Transient decrease in sound tolerance levels following hearing deprivation in normal-hearing subjects

Objective:To determine the circadian influence on sound sensitivity produced by temporal hearing deprivation in healthy normal human subjects.Design:Participants underwent bilateral earplugging before completion of anthropometry,the author's developed questionnaire,the Hamilton Anxiety and Depression Inventory,pure tone audiometry(PTA),stapedial reflex thresholds(SRT),distortion products otoacoustic emissions input/output(DPOAE-I/O),and uncomfortable loudness levels(ULLs).Afterward,the participants were randomly divided into group A,starting at 8:00 a.m.and finishing at 8:00 p.m.,and group B,starting at 4:00 p.m.and ending at 4:00 a.m.Serum cortisol levels and audiological test results were obtained at the beginning and end of the session and 24-h free urinary cortisol levels were measured.Study sample:Thirty healthy volunteers.Results:PTA was 2.68 and 3.33 dB HL in groups A and B,respectively,with no statistical difference between them.ULLs were significantly lower in group A compared to group B,with an average of 8.1 dB SPL in group A and 3.3 dB SPL in group B(p<0.0001).A SRT shift was observed in group A,with no difference in group B,and a night shift in DPOAE-I/O in group B.Conclusions:Reduced loudness tolerance is demonstrated during daytime hearing deprivation in contrast to nighttime;this may be due to increased central gain in the awake cortex.

Focal alteration of the intraretinal layers in neurodegenerative disorders

Focal intraretinal alterations have been studied to advance our understanding of the pathology of neurodegenerative diseases.The current literature involving focal alterations in the intraretinal layers was reviewed through PubMed using the search terms“focal alteration”,“region of interest”,“optical coherence tomography”,“glaucoma”,“multiple sclerosis”,“Alzheimer’s disease”,“Parkinson disease”,“neurodegenerative diseases”and other related items.It was found that focal alterations of intraretinal layers were different in various neurodegenerative diseases.The typical focal thinning might help differentiate various ocular and cerebral diseases,track disease progression,and evaluate the outcome of clinical trials.Advanced exploration of focal intraretinal alterations will help to further validate their clinical and research utility.

Retinal nerve fiber layer (RNFL) integrity and its relations to retinal microvasculature and microcirculation in myopic eyes

Background:The aim was to determine retinal nerve fiber layer function and its relations to retinal microvasculature and microcirculation in patients with myopia.Method:Polarization-sensitive optical coherence tomography(PS-OCT)was used to measure phase retardation per unit depth(PR/UD,proportional to the birefringence)of the retinal nerve fiber layer(RNFL).Optical coherence tomography angiography(OCTA)was used to measure macular vessel density analyzed using fractal analysis.In addition,a retinal function imager(RFI)was used to measure macular blood flow velocities in arterioles and venules.Twenty-two patients with moderate myopia(MM,refraction>3 and<6 diopters),seventeen patients with high myopia(HM,≥6 D)and 29 healthy control subjects(HC,≤3.00 D)were recruited.One eye of each patient was imaged.Results:Although the average PR/UD of the RNFL in the HM group did not reach a significant level,the birefringence of the inferior quadrant was significantly lower(P<0.05)in the HM group compared to the HC group.Significant thinning of the average RNFL and focal thinning of RFNL in temporal,superior and inferior quadrants in the HM group were found,compared to the HC group(P<0.05).There were no significant differences of retinal blood flow velocities in arterioles and venules among groups(P>0.05).The macular vessel density in both superficial and deep vascular plexuses was significantly lower in the HM group than in the other two groups(P<0.05)as well as in the MM group than in the HC group(P<0.05).The average PR/UD and PR/UD in the inferior quadrant were not related to refraction,axial length,blood flow velocities and macular vessel densities(r ranged from−0.09 to 0.19,P>0.05).Conclusions:The impairment of the retinal nerve fiber birefringence in the HM group may be one of the independent features in high myopic eyes,which appeared not to relate to macular microvascular density and blood flow velocity.

Nutritional and medical food therapies for diabetic retinopathy

Diabetic retinopathy(DR)is a form of microangiopathy.Reducing oxidative stress in the mitochondria and cell membranes decreases ischemic injury and end-organ damage to the retina.New approaches are needed,which reduce the risk and improve the outcomes of DR while complementing current therapeutic approaches.Homocysteine(Hcy)elevation and oxidative stress are potential therapeutic targets in DR.Common genetic polymorphisms such as those of methylenetetrahydrofolate reductase(MTHFR),increase Hcy and DR risk and severity.Patients with DR have high incidences of deficiencies of crucial vitamins,minerals,and related compounds,which also lead to elevation of Hcy and oxidative stress.Addressing the effects of the MTHFR polymorphism and addressing comorbid deficiencies and insufficiencies reduce the impact and severity of the disease.This approach provides safe and simple strategies that support conventional care and improve outcomes.Suboptimal vitamin co-factor availability also impairs the release of neurotrophic and neuroprotective growth factors.Collectively,this accounts for variability in presentation and response of DR to conventional therapy.Fortunately,there are straightforward recommendations for addressing these issues and supporting traditional treatment plans.We have reviewed the literature for nutritional interventions that support conventional therapies to reduce disease risk and severity.Optimal combinations of vitamins B1,B2,B6,L-methylfolate,methylcobalamin(B12),C,D,natural vitamin E complex,lutein,zeaxanthin,alpha-lipoic acid,and n-acetylcysteine are identified for protecting the retina and choroid.Certain medical foods have been successfully used as therapy for retinopathy.Recommendations based on this review and our clinical experience are developed for clinicians to use to support conventional therapy for DR.DR from both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM)have similar retinal findings and responses to nutritional therapies.

Nutritional and medical food therapies for diabetic retinopathy

Diabetic retinopathy(DR)is a form of microangiopathy.Reducing oxidative stress in the mitochondria and cell membranes decreases ischemic injury and end-organ damage to the retina.New approaches are needed,which reduce the risk and improve the outcomes of DR while complementing current therapeutic approaches.Homocysteine(Hcy)elevation and oxidative stress are potential therapeutic targets in DR.Common genetic polymorphisms such as those of methylenetetrahydrofolate reductase(MTHFR),increase Hcy and DR risk and severity.Patients with DR have high incidences of deficiencies of crucial vitamins,minerals,and related compounds,which also lead to elevation of Hcy and oxidative stress.Addressing the effects of the MTHFR polymorphism and addressing comorbid deficiencies and insufficiencies reduce the impact and severity of the disease.This approach provides safe and simple strategies that support conventional care and improve outcomes.Suboptimal vitamin cofactor availability also impairs the release of neurotrophic and neuroprotective growth factors.Collectively,this accounts for variability in presentation and response of DR to conventional therapy.Fortunately,there are straightforward recommendations for addressing these issues and supporting traditional treatment plans.We have reviewed the literature for nutritional interventions that support conventional therapies to reduce disease risk and severity.Optimal combinations of vitamins B1,B2,B6,L-methylfolate,methylcobalamin(B12),C,D,natural vitamin E complex,lutein,zeaxanthin,alpha-lipoic acid,and n-acetylcysteine are identified for protecting the retina and choroid.Certain medical foods have been successfully used as therapy for retinopathy.Recommendations based on this review and our clinical experience are developed for clinicians to use to support conventional therapy for DR.DR from both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM)have similar retinal findings and responses to nutritional therapies.