Assessment of motor recovery and decline

Assessment of motor disorders forms an important ingredient of neurology, rehabilitation medicine and orthopaedics. Until now, however, many of the employed assessment tools are derived from empirical knowledge. Almost no relation exists with modern theoretical notions about motor control. In the present article, motor control theory is reviewed in the light of its potential contribution to understanding motor recovery. An attempt is made to present a theoretical framework for the assessment of motor disorders related to recent insights in motor control. The framework emphasizes the dynamical character of recovery. The principle of output optimization is discussed and it is stressed that compensation plays a permanent role in adapting to damage of the body or to changes in the environment. An assessment procedure is introduced to measure the (mental) costs of this compensation. It is argued that changes in the costs of compensation across time reflect recovery

Obscured Asymptotic Giant Branch Variables in the Large Magellanic Cloud and the Period-Luminosity Relation

The characteristics of oxygen-rich and carbon-rich, large amplitude (dK>0.4 mag), asymptotic giant branch variables in the Large Magellanic Clouds are discussed, with an emphasis on those obscured by dust. Near-infrared photometry, obtained over about 8 years, is combined with published mid-infrared observations from IRAS and ISO to determine bolometric magnitudes for 42 stars. Pulsation periods of the O-rich stars are in the range 116<P<1393 days, while those for C-rich stars have 298<P<939 days. In addition to the regular pulsations, one O-rich star and four C-rich stars show large amplitude, dK> 0.6 mag, secular or very long period variations which may be associated with changes in their mass-loss rates. We discuss and compare various methods of determining the bolometric magnitudes and show, perhaps surprisingly, that most of the very long period stars seem to follow an extrapolation of the period-luminosity relation determined for stars with shorter periods - although the details do depend on how the bolometric magnitudes are calculated. Three stars with thin shells, which are clearly more luminous than the obscured AGB stars, are undergoing hot bottom burning, while other stars with similar luminosities have yet to be investigated in sufficient detail to determine their status in this regard. We suggest that an apparent change in slope of the period luminosity relation around 400-420 days is caused by variables with luminosities brighter than the predictions of the core-mass luminosity relation, due to excess flux from hot bottom burning.Comment: 20 pages, 20 figures, accepted for MNRA

The elevation of the anion gap in steady state chronic kidney disease may be less prominent than generally accepted

BACKGROUND: A presumed cause of metabolic acidosis in chronic kidney disease (CKD) is accumulation of unmeasured anions, leading to a high anion gap (AG). In patients with CKD with a high AG, only minor increases are expected. The aim of this study is to evaluate the magnitude of the AG in documented steady state CKD to examine the effect of CKD on a high-AG metabolic acidosis (HAGMA).METHODS: In this cross-sectional study the AG, bicarbonate, and chloride were evaluated in 1045 blood and urine samples of 501 patients with steady state CKD in the outpatient clinic. The influence of phosphate, albumin and potassium on the AG were evaluated.RESULTS: The mean AG increased from 8.8 mEq/l (±1.57) in CKD stage 1 to 11.2 mEq/l (±2.22) in CKD stage 5 ( P &lt; 0.001). Correction for albumin or phosphate did not influence the magnitude of the AG. Correction for potassium did alter the prevalence of HAGMA, but not the severity. [HCO 3 -] decreased between CKD stages 1 and 5 by 5.1 mEq/l. The [Cl -] increased by 2.6 mEq/l between CKD stages 1 and 5. CONCLUSIONS: The elevation of the AG in patients with steady state CKD is limited and less pronounced than the decrease in [HCO 3 -]. Normal AG metabolic acidosis seems to be more important in CKD than HAGMA. The CKD stage and the magnitude of the AG should be taken into account when evaluating a patient with HAGMA. This study suggests that an AG &gt;15 mEq/l is rarely due to renal failure alone. </p

Oxalate nephropathy in an elderly patient with newly diagnosed celiac disease:a case report

Oxalate nephropathy, due to secondary hyperoxaluria has widely been described in gastrointestinal diseases. However, reports of oxalate nephropathy in newly diagnosed celiac disease are rare. A 72-year-old Caucasian male presented to the hospital with abdominal discomfort and acute renal insufficiency with a creatinine of 290 µmol/L. The clinical course, laboratory results and urinalysis were suspect for tubular injury. Renal biopsy showed calcium oxalate depositions. Elevated plasma and urine oxalate levels established the diagnosis oxalate nephropathy. The abdominal complaints with steatorrhea and positive anti-tissue transglutaminase antibodies were diagnosed as celiac disease, which was confirmed after duodenal biopsies. Treatment with prednisone, and gluten-free, low oxalate and normal calcium diet, lowered the plasma oxalate levels and improved his renal function. Decreased absorption of free fatty acids can lead to increased free oxalate in the colon due to the binding of free fatty acids to calcium, preventing the formation of the less absorbable calcium oxalate in the colon. Oxalate dispositions in the kidney can lead to acute tubular injury and chronic renal insufficiency. Celiac disease is therefore one of the intestinal diseases that can lead to hyperoxaluria and oxalate nephropathy.</p

Subarcsecond Submillimeter Imaging of the Ultracompact HII Region G5.89-0.39

We present the first subarcsecond submillimeter images of the enigmatic ultracompact HII region (UCHII) G5.89-0.39. Observed with the SMA, the 875 micron continuum emission exhibits a shell-like morphology similar to longer wavelengths. By using images with comparable angular resolution at five frequencies obtained from the VLA archive and CARMA, we have removed the free-free component from the 875 micron image. We find five sources of dust emission: two compact warm objects (SMA1 and SMA2) along the periphery of the shell, and three additional regions further out. There is no dust emission inside the shell, supporting the picture of a dust-free cavity surrounded by high density gas. At subarcsecond resolution, most of the molecular gas tracers encircle the UCHII region and appear to constrain its expansion. We also find G5.89-0.39 to be almost completely lacking in organic molecular line emission. The dust cores SMA1 and SMA2 exhibit compact spatial peaks in optically-thin gas tracers (e.g. 34SO2), while SMA1 also coincides with 11.9 micron emission. In CO(3-2), we find a high-velocity north/south bipolar outflow centered on SMA1, aligned with infrared H2 knots, and responsible for much of the maser activity. We conclude that SMA1 is an embedded intermediate mass protostar with an estimated luminosity of 3000 Lsun and a circumstellar mass of ~1 Msun. Finally, we have discovered an NH3 (3,3) maser 12 arcsec northwest of the UCHII region, coincident with a 44 GHz CH3OH maser, and possibly associated with the Br gamma outflow source identified by Puga et al. (2006).Comment: 41 pages, 11 figures, published in The Astrophysical Journal (2008) Volume 680, Issue 2, pp. 1271-1288. An error in the registration of the marker positions in Figure 11 has been corrected in this versio