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Intracellular Mg2+ interacts with structural determinants of the narrow constriction contributed by the NR1-subunit in the NMDA receptor channel.

1. N-methyl-D-aspartate (NMDA) receptor channels are blocked by intracellular Mg2+ in a voltage-dependent manner. Amino acid residues positioned at or near the narrow constriction that interact with intracellular Mg2+ were identified in recombinant NR1-NR2A channels expressed in Xenopus oocytes or human embryonic kidney (HEK) 293 cells. 2. In the absence of extracellular Ca2+, the block of wild-type channel by intracellular Mg2+ measured using macroscopic currents showed a voltage dependence (delta) of around 0.38 and a voltage-independent affinity for the channel of 4 mM. These parameters were independent of the Mg2+ concentration (0.05-10mM), and were indistinguishable from those found for the reduction of single channel amplitudes under the same ionic conditions. Under bionic conditions with high intracellular Mg2+ and K+ extracellularly, Mg2+ was weakly permeant. Mg2+ efflux, however, attenuated the block only at positive potentials (> +80 mV). 3. Substitutions of the N-site asparagine in the NR1-subunit altered intracellular Mg2+ block over physiological membrane potentials (+10 to +50 mV). Substitution of glycine, glutamine or serine attenuated the extent of block whereas the negatively charged aspartate enhanced it, consistent with the side chain of the native asparagine at this position contributing to a blocking site for intracellular Mg2+. 4. Substitutions of the N-site or N + 1 site asparagine in the NR2A-subunit, which form a blocking site for extracellular Mg2+, also altered the block by intracellular Mg2+. However, for the NR2A-subunit N-site asparagine, the block was reduced but only at non-physiological high potentials (> +70 mV). 5. The NR2A-subunit N + 1 site asparagine, which together with NR1-subunit N-site asparagine forms the narrow constriction of the channel, also contributed to a blocking site for intracellular Mg2+. However, it did so to lesser extent than the NR1-subunit N-site and in a manner different from its contribution to a blocking site for extracellular Mg2+. 6. It is concluded that intracellular Mg2+ interacts with residues that form the narrow constriction in the NMDA receptor channel with the N-site asparagine of the NR1-subunit representing the dominant blocking site. Thus, intracellular Mg2+ interacts with different asparagine residues at the narrow constriction than extracellular Mg2+, although the two blocking sites are positioned very close to each other.

Animals↗

Adjacent asparagines in the NR2-subunit of the NMDA receptor channel control the voltage-dependent block by extracellular Mg2+.

1. The voltage-dependent block of N-methyl-D-aspartate (NMDA) receptor channels by extracellular Mg2+ is a critical determinant of its contribution to CNS synaptic physiology. The function of the narrow constriction of the channel in determining the block was investigated by analysing the effects of a set different amino acid substitutions at exposed residues positioned at or near this region. NMDA receptor channels, composed of wild-type and mutant NR1- and NR2A-subunits, were expressed in Xenopus oocytes or human embryonic kidney (HEK) 293 cells. 2. In wild-type channels, the voltage dependence (delta) of the block Mg2+ was concentration dependent with values of delta of integral of 0.82 in 0.07 mM and higher concentrations. Under bionic conditions with high extracellular Mg2+ and K+ as the reference ion, Mg2+ weakly permeated the channel. Over intermediate potentials (approximately -60 to -10 mV), this weak permeability had no apparent effect on the block but at potentials negative to approximately -60mV, it attenuated the extent and voltage dependence of the block. 3. Substitutions of glycine, serine, glutamine or aspartate for the N-site asparagine in the NR1-subunit enhanced the extent of block over intermediate potentials but left the voltage dependence of the block unchanged indicating that structural determinants of the block remained. These same substitutions either attenuated or left unchanged the apparent Mg2+ permeability. 4. In channels containing substitutions of glycine, serine or glutamine for the N-site asparagine in the NR2A-subunit, the block Mg2+ was reduced at negative potentials. Over intermediate potentials, the block was not strongly attenuated except for the glutamine substitution which reduced the voltage dependence of the block to integral of 0.57 in 0.7 mM Mg2+. 5. Equivalent substitutions for the N + 1 site asparagine in the NR2A-subunit strongly attenuated the block over the entire voltage range. In 0.7 mM Mg2+, the voltage dependence of the block was reduced to 0.50 (glycine), 0.53 (serine) and 0.46 (glutamine). 6. Channels containing substitutions of the N-site or N + 1 site asparagines in the NR2A-subunit showed an increased Mg2+ permeability suggesting that these adjacent asparagines form a barrier for inward Mg2+ flux. Changes in this barrier contribute, at least in part, to the mechanism underlying disruption of the block following substitution of these residues. 7. The adjacent NR2A-subunit asparagines are positioned at or near the narrow constriction of the channel. Pore size, however, did not determine how effectively Mg2+ blocks mutant channels. 8. It is concluded that, at the narrow constriction in the NMDA receptor channel, the adjacent NR2A-subunit asparagines, the N-site and N + 1 site, but not the N-site asparagine of the NR1-subunit, form a critical blocking site for extracellular Mg2+. The contribution to the blocking site, in contrast to the prevailing view, is stronger for the N + 1 site than for the N-site asparagine. The block may involve binding of Mg2+ to these residues.

Amino Acid Sequence↗

Speech recognition in noise as a function of the number of spectral channels: comparison of acoustic hearing and cochlear implants.

Speech recognition was measured as a function of spectral resolution (number of spectral channels) and speech-to-noise ratio in normal-hearing (NH) and cochlear-implant (CI) listeners. Vowel, consonant, word, and sentence recognition were measured in five normal-hearing listeners, ten listeners with the Nucleus-22 cochlear implant, and nine listeners with the Advanced Bionics Clarion cochlear implant. Recognition was measured as a function of the number of spectral channels (noise bands or electrodes) at signal-to-noise ratios of + 15, + 10, +5, 0 dB, and in quiet. Performance with three different speech processing strategies (SPEAK, CIS, and SAS) was similar across all conditions, and improved as the number of electrodes increased (up to seven or eight) for all conditions. For all noise levels, vowel and consonant recognition with the SPEAK speech processor did not improve with more than seven electrodes, while for normal-hearing listeners, performance continued to increase up to at least 20 channels. Speech recognition on more difficult speech materials (word and sentence recognition) showed a marginally significant increase in Nucleus-22 listeners from seven to ten electrodes. The average implant score on all processing strategies was poorer than scores of NH listeners with similar processing. However, the best CI scores were similar to the normal-hearing scores for that condition (up to seven channels). CI listeners with the highest performance level increased in performance as the number of electrodes increased up to seven, while CI listeners with low levels of speech recognition did not increase in performance as the number of electrodes was increased beyond four. These results quantify the effect of number of spectral channels on speech recognition in noise and demonstrate that most CI subjects are not able to fully utilize the spectral information provided by the number of electrodes used in their implant.

Adult↗

Music perception with cochlear implants and residual hearing.

AIM: The aims of this study were to examine the music perception abilities of Cochlear Nucleus Hybrid (acoustic plus electric stimulation) cochlear implant (CI) recipients and to compare their performance with that of normal-hearing (NH) adults and CI recipients using conventional long-electrode (LE) devices (Advanced Bionics: 90K, Clarion, CIIHF; Cochlear Corporation: CI24M, CI22, Contour; Ineraid). Hybrid CI recipients were compared with NH adults and LE CI recipients on recognition of (a) real-world melodies and (b) musical instruments. PATIENTS AND METHODS: We tested 4 Hybrid CI recipients, 17 NH adults, and 39 LE CI recipients on open-set recognition of real-world songs presented with and without lyrics. We also tested 14 Hybrid CI recipients, 21 NH adults, and 174 LE CI recipients on closed-set recognition of 8 musical instruments playing a 7-note phrase. RESULTS: On recognition of real-world songs, both the Hybrid recipients and NH listeners were significantly more accurate (p < 0.0001) than the LE CI recipients in the no lyrics condition, which required reliance on musical cues only. The LE group was significantly less accurate than either the Hybrid or NH group (p < 0.0001) on instrument recognition for low and high frequency ranges. CONCLUSIONS: These results, while preliminary in nature, suggest that preservation of low-frequency acoustic hearing is important for perception of real-world musical stimuli.

Acoustic Stimulation↗

Novel intracochlear electrode positioner: effects on electrode position.

Spiral ganglion cells, located in the cochlear modiolus, are widely thought to be the neural elements stimulated by cochlear implants (CIs). Positioning CI electrodes adjacent to the modiolus may allow delivery of more focused, discrete fields of electrical stimulation, reducing both current requirements and the channel interaction associated with simultaneous stimulation. In order to provide greater consistency in positioning CI electrodes against the modiolus, Advanced Bionics Corporation has designed a silicone intracochlear positioner that is inserted alongside the electrode. Placed against the outer wall of the scala tympani, it directs the electrode array toward the modiolus. Five fresh-frozen temporal bones were studied to validate enhanced electrode placement. Electrode position was documented with image-enhanced digital fluoroscopy, and the distance to the modiolus was measured with computer-assisted morphometrics. The electrode positioner was highly effective in positioning the electrodes closer to the modiolus (p < .001).

Adult↗

Effects of converting bilateral cochlear implant subjects to a strategy with increased rate and number of channels.

OBJECTIVES: Three different Advanced Bionics processing strategies were evaluated: 1) 8-channel, 813 pulses per second (pps), Continuous Interleaved Sampling (CIS); 2) 16-channel, 5,100 pps, HiResolution Paired (HiRes P); and 3) 16-channel, 2,900 pps, HiResolution Sequential (HiRes S). METHODS: Seven adult bilateral Clarion CII cochlear implant recipients who had been using a CIS processing strategy for at least 18 months participated in this study. Sentence recognition in multitalker babble from the front was collected on subjects using their CIS strategy and after subjects were programmed for the first time with HiRes P and HiRes S strategies. An ABAB design was implemented for 1 month whereby subjects used each HiResolution strategy every other day. Sentence recognition testing was repeated at the 1- and 3-month post-HiResolution test intervals. RESULTS: Comparisons between the CIS and HiResolution strategies showed immediate improvements for 5 subjects in favor of the HiResolution strategies. After 1 month of alternating between the HiRes P and HiRes S strategies, remarkably, 2 subjects showed improvements of 60%, 2 subjects showed improvements of 40%, and 2 subjects showed improvements of 30% over the CIS strategy that they had previously used for at least 18 months. The results after 3 months of use were consistent with those obtained at 1 month. CONCLUSIONS: The HiRes S and HiRes P strategies resulted in dramatic improvements in speech perception in noise for a subset of subjects who had been using the CIS strategy bilaterally. This finding demonstrates that these subjects were able to tolerate a more difficult signal-to-noise ratio. Further work is needed to determine the independent effects of rate versus number of channels.

Adult↗

Neuronal networks and synaptic plasticity: understanding complex system dynamics by interfacing neurons with silicon technologies.

Information processing in the central nervous system is primarily mediated through synaptic connections between neurons. This connectivity in turn defines how large ensembles of neurons may coordinate network output to execute complex sensory and motor functions including learning and memory. The synaptic connectivity between any given pair of neurons is not hard-wired; rather it exhibits a high degree of plasticity, which in turn forms the basis for learning and memory. While there has been extensive research to define the cellular and molecular basis of synaptic plasticity, at the level of either pairs of neurons or smaller networks, analysis of larger neuronal ensembles has proved technically challenging. The ability to monitor the activities of larger neuronal networks simultaneously and non-invasively is a necessary prerequisite to understanding how neuronal networks function at the systems level. Here we describe recent breakthroughs in the area of various bionic hybrids whereby neuronal networks have been successfully interfaced with silicon devices to monitor the output of synaptically connected neurons. These technologies hold tremendous potential for future research not only in the area of synaptic plasticity but also for the development of strategies that will enable implantation of electronic devices in live animals during various memory tasks.

Animals↗

Optimal design of a six-bar linkage with one degree of freedom for an anthropomorphic three-jointed finger mechanism.

This research concerns the design of a three-jointed, anthropomorphic, finger mechanism for use as a prosthesis or robotic end-effector. Based on a study of finger configurations for the human hand, a six-bar linkage with one degree of freedom is proposed. A model of the fingertip displacement of the mechanism is derived by a vector analysis approach. The effects of joint friction on the transmission efficiency are analysed. By measuring the joint positions of a human finger, a mathematical model of the pinching and holding configurations are developed. Optimal parameters for the finger mechanism are obtained by non-linear programming based on an objective functional involving motion posture and locus, transmission efficiency and weight subject to geometric and bionic constraints. Simulation results indicate that the mechanism is useful for a variety of prosthetic and robotic applications.

Biomechanical Phenomena↗

Entertainment television and hearing students' attitudes regarding the pediatric cochlear implant.

The cochlear implant, a bionic technology that restores sound sensation in some patients, has become ethically controversial in the 20 years since its introduction. This controversy recently has entered American entertainment culture, with the issue of pediatric implants emerging in episodes of popular TV programs. This pilot study examines the effects of one such TV episode on the attitudes of hearing college students with minimal prior exposure to the controversy, using a posttest-only control group design. The control group (N = 17) watched an unrelated entertainment video and filled out an original 10-item attitude scale. The treatment group (N = 18), which viewed an episode of the dramatic series Gideon's Crossing addressing the cochlear implant issue, also filled out the attitude scale. A t test was applied, and it was determined that no significant difference existed between the two groups' attitudes regarding pediatric cochlear implants. Although there was wide variability on individual items, overall scores indicated that both groups were neutral, or undecided, regarding cochlear implantation in children.

Adolescent↗

Retinal remodeling in inherited photoreceptor degenerations.

Photoreceptor degenerations initiated in rods or the retinal pigmented epithelium usually evoke secondary cone death and sensory deafferentation of the surviving neural retina. In the mature central nervous system, deafferentation evokes atrophy and connective re-patterning. It has been assumed that the neural retina does not remodel, and that it is a passive survivor. Screening of advanced stages of human and rodent retinal degenerations with computational molecular phenotyping has exposed a prolonged period of aggressive negative remodeling in which neurons migrate along aberrant glial columns and seals, restructuring the adult neural retina (1). Many neurons die, but survivors rewire the remnant inner plexiform layer (IPL), forming thousands of novel ectopic microneuromas in the remnant inner nuclear layer (INL). Bipolar and amacrine cells engage in new circuits that are most likely corruptive. Remodeling in human and rodent retinas emerges regardless of the molecular defects that initially trigger retinal degenerations. Although remodeling may constrain therapeutic intervals for molecular, cellular, or bionic rescue, the exposure of intrinsic retinal remodeling by the removal of sensory control in retinal degenerations suggests that neuronal organization in the normal retina may be more plastic than previously believed.

Amacrine Cells↗

A matched-pair comparison of two cochlear implant systems.

OBJECTIVES: To compare the overall performance of two implant systems based on audiologic outcome, tinnitus handicap, and quality of life using objective and subjective measures. DESIGN: Retrospective cohort study. SETTING: Sunnybrook & Women's College Health Science Centre. METHODS: Two matched groups, with 24 Nucleus 22 SPEAK (Advanced Bionics, Symlar, CA) and 24 Clarion CIS (Cochlear Corporation, Sydney, Australia), were selected. Patients were administered survey forms to evaluate subjective tinnitus and dizziness symptomatology, as well as a 27-item tinnitus handicap questionnaire. Both groups were administered survey forms to assess the frequency of implant use, the subjective benefit derived, and the perceived impact on quality of life. The 36-Item Short-Form (SF-36) Health Survey was administered as a measure of quality of life at 6 months postimplant. Standardized open-set speech recognition parameters were evaluated at 24 months postimplant. Vestibular function was determined by pre-and postimplant electronystagmography with caloric testing. The first author was blinded to implant type during data collection and analysis RESULTS: Cochlear implantation yielded a significant 22% reduction in overall tinnitus handicap (p < .05). There was a 27% reduction in vestibular function that failed to show statistical significance (p = .78). There was no significant reduction in vestibular function postimplant in either group. The average open-set speech perception responses at 24 months postimplant were monosyllabic word recognition 45%, phoneme recognition 65%, and sentence recognition 86.5%. There was no significant difference with respect to implant type. Overall, 76% of implantees reported satisfaction with the amount of subjective benefit they received from their implants. Furthermore, 96% reported an overall positive impact on quality of life. CONCLUSION: Overall, there was no significant difference between the two multichannel devices studied using the present software and hardware configurations.

Adult↗

Evaluation of the high-resolution speech coding strategy for the Clarion CII cochlear implant system.

Four postlinguistically deafened adults were implanted with the Clarion CII cochlear implant with the HiFocus II electrode in an evaluation of performance with a new speech coding strategy (high resolution) compared with current speech coding strategies (multiple pulsatile sampler, continuous interleaved sampling, and simultaneous analog stimulation). These strategies were implemented in the Platinum speech processor from Advanced Bionics Corporation (Sylmar, CA). Postoperatively, subjects were fitted with the traditional coding strategies and over the first month were allowed to determine their strategy of choice. This strategy was used to evaluate open-set speech recognition performance at 1 month and 3 months postfitting. At 3 months postfitting, subjects were reprogrammed with the high-resolution strategy. They returned for speech recognition testing at 1 month and 3 months postfitting with this strategy. Performance was significantly better with the high-resolution strategy for all four subjects, particularly when listening to speech in background noise. This finding was in agreement with their strong preference for the high-resolution strategy, and all four patients continue to use the high-resolution strategy.

Adult↗

Early-deafened adult cochlear implant users: assessment of outcomes.

OBJECTIVE: To determine whether adults deafened in the prelingual and perilingual stages of speech development realize objective and subjective benefits from cochlear implantation. METHOD: Retrospective analysis of the open-set speech recognition and subjective data such as use and quality of life. RESULTS: Between 1989 and 1999, 198 deafened adults underwent cochlear implantation at Sunnybrook and Women's College Health Sciences Centre. Of these, 44 patients were deafened pre- or perilingually. These subjects were implanted with a Nucleus 22, Nucleus 24 (Cochlear Corporation, Denver, Colorado, USA), or Clarion (Advanced Bionics Corporation, Sylmar, California, USA) device. The average age at implantation was 34 years (range 14-62 years). Significant differences in speech perception, as measured by a composite score of open-set word, phoneme, and sentence recognition, were found among groups who differed by type of education and communication training received in childhood. CONCLUSION: By and large, open-set speech recognition in prelingually and perilingually deafened adults is inferior to that achieved in postlingually deafened adults and varies according to the type of communication training they received. However, cochlear implants have significantly improved the overall communication skills and quality of life in all subgroups of patients.

Adolescent↗

Toward a hybrid artificial pancreas.

Management of insulinopenic diabetic individuals centers on administration of insulin by means of multiple injections, a wearable or implantable insulin-infusion pump, or a whole-organ or segmental-pancreas transplant. Preliminary trials indicate that surgical implantation of a hybrid device containing living insulin-secreting tissue may function as a combined glucose sensor and insulin-infusion pump. By means of a chamber composed of a semipermeable membrane shaped into hollow fibers or a box surrounding endocrine tissue, pilot studies have shown that isolated islets of Langerhans, fragments of insulinoma, or a fetal pancreas retains function for days to weeks, as judged by the ability to sustain euglycemic conditions in chemically induced diabetic rats. Lacking clear proof that normalizing blood glucose levels will prevent vascular complications of diabetes in humans, the case for further development of a hybrid (tissue plus fabricated components) device rests mainly on optimistic extrapolation of results attained in the chemically induced diabetic rat and dog. For the minority of diabetic patients who have insulin-dependent diabetes, the benefit afforded by a bionic device establishing internal insulin release regulated by silently sensed blood glucose level is more than enough payoff for the discomfort and surgery involved in its implantation. Further trials of a hybrid artificial pancreas in the dog appear warranted as a logical extension of preliminary studies with this species.

Animals↗

Depth and quality of electrode insertion: a radiologic and pitch scaling assessment of two cochlear implant systems.

OBJECTIVE: To compare the depth of electrode insertion in two types of cochlear implants, and to assess the ability of the implantees in each group to place-pitch during random electrical stimulation. STUDY DESIGN: This was a prospective clinical study. SETTING: This study was performed at an implant program within a university teaching hospital. PATIENTS: Five consecutive patients with the Clarion (Advanced Bionics, Symlar, CA, U.S.A.) device and 5 with the Nucleus-22 (Cochlear Corporation, Sydney, Australia) implants were enrolled. All 10 implantees had fully active and functioning electrodes. INTERVENTIONS: The depth of insertion was determined using plain anteroposterior skull film and high resolution computed tomography (CT). The quality of electrode insertion was assessed by pitch scaling; electrodes were randomly stimulated to generate subjective pitch responses. OUTCOME MEASURES: The depth of electrode insertion was measured radiographically as degrees of angular rotation within the cochlea. For pitch scaling, the averaged responses to electrical stimulation was plotted against the "place" of the electrodes along the array. Pitch range, plateauing, and reversal of pitches were also noted. Insertion depth was correlated with the result of pitch scaling and open-set speech discrimination at 3 months. RESULTS: The mean insertion depth was 406 degrees for the Clarion device and 254 degrees for the Nucleus device. CT was used to confirm the intracochlear placement of the electrodes and their relationships to the cochleostomy site. It did not confer more information than the plain films unless kinking had occurred. Pitch perception was consistent with the tonotopic organization of the cochlea. The Nucleus-22 recipients displayed a broader range of pitches with less plateaus and reversals than the Clarion implants. The depth of insertion did not compare well with the outcome of pitch scaling or with open-set speech discrimination scores in either group of implantees. CONCLUSION: The preformed spiral array of the Clarion device allowed deeper electrode insertion compared to the Nucleus-22 device. However, depth of insertion did not translate into better pitch placement.

Adult↗

The CLARION Multi-Strategy Cochlear Implant.

The Clarion cochlear implant is the result of many years of research and development, first at the University of California, San Francisco and the Research Triangle Institute of North Carolina, and then at Advanced Bionics Corporation in Sylmar, California. Approved by the US Food and Drug Administration after carefully monitored investigational clinical trials in both the adult and pediatric populations, it has now been implanted in approximately 3,000 patients worldwide. A fully flexible, programmable system, the Clarion offers multiple strategies and options in speech processing. The coupling mode, the stimulating waveform, and the temporal pattern of stimulation can be selected to allow each patient an opportunity to be fitted with the strategy that offers the highest level of performance. This paper describes the current status of the Clarion system. However, Clarion development has been a dynamic process, and from its initial introduction in 1991, the system has been modified and continually improved. The process of improvement and advancement is ongoing. New speech processing strategies and hardware developments are briefly summarized at the conclusion of this paper.

Cochlear Implants↗

Health care technology assessment and adoption: a case study.

Today's progressive hospital and health care system managers look to new ways to retain or augment their market share and to position themselves in their service areas. Since diffusion of new technologies into health care is market driven, informed decisions on the adoption of certain emerging patient care technologies can place a health care organization in a favorable financial position. There is a compelling need for hospital management and the governing board to collaborate with their medical staff on the development of an acceptable process to quickly identify and implement appropriate new technologies into the patient care environment. This joint effort is vital to ensure the integration of sound clinical values and objectives with planned institutional business strategies. Mount Carmel Health, a multifaceted health care corporation in central Ohio, has met the challenge of managing patient needs, physician interests, and limited hospital resources by forming a unique entity within the organization for the effective assessment and adoption of the latest medical technology. The division, which is called the Advanced Treatment and Bionics Institute (ATBI), is charged with assessing the latest clinical technologies and managing a hospital's adoption of the most appropriate ones. It serves to organize and streamline the identification, acquisition, adoption, and implementation of innovative treatment technologies at Mount Carmel hospitals.

Academies and Institutes↗

A new world view of genetics service models.

Identification of the components of the Human Genome and their relevance to health and disease is revolutionizing the provision of genetic services and all areas of health care. New genetic tools to diagnose, manage, and treat common diseases, along with Web-based innovations are changing the shape of how genetic services will be accessed and delivered. These advances represent a "bionic convergence" that will fundamentally transform medicine during the next few decades. The convergence of biotechnology and electronics is creating an expanding array of health care opportunities for clients and offers innovative opportunities for health promotion, restoration and management. Families and communities will soon be able to participate more fully in the direction and design of their own genetic health. Nurses with their long history of providing holistic, family-centered care in all practice settings, can help to create new dimensions to their practice to support their clients as they meet these health care innovations. This article explores a New World view of genetics services, and describes futuristic models for their provision. Nursing participation in and preparation for future genetics services also is described.

Ethics, Clinical↗