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Background: To investigate the role of native T 1 mapping in the non-invasive quantitative assessment of renal function and renal fibrosis (RF) in chronic kidney disease (CKD) patients., Methods: A prospective analysis of 71 consecutive patients [no RF (0%): 9 cases; mild RF (<25%): 36 cases; moderate RF (25-50%): 17 cases; severe RF (>50%): 9 cases] who were clinically diagnosed with CKD that was pathologically confirmed and who underwent magnetic resonance imaging (MRI) examination between October 2021 and September 2022 was performed. T 1 -C (mean cortical T 1 value), T 1 -M (mean medullary T 1 value), ΔT 1 (mean corticomedullary difference) and T 1 % (mean corticomedullary ratio) values were compared. Correlations between T 1 parameters and clinical and histopathological values were analyzed. Regression analysis was performed to determine independent predictors of RF. The areas under the receiver operating characteristic curve (AUC) were calculated to assess the diagnostic value of RF., Results: The T 1 -C, ΔT 1 and T 1 % values (P<0.05) were significantly different in the CKD group, but T 1 -M was not (P>0.05). The ΔT 1 and T 1 % values showed significant differences in pairwise comparisons among CKD subgroups (P<0.05) except for CKD 2 and 3. ΔT 1 and T 1 % were moderately correlated with the estimated glomerular filtration rate (ΔT 1 : r s =-0.561; T 1 %: r=-0.602), serum creatinine (ΔT 1 : r s =0.591; T 1 %: r s =0.563), blood urea nitrogen (ΔT 1 : r s =0.433; T 1 %: r s =0.435) and histopathological score (ΔT 1 : r s =0.630; T 1 %: r s =0.658). ΔT 1 and T 1 %, but not T 1 -C, were independent predictors of RF (P<0.05). ΔT 1 and T 1 % were set as -410.07 ms and 0.8222 with great specificity [ΔT 1 : 91.7% (77.5-98.2%); T 1 %: 97.2% (85.5-99.9%)] to identify mild RF and moderate-severe RF. The optimal cutoff values for differentiating severe RF from mild-moderate RF were -343.81 ms (ΔT 1 ) and 0.8359 (T 1 %) with high sensitivity [both 100% (66.4-100%)] and specificity [ΔT 1 : 90.6% (79.3-96.9%); T 1 %: 94.3% (84.3-98.8%)]., Conclusions: ΔT 1 and T 1 % overwhelm T 1 -C for assessment of renal function and RF in CKD patients. ΔT 1 and T 1 % identify patients with <25% and >50% fibrosis, which can guide clinical decision-making and help to avoid biopsy-related bleeding., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-22-1304/coif). The authors have no conflicts of interest to declare., (2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

BACKGROUND. PI-RADS version 2.1 (v2.1) introduced a number of key changes to the assessment of transition zone (TZ) lesions. OBJECTIVE. The purpose of this study was to evaluate interobserver agreement and diagnostic accuracy for detecting TZ prostate cancer (PCa) and clinically significant PCa (csPCa) by use of PI-RADS v2 and PI-RADS v2.1 among radiologists with different levels of experience. METHODS. This retrospective study included 355 biopsy-naïve patients who from January 2017 to March 2020 underwent prostate MRI that showed a TZ lesion and underwent subsequent biopsy. PCa was diagnosed in 93 patients (International Society of Urological Pathology [ISUP] grade group 1, n = 34; ISUP grade group ≥ 2, n = 59) and non-cancerous lesions in 262 patients. Five radiologists with varying experience in prostate MRI scored lesions using PI-RADS v2 and PI-RADS v2.1 in sessions separated by at least 4 weeks. Interobserver agreement was evaluated with kappa and Kendall W statistics. ROC curve analysis was used to evaluate performance in detection of TZ PCa and csPCa. RESULTS. Interobserver agreement among all readers was higher for PI-RADS v2.1 than for PI-RADS v2 (mean weighted κ = 0.700 vs 0.622; Kendall W = 0.805 vs 0.728; p = .03). The pooled AUC values for detecting TZ PCa and csPCa were higher among all readers using PI-RADS v2.1 (0.866 vs 0.827 for TZ PCa; 0.929 vs 0.899 for TZ csPCa; p < .001). For detecting TZ PCa, the pooled sensitivity, specificity, and accuracy were 86.9%, 79.4%, and 75.4% among all readers for PI-RADS v2.1 compared with 79.4%, 71.8%, and 73.8% for PI-RADS v2. For detecting TZ csPCa, the pooled sensitivity, specificity, and accuracy were 84.8%, 90.9%, and 89.9% among all readers for PI-RADS v2.1 compared with 81.4%, 89.9%, and 88.5% for PI-RADS v2. Reader 1, who had the least experience, had the lowest sensitivity, specificity, and accuracy (78.0%, 89.2%, and 87.3%). Reader 5, who had the most experience, had the highest sensitivity, specificity, and accuracy (88.1%, 92.9%, and 92.1%) in detecting csPCa. CONCLUSION. PI-RADS v2.1 had better interobserver agreement and diagnostic accuracy than PI-RADS v2 for evaluating TZ lesions. Reader experience continues to affect the performance of prostate MRI interpretation with PI-RADS v2.1. CLINICAL IMPACT. PI-RADS v2.1 is more accurate and reproducible than PI-RADS v2 for the diagnosis of TZ PCa.

Objective: To establish the method of recording auditory brainstem responses electrically stimulated via round-window niche in cochlear implants., Methods: Self-made platinum iridium alloy as a spherical electrode stimulation electrode, modified cochlear implants connected to in vitro speech processor as a electro-stimulator and evoke potential instrument for Bio-logic Navigator Pro, 17 cochlear implant patients with various ages and of different causes, including auditory neuropathy (2 cases), ossified cochlea (1 case), inner ear malformation (5 cases), leukodystrophy (1 case), unknown and reason (8 cases) were investigated during cochlear implant surgery. Before cochlear implantation, stimulation electrode was placed in the round-window niche while charge balanced biphasic constant current was used as electrical stimulation via round window niche, and then electrically evoked auditory brainstem response was recorded., Results: Electrically evoked auditory brainstem response waveforms were clearly recorded in all 17 cases. The latencies of III and V waves were (2.12 +/- 0.18) ms and (4.18 +/- 0.19) ms respectively, with threshold as (220.0 +/- 16.04) CL. The waveforms of the 2 patients with auditory neuropathy, 5 patients with inner ear malformation, 1 patient with ossified cochlea and 1 patient with leukodystrophy were well differentiated., Conclusions: Monitoring electrically evoked auditory brainstem response was an objective nerve electrophysiological testing method that accurately reflects function completeness of auditory pathway. It had important value for helping making the judgment whether patients could acquire auditory response after cochlear implantation. This method was safe and gave high emission of auditory response, therefore should be spread widely.

Objective: To approach the incidence rate, symptoms, etiologies, correlating reasons, consequences and treatments of local responses caused by implant after cochlear implantation and to provide reference for the future works., Methods: From 1995 to 2007 there were 997 cases adopted cochlear implantation in Peding Union Medical College Hospital. Ten cases experienced local responses were analyzed retrospectively., Results: The incidence of local response was 1.003%. There were 6 males and 4 females. The ages were between 13 months to 8 years old. The average age was 34 months. The devices mainly were made by Cochlear and Med-EL companies. The mainly symptoms and signs were local swellings, complaint of pruritus after ear, decrease of sound legibility and so on. Onset frequencies of this disease was 1 to 8 times. The bacterium cultured of displacing liquids was negative. But the IgE was detected in 2 cases. Results showed the patients were midrange status of hypersensitivity. Positive conservative treatments must be done including antibiotics, antihistamines, necessarily using immunotherapy., Conclusions: Besides local infection of bacteria, the allergy caused by silicone of implant coupled be a reason. Although the diagnose of this disease was difficult, but the screening of source of hypersensitivity was necessary before operation. It was recurrent attacks and maybe liable by kindred patients. Onset age was more below 4 years old. The patch test should be done again when the symptoms were occurrence after operation. If severe secondary infection was occurred and the states could not be well controlled the devices in the body must be explanted immediately. When the conditions were stable reimplantation could be experienced by non-sensibilisinogen devices.

Objective: To determine the prevalence of SLC26A4 (PDS) gene mutations in cochlear implant recipients with inner ear malformation, and the correlation between SLC26A4 (PDS) gene mutation and inner ear malformation and intra-operative testing of the electrically evoked auditory nerve compound action potentials (ECAP)., Methods: Peripheral blood samples were collected from 48 cochlear implant recipients with temporal bone malformation and 50 healthy controls. Genomic DNA was extracted from the blood; PCR and direct sequencing were used to detect the mutations of SLC26A4 (PDS) gene. During the implantation of artificial cochlea the 48 recipients underwent intraoperative neural response telemetry (NRT) to measure the electrically evoked auditory nerve compound action potentials (ECAP)., Results: SLC26A4 (PDS) mutations were detected in 70.3% (26/37) of the patients with enlarged vestibular aqueduct (EVA), and 18.2% (2/11) of the patients with other malformations of inner ear. Fifteen different mutations were identified, 8 of which had never been previously reported. The IVS7-2A>G mutation was the most prevalent mutation of SLC26A4 (PDS) gene, accounting for 45.9% (17/37) in the EVA patients. No association was detected between SLC26A4 mutation and ECAP., Conclusion: Mutations in the SLC26A4 (PDS) gene is a major cause of EVA, with IVS7-2A>G as the most common mutation form.

Objective: To evaluate the indications, surgical techniques and complications of cochlear implantation in patients with otitis media-related diseases., Methods: Retrospective study of the data collected from patients receiving cochlear implantation. Totally 866 cases of cochlear implantation were performed in Peking Union Medical College Hospital from May 1995 to February 2006. Among which, 41 patients with otitis media-related diseases were grouped into 5 types: chronic secretory otitis media (13 cases), silent (subclinical) otitis media (18 cases), dry eardrum perforation (1 case), bilateral cholesteatoma of middle ear (2 cases) and middle ear granuloma (7 cases). Seven cases were accompanied with deformities of middle ear and (or) inner ear. Pedicled aponeurosis of occipitofrontalis muscle was transplanted to cover and protect the inserted electrodes and facial nerve in a patient with bilateral cholesteatoma after radical mastoidectomy., Results: All the 41 patients with otitis media-related diseases were successfully implanted in one stage or staged operations and followed up uneventfully for 5 months to 6 years and 11 months. All implant devices had worked normally and all patients had performed well., Conclusions: Patients with chronic secretory otitis media, silent (subclinical) otitis media, middle ear granuloma or dry ear-drum perforation could be operated in one stage or staged procedures safely and effectively. Patients with bilateral cholesteatoma could be implanted after radical removal of related lesions. Pedicled aponeurosis of occipitofrontalis muscle could be transplanted in cases of mastoid bowl to cover and protect the inserted electrodes and the exposed facial nerve and with easy access to observe the mastoid cavity. Active suppurative otitis media was contraindicated for cochlear implantation. Long-term following-up was essential for better evaluation of the outcomes of cochlear implantation in patients with otitis media-related diseases.

Objective: To determine the prevalence of GJB2 gene mutations in patients undergoing cochlear implantation., Methods: We enrolled 115 cochlear implant recipients for mutation screening. Genomic DNA was extracted from the blood of all patients, amplified in PCR and analyzed for single strand conformation polymorphism (SSCP) or direct sequencing to detect mutations of GJB2 gene., Results: The result shows that the GJB2 mutations are detected in 36.5% (42/115) of the cochlear implant recipients, and especially 41% (41/100) of the non-syndromic deafness patients, only 1 inner ear malformation patient was detected with GJB2 mutations. This study found 11 different variations in the GJB2 gene. The 235delC mutation was the most prevalent mutation accounting for 18.3% (41/230) in all cochlear implant recipients and 21% (42/200) in non-syndromic deafness group. 187G > T and 230G > A mutations were novel mutation of GJB2 gene in the Chinese population., Conclusion: Mutations in the GJB2 gene were a major cause of deafness in cochlear implant recipients, the carrier frequency of 235delC mutation was highest.

Objective: To observe voice characteristic of pre-lingual cochlear implant adults for cochlear implantation and phoniatrics., Methods: 3s-sustained voice of vowel [ a: ] of 28 pre-lingual cochlear implant adults, 18 pre-lingual deafness adults and 10 adults with normal hearing were analyzed. Specifically, the Voice analyses include fundamental frequency, first formant, second formant, frequency perturbation quotient (FPQ), amplitude perturbation quotient (APQ) and harmonic noise ratio (HNR). The outcomes of 3 groups were compared., Results: The fundamental frequency was lower in cochlear implant group [(175.42+/-25. 31) Hz] than that in deafness group [(210.84+/-54.300) Hz] (P = 0.02). The position of formant of cochlear implant group [F2 = (1264. 64 +/- 152.19) Hz] was more access to normal than that of normal hearing group[ F2 = (1422.44 +/- 232. 37) Hz, P = 0. 02]. FPQ of cochlear implant group (2.09 +/- 1.15) was more access to normal than that of deafness group (5.32+/-4.29, P=0.006). The voice of cochlear implanted and deafness adults were much more different individually., Conclusions: In the aspect of acoustic characteristic of voice, pre-lingual cochlear implant adults could benefit cochlear implantation finitely. As speech perception of pre-lingual cochlear implant adults was far worse than that of children and post-lingual cochlear implant adults, the general outcome of pre-lingual cochlear implant adults was very limited. Cochlear implant of those candidate should be cautious.

Objective: To summarize and analyze the etiology, surgical indications, operation methods and outcomes of cochlear implantation., Methods: 533 cases (534 ears) with severe and profound hearing loss received cochlear implant, 489 were pre-lingual deafness and 38 cases were post-lingual deafness. Their ages at implant, 1 to approximately 3 were 167, approximately 5 were 77, approximately 7 were 73, approximately 14 were 136, approximately 17 were 28, >17 were 52. 76 cases (14. 3%) were found the middle and inner ear malformations. That included Mondini 26 in cases, Common cavity in 10 cases and Large vestibule aqueduct syndrome in 20 cases. The average pure tone threshold were 105.5 dB HL, ABR threshold were >95 dB nHL and 40 Hz threshold in 500 Hz were 101.7 dB. The devices they used were Nucleus 22M in 27 ears, 24M in 308 ears, 24R Contour in 131 ears and 24R ST in 21 ears; Med El C40+ in 44 ears; Clarion CI in 3 ears. Facial recess approach was performed in normal cases, and in Common cavity cases horizontal semicircular canal approach was used. Preoperative hearing and speech evaluations were done in most cases., Results: In 26 Mondini case, gusher were happened in 20 cases. The insertion depth in normal cases: Nucleus were 30 bands, Med El were 31 mm. In Mondini cases, Nucleus were 28 bands. In Common cavity cases, Nucleus were 26 bands. Of 533 cases, The average of open set sentences discrimination of post-lingual deafness was 70%, the satisfaction rate of questionnaire for pre-lingual deafness under 17 years old was 94.7%., Conclusions: Cochlear implant is a useful method to restore the hearing of the patients with severe and profound hearing loss. It is important for the outcomes with proper preoperative assessment, surgery and postoperative speech and hearing evaluations.

Objective: To investigate tone recognition and electrode discrimination in prelingually deafened children with the Nucleus device, and to develop guidelines for customized mapping in the implant users., Methods: Fourteen prelingually deafened children with cochlear implants participated in this study. Tone recognition was measured with a four-alternative, forced choice procedure from 25 consonant-vowel syllables, each of which had four tonal variations. Electrode discrimination was measured using a same-difference procedure on 7 pairs of electrodes covering the entire electrode array., Results: Tone recognition ranged from 35% to 99% correct with a mean of 62.8% and standard deviation of 14.7% in these users. Electrode discrimination had the mean threshold of 3.4 +/- 0.9, with the best performance from the middle electrodes (E 14 and E 17) at 2.6 and the followed performance at the most apical electrode (E 20)., Conclusion: The results showed significant individual differences from both tone recognition and electrode discrimination, but there is significant correlation between them.

Objective: To investigate the attenuation of cisplatin-induced toxicity in the spiral ganglion neuron (SGNC) by the localized expression of the neurotrophin-3 (NT-3) and glial cell line-derived nerutrophic factor (GDNF) via HSV-Amplicon., Methods: We constructed the HSV-Amplicon vectors, which could express the NT-3 and GDNF under separate transcriptional control. Helper virus-free amplicon stocks were assessed in vitro for their capacity in the cultured inner ear cells. The ELISA was used to detect the production of NT-3 and GDNF. Three groups of mice were injected with cisplatin (8 mg/kg), followed by instillation of HSVnt-3myc/gdnf, HSVnt-3myc/lac or HSVlac. The numbers of SGNC were analyzed 4 weeks later., Results: The HSVnt-3myc/gdnf transduction resulted in production of NT-3 up to 11.44 micro g/ml and GDNF up to 1.79 ng/ml in cultured medium over 48 h. There were significant differences among three groups (P < 0.01). Cochleae transduced with HSVnt-3myc/gdnf and HSVnt-3myc/lac harbored from the mice had greater number of surviving SGNC. The ratio of SGNC survival (%) in HSVnt-3myc/gdnf, HSVnt-3myc/lac and HSVlac was 88%, 77% and 22%, respectively., Conclusion: The transduction of NT-3/GDNF by HSV-Amplicon greatly attenuated SGNC the cisplatin-induced ototoxicity in mice.

Objective: To evaluate the intraoperative obstacles and post-operative outcomes of cochlear implantation in children with enlarged vestibular aqueduct syndrome., Methods: Between May 1995 and June 2002, 10 patients with enlarged vestibular aqueduct syndrome received cochlear implantation in Pekin Union Medical College Hospital. The clinical records of 10 cases of enlarged vestibular aqueduct syndrome were analyzed retrospectively., Results: Via cochleostomy pulsatile clear fluid gusher occurred in 8 cases, which were easily controlled by quickly inserting the electrode array and sealing the cochleostomy with muscle tissue in each instance. The implant was inserted without difficulty in all patients. There have been no post-operatively complications, and audiologic outcome of the 10 patients with cochlear implantation were almost the same as the other patients without inner ear malformations. Five cases of them can even speak better than the other prelingual deafness that may be attributed in part to postlingual deafness., Conclusions: Despite pulsatile clear fluid gusher in cochlear implantation, no post-operatively complications have been found, and the outcome of these 10 patients with cochlear implantation was excellent. Cochlear implantation can be safely and effectively performed in patients with profound sensorineural hearing loss (SNHL) associated with enlarged vestibular aqueduct syndrome.