Calcarisporium cordycipiticola is the pathogen in the white mildew disease of Cordyceps militaris, one of the popular mushrooms. This disease frequently occurs and there is no effective method for disease prevention and control. In the present study, C. militaris is found to be the only host of C. cordycipiticola, indicating strict host specificity. The infection process was monitored by fluorescent labeling and scanning and transmission electron microscopes. C. cordycipiticola can invade into the gaps among hyphae of the fruiting bodies of the host and fill them gradually. It can degrade the hyphae of the host by both direct contact and noncontact. The parasitism is initially biotrophic, and then necrotrophic as mycoparasitic interaction progresses. The approximate chromosome-level genome assembly of C. cordycipiticola yielded an N50 length of 5.45 Mbp and a total size of 34.51 Mbp, encoding 10,443 proteins. Phylogenomic analysis revealed that C. cordycipiticola is phylogenetically close to its specific host, C. militaris. A comparative genomic analysis showed that the number of CAZymes of C. cordycipiticola was much less than in other mycoparasites, which might be attributed to its host specificity. Secondary metabolite cluster analysis disclosed the great biosynthetic capabilities and potential mycotoxin production capability. This study provides insights into the potential pathogenesis and interaction between mycoparasite and its host. Cordyceps militaris (L.) Fr., one of the famous edible and medicinal fungi, has been widely used as an herbal drug and tonic in East Asia. The fruiting bodies have been cultivated artificially and it is estimated that the annual value of production of C. militaris is about 10 billion RMB in China  domains, whereas P450 members were contracted noticeably . Py. PyAspern nature . TranscrAlternaria brassicicola ATCC 96,836 [A. brassicicola ATCC 96,836  which was confirmed to be involved in depudecin biosynthesis in C 96,836 . MoreoveC 96,836 . HoweverC 96,836 .C. cordycipiticola , and homologous comparison found that the six proteins of the cluster 17 of C. cordycipiticola shared a sequence identity of 25–52% with those of A. solani  with SOL1 which has been confirmed for solanapyrone biosynthesis in a solani . The clu. solani . Transcr. solani , indicatHypomyces subiculosus which were responsible for hypothemycin biosynthesis   with CitS responsible for citrinin biosynthesis in us ruber . Flankinand 50%) . Transcrand 50%) , indicatC. cordycipiticola was found to parasitize and degrade the hyphae of the fruiting body of C. militaris, by direct contact and noncontact (Mycoparasitism is a lifestyle where a living fungus (host or prey) is parasitized by and acts as a nutrient source of another fungus (mycoparasite or predator) , which cncontact . The appC. cordycipiticola cannot infect the other species of Cordycipitaceae, including B. bassiana, C. tenuipes and I. cicadae  and the truffle parasite T. ophioglossoides (31.2 Mbp), but a pronounced reduction than that of C. rosea (55.18 to 70.7 Mbp) [C. rosea and 10,443 in C. cordycipiticola).Sequencing and analyses of the genomes of mycoparasites rma spp.  and C. rC. rosea , as wellossoides  and Escos weberi  in the os weberi . The C. 0.7 Mbp) . This reC. cordycipiticola which were consistent with the mycoparasitic lifestyle. The proportion of genes encoding secreted proteins (9.02%) is relatively high; the pathogen-secreted effectors were mainly enriched with amino sugar and nucleotide sugar metabolism (ko00520); the most abundant family of GHs for C. cordycipiticola was GH16 and GH18  was much less than that of the other mycoparasitic fungi, C. rosea (656), T. harziam (516) and T. atroviride (473), especially those for cell wall degradation  was more than twice of its host C. militaris [Trichoderma species and C. rosea are especially enriched in SM-related genes [E. weberi, which kills its ant-cultivated host fungi from a distance, thereby likely involving secreted toxins [C. cordycipiticola. In some cases, for the hyphae of the host which did not contact with those of the pathogens directly, the cell organelles had been lost even if the cell wall was only partially degraded and deformed (C. cordycipiticola and promote iron absorption during infection, which is our ongoing project.Fungal SMs serve survival functions by supporting the fungus in competition against other microbes, in self-protection and defense, and have important roles in communication and interaction with other organisms . The numilitaris . It was ed genes  which sed toxins . The samdeformed A–C. It wC. militaris have been consumed worldwide as a tonic [C. cordycipiticola may mix with the fruiting bodies for sale and so the safety is still of concerned. Our genome data suggest that there are some gene clusters for mycotoxin-production, such as solanapyrone, hypothemycin, zearalenone and citrinin-related compounds (C. cordycipiticola should not be consumed.The fruiting bodies of  a tonic . Sometimompounds . TranscrC. cordycipiticola is evolutionarily close to its specific host, C. militaris (C. militaris diverged from C. cordycipiticola around 80.9–62.2 MYA (Phylogenomic analysis based on the single copy orthologs of 32 fungi revealed that ilitaris , which m62.2 MYA  after orMycoparasitism generally involves four sequential steps: chemotropism, recognition, attachment and cell wall penetration, and digestion of host cell content . The pre


Certain consonant sounds called fricatives  are difficult to hear over the telephone; phones exclude high-frequency sounds that affect their intelligibility. This may be problematic for older adults responding to phone-based memory tests. Many older adults have some degree of hearing loss, and older men have it more in the high-frequency range. Hearing loss, in combination with phone bandwidth restrictions, may reduce older adults’ recall of fricative words. Participants  in the 1998 wave of the Health and Retirement study (HRS) completed a word list immediate recall task over the phone. List 4 recall was examined because it was evenly split (5 each) between words with and without fricative consonant sounds. Subjective ratings of hearing and health, age, depression, and education were also measured. A Wilcoxon signed-rank test showed participants recalled fewer fricative (M=2.8) than nonfricative (M=3.0) words, Z=-8.47, p<.001. An ordinal regression for fricative word recall indicated a sex by hearing interaction; males with worse hearing were less likely to recall more fricative words, OR=.94, 95% CI , p=.076, after controlling for age, education, health, and depression. An ordinal regression for nonfricative word recall did not show a main effect for hearing or a hearing by sex interaction. For both models, age, education, and health were related to recall. Consonant sounds may influence phone-based word recall, particularly for older men. Attention should be paid to word selection when designing phone-based cognitive tests in order to avoid memory impairment overestimation.


Deaf and hard of hearing people use a variety of assistive devices and technologies as a strategy to mitigate, counter or compensate for life difficulties resulting from hearing loss. Although outcome measures are commonly used with hearing aids, few studies have explored the perceived psychosocial impact of other assistive devices and technologies or the factors leading to their abandonment or lack of use. Therefore, the main aim of this study was to assess the psychosocial impact of different assistive devices on deaf and hard of hearing people using the Psychosocial Impact of Assistive Devices Scale. The sample was made up of 291 individuals, 176 women and 115 men, with an average age of 56.12 years (standard deviation (SD) = 25.11), who were all users of different assistive devices. Overall, the results of the study showed that the use of assistive devices had a positive psychosocial impact, although this impact varied slightly depending on the specific type of device. Moreover, a relationship was identified between the psychosocial impact and the probability of future abandonment of a hearing aid or a cochlear implant. The results point to the importance of considering the psychosocial impact derived from the use of a device as a relevant variable in the adoption process of assistive technologies for deaf and hard of hearing people. Hearing loss is a global issue and one of the main concerns of the World Health Organisation (WHO)  which esGiven the high frequency of use of all these technologies, one of the most active fields of research in audiological rehabilitation is dedicated to outcome measures derived from the use of assistive technologies (AT) for audition . BroadlyIn the field of outcome measures, it is important to conduct studies to design assessment tools with good metric properties and to evaluate outcomes not only in terms of hearing improvement, but also in relation to their impact on psychosocial well-being and occupational performance ,17,18,19There is a significant body of research examining the performance and usefulness of different generic and specific outcome measures for hearing aids. For example, Saunders and Jutai  examinedMore generally, a number of studies have assessed different aspects relating to the use of AT in deaf and hard of hearing, including the psychosocial impact deriving from its use ,25,26,27Another interesting area in the field of outcome measures is the study of the abandonment of AT. Despite the usefulness of assistive technologies, in some cases adopted devices are abandoned; in the case of hearing aids, studies have reported abandonment rates of up to 78% . The facDespite the extensive body of literature on outcome measures in auditory assistive devices, very few studies have focused on evaluating their psychosocial impact. Among these, fewer still have analysed the perceived impact of the use of different devices in a differential manner. Therefore, this study aims to evaluate the psychosocial impact deriving from the use of different AT for communication by deaf and hard of hearing people, as well as to analyse the psychosocial impact of different types of device and the effect of these differences on the abandonment or lack of use of AT.The sample for this study was selected using non-probability convenience sampling. The sample was made up of 291 individuals, 176 women and 115 men, with an average age of 56.12 years (SD = 25.11). The AT covered by the study were CI (n = 30), hearing aids (n = 137) and ICT (n = 124), including mobile devices  (n = 26), VRS (n = 66) or software to conduct video-calls like ooVoo (n = 17), a cross-platform instant voice and text messaging app, and Skype (n = 15). The study was carried out with users of associations for deaf and hard of hearing people at residential centres in several different regions in Spain. A total of 33 centres were contacted, of which 16 participated in the study see . The incThe data collection procedure was based on the application of the researchers’ custom-made socio-demographic questionnaire and the PIADS scale. In this study, data collection was carried out by means of individual interviews, lasting between 30 and 90 min, depending on the characteristics of the participants. Questions were supplied in writing and in Spanish sign language. Contact was made through in-person and/or virtual interviews at different associations with professionals working directly with hard of hearing and/or deaf people. The study was structured in three phases; the first phase was aimed to obtain data from deaf and hard of hearing individuals who used ICTs to improve daily occupational performance, especially in areas such as the instrumental activities of daily life such as communication management, use of financial management, maintain security and respond to emergency . Participants from this group answered by means of a self-administered online questionnaire. The second phase was aimed at obtaining data from people who only used hearing aids . For this group, the interviews were carried out in person face to face. Finally, the third phase involved obtaining data from individuals who used CI exclusively (they only used one CI and not a CI and hearing aid simultaneously), by way of face to face interviews. Detailed information about the study and its objectives was provided and the researchers requested collaboration from the associations and centres, as well as from the professionals. If they accepted, several dates were proposed for conducting the interviews and the administration of questionnaires. Following the initial evaluation, the participants using hearing aids and cochlear implants were contacted again 12 months later to find out whether they continued to use the same AT or whether they had discontinued their use . This contact was made directly with participants or, where necessary, with their associations or centres. One hearing aid user could not be evaluated because he had passed away.The PIADS scale is a 26-item self-report survey which assesses the functional independence, wellbeing and quality of life linked to the use of assistive technology . It is aThe Survey of Technology Use-Consumer (SOTU-C), part of the matching person and technology (MPT) model , is a foIn order to attain the study objectives, several analyses of the data were conducted.Firstly, a descriptive analysis of the total PIADS scale and its three subscales was carried out. This analysis showed that the average impact was positive for the three subscales of self-esteem , adaptability  and competence , and for the total PIADS scale .Secondly, the scores for the total scale and the three subscales were calculated grouping each type of assistive device according to four groups: HA, CI, ICT and VRS. As shown in p < 0.01] and type of hearing loss  but, importantly, a non-significant interaction . Similar analysis showed non-significant interactions for age , gender  or onset of loss . Therefore, neither of those variables were included in the subsequent analyses.First, and in order to determine whether the type of loss could have a significant effect on psychosocial impact, a robust two-way ANOVA with type of hearing loss (hypoacusis or cophosis) and type-of-device as between variables, and PIADS global score as dependent variable was performed. Results showed significant main effects of type of device , PIADS scores  and the interaction . To explore those main effects and the interaction a set of robust one factor ANOVAs were performed for global PIADS score and for each subdimension score.Second, a robust two-way mixed ANOVA with type-of-device as between variable and PIADS subdimensions scores as a within variable showed significant effects for type-of-device . Post-hoc tests showed a significantly lower psychosocial impact for ICTs compared to hearing aids , CIs  and VRSs . No other differences were found to be significant.For PIADS global score, the analysis showed differences as a function of the type-of-device groups  and self-esteem . In relation to competence, post-hoc tests showed lower psychosocial impact for ICTs in comparison to hearing aids , CIs  and VRSs . The same results were found for self-esteem dimension, with lower impact scores for ICTs in comparison to hearing aids , CIs  and VRSs . For adaptability dimension , post-hoc tests showed lower scores for ICTs in comparison to hearing aids  and VRSs .A quite similar pattern of results was obtained for subdimensions of competence [F = 11.31, Finally, the analysis also examined abandonment of AT. To this end, the researchers contacted the participants who used hearing aids and CI one year after the first round of data collection for the study and asked whether or not they continued to use the AT. A total of 25 participants had abandoned hearing aids and six participants had abandoned cochlear implants. The results are shown in As can be seen in First, the correlation analysis revealed that abandonment only showed significant and negative correlations with the dimensions of the PIADS scale. In the case of the HA a, the coIn order to explore the predictive power of the psychosocial impact and other variables on abandonment for each type of AT, multiple logistic regression analyses were carried out with abandonment (YES/NO) as the dependent variable. A best subset regression procedure  was usedAs can be seen in Although it was not possible to perform this same analysis on the subsample of CI users, given its small sample size, a similar analysis was performed including users of both HA and CI. As shown in The research carried out for this study aimed to explore the psychosocial impact deriving from the use of different AT and other technologies among deaf and hard of hearing people and the relationship between psychosocial impact and future abandonment of these devices.First, analyses have shown positive impact results, independent of the type of hearing loss, for all device types. Second, results have also shown that some AT and technologies are associated with better outcomes in terms of their psychosocial impact. For example, it is relevant to note that participants who used VRS, HAs and CIs obtained better outcomes than users of more common ICTs, corroborating the findings of previous studies .Third, the results for hearing aids clearly endorse their use, with a positive psychosocial impact across all types. Previous studies concluded that the use of hearing aids leads to higher satisfaction levels, improved quality of life and greater self-esteem ,50,51, iMeanwhile, the results showed a positive impact on quality of life among CI users, corroborating the findings of other studies ,57,58,59Finally, the possible relationship between psychosocial impact and abandonment or lack of use of AT was explored. The results for the total PIADS scale and its three subscales showed that the scores obtained by the participants who had abandoned AT a year after the initial study were far lower than those of the other participants (near zero or even negative). Logistic regression analysis were used to supplement these results, pointing to the predictive qualities of the PIADS scale and its three dimensions as useful constructs to determine the probability of future abandonment of an assistive device. Specifically, the results indicate that high competence and self-esteem derived from the use of a hearing aid are associated to a decreased probability of future abandonment of the device. Globally, self-esteem seems to be the dimension most clearly implicated in the abandonment of HA and CI in deaf and hard of hearing people. This result is consistent with those from other studies that have shown the vulnerability of self-esteem in the deaf population and its relation to the satisfaction with different hearing aids and devices ,65,66. IThe current study also found a high percentage (20%) of CI non-use or abandonment. However, it is important to emphasize that these results are preliminary and larger-scale studies are required. Although the literature on non-use or abandonment of CI use is scarce, some other studies have provided converging data. For example, Summerfield and Mashall  found a Therefore, it seems necessary to carry out longitudinal studies to explore the factors of CI abandonment, considering important dimensions such as Deaf identity, as indicated by other researchers , and othA major limitation of this study is the lack of an objective measure of the severity of hearing loss . Although the literature is mixed regarding the relationship between severity of loss and satisfaction with or adoption of a hearing aid, it would have been interesting to explore its possible effect on psychosocial impact. For example, the review of Wong, Hickson and McPherson  showed sFurthermore, the non-probability convenience sampling used, as well as the small sample size, complicates the generalizability of the results. Moreover, the abandonment study was only carried out with CI and hearing aid users, so the results cannot be easily generalised to other auditory assistive devices. Also, the factors associated with abandonment have not been systematically explored.Some other limitations derive from the use of the PIADS scale. First, it is not yet clearly established in the literature that the PIADS subscales can assess separate constructs and this could limit conclusions based on the use of subscale scores. For example, in a recent study analyzing the factor structure of the Spanish version of the scale , the resTo conclude, AT can be a useful intervention tool to mitigate the repercussions of hearing loss on people’s daily activities and roles. However, further research is needed on outcome measures for evaluating, selecting and acquiring an AT ,45,82,83


To compare inpatient treated patients with idiopathic (ISSNHL) and non-idiopathic sudden sensorineural hearing loss (NISSNHL) regarding frequency, hearing loss, treatment and outcome.All 574 inpatient patients  with ISSNHL and NISSNHL, who were treated in federal state Thuringia in 2011 and 2012, were included retrospectively. Univariate and multivariate statistical analyses were performed.p < 0.001). The mean interval between onset of hearing loss to inpatient treatment was shorter in ISSNHL (7.7 days) than in NISSNHL . The initial hearing loss of the three most affected frequencies in pure-tone average (3PTAmax) scaled 72.9 dBHL ± 31.3 dBHL in ISSNHL and 67.4 dBHL ± 30.5 dBHL in NISSNHL. In the case of acute otitis media, 3PTAmax (59.7 dBHL ± 24.6 dBHL) was lower than in the case of varicella-zoster infection or Lyme disease . Mean absolute hearing gain (Δ3PTAmaxabs) was 8.1 dB ± 18.8 dB in patients with ISSNHL, and not different in NISSNHL patients with 10.2 dB ± 17.6 dB. A Δ3PTAmaxabs ≥ 10 dB was reached in 34.3% of the patients with ISSNHL and to a significantly higher rate of 48.8% in NISSNHL patients (p = 0.011).ISSNHL was diagnosed in 490 patients (85%), NISSNHL in 84 patients (15%). 49% of these cases had hearing loss due to acute otitis media, 37% through varicella-zoster infection or Lyme disease, 10% through Menière disease and 7% due to other reasons. Patients with ISSNHL and NISSNHL showed no difference between age, gender, side of hearing loss, presence of tinnitus or vertigo and their comorbidities. 45% of patients with ISSNHL and 62% with NISSNHL had an outpatient treatment prior to inpatient treatment (ISSNHL and NISSNHL show no relevant baseline differences. ISSNHL tends to have a higher initial hearing loss. NISSHNL shows a better outcome than ISSNHL.The online version contains supplementary material available at 10.1007/s00405-021-06691-y. So far, many studies have analyzed epidemiological data for idiopathic sudden sensorineural hearing loss (ISSNHL) , 2. In aIn contrast, not much is known on the outcome of non-idiopathic sudden sensorineural hearing loss (NISSNHL), because in all studies analyzing hearing loss and recovery these patients are excluded , 10. TheIn the federal state of Thuringia, there are eight hospitals with departments for ears-nose-throat (ENT) medicine. These have formed a network for the scientific evaluation of ENT diseases , 12. RecWe performed a retrospective analysis in all eight ENT departments of the federal state Thuringia. All patients who were hospitalized in 2011 and 2012 due to acute hearing loss with the ICD codes  H91.0, H91.1, H91.2, H91.3, H91.8 and H91.9 were included in the study. A positive ethical vote for the evaluation of the underlying data was obtained . A total of 723 patients with the above-mentioned diagnoses were treated as inpatient patients and were included in the primary dataset. It made no difference whether the patients had comorbidities or had already received prior outpatient treatment. 58 patients were initially excluded from the evaluation due to missing data sets  and 91 patients were excluded due to a lack of initial hearing loss, inpatient treatment due to middle ear surgery or cochlear implantation or lack of follow-up hearing examinations. Of the remaining 574 patients, 490 had an idiopathic sudden sensorineural hearing loss (ISSNHL) while the remaining 84 patients had a disease underlying the hearing loss  and were classified as NISSNHL. All 574 patients, ISSNHL as well as NISSNHL, were examined in the present study .The follow-up was recorded and evaluated until August 2013. Patient data such as age and gender, clinical and functional examination, medical and surgical treatment were recorded and the treatment of hearing loss in the case of ISSNHL compared to NISSNHL was evaluated.abs = PTApre minus PTApost in dB) [rel = 100*(PTApre minus PTApost)/PTApre and relative hearing improvement compared to the contralateral ear  ΔPTArelcontral = 100* (PTApre minus PTApost)/. ΔPTAabs ≥ 10 dB, ΔPTAabs ≥ 15 dB, ΔPTArel ≥ 50% and ΔPTArelcontral ≥ 50% in a dichotomous distribution (yes / no) were considered as criterions for a successful improvement [The extent of the initial hearing loss was described using the pure-tone average (PTA) in decibels hearing level (dB HL). The average hearing loss of the three most affected frequencies 3PTAmax), 10 frequencies , 9 frequencies , 4frequencies , low- , middle- , and high frequency  hearing loss were calculated PTAmax, 1, 14. Heat in dB) . Furtherrovement . Kanazakrovement .www.tls.thueringen.de).The epidemiological statistics were calculated on the basis of the annual average population of Thuringia from 2011 and 2012, which are published in the online database of the statistical office of the federal state of Thuringia (The patients affected by ISSNHL were treated according to the German guidelines for the treatment of sudden hearing loss: All patients received intravenous prednisolone therapy. Prednisolone was administered in a dose of 250 mg/d (range of 100–500 mg/d) , 8. The p < 0.05.Unless otherwise noted, data were presented with mean values ± standard deviation (SD). All statistical analyses were performed using IBM SPSS, version 24.0.0.0. The non-parametric Mann–Whitney-U-test for independent metric data was applied to compare different subgroups of patients. The Chi-square test was applied for independent nominal data. The non-parametric Wilcoxon test for dependent metric data was applied to analyze differences between initial hearing loss and final hearing loss on the affected ear at the end of the follow-up. A multivariate binary logistic regression was performed including the significant associations. Nominal p-values of two-tailed tests are reported. The significance level was set at p = 0.218). There was no side predominance of acute hearing loss neither in ISSNHL nor in NISSNHL (p = 0.197). The accompanying symptoms like tinnitus  or vertigo  occurred equally frequently in both groups (Table p = 0.117), coronary heart disease (p = 0.601), diabetes mellitus type II (p = 0.414), hypercholesterolemia (p = 0.755) and arterial hypertension (p = 0.754) occurred equally frequently in ISSNHL and NISSNHL (Table p < 0.001). The time from the onset of hearing loss to hospital admission was less for NISSNHL (7.7 days ± 12.2 days) than for ISSNHL . The majority of the patients (98.1%) received prednisolone therapy during the inpatient stay . Patients with NISSNHL had to undergo surgery during the hospital stay more often (52%) than patients with ISSNHL  . 12% of the patients had an acute deafness and 2% had a combined vestibulocochlear lesion . Considering the 10PTA, 9PTA, 4PTA, LF-3PTA and MF-3PTA ISSNHL had more severe hearing loss than NISSNHL (p < 0.05)  . In LF-3PTA 27.4% of NISSNHL and 42% of ISSNHL reached ΔPTAabs ≥ 10 dB (p = 0.011) and 17.9% of NISSNHL and 32.2% of ISSNHL reached ΔPTAabs ≥ 15 dB. Other parameters showed no difference in NISSNHL and ISSNHL  at NISSNHL was 67.4 dBHL ± 30.5dBHL and showed no statistical difference to hearing loss at ISSNHL with a 3PTAmax of 72.9 dBHL ± 31.3 dB (p = 0.033)   and that more patients with prior outpatient treatment showed a hearing impairment of Δ3PTAmaxabs ≥ 10 dB (p = 0.032). There was no difference for the tinnitus (p = 0.325), as well as for the comorbidities of coronary heart disease (p = 0.531), hypercholesterolemia (p = 0.439), diabetes mellitus type II (p = 0.653) and arterial hypertension (p = 0.850)  inhabitants in 2011 and 2012. In total, an average of 16.61 inpatients per 100,000 habitants was treated in Thuringia per year. Of these, 11.25 inpatients per 100,000 habitants had an ISSNHL and 1.93 per 100,000 inhabitant people per year had an NISSNHL . There was no difference in gender distribution. The incidence of the ISSNHL was 21.6/100,000 in women and 23.4/100,000 in men. The incidence of NISSNHL was 3.5/100,000 in women and 4.2/100,000 in men.abs [In the current study, causes for sensorineural hearing losses were found in 14.6%, which corresponds to the numbers reported so far . There wabs . An explabs , 18, whiabs .Studies that directly compare ISSNHL and NISSNHL are not known. Therefore, the retrospective study presented here with a total of 490 patients with ISSNHL and 84 patients with NISSNHL is the largest study of this type published to date. One disadvantage of the current study is that only patients with acute hearing loss were included here. Patients treated in hospital with the ICD codes H65.0, H65.1, H65.2, H65.3 H65.4 H65.9, H66.0, H66.1, H66.2, H66.3, H66.4, H66.9, H67.0* H67.1*, H67.8*, H83.0, H73.0, J11.8,H70.0, H70.2, H70 0.8, H70.9, B02.8 and A69.2 for any underlying disease were not included. Therefore, there is an unreported number of patients with other diseases combined with sensorineural hearing loss. Likewise, the true incidence of diseases is underestimated here because only patients who have been hospitalized are included in this evaluation. This is associated with a selection bias in favor of the more severe cases. The evaluation of hearing loss and hearing gain is handled inconsistently in most studies –21. So fThe data on the occurrence, extent and recovery of ISSNHL have already been discussed in detail elsewhere . TherefoIn addition to potentially life-threatening complications, acute otitis media can lead to a permanent impairment of the patient due to hearing loss . A zosteIn the present study, it was found that acute otitis media and Menière disease showed significantly less absolute hearing loss compared to the other subgroups. Many evaluations consider hearing loss, but often no distinction is made between the appearance of conductive hearing loss and sensorineural hearing loss. Occasionally the absolute extent of hearing loss (in dBHL) is not described. For acute otitis media hearing loss is reported between 25 and 40 dBHL , 35–37. So far, there is no guideline for the treatment of acute otitis media with sensorineural hearing loss in Germany. The German Society for General Medicine and Family Medicine published a S2k-guideline "Earache": In the guideline, initially symptomatic treatment and, in the event of a lack of improvement or indications of a complicated course, antibiotics are used . In acutThe current retrospective study examines inpatients with ISSNHL and NISSNHL in Thuringia in 2011 and 2012. It can be seen that ISSNHL tends to have a higher initial hearing loss than patients with NISSNHL. ISSNHL and NISSNHL show no difference in the degree of absolute or relative hearing improvement. However, patients with NISSNHL are more likely to show successful hearing improvement considering the 3PTAmax. The data are not sufficient to show prognostic differences of subgroups at NISSNHL. However, we were able to show that patients with acute otitis media and Menière disease show an initially lower hearing loss compared to patients with varicella zoster or Lyme disease or other underlying diseases.Supplementary file 1 (TIF 12771 KB) Supplemental Digital Content 1. Inclusion and exclusion of patients´ datasets. 574 patients were analyzed. 490 patients had an ISSNHL , 84 patients had a NISSNHL .Below is the link to the electronic supplementary material.


Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common form of autoimmune polyneuropathy. It is a chronic disease and may be monophasic, progressive or recurrent with exacerbations and incomplete remissions, causing accumulating disability. In recent years, there has been rapid progress in understanding the background of CIDP, which allowed us to distinguish specific phenotypes of this disease. This in turn allowed us to better understand the mechanism of response or non-response to various forms of therapy. On the basis of a review of the relevant literature, the authors present the current state of knowledge concerning the pathophysiology of the different clinical phenotypes of CIDP as well as ongoing research in this field, with reference to key points of immune-mediated processes involved in the background of CIDP.  Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common form of autoimmune polyneuropathy. It is a chronic disease and may be monophasic, progressive or recurrent. Patients with CIDP were first described by Hermann Eichhorst, a German neurologist working in Switzerland, in 1890 ,3, and tThe prevalence of CIDP is estimated at 1.2–8.9 per 100,000 people. The disease can appear at any age, more often around the age of 50; 10% of CIDP cases are children (rarely under the age of 1) . Pre-symClinically, CIDP presents as a progressive symmetrical limbs’ paresis that affects both the distal and proximal parts. The essence of CIDP is a selective involvement of peripheral nerves, plexuses or nerve roots. Limb weakness is accompanied by paraesthesia and a decreased sense of touch, pain and temperature. Impairment of deep sensation can lead to imbalance. Occasionally, cranial nerve involvement is observed. Tendon reflexes are weakened or suppressed in all limbs ,7,8. CIDThe current criteria for the diagnosis of CIDP have been developed by the European Federation of Neurological Societies (EFNS) in cooperation with the Peripheral Nerve Society (PNS) in 2021 . AccordiThe electrodiagnostic examinations may be supplemented by examination of the cerebrospinal fluid and Magnetic Resonance Imaging (MRI) of the roots and nerve plexuses. Peripheral nerve biopsy does not give a definite confirmation/exclusion of the CIDP diagnosis ,12,13.The typical form of CIDP is a sensorimotor form with a chronic onset, symmetrical symptoms distribution, usually more proximal than distal . In apprThe authors conducted a literature search focused on the topic of immunological characteristic of various phenotypes of CIDP. The search engines PubMed via MEDLINE and Google Scholar were used from the beginning of 2010, until 31 October 2021. Reviews and research studies, classified according to their relevance, were initially included, with subsequent exclusion of conference abstracts and papers written in languages other than English. In addition, reference lists from the eligible publications were searched for their relevance to the topic. With the uses of keywords as follows: chronic inflammatory demyelinating polyneuropathy, CIDP, anatomy, physiology, phenotypes, immunology, inflammatory process, demyelination process, nodal and paranodal antibodies, and atypical form. In addition to using singular key words, to find the most relevant records, the authors used PubMed Advanced Search Builder as well. The advanced queries used were as follows: (((CIDP) AND (phenotypes)) AND (immunology))); ((chronic inflammatory demyelinating polyneuropathy) OR (CIDP)) AND (((inflammatory process) OR (immunology)) OR )). To find the most relevant paper, two analysts (ED and MWP) were working separately by screening the search engines.As a result, 743 records were identified and screened separately by ED and MWP. Each of the analysts prepared their own list of records identified as relevant to the study. Then, these record lists were double read by both of them, and 110 abstracts were found to be relevant. Then, full text manuscripts were acquired. Then, all articles were read independently by both analysts. Each analyst worked independently and prepared their own list of relevant full-text manuscripts. Both lists were compered, and by discussion, 83 publications were found to be the most relevant to the study and included in this review. Two critical physical parameters influence the speed of conduction in the nervous system: the axon’s diameter and the axon membrane’s resistance to ion leakage out of the cell. The larger the axon diameter or the more leak-resistant the membrane, the faster an action potential will move. The myelin sheath, the greatly extended and modified plasma membrane, is wrapped around the nerves’ axons, isolating them. The ion channels are clustered in Ranvier nodes, holding the action potential in the nodes regions. It reduces the space and time requirements for the action potential propagation continuous to saltatory conduction. Structures located in nodes and paranodal region are important in numerous pathologies of the peripheral nervous system, which are associated with dysfunction of nodal gangliosides 170,171 ,16, neurThe formation of Ranvier’s node is associated with the clustering of sodium channels near the edge of the forming myelin sheath. This process has been observed in the peripheral nervous system, studying Schwann cells  and in tSchwann cell microvilli surround an area that can be divided into the node of Ranvier (NOR), the paranodal junction (PNJ), and the juxtaparanodal region (JXP). All of them are covered by the basal lamina (BL) . The intIn turn, structures relevant to the pathophysiology of CIDP can be distinguished in each of these regions (for NOR region and PNJ—Ranvier’s node is an area enriched in sodium channels (NaCh) and diverse potassium channels  ,28,29. TSeveral transmembrane proteins of Schwann cells are expressed in the node of Ranvier, such as NrCAM, gliomedin, dystroglycan (αDG and βDG), syndecan 3 and 4 (Syn3 and Syn4) and protein M6B ,34,35,36In the PNJ in the central and peripheral nervous systems, the neurofascin protein (NF155) and myelin-associated glycoprotein (MAG) are staged on the glial cell side. In Schwann cells NF 155 binds, with the help of protein 4.1G, to the ankyrin B (AnkB) and further to the proteins of the cytoskeleton: spectrin β2 and α2 . Axonal The paranodal region full of axo-glial junctions play a role in stabilization of nodes probably by acting as diffusion barriers, segregating ion channels at the node from those in the juxtaparanodes  and limiThe axonal membrane contains several isoforms of voltage-gated potassium channels (Kv1) at the JXP . PotassiProtein 4.1 families also play a crucial role in the integrity of the JXP, e.g., 4.1G targets and stabilizes the glial cell adhesion molecules  . TransmeAntibodies against nodal and paranodal proteins: NF155, NF140, NF186, CNTN1, and Caspr1 have been described in CIDP ,49,50,51The standard treatment, considered an autoimmune origin of CIDP, is based on the administration of corticosteroids, immunoglobulins, plasma exchange and immunosuppressive therapy . The subPatients without defined presence of antibodies (seronegative) CIDP respond to immunotherapy in 60–80% of cases, while as much as 80% of patients with nodal/paranodal antibodies have poor response to the therapy ,52. IVIgThe exact mechanism of nodal and paranodal antibodies remains unclear, and probably there are some discrepancies among distinct classes . The pooCIDP is a form of chronic neuropathy that is presumably caused by heterogeneous immune-mediated processes. The exact mechanisms of neuropathy in classical macrophage-induced demyelination remain unclear despite the long-standing recognition of this process in CIDP ,2,3,4.Classical macrophage-induced demyelination is basic in the pathogenesis of CIDP and is found in some patients in every major subtype, including typical CIDP, DADS, MADSAM and purely sensory subtypes. Early ultrastructural studies using biopsy specimens from patients with CIDP have demonstrated the stripping of morphologically normal myelin lamellae by cytoplasmic processes of macrophages ,66. MyelRecent studies have led to the concept of nodopathy or paranodopathy. The mechanisms initiated by autoantibodies against paranodal junction proteins (neurofascin 155 and contactin 1) have been demonstrated. Paranodal dissection resulting from the attachment of immunoglobulin G4 (IgG4) at paranodal junctions and the absence of macrophage-induced demyelination are characteristic pathologic features in patients with such antibodies . AntibodDifferences in lesion distribution and repair processes by Schwann cells may determine differences between subtypes. It is suggested that in typical CIDP there is preferential involvement of proximal and distal nerve segments, whereas in MADSAM there is a marked involvement of central nerve segments. These findings suggest that humoral rather than cellular immunity predominates in the former, as the nerve roots and neuromuscular junctions are devoid of the blood-nerve barrier ,13,59.+ CIDP) with patients lacking anti-NF155 antibodies (NF155- CIDP). A macrophage-induced demyelination was not observed in NF155+ CIDP [+ CIDP, the downregulation of IL1β is consistent with the absence of macrophage-mediated demyelination. Lymphocytes Th2 and IL 13 cytokines downregulate IL1β. Thus, it is possible that overrepresented Th2 (type 2 helper T cell) cytokines play a critical role in inducing IgG4 autoantibodies via the effects on IL4/IL13/IL10 and spinal root inflammation or by downregulation of IL1β and macrophage functions [+ and NF155− CIDP, but more marked in NF155+ CIDP. IL-1ra is a representative anti-inflammatory cytokine. Pronounced decrease in IL-1ra levels in NF155+ CIDP patients may also contribute to severe spinal root inflammation. Intrathecal upregulation Th2 cell cytokines is characteristic for IgG4 NF155+ CIDP, while type 1 helper T cell (Th1) cytokines are increased in CIDP regardless of the presence or absence of anti-NF155 antibodies. The findings suggest that overproduction of Th2 cell cytokines is unique to NF155+ CIDP [Studies have also compared the immunological profile of CIDP patients with IgG4 anti-neurofascin 155 (NF155) antibodies  reactivity. Immunoglobulin IgG4 is not capable of activating the classical complement pathway or forming immune complexes. Subclasses lacking the ability to activate complement can interact with other immunoglobulin subclasses and activate complement via the lectin pathway in the mouse models. IgG4 can also act as a neutralizing or blocking antibody, protecting the organism from severe allergic reactions caused by food or environmental allergens. In the response to Th2-dependent cytokines such as interleukins (IL)-4, -5, -10 and -13 and transforming growth factor β (TGF-β) eosinophilia activation can occur, IgG4 and IgE levels increase and fibrosis progresses. These cytokines, especially IL-10, are responsible for allergic symptoms, eosinophilia, and increased IgE and IgG4 levels. It seems that the overexpression of Th2 lymphocytes and Treg lymphocytes and their dependent cytokines plays a major role in the pathogenesis of IgG4-mediated diseases. The role of innate immunity in the pathogenesis of IgG4-RD is also under consideration. Peripheral blood innate immune cells, such as plasmacytoid dendritic cells and monocytes isolated from patients with IgG4-RD, promote IgG4 production by B cells. Activation of the innate immune response by microbe- and/or damage-associated molecular patterns stimulates production of type I interferon and B cell-activating factor by innate immune cells and results in IgG4 production by B cells. Macrophage and basophil cell dysfunction and overexpression of various cytokines including BAFF (TNF superfamily member) and APRIL (a proliferation-inducing ligand) have been demonstrated ,71,72.Neurofascin is crucial in constructing and maintaining the nodes of Ranvier. The mature nervous system predominantly expresses a neuronal isoform, NF186, and a glial isoform, NF155, whereas immature neurons express NF180 and NF166. Glial NF155 is expressed at paranodal loops of Schwann cells in the PNS and in oligodendrocytes in the CNS. Glial NF155 acts as a cell adhesion molecule, interacting with axonal CNTN1 and CASPR1 ,75,76,77The CNTN1-Caspr1-NF155 complex is required to maintain paranodal architecture and to maintain myelin insulation of the axon for nerve impulses propagation along myelinated axons. In patients with CIDP IgG1 and IgG4 subclasses autoantibodies are directed against CNTN1, and they can alter the paranodal architecture. IgG4 antibodies have a potential to block the NF155-CNTN1 interaction. Autoantibodies against NF155 (as well as against CNTN1 and possibly Caspr1) cause demyelinating lesions in both the CNS and PNS, termed combined central and peripheral demyelination (CCPD). However, there are some differences between individual patients. Patients with NF155 antibody-positive CIDP have a distinct clinical phenotype, which is defined by low-frequency, high-amplitude tremor, sensory ataxia and poor response to IVIG. Additionally, the anti-NF155 antibody-positive form of CIDP is exceptional in that it is associated with a high incidence of subclinical demyelinating lesions in the central nervous system ,78,79. ANeurofascins -140 and -186 , also expressed on motoneuron paranodes, seem to be the main target of autoantibodies in some CIDP patients ,75,76,77Motor neurons have heterogeneous axon initial segments (AISs), which underlie different spiking properties. Duflocq et al. identified a hemi-node-type organization in all α-motor neurons, with a contact-related protein (Caspr)+ paranode and a Caspr2+ and Kv1+ paranode compartment, identified as para-AIS and juxtapara (JXP)-AIS, adjacent to the AIS where the myelin sheath begins, which might limit some AIS plasticity . ProteinThere are only a few publications on CIDP patients with IgG4 subclass antibodies against Caspr1, therefore antibodies against other protein located on motoneuron paranodes or complexed Caspr1/CNTN1 should be considered ,63,79.CIDP is an acquired autoimmune neuropathy the pathogenesis that is not yet well understood. The involvement of autoreactive T lymphocytes, B lymphocytes, complement components, inflammatory chemokines and cytokines, antibodies to various glycoprotein and glycolipid nerve structures has been confirmed in the development of CIDP. The discovery of autoantibodies against the proteins of the node of Ranvier and the paranodal region in patients with atypical CIDP confirms the pathogenetic variety. The patients with these antibodies are mostly young, and the course of the disease is sudden, with the development of significant disability and a poor response to immunoglobulin treatment, but a potentially positive response to rituximab.Advances in research into the immunopathogenesis of CIDP will contribute to the correct diagnosis of this neuropathy and the application of the effective treatment.


Borreliella burgdorferi. Subunit and bacterin vaccines are available for the prevention of LD in dogs. LD bacterin vaccines, which are comprised of cell lysates of two strains of B. burgdorferi, contain over 1000 different proteins and cellular constituents. In contrast, subunit vaccines are defined in composition and consist of either outer surface protein (Osp)A or OspA and an OspC chimeritope. In this study, we comparatively assessed antibody responses to OspA and OspC induced by vaccination with all canine bacterin and subunit LD vaccines that are commercially available in North America.Lyme disease (LD), the most common tick-borne disease of canines and humans in N. America, is caused by the spirochete Dogs were administered a two-dose series of the vaccine to which they were assigned (3 weeks apart): Subunit-AC, Subunit-A, Bacterin-1, and Bacterin-2. Antibody titers to OspA and OspC were determined by ELISA and the ability of each vaccine to elicit antibodies that recognize diverse OspC proteins (referred to as OspC types) assessed by immunoblot. While all of the vaccines elicited similar OspA antibody responses, only Subunit-AC triggered a robust and broadly cross-reactive antibody response to divergent OspC proteins. The data presented within provide new information regarding vaccination-induced antibody responses to key tick and mammalian phase antigens by both subunit and bacterin LD canine vaccine formulations. Borreliella burgdorferi is the primary causative agent of LD; in Europe, B. burgdorferi, Borreliella bavariensis, Borreliella garinii, and Borreliella afzelii are associated with disease (Ixodes spp. ticks (B. burgdorferi antibody (Ab) tests were catalogued by the Companion Animal Parasite Council (CAPC) in 2020 in the US.1 The actual number of B. burgdorferi-positive antibody tests is assumed to be much higher since only 30% of test data are collected by CAPC each year. The precise number of antibody-positive tests in European dogs is more difficult to determine due to differences in data collection. While a positive antibody test does not in all cases indicate active infection, it is clear from recent studies that geographic distribution of ixodid ticks is expanding (Lyme disease (LD) is a significant health concern that affects companion animals  and huma disease . The LD p. ticks . LD is tp. ticks . In dogsxpanding  and the xpanding .B. burgdorferi infected dogs is common .Preventative strategies for LD in dogs include vaccination and the use of tick repellants and acaricides . In NortSince the discovery of the causative agents of LD , OspA anWhile the specific antigens in bacterin vaccines that contribute to protective immunity have not been defined, it has been suggested that OspA and OspC are key contributors . Due to In this study, we compared antibody responses to OspA and OspC in dogs vaccinated with the subunit and bacterin-based canine LD vaccines available in North America. In addition to antigen specific IgG titer determination, we assessed the potential of each vaccine to induce antibodies that recognize diverse OspC types and therefore potentially target diverse strains of the LD spirochetes. We demonstrate that there are both quantitative and qualitative differences in the antibody responses to OspC elicited by each vaccine. This study addresses key questions surrounding the potential contributions of OspA and OspC to protective immunity induced by administration of canine LD vaccines.Purpose-bred beagles  were obtained from Ridglan Farms and acclimated for 7 days prior to initiating the study. Animals were sorted by date of birth and litter (dam) to form blocks of four dogs. Half of the blocks were randomly assigned to each of two rooms. Within rooms, blocks were randomly assigned to pens. The randomization was performed using a SAS program that utilizes a random number generator function (ranuni). Animals were observed at least once daily for general health and potential adverse health events. Dogs were maintained at research sites in accordance with USDA Animal Welfare Regulations . The Zoetis Institutional Animal Care and Use Committee (IACUC) approved all protocols . Inclusion criteria consisted of negative antibody tests for OspA, OspC, and VlsE (C6 peptide) and good overall health. Screening for antibodies to OspA and OspC was done by ELISA as detailed below. To screen for antibodies to VlsE the SNAP 4Dx Plus lateral flow test was employed (IDEXX). Vaccines Subunit-AC , Bacterin-1 , Subunit-A , and Bacterin-2  were randomly assigned to each treatment group and administered per the manufacturers’ label instructions on days 0 and 21. Blood was collected and serum harvested on Days 0, 21, and 35 using standard protocols.ospC genotype with PCR primers that possess tail sequences that allow for ligase independent cloning (LIC). PCR was performed using Pfu DNA polymerase according to the manufacturers protocol (Promega). The amplicons were purified using QIAquick PCR purification kits (QIAgen), annealed with pET46 Ek/LIC or pET45b+ (Novagen), transformed into Escherichia coli NovaBlue(DE3) cells (Novagen), recovered, purified, and transformed into E. coli BL21(DE3) cells (Novagen). Protein expression was induced with IPTG (1 mM) using standard methods. The cells were recovered by centrifugation , suspended in lysis buffer , sonicated, and centrifuged . The N-terminal hexahistidine tagged OspC proteins were purified from the soluble fraction by nickel affinity chromatography using a Fast Protein Liquid Chromatography system  with a 1 mL HisTrap FF column (Cytvia). Samples were loaded into a 10 ml Superloop (Cytvia) in running buffer  followed by washing with 10 mL of running buffer. Proteins were eluted with elution buffer . One mL fractions were collected from under the peak and dialyzed into phosphate buffered saline (PBS) overnight using Spectra/Por 1 (6–8 kDa cutoff) dialysis membranes (Spectrum Laboratories). Purified OspA and the OspC chimeritope, Ch14, that are the antigens contained in the Subunit-AC vaccine, were provided by Zoetis. The concentrations of the recombinant proteins were determined using the BCA assay.The genes encoding 23 full-length OspC proteins . Recombinant serotype 1 OspA, the most dominant OspA serotype in North America , served The recombinant OspC types (500 ng) were assessed by SDS-PAGE, visualized by staining with Coomassie brilliant blue, immunoblotted, and screened as previously described with sera collected on Day 0 and 35 at a 1:1000 dilution . Due to P < 0.05).Antibody titers were logarithmically transformed. The transformed titers were analyzed with a general linear-mixed model for repeated measures. Pairwise treatment comparisons were made at each time point. Least square means at each time point, standard errors, and 95% confidence intervals were back-transformed to obtain the geometric mean titers (GMTs), standard errors, and their confidence intervals. In addition, minimums and maximums were calculated for each treatment and time point. All analyses were performed using the SAS software suite and all hypothesis tests were carried out at the 0.05 level of significance . Similarly, the difference in the GMT of study group Bacterin-1 versus study groups Subunit-A and Bacterin-2 was also significant (P = 0.0002). To compare OspC antibody responses elicited by each vaccine, the sera were screened by ELISA and individual titers and GMTS for each study group were determined. The antibody response to OspC differed among the study groups ; Table 2To assess the breadth or conversely the specificity of the IgG response to OspC in dogs administered each vaccine, pooled sera from each treatment group were screened against 23 different recombinant OspC type proteins using an immunoblot format . ConsistB. burgdorferi during its cultivation (B. burgdorferi B31 type strain population express detectable levels of OspC (B. burgdorferi strain that expresses OspA and a second strain that, because it is OspA-deficient (In this study, antibody responses to OspA and OspC in dogs administered commercially available bacterin and subunit LD vaccines were compared. After completion of the vaccine series, the anti-OspA GMTs were robust and similar for all vaccines assessed. An independent study, similarly reported that Subunit-AC and Subunit-A vaccines elicited equivalent anti-OspA antibody titers in dogs after the administration of two doses . Howevertivation . One stu of OspC . Howevereficient , expresseficient . While teficient , to our Borrelia mayonii (B. burgdorferi, repeated vaccine administration is required to maintain the minimal protective titer. The high OspA and OspC antibody titers induced by Subunit-AC allow for antibody-mediated killing to occur in both the tick and mammal with the potential for an OspC-induced anamnestic response (Serum from dogs administered Subunit-AC was strongly immunoreactive with a diverse array of recombinant OspC proteins including OspC types associated with strains from both North America and Europe. In addition, the antibodies induced by Subunit-AC also bound to the OspC protein from the recently identified species  mayonii ,b, sugge mayonii . The LD  mayonii , protect mayonii . Becauseresponse . In summ


Background and Purpose: Robot-assisted cochlear implantation has recently been implemented in clinical practice; however, its effect on hearing outcomes is unknown. The aim of this preliminary study was to evaluate hearing performance 1 year post-implantation whether the electrode array was inserted manually or assisted by a robot.Methods: Forty-two profoundly deaf adults were implanted either manually (n = 21) or assisted by a robot  with three different electrode array types. Participants were paired by age, and electrode array type. The scalar position of the electrode array in the cochlea was assessed by 3D reconstruction from the pre- and post-implantation computed tomography. Pure-tone audiometry and speech perception in silence (percentage of disyllabic words at 60 dB) were tested on the implanted ear 1 year post-implantation in free-field conditions. The pure-tone average was calculated at 250–500–750 Hz, 500–1,000–2,000–3,000 Hz, and 3,000–4,000–8,000 Hz for low, mid, and high frequencies, respectively.Results: One year after cochlear implantation, restoration of the high-frequency thresholds was associated with better speech perception in silence, but not with low or mid frequencies . Although array translocation was similar using either technique, the number of translocated electrodes was lower when the electrode arrays had been inserted with the assistance of the robot compared with manual insertion .Conclusion: The restoration of high-frequency thresholds  by cochlear implantation was associated with good speech perception in silence. The numbers of translocated electrodes were reduced after a robot-assisted insertion. Cochlear implants are medical devices aiming to electrically stimulate ganglion of the auditory nerve and to restore hearing in patients with severe to profound hearing loss. The hearing outcomes after cochlear implantation depend on improvable , and definite factors .Electrode array insertion is performed surgically with micro-instruments under microscopic view. Optimization of this surgical step has been associated with hearing outcomes, and aims to insert the electrode array into the scala tympani –4, and tWith regard to speech perception in cochlear implanted patients, its relationship with restoration of post-implantation pure-tone thresholds is not clear. Some studies show that pure-tone performance is not related to speech perception . On the The aim of the study was to assess speech perception in silence 1 year postoperatively in profoundly deaf adults who underwent robot-assisted or manual cochlear implantation, and its relationship with restoration of pure-tone audiometry.n = 21) or manual (n = 21). Each patient from the robot-assisted group was paired with one of the manually inserted group by age, and cochlear implant type. Robot-assisted cochlear implantations were performed between July 2019 and March 2020, and between July 2018 and November 2019 for manual implantation. Data on the electrode array position have been partially published   . All patThree types of electrode arrays were inserted:n = 22). This is a straight electrode array with an active length of 19.1 mm and 22 electrodes;Cochlear™ Nucleus® CI522 or CI622  (n = 16). This is a straight electrode array with an active length of 20 mm and 16 electrodes;Advanced Bionics HiFocus™ Slim J  (n = 6). This pre-curved electrode array has an active length of 15.5 mm and 16 electrodes.Advanced Bionics HiFocus™ Mid-Scala electrode array . A classical surgical approach was used to reach the round window region: retroauricular incision, mastoidectomy, and posterior tympanotomy. The array was usually inserted through the round window except in two cases in whom a cochleostomy was performed due to a non-visible round window.With regard to the robot-assisted insertions, the RobOtol® arm  was controlled by the surgeon using a SpaceMouse® . For straight arrays, insertion was completely performed at a speed of 0.25 mm/s with specifically designed insertion tools . The Mid-Scala array was positioned on the insertion tool and both were coupled to the robot arm . The array was partially inserted up to the mark indicating the beginning of the coiling of the basal turn and then manually ejected from the insertion tool. With regard to the manual insertions, they were performed using surgical instruments specially designed by the manufacturer.https://horosproject.org/). Post-implantation CT was performed 24 h after surgery. Using the same 3D multiplanar reconstruction, the number of extracochlear electrodes, and the depth of insertion  were determined.Pre-implantation computed tomography (CT) was performed in all patients. Distance A , and distance B  were determined using 3D multiplanar reconstruction of the images performed using Horos v.2.2.0 open source software (http://www.itksnap.org). This method was used to determine the intrascalar position of each electrode according to the basilar membrane as previously described (http://www.cloudcompare.org/)  .The position of each electrode was determined according to its position relative to the basilar membrane as either a non-translocated electrode (under the basilar membrane) or a translocated electrode (above the basilar membrane). Array translocation was defined when at least one electrode was located in the scala vestibuli. The location of the translocation was determined according to the baseline (0° degrees) between the center of the round window and the modiolus and classified as proximal (start of array translocation before 180°), or distal (after 180°). The percentage of translocated electrodes was calculated as the number of translocated electrodes/total number of electrodes in the array × 100.Hearing tests were performed 1 year after surgery. The implanted ear was independently assessed in an acoustically isolated room, without any hearing aid on the contralateral side and the ear plugged if necessary. The speaker was placed 1 meter in front of the patient. Free-field pure-tone audiometry was assessed to determine the hearing thresholds at the frequencies 250, 500, 750, 1,000, 2,000, 3,000, 4,000, and 8,000 Hz. Based on the Committee on Hearing and Equilibrium guidelines, the pure-tone average (PTA) was calculated as the mean of the thresholds at 500, 1,000, 2,000, and 3,000 Hz . From thSpeech perception in silence was assessed using disyllabic words and the speech discrimination score (SDS) was determined at 60 dB SPL and expressed as the percentage of words correctly recognized at this acoustic pressure.https://www.R-project.org/). A p < 0.05 was considered to be significant.All numeric variables were expressed as means and standard deviations. Non-parametric tests were performed to assess the association between hearing performance and robotic/manual insertion and the intrascalar position of the electrode array. Linear and non-linear regression were performed to analyze the association between speech perception in silence and pure-tone audiometry threshold. The models were compared using ANOVA analysis to choose the best fitted model. All statistical analysis was performed using R v3.3.3 statistical software . The translocation rate was not associated with the etiology of the hearing loss . Moreover, the ratio of array translocation was similar in robot-assisted , and manual  insertion. However, considering the number of translocated electrodes, this was lower in the case of robot-assisted insertion  compared to manual insertion   were observed, and the translocation rate was similar whatever the type of electrode array . With regard to pure tone audiometry, there were no differences between translocation and no translocation of the electrode and the low-frequency PTA (p = 0.62), mid-frequency PTA (p = 0.51), or high-frequency PTA . This trend did not vary for the low-frequency PTA , mid-frequency PTA , and high-frequency PTA .Regarding the number of translocated electrodes, there was still no correlation between the percentage of translocated electrodes and speech performance in silence (In two cases (4%), the electrode was inserted through a cochleostomy . In bothn = 21), and post-implantation: robot-assisted: 66 ± 30.8% (n = 21). Neither low-frequency PTA nor mid-frequency PTA was associated with the speech perception scores . Patients with speech perception scores > 50% clearly had better high-frequency PTA  than those with speech perception scores ≤ 50%  . With regard to the electrode array type, the speech performance in silence was similar whatever the electrode array used . The depth of insertion was not correlated with speech perception in silence .At 1 year post-implantation, the overall speech perception in silence with the implanted ear was improved: pre-implantation SDS: 0 ± 0%; post-implantation: manual: 65 ± 25.8%  were paired by age, duration of profound deafness and electrode array type. However, we cannot exclude variability due to the etiology of hearing loss. Second: the sampling method was taken in a non-probability way (hearing performance at 1 year of the first patients implanted by the robot). A randomized study would be required to compare the hearing performance of the robot-assisted array insertion to manual ones.In summary, this is a preliminary study to provide hearing outcomes for robot-assisted electrode array insertion. Regardless the array insertion technique , our data suggest that restoration of high frequency thresholds  is associated with better speech perception in silence 1 year postoperatively. The intrascalar position of the array was not associated with hearing performance but proximal translocation was deleterious to high frequency thresholds. A prospective and randomized trial with comparable groups will be required to assess the relevance of robot-based insertion in hearing performance.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by CNIL N° 20191219182243. The patients/participants provided their written informed consent to participate in this study.RT, HD, GL, OS, EF, IM, and YN contributed to conception and design of the study. RT and HD organized the database. RT performed the statistical analysis and wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.The study was supported by research funding from Fondation pour l'Audition (Starting Grant IDA-2020), ANR Robocop ANR-19-CE19-0026-02.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. 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Deafness is a total or partial hearing loss that may appear at any age and with different degrees of severity. Approximately 50% of hearing loss have a genetic origin, and among them, non-syndromic sensorineural deafness represents about 70% of the cases. From them, 80% correspond to autosomal recessive inheritance deafness. Autosomal recessive deafness was not studied enough at the molecular level in Iraq. This study aimed to verify the frequency of three GJB2 mutations in non-syndromic sensorineural deafness in the Iraqi population. The current case-control study was conducted from January 2018 to January 2020. The study included 95 deafness patients  and 110 healthy control group. Age and sex were matched between the two groups. In order to detect c.35delG, 235delC, and 167delT mutations in the GJB2 gene, we employed the PCR-RFLP technique. The c.35delG was the main frequent mutation encountered with the GJB2 gene among patients with autosomal recessive non-syndromic sensorineural hearing loss. Among them, 35 (36.8%) were homozygous, 40 (42.1%) were heterozygous, and 20 (21.1%) were wild genotypes. The second-degree mutation in the GJB2 gene was c.235delC mutation, which from the 95 deaf patients, there were 20 (21.1%) with homozygous, 33 (34.7%) heterozygous, and 42 (44.2%) wild genotypes. None of the 95 deaf patients showed the c.167delT mutation, and no mutations appeared in the control group. Our data concluded that the GJB2 c.35delG and c.235delC gene mutations were the main cause of autosomal recessive non-syndromic sensorineural hearing loss in the Iraqi deaf population. Deafness is the partial or complete loss of hearing capacity, affecting 6 to 8% of the developed country’s population at any age and with varying severity. The consequences to the individual and society are highly influenced by the age of appearance and its severity. When occurring early in childhood and comprising a severe defect, it causes profound limitations for learning to speak and subsequent cognitive and psychosocial disorders. In the elderly, it affects the quality of life due to the isolation of the individual affected . CongeniNo molecular study of the connexin 26 (GJB2) genes was reported in Iraqi patients with non-syndromic sensorineural hearing loss. Therefore, this study aimed to investigate the common c.35delG, c.235delC, and c.167delT mutations in the connexin 26 (GJB2) genes in Iraqi deafness patients.Ninety-five patients diagnosed with bilateral non-syndromic sensorineural hearing loss were studied from January 2018 to January 2020. The subjects were 55 males and 40 females from the middle Euphrates region of Iraq, and their ages ranged from 11–40 years old. Among them, 75 were sporadic cases of hearing loss, compatible with recessive inheritance, while the other 20 probands were from families with more than one sib of non-syndromic hearing loss. Age and gender matched with the control group, which consisted of 110 voluntary healthy individuals unrelated to patients. The sample size was calculated using the online software OSSE . IndividAll individuals underwent pure-tone audiometry by a diagnostic audiometer  in a soundproof room. Pure-tone averages of more than 25 dBHL  were defined as hearing loss according to the hearing loss classification . The resVenous blood (1ml) was collected from all individuals who participated in this study. Genomic DNA was isolated and purified from peripheral blood lymphocytes using ReliaPrep™ Blood gDNA Miniprep System (Promega) according to the manufacturer’s protocol. Extracted DNA was used in screening for the selected mutations. PCR-Restriction fragment length polymorphism (PCR-RFLP) analyses were performed to detect three GJB2 common mutations previously described by other investigators and indicated in The current study involved three mutations in Connexin 26 (GJB2) gene-related with non-syndromic autosomal recessive deaf-mute among 95 patients. 55 (57.9%) were males, and 40 (42.1%) were females. According to the results of our survey, endogamy marriage between parents of deaf patients was more common (80%), and there was a family history of deafness in either the mother’s family (39%) or the father’s family (42%). However, 89 out of 95 (94%) of the patients’ parents have normal hearing. The presented data for five of the remaining sex patients appeared that their paternal and maternal grandparents have normal hearing. Hence, from the interview outcomes, all patients were considered as having autosomal recessive non-syndromic hearing loss. A total of 95 deaf patients with ARNSHL who were recruited in this study were included 75 simplex proband’s which refers to sporadic patients whose families have no one suffering from hearing loss, and 20 multiplex proband’s which means that there is at least one first or second degree deaf relative in their families. Clinical characteristics of deaf patients and hearing tests confirmed that the level of hearing loss was severe to profound in 91 patients; the remaining 4 showed a moderate hearing loss, as shown in On the other hand, the c235delC mutation was the second-degree mutation in the GJB2 gene from deaf patients; there were 20 (21.1%) patients with homozygous genotype, 33 (34.7%) heterozygous genotype, and 42 (44.2) wild genotypes for the tested mutation as shown in et al. [et al. in patients from Cuba and Spain [The GJB2 gene encoding the gap-junction protein Connexin 26 caused different forms of hearing impairment, in particular autosomal recessive non-syndromic hearing impairment. The mutations of this gene as heterozygous or homozygous forms influence the activities of the gap junctions and thus prevent the transformation of the mechanical signal into an electrical signal. Hence deafness was installed as bilateral and symmetrical, most often severe or profound . Mutatioet al. , who stuet al. –17. Thernd Spain . Furthernd Spain . The c.3nd Spain –20. Another less frequent frameshift mutation, c.235delC, was reported in this study, which was detected in 53 (55.8%) of all ARNSHL patients, including 20 21.1%) homozygous and 33 (34.7%) heterozygous genotypes of mutant alleles. The c.235delC mutation was the most common mutation that caused premature protein termination in patients suffering from hearing loss in East and Southeast Asia, while lower frequencies were recorded in Oceania and Europe .1% homoz–26. TherThese data support the usage of screening programs in the future, for example, suitable genetic tests, as a valuable complement to audiometric screen for identifying neonates with heritable congenital hearing impairment in non-endogamous Iraqi. Applying this test could facilitate the earlier habilitation in a substantial percentage of deaf infants and ultimately provide parents with appropriate prognostic for genetic counsel, specific clinical diagnosis, and relevant medical administration information.We concluded from the current study that Connexin 26 (GJB2) c.35delG and c.235delC gene mutations were the causative agent for congenital autosomal recessive hearing loss in the Iraqi population. These data can support the screening programs of audiometric recognizing neonates with congenital inherited hearing loss in Iraqi endogamy parents.The authors declare that there is no conflict of interest.This case-control study was approved by the medical ethics committee in the Faculty of Medicine/Kufa University .Informed consent was obtained from all participants’ relatives and parents of patients younger than 18 years.The authors want to thank the patients for their cooperation during the time of the study. Also, our thank appreciation extends to the staff of ENT Departments from the Middle Euphrates region of Iraq for their support during sample collection, mainly ENT Department in Al-Sadder hospital in Najaf/Iraq. Finally, the authors want to thank Dr. Saad Mahbobah for his support.AMA-j is the corresponding author and was involved in collecting data, manuscript concept, writing, genetic analysis, submitted manuscript, revision, and galley proof. HAS was involved in data collection and assessed the audiology of hearing. SMA-k was involved in data collection, manuscript concept, writing, and genetic analysis.


The El Niño–Southern Oscillation is one of the most important drivers of climate change on Earth, and is characterised by warmer (El Niño) or colder (La Niña) ocean surface temperatures in the equatorial Pacific. Tropical cyclones (TCs) and meridional circulation are the most influential weather events and climate phenomena, respectively. However, the link between TCs and meridional circulation anomalies (MCA) during El Niño years is unclear. Therefore, we calculated the accumulated cyclone energy index of TCs and the mass stream function of MCA from 1980 to 2018. Our results showed that TCs were closely related to the asymmetry of the MCA in the Central Pacific during El Niño years. An updraft anomaly in the North Pacific was found, which affected the response of MCA to El Niño from May to October during El Niño years. Therefore, the MCA intensity difference between the North and South Pacific increased, and the asymmetry was strengthened. This phenomenon may be strengthened by the combined effects of the equatorial westerly wind, relative vorticity, and warm ocean surfaces, which are controlled by El Niño. The equatorial westerly wind produces positive shear north of the equator, which increases the relative vorticity. The increase in relative vorticity is accompanied by a monsoon trough, leading to increased precipitation and updrafts. The background of the relative vorticity, updraft, and monsoon trough may be conducive to the generation and development of TCs. Our results prove that the possible link between TCs and the asymmetry of the MCA during El Niño years is derived from the combined effect of the equatorial westerly wind, relative vorticity, and warm ocean surfaces, thus providing a partial explanation for the link between TCs and the MCA. El Niño and La Niña (known as the El Niño–Southern Oscillation (ENSO)) represent the strongest interannual fluctuation of the global climate system. Due to changes in the atmosphere and ocean circulation, ENSO can affect the global atmosphere, ocean/terrestrial ecosystems, fisheries, agriculture, and human activities . ExtremeTropical cyclones (TCs) are one of the most destructive natural disasters  and haveThe low-latitude meridional circulation (MC), also called the Hadley circulation, is a thermally driven MC in tropical regions. MCs play an important role in balancing the mass, energy, and angular momentum of the atmosphere between the two hemispheres . Therefohttps://www.ncdc.noaa.gov/ibtracs/) [The maximum 1-min sustained wind speed and central minimum pressure of TCs in the North Pacific Ocean from 1980 to 2018 were obtained from the IBTrACS (available online at btracs/) .https://origin.cpc.ncep.noaa.gov/products/analysis_monitoring/ensostuff/ONI_v5.php).The Oceanic Niño Index (ONI) was used to describe ENSO events in the present study. ONI is calculated based on the 3-month moving average of the SSTA in the NINO-3.4 region . ONI data from 1980 to 2018 were obtained from the National Oceanic Atmospheric Administration (NOAA) .The monthly average global sea surface temperature, horizontal wind, vertical wind, total precipitation, sea level pressure, and relative vorticity (0.25° × 0.25°) from 1980 to 2018 were derived from the fifth-generation reanalysis data of the European Centre for Medium-Range Weather Forecasts . The events were defined as five consecutive overlapping 3-month periods at or above the +0.5 anomaly for warm (El Niño) events, and at or below the -0.5 anomaly for cold (La Niña) events. The threshold was further categorised into weak (with a 0.5 to 0.9 SSTA), moderate (1.0 to 1.4), strong (1.5 to 1.9), and very strong (≥ 2.0) events. In this study, an event must have equalled or exceeded the threshold for at least three consecutive overlapping 3-month periods for it to be categorised as weak, moderate, strong, or very strong.The selection criteria for El Niño events were based on the NOAA standards .ACE is an index used to measure the activity of TCs. It combines the number of TCs systems, their duration, and their intensity. It is calculated by squaring the maximum sustained surface wind in the system every 6 hours that the TCs are a classified as a “Named Storm”, and then summing it up for the period. The ACE index was calculated using To conveniently compare the variables and results, it is necessary to normalise the data. The normalised variable can be calculated using θ) can be expressed as:The meridional-vertical MSF is an important index for describing MC . In spheNRV is defined as the average relative vorticity at 850-hPa in the North Pacific . The monthly average global relative vorticity (0.25° × 0.25°) from 1980 to 2018 was derived from the ERA5.EWW is defined as the zonal average wind speed at 850-hPa in the equatorial region . The monthly average global wind speed (0.25° × 0.25°) from 1980 to 2018 was derived from ERA5.All monthly datasets were pre-processed using the 3-month moving average. All variables in the research were abnormal quantities. We calculated monthly climatic averages from 1980 to 2018, and the anomalous field was obtained by subtracting the monthly climatic averages.Studies have investigated the MCA in the North and South Pacific during ENSO since 1996 . Their fTo identify the region in which the MCA responds to El Niño in the Pacific and extend the connection between the MCA and TCs during El Niño years, we calculated a linear regression between ONI and the meridional wind anomaly at 200-hPa and 850-hPa in the Pacific, and the results are presented in The Central Pacific generally lies between 180°W–140°W. Our research on the MCA includes both the Central Pacific (180°W–140°W) and the south-eastern West North Pacific . The areas of significant MCA response to El Niño were mainly concentrated within 140°E–140°W . In the To research the monthly MCA changes during El Niño years, 8 El Niño events from 1980 to 2018 were presented: 1982–83, 1986–87, 1991–92, 1994–95, 1997–98, 2002–03, 2009–10, 2015–16. As each El Niño event has obvious differences, analysing each one individually will cause confusion and fail to identify the commonality of the MCA asymmetry. Therefore, we first averaged the MCA of the eight El Niño events to better investigate the asymmetry of the MCA during El Niño years. We used the MSF to describe the MCA, as the zonal average MSF is an important indicator for describing MC . After aWe observed an updraft anomaly (represented by the updraft in the following) between 0°–20°N that coexists with the asymmetry of the MCA from May to October during the El Niño developing year. This specific airflow may lead to the asymmetry of MCA. An equatorially symmetric SSTA can lead to an equatorially symmetric MCA during El Niño years , 22. TheThe asymmetry of the MCA mainly occurs from May to October during the El Niño developing year . We furtIn the previous section, we connected the updraft to the asymmetry of the MCA. Next, we connect several atmospheric quantities to the updraft, which will extend the connection between TCs and the asymmetry of the MCA. First, we determined the atmospheric quantity that may affect the updraft during El Niño years. We selected two atmospheric quantities that may affect the updraft in the North Pacific: the EWW and NRV.We used the zonal average wind speed anomaly at 850-hPa in the equatorial region  to define EWW (see method). The ONI and EWW belong to the SSTA and the Southern Oscillation of ENSO, respectively. All variables form aspects of ENSO, and the connection between them was recognised as early as 1969 . The EWWWe also considered TCs in order to link the asymmetry of the MCA to TCs. TCs are low-pressure vortices that occur on tropical or subtropical ocean surfaces and are powerful tropical weather systems. Research suggests that the relative vorticity of the lower atmosphere plays an important role in the generation and development of TCs . AccordiThe ACE index is the measure of TCs activity used by NOAA, which reflects the overall intensity and duration of the tropical cyclone activity. The ACE index calculation selects the monthly active TCs in the North Pacific . We used the MSF to describe the MCA in the South Pacific (SMSF * -1). For ENSO, the SSTA (ONI) in the NINO-3.4 area  was used to define its intensity. Except for the ONI, all elements were standardised for better comparison. The inter-annual changes in each element are shown in The EWW is the near-surface atmospheric branch of the Southern Oscillation of ENSO and is strictly controlled by the SSTA in the Central and eastern Pacific . The corResearch shows that the MCAs between 0° and 30°N in the North Pacific and between 0° and 30°S in the South Pacific are closely related to ENSO events . The MCAAccording to the definition of relative vorticity in fluid mechanics, the shear vorticity is related to the uneven distribution of the horizontal wind speed along the normal direction of the streamline. When the EWW flows from west to east at the equator, it interacts with the northeast trade wind (flowing to the equator) to form a greater wind speed shear, which enhances vorticity in the North Pacific. Therefore, the EWW may have a positive effect on the relative vorticity anomaly in the North Pacific. The correlation coefficient between EWW and NRV was 0.93 .El Niño affects the generation and development of TCs by affecting various atmospheric and oceanic conditions . These iIn summary, we propose two atmospheric quantities (EWW and NRV) that may affect the updraft. This connection would suggest a link between TCs and MCA asymmetry.In the previous sections, we found that updrafts can enhance the asymmetry of the MCA in the North and South Pacific, and some atmospheric quantities related to the updraft may contribute to the formation and development of TCs. The updraft controlled by El Niño may become a bridge linking the MCA and TCs. To investigate the combined effects of the EWW and NRV on the updraft, we assessed composite wind, relative vorticity, total precipitation, and the vertical velocity anomaly from May to October during eight El Niño development years.The regions on the equatorward side of the trade winds are areas of large-scale surface cyclonic wind shear  . The EWWThe MT is defined as the region between the low-level equatorial westerlies on its equatorward side and the low-level trade wind easterlies on its poleward side. It is characterised by a local, zonally elongated sea level pressure minimum and enhanced rainfall . ConsistThe same result was also observed for the monthly changes. We assessed the composite meridional mean (5°N–20°N) monthly sea surface temperature, the EWW, relative vorticity, total precipitation, and vertical velocity anomaly from May to October during the development of eight El Niño events.First, we considered whether the MT-RV has similar characteristics to that of the MT. The MT has been found to be related to the sea level pressure minimum and enhanced rainfall . The relNext, we considered the vertical velocity anomaly (VVA) from the perspective of the SSTA. The VVA and SSTA are shown in The EWW anomaly is considered to be an important component. EWW is shown in By building the connection between MT and NRV, we linked the EWW, NRV, and the updraft. Next, we demonstrate how the MT-RV acts as a bridge connecting TCs.The relationship between relative vorticity and TCs can also be explained by the MT-RV. Research has shown that the MT in the western North Pacific can largely determine the area of mean TCs formation by providing favourable thermodynamic and dynamic large-scale conditions for TCs formation, such as cyclonic relative vorticity, a moist mid-level troposphere, and weak vertical wind shear , 39. TheWe studied the composite monthly relative vorticity at 850-hPa and the TCs from May to October during eight El Niño events, and the results are presented in The physical mechanism underlying this association is unclear. Some research shows that increases in TCs activity is attributed to increases in weather-scale disturbances associated with MT in the south-eastern quadrant  of the western North Pacific . SynoptiOur research showed that the updraft may be affected by the combined effects of the EWW, NRV, and a warm ocean surface. The background of the relative vorticity and MT is conducive to the generation and development of TCs. Each El Niño event was studied individually.The results are presented in Our research mainly focused on the asymmetry of the meridional circulation anomaly (MCA) in the Central Pacific  from May to October during eight El Niño events. We found that the asymmetry of the MCA may be enhanced by the updraft anomaly in the North Pacific . The updraft anomaly was strengthened by the combined effects of the positive equatorial westerly wind anomaly, positive relative vorticity anomaly, and warm ocean surfaces. Moreover, the background of the updraft anomaly, positive relative vorticity anomaly, and monsoon trough (MT), which are controlled by El Niño in the MT-RV region , may be conducive to the generation and development of tropical cyclones (TCs).Our results show that the updraft anomaly may enhance MCA asymmetry. TCs are connected to the updraft anomaly by the relative vorticity related to the MT in the MT-RV region. The updraft controlled by El Niño may become a bridge linking the MCA and TCs. Therefore, we propose a possible link between TCs and the asymmetry of MCA, however the proof of the physical mechanism is still lack. For instance, the definition of MT is vague and the physical mechanism concerning the formation and development of TCs is lack. In addition, the theory that relative vorticity can promote the generation and development of TCs is still controversial because large-scale environmental factors promoting the generation and development of TCs still lack a clear physical mechanism. Therefore, it may be possible that more TCs would increase the relative vorticity. Moreover, the connection between MT and TCs is more based on statistical research. To further confirm our findings, future studies should use the model to further verify the physical mechanisms.