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Test results and management data are summarized for 260 patients with diagnoses of Auditory Neuropathy Spectrum Disorder (ANSD). Hearing aids were tried in 85 of these patients, and 49 patients tried cochlear implants. Approximately 15% reported some benefit from hearing aids for language learning, while improvement in speech comprehension and language acquisition was reported in 85% of patients who were implanted. Approximately 5% (13/260) of the total population developed normal speech and language without intervention. Patients were diagnosed at our laboratory (n=66) or referred from other sites (n=194), and all showed absent/grossly abnormal auditory brainstem responses (ABR), often 'ringing' cochlear microphonics, and the presence or history of otoacoustic emissions. Etiologies and co-existing conditions included genetic (n=41), peripheral neuropathies (n=20), perinatal jaundice and/or anoxia and/or prematurity (n=74). These patients comprise 10% or more of hearing impaired patients; their language acquisition trajectories are generally unpredictable from their audiograms. [ABSTRACT FROM AUTHOR]

We extracted a subpopulation of 136 patients (from our database of 257 AN/AD subjects) in whom middle ear muscle reflexes had been measured. None showed normal reflexes at all frequencies tested. Only three subjects showed any reflexes at 95 dB HL or below, but never at both 1 and 2 kHz in both ears whether ipsilaterally or contralaterally elicited. All the other reflex measures in these remaining 133 patients were either absent or observed above 100 dB HL, which is incongruous with their normal otoacoustic emissions throughout the frequency bands. Therefore, we urge colleagues to test ipsilateral middle ear muscle reflex at least at 1 kHz and 2 kHz in any perinatal hearing screening that depends solely on otoacoustic emissions. If the emissions are present and the reflexes are absent or elevated, an ABR may be required to properly intervene, because the management of AN/AD patients often differs drastically from what the behavioral audiogram or the ABR suggest. [ABSTRACT FROM AUTHOR]

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Background: Previous studies have demonstrated that proactive psychiatric consultation reduces hospital length of stay (LOS) in the general medical setting; however this model has not been studied in the intensive care unit (ICU)., Objective: To compare outcomes between a conventional consultation model and a proactive psychiatric consultation model., Methods: Two medical ICUs (MICUs) were randomized to proactive psychiatric consultation vs conventional consultation psychiatric models. Proactive consultation included embedding a psychiatrist into daily MICU team rounds on all patients. In the conventional consultation MICU, psychiatric consultations were activated when deemed necessary. Primary outcomes were hospital LOS and MICU LOS. Secondary outcomes included delirium-coma-free hours and ventilator-free hours., Results: A total of 429 patients were admitted to the proactive consultation MICU; 393 patients were admitted to the conventional consultation MICU. The consultation rate for the intervention group was 24.2% vs 6.1% in the control group (p < 0.001). Time to psychiatric consultation was shorter in the intervention group. Median hospital LOS was 6.92 days, interquartile range 3.70-14.31 in the intervention group vs 7.69 days, interquartile range 3.95-16.21 in the control group (p = 0.113). MICU LOS, delirium-coma-free hours, and ventilator-free hours were not significantly different between the 2 groups. Among the respiratory failure subgroup, hospital LOS was shorter in the intervention vs control group (median 9.46 days, interquartile range 4.95-17.56 vs 12.29 days, interquartile range 6.58-21.10, p = 0.011)., Conclusions: Proactive psychiatric consultation in a MICU was associated with decreased time to consultation among all patients and shorter hospital LOS among patients with respiratory failure., (Copyright © 2018 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Acute cartilage injuries induce cell death and are associated with an increased incidence of osteoarthritis development later in life. The objective of this study was to investigate the effect of posttraumatic cyclic compressive loading on chondrocyte viability and apoptosis in porcine articular cartilage plugs., Hypothesis: Compressive loading of acutely injured cartilage can maintain chondrocyte viability by reducing apoptosis after a traumatic impact injury., Study Design: In vitro controlled laboratory study., Level of Evidence: Level 5., Methods: Each experiment compared 4 test groups: control, impact, impact with compressive loading (either 0.5 or 0.8 MPa), and no impact but compressive loading (n = 15 per group). Flat, full-thickness articular cartilage plugs were harvested from the trochlear region of porcine knees. A drop tower was utilized to introduce an impact injury. The articular plugs were subjected to two 30-minute cycles of either 0.5 or 0.8 MPa of dynamic loading. Cell viability, apoptosis, and gene expression of samples were evaluated 24 hours postimpaction., Results: Cell viability staining showed that 0.5 MPa of dynamic compressive loading increased cell viability compared with the impact group. Apoptotic analysis revealed a decrease in apoptotic expression in the group with 0.5 MPa of dynamic compressive loading compared with the impact group. Significantly higher caspase 3 and lower collagen II expressions were observed in impacted samples without compressive loading, compared with those with. Compressive loading of nonimpacted samples significantly increased collagen II and decreased caspase 3 expressions., Conclusion: In this porcine in vitro model, dynamic compressive loading at subphysiological levels immediately following impact injury decreases apoptotic expression, thereby maintaining chondrocyte viability., Clinical Relevance: Therapeutic exercises could be designed to deliver subphysiological loading to the injured cartilage, thereby minimizing injury.

Polar orbiting environmental satellites operated by the National Oceanographic and Atmospheric Administration acquire daytime and nighttime thermal infrared measurements of the earth's surface around the world at a spatial resolution of 1.1 km. Day-night pairs of this imagery from the Advanced Very High Resolution Radiometer (AVHRR) were processed to produce temperature maximum, temperature minimum, and diurnal temperature difference (dT) maps of the lower Nile River valley. Nile delta subsets of the dT maps for August 16, 1990 and February 14, 1991 were analyzed in detail. Values of dT at specific locations were derived using the median of 5 x 5 pixels centered on the latitude and longitude of 41 survey sites listed in 1935, 1983, and 1990 schistosomiasis surveys of the Nile Delta. A Spearman correlation coefficient matrix revealed an inverse relationship between site dT values for August 16, 1990 and February 14, 1991 and prevalence of Schistosoma mansoni in the 1935 and 1983 surveys. For S. haematobium, a positive association of site dT values and prevalence was seen for 1935 only. A significant association was observed between 1935 S. mansoni prevalence and that observed in 1983 and 1990; S. haematobium prevalence in 1935 was not correlated with the later surveys. The results suggest that AVHRR thermal difference maps reflect regional hydrologic conditions that can be used as a predictor of environmental risk of schistosomiasis for control program management.

Every infant under one year of age presenting with wheezing-associated respiratory illness in the town of Ekron, Israel, over a period of six months was examined. An unusually high 6-month incidence rate of 72.7/100 children was found in the general pediatric clinic which all town children attended. No clear explanation for the high incidence rate emerged, but genetic factors, infant feeding practices and crowding may play a role. The study confirms clinical impressions of a high prevalence of wheezing-associated diseases in Israel.