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ObjectiveTo investigate retrospectively the frequency of usage of bimodal stimulation among cochlear implant (CI) users, as well its clinical benefit relative to unilateral use.DesignAll subjects had been monitored with the clinical Minimal Outcome Measurements test battery.Study samples103 adults with bilateral postlingual profound sensorineural hearing loss and unilateral CI use were extracted from the local database. These were divided into two groups: those who only used a CI and those who used bimodal stimulation.ResultsThe preoperative contralateral residual hearing in the bimodal group was significantly better than that of the CI-only group. In both groups, speech perception in quiet and in noise improved after CI, with no significant difference between postoperative unimodal conditions. For the bimodal group, an additional significant improvement was found for the bimodal condition compared to the unimodal.ConclusionGiven the observed auditory benefit of bimodal stimulation in comparison to unimodal stimulation and given the finding that degree of residual hearing is not correlated with bimodal benefits, it is recommended to encourage CI recipients to continue contralateral HA use after CI. As a result of expanding CI criteria worldwide, the population of bimodal users is expected to grow in the near future.

Supplementary methods. Sputum induction, bronchial biopsies, skin auto-fluorescence. Supplementary Table 1. AGE and RAGE expression in young and old never-smokers and smokers, and COPD GOLD stages. Supplementary Table 2. Correlations of AGEs and RAGE between different compartments. Supplementary Table 3. Expression QTL analysis of AGER. Supplementary Table 4. SNP association with AGE levels detected in the skin. Supplementary Figure 1. Quantitative analyses of AGEs (left panel) and RAGE (right panel) expression in A) intact epithelium, B) basal epithelium, C) smooth muscle, D) connective tissue of bronchial biopsies. Intensity of staining was scored by a 4-points scale: 0=negative staining, 1=weak positive, 2=positive, and 3=strong positive. Horizontal bars represent median values. Supplementary Figure 2. Representative immunohistological staining of AGEs (AGE 1/750, Cosmo Bio Clone 6D12) and RAGE (RAGE 1/1500, Abcam, ab7764) in young healthy controls, old healthy controls and COPD patients. Pictures are shown as 40x magnification, scans taken using the Hamamatsu Slide Scanner (Hamamatsu Photonics, Hamamatsu City, Japan). Supplementary Figure 3. Quantitative analyses of AGEs (left panel) and RAGE (right panel) expression in A) epithelium and B) smooth muscle of the peripheral airways. Intensity of staining was scored by a 4-points scale: 0=negative staining, 1=weak positive, 2=positive, and 3=strong positive. Horizontal bars represent median values.

Screening for lung cancer with computed tomography (CT) appears to be highly effective. A large randomized trial in the United States reported a 7% reduction in all-cause mortality in patients screened by CT in comparison with those screened by chest radiography. The problem of dealing with the large number of pulmonary nodules and false positive test results could be solved by a protocol from the Dutch-Belgian lung cancer screening trial which proposes a strategy based on nodule volume and volumetry. Additional findings related to chronic obstructive pulmonary disease and cardiovascular disease are common in lung cancer screening and may provide an opportunity to increase screening benefits at minimal cost in the future. As CT is superior to radiography in lung cancer detection, CT seems the preferred imaging modality for case finding. As more trial results have to be awaited and cost-effectiveness and optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation.

A patient with deteriorating pulmonary melioidosis rapidly recovered after treatment with ceftazidime. To prevent possible relapses, an oral maintenance regimen of amoxicillin and clavulanic acid was prescribed for a period of three months. Melioidosis is caused by Pseudomonas pseudomallei. It is an insidious disease because of its variable clinical presentation, possible long-term asymptomatic carriage, broad-spectrum resistance to first-line antibiotics, and high mortality rate. As in our patient, the diagnosis should be particularly considered when there is reduced immunologic resistance and previous exposure in endemic areas, such as Southeast Asia.

Background The Global initiative for chronic Obstructive Lung Disease (GOLD) defines COPD as a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7. Age-dependent cut-off values below the lower fifth percentile (LLN) of this ratio derived from the general population have been proposed as an alternative. We wanted to assess the diagnostic accuracy and prognostic capability of the GOLD and LLN definition when compared to an expert-based diagnosis. Methods In a prospective cohort study, 405 patients aged ≥ 65 years with a general practitioner's diagnosis of COPD were recruited and followed up for 4.5 (median; quartiles 3.9; 5.1) years. Prevalence rates of COPD according to GOLD and three LLN definitions and diagnostic performance measurements were calculated. The reference standard was the diagnosis of COPD of an expert panel that used all available diagnostic information, including spirometry and bodyplethysmography. Results Compared to the expert panel diagnosis, 'GOLD-COPD' misclassified 69 (28%) patients, and the three LLNs misclassified 114 (46%), 96 (39%), and 98 (40%) patients, respectively. The GOLD classification led to more false positives, the LLNs to more false negative diagnoses. The main predictors beyond the FEV1/FVC ratio for an expert diagnosis of COPD were the FEV1 % predicted, and the residual volume/total lung capacity ratio (RV/TLC). Adding FEV1 and RV/TLC to GOLD or LLN improved the diagnostic accuracy, resulting in a significant reduction of up to 50% of the number of misdiagnoses. The expert diagnosis of COPD better predicts exacerbations, hospitalizations and mortality than GOLD or LLN. Conclusions GOLD criteria over-diagnose COPD, while LLN definitions under-diagnose COPD in elderly patients as compared to an expert panel diagnosis. Incorporating FEV1 and RV/TLC into the GOLD-COPD or LLN-based definition brings both definitions closer to expert panel diagnosis of COPD, and to daily clinical practice.