The effect of a gluten-free diet on a patient complaining of severe tinnitus

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The emitted dose of drug from a valved holding chamber using five pressurized metered dose inhalers.

Background. The dose available at the mouth from a pressurised metered-dose inhaler (pMDI) cannot stay the same if it is used with a valved holding chamber (VHC). A different aerosol drug delivery system is created when the pMDI is used with the VHC and therefore the dose delivered to the patients is no longer that released from the pMDI alone, but the one emitted by the new system. This study aims to verify the emitted dose of five pMDI drugs when used with a VHC. Methods. The emitted dose was expressed as the amount of drug within the respirable fraction available at the end of the VHC, i.e. the drug output (measured by high performance liquid chromatography) multiplied by the percentage of FDF determined using a laser diffraction analyser. Results. the emitted doses were drastically reduced in comparison with the nominal doses (Beclomethasone from 250 to 90.5 µg, Budesonide from 200 to 100 µg, Ciclesonide from 160 to 102 µg Fluticasone from 250 to 116 µg, Salbutamol from 100 to 54 µg). Conclusions. When pMDIs are employed with a VHC, the emitted dose drastically changes; it is more or less halved. In order to facilitate prescription by the physician, both the nominal and the emitted doses should be reported in the VHC package

Electromyographic activity of sternocleidomastoid and masticatory muscles in patients with vestibular lesions

This study evaluated the electromyographic characteristics of masticatory and neck muscles in subjects with vestibular lesions. Surface electromyography of the masseter, temporalis and sternocleidomastoid muscles was performed in 19 patients with Ménière's disease, 12 patients with an acute peripheral vestibular lesion, and 19 control subjects matched for sex and age. During maximum voluntary clenching, patients with peripheral vestibular lesions had the highest co-contraction of the sternocleidomastoid muscle (analysis of covariance, p=0.02), the control subjects had the smallest values, and the patients with Ménière's disease had intermediate values. The control subjects had larger standardized muscle activities than the other patient groups (p=0.001). In conclusion, during maximum voluntary tooth clenching, patients with vestibular alterations have both more active neck muscles, and less active masticatory muscles than normal controls. Results underline the importance of a more inclusive craniocervical assessment of patients with vestibular lesions

A novel mutation within the MIR96 gene causes non-syndromic inherited hearing loss in an Italian family by altering pre-miRNA processing

The miR-96, miR-182 and miR-183 microRNA (miRNA) family is essential for differentiation and function of the vertebrate inner ear. Recently, point mutations within the seed region of miR-96 were reported in two Spanish families with autosomal dominant non-syndromic sensorineural hearing loss (NSHL) and in a mouse model of NSHL. We screened 882 NSHL patients and 836 normal-hearing Italian controls and identified one putative novel mutation within the miR-96 gene in a family with autosomal dominant NSHL. Although located outside the mature miR-96 sequence, the detected variant replaces a highly conserved nucleotide within the companion miR-96*, and is predicted to reduce the stability of the pre-miRNA hairpin. To evaluate the effect of the detected mutation on miR-96/mir-96* biogenesis, we investigated the maturation of miR-96 by transient expression in mammalian cells, followed by real-time reverse-transcription polymerase chain reaction (PCR). We found that both miR-96 and miR-96* levels were significantly reduced in the mutant, whereas the precursor levels were unaffected. Moreover, miR-96 and miR-96* expression levels could be restored by a compensatory mutation that reconstitutes the secondary structure of the pre-miR-96 hairpin, demonstrating that the mutation hinders precursor processing, probably interfering with Dicer cleavage. Finally, even though the mature miR-96 sequence is not altered, we demonstrated that the identified mutation significantly impacts on miR-96 regulation of selected targets. In conclusion, we provide further evidence of the involvement of miR-96 mutations in human deafness and demonstrate that a quantitative defect of this miRNA may contribute to NSHL

The MCS (mechanic, cybernetics and synergetics) method in vestibular rehabilitation

Vertigo and dizziness are conscious symptoms and the disturbances are not disequilibrium or nystagmus but the consciousness of disequilibrium and nystagmus. Thus physical rehabilitation must not only be pointed to resolution of objective disorder but it must be aimed to resolution of subjective consciousness of the disorder itself. MCS is the achronimus of mechanic , cybernetics and synergetics. We said that to prepare a particular protocol of treatment is necessary to have in mind a particular model of the Equilibrium system. Under a mechanic point of view we can consider the Equilibrium function as the result of the sum of these reflexes, the contemporary but distinct activation of some or all of these reflexes, according to the need: gaze, standing, walking. Under a cybernetics point view all the structures, peripheral and central, that contribute to the BOR and BSR constitute a system. A System is a network of different structures interconnected , interacting to reach a common goal. In this case the goal is human balance. The structures that provide the BOR and the BSR consitute the so-called Equilibrium System. Lackner remembered that the so-called vestibular nuclei are real polisensorial relays and that they are not only correlated to the activity of the vestibule. Thus it is uncorrected to define those nuclei as vestibular nuclei. They are true Balance nuclei that act together cerebellum and reticular formations to provide the sub-cortical component of human Equilibrium. Under the neurophysiological point of view the Equilibrium system (ES) is the Vestibular system. In order to reduce misinterpretation we prepose to refer to the Equilibrium System comprehending also the vestibular part of informations and reflexes. Synergetics model is based on the papers of Haken. He proposed his model to simplify complex functions such as macroeconomics processes, some physics phenomena such as clouds formation and many other complex phenomena. He proposed that every phenomenon, every function, is the macroscopic result of microscopic arrangements of the components that acts together to produce the phenomenon itself (that is to perform the function). By this point of view a system can be subdivided into different functional levels. Each lower, microscopic, level is directly communicating and interconnected with the upper, macroscopic, level.</p

Vestibular rehabilitation in whiplash injuries

Whiplash injury can be defined as a non-contact rapid acceleration-deceleration head-neck trauma during which the kinematics of the cervical spine are completely disrupted. Because of the impact a sudden violent head retro-flexion is followed by an as much as violent head antero-flexion. The therapy influenced Tonic muscles by increasing labyrinthine percentage and induced a reduction in activity of Phasic muscles by decreasing Somatosensorial and Visive Percentag

Sound influence on vestibulo-spinal control

It has been known for a long time that the application of intense acoustic stimuli to the ear can induce reflex muscle responses. The classic physiology describes reflex responses of neck muscles aimed at turning the head towards the source of acoustic stimuli. It is well known Tullio phenomenon (1929) which is a rare but remarkable clinical entity consisting of a rotatory vertigo and unsteadiness evoked by extremely loud sounds (ipsilateral nystagmus ). The link between the vibratory energy and the vestibular response takes place in the saccule which is located between choclea and utriculus on one side and semicircular canals on the other side. The acoustic stimulation induces movements of the stapes footplate which excite macular receptors of the sacculus, due to their close proximity. Therefore, acoustic stimulation activates the vestibulo-spinal pathway by stimulating saccular maculae EMG/ABR recording from ipsi SCM showes a P13/N23 biphasic complex

Vertigo Rehabilitation Protocols

XII, 244 p. 141 illus., 25 illus. in color.onlin

Whiplash InjuriesDiagnosis and Treatment /

XIV, 404 p. 114 illus., 26 illus. in color.onlin