Serum collagenase-2 and BMI levels in pregnant women with striae gravidarum

Summary

Objective

Striae gravidarum is a form of scarring on the skin observed during pregnancy and can cause serious cosmetic problems. Striae gravidarum may be influenced by hormonal changes, although the etiology is not clear. The aim of this study was to investigate whether body mass index (BMI) and serum collagenase-2 levels in pregnant women are related to the development of striae gravidarum.

Methods

Thirty pregnant women with striae, 30 pregnant women without striae, and 32 health controls were enrolled in the study.

Results

BMI and serum collagenase-2 levels were measured in the participants.

Conclusion

Pregnant women with striae gravidarum had increased serum collagenase-2 and BMI levels when compared to pregnant women without striae gravidarum and healthy controls (P < 0.05). The increase in serum collagenase-2 levels was related to the development of striae gravidarum alone, or secondary to BMI increase.

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Bout-associated intrinsic functional network changes in cluster headache: A longitudinal resting-state functional MRI study

Background

Previous imaging studies on the pathogenesis of cluster headache (CH) have implicated the hypothalamus and multiple brain networks. However, very little is known regarding dynamic bout-associated, large-scale resting state functional network changes related to CH.

Methods

Resting-state functional magnetic resonance imaging data were obtained from CH patients and matched controls. Data were analyzed using independent component analysis for exploratory assessment of the changes in intrinsic brain networks and their relationship between in-bout and out-of-bout periods, as well as correlations with clinical observations.

Results

Compared to healthy controls, CH patients had functional connectivity (FC) changes in the temporal, frontal, salience, default mode, somatosensory, dorsal attention, and visual networks, independent of bout period. Compared to out-of-bout scans, in-bout scans showed altered FC in the frontal and dorsal attention networks. Lower frontal network FC correlated with longer duration of CH.

Conclusions

The present findings suggest that episodic CH with dynamic bout period shifts may involve bout-associated FC changes in multiple discrete cortical areas within networks outside traditional pain processing areas. Dynamic changes in FC in frontal and dorsal attention networks between bout periods could be important for understanding episodic CH pathophysiology.

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Development of an Innovative 3D Printed Rigid Bronchoscopy Training Model

Objectives:

The objective of this study was to create a 3D printed airway model simulating the size and mechanical properties of various age groups for foreign body removal training.

Methods:

Three-dimensional printing technology was used to print the anatomically correct airway from rubber-like translucent material, simulating the mechanical properties of human airway tissue. The model's effectiveness in trainee education was evaluated by otolaryngology residents with varying levels of experience. As part of an Airway Emergencies course, a rigid bronchoscopy procedure was performed on the 3D printed model as well as a porcine model. The participants completed surveys comparing the validity of the 2 models and the effectiveness of the overall training experience.

Results:

The 3D printed model, which is accurate in terms of anatomy and mechanical properties, was found to be comparable to a porcine model in regards to participant satisfaction as well as face validity.

Conclusions:

The 3D printed airway model is able to be accurately scaled to various sizes and simulate the mechanical properties of the desired age group. The 3D printed model provides an excellent alternative to animal models in terms of practicality, logistics of use, and anatomical accuracy.

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The Incudostapedial Versus Malleostapedial Bone-Cement Rebridging: Which One Should We Really Prefer?

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Bronchial Compression and Tracheosophageal Fistula Secondary to Prolonged Esophageal Foreign Body

Introduction:

Foreign body ingestion is a common pediatric problem that can have a delayed presentation, as presented herein.

Case Report:

We present the case of a 15-year-old female who developed bronchial compression and an acquired tracheoesophageal fistula secondary to a longstanding esophageal foreign body.

Discussion:

There are several challenges in diagnosis and management of this unusual situation. We review the literature regarding prolonged retention of foreign bodies and the challenges in diagnosis in the developmentally disabled child.

Conclusion:

Providers must have a high suspicion for foreign bodies in the case of unusual symptoms present in children with neurodevelopmental delays.

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Feasibility Study for Transnasal Endoscopic Repair of Orbital Floor Fracture With Alloplastic Implant

Objective:

Fractures of the orbital floor are common yet repaired by various techniques, including open periorbital, transantral endoscopic, and endoscopic endonasal approaches. To date, endoscopic endonasal repair of an orbital floor fracture using an alloplastic implant has not been described. We aim to determine the technique and limitations of completely endoscopic endonasal orbital floor repair using an alloplastic implant.

Study Design:

Cadaveric anatomic study and retrospective case series.

Methods:

Cadaveric study of 12 sides with endoscopic sinonasal dissection followed by the creation and repair of an isolated orbital floor fracture using an alloplastic implant. Four representative patient cases are presented in which the techniques developed in the cadaveric study were employed. Patients were selected for this technique based on the results of the cadaveric study.

Results:

Cadaveric study demonstrated feasibility of access and repair for fractures that did not extend lateral to the infraorbital canal or anterior to the nasolacrimal duct. In all cadaveric sides and in all 4 patient cases, successful alloplastic orbital floor reconstruction was achieved.

Conclusion:

This method of repair is feasible for selected patients and may be considered in cases of favorable fracture anatomy with or without concomitant indication for an ipsilateral sinus procedure.

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Preliminary cross-sectional reliability and validity of the Skull Base Inventory (SBI) quality of life questionnaire

Abstract

Background

The Skull Base Inventory (SBI) was developed to assess the quality of life of patients undergoing endoscopic or open approaches for anterior and central skull base pathologies. In this study, we sought to establish the discriminative and evaluative properties for this instrument.

Methods

The SBI was administered in a cross-sectional fashion to patients who previously had skull base surgery after treatment and then again 2 weeks after completing the instrument. Internal consistency, test-retest reliability, and construct validity were determined. Four constructs were evaluated with the following a priori hypotheses: lower scores will be seen in patients with 1.malignant versus benign histology, 2.a history of radiation versus none, and those with 3.recurrences versus no recurrence, and 4.items deemed relevant versus irrelevant by respondents.

Results

Fifty-two patients completed the questionnaire; 32 had endoscopic and 20 open surgeries. Internal consistency was good (>0.7 and <0.95) for all domains except one. Test-retest reliability was good (>0.70) for 38 of 41 items. Four constructs were evaluated and three were consistent with a priori hypotheses (p < 0.05). The instrument failed to confirm the hypothesis that malignant tumours are associated with poorer scores than benign.

Conclusions

The SBI demonstrated preliminary reliability and validity for discriminative use.

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Preliminary cross-sectional reliability and validity of the Skull Base Inventory (SBI) quality of life questionnaire

The Skull Base Inventory (SBI) was developed to assess the quality of life of patients undergoing endoscopic or open approaches for anterior and central skull base pathologies. In this study, we sought to esta...

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Clinicopathologic Features of Fatal Non-Anaplastic Follicular Cell–Derived Thyroid Carcinomas

Thyroid , Vol. 0, No. 0.


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Physiological and Metabolic Changes During the Transition from Hyperthyroidism to Euthyroidism in Graves' Disease

Thyroid , Vol. 0, No. 0.


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Cost utility analysis of the SQ® HDM SLIT-tablet in house dust mite allergic asthma patients in a German setting

Asthma affects an estimated 300 million people worldwide with the condition associated with significant healthcare utilisation costs and a large impact on patient quality of life. The SQ® HDM SLIT-tablet (ACARIZA...

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The Influence of Cochlear Mechanical Dysfunction, Temporal Processing Deficits, and Age on the Intelligibility of Audible Speech in Noise for Hearing-Impaired Listeners

The aim of this study was to assess the relative importance of cochlear mechanical dysfunction, temporal processing deficits, and age on the ability of hearing-impaired listeners to understand speech in noisy backgrounds. Sixty-eight listeners took part in the study. They were provided with linear, frequency-specific amplification to compensate for their audiometric losses, and intelligibility was assessed for speech-shaped noise (SSN) and a time-reversed two-talker masker (R2TM). Behavioral estimates of cochlear gain loss and residual compression were available from a previous study and were used as indicators of cochlear mechanical dysfunction. Temporal processing abilities were assessed using frequency modulation detection thresholds. Age, audiometric thresholds, and the difference between audiometric threshold and cochlear gain loss were also included in the analyses. Stepwise multiple linear regression models were used to assess the relative importance of the various factors for intelligibility. Results showed that (a) cochlear gain loss was unrelated to intelligibility, (b) residual cochlear compression was related to intelligibility in SSN but not in a R2TM, (c) temporal processing was strongly related to intelligibility in a R2TM and much less so in SSN, and (d) age per se impaired intelligibility. In summary, all factors affected intelligibility, but their relative importance varied across maskers.

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Preferred Compression Speed for Speech and Music and Its Relationship to Sensitivity to Temporal Fine Structure

Multichannel amplitude compression is widely used in hearing aids. The preferred compression speed varies across individuals. Moore (2008) suggested that reduced sensitivity to temporal fine structure (TFS) may be associated with preference for slow compression. This idea was tested using a simulated hearing aid. It was also assessed whether preferences for compression speed depend on the type of stimulus: speech or music. Twenty-two hearing-impaired subjects were tested, and the stimulated hearing aid was fitted individually using the CAM2A method. On each trial, a given segment of speech or music was presented twice. One segment was processed with fast compression and the other with slow compression, and the order was balanced across trials. The subject indicated which segment was preferred and by how much. On average, slow compression was preferred over fast compression, more so for music, but there were distinct individual differences, which were highly correlated for speech and music. Sensitivity to TFS was assessed using the difference limen for frequency at 2000 Hz and by two measures of sensitivity to interaural phase at low frequencies. The results for the difference limens for frequency, but not the measures of sensitivity to interaural phase, supported the suggestion that preference for compression speed is affected by sensitivity to TFS.

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Perceptual Spaces Induced by Cochlear Implant All-Polar Stimulation Mode

It has been argued that a main limitation of the cochlear implant is the spread of current induced by each electrode, which activates an inappropriately large range of sensory neurons. To reduce this spread, an alternative stimulation mode, the all-polar mode, was tested with five participants. It was designed to activate all the electrodes simultaneously with appropriate current levels and polarities to recruit narrower regions of auditory nerves at specific intracochlear electrode positions (denoted all-polar electrodes). In this study, the all-polar mode was compared with the current commercial stimulation mode: the monopolar mode. The participants were asked to judge the sound dissimilarity between pairs of two-electrode pulse-train stimuli that differed in the electrode positions and were presented in either monopolar or all-polar mode with pulses on the two electrodes presented either sequentially or simultaneously. The dissimilarity ratings were analyzed using a multidimensional scaling technique and three-dimensional stimulus perceptual spaces were produced. For all the conditions (mode and simultaneity), the first perceptual dimension was highly correlated with the position of the most apical activated electrode of the electrical stimulation and the second dimension with the position of the most basal electrode. In both sequential and simultaneous conditions, the monopolar and all-polar stimuli were significantly separated by a third dimension, which may indicate that all-polar stimuli have a perceptual quality that differs from monopolar stimuli. Overall, the results suggest that both modes might successfully represent spectral information in a sound processing strategy.

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Forward-Masked Frequency Selectivity Improvements in Simulated and Actual Cochlear Implant Users Using a Preprocessing Algorithm

Frequency selectivity can be quantified using masking paradigms, such as psychophysical tuning curves (PTCs). Normal-hearing (NH) listeners show sharp PTCs that are level- and frequency-dependent, whereas frequency selectivity is strongly reduced in cochlear implant (CI) users. This study aims at (a) assessing individual shapes of PTCs in CI users, (b) comparing these shapes to those of simulated CI listeners (NH listeners hearing through a CI simulation), and (c) increasing the sharpness of PTCs using a biologically inspired dynamic compression algorithm, BioAid, which has been shown to sharpen the PTC shape in hearing-impaired listeners. A three-alternative-forced-choice forward-masking technique was used to assess PTCs in 8 CI users (with their own speech processor) and 11 NH listeners (with and without listening through a vocoder to simulate electric hearing). CI users showed flat PTCs with large interindividual variability in shape, whereas simulated CI listeners had PTCs of the same average flatness, but more homogeneous shapes across listeners. The algorithm BioAid was used to process the stimuli before entering the CI users' speech processor or the vocoder simulation. This algorithm was able to partially restore frequency selectivity in both groups, particularly in seven out of eight CI users, meaning significantly sharper PTCs than in the unprocessed condition. The results indicate that algorithms can improve the large-scale sharpness of frequency selectivity in some CI users. This finding may be useful for the design of sound coding strategies particularly for situations in which high frequency selectivity is desired, such as for music perception.

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Complex-Tone Pitch Discrimination in Listeners With Sensorineural Hearing Loss

Physiological studies have shown that noise-induced sensorineural hearing loss (SNHL) enhances the amplitude of envelope coding in auditory-nerve fibers. As pitch coding of unresolved complex tones is assumed to rely on temporal envelope coding mechanisms, this study investigated pitch-discrimination performance in listeners with SNHL. Pitch-discrimination thresholds were obtained for 14 normal-hearing (NH) and 10 hearing-impaired (HI) listeners for sine-phase (SP) and random-phase (RP) complex tones. When all harmonics were unresolved, the HI listeners performed, on average, worse than NH listeners in the RP condition but similarly to NH listeners in the SP condition. The increase in pitch-discrimination performance for the SP relative to the RP condition (F₀DL ratio) was significantly larger in the HI as compared with the NH listeners. Cochlear compression and auditory-filter bandwidths were estimated in the same listeners. The estimated reduction of cochlear compression was significantly correlated with the increase in the F₀DL ratio, while no correlation was found with filter bandwidth. The effects of degraded frequency selectivity and loss of compression were considered in a simplified peripheral model as potential factors in envelope enhancement. The model revealed that reducing cochlear compression significantly enhanced the envelope of an unresolved SP complex tone, while not affecting the envelope of a RP complex tone. This envelope enhancement in the SP condition was significantly correlated with the increased pitch-discrimination performance for the SP relative to the RP condition in the HI listeners.

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Toward a Diagnostic Test for Hidden Hearing Loss

Cochlear synaptopathy (or hidden hearing loss), due to noise exposure or aging, has been demonstrated in animal models using histological techniques. However, diagnosis of the condition in individual humans is problematic because of (a) test reliability and (b) lack of a gold standard validation measure. Wave I of the transient-evoked auditory brainstem response is a noninvasive electrophysiological measure of auditory nerve function and has been validated in the animal models. However, in humans, Wave I amplitude shows high variability both between and within individuals. The frequency-following response, a sustained evoked potential reflecting synchronous neural activity in the rostral brainstem, is potentially more robust than auditory brainstem response Wave I. However, the frequency-following response is a measure of central activity and may be dependent on individual differences in central processing. Psychophysical measures are also affected by intersubject variability in central processing. Differential measures may help to reduce intersubject variability due to unrelated factors. A measure can be compared, within an individual, between conditions that are affected differently by cochlear synaptopathy. Validation of the metrics is also an issue. Comparisons with animal models, computational modeling, auditory nerve imaging, and human temporal bone histology are all potential options for validation, but there are technical and practical hurdles and difficulties in interpretation. Despite the obstacles, a diagnostic test for hidden hearing loss is a worthwhile goal, with important implications for clinical practice and health surveillance.

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Investigating Differences in Preferred Noise Reduction Strength Among Hearing Aid Users

Even though hearing aid (HA) users can respond very differently to noise reduction (NR) processing, knowledge about possible drivers of this variability (and thus ways of addressing it in HA fittings) is sparse. The current study investigated differences in preferred NR strength among HA users. Participants were groups of experienced users with clear preferences ("NR lovers"; N = 14) or dislikes ("NR haters"; N = 13) for strong NR processing, as determined in two earlier studies. Maximally acceptable background noise levels, detection thresholds for speech distortions caused by NR processing, and self-reported "sound personality" traits were considered as candidate measures for explaining group membership. Participants also adjusted the strength of the (binaural coherence-based) NR algorithm to their preferred level. Consistent with previous findings, NR lovers favored stronger processing than NR haters, although there also was some overlap. While maximally acceptable noise levels and detection thresholds for speech distortions tended to be higher for NR lovers than for NR haters, group differences were only marginally significant. No clear group differences were observed in the self-report data. Taken together, these results indicate that preferred NR strength is an individual trait that is fairly stable across time and that is not easily captured by psychoacoustic, audiological, or self-report measures aimed at indexing susceptibility to background noise and processing artifacts. To achieve more personalized NR processing, an effective approach may be to let HA users determine the optimal setting themselves during the fitting process.

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Sentence Recognition Prediction for Hearing-impaired Listeners in Stationary and Fluctuation Noise With FADE: Empowering the Attenuation and Distortion Concept by Plomp With a Quantitative Processing Model

To characterize the individual patient's hearing impairment as obtained with the matrix sentence recognition test, a simulation Framework for Auditory Discrimination Experiments (FADE) is extended here using the Attenuation and Distortion (A+D) approach by Plomp as a blueprint for setting the individual processing parameters. FADE has been shown to predict the outcome of both speech recognition tests and psychoacoustic experiments based on simulations using an automatic speech recognition system requiring only few assumptions. It builds on the closed-set matrix sentence recognition test which is advantageous for testing individual speech recognition in a way comparable across languages. Individual predictions of speech recognition thresholds in stationary and in fluctuating noise were derived using the audiogram and an estimate of the internal level uncertainty for modeling the individual Plomp curves fitted to the data with the Attenuation (A-) and Distortion (D-) parameters of the Plomp approach. The "typical" audiogram shapes from Bisgaard et al with or without a "typical" level uncertainty and the individual data were used for individual predictions. As a result, the individualization of the level uncertainty was found to be more important than the exact shape of the individual audiogram to accurately model the outcome of the German Matrix test in stationary or fluctuating noise for listeners with hearing impairment. The prediction accuracy of the individualized approach also outperforms the (modified) Speech Intelligibility Index approach which is based on the individual threshold data only.

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