Measures of Speech Understanding in Noise for Young Children with a Cochlear Implant in Mainstream and Special Education

The use of two types of speech-in-noise (SPIN) assessment, namely digits-in-noise self-tests and open-set, monosyllabic word tests, to assess the SPIN understanding performance of children with cochlear implants (CI) in mainstream and special education, was investigated. The tests' feasibility and reliability and the influence of specific cognitive abilities on their results were studied. The results of 30 children with CIs in mainstream and special education were compared to those of 60 normal-hearing children in elementary school. Results indicate that the digit triplet test (DTT) was feasible for all children tested in this study, as seen by the familiarity of all the digits, the high stability of the test results (<3 dB SNR), and a small measurement error (≤2 dB SNR). Remembering full triplets did not form a problem and results did not show systematic attention loss. For children with CIs, the performance on the DTT was strongly related to the performance on the open-set monosyllabic word-in-noise task. However, small but significant differences were observed in the performance of children with CIs in mainstream and special education on the monosyllabic word test. Both tests showed little influence of cognitive abilities, making them both useful in situations where the bottom-up auditory aspect of SPIN performance needs to be investigated or in situations where sentence-in-noise tests are too challenging.

Correction to: [89Zr]Zr-cetuximab PET/CT as biomarker for cetuximab monotherapy in patients with RAS wild-type advanced colorectal cancer

Missing Electronic Supplementary Materials.

[89Zr]Zr-cetuximab PET/CT as biomarker for cetuximab monotherapy in patients with RAS wild-type advanced colorectal cancer

PURPOSE

One-third of patients with RAS wild-type mCRC do not benefit from anti-EGFR monoclonal antibodies. This might be a result of variable pharmacokinetics and insufficient tumor targeting. We evaluated cetuximab tumor accumulation on [⁸⁹Zr]Zr-cetuximab PET/CT as a potential predictive biomarker and determinant for an escalating dosing strategy.

PATIENTS AND METHODS

PET/CT imaging of [⁸⁹Zr]Zr-cetuximab (37 MBq/10 mg) after a therapeutic pre-dose (500 mg/m² ≤ 2 h) cetuximab was performed at the start of treatment. Patients without visual tumor uptake underwent dose escalation and a subsequent [⁸⁹Zr]Zr-cetuximab PET/CT. Treatment benefit was defined as stable disease or response on CT scan evaluation after 8 weeks.

RESULTS

Visual tumor uptake on [⁸⁹Zr]Zr-cetuximab PET/CT was observed in 66% of 35 patients. There was no relationship between PET positivity and treatment benefit (52% versus 80% for PET-negative, P = 0.16), progression-free survival (3.6 versus 5.7 months, P = 0.15), or overall survival (7.1 versus 9.4 months, P = 0.29). However, in 67% of PET-negative patients, cetuximab dose escalation (750-1250 mg/m²) was applied, potentially influencing outcome in this group. None of the second [⁸⁹Zr]Zr-cetuximab PET/CT was positive. Eighty percent of patients without visual tumor uptake had treatment benefit, making [⁸⁹Zr]Zr-cetuximab PET/CT unsuitable as a predictive biomarker. Tumor SUV_peak did not correlate to changes in tumor size on CT (P = 0.23), treatment benefit, nor progression-free survival. Cetuximab pharmacokinetics were not related to treatment benefit. BRAF mutations, right-sidedness, and low sEGFR were correlated with intrinsic resistance to cetuximab.

CONCLUSION

Tumor uptake on [⁸⁹Zr]Zr-cetuximab PET/CT failed to predict treatment benefit in patients with RAS wild-type mCRC receiving cetuximab monotherapy. BRAF mutations, right-sidedness, and low sEGFR correlated with intrinsic resistance to cetuximab.

A Role for Acoustic Stimulation in Advanced Otosclerosis: Direct Acoustic Cochlear Implant versus Cochlear Implant

Recent findings support the efficacy of the direct acoustic cochlear implant (DACI) in patients with advanced otosclerosis whose rehabilitation is very challenging. Standard treatment consists of stapes surgery combined with hearing aids or a cochlear implant (CI). CI surgery, however, is often challenging depending on the grade of otosclerosis. This study aims to compare speech perception scores in quiet and noise of 6 DACI and 12 CI patients with advanced otosclerosis at 3 and 12 months after fitting. Preoperative computed tomographic scans of all patients were scored by experts using an existing otosclerosis grading system (stages 1–3). Speech perception in quiet was significantly better for DACI compared to CI users at 3 months after fitting. At 12 months, no difference was found between DACI and CI patients. Speech perception scores in noise were significantly better in the DACI group. In summary, a DACI system seems to provide an effective treatment option as the acoustic component can be preserved in patients with advanced otosclerosis.

Clinicopathological characteristics and outcome of 31 patients with ETV6-NTRK3 fusion gene confirmed (mammary analogue) secretory carcinoma of salivary glands

OBJECTIVES

In 2010, a new subtype of salivary gland cancer (SGC), (mammary analogue) secretory carcinoma (SC), was defined, characterized by the ETV6-NTRK3 fusion gene. As clinical behavior and outcome data of this histological subtype tumor are still sparse, we aimed to describe the clinicopathological course and outcome of a series of translocation positive SC patients.

PATIENT AND METHODS

We re-evaluated the pathological diagnosis of a subset of SGCs, diagnosed in 4 of 8 Dutch head and neck centers. Subsequently, tumors with a morphological resemblance to SC were tested for the ETV6-NTRK3 fusion gene using RT-PCR. Furthermore, patients prospectively diagnosed with SC were included. The clinical characteristics and outcomes were retrieved from the patient files.

RESULTS

Thirty-one patients with ETV6-NTRK3 fusion gene positive SC were included. The median age was 49 years, 17 patients (55%) were male. Eighteen tumors (58%) arose in the parotid gland. One patient presented with lymph node metastasis. All patients underwent tumor resection and 4 patients had a neck dissection. Four patients had re-resection and 15 patients (48%) received postoperative radiotherapy. One patient developed a local recurrence, no regional recurrences or distant metastases were observed. After a median follow-up of 49 months the 5- and 10-year overall survival were 95%, the 5- and 10-year disease free survival were 89%.

CONCLUSION

The clinical course of SC is favorable with a low rate of locoregional recurrence and excellent survival. Given the low incidence of nodal metastases, elective neck treatment, i.e. surgery and/or radiotherapy, does not seem to be indicated.

Predictive factors of speech understanding in adults with cochlear implants

OBJECTIVE

The aim of this study was to analyse the factors that influenced speech recognition scores in quiet conditions and speech reception threshold levels (SRT) in fixed noise conditions, after cochlear implant (CI) surgery in adults with postlinguistic deafness.

STUDY DESIGN

Combined retrospective and prospective study in a tertiary referral centre.

METHODS

We included 66 patients that received implants between 2002 and 2013. We retrospectively collected speech recognition scores and 14 demographic, audiological, and technical factors, including gender, age at implantation, aetiology, hearing loss progression, preoperative Pure Tone Average (PTA), hearing loss onset age and duration, duration and use of hearing aids (HAs); implantation in the best or worst ear; implantation on the right or left side; use of HA after implantation; and the duration and type of CI. We prospectively tested a subgroup of 21 patients for SRT in fixed noise.

RESULTS

The hearing loss duration significantly affected speech recognition scores in quiet conditions (H (4) = 10.567, p =0.032) and SRTs in fixed noise conditions (rs = 0.466, p = 0.033). The PTA of the better ear significantly affected only the SRT in fixed noise conditions (rs = 0.57 1, p = 0.007).

CONCLUSION

The duration of hearing loss and the PTA of the best ear had significant effects on the outcomes of speech recognition and SRT in quiet and fixed noise conditions, respectively. These findings are important for counselling CI candidates. Further studies in larger study populations are warranted.

[Movement disorders due to modern antidepressants and mood stabilizers]

BACKGROUND

Personal experience and recent literature indicate that clinicians often underestimate the severity and the range of movement disorders that can result from treatment with antidepressants and mood stabilisers.

AIM

To describe the prevalence, nature, symptoms and treatment of the movement disorders arising from the use of antidepressants and mood stabilisers.

METHOD

We searched Medline for relevant case-reports (patients > 18 years) and review articles for the period 1966 - January 2014). Our search was based on the search-terms '(drug-induced) movement disorders' and 'extrapyramidal symptoms', 'antidepressants', 'mood stabilisers', 'antiepileptics' and 'lithium'. The results were supplemented by movement disorders reported in the database of The Netherlands Pharmacovigilance Centre Lareb.

RESULTS

The most prevalent side-effects were found to be tremor, acathisia, dystonia and (tardive) dyskinesia.

CONCLUSION

The clinician needs to be aware of the movement disorders that can result from treatment with antidepressants and mood stabilisers. Symptoms can generally be alleviated by adjusting the prescribed medication or sometimes by stopping the principal causal agent completely.

Intra-isolate genome variation in arbuscular mycorrhizal fungi persists in the transcriptome

Arbuscular mycorrhizal fungi (AMF) are heterokaryotes with an unusual genetic makeup. Substantial genetic variation occurs among nuclei within a single mycelium or isolate. AMF reproduce through spores that contain varying fractions of this heterogeneous population of nuclei. It is not clear whether this genetic variation on the genome level actually contributes to the AMF phenotype. To investigate the extent to which polymorphisms in nuclear genes are transcribed, we analysed the intra-isolate genomic and cDNA sequence variation of two genes, the large subunit ribosomal RNA (LSU rDNA) of Glomus sp. DAOM-197198 (previously known as G. intraradices) and the POL1-like sequence (PLS) of Glomus etunicatum. For both genes, we find high sequence variation at the genome and transcriptome level. Reconstruction of LSU rDNA secondary structure shows that all variants are functional. Patterns of PLS sequence polymorphism indicate that there is one functional gene copy, PLS2, which is preferentially transcribed, and one gene copy, PLS1, which is a pseudogene. This is the first study that investigates AMF intra-isolate variation at the transcriptome level. In conclusion, it is possible that, in AMF, multiple nuclear genomes contribute to a single phenotype.

Successful treatment of fulminant pneumococcal sepsis with recombinant tissue plasminogen activator

This case report describes a patient with a rapidly progressive pneumococcal septic shock and purpura fulminans. Despite maximal conventional treatment, the patient developed progressive multiple organ failure with imminent necrosis of the extremities. This extremely rare, but often fatal, disease responded dramatically to the infusion of recombinant tissue plasminogen activator.

Critical care pathway development: the way forward

In many NHS trusts throughout the UK, critical pathways are being used as a method of managing patient care, enabling trusts to ensure that patients receive appropriate, high quality, cost-effective care. At the same time they can meet some of the requirements of The Patient's Charter, such as involving patients in decision making and keeping them informed during periods of treatment. This article first describes critical pathways and then discusses briefly the reasons why pathways were developed at the Guy's and St Thomas' Trust, and the stages of development before their introduction.

Hip arthroplasty for osteoarthritis

Mary, a 52-year-old woman, was admitted for a right total hip arthroplasty. She had taken early retirement from her job as a bus conductress. She had worked on double-decker buses for the past 15 years and had found it increasingly difficult to manage the stairs. Her condition became severe enough to prohibit her working, as she suffered a great deal of intractable pain both day and night. The pain and unstable nature of her movements necessitated the use of a walking stick for support. She was rather obese, but had managed to lose half a stone before admission.