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In re E.G., a Minor: death over life: a judicial trend continues as the Illinois Supreme Court grants minors the right to refuse life-saving medical treatment.
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Pitch modulates lexical identification in spoken word recognition: ERP and behavioral evidence.
Event-related potentials (ERPs) were recorded in cross-modal word fragment priming (CMWP) to address the function of pitch for the identification of spoken words. In CMWP fragments of spoken words (e.g., re taken from Regal [Engl. shelves]) are immediately followed by visual targets. Together with reduced reaction times (RTs), an ERP deflection named P350 has been found to be reduced for targets, which match the primes (e.g., in the prime-target pair re-REGAL) as compared to unrelated targets (e.g., re-WIRBEL [Engl. burble]). The P350 has been related to facilitated lexical identification [Friedrich, Kotz, Friederici and Gunter (in press), ERPs reflect lexical identification in word fragment priming, JOCN]. In the present study, we presented syllable primes with different pitch contours. One version of each prime bore a stressed pitch contour (e.g., re_1), the other an unstressed pitch contour (e.g., re_2). Primes were combined with targets being either stressed on the first syllable (e.g., REgel [Engl. rule]) or on the second syllable (e.g., reGAL [Engl. shelves]). We found a reduced amplitude of the P350 and slightly faster reactions for targets with a stress pattern that matched the pitch of the primes (e.g., re_1-REgel) as compared to targets with a stress pattern that did not match the pitch of the primes (e.g., re_1-reGAL). The present study replicates the P350 effect with different material, and indicates that pitch is used for lexical identification in spoken word recognition.
Computational analysis of micron-particle deposition in a human triple bifurcation airway model.
Steady laminar axisymmetric inhalation flow and wall deposition of micron-size particles in representative triple bifurcation airways have been simulated using a commercial finite-volume code with user-enhanced programs. Assuming spherical non-interacting particles (3 microm</=d(p)</=7 microm), various inlet Reynolds numbers (Re=500-2000) and Stokes numbers (St=0.02-0.23) were considered. The resulting particle deposition patterns were analyzed and then summarized in terms of deposition efficiencies, i.e. DE=DE(Re,St) Surprisingly high DE-values occur at relatively low Reynolds numbers (e.g., Re=500) in the third bifurcation. The quantitative results are of interest to researchers either conducting health risk assessment studies for inhaled particulate pollutants or analyzing drug aerosol inhalation and deposition at desired lung target sites.
The role of the right hemisphere in the production of linguistic stress.
Recent research has proposed a general prosodic disturbance associated with right hemisphere damage (RHD), one encompassing both affective and linguistic functions. The present study attempted to explore whether the ability to produce linguistic prosody was impaired in this patient population. Productions of phonemic stress tokens (e.g., Re'dcoat vs. red coa't) as well as examples of contrastive stress, or sentential emphasis (e.g., Sam hated the movie), were elicited from eight male speakers with unilateral right hemisphere CVAs and seven male control subjects. Two types of analyses were conducted on these utterances. Acoustic analysis focused on the correlates associated with word stress, namely changes in amplitude, duration, and fundamental frequency. The perceptual saliency of emerging cues to stress was also examined by presentation of test tokens to phonetically trained listeners for identification of stress placement. The patients as a group produced fewer acoustic cues to stress compared to the normal subjects, but no statistical differences were found between groups for either stress at the phrase level or at the sentence level. In the perceptual analysis, stress produced by the patient group was judged to be less salient than that for the normal group, although a high degree of variability was evident in both populations. The data suggest a spared processing mechanism for linguistic prosody in RHD speakers, thus mitigating against the view of a general dysprosody tied to RHD.
New Explanation for Ligand Bending in Transition Metal Tris(dithiolate) Complexes.
The results of Fenske-Hall molecular orbital calculations are reported for the trigonal prismatic complexes Mo(S(2)C(2)H(2))(3) and Mo(S(2)C(6)H(4))(3). Both complexes exhibit a bend of the S-C-C-S ligand plane away from the S-Mo-S plane. A series of calculations which systematically follow the changes in electronic structure as the bend angle alpha is varied between 0 and 30 degrees indicates that the bend can be attributed to a second order Jahn-Teller distortion. The driving force for this distortion, which allows mixing between a set of ligand pi orbitals and the metal d(z)()()2 orbital, should be greatest for d(0) systems. In these systems the bent geometry leads to the stabilization of the doubly occupied HOMO. The driving force for ligand bending should be lower in systems having more or fewer electrons (e.g. Re(S(2)C(2)Ph(2))(3) or V(S(2)C(2)Ph(2))(3), respectively). While the steric bulk of the dithiolate ligands in the latter complexes may also influence the degree of ligand bending, this is probably a secondary effect.
Olefin epoxidation with bis(trimethylsilyl) peroxide catalyzed by inorganic oxorhenium derivatives. Controlled release of hydrogen peroxide.
The replacement of organometallic rhenium species (e.g., CH(3)ReO(3)) by less expensive and more readily available inorganic rhenium oxides (e.g., Re(2)O(7), ReO(3)(OH), and ReO(3)) can be accomplished using bis(trimethylsilyl) peroxide (BTSP) as oxidant in place of aqueous H(2)O(2). Using a catalytic amount of a proton source, controlled release of hydrogen peroxide helps preserve sensitive peroxorhenium species and enables catalytic turnover to take place. Systematic investigation of the oxorhenium catalyst precursors, substrate scope, and effects of various additives on olefin epoxidation with BTSP are reported in this contribution.
End-to-side nerve suture in clinical practice.
The phenomenon of lateral sprouting of axons into an end-to-side sutured recipient nerve is well documented. The exact nature, however, still needs further investigation. Since 1996, we have been continuously involved in primate research as well as using this end-to-side nerve suture (ETSNS) method in clinical practice. Fifty-six patients with a variety of conditions, ranging from brachial plexus avulsion to digital nerve lesions, have been operated. From our experience, it seems that the best results achieved are proximal motor re-innervation (e.g. biceps) and distal sensory re-innervation (e.g. volar skin of the hand). The discussion will cover various aspects for ETSNS in the human patient, such as indications, parameters, technique, and the importance of rehabilitation. ETSNS restores function in conditions previously difficult to operate, and may replace nerve grafting in many instances. It provides an additional method in our armamentarium in peripheral nerve surgery.
Novel anti-obesity drugs.
There is increasing evidence that body weight is homeostatically regulated and that in obesity this regulation maintains weight at a high level. Weight loss activates mechanisms that are designed to return individuals to their pre-existing weight. This explains the universally poor results of current strategies to maintain weight loss. On this basis, life-long drug therapy may be justified for those with significant obesity. Currently available drugs include selective serotonin re-uptake inhibitors (e.g., fluoxetine), noradrenergic re-uptake inhibitors (e.g., phentermine), a serotonin and noradrenergic re-uptake inhibitor (sibutramine) and an intestinal lipase inhibitor (orlistat). An active research program is underway to develop new agents based on the rapidly expanding knowledge of the complex mechanisms regulating body weight. Leptin, a hormone produced by adipocytes that inhibits food intake, has undergone clinical trials and analogues are currently being developed. Other agents include amylin, melanocortin-4 receptor agonists, neuropeptide Y antagonists, beta(3) adrenergic agonists and glucagon-like peptide-1 agonists. As some redundancy exists in the central regulatory system controlling body weight, some agents might need to be used in combination to be effective.
The influence of different floor stiffness on mechanical efficiency of leg extensor muscle.
The mechanical behaviour of skeletal muscle is influenced by internal factors (e.g. re-use of elastic energy) and/or external conditions (e.g. floor compliance, shoe structure etc.). These factors have an effect on muscular work economy-this was investigated in the present study. Eight subjects were tested during three different series of jumps. Each series consisted of rhythmical vertical jumps performed at desired frequency and height for 1 min. The first (1) series was executed on the laboratory floor without rebound condition (subjects were asked to maintain 1 s period in an isometric condition before concentric work was performed), the second (II) and the third (III) series were performed in rebound conditions respectively on a laboratory floor (hard surface) and on a special panel possessing high compliance (a special foam rubber panel with stiffness of 14.4 kN/m). Expired air was collected during the test and recovery for determination of energy expenditure. Mechanical work was calculated from the vertical displacement of the body during the jumps. The results indicated that the net efficiency in the jumps without prestretch of the leg extensor muscles (series I) was the lowest (19.4%). In contrast, the net efficiency observed in rebound jumps (series II and III) was respectively 30.8% and 33.1%, demonstrating that the reuse of elastic energy (Wel) plays an important role for muscular work efficiency. However, the contribution of Wel to the total work performed was different p < 0.05, Student's t-test) in jumps on the special panel (41%) compared to the normal surface (37%), even if the total amount of stored elastic energy was the same in both conditions. The different efficiency observed between series II and III was attributed to the compliance of the surface on which the tests were executed. It was suggested that man could change his neuromuscular pattern to adapt muscular behaviour for matching the damped properties shown by the high compliance surface. Finally, the soft surface may favour a very low rate of running injuries.
Evaluation of a shared-work program for reducing assistance provided to supported workers with severe multiple disabilities.
Concern has been expressed recently regarding the need to enhance the performance of individuals with highly significant disabilities in community-based, supported jobs. We evaluated a shared-work program for reducing job coach assistance provided to three workers with severe multiple disabilities in a publishing company. Following systematic observations of the assistance provided as each worker worked on entire job tasks, steps comprising the tasks were then re-assigned across workers. The re-assignment involved assigning each worker only those task steps for which the respective worker received the least amount of assistance (e.g., re-assigning steps that a worker could not complete due to physical disabilities), and ensuring the entire tasks were still completed by combining steps performed by all three workers. The shared-work program was accompanied by reductions in job coach assistance provided to each worker. Work productivity of the supported workers initially decreased but then increased to a level equivalent to the higher ranges of baseline productivity. These results suggested that the shared-work program appears to represent a viable means of enhancing supported work performance of people with severe multiple disabilities in some types of community jobs. Future research needs discussed focus on evaluating shared-work approaches with other jobs, and developing additional community work models specifically for people with highly significant disabilities.
Toddlers recognize verbs in novel situations and sentences.
Toddlers' (MA=22 and 27 months) ability to extend newly taught verbs to new situational and sentential contexts was investigated. Children were interactively taught two novel verbs, presented in only the transitive frame (e.g. You're lorping the ball), in a playroom setting. They then viewed the verb actions presented on side-by-side monitors and were asked to distinguish the verbs in three test frames (transitive, intransitive, neutral (e.g. lorping)). Both groups demonstrated learning of the verbs in the new situation and generalized the verbs to the intransitive sentence frame, but neither generalized reliably to the neutral frame. We conclude that even 22-month-olds demonstrate considerable context independence in their verb representations.
[Long-term results of endoprosthetic joint replacement and synovectomy].
The operations most frequently performed for chronic polyarthritis are synovectomy and artificial joint replacement. The radioisotope synovectomy has in general reduced the need for operative synovectomy. Multicenter studies of the late results of operative synovectomy (over 10 years after the operation) show a lasting improvement in pain, although radiographically the destructive changes that are seen 10 years after the operation are similar to the non-operated side. The synovectomy can therefore buy important time since re-operation, e.g. arthroplasty, is performed mainly on clinical grounds and not on the roentgenographic appearance. Operative synovectomy (Larsen 0-2) is indicated when the radioisotope synovectomy fails. It should be performed as soon as possible. Primary operative synovectomy is mainly advised when mechanical factors are predominant (tenosynovitis, large masses of fibrin in a joint etc.) and where a denervation effect is produced at the same time (e.g. in the wrist). The remainder of this report concerns the multiplicity of problems with the various wrist- and finger joint-arthroplasties. Cemented prostheses and those with a fixed axis have been shown in the world literature to have a high need for re-operation because of loosening and secondary deformities of the fingers. The silastic spacer is more adaptable but is not without problems. This is particularly seen with constitutional or cortisone-induced ligamentous laxity where bone resorption due to the piston effect and abrasion becomes evident together with sinking and often breakage of the prosthesis. The attempts made to prevent this are reported. The improvement in function from the MP-arthroplasty is very dependent upon the condition of the PIP-joints and the thumb. The significance of this with respect to the operative indication is discussed. Although the PIP-arthroplasty can initially have a good range of motion, a reduction after a number of years can be seen because of periprosthetic fibrosis. In general, when the operative indication is correctly made and with good postoperative management, arthroplasty can give good long-term results. The carpometacarpal joint of the thumb is relatively seldom involved in polyarthritis and the main indication for arthroplasty is osteoarthritis. The extent of trapezium resection and the various types of prostheses are discussed. The authors warn against treating a single joint in isolation without considering the other joints which work together with it in a functional chain.
Enteric neuroplasticity evoked by inflammation.
Neuroplastic changes in the enteric nervous system (ENS) may be observed in physiological states, such as development and aging, or occur as a consequence of different pathological conditions, ranging from enteric neuropathies (e.g., Hirschsprung's disease) to intestinal (e.g., inflammatory bowel disease) or extra-intestinal diseases (e.g., Parkinson's disease). Studying ENS plasticity may help to elucidate the pathophysiology of several diseases and have a bearing on the development of new pharmacological interventions. In the present review, we would like to focus on neuronal plasticity evoked by gastrointestinal inflammation occurring in inflammatory bowel disease and in a subset of patients with severe derangement of gut motility due to an enteric neuropathy characterized by an inflammatory infiltrate of the enteric plexuses. Major features of neuroplasticity within the enteric microenvironment encompass structural abnormalities ranging from nerve re-arrangement (e.g., hypertrophy and hyperplasia) to degeneration and loss of enteric ganglion cells; altered synthesis, content and release of neurotransmitters as well as up- or down-regulation of receptor systems; gastrointestinal dysfunction characterized by sensory-motor and secretory impairment of the gut. Interestingly, neuronal changes may also occur in segments of the gastrointestinal tract remote from the site of the original inflammation, e.g. the ileum may show neuroplastic changes during colitis. Sometimes, the inflamed site may even be outside the gut. Among potential mechanisms underlying ENS plasticity, neurotrophins and enteric glia deserve special attention. A better comprehension of ENS plasticity during inflammation could be instrumental to develop new therapeutic options for patients with IBD and inflammatory enteric neuropathies.
Probing depth at re-evaluation following initial periodontal therapy to indicate the initial response to treatment.
9 adult subjects with severe periodontitis were monitored following oral hygiene instruction and a single episode of crown and root debridement. Baseline recordings for probing attachment level were obtained both immediately pre-instrumentation and immediately post-instrumentation. Sites with gain, no change or loss of probing attachment level at 3 and 12 months compared to both pre- and post-instrumentation were identified. The classification was based upon the use of triplicate recordings at each time point, a site-specific standard deviation for measurement variability, and the requirement of a minimum of 1.0 mm change. The relative frequencies of gain, no change, and loss of probing attachment were then calculated for sites of various residual probing depths at 3 and 12 months. This was performed to evaluate if a given probing depth at re-evaluation, e.g., 7.0-7.5 mm, could be used as an indicator of the need for supplementary treatment following the initial therapy, based upon the observed probing attachment changes compared to baseline. As an example of the results of the present study, 60% of sites with residual probing depths of 7.0-7.5 mm showed probing attachment gain greater than or equal to 1.0 mm compared to the post-instrumentation baseline, and only 2% had undergone probing attachment loss greater than or equal to 1.0 mm. The overall results suggest that a relatively deep residual probing depth at re-evaluation following initial therapy, by itself, provides little evidence of lack of improvement compared to baseline. On this basis, the use of a specific probing depth at 3 or 12 months following treatment as a yardstick for the provision of supplementary treatment may not be justified.
[Potassium activity in the cat cortex: experimental epilepsy].
Two mechanisms are discussed which link extracellular potassium accumulation and epileptogenic neuronal hyperactivity in the cortex. The potassium concentration (aK) of the environment of a repetitively discharging membrane can increase sufficiently for a supra-threshold depolarization at afferent erminals. This can explain the finding of ectopic spike generation and the antidromic breakthrough in thalamo-cortical projections after a primary cortical discharge. Spread and recurrent enhancement of excitatory drives may be the result of this mechanism. Initiation and termination of seizure is not explained by potassium accumulation. There is a ceiling level in potassium of about 10 mequ/1 which is strictly maintained during normal as well as epileptiform activity. This level is probably not high enough for depolarizing inactivation of neuronal membranes. Stimulation of cortical afferents can have a dual effect on aK. After a primary shortlasting increase, aK can reach subnormal values. This is possibly brought about by a stimulated re-uptake of K+. Seizures can be initiated at these subnormal levels. The effect of the re-uptake e.g. hyperpolarization of terminal afferents and increase of evoked transmitter release is discussed for the initiation for paroxysmal activity.
[Succinylcholine--update].
The action profile of succinylcholine is unmatched even 50 years after its introduction into anaesthestic practice. This is probably why succinylcholine, despite its many and partly life-threatening side-effects, is still considered to be indispensable by many anaesthetists and emergency doctors. The main indication for succinylcholine--the facilitation of endotracheal intubation in patients considered to be at an increased risk of aspiration of gastric fluid, e.g. patients undergoing a Caesarean section or presenting with an ileus--remains undisputed. Some of the side-effects of succinylcholine can be diminished by precurarisation. However, just like priming, this technique holds some considerable dangers (such as a clinically significant attenuation of the protective reflexes) and has become a matter of increasing controversy. Rocuronium (> or = 1 mg/kg) is currently the best alternative to succinylcholine for rapid sequence induction. The routine use of succinylcholine as a relaxant for intubation is questionable, mainly because there are a number of modern anaesthetic techniques (laryngeal mask airway) and new drugs (rocuronium, mivacurium, remifentanil) which make succinylcholine quite dispensable except for a few situations (e.g. re-positioning of fractures). In the case of an expected difficult airway no muscle relaxant should be given, because severe hypoxaemia in these patients probably can only be prevented by a professional airway management. Succinylcholine is no longer an option in elective paediatric anaesthesia. The drug, however, retains its value in critical situations where a rapid onset but a short duration of action is of prime importance.