Validity of endoscopic ossiculoplasty immediately after its introduction for ossicular chain disruption.

BACKGROUND: Transcanal endoscopic ear surgery (TEES) reportedly requires a long learning curve and may be associated with more complications and longer operative times than microscopic ear surgery (MES). In this study, we aimed to examine the usefulness and validity of TEES for ossicular chain disruption in the early stages of its introduction in our institution. METHODS: TEES was performed on 11 ears (10 with congenital ossicular chain discontinuity and 1 with traumatic ossicular chain dislocation), and MES was performed with a retroauricular incision on 18 ears (6 with congenital ossicular chain discontinuity and 12 with traumatic ossicular chain dislocation) in a tertiary referral center. Postoperative hearing results, operative times, and postoperative hospital length of stay were retrospectively reviewed. The Mann-Whitney U test and Fisher's exact test was performed to compare variables between the TEES and MES groups. Pre- and postoperative air- and bone-conduction thresholds and the air-bone gap of each group were compared using the Wilcoxon signed-rank test. The Mann-Whitney U test and Wilcoxon signed-rank was performed to compare the pre- and postoperative air-bone gaps between the diagnoses. RESULTS: No significant differences in the postoperative air-conduction thresholds, bone-conduction thresholds, air-bone gaps, or incidence of air-bone gap ≤ 20 dB were observed between the TEES and MES groups. The air-conduction thresholds and air-bone gaps of the TEES group significantly improved postoperatively. The air-conduction thresholds and air-bone gaps of the MES group also significantly improved postoperatively. No significant difference was observed in the operative times between the groups (TEES group: median, 80 min; MES group: median, 85.5 min). The TEES group had a significantly shorter postoperative hospital stay (median, 2 days) than the MES group (median, 7.5 days). CONCLUSIONS: TEES was considered appropriate for the treatment of ossicular chain disruption, even immediately after its introduction at our institution. For expert microscopic ear surgeons, ossicular chain disruption may be considered a suitable indication for the introduction of TEES.

Neutrophil Extracellular Trap Formation and Deoxyribonuclease I Activity in Patients with Otitis Media with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

INTRODUCTION: No previous studies have evaluated the levels of neutrophil extracellular trap (NET) remnants or the importance of deoxyribonuclease (DNase) I activity based on the disease activity of otitis media with antineutrophil cytoplasmic antibody-associated vasculitis (OMAAV). The aim of this study was to explore the formation of NETs in the middle ear of patients with OMAAV during the onset and remission phases of the disease, with a particular focus on the relationships between the quantifiable levels of NET remnants and DNase I activity. METHODS: OMAAV patients were eligible for inclusion. Patients with otitis media with effusion (OME) were examined as controls. The levels of cell-free deoxyribonucleic acid (DNA), citrullinated-histone H3 (cit-H3)-DNA complex, and myeloperoxidase (MPO)-DNA complex were quantified using an enzyme-linked immunosorbent assay. DNase I activity was measured using a fluorometric method. RESULTS: The quantifiable levels of cell-free DNA, cit-H3-DNA complex, and MPO-DNA complex in the middle ear lavage of patients with OMAAV at onset were significantly higher than those in patients with OMAAV at remission and in patients with OME. DNase I activity in the patients with OMAAV at onset was significantly lower than those in patients with OMAAV at remission and OME and was negatively correlated with the level of MPO-DNA complex. CONCLUSIONS: This study suggests that NET remnants and DNase I activity may be potentially useful biomarkers for the diagnosis and disease activity of OMAAV.

Effect of radioprotective curtain length on the scattered dose rate distribution and endoscopist eye lens dose with an over-couch fluoroscopy system.

Sufficient dose reduction may not be achieved if radioprotective curtains are folded. This study aimed to evaluate the scattered dose rate distribution and physician eye lens dose at different curtain lengths. Using an over-couch fluoroscopy system, dH*(10)/dt was measured using a survey meter 150 cm from the floor at 29 positions in the examination room when the curtain lengths were 0% (no curtain), 50%, 75%, and 100%. The absorbed dose rates in the air at the positions of endoscopist and assistant were calculated using a Monte Carlo simulation by varying the curtain length from 0 to 100%. The air kerma was measured by 10 min fluoroscopy using optically stimulated luminescence dosimeters at the eye surfaces of the endoscopist phantom and the outside and inside of the radioprotective goggles. At curtain lengths of 50%, 75%, and 100%, the ratios of dH*(10)/dt relative to 0% ranged from 80.8 to 104.1%, 10.5 to 61.0%, and 11.8 to 24.8%, respectively. In the simulation, the absorbed dose rates at the endoscopist's and assistant's positions changed rapidly between 55 and 75% and 65% and 80% of the curtain length, respectively. At the 0%, 50%, 75%, and 100% curtain lengths, the air kerma at the left eye surface of the endoscopist phantom was 237 ± 29, 271 ± 30, 37.7 ± 7.5, and 33.5 ± 6.1 µGy, respectively. Therefore, a curtain length of 75% or greater is required to achieve a sufficient eye lens dose reduction effect at the position of the endoscopist.

Effect of PCDH19 missense mutations on cell-to-cell proximity and neuronal development under heterotypic conditions.

The mutation of the X-linked protocadherin (PCDH) 19 gene in heterozygous females causes epilepsy. However, because of the erosion of X-chromosome inactivation (XCI) in female human pluripotent stem cells, precise disease modeling often leads to failure. In this study, using a mathematical approach and induced pluripotent stem cells retaining XCI derived from patients with PCDH19 missense mutations, we found that heterotypic conditions, which are composed of wild-type and missense PCDH19, led to significant cell-to-cell proximity and impaired neuronal differentiation, accompanied by the aberrant accumulation of doublecortin, a microtubule-associated protein. Our findings suggest that ease of adhesion between cells expressing either wild-type or missense PCDH19 might lead to aberrant cell aggregation in early embryonic phases, causing poor neuronal development.

Evaluation of quality of life for patients with resolved facial nerve palsy.

OBJECTIVES: The quality of life (QOL) for patients with resolved facial nerve palsy has not been evaluated adequately. The objective of this study is to investigate QOL for patients with resolved facial nerve palsy. METHODS: Forty-seven patients with resolved facial nerve palsy were included and the patients' QOL was evaluated using the Facial Clinimetric Evaluation Scale (FaCE Scale). RESULTS: Twenty-two of the 47 patients (46.8%) with resolved facial nerve palsy showed impaired QOL, especially in terms of facial comfort and eye comfort. In 10 cases followed-up after the condition was judged to be resolved, the median scores for the FaCE scale at the time the condition was judged to be resolved and at the last visit were 65.5 and 72, respectively. The mean durations from the onset of the palsy to diagnosis of cure and to the last visit were 2.4 ± 1.6 and 4.3 ± 2.2 months, respectively. There was a significant improvement in QOL after the condition was judged to be resolved. CONCLUSION: There were discrepancies between QOL and facial movement as evaluated by physicians in patients in whom facial nerve palsy was resolved as in patients with non-cured facial nerve palsy. Patients' QOL continued to improve even after physicians judged the condition to be resolved and this result indicated that there were cases where improvement in QOL was delayed in comparison to improvement in facial movement.

Pre- and post-operative semicircular canal function evaluated by video head impulse test in patients with vestibular schwannoma.

OBJECTIVES: To evaluate pre- and post-operative semicircular canal function in patients with vestibular schwannoma (VS) by the video Head Impulse Test (vHIT). METHODS: Nineteen patients with VS who underwent surgery were enrolled in this study. The gain in vestibulo-ocular reflex (VOR) and the degree of scatter in catch-up saccades were examined pre- and post-operatively for the semicircular canals in VS patients. RESULTS: Ten of 19 cases (52.6 %) with VS were defined as demonstrating both superior vestibular nerve (SVN) and inferior vestibular nerve (IVN) impairment from the results of pre-operative vHIT. Hearing level and subjective vestibular symptoms showed significant correlations with pre-operative semicircular canal function. Compared to pre-operative vHIT results, VOR gains within 1 month after surgery were significantly reduced in all three canals; however, significant differences had disappeared in the anterior and posterior semicircular canals at 6 months after surgery. Cases of unknown origin had a significantly greater reduction in posterior semicircular canal function after surgery compared with those with disease of IVN origin. CONCLUSIONS: As vHIT could evaluate pre-operative vestibular nerve impairment, post-operative VOR gain reduction and the degree of vestibular compensation, semicircular canal function evaluated by vHIT provides a good deal of useful information regarding VS patients undergoing surgery compared to caloric testing, and vHIT should be performed pre- and post-operatively for patients with VS.

Half-value layer measurements using solid-state detectors and single-rotation technique with lead apertures in spiral computed tomography with and without a tin filter.

Solid-state detectors (SSDs) may be used along with a lead collimator for half-value layer (HVL) measurement using computed tomography (CT) with or without a tin filter. We aimed to compare HVL measurements obtained using three SSDs (AGMS-DM+ , X2 R/F sensor, and Black Piranha) with those obtained using the single-rotation technique with lead apertures (SRTLA). HVL measurements were performed using spiral CT at tube voltages of 70-140 kV without a tin filter and 100-140 kV (Sn 100-140 kV) with a tin filter in increments of 10 kV. For SRTLA, a 0.6-cc ionization chamber was suspended at the isocenter to measure the free-in-air kerma rate ( K ˙ air ) values. Five apertures were made on the gantry cover using lead sheets, and four aluminum plates were placed on these apertures. HVLs in SRTLA were obtained from K ˙ air decline curves. Subsequently, SSDs inserted into the lead collimator were placed on the gantry cover and used to measure HVLs. Maximum HVL differences of AGMS-DM+ , X2 R/F sensor, and Black Piranha with respect to SRTLA without/with a tin filter were - 0.09/0.6 (only two Sn 100-110 kV) mm, - 0.50/ - 0.6 mm, and - 0.17/(no data available) mm, respectively. These values were within the specification limit. SSDs inserted into the lead collimator could be used to measure HVL using spiral CT without a tin filter. HVLs could be measured with a tin filter using only the X2 R/F sensor, and further improvement of its calibration accuracy with respect to other SSDs is warranted.

Quantitative Evaluations of Vestibular Function in Patients With Petrous Apex Cholesterol Granulomas Treated With an Endoscopic Transsphenoidal Approach: A Report of Two Cases.

OBJECTIVE: We report two cases of petrous apex cholesterol granuloma (PACG) treated with an endoscopic transsphenoidal approach. Vestibular functions of the two patients were evaluated quantitatively by video Head Impulse Test (vHIT) and/or vestibular evoked myogenic potentials (VEMPs). PATIENTS: Two patients with PACG who experienced episodes of dizziness are presented. INTERVENTION: An endoscopic transsphenoidal approach to PACG. MAIN OUTCOME MEASURE: The preoperative and postoperative vestibular functions as evaluated by vHIT and VEMP. RESULTS: Two cases of PACG were treated by a transsphenoidal approach. The internal auditory canal was compressed by the PACG in both cases. The patients both experienced episodes of dizziness before surgery and preoperative vestibular testing including vHIT and VEMP indicated dysfunction of vestibular nerves. After surgery, their symptoms were completely resolved, and the vestibular testing results were improved. CONCLUSIONS: This article is noteworthy for being the first to publish quantitative vestibular function testing for patients with PACG with vestibular dysfunction. PACG may show various symptoms, with dizziness being one of the most common symptoms. In cases in which the internal auditory canal is compressed by the PACG, vestibular functions should be evaluated by vHIT and VEMP. In the present cases, dizziness was found to be resolved by surgery to release the compression on internal auditory canal. Based on the present cases, the transsphenoidal approach is considered to be both safe and effective.

Salivary fluoride concentrations following toothbrushing with experimental toothpaste containing surface pre-reacted glass-ionomer (S-PRG) filler.

BACKGROUND: Single-blind 9 case comparative studies were conducted to evaluate salivary fluoride concentrations following toothbrushing using experimental toothpaste containing surface pre-reacted glass-ionomer (S-PRG) fillers. Preliminary tests were conducted in order to determine the volume of usage as well as the concentrations (wt %) of S-PRG filler. Based on the results given these experiments, we compared the salivary fluoride concentrations following toothbrushing with 0.5 g of 4 different types of toothpastes: 5 wt % S-PRG filler, 1400 ppm F AmF (amine fluoride), 1500 ppm F NaF (sodium fluoride), and MFP (monofluorophosphate) containing toothpaste. METHODS: Of the 12 participants, 7 participated in the preliminary study and 8 in the main study. All participants brushed their teeth using the scrubbing method for 2 min. At first, 1.0 and 0.5 g of 20 wt % S-PRG filler toothpastes were used to compare, then followed by 0.5 g of 0 (control), 1, and 5 wt % S-PRG toothpastes, respectively. The participants spat out once and rinsed with 15 mL of distilled water for 5 s. Saliva was collected for 3 min each at different time intervals of 0 (baseline), 5, 10, 15, 30, 60, 120, and 180 min after the rinsing. Fluoride concentrations were determined using a fluoride electrode, and the area under the salivary clearance - time curve (AUC: ppm‧min) of each toothpaste was calculated as the salivary fluoride retention. The main study was then conducted to evaluate the salivary fluoride concentrations as well as the AUC value using 0.5 g of 5 wt % S-PRG filler toothpaste, followed by NaF, MFP, and AmF toothpastes. RESULTS: Since there were no statistical differences between using 1.0 and 0.5 g of 20 wt % S-PRG toothpastes in salivary fluoride concentrations as well as the AUC value throughout the 180 min measurement, the volume was set as 0.5 g for the following studies. Concentrations of 5 and 20 wt % S-PRG toothpastes retained 0.09 ppm F or more in saliva even after 180 min. No statistical differences were seen in the salivary fluoride concentrations at any time intervals as well as the AUC value between 5 and 20 wt % S-PRG toothpastes. Based on these results, the concentration of 5 wt % S-PRG toothpaste was used for the main comparative study. MFP toothpaste resulted in by far the lowest salivary fluoride concentrations (0.06 ppm F at 180 min) and the AUC value (24.6 ppm‧min), whereas 5 wt % S-PRG toothpaste (0.15 ppm F at 180 min, 92.3 ppm‧min) displayed retention on par with AmF toothpaste which appeared to result in higher values (0.17 ppm F at 180 min, 103 ppm‧min), compared to NaF toothpaste (0.12 ppm F at 180 min, 49.3 ppm‧min). CONCLUSIONS: The salivary fluoride concentrations following toothbrushing with 0.5 g of 5 wt % S-PRG filler containing toothpaste showed retention similar to the best performing 1400 ppm F AmF toothpaste even 180 min after toothbrushing.

Energy-based Hp(3) measurement using solid-state detector.

This study aimed to develop an energy-based Hp(3) measurement method using a solid-state detector (SSD). Incident and entrance surface air kerma were measured using an ionization chamber placed free-in-air and in front of an anthropomorphic or slab phantom. Subsequently, three SSDs were placed free-in-air, and half-value layer and readings were obtained. After measurements, an X-ray beam quality correction factor $\left ({{k}}_{{Q},{{Q}}_{\mathbf{0}}}^{{SSD}}\right)$, backscatter factor (BSF) and conversion factor from incident air kerma to Hp(3) (C3) were determined. Then, the incident air kerma by SSD $\left ({{K}}_{{a},{i}}^{{SSD}}\right )$, Hp(3) and Hp(3)/${{K}}_{{a},{i}}^{{SSD}}$ were calculated. The ${{k}}_{{Q},{{Q}}_{\mathbf{0}}}^{{SSD}}$ was almost consistent for all SSDs. The C3 and BSF were found to increase as tube potential increased. The Hp(3)/${{K}}_{{a},{i}}^{{SSD}}$ calculated with the anthropomorphic and slab phantoms were consistent within 2.1% and 2.6% for all SSDs, respectively. This method improves the energy dependence of Hp(3) measurement and can estimate the Hp(3) measurement error for dedicated Hp(3) dosemeters.

Nanosheet coating improves stability of human pluripotent stem cell culture on glass substrates.

High-resolution imaging analysis using various types of cells is an essential tool for dissecting cell functions. Generally, obtaining such images requires the cells to be cultured on glass substrates; however, it often results in the unstable status of cells. In this study, we report that coating the glass substrate using nanosheet composed of hydrophobic polystyrene, with Matrigel, significantly improves the viability of human pluripotent stem cells (hPSCs). Moreover, the nanosheet coating does not affect the transcriptome status of hPSC and enables researchers to perform the high-resolution imaging assay. These results indicate that the nanosheet coating is beneficial to the cells vulnerable to glass substrate culture. Using the nanosheet coating, we revealed that the spreading status of lnc RNA XIST, essential for X-chromosome inactivation (XCI) in female cells, in the nuclei significantly differs in each hPSC line. Taken together, our study provides a novel method to investigate biological questions using high-resolution imaging techniques.

Discrepancies in the caloric testing and video Head Impulse Test results in a case with bilateral lateral semicircular canal malformations.

Lateral semicircular canal (LSCC) malformations represent one of the most common types of inner ear malformation. As many cases of LSCC malformations are asymptomatic, detailed vestibular functions in such cases remain unclear. We present a case with bilateral LSCC malformations for whom the function of each vestibular organ was evaluated by caloric testing, video Head Impulse Test (vHIT) and vestibular evoked myogenic potentials (VEMP). Caloric testing showed canal paresis of the left side, whereas vHIT showed bilateral normal semicircular canal function. The results of VEMP indicated left saccular dysfunction. Discrepancies in caloric testing and vHIT results were observed and these discrepancies are thought to be due to endolymphatic hydrops rather than vestibular hypofunction, similar to that in Meniere disease.

Genetic Characterization of Staphylococcus aureus, Staphylococcus argenteus, and Coagulase-Negative Staphylococci Colonizing Oral Cavity and Hand of Healthy Adults in Northern Japan.

The spread of methicillin resistance and virulence among staphylococci in the community poses a public health concern. In this study, we investigated the prevalence of Staphylococcus species colonizing the oral cavity and hand (skin) of healthy university students and their phenotypic and genetic characteristics in northern Japan. Among a total of 332 subjects, 6 and 110 methicillin-resistant and susceptible Staphylococcus aureus (MRSA and MSSA, respectively) isolates were recovered from 105 subjects. MRSA isolates were genotyped as CC5, CC8, CC45, and CC59 with SCCmec-IIa or IV, among which an isolate of ST6562 (single-locus variant of ST8) harbored SCCmec-IVa, PVL genes and ACME-I, which are the same traits as the USA300 clone. ST1223 S. argenteus was isolated from the oral cavity and hand of a single student. Coagulase-negative Staphylococcus (CoNS) was recovered from 154 subjects (172 isolates), and classified into 17 species, with S. capitis being the most common (38%), followed by S. warneri (24%) and S. epidermidis (15%), including nine mecA-positive isolates. S. capitis was differentiated into seven clusters/subclusters, and genetic factors associated with the NRCS-A clone (nsr, tarJ, ebh) were detected in 10-21% of isolates. The colonization of the USA300-like MRSA variant and S. capitis with the traits of the NRCS-A clone in healthy individuals was noteworthy.

Reducing stray radiation with a novel detachable lead arm support in percutaneous coronary intervention.

BACKGROUND: Placing radioprotective devices near patients reduces stray radiation during percutaneous coronary intervention (PCI), a promising technique for treating coronary artery disease. Therefore, lead arm support may effectively reduce occupational radiation dose to cardiologists. PURPOSE: We aimed to estimate the reduction of stray radiation using a novel detachable lead arm support (DLAS) in PCI. MATERIALS AND METHODS: A dedicated cardiovascular angiography system was equipped with the conventional 0.5-mm lead curtain suspended from the table side rail. The DLAS was developed using an L-shaped acrylic board and detachable water-resistant covers encasing the 0.5-, 0.75-, or 1.0-mm lead. The DLAS was placed adjacent to a female anthropomorphic phantom lying on the examination tabletop at the patient entrance reference point. An ionization chamber survey meter was placed 100 cm away from the isocenter to emulate the cardiologist's position. Dose reduction using the L-shaped acrylic board, DLAS, lead curtain, and their combination each was measured at five heights (80-160 cm in 20-cm increments) when acquiring cardiac images of the patient phantom with 10 gantry angulations, typical for PCI. RESULTS: Median dose reductions of stray radiation using the L-shaped acrylic board were 9.0%, 8.8%, 12.4%, 12.3%, and 6.4% at 80-, 100-, 120-, 140-, and 160-cm heights, respectively. Dose reduction using DLAS with a 0.5-mm lead was almost identical to that using DLAS with 0.75- and 1.0-mm leads; mean dose reductions using these three DLASs increased to 16.2%, 45.1%, 66.0%, 64.2%, and 43.0%, respectively. Similarly, dose reductions using the conventional lead curtain were 95.9%, 95.5%, 83.7%, 26.0%, and 19.6%, respectively. The combination of DLAS with 0.5-mm lead and lead curtain could increase dose reductions to 96.0%, 95.8%, 93.8%, 71.1%, and 47.1%, respectively. CONCLUSIONS: DLAS reduces stray radiation at 120-, 140-, and 160-cm heights, where the conventional lead curtain provides insufficient protection.

Association of gene mutations with clinicopathologic features in patients with external auditory canal squamous cell carcinoma.

BACKGROUND: External auditory canal squamous cell carcinoma (EACSCC) is a rare form of malignant tumor. Due to the extremely limited understanding of the genomic landscape in EACSCC, the association between gene mutations and clinicopathologic features remains unclear. This study aimed to explore somatic gene mutations associated with the clinicopathological features in patients with EACSCC, and to identify the candidate gene mutations for predicting survival outcome in EACSCC. METHODS: Twenty-two tissue samples obtained from patients with EACSCC were analyzed for genetic mutations based on targeted next-generation sequencing and genetic expression based on IHC staining to investigate the driver of tumorigenesis and/or the candidates of genes for predicting clinical outcome in EACSCC. RESULTS: Gene alterations were most frequently observed in TP53 (59.1%), followed by CREBBP (9.1%). TP53 mutations showed significant correlation with T classification (P = 0.027) and p53 expression phenotype (P < 0.001). The 5-year overall survival (OS) rates for EACSCC patients with TP53 mutations and wild-type TP53 were 45.0% and 75.0%, respectively. Multivariable analysis using the Cox proportional hazards model demonstrated that TP53 mutations were independent predictors of OS rates for EACSCC patients (P = 0.007). CONCLUSION: This study has suggested that TP53 mutations have potential for use as a biomarker for identifying individuals at high risk of developing tumors and for predicting survival outcome in EACSCC. IHC staining for p53 might play a useful role as screening tool for detecting TP53 mutations in patients with EACSCC.

Synthesis of Carbon Nanoparticles with Cobalt-Rich Shell via Pyrolysis of Zn-ZIF@Co/Zn-ZIF: Relevance of Co(III) Precursors.

To the best of our knowledge, this is the first report on the rapid one-pot synthesis of a unique core-shell-structured zeolitic imidazolate framework (ZIF) using Co(III) and Zn(II) precursors. The key to obtaining this unique structure is the use of a Co(III) precursor as the starting material. Transmission electron microscopy (TEM) reveals that Co was present within a 30-nm-thick shell layer of the ZIF material. Thermal decomposition of the ZIF material affords core-shell-structured carbon nanoparticles that have Co on the external surface of the carbon grain. We have previously demonstrated that this carbonaceous material obtained by thermal decomposition exhibited high performance as an adsorbent for nitric oxide, even in the presence of excess oxygen and water vapor, and therefore, it was a suitable material for NOx elimination at low temperatures. The growth mechanism of the synthesized ZIF particles and the differences between synthesized ZIF and conventional Co(II)-ZIF-67 are discussed. The reactivity of the Co(III) precursor is much lower than that of the Co(II) species, leading to slower precipitation of Co(III) than that of Zn(II), thus forming the core-shell structure.

Immediate Prostate-specific Antigen Decline After Enzalutamide Following Abiraterone Predicts Survival in Castration-resistant Disease.

BACKGROUND/AIM: Although the sequential use of abiraterone and enzalutamide is not recommended because of possible cross-resistance, many patients with metastatic castration-resistant prostate cancer (mCRPC) are receiving sequential abiraterone and enzalutamide in the real world, and a subset of patients can benefit from sequential therapy with these drugs. This study aimed to identify patients who could benefit from the sequential use of enzalutamide after abiraterone use. PATIENTS AND METHODS: We included 70 patients with mCRPC who received enzalutamide sequentially following abiraterone treatment. Decline in the prostatespecific antigen (PSA) levels at 4 weeks after enzalutamide initiation and the association between decline in PSA levels and survival were analyzed. RESULTS: Sixteen men (22.9%) achieved a decline of >50% in PSA levels after 4 weeks of enzalutamide administration. Overall survival (OS) after enzalutamide among men with >50% decline at 4 weeks was significantly better than that among men with a PSA decline <50% (not reached vs. 34 months, p=0.008). OS after first-line abiraterone treatment for men with PSA decline >50% and <50% was not reached and 46 months, respectively (p=0.007). A PSA decline of >50% at 4 weeks of enzalutamide administration was an independent predictor of longer OS. CONCLUSION: A PSA decline of >50% at 4 weeks after the start of sequential enzalutamide treatment following abiraterone treatment predicted long-term survival in patients with mCRPC. Early PSA decline can identify patients who benefit from second-line enzalutamide after abiraterone treatment and can be useful as a decision-making tool regarding treatment.

Evaluation of Semicircular Canal Function by Video Head Impulse Test in Patients With Labyrinthine Fistula Due to Cholesteatoma.

OBJECTIVES: To evaluate semicircular canal function in patients with labyrinthine fistula (LF) due to cholesteatoma by the video Head Impulse Test (vHIT). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Ten patients with LF due to cholesteatoma and six without LF underwent vestibular examination. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: The gain in vestibulo-ocular reflex (VOR) and the presence of catch-up saccade were examined for the semicircular canals in patients with LF. RESULTS: Seven of 10 cases (70.0%) in the fistula group were judged to have semicircular canal dysfunction based on preoperative evaluation. VOR gains in the patients with LF were significantly lower than those in the patients without LF. VOR gain decreased significantly in accordance with the severity of the LF. The postoperative VOR gain more than 6 months after surgery was significantly improved compared with the preoperative VOR gain. CONCLUSIONS: The vHIT is thought to be the most suitable method for evaluating semicircular canal function in patients with LF due to cholesteatoma as it is not influenced by middle ear pathology and can evaluate the function of the vertical canals. The vHIT could predict whether a LF is present or not before surgery, and the vHIT is essential for surgery for patients with LF.

Psychological evaluation for patients with non-cured facial nerve palsy.

OBJECTIVE: The aim of the present study was to evaluate the psychological condition of patients with non-cured facial nerve palsy and to investigate whether their psychological condition is correlated with the degree of facial nerve palsy, synkinesis or quality of life. METHODS: Thirty patients with non-cured facial nerve palsy were enrolled in this study. Psychological conditions were evaluated by questionnaires including State-Trait Anxiety Inventory and Self-rating Depression Scale. RESULTS: Of the thirty patients with non-cured facial nerve palsy, 17 (56.7%) and 15 patients (50.0%) felt anxiety and depression, respectively. Although there were no significant correlations between their psychological condition and the degree of facial nerve palsy or that of sequelae, significant correlations were observed between psychological condition and the degree of QOL, especially in terms of social function. CONCLUSIONS AND SIGNIFICANCE: Disabilities associated with facial nerve palsy may be overlooked when evaluation is performed by physician-graded instruments alone. To resolve this problem, patients with non-cured facial nerve palsy should be evaluated by not only physician-graded tools but also patient-based assessment tools.

The Quantification of Extracellular Trap Cell Death-Derived Products as Diagnostic Biomarkers for Otitis Media With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and Eosinophilic Otitis Media.

OBJECTIVE: This study aimed to quantify the cell-free deoxyribonucleic acid (DNA), citrullinated-histone H3 (cit-H3)-DNA complex, and myeloperoxidase (MPO)-DNA complex as extracellular trap cell death (ETosis)-derived products in the middle ear fluid, and to identify diagnostic biomarkers for the discrimination of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) from eosinophilic otitis media (EOM). STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: OMAAV patients were eligible for inclusion in this analysis. Patients with EOM were examined as controls. INTERVENTION: All samples were obtained from the middle ear fluid in patients with OMAAV or EOM. The fluid samples were aspirated from the middle ear through the anterior-inferior portion of the tympanic membrane using a 1-ml tuberculin syringe with a 24- or 26-gauge needle under a microscope. MAIN OUTCOME MEASURES: The levels of cell-free DNA, cit-H3-DNA complex and MPO-DNA complex in the fluid samples were quantified using an enzyme-linked immunosorbent assay. RESULTS: Patients with OMAAV showed significantly higher levels of MPO-DNA complex compared to patients with EOM, regardless of the serum ANCA status at the time of sampling (p < 0.001 and p < 0.001, respectively). Meanwhile, there were no significant differences in the values of cell-free DNA or cit-H3-DNA complex between the OMAAV and EOM patients. CONCLUSION: The findings of this study suggest that the detection and quantification of MPO-DNA complex in the otitis media fluid can be utilized to discriminate OMAAV, especially in cases of eosinophilic granulomatosis with polyangiitis, from EOM regardless of the serum ANCA status. It should be noted that it is possible for cell-free DNA and cit-H3-DNA complex in fluid samples to be derived from dead cells other than neutrophils that undergo ETosis.