Inhibition of lordosis behavior in male and female rats by androgens and progesterone.

Several studies suggest that when manipulated experimentally in adulthood, the lordosis response to estrogen can be increased dramatically in male rats. Because adult-gonadectomized (Gx) animals were used in these studies, the lack of testicular hormones in adulthood may have been a factor. To examine this possibility, adult-Gx rats were implanted with blank (Bk)-, testosterone (T)-, 5alpha-dihydrotestosterone (DHT)-, or progesterone (P)-filled capsules, alone or in combination. We report a new finding, that a combined treatment of T plus P (T+P) at physiological doses for the male, but not T or P alone, reduced lordosis significantly in males, with and without estrogen priming. T+P did not inhibit lordosis in females, nor did this specific treatment affect open field, aggressive, and male copulatory behaviors. In confirming studies done with much higher doses, DHT reduced lordosis in both sexes. DHT and T+P also reduced lordosis in adrenalectomized/Gx males. Mechanisms responsible for the T+P inhibition of lordosis in males are not known, but they may include an upregulation of androgen receptors by P, and this possibility is discussed.

Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures.

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinician's repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.

Inter- and intrajudge reliability of a clinical examination of swallowing in adults.

This study investigates inter- and intrajudge reliability of a clinical examination of swallowing in adults. Several investigations have sought correlations between clinical indicators of dysphagia and the actual presence of dysphagia as determined by videofluoroscopy. Whereas some investigations have reported interjudge reliability for the videofluoroscopic measures employed, none have reported reliability for clinical measures. Without established reliability for rating clinical measures, conclusions drawn regarding the utility of a measure for detecting aspiration can be called into question. Results of the present study indicate that fewer than 50% of the measures clinicians typically employ are rated with sufficient inter- and intrajudge reliability. Measures of vocal quality and oral motor function were rated more reliably than were history measures or measures taken during trial swallows. There is a need to define more clearly the measures employed in clinical examinations and to be consistent in reporting reliability for clinical measures of swallowing function in future research.

The interdependency of protein-energy malnutrition, aging, and dysphagia.

Advancing age is increasingly associated with confounding chronic and acute ailments, predisposing elderly individuals to conditions such as malnutrition and swallowing dysfunction. This enhanced susceptibility to malnutrition and dysphagia in this aging demographic lends itself to exacerbating, disabling conditions that may result in increased morbidity and mortality in the event of an aspiration episode. Early identification of substandard nutritional status and subsequent interventiion in the elderly dysphagic population may circumvent the deleterious effects of malnutrition.

Effects of pattern, spatial frequency, number, and rate of stimulus presentation on the accuracy of detection.

Brief trains of pulsed stimuli were used to assess whether magnocellular or parvocellular visual pathways could be differentiated perceptually. Trains of either one to four sine-wave, square-wave, or checkerboard gratings were presented at three temporal and two spatial frequencies to six observers. The task of the observer was to report the perceived number of stimuli (gratings) in a train. The difference between actual number and perceived number of gratings was recorded as an error score. It was found that neither the pattern nor the spatial frequency of the gratings significantly affected perceptual accuracy. On the other hand, the number of gratings in a train and the interstimulus interval between gratings produced significant differences. Perceptual accuracy was greater when lower numbers of gratings in a train were presented with longer interstimulus intervals. The observers typically reported fewer stimuli than were presented. The source of the discrepancy is discussed in terms of a light adaptive process initiated in the retina.

Effects of testosterone and progesterone on brain 5alpha-reductase and aromatase in Long-Evans males and comparison of aromatase in Long-Evans vs. Sprague-Dawley rats.

We investigated medial basal hypothalamic-preoptic area (MBH-POA) 5alpha-reductase and aromatase enzyme activities in gonadally intact and castrated adult Long-Evans (L-E) male rats treated with testosterone (T), progesterone (P), and a combination of T+P. MBH-POA 5alpha-reductase and aromatase activities did not differ significantly among the groups. The lack of a difference in MBH-POA aromatase between control and castrated L-E animals was unexpected. In two further experiments, MBH-POA aromatase was examined in intact and castrated L-E and Sprague-Dawley (S-D) rats, using direct and indirect assays. The activity in castrated S-D (but again, not in L-E) rats significantly decreased compared to control values. These data suggest that the absence of gonads does not decrease MBH-POA aromatase in adult L-E rats.

Gonadal steroid-dependent GAL-IR cells within the medial preoptic nucleus (MPN) and the stimulatory effects of GAL within the MPN on sexual behaviors.

More GAL-I cells exist within sexually dimorphic cell groups of the medial preoptic nucleus (MPN) in male rate than females, a large percentage of estrogen-concentrating cells within MPN cell groups are also GAL-immunoreactive (GAL-IR), and significantly more GAL-IR cells are visible with estrogen or its precursor, testosterone. Gonadal steroids also increase the size (diameter) of MPN GAL-IR cells and the number of GAL-IR cell processes within a portion of the MPN called the "GAL-IR MPOA plexus," which exists in males only. GAL microinjected into the MPN stimulated male-typical sexual behaviors, with more testosterone required in females than males. Immunoneutralization with anti-GAL serum inhibited male-typical sexual behavior, indicating a role for endogenous GAL within the MPN. Microinjection of GAL into the MPN also stimulated female-typical sexual behaviors in estrogen-treated females and males, and GAL within the MPN dramatically overrode an inhibition of lordosis by dihydrotestosterone in rats of both sexes.

Reconstruction of neglected Achilles tendon injury.

Chronic Achilles tendon injuries are debilitating injuries that are often difficult to treat. A review of previously reported procedures is presented. A new technique for repair is presented utilizing a transfer of the flexor hallicus longus muscle and tendon to provide a dynamic repair. A review of the clinical outcome from this procedure is provided.

Using cervical auscultation in the clinical dysphagia examination in long-term care.

The ability of the clinical dysphagia examination to identify patients who aspirate and to determine specialized diet management has been suspect. In long-term care, however, the clinical examination can be the only assessment procedure available to clinicians. Cervical auscultation with stethoscope was incorporated into the clinical examination for dysphagia in an attempt to enhance the clinical examination's ability to detect aspiration and to determine specialized diet management in long-term care. Comparison of the clinical examination's results with results from videofluoroscopy revealed significant agreement in both areas. Results support the use of cervical auscultation as a highly sensitive and specific method of dysphagia assessment in long-term care.

Role of epinephrine during insulin-induced hypoglycemia in fasted rats.

Responses to insulin-induced hypoglycemia in fasted sham-operated (SHAM), adrenodemedullated (ADM), and epinephrine-infused ADM (ADM + E) rats were studied to ascertain the specific role of epinephrine in increasing resting skeletal muscle content of adenosine 3',5'-cyclic monophosphate (cAMP) and fructose 2,6-bisphosphate (F-2,6-P2), which are involved in stimulation of muscle glycogenolysis and lactate production. Rats from each group were fasted for 24 h and then infused intravenously with insulin (30, 60, or 90 min) to produce plasma insulin values of approximately 92 microU/ml. One-half of the insulin-infused ADM rats were also infused with epinephrine (ADM + E). Muscle and blood lactate, muscle cAMP, and muscle F-2,6-P2 increased and muscle glycogen decreased in SHAM rats. Each of these changes was prevented or attenuated in ADM rats and restored in ADM + E rats. Liver cAMP, glycogen, and F-2,6-P2 responses to hypoglycemia were similar in SHAM, ADM, and ADM + E rats. Blood glucose decreased to 0.74 +/- 0.05 mM in ADM rats compared with 1.54 +/- 0.11 mM in SHAM and 1.34 +/- 0.15 mM in ADM + E rats after 90 min of insulin infusion. The increase in plasma epinephrine is therefore essential in the counterregulatory response to insulin-induced hypoglycemia in fasted rats. Resting skeletal muscle glycogenolysis and lactate production for hepatic gluconeogenic substrate appear to be important components of the counterregulatory response in fasted rats.

Word-retrieval in aphasia: an investigation of semantic complexity.

Performance of aphasic subjects in adjective recognition and production tasks in which adjectives varied in semantic feature and markedness complexity was investigated. Twelve pairs of adjectives were examined in three experimental tasks; viz., picture recognition, antonym production, and sentence completion. Subjects were eight nonfluent and eight fluent aphasics. The results indicate significant differences in performance were dependent upon semantic features, markedness, experimental tasks, and type of aphasia. The discussion related semantic complexity to cognitive processes.

Cognitive loci of impairments in picture naming by aphasic subjects.

In order to identify the process or processes responsible for impaired naming by aphasic patients, ten aphasic adults and ten normal adults performed three independent tasks--picture naming, modified Sternberg picture recognition, and modified Sternberg random shape recognition (Sternberg, 1966). Response times and error percentages were the dependent variables. Independent variables in naming were stimulus codability measured in bits of uncertainty (two levels) and number of naming trials (three trials). Independent variables in the recognition tasks were uncertainty (two levels), number of stimuli to be remembered (two or four stimuli) and response type ("yes" or "no"). The results showed that uncertainty had significant effects on naming but not on recognition performance. The aphasic group produced significantly longer naming response times regardless of uncertainty level. The differences between groups were much greater for high-uncertainty pictures (1100 msec) than for low-uncertainty pictures (270 msec). A comparison of estimates of word retrieval times showed that the two subject groups differed significantly for high-uncertainty but not for low-uncertainty items. It was concluded that (1) use of the term "word retrieval problem" rather than "loss of memory problem" was justified to describe the major component in the aphasic naming impairment for high-uncertainty items, and (2) when naming low-uncertainty items these aphasic subjects did not demonstrate a word retrieval problem. The results indicate that treatment procedures designed to improve naming should be process rather than content oriented.

A simple approach to standardized spinal radiographs.

Present methods of obtaining spine radiographs for the clinical assessment of scoliosis are inadequate. Routine quantitative measurements made on anterior-posterior (A-P) and lateral radiographs describing the spinal deformities are grossly inaccurate since they are two-dimensional measurements of three-dimensional deformities. The approach described in this paper uses a simple device, the "Throne," which ensures reproducible positioning of patients for sitting spine radiographs as well as exact orthogonality of A-P and lateral film exposures. These two views of the spine form the data in digitized form for input into a computer program which generates the 3-D geometry of the line passing through the centers of each vertebral body from L5 to T1. Parameters describing the 3-D deformities of the spine are calculated automatically and converted to printed form for detailed examination and to plotted form for clinical use. Approximately 80 postambulatory Duchenne muscular dystrophy patients are being followed using this method. Of these, 20 have been followed for periods of 2 to 3 years. Costs of the method are minimal. The "Throne" can be built for approximately $50 of materials and 30 hours of labor. Each set of A-P and lateral radiographs can be processed in less than 5 minutes, including digitizing time at a computer cost of about 50 cents. The computer program may be handled by a minicomputer.