Tinnitus patients lost to follow-up

Abstract

Tinnitus patients without hearing loss or hyperacusis often start tinnitus retraining therapy but do not return to the tinnitus clinic for follow-up visits. The aim of this study was to evaluate how these ‘missing patients’ feel and whether they still use their sound generators after they discontinue retraining therapy. We interviewed 269 tinnitus patients by phone who never returned to the clinic after receiving initial counseling and a generator for sound enrichment. Twenty-six percent did not have tinnitus anymore, 30.5% still used the sound generator to treat their tinnitus, and 43.5% did not use their sound generator but still suffered from tinnitus. This study suggests that therapists need to contact missing patients periodically to follow their improvement, encourage them, and decide on new therapeutic approaches as necessary.

Sumario

Los pacientes con acúfeno, sin hipoacusia ni hiperacusia, a menudo inician terapia de re-entrenamiento para el acúfeno pero no regresen a la clínica de acúfenos para citas de seguimiento. El objetivo de este estudio fue evaluar cómo se sienten estos “pacientes perdidos” de la consulta y si aún utilizan sus generadores de sonido luego de que suspenden la terapia de re-entrenamiento. Entrevistamos por teléfono a 269 pacientes que nunca retornaron a la clínica, luego de recibir una sesión de orientación inicial y un generador de enriquecimiento sonoro. Veintiséis por ciento no volvieron a tener acúfeno, 30.5% aún usaban el generador de sonido para tratar su acúfeno, y 43.5% no usaron su generador de sonido y aún sufren del acúfeno. Este estudio sugiere que los terapeutas necesitan contactar periódicamente a sus pacientes perdidos de la consulta, para dar seguimiento a su evolución, estimularlos, y para tomar decisiones sobre nuevos enfoques terapéuticos conforme sea necesario.     

Central body fat changes in men affected by post-surgical hypogonadotropic hypogonadism undergoing testosterone replacement therapy are modulated by androgen receptor CAG polymorphism

Background and aimsLittle is known about the effect of androgen receptor (AR) gene CAG repeat polymorphism in conditioning body composition changes after testosterone replacement therapy (TRT). In this study, we aimed to clarify this aspect by focussing our attention on male post-surgical hypogonadotropic hypogonadism, a condition often associated with partial or total hypopituitarism.Methods and resultsFourteen men affected by post-surgical hypogonadotropic hypogonadism and undergoing several replacement hormone therapies were evaluated before and after TRT. Dual-energy X-ray absorptiometry (DEXA)-derived body composition measurements, pituitary-dependent hormones and AR gene CAG repeat polymorphism were considered. While testosterone and insulin-like growth factor-1 (IGF-1) levels increased after TRT, cortisol concentration decreased. No anthropometric or body composition parameters varied significantly, except for abdominal fat decrease. The number of CAG triplets was positively and significantly correlated with this abdominal fat decrease, while the opposite occurred between the latter and Δ-testosterone. No correlation of IGF-1 or cortisol variation (Δ-) with Δ-abdominal fat was found. At multiple linear regression, after correction for Δ-testosterone, the positive association between CAG triplet number and abdominal fat change was confirmed.ConclusionsIn male post-surgical hypogonadotropic hypogonadism, shorter length of AR CAG repeat tract is independently associated with a more marked decrease of abdominal fat after TRT.     

The role of BDNF and HPA axis in the neurobiology of burnout syndrome

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p=0.592; for cortisol level after 1 mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66+/-18.15 pg/ml) as compared to healthy controls (102.18+/-20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions.     

225例耳鸣患者的康复训练与研究

目的 探讨耳鸣患者康复指导的方法。方法 将225例长期主观耳鸣患者分为2组，实验组117例，在医护人员指导下采用长期坚持不全掩蔽、松弛训练、转移注意力和心理咨询等康复训练，并且使用有声材料如耳鸣掩蔽器、助听器、音乐光盘、收音机、磁带等以协助达到对耳鸣适应和习惯的目的。对照组108例不给予任何指导，在治疗后2个月、6个月、12个月对两种康复方法进行分析。结果 实验组117例患者中2个月适应率为17．09％、6个月适应率为82．05％、12个月适应率为88．03％。对照组108例患者2个月适应率为2．78％、6个月适应率为26．85％、12个月适应率为41．67％。两组分别在2个月、6个月、12个月比较（χ^2 检验），均有显著性差异（P＜0．01）。结论 耳鸣患者的不全掩蔽、松弛训练、转移注意力和心理咨询等训练方法有利于患者康复。     

正常人群窦房结功能测定的研究

目的 :测定柳州健康自愿者的窦房结恢复时间 (SNRT)、矫正窦房结恢复时间 (CSNRT)、总恢复时间 (TRT)、窦房传导时间 (SCAT) ,为诊断病态窦房结综合征 (SSS)制定标准值。方法 :应用食道调搏术 S1 S2 分级递增法及 8次法或 区法测定 SNRT、CSNRT、TRT、SCAT。结果 :柳州地区正常人群 SNRT为 (1 0 69.36± 2 0 8.69) ms,CSNRT为(2 92 .41± 1 2 1 .37) ms,TRT为 (42 37.96± 871 .67) ms,SCAT为 (1 4 0 .94± 45.58) ms。结论 :柳州地区正常人群窦房结功能与其他地区无明显差异     

Effects of testosterone therapy in adult males with hypogonadism and T2DM: A meta-analysis and systematic review

Background and aimsTestosterone supplementation therapy (TST) is a longstanding treatment for hypogonadal men with type 2 diabetes mellitus (T2DM), even though the benefits of TST are variable among trials. This meta-analysis was done to determine the specific role of TST in hypogonadal men with T2DM.MethodsPubMed, Embase, and Google Scholar were queried to discover eligible randomized controlled trials (RCTs) and observational studies. To quantify the specific effects of TST, we estimated pooled mean differences (MDs) and relative risks with 95% confidence intervals (CIs).ResultsOur meta-analysis included 1596 hypogonadal T2DM subjects from 12 randomized controlled trials and one observational study. TST can significantly enhance glycemic control compared to placebo by decreasing homeostatic model assessment of insulin resistance (WMD = ?1.55 [-2.65, ?0.45]; p = 0.26; I2 = 20.2%), fasting glucose (WMD = ?0.35 [-0.79, 0.10]; p = 0.07; I2 = 69.7%), fasting insulin (WMD = ?2.88 [-6.12, 0.36]; p = In addition, TST can decrease cholesterol (WMD = ?0.28 [-0.47, ?0.09] p = 0.0008; I2 = 91%) and triglyceride (WMD = ?0.23 [-0.43, ?0.03] p = 0.03; I2 = 79.2%). Furthermore, Testosterone therapy is related to a significant rise in total testosterone levels (WMD = 5.08 [2.90, 7.26] p = 0.0002; I2 = 92.9%). Pooling of free testosterone levels indicated a larger increase in the patients who got TST than placebo (WMD = 81.21 [23.87, 138.54] p = 0.07; I2 = 70%).ConclusionOur findings suggested that TST can enhance glycemic control and hormone levels and reduce total cholesterol, triglyceride, LDL cholesterol whereas increase HDL cholesterol in hypogonadal T2DM patients. Therefore, in these patients, we propose TST alongside anti-diabetic treatment.     

尿视黄醇结合蛋白与转铁蛋白对判断小儿重症肺炎时肾损害的价值

目的　 探讨尿视黄醇结合蛋白 (RBP)和尿转铁蛋白 (TRF)水平在小儿重症肺炎肾功能损害的临床价值。 方法 　选择小儿重症肺炎 6 1例、轻症 84例、正常健康儿童 6 0例 ,用酶联免疫法检测尿RBP及TRF ,同时测定其血尿素氮 (BUN)、肌酐(SCr)。 结果 　重症肺炎组RBP、TRF明显高于对照组 (P <0 0 1) ,而BUN、SCr无显著变化。 结论 　RBP、TRF能敏感地反映肾功能 ,了解早期肾功能损害 ,用尿液检测 ,取材方便 ,减轻静脉抽血对患儿的创伤 ,值得临床试用