Efficacy of high dose systemic versus combined (systemic and intratympanic) corticosteroid therapy in idiopathic sudden sensorineural hearing loss: A prospective randomized trial and risk factor analysis

The pathophysiology and the proper treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) are an ongoing subject of debate. Locally or systemic administered corticosteroids are the most accepted drugs of treatment in reference to ISSNHL (idiopathic sudden sensorineural hearing loss), however, no strong evidence nor guidelines regarding their effectiveness yet exists. In our prospective, randomized, controlled trial 78 participants were enrolled. Patients were randomly assigned based on the day of admission to two groups according to treatment: group SS (n = 43) received intravenous systemic methylprednisolone alone, and group CT (n = 35) received intratympanic dexamethasone + systemic methylprednisolone. The primary outcome was to compare the hearing outcomes between the treatment groups based on different, widely accepted categories (Siegel, Kanzaki, modified Siegel and PTA4 gain). In consideration of the secondary outcome, we examined the effect of the various risk factors on the hearing improvement. No differences were detected regarding hearing improvement between the two groups, based on any criteria [Siegel's criteria (p = 0.604); Kanzaki's criteria (p = 0.720); modified Siegel's criteria (p = 0.524) and PTA 4 gain (p = 0.569)]. However, several clinical factors such as vertigo (p = 0.039), or cardiovascular comorbidity (p = 0.02) and the severity of initial hearing loss (p = 0.033) were found to bear a significant impact upon the hearing outcome. To the best of our knowledge, this is the first randomized controlled trial comparing high dose systemic and combination corticosteroid therapy in ISSNHL patients. Our findings suggest coexisting cardiovascular comorbidity, vertigo and severity of the initial hearing loss may bear a significantly higher impact upon hearing improvement, than the additional intratympanic steroid administration. The presented trial was registered in the European Union Drug Regulating Authorities Clinical Trials Database (name: Combinated systemic and intratympanic steroid therapy in idiopathic sudden sensorineural hearing loss, No.: 2017-000658-20) and with the ethical approval of The National Institute of Pharmacy and Nutrition (OGYÉI) (protocol No.: 7621, on 2017.02.16.).

Decreasing suicide mortality in Hungary – What are the main causes?

Introduction

Depression and suicidal behaviour are major public health problems everywhere but particularly in Hungary where until 2000 the suicide rate was among the highest in the world.

Objectives

To analyse the possible causes of declining national suicide rate of Hungary.

Methods

Review of the scientific literature on Hungarian suicide scene published in the last 40 years.

Results

The peak of Hungarian national suicide rate was in 1985 (46/100.000) but due to a steady and continuous, year by year decline, in 2019 it was only 16/100.000, which represents a more than 65% decrease. Rate of unrecognised/untreated mood disorders, availability of health/psychiatric care, antidepressant and lithium prescription, unemployment, smoking and alcohol consumption as well as lithium and arsenic contents of drinking water were the most investigated possible determinants of suicide mortality of the country. More widespread and effective treatment of psychiatric/mood disorder patients, decreased rate of unemployment and smoking as well as the continuously improving living standards were the most important contributors to the great decline of the national suicide rate. However, in 2020 – the first year of the COVID-19 pandemic – the national suicide rate rose by 16%, which was almost totally accounted for by the increase of suicides among males.

Conclusions

Suicidal behaviour is preventable in many cases, but as it is a complex, multicausal phenomenon, its prevention should involve several medical/psychiatric, psychosocial and community interventions.

Disclosure

No significant relationships.

Flow cytometric analysis of extracellular vesicle subsets in plasma: impact of swarm by particles of non-interest

Essentials Extracellular vesicles (EVs) in biological fluids are promising biomarkers for disease. Fluorescence-based flow cytometric analysis is suitable to detect low abundant EV subsets. Particles of non-interest can induce false-positive light scatter and fluorescent signals. Interference of particles of non-interest can be monitored by analyzing serial dilutions.

SUMMARY

Background Extracellular vesicles (EVs) in plasma are increasingly being recognized as potential biomarkers. EV analysis for diagnostic purposes should be robust and should allow analysis of EV subsets with a wide range of abundance and in a large number of patient samples. Flow cytometry offers possibilities to meet these criteria, as it allows multiparameter analysis of individual EVs. However, analysis of plasma EVs is challenging, because of their size and heterogeneity, and the presence of other submicrometer-sized particles in plasma that could interfere with EV analysis. Objectives To explore whether fluorescence-based flow cytometric analysis of EV subsets is suitable when the EVs of interest are present in low abundance in a background of non-labeled or differently labeled EVs and particles. Methods Fluorescently labeled EVs of interest were spiked at different ratios in full plasma, purified plasma components, or (non-)fluorescent polystyrene beads, and subsequently analyzed by flow cytometry with fluorescence threshold triggering. Results We found that light scatter detection of low-abundance or rare EV subsets during fluorescence threshold triggering was severely affected by particles of non-interest, owing to coincidence and swarming. Importantly, we show that interfering particles labeled with different fluorophores induced false-positive fluorescent signals on the particles of interest. These unwanted effects could only be discerned and controlled by performing serial dilutions and analyzing light scatter and fluorescence parameters. Conclusions We demonstrate how particles of non-interest in plasma can impact on the light scatter and fluorescence detection of low-abundance EVs of interest during fluorescence-based flow cytometric analysis, and provide a means to prevent erroneous data interpretation.

Reactions of tobacco genotypes with different antioxidant capacities to powdery mildew and Tobacco mosaic virus infections

The interactions of powdery mildew (Golovinomyces orontii) and Tobacco mosaic virus (TMV) with tobacco lines having down or upregulated antioxidants were investigated. Xanthi-nc, its salicylic acid-deficient NahG mutant, a paraquat-sensitive Samsun (PS) and its paraquat tolerant (PT) mutant were used. Cell membrane damage caused by H2O2 was significantly higher in NahG than Xanthi, whereas it was lower in PT than in PS. Leakage of ions from PT was reduced by the powdery mildew infection. On the other hand TMV inoculation led to a 6-fold and 2-fold elevation of ion leakage from hypersensitive resistant NahG and Xanthi leaves, respectively, whereas ion leakage increased slightly from susceptible PS leaves. G. orontii infection induced ribonuclease (RNase) enzyme activity in extracts from Xanthi and NahG (about 200-250% increase) and weakly (about 20-30% increase) from PS and PT lines. Pre-treatment with protein kinase inhibitor staurosporine or protein phosphatase inhibitor okadaic acid very strongly inhibited mildew development on tobacco lines. Our experiments suggest that protein kinases inhibited by staurosporine seem to be important factors, while protein phosphatases inhibited by okadaic acid play less significant role in TMV-induced lesion development. Both powdery mildew and TMV infections up-regulated the expression of PR-1b, PR-1c and WRKY12 genes in all tobacco lines to various extents.

Monocyte activation drives preservation of membrane thiols by promoting release of oxidised membrane moieties via extracellular vesicles

The redox state of cellular exofacial molecules is reflected by the amount of available thiols. Furthermore, surface thiols can be considered as indicators of immune cell activation. One group of thiol containing proteins, peroxiredoxins, in particular, have been associated with inflammation. In this study, we assessed surface thiols of the U937 and Thp1 monocyte cell lines and primary monocytes in vitro upon inflammatory stimulation by irreversibly labelling the cells with a fluorescent derivative of maleimide. We also investigated exofacial thiols on circulating blood mononuclear cells in patients with rheumatoid arthritis and healthy controls. When analysing extracellular vesicles, we combined thiol labelling with the use of antibodies to specific CD markers to exclude extracellular vesicle mimicking signals from thiol containing protein aggregates. Furthermore, differential detergent lysis was applied to confirm the vesicular nature of the detected extracellular events in blood plasma. We found an increase in exofacial thiols on monocytes upon in vitro stimulation by LPS or TNF, both in primary monocytes and monocytic cell lines (p<0.0005). At the same time, newly released extracellular vesicles showed a decrease in their exofacial thiols compared with those from unstimulated cells (p<0.05). We also found a significant elevation of surface thiols on circulating monocytes in rheumatoid arthritis patients (p<0.05) and newly released extracellular vesicles of isolated CD14⁺ cells from rheumatoid arthritis patients had decreased thiol levels compared with healthy subjects (p<0.01). Exofacial peroxiredoxin 1 was demonstrated on the surface of primary and cultured monocytes, and the number of peroxiredoxin 1 positive extracellular vesicles was increased in rheumatoid arthritis blood plasma (p<0.05). Furthermore, an overoxidised form of peroxiredoxin was detected in extracellular vesicle-enriched preparations from blood plasma. Our data show that cell surface thiols play a protective role and reflect oxidative stress resistance state in activated immune cells. Furthermore, they support a role of extracellular vesicles in the redox regulation of human monocytes, possibly representing an antioxidant mechanism.

Experimental study on the mechanical interaction between silicon neural microprobes and rat dura mater during insertion

In vivo insertion experiments are essential to optimize novel neural implants. Our work focuses on the interaction between intact dura mater of rats and as-fabricated single-shaft silicon microprobes realized by deep reactive ion etching. Implantation parameters like penetration force and dimpling through intact dura mater were studied as a function of insertion speed, microprobe cross-section, tip angle and animal age. To reduce tissue resistance, we proposed a unique tip sharpening technique, which was also evaluated in in vivo insertion tests. By doubling the insertion speed (between 1.2 and 10.5 mm/min), an increase of 10-35% in penetration forces was measured. When decreasing the cross-section of the microprobes, penetration forces and dimpling was reduced by as much as 30-50% at constant insertion speeds. Force was noticed to gradually decrease by decreasing tip angles. Measured penetration forces through dura mater were reduced even down to 11±3 mN compared to unsharpened (49±13 mN) probes by utilizing our unique tip sharpening technique, which is very close to exerted penetration force in the case of retracted dura (5±1.5 mN). Our findings imply that age remarkably alters the elasticity of intact dura mater. The decreasing stiffness of dura mater results in a significant rise in penetration force and decrease in dimpling. Our work is the first in vivo comparative study on microelectrode penetration through intact and retracted dura mater.

Introducing nanoscaled surface morphology and percolation barrier network into mesoporous silica coatings

The advantages of surface pattern and mesoporous character of silica thin films were combined, while preserving the interconnected pore system or creating laterally separated porous volumes surrounded by nonpermeable compact zones.

Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study

BACKGROUND

Osteoarthritis is the most frequent joint disease and is a leading cause of pain and locomotor disability in elderly people. The treatment of osteoarthritis includes non-pharmacological, pharmacological, and surgical therapies. Silver level evidence has been found concerning balneotherapy in osteoarthritis.

AIM OF THE STUDY

The aim of this study was to evaluate how Lake Hévíz thermal mineral water therapy influences pain, knee function, and quality of life in patients with knee osteoarthritis, compared to the control group.

STUDY DESIGN

randomized, controlled, single-blind, follow-up study.

SETTING

Spa Hévíz and St. Andrew Hospital for Rheumatic Diseases

POPULATION

This study included 77 outpatients between 45 and 75 years of age with mild to moderate osteoarthritis of the knee meeting the American College of Rheumatology classification criteria.

METHODS

Patients were randomized into two groups. In group I (n = 38), subjects bathed in Lake Hévíz and in group II (N.=39), patients were treated in a pool full of tap water. Water temperature was 34 °C for both groups. Participants underwent 30-minute therapy sessions, five times a week for three weeks. Outcome measures were pain visual analogue scale scores, active flexion degree, knee circumference, stair-climb time, Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and EuroQoL Group 5-Dimension Self-Report Questionnaire score (EQ-5D). Study parameters were recorded at baseline, immediately after treatment, and after 15 weeks.

RESULTS

Comparison of the two groups revealed a statistically significant difference in pain visual analogue scale scores (P<0.01), active flexion degree (P<0.01), physical function components of WOMAC (P<0.05), and EQ-5D scores (P<0.05) even after 15 weeks.

CONCLUSIONS

Balneotherapy improved pain, function as well as the quality of life in patients with knee osteoarthritis.

CLINICAL REHABILITATION IMPACT

Balneotherapy is a potentially useful treatment modality for patients with knee osteoarthritis.

[Systemic sclerosis and pregnancy. A review of the current literature]

Pregnancy in women diagnosed with systemic sclerosis generally has a favorable outcome according to most recent studies. Women with systemic sclerosis who wish to become pregnant should achieve low disease activity for at least 6 months prior to conception. Regular follow-up of pregnant scleroderma patients by an interdisciplinary medical team including gynaecologists and rheumatologists is necessary to control disease activity and avoid possible complications. Severe organ involvement, early diffuse systemic sclerosis with rapid onset, and pulmonary hypertension ought to discourage patients from pregnancy, as these situations are at high risk of complications for both mother and fetus during pregnancy.

Treatment of early hepatic artery complications after adult liver transplantation: A single center experience

Introduction

Hepatic artery complication represents recognized sequel of liver transplantation that carries significant morbidity and mortality. Besides retransplantation, hepatic artery recanalization is provided surgically, or by percutaneous angioplasty and stent placement. This study provides an analysis of a single center experience comparing surgical and interventional treatments in cases of early hepatic artery complications.

Methods

In this retrospective single center study, 25 of 365 liver transplant recipients were enrolled who developed early hepatic artery complication after transplantation. Percutaneous intervention was performed in 10 cases, while surgical therapy in 15 cases. Mean follow-up time was not different between the groups (505±377 vs. 706±940 days, respectively).

Results

6 patients in the Intervention Group and 10 patients in the Surgery Group are alive. The retransplantation rate (1 and 3) was lower after interventional procedures, while the development of biliary complications was higher. The mortality rate was higher after operative treatment (2 and 5).

Conclusion

Interventional therapy is a feasible and safe technique for treatment of early hepatic artery complication after transplantation. Being less invasive it is an invaluable alternative treatment having results comparable to surgical methods.

Long-term follow-up of patients with obsessive-compulsive disorder treated by anterior capsulotomy: a neuropsychological study

BACKGROUND

For treatment-refractory Obsessive-Compulsive-Disorder (OCD) patients, anterior capsulotomy is a potential therapy. We investigated what kinds of cognitive deficits treatment-refractory patients have and how anterior capsulotomy modifies their clinical and cognitive profiles.

METHODS

Ten treatment-refractory OCD patients were examined in two groups (operated and non-operated) with 5 participants in each group, matched for symptom severity, gender, age and education. The operated group was treated with anterior capsulotomy; the non-operated group was treated only with pharmaco- and psychotherapy. The Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS) was used to measure OCD symptoms, and ten neuropsychological tests were used to measure cognitive functioning.

RESULTS

In the operated group, the score of Y-BOCS score significantly decreased during the two-year follow-up period. Additionally, we found a significant increase in neuropsychological test scores on the Wechsler Intelligence Test (MAWI), California Sorting Test Part A (CST-A), Stroop Test Interference Score (STR-I), Verbal Fluency Test and Iowa Gambling Test. As a negative result, we observed intrusion errors in the Category Fluency Test. In the non-operated group significant improvement was found in Y-BOCS scores. At follow-up, we found significant differences between the operated and non-operated groups on three neuropsychological tests: Trail Making Test Part B, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Attention Index and RBANS Language Index, with better performance in the non-operated group.

CONCLUSIONS

Both treatment methods (i.e. anterior capsulotomy and pharmaco- and psychotherapy) seem effective in reducing OCD symptoms and cognitive deficits, but, importantly, to different degrees. The clinical and neuropsychological improvements were more impressive in the operated group.

Radiofrequency ablation of an intercalyceal neoplasm in a transplanted kidney using percutaneous nephrostomy for cooling — Safety and early result

Kidney neoplasms can occur after kidney transplantation in low percentage. In this report we delineate a rare case of neoplasm in the transplanted kidney detected on screening ultrasonographic examination. Due to the intercalyceal location of the tumor percutaneous radiofrequency ablation was planned with continuous cooling the collecting system avoiding the thermal damage. To the best of our knowledge this method has never been reported applying in transplanted kidney. The two-month CT follow-up verified no residual tumor and the kidney function remained in normal range during this period. These facts imply that the method can be safely applied.

Downstaging of hepatocellular carcinoma with radiofrequency ablation on the Hungarian liver transplantation waiting list — Early results and learned lessons

Hepatocellular carcinoma, which has developed in liver cirrhosis is a disease where liver transplantation can provide a cure both for the tumour and the underlying liver damage. However, patients can only be transplanted when the tumour number and size do not exceed the Milan criteria. Tumour ablation methods — such as radiofrequency ablation — can provide a chance to make the patient eligible for transplantation. Among the 416 Hungarian liver transplanted patients there are 6 who had received different types of ablative therapy as bridging therapy in different institutions. On the basis of analysis of the patients' data we created a guideline for the treatment of cirrhotic patients with hepatocellular carcinoma with the aim of developing a uniform Hungarian approach.

Ultrasound-guided, intraglandular injection of botulinum toxin A in children suffering from excessive salivation

Background: The aim of this study was to describe the authors' minimally invasive procedure developed to significantly decrease excessive salivation in children suffering from chronic neurological diseases, using botulinum toxin A.

Objective: Ultrasound-guided, intraglandular injection of botulinum toxin blocks the parasympathetic innervation of salivary glands, resulting in a temporary decrease in saliva production and improved quality of life, lasting about three to four months.

Materials and methods: Prior to introducing the method into clinical practice, animal experiments were conducted in order to verify the lack of histological changes three months following botulinum toxin administration. Twenty-one children were included in the clinical study, with ages ranging from two and a half to 14 years.

Results: The animal studies did not reveal any histological changes three months after botulinum toxin administration. Although botulinum toxin A proved to be ineffective in a single case, the majority of the other 20 patients responded well, with a highly significant reduction of their symptoms. The parents of 18 responder children requested repeated treatment with botulinum toxin A. However, two families refused to be further involved in the study, despite good results. The protein content of saliva, regulated by sympathetic innervation, was not affected by the treatment.

Conclusion: This minimally invasive method, applied repeatedly three to four times a year, may be a viable alternative to surgical procedures such as submandibular duct relocation, duct ligature or nervus tympanicus neurectomy.

Topographical organisation of projections from the nucleus isthmi magnocellularis to the optic tectum of the chick brain

The anatomical connection of the magnocellular isthmic nucleus with the optic tectum was investigated with the axonal tracer biotinylated dextran amine. Following iontophoretic injection of this tracer into different areas of the chick optic tectum, neurones of both magno- and parvocellular isthmic nuclei were labelled together in a topographical arrangement. The number of labelled neurones in the parvocellular nucleus was generally higher than in magnocellular. Using different locations of the tracer injections, systematic shifts in the location of the labelled neurones were detected. The labelled axons were seen to course along the shortest possible distance between the injection site and the cells of origin, i.e., the ventral part of the tectum received projections from neurones located ventrally in the isthmic nuclei, the dorsal tectum from neurones in the dorsal part, and the lateral extension of the tectum from neurones lying midway along the nuclei. This parallel and topographic projection of the two nuclei was primarily observed in sagittal sections. After tracer injections into the magnocellular nucleus, the terminal arbours were seen to extend from the deep layers (11-12) to layer 2 of the tectum. The projections observed appeared to be topographically organised, and furthermore appeared to be parallel with and complimentary to previously described projections of the parvocellular isthmic nucleus.

Anterograde tracer study on the nucleus geniculatus dorsalis and its internal synaptic structure in chick brain

In the present study the terminals of retinal fibres and those of internal layer cells in ventral geniculate nucleus of chicks were labelled with the anterograde tracer biotinylated dextran amine. The tracer showed the connections from the internal cell layers of ventral geniculate nucleus to the medial part of the dorsal lateral geniculate nucleus. The labelled retinal terminals were located exactly in the lateral part of nucleus. The labelled terminals in the two parts of the nucleus were analysed with the electron microscope and showed a different synaptic organisation in the two parts of the dorsal lateral geniculate nucleus. In the lateral part, two kinds of synaptic glomeruli were found mostly in the vicinity of large dendrites, which are proximal dendrites of projection neurons. One type is a simple glomerulus containing a large dendrite, a large optic terminal and a large and/or series of asymmetrical synapses surrounded by glial processes. The other type is a complex synaptic unit with several pre- and postsynaptic components, among them synapses of GABA-positive axon terminals and/or dendraxons. No glomeruli were found in the medial part of the nucleus. In the medial part of the lateral geniculate nucleus, the terminals of internal layer cell axons established asymmetrical synapses with dendrites. Often, a large terminals and large dendritic profiles established serial asymmetrical synapses. GABA-positive myelinated fibres entered and ramified in both parts of the dorsal lateral geniculate nucleus, and GABA-positive terminals were seen to form synapses on the same dendrite near to the asymmetrical contacts. To our knowledge, this is the first report of the connection from ventral geniculate internal layer cells to the dorsal lateral geniculate nucleus in the chick.

The axon arbourisation of nuclei isthmi neurons in the optic tectum of the chick and pigeon. A Golgi and anterograde tracer-study

The optic tectum is reciprocally connected to the nuclei isthmi pars magnocellularis (Imc) and pars parvocellularis (Ipc), which have different modulatory effects on optic transmission. We studied the axon arbourisation of these isthmic nuclei in the optic tectum in order to differentiate between them using Golgi-impregnated preparations both in chickens and pigeons. In addition, sections from animals injected with the anterograde tracer biotinylated dextran-amine (BDA) into the Imc were examined in the bright-field and electron microscope to identify the axon arbourisations and terminals. Also, GABA immunogold stained sections were examined in the electron microscope. In Golgi preparations, slab-like (or poplar tree-like) axon terminal arbourisations of both magnocellular and parvocellular isthmic nuclei neurons were found extending to the tectal surface, with similar branching patterns, but different lengths. The axon arbourisations extending from layer 5 of the optic tectum to the surface were termed type 1, whereas those extending from the internal (12-11) layers to the tectal surface were termed type 2. Type 2 arbourisations very closely matched arbourisations observed in BDA injected material, indicating that Imc neurons gave rise to type 2 arbourisations. The two kinds of axon arbourisation in the external tectal layers were alike in both types of bird, except for the width, which was about 10 mum larger in the type 2 axon arbour. Controlling for size, there was no significant difference between chicks and pigeons. The significance of these afferents in the optic tectum is discussed.