Neurophysiological signatures of prediction in language: A critical review of anticipatory negativities

Recent event-related potential (ERP) studies in language comprehension converge in finding anticipatory negativities preceding words or word segments that can be pre-activated based on either sentence contexts or phonological cues. We review these findings from different paradigms in the light of evidence from other cognitive domains in which slow negative potentials have long been associated with anticipatory processes and discuss their potential underlying mechanisms. We propose that this family of anticipatory negativities captures common mechanisms associated with the pre-activation of linguistic information both within words and within sentences. Future studies could utilize these anticipatory negativities in combination with other, well-established ERPs, to simultaneously track prediction-related processes emerging at different time intervals (before and after the perception of pre-activated input) and with distinct time courses (shorter-lived and longer-lived cognitive operations).

Swift Prosodic Modulation of Lexical Access: Brain Potentials From Three North Germanic Language Varieties

PURPOSE

According to most models of spoken word recognition, listeners probabilistically activate a set of lexical candidates, which is incrementally updated as the speech signal unfolds. Speech carries segmental (speech sound) as well as suprasegmental (prosodic) information. The role of the latter in spoken word recognition is less clear. We investigated how suprasegments (tone and voice quality) in three North Germanic language varieties affected lexical access by scrutinizing temporally fine-grained neurophysiological effects of lexical uncertainty and information gain.

METHOD

Three event-related potential (ERP) studies were reanalyzed. In all varieties investigated, suprasegments are associated with specific word endings. Swedish has two lexical "word accents" realized as pitch falls with different timings across dialects. In Danish, the distinction is in voice quality. We combined pronunciation lexica and frequency lists to calculate estimates of lexical uncertainty about an unfolding word and information gain upon hearing a suprasegmental cue and the segment upon which it manifests. We used single-trial mixed-effects regression models run every 4 ms.

RESULTS

Only lexical uncertainty showed solid results: a frontal effect at 150-400 ms after suprasegmental cue onset and a later posterior effect after 200 ms. While a model including only segmental information mostly performed better, it was outperformed by the suprasegmental model at 200-330 ms at frontal sites.

CONCLUSIONS

The study points to suprasegmental cues contributing to lexical access over and beyond segments after around 200 ms in the North Germanic varieties investigated. Furthermore, the findings indicate that a previously reported "pre-activation negativity" predominantly reflects forward-looking processing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25016486.

The predictive function of Swedish word accents

Swedish lexical word accents have been repeatedly said to have a low functional load. Even so, the language has kept these tones ever since they emerged probably over a thousand years ago. This article proposes that the primary function of word accents is for listeners to be able to predict upcoming morphological structures and narrow down the lexical competition rather than being lexically distinctive. Psycho- and neurophysiological evidence for the predictive function of word accents is discussed. A novel analysis displays that word accents have a facilitative role in word processing. Specifically, a correlation is revealed between how much incorrect word accents hinder listeners' processing and how much they reduce response times when correct. Finally, a dual-route model of the predictive use of word accents with distinct neural substrates is put forth.

Native language experience shapes pre-attentive foreign tone processing and guides rapid memory trace build-up: An ERP study

Language experience, particularly from our native language (L1), shapes our perception of other languages around us. The present study examined how L1 experience moulds the initial processing of foreign (L2) tone during acquisition. In particular, we investigated whether learners were able to rapidly forge new neural memory traces for novel tonal words, which was tracked by recording learners’ ERP responses during two word acquisition sessions. We manipulated the degree of L1–L2 familiarity by comparing learners with a nontonal L1 (German) and a tonal L1 (Swedish) and by using tones that were similar (fall) or dissimilar (high, low, rise) to those occurring in Swedish. Our results indicate that a rapid, pre‐attentive memory trace build‐up for tone manifests in an early ERP component at ~50 ms but only at particularly high levels of L1–L2 similarity. Specifically, early processing was facilitated for an L2 tone that had a familiar pitch shape (fall) and word‐level function (inflection). This underlines the importance of these L1 properties for the early processing of L2 tone. In comparison, a later anterior negativity related to the processing of the tones’ grammatical content was unaffected by native language experience but was instead influenced by lexicality, pitch prominence, entrenchment, and successful learning. Behaviorally, learning effects emerged for all learners and tone types, regardless of L1–L2 familiarity or pitch prominence. Together, the findings suggest that while L1‐based facilitation effects occur, they mainly affect early processing stages and do not necessarily result in more successful L2 acquisition at behavioral level.

Our findings add important evidence that contributes to answering the open question of how similarity between native and target language influences target language processing and acquisition. We found facilitative effects of similarity only at pre‐attentive levels and only when the degree of similarity was high. Late processing and successful acquisition, on the other hand, were unaffected by the target words’ similarity to native language properties.

Cortical and white matter correlates of language-learning aptitudes

People learn new languages with varying degrees of success but what are the neuroanatomical correlates of the difference in language‐learning aptitude? In this study, we set out to investigate how differences in cortical morphology and white matter microstructure correlate with aptitudes for vocabulary learning, phonetic memory, and grammatical inferencing as measured by the first‐language neutral LLAMA test battery. We used ultra‐high field (7T) magnetic resonance imaging to estimate the cortical thickness and surface area from sub‐millimeter resolved image volumes. Further, diffusion kurtosis imaging was used to map diffusion properties related to the tissue microstructure from known language‐related white matter tracts. We found a correlation between cortical surface area in the left posterior‐inferior precuneus and vocabulary learning aptitude, possibly indicating a greater predisposition for storing word‐figure associations. Moreover, we report negative correlations between scores for phonetic memory and axial kurtosis in left arcuate fasciculus as well as mean kurtosis, axial kurtosis, and radial kurtosis of the left superior longitudinal fasciculus III, which are tracts connecting cortical areas important for phonological working memory.

Cortical thickness and surface area of left anterior temporal areas affects processing of phonological cues to morphosyntax

Lack of methods to experimentally assess the perceptual processing of sound features and allow one to measure differences in phonological proficiency has been a limitation for speech processing studies in native speakers. Tonal features associated with Swedish word-stems, word accents, which cue grammatical suffixes, constitute, however, such sound features that can be exploited to generate measures of reliance on morphosyntactically relevant phonological information during word processing. Specifically, there is a natural variance between native speakers in response time (RT) difference between phonologically valid and invalid word accent-suffix combinations that can be used to quantify perceptual phonological proficiency. This study uses ultra-high field magnetic resonance imaging (MRI) to investigate word accents as phonological cues to morphosyntactic meaning. The study adds to the understanding of the neural basis for both morphosyntactically relevant phonological cues by reporting correlations between differences in listeners' RT for validly and invalidly cued suffixes and cortical thickness in left anterior and middle temporal gyrus, and the left anterior superior temporal sulcus as well as cortical surface area in the left middle and inferior temporal gyri. The cortical areas studied are known constituents of the ventral speech processing stream, necessary for word and phrase recognition.

Cortical thickness of Broca's area and right homologue is related to grammar learning aptitude and pitch discrimination proficiency

Aptitude for and proficiency in acquiring new languages varies in the human population but their neural bases are largely unknown. We investigated the influence of cortical thickness on language learning predictors measured by the LLAMA tests and a pitch-change discrimination test. The LLAMA tests are first language-independent assessments of language learning aptitude for vocabulary, phonetic working memory, sound-symbol correspondence (not used in this study), and grammatical inferencing. Pitch perception proficiency is known to predict aptitude for learning new phonology. Results show a correlation between scores in a grammatical meaning-inferencing aptitude test and cortical thickness of Broca's area (r(30) = 0.65, p = 0.0202) and other frontal areas (r(30) = 0.66, p = 0.0137). Further, a correlation was found between proficiency in discriminating pitch-change direction and cortical thickness of the right Broca homologue (r(30) = 0.57, p = 0.0006). However, no correlations were found for aptitude for vocabulary learning or phonetic working memory. Results contribute to locating cortical regions important for language-learning aptitude.

Rapid syntactic pre-activation in Broca's area: Concurrent electrophysiological and haemodynamic recordings

Listeners are constantly trying to predict what the speaker will say next. We concurrently measured the electrophysiological and haemodynamic correlates of syntactic pre-activation, investigating when and where the brain processes speech melody cues to upcoming word order structure. Pre-activation of syntactic structure was reflected in a left-lateralised pre-activation negativity (PrAN), which was subserved by Broca's area in the left inferior frontal gyrus, as well as the contiguous left anterior insula.

Cortical thickness of planum temporale and pars opercularis in native language tone processing

The present study investigated the relationship between linguistic tone processing and cortical thickness of bilateral planum temporale (PT) and pars opercularis of the inferior frontal gyrus (IFGpo). Swedish tones on word stems function as cues to upcoming endings. Correlating structural brain imaging data with participants' response time patterns for suffixes, we found that thicker cortex in the left PT was associated with greater reliance on tones to anticipate upcoming inflections on real words. On inflected pseudoword stems, however, the cortical thickness of left IFGpo was associated with tone-suffix processing. Thus cortical thickness of the left PT might play a role in processing tones as part of stored representations for familiar speech segments, most likely when inflected forms are accessed as whole words. In the absence of stored representations, listeners might need to rely on morphosyntactic rules specifying tone-suffix associations, potentially facilitated by greater cortical thickness of left IFGpo.

Tone-grammar association within words: Concurrent ERP and fMRI show rapid neural pre-activation and involvement of left inferior frontal gyrus in pseudoword processing

Using a concurrent ERP/fMRI paradigm, we investigated how listeners take advantage of morphologically relevant tonal information at the beginning of words to predict and pre-activate likely word endings. More predictive, low tone word stems gave rise to a 'pre-activation negativity' (PrAN) in the ERPs, a brain potential which has previously been found to increase along with the degree of predictive certainty as regards how a word is going to end. It is suggested that more predictive, low tone stems lead to rapid access to word endings with processing subserved by the left primary auditory cortex as well as the supramarginal gyrus, while high tone stems - which are less predictive - decrease predictive certainty, leading to increased competition between activated word endings, which needs to be resolved by the left inferior frontal gyrus.

Stem Tones Pre-activate Suffixes in the Brain

Results from the present event-related potentials (ERP) study show that tones on Swedish word stems can rapidly pre-activate upcoming suffixes, even when the word stem does not carry any lexical meaning. Results also show that listeners are able to rapidly restore suffixes which are replaced with a cough. Accuracy in restoring suffixes correlated positively with the amplitude of an anterior negative ERP elicited by stem tones. This effect is proposed to reflect suffix pre-activation. Suffixes that were cued by an incorrect tone elicited a left-anterior negativity and a P600, suggesting that the correct processing of the suffix is crucially tied to the activation of the preceding validly associated tone.

Pre-Activation Negativity (PrAN) in Brain Potentials to Unfolding Words

We describe an event-related potential (ERP) effect termed the “pre-activation negativity” (PrAN), which is proposed to index the degree of pre-activation of upcoming word-internal morphemes in speech processing. Using lexical competition measures based on word-initial speech fragments (WIFs), as well as statistical analyses of ERP data from three experiments, it is shown that the PrAN is sensitive to lexical competition and that it reflects the degree of predictive certainty: the negativity is larger when there are fewer upcoming lexical competitors.

Time-Driven Effects on Processing Relative Clauses

The present response time study investigated how a hypothesized time-based working memory constraint of 2-3 s affects the resolution of grammatical and semantic dependencies. Congruent and incongruent object relative (OR) and subject relative sentences were read at different presentation rates so that the distance between dependent words was either shorter or longer than 2-3 s. Incongruent OR sentences showed an effect of presentation rate. Experiment 1 focused on grammatical dependencies. Processing of adjectives with agreement features mismatching those of the preceding dependent word showed rapid agreement resolution at a time-interval below 2 s. Dependency intervals over 3 s reflected a different, more time-consuming process possibly due to extended search in sentence semantic representations as the grammatical form of the first word in the dependency fades away. In experiment 2, focusing on semantic dependencies, incongruent OR sentences displayed a different pattern: a gradual increase in processing time as a function of distance between dependent words. Thus, the 2-3 s long time-window seems to constrain the maintenance of grammatical forms in working memory.

Word tones cueing morphosyntactic structure: Neuroanatomical substrates and activation time-course assessed by EEG and fMRI

Previous studies distinguish between right hemisphere-dominant processing of prosodic/tonal information and left-hemispheric modulation of grammatical information as well as lexical tones. Swedish word accents offer a prime testing ground to better understand this division. Although similar to lexical tones, word accents are determined by words' morphosyntactic structure, which enables listeners to use the tone at the beginning of a word to predict its grammatical ending. We recorded electrophysiological and hemodynamic brain responses to words where stem tones matched or mismatched inflectional suffixes. Tones produced brain potential effects after 136 ms, correlating with subject variability in average BOLD in left primary auditory cortex, superior temporal gyrus, and inferior frontal gyrus. Invalidly cued suffixes activated the left inferior parietal lobe, arguably reflecting increased processing cost of their meaning. Thus, interaction of word accent tones with grammatical morphology yielded a rapid neural response correlating in subject variability with activations in predominantly left-hemispheric brain areas.

Sensory-specific anomic aphasia following left occipital lesions: data from free oral descriptions of concrete word meanings

The present study investigated hierarchical lexical semantic structure in oral descriptions of concrete word meanings produced by a subject (ZZ) diagnosed with anomic aphasia due to left occipital lesions. The focus of the analysis was production of a) nouns at different levels of semantic specificity (e.g., "robin"-"bird"-"animal") and b) words describing sensory or motor experiences (e.g., "blue," "soft," "fly"). Results show that in contrast to healthy and aphasic controls, who produced words at all levels of specificity and mainly vision-related sensory information, ZZ produced almost exclusively nouns at the most non-specific levels and words associated with sound and movement.

Time-driven effects on processing grammatical agreement

“Agreement” is a grammatical relation between words; e.g., the verbal suffix –s reflects agreement with a singular subject (He run-s). Previous studies with time intervals under 2.5 s between disagreeing words have found a left-lateralized negative brain potential, arguably reflecting detection of the morphosyntactic violation. We tested the neurophysiological effects of number agreement between the first and last word in sentences at temporal distances between 1.75 and 3.25 s. Distances were varied by visually presenting sentences word by word at different rates. For distances under 2.5 s, a left-lateralized negativity was observed. At a 3.25-s interval, an anterior, slightly right-lateralized negativity was found. At an intermediate distance of 2.75 s, the difference between disagreement and agreement at left electrodes correlated with participants' working memory span. Results indicate that different brain processes occur when agreement involves agreement domains approaching and exceeding 3 s than when the agreement dependency involves shorter temporal intervals.

Time-driven effects on parsing during reading

The phonological trace of perceived words starts fading away in short-term memory after a few seconds. Spoken utterances are usually 2-3s long, possibly to allow the listener to parse the words into coherent prosodic phrases while they still have a clear representation. Results from this brain potential study suggest that even during silent reading, words are organized into 2-3s long 'implicit' prosodic phrases. Participants read the same sentences word by word at different presentation rates. Clause-final words occurring at multiples of 2-3s from sentence onset yielded increased positivity, irrespective of presentation rate. The effect was interpreted as a closure positive shift (CPS), reflecting insertion of implicit prosodic phrase boundaries every 2-3s. Additionally, in participants with low working memory span, clauses over 3s long produced a negativity, possibly indicating increased working memory load.

Activating without Inhibiting: Left-edge Boundary Tones and Syntactic Processing

Right-edge boundary tones have earlier been found to restrict syntactic processing by closing a clause for further integration of incoming words. The role of left-edge intonation, however, has received little attention to date. We show that Swedish left-edge boundary tones selectively facilitate the on-line processing of main clauses, the syntactic structure they are associated with. In spoken Swedish, main clauses are produced with a left-edge boundary tone, which is absent in subordinate clauses. Main and subordinate clauses are further distinguished syntactically by word order when containing sentence adverbs. The effects of tone and word order on the processing of embedded main, subordinate, and neutral clauses (lacking sentence adverbs) were measured using ERPs. A posterior P600 in embedded main clauses and a smaller P600 in subordinate clauses indicated that embedded clauses with sentence adverbs were structurally less expected than neutral clauses and thus were reanalyzed. The tone functioned as a cue for main clause word order, selectively reducing the P600 in embedded main clauses, without affecting the processing of subordinate or neutral clauses. Its perception was reflected in a right frontal P200 effect. The left-edge boundary tone thus seems to activate a main clause structure, albeit without suppressing alternative structures. The P600 was also preceded by a short positive effect in cases where a left-edge boundary tone was absent.

Modeling the meaning of words: neural correlates of abstract and concrete noun processing

We present a model relating analysis of abstract and concrete word meaning in terms of semantic features and contextual frames within a general framework of neurocognitive information processing. The approach taken here assumes concrete noun meanings to be intimately related to sensory feature constellations. These features are processed by posterior sensory regions of the brain, e.g. the occipital lobe, which handles visual information. The interpretation of abstract nouns, however, is likely to be more dependent on semantic frames and linguistic context. A greater involvement of more anteriorly located, perisylvian brain areas has previously been found for the processing of abstract words. In the present study, a word association test was carried out in order to compare semantic processing in healthy subjects (n=12) with subjects with aphasia due to perisylvian lesions (n=3) and occipital lesions (n=1). The word associations were coded into different categories depending on their semantic content. A double dissociation was found, where, compared to the controls, the perisylvian aphasic subjects had problems associating to abstract nouns and produced fewer semantic framebased associations, whereas the occipital aphasic subject showed disturbances in concrete noun processing and made fewer semantic feature based associations.

Dose exposure of patients undergoing comprehensive stroke imaging by multidetector-row CT: comparison of 320-detector row and 64-detector row CT scanners

BACKGROUND AND PURPOSE

Recently introduced 320-detector row CT enables whole brain perfusion imaging compared to a limited scanning area in 64-detector row CT. Our aim was to evaluate patient radiation exposure in comprehensive stroke imaging by using multidetector row CT consisting of standard CT of the head, CTA of cerebral and cervical vessels, and CTP.

MATERIAL AND METHODS

Organ doses were measured by using LiF-TLDs located at several organ sites in an Alderson-Rando phantom. Effective doses were derived from these measurements. Stroke protocols including noncontrast head CT, CTA of cerebral and cervical vessels, and CTP were performed on 320- and 64-detector row scanners.

RESULTS

Measured effective doses for the different scanning protocols ranged between 1.61 and 4.56 mSv, resulting in an effective dose for complete stroke imaging of 7.52/7.54 mSv (m/f) for 64-detector row CT and 10.56/10.6 mSv (m/f) for 320-detector row CT. The highest organ doses within the area of the primary beam were measured in the skin (92 mGy) and cerebral hemispheres (69.91 mGy). Use of an eye-protection device resulted in a 54% decrease of the lens dose measured for the combo protocol for whole-brain perfusion with the 320-detector row CT scanner.

CONCLUSIONS

Phantom measurements indicate that comprehensive stroke imaging with multidetector row CT may result in effective radiation doses from 7.52 mSv (64-detector row CT) to 10.6 mSv (320-detector row CT). The technique of 320-detector row CT offers additional information on the time course of vascular enhancement and whole-brain perfusion. Physicians should weigh the potential of the new technique against the higher radiation dose that is needed. Critical doses that would cause organ damage were not reached.

Acute chest pain without obvious organic cause before the age of 40. Respiratory and circulatory response to mental stress

Reactivity to mental stress and relaxation was studied in 63 consecutive patients below the age of 40 attending the emergency care unit because of chest pain without obvious organic cause. The results were compared with a control group (n = 32). Of the patients, 41% reported chest pain or oppression in the chest during mental stress compared to 10% of the control subjects (p less than 0.01). During relaxation the subjects in the female patient group reported significantly less ability to relax and had significantly higher respiration rate as compared to the female control group. There were no significant differences between the groups regarding heart rate, blood pressure or end-tidal PCO2 and there was no evidence of hyperventilation, neither during relaxation nor during mental stress. In combination with our earlier findings of high scores for "type A behaviour", "neuroticism", "vital exhaustion" and "stressful life events" these findings indicate that psychosomatic mechanisms may be of great importance for the development of chest pain in this group of patients.

Measuring syntactic complexity in spontaneous spoken Swedish

Hesitation disfluencies after phonetically prominent stranded function words are thought to reflect the cognitive coding of complex structures. Speech fragments following the Swedish function word att 'that' were analyzed syntactically, and divided into two groups: one with att in disfluent contexts, and the other with att in fluent contexts. Complexity was calculated in terms of a number of measures related to syntactic tree structures produced by the analysis tool GRAMMAL. Results showed that disfluent att is in general associated with significantly higher mean complexity values than fluent att. This information can be used to predict whether the function word at the beginning of a fragment is likely to be disfluent or not. Two kinds of statistical classification algorithms (Bayesian and neural networks) were used to test this hypothesis. The best result was 71% correctly classified cases, which is significantly better than a system that is based on selecting the data's majority class.

Dynamic arc radiosurgery and radiotherapy: commissioning and verification of dose distributions

PURPOSE

Conformal stereotactic radiosurgery and radiotherapy using a linear accelerator and a micromultileaf collimator (mMLC) offer the possibility of irradiating irregularly shaped target volumes. Dynamic arc radiosurgery and radiotherapy, i.e., stereotactic radiation therapy combining a moving gantry with a dynamic mMLC, enable the radiation even of lesions with concave structures.

METHODS AND MATERIALS

The dynamic arc method requires additional tools for quality assurance (QA) and three-dimensional verification at a high spatial resolution. A QA program was developed. Dose distributions of planning target volumes with concavities were investigated in polymer gel phantoms. The radiation-induced change of the relaxation rate R(2) was measured by magnetic resonance imaging. The distributions were compared with image processing tools.

RESULTS

Using the therapy-planning software BrainSCAN 4.0 (and 4.1 beta) in combination with the mMLC m3, deviations between the planned and measured 90% isodoses of about 2 mm were registered in the isocenter plane. Three-dimensional verification was feasible in the range of accuracy achieved in planning and dose measurement.

CONCLUSIONS

Dynamic arc radiosurgery and radiotherapy offer excellent conformation even for complicated planning target volumes with concavities. The dose distribution calculated with the treatment-planning software used can be accomplished with the available equipment. Patients can be treated by dynamic arc radiosurgery and radiotherapy.

Plasma levels of cytokines in primary septic shock in humans: correlation with disease severity

Thirteen patients (median age, 20 years) with life-threatening primary septic shock (10 meningococcal, 3 pneumococcal infections) were studied prospectively. All had a short history of sepsis (< or = 24 h) and no severe underlying disease. Two (15%) died. The logarithm of the initial plasma levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-6, IL-1 receptor antagonist (ra), and plasminogen activator inhibitor (PAI)-1 correlated significantly with APACHE II scores (r2 = .67, .57, .68, .81, and .68, respectively). The plasma levels of endotoxin, TNF-alpha, IL-1 beta, and PAI-1 decreased toward normal levels within the first 24 h of treatment, but IL-6 and IL-1ra levels remained high until clinical recovery. On admission, the molar excess of IL-1ra to IL-1 beta was > 2000-fold in 11 of the 13 patients. Acute plasmapheresis in 11 of the 13 patients significantly increased the plasma clearance of TNF-alpha (P = .02).

Nosocomial spread of hepatitis B virus (HBV) in a haemodialysis unit confirmed by HBV DNA sequencing

An outbreak of hepatitis B virus (HBV) infection in a haemodialysis unit is described. Four patients in the unit contracted subclinical HBV infection within three months. DNA sequence analysis of the S gene of HBV isolates from chronic carriers and newly infected patients in the unit aided in tracing possible transmission pathways. Three newly infected patients had received partial or complete HBV vaccination previously. HBV was rapidly cleared from all three although the anti-HBs titre had not reached 10 IU L-1 in any of them at the time of infection.

Seroconversion to hepatitis C virus in dialysis patients: a retrospective and prospective study

The prevalence and incidence of hepatitis C virus (HCV) infections were studied in 236 dialysis patients and related to clinical data at two hospitals in Stockholm, Sweden. Patients were followed during 12 months and tested by 1st- and 2nd-generation anti-HCV assays. Time of seroconversion to HCV could be determined by retrospective analysis of stored serum samples. A total of 36 (15%) patients were anti-HCV positive. Time of seroconversion could be determined for 23 patients and was in the majority of cases associated with blood transfusions, but late seroconversion (more than 6 months after transfusion) as well as lack of transfusion in some cases implied that HCV might be transmitted through dialysis equipment. Persistence of elevated alanine amino-transferase levels for more than 6 months occurred in 17% of anti-HCV-positive patients. In conclusion, routes of transmission in dialysis units have to be further evaluated since routes other than transfusion may occur and diagnosis may be delayed in this group of patients probably due to a poor immunological response.

Plasmapheresis in the treatment of primary septic shock in humans

14 patients (mean age 25.5 yrs) with life-threatening primary septic shock were eligible for treatment with acute plasmapheresis in a prospective study. They had a short history of sepsis and had no severe underlying disease. 10/14 patients had systemic meningococcal disease. All patients were severely ill with a mean APACHE II score of 25.0. 12/14 patients were treated with plasmapheresis exchanging 1 plasma volume within hours of admission. 11/14 patients survived without major sequelae and 3 (21%) died of irreversible septic shock. This mortality is lower than that predicted from the APACHE II scores (55.2%). A subgroup of plasmapheresis-treated patients with septic shock and extensive petechiae were compared to a historical control group. The mortality in the treatment group was 1/7 (14%) versus 8/21 (38%) in the control group. We conclude that acute plasmapheresis may be a therapeutic option in the early stages of severe primary non-surgical septic shock.

Five-year follow-up of young adults visiting an emergency unit because of atypical chest pain

A five-year follow-up, by means of a personal interview, was performed on patients below the age of 40 years with acute chest pain without obvious organic cause (n = 64). They had been consecutively admitted to the emergency unit over a period of 8 weeks, and had all been subjected to a thorough medical and psychosocial investigation with feedback soon after the initial consultation (investigation patient group, IP). For comparison, a non-investigation patient (NIP) group (n = 51) was recruited over a period of 8 separate weeks. Half of the patients in each group reported at the follow-up that they continued to suffer from chest pain. Compared to normal subjects, they reported more depression. This means that the initial research programme performed in the investigation group had no sustained therapeutic effect compared to routine care at the emergency unit. Tension, anxiety and number of consultations with a physician, as reported in the initial investigation, were negatively correlated with the outcome at follow-up. We conclude that acute chest pain without obvious organic cause in young adults is a condition with an excellent prognosis in strictly physical terms. However, a high proportion of the patients continue to suffer from chest pain for several years, and many of them continue to be consumers of medical resources. We therefore suggest that therapeutic programmes should be developed, particularly for those who report psychological symptoms and those with a history of many consultations with physicians.

Fatal outcome of bilateral nephrectomy in a patient with polycystic kidney disease. Case report

A 49-year-old woman had polycystic kidneys and liver cysts first diagnosed in 1968. She presented with hepatic and renal failure in 1980 and by 1988 was undergoing regular haemodialysis. In February 1989 she had bilateral nephrectomy (before renal transplantation) but developed septic shock and died. The reported mortality of bilateral nephrectomy before kidney transplantation is about 5%, and patients should be carefully selected and assessed before operation.

Clinical symptoms in young adults with atypical chest pain attending the emergency department

Clinical symptoms were studied in 69 consecutive patients below the age of 40 years who were attending the emergency unit because of unexplained chest pain. In a structured interview a few weeks after the emergency visit, only one-third of the patients reported that they believed in the doctor's diagnosis; they believed in a psychological or cardiac origin of the pain more often than the doctors. The chest pain was most often described as oppressive and/or stabbing. In 95% of cases it was central or left-sided. Associated symptoms were commonly reported, breathlessness being most commonly reported by two-thirds of the patients, followed by dizziness, palpitation and numbness/tingling. Mental symptoms such as tiredness, anxiety and tension were frequently reported. On the basis of the background literature the aetiology is discussed. We conclude that immediate symptom analysis, including psychosomatic symptoms, particularly breathing problems, is of central importance.

Acute chest pain without obvious organic cause before the age of 40 years: response to forced hyperventilation

A hyperventilation provocation test (HVPT) was performed on a group (n = 63) of consecutive patients, below the age of 40 years, attending an emergency care unit complaining of chest pain without obvious organic cause. The results were compared with those for a control group (n = 32). There was no tendency to hyperventilate in the patient group, either after discontinuing hyperventilation or during the ensuing relaxation period. PETCO2 measurements during this time thus showed no significant differences between the patient group and the control group. During the HVPT, 44% of patients reported three or more listed symptoms familiar to them from earlier occasions and regarded as typical of hyperventilation, compared to 23% of the controls (P less than 0.05). In a previously reported study, 38% of the patients were found to have similar symptoms during standardized mental stress, despite lack of hypocapnia. It is concluded that, on the basis of PETCO2 measurements, there were no signs of abnormal hyperventilation in the patient group. Moreover, the HVPT did not appear to be specific for diagnosis of hyperventilation syndrome, since mental stress itself was able to reproduce symptoms without concomitant hypocapnia, and since the provocation test was 'positive' in many control subjects.

Structure-activity relationships in mutagenicity and in nucleophilic ring opening of N-(arylmethyl)phenanthrene 9,10-imines

Ten derivatives of N-benzylphenanthrene 9,10-imine with different substituents on the phenyl ring were synthesized and subjected to mutagenicity tests in Salmonella typhimurium TA100. While electron donating groups were found to enhance the biological activity, electron attracting and bulky substituents lowered the mutagenic potency. A similar dependence on the electronic structure was observed in triethylamine/acetonitrile-promoted interaction of the title imines and 4-nitrothiophenol. This similarity suggests that both biochemical and chemical processes involve mechanisms in which protonation of the aziridine nitrogen is rate controlling, and the attack of the cellular or model nucleophile is a fast step. In contrast to these processes, the reaction of the imines with 4-nitrothiophenol in the presence of 1,5-diazabicyclo[4.3.0] non-5-ene proved to proceed by an SN2 mechanism and to be enhanced by electron attracting substituents.

Differentiated neuroblastoma cells are more susceptible to aluminium toxicity than developing cells

The influence of aluminium (20-50 micrograms/ml) on neuronal function was examined using electrophysiological techniques and neuroblastoma clone cells which offer a convenient model of differentiating and fully active neurons. Two specific questions were addressed: 1) Can differentiated cells maintain their normal excitable function when exposed to aluminium? 2) Can proper development of electrophysiological properties be achieved in its presence? We report that aluminium caused premature onset of deterioration in fully differentiated cells. Within 4-6 days they depolarized from -29.3 +/- 0.9 mV to levels lower than -15 mV; compound polyphasic action potentials were gradually replaced by slow monophasic spikes before the final loss of excitable properties and structural deformations was noticed. Developing cells followed the normal pattern of differentiation in the presence of aluminium: within 7 days they extended neurites, hyperpolarized and exhibited polyphasic spikes. These results show that neuroblastoma cells are apparently less susceptible to aluminium's toxicity during the process of development than after differentiation. Possible mechanisms by which aluminium may exert its effects are discussed in view of these observations.

Acute chest pain without obvious organic cause before age 40--personality and recent life events

Personality and life events were measured in 69 consecutive patients (36 men and 33 women) below age 40 attending the emergency care unit because of chest pain without obvious organic cause (91% participation rate). The results were compared with 32 randomly sampled healthy subjects matched with regard to age and sex (86% participation rate). The patient group had significantly higher scores for "neuroticism', 'Type A behaviour' and 'vital exhaustion'. Further more the patients had experienced significantly more life events, in particular uncontrollable ones, during the last year. We conclude that 'Type A behaviour', 'neuroticism', 'vital exhaustion' and critical recent life events are linked with emergency consultation for chest pain of non-cardiac origin. Possible explanations of the link between the psychological reaction and the chest pain are enhanced tension in the thoracic muscles producing chest pain and oesophageal disorders. This study stresses the importance of careful medical and psychosocial examination of each case of unexplained chest pain at the emergency care unit.

Replacement of 5-methylcytosine by cytosine: a possible mechanism for transient DNA demethylation during differentiation

In an earlier study it was discovered that when Friend erythroleukemia cells (FELC) were exposed to a variety of chemical agents capable of inducing differentiation, their DNA underwent genome-wide transient demethylation. In an attempt to elucidate the biochemical mechanism responsible for this phenomenon we have induced FELC with 5 mM hexamethylenebisacetamide and labeled the DNA in vivo with a density label, 5-bromodeoxyuridine, and a radioactive label, deoxy[5-3H]cytidine. Newly replicated DNA (heavy-light) was separated from parental DNA (light-light) by isopycnic centrifugation. Incorporation of deoxy[5-3H]cytidine into light-light duplex DNA has been observed only in induced cells concomitantly with the demethylation of the DNA, whereas, in parallel experiments, deoxy[G-3H]adenosine was not incorporated into light-light DNA. It was also found that the labeling of light-light DNA with deoxy[5-3H]cytidine is transient since the 3H label was removed from the DNA during the period of de novo DNA methylation that follows the demethylation. These results, taken together, strongly suggest that the demethylation of the DNA during differentiation is achieved by an enzymatic mechanism whereby 5-methylcytosine is replaced by cytosine.

The apical surface of canine chief cell monolayers resists H+ back-diffusion

The resistance of the gastric mucosa to acid and peptic injury is reflected by a resistance to the back-diffusion of H+ from gastric lumen to blood. The nature of this 'barrier', however, remains undefined. Using Ussing chambers, we have now studied the acid-barrier function of monolayers prepared from dispersed canine fundic chief cells. These monolayers secrete pepsinogen in response to stimulation. We found that, on acidification of the apical solution to pH 2, transepithelial resistance (R) increased 2.6-fold and the monolayers maintained this 1:100,000 H+ concentration gradient for more than 4 h. The addition of aspirin to the acidified apical solution caused a rapid decay in R, as did acidification of the basolateral solution to a pH less than 5.5. Ouabain-treated monolayers displayed the rise in R expected with apical acidification, while potential difference (V) and short-circuit current (Isc) decreased essentially to zero, indicating impermeability to H+. However, if the integrity of the ouabain-treated monolayers was disrupted by low apical pH, H+ permeation occurred, reflected by an Isc that was dependent on the H+ gradient across monolayers. These data indicate that the apical surface of chief cells is a very tight barrier to H+ diffusion and may be an important element resisting acid-peptic injury.