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Introduction Current literature does not provide strong evidence that remote programming of hearing aids is effective, despite its increasing use by audiologists. We tested speech perception outcomes, real-ear insertion gain, and changes in self-perceived hearing impairment after face-to-face and remote programming of hearing aids in a randomized multicentre, single-blind crossover study. Methods Adult experienced hearing aid users were enrolled during routine follow-up visits to audiology clinics. Hearing aids were programmed both face to face and remotely, then participants randomly received either the face-to-face or remote settings in a blinded manner and were evaluated 5 weeks later. Participants then received the other settings and were evaluated 5 weeks later. Results Data from 52 out of 60 participants were analysed. We found excellent concordance in performance of hearing aids programmed face to face and remotely for speech understanding in quiet (phonetically balanced kindergarten test – intraclass correlation coefficient of 0.92 (95% confidence interval: 0.87–0.95)), and good concordance in performance for speech understanding in noise (phonetically balanced kindergarten +5 dB signal-to-noise ratio – intraclass correlation coefficient of 0.71 (95% confidence interval: 0.55–0.82)). Face-to-face and remote programming took 10 minutes (±2.9) and 10 minutes (±2.8), respectively. Real-ear insertion gains were highly correlated for input sound at 50, 65 and 80 dB sound pressure levels. The programming type did not affect the abbreviated profile of hearing aid questionnaire scores. Conclusions In experienced hearing aid users, face-to-face and remote programming of hearing aids give similar results in terms of speech perception, with no increase in the time spent on patients’ care and no difference in self-reported hearing benefit. ClinicalTrials.gov Identifier NCT02589561

The theory of a fetal origin of adult diseases links many pathological conditions to very early life events and is known as a "developmental programming" phenomenon. The mechanisms of this phenomenon are not quite understood and have been explained by inflammation, stress, etc. In particular the epidemic of obesity, with more than 64% of women being overweight or obese, has been associated with conditions in later life such as mental disorders, diabetes, asthma, and irritable bowel syndrome. Interestingly, these diseases were classified a decade ago as Clinical Syndrome of Endocannabinoid Deficiency (CECD), which was first described by Russo in 2004. Cannabinoids have been used for the treatment of chronic pain for millenniums and act through the mechanism of "kick-starting" the components of the endogenous cannabinoid system (ECS). ECS is a pharmacological target for the treatment of obesity, inflammation, cardiovascular and neuronal damage, and pain. We hypothesize that the deteriorating effect of maternal obesity on offspring health is explained by the mechanism of Fetal Syndrome of Endocannabinoid Deficiency (FSECD), which accompanies maternal obesity. Here we provide support for this hypothesis.

International audience; OBJECTIVE:Teleotoscopy requires the assistance of telehealth facilitators; but their training requirements remain to be determined. We evaluated the use of an otoscopy simulator to train facilitators to remote otoscopies sent via the Internet using a teleaudiology platform.DESIGN:Neurotologists experts were asked to identify images using the otoscopy simulator and to perform an identification task of significant anatomical landmarks. The experts were asked to repeat those tasks remotely, with the help of facilitators who either received basic training, or no training prior to the experiment.STUDY SAMPLE:Three experts, three trained facilitators and three untrained facilitators participated in this study.RESULTS:The use of an otoscopy simulator in addition to remote otoscopy yielded a good inter- and intrarater agreement (κ between 0.81-1, and 0.80-0.87, respectively). The accuracy of diagnosis was high on-site (11.7% error) and remotely (0% error). The time required for landmark identification task was not increased when performed remotely with a trained facilitator versus on-site otoscopy (9.3 versus 9.2 s/landmark). Conversely, the lack of training of facilitators increased significantly this time (15.6 s/landmark, p

Introduction: Percutaneous fetoscopic endoluminal reversible tracheal occlusion (FETO) was developed to prevent the pulmonary complications of fetal congenital diaphragmatic herniation. There is an urgent need to establish the closest to human translational model of FETO in order to improve fetal outcomes and to determine new clinical approaches and applications. Material and Methods: Seven non-human primates underwent two subsequent surgeries: the first, the FETO in the experimental group (n = 3) or sham operation in the control animals (S-FETO, n = 4) at 132-142 days of gestation (dGA); the second, the reversal of occlusion or sham operation at 162 ± 5 dGA. Maternal stress axis, complete blood count, and biochemical parameters were evaluated and newborn tracheal radiography was performed. Results: The average pregnancy duration and neonatal weights in the FETO group did not differ from the animals in the S-FETO group. There was no bleeding or premature fetal membrane rupture during the procedures in any of the baboons. The maximal tracheal width was 7.02 ± 0.6 mm in the FETO versus 5.46 ± 0.6 mm in S-FETO group. Discussion: This is the very first report of a successful FETO model in non-human primates. Similarities to human tracheomegaly were for the first time documented in any model studied.

This reading of Hergé's Tintin au Tibet uses the notions of 'the daydream' and 'the haunting idea' in order to approach the text not at the level of its plot, but at that of the imaginary that underlies it, whose presence is betrayed through two series of obsessive reiterations and wordplays around the name of Tchang, the lost object of Tintin's quest. A digression via Lewis Carroll's Through the Looking Glass establishes it as an important intertext, prefiguring Hergé's album in a number of ways: the metaphorical function of the chess game and its close association with the state of dreaming or daydreaming, and the way in which the use of language, particularly the proper name, becomes analogous to dreamwork as words exceed their literal meaning and slide along the signifying chain, destabilising meaning and identity. The article then focuses on Tintin au Tibet, demonstrating the key importance of the famous large panel on the second page, in which the word 'Tchang', cried out by Tintin on waking, is substituted by Hergé for any images of the dream itself. The reverberation of the word, and of words resembling it, is tracked through the remainder of the text, along with a more generalised problematic around proper names and a compulsive tendency to repetition, symptoms of an unconscious grappling with the elusiveness and fluctuating nature of self and other, ontological questions that linger after narrative resolution has been achieved.

Placental abruption is a serious condition that increases perinatal morbidity and mortality. Clinical prevention and treatment options are limited, especially in human preterm deliveries. Knowledge of the mechanisms that keep the placenta in place during pregnancy is critical for developing strategies for the prevention of abruption. Failure of physiological transformation of spiral arteries has been described as a major contributing factor of the placental abruption development. Baboons (Papio spp.) share striking similarities with humans in regard to placental structure, utero-placental blood flow, and fetal development; however, the mode of trophoblast invasion is shallow in baboons. This fact prompted the hypothesis that the incidence of placental abruption will be increased in baboons compared to humans.Baboon placentas were collected between 2002 and 2008. Two independent veterinary pathologists evaluated the slides. A certified physician pathologist performed additional histology.Placental abruption was diagnosed in 22 baboons among 2423 live births during the study period (0.9% prevalence). The most common clinical presentations were fetal demise and vaginal bleeding. The most common pathological findings were intraplacental hemorrhages with or without hematoma formation (86.4%). Other findings consisted of neutrophil infiltration (50%), decidual necrosis (22.7%), decidual vascular congestion and inflammation, villous congestion and retroplacental hemorrhage/hematoma (each 18.2%). These pathologic findings were the same for term and preterm deliveries.This is the first systematic study of placental abruption in non-human primates, analyzing a large colony of baboons. Despite differences in trophoblast invasion, the clinical features observed in placental abruption affecting baboons resembled those reported in humans. The cluster of placental pathological findings in baboons also agreed with clinical reports, but the prevalence of these findings differed between baboons and humans. We discuss a mechanism of anti-abruption forces that offset shallow trophoblast invasion observed in baboons.

Percutaneous fetoscopic endoluminal reversible tracheal occlusion (FETO) was developed to prevent the pulmonary complications of fetal congenital diaphragmatic herniation. There is an urgent need to establish the closest to human translational model of FETO in order to improve fetal outcomes and to determine new clinical approaches and applications.Seven non-human primates underwent two subsequent surgeries: the first, the FETO in the experimental group (n = 3) or sham operation in the control animals (S-FETO, n = 4) at 132-142 days of gestation (dGA); the second, the reversal of occlusion or sham operation at 162 ± 5 dGA. Maternal stress axis, complete blood count, and biochemical parameters were evaluated and newborn tracheal radiography was performed.The average pregnancy duration and neonatal weights in the FETO group did not differ from the animals in the S-FETO group. There was no bleeding or premature fetal membrane rupture during the procedures in any of the baboons. The maximal tracheal width was 7.02 ± 0.6 mm in the FETO versus 5.46 ± 0.6 mm in S-FETO group.This is the very first report of a successful FETO model in non-human primates. Similarities to human tracheomegaly were for the first time documented in any model studied.

Objective. To describe the trends in incidence, characteristics, and outcomes of women with eclampsia.Methods. We reviewed and abstracted data from medical records of all women diagnosed with eclampsia in our institution from August 1998 to April 2011. In addition to overall characteristics and outcomes, the cases were stratified by onset: antenatal versus postnatal and early (U, andt-tests. A two-sidedP<0.05was considered statistically significant.Results. We identified 87 eclampsia cases out of 59,388 deliveries; 62 cases were diagnosed before delivery, and 25 had a postnatal onset. Among the 62 antenatal cases, 41 were diagnosed before 32 weeks and 21 at or after 32 weeks of gestation. Antenatal cases had higher systolic (P=0.03) and diastolic (P=0.01) blood pressures, more abnormal dipstick-test proteinuria (P=0.002), and lower platelet counts (P≤0.001) than postnatal cases. Early eclampsia cases were complicated more often with HELLP syndrome than late eclampsia cases (P=0.007).Conclusion. The occurrence of eclampsia has decreased over time. The earlier the onset is, the worse the outcome appears to be.

Objective: To determine whether the acceleration/ejection time ratio of the fetal main pulmonary artery Doppler waveform (PATET) can accurately predict the results of fetal lung maturity testing in amniotic fluid. Methods: We prospectively studied pregnant women attending our ultrasound unit for clinically indicated fetal lung maturity testing. An ultrasound examination that included measurement of the PATET was performed before the results of the amniocentesis were reported. The results of the PATET and the surfactant/albumin ratio were compared, and a receiver operating characteristic curve was used to determine the PATET cutoff with the optimal sensitivity and specificity for predicting surfactant/albumin ratio results. p < 0.05 was considered statistically significant. Results: Forty-three patients were included in this study. The receiver operating characteristic curve demonstrated that a PATET cutoff of 0.3149 provided a specificity of 93% (95% CI 77-98%), a sensitivity of 73% (95% CI 48-89%), a negative predictive value of 87% (95% CI 70-95%), and a positive predictive value of 85% (95% CI 58-96%) for predicting immature surfactant/albumin ratio results. Conclusion: The PATET may provide a noninvasive means of determining fetal lung maturity with acceptable levels of sensitivity, specificity, and predictive values.

More than one-fourth of U.S. women are overweight; more than one-third are obese. Maternal obesity has been linked to an increased incidence of stillbirths, fetal macrosomia, fetal intrauterine growth restriction and pre-eclampsia. The placenta plays a key role in the nutrients and oxygen supply to the fetus. The data about structural changes in the placental villous membrane (VM), a major component of the feto-maternal nutrient and oxygen exchange barrier, during obesity are sparse and inconsistent. Our objective was to evaluate the morphometric changes in the placental exchange barrier in a baboon model of obesity.The previously described baboon model of maternal obesity was studied. We compared 4 obese to 4 non-obese baboons. Placental stereology with the use of transmission electron microscopy was performed to estimate VM oxygen diffusing capacities and morphometry.The specific placental oxygen diffusing capacities per unit of fetal weight were similar in baboons and humans. Maternal leptin concentrations correlated negatively with placental basement membrane thickness (r = -0.78, p 0.05), while fetal leptin levels correlated negatively with endothelial thickness of fetal capillaries (r = -0.78, p 0.05). The total and specific villous membrane oxygen diffusing capacities were not different between the two groups.To the best of our knowledge this is the first report of placental oxygen diffusing capacities and placental ultrastructural changes in a baboon model of obesity. Previously reported placental inflammation in maternal obesity is not associated with changes in the VM diffusing capacities and ultrastructure.

The measurement of the middle cerebral artery peak systolic velocity, a noninvasive technique, has become the standard for the diagnosis of fetal anemia. The middle cerebral artery peak systolic velocity is used because of its ease of measurement and its high sensitivity in predicting anemia. This diagnostic tool should only be used with fetuses at risk for anemia and in medical centers with adequate training in the technique.

We studied the independent role of air pollution and passive smoking on respiratory symptoms and group of symptoms by following 46 adult nonsmokers for 14 wk. Outcomes included the incidence of 15 symptoms. After adjustment for passive smoking, clear rhinorrhea and cough were positively related to nitrogen dioxide (NO2), particles (PM10), and black smoke (BS); whereas headache was positively related to BS. Sneezing, sore throat, and cough were independently positively related to passive smoking. After adjustment for passive smoking, the occurrence of groups of symptoms and of the “sore throat group” were related to three pollutants. The occurrence of the “possible infection group” was positively related to BS. The occurrence of every group of symptoms was independently related to passive smoking. In conclusion, the prevailing levels of air pollution and passive smoking had independent effects on symptoms and groups of symptoms.

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It may be difficult to manage nulliparous women who have labor induced because these women are likelier to have an "unfavorable" cervix, and consequently a lower rate of successful vaginal delivery (VD). There may also be a lower threshold for cesarean delivery (CD). This study examined the relationship between the duration of labor induction and successful VD in 340 nulliparous women with singleton pregnancies at 37 weeks' or more of gestation who underwent induction at a single center. These individuals represented one-fourth of 1352 nulliparous women who delivered at term during the 12-month study period. All but 35 of 340 women in the study reached the active phase of labor. These 35 women underwent CD during the latent phase. Three-fourths of women in this study achieved vaginal delivery. More than half of the study group had an "unfavorable" cervix. One-fourth of women, about 40% of whom remained in latent labor, required CD. Indications for CD in women remaining in latent labor were about evenly divided between labor arrest/failed induction and a nonreassuring fetal status. About 40% of women achieving VD had a rate of cervical dilation during active labor of less than 1 cm per hour. Fetal acidemia, admission to neonatal intensive care, chorioamnionitis, and endometritis all were more likely in women requiring CD. Prolonged induction-to-delivery intervals did not appear to be associated with adverse maternal or neonatal outcomes. Only about 6% of nulliparous women in this study who had labor induced at term remained undelivered after 48 hours. This study demonstrated that labor progresses much more slowly than expected in nulliparous women undergoing induction. A reasonably high rate of VD can be achieved in this population with a low rate of complications.

tional groups were carried out using the Gene Ontology (Go) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) RESULTS: Fetal hearts from 10-18 GA showed expression of genes coding for contractile proteins and fatty acid metabolism. When analyzed by gestational age, first trimester hearts showed myosin related genes to be upregulated more than 5 fold compared to second trimester heart which showed genes involved in energy production and cardiac remodeling to be upregulated more than 5 fold. Retinol and GABA receptors were upregulated in ST hearts CONCLUSION: Fetal heart development during FT is dominated by genes coding for myocardial development and differentiation. ST development is dominated by energy generation and cardiomyocyte communication for contractile coordination/proliferation. Fatty acid metabolism can be seen as early as 10 weeks and gets stronger as the heart matures. Retinol receptor and GABA receptors have not been described previously in human fetal heart during this period. For the first time global gene expression of heart has been described in human samples to create a database of normal development to understand and compare with known fetal pathology.

• We performed threshold static perimetry on 19 patients who had ingested canthaxanthin; 11 had maculopathy and eight did not. Patients with no history of canthaxanthin ingestion served as controls. All patients had visual acuity of 6/9 or better. Threshold static perimetry was reevaluated two to three years after cessation of canthaxanthin ingestion. For both testing sessions, patients with maculopathy presented lower retinal sensitivity than controls, while patients without maculopathy did not differ significantly from the control group. These results suggest that canthaxanthin retinopathy can adversely affect the neurosensory retina.

• Canthaxanthin intake is associated with golden yellow crystalline deposits in the retina around the macula and low static luminance threshold. Our study assesses the anatomic and functional reversibility of canthaxanthin retinopathy. The number of retinal deposits was evaluated in nine patients, two to four times over a mean period of 55 months. There was no significant difference after a nine-month follow-up. A statistically significant decrease in the number of retinal deposits was found after an observation period of 26 months. The deposits disappeared slowly, while some remained even seven years after canthaxanthin therapy was discontinued. Threshold static perimetry performed on eight patients with retinopathy and seven controls did not differ significantly between the two groups at the end of the follow-up period. The results demonstrate that canthaxanthin retinopathy is reversible.