Respiratory arrest in familial hemiplegic migraine: a clinical and neuropathological study.

We describe a fatal case of familial hemiplegic migraine. A transient respiratory arrest in this patient led to a persistent "vegetative state," culminating in death four months later. Neuropathological findings included deep microinfarcts in the basal ganglia and a remarkable sparing of brain-stem nuclei associated with the function of respiration.     

Timing of neural commands: a model study with neuronal networks

Networks constructed of biologically realistic model neurons (neuroids) were used to study how in a neural assembly using pulse (interval)-coded information slow rhythmical oscillations with possible mode transitions might occur and how the efferent commands might be structured and their phase-shifts created. The simulations show that slow oscillations (in the hertz range) can be derived from reverberatory spiking in relatively short closed loops (fewer than ten neuroids) with the inputs protected against disturbing afferent signals and the outputs coupled by convergence on a common neuroid. Slow oscillations can be modified by a tonic activity entering the network; this activity changes the transmission time in the coupled loops involved. The structuring of the regulatory commands (in the millisecond range) was achieved by simulation of sequential activity propagation in a non-ring neuronal assembly supervised by a tonic activity in a set of inputs. The tonic activity acted as an instructive signal influencing the pattern of the functional connectivity in such a way that a particular efferent command was generated by the instructed network. Received: 3 March 1997 / Accepted in revised form: 15 July 1997     

Amino-terminal arm of the lambda repressor: a 1H NMR study

The N-terminal arm of the lambda repressor is shown to be flexible in solution by one- and two-dimensional 1H NMR methods. In particular, the relaxation of Thr-2 is largely independent of macromolecular tumbling. The conformation of the operator-binding domain is not affected by the removal of the first three residues nor by a point mutation, Lys-4----Gln. These results support a proposed model of the lambda repressor-operator complex in which the N-terminal arm of the repressor is assumed to be flexible and to wrap around the operator double helix.     

Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with Journey prosthesis: a finite element study

Isolated patellofemoral (PF) arthritis of the knee is a common cause of anterior knee pain and disability. Patellofemoral arthroplasty (PFA) is a bone conserving solution for patients with PF degeneration. Failure mechanisms of PFA include growing tibiofemoral arthritis and loosening of components. The implant loosening can be associated with bone resorption or fatigue-failure of bone by overload. This research work aims at determining the structural effects of the implantation of PF prosthesis Journey PFJ (Smith & Nephew, Inc., Memphis, TN, USA) on femoral cancellous bone. For this purpose, the finite element method is considered to perform computational simulations for different conditions, such as well-fixed and loosening scenarios. From the global results obtained, in the well-fixed scenario, a decrease in strain on cancellous bone was noticed, which can be related to bone resorption. In the loosening scenario, when the cement layer becomes inefficient, a significant increase in cancellous bone strain was observed, which can be associated with bone fatigue-failure.These strain changes suggest a weakness of the femur after PFA.     

The role of the plant properties in point-to-point arm movements: a robustness study

In recent papers we demonstrated by means of a modeling study that the smoothness of hand paths and the bell-shaped character of hand velocity profiles which have been experimentally observed in point-to-point arm movements can be largely attributed to the biomechanical properties of the arm rather than to specific planning by the central nervous system. In this paper we present a study of the robustness of our earlier results comprising two goals: (i) the determination of the range of model parameters for which such observations remain valid, (ii) the identification of possible relationships between model parameters and kinematic variables. The results of this study imply three conclusions: (i) the valid range of the tested model parameters (namely the main muscle parameters) is large, (ii) the modeled phenomena are well behaved in that parametric changes do not give rise to bifurcations or other behavioral discontinuities in the analyzed ranges, (iii) there exist precise relationships between certain muscle parameters and the time course of the hand velocity. These results point out that the phenomena observed in our previous work are indeed robust and can lead to useful insights into the mechanisms comprising the regulatory action of the central nervous system as well as into the design principles for biologically inspired artificial arms. Received: 4 December 1995 / Accepted in revised form: 6 November 1996     

Special management of insulin lispro in continuous subcutaneous insulin infusion in young diabetic children: a randomized cross-over study

OBJECTIVE: To compare the safety, efficacy and management of insulin lispro (LP) with regular human insulin (RH) in young diabetic children treated with continuous subcutaneous insulin infusion (CSII). STUDY DESIGN: 27 very young diabetic children (age 4.6 +/- 2.2 years) treated with CSII participated in an open-label, randomized cross-over multicenter study comparing 2 periods of 16 weeks of CSII with LP or RH. RESULTS: Mean daily basal rate was significantly higher during the LP period (p = 0.04). No differences were seen in changes in HbA1c levels, number of hypoglycemic events, cutaneous infections and catheter occlusions. There was no significant difference between the two treatments for preprandial and postprandial glucose values, although prandial glucose excursions tended to be lower with LP (significant at dinner, p = 0.01). Mean blood glucose levels were significantly higher at 0.00 and 3.00 a.m. during LP therapy (p < 0.05). No episode of ketoacidosis occurred during LP treatment. More parents indicated that LP made their own and the child's daily life easier (p = 0.02) and preferred LP (p = 0.01). CONCLUSIONS: LP in CSII therapy in children is safe, as effective as RH, improved postprandial excursions, met the needs of young children in their daily life well, and gained their parents' satisfaction and preference. However, a shorter duration of LP resulted in hyperglycemia during the first part of the night, which must be compensated for by increasing nocturnal basal rates during this time.     

Reconstruction of shoulder function using a reflected long head biceps: a moment arm study

A tendon transfer technique is proposed for the reconstruction of the paralyzed shoulders secondary to brachial plexus injury. This innovative technique does not require bone-to-bone or tendon to-bone fixation, and attempts to overcome other clinical limitations such as those due to insufficient length of donor muscle. The approach is referred to as the reflected long head biceps (RLHB) technique. The long head of biceps tendons is utilized as a bridging tendon graft. Two surgical alternatives, namely the through-deltoid (TD) pathway and the sub-deltoid (SD) pathway, were studied. The moment arms of the transferred tendons were assessed and reported. The TD technique yielded a larger moment than the SD technique. In the plane 30 degrees anterior to the scapular plane, the average moment arms were 3.8cm TD and 3.0cm SD at zero elevation. Such differences tended to further widen with increasing elevation. At 80 degrees elevation, the moment arms became 3.2cm TD and 1.2cm SD. The results supported the clinical feasibility of this RLHB tendon transfer approach.     

Adhesion molecules in subjects with COPD and healthy non-smokers: a cross sectional parallel group study

Background

The aim of the study was to investigate how the expression of adhesion molecules changes as neutrophils migrate from the circulation to the lung and if these changes differ between non-smoking subjects and smokers with and without COPD.

Methods

Non-smoking healthy subjects (n=22), smokers without (n=21) and with COPD (n=18) were included. Neutrophils from peripheral blood, sputum and bronchial biopsies were analysed for cell surface expression of adhesion molecules (CD11b, CD62L, CD162). Serum, sputum supernatant and BAL-fluid were analysed for soluble adhesion molecules (ICAM-1, -3, E-selectin, P-selectin, VCAM-1, PECAM-1).

Results

Expression of CD11b was increased on circulating neutrophils from smokers with COPD. It was also increased on sputum neutrophils in both smokers groups, but not in non-smokers, as compared to circulating neutrophils.Serum ICAM-1 was higher in the COPD group compared to the other two groups (p<0.05) and PECAM-1 was lower in smokers without COPD than in non-smoking controls and the COPD group (p<0.05). In BAL-fluid ICAM-1 was lower in the COPD group than in the other groups (p<0.05).

Conclusions

Thus, our data strongly support the involvement of a systemic component in COPD and demonstrate that in smokers neutrophils are activated to a greater extent at the point of transition from the circulation into the lungs than in non-smokers.     

Results of a study of acute paretic diseases in children according to material from a epidemiologic examination of the foci]

The authors carried out epidemiological examination of 160 foci of acute paretic diseases (APD) with serovirological examination of 181 patients and 413 contacts. Polioviruses were found to be etiologically responsible for the disease, as indicated by the results of serological examination in 37% of the patients, and by isolation of polioviruses (of the I and III types) in 4% of cases. As revealed, the vaccination scheme (periods and number of vaccinations) was not properly followed in 81.7% of those who contracted the disease. There were some differences in the characteristics of the foci in the child collective bodies and in families. Only individual cases of the disease were as a rule revealed in the familial foci, whereas in 9.6% of creches and kindergartens there were from 2 to 4 cases in each focus.     

Epicardial fat volume is associated with coronary microvascular response in healthy subjects: a pilot study

Epicardial fat (EF) is an active ectopic fat depot, which has been associated with coronary atherosclerosis, and which could early influence endothelial function. We thus investigated the relationship between EF and endothelium-dependent vasoreactivity of the coronary microcirculation, in highly selected healthy volunteers. Myocardial blood flow (MBF) was determined by measuring coronary sinus flow with velocity-encoded cine magnetic resonance imaging (MRI) at 3T. We measured MBF at baseline and in response to sympathetic stimulation by cold pressor testing (CPT) in 30 healthy volunteers with normal left ventricular (LV) function (age 22 ± 4 years, BMI = 21.3 ± 2.8 kg/m(2)). EF volume was volumetrically assessed by manual delineation on short-axis views. CPT was applied by immersing one foot in ice water for 4 min. Mean EF volume was 56 ± 26 ml and mean LV mass 100 ± 28 g. CPT significantly increased heart rate (HR) by 32 ± 19%, systolic blood pressure by 14 ± 10%, and rate-pressure product by 45 ± 25%, P < 0.0001. The increase in HR, reflecting sympathetic stimulation, was not influenced by sex, age or EF volume. CPT induced a decrease in coronary vascular resistance (135 ± 72 vs. 100 ± 42 mm Hg.ml(-1).min.g, P = 0.0006), and a significant increase in MBF (0.81 ± 0.37 vs. 1.24 ± 0.56 ml.min(-1).g(-1), P < 0.0001). Interestingly, we found a significant negative correlation between EF volume and ΔMBF (r= - 0.40, P = 0.03), which remained significant after adjusting for ΔHR. ΔMBF was also associated with adiponectin (r = 0.41, P = 0.046), but not with waist circumference, BMI, C-reactive protein, lipid or glycemic parameters. In multivariate analysis, adiponectin and EF volume remained both independently associated with ΔMBF. A high EF amount is associated with a lower coronary microvascular response, suggesting that EF could early influence endothelial function.     

Nasal provocation test with histamine: rhinomanometry study of normal subjects

Nasal reactivity to histamine was evaluated in 40 normal subjects. The application of a chloride histamine solution (1 mg) registered in 90% of the subjects the appearance of sneezing with the number of sneezes ranging between one and fourteen (5.7 +/- 3.76) and an average increase in the total resistence in the inspiration phase of 93.1% (+/- 63.2) and in the expiration phase of 98.1% (+/- 60.5) with a range between 37.7% and 24.1%. The authors conclude that sneezing and above all nasal congestion evaluated rhinomanometrically represent two important parameters in the evaluation of nasal reaction; an increase greater than or equal to 200% of the total nasal resistance can surely be considered an index of nasal hyperreactivity.     

Subjective sleep quality in noncomplaining elderly subjects: results of a follow-up study

The present study aims at investigating subjective sleep quality and its stability in a sample of not complaining elderly subjects (60 to 85 years). Sleep quality was assessed by means of the Pittsburgh Sleep Quality Index (PSQI). At baseline 91 subjects (46 males and 45 females; age: 66.7+/-5.8 years) completed the PSQI. The follow-up study was performed 16 +/-5 months later (response rate: 82.4 %). In the present sample the PSQI revealed that, in spite of the noncomplaining status, sleep is disturbed (PSQI > 5) in 26.0 % of the male and 34.5 % of the female population. Furthermore, sleep quality does not change systematically over the time course of this study. The mean of intraindividual differences is 0.1+/-2.5. This discrepancy between the subjects' claims of no sleep disturbance and their endorsing of PSQI items indicative of disturbed sleep probably reflects an adaptation in the perception of disturbed sleep.     

Implant-supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report

doi: 10.1111/j.1741‐2358.2011.00561.x Implant‐supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report Objective: To describe the use of dental implants in the treatment of velopharyngeal incompetence. Background: Velopharyngeal incompetence is characterized by the inability to contract the tissues of the soft palate. The most common causes are neuromuscular problems resulting from concussion and degenerative conditions of the central nervous system. Materials and methods: The treatment using palatal lift prosthesis is well established in the literature; however, reports on the use of osseointegrated implants are scarce. Rehabilitation using only this type of fibromucosal support is difficult in edentulous patients, since the prosthesis has a palatal lift extension. Results: The implants provided retention and stability to the prosthesis, improving swallowing and speech and contributing to improve the patient’s quality of life. Conclusion: This article reports the rehabilitation of a patient with a totally edentulous maxilla with velopharyngeal incompetence using an implant‐retained palatal lift prosthesis.     

Efficacy of a hybrid assistive limb in post-stroke hemiplegic patients: a preliminary report

Background  

Robotic devices are expected to be widely used in various applications including support for the independent mobility of the elderly with muscle weakness and people with impaired motor function as well as support for nursing care that involves heavy laborious work. We evaluated the effects of a hybrid assistive limb robot suit on the gait of stroke patients undergoing rehabilitation.