Endolymphatic Hydrops in Fluctuating Hearing Loss and Recurrent Vertigo.

Background: Endolymphatic hydrops (EH) is the histopathological hallmark of Ménière's disease (MD) and has been found by in vivo magnetic resonance imaging (MRI) in patients with several inner ear syndromes without definite MD criteria. The incidence and relevance of this finding is under debate. Purpose: The purpose of the study is to evaluate the prevalence and characteristics of EH and audiovestibular test results in groups of patients with fluctuating audiovestibular symptoms not fulfilling the actual criteria for definite MD and compare them with a similar group of patients with definite MD and a group of patients with recent idiopathic sudden neurosensory hearing loss (ISSNHL). Material and Methods: 170 patients were included, 83 with definite MD, 38 with fluctuating sensorineural hearing loss, 34 with recurrent vertigo, and 15 with ISSNHL. The clinical variables, audiovestibular tests, and EH were evaluated and compared. Logistic proportional hazard models were used to obtain the odds ratio for hydrops development, including a multivariable adjusted model for potential confounders. Results: No statistical differences between groups were found regarding disease duration, episodes, Tumarkin spells, migraine, vascular risk factors, or vestibular tests; only hearing loss showed differences. Regarding EH, we found significant differences between groups, with odds ratio (OR) for EH presence in definite MD group vs. all other patients of 11.43 (4.5-29.02; p < 0.001). If the ISSNHL group was used as reference, OR was 55.2 (11.9-253.9; p < 0.001) for the definite MD group, 9.9 (2.1-38.9; p = 0.003) for the recurrent vertigo group, and 5.1 (1.2-21.7; p = 0.03) for the group with fluctuating sensorineural hearing loss. Conclusion: The percentage of patients with EH varies between groups. It is minimal in the ISSNHL group and increases in groups with increasing fluctuating audiovestibular symptoms, with a rate of severe EH similar to the known rate of progression to definite MD in those groups, suggesting that presence of EH by MRI could be related to the risk of progression to definite MD. Thus, EH imaging in these patients is recommended.

Endolymphatic hydrops severity in magnetic resonance imaging evidences disparate vestibular test results.

OBJECTIVES: It has been suggested that in Ménière's disease (MD) a dissociated result in the caloric test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this study is that based on endolymphatic hydrops' cochleocentric progression, hydrops should also be more severe in the vestibule of these patients than in those for whom both tests are normal. METHODS: 22 consecutive patients with unilateral definite MD were included and classified as NN if both tests were normal or AN if the caloric test was abnormal. MRI evaluation of endolymphatic hydrops was carried out with a T2-FLAIR sequence performed 4h after intravenous gadolinium administration. The laterality and degree of vestibular endolymphatic hydrops and the presence or absence of cochlear endolymphatic hydrops were recorded. Demographic data, audiometric and vestibular evoked myogenic potentials were collected, and video head-impulse and caloric tests were performed. RESULTS: Patients in both groups (NN and AN) were similar in terms of demographic data and hearing loss. The interaural asymmetry ratio was significantly higher for ocular and cervical VEMP in patients in the AN group. There was a significantly higher degree of hydrops in the vestibule of the affected ear of AN patients (χ2; p=0.028). CONCLUSION: Significant canal paresis in the caloric test is associated with more severe endolymphatic hydrops in the vestibule as detected with gadolinium-enhanced MRI and with a more severe vestibular deficit. LEVEL OF EVIDENCE: 2a.

Normative data for static balance testing in healthy individuals using open source computerized posturography.

PURPOSE: Computerized posturography is the gold standard for balance assessment. Because of the great cost and dimensions of commercial equipments, low-cost and portable devices have been developed and validated, such as RombergLab, a software in open source term which works connected with a low-cost force platform. The objective of this study was to obtain normative posturography data using this software. METHODS: A multicentric prospective and descriptive study, with 350 healthy participants, was designed. Static postural stability (measured using the modified clinical test of sensory interaction on balance) was evaluated using the software connected to the force platform. Using the confidence ellipse area (CEA) in each condition, global equilibrium score (GES) was calculated and adjusted for significant variable factors using cluster analysis. RESULTS: Mean (SD) GES was 0.72 (0.22). Age (p < 0.01), height (p < 0.01) and recruitment center (p < 0.05) were found as influence factors for GES. Cluster analysis obtained 16 groups stratified by age and height. GES decreases with age and height (p < 0.005). No significant interaction of age nor height was found with GES in these clusters (p > 0.05). After correction for height and age, GES was no longer influenced by the recruitment center (p > 0.05). CONCLUSIONS: With the introduction of the global equilibrium score values of the present study into the software, we consider RombergLab v1.3 a reference posturography tool for healthy individuals. Further studies are needed for validating it as a suitable instrumented test for screening between healthy and pathologic subjects and its reliability over time for the follow-up of patients.

Erratum: Thoracoscopic Patch Repair of Congenital Diaphragmatic Hernia in a Neonate Using Spiral Tacks: A Case Report.

[This corrects the article on p. 31 in vol. 4, PMID: 26290813.].

Thoracoscopic Patch Repair of Congenital Diaphragmatic Hernia in a Neonate using Spiral Tacks: A Case Report.

We present a case of congenital diaphragmatic hernia that was successfully treated with spi-ral tacks using thoracoscopy. A newborn female was diagnosed with a diaphragmatic hernia at 20 weeks of gestation. The defect was surgically repaired by thoracoscopy and primary closure. On postoperative day 25, she developed respiratory distress. Chest x-ray showed a recurrence and was taken to the OR for surgical repair with spiral tacks.

Immediate acoustic effects of straw phonation exercises in subjects with dysphonic voices.

Abstract This study sought to measure any acoustic changes in the speaking voice immediately after phonation exercises involving plastic straws versus phonation exercises with the open vowel /a/. Forty-one primary school teachers with slightly dysphonic voices were asked to participate in four phonatory tasks. Phonetically balanced text at habitual intensity level and speaking fundamental frequency was recorded. Acoustical analysis with long-term average spectrum was performed. Significant changes after therapy for the experimental group include the alpha ratio, L1-L0 ratio and ratio between 1-5 kHz and 5-8 kHz. The results indicate that the use of phonatory tasks with straw exercises can have immediate therapeutic acoustic effects in dysphonic voices. Long-term effects were not assessed in this study.

4-Methylthioamphetamine increases dopamine in the rat striatum and has rewarding effects in vivo.

4-Methylthioamphetamine (MTA) is a phenylisopropylamine derivative whose use has been associated with severe intoxications. MTA is usually regarded as a selective serotonin-releasing agent. Nevertheless, previous data have suggested that its mechanism of action probably involves a catecholaminergic component. As little is known about dopaminergic effects of this drug, in this work the actions of MTA upon the dopamine (DA) transporter (DAT) were studied in vitro, in vivo and in silico. Also, the possible abuse liability of MTA was behaviourally assessed. MTA exhibited an in vitro affinity for the rat DAT in the low micromolar range (6.01 µM) and induced a significant, dose-dependent increase in striatal DA. MTA significantly increased c-Fos-positive cells in striatum and nucleus accumbens, induced conditioned place preference and increased locomotor activity. Docking experiments were performed in a homology model of the DAT. In conclusion, our results show that MTA is able to increase extracellular striatal DA levels and that its administration has rewarding properties. These effects were observed at concentrations or doses that can be relevant to its use in human beings.

Efectos acústicos inmediatos de una secuencia de ejercicios vocales con tubos de resonancia / Immediate effects of a vocal exercise sequence with resonance tubes

OBJETIVO: el propósito de este estudio es conocer el efecto acústico inmediato de una secuencia de ejercicios fonatorios utilizando tubos de resonancia en un grupo de sujetos disfónicos. MÉTODO: se aplicó una secuencia única de cuatro tareas fonatorias dentro de tubos de resonancia a veinticuatro profesores con voces disfónicas, evaluadas perceptualmente con la escala GRBAS. Las muestras de voz fueron grabadas antes y después de la secuencia de ejercicios. El análisis acústico incluyó Cepstrum, Jitter, Shimmer y relación armónico-ruido (NHR). Se solitó completar un protocolo de autovaloración vocal posterior a la secuencia de ejercicios para evaluar los efectos subjetivos. Se compararon los valores de los parámetros acústicos en las muestras pre y post entrenamiento. RESULTADOS: cambios significativos fueron obtenidos en el análisis Cepstral, Jitter y relación armónico-ruido. En la autovaloración, los efectos positivos predominaron sobre los negativos, siendo los principales: voz más estable, voz más clara y garganta más abierta. CONCLUSIÓN: el uso de tareas fonatorias dentro de tubos de resonancia puede tener un efecto fisiológico terapéutico inmediato en sujetos con voces disfónicas y una percepción subjetiva de mejoría en la producción de la voz posterior a la terapia.

PURPOSE: the purpose of this study is to determine the immediately acoustic effect of phonatory exercise sequence using resonance tubes in a group of dysphonic subjects METHOD: a unique sequence of four phonatory tasks within resonance tubes was applied in twenty-four teachers with dysphonic voices, assessed perceptually with GRBAS scale. Voice samples were recorded before and after the exercise sequence. Acoustic analysis included the following items: Cepstrum, Jitter, Shimmer, noise-harmonic ratio (NHR). Subjects were asked to fill out a vocal self-assessment protocol after the exercise sequence in order to assess the subjective effects of these exercises. Acoustic parameters of voice samples pre and post training were compared. RESULTS: significant changes were obtained in the Cepstral analysis, jitter and harmonic-to-noise ratio. In the self-assessment, positive effects prevailed over the negative ones, being the main, as follows: more steady voice, more clear voice and more open throat sensation. CONCLUSION: the outcome indicates that the use of phonatory tasks with resonance tubes may have immediate therapeutic physiological effects on subjects with hoarse voices and a subjective perception of improvement in voice production after the therapy.

Influence of protonation on substrate and inhibitor interactions at the active site of human monoamine oxidase-A.

Although substrate conversion mediated by human monoaminooxidase (hMAO) has been associated with the deprotonated state of their amine moiety, data regarding the influence of protonation on substrate binding at the active site are scarce. Thus, in order to assess protonation influence, steered molecular dynamics (SMD) runs were carried out. These simulations revealed that the protonated form of the substrate serotonin (5-HT) exhibited stronger interactions at the protein surface compared to the neutral form. The latter displayed stronger interactions in the active site cavity. These observations support the possible role of the deprotonated form in substrate conversion. Multigrid docking studies carried out to rationalize the role of 5-HT protonation in other sites besides the active site indicated two energetically favored docking sites for the protonated form of 5-HT on the enzyme surface. These sites seem to be interconnected with the substrate/inhibitor cavity, as revealed by the tunnels observed by means of CAVER program. pK(a) calculations in the surface loci pointed to Glu³²7, Asp³²8, His488, and Asp¹³² as candidates for a possible in situ deprotonation step. Docking analysis of a group of inhibitors (structurally related to substrates) showed further interactions with the same two docking access sites. Interestingly, the protonated/deprotonated amine moiety of almost all compounds attained different docking poses in the active site, none of them oriented to the flavin moiety, thus producing a more variable and less productive orientations to act as substrates. Our results highlight the role of deprotonation in facilitating substrate conversion and also might reflect the necessity of inhibitor molecules to adopt specific orientations to achieve enzyme inhibition.

Frequency of S and Z alleles for alpha-1-antitrypsin and tumor necrosis factor alpha -308 promoter polymorphism in northeastern Mexico.

Diseases characterized by airway inflammation, excessive secretion, and obstruction affect a substantial proportion of the population. Studies for understanding the mechanisms underlying these processes are focused on the initiation and maintenance of inflammation. Polymorphisms on DNA sequence of response mediators such as alpha-1-antitrypsin (AAT) and tumor necrosis factor (TNF) alpha have the capacity to influence presentation of diseases, affecting protein amount and/or functionality, and can be analyzed as disease modulators. The purpose of this study was to analyze AAT S and Z alleles and -308G/A TNF-alpha polymorphism on the northeast Mexico mestizo population to compare the influence of these genes in several diseases. DNA samples from 103 volunteers (healthy group) were tested for modifier gene variants by polymerase chain reaction-RFLP as follows: AAT gene for S and Z alleles and TNF-alpha promoter -308G/A (TNF1/TNF2) alleles. Allele frequency for S and TNF2 alleles were 1.5 and 2.4%, respectively, whereas the Z allele was not detected. This study shows low frequencies of the AAT S and TNF2 alleles, and the Z allele was not found. Correlation studies in the future will allow to determine if these alleles have some influence in the clinical presentation of diverse diseases in this group of people.

Variación de los fosfolípidos, colesterol y triglicéridos en el suero con el uso de surfactante en neonatos con enfermedad de membrana hialina / Variations in phospholipids, cholesterol and triglycerids with exogen surfactant application in neonates with hialine membrane disease

El objetivo de este estudio prospectivo fue analizar las variaciones séricas de los lípidos y su repercusión al aplicar surfactante endotraqueal. Se formaron dos grupos, el A de neonatos a los cuales se les puso surfactante natural de extracto de pulmón de bovino y el grupo B al cual se les puso solución fisiológica. Los criterios de inclusión para ambos grupos fueron: ser menores de 37 semanas, diagnóstico de enfermedad de membrana hialina, necesidad de ventilación mecánica. A los dos grupos se les determinó fosfolípidos, colesterol y triglicéridos séricos antes (basales) y 24 horas después de aplicado el surfactante y la solución fisiológica (controles). Al conformar el grupo A vs el B los resultados obtenidos fueron: no encontramos diferencia estadística en cuanto a peso (1340 ñ 341 vs 1320 ñ 377) y edad gestacional (34 ñ 2.3 vs 34.6 ñ 1.8), tampoco en sexo, vía de nacimiento, Apgar y trofismo. Al comparar los valores controles de ambos grupos encontramos un aumento en el grupo A para fosfolípidos y colesterol (P<0.01). Al confrontar los valores basales vs controles encontramos aumento en el grupo A para fosfolípidos y colesterol (P<0.001), en el grupo B hubo una disminución en el colesterol (P<0.05). Concluimos que el uso de surfactante natural de extracto de pulmón de bovino, produce un aumento de los fosfolípidos y colesterol en sangre, sin repercusión hemodinámica