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Voice pitch carries important cues for speech perception in humans. Recent studies have shown the feasibility of recording the frequency-following response (FFR) to voice pitch in normal-hearing listeners. The presence of such a response, however, has been dependent on subjective interpretation of experimenters. The purpose of this study was to develop and test an automated procedure including a control-experimental protocol and response-threshold criteria suitable for extracting FFRs to voice pitch, and compare the results to human judgments.A set of four Mandarin tones (Tone 1 flat; Tone 2 rising; Tone 3 dipping; and Tone 4 falling) were prepared to reflect the four contrastive pitch contours. Two distinctive algorithms, short-term autocorrelation in the time domain and narrow-band spectrogram in the frequency domain, were used to estimate the Frequency Error, Slope Error, Tracking Accuracy, Pitch Strength and Pitch-Noise Ratio of the recordings from individual listeners as well as the power and false-positive rates of each algorithm.Eleven native speakers (five males; age: mean ± SD = 31.4 ± 4.7 years) of Mandarin Chinese were recruited.The results demonstrated that both algorithms were suitable for extracting FFRs and the objective measures showed comparable results to human judgments.The automated procedure used in this study, including the use of the control-experimental protocol and response thresholds used for each of the five objective indices, can be used for difficult-to-test patients and may prove to be useful as an assessment and diagnostic method in both clinical and basic research efforts.

article i nfo Background: Identification of tumor biomarkers to assist early diagnosis and monitoring of disease progression may potentially decrease the mortality and morbidity associated with oral cancer. Methods: Amousemodelwithoralsquamouscellcarcinoma(OSCC)inducedby4-nitroquinoline1-oxide(4-NQO)/ arecoline in drinking water was established to discover stage-associated biomarkers. A proteomics approach, immunoblotandimmunohistochemicalanalysiswereusedtovalidatetheexpressedbiomarkersinmicewithOSCC. Human plasma samples were also collected and candidate biomarkers were evaluated using enzyme-linked immunosorbent assay. Results: Proteomic profiling of mouse plasma samples indicated that haptoglobin and apolipoprotein A1 precursor wereup-regulatedinthemicewithOSCC.Immunoblottingofplasmasamplesandimmunohistochemicalanalysisof oral tissues showed a significantly higher level of haptoglobin in the OSCC mice than in the control mice. The expression of haptoglobin in human plasma samples from 52 patients with OSCC indicated a strong correlation between the increasing levels of haptoglobin and the clinical stages of OSCC (Pb0.01). Conclusions: These results suggest that haptoglobin has a great potential as a sensitive plasma biomarker for early detection of patients with OSCC.

Otitis media with effusion (OME) has a higher incidence in adult intensive care unit (ICU) patients. This observational study sought to examine the effect of tracheostomy on OME in critically ill patients and explore the predisposing factors.Twenty-seven ICU patients who had undergone prolonged intubation (more than 14 days) received traditional tracheostomies. Otoscopic examination, tympanometry, and spectral gradient acoustic reflectometry were performed both at the time of the tracheostomy and 7 days later. We collected data on the patients' demographics (age and gender), underlying diseases, duration of intubation prior to the tracheostomy, history of gastroesophageal reflux disease, length of antibiotic use, level of consciousness, and presence of nasogastric tubes.At the time of the tracheostomy, 25 (46%) ears from 14 (52%) patients were classified as cases of OME, 17 (31%) ears and 7 (26%) patients as normal cases, and 12 (11%) ears from 6 (11%) patients as cases of negative pressure in the tympanic cavity. Seven days after the tracheostomy, OME was resolved in 17 (68%) ears and persisted in 6 (24%) ears, whereas negative pressure developed in 2 (8%) ears. Our data showed that the incidence of OME reduced from 46% to 22% after tracheostomy was performed on the patients.The incidence of OME in adult ICU patients who were intubated for more than 14 days was found to reduce after tracheostomy. Notably, the rate of improvement in the conscious patients was significantly higher than that in the unconscious patients.

Conclusion. Mitochondrial dysfunction in the cochlea potentiates the ototoxicity of aminoglycosides. Objective. This study examined whether mitochondrial dysfunction in the cochlea affects the ototoxicity of aminoglycosides. Materials and methods. Nineteen guinea pigs were treated with the mitochondrial toxin 3-nitropropionic acid (3-NP), kanamycin, both agents, or normal saline as control. After 14 days, hair cell loss and auditory brainstem response (ABR) were assessed. Results. The administration of 400 mg/kg of kanamycin caused neither hair cell loss nor ABR threshold shift. Administration of 3-NP caused mild ABR threshold shift without significant hair cell loss. Administration of 3-NP and kanamycin caused ABR threshold shift and significant hair cell loss.

Detailed radiological assessment by high resolution computed tomography (HRCT) of temporal bone is demanded before any temporal bone or skull base surgery. The aim of this study was to measure the relations between the anatomical landmarks of the temporal bone and to assist the otolaryngologist in establishing accurate preoperative evaluation. We enrolled 43 patients who underwent temporal bone HRCT between February 2004 and May 2004. Contiguous axial and coronal images at 1.0 mm thickness were obtained. Some landmarks such as the superior and inferior lips of the internal acoustic canal (IAC), the malleoincus joint, and the posterior semicircular canal were labeled in the coronal and axial views. Then we measured the distance between them. Average IAC diameter in the coronal and axial views was 5.33 mm and 6.92 mm. Average IAC length in the coronal and axial views was 12.29 mm and 11.09 mm. The thickness of the retrolabyrinthine bone was 3.78 mm. The incidence of thinning bone overlying the superior semicircular canal was 2.3%. Our data could be applied to normal distribution because there were no statistical differences between the measurements of normal ears and diseased ears. Several specific measurements can be applied to the preoperative evaluation of vestibular schwannoma including the retrosigmoid approach, the translabyrinthine approach and the middle fossa approach.

Methods: We design two-phase prospective intervention study in public 1800-bed medical center in Taipei, Taiwan. Cleaning efficacy was monitored by ATP bioluminescence after the daily morning cleaning program completed in a CICU and a MICU. The following high-touch surfaces were monitored: bed rails, surfaces of vital monitors, intravenous injection sets, bed tables, and handles of the nursing care cart. The threshold for cleanliness was set at a level of 250 relative light units (RLU). The intervention included an infection control education program, use of disposable wipes rather than a reusable microfiber towel, and feedback the monitoring result. Results: In phase I, only 43.9% of surfaces were clean (RLU < 250) after the daily cleaning process, and some of the surfaces were even more contaminated. In phase II, 88.1% of surfaces were clean after the daily cleaning process, significantly from phase I. The infection rate also declined after the intervention, from 21.0& to 10.7& in the MICU (p Z 0.047) and from 15.6& to5.6& in the CICU (p Z 0.028). Conclusions: Implementation of a new cleaning program that included use of disposable wipes and monitoring by ATP levels significantly reduced contamination of surfaces and infection rate in our ICUs.

Objective: Previous research has shown the usefulness of utilizing auditory chimeras (i.e., interchanging the envelope and fine structure of two different sounds) in assessing a listener’s perception of the envelope and fine structure for an acoustic stimulus. However, research comparing and contrasting behavioral and electrophysiological responses to this stimulus type is scarce. Design: Two sets of chimeric stimuli were constructed by interchanging the envelopes and fine-structures of the rising /yi2/ and falling /yi4/ Mandarin pitch contours that were filtered through 1, 2, 4, 8, 16, 32, and 64 frequency banks. Behavioral pitch-perception tasks (through a single-interval, two-alternative, forced-choice paradigm) and electrophysiological responses (through the frequency-following response to voice pitch using validated scalp-recorded potential methods) were obtained from two groups of participants (native speakers of a tonal or nontonal language). Study Sample: Thirteen American and 13 Chinese adults were recruited. Results: A two-way analysis of variance showed significance (p

Introduction : Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements. Methods : A redesigned clinical mentoring program was launched in a medical center according to previous theoretical and practical studies on clinical training workplaces, including the elements of mentor qualifications, positive and active enhancers for mentor–mentee relationship building, the timing of mentoring performance evaluation, and financial and professional incentives. A four-wave web survey was conducted, comprising one evaluation of the former mentoring program and three evaluations of the redesigned clinical mentoring program. Sixty-four fifth-year medical students in clerkships who responded to the first wave and to at least two of the three following waves were included in the study. A structured and validated questionnaire encompassing 15 items on mentor performance and the personal characteristics of the clerks was used. Mixed linear models were developed for repeated measurements and to adjust for personal characteristics. Results : The results revealed that the redesigned mentoring program improved the mentors’ performance over time for most evaluated items regarding professional development and personal support provided to the mentees. Conclusions : Our findings serve as an improved framework for the role of the institution and demonstrate how institutional policies, programs, and structures can shape a clinical mentoring program. We recommend the adoption of mentorship schemes for other cohorts of medical students and for different learning and training stages involved in becoming a physician. Keywords: clinical mentoring; clerks; mentoring program; mentor; mentee; medical student; Taiwan; longitudinal survey (Published: 16 September 2015) Citation: Med Educ Online 2015, 20: 28327 - http://dx.doi.org/10.3402/meo.v20.28327

Objective: To assess the association of the interleukin (IL)-1 and the IL-1 receptor antagonist (IL-1Ra) gene polymorphisms with chronic rhinosinusitis (CRS). Design: Genotyping of the 2 IL-1 gene (IL1B) polymorphisms (promoter and exon) and the IL-1Ra gene (IL1RN) polymorphism (intron 2) was performed using polymerase chain reaction and restriction length fragment polymorphism analyses. Setting: Prospective study, tertiary medical center. Patients: The study population comprised 88 consecutive adult Taiwan-Chinese patients who met stringent criteria for CRS and received endoscopic sinus surgery and 103 healthy volunteers of the same ethnicity and similar age range. Of the 88 patients, 61 had CRS with nasal polyps, while the other 27 had CRS without nasal polyps. Results: There were significant differences in the distribution of the IL1RN polymorphism between the control subjects and patients with CRS (P.05). The II allele ofIL1RN occurred more frequently in the CRS patient group, and the odds ratio for subjects with I/II genotype was 3.39 (95% confidence interval, 1.25-9.18). In the case of CRS without nasal polyps, the odds ratio for subjects with I/II genotype was further increased to 4.75 (1.3916.25). There was no association between the other 2 polymorphisms of IL1B and CRS. Conclusion: Increased prevalence of IL1RN polymorphism in patients with CRS suggests that this polymorphism, or a polymorphism in linkage disequilibrium with it, may be involved in the development of CRS.

Although laryngomalacia is the leading cause of stridor in infancy, vocal cord paralysis, despite its low incidence, is still the second most common cause. However, the etiology of infant vocal cord paralysis is different from that of adults, and the management protocol is controversial. Therefore, we conducted this study to better characterize the cause and outcome of vocal cord paralysis in infants. From January 1997 to December 2003, we treated thirteen infants younger than one year for vocal cord paralysis. Seven infants were idiopathic (idiopathic group), two might be caused by prior surgery (iatrogenic group), two might be caused by central neuropathy (neurological group), and two were born after difficult delivery (obstetrical group). In the idiopathic group, six infants spontaneously recovered and one infant had right-side recovery, but the left side was still paralytic. All infants in the iatrogenic and obstetrical groups spontaneously recovered. However, no infant in the neurological group recovered. Spontaneous recovery occurred in 76.9% of affected infants. More than half (70%) of these spontaneous recoveries occurred within 6 months. In our experience, direct flexible laryngoscopy is mandatory for all infants younger than one year of age presenting with stridor. Except for extreme infants (e. g. bilateral vocal cord paralysis with severe respiratory distress and central neuropathy) who require a temporary tracheotomy to relieve the airway obstruction, we recommend waiting for at least 6 months before proceeding to invasive surgical interventions.

Deep neck infection is a potentially life-threatening disease and rarely seen in children. Because of the obscure complaints and symptoms, the diagnosis of deep neck infection may be delayed, which may result in inappropriate treatment. This retrospective study was aimed at analyzing the occurrence of complications, diagnostic methods and proper managements of deep neck infection in children.A retrospective study was performed on 30 children with deep neck infection treated from October 1999 through October 2003. The etiology, clinical symptoms, laboratory examination, radiological examination, bacteriology, and treatments were retrospectively analyzed.The most common predisposing factors were tonsillitis and upper respiratory tract infection. The most common symptoms were fever (93.3%) and painful swelling of the neck (70.0%). Both peritonsillar (24.3%) and parapharyngeal space infections (24.3%) were the most common, followed by submandibular space infections (18.9%). The most common pathogens isolated were Staphylococcus aureus (27.3%) and viridans streptococci (22.7%). The mean duration of hospitalization was 7.9 days, with a range from 2 to 18 days. Complications occurred in 2 patients, including recurrence and pulmonary edema.Deep neck infection should be suspected in a child who presents with fever and painful swelling of the neck. Staphylococcus aureus and viridans streptococci were the most common pathogens. Computed tomography scan should be performed in time and infections in peritonsillar and ,parapharyngeal spaces were the most common.

Metastatic hepatocellular carcinoma (HCC) in the sinonasal region is rare. We report the case of a 45-year-old male hepatitis B carrier who had metastatic HCC 2 years after resection of the primary tumor. The patient died of terminal hepatic failure 6 weeks after the discovery of nasal septal metastasis. The clinical and histopathologic characteristics of the primary and metastatic hepatocellular tumors are described. This is the first reported case of nasal septal metastasis from HCC.

Laryngeal photographs from 165 Taiwanese subjects were taken during microlaryngoscopy. Photographs of the vocal fold during the open phase were chosen. For measuring the vocal fold length, both the photograph of a ruler and the larynx were taken under the operating microscope, thus forming a ‘new scale’. Photographs of the vocal fold and the ruler were then processed at the same power of magnification. The length of the vocal folds was measured with the ‘new scale’. In 100 patients receivingdirect laryngoscopy under neuroleptic anaesthesia, the vocal fold length was 14.6 ± 1.2 mm (n = 35) for males and 11.1 ± 1.0 mm (n = 65) for females. In 65 patients under general anaesthesia, the vocal fold length was 15.3 ± 1.6 mm (n = 23) for males and 13.5 ± 1.3 mm (n = 42) for females. Statistical analysis revealed a significant difference between both groups and both sexes. Elongation of the vocal fold under general rather than neuroleptic anaesthesia may be important when performing functional surgery of the vocal fold.

Endotracheal intubation is an important airway procedure in the management of neonates and infants. Prolonged intubation may result in severe laryngeal injury which may lead to chronic laryngeal disability. The nature and causes of post-extubation airway obstruction were evaluated with videoendoscopy. From June 1998 to September 2000, detailed videoendoscopic examination of pediatric airway was performed in 30 children who had persistent stridor after endotracheal extubation or failure of elective extubation. Common locations of post-extubation lesion are the posterior glottis and subglottis. Retrospective analysis of the causes of stridor included: (1) isolated intubation laryngotracheitis (n = 19); (2) intubation laryngotracheitis with neuromuscular dysfunction which resulted in tongue drop, laryngotracheal incoordination, saliva pooling over the larynx or poor cough reflex(n = 5); and (3) specific airway problems such as laryngomalacia, subglottic stenosis or vocal paralysis(n = 6). We favored the term of "intubation laryngotracheitis" instead of "intubation injury" or 'intubation trauma". Although most cases of intubation laryngotracheitis heal, leaving a normal or near-normal larynx, some of them still suffer from airway obstruction after endotracheal extubation. Specific airway problems such as severe laryngomalacia or vocal cords paralysis and neurogenic defects should also be taken into consideration.

The aim of the study was to determine whether brazilin exhibits any anti-inflammatory effects that inhibit T helper cell type II (TH2) responses and whether it suppresses allergic inflammation reactions in a murine model of asthma. We found that brazilin inhibited phorbol myristate acetate (PMA) + cyclic adenosine monophosphate (cAMP)-induced IL-4 and IL-5 expression in EL-4 T cells with respect to both RNA and protein levels in a dose-dependent manner. After intratracheal instillation of brazilin in ovalbumin (OVA)-immunized mice, we found that brazilin-treated mice exhibited decreases in the release of IL-4, IL-5, IL-13, eotaxin, and TNF-α in bronchoalveolar lavage fluid (BALF), inhibited TH2 functioning by a decrease in IL-4 production, and the attenuation of the OVA-induced lung eosinophilia, and airway hyperresponsiveness and remodeling. These results suggest that brazilin exhibits an anti-TH2 reaction both in vitro and in vivo. Brazilin as demonstrates therapeutic potential for allergic diseases.

A cantilever beam deposited with single-domain magnetic multilayers to observe actuation behavior under an external magnetic field is proposed. It is observed that the deflection and angular deflection in the substrate plane of the cantilever beam both exhibit hysteresis, and the magnetization switching of single-domain magnetic thin film is directly observed in the actuation process.

Background: Most lymphomas that involve the tonsil are large B cell lymphomas. Large B-cell lymphoma is a high grade malignancy which progresses rapidly. Tonsillar lymphoma usually presents as either a unilaterally enlarged palatine tonsil or as an ulcerative and fungating lesion over the tonsillar area. Small lymphocytic lymphomas (SLL) of the Waldeyer's ring are uncommon. Case presentation: We report a 41-year-old male who presented with a ten-year history of snoring. Physical examination revealed smooth bilateral symmetrically enlarged tonsils without abnormal surface change or cervical lymphadenopathy. Palatal redundancy and a narrowed oropharyngeal airway were also noted. The respiratory disturbance index (RDI) was 66 per hour, and severe obstruction sleep apnea (OSA) was suspected. No B symptoms, sore throat, odynophagia or dysphagia was found. We performed uvulopalatopharyngoplasty (UPPP) and pathological examination revealed incidental small B-cell lymphocytic lymphoma (SLL). Conclusion: It is uncommon for lymphoma to initially present as OSA. SLL is an indolent malignancy and is not easy to detect in the early stage. We conclude that SLL may be a contributing factor of OSA in the present case.

Background Hyperbaric oxygen therapy (HBOT) is a known adjuvant for treating ischemia-related inner ear diseases. Controversies still exist in the role of HBOT in cochlear diseases. Few studies to date have investigated the cellular changes that occur in inner ears after HBOT. Nitric oxide, which is synthesized by nitric oxide synthase (NOS), is an important signaling molecule in cochlear physiology and pathology. Here we investigated the effects of hyperbaric oxygen on eardrum morphology, cochlear function and expression of NOS isoforms in cochlear substructures after repetitive HBOT in guinea pigs. Results Minor changes in the eardrum were observed after repetitive HBOT, which did not result in a significant hearing threshold shift by tone burst auditory brainstem responses. A differential effect of HBOT on the expression of NOS isoforms was identified. Upregulation of constitutive NOS (nNOS and eNOS) was found in the substructures of the cochlea after HBOT, but inducible NOS was not found in normal or HBOT animals, as shown by immunohistochemistry. There was no obvious DNA fragmentation present in this HBOT animal model. Conclusions The present evidence indicates that the customary HBOT protocol may increase constitutive NOS expression but such upregulation did not cause cell death in the treated cochlea. The cochlear morphology and auditory function are consequently not changed through the protocol.