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In parallel with the auditory afferent system, the auditory efferent system is active in all parts of the auditory pathways from auditory cortex to the cochlea. The auditory efferent system has two main segments: the rostral and the caudal parts. The rostral part, which starts from the cortical centers to thalamic nuclei and continues into collicular pathways in rostral brainstem, which sends its neural fibers to the main collicular nuclei especially inferior colliculus. The caudal part includes the olivocochlear bundle, which originates from the superior olivary complex and terminates on the cochlear hair cells. Most studies about the auditory efferent system have focused only on the caudal part using otoacoustic emission suppression test. Speech-evoked auditory brainstem response (S-ABR) as an electrophysiologic test that uses speech stimuli to simulate real-life auditory conditions, reflects the performance of rostral brainstem centers, so structurally seems to be an appropriate candidate to examine the rostral part of the auditory efferent system. Our hypothesis is that S-ABR in noisy condition, a typical condition for stimulating the auditory efferent system, has the potential to be used as an objective noninvasive electrophysiologic test for studying the rostral auditory efferent system in diagnosis and treatment/rehabilitation follow-ups. In addition, S-ABR can potentially reflect higher-order auditory functions and the effects of their dysfunctions on the lower brainstem. This characteristic makes S-ABR even more suitable tool for evaluation of the efferent system. To evaluate our hypothesis, Eighteen normal hearing subjects in the age range of 18-25 were tested in a pilot study for S-ABR in quiet mode and three signal to noise ratios of +10,0 and -10 for both ears. Then we checked the correlation between the results of S-ABR in different conditions and scores of auditory behavioral tests that auditory efferent system is involved in them: Consonant-Vowel perception in noise, dichotic Consonant-Vowel-Consonant and sound lateralization in noise. The results of our pilot study showed a significant correlation between S-ABR changes in noise with the scores of the behavioral tests in noisy or dichotic situations. Findings of the current study suggest that S-ABR with specific contralateral noise can be an appropriate option for evaluating the performance of rostral part of the auditory efferent system and may be suitable for top-down auditory training follow-ups, although the generalization of these results needs further studies in different groups with different auditory processing abnormalities or skills., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: 'Palpitation' is one of the most common complaints in patients referring to cardiologists. In modern medicine era, these patients suffer from much distress and some cases are known to be difficult to treat. Although the clinician's first duty is obviously to search for an organic basis for this symptom, the diagnostic evaluation is frequently unrevealing. However, clinical experience suggests that psychiatric causes are relatively common., Objectives: This research aimed to screen for mental disorders in patients complaining of palpitation and healthy persons in order to perform a preliminary comparison between them., Patients and Methods: This is a case-control study to screen mental disorders. The target population consisted of adult volunteers with benign palpitation and their matched healthy persons. They were referred during a 10-month-period to the cardiology outpatient's clinic of Mostafa Khomeini hospital in Tehran, Iran. Sampling was accidental and eventually 110 participants comprised the sample size. The measuring tool was GHQ-28 (28-item general health questionnaire) and the main variable was the questionnaire score obtained from the Likert scoring method., Results: Comparing two groups showed that the number of participants with the scores more than cut-off point in palpitation group was significantly more than healthy person group (85.4% vs. 43.6% with P < 0.001). Also the total score of GHQ-28 and scores of its subscale (somatization, anxiety, and social dysfunction) in patients complaining of palpitation were significantly more than those of the healthy participants (34.2 vs. 25.7, 8.9 vs. 6.4, 9.4 vs. 6.4, and 12.3 vs. 10.8, respectively with P < 0.001, P = 0.001, P < 0.001, and P < 0.007, respectively)., Conclusions: Palpitation is the most common symptom in psychiatric disorders such as anxiety and somatization disorders. According to the results of this study, psychiatric causes have an important role in Iranian patients complaining of palpitations (benign form). Considering this fact may lead to a more effective treatment of benign palpitations.

Background: Communication is an important aspect of everyday life especially for elderly people. Hearing loss can impair the exchange of information and therefore reduces the quality of life. The purpose of this study was to investigate the quality of life in elderly people who are hard of hearing after wearing a hearing aid., Methods: Hearing-impaired old people who referred to the rehabilitation centers of Tehran Welfare Organization for having a hearing aid completed the Hearing Handicap Inventory for the Elderly questionnaire before and three months after using a hearing aid. Scores of the effects of hearing loss on quality of life were compared for each subject and between males and females., Results: The results showed a significant improvement of the quality of life after three months of using a hearing aid in all participants and betterment of their most important problems i.e., the communication and exchange of information., Conclusion: In conclusion, with respect to the beneficial effects of hearing aids in presbycusis and due to the significant improvement in the quality of life, hearing aids are recommended for this group of population.

Background/objective: The status of pelvic supporting organs and possible related factors in a population of Iranian women, 18 - 68 years of age, were studied in primary health care centers., Methods: In this cross-sectional study, 3,730 women were visited in three primary health care centers. The status of their pelvic supporting organs was measured according to the pelvic organ prolapse quantification system. Stages of prolapse were evaluated for trends in terms of various variables, using the Pearson chi2 statistical test. Demographic and obstetric factors were tested for potential confounding variables with logistic regression analysis., Results: The mean age was 36 (range: 18 - 68) years. The overall distribution of pelvic organ prolapse was as follows: stage 0, 47%; stage 1, 23.1%; stage 2, 18.3%; and stage 3, 11.6%. Based on logistic regression analysis, age > or =50 years, menopause, gravidity >3, parity >3, number of vaginal deliveries >3, history of operative delivery, history of vaginal delivery without episiotomy, and home delivery were found to be independent risk factors for development of pelvic organ prolapse., Conclusion: The overall rate of prolapse was 53%, with most subjects having stage 1 or 2. Several factors influence development of pelvic organ prolapse.

Objective: To investigate the effect of exercise during pregnancy on the intensity of low back pain and kinematics of spine., Method: A prospective randomized study was designed. 107 women participated in an exercise program three times a week during second half of pregnancy for 12 weeks and 105 as control group. All filled a questionnaire between 17-22 weeks of gestation and 12 weeks later for assessment of their back pain intensity. Lordosis and flexibility of spine were measured by Flexible ruler and Side bending test, respectively, at the same times. Weight gain during pregnancy, Pregnancy length and neonatal weight were recorded., Result: Low back pain intensity was increased in the control group. The exercise group showed significant reduction in the intensity of low back pain after exercise (p<0.0001). Flexibility of spine decreased more in the exercise group (p<0.0001). Weight gain during pregnancy, pregnancy length and neonatal weight were not different between the two groups., Conclusion: Exercise during second half of the pregnancy significantly reduced the intensity of low back pain, had no detectable effect on lordosis and had significant effect on flexibility of spine.

Objectives: To determine whether concentrations of beta-HCG in cervicovaginal secretions could predict spontaneous preterm birth (SPB) in asymptomatic high risk pregnancies., Methods: A cohort study was undertaken with cervicovaginal samples collected from 540 pregnant women between 20 to 28 weeks of gestation. Levels of beta-HCG were measured by ELISA test., Results: There was 3.2-fold increase in cervicovaginal beta-HCG concentrations among patients with SPB vs. term delivery. A single cervicovaginal beta-HCG > 77.8 mIU/ml, between 20 and 28 weeks' gestation, identified patients with subsequent SPB vs. term delivery with sensitivity of 87.5% (95% CI: 47.4-97.9) and a specificity of 97% (95% CI: 86.5-99.4) with positive and negative predictive values of 88.5% and 98%, respectively. Multiple logistic regression indicates that cervicovaginal beta-HCG level > 77.8 mIU/ml was an independent predictor of SPB (adjusted odds ratio 19.97, 95% CI: 10.65-37.45)., Conclusions: Cervicovaginal beta-HCG is a sensitive and specific predictor of patients with subsequent preterm delivery., (Copyright 2004 International Federation of Gynecology and Obstetrics)