Methods: Comatose out-of-hospital

Methods: Comatose out-of-hospital Nepicastat ic50 cardiac arrest (OHCA) patients who underwent brain MRI between January 2008 and July 2012 were identified from an OHCA registry. Apparent diffusion coefficient (ADC) axial images were analyzed using a program to detect and characterize clusters of low ADC pixels from six brain regions including frontal, occipital, parietal, rolandic and temporal and basal ganglia region. Identified clusters were ranked according to size, mean ADC and minimum ADC to assess the regional maximum cluster size

(MCS), lowest mean ADC (LMEAN) and lowest minimum ADC (LMIN). Their power to predict poor outcome, defined as 6-month CPC 3 or higher, was assessed by contingency table analyses.

Results: 51 OHCA patients were eligible during the study period. The

sensitivities of MCS, LMEAN and LMIN to detect poor outcome varied according to brain region from 62.5 to 90.0%, 50.0 to 72.5% and 42.5 to 82.5% with their specificities set to 100%, respectively. The MCS of occipital region showed most favorable test profile (sensitivity 90%, specificity 100%; AUROC 0.940, 95% confidence interval 0.874-1.000).

Conclusion: The cluster-based computerized image analysis might be a simple but useful method for prediction of poor neurologic outcome. Future studies validating its prognostic performance are required. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Objective: To develop a transmastoid-posterior tympanotomy approach for the implantation of a penetrating auditory prosthesis SNS-032 in vitro in the most distal portion of the cochlear nerve.

Background: Animal studies suggest that penetrating cochlear Selleck BMS345541 nerve implants may overcome limitations of current cochlear implant systems. One step toward human implantation is the development of a suitable surgical approach.

Methods: In computer-rendered 3-dimensional (3-D) models (based on micro-CT scans of 10 human temporal bones), we simulated trajectories through the most basal part of the cochlea that gave access to the most distal portion of the cochlear nerve with minimal damage to intracochlear structures. We determined their vectors

with respect to the mid-modiolar axis and posterior round window edge and assessed if they intersected the chorda tympani nerve.

Results: The typical vector obtained with these 3-D models ran in an anterosuperior direction, through the inferior part of the facial recess and anterior round window edge. In 7 of 10 temporal bones, this trajectory intersected the chorda tympani nerve. Based on the vectors, dummy probes were implanted in 3 of 10 temporal bones, and the need for chorda tympani removal was confirmed in accordance with the 3-D models. Postoperative micro-CT scans revealed that all probes were successfully implanted in the cochlear nerve, whereas the osseous spiral lamina and basilar membrane were preserved.

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