Effects of demographic, audiologic, and hearing-aid-related variables on the outcomes of using hearing aids.

PURPOSE: To examine the influence of demographic, audiologic, and hearing-aid (HA)-related variables on HA outcomes. METHODS: In total, 235 adults with hearing loss (HL) who used HAs for at least 3 months were included in the study, and completed audiologic tests and the Chinese version of the International Outcome Inventory for Hearing Aids (IOI-HA). Spearman correlation analysis and Wilcoxon test were conducted to identify factors related to IOI-HA overall and subscales scores. Stepwise multiple linear regression analysis was subsequently performed to determine the influence of factors on HA outcomes. RESULTS: Age, daily use time, HA price, pure tone average (PTA) threshold, word recognition score (WRS), fitting (bilateral or unilateral), and HA style were associated with IOI-HA overall and subscales scores. However, only WRS, daily HA use time, HA price, and age entered the final regression model and were factors determining HA outcomes. CONCLUSIONS: HA outcome is a multi-dimensional construct. In this study, WRS had the greatest influence on HA outcomes and seemed to be a primary predictor. Thus, HA owners with a higher WRS before HA fitting may indicate better satisfaction. Daily use time, HA price, and patient age also made significant contributions to HA outcomes and should be considered in clinical practice to facilitate auditory rehabilitation.

Objective and Subjective Outcomes in Patients with Hearing Aids: A Cross-Sectional, Comparative, Associational Study.

INTRODUCTION: Outcome assessment for hearing aids (HAs) is an essential part of HA fitting and validation. There is no consensus about the best or standard approach for evaluating HA outcomes. And, the relationship between objective and subjective measures is ambiguous. This study aimed to determine the outcomes after HA fitting, explore correlations between subjective benefit and acoustic gain improvement as well as objective audiologic tests, and investigate several variables that may improve patients' perceived benefits. METHODS: Eighty adults with bilateral symmetrical hearing loss using HAs for at least 1 month were included in this study. All subjects completed the pure tone average (PTA) threshold and word recognition score (WRS) tests in unaided and aided conditions. We also administered the Chinese version of International Outcome Inventory for Hearing Aids (IOI-HA), to measure participants' subjective benefits. Objective HA benefit (acoustic gain improvement) was defined as the difference in thresholds or scores between aided and unaided conditions indicated with ΔPTA and ΔWRS. Thus, patients' baseline hearing levels were taken into account. Correlations were assessed among objective audiologic tests (PTA and WRS), acoustic gain improvement (ΔPTA and ΔWRS), multiple potential factors, and IOI-HA overall scores. RESULTS: PTA decreased significantly, but WRS did not increase when aided listening was compared to unaided listening. Negative correlations between PTAs and IOI-HA scores were significant but weak (r = -0.370 and r = -0.393, all p < 0.05). Significant weak positive correlations were found between WRSs and IOI-HA (r = 0.386 and r = 0.309, all p < 0.05). However, there was no correlation among ΔPTA, ΔWRS, and IOI-HA (r = 0.056 and r = -0.086, all p > 0.05). Moreover, 2 nonaudiological factors (age and daily use time) were significantly correlated with IOI-HA (r = -0.269 and r = 0.242, all p < 0.05). CONCLUSIONS: Correlations among objective audiologic tests, acoustic gain, and subjective patient-reported outcomes were weak or absent. Subjective questionnaires and objective tests do not reflect the same hearing capability. Therefore, it is advisable to evaluate both objective and subjective outcomes when analyzing HA benefits on a regular basis and pay equal attention to nonaudiological and audiological factors.

Knockout of immunotherapy prognostic marker genes eliminates the effect of the anti-PD-1 treatment.

The efficacy of immunotherapy is largely patient-specific due to heterogeneity in tumors. Combining statistic power from a variety of immunotherapies across cancer types, we found four biological pathways significantly correlated with patient survival following immunotherapy. The expression of immunotherapy prognostic marker genes (IPMGs) in these pathways can predict the patient survival with high accuracy not only in the TCGA cohort (89.36%) but also in two other independent cohorts (80.91%), highlighting that the activity of the IPMGs can reflect the sensitivity of the tumor immune microenvironment (TIME) to immunotherapies. Using mouse models, we show that knockout of one of the IPMGs, MALT1, which is critical for the T-cell receptor signaling, can eliminate the antitumor effect of anti-PD-1 treatment completely by impairing the activation of CD8+ T cells. Notably, knockout of another IPMG, CLEC4D, a C-type lectin receptor that expressed on myeloid cells, also reduced the effect of anti-PD-1 treatment potentially through maintaining the immunosuppressive effects of myeloid cells. Our results suggest that priming TIME via activating the IPMGs may increase the response rate and the effect of immune checkpoint blockers.

Chrom-Lasso: a lasso regression-based model to detect functional interactions using Hi-C data.

Hi-C is a genome-wide assay based on Chromosome Conformation Capture and high-throughput sequencing to decipher 3D chromatin organization in the nucleus. However, computational methods to detect functional interactions utilizing Hi-C data face challenges including the correction for various sources of biases and the identification of functional interactions with low counts of interacting fragments. We present Chrom-Lasso, a lasso linear regression model that removes complex biases assumption-free and identifies functional interacting loci with increased power by combining information of local reads distribution surrounding the area of interest. We showed that interacting regions identified by Chrom-Lasso are more enriched for 5C validated interactions and functional GWAS hits than that of GOTHiC and Fit-Hi-C. To further demonstrate the ability of Chrom-Lasso to detect interactions of functional importance, we performed time-series Hi-C and RNA-seq during T cell activation and exhaustion. We showed that the dynamic changes in gene expression and chromatin interactions identified by Chrom-Lasso were largely concordant with each other. Finally, we experimentally confirmed Chrom-Lasso's finding that Erbb3 was co-regulated with distinct neighboring genes at different states during T cell activation. Our results highlight Chrom-Lasso's utility in detecting weak functional interaction between cis-regulatory elements, such as promoters and enhancers.

Investigation on chronic tinnitus efficacy of combination of non-repetitive preferred music and educational counseling: a preliminary study.

PURPOSE: To improve the efficacy of music therapy on tinnitus relief, specific music that was not repetitively played and satisfies individualized preference was developed. The aim of this study was to investigate effects of combination of the specific music and educational counseling on tinnitus relief in short term. METHODS: Sixty patients suffering from chronic tinnitus were included. The non-randomized controlled study was designed with two intervention groups: educational counseling (EC, which included a 1-h individualized instruction) and preferred music therapy [PMT, which included EC plus 15, 30-min preferred music sessions (PMS)]. Three assessments-the Chinese-Mandarin version of Tinnitus Handicap Inventory (THI-CM), Tinnitus Evaluation Questionnaire (TEQ), and Visual Analogue Scale (VAS) were administered before and 1, 2, 3 weeks after initiation of treatment to evaluate the efficacy. RESULTS: Twenty-six patients in PMT group attained a clinically meaningful improvement in THI compared to 15 in the EC group, though both groups achieved a statistically relevant reduction in the 3 assessments. CONCLUSION: The PMT had a positive impact on chronic tinnitus and related distress in a short term. It outperformed the separate EC, which is an appropriate treatment option in clinic. Therefore, it presents a possible complement to the therapeutic spectrum in chronic tinnitus. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900022624. Registered on 19 April 2019.

Clinical practicality of the dizziness handicap inventory for evaluating dizziness in the Mandarin Chinese-speaking population: a prospective cross-sectional analysis.

OBJECTIVE: To explore the clinical practicality of the dizziness handicap inventory (DHI) in the Mandarin Chinese-speaking population and compare patients' and physicians' assessments of the impact of dizziness on the quality of life using the DHI. DESIGN: Prospective cross-sectional. STUDY SAMPLE: Overall, 144 consecutive patients aged ≥ 18 years seeking treatment for dizziness in an Ear-Nose-Throat clinic in China. RESULTS: Some items in the DHI could not be completed by both patients (46/144, 31.9%) and physicians (26/144, 18.1%). In fully completed DHIs (98/144, 68.1%), the patients' self-assessment scores were higher than the physicians' assessment scores (average 44.04 ± 21.38 vs 35.94 ± 16.99; p < 0.05). The strength of the correlation between the patients' and physicians' total DHI scores was high (r = 0.80; p < 0.05). Moreover, at a cut-off point of 18, the discrepancy scores of 77.6% (76/98) of the cases did not exceed the minimum detectable change (MDC) of the DHI. CONCLUSIONS: The clinical practicality of the DHI in such settings requires improvement. Even though physician interviews can increase the degree of questionnaire completion, not all items can be completed. Although the physicians' assessment scores were lower than the patients' self-assessment scores, the majority of the discordancy scores were within the MDC of the DHI.

Healthy lifestyle consultation based on traditional Chinese medicine versus routine patient education in the treatment of idiopathic sudden sensorineural hearing loss after failure of systemic therapy: study protocol for a clinical randomised trial.

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is a major cause of deafness. Despite the advances in systemic therapy, some cases of ISSNHL are untreated, because the exact ISSNHL aetiology is unclear. Traditional Chinese medicine (TCM) has been used to treat diseases for thousands of years and is popular and widely practiced in Asia. TCM includes guidance on a healthy lifestyle. In recent decades, the relationship between lifestyle and disease has been emphasised; an unhealthy lifestyle may lead to illnesses. Thus, this study aims to compare the efficacy of lifestyle modification based on TCM with the usual consultation of ISSNHL after failure of a 2-week systemic therapy to provide a scientific basis for clinical decisions. METHODS: This study is a clinical randomised trial that involves 56 patients diagnosed with ISSNHL but who have had incomplete recovery after initial management (at least 2 weeks of routine Western medical treatment). The study is performed in accordance with the sudden hearing loss clinical guideline of the American Academy of Otolaryngology-Head and Neck Surgery, published in 2012. Participants are randomly distributed into two groups: the healthy lifestyle modification group based on TCM and the control group (1:1 ratio). Patient follow-up lasts for 3 months. The primary outcome measure is the effective rate of hearing improvement, which is defined as the proportion of patients with at least 15 dB of improvement in the average thresholds of hearing loss frequency. The secondary outcome measures are improvements in word recognition score, Tinnitus Handicap Inventory and visual analogue scale for ear blockage and dizziness. Assessments are made at baseline and after lifestyle modification for 1 and 3 months. DISCUSSION: The efficacy of healthy lifestyle modification based on a TCM programme for patients with ISSNHL with incomplete recovery after failure of initial systemic therapy is determined in this trial. Positive results will provide clinical evidence on the effects of a TCM-based healthy lifestyle, which could be recommended as salvage therapy for patients with ISSNHL. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-INR-17011459. Registered on 22 May 2017.