Cochlear Implants in Five Cases of Auditory Neuropathy: Postoperative Findings and Progress

Objectives To review our experiences with some of the preoperative and postoperative findings in five children who were diagnosed with auditory neuropathy and were provided with cochlear implants. We describe changes in auditory function, which enabled these children to have significant improvement in their hearing and communication skills. Study Design Pre‐ and postoperatively, these children received complete medical examinations at Mayo Clinic, including related consultations in audiology, pediatrics, neurology, medical genetics, otolaryngology, psychology, speech pathology, and radiology. Methods These children typically had additional medical and audiological examinations at more than one medical center. The hearing assessments of these children included appropriate behavioral audiometric techniques, objective measures of middle ear function, acoustic reflex studies, transient (TOAE) or distortion product (DPOAE) otoacoustic emissions, auditory brainstem responses (ABR), and, in some cases, transtympanic electrocochleography (ECoG). After placement of the internal cochlear implant devices (Nucleus CI24), intraoperatively we measured electrode impedances, visually detected electrical stapedius reflexes (VESR) and neural response telemetry (NRT). These intraoperative objective measures were used to help program the speech processor for each child. Postoperatively, each child has had regular follow‐up to assure complete healing of the surgical incision, to assess their general medical conditions, and for speech processor programming. Their hearing and communication skills have been assessed on a regular basis. Postoperatively, we have also repeated electrode impedance measurements, NRT measurements, otoacoustic emissions, and electrical auditory brainstem responses (EABR). We now have 1 year or more follow‐up information on the five children. Results The five children implanted at Mayo Clinic Rochester have not had any postoperative medical or cochlear implant device complications. All of the children have shown significant improvements in their sound detection, speech perception abilities and communication skills. All of the children have shown evidence of good NRT results. All but case D (who was not tested) showed evidence of good postoperative EABR results. Otoacoustic emissions typically remained in the non‐operated ear but, as expected, they are now absent in the operated ear. Conclusion Our experiences with cochlear implantation for children diagnosed with auditory neuropathy have been very positive. The five children we have implanted have not had any complications postoperatively, and each child has shown improved listening and communication skills that have enabled each child to take advantage of different communication and educational options.     

便携式双通道脑电遥测系统的研制

目的 研制一套便携式的双通道脑电遥测系统.方法 1）脑电放大器,AD8221仪用放大器为前置放大端,精密放大器AD824完成放大、滤波以及电平调整;2）无线传输,采用两片nRF24E1作为无线收发主芯片,该芯片集成8051内核、8通道A/D转换器,通过软件编程实现双通道脑电信号的采集和数据打包.3）电源设计,系统采用锂电池供电,并有电源充放电管理和监测报警电路.结果 经测试性能达到要求,可用于便携式脑电信号的采集. 结论 这套研制便携式脑电遥测系统的方法是可行的,进一步改进后可做成头戴式遥测系统.     

Atrial Fibrillation Therapy in Patients with a CRT Defibrillator with Wireless Telemetry

Background: Atrial fibrillation (AF) is a major cause of morbidity and mortality, especially in patients with congestive heart failure.
Objectives: The purposes of this international, prospective multicenter study were to evaluate the efficacy of atrial shock therapy in patients with a cardiac resynchronization therapy defibrillator (CRT-D) and to evaluate the safety of the new CRT-D. The effectiveness of a new wireless telemetry system was also evaluated.
Methods: A total of 282 patients, without permanent AF, who had indications for a CRT-D were included. Atrial shock therapy was tested on both spontaneous and induced AF episodes. The effectiveness of the Medtronic wireless telemetry system (Conexus; Medtronic Inc., Minneapolis, MN, USA) was also tested. Secondary endpoints included the heart failure Clinical Composite Response, system performance evaluation, and adverse event summary.
Results: Atrial shock therapy was successful in 168 of 171 episodes (98.2%). Of these, 138 episodes were induced and 33 were spontaneous. Successful cardioversion occurred in 137 of the 138 induced-AF episodes (86.1% with 12 joule (J), 13.1% with 24 J, and 0.7% with 35 J). During the first 3 months of implant, there were 43 system-related complications in 37 subjects out of 278 subjects. There were 1,999 Conexus telemetry uses recorded during this study. This includes 282 uses during the implant procedure. There were no cases of complete loss of telemetry or any adverse events reported using this system.
Conclusion: We achieved an atrial shock efficacy of 98.2% in patients who met standard CRT-D indications. The wireless telemetry performed well with no reported unanticipated adverse device effects.     

The safety of UK video telemetry units: Results of a national service evaluation

PurposeTo assess patient safety during seizures occurring on UK video telemetry units and identify factors in unit infrastructure which may improve safety with the intention of producing national guidelines.MethodsA prospective multicentre national service evaluation of the occurrence of adverse events and level of nurse attendance during seizures occurring on video telemetry units was performed. Data from 272 seizures from 27 video telemetry units across the UK were analysed.ResultsAdverse events occurred in 12% of seizures: 7% were physical events such as falls or respiratory compromise and 5% were unnoticed seizures. Nursing staff did not attend the patients in 44% of seizures and attendance was delayed beyond 30 s in a further 29%. Only 27% of seizures were attended by a Healthcare Professional within half a minute. The most important factor shown to improve timely attendance of patients during seizures was the presence of a nurse dedicated to the telemetry bed(s). The site of the telemetry bed (bay or cubicle) and method of observation (direct or indirect) was less important. An optimal nurse-to-patient ratio was difficult to identify but the study suggests that a ratio of at least 1 nurse to 4 patients is appropriate.ConclusionThe results provide an evidence base for the production of national standards and guidelines for surveillance of patients during video telemetry to improve patient safety.     

Wearable Devices for Ambulatory Cardiac Monitoring: JACC State-of-the-Art Review

Ambulatory monitoring devices are enabling a new paradigm of health care by collecting and analyzing long-term data for reliable diagnostics. These devices are becoming increasingly popular for continuous monitoring of cardiac diseases. Recent advancements have enabled solutions that are both affordable and reliable, allowing monitoring of vulnerable populations from the comfort of their homes. They provide early detection of important physiological events, leading to timely alerts for seeking medical attention. In this review, the authors aim to summarize the recent developments in the area of ambulatory and remote monitoring solutions for cardiac diagnostics. The authors cover solutions based on wearable devices, smartphones, and other ambulatory sensors. The authors also present an overview of the limitations of current technologies, their effectiveness, and their adoption in the general population, and discuss some of the recently proposed methods to overcome these challenges. Lastly, we discuss the possibilities opened by this new paradigm, for the future of health care and personalized medicine.     

Foraging success of biological Lévy flights recorded in situ

It is an open question how animals find food in dynamic natural environments where they possess little or no knowledge of where resources are located. Foraging theory predicts that in environments with sparsely distributed target resources, where forager knowledge about resources' locations is incomplete, Lévy flight movements optimize the success of random searches. However, the putative success of Lévy foraging has been demonstrated only in model simulations. Here, we use high-temporal-resolution Global Positioning System (GPS) tracking of wandering (Diomedea exulans) and black-browed albatrosses (Thalassarche melanophrys) with simultaneous recording of prey captures, to show that both species exhibit Lévy and Brownian movement patterns. We find that total prey masses captured by wandering albatrosses during Lévy movements exceed daily energy requirements by nearly fourfold, and approached yields by Brownian movements in other habitats. These results, together with our reanalysis of previously published albatross data, overturn the notion that albatrosses do not exhibit Lévy patterns during foraging, and demonstrate that Lévy flights of predators in dynamic natural environments present a beneficial alternative strategy to simple, spatially intensive behaviors. Our findings add support to the possibility that biological Lévy flight may have naturally evolved as a search strategy in response to sparse resources and scant information.     

Telemetry outside critical care units: Patterns of utilization and influence on management decisions

Background: Guidelines for the use of telemetry in hospitalized patients have been proposed by the American College of Cardiology (ACC). However, there have been only a few studies which have investigated the usefulness of these guidelines in clinical practice. Hypothesis: This study assessed the role of telemetry in the decision making process outside the critical care units. Methods: The observational study, lasting 4 weeks, was conducted in the telemetry unit of a tertiary care teaching hospital and included 61 male patients (age range 40-61 years). They had been directly admitted to the telemetry unit or transferred from a critical care unit and were followed for as long as telemetry was active. Indication for telemetry and the contribution of telemetry to management decisions were assessed by a physician not involved in the care of the patient. Results: Cumulative number of telemetry days was 379 with a mean of 6.2 days per patient. Total number of telemetry events was 297. According to the ACC classification, 14 patients (22.9%) had class I indication, 21 patients (34.4%) had class II indication, and 26 patients (42.6%) had class III indication. Telemetry events were seen in 18.2% of class I patients, in 39.7% of class II patients, and in 42.1% of class III patients. Only 12 telemetry events (4%) resulted in patient management, with none belonging to class III. Conclusion: Telemetry findings in patients outside the critical care units are not usually responsible for major therapeutic changes. The value of telemetry in such patients may be overrated.     

动静态心肺功能遥测系统重测信度的评价

目的　评价动静态心肺功能遥测系统 (K4b2 ) (Cosmed ,罗马 ,意大利 )的重测信度。方法　随机抽取 10名 2 0～ 2 2岁年龄组健康男性大学生作为研究对象 ,自早餐后 1h起 ,研究对象保持静卧状态 ,测试者采用K4b2 遥测系统进行代谢功能、通气功能与换气功能指标的重复测定 ,即每隔 30min测试 1次 ,每次测试 5min ,重复测试 5次 ,所有测试 1周内完成。采用重复测量方差分析、Pearson相关分析、变异系数 (CV)等评价K4b2 遥测系统的重测信度。结果　除二氧化碳容量 (VCO2 )外 ,其余各指标 5次测试间差异无显著性 (P >0 0 5 )。Pearson相关分析发现 ,氧耗量 (VO2 )、呼吸商、潮气量、每分钟通气量、呼吸频率、氧通气当量、二氧化碳当量等指标不同测试之间均显著相关 (P <0 0 5 ) ;各指标相关系数的中位数均高于0 6 5。除VO2 、VCO2 外 ,其余指标重复测定的变异系数均小于 10 %。结论　K4b2 遥测系统对于静息状态下各指标的重测信度较好     

无线遥测电子体温计的研制

介绍一种具有无线遥测功能的电子体温测量系统。该系统主要包括测温模块(电子体温计)、发射模块、接收模块、计算机终端。测温模块采用美国TI公司的MSP430作为采集和控制器;发射和接收模块均采用美国TI公司的无线收发芯片TRF6900,并以MSP430作为其控制器。接收模块通过RS232接口将温度数据传送至计算机进行显示。