Depression in Ménière's disease: a systematic review and meta-analysis.

BACKGROUND: Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression. METHODS: Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study. RESULTS: Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21-88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9-63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire - Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively. CONCLUSION: The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.

Lipomyelomeningocele for the urologist: Should we view it the same as myelomeningocele?

INTRODUCTION: The primary urologic objectives for lipomyelomeningocele (LMM) and myelomeningocele (MM) are preserving renal integrity and achieving continence. Due to this common ground, LMM and MM are urologically treated the same. However, unlike MM, LMM may present with no evident functional concerns. Indications for and timing of tethered cord release (TCR) in LMM are therefore controversial. Long-term urologic outcomes are not well defined. OBJECTIVE: Expectations for continence and potential for intermittent catheterization (CIC) following TCR in LMM are important for realistically counseling families regarding future needs. The present study aimed to identify prognostic factors for continence and need for CIC in LMM. STUDY DESIGN: The present study retrospectively identified 143 patients from the multidisciplinary clinic who underwent TCR for LMM between 1995 and 2010. Concomitant anorectal/genitourinary anomalies, filar lipoma, fatty filum, previous TCR, and follow-up <1 year were excluded. Analysis was limited to those toilet trained or aged ≥6 years at latest follow-up. Lipomyelomeningocele was classified as dorsal, distal, transitional or chaotic. Pre- and post-TCR urologic status was assessed. Ability to achieve urinary continence, with or without CIC, was the primary outcome, and need for CIC was the secondary outcome of interest. RESULTS: A total of 56 patients met inclusion criteria. Median age at TCR was 4.4 months (range 1.0-224.0) with a median follow-up of 10.7 years (range 1.3-19.1); 68% were asymptomatic at presentation. Clinical symptoms were urologic in 7%. At the latest follow-up, 86% of patients were continent spontaneously or with CIC (Summary Fig.). Of the four patients who presented with urologic symptoms, all were continent, but three required CIC. Overall, 23% of patients required CIC. Median age at CIC initiation was 7.6 years (range 1.6-17.4). Long-term continence was not associated with any demographic, anatomic, surgical or functional variable. Need for CIC at latest follow-up was associated with symptomatic presentation, partial TCR, transitional lipoma, and high-risk pre-operative urodynamics. DISCUSSION: In this series of primary TCR for LMM, where 93% of patients were urologically asymptomatic before TCR, prospects for continence were excellent. No studied parameter clearly impacted continence; however, need for CIC was associated with multiple variables. CONCLUSIONS: Clear predictors for continence after TCR will require additional long-term patient outcomes. Families can anticipate 23% likelihood of CIC, which is considerably less than in MM, but long-term urologic follow-up is still strongly recommended.

In vivo photothermal optical coherence tomography of gold nanorod contrast agents.

Photothermal optical coherence tomography (PT-OCT) is a potentially powerful tool for molecular imaging. Here, we characterize PT-OCT imaging of gold nanorod (GNR) contrast agents in phantoms, and we apply these techniques for in vivo GNR imaging. The PT-OCT signal was compared to the bio-heat equation in phantoms, and in vivo PT-OCT images were acquired from subcutaneous 400 pM GNR Matrigel injections into mice. Experiments revealed that PT-OCT signals varied as predicted by the bio-heat equation, with significant PT-OCT signal increases at 7.5 pM GNR compared to a scattering control (p < 0.01) while imaging in common path configuration. In vivo PT-OCT images demonstrated an appreciable increase in signal in the presence of GNRs compared to controls. Additionally, in vivo PT-OCT GNR signals were spatially distinct from blood vessels imaged with Doppler OCT. We anticipate that the demonstrated in vivo PT-OCT sensitivity to GNR contrast agents is sufficient to image molecular expression in vivo. Therefore, this work demonstrates the translation of PT-OCT to in vivo imaging and represents the next step towards its use as an in vivo molecular imaging tool.

Temperature dependence of the energy gap of semiconductors in the low-temperature limit.

The temperature dependence of the electronic states and energy gaps of semiconductors is an old but still important experimental and theoretical topic. Remarkably, extant results do not clarify the asymptotic T-->0 behavior. Recent breakthroughs in the spectroscopy of enriched 28Si allow us to measure changes in the band gap over the liquid 4He temperature range with an astounding precision of one part in 10(8), revealing a T4.0+/-0.2 decrease with increasing T. This is in excellent agreement with a theoretical argument predicting an exponent of 4. This power law should apply, in the low temperature limit, to the temperature dependence of the energies of all electronic states in semiconductors and insulators.

Perceptual "vowel spaces" of cochlear implant users: implications for the study of auditory adaptation to spectral shift.

Cochlear implant (CI) users differ in their ability to perceive and recognize speech sounds. Two possible reasons for such individual differences may lie in their ability to discriminate formant frequencies or to adapt to the spectrally shifted information presented by cochlear implants, a basalward shift related to the implant's depth of insertion in the cochlea. In the present study, we examined these two alternatives using a method-of-adjustment (MOA) procedure with 330 synthetic vowel stimuli varying in F1 and F2 that were arranged in a two-dimensional grid. Subjects were asked to label the synthetic stimuli that matched ten monophthongal vowels in visually presented words. Subjects then provided goodness ratings for the stimuli they had chosen. The subjects' responses to all ten vowels were used to construct individual perceptual "vowel spaces." If CI users fail to adapt completely to the basalward spectral shift, then the formant frequencies of their vowel categories should be shifted lower in both F1 and F2. However, with one exception, no systematic shifts were observed in the vowel spaces of CI users. Instead, the vowel spaces differed from one another in the relative size of their vowel categories. The results suggest that differences in formant frequency discrimination may account for the individual differences in vowel perception observed in cochlear implant users.

Usefulness of surveillance cultures in neonatal extracorporeal membrane oxygenation.

Sepsis is difficult to identify in patients treated with extracorporeal membrane oxygenation (ECMO). This study evaluates the usefulness of surveillance cultures obtained during ECMO. We retrospectively reviewed the records of 187 patients from four ECMO centers with birth weights 1,574 to 4,900 gm and gestational ages 33-43 weeks, over a 4 year interval. Most patients had surveillance blood cultures daily, and tracheal aspirates and urine culture every other day. Charts were reviewed for culture results before, during, and for the 7 days after ECMO, and clinical response to the culture results. A total of 2,423 cultures were obtained during 1,487 days of ECMO, of which 155 were positive (6.4%): 13 of 1,370 blood cultures (0.9%), 137 of 850 tracheal aspirate cultures (16%), and 5 of 203 urine cultures (2.3%). After 72 hours, tracheal aspirate cultures became positive with nosocomial organisms in 33 of 131 patients. None of 153 bacterial urine cultures were positive, and only one of 34 viral urine cultures were positive (CMV). We conclude that routine daily blood cultures are not useful in neonatal ECMO. Tracheal aspirate cultures may be helpful in the management of antibiotic therapy in patients on ECMO for more than 5 days. Routine bacterial urine cultures did not provide useful information.

Formation and persistence of O(6)-methylguanine in the mouse colon following treatment with 1,2-dimethylhydrazine as measured by an O(6)-alkylguanine-DNA alkyltransferase inactivation assay.

Female SWR mice were treated with 1,2-dimethylhydrazine (DMH: 6.8 mg/kg i.p. injection) once weekly for up to 10 weeks, a dosing regime that produced tumours principally within the distal colon (Jackson et al., 1999. Carcinogenesis 20, 509-513). O(6)-Methylguanine (O(6)-MeG) levels, measured using a simple [3H]-based O(6)-alkylguanine-DNA alkyltransferase (ATase) inactivation assay, ranged from 0.6 to 16.7 fmol/microg DNA with: (i) highest levels in the distal colon; and (ii) higher levels after 68 mg/kg total DMH than 6.8 mg/kg DMH. Basal ATase activity varied between 0.97 and 1.22 fmol/microg DNA within the colon but was not associated with adduct levels or tumour induction. After 6.8 mg/kg DMH, the half life of O(6)-MeG in colonic tissue was 36-42 h whereas after 68 mg/kg DMH, t1/2 was approximately 25, 57 and 96 h in the proximal, mid and distal colon, respectively. Tumour induction was thus associated with the levels and persistence of O(6)-MeG in the distal colon.

Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions.

Because many preventable medication errors occur at the ordering stage, a program for improving the quality of writing inpatient orders and outpatient prescriptions at one institution was developed. To determine whether potential problems existed in the order-writing process for inpatients, all physician orders for a seven-day period in 1997 were reviewed (n = 3740). More than 10% of all orders had illegible handwriting or were written with a felt-tip pen, which makes NCR copies difficult to read. Other potential errors were also identified. Following educational programs for physicians and residents focusing on the importance of writing orders clearly, physician orders were reviewed for a 24-hour period (n = 654). The use of felt-tip pens decreased to 1.37% of all orders, and no orders had illegible handwriting. A similar quality improvement approach was used to evaluate the outpatient prescription-writing process. A review of all new prescriptions for a consecutive seven-day period at a local hospital-owned community pharmacy (n = 1425) revealed that about 15% of the prescriptions had illegible handwriting and roughly 10% were incomplete. Additional data were gathered through a survey sent to 71 outside provider pharmacies requesting information on problems related to prescriptions written by physicians from the institution; 66% responded. Failure to print prescriber name (96%), illegible signature (94%), failure to include DEA number (89%), and illegible handwriting other than signature (69%) were reported as the main problems. Each physician was given a self-inking name stamp to use when writing prescriptions. In addition, educational programs covering examples of poorly written prescriptions and the legal requirements of a prescription were held for physicians and residents. A follow-up survey showed that 72% of pharmacies saw stamps being used; when stamps were not used, however, illegible signatures continued to be a problem. Follow-up reviews of outpatient prescriptions indicate improvements in handwriting and completeness, but continuing educational efforts are needed. The quality of order writing for inpatients and outpatients continues to be monitored on a regular basis. Ongoing educational programs, follow-up reminders, and feedback to physicians have greatly improved the prescription-writing habits of physicians.

Modeling phoneme and open-set word recognition by cochlear implant users: a preliminary report.

On the basis of the good predictions for phonemes correct, we conclude that closed-set feature identification may successfully predict phoneme identification in an open-set word recognition task. For word recognition, however, the PCM model underpredicted observed performance, and the addition of a mental lexicon (ie, the SPAMR model) was needed for a good match to data averaged across 7 adults with CIs. The predictions for words correct improved with the addition of a lexicon, providing support for the hypothesis that lexical information is used in open-set spoken word recognition by CI users. The perception of words more complex than CNCs is also likely to require lexical knowledge (Frisch et al, this supplement, pp 60-62) In the future, we will use the performance off individual CI users on psychophysical tasks to generate predicted vowel and consonant confusion matrices to be used to predict open-set spoken word recognition.

Some computational analyses of the PBK test: effects of frequency and lexical density on spoken word recognition.

OBJECTIVE: The Phonetically Balanced Kindergarten (PBK) Test (Haskins, Reference Note 2) has been used for almost 50 yr to assess spoken word recognition performance in children with hearing impairments. The test originally consisted of four lists of 50 words, but only three of the lists (lists 1, 3, and 4) were considered "equivalent" enough to be used clinically with children. Our goal was to determine if the lexical properties of the different PBK lists could explain any differences between the three "equivalent" lists and the fourth PBK list (List 2) that has not been used in clinical testing. DESIGN: Word frequency and lexical neighborhood frequency and density measures were obtained from a computerized database for all of the words on the four lists from the PBK Test as well as the words from a single PB-50 (Egan, 1948) word list. RESULTS: The words in the "easy" PBK list (List 2) were of higher frequency than the words in the three "equivalent" lists. Moreover, the lexical neighborhoods of the words on the "easy" list contained fewer phonetically similar words than the neighborhoods of the words on the other three "equivalent" lists. CONCLUSIONS: It is important for researchers to consider word frequency and lexical neighborhood frequency and density when constructing word lists for testing speech perception. The results of this computational analysis of the PBK Test provide additional support for the proposal that spoken words are recognized "relationally" in the context of other phonetically similar words in the lexicon. Implications of using open-set word recognition tests with children with hearing impairments are discussed with regard to the specific vocabulary and information processing demands of the PBK Test.

Comparison of speech perception in pediatric CLARION cochlear implant and hearing aid users.

Multichannel cochlear implants (CIs) allow many profoundly deaf children to achieve high levels of speech perception. In order to develop optimal criteria for implantation, it is crucial to test representative samples (or, if possible, full populations) of CI users and compare their results to those of hearing aid (HA) users of the same age and communication mode (oral or total communication) to determine which subgroups of HA users may obtain more perceptual benefit from a CI than from an HA. Word and phoneme identification skills of deaf children who use either HAs or CIs were evaluated and compared. The CI group included all of the prelingually deaf children in the United States who were implanted with the CLARION Multi-Strategy Cochlear Implant during the clinical trial (as of January 1998). Before implantation, the mean scores on the PB-K test (scored phonemically) were lower for prospective CI users than for HA users. However, by 12 to 18 months postimplantation, the average scores for the CI users were higher than those of HA users with residual hearing in the 101- to 110-dB hearing level (HL) range. The CI scores were similar to those of HA users with residual hearing in the 90- to 100-dB HL range.

Endotoxemia in mice stimulates production of complement C3 and serum amyloid A in mucosa of small intestine.

We examined the effect of endotoxemia in mice on protein and mRNA levels for the acute phase proteins complement C3 and serum amyloid A (SAA) in jejunal mucosa. Endotoxemia was induced in mice by the subcutaneous injection of 250 microg lipopolysaccharide per mouse. Control mice were injected with saline. C3 and SAA were measured by ELISA. Messenger RNA levels were determined by Northern blot analysis or competitive PCR. Immunohistochemistry was performed to determine in which cell type(s) C3 and SAA were present. Mucosal C3 and SAA protein and mRNA levels were increased in endotoxemic mice. Immunohistochemistry showed that C3 was present in both enterocytes and cells of the lamina propria, whereas SAA was seen mainly in lamina propria cells. Results suggest that endotoxemia stimulates production of C3 and SAA in small intestinal mucosa. The response may be regulated at the transcriptional level and probably reflects increased synthesis of the acute phase proteins in both enterocytes and cells of the lamina propria.

Utility of daily head ultrasonography for infants on extracorporeal membrane oxygenation.

BACKGROUND/PURPOSE: Intracranial hemorrhage (ICH) is a major concern during extracorporeal membrane oxygenation (ECMO). Daily cranial ultrasonography has been used by many ECMO centers as a diagnostic tool for both detecting and following ICH while infants are on bypass. The purpose of this patient review was to look at the usefulness of performing daily cranial ultrasonography (HUS) in infants on ECMO in detecting intraventricular hemorrhage of a magnitude sufficient to alter patient treatment. METHODS: The authors reviewed retrospectively all of the records of all neonates treated with ECMO at the Hermann Children's Hospital, Wilford Hall USAF Medical Center, Cincinnati Children's Hospital, The University of Texas Medical Branch at Galveston, and Texas Children's Hospital between February 1986 to March 1995. Two hundred ninety-eight patients were placed on ECMO during this period. All patients had HUS before, and daily while on ECMO, and all were reviewed by the staff radiologists. A total of 2,518 HUS examinations were performed. RESULTS: Fifty-two of 298 patients (17.5%) had an intraventricular hemorrhage seen on ultrasound scan. Nine of 52 patients (17.3%) had an ICH seen on the initial HUS examination before ECMO, all of which were grade I, and 43 of 52 patients (82.7%) had ICH while on ECMO. Of these ICH, 15 were grade I, 10 were grade II, 10 were grade III, and eight were grade IV. Forty of these ICH (93%) were diagnosed by HUS during the first 5 days of the ECMO course. Seven hundred eighty-six HUS were performed after day 5, at an estimated cost of $300,000 to $450,000 (charges), demonstrating three new intraventricular hemorrhages, one grade I, and one grade IV on day 7 and one grade I on day 8. Eight patients were taken off ECMO because of ICH diagnosed within the first 5 days. One patient was taken off ECMO because of ICH diagnosed after 5 days. This patient had clinical symptoms suggestive of ICH. CONCLUSIONS: Almost all ICH occur during the first 5 days of an ECMO course. Unless there is a clinical suspicion, it is not cost effective to perform HUS after the fifth day on ECMO, because subsequent HUS examinations are unlikely to yield information significant enough to alter management.

Improvements in speech perception by children with profound prelingual hearing loss: effects of device, communication mode, and chronological age.

The present investigation expanded on an earlier study by Miyamoto, Osberger, Todd, Robbins, Karasek, et al. (1994) who compared the speech perception skills of two groups of children with profound prelingual hearing loss. The first group had received the Nucleus multichannel cochlear implant and was tested longitudinally. The second group, who were not implanted and used conventional hearing aids, was tested at a single point in time. In the present study, speech perception scores were examined over time for both groups of children as a function of communication mode of the child. Separate linear regressions of speech perception scores as a function of age were computed to estimate the rate of improvement in speech perception abilities that might be expected due to maturation for the hearing aid users (n=58) within each communication mode. The resulting regression lines were used to compare the estimated rate of speech perception growth for each hearing aid group to the observed gains in speech perception made by the children with multichannel cochlear implants. A large number of children using cochlear implants (n=74) were tested over a long period of implant use (m=3.5 years) that ranged from zero to 8.5 years. In general, speech perception scores for the children using cochlear implants were higher than those predicted for a group of children with 101-110 dB HL of hearing loss using hearing aids, and they approached the scores predicted for a group of children with 90-100 dB HL of hearing loss using hearing aids.

Psychometric equivalence of recorded spondaic words as test items.

In the determination of the speech-reception threshold (SRT), spondaic words are assumed to be homogeneous with respect to intelligibility; and the assumption of equal intelligibility requires that the words be comparable for all signal levels. Previous attempts to assess the equal intelligibility assumption using word thresholds as the sole criterion are not an adequate basis for specifying the equality of intelligibility. In the present study, the recorded spondaic words (Tillman recording) were analyzed in an attempt to create a more homogeneous set of spondaic words for future laboratory work. To achieve this goal, the data reported by Young, Dudley, and Gunter (1982) and data collected in our laboratory were fitted to a logistic function (psychometric function) from which a 50% point (threshold) and slope were obtained. To specify their acoustical parameters, the recorded spondaic words were digitized and the RMS level and duration of each syllable and word were calculated. None of the RMS or duration measures were correlated with word thresholds, so no attempt was made to equate level or duration. On the other hand, when the threshold of each word was adjusted to equal the mean threshold of the set (n = 36), the dispersion among word thresholds and slopes was greatly reduced. Further, we recommend that small sets of "equally intelligible" spondaic words not be used for clinical testing because set size is a strong factor in determining threshold for spondees (Meyer & Bilger, 1997; Punch & Howard, 1985).

Effect of set size and method on speech reception thresholds in noise.

OBJECTIVE: The threshold for speech is known to improve as signal (Miller, Heise, & Lichten, 1951) or response (Pollack, 1959) uncertainty is decreased. The definition of threshold as the signal level or signal to noise ratio (S/N) at which a fixed percent-correct score is obtained, therefore, becomes problematic when set size, M, is varied through the range for which threshold varies systematically (M = 2 to M = 16) because the meaning of that fixed percent changes as M is increased or decreased. The goal of the present study is to examine the effect of set size, M, on speech reception thresholds (SRTs) under two testing strategies. DESIGN: SRTs were obtained in the presence of 80 dB SPL white noise for sets containing 2, 4, 8, and 16 words using two different procedures, one in which threshold was based on a fixed percent correct (American Speech-Language-Hearing Association, 1988) and one in which threshold was defined in terms of d' = 1.00. The subjects were 12 young women with normal hearing and little or no experience with audiologic testing procedures. RESULTS: When threshold was based on a fixed percent correct, S/N at threshold was found to be dependent on set size (F = 3.333; df = 3, 33; p = 0.031). When threshold was defined in terms of d' = 1.00, S/N at threshold was found to be independent of set size. CONCLUSIONS: If a smaller set size than that recommended by the American Speech-Language-Hearing Association (1988) guidelines is to be used for obtaining SRTs in a clinical setting, thresholds should be based on a criterion-free measure that is independent of the size of the set of words being tested, if possible.

Sepsis and endotoxaemia in mice stimulate the expression of interleukin-I and interleukin-6 in the central nervous system.

1. In previous studies, experimental endotoxaemia was found to stimulate cytokine production in the central nervous system. The effect of sepsis on brain cytokines is not fully known. We compared the effect of endotoxaemia and sepsis on brain interleukin-1 and interleukin-6 expression. 2. Male A/J mice were injected subcutaneously with lipopolysaccharide (10 mg/kg) or an equal volume of saline as control. Sepsis was induced by caecal ligation and puncture (CLP); control mice underwent sham-operation. Brain tissue was assayed for interleukin-1 and interleukin-6 by ELISA. Northern blotting or the polymerase chain reaction was used to determine cytokine mRNA levels. 3. Administration of endotoxin induced a greater than fourfold increase in brain interleukin-1, a greater than threefold increase in interleukin-6 and an increase in mRNA for both cytokines. Caecal ligation and puncture resulted in increased brain interleukin-1 and interleukin-6 levels, but the changes were less pronounced and occurred later than after injection of endotoxin. There was no detectable difference in brain interleukin-1 mRNA between septic and sham-operated mice, whereas interleukin-6 mRNA was increased in brains of septic animals. 4. Sepsis and endotoxaemia resulted in similar, although not identical, changes in brain interleukin-1 and interleukin-6 concentrations and mRNA levels, suggesting that increased cytokine production in the central nervous system is part of the systemic response to sepsis and may be mediated by endotoxin.