Evaluating the effectiveness and reliability of the Vibrant Soundbridge and Bonebridge auditory implants in clinical practice: Study design and methods for a multi-centre longitudinal observational study.

BACKGROUND: The Vibrant Soundbridge middle ear implant and the Bonebridge bone conducting hearing device are hearing implants that use radio frequency transmission to send information from the sound processor to the internal transducer. This reduces the risk of skin problems and infection but requires a more involved surgical procedure than competitor skin penetrating devices. It is not known whether more complex surgery will lead to additional complications. There is little information available on the reliability of these systems and adverse medical or surgical events. The primary research question is to determine the reliability and complication rate for the Vibrant Soundbridge and Bonebridge. The secondary research question explores changes in quality of life following implantation of the devices. The tertiary research question looks at effectiveness via changes in auditory performance. METHOD: The study was designed based on a combination of a literature search, two clinician focus groups and expert review.A multi-centre longitudinal observational study was designed. There are three study groups, two will have been implanted prior to the start of the study and one group, the prospective group, will be implanted after initiation of the study. Outcomes are surgical questionnaires, measures of quality of life, user satisfaction and speech perception tests in quiet and in noise. CONCLUSION: This is the first multi-centre study to look at these interventions and includes follow up over time to understand effectiveness, reliability, quality of life and complications.

Differential regulation of cortical NMDA receptor subunits by sensory learning.

NMDA receptor is an important player in neuronal plasticity, including cortical reorganization. In the adult cerebral cortex, the receptor properties are regulated by relative expression of NR2A and NR2B subunits. We have previously found that 3 days of sensory conditioning, in which stimulation of whiskers was paired with a tail shock, induce NMDA-receptor-dependent expansion of metabolically labeled cortical representations of the stimulated vibrissae. Here, we examined the effect of learning-induced cortical reorganization upon expression of NR2A and NR2B NMDA receptor subunits. An increase in NR2A mRNA expression in the barrel of the "trained" row of vibrissae was observed with in situ hybridization 24 h after sensory conditioning. NR2B mRNA expression level did not change. Protein level of both regulatory subunits and obligatory NR1 subunit were examined in P2 fraction. NR2A protein level was found elevated 1 h and 24 h after the sensory conditioning, but not in controls which received only whisker stimulation, signifying that the change was associated with cortical map reorganization. NR2B protein level was transiently elevated in both trained and stimulated control groups. NR1 protein level did not change. The results show that simple sensory learning induces a change in expression of regulatory NMDA receptor subunits, indicating a potential for receptor channel properties modification.

Learning-induced plasticity of cortical representations does not affect GAD65 mRNA expression and immunolabeling of cortical neuropil.

Two forms of glutamic acid decarboxylase (GAD) are present in inhibitory neurons of the mammalian brain, a 65-kDa isoform (GAD65) and a 67-kDa isoform (GAD67). We have previously found that GAD67 is upregulated during learning-dependent plasticity of cortical vibrissal representations of adult mice. After sensory conditioning involving pairing stimulation of vibrissae with a tail shock, the increase in mRNA expression and density of GAD67-immunoreactive neurons was observed in barrels representing vibrissae activated during the training. In the present study, using the same experimental model, we examined GAD65 mRNA and protein levels in the barrel cortex. For this purpose, we used in situ hybridization and immunohistochemistry. No changes in the level of GAD65 mRNA expression were detected after the training. The pattern of GAD65 mRNA expression was complementary to that observed for GAD67. Immunocytochemical analysis found no changes in immunolabeling of neuropil of the barrels representing the vibrissae activated during the training. The results show that, in contrast to GAD67, cortical plasticity induced by sensory learning does not affect the expression of GAD65.

[Estrogens and synaptic plasticity]. / Estrogeny i plastycznosc synapsy.

Estrogens influence morphology of the brain not only in structures linked to reproductive cycle and reproductive behavior but also structure engaged in memory and cognitive functions. Estrogens stimulate synaptogenesis in pyramidal neurons of CA1 field of hippocampus. Increase in the number of spines on apical dendrites in rats occurs in the prostures phase of the cycle as well as exogenous estradiol application in ovariectomized females. The new synapses are enriched in NMDA receptor and it was found that their generation involves activation of NMDA receptors, PKA and CREB. Estradiol-induced synaptogenesis is accompanied by facilitation of LTP induction. Estradiol affects pyramidal cells of CA1 probably by inhibiting GABA-ergic interneurons. It also modulates unspecific activatory systems, which contribute significantly to neuroplasticity.