Models to predict positive and negative effects of cochlear implantation on tinnitus.

OBJECTIVES: The effect of cochlear implantation on tinnitus is heterogeneous: implantation does not always reduce tinnitus and may even worsen tinnitus. Therefore, it is important to know which factors influence the consequences of cochlear implantation for tinnitus. To date, no consensus has been reached regarding the factors that influence tinnitus. This study aimed to create prognostic models, using binary logistic regression analyses to predict positive or negative changes in tinnitus after cochlear implantation. METHODS: For this study we retrospectively sent two questionnaire packages to 117 cochlear implant patients. RESULTS: In the binary logistic regression analyses of the responses to the questionnaires, it was not possible to create a significant model to predict a positive effect of cochlear implantation on tinnitus. However, a negative effect of cochlear implantation on tinnitus was predictable, using a backward stepwise selection method in a model including the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Tinnitus Handicap Questionnaire (THQ) (P < .001, Nagelkerke R2 = 0.529). CONCLUSIONS: Our results suggest that the lower the preoperative tinnitus handicap and the preoperative hearing handicap, the higher the chance that cochlear implantation will worsen tinnitus. More research needs to be done, preferable in a big prospective study, to make this model instrumental for clinical decision making and preoperative patient counselling. However, our results might suggest that preoperative THQ and APHAB screening could be meaningful. Especially in patients who are afraid to develop tinnitus or tinnitus worsening as complication of cochlear implantation. LEVEL OF EVIDENCE: 4.

[Follow-up diagnostics, referral and follow-up of hepatitis B and C patients]. / Vervolgdiagnostiek, follow-up en verwijzing van patiënten met hepatitis B en C.

OBJECTIVE: To study the extent to which follow-up diagnostics, referral to secondary care and follow-up are in accordance with the practice guideline of the Dutch College of General Practitioners 'Viral hepatitis and other liver disorders' after a hepatitis B (HBV) or C (HCV) infection has been diagnosed at the general practice. DESIGN: Retrospective cohort study. METHOD: Patient records were obtained from the Dutch 'Integrated primary care information' (IPCI) database which contains data from patients from general practices. Records of patients with a first-time positive HBsAg or anti-HCV test result in the period between 2008 and 2015 were manually validated and data on follow-up diagnostics, referral and follow-up were found. RESULTS: A total of 117 patients tested positive for HBsAg and 101 patients tested positive for anti-HCV. Most HBV patients were subsequently tested for HBeAg (92%) and ALT (80%). Of the 41 HBV patients who were eligible for referral, 37 (90%) were actually referred to a specialist. 49 HCV patients (49%) were found negative after a confirmation or RNA test. 87% of the remaining 52 HCV patients were referred (n = 45). 21 (43%) of the 49 HBV patients who were not eligible for referral were tested for ALT after an average of 11.5 months. 14 (29%) of these patients subsequently received a second follow-up ALT test and 8 (16%) received a third. CONCLUSION: Almost all HBV and HCV patients who are eligible for referral, are actually referred to a specialist. Most HBV patients received the correct follow-up diagnostics after a positive HbsAg test result. However, in few HBV patients who were not eligible for referral, was the ALT level checked every year for three years. The general practitioner, as well as the patient, should receive a reminder for this.

[Mortality due to chronic viral hepatitis B and C infections in the Netherlands]. / Sterfte aan chronische hepatitis B en C in Nederland.

OBJECTIVE: To estimate mortality due to chronic hepatitis B-virus (HBV) and hepatitis C-virus (HCV) infections in the Netherlands from 2002 to 2015. DESIGN: A cross-sectional analysis based on cause-of-death statistics. METHOD: From Statistics Netherlands we obtained detailed data regarding the number of deaths per year in the following ICD-10 categories: chronic viral hepatitis; malignant neoplasm of the liver and intrahepatic bile ducts; fibrosis and cirrhosis of the liver; and alcoholic liver disease. We determined the population-attributable fractions (PAF) of HBV and HCV infections in mortality due to hepatocellular carcinoma (HCC) and cirrhosis of the liver, and added these to the recorded mortality from viral hepatitis in order to calculate total mortality. We used Dutch research as a basis for allocation to HCC, and a range of PAFs from 3 studies for cirrhosis. Poisson regression was used to assess mortality trends over time and any differences in demographic characteristics. RESULTS: Around 500 Dutch people died annually of chronic viral hepatitis from 2002 to 2015, according to our 'middle' estimate; the 'lowest' estimate yields 340 and the 'highest' 600 people per year. The total mortality due to a chronic HBV and HCV infection did not change over time. The mortality for HCC due to viral hepatitis increased slightly over time and the mortality for cirrhosis decreased slightly. HCC mortality due to viral hepatitis was higher in Dutch people of non-western origin. CONCLUSION: Mortality from chronic viral hepatitis is mostly the result of cirrhosis of the liver and HCC. About 500 persons died annually from 2002 to 2015 from causes linked to viral hepatitis.

Predictors of HPV vaccination uptake: a longitudinal study among parents.

To assess among parents longitudinal predictors of human papillomavirus (HPV) vaccination uptake for their daughters, random samples of parents were identified via municipal services and sent baseline questionnaires in June 2009 and follow-up questionnaires in November 2011 after their uptake decision. Hierarchical logistic regression analysis was used to assess whether demographic characteristics, and affective and social cognitive factors, predicted uptake at follow-up. Response rates of the baseline and follow-up questionnaire were 29.8% (1762/5918) and 74.3% (793/1067), respectively. Uptake was predicted by a later (2011) versus earlier (2010) decision about uptake as HPV vaccination implementation [odds ratio (OR) 2.48; 95% confidence interval (CI) 1.11-5.52], anticipated regret about no uptake (OR 1.43; 95% CI 1.08-1.89) and intention (OR 2.61; 95% CI 1.47-4.61). There was an interaction between ambivalence and attitude (OR 1.68; 95% CI 1.14-2.47); parents with a positive attitude and a high ambivalence toward vaccination were more likely to have their daughter vaccinated than parents with a positive attitude and a low ambivalence. An informed choice about uptake (5/7 correct items) was made by 44%. In conclusion, uptake was predicted by intention, a later (2011) versus earlier (2010) decision and by anticipated regret about no uptake. Decisions regarding new vaccines are difficult to make, we recommend a well-balanced implementation process.

Three-dimensional reconstruction of the pigeon inner ear.

Three-dimensional reconstructions of the inner ear of the pigeon (Columba livia domestica), from two-dimensional images, obtained with (conventional) light microscopy or orthogonal-plane fluorescence optical sectioning (OPFOS), are presented. The results are compared with available information on the dimensions and orientation of the semicircular canals.

Three-dimensional reconstruction of the guinea pig inner ear, comparison of OPFOS and light microscopy, applications of 3D reconstruction.

Three-dimensional (3D) reconstruction of anatomical structures can give additional insight into the morphology and function of these structures. We compare 3D reconstructions of the guinea pig inner ear, using light microscopy and orthogonal plane fluorescence optical sectioning microscopy. Applications of 3D reconstruction of the inner ear are further explored. For each method two bullas were prepared for 3D reconstruction. Both methods are explained. In general, the 3D reconstructions using orthogonal plane fluorescence optical sectioning microscopy are superior to light microscopy. The exact spiral shape of the cochlea could be reconstructed using orthogonal plane fluorescence optical sectioning microscopy and the length of the basilar membrane measured. When a resolution of 20 microm is sufficient, orthogonal plane fluorescence optical sectioning microscopy is a superior technique for 3D reconstruction of inner ear structures in animals.

Unilateral hearing loss as primary symptom of craniopharyngioma in a six-year-old girl.

OBJECTIVE: We report a rare case of otological presentation of craniopharyngioma. METHOD: Case report and review of world literature concerning presentations of craniopharyngioma. RESULTS: A six-year-old girl was referred to our department with unilateral hearing loss. This appeared to be a complete sensorineural hearing loss. Otoacoustic emissions were reproducible on both sides. Magnetic resonance scanning revealed a massive, cystic craniopharyngioma exerting pressure on the patient's ventricular system and brainstem and also invading the internal acoustic canal. The mass was resected via a craniotomy. The patient's hearing loss completely recovered, and she experienced no neurological or endocrinological side effects of the treatment. Craniopharyngioma have a prevalence of 0.13-2:100,000. CONCLUSION: Craniopharyngioma is a rare disease. First presentation with otological symptoms is extremely rare. Otoacoustic emissions can differentiate between cochlear and retrocochlear causes of sensorineural hearing loss.

Morphology and function of Bast's valve: additional insight in its functioning using 3D-reconstruction.

The utriculo-endolymphatic valve was discovered by Bast in 1928. The function of Bast's valve is still unclear. By means of orthogonal-plane fluorescence optical sectioning (OPFOS) microscopy 3D-reconstructions of the valve and its surrounding region are depicted. The shape of the duct at the utricular side is that of a flattened funnel. In the direction of the endolymphatic duct and sac this funnel runs into a very narrow duct. The valve itself has a rigid 'arch-like' configuration. The opposing thin, one cell-layer thick, utricular membrane is highly compliant. We propose that opening and closure of the valve occurs through movement of the flexible base/utricular membrane away from and toward the relatively rigid valve lip.

The relationship of the round window membrane to the cochlear aqueduct shown in three-dimensional imaging.

The round window membrane and cochlear aqueduct complex in the guinea pig are reconstructed with 3D-imaging, using orthogonal plane fluorescence optical sectioning (OPFOS). The 3D-images show that the periotic duct and the aqueduct are connected to a pouch-like extension of the round window. The function of this may be regulation of aqueduct flow resistance under the influence of a pressure difference between inner ear fluid and middle ear.

Low serum magnesium is associated with decreased graft survival in patients with chronic cyclosporin nephrotoxicity.

BACKGROUND: Hypomagnesaemia is a common side effect of cyclosporin A (CsA) therapy. Animal studies suggest that magnesium (Mg) supplementation inhibits chronic CsA nephropathy. METHODS: To determine if low Mg levels correlate with true CsA-induced nephrotoxicity in humans, we examined kidney transplant biopsy records at our centre for all transplant biopsies performed between 1990 and 2002. We simultaneously reviewed the medical records to determine whether serum Mg levels were checked at the time of biopsy. Those individuals with histologically proven CsA nephrotoxicity were studied. RESULTS: Serum total Mg levels were available for 320 patients, 60 of whom were diagnosed with chronic CsA-mediated nephropathy. Patients were divided in two groups, a low Mg [n = 29, 1.8 (1.67-1.9) mg/dl or 0.74 (0.68-0.78) mmol/l] and a normal Mg group [n = 31, 2.2 (2.0-2.4) mg/dl or 0.9 (0.82-0.98) mmol/l, P<0.05] based on the median Mg level in the entire cohort (2 mg/dl or 0.82 mmol/l). Both groups were analysed for disease progression and graft loss using the slope of creatinine clearance (CCR) and multivariate analyses. Although the CCR at the time of biopsy was greater in the low Mg group [44.3 (36.3-64.3) ml/min vs 37.8 (25.2-47.3) ml/min, P<0.05), the decline in graft function was faster in this group (-8.9+/-3.5 vs 1+/-2.7 ml/min/year; P = 0.02) compared with the normal Mg cohort. Using Cox proportional hazards analyses, the adjusted graft survival was significantly reduced in the low Mg group 5 years after biopsy. CONCLUSIONS: Our study demonstrates that low serum Mg levels were associated with a faster rate of decline in kidney allograft function and increased rates of graft loss in renal transplant recipients with chronic CsA nephropathy. This suggests that hypomagnesaemia could potentiate CsA-mediated nephropathy.

Population differences in Trifolium repens L. response to ultraviolet-B radiation: foliar chemistry and consequences for two lepidopteran herbivores.

White clover growing in New Zealand is experiencing increasing levels of ultraviolet-B (UV-B) radiation as a result of ozone depletion. We evaluated the effects of UV-B radiation on the foliar chemistry of two populations of white clover (Trifolium repens L.), 'Huia' and 'Tienshan,' and the consequences for the performance of armyworms (Spodoptera litura) and cutworms (Graphania mutans). Plants were grown in controlled environment rooms with and without supplemental UV-B radiation at a dose of 13.3 kJ m-2 day-1, corresponding to a 25% mid-summer ozone depletion above Palmerston North, New Zealand. In both white clover populations, UV-B radiation elicited changes in foliar chemistry, including slight increases in nitrogen concentrations and decreases in carbohydrate concentrations. In addition, the 'Huia' population showed decreases in fiber concentrations and marked increases in cyanogenic activity. No change in UV-absorbing compounds was detected in either population. Long- and short-term feeding trials were conducted to assess dietary effects on insect growth, consumption, and food utilization. Changes in the performance of both insect species were generally small. The most pronounced effect was a 36% reduction in weight of S. litura after 2 weeks of feeding on Huia grown at high UV, but larval development times were only slightly prolonged and pupal weights were unaffected. S. litura short-term performance was affected by differences in white clover population. The long-term performance of G. mutans was not affected and its short-term performance (stadium duration and consumption rate) was only marginally affected by the high-UV treatment. We conclude that the effects of elevated UV-B radiation on white clover plant chemistry can be specific to certain plant populations. The differences in sensitivity of the two generalist insect species suggest that effects may also be specific to certain plant-herbivore associations. These results indicate that future UV-B herbivory studies should examine genotypic effects in both plants and animals.

[Carotid stenting: acute results and complications]. / Karotisstent: Akutergebnisse und Komplikationen.

The treatment of carotid stenoses with balloon angioplasty and stenting is a new and not generally established method. During a one year period 65 patients (22 female, 43 male, mean age: 73 years, 47 with neurologic symptoms, 8 with contralateral carotid occlusion) with significant (>70%) carotid stenosis were treated with balloon angioplasty and balloon expandable stents. The primary technical success rate was 98% (65/66 patients) respectively 99% (69/70 stenoses). A combined procedure was performed in 11 /17%) patients with stenting in both carotid arteries in 4 patients with additional coronary interventions in 6 patients and stenting of the origin of the common carotid artery in one patient.Severe neurologic complications occurred in 4 (6.2%) patients (1 death, 1 major stroke, 2 minor strokes) and short lasting neurologic deficits in additional 4 (6.2%) patients. Cardiovascular complications were not observed. Local (inguinal) problems occurred in 3 (4.5%) patients (2 aneurysma spuria, 1 transfusion for hematoma). Frequently, balloon insufflation was associated with bradycardia (40%) and additional hypotension (11%). In summary, carotid stenting can be performed with technically high success rates (99%), but it is adversely influenced by not infrequent thromboembolic cerebral events (12.4%). The possibility to perform combined procedures with interventions in other vessels (both carotid arteries, coronary arteries, aortic arch arteries) is advantageous.

The changing focus of marine mammal conservation.

Overexploitation has been the principal focus of marine mammal conservation. Less attention has been paid to bycatch in commercial fisheries; entanglement in lost and discarded fishing gear; food shortages owing to climate change and/or overharvesting of essential prey; point and non-point source pollution; and diseases. Also, relatively little attention has been paid to situations where marine mammals pose threats to the existence and human uses of other marine species. As overexploitation is addressed, focus must be shifted to these problems that are no less significant.

Characterization of swallowing and defecation in Parkinson's disease.

UNLABELLED: Despite the high prevalence of Parkinson's disease, the pathophysiology of its gastrointestinal symptoms remains poorly understood. OBJECTIVES: to evaluate swallowing and defecatory function in patients with Parkinson's disease and age- and sex-matched controls and to correlate objective findings with subjective symptoms. METHODS: The following studies were performed on 13 patients with Parkinson's disease and seven controls: extrapyramidal function assessment, gastrointestinal symptom survey, videoesophagram, colon transit study, defecography, and anorectal manometry. RESULTS: Abnormal salivation (frequency, %, control vs. Parkinson's disease: 14 vs. 77, p < 0.05), dysphagia (14 vs. 77, p < 0.05), constipation (14 vs. 31, p < 0.05), and defecatory dysfunction (29 vs. 77, p < 0.05) were more common among Parkinsonian patients. However, videoesophagographic abnormalities were equally common in both groups. Colon transit time was significantly prolonged in the Parkinson's disease group. Altered puborectalis function was noted on defecography in 31% of Parkinson's disease subjects, but in none of the controls (p < 0.05). Anorectal manometry identified several abnormalities in the Parkinson's disease group, which included decreased basal anal sphincter pressures, prominent phasic fluctuations on squeeze, and a hyper-contractile external sphincter response to the rectosphincteric reflex. Many patients exhibited both slow transit and manometric abnormalities, and symptoms were poor predictors of test results. CONCLUSION: In this group of patients with mild to moderate Parkinson's disease, videoesophagographic abnormalities were not confined to the patients with Parkinson's disease. Studies of colonic and anorectal function, in contrast, identified a number of abnormalities. Therefore, colonic and anorectal dysfunction appears to be an early gastrointestinal manifestation of Parkinson's disease, and may represent the direct involvement of the gut by this disease process.

Defecatory function in Parkinson's disease: response to apomorphine.

We evaluated the effects of the dopaminergic agent apomorphine on defecation and anorectal function in patients with Parkinson's disease (PD). A gastrointestinal symptom survey, extrapyramidal assessment, defecating proctogram, and anorectal manometric study were performed in 8 subjects with PD. Basal studies showing abnormalities were repeated following apomorphine administration. Prior defecographic abnormalities were normalized following apomorphine injection in 1 of 3 subjects and significant improvements in manometric parameters were observed in all 5 subjects who underwent repeat anorectal manometry. We conclude that apomorphine can correct anorectal dysfunction in PD, and that these abnormalities may be a consequence of dopamine deficiency secondary to the PD process. These findings may also have therapeutic implications.

Gastrointestinal symptoms in Parkinson disease: 18-month follow-up study.

In a recent study we identified abnormal salivation, dysphagia, nausea, constipation, and defecatory dysfunction as those gastrointestinal (GI) symptoms associated with Parkinson disease (PD) and characterized their relationship to PD severity and therapy. In this study, we re-evaluated these symptoms and their relationship to parameters of PD 18 months later. Sixty-six percent of the original participants responded. Over the 18 months, 68% of originally untreated PD subjects commenced anti-PD therapy. Abnormal salivation, dysphagia, nausea, constipation, and defecatory dysfunction were again identified as those GI symptoms more common in PD. Constipation increased both in severity and frequency. Comparison of GI symptom scores and parameters of PD dysfunction failed to reveal significant progression of either GI symptomatology or PD dysfunction, or the development of new GI symptoms over the 18-month period. This study validates our GI dysfunction assessment system and confirms abnormal salivation, dysphagia, nausea, constipation, and defecatory function as those GI symptoms truly associated with PD. A direct relationship between PD and its related GI symptoms is again supported.

CQA 206-291 in Parkinson's disease.

CQA 206-291, a mixed D1-D2 receptor agonist that also possesses dualistic dopamine antagonist-agonist properties, was investigated in a double-blind, placebo-controlled trial in individuals with Parkinson's disease of moderate severity. Significant improvement was noted in the treatment groups compared to the placebo group. Adverse effects were generally mild and transient. CQA appears to be an effective, well-tolerated agent in the treatment of Parkinson's disease. Nevertheless, because of laboratory-based toxicity concerns, CQA has been withdrawn from further human study and will not be developed clinically.

Sinemet CR in Parkinson's disease.

Sinemet CR, a controlled release carbidopa/levodopa preparation, was compared to conventional carbidopa/levodopa in a double blind, placebo-controlled trial. Comparable clinical benefits and adverse effects were noted with the two medications. However significantly less frequent dosing was necessary with Sinemet CR.

Gastrointestinal symptoms in Parkinson's disease.

We have investigated the prevalence of gastrointestinal (GI) symptoms in 98 individuals with Parkinson's disease (PD) and in a control group of 50. Seventy-nine of those with PD were being treated with dopaminergic medications and 19 were untreated. Those symptoms occurring more frequently in PD patients than in controls included abnormal salivation, dysphagia, nausea, constipation, and defecatory dysfunction. Except for defecatory dysfunction, symptoms did not correlate with treatment but instead correlated with disease severity. This suggests that the GI symptoms of PD reflect direct involvement in the GI tract by the primary disease process.