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Introduction Persons with multiple sclerosis (MS) frequently report pain that negatively affects their quality of life. Evidence linking pain and corticospinal excitability in MS is sparse. We aimed to (1) examine differences in corticospinal excitability in MS participants with and without pain and (2) explore predictors of pain. Methods Sixty-four participants rated their pain severity on a visual analog scale (VAS). Transcranial magnetic stimulation (TMS) and validated clinical instruments characterized corticospinal excitability and subjective disease features like mood and fatigue. We retrieved information on participants' prescriptions and disability status from their clinical records. Results Fifty-five percent of participants reported pain that affected their daily functioning. Persons with pain had significantly greater fatigue and lower area under the excitatory motor evoked potential (MEP) recruitment curve (eREC AUC), a measure of total corticospinal excitability. After controlling for age, disability status, and pain medications, increased fatigue and decreased eREC AUC together explained 40% of the variance in pain. Discussion Pain in MS is multifactorial and relates to both greater fatigue and lesser corticospinal excitability. Future work should better characterize relationships between these outcomes to develop targeted pain interventions such as neuromodulation. Summary We examined pain in MS. Individuals with pain had higher fatigue and lower corticospinal excitability than those without pain. These outcomes significantly predicted self-reported pain.

The enolase superfamily (ENS) has served as a paradigm for understanding how enzymes that share a conserved structure, as well as a common partial reaction (i.e., metal-assisted, Brønsted base-catalyzed enol(ate) formation), evolved from a common progenitor to catalyze mechanistically diverse reactions. Enzymes of the mandelate racemase (MR)-subgroup of the ENS share interdigitating loops between adjacent, 2-fold symmetry-related protomers of the tightly associated homodimers that comprise their quaternary structures. For the MR-subgroup members MR and d-tartrate dehydratase (TarD), the tip of the loop contributes a binding determinant to the adjacent active site (i.e., Leu 93 and Lys 102, respectively). To assess the role of Leu 93 of MR in substrate specificity and catalysis, we constructed L93 variants bearing hydrophobic (L93A, L93F, and L93W), polar neutral (L93N), acidic (L93D), or basic (L93K and L93R) residues at position 93. Gel filtration-HPLC revealed that wild-type MR and all L93 MR variants, apart from L93R MR (dimeric), were tetrameric in solution. The catalytic efficiency (k

The objective of this study was to investigate the effects of supplementation of an exogenous enzyme preparation (EEP) on performance, total-tract digestibility of nutrients, plasma AA profile, and milk fatty acids composition in lactating dairy cows fed a reduced-starch diet compared with a normal-starch diet (i.e., positive control). Forty-eight Holstein cows (28 primiparous and 20 multiparous) were enrolled in a 10-wk randomized complete block design experiment with 16 cows per treatment. Treatments were as follows: (1) normal-starch diet (control) containing (% dry matter basis) 24.8% starch and 33.0% neutral detergent fiber (NDF), (2) reduced-starch diet (RSD) containing 18.4% starch and 39.1% NDF, or (3) RSD supplemented with 10 g/cow per day of an EEP (ENZ). The EEP contained amylolytic and fibrolytic activities and was top-dressed on the total mixed ration at the time of feeding. Compared with normal-starch diet, dry matter intake and milk and energy-corrected milk (ECM) yields were lower (on average by 7.1, 9.5, and 7.2%, respectively) for cows on the RSD treatments. Concentrations, but not yields, of milk fat and total solids were increased by RSD. Energy-corrected milk feed efficiency did not differ among treatments. Total-tract digestibility of NDF tended to increase by RSD treatments. Plasma AA concentrations were not affected by treatment, except that of 3-methylhistidine was increased by ENZ, compared with RSD. Blood glucose concentration tended to be lower in cows on the RSD treatments, but ENZ increased glucose and tended to increase insulin concentrations at 4 h after feeding when compared with RSD. Cows on the RSD treatments had decreased concentrations of de novo fatty acids and tended to have increased concentrations of preformed fatty acids in milk. Overall, decreasing dietary starch concentration by 26% decreased dry matter intake, milk, and ECM yields, but ECM feed efficiency was not different among treatments. The negative effects of reducing dietary starch on production were not attenuated by the EEP.

Mandelate racemase (MR) catalyzes the interconversion of the enantiomers of mandelate using a two-base mechanism with Lys 166 acting as the Bronsted base to abstract the α-proton from (S)-mandelate. The resulting intermediate is subsequently re-protonated by the conjugate acid of His 297 to yield (R)-mandelate. The roles of these amino acids are reversed when (R)-mandelate is the substrate. The side chains of Tyr 137, Lys 164, and Lys 166 form a H-bonding network and the proximity of the two e-NH3+ groups is believed to lower the pKa of Lys 166. We used site-directed mutagenesis, kinetics, and pH-rate studies to explore the roles of Lys 164 (K164 C/M) and Tyr 137 (Y137 L/F/S/T) in catalysis. The efficiency (kcat/Km) was reduced ∼3.5 × 105-fold for K164C MR, relative to wild-type MR, indicating a major role for this residue in catalysis. The efficiency of Y137F MR, however, was reduced only 25–30-fold. pH-Rate profiles (log kcat vs. pH) revealed that substitution of Tyr 137 by Phe increased the kinetic pKa of Lys 166 from 5.88 ± 0.02 to 7.3 ± 0.2. Hence, Tyr 137 plays an important role in facilitating the reduction of the pKa of the Bronsted base Lys 166 by ∼1.4 units. Interestingly, the Phe substitution also increased the kinetic pKa of His 297 from 5.97 ± 0.04 to 7.1 ± 0.1. Thus, the Tyr 137-Lys 164-Lys 166 H-bonding network plays a broader role in modulating the pKa of catalytic residues by influencing the electrostatic character of the entire active site, not only by decreasing the observed pKa value of Lys 166, but also by decreasing the pKa of His 297 by 1.1 units.

Background The selection of optimal donor is crucial for successful hematopoietic stem cell transplantation (HSCT). Thereby, it is appropriate to know, in addition to basic human leukocyte antigen (HLA) gene matches, other immunogenic or nonimmunogenic parameters predicting the outcome of transplant. Objective A unified approach is necessary to provide a comprehensive view of the patient-donor compatibility characterization outside of standard HLA genes. The approach should be applicable as a tool for optimizing procedures for extended donor typing and/or verification typing of a donor. Methods The study used the summary, unification, and innovation of existing practical knowledge and experience of the Czech National Marrow Donor Registry of various factors beyond HLA matching with impact on transplant outcome. Results An information technology system–implemented procedure (a verification algorithm) is presented as the decision support approach for prematurely discarding less suitable donors from the transplantation process. It is intended primarily for the transplant specialist to help establish optimal procedures for verifying and determining donor critical factors. Conclusions A process defining HLAs, killer cell immunoglobulin–like receptors, and cytokine typing strategies was proposed to provide support to a transplant specialist in refining the choice of a suitable donor.

Das Harlekinsyndrom ist eine seltene Symptomkonstellation, gekennzeichnet durch einseitige Anhidrose und Blasse des Gesichts auf der betroffenen Seite, was insbesondere durch kontralaterale Rotung wahrend sportlicher Aktivitat erkennbar wird. Das Syndrom ist meistens idiopathisch, tritt aber auch nach thoraxchirurgischen Eingriffen auf, vor allem bei Oberlappenresektionen. Im Folgenden prasentieren wir zwei Falle eines Harlekinsyndroms nach zervikothorakaler Skoliosechirurgie.

Harlequin syndrome is a rare combination of symptoms, characterized by unilateral facial anhidrosis and paleness on the affected side, becoming obvious by contralateral flushing mainly during sports activity. The syndrome is mostly idiopathic, however it is also described as a complication of thoracic surgery, i.e. superior lobectomy. Here, we report on two cases of Harlequin syndrome following scoliosis surgery at the cervicothoracic junction.

Mandelate racemase (MR) catalyzes the interconversion of the enantiomers of mandelate using a two-base mechanism with Lys 166 acting as the Brønsted base to abstract the α-proton from (S)-mandelate. The resulting intermediate is subsequently re-protonated by the conjugate acid of His 297 to yield (R)-mandelate. The roles of these amino acids are reversed when (R)-mandelate is the substrate. The side chains of Tyr 137, Lys 164, and Lys 166 form a H-bonding network and the proximity of the two ε-NH

Research notes supply chains where competitors selling the same types of products at the same level of the supply chain may work together to achieve superior profits, using the term “co-opetition” to describe the phenomenon. Using a co-opetitive supply chain design in the bearing and power transmission industry as a practical guide, we develop a multi-level simulation to compare the effects of serial versus a co-opetitive supply chain design on inventory management, order fulfillment, and cost performance. Specifically, we examine supply chain network membership, product demand volatility, and in-transit shipping consolidation effects in our model. This research aims to (1) quantify the performance benefits to be expected from co-opetition and (2) examine the structural conditions present that may enable these co-opetitive networks to achieve value-added inventory cost and delivery performance. We find that the co-opetitive distribution strategies can significantly improve inventory management performance when supply chains have a larger number of competing products, manufacturer׳s product freight-billing allows for in-transit shipping, and supply networks have a longer reach.

The Northridge earthquake of 1994 displaced almost 10,000 families and destroyed major transportation infrastructure within Southern California, and Hurricane Katrina created the largest national housing crisis since the Dust Bowl of 1930, destroying over 300,000 homes and leaving over one million people seeking shelter. Numerous smaller disasters each year such as tornados, costal or inland flooding, and less severe earthquakes also destroy homes and displace families, although on a much smaller scale. Arranging housing for disaster victims ranks as a top priority after the immediate needs for food and medical care are met. This task becomes more challenging as families are displaced for a longer period of time due to increases in costs, government involvement, and expectations of the victims. In early 2009, FEMA released the first-ever National Disaster Housing Strategy which calls for improved planning and outlines the key principles and policies guiding disaster sheltering, interim housing, and restoration of permanent housing. While all three housing problems are very difficult, the provision of adequate temporary or interim housing is perhaps the most challenging. A few researchers have addressed the issue of optimal allocation of temporary housing, but have focused primarily on the first part of the problem which focuses on the selection of adequate capacity from among available interim housing alternatives. The second part of the problem, which consists of recommending housing alternatives to individual families from the pool of temporary housing units selected in phase one such that educational, healthcare, and socio-economic needs are met, has not yet been addressed to the best of our knowledge. We propose a decision support system for assigning families to housing units which addresses these needs. We develop a benchmark integer programming model for developing a balanced housing plan, and then use the model to evaluate three heuristics which could be practically applied with our system. We use a prototypical example to illustrate the model and evaluate the heuristics, and to demonstrate their appropriateness for the development of realistic real-time housing recommendations. We model the recommendation of housing alternatives to disaster victims.Our goal is to minimize distance to socio-economic support structure.Heuristics are developed to allow for real-time support.The best heuristic uses a weighted preference between distance and housing size.We use this heuristic as the foundation of a decision support system.

Instructors look for ways to explain to students how supply chains can be constructed so that competing suppliers can work together to improve inventory management performance (i.e., a phenomenon known as co-opetition). An Excel spreadsheet-driven simulation is presented that models a complete multilevel supply chain system—customer, retailer, wholesaler, distributor, and manufacturer—for up to six competing products. Students are provided the opportunity to compare the inventory cost and other key performance metrics of the alternative multilevel supply chain structures. This article explains the simulation model, describes the instructional approach, and presents assessment results from students in an introductory operations management course. Students find that the simulation is easy to use and helps them understand the performance impact of strategic supplier collaborations on supply chain operating performance.

Sudden unilateral loss of vestibular function is the most severe condition that can occur in the vestibular system. The clinical syndrome is caused by the physiologic properties of the vestibulo-ocular reflex (VOR) arc. In the normal situation, the two peripheral vestibular end organs are connected to a functional unit in coplanar pairs of semicircular canals working in a push-pull mode. "Push-pull" mode means that, when one side is excited, the other side is inhibited, and vice versa due to two mechanisms. First, first-order vestibular afferents are bipolar cells. They have a tonic firing rate that is modulated up or down depending on the direction of rotation. Second, via inhibitory neural connections of second-order vestibular neurons between the vestibular nuclei (vestibular commissural system), the excited side inhibits further the contralateral side. The neural signals are encoded as the difference of the change in firing rate of the vestibular neurons modulating the tonic firing rate on both sides in opposite directions (one side up, the contralateral side down). When the head is not moving, the two peripheral vestibular end organs generate a resting firing rate, which is exactly equal on both sides. When the head is rotated, for example, to the right, the right-sided first-order vestibular afferents increase their discharge rate and the left-sided ones decrease their firing rate. This leads to increase in firing rate of also the type I second-order vestibular neurons in the vestibular nuclei, which synapse with inhibitory type II neurons on the contralateral side, further decreasing the firing rate in the second-order vestibular neurons in the contralateral vestibular nucleus. When the direction of head rotation is reversed, the behavior of the type I neurons on the two sides of the head is reversed. The same relation exists between the coplanar vertical canal afferents on the two sides of the head. When there is unilateral damage to the end organ or the vestibular nerve, the resting firing frequency is drastically reduced or even silenced on the lesioned side, thereby creating a tonic imbalance between the normal resting firing on the healthy side and the lesioned side. This tonic imbalance mimics a permanent rotation toward the healthy side (the side with the higher firing rate), resulting, via the VOR, in a slow-phase drift of the eyes toward the side of the lesion, interrupted by rapid quick-phase resetting eye movements toward the healthy side. This leads to the typical vestibular spontaneous horizontal-torsional nystagmus together with rotational vertigo and postural imbalance, with the tendency to fall toward the lesioned side. The tonic imbalance with the hallmark of spontaneous nystagmus usually recovers within days to weeks after the lesion due to the central restoration of tonic activity on the lesioned side. The dynamic changes, however, might be long-lasting when the peripheral sensors do not recover their function. This causes asymmetric VOR responses, with weaker responses when the head is rotated rapidly toward the lesioned side, leading to transient oscillopsia.

Although large amounts of disaster-generated debris significantly strain landfill capacities, until recently existing policy provided no financial incentive to consider other disposal alternatives such as recycling. In 2007, the U.S. Federal Emergency Management Agency (FEMA) released a new pilot program that provides incentives for communities to recycle by allowing them to retain revenue from the sale of disaster debris. This first-ever policy offers significant financial benefits for communities seeking to cleanup in an environmentally responsible way but requires reexamining existing assumptions and decision processes that are based on prior reimbursement programs. This paper presents a decision model with recycling incentives for locating temporary disposal and storage reduction (TDSR) facilities in support of disaster debris cleanup operations. A facility location model is proposed to incorporate the unique assumptions, objectives, and constraints of disaster recovery in light of FEMA’s new policy.

According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (≥60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

Objectives. The effectiveness of 2 different types of gait training in stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath− based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35). Methods. Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender, and lesion site. Motor function in both groups was pre-assessed by the Barthel Index and the Fugl-Meyer Scales. Results. Pre- to posttest measures showed a significant improvement in the RAS group for velocity ( P = .006), stride length ( P = .0001), cadence ( P = .0001) and symmetry ( P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence. Conclusions. The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.

Die Kasuistik beschreibt einerseits den recht typischen, langen Leidensweg, andererseits die diagnostische Methodik zur Entdeckung einer vestibularen Paroxysmie durch neurovaskulare Kompression als Genese von attackenweisem Schwindel und Tinnitus. Entscheidend ist primar die Anamnese: haufige, kurz dauernde gerichtete Schwindelattacken, gelegentlich begleitet von Tinnitus. Diese Schwindelattacken konnen versuchsweise in Analogie zur Trigeminusneuralgie mit Carbamazepin medikamentos behandelt werden bzw. bei Versagen dieser Therapieoption recht erfolgreich neurochirurgisch mit einer mikrovaskularen Dekompression.

Diabetes has significant implications for cardiac surgery. It is not only a major risk factor for coronary heart disease but also increases the risk for cerebrovascular complications during heart surgery. Surgical technique is pivotal for the outcome. "Off-pump" surgery carries a lower risk for stroke than conventional heart surgery. When a stroke happens, diabetes plays also a major role for the final outcome. Initial blood glucose levels during a stroke and final outcome are highly correlated. Consequently, patients with ischemic stroke after cardiac surgery should be treated according to the current criteria for stroke treatment. This includes strict monitoring of blood glucose level and avoidance of hypo- as well as hyperglycemia.

A unique dataset of stomach contents sampled between 1977 and 1999 in the central Baltic Sea was used to perform a comprehensive study of the feeding ecology of Central Baltic herring Clupea harengus and sprat Sprattus sprattus. Both fish species were mainly preying upon calanoid copepods with Pseudocalanus sp. dominating the diet of herring, whereas sprat generally preferred Temora longicornis. Sprat preyed upon older copepodite stages, indicating size-selective particulate feeding, whereas herring additionally fed on smaller copepodite stages, indicating occasional low food supply inducing filter-feeding. Additional food sources other than copepods were mysids in winter and autumn for medium to large herring, as well as cladocerans for sprat in spring and summer, determined by the seasonal occurrence of these plankton species. Seasonally the highest feeding activity of both fishes species occurred in spring and summer, the main reproductive periods of calanoid copepods. The most important food item for both predators in spring was Pseudocalanus sp. In summer sprat switched to T. longicornis and Acartia spp. Since the late 1970s, the total stomach fullness decreased and the fraction of empty stomachs increased. In parallel the amount of Pseudocalanus sp. in the diets of both fish species decreased. Further, a considerable dietary overlap between both species in spring indicated considerable competition for food resources, especially due to an enlarged sprat stock. The results of this study support the hypothesis that growth reductions observed in Baltic herring and sprat are due to combination of a change in food availability and an increase in density-dependent competition.

Pseudocalanus elongatus is a key species in the pelagic zone of the deep basins of the Central Baltic Sea. The copepod serves as a major food organism for larval as well as for adult, pelagic planktivorous fish. Large interannual fluctuations in the standing stock of P. elongatus have been attributed to significant changes in the hydrographic environment over the last two decades. In particular, the decreasing salinity in the Baltic deep basins, a result of a change in atmospheric forcing leading to an increase in rainfall since the 1980s and of a lack of pulses of saline water intrusions from the North Sea, was found to affect reproduction and maturation of the copepod. In parallel, dramatic changes in the weight-at-age of herring, one of the most important commercial fishes of the Baltic Sea, have been observed since the late 1980s. Using time-series on herring stomach contents, as well as length and weight, we provide evidence for a chain of events relating variability in climate, salinity and P. elongatus abundance to changes in diet and condition of herring in the Central Baltic Sea.

The driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.

We report the case of a 35-year-old woman who developed headache and psychosis and gradually became comatose within 3 weeks after a flu-like infection. MRI revealed bifrontal demyelination consistent with acute disseminating encephalomyelitis (ADEM). Two different cerebrospinal fluid samples were positively tested for Legionella cincinnatiensis by direct sequencing of a PCR-amplified Legionella-specific fragment. This result made it possible to interpret the initial symptoms as Pontiac fever. We think it most likely that this is a case of ADEM following the very rare situation of a systemic infection with L. cincinnatiensis. A review of the literature on Legionella-associated encephalopathy suggests that some of these cases may also have had ADEM.

A radioactive nuclear beam of 10.2 MeV $^{6}\mathrm{He}$, with typical intensity 5\ifmmode\times\else\texttimes\fi{}${10}^{4}$ ${\mathrm{s}}^{\mathrm{\ensuremath{-}}1}$, was produced via the $^{9}\mathrm{Be}$${(}^{7}$Li${,}^{6}$He${)}^{10}$B reaction and elastically scattered from targets of $^{12}\mathrm{C}$, $^{\mathrm{nat}}\mathrm{Ni}$, and $^{197}\mathrm{Au}$. Scattering from C and Ni was observed through sufficiently large angles (up to 60\ifmmode^\circ\else\textdegree\fi{} c.m. and 85\ifmmode^\circ\else\textdegree\fi{} c.m., respectively) to show large deviations from Rutherford scattering. The Au target gave, as expected, pure Rutherford scattering. Optical potential previously used for low-energy $^{6}\mathrm{Li}$ and $^{8}\mathrm{Li}$ ions generally accounted for the shapes of the angular distributions but, for $^{12}\mathrm{C}$, predict oscillations not present in the $^{6}\mathrm{He}$ data. $^{4}\mathrm{He}$ optical potentials predict much smaller deviations from Rutherford scattering than those observed.

A magnetic spectrograph and position-sensitive detectors were used to measure the total nuclear reaction probability [eta][sub [ital R]] for [alpha]+CsI at 116 MeV, [sup 14]N+CsI at 265 and 385 MeV, and [sup 14]N+Si at 271 and 390 MeV. From these [eta][sub [ital R]]'s, average reaction cross sections [sigma][sub [ital R]] were deduced for [alpha] and [sup 14]N on CsI; these agree with optical and strong absorption model predictions. These same models predict [sigma][sub [ital R]]'s for [sup 14]N+Si which vary by nearly a factor of 2; our measurement favors the smaller predictions.

According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (or = 60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

Die beste Methode die Funktion der Gleichgewichtsorgane zu uberprufen ist die Untersuchung des vestibulo-okularen Reflexes (VOR). Dieser Reflex hat die Aufgabe, wahrend Kopf- und Korperbewegungen im dreidimensionalen Raum das Bild auf der Netzhaut in allen Freiheitsgraden stabil zu halten, indem die Augen genau gegensinnig zur Kopfdrehung bewegt werden. Wenn Storungen im VOR auftreten, kommt es zu Fehlern bei den erzeugten Augenbewegungen, die der Patient als Scheinbewegungen der Umwelt und als Schwindel empfindet. Durch genaue Beobachtung der Augenbewegungen (z.B. Spontan- und Provokationsnystagmus, pathologische Einstellbewegungen) ist eine Diagnostik auf der Funktionsebene einzelner Bogengange moglich. Man macht sich dabei die bekannte Eigenschaft des VOR zunutze, dass eine isolierte Stimulation der Nervenfasern eines Bogengangs Augenbewegungen ungefahr in der Ebene des jeweils stimulierten Bogengangs auslost. Werden gleichzeitig die Nervenfasern zweier Bogengange stimuliert, ergibt sich eine Augenbewegungsrichtung, die dem geometrischen Mittel der beiden stimulierten Ebenen entspricht. Dieser einfache geometrische Zusammenhang ermoglicht, z.B. bei einem Spontan- oder Provokationsnystagmus auf die auslosenden Bogengange zuruck zu schliesen. Grundsatzlich kann man zwei wesentliche Storungmuster unterscheiden, entweder es kommt zu inadequater Ubererregung einer Seite (Reizschwindel) oder zum einseitigen Ausfall einer Seite (Ausfallschwindel). Die komplexe Funktionsweise der Gleichgewichtsorgane und der durch sie ausgelosten Reflexe konnte durch moderne neurootologische Untersuchungstechniken in den letzten Jahren weitgehend entschlusselt werden. Dies hat zur Entwicklung einfacher klinischer Untersuchungsmethoden gefuhrt, die direkt am Krankenbett eingesetzt werden konnen und sehr prazise die Funktion der verschiedenen Anteile der Gleichgewichtsorgane uberprufen. Anhand typischer klinischer Beispiele werden die Moglichkeiten dieser Untersuchungsmethoden dargestellt.

o Abstract - To further elucidate possible central plastic adaptive processes during the recovery from a unilateral peripheral vestibular lesion, we inves­ tigated vestibular functions in humans over a period of 2 months after an acute unilateral labyrinthine lesion. A unilateral peripheral vestibular lesion cre­ ates both a tonic imbalance that causes spontane­ ous nystagmus and a decrease and directional asymmetry of dynamic vestibular responses. We es­ tablish that the tonic imbalance expressed by the spontaneous nystagmus rapidly decreased (similar to other species), whether the lesion remained com­ plete or not. This rebalancing, in the case of com­ plete lesions, is at least partly due to restoration of central vestibular tone on the lesioned side. This restoration of tone also explains, in the case of a complete lesion, the recovery of dynamic vestibu­ lar responses for high-velocity inhibitory stimula­ tion of the remaining labyrinth. A clear recovery of the dynamic response for excitatory stimulation of the remaining labyrinth cannot be proven, as has been shown in monkeys during the first 4 days af­ ter a unilateral vestibular lesion. This is probably due to the fact that in our patients the first record­ ing could not be performed before day 3 after the onset of symptoms. Therefore, any fast dynamic recovery may have been missed. o Keywords - VOR compensation; unilateral labyrinthine lesion; vestibular system, human.

The authors report an 18-year-old male patient with acute onset hemiparesis on the right side, difficulties in speaking and swallowing, and upbeat nystagmus changing to downbeat nystagmus on convergence, with a circumscribed structural lesion in the lower medulla on MRI scan. Stereotactic biopsy did not disclose the diagnosis, only nonspecific edema with gliosis and siderophages was found. Accordingly, a nonspecific inflammation was suspected. Over several months most of the symptoms, except the hemiparesis, subsided despite the fact that the lesion did not change in size or enhancement on MRI scan. To our knowledge, this is the first case with a localized structural lesion that shows this unusual oculomotor syndrome. The syndrome is discussed in the light of recent results on the origin of vertical spontaneous nystagmus.

The diagnosis and treatment of vertigo are very common in ear nose and throat medicine and neurology. As our case report demonstrates, an interdisciplinary approach is often useful for finding the correct diagnosis. Diagnosing disabling positional vertigo now seems uncomplicated using special MRI. More important is the history of frequent, short-term vertigo, sometimes accompanied by tinnitus. In analogy to trigeminal neuralgia, treatment should be started with carbamazepine or similar drugs. If unsuccessful, microvascular decompression as a neurosurgical intervention is recommended.

Diabetes has significant implications for cardiac surgery. It is not only a major risk factor for coronary heart disease but also increases the risk for cerebrovascular complications during heart surgery. Surgical technique is pivotal for the outcome. "Off-pump" surgery carries a lower risk for stroke than conventional heart surgery. When a stroke happens, diabetes plays also a major role for the final outcome. Initial blood glucose levels during a stroke and final outcome are highly correlated. Consequently, patients with ischemic stroke after cardiac surgery should be treated according to the current criteria for stroke treatment. This includes strict monitoring of blood glucose level and avoidance of hypo- as well as hyperglycemia.

Slow saccades are often found in degenerative ataxia. Experimental studies have shown that horizontal saccades are generated in the paramedian pontine reticular formation and that lesions in this area produce slow saccades. Based on these findings, saccade slowing should be a frequent feature of olivopontocerebellar atrophy, a type of cerebellar degeneration with prominent involvement of the pons. To test this hypothesis, saccade velocity was measured in 31 patients with autosomal dominant cerebellar ataxia (ADCA) and 17 patients with idiopathic cerebellar ataxia (IDCA). Saccade velocity was reduced in most patients with ADCA whereas it was normal in IDCA although olivopontocerebellar atrophy occurred in both groups. Saccade velocities correlated with pontine size in ADCA but not in IDCA. The data disprove the hypothesis that saccadic slowing is a clinical hallmark of olivopontocerebellar atrophy. Instead, only patients with ADCA and morphological features of olivopontocerebellar atrophy have slow saccades.

Proof of the effectiveness of preventive measures that reduce established risk traits for atherothrombotic disorders has spurred attempts to systematically apply these interventions among susceptible populations. One such attempt is the Cardiovascular Risk Factor Management (CVRFM) Program, launched in 2003 to optimize clinical management and outcomes for 75,000 Kaiser Permanente Northwest Region (KPNW) members with atherosclerotic cardiovascular disease (CVD) or hypertension. The CVRFM Program is a centralized, multidisciplinary, proactive telephone-based clinical management intervention consisting of an “outreach” call, an interview, a mailed individualized care plan and information packet, regular follow-up (including protocolized medication management) and—when “goal status” is achieved—transfer of the patient to a maintenance plan. Quarterly evaluation of effectiveness entailed measurement of a range of clinical, utilization, and member satisfaction outcomes. Results by the fourth quarter were outstanding: For example, >98% of participants with coronary disease or diabetes had LDL cholesterol testing, >90% of coronary patients received aspirin or statin treatment, 99% were “extremely” or “very” satisfied with the program, and reductions were observed in the number of hospitalizations and visits to the emergency department and clinic. Mathematical models predict a decrease in myocardial infarctions and cardiovascular mortality within two years after implementing the program, the underlying principles of which should yield similar improvement in other Kaiser Permanente (KP) Regions and in other health care organizations.

The Latvian coastal zone in the South-Eastern Baltic is a very important part of the Baltic Sea. The environmental conflict is observed in this area. On the one hand this area is under high level of contamination and sedimentation, on the other hand biocenoses which occur most frequently and basic herring spawning grounds are situated there. Blue mussels (Mytilus edulis) and marine red algae (Furcellaria lumbricalis) are the basic species-indicators for the coastal area of Latvia and Lithuania. Blue mussels are a filtrator, Furcellaria is the oxygen producer, an organic and mineral substance user, therefore these biocenoses exhibit high biofiltration and biosedimentation ability and thereby cooperate in the water self purification processes. Furcellaria is the best natural substratum for herring spawn. Furthermore, the algae are valuable raw material for agar-agar production. Different researchers investigated the distribution and abundance of Furcellaria at the Lithuanian and Latvian coast from 1955 to the present day. Investigations of herring spawning grounds, distribution and abundance of Furcellaria and Mytilus edulis were the main part of benthic biocenoses monitoring which was annually carried out by the Latvian Fisheries Research Institute in 1980–1990 from Klaipeda to Ventspils and episodically in 1998–2003 in the Latvian coastal zone. The values on Furcellaria biomass for 1928–1938 were reconstructed basing on the data of the algae discharges on a shore in that period and the total biomass of Furcellaria was estimated at the level of about 200 thousand tones. The high level of Furcellaria stock in the Latvian coastal zone in 1928–1938 indicates good environmental quality of coastal waters. The extreme decreasing of algae biomass was observed after two large oil accidents near the coast (tankers “Antonio Gramshi” near Ventspils in1979 and “Globe Asime” near Klaipeda in 1981). In the result of the accidents environmental conditions changed for the worse and the habitat of Furcellaria strongly diminished. Our observations in 1998, 1999 and 2003 showed some relative restoration of Furcellaria stock as compared with 1990. Blue mussel distribution and biomass changed inconsiderably during 1980–1998. However, after dumping of dragging sand near the Liepaja port (2001) total biomass of blue mussels decreased about 2 times as compared with previous estimations. The observations and sampling of macrobenthos were carried out using underwater photography, a TV system and SCUBA diving. Surfer Mapping System was used to mapping of Furcellaria and Blue mussels.

We examine active-sterile neutrino conversion in the late time post-core-bounce supernova environment. By including the effect of feedback on the Mikheyev-Smirnov-Wolfenstein (MSW) conversion potential, we obtain a large range of neutrino mixing parameters which produce a favorable environment for the r-process. We look at the signature of this effect in the current generation of neutrino detectors now coming on line. We also investigate the impact of the neutrino-neutrino forward-scattering-induced potential on the MSW conversion. © 2002 Elsevier Science B.V. All rights reserved.

OBJECTIVE: To examine the concept of selective superior and inferior vestibular nerve involvement in vestibular neuritis by studying the distribution of semicircular canal (SCC) involvement in such patients. BACKGROUND: Vestibular neuritis was traditionally thought to involve the superior and inferior vestibular nerves. Recent work suggests that in some patients, only the superior nerve is involved. So far there are no reported cases of selective involvement of the inferior vestibular nerve. METHODS: The authors measured the vestibuloocular reflex from individual SCC at natural head accelerations using the head impulse test. The authors studied 33 patients with acute unilateral peripheral vestibulopathy, including 29 with classic vestibular neuritis and 4 with simultaneous ipsilateral hearing loss, 18 healthy subjects and 15 surgical unilateral vestibular deafferented patients. RESULTS: In patients with preserved hearing, eight had deficits in all three SCC, suggesting involvement of the superior and inferior vestibular nerves. Twenty-one had a lateral SCC deficit or a combined lateral and anterior SCC deficit consistent with selective involvement of the superior vestibular nerve. Two patients with ipsilateral hearing loss had normal caloric responses and an isolated posterior SCC deficit on impulsive testing. The authors propose that these two patients had a selective loss of inferior vestibular nerve function. CONCLUSION: Vestibular neuritis can affect the superior and inferior vestibular nerves together or can selectively affect the superior vestibular nerve.

CE-MRA is a powerful tool for the non-invasive evaluation of carotid artery occlusive disease. However, due to certain drawbacks, it has not completely replaced DSA. The purpose of this study was to evaluate if Gd-BOPTA, a contrast agent with high T1 relaxivity, can increase the diagnostic accuracy of CE-MRA.The CE-MRA examinations of 54 consecutive patients were evaluated by two experienced radiologists, independently. The examinations of 27 patients were contrasted either with 20 ml Gd-BOPTA or with 20 ml Gd-DTPA. The reviewers were blinded to the contrast agent chosen and to the ultrasound results. They rated the overall image quality and the degree of the ICA stenoses.For the estimation of the degree of the ICA stenoses there was a high interrater validity. In comparison to the ultrasound findings, 6 of 50 high-degree stenoses were underestimated as moderate stenoses. In one of seven sonographically occluded vessels, MRA revealed residual patency in the vessel lumen. It was not possible to identify the contrast agent that was taken for a study. Subjective estimation of the image quality (arterial contrast of the ICA, contrast of the other vessels, and general impression) did not significantly change with the contrast agent employed.The diagnostic accuracy of CE-MRA for the evaluation of internal carotid artery stenoses is not improved by Gd-BOPTA if identical volumina of contrast media are applied. The potential of this contrast agent can be the reduction of the amount of contrast without loss of diagnostic information. Further studies are necessary.

We discuss how matter-enhanced active-sterile neutrino transformation in both neutrino and antineutrino channels could enable the production of the rapid neutron capture (r-process) nuclei in neutrino-heated supernova ejecta. In this scheme the lightest sterile neutrino would be heavier than the electron neutrino and split from it by a vacuum mass-squared difference roughly between 3 and 70 eV$^2$ and vacuum mixing angle given by $\sin^2 2\theta_{es} > 10^{-4}$., Comment: 27 pages plus twelve figures. Submitted to Phys. Rev. C

Eye muscles in humans are arranged such that, by appropriate activation, they allow for eye rotations with three degrees of freedom. Yet it has been known for more than a century that during fixation, while the head is stationary, the eyes do only utilize the horizontal and vertical degrees of rotational freedom while the torsional position of the line of sight is kept constant, i.e., during fixation, the eye is restricted to a two-dimensional (2-D) subspace of the three-dimensional (3-D) space of all possible orientations. This has been first described qualitatively by Donders (1847) who stated that the amount of torsion is fixed for all eye positions, independent of from where the eye has reached a particular position. The geometric consequence of this statement is that all eye positions lie in a 2-D surface. By observing the systematic tilt of afterimages in different gaze directions, Helmholtz was able to determine which 2-D subspace the eye is restricted to. He found, according to what Listing suggested, that the eye positions are not only confined to a surface but to a plane called Listing’s plane. This result, cited as Listing’s law (LL) by Helmholtz (1863), is most simply described if eye positions are expressed in terms of the axes of their rotational displacements from a particular eye position known as primary position and represented by angular position vectors. Then LL states that the eye assumes only those positions that can be reached from primary position by a single rotation about an axis in Listing’s plane, which lies orthogonal to the gaze direction in primary position.