Δευτέρα 7 Δεκεμβρίου 2020

Epicutaneous Immunotherapy for Treatment of Peanut Allergy: Follow-up from the Consortium for Food Allergy Research

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Capsule Summary: With extended Viaskin peanut 250 mcg treatment for 130 weeks, persistent desensitization and immunomodulatory changes were observed, associated with favorable safety, tolerability, and adherence profiles. Treatment success was observed predominantly in younger participants.
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Relationship between cognitive impairment and olfactory function among older adults with olfactory impairment

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Understanding the relationships among aging, cognitive function, and olfaction may be useful for diagnosing olfactory decline in older adults. Olfactory function declines in the early stage of neurodegenerative diseases, including Alzheimer's and Parkinson's diseases. Aging and cognitive impairment are associated with olfactory decline. Moreover, the assessment of hyposmia and anosmia is paramount to the diagnosis of neurodegenerative diseases. We aimed to assess the relationships among aging, cognitive function, and olfaction in patients with olfactory impairment.
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Idiopathic Sudden Sensorineural Hearing Loss: Speech Intelligibility Deficits Following Threshold Recovery

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Objectives: This retrospective study tests the hypothesis that patients who have recovered from idiopathic sudden sensorineural hearing loss (SSNHL) show deficits in word recognition tasks that cannot be entirely explained by a loss in audibility. Design: We reviewed the audiologic profile of 166 patients presenting with a unilateral SSNHL. Hearing loss severity, degree of threshold recovery, residual hearing loss, and word recognition performance were considered as outcome variables. Age, route of treatment, delay between SSNHL onset and treatment, and audiogram configuration were considered as predictor variables. Results: Severity, residual hearing loss, and recovery were highly variable across patients. While age and onset-treatment delay could not account for the severity, residual hearing loss and recovery in thresholds, configuration of the SSNHL and overall inner ear status as measured by thresholds on the contralateral ear were predictive of threshold recovery. Speech recognition performance was significantly poorer than predicted by the speech intelligibility curve derived from the patient's audiogram. Conclusions: SSNHL is associated with (1) changes in thresholds that are consistent with ischemia and (2) speech intelligibility deficits that cannot be entirely explained by a change in hearing sensitivity. ACKNOWLEDGMENTS: The authors are grateful to William Goedicke and Piotr Marciniak for their technical help and logistic support. This work was supported by the National Institutes of Health—National Institute on Deafness and Other Communication Disorders P50 DC015857 (S.F.M., Project principal investigator). S.F.M. conceived and designed research; M.O. collected the data, A.P. developed software for data acquisition and analysis, M.O. and S.F.M. performed data analysis, and S.F.M., D.B.W., and M.C.L. wrote, edited and revised the article. The authors have no conflicts of interest to disclose. Received June 8, 2020; accepted October 1, 2020 Address for correspondence: Stéphane F. Maison, Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA 02114-3096, USA. E-mail: stephane_maison@meei.harvard.edu Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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Efficient Detection of Cortical Auditory Evoked Potentials in Adults Using Bootstrapped Methods

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Background: Statistical detection methods are useful tools for assisting clinicians with cortical auditory evoked potential (CAEP) detection, and can help improve the overall efficiency and reliability of the test. However, many of these detection methods rely on parametric distributions when evaluating test significance, and thus make various assumptions regarding the electroencephalogram (EEG) data. When these assumptions are violated, reduced test sensitivities and/or increased or decreased false-positive rates can be expected. As an alternative to the parametric approach, test significance can be evaluated using a bootstrap, which does not require some of the aforementioned assumptions. Bootstrapping also permits a large amount of freedom when choosing or designing the statistical test for response detection, as the distributions underlying the test statistic no longer need to be known prior to the test. Objectives: To improve the reliability and efficiency of CAEP-related applications by improving the specificity and sensitivity of objective CAEP detection methods. Design: The methods included in the assessment were Hotelling's T2 test, the Fmp, four modified q-sample statistics, and various template-based detection methods (calculated between the ensemble coherent average and some predefined template), including the correlation coefficient, covariance, and dynamic time-warping (DTW). The assessment was carried out using both simulations and a CAEP threshold series collected from 23 adults with normal hearing. Results: The most sensitive method was DTW, evaluated using the bootstrap, with maximum increases in test sensitivity (relative to the conventional Hotelling's T2 test) of up to 30%. An important factor underlying the performance of DTW is that the template adopted for the analysis correlates well with the subjects' CAEP. Conclusion: When subjects' CAEP morphology is approximately known before the test, then the DTW algorithm provides a highly sensitive method for CAEP detection. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors would also like to thank Jo Brooks and Sara Al-Hanbali for data collection. This article presents independent research funded by the Oticon Fonden and by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0214-33009). K.J.M. was supported by the NIHR Manchester Biomedial Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. M.A.C. and D.M.S. contributed toward algorithm design and data analysis, S.L.B., K.J.M., A.V., M.A.S., J.M.H., and L.B.S. contributed toward project conception and/or experiment design and/or data acquisition and interpretation. All authors contributed toward the drafting and critical revision of the manuscript. The authors declare no conflicts of interest to disclose. Received September 27, 2019; accepted August 12, 2020. Address for correspondence: Michael Alexander Chesnaye, Institute of Sound and Vibration Research, Faculty of Engineering and the Environment, University of Southampton, United Kingdom. E-mail: mac1r19@soton.ac.uk Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms

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Objectives: The aim was to assess the internal consistency and convergent and discriminant validity of a new questionnaire for hyperacusis, the Inventory of Hyperacusis Symptoms (IHS; Greenberg & Carlos 2018), using a clinical population. Design: This was a retrospective study. Data were gathered from the records of 100 consecutive patients who sought help for tinnitus and/or hyperacusis from an audiology clinic in the United Kingdom. The average age of the patients was 55 years (SD = 13 years). Audiological measures were the pure-tone average threshold (PTA) and uncomfortable loudness levels (ULL). Questionnaires administered were: IHS, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire-9. Results: Cronbach's alpha for the 25-item IHS questionnaire was 0.96. Neither the total IHS score nor scores for any of its five subscales were correlated with the PTA of the better or worse ear. This supports the discriminant validity of the IHS, as hyperacusis is thought to be independent of the PTA. There were moderately strong correlations between IHS total scores and scores for the HQ, Tinnitus Handicap Inventory, Generalized Anxiety Disorder, and Patient Health Questionnaire-9, with r = 0.58, 0.58, 0.61, 0.54, respectively. Thus, although IHS scores may reflect hyperacusis itself, they may also reflect the coexistence of tinnitus, anxiety, and depression. The total score on the IHS was significantly different between patients with and without hyperacusis (as diagnosed based on ULLs or HQ scores). Using the HQ score as a reference, the area under the receiver operating characteristic for the IHS was 0.80 (95% confidence interval = 0.71 to 0.89) and the cutoff point of the IHS with high est overall accuracy was 56/100. The corresponding sensitivity and specificity were 74% and 82%. Conclusions: The IHS has good internal consistency and reasonably high convergent validity, as indicated by the relationship of IHS scores to HQ scores and ULLs, but IHS scores may also partly reflect the co-occurrence of tinnitus, anxiety, and depression. We propose an IHS cutoff score of 56 instead of 69 for diagnosing hyperacusis. ACKNOWLEDGMENTS: We thank the members of the THTSC at RSCH (Viveka Owen, Jemma Hatton, Jennifer Whiffin, Jenni Stevens, and Judith Ballinger) for their help in data collection. The authors have no conflicts of interest to disclose. Received October 20, 2019; accepted October 3, 2020 Address for correspondence: Hashir Aazh, Tinnitus & Hyperacusis Therapy Specialist Clinic, Audiology Department, Royal Surrey NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, United Kingdom. E-mail: info@hashirtinnitusclinic.com Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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Advances in cutaneous allergy

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Atopic dermatitis (AD) has now been well documented to be associated with an important impact on quality of life and is a major driver of not only systemic comorbidities including other allergic diseases (such as asthma and food allergy) but also cardiovascular and autoimmune diseases.1 Sleep disturbance and adverse effects on mental health are common in patients with AD. A major contributor for these events is the skin and resultant systemic immune activation associated with AD.2 Recent studies support the importance of skin barrier dysfunction in driving cutaneous allergy.
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Frequency of awake bruxism behavior in orthodontic patients: randomized clinical trial

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Abstract

Introduction

The influence of aligners on the activity of the masticatory muscles is still controversial, especially regarding the behavior associated with awake bruxism (AB).

Objective

To compare the frequency of AB behaviors between patients treated with aligners and fixed appliances.

Methods

The sample comprised 38 Class I patients (mean age 22.08 years), divided by simple randomization into two groups: OA group; orthodontic aligners (n 19) and FA group; fixed appliance (n 19). The frequency of AB was investigated by the ecological momentary assessment using an online device (mentimeter), during 7 following days at different timepoints, before and after appliance placement and in the 2nd, 3rd, 4th and 6th months of orthodontic treatment. These variables were also evaluated: level of anxiety by the State‐Trait Anxiety Inventory, stress by the Perceived Stress Scale, catastrophizing related to pain and degree of hypervigilance by the Pain Vigilance and Awareness Questionnaire, and the presence of facial pain evaluated by the DC/TMD.

Results

There was no difference between groups in the frequency of AB behaviors, with mean of 53.5% for group OA and 51.3% for FA. The most frequent behavior was slightly touching the teeth, and in FA group there was a significant reduction in this behavior soon after appliance placement. The groups did not differ concerning the degree of anxiety, stress, catastrophizing, hypervigilance and facial pain.

Conclusion

The orthodontic treatment performed with aligners or fixed appliances did not influence the frequency of AB during the 6 months of treatment.

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