Vitamin C as a potential ameliorating agent against hepatotoxicity among alcoholic abusers.

OBJECTIVE: Drug and substance abuse remains a major medical problem globally. Alcohol consumption, particularly heavy drinking, is an important risk factor for many health problems and is a major contributor to the global burden of disease. Vitamin C has proven to be defensive against toxic substances and provides antioxidant and cytoprotective activity to hepatocytes. The aim of this study was to investigate vitamin C as a potential ameliorating agent against hepatotoxicity among alcohol abusers. PATIENTS AND METHODS: This study was a cross-sectional study that included eighty male hospitalized alcohol abusers and twenty healthy people as a control group. Alcohol abusers received standard treatment plus vitamin C. Total protein, albumin, total Bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and 8-hydroxhguanosine (8-OHdG) were investigated. RESULTS: This study reported that, in the alcohol abuser group, there was a significant increase in the total protein, bilirubin, AST, ALT, ALP, TBARS, SOD and 8-OHdG; on the other hand, there was a significant decrease in albumin, GSH and CAT compared with the control group. The alcohol abuser group treated with vitamin C showed a significant decrease in total protein, bilirubin, AST, ALT, ALP, TBARS, SOD and 8-OHdG; on the other hand, there was a significant increase in albumin, GSH and CAT compared with the control group. CONCLUSIONS: This study's findings suggest that alcohol abuse induces significant alterations in various hepatic biochemical parameters and oxidative stress and that vitamin C has a partial protective role in countering alcohol abuse-induced hepatotoxicity. Using vitamin C as an adjunctive supplement to standard treatment may be helpful in minimizing the toxic side effects of alcohol abuse.

Long term experience of robotic retroperitoneal partial nephrectomy as the default approach in the management of renal masses: should the paradigm shift?

Although retroperitoneal surgery has demonstrated a better quality of recovery compared to transperitoneal routes, Retroperitoneal Robot Assisted Partial Nephrectomy (RRAPN) remains proportionally infrequent. As the boundaries of what is achievable robotically continue to be pushed, we present our experience at a high-volume tertiary referral centre that specialises in retroperitoneal surgery, exploring its feasibility as standard of care in the management of small renal masses. A prospective database of 784 RAPNs (2009-2020) was reviewed and 721 RRAPNs (92%) were performed at our centre. In our practice, we utilise a four-port approach to RRAPN. Patient, tumour and operative characteristics were assessed and both oncological outcomes and trifecta and pentafecta achievements were determined. Pentafecta was defined as achieving trifecta (negative surgical margin, no post-operative complications and WIT of < 25 min) plus over 90% estimated GFR preservation and no CKD stage upgrading at 1 year. Multivariate analysis was conducted to predict peri-operative factors which may prevent achieving a trifecta/pentafecta outcome. From 784 cases, 112 RAPNs were performed for imperative reasons, whilst the remainder were elective. Mean BMI ± s.d amongst our cohort was 28.6 ± 5.7. Mean tumour size was 3.1 cm (range 0.8-10.5 cm) and 47% of cases were stratified as intermediate/high risk using R.E.N.A.L nephrometry scoring. Forty-six patients had lesions in a hilar location, and 31% were anterior. Median blood loss was 30mls, with an open conversion rate of 1% and transfusion rate of 1.6%. Median warm ischaemic time (WIT) was 21 min, positive surgical margins were found in 4% and our post-operative Clavien 3/ > complication rate was 2.6%. We had a 1-day median length of stay with a 30 day readmission rate of 2%. Of 631 patients (80%) with a definitive histological diagnosis of cancer, 23% had T1b/ > disease. Over a mean 15 month follow-up period (range 1-125 months), 2% of patients developed recurrences and our cohort demonstrated a 99% 5 year cancer specific survival. Trifecta was achieved in 67% of cases and pentafecta in 47%. Age (p = 0.05), operative time (p = 0.008), pT1b tumours (p = 0.03), R.E.N.A.L score and blood loss (p = 0.001) were found to statistically significantly influence achievement of trifecta. Pentafecta achievement was influenced by R.E.N.A.L score (p = 0.008), operative time (p = 0.001) and blood loss (p = 0.001). We demonstrate the retroperitoneal approach in RAPN is feasible and safe irrespective of lesion location and complexity. In the hands of high-volume centres that are skilled in the retroperitoneal approach the benefits of retroperitoneal surgery can be extended even to challenging cohorts of patients without compromising their oncological or functional outcomes.

Study on the mechanism of KCl replacement of NaCl on the water retention of salted pork.

The reasons for the change in the water retention capability of salted pork caused by potassium chloride (KCl) instead of sodium chloride (NaCl) were investigated. Accompanied by the gradually increased substitution rate of KCl, the oxidative degradation of protein, water content, water activity (aw), gap, as well as water loss in salted pork were increased, and the results showed significant differences (p < 0.05). LF-NMR results indicated that NaCl was replaced by KCl, which can observably increased the mobility of water in the salted pork (p < 0.05). All indexes showed excellent correlation. NaCl was replaced by KCl, which affected the water retention capability of salted pork, because K+ promoted changes in the meat's physicochemical properties. The KCl replacement group presented higher water content, while displayed lower water retention capability.

Effects of in vitro oxidation on myofibrillar protein charge, aggregation, and structural characteristics.

The effects of oxidation degree on the isoelectric point (pI), aggregation, and structural characteristics for pork myofibrillar protein (MP) were studied by employing extracted MP, which was incubated by using a hydroxyl radical oxidation system. The concentrations of hydrogen peroxide (H2O2) were 0, 0.5, 1, 3, 5, 10, and 20 mM. With the increased oxidation degree, the contents of α-helix, ionic bonds, and hydrogen bonds decreased significantly (P < 0.05). Moreover, the pI value and total amino acids showed a declining trend, and the ß-sheet as well as solubility rised firstly and then declined. On the contrary, random curl, ß-turn, and turbidity increased significantly (P < 0.05). Therefore, amino acid side chain groups were modified, and the opposite effect, caused by oxidation that leads to protein cross-linking and aggregation, was greater than the promotion effect, such as net negative charge, these are the main factors that leads to the instability of protein solution systems.

Effect of inhaled waste anaesthetic gas on blood and liver parameters among hospital staff.

A significant health risk exists within a section of health workers that are exposed to anaesthetic gas and vapours, found in the atmosphere of treatment or operating rooms. These compounds are classified as waste anaesthetic gases (WAG). The present study aimed at identifying alterations in hepatic and haematological parameters occurring as a result of chronic exposure to WAG potentially affecting the health of team members working in hospitals. Therefore, operating room operatives, vulnerable to long-standing WAG exposure, were recruited for this study. Sevoflurane anaesthesia metabolites (inorganic fluoride and hexafluoroisopropanol (HFIP)), haematological indices and liver toxicity markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and osteopontin) were measured. The collected results showed increased plasma inorganic fluoride, HFIP and liver toxicity markers, as well as disturbances in haematological parameters. In conclusion, exposure to halogenated inhalational anaesthetics, in general, and Sevoflurane, in particular, induces alterations in hepatic markers and haematological indices.

Effects of NaCl substitutes on physicochemical properties of salted pork.

The effects of NaCl substitutes (KCl and Ca-ascorbate) at a certain concentration (15%) on the salted pork microstructure were investigated. The changes of water, salt, element (Na, K and Ca) content and total weight in salted pork under different kinds of salts, concentration and salting time were also discussed. Results show the different treatments significantly affected the element content of salted pork. Under high concentration (20%) salting, the relationship with corresponding element content is K (5.08%) > Na (2.73%) > Ca (0.82%). In the mixed salt solution, Ca element significantly inhibited the content increases of Na than K, and sodium salt substitution with potassium and calcium salts significantly reduced the sodium content in salted pork. The relationship of specific surface area in pork salted with three kinds of salts (15% concentration) is KCl group (4.3011 m2/g) > NaCl group (4.2902 m2/g) > Ca-ascorbate group (4.2319 m2/g). K, Na, and Ca have a certain impact on the microstructure, which affects the increase of salt content in salted pork.

Effect of in vitro oxidation on the water retention mechanism of myofibrillar proteins gel from pork muscles.

The aim of this study was to investigate the effects of oxidation on the structure of pork myofibrillar proteins (MPs) and the water retention mechanism of MPs gel. In a Fenton reaction system, protein oxidation increases (P < 0.05) with hydrogen peroxide (H2O2) concentration (0, 0.5, 1, 3, 5, 10, and 20 mmol/L). The Brunauer-Emmett-Teller surface area of the proteins gel gradually increased (P < 0.05) from 6.17 m2/g to 14.73 m2/g. Low field nuclear magnetic resonance results showed that immobilized water in the gel gradually decreased but free water content gradually increased (P < 0.05). Gel strength and water holding capacity (WHC) increased and then decreased. The results reveal that moderate oxidation contributes to the compact and uniform pore structure, higher WHC of proteins gel as well. However, excessive oxidation leads to increase pores and changes in water states of gel, leading to lower WHC.

Effects of malondialdehyde as a byproduct of lipid oxidation on protein oxidation in rabbit meat.

The effects of malondialdehyde (MDA) as a byproduct of lipid oxidation on myoglobin and myofibrillar proteins (MP) oxidations in muscle homogenates containing components native to rabbit muscle were investigated. For myoglobin, MDA could lead to increase in metmyoglobin percentage. For MP, MDA could promote protein carbonylation and loss of tryptophan fluorescence. In addition, MDA could affect reactive oxygen species (ROS)-generating system by promoting the formation of hypervalent myoglobin species and release of non-heme iron. The result of MDA-MP adducts fluorescence intensity indicated that ROS-generating systems may be the main reason for protein carbonylation at the later of incubation treatment. SDS-PAGE analysis revealed that the ability of ROS-generating systems to facilitate protein oxidation was enhanced with MDA, which was responsible for the formation of protein cross-linking throughout incubation treatment. Taken together, the ability of MDA on promoting the oxidation of MP in rabbit muscle homogenates may be relied on both adduct reactions and the influence on ROS-generating system.

Does protein oxidation affect proteolysis in low sodium Chinese traditional bacon processing?

This work investigated protein oxidation, proteolysis and their interrelationship during the manufacturing process of low-sodium Chinese traditional bacon. The bacons were prepared by four different salting treatments: substituting sodium chloride (NaCl) using 0, 30, 50, and 70% of potassium chloride (KCl). Protein oxidation was evaluated by total carbonylation, thiol oxidation, and tryptophan fluorescence changes. Proteolysis was detected by non-protein nitrogen, free amino acid, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. In the manufacturing process of low-sodium Chinese bacon, protein oxidation and protein proteolysis were simultaneously observed. Electrophoresis pattern showed that 70% substitution of KCl could promote proteolysis, meanwhile, protein oxidation possibly facilitated by 70% KCl replacement resulted in reduced tryptophan fluorescence and increased total carbonyl content. Additionally, a good correlation between protein oxidation and proteolysis was observed.

Activation of the molecular and functional effects of Nrf2 against chronic iron oxide nanorod overload-induced cardiotoxicity.

Reactive oxygen species have a significant role in the pathogenesis of iron oxide nanorod (IONR) overload-induced organ toxicity in some organs such as the lungs. Green tea induces upregulation of phase II antioxidant enzymes that are transcriptionally organized by the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) that when activated antagonize the oxidative stress induced by IONR overload that causes cardiotoxicity. The aim of the present study was to determine whether treatment of cardiotoxicity with iron chelators (deferiprone (DFP) or deferoxamine (DFO)) alone or in combination with phytochemical activation of Nrf2 (green tea) can protect cardiomyocytes from IONR overload-induced cardiotoxicity. One hundred five rats were distributed into seven groups: two control groups (non-IONR-overloaded and IONR-overloaded) and five IONR-overloaded groups such as a green tea group, DFP group, DFP combined with green tea group, DFO group, and DFO combined with green tea. Blood samples and cardiac tissues were obtained for estimation of total iron-binding capacity, ratio of myocardial 8-hydroxy-2'-deoxyguanosine/myocardial 2-deoxyguanosine, thiobarbituric acid reactive substances, glutathione (GSH) contents, and histopathological examination. The results showed mild histopathological changes in the heart and a significant decrease in all biochemical parameters, except for myocardial GSH, in the DFP group. The addition of green tea improved the biochemical and histopathological results compared with chelators alone.

Hormonal profile and follicular dynamics concurrent with CIDR and insulin modified Ovsync TAI programs and their impacts on the fertility response in buffaloes.

Fifty one cyclic Egyptian buffaloes were used to study the hormonal profile and follicular dynamics concurrent with CIDR and insulin modified Ovsync TAI programs and their impacts on the consequent fertility responses. The buffaloes were randomly assigned into 3 ovulation synchronization protocols: Ovsync-alone (n = 13, control) CIDR-sync (n = 20) and Insulin-sync (n = 18). Ovsync-alone protocol consisted of two im injections of 20 µg bueserlin (GnRHa) on Day 0 (GnRH 1) and on Day 9 (GnRH 2) with an im injection of 500 µg of cloprostenol sodium (PGF2 α) on Day 7. The CIDR-sync protocol consisted of the same treatment protocol as in Ovsync in addition to intra-vaginal insertion of CIDR (contains 1.38 gm of progesterone) on Day 0 followed by removal on Day 7. The Insulin-sync protocol consisted of the same treatment protocol as in Ovsync plus 3 sc injections of insulin at a dose of 0.25 i.u/1 kg, on Days 7, 8, and 9. Buffaloes in all groups were inseminated 16 h after GnRH2 by the same inseminator using frozen semen in straws. Blood samples were collected on Days 0, 3, 5 for serum progesterone assay and on Day 9 to measure serum concentrations of estradiol, insulin and IGF-1. Transrectal ultrasonographic scanning of the ovaries was conducted on Days 7, 8 and 9 to record the diameter of the largest follicle. Pregnancy diagnosis was conducted on Day 30 post-TAI by trans-rectal ultrasonographic scanning of the uterus to calculate conception rate. The serum progesterone concentration showed an increase (p < 0.01) in pregnant compared with non-pregnant buffaloes in both Ovsync-alone and Insulin-sync groups, but not in CIDR-sync group (p > 0.05) on Days 3 and 5. The serum estradiol concentration on Day 9 showed an increase (p < 0.01) in pregnant compared with the non-pregnant buffaloes in all of the treated groups. In Insulin-sync and Ovsync-alone groups, the diameter of the largest follicle (LF) was larger (p < 0.01) in pregnant compared with non-pregnant buffaloes, but in CIDR-sync, the diameter of the (LF) was larger (p < 0.01) in non-pregnant compared with pregnant buffaloes. Also, the results showed that the greatest diameter of LF was observed in pregnant buffaloes in Insulin-sync compared with either pregnant or non-pregnant buffaloes in all groups. It is concluded that modified CIDR-sync and Insulin-sync could improve fertility response through modulating hormonal profile and follicular dynamics in buffaloes during low breeding season.

Long term self esteem assessment after height increase by lengthening and then nailing.

The purpose of the study is to assess the long term psychosocial functioning after height increase, using the external fixation then nailing method. Rosenberg Self-esteem scale and a questionnaire to assess social functioning were completed by 28 patients both preoperatively and at a mean follow-up of 7 years. The mean total score of RSE self-esteem for the 28 patients before lengthening was 21.5 (SD 1.03) (20-24). The mean total score of RSE for the patients 1 year after lengthening was 22 (SD 1.17) (20-24) with highly significant difference (p = 0.002).The mean total RSE self-esteem score after 7 years was 21.7 (SD 1.12) (21-25) with no significant difference (p = 0.11) Improvement was an evident in the short term self esteem after 1 year of follow up of the patients with height increase. On the other hand, there was an evident deterioration in the long term psychosocial evaluation during follow up after 7 years of height increase, returning to near pre-operative levels of self esteem.

The Prevalence of Clinically Significant Prostate Cancer According to Commonly Used Histological Thresholds in Men Undergoing Template Prostate Mapping Biopsies.

PURPOSE: Transrectal prostate biopsies are inaccurate and, thus, the prevalence of clinically significant prostate cancer in men undergoing biopsy is unknown. We determined the ability of different histological thresholds to denote clinically significant cancer in men undergoing a more accurate biopsy, that of transperineal template prostate mapping. MATERIALS AND METHODS: In this multicenter, cross-sectional cohort of men who underwent template prostate mapping biopsies between May 2006 and January 2012, 4 different thresholds of significance combining tumor grade and burden were used to measure the consequent variation with respect to the prevalence of clinically significant disease. RESULTS: Of 1,203 men 17% (199) had no previous biopsy, 38% (455) had a prior negative transrectal ultrasound biopsy, 24% (289) were on active surveillance and 21% (260) were seeking risk stratification. Mean patient age was 63.5 years (SD 7.6) and median prostate specific antigen was 7.4 ng/ml (IQR 5.3-10.5). Overall 35% of the patients (424) had no cancer detected. The prevalence of clinically significant cancer varied between 14% and 83% according to the histological threshold used, in particular between 30% and 51% among men who had no previous biopsy, between 14% and 27% among men who had a prior negative biopsy, between 36% and 74% among men on active surveillance, and between 47% and 83% among men seeking risk stratification. CONCLUSIONS: According to template prostate mapping biopsy between 1 in 2 and 1 in 3 men have prostate cancer that is histologically defined as clinically significant. This suggests that the commonly used thresholds may be set too low.

Vestibular evaluation in children with otitis media with effusion.

BACKGROUND: Fifty per cent of children with serous otitis media may have some balance disturbances. OBJECTIVE: To evaluate vestibular function in children with otitis media with effusion. METHODS: The control group comprised 25 children with bilateral normal hearing and middle-ear function. The study group consisted of 30 children with bilateral otitis media with effusion; these were divided into 2 subgroups according to air-bone gap size. Measures included the Arabic Dizziness Handicap Inventory, an imbalance evaluation sheet for children, vestibular bedside tests for children, and air- and bone-conducted vestibular-evoked myogenic potential testing. RESULTS: Arabic Dizziness Handicap Inventory scores and some vestibular bedside test results were significantly abnormal, with normal video-nystagmography results, in children with otitis media with effusion. Air-conducted vestibular-evoked myogenic potentials were recorded in 73 per cent of children with otitis media with effusion, with significantly delayed latencies. Bone-conducted vestibular-evoked myogenic potentials were successfully detected in 100 per cent of children with otitis media with effusion with similar results to the control group. CONCLUSION: The Arabic Dizziness Handicap Inventory and vestibular bedside tests are valuable tools for detecting vestibular impairment in children. Bone-conducted vestibular-evoked myogenic potentials are useful for vestibular system evaluation.

Impact of varicocelectomy on premature ejaculation in varicocele patients.

In a prospective manner, we studied the effect of varicocelectomy on premature ejaculation and testicular hormonal function in patients with varicocele. Microsurgical subinguinal varicocelectomy was carried out in 73 patients with clinical varicocele associated with premature ejaculation (group 1) and compared with 56 patients without operative intervention (group 2; control). The primary efficacy variable was the mean change in the Premature Ejaculation Diagnostic Tool. The changes in International Index of Erectile Function questionnaire, total serum testosterone and testicular size were also assessed. In group 1, the Premature Ejaculation Diagnostic Tool decreased significantly after varicocelectomy, from 15.56 to 11.37 (P < 0.001), indicating improvement of premature ejaculation. Thirty patients (41.1%) showed improvement of premature ejaculation compared to 5.3% in the control group (P < 0.001). In group I, but not in group II, testosterone levels and International Index of Erectile Function values increased significantly when compared with pre-operative values (P < 0.001 and 0.040 respectively). Testicular size increased after varicocelectomy, but this increase was nonsignificant till the end of study (P = 0.054). We concluded that varicocelectomy is clearly related to improvement of premature ejaculation and testicular hormonal function in varicocele patients.

Serum concentration of IL-17, IL-23 and TNF-α among patients with chronic spontaneous urticaria: association with disease activity and autologous serum skin test.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a common skin disorder, which is considered in a subset of patients to be an autoimmune disorder. T helper 17 (Th17) cells are crucially involved in the pathogenesis of some autoimmune diseases. OBJECTIVES: Our aim was to test the association of Th17 with CSU. We examined interleukin (IL)-17, IL-23 and tumor necrosis factor-alpha (TNF-α) serum levels in CSU patients and studied their association with urticaria activity and autologous serum skin test (ASST). SUBJECTS AND METHODS: Serum concentration of IL-17, IL-23 and TNF-α were measured in 75 patients with CSU and 30 healthy control subjects. Disease activity was assessed by using urticaria activity score (UAS) as recommended by EAACI/GA(2)LEN/EDF/WAO Guidelines. RESULTS: Serum concentration of IL-17, IL-23 and TNF-α were significantly higher in CSU patients as compared with the healthy control subjects (mean: 35.51 ± 31.14 vs. 4.60 ± 1.38 pg/mL; P < 0.001, 38.95 ± 27.82 vs. 9.87 ± 4.62 pg/mL; P > 0.001 and 17.93 ± 6.05 vs. 6.87 ± 3.73 pg/mL; P = 0.004, respectively). There were significant positive correlation between serum IL-17, IL-23, TNF-α and disease activity assessed by cumulative UAS for 7 days before blood sampling. The Serum concentration of IL-17, IL-23 and TNF-α were also significantly higher in ASST positive patients than in ASST negative patients. CONCLUSION: Our results showed high serum levels of IL-17, IL-23 and TNF-α among CSU patients which may highlight a functional role of these cytokines in the pathogenesis of this important and common skin disease. It also may provide the rationale for new treatment strategies in chronic urticaria.

Botulinum toxin injection for management of temporomandibular joint clicking.

The aim of the present study was to investigate the effect of botulinum toxin type A (BTX-A) injection in the lateral pterygoid (LP) muscle on temporomandibular joint (TMJ) clicking. The study enrolled seven patients with a total of 11 joints; all patients were stage I or II of Wilke's staging for internal derangement. BTX-A was injected in the ipsilateral LP muscle with electromyogram (EMG) guidance and the subjects were assessed for 4 months. Maximum inter-incisal opening, range of lateral movement, and the presence of a click were recorded throughout the follow-up period, and magnetic resonance imaging (MRI) was ordered at the end of the 4 months. The results showed that the decrease in inter-incisal opening and side to side movement immediately postoperative was statistically significant, while the difference by the end of the follow-up period was insignificant. MRI showed a marked improvement in disc position postoperatively. It may be concluded that BTX injection in the LP muscle leads to the disappearance of joint clicking clinically and a significant improvement in disc position as shown on MRI.

Auditory steady state response in auditory neuropathy.

REVIEW: Auditory neuropathy is a disorder characterised by preservation of outer hair cell function, with normal otoacoustic emissions and/or cochlear microphonics, but an absent or distorted auditory brainstem response. PURPOSE: This study aimed to objectively assess hearing thresholds in patients with auditory neuropathy, using the auditory steady state response. MATERIALS AND METHODS: Thirteen patients with auditory neuropathy and 15 normal hearing subjects were examined. Audiological evaluation included basic audiological tests, otoacoustic emissions, auditory brainstem response and auditory steady state response. RESULTS: In the auditory neuropathy patients, the auditory brainstem response was absent in 11 patients, while the auditory steady state response was absent in only three. CONCLUSION: The auditory steady state response may serve as a valuable objective measure for assessing the hearing threshold across different frequencies in patients with auditory neuropathy. We recommend that auditory steady state response be used to complete the evaluation of patients with auditory neuropathy.

Acoustically evoked, short latency negative response in children with sensorineural hearing loss.

INTRODUCTION: The auditory brainstem response consists of fast and slow waves. The acoustically evoked, short latency negative response is a large, negative deflection with a latency of 3 milliseconds which has been reported in patients with profound hearing loss. It may be of vestibular, particularly saccular, origin, as is the vestibular evoked myogenic potential. PURPOSE: To assess the presence of acoustically evoked, short latency negative responses in children with severe to profound sensorineural hearing loss. MATERIALS AND METHODS: Twenty-three children (46 ears) with sensorineural hearing loss underwent audiological evaluation and auditory brainstem response, vestibular evoked myogenic potential and caloric testing. RESULTS: An acoustically evoked, short latency negative response was present in 30.43 per cent of ears and absent in 69.57 per cent. Vestibular evoked myogenic potentials were recorded in all ears in the former group, but in only 53.13 per cent in the latter group. Caloric testing was normal in 82.6 per cent of the total ears tested. CONCLUSION: The presence of an acoustically evoked, short latency negative response is dependent not on residual hearing but on normal saccular function. This response can be measured in patients who cannot contract their neck muscles.