Reliability of Auditory Function Tests in Severely Hearing-Impaired and Deaf Subjects

The test-retest variability of a series of auditory functions has been investigated in a group of severely hearing-impaired and deaf subjects (64 ears, median Fletcher index: 80 dB) and in a group of 10 controls with normal hearing. An adaptive forced-choice procedure was used for both groups. The functions were: tone audiogram, difference limen for intensity, difference limen for frequency, modulation transfer function and critical ratio. In spite of sometimes strongly deviating function values within the hearing-impaired group, the test-retest variability of the two groups was found to be of the same order of magnitude, except for the tone audiogram where the variability in the hearing-impaired group was twice that for the control group.

Nous avons examiné la variabilité des mesures répétées de quelques fonctions auditives dans un groupe de sujets ayant des troubles auditifs importants (64 oreilles; médiane de l'index de Fletcher 80 dB). Par comparaison nous avons aussi examiné un groupe de 10 sujets ayant une audition normale. Dans les deux groupes nous avons utilisé une procédure adaptive et de choix forcé. Nous avons examiné les seuils auditifs, les seuils différentiels d'intensité et de fréquence, la fonction de transfert de modulation et le rapport critique. Malgré les anomalies majeures du groupe des malentendants, la variabilité des mesures dans les deux groupes est équivalente, à l'exception de la variabilité des seuils auditifs qui est deux fois plus grande chez les malentendants.     

A Community of Healing: Psychosocial Functions of Integrative Medicine Perceived by Oncology Patients/Survivors,Healthcare Professionals,and CAM Providers

ObjectiveA whole systems research approach was used to explore the psychosocial functions attributed to an Integrative Medicine oncology program. Field research was conducted at a cancer clinic to answer the following questions: (1) what meanings do the participants attribute to the Integrative Medicine oncology program; (2) what contributes to sustaining the Integrative Medicine program; and (3) what role does the Integrative Medicine program play in the lives of the participants.MethodsParticipant observation and in-depth interviews were conducted at a community-based cancer clinic that offers various complementary modalities along with conventional cancer treatments.ParticipantsThe data were obtained from a total of 23 participants including cancer patients/survivors, caregivers, volunteers who provided the complementary therapies, and healthcare professionals at the clinic.ResultsResults indicated that the Integrative Medicine program had three major psychosocial functions for those involved. Participants viewed the Integrative Medicine program as a place (1) to exchange health/medical information and learn from others' experiences and expertise, (2) to give and receive emotional support, and (3) for the individual to act on his/her transformed new identity and new life goals through serving others.ConclusionsThe results illustrate the positive psychosocial impacts an Integrative Medicine program may bring to individuals involved in it and suggest the value of using a whole systems research (WSR) approach to Integrative Medicine research.     

心脏自主神经节消融治疗睡眠呼吸暂停并发心房颤动的实验研究

目的研究心脏自主神经节（GP）消融对睡眠呼吸暂停（sA）并发心房颤动（房颤）的影响。方法成年杂种犬13只，采用随机数字法分为2组。第1组先制作SA模型再行GP消融（n=7），分别在基础状态、SA1h和GP消融后记录心电图、采集动脉血及测量心房、肺静脉和上腔静脉的不应期（ERP）和心房易颤窗口（WOV）；第2组先行GP消融再制作SA模型（n=6），分别在基础状态、GP消融后和SA1h后收集或测量以上参数。比较心率、血压、动脉血气、心率变异性（HRV）和各部位ERP、WOV在两组之间和消融前后的变化。结果第1组在SA过程中，心率、血压先上升后下降，SA1h末HRV低频／高频比值（LF／HF）减小[（0．6±0．2）对（0．8±0．2），P〈0．05]，各部位ERP显著缩短，2WOV显著增加（P〈0．05）。GP消融后LF／HF增大[（1．1±0．3）对（0．8±0．2），P〈0．05]，各部位ERP显著延长，EWOV显著减小（P〈0．05）。第2组在GP消融后，SA过程中心率、血压同样先上升后下降，各部位ERP不同程度缩短，但LF／HF和EWOV变化则不明显。无论先SA或者先消融GP，两组犬在SA1h末均出现低氧血症、高碳酸血症和酸中毒。结论自主神经活性的变化在SA并发的房颤中起着重要作用，消融心脏GP可以逆转或阻止SA导致的房颤。     

Non-randomized controlled prospective study on perioperative levels of stress and dysautonomia during dental implant surgery

PurposeThe purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery.MethodsA total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1 h preoperatively, and 1 h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity.ResultsCgA levels were significantly higher (p < 0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only ΔL/H and ΔCCV(HF) were significantly lower (p < 0.05) at 1 h preoperatively in patients who received sedation than those who received only local anesthesia.ConclusionsCgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially ΔL/H and ΔCCV(HF), could be useful for assessing tension and anxiety.     

From the Cover: The age-specific force of natural selection and biodemographic walls of death

W. D. Hamilton’s celebrated formula for the age-specific force of natural selection furnishes predictions for senescent mortality due to mutation accumulation, at the price of reliance on a linear approximation. Applying to Hamilton’s setting the full nonlinear demographic model for mutation accumulation recently developed by Evans, Steinsaltz, and Wachter, we find surprising differences. Nonlinear interactions cause the collapse of Hamilton-style predictions in the most commonly studied case, refine predictions in other cases, and allow walls of death at ages before the end of reproduction. Haldane’s principle for genetic load has an exact but unfamiliar generalization.     

Impact of general cognition and executive function deficits on addiction treatment outcomes: Systematic review and discussion of neurocognitive pathways

This systematic review aims to examine growing evidence linking cognitive-executive functions with addiction treatment outcomes, and to discuss significant cognitive predictors drawing upon addiction neuroscience theory. We conducted a systematic search to identify studies using measures of general cognition and executive functions in patients with substance use disorders for the purpose of predicting two treatment outcomes: therapeutic adherence and relapse. Forty-six studies were selected, and sample characteristics, timing of assessments, and cognitive measures were analyzed. We observed significant methodological differences across studies, resulting in substantial variability in the relationships between cognitive-executive domains and treatment outcomes. Notwithstanding this variability, we found evidence of associations, of medium effect size, between general cognition and treatment adherence, and between reward-based decision-making and relapse. The link between general cognition and treatment adherence is consistent with emerging evidence linking limited cognitive-executive resources with less ability to benefit from talk therapies. The link between reward-based decision-making and relapse accords with decision neuroscience models of addiction. Findings may inform preclinical and clinical research concerning addiction treatment mechanisms.     

Forehead sympathetic skin responses in determining autonomic involvement in Parkinson’s disease

ObjectiveThe purpose of this study was to evaluate forehead sympathetic skin response (SSR) and demonstrate any differences with extremity SSR in determining autonomic nervous system (ANS) involvement in patients with Parkinson’s disease (PD).MethodsTwenty early stage, 20 advanced stage idiopathic PD patients and 20 healthy controls participated in this study. SSR of forehead, hands and feet, heart rate variability (HRV), orthostatic intolerance, QT intervals and dysautonomic symptoms were evaluated.ResultsAbsent forehead SSR was determined unilaterally in 4, bilaterally in 7 early stage patients, and unilaterally in 4, bilaterally in 8 advanced stage PD patients; there was significant difference between early and advanced stage PD and control groups in terms of the lack of SSR (p = 0.000). Absent extremity SSR was determined in at least 1 extremity of 3 advanced stage PD patients, and none of the early stage PD patients. No difference was noted in HRV at rest between early and advanced stage PD and control groups (p = 0.218); but HRV at deep breathing was lower in both early and advanced PD patients compared to controls (p = 0.014, p = 0.002, respectively).ConclusionForehead SSR is more sensitive in determining ANS dysfunction not only in late but also in early stage of PD.SignificanceWith further supportive research, forehead SSR might be used as a simple diagnostic electrophysiological test in the early diagnosis of ANS dysfunction enabling proper treatment and increasing the quality of life of PD patients.     

Susceptibility to interference and intrusion errors in consequence of the dominant hemisphere’s hippocampal infarct: A case report

We present a case of a man with an ischemic lesion of the left hippocampus. Detailed neuropsychological assessment revealed susceptibility to retroactive interference and a tendency to make intrusion errors in addition to mild deficits in the verbal memory processes. Although retroactive interference and intrusion errors are normally considered to be the manifestations of frontal lobe dysfunctions, the idea of susceptibility to interference has recently begun to emerge in the literature, as an explanation of medial temporal lobe amnesia. Our data support this new theory, suggesting that one role of the hippocampus is to decrease the interference during the learning processes.