Cochlear Implantation Via the Middle Fossa Approach: Surgical and Programming Considerations

Objectives: To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases. Study Design: Retrospective case review. Setting: Tertiary-care referral center with a well-established cochlear implant program. Patients: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation. Interventions: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients. Main Outcome Measures: Complications, hearing thresholds, and speech perception outcomes were evaluated. Results: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP. Conclusion: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.

17 beta-Estradiol replacement in young, adult and middle-aged female ovariectomized rats promotes improvement of spatial reference memory and an antidepressant effect and alters monoamines and BDNF levels in memory- and depression-related brain areas

Clinical and experimental evidence suggest that estrogens have a major impact on cognition, presenting neurotrophic and neuroprotective actions in regions involved in such function. In opposite, some studies indicate that certain hormone therapy regimens may provoke detrimental effects over female cognitive and neurological function. Therefore, we decided to investigate how estrogen treatment would influence cognition and depression in different ages. For that matter, this study assessed the effects of chronic 17 beta-estradiol treatment over cognition and depressive-like behaviors of young (3 months old), adult (7 months old) and middle-aged (12 months old) reproductive female Wistar rats. These functions were also correlated with alterations in the serotonergic system, as well as hippocampal BDNF. 17 beta-Estradiol treatment did not influence animals' locomotor activity and exploratory behavior, but it was able to improve the performance of adult and middle-aged rats in the Morris water maze, the latter being more responsive to the treatment. Young and adult rats displayed decreased immobility time in the forced swimming test, suggesting an effect of 17 beta-estradiol also over such depressive-like behavior. This same test revealed increased swimming behavior, triggered by serotonergic pathway, in adult rats. Neurochemical evaluations indicated that 17 beta-estradiol treatment was able to increase serotonin turnover rate in the hippocampus of adult rats. Interestingly, estrogen treatment increased BDNF levels from animals of all ages. These findings support the notion that the beneficial effects of 17 beta-estradiol over spatial reference memory and depressive-like behavior are evident only when hormone therapy occurs at early ages and early stages of hormonal decline. (C) 2011 Elsevier B.V. All rights reserved.

Alteration of distortion product otoacoustic emission input/output functions in subjects with a previous history of middle ear dysfunction

Background: The aim of this study was to investigate the effects of sub-clinical alterations on the amplitudes and slopes of the DPOAE input-output responses from subjects with previous history of middle ear dysfunction. Material/Methods: The study included 15 subjects with and 15 subjects without a history of otitis media in the last 10 years. All participants were assessed with acoustic immittance, pure-tone audiometry, and DPOAEs. For the later, I/O functions and I/O slopes were estimated at 1501, 2002, 3174, 4004 and 6384Hz. Results: No statistically significant differences were found between the 2 groups in terms of behavioral thresholds. The group with a previous history of middle ear dysfunction presented significantly lower mean DPOAE amplitudes at 2002, 3174 and 4004 Hz. In terms of DPOAE slopes, no statistically significant differences were observed at the tested frequencies, except at 3174 Hz. Conclusions: Middle ear pathologies can produce subclinical alterations that are undetectable with traditional pure-tone audiometry. The data from the present study show that reduced amplitude DPOAEs are associated with a previous history of middle ear complications. The corresponding DPOAE slopes were affected at only 1 tested frequency, suggesting that the cochlear non-linearity is preserved. Considering these results, it remains to be elucidated to what degree the DPOAE amplitude attenuation interferes with higher-order auditory tasks.

Surgical complications in 550 consecutive cochlear implantation

Cochlear implantation is a safe and reliable method for auditory restoration in patients with severe to profound hearing loss. Objective: To describe the surgical complications of cochlear implantation. Materials and Methods: Information from 591 consecutive multichannel cochlear implant surgeries were retrospectively analyzed. All patients were followed-up for at least one year. Forty-one patients were excluded because of missing data, follow-up loss or middle fossa approach. Results: Of 550 cochlear implantation analyzed, 341 were performed in children or adolescents, and 209 in adults. The mean hearing loss time was 6.3 +/- 6.7 years for prelingual loss and 12.1 +/- 11.6 years for postlingual. Mean follow-up was 3.9 +/- 2.8 years. Major complications occurred in 8.9% and minor in 7.8%. Problems during electrode insertion (3.8%) were the most frequent major complication followed by flap dehiscence (1.4%). Temporary facial palsy (2.2%), canal-wall lesion (2.2%) and tympanic membrane lesion (1.8%) were the more frequent minor complications. No death occurred. Conclusion: There was a low rate of surgical complications, most of them been successfully managed. These results confirm that cochlear implant is a safe surgery and most surgical complications can be managed with conservative measures or minimal intervention.

Low Bone Mineral Density in Middle-Aged Breast Cancer Survivors: Prevalence and Associated Factors

Background: The aim of this study was to investigate the prevalence of low bone mineral density (BMD) and associated factors in middle-aged breast cancer survivors (BCS). Patients and Methods: A cross-sectional study was conducted with 70 BCS of 45-65 years of age undergoing complete oncology treatment. Logistic regression models were used to identify factors associated with low BMD (osteopenia and osteoporosis taken together as a single group). Results: The mean age of participants was 53.2 +/- 5.9 years. BMD was low at the femoral neck in 28.6% of patients and at the lumbar spine in 45.7%. Body mass index <= 30 kg/m(2) (adjusted odds ratio (OR) 3.43; 95% confidence interval (CI) 1.0-11.3) and postmenopausal status (OR adjusted 20.42; 95% CI 2.0-201.2) were associated with low BMD at the lumbar spine. Femoral neck measurements, age > 50 years (OR 3.41; 95% CI 1.0-11.6), and time since diagnosis > 50 months (OR adjusted 3.34; 95% CI 1.0-11.3) increased the likelihood of low BMD. Conclusion: These findings show that low BMD is common in middle-aged BCS. Factors were identified that may affect BMD in BCS and should be considered when implementing strategies to minimize bone loss in middle-aged women with breast cancer.

Morphology and surface sedimentation on the upper and middle continental slope off Uruguay

This paper presents for the first time a morphological and surface sediment characterization of the Uruguayan outer continental shelf and slope. The study is based on a high-resolution coverage using hydrographical, geomorphological and sedimentological sampling and several textural and productivity proxies. Along slope terraces and an important canyon system characterizes continental slope morphology, indicating that across- and down-slope sedimentary processes control large-scale sedimentation. Terraces represent the prolongation of the Argentinean Contouritic Depositional System that vanishes in the study area, presumably as a result of the dynamic of the Brazil-Malvinas confluence. Canyons incised in the upper slope are likely related to low-stand sea level conditions. At the outer shelf and shallow upper slope (170-250 m depth), off-shelf sand transport is inferred from the distribution of relict sand and reworked biogenic gravel. In the upper continental slope, the northern region is characterized by an erosive environment controlled by a steep slope and the southward flowing Brazil current. In the south, a depositional environment is enhanced by the presence of a gentler slope and seaward incised canyons and is mainly controlled by hemipelagic processes associated with nutrient-rich Sub-Antarctic Waters (SAW), by its confluence with South Atlantic Central Waters (SACW) and by the Rio de la Plata’s (RdlP) influence. Additionally, within the upper slope, the occurrence of igneous-metamorphic cobbles and pebbles in canyon and mound lag deposits suggests the influence of glacial fluvial discharge and/or iceberg transport processes. In the middle slope, sedimentation is controlled by thermohaline-induced deep-water bottom currents. The decreasing influence of the erosive Antarctic Intermediate Water (AAIW) is evident in a northward diminution in grain size. The variety of transport and sedimentary processes identified reflect the control of the Brazil-Malvinas confluence zone and the Rio de la Plata’s discharge.

The Social City : Middle-way approaches to housing and sub-urban golvernmentality in southern Stockholm, 1900-1945

This dissertation deals with the period bridging the era of extreme housing shortages in Stockholm on the eve of industrialisation and the much admired programmes of housing provision that followed after the second world war, when Stockholm district Vällingby became an example for underground railway-serviced ”new towns”. It is argued that important changes were made in the housing and town planning policy in Stockholm in this period that paved the way for the successful ensuing period. Foremost among these changes was the uniquely developed practice of municipal leaseholding with the help of site leasehold rights (Erbbaurecht). The study is informed by recent developments in Foucauldian social research, which go under the heading ’governmentality’. Developments within urban planning are understood as different solutions to the problem of urban order. To a large extent, urban and housing policies changed during the period from direct interventions into the lives of inhabitants connected to a liberal understanding of housing provision, to the building of a disciplinary city, and the conduct of ’governmental’ power, building on increased activity on behalf of the local state to provide housing and the integration and co-operation of large collectives. Municipal leaseholding was a fundamental means for the implementation of this policy. When the new policies were introduced, they were limited to the outer parts of the city and administered by special administrative bodies. This administrative and spatial separation was largely upheld throughout the period, and represented as the parallel building of a ’social’ outer city, while things in the inner ’mercantile’ city proceeded more or less as before. This separation was founded in a radical difference in land holding policy: while sites in the inner city were privatised and sold at market values, land in the outer city was mostly leasehold land, distributed according to administrative – and thus politically decided – priorities. These differences were also understood and acknowledged by the inhabitants. Thorough studies of the local press and the organisational life of the southern parts of the outer city reveals that the local identity was tightly connected with the representations connected to the different land holding systems. Inhabitants in the south-western parts of the city, which in this period was still largely built on private sites, displayed a spatial understanding built on the contradictions between centre and periphery. The inhabitants living on leaseholding sites, however, showed a clear understanding of their position as members of model communities, tightly connected to the policy of the municipal administration. The organisations on leaseholding sites also displayed a deep co-operation with the administration. As the analyses of election results show, the inhabitants also seemed to have felt a greater degree of integration with the society at large, than people living in other parts of the city. The leaseholding system in Stockholm has persisted until today and has been one of the strongest in the world, although the local neo-liberal politicians are currently disposing it off.

A corpus of Middle English medical prologues in the Sloane Collection of The British Libray: an introduction to the genre in prose

[ES] Esta tesis trata sobre los prólogos a textos ingleses de carácter médico escritos o copiados en forma de prosa durante el siglo XV. En este trabajo se han contemplado dos objetivos generales: por un lado, la creación de un corpus con todos los prólogos inéditos que cumplen con estos criterios y que se encuentran en la colección de Sloana en la British Library de Londres, según Voigts & Kurtz: Scientific an Medical Writtings in Old and Middle English: An Electronic Reference (2000); y por otro, la presentación de estod prólogos como conjunto, incluyendo: los datos recopilados sobre la codicología de los manuscritos, afiliación de los textos, sus fuentes y el dialecto utilizado. Asimismo, como parte de esta presentación, se aporta un análisis original de la estructura, forma y contenido de los materiales seleccionados para el estudio. El propósito de esta tesis es llenar un hueco en la literatura académica acerca de los prólogos a textos médicos escritos en inglés medieval tardío, tal y como lo señala Voigts (1982:54)

Relationships between running economy and mechanics in middle-distance runners

Running economy (RE), i.e. the oxygen consumption at a given submaximal speed, is an important determinant of endurance running performance. So far, investigators have widely attempted to individuate the factors affecting RE in competitive athletes, focusing mainly on the relationships between RE and running biomechanics. However, the current results are inconsistent and a clear mechanical profile of an economic runner has not been yet established. The present work aimed to better understand how the running technique influences RE in sub-elite middle-distance runners by investigating the biomechanical parameters acting on RE and the underlying mechanisms. Special emphasis was given to accounting for intra-individual variability in RE at different speeds and to assessing track running rather than treadmill running. In Study One, a factor analysis was used to reduce the 30 considered mechanical parameters to few global descriptors of the running mechanics. Then, a biomechanical comparison between economic and non economic runners and a multiple regression analysis (with RE as criterion variable and mechanical indices as independent variables) were performed. It was found that a better RE was associated to higher knee and ankle flexion in the support phase, and that the combination of seven individuated mechanical measures explains ∼72% of the variability in RE. In Study Two, a mathematical model predicting RE a priori from the rate of force production, originally developed and used in the field of comparative biology, was adapted and tested in competitive athletes. The model showed a very good fit (R2=0.86). In conclusion, the results of this dissertation suggest that the very complex interrelationships among the mechanical parameters affecting RE may be successfully dealt with through multivariate statistical analyses and the application of theoretical mathematical models. Thanks to these results, coaches are provided with useful tools to assess the biomechanical profile of their athletes. Thus, individual weaknesses in the running technique may be identified and removed, with the ultimate goal to improve RE.

New catalysts for the water gas shift reaction at middle-temperature

H2 demand is continuously increasing since its many relevant applications, for example, in the ammonia production, refinery processes or fuel cells. The Water Gas Shift (WGS) reaction (CO + H2O = CO2 + H2 DeltaH = -41.1 kJ.mol-1) is a step in the H2 production, reducing significantly the CO content and increasing the H2 one in the gas mixtures obtained from steam reforming. Industrially, the reaction is carried out in two stages with different temperature: the first stage operates at high temperature (350-450 °C) using Fe-based catalysts, while the second one is performed at lower temperature (190-250 °C) over Cu-based catalysts. However, recently, an increasing interest emerges to develop new catalytic formulations, operating in a single-stage at middle temperature (MTS), while maintaining optimum characteristics of activity and stability. These formulations may be obtained by improving activity and selectivity of Fe-based catalysts or increasing thermal stability of Cu-based catalysts. In the present work, Cu-based catalysts (Cu/ZnO/Al2O3) prepared starting from hydrotalcite-type precursors show good homogeneity and very interesting physical properties, which worsen by increasing the Cu content. Among the catalysts with different Cu contents, the catalyst with 20 wt.% of Cu represents the best compromise to obtain high catalytic activity and stability. On these bases, the catalytic performances seem to depend on both metallic Cu surface area and synergetic interactions between Cu and ZnO. The increase of the Al content enhances the homogeneity of the precursors, leading to a higher Cu dispersion and consequent better catalytic performances. The catalyst with 20 wt.% of Cu and a molar ratio M(II)/M(III) of 2 shows a high activity also at 250 °C and a good stability at middle temperature. Thus, it may be considered an optimum catalyst for the WGS reaction at middle temperature (about 300 °C). Finally, by replacing 50 % (as at. ratio) of Zn by Mg (which is not active in the WGS reaction), better physical properties were observed, although associate with poor catalytic performances. This result confirms the important role of ZnO on the catalytic performances, favoring synergetic interactions with metallic Cu.