Degree Of Elevation Research Articles

Clinical and electrocardiographic characteristics in patients with fulminant myocarditis.

BackgroundThe purpose of this study was to evaluate clinical and electrocardiographic characteristics in patients with fulminant myocarditis.MethodsA total of 72 patients were divided into three groups: pericarditis (control: n = 25), acute myocarditis (n = 27), and fulminant myocarditis (n = 20). Patients' characteristics and electrocardiograms on admission were retrospectively analyzed in the three groups.ResultsBNP levels in the fulminant group were significantly higher than those in the other two groups. ST elevation was observed at lead aVR in the fulminant myocarditis group, whereas ST depression was observed at lead aVR in the other groups (p = .001). The maximum degree of ST elevation among the three groups was similar. However, the number of ST‐elevation leads in the fulminant myocarditis group was significantly lower than that in the other groups (p = .004). The voltage of R wave in lead V5 in the fulminant myocarditis group was significantly lower than that in the other groups (p = .005). Moreover, in the Cabrera sequence, the prevalence of ST elevation in the inferior leads, aVR, and V3–V6 in the fulminant myocarditis group was significantly or nearly significantly lower than that in the other groups.ConclusionsIn fulminant myocarditis, ST‐segment elevation was observed in lead aVR, and contrarily, the number and extent of ST‐segment elevation and R wave voltage were smaller than those in the other groups. These results suggest that the number of myocytes with maintained action potential may be reduced following progressive myocardial damage and interstitial edema due to severe inflammation.

Clinical, Biochemical, and Echocardiographic Characteristics of Severe SARS-COV-2 Infection: Correlates of In-hospital Morbidity and Mortality

Background: Patients with cardiovascular disease are more susceptible to coronavirus disease 2019 (COVID-19) and have worse outcomes when infected. While multiple studies have reported an association between biochemical myocardial injury and consequent adverse events, these studies have been limited by a lack of echocardiographic data. This study reports a comprehensive echocardiographic evaluation of patients with severe COVID-19 at a large quaternary care hospital in New Jersey. Methods: Clinical, biochemical, and echocardiographic features of consecutive patients with severe COVID-19 undergoing echocardiography were studied. Clinical outcomes data including length of stay, requirement of mechanical ventilation, and in-hospital mortality were collected. Results: 987 patients with confirmed COVID-19 infection were treated at our institution of which 197 consecutive patients (20%) underwent echocardiographic evaluation. The median age of the cohort was 64 years. 38% of these patients were females, 23% had known CAD, and 21% had CKD. 55% of patients required mechanical ventilation and 49% required vasopressors, representing a critically-ill patient population with significant mortality of 44% during the index hospitalization. There was a high prevalence of echocardiographic abnormalities including right ventricular dilation (30%) or dysfunction (23%), left ventricular dysfunction (24%), and pericardial effusion (14%). Multiple biomarkers including troponin T, pro-BNP, D-dimer and CRP were strongly associated with echocardiographic abnormalities and in-hospital mortality. On Cox regression analysis, age (HR 1.03/year),pre-existing CAD (HR 2.7), and mechanical ventilation (HR 2.64) were the strongest independent predictors of in-hospital mortality. Conclusions: Severe COVID-19 infection is accompanied by a significant burden of echocardiographic abnormalities that are strongly correlated with higher degrees of inflammation and biomarker elevation. Additional investigation is warranted in assessing the role of a biomarker-guided approach for early cardiac surveillance using echocardiography to further risk stratify patients and tailor adjunctive therapy.

Efforts to Grow Entrepreneurship Among Students

This study means to dissect the execution of business training in tertiary establishments, its connection to the skills of graduates anticipated by the universe of work and other supporting abilities. The open joblessness rate in Indonesia is very high, arriving at 9-10% and incorporates taught jobless school graduated class. To conquer the elevated degree of instructed joblessness, encouraging business venture among students is considered significant. There are five fundamental substances in business venture, to be specific: (1) a solid will to work freely, have brilliant thoughts, and be hopeful in business, foster new, exceptional thoughts, draw in many individuals, particularly in the financial field; (2) the capacity to face challenges and decide; (3) readiness to think and act imaginatively and creatively; (4) eagerness to work cautiously, constantly and gainfully; (5) work with the soul of harmony and sound business morals..

First Look into the Use of Fish Scales as a Medium for Multi-Hormone Stress Analyses

Recent efforts have provided convincing evidence for the use of fish scale cortisol concentration in the assessment of long-term stress in fishes. However, cortisol alone is not sufficient to fully describe this state of long-term stress. Dehydroepiandrosterone (DHEA) is an androgen with actions that oppose those of cortisol. The means by which DHEA negates the effects of cortisol occurs in part via changes in the metabolism of cortisol to cortisone. The quantitation of cortisol, DHEA and cortisone could therefore provide a more comprehensive assessment of the overall status of physiological stress. As DHEA and cortisone have yet to be quantified within the fish scale, our first objective was to ensure our sample processing protocol for cortisol was applicable to cortisone and DHEA. Following this, we induced a state of long-term stress in goldfish (Carassius auratus). Some degree of elevation in all hormones was observed in the stressed fish scales. Additionally, cortisol and cortisone were significantly elevated in the stressed fish serum in comparison to controls while DHEA was undetectable in either group. Overall, these results suggest that fish scales provide an appropriate medium for the assessment of long-term stress in fishes via the quantitation of relevant steroid hormones.

Acute Heart Failure, 90-Day Mortality, and Gravitational Ischemia in the Brain.

During the 90 days following hospitalization for acute heart failure, the ejection fraction and type of discharge medications have been shown in clinical trials to have little effect on mortality. We examined the recent literature addressing brain-related etiologies of sudden death following heart failure. Two mechanisms of sudden unexpected death have been suggested to possibly result from four significant influences on pathophysiology in the brain. The two causes of sudden death are (1) severe cardiac arrhythmia and (2) neurogenic pulmonary edema. They are both mediated through the brainstem autonomic nuclei generally and executed specifically through the dorsal motor nucleus of the vagus nerve. The four significant influences on pathophysiology, all contributing to ischemia in the brainstem autonomic nuclei, are: (1) Hyper-stimulation of neurons in the solitary tract nucleus, increasing their metabolic requirements; (2) Inadequate blood flow at a vascular watershed terminus, perfusing the autonomic nuclei; (3) Additionally decreased blood flow, globally throughout the brain, following vasoconstriction related to relative hyperventilation and decreased pCO2 levels; (4) Gravitational ischemia in the brainstem caused by the weight of the cerebral hemispheres sitting above the brainstem. Changes in head tilt release gravitational ischemia in the brain. There is no specific head position relative to gravity that is considered favorable or unfavorable for an extended period of time, longer than 24 h. Even a small degree of head elevation, used in managing pulmonary congestion, may increase gravitational ischemia in the posterior fossa and brainstem. In this paper, we suggest a new and important research avenue for intervening in cardiac arrhythmias and preventing their occurrence through the non-invasive use of head-tilting and other head repositioning maneuvers. This could potentially help many geriatric patients with heart failure, who have decreased mobility in bed, and who tend to stay in one position longer, thereby increasing gravitational ischemia in the brain.

Automative vehicle computerization system

The genuine force of this undertaking lies not in direct selling of items, but rather in the development of more grounded associations with clients and conveying of an elevated degree of administration and backing, which thusly further develops association deals and its generosity. A help association is a business element that deals with overhauling a client system in the after deals area. As the quantity of clients and size of tasks expands, the association isolates the topographical region into administration regions and branch areas, to permit Engineers to be more receptive to the client needs. Vehicle computerization System is web application created in ASP.Net and it is carried out by utilizing windows apparatus. This application gives a simple and straightforward method for selling or buy vehicles on the web. Clients can strive divider the subtleties of the vehicles and can buy the vehicle. Clients can see every one of the subtleties of the vehicle and send a solicitation to buy the vehicle. The primary point of fostering this Vehicle computerization System is to give effective robotization administration to the vehicle organizations and vehicle adjusting focus.

165-LB: The Impact of COVID-19 Vaccination on Development of Hyperglycemic Crisis

Hyperglycemic crisis (HC) has been reported in patients with COVID-19 infection, but there is little data about HC following COVID-19 vaccination, with 10 patients described to date. We performed a retrospective observational study examining the correlation between COVID-19 vaccination and HC in adult patients admitted from 1/1/21-7/1/21 at our institution. There were 91 admissions for HC during the study period. Forty-one were admissions for diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) , 2 of which also had hyperglycemic hyperosmolar state (HHS) . In patients with type 2 diabetes (T2D) , there were 49 admissions for DKA, 6 of which also had HHS, and 1 admission for HHS alone. In patients with T1D, 17 admissions occurred following COVID-19 vaccination, ranging from <24 hours to more than 3 months after, including 1 new diagnosis of T1D. All cases had a trigger of insulin omission or other medical illness, including 7 with admission for COVID-19 infection. In patients with T2D, 20 DKA or overlap admissions and 1 HHS admission occurred following COVID-19 vaccination, ranging from 1 to 40 days after. Six of these patients had no clear trigger of medical illness or insulin omission, 3 of which were new diagnoses of T2D. Two were following the first vaccination and 4 following the second vaccination. Hemoglobin A1c at admission was >11% in all 6 of these patients. Among patients with T1D, there were no cases of HC that appeared to be attributable to COVID-19 vaccination. In patients with T2D, while there were six cases following vaccination with no other clear trigger, the degree of hemoglobin A1C elevation at the time of admission was suggestive of longer duration of poor glycemic control. Three of these cases did have acute symptom onset following vaccination within one week of presentation, so it is possible that HC was provoked by vaccination in these patients. While it is not clear that COVID vaccination leads to HC in T1D, it may be an acute trigger for HC in patients with T2D who have poor underlying glycemic control. Large scale population studies are needed to better assess rates of HC following COVID-19 vaccination. Disclosure K. L. Modzelewski: None. S. Alexanian: None.

Redesign Arabic Calligraphy Outline by using Bezier, Wang-Ball and Said-Ball Curves

In the history of the revitalization of traditional art in the modern world, Arabic calligraphy was one of the art phenomena. This research suggests using Bezier curves, Wang Ball curves, and Said-Ball curves to improve Arabic calligraphy. Our goal in calligraphy is to achieve a smooth beautifying contour of a character. The calligraphy outline, which was largely Arabic, was frequently applied in Bezier curve degrees two and three. As a result, the degree elevation for each curve was increased until it reached degree four, allowing for greater Bezier curve study. This paper presents the comparisons between those three curves by using the Arabic calligraphy "Aamin" as the subject. Curve fitting, curve manipulation, mixing, and merging of curves were all examples of how Bezier curves were employed in Computer Aided Design. Ball curves, also known as a generalized ball basis, are a type of curve that has arbitrary even and odd degrees. There were two types of generalized ball curves: Wang-ball curves and Said-ball curves, each with their own special position parameter. The best curves of the Bezier, Wang-Ball, and Said-Ball curves were combined to create "Aamin" calligraphy. All of the results were programmed into the MATLAB software and graphed. For the redesign “Aamin” calligraphy Bezier curve computes the best time compared to Wang-Ball and Said-Ball curve. The computation time in MATLAB software for the degree 2, degree 3 and degree 4 are 1.48 seconds, 1.52 seconds and 2.50 seconds respectively. The higher the degree elevation, the longer the computation time to generate "Aamin" calligraphy, according to these findings. This research provides the fundamental design and empirical findings in the process of improving the production of computerized Arabic calligraphy.

Inhibitors of IFN gene stimulators (STING) improve intestinal ischemia–reperfusion-induced acute lung injury by activating AMPK signaling

BackgroundAcute lung injury (ALI) caused by intestinal ischemia–reperfusion is a life-threatening disease. Interferon gene stimulator (STING) is a cytoplasmic DNA sensor that participates in the initiation of the inflammatory response. This study aims to establish whether C-176 (STING inhibitor) improves ALI under intestinal ischemia–reperfusion conditions.MethodsTo induce ALI, 72 male C57BL/6 mice were subjected to intestinal ischemia for 60 min and reperfusion for 3 h. Through intraperitoneal injection, C-176, a selective STING inhibitor, was injected 30 min before surgical treatment; meanwhile, compound C, an antagonist of adenosine monophosphate-activated protein kinase (AMPK), was administered 30 min after surgery. Based on immunofluorescence and Western blot assays, post-ALI assessments included lung water content (TLW), bronchoalveolar lavage fluid (BALF) protein, H&E staining, Masson staining, pulmonary pyroptosis [Gasdermin-D (GSDMD), cleaved caspase-1], and apoptosis (TUNEL, cleaved caspase-3).ResultsC-176 administration significantly attenuated intestinal ischemia–reperfusion-mediated ALI; this effect was reflected by exacerbated TLW and BALF protein, aggravated lung injury score, elevated degree of pulmonary fibrosis, increased TUNEL- and GSDMD-positive cells, and upregulated phospho-AMPK, cleaved caspase-1, cleaved caspase-3 and IFNβ mRNA expression. Moreover, C-176 increased phospho-AMPK under ALI conditions. Nonetheless, compound C partially reversed these beneficial effects.ConclusionC-176, a selective STING inhibitor, improves intestinal ischemia–reperfusion-mediated ALI, and its underlying mechanism may be associated with AMPK signal activation.

Identifying predictors for source culture positivity in children with acute musculoskeletal infections.

Identifying the causative bacterial pathogen for children with acute hematogenous musculoskeletal infections (MSKIs) allows for improved care. The purpose of our study was to determine if clinical markers could predict which patients will have a causative pathogen found on source culture alone, thus being highest yield to undergo operative diagnostic procedures. A single-center, retrospective cohort study was performed. Medical records for patients between 6months and 18 years of age admitted between July 2014 and September 2018 with a discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis were reviewed. Patients were stratified based on results of blood and source cultures. Predictors of interest were screened on a univariable basis with significant predictors retained in a multivariate analysis. There were 170 patients included. No predictors were significantly associated with increased odds of having a causative pathogen found on source culture alone. Degree of C-reactive protein elevation and history of fever were associated with decreased odds of being source culture positive, OR (95% CI); 0.92 (0.87, 0.98) and 0.39 (0.19, 0.81), respectively. Predictive modeling failed to identify children with MSKIs whose causative pathogen was found by source culture alone. It is difficult to predict which MSKI patients will be highest yield for operative diagnostic procedures.

CORRELATION BETWEEN PLATELET COUNT, D-DIMER AND DISEASE OUTCOME IN PATIENTS ADMITTED WITH COVID 19 DISEASE IN A TERTIARY CARE CENTRE

Corona virus disease 2019 (COVID 19) is a novel infectious disease which causes a spectrum of disease with respiratory and systemic inammation which leads to severe disease in 10 – 15 % of patients. Some patients develop a severe proinammatory state which can be associated with a unique coagulopathy leading to complications like ARDS and DIC. COVID 19 is a disease which lacks established laboratory markers available to evaluate illness severity and disease outcome. COVID 19 patients often have thrombocytopenia (5-41%) and appear to have increased platelet consumption, together with a corresponding increase in platelet production. The degree of D-dimer elevation positively correlates with morbidity in COVID 19 patients. Platelet count and D-dimer may be used as biomarkers to assess disease severity and may be useful for triaging patients and predicting the outcome of disease in resource limited settings.

BMI Metrics Are Poor Predictors of Pediatric Nonalcoholic Fatty Liver Disease Severity.

Background: Alternative BMI metrics are superior to BMI z score (BMIz) in tracking obesity but have not been evaluated in patients with nonalcoholic fatty liver disease (NAFLD). Our objective was to evaluate whether BMI-adjusted z score (BMIaz) or BMI expressed as a percentage of the 95th percentile (%BMIp95) are better predictors of degree of alanine aminotransferase (ALT) elevation, a surrogate for NAFLD severity, compared with BMIz in patients with NAFLD. Methods: A retrospective study of 776 subjects aged 2-18 years with BMIz > 1.0 followed in a NAFLD subspecialty clinic was conducted. Regression analysis was used to determine predictors of elevated ALT. Results: There was no association between BMIz, BMIaz, or %BMIp95 and degree of ALT elevation using linear or logistic regression. Conclusion: These results do not support the use of alternative BMI metrics for evaluating NAFLD severity. Future studies should investigate longitudinal assessments and correlation with histology.

IMMUNOHISTOCHEMICAL STUDY OF THE BRAIN AQUAPORIN-4 IN THE RAT ACUTE LIVER FAILURE MODEL

Acute liver failure as well as acute-on-chronic liver failure result in the development of acute hepatic encephalopathy (HE) characterized by the major pathophysiologic event in form of the brain edema formation. Among brain cells, astrocytes are considered to be a central cellular population most sensitive to ammonia exposure in HE being the primarily cellular source of glutamine synthetase for ammonia metabolism. Astrocyte swelling is considered to be a principal sign of acute HE, while the exact molecular mechanisms of this event are still not fully understood. According to current concepts on HE, alteration in AQP4 regulation can play one of the central roles in the brain edema development and progression in hyperammonemia states. Considering high region- and context-specific heterogeneity of astroglial populations in the CNS, AQP4 involvement in the links of HE can also sustain mentioned conventional diversity.
 The aim of the study: to determine the immunohistochemical level of the brain aquaporin 4 (AQP4) expression in the experimental acute liver failure in rats.
 Materials and methods. The study was conducted in Wistar rats: 5 sham (control) animals and 10 rats with acetaminophen induced liver failure model (AILF). The immunohistochemical study of AQP4 expression was carried out in the sensorimotor cortex, white matter, hippocampus, thalamus and caudate nucleus/putamen regions between 12 and 24 h after acetaminophen treatment.
 Results. Starting from the 6th hour after acetaminophen treatment all AILF-animals showed the progressive impairment of clinical signs of acute liver failure, evidenced histologically by spread liver centrilobular necrosis and finished in 6 rats by comatose state up to 24 h (constituted subgroup AILF-B, “non-survived”). 4 animals survived until the 24 h - subgroup AILF-A, “survived”. In the AILF-B group, starting from 16 to 24 hours after acetaminophen treatment, a significant (relative to control) regionally-specific dynamic increase AQP4 levels was observed in the brain: in the cortex – by 405.17 %, hippocampus – by 387.38%, caudate nucleus/putamen – by 314.11%; from 12th hour: in the thalamus – by 342.66% and subcortical white matter – by 297.77%; with the highest elevation of AQP4 expression in the cortex among other studied regions: by 5.05 times.
 Conclusions. AILF in rats induces dynamic increase in AQP4 levels in the cortex, hippocampus and caudate nucleus/putamen by 12th hours and in the white matter and thalamus – by 16th h after the acetaminophen overdosing with the highest elevation in the cortical region. The heterogeneity in the degree of AQP4 elevation among different brain regions potentially may indicate brain territories more susceptible for systemic toxic exposure and damage in acute liver failure. Furthermore, the earliest reliable increase of AQP4 levels in the cortex, hippocampus and caudate/putamen might propose the faster reactivity of the local astroglial populations in response to the hyperammonemia among other regions. Consequently, the later and lower rates of AQP4 elevation in the white matter might indicate local astroglia as less reactive and/or more protected from the harmful exposure at a certain time period of the experiment. The higher cortical levels of AQP4 in the non-survived animals compared to survived ones reflect the significance of AQP4-involving mechanisms in the aggravation of acute HE, as well as the role of AQP4 alterations in thanatogenesis in the conditions of acute liver failure.

Low-cost system for sunlight incidence angle measurement using optical fiber

The development and optimization of renewable energy systems are some of the most necessary topics to advance towards secure and sustainable energy models. Photovoltaic energy is one of those sustainable options that could contribute to the reduction of greenhouse gas emissions. The optimal angle of solar incidence producing the highest absorption in a day is an important parameter to install photovoltaic systems. This value is often estimated using simulation models based on geographic location; however, those models ignore the influence of nearby obstruction objects, albedo, and local weather conditions. Such a problem is addressed in this work by designing a system to estimate the optimum angle of solar incidence for the photovoltaic panels. The system is based on an arrangement of 33 measurement points spaced in arcs every 45 degrees in azimuth and every 22.5 degrees in elevation, which provides a wide range for analysis. The light captured by each optical fiber is transmitted to a flat array where the power is measured using a single RGB camera.

Damage and deterioration characteristics of basic magnesium sulfate cement-coral aggregate concrete exposed to elevated temperature

Different proportions of coral aggregate, coral sand and basic magnesium sulfate cement (BMSC) were used to prepare the basic magnesium sulfate cement-coral aggregate concrete (BMSC-CAC), which was applied in the island and marine engineering as a brand new type of concrete. The specimens of BMSC-CAC exposed to elevated temperature (100°C, 300°C, 500°C, 700°C, and 900°C) were tested by the non-destructive method to obtain the surface characteristics at different temperatures. A new parameter, elevated temperature damage (D), derived from continuous damage mechanics (CDM) was applied to indicate the degree of concrete damage after being exposed to elevated temperature. The surface characteristics of the specimen were changed significantly at different temperatures, especially the aggregate colours. The fitting relationship between ultrasonic velocity and temperature was established, which can be well used to fit different types of concrete. The elevated temperature damage degree (D) was defined by damage mechanics, and the mathematical relationship between D and the residual compressive strength was discussed.

Clinical spectrum and outcome of elevated serum transaminases in tropical infections among children aged one month to 18 years in an urban tertiary care centre: a prospective observational study

Background: Tropical infections are common in our country and occur with a variable elevation of transaminases in a majority of them and they pose as a differential diagnosis to the viral infections affecting the liver including COVID-19 and complications like HLH and also paracetamol toxicity. Aim was to study the clinical profile and degree of elevation of liver enzymes in tropical infections in children aged one month to18 years.Methods: A prospective observational study of children from one month to 18 years of age with tropical infections in Mehta's multispeciality hospitals, Chennai, India between June 2017 and May 2019 was analyzed. Elevation of liver enzymes was categorized as mild (1-3 fold), moderate (3-20 fold) and severe (>20 fold).Results: Dengue was the most common infection in our study and the majority (49.07%), followed by enteric fever (78.06%), malaria (27.27%) and leptospirosis (25%), all had a mild elevation of SGOT. Severe elevation of SGOT was seen in 25% of leptospirosis and less than 10% in malaria and none with scrub typhus. SGPT elevation was severe in 50% of leptospirosis. Dengue shock syndrome had a severe elevation of transaminases.Conclusions: The most common infection was dengue and the majority had mild elevation and those with shock had a severe elevation of transaminases whereas shock was not a feature in leptospirosis even in severe elevation in our study. Though liver enzymes were very much elevated, children recovered without any residual liver damage.

The influence of elevated international normalized ratio on complications following total shoulder arthroplasty.

Identifying preoperative risk factors for complications following total shoulder arthroplasty (TSA) has both clinical and financial implications. The purpose of this study was to determine the influence of different degrees of preoperative INR elevation on complications following TSA. Patients undergoing primary TSA from 2007 to 2018 were identified in a national database. Patients were stratified into 4 cohorts: INR of <1.0, INR of >1.0 to 1.25, INR of >1.25 to 1.5, and INR of >1.5. Postoperative complications were assessed. Multivariate logistic regressions were performed to adjust for differences in demographics and comorbidities among the INR groups. Following adjustment and relative to patients with an INR of <1.0, those with INR of >1.0-1.25, >1.25-1.5, and >1.5 had 1.6-times, 2.4-times, and 2.8-times higher odds of having postoperative bleeding requiring transfusion, respectively (p < 0.05 for all). Relative to patients with INR <1.0, those with INR of > 1.25-1.5 and INR of >1.5 had 7.8-times and 7.0-times higher odds of having pulmonary complications, respectively (p < 0.05 for both). With increasing INR levels, there is an independent and step-wise increase in odd ratios for postoperative complications. Current guidelines for preoperative INR thresholds may need to be adjusted for more predictive risk-stratification for TSA. III.

Multicenter, prospective, observational study of chemotherapy-induced dysgeusia in gastrointestinal cancer

PurposeDysgeusia is an adverse event caused by chemotherapy. Although retrospective studies have shown zinc administration improves dysgeusia, there have been no prospective studies. The present study examined effects of zinc therapy on dysgeusia in patients with gastrointestinal cancer.MethodsThis multicenter, prospective, observational study enrolled patients with dysgeusia during chemotherapy treatment. Patients received no intervention (control), polaprezinc p.o., or zinc acetate hydrate p.o., and serum zinc levels were measured at 0 (baseline), 6, and 12 weeks. Dysgeusia was assessed using CTCAE v5.0 and subjective total taste acuity (STTA) criteria using questionnaires at baseline and 12 weeks.ResultsFrom February 2020 to June 2021, 180 patients were enrolled from 17 institutes. There were no differences in mean baseline serum zinc levels among the groups (67.3, 66.6, and 67.5 μg/dL in the no intervention, polaprezinc, and zinc acetate hydrate groups, respectively. P = 0.846). The changes in mean serum zinc levels after 12 weeks were − 3.8, + 14.3, and + 46.6 μg/dL, and the efficacy rates of dysgeusia were 33.3%, 36.8%, and 34.6% using CTCAE and 33.3%, 52.6%, 32.7% using STTA in the no intervention, polaprezinc, and zinc acetate hydrate groups, respectively. The STTA scores improved in all groups, with significant improvement observed in the polaprezinc group compared with the no intervention group (P = 0.045).ConclusionThere was no significant correlation between the degree of serum zinc elevation and improvement in dysgeusia, suggesting that polaprezinc, but not zinc acetate hydrate, was effective in improving chemotherapy-induced dysgeusia.Trial registration.UMIN000039653. Date of registration: March 2, 2020.

20-Year-Old Man With Elevated Liver Tests

20-Year-Old Man With Elevated Liver Tests

Threshold Equalizing Noise Test Reveals Suprathreshold Loss of Hearing Function, Even in the "Normal" Audiogram Range.

Objectives:The threshold equalizing noise (TEN(HL)) is a clinically administered test to detect cochlear “dead regions” (i.e., regions of loss of inner hair cell [IHC] connectivity), using a “pass/fail” criterion based on the degree of elevation of a masked threshold in a tone-detection task. With sensorineural hearing loss, some elevation of the masked threshold is commonly observed but usually insufficient to create a “fail” diagnosis. The experiment reported here investigated whether the gray area between pass and fail contained information that correlated with factors such as age or cumulative high-level noise exposure (>100 dBA sound pressure levels), possibly indicative of damage to cochlear structures other than the more commonly implicated outer hair cells.Design:One hundred and twelve participants (71 female) who underwent audiometric screening for a sensorineural hearing loss, classified as either normal or mild, were recruited. Their age range was 32 to 74 years. They were administered the TEN test at four frequencies, 0.75, 1, 3, and 4 kHz, and at two sensation levels, 12 and 24 dB above their pure-tone absolute threshold at each frequency. The test frequencies were chosen to lie either distinctly away from, or within, the 2 to 6 kHz region where noise-induced hearing loss is first clinically observed as a notch in the audiogram. Cumulative noise exposure was assessed by the Noise Exposure Structured Interview (NESI). Elements of the NESI also permitted participant stratification by music experience.Results:Across all frequencies and testing levels, a strong positive correlation was observed between elevation of TEN threshold and absolute threshold. These correlations were little-changed even after noise exposure and music experience were factored out. The correlations were observed even within the range of “normal” hearing (absolute thresholds ≤15 dB HL).Conclusions:Using a clinical test, sensorineural hearing deficits were observable even within the range of clinically “normal” hearing. Results from the TEN test residing between “pass” and “fail” are dominated by processes not related to IHCs. The TEN test for IHC-related function should therefore only be considered for its originally designed function, to generate a binary decision, either pass or fail.