Combining Serum Procalcitonin Level, Thromboelastography, and Platelet Count to Predict Short-term Development of Septic Shock in Intensive Care Unit.

OBJECTIVE: Despite the recent advances in diagnosis and treatment, sepsis continues to lead to high morbidity and mortality. Early diagnosis and prompt treatment are essential to save lives. However, most biomarkers can only help to diagnose sepsis, but cannot predict the development of septic shock in high-risk patients. The present study determined whether the combined measurement of procalcitonin (PCT), thromboelastography (TEG) and platelet (PLT) count can predict the development of septic shock. METHODS: A retrospective study was conducted on 175 septic patients who were admitted to the intensive care unit between January 2017 and February 2021. These patients were divided into two groups: 73 patients who developed septic shock were assigned to the septic shock group, while the remaining 102 patients were assigned to the sepsis group. Then, the demographic, clinical and laboratory data were recorded, and the predictive values of PCT, TEG and PLT count for the development of septic shock were analyzed. RESULTS: Compared to the sepsis group, the septic shock group had statistically lower PLT count and TEG measurements in the R value, K value, α angle, maximum amplitude, and coagulation index, but had longer prothrombin time (DT), longer activated partial thromboplastin time (APTT), and higher PCT levels. Furthermore, the Sequential Organ Failure Assessment (SOFA) score was higher in the septic shock group. The multivariate logistic regression analysis revealed that PCT, TEG and PLT count were associated with the development of septic shock. The area under the curve analysis revealed that the combined measurement of PCT, TEG and PLT count can be used to predict the development of septic shock with higher accuracy, when compared to individual measurements. CONCLUSION: The combined measurement of PCT, TEG and PLT count is a novel approach to predict the development of septic shock in high-risk patients.

Early detection of noise-induced hearing loss.

BACKGROUND: Noise-induced hearing loss (NIHL) is the second most common acquired hearing loss following presbycusis. Exposure to recreational noise and minimal use of hearing protection increase the prevalence of NIHL in young females. NIHL is irreversible. Identifying minor hearing pathologies before they progress to hearing problems that affect daily life is crucial. AIM: To compare the advantages and disadvantages of extended high frequency (EHF) and otoacoustic emission and determine an indicator of hearing pathologies at the early sub-clinical stage. METHODS: This cross-sectional study was implemented in West China Hospital of Sichuan University from May to September 2019. A total of 86 participants, aged 18-22 years, were recruited to establish normative thresholds for EHF. Another 159 adults, aged 18-25 years with normal hearing (0.25-8 kHz ≤ 25 dBHL), were allocated to low noise and noise exposure groups. Distortion otoacoustic emission (DPOAE), transient evoked otoacoustic emissions (TEOAE), and EHF were assessed in the two groups to determine the superior technique for detecting early-stage noise-induced pathologies. The chi-square test was used to assess the noise and low noise exposure groups with respect to extended high-frequency audiometry (EHFA), DPOAE, and TEOAE. P ≤ 0.05 was considered statistically significant. RESULTS: A total of 86 participants (66 females and 20 males) aged between 18 and 22 (average: 20.58 ± 1.13) years were recruited to establish normative thresholds for EHF. The normative thresholds for 9, 10, 11.2, 12.5, 14, 16, 18, and 20 kHz were 15, 10, 20, 15, 15, 20, 28, and 0 dBHL, respectively. A total of 201 participants were recruited and examined for eligibility. Among them, 159 adults aged between 18 and 25 years were eligible in this study. No statistical difference was detected between the noise exposure and the low noise exposure groups using EHFA, DPOAE, and TEOAE (P > 0.05) except in the right ear at 4 kHz using TEOAE (abnormal rate 20.4% vs 5.2%, respectively; P = 0.05). CONCLUSION: These results showed TEOAE as the earliest indicator of minor pathology compared to DPOAE and EHFA. However, a multicenter controlled study or prospective study is essential to verify these results.

Outcome assessment alternatives for young children during the first 12 months after pediatric hearing-aid fittings.

OBJECTIVE: Perform longitudinal evaluations of young children during the first 12 months after initial hearing-aid fitting. Document evidence of early prelingual auditory development (EPLAD), identify factors that affect EPLAD, and define performance milestones that can guide best practices. DESIGN: Unblinded, prospective, within-subject, repeated-measures design. Audiological measures and measures of EPLAD were taken at baseline, 3, 6, and 12 months after hearing-aid fitting. STUDY SAMPLE: Subjects were 45 pediatric patients initially fitted with hearing aids between 1 and 5.5 years of age. Four groups were formed for analysis purposes based on severity of hearing loss (moderate-to-severe and profound) and initial fitting age (≤ 30 months and > 30 months). RESULTS: All groups exhibited statistically significant increases in EPLAD within six months of hearing-aid fitting, and those with profound losses exhibited further statistically significant improvement between six and 12 months. Similar EPLAD levels were reached at 12 months regardless of severity of hearing loss. The EPLAD trajectory is similar to that following early cochlear implantation. CONCLUSIONS: Measures of EPLAD provide a means of evaluating outcomes following early pediatric hearing-aid intervention, supplementing behavioral audiological measures.

Development of the Mandarin early speech perception test: children with normal hearing and the effects of dialect exposure.

OBJECTIVES: The first objective of this study was to create a recorded Mandarin Early Speech Perception (MESP) test based on the English Early Speech Perception test (), a closed-set assessment tool for evaluation of early speech perception abilities in children. The second objective was to determine whether each of the MESP subtests is appropriate for children with these abilities. The third objective was to examine the effects of early exposure to and use of Putonghua (Standard Mandarin), as used for the recordings, on performance for each subtest. DESIGN: MESP test items were developed by sampling approximately 200 picturable words, twice the number required for the test, from Chinese children's books. A sample (N = 17) of 2.0- to 5.0-yr-old developmentally normal children identified the words from pictures and then recognized the words when tested with live voice by pointing to the pictures. Only words that were accurately identified and recognized by children of all ages were selected. An additional sample (N = 92) of 2.0- to 5.0-yr-old developmentally normal children was tested with the subtests of the MESP. Information about each child's daily Putonghua exposure and use was used to separate the sample into two groups. Subtest scores for the two groups were compared to examine the effects of early dialect exposure on performance. RESULTS: Fewer than 2% of the words used in the six subtests of the MESP were incorrectly named and recognized. Each subtest measures a different category of early speech perception. The categories are hierarchically structured. Categories 1, 2, and 3, Speech Sound Detection, Speech Pattern Perception, and Spondee Recognition, parallel the ESP. Categories 4, 5, and 6 of the MESP, Vowel Perception, Consonant Perception, and Tone Perception, are more difficult tests that provide information about segmental and tonal cues for Mandarin speech perception. All children in all age groups reached all MESP categories successfully, with the exception of three children in the youngest age group for the Tone Perception test. The two oldest groups of children who were not exposed primarily to Putonghua had slightly lower scores on both the Consonant and Tone Perception tests than children who were primarily exposed to Putonghua. These results suggest that development of tone perception continues beyond the MESP age range. Nonetheless, children as young as 2 yr of age could be tested on all of the MESP subtests. CONCLUSIONS: The development of the MESP has produced a recorded objective test for the evaluation of early speech perception in Mandarin-speaking children using a standardized protocol. The hierarchical structure of the first three MESP categories parallels that of the ESP, while restricting the occurrence of some tones. Additional MESP categories allow control and variation of Mandarin segmental and tonal contrasts. The MESP is part of a Mandarin hierarchical test battery for assessment of speech perception in young children.