Reconstructive procedures for disturbed functions within the upper airway: pharyngeal breathing/snoring

Breathing disorders which have their origin within the pharynx mainly occur during sleep. These so-called obstructive sleep-related breathing disorders include three different disturbances which have to be distinguished properly: simple snoring, upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA). Each disturbance requires a different treatment

A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study.

BACKGROUND:Effectiveness of early intensive aphasia rehabilitation after stroke is unknown. The Very Early Rehabilitation for SpEech trial (VERSE) aimed to determine whether intensive aphasia therapy, beginning within 14 days after stroke, improved communication recovery compared to usual care. METHODS:Prospective, randomized, single-blinded trial conducted at 17 acute-care hospitals across Australia/New Zealand from 2014 to 2018. Participants with aphasia following acute stroke were randomized to receive usual care (direct usual care aphasia therapy), or one of two higher intensity regimens (20 sessions of either non-prescribed (usual care-plus or prescribed (VERSE) direct aphasia therapy). The primary outcome was improvement of communication on the Western Aphasia Battery-Revised Aphasia Quotient (AQ) at 12 weeks after stroke. Our pre-planned intention to treat analysis combined high intensity groups for the primary outcome. FINDINGS:Among 13,654 acute stroke patients screened, 25% (3477) had aphasia, of whom 25% (866) were eligible and 246 randomized to usual care (n = 81; 33%), usual care-plus (n = 82; 33%) or VERSE (n = 83; 34%). At 12 weeks after stroke, the primary outcome was assessed in 217 participants (88%); 14 had died, 9 had withdrawn, and 6 were too unwell for assessment. Communication recovery was 50.3% (95% CI 45.7-54.8) in the high intensity group (n = 147) and 52.1% (95% CI 46.1-58.1) in the usual care group (n = 70; difference -1.8, 95% CI -8.7-5.0). There was no difference between groups in non-fatal or fatal adverse events (p = 0.72). INTERPRETATION:Early, intensive aphasia therapy did not improve communication recovery within 12 weeks post stroke compared to usual care

Response to sedimentation stress of the gorgonian coral Primnoella chilensis from the Chilean fjord region

Sedimentation is one of the main disturbance factors influencing benthic communities and coastal reef organisms through a variety of mechanisms. In Chilean Patagonia, rising anthropogenic intrusions such as coastal road projects and aquaculture installations threaten the local biodiversity causing increased sedimentation with even more to be expected. Primnoella chilensis (Philippi, 1894) is an important habitat-forming gorgonian coral, abundant in this region, but significant abundance decreases were reported for the last decade. The present study aimed to describe physiological and behavioural stress responses of P. chilensis to increased sedimentation. Therefore, two laboratory experiments were conducted measuring colonies' responses in respiration for 18 hours as well as documenting polyp activity and mucus secretion for 15 days under sediment exposure. No significant differences in oxygen consumption were measured, presumably due to the low number of test organisms. Further, no mucus secretion or changes in colonies' overall activity were detected. However, an analysis on single polyp level revealed a significantly increased percentage of open polyps when exposed to high sedimentation. This increased activity may be explained by intensified filter-feeding behaviour and active sediment rejection. In addition, a spawning event was detected as a possible stress reaction. All in all, the results suggest that P. chilensis is able to tolerate the simulated sedimentation loads of 225 and 450 mm/y due to its morphology and compartmentalized behaviour. This goes along with previous findings on gorgonian corals. Nonetheless, anthropogenic disturbances may by far exceed and alter natural ones due to their extent and persistence causing unpredictable, dangerous conditions for the benthic community

Cultural continuity and discontinuity during the late bronze age in Eastern Hesse

Während der Mittelbronzezeit bildet sich in Osthessen mit der Fulda-Werra-Gruppe ein eigenständiger Kulturraum heraus, der mit den Nachbarräumen in kulturellem Austausch steht. Am Übergang zur späten Bronzezeit ist ein massiver Wandel zu beobachten. Wie in weiten Teilen Europas kommt es auch in Osthessen zu einem Wechsel von der überhügelten Körperbestattung zum Brandflachgrab. In dieser Zeit zerbricht in Osthessen der einheitliche Kulturraum, stattdessen machen sich starke Einflüsse aus den Nachbarräumen bemerkbar, die offensichtlich auch mit Einwanderungen einzelner Bevölkerungsgruppen in Verbindung stehen. Der Übergang zur Eisenzeit gestaltet sich fließend. Einerseits endet die Befestigung auf dem Haimberg spätestens in dieser Zeit, andererseits werden mehrere Gräberfelder offensichtlich durchgehend belegt. Die Waffenfunde auf dem Sängersberg zeigen an, dass die verschiedenen Umbrüche auch in Osthessen offensichtlich mit bewaffneten Konflikten verbunden waren, deren Umfang jedoch bisher ebenso wenig bestimmbar ist, wie Herkunft und Zusammensetzung der Kontrahenten.During the Middle Bronze Age in eastern Hesse an independent cultural sphere formed in the Fulda-Werra group, which carried on cultural exchange with neighbouring regions. At the transition to the Late Bronze Age an enormous change occurred. As in many other places in Europe, in eastern Hesse as well there was a change in burial customs from inhumation graves under a barrow to flat cremation graves. During this time the homogeneous cultural sphere in eastern Hesse collapsed, while strong influences from neighbouring regions became noticeable. Evidently, these influences were also linked with the migrations of individual groups of people. The transition to the Iron Age followed smoothly. During this time at the latest the fortification of the Haimberg came to an end, whereas several cemeteries evidently continued in uninterrupted use. Finds of weapons on the Sängersberg demonstrate that the various upheavals in eastern Hesse were obviously connected with armed conflicts. However, the extent of these conflicts as well as the origin and composition of the opponent parties involved are still difficult to determine