Course of hearing loss and occurrence of tinnitus

Chronic tinnitus is often accompanied by a hearing impairment, but it is still unknown whether hearing loss can actually cause tinnitus. The association between the pitch of the tinnitus sensation and the audiogram edge in patients with high-frequency hearing loss suggests a functional relation, but a large fraction of patients with hearing loss does not present symptoms of tinnitus. We therefore, investigated how the occurrence of tinnitus is related to the shape of the audiogram. We analyzed a sample where all patients had noise-induced hearing loss, containing 30 patients without tinnitus, 24 patients with tone-like tinnitus, and 17 patients with noise-like tinnitus. All patients had moderate to severe high-frequency hearing loss, and only minor to moderate hearing loss at low frequencies. We found that tinnitus patients had less overall hearing loss than patients without tinnitus. Moreover, the maximum steepness of the audiogram was higher in patients with tinnitus (-52.9+/-1.9 dB/octave) compared to patients without tinnitus (-43.1+/-2.4 dB/octave). Differences in overall hearing loss and maximum steepness between tone-like and noise-like tinnitus were not significant. For tone-like tinnitus, there was a clear association between the tinnitus pitch and the edge of the audiogram, with tinnitus pitch being on average 1.48+/-0.12 octaves above the audiogram edge frequency, and 0.81+/-0.1 octaves above the frequency with the steepest slope. Our results suggest that the occurrence of tinnitus is promoted by a steep audiogram slope. A steep slope leads to abrupt discontinuities in the activity along the tonotopic axis of the auditory system, which could be misinterpreted as sound.     

Real‐time motion and B0 corrected single voxel spectroscopy using volumetric navigators

In population groups where head pose cannot be assumed to be constant during a magnetic resonance spectroscopy examination or in difficult‐to‐shim regions of the brain, real‐time volume of interest, frequency, and shim optimization may be necessary. We investigate the effect of pose change on the B₀ homogeneity of a (2 cm)³ volume and observe typical first‐order shim changes of 1 μT/m per 1° rotation (chin down to up) in four different volumes of interest in a single volunteer. An echo planar imaging volume navigator was constructed to measure and apply in real‐time within each pulse repetition time: volume of interest positioning, frequency adjustment, and first‐order shim adjustment. This volume navigator is demonstrated in six healthy volunteers and achieved a mean linewidth of 4.4 Hz, similar to that obtained by manual shim adjustment of 4.9 Hz. Furthermore, this linewidth is maintained by the volume navigator at 4.9 Hz in the presence of pose change. By comparison, a mean linewidth of 7.5 Hz was observed, when no correction was applied. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

The mandibularly fixed hinge axis--investigation of patients with sound and pathological jaws.

In former works, we had proved that test persons with sound temporomandibular joints (TMJs) used a mandibularly fixed hinge axis (MFHA) and were able to pilot the mandible by solely two kinematical degrees of freedom. We wondered if we could evaluate the MFHA the same way for patients who had problems with their TMJs. Actually, the MFHA could be determined likewise. The results could provide information on the reason for the distortion of the movement of the TMJs, which cannot be yielded by X-ray radiographs.     

Illness representations and quality of life scores in haemodialysis patients.

BACKGROUND: Health-related quality of life (QoL) in haemodialysis (HD) patients is a significant predictor of mortality and hospitalization. Patients' adaptation to a chronic disease is determined by their beliefs about illness and treatment. In this cross-sectional study we examined the impact of illness representations on QoL of HD patients and the influence of HD duration on this relationship. METHODS: Eighty-two clinically stable HD patients completed the Short Form-36 Health Survey (mean age 47.9+/-12.1, mean treatment duration 72+/-50.6, 53.6% males). Illness representations were assessed by a structured interview containing questions derived from The Revised Illness Perception Questionnaire. RESULTS: Our results indicate a relatively low QoL of HD patients, with an important proportion of patients scoring less than 43 for the physical component summary (65.9%) and less than 51 for the mental component summary (58.5%). HD patients consider their illness as having a chronic course, which they understand and control quite well. A higher personal control is associated with a lower emotional response and a better understanding of the disease. However, the perceived negative consequences of the disease upon patients' personal lives are considerable, as is their emotional response. Four of the six components of illness representations were strongly related to QoL parameters. On multiple regression analysis, between 15 and 31% in the variance of the physical and mental component of QoL was explained by three dimensions of illness representations: the perceived course of the disease, personal control and emotional response. Only the emotional response dimension of the illness representations is related to treatment duration (r = -0.48, P<0.01). CONCLUSION: Our study demonstrates important relationships between illness representations and QoL in end-stage renal disease patients treated by HD. Future research will have to plan for interventions that could alter illness representations in order to confirm the real impact of illness representations upon patients' QoL.     

Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions

Background Medication non-adherence may lead to poor therapeutic outcomes. Cognitive functions deteriorate with age, contributing to decreased adherence. Interventions have been tested to improve adherence in seniors with cognitive impairment or Alzheimer disease (AD), but high-quality systematic reviews are lacking. It remains unclear which interventions are promising. Objectives We conducted a systematic review to identify, describe, and evaluate interventions aimed at improving medication adherence among seniors with any type of cognitive impairment. Methods Following NICE guidance, databases and websites were searched using combinations of controlled and free vocabulary. All adherence-enhancing interventions and study designs were considered. Studies had to include community dwelling seniors, aged 65 years or older, with cognitive impairment, receiving at least one medication for a chronic condition, and an adherence measure. Study characteristics and methodological quality were assessed. Results We identified 13 interventions, including six RCTs. Two studies were of poor, nine of low/medium and two of high quality. Seven studies had sample sizes below 50 and six interventions focused on adherence to AD medication. Six interventions tested a behavioral, four a medication oriented, two an educational and one a multi-faceted approach. Studies rarely assessed therapeutic outcomes. All but one intervention showed improved adherence. Conclusion Three medium quality studies showed better adherence with patches than with pills for AD treatment. Promising interventions used educational or reminding strategies, including one high quality RCT. Nine studies were of low/moderate quality. High quality RCTs using a theoretical framework for intervention selection are needed to identify strategies for improved adherence in these seniors.     

The value of histological changes and immunohistochemical markers Ki67 and p53 in the assessment of ulcerative colitis related dysplasia

The risk of carcinoma increases in patients with a 10-year or longer duration of ulcerative colitis (UC). To search for a more objective parameter to assess epithelial dysplasia. The study comprised 25 cases of longstanding UC: 7 cases with regenerative atypia, 7 with low grade dysplasia, 7 with high grade dysplasia, and 4 cases indefinite for dysplasia. The colonic biopsies obtained during endoscopy were stained with H&E to identify the aforementioned categories. Seventy-five sections from biopsy specimens were stained immunohistochemically to detect differences in the frequency and pattern of nuclei positive for the proliferation marker Ki67 and p53. In high grade dysplasia, the distribution of Ki67 positive cells was diffuse throughout the full length of the crypt, whereas low grade dysplasia and epithelium indefinite for dysplasia, as well as regenerative epithelium, showed an expanded basal zone. None of the regenerative atypia cases showed strong intensity p53 staining compared to dysplasia cases. None of the high grade dysplasia cases showed restricted p53 staining to the lower two thirds of the crypt. All the cases of HGD showed extension of Ki67 and p53 staining above the basal two thirds of the crypt. Ki67 and p53 immunostained cell assessment combined with routine histological evaluation of colorectal mucosa can improve the diagnostic accuracy, as well as the assessment of malignant transformation risk.     

Real-time motion and B0 correction for localized adiabatic selective refocusing (LASER) MRSI using echo planar imaging volumetric navigators

A method is presented to correct the effects of motion and motion‐related B₀ perturbations on spectroscopic imaging in real time through the use of a volumetric navigator. It is demonstrated that, for an axial slice, lifting the chin significantly disrupts the B₀ homogeneity in the zero‐order (frequency), first‐order Y (coronal) axis and second‐order ZY term. This volumetric navigator is able to measure and correct in real time both head pose and zero‐ to first‐order B₀ inhomogeneities. The volumetric navigator was validated in six volunteers who deliberately lifted and then dropped their chin during the scan. These scans show that motion correction alone is not sufficient to recover the spectral quality. By applying real‐time shim adjustments, spectral quality was fully recovered to linewidths below 0.08 ppm and the signal‐to‐noise ratio to within acceptable limits in five of six subjects. In the sixth subject, 83% of the spectra within the volume of interest were recovered, compared with the worst case nonshim‐corrected scan, where none of the voxels fell within these quality bounds. It is shown that the use of a volumetric navigator comes at no additional cost to the scan time or spectral signal‐to‐noise ratio. Copyright © 2011 John Wiley & Sons, Ltd.     

Spatial variability and reproducibility of GABA‐edited MEGA‐LASER 3D‐MRSI in the brain at 3 T

The reproducibility of gamma‐aminobutyric acid (GABA) quantification results, obtained with MRSI, was determined on a 3 T MR scanner in healthy adults. In this study, a spiral‐encoded, GABA‐edited, MEGA‐LASER MRSI sequence with real‐time motion–scanner‐instability corrections was applied for robust 3D mapping of neurotransmitters in the brain. In particular, the GABA⁺ (i.e. GABA plus macromolecule contamination) and Glx (i.e. glutamate plus glutamine contamination) signal was measured. This sequence enables 3D‐MRSI with about 3 cm³ nominal resolution in about 20 min. Since reliable quantification of GABA is challenging, the spatial distribution of the inter‐subject and intra‐subject variability of GABA⁺ and Glx levels was studied via test–retest assessment in 14 healthy volunteers (seven men–seven women). For both inter‐subject and intra‐subject repeated measurement sessions a low coefficient of variation (CV) and a high intraclass correlation coefficient (ICC) were found for GABA⁺ and Glx ratios across all evaluated voxels (intra?/inter‐subject: GABA⁺ ratios, CV ~ 8%–ICC > 0.75; Glx ratios, CV ~ 6%–ICC > 0.70). The same was found in selected brain regions for Glx ratios versus GABA⁺ ratios (CV varied from about 5% versus about 8% in occipital and parietal regions, to about 8% versus about 10% in the frontal area, thalamus, and basal ganglia). These results provide evidence that 3D mapping of GABA⁺ and Glx using the described methodology provides high reproducibility for application in clinical and neuroscientific studies.     

The Efficacy of a Brief,Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial

BackgroundHigh COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance.ObjectiveThis study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures.MethodsUsing a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention.ResultsAnalyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ²₁=20.55, P<.001). The between-group difference in postintervention intentions (χ²₃=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate.ConclusionsAlthough the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases.Trial RegistrationClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT04960228","term_id":"NCT04960228"}}NCT04960228; https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT04960228","term_id":"NCT04960228"}}NCT04960228