Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment

Background: Sudden sensorineural hearing loss(SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy(IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy(SST).Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors.Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group(n = 25) or the treatment group(n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST.Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies(250-8000 Hz) compared with the control group(P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment(P = 0.002), whereas age, duration of SST, and time of IST were not(P > 0.05).Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

A hierarchical byzantine fault tolerance consensus protocol for the Internet of Things

The inefficiency of Consensus protocols is a significant impediment to blockchain and IoT convergence development.To solve the problems like inefficiency and poor dynamics of the Practical Byzantine Fault Tolerance(PBFT)in IoT scenarios,a hierarchical consensus protocol called DCBFT is proposed.Above all,we propose an improved k-sums algorithm to build a two-level consensus cluster,achieving an hierarchical management for IoT devices.Next,A scalable two-level consensus protocol is proposed,which uses a multi-primary node mechanism to solve the single-point-of-failure problem.In addition,a data synchronization process is introduced to ensure the consistency of block data after view changes.Finally,A dynamic reputation evaluation model is introduced to update the nodes’reputation values and complete the rotation of consensus nodes at the end of each consensus round.The experimental results show that DCBFT has a more robust dynamic and higher consensus efficiency.Moreover,After running for some time,the performance of DCBFT shows some improvement.

A review on simulation models of cascading failures in power systems

Among various power system disturbances,cascading failures are considered the most serious and extreme threats to grid operations,potentially leading to significant stability issues or even widespread power blackouts.Simulating power systems’behaviors during cascading failures is of great importance to comprehend how failures originate and propagate,as well as to develop effective preventive and mitigative control strategies.The intricate mechanism of cascading failures,characterized by multi-timescale dynamics,presents exceptional challenges for their simulations.This paper provides a comprehensive review of simulation models for cascading failures,providing a systematic categorization and a comparison of these models.The challenges and potential research directions for the future are also discussed.