BACKGROUND: H1 antihistamines (AHs), categorized as first-generation antihistamines (FGAs) or second-generation antihistamines (SGAs), possess anticholinergic properties linked to heightened dementia risk.
OBJECTIVE: To explore dementia risk in patients with allergic rhinitis using AHs.
METHODS: Taiwanese patients with new-onset allergic rhinitis (2011-2017) constituted the study population (677,971 with FGAs or SGAs, 36,081 without AHs). AH use was measured in cumulative defined daily dose (cDDD). Patients were grouped by cDDD (nonuser, <60 cDDD, 60-120 cDDD, and >120 cDDD). A Cox proportional hazard model assessed the AH-dementia association. Sensitivity analysis explored AH effects on dementia risk across subgroups and associations between specific AHs and dementia types.
RESULTS: FGAs in patients with allergic rhinitis were associated with elevated dementia risk. At less than 60 cDDD, adjusted hazard ratio (aHR) was 1.13 (95% CI, 1.09-1.17); at 60 to 120 cDDD, aHR was 1.29 (95% CI, 1.21-1.38); and at more than 120 cDDD, aHR was 1.51 (95% CI, 1.42-1.62). SGAs also raised dementia risk. At less than 60 cDDD, aHR was 1.11 (95% CI, 1.05-1.17); at 60 to 120 cDDD, aHR was 1.19 (95% CI, 1.12-1.26); and at more than 120 cDDD, aHR was 1.26 (95% CI, 1.19-1.33).
CONCLUSIONS: Patients with allergic rhinitis on FGAs or SGAs face an escalating dementia risk with increasing cumulative dosage. Moreover, FGAs exhibit a higher dementia risk compared with SGAs. Nevertheless, extensive clinical trials are imperative for confirming the association between FGA use, SGA use, and dementia risk.

OBJECTIVE: Comparative assessment of the level of differentiating growth factor 15 (GDF 15 ) against the background of a 6-month course of respiratory support in the mode of automatic positive pressure in the airways therapy (aPAP therapy) in patients with obstructive sleep apnea syndrome (OSA).
METHODS: 59 men participated in the study, the average age was 51.9±2.4 years. The main group (MG1) consisted of 30 patients with a verified diagnosis of moderate OSA. 29 men of comparable age and body weight made up the control group (CG) without an objectively confirmed diagnosis of OSA. After the stage of introduction into the study, the type of respiratory support with individual pressure settings was selected for patients with MG1. After 6 months of aPAP therapy with high compliance (at least 85%), the same patients who made up MG2 after treatment underwent repeated polysomnography (PSG) and the GDF 15 content was evaluated. Methods: questionnaire, examination, polysomnography, enzyme immunoassay of blood serum to determine the content of GDF 15.
RESULTS: A 6-month course of aPAP therapy with a high degree of compliance significantly improved the sleep structure and breathing pattern: the representation of NREM 3 increased from 79.2±15.6 to 102.6±21.6 minutes and the REM phase from 56.9± 13.6 to 115.6±26.8. Episodes of apnea were eliminated - apnea-hypopnea index decreased from 21.1 [17.3; 39.1] to 2.5 [1.8; 4.6] and the average values of SaO2 increased from 85.9% to 91.5%. At the same time, a statistically significant excess of GDF 15 was revealed in MG1 - 20.4 [14.16; 31.71] and MG2 - 17.2 [13.63; 24.44]) in comparison with CG - 13.65 [10.7; 17.09]. Despite the lack of statistical significance, a change in the level of GDF 15 was revealed in the form of a decrease in its concentration after a 6-month course of aPAP therapy.
CONCLUSIONS: A 6-month course of aPAP therapy made it possible to eliminate intermittent nocturnal hypoxia and improve sleep structure in patients with OSA, as well as reduce the content of GDF 15 protein in blood serum in patients with OSA. However, the tendency to decrease the content of this protein, despite the lack of statistical reliability, confirms the effectiveness of OSA therapy and the possibility of preventing early and pathological aging from the standpoint of somnology and molecular biogerontology.
UNASSIGNED: Сравнительная оценка уровня дифференцировочного фактора роста 15 (GDF 15) на фоне 6-месячного курса респираторной поддержки в режиме автоматического создания положительного давления в дыхательных путях (automatic Positive Airway Pressure — aPAP-терапия) у пациентов с синдромом обструктивного апноэ сна (СОАС).
UNASSIGNED: В исследовании участвовали 59 мужчин, средний возраст 51,9±2,4 года. Основную группу (ОГ1) составили 30 пациентов с верифицированным диагнозом СОАС средней степени тяжести. Контрольную группу (КГ) составили 29 мужчин, сопоставимых по возрасту и массе тела, без объективно подтвержденного диагноза СОАС. После этапа введения в исследование пациентам ОГ1 был подобран тип респираторной поддержки с индивидуальными настройками давления. Через 6 мес aPAP-терапии с высоким комплаенсом (не менее 85%) этим же пациентам, которые составили после лечения ОГ2, была проведена повторная полисомнография (ПСГ) и оценено содержание GDF 15. Методы: анкетирование, осмотр, ПСГ, иммуноферментный анализ сыворотки крови для определения содержания GDF 15.
UNASSIGNED: Шестимесячный курс aPAP-терапии с высокой степенью комплаентности позволил значимо улучшить структуру сна и паттерн дыхания: увеличились представленность фазы медленного сна 3 (NREM 3) с 79,2±15,6 до 102,6±21,6 мин и фазы сна с быстрыми движениями глаз (REM) с 56,9±13,6 до 115,6±26,8. Устранены эпизоды апноэ — индекс апноэ-гипопноэ уменьшился с 21,1 [17,3; 39,1] до 2,5 [1,8; 4,6], увеличились средние значения сатурации крови кислородом (SaO2) с 85,9 до 91,5%. При этом выявлено статистически достоверное превышение GDF 15 в ОГ1 — 20,4 [14,16; 31,71] и ОГ2 — 17,2 [13,63; 24,44]) в сравнении с КГ — 13,65 [10,7; 17,09] пг/мл. Несмотря на отсутствие статистической значимости, выявлено изменение уровня GDF 15 в виде уменьшения его концентрации после 6-месячного курса aPAP-терапии.
UNASSIGNED: Шестимесячный курс aPAP-терапии позволил устранить интермиттирующую ночную гипоксию и улучшить структуру сна у пациентов с СОАС, а также снизить содержание белка GDF 15 в сыворотке крови у пациентов с СОАС. Однако тенденция к снижению содержания данного белка, несмотря на отсутствие статистической достоверности, является подтверждением эффективности терапии СОАС и возможности профилактики раннего и патологического старения с позиции сомнологии и молекулярной биогеронтологии.

OBJECTIVE: Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA).
METHODS: The literature search was carried out using the databases PubMED, Google Scholar, E-library, Cyberleninka for the period 2013-2023 and included reviews and original articles.
RESULTS: The main groups of factors affecting adherence to CPAP therapy in patients with OSA have been established. These include sociodemographic and socioeconomic factors, the severity of OSA and the severity of clinical symptoms, and psychosocial factors. Strategies that can improve adherence were identified (educational technologies for patients, telemedicine technologies, behavioral therapy, modern technical interventions).
CONCLUSIONS: Factors that improve adherence to CPAP therapy are high levels of education and income, more severe OSA forms accompanied by daytime sleepiness, support from the patient\'s spouse and social support. Factors such as low levels of education and income, smoking, symptoms of depression and hypochondria, as well as side-effects worsen adherence to CPAP therapy, including refusal to continue treatment. It should be noted that all the identified factors are very closely associated with each other, so it is necessary to evaluate them comprehensively in each patient with OSA.
UNASSIGNED: Анализ факторов, оказывающих влияние на приверженность неинвазивной вентиляции постоянным положительным давлением воздушного потока во время сна (CPAP-терапия) пациентов с СОАС.
UNASSIGNED: Поиск литературы проводился с помощью поисковых систем PubMed, Google Scholar, eLIBRARY, Киберленинка за период 2013—2023 гг. и включал обзорные и оригинальные статьи.
UNASSIGNED: Установлены основные группы факторов, оказывающих влияние на приверженность CPAP-терапии пациентов с СОАС. К ним относятся социально-демографические и социально-экономические факторы, степень тяжести СОАС и выраженность клинических симптомов, психосоциальные факторы. Выявлены мероприятия, направленные на улучшение приверженности (обучающие технологии для пациентов, телемедицинские технологии, поведенческая терапия, современные технические решения).
UNASSIGNED: Исходя из вышеизложенного, факторами, улучшающими приверженность CPAP-терапии, являются высокие уровни образованности и доходов пациентов, более тяжелые формы СОАС, сопровождающиеся дневной сонливостью, поддержка супруга пациента и социальная поддержка. А такие факторы, как низкие уровни образования и доходов, курение, наличие симптомов депрессии и ипохондрии, а также возникающие побочные эффекты, ухудшают приверженность CPAP-терапии вплоть до отказа от продолжения лечения. Следует отметить, что все выявленные факторы очень тесно взаимосвязаны друг с другом, поэтому необходимо оценивать их комплексно у каждого пациента с СОАС.

BACKGROUND: Despite the ability of cochlear implants (CIs) to provide children with access to speech, there is considerable variability in spoken language outcomes. Research aimed at identifying factors influencing speech production accuracy is needed.
OBJECTIVE: To characterize the consonant production accuracy of children with cochlear implants (CWCI) and an age-matched group of children with typical hearing (CWTH) and to explore several factors that potentially affect the ability of both groups to accurately produce consonants.
METHODS: We administered the Bankson-Bernthal Test of Phonology (BBTOP) to a group of 25 CWCI (mean age = 4;9, SD = 1;6, range = 3;2-8;5) implanted prior to 30 months of age with a mean duration of implant usage of 3;6 and an age-matched group of 25 CWTH (mean age = 5;0, SD = 1;6, range = 3;1-8;6). The recorded results were transcribed, and the accuracy of the target consonants was determined. Expressive vocabulary size estimates were obtained from a language sample using the number of different words (NDW). A parent questionnaire provided information about maternal education, duration of CIs experience and other demographic characteristics of each child.
RESULTS: The CWCI group demonstrated some similarities to, and some differences from, their hearing peers. The CWCI demonstrated poorer consonant production accuracy overall and in various phonetic categories and word positions. However, both groups produced initial consonants more accurately than final consonants. Whilst CWCI had poorer production accuracy than CWTH for all phonetic categories (stops, nasals, fricatives, affricates, liquids and glides and consonant clusters), both groups exhibited similar error patterns across categories. For CWCI, the factors most related to consonant production accuracy when considered individually were expressive vocabulary size, followed by duration of CI experience, chronological age, maternal education and gender. The combination of maternal education and vocabulary size resulted in the best model of consonant production accuracy for this group. For the CWTH, chronological age followed by vocabulary size were most related to consonant production accuracy. No combination of factors yielded an improved model for the CWTH.
CONCLUSIONS: Whilst group differences in production accuracy between the CWCI and CWTH were found, the pattern of errors was similar for the two groups of children, suggesting that the children are at earlier stages of overall consonant production development. Although duration of CI experience was a significant covariate in a single-variable model of consonant production accuracy for CWCI, the best multivariate model of consonant production accuracy for these children was based on the combination of expressive vocabulary size and maternal education.
CONCLUSIONS: What is already known on the subject Research has shown that a range of factors is associated with consonant production accuracy by CWCIs, including factors such as the age at implant, duration of implant use, gender, other language skills and maternal education. Despite numerous studies that have examined speech sound production in these children, most have explored a limited number of factors that might explain the variability in scores obtained. Research that examines the potential role of a range of child-related and environmental factors in the same children is needed to determine the predictive role of these factors in speech production outcomes. What this paper adds to the existing knowledge Whilst the consonant production accuracy was lower for the CWCIs than for their typically hearing peers, there were some similarities suggesting that these children are experiencing similar, but delayed, acquisition of consonant production skills to that of their hearing peers. Whilst several factors are predictive of consonant production accuracy in children with implants, vocabulary diversity and maternal education, an indirect measure of socio-economic status, were the best combined predictors of consonant production accuracy. What are the potential or actual clinical implications of this work? Understanding the factors that shape individual differences in CWCI speech production is important for effective clinical decision-making and intervention planning. The present findings point to two potentially important factors related to speech sound production beyond the duration of robust hearing in CWCI, namely, a lexical diversity and maternal education. This suggests that intervention is likely most efficient that addresses both vocabulary development and speech sound development together. The current findings further suggest the importance of parental involvement and commitment to spoken language development and the importance of receiving early and consistent intervention aimed both at skill development and parental efficacy.

UNASSIGNED: Administrationof allergen mixtures of many components comprises the most common approach forAmerican allergists regarding the management of polyallergic patients. Europeanallergists, however, are more reluctant to this type of treatment due to thepotential drawbacks of mixing extracts.
UNASSIGNED: To assess theefficacy and safety of subcutaneous immunotherapy (SCIT) with polymerizedallergen mixtures without dilutional effect in polyallergic patients.Thisobservational, prospective, multicenter study included patients (between 5-60 years) with respiratory allergic diseases that had been prescribed with SCITwith mixtures of two pollen or mite extracts. Changesin Symptoms and Medication Score (SMS) and in rhinitis quality of life questionnaire (RQLQ), subjective clinicalimprovement, treatment satisfaction and tolerability were assessed after the1-year treatment.
UNASSIGNED: 115 patientswere included in the assessment. Mean global SMS decreased from 3.5 (SD = 1.1) to1.6 (SD = 1.2) points, with a meanabsolute reduction of 1.6 (SD = 1.3) points in the RQLQ score (p < 0.001, Wilcoxon test). General subjective clinical improvements anda good treatment satisfaction and tolerability were observed.
UNASSIGNED: SCIT with polymerizedallergen mixtures from either pollen or mite extracts proved to be an effectiveand safe treatment option for polyallergic patients suffering from allergicrespiratory diseases.

UNASSIGNED: Sensorineural hearing loss (SNHL) is the most common form of sensory deprivation and is often unrecognized by patients, inducing not only auditory but also nonauditory symptoms. Data-driven classifier modeling with the combination of neural static and dynamic imaging features could be effectively used to classify SNHL individuals and healthy controls (HCs).
UNASSIGNED: We conducted hearing evaluation, neurological scale tests and resting-state MRI on 110 SNHL patients and 106 HCs. A total of 1,267 static and dynamic imaging characteristics were extracted from MRI data, and three methods of feature selection were computed, including the Spearman rank correlation test, least absolute shrinkage and selection operator (LASSO) and t test as well as LASSO. Linear, polynomial, radial basis functional kernel (RBF) and sigmoid support vector machine (SVM) models were chosen as the classifiers with fivefold cross-validation. The receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity and accuracy were calculated for each model.
UNASSIGNED: SNHL subjects had higher hearing thresholds in each frequency, as well as worse performance in cognitive and emotional evaluations, than HCs. After comparison, the selected brain regions using LASSO based on static and dynamic features were consistent with the between-group analysis, including auditory and nonauditory areas. The subsequent AUCs of the four SVM models (linear, polynomial, RBF and sigmoid) were as follows: 0.8075, 0.7340, 0.8462 and 0.8562. The RBF and sigmoid SVM had relatively higher accuracy, sensitivity and specificity.
UNASSIGNED: Our research raised attention to static and dynamic alterations underlying hearing deprivation. Machine learning-based models may provide several useful biomarkers for the classification and diagnosis of SNHL.

UNASSIGNED: Early identification of newborns with congenital cytomegalovirus (CMV) is necessary to provide antiviral therapy and other interventions that can improve outcomes. Prior research demonstrates that universal newborn CMV screening would be the most cost-effective approach to identifying newborns who are infected. CMV is not uniformly prevalent, and it is uncertain whether universal screening would remain cost-effective in lower-prevalence neighborhoods. Our aim was to identify geographic heterogeneity in the cost-effectiveness of universal newborn CMV screening by combining a geospatial analysis with a preexisting cost-effectiveness analysis.
UNASSIGNED: This study used the CMV testing results and zip code location data of 96 785 newborns in 7 metropolitan areas who had been tested for CMV as part of the CMV and Hearing Multicenter Screening study. A hierarchical bayesian generalized additive model was constructed to evaluate geographic variability in the odds of CMV. The zip code-level odds of CMV were then used to weight the results of a previously published model evaluating universal CMV screening vs symptom-targeted screening.
UNASSIGNED: The odds of CMV were heterogeneous over large geographic scales, with the highest odds in the southeastern United States. Universal screening was more cost-effective and afforded more averted cases of severe hearing loss than targeted testing. Universal screening remained the most cost-effective option even in areas with the lowest CMV prevalence.
UNASSIGNED: Universal newborn CMV screening is cost-effective regardless of underlying CMV prevalence and is the preferred strategy to reduce morbidity from congenital CMV.

Eagle\'s syndrome is a condition characterized by an elongated styloid process or a calcified stylohyoid ligament, which can lead to a plethora of symptoms, such as neck and facial pain upon movement, dysphagia, pharyngeal foreign body sensation, headache, and vertigo-like sensations. This pathology may affect one or both of a patient\'s styloid processes (unilateral or bilateral), with most of these cases going undiagnosed due to the vague nature of their symptoms. Nonetheless, the diagnosis of Eagle\'s syndrome must derive from the combined findings of both clinical examination and radiographic imaging. Symptomatic patients may require conservative or surgical treatment.

Auditory hair cells (HCs) are the mechanosensory receptors of the cochlea, and HC loss or malfunction can result from genetic defects. Dock4, a member of the Dock180-related protein superfamily, is a guanine nucleotide exchange factor for Rac1, and previous reports have shown that Dock4 mutations are associated with autism spectrum disorder, myelodysplastic syndromes, and tumorigenesis. Here, we found that Dock4 is highly expressed in the cochlear HCs of mice. However, the role of Dock4 in the inner ear has not yet been investigated. Taking advantage of the piggyBac transposon system, Dock4 knockdown (KD) mice were established to explore the role of Dock4 in the cochlea. Compared to wild-type controls, Dock4 KD mice showed significant hearing impairment from postnatal day 60. Dock4 KD mice showed hair bundle deficits and increased oxidative stress, which eventually led to HC apoptosis, late-onset HC loss, and progressive hearing loss. Furthermore, molecular mechanism studies showed that Rac1/β-catenin signaling was significantly downregulated in Dock4 KD cochleae and that this was the cause for the disorganized stereocilia and increased oxidative stress in HCs. Overall, our work demonstrates that the Dock4/Rac1/β-catenin signaling pathway plays a critical role in the maintenance of auditory HCs and hearing function.

BACKGROUND: Bioresorbable nasal packing is associated with a decreased incidence of adhesions and bleeding postoperatively after endoscopic sinus surgery (ESS). However, discomfort during postoperative debridement is still a major area of concern for patients. Our objective was to compare the efficacy of a peptide hydrogel to that of a chitosan-based polymer in reducing pain during debridement after ESS.
METHODS: A prospective, multicenter, randomized, blinded trial was conducted in adults undergoing bilateral total ethmoidectomy for chronic rhinosinusitis. Participants served as their own controls with each subject receiving the hydrogel in a randomized ethmoid cavity and chitosan-based polymer in the contralateral ethmoid cavity. Participants were evaluated at 1, 4, and 12 weeks postoperatively. Pain during debridement as well as endoscopic evaluation of mucosal healing and hemostasis were measured.
RESULTS: Thirty patients who underwent ESS were included in this trial. During the week 1 postoperative debridement, patients reported significantly less pain on the hydrogel-treated side compared to the chitosan-based polymer-treated side. There were no significant differences in bleeding severity, Lund-Kennedy scores, debridement time, or need for further intervention between the two groups.
CONCLUSIONS: This study demonstrated the efficacy of a peptide hydrogel in minimizing pain during postoperative debridement.