Repeatedly successful closure of the larynx for the treatment of chronic aspiration with the use of botulinum toxin A

Botulinum toxin A was used preoperatively to temporarily paralyze the intrinsic laryngeal muscles to hinder movements during the healing period after operation. In addition, toxin was injected into the cricopharyngeal muscle to allow a better passive drainage of the saliva into the esophagus. We treated six patients. Three suffered from chronic aspiration problems after multiple lower cranial nerve lesions, and three patients were apallic (after stroke and major brain injury). Two weeks before scheduled operation, we injected the toxin into the posterior cricoarytenoid muscles, the aryepiglottic muscles, and the vocalis muscle on both sides, as well as the cricopharyngeal muscle. The amount of injected toxin varied between 1.0 and 1.4 mL, equal to 200 to 280 units of botulinum toxin A (Dysport). After a complete palsy of these muscles (controlled by direct electromyography), a closure of the larynx was performed. After laminotomy and exposure of the intralaryngeal structures, the false vocal cords were mobilized and adapted with sutures. Because involuntary movements of the intralaryngeal musculature were absent, primary healing without complications occurred in all cases. Aspiration and related complications disappeared in all patients. In addition, the intensity of patient care could be considerably reduced. Preoperative use of botulinum toxin A allows sufficient laryngeal closure. This procedure is especially useful in the treatment of children and young adults, preserving the ability of later speech rehabilitation because of the return of voluntary movements of the intrinsic laryngeal muscles 6 months after the injection. Furthermore, this technique, as minimal surgical intervention, can be performed in high-risk patients.     

Immunohistochemical and genetic evidence of myeloperoxidase involvement in multiple sclerosis

The influence of sampling time on the frequencies of micronuclei, centromere-positive micronuclei and chromosome nondisjunction was investigated in binucleated lymphocytes following treatment with a known clastogen (mitomycin C) or an aneuploidy-inducing agent (vincristine sulfate). Cytochalasin B (6 micrograms/ml) was added 44 h after mitogen stimulation and cultures were harvested 12, 28, 36 and 48 h thereafter. Micronucleated cells and micronuclei were significantly induced by the two treatments at all sampling times. Furthermore, in situ hybridization with an 'all centromeres' probe showed that vincristine-induced micronuclei were prevalently centromere-positive whereas in mitomycin C-treated cultures only a minor fraction of induced micronuclei contained the hybridization signals. Chromosome nondisjunction rates, as measured by in situ hybridization with chromosome 7- and 11-specific alphoid probes, significantly increased following vincristine treatment. Chromosome nondisjunction and total micronucleus frequencies were found to increase with time both in controls and in mutagen-treated cultures, whereas the percentage of centromere-positive micronuclei in the different treatments was not influenced by the sampling time. Our data suggest that even in the presence of 6 micrograms/ml cytochalasin B, the abnormal segregation of binucleated cells may contribute to the baseline level of micronuclei and influence the results obtained. The introduction of a short cytochalasin B treatment (between 12 and 28 h) in the cytokinesis-blocked micronucleus assay may avoid the cytochalasin B effect on micronucleus frequencies.     

A Rate-Distortion Function for Vector Quantization with a Variable Block-Size Classification Model

In this paper, a rate-distortion function (RDF),R(D), is presented for a variable block-size classification (VBSC) model. We obtain a theoreticalR(D) bound on the performance of vector quantization (VQ) based on the VBSC model. It is theoretically proved that theR(D) bound of the VBSC model is lower than those of the Gaussian model and the fixed block-size classification (FBSC) model for the bit rates of interest. In the comparison tests of VBSC model-based VQ and FBSC model-based VQ, which were carried out by using a monochrome still image, it was seen that the former technique outperforms the latter technique, subjectively as well as objectively. We also experimentally evaluate a RDF for the VBSC model and compare this with the theoretical RDF. There is a gap of 0.07–0.1 bpp between the theoretical RDF and the experimental RDF in VQ coding without entropy coding. We have reduced the gap to 0.02–0.03 bpp by subsequently employing a Huffman coder for entropy coding. It is expected that the theoretical bound can be approached more closely by the experimental RDF by using a modified asymptotic RDF.     

Insertion of a covered self-expandable esophageal metal stent for a malignant tracheoesophageal fistula in a patient with Zenker''s diverticulum

A 50-year-old woman presented with sensorimotor polyneuropathy in the lower limbs. Biopsy of the muscle revealed neurogenic changes, and electrophysiological study and pathology of the biopsied nerve indicated myelinoaxonal degeneration. Her symptoms responded to neither plasmapheresis nor prednisolone. Pelvic radiography disclosed an osteosclerotic lesion that was subsequently diagnosed as IgA-lambda plasmacytoma by biopsy. Radiation therapy for this solitary osteosclerotic myeloma improved the patient's polyneuropathy. In Japan, reports of cases of polyneuropathy associated with osteosclerotic myeloma without multiorgan disorders as in our case have not previously been described; thus, such cases may be misdiagnosed. Therefore, in patients with polyneuropathy of unknown etiology, a systemic bone survey and repeated searches for M-protein are important. Treatment of bone lesions in patients with solitary osteosclerotic myeloma may improve the associated polyneuropathy.     

Dissociation of the protein primer and DNA polymerase after initiation of adenovirus DNA replication

Initiation of adenovirus DNA replication occurs by a jumping back mechanism in which the precursor terminal priming protein (pTP) forms a pTP.trinucleotide complex (pTP.CAT) catalyzed by the viral DNA polymerase (pol). This covalent complex subsequently jumps back 3 bases to permit the start of chain elongation. Before initiation, pTP and pol form a tight heterodimer. We investigated the fate of this pTP.pol complex during the various steps in replication. Employing in vitro initiation and elongation on both natural viral templates and synthetic oligonucleotides followed by glycerol gradient separation of the reaction products, we established that pTP and pol are separated during elongation. Whereas pTP.C and pTP. CA were still bound to the polymerase, after the formation of pTP. CAT 60% of the pTP.pol complex had dissociated. Dissociation coincides with a change in sensitivity to inhibitors and in Km for dNTPs, suggesting a conformational change in the polymerase, both in the active site and in the pTP interaction domain. In agreement with this, the polymerase becomes a more efficient enzyme after release of the pTP primer. We also investigated whether the synthesis of a pTP initiation intermediate is confined to three nucleotides. Employing synthetic oligonucleotide templates with a sequence repeat of two nucleotides (GAGAGAGA ... instead of the natural GTAGTA ... ) we show that G5 rather than G3 is used to start, leading to a pTP. tetranucleotide (CTCT) intermediate that subsequently jumps back. This indicates flexibility in the use of the start site with a preference for the synthesis of three or four nucleotides during initiation rather than two.     

Parallel implementation of backpropagation neural networks on aheterogeneous array of transputers

This paper analyzes parallel implementation of the backpropagation training algorithm on a heterogeneous transputer network (i.e., transputers of different speed and memory) connected in a pipelined ring topology. Training-set parallelism is employed as the parallelizing paradigm for the backpropagation algorithm. It is shown through analysis that finding the optimal allocation of the training patterns amongst the processors to minimize the time for a training epoch is a mixed integer programming problem. Using mixed integer programming optimal pattern allocations for heterogeneous processor networks having a mixture of T805-20 (20 MHz) and T805-25 (25 MHz) transputers are theoretically found for two benchmark problems. The time for an epoch corresponding to the optimal pattern allocations is then obtained experimentally for the benchmark problems from the T805-20, TS805-25 heterogeneous networks. A Monte Carlo simulation study is carried out to statistically verify the optimality of the epoch time obtained from the mixed integer programming based allocations. In this study pattern allocations are randomly generated and the corresponding time for an epoch is experimentally obtained from the heterogeneous network. The mean and standard deviation for the epoch times from the random allocations are then compared with the optimal epoch time. The results show the optimal epoch time to be always lower than the mean epoch times by more than three standard deviations (3sigma) for all the sample sizes used in the study thus giving validity to the theoretical analysis.     

Efficacy and safety of fexofenadine hydrochloride for treatment of seasonal allergic rhinitis

BACKGROUND: The positive portrayal of violence and weapon carrying in televised music videos is thought to have a considerable influence on the normative expectations of adolescents about these behaviors. OBJECTIVES: To perform a content analysis of the depictions of violence and weapon carrying in music videos, including 5 genres of music (rock, rap, adult contemporary, rhythm and blues, and country), from 4 television networks and to analyze the degree of sexuality or eroticism portrayed in each video and its association with violence and weapon carrying, as an indicator of the desirability of violent behaviors. METHODS: Five hundred eighteen videos were recorded during randomly selected days and times of the day from the Music Television, Video Hits One, Black Entertainment Television, and Country Music Television networks. Four female and 4 male observers aged 17 to 24 years were trained to use a standardized content analysis instrument. Interobserver reliability testing resulted in a mean (+/- SD) percentage agreement of 89.25% +/- 7.10% and a mean (+/- SD) kappa of 0.73 +/- 0.20. All videos were observed by rotating 2-person, male-female teams that were required to reach agreement on each behavior that was scored. Music genre and network differences in behaviors were analyzed with chi 2 tests. RESULTS: A higher percentage (22.4%) of Music Television videos portrayed overt violence than Video Hits One (11.8%), Country Music Television (11.8%), and Black Entertainment Television (11.5%) videos (P = .02). Rap (20.4%) had the highest portrayal of violence, followed by rock (19.8%), country (10.8%), adult contemporary (9.7%), and rhythm and blues (5.9%) (P = .006). Weapon carrying was higher on Music Television (25.0%) than on Black Entertainment Television (11.5%), Video Hits One (8.4%), and Country Music Television (6.9%) (P < .001). Weapon carrying was also higher in rock (19.8%) and rap (19.5%) videos than in adult contemporary (16.1%), rhythm and blues (6.9%), and country (6.3%) videos (P = .002). The videos with the highest level of sexuality or eroticism were found to be less likely to contain violence (P < or = .04). CONCLUSION: Because most music videos are between 3 and 4 minutes long, these data indicate that even modest levels of viewing may result in substantial exposure to violence and weapon carrying, which is glamorized by music artists, actors, and actresses.     

Polycrystalline silicon-germanium thin-film transistors

The fabrication of p- and n-channel MOS thin-film transistors (TFT's) in polycrystalline silicon-germanium (poly-Si_1-xGe _x) films is described, and their electrical characteristics are presented. Various technological issues are then addressed in order to provide direction for further work in optimizing the fabrication process. The initial devices fabricated in this work exhibit well behaved electrical characteristics; enhanced performance is expected to accompany improvements in the crystallization and defect-passivation processes. Compared to a poly-Si TFT technology, an optimized poly-Si _1-xGe_x TFT technology may ultimately be able to provide a lower-temperature, shorter-time processing capability at little expense to device performance and it is therefore promising for large-area electronics applications     

Transmission electron microscopy detection of microtexture variations and their effects on thin film stability

We have studied grain growth and the development of preferred orientation in thin gold films using transmission electron microscopy conical dark field imaging. The technique is capable of detecting texture variations characterized by mean orientation differences smaller than 5°. We have observed microscopic regions with distinct 〈111〉 fiber textures that differ, primarily, in the mean azimuthal deviation from the fiber axis. For one texture, the 〈111〉 axes of individual grains are found to have an average deviation of 1.5° from the foil normal, a second is characterized by a mean deviation of 5°, and a third is more nearly random with only a slight 〈111〉 orientation preference. The shapes of the differently oriented regions depend on the preparation of the sodium chloride substrate before deposition. We have studied the dependence of preferential orientation development on substrate surface topography and the evolution of microstructure in differently textured regions. Hillock growth, observed only in nearly randomly oriented regions of the films, cannot be explained by current theories of grain growth or hillock formation.