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This study puts both esports gameplay and spectatorship into consideration and pinpoints how individual and structural factors explain why people play and watch esports to better understand the complexities and intricacies of esports consumption. Results indicate that both measures commonly associated with active audience, and structural theories played a significant role in explaining esports consumption. Specifically, esports gameplay was explained relatively more by structural factors than by individual factors. Different from esports gameplay, esports spectatorship was driven significantly more by individual factors. Preferences, motivations, availability, and access significantly predicted both esports gameplay and spectatorship. Sports fandom and use of interactive features, on the other hand, only predicted esports spectatorship but did not influence gameplay. By employing an integrative approach, this study aids in the development of conceptual framework that will serve to predict esports consumer behavior.

Introduction Burn injuries are life-threatening conditions consisting of elevated oxidative stress, severe inflammation, and an increased hypermetabolic and catabolic state. It is recommended to start enteral nutrition (EN) early in the burn injured patients. These patients undergo many operations, and with stopping of EN the intermittent caloric deficit multiplies. This leads to increased risk of negative outcomes. We sought to analyze the efficacy of continuing EN feedings during burn surgeries to maximize caloric intake while also evaluating for adverse outcomes such as pneumonia. Methods A retrospective chart review of intraoperative feeding and pneumonia rates in pediatric and adult burn patients admitted during 2011-2017 to a regional burn center was conducted. Inclusion criteria included patients with secured airway via endotracheal tube or tracheostomy, mechanical ventilation for at least four days, and those who received EN during operations. The 2017 National Burn Repository (NBR) was used as the control population with mechanical ventilation ≥4 days and a yes/no pneumonia diagnosis. Our assumption was that these patients likely did not receive intraoperative EN as this is not standard protocol at this time. Results 67 patients from our center and 779 NBR patients met inclusion criterion. EN were provided in 49-79% of total operations in the study group. The study group had a longer length of stay (LOS: 62 ± 34.4 vs 41 Days ± 31.7; p< 0.0001), Ventilator days (39 ± 28.9 vs 23 ± 43.9; p< 0.0001) and total body surface area burn percentage (TBSA: 36 ± 21 vs 31 ± 23 p-0.029). The relationship between pneumonia, inhalation injury, COPD, diabetes, and current smoking status was examined in the case population. The odds of a patient with inhalation injury developing pneumonia was 2.83 times greater than a patient without an inhalation injury. There was a higher pneumonia rate in the study group compared to control population (56.7% vs 18.9%; p< 0.0001). However based on a multinomial logistics regression analysis, there was no statistically significant association between intraoperative feeding and pneumonia in the study group (p-0.597). Conclusions We found a significant difference in the occurrence of pneumonia in our patient group compared to the NBR population, but our patients had higher LOS, ventilator days and TBSA burns. This suggest that our study group may have had higher acuity increasing risk of pneumonia. Our pneumonia rates do correspond with the rates reported from other comparable populations of burn patients. Despite this we did not find and association suggesting intraoperative feedings as the cause.

This study examined the effects of writing letters of gratitude on three primary qualities of well-being; happiness (positive affect), life-satisfaction (cognitive evaluation), and depression (negative affect). Gratitude was also assessed. Participants included 219 men and women who wrote three letters of gratitude over a 3 week period. A two-way mixed method ANOVA with a between factor (writers vs. non-writers) and within subject factor (time of testing) analysis was conducted. Results indicated that writing letters of gratitude increased participants’ happiness and life satisfaction, while decreasing depressive symptoms. The implications of this approach for intervention are discussed.

This multicentre phase II study evaluated the efficacy and safety of preoperative capecitabine plus oxaliplatin and radiotherapy (RT) in patients with locally advanced rectal cancer (T3/T4 rectal adenocarcinoma with or without nodal involvement). Treatment consisted of one cycle of XELOX (capecitabine 1000 mg m(-2) bid on days 1-14 and oxaliplatin 130 mg m(-2) on day 1), followed by RT (1.8 Gy fractions 5 days per week for 5 weeks) plus CAPOX (capecitabine 825 mg m(-2) bid on days 22-35 and 43-56, and oxaliplatin 50 mg m(-2) on days 22, 29, 43 and 50). Surgery was recommended 5 weeks after completion of chemoradiotherapy. The primary end point was pathological complete tumour response (pCR). Sixty patients were enrolled. In the intent-to-treat population, the pCR rate was 23% (95% CI: 13-36%). 58 patients underwent surgery; R0 resection was achieved in 57 (98%) patients, including all 5 patients with T4 tumours. Sphincter preservation was achieved in 49 (84%) patients. Tumour and/or nodal downstaging was observed in 39 (65%) patients. The most common grade 3/4 adverse events were diarrhoea (20%) and lymphocytopaenia (43%). Preoperative capecitabine, oxaliplatin and RT achieved encouraging rates of pCR, R0 resection, sphincter preservation and tumour downstaging in patients with locally advanced rectal cancer.

This paper explores incremental and convergent validity through the combined use of a self-report paper-pencil instrument (known as the Family Intrusiveness Scale) and the Rorschach projective method. Both methodologies were employed to assess family processes vis-a-vis distance regulation and interpersonal relatedness. Evidence supporting the use of this mixed-method strategy was generated in the significant associations found between family intrusiveness and projective method subscale scores in the areas of cooperation and personalization. Future directions regarding the innovative use of mixed-method strategies in the family field are discussed.

This manuscript discusses a letters of gratitude assignment based on gratitude research and on the family strengths framework. Instructors can use this assignment in various family science courses. The assignment represents a relatively simple, cost-effective strategy to strengthen family ties and improve health in emerging adults. This paper provides information on the importance of gratitude, on academic and familial benefits of the assignment, and an explanation of the assignment.

Hypoxic pulmonary vasoconstriction is associated with but may not be sufficient for the development of high-altitude pulmonary oedema (HAPO). Hypoxia is known to induce an inflammatory response in immune cells and endothelial cells. It has been speculated that hypoxia-induced inflammatory cytokines at high altitude may contribute to the development of HAPO by causing capillary leakage in the lung. We were interested if such an inflammatory response, possibly involved in a later development of HAPO, is detectable at high altitude in individuals without HAPO. We examined the plasma levels of interleukin 6 (IL-6), interleukin 1 receptor antagonist (IL-1ra) and C-reactive protein (CRP) in two independent studies: study A, Jungfraujoch, Switzerland, three overnight stays at 3458 m, n=12; study B: Capanna Regina Margherita, Italy, 3 overnight stays at 3647 m and one overnight stay at 4559 m, n=10. In both studies, probands showed symptoms of acute mountain sickness but no signs of HAPO. At the Jungfraujoch, IL-6 increased from 0.1+/-0.03 pg/ml to 2. 0+/-0.5 pg/ml (day 2, P=0.03), IL-1ra from 101+/-21 to 284+/-73 pg/ml (day 2, P=0.01), and CRP from 1.0+/-0.4 to 5.8+/-1.5 micrograms/ml (day 4, P=0.01). At the Capanna Margherita, IL-6 increased from 0. 5+/-0.2 pg/ml to 2.0+/-0.8 pg/ml (P=0.02), IL-1ra from 118+/-25 to 213+/-28 pg/ml (P=0.02), and CRP from 0.4+/-0.03 to 3.5+/-1.1 micrograms/ml (P=0.03). IL-8 was below the detection limit of the ELISA (

Recently, the first apheresis technique for direct adsorption of low-density lipoprotein (LDL) and lipoprotein(a) [Lp(a)] from whole blood (DALI) was developed that does not require a prior plasma separation. That markedly simplifies the extracorporeal circuit. The aim of the present study was to test the acute biocompatibility, efficacy, and selectivity of DALI apheresis. In a prospective clinical study, 6 hypercholesterolemic patients suffering from angiographically proven atherosclerosis were treated 4 times each by DALI. 1.3 patient blood volumes were treated per session at blood flow rates of 60-80 ml/min using 750 or 1,000 ml of polyacrylate/polyacrylamide adsorber gel. The anticoagulation consisted of an initial heparin bolus followed by a citrate infusion. The sessions were clinically essentially uneventful. Mean corrected reductions of lipoproteins amounted to 65% for LDL-cholesterol, 54% for Lp(a), 28% for triglycerides, 1% for HDL-cholesterol, and 8% for fibrinogen. The selectivity of lipoprotein removal was high. Cell counts remained virtually unchanged and no signs of hemolysis or clotting were detected. Cell activation parameters elastase, beta-thromboglobulin, interleukin-1beta, and IL-6 showed no significant increase. Complement activation was negligible. There was significant, but clinically asymptomatic, bradykinin activation in the adsorber with mean maxima of 12,000 pg/ml in the efferent line at 1,000 ml of treated blood volume. In conclusion, DALI proved to be safe, selective, and efficient for the adsorption of LDL-C and Lp(a), which simplifies substantially the extracorporeal therapy in hypercholesterolemic patients.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder, characterized by progressive loss of motor neurons. However, ALS has been recognized to involve several non-motor systems. Subclinical involvement of the autonomic system (i.e. of cardial or sudomotor regulation) has been described in ALS. Gastrointestinal motor dysfunction can occur in amyotrophic lateral sclerosis, even if patients do not complain of gastrointestinal symptoms. New techniques in non-invasive evaluation of gastrointestinal function showed delayed gastric emptying and delayed colonic transit times in patients with ALS.

This study examined two questions in the use of the MMPI-A with 13-year-old inpatients: (a) are the profiles of 13-year-old inpatients markedly different from those produced by 14-year-old inpatients, and (b) what is the effect of scoring with standard MMPI-A norms versus Archer MMPI-A norms for 13-year-olds. Protocols from 56 13-year-old and 85 14-yearold psychiatric inpatients were analyzed. No significant differences were found for age in mean T scores, and no clear pattern of differences was found in percentage of elevations into the clinical range (T? 65) for validity, clinical, content, or supplemental scales. A strong multivariate effect was found with the use of Archer MMPI-A norms resulting in lower T-score values than when standard MMPI-A norms are used. However, univariate differences based on norms were not routinely found with statistically significant differences in only 2 of the 38 scales for males and 7 of the 38 scales for females. The two major exceptions to this finding were that the use of Archer norms versus standard MMPI-A norms resulting in significantly higher mean T scores and a significantly higher percentage of cases falling within the clinical range for Scale 1 and the depression content scale.

Four children from two families with characteristics of Marinesco-Sjögren syndrome (congenital cataract, ataxia) are presented. All children had clinical and neurophysiological signs of a demyelinating polyneuropathy. Three of them developed acute rhabdomyolysis with marked weakness and CK levels of up to 40,000 U/I following a viral infection. In all children CK levels returned to normal within two weeks. Symptoms were recurrent in one of the children and resulted in a severe disability. In two other children recovery of motor function took about a month following the first attack. Metabolic disorders of the muscle were excluded by pathobiochemical examination of a muscle biopsy in one of the children. In conclusion, acute rhabdomyolysis can occur as a neuromuscular complication of Marinesco-Sjögren syndrome.

Objective To report on 3 patients with inflammatory demyelinating peripheral neuropathy in strong temporal coincidence with the initiation of peritoneal dialysis (PD) therapy. Setting Nephrology and Neurology Department of the University Hospital, Munich, Germany. Patients Three patients with end-stage renal failure presented with the clinical picture of inflammatory demyelinating peripheral neuropathy within 4 to 10 weeks after start of continuous ambulatory peritoneal dialysis (CAPD). They had acute or subacute onset of lower extremity or generalized weakness, diminished reflexes, elevated spinal fluid protein levels, and signs of demyelinating neuropathy on electrophysiological testing. Measures Clinical follow-up, nerve conduction studies, cerebral spinal fluid (CSF). Results All patients did not improve under intensified PD therapy but took profit from immunomodulatory therapy. One bed-bound patient improved after change to hemodialysis and showed complete remission after renal transplantation. Conclusion Because of strong temporal coincidence, a causal relationship between CAPD and inflammatory demyelinating peripheral neuropathies can be suspected in these 3 patients.

Eine 50jahrige Patientin wurde wegen rasch progredienter Gangunsicherheit, Parasthesien und wiederholt einschiesenden, zum Teil sehr schmerzhaften Muskelkontraktionen an Armen und Beinen stationar aufgenommen. Als Ursache der Beschwerden fand sich ein kleinzelliges Bronchialkarzinom (T2 N3 M0) mit Nachweis von Anti-Hu-Autoantikorpern (zytoplasmatische antineuronale Antikorper). Die neurologische Symptomatik konnte nach Ausschlus anderer Ursachen als paraneoplastische subakute zerebellare Degeneration, paraneoplastische subakute sensorische Neuronopathie (SSN), paraneoplastische Myoklonien und paraneoplastische Neuromyotonie eingestuft werden. Mit Remission des Tumors unter Chemotherapie waren Anti-Hu-Antikorper nicht mehr nachweisbar, und die neurologische Symptomatik bildete sich vollstandig zuruck. Die Kasuistik zeigt, das die paraneoplastische Bildung von Anti-Hu-Autoantikorpern eine Vielzahl neuronaler Funktionssysteme betreffen und damit verschiedene neurologische Symptome bedingen kann.

This study reports on the relationship between perceived family social support (FSS) and family intrusiveness (FI) in a sample of young adult women. These family system variables were hypothesized to be inversely correlated. The potential for a positive correlation was also explored to determine whether or not family support can coincide with deleterious intrusive social interaction. Results of the study showed an inverse correlation rather than positive. Implications and directions for future research are discussed.

A middle-aged patient presented with subacute muscular stiffness, myocloni of both extremity and facial muscles, gait ataxia and symmetrical distal painful paraesthesias. Electrophysiologically, neuromyotonia was confirmed. High titer anti-Hu antibodies were detected, but no other paraneoplastic antibodies were found. Small-cell lung cancer was diagnosed. Under chemotherapy tumor remission was achieved and, except for minor sensory deficits, neurological symptoms disappeared. This report shows that paraneoplastic syndromes associated with antibodies to neuronal nucleoproteins (anti-Hu antibodies) may be associated with a syndrome including neuromyotonia, sensory neuropathy, cerebellar symptoms and myocloni.

Extracorporeal procedures for the elimination of autoantibodies are an important therapeutic option in various neuroimmunological diseases, especially those with neuromuscular involvement. Recent advances with the development of selective apheresis methods have given extracorporeal therapeutic procedures a new perspective. In this article, we review the therapeutic use of plasma exchange and immunoadsorption therapy in different neuroimmunological diseases.

A new downhole measurement technique has been proposed based on optical fiber Bragg grating (FBG) sensors for long-term monitoring of strain and its corresponding stress build-up in geological fault zones. Design and development of the present downhole sensor installation equipment have been demonstrated. Results from laboratory tests and from first field experiments in a research borehole at Trizonia island in the Gulf of Corinth area (Greece) have been reported.

Corresponding Author: Michael Schmuecking, MD E-Mail: michael.schmuecking@insel.ch Inclusion criteria: Informed consent, histologically proven NSCLC stage I or hypermetabolic oligometastatic lung lesions. Peripheral or central localization, maximal tumor diameter of 45mm. Karnofsky index > 60%. Medically inoperable. Moving of the lung lesion during breathing less than 5mm as detected by 4D-CT. Initial staging: whole body 18F-FDG PET/CT in radiation treatment position, MRI of the brain. Optional for staging: 18F-FDG PET/CT of the lung in breath hold technique in radiation treatment position. Radiation treatment planning: 4D-CT and angio-CT in radiation treatment position for target volume delineation. BodyFIX® vacuum cushions for comfortable, accurate and reproducible patient positioning during radiation treatment. Using 4DCT for target volume delineation, a Boolean operation was used to sum the multiple gross target volumes (GTV) delineated in diagnostic lung window to form an internal target volume (ITV). The planning target volume was derived by a three-dimensional isotropic expansion of the ITV by 5mm to account for both microscopic extension and daily setup errors. Using non-gated PET/CT (frame mode) for target volume delineation of the ITV the iso-line of SUV 2.5 was used or the tumor/background algorithm as proposed by Nestle et al. JNM 2005. For 16/22 lung lesions the prescription dose was 5 x 12 Gy, for 1/22 centrally located lung lesion the prescription dose was 5 x 10 Gy, for the initial 5/22 lesions the prescription dose was 5 x 7 Gy. For all patients the prescription isodose was the 80% line (prescription line identical with the planning target volume). Maximal time for follow-up: 21 months, mean time for follow-up: 13 months. By design, stereotactic body radiotherapy (SBRT) is applied to small treatment volumes, using fewer but significantly higher dose fractions, and steep dose gradients – all of which act to maximize cell kill and minimize the risk of damage to the surrounding normal tissues.

Peripheral polyneuropathies associated with monoclonal IgM gammopathy of undetermined significance often have a progressive course and optimal treatment has not been established. We report on a patient diagnosed with polyneuropathy associated with benign IgM gammopathy, who was successfully treated with antibody-based immunoadsorption only. The neurological symptoms of the patient improved continuously over six months of treatment. Controlled trials should be performed to define this indication for antibody-based immunoadsorption therapy.

A randomized two-part study was conducted in order to determine the efficacy of theophylline in the treatment of acute mountain sickness during fast ascent to altitudes >2,500 m. Fourteen healthy male subjects participated in a randomized single-blind placebo-controlled crossover study carried out in a decompression chamber (simulated altitude 4,500 m). A second randomized single-blind, placebo-controlled study was conducted at a high-altitude research laboratory (3,454 m) and included 21 healthy male subjects. The study medication was either 375 mg oral slow-release theophylline (250 mg if

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive loss of motor neurons. However, ALS has been recognized to also involve non-motor systems. Subclinical involvement of the autonomic system in ALS has been described. The recently developed (13)C-octanoic acid breath test allows the noninvasive measurement of gastric emptying. With this new technique we investigated 18 patients with ALS and 14 healthy volunteers. None of the patients had diabetes mellitus or other disorders known to cause autonomic dysfunction. The participants received a solid standard test meal labeled with (13)C-octanoic acid. Breath samples were taken at 15-min intervals for 5 h and were analyzed for (13)CO(2) by isotope selective nondispersive infrared spectrometry. Gastric emptying peak time (t(peak)) and emptying half time (t(1/2)) were determined. All healthy volunteers displayed normal gastric emptying with a mean emptying t(1/2) of 138 +/- 34 (range 68-172) min. Gastric emptying was delayed (t(1/2)160 min) in 15 of 18 patients with ALS. Emptying t(1/2) in ALS patients was 218 +/- 48 (range 126-278) min (p0.001). These results are compatible with autonomic involvement in patients with ALS, causing delayed gastric emptying of solids and encouraging the theory that ALS is a multisystem disease rather than a disease of the motor neurons only.

Transforming growth factors-beta 1, 2, and 3 are known for their regulatory function in embryogenesis, fibrogenesis, and tissue repair of different cell types. A trophic function of TGF-beta subclasses for motoneurons has been shown in vitro. TGF-beta 1 is a potent survival factor for cultured embryonic rat motoneurons. In addition, TGF-beta 1 stimulates proliferation of rat Schwann cells. Recently, TGF-beta 2 has been reported to be associated with the subsynaptic nuclei of mature rat neuromuscular junctions. In this study, we investigated the expression of TGF-beta 1, 2, and 3 at neuromuscular junctions in skeletal muscle of 11 adults without neuromuscular disease. On muscle biopsies, neuromuscular junctions were depicted by acetylcholine esterase reaction and acetylcholine receptor antibodies. TGF-beta 1; 2, and 3 were stained immunohistochemically with monoclonal antibodies. Some muscle fibers showed low levels of inhomogeneous immunoreactivity for both TGF-beta 1 and TGF-beta 3. Intense immunoreactivity of TGF-beta 1 and 3 was shown at the postsynaptic area of neuromuscular junctions. TGF-beta 2 was expressed in the same subcellular distribution, but less strongly. In conclusion, the colocalization of TGF-beta with neuromuscular junctions may suggest a significant function in neuromuscular communication.

The DALI low-density lipoprotein (LDL) apheresis system is the first whole-blood apheresis system in regular clinical use. DALI stands for direct adsorption of lipoproteins, which describes the basic principle of operation of this newly developed LDL apheresis procedure.The selective removal of LDLs and lipoprotein (a) [Lp(a)] is performed in human whole blood by adsorption onto polyacrylate-coated polyacrylamide beads in an adsorber. This article describes the results of the first open multicentre clinical trial in 14 patients in whom the safety and the efficacy of the system were tested. All patients were treated on average 17 times on a weekly basis. In total, 238 sessions were carried out during the study without severe side-effects. On average, 7675 mL of the patients' whole blood was processed in about 2 h. Anticoagulation in the extracorporeal system was carried out by first giving a heparin bolus followed by continuous addition of an acid citrate dextrose (ACD-A) infusion during the treatment.The processing of nearly 1.6 times the patient blood volumes resulted in a reduction in the median LDL-cholesterol level by 66-77% (dependent on the system configuration). The Lp(a) concentrations were reduced by 59-73% (dependent on the system configuration). HDL-cholesterol, blood cell count and the other clinical parameters were not significantly affected.Based on this short-term evaluation, the DALI apheresis system is a well-tolerated, effective and simple way of reducing LDL and Lp(a) in human whole blood. The system has been introduced to clinical practice. However, to use the DALI apheresis system in clinical routine, further evaluation of long-term effects is required.

This study examined two questions in the use of the MMPI-A with 13-year-old inpatients: (a) are the profiles of 13-year-old inpatients markedly different from those produced by 14-year-old inpatients, and (b) what is the effect of scoring with standard MMPI-A norms versus Archer MMPI-A norms for 13-year-olds. Protocols from 56 13-year-old and 85 14-year-old psychiatric inpatients were analyzed. No significant differences were found for age in mean T scores, and no clear pattern of differences was found in percentage of elevations into the clinical range (T 65) for validity, clinical, content, or supplemental scales. A strong multivariate effect was found with the use of Archer MMPI-A norms resulting in lower T-score values than when standard MMPI-A norms are used. However, univariate differences based on norms were not routinely found with statistically significant differences in only 2 of the 38 scales for males and 7 of the 38 scales for females. The two major exceptions to this finding were that the use of Archer norms versus standard MMPI-A norms resulting in significantly higher mean T scores and a significantly higher percentage of cases falling within the clinical range for Scale 1 and the depression content scale.

This is the report of a late-onset carbamazepine-induced systemic lupus erythematosus in a 34-year-old patient who had been treated with daily carbamazepine for 8 years because of complex partial seizures. When carbamazepine was discontinued, symptoms rapidly improved and antinuclear antibodies disappeared. So far, few cases have been reported of carbamazepine-induced lupus erythematosus within months after the start of treatment. This is the first case report about carbamazepine-induced systemic lupus erythematosus with serological confirmation after years of treatment without side effects.

The expression of tenascin, NCAM, vimentin and HSP-70 was examined in 15 patients with dermatomyositis and 12 patients with polymyositis. All biopsies with dermatomyositis showed a confluent network of tenascin expression in the extracellular space. This network surrounded numerous fibers (39 up to 320). Tenascin expression preceded other histological and immunohistochemical signs of dermatomyositis such as the expression of N-CAM and vimentin and the appearance of perifascicular atrophy and inflammatory response. Tenascin expression was found in 3 biopsies where microtubular inclusions in the arteriolar walls were absent. In contrast, tenascin expression was confined to the surroundings of necrotic fibers also expressing vimentin or N-CAM in polymyositis. In general, tenascin was found in the vicinity of inflammatory cells, only. These findings suggest that tenascin is induced by ischemic stress in dermatomyositis. Widespread tenascin expression in a fascicular distribution is a specific marker, if an inflammatory myopathy has been proven by standard techniques. In some cases, tenascin staining might confirm the clinical diagnosis of dermatomyositis, where other histological findings are inconclusive.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder, characterized by progressive loss of motor neurons. However, ALS has been recognized to involve several non-motor systems, subclinically. Cardiac and sudomotor autonomic involvement in ALS has been described. Recently, delayed gastric emptying was reported. The aim of this study was to assess colonic transit time in patients with ALS. Therefore, measurement of total and segmental colonic transit times using radio-opaque markers was performed in 14 patients with ALS and 14 healthy age-matched volunteers. Multiple-ingestion, single-radiograph technique was used. Segmental and colonic transit times were calculated from the number of retained markers. Nine of 14 patients with ALS showed markedly delayed colonic transit times if compared to healthy controls. Colonic transit in ALS patients was significantly delayed in the right and left colon; the rectosigmoid transit did not show major delay. The colonic transit times did not correlate with bulbar involvement, Norris score, walking disability or duration of the disease. In summary, colonic dysfunction in ALS may be a result of inactivity or inadequate fiber intake. However, it also may represent a gastrointestinal autonomic involvement due to nerval degeneration. Considering ALS as a multisystem disorder including the autonomic nervous system may have implications for research into pathogenesis and therapy of neurodegenerative disease.

In previous studies, ultrasonography was a very sensitive method in detecting fasciculations. The present study was intended to examine the prevalence of ultrasonographically visible fasciculations in patients with neuromuscular diseases affecting the lower extremities. Ultrasonography of 9 muscles (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, sartorius, semitendinosus, tibialis anterior, gastrocnemius, and soleus muscles) was performed bilaterally in 70 adult healthy subjects and 172 patients with various neuromuscular diseases. Fasciculations were detected in 109 (63%) of 172 patients. The median value of affected muscles was 10 (range 1-18). Patients with spinal muscular atrophy (37/38, p < 0.001), hereditary motor and sensory neuropathy (24/25, p < 0.001), and lumbosacral radiculopathy with motor deficits (24/29, p < 0.001) exhibited fasciculations more frequently than did healthy volunteers. Radiculopathy with sensory deficits, lesions of either plexus or peripheral nerves, compartment syndrome, and myopathy were not associated with a significantly enhanced prevalence of fasciculations in the patient group compared to the control group. In summary, fasciculations are a frequent ultrasonographic sign in neuromuscular diseases. They are almost regularly found in patients with spinal muscular atrophy and those with hereditary motor and sensory neuropathy. Thus, the absence of fasciculations in ultrasonographic assessment should give cause for reconsidering these diagnoses.

Acute mountain sickness (AMS) is characterized by headache often accompanied by gastrointestinal complaints that vary from anorexia through nausea to vomiting. The aim of this study was to investigate the influence of high altitude on plasma levels of gastroenteropancreatic (GEP) peptides and their association to AMS symptoms. Plasma levels of 6 GEP peptides were measured by radioimmunoassay in 11 subjects at 490 m (Munich, Germany) and, after rapid passive ascent to 3454 m (Jungfraujoch, Switzerland), over the course of three days. In a second study (n = 5), the same peptides and ghrelin were measured in subjects who consumed standardized liquid meals at these two elevations. AMS symptoms and oxygen saturation were monitored. In the first study, both fasting (morning 8 a.m.) and stimulated (evening 8 p.m.) plasma levels of pancreatic polypeptide (PP) and cholecystokinin (CCK) were significantly lower at high altitude as compared to baseline, whereas gastrin and motilin concentrations were significantly increased. Fasting plasma neurotensin was significantly enhanced whereas stimulated levels were reduced. Both fasting and stimulated plasma motilin levels correlated with gastrointestinal symptom severity (r = 0.294, p = 0.05, and r = 0.41, p = 0.006, respectively). Mean O(2)-saturation dropped from 96% to 88% at high altitude. In the second study, meal-stimulated integrated (= area under curve) plasma CCK, PP, and neurotensin values were significantly suppressed at high altitude, whereas integrated levels of gastrin were increased and integrated VIP and ghrelin levels were unchanged. In summary, our data show that acute exposure to a hypobaric hypoxic environment causes significant changes in fasting and stimulated plasma levels of GEP peptides over consecutive days and after a standardized meal. The changes of peptide levels were not uniform. Based on the inhibition of PP and neurotensin release a reduction of the cholinergic tone can be postulated.

The neutronics of a fusion reactor blanket is investigated at a mock-up consisting of steel, uranium, lithium-aluminium, polyethylene and steel in slab geometry. Beside functionals of the uranium part the lithium production rate of the LiAl-slabs per one 14 MeV neutron bombarding the assembly is measured with both Li2CO3-probes and liquid scintillator technique and LiF-thermoluminescence probes. The neutron spectra leaking several slab assemblies per one 14 MeV incidence neutron are measured with time-of-flight technique. The measured quantities are compared with calculated ones using the three dimensional Monte Carlo codes MORSE, BLANK and MCNP and data of the libraries ENDF/B and ENDL.

Reactivation of Chronic Hepatitis C Virus Infection by Immunoadsorption in Factor VIII Inhibitor Haemophilia

Reduction of Acquired High Titer Factor VIII Antibodies by Extracorporeal Antibody-based Immunoadsorption without Additional Immunosuppressive Therapy

1998;113;1428 Chest Hautmann, Matthias Tschop, Rainald Fischer and Rudolf M. Huber Marcell Toepfer, Gunther Hartmann, Maximilian Schlosshauer, Hubert Adrenomedullin: A Player at High Altitude? http://chestjournal.chestpubs.org/content/113/5/1428.2.citation services can be found online on the World Wide Web at: The online version of this article, along with updated information and ISSN:0012-3692 ) http://chestjournal.chestpubs.org/site/misc/reprints.xhtml ( written permission of the copyright holder. this article or PDF may be reproduced or distributed without the prior Dundee Road, Northbrook, IL 60062. All rights reserved. No part of Copyright1998by the American College of Chest Physicians, 3300 Physicians. It has been published monthly since 1935. is the official journal of the American College of Chest Chest