Ethnic differences in incidence of hepatitis B surface antigen seroclearance in a real-life multicenter clinical cohort of 4737 patients with chronic hepatitis B infection

Summary

Background

Hepatitis B surface antigen (HBsAg) positivity is associated with increased risk for cirrhosis and hepatocellular carcinoma (HCC). HBsAg seroclearance is thought to be rare in general, but cohort data from US patients are limited.

Aim

To determine the incidence of HBsAg seroclearance in a real-life US cohort.

Methods

In total, 4737 patients with chronic hepatitis B from five primary care, gastroenterology and multispecialty centres, and a university medical centre were retrospectively enrolled between 2001 and 2014 with data obtained by manual review of individual patient medical records. Seroclearance was determined by loss of HBsAg seropositivity. Persistent HBsAg was confirmed by direct serology or by proxy with positive hepatitis B e-antigen (HBeAg) or HBV DNA levels.

Results

HBsAg seroclearance occurred in 52 patients over 16 844 person-years (0.31% annually, 1.2% overall). Median follow-up was 32 months, and mean age 45 ± 14 years. Incidence of HBsAg seroclearance was higher in non-Asians, age >45, males, and those with baseline HBV DNA ≤10 000 IU/mL. On multivariate Cox proportional modelling, non-Asian ethnicity (HR 2.8), male sex (HR 2.1), baseline HBVDNA ≤10 000 (HR 2.0) and age >45 (HR 1.8) were significant independent predictors of seroclearance.

Conclusion

HBsAg seroclearance rates were lower than previously described in this real-life cohort of patients with chronic hepatitis B, especially among Asian, female and younger patients.

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Place dependent stimulation rates improve pitch perception in cochlear implantees with single-sided deafness

Publication date: Available online 1 July 2016
Source:Hearing Research
Author(s): Tobias Rader, Julia Döge, Youssef Adel, Tobias Weißgerber, Uwe Baumann
In normal hearing, the pitch of an acoustic tone can theoretically be encoded by either the place of stimulation in the cochlea or the corresponding rate of vibration. Thus spectral attributes and temporal fine structure of an acoustic signal are naturally correlated. Cochlear implants (CIs), neural prosthetic devices that restore hearing in the profoundly hearing impaired, currently disregard this mechanism; electrical stimulation is provided at fixed electrode positions with default place independent stimulation rate assignments. This does not account for individual cochlear encoding depending on electrode array placement, variations in insertion depth, and the proximity to nerve fibers. Encoding pitch in such manner delivers limited tonal information. Consequently, music appraisal in CI users is often rated cacophonic while speech perception in quiet is close to normal in top performers. We hypothesize that this limitation in electric stimulation is at least partially due to the mismatch between frequency and place encoding in CIs. In the present study, we determined individual electrode locations by analysis of cochlear radiographic images obtained after surgery and calculated place dependent stimulation rates according to models of the normal tonotopic function. Pitch matching in CI users with single-sided deafness shows that place dependent stimulation rates allow thus far unparalleled restoration of tonotopic pitch perception. Collapsed data of matched pitch frequencies as a function of calculated electrical stimulation rate were well fitted by linear regression (R² = 0.878). Sound processing strategies incorporating place dependent stimulation rates are expected to improve pitch perception in CI users.



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Facial Nerve Disorders and Diseases: Diagnosis and Management: Orlando Guntinas-Lichius and Barry M. Schaitkin; Stuttgart: Thieme, 2015.

No abstract available

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Content Validity of Temporal Bone Models Printed Via Inexpensive Methods and Materials.

Hypothesis: Computed tomographic (CT) scans of the 3-D printed temporal bone models will be within 15% accuracy of the CT scans of the cadaveric temporal bones. Background: Previous studies have evaluated the face validity of 3-D-printed temporal bone models designed to train otolaryngology residents. The purpose of the study was to determine the content validity of temporal bone models printed using inexpensive printers and materials. Methods: Four cadaveric temporal bones were randomly selected and clinical temporal bone CT scans were obtained. Models were generated using previously described methods in acrylonitrile butadiene styrene (ABS) plastic using the Makerbot Replicator 2x and Hyrel printers. Models were radiographically scanned using the same protocol as the cadaveric bones. Four images from each cadaveric CT series and four corresponding images from the model CT series were selected, and voxel values were normalized to black or white. Scan slices were compared using PixelDiff software. Gross anatomic structures were evaluated in the model scans by four board certified otolaryngologists on a 4-point scale. Results: Mean pixel difference between the cadaver and model scans was 14.25 +/- 2.30% at the four selected CT slices. Mean cortical bone width difference and mean external auditory canal width difference were 0.58 +/- 0.66 mm and 0.55 +/- 0.46 mm, respectively. Expert raters felt the mastoid air cells were well represented (2.5 +/- 0.5), while middle ear and otic capsule structures were not accurately rendered (all averaged

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Influence of Posterior Fossa Volume on Clinical Outcomes After Vestibular Schwannoma Resection.

Objectives: To determine the influence of posterior fossa dimensions on surgical outcomes after vestibular schwannoma management. Study Design: Retrospective chart review. Setting: Tertiary care academic medical center. Patients: Patients with sporadic vestibular schwannomas who underwent surgical resection via retrosigmoid or translabyrinthine techniques. Interventions: Diagnostic. Main Outcome Measures: One and two-way analysis of variance (ANOVAs) of the cohort based on volumetric and clinical outcome groupings. Results: A total of 95 patients were identified. A one-way ANOVA looking at the entire cohort of patients showed that outcomes like surgical time (p

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Acoustic Transmission Characteristics of a Eustachian Tube Volitionally Opened in Two Living Subjects.

Objective: To assess the acoustic transmission characteristics of the Eustachian tube (ET) in living subjects in verified patent and closed ET states to facilitate the detection and quantification of ET function using acoustic measures such as sonotubometry. Patients: The two subjects in this study had no history of ear disease nor previous ear surgery and were capable of volitionally opening and closing their ET. Interventions: Tympanometry and otologic examinations were used to confirm ET patent and closed states by observing tympanic membrane movement with respiration and by acoustic immitance measurements during forced respiration. A series of 500-ms long chirps containing frequencies from 100 Hz to 10 kHz were introduced into the nasal cavity during both ET states and recorded by microphones in both the contralateral naris and external auditory canal. Main Outcome Measures: Acoustic energy transmission through the ET across the 0.1 to 10 kHz frequency range in the closed state versus the patent state. Results: An increase in acoustic energy transmission occurs across the frequencies of 1 to 4 kHz between the closed and patent ET states, particularly in frequencies below 2.5 kHz. Conclusions: Results support sonotubometry as a potential diagnostic tool for ET dysfunction. Acoustic differences between the ET states manifest as a general increase in transmitted signal amplitude. Characterizing the acoustic properties in the verified patent and closed ET states allows investigators to more reliably interpret sonotubometric tests of ET function. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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A Historical Recount: Discovering Meniere's Disease and Its Association with Migraine Headaches.

Objectives: In evaluating the historical context of the first description of Meniere's disease, its association with migraine headaches is compelling. We have outlined the events and observations of Prosper Meniere, which led him to establish a link between migraine headaches and his eponymous disease. Study Design: Prosper Meniere's original French writings were translated by our group and used to recount his observations and thoughts. Miles Atkinson's English translations were used as a reference. Additional otological texts of the era were also reviewed as it relates to Meniere's disease. Methods: Prosper Meniere wrote a series of four articles 1 year before his death. In one of these articles, he makes references to migraine headaches on several occasions. These original writings were analyzed, and the physical findings he described were interpreted based on their relation to migraine headaches. Results: The passages in his published articles provide historical insight into Meniere's observations. His writings describe in detail symptoms of migraine headaches uniquely evident in his patient population. Through his observations, he recognized that in addition to exhibiting symptoms of tinnitus, hearing loss and vertigo his patients also suffered from migraine headaches. Conclusions: Although his colleagues discounted Meniere's theory concerning migraine headaches, he continued to make deductive inferences and publish his findings, leading to the association of migraine headaches and Meniere's disease. Today, this association continues to be debated, adding to Prosper Meniere's legacy. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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