普通话双音节词表在听力正常青年中的复测信度分析

目的分析9张普通话双音节词表应用于听力正常青年人的复测信度,得出其临界差值,以利于对测试结果进行合理分析。方法选取听力言语正常的18～27岁青年受试者32例,以具有等价性的9张普通话双音节词表对其中5名受试者进行预实验,得出正式测试的给声强度,再对27名受试者进行正式测试,得出受试者的言语识别率。7～28天后,再以同样的测试条件进行复测比较各表两次测试言语识别率得分差值。结果复测和初测的言语识别率分别为52.40%±13.82%和50.74%±13.51%,各表复测和初测结果的差异无统计学意义(P>0.05),复测和初测差值的标准差为12.0%,转化成95%置信度下的临界差值(critical difference,CD)为23.6%。结论普通话双音节词表具有较好的复测信度,可初步应用于临床测试和试验研究。以该表进行言语识别率测试时,两次测试差值超过23.6%方可认为两次结果有差异。     

正常人单音节词及语句识别-强度函数测试

目的:对难度等价性一致的普通话言语测听材料(MSTMs)中的单音节词表和句表进行分析,以期描绘出基于此测试材料的听力正常人识别-强度函数曲线.方法:选取18～25岁具有大专以上学历、且日常生活中以普通话作为交流方式的40例听力正常人作为受试者,对其中8例受试者进行预试验,从而获得正式测试时所需的给声强度;对其余32例受试者进行正式的言语识别测试.采用MSTMs中经过等价性评估的7张(每张50词)单音节词表和15张句表(每表50个关键词)作为测试材料.使用SPSS11.0软件对数据进行分析.结果:MSTMs单音节词表的言语识别率与给声强度间的函数关系的线性部分为Y=3.194X-46.147,识别率为50%时的给声强度为30.1 dBSPL;MSTMs句表的言语识别率与给声强度间的函数关系的线性部分为Y=7.419X-121.744,识别率为50%时的给声强度为23.1 dBSPL.结论:本研究初步建立了基于具有难度等价性的7张普通话单音节测听词汇表和15张普通话语句测听词汇表的正常人识别-强度函数曲线,为临床应用提供了基于MSTMs的正常听力者的鉴别标准.     

汉语单音节测听表在北京听力正常人群中的复测信度评估

目的 评价22张等价的单音节测听表在正常人群中的复测信度,以利于采用该言语测听材料时得出合理可靠的结论.方法 招募北京22名18～30岁耳科正常人,在10 dB HLSpeech强度下,以拉丁方实验设计方案,依次进行22张单音节表的识别率测试.间隔6～35天,在完全相同的条件下重新进行第二轮次的识别率测试.结果 两轮测试的识别率分别为74.0%±12.2%和72.4%±10.3%,经配对t检验显示P=0.000152.逐表汇总两轮测试得分的差值,统计该差值在22名受试者中的标准差为9.3%,转化成95%置信度下的临界差值(critical difference)为18.3%.两轮测试得分的相关系数为0.684.结论 正常人使用该套单音节测听表进行有关言语工程的评价研究时,同一受试者前后两次识别率之差只有高于18.3%时,方可认为处置有效.     

一组汉语普通话单音节表在听力损失人群中的复测信度研究

目的评价一组经过等价性验证的汉语普通话单音节表在听力损失患者中的复测信度。方法使用一组等价的单音节表对18名有听力损失的受试者进行识别率测试,测试强度在纯音平均听阈上30dB,每位受试者以不同表号起始顺序测完所有表,并在间隔1到16天后以相同表序再次进行测试,对两轮结果进行统计学分析。结果两轮测试得分的相关系数为0．931,对两轮测试的识别率得分进行“合理化”反正弦变换后,计算两轮得分差值的标准差,获得该组表在95％置信度下的临界差值为16．3％。结论这组普通话单音节表在评价治疗或助听前后的效果时,只有识别率差值超过16．3％,才能得出“处置有效”的结论。     

汉语普通话单音节测听表的建立与评估

目的 建立一套普通话单音节测听表并验证其效度、信度和敏感度,期望成为国内标准化的言语识别率测听材料.方法 遵循简短、音位平衡、常用、覆盖等原则,生成30张音位平衡单音节表,每表对应25个常用汉字.由专业男性播音员朗读,经数字化录音及声学处理,录制成CD.研究分为三个阶段:①招募60名听力正常年轻人,采用随机区组设计:言语测听表号与测听强度均衡排布,每一受试者均变换6种强度(言语听力级-1、5、11、15、21、27 dB)以循环顺序聆听全部30张单音节表.计算每表每一声级下的言语识别率得分,以logistic曲线回归来拟合识别率-强度(P-I)函数.对30张词表的识别率进行双因素(表号、强度)方差分析和Post-Hoc两两比较,得到22张等价表.②北京22名听力正常年轻人,采用拉丁方设计,在言语听力级10 dB强度下依次测试22张等价表的识别率.间隔6～35 d,在完全相同的条件下重新进行第二轮识别率测试.两轮测试的识别率经"合理化"的反正弦变换后,逐表汇总两轮测试分差,该分差值在22名受试者中的标准差为9.3%,转化成95%置信度下的临界分差为18.3%.③采用拉丁方设计方案,对18名感音性听力损失患者在其纯音平均听阈上30 dB或最大舒适级,测试其对18张等价表的识别率.间隔1～16 d在相同条件下再次进行测试.两轮测试的识别率经"合理化"的反正弦变换后,分别为(68.0±15.9)%和(69.2±14.6)%,配对t检验,P=0.107.两轮测试分差,在18名患者中的标准差为8.3%,转化成95%置信度下的临界分差为16.3%.结果 创建了一套22张等价的标准化的言语识别率测听表.每表由音位平衡的25个单音节构成,播放时间约2 min.听力正常人的单音节识别阈为言语听力级(8.30±0.84)dB,P-I函数的斜率为(4.0±0.3)%/dB.临床评判受试者言语识别率差异时,只要分差超过临界分差--正常人(18.3%)、患者(16.3%),即可确认具有统计学意义上的显著性差异.结论 成功建立起一套普通话单音节测听表,具有较高的效度、信度和敏感度,便于临床应用.     

汉语普通话单音节测听表的多中心复测信度研究

目的 研究自行开发的汉语普通话单音节测听表在不同方言区听力正常人群中的复测信度.方法 选择北方方言、吴越、闽北、闽南、粤、鄂等6个典型的方言区,确定大连、上海、杭州、武汉、广州、福州、厦门等7个城市作为测试中心.每个测试中心分别招募22名听力言语正常受试者.以均衡排序的方式测试每位受试者全部22张字表在言语听力级7 dB下的单音节识别率,间隔10 d至1个月后在完全相同的条件下重复进行第二轮测试.结果 相关分析显示前后两次单音节识别测试得分之间存在较密切的线性相关关系(r=0.682,P<0.01).配对student-t检验表明初测得分与复测得分之间差异具有统计学意义(P<0.01),总体复测平均得分(68.5%)高于初测平均得分(65.8%)2.7%,得分差值的标准差为10.1%.本测试材料在7个中心的总体95%可信区间临界差值为19.8%,相当于5个测试项.单因素方差分析显示总体的两次得分差值具有统计学意义(P<0.01).7家中心总体的得分差值与两次测试的时间间隔之间无相关关系(P=0.947).结论 测试变异度在各方言测试中心之间存在差异.汉语单音节识别材料受记忆效应的影响小.Pearson相关系数r不适用于测听材料复测信度的评估.     

安静条件下语句识别表的等价性研究

目的 通过对解放军总医院研制的12张普通话儿童语句测听词表的难度等价性研究,判断该套材料是否符合言语测听材料的标准,以期挑选出具有难度一致性的词表应用于临床.方法 选取36名听力正常青年受试者,采用听说复述的方式,进行12组句表的测试(每组句表有50个关键词),以关键词计分,然后对各表得分进行统计学分析.结果 进行双因素(表号和强度)方差分析和Post-Hoc两两比较,12张测试表无统计学差异.结论 12张语句识别表具有较好的难度等价性,可应用于临床测试和实验研究.     

福州方言人群单音节词识别-强度函数修正值探讨

目的采用标准化言语测听材料《普通话言语测听材料》对福州方言人群开展言语测听,根据测试结果研究影响普通话识别特征因素,探讨标准化测听材料在福建方言人群的测试效果并找出标准化应用强度函数修正值;方法选取56例受试者均具有大专以上学历,年龄18～25岁,其中方言组36例,标准普通话组20例;采用MSTMs中经过等价性评估的7张(每张50词)单音节词表作为测试材料对56例受试者进行言语识别率测试;使用SPSS17.0软件对数据进行分析,描绘言语识别率与给声强度间的函数曲线并将福州方言人群测试结果与普通话组数据进行单因素方差分析。结果福州话方言组及普通话单音节词表的言语识别率与给声强度间的函数关系的线性部分分别为Y=3.074X-36.157和Y=3.163X-40.498。结论本研究初步建立了基于具有难度等价性的7张普通话单音节测听词汇表的福州话方言人群正常人识别-强度函数曲线;方言组母语为福州话并熟练掌握普通话人群在应用MSTMs普通话版言语测听词表可无需校正。     

语谱噪声下普通话单音节小词表等价性分析

目的 对经由语音学专家修订的24张普通话单音节小词表进行不同信噪比下的言语识别率测试和难度等价性评估,以期选出具有较高信度者用于临床和科研工作.方法 选取听力言语正常的青年受试者48例,运用首都医科大学生物医学工程学院与首都医科大学附属北京同仁医院(以下简称北京同仁医院)联合开发的汉语言语测听智能化系统,在4种不同信噪比下通过同侧耳机给声,对受试者进行24张单音节小词表言语识别率的心理声学测量.使用SPSS 17.0软件进行P-I函数拟合和统计分析.结果 (1)24张普通话单音节小词表中11张彼此难度等价;(2)线性拟合了24张小词表噪声下信噪比一言语识别率的P-I曲线;(3)得到24张小词表噪声下信噪比-言语识别率的线性拟合方程,并分别反解出各表识别率为50%点处对应信噪比,24张词表总方程该点对应信噪比为-0.03 dB.结论 本试验初步证明.所得等价的11张普通话单音节小词表,可初步应用于临床测试和试验研究,并在正常人群中交互使用.     

嘈杂语噪声下普通话儿童语句测听表的标准化

目的 研究嘈杂语噪声下普通话语句识别测听材料在学龄前儿童言语测听中的效度、信度和敏感度指标,并分析年龄、性别因素对测听结果的影响.方法 招募54名北京市4～6岁听力言语正常儿童(分成4.0～、4.5～、5.0～6.0岁三组,每组18名,男女各半),应用27张中文嘈杂语噪声下普通话语句识别表,采用随机区组裂区设计,在幼儿园简易声场(本底噪声＜40 dB A)在SNR=+1、-2、-5 dB三种条件下由同一扬声器播放语句(强度固定为65 dB SPL)和噪声,由儿童复述所听到的语句,逐一计算各表的言语识别率.结果 ①多种信噪比下的识别率得分在各表之间的差异无统计学意义;②各表对学龄前儿童的识别率(performance)-信噪比(SNR)函数显示,SNR50阈值为-1.96±0.19 dB SNR,斜率为15.8%±1.1%/dB;③各表得分经"合理化的"反正弦变换,推定在95%置信度下的临界差值(critical difference,CD)为24.6%;④4～4.5岁儿童与另两组儿童之间的得分差异有统计学意义(P=0.000 000),另二组儿童之间的得分差异无统计学意义(P=0.895 199).男女之间的差异也有统计学意义(P=0.000 000).结论 ①27张中文嘈杂语噪声下的普通话语句识别表,对学龄前儿童彼此等价;②学龄前儿童50%语句识别率所对应的SNR50接近-2 dB,测试的敏感度为15.8%/dB,均低于成人水平;③男女儿童在噪声下的语句识别能力虽略有差异,但远小于信度指标所对应的24.6%的临界差值;④每表测试时间仅1.5分钟,适用于4.5岁以上的城市儿童.     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.