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Background/Purpose: This study measured the acceleration magnitude using a dummy model filled with various air-material ratios to elucidate the mechanism of resonance effect on ocular vestibular-evoked myogenic potential (oVEMP). Methods: With the percentages of air volume altered by filling various materials (water, glycerol, or ethanol) in an acrylic-made hollow spherical model, a minishaker was utilized to deliver vibration stimuli to the model. Then, acceleration magnitude of each model was measured. Results: Since the air was most occupied at the upper part of the model (z-axis), acceleration magnitude along the z-axis was selected for comparison. An increasing trend of the z-axis acceleration magnitude ranging 0.110–0.759 g was identified in air–water model with air volume percentage ranged 40–100%. On the other hand, a significant increasing trend of acceleration magnitude along the z-axis (0.157–0.759 g) was noted in air-glycerol model with 80–100% of air volume. While in air-ethanol model, a significant increasing trend in acceleration magnitude along the z-axis ranged 0.121–0.759 g correlating with 40–100% of air volume. Conclusion: The mechanism for eliciting oVEMP is via the first-order bone vibration coupled with the second-order resonance effect. Both percentage of air volume (i.e. frontal sinus) and density of filling media (i.e. skull property) may contribute to the resonance effect, which then increases the acceleration magnitude so as to enhance the elicitation of oVEMP.

Purpose: In advanced or high-grade prostate cancer (PCa), prostate-specific antigen (PSA) is usually elevated, however, some patients may present with low initial PSA (iPSA) levels. The objective of this study was to evaluate whether different iPSA levels were associated with dissimilar clinical outcomes among men with high-grade PCa and advanced disease after robot-assisted laparoscopic radical prostatectomy (RaLRP). Methods: This study enrolled 69 PCa patients with initial Gleason score ≥8 and pathologic T-stage ≥3a from April 2012 to December 2018. Patients were stratified into 3 groups based on iPSA levels at diagnosis:

Background/Purpose: The inflammatory milieu has been firmly established to affect cancer progression. However, the connection between natural killer (NK) cells and prostate cancer (PCa) has not been elucidated. Methods: Prospective data on NK cell activity (NKA) and NK cell subset distribution patterns were evaluated from 51 patients treated with robot-assisted laparoscopic radical prostatectomy. Whole-blood samples were collected from patients preoperatively and 4–6 weeks postoperatively. The samples were subjected to NKA tests, NK cell number counts, determination of the NKG2D (activating receptor of NK cells), NKG2A (inhibiting receptor), and other surface markers. All the analyses were compared to the clinicopathological characteristics of patients. NKA was estimated by measuring interferon-γ (IFN-γ) levels after stimulation of the peripheral blood with PROMOCA™, which specifically stimulates the release of IFN-γ from NK cells. Results: NKA was lower in patients with PCa than in healthy participants (484.66 vs. 1550 pg/mL). A paired comparison revealed significantly higher NKA postoperatively than preoperatively (1054 vs. 484.66 pg/mL; p = 0.011). Patients with negative surgical margins exhibited significantly higher postoperative NKA and NKA ratio (postoperative NKA/preoperative NKA) than those with positive margins (557 vs. 1921 pg/mL, p

Pediatric cardiac computed tomography (CT) is a noninvasive imaging modality used to clearly demonstrate the anatomical detail of congenital heart diseases. We investigated the impact of cardiac CT on the utilization of cardiac catheterization among children with congenital heart disease. Methods: The study sample consisted of 2648 cardiac CT and 3814 cardiac catheterization from 1999 to 2009 for congenital heart diseases. Diagnoses were categorized into 11 disease groups. The numbers of examination, according to the different modalities, were compared using temporal trend analyses. The estimated effective radiation doses (mSv) of CT and catheterization were calculated and compared. Results: The number of CT scans and interventional catheterizations had a slight annual increase of 1.2% and 2.7%, respectively, whereas that of diagnostic catheterization decreased by 6.2% per year. Disease groups fell into two categories according to utilization trend differences between CT and diagnostic catheterization. The increased use of CT reduces the need for diagnostic catheterization in patients with atrioventricular connection disorder, coronary arterial disorder, great vessel disorder, septal disorder, tetralogy of Fallot, and ventriculoarterial connection disorder. Clinicians choose either catheterization or CT, or both examinations, depending on clinical conditions, in patients with semilunar valvular disorder, heterotaxy, myocardial disorder, pericardial disorder, and pulmonary vein disorder. The radiation dose of CT was lower than that of diagnostic cardiac catheterization in all age groups. Conclusion: The use of noninvasive CT in children with selected heart conditions might reduce the use of diagnostic cardiac catheterization. This may release time and facilities within the catheterization laboratory to meet the increasing demand for cardiac interventions.

The technical and ergonomic details of laparoendoscopic single site (LESS) reconstruction have not been reported. In this study, we explored the feasibility and safety of performing advanced LESS upper urinary tract reconstruction with conventional laparoscopic instruments. Methods: Between September 2010 and March 2011, we retrospectively reviewed prospectively collected data from five patients who underwent LESS urinary tract reconstruction. The LESS reconstruction included pyeloureterostomy (N = 1), dismembered pyeloplasty (N = 2), ureteroneocystostomy (N = 1), and ureteroplasty for bifid blind ending ureter (N = 1). The perioperative and postoperative parameters were collected for analysis. The ergonomic principles and techniques are detailed. Results: All reconstructive LESS procedures were completed successfully without open conversion or laparoscopic conversion. Ancillary ports or ancillary instruments were not applied in any of the patients. The mean patient age was 40.4 years. The mean operative time was 213 ± 69 minutes, the estimated blood loss ranged from minimal to 50 mL, and the mean hospital stay was 4.4 ± 4 days. No operation-related complication occurred. Conclusion: Based on our ergonomic principles and suturing/knotting techniques, conventional laparoscopic instruments are feasible and safe for LESS urinary reconstructive procedures.

The efficacy of porcine small intestine submucosa (SIS) implants in hernia repair has rarely been reported and remained elusive. We herein report our experience to further elucidate the efficacy of SIS mesh in herniorrhaphy. Methods: Between June 2008 and October 2009, a total of 82 patients with 125 inguinal hernias undergoing endoscopic total extraperitoneal (TEP) herniorrhaphy were included. Seventy patients (with 108 hernias) had traditional polypropylene and 12 patients (with 17 hernias) had SIS mesh repair. Postoperative complications and recurrence rates were compared between the two meshes. Results: The demographics between two groups were similar. All operations were performed smoothly with laparoscopy, and the postoperative courses were uneventful. After a median follow-up of 18 months, five (7%) in the polypropylene group and three (25%) in the SIS group had chronic pain (p = 0.09). Five of 17 (29.4%) hernia repairs in the SIS group had an ipsilateral recurrence, compared to no recurrence in the polypropylene group. In the five cases, the second laparoscopy revealed the SIS mesh had been totally degraded and there was no obvious fibrotic tissue in the previous mesh sites. Conclusion: Our data suggest that the use of SIS mesh in endoscopic TEP herniorrhaphy might be associated with a high recurrence rate. The second look laparoscopy in these recurrent cases revealed slow and inadequate integration of host tissue. More evidence is still required to further evaluate the efficacy of SIS mesh in endoscopic TEP herniorrhaphy.

Early hearing rehabilitation programs eventually require measurement of the hearing threshold cutoff values over the whole range of speech frequencies. With tone burst auditory brainstem responses, excellent agreement and correlation between evoked-potential and behavioral thresholds have been demonstrated by previous studies. This study investigated the effects of different ages and degrees of hearing loss on the agreement and correlation in a large series of infants and young children in Taiwan. Methods: Medical records were reviewed from a large series of 1281 infants and young children aged from 3 months to 3 years who had undergone diagnostic audiometry, including sound field audiometry and tone burst auditory brainstem response measurements. The effects of age and hearing loss on the agreement and correlation between two measured thresholds were studied. Results: Significant correlations (p < 0.001) were seen between the two measured thresholds across groups of different ages and different degrees of hearing loss greater than 20 dB HL. However, the degree of correlation deteriorated at lower degrees of hearing loss. Correlations for hearing thresholds less than 20 dB HL were not significant at 1000, 2000 and 4000 Hz. Conclusion: The evoked-potentials test, properly obtained and interpreted with respect to the effects of age and degree of hearing loss, may provide a very informative hearing threshold reference to help in behavioral audiometric evaluation in infants and young children with hearing loss.

It is widely assumed that damage to the peripheral hearing system is an essential prerequisite for the occurrence of tinnitus. However, previous studies have failed to target tinnitus patients with normal hearing. This study aims to investigate if tinnitus patients with normal audiological presentation demonstrate increased intensity dependence at the selected frequencies. Methods: This study applied auditory cortical evoked potential test to investigate nine tinnitus patients with normal audiological presentation and nine age-and sex-matched healthy subjects without tinnitus. Auditory cortical evoked potentials (N1-P2) were elicited from stimuli at four frequencies (4000, 2000, 1000 and 500 Hz) with five intensities (50, 56, 62, 68 and 74 dB nHL). Intensity dependences by latency of N1 and amplitude of N1-P2 were surveyed at midline electrodes. Results: The results showed that the intensity dependence by latency of N1 to the pooled frequencies at three midline electrodes, e.g. Fz, Cz and Pz, revealed non-significant difference. However, significant differences existed in the intensity dependence of amplitude N1-P2 to the pooled frequencies at the Fz and Cz positions. These differences suggested that tinnitus patients tended to respond less to increased sound intensity and were inclined to weaker intensity dependence. Conclusion: Increased intensity dependence of N1-P2 component at the selected frequencies cannot be demonstrated in tinnitus patients with normal hearing. Restated, the edge frequency phenomenon fails to present in tinnitus patients with normal hearing, a different characteristic from tinnitus patients with hearing loss.