Perineural versus intravenous dexamethasone as adjuncts to local anaesthetic brachial plexus block for shoulder surgery.

This randomised, double-blind, placebo-controlled study compared the effect of perineural with intravenous dexamethasone, both administered concomitantly with interscalene brachial plexus block for shoulder surgery. Patients received 8 mg dexamethasone mixed with ropivacaine in the block injection (n = 42), 8 mg dexamethasone intravenously at the time of the block (n = 37), or intravenous saline (n = 41) at the time of the block. Perineural and intravenous dexamethasone resulted in prolonged mean (SD) duration of block to 16.9 (5.2) h and 18.2 (6.4) h, respectively, compared with 13.8 (3.8) h for saline (p = 0.001). Mean (SD) opioid consumption (morphine equivalents) during the first 24 h after postanaesthesia recovery arrival was 12.2 (9.3) mg in the perineural dexamethasone, 17.1 (15.9) mg in the intravenous dexamethasone and 24.1 (14.3) mg in the saline groups (p = 0.001). Dexamethasone via either route reduced anti-emetic use (p = 0.046). There was no effect on patient satisfaction. These results suggest that both perineural and intravenous dexamethasone are useful adjuncts to ropivacaine interscalene block, with the intravenous route preferred as this avoids the possibility of neural toxicity of dexamethasone.

Bioprocess kinetics in a horizontal rotating tubular bioreactor.

A horizontal rotating tubular bioreactor (HRTB) is a plug flow bioreactor whose interior is provided with O-ring-shaped partition walls that serve as carriers for microbial biomass. During this investigation, microbial biomass was grown in suspension and on the bioreactor inner surface as a microbial biofilm with average mass that was considerably higher than suspended biomass. The dynamics of bioprocess in HRTB was studied by different combinations of process parameters (bioreactor rotation speed and mean residence time) and it was monitored by withdrawing the samples from five positions along the bioreactor. During this investigation it was also observed that mean residence time had a more pronounced effect on the bioprocess dynamics than bioreactor rotation speed. For the description of bioprocess kinetics in HRTB an unstructured kinetic model was established that defines biomass growth, product formations and substrate consumption rate by using a modified Monod (Levenspiel) model. This kinetic model defines changes in suspension and in microbial biofilm, and it shows relatively good agreement with experimental data.

The rotating frame nuclear Overhauser effect spectroscopy experiment as an aid to determining solution structures of DNA oligomers.

Important intrinsic characteristics of the rotating frame nuclear Overhauser effect spectroscopy (ROESY) experiment were found to be advantageous in DNA solution structure determination. In a ROESY experiment, the different mechanisms of relaxation result in different signs of cross peaks, enabling a clear distinction between H2' resonances and H2" resonances of the DNA sugar backbone. This method is of particular importance in crowded spectra, for purine resonances whose H2', H2" protons typically resonate closely, as well as in conditions where line broadening makes coupling constants in a correlated spectroscopy experiment impossible to determine. By observing the signs of cross peaks in the base proton to H2', H2" sugar proton region, the ROESY spectrum can be used to distinguish A-form, B-form, and Z-form DNA.

Prenylflavonoid variation in Humulus lupulus: distribution and taxonomic significance of xanthogalenol and 4'-O-methylxanthohumol.

The resins produced by either lupulin or leaf glands of over 120 plants of Humulus lupulus and one plant of H. japonicus (Cannabinaceae) were analyzed for the presence of prenylated flavonoids. The H. lupulus taxa investigated were H. lupulus var. lupulus from Europe, H. lupulus var. cordifolius from Japan, and H. lupulus from North America. Fifty-two of the plants examined were cultivars of European, American, and Japanese origin. Twenty-two flavonoids were detected in the glandular exudates of H. lupulus by HPLC-MS MS. Xanthohumol (3'-prenyl-6'-O-methylchalconaringenin) was the principal prenylflavonoid in all H. lupulus plants and was accompanied by 11 structurally similar chalcones. Ten flavonoids were identified as the flavanone isomers of these chalcones. Three other prenylchalcones were isolated from H. lupulus cv. 'Galena', one of which was identified as 3'-prenyl-4'-O-methylchalconaringenin (named 'xanthogalenol'). The distribution of three 4'-O-methylchalcones, i.e. xanthogalenol, 4'-O-methylxanthohumol, and 4',6'-di-O-methylchalconaringenin, was found to be limited to wild American plants from the Missouri-Mississippi river basin, H. lupulus var. cordifolius, and most of their descendents. These 4'-O-methylchalcones were absent from cultivars of European origin, and from wild hops from Europe and southwestern USA. The flavonoid dichotomy (presence versus absence of 4'-O-methylchalcones) indicates that there are at least two evolutionary lineages within H. lupulus (European and Japanese American), which is in agreement with morphological, molecular, and phytogeographical evidence. Leaf glands of H. japonicus from eastern Asia did not produce the H. lupulus prenylflavonoids.

A novel 2-hydroxyflavanone from collinsonia canadensis

A new flavonoid, 2,5-dihydroxy-6,7-dimethoxyflavanone (1), was isolated from the leaf and stem exudates of Collinsonia canadensis along with three known flavones, baicalein-6,7-dimethyl ether (2), norwogenin-7,8-dimethyl ether (3), and tectochrysin (5-hydroxy-7-methoxyflavone).

A replication to increase happiness indices among some people with profound multiple disabilities.

A replication of Green and Reid was made for four people with profound multiple disabilities by systematically increasing their happiness indices in a Fun Time activity during which their preferred stimuli were provided. In ABAB reversal designs, 3 of the 4 participants replicated the demonstration of the happiness indices, while the fourth individual showed reduced unhappiness indices when his preferred stimulation was presented. These effects were obtained despite the selection of preferred stimuli without formal assessment procedures and the use of brief training procedures for staff providing the stimulation. A subgroup of three individuals with profound multiple disabilities and minimal (almost no) movement failed to show any indices of happiness or unhappiness with this procedure. Uses for happiness indices were discussed. Alternative programming was suggested for individuals who failed to show any indices of happiness.

Structure of the Bacillus subtilis phage SPO1-encoded type II DNA-binding protein TF1 in solution.

The solution structure of a type II DNA-binding protein, the bacteriophage SPO1-encoded transcription factor 1 (TF1), was determined using NMR spectroscopy. Selective 2H-labeling, 13C-labeling and isotopic heterodimers were used to distinguish contacts between and within monomers of the dimeric protein. A total of 1914 distance and dihedral angle constraints derived from NMR experiments were used in structure calculations using restrained molecular dynamics and simulated annealing protocols. The ensemble of 30 calculated structures has a root-mean-square deviation (r.m.s.d.) of 0.9 A, about the average structure for the backbone atoms, and 1.2 A for all heavy-atoms of the dimeric core (helices 1 and 2) and the beta-sheets. A severe helix distortion at residues 92-93 in the middle of helix 3 is associated with r.m.s.d. of approximately 1.5 A for the helix 3 backbone. Deviations of approximately 5 A or larger are noted for the very flexible beta-ribbon arms that constitute part of a proposed DNA-binding region. A structural model of TF1 has been calculated based on the previously reported crystal structure of the homologous HU protein and this model was used as the starting structure for calculations. A comparison between the calculated average solution structure of TF1 and a solution structure of HU indicates a similarity in the dimeric core (excluding the nine amino acid residue tail) with pairwise deviations of 2 to 3 A. The largest deviations between the average structure and the HU solution structure were found in the beta-ribbon arms, as expected. A 4 A deviation is found at residue 15 of TF1 which is in a loop connecting two helical segments; it has been reported that substitution of Glu15 by Gly increases the thermostability of TF1. The homology between TF1 and other proteins of this family leads us to anticipate similar tertiary structures.

Current limits to reinforcer identification for some persons with profound multiple disabilities.

Fifteen persons with profound mental retardation were divided into two groups. One group was identified with chronic training needs by habilitative staff and the other group served as a control. In an attempt to identify a reinforcer, each participant received a preference assessment and a simple, low-effort treatment procedure. In Experiment 1, only individuals who approached at least one stimulus on 80% or more of the preference assessment trials ("high preference") showed reinforcement effects in treatment. However, three individuals showing high preference failed to show treatment effects. All persons identified with chronic training needs failed to show reinforcement effects. Experiment 2 analyzed characteristics of the two groups and found significant differences in overall movement and response latency. Limitations of the current reinforcement technology were apparent for identifying reinforcers in the group with chronic training problems. Research is suggested for evaluating training alternatives for people with profound multiple disabilities who move very little or who respond with very long latencies.

Teaching key use to persons with severe disabilities in congregate living settings.

Key use remains overlooked for increasing independent material use by persons with severe mental retardation. In Experiment 1, a procedure to train key locating was evaluated in a multiple-probe withdrawal design across three groups of participants. Most participants located their keys when reinforced for doing so; however, key locating decreased when the reinforcement procedure was withdrawn. In Experiment 2, a multiple probe design across four participant groups was used to evaluate a training procedure to teach key use. Twenty of 25 participants used a key to open and lock their personal lockers as a result of training. However, only 36% of the participants were able to use their keys without prompts from experimenters.

Stimulus fading as treatment for obscenity in a brain-injured adult.

Obscene verbalizations of a person with traumatic brain injury were treated using stimulus fading as the singular form of intervention. Results of a functional assessment revealed that obscenity was maintained by negative reinforcement. Stimulus fading (initial elimination of instructional demands followed by their gradual reintroduction) produced immediate and substantial reductions in obscenity that were maintained as the frequency of demands increased to baseline levels. Potential applications of the use of antecedent treatment strategies are discussed.

Stimulus variation as a means of enhancing punishment effects.

We compared the effects of varied punishers (presentation of one of three available punishers) with the single presentation of one of the punishers on the occurrence of inappropriate behaviors with three developmentally delayed children. Two children were presented with varied-punisher conditions in which either overcorrection, time-out, or a verbal "no" was presented contingent upon inappropiate behavior. A loud noise was substituted for overcorrection for a third child. Results of the multielement with reversal design indicated that both punishment formats produced a decrease in the target behaviors with the varied-punisher format slightly more effective than the single presentations of the punishers. The results suggest the use of varied punishers as a means of enhancing the effects of less intrusive procedures to effectively reduce inappropriate behaviors.

Assessment and treatment of multiple behavior problems exhibited by a profoundly retarded adolescent.

The severe aggression and noncompliance of a profoundly retarded blind male were subjected to extensive behavioral assessment in order to identify controlling variables. The assessment, conducted across settings and therapists, suggested that these inappropriate behaviors functioned to avoid or terminate nonpreferred activities. Intervention consisted of manual guidance when there was noncompliance with instructions and edible reinforcement upon compliance; there were no direct contingencies for the inappropriate behaviors. Treatment procedures were implemented in a multiple baseline design across therapists and settings. Results show that the intervention consistently increased compliance, with concurrent decreases in inappropriate behaviors. Edible reinforcement and neuroleptic medication were withdrawn systematically with no loss of therapeutic gains. Family members and school personnel were trained to use the intervention procedures. Results are discussed in terms of functional assessment, response covariation, compliance training, parent and staff training, and behavioral assessment of the effects of neuroleptic medication.

Analysis of environmental determinants of aggression and disruption in mentally retarded children.

This study evaluated methods for empirically identifying environmental determinants of aggressive and disruptive behavior in three developmentally delayed children. A variety of sessions conducted on an inpatient treatment unit were designed to stimulate contingencies maintaining aggression and disruption in the subjects' natural environments. The basic analog conditions included: instructional demands, contingent social disapproval, and structured play. In addition, variations of the three basic conditions were developed based on informal observation and parental reports of naturally occurring contingencies. Results showed considerable variability both between and within subjects. However, for each subject a specific analog condition was shown to produce relatively higher rates of aberrant behavior. Subsequently, behavioral treatments based on assessment results were successfully implemented with two of the subjects. Results are discussed in terms of the importance and practical limitations of conducting systematic assessment of aberrant repertoires in developmentally delayed clients.

Effectiveness of brief time-out with and without contingent delay: a comparative analysis.

We evaluated a commonly used component of brief time-out, in which release from time-out is delayed contingent on the occurrence of disruption. Data were collected for one normal and two mentally retarded children on time-out-producing behaviors (aggression and disruption) as well as delay-producing behaviors during time-out (loud vocalizations, out-of-chair, aggression, and disruption). The results of a combination ABAC reversal and multiple-baseline design indicated that, under the conditions used in this investigation, both delay and no delay variations were effective in reducing the frequency of the target behaviors. Implications for the use of time-out to reduce aberrant behaviors are discussed.

Assessment of stimulus preference and reinforcer value with profoundly retarded individuals.

We evaluated a procedure for identifying potential reinforcers with profoundly retarded individuals. In Experiment 1, six persons were repeatedly exposed to 16 stimuli, and approach behaviors to each stimulus were used to identify preferred and nonpreferred stimuli. In Experiment 2, we examined the reinforcing properties of preferred and nonpreferred stimuli by delivering them contingently on the occurrence of arbitrarily selected responses. Results revealed that the preferred stimulus conditions typically produced higher rates of responding than did either the baseline or the nonpreferred stimulus conditions, suggesting that the procedure can be used to assess reinforcer value for individuals with limited behavioral repertoires.

Leisure-dance instruction for severely and profoundly retarded persons: teaching an intermediate community-living skill.

We evaluated an approach for teaching an intermediate community living skill via a leisure-dance activity to institutionalized severely and profoundly retarded persons. The targeted skill was considered as intermediate in contrast to a community living skill per se because it was based on successful performances of higher functioning, noninstitutionalized retarded persons as opposed to nonhandicapped individuals. Definitions for appropriate dancing were established and then validated through observations of the performance of retarded persons living in the local community. The dance skills were then taught to four participants through serial training in leg movements, arm movements, and coordinated leg and arm movements, plus follow-up trainer supervision. Generalization was also programmed by way of multiple trainers and training settings. Results during structured assessments showed that all four residents acquired the dance skills and that both serial training and follow-up supervision were necessary for skill acquisition. Generalized increases in appropriate dancing at dances attended by the participants and retarded persons from the community were also demonstrated. However, in most cases some active supervision by caregivers was needed to enhance the generalized improvements. Results are discussed in terms of the applicability of this approach for validating goals when training other community-related skills to low-functioning populations.

[The role of alpha-1-antitrypsin in patients with laryngeal carcinoma]. / Die Rolle von Alpha-1-Antitrypsin bei Patienten mit Larynxkarzinom.

Alpha-1-antitrypsin was elevated in patients with laryngeal and hypopharyngeal carcinoma and this increase positively correlated with the tumor size. Surgery and radiotherapy (preoperative or primary) caused a statistically significant increase in the activity of this antienzyme. Possibility the inability of the alpha-1-antitrypsin to reactively increase is responsible for the malignant development of some laryngeal tumors which appear relatively benign according to histological findings and their spread. The reactive increase of the alpha-1-antitrypsin is prognostically more important than its momentary blood level. These investigations confirmed the complexity of malignant tumors in not only their development but also their course. The alpha-1-antitrypsin - the inhibitor of the proteolytic enzyme - is one of the factors in the development of the tumor and particularly in its propagation.

[AN attempt to clear up the fact why the foreign bodies are impacted between the first and second narrowing of the oesophagus (author's transl)]. / Ein Erklärungsversuch zur Fremdkörpereinklemmung zwischen erster und zweiter Enge de Speiseröhre.

We tried, based on anatomical and physiological properties of the oesophagus in the region of triangle of Laimer, to clear up why the smaller, in general flat objects are impacted most often just under the "oesophagus mouth" and why they are very easily overlooked in this region.

Teaching the handicapped to eat in public places: acquisition, generalization and maintenance of restaurant skills.

This study examined classroom-based instruction in restaurant skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.

Evaluating a supervision program for developing and maintaining therapeutic staff-resident interactions during institutional care routines.

This study evaluated a program to teach and maintain language training interactions between institutional staff and profoundly handicapped children during a routine care task. Following baseline observations of bath sessions, staff were sequentially taught in multiple baseline fashion to vocalize more during the bath, praise child vocalizations, imitate sounds, and provide sound prompts. Procedures included a brief in-service meeting followed by a series of supervisory prompts and feedback. Results indicated that staff acquired the interaction skills in the bath sessions and that the skills generalized to another direct care task, dressing. The number of days on which components of supervision were implemented decreased from 47% of all days during the experimental conditions to 19% of the days during a 19-week maintenance period with no decrease in staff behavior. The interactions were shown not to interfere with the quality of the direct care task nor to increase the amount of time necessary to complete it. Also, some increases were noted for child vocalization frequencies. The advantages of providing therapeutic interactions during care routines are discussed along with the need for staff management techniques with long-term maintenance value.