Study Design: Survey of 480 American neurotologists.
Main
Outcome Measures: 1) The frequency with which neurotologists/otologists in the United States order MRI in sudden deafness and ASNHL, 2) the frequency of medicolegal issues as motivations for ordering MRIs, 3) the frequency of abnormal MRIs, and 4) the prevalence of auditory brainstem reflex (ABR) and acoustic reflex testing as screening tools before ordering an MRI.
Results: Approximately 146 responses (30.4%) were received. Ninety-five percent selleck inhibitor and 94% ordered MRIs in their patients with ASNHL and sudden deafness respectively. Forty percent of the respondents said medicolegal concerns factored Adavosertib into their decision to order a scan. Seventy-seven
percent and 82% reported finding vestibular schwannomas in less than 1% to 4% of MRIs for ASNHL and sudden deafness, respectively. Approximately one-third of the respondents still use ABR and acoustic reflex testing as screening tools.
Conclusion: MRIs are the gold standard for determining retrocochlear pathology in the setting of sudden deafness and ASNHL but are expensive. Approximately one-third of the respondents still use ABR and acoustic reflex testing as screening tools before ordering MRI. MRI typically have a low yield in finding an abnormality (usually < 1%-4%). Neurotologists in our survey seem to recognize this quandary: they usually order an MRI, although they know it will usually be negative, and 40% of them cite medicolegal concerns as one of the motivations for their decision. This suggests that routine use of MRI partially
reflects the practice of defensive medicine rather than medicine based on evidence. Perhaps MRIs THZ1 cost are rarely indicated as the initial screening tool in ASNHL and sudden deafness, given their high cost and low yield of abnormal findings, and their routine use should and could be reduced to contain medical costs.”
“We report the expression pattern of heat shock proteins (HSPs) in an Antarctic psychrotrophic strain of Cellulosimicrobium cellulans (DSM 22151) by comparing with its mesophilic counterpart (DSM 43879(T)) at different temperatures. In both strains, the synthesis of HSPs declined with growth phase. The Antarctic isolate could upregulate 60 kDa, 52 kDa and 41.6 kDa HSPs at 60 degrees C while for its mesophilic counterpart, regulation was restricted to a 64 kDa fraction. The highly unstable nature of this fraction could have led to the impaired thermotolerance exhibited by the mesophilic strain. The downshift of thermal shock from 60 degrees C to 45 degrees C resulted in further upregulation of HSPs in the psychrotrophic strain, while there was no marked variation in the mesophilic strain. This work highlights the significance of a 60 kDa protein in the Antarctic strain of C.