Initial clinical experience imaging scatterer size and strain in thyroid nodules.

OBJECTIVE: This article describes a new research ultrasound scanner that can be programmed to produce elastograms and backscatter parametric images in real time. Its performance was evaluated in a clinical setting. METHODS: Radio frequency data were acquired from 13 patients with thyroid nodules and from 4 normal thyroids, along with reference phantom data. Scatterer size was deduced by measuring the backscatter versus frequency and fitting data to a model. Strain was obtained by a cross-correlation method, comparing precompression and postcompression radio frequency signals. Scatterer size contrast was defined as the observed contrast between the "normal" and "abnormal" tissue in the same gland or, when considering diffuse conditions, by comparing with normal values. Strain contrast was estimated if abnormal and normal tissue was captured in the same palpation, that is, excluding diffuse disease, which was the case for 9 subjects. RESULTS: On scatterer size images, 4 nodules exhibited positive contrast versus the adjacent normal parenchyma, indicating larger scatterers. Five nodules were isoechoic, and 4 had negative contrast. Four nodules exhibited positive strain contrast, indicating that they were softer than the normal parenchyma. Two nodules had the same brightness, and 3 were darker than the background thyroid tissue on strain images. CONCLUSIONS: Contrast was observed between nodules and thyroid parenchymal tissue for both types of parametric images. Further work is needed to determine whether the diagnostic importance of these parameters in characterizing thyroid nodules might be worthwhile. Both modes must be of a sufficient frame rate to provide real-time feedback to operators, which will require further work.     

NF-kappaB mediated glucocorticoid response in the inner ear after acoustic trauma

The inner ear of humans and experimental animals demonstrate an abundance of glucocorticoid receptors (GR). Glucocorticoids (GC) are widely used to treat different hearing disorders; yet the mechanisms of GC action on the inner ear are unknown. We demonstrate how GR can directly modulate hearing sensitivity in response to a moderate acoustic trauma that results in a hearing loss (10-30 dB). The GC agonist (dexamethasone) and the drugs (metyrapone + RU 486) showed opposing effects on hearing threshold shifts. GC agonist (dexamethasone) decreased the hearing threshold whereas pre-treatment with a GC synthesis inhibitor (metyrapone) in combination with a GR antagonist (RU 486) exacerbated auditory threshold shifts (25-60 dB) after acoustic trauma with statistically significant increase in GR mRNA and GR protein compared with the vehicle and acoustic trauma group. Acoustic trauma caused a significant increase in the nuclear transport of NF-kappaB, whereas pre-treatment with the drugs (metyrapone and RU 486) blocked NF-kappaB nuclear transport into spiral ganglion nuclei. An NF-kappaB inhibitor, pyrrolidine dithiocarbamate ammonium blocked the trauma-induced translocation of NF-kappaB and resulted in a hearing loss (45-60) dB. These results indicate that several factors define the responsiveness of the inner ear to GC, including the availability of ligand or receptor, and the nuclear translocation of GR and NF-kappaB. These findings will further our understanding of individual GC responsiveness to steroid treatment, and will help improve the development of pharmaceuticals to selectively target GR in the inner ear for individuals with increased sensitivity to acoustic trauma.     

Temporal information in tones,broadband noise,and natural vocalizations is conveyed by differential spiking responses in the superior paraolivary nucleus

Communication sounds across all mammals consist of multiple frequencies repeated in sequence. The onset and offset of vocalizations are potentially important cues for recognizing distinct units, such as phonemes and syllables, which are needed to perceive meaningful communication. The superior paraolivary nucleus (SPON) in the auditory brainstem has been implicated in the processing of rhythmic sounds. Here, we compared how best frequency tones (BFTs), broadband noise (BBN), and natural mouse calls elicit onset and offset spiking in the mouse SPON. The results demonstrate that onset spiking typically occurs in response to BBN, but not BFT stimulation, while spiking at the sound offset occurs for both stimulus types. This effect of stimulus bandwidth on spiking is consistent with two of the established inputs to the SPON from the octopus cells (onset spiking) and medial nucleus of the trapezoid body (offset spiking). Natural mouse calls elicit two main spiking peaks. The first spiking peak, which is weak or absent with BFT stimulation, occurs most consistently during the call envelope, while the second spiking peak occurs at the call offset. This suggests that the combined spiking activity in the SPON elicited by vocalizations reflects the entire envelope, that is, the coarse amplitude waveform. Since the output from the SPON is purely inhibitory, it is speculated that, at the level of the inferior colliculus, the broadly tuned first peak may improve the signal‐to‐noise ratio of the subsequent, more call frequency‐specific peak. Thus, the SPON may provide a dual inhibition mechanism for tracking phonetic boundaries in social‐vocal communication.     

复发听神经瘤的临床特征分析与显微外科手术治疗

目的 探讨不同类型复发听神经瘤的临床特征及其显微外科手术治疗方法.方法 回顾性分析2010年1月至2016年10月华中科技大学同济医学院附属同济医院神经外科收治的29例复发听神经瘤患者的临床资料.初次手术全切除后复发11例（全切复发组）,初次不全切除后复发18例（非全切复发组）.比较两组患者的年龄、原发肿瘤最大径、复发肿瘤最大径、肿瘤囊性变、两次手术间隔时间、并发症、House-Brackmann面神经功能分级（H-B分级）.结果 全切复发组的平均年龄大于非全切复发组[分别为（52.2±10.8）岁和（33.0±5.5）岁,P〈0.05],前者两次手术间隔时间也明显大于后者[分别为（93.3±30.0）个月和（45.0±15.6）个月,P〈0.001].两组的原发肿瘤最大径、复发肿瘤最大径、肿瘤囊性变的比率、并发症发生率、面神经功能良好（H-B分级Ⅰ、Ⅱ级）比率的差异均无统计学意义（均P〉0.05）.29例患者的随访时间为3-37个月,平均（11.7±3.1）个月.肿瘤全切除28例,近全切除1例.术中面神经解剖保留率为93％ （27/29）.术后实用听力保留率为7％ （2/29）,面神经功能良好的比率为41％ （12/29）.结论 听神经瘤不全切除后残留复发者的两次手术间隔时间明显较全切除者短.在保护神经功能的前提下,初次全切除是听神经瘤患者获得最佳临床疗效的首选方法.对于复发听神经瘤建议早期积极手术.     

改良经耳囊径路在听神经瘤手术中的初步应用

目的探讨改良经耳囊径路在听神经瘤手术中的初步应用。方法回顾性纳入2017年3月至2017年8月首都医科大学附属北京天坛医院耳鼻喉科采用改良经耳囊径路行手术切除的8例听神经瘤患者,术后6h复查头颅CT排除颅内出血;术后1周复查头颅MRI判定有无肿瘤残留。所有患者均行门诊随访,随访内容为按House—Brackmann（H—B）分级标准评估面神经功能。结果8例患者均完全切除肿瘤,面神经结构均保留。术后6h复查头颅CT,8例患者均无颅内出血;术后1周复查头颅MRI,8例患者均未见肿瘤残留。术后8例患者的患耳均丧失听力,其中5例出现眩晕,经对症治疗后症状缓解。所有患者术后均无脑脊液耳漏、颅内出血,颅内感染、偏瘫等并发症,无一例死亡。8例患者的随访时间为2周至5个月,平均（10．3±7．2）周。按照H—B分级标准评估面神经功能,其中3／8的患者为I级,3／8的患者为Ⅱ级,1／8的患者为Ⅲ级,1／8的患者为Ⅳ级。结论改良经耳囊径路可在保留耳蜗结构的基础上实现对听神经瘤的完全切除,同时可以最大限度地保留面神经功能,并减少脑脊液漏等术后并发症。     

大型听神经瘤的显微手术治疗及术中面神经保护

目的 探讨显微手术切除大型（肿瘤最大径>3 cm）听神经瘤的疗效及术中面神经保护的方法。方法 回顾性分析2014年1月至2018年2月手术治疗的86例大型听神经瘤的临床资料,均在电生理监测下采用枕下乙状窦后入路显微手术。结果 肿瘤全切除83例,近全切除3例。面神经保留78例（91%）;术后1周面神经功能House-Backmann分级:1级11例,2级37例,3级22例,4级16例。术后门诊随访3~30个月,术区皮下积液4例,口唇疱疹9例,无死亡病例。结论 术前多模态肿瘤-神经评估,术中实时电生理监测,精细显微手术对大型听神经瘤全切和保留面神经功能可提供保障。     

耳聋左慈丸加味联合声治疗对肾精亏虚型耳鸣及抗氧化作用的观察

目的:探讨耳聋左慈丸加味联合声治疗对肾精亏虚型耳鸣的临床疗效和对超氧化物歧化酶(SOD),丙二醛(MDA),谷胱甘肽过氧化物酶(GSH-Px),总抗氧化能力(T-AOC)指标的影响。方法:将79例患者随机按数字表法分为对照组39例和观察组40例。对照组采用声治疗,观察组在声治疗的基础上采用耳聋左慈丸加味内服。两组疗程均为连续治疗3个月。进行治疗前后耳鸣严重程度、耳鸣残疾评估量表(THI),用焦虑自评量表,睡眠自评量表(SRSS)和肾精亏虚证评分;检测治疗前后SOD,MDA,GSH-Px和T-AOC水平。结果:经秩和检验,观察组临床疗效优于对照组(Z=1.936,P0.05);观察组患者耳鸣残疾程度轻于对照组,差异有统计学意义(Z=1.848,P0.05);治疗后观察组患者耳鸣残疾程度轻于对照组,差异有统计学意义(Z=1.887,P0.05);治疗后观察组患者耳鸣严重程度,THI,SA,SRSS和肾精亏虚证评分均低于对照组(P0.01);治疗后观察组患者MDA水平低于对照组,SOD,GSH-Px和T-AOC水平均高于对照组(P0.01)。结论:在声治疗的基础上,耳聋左慈丸加味治疗肾精亏虚型耳鸣患者,可减轻耳鸣严重程度和耳鸣残疾程度,改善临床症状,并对焦虑和睡眠有明显的改善作用,还具有一定的抗氧自由基损伤作用,临床疗效优于单纯的声治疗。     

Age-related features of the interaction of learning success and characteristics of auditory operative memory

The characteristics of the interaction between learning success and measures of auditory operative memory were studied by psychoacoustic testing of 42 medical workers aged 20–65 years trained to work in areas new to them (information science). Three age groups were identified: 20–35 years, 36–50 years, and 51–65 years. The acoustic test consisted of a single presentation via headphones of 12 sequential target words from information science with subsequent presentation of 12 target and 12 masking words in random order. The subjects’ task was to recognize the target words. Stepwise linear regression analysis identified a relationship between the efficiency with which the new material was learned and measures of auditory operative memory, whose role in learning success increased with age. Since subjects older than 35 years showed a reduction in remembering efficiency, it was suggested that age-related changes in the characteristics of auditory operative memory are one of the major reasons for degradation of the ability to learn new material. __________ Translated from Zhurnal Vysshei Nervnoi Deyatel’nosti imeni I. P. Pavlova, Vol. 57, No. 3, pp. 268–275, May–June, 2007.