Food protein-induced enterocolitis syndrome due to banana: an uncommon entity

Food protein-induced enterocolitis syndrome is a non-IgE-mediated food allergy that typically occurs within the first year of age and it is often misdiagnosed for its rarity. This syndrome is usually caused by milk or soy in formula-fed infants, but it can also be associated to solid food proteins, fruit proteins included. We describe and discuss the first case of an infant with mild acute/lateform ofFPIES due to banana only.

Alpha- and beta-secretase activity as a function of age and beta-amyloid in Down syndrome and normal brain

Aged individuals with Down syndrome (DS) develop Alzheimer's disease (AD) neuropathology by the age of 40 years. The purpose of the current study was to measure age-associated changes in APP processing in 36 individuals with DS (5 months-69 years) and in 26 controls (5 months-100 years). Alpha-secretase significantly decreased with age in DS, particularly in cases over the age of 40 years and was stable in controls. The levels of C-terminal fragments of APP reflecting alpha-secretase processing (CTF-alpha) decreased with age in both groups. In both groups, there was significant increase in beta-secretase activity with age. CTF-beta remained constant with age in controls suggesting compensatory increases in turnover/clearance mechanisms. In DS, young individuals had the lowest CTF-beta levels that may reflect rapid conversion of beta-amyloid (Abeta) to soluble pools or efficient CTF-beta clearance mechanisms. Treatments to slow or prevent AD in the general population targeting secretase activity may be more efficacious in adults with DS if combined with approaches that enhance Abeta degradation and clearance.

Nasal NO: normal values in children age 6 through to 17 years

The present study is an assessment of normal values of nasal nitric oxide (nNO) in healthy children. Healthy children aged between 6-17 yrs were recruited from three schools in Rotterdam (The Netherlands). Breath was held for 10 s, while air was extracted from one nostril at 700 mL.min(-1). The mean nNO value at the response plateau after 7-10 s was recorded and the average of three measurements was used. In total, 340 children participated; the male:female ratio was 156:184. Three reliable measurements were available in 85% of the children. The nNO concentrations were distributed normally (mean 449 ppb, SD 115). They were not associated with sex, passive smoking or body mass index. In children aged <12 yrs nNO correlated positively with age, history of adenoidectomy and ambient NO. In children aged > or =12 yrs ambient NO was the only significant modifier. Prediction rules for nNO values in children were formulated. In conclusion, the current study presents normal values for nasal nitric oxide in children, which can be used to assess the value of nasal nitric oxide in respiratory illnesses.

[Candida pneumonia in patients without definitive immunodeficiency]

The occurrence of community-acquired pneumonia due to yeast-like fungi of the genus Candida in patients without manifest immunodeficiency has previously been discounted. However, such pneumonias may indeed occur in patients with chronic parenchymal lung damage, e.g. from nicotine. Candida pneumonia can be triggered in these patients for example by trivial viral infections. Three corresponding cases are discussed.

Plasticity in the adult human central auditory system: evidence from late-onset profound unilateral deafness

Experience-related changes in central nervous system (CNS) activity have been observed in the adult brain of many mammalian species, including humans. In humans, late-onset profound unilateral deafness creates an opportunity to study plasticity in the adult CNS consequent to monaural auditory deprivation. CNS activity was assessed by measuring long-latency auditory evoked potentials (AEPs) recorded from teens and adults with late-onset (post-childhood) profound unilateral deafness. Compared to monaurally stimulated normal-hearing subjects, the AEPs recorded from central electrode sites located over auditory cortical areas showed significant increases in inter-hemispheric waveform cross-correlation coefficients, and in inter-hemispheric AEP peak amplitude correlations. These increases provide evidence of substantial changes from the normal pattern of asymmetrical (contralateral > ipsilateral amplitude) and asynchronous (contralateral earlier than ipsilateral) central auditory system activation in the normal-hearing population to a much more symmetrical and synchronous activation in the unilaterally deaf. These cross-sectional analyses of AEP data recorded from the unilaterally deaf also suggest that the changes in cortical activity occur gradually and continue for at least 2 years after the onset of hearing loss. Analyses of peak amplitude correlations suggest that the increased inter-hemispheric symmetry may be a consequence of changes in the generators producing the N (approximately 100 ms peak latency) potential. These experience-related changes in central auditory system activity following late-onset profound unilateral deafness thus provide evidence of the presence and the time course of auditory system plasticity in the adult brain.

Maturation of the mismatch negativity: effects of profound deafness and cochlear implant use

The use of cochlear implants to restore auditory sensation in deaf children is increasing, with a trend toward earlier implantation. However, little is known about how auditory deprivation and subsequent cochlear implant use affect the maturing human central auditory system. Our previous studies have demonstrated that the obligatory auditory evoked potentials (AEPs) of implanted children are very different from those of normal-hearing children. Unlike the obligatory potentials, which primarily reflect neural responses to stimulus onset, the mismatch negativity (MMN) provides a neurophysiological measure of auditory short-term memory and discrimination processes. The purpose of this investigation is to review our studies of the effects of auditory deprivation due to profound deafness and cochlear implant use on the maturation of the MMN in children, placed in the context of overall age-related changes in the AEPs. The development and application of a statistical technique to assess the MMN in individuals is also reviewed. Results show that although the morphology of the obligatory AEPs is substantially altered by the absence of a normal N(1) peak, the MMN is robustly present in a group of implanted children who have good spoken language perception through their device. Differences exist in the scalp distribution of the MMN between implanted and normal-hearing children. Specifically, the MMN appears to be more symmetrical in amplitude over both hemispheres, whereas it is initially much larger over the contralateral hemisphere in normal-hearing children. These findings suggest that, compared to N(1), the MMN is a better measure of basic auditory processes necessary for the development of spoken language perception skills in profoundly deaf children and adults who use a cochlear implant.

Maturation of human central auditory system activity: evidence from multi-channel evoked potentials

OBJECTIVE

The purpose of this study was to evaluate central auditory system maturation based on detailed data from multi-electrode recordings of long-latency auditory evoked potentials (AEPs).

METHODS

AEPs were measured at 30 scalp-electrode locations from 118 subjects between 5 and 20 years of age. Analyses focused on age-related latency and amplitude changes in the P1, N1b, P2, and N2 peaks of the AEPs generated by a brief train of clicks presented to the left ear.

RESULTS

Substantial and unexpected changes that extend well into adolescence were found for both the amplitude and latency of the AEP components. While the maturational changes in latency followed a pattern of gradual change, amplitude changes tended to be more abrupt and step-like. Age-related latency decreases were largest for the P1 and N1b peaks. In contrast, P2 latency did not change significantly and the N2 peak increased in latency as a function of age. Abrupt changes in P1, P1-N1b, and N2 peak amplitude (also RMS amplitude) were observed around age 10 at the lateral electrode locations C3 and C4, but not at the midline electrodes Cz and Fz. These changes in amplitude coincided with a sharp increase and plateau in AEP peak and RMS amplitude variability from 9 to 11 years of age.

CONCLUSIONS

These analyses demonstrated that the observed pattern of AEP maturation depends on the scalp location at which the responses are recorded. The distinct maturational time courses observed for individual AEP peaks support a model of AEP generation in which activity originates from two or more at least partly independent central nervous system pathways. A striking parallel was observed between previously reported maturational changes in auditory cortex synaptic density and, in particular, the age-related changes in P1 amplitude. The results indicate that some areas of the brain activated by sound stimulation have a maturational time course that extends into adolescence. Maturation of certain auditory processing skills such as speech recognition in noise also has a prolonged time course. This raises the possibility that the emergence of adult-like auditory processing skills may be governed by the same maturing neural processes that affect AEP latency and amplitude.

Activating separate ascending auditory pathways produces different human thalamic/cortical responses

When auditory nerve function is lost due to surgical removal of bilateral acoustic tumors in cases of neurofibromatosis type 2, a sense of hearing may be restored by means of an auditory brainstem implant (ABI), which electrically stimulates the cochlear nucleus. Electrically evoked auditory brainstem responses recorded from ABI subjects exhibit a variety of waveforms due to the presence or absence of different components. Evidently, ABI stimulation activates different ascending auditory pathways in different individuals. This study examined whether such differences at the brainstem level are associated with corresponding differences at higher levels. Multichannel recordings of electrically evoked middle-latency and late auditory responses were obtained from two ABI subjects whose very different electrically evoked auditory brainstem responses represent distinct categories of waveform morphology. The waveforms of both types of response were qualitatively similar in that for each condition tested there were corresponding main peaks and troughs. Quantitatively, however, there were differences in the scalp distributions and magnitudes of all components present. One subject had distributions suggesting bilateral activation and an N1-P2 complex of large amplitude, whereas the other subject had distributions suggesting unilateral activation contralateral to the side of stimulation and an N1-P2 complex of small amplitude. The differences suggest that activation of different ascending pathways in the auditory system results in different spatial and temporal patterns of neural activity in the thalamic and/or cortical auditory areas.

Spatial mislocalization of EEG electrodes -- effects on accuracy of dipole estimation

OBJECTIVE

The estimation of cortical current activity from scalp-recorded potentials is a complicated mathematical problem that requires fairly precise knowledge of the location of the scalp electrodes. It is expected that spatial mislocalization of electrodes will introduce errors in this estimation. The present study uses simulated and real data to quantify these errors for dipole current sources in a spherical head model.

METHODS

A 3-dimensional digitizer was used to locate the positions of 31 scalp electrodes placed on the head according to the 10-20 system in 10 normal subjects. Dipole localizations were performed on auditory evoked potentials (AEPs) collected from these subjects.

RESULTS

Computer simulations with several dipole source configurations suggest that errors in locations and orientations on the order of 5 mm and 5 degrees, respectively, are possible for electrode mislocalizations of about 5 degrees. In actual experimental settings, digitized electrode positions were typically mislocalized by an average of about 4 degrees from their standard 10-20 positions on a spherical model. These differences in electrode positions translated to mean differences of about 8 mm in dipole locations and 5 degrees in dipole orientations.

CONCLUSIONS

Dipole estimation errors due to electrode mislocalizations are within the limits of errors due to other modeling approximations and noise.

The effects of sensory hearing loss on cochlear filter times estimated from auditory brainstem response latencies

Derived-band auditory brainstem responses (ABRs) were obtained in 43 normal-hearing and 80 cochlear hearing-impaired individuals using clicks and high-pass noise masking. The response times across the cochlea [the latency difference between wave V's of the 5.7- and 1.4-kHz center frequency (CF) derived bands] were calculated for five levels of click stimulation ranging from 53 to 93 dB p.-p.e. SPL (23 to 63 dB nHL) in 10-dB steps. Cochlear response times appeared to shorten significantly with hearing loss, especially when the average pure tone (1 to 8 kHz) hearing loss exceeded 30 dB. Examination of derived-band latencies indicates that this shortening is due to a dramatic decrease of wave V latency in the lower CF derived band. Estimates of cochlear filter times in terms of the number of periods to maximum response (Nmax) were calculated from derived-band latencies corrected for gender-dependent cochlear transport and neural conduction times. Nmax decreased as a function of hearing loss, especially for the low CF derived bands. The functions were similar for both males and females. These results are consistent with broader cochlear tuning due to peripheral hearing loss. Estimating filter response times from ABR latencies enhances objective noninvasive diagnosis and allows delineation of the differential effects of pathology on the underlying cochlear mechanisms involved in cochlear transport and filter build-up times.

Spatio-temporal EEG source localization using simulated annealing

The estimation of multiple dipole parameters in spatio-temporal source modeling (STSM) of electroencephalographic (EEG) data is a difficult nonlinear optimization problem due to multiple local minima in the cost function. A straightforward iterative optimization approach to such a problem is very susceptible to being trapped in a local minimum, thereby resulting in incorrect estimates of the dipole parameters. In this paper, we present and evaluate a more robust optimization approach based on the simulated annealing algorithm. The complexity of this approach for the STSM problem was reduced by separating the dipole parameters into linear (moment) and nonlinear (location) components. The effectiveness of the proposed method and its superiority over the traditional nonlinear simplex technique in escaping local minima were tested and demonstrated through computer simulations. The annealing algorithm and its implementation for multidipole estimation are also discussed. We found the simulated annealing approach to be 7-31% more effective than the simplex method at converging to the true global minimum for a number of different kinds of three-dipole problems simulated in this work. In addition, the computational cost of the proposed approach was only marginally higher than its simplex counterpart. The annealing method also yielded similar solutions irrespective of the initial guesses used. The proposed simulated annealing method is an attractive alternative to the simplex method that is currently more common in dipole estimation applications.

Successful detection of small acoustic tumors using the stacked derived-band auditory brain stem response amplitude

HYPOTHESIS

The aim of this study was to show that a new auditory brain stem response (ABR) measure, the stacked derived-band ABR amplitude, can detect small acoustic intracanalicular tumors missed by standard ABR measures.

BACKGROUND

Recent studies clearly have shown that standard ABR latency measures have inadequate sensitivity to detection of small intracanalicular acoustic tumors. Consequently, despite its relatively low cost and wide availability, the standard ABR test has been replaced as a diagnostic screening tool by magnetic resonance imaging (MRI) with gadolinium (GdDTPA) contrast. However, screening with MRIs can be problematic because of their high cost, limited availability, and impact on patient comfort. Thus, an ABR method capable of detecting small tumors with good specificity would be an invaluable cost-effective screening tool for reducing the number of patients without tumor imaged.

METHODS

Derived-band ABRs were obtained to 63-dB normal hearing level (nHL) clicks using high-pass noise-masking procedures. The new measure is the wave V amplitude of a stacked ABR constructed by temporally aligning wave V of each derived-band ABR and then summing the time-shifted responses.

RESULTS

In a series of 25 tumor cases, 5 small (< or = 1 cm) intracanalicular tumors, missed by standard ABR latency measures, were detected by this new stacked ABR method. The stacked wave V ABR amplitudes in all five cases were significantly lower than those obtained in a group of normal-hearing individuals without tumors.

CONCLUSIONS

A new ABR measure, the stacked derived-band ABR amplitude, is sensitive to the presence of small intracanalicular tumors in patients and has excellent specificity for the absence of tumors in normal-hearing individuals. This method, in combination with standard ABR measures, appears promising both as a cost-effective approach to reducing the number of patients without tumors imaged and as a method for acoustic tumor screening when MRI scans: 1) are unavailable; 2) are not appropriate because of patient comfort; and 3) need to be justified because of their cost.

Integrated mismatch negativity (MMNi): a noise-free representation of evoked responses allowing single-point distribution-free statistical tests

If the repeated presentation of a single (standard) auditory stimulus is randomly interspersed with a second acoustically different (deviant) stimulus, the cortical activity evoked by the deviant stimulus can contain a negative component known as the mismatch negativity (MMN). The MMN is derived by subtracting the averaged response evoked by the standard stimulus from that evoked by the deviant stimulus. When the magnitude of the response is small or the signal-to-noise ratio is poor, it is difficult to judge the presence or absence of the MMN simply by visual inspection, and statistical detection techniques become necessary. A method of analysis is proposed to quantify the magnitude and statistically evaluate the presence of the MMN based on time-integrated evoked responses. This paper demonstrates the use of this integrated mismatch negativity (MMNi) analysis to detect the MMN evoked by stimulus contrasts near the perceptual threshold of two subjects. The MMNi, by virtue of being equivalent to a low-pass filtered response, presents an almost noise-free estimate of MMN magnitude. A single measure of the integrated evoked response at a fixed time point is used in a distribution-free statistic that compares the magnitude of the averaged response evoked by the deviant stimulus with a magnitude distribution derived from 200 subaveraged responses to the standard stimulus (with the number of sweeps per average equal to that of the deviant stimulus). This allows a calculation of the exact probability for the null hypothesis that the negative magnitude of the response evoked by the deviant stimulus is drawn from the magnitude distribution of responses evoked by the standard stimulus. Rejection of this hypothesis provides objective evidence of the presence of the MMN.

Maturational delays in cortical evoked potentials in cochlear implant users

We studied the effects of prolonged auditory deprivation in children in whom auditory stimulation was restored by a cochlear implant. The latency of the P1 component of the late cortical potential was used as the indicator of auditory system maturation. For normal-hearing children there is a gradual evolution of evoked potential features that extends through adolescence with P1 latency becoming adult-like at about age 15. It appears that maturation of P1 latency in normal and implanted children occurs at the same rate, but the time to maturity in implanted subjects is delayed by an amount approximately equal to the duration of deafness.

Auditory system plasticity in children after long periods of complete deafness

Deaf children fitted with a cochlear implant provide a unique opportunity to examine the effects of auditory deprivation on the maturation of the human auditory system. We compared cortical evoked potentials recorded in implanted and normal-hearing children and found that age-dependent latency changes for the P1 component, fitted to a decaying exponential curve, showed the same rate of maturation. For implanted children, however, maturational delays for P1 latency approximated the period of auditory deprivation prior to implantation. This indicates the auditory system does not mature without stimulation. Nonetheless, the auditory system retains its plasticity during the period of deafness since the re-introduction of stimulation by the cochlear implant resumes the normal maturational sequence.

Maturation of human cortical auditory function: differences between normal-hearing children and children with cochlear implants

OBJECTIVE

We investigated maturation of cortical auditory function in normal-hearing children and in children who receive stimulation of their auditory system through a cochlear implant.

DESIGN

As a measure of cortical auditory function, auditory evoked responses (AERs) were recorded from normal-hearing children and adults as well as from children and adults fitted with a cochlear implant. Morphological and latency changes for evoked responses recorded at electrode Cz are reported.

RESULTS

For normal-hearing children, there is a gradual evolution of AER features that extends through adolescence, with P1 latency becoming adult-like in the late teens. Latency changes for P1 occur at the same rate for implanted children, but the overall maturation sequence is delayed. By extrapolation from the existing data, the age at which P1 latency becomes adult-like is delayed by approximately 5 yr for the implanted population. Other typical features of the AER, namely N1 and P2, are either delayed in developing or absent in the implanted children.

CONCLUSIONS

These preliminary findings suggest both similarities and differences in cortical auditory maturation for normal-hearing and implanted children. For implanted children, the 5 yr delay for maturation of P1 latency roughly corresponds to the average 4.5 yr interval between the onset of deafness and the time of implantation. These findings suggest that during the period of deafness, maturation of cortical auditory function does not progress. However, some, if not all, maturational processes resume after stimulation is reintroduced.

Variable effects of click polarity on auditory brain-stem response latencies: analyses of narrow-band ABRs suggest possible explanations

The auditory brain-stem responses (ABRs) to rarefaction and condensation clicks were obtained for 12 normal-hearing subjects in quiet, and high-pass masking at 8, 4, 2, 1, and 0.5 kHz. Derived narrow-band wave V latency differences were analyzed with respect to (1) stimulus polarity, (2) absolute differences irrespective of polarity. The analyses revealed no significant stimulus polarity effects on latency for the derived bands. Absolute latency differences regardless of polarity tended to be greater for those derived bands having lower characteristic frequencies (CFs). However, these differences were smaller than the expected half-period of the theoretical CF. Further analyses in three additional subjects using repeated runs of the same polarity indicate that this increase in absolute latency difference with lower derived band CF does not reflect a simple half-period change owing to polarity, but rather to the increase variability in measuring the peak latency of the lower CF derived bands. The variability is consistent with variability of eighth nerve PST histograms behavior observed in animal work [Kiang et al., "Discharge patterns of single fibers in the cat's auditory nerve," Research Monograph No. 35 (MIT, Cambridge, MA, 1965)]. Thus claimed polarity effects observed in other ABR work using absolute values may have been affected by this variability. It appears from these current data that half-period latency shifts of wave V owing to stimulus polarity differences are not observed in derived bands responses initiated from frequency specific regions of the cochlea.

Use of quantitative measures of auditory brain-stem response peak amplitude and residual background noise in the decision to stop averaging

An objective quantitative approach to the decision of when to stop averaging sweeps in auditory brain-stem response (ABR) testing is presented. This decision is based on (1) the knowledge of the amplitude distributions of wave V in the ABRs of normal hearing individuals for varying stimulus levels, (2) calculated estimates of the residual background noise in the average, and (3) use of a quantitative statistical detector of an evoked potential. Several reasons for terminating an average are presented along with a specific protocol for each of the reasons. These protocols provide a general but consistent framework to address the issue of when to stop averaging and should improve the efficiency of ABR testing. Furthermore, it is quite possible to automate the procedure and the decision process.

The mismatch negativity in cochlear implant users

For individuals with severe or profound hearing loss, electrical stimulation of surviving neural elements by a cochlear implant may partly restore a sensation of hearing. Determining the extent of restoration based on behavioral measures may be difficult, particularly when evaluating young children or individuals who have little or no experience with normal hearing. In normal-hearing individuals, an objective measure of sound discrimination may be obtained by studying the mismatch negativity (MMN) component of the auditory evoked potential. The MMN may be evoked by a number of physical differences in acoustic stimuli including duration and pitch. For cochlear implant users, analogous stimulus differences may be produced by changing the length of a stimulus pulse train or by changing the pair of activated electrodes along a multi-electrode implant array. This paper will provide an overview of our current results, comparing evoked response data recorded from both normal-hearing individuals and cochlear implant users. In both normal-hearing individuals and cochlear implant users, MMNs were evoked by differences in stimulus train duration and pitch (or electrode pair activation in cochlear implant users). These findings suggest that the MMN may be a useful method for assessing the discriminability of electrical stimulation patterns produced by a cochlear implant. Eventually, information gained by MMN testing may yield important information for developing rehabilitation programs for the individual user.

Auditory brainstem response (ABR) peak amplitude variability reflects individual differences in cochlear response times

Previously, it was shown [Don et al., J. Acoust. Soc. Am. 94, 2135-2148 (1993)] that cochlear response times are gender specific and about 13% shorter in females than in males. It is also suggested that one of the possible reasons click-evoked auditory brainstem response (ABR) waveforms recorded from females are better defined and have larger amplitudes than those of males is due to a sex difference in cochlear response times leading to better synchronization of the cochlear output across the frequency regions. Variability in cochlear response times would also lead to variability in click evoked ABR amplitudes. The high-pass noise masking derived ABR technique was used to investigate the effect of normalizing the individual temporal variability at the neural and cochlear levels. This involved adjusting for differences in neural conduction time (I-V delay) by a compression or expansion of the derived ABR waveforms and by adjusting for differences in cochlear response times by a shift of the derived ABR waveforms. A summation of the compressed and shifted ABRs results in a normalized unmasked ABR waveform that can then be compared for amplitude variability with the unprocessed unmasked ABRs. Compensation for the neutral I-V variability had little effect while compensation for cochlear response times, particularly the delay between the 5.7- and 2.8-kHz regions, greatly affected the amplitude of wave V of the compounded ABR. This work provides a better understanding of the significant relationship between cochlear response times and variability of the ABR peak amplitudes.

Evaluating residual background noise in human auditory brain-stem responses

The nature of the residual background noise in ABR averages was empirically examined in normal hearing objects. The residual noise in the average was estimated with use of the technique described by Elberling and Don [Scand. Audiol. 13, 187-197 (1984)]. Low-level click stimuli were presented in 2-dB steps spanning the range from 30 to 48 dB p-p.e. SPL. For each stimulus level, 10,000 sweeps were acquired and stored for analysis. Shortcomings of the use of artifact rejection and standard averaging are demonstrated. It is further demonstrated how application of the Bayesian estimation technique of Elberling and Wahlgreen [Scand. Audiol. 14, 89-96 (1985)] to form weighted averages can help minimize these shortcomings. Finally, the effects of smaller sweep block sizes on the Bayesian technique's ability to control the destructive effects of nonstationary noise are analyzed. Minimizing the destructive effects increases the value of statistical techniques used to detect objectively or to control the quality of ABR recordings. In all, these techniques in combination improve not only the accuracy of test interpretation but also the efficiency of clinical test time, which is becoming important for the control of medical costs.

Spatio-temporal source modeling of evoked potentials to acoustic and cochlear implant stimulation

Spatio-temporal source modeling (STSM) of event-related potentials was used to estimate the loci and characteristics of cortical activity evoked by acoustic stimulation in normal hearing subjects and by electrical stimulation in cochlear implant (CI) subjects. In both groups of subjects, source solutions obtained for the N1/P2 complex were located in the superior half of the temporal lobe in the head model. Results indicate that it may be possible to determine whether stimulation of different implant channels activates different regions of cochleotopically organized auditory cortex. Auditory system activation can be assessed further by examining the characteristics of the source wave forms. For example, subjects whose cochlear implants provided auditory sensations and normal hearing subjects had similar source activity. In contrast, a subject in whom implant activation evoked eyelid movements exhibited different source wave forms. STSM analysis may provide an electrophysiological technique for guiding rehabilitation programs based on the capabilities of the individual implant user and for disentangling the complex response patterns to electrical stimulation of the brain.

Gender differences in cochlear response time: an explanation for gender amplitude differences in the unmasked auditory brain-stem response

Derived narrow-band auditory brain-stem responses (ABRs) in young normal-hearing subjects revealed a significant gender difference in response time between frequency regions of the cochlea. Females showed shorter delays than males between derived bands. This differential has not been previously reported. As in many early studies, the unmasked amplitude of the wave V complex was significantly larger (30%) in females than males. However, differences in amplitudes of the narrow-band responses were too small to account for the differential in the unmasked response. It is hypothesized that the larger amplitude of the unmasked wave V complex in females occurs because of a faster response time across the cochlea leading to better neural synchrony and, therefore, larger amplitudes. Furthermore, results can be explained by assuming that the stiffness gradient in the cochlea is 13% larger in females than in males. If males and females have the same cochlear tonotopic mapping, the female cochlea should be 13% shorter. This prediction is highly consistent with recent anatomical studies of cochlear length and gender. The results of the present study indicated possibly important cochlear mechanisms that influence the main parameters of ABRs. An understanding of these cochlear mechanisms may improve the diagnostic capabilities of ABRs in patients with peripheral hearing loss.

Place-specific derived cochlear microphonics from human ears

The high-pass noise masking technique was used to obtain derived frequency-specific cochlear microphonics (CM) from subtracted waveforms to rarefaction and condensation stimuli recorded with a tympanic membrane electrode. Two characteristics suggest that the response is place-specific CM: the derived response retains the same frequency as the stimulating toneburst and the response follows the stimulus polarity. For click stimulation, derived neural responses make the place-specific CM difficult to observe except in the 2-1 kHz derived band. In contrast, place-specific CM evoked by 0.5 and 1 kHz tonebursts can usually be detected in at least three derived bands. The amplitude of the response is largest in the derived band with center-frequency (CF) just above that of the toneburst. This discovery of a place-specific CM offers the possibility of assessing (outer) hair cell function in the apical part of the human cochlea.

Pentamidine aerosol increases the number of alveolar macrophages in HIV-infected patients

In order to determine the possible effect of aerosolized pentamidine on the cellular composition of the bronchoalveolar lavage fluid in HIV-infected patients, differential counts of 22 consecutive patients who had been rebronchoscopied after 3-19 months were reviewed. Eleven patients were started on pentamidine prophylaxis subsequent to their first presentation. Eleven patients had never taken pentamidine or had discontinued the prophylactic regimen. Compared to first bronchoscopy, the bronchoalveolar lavage (BAL) from patients on regular prophylaxis revealed a significant increase in absolute alveolar macrophage (AM) counts at second presentation (20.8 +/- 11.2 to 50.3 +/- 39.4 x 10(5) cells/100 ml BAL; P less than 0.01). The AM counts of those without pentamidine remained essentially unchanged. Lymphocytes, including CD4 and CD8 subtypes, and neutrophils did not change over time in either group. The results of this retrospective analysis suggest that, in addition to its antimicrobial action, pentamidine may modulate local lung defence mechanisms, particularly by increasing the absolute number of AM.

Absence of both auditory evoked potentials and auditory percepts dependent on timing cues

An 11-yr-old girl had an absence of sensory components of auditory evoked potentials (brainstem, middle and long-latency) to click and tone burst stimuli that she could clearly hear. Psychoacoustic tests revealed a marked impairment of those auditory perceptions dependent on temporal cues, that is, lateralization of binaural clicks, change of binaural masked threshold with changes in signal phase, binaural beats, detection of paired monaural clicks, monaural detection of a silent gap in a sound, and monaural threshold elevation for short duration tones. In contrast, auditory functions reflecting intensity or frequency discriminations (difference limens) were only minimally impaired. Pure tone audiometry showed a moderate (50 dB) bilateral hearing loss with a disproportionate severe loss of word intelligibility. Those auditory evoked potentials that were preserved included (1) cochlear microphonics reflecting hair cell activity; (2) cortical sustained potentials reflecting processing of slowly changing signals; and (3) long-latency cognitive components (P300, processing negativity) reflecting endogenous auditory cognitive processes. Both the evoked potential and perceptual deficits are attributed to changes in temporal encoding of acoustic signals perhaps occurring at the synapse between hair cell and eighth nerve dendrites. The results from this patient are discussed in relation to previously published cases with absent auditory evoked potentials and preserved hearing.

Chemical modification of the actin binding site of rabbit muscle aldolase by diethylpyrocarbonate

To extend the available information on the significance of the interactions between glycolytic enzymes and the actin component of the cellular ultrastructure, investigations into the compositional characteristics of the actin binding site on one of the major glycolytic enzymes, aldolase, have been undertaken. As the electrostatic nature of the association has been previously reported indicative of a cationic region on the enzyme involved in the binding, these studies have investigated the possibility of the involvement of histidine residues in this binding region. By the use of the histidine specific reagent, diethylpyrocarbonate, we have been able to establish a difference in nature of an actin binding domain and the active site domain which does contain an essential histidine. The results have been discussed in relation to the significance of this finding with respect to the binding of aldolase to subcellular structure.

The influence of deoxyribonuclease I and cytochalasin D on the release of glycolytic enzymes from digitonized cells

In permeabilized cells, deoxyribonuclease I has been demonstrated to cause a decrease in the extent of binding to cellular structure of all of the glycolytic enzymes other than phosphofructokinase, with this decrease being most marked for aldolase and glyceraldehydephosphate dehydrogenase. Cytochalasin D, in contrast, did not produce this type of effect. These results have been discussed in relation to the evidence for the existence of a complex of glycolytic enzymes which binds to elements of the cytoplasmic matrix, and the possible organization of this complex.

Glycolysis--new concepts in an old pathway

A survey of the existing data on the interactions of glycolytic enzymes with the cellular structure in mammalian tissues has substantiated the occurrence of an extensive degree of such associations in all tissues and during all stages of development. Furthermore, a considerable specificity was evident between the individual multiple forms of the enzymes in relation to these associations. In reviewing these data, a model has been developed which proposes that the glycolytic sequence is best described as consisting of a number of segments in vivo, each segment formed by a cluster of isozymes, many of which can interact with the actin containing filaments of the cytomatrix. The novel features of this segmentation and compartmentation have been described, and evidence has been provided that these phenomena collectively play a key role in meeting the different types of energy requirement in the cytoplasm of divergent cell types, with the wide selection of isozymes in this system offering the potential for increased flexibility and control in this important area of metabolism.

Induced temporary threshold shift in guinea pigs

The etiology of an incidentally discovered temporary threshold shift observed in an experimental animal (Harley guinea pig) is discussed with its potential implications for auditory research.

Threshold characteristics of the human auditory brain stem response

Auditory brain stem responses (ABRs) were recorded from ten normal-hearing subjects in response to 100-microseconds clicks from a TDH 49 earphone at a rate of 48 pps and at levels randomly varied in 2-dB steps between 34 and 52 dB p.e. SPL. At each level, 10 000 epochs were averaged with use of a weighted concept and a running estimate was made of the signal-to-noise ratio (SNR). This quantity was used to detect the presence of the ABR and the median threshold was found at 38 dB p.e. SPL. The mean averaged background noise level was 11.3 nVrms, and the "true" ABRrms amplitude function crossed this value at 35.5 dB p.e. SPL, which indicates the level where the SNR = 1. By extrapolation, it was found that the ABR amplitude became zero at 32 dB p.e. SPL. The perceptual thresholds of the click were estimated by means of a modified block up-down procedure, and the median value was found at 33 dB p.e. SPL. The slope of the amplitude function and the magnitude of the averaged background noise are the two factors responsible for the ABR threshold sensitivity, which thus depends on both physiological and technical parameters. Therefore, these have to be considered together with the method of detection when the ABR is used to indicate the hearing sensitivity.

Detection functions for the human auditory brainstem response

Previously obtained data characterizing the auditory brainstem response near the threshold for detection in 10 normal-hearing subjects are used to evaluate the detection method applied. The basic detection formula is described in terms of rates of true positive and false positive ABR detection and in combination with the normative ABR values used to calculate the ABR detection functions as well as the corresponding receiver operating characteristics (ROC curves). The observed distribution of the ABR-threshold levels is similar to that derived from the detection function, and therefore verifies the present results which are based partly on theoretical considerations.

Mechanisms of central conduction time prolongation in brain-stem auditory evoked potentials

The wave I-wave V delay in the auditory brain-stem response is commonly used as a diagnostic tool in otoneurology. Normative values have been established for different populations and different types of stimuli. This I-V delay has been known for some time as "central conduction time" or "central transmission time." This implies that the measure reflects in normal and in pathologic cases delays due to nerve conduction, synaptic transmission, and neural integration and is not caused by cochlear processes. By virtue of the traveling wave delay in the cochlea, amounting to some 4 ms from the base to the "500-Hz place," it is conceivable that this delay contributes to the I-V delay. From a series of 69 pontine angle tumors in which the auditory brain-stem response was recorded, we selected cases with an apparent peripheral origin of a prolonged I-V delay by comparing the whole-click response to responses derived from high-pass noise masking. It seems that cases with an increased I-V delay in the whole-click response but (almost) normal I-V delays in the narrow-band response are indicative of small intracanalicular acoustic neuroma.

A rapid method of concentrating proteins in small volumes with high recovery using Sephadex G-25

A method for concentrating small (10 to 500 microliter) volumes of protein solutions by mixing in a microcentrifuge tube with measured volumes of dry Sephadex G-25 is described. The tube is centrifuged, and the protein solution concentrated up to fivefold passes through a small hole in the base of the tube and is collected. Recovery of protein is 90-95%.

Objective detection of averaged auditory brainstem responses

Detection of an auditory brainstem response, ABR, usually relies on visual evaluation of two or more data acquisition runs of a fixed number of sweeps to determine if there is sufficient replication of the averaged waveforms to indicate a response. Visual interpretation can be difficult when the signal-to-noise ratio is poor because of either a small response or high levels of physiological background noise. Moreover, variations in the background noise from run to run can result in poor or spurious replications of component peaks and troughs in the waveform. A previous study (Elberling & Don, 1984) described a statistical approach for objective evaluation of the quality of an ABR recording. The method uses variance analysis in calculating the ratio of the magnitude of the ABR to the estimated averaged background noise. This study further applies this method to obtain a quantitative definition of the ABR threshold, to demonstrate its application in automatic threshold detection, and to estimate the number of sweeps required to reach detection criterion. Application of this method is valuable in reducing the variability of test interpretation and in maximizing the efficiency of recording ABRs by avoiding the averaging of excessive or insufficient numbers of sweeps. These improvements enhance the cost-benefit of ABR testing to the patient.

Quality estimation of averaged auditory brainstem responses

In its clinical use, the auditory brainstem responses, ABR, are recovered from the background noise by averaging a number of post-stimulus time epochs, sweeps. Normally, the test protocol prescribes a fixed number of sweeps to be employed and recording of replications is frequently recommended, too. Since both the ABR and the background noise differ in magnitude among patients and test sessions, such a test protocol can never ensure a given minimum "quality" or signal-to-noise ratio, SNR, of the averaged ABR. In an attempt to solve this problem, a method is proposed to evaluate, in statistical terms, the "quality" or SNR of the averaged recording. This is done by calculating the ratio between the estimated magnitude of the ABR and that of the averaged background noise. The method can be employed "on-line" in an adaptive strategy to estimate the number of sweeps necessary to obtain a given minimum "quality" of the averaged ABR. It can be used in suprathreshold recordings as well as in automatic "threshold" detection and it is a practical tool to analyze and improve the cost-benefit of the ABR test.

Analysis of the click-evoked brainstem potentials in humans using high-pass noise masking. II. Effect of click intensity

Derived narrow-band brainstem responses were obtained for click levels of 10--60 dB SL in normal hearing subjects. The amplitudes and latencies of the wave I, wave III, and wave V components in the derived BSER were studied as a function of click intensity. Characteristic differences were found between the input-output behavior of waves I and III on one hand and wave V on the other hand, especially for the low-frequency narrow bands (center frequencies of 0.5 and 1.0 kHz). While the wave I and wave III (peak-to-succeeding trough) amplitude showed a small (20--30 dB) dynamic range with saturation effects, the wave V amplitude continued to increase across the intensity range studied. At the high-frequency end (narrow-band center frequencies of 4 and 8 kHz), wave V also showed saturation. It is suggested that this difference across center frequency (place of origin along the cochlear partition) is responsible for the dominance of wave V at low-frequency stimulation (e.g., with tonebursts). The latencies of the three waves studied maintained their constant interwave delays across the observed intensity range in each narrow band. Quite large (up to 3.5 ms) increases in the narrow-band latencies were found for decreasing click levels; this is comparable in value with those for the unmasked BSER although the mechanism seems to be different. The major contribution to the BSER which determines its latencies, originates at 60 dB SL from the 8-kHz region but at low SL (10 and 20 dB) from the 2-kHz region. At these low intensity levels, the contribution from the apical part of the cochlea, however, is still of the same size as that from the high-frequency end.

Electrocochleography and auditory brainstem electric responses in patients with pontine angle tumors

In 45 patients with surgically proven pontine angle tumors, compound action potential (AP) and summating potential (SP) were recorded with transtympanic electrocochleography (ECochG) together with brainstem electric responses (BSER). The aims were to quantify the mechanism by which tumors cause hearing loss and evaluate the diagnostic potentials of ECochG and BSER for detecting eighth nerve and brainstem tumors. Except for AP latency and narrow band AP waveform, response parameters recorded by ECochG are uncorrelated. Four uncorrelated parameters were abnormal in only 10% of the cases, three in 25%, two in 40%, and one in 90%. The BSER criterion was the latency delay between waves I and IV and resulted in about 90% detection, improving to 95% when used in combination with ther interaural wave V delay criterion. ECochG results provide evidence that, for hearing losses up to 60 dB HL, the origin is cochlear, resembling that caused by Meniere's disease. Evidence is presented that the increase in I-V delay in the BSERs is caused by differential action of the tumor upon low and high frequency fibers in the auditory nerve and that desynchronization of the firings of the nerve fibers is of more importance than an increase in neural conduction time. ECochG as the sole test for detection of pontine angle tumors appears to be of limited value. Brainstem response on its own has great merits; however, it should be emphasized that no wave I was detected in about 30% of the cases. The 95% detection score obtained with BSER depends on specifying the latency of wave I. For these cases, we substituted the latency of the AP recorded by ECochG.

Reconstruction of the audiogram using brain stem responses and high-pass noise masking

Contributions to the brain stem electrical responses (BSER) presumably initiated from specific frequency regions of the cochlea with center frequencies similar to the major audiometric frequencies (0.5, 1, 2, 4, and 8 kHz) are derived by the application of a high-pass noise masking technique utilizing click stimuli. In normal hearing subjects, these derived narrow-band responses from the midfrequency regions (4, 2, and 1 kHz) can be recognized at click levels as low as 10 dB HL. For the frequency regions around 8 kHz and 0.5 kHz, these derived responses can be discerned at click levels of 30 dB HL and higher. When one uses the lowest click level at which these derived responses can be obtained from a given frequency region, the differences between a patient with a hearing loss and a normal hearing subject correlate well with the amount of hearing loss (air conduction) recorded by conventional pure tone audiometry. Use of the high-pass noise masking technique to reconstruct the audiogram may be of great potential value in assessing young children and other individuals who cannot or will not respond to conventional audiometry.

Analysis of the click-evoked brainstem potentials in man unsing high-pass noise masking

Brainstem electrical responses (BSER) to 60-dB-SL click in noise high passed at various cutoff frequencies separated b 1/2-octave steps were recorded in normal-hearing adult subjects. By applying a derived response technique, narrow-band contributions to the BSER from specific portions of the basilar membrane were revealed. Latencies and amplitudes of the various waves in the derived BSER were recorded. Results indicate that nearly the whole cochlear partition can contribute to the brainstem response. The shifts in latency of waves I, III, and V and amplitude changes of waves I and III as a function of CF appear to be fully comparable to those of the AP. In contrast, the amplitude behavior of wave V as a function of CF is different from waves I and III depending upon frequency range. The discrepency in the behavior of wave V with respect to the earlier waves suggests some sort of neural reorganization at the level where was V is generated. The fact that there are contributions to the brainstem response from apical portions of the cochlea opens the possibility for extending the brainstem technique in assessing the higher cochlear turn function.