1 random variables. Using symbolic dynamics of coupled maps and cellular automata as model systems, we demonstrate that these measures are able to identify complex dynamical regimes.

Identification and characterization of novel senescence-associated genes from barley (Hordeum vulgare) primary leaves.

Leaf senescence is the final developmental stage of a leaf. The progression of barley primary leaf senescence was followed by measuring the senescence-specific decrease in chlorophyll content and photosystem II efficiency. In order to isolate novel factors involved in leaf senescence, a differential display approach with mRNA populations from young and senescing primary barley leaves was applied. In this approach, 90 senescence up-regulated cDNAs were identified. Nine of these clones were, after sequence analyses, further characterized. The senescence-associated expression was confirmed by Northern analyses or quantitative RealTime-PCR. In addition, involvement of the phytohormones ethylene and abscisic acid in regulation of these nine novel senescence-induced cDNA fragments was investigated. Two cDNA clones showed homologies to genes with a putative regulatory function. Two clones possessed high homologies to barley retroelements, and five clones may be involved in degradation or transport processes. One of these genes was further analysed. It encodes an ADP ribosylation factor 1-like protein (HvARF1) and includes sequence motifs representing a myristoylation site and four typical and well conserved ARF-like protein domains. The localization of the protein was investigated by confocal laser scanning microscopy of onion epidermal cells after particle bombardment with chimeric HvARF1-GFP constructs. Possible physiological roles of these nine novel SAGs during barley leaf senescence are discussed.

[Hutchinson-Gilford progeria syndrome: clinical and molecular analysis in an African patient]. / Le syndrome de Hutchinson-Gilford (progèria): analyse clinique et moléculaire chez une patiente d'origine africaine.

Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare genetic disease characterized by an early onset of several clinical features including premature ageing in children. Approximately 80% of HGPS cases are caused by a de novo single-base pair substitution c.1824 C>T (GGC > GGT, p.Gly608Gly) within the exon 11 of the LMNA gene which codes for lamins A and C proteins. This mutation creates an abnormal splice donor site, leading to the formation of a truncated lamin A protein. Only a very few cases of African patients with HGPS have been reported, but none of them has been characterized at the molecular level. We report here a 12 year-old-girl African patient with HGPS, in whom the p.Gly608Gly heterozygous disease-causing mutation was found.

A rare case: mosaic trisomy 22.

A 9-year-old female child of healthy parents (mother: 43 years, father: 44 years) was referred to our center because of severe mental retardation. While pedigree analysis was not contributory, two older sibs were normal and healthy. Physical examination revealed facial dysmorphism, microcephaly and hyperflexibility of all joints. Her chromosome constitution showed a mosaic pattern; mos 46,XX[98]/47,XX,+22[2]. So skin biopsy was performed and mosaic trisomy 22 was confirmed with FISH analysis (46,XX[73]/47,XX,+22[27]). Physical features of this case seemed consistent with her mosaic constitution. This report would be a demonstrative example to show the significant contribution of FISH in states of mosaicism.

Topical anaesthesia in haemodialysis: evaluation of topical anaesthesia with lidocaine during vascular access in children undergoing long-term haemodialysis for chronic renal failure.

Children with chronic renal failure are frequently exposed to painful invasive procedures. Ointments containing lignocaine-prilocaine, when used before intravenous punctures, have been reported to lessen the pain sensation. The aim of this study was to interpret the effectiveness of lidocaine 2.5% ointment in preventing pain when used before venous and arterial punctures in children undergoing a haemodialysis programme for chronic renal failure. Eight children were included in this study. The pain level was identified by the patients using a linear analogue scale. When topical anaesthetic and placebo were compared, there was no statistical difference in interpretation of pain during arterial (P > 0.4), venous (P > 0.375) or both (P > 0.4) procedures. We conclude that lidocaine 2.5% ointment is not effective in preventing pain in children undergoing long-term haemodialysis. In these patients some other factors, like psychological factors, puncture technique and needle size must be taken into consideration for the prevention of pain.

Congenital chylothorax.

Congenital chylothorax is a rare condition in which chyle accumulates in the pleural space because of an intrauterine obstruction or anomalies of the thoracic duct. This paper presents a case of congenital chylothorax diagnosed antepartum echographically. The patient's history revealed a previous sibling with a similar diagnosis. The baby developed respiratory distress after delivery and the diagnosis was established by thoracentesis. Computed tomography of the chest and nuclear lymphangiography were obtained to evaluate the origin of the pleural effusion, but a congenital fistula or other pathology of the thoracic duct could not be demonstrated. Management of the baby consisted of ventilatory support in the delivery room, repeated thoracentesis and thoracostomy tube drainage, total parenteral nutrition and formula containing medium-chain triglycerides. The infant was discharged six weeks after birth in good condition.