Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière’s Disease

To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Meniere's disease. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral neurotology clinic. PATIENTS: One hundred twenty-nine subjects diagnosed with unilateral Meniere's disease still having vertigo despite medical therapy. INTERVENTION: IT dexamethasone injections as needed to control vertigo attacks. MAIN OUTCOME MEASURE: A Kaplan-Meier time-to-event method was used to determine the rate of "survival," meaning sufficient satisfaction with vertigo control that the subject did not wish to have subsequent ablative treatment. "Failure" was defined as poor control and the choice to proceed to ablative treatment. RESULTS: Acceptable vertigo control ("survival") was achieved in 117 (91%) of 129 subjects. Vertigo control required only one dexamethasone injection in 48 (37%), 2 injections in 26 (20%), 3 injections in 18 (14%), and 4 injections in 10 (8%). More than 4 injections were needed in 15 subjects (21%). Of 12 failures (9%), 9 occurred within 6 months of the first IT dexamethasone injection. Follow-up data for 2 years were available for 96 subjects. Of these, 87 (91%) had vertigo control with IT dexamethasone, of whom 61 (70)% required no further injections after 2 years, 23 (26%) continued to receive IT dexamethasone injections, and 3 (3%) chose IT gentamicin treatment. CONCLUSION: IT dexamethasone injection therapy on an as-needed outpatient basis can provide vertigo control that is satisfactory in patients with Meniere's disease. The Kaplan-Meier method addresses the need for an outcome measure suited to repeated treatments and variable lengths of follow-up. However, due to the retrospective nature of this study, the presence of bias caused by loss of subjects from follow-up cannot be ruled out

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Static and dynamic discharge properties of vestibular-nerve afferents in the mouse are affected by core body temperature

Se propone un nuevo selector de fases basado en las corrientes totales de falta para protección diferencial de línea. Analizando el comportamiento teórico de las corrientes de falta en las redes de secuencia, se modelará un selector que determinará el tipo de falta y, por tanto, las fases que estarán siendo afectadas en cada caso. Con el método propuesto se logrará un aumento considerable en la sensibilidad de la protección diferencial. Además, a través de las simulaciones realizadas se verificará tanto su fiabilidad como su efectividad.Lineen babes diferentzialetan suertatzen diren guztizko korronteetako faltetan oinarritutako fase-selektore berri bat proposatzen da. Sekuentzia-sareetako falta-korronteen ibilera teorikoa aztertuz, falta-mota zehaztuko duen selektorearen eredua egingo da, eta, hortik, kasu bakoitzean faltagatik eragindako faseak zehaztuko dira. Proposatutako metodoarekin batera, babes-diferentzialeko sentsibilitatearen handipen nabarigarria lortuko da. Gainera, egindako simulazioen bitartez, fidagarritasuna ez ezik, eraginkortasuna ere egiaztatuko da.A new phase selector is presented based on the total fault currents for line differential protection. Analysing the theoretical behaviour of fault currents in sequence networks, a selector will be modelled to determine the type of fault and, therefore, the phases that will be affected in each type of fault. With the proposed method, a considerable increase in the sensitivity of the differential protection will be achieved. Furthermore, through simulations both, its reliability and its effectiveness will be verified