Applying the reference values of real-ear-to-coupler-difference for deaf and hard-of-hearing children in Taiwan: Cautions and considerations

Measurement of real-ear-to-coupler differentials (RECDs) is a critical part of the hearing aid (HA) verification process. This study examines the validity of reference RECD values preset by the HA analyzer, Audioscan RM500, for deaf-and-hard-of-hearing (DHH) children in Taiwan. RECD measurements were performed on 658 ears of DHH children. A linear mixed model was used to analyze the reference and measured RECD values. The findings revealed slight disparities between normative RECD values from North America and those observed in Taiwanese DHH children. While generally small (less than 5 dB), these differences imply potential challenges in achieving optimal HA fitting in specific scenarios. Therefore, we recommend individualized RECD/REM measurements for cases of poor auditory performance, certain frequency ranges, or notable variations in ear canal volume. From a clinical perspective, while broadly applicable, the use of North American RECD normative data in Taiwan requires cautious consideration of potential minor variations. This study contributes to current knowledge by affirming the use of a Western RECD database for Taiwanese DHH children. However, we underscore the ongoing importance of individualized HA fitting strategies, particularly for cases with stagnant intervention progress. While built-in RECD reference values can offer preliminary fitting guidance, especially in busy clinical settings, our study sheds light on the circumstances where caution is essential. Audiologists can efficiently allocate their time and effort by focusing on personalized RECD measurements for cases exhibiting suboptimal intervention outcomes, thereby effectively optimizing HA gain settings.

Behavioral and Neural Assessments of Auditory Skill Development After Hearing Instrument Fitting in Children: Case Reports and Clinical Implications

PURPOSE

The purpose of this study was to comprehensively monitor the auditory skill development of children with hearing loss after hearing instrument fitting, and a battery of four assessments was proposed.

METHOD

This battery was designed to fill the gap in speech discrimination in clinically available evaluations. The battery includes both behavioral and neural assessments. On the other hand, both tests in structured settings (sound-treated booth) and daily life were included in the battery. The four assessments include visual reinforced infant speech discrimination (VRISD), cortical auditory evoked potentials (CAEP), Auditory Skills Checklist (ASC), and Parents' Evaluation of Aural/Oral Performance of Children (PEACH).

RESULTS

Two cases were reported, and their clinical implications were discussed.

CONCLUSIONS

The proposed comprehensive assessment battery is suitable for evaluating children who are developmentally appropriate for visual reinforcement audiometry. More importantly, the VRISD assessment fills in the current gap, which is the discrimination stage, for the available clinical tests for assessing auditory developmental stages.

Mandarin Tone and Vowel Recognition in Cochlear Implant Users: Effects of Talker Variability and Bimodal Hearing

OBJECTIVES

For cochlear implant (CI) users with residual low-frequency acoustic hearing in the nonimplanted ear, bimodal hearing combining the use of a CI and a contralateral hearing aid (HA) may provide more salient talker voice cues than CI alone to handle the variability of talker identity across trials. This study tested the effects of talker variability, bimodal hearing, and their interaction on response accuracy and time of CI users' Mandarin tone, vowel, and syllable recognition (i.e., combined Mandarin tone and vowel recognition in this study).

DESIGN

Fifteen prelingually deafened native Mandarin-speaking CI users (at age 20 or lower) participated in this study. Four talkers each produced six Mandarin single-vowel syllables in four lexical tones. The stimuli were presented in quiet via a single loudspeaker. To study the effects of talker variability, Mandarin tone, vowel, and syllable recognition was tested in two presentation conditions: with stimuli blocked according to talker (blocked-talker condition) or mixed across talkers from trial to trial (mixed-talker condition). To explore the effects of bimodal hearing, two processor conditions were tested: CI alone or CI + HA. The cumulative response time was recorded as an indirect indicator of the cognitive load or listening effort in each condition. The correlations were computed between demographic/hearing factors (e.g., hearing thresholds in the nonimplanted ear) and bimodal performance/benefits (where bimodal benefits refer to the performance differences between CI alone and CI + HA).

RESULTS

Mandarin tone recognition with both CI alone and CI + HA was significantly poorer in the mixed-talker condition than in the blocked-talker condition, while vowel recognition was comparable in the two presentation conditions. Bimodal hearing significantly improved Mandarin tone recognition but not vowel recognition. Mandarin syllable recognition was significantly affected by both talker variability and bimodal hearing. The cumulative response time significantly reduced with CI + HA compared with CI alone, but remained invariant with respect to talker variability. There was no interaction between talker variability and bimodal hearing for any performance measure adopted in this study. Correlation analyses revealed that the bimodal performance and benefits in Mandarin tone, vowel, and syllable recognition could not be predicted by the hearing thresholds in the nonimplanted ear or by the demographic factors of the participants.

CONCLUSIONS

Talker variability from trial to trial significantly degraded Mandarin tone and syllable recognition performance in both the CI alone and CI + HA conditions. While bimodal hearing did not reduce the talker variability effects on Mandarin tone and syllable recognition, generally better Mandarin tone and syllable recognition performance with shorter response time (an indicator of less listening effort) was observed when a contralateral HA was used in conjunction with the CI. On the other hand, vowel recognition was not significantly affected by either talker variability or bimodal hearing, because ceiling effects could not be counted out of the vowel recognition results.

Perception of speech produced by native and nonnative talkers by listeners with normal hearing and listeners with cochlear implants

PURPOSE The aim of this study was to evaluate the understanding of English sentences produced by native (English) and nonnative (Spanish) talkers by listeners with normal hearing (NH) and listeners with cochlear implants (CIs). METHOD Sentence recognition in noise was measured in adult subjects with CIs and subjects with NH, all of whom were native talkers of American English. Test sentences were from the Hearing in Noise Test (HINT) database and were produced in English by four native and eight nonnative talkers. Subjects also rated the intelligibility and accent for each talker. RESULTS The speech recognition thresholds in noise of subjects with CIs and subjects with NH were 4.23 dB and 1.32 dB poorer with nonnative talkers than with native talkers, respectively. Performance was significantly correlated with talker intelligibility and accent ratings for subjects with CIs but only correlated with talker intelligibility ratings for subjects with NH. For all subjects, performance with individual nonnative talkers was significantly correlated with talkers' number of years of residence in the United States. CONCLUSION CI users exhibited a larger deficit in speech understanding with nonnative talkers than did subjects with NH, relative to native talkers. Nonnative talkers' experience with native culture contributed strongly to speech understanding in noise, intelligibility ratings, and accent ratings of both listeners with NH and listeners with CIs.

SEMI-CONSTRAINED TOTAL ELBOW ARTHROPLASTY IN CHINESE RHEUMATOID PATIENTS

Seventeen Coonrad-Morrey semi-constrained total elbow replacements were performed on 14 Chinese rheumatoid patients. The elbows were reviewed retrospectively after a mean follow-up of 36 months (range 12–89 months.) After the operation, all patients were satisfied and there was no pain in 15 elbows. There was no radiological sign of loosening in the implanted prostheses and bone graft was incorporated in 93% of primary elbow replacements. The Mayo Elbow Performance Score was improved from an average of 40 (range 20–75) to an average of 93 (range 65–100). The arc of flexion was improved from an average of 89° (range 0°–125°) to 104° (range 35°–125°). The sizes of implants can be predicted accurately by the planning template in only four elbows (24%) and there were early complications in seven elbows (41%), with one prosthesis removed because of deep infection.

Dual analysis of triglycerides from certain common lipids and seed extracts

A number of reference oils, two commercial oils, and several oil extracts from seeds of Nicotiana species were analyzed for the fatty acid content and also for triglyceride composition. The seed oils were obtained using an accelerated solvent extraction procedure, which was proven to be very efficient and reproducible. The fatty acids were analyzed after the hydrolysis of the oils, using trimethylsilylation and gas chromatography/mass spectrometry (GC/MS) analysis. The levels of sixteen molecular species of triglycerides in the oils were measured after GC separation using MS for identification and flame ionization detection (FID) for quantitation. The results for the fatty acids and those for triglycerides were combined to generate uniform information regarding the composition of the analyzed oils. For a number of oils, the individual triglyceride quantitation and mass spectra were reported for the first time. The study showed that in some cases, oils with similar fatty acid content do not have the same triglycerides profile. The fatty acids and triglycerides profile for selected Nicotiana species were described for the first time in the literature.

Effects of talker variability on vowel recognition in cochlear implants

PURPOSE

To investigate the effects of talker variability on vowel recognition by cochlear implant (CI) users and by normal-hearing (NH) participants listening to 4-channel acoustic CI simulations.

METHOD

CI users were tested with their clinically assigned speech processors. For NH participants, 3 CI processors were simulated, using different combinations of carrier type and temporal envelope cutoff frequency (noise band/160 Hz, sine wave/160 Hz, and sine wave/20 Hz). Vowel recognition was measured for 4 talkers, presented in either a single-talker context (1 talker per test block) or a multi-talker context (4 talkers per test block).

RESULTS

CI users' vowel recognition was significantly poorer in the multi-talker context than in the single-talker context. When noise-band carriers were used in the simulations, NH performance was not significantly affected by talker variability. However, when sine-wave carriers were used in the simulations, NH performance was significantly affected by talker variability in both envelope filter conditions.

CONCLUSIONS

Because fundamental frequency was not preserved by the 20-Hz envelope filter and only partially preserved by the 160-Hz envelope filter, both spectral and temporal cues contributed to the talker variability effects observed with sine-wave carriers. Similarly, spectral and temporal cues may have contributed to the talker variability effects observed with CI participants.

Pax-7 Immunoreactivity in the Post-natal Chicken Central Nervous System

In this immunocytochemical study on the constitutive expression of Pax-7 protein in the postnatal chicken brain, Pax-7 showed region and cell type specific expression. In the optic tectum, only cells in grey matter showed positive immunoreactivities (IRs), whereas those in the white matters did not show any IRs. In thalamic nuclei and several pontine nuclei, we also localized Pax-7 positive IRs. On the contrary, in the cerebellum, Pax-7 was mainly localized within the Bergmann glia, whereas Purkinje cells did not show any IRs. In double immunolabelling studies, most of the Pax-7 IRs did not originate from neuroglial cells such as oligodendrocytes, microglia or astrocytes, but from neurons, with the exception of Bergmann glia in the cerebellum. The presence of Pax-7 IRs in the adult chicken brain could suggest that Pax-7 might play a role in maintaining normal physiological function in some postnatal chicken brain cells.

Research Note: American Children's Time Use in After-School Activities

90 Grade 4 children from upstate New York completed a “what I usually do” questionnaire, reporting on their after-school activities. Contrary to the concerns of some psychologists, there was no evidence that the children were being “hurried” out of childhood or “hot-housed” to develop academic or other excellence. The children's time was largely spent in enjoyable, self-chosen, and nonacademic activities, most often play or television viewing.

Osteochondral grafting of the metacarpophalangeal joint in rheumatoid arthritis

We report two cases of isolated metacarpophalangeal joint subluxation in rheumatoid patients with dorsal osteochondral defects on the base of the proximal phalanx. These were treated by open reduction, autologous osteochondral grafting and synovectomy. Stable reduction was maintained and appeared to delay the deterioration of the joint.

Factors attributing to the psychological recovery from the 1999 Taiwan earthquake among junior high school students: a focus group interview study

The aim of this study was to evaluate the factors contributing to the psychological recovery from the 1999 Taiwan earthquake from the perspective of adolescents in Chungliao. A total of 22 junior high school students who had significant decrease of Impact of Event Scale (IES) scores in the follow-up period of 9 months were recruited to participate in one of three focus groups. By applying the method of focus group interviewing, adolescents' attributions of factors relating to the improvements of psychological reactions were collected. All interviews were tape-recorded and the transcripts were approached by content analysis. Four major factors contributing to psychological recovery from the earthquake are clustered: (1) self-healing effect as time passed away; (2) assistance from people of the non-afflicted areas; (3) being engaged in interests in leisure time; and (4) other important events happening after the earthquake. Several factors contributed to the psychological recovery of adolescents from the experience of the earthquake. The results of this study can serve as the basis of further treatment strategies for the adolescent refugees from major disasters.

The role of heterocellular hereditary persistence of fetal haemoglobin in beta(0)-thalassaemia intermedia

Beta(0)-thalassaemia intermedia (beta(0)-TI) describes patients who lack beta-globin synthesis yet manifest a non-transfusion-dependent form of beta-thalassaemia. Co-inheritance of alpha-thalassaemia, certain variants of the beta-like globin gene cluster and elevated fetal haemoglobin (HbF) production are all associated with beta(0)-TI. However, the mild phenotypes of many beta(0)-TI patients are unexplained. Genetically determined HbF levels in beta-thalassaemia are difficult to assess because erythrocytes containing HbF (F cells) preferentially survive over erythrocytes without HbF. To evaluate the importance of genetically elevated HbF in beta-thalassaemia, F-cell levels of 19 TI patients' relatives were compared with relatives of transfusion-dependent beta-thalassaemia major patients and those of beta-globin genotype-matched controls. The beta-globin and alpha-globin genotypes, as well as their Ggamma promoter were also examined. Using this approach, in all but one patient the mild phenotype was attributable to either alpha-globin genotype, gamma-globin promoter polymorphism or inherited elevated F-cell levels. The findings of this study establish the F-cell levels required to modify the degree of disease severity significantly and demonstrate that F-cell level is a crucial parameter in the understanding of phenotypic variation in beta-thalassaemia.

Experimental infection of murine splenic lymphocytes and granulocytes with Toxoplasma gondii RH tachyzoites

Toxoplasma gondii, an intracellular protozoan infecting many kinds of eukaryotic cells, has been used to experimentally infect macrophages, epithelial cells, fibroblasts, and various cancer cells, but rarely T and B lymphocytes or granulocytes. The present study was performed to determine the susceptibility of murine (BALB/c or CBA) splenic T and B lymphocytes, and granulocytes to infection with T. gondii RH tachyzoites. The ultrastructure of the infected host cells was observed by TEM, and the degree of intracellular parasite proliferation was quantified using 3H-uracil uptake assay. At 24 hrs post-culture, the host cell cytoplasm was found to contain 1 or 2, or a maximum of 7-8 tachyzoites. Infected T lymphocytes demonstrated a peripherally displaced nucleus, a parasitophorous vacuole enveloping the parasite, and an increased number of mitochondria. In B lymphocytes infected with tachyzoites, RER was not well developed compared to uninfected B lymphocytes. Uninfected granulocytes contained many electron-dense granules, but T. gondii-infected granulocytes demonstrated a decreased number of granules. Based on the 3H-uracil uptake assay, the susceptibility of T and B lymphocytes, and granulocytes, to infection with T. gondii tachyzoites was fairly high irrespective of cell type and strain of mouse. This strongly suggests deterioration in the functioning of infected host immune cells.

Stereoselective high-performance liquid chromatography determination of propranolol and 4-hydroxypropranolol in human plasma after pre-column derivatization

A stereoselective reversed-phase HPLC assay to quantify S-(-) and R-(+) enantiomers of propranolol and 4-hydroxypropranolol in human plasma was developed. The method involved liquid-liquid extraction for sample clean-up and employed 2,3,4,6-tetra-O-acetyl-beta-glucopyranosyl isothiocyanate as a pre-column chiral derivatization reagent. The internal standard used was 4-methylpropranolol. The derivatized products were separated on an Altex C18 column using a mixture of acetonitrile-water-phosphoric acid-triethylamine (58:42:0.1:0.06 and 50:50:0.15:0.06, v/v, for propranolol and 4-hydroxypropranolol, respectively) as mobile phase. The detection of propranolol derivatives was made at lambda(ex)=280 nm and lambda(em)=325 nm, and the corresponding 325 and 400 nm were used for 4-hydroxypropranolol derivatives. The assay was linear from 1 to 100 ng/ml and from 2 to 50 ng/ml using 0.5 ml of human plasma for propranolol and 4-hydroxypropranolol enantiomers, respectively. The present assay is used to quantify the enantiomers of propranolol and 4-hydroxypropranolol, respectively, in human plasma for pharmacokinetic studies.

The psychiatric manifestation of Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease (CJD) is considered to be very rare in the population, and the psychiatric manifestation of the disease even rarer with only one report in the past few years in Taiwan. To clarify whether the psychiatric manifestation of CJD is really rare or whether it is neglected in Taiwan, the authors reviewed the discharge notes of patients who had been admitted to a neurological unit in the past 15 years and conducted a chart review of the patients of CJD supported by the clinical courses, EEG finding and brain biopsies. An inquiry was made by telephoning their families to follow up their condition after discharge. Five of the 8 cases with CJD had psychiatric symptoms including changes of mood, thought, behavior and perception during their course of illness. Four cases had been sent to the psychiatric unit and received treatment under several kinds of psychiatric diagnoses. Two patients had been admitted to the psychiatric unit and one had received electroconvulsive treatment. Two of the patients had been suspected to be the victims of neuroleptic malignant syndrome. It is likely that it is psychiatrists who will meet CJD patients first in the early stages of disease. CJD should be kept in mind and EEGs with detailed neurological checkups should be completed, if the cognitive functions of the patients with unusual neurological symptoms deteriorate quickly and their psychiatric symptoms fail to respond to any treatment.

The relative importance of the X-linked FCP locus and beta-globin haplotypes in determining haemoglobin F levels: a study of SS patients homozygous for beta S haplotypes

Five factors have been hypothesized to influence the 20-fold variation in fetal haemoglobin (Hb F) levels in sickle cell anaemia (SS): age sex, alpha-globin gene number, beta-globin haplotype, and the X-linked F-cell production locus (FCP) that regulates the production of Hb F containing erythrocytes (F cells). We analysed the association of these factors with Hb F levels in 112 SS patients living in France who are homozygous for the three common African beta-globin haplotypes (Benin, Bantu or Central African Republic and Senegal). We found that: (1) FCP accounts for about 40% of the overall variation in Hb F levels, (2) when the FCP influence is removed, beta-globin haplotype is associated with 14% of the remaining Hb F variation, and (3) the other factors have little influence. Comparison with our previous study of SS individuals in Jamaica leads to the following conclusions: (1) the X-linked FCP locus is a major determinant of Hb F levels in SS disease, (2) factors linked to the beta-globin haplotype have only a small effect on the variation in Hb F levels, in either the homozygous or heterozygous state, and (3)approximately half of the variation in Hb F levels still remains to be explained.

The combined use of flaps based on the subscapular vascular system for limb reconstruction

The combined use of flaps based on the subscapular vascular system for limb reconstructions has been infrequently reported. Such combinations have mainly been used for mandibular and facial reconstructions. We have used these flaps as free flaps for lower limb reconstructions in 7 patients, in 6 cases after trauma and in one after infection. A latissimus dorsi muscle or musculocutaneous flap and serratus anterior muscle flap were used together in 4 cases, and a latissimus dorsi muscle flap and parascapular flap in 3 cases. All cases healed satisfactorily. The indications for the combined use of these flaps are to resurface two separate defects simultaneously or to resurface very large defects. The anatomy of the subscapular vascular system allows the combined use of two or more flaps. It has the advantage of requiring anastomosis of one vascular pedicle only. Such combined flaps are particularly suitable for resurfacing defects wider than their length in relation to the long axis of the limb.

The anatomic basis and clinical applications of flaps based on the posterior tibial vessels

The vascular anatomy of the posterior tibial vessels has been studied in 20 legs of 10 cadavers. The number, size and distribution of the direct cutaneous and direct muscle branches of the posterior tibial vessels were recorded. For analysis, the leg was divided into four equal segments, Zone I being the most distal and Zone IV the most proximal. The direct cutaneous branches were found to cluster mainly around Zone II. The direct muscle branches to the soleus and flexor digitorum longus muscles arose chiefly in Zones II and III. Based on this knowledge, we performed fasciocutaneous, island soleus muscle, musculo-fasciocutaneous and flexor digitorum longus muscle flaps based on the posterior tibial vessels in 12 patients. Four were free fasciocutaneous flaps and eight were pedicled flaps. All flaps survived and there were no major complications. Delayed wound healing was encountered in three patients.

[Studies on the anti-virus effect of Glycyrrhiza uralensis Fish. polysaccharide]

The anti-virus activity of GPS has been investigated in vitro using L-929 and FL cell line infected with 7 kinds of DNA or RNA virus, and the mechanism by which GPS exhibits the anti-virus activity has been studied. The results show that GPS may inhibit the growth of VSV, AdVIII, HSV-1 or VV and CPE is also suppressed by GPS for protecting culture cell from virus infection.

Cocarcinogenic action of aspirin on gastric tumors induced by N-nitroso-N-methylnitroguanidine in rats

Albino rats (noninbred) were divided into 4 groups: 1) 56 control rats, 2) 40 rats fed 1 ml aspirin suspension (40 mg/ml) twice a week, 3) 20 rats given N-nitroso-N-methylnitroguanidine (MNNG) solution (250 micrograms/ml) to drink ad libitum, and 4) 40 rats given both aspirin and MNNG. In 18 months, there were no gastrointestinal tumors in groups 1 and 2, 8 cases of gastric tumors in group 3, and 37 cases of gastric tumors in group 4. Adenocarcinomas of the glandular stomach were found in 21 of 40 rats in group 4 but in only 4 of the 20 rats in group 3; the difference in incidence was significant. Histologic and electron microscopic examination of the epidermoid carcinomas and adenocarcinomas in group 4 showed no difference from such tumors induced by MNNG only. Hyperplasia of the forestomach mucosa and hyperplasia of the pyloric gland region of the glandular stomach in group 4 were more severe.

Asymmetry, Its Importance to the Action and Metabolism of Abscisic Acid

Unlabeled and (14)C-labeled enantiomorphs of abscisic acid (ABA) were obtained through acetylcellulose chromatography and tested as inducers of abscission, as inhibitors of seed germination, and as antagonists of gibberellic acid-induced synthesis and release of alpha-amylase. The activity of the R isomer was either equal to or less than that of the naturally occurring S form. Greatest differences were in the inhibition of root-related growth. In excised beam axes, although uptake of S-[(14C)]ABA is faster, the internal concentration of R-ABA is higher because of faster conversion of S-ABA to inactive metabolic products. In axes a reversal in chirality is less important to the physiological action of ABA than to its metabolism.