High Cardio-Ankle Vascular Index Values in Idiopathic Sudden Sensorineural Hearing Loss Patients Indicate Better Prognosis.

OBJECTIVE: Vascular disorders and viral infections are the presumed etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) and acute sensorineural hearing loss, with no identifiable cause. However, no clinical test for estimating the extent of vascular involvement in ISSNHL has been reported despite its potential impact on prognosis and treatment. We investigated the correlation between the cardio-ankle vascular index (CAVI), which reflects arterial stiffness and elasticity, and hearing improvement to ascertain its usefulness as an additional indicator of ISSNHL prognosis and etiology. METHODS: We enrolled 182 patients diagnosed with definite ISSNHL. The percentage of mild ISSNHL patients and that of patients experiencing no change were compared between the high-CAVI and low-CAVI groups. Age, initial and final pure-tone average (PTA) values, CAVI, presence or absence of vertigo, and medical histories were retrospectively reviewed and included in univariate and multivariate analyses. RESULTS: The percentage of mild ISSNHL patients was smaller in the high-CAVI group than in the low-CAVI group, whereas the percentage of patients experiencing no change was smaller in the high-CAVI group than in the low-CAVI group, although patients in the high-CAVI group were significantly older than those in the low-CAVI group. The Cox proportional hazard model revealed that high CAVI, hypertension, younger age, and initial PTA <90 dB were associated with hearing improvement. CONCLUSIONS: ISSNHL in patients with high CAVI was more severe but had a better prognosis than that in those with low CAVI. CAVI may help evaluate diseases of vascular and other etiologies, as well as ISSNHL.

Synthesis of multisubstituted cycloalkenes through carbomagnesiation of strained cycloalkynes.

An efficient synthetic method of seven- and six-membered cycloalkenes through the generation of strained cycloalkynes and following carbomagnesiation is described. Further bond formations of the resulting cycloalkenylmagnesium intermediates with a wide variety of electrophiles enabled us to prepare diverse cycloalkene derivatives including benzoxepine analogs having a fully substituted alkene structure.

Interfacial Hydrolysis of Acetals on Protonated TEMPO-oxidized Cellulose Nanofibers.

2,2,6,6-Tetramethylpiperidine-1-oxyl (TEMPO)-oxidized cellulose nanofibers (TOCNs), which have a high-density of exposed carboxylic acid groups on their crystalline surfaces, effectively act as acid catalysts in acetal hydrolysis. Carboxy-free cellulose nanofibers, polymeric carboxylic acids, and homogeneous acetic acid do not show significant catalytic activity under the same reaction conditions. Mercerized TOCNs differing from the original TOCNs in a crystalline structure were also ineffective, which suggests that the unique nanoarchitectural features of TOCNs, such as regularly aligned carboxylic acid groups, large specific surface areas, and structural rigidity, must be major factors in the acceleration of acetal hydrolysis. Kinetic analysis suggested that substrates and/or acid catalyst species were concentrated on the TOCN crystalline surfaces, which significantly enhanced the catalytic activity.

Dominant foot could affect the postural control in vestibular neuritis perceived by dynamic body balance.

During attacks of vestibular neuritis (VN), patients typically lose postural balance, with resultant postural inclination, gait deviation toward the lesion side, and tendency to fall. In this study, we examined and analyzed static and dynamic postural control during attacks of VN to characterize differences in postural control between right and left VN. Subjects were patients diagnosed with VN at the Department of Otolaryngology, Toho University Sakura Medical Center, and underwent in-patient treatment. Twenty-five patients who had spontaneous nystagmus were assessed within 3days after the onset; all were right-foot dominant. Right VN was detected in nine patients (men: 4, women: 5; mean age: 57.6±17.08years [range: 23-82]) and left VN in 16 patients (men: 10, women: 6; mean age: 58.4±14.08years [range: 23-85 years]); the percentages of canal paresis of right and left VN were 86.88±18.1% and 86.02±15.0%, respectively. Statistical comparisons were conducted using the independent t-test. In stabilometry, with eyes opened, no significant differences were found between patients with right and left VN. However, with eyes closed, the center of horizontal movement significantly shifted ipsilateral (p<0.01). The differences in the lateral and anteroposterior body tracking test (BTT) were statistically significant (p=0.0039 and p=0.0376, respectively), with greater changes in cases with right VN. Thus, the dominant foot might contribute to the postural control mechanism.

[Tracking axis of the body tracking test(BTT)].

We report herein on the use of the body tracking test (BTT), which is a method for quantitatively evaluating dynamic body balancing function, and how the body center moves during tracking by healthy subjects. We investigated 779 healthy subjects with no history of vertigo or balance disorder and a mean age of 37.9 years. Breakdown is as follows. Under 10 years old is 81 (37 boy and 44 girl), 10 years of age is 162 (73 boy and 89 girl), 20 years of age is 110 (43 men and 67 women), 30 years of age is 73 (44 male, 29 female), 40 years of age is 79 (49 men and 30 women), 50 years of age is 77 (40 men and 37 women), 60 years of age is 100 (53 men and 47 women), 70 years of age is 73 (27 men and 46 women), 80 years of age is 24 (15 men and 9 women). For the visual stimulus, we used a constant-speed antero-posterior (A-P) stimulus BTT and a constant-speed lateral BTT. BTT analysis involved principal axis analysis, in which the principal axis was the first principal component according to a principal component analysis technique. The axis tilt in the principal axis direction was assessed by calculating the coordinate Y-axis and X-axis tilt. In the anteroposterior (A-P) BTT, subjects of all ages exhibited an angle of tilt in the clockwise direction (the "plus" direction), together with the position vector and velocity vector. In the lateral BTT, we observed that the subjects tracked with a tilt in the counter-clockwise direction (the "minus" direction), together with the position vector and velocity vector. In terms of the subjects' ages, the angle of tilt from 0 degree in the antero-posterior (A-P) BTT showed the clockwise direction (the "plus" direction). In the lateral BTT, subjects 10 to 30 years of age exhibited tracking along the X-axis, with no observable tilt. Movement of the center of gravity may be a major acquired ability (practice) with respect to the direction of tilt of the tracking axis. Spatial sensory ability primarily involves the right parietal lobe of the brain, and somatosensory information from the left side of the body is believed to be used more for the positional relationships between the legs and the torso. Deviation of the principal axis appears to be related to the relationship between the dominant foot and the pivot foot, as well as to the functions of the parietal lobe that are involved in spatial sensing.

[Non-specific exercise therapy for benign paroxysmal postural vertigo].

We treated 1145 patients diagnosed as having benign paroxysmal postural vertigo at the Toho University Medical Center Sakura Hospital from August 2007 to July 2009 by the exercise therapy developed by us. The most advantageous characteristic of our method is that patients can perform the exercises themselves at their own pace in their homes, even if the affected side cannot be identified and/or the patients have any orthopedic cervical and/or spinal problems. In 80.7% and 91.7% of the patients in our case series, the vertigo was no longer present at one and three months, respectively. In addition, the vertigo disappeared within two weeks in the patients who were examined within one week of the start of the symptom. The longer the period between the onset of vertigo and the hospital visit, the longer the period needed for control of the symptom.