Screening macroalgae for mitigation of enteric methane in vitro

This study investigated the effects of 67 species of macroalgae on methanogenesis and rumen fermentation in vitro. Specimens were analyzed for their effect on ruminal fermentation and microbial community profiles. Incubations were carried out in an automated gas production system for 24-h and macroalgae were tested at 2% (feed dry matter basis) inclusion rate. Methane yield was decreased 99% by Asparagopsis taxiformis (AT) when compared with the control. Colpomenia peregrina also decreased methane yield 14% compared with control; no other species influenced methane yield. Total gas production was decreased 14 and 10% by AT and Sargassum horneri compared with control, respectively. Total volatile fatty acid (VFA) concentration was decreased between 5 and 8% by 3 macroalgae, whereas AT reduced it by 10%. Molar proportion of acetate was decreased 9% by AT, along with an increase in propionate by 14%. Asparagopsis taxiformis also increased butyrate and valerate molar proportions by 7 and 24%, respectively, whereas 3 macroalgae species decreased molar proportion of butyrate 3 to 5%. Vertebrata lanosa increased ammonia concentration, whereas 3 other species decreased it. Inclusion of AT decreased relative abundance of Prevotella, Bacteroidales, Firmicutes and Methanobacteriaceae, whereas Clostridium, Anaerovibrio and Methanobrevibacter were increased. Specific gene activities for Methanosphaera stadtmane and Methanobrevibacter ruminantium were decreased by AT inclusion. In this in vitro study, Asparagopsis taxiformis was most effective in decreasing methane concentration and yield, but also decreased total gas production and VFA concentration which indicates overall inhibition of ruminal fermentation. No other macroalgae were identified as potential mitigants of enteric methane.

Performance of dairy cows fed normal- or reduced-starch diets supplemented with an exogenous enzyme preparation

The objective of this study was to investigate the effects of supplementation of an exogenous enzyme preparation (EEP) on performance, total-tract digestibility of nutrients, plasma AA profile, and milk fatty acids composition in lactating dairy cows fed a reduced-starch diet compared with a normal-starch diet (i.e., positive control). Forty-eight Holstein cows (28 primiparous and 20 multiparous) were enrolled in a 10-wk randomized complete block design experiment with 16 cows per treatment. Treatments were as follows: (1) normal-starch diet (control) containing (% dry matter basis) 24.8% starch and 33.0% neutral detergent fiber (NDF), (2) reduced-starch diet (RSD) containing 18.4% starch and 39.1% NDF, or (3) RSD supplemented with 10 g/cow per day of an EEP (ENZ). The EEP contained amylolytic and fibrolytic activities and was top-dressed on the total mixed ration at the time of feeding. Compared with normal-starch diet, dry matter intake and milk and energy-corrected milk (ECM) yields were lower (on average by 7.1, 9.5, and 7.2%, respectively) for cows on the RSD treatments. Concentrations, but not yields, of milk fat and total solids were increased by RSD. Energy-corrected milk feed efficiency did not differ among treatments. Total-tract digestibility of NDF tended to increase by RSD treatments. Plasma AA concentrations were not affected by treatment, except that of 3-methylhistidine was increased by ENZ, compared with RSD. Blood glucose concentration tended to be lower in cows on the RSD treatments, but ENZ increased glucose and tended to increase insulin concentrations at 4 h after feeding when compared with RSD. Cows on the RSD treatments had decreased concentrations of de novo fatty acids and tended to have increased concentrations of preformed fatty acids in milk. Overall, decreasing dietary starch concentration by 26% decreased dry matter intake, milk, and ECM yields, but ECM feed efficiency was not different among treatments. The negative effects of reducing dietary starch on production were not attenuated by the EEP.

Production effects and bioavailability of N-acetyl-l-methionine in lactating dairy cows

Two experiments were conducted to investigate the production effects of N-acetyl-l-methionine (NALM; experiment 1) and to estimate its bioavailability (BA) and rumen escape (RE; experiment 2), respectively, in lactating dairy cows. In experiment 1, 18 multiparous Holstein cows were used in a replicated, 3 × 3 Latin square design experiment with three 28-d periods. Treatments were (1) basal diet estimated to supply 45 g/d digestible Met (dMet) or 1.47% of metabolizable protein (MP; control), (2) basal diet top-dressed with 32 g/d of NALM to achieve dMet supply of 2.2% of MP, and (3) basal diet top-dressed with 56 g/d of NALM to achieve dMet supply of 2.6% of MP. The NALM treatments supplied estimated 17 and 29 g/d dMet from NALM, respectively, based on manufacturer's specifications. In experiment 2, 4 rumen-cannulated lactating Holstein cows were used in a 4 × 4 Latin square design experiment with four 12-d periods. A 12-d period for baseline data collection and 4 d for determination of RE of NALM preceded the Latin square experiment. For determination of RE, 30 g of NALM were dosed into the rumen simultaneously with Cr-EDTA (used as a rumen fluid kinetics marker) and samples of ruminal contents were collected at 0 (before dosing), 1, 2, 4, 6, 8, 10, 14, 18, and 24 h after dosing. Rumen escape of NALM was calculated using the estimated passage rate based on the measured Cr rate of disappearance. Bioavailability of abomasally dosed NALM was determined using the area under the curve of plasma Met concentration technique. Two doses of l-Met (providing 7.5 and 15 g of dMet) and 2 doses of NALM (11.2 and 14.4 g dMet) were separately pulse-dosed into the abomasum of the cows and blood was collected from the jugular vein for Met concentration analysis at 0 (before dosing), 1, 2, 4, 6, 8, 10, 12, 14, 18, and 24 h after dosing. Supplementation of NALM did not affect DMI, milk yield, feed efficiency, or milk protein and lactose concentrations and yields in experiment 1. Milk fat concentration and energy-corrected milk yield decreased linearly with NALM dose. Plasma Met concentration was not affected by NALM dose. The estimated relative BA of abomasally dosed NALM (experiment 2) was 50% when dosed at 14.4 g/cow (11.2 g/d dMet from NALM) and 24% when dosed at 28.8 g/cow (14.4 g/d dMet from NALM). The estimated RE of NALM was 19% based on the measured k_p of Cr at 11%/h. The total availability of ingested NALM was estimated at 9.5% for the lower NALM dose when taking into account RE (19%) and bioavailability in the small intestine (50%). Overall, NALM supplementation to mid-lactation dairy cows fed a MP-adequate basal diet below NRC (2001) recommendations (45 g/d or 1.47% Met of MP) decreased milk fat and energy-corrected milk yields but did not affect milk or milk true protein yields. Further evaluation of BA of NALM at different doses is warranted. In addition, intestinal conversion of NALM to Met needs additional investigation to establish a possible saturation of the enzyme aminoacylase I at higher NALM doses.

Dietary supplementation with rumen-protected capsicum during the transition period improves the metabolic status of dairy cows

In ruminants, it has been observed that capsicum oleoresin can alter insulin responses and that high-intensity artificial sweetener can increase glucose absorption from the small intestine. Because glucose metabolism and insulin responses are critical during early lactation, these supplements might have an effect on the metabolic status of dairy cows during the transition period. The objective of this experiment was to evaluate the effects of rumen-protected capsicum oleoresin fed alone or in combination with artificial sweetener during the transition period on lactational performance and susceptibility to subclinical ketosis in dairy cows. Fifteen primiparous and 30 multiparous Holstein cows (a total of 39 cows finished the study) were arranged in a randomized complete block design during d -21 to 60 relative to parturition. Cows within block were randomly assigned to one of the following treatments: no supplement (CON), supplementation with 100 mg of rumen-protected capsicum/cow per day (RPCap), or RPCap plus 2 g of high-intensity artificial sweetener/cow per day (RPCapS). For both the RPCap and RPCapS treatments, only rumen-protected capsicum was fed during the dry period. From d 8 to 11 of lactation, intake was limited to 70% of predicted dry matter intake to induce subclinical ketosis. Production variables were recorded daily, samples for milk composition were collected on wk 2, 4, 6, and 8, and blood samples were collected on wk -2, 1, 2, and 4 of the experiment for analysis of metabolic hormones and blood cell counts. Supplementation with rumen-protected capsicum increased serum insulin and decreased β-hydroxybutyrate concentrations precalving, indicating a decrease in lipolysis. During the lactation period, RPCap was associated with a trend for increased milk production and feed efficiency following the ketosis challenge. Supplementation with RPCapS appeared to negate the response to rumen-protected capsicum. All cows developed subclinical ketosis during the challenge, and this was not affected by treatment. We conclude that treatments did not decrease susceptibility to subclinical ketosis; however, dietary supplementation with rumen-protected capsicum was effective at improving energy status precalving and tended to increased milk production and feed efficiency. The mechanism underlying these responses is unclear.

Optimal Donor Selection During Verification Process: Which Factors Are Worth Knowing?

BACKGROUND

The selection of optimal donor is crucial for successful hematopoietic stem cell transplantation (HSCT). Thereby, it is appropriate to know, in addition to basic human leukocyte antigen (HLA) gene matches, other immunogenic or nonimmunogenic parameters predicting the outcome of transplant.

OBJECTIVE

A unified approach is necessary to provide a comprehensive view of the patient-donor compatibility characterization outside of standard HLA genes. The approach should be applicable as a tool for optimizing procedures for extended donor typing and/or verification typing of a donor.

METHODS

The study used the summary, unification, and innovation of existing practical knowledge and experience of the Czech National Marrow Donor Registry of various factors beyond HLA matching with impact on transplant outcome.

RESULTS

An information technology system-implemented procedure (a verification algorithm) is presented as the decision support approach for prematurely discarding less suitable donors from the transplantation process. It is intended primarily for the transplant specialist to help establish optimal procedures for verifying and determining donor critical factors.

CONCLUSIONS

A process defining HLAs, killer cell immunoglobulin-like receptors, and cytokine typing strategies was proposed to provide support to a transplant specialist in refining the choice of a suitable donor.

[Assessment of driving in patients with vertigo and dizziness]

The driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.

[Traffic medicine expert opinions in otorhinolaryngology: current aspects]

According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (> or = 60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

[Vestibular paroxysmia. A rare but important differential diagnosis]

The diagnosis and treatment of vertigo are very common in ear nose and throat medicine and neurology. As our case report demonstrates, an interdisciplinary approach is often useful for finding the correct diagnosis. Diagnosing disabling positional vertigo now seems uncomplicated using special MRI. More important is the history of frequent, short-term vertigo, sometimes accompanied by tinnitus. In analogy to trigeminal neuralgia, treatment should be started with carbamazepine or similar drugs. If unsuccessful, microvascular decompression as a neurosurgical intervention is recommended.

Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial

OBJECTIVES

The effectiveness of 2 different types of gait training in stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath- based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35).

METHODS

Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender, and lesion site. Motor function in both groups was pre-assessed by the Barthel Index and the Fugl-Meyer Scales.

RESULTS

Pre- to posttest measures showed a significant improvement in the RAS group for velocity (P = .006), stride length (P = .0001), cadence (P = .0001) and symmetry (P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence.

CONCLUSIONS

The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.

[Diabetes and cerebrovascular disease]

Diabetes has significant implications for cardiac surgery. It is not only a major risk factor for coronary heart disease but also increases the risk for cerebrovascular complications during heart surgery. Surgical technique is pivotal for the outcome. "Off-pump" surgery carries a lower risk for stroke than conventional heart surgery. When a stroke happens, diabetes plays also a major role for the final outcome. Initial blood glucose levels during a stroke and final outcome are highly correlated. Consequently, patients with ischemic stroke after cardiac surgery should be treated according to the current criteria for stroke treatment. This includes strict monitoring of blood glucose level and avoidance of hypo- as well as hyperglycemia.

Saccade Velocity as a Surrogate Disease Marker in Spinocerebellar Ataxia Type 2

We measured in 82 spinocerebellar ataxia type 2 (SCA2) patients and in 80 controls maximal saccade velocity (MSV) and correlated it to polyglutamine expansion size and disease duration. MSV is strongly decreased in SCA2 patients and is influenced mostly by polyglutamine size.

The perception of body orientation after neck-proprioceptive stimulation. Effects of time and of visual cueing

Different sensory systems (e.g. proprioception and vision) have a combined influence on the perception of body orientation, but the timescale over which they can be integrated remains unknown. Here we examined how visual information and neck proprioception interact in perception of the "subjective straight ahead" (SSA), as a function of time since initial stimulation. In complete darkness, healthy subjects directed a laser spot to the point felt subjectively to be exactly straight ahead of the trunk. As previously observed, left neck muscle vibration led to a disparity between subjective perception and objective position of the body midline, with SSA misplaced to the left. We found that this displacement was sustained throughout 28 min of continuous proprioceptive stimulation, provided there was no visual input. Moreover, prolonged vibration of neck muscles leads to a continuing disparity between subjective and objective body orientation even after offset of the vibration; the longer the preceding vibration, the more persistent the illusory deviation of body orientation. To examine the role of vision, one group of subjects fixated a central visual target at the start of each block of continuous neck vibration, with SSA then measured at successive intervals in darkness. The illusory deviation of SSA was eliminated whenever visual input was provided, but returned as a linear function of time when visual information was eliminated. These results reveal: the persistent effects of neck proprioception on the SSA, both during and after vibration; the influence of vision; and integration between incoming proprioceptive information and working memory traces of visual information.

The visual consequences of deviations in the orientation of the axis of rotation of the human vestibulo-ocular reflex

The 3D orientation and amplitude of the movement of each eye evoked by predictable, sinusoidal and non-predictable, sum-of-sines rotation about roll, yaw, pitch and intermediate axes were measured in seven subjects. The rotation axis of the eyes was not always perfectly aligned with the stimulus axis but showed systematic deviations that depended on the orientation of the rotation axis of the head. Misalignment of the oculomotor response with the stimulus axis is equivalent to adding an orthogonal, non-compensatory vector that potentially could introduce retinal slip, rather than compensate for it. The variations in orientation could not be readily explained as an artifact arising from the differential processing of the roll component. Instead, differences in the movements of the left and right eyes had trends appropriate for compensating for the geometrical demands of the translation of the eyes that must necessarily accompany natural head rotation.

Individual semicircular canal function in superior and inferior vestibular neuritis

OBJECTIVE

To examine the concept of selective superior and inferior vestibular nerve involvement in vestibular neuritis by studying the distribution of semicircular canal (SCC) involvement in such patients.

BACKGROUND

Vestibular neuritis was traditionally thought to involve the superior and inferior vestibular nerves. Recent work suggests that in some patients, only the superior nerve is involved. So far there are no reported cases of selective involvement of the inferior vestibular nerve.

METHODS

The authors measured the vestibuloocular reflex from individual SCC at natural head accelerations using the head impulse test. The authors studied 33 patients with acute unilateral peripheral vestibulopathy, including 29 with classic vestibular neuritis and 4 with simultaneous ipsilateral hearing loss, 18 healthy subjects and 15 surgical unilateral vestibular deafferented patients.

RESULTS

In patients with preserved hearing, eight had deficits in all three SCC, suggesting involvement of the superior and inferior vestibular nerves. Twenty-one had a lateral SCC deficit or a combined lateral and anterior SCC deficit consistent with selective involvement of the superior vestibular nerve. Two patients with ipsilateral hearing loss had normal caloric responses and an isolated posterior SCC deficit on impulsive testing. The authors propose that these two patients had a selective loss of inferior vestibular nerve function.

CONCLUSION

Vestibular neuritis can affect the superior and inferior vestibular nerves together or can selectively affect the superior vestibular nerve.

[Contrast enhanced MR-angiography (CE-MRA): do contrast media with higher T1 relaxation improve imaging of carotid stenoses?]

PURPOSE

CE-MRA is a powerful tool for the non-invasive evaluation of carotid artery occlusive disease. However, due to certain drawbacks, it has not completely replaced DSA. The purpose of this study was to evaluate if Gd-BOPTA, a contrast agent with high T1 relaxivity, can increase the diagnostic accuracy of CE-MRA.

MATERIAL AND METHODS

The CE-MRA examinations of 54 consecutive patients were evaluated by two experienced radiologists, independently. The examinations of 27 patients were contrasted either with 20 ml Gd-BOPTA or with 20 ml Gd-DTPA. The reviewers were blinded to the contrast agent chosen and to the ultrasound results. They rated the overall image quality and the degree of the ICA stenoses.

RESULTS

For the estimation of the degree of the ICA stenoses there was a high interrater validity. In comparison to the ultrasound findings, 6 of 50 high-degree stenoses were underestimated as moderate stenoses. In one of seven sonographically occluded vessels, MRA revealed residual patency in the vessel lumen. It was not possible to identify the contrast agent that was taken for a study. Subjective estimation of the image quality (arterial contrast of the ICA, contrast of the other vessels, and general impression) did not significantly change with the contrast agent employed.

CONCLUSION

The diagnostic accuracy of CE-MRA for the evaluation of internal carotid artery stenoses is not improved by Gd-BOPTA if identical volumina of contrast media are applied. The potential of this contrast agent can be the reduction of the amount of contrast without loss of diagnostic information. Further studies are necessary.

Ultrasonography and contrast-enhanced MRA in ICA-stenosis: is conventional angiography obsolete?

BACKGROUND

The standard techniques for the screening and staging of internal carotid artery (ICA) stenosis are Doppler (continuous wave) and Duplex sonography. For the imaging of ICA occlusive disease, magnetic resonance angiography (MRA) is replacing digital subtraction angiography (DSA). The purpose of this observational study was to assess whether contrast enhanced MRA (CE-MRA) combined with ultrasound provided sufficient information for the planning of surgical treatment.

METHODS

CE-MRA was performed in 195 patients (mean age 67.5 years) with sonographic evidence of severe ICA stenosis. The MRA examination protocol contained a heavily T1-weighted contrast bolus enhanced 3D-gradient echo sequence. The degree of stenosis was estimated retrospectively by two experienced neuroradiologists who were blinded to the sonographic findings.

RESULTS

The consistency of MRA and ultrasound was sufficient to plan thrombendarterectomy in 182/195 patients. The estimations of the degree of stenosis were congruent between MRA and ultrasound in 91% of 197 vessels with high-degree carotid artery stenosis. CE-MRA evaluation had a high interobserver agreement. In 3 cases ultrasound examination diagnosed a filiform ICA stenosis which was not visible with MRA. In all these cases, DSA and the intraoperative findings revealed very short (1-2 mm), high-grade, excentric stenosis. CE-MRA correctly detected patency in 5 patients with high-grade and low-flow carotid artery stenosis, which had been regarded as occluded by ultrasound. Conversely with, in CE-MRA two occluded vessels were falsely considered as open.

CONCLUSION

The combination of sonography and CE-MRA is a powerful tool for the non-invasive presurgical evaluation of the carotid arteries. DSA should be reserved for selected cases.

The motor side of depth vision

To achieve stereoscopic vision, the brain must search for corresponding image features on the two retinas. As long as the eyes stay still, corresponding features are confined to narrow bands called epipolar lines. But when the eyes change position, the epipolar lines migrate on the retinas. To find the matching features, the brain must either search different retinal bands depending on current eye position, or search retina-fixed zones that are large enough to cover all usual locations of the epipolar lines. Here we show, using a new type of stereogram in which the depth image vanishes at certain gaze elevations, that the search zones are retina-fixed. This being the case, motor control acquires a crucial function in depth vision: we show that the eyes twist about their lines of sight in a way that reduces the motion of the epipolar lines, allowing stereopsis to get by with smaller search zones and thereby lightening its computational load.

Three-dimensional spatial characteristics of caloric nystagmus

We investigated the three-dimensional spatial characteristics of caloric nystagmus during excitation and inhibition of the lateral semicircular canal in five normal human subjects. Each subject was repositioned in 45 degrees steps at 1-min intervals such that the right lateral semicircular canal plane was reoriented in pitch, from 135 degrees backwards from the upright position to 135 degrees forwards, while the right ear was continuously stimulated with air at 44 degrees C. In orientations in which caloric stimulus resulted in excitation of the right lateral semicircular canal, the eye velocity axis was orthogonal to the average orientation of the right lateral semicircular canal plane. However, in orientations in which caloric stimulus resulted in inhibition of the right lateral semicircular canal, the eye velocity axis was orthogonal to the average orientation of the left and not the right lateral semicircular canal plane. These findings suggest that velocity and direction of caloric nystagmus depend not only on the absolute magnitude of vestibular activity on the stimulated side but also on the differences in activity between the left and right vestibular nuclei, most probably mediated centrally via brainstem commissural pathways.

Three-dimensional eye-movement responses to off-vertical axis rotations in humans

We recorded three-dimensional eye movements elicited by velocity steps about axes that were tilted with respect to the earth-vertical. Subjects were accelerated in 1 s from zero to 100 degrees/s, and the axis of rotation was tilted by 15 degrees, 30 degrees, 60 degrees, or 90 degrees. This stimulus induced a constant horizontal velocity component that was directed opposite to the direction of rotation, as well as a modulation of the horizontal, vertical and torsional components with the frequency of the rotation. The maximum steady-state response in the horizontal constant-velocity component was much smaller than in other species (about 6 degrees/s), reaching a maximum at a tilt angle of about 60 degrees. While the amplitude of the horizontal modulation component increased up to a tilt angle of 90 degrees (8.4 degrees/s), the vertical and torsional modulation amplitudes saturated around 60 degrees (ca. 2.5 degrees/s). At small tilt angles, the horizontal modulation component showed a small phase lag with respect to the chair position, which turned into a small phase lead at large tilt angles. The torsional component showed a phase lead that increased with increasing tilt angle. The vertical and torsional velocity modulation at large tilt angles was not predicted by a recent model of otolith-canal interaction by Merfeld. Agreement between model and experimental data could be achieved, however, by introducing a constant force along the body's z-axis to compensate for the gravitational pull on the otoliths in the head-upright position. This approach had been suggested previously to explain the direction of the perceived subjective vertical during roll under different g-levels, and produced in our model the observed vertical and torsional modulation components at large tilt angles.

Assessing vestibular function: which tests, when?

Vertigo and dizziness are common complaints encountered in clinical practice. The patient's history and a thorough otoneurological evaluation are essential for identifying the specific pathology behind the patient's complaints. If the patient reports an illusion of movement (vertigo), this most likely indicates an imbalance within the vestibular system. A sensation of rotatory movement together with a spontaneous nystagmus suggests a lesion involving the semicircular canals, while an illusion of linear movement indicates a disturbance of the otoliths. Nystagmus of central origin or caused by a peripheral vestibular lesion can usually be distinguished by other features in the history or on clinical examination. While peripheral vestibular lesions usually lead to a mixed horizontal-torsional or vertical-torsional nystagmus, a pure vertical or pure torsional nystagmus is always caused by a central lesion. With simple bedside tests such as head-shaking nystagmus and rapid head impulses deficits in labyrinthine function can clearly be detected. For a more thorough investigation of vestibular function at the level of individual semicircular canals and the otoliths, modern techniques are now available such as three-dimensional eye movement vector analysis for the evaluation of individual semicircular canal function, measurement of the subjective visual vertical for utricular, and click-evoked myogenic potentials for saccular testing.

Cerebral vein thrombosis in a case with thromboangiitis obliterans

Thromboangiitis obliterans is a chronic inflammatory vessel disease that involves predominantly the small and medium-sized arteries and veins of the distal extremities. Appearance and cessation of symptoms are closely related to patterns of tobacco consumption. That cerebral arteries can also be involved is shown by reports of rare cases in which cerebral artery occlusion led to infarction. We report on a 28-year-old man with thromboangiitis obliterans who developed extensive cerebral vein thrombosis after a single episode of cigarette smoking following several years of nonsmoking. Despite extensive evaluation, no other known cause or predisposition of cerebral vein thrombosis could be found. This case suggests that cerebral veins can be involved in thromboangiitis obliterans and patients with thromboangiitis obliterans might be at risk for cerebral vein thrombosis.

Autosomal dominant cerebellar ataxia type I: oculomotor abnormalities in families with SCA1, SCA2, and SCA3

Forty-six patients suffering from autosomal dominant cerebellar ataxia type I (ADCA I) underwent to a genotype-phenotype correlation analysis by molecular genetic assignment to the spinocerebellar ataxia type 1, 2, or 3 (SCA1, SCA2, SCA3) genetic locus and electro-oculography. Oculomotor deficits that are attributed to dysfunction of cerebellar structures occurred in all three mutations without major differences between the groups. Gaze-evoked nystagmus, however, was not found to be associated with SCA2. Square wave jerks were exclusively observed in SCA3. The gain in vestibulo-ocular reflex was significantly impaired in SCA3 and SCA1. In SCA3 the severity of vestibular impairment increased with CAG repeat length. Severe saccade slowing was a highly characteristic feature of SCA2. In SCA3 saccade velocity was normal to mildly reduced while SCA1 fell into an intermediate range. The present data show that each mutation is associated with a distinct syndrome of oculomotor deficits. Reduced saccade velocity and the absence of both square-wave jerks and gaze-evoked nystagmus allow one SCA2 to be distinguished from SCA3 patients in almost all cases. The eye movement disorder of SCA1 patients, however, overlaps with both SCA2 and SCA3.

3D eye movements--basics and clinical applications

The eye muscles in humans are arranged such that they allow rotations of the globe about any axis in three-dimensional space. Only 3D analysis techniques will suffice to describe the sometimes complex dependencies between the elicited eye movements and the stimulation conditions. With the recent availability of modern 3D eye movement measurement techniques and the further development of appropriate mathematical descriptions, we are now able to study eye movements in all three degrees of freedom. This article describes the basic mathematical tools for 3D eye movement analysis like rotation vectors, reference frames, coordinate systems, and the concept of Listing's law. In a second part some clinical applications are presented. The close coupling between the vestibular and the oculomotor system suggests that by observing spontaneous and elicited eye movements in the case of an acute unilateral vestibular pathology we might be able to find out which parts of the vestibular system (that is, which of the semicircular canals or which of the otoliths) are affected. The rationale of such an analysis is based on the observation that electrical stimulation of single semicircular canal afferents in animals induces eye movements that lie roughly in the plane of the canal. It is, therefore, possible to deduce which canals cause the eye movements observed when only some parts of the vestibular system are defective. Thus, the analysis of 3D movements not only provides an improved understanding of how the brain organizes movement in 3D space, but also has the potential to significantly improve our diagnostic capabilities.

Persistent cerebellar deterioration in a patient with lobar pneumonia under lithium, carbamazepine, and trifluperidol treatment

We report on a patient with schizoaffective disorder who was on combination therapy of lithium, carbamazepine, and the neuroleptic trifluperidol. He experienced a lobar pneumonia and developed an acute and persistent cerebellar deterioration which was most likely due to lithium toxicity, while the serum lithium level was within the therapeutic range. The combination of lithium, carbamazepine, and neuroleptics is common, and is generally considered to be safe. The reported case suggests that this regimen might increase the risk of intoxication with potentially disabling side-effects.

Non-commutativity in the brain

In non-commutative algebra, order makes a difference to multiplication, so that a x b not equal to b x a. This feature is necessary for computing rotary motion, because order makes a difference to the combined effect of two rotations. It has therefore been proposed that there are non-commutative operators in the brain circuits that deal with rotations, including motor circuits that steer the eyes, head and limbs, and sensory circuits that handle spatial information. This idea is controversial: studies of eye and head control have revealed behaviours that are consistent with non-commutativity in the brain, but none that clearly rules out all commutative models. Here we demonstrate non-commutative computation in the vestibulo-ocular reflex. We show that subjects rotated in darkness can hold their gaze points stable in space, correctly computing different final eye-position commands when put through the same two rotations in different orders, in a way that is unattainable by any commutative system.

Echo planar perfusion imaging with high spatial and temporal resolution: methodology and clinical aspects

The purpose of the present study was to analyse specific advantages of calculated parameter images and their limitations using an optimized echo-planar imaging (EPI) technique with high spatial and temporal resolution. Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) was performed in 12 patients with cerebrovascular disease and in 13 patients with brain tumours. For MR imaging of cerebral perfusion an EPI sequence was developed which provides a temporal resolution of 0.68 s for three slices with a 128 x 128 image matrix. To evaluate DSC-MRI, the following parameter images were calculated pixelwise: (1) Maximum signal reduction (MSR); (2) maximum signal difference (delta SR); (3) time-to-peak (Tp); and (4) integral of signal-intensity-time curve until Tp (SInt). The MSR maps were superior in the detection of acute infarctions and delta SR maps in the delineation of vasogenic brain oedema. The time-to-peak (Tp) maps seemed to be highly sensitive in the detection of poststenotic malperfused brain areas (sensitivity 90%). Hyperperfused areas of brain tumours were detectable down to a diameter of 1 cm with high sensitivity (> 90%). Distinct clinical and neuroradiological conditions revealed different suitabilities for the parameter images. The time-to-peak (Tp) maps may be an important advantage in the detection of post-stenotic "areas at risk", due to an improved temporal resolution using an EPI technique. With regard to spatial resolution, a matrix size of 128 x 128 is sufficient for all clinical conditions. According to our results, a further increase in matrix size would not improve the spatial resolution in DSC-MRI, since the degree of the vascularization of lesions and the susceptibility effect itself seem to be the limiting factors.

New insights into positional alcohol nystagmus using three-dimensional eye-movement analysis

The semicircular canals selectively transduce angular velocity and are normally insensitive to gravity and linear acceleration. In acute alcohol intoxication, however, the cupula becomes lighter than the endolymph, rendering it sensitive to gravity (buoyancy hypothesis). This results in positional alcohol nystagmus (PAN) and rotatory vertigo. We evaluated PAN in 8 normal subjects by means of three-dimensional eye-movement analysis in an attempt to clarify if the buoyancy mechanism is sufficient to explain PAN. Forty minutes after intake of 0.8 g of alcohol/kg of body weight, the subjects were positioned such that the lateral canals were earth vertical. They were then rotated in the plane of the lateral canals about an earth-horizontal axis to either 45 degrees or 90 degrees , right or left ear down, and eye movements were recorded for 40 seconds in each position. The spatial analysis of the responses showed that in addition to the nystagmus induced by the buoyancy of all six cupulae, alcohol intoxication also causes a vertical velocity offset (in all subjects, slow phase down) that is independent of the orientation of the subject in space. The offset may represent a toxic effect on central vestibular pathways, producing a tone imbalance of the vertical vestibulo-ocular reflex.

Disentangling gravitational, environmental, and egocentric reference frames in spatial neglect

Previous studies in neglect patients using rotation of the body around the roll-axis revealed neglect of visual stimuli not only in the egocentric, body-centered left but also in the environmental left. The latter has been taken as evidence for a gravity-based environment-centered component of neglect occurring independently of the subject's actual body orientation. However, by using visual stimuli in a normally lightened room, the studies confounded the gravitational upright with the visible upright of the surround. Thus, it is possible that the visible upright of the environment may have served the role of the gravitational upright relative to which neglect occurred. The present experiment evaluated the influence of gravity on contralateral neglect when no visual information was presented. In complete darkness, neglect patients' exploratory eye movements were recorded in five experimental conditions: body in normal upright position, body titled 30 degrees to the left and 30 degrees to the right, and body pitched 30 degrees backward and 30 degrees forward. In the upright orientation, the patients with neglect showed a bias of ocular exploration to the ipsilesional right side. In egocentric body coordinates, we found no significant differences between the orientation of the biased search field in the different experimental conditions showing that the search field shifted with the orientation of the body. No significant decrease or enhancement of neglect was observed when body orientation was varied in the different conditions. In conclusion, the present results revealed that the modulation of gravitational forces has no significant influence on the exploratory bias of these patients. When visual information was excluded and only graviceptive information was available, the patients' failure to explore the contralesional part of space appeared purely body-centered. The results argue against a disturbed representation of space in neglect that encodes locations in a gravity-based reference system.

Acute disseminated encephalomyelitis following Pontiac fever

We report the case of a 35-year-old woman who developed headache and psychosis and gradually became comatose within 3 weeks after a flu-like infection. MRI revealed bifrontal demyelination consistent with acute disseminating encephalomyelitis (ADEM). Two different cerebrospinal fluid samples were positively tested for Legionella cincinnatiensis by direct sequencing of a PCR-amplified Legionella-specific fragment. This result made it possible to interpret the initial symptoms as Pontiac fever. We think it most likely that this is a case of ADEM following the very rare situation of a systemic infection with L. cincinnatiensis. A review of the literature on Legionella-associated encephalopathy suggests that some of these cases may also have had ADEM.

Contribution of the vertical semicircular canals to the caloric nystagmus

Modulation of the caloric nystagmus in response to repositioning the plane of one vertical semicircular canal from gravitational horizontal to vertical during continuous caloric stimulation was used to measure the vertical canal's contribution to the nystagmus. The rationale was to examine the thermovective response from one vertical canal at a time, after a temperature gradient had been established across its two limbs. The nystagmus was measured and analysed in three dimensions using orthogonal head-referenced coordinates. The magnitude of each semicircular canal's contribution to the overall caloric response, the canal vector, was determined in non-orthogonal, contravariant semicircular canal plane coordinates. By using the canal plane reorientation technique and contravariant canal plane coordinates, we were able to measure the proportional thermovective response magnitude generated by each vertical canal during caloric stimulation. We found that the anterior canal contributed about one-third and the posterior canal about one-tenth as much as the lateral canal did to the overall caloric response magnitude when it was reoriented from horizontal to vertical. Comparison of the eye rotation axis before and after each vertical canal plane reorientation, with the geometry of the stimulated semicircular canals, also showed directional modulation of the caloric nystagmus by the vertical canal response. When one vertical canal plane was horizontal during caloric stimulation, the eye rotation axis aligned with the resultant of the other vertical canal and the lateral canal response axes. After vertical canal plane reorientation, the eye rotation axis realigned towards the resultant of the maximally stimulated vertical canal and the lateral canal, by 55.2+/-33.9 degrees (mean+/-SD) after anterior canal plane reorientation and by 32.3+/-21.2 degrees after posterior canal reorientation.

Association between angiotensin I-converting enzyme genotypes, extracranial artery stenosis, and stroke

The insertion(I)/deletion(D) polymorphism of the angiotensin-converting-enzyme (ACE) gene has been associated with an increased risk of myocardial infarction, lacunar stroke, and with an increased intimal-medial thickness in several populations. The aim of this study was to evaluate whether the ACE I/D genotype is associated with stenosis of extracranial arteries and stroke in middle-aged and aged men and women. We studied 388 patients (247 male, 141 female) using Doppler and Duplex ultrasound of the extracranial arteries. Patients' history was obtained by standard questionnaire and by the hospital case records. Genomic DNA was analyzed by polymerase chain reaction (PCR) to identify the I/D polymorphism, with a second insertion specific PCR in samples classified as homozygous DD genotypes to prevent mistyping. The ACE genotype groups (DD 132, ID 164, II 92) were well matched for the basic characteristics. The DD genotype was more common in patients with extracranial artery stenosis > or = 50%, compared with patients without stenosis (59/147 versus 73/241, odds ratio 1.54, 95%-CI 1.01-2.37), but was not associated with a history of stroke (30/91 versus 102/297, odds ratio 0.94, 95%-CI 0.57-1.54). The association of the DD genotype with extracranial artery stenosis was also present in hypertensive subjects (n = 206, odds ratio 1.76, 95%-CI 0.99-3.17). In the whole group multiple logistic regression analysis revealed that the association of the DD genotype with extracranial artery stenosis was independent of age, gender, hypertension, hyperlipidemia, and diabetes. In conclusion, the ACE DD genotype is a weak risk factor for hemodynamically relevant stenosis of extracranial arteries, but not for stroke.

Optimizing gaze control in three dimensions

Horizontal and vertical movements of the human eye bring new objects to the center of the visual field, but torsional movements rotate the visual world about its center. Ocular torsion stays near zero during head-fixed gaze shifts, and eye movements to visual targets are thought to be driven by purely horizontal and vertical commands. Here, analysis of eye-head gaze shifts revealed that gaze commands were three-dimensional, with a separate neural control system for torsion. Active torsion optimized gaze control as no two-dimensional system could have, stabilizing the retinal image as quickly as possible when it would otherwise have spun around the fixation point.

Smooth pursuit eye movements and otolith-ocular responses are differently impaired in cerebellar ataxia

Horizontal and vertical smooth pursuit was compared with otolith-ocular responses in 11 patients with cerebellar ataxia and 21 normal subjects using three-dimensional magnetic search coil eye movement recordings. Otolith-ocular responses were investigated during off-vertical axis rotation. This stimulus induces nystagmus consisting of the exponentially decaying canalicular response, and an eye-velocity modulation and offset which arise from the excitation of the otoliths by the gravity vector, which lasts as long as the rotation continues. Otolith-ocular reflexes are intimately interrelated with visual tracking when real targets are viewed during linear motion. The responses of both the translational vestibulo-ocular reflex and the pursuit system have been shown to be linearly dependent on the inverse of the viewing distance, so that a common central pathway for the two systems has been suggested, probably travelling through the cerebellum. Thus, the aim of the study was to evaluate to what extent these reflexes are disturbed in cerebellar disease. The results confirm the earlier notion that in normal subjects pursuit performance is better for horizontal than for vertical tracking, and that it is better for upward than for downward tracking. This pattern is also found in patients. In addition, smooth pursuit performance is clearly degraded in patients, but the modulation of eye-velocity during off-vertical axis rotation is enhanced. Since the amount of this enhancement does not correlate with the amount of pursuit impairment, degradation of smooth pursuit and pathological enhancement of otolith-ocular responses seem to be independent effects of cerebellar degeneration. Thus, the increase in the otolith-ocular response in patients cannot be attributed to adaptational mechanisms trying to overcome the smooth pursuit deficiency; it is more likely to represent pathological disinhibition of otolith derived responses. The absence of compensatory eye-velocity offset during off-vertical axis rotation may reflect the fact that in patients the otolith signals are not utilized in computations thought to be important for spatial orientation mechanisms arising from the interaction of vestibular, visual and somatosensory signals.

Three-dimensional eye movement analysis during caloric stimulation used to test vertical semicircular canal function

HYPOTHESIS AND BACKGROUND

Quantitative caloric testing is considered to be one of the most sensitive parameters in the diagnosis of peripheral vestibular disorders. In the past, because of limitations in the methods, the evaluation of the caloric response was restricted to mainly lateral semicircular canal functions. In this study, the authors tried to extend caloric testing to the function of all semicircular canals by using three-dimensional (3-D) analysis techniques.

METHODS

The authors studied in seven normal subjects 3-D eye movement responses to air caloric of the right ear with the subjects positioned in standard caloric position (lateral semicircular canal vertical) or such that one of the three semicircular canals of the right side was horizontal. Movement of the left eye was measured in 3-D with a dual-magnetic search coil. During stimulation, 10 seconds of maximum response were selected and desaccaded to yield the slow-phase velocity profile. From this profile, the average magnitude and direction of the eye rotation axis (velocity vector) were calculated in head coordinates.

RESULTS

In all subjects, in standard caloric position, warm caloric produced eye velocity vectors that clustered closely along the direction expected from an excitation of the right lateral semicircular canal. When the subjects were positioned with one of the vertical semicircular canals horizontal, the orientation of the velocity vectors shifted toward a direction expected from the combined excitation of the lateral and the other vertical semicircular canal and vice versa.

CONCLUSIONS

The 3-D eye movement recordings during caloric stimulation in different head positions allow the evaluation of the function of all semicircular canals.

Dissociation between the perception of body verticality and the visual vertical in acute peripheral vestibular disorder in humans

Estimates of the subjective visual and postural vertical were obtained from five patients with acute peripheral vestibular lesions and 20 normal subjects. The visual vertical was assessed by asking the subjects to align a target line to earth vertical by means of remote control. Postural vertical judgments were obtained by exposing them to rotational displacements in the roll plane while sitting on a motor-driven chair and requiring them to align their body to vertical using a joystick control. While the patients showed strong deviations of the visual vertical towards the lesion side, their postural vertical judgments remained veridical. We conclude that the above perceptions are not processed identically and that the participating sensory systems are differently weighted during these tasks.

Saccade velocity in idiopathic and autosomal dominant cerebellar ataxia

Slow saccades are often found in degenerative ataxia. Experimental studies have shown that horizontal saccades are generated in the paramedian pontine reticular formation and that lesions in this area produce slow saccades. Based on these findings, saccade slowing should be a frequent feature of olivopontocerebellar atrophy, a type of cerebellar degeneration with prominent involvement of the pons. To test this hypothesis, saccade velocity was measured in 31 patients with autosomal dominant cerebellar ataxia (ADCA) and 17 patients with idiopathic cerebellar ataxia (IDCA). Saccade velocity was reduced in most patients with ADCA whereas it was normal in IDCA although olivopontocerebellar atrophy occurred in both groups. Saccade velocities correlated with pontine size in ADCA but not in IDCA. The data disprove the hypothesis that saccadic slowing is a clinical hallmark of olivopontocerebellar atrophy. Instead, only patients with ADCA and morphological features of olivopontocerebellar atrophy have slow saccades.

Three-dimensional analysis of spontaneous nystagmus in peripheral vestibular lesions

The direction of spontaneous nystagmus was recorded in three dimensions with scleral dual search coils in three patients after vestibular neurectomy and in seven patients with vestibular neuritis. The rotation vectors of the spontaneous nystagmus clustered along the sensitivity vector of the lateral semicircular canal (SCC). The direction of the spontaneous nystagmus after resection of the whole eighth nerve was not different from that after resection of only the superior branch of the vestibular nerve. Deviations from this direction were observed only after resection of the inferior vestibular nerve and in one patient with vestibular neuritis. The absence of nystagmus components in direction of the vertical SCC reflects an anisotropy of oculomotor efferents of the vestibulo-ocular reflex are rather than a lesion limited to the lateral SCC afferents. Therefore, the three-dimensional analysis of spontaneous nystagmus does not permit accurate localization of a peripheral vestibular lesion.