Herpes simplex virus 2-induced aseptic meningitis presenting with sudden deafness:A case report

BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses,and herpes simplex virus type 2(HSV-2)].Aseptic meningitis can have various presentations,including sensori-neural deafness.While sensorineural deafness from mumps meningoencephalitis has been reported,cases of HSV-2-induced hearing loss are rare.Herein,we re-port a case of HSV-2-induced meningitis that presented with sudden deafness.CASE SUMMARY A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day.Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss(thresholds 80-90 dB).After treatment with high-dose steroids for 1 week,he experienced an acute consciousness change with left hemiparesis.The laboratory data showed no significant abnormalities.Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemo-rrhage or obvious brain lesion.The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity.Hence,under the diagnosis of herpes meningoenceph-alitis,acyclovir was prescribed and his symptoms gradually resolved.CONCLUSION This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.

Analysis of gravity wave activity during stratospheric sudden warmings in the northern hemisphere

Due to the significant changes they bring to high latitude stratospheric temperature and wind,stratospheric sudden warmings(SSWs)can have an impact on the propagation and energy distribution of gravity waves(GWs).The variation characteristics of GWs during SSWs have always been an important issue.Using temperature data from January to March in 2014−2016,provided by the Constellation Observing System for Meteorology,Ionosphere and Climate(COSMIC)mission,we have analyzed global GW activity at 15−40 km in the Northern Hemisphere during SSW events.During the SSWs that we studied,the stratospheric temperature rose in one or two longitudinal regions in the Northern Hemisphere;the areas affected extended to the east of 90°W.During these SSWs,the potential energy density(E_(p)of GWs expanded and covered a larger range of longitude and altitude,exhibiting an eastward and downward extension.The E_(p)usually increased,while partially filtered by the eastward zonal winds.When zonal winds weakened or turned westward,E_(p)began to strengthen.After SSWs,the E_(p)usually decreased.These observations can serve as a reference for analyzing the interaction mechanism between SSWs and GWs in future work.

Preface to the Special Issue on Causes, Impacts, and Predictability of Droughts for the Past, Present, and Future

Drought is a recurring dry condition with below-normal precipitation and is often associated with warm temperatures or heatwaves. A drought event can develop slowly over several weeks or suddenly within days, commonly under abnormal atmospheric conditions(e.g., quasi-stationary high-pressure systems), and can persist for weeks, months, or even years.

Controlled release of dexamethasone from fibrin sealant for intratympanic administration in inner ear therapy

The aim of the present work was to show the sustainability of fibrin sealant in releasing dexamethasone and adjust the protocol for clinical application of the novel method in the treatment of Meniere’s disease (MD) and sudden sensorineural hearing loss (SSHL).Gelation occurred shortly after mixing dexamethasone-containing fibrinogen with thrombin.Dexamethasone was constantly released for at least 16 d at a stable level after 7d in protocol 1 (low-dose),while it was robustly released within 4 d and slowed afterward until 10 d in protocol 2(high-dose).There were significant differences among the time points in Protocol 2 (p<0.01,ANOVA),and the exponential model with the formula y=15.299*e~(-0.483*t) fits the association.The estimated concentration of dexamethasone released on 7 d in protocol 2 was slightly lower than that observed in protocol 1.The fibrin sealant is capable of constantly releasing dexamethasone with adjustable dynamics.Targeted and minimally invasive administration of the material can be achieved in the clinic by sequential injections of the fluids using a soft-tipped catheter.

The sudden ocean warming and its potential influences on earlyfrozen landfast ice in the Prydz Bay, East Antarctica

The ocean conditions beneath the ice cover play a key role in understanding the sea ice mass balance in the polar regions.An integrated high-frequency ice-ocean observation system,including Acoustic Doppler Velocimeter,Conductivity-Temperature-Depth Sensor,and Sea Ice Mass Balance Array(SIMBA),was deployed in the landfast ice region close to the Chinese Zhongshan Station in Antarctica.A sudden ocean warming of 0.14℃(p<0.01)was observed beneath early-frozen landfast ice,from(−1.60±0.03)℃during April 16-19 to(−1.46±0.07)℃during April 20-23,2021,which is the only significant warming event in the nearly 8-month records.The sudden ocean warming brought a double rise in oceanic heat flux,from(21.7±11.1)W/m^(2) during April 16-19 to(44.8±21.3)W/m^(2) during April 20-23,2021,which shifted the original growth phase at the ice bottom,leading to a 2 cm melting,as shown from SIMBA and borehole observations.Simultaneously,the slowdown of ice bottom freezing decreased salt rejection,and the daily trend of observed ocean salinity changed from+0.02 d^(-1) during April 16-19,2021 to+0.003 d^(-1) during April 20-23,2021.The potential reasons are increased air temperature due to the transit cyclones and the weakened vertical ocean mixing due to the tide phase transformation from semi-diurnal to diurnal.The high-frequency observations within the ice-ocean boundary layer enhance the comprehensive investigation of the ocean’s influence on ice evolution at a daily scale.

Control of Nozzle Flow Using Rectangular Ribs at Sonic and Supersonic Mach Numbers

This study deals with base pressure management in a duct for various values of the Mach number(M),namely,Mach number corresponding to sonic and four supersonic conditions.In addition to the Mach number,the nozzle pressure ratio(NPR),the area ratio,the rib dimension,and the duct length are influential parameters.The following specific values are examined at M=1,1.36,1.64,and 2,and NPRs between 1.5 and 10.The base pressure is determined by positioning ribs of varying heights at predetermined intervals throughout the length of the square duct.When the level of expansion is varied,it is seen that the base pressure initially drops for overexpanded flows and increases for under-expanded flows.When ribs are present,the flow field in the duct and pressure inside the duct fluctuate as the base pressure rises.Under-expanded flows can achieve a base pressure value that is suitably high without experiencing excessive changes in the duct flow in terms of static pressure if a rib height around 10%of the duct height close to the nozzle exit is considered.Rectangular rib passive control does not negatively affect the duct’s flow field.

Challenging situation of coronary artery anomaly associated with ischemia and/or risk of sudden death

Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked.The incidence of coronary artery anomalies is as low as 1%-2%of the general population,even when the various types are combined.Coronary anomalies are practically challenging when the left and right coronary ostium are not found around their normal positions during coronary angiography with a catheter.If there is atherosclerotic stenosis of the coronary artery with an anomaly and percutaneous coronary intervention(PCI)is required,the suitability of the guiding catheter at the entrance and the adequate back up force of the guiding catheter are issues.The level of PCI risk itself should also be considered on a caseby-case basis.In this case,emission computed tomography in the R-1 subtype single coronary artery proved that ischemia occurred in an area where the coronary artery was not visible to the naked eye.Meticulous follow-up would be crucial,because sudden death may occur in single coronary arteries.To prevent atherosclerosis with full efforts is also important,as the authors indicated admirably.

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.

Long-term variation of Arctic Sudden Stratospheric Warmings(SSW)and potential causes

Utilizing the European Centre for Medium-Range Weather Forecast(ECMWF)Reanalysis v5(ERA5),for the first time,we have confirmed close links among Sudden Stratospheric Warmings(SSWs)in the Northern Hemisphere(NH),the polar vortices,and stratospheric Planetary Waves(PWs)by analyzing and comparing their trends.Interestingly,within overall increasing trends,the duration and strength of SSWs exhibit increasing and decreasing trends before and after the winter of 2002,respectively.To reveal possible physical mechanisms driving these trends,we analyzed the long-term trends of the winter(from December to February)polar vortices and of stratospheric PWs with zonal wave number 1.Notably,our results show that in all three time periods(the entire period of 41winters,1980 to 2020,and the two subperiods—1980-2002 and 2002-2020)enhancing SSWs were always accompanied by weakening winter polar vortices and strengthening polar PWs like Stationary Planetary Waves(SPWs)and 16-day waves,and vice versa.This is the first proof,based on ERA5 long-term trend data,that weakening polar vortices and enhancing stratospheric PWs(especially SPWs)could cause an increase in SSWs.

Evaluation of angiotensin converting enzyme insertion/deletion, alpha adducin (ADD1) G460W, and IL-10 gene polymorphisms, and determination of prognostic effects in idiopathic sudden sensorineural hearing loss

Objective:The aim of this study was to examine angiotensin converting enzyme(ACE)insertion/deletion,alpha adducin,and interleukin-10(IL-10)gene polymorphisms(GPs)in terms of both idiopathic sudden sensorineural hearing loss(ISSNHL)risk and their potential prognostic effects.Methods:The study group consisted of 70 patients and the control group consisted of 50 patients.Venous blood samples were analyzed for relevant GPs via kompetitive allele-specific polymerase chain reaction.Age,sex,affected side,tinnitus,and vertiginous symptom status,number of days between symptom onset and hospital admission,pure tone audiometry results at admission and after treatment were included in the study.Data were compared statistically.Results:The D allele of ACE insertion/deletion GP was significantly more frequent in patients with ISSNHL than in the control group(p=0.032).II genotype was associated with a reduced risk of ISSNHL(p=0.036).The amount of hearing loss was significantly higher in patients with the TT genotype(p=0.027)and T allele of the IL-10 GP(p=0.035)than in the patients without this allele.Severe hearing loss was a poor prognostic factor(p=0.008).Conclusions:The D allele of ACE insertion/deletion GP may be involved in the ISSNHL etiology.Due to the association of this allele with occlusive vascular pathologies,ischemia is believed to be a common pathway in the etiopathogenesis of ISSNHL.

Clinical characteristics and analysis of vestibular-evoked myogenic potentials in patients with sudden sensorineural hearing loss in different ages

BACKGROUND Numerous studies have found that patients experiencing sudden sensorineural hearing loss(SSHL),with or without accompanying vertigo,often show impaired vestibular function.However,there is a dearth of studies analyzing vestibularevoked myogenic potentials(VEMPs)in SSHL patients across various age groups.AIM To investigate vestibular condition in SSHL patients across various age demographics.METHODS Clinical data of 84 SSHL patients were investigated retrospectively.Audiometry,cervical vestibular evoked myogenic potentials(c-VEMPs),and ocular vestibular evoked myogenic potentials(o-VEMPs)were conducted on these patients.Parameters assessed included the latencies of P1 and N1 waves,as well as the amplitudes of P1–N1 waves.Moreover,the study evaluated the influence of factors such as sex,affected side,configuration of hearing loss,and presence of accompanying vertigo.RESULTS Among the 84 SSHL patients,no significant differences were observed among the three groups in terms of gender,affected side,and the presence or absence of vertigo.Group II(aged 41–60 years)had the highest number of SSHL cases.The rates of absent o-VEMPs in the affected ears were 20.83%,31.58%,and 22.72%for the three age groups,respectively,with no statistically significant difference among them.The rates of absent c-VEMPs in the affected ears were 8.3%,34.21%,and 18.18%for the three age groups,respectively,with significant differences.In the unaffected ears,there were differences observed in the extraction rates of o-VEMPs in the unaffected ears among the age groups.In the three age groups,no significant differences were noted in the three age groups in the latencies of P1 and N1 waves or in the amplitude of N1–P1 waves for c-VEMPs and o-VEMPs,either on the affected side or on the unaffected side,across the three age groups.CONCLUSION The extraction rate of VEMPs is more valuable than parameters.Regardless of the presence of vertigo,vestibular organs are involved in SSHL.Notably,SSHL patients aged 41–60 appear more susceptible to damage to the inferior vestibular nerve and saccule.

Therapeutic efficacy of methylprednisolone sodium succinate via diverse administration routes for mid-to high-frequency sudden sensorineural hearing loss

BACKGROUND Sudden sensorineural hearing loss(SSNHL),characterized by a rapid and unexplained loss of hearing,particularly at moderate to high frequencies,presents a significant clinical challenge.The therapeutic use of methylprednisolone sodium succinate(MPSS)via different administration routes,in combination with conventional medications,remains a topic of interest.AIM To compare the therapeutic efficacy of MPSS administered via different routes in combination with conventional drugs for the treatment of mid-to high-frequency SSNHL.METHODS The medical records of 109 patients with mid-to high-frequency SSNHL were analyzed.The patients were divided into three groups based on the route of administration:Group A[intratympanic(IT)injection of MPSS combined with mecobalamin and Ginkgo biloba leaf extract injection],Group B(intravenous injection of MPSS combined with mecobalamin and Ginkgo biloba leaf extract injection),and Group C(single IT injection of MPSS).The intervention effects were compared and analyzed.RESULTS The posttreatment auditory thresholds in Group A(21.23±3.34)were significantly lower than those in Groups B(28.52±3.36)and C(30.23±4.21;P<0.05).Group A also exhibited a significantly greater speech recognition rate(92.23±5.34)than Groups B and C.The disappearance time of tinnitus,time to hearing recovery,and disappearance time of vertigo in Group A were significantly shorter than those in Groups B and C(P<0.05).The total effective rate in Group A(97.56%)was significantly greater than that in Groups B and C(77.14%and 78.79%,χ^(2)=7.898,P=0.019).Moreover,the incidence of adverse reactions in Groups A and C was significantly lower than that in Group B(4.88%,3.03%vs 2.57%,χ^(2)=11.443,P=0.003),and the recurrence rate in Group A was significantly lower than that in Groups B and C(2.44%vs 20.00%vs 21.21%,χ^(2)=7.120,P=0.028).CONCLUSION IT injection of MPSS combined with conventional treatment demonstrates superior efficacy and safety compared to systemic administration via intravenous infusion and a single IT injection of MPSS.This approach effectively improves patients'hearing and reduces the risk of disease recurrence.

突发性聋患者中枢敏化因素分析及临床干预

目的探讨突发性聋的可能机制,以及中枢敏化因素临床干预在突发性聋患者中的应用分析。方法选取2020年1月~2023年1月在解放军总医院第三医学中心耳鼻咽喉头颈外科住院治疗且合并偏头痛或其他中枢敏化因素的37例突发性聋患者作为治疗组,随机选取同期无偏头痛及其他中枢敏化因素的30例突发性聋患者作为对照组。两组患者均参照突发性聋指南进行规范化分型治疗,对合并偏头痛或其他中枢敏化因素的患者进行抗偏头痛治疗,比较两组的治疗效果。结果治疗组总有效率为81.1%(30/37),其中痊愈13例、显效10例、有效7例、无效7例;对照组总有效率66.7%(20/30),其中痊愈6例、显效6例、有效8例、无效10例。治疗组痊愈及显效比例高于对照组,两组总有效率差异无统计学意义(χ^(2)=1.1364,P>0.05)。结论偏头痛是中枢敏化的一种表现形式,中枢敏化可能参与到一部分突发性聋患者的发病机制中,对突发性聋患者进行中枢敏化评估,合并偏头痛或其他中枢敏化因素的突发性聋患者可以考虑配合抗偏头痛药物进行治疗,有可能改善患者预后。

Protocol of Investigation on Sudden Death at Autopsy, Including Molecular, Genetic and Toxicology Testing

The role of the autopsy: 1) Whether the death is ascribable to a natural or unnatural cause and when natural, if cardiac or extra-cardiac;2) The nosology of the cardiac diseases and the mechanism of cardiac death, whether arrhythmic or mechanical;3) If the cardiac disease is inherited, screening and counselling of the next of kin is required. About 30% of sudden deaths is ascribable to genetically determined morbid entities, mostly transmissible with the autosomal dominant pattern of inheritance, so that 50% of the first degree relatives are genetically affected (“carriers”) and exposed at risk;4) If toxic or illicit drug abuse was involved.

Hang in There!

There are many good phrases that use the word hang.When you hang up on someone,you end a phone call suddenly.You do not finish the conversation.When you hang out with people,you spend time with them.If you want to hang on to something,you want to save it.You don't want to let it go.If you hang it up,you quit something orlet it go.And when you tell someone,"Hang in there!"you're encouraging them to keep doing something.

突发性聋伴耳鸣患者治疗前后耳鸣残疾量表和视觉模拟量表比较及相关性

突发性聋伴耳鸣的发病率较高，多数耳呜患者可伴情绪紧张和疲劳，这成为众多临床医师工作中需要解决的问题。耳呜作为一种主观感受，缺乏客观有效的检测手段。国外应用于评价耳呜的最常用量表主要有耳鸣残疾量表（tinnitus handicap inventory，THI）和视觉模拟量表（visual-analoguescale，VAS）。

鼓室内注射地塞米松治疗2型糖尿病伴突发性聋

突发性聋是是耳科急症之一，具体病因、发病机制目前尚不明了。激素治疗突发性聋已得到大多数学者认可。近年鼓室内激素局部注射已经成为突发性聋治疗的热点。对于2型糖尿病伴突发性聋患者，由于激素全身使用的不良反应，鼓室内局部注射地塞米松可提供更多选择。本文对我院2009年7月-2012年1月收治69例2型糖尿病伴突发性聋患者行鼓室内注射给药，报道如下。

美国耳鼻咽喉头颈外科基金会突发性聋诊疗指南解读及国内诊疗现状

突发性聋(sudden hearing loss,SHL)是耳鼻咽喉科常见急症,近年发病有增加趋势。其病因复杂,治疗方案甚多,尚未统一。本文对美国耳鼻咽喉头颈外科基金会(AAO-HNSF)于2012年3月初发布的SHL临床实践指南进行解读,并对国内突发性聋的诊疗现状做一综述。

鼓室注射甲泼尼龙治疗重度以上突发性聋的疗效观察

近年来，国内外已经越来越多地将鼓室注射类固醇激素应用于治疗突发性聋（sudden deafness，SD）。我科对46例重度以上突发性聋患者分别给予全身地塞米松及鼓室内注射甲泼尼龙治疗，现报道如下。

鼓室注射地塞米松磷酸钠注射液与注射用甲泼尼龙琥珀酸钠治疗突发性聋疗效观察及不良反应分析

目的探讨地塞米松磷酸钠注射液与注射用甲泼尼龙琥珀酸钠鼓室内注射治疗突发性聋的临床疗效并分析两种注射治疗后的不良反应。方法 2018年9月~2019年12月收治的单侧突发性聋患者94例,按数字表法随机分为A组(注射用甲泼尼龙琥珀酸钠组)和B组(地塞米松磷酸钠注射液组)各47例,分别行鼓室内注射注射用甲泼尼龙琥珀酸钠和鼓室内注射地塞米松磷酸钠注射液治疗,分析两组患者治疗前后纯音听阈值变化情况,并观察两组不良反应和空腹血糖变化情况。结果两组患者治疗后纯音听阈较治疗前均有明显改善(A组:t=9.86,P=0.001;B组:t=2.91,P=0.005),A组总有效率82.9%,B组总有效率为63.8%,两组总有效率比较,差异有统计学意义(χ2=4.41,P=0.036);两组总体不良反应率比较,差异无统计学意义(P>0.05);两组治疗前后空腹血糖变化比较,差异无统计学意义(P>0.05)。结论两种治疗方法均能改善突发性聋患者的纯音听阈,但注射用甲泼尼龙琥珀酸钠效果较地塞米松磷酸钠注射液更佳,两者的不良反应情况基本相仿。