Implantación coclear bilateral en niños. Comparativa con la implantación unilateral y la estimulación bimodal

Introducción El diagnóstico precoz de las enfermedades supone el primer elemento para llegar a un tratamiento eficaz. Esta actuación es mucho más determinante en los casos de hipoacusia en recién nacidos/as, dada la estrecha relación existente entre audición y lenguaje. En realidad, sólo disponemos de los primeros cinco o seis años para evitar que las pérdidas de audición tengan efectos permanentes en el desarrollo de ese lenguaje. Esto es debido al período crítico de aprendizaje, en el cual quedan selladas las características morfológicas y funcionales de las áreas corticales del lenguaje. Realizar una detección precoz de los problemas auditivos permite llevar a cabo el tratamiento lo antes posible para que así, el/la niño/a, desarrolle de forma completa y satisfactoria sus habilidades socio-lingüísticas. Objetivo La finalidad de este trabajo es demostrar, no sólo que la instauración de un tratamiento frente a la hipoacusia infantil ha de ser precoz, sino que éste debe ser el más eficaz para combatirla. Debemos asegurar que, entre las distintas modalidades terapéuticas que disponemos hoy en día, no existen diferencias significativas en la adquisición de las capacidades auditivas necesarias para que estos/as niños/as consigan un desarrollo del lenguaje y unas condiciones cognitivas y sociales equiparables a las que poseen los/as niños/as normo-oyentes. Y, en el caso que existan estas diferencias, debemos ser conscientes de las mismas para escoger la modalidad terapéutica que mejores resultados vaya a proporcionar. Material y métodos Presentamos un estudio observacional, longitudinal y retrospectivo que incluye a todos/as los/as niños/as procedentes del programa de screening desde el año 1999 hasta el 2013 diagnosticados de hipoacusia severo-profunda bilateral e implantados antes de los 6 años. Dividimos la muestra en tres grupos: los/las implantados/as unilateralmente, los/las usuarios/as de una estimulación bimodal (mediante un implante coclear unilateral y una prótesis auditiva contralateral) y los/as sometidos/as a una implantación coclear bilateral. Se analizan, desde los seis meses post-implantación, de forma anual, hasta los cinco años post-cirugía, los resultados que obtienen estos tres grupos en la audiometría tonal en campo libre, determinando los umbrales de audición, en las pruebas verbales, detectando los niveles de inteligibilidad y en los test de IT-Mais (comprensión), Nottingham (discriminación) y LittlEars (correlación cronológica). También se comparan los resultados en esta batería de pruebas diviendo la muestra según la edad, en menores de 2 años y los/las de edad comprendida entre los 2 y 6 años. Resultados Los/as niños/as sometidos/as a implantación coclear única, estimulación bimodal o implantación coclear bilateral de forma más precoz, han obtenido mejores resultados en las pruebas tonales y verbales respecto a los/las niños/as implantados/as más tardíamente en cada una de estas modalidades. Además, se confirma que en todas las pruebas auditivas realizadas e independientemente de la edad, la implantación coclear única de un oído, sin ayuda de prótesis auditiva en el contralateral, se ve ampliamente superada por la estimulación bilateral con sendos implantes cocleares o con audífono más implante coclear. Por último, la implantación coclear bilateral ha demostrado ser la opción con resultados estadísticamente superiores, tanto en la audiometría tonal como en las pruebas verbales, en el grupo de niños/as de edades comprendidas entre los dos y los seis años. En el caso de los menores de dos años, la implantación coclear bilateral solo ha podido confirmar su superioridad frente a la estimulación bimodal en las pruebas verbales a partir del tercer año tras la implantación. Conclusión Ante un/a niño/a con hipoacusia severo-profunda bilateral debemos abogar siempre por la implantación coclear bilateral lo más temprana posible, logrando, con ello, un desarrollo de las funciones auditivas y del lenguaje idéntico al de los normoyentes y que permitirá a esa criatura adaptarse a su entorno social de forma exitosa, hecho que no se puede asegurar con ninguno de los otros dos tipos de estimulación auditiva.Introduction The early diagnosis of diseases is the first element to reach an effective treatment. This performance is much more decisive in cases of hearing loss in newborns, given the close relationship between hearing and language. In reality, we only have the first five or six years to prevent hearing loss from having permanent effects on the development of that language. This is due to the critical period of learning, in which the morphological and functional characteristics of the cortical areas of language are sealed. Performing an early detection of hearing problems allows the treatment to be carried out as soon as possible so the children can develop their socio-linguistic skills in a successful way. Objective The purpose of this work is to demonstrate that the establishment of a treatment against children's hearing loss has to be early and, above all, the most effective one. We must ensure that among the different therapeutic modalities we have today, there are no significant differences in the acquisition of the listening skills necessary for these children to achieve language development and cognitive and social conditions comparable to those children that have a normal hearing. If therefore these differences should exist, we must be aware of them in order to choose the therapeutic modality that will provide the best results. Material and methods We present an observational, longitudinal and retrospective study that includes all children from the screening program from 1999 to 2013 diagnosed with bilateral severe-profound hearing loss and implanted before 6 years of age. We divided the sample into three groups: unilaterally implanted, users of bimodal stimulation (with a cochlear implant and a contralateral hearing aid) and bilaterally implanted. The results obtained by these three groups in the tonal audiometry, in the verbal tests and in the IT-Mais (comprehension), Nottingham (discrimination) and LittlEars (chronological correlation) tests are analyzed from the six months post-implantation up to the five years post-surgery. The results are also compared according to the age (those who underwent the surgery before the first 2 years and those who did it between the age of 2 and 6). Results Children undergoing single cochlear implantation, bimodal stimulation or bilateral cochlear implantation at an early age have obtained better results in tone and verbal tests compared to those who got the implant later. In addition, the single cochlear implantation is greatly surpassed by bilateral stimulation and by bilateral implantation in all the evaluated tests. Finally, bilateral cochlear implantation has proven to be the best option, with statistically superior results in the group of children aged between two and six years. When it comes to children under two years, bilateral cochlear implantation has only been able to confirm their superiority over bimodal stimulation in verbal tests from the third year after the implantation. Conclusion We must always advocate bilateral cochlear implantation as early as possible in a child with a bilateral severe-profound hearing loss, achieving a development of auditory and language functions that will allow this child to successfully adapt to its social environment. This fact cannot be assured with neither of the other two types of auditory stimulations

A Deep Insight into Different Acidic Additives as Doping Agents for Enhancing Proton Conductivity on Polybenzimidazole Membranes

The use of phosphoric acid doped polybenzimidazole (PBI) membranes for fuel cell applications has been extensively studied in the past decades. In this article, we present a systematic study of the physicochemical properties and proton conductivity of PBI membranes doped with the commonly used phosphoric acid at different concentrations (0.1, 1, and 14 M), and with other alternative acids such as phytic acid (0.075 M) and phosphotungstic acid (HPW, 0.1 M). The use of these three acids was reflected in the formation of channels in the polymeric network as observed by cross-section SEM images. The acid doping enhanced proton conductivity of PBI membranes and, after doping, these conducting materials maintained their mechanical properties and thermal stability for their application as proton exchange membrane fuel cells, capable of operating at intermediate or high temperatures. Under doping with similar acidic concentrations, membranes with phytic acid displayed a superior conducting behavior when compared to doping with phosphoric acid or phosphotungstic acid

Experimental study of the oriented immobilization of antibodies on photonic sensing structures by using protein A as an intermediate layer

A proper antibody immobilization on a biosensor is a crucial step in order to obtain a high sensitivity to be able to detect low target analyte concentrations. In this paper, we present an experimental study of the immobilization process of antibodies as bioreceptors on a photonic ring resonator sensor. A protein A intermediate layer was created on the sensor surface in order to obtain an oriented immobilization of the antibodies, which enhances the interaction with the target antigens to be detected. The anti-bovine serum albumin (antiBSA)-bovine serum albumin (BSA) pair was used as a model for our study. An opto-fluidic setup was developed in order to flow the different reagents and, simultaneously, to monitor in real-time the spectral response of the photonic sensing structure. The antiBSA immobilization and the BSA detection, their repeatability, and specificity were studied in different conditions of the sensor surface. Finally, an experimental limit of detection for BSA recognition of only 1 ng/mL was obtained

Phosphoric Acid Doped Polybenzimidazole (PBI)/Zeolitic Imidazolate Framework Composite Membranes with Significantly Enhanced Proton Conductivity under Low Humidity Conditions

The preparation and characterization of composite polybenzimidazole (PBI) membranes containing zeolitic imidazolate framework 8 (ZIF-8) and zeolitic imidazolate framework 67 (ZIF-67) is reported. The phosphoric acid doped composite membranes display proton conductivity values that increase with increasing temperatures, maintaining their conductivity under anhydrous conditions. The addition of ZIF to the polymeric matrix enhances proton transport relative to the values observed for PBI and ZIFs alone. For example, the proton conductivity of PBI@ZIF-8 reaches 3.1 x 10-3 S·cm-1 at 200 ºC and higher values were obtained for PBI@ZIF-67 membranes, with proton conductivities up to 4.1 x 10-2 S·cm-1. Interestingly, a composite membrane containing a 5 wt.% binary mixture of ZIF-8 and ZIF-67 yielded a proton conductivity of 9.2 x 10-2 S·cm-1, showing a synergistic effect on the proton conductivity

HÁBITOS Y PROMOCIÓN DE LA ACTIVIDAD FÍSICA EN LA COMARCA DEL MAESTRAZGO (TERUEL)

El estudio pretende medir las variables que influyen en los niveles de actividad física. La muestra consta de adolescentes y adultos. Se han utilizado cuestionarios subjetivos para dicha medición, de forma que diferentes ítems o preguntas aluden a las variables estudiadas. Se evidencia un claro bajo nivel de actividad física tanto para adolescentes como para adultos, además los comportamientos sedentarios para ambos grupos resultan excesivos. Destacar que ningún de los grupos percibe excesiva problemática para realizar ejercicio en su comarca y además reconocen que disfrutan con ella, por lo que las estrategias de promoción se hacen factibles

Obtención empírica del límite frecuencial entre las bandas de baja y altra frecuencia en análisis de variabilidad del ritmo cardíaco: aplicación en ratas y humanos

Se propone un nuevo método para la determinación empírica de los límites entre las bandas de baja frecuencia y alta frecuencia del espectro de potencia de las series RR en los estudios de variabilidad del ritmo cardíaco. El método se ha aplicado a series RR obtenidas en humanos y ratas Sprague-Dawley. Para humanos el límite coincide con la recomendación de 0,15 Hz mientras que para ratas Sprague-Dawley la metodología empleada sugiere un límite de 0,75 Hz.Postprint (published version

Proton conductivity through polybenzimidazole composite membranes containing silica nanofiber mats

The quest for sustainable and more efficient energy-converting devices has been the focus of researchers′ efforts in the past decades. In this study, SiO2 nanofiber mats were fabricated through an electrospinning process and later functionalized using silane chemistry to introduce different polar groups −OH (neutral), −SO3H (acidic) and −NH2 (basic). The modified nanofiber mats were embedded in PBI to fabricate mixed matrix membranes. The incorporation of these nanofiber mats in the PBI matrix showed an improvement in the chemical and thermal stability of the composite membranes. Proton conduction measurements show that PBI composite membranes containing nanofiber mats with basic groups showed higher proton conductivities, reaching values as high as 4 mS·cm−1 at 200 °C

Ionic Liquid Composite Polybenzimidazol Membranes for High Temperature PEMFC Applications

A series of proton exchange membranes based on polybenzimidazole (PBI) were prepared using the low cost ionic liquids (ILs) derived from 1-butyl-3-methylimidazolium (BMIM) bearing different anions as conductive fillers in the polymeric matrix with the aim of enhancing the proton conductivity of PBI membranes. The composite membranes prepared by casting method (containing 5 wt. % of IL) exhibited good thermal, dimensional, mechanical, and oxidative stability for fuel cell applications. The effects of anion, temperature on the proton conductivity of phosphoric acid-doped membranes were systematically investigated by electrochemical impedance spectroscopy. The PBI composite membranes containing 1-butyl-3-methylimidazolium-derived ionic liquids exhibited high proton conductivity of 0.098 S·cm-1 at 120 ºC when tetrafluoroborate anion was present in the polymeric matrix. This conductivity enhancement might be attributed to the formed hydrogen-bond networks between the IL molecules and the phosphoric acid molecules distributed along the polymeric matrix