[Methodological aspects of high resolution manometry of the pharynx and upper esophageal sphincter]

BACKGROUND

High resolution manometry (HRM) is used increasingly to investigate muscular functions of the pharynx and the upper esophageal sphincter (UES) during swallowing. Beside the use of different manometry systems and catheters the ways in which parameters are calculated differ greatly among studies. The aim of this study was to present and compare these parameters and show which difficulties need to still be overcome.

METHOD

A selective literature search in PubMed was performed. Only those studies were included which explained in detail how each of the swallowing parameters was obtained. The parameters are presented using our own HRM-data and different ways of evaluation are discussed.

RESULTS

The dynamic opening of the UES, the proceeding of the pressure wave, the functioning of the velopharynx and the tongue base region are of interest when evaluating swallowing function. Minimum and maximum pressures, time intervals, average pressures, pressure gradients, pressure integrals and anatomical parameters are used to describe functioning of these regions.

CONCLUSION

In order to compare the data collected with HRM-systems, it is necessary to consider catheter specifications, the manometry system involved and also how exactly swallowing parameters were evaluated. It would be helpful to include analysis strategies in the producers software in order to make HRM studies comparable. Moreover, a consensus has to be reached regarding study protocols and which parameters should be collected in order to differentiate normal form pathological swallows.

[Assessment inventories for hearing aid outcome]

BACKGROUND

At the beginning of 2012 new fee schedule positions have been introduced to the ambulatory physician fee schedule ("Einheitlicher Bewertungsmaßstab", EBM) regarding the hearing aid fittings of youngsters and adults. With regards to quality assurance the use of a hearing aid outcome self-assessment inventory is made compulsive. This article aims to review available hearing aid (self-) assessment inventories as well as the evaluations regarding criteria for test quality implemented.

METHOD

For this systematic review a selective literature research in PubMed has been carried out.

RESULTS

There are various self assessment inventories measuring hearing aid benefit. Many of the studies evaluating these inventories were implemented during the 1980ies and early 90ies when analogue hearing aids were commonly used. These results cannot automatically be transferred to the nowadays common digital devices. Only a small amount of studies investigated German translations of the mostly originally English inventories.

DISCUSSION

In order to be able to identify the actual meaning of resulting values from these inventories, it is important for ENT doctors and audiologists to be well informed of the tests' quality criteria.

[Consensus recommendations of the German Radiology Society (DRG), the German Cardiac Society (DGK) and the German Society for Pediatric Cardiology (DGPK) on the use of cardiac imaging with computed tomography and magnetic resonance imaging]

Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) have been developed rapidly in the last decade. Technical improvements and broad availability of modern CT and MRI scanners have led to an increasing and regular use of both diagnostic methods in clinical routine. Therefore, this German consensus document has been developed in collaboration by the German Cardiac Society, German Radiology Society, and the German Society for Pediatric Cardiology. It is not oriented on modalities and methods, but rather on disease entities. This consensus document deals with coronary artery disease, cardiomyopathies, arrhythmias, valvular diseases, pericardial diseases and structural changes, as well as with congenital heart defects. For different clinical scenarios both imaging modalities CT and MRI are compared and evaluated in the specific context.

Plantarflexor stretch training increases reciprocal inhibition measured during voluntary dorsiflexion

Agonist-mediated reciprocal inhibition (RI) in distal skeletal muscles is an important neurophysiological phenomenon leading to improved movement coordination and efficiency. It has been shown to be reduced in aged and clinical populations, so the development of interventions augmenting RI is an important research goal. We examined the efficacy of using chronic passive muscle stretching to augment RI. The influence of 3 wk of plantarflexor stretching (4 × 30 s, two times/day) on RI of soleus and gastrocnemius initiated by tonic, voluntary dorsiflexion contractions [20% of maximum voluntary contraction (MVC)] was examined in 11 healthy men who performed stretch training and in nine nontraining controls. Hoffmann's reflexes (H-reflexes) were elicited by tibial nerve stimulation during both weak isometric (2% MVC) plantarflexions and dorsiflexion contractions at 20% MVC. Changes were examined at three joint angles, normalized to each subject's range of motion (ROM; plantarflexed = 10 ± 0°, neutral = −3.3 ± 2.9°, dorsiflexed = −16.5 ± 5.6°). No changes were detected in controls. A 20% increase in ROM in the stretch subjects was associated with a significant decrease in maximum H-reflex (Hmax): maximum evoked potential (Mmax), measured during 2% plantarflexion at the plantarflexed and neutral angles in soleus and at the plantarflexed angle in gastrocnemius ( P < 0.05–0.01). By contrast, decreases in Hmax:Mmax during 20% dorsiflexion contract were also seen at each angle in soleus and at the dorsiflexed angle in gastrocnemius. However, a greater decrease in Hmax:Mmax measured during voluntary dorsiflexion rather than during plantarflexion, which indicates a specific change in RI, was detected only at the dorsiflexed angle (−30.7 ± 9.4% and −35.8 ± 6.8% for soleus and gastrocnemius, respectively). These results demonstrate the efficacy of soleus-gastrocnemius stretch training in increasing agonist-mediated RI from tibialis anterior onto soleus-gastrocnemius in young, healthy individuals at dorsiflexed, but not plantarflexed, joint angles.

Pharmacological effects of Lu AA21004: a novel multimodal compound for the treatment of major depressive disorder

1-[2-(2,4-Dimethylphenyl-sulfanyl)-phenyl]-piperazine (Lu AA21004) is a human (h) serotonin (5-HT)(3A) receptor antagonist (K(i) = 3.7 nM), h5-HT(7) receptor antagonist (K(i) = 19 nM), h5-HT(1B) receptor partial agonist (K(i) = 33 nM), h5-HT(1A) receptor agonist (K(i) = 15 nM), and a human 5-HT transporter (SERT) inhibitor (K(i) = 1.6 nM) (J Med Chem 54:3206-3221, 2011). Here, we confirm that Lu AA21004 is a partial h5-HT(1B) receptor agonist [EC(50) = 460 nM, intrinsic activity = 22%] using a whole-cell cAMP-based assay and demonstrate that Lu AA21004 is a rat (r) 5-HT(7) receptor antagonist (K(i) = 200 nM and IC(50) = 2080 nM). In vivo, Lu AA21004 occupies the r5-HT(1B) receptor and rSERT (ED(50) = 3.2 and 0.4 mg/kg, respectively) after subcutaneous administration and is a 5-HT(3) receptor antagonist in the Bezold-Jarisch reflex assay (ED(50) = 0.11 mg/kg s.c.). In rat microdialysis experiments, Lu AA21004 (2.5-10.0 mg/kg s.c.) increased extracellular 5-HT, dopamine, and noradrenaline in the medial prefrontal cortex and ventral hippocampus. Lu AA21004 (5 mg/kg per day for 3 days; minipump subcutaneously), corresponding to 41% rSERT occupancy, significantly increased extracellular 5-HT in the ventral hippocampus. Furthermore, the 5-HT(3) receptor antagonist, ondansetron, potentiated the increase in extracellular levels of 5-HT induced by citalopram. Lu AA21004 has antidepressant- and anxiolytic-like effects in the rat forced swim (Flinders Sensitive Line) and social interaction and conditioned fear tests (minimal effective doses: 7.8, 2.0, and 3.9 mg/kg). In conclusion, Lu AA21004 mediates its pharmacological effects via two pharmacological modalities: SERT inhibition and 5-HT receptor modulation. In vivo, this results in enhanced release of several neurotransmitters and antidepressant- and anxiolytic-like profiles at doses for which targets in addition to the SERT are occupied. The multimodal activity profile of Lu AA21004 is distinct from that of current antidepressants.

Effect of diet on the incidence of and mortality owing to gastritis and renal disease in captive cheetahs (Acinonyx jubatus) in South Africa

Seventy-two adult cheetahs were evaluated for the degree of gastritis by endoscopic biopsy and for renal disease by serum creatinine. Cheetahs free of Grade 3 gastritis and renal disease were placed on Trial A; remaining cheetahs were placed on Trial B, which ran concurrently. All cheetahs were monitored for 4 years. Cheetahs exited Trial A and entered Trial B if they developed Grade 3 gastritis or renal disease. Cheetahs exited Trial B if they developed clinical gastritis or renal disease that required a dietary change or aggressive medical therapy or died owing to either disease. Cheetahs on Trial A were fed either a supplemented meat diet (N = 26) or commercial cat food (N = 22). Cheetahs on Trial B were fed either the same meat diet (N = 28) or a commercial dry cat food formulated for renal disease (N = 16). Cheetahs fed meat on Trial A had a daily hazard of developing Grade 3 gastritis 2.21 times higher (95% CI 0.95-5.15) than cheetahs fed commercial cat food. This hazard was not statistically significant (P = 0.07). Mean gastritis scores were not significantly different between the two groups. Cheetahs fed commercial cat food in both Trials had lower serum urea levels and higher creatinine levels than those fed meat. Evidence for the effect of diet in cheetahs with gastritis and/or renal disease (Trial B) was inconclusive. The number of cheetahs dying of gastritis or renal disease at the facility has dropped markedly since the study began. These results indicate that diet may play an important role in the incidence of Grade 3 gastritis and that dietary and/or therapeutic management of gastritis may reduce mortality owing to gastritis and renal disease in captive cheetahs.

Mechanical-tactile stimulation (MTS) intervention in a neonatal stress model improves long-term outcomes on bone

OBJECTIVES

Neonatal stress impairs postnatal bone mineralization. Evidence suggests that mechanical tactile stimulation (MTS) in early life decreases stress hormones and improves bone mineralization. Insulin-like growth factor (IGF1) is impacted by stress and essential to bone development. We hypothesized that MTS administered during neonatal stress would improve bone phenotype in later life. We also predicted an increase in bone specific mRNA expression of IGF1 related pathways.

METHODS

Neonatal stress (STRESS) and MTS (STRESS+10 min of MTS) were given from D6 to D10 of rat life and tissue was harvested on D60 of life. Dual energy x-ray absorptiometry (DXA), bone morphometry, serum osteocalcin, type I procollagen N-terminal propeptide (PINP), tartrate-resistant acid phosphatase (TRAP), and bone and liver mRNA levels of IGF1, IGF1 receptor (IGF1R), and growth hormone receptor (GHR) were measured.

RESULTS

Stress resulted in reduced bone area and bone mineral content (BMC) compared to naive control (CTL). MTS intervention increased BMC and tibial growth plate width compared to STRESS. MTS also resulted in higher osteocalcin, and, in males, lower TRAP (p<0.05). MTS resulted in three-fold, two-fold, and six-fold higher bone specific IGF1, IGF1R, and GHR, respectively (p ≤ 0.001) compared to STRESS.

CONCLUSIONS

MTS in early postnatal life improves long-term bone mineralization. IGF1 and related pathways may explain improved BMC.

A late methanogen origin for molybdenum-dependent nitrogenase

Mounting evidence indicates the presence of a near complete biological nitrogen cycle in redox-stratified oceans during the late Archean to early Proterozoic (c. 2.5-2.0 Ga). It has been suggested that the iron (Fe)- or vanadium (V)-dependent nitrogenase rather than molybdenum (Mo)-dependent form was responsible for dinitrogen fixation during this time because oceans were depleted in Mo and rich in Fe. We evaluated this hypothesis by examining the phylogenetic relationships of proteins that are required for the biosynthesis of the active site cofactor of Mo-nitrogenase in relation to structural proteins required for Fe-, V- and Mo-nitrogenase. The results are highly suggestive that among extant nitrogen-fixing organisms for which genomic information exists, Mo-nitrogenase is unlikely to have been associated with the Last Universal Common Ancestor. Rather, the origin of Mo-nitrogenase can be traced to an ancestor of the anaerobic and hydrogenotrophic methanogens with acquisition in the bacterial domain via lateral gene transfer involving an anaerobic member of the Firmicutes. A comparison of substitution rates estimated for proteins required for the biosynthesis of the nitrogenase active site cofactor and for a set of paralogous proteins required for the biosynthesis of bacteriochlorophyll suggests that Nif emerged from a nitrogenase-like ancestor approximately 1.5-2.2 Ga. An origin and ensuing proliferation of Mo-nitrogenase under anoxic conditions would likely have occurred in an environment where anaerobic methanogens and Firmicutes coexisted and where Mo was at least episodically available, such as in a redox-stratified Proterozoic ocean basin.

Consensus statement on epidemiological studies of medical conditions in tennis, April 2009

BACKGROUND

The reported incidence, severity and nature of injuries sustained in tennis vary considerably between studies. While some of these variations can be explained by differences in sample populations and conditions, the main reasons are related to differences in definitions and methodologies employed in the studies.

OBJECTIVE

This statement aims to review existing consensus statements for injury surveillance in other sports in order to establish definitions, methods and reporting procedures that are applicable to the specific requirements of tennis.

DESIGN

The International Tennis Federation facilitated a meeting of 11 experts from seven countries representing a range of tennis stakeholders. Using a mixed methods consensus approach, key issues related to definitions, methodology and implementation were discussed and voted on by the group during a structured 1-day meeting. Following this meeting, two members of the group collaborated to produce a draft statement, based on the group discussions and voting outcomes. Three revisions were prepared and circulated for comment before the final consensus statement was produced.

RESULTS

A definition of medical conditions (injuries and illnesses) that should be recorded in tennis epidemiological studies and criteria for recording the severity and nature of these conditions are proposed. Suggestions are made for recording players' baseline information together with recommendations on how medical conditions sustained during match play and training should be reported.

CONCLUSIONS

The definitions and methodology proposed for recording injuries and illnesses sustained during tennis activities will lead to more consistent and comparable data being collected. The surveillance procedures presented here may also be applicable to other racket sports.

Periodic paralysis: an unusual presentation of thyrotoxicosis

Thyrotoxic Periodic Paralysis (TPP) is a rare complication of thyrotoxicosis and is up to 20 times more common in males. Cases usually present with painless muscle weakness precipitated by heavy exercise, fasting, an alcohol binge or large carbohydrate meal. Serum potassium is low in the majority, but normokalaemic (or even hyperkalaemic) TPP is recognised. Acute treatment of any electrolyte disorder, administration of a beta-blocker and treatment of the thyrotoxicosis leads to complete resolution. This rare diagnosis should be considered by the Acute Physician when confronted with any case of muscle weakness.

Pharmacokinetic targeting of i.v. BU with fludarabine as conditioning before hematopoietic cell transplant: the effect of first-dose area under the concentration time curve on transplant-related outcomes

We used pharmacokinetic (PK) targeting of BU in 145 consecutive patients treated with fludarabine and i.v. BU. BU was given once daily at 130 mg/m(2) per day on days 1 and 2; doses for days 3 and 4 were adjusted in 92 patients (63%) to an average daily area under the concentration-time curve (AUC) of 5300 μM/min. In the remaining 53 patients, the first-dose AUC was within the target range and no dosing adjustments were required. First-dose AUC, maximum concentration and clearance were not correlated with age, race, ethnicity, performance status, or hematopoietic cell transplant comorbidity index. Women had higher clearance than men (median 2.9 vs 2.5 mL/min/kg; P=0.001). BU toxicities were not associated with first-dose AUC or any other PK parameter measured. First-dose BU AUC was not associated with non-relapse mortality (NRM) or survival, but higher AUC was predictive of relapse. We did not find an increased risk of toxicity or NRM in patients with high first-dose AUC presumably because of the dose adjustment. We conclude that PK targeting of BU as described here provides a simple, safe and effective method of delivering high BU doses before transplantation in a wide variety of patients.

The Golden Potato Cyst Nematode Globodera rostochiensis Pathotype Ro1 in the Saint-Amable Regulated Area in Quebec, Canada

The golden potato cyst nematode, Globodera rostochiensis (Wollenweber, 1923) Behren, is an economically important parasite of potato (Solanum tuberosum L. subsp. tuberosum) and is recognized as a quarantine pest internationally (2). This pest attacks potato plants and causes stunting of the haulm and the root system, leaf yellowing, and tuber yield losses (2). The pathotype scheme proposed by Kort et al. distinguishes five pathotypes (Ro1, Ro2, Ro3, Ro4, and Ro5) of G. rostochiensis using differential Solanum clones (1). Several resistance genes and quantitative trait loci (QTL) that have been identified in wild Solanum species confer resistance to different G. rostochiensis pathotypes and have been introgressed into commercial potato cultivars (2). Determining G. rostochiensis pathotype(s) is essential to implement efficient management strategies, which include using resistant potato varieties. G. rostochiensis was discovered in the municipality of Saint-Amable, Quebec (QC), Canada in 2006 (3) and was subsequently characterized (4). In this study, cysts were collected from 11 representative infested fields and confirmed to be G. rostochiensis (3). The pathotypes of these nematodes were assessed on seven differential clones (S. tuberosum subsp. tuberosum cv. Desiree, S. tuberosum × S. andigena cv. Maris Piper, S. kurtzianum hybrid 60.21.19, S. vernei hybrid 62.33.3, S. vernei hybrid 58.1642/4, S. vernei hybrid 65.346/19, and S. multidissectum hybrid P55/7) in 2007 and 2009. Briefly, in each 1-liter plastic pot containing 907 g (2 lbs) of soil (3:1 loam/grit v v-1), a single differential Solanum clone was planted and 15 cysts from 1 of 11 fields were inoculated. Five replicates were set up for each Solanum-nematode combination and the pots were arranged in a completely randomized design in a greenhouse at 22°C with a 16-h light period per day. Nine weeks after inoculation, cysts were extracted from each pot and counted. Reproduction factor (Rf) for each replicate was calculated (Rf = Pf/Pi; Pf is the final cyst number and Pi is the initial cyst number added to each pot). Rf values were used to categorize the differential clones into two groups, "susceptible" leading to increase in nematode numbers (Rf > 1) and "resistant" resulting in decrease in nematode numbers (Rf ≤ 1) (1). Our results in 2007 and 2009 were consistent and the pathotype of the nematodes collected from all the fields were identified as Ro1. To our knowledge, this is the first time that the pathotype of G. rostochiensis in the Saint-Amable regulated area was identified. Accordingly, potato cultivars carrying genes or QTL resistant to G. rostochiensis pathotype Ro1 can be used to reduce the nematode numbers in infested fields in the Saint-Amable area, QC. References: (1) J. Kort et al. Nematologica 23:333, 1977. (2) R. J. Marks and B. B. Brodie. Potato Cyst Nematodes: Biology, Distribution, and Control. 1st ed. CAB International, Wallingford, 1998. (3) F. Sun et al. Plant Dis. 91:908, 2007. (4) Q. Yu et al. Can. J. Plant Pathol. 32:264, 2010.

Acute hemodynamic changes after rapid intravenous bolus dosing of dexmedetomidine in pediatric heart transplant patients undergoing routine cardiac catheterization

BACKGROUND

Dexmedetomidine is a highly selective α(2)-adrenoceptor agonist with sedative, anxiolytic, and analgesic properties that has minimal effects on respiratory drive. Its sedative and hypotensive effects are mediated via central α(2A) and imidazoline type 1 receptors while activation of peripheral α(2B)-adrenoceptors result in an increase in arterial blood pressure and systemic vascular resistance. In this randomized, prospective, clinical study, we attempted to quantify the short-term hemodynamic effects resulting from a rapid i.v. bolus administration of dexmedetomidine in pediatric cardiac transplant patients.

METHODS

Twelve patients, aged 10 years or younger, weighing ≤40 kg, presenting for routine surveillance of right and left heart cardiac catheterization after cardiac transplantation were enrolled. After an inhaled or i.v. induction, the tracheas were intubated and anesthesia was maintained with 1 minimum alveolar concentration of isoflurane in room air, fentanyl (1 μg/kg), and rocuronium (1 mg/kg). At the completion of the planned cardiac catheterization, 100% oxygen was administered. After recording a set of baseline values that included heart rate (HR), systolic blood pressure, diastolic blood pressure, central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure, and thermodilution-based cardiac output, a rapid i.v. dexmedetomidine bolus of either 0.25 or 0.5 μg/kg was administered over 5 seconds. The hemodynamic measurements were repeated at 1 minute and 5 minutes.

RESULTS

There were 6 patients in each group. Investigation suggested that systolic blood pressure, diastolic blood pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure, and systemic vascular resistance all increased at 1 minute after rapid i.v. bolus for both doses and decreased significantly to near baseline for both doses by 5 minutes. The transient increase in pressures was more pronounced in the systemic system than in the pulmonary system. In the systemic system, there was a larger percent increase in the diastolic pressures than the systolic pressures. Cardiac output, central venous pressure, and pulmonary vascular resistance did not change significantly. HR decreased at 1 minute for both doses and was, within the 0.5 μg/kg group, the only hemodynamic variable still changed from baseline at the 5-minute time point.

CONCLUSION

Rapid i.v. bolus administration of dexmedetomidine in this small sample of children having undergone heart transplants was clinically well tolerated, although it resulted in a transient but significant increase in systemic and pulmonary pressure and a decrease in HR. In the systemic system, there is a larger percent increase in the diastolic pressures than the systolic pressures and, furthermore, these transient increases in pressures were more pronounced in the systemic system than in the pulmonary system.

Using mixed methods to design a web-based behavioural intervention to reduce transmission of colds and flu

This mixed methods study informed the development of our web-based intervention to reduce the risk of transmission of respiratory infections. Two qualitative studies examined 28 users' responses to website materials, and elicited additional beliefs. A questionnaire study (N = 129) tested key intervention assumptions: that hand-washing is considered the most feasible preventive behaviour; behavioural determinants were related to behavioural intentions; beliefs related to hand-washing intentions and behaviour. Thematic analysis of the qualitative data revealed important issues, such as the belief that catching minor infections is beneficial to the immune system. The questionnaire results confirmed our assumptions, including hand-washing as the appropriate target behaviour.