Objective. To prospectively evaluate histopathologic, blood cellular, serologic, and clinical changes in response to abatacept treatment in patients with primary Sjögren's syndrome (SS). Methods. Blood, saliva, and minor salivary gland biopsy samples were obtained before and after the last of 8 doses of abatacept in 11 primary SS patients. The histologic data evaluated the numbers of lymphocytic foci and B and T cell subtypes (CD20؉, CD3؉, CD4؉, and CD8؉). The numbers of FoxP3؉ regulatory T cells were measured and the FoxP3:CD3 ratio was calculated. Histologic data were compared with results from peripheral blood and with changes in saliva secretion. Results. The numbers of lymphocytic foci decreased significantly (P ‫؍‬ 0.041). Numbers of local FoxP3؉ T cells decreased significantly in percentage of total lymphocytic infiltrates (P ‫؍‬ 0.037). In the peripheral blood, B cells increased (P ‫؍‬ 0.038). This was due to an expansion of the naive B cell pool (P ‫؍‬ 0.034). When adjusting for disease duration, an increase was also noted for total lymphocytes (P ‫؍‬ 0.044) and for CD4 cells (P ‫؍‬ 0.009). Gamma globulins decreased significantly (P ‫؍‬ 0.005), but IgG reduction did not reach significance. Adjusted for disease duration, saliva production increased significantly (P ‫؍‬ 0.029). Conclusion. CTLA-4Ig treatment significantly reduces glandular inflammation in primary SS, induces several cellular changes, and increases saliva production. Remarkably, this increase in saliva production is significantly influenced by disease duration.

The data of 46 adults with single-sided sensorineural deafness who were candidates for bone-anchored hearing aids (Baha) CROS (contralateral routing of signals) were analyzed. All candidates tested a Baha with a headband in their normal environment. Subsequently, 29 of the candidates chose a permanent Baha CROS fitting, and 17 declined, thus forming the two study groups. No significant difference regarding age, sex or duration of deafness was found between the two groups. Similarly, the transcranial attenuation was not significantly different between those who accepted and declined a Baha. Subjects with some residual hearing in their poorer ear tended to decline a Baha, but the effect was not statistically significant. For a subset of 28 subjects, the Bern Benefit in Single-Sided Deafness questionnaire was administered. The questionnaire consists of 10 visual analogue scales rating the subjectively perceived benefit of the Baha or any other CROS device in different situations. Scores were found to be significantly higher for speech understanding at some distance (p = 0.026), for speech understanding in noise (p = 0.037), for group conversations (p < 0.01), and for the overall benefit (p < 0.01) for those candidates who chose to use a Baha as a CROS device permanently.

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A histo- and immunohistochemical examination of the superior deep cervical lymph nodes was performed in a group of 19 patients who died from intracerebral haemorrhage. For comparison two control groups without cerebral lesions were studied (n = 17, n = 13). Free iron deposits as shown within the lymph nodes by Prussian blue reaction were seen significantly more often following intracerebral haemorrhage than without bleeding. The expression of CD 68 (a marker for macrophages) or CR 3/43 (microglia) gave a strong reaction, but there are no significant differences between the three groups. Glial fibrillary acidic protein was rarely seen in the three groups. Raising the CSF pressure results in increased CSF drainage into the cervical lymph nodes. The clinical importance of this lymphatic drainage suggests a communication between the brain and the immune system of the head and neck, with a possible selective up- and down-regulation.

The level of improvement in the audiological results of Baha(®) users mainly depends on the patient's preoperative hearing thresholds and the type of Baha sound processor used. This investigation shows correlations between the preoperative hearing threshold and postoperative aided thresholds and audiological results in speech understanding in quiet of 84 Baha users with unilateral conductive hearing loss, bilateral conductive hearing loss and bilateral mixed hearing loss. Secondly, speech understanding in noise of 26 Baha users with different Baha sound processors (Compact, Divino, and BP100) is investigated. Linear regression between aided sound field thresholds and bone conduction (BC) thresholds of the better ear shows highest correlation coefficients and the steepest slope. Differences between better BC thresholds and aided sound field thresholds are smallest for mid-frequencies (1 and 2 kHz) and become larger at 0.5 and 4 kHz. For Baha users, the gain in speech recognition in quiet can be expected to lie in the order of magnitude of the gain in their hearing threshold. Compared to its predecessor sound processors Baha(®) Compact and Baha(®) Divino, Baha(®) BP100 improves speech understanding in noise significantly by +0.9 to +4.6 dB signal-to-noise ratio, depending on the setting and the use of directional microphone. For Baha users with unilateral and bilateral conductive hearing loss and bilateral mixed hearing loss, audiological results in aided sound field thresholds can be estimated with the better BC hearing threshold. The benefit in speech understanding in quiet can be expected to be similar to the gain in their sound field hearing threshold. The most recent technology of Baha sound processor improves speech understanding in noise by an order of magnitude that is well perceived by users and which can be very useful in everyday life.