Facial nerve stimulation by a cochlear implant in a hemodialysis patient with bone of low mineral density

We report a natural experiment that took place in a cardiac intensive care unit (CICU). We had been alerted to the possibility that sunny rooms would be conducive to better outcomes by our findings in the psychiatric unit, and by reports that depressed cardiac patients did less well than those in normal mood. The 628 subjects were patients admitted directly to the CICU with a first attack of myocardial infarction (MI). Outcomes of those treated in sunny rooms and those treated in dull rooms were retrospectively compared for fatal outcomes and for length of stay in the CICU. Patients stayed a shorter time in the sunny rooms, but the significant difference was confined to women (2.3 days in sunny rooms, 3.3 days in dull rooms). Mortality in both sexes was consistently higher in dull rooms (39/335 dull, 21/293 sunny). We conclude that illumination may be relevant to outcome in MI, and that this natural experiment merits replication.     

First field trials with a portable CIS processor for the Ineraid multichannel cochlear implant

The continuous interleaved sampling (CIS) strategy is a promising sound processing strategy for multichannel cochlear implants which provides immediate improvements in speech recognition when tested on Ineraid users: patients with only a few hours of experience (in laboratory testing) with the CIS strategy score better than with the Ineraid prosthesis they used since they, were implanted. The goal of this study was to evaluate the benefits that can be gained by the use of the new strategy in every day life. Two patients, implanted with the Ineraid multichannel cochlear implant, were equipped with a portable numerical processor programmed to implement a high rate CIS strategy. Their speech recognition was evaluated periodically with consonant and vowel identification tests for more than 6 months of use. Tests were also made with the Ineraid processor during the same experimental sessions and patients were regularly interviewed about their experience. Performance with the portable CIS processor was superior or equal to that obtained previously in the laboratory with the same strategy. Both patients achieved the best scores in 6 years of cochlear implant use. Qualitative reports from the patients suggest that the CIS strategy can improve "hearing" performance of cochlear implant users in many important situations of every day life. Altogether, these results hold great promises for all users of the Ineraid multichannel cochlear implant.     

The relation between electric auditory brain stem and cognitive responses and speech perception in cochlear implant users

Electrically evoked brainstem responses (EABR) and event-related cortical potentials were recorded in seven postlingually deaf adults who were experienced users of a Nucleus multichannel cochlear implant. The patients were divided into two subgroups: good performers and moderate performers. Poor EABR were found in two of the moderate performers. The latencies and amplitudes of the cortical N1 P2 complex in the good performers were within the same range as those of subjects with normal hearing, but were deviant in the group of moderate performers. This may indicate disturbed cochleotopical organization of the auditory cortex in the latter group. P300 measurements in the good performers showed normal latencies, whereas in the moderate performers they were prolonged. The results suggest that the outcomes of electrophysiological measurements to assess the integrity of a patient's auditory neural system on a brainstem and a cortical level, are related to the patient's performance with the cochlear implant.     

Iatrogenic tinnitus and kophosis treated by cochlear implant. Apropos of a case

A severe iatrogenic tinnitus has been successfully improved by cochlear implant, despite the hearing and intelligibility of the opposite ear were not profoundly impaired. This case report allows to discuss the eventual enlargement of the classic cochlear implant indications.     

Physician recommendations and patient autonomy: finding a balance between physician power and patient choice

Medical care in the United States has rapidly moved away from a paternalistic approach to patients and toward an emphasis on patient autonomy. At one extreme end of this spectrum is the "independent choice" model of decision making, in which physicians objectively present patients with options and odds but withhold their own experience and recommendations to avoid overly influencing patients. This model confuses the concepts of independence and autonomy and assumes that the physician's exercise of power and influence inevitably diminishes the patient's ability to choose freely. It sacrifices competence for control, and it discourages active persuasion when differences of opinion exist between physician and patient. This paper proposes an "enhanced autonomy" model, which encourages patients and physicians to actively exchange ideas, explicitly negotiate differences, and share power and influence to serve the patient's best interests. Recommendations are offered that promote an intense collaboration between patient and physician so that patients can autonomously make choices that are informed by both the medical facts and the physician's experience.     

Use of ECT in a patient with a Harrington rod implant

A 50-year-old depressed patient with prior Harrington rod implantation and spinal disease was treated with 6 electroconvulsive therapy (ECT) treatments, despite conflicting orthopedic recommendations. Complete muscle relaxation was achieved with succinylcholine 2.1-2.2 mg/kg without complication during or after ECT. Concerns and recommendations regarding the use of ECT in patients with Harrington rods are discussed.     

Labeling of musical interval size by cochlear implant patients and normally hearing subjects

OBJECTIVE: To compare the performance of cochlear implant patients and normal-hearing subjects on a musical interval labeling task, and to determine whether information regarding musical interval size is available to cochlear implant patients under realistic everyday listening conditions. DESIGN: Two Nucleus cochlear implant patients listened to musical intervals that consisted of systematic variations of electric pulse rate on single bipolar intracochlear electrode pairs, whereas normal-hearing listeners were presented with the acoustical analog of these stimuli. Subjects labeled the intonation quality of the stimulus intervals ("flat," "sharp," or "in tune"), relative to their memory for specific intervals abstracted from familiar melodies. The cochlear implant patients, in addition, performed this task with realistic acoustical musical stimuli. RESULTS: The interval labeling behavior of cochlear implant subjects, at low pulse rates, was similar to that of normal-hearing subjects. Furthermore, pitch interval information does not appear to be available to cochlear implant subjects when they are listening to acoustical stimuli via their speech processors. CONCLUSIONS: Temporal information appears to be sufficient for the perception of musical pitch. Encoding strategies that are highly successful in restoring speech understanding do not necessarily provide information regarding melodic pitch interval size.     

Intonation of musical intervals by musical intervals by deaf subjects stimulated with single bipolar cochlear implant electrodes

Aqueous alcoholic mallow flower extracts were analyzed both by HPTLC-densitometry in the reflectance mode at 530 nm and by reversed-phase HPLC with gradient elution. For the mallow flower anthocyanins the best chromatographic resolution was obtained by HPLC, which revealed only two main compounds, confirmed by FAB-MS: malvidin 3,5-O-diglucoside (malvin) and malvidin 3-O-(6"-O-malonylglucoside)-5-O-glucoside. The HPTLC densitometric method on cellulose plates provides accuracy, reproducibility and selectivity for the quantitative analysis of the anthocyanins and this method was shown to be much more sensitive than the HPLC-DAD system, at 530 nm. Both methods give comparable quantitative results for total anthocyanins when applied to mallow flowers from two different sources: Italy and Albania.     

Psychophysical and speech perception studies: a case report on a binaural cochlear implant subject

Further improvements in speech perception for cochlear implant patients in quiet and in noise should be possible with speech processing strategies using binaural implants. For this reason, presented here is a series of initial psychophysical and speech perception studies on the authors' first binaural cochlear implant patient. For an approximate matching of the places of stimulation on the two sides, the patient usually reported a single percept when the two sides were simultaneously stimulated. Lateralization was strongly influenced by amplitude differences between the electrical stimuli on the two sides, but only weakly by interaural time delays. Speech testing, comparing monaural with binaural electrical stimulation, showed a binaural advantage particularly in noise.     

Effects of amplitude nonlinearity on phoneme recognition by cochlear implant users and normal-hearing listeners

It is widely assumed that the proper transformation of acoustic amplitude to electric amplitude is a critical factor affecting speech recognition in cochlear implant users and normal-hearing listeners. A four-channel noise-band speech processor was implemented, reducing spectral information to four bands. A power-law transformation was applied to the amplitude mapping stage in the speech processor design, and the exponent of the power function varied from a strongly compressive (p = 0.05) to a weakly compressive (p = 0.75) for implant listeners and from 0.3 to 3.0 for acoustic listeners. Results for implants showed that the best performance was achieved with an exponent of about 0.2, and performance gradually deteriorated when either more compressive or less compressive exponents were applied. The loudness growth functions of the four activated electrodes in each subject were measured and those data were well fit by a power function with a mean exponent of 2.72. The results indicated that the best performance was achieved when the normal loudness growth was restored. For acoustic listeners, results were similar to those observed with cochlear implant listeners, except that best performance was achieved with no amplitude nonlinearity (p = 1.0). The similarity of results in both acoustic and electric stimulation indicated that the performance deterioration observed for extreme nonlinearity was due to similar perceptual effects. The function relating amplitude mapping exponent and performance was relatively flat, indicating that phoneme recognition was only mildly affected by amplitude nonlinearity.     

Pulse rate matching by cochlear implant patients: effects of loudness randomization and electrode position

There is little support in the dental literature to justify the use of lasers for periodontal root therapy. To the contrary, there are several in vitro studies suggesting potentially adverse effects when lasers are applied to root surfaces. The purpose of this study was to evaluate, in vivo, soft tissue attachment to root surfaces following CO2 laser irradiation. Using a four-quadrant design with one quadrant serving as an untreated control, the remaining quadrants in each of two dogs were treated by (1) scaling and root planing, (2) laser only, and (3) laser followed by scaling and root planing. Prior to the assigned treatments, the roots of three teeth in each quadrant (including the control) were exposed by flap reflection and ostectomy. After root therapy the flaps were repositioned and allowed to heal for 28 days. Clinical attachment levels were determined prior to surgery, at 28 days, and by histologic measurement. Results indicate that specimens treated with laser only lost attachment compared to controls and other treatment groups. Furthermore, there was no histologic evidence of soft tissue attachment to a laser-treated surface that featured a residual char layer.     

Sound-induced activation of auditory cortices in cochlear implant users with post- and prelingual deafness demonstrated by positron emission tomography

Lactoferrin has been for the first time purified from the porcine cauda epididymal fluid as a 70 kDa protein. Both Western and Northern blot analyses show that lactoferrin is synthesized in the regions from the distal caput to the cauda epididymis and secreted into the luminal fluid. Lactoferrin is first secreted as a 75 kDa glycoprotein and its carbohydrate moieties are gradually digested to form 70 kDa protein in the cauda epididymis. Lactoferrin has already bound to the surface of the epididymal sperm because the anti-lactoferrin antiserum induces the mature sperm tail-to-tail agglutination. These results strongly suggest new physiological functions of lactoferrin on the sperm maturation in the epididymis.     

Treatment of a depressive disorder patient with EEG-driven photic stimulation

This study examined the effects of electroencephalographic- (EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subject's own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression, and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment. Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression, or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patient's depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance.     

In vivo measurement of implant loads in a patient with a fractured vertebral body

For several medical interventions, increasing experience results in improved outcome. This finding may result from better patient selection or increased skill levels. This report examines whether there is a relationship between center experience and patient outcome for liver transplantation, and if so, whether the relationship is explained by patient or donor selection or level of experience required to obtain optimal results. The United Network for Organ Sharing Scientific Liver Transplant Registry includes all procedures performed in the United States since October 1987. The date of the first transplantation and the number of operations performed were used to define 42 new and 27 experienced centers. Within new centers, experience was quantified by the sequence number of each transplantation. Characteristics of 6,180 recipients and donors were compared between new and experienced centers using the chi 2 test for association. A linear trend test identified whether these characteristics varied with experience within new centers. The independent association between experience in new centers and perioperative mortality was examined using logistic regression. Patient and donor selection criteria differ between experienced and new centers and change within new centers as experience is gained. Adjusting for calendar year and various patient and donor characteristics, perioperative mortality rates decrease in new centers as experience is gained. After 20 transplantations are performed, perioperative mortality in new centers is not significantly different than that in experienced centers. Criteria for recipient and donor selection change as centers gain experience. Despite these differences and improvements that have occurred over time, increasing experience in centers performing liver transplantations is associated with reduced perioperative mortality.     

The recognition of vowels produced by men, women, boys, and girls by cochlear implant patients using a six-channel CIS processor

Five patients who used a six-channel, continuous interleaved sampling (CIS) cochlear implant were presented vowels, in two experiments, from a large sample of men, women, boys, and girls for identification. At issue in the first experiment was whether vowels from one speaker group, i.e., men, were more identifiable than vowels from other speaker groups. At issue in the second experiment was the role of the fifth and sixth channels in the identification of vowels from the different speaker groups. It was found in experiment 1 that (i) the vowels produced by men were easier to identify than vowels produced by any of the other speaker groups, (ii) vowels from women and boys were more difficult to identify than vowels from men but less difficult than vowels from girls, and (iii) vowels from girls were more difficult to identify than vowels from all other groups. In experiment 2 removal of channels 5 and 6 from the processor impaired the identification of vowels produced by women, boys and girls but did not impair the identification of vowels produced by men. The results of experiment 1 demonstrate that scores on tests of vowels produced by men overestimate the ability of patients to recognize vowels in the broader context of multi-talker communication. The results of experiment 2 demonstrate that channels 5 and 6 become more important for vowel recognition as the second formants of the speakers increase in frequency.     

Assessment of basal sound identification skills and communication abilities in profoundly deaf children fitted with hearing aids or a cochlear implant

Recent in vitro findings suggest that bisphosphonates, potent inhibitors of osteoclastic bone resorption, may also have a direct action on osteoblasts. The purpose of this study was to search for potential effects of etidronate and alendronate on the formation of early and late osteoblastic cell precursors by measuring the number of colony-forming units for fibroblasts (CFU-F) and colony-forming units for osteoblasts (CFU-OB) in murine and human bone marrow cultures. In murine marrow cultures, etidronate (10(-5) to 10(-9) mol/L) significantly stimulated the formation of CFU-F with a maximal effect at 10(-5) mol/L (mean increase over control values+/-SD: 106+/-17%;p < 0.001), whereas alendronate had a biphasic effect, being stimulatory at concentrations below 10(-7) mol/L (78+/-5%; p < 0.001), and inhibitory at higher doses. The formation of CFU-OB was also inhibited by both bisphosphonates at the highest concentrations (10(-5) mol/L and 10(-6) mol/L), but it was significantly stimulated at lower concentrations (from 10(-7) to 10(-9) mol/L for etidronate and 10(-7) to 10(-10) mol/I, for alendronate; p < 0.001). In human bone marrow cultures, alendronate (10(-8) to 10-(12) mol/L) increased CFU-F formation with a maximal effect at 10(-10) mol/L (161+/-12 %; p < 0.01). CFU-OB formation, observed only in the presence of dexamethasone (10(-8) mol/L), was markedly stimulated by alendronate at the above concentrations with a maximal increase at 10(-10) mol/L (133+/-34%; p < 0.001). The in vivo short-term effects of bisphosphonates on the formation of early osteoblast precursors were also studied in bone marrow cultures from young female mice treated with weekly subcutaneous injections of etidronate (0.3, 3, and 30 mg/kg) or alendronate (0.3, 3, and 30 microg/kg) and from aging female mice treated with the two lowest doses of both drugs. After 1 month of treatment, etidronate (0.3 and 3 mg/kg) and alendronate (0.3 and 3 microg/kg) significantly increased the number of CFU-F colonies in the bone marrow from young and old animals, whereas the highest dose of both drugs had no effect in young mice. Our results, together with previously reported observations of bone-forming effects in osteoporosis, suggest that bisphosphonates may have, in vivo, a potentially relevant influence on cells of the osteoblastic lineage, distinct from their inhibitory action on osteoclasts.