Risk factors and etiology of childhood hearing loss: a cohort review of 296 subjects

Abstract

Background: The association between the Joint Committee on Infant Hearing (JCIH) risk factors and etiology of hearing loss (HL) is not studied well in children.

Objectives: To clarify the etiologic causes and evaluate the JCIH risk characteristics of children with HL.

Methods: A retrospective study of 296 children with HL born between 2009.01 and 2013.12 in Stokholm. Demographic data, family and medical histories, audiologic results, imaging findings, and genetic results were ascertained and analyzed.

Results: In 221 with bilateral hearing loss (BHL), family history and neonatal risk indicators were the most common risks (59 each), followed by syndrome related risks. In 75 with unilateral hearing loss (UHL), craniofacial anomaly was the most common risk, followed by family history. Etiology was established in 93 with BHL, in which syndromic HL accounted for 37.2%, chromosomal aberrations for 21.3%, and environmental causes for 19.1%. Etiology was established in 35 with UHL, in which ear malformation accounted for the most (74.3%), followed by environmental causes (14.3%).

Conclusions and significance: Childhood HL can be attributed to a variety of causes with an etiology identifiable in 42.5% of BHL and 46.7% of UHL. BHL and UHL have different patterns of JCIH risk exposure and etiology.     

Score EGSYS para predição de etiologia cardíaca na síncope: tem utilidade no contexto de consulta?

IntroductionThe EGSYS score uses clinical variables to predict which patients may have cardiac (CS) or non‐cardiac syncope (NCS) and has been validated in the emergency department setting. This study aims to determine whether the score has the same applicability in an outpatient setting.MethodsIn this retrospective study of all patients observed in the outpatient setting of a hospital with a syncope unit between January 2015 and December 2016, the EGSYS score was calculated for each patient, and its sensitivity and specificity were determined for the prediction of CS in patients with score ≥3.ResultsA total of 224 patients, mean age 64.3±21.7 years, 116 (51.8%) male, were analyzed. In the 163 (72.7%) patients with confirmed syncope, CS was diagnosed in 27 (16.6%) and NCS in 136 (83.4%). The EGSYS score was ≥3 in 40 (20.0%) patients with NCS and in 13 (48.1%) with CS. A positive score had a sensitivity of 48.2% (95% CI: 28.7‐68.1), a specificity of 77.9% (95% CI: 70.0‐84.6), and a positive and negative predictive value of 30.2% (95% CI: 20.8‐41.8) and 88.3% (95% CI: 83.9‐91.7), respectively.ConclusionThe EGSYS score has limited usefulness in an outpatient setting, where observed patients have already been been medically assessed. Given its high specificity and negative predictive value, it may be useful to reassure low‐risk patients and family members.     

乌司他丁对冠状动脉搭桥术后患者认知功能障碍的影响

目的探讨不同剂量乌司他丁对冠状动脉搭桥术患者术后认知功能障碍的影响及其可能的作用机制。方法选择2013年1月至2014年6月在南京医科大学附属南京医院就诊择期行冠状动脉搭桥术的老年患者127例, 分为三组:大剂量乌司他丁组(1.6万U/kg)、小剂量乌司他丁组(0.8万U/kg)和对照组(等容量的生理盐水)。所有患者在手术当日和次日晨8时测血浆皮质醇浓度, 并在术前、开胸、术毕、术后6 h和术后24 h分别检测IL-6、IL-10、TNF-α和S100β蛋白水平。术前1 d、术后1周和3个月分别应用精神神经测试组合量表评估患者认知功能的变化判定有无术后认知功能障碍, 计算各组患者术后认知功能障碍的发生率, 并且比较术后1周是否发生术后认知功能障碍患者S100β蛋白水平。结果最终93例患者完成研究, 三组患者一般资料比较差异均无统计学意义(均 P>0.05)。与术前相比较, 对照组患者术后24 h血浆皮质醇浓度升高明显( P < 0.01), 且大剂量和小剂量乌司他丁组患者术后血浆皮质醇浓度均较对照组低(均 P < 0.01);三组患者术毕、术后6 h和24 h血浆IL-6、IL-10、TNF-α水平及S100β蛋白水平均高于术前(均 P < 0.05);大剂量和小剂量乌司他丁组患者在术毕、术后6 h和24 h血浆IL-6、TNF-α水平浇以及在术后6 h S100β蛋白水平均比相对应时间点的对照组患者降低(均 P < 0.05), 但大剂量和小剂量乌司他丁组患者组间差异无统计学意义( P>0.05)。大剂量和小剂量乌司他丁组患者术后1周认知功能障碍发生率(25.8%和23.3%)均低于对照组(50.0%), 差异有统计学意义(均 P < 0.05);而大剂量和小剂量乌司他丁组术后3个月的术后认知功能障碍发生率(12.9%和16.7%)与对照组(28.1%)比较, 差异均无统计学意义( P>0.05)。术后认知功能障碍组( n=31) 在术后24 h血清S100β蛋白水平高于非术后认知功能障碍组( n=62), 其差异具有统计学意义( P < 0.05)。 结论乌司他丁可降低冠状动脉搭桥术患者术后1周的术后认知功能障碍的发生率, 其机制可能与减轻炎性反应及脑损伤有关。     

Extracorporeal Membrane Oxygenation as a Bridge to Surgery for Infective Endocarditis Complicated by Aorto-Atrial Fistula and Cardiopulmonary Collapse

The timing of surgery for active infective endocarditis is challenging when patients exhibit mechanical dysfunction and hemodynamic compromise. Extracorporeal membrane oxygenation has been described in treating sepsis but not, insofar as we know, in treating the acute mechanical sequelae that arise from infective endocarditis. We report perhaps the first case that shows the usefulness of extracorporeal membrane oxygenation as a bridge to definitive treatment in a 35-year-old man who had infective endocarditis followed by aorto-atrial fistula and cardiopulmonary collapse.     

结肠镜下单纯性直肠溃疡的临床特征分析

目的:分析结肠镜发现的单纯性直肠溃疡的临床特征及病理特点。方法:回顾性分析2016 年9 月—2022 年3 月在天津市人民医院消化内科进行结肠镜检查的37 489 例患者的临床资料。入选标准:直肠溃疡，直径≥ 0.2 cm，单发或多发，无结肠炎及结肠溃疡等其他结直肠疾病。入选患者44 例，占同期行结肠镜检查者的1.17‰(44/37 489)。其中男性21例，女性23 例，年龄16~81 岁，平均(53.0±14.8)岁。结果:44 例单纯性直肠溃疡的症状包括便血、腹痛、排便不尽感、下腹/ 肛门坠胀、腹泻、腹胀及排便次数增多等，还有个别患者出现排便费力、里急后重及发热等表现。其中以腹痛及便血最为常见，占比达40% 以上。内镜表现:溃疡直径0.2~1.0 cm 者24 例，1.1~3.0 cm 者13 例，＞ 3.0 cm 者7 例。单发溃疡25 例(56.8%)，多发溃疡12 例(27.3%)，占据管腔1/4 及以上大溃疡7 例(15.9%)。病因学分析:非特异性直肠炎29 例，溃疡性直肠炎5 例，缺血性直肠炎4 例，肠克罗恩病、肠阿米巴病各1 例，还有4 例未明确病因，其中病理可见异型细胞3 例，疑似血管炎相关疾病1 例。结论:非特异性直肠炎在单纯性直肠溃疡中所占比例较高。内镜联合活检对于明确单纯性直肠溃疡的病因具有重要意义。     

基于五运六气理论对新型冠状病毒感染肺炎的几点思考

基于五运六气理论,尤其是三年化疫理论,对当前正在流行的新型冠状病毒感染的肺炎进行病因病机分析及分期诊疗指导。     

Edward Zigler's legacy in the study of persons with intellectual disability: the developmental approach and the advent of a more rigorous and compassionate science

Edward Zigler transformed the science and humanity of the work with persons with intellectual disability. The developmental approach is Ed's great contribution to the field of intellectual disability as it both led to more conceptually compelling and methodologically rigorous science and provided an alternative to the Zeitgeist of segregation, defect, and pathology that had prevailed for decades. In an entirely unique way, the developmental approach allowed a seamless integration of increasingly precise science with concern for the “whole child” and their family. Thus, Ed's legacy led to a discipline in which scholarship and compassion prevail hand in hand as the integrity of science and of the person are mutually informative and interdependent.