Antigenic Proteins Involved in Occupational Rhinitis 1 and Asthma Caused by Obeche Wood (Triplochiton Scleroxylon)

Background Obeche wood dust is a known cause of occupational asthma where an IgE-mediated mechanism has been demonstrated. Objective To characterize the allergenic profile of obeche wood dust and evaluate the reactivity of the proteins by in vitro, ex vivo and in vivo assays in carpenters with confirmed rhinitis and/or asthma Materials and methods An in-house obeche extract was obtained, and two IgE binding bands were purified (24 and 12 kDa) and sequenced by N-terminal identity. Specific IgE and IgG, basophil activation tests and skin prick tests (SPTs) were performed with whole extract and purified proteins. CCD binding was analyzed by ELISA inhibition studies. Results Sixty-two subjects participated: 12 with confirmed occupational asthma/rhinitis (ORA+), 40 asymptomatic exposed (ORA−), and 10 controls. Of the confirmed subjects, 83% had a positive SPT to obeche. There was a 100% recognition by ELISA in symptomatic subjects vs. 30% and 10% in asymptomatic exposed subjects and controls respectively (p<0.05). Two new proteins were purified, a 24 kDa protein identified as a putative thaumatin-like protein and a 12 kDa gamma-expansin. Both showed allergenic activity in vitro, with the putative thaumatin being the most active, with 92% recognition by ELISA and 100% by basophil activation test in ORA+ subjects. Cross-reactivity due to CCD was ruled out in 82% of cases. Conclusions Two proteins of obeche wood were identified and were recognized by a high percentage of symptomatic subjects and by a small proportion of asymptomatic exposed subjects. Further studies are required to evaluate cross reactivity with other plant allergens.

Análisis experimental y por el método de los elementos finitos del estado de tensiones en uniones carpinteras de empalme de llave

In this research, the halved and tabled traditional timber scarf joint is analyzed. This joint consists in two end joint pieces usually subjected to tension. Initially, the study is discussed from an experimental point of view. In this way, 3 critical cross-sections are established (section of the notch, section of the horizontal plane and reduced section) and mechanical tests are performed to achieve the failure on each of critical sections by changing the geometry of the joint. The study is completed by developing a finite element model which allows verify experimental results and extend the analysis to other geometries. This model has to simulate the real behavior of the material which is being studied, so mechanical tests are performed to obtain the elastic constants and the coefficients of friction of the material. In the reduced section, an abrupt decrease of the effective cross-section takes place, and this effect is also experimentally analyzed. These tests indicate that a crack is initiated before the bending-tension failure occurs in the reduced section. The test material consists of wood of Pinus sylvestris L. coming from the “Valsaín´s Sawmill” (Segovia) with “premium quality” according to the nonstructural wood visual classification of sawmill. It is observed that initiation of a crack, in the mortise (bottom of reduced section), and shear stress concentration, at the initial part of the heel (beginning of horizontal plane), completely determine the mechanical behaviour of the joint, resulting in 3 failure modes: local compression failure in the section of the notch, shear failure in the horizontal plane, and failure of stresses concentration, mainly perpendicular to the grain tension, at the bottom of reduced section. The geometric optimization is obtained for halved and tabled traditional scarf joint, when the joint has made with similar properties of wood than tested specimens, for any height and width of the cross-section. It is considered the failure due to the initiation of a crack in reduced section, by applying a correction coefficient into the usual equation used to design the members subjected to both tension and bending. Therefore, it is possible to obtain, analytically, the design conditions to be met of the 3 critical cross-sections. According to the theoretical optimization, the tension strength of complete cross-section is reduced until 14%, when using this type of joint. The experimental optimization indicates even a greater reduction, until 6%. En el presente trabajo de investigación se analiza el comportamiento mecánico de las uniones tradicionales de empalme de llave, que consisten en dos piezas unidas por sus testas transmitiéndose entre ellas principalmente un esfuerzo de tracción. Inicialmente, el estudio se aborda desde un punto de vista experimental. De este modo, se establecen las 3 secciones críticas o de estudio (sección del encaje, sección rasante del cogote y sección reducida) y se realizan ensayos mecánicos, variando la geometría de la unión, para alcanzar la rotura en cada una de ellas. Se completa el estudio mediante la elaboración de un modelo por elementos finitos que permite verificar los resultados experimentales y ampliar el análisis a otras geometrías. Este modelo debe simular el comportamiento real del material objeto de estudio, por lo que se realizan ensayos para obtener las constantes elásticas y los coeficientes de rozamiento del mismo. También se analiza, experimentalmente, el efecto entalladura que reduce bruscamente la sección completa del tirante, estableciendo que el fallo por flexotracción en la sección reducida de la pieza, no llega a producirse por el inicio previo de una grieta. El material de ensayo consiste en madera de Pinus sylvestris L. (pino silvestre) procedente del Aserradero de Valsaín (Segovia) y de calidad “Extra” o “Primera” según la clasificación visual no estructural del aserradero. Se observa que el inicio de una grieta en la mortaja del rediente y la concentración de tensiones tangenciales en la parte inicial del cogote, determinan completamente el comportamiento mecánico de la unión, dando lugar a 3 modos distintos de rotura: fallo por compresión en la sección del encaje, fallo por cortante en la sección rasante y fallo por concentración de tensiones, principalmente tracciones perpendiculares, en el rebaje de la sección reducida. Se consigue optimizar geométricamente cualquier empalme de llave confeccionado con madera de características similares a la ensayada, para cualquier valor de la altura y de la anchura de la sección. Se considera el agotamiento en la sección reducida causado por el inicio de grieta, mediante la aplicación de un coeficiente corrector en la expresión habitual de agotamiento por flexotracción, en consecuencia, finalmente es posible obtener, de modo analítico, un valor del índice de agotamiento en cada una de las 3 secciones de estudio. La optimización teórica del empalme de llave indica que la capacidad resistente del tirante bruto se reduce al 14%, cuando se coloca este tipo de unión tradicional. Experimentalmente se obtiene, que, para la sección ensayada, la capacidad resistente del tirante bruto se reduce todavía más, llegando al 6%.

Numerical and experimental study of appendages in racing yachts and their influence on the free surface

Las prestaciones de un velero de regatas se estiman por medio de los Programas de Predicción de Velocidad (VPP) que incluyen las características de estabilidad y modelos aero e hidrodinámico del barco. Por esta razón, es importante tener una evaluación adecuada de las fuerzas en apéndices y de su variación en diferentes condiciones de navegación, escora y deriva. Además, para el cálculo de las fuerzas en los apéndices es importante conocer sus características hidrodinámicas cuando trabajan conjuntamente en un campo fluido fuertemente modificado por la carena. Por esta razón, se han utilizado una serie de ensayos realizados en el Canal de Ensayos de la ETSIN con el objetivo de validar códigos numéricos que permiten una evaluación más rápida y focalizada en los distintos fenómenos que se producen. Dichos ensayos se han realizado de forma que pudiera medirse independientemente las fuerzas hidrodinámicas en cada apéndice, lo que permitirá evaluar el reparto de fuerzas en diferentes condiciones de navegación para poder profundizar en las interacciones entre carena, quilla y timón. Las técnicas numéricas permiten capturar detalles que difícilmente se pueden visualizar en ensayos experimentales. En este sentido, se han probado las últimas técnicas utilizadas en los últimos workshops y se ha enfocado el estudio a un nuevo método con el objetivo de mostrar una metodologia más rápida que pueda servir a la industria para este tipo de aproximación al problema. ABSTRACT The performances of a racing sailboat are estimated by means of the speed prediction programs (VPP), which include the ship stability characteristics and the aero and hydrodynamic models. For this reason, it is important to have an adequate evaluation of the forces in appendices and its variation in different sailing conditions, heel and leeway Moreover, for the analysis of the forces in the appendices, it is important to know their hydrodynamic characteristics when they work together in a fluid field strongly modified by the canoe body. For this reason, several tests have been done in the ETSIN towing tank with the aim to validate numeric codes that allowing faster analysis and they permit to focus on the different phenomena that occur there. Such tests have been done in a way that the hydrodynamic forces in each appendage could be measured independently allowing assessing the distribution of forces in different sailing conditions to be able to deepen the interactions between the canoe body, the keel and the rudder. Numerical techniques allow capturing details that can hardly be displayed in experimental tests. In this sense, the latest techniques used in the recent workshops have been reviewed and the study has been focused to propose a new model with the aim to show a new faster methodology which serves the industry for this type of approach to the problem.

Is Microarray Analysis Really Useful and Sufficient to Diagnose Nut Allergy in the Mediterranean Area?

Background: Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy. Objective: To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy. Methods: sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cor a 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges. Results: Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP?sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P<.05). Similar rates of Cor a 8 and Jug r 3 sensitization were detected by both techniques. Conclusions: The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved.

Occupational allergic multiorgan disease induced by wheat flour

Bakers are repeatedly exposed to wheat flour (WF) and may develop sensitization and occupational rhinoconjunctivitis and/or asthma to WF allergens.1 Several wheat proteins have been identified as causative allergens of occupational respiratory allergy in bakery workers.1 Testing of IgE reactivity in patients with different clinical profiles of wheat allergy (food allergy, wheat-dependent exercise-induced anaphylaxis, and baker's asthma) to salt-soluble and salt-insoluble protein fractions from WF revealed a high degree of heterogeneity in the recognized allergens. However, mainly salt-soluble proteins (albumins, globulins) seem to be associated with baker's asthma, and prolamins (gliadins, glutenins) with wheat-dependent exercise-induced anaphylaxis, whereas both protein fractions reacted to IgE from food-allergic patients.1 Notwithstanding, gliadins have also been incriminated as causative allergens in baker's asthma.2 We report on a 31-year-old woman who had been exposed to WF practically since birth because her family owned a bakery housed in the same home where they lived. She moved from this house when she was 25 years, but she continued working every day in the family bakery. In the last 8 years she had suffered from work-related nasal and ocular symptoms such as itching, watery eyes, sneezing, nasal stuffiness, and rhinorrhea. These symptoms markedly improved when away from work and worsened at work. In the last 5 years, she had also experienced dysphagia with frequent choking, especially when ingesting meats or cephalopods, which had partially improved with omeprazole therapy. Two years before referral to our clinic, she began to have dry cough and breathlessness, which she also attributed to her work environment. Upper and lower respiratory tract symptoms increased when sifting the WF and making the dough. The patient did not experience gastrointestinal symptoms with ingestion of cereal products. Skin prick test results were positive to grass (mean wheal, 6 mm), cypress (5 mm) and Russian thistle pollen (4 mm), WF (4 mm), and peach lipid transfer protein (6 mm) and were negative to rice flour, corn flour, profilin, mites, molds, and animal dander. Skin prick test with a homemade WF extract (10% wt/vol) was strongly positive (15 mm). Serologic tests yielded the following results: eosinophil cationic protein, 47 ?g/L; total serum IgE, 74 kU/L; specific IgE (ImmunoCAP; ThermoFisher, Uppsala, Sweden) to WF, 7.4 kU/L; barley flour, 1.24 kU/L; and corn, gluten, alpha-amylase, peach, and apple, less than 0.35 kU/L. Specific IgE binding to microarrayed purified WF allergens (WDAI-0.19, WDAI-0.53, WTAI-CM1, WTAI-CM2, WTAI-CM3, WTAI-CM16, WTAI-CM17, Tri a 14, profilin, ?-5-gliadin, Tri a Bd 36 and Tri a TLP, and gliadin and glutamine fractions) was assessed as described elsewhere.3 The patient's serum specifically recognized ?-5-gliadin and the gliadin fraction, and no IgE reactivity was observed to other wheat allergens. Spirometry revealed a forced vital capacity of 3.88 L (88%), an FEV1 of 3.04 L (87%), and FEV1/forced vital capacity of 83%. A methacholine inhalation test was performed following an abbreviated protocol,4 and the results were expressed as PD20 in cumulative dose (mg) of methacholine. Methacholine inhalation challenge test result was positive (0.24 mg cumulative dose) when she was working, and after a 3-month period away from work and with no visits to the bakery house, it gave a negative result. A chest x-ray was normal. Specific inhalation challenge test was carried out in the hospital laboratory by tipping WF from one tray to another for 15 minutes. Spirometry was performed at baseline and at 2, 5, 10, 15, 20, 30, 45, and 60 minutes after the challenge with WF. Peak expiratory flow was measured at baseline and then hourly over 24 hours (respecting sleeping time). A 12% fall in FEV1 was observed at 20 minutes and a 26% drop in peak expiratory flow at 9 hours after exposure to WF,

Clinical presentation, allergens, and management of wheat allergy

IgE-mediated allergy to wheat proteins can be caused by exposure through ingestion, inhalation, or skin/mucosal contact, and can affect various populations and age groups. Respiratory allergy to wheat proteins is commonly observed in adult patients occupationally exposed to flour, whereas wheat food allergy is more common in children. Wheat allergy is of growing importance for patients with recurrent anaphylaxis, especially when exercise related. The diagnosis of wheat allergy relies on a consistent clinical history, skin prick testing with well-characterized extracts and specific IgE tests. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several wheat components. However, a high degree of heterogeneity has been found in the recognition pattern of allergens among patient groups with different clinical profiles, as well as within each group. Thus, oral provocation with wheat or the implicated cereal is the reference test for the definitive diagnosis of ingested wheat/cereal allergy.

A Recombinant Sal k 1 Isoform as an Alternative to the Polymorphic Allergen from Salsola kali Pollen for Allergy Diagnosis

The incidence of Amaranthaceae pollen allergy has increased due to the desertification occurring in many countries. In some regions of Spain, Salsola kali is the main cause of pollinosis, at almost the same level as olive and grass pollen. Sal k 1 - the sensitization marker of S. kali pollinosis - is used in clinical diagnosis, but is purified at a low yield from pollen. We aimed to produce a recombinant (r)Sal k 1 able to span the structural and immunological properties of the natural isoforms from pollen, and validate its potential use for diagnosis. METHODS: Specific cDNA was amplified by PCR, cloned into the pET41b vector and used to transform BL21 (DE3) Escherichia coli cells. Immunoblotting, ELISA, basophil activation and skin-prick tests were used to validate the recombinant protein against Sal k 1 isolated from pollen. Sera and blood cells from S. kali pollen-sensitized patients and specific monoclonal and polyclonal antisera were used. RESULTS: rSal k 1 was produced in bacteria with a yield of 7.5 mg/l of cell culture. The protein was purified to homogeneity and structural and immunologically validated against the natural form. rSal k 1 exhibited a higher IgE cross-reactivity with plant-derived food extracts such as peanut, almond or tomato than with pollen sources such as Platanus acerifolia and Oleaceae members. CONCLUSIONS: rSal k 1 expressed in bacteria retains intact structural and immunological properties in comparison to the pollen-derived allergen. It spans the immunological properties of most of the isoforms found in pollen, and it might substitute natural Sal k 1 in clinical diagnosis.

Continuous amperometric monitoring of glucose in a brittle diabetic chimpanzee with a miniature subcutaneous electrode

The performance of an amperometric biosensor, consisting of a subcutaneously implanted miniature (0.29 mm diameter, 5 × 10−4 cm2 mass transporting area), 90 s 10–90% rise/decay time glucose electrode, and an on-the-skin electrocardiogram Ag/AgCl electrode was tested in an unconstrained, naturally diabetic, brittle, type I, insulin-dependent chimpanzee. The chimpanzee was trained to wear on her wrist a small electronic package and to present her heel for capillary blood samples. In five sets of measurements, averaging 5 h each, 82 capillary blood samples were assayed, their concentrations ranging from 35 to 400 mg/dl. The current readings were translated to blood glucose concentration by assaying, at t = 1 h, one blood sample for each implanted sensor. The rms error in the correlation between the sensor-measured glucose concentration and that in capillary blood was 17.2%, 4.9% above the intrinsic 12.3% rms error of the Accu-Chek II reference, through which the illness of the chimpanzee was routinely managed. Linear regression analysis of the data points taken at t>1 h yielded the relationship (Accu-Chek) = 0.98 × (implanted sensor) + 4.2 mg/dl, r2 = 0.94. The capillary blood and the subcutaneous glucose concentrations were statistically indistinguishable when the rate of change was less than 1 mg/(dl⋅min). However, when the rate of decline exceeded 1.8 mg/(dl⋅min) after insulin injection, the subcutaneous glucose concentration was transiently higher.

Tolerância ao leite processado em altas temperaturas em pacientes com alergia ao leite de vaca mediada pela imunoglobulina E

INTRODUÇÃO: A incidência de pacientes apresentando alergia à proteína do leite de vaca (APLV) após os 5 anos de idade vem crescendo. Definir se estes pacientes tolerariam a ingestão de alimento produzido com leite processado a altas temperaturas (LPAT) proporcionaria melhor qualidade de vida, definiria melhor prognóstico e possibilitaria avaliar a indicação de dessensibilização com muffin. OBJETIVO: (1) identificar quais pacientes com APLV persistente aos quatro anos poderiam tolerar a ingestão de LPAT, (2) descrever as características clínicas e laboratoriais dos grupos reativo e não reativo ao LPAT, e (3) compara-las entre os dois grupos. MÉTODOS: Estudo transversal, utilizando amostra de conveniência, incluindo todos os pacientes acompanhados no ambulatório de alergia alimentar do Instituto da Criança HCFMUSP que preenchiam os critérios de inclusão e que concordaram em realizar o TPO, entre janeiro/2013 e novembro/2014. Os pacientes foram admitidos em hospital-dia sob supervisão médica e submetidos à ingestão de um muffin contendo 2,8 gramas de proteína do leite de vaca. Foram definidos como tolerantes se não apresentassem nenhuma reação alérgica. Estes pacientes foram submetidos na sequência a novo TPO com leite de vaca in natura para excluir a tolerância ao leite de vaca. RESULTADOS: Foram realizados 38 TPO com LPAT, sendo que 30 pacientes (15 masculinos) preencheram todos os critérios de inclusão. A mediana da idade foi de 7 anos e 7 meses (4a10m -14a2m). 14 pacientes (46%) não apresentaram reação após a ingestão do muffin, sendo considerados como não reativos. A análise comparativa entre os grupos reativos e não reativos ao LPAT, não mostrou diferença estatisticamente significante quanto às características clínicas: idade (p=0,8), sexo (p=0,4), história pessoal de rinite (p=0,7), história pessoal de asma (p=0,7), história pessoal de outras alergias (p=0,6), história familiar de rinite (p=0,7), história familiar de asma (p=0,3), história familiar de outras alergias (p=0,1), relato de anafilaxia prévia (p=0,07), relato de ingestão de traços de leite previamente ao TPO (p=0,4), relato de reação alérgica no último ano antes da provocação (p=0,6), relato de anafilaxia no último ano antes do TPO (p=0,6). Não se observou diferença estatisticamente significante entre os dois grupos para IgE total (p=0,1) e eosinófilos (p=0,6). O teste de puntura para leite de vaca e frações mostrou diferença estatisticamente significante para ?-lactoalbumina (p= 0,01) e para a caseína (p = 0,004); em relação ao ImmunoCAP® apenas para a caseína (p= 0,05) essa diferença foi significante. Ao avaliar estes pacientes 1 ano após o TPO, nenhum dos 16 pacientes que foram reativos ao LPAT estava ingerindo leite de vaca, enquanto 28% dos pacientes que foram tolerantes ao LPAT estavam consumindo leite de vaca in natura sem reação (p=0,037). CONCLUSÃO: O estudo mostrou que os pacientes com APLV desta amostra brasileira apresentaram 2 diferentes fenótipos, sendo que aproximadamente metade tolerou o LPAT. Sendo assim, o TPO para LPAT deve ser considerado para pacientes com APLV, sempre sob supervisão médica e estrutura segura e adequada, pois pode contribuir para uma mudança no paradigma do seguimento destes pacientes. Teste de puntura e ImmunoCAP® para caseína podem sugerir quais pacientes estariam tolerantes ao TPO com LPAT, reforçando dados da literatura internacional

Polissensibilização alimentar : um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

The Missing Piece: Empowerment of Roma Grassroots Organisations in EU Roma Integration Policies. IES Policy Brief Issue 2014/10/December 2014

Summary. The fourth edition of Roma Pride has brought Roma civic activism back in the spotlight. This Roma-rights mobilization, taking place every October in several European cities, has emphasized the centrality of an active civil society in pursuing a successful integration of the Roma in Europe. The ‘Award for Roma Integration’ and the ‘Civil Society Prize 2014’ conferred last October by the European Union (EU) to Roma and pro-Roma Civil Society Organizations (CSOs) have confirmed this approach. Nonetheless, a general discontent towards the EU Roma Integration Policies exists within the Roma Civil Society, who calls for stronger support to and the promotion of “Romaled change”. This Policy Brief investigates the reasons behind such discontent and identifies the ‘distance’ from Roma communities as the Achilles heel of EU policies. It argues for further efforts by the EU to empower Roma organisations operating at the grassroots through community capacity building, structured dialogue and simplification of the funding mechanisms.

The works of Jack London. --

[v.1] Adventure. -- [v.2] Before Adam. -- [v.3] Burning Daylight. -- [v.4] The call of the wild. -- [v.5] The cruise of the Snark. -- [v.6] The iron heel. -- [v.7] Martin Eden. -- [v.8] The sea-wolf. -- [v.9] South sea tales. -- [v.10] The valley of the moon. -- [v.11] When God laughs. -- [v.12] White Fang.

Nederlandsch tijdschrift voor verloskunde, ziekten der vrouwenen en der kindern.

Mode of access: Internet.

Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis

Background: Although a lowered medial longitudinal arch has been cited as a causal factor in plantar fasciitis, there is little experimental evidence linking arch motion to the pathogenesis of the condition. This study investigated the sagittal movement of the arch in subjects with and without plantar fasciitis during gait. Methods: Digital fluoroscopy was used to acquire dynamic lateral radiographs from 10 subjects with unilateral plantar fasciitis and 10 matched control subjects. The arch angle and the first metatarsophalangeal joint angle were digitized and their respective maxima recorded. Sagittal movement of the arch was defined as the angular change between heel strike and the maximum arch angle observed during the stance phase of gait. The-thickness of the proximal plantar fascia was determined from sagittal sonograms of both feet. ANOVA models were used to identify differences between limbs with respect to each dependent variable. Relationships between arch movement and fascial thickness were investigated using correlations. Results: There was no significant difference in either the movement or maximum arch angle between limbs. However, subjects with plantar fasciitis were found to have a larger metatarsophalangeal joint angle than controls (P < 0.05). Whereas the symptomatic and asymptomatic plantar fascia were thicker than those of control feet (P < 0.05), significant correlations were noted between fascial thickness and peak arch and metatarsophalangeal joint angles (P < 0.05) in the symptomatic limb only. Conclusions: Neither abnormal shape nor movement of the arch are associated with chronic plantar fasciitis. However, arch mechanics may influence the severity of plantar fasciitis once the condition is present. Digital flexion, in contrast, has a protective role in what might be a bilateral disease process.

Hearing sensitivity and bone mineral density in older adults: the Health, Aging and Body Composition Study

Bone mineral density (BMD) may be associated with hearing loss in older adults. Demineralization of the cochlear capsule has been associated with hearing loss in those with Paget's disease of the bone and otosclerosis. Osteoporosis may also result in cochlear capsule demineralization. We hypothesized that lower hip BMD and lower heel ultrasound measurements would be associated with hearing loss in a population-based sample of 2,089 older black and white men and women. Bone parameters and hearing function were measured at the fourth clinical follow-up visit. Audiometric threshold testing was used to measure air- and bone-conduction hearing sensitivity. BMD of the hip and its subregions was measured using dual-energy X-ray absorptiometry. Calcaneal bone measurements [broadband ultrasound attenuation (BUA), speed of sound (SOS) and the quantitative ultrasound index (QUI)] were obtained using heel ultrasound. After adjusting for known hearing loss risk factors, no association was found between hearing and any of the bone measurements in whites and black women. In black men, however, lower hip BMD was associated with higher odds of hearing loss; for each standard deviation decrease in total hip BMD, the odds of hearing loss were 1.41 (95% confidence interval 1.08, 1.83), 1.39 (95% CI 1.07, 1.82) for femoral neck BMD and 1.65 (95% CI 1.26, 2.16) for trochanter BMD. Conductive hearing loss was associated with lower heel ultrasound measurements, though only among white men. The results of this study are mixed and inconclusive. Lower BMD of the hip and its subregions was associated with hearing loss among black men, but not among whites or black women. Lower measurements on heel ultrasound were associated with conductive hearing loss, though only among white men. These results suggest that axial and appendicular bone parameters may be modestly associated with hearing loss in older men, but not in women.