Citations

Attempts to specify normal threshold sensitivity by bone conduction have been unsuccessful because of problems in obtaining reliable measurements from commercially available artificial mastoids. Recent design modifications incorporated in the Bruel and Kjaer 4930 artificial mastoids have resulted in greater uniformity among these units. However, the new design has resulted in impedances that are higher than those recommended in current standards. Bone-conduction thresholds referenced to measurements made on B x00026 K 4930 artificial mastoids with the new design were performed on 60 normal listeners by three participating laboratories. The results are reported for consideration in the development of a reference threshold for hearing by bone conduction.

Abstract Background This study aimed to have international experts converge on a harmonized definition of whole hippocampus boundaries and segmentation procedures, to define standard operating procedures for magnetic resonance (MR)‐based manual hippocampal segmentation. Methods The panel received a questionnaire regarding whole hippocampus boundaries and segmentation procedures. Quantitative information was supplied to allow evidence‐based answers. A recursive and anonymous Delphi procedure was used to achieve convergence. Significance of agreement among panelists was assessed by exact probability on Fisher's and binomial tests. Results Agreement was significant on the inclusion of alveus/fimbria ( P = .021), whole hippocampal tail ( P = .013), medial border of the body according to visible morphology ( P = .0006), and on this combined set of features ( P = .001). This definition captures 100% of hippocampal tissue, 100% of Alzheimer’s disease‐related atrophy, and demonstrated good reliability on preliminary intrarater (0.98) and inter‐rater (0.94) estimates. Discussion Consensus was achieved among international experts with respect to hippocampal segmentation using MR resulting in a harmonized segmentation protocol.

Abstract Background: In 2000, cyclophosphamide(C), epirubicin(E) and fluorouracil (F) (CEF) and doxorubicin (A) and C followed by paclitaxel (T) (AC/T) given every three weeks were commonly used regimens in Canada and the USA to treat women with node positive or high risk node negative operable breast cancer. In a previous trial in women with locally advanced breast cancer, 3 months of dose-dense EC was equivalent to six months of CEF. We hypothesized that the addition of 3 months of a taxane following dose-dense EC would be superior to CEF alone or AC/T. In a randomized trial in women with early breast cancer we compared CEF, dose dense EC/T and AC/T. An interim analysis (JCO, 2010) conducted when 50% of the events for the relapse-free-survival (RFS) analysis were observed, demonstrated that AC/T administered every 3 weeks was significantly inferior to CEF or EC/T. The results of the final RFS including CEF versus EC/T will be presented. Methods: Women, 60 years or younger, with operable axillary node positive or high risk node negative breast cancer were randomized to adjuvant CEF, EC/T or AC/T. CEF was given for 6 cycles and consisted of: C 75 mg/m2 orally on Days 1–14, and E 60 mg/m2 and F 500 mg/m2, IV on Days 1 and 8. CEF patients received concurrent antibiotic prophylaxis. EC/T consisted of 6 cycles of EC every 14 days; E 120 mg/m2 and C 830 mg/m2, both IV on Day 1 with filgrastim 5 [ug]/kg/day subcutaneous from Days 2–13 and epoetin alpha 40,000 units subcutaneous once weekly. After completion of EC, 4 cycles of T 175 mg/m2 every 21 days with filgrastim and epoetin alpha were given. The AC/T regimen consisted of A 60 mg/m2 and C 600 mg/m2 IV every 21 days for 4 cycles. This was followed by T 175 mg/m2 every 21 days for 4 cycles. The final analysis for RFS was planned when 453 events were observed permitting the detection of a hazard ratio (HR) of 1.43 between CEF and AC/T and a HR of 1.43 between EC/T and the best of the other two arms. Quality of Life data using the EORTC C-30 and the Breast Cancer Chemotherapy questionnaires were collected throughout the study. The results will be available at the time of the presentation. Results: A total of 2104 women were enrolled between December 2000 and April 2005. The required 453 events for the RFS analysis were observed by the clinical cut-off date of March 30, 2012. At this point 369 deaths had been observed. The median follow-up is 87.5 months. Outstanding data and queries are currently being collected and reviewed with an expected database lock and final analysis mid August, 2012. Febrile neutropenia remains higher on the CEF and EC/T arms while more neuropathy was seen in the taxane containing regimens. Conclusions: Although the two regimens considered a standard of care at the time the study was initiated are no longer widely used, the trial results will enhance our understanding of the magnitude of benefit of taxane following an anthracycline, the significance of cumulative anthracycline dose, and the role of dose density/ intensity as backbone of conventional chemo regimens. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-13-01.

Cochlear and neural auditory function for a series of 30 patients with acoustic neuroma was assessed pre- and postoperatively by transiently evoked otoacoustic emission (TEOAE), auditory brain stem response (ABR), and acoustic reflex measures. Employing a retrosigmoid surgical approach, physical integrity of the acoustic nerve was preserved for 22 patients. TEOAEs were observed preoperatively for 13 patients and postoperatively for 6 of them. Postoperative neural function remained unchanged or improved following surgery for 7 patients, and cochlear function decreased. TEOAE, ABR, and acoustic reflex measurements were considered valuable in providing information about site of lesion and probable mechanisms of injury associated with tumor removal.

Simultaneous four-channel (ipsilateral, contralateral, horizontal, and noncephalic) ABR recordings were reviewed by three audiologists for 187 ears of nontumor patients, and 13 ears of patients having eighth nerve tumors. Waveforms from a subgroup of 63 ears were reexamined by the same audiologists to assess inter- and intra-judge consistency. For nontumor ears, the ipsilateral tracings provided the best identification of Waves I and III; the ipsilateral and noncephalic recordings allowed equal identification of Wave V. Waves I, III, and V generally were more robust from the ipsilateral electrode array than from any of the other electrode montages for the tumor ears. Three-way inter-judge agreement ranged from 82% to 87% for ipsilateral Waves I, III, and V and for noncephalic Wave V. Agreement between pairs of judges ranged from 86% to 100%. Intra-judge agreement ranged from 87% to 94% for ipsilateral Waves I, III, and V, and from 92% to 95% for noncephalic Wave V.

Audiologic test results were reviewed for 30 patients whose hearing was preserved following eighth nerve tumor surgery. Speech reception thresholds, 4,000-Hz thresholds, acoustic reflexes, and ABR wave I absolute latencies were generally unchanged or poorer following surgery; word recognition scores were essentially unchanged. By contrast, ABR waves III and V, and the I–III and I–V interpeak intervals, were generally improved postoperatively, including several patients who had clear waves following surgery despite absent preoperative responses. The improved ABR tracings likely indicate increased neural synchrony due to reduced pressure on the cochlear nerve following surgery, whereas the reduced hearing sensitivity probably reflects cochlear damage coincident to the surgery.

ABR absolute latencies and interpeak intervals were reviewed for 684 non-tumor ears and 75 eighth-nerve tumor ears having various degrees of high frequency hearing loss. For non-tumor ears, the percentage of abnormal absolute latencies for waves I, III, and V increased rather systematically as hearing loss increased, whereas absolute latencies for eighth-nerve tumor ears were largely abnormal regardless of hearing loss. Interpeak intervals were normal for most of the non-tumor ears, but the I–III and I–V intervals were abnormal for most of the tumor ears. The most sensitive index for otoneurologic assessment was a combination of abnormal wave V interaural latency differences or I–V interpeak interval, and the most specific criterion was the I–V interpeak interval. Tumor size influenced sensitivity of most ABR indices.

Multichannel ABR recordings for 30 otoneurologic patients were reviewed independently by three audiologists to assess interjudge consistency in determining absolute latencies and overall interpretation of ABR results. Four months later, the tracings were reviewed a second time to evaluate intrajudge consistency in interpretation of ABR waveforms. Interjudge agreement in marking latencies for waves I, III, and V within 0.2 ms was on the order of 90% or better. Intrajudge consistency was slightly higher. Only rarely did inter- or intrajudge differences in latency measurements exceed 0.3 ms. Agreement in overall interpretation of ABR results as "normal" or "abnormal" was unanimous for 90% of the patients. Across pairs of judges, the agreement for "normal" and "abnormal" classification of the ABR tracings was 97%. Intrajudge consistency for "normal" and "abnormal" categorization of the ABR results was 100% for one judge, 97% for the other two judges.