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Han SY, Kim YH. Microalbuminuria and Functional Iron Deficiency are Risk Factors for Hearing Loss in Adolescents. Laryngoscope 2024; 134:3329-3334. [PMID: 38314940 DOI: 10.1002/lary.31317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Renal impairment and some systemic diseases are associated with hearing loss (HL) in adults. However, studies of these relationship in adolescents are rare. The objective of this study was to determine the association between HL and renal or systemic disease in adolescents. METHODS Subjects were extracted from the 5th Korea National Health and Nutrition Examination Survey from 2011 to 2012. We included adolescents aged 10-19 years old with normal tympanic membrane and those who underwent a physical and laboratory examination and pure tone audiometry. HL, high-frequency hearing loss (HFHL), albuminuria, impaired glomerular filtration rate, hypertension, diabetes, and obesity were evaluated based on the data. RESULTS Individuals with microalbuminruia (MIA) exhibited higher prevalence of HL (p = 0.003) and HFHL (p = 0.012) than those without MIA. The prevalence of HL and HFHL appeared to increase according to the severity of albuminuria. Additionally, individuals with HL or HFHL showed lower transferrin saturation (TSAT) than individuals without HL (p = 0.002) or HFHL (p = 0.001). And, HFHL was associated with lower ferritin levels (p = 0.017). HL and HFHL were related to MIA (p = 0.004 and p = 0.022, respectively) and TSAT (p = 0.005 and p = 0.011, respectively) after controlling other factors. CONCLUSION MIA and TSAT level were independently associated with the HL and HFHL. Since MIA can be easily detected by dipstick test and urine analysis, hearing evaluations for individuals with MIA might be helpful to identify hearing impairments earlier in adolescents. LEVEL OF EVIDENCE 3 (individual cross-sectional study) Laryngoscope, 134:3329-3334, 2024.
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Affiliation(s)
- Sang-Yoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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2
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S. P, V. A, R.B. NN, S. R. Pure Tone Audiometry in Anemia Patients. Indian J Otolaryngol Head Neck Surg 2024; 76:1711-1715. [PMID: 38566725 PMCID: PMC10982188 DOI: 10.1007/s12070-023-04388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
Aim Anaemia is a prevalent medical condition that impacts a significant proportion of the worldwide populace. While the cardiovascular and respiratory systems' influence on anaemia has been extensively researched, its effect on the auditory system remains unclear. The objective of this investigation was to assess the pure tone audiometry of individuals with anaemia and establish a connection between the type of hearing impairment and the level of anaemia, if any. Materials and Methods This cross-sectional study comprised 100 patients who were diagnosed with anaemia. All study participants underwent a thorough general examination and hearing assessment, which encompassed tuning fork tests, and pure-tone audiometry. Statistical analysis was utilized to determine the type and severity of hearing loss and its correlation with the degree of anaemia. Results Our research findings indicate that 46.8% of moderately anaemic patients and 62.9% of patients with severe anaemia exhibited sensorineural hearing loss. A significant correlation was observed between the degree of anaemia (p < 0.05) and hearing loss. Our research findings indicate that individuals with moderate and severe anaemia exhibit a notably greater incidence of hearing impairment in comparison to those with mild anaemia. Conclusion The research findings thus suggest a potential correlation between anaemia and auditory impairment. The timely identification and management of anaemia could potentially play a crucial role in preventing or reducing hearing impairment among individuals with anaemia. Additional research is required to clarify the mechanisms that underlie this association and to investigate possible interventions for mitigating the risk of hearing impairment in individuals with anaemia.
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Affiliation(s)
- Prabakaran S.
- Department of ENT, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu India
| | - Adithya V.
- Department of ENT, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu India
| | - Namasivaya Navin R.B.
- Department of ENT, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu India
| | - Rajasekaran S.
- Department of ENT, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu India
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3
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Yang T, Chen HJ, Zhang CY, He D, Yuan W. Association of blood heavy metal concentrations with hearing loss: a systematic review and meta-analysis. Public Health 2024; 227:95-102. [PMID: 38142497 DOI: 10.1016/j.puhe.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 08/24/2023] [Accepted: 10/09/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES This study aimed to assess the associations between blood heavy metal concentrations and hearing loss. STUDY DESIGN This was a systematic review and meta-analysis. METHODS A comprehensive literature search was performed using Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature, Wanfang and Weipu databases. Ten studies were included, and a random or fixed-effects model was used for the meta-analysis. Review Manager 5.4 software was used for data synthesis, and Stata 15.1 software was used for the publication bias and sensitivity analyses. RESULTS Blood lead concentrations were significantly and substantially associated with hearing loss (mean difference (MD) = 1.14; 95% confidence interval [CI] = 0.03, 2.26; P = 0.04; I2 = 81%), and iron deficiency was significantly related to hearing loss (MD = -0.42; 95% CI = -0.66, -0.18; P = 0.12; I2 = 60%). CONCLUSIONS These results suggest an association between blood heavy metal concentrations and hearing loss. However, there were limitations: confounding factors, lack of description for the specific methods of blinding and independent verification of case definition, limited sample size, Chinese publications comprising half of the primary data and the lack of assessment of the relationship between different blood heavy metal concentrations and the severity of hearing loss. Therefore, larger and well-designed prospective cohort studies are required for further exploration.
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Affiliation(s)
- T Yang
- Chongqing Medical University, Chongqing, 400016, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing, 400714, China; Chongqing School, University of Chinese Academy of Sciences, Chongqing, 400714, China; Chongqing General Hospital, Chongqing, 401121, China.
| | - H J Chen
- Chongqing Medical University, Chongqing, 400016, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing, 400714, China; Chongqing School, University of Chinese Academy of Sciences, Chongqing, 400714, China; Chongqing General Hospital, Chongqing, 401121, China.
| | - C Y Zhang
- Chongqing Medical University, Chongqing, 400016, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing, 400714, China; Chongqing School, University of Chinese Academy of Sciences, Chongqing, 400714, China; Chongqing General Hospital, Chongqing, 401121, China.
| | - D He
- Chongqing Medical University, Chongqing, 400016, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing, 400714, China; Chongqing School, University of Chinese Academy of Sciences, Chongqing, 400714, China; Chongqing General Hospital, Chongqing, 401121, China.
| | - W Yuan
- Chongqing Medical University, Chongqing, 400016, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing, 400714, China; Chongqing School, University of Chinese Academy of Sciences, Chongqing, 400714, China; Chongqing General Hospital, Chongqing, 401121, China.
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Sherratt S. Hearing Loss and Disorders: The Repercussions of Climate Change. Am J Audiol 2023; 32:793-811. [PMID: 37812783 DOI: 10.1044/2023_aja-23-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
PURPOSE Climate change is considered to be the greatest threat to human health in the 21st century, and its effects are accelerating. Extensive research has clearly demonstrated its increasing impact across the continuum of health conditions. Despite this, there has been limited attention to the ramifications of climate change on hearing loss and hearing disorders. This lack of consideration is somewhat surprising as the environment itself and its changing nature have a substantial effect on hearing. METHOD Tackling climate change could be the greatest global health opportunity of the 21st century. To address this issue, this tutorial provides a general introduction to climate change and its three major elements (pollution, infectious diseases, and extreme weather events) and their effects on health. The substantial consequences of climate change for the incidence, development, and exacerbation of hearing loss and disorders are clearly described and detailed. CONCLUSIONS The challenge of responding to this very real and escalating threat to hearing requires a combination of prevention, advocacy, and education. These three roles place audiologists in the perfect position to take action on the far-reaching effects of climate change on hearing loss and disorders. To respond to this challenge and to fulfill these roles, several strategies, ranging from the individual level to the global level, are delineated for audiologists to incorporate into their practice.
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Affiliation(s)
- Sue Sherratt
- Communication Research Australia, Newcastle, New South Wales
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5
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Graham AS, Ben-Azu B, Tremblay MÈ, Torre P, Senekal M, Laughton B, van der Kouwe A, Jankiewicz M, Kaba M, Holmes MJ. A review of the auditory-gut-brain axis. Front Neurosci 2023; 17:1183694. [PMID: 37600010 PMCID: PMC10435389 DOI: 10.3389/fnins.2023.1183694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Hearing loss places a substantial burden on medical resources across the world and impacts quality of life for those affected. Further, it can occur peripherally and/or centrally. With many possible causes of hearing loss, there is scope for investigating the underlying mechanisms involved. Various signaling pathways connecting gut microbes and the brain (the gut-brain axis) have been identified and well established in a variety of diseases and disorders. However, the role of these pathways in providing links to other parts of the body has not been explored in much depth. Therefore, the aim of this review is to explore potential underlying mechanisms that connect the auditory system to the gut-brain axis. Using select keywords in PubMed, and additional hand-searching in google scholar, relevant studies were identified. In this review we summarize the key players in the auditory-gut-brain axis under four subheadings: anatomical, extracellular, immune and dietary. Firstly, we identify important anatomical structures in the auditory-gut-brain axis, particularly highlighting a direct connection provided by the vagus nerve. Leading on from this we discuss several extracellular signaling pathways which might connect the ear, gut and brain. A link is established between inflammatory responses in the ear and gut microbiome-altering interventions, highlighting a contribution of the immune system. Finally, we discuss the contribution of diet to the auditory-gut-brain axis. Based on the reviewed literature, we propose numerous possible key players connecting the auditory system to the gut-brain axis. In the future, a more thorough investigation of these key players in animal models and human research may provide insight and assist in developing effective interventions for treating hearing loss.
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Affiliation(s)
- Amy S. Graham
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Benneth Ben-Azu
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Département de Médecine Moléculaire, Université Laval, Québec City, QC, Canada
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
- Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada
- Institute for Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States
| | - Marjanne Senekal
- Department of Human Biology, Division of Physiological Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Marcin Jankiewicz
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Mamadou Kaba
- Department of Pathology, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- ImageTech, Simon Fraser University, Surrey, BC, Canada
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Kose Celebi N, Deveci HS, Kulekci Ozturk S, Aslan Dundar T. Clinical role of vitamin D, vitamin B12, folate levels and hematological parameters in patients with sudden sensorineural hearing loss. Acta Otolaryngol 2023; 143:596-601. [PMID: 37498186 DOI: 10.1080/00016489.2023.2235398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Sudden sensorineural hearing loss (SSNHL), which is frequently observed in otolaryngology clinics, is characterized by sudden onset hearing loss that can develop within hours or days. Its etiology is still not fully understood. AIMS/OBJECTIVES This research aims to identify prognostic biomarkers that can be utilized to assess the progress of SSNHL as well as circumstances that may predispose individuals to the disease. MATERIALS AND METHODS Between 1 January 2019 and 1 October 2020, patients diagnosed with SSNHL in our clinic and a control group consisting of healthy people were examined retrospectively. The files of the groups were examined and the levels of hemoglobin, Neutrophil-Lymphocyte Ratio (NLR), ferritin, iron, iron binding capacity (UIBC), vitamin D, vitamin B12, folate were statistically compared with the control group. In addition, the effect of the parameters studied in the patient group on the degree of recovery was examined. RESULTS There was no statistically significant difference between the groups in terms of mean age and gender distribution (p > .05). NLR level of the patient group was higher than the control group (p < .05). Vitamin D level of the patient group was lower than the control group (p < .05). NLR and vitamin D levels had no effect on the degree of recovery (p > .05). There was no significant difference between the groups in terms of other parameters (p > .05). CONCLUSIONS AND SIGNIFICANCE We think that our study can be a guide for adding vitamin D as a routine laboratory test in patients with SSNHL. In addition, we think that NLR value can be used as a marker in patients with SSNHL. It is recommended to investigate the role of vitamin D supplementation in better and faster response in these patients.
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Affiliation(s)
- Nurdan Kose Celebi
- Otorhinolaryngology, İstanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Hande Senem Deveci
- Otorhinolaryngology, İstanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Semra Kulekci Ozturk
- Otorhinolaryngology, İstanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Tugba Aslan Dundar
- Otorhinolaryngology, İstanbul Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
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7
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Xie W, Karpeta N, Tong B, Liu Y, Zhang Z, Duan M. Comorbidities and laboratory changes of sudden sensorineural hearing loss: a review. Front Neurol 2023; 14:1142459. [PMID: 37144001 PMCID: PMC10151530 DOI: 10.3389/fneur.2023.1142459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Sudden sensorineural hearing loss (SSNHL) is defined as an abrupt hearing loss of more than 30 dB in three contiguous frequencies within 72 h. It is an emergency disease requiring immediate diagnosis and treatment. The incidence of SSNHL in Western countries' population is estimated between 5 and 20 per 1,00,000 inhabitants. The etiology of SSNHL remains unknown. Due to the uncertainty of the cause of SSNHL, at present, no specific treatment targets the cause of SSNHL, resulting in poor efficacy. Previous studies have reported that some comorbidities are risk factors for SSNHL, and some laboratory results may provide some clues for the etiology of SSNHL. Atherosclerosis, microthrombosis, inflammation, and the immune system may be the main etiological factors for SSNHL. This study confirms that SSNHL is a multifactorial disease. Some comorbidities, such as virus infections, are suggested to be the causes of SSNHL. In summary, by analyzing the etiology of SSNHL, more targeting treatments should be used to achieve a better effect.
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Affiliation(s)
- Wen Xie
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Niki Karpeta
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology-Head and Neck Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Busheng Tong
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China
| | - Yuehui Liu
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhilin Zhang
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Maoli Duan
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otolaryngology-Head and Neck Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Maoli Duan
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Grampurohit A, Sandeep S, Ashok P, Shilpa C, Thanzeemunissa. Study of Association of Sensory Neural Hearing Loss with Iron Deficiency Anaemia. Indian J Otolaryngol Head Neck Surg 2022; 74:3800-3805. [PMID: 36742865 PMCID: PMC9895360 DOI: 10.1007/s12070-021-02619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Hearing loss is an ignored community health problem. Along with various mental and motor developmental impairments, iron deficiency anemia (IDA) may cause hearing abnormalities. Study aimed to correlate the Sensorineural hearing loss with iron deficiency anemia in adults. This case control study conducted. Total of 200 participants fulfilling the inclusion criteria were included in present study and grouped into group 1 as cases and group 2 as controls. The participants included in present study after obtaining the consent and evaluated for the iron profile, PTA, OAE for sensory neural hearing loss. They were followed up for 3 months and 6 months. The mean age of case was 41.9 ± 10.77 and there was female preponderance in present study with 120 female and 80 males. Among 100 participants with iron deficiency anemia, twenty among them had the SNHL. The hearing impairment improved with the treatment of the IDA in patients in follow-up. There is a significant association between the SNHL and the Iron deficiency anemia in the patient. The treatment of IDA improves the hearing loss among the adults. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02619-4.
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Affiliation(s)
| | - S. Sandeep
- JSS Medical College and Hospital, Mysore, Karnataka India
| | - P. Ashok
- JSS Medical College and Hospital, Mysore, Karnataka India
| | - C. Shilpa
- JSS Medical College and Hospital, Mysore, Karnataka India
| | - Thanzeemunissa
- JSS Medical College and Hospital, Mysore, Karnataka India
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Jain C, Pushpoth Gangadharan VG, Kadabasal Basavaraja C, Lakshmi A. Relationship Between Peripheral and Central Auditory Abilities and Iron Deficiency Anemia in Adolescent Girls. Am J Audiol 2021; 30:1037-1047. [PMID: 34662243 DOI: 10.1044/2021_aja-21-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study evaluated the peripheral hearing and central auditory processing abilities in Indian adolescent girls with iron deficiency anemia (IDA). METHOD The participants consisted of 75 adolescent girls with IDA, 50 adolescent girls without IDA, and 50 adolescent boys without IDA. Participants underwent a test battery to evaluate auditory processing and peripheral hearing assessment. In this study, central auditory processing abilities were assessed using Speech Perception in Noise test in Kannada (SPIN-K) and quick speech perception in noise tests in Kannada, dichotic consonant-vowel test, gap detection threshold (GDT), and auditory digit sequencing and auditory digit span tests. RESULTS Results showed that the hearing thresholds at extremely low and high frequencies (250 and 8000 Hz), although within clinically normal limits, were poorer in girls with IDA than in the control groups. Also, girls with IDA performed poorly in SPIN-K of the right ear, GDT, and auditory backward digit span tests. CONCLUSION These subtle auditory deficiencies may be attributed to the compromised blood supply to the central auditory nervous system, as observed in the current study.
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Affiliation(s)
- Chandni Jain
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, Karnataka, India
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Chen W, Geng Y, Luo S, Lin N, Sha Y. The Correlation of Clinical Features and Endolymphatic Hydrops Visualized by 3D-Real IR MRI in Children With Sudden Sensorineural Hearing Loss. EAR, NOSE & THROAT JOURNAL 2021; 102:NP257-NP264. [PMID: 33848202 DOI: 10.1177/01455613211009432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the correlation between clinical features and endolymphatic hydrops (EH) in children with sudden sensorineural hearing loss (SSNHL). METHODS We collected 30 SSNHL children aged ≤17 years old, all of whom underwent intravenous gadolinium injection. After 4 hours, inner ear 3-dimensional inversion recovery sequence with real reconstruction (3D-real IR) magnetic resonance imaging was performed. Combined with their medical history such as gender, age, disease course, hearing loss, and so on, the results were analyzed. RESULTS Different degrees of EH were shown in the vestibule or different turns of cochlea in the affected ears of SSNHL children, and 12 (40%) of 30 children showed positive EH. Age, low and middle frequency hearing loss, and other clinical symptoms such as dizziness and ear fullness have been shown to be related to a certain degree of EH in vestibule or cochlea, whereas no relationship was found between EH and other clinical features such as high-frequency hearing loss, gender, affected side, and tinnitus. CONCLUSIONS Endolymphatic hydrops may not reflect the trend of disease progression over time in children with SSNHL, but the age of onset may be an important factor in the presence or absence of EH. Endolymphatic hydrops may be one of the causes of dizziness and ear fullness but has no obvious connection with the occurrence of tinnitus. Older SSNHL children with dizziness and ear fullness should maintain long-term follow-up to dynamically monitor the changes in EH.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yue Geng
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Siqi Luo
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Naier Lin
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
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Sundagumaran H, Seethapathy J. Outer hair cell functioning in infants with iron deficiency anemia. Int J Pediatr Otorhinolaryngol 2020; 138:110393. [PMID: 33152983 DOI: 10.1016/j.ijporl.2020.110393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Distortion product otoacoustic emissions (DPOAE) in infants with Iron Deficiency Anemia (IDA) helps in understanding the cochlear status especially the functioning of outer hair cells. OBJECTIVES To analyze the presence of DPOAE across frequencies and DP amplitude in infants with and without IDA. METHOD DPOAE were recorded on 40 infants with IDA and 40 infants without IDA in the age range of 6-24 months. Cubic DPOAEs (2f1-f2) were measured at six f2 frequencies (1500 Hz, 2000 Hz, 3000 Hz, 4500 Hz, 6000 Hz & 8000 Hz) with primary tone stimulus of intensity L1 equal to 65 dBSPL and L2 equal to 55 dBSPL. Immittance audiometry was performed using 226 Hz probe tone prior to DPOAE recording to ascertain normal middle ear functioning. RESULTS DPOAEs were present in all infants with and without IDA across frequencies tested. DP amplitude across the frequencies did not show any statistically significant difference (p < 0.05) between anemic and non-anemic groups. There was no statistically significant difference observed when both the groups were compared in terms of gender and age. CONCLUSION The study indicated that reduced iron levels does not have any influence on outer hair cell functioning as there were no changes observed in the DPOAE amplitude levels between infants with IDA and infants without IDA. Iron status does not seem to have a direct effect on outer hair cell functioning in infants. However, fine structure DPOAEs can reveal even more precise changes (if any) that are caused due to iron deficiency.
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Affiliation(s)
| | - Jayashree Seethapathy
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to Be University), Chennai, India, 600 116.
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Kim SY, Wee JH, Min C, Yoo DM, Choi HG. Sudden Sensorineural Hearing Loss Associated with Nutritional Anemia: A Nested Case-Control Study Using a National Health Screening Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6478. [PMID: 32899573 PMCID: PMC7558085 DOI: 10.3390/ijerph17186478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Previous studies have suggested an association of anemia with hearing loss. The aim of this study was to investigate the association of nutritional anemia with sudden sensorineural hearing loss (SSNHL), as previous studies in this aspect are lacking. We analyzed data from the Korean National Health Insurance Service-Health Screening Cohort 2002-2015. Patients with SSNHL (n = 9393) were paired with 37,572 age-, sex-, income-, and region of residence-matched controls. Both groups were assessed for a history of nutritional anemia. Conditional logistic regression analyses were performed to calculate the odds ratios (ORs) (95% confidence interval, CI) for a previous diagnosis of nutritional anemia and for the hemoglobin level in patients with SSNHL. Subgroup analyses were conducted for age and sex. Age, sex, income, and region of residence were stratified. Obesity, smoking, drinking alcohol, systolic/diastolic blood pressure, fasting blood glucose, total cholesterol, and the Charlson Comorbidity Index were considered in the regression models. Nutritional anemia was present in 4.8% (449/9393) of patients with SSNHL and 4.0% (1494/37,572) of controls (p < 0.001). The SSNHL group demonstrated 1.20-fold higher odds for nutritional anemia (95% CI = 1.08-1.34, p = 0.001). Hemoglobin levels were not associated with SSNHL. In subgroups <60 years old, there was a consistent positive association of nutritional anemia with SSNHL (adjusted OR = 1.55, 95% CI = 1.11-2.15, p = 0.010 for men <60 years old, and adjusted OR = 1.22, 95% CI = 1.02-1.45, p = 0.028 for women <60 years old). Nutritional anemia, but not hemoglobin level, was associated with an increased risk of SSNHL.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea;
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Korea;
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea; (C.M.); (D.-M.Y.)
- Graduate School of Public Health, Seoul National University, Seoul 01811, Korea
| | - Dae-Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea; (C.M.); (D.-M.Y.)
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Korea;
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea; (C.M.); (D.-M.Y.)
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Association between Anemia and Auditory Threshold Shifts in the US Population: National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113916. [PMID: 32492846 PMCID: PMC7312977 DOI: 10.3390/ijerph17113916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 01/24/2023]
Abstract
Existing evidence indicates that both iron deficiency anemia and sickle cell anemia have been previously associated with hearing loss. However, human data investigating the association between anemia and auditory threshold shifts at different frequencies in the adolescent, adult and elderly population are extremely limited to date. Therefore, this cross-sectional study used the dataset from the US National Health and Nutrition Examination Survey from 2005 to 2012 to explore differences in low- or high-frequency hearing thresholds and hearing loss prevalence between participants with and without anemia. A total of 918 patients with anemia and 8213 without anemia were included. Results indicated that low- and high-frequency pure tone average were significantly higher in patients with anemia than that in those without anemia in the elderly, but not in adult or adolescent population. In addition, the prevalence of low-frequency hearing loss but not high-frequency hearing loss was also higher in patients with anemia than in those without anemia in the elderly population. After adjusting various confounders, multiple regression models still indicated that patients with anemia tended to have larger threshold shift. In conclusion, anemia was associated with auditory threshold shifts in the elderly population, especially those vulnerable to low-frequency hearing loss.
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Sholle ET, Cusick M, Davila MA, Kabariti J, Flores S, Campion TR. Characterizing Basic and Complex Usage of i2b2 at an Academic Medical Center. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2020; 2020:589-596. [PMID: 32477681 PMCID: PMC7233105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Developed to enable basic queries for cohort discovery, i2b2 has evolved to support complex queries. Little is known whether query sophistication - and the informatics resources required to support it - addresses researcher needs. In three years at our institution, 609 researchers ran 6,662 queries and requested re-identification of 80 patient cohorts to support specific studies. After characterizing all queries as "basic" or "complex" with respect to use of sophisticated query features, we found that the majority of all queries, and the majority of queries resulting in a request for cohort re-identification, did not use complex i2b2 features. Data domains that required extensive effort to implement saw relatively little use compared to common domains (e.g., diagnoses). These findings suggest that efforts to ensure the performance of basic queries using common data domains may better serve the needs of the research community than efforts to integrate novel domains or introduce complex new features.
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Affiliation(s)
- Evan T Sholle
- Information Technologies and Services Department, Weill Cornell Medicine, New York, NY
| | - Marika Cusick
- Information Technologies and Services Department, Weill Cornell Medicine, New York, NY
| | - Marcos A Davila
- Information Technologies and Services Department, Weill Cornell Medicine, New York, NY
| | - Joseph Kabariti
- Information Technologies and Services Department, Weill Cornell Medicine, New York, NY
| | - Steven Flores
- Information Technologies and Services Department, Weill Cornell Medicine, New York, NY
| | - Thomas R Campion
- Information Technologies and Services Department, Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
- Clinical and Translational Science Center, Weill Cornell Medicine, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
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15
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Rhew K, Oh JM. Association between atopic disease and anemia in pediatrics: a cross-sectional study. BMC Pediatr 2019; 19:455. [PMID: 31760939 PMCID: PMC6876088 DOI: 10.1186/s12887-019-1836-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Atopic diseases, such as atopic dermatitis, allergic rhinitis, and asthma, are inflammatory diseases common in pediatric patients. This study investigated whether these inflammatory atopic diseases were associated with anemia in pediatrics. METHODS A cross-sectional study was conducted using a pediatric dataset from the Health Insurance Review and Assessment Service (HIRA) of South Korea in 2016. Multivariable logistic regression, adjusting for demographic covariates was used for analyse the association between atopic disease and iron deficiency anemia (IDA). RESULTS A total of 846,718 pediatric patients were included in the study. Of these, 19,594 (2.31%) had a diagnosis of IDA. The logistic regression analyses including covariates revealed there were association between atopic disease and IDA. The adjusted OR (aOR) of IDA was 1.42 (95% CI, 1.37-1.47) for atopic dermatitis, 1.25 (95% CI, 1.21-1.29) for allergic rhinitis, and 1.71 (95% CI, 1.65-1.76) for asthma. IDA was more prevalent in patients with multiple comorbid atopic diseases, with aOR of 1.30 (95% CI, 1.25-1.35), 1.81 (95% CI, 1.73-1.89), and 2.58 (95% CI, 2.43-2.73) for 1, 2, or 3 atopic diagnoses. There was no evidence of multicollinearity among covariates. CONCLUSIONS Our findings suggest that atopic disease was associated with IDA. Further study is needed to clarify the distinction between IDA and/or AI to better understand the cause of anemia in patients with inflammatory diseases.
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Affiliation(s)
- Kiyon Rhew
- College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.,College of Pharmacy, Dongduk Women's University, 60 Hwarang-ro 13-gil, Seongbuk-gu, Seoul, 02748, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea. .,Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Association of anemia with sensorineural hearing loss: a systematic review and meta-analysis. BMC Res Notes 2019; 12:283. [PMID: 31122277 PMCID: PMC6533653 DOI: 10.1186/s13104-019-4323-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/18/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Evidence shows that anemic individuals are at a higher risk of hearing loss. However, there is no systematic review and meta-analysis study. Thus, we aimed to meta-analyze the existing evidence on the association of iron deficiency anemia (IDA) with sensorineural hearing loss (SNHL). We searched PubMed, MEDLINE, Embase, Scopus, and Google Scholar from inception through October 30, 2017, for studies done on the association of the IDA with SNHL. Pooled odds ratio (OR) was calculated by random effect meta-analysis method. Heterogeneity was assessed by I2 metrics. RESULT Four studies, covering a total of 344,080 adults and children, were included. The odds of SNHL was higher by 55% in individuals with IDA, compared with individuals without IDA (OR = 1.55, 95% CI 1.17-2.06; P = 0.03). The age-specific ORs were 1.36 (95% CI 1.15-1.61; P = 0.27) and 3.67 (95% CI 1.72-7.84) for adults and children, respectively. IDA may be a contributing factor to hearing loss. Further studies are warranted, including whether IDA treatment reduces the risk of hearing loss. Meanwhile, hearing loss screening in anemic individuals, or vice versa, may represent an important consideration. PROSPERO registration CRD42017082108.
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Cordero D, Aguilar AM, Casanovas C, Vargas E, Lutter CK. Anemia in Bolivian children: a comparative analysis among three regions of different altitudes. Ann N Y Acad Sci 2019; 1450:281-290. [PMID: 30883800 DOI: 10.1111/nyas.14038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/22/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
Abstract
Here, we analyzed four population-based demographic and health surveys conducted in Bolivia between 1998 and 2016 to understand trends in anemia in children from 6 to 59 months of age by selected sociodemographic characteristics and three categories of altitude: low, medium, and high. Over the 18-year period, the prevalence of anemia was virtually unchanged while that in children living at high altitude increased. Anemia in children living at all three altitude categories is more than 40% and a severe public health problem according to the World Health Organization. We did not identify a single consistent risk factor for anemia in children living at high altitude compared with those living at medium or low altitude. The most consistent characteristic associated with childhood anemia across the three altitude categories was diarrhea in the last 2 weeks. Low length/height for age, an adolescent or anemic mother, a mother with no or little education, and a mother who speaks Quechua or Aymara were also risk factors. We conclude that it is necessary to review anemia policies and programs and prioritize children who are at greatest risk of developing anemia, particularly those living at high altitude. As iron deficiency appears to explain only a small part of childhood anemia, there is also a need to better understand its other causes and develop appropriate interventions.
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Affiliation(s)
| | - Ana Maria Aguilar
- Instituto de Investigación en Salud y Desarrollo, Universidad Mayor de San Andres, La Paz, Bolivia
| | - Carmen Casanovas
- Facultad de Medicina, Universidad Mayor de San Andres, La Paz, Bolivia
| | | | - Chessa K Lutter
- Division of Food Security and Agriculture, RTI International, Washington DC.,University of Maryland School of Public Health, College Park, Maryland
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Puga AM, Pajares MA, Varela-Moreiras G, Partearroyo T. Interplay between Nutrition and Hearing Loss: State of Art. Nutrients 2018; 11:nu11010035. [PMID: 30586880 PMCID: PMC6356655 DOI: 10.3390/nu11010035] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022] Open
Abstract
Hearing loss has been recently ranked as the fifth leading cause of years lived with disability, ahead of many other chronic diseases such as diabetes, dementia, or chronic obstructive pulmonary disease. Moreover, according to the World Health Organization, moderate-to-profound hearing loss affects about 466 million people worldwide. Its incidence varies in each population segment, affecting approximately 10% of children and increasing to 30% of the population over 65 years. However, hearing loss receives still very limited research funding and public awareness. This sensory impairment is caused by genetic and environmental factors, and among the latter, the nutritional status has acquired relevance due its association to hearing loss detected in recent epidemiological studies. Several experimental models have proved that the onset and progression of hearing loss are closely linked to the availability of nutrients and their metabolism. Here, we have reviewed studies focused on nutrient effects on auditory function. These studies support the potential of nutritional therapy for the protection against hearing loss progression, which is especially relevant to the aging process and related quality of life.
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Affiliation(s)
- Ana M Puga
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, 28668 Madrid, Spain.
| | - María A Pajares
- Department of Structural and Chemical Biology, Centro de Investigaciones Biológicas (CSIC), 28040 Madrid, Spain.
- Molecular Hepatology Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain.
| | - Gregorio Varela-Moreiras
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, 28668 Madrid, Spain.
| | - Teresa Partearroyo
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, 28668 Madrid, Spain.
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Fu XY, Xie XT. [Association between iron deficiency and brain developmental disorder in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:964-967. [PMID: 30477632 PMCID: PMC7389029 DOI: 10.7499/j.issn.1008-8830.2018.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
Iron deficiency (ID) is the most common trace element deficiency in childhood. Recent studies have shown that late fetus period, neonatal period, and infancy are important periods for brain development, and ID during these periods may cause irreversible damage to brain development, including abnormal emotion and behavior, cognitive decline, and attention deficit, which may still be present in adulthood. Therefore, it should be taken seriously. This article summarizes the research advances in major mechanisms involved in brain developmental disorder due to ID in the early stage of life and related intervention measures.
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Affiliation(s)
- Xiao-Yan Fu
- Department of Pediatrics, Shanghai Luodian Hospital, Shanghai 201908, China.
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20
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Jha MK, Jo M, Kim JH, Suk K. Microglia-Astrocyte Crosstalk: An Intimate Molecular Conversation. Neuroscientist 2018; 25:227-240. [PMID: 29931997 DOI: 10.1177/1073858418783959] [Citation(s) in RCA: 341] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Microglia-astrocyte crosstalk has recently been at the forefront of glial research. Emerging evidence illustrates that microglia- and astrocyte-derived signals are the functional determinants for the fates of astrocytes and microglia, respectively. By releasing diverse signaling molecules, both microglia and astrocytes establish autocrine feedback and their bidirectional conversation for a tight reciprocal modulation during central nervous system (CNS) insult or injury. Microglia, the constant sensors of changes in the CNS microenvironment and restorers of tissue homeostasis, not only serve as the primary immune cells of the CNS but also regulate the innate immune functions of astrocytes. Similarly, microglia determine the functions of reactive astrocytes, ranging from neuroprotective to neurotoxic. Conversely, astrocytes through their secreted molecules regulate microglial phenotypes and functions ranging from motility to phagocytosis. Altogether, the microglia-astrocyte crosstalk is fundamental to neuronal functions and dysfunctions. This review discusses the current understanding of the intimate molecular conversation between microglia and astrocytes and outlines its potential implications in CNS health and disease.
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Affiliation(s)
- Mithilesh Kumar Jha
- 1 Department of Pharmacology, Brain Science & Engineering Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,2 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Myungjin Jo
- 1 Department of Pharmacology, Brain Science & Engineering Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,3 Korea Brain Research Institute, Daegu, Republic of Korea
| | - Jae-Hong Kim
- 1 Department of Pharmacology, Brain Science & Engineering Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kyoungho Suk
- 1 Department of Pharmacology, Brain Science & Engineering Institute, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Kiss JE, Vassallo RR. How do we manage iron deficiency after blood donation? Br J Haematol 2018; 181:590-603. [DOI: 10.1111/bjh.15136] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph E. Kiss
- Hemapheresis and Blood Services; The institute for Transfusion Medicine; Pittsburgh PA USA
| | - Ralph R. Vassallo
- Chief Medical and Scientific Officer; Blood Systems, Inc.; Scottsdale AZ USA
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