100 Years since Robert Barany's visit to the Zaragoza medical faculty

In December 1923, a twelve-day course took place at the University of Zaragoza, specifically at the Faculty of Medicine, given by Professor Róbert Bárány, who was awarded the Nobel Prize for Medicine in 1914 for his discoveries on the vestibular apparatus. Professor Robert Bárány came to the faculty at the invitation of Professor Victor Fairén through the University Exchange programme. This course consisted of four lectures and twelve lessons a day in which he presented his knowledge of the physiopathology of the vestibule and cerebellum, as well as practical demonstrations of the physical examination of nystagmus and cerebellar pathology. Lorente de Nó, a doctorate student of medicine, was one of the most outstanding students on the course. His intellect was already outstanding in those years, which helped him to discuss the physiopathology of nystagmus with Professor Bárány. The relationship he forged with the Nobel laureate in Zaragoza would be decisive for his future as a researcher. The aim of this work is to compile and integrate the available information on the course that Professor Bárány took in the city of Zaragoza, consulting official documents from the university and the city, articles, books and the press of the time.

Performance in Kahoot! activities as predictive of exam performance

BACKGROUND

Game-based learning (GBL) is effective for increasing participation, creativity, and student motivation. However, the discriminative value of GBL for knowledge acquisition has not yet been proven. The aim of this study is to assess the value of Kahoot! as a discriminative tool for formative assessment in medical education in two different subjects.

METHODS

A prospective experimental study was conducted on a sample of 173 students enrolled in neuroanatomy (2021-2022). One hundred twenty-five students individually completed the Kahoot! prior to the final exam. In addition, students enrolled in human histology during two academic courses were included in the study. The control group course (2018-2019) received a traditional teaching methodology (N = 211), while Kahoot! was implemented during 2020-2021 (N = 200). All students completed similar final exams for neuroanatomy and human histology based on theory tests and image exams.

RESULTS

The correlation between the Kahoot score and the final grade was analyzed for all students enrolled in neuroanatomy who completed both exercises. The correlation between the Kahoot exercise and the theory test, image exam and final grade was significantly positive in all cases (r = 0.334 p < 0.001, r = 0.278 p = 0.002 and r = 0.355 p < 0.001, respectively). Moreover, students who completed the Kahoot! exercise obtained significantly higher grades in all parts of the exam. Regarding human histology, the theory tests, image exams and final grades were significantly higher when using Kahoot! versus the "traditional" methodology (p < 0.001, p < 0.001 and p = 0.014, respectively).

CONCLUSIONS

Our study demonstrates for the first time that Kahoot! can be used to improve and predict the final grade in medical education subjects.

1177 Cost Effectiveness Of Diagnostic Approaches To Sleep Apnea Evaluation During Inpatient Rehabilitation For Moderate To Severe TBI

Introduction

Recent work has highlighted prevalent obstructive sleep apnea (OSA) after traumatic brain injury (TBI) when patients are vulnerable to disruption of neural repair. The recently completed clinical trial comparing screening and diagnostic tools for OSA during inpatient rehabilitation provided the opportunity to conduct economic modeling of phased approaches using actual trial findings to address one perspective (the payor) on the value of phased testing.

Methods

A cost-effectiveness analysis of four phased approaches to OSA diagnosis including initial utilization of portable sleep monitoring [HSAT] regardless of pre-test probability, determination of pre-test probability using two prediction models [STOPBANG, MAPI], and initial assessment using Level 1 polysomnography was conducted. The analyses were modeled assuming all participants were considered high risk thus a negative screen or portable diagnostic test would result in a participant being referred for Level 1 polysomnography. The cost aversion used in analyses were derived from a recent white paper on the economic modeling of untreated OSA. Trial data from 214 participants were used in analyses (mean age 44 [SD 18], 82% male, 75% white, with primarily motor-vehicle related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8 (SD 5).

Results

At AHI ≥15 (33.6%), the prediction models (STOPBANG [-$5,291], MAPI [-$5,262]) resulted in greater cost savings and effectiveness relative to the HSAT approach (-$5,210) and initial use of Level 1 PSG (-$5,011). Sensitivity analyses at AHI ≥5 (70.1%) revealed the initial use of HSAT (-$6,322.85) relative to the prediction models (MAPI [-$6,249.71], STOPBANG [-$6,237) and initial assessment with Level 1 PSG (-$5,977) resulted in greater savings and cost effectiveness.

Conclusion

The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-effective approach varying by incidence of OSA.

Support

PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).

0606 Comparative Effectiveness of Sleep Apnea Screening Tools During Inpatient Rehabilitation for Moderate to Severe TBI

Introduction

Recent studies highlight prevalent obstructive sleep apnea after moderate to severe TBI during a time of critical neural repair. The purpose of this study is to determine the diagnostic sensitivity, specificity and comparative effectiveness of traditional sleep apnea screening tools in TBI neurorehabilitation admissions.

Methods

This is a prospective diagnostic comparative effectiveness trial of sleep apnea screening tools (STOPBANG, Berlin, MAPI [Multi-Apnea Prediction Index]) relative Level 1 polysomnography at six TBI Model System Inpatient Rehabilitation Centers. Between 05/2017 and 02/2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. The primary outcome was the Area Under the Curve (AUC) of screening tools relative to total apnea hypopnea index ≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (IQR 29-47).

Results

Participants were primarily young to middle age (AGE IQR 28,40,59), male (81%), white (74%), and had primarily severe TBI (IQR GCS 3,6,14). A subset (26%) had a history of military service. Results revealed that the Berlin high risk score (ROC-AUC=0.63) was inferior to the MAPI (ROC-AUC = 0.7802) (p=.0211, CI: 0.0181, 0.2233) and STOPBANG (ROCAUC = 0.7852) (p=.0006, CI: 0.0629, 0.2302); both of which had comparable AUC (p=.7245, CI: -0.0472, 0.0678). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI&gt;5. The pattern was similar across TBI severity subgroups except for delirium or post-traumatic amnesia status wherein the MAPI outperformed the Berlin and STOPBANG. Youden’s Index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples.

Conclusion

This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for moderate to severe TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.

Support

PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).

Measurements of cesium in Arctic beluga and caribou before and after the Fukushima accident of 2011

Concern from northern communities following the Fukushima Daiichi nuclear accident of March 2011 has prompted a reassessment of the safety of their traditional foods with respect to radioactivity levels. To this end, a study was conducted to measure the levels of radionuclides in Arctic caribou (Rangifer tarandus) and beluga (Delphinapterus leucas). The main radionuclide of concern is cesium-137, which is easily transferred through the lichen-caribou food chain. Previous studies have been conducted on the cesium-137 levels in Canadian caribou herds from 1958 to 2000, allowing researchers to determine the amount of cesium-137 in caribou specifically attributable to atmospheric weapons testing and the Chernobyl nuclear accident in 1986. In this study, samples of lichens, mushrooms, caribou, beluga and beluga prey collected before and after the Fukushima accident were analyzed for radioactivity levels. Samples were processed and measured using gamma ray spectroscopy to identify the radionuclides present and determine the radioactivity concentration. Both calibration standards and Monte Carlo simulations were used to determine the efficiency of the detectors for the samples, taking into account differences in individual sample sizes as well as matrices. In particular, a careful analysis of the atomic composition of lichens and mushrooms was performed to ensure the efficiencies for these sample types were correct. A comparison of the concentrations from before and after the accident indicated that there was no increase in radioactivity as a result of the atmospheric plume from the Fukushima accident. Some cesium-137, likely attributable to fallout from atmospheric weapons testing of the 1950s and 1960s (since there was no cesium-134 measured in the samples), was measured in the post Fukushima caribou and beluga whale samples; however, this amount was determined to be insignificant for any radiological concern (9.1 ± 1.8 and 0.63 ± 0.23 Bq kg^-1 ww respectively). The activity concentrations of cesium-137 was about 200 times smaller than that of natural radioactive potassium in the beluga samples. Both the caribou and beluga results showed that these foods continue to be a healthy food choice for northern Canadians with respect to radioactivity, and this result has been communicated to the nearby northern communities and stakeholders.

Cryopreservation of specialized chicken lines using cultured primordial germ cells

Biosecurity and sustainability in poultry production requires reliable germplasm conservation. Germplasm conservation in poultry is more challenging in comparison to other livestock species. Embryo cryopreservation is not feasible for egg-laying animals, and chicken semen conservation has variable success for different chicken breeds. A potential solution is the cryopreservation of the committed diploid stem cell precursors to the gametes, the primordial germ cells ( PGCS: ). Primordial germ cells are the lineage-restricted cells found at early embryonic stages in birds and form the sperm and eggs. We demonstrate here, using flocks of partially inbred, lower-fertility, major histocompatibility complex- ( MHC-: ) restricted lines of chicken, that we can easily derive and cryopreserve a sufficient number of independent lines of male and female PGCs that would be sufficient to reconstitute a poultry breed. We demonstrate that germ-line transmission can be attained from these PGCs using a commercial layer line of chickens as a surrogate host. This research is a major step in developing and demonstrating that cryopreserved PGCs could be used for the biobanking of specialized flocks of birds used in research settings. The prospective application of this technology to poultry production will further increase sustainability to meet current and future production needs.

Seeding an arbitrary convention in capuchin monkeys: the effect of social context

The study of social learning in non-human animals has advanced beyond attempts to determine which animals are capable of learning socially to investigations of the factors that influence transmission. Capuchin monkeys (Sapajus sp.) are adept social learners of various behaviours including extractive foraging techniques and social customs. Here, we conducted an open diffusion experiment to determine whether capuchins would learn an arbitrary convention from a knowledgeable demonstrator. In addition, we investigated whether rank, sex and social context affected acquisition and expression of the behaviour. Participation in the experiment was strongly influenced by dominance rank in the group setting. However, when tested individually, the majority of individuals participated and faithfully copied the convention that was seeded into their group. Our findings demonstrate that capuchins can acquire an arbitrary convention via social learning, but that social context must be carefully considered in studies of social learning.

Anatomical and genetic study of an ancient animal tooth showing brachyodont and hypsodont mixed taxonomical characteristics

A non-human dental piece was found in a Roman Empire tomb dated the 3rd century A.C. in Zaragoza (Spain). The morphology of this piece showed mixed brachyodont (carnivores) and hypsodont (herbivores) characteristics. As a result, the taxonomical assignation of the piece was impossible. Therefore, a protocol based on the DNA sequence of the cytochrome c oxidase subunit 1 mitochondrial region (COI) was applied. For this purpose, a pair of primers able to amplify this region in a large variety of animals was designed. The results point to a species of the Genus Bos (Family Bovidae). This assignation was later confirmed by these quencing of a short fragment of the mitochondrial D-loop region. A complete morphological description of the tooth is presented together with the DNA sequence study and comparison protocol.

Effects of the relationship between ⁶⁵Zn and blood cells. A dynamic and morphological study

We have studied the dynamic pathway of ⁶⁵Zn and its autoradiographic location in blood cells, even at the ultra-structural level. We have found evidence that tends to confirm the old biochemical postulates about the capacity of this isotope to displace iron in the haemoglobin molecule. Recently, the bibliography has demonstrated that ⁵⁷Co is also able to perform this displacement, but unlike ⁶⁵Zn it does not invalidate the Redox function of the molecule. In the case of ⁶⁵Zn, the mentioned displacement invalidates this function because the radionuclide can only use valence 2. We have also contributed evidence of erythrocytes destruction by the spleen after the incorporation of ⁶⁵Zn, as well as the clearly marked degradation of haematic pigments inside the spleen.

Canadian population risk of radon induced lung cancer: a re-assessment based on the recent cross-Canada radon survey

Exposure to indoor radon has been determined to be the second leading cause of lung cancer after tobacco smoking. Canadian population risk of radon induced lung cancer was assessed in 2005 with the radon distribution characteristics determined from a radon survey carried out in the late 1970s in 19 cities. In that survey, a grab sampling method was used to measure radon levels. The observed radon concentration in 14,000 Canadian homes surveyed followed a log-normal distribution with a geometric mean (GM) of 11.2 Bq m(-3) and a geometric standard deviation (GSD) of 3.9. Based on the information from that survey, it was estimated that ∼10 % of lung cancers in Canada resulted from indoor radon exposure. To gain a better understanding of radon concentrations in homes across the country, a national residential radon survey was launched in April 2009. In the recent survey, long-term (3 month or longer) indoor radon measurements were made in roughly 14 000 homes in 121 health regions across Canada. The observed radon concentrations follow, as expected, a log-normal distribution with a GM of 41.9 Bq m(-3) and a GSD of 2.8. Based on the more accurate radon distribution characteristics obtained from the recent cross-Canada radon survey, a re-assessment of Canadian population risk for radon induced lung cancer was undertaken. The theoretical estimates show that 16 % of lung cancer deaths among Canadians are attributable to indoor radon exposure. These results strongly suggest the ongoing need for the Canadian National Radon Program. In particular, there is a need for a focus on education and awareness by all levels of government, and in partnership with key stakeholders, to encourage Canadians to take action to reduce the risk from indoor radon exposure.

Pharmacologic treatment of cognitive and behavioral sequelae of traumatic brain injury: practicing in the absence of strong evidence

Cognitive and behavioral sequelae of traumatic brain injury (TBI) interfere with the rehabilitation process and are among the most important sources of long-term disability. Many psychoactive drugs that have been studied in other patient populations are widely used to treat these deficits, but rigorous evidence of their efficacy in TBI is lacking. Use of psychoactive medications in the early post-injury period may appear to be clinically effective, because of the confounding effects of natural recovery. Even single subject assessment methods have limited ability to disentangle drug effects from natural recovery in this period because of the rapid pace and variability of recovery, requiring the application of more traditional parallel group controlled designs. However, the prevalent use of unproven psychoactive drugs in clinical practice can promote a culture of intervention that makes enrollment in controlled studies more challenging. For these reasons, we argue that the early use of unproven psychoactive medications after TBI should be limited, that placebo controlled group studies should be encouraged, and that single subject methods can be most productively used in later periods when natural recovery has slowed.

Fluorescent ligand binding reveals heterogeneous distribution of adrenoceptors and 'cannabinoid-like' receptors in small arteries

BACKGROUND AND PURPOSE

Pharmacological analysis of synergism or functional antagonism between different receptors commonly assumes that interacting receptors are located in the same cells. We have now investigated the distribution of alpha-adrenoceptors, beta-adrenoceptors and cannabinoid-like (GPR55) receptors in the mouse arteries.

EXPERIMENTAL APPROACH

Fluorescence intensity from vascular tissue incubated with fluorescent ligands (alpha(1)-adrenoceptor ligand, BODIPY-FL-prazosin, QAPB; beta-adrenoceptor ligand, TMR-CGP12177; fluorescent angiotensin II; a novel diarylpyrazole cannabinoid ligand (Tocrifluor 1117, T1117) was measured with confocal microscopy. Small mesenteric and tail arteries of wild-type and alpha(1B/D)-adrenoceptor-KO mice were used.

KEY RESULTS

T1117, a fluorescent form of the cannabinoid CB(1) receptor antagonist AM251, was a ligand for GPR55, with low affinity for CB(1) receptors. In mesenteric arterial smooth muscle cells, alpha(1A)-adrenoceptors were predominantly located in different cells from those with beta-adrenoceptors, angiotensin receptors or cannabinoid-like (GPR55) receptors. Cells with beta-adrenoceptors predominated at arterial branches. Endothelial cells expressed beta-adrenoceptors, alpha-adrenoceptors and cannabinoid-like receptors. Only endothelial alpha-adrenoceptors appeared in clusters. Adventitia was a rich source of G protein-coupled receptors (GPCRs), particularly fibroblasts and nerve tracts, where Schwann cells bound alpha-adrenoceptor, beta-adrenoceptor and CB-receptor ligands, with a mix of separate receptor locations and co-localization.

CONCLUSIONS AND IMPLICATIONS

Within each cell type, each GPCR had a distinctive heterogeneous distribution with limited co-localization, providing a guide to the possibilities for functional synergism, and suggesting a new paradigm for synergism in which interactions may be either between cells or involve converging intracellular signalling processes.

Neuropsychological outcome and community re-integration following traumatic brain injury: The impact of frontal and non-frontal lesions

PRIMARY OBJECTIVE

To examine the relationship between cortical lesion location and brain injury outcome. It was hypothesized that focal frontal lesions after traumatic brain injury (TBI) would result in decreased executive and memory functioning and poor community participation outcome.

RESEARCH DESIGN

Three quasi-experimental, prospective studies employed a total of 643 patients with focal frontal, fronto-temporal, non-frontal or no lesions in CT scans.

METHODS AND PROCEDURES

CT scan analysis, neuropsychological assessment, the Neurobehavioural Functioning Inventory (NFI), the Community Integration Questionnaire (CIQ).

MAIN RESULTS

In study 1, frontal and fronto-temporal groups performed worse in executive functioning and better in constructional ability. Study 2 found no differences in neuropsychological and community re-integration measures at 1-year follow-up. Study 3 found comparable neuropsychological test score improvement across groups over 1 year.

CONCLUSIONS

Results are consistent with previous findings and document the potential for test score improvement with rehabilitation and suggest that lesion location needs to be considered when individual rehabilitation plans are being implemented in the post-acute stage of TBI.

Anatomo-radiological study of the Superior Semicircular Canal Dehiscence Radiological considerations of Superior and Posterior Semicircular Canals

INTRODUCTION

The main purpose of this study is to determine the radiological incidence of Superior (SSCD) and Posterior Semicircular Canal Dehiscence (PSCD) and to compare radiologic SSCD to the incidence of this condition on cadaver specimen. We have also analysed the relation between the ossification state of the semicircular canals and the degree of mastoid pneumatization and integrity of Tegmen Tympani.

MATERIAL AND METHODS

Temporal bones have been investigated by means of CT scan on patients and direct observation on cadaver specimen, respectively.

RESULTS

604 ears and 160 cadaver temporal bones have been investigated by means of CT scan and direct observation, respectively. 3.6% and 0.3% of the studied ears had SSCD and PSCD, respectively, on CT scan. Only 0.6% of the cadaver specimen ears did have anatomical SSCD. Degree of pneumatization of the mastoid bone is related to the mean thickness of bone overlying the Superior and Posterior Semicircular Canal. Radiological absence of Tegmen Tympani is more frequent in ears that also have radiologic SSCD.

CONCLUSION

CT scanning gives higher incidence figures of SSCD than anatomical studies, 3.6% vs. 0.6%. We also found a 0.6% incidence of radiological PSCD in the studied ears. There is a direct relation between the degree of ossification of Superior and Posterior Semicircular Canal and certain temporal bone anatomic features: temporal bone pneumatization and absence/presence of Tegmen Tympani or Antri.

Predictors of short-term outcome in brain-injured patients with disorders of consciousness

OBJECTIVES

To investigate predictors of recovery from the vegetative state (VS) and minimally conscious state (MCS) after brain injury as measured by the widely used Disability Rating Scale (DRS) and to explore differences in rate of recovery and predictors of recovery during inpatient rehabilitation in patients with non-traumatic (NTBI) and traumatic brain injury (TBI).

DESIGN

Longitudinal observational cohort design and retrospective comparison study, in which an initial DRS score was collected at the time of study enrollment. Weekly DRS scores were recorded until discharge from the rehabilitation center for both NTBI and TBI patients.

SETTING

Seven acute inpatient rehabilitation facilities in the United States and Europe with specialized programs for VS and MCS patients (the Consciousness Consortium).

PARTICIPANTS

One hundred sixty-nine patients with a non-traumatic (N=50) and a traumatic (N=119) brain injury who were in the VS or MCS states.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

DRS score at 13 weeks after injury; change in DRS score over 6 weeks post-admission; and time until commands were first followed (for patients who did not show command-following at or within 2 weeks of admission).

RESULTS

Both time between injury and enrollment and DRS score at enrollment were significant predictors of DRS score at week 13 post-injury but the main effect of etiology only approached significance. Etiology was however a significant predictor of the amount of recovery observed over the 6 weeks following enrollment. Time between injury and enrollment was also a good predictor of this outcome, but not DRS score at enrollment. For the time until commands were first followed, patients with better DRS scores at enrollment, and those with faster early rates of change recovered command following sooner than those with worse DRS scores or slower initial rates of change. The etiology was not a significant predictor for this last outcome. None of these predictive models explained sufficient variance to allow their use in individual clinical decision making.

CONCLUSIONS

Time post-injury and DRS score at enrollment are predictors of early recovery among patients with disorders of consciousness, depending on the outcome measure chosen. Etiology was also a significant predictor in some analyses, with traumatically injured patients recovering more than those with non-traumatic injuries. However, the hypothesized interaction between etiology and time post-injury did not reach significance in any of the analyses suggesting that, within the time frame studied, the decline in prognosis with the passage of time was similar in the two groups.

289 COOPERATIVE EXPRESSION OF PLURIPOTENCY-RELATED GENES AND NEURAL CREST MARKER GENES IN PORCINE GFP-TRANSGENIC SKIN-DERIVED PROGENITORS

Recently neural crest derived multipotent progenitors from skin have attracted much attention as the skin may provide an accessible, autologous source of stem cells available with therapeutic potential (Toma JG et al. 2001 Nat. Cell Biol. 3, 778–784). The multipotent property of stem cells could be tracked back to the expression of specific marker genes that are exclusively expressed in multipotent stem cells rather than any other types of differentiated cells. Here we demonstrate the property of multipotency and neural crest origin of porcine GFP-transgenic skin derived progenitors (termed pSKP) in vitro by marker gene expression analysis. The pSKP cells were isolated from the back skin of GFP transgenic fetuses by serum-free selection culture in the presence of EGF (20 ng mL–1) and bFGF (40 ng mL–1), and developed into spheres in 1–2 weeks (Dyce PW et al. 2004 Biochem. Biophy. Res. Commun. 316, 651–658). Three groups of RT-PCR primers were used on total RNA from purified pSKP cells: pluripotency related genes (Oct4, Sox2, Nanog, Stat3), neural crest marker genes (p75NGFR, Slug, Twist, Pax3, Sox9, Sox10) and lineage specific genes (GFAP, tubulin β-III, leptin). Expression of both pluripotency related genes and neural crest marker genes were detected in undifferentiated pSKP cells. In addition, transcripts for fibronectin, vimentin and nestin (neural stem cell marker) were also present. The percentage of positive cells for Oct4, fibronection and vimentin were 12.3%, 67.9% and 53.7% respectively. Differentiation assays showed the appearance of tubulin β-III positive (39.4%) and GFAP-positive (42.6%) cells in cultures by immunocytochemistry, which share the characteristics of neurons and glial cells, respectively. Thus, we confirm the multiple lineage potentials and neural crest origin of pSKP cells in the level of marker gene expression. This work was funded by National Institutes of Health National Center for Research Resources RR013438.

Inclusive K(S);(0)K(S);(0) resonance production in ep collisions at HERA

Inclusive K_{S};{0}K_{S};{0} production in ep collisions at the DESY ep collider HERA was studied with the ZEUS detector using an integrated luminosity of 0.5 fb;{-1}. Enhancements in the mass spectrum were observed and are attributed to the production of f_{2}(1270)/a_{2};{0}(1320), f_{2};{'}(1525) and f_{0}(1710). Masses and widths were obtained using a fit which takes into account theoretical predictions based on SU(3) symmetry arguments, and are consistent with the Particle Data Group values. The f_{0}(1710) state, which has a mass consistent with a glueball candidate, was observed with a statistical significance of 5 standard deviations. However, if this state is the same as that seen in gammagamma-->K_{S};{0}K_{S};{0}, it is unlikely to be a pure glueball state.

Development of the dynamic structure (force lines) of the middle ear ossicles in human foetuses

OBJECTIVES

To study the ontogenic development of the organisation of the human middle ear ossicles structure.

MATERIAL AND METHODS

46 human temporal bones of ages varying from 32 days post-conception to newborns.

RESULTS

The development of the structural organisation of the malleus begins at 16 weeks via two cortical fascicles situated in the neck; at 21 weeks they extend towards the head, at 23 weeks to the lateral process and at 24 weeks to the handle. In the handle, the force lines are transmitted via three cardinal fascicles, two of them via the cortical fascicle and one via the centre, which starts after 29 weeks' development and is consolidated after 31 weeks. In the incus the force lines start at 16 weeks via two cortical fascicles situated in the long process, which progressively extend in a rostro-caudal direction between 17 and 20 weeks. At 21 weeks they occupy the whole extension of the long process and at 22 weeks the fusion of both cortical fascicles begins. From 30 weeks onwards it is strengthened by the crossing of bone trabeculae from one cortical to another. Two fascicles come out of the incus body, surrounding the medullary cavity and going in the direction of the short process. In the beginning, the stapes have two cortical fascicles in their crura. The remodelling process makes the internal cortical fascicle disappear and after 31 weeks all the force lines run through the external cortical fascicle. The tympanic membrane of the stapes footplate undergoes a remodelling process and after 28 weeks bony trabeculae are deposited. In newborns (40 weeks), the ossicles' structure is cavitary and has not been completed. The fan-shaped trabecular fascicle, which starts in the articular facets of the malleus and the incus, still has to develop.

Patterns of spontaneous recovery of neglect and associated disorders in acute right brain-damaged patients

OBJECTIVES

The evolutionary pattern of spontaneous recovery from acute neglect was studied by assessing cognitive deficits and motor impairments. Detailed lesion reconstruction was also performed to correlate the presence of and recovery from neglect to neural substrates.

METHODS

A consecutive series of right brain-damaged (RBD) patients with and without neglect underwent weekly tests in the acute phase of the illness. The battery assessed neglect deficits, neglect-related deficits, and motor impairment. Age-matched normal subjects were also investigated to ascertain the presence of non lateralised attentional deficits. Some neglect patients were also available for later investigation during the chronic phase of their illness.

RESULTS

Partial recovery of neglect deficits was observed at the end of the acute period and during the chronic phase. Spatial attention was impaired in acute neglect patients, while non spatial attentional deficits were present in RBD patients with and without acute neglect. A strong association was found between acute neglect and fronto-parietal lesions. Similar lesions were associated with neglect persistence. In the chronic stage, neglect recovery was paralleled by improved motor control of the contralesional upper limb, thus emphasising that neglect is a negative prognostic factor in motor functional recovery.

CONCLUSIONS

These findings show that spatial attention deficits partially improve during the acute phase of the disease in less than half the patients investigated. There was an improvement in left visuospatial neglect at a later, chronic stage of the disease, but this recovery was not complete.

Hemispatial neglect: Subtypes, neuroanatomy, and disability

OBJECTIVE

To assess the relative frequency of occurrence of motor, perceptual, peripersonal, and personal neglect subtypes, the association of neglect and other related deficits (e.g., deficient nonlateralized attention, anosognosia), and the neuroanatomic substrates of neglect in patients with right hemisphere stroke in rehabilitation settings.

METHODS

The authors assessed 166 rehabilitation inpatients and outpatients with right hemisphere stroke with measures of neglect and neglect subtypes, attention, motor and sensory function, functional disability, and family burden. Detailed lesion analyses were also performed.

RESULTS

Neglect was present in 48% of right hemisphere stroke patients. Patients with neglect had more motor impairment, sensory dysfunction, visual extinction, basic (nonlateralized) attention deficit, and anosognosia than did patients without neglect. Personal neglect occurred in 1% and peripersonal neglect in 27%, motor neglect in 17%, and perceptual neglect in 21%. Neglect severity predicted scores on the Functional Independence Measure and Family Burden Questionnaire more accurately than did number of lesioned regions.

CONCLUSIONS

The neglect syndrome per se, rather than overall stroke severity, predicts poor outcome in right hemisphere stroke. Dissociations between tasks assessing neglect subtypes support the existence of these subtypes. Finally, neglect results from lesions at various loci within a distributed system mediating several aspects of attention and spatiomotor performance.

Morphometric study of testis of Wistar rat after open-ended vasectomy

The effects on the testis of open-ended vasectomy in the Wistar rat have been assessed morphometrically and evaluated statistically at 1, 4, 12, and 24 weeks after operation, and compared to those in sham-operated controls. The open-ended technique, ie, without ligation of the epididymal end of the cut ductus deferens, allowed drainage of sperm into the spermatic cord. During the period of our study, it did not affect the structure of the testis; although the germinal epithelium, basement membrane, and the stroma and cells of the interstitial space all showed variations when compared to the control group, these were not statistically significant.

The minimally conscious state: definition and diagnostic criteria

OBJECTIVE

To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS).

BACKGROUND

There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish patients in MCS from those in coma and VS because preliminary findings suggest that there are meaningful differences in outcome.

METHODS

An evidence-based literature review of disorders of consciousness was completed to define MCS, develop diagnostic criteria for entry into MCS, and identify markers for emergence to higher levels of cognitive function.

RESULTS

There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS. Therefore, a consensus-based case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation.

CONCLUSIONS

MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to MCS from coma or VS after acute brain injury. MCS may also result from degenerative or congenital nervous system disorders. This condition is often transient but may also exist as a permanent outcome. Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.

Prediction of functional outcomes after traumatic brain injury: a comparison of 2 measures of duration of unconsciousness

OBJECTIVE

To compare the usefulness of time until motor localization occurs versus time until commands are followed in predicting outcome after traumatic brain injury (TBI).

DESIGN

A retrospective analysis of data from a prospective cohort study of subjects with severe TBI.

SETTING

Seventeen Traumatic Brain Injury Model System programs.

PARTICIPANTS

A total of 496 subjects, recruited through the TBI Model System programs, with loss of consciousness greater than 1 day, with no late neurosurgical complications, and complete data for all measures.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Time until Glasgow Coma Scale (GCS) motor score of 5 (time to motor localization) and time until GCS motor score of 6 (time until commands were followed) were abstracted from medical records. Functional outcomes were assessed at inpatient rehabilitation admission and discharge, along with acute and rehabilitation lengths of stay and charges.

RESULTS

Time until commands were followed was a better predictor of all of the outcomes assessed than time until motor localization occurred. In multiple regression models, time until motor localization did not add significantly to the prediction provided by time until commands were followed. The predictive power of time to command following was superior even in the subgroup with poor language comprehension as measured by the Token Test.

CONCLUSION

Despite the theoretical appeal of time to motor localization (eg, in persons with language comprehension problems), time to command following appears to be a more powerful predictor of outcome after severe brain injury.

[Structural peculiarities of the human cerebral communicating arteries and their repercussion in encephalic vascular pathology]

INTRODUCTION

The cerebrovascular accidents are one of the most frequent causes of morbimortality. Most of them are caused for the break of aneurysms in communicating arteries. The weak structure of these vessels explain the reason of these accidents.

OBJECTIVE

The reason of this paper is study the organization of communicating arteries as cause of this fragility. Material and methods. The material of this study is composed of 61 human cerebral communicating arteries, grouped in decades. The study has been carried out by histological routine.

RESULTS

In general the structure of cerebral communicating arteries is characterized for the thinness and irregularity of the wall. In the childhood the internal elastic membrane and tunica media show thicker, while in young and adult people appear elastic fibers and reticulin as well as smooth muscle cells in tunica media. In adulthood (50 60 years) collagen in adventicia occupies tunica media, and adventicia is weaked. There are frequent media defects in these communicating arteries, that are usually repaired for conjunctive tissue stopper with abundance of collagen fibers. Starting from 4th decade the internal elastic membrane shows a great number of fenestrae through muscle and fiber tissue of media occupying subintimal space. Doubtless media defects mean the most severe threat of vascular outbreak.

CONCLUSION

The structural evolution with the age of communicating arteries, with predominance of collagen over elastin and reticulin, could be their reason of fragility.

Long-term causes of death after traumatic brain injury

OBJECTIVE

To determine which causes of death are more frequent in persons with traumatic brain injury (TBI), and by how much, compared with the general population. Our focus was the period beginning 1 yr after injury.

DESIGN

Subjects were 2320 Californians with long-term mental disability after a TBI at age 10 yr or more, followed up between 1988 and 1997. The units of study were person-years, each linked to the subject's age, gender, level of ambulation, time since injury, and cause of death (if any) for the specific year. Observed numbers of cause-specific deaths were compared with numbers expected according to general population mortality rates.

RESULTS

Mortality was higher between 1.0 and 5.0 yr postinjury than after 5.0 yr and was strongly related to reduced mobility. Death rates were elevated for circulatory diseases, respiratory diseases, choking/suffocation, and seizures, with seizure deaths being relatively frequent, even among the most ambulatory.

CONCLUSIONS

Death rates for several causes are elevated in persons with long-term sequelae of TBI. The increased risk of choking/suffocation should be of interest to caregivers. Life expectancy seems to be reduced, even for patients who are fully ambulatory.

Contribution to the development of the stapedius muscle structure in human fetuses

The purpose of this report is to contribute to the knowledge of the morphogenesis of the human stapedius muscle. We have studied the stapedius structure development in 17 temporal bones from human fetuses. Chronological ages were from 48 days (21 mm) to 29 weeks (270 mm). Samples were fixed in 10% formol, decalcified with 2% nitric acid, embedded in Paraplast, sectioned in sequence of 7 microns and were stained with haematoxylin & eosin and Martins' trichrome. Four maturation stages were observed in the development of the stapedius muscle structure. First, the formation of the 'primordium muscularis' in the mesenchyme of the tympanic cavity (promyoblasts) was observed in a 36-mm embryo. Second, its differentiation into myoblasts, and its next cellular fusion to form muscle tubes, was seen in a 99-mm foetus. In the third stage, myofibrogenesis phenomena were developed, to synthesize, the myotube myoblasts, myofilaments, phenomena we observed that took place during the 14th to 17th weeks of development. The last stage was characterized by the presence of striated muscle fibres, at first intermingled with myotubes (18th to 26th weeks), until in the 29th week fetuses (270 mm) the skeletal muscle fibre was completely differentiated. We conclude that in the 29th week of development (270 mm) the stapedius muscle structure is completely differentiated, although the functional development is not complete until birth.

The sexual behaviors of African American women living with HIV disease: is perceived HIV status altering sexual behavior?

The purpose of the study was to compare the sexual risk behaviors of heterosexual African American women living with HIV disease to women who perceive themselves to be HIV negative using a comparative descriptive design. Data were collected using a demographics questionnaire developed by the investigator and the Safe Sex Behavior Questionnaire (SSBQ). The HIV-positive sample was collected in two public service agencies that provide case management for HIV-positive individuals. The HIV-negative sample was collected in the surrounding community, populated primarily by low-income African Americans. The HIV-positive group demonstrated lower levels of income and education. Scores on the SSBQ indicated no statistical difference between the high-risk sexual behaviors of the HIV-positive and HIV-negative groups. No statistically significant difference was found in the reported past sexual experiences of the two groups, although mean SSBQ scores were higher in the HIV-positive group. The levels of sexual behaviors in both groups were consistent with the high-risk sexual behaviors of HIV-negative persons reported in the literature. This illustrates the need for nursing as a profession to improve programs directed toward altering the behaviors of those at high risk of contracting or transmitting HIV disease.

MHC class II associations with autoantibody and T cell immune responses to the scleroderma autoantigen topoisomerase I

Topoisomerase I (topo I) is a major autoantigen recognized by autoantibodies in about 30% of sera from patients with systemic sclerosis (SSc). Certain HLA-DRB1 and HLA-DQB1 alleles have been reported to be associated with autoantibody and T-cell responses to topo I suggesting a T-cell dependent process. We have examined the MHC class II allele associations with anti-topo I antibodies in 16 patients with SSc compared to 250 healthy controls. Furthermore, we have studied the T cell responses to a recombinant full-length topo I molecule purified from a baculovirus expression system in eight patients with SSc and eight controls (five healthy and three with autoimmune disease). HLA-DR5 was significantly increased in patients with anti-topo I antibodies (P< 0.02). Proliferative peripheral blood mononuclear cell (PBMC) responses to soluble topo I were present in nine of 16 individuals (four of eight with SSc and five of eight controls), including the three SSc patients with anti-topo I antibodies. Homozygosity for HLA DQB1:30:Y alleles was present in five of nine responders (P< 0.03) compared to none of the non-responders. Our findings support the notion that the MHC class II background influences the ability to generate an autoimmune response to intracellular autoantigens to which the immune system may not have been tolerized. Additional factors associated with the generation of autoantibodies appear to be more intimately associated with the development of SSc.

Changes in strength over time among polio survivors

OBJECTIVE

To study changes in the strength of different muscle groups in polio survivors over a period of approximately 9 months.

DESIGN

Longitudinal study.

SETTING

Moss Rehabilitation Research Institute.

PARTICIPANTS

One hundred twenty subjects (57 men, 63 women) were studied on three occasions, each 3 to 5 months apart. Subjects were recruited through the Einstein-Moss Post-Polio Management Program. newspaper advertisements, and polio support groups.

MAIN OUTCOME MEASURES

Isometric strength of 30 muscle groups (16 in upper extremities, 14 in lower extremities) was measured, using a hand-held dynamometer.

RESULTS

Data were analyzed in two separate groups: upper-extremity muscles and lower-extremity muscles. Results for the upper-extremity muscles revealed evidence of a significant deterioration in strength. The amount of deterioration differed among muscles and increased with age. There was also evidence of deterioration in strength in the flexor muscles in the ankle, hip, and knee. However, the rate of deterioration in these muscles was not strongly related to age, time since polio, gender, symptom status, or history of residual weakness.

CONCLUSIONS

Strength is deteriorating among polio survivors at a rate higher than that associated with normal aging. This deterioration is not occurring in the extensor, or so-called "weight-bearing" muscles, but is occurring in many of the upper-extremity muscle groups and in the flexor muscles in the lower extremities.

The relation between lower extremity strength and shoulder overuse symptoms: a model based on polio survivors

OBJECTIVE

To determine the relation between lower extremity weakness and shoulder overuse symptoms among polio survivors. We predicted that individuals with moderate weakness in their leg extensor muscles would use their arms to help compensate for this weakness and would be at high risk for developing symptoms of shoulder overuse.

DESIGN

A cohort study of polio survivors recruited from the Einstein-Moss Postpolio Management Program (Philadelphia), the community, and the surrounding region.

SETTING

A research laboratory at Moss Rehabilitation Research Institute, Philadelphia, PA.

PARTICIPANTS

One hundred ninety-four polio survivors. Demographic and medical history data, symptom data, and strength data were obtained for each.

MAIN OUTCOME MEASURES

Presence or absence of shoulder symptoms and ratings of pain by visual analogue scale were recorded. Strength was measured using a hand-held dynamometer and manual muscle testing.

RESULTS

Shoulder symptoms could be grouped into two distinct clusters based on the type of testing used for assessment. Symptoms elicited by palpation were present in 26% of the subjects and were strongly related to knee extensor strength and weight. These symptoms were more common among women than men (42% and 10%, respectively). Symptoms elicited by resistance tests were present in 33% of the subjects and were seen with equal frequency in both sexes. These symptoms were also related to lower extremity strength, but the specific relationship was not as clear as for the palpation-related symptoms.

CONCLUSIONS

Lower extremity weakness predisposes individuals to shoulder overuse symptoms. Sex and body weight are contributing factors. These results may be generalized to other populations with lower extremity weakness, including the elderly.

The vasectomized testis

We have performed a qualitative study on effects of vasectomy on the testicular structure. Vasectomy performed with the traditional technique changes testicular structure. At first, the injuries are slight and restricted, but gradually, and in a time-dependent manner, become more severe and extensive. Ultrastructure studies indicate that the spermatogonia and Sertoli's cells are the most resistant to vasectomy, and are even observed in some regenerating testes lacking a complete germinal epithelium. Morphometric studies revealed a decrease in epithelial depth, an increase in the thickness of the basement membrane and in surface of the interstitial space, all significant (P < 0.01) with respect to the control. However, the percentage of the interstitial tissue occupied by cells, did not show any significant difference. We propose that the increase of intraluminal pressure is the essential factor that provokes testicular atrophy.

Frequency and duration of inattentive behavior after traumatic brain injury: effects of distraction, task, and practice

Traumatic brain injury (TBI) is associated with impairments of attention, most typically measured through tests of information processing, or by subjective symptom endorsement by patients, families, and clinicians. We have previously shown increased rates of off-task behavior among patients with TBI versus controls as defined by videotaped records of independent work in distracting environments. In this research, we report on a more detailed method of coding such videotaped records which allows measurement of the precise number of off-task behaviors, their durations, and their relationship to distracting events. Using this method, we studied 20 patients with recent moderate-to-severe TBI and 20 demographically comparable controls as they performed independent work tasks while being subjected to controlled distracting events. This research confirms that patients are markedly less attentive than controls both in the presence of distractions and in their absence, that distractions have an influence on off-task behavior in both groups, and that the disruptive impact of distractors wanes relatively quickly for controls but not for patients. The duration of distraction produced by various classes of distracting events appeared similar for patients and controls, although the power to detect differences in behavioral duration between groups was limited. The pattern of inattentiveness among patients showed minimal relationship to measures of injury severity within this sample.

Elastin variations implicating in vascular smooth muscle cells phenotype in human tortuous arteries

The aim of the present work was to study the morphological implications between the elastin and the phenotypic expression of the vascular smooth muscle cells. For this purpose, sixty human tortuous arteries from different territories have been studied. We have measured the morphometric indexes Intimal Thickening Index and Elastolyse Index and they have been quantified with computer system analysis, image-colour corresponding to the orcein and Verhoëff reactions for detecting elastin and the alpha-actin in the smooth muscle cells. We compared both territorial arteries from the cranial and from abdominal origin. The elastin concentration was similar in both territories, but not its morphology according to its spatial distribution. We have observed a relationship between the elastin structural organisation from the media of arteries and of the internal elastic lamina in these territories and the variation of reactivity to the smooth muscle alpha-actin as a marker of the phenotypic state. Our results confirm the hypothesis that elastin, besides intervening in the architecture of the arterial wall, is a factor implicated in the phenotypic variability of the smooth muscle cells and in the development and evolution of the intimal thickenings in human atherosclerosis.

Phagocytosis of mycobacteria by U937 cells: a rapid method for monitoring uptake and separating phagocytosed and free bacteria by magnetic beads

A human-derived monocytic cell line (U937) was induced to phagocytose Mycobacterium phlei by the addition of phorbol myristate acetate (PMA) to the culture medium for 50-60 h. Cells not treated with PMA were unable to phagocytose M. phlei. Magnetic beads enabled a rapid and highly efficient separation of phagocytosed and free bacteria to be achieved, an approach which is particularly useful if colony plating is used to enumerate bacterial survival within phagocytic cells. Fluorescence-activated cell sorting (FACS) analysis showed that 98% of U937 cells contained viable bacteria after 3 h.

[Experimental vasectomy: comparison of epididymal structure with various surgical techniques]

OBJECTIVE

To analyze the effects of different surgical techniques of vasectomy on the epididymal structure.

METHODS

Experimental vasectomies were performed in dogs using the conventional and open-ended techniques. The animals were orchidectomized 1 to 12 months after vasectomy and the epididymal structure was analyzed.

RESULTS

The epididymal structure of dogs submitted to the conventional technique showed marked ectasia, reinforced basement membrane, loss of stereocilia in the principal cells, and formation of spermatic granulomas in interstitial tissue. At 12 months the principal cells showed signs of degenerative changes. In the different time periods analyzed in the study, no changes were observed in the epididymal structure of dogs submitted to the open-ended technique.

CONCLUSIONS

The changes observed in the principal cells are ascribable to the increased intraluminal pressure produced by ligation of both ends of the vas deferens (conventional technique), since no changes were found in the epididymal structure of dogs submitted to the open-ended technique, at least in the different time periods analyzed in the study.