Tumour necrosis factor-α inhibition can stabilize disease in progressive vitiligo

Tumour necrosis factor (TNF)-α, a proinflammatory cytokine central to many autoimmune diseases, has been implicated in the depigmentation process in vitiligo. We review its role in vitiligo by exploring its pro- and anti-inflammatory properties and examine the effects of blocking its actions with TNF-α antagonist therapeutics in reports available in the literature. We found that TNF-α inhibition halts disease progression in patients with progressive vitiligo but that, paradoxically, treatment can be associated with de novo vitiligo development in some patients when used for other autoimmune conditions, particularly when using adalimumab and infliximab. These studies reinforce the importance of stating appropriate outcomes measures, as most pilot trials propose to measure repigmentation, whereas halting depigmentation is commonly overlooked as a measure of success. We conclude that TNF-α inhibition has proven useful for patients with progressive vitiligo, where TNF-α inhibition is able to quash cytotoxic T-cell-mediated melanocyte destruction. However, a lingering concern for initiating de novo disease will likely prevent more widespread application of TNF inhibitors to treat vitiligo.

Newborn hearing screening using the Crib-O-Gram

The purpose of this investigation was to identify variables that might affect the failure rate and test duration of Crib-O-Gram hearing screenings. One hundred sixty-three infants who graduated from a neonatal intensive care unit were screened. All screenings were performed by nurses in the open nursery. For the purposes of statistical analyses the infants were divided into three groups: group A--passed the first screening; group B--failed the first screening and passed the second screening; and group C--failed both screenings. The length of Crib-O-Gram screening and screening outcome were not associated with gestational age, conceptional age, weight, or time at which the test commenced. Infants who failed the screening twice had shorter screening durations than infants who passed the screening the first time.

Bone-conduction masking for threshold assessment in auditory brain stem response testing

The viability of applying Sensorineural Acuity Level (SAL) audiometry to auditory brain stem response (ABR) testing was investigated using 38 subjects with normal hearing, conductive, sensorineural, and mixed hearing losses. The stimuli were clicks, 4000, 2000, and 1000 Hz tone-pips. After ABR thresholds (ABRt) were obtained, bone-conducted noise was used to mask the response to a stimulus 5 dB above ABR threshold (ABRt + 5). Estimates of behavioral bone-conduction thresholds were made by observing the amount of noise needed to mask ABRt + 5. Estimates of behavioral air-conduction thresholds were based upon ABRt. Results indicated that ABRt was within +/- 10 dB of behavioral air-conduction threshold across subject groups at least 74% of the time for all tone-pip stimuli. ABRt was within +/- 15 dB of the pure-tone average of 1000, 2000, and 4000 Hz 75% of the time when click stimuli were used. Derived bone-conduction thresholds were within +/- 10 dB of the actual bone-conduction threshold at least 73% of the time for all stimuli. It was concluded that, when used in a conservative manner, the application of SAL audiometry to ABR testing may increase the reliability and confidence with which decisions are made concerning the type and degree of hearing loss in difficult-to-test patients.

Evaluation of a new tape recording of the synthetic sentence identification test

The purpose of this study was to collect normative data on a commercially available tape recording of the Synthetic Sentence Identification test with ipsilateral competing message. Twenty normal-hearing subjects with no history of central auditory dysfunction were used. Mean percentage of intelligibility scores and standard deviations were obtained at various message-competition ratios. Results were compared to previous research. The data obtained using this recording can now be used as a reference for making clinical judgments.