Reliability of inertial sensors in the assessment of patients with vestibular disorders: a feasibility study.

BACKGROUND: Vestibular disorders affect an individual's stability, balance, and gait and predispose them to falls. Traditional laboratory-based semi-objective vestibular assessments are intrusive and cumbersome provide little information about their functional ability. Commercially available wearable inertial sensors allow us to make this real life assessments objective, with a detailed view of their functional abilities. Timed Up and Go (TUG) and Postural Sway tests are commonly used tests for gait and balance assessments. Our aim was to assess the feasibility, test-retest reliability and ability to classify fall status in individuals with vestibular disorders using parameters derived from the commercially available wearable system (inertial sensors and the Mobility Lab Software, APDM, Inc.). METHODS: We recruited 27 individuals diagnosed either with unilateral or bilateral vestibular loss on vestibular function testing. Instrumented Timed Up and Go (iTUG) and Postural Sway (iSway) were administered three times during the first session and then repeated at a similar time the following week. To evaluate within and between sessions reliability of the parameters the Intra-Class Correlation coefficient (ICC) was used. Subsequently, the ability of reliable parameters (ICC ≥ 0.8) to classify fallers from non-fallers was estimated. RESULTS: The iTUG test parameters showed good within and between sessions' reliability with mean ICC (between-sessions) values of 0.81 ± 0.17 and 0.69 ± 0.15, respectively. For the iSway test, the relative figures were; 0.76 ± 0.13 and 0.71 ± 0.14, respectively. A retrospective falls classification analysis with past 12 months falls history data yielded an accuracy of 66.70% with an area under the curve of 0.79. Mean Distance from centre of COP (mm) of accelerometer's trajectory (m/s2) from the iSway test was the only significant parameter to classify fallers from non-fallers. CONCLUSIONS: Using a commercially available wearable system a subset of reliable iTUG and iSway parameters were identified and their ability to classify fallers were estimated. These parameters have potential to augment assessments of vestibular patients to enable clinicians and therapists to provide objective, tailored, personalised interventions for their gait and postural control and also to objectively evaluate and monitor the efficiency of their interventions.

Bone-conduction hearing aids in an elderly population: complications and quality of life assessment.

To determine whether an elderly population with hearing impairment can be adequately rehabilitated with a bone-conduction hearing aid and whether the putative relationship between the elderly and an increased complication rate is justified. The study design was a retrospective case note review with a postal and telephone questionnaire, which was carried out in a tertiary centre. All patients aged 60 or over underwent implantation with a bone-conduction aid between 2009 and 2013 for conductive, SSD or mixed hearing loss. Outcome measures were complication rates and quality of life assessment using the Glasgow Benefit Inventory. The influence of patient and surgical factors on the complication rate was assessed. Fifty-one patients were implanted. Mean age was 67 years (range 60-89 years). The mean benefit, satisfaction and global GBI scores were 70 % (range 0-100 %), 70 % (0-100 %) and 82 % (83-100 %), respectively. The residual disability was 18 % (0-25 %). The adverse skin reaction rate was 16 % and the fixture loss rate was 2 %. There was a demonstrable increase in the complication rate with the dermatome (45 %; 5 patients) compared to the Sheffield 'S' (13 %; 2 patients) or linear incision techniques (29 %; 7 patients). The bone-conduction hearing aids are ideal method of hearing rehabilitation in the elderly for all forms of hearing loss. It provides significant benefit with no increased complication rate, which is imperative if social isolation is to be avoided and cognition preserved in this growing elderly population.

Angiopoietins 1 and 2 and Tie-2 receptor expression in human ductal breast disease.

AIMS: This study aimed to identify the involvement of the angiopoietin/Tie-2 receptor system in breast cancer development, progression, metastasis and angiogenesis. METHODS AND RESULTS: We quantified and correlated angiopoietin-1 (Ang-1), Ang-2 and Tie-2 expression in sections of normal human breast, benign and premalignant hyperplastic tissue, pre-invasive and invasive cancer, and compared these findings with our previously published data on vascular endothelial growth factor (VEGF) and microvessel density (MVD) in the same samples. A breast cancer tissue microarray was used to evaluate the prognostic value of these factors. Histological analysis revealed a significant decrease in Ang-1 expression (P = 0.001) and an inverse correlation with MVD (r = -0.442, P = 0.008) and VEGF (r = -0.510, P = 0.002) in the non-invasive lesions. In contrast Ang-2 expression increased significantly (P = 0.0004) with increasing severity of lesion and correlated with MVD (r = 0.570; P = 0.0002), while Tie-2 expression remained relatively unchanged. Expression of all three factors was reduced in invasive breast cancer and did not correlate with oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), lymph node status or tumour grade. CONCLUSIONS: These data suggest that a change in the angiopoietin balance in favour of Ang-2 is associated with the angiogenic switch at the onset of hyperplasia in the breast. However, angiopoietins and the Tie-2 receptor are not related to known prognostic indicators in invasive breast cancer.

Minimal access surgery for implantable bone conduction systems: early experience with the "Sheffield" incision.

INTRODUCTION: To compare the results of the "Sheffield" incision technique for implantable temporal bone conduction systems against the previous inferiorly based flap technique. MATERIALS AND METHODS: Bone-Anchored Hearing Aid surgery performed over a 2-year period using the new incision (32 patients) was monitored prospectively. A short "lazy S" incision, within the hairline was used followed by soft tissue reduction and implantation. Age range was 6 to 76 years. Average follow-up was 6 months. The results in this group were compared with those of a similar group (20 patients) where the inferiorly based flap was used. RESULTS: The "Sheffield" incision produced more aesthetically pleasing flaps, and patient satisfaction was high. There were no major complications like flap necrosis or fixture loss (against 25% flap necrosis in the flap technique). One patient had a wound hematoma and subsequent wound dehiscence, which needed clearing and closure under anesthetic. Minor complications included granulations in 4 (13%) at the lower edges of the incision (55% in the flap technique), skin redness in 3 (9%) of Holgers Grade 2, and small wound dehiscence in 3 (3%), all of which settled conservatively. DISCUSSION: The results of the "Sheffield" incision compare well with other similar case series and with our own results from using the alternative inferior flap technique. In addition, it offers simplicity, speed, and aesthetically pleasing results with minimal postoperative management.