The influence of vertigo, hearing impairment and tinnitus on the daily life of Menière patients

The aim of this questionnaire study was to investigate the impact of the symptoms in Meniere's disease on the daily life of patients and to analyse the relationships between the cardinal symptoms and environmental, emotional and activity factors. The study comprised 514 patients, recruited from two different sources. The results showed that vertigo, hearing impairment and tinnitus had a strong negative influence on the daily life of patients. Seventy-five percent of the subjects avoided certain everyday activities or situations because of the disease. However, the correlation between discomfort and reported satisfaction with life was moderate. Most of the subjects experienced premonitory symptoms of the attacks and 80% reported relations between external factors and vertigo attacks.

Elderly hearing-impaired persons’ coping behavior

Little is known about the coping behavior associated with hearing impairment. In this study, 24 elderly hearing-impaired participants participated in a structured video interview including communication faults (provocations) presented in association with sounds. The participants also completed measures of self-perceived hearing handicap, optimism, and depression. Several behaviors were coded independently by two observers using a rating scale that reached average Cohen's kappa of .75. A more conservative estimate resulted in a kappa of .50. Results showed that the provocations affected behavior differently. Especially problematic for the participants was a provocation in which the interviewer talked with his hand in front of his mouth. With one exception, no gender differences were found. Few significant relations between the assessed behaviors and self-assessed handicap, optimism, and depression were found. Hearing measurement (pure tone average and speech recognition) were not clearly related with the coping behaviors assessed. Behavioral observation techniques designed for the elderly hearing impaired should be further studied.

Neutron diffraction study of [Pt(en)2][Pt(en)2I2](ClO4)4 at 20 K: structure and evidence of a new phase transition

The structure at 20 K of fully deuterated [Pt(en)2][Pt(en)2I2](ClO4)4, where en = ethylenediamine, has been determined by neutron diffraction on a single-crystal. It is shown that the symmetry is monoclinic with cell parameters a = 16.650 (7), b = 5.760 (2), c = 14.751 (2) Å and β = 99.19 (1)°, that is, with respect to the previously reported room-temperature structures, a doubling of the c parameter is observed. The space group is C2/c and the refinements lead to an R value of 0.0374. All the bond lengths (C—C, C—N, C—D, N—D and Cl—O) and angles are consistent with the expected values and the main difference with respect to the previously reported room-temperature structures results in an ordering of the stacking of the ethylenediamines. The iodines are distributed over two sites, which gives two Pt—I distances, 2.712 (3) Å, attributed to the PtIV—I bond, and 3.048 (3) Å, attributed to PtII—I. Actually, very weak diffraction peaks that provide evidence for an additional doubling of the a and b parameters are also observed and a space group C2 is therefore proposed. This could result from a very slight ordering of the chains with respect to one another, but, due to the weakness of such signals and the large number of atoms to be considered, no reliable refinement has been obtained in C2. On the other hand, on heating the crystal the diffraction peaks with I odd greatly decrease in intensity between 150 and 160 K, which unambiguously argues for the existence of a phase transition presumably connected to an order—disorder of the ethylenediamines.

CD8(+) T cell-mediated spontaneous diabetes in neonatal mice

Transgenic mice that express the influenza virus hemagglutinin (HA) on pancreatic islet beta cells (ins-HA) demonstrate tolerance of HA even after immunization with influenza virus. Surprisingly, when Ins-HA mice were mated with a transgenic mouse expressing a TCR specific for an epitope of HA that is restricted by MHC class I H-2Kd (Clone-4 TCR), the resulting double transgenic (Ins-HA x Clone-4 TCR)F1 neonates developed spontaneous autoimmune diabetes immediately after birth and died within 10 days. This represents a unique situation in which all safeguards within the immune system that normally maintain tolerance of self-antigens in the neonate are insufficient.

CD8(+) T cell-mediated spontaneous diabetes in neonatal mice

Transgenic mice that express the influenza virus hemagglutinin (HA) on pancreatic islet beta cells (ins-HA) demonstrate tolerance of HA even after immunization with influenza virus. Surprisingly, when Ins-HA mice were mated with a transgenic mouse expressing a TCR specific for an epitope of HA that is restricted by MHC class I H-2Kd (Clone-4 TCR), the resulting double transgenic (Ins-HA x Clone-4 TCR)F1 neonates developed spontaneous autoimmune diabetes immediately after birth and died within 10 days. This represents a unique situation in which all safeguards within the immune system that normally maintain tolerance of self-antigens in the neonate are insufficient.

Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial

OBJECTIVE

To evaluate the effectiveness of intranasal lidocaine for treatment of acute migraine headache.

DESIGN

Prospective, randomized, double-blind, placebo-controlled trial.

SETTING

Community urgent care department.

PATIENTS

A total of 81 patients (67 women and 14 men; median age, 42 years; range, 19-68 years) with a chief complaint of headache who fulfilled criteria of the International Headache Society for migraine participated. Patients were excluded if headache had lasted more than 3 days or if the frequency of severe headache was more than once per week.

INTERVENTION

Patients were randomized in a 2:1 ratio to receive a 4 percent solution of intranasal lidocaine or saline placebo, respectively.

MAIN OUTCOME MEASURES

The primary outcome measure was at least 50 percent reduction of headache within 15 minutes after treatment. Secondary measures include reduction in nausea and photophobia, use of rescue medication, relapse of headache, and change in headache disability scores.

RESULTS

Of 53 patients who received intranasal lidocaine, 29 (55 percent) had at least a 50 percent reduction of headache compared with 6 (21 percent) of 28 controls (P=.004). Nausea and photophobia were significantly reduced (P=.03 and P=.001, respectively). Rescue medication for headache relief was needed in 15 (28 percent) of 53 patients in the lidocaine group vs 20 (71 percent) of 28 controls (P<.001). Among those with initial relief of headache, relapse of headache occurred in 10 (42 percent) of 24 in the lidocaine group vs 5 (83 percent) of 6 in the control group (P=.17), usually within the first hour after treatment.

CONCLUSIONS

Intranasal lidocaine provides rapid relief of headache in approximately 55 percent of ambulatory patients with migraine. Relapse of headache is common and occurs early after treatment.

A two-year follow-up examination of a behavioural treatment approach to hearing tactics

Twenty elderly hearing impaired patients participated in a two-year follow-up study on the effects of behavioural treatment aimed at increasing coping with hearing impairment. Subjects who had received treatment were compared with untreated controls using the Hearing Coping Assessment (HCA) and the Communication Strategies Subscale of the Communication Profile for the Hearing Impaired (CPHI-CSS). The group treatment package included applied relaxation, video self-modelling, exposure, information, and the teaching of hearing tactics. Results showed some effects in favour of the treatment on the HCA at post-treatment, but no differences at follow-up. The results on the CPHI-CSS using pre-treatment HCA scores as covariate showed significant multivariate effects on the subscales measuring maladaptive behaviours, non-verbal strategies, and on the CPHI-CSS total score. No significant multivariate effect was found for the verbal strategies subscale. As no pre-treatment data were available, results on the CPHI-CSS should be interpreted with caution. Overall, the results from this study give some support for the implementation of behavioural treatment in audiological rehabilitation.

Dispositional optimism, dysphoria, health, and coping with hearing impairment in elderly adults

Sixty-eight elderly hearing impaired subjects were interviewed and completed self-report measures on hearing disability, dispositional optimism, dysphoria, and general health. The measures used were the Hearing Coping Assessment (HCA), the Hearing Questions (HQ), the Life Orientation Test (LOT), The Beck Depression Inventory (BDI), and a subscale from the Göteborg Quality of Life (GQL). Psychometric analyses of HCA, HQ, LOT, BDI, and GQL revealed high reliability in terms of Cronbach's Alpha and split-half r's. Significant intercorrelations were found between several measures, but not with pure-tone audiometry (0.5, 1, 2, and 3 kHz). Cluster analysis was used to identify subgroups in the sample. As a result three clusters were identified interpreted as 'high copers', 'copers with moderate psychological and somatic complaints', and 'low copers'. Results from the cluster analyses were confirmed by using two different clustering methods and by between-cluster comparisons on the HQ, which had not been used to obtain the clusters.

An evaluation of a behavioural treatment approach to hearing impairment

Twenty-four elderly hearing impaired Ss participated in an experimental treatment study and received either behavioural group treatment or served as untreated controls. The treatment package included applied relaxation, video self-modelling, exposure, information and various coping skills. Assessments (pre-post) were conducted using a structured video-interview measuring coping behaviour. In order to evoke behavioural compensation small acoustic provocations were included in the interview. The edited videos were then rated blindly by two trained observers. Pre-post assessments also included daily registered hearing problems on visual analogue scales and a questionnaire. Finally, a one month follow-up blind telephone interview was conducted. Results showed significant beneficial effects in favour of the treatment package and support the implementation of a behavioural approach in audiological rehabilitation research.

Development of a short scale for self-assessment of experiences of hearing loss. The hearing coping assessment

A short scale for self-assessment of experiences of hearing impairment--the Hearing Coping Assessment (HCA) was developed and administered to 114 consecutive hearing-impaired patients at a Swedish hearing centre. The scale was evaluated in terms of descriptive statistics, reliability, principal components analysis, and validity. The results showed high internal consistency, high split-half correlation, and high item-total correlations. Significant correlations were found between the HCA questionnaire and measures of optimism, depressive syndrome, and audiogram (PTA). The principal component analysis showed two meaningful factors. The first mainly represents disability, and the second emotional reactions due to hearing loss. Aspects of handicap were present in both factors. The subjects in this study were no less optimistic nor did they show more signs of depressive syndrome than comparable norm groups. Still, optimists reported fewer hearing problems as measured by the HCA. The HCA is proposed as a suitable assessment scale in studies on the effects of counselling.

On the various manifestations of spontaneous autoimmune diabetes in rodent models

Autoimmune (type 1) diabetes mellitus in mouse, rat, and humans shares several features, including T lymphocyte infiltration into pancreatic islets and a dependence on permissive class II major histocompatibility complex (MHC) alleles. We report here on an experimental model involving mice that express influenza hemagglutinin (HA) under the control of the insulin promoter and, at the same time, a transgenic class II MHC-restricted T cell receptor (TcR) specific for an HA peptide. These mice spontaneously develop islet infiltrates resembling those found in NOD mice and most animals become diabetic within 8 weeks of age. Because of the availability of a clonotypic TcR antibody, we can be confident that the Ins-HA transgene does not induce any measurable alterations in the vast majority of T cells with the transgenic TcR in primary and secondary lymphoid organs. Continuous export of large numbers of HA-specific lymphocytes from the thymus was not required for the manifestation of the disease since mice thymectomized at 3 days after birth still developed the disease albeit with smaller infiltrates.

Heterologous and homologous plasmid integration at a spore-pigment locus in Penicillium paxilli generates large deletions

Mutations in a spore pigmentation locus (brs; brown spore) in Penicillium paxilli were isolated at a relatively-high frequency (0.17%) following integrative transformation of the hygromycin-resistance plasmid pAN7-1. A molecular analysis of four independently-isolated Brs- mutants showed that all contained pAN7-1 integrated at a single-site that was unique for each mutant. A previously-described Brs- mutant, YI-34 (Itoh et al. 1994), was a two-site integration. Three of the mutants had multiple copies of pAN7-1 arranged in head-to-tail tandem arrays. A 9.6-kb BamHI junction fragment was cloned from one of these, YI-33, by plasmid rescue and used to isolate two overlapping lambda clones, lambda WB33-1 and lambda WB33-2, that span about 30 kb in the region of the wild-type locus. When genomic digests of the five Brs- mutants were probed with these lambda clones all of them were found to contain an extensive deletion through a common region of the P. paxilli genome. Subsequent attempts to generate one-step gene replacements within a 4.5-kb EcoRI fragment at the wild-type locus resulted in the isolation of Brs- mutants at a frequency of 1.6%, but all mutants with this phenotype were also found to contain an extensive genomic deletion. Therefore, a common outcome of both heterologous and homologous plasmid integration at this locus is deletion formation.

Management of the thyroid isthmus in tracheostomy: a prospective and retrospective study

The thyroid isthmus is often encountered while a tracheostomy is being performed. This study details retrospective and prospective comparison of electrocautery division of the isthmus with older techniques. In this study, electrocautery division of the thyroid isthmus during tracheostomy is faster and as safe as other techniques with respect to blood loss, perioperative complications, and airway outcome.

Integrative transformation of the mycotoxin-producing fungus, Penicillium paxilli

A high frequency transformation system has been developed for Penicillium paxilli using pAN7-1. Up to 44% of the primary transformants were heterokaryons. Loss of hygromycin resistance was observed in primary transformants that were sub-cultured on non-selective media, but single spores of these primary transformants were mitotically stable on both selective and non-selective media. A molecular analysis of the transformants generated showed that 78% had single-site integrations, with half of these containing a single copy of pAN7-1. CHEF-gel electrophoresis showed that P. paxilli has at least six chromosomes with a total genome size of about 23.4 Mb.

An experimental evaluation of the effects of transcutaneous nerve stimulation (TNS) and applied relaxation (AR) on hearing ability, tinnitus and dizziness in patients with Menière's disease

In 20 patients diagnosed with Menière's disease, transcutaneous nerve stimulation (TNS) and applied relaxation (AR) were used as a treatment aimed at reducing tinnitus and dizziness and increasing hearing ability. The main aim of the study was to examine whether TNS could be regarded as a more beneficial treatment regimen than AR. An experimental between-group cross-over design was used. The results from the experimental phase (group comparisons) showed a significantly increased ability to hear for the TNS group when measured on visual analogue scales. During the same period, the AR-group showed a significant hearing improvement for the ear not primarily affected by Menière's disease as measured with pure tone audiometry. The vestibular tests did not reveal any significant changes either after TNS or AR intervention. Tinnitus matching showed changes of pitch and loudness before and after both TNS and AR intervention. However, no statistically significant changes between treatment regimes were found on these measures. The results from this study did not show TNS to be superior to AR in reducing tinnitus, dizziness or increasing hearing ability.

Secretion of thermostable DNA polymerase using a novel baculovirus vector

Baculovirus-mediated expression has become a powerful tool for the high yield production of functionally active recombinant proteins. In order to further enhance the utility of this expression system, we constructed versatile transfer vectors that facilitate the secretion of recombinant proteins from host insect cells by inserting functional secretory leader sequences down-stream of the polyhedrin promoter. In-frame insertion of cDNA sequences results in the synthesis of fusion proteins containing a heterologous signal sequence which directs the recombinant protein to the secretory pathway. Human and insect leader sequences were successfully tested with a number of proteins including the thermostable Pyrococcus furiousus (Pfu) DNA polymerase in an effort to maximize secretion of heterologous proteins from insect cells. The human placental alkaline phosphatase signal sequence (MLGPCMLLLLLLLGLRLQLSLG) proved to be optimal for the secretion of not only this thermostable bacterial enzyme but also for the secretion of other biologically active polypeptides.

Control and dispositional style among the hearing-impaired in communication situations

Forty hearing-impaired subjects were exposed to three stressful communication situations in a laboratory setting. The communication patterns used and the extent to which the subjects succeeded in coping with the situations were studied. Measures, such as the life orientation test measuring dispositional style, a hearing questionnaire measuring the ability to cope with different hearing situations, degree of control and pure-tone audiometry were performed. Coping behaviour and expressed emotion during communication situations were also observed. The results showed that controllability together with dispositional style and aspects of expressed emotion played an important role in explaining the overall success rates of hearing-impaired individuals.