Effects of training and using an audio-tactile sensory substitution device on speech-in-noise understanding.

Understanding speech in background noise is challenging. Wearing face-masks, imposed by the COVID19-pandemics, makes it even harder. We developed a multi-sensory setup, including a sensory substitution device (SSD) that can deliver speech simultaneously through audition and as vibrations on the fingertips. The vibrations correspond to low frequencies extracted from the speech input. We trained two groups of non-native English speakers in understanding distorted speech in noise. After a short session (30-45 min) of repeating sentences, with or without concurrent matching vibrations, we showed comparable mean group improvement of 14-16 dB in Speech Reception Threshold (SRT) in two test conditions, i.e., when the participants were asked to repeat sentences only from hearing and also when matching vibrations on fingertips were present. This is a very strong effect, if one considers that a 10 dB difference corresponds to doubling of the perceived loudness. The number of sentence repetitions needed for both types of training to complete the task was comparable. Meanwhile, the mean group SNR for the audio-tactile training (14.7 ± 8.7) was significantly lower (harder) than for the auditory training (23.9 ± 11.8), which indicates a potential facilitating effect of the added vibrations. In addition, both before and after training most of the participants (70-80%) showed better performance (by mean 4-6 dB) in speech-in-noise understanding when the audio sentences were accompanied with matching vibrations. This is the same magnitude of multisensory benefit that we reported, with no training at all, in our previous study using the same experimental procedures. After training, performance in this test condition was also best in both groups (SRT ~ 2 dB). The least significant effect of both training types was found in the third test condition, i.e. when participants were repeating sentences accompanied with non-matching tactile vibrations and the performance in this condition was also poorest after training. The results indicate that both types of training may remove some level of difficulty in sound perception, which might enable a more proper use of speech inputs delivered via vibrotactile stimulation. We discuss the implications of these novel findings with respect to basic science. In particular, we show that even in adulthood, i.e. long after the classical "critical periods" of development have passed, a new pairing between a certain computation (here, speech processing) and an atypical sensory modality (here, touch) can be established and trained, and that this process can be rapid and intuitive. We further present possible applications of our training program and the SSD for auditory rehabilitation in patients with hearing (and sight) deficits, as well as healthy individuals in suboptimal acoustic situations.

Effect of yoga training on the tinnitus induced distress.

The study addressed the efficacy of 12 weeks of yoga training in treating 25 patients with chronic tinnitus. Ten of the patients underwent magnetic resonance imaging (MRI) before and after training. A control group comprised 13 people reporting chronic tinnitus. All participants were assessed with the Tinnitus Functional Index. After the 12-week yoga course, the areas considered to have benefited most were the sense of control of tinnitus, sleep, quality of life, and intrusiveness. The MRI studies indicated that connections in the white matter of the motor cortex appeared to be stronger as a result of training. Yoga training has good potential to improve the daily functioning of patients with chronic tinnitus and can be considered a promising supporting method for tinnitus treatment.

Effects of age, HIV, and HIV-associated clinical factors on neuropsychological functioning and brain regional volume in HIV+ patients on effective treatment.

It is yet unclear if people infected with human immunodeficiency virus (HIV+) on stable, combined antiretroviral therapies (cARTs) decline with age at the same or greater rate than healthy people. In this study, we examined independent and interactive effects of HIV, age, and HIV-related clinical parameters on neuropsychological functioning and brain regional volume in a sizable group of Polish HIV+ men receiving cART. We also estimated the impact of nadir CD4 cell count, CD4 cell count during participation in the study, duration of HIV infection, or duration of cART along with age. Ninety-one HIV+ and 95 control (HIV-) volunteers ages 23-75 completed a battery of neuropsychological tests, and 54 HIV+ and 62 HIV- of these volunteers participated in a brain imaging assessment. Regional brain volume in the cortical and subcortical regions was measured using voxel-based morphometry. We have found that HIV and older age were independently related to lower attention, working memory, nonverbal fluency, and visuomotor dexterity. Older age but not HIV was associated with less volume in several cortical and subcortical brain regions. In the oldest HIV+ participants, age had a moderating effect on the relationship between the duration of cART and visuomotor performance, such as that older age decreased speed of visuomotor performance along with every year on cART. Such results may reflect the efficacy of cART in preventing HIV-associated brain damage. They also highlight the importance of monitoring neuropsychological functioning and brain structure in HIV+ patients. This is particularly important in older patients with long adherence to cART.

Cross-modal comparisons of stimulus specificity and commonality in phonological processing.

Phonological processing is a fundamental ability which underlies language comprehension. Functional neuroanatomy of phonology constitutes a matter of ongoing debate. In the present study, subjects performed visual (rhyme detection) and auditory (identification of spoken words starting with a given consonant) tasks that were contrasted with matched nonverbal tasks. We identified regions critical for phonological processing which were either stimulus specific or supramodal. The results revealed a high degree of modality specificity in both visual and auditory networks. Moreover, we observed a modality independent region in the left middle temporal gyrus (MTG)/superior temporal sulcus (STS), between a more anterior temporal area with auditory specificity and a more posterior temporal area with visual specificity. This dissociation in functional neuroanatomy suggests that this area may be a core region for supramodal phonological processing, acting as a gateway between spatially separate, but stimulus specific, phonological processes and more general linguistic functions.

Can slight glucose intolerance during pregnancy predict future maternal atherosclerotic morbidity?

AIM: o examine the association between glucose level during pregnancy and the subsequent development of long-term maternal atherosclerotic morbidity. METHODS: A retrospective case-control study was conducted. The study included all women who had at least one glucose measurement during their pregnancies. Cases were all women who delivered between the years 2000-2012 and subsequently developed atherosclerotic morbidity (n = 815). Controls were randomly matched by age and year of delivery (n = 6065). The atherosclerotic morbidity group was further divided by severity: major events (cardiovascular, cerebrovascular disease, chronic renal failure), minor events (hypertension, diabetes mellitus and hyperlipidaemia without target organ damage or complications) and cardiac evaluation tests (such as coronary angiography without records of atherosclerosis, cardiac scan and stress test). The mean follow-up duration for the study group was 74 months. Cox proportional hazards model was used to control for confounders. RESULTS: A significant linear association was found between glucose levels during pregnancy and long-term maternal atherosclerotic morbidity. Among the cases with severe atherosclerotic morbidity, the proportion of women with a high glucose level (> 5.5 mmol/l) was the highest, whereas in controls it was the lowest (P < 0.001). In a Cox proportional hazard model, adjusted for atherosclerotic confounders such as gestational diabetes, pre-eclampsia and obesity, a glucose level of > 5.5 mmol/l was noted as an independent risk factor for hospitalizations later in non-pregnant life (hazard ratio = 1.3, 95% confidence interval 1.1-1.5, P < 0.003). CONCLUSION: A high glucose level during pregnancy, even if within the range of slight glucose intolerance, may serve as a marker for future maternal atherosclerotic morbidity. Further long-term studies are needed to confirm our findings.

Statin adherence and LDL cholesterol levels. Should we assess adherence prior to statin upgrade?

BACKGROUND: Adherence to statin therapy has been shown to be suboptimal. In statin-treated patients with residual elevated low density lipoprotein cholesterol (LDL-C) levels the physician must decide whether to switch to a more potent statin or try and achieve better adherence. We examined the association between adherence and LDL-C within low, moderate and high intensity statin groups in a "real world" setting. METHODS: We assessed annual adherence by the mean MPR (Medication Possession Ratio = number of purchased/prescribed daily doses) in unselected patient group. Statins were stratified (ACC/AHA Guideline) into low, moderate and high intensity groups. The impact of adherence on LDL levels was assessed by LOESS (locally weighted scatter plot smoothing). RESULTS: Out of 1183 patients 173 (14.6%) were treated with low, 923 (78.0%) with moderate and 87 (7.4%) with high intensity statins. Statin intensity was inversely associated with adherence (MPR 77±21, 73±22 and 69±21% for low, moderate and high intensity respectively, p=0.018). Non-adjusted LDL levels decreased with higher adherence: a 10% adherence increase resulted in LDL decrease of 3.5, 5.8 and 7.1mg/dL in low, moderate and high intensity groups. Analysis of the adherence effect on LDL levels adjusted for age, DM and ischemic heart disease showed that MPR above 80% was associated with an additional decrease in LDL levels only in the high intensity group. CONCLUSIONS: Increased adherence to statins beyond an MPR of 80% improves LDL levels only among patients given high intensity therapy. Switching from lower to higher intensity therapy may be more effective than further efforts to increase adherence.

Creatinine level as a predictor of hypertensive disorders during pregnancy.

This study aims to examine the association between creatinine level during the first 20 weeks of pregnancy and the development of pre-eclampsia in the second half of the pregnancy. The study population included all registered births (n=9341) between 2001 and 2007 in a tertiary medical centre. Student's t-test and receiver operating characteristic (ROC) curves were used to determine any association. Significant association was documented between creatinine level in the first 20 weeks and the prevalence of hypertensive disorders. The mean plasma creatinine value in women with mild pre-eclampsia versus healthy women was 0.59 mg/dL +/- 0.14 versus 0.57 mg/dL +/- 0.15, respectively (P = 0.023). The mean plasma creatinine value in women with severe pre-eclampsia versus healthy women was 0.61 mg/dL +/- 0.17 versus 0.58 mg/dL +/- 0.15, respectively (P = 0.040). The mean plasma creatinine value in women with hypertensive disorders versus healthy women was 0.60 mg/dL +/- 0.15 versus 0.58 mg/dL +/- 0.15, respectively (P=0.003). The ROC curve demonstrated a significant association between creatinine level in the first 20 weeks of pregnancy and the development of mild and severe pre-eclampsia in the second half of pregnancy (area under the curve: 0.54, 95% confidence interval [CI]: 0.51-0.57, P = 0.02, and 0.56, 95% CI: 0.50-0.62, P = 0.033, respectively). Higher creatinine levels during the first 20 weeks of pregnancy are associated with a higher risk of developing mild and severe pre-eclampsia.

Changes in fMRI BOLD response to increasing and decreasing task difficulty during auditory perception of temporal order.

We have discovered changes in brain activation during difficult and easy milliseconds timing. Structures engaged in difficult and easier auditory temporal-order judgment were identified in 17 young healthy listeners presented with paired-white-noises of different durations. Within each pair, a short (10 ms) and a long (50 ms) noise was separated by a silent gap of 10, 60 or 160 ms, corresponding to three levels of task difficulty, i.e. difficult, moderate and easy conditions, respectively. A block design paradigm was applied. In temporal-order judgment task subjects were required to define the order of noises within each pair, i.e. short-long or long-short. In the control task they only detected the presentation of the stimulus pair. A multiple regression with 'task difficulty' as a regressor ('difficult', 'moderate', 'easy') showed dynamic changes in neural activity. Increasing activations accompanying increased task difficulty were found in both bilateral inferior parietal lobuli and inferior frontal gyri, thus, in classic regions related to attentional and working memory processes. Conversely, decreased task difficulty was accompanied by increasing involvement of more specific timing areas, namely bilateral medial frontal gyri and left cerebellum. These findings strongly suggest engagement of different neural networks in difficult or easier timing and indicate a framework for understanding timing representation in the brain.

Preserving the left arm vein in cases of hemodialysis access generating left internal mammary artery steal syndrome.

In patients undergoing chronic hemodialysis (HD) through an arm arteriovenous fistula (AVF), coronary insufficiency can occur if the patient undergoes a coronary artery bypass graft (CABG) using the ipsilateral internal mammary artery (1-4). Therefore, the creation of a new AVF after CABG should avoid using the arm ipsilateral to the side where the internal thoracic artery was used. In cases where coronary syndrome appears when this advice is not followed, treatment should be offered aimed at overcoming the hemodynamic interference between the diminished coronary supply through the left or right internal mammary artery by closure of the existing fistula, with or without temporary central venous line insertion until the maturation of a new fistula. We suggest a different approach by moving only the arterial inflow site of the AVF to the controlateral subclavian artery, but in addition, leaving the well functioning venous outflow tract intact. In cases of left internal mammary steal it is achieved by creating a conduit running from the right subclavian artery to the left cephalic vein; therefore, creating a new arterial inflow source, connected to the existing functioning old venous outflow tract to maintain an immediately functioning new fistula without a coronary steal.

[Prevalence of fibromyalgia in type 2 diabetes mellitus].

This study aimed to assess the prevalence of fibromyalgia and other pain characteristics among patients with type 2 diabetes mellitus. We assessed 137 patients with type 2 diabetes mellitus and a control group of 139 patients matched for age and sex that do not suffer from diabetes mellitus. We examined 9 of 18 typical tender points and 4 control points with a dolorimeter. There was no difference in the prevalence of fibromyalgia among men in both groups. However, diabetic men had more tender points than men in the control group and their threshold for pain at the corresponding tender points was significantly lower compared to that of the men in the control group. The diabetic men also reported more pain than patients in the control group. Diabetic women, on the other hand, had a significantly higher prevalence of fibromyalgia than women in the control group: 23.3% versus 10.6% respectively (p = 0.043). There was no significant difference in the number of tender points and the pain threshold in the two groups of women. Diabetic women reported more pain than the women in the control group. In both diabetic men and women the number of tender points and dolorimeter count directly correlated with the duration of diabetes.

Kingella endocarditis and meningitis in a patient with SLE and associated antiphospholipid syndrome.

We describe a patient with SLE and antiphospholipid syndrome who presented with severe headache and fever. Lumbar puncture analyses indicated meningitis. Kingella kingae was isolated from her blood cultures. A large mobile vegetation was seen on her mitral valve. The association between SLE, Libman-Sacks endocarditis and bacterial endocarditis is discussed.