[Determination of hearing thresholds in children using auditory brainstem responses : Influence of sedation and anaesthesia on quality and measurement time]. / Hörschwellenbestimmungen bei Kindern mittels früher akustisch evozierter Potenziale : Einfluss von Sedierung und Narkose auf Qualität und Messzeit.

BACKGROUND: A fundamental prerequisite for successful application of auditory brainstem responses (ABR) in paedaudiological diagnostics is to ensure a high quality of the measurement. This is commonly quantified by means of the residual noise. Key factors are the averaging number and the magnitude of spontaneous electroencephalogram (EEG). This is the first study to quantify the influence of different forms of sedation (anaesthesia, sedation with chloral hydrate or melatonin, natural sleep) on the individual EEG magnitude in children. MATERIALS AND METHODS: ABR measurements of 80 children aged between 1 month and 6 years were analysed retrospectively. Individual mean EEG amplitude was calculated from the averaging number and the residual noise. The results were analysed statistically with the type of sedation as a factor. From the mean EEG amplitudes, a theoretical recording time for a residual noise level of 35 nV was estimated. RESULTS: The spontaneous EEG activity is, on average, 2.5-times larger in awake children than in naturally sleeping children and more than 4­times larger than in sedated children. Although the EEG amplitude in intubation anaesthesia was smaller than with the other three types of sedation, this difference was not significant. The theoretical measurement time for 35 nV of residual noise was 10-times larger in awake than in sedated children. CONCLUSION: The large difference in spontaneous EEG activity between awake and sedated children indicates that sedation should be used for estimation of hearing thresholds on the basis of ABR. Only in rare cases is a reliable estimate of hearing thresholds likely to be obtained from ABR in awake children. Since different types of sedation do not influence the measurement time significantly, selection can be made solely on the basis of age and medical indication.

Comparison of the lattice-Boltzmann model with the finite-difference time-domain method for electrodynamics.

A three-dimensional lattice-Boltzmann model (LBM) for the simulation of the Maxwell equations is presented. The inclusion of media follows an extension of a special limit described in the literature which is applicable to this LBM and does not harm the stability of simulations. The focus of the present study lies on the properties of numerical accuracy and stability of the LBM in comparison to the standard finite-difference time-domain (FDTD) method based on Yee's method. Typical examples, often investigated in the context of numerical simulations, are considered. These include the propagation of electrodynamic (EM) fields in one- and three-dimensional systems. Results of this simulations are compared to the ones of their theoretical predictions. Further on, long-time simulations are done in systems with periodic boundary conditions to check if the total energy is conserved. To investigate the effect of the numeric impedance, the propagation of an EM pulse is monitored spatially and temporarily in a two-dimensional system. The simulation results indicate, in contrast to the one obtained from the FDTD method, that the presented LBM does fulfill the expected energy conservation and is not effected by the numerical impedance. This LBM therefore represents a valuable alternative for the simulation of EM problems like long-time simulations by avoiding intrinsic properties the FDTD method suffers from.

Stable lattice Boltzmann model for Maxwell equations in media.

The present work shows a method for stable simulations via the lattice Boltzmann (LB) model for electromagnetic waves (EM) transiting homogeneous media. LB models for such media were already presented in the literature, but they suffer from numerical instability when the media transitions are sharp. We use one of these models in the limit of pure vacuum derived from Liu and Yan [Appl. Math. MODEL: 38, 1710 (2014)AMMODL0307-904X10.1016/j.apm.2013.09.009] and apply an extension that treats the effects of polarization and magnetization separately. We show simulations of simple examples in which EM waves travel into media to quantify error scaling, stability, accuracy, and time scaling. For conductive media, we use the Strang splitting and check the simulations accuracy at the example of the skin effect. Like pure EM propagation, the error for the static limits, which are constructed with a current density added in a first-order scheme, can be less than 1%. The presented method is an easily implemented alternative for the stabilization of simulation for EM waves propagating in spatially complex structured media properties and arbitrary transitions.

[Speaker discrimination in cochlear implant users]. / Sprecherunterscheidung mit Cochleaimplantaten.

BACKGROUND: Although the word and sentence recognition skills of cochlear implant (CI) users have been studied extensively, little is known about their ability to distinguish between individuals on the basis of voice, an important skill for social communication. METHODS: Speech material from the Oldenburg Logatome Corpus (OLLO) was used to build a set of 120 logatome pairs spoken by 15 male and 15 female speakers, with no overlap of the fundamental frequencies of the two groups of speakers. Each pair contained two different logatomes. For half of the pairs, the two logatomes were spoken by the same speaker, for the other half they were spoken by different speakers. Using a same-different paradigm, 13 adult normal-hearing listeners and 13 adult post-lingually deafened CI users were asked whether the pair of different logatomes were spoken by the same or by different speakers. RESULTS: Mean speaker discrimination score for the CI users was 74.6 % correct and for the normal-hearing listeners 89.6 % correct. A significant influence of voice gender on speaker discrimination score was found in CI users and in normal hearing listeners. CONCLUSION: The results of the CI users were significantly above the level of chance and no ceiling effect was observed for the normal-hearing listeners, i. e., the presented set of logatome pairs from the OLLO seems to be very well suited to speaker discrimination experiments in CI users and quantitative comparison to normal-hearing listeners. CI users are able to discriminate between speakers but their performance is slightly worse than that of normal-hearing listeners.

Loudness of subcritical sounds as a function of bandwidth, center frequency, and level.

Level differences at equal loudness between band-pass noise and pure tones with a frequency equal to the center frequency of the noise were measured in normal-hearing listeners using a loudness matching procedure. The center frequencies were 750, 1500, and 3000 Hz and noise bandwidths from 5 to 1620 Hz were used. The level of the reference pure tone was 30, 50, or 70 dB. For all center frequencies and reference levels, the level at equal loudness was close to 0 dB for the narrowest bandwidth, increased with bandwidth for bandwidths smaller than the critical bandwidth, and decreased for bandwidths larger than the critical bandwidth. For bandwidths considerably larger than the critical bandwidth, the level difference was negative. The maximum positive level difference was measured for a bandwidth close to the critical bandwidth. This maximum level difference decreased with increasing reference level. A similar effect was found when the level differences were derived from data of an additional categorical loudness scaling experiment. The results indicate that the decrease of loudness at equal level with increasing subcritical bandwidth is a common property of the auditory system which is not taken into account in current loudness models.

[On the effect of reverberation on speech intelligibility by cochlear implant listeners]. / Zur Wahrnehmung verhallter Sprache mit Cochleaimplantaten.

BACKGROUND: An important parameter for characterization of the acoustic quality of closed rooms is reverberation. There is a rising interest in evaluating the ability of cochlear implant (CI) users to understand speech in real-world environments. Whereas the influence of noise on speech perception has been widely investigated, much less is known about the detrimental effect of reverberation. The present study aimed to investigate the influence of reverberation time on the speech perception of CI users and subjects with normal hearing. METHOD: A reverberated version of the sentences of the Oldenburg sentence test (OLSA) which is a widely used German test to measure speech reception thresholds (SRT) in cochlear implant users was generated using professional audio processing software. The reverberation times used were 0.7, 1.0, 1.5 and 2.0 s. For these four reverberation times and for a non-reverberated control condition, the SRT was measured in eight adult CI users and in eight subjects with normal hearing. RESULTS: To characterize the detrimental effect of reverberation the SRT differences between the reverberated and non-reverberated conditions were calculated. These SRT differences revealed a significant effect of reverberation in CI users with, e.g. a mean SRT increase of 2.9 dB in CI users and 0.9 dB in subjects with normal hearing for a reverberation time of 0.7 s. A strong correlation was found between the SRT increase and the SRT in the non-reverberated condition, highlighting the problems of poor performers in reverberant environments. CONCLUSION: The results of the current investigation indicated that reverberation results in decreased speech understanding of CI users.

Loudness of sounds with a subcritical bandwidth: a challenge to current loudness models?

Level differences at equal loudness were measured for bandpass noises centered at 1.5 kHz with bandwidths from 5 to 405 Hz and a 1.5-kHz pure tone. Irrespective of the reference (tone or 135-Hz wide noise), the data indicate a decrease in loudness with increasing bandwidth. This is at odds with the assumption of stationary loudness models that loudness for sounds with a subcritical bandwidth is determined by the intensity and center frequency only. It is also not in agreement with dynamic loudness models, which predict higher levels for a tone than for equally loud noises, i.e., the opposite effect.

Increased intensity discrimination thresholds in tinnitus subjects with a normal audiogram.

Recent auditory brain stem response measurements in tinnitus subjects with normal audiograms indicate the presence of hidden hearing loss that manifests as reduced neural output from the cochlea at high sound intensities, and results from mice suggest a link to deafferentation of auditory nerve fibers. As deafferentation would lead to deficits in hearing performance, the present study investigates whether tinnitus patients with normal hearing thresholds show impairment in intensity discrimination compared to an audiometrically matched control group. Intensity discrimination thresholds were significantly increased in the tinnitus frequency range, consistent with the hypothesis that auditory nerve fiber deafferentation is associated with tinnitus.

Rebound depolarization in single units of the ventral cochlear nucleus: a contribution to grouping by common onset?

Simultaneous grouping by common onset time is believed to be a powerful cue in auditory perception; components that start or stop roughly at the same time are judged as far more likely to have originated from the same source. Here we report a simple experiment designed to simulate a complex psychophysical paradigm first described by Darwin and Sutherland [(1984) Grouping frequency components of vowels. When is a harmonic not a harmonic? Quarterly J of Experimental Psychology: Hum Exp Psychol 36(A):193-208]. It is possible to change the perception of the vowel /I/ to /epsilon/ by manipulating the harmonics around the first formant (F1). Increasing the amplitude of one harmonic around F1 caused the perception of the vowel to change from /I/ to /epsilon/. Extending the increased component before the vowel could, however, greatly reduce this change. The role of neural adaptation in this effect was questioned by repeating the experiment but this time using a 'captor' tone which was switched on with the asynchronous harmonic and off when the vowel started. This time the vowel percept did change in a fashion analogous to the effect of an increase in the amplitude of the fourth harmonic (which is close to F1). This effect was explained by assuming that the captor had grouped with the leading portion of the asynchronous component enabling the remainder of the asynchronous component to be grouped with the remainder of the components. We propose a relatively low-level neuronal explanation for this grouping effect: the captor reduces the neural response to the leading segment of the asynchronous component by activating across-frequency suppression, either from the cochlea, or acting via a wideband inhibitor in the ventral cochlear nucleus. The reduction in neural response results in a release from adaptation with the offset of the captor terminating the inhibition, such that the response to the continuation of that component is now enhanced. Using a simplified paradigm we show that both primary-like and chopper units in the ventral cochlear nucleus of the anesthetized guinea pig may show a rebound in excitation when a captor is positioned so as to stimulate the suppressive sidebands in its receptive field. The strength of the rebound was positively correlated with the strength of the suppression. These and other results are consistent with the view that low-level mechanisms underlie the psychophysical captor effect.

[European perspectives of health telematics]. / Europäische Perspektive der Gesundheitstelematik.

The European perspectives of the present German developments in the field of health telematics are discussed critically. It is pointed out that technical projects have been financed with considerable means in the EU, however with out having any lasting effect on the value of health telematics in the health systems of Europe. A decisive cause is that the "health" topic was not codified in the Roman contracts. The international, global market is a crucial factor for international development and thus also for the orientation of the German projects and their economical and political success. The USA plays a dominant role on the global market. Caused by different reasons a corresponding market potential in the EU cannot be expected in the foreseeable future. With regard to the new options provided by telematics, it is therefore recommended that the national health services be reorganized, thus increasing quality and efficiency. With regard to progressively individualized medical care, the subject of "health" should afterwards be included in the European contracts. In the long run, an adjustment of the systems and uniform use of telematics could be achieved. Till then the coordination between the national governments in the area of health politics is seen as the most effective means for European integration.

Three-dimensional reconstruction and volumetry of intracranial haemorrhage and its mass effect.

Intracerebral haemorrhage still causes considerable disability and mortality. The studies on conservative and operative management are inconclusive, probably due to inexact volumetry of the haemorrhage. We investigated whether three-dimensional (3-D), voxel-based volumetry of the haemorrhage and its mass effect is feasible with routine computed tomography (CT) scans. The volumes of the haemorrhage, ventricles, midline shift, the intracranial volume and ventricular compression in CT scans of 12 patients with basal ganglia haemorrhage were determined with the 3-D slicer software. Indices of haemorrhage and intracranial or ventricular volume were calculated and correlated with the clinical data. The intended measures could be determined with an acceptable intra-individual variability. The 3-D volumetric data tended to correlate better with the clinical course than the conventionally assessed distance of midline shift and volume of haemorrhage. 3-D volumetry of intracranial haemorrhage and its mass effect is feasible with routine CT examination. Prospective studies should assess its value for clinical studies on intracranial space-occupying diseases.

Implementation of a practical model for light and heat distribution using laser-induced thermotherapy near to a large vessel.

This paper introduces a simulation model for light and heat transport in tissues including perfusion effects. The model enables an efficient simulation of the damaged zone induced with an optical fibre for laser interstitial thermotherapy (LITT). It is designed specially for, but not limited to, tissue ablation in the neck region near to vessels. We describe in detail the effects of the rise in temperature caused by the absorption of light in tissue, using the heat equation and including the cooling effects of flow in vessels and of microperfusion in tissue in order to determine the extent of thermal damage. The extent of the necrosis zone is calculated with a damage function at each point of a finite element method (FEM) mesh. The FEM mesh is implemented with FEMLAB 2.3 as an add-on for finite element modelling for Matlab 6.5. LITT for tumour ablation in liver and some other anatomical regions is a well-known and established method (Bundesärztekammer und Kassenärztliche Bundesvereinigung 2002 Assessment der Bundesärztekammer und der Kassenärztlichen Bundesvereinigung, Köln). Investigations of treatments using LITT in the neck region are still in progress. We propose a refined model to validate the LITT method in the future in another anatomic region, e.g., in the highly sensitive region of the neck. Our calculations show that in order to induce a lesion with a maximum diameter of about 1 cm near to a large vessel, an application time between 3 and 4 min is needed using a laser power of about 10 W with a Nd:YAG 1064 nm radiation wavelength.

Single amino acid substitutions in kappa-conotoxin PVIIA disrupt interaction with the shaker K+ channel.

kappa-Conotoxin PVIIA (kappa-PVIIA), a 27-amino acid peptide with three disulfide cross-links, isolated from the venom of Conus purpurascens, is the first conopeptide shown to inhibit the Shaker K(+) channel (Terlau, H., Shon, K., Grilley, M., Stocker, M., Stühmer, W., and Olivera, B. M. (1996) Nature 381, 148-151). Recently, two groups independently determined the solution structure for kappa-PVIIA using NMR; although the structures reported were similar, two mutually exclusive models for the interaction of the peptide with the Shaker channel were proposed. We carried out a structure/function analysis of kappa-PVIIA, with alanine substitutions for all amino acids postulated to be key residues by both groups. Our data are consistent with the critical dyad model developed by Ménez and co-workers (Dauplais, M., Lecoq, A., Song, J. , Cotton, J., Jamin, N., Gilquin, B., Roumestand, C., Vita, C., de Medeiros, C., Rowan, E. G., Harvey, A. L., and Ménez, A. (1997) J. Biol. Chem. 272, 4802-4809) for polypeptide antagonists of K(+) channels. In the case of kappa-PVIIA, Lys(7) and Phe(9) are essential for activity as predicted by Savarin et al. (Savarin, P., Guenneugues, M., Gilquin, B., Lamthanh, H., Gasparini, S., Zinn-Justin, S., and Ménez, A. (1998) Biochemistry 37, 5407-5416); these workers also correctly predicted an important role for Lys(25). Thus, although kappa-conotoxin PVIIA has no obvious sequence homology to polypeptide toxins from other venomous animals that interact with voltage-gated K(+) channels, there may be convergent functional features in diverse K(+) channel polypeptide antagonists.

Recommendations on the design of hospital Intranets.

Intranets are being widely introduced in hospitals like in many other organisations. Although their development is just like setting up any other information system in a hospital, there is a tendency to neglect well established principles of software engineering and information system design in that area. Starting from a functional definition of an intranet, we illustrate its potential importance for a hospital from different aspects. A systematic framework for an iterative design and maintenance process is suggested. Some important design principles are depicted.

Within-channel cues in comodulation masking release (CMR): experiments and model predictions using a modulation-filterbank model.

Experiments and model calculations were performed to study the influence of within-channel cues versus across-channel cues in comodulation masking release (CMR). A class of CMR experiments is considered that are characterized by a single (unmodulated or modulated) bandpass noise masker with variable bandwidth centered at the signal frequency. A modulation-filterbank model suggested by Dau et al. [J. Acoust. Soc. Am. 102, 2892-2905 (1997)] was employed to quantitatively predict the experimental data. Effects of varying masker bandwidth, center frequency, modulator bandwidth, modulator type, and signal duration on CMR were examined. In addition, the effect of band limiting the noise before or after modulation was shown to influence the CMR in the same way as a systematic variation of the modulation depth. It is demonstrated that a single-channel analysis, which analyzes only the information from one peripheral channel, quantitatively accounts for the CMR in most cases, indicating that an across-channel process is generally not necessary for simulating results from this class of CMR experiments. True across-channel processes may be found in another class of CMR experiments.

Intrinsic envelope fluctuations and modulation-detection thresholds for narrow-band noise carriers.

A model is presented which calculates the intrinsic envelope power of a bandpass noise carrier within the passband of a hypothetical modulation filter tuned to a specific modulation frequency. Model predictions are compared to experimentally obtained amplitude modulation (AM) detection thresholds. In experiment 1, thresholds for modulation rates of 5, 25, and 100 Hz imposed on a bandpass Gaussian noise carrier with a fixed upper cutoff frequency of 6 kHz and a bandwidth in the range from 1 to 6000 Hz were obtained. In experiment 2, three noises with different spectra of the intrinsic fluctuations served as the carrier: Gaussian noise, multiplied noise, and low-noise noise. In each case, the carrier was spectrally centered at 5 kHz and had a bandwidth of 50 Hz. The AM detection thresholds were obtained for modulation frequencies of 10, 20, 30, 50, 70, and 100 Hz. The intrinsic envelope power of the carrier at the output of the modulation filter tuned to the signal modulation frequency appears to provide a good estimate for AM detection threshold. The results are compared with predictions on the basis of the more complex auditory processing model by Dau et al.

Histidyl-tRNA synthetase.

Histidyl-tRNA synthetase (HisRS) is responsible for the synthesis of histidyl-transfer RNA, which is essential for the incorporation of histidine into proteins. This amino acid has uniquely moderate basic properties and is an important group in many catalytic functions of enzymes. A compilation of currently known primary structures of HisRS shows that the subunits of these homo-dimeric enzymes consist of 420-550 amino acid residues. This represents a relatively short chain length among aminoacyl-tRNA synthetases (aaRS), whose peptide chain sizes range from about 300 to 1100 amino acid residues. The crystal structures of HisRS from two organisms and their complexes with histidine, histidyl-adenylate and histidinol with ATP have been solved. HisRS from Escherichia coli and Thermus thermophilus are very similar dimeric enzymes consisting of three domains: the N-terminal catalytic domain containing the six-stranded antiparallel beta-sheet and the three motifs characteristic of class II aaRS, a HisRS-specific helical domain inserted between motifs 2 and 3 that may contact the acceptor stem of the tRNA, and a C-terminal alpha/beta domain that may be involved in the recognition of the anticodon stem and loop of tRNA(His). The aminoacylation reaction follows the standard two-step mechanism. HisRS also belongs to the group of aaRS that can rapidly synthesize diadenosine tetraphosphate, a compound that is suspected to be involved in several regulatory mechanisms of cell metabolism. Many analogs of histidine have been tested for their properties as substrates or inhibitors of HisRS, leading to the elucidation of structure-activity relationships concerning configuration, importance of the carboxy and amino group, and the nature of the side chain. HisRS has been found to act as a particularly important antigen in autoimmune diseases such as rheumatic arthritis or myositis. Successful attempts have been made to identify epitopes responsible for the complexation with such auto-antibodies.

The physiologic effects of inverse ratio ventilation.

STUDY OBJECTIVES: The efficacy of inverse ratio ventilation in ARDS is not clear. Furthermore, the mechanism responsible has not been determined. We designed an animal study to determine if inverse ratio ventilation improves gas exchange and by what mechanism. DESIGN: Prospective randomized, controlled design was used. SETTING: University of Missouri Pulmonary/Critical Care Animal Laboratory. PARTICIPANTS: Nine dogs with oleic acid-induced lung injury as control animals to assess stability of the model, nine in the experimental model. INTERVENTIONS: Conventional ventilation with full recruitment extrinsic positive end-expiratory pressure (PEEP) was compared with two other modes of ventilation. One was inverse ratio with extrinsic PEEP and the second was inverse ratio with intrinsic PEEP equal to full recruitment PEEP. Full recruitment levels of PEEP were defined by optimizing compliance, then increasing PEEP by 2.5 cm/H2O. Each type of ventilation was maintained for 45 min after the edema had stabilized. Comparison of lung injury over time requires stability of the model over time. Therefore, we also assessed the stability of the preparation over time by examining compliance, extravascular lung water, and venous admixture in nine control dogs with equivalent lung injury over the same time span. MEASUREMENTS AND RESULTS: Mean airway pressure was increased by both types of inverse ratio ventilation, while compliance remained stable. Venous admixture was reduced (conv=0.32+/-0.12, inverse ratio with extrinsic PEEP=0.24+/-0.10, inverse ratio with intrinsic PEEP=0.28+/-0.11) with inverse ratio with extrinsic PEEP, but the improvement was less with inverse ratio with intrinsic PEEP, even though the mean airway pressure was higher. CONCLUSIONS: We conclude that increasing mean airway pressure by prolongation of the inspiratory time improves gas exchange in our model of ARDS, but when mean airway pressure is increased further, allowing the development of intrinsic PEEP, the beneficial effects on gas exchange are less. Increasing mean airway pressure with intrinsic PEEP is not equivalent to other methods of increasing mean airway pressure.

ATP binding site of P2X channel proteins: structural similarities with class II aminoacyl-tRNA synthetases.

The extracellular loop of P2X channel proteins contains a sequence stretch (positions 170-330) that exhibits similarities with the catalytic domains of class II aminoacyl-tRNA synthetases as shown by secondary structure predictions and sequence alignments. The arrangement of several conserved cysteines (positions 110-170) shows similarities with metal binding regions of metallothioneins and zinc finger motifs. Thus, for the extracellular part of P2X channel proteins a metal binding domain and an antiparallel six-stranded beta-pleated sheet containing the ATP binding site are very probable. The putative channel forming H5 part (positions 320-340) shows similarities with the enzyme motif 1 responsible for aggregation of subunits to the holoenzyme.

Importance of dental problems according to 12- to 16-year-old children.

The willingness to take preventive action is partly determined by the perceived importance of the disease. The purpose of this study was to investigate the relationship of age, sex, education, and ethnicity to the importance of dental and other health problems by 12- to 16-year-old children. The children (361 boys, 272 girls) attending Dutch schools were asked a series of questions requiring a choice by students as to the more important problems in a given pair of conditions. Conditions included systemic, dental, and psychological problems. Nervousness was the least important problem and hearing disability the most of the nine ranked. Having full dentures was ranked third, bad teeth fifth, and toothache sixth of the nine from least (first) to most important (ninth). Age, sex, education, and ethnicity showed no relationship to importance of problems alone or in aggregate.