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Objective: Arousal (AR) from sleep is associated with an autonomic reflex activation raising blood pressure and heart rate (HR). Recent studies indicate that sleep deprivation may affect the autonomic system, contributing to high vascular risk. Since in sleep disorders a sleep fragmentation and a partial sleep deprivation occurs, it could be suggested that the cardiovascular effects observed at AR from sleep might be physiologically affected when associated with sleep deprivation. The aim of the study was to examine the effect of sleep deprivation on cardiac arousal response in healthy subjects., Methods: Seven healthy male subjects participated in a 64 h sleep deprivation protocol. Arousals were classified into four groups, i.e. >3<6 s, >6<10 s, >10<15 s and >15 s, according to their duration. Pre-AR HR values were measured during 10 beats preceding the AR onset, and the event-related HR fluctuations were calculated during the 20 beats following AR onset. As an index of cardiac activation, the ratio of highest HR in the post-AR period over the lowest recorded before AR (HR ratio) was calculated., Results: For AR lasting less than 10 s, the occurrence of AR induces typical HR oscillations in a bimodal pattern, tachycardia followed by bradycardia. For AR lasting more than 10 s, i.e. awakenings, the pattern was unimodal with a more marked and sustained HR rise. The HR response was consistently similar across nights, during NREM and REM sleep, without difference between conditions., Conclusions: Overall, total sleep deprivation appeared to have no substantial effect on cardiac response to spontaneous arousals and awakenings from sleep in healthy subjects. Further studies are needed to clarify the role of chronic sleep deprivation on cardiovascular risk in patients with sleep disorders., Significance: In healthy subjects acute prolonged sleep deprivation does not affect the cardiac response to arousal.

Objective: Typical changes in spectral electroencephalographic (EEG) activity and heart rate (HR) have been described in periodic leg movements (PLM) associated with or without microarousals (MA). We aimed to determine the effects of sleep stage and wakefulness on these responses to ascertain whether a common pattern of EEG and HR activation takes place., Methods: The time course of EEG spectral activity and HR variability associated with PLM was analysed in 13 patients during light NREM sleep, rapid-eye-movement (REM) sleep and wakefulness. The same analysis was also conducted for PLM without MA occurring in stage 2., Results: A significant EEG and electrocardiogram (ECG) activation was found associated with PLM during sleep, but not during wakefulness. While in light NREM sleep, an increase in delta and theta bands was detected before the PLM onset, in REM sleep the EEG activation occurred simultaneously with the PLM onset. Moreover, during stage 1 and REM sleep, alpha and fast frequencies tended to remain sustained after the PLM onset. In contrast, during wakefulness, a small and not significant increase in cerebral activity was present, starting at the PLM onset and persisting in the post-movement period. A typical pattern of cardiac response was present during NREM and REM sleep, the autonomic activation being lesser and prolonged during wakefulness., Conclusions: We conclude that the EEG and HR responses to PLM differ between sleep stages and wakefulness with lesser changes found during wakefulness., Significance: These findings suggest that specific sleep state-dependent mechanisms may underlie the occurrence of PLM.

A shorter phase angle between habitual wake time and underlying circadian rhythms has been reported in evening types (E types) compared to morning-types (M types). In this study, phase angles were compared between 12 E types and 12 M types to verify if this difference was observed when the sleep schedule was relatively free from external social constraints. Subjects were selected according to their Morningness-Eveningness Questionnaire score (MEQ score). There were 6 men and 6 women in each group (ages 19-34 years), and all had a habitual sleep duration between 7 and 9 h. Sleep schedule was recorded by actigraphy and averaged over 7 days. Circadian phase was estimated by the hour of temperature minimum (T(min)) in a 26-h recording and by the timing of the onset of melatonin secretion (dim-light melatonin onset [DLMO]) measured in saliva samples. Phase angles were defined as the interval between phase markers and averaged wake time. Results showed that, in the present experimental conditions, phase angles were very similar in the 2 groups of subjects. However, results confirmed the previously reported correlation between phase and phase angle, showing that a later circadian phase was associated with a shorter phase angle. Gender comparisons showed that for a same MEQ score, women had an earlier DLMO and a longer phase angle between DLMO and wake time. Despite a significant difference in the averaged circadian phases between E-type and M-type groups, there was an overlap in the circadian phases of the subjects of the 2 groups. Further comparisons were made between the 2 circadian types, separately for the subgroups with overlapping or nonoverlapping circadian phases. In both subgroups, the significant difference between MEQ scores, bedtimes, and wake times were maintained in the expected direction. In the subgroup with nonoverlapping circadian phases, phase angles were shorter in E-type subjects, in accordance with previous studies. However, in the overlapping subgroup, phase angles were significantly longer in E types compared to M types. Results suggest that the morningness-eveningness preference identified by the MEQ score refers to 2 distinct mechanisms, 1 associated with a difference in circadian period and phase of entrainment and the other associated with chronobiological aspects of sleep regulation.

Reflectance FTIR spectroscopy (RAIRS) was used to study the chemisorption and intermolecular interactions of methyl pyruvate and (+/-)-1-(1-naphthyl)ethylamine (NEA) on Pt(111). NEA serves, in this study, as a tractable model of a chiral modifier in the asymmetric hydrogenation of alpha-dicarbonyls on alkaloid-modified platinum surfaces-the Orito reaction. The results show the presence of a majority enediolate state on the clean surface. A perpendicularly adsorbed trans conformation state is populated at close to full-monolayer coverage on the clean surface. The latter state desorbs at 185 K. The enediolate undergoes dissociation at 230 K. NEA displays hydrogen-bond association at high coverages. Coadsorption studies show that NEA inhibits the formation of the enediolate state. Multilayer methyl pyruvate shows a clear hydrogen-bond interaction with chemisorbed NEA, leading to a reorientation of the ethylamine group. The high-coverage trans-chemisorbed methyl pyruvate state also hydrogen-bonds to chemisorbed NEA. The latter interaction renders the trans state stable to above 300 K. A new schematic mechanism for the Orito reaction is proposed on the basis of these data.

Fourteen healthy subjects (8 women, 6 men, aged 22-35 yr) were recruited. Each subject was exposed, in a counterbalanced order, to bright white light (BWL: 3000 lux) and to dim red light (DRL: <15 lux) at a 1-week interval. Light treatments were administered from 00:30 to 04:30 h during sleep deprivation. Salivary melatonin and urinary cortisol concentrations were measured as was core body temperature. Vigilance levels were evaluated by subjective estimates, maintenance of wakefulness tests (MWT), waking EEG recordings, and three performance tests. Under BWL melatonin secretion was suppressed and core body temperature was significantly higher than under DRL. The BWL and DRL conditions produced no difference in cortisol secretion. Significant effects of BWL treatment were found for the MWT and theta-alpha and beta-1 frequency bands of the waking EEG. There was no significant effect of BWL on subjective alertness and performance. Vigilance measures were similar under the two conditions for the tests performed 1.5 h after the end of light treatments. Overall, the findings suggest that bright light (BL) exposure in the first half of the night decreases EEG-defined sleep propensity but has only modest effects on other aspects of vigilance.

The load-sharing characteristics of threaded interbody cages before and after cyclic loading are poorly understood. In the current study, lumbar interbody cages were filled with epoxy, sectioned longitudinally, and pressure sensors were placed between halves of the cages to measure the distribution of loads between and within the cages. Human lumbar spine segments were instrumented anteriorly with bilateral cages and subjected to cyclic compression loads combined with flexion and extension moments. Sagittal plane motion between vertebrae on either side of the cages also was measured during application of cyclic compression and flexion loads. A small but statistically significant asymmetry was found in the distribution of load between the left and right cages, and the extent of asymmetry varied during compression and flexion loading. With ligament tension only, 66% of the load was supported by the posterior regions of the cages, whereas during peaks in the combined compression and flexion loading, only 33% of the load was supported by the posterior regions. The cages reduced intervertebral motion 78% during forward flexion, whereas extension resulted in a 100% increase in motion. Surgeons should recognize that bilateral cages may not share loads equally, and the results of this study suggest that early extension should be restricted after the placement of anterior lumbar interbody cages.

We have examined the contribution of the red nucleus to the control of locomotion in the cat. Neuronal activity was recorded from 157 rubral neurons, including identified rubrospinal neurons, in three cats trained to walk on a treadmill and to step over obstacles attached to the moving belt. Of 72 neurons with a receptive field confined to the contralateral forelimb, 66 were phasically active during unobstructed locomotion. The maximal activity of the majority of neurons (59/66) was centered around the swing phase of locomotion. Slightly more than half of the neurons (36/66) were phasically activity during both swing and stance. In addition, some rubral neurons (14/66) showed multiple periods of phasic activity within the swing phase of the locomotor cycle. Periods of phasic discharge temporally coincident with the swing phase of the ipsilateral limb were observed in 7/66 neurons. During voluntary gait modifications, most forelimb-related neurons (70/72) showed a significant increase in their discharge activity when the contralateral limb was the first to step over the obstacle (lead condition). Maximal activity in nearly all cells (63/70) was observed during the swing phase, and 23/63 rubral neurons exhibited multiple increases of activity during the modified swing phase. A number of cells (18/70) showed multiple periods of increased activity during swing and stance. Many of the neurons (35/63, 56%) showed an increase in activity at the end of the swing phase; this period of activity was temporally coincident with the period of activity in wrist dorsiflexors, such as the extensor digitorum communis. A smaller proportion of neurons with receptive fields restricted to the hindlimbs showed similar characteristics to those observed in the population of forelimb-related neurons. The overall characteristics of these rubral neurons are similar to those that we obtained previously from pyramidal tract neurons recorded from the motor cortex during an identical task. However, in contrast to the results obtained in the rubral neurons, most motor cortical neurons showed only one period of increased activity during the step cycle. We suggest that both structures contribute to the modifications of the pattern of EMG activity that are required to produce the change in limb trajectory needed to step over an obstacle. However, the results suggest an additional role for the red nucleus in regulating intra- and interlimb coordination.

We identify and characterize several phosphorylated forms of the hSpt5 subunit of the DRB sensitivity-inducing factor (DSIF). A 175-kDa phosphorylated form of hSpt5 is bound to nuclei of interphase HeLa cells. This form is rapidly dephosphorylated when cultured cells are exposed to various drugs belonging to distinct chemical families. All these compounds are known to inhibit the protein kinase Cdk9, which phosphorylates in vitro hSpt5 and Rpb1, the largest subunit of RNA polymerase II. The efficiency to promote the dephosphorylation of both proteins matches their capacity to inhibit purified Cdk9 kinase, suggesting that Cdk9 is the major kinase phosphorylating hSpt5 and Rpb1 in vivo. We show that Cdk9 phosphorylates both the CTR1 and the CTR2 domains of recombinant hSpt5. These domains contain numerous serine-proline and threonine-proline residues similar to those found in the carboxyl-terminal domain (CTD) of Rpb1. The structural homology between hSpt5 CTRs and the Rpb1 CTD is further highlighted by the presence on both proteins of a phosphoepitope recognized by the monoclonal antibody CC-3. Of particular interest, the peptidyl-prolyl isomerase Pin1 interacts with Cdk9-phosphorylated hSpt5. Cdk9 dependent phosphorylation of Rpb1 and hSpt5 followed by Pin1 interaction might thus contribute to the regulation of transcription, pre-mRNA maturation, and the dynamics of these proteins in interphase and mitosis., (Copyright 2001 Academic Press.)

Background: Influenza causes school absenteeism and may cause parents to miss work to care for sick children. However, it is not known whether these factors influence parental acceptance of childhood vaccination., Methods: A survey was mailed to parents of 1,805 children attending 3 elementary schools. It included questions about school absenteeism and employment status for adults who stayed home to care for an ill child. Parents were asked if they would consider vaccinating their child against a common wintertime respiratory virus., Results: Of the 972 surveys returned (54% return rate), 954 could be analyzed. Only 13% of respondents stated that they would not consider vaccination for their child. Sixty-nine percent of children had been absent from school because of a nonasthma respiratory illness, with an average of 2.54 days missed per child. Among respondents whose child had missed any school, 33% would definitely consider vaccination compared with 24% of respondents whose child had not missed school (P < 0.01). As children missed more school days, vaccine acceptance increased. In 53% of families, an adult had to miss work to care for the ill child. Vaccine acceptance was higher if an adult caretaker had to lose time from work because of a child's illness (35% versus 25% for non-working caretakers, P < 0.01)., Conclusion: Vaccine acceptance was closely linked with the amount of absenteeism caused by respiratory illness in the previous year. Parents who had to miss work to care for an ill child were more accepting of the vaccine than were other parents.

Objective: To analyze the costs and benefits of influenza vaccination of healthy school-aged children., Design: The analysis was based on data from the literature. Total costs included direct medical costs for vaccination, physician visits, and treatment as well as indirect costs. Indirect costs were in the form of lost productivity when working parents stayed home to care for ill children or to take children to an office for vaccination. The total costs of vaccination strategies were compared with the total cost of not vaccinating. For the base case, the vaccine was assumed to have no effect on rates of otitis media., Setting: Two hypothetical scenarios were investigated 1) individual-initiated vaccination and 2) vaccination in a group-based setting. The former scenario required the child to be accompanied to a clinic by a parent during usual work hours., Results: Vaccination resulted in a net savings per child vaccinated of $4 for individual-initiated vaccination and of $35 for group-based vaccination. The savings were caused primarily by averted indirect costs. Moderate increases in the cost of vaccination or reductions in the rate of influenza would eliminate the savings for individual-initiated vaccination but not for group-based vaccination. Alternatively, if influenza vaccination was effective in reducing rates of otitis media, the net savings from vaccination would be substantially higher than the base case., Conclusion: Vaccination of school-aged children against influenza could have substantial financial benefits to society, especially if performed in a group-based setting. influenza, cost-effectiveness, vaccination, children, cost.

Effects of red nucleus microstimulation on the locomotor pattern and timing in the intact cat: a comparison with the motor cortex. To determine the extent to which the rubrospinal tract is capable of modifying locomotion in the intact cat, we applied microstimulation (cathodal current, 330 Hz; pulse duration 0.2 ms; maximal current, 25 microA) to the red nucleus during locomotion. The stimuli were applied either as short trains (33 ms) of impulses to determine the capacity of the rubrospinal tract to modify the level of electromyographic (EMG) activity in different flexors and extensors at different phases of the step cycle or as long trains (200 ms) of pulses to determine the effect of the red nucleus on cycle timing. Stimuli were also applied with the cat at rest (33-ms train). This latter stimulation evoked short-latency (average = 11.8-19.0 ms) facilitatory responses in all of the physiological flexor muscles of the forelimb that were recorded; facilitatory responses were also common in the elbow extensor, lateral head of triceps but were rare in the physiological wrist and digit extensor, palmaris longus. Responses were still evoked in most muscles when the current was decreased to near threshold (3-10 microA). Stimulation during locomotion with the short trains of stimuli evoked shorter-latency (average = 6.0-12.5 ms) facilitatory responses in flexor muscles during the swing phase of locomotion and, except in the case of the extensor digitorum communis, evoked substantially smaller responses in stance. The same stimuli also evoked facilitatory responses in the extensor muscles during swing and produced more complex effects involving both facilitation and suppression in stance. Increasing the duration of the train to 200 ms modified the amplitude and duration of the EMG activity of both flexors and extensors but had little significant effect on the cycle duration. In contrast, whereas stimulation of the motor cortex with short trains of stimuli during locomotion had very similar effects to that of the red nucleus, increasing the train duration to 200 ms frequently produced a marked reset of the step cycle by curtailing stance and initiating a new period of swing. The results suggest that whereas both the motor cortex and the red nucleus have access to the interneuronal circuits responsible for controlling the structure of the EMG activity in the step cycle, only the motor cortex has access to the circuits responsible for controlling cycle timing.

The safe control of walking over different terrains requires appropriate adaptations in the dynamic and kinematic limb patterns. To date, the study of locomotor dynamics in the cat has been confined to level, unobstructed walking. The present study extends the work of Lavoie et al. by applying linked segment analyses to estimate muscle contributions to torque and mechanical power at the hindlimb joints of two female cats during both unobstructed walking and obstacle avoidance. Data during obstacle avoidance were analyzed both when the hindlimb led in clearance and was farthest from the obstacle, and when it trailed in clearance and was closest or near to the obstacle. It was found that, in both the Far and Near obstructed conditions, the cats cleared the obstacles primarily by increasing the knee flexor torque already used during unobstructed gait. Contributions from the hip and ankle muscle groups were more variable. There was more emphasis on the hip extensors in mid to late stance, and the hip flexors generated a small amount of energy at paw-lift in the Far condition. In the Near condition, the hip extensors were employed to control hip flexion. We suggest that hip flexor generation power in mid-swing contributes to the clearance of the upcoming obstacle in the Far condition while, in the Near condition, hip flexion advances the already extended limb ahead of the obstacle. The ankle was actively dorsiflexed in the Near condition but was maintained in extension in the Far condition. The emphasis on active knee flexor control by the cat to avoid obstacles, as well as the dependence of ankle control on obstacle proximity, is similar to strategies seen for humans. However, the knee flexor strategy is innate to the cat's normal level walking control, whereas in humans active knee flexion at toe-off requires a reorganization from level, non-obstructed gait.

The phosphorylation of the carboxy-terminal domain of the largest subunit of RNA polymerase II plays an important role in the regulation of transcriptional activity and is also implicated in pre-mRNA processing. Different stresses, such as a heat shock, induce a marked alteration in the phosphorylation of this domain. The expression of stress genes by RNA polymerase II, to the detriment of other genes, could be attributable to such modifications of the phosphorylation sites. Using two phosphodependent antibodies recognizing distinct hyperphosphorylated forms of RNA polymerase II largest subunit, we studied the phosphorylation state of the subunit in different species after heat shocks of varying intensities. One of these antibodies, CC-3, preferentially recognizes the carboxy-terminal domain of the largest subunit under normal conditions, but its reactivity is diminished during stress. In contrast, the other antibody used, MPM-2, demonstrated a strong reactivity after a heat shock in most species studied. Therefore, CC-3 and MPM-2 antibodies discriminate between phosphoisomers that may be functionally different. Our results further indicate that the pattern of phosphorylation of RNA polymerase II in most species varies in response to environmental stress.

The monoclonal antibody CC-3 recognizes a phosphodependent epitope on a 255 kDa nuclear matrix protein (p255) recently shown to associate with splicing complexes as part of the [U4/U6.U5] tri-snRNP particle [Chabot et al. (1995) Nucleic Acids Res. 23, 3206-3213]. In mouse and Drosophila cultured cells the electrophoretic mobility of p255, faster in the latter species, was identical to that of the hyperphosphorylated form of RNA polymerase II largest subunit (IIo). The CC-3 immunoreactivity of p255 was abolished by 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole, which is known to cause the dephosphorylation of the C-terminal domain of subunit IIo by inhibiting the TFIIH-associated kinase. The identity of p255 was confirmed by showing that CC-3-immunoprecipitated p255 was recognized by POL3/3 and 8WG16, two antibodies specific to RNA polymerase II largest subunit. Lastly, the recovery of RNA polymerase II largest subunit from HeLa splicing mixtures was compromised by EDTA, which prevents the interaction of p255 with splicing complexes and inhibits splicing. Our results indicate that p255 represents a highly phosphorylated form of RNA polymerase II largest subunit physically associated with spliceosomes and possibly involved in coupling transcription to RNA processing.

A controlled trial of cyclosporine in patients diagnosed with progressive membranous nephropathy (MGN) was carried out to determine whether cyclosporine (D) would be more effective than placebo (P) in reducing the rate of deterioration in renal function. Patients (N = 64) with MGN were placed on a restricted protein diet (< or = 0.9 g/kg) and followed closely for 12 months (Part 1). Patients at high risk of progression based on an absolute loss in creatinine clearance (CCr) of > or = 8 ml/min and persistent nephrotic range proteinuria (Pr) were selected and randomly assigned to either (D) (N = 9) or (P) (N = 8) for 12 months (Part 2). No differences in the two groups were noted at entry. After 12 months, the improvement in CCr slope in ml/min/month was significantly greater in the D patients (D + 2.1 vs. P + 0.5, mean difference 1.6; 95% CI 0.3 to 3.0, P < 0.02). This improvement was maintained in six of eight D (75%) over a mean follow-up period of 21 months. Daily Pr also improved with D (by month 3, D - 4.5 g/day vs. P + 0.7 g/day, P = 0.02) and was sustained in six of eight (75%) D patients. When Pr was expressed as a function of their concurrent CCr, the D versus P patients' time to halving was faster (P = 0.02) and absolute number higher (4/9 D vs 0/8 P). In the D group a trend towards worse hypertension and an increase in the number of transient rises in serum creatinine were noted.(ABSTRACT TRUNCATED AT 250 WORDS)

A 31-year-old, obese woman with extrameningeal cryptococcal disease was admitted to the Medical College of Virginia for antifungal therapy. Various physiologic variables influence flucytosine pharmacokinetics, and there are no guidelines for dosing the agent in obese patients. This patient received a dosage based on her ideal body weight, and serum drug concentrations were monitored. She recovered without sequelae.

As part of a study to characterize the postural reactions that occur during voluntary gait modification, we examined the kinematic, electromyographic (EMG), and kinetic responses that occurred when cats stepped over an obstacle placed in their path. Analyses of the kinematics as each of the forelimbs stepped over the obstacle showed that changes in joint angles were most pronounced at the elbow of the first (lead) limb, and at the shoulder of the second (trailing) limb. In the hindlimbs, there was a pronounced change in the knee joint angle in both the leading and trailing limbs. Examination of the horizontal and vertical velocities of the tip of the forepaw suggests that the movements can be divided into two phases: one in which the limb is rapidly lifted above and over the obstacle, and a slower one during which the limb is carefully repositioned on the floor. On the basis of the velocity profiles, we suggest that the repositioning of the paw on the support surface is more critically controlled for the forelimb than for the hindlimb. Analysis of the changes in the ground reaction forces in the supporting limbs during these gait modifications showed that there were two major increases in vertical reaction force. One of these occurred as the two forelimbs were straddling the obstacle, the other when the two hindlimbs were straddling it. There was also a net increase in the anteroposterior force that resulted in a small increase in propulsion as the cat stepped over the obstacle. Each change in the vertical ground reaction force was paralleled by a similar change in the amplitude of the EMG recorded from the respective extensor muscles. An analysis of the vertical displacement of the scapula and of the pelvis showed that there was a slight increase in the height of the scapula in the support limb just prior to and during the swing phase of the trailing forelimb, and a more pronounced and progressive change in the height of the pelvis prior to and during the passage of both hindlimbs over the obstacle. We suggest that the increases in vertical ground reaction force raise the height of the body sufficiently to allow, respectively, passage of the trail forelimb and each of the hindlimbs over the obstacle. The results are discussed with respect to both the biomechanical changes underlying these gait modifications and the neuronal mechanisms implicated in their control.

Genital herpes infections are a major source of morbidity. These infections are responsible for significant health problems, including direct physical discomfort associated with outbreaks, potential complications such as neonatal transmission, and the often devastating psychological effects of a chronic illness. In addition, herpes infections have been identified as a significant co-factor in the transmission of human immunodeficiency virus infection. Accurate and rapid diagnosis and treatment are important steps necessary to minimize these effects.

Twenty-three patients with progressive systemic sclerosis (PSS) were studied by radionuclide esophageal transit (RT) and esophageal manometry. Twenty-two patients had abnormal manometry ranging from lower esophageal sphincter incompetence to aperistaltism. Of these 22 patients, twenty (91%) had abnormal RT with prolongation of transit time. A characteristic RT pattern showing stagnation of the radionuclide in the distal and middle segments of the esophagus was demonstrated in 82% of the patients with advanced sclerodermatous involvement of the esophagus. Fifteen of the 19 controls (79%) studied had a normal RT. Four showed prolongation of transit time without stagnation. We conclude that RT is a safe, noninvasive, highly sensitive method which might be used as an alternative to esophageal manometry. However, it may lack specificity.

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant transmitted condition seen mainly in the French Canadian population. Twenty-one patients with an established diagnosis of this rare disease underwent inferior constrictor myotomy. All patients were evaluated clinically and 12 of them underwent pharyngoesophageal manometric evaluation both preoperatively and postoperatively. All patients presented with severe oropharyngeal dysphagia and frequent aspiration together with pharyngooral and pharyngonasal regurgitation. Our results showed that all symptoms were significantly improved after inferior constrictor myotomy. Manometric assessment showed significant differences in pressure, duration and frequency of pharyngeal contraction when compared with a control group. After surgery pharyngeal contraction frequency was significantly lowered toward the normal level but other parameters of pharyngeal function remained unchanged. At the level of the upper esophageal sphincter, resting and closing pressure, relaxation time, relaxation and coordination were studied. There was no significant difference between control subjects and OPMD patients for these variables. Surgery significantly lowered the resting and closing pressure of the sphincter but did not modify significantly the other parameters.