Mean Threshold Research Articles

BIOM-44.18F-DOPA-PET THRESHOLDS FOR BOTH NEWLY DIAGNOSED AND RECURRENT ASTROCYTOMA USING PATHOLOGICAL GROUPING OF SPATIALLY CORRELATED BIOPSIES

Abstract BACKGROUND Glioma radiotherapy planning requires accurate tumor delineation. While T1- contrast-enhanced-MRI (T1-CE-MRI) is the standard, due to blood-brain-barrier breakdown dependencies, T1-CE-MRI fails to reflect the extent of glioma. Studies using amino acid PET tracers report glioma uptake up to 3cm-4cm beyond T1-CE. In this study, amino acid tracer 18F-fluoro-dihydroxyphenylalanine (18F-DOPA) uptake was correlated with histopathological features to determine tumor thresholds. METHODS Using registered 18F-DOPA-PET and T1-CE-MRI images in the Stealth Neuronavigation system targeting concordant and discordant regions, 181 stereotactic biopsy samples (newly-diagnosed=74; recurrent=107) were obtained from 59 enrolled astrocytoma patients across two prospective phase II clinical trials between 2010-2019. An experienced neuropathologist reviewed each sample with hematoxylin and eosin stain and assigned an alphanumeric score: mitotic activity (0=no tumor; 1=no mitosis; 2=few/scattered mitosis; 3=frequent mitosis) and cellular density (A=<25%; B=25%-50%; C=50%-75%; D=>75%). Samples assigned 1C-1D, 2B-2D, or 3A-3D were categorized as histopathological high-score (aggressive disease), remaining samples as low-score. Relative mean (rFDOPA_mean) tumor-to-background uptake ratios were computed for 5mm uniformly expanded volumes from each Stealth biopsy coordinate using the crescent and wedge normalization methods. Relative uptake was compared overall and separately within newly-diagnosed/recurrent disease subgroups. An optimal rFDOPA_mean threshold to delineate high- from low-score was determined using the maximal Youden index of ROC curves. RESULTS Overall, high-score samples (n=116) had higher median (IQR) rFDOPA_mean uptake than low-score samples (n=65): high-score rFDOPA:mean=1.70(1.16-2.26), low-score rFDOPA:mean=1.16(0.83-1.49), Kruskal-Wallis p<0.001. The uptake difference between high- vs. low-score samples was observed within newly-diagnosed and recurrent subgroups, but was only significant for newly-diagnosed (p<0.001). For newly-diagnosed, an rFDOPA:mean=1.49 cutoff between high- and low-score groups shows 69% accuracy, 63% sensitivity, 80% specificity (AUC=0.782). Using the wedge normalization method, rFDOPA_mean values were 0.2 higher than crescent method values. CONCLUSIONS This work presents histologically verified 18F-DOPA-PET thresholds for aggressive disease in newly-diagnosed astrocytoma patients. Separate thresholds will need to be determined for recurrent glioma patients.

Effect of the renin-angiotensin-aldosterone system inhibitors on time to nucleic acid negative conversion in hypertensive patients with SARS-CoV-2 omicron infection: a propensity score matching study.

We examined the relationship between RAAS inhibitor use and Omicron infection in mildly symptomatic patients. This retrospective case-control observational study included 50,121 patients with mild Omicron infection from the largest "Fangcang" shelter hospital in Shanghai between April 9, 2022, and May 21, 2022. Using 1:1 propensity score matching (PSM), we classified 4394 COVID-19 patients into hypertension and non-hypertension groups, and 406 hypertensive patients into RAAS inhibitor and non-RAAS inhibitor groups. The risk of initial symptoms of infection, cumulative negative conversion rates, time to nucleic-acid negative conversion, and viral loads were compared. In the hypertension group, the median number of days for nucleic-acid negative conversion was 7.0 (IQR, 5.0-9.0), which was greater than non-hypertensive group (median (IQR) 6.0 (4.0-8.0), P < 0.001, Cohen's d = 0.29); the mean and minimum cycle threshold values (CT-values) were significantly lower (P < 0.001, Cohen's d = 0.23). In the RAAS inhibitors group, the median number of days for nucleic-acid negative conversion was 7.0 days (IQR, 5.0-9.0), which was shorter than the non-RAAS inhibitors group ([median (IQR)] 8.0 (6.0-10.0), P < 0.001, Cohen's d = 0.34), the cumulative negative conversion rates at 3-8 days being all higher than non-RAAS inhibitors groups (P < 0.05). The most significant difference in negative conversion rate between the RAAS inhibitor and non-RAAS inhibitor group was on the 4th day. No significant difference was observed in mean and minimum CT-values from RAAS inhibitor and non-RAAS inhibitor groups (P > 0.05). RAAS inhibitor use in patients with hypertension is associated with nucleic-acid negative conversion duration and negative conversion rate. RAAS inhibitors clearly do not aggravate or prolong COVID-19.

Safety profile, electrical performances and clinical outcomes of a novel leadless pacemaker; first results from real-world clinical practice in Saudi Arabia

Abstract Introduction Leadless pacemakers (LP) are emerging as an effective and safe alternative to transvenous pacemakers to reduce lead-related and pocket-related complications and to improve patient experience. A new LP system, the Aveir VR, has been approved in 2022 for US and other countries, and in 2023 for Europe, and features innovative characteristics such as the active fixation helix mechanism and the possibility to measure sensing/pacing parameters before LP deployment. Purpose Evaluate safety, electrical performances and clinical outcomes associated with the first Aveir VR LP implants in 2 Hospitals in Saudi Arabia. Methods We performed a prospective evaluation of all-comer patients who received Aveir VR LP. Decision for LP implant was based on conditions such as cardiac pacing indication, lack of upper extremity venous access, risk of device infection, and life expectancy, and using shared decision-making. Clinical and electrical data were collected at implant and at 1st and 6th month visits. Results A total of 54 patients (25 female, mean age 69 years) were included between December 2022 and October 2023. Pacemaker implant indication was AV block in 25 (46%) patients, sinus node disease in 19 (35%) patients, atrial fibrillation and slow ventricular response in 9 (17%) patients and left bundle branch block in 1 (2%) patient. Implant was successful in all attempted cases. Final device position was lower septum in 51/54 (94.4%) patients and mid-septum in 3/54 (5.6%) patients. Mean procedure time was 48±22 minutes and showed a decreasing trend as a function of operator experience with a mean of 55, 50 and 36 minutes in the first, second and third group of consecutive implants, respectively. Mean fluoroscopic time was 11±8 minutes and showed a decreasing trend as a function of operator experience with a mean of 13, 13 and 6 minutes in the first, second and third group of consecutive implants, respectively. Final device position was achieved at first attempt in 42/54 (77.8%) cases and at first or second attempt in 51/54 (94.4%) cases. At implant mean R wave sensing was 7.6±3.7 mV, mean impedance was 724±335 Ohm, mean threshold was 1.0±0.6 V at 0.4 ms. During implant there was one patient with pericardial effusion treated with pericardiocentesis. In a mean follow-up of 73 days there were no procedure-related or device-related complications, electrical parameters showed acceptable values, and all implanted devices performed as expected. Median longevity, estimated at last follow-up visit, was 19 years (interquartile range: 12-20 years). Conclusion First real-world cases of use of a novel leadless pacemaker in Saudi Arabia show optimal feasibility and good safety profile and electrical performances. Procedure and fluoroscopic times were acceptable and decreased as a function of operator experience. Longevity estimations predict very long service life-times.

Serial changes in left atrial strain in symptomatic obstructive hypertrophic cardiomyopathy treated with mavacamten: insights from VALOR-HCM trial

Abstract Background In severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM), the VALOR-HCM phase 3 randomized, double-blind, placebo-controlled clinical trial demonstrated that mavacamten, a cardiac myosin inhibitor, reduces the eligibility for septal reduction therapy with sustained improvement in left ventricular (LV) outflow tract gradients and symptoms. Mavacamten also resulted in favorable cardiac remodeling, including improvement in left atrial volume index (LAVI), LV diastolic function, and biomarkers (NT-proBNP and troponin T). However, the impact of mavacamten on LA function is not known. Objective We sought to assess serial changes in LA strain measures in patients enrolled in the VALOR-HCM trial. Methods VALOR-HCM included 112 symptomatic obstructive HCM patients (mean age 60 years, 51% male). Patients assigned to mavacamten at baseline (n=56) continued therapy for 56 weeks and those assigned to placebo crossed over to mavacamten (n=52) from week 16-56 (40-week exposure). Echocardiographic LA strain assessment was performed according to the current American and European guideline recommendations, using a vendor-neutral post processing software. For assessment of LA strain components (reservoir, conduit, and contraction), the non-foreshortened apical 4-chamber view was utilized. The zero reference was set at end-diastole. Results Serial changes in LAVI and all components of mean LA strain from baseline to week 56 are shown in the Figure. At baseline, LAVI and all mean LA strain values were worse than reported normal mean thresholds. There was a continued and significant improvement in all 3 LA strain values, from baseline to week 56, along with a significant reduction in LAVI. Improvement in LAVI was seen earlier than improvements in LA strain. There was a significant inverse correlation between change in mean LAVI and LA reservoir strain from baseline to week 56 (r= -0.42, p&amp;lt;0.001). Conclusions In the VALOR-HCM trial, average LAVI and baseline LA strain values were significantly worse than reported normal thresholds. Treatment with mavacamten resulted in an improvement in LAVI and LA strain values from baseline through week 56 suggesting a sustained favorable impact on cardiac remodeling. The advantageous cardiac remodeling associated with long-term treatment with mavacamten may in turn have a favorable impact on the observed high burden of atrial tachyarrhythmias in HCM.Serial changes in LA strain in VALOR-HCM

A deep learning method for contactless emotion recognition from ballistocardiogram

Emotion recognition is a major research point in the field of affective computing. Existing research on the application of physiological signals to emotion recognition mainly focuses on the processing of contact signals. However, there are issues with contact signal acquisition equipment, such as limited portability and poor user compliance, which make it difficult to promote its use. To explore a new method for emotion recognition based on contactless ballistocardiogram (BCG), we proposed a SE-CNN model with a multi-class focal loss function. To construct the dataset, we used audio-visual stimuli to evoke the subjects’ emotions and collected data on the subjects’ three discrete emotions, positive, neutral, and negative, through our established BCG signal acquisition system based on a piezoelectric ceramics sensor. Root mean square filter and thresholding were used to detect and eliminate motion artifacts of BCG signals. We did two kinds of preprocessing on BCG signals: wavelet transform and bandpass filtering, to explore the effect of different components of BCG on emotion recognition. Subsequently, we verified the model’s performance and cross-time working ability through traditional K-Fold and our proposed K-Session cross-validation methods. The results showed that the band-pass filtering method was more beneficial to the current classification task. Under K-Fold cross-validation, the model’s accuracy, precision, and recall were 97.21%, 97.00%, and 97.11%. Under K-Session cross-validation, the model’s accuracy, precision, and recall were 94.66%, 93.92%, and 94.86%, respectively, all of which were better than the classification effect of synchronous ECG. The reliability of BCG in contactless emotion recognition was proved.

Selection of inner ear fenestration strategy and surgical effect of patients with oval window atresia accompanied by facial nerve aberration

Objective: To summarize the clinical features and postoperative efficacy of patients with oval window atresia accompanied by facial nerve aberration. Methods: The clinical data of patients with congenital middle ear malformation with facial nerve aberration admitted to our hospital from January 2015 to March 2023 were retrospectively analyzed. There were 97 cases (133 ears) in total. Among them, 39 patients (44 ears) had complete follow-up data, including 27 male patients and 12 females, aged 7-48 years old, with an average age of 17.8 years old. Of these, 14 cases (16 ears) were patients combined with facial nerve aberration, and 25 cases (28 ears) were without facial nerve aberration. The results of imaging examination, pure-tone audiometry, selection of surgical strategy, intraoperative findings and postoperative hearing improvement were summarized and analyzed. The malformations of malleus, incus, stapes, oval window and facial nerve were recorded. Prism 9 software was used to statistically analyze the mean bone conductance and air-bone gap of patients before and after surgery. Results: All the 14 patients (16 ears) with middle ear malformation accompanied by facial nerve aberration and oval window atresia showed poor hearing and no facial palsy since childhood. High resolution CT (HRCT) examination of temporal bone, pure tone audiometry and Gelle test were performed before surgery. The malformations of malleus, incus, stapes, oval window and facial nerve were recorded. Preoperative high-resolution CT (HRCT) examination of temporal bone found 12 ears with 4 or more deformities, accounting for 75.00%, in the group of patients with facial nerve malformation. The preoperative average bone conductive threshold was (15.3±10.4) dB and the average air-bone gap was (46.3±10.6) dB in pure-tone audiometry (0.5, 1, 2, 4kHz). According to the different degrees of facial nerve and ossicle malformation, we performed three different hearing reconstruction strategies for the 14 patients (16 ears) with facial nerve aberration and oval window atresia, including 7 ears of incus bypass artificial stape implantation, 7 ears of Malleostapedotomy (MS) and 2 ears of Malleus-cochlear-prothesis (MCP). After 3 months to 18 months of follow-up, all patients showed no facial paralysis. The postoperative mean bone conductive threshold was (15.7±7.9) dB and air-bone gap was (19.8±8.5) dB. There were significant differences in mean air-bone gap before and after operation (t=7.766, P<0.05), and there was no significant difference between the mean bone conductive threshold before and after surgery (t=0.225, P=0.824). There was no significant difference of mean reduction of air-bone gap between patients with and without facial nerve aberration (t=1.412, P=0.165). There was no significant difference between the three hearing reconstruction strategies. There was no significant displacement of the Piston examined by U-HRCT. Conclusion: For patients of middle ear malformation whose facial nerve cover the oval window partially, incus bypass artificial stape implantation or Malleostapedotomy (MS) can be selected according to the specific condition of auditory ossis malformation, and for patients whose facial nerve completely covers the oval window area, Malleus-cochlear-prothesis (MCP) can be selected. Three types of stapes surgery are safe and reliable for patients with oval window atresia accompanied by facial nerve aberration. There was no significant difference in efficacy between them. Preoperative HRCT assessment of middle ear malformation is effective. There is no significant difference of surgical effect with or without facial nerve aberration. The U-HRCT can be used to evaluate the middle ear malformation before surgery and the Piston implantation status after surgery. Due to the risks of surgery, those who do not want to undergo surgery can choose artificial hearing AIDS, such as hearing aid, vibrating soundbridge, bone bridge or bone-anchored hearing aid.

Development and evaluation of a novel user-operated slider-based audiometry method.

To evaluate a novel user-operated audiometry method allowing users full control in determining their pure-tone hearing thresholds. Comparative study. Participants were recruited from a hearing clinic after undergoing manual audiometry (six frequencies). They then performed test-retests of a new test (slider audiometry, eight frequencies) and completed the System Usability Scale questionnaire. 37 adult participants, including 30 hearing-impaired and seven normal-hearing individuals. Mean (SD) threshold differences for octave frequencies between 250 to 2000 Hz between manual and slider audiometry ranged from -7.8 (6.6) to -5.7 (6.5) dB and were significant. For 4000 and 8000 Hz mean differences were -0.3 (8.4) and 0.0 (9.7) dB and insignificant. Standard deviations ranged from 6.5 to 9.7 dB across six tested frequencies. Slider test-retest mean threshold differences ranged from -1.4 (4.7) to 0.3 (6.0) dB across eight tested frequencies, with standard deviations ranging from 4.1 to 8.5 dB. The average usability score for the slider audiometry was 88.3. When compared to manual audiometry, the slider audiometry demonstrated validity at 4000 and 8000 Hz but found significantly lower thresholds for octave frequencies between 250 to 2000 Hz. Test-retests of the new method revealed small mean differences and acceptable SDs.

Assessment of fluid responsiveness using pulse pressure variation, stroke volume variation, plethysmographic variability index, central venous pressure, and inferior vena cava variation in patients undergoing mechanical ventilation: a systematic review and meta-analysis

ImportanceManeuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes.ObjectiveTo describe maneuvers for assessing fluid responsiveness in mechanically ventilated patients.RegistrationThe protocol was registered at PROSPERO: CRD42019146781.Information sources and searchPubMed, EMBASE, CINAHL, SCOPUS, and Web of Science were search from inception to 08/08/2023.Study selection and data collectionProspective and intervention studies were selected.Statistical analysisData for each maneuver were reported individually and data from the five most employed maneuvers were aggregated. A traditional and a Bayesian meta-analysis approach were performed.ResultsA total of 69 studies, encompassing 3185 fluid challenges and 2711 patients were analyzed. The prevalence of fluid responsiveness was 49.9%. Pulse pressure variation (PPV) was studied in 40 studies, mean threshold with 95% confidence intervals (95% CI) = 11.5 (10.5–12.4)%, and area under the receiver operating characteristics curve (AUC) with 95% CI was 0.87 (0.84–0.90). Stroke volume variation (SVV) was studied in 24 studies, mean threshold with 95% CI = 12.1 (10.9–13.3)%, and AUC with 95% CI was 0.87 (0.84–0.91). The plethysmographic variability index (PVI) was studied in 17 studies, mean threshold = 13.8 (12.3–15.3)%, and AUC was 0.88 (0.82–0.94). Central venous pressure (CVP) was studied in 12 studies, mean threshold with 95% CI = 9.0 (7.7–10.1) mmHg, and AUC with 95% CI was 0.77 (0.69–0.87). Inferior vena cava variation (∆IVC) was studied in 8 studies, mean threshold = 15.4 (13.3–17.6)%, and AUC with 95% CI was 0.83 (0.78–0.89).ConclusionsFluid responsiveness can be reliably assessed in adult patients under mechanical ventilation. Among the five maneuvers compared in predicting fluid responsiveness, PPV, SVV, and PVI were superior to CVP and ∆IVC. However, there is no data supporting any of the above mentioned as being the best maneuver. Additionally, other well-established tests, such as the passive leg raising test, end-expiratory occlusion test, and tidal volume challenge, are also reliable.

THE USE OF NERVE MONITORIZATION IN PAROTID, SUBMANDIBULAR GLAND AND FACIAL SURGERY AND ITS EFFECT ON PROGNOSIS

Objective: The facial nerve and its branches are at risk during facial surgery. The surgery with the highest risk is parotid and submandibular gland surgery. An attempt was made to determine threshold values in terms of paralysis in nerve monitoring parameters. These determined values could not be used to predict facial nerve function after surgery. The aim of this study is to investigate the relationship between the parameters detected by nerve stimulation during surgery and postoperative facial nerve dysfunction in patients who underwent parotid and submandibular gland surgery. Material and Methods: A total of 29 facial nerve branches of 13 patients who underwent superficial parotidectomy or submandibular gland resection were examined. Patients were examined in two groups: those who did not develop paralysis after surgery and those who developed paralysis or sequelae. The relationship between the patient's pre- and postoperative House-Brackmann staging and potential changes detected during surgery was investigated. Results: Paralysis was detected in 8 of 29 nerves that were stimulated, and the affected branches were the cervicofacial branch and the marginal mandibular branch. No difference was observed in the mean threshold stimulation values and responses determined before, during and at the end of dissection between patients who developed paralysis and those who did not. Conclusion: Unlike the literature, it is determined that no electrophysiological measurement result can predict the postoperative phase as a result of ROC-curve analysis and logistic regression analysis. It is thought that these results are caused by the fact that the developing paralysis is at low stages and heal within one month.

Efficacy comparison of multipoint and single point scanning panretinal laser photocoagulation in non-proliferative diabetic retinopathy treatment.

Non-proliferative diabetic retinopathy (NPDR) poses a significant challenge in diabetes management due to its microvascular changes in the retina. Laser photocoagulation, a conventional therapy, aims to mitigate the risk of progressing to proliferative diabetic retinopathy (PDR). To compare the efficacy and safety of multi-spot vs single-spot scanning panretinal laser photocoagulation in NPDR patients. Forty-nine NPDR patients (86 eyes) treated between September 2020 and July 2022 were included. They were randomly allocated into single-spot (n = 23, 40 eyes) and multi-spot (n = 26, 46 eyes) groups. Treatment outcomes, including best-corrected visual acuity (BCVA), central macular thickness (CMT), and mean threshold sensitivity, were assessed at predetermined intervals over 12 months. Adverse reactions were also recorded. Energy levels did not significantly differ between groups (P > 0.05), but the multi-spot group exhibited lower energy density (P < 0.05). BCVA and CMT improvements were noted in the multi-spot group at one-month post-treatment (P < 0.05). Adverse reaction incidence was similar between groups (P > 0.05). While energy intensity and safety were comparable between modalities, multi-spot scanning demonstrated lower energy density and showed superior short-term improvements in BCVA and CMT for NPDR patients, with reduced laser-induced damage.

Effect of intra-vaginal electric stimulation on bladder compliance in stress urinary incontinence patients: the involvement of autonomic tone.

In addition to the well-established advantage that strengthened pelvic musculature increases urethral resistance in stress urinary incontinence (SUI) patients, intra-vaginal electrical stimulation (iVES) has been shown in preclinical studies to improve bladder capacity via the pudendal-hypogastric mechanism. This study investigated whether iVES also benefits bladder storage in SUI patients by focusing on compliance, a viscoelastic parameter critically defining the bladder's storage function, in a clinical study. Moreover, the potential involvement of stimulation-induced neuromodulation in iVES-modified compliance was investigated by comparing the therapeutic outcomes of SUI patients treated with iVES to those who underwent a trans-obturator tape (TOT) implantation surgery, where a mid-urethral sling was implanted without electric stimulation. Urodynamic and viscoelastic data were collected from 21 SUI patients treated with a regimen combining iVES and biofeedback-assisted pelvic floor muscle training (iVES-bPFMT; 20-min iVES and 20-min bPFMT sessions, twice per week, for 3 months). This regimen complied with ethical standards. Data from 21 SUI patients who received TOT implantation were retrospectively analyzed. Mean compliance (Cm), infused volume (Vinf), and threshold pressure (Pthr) from the pressure-flow/volume investigations were assessed. Compared with the pretreatment control, iVES-bPFMT consistently and significantly increased Cm (18/21; 85%, p = 0.017, N = 21) and Vinf (16/21; 76%, p = 0.046; N = 21) but decreased Pthr (16/21; 76%, p = 0.026, N = 21). In contrast, TOT implantation did not result in consistent or significant changes in Cm, Vinf, or Pthr (p = 0.744, p = 0.295, p = 0.651, respectively; all N = 21). Our results provide viscoelastic and thermodynamic evidence supporting an additional benefit of iVES-bPFMT to bladder storage in SUI patients by modifying bladder compliance, possibly due to the potentiated hypogastric tone, which did not occur in TOT-treated SUI patients.Clinical trial registration: ClinicalTrials.gov, NCT02185235 and NCT05977231.

Assessment of the status of PM2.5 and ground-level O3 pollution variations and meteorological factor effects: A case study in Long An Province, Vietnam

Abstract Long An Province has a favorable geographical position in socio-economic development exchanges and is a fundamental bridge between the area of Ho Chi Minh City (HCMC) and the Southeast localities with the Southwestern provinces. Along with the master plan for socio-economic development with a vision for 2030, the province’s air quality issues, especially PM2.5 and surface O3 pollution, will be complex and pose many challenges to effective air pollution management and control. This study aims to investigate the effects of major meteorological characteristics (temperature–T, relative humidity–RH, surface pressure–P, and wind speed–WS) on temporal changes in the correlation between PM2.5 and surface O3 concentrations in Long An province in the 2018-2020 period (computed by a system of coupled WRF/CMAQ models) through trend evaluation using by Mann-Kendall (MK) Test and Theil-Sen Slope, and Pearson correlation analysis. The study results reported that in terms of temporal variations, both value levels of PM2.5 and O3 in the dry season tended to surpass that in the rainy season. Moreover, PM2.5 levels tended to exceed the 24-hour mean threshold (between 1.001 and 3.14 times) and the annual mean threshold (from 1.81 to 2.03 times) of the Vietnamese National Ambient Air Quality Standard. Based on the Pearson correlation analysis, significant influences of meteorological conditions on the pollution status of PM2.5 and surface O3 were also demonstrated, such as the different positive and negative correlations of each meteorological factor on concentration. These outstanding results serve as an essential reference for developing air quality targets and proposing future air pollutant control measures in Long An Province.

Composite Outcome Measures for Psoriatic Arthritis: OMERACT and 3 and 4 Visual Analog Scale Progress in 2023.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) psoriatic arthritis (PsA) working group provided updates at the GRAPPA 2023 annual meeting on its work to evaluate composite outcome measures for PsA. An ongoing systematic literature review is in progress to evaluate psychometric measurement properties using the OMERACT filter 2.2 for a list of candidate composite outcome measures, which include minimal disease activity (MDA), Disease Activity for Psoriatic Arthritis (DAPSA), American College of Rheumatology (ACR) response criteria, Psoriatic Arthritis Disease Activity Score (PASDAS), Composite Psoriatic Disease Activity Index (CPDAI), 3 visual analog scale (3VAS), and 4VAS. The performance of the 3VAS and 4VAS in clinical practice and a synthesis of new data were presented, including estimates for minimal clinically important differences and thresholds of meaning, discrimination and construct validity, and longitudinal construct validity. Numeric rating scale (NRS) versions of the VAS have also been tested. Performance characteristics and psychometric properties are similar to the ASSESS study, a UK multicenter study, indicating that the VAS scales may be feasible tools for routine clinical care with a preference for the 4VAS because of superior face validity and clinical utility.

The Influence of Asymmetric Hearing Loss on Peripheral and Central Auditory Processing Abilities in Patients With Vestibular Schwannoma.

Asymmetric or unilateral hearing loss (AHL) may cause irreversible changes in the processing of acoustic signals in the auditory system. We aim to provide a comprehensive view of the auditory processing abilities for subjects with acquired AHL, and to examine the influence of AHL on speech perception under difficult conditions, and on auditory temporal and intensity processing. We examined peripheral and central auditory functions for 25 subjects with AHL resulting from vestibular schwannoma, and compared them to those from 24 normal-hearing controls that were matched with the AHL subjects in mean age and hearing thresholds in the healthy ear. Besides the basic hearing threshold assessment, the tests comprised the detection of tones and gaps in a continuous noise, comprehension of speech in babble noise, binaural interactions, difference limen of intensity, and detection of frequency modulation. For the AHL subjects, the selected tests were performed separately for the healthy and diseased ear. We observed that binaural speech comprehension, gap detection, and frequency modulation detection abilities were dominated by the healthy ear and were comparable for both groups. The AHL subjects were less sensitive to interaural delays, however, they exhibited a higher sensitivity to sound level, as indicated by lower difference limen of intensity and a higher sensitivity to interaural intensity difference. Correlations between the individual test scores indicated that speech comprehension by the AHL subjects was associated with different auditory processing mechanisms than for the control subjects. The data suggest that AHL influences both peripheral and central auditory processing abilities and that speech comprehension under difficult conditions relies on different mechanisms for the AHL subjects than for normal-hearing controls.

Client Oriented Scale of Improvement in First-Time and Experienced Hearing Aid Users: An Analysis of Five Predetermined Predictability Categories through Audiometric and Speech Testing.

Objectives: The aim of our investigation was to explore the relationship between unaided pure-tone and speech audiometry and self-reported aided performance measured according to five predetermined COSI categories among first-time hearing aid users and experienced hearing aid users. Methods: Data from 286 patients were retrospectively evaluated. We divided the sample into first-time hearing aid users (G1) and experienced hearing aid users (G2). The correlation between unaided tonal and speech audiometry and five preliminary selected client-oriented scale of improvement (COSI) categories was studied. Results: A greater percentage of hearing aid users aged >80 years and a higher prevalence of severe-to-profound hearing loss in G2 group were observed (p < 0.05). For the total cohort, a mean hearing threshold of 60.37 ± 18.77 db HL emerged in the right ear, and 59.97 ± 18.76 db HL was detected in the left ear (p > 0.05). A significant statistical difference was observed in the group of first-time hearing aid users for the "Television/Radio at normal volume" item, where patients with a lower speech intellection threshold (SIT) were associated with higher COSI scores (p = 0.019). Studying the relationship between the speech reception threshold (SRT) and the COSI item "conversation with 1 or 2 in noise" evidenced worse speech audiometry in patients who scored ≤2 among experienced hearing aid users (p = 0.00012); a higher mean 4-8 kHz frequencies threshold for the better ear was found within the G2 group among those who scored ≤2 in the COSI item "conversation with 1 or 2 in quiet" (p = 0.043). Conclusions: Our study confirms a poor correlation between unaided tonal and speech audiometry and self-reported patient assessment. Although we included only five COSI categories in this study, it is clear that unaided audiometric tests may drive the choice of proper hearing rehabilitation, but their value in predicting the benefit of hearing aids remains limited.

Personality Measurement of Students Using Item Response Theory Models: Stability Responses from Nigerian Institutions

Item Response Theory (IRT) is utilised to detect bias in assessment tools and address issues such as faked or manipulated responses, enhancing the reliability and stability of conclusions in personality assessment. This article examines the item parameter estimates of a scale and the effectiveness of one-, two-, and three-parameter logistic models in analysing response stability in personality measurement from repeated administration. Three hundred undergraduate students at three tertiary institutions in Nigeria were sampled using a multi-stage sampling procedure. Data was collected using an adapted version of the Big Five Inventory (BFI) with a reliability coefficient of 0.85. The results showed that the item parameter estimates (mean threshold) are within the recommended benchmarks. A comparison of the three IRT models based on the Likelihood ratio (InL), Akaike Information Criterion (AIC), and Bayesian Information Criterion (BIC) values revealed that the two-parameter logistic model best fit the personality data among undergraduates from repeated administration. It is recommended that, rather than relying solely on a statistical decision-making process, IRT fit and model comparison should be applied to gain insight into the functioning of items and tests.

Inter-trial Variation in the Sensitivity of Thermal Threshold Testing for the Diagnosis of Neuropathy in Type 2 Diabetes Mellitus.

Thermal threshold testing (TTT) is a simple non-invasive approach for diagnosing diabetic neuropathy earlier. Conventionally the TTT is done in all four limbs and at least 6 trials are done to obtain the mean threshold, which is time consuming. We propose to assess the validity and reliability of reduced number of trials of TTT in the lower limbs. After obtaining ethics approval from the Institute Ethics Committee, 100 patients with type 2 Diabetes Mellitus of both gender between the ages of 35 to 65 years attending medicine OPD were recruited. Neuropathy assessment was done using Temperature threshold testing. At least 6 trials were performed for each site and the mean threshold obtained. The mean of 5 trials, 4 trials and 3 trials were noted for the comparison. On comparing hot tests of 3 trials with 6 trials had a sensitivity and specificity of 88.7% and 96.6 %. In cold threshold testing, 4 trials and 3 trials showed similar results of sensitivity of 77.8%, specificity of 98.8%. The measures of agreement between the hot trials 6 vs 5 had Kappa value of 0.953, 6vs 4 showed a Kappa value of 0.862 and 6 vs 3 showed Kappa value of 0.819. Hot threshold tests of lower limb are more sensitive than cold thresholds. The 4 trial test is a reliable test and can be performed over 6 trial tests. When time is a factor, three trials are sufficient to diagnose small fibre neuropathy.

Normoacusia y discriminación verbal en entornos sonoros reales

IntroductionHuman beings are constantly exposed to complex acoustic environments every day, which even pose challenges for individuals with normal hearing. Speech perception relies not only on fixed elements within the acoustic wave but is also influenced by various factors. These factors include speech intensity, environmental noise, the presence of other speakers, individual specific characteristics, spatial separatios of sound sources, ambient reverberation, and audiovisual cues. The objective of this study is twofold: to determine the auditory capacity of normal hearing individuals to discriminate spoken words in real-life acoustic conditions and perform a phonetic analysis of misunderstood spoken words. Materials and methodsThis is a descriptive observational cross-sectional study involving 20 normal hearing individuals. Verbal audiometry was conducted in an open-field environment, with sounds masked by simulated real-word acoustic environment at various sound intensity levels. To enhance sound emission, 2D visual images related to the sounds were displayed on a television. We analyzed the percentage of correct answers and performed a phonetic analysis of misunderstood spanish bisyllabic words in each environment. Results14 women (70%) and 6 men (30%), with an average age of 26±5,4 years and a mean airway hearing threshold in the right ear of 10,56±3,52dB SPL and in the left ear of 10,12±2,49dB SPL. The percentage of verbal discrimination in the ‘Ocean’ sound environment was 97,2±5,04%, ‘Restaurant’ was 94±4,58%, and ‘Traffic’ was 86,2±9,94% (p=0,000). Regarding the phonetic analysis, the allophones that exhibited statistically significant differences were as follows: [o] (p=0,002) within the group of vocalic phonemes, [n] (p=0,000) of voiced nasal consonants, [ɾ] (p=0,0016) of voiced fricatives, [b] (p=0,000) and [g] (p=0,045) of voiced stops. ConclusionsThe dynamic properties of the acoustic environment can impact the ability of a normal hearing individual to extract information from a voice signal. Our study demonstrates that this ability decreases when the voice signal is masked by one or more simultaneous interfering voices, as observed in a ‘Restaurant’ environment, and when it is masked by a continuous and intense noise environment such as ‘Traffic’. Regarding the phonetic analysis, when the sound environment was composed of continuous-low frequency noise, we found that nasal consonants were particularly challenging to identify. Furthermore, in situations with distracting verbal signals, vowels and vibrating consonants exhibited the worst intelligibility.

Normal hearing and verbal discrimination in real sounds environments

IntroductionHuman beings are constantly exposed to complex acoustic environments every day, which even pose challenges for individuals with normal hearing. Speech perception relies not only on fixed elements within the acoustic wave but is also influenced by various factors. These factors include speech intensity, environmental noise, the presence of other speakers, individual specific characteristics, spatial separatios of sound sources, ambient reverberation, and audiovisual cues. The objective of this study is twofold: to determine the auditory capacity of normal hearing individuals to discriminate spoken words in real-life acoustic conditions and perform a phonetic analysis of misunderstood spoken words. Materials and methodsThis is a descriptive observational cross-sectional study involving 20 normal hearing individuals. Verbal audiometry was conducted in an open-field environment, with sounds masked by simulated real-word acoustic environment at various sound intensity levels. To enhance sound emission, 2D visual images related to the sounds were displayed on a television. We analyzed the percentage of correct answers and performed a phonetic analysis of misunderstood Spanish bisyllabic words in each environment. Results14 women (70%) and 6 men (30%), with an average age of 26 ± 5,4 years and a mean airway hearing threshold in the right ear of 10,56 ± 3,52 dB SPL and in the left ear of 10,12 ± 2,49 dB SPL. The percentage of verbal discrimination in the “Ocean” sound environment was 97,2 ± 5,04%, “Restaurant” was 94 ± 4,58%, and “Traffic” was 86,2 ± 9,94% (p = 0,000). Regarding the phonetic analysis, the allophones that exhibited statistically significant differences were as follows: [o] (p = 0,002) within the group of vocalic phonemes, [n] (p = 0,000) of voiced nasal consonants, [r] (p = 0,0016) of voiced fricatives, [b] (p = 0,000) and [g] (p = 0,045) of voiced stops. ConclusionThe dynamic properties of the acoustic environment can impact the ability of a normal hearing individual to extract information from a voice signal. Our study demonstrates that this ability decreases when the voice signal is masked by one or more simultaneous interfering voices, as observed in a “Restaurant” environment, and when it is masked by a continuous and intense noise environment such as “Traffic”. Regarding the phonetic analysis, when the sound environment was composed of continuous-low frequency noise, we found that nasal consonants were particularly challenging to identify. Furthermore in situations with distracting verbal signals, vowels and vibrating consonants exhibited the worst intelligibility.

Impact of Migraine and Vestibular Migraine on Audiometric Profiles and Quality of Life in Patients With Tinnitus.

To investigate the clinical manifestations and complete auditory function in primary tinnitus patients with and without migraine or vestibular migraine. Retrospective case-control study. A tertiary referral center. This study enrolled 298 patients from the Kaohsiung Veterans General Hospital. All patients were diagnosed with primary tinnitus by a neurotologist between April 2020 and August 2021. Patients were excluded if they had histories of chronic otitis media, idiopathic sudden sensorineural hearing loss, Ménière's disease, skull base neoplasm, or temporal bone trauma. Twenty-five-item Tinnitus Handicap Inventory (THI), speech audiometry including speech recognition threshold, most comfortable level, uncomfortable loudness levels, dynamic range, and pure-tone audiometry. Objective hearing loss is defined as a mean threshold greater than 25 dB. Extremely elevated THI is defined as a score greater than 1 standard deviation above the mean THI. Among the 298 patients with tinnitus, 149 were women and 149 were men, with a mean age of 57.06 (range, 19.22-94.58) years.A total of 125 patients completed the THI questionnaire during their initial visit. The median THI score was 32 (95% confidence interval: 13.98-56.00), and the mean score was 34.99 with a standard deviation of 21.01. The sole contributing factor significantly associated with higher total THI score was the diagnosis of migraine or vestibular migraine (p < 0.001, odds ratio = 19.41).Tinnitus patients with migraine or vestibular migraine exhibited significantly lower mean pure-tone auditory thresholds (right 22.2 versus 29.5, p = 0.002; left 22.5 versus 30.4, p < 0.001), speech recognition threshold (right 20.0 versus 25.2, p = 0.016; left 20.2 versus 25.5, p = 0.019), and most comfortable levels values (right 46.1 versus 51.4, p = 0.007; left 46.9 versus 51.4, p = 0.021) compared with the tinnitus patients without migraine. In this population-based study, patients with primary tinnitus experienced significantly higher THI scores and exhibited concurrent symptoms, including dizziness/vertigo, cervicalgia, and migraine or vestibular migraine. Among these parameters, the diagnosis of migraine or vestibular migraine was the sole contributor to significant higher THI score.