Functional connectivity among ventrolateral medullary respiratory neurones and responses during fictive cough in the cat

This study tested predictions from a network model of ventrolateral medullary respiratory neurone interactions for the generation of the cough motor pattern observed in inspiratory and expiratory pump muscles. Data were from 34 mid-collicularly decerebrated, paralysed, artificially ventilated cats. Cough-like patterns (fictive cough) in efferent phrenic and lumbar nerve activities were elicited by mechanical stimulation of the intrathoracic trachea. Neurones in the ventral respiratory group, including the Botzinger and pre-Botzinger complexes, were monitored simultaneously with microelectrode arrays. Spike trains were analysed for evidence of functional connectivity and responses during fictive cough with cycle-triggered histograms, autocorrelograms, cross-correlograms, and spike-triggered averages of phrenic and recurrent laryngeal nerve activities. Significant cross-correlogram features were detected in 151 of 1988 pairs of respiratory modulated neurones. There were 59 central peaks, 5 central troughs, 11 offset peaks and 2 offset troughs among inspiratory neurone pairs. Among expiratory neurones there were 23 central peaks, 8 offset peaks and 4 offset troughs. Correlations between inspiratory and expiratory neurones included 20 central peaks, 10 central troughs and 9 offset troughs. Spike-triggered averages of phrenic motoneurone activity had 51 offset peaks and 5 offset troughs. The concurrent responses and multiple short time scale correlations support parallel and serial network interactions proposed in our model for the generation of the cough motor pattern in the respiratory pump muscles. Inferred associations included the following. (a) Excitation of augmenting inspiratory (I-Aug) neurones and phrenic motoneurones by I-Aug neurones. (b) Inhibition of augmenting expiratory (E-Aug) neurones by decrementing inspiratory (I-Dec) neurones. (c) Inhibition of I-Aug, I-Dec and E-Aug neurones by E-Dec neurones. (d) Inhibition of I-Aug and I-Dec neurones and phrenic motoneurones by E-Aug neurones. The data also confirm previous results and support hypotheses in current network models for the generation of the eupnoeic pattern.

Responses of simultaneously recorded respiratory-related medullary neurons to stimulation of multiple sensory modalities

This study addresses the hypothesis that multiple afferent systems share elements of a distributed brain stem network that modulates the respiratory motor pattern. Data were collected from 18 decerebrate, bilaterally vagotomized, paralyzed, artificially ventilated cats. Up to 28 neurons distributed in the rostral and caudal ventral respiratory group, nucleus tractus solitarius, and raphe obscurus were recorded simultaneously with microelectrode arrays. Phases of the respiratory cycle and inspiratory drive were assessed from integrated efferent phrenic nerve activity. Carotid chemoreceptors were stimulated by injection of CO2-saturated saline solution via the external carotid artery. Baroreceptors were stimulated by increased blood pressure secondary to inflation of an embolectomy catheter in the descending aorta. Cutaneous nociceptors were stimulated by pinching a footpad. Four hundred seventy-four neurons were tested for respiratory modulated firing rates and responses; 403 neurons were tested with stimulation of all 3 modalities. Chemoreceptor stimulation and pinch, perturbations that tend to increase respiratory drive, caused similar responses in 52 neurons; 28 responded oppositely. Chemoreceptor and baroreceptor stimulation resulted in similar primary responses in 45 neurons; 48 responded oppositely. Similar responses to baroreceptor stimulation and pinch were recorded for 38 neurons; opposite effects were measured in 26 neurons. Among simultaneously recorded neurons, distinct combinations of firing rate changes were evoked in response to stimulation of the different modalities. The results show a functional convergence of information from carotid chemoreceptors, baroreceptors, and cutaneous nociceptors on respiratory-modulated neurons distributed in the medulla. The data are consistent with the hypothesis that brain stem neurons have overlapping memberships in multifunctional groups that influence the respiratory motor pattern.

Multimodal medullary neurons and correlational linkages of the respiratory network

This study addresses the hypothesis that multiple sensory systems, each capable of reflexly altering breathing, jointly influence neurons of the brain stem respiratory network. Carotid chemoreceptors, baroreceptors, and foot pad nociceptors were stimulated sequentially in 33 Dial-urethan-anesthetized or decerebrate vagotomized adult cats. Neuronal impulses were monitored with microelectrode arrays in the rostral and caudal ventral respiratory group (VRG), nucleus tractus solitarius (NTS), and n. raphe obscurus. Efferent phrenic nerve activity was recorded. Spike trains of 889 neurons were analyzed with cycle-triggered histograms and tested for respiratory-modulated firing rates. Responses to stimulus protocols were assessed with peristimulus time and cumulative sum histograms. Cross-correlation analysis was used to test for nonrandom temporal relationships between spike trains. Spike-triggered averages of efferent phrenic activity and antidromic stimulation methods provided evidence for functional associations of bulbar neurons with phrenic motoneurons. Spike train cross-correlograms were calculated for 6,471 pairs of neurons. Significant correlogram features were detected for 425 pairs, including 189 primary central peaks or troughs, 156 offset peaks or troughs, and 80 pairs with multiple peaks and troughs. The results provide evidence that correlational medullary assemblies include neurons with overlapping memberships in groups responsive to different sets of sensory modalities. The data suggest and support several hypotheses concerning cooperative relationships that modulate the respiratory motor pattern. 1) Neurons responsive to a single tested modality promote or limit changes in firing rate of multimodal target neurons. 2) Multimodal neurons contribute to changes in firing rate of neurons responsive to a single tested modality. 3) Multimodal neurons may promote responses during stimulation of one modality and "limit" changes in firing rates during stimulation of another sensory modality. 4) Caudal VRG inspiratory neurons have inhibitory connections that provide negative feedback regulation of inspiratory drive and phase duration.

Charged beads enhance cutaneous wound healing in rhesus non-human primates

Enhanced cutaneous wound healing by positively charged cross-linked diethylaminoethyl dextran beads (CLDD) was studied in a standardized incisional wound model in 20 adult and 20 geriatric Macaca mulatta (rhesus) partitioned equally over five time periods. Physiologic saline served as a control. Soft-tissue linear incisions were prepared between and 1 cm inferior to the scapulae. There were four incisions per rhesus; each incision was 1.5 cm long with 1 cm of undisturbed tissue between incisions, and both the experimental CLDD and physiologic saline treatments were administered to each rhesus. The incision treatments were either CLDD and soft-tissue closure with 4-0 BioSyn sutures or sterile physiologic saline and closure with 4-0 BioSyn sutures. The hypothesis was CLDD would enhance cutaneous wound repair. Verification of the hypothesis consisted of clinical examinations and histologic and tensiometric evaluations on biopsy specimens at 10 and 15 days, whereas 5-day and 2- and 4-month groups were assessed clinically and biopsy specimens were assessed histologically. The clinical course of healing for all groups was unremarkable. At 10 days, incisions in adult rhesus treated with CLDD had a 30-percent greater tensile strength compared with the physiologic saline-treated incisions (p = 0.01), whereas for geriatric rhesus, the CLDD treatment proved to be 15 percent greater in tensile strength compared with the physiologic saline cohort (p = 0.11). By day 15, incisions in adult rhesus were 26 percent stronger than the saline treatment group (p = 0.07), and the difference was 36 percent (p = 0.02) for the geriatric rhesus. From 5 through 15 days, histologic observations revealed a gradual decrease in quantity and integrity of CLDD, with no remnants of CLDD at either 2 or 4 months. Macrophages and multinucleated giant cells were localized in the dermis and were associated with the CLDD. These cells decreased commensurately with the decrease of CLDD beads. The data suggest that CLDD can enhance significantly the tensile properties of healing cutaneous wounds in both adult and geriatric rhesus. Moreover, if the wound healing is enhanced in geriatric patients, this finding may be clinically germane to conditions where wound healing is compromised, such as in diabetics and patients on steroids.

Medullary raphe neurones and baroreceptor modulation of the respiratory motor pattern in the cat

1. Perturbations of arterial blood pressure change medullary raphe neurone activity and the respiratory motor pattern. This study sought evidence for actions of baroresponsive raphe neurones on the medullary respiratory network. 2. Blood pressure was perturbed by intravenous injection of an alpha1-adrenergic receptor agonist, unilateral pressure changes in the carotid sinus, or occlusion of the descending aorta in thirty-six Dial-urethane-anaesthetized, vagotomized, paralysed, artificially ventilated cats. Neurones were monitored with microelectrode arrays in two or three of the following domains: nucleus raphe obscurus-nucleus raphe pallidus, nucleus raphe magnus, and rostral and caudal ventrolateral medulla. Data were analysed with cycle-triggered histograms, peristimulus time and cumulative sum histograms, cross-correlograms and spike-triggered averages of efferent phrenic nerve activity. 3. Prolongation of the expiratory phase and decreased peak integrated phrenic amplitude were most frequently observed. Of 707 neurones studied, 310 had altered firing rates during stimulation; changes in opposite directions were monitored simultaneously in fifty-six of eighty-seven data sets with at least two baroresponsive neurones. 4. Short time scale correlations were detected between neurones in 347 of 3388 pairs. Seventeen pairs of baroresponsive raphe neurones exhibited significant offset correlogram features indicative of paucisynaptic interactions. In correlated raphe-ventrolateral medullary neurone pairs with at least one baroresponsive neurone, six of seven ventrolateral medullary decrementing expiratory (E-Decr) neurones increased their firing rate during baroreceptor stimulation. Thirteen of fifteen ventrolateral medullary inspiratory neurones correlated with raphe cells decreased their firing rate during baroreceptor stimulation. 5. The results support the hypothesis that raphe neuronal assemblies transform and transmit information from baroreceptors to neurones in the ventral respiratory group. The inferred actions both limit and promote responses to sensory perturbations and match predictions from simulations of the respiratory network.

Ventrolateral medullary respiratory network and a model of cough motor pattern generation

The primary hypothesis of this study was that the cough motor pattern is produced, at least in part, by the medullary respiratory neuronal network in response to inputs from "cough" and pulmonary stretch receptor relay neurons in the nucleus tractus solitarii. Computer simulations of a distributed network model with proposed connections from the nucleus tractus solitarii to ventrolateral medullary respiratory neurons produced coughlike inspiratory and expiratory motor patterns. Predicted responses of various "types" of neurons (I-DRIVER, I-AUG, I-DEC, E-AUG, and E-DEC) derived from the simulations were tested in vivo. Parallel and sequential responses of functionally characterized respiratory-modulated neurons were monitored during fictive cough in decerebrate, paralyzed, ventilated cats. Coughlike patterns in phrenic and lumbar nerves were elicited by mechanical stimulation of the intrathoracic trachea. Altered discharge patterns were measured in most types of respiratory neurons during fictive cough. The results supported many of the specific predictions of our cough generation model and suggested several revisions. The two main conclusions were as follows: 1) The Bötzinger/rostral ventral respiratory group neurons implicated in the generation of the eupneic pattern of breathing also participate in the configuration of the cough motor pattern. 2) This altered activity of Bötzinger/rostral ventral respiratory group neurons is transmitted to phrenic, intercostal, and abdominal motoneurons via the same bulbospinal neurons that provide descending drive during eupnea.

Repeated patterns of distributed synchrony in neuronal assemblies

Models of brain function predict that the recurrence of a process or state will be reflected in repeated patterns of correlated activity. Previous work on medullary raphe assembly dynamics revealed transient changes in impulse synchrony. This study tested the hypothesis that these variations in synchrony include distributed nonrandom patterns of association. Spike trains were recorded simultaneously in the ventrolateral medulla, n. raphe obscurus, and n. raphe magnus of four anesthetized (Dial), vagotomized, paralyzed, and artificially ventilated adult cats. The "gravitational" representation of spike trains was used to detect moments of impulse synchrony in neuronal assemblies visualized as variations in the aggregation velocities of particles corresponding to each neuron. Template matching algorithms were developed to identify excessively repeating patterns of particle condensation rates. Repeating patterns were detected in each animal. The reiterated patterns represented an emergent property not apparent in either corresponding firing rate histograms or conventional gravity representations. Overlapping subsets of neurons represented in different patterns were unmasked when the template resolution was changed. The results demonstrate repeated transient network configurations defined by the tightness and duration of synchrony in different combinations of neurons and suggest that multiple information streams are conveyed concurrently by fluctuations in the synchrony of on-going activity.

Cerebellar modulation of cough motor pattern in cats

Cerebellar modulation of cough motor pattern in cats. J. Appl. Physiol. 83(2): 391-397, 1997.-The cerebellum modulates respiratory muscle activity in part via its influence on the central respiratory pattern generator. Because coughing requires well-coordinated respiratory muscle activity, studies were conducted to determine whether the cerebellum influences the centrally generated cough motor pattern. Integrated phrenic and lumbar efferent neurograms (PN and LN, respectively) were monitored in decerebrated, paralyzed, and ventilated cats. Mechanical probing of the intrathoracic trachea was used to evoke fictive coughs; i.e., large increases in PN and LN amplitudes. Cerebellectomy resulted in a decrease in the number of coughs per trial (cough frequency) and LN peak amplitudes without any consistent change in PN peak amplitudes. Cerebellar nuclei [the rostral interposed nucleus (INr) and the rostral fastigial nucleus (FNr)] known to be involved in respiratory control were ablated to determine their potential role in the cough response. Control (eupneic) respiratory frequency was not affected by cerebellectomy or INr/FNr lesions. Cough frequency was depressed by lesion of the INr but not by ablation of the FNr. No significant changes in PN and LN amplitudes were observed after lesion of either the INr or FNr. These results suggest that the cerebellum, specifically the INr, is involved in modulation of the frequency of centrally generated coughing.

Brainstem respiratory networks and cough

The focus of this review is work that supports a model of the medullary neuronal network that is involved in producing the cough motor pattern of inspiratory and expiratory pump muscles. Evidence is presented that supports the following hypotheses: (1) Bulbospinal drive to respiratory motoneurons during cough arises, at least in part, from the same medullary neurons involved in providing drive during eupnoea. (2) Medullary Bötzinger/ rostral ventral respiratory group neurons implicated in generating and shaping the eupnoeic pattern of breathing are also involved in producing the central cough motor pattern. The results were not consistent with a "cough centre" separate from the BOT/VRG. Observed neurons (in cats) included most of all previously identified respiratory modulated "types". The results showed that there were alterations in discharge patterns of all respiratory neurons during fictive cough. Many "types" responded as predicted by cough model network simulations. Based on neuron behaviours in our studies and inferred synaptic actions among BOT/VRG neurons, we propose a preliminary model for cough generation by the BOT/rVRG network.

Inspiratory drive and phase duration during carotid chemoreceptor stimulation in the cat: medullary neurone correlations

1. This study addressed the hypothesis that there is a parallel processing of input from carotid chemoreceptors to brainstem neurones involved in inspiratory phase timing and control of inspiratory motor output amplitude. Data were from fifteen anaesthetized, bilaterally vagotomized, paralysed, artificially ventilated cats. Carotid chemoreceptors were stimulated by close arterial injection of 200 microliters of CO2-saturated saline solution. 2. Planar arrays of tungsten microelectrodes were used to monitor simultaneously up to twenty-two neurones in the nucleus tractus solitarii (NTS) and ventral respiratory group (VRG). Spike trains were analysed with two statistical tests of respiratory modulation, cycle-triggered histograms, peristimulus-time histograms, cumulative sum histograms and cross-correlograms. 3. In NTS, 16 of 26 neurones with respiratory and 12 of 27 without respiratory modulation changed firing rate during carotid chemoreceptor stimulation. In the VRG 72 of 112 respiratory and 14 of 48 non-respiratory neurones changed firing rate during stimulation. 4. The spike trains of 85 of 1276 pairs (6.7%) of cells exhibited short time scale correlations indicative of paucisynaptic interactions. Ten pairs of neurones were each composed of a rostral VRG phasic inspiratory neurone that responded to carotid chemoreceptor stimulation with a decline in firing rate and a caudal VRG phasic inspiratory neurone that increased its firing rate. Cross-correlograms from two of the pairs had features consistent with excitation of the caudal neurones by the rostral cells. A decrease in the duration of activity of the rostral VRG neurones was paralleled by the decrease in inspiratory time of phrenic nerve activity. Caudal VRG inspiratory neurones increased their activity as phrenic amplitude increased. Spike-triggered averages of all four neurones indicated post-spike facilitation of phrenic motoneurones. 5. The results support the hypothesis that unilateral stimulation of carotid chemoreceptors results in parallel actions. (a) Inhibition of rostral VRG I-Driver neurones decreases inspiratory duration. (b) Concurrent excitation of premotor VRG and dorsal respiratory group inspiratory neurones increases inspiratory drive to phrenic motoneurones. Other data suggest that responsive ipsilateral neurones act to regulate contralateral neurones.

Long-term facilitation of phrenic nerve activity in cats: responses and short time scale correlations of medullary neurones

1. Stimulation of either peripheral chemoreceptors or nucleus raphe obscurus results in long-term facilitation of phrenic motoneurone activity. The first objective of this work was to measure the concurrent responses of neurones in the nucleus raphe obscurus, the nucleus tractus solitarii, and the regions of the retrofacial nucleus, nucleus ambiguus and nucleus retroambigualis during induction of long-term facilitation. A second goal was to assess functional relationships of the chemoresponsive raphe neurones with neurones in the other monitored locations and with phrenic motoneurones. 2. Up to thirty single medullary neurones and phrenic nerve efferent activity were recorded simultaneously in fifteen anaesthetized, paralysed, vagotomized, artificially ventilated adult cats. Carotid chemoreceptors were stimulated by close arterial injection of 200 microliters of CO2-saturated saline solution. Spike trains were analysed with cycle-triggered histograms and two statistical tests for respiratory modulation. Peristimulus-time histograms and cumulative sum histograms were used to assess responses to stimulation. Cross-correlation was used to test for non-random temporal relationships between spike trains. Spike-triggered average histograms provided evidence for functional associations with phrenic motoneurones. 3. One hundred and thirteen of 348 neurones were monitored in the nucleus raphe obscurus. The firing rates of twenty-nine raphe neurones increased during stimulation; eighteen decreased. In twenty-one pairs of concurrently monitored raphe neurones, the firing rate of one increased its activity during stimulation then decreased, while the other showed an increase that began as the rate of the former declined. Eighteen chemoresponsive raphe neurones had short time scale features in their phrenic spike-triggered averages. Short time scale features were found in cross-correlograms from 184 of 1407 neurone pairs. 4. The data suggest parallel routes by which carotid chemoreceptors influence medullary raphe neurones and support the hypotheses that mid-line respiratory-related neuronal assemblies transform information from those receptors and regulate the gain of respiratory motor output.

Distributed actions and dynamic associations in respiratory-related neuronal assemblies of the ventrolateral medulla and brain stem midline: evidence from spike train analysis

1. Considerable evidence indicates that neurons in the brain stem midline and ventrolateral medulla participate in the control of breathing. This work was undertaken to detect and evaluate evidence for functional links that coordinate the parallel operations of neurons distributed in these two domains. 2. Data were from 51 Dial-urethan-anesthetized, bilaterally vagotomized, paralyzed, artificially ventilated cats. Planar arrays of tungsten microelectrodes were used to monitor simultaneously spike trains in two or three of the following regions: n. raphe obscurus-n. raphe pallidus, n. raphe magnus, rostral ventrolateral medulla, and caudal ventrolateral medulla. Efferent phrenic nerve activity was recorded to indicate the phases of the respiratory cycle. Electrodes in the ventral spinal cord (C3) were used in antidromic stimulation tests for spinal projections of neurons. 3. Spike trains of 1,243 neurons were tested for respiratory modulated firing rates with cycle-triggered histograms and an analysis of variance with the use of a subjects-by-treatments experimental design. Functional associations were detected and evaluated with cross-correlograms, snowflakes, and the gravity method. 4. Each of 2,310 pairs of neurons studied included one neuron monitored within 0.6 nm of the brain stem midline and a second cell recorded in the ventrolateral medulla; 117 of these pairs (5%) included a neuron with a spinal projection, identified with antidromic stimulation methods, that extended to at least the third cervical segment. Short-time scale correlations were detected in 110 (4.7%) pairs of neurons. Primary cross-correlogram features included 40 central peaks, 47 offset peaks, 4 central troughs, and 19 offset troughs. 5. In 14 data sets, multiple short-time scale correlations were found among three or more simultaneously recorded neurons distributed between both midline and ventrolateral domains. The results suggested that elements of up to three layers of interneurons were monitored simultaneously. Evidence for concurrent serial and parallel regulation of impulse synchrony was detected. Gravitational representations demonstrated respiratory-phase dependent synchrony among neurons distributed in both brain stem regions. 6. The results support a model of the brain stem respiratory network composed of coordinated distributed subassemblies and provide evidence for several hypotheses. 1) Copies of respiratory drive information from rostral ventrolateral medullary (RVLM) respiratory neurons are transmitted to midline neurons. 2) Midline neurons act on respiratory-related neurons in the RVLM to modulate phase timing. 3) Impulse synchrony of midline neurons is influenced by concurrent divergent actions of both midline and ventrolateral neurons.(ABSTRACT TRUNCATED AT 400 WORDS)

Percutaneous endoscopic gastrostomy--its application in patients with neurological disease

We performed percutaneous endoscopic gastrostomy (PEG) in 30 patients with prolonged swallowing difficulty (> 4 weeks duration). The average procedure time was 25 minutes. PEG insertion was done on an outpatient basis in four patients. The complication rate was 10% and included failed insertion, peristomal infection and herniation of the gastric mucosa at the gastrostomy exist site. At follow-up, the PEG tube continued to function in 18/22 of the surviving patients with a median in-use time of 85 days. Seven patients died from their original disease. Over a 28-day period, the weight gain among the patients ranged from 3kg to 7kg (mean 4.5kg) and average serum albumin increased from 29g/dl to 35g/dl. This confirms that PEG is a safe, easy and effective method of long-term enteral feeding in patients with neurological disease.

Immunohistochemical assessment of proliferative activity in adrenocortical neoplasms

Although many histologic criteria have been utilized to help distinguish benign from malignant adrenocortical tumors, it still may be difficult to assess the biologic potential of a given tumor. We evaluated 19 adenomas and 15 primary carcinomas with the avidin-biotin complex peroxidase method utilizing formalin-fixed, paraffin-embedded tissues with monoclonal antibodies for proliferating cell nuclear antigen (PC10) and Ki-67 (MIB 1) to determine if staining for these antigens could be used to help differentiate benign from malignant adrenocortical neoplasms. We also evaluated whether these markers could be used as prognostic indicators. Labeling indices for both PCNA and Ki-67 were determined by enumerating 1000 tumor cells, and expressed as a percentage of cells with nuclear staining. A PCNA and a Ki-67 score was obtained by the product of the staining intensity (0-3+) and the extent of nuclear staining, expressed as an estimate of the percentage of cells staining. Both PCNA and Ki-67 score and labeling index were correlated with mitotic counts, histologic diagnosis, and clinical outcome. Follow-up period for patients ranged from 4 months to 12 years with a mean of 25 months. Mitotic counts correlated with histologic diagnosis and clinical outcome. Both Ki-67 score and labeling index were significantly higher in malignant than in benign tumors, and correlated with mitotic counts and clinical outcome. There was a strong correlation between Ki-67 score and labeling index, indicating that Ki-67 score may be a more rapid and equally accurate method of estimating proliferative index of a tumor. PCNA score and labeling index did not correlate with histologic diagnosis or clinical outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastroesophageal reflux in infancy: review and update

Gastroesophageal reflux is a common occurrence in infancy. The purpose of this article is to describe gastroesophageal reflux and differentiate among its three categories. Initial evaluation includes an accurate history and growth assessment. Continued monitoring of growth is important to determine when and if intervention is necessary. The nurse practitioner will be able to make referrals or prescribe treatment based on the guidelines presented. Having knowledge of the various aspects of this problem will enable the nurse practitioner to assess and monitor the infant and reassure parents.

Cerebral cortical evoked potentials elicited by cat intercostal muscle mechanoreceptors

Intercostal muscle afferents discharge in response to changes in intercostal muscle mechanics and have spinal and brain stem projections. It was hypothesized that intercostal muscle mechanoreceptors also project to the sensorimotor cortex. In cats, the proximal muscle branch of an intercostal nerve was used for electrical stimulation. The mechanical stimulation was stretch of an isolated intercostal space. The sensorimotor cortex was mapped with a surface ball electrode. Primary cortical evoked potentials (CEP) were found in area 3a of the sensorimotor cortex with mechanical and electrical stimulation. The CEP was elicited with the smallest stretch amplitude used, 50 microns. The CEP response showed little increase beyond 300-microns stretch. The CEP elicited by 50-microns stretch suggests an initial cortical activation by intercostal muscle spindles. The minimal increase in CEP amplitude with stretch > 300 microns suggests that the CEP response is primarily due to muscle spindle recruitment. The increase in amplitude beyond this stretch may be due to recruitment of tendon organs. These results demonstrate a short-latency projection of intercostal muscle mechanoreceptors to the sensorimotor region of the cerebral cortex. This cortical activation may be involved in respiratory sensations and/or transcortical reflex responses to changes in respiratory muscle mechanics.

An analysis of a board game as a treatment activity

Occupational therapists often use tabletop board games in treatment to help adult clients with physical disabilities improve the perceptual, cognitive, sensory, and fine motor skill components of occupational behavior. Detailed activity analyses of these types of activities, including performance norms, are not available in the occupational therapy literature. Such analyses would help therapists consider the multiple skill demands of tabletop games and allow more systematic grading of these treatment activities. This paper presents a model for analyzing therapeutic activities in relation to relevant motor learning and cognitive-perceptual literature. Included in this analysis are a description of the activity, examination of its component skills and of the qualitative features of activity performance, suggestions for grading and for treatment goals, and some preliminary performance standards derived from a pilot study of 18 adults without physical disabilities. The issue of transfer of skills between games and functional activities is also discussed.

Dynamic reconfiguration of brain stem neural assemblies: respiratory phase-dependent synchrony versus modulation of firing rates

1. The objective of this work was to determine whether configurations of midline brain stem neural assemblies change during the respiratory cycle. 2. Spike trains of several single neurons were recorded simultaneously in anesthetized, paralyzed, bilaterally vagotomized, artificially ventilated cats. Data were analyzed with cross-correlational and gravity methods. 3. Sequential samples from each of eight groups of neurons known to contain synchronously discharging neurons exhibited temporal variations in that synchrony. 4. Gravity analysis of short (less than 200-s) samples of spike train data revealed 20 pairs of clustered particles that were not predicted from cross-correlation analysis of the parent data sets (greater than 20 min). 5. Twenty-nine groups of three to eight simultaneously monitored neurons, each with at least two synchronously discharging neurons, were analyzed for evidence of respiratory phase-dependent modulation of that coordinated activity. Spikes from successive interleaved inspiratory and expiratory intervals were analyzed separately. 6. Neurons pairs in 11 groups were more synchronous during the inspiratory interval; six groups had pairs that were more synchronous during the expiratory period. In two groups, different pairs were synchronous in different respiratory phases. In 11 of the 26 pairs that exhibited phase-dependent differences in synchrony, neither neuron had a respiratory-modulated firing rate as judged by either the cycle-triggered histogram or an analysis of variance of their firing rates. 7. Configurations of respiratory-related brain stem neural networks changed with time and the phases of breathing. Neurons with no apparent respiratory modulation of their individual firing rates collectively exhibited respiratory phase-dependent modulation of their impulse synchrony.(ABSTRACT TRUNCATED AT 250 WORDS)

Respiratory-related neural assemblies in the brain stem midline

1. The initial objective of this study was to determine whether respiratory-related neural assemblies exist in the brain stem midline. A second goal was to seek evidence for concurrent relationships among the neurons that could generate the detected synchrony. 2. Experiments were conducted on anesthetized, paralyzed, bilaterally vagotomized, artificially ventilated cats. Spike trains of four to nine simultaneously monitored neurons were recorded in the regions of n. raphe obscurus-n. raphe pallidus and n. raphe magnus. 3. Data were analyzed with cycle-triggered histograms, cross-correlograms, snowflakes, and the gravitational representation. A significance test for the gravity method was developed and tested with spike trains generated by simulated networks with defined connections. 4. Ninety-three groups of neurons from 24 cats were studied. Thirty-nine groups from 19 cats included neurons that discharged synchronously on a millisecond time scale; less than or equal to 19 pairs of synchronously discharging neurons were found in one group. Twenty-seven of these 39 groups included neurons that had respiratory-modulated firing rates and discharged synchronously with other group members. Synchronous assemblies included cells monitored at rostral or caudal locations, or both. 5. Six classes of relationships were inferred from groups of neurons with multiple correlations: divergence (n = 11); convergence (n = 7); connections with opposite actions between neurons (n = 5); projections of synchronous neurons to separate targets (n = 5); projections to one neuron in a synchronous group (n = 4); and projections between two synchronous groups with common elements (n = 6). 6. The results document the existence of assemblies of synchronously discharging respiratory-related neurons in midline regions of the brain stem and suggest that divergent excitatory and inhibitory connections within the midline participate in the generation of that synchrony. Links between assemblies may operate to stabilize their collective activity in a particular state.

Functional connectivity between brain stem midline neurons with respiratory-modulated firing rates

1. Recent evidence supports the idea that neurons distributed along the midline of the brain stem contribute to the regulation of breathing. This study sought evidence for functional connections between midline neurons with respiratory-modulated firing rates. 2. Experiments were conducted on 38 anesthetized, paralyzed, bilaterally vagotomized, artificially ventilated cats. Planar arrays of tungsten microelectrodes were used to monitor spike trains of two or more midline neurons simultaneously in the regions of n. raphe obscurus, n. raphe pallidus, and n. raphe magnus. Efferent phrenic nerve activity was recorded. Data were analyzed with auto- and cross-correlograms and cycle-triggered histograms. Spike trains of neurons were also tested for respiratory modulation by an analysis of variance with the use of a subjects-by-treatments experimental design. 3. Of 584 neurons studied, 99.1% were tonic, i.e., they had firing probabilities greater than zero in all phases of the respiratory cycle. Fifty-three percent of the neurons had respiratory-modulated firing rates; 223 cells were more active during the expiratory (E) interval; 88 neurons were inspiratory (I)-related. The remaining cells were classified as having no respiratory-related modulation of firing rate (NRR). 4. The spike trains of 210 of 1,078 pairs (19.5%) of brain stem midline neurons exhibited short-time scale correlations indicative of paucisynaptic interactions. Primary cross-correlogram features included 129 central peaks, 45 offset peaks, two central troughs, and 57 offset troughs. Twenty-two of the neuronal pairs analyzed had both offset peaks and troughs. Correlograms from an additional 35 pairs of neurons had multiple peaks and troughs without a significant primary feature. 5. The frequency of correlations for neuron pairs composed of cells with respiratory-modulated firing rates was as follows: E-E, 40/185 (22%); E-I, 23/111 (21%); E-NRR, 45/297 (15%); I-I, 11/25 (44%); and I-NRR, 13/104 (13%). Twenty-two percent of the NRR pairs (79/357) exhibited short-time scale correlations. 6. Thirty pairs of neurons included a cell with an antidromically identified axonal projection extending to at least the third cervical segment. The mean estimated conduction velocity based on the single-site stimulation method was 26.5 +/- 9.9 (SD) m/s. 7. The results provide evidence for inhibitory and excitatory functional connections between midline brain stem neurons. Data support the hypothesis that the respiratory-modulated discharge patterns of midline neurons are, at least in part, a consequence of the synaptic actions of other midline cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Hepatic artery aneurysm

OBJECTIVE

To present a successfully treated case of hepatic artery aneurysm.

CLINICAL FEATURES

A 76-year-old, retired male Caucasian presented with acute abdominal pain which was diagnosed as acute cholecystitis. An aneurysm of the hepatic artery was found at operation for cholecystectomy, and an arteriogram confirmed the position of the aneurysm, distal to the origin of the gastroduodenal artery.

INTERVENTION AND OUTCOME

The aneurysm was resected and replaced with an 8 mm diameter woven Dacron graft. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day.

CONCLUSION

Aneurysms of the hepatic artery can be resected with restoration of arterial continuity.

Absence of both auditory evoked potentials and auditory percepts dependent on timing cues

An 11-yr-old girl had an absence of sensory components of auditory evoked potentials (brainstem, middle and long-latency) to click and tone burst stimuli that she could clearly hear. Psychoacoustic tests revealed a marked impairment of those auditory perceptions dependent on temporal cues, that is, lateralization of binaural clicks, change of binaural masked threshold with changes in signal phase, binaural beats, detection of paired monaural clicks, monaural detection of a silent gap in a sound, and monaural threshold elevation for short duration tones. In contrast, auditory functions reflecting intensity or frequency discriminations (difference limens) were only minimally impaired. Pure tone audiometry showed a moderate (50 dB) bilateral hearing loss with a disproportionate severe loss of word intelligibility. Those auditory evoked potentials that were preserved included (1) cochlear microphonics reflecting hair cell activity; (2) cortical sustained potentials reflecting processing of slowly changing signals; and (3) long-latency cognitive components (P300, processing negativity) reflecting endogenous auditory cognitive processes. Both the evoked potential and perceptual deficits are attributed to changes in temporal encoding of acoustic signals perhaps occurring at the synapse between hair cell and eighth nerve dendrites. The results from this patient are discussed in relation to previously published cases with absent auditory evoked potentials and preserved hearing.

Hypoxemia alone does not explain blood pressure elevations after obstructive apneas

In patients with obstructive sleep apnea (OSA), substantial elevations of systemic blood pressure (BP) and depressions of oxyhemoglobin saturation (SaO2) accompany apnea termination. The causes of the BP elevations, which contribute significantly to nocturnal hypertension in OSA, have not been defined precisely. To assess the relative contribution of arterial hypoxemia, we observed mean arterial pressure (MAP) changes following obstructive apneas in 11 OSA patients during non-rapid-eye-movement (NREM) sleep and then under three experimental conditions: 1) apnea with O2 supplementation; 2) hypoxemia (SaO2 80%) without apnea; and 3) arousal from sleep with neither hypoxemia nor apnea. We found that apneas recorded during O2 supplementation (SaO2 nadir 93.6% +/- 2.4; mean +/- SD) in six subjects were associated with equivalent postapneic MAP elevations compared with unsupplemented apneas (SaO2 nadir 79-82%): 18.8 +/- 7.1 vs. 21.3 +/- 9.2 mmHg (mean change MAP +/- SD); in the absence of respiratory and sleep disruption in eight subjects, hypoxemia was not associated with the BP elevations observed following apneas: -5.4 +/- 19 vs. 19.1 +/- 7.8 mmHg (P less than 0.01); and in five subjects, auditory arousal alone was associated with MAP elevation similar to that observed following apneas: 24.0 +/- 8.1 vs. 22.0 +/- 6.9 mmHg. We conclude that in NREM sleep postapneic BP elevations are not primarily attributable to arterial hypoxemia. Other factors associated with apnea termination, including arousal from sleep, reinflation of the lungs, and changes of intrathoracic pressure, may be responsible for these elevations.

Reduced subendocardial coronary reserve. A potential mechanism for impaired diastolic function in the hypertrophied and failing heart

The association between pressure overload, left ventricular (LV) hypertrophy and failure, and abnormalities in diastolic function has been described both clinically and experimentally. The mechanisms underlying this association, however, are complex and controversial. Factors that have been implicated include mechanical alterations due to hypertrophy alone, changes in collagen type and content, alterations in beta-adrenergic responsiveness, and chronic myocardial ischemia. Studies in our laboratory have identified limitations in subendocardial flow reserve in compensated LV hypertrophy and near exhaustion in subendocardial reserve in animals with decompensated LV hypertrophy and failure. These abnormalities in coronary reserve are associated with impaired diastolic function, particularly during periods of physiological stress. For example, with pacing-induced stress, impairment in diastolic function was observed in conscious dogs with compensated LV hypertrophy. In conscious dogs with LV hypertrophy and failure, isoproterenol also resulted in altered diastolic function. Thus, in the model of severe pressure-overload hypertrophy, which is characterized by limitations in coronary reserve, the mechanism of subendocardial ischemia might be responsible in part for the impairment in diastolic function observed in response to superimposed stress.

Intercostal and abdominal muscle afferent influence on caudal medullary expiratory neurons that drive abdominal muscles

Our objective was to determine if caudal ventral respiratory group (VRG) expiratory (E) neurons that drive abdominal expiratory motoneurons in the lumbar cord respond to intercostal and lumbar nerve afferent stimulation. Results showed that 92% of medullary E-neurons that were antidromically activated from the upper lumbar cord reduced their activity in response to stimulation of external and internal intercostal and lumbar nerve afferents. We conclude that afferent information from intercostal and abdominal muscle tendon organs has an inhibitory effect on caudal VRG E-neurons that drive abdominal expiratory motoneurons.

Prevalence, intensity and ocular manifestations of Onchocerca volvulus infection in Dimbelenge, Zaire

In the zone of Dimbelenge (West Kasai region), Zaire we studied the prevalence, intensity and ocular manifestations of Onchocerca volvulus infection. We used the cluster sampling method to draw a sample of 327 people from a total population of 17,870. The prevalence of microfilaria in skin snips was 82.1% in people 20 years of age and older. The Community Microfilarial Load was 3.5. Blindness in 12 of 13 adults (92.3%) was caused by onchocerciasis. The rate of onchocercal blindness in the adult population was 5.1%. Twenty-four percent of adults had retinal changes as a result of onchocercal infection.

Discharge patterns of rostrolateral medullary expiratory neurons in the cat: regulation by concurrent network processes

1. The identification of numerous functional connections among medullary respiratory related neurons led us to postulate specific short time scale correlations among neuronal spike trains consistent with 1) inhibition of rostrolateral medullary augmenting expiratory (E-AUG) neurons by other E-AUG cells, and 2) inhibitory control of the postulated E-AUG neural network by decrementing expiratory (E-DEC) neurons. Recent observations of reduced rostrolateral E-AUG cell activity following stimulation of sensory afferents raised the additional question of whether reflex control mechanisms use the identified functional connections to mediate their effects. 2. Experiments were conducted on 42 anesthetized, paralyzed, bilaterally vagotomized, artificially ventilated cats. Impulse trains of two or more respiratory related neurons of the lateral medulla, including at least one rostrolateral medullary E-AUG neuron, were simultaneously recorded together with phrenic nerve efferent activity. Most neurons were tested for spinal axonal projections with antidromic stimulation methods. In some experiments, the central cut end of the right vagus nerve was electrically stimulated during the expiratory interval. Data were analyzed using cycle-triggered histograms, auto- and cross-correlograms, logical cross-correlograms, snowflake scatter diagrams, and peristimulus time histograms. 3. Seven of 73 pairs (9.6%) of ipsilateral E-AUG neurons exhibited short time scale correlations in firing probability. Two rostral pairs had coincident increases in activity. Five pairs were characterized by a reduction in activity in a rostral neuron following spikes in the other cell; concurrent serial inhibition among one set of three E-AUG neurons was indicated. These five pairs, together with three other similarly correlated pairs described previously, were studied further: spikes recorded during the first and second halves of the expiratory (E) phase were analyzed separately. This phase segmentation unmasked multiple correlations implying reciprocal inhibition between one pair of E-AUG neurons. Short time scale troughs in correlograms generated from late E-phase spike trains had significantly (P less than 0.05) greater detectability indices than troughs in early E-phase correlograms. Multineuron correlations revealed two cases in which the firing probability of the target E-AUG neuron was reduced less when only reference E-AUG cell spikes coincident with spikes in a third, E-DEC, neuron were used as trigger events. 4. Enhanced rostral E-AUG neuron firing probabilities coincident with or following impulses in ipsilateral E-DEC neurons were detected in 6 of 94 (6.4%) rostral pairs.(ABSTRACT TRUNCATED AT 400 WORDS)

Heparin lock intravenous line. Use in newborn infants. A controlled trial

The heparin lock technique has been available for parenteral access in older children and adults but has not yet been described for use in newborns. We randomized 39 newborns who needed parenteral medication in the intermediate care nursery to receive a heparin lock catheter (17) or an intravenous line kept patent by continuous low infusion rate (22). There were no differences between study groups with regard to birthweight, gestational age, or distribution of diagnoses. Infants in the heparin lock group were enrolled in the study on average 1 day longer than the continuous intravenous group (p less than 0.05). Subcutaneous infiltration occurred twice as frequently with the continuous intravenous line (p = 0.0015), and the life span was significantly less than heparin lock (1.0 +/- 0.5 days versus 2.1 +/- 1.0 days, p = 0.0003). Infants with continuous intravenous lines received approximately 20 ml/kg/day greater quantity of fluid (p less than 0.0001). There was no difference between groups with regard to mean heparin activity level. None of the infants developed hemorrhagic complications, thrombophlebitis, or documented nosocomial infection. Nurses significantly favored heparin locks over continuous intravenous lines for ease of use. The heparin lock technique is a safe and reasonable alternative to a continuous low infusion intravenous line for administering parenteral medications to intermediate care newborns.

Gravitational representation of simultaneously recorded brainstem respiratory neuron spike trains

Experiments designed to study concurrent processes in neural networks have been hampered by limitations of available analytical methods. A recently described gravitational representation of spike train data was used to evaluate groups of simultaneously monitored medullary respiratory related neurons in anesthetized, vagotomized cats. The results establish that the method can detect and define functional associations among elements of such groups after as few as 20 respiratory cycles.

Medullary neurons mediating the inhibition of inspiration by intercostal muscle tendon organs?

Studies were conducted to test the hypothesis that nonrespiratory-modulated units are last-order interneurons mediating the effects of intercostal muscle tendon organs on medullary inspiratory neuron activity. Vagotomized, anesthetized, or decerebrate cats were used. Results show the following. 1) Afferents from different receptor types (i.e., intercostal tendon organs and chest wall cutaneous receptors) that inhibit medullary inspiratory neuron activities evoke the same units. 2) Gastrocnemius muscle group I afferent fibers evoke some of the same units as intercostal afferents but do not alter respiratory activity. 3) The "pneumotaxic center" and laryngeal nerve afferents, which inhibit medullary inspiratory activity, evoke different medullary units than intercostal afferents. 4) Evoked units are not active in spontaneously breathing cats. Additional results suggest that a few respiratory neurons near the retrofacial nucleus may be involved in the mediation of the inspiratory inhibitory effects of intercostal tendon organs. These results do not establish the mechanism by which intercostal muscle tendon organs reduces medullary inspiratory activity.

Respiratory pattern changes produced by intercostal muscle/rib vibration

Large-amplitude vibration of the intercostal muscles/ribs has an inhibitory effect on inspiratory motor output. This effect has been attributed, in part, to the stimulation of intercostal muscle tendon organs. Intercostal muscle/rib vibration can also produce a decrease or increase in respiratory frequency. Studies were conducted 1) to determine whether, in addition to intercostal tendon organs, costovertebral joint mechanoreceptors (CVJR's) contribute to the inspiratory inhibitory effect of intercostal muscle/rib vibration (IMV) and 2) to explain the different respiratory frequency responses to IMV previously reported. Phrenic (C5) activity was monitored in paralyzed thoracotomized, artificially ventilated cats. Vibration (125 Hz) at amplitudes greater than 1,200 micron of one T6 intercostal space in decerebrated vagotomized rats reduced phrenic activity. This response was still present but weaker in some animals after denervation of the T6 intercostal muscles. Subsequent denervation of the T6 CVJR's by dorsal root sections eliminated this effect. Respiratory frequency decreased during simultaneous vibration (greater than 1,200 micron) of the T5 and T7 intercostal spaces in vagotomized cats. Respiratory frequency increased during IMV of two intercostal spaces (greater than 1,300 micron) in vagal intact cats. The use of different anesthetics (pentobarbital, allobarbital) did not alter these results. We conclude that CVJR's may contribute to the inhibitory effect of IMV on medullary inspiratory activity. The presence or absence of pulmonary vagal afferents can account for the different respiratory frequency responses to IMV, and different anesthetics did not influence these results.

Expiratory neurons in the region of the retrofacial nucleus: inhibitory effects of intercostal tendon organs

Intercostal muscle tendon organs have an inhibitory effect on the medullary neurons driving all inspiratory muscles, and on a subpopulation of medullary bulbospinal expiratory neurons. Results from this study showed that the activity of expiratory related neurons in the region of the retrofacial nucleus (Botzinger complex) decreases during tendon organ afferent stimulation; the response is similar to that of caudal bulbospinal expiratory neurons. We conclude that these expiratory neurons do not mediate the tendon organ inhibition of medullary inspiratory neuronal activity.

Functional associations among simultaneously monitored lateral medullary respiratory neurons in the cat. I. Evidence for excitatory and inhibitory actions of inspiratory neurons

Data were obtained from 45 anesthetized (Dial), paralyzed, artificially ventilated, bilaterally vagotomized cats. Arrays of extracellular electrodes were used to monitor simultaneously the activities of lateral medullary respiratory neurons located in the rostral and caudal regions of the ventral respiratory group. The average discharge rate as a function of time in the respiratory cycle was determined for each neuron and concurrent phrenic nerve activity. Most cells were tested for axonal projections to the spinal cord or the ipsilateral vagus nerve using antidromic stimulation techniques. Seven hundred and sixty-one pairs of ipsilateral respiratory neurons that contained at least one neuron whose maximum discharge rate occurred during the inspiratory phase were analyzed by cross-correlation of the simultaneously recorded spike trains. Twenty-three percent of the 410 pairs of inspiratory (I) neurons showed short time scale correlations indicative of functional association due to paucisynaptic connections or shared inputs. Eight per cent of the 351 pairs composed of an I cell and and expiratory (E) neuron were correlated. We found evidence for excitation of both bulbospinal I neurons and I cells that were not antidromically activated by stimulation of the spinal cord and vagus nerve (NAA neurons) by NAA I cells. We also obtained data suggesting inhibitory actions of cells whose maximum discharge rate occurred in the first half of the I phase (I-DEC neurons). These actions included inhibition of other I-DEC neurons, inhibition of cells whose greatest firing rate occurred in the last half of the I phase (I-AUG neurons), inhibition of E-DEC neurons, and inhibition of E-AUG cells. Sixty-two percent (31/50) of the correlations that could be interpreted as evidence for an excitatory or inhibitory paucisynaptic connection were detected in pairs composed of a caudal and a rostral ventral respiratory group neuron. Eighty-eight percent (14/16) of proposed intergroup excitatory connections involved a projection from the rostral neuron of the pair to the caudal cell, whereas 73% (11/15) of proposed inhibitory connections involved a caudal-to-rostral projection. These results support and suggest several hypotheses for mechanisms that may help to control the development of augmenting activity in and the timing of each phase of the respiratory cycle.

Functional associations among simultaneously monitored lateral medullary respiratory neurons in the cat. II. Evidence for inhibitory actions of expiratory neurons

Arrays of extracellular electrodes were used to monitor simultaneously several (2-8) respiratory neurons in the lateral medulla of anesthetized, paralyzed, bilaterally vagotomized, artificially ventilated cats. Efferent phrenic nerve activity was also recorded. The average discharge rate as a function of time in the respiratory cycle was determined for each neuron. Most cells were tested for spinal or vagal axonal projections using antidromic stimulation methods. Cross-correlational methods were used to analyze spike trains of 480 cell pairs. Each pair included at least one neuron most active during the expiratory phase. All simultaneously recorded neurons were located in the same side of the brain stem. Twenty-six percent (33/129) of the expiratory (E) neuron pairs exhibited short time scale correlations indicative of paucisynaptic interactions or shared inputs, whereas 8% (27/351) of the pairs consisting of an E neuron and an inspiratory (I) cell were similarly correlated. Evidence for several inhibitory actions of E neurons was found: 1) inhibition of I neurons by E neurons with both decrementing (DEC) and augmenting (AUG) firing patterns; 2) inhibition of E-DEC and E-AUG neurons by E-DEC cells; 3) inhibition of E-DEC and E-AUG neurons by E-AUG neurons; and 4) inhibition of E-DEC neurons by tonic I-E phase-spanning cells. Because several cells were recorded simultaneously, direct evidence for concurrent parallel and serial inhibitory processes was also obtained. The results suggest and support several hypotheses for mechanisms that may help to generate and control the pattern and coordination of respiratory motoneuron activities.

Medullary inspiratory activity: influence of intercostal tendon organs and muscle spindle endings

Studies were conducted to determine the effects of intercostal muscle spindle endings (MSEs) and tendon organs (TOs) on medullary inspiratory activity in decerebrate and allobarbital-anesthetized cats. Impeded muscle contractions, elicited by electrical stimulation of the peripheral cut end of the T6 ventral root, were used to stimulate external and internal intercostal TOs without MSEs. Impeded contractions of either the external or internal intercostal muscles reduced phrenic and medullary inspiratory neuronal activities. Vibration was used to selectively stimulate external or internal intercostal MSEs (90 and 40 micron amplitude, respectively). Selective stimulation of either external or internal intercostal MSEs did not change phrenic or medullary inspiratory neuronal activities. It is concluded that both external and internal intercostal TOs have a generalized inhibitory effect on medullary inspiratory activity and intercostal MSEs have no effect on medullary inspiratory activity.

Medullary expiratory activity: influence of intercostal tendon organs and muscle spindle endings

Studies were conducted to determine the effects of intercostal muscle spindle endings (MSEs) and tendon organs (TOs) on medullary expiratory activity in decerebrate cats. Impeded intercostal muscle contractions, elicited by electrical stimulation of the peripheral cut end of the T6 ventral root, were used to stimulate intercostal TOs without MSEs. Impeded contractions of the intercostal muscles augmented expiratory laryngeal motoneuron activity, and either had no effect on or reduced the activity of bulbospinal expiratory neurons. Vibration was used to stimulate intercostal MSEs. Intercostal MSEs had no effect on medullary expiratory neuron activity. It is concluded that both external and internal intercostal TOs have an excitatory effect on expiratory laryngeal motoneuron activity and an inhibitory effect on a subpopulation of expiratory neurons driving intercostal and/or abdominal muscles, and intercostal MSEs have no direct influence on medullary expiratory activity.

Foramen magnum stenosis in homozygous achondroplasia

A 4-month-old female with homozygous achondroplasia and daytime apnea was found to have a small foramen magnum by computerized tomography. Following suboccipital craniectomy and C1-C2 laminectomy respiratory problems did not recur during a 7 month post-operative period. We suggest that the respiratory problems in homozygous achondroplasia may be due to brainstem compression from an abnormally small foramen magnum.

Interactions between rostral pontine and ventral medullary respiratory neurons

Lesioning studies have demonstrated that the respiratory rhythm is generated within the brain stem and that connections between the pons and the medulla must be intact for the generation of eupneic breathing in the decerebrate or anesthetized vagotomized cat. However, the nature of proposed functional connections between pontine and medullary respiratory neurons is not well understood. The possibility of interactions between respiratory neurons of the rostral pons (n. parabrachialis medialis, Kölliker-Fuse nucleus) and the ipsilateral ventral respiratory group (VRG; n. retroambigualis, n. ambiguus, retrofacial nucleus) was investigated because of neuroanatomical and electrophysiological evidence for such connections. Phrenic nerve activity and pontine and medullary single-unit respiratory related activities were recorded extracellularly in 44 decerebrate, vagotomized, paralyzed, and artificially ventilated cats. Cross-correlation analysis was employed to detect and evaluate functional associations of pairs of cells. Eighteen (7%) of the 255 pairs of respiratory neurons analyzed showed evidence of short time scale correlations indicative of a functional interaction. The interpretations of the detected correlations suggest that some cell pairs were correlated due to mono- or paucisynaptic connections, while others were correlated due to the influence of an unobserved shared input. The interpretations for 11 of the 15 cell pairs for which a monosynaptic connection may be postulated involve a projection from a tonically active respiratory neuron. Twelve of the 18 positive correlations involved neurons whose maximum rates of discharge occurred during different parts of the respiratory cycle. The results of this study provide the first evidence of functional connections among pontine and medullary respiratory neurons based on the evaluation of simultaneously recorded spike trains and suggest that the role of the rostral pontine respiratory neurons in the control of the respiratory rhythm may be mediated by various types of interactions. When considered with the results of other studies, our data suggest that monosynaptic interactions between VRG and rostral pontine respiratory neurons play a limited role in the control of the respiratory cycle in the decerebrate vagotomized cat. It is likely that the influence of the pons on ventral medullary neurons (and vice-versa) is also exerted via polysynaptic pathways and/or via brain stem neurons not sampled in this study.

Non-vagal reflex effects on medullary inspiratory neurons during inspiratory loading

Studies were conducted to compare the first-breath responses of medullary Dorsal and Ventral Respiratory Group inspiratory (I) neurons to the mechanical loading (tracheal occlusion, TO) of inspiration in unanesthetized (decerebrate) and anesthetized (Dial) vagotomized cats, and to determine the sources of the sensory activity causing the changes in I-neuron activity. In decerebrate cats, TO resulted in a prolongation of the firing duration in 49% of the I-neurons. There was a delayed onset of firing in 7% of the I-neurons. The responses of I-neurons to TO in anesthetized cats were similar to the responses in decerebrate cats. Changes in I-neuron activity with TO were still present in cats with their cervical (C3-7) or thoracic (T1-9) dorsal roots cut, and absent when both cervical and thoracic dorsal roots were cut. The most probable sources of the cervical and thoracic afferent information altering medullary I-neuron activity during loading are the diaphragm and inspiratory intercostal muscles.

Cryptosporidiosis in an urban community

Over three months Cryptosporidium oocysts were identified in faecal samples from 43 (5%) of 867 patients presenting to their general practitioners with gastrointestinal symptoms. Cryptosporidium was the second most common enteric pathogen identified. Of the 867 patients, 329 were children aged under 5, of whom 24 (7%) excreted Cryptosporidium. A characteristic clinical presentation of infection with Cryptosporidium was recognised--namely, mild gastroenteritis with four to six watery, mucoid, and offensive motions a day, which lasted for one to two weeks. The source of infection was not identified, but direct contact with farm animals was not a feature and no association with a common water supply could be established.

A national task analysis of infection control practitioners, 1982 Part three: The relationship between hospital size and tasks performed

One aspect of the Certification Board of Infection Control's (CBIC) task analysis survey was to determine those tasks done most frequently and considered most important by ICPs. A randomized stratified sample of ICPs was taken from U.S. hospitals of various bed-size categories. There were 473 responses (78.8%) from a targeted sample of 600 ICPs. Statistical analyses were done to find if a relationship existed between hospital size and the tasks performed. The frequency of performance and importance of the majority of infection control tasks studied were found to vary in relation to hospital size. Some tasks were found to be both important and frequently performed by the majority of ICPs in all hospital bed-size categories. These included performing and reporting epidemiologic surveillance, educating personnel, developing infection control policies and procedures, and consulting with hospital personnel. Other tasks were found to be relatively less important and infrequently performed by the majority of ICPs in all hospital bed-size categories. These included performing bedside patient care procedures, recommending specific antimicrobial therapy, and using statistical methods. The greatest differences in the performance of tasks were found in the subsample of the ICPs from hospitals with less than or equal to 100 beds.

A national task analysis of infection control practitioners, 1982

Respondents (N = 473) from a randomized stratified sample (N = 600) of U.S. hospital ICPs in a national survey sponsored by the Certification Board of Infection Control were asked to rate specific task, knowledge, and ability statements related to infection control for frequency and importance. The questions included 175 items, of which 99 were for specific tasks and 76 were for knowledge and abilities for practice. Areas covered included patient care practices, infectious diseases, epidemiology and statistics, microbiologic practices, sterilization and disinfection, education, employee health services, and management and communications. A "profile respondent" group (N = 317) was defined as persons most likely to be practicing the full scope of infection control practice and was used to identify key tasks, knowledge, and abilities for practice. Results showed that patient care practices (i.e., suctioning, dressing changes, and catheterization) were rarely performed. The development of infection control policies and procedures were key tasks. Knowledge of microbiology and infectious diseases in order to interpret laboratory reports and other patient data was rated as essential; however, few respondents actually performed laboratory procedures. Epidemiologic principles were frequently used for surveillance and problem investigation. Although presentation of epidemiologic data was rated as important, analytic statistics were rarely used. Assessment of educational needs and teaching were large components of ICPs' activities.

A national task analysis of infection control practitioners, 1992 Part One: Methodology and demography

A task analysis survey was conducted in 1982 by the Certification Board of Infection Control ( CBIC ) to determine the tasks performed by ICPs and the knowledge and abilities needed to perform these tasks. Data were obtained from 473 (78.8%) respondents to a nationwide mail survey of 600 ICPs . The respondents represent a randomized, stratified sample of ICPs in various types of U.S. acute care hospitals ranging in size from fewer than 50 beds to more than 500 beds. The results of the survey were used, in part, to develop the Infection Control Certification Examination, offered for the first time on November 19, 1983. According to the survey results, the modal or typical ICP is a white woman between the ages of 31 and 50 years using the title of infection control nurse. She has been employed full time for 2 to 10 years in infection control practice in a Joint Commission on Accreditation of Hospitals (JCAH)--accredited community acute care hospital having 301 to 500 beds. She is working at the supervisory level, is on the nursing department payroll, votes as a member of the hospital's infection control committee, and received her last degree or diploma more than 15 years ago.

Intercostal and abdominal muscle afferent influence on pneumotaxic center respiratory neurons

The experiments were performed on mid-collicular decerebrated, vagotomized, paralyzed, artificially ventilated cats. Phrenic (PA) and pneumotaxic center (PC) respiratory neuron (extracellular) activities were recorded during electrical stimulation of intercostal nerve proprioceptor afferents (external, internal or lateral intercostal nerves). Intercostal nerve stimulation (INS) of sufficient intensity to reduce PA also reduced the activity of phasic PC I-neurons and the I-modulated portion of tonic firing I-neurons. The stimulus-response latency for the reduction in PA was always shorter than the latency for the reduction in I-neuron activity. Baseline tonic activity (during E-phase) was unaffected by INS in most tonic I-neurons. The predominant response of PC IE- and E-neurons to INS was augmentation of their activity. Stimulus-response latency studies showed that the increase in IE- and E-neuron activity occurred after the decrease in PA. It is concluded that: (1) the reduced PC I-neuron activity following INS is due primarily to disfacilitation resulting probably from decreased activity in medullary I-neurons that drive the PC I-neurons, (2) PC IE- and E-neurons are not the primary neurons mediating the inspiratory inhibitory effects of intercostal and abdominal muscle proprioceptors on medullary I drive, (3) the changes in PC IE- and E-neuron activity is not due secondarily to changes in DRG and VRG IE- or E-neuron activities, and (4) the reflex effects are due to stimulation of low threshold Group I afferent fibers.

Lumbar spinal nerve lateral entrapment

In past years, lumbar nerve lateral entrapment seldom has been diagnosed. A presumptive preoperative diagnosis has been made based on clinical findings and radiographs demonstrating disc resorption. The Computed Tomography scan has made it possible to diagnose the lesion with certainty and accuracy. Treatment for patients who do not respond to conservative measures is a bilateral minimal partial laminectomy. The lateral canal is enlarged by removing the medial and anterior parts of the superior articular process. Adhesion formation is prevented by placing a free fat graft posterior to the dura. Instability is diagnosed by examining stress radiographs and, when present, is treated by a one level posterolateral fusion. After operation, marked improvement was obtained in 62% of patients and slight improvement in another 21%; 17% were unimproved. Sixty-two per cent of patients reported no pain or mild pain. Sixty-six per cent resumed their previous occupation.