Ear, nose and throat manifestations of Lyme disease

The manifestations of Lyme disease as they may present to the ENT surgeon are discussed. The most important ENT symptom is facial palsy. Particularly when combined with other cranial palsies, systemic illness or signs of meningeal irritation, the diagnosis must be considered. Three case reports are used to illustrate the presentation and diagnosis and treatment of Lyme disease. The characteristics of the disease are reviewed and the limitations of serological testing outlined. The literature has concentrated on bilateral or relapsing facial palsy. A review of palsies in Zurich that presented to the ENT clinic found only unilateral and partial palsies. The diagnosis should be considered in every case of facial palsy of unknown aetiology especially in childre

Active Emergence from Propofol General Anesthesia Is Induced by Methylphenidate

Background: A recent study showed that methylphenidate induces emergence from isoflurane general anesthesia. Isoflurane and propofol are general anesthetics that may have distinct molecular mechanisms of action. The objective of this study was to test the hypothesis that methylphenidate actively induces emergence from propofol general anesthesia. Methods: Using adult rats, the effect of methylphenidate on time to emergence after a single bolus of propofol was determined. The ability of methylphenidate to restore righting during a continuous target-controlled infusion (TCI) of propofol was also tested. In a separate group of rats, a TCI of propofol was established and spectral analysis was performed on electroencephalogram recordings taken before and after methylphenidate administration. Results: Methylphenidate decreased median time to emergence after a single dose of propofol from 735 s (95% CI: 598–897 s, n = 6) to 448 s (95% CI: 371–495 s, n = 6). The difference was statistically significant (P = 0.0051). During continuous propofol anesthesia with a median final target plasma concentration of 4.0 μg/ml (95% CI: 3.2–4.6, n = 6), none of the rats exhibited purposeful movements after injection of normal saline. After methylphenidate, however, all six rats promptly exhibited arousal and had restoration of righting with a median time of 82 s (95% CI: 30–166 s). Spectral analysis of electroencephalogram data demonstrated a shift in peak power from δ (less than 4 Hz) to θ (4–8 Hz) and β (12–30 Hz) after administration of methylphenidate, indicating arousal in 4/4 rats. Conclusions: Methylphenidate decreases time to emergence after a single dose of propofol, and induces emergence during continuous propofol anesthesia in rats. Further study is warranted to test the hypothesis that methylphenidate induces emergence from propofol general anesthesia in humans.National Institutes of Health (U.S.) (Grant DP1-OD003646)National Institutes of Health (U.S.) (Grant K08-GM094394)Massachusetts General Hospital. Dept. of Anesthesia and Critical Car

Communities of wood-inhabiting bryophytes and fungi on dead beech logs in Europe - reflecting substrate quality or shaped by climate and forest conditions?

Aim: Fungi are drivers of wood decay in forested ecosystem, while bryophytes use dead wood as a platform for their autotrophic lifestyle. We tested the hypothesis that fungal communities on beech logs are mainly structured by substrate quality, while bryophyte communities are structured by climatic gradients. In addition, we tested whether community structure in both organism groups is altered along a gradient from nearly pristine forest to forests heavily affected by management and human disturbance in the past. Location: Europe. Methods: We surveyed 1207 fallen beech logs in 26 of the best-preserved forest stands across six European countries, representing a gradient in overall naturalness of the forest landscape. Recorded species were classified into ecological guilds. Indirect ordination and variation partitioning was used to analyse the relationship between species composition and environmental variables, recorded at log or site level. Results: In total, 10,367 bryophyte and 15,575 fungal records were made, representing 157 and 272 species, respectively. Fungal communities were more clearly structured by substrate quality than were bryophyte communities. In both groups a distinct turnover in species composition was evident along a longitudinal gradient from Central to Western Europe. Fungi specialized in trunk rot and specialized epixylic bryophytes were scarcely represented in Atlantic regions, and partly replaced by species belonging to less specialized guilds. Variables related to climate and forest conditions were confounded along this main geographical gradient in community composition. Main conclusions: We found that bryophyte and fungal communities co-occurring on fallen beech logs in European beech forest reserves differed in their responses to biogeographical drivers and local-scale habitat filters. Both groups responded to major gradients in climate and forest conditions, but the loss of specialist guilds in degraded forest landscapes points to a functionally important effect of forest landscape degradation at the European continental scale. © 2014 John Wiley & Sons Ltd

Regulation of Arousal by Adenosine A1 and A2A Receptors in the Prefrontal Cortex of C57BL/6J Mouse.

Adenosine levels in the basal forebrain and cortex increase with prolonged wakefulness to promote sleep. Caffeine increases wakefulness by blocking adenosine receptors, yet the neurotransmitter systems and brain regions through which adenosine receptor blockade causes arousal are incompletely understood. The prefrontal cortex (PFC) contributes to the regulation of sleep and wakefulness. This thesis research sought to elucidate the mechanisms by which adenosine A1 and A2A receptors in PFC modulate acetylcholine (ACh) release, behavioral and electroencephalographic (EEG) arousal, and sleep. Aim 1 tested the hypothesis that adenosine A1 and A2A receptors in mouse PFC modulate PFC ACh release, behavioral arousal, and EEG delta power. Microdialysis administration of adenosine A1 and A2A receptor agonists and antagonists significantly altered ACh release, anesthesia recovery time, and EEG delta power. The data support the interpretation that caffeine promotes arousal, in part, by blocking PFC adenosine A1 receptors. Aim 2 tested the hypothesis that endogenous adenosine in the PFC acts through adenosine A1 receptors to modulate sleep and wakefulness. Microinjection of an adenosine A1 receptor antagonist into the PFC increased wakefulness and decreased NREM sleep. These results suggest that one mechanism by which the PFC modulates behavioral arousal is through descending input to caudal arousal control centers. The pontine reticular formation (PRF) regulates sleep/wake states and Aim 3 tested the hypothesis that adenosine A1 and A2A receptors in the PFC modulate ACh release in the PRF. Microdialysis delivery of an adenosine A2A receptor agonist, A1 receptor antagonist, and caffeine to the PFC increased PRF ACh release, whereas administering an A1 receptor agonist decreased PRF ACh release. These findings are the first to demonstrate that pharmacological manipulation of the PFC can alter neurotransmitter release in the PRF, and suggest that one mechanism by which PFC adenosine A1 and A2A receptors modulate behavioral arousal is by altering PRF ACh release. The results support the interpretation that adenosine A1 and A2A receptors in the PFC modulate ACh release and behavioral arousal (Aim 1); modulate sleep and wakefulness (Aim 2); and modulate ACh release in the PRF (Aim 3).Ph.D.Molecular and Integrative PhysiologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/61642/1/vandortc_1.pd

Design and characterisation of the CLICTD pixelated monolithic sensor chip

A novel monolithic pixelated sensor and readout chip, the CLIC Tracker Detector (CLICTD) chip, is presented. The CLICTD chip was designed targeting the requirements of the silicon tracker development for the experiment at the Compact Linear Collider (CLIC), and has been fabricated in a modified 180 nm CMOS imaging process with charge collection on a high-resistivity p-type epitaxial layer. The chip features a matrix of 16×128 elongated channels, each measuring 300×30 μm2. Each channel contains 8 equidistant collection electrodes and analog readout circuits to ensure prompt signal formation. A simultaneous 8-bit Time-of-Arrival (with 10 ns time bins) and 5-bit Time-over-Threshold measurement is performed on the combined digital output of the 8 sub-pixels in every channel. The chip has been fabricated in two process variants and characterised in laboratory measurements using electrical test pulses and radiation sources. Results show a minimum threshold between 135 and 180 e‾ and a noise of about 14 e‾ RMS. The design aspects and characterisation results of the CLICTD chip are presented

Quantifying bladder outflow obstruction in men:A comparison of four approximation methods exploiting large data samples

Introduction: A pressure flow study (PFS), part of the International Continence Society standard urodynamic test, is regarded gold standard for the classification and quantification of the urethral resistance (UR), expressed in the bladder outflow obstruction (BOO). For men with benign prostatic hyperplasia, the minimum urethral opening pressure (pmuo), found at the end of the passive urethral resistance relation is considered the relevant parameter describing BOO. However, in clinical practice, direct measurements of pmuo are easily confounded by terminal dribbling. For that reason, alternative methods were developed to derive pmuo, and thereby assess BOO using the maximum urine flow rate (Qmax) and the corresponding pressure (pdetQmax) instead. These methods were never directly compared against a large data set. With the increasing variety of treatments becoming available more precise grading of UR may become of relevance. The current study compares four well-known methods to approximate pmuo and examines the relation between pmuo and pdetQmax. Methods: In total, 1717 high-quality PFS of men referred with lower urinary tract symptoms between 2003 and 2020 without earlier lower urinary tract surgery were included. From these recordings, pmuo was calculated according to three one-parameter methods. In addition, a three-parameter method (3PM) was used, based on a fit through the lowest pressure flank of the pressure-flow plot. The estimated pmuo's were compared with a precisely assessed pmuo. A difference of &lt;10 cmH2O between an estimate and the actual pmuo was considered accurate. A comparison between the four approximation methods and the actual pmuo was visualized using a Bland–Altman plot. The differences between the actual and the estimated slope were assessed and dependency on pmuo was analyzed. Results: A total of 1717 studies were analyzed. In 55 (3.2%) PFS, 3PM analysis was impossible because all pressures after Qmax were higher than pdetQmax. The 3PM model was superior in predicting pmuo, with 75.9% of the approximations within a range of +10 or −10 cmH2O of the actual pmuo. Moreover, pmuo according to urethral resistance A (URA) and linearized passive urethral resistance relation (linPURR) appear equally reliable. Bladder outflow obstruction index (BOOI) was significantly less accurate when compared to all others. Bland–Altman analysis showed a tendency of BOOI to overestimate pmuo in men with higher grades of UR, while URA tended to underestimate pmuo in those cases. The slope between pmuo and pdetQmax-Qmax increased with larger pmuo, as opposed to the constant relation proposed within BOOI. Although significant differences were found, the clinical relevance of those differences is not known. Conclusion: Of the four methods to estimate pmuo and quantify BOO, 3PM was found the most accurate and BOOI the least accurate. As 3PM is not generally available and performance in lower quality PFS is unknown, linPURR is (for now) the most physiologically accurate.</p

Fiber-optic endoscopic evaluation of swallowing to assess swallowing outcomes as a function of head position in a normal population

BACKGROUND: Head position practice has been shown to influence pill-swallowing ability, but the impact of head position on measures of swallowing outcomes has not yet been studied with fiber-optic endoscopic evaluation of swallowing (FEES). The primary purpose of this study was to determine whether head position impacts penetration-aspiration scale scores and/or post-swallow pharyngeal residue as assessed by FEES. Documenting the incidence of pharyngeal residue and laryngeal penetration and aspiration in a normal population was a secondary goal. METHODS: Adults without swallowing difficulties (N = 84) were taught a pill swallowing technique based on learning five head positions and were asked to practice with small, hard candies (e.g., TicTacs) for two weeks. Then they demonstrated swallowing in each of the head positions for two conditions, liquid and purée, while undergoing FEES. RESULTS: Out of 840 examined swallows, one event of aspiration and 5 events of penetration occurred. During practice >50% participants found positions they preferred over the center position for swallowing but head position was not associated with penetration-aspiration scores assessed by FEES. Significant associations and non-significant trends were found between pharyngeal residue and three variables: age, most preferred head position, and least preferred head position. CONCLUSION: Head position during swallowing (head up) and age greater than 40 years may result in increased pharyngeal residue but not laryngeal penetration or aspiration

Synthesis of [ 18 F]phencyclidines for glutamate receptor mapping

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90096/1/25802601150_ftp.pd