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Live Imaging of the Dehydration Effect of Isosorbide on the Normal and Hydropic Guinea Pig Cochleae Using Optical Coherence Tomography. Otol Neurotol 2023; 44:833-837. [PMID: 37464452 DOI: 10.1097/mao.0000000000003962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To investigate the isosorbide-induced dehydration effect on the endolymphatic space by intratympanic administration of isosorbide. BACKGROUND Isosorbide, an osmotic diuretic, is used orally as a typical conservative therapy for Menière's disease (MD) in Japan. The dehydration effect occurs 6 hours after isosorbide ingestion. Intratympanic administration of isosorbide resolves endolymphatic hydrops faster than oral ingestion. In addition, the dehydration effect has never been shown directly. Therefore, we investigated the dehydration effect of intratympanic administration of isosorbide on endolymphatic hydrops using optical coherence tomography. METHODS We used eight Hartley guinea pigs, divided into normal and hydrops groups. In the hydrops group, the animals underwent endolymphatic sac obliteration to create endolymphatic hydrops. We obtained midmodiolar section images of the cochleae using optical coherence tomography. Then, 50 to 70% isosorbide was sequentially administered intratympanically for 5 minutes, and the apical turn of the cochlea was observed. The relative midmodiolar cross-sectional area of the scala media was calculated for quantitative assessment of the endolymphatic space. RESULTS In the normal group, 50% isosorbide had a slight but significant dehydration effect on the scala media; at 55 to 70%, Reissner's membrane became flat. In the hydrops group, 50% isosorbide slightly reduced endolymphatic hydrops; 65% flattened Reissner's membrane, and 70% slightly concaved it toward the basilar membrane. CONCLUSION The results suggest that we could select the concentration of isosorbide according to the stage or severity of MD and relief from acute attack. Intratympanic administration of isosorbide may be a promising treatment for patients with MD.
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Live imaging and functional changes of the inner ear in an animal model of Meniere's disease. Sci Rep 2020; 10:12271. [PMID: 32704101 PMCID: PMC7378199 DOI: 10.1038/s41598-020-68352-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022] Open
Abstract
The symptoms of Meniere's disease (MD) are generally considered to be related to endolymphatic hydrops (EH). There are many recent reports supporting the possibility that vasopressin (VP) is closely linked to the formation of EH in Meniere's disease. Based on this, we developed a clinically relevant animal model of Meniere's disease in which a VP type 2 receptor agonist was administered after electrocauterization of the endolymphatic sac. We report live imaging of the internal structure, and functional changes of the inner ear after electrocauterization of the endolymphatic sac and administration of a VP type 2 receptor agonist. In this model, the development of EH was visualized in vivo using optical coherence tomography, there was no rupture of Reissner's membrane, and low-tone hearing loss and vertiginous attacks were observed. This study suggested that acute attacks are caused by the abrupt development of EH. This is the first report of live imaging of the development of EH induced by the administration of a VP type 2 receptor agonist.
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Noisy Galvanic Vestibular Stimulation Sustainably Improves Posture in Bilateral Vestibulopathy. Front Neurol 2018; 9:900. [PMID: 30405522 PMCID: PMC6204397 DOI: 10.3389/fneur.2018.00900] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022] Open
Abstract
Patients with bilateral vestibulopathy (BV) suffer from persistent postural imbalance, leading to a marked decrease in quality of life and a higher risk of falls. However, so far, the effective treatments for BV are very limited. We examined whether long-term noisy galvanic vestibular stimulation (nGVS) keeps improving body balance after the cessation of the stimulus in BV patients. Thirteen BV patients received nGVS for 30 min with a lower intensity than the intensity at which they feel any cutaneous sensations, and their postural movement was monitored for 6 h after the stimuli. The same session was repeated at 14-day intervals. Stance tasks on two legs were performed with eyes closed. The velocity of the center of pressure (COP) movement, the area enclosed by the COP movement, and the root mean square of the displacement of the COP were measured. The power spectrum of the COP movement was assessed. Subjective improvement of body balance was graded as worsened (−2), slightly worsened (−1), unchanged (0), slightly improved (+1) and improved (+2) in comparison with that without nGVS. In each session, the velocity of the COP movement was significantly improved for 6 h after the stimulus had ceased (P < 0.01). Concomitantly, the mean frequency of the COP power spectrum was significantly reduced in the anterior-posterior axis (P < 0.05). Subjective symptoms of imbalance were improved during the post-stimulation effect (P < 0.05). nGVS leads to an improvement in body balance that lasts for several hours after the end of the stimulus in BV patients with a reduction in the high-frequency components of their postural movement. This trial was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMINCTR: UMIN000028054).
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Noisy vestibular stimulation increases gait speed in normals and in bilateral vestibulopathy. Brain Stimul 2018; 11:709-715. [PMID: 29563049 DOI: 10.1016/j.brs.2018.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Galvanic vestibular stimulation delivered as zero-mean current noise (noisy GVS) has been shown to improve static and dynamic postural stability probably by enhancing vestibular information. OBJECTIVE /Hypothesis: To examine the effect of an imperceptible level of noisy GVS on dynamic locomotion in normal subjects as well as in patients with bilateral vestibulopathy. METHODS Walking performance of 19 healthy subjects and 12 patients with bilateral vestibulopathy at their preferred speed was examined during application of noisy GVS with an amplitude ranging from 0 to 1000 μA. The gait velocity, stride length and stride time were analyzed. RESULTS Noisy GVS had significant effects on gait velocity, stride length and stride time in healthy subjects as well as in patients with bilateral vestibulopathy (p < 0.05). The optimal amplitude of noisy GVS improved gait velocity by 10.9 ± 1.2%, stride length by 5.7 ± 1.2% and stride time by 4.6 ± 7% (p < 0.0001) compared to the control session in healthy subjects. The optimal stimulus improved gait velocity by 12.8 ± 1.3%, stride length by 8.3 ± 1.1% and stride time by 3.7 ± 7% (p < 0.0001) in patients with bilateral vestibulopathy. The improved values of these parameters of locomotion by noisy GVS in the patients were not significantly different from those in healthy subjects in the control condition (p > 0.4). CONCLUSION Noisy GVS is effective in improving gait performance in healthy subjects as well as in patients with bilateral vestibulopathy.
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Effects of Peripheral Vestibular Dysfunction on Dynamic Postural Stability Measured by the Functional Reach Test and Timed Up and Go Test. Ann Otol Rhinol Laryngol 2017; 126:438-444. [PMID: 28436247 DOI: 10.1177/0003489417700439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the influence of vestibular function on dynamic postural stability assessed by the functional reach test (FRT) and the timed up and go test (TUG). STUDY DESIGN Retrospective study. SETTING Tertiary referral center. SUBJECTS AND METHODS The FRT and TUG were performed in 399 patients with dizziness. The effects of peripheral vestibular dysfunction assessed by the caloric test and cervical vestibular evoked myogenic potentials (cVEMPs) to air-conducted sound (500 Hz, tone burst) on the results of FRT and TUG were analyzed. RESULTS Neither FRT nor TUG scores showed significant differences in relation to the results of the caloric test ( P > .3). The FRT scores in patients who showed abnormal cVEMP responses on both sides were significantly smaller than those in patients who showed normal cVEMP responses ( P < .01). The TUG scores in patients who showed abnormal cVEMP responses on both sides were significantly greater than those in patients who showed normal cVEMP responses ( P < .05). CONCLUSION The vestibulo-spinal reflex mediated by the saccule and its afferents is one of the factors that influence the maintenance of dynamic postural stability as measured by FRT and TUG.
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Abstract
A 77-year-old man was suspected of having tumor-induced osteomalacia (TIO) because of hypophosphatemia (1.9 mg/dL) and elevated serum fibroblast growth factor 23 (FGF23) level (186.9 pg/mL). We detected a tumor in his left parotid gland, and the FGF23 level in the left external jugular vein indicated that the tumor overproduced FGF23. After the removal of the tumor, the serum FGF23 level rapidly decreased, and the serum phosphate normalized. This is the first case of TIO caused by a tumor in a parotid gland. This case indicates that the responsible tumors for TIO can be quite diverse.
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Abstract
Objective: To investigate whether both cervical and ocular vestibular myogenic potentials (cVEMPs and oVEMPs) to air-conducted sound (ACS) and bone-conducted vibration (BCV) can help to differentiate vestibular migraine (VM) and Menière’s disease (MD). Study Design: Retrospective study. Settings: A tertiary referral center. Subjects and Methods: Twenty-eight patients with VM, 28 patients with definite unilateral MD, and 28 age-matched controls were included. Cervical VEMPs to 500 Hz ACS (cVEMPs-air) and 500 Hz BCV (cVEMPs-bone), oVEMPs to 500 Hz ACS (oVEMPs-air) and 500 Hz BCV (oVEMPs-bone), and caloric tests were performed. Results of these vestibular function tests were compared between the groups. Results: The prevalence of abnormality was significantly higher in VM than in controls only for the caloric test ( P < .05). Asymmetry ratios (ARs) for cVEMPs-air and oVEMPs-air were significantly larger in VM than in controls ( P < .05). Between VM and MD, the prevalence of abnormality was significantly different only for oVEMPs-air. The ARs for oVEMPs-air and caloric test asymmetries were significantly smaller in VM than in MD ( P < .05). Conclusions: Among the vestibular function tests, oVEMPs-air may be most helpful for the differentiation of VM from MD as a group.
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Dehydration effects of a V2 antagonist on endolymphatic hydrops in guinea pigs. Hear Res 2016; 332:151-159. [DOI: 10.1016/j.heares.2015.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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Characteristics of vertigo and the affected vestibular nerve systems in idiopathic bilateral vestibulopathy. Acta Otolaryngol 2015; 136:43-7. [PMID: 26381713 DOI: 10.3109/00016489.2015.1082193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONCLUSION Vertigo attacks in IBV patients involving both the superior and inferior vestibular nerve systems were significantly more severe than vertigo attacks in patients with selective involvement of the inferior vestibular nerve system alone. OBJECTIVE To investigate the relationship between the frequency and duration of vertigo and the affected vestibular nerve system in idiopathic bilateral vestibulopathy (IBV). METHODS This study categorized 44 IBV patients into the following three sub-groups according to the affected vestibular nerve system: superior, inferior, and mixed type. These patients were also categorized into the following three sub-groups according to their clinical time course: progressive type showing no episodes of vertigo, sequential type showing recurrent vertigo attacks and single-attack type showing a single episode of vertigo. RESULTS Ten, 11 and 23 patients were classified as the superior, the inferior, and the mixed type, respectively. Seventeen, 23, and four patients were classified as the progressive, the sequential, and the single-attack type, respectively. For the patients having one or more vertigo attacks, the duration of the vertigo attack was longer than 24 h in 69% of the mixed type, and the duration of vertigo in the mixed type was significantly longer than that in the inferior type (p < 0.05).
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Involvement of vestibular organs in idiopathic sudden hearing loss with vertigo: An analysis using oVEMP and cVEMP testing. Clin Neurophysiol 2015; 126:1033-8. [DOI: 10.1016/j.clinph.2014.07.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/25/2014] [Accepted: 07/09/2014] [Indexed: 02/02/2023]
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Clinical Characteristics of Patients With Abnormal Ocular/Cervical Vestibular Evoked Myogenic Potentials in the Presence of Normal Caloric Responses. Ann Otol Rhinol Laryngol 2014; 124:458-65. [DOI: 10.1177/0003489414564997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective: To investigate the clinical features and vestibular symptoms of patients with abnormal ocular vestibular evoked myogenic potentials (oVEMPs) and/or cervical VEMPs (cVEMPs) in the presence of normal caloric responses. Study Design: Retrospective chart review. Setting: Tertiary referral center. Methods: One thousand five hundred twenty-one consecutive patients with balance problems who underwent the caloric, cVEMP, and oVEMP tests were included, and patients who showed abnormal oVEMPs and/or cVEMPs in the presence of normal caloric responses were selected. Clinical characteristics, diagnoses, and vestibular symptoms of the patients were analyzed. Results: Of the 1521 patients, 227 (15%) were found to have abnormal oVEMPs and/or cVEMP responses with normal caloric responses. Benign paroxysmal positional vertigo (BBPV), Meniere’s disease, and vestibular migraine were the common diagnoses of these patients. Eighty-one patients (36%) could not be diagnosed with a recognizable disease. Multiple episodes of spinning vertigo with a duration of seconds to hours were their most common vestibular symptoms. Conclusion: BPPV, Meniere’s disease, and vestibular migraine are the most frequent diagnoses showing abnormal oVEMP and/or cVEMPs without canal paresis. Apart from these clinical entities, a portion of undiagnosed patients with multiple episodes of vertigo might have a disease that involves the otolith organs only.
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The effect of aging on the center-of-pressure power spectrum in foam posturography. Neurosci Lett 2014; 585:92-7. [PMID: 25433179 DOI: 10.1016/j.neulet.2014.11.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/15/2014] [Accepted: 11/24/2014] [Indexed: 11/28/2022]
Abstract
To assess age-related frequency-domain characteristics of the sway of center of pressure (COP) in foam posturography, two-legged stance tasks were performed by 163 controls in 4 conditions: eyes open with and without foam rubber, and eyes closed with and without foam rubber. The areas under the curve (AUCs) of power spectral density of the COP were calculated across low frequency (≥0.02 Hz and <0.1 Hz, LF-AUC), middle frequency (≥0.1 Hz and <1 Hz, MF-AUC) and high frequency (≥1 Hz and <10 Hz, HF-AUC) ranges. We categorized the controls into 7 age groups and analyzed each AUC in the 4 conditions. MF- and HF-AUCs tended to show a difference between younger and older age-groups in all 4 conditions. Comparing the number of pairs in which a significant difference was shown, the condition with foam rubber, especially with eyes open, tended to highlight age-related changes. In the medial-lateral axis in the eyes open/foam rubber condition, the MF-AUC of the ≥ 75 years group was significantly larger than that of the 65-74 years group, and the MF-AUC of the 65-74 years group was significantly higher than that of the 55-64 years group, although there were no significant differences of MF-AUC among age groups under 54 years. In this condition, although HF-AUC did not change in groups over 35 years old, HF-AUC of each age group over 35 years old was significantly larger than that of the group under 24 years old. This result suggests that, in the medial-lateral axis in the eyes open/foam rubber condition, MF-AUC is specifically affected by age in late-middle-aged (ages 55-64) and older subjects, while HF-AUC is specifically affected by age in early-middle-aged (ages 35-44) subjects.
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The diagnostic value of vestibular evoked myogenic potentials in patients with Meniere's disease. J Vestib Res 2014; 23:249-57. [PMID: 24284605 DOI: 10.3233/ves-130484] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To estimate the sensitivity and specificity of vestibular evoked myogenic potentials (VEMPs) in comparison with caloric test in diagnosing Meniere's disease (MD) among patients with dizziness. METHODS Data were retrospectively collected from 1,170 consecutive patients who underwent vestibular tests. Among them, 114 patients were diagnosed as having unilateral definite MD. VEMPs in response to clicks and short tone burst stimulation as well as caloric tests were performed. The sensitivity and specificity of each test were evaluated. The results of each test were compared with hearing level and staging of MD. RESULTS The sensitivity and specificity of VEMPs were 50.0% and 48.9%, while those of the caloric test were 37.7% and 51.2%, respectively. There was no significant difference in hearing level between patients appropriately or inappropriately identified by VEMPs, whereas there was a significant difference in those of the caloric test. Combined use of VEMP and caloric test increased the sensitivity to 65.8%. CONCLUSION Although the sensitivity and specificity of VEMPs in diagnosing MD were not high, they were comparable to those of caloric test. VEMPs as well as caloric testing may give additional information as part of a diagnostic test battery for detecting vestibular abnormalities in MD.
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Postural stability in vestibular neuritis: Age, disease duration, and residual vestibular function. Laryngoscope 2013; 124:974-9. [DOI: 10.1002/lary.24342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/24/2013] [Accepted: 07/15/2013] [Indexed: 11/11/2022]
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Abstract
Objective To assess the influence of factors that can affect the postural instability of Ménière’s disease (MD) patients. Study Design Case-control study. Setting Outpatient clinic in a university hospital. Subjects and Methods Fifty-four definite MD patients and 66 controls were included. Two-legged stance tasks were performed in 4 conditions: eyes open with and without foam rubber and eyes closed with and without foam rubber. We examined 6 variables: the velocity of movement of the center of pressure (COP), the envelopment area traced by the movement of the COP, Romberg’s ratio of velocity and area, and the foam ratios of velocity and area. For patients, stepwise multiple regression analyses were performed to explore the relationship between the 6 variables and the following independent variables: gender, age, the presence of abnormal caloric and/or cervical vestibular evoked myogenic potential (cVEMP) responses, the time elapsed since the last vertigo attack, and the disease duration. Results The presence of MD had a significantly positive relationship with all 6 of the variables ( P < .05). The presence of abnormal caloric and/or cVEMP responses had a significantly positive relationship with Romberg’s ratio of velocity ( P < .05) and area ( P < .01). The shorter time interval from last vertigo attack to measurement had a significantly positive relationship with the foam ratio of area ( P < .01). Conclusion MD patients show poor postural performance, which is affected by the existence of their peripheral vestibular function and the shorter time interval from last vertigo attack to measurement.
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Abstract
CONCLUSION We found that aquaporins (AQPs) in the fluid transporting cells, such as vestibular dark cells and endolymphatic sac epithelial cells, seem to be of importance in fluid transport in the inner ear, while those in the sensory and ganglion cells may play a functional role in sensory cell transduction. OBJECTIVE Expression of AQPs (0-12) was analyzed in normal mouse vestibular end organs. METHODS CBA/J mice were used in this study. Localization of AQPs 0-12 in the vestibular end organs and endolymphatic sac was investigated by immunohistochemistry. RESULTS The AQPs were found abundantly distributed in many structures in the vestibular end organs, i.e. vestibular sensory and supporting cells, vestibular dark cells, vestibular ganglion cells, and the endolymphatic sac.
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Ocular vestibular evoked myogenic potential elicited from binaural air-conducted stimulations: clinical feasibility in patients with peripheral vestibular dysfunction. Acta Otolaryngol 2013; 133:708-13. [PMID: 23768055 DOI: 10.3109/00016489.2013.767476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Ocular vestibular evoked myogenic potentials (oVEMPs) to binaural air-conducted stimulation (ACS) may provide a convenient way of assessing the crossed vestibulo-ocular reflex in patients with vestibular dysfunction as well as in healthy subjects. OBJECTIVE To investigate the clinical feasibility of using oVEMPs in response to binaural ACS to assess normal subjects and patients with vestibular dysfunction. METHODS The study investigated 24 normal subjects (14 men and 10 women, aged from 23 to 60 years) and 14 patients with unilateral peripheral vestibular dysfunction. Each subject underwent oVEMP testing in response to monaural ACS and binaural ACS (500 Hz tone burst, 135 dBSPL). RESULTS In normal subjects, bilateral oVEMPs were elicited in 75% of subjects in response to monaural ACS and in 91% in response to binaural ACS. Asymmetry ratios (ARs) of the responses to binaural ACS were significantly smaller than those of the responses to monaural ACS (p < 0.01). In patients with unilateral vestibular dysfunction, there were no significant differences in the amplitude, latency, or AR of the responses between monaural and binaural ACS. Approximately 30% of patients showed reduced ARs to binaural ACS relative to monaural ACS, primarily due to contamination by uncrossed responses elicited in healthy ears.
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Diagnostic usefulness of multifrequency tympanometry for Ménière's disease. Audiol Neurootol 2013; 18:152-60. [PMID: 23392344 DOI: 10.1159/000346343] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 12/06/2012] [Indexed: 11/19/2022] Open
Abstract
Multifrequency tympanometry (MFT) is the measurement of the impedance of the middle ear transmission system at a wide range of frequencies from 200 Hz to 2 kHz. A potential use of MFT as a new diagnostic tool for detecting endolymphatic hydrops has recently been reported. However, its clinical usefulness for diagnosing Ménière's disease (MD) remains unclear. To evaluate the clinical usefulness of MFT as a new qualitative and diagnostic test for MD, we performed MFT in 70 patients with unilateral or bilateral MD and in 29 normal control subjects. The width of double peaks in the admittance tympanograms (Y width) at 2 kHz and the resonance frequency (RF) were analyzed, and receiver operating characteristic (ROC) curves were constructed. The Y width in MD-affected ears was significantly greater than that in control ears (p < 0.001). The RF in MD-affected ears was significantly lower than that in control ears (p < 0.01). Neither the Y width nor RF had a significant relationship with hearing levels or the results of caloric and vestibular myogenic potential testings. The area under the ROC curve was 0.71 for the Y width and 0.66 for the RF. At the optimal cutoff points, the sensitivity and specificity of the Y width were 47.3 and 86.8%, respectively, and those of the RF were 41.3 and 84.2%, respectively. These results indicated that MFT is significantly associated with the presence of MD, but its diagnostic accuracy is only modest. MFT is a simple, noninvasive test, which should be considered as a complementary test in the diagnosis of MD.
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Effect of Vestibular Dysfunction on the Development of Gross Motor Function in Children with Profound Hearing Loss. Audiol Neurootol 2013; 18:143-51. [DOI: 10.1159/000346344] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 12/06/2012] [Indexed: 01/20/2023] Open
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Evaluation of the Internal Structure of Normal and Pathological Guinea Pig Cochleae Using Optical Coherence Tomography. ACTA ACUST UNITED AC 2013; 18:335-43. [DOI: 10.1159/000354620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022]
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Abstract
CONCLUSIONS Inferior vestibular neuritis (IVN) is a relatively minor subtype of vestibular neuritis (VN) and its clinical characteristics are unique. OBJECTIVES To clarify clinical characteristics of IVN in comparison with conventional VN. METHODS This was a retrospective case series review. Caloric responses and cervical vestibular evoked myogenic potential (cVEMP) responses were measured in 71 patients with VN. The patients were classified into three groups: (1) IVN group, who showed only asymmetrical cVEMP responses; (2) superior VN (SVN) group, who showed only asymmetrical caloric responses; (3) total VN (TVN) group, who showed asymmetrical responses in both tests. The clinical records of time course of subjective symptoms (duration of attack, duration of hospitalization, and time to remission) were reviewed and other profiles (age, sex, affected side, acute symptoms, and sequelae) were evaluated. RESULTS Of the 71 patients with VN, 13 (18%) were classified as having IVN. The mean age and time to remission of patients with IVN (44.2 ± 4.8 years, 0.9 ± 0.5 months) were significantly lower and shorter, respectively, than those of patients with TVN (57.3 ± 2.5 years, 4.9 ± 4.7 months). There were no significant differences in other symptoms and profiles among the three groups. No patients with IVN showed benign paroxysmal positional vertigo as a sequela.
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Localization of aquaporins 1, 2, and 3 and vasopressin type 2 receptor in the mouse inner ear. Acta Otolaryngol 2012; 132:807-13. [PMID: 22768909 DOI: 10.3109/00016489.2012.662718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION It is suggested that aquaporins (AQPs) 1, 2, and 3, and vasopressin type 2 receptors (V2Rs) in the fluid transporting cells, such as stria vascularis, vestibular dark and transitional cells, and endolymphatic sac epithelial cells, have an important role in fluid transport in the inner ear, while those in the sensory and ganglion cells may play a functional role in the sensory cell transduction system. OBJECTIVE To analyze expression of AQP1, AQP2, and AQP3 as well as V2Rs in the normal mouse inner ear. METHODS CBA/J mice were used in this study. Localization of AQP1, AQP2, AQP3, and V2Rs in the inner ear, i.e. cochlea, vestibular end organs, and endolymphatic sac, was investigated by immunohistochemistry. RESULTS The results show that AQP1, AQP2, AQP3, and V2Rs are abundantly distributed in many inner ear structures, i.e. stria vascularis, inner and outer hair cells, spiral ganglion cells, vestibular sensory and ganglion cells, vestibular dark and transitional cells, and the endolymphatic sac.
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The mitochondrial A3243G mutation involves the peripheral vestibule as well as the cochlea. Laryngoscope 2011; 121:1821-4. [PMID: 21792976 DOI: 10.1002/lary.21879] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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[A case of papillary thyroid carcinoma metastatic to the sphenoid sinus presenting with epistaxis]. ACTA ACUST UNITED AC 2010; 113:62-6. [PMID: 20225705 DOI: 10.3950/jibiinkoka.113.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Distant metastasis from differentiated thyroid carcinoma is rare and metastasis to the paranasal sinus is extremely rare. We report a case of differentiated papillary thyroid carcinoma (PTC) with metastases to the sphenoid sinus presenting with epistaxis. An 81-year-old undergoing partial lobectomy for differentiated PTC 9 years earlier presented with intermittent epistaxis. Imaging showed a mass filling the sphenoid sinus and extending to the intracranial cavity. Histopathological diagnosis using endoscopic biopsy indicated a metastatic PTC tumor. Compared to the primary site, the metastatic tumor was poorly differentiated thyroid carcinoma. Despite external beam radiation therapy, her general condition worsened and she was moved to a hospice.
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Differential diagnosis of proptosis: report of 2 cases. Auris Nasus Larynx 2010; 37:526-9. [PMID: 20053515 DOI: 10.1016/j.anl.2009.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 11/30/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
Abstract
We rarely encounter patients with proptosis, however, it is known that inflammation and extension of paranasal sinus tumors may cause this condition. We should consider the diseases that may cause proptosis to facilitate the diagnosis. Recently, we treated proptosis in 2 cases, one with inflammatory myofibroblastic tumor (IMT) and the other with malignant lymphoma. As these 2 diseases show various clinical features and these features frequently overlap, it is difficult to differentiate between IMT and malignant lymphoma without pathological examinations. In this study, we review the relevant literature reports and discuss the difficulties in establishing a clinicopathological diagnosis and present a slight distinction in magnetic resonance imaging.
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Indication of the Side of Delayed Endolymphatic Hydrops by Vestibular Evoked Myogenic Potential and Caloric Test. ACTA ACUST UNITED AC 2010; 72:242-6. [DOI: 10.1159/000314696] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/20/2010] [Indexed: 11/19/2022]
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Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease that is characterized by varying degrees of parkinsonism and cerebellar, corticospinal, and autonomic dysfunction. Vocal cord abductor paralysis (VCAP) is considered a sign of a poor prognosis in MSA, because it is a life-threatening complication that may cause nocturnal sudden death. This case report presents a patient who was treated for Parkinson's disease, and complained of dizziness and sleep apnea. We examined VCAP using fiberoptic laryngoscopy as the possible cause of sleep apnea. VCAP usually occurs in the advanced stages of MSA and is accompanied by a worsening of other symptoms. Optokinetic nystagmus was severely impaired and the caloric test response was bilaterally absent. Objective findings such as VCAP and abnormal neuro-otological results led to the diagnosis of MSA.
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Abstract
A HDTV camera having a direct-sensing x-ray high-gain avalanche rushing amorphous photoconductor (HARP) tube was used, for the first time, to acquire x-ray phase maps. The tube can achieve a high sensitivity as a result of the avalanche multiplication process in the HARP target. A beryllium plate, rather than a glass plate, was used as the face plate of the tube to minimize the loss of x-rays due to absorption, and a 15 microm thick HARP target was directly formed on it. In the experiment, the x-ray phase shifts produced by a rat liver were measured using synchrotron x-rays (lambda = 0.0766 nm) and a triple Laue-case (LLL) x-ray interferometer. Interference patterns produced by the sample were observed with the direct-sensing x-ray HARP tube camera. A voltage of 1300 V was applied to the HARP target to give an output signal gain of two. The camera was operated in 1125 scanning-line mode, and real-time images were stored on a workstation at a rate of 30 images/s with an image format of 960 (H) x 1100 (V) pixels. A phase-map image of the sample was successfully obtained using the fringe scanning method and phase unwrapping. The observed phase shifts ranged from 50 degrees to 200 degrees . Trees of blood vessels in the rat liver were clearly depicted without using a contrast agent. The spatial resolution of the x-ray camera was estimated to be better than 35 microm in the vertical direction and 100 microm in the horizontal direction.
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[Simple ulcer of the ileocaecal region associated with thyroid cancer, report of a case]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 1997; 94:475-9. [PMID: 9277111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
A total of 961 medaka, separated chronologically from the first to the fifth year of life, were examined for spontaneous tumor development. While no liver tumors were found in either male or female medaka under the age of 1 year and the incidence in 2-year-old fish was relatively low (males 1.9% and females 1.7%), they became more common with advancing age. The incidence was higher in females than in males from 3 to 5 years of age, reaching 7.1% in 5-year-old female stock. These liver tumors included a total of 12 adenomas and 9 hepatocellular carcinomas. The hepatocellular carcinomas were histologically well differentiated and were all observed in female medaka. Spontaneous tumors occurring in organs other than the liver were rare and sporadic. Four squamous cell carcinomas, 5 melanomas and 4 lymphosarcomas were observed with no sexual or pronounced age bias being evident. The squamous cell carcinomas developed in the surface epithelium with local invasion into the dermis. Melanomas occurred in the abdominal cavity and demonstrated systemic invasion into various parts of the body. Three out of the 4 lymphosarcomas arose from the inner part of the operculum suggesting that these tumors were of thymic origin. They also showed extensive invasion. The data indicate a particular susceptibility of older female medaka to liver but not other tumor development.
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[Cultured fish cells]. TANPAKUSHITSU KAKUSAN KOSO. PROTEIN, NUCLEIC ACID, ENZYME 1989; 34:186-92. [PMID: 2734451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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The production of cloned fish in the medaka (Oryzias latipes). THE JOURNAL OF EXPERIMENTAL ZOOLOGY 1985; 236:335-41. [PMID: 4086988 DOI: 10.1002/jez.1402360311] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The measurement of cellular DNA content by DNA microfluorometry revealed that medaka embryos that were fertilized with normal sperm and exposed to heat shock (41 degrees C for 3 min) or hydrostatic pressure (700 kg/cm2 for 10 min) at 85-95 min after insemination were tetraploid. Embryos fertilized with normal sperm and exposed to heat shock (41 degrees C for 2 min at 2-3 min after insemination) were triploid. These results suggest that heat shock or hydrostatic pressure at 85-95 min after insemination arrests the first cleavage, while heat shock at 2-3 min after insemination arrests the second meiotic division. Medaka clones have been produced by the following method: Eggs from orange-red or variegated variety were activated by UV-irradiated, genetically impotent sperm of wild-type fish (UV sperm). The haploid eggs obtained were diploidized by preventing the first cleavage with heat shock or hydrostatic pressure to produce homozygous females. Each of the two homozygous females was mated with vasectomized male in isotonic balanced salt solution to collect unfertilized eggs. The collected eggs were activated with UV sperm and converted from haploid to diploid by arrest of the second meiotic division with heat shock. Hatched fry of each homozygous diploid (all females) were fed with a methyltestosterone-containing diet (40 micrograms/gm diet) to produce sex-reversed males, which were mated with brood females, and thus two cloned lines were obtained.
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Effects of Dose Fractionation and Cycloheximide on the Heat-Shock Induction of Radiation Resistance in Primordial Germ Cells of the Fish Oryzias latipes. Radiat Res 1985. [DOI: 10.2307/3576779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Effect of heat on radiosensitivity at different developmental stages of embryos of the fish Oryzias latipes. INTERNATIONAL JOURNAL OF RADIATION BIOLOGY AND RELATED STUDIES IN PHYSICS, CHEMISTRY, AND MEDICINE 1985; 48:505-12. [PMID: 3876303 DOI: 10.1080/09553008514551571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Embryos of the fish, Oryzias latipes, at various developmental stages were heated before or after gamma-irradiation. The lethal effects of heat and radiation treatments were determined by the hatchability of the irradiated embryos. The radiosensitivity suddenly decreased at 3-days after fertilization. Heat (41 degrees C), either preceding or following irradiation, decreased the shoulder region (Dq) of the dose-response curves of the embryos irradiated at the 1-3 day stages, and increased the slope (D0) only at the 3 day stage. The magnitude of enhancement of radiosensitivity by pre- and post-heating was found to depend on the time and temperature of the heat as well as the developmental stage of the embryos; in 1- and 2-day embryos the effectiveness of post-irradiation heating was larger than that of pre-irradiation heating whereas in 3-day embryos there was no difference between the effectiveness of pre- and post-treatment. The sequence of heat (41 degrees C) and radiation treatment, and the time interval between the two treatments, also influenced the effectiveness of heat on radiosensitivity, depending upon the developmental stage; recovery from heat effects was not observed within a time interval of up to 3 h before radiation exposure for either 1- or 3-day embryos, whereas recovery from the radiation lesion occurred, for only 1-day embryos, within 1 h of subsequent heat exposure.
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Whole-body X-irradiation of mice accelerates polyploidization of hepatocytes. INTERNATIONAL JOURNAL OF RADIATION BIOLOGY AND RELATED STUDIES IN PHYSICS, CHEMISTRY, AND MEDICINE 1985; 47:261-5. [PMID: 3884522 DOI: 10.1080/09553008514550391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Male C57BL/6 mice were whole-body irradiated with 4.75 Gy of X-rays at the age of 2 months and killed at 2, 6, 12 and 19 months after irradiation. The percentage survival began to decline earlier and faster in the irradiated group than the controls up to 19 months after exposure when the study was terminated. The nuclear DNA content of individual hepatocytes was measured by a Feulgen-DNA microfluorometric method, and hepatocytes were classified into various ploidy classes. In the irradiated mice, the degree of polyploidization was significantly higher than the controls by 2 months after exposure and steadily increased up to 6 months after exposure. Thereafter, however, a slow return to the control level was found up to 19 months after irradiation. These results appear to support a hypothesis that radiation accelerates the ageing process as judged from hepatocyte polyploidization.
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Effect of gamma irradiation on the reproductive system of the pond snail Physa acuta. Radiat Res 1984; 98:362-9. [PMID: 6547235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Changes in the survival rate in adults and embryos of the pond snail Physa acuta were studied after acute whole-body gamma irradiation. The LD50 value of the adult snails was about 40 kR. The LD50 values of the embryos irradiated 0 and 1 day after oviposition were about 0.9 and 2 kR, respectively. Histological changes in the ovotestis, the number of eggs laid, and their hatchability were examined in the irradiated adult snails. A fall and a subsequent recovery were observed for these characteristics after irradiation with 8 kR of gamma rays. The relative constitution of the germ-cell populations was greatly changed by the same dose of gamma rays. The proportion of immature germ cells was reduced, and the total number of germ cells also diminished 11 days after irradiation. After depletion, the ovotestis was first repopulated with gonia , and then with oocytes, spermatocytes, and spermatids.
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The unique responses of the primordial germ cells in the fish Oryzias latipes to gamma-rays. INTERNATIONAL JOURNAL OF RADIATION BIOLOGY AND RELATED STUDIES IN PHYSICS, CHEMISTRY, AND MEDICINE 1984; 45:227-35. [PMID: 6609136 DOI: 10.1080/09553008414550321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The effects of gamma-radiation on the development of the primordial germ cells (PGCs) of medaka embryos (Oryzias latipes) during the early stages of development were quantitatively examined and compared to the effects on the intestinal cells. The PGCs develop in three stages: an extra-gonadal proliferative stage (1-2.5 days after fertilization), a mitotically inactive stage after the termination of the migration into the gonad (2.5-4.5 days), and an extensive proliferative stage (between 4.5 days and hatching). A dose-rate effect was absent in the PGCs, regardless of their mitotic activity, when dose rates were 2.5 and 0.14 Gy/min. The radiation effect on the PGCs was not reduced by hypoxia and was not enhanced by heat treatment during the proliferating stages. Conversely, radiation resistance was induced in the PCGs during the mitotocally inactive stage by hypoxia and, unexpectedly, by heat treatment. From the present data, we conclude that the PGCs have a small repair ability, and we discuss the radiation resistance induced in the PGCs by hypoxia and heat treatment.
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Abstract
Males of the fish Oryzias latipes were treated with various chemicals and then mated with normal females. The fertility and hatchability of the eggs laid by the parents were examined, and the dominant lethal effects were estimated. Mitomycin C induced dominant lethals in the fish spermatids and spermatocytes after the males had been treated with concentrations of 2.5 and 25 micrograms/ml. Methyl methanesulfonate (MMS) induced dominant lethals in spermatozoa and spermatozoa and spermatids after the injection of 200 and 400 mg/kg. These results are in good agreement with the results obtained with mice. However, the effects of ethyl methanesulfonate (EMS) were not clear on spermatogenic cells at any stage. We could not recognize any significant induction of dominant lethals by urethanes, bleomycin, caffeine, and two kinds of food-color additives, at least under the present experimental conditions.
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Mortality of the earthworms, Eisenia foetida, after gamma-irradiation at different stages of their life history. JOURNAL OF RADIATION RESEARCH 1983; 24:209-220. [PMID: 6686610 DOI: 10.1269/jrr.24.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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41
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Effects of gamma-rays on the taste buds of embryos and adults of the fish Oryzias latipes. JOURNAL OF RADIATION RESEARCH 1983; 24:278-283. [PMID: 6663544 DOI: 10.1269/jrr.24.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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42
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Abnormal morphogenesis of sea urchin embryo induced by UV partial irradiation given at cleavage stage. JOURNAL OF RADIATION RESEARCH 1983; 24:197-202. [PMID: 6663536 DOI: 10.1269/jrr.24.197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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43
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Abstract
When laying females or males of the small fish Oryzias latipes were irradiated with gamma-rays and then mated with a non-irradiated partner, the fertility and hatchability of the embryos were reduced as the doses increased. In respect to hatchability (the induction of dominant lethality), the male was more sensitive than the female, and mature sperm were most sensitive among the various stages of spermatogenetic cells. The dose-rate effects on the production of the dominant lethality were observed in spermatogonia and spermatocytes. The inbred strain of the fish, HB-1, was sensitive to gamma-rays. Since the relationship between dose and the decrease in hatchability was almost linear, at least within a limited range, we think that this system would be useful for monitoring mutagenic factors in an aquatic environment.
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Effects of gamma-irradiation on the rejection of transplanted scale melanophores in the teleost, Oryzias latipes. DEVELOPMENTAL AND COMPARATIVE IMMUNOLOGY 1983; 7:51-58. [PMID: 6341107 DOI: 10.1016/0145-305x(83)90054-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The effects of gamma-irradiation on allograft rejection in the teleost, Oryzias latipes, were examined at 25 degrees C. The survival of melanophores in the transplanted scale was observed as an index of rejection. Allografts were rejected in non-irradiated fish within 7 days. In the gamma-irradiated recipients (2kR), the grafts were rejected more slowly, but still within 20 days. The gamma-ray effects, however, disappeared almost completely within 25 days after the irradiation. If the same recipient again received transplants, the secondary response occurred clearly and the melanophores were rejected very rapidly. The secondary response was suppressed by gamma-rays if the fish was irradiated just before the second transplantation. Immunologic memory against the first transplants disappeared within 30 days, a period shorter than that of mammals.
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45
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Photoreactivation and excision repair of thymine dimers in ultraviolet-irradiated cultured fish cells. Radiat Res 1982; 90:501-8. [PMID: 7089174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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46
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Effects of gamma-rays on morphology of the thymus of the adult fish of Oryzias latipes. JOURNAL OF RADIATION RESEARCH 1982; 23:253-259. [PMID: 7131387 DOI: 10.1269/jrr.23.253] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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47
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48
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Resistance of a cultured fish cell line (CAF-MM1) to gamma irradiation. Radiat Res 1982; 89:334-47. [PMID: 7063616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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49
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Abstract
The thymus of the teleost fish Oryzias latipes is a paired structure found at the dorsoposterior part of the gill chamber. In 3-month-old fish, the thymus shows a great development. The thymus displays atrophy during aging, and the thymus involution continues until 5 years of age. Male thymus shows heavier involution than female thymus of the same age. Emigration of thymus cells takes place at all ages but increases with age.
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Rejoining of DNA strand breaks after gamma-irradiation in cultured fish cells, CAF-MM1. INTERNATIONAL JOURNAL OF RADIATION BIOLOGY AND RELATED STUDIES IN PHYSICS, CHEMISTRY, AND MEDICINE 1982; 41:85-90. [PMID: 6977509 DOI: 10.1080/09553008214550081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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