Cochlear implant (CI) candidates with residual low-frequency hearing increasingly receive hearing-preserving electrode arrays to enable electric–acoustic stimulation (EAS). However, assessing very low-frequency hearing in newborns and young children remains difficult. Previous work has shown that acoustic stimulation can mask electrically evoked auditory percepts when stimulation sites are spatially separated. Whether such masking also occurs when electric stimulation is delivered near the round window (RW), prior to cochlear insertion, remains unclear. This study investigated ipsilateral acoustic masking of electric stimulation delivered at apical, basal, and near-RW sites in 12 EAS users with residual low-frequency hearing implanted with short or partially inserted electrode arrays. Using a psychophysical paradigm, threshold elevations of electric pulse trains were measured during simultaneous acoustic stimulation. Electric stimulation was applied at extra-cochlear RW locations and intra-cochlear basal and apical electrodes, while stimulation parameters were systematically varied. Electric stimulation near the RW reliably evoked auditory percepts without side effects, though optimal stimulation parameters and masking strength varied across participants. Strong acoustic masking was consistently observed for apical stimulation, whereas weaker but measurable masking occurred for basal and RW stimulation. A cochlear lumped-parameter model indicated that approximately 5% of current delivered at the RW can reach apical regions, explaining the observed masking by low-frequency acoustic tones. Masking strength correlated with residual hearing for apical stimulation only. These findings indicate that acoustic masking of apical electric stimulation, which correlated with residual hearing, holds potential as a diagnostic tool for assessing low-frequency hearing post-operatively. The detection of masking during both RW and basal stimulation represents a promising result, indicating that these stimulation paradigms can produce quantifiable effects. Given the considerable variability observed among participants, further investigation is required to establish the extent to which masking measures reflect residual hearing or hearing loss. Nonetheless, these results provide novel insight into auditory perception and side effects associated with basal and extra-cochlear electric stimulation, informing future efforts to optimize this approach for low-frequency hearing assessment. ### Competing Interest Statement The authors have declared no competing interest. European Research Council, 101044753 Agencia Estatal de Investigación, ATR2023-145064
Mutations in the RNA-binding protein roquin-1 are known to result in humoral autoimmunity. Heissmeyer and colleagues show that MALT1 cleavage of roquin and regnase-1 downstream of TCR signaling releases cooperatively repressed targets to promote T H 17 cell differentiation
The digital transformation of healthcare is rapidly reshaping neurology, particularly in the field of movement disorders, where continuous monitoring, long disease trajectories, and complex multimodal care create a high demand for innovative solutions. Wearable sensors, digital diagnostics, app-based therapeutics, and integrated hybrid care networks and digital supported care pathways promise earlier diagnosis, personalized treatment and care management, and improved long-term outcomes. However, real-world implementation in managed outpatient care remains fragmented and faces major barriers beyond pure technological feasibility. This position paper critically reviews the current state of digital technologies in movement disorder care, identifies key systemic, ethical, and economic roadblocks, and proposes a pragmatic roadmap toward a realistic and ethically sound digital outpatient clinic. We argue that the future digital clinic will not be defined solely by technical progress, but by how consciously healthcare systems integrate digital tools to hybrid care solutions while preserving human-centered, equitable, and evidence-based care.
While the aetiology of Parkinson’s disease (PD) involves genetic and environmental factors, emerging evidence has suggested a surprising link between lipid metabolism - particularly serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) - and the pathogenesis of PD. Cholesterol plays a vital role in neuronal membrane integrity, myelination, and synaptic function. However, its peripheral concentration and regulatory mechanisms in the central nervous system (CNS), remain incompletely understood in the context of PD. This review aims to systematically examine the current literature on the relationship between TC and LDL-C with the risk and progression of PD in longitudinal patient cohorts. A systematic literature search was conducted using PubMed with the keywords “Parkinson’s disease” AND “cholesterol” and “Parkinson’s disease” AND “LDL.” Inclusion criteria encompassed English-language longitudinal human studies published before October 2024, with data on cholesterol levels in relation to PD incidence or progression. Fourteen studies met the eligibility criteria. Twelve of the 14 included studies reported an inverse association between lower serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels and increased risk for PD onset as well as faster disease progression. Notably, this pattern was not uniform across all subgroups: age, sex, BMI, and statin use modulated the strength and direction of associations. Despite some heterogeneity across studies, there is growing evidence that lower TC and LDL-C may be associated with a higher risk and more rapid progression of PD. Future research should focus on mechanistic studies and stratified analyses to clarify whether and how cholesterol modulation could contribute to neuroprotective strategies in PD.
To evaluate the effects of tiotropium/olodaterol (T/O) on phase-resolved functional lung (PREFUL) MRI parameters in hyperinflated chronic obstructive pulmonary disease (COPD) patients and examine correlations with conventional cardiopulmonary and hyperpolarized 129Xe MRI measures. Retrospective subanalysis of a prospective, randomized, placebo-controlled, crossover trial with open-label extension. Thirty-two patients with moderate-to-severe COPD (61.5 ± 7.7 years; 17 men); 30 completed the MRI extension at 1.5 T. PREFUL analysis yielded regional ventilation (RVent), flow-volume loop correlation metric (FVL-CM), normalized perfusion (QN), ventilation defect percentage (VDP), perfusion defect percentage (QDP), V/Q match metrics (VQM), and pulmonary pulse wave velocity (PWV; post-hoc parameter). Linear mixed-effects models tested treatment effects; correlations were evaluated with Spearman’s rank and bootstrap 95
