[Do Early Cochlear-Implanted Toddlers Show a Better Speech Development than Later Implanted Children?] / Haben früh cochleaimplantierte Kinder eine bessere Sprachentwicklung als später versorgte Kinder?

Objective: Long term goal in early cochlea implantation in children without any additional disabilities is an age-appropriate speech development. Material and Methods: Speech development in deaf children with cochlear-implant(s) (n=60) was examined with the german language test battery SETK-2 ("Sprachentwicklungstest für 2-jährige Kinder") 2 years after first mapping of the speech processor. Results: More than 68% of the subjects show in all 4 subtests hearing-age equivalent results in receptive and expressive language. 12 children were additionally evaluated by chronological age. 4 of these children show age-appropriate results. There is no significant difference between the children implanted earlier in life (≤12 months) and later implanted children (≥13 months). But it must be kept in mind, that children who were implanted earlier show the same results at a younger age. The discrepancy between their chronological age and their speech development-age is smaller. Speech development in children who grow up bilingually was delayed in German. Conclusions: The results lead to the conclusion that the time of the cochlea implantation is crucial for further development of the children who were born deaf. Rehabilitation concepts have to put a special focus on children who grow up with more than one language.

[Receptive and expressive speech development in children with cochlear implant]. / Rezeptive und expressive Sprachentwicklung bei Kindern mit CI-Versorgung.

OBJECTIVE: This study's aim is the assessment of language development of children with Cochlea Implant (CI). It focusses on receptive and expressive language development as well as auditory memory skills. MATERIAL AND METHODS: Grimm's language development test (SETK 3-5) evaluates receptive, expressive language development and auditory memory. Data of 49 children who received their implant within their first 3 years of life were compared to the norms of hearing children at the age of 3.0-3.5 years. According to the age at implantation the cohort was subdivided in 3 groups: cochlear implantation within the first 12 months of life (group 1), during the 13th and 24th months of life (group 2) and after 25 or more months of life (group 3). RESULTS: It was possible to collect complete data of all SETK 3-5 subtests in 63% of the participants. A homogeneous profile of all subtests indicates a balanced receptive and expressive language development. Thus reduces the gap between hearing/language age and chronological age. Receptive and expressive language and auditory memory milestones in children implanted within their first year of life are achieved earlier in comparison to later implanted children. CONCLUSION: The Language Test for Children (SETK 3-5) is an appropriate test procedure to be used for language assessment of children who received a CI. It can be used from age 3 on to administer data on receptive and expressive language development and auditory memory.

[Phonological development in children with cochlear implant(s)]. / Phonologische Entwicklung bei Kindern mit Cochleaimplantat(en).

BACKGROUND: Normal-hearing children show signs of various phonological processes during language development. These processes represent simplifications of articulation, which are overcome at different time points. For the German language, there are currently no reliable data regarding whether these developmental stages also apply to deaf children with cochlear implants (CI). MATERIALS AND METHODS: Phonological development in deaf children with CI was examined and evaluated with the PLAKSS ("Psycholinguistischen Analyse kindlicher Sprechstörungen"). The results of this analysis (time of test 1 = T1, n = 33) were compared to those of a PLAKSS diagnostic evaluation performed 1 year previously (time of test 0 = T0, n = 31). RESULTS: At T1, 76 % of the whole group showed a phonological development that did not correspond to their hearing age (as measured from the time of the first CI implantation). The most frequently observed phonological processes were the reduction of consonant clusters and fronting. However, 83 % of the group had fewer phonological processes inappropriate to their hearing age at T1 than they did at T0. CONCLUSION: The phonological development of children with CI is not equivalent to their hearing age and is structured differently to that of normal-hearing children.

The visually controlled prey-capture behaviour of the European mantispid Mantispa styriaca.

Mantispids (Mantispa styriaca) are predatory insects; on bright sunny days, they wait in ambush for insect prey. The prey is captured as soon as it is within reach by means of lightning-speed strikes with the powerful forelegs. The strikes can take less than 60 ms. The mantispid accomplishes this almost as effectively as the larger praying mantis, which occupies a similar habitat, even though the praying mantis has apposition eyes with a high-resolution fovea, whereas the mantispid has unspecialized optical superposition eyes. Mantispa styriaca reacts to an item of prey when the latter covers a critical visual angle. The detection of prey immediately triggers adjustment reactions in the mantispid, which attempts to position the prey item in the visual field of both eyes and in the capture zone. Irrespective of the size of the prey, the capture reaction of the mantispid is always triggered if the distance to the prey falls below a certain critical value. As indicated by the analysis of individual video frames, immediately before an aimed strike, the item of prey is always positioned exactly in the centre of the binocular field of vision in the extended midsagittal plane of the mantispid's head. The strike may be triggered by the ommatidia of the left and right eyes, the lines of sight of which converge precisely on this region. The principal conclusion to be drawn is that the prey-capture behaviour of the mantispid appears to be based on a triangulation mechanism.

Continuous intravenous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease. A randomized, controlled trial.

BACKGROUND: Pulmonary hypertension is a progressive and often fatal complication of the scleroderma spectrum of disease for which no treatment has been proven effective in a randomized trial. OBJECTIVE: To determine the effect of epoprostenol on pulmonary hypertension secondary to the scleroderma spectrum of disease. DESIGN: Randomized, open-label, controlled trial. SETTING: 17 pulmonary hypertension referral centers. PATIENTS: 111 patients with moderate to severe pulmonary hypertension. INTERVENTION: Epoprostenol plus conventional therapy or conventional therapy alone. MEASUREMENTS: The primary outcome measure was exercise capacity. Other measures were cardiopulmonary hemodynamics, signs and symptoms of pulmonary hypertension and scleroderma, and survival. RESULTS: Exercise capacity improved with epoprostenol (median distance walked in 6 minutes, 316 m at 12 weeks compared with 270 m at baseline) but decreased with conventional therapy (192 m at 12 weeks compared with 240 m at baseline). The difference between treatment groups in the median distance walked at week 12 was 108 m (95% CI, 55.2 m to 180.0 m) (P < 0.001). Hemodynamics improved at 12 weeks with epoprostenol. The changes in mean pulmonary artery pressure for the epoprostenol and conventional therapy groups were -5.0 and 0.9 mm Hg, respectively (difference, -6.0 mm Hg [CI, -9.0 to -3.0 mm Hg), and the mean changes in pulmonary vascular resistance were -4.6 and 0.9 mm Hg/L per minute, respectively (difference, -5.5 mm Hg/L per minute [CI, -7.3 to -3.7 mm Hg/L per minute). Twenty-one patients treated with epoprostenol and no patients receiving conventional therapy showed improved New York Heart Association functional class. Borg Dyspnea Scores and Dyspnea-Fatigue Ratings improved in the epoprostenol group. Trends toward greater improvement in severity of the Raynaud phenomenon and fewer new digital ulcers were seen in the epoprostenol group. Four patients in the epoprostenol group and five in the conventional therapy group died (P value not significant). Side effects of epoprostenol therapy included jaw pain, nausea, and anorexia. Adverse events related to the epoprostenol delivery system included sepsis, cellulitis, hemorrhage, and pneumothorax (4% incidence for each condition). CONCLUSIONS: Continuous epoprostenol therapy improves exercise capacity and cardiopulmonary hemodynamics in patients with pulmonary hypertension due to the scleroderma spectrum of disease.

Gold toning preserves integrity of silver enhanced immunogold particles during osmium tetroxide treatment for demonstration of a biogenic amine.

We describe a protocol that enhances immunolabelling of nervous tissue for ultrastructural study. Insect tissue is fixed, sectioned, and labelled with a polyclonal antiserum against serotonin and a secondary antibody conjugated with 1 nm colloidal gold. The gold particles are silver-enhanced to ease detection and then protected by gold toning. Finally, the tissue is post fixed in glutaraldehyde fixative followed by osmium tetroxide and further processed for electron microscopy. We demonstrated on insect nervous tissue that gold toning protects marker particles from the influence of osmium tetroxide. Use of buffered solutions throughout the protocol led to well preserved ultrastructural details, and marker particle size was not reduced with a short gold toning time. We also suggest use of this protocol for vertebrate or other invertebrate tissue.

Motion detection in insect orientation and navigation.

The visual systems of insects are exquisitely sensitive to motion. Over the past 40 years or so, motion processing in insects has been studied and characterised primarily through the optomotor response. This response, which is a turning response evoked by the apparent movement of the visual environment, serves to stabilise the insect's orientation with respect to the environment. Research over the past decade, however, is beginning to reveal the existence of a variety of other behavioural responses in insects, that use motion information in different ways. Here we review some of the recently characterised behaviours, describe the inferred properties of the underlying movement-detecting processes, and propose modified or new models to account for them.

Serotonin-immunoreactive neurones in the visual system of the praying mantis: an immunohistochemical, confocal laser scanning and electron microscopic study.

The distribution, number, and morphology of serotonin-immunoreactive (5-HTi) neurones in the optic lobe of the praying mantis Tenodera sinensis were studied using conventional microscopy and confocal laser scanning microscopy. Five or six 5-HTi neurones connect the lobula complex with the medulla, and at least 50 5-HTi neurones appear to be confined to the medulla. In addition, a few large 5-HTi processes from the protocerebrum supply the lobula complex, and two large 5-HTi processes from the protocerebrum ramify in the medulla and lamina, where they show wide field arborisations. In order to provide a basis for understanding the action of serotonin in the lamina, the ultrastructure of its 5-HTi terminals was examined by conventional and immunohistochemical electron microscopy. The 5-HTi profiles were filled with dense core vesicles and made synapses. Output synapses from 5-HTi profiles outnumbered inputs by about 3 to 1. The terminals of the 5-HTi neurones were in close contact with cells of various types, including large monopolar cells, but close apposition to photoreceptor terminals was rare, and no synapses were found between 5-HTi terminals and photoreceptor terminals.

Effect of fluticasone propionate aqueous nasal spray versus oral prednisone on the hypothalamic-pituitary-adrenal axis.

BACKGROUND: Fluticasone propionate is a glucocorticoid with negligible oral bioavailability and very low intranasal bioavailability that is used as an intranasal spray for the treatment of rhinitis. OBJECTIVE: The purpose of this study was to evaluate the hypothalamic-pituitary-adrenal (HPA)axis effects of fluticasone propionate aqueous nasal spray (FP ANS) compared with oral prednisone and placebo by using a 6-hour cosyntropin infusion test. METHODS: In a 4-week, randomized, double-blind, double-dummy, placebo-controlled parallel-group study, 105 adult patients with allergic rhinitis were randomly assigned to receive FP ANS 200 microg once daily, FP ANS 400 microg twice daily, oral prednisone 7.5 mg once daily, oral prednisone 15 mg once daily, or placebo. HPA-axis function was assessed at the screening visit and after 4 weeks of treatment by measuring morning plasma cortisol concentrations and poststimulation concentrations of plasma and urinary cortisol. RESULTS: There was no evidence of altered HPA-axis response to cosyntropin by the end of treatment with FP ANS 200 microg once daily or FP ANS 400 microg twice daily when compared with placebo. In contrast, 4 weeks of treatment with oral prednisone 7.5 or 15 mg once daily was associated with significant (p < 0.05 vs placebo) reduction in HPA-axis function, as evidenced by lower plasma cortisol concentrations (area under the plasma concentration-time curve and peak concentrations) after cosyntropin stimulation and reduced mean 24-hour urinary cortisol excretion. FP ANS 400 microg twice daily and both prednisone regimens were associated with a significant (p < 0.05 vs placebo) reduction in mean morning plasma cortisol concentrations. CONCLUSION: These results indicate that a 4-week course of FP ANS at four times the recommended dose does not suppress adrenal function in response to a 6-hour cosyntropin stimulation test.

Spatial vision in the course of an insect's life.

Praying mantises are considered to be phylogenetically ancient insects with their roots in the palaeozoic Protoblattoidea. They have evolved two mechanisms for spatial vision: (a) estimating the distance to moving prey objects with the use of binocular disparity [Rossel, 1983] and (b) estimating the distance to stationary target objects with motion parallax produced by head movements [Poteser and Kral, 1995]. There is no doubt that the ability to use both visual cues is congenital, but the degree to which either mechanism is developed and its significance to the individual depends to some extent upon the animal's age and exposure to prey species and environmental cues. Experience and learning play an important role. It appears that young mantises can perform both binocular and monocular calculations of distance but they grow to depend more on the binocular mechanism. Motion parallax plays an important role in movement strategy throughout the course of a mantis's life, but this mechanism appears to be particularly in early life.

Proprioceptive contribution to distance estimation by motion parallax in a praying mantid

The behavioural experiments described here examined, in the praying mantis Tenodera sinensis, the manner in which the proprioceptive cervical hair plate sensilla are involved in the measurement of the distance to a jump target with the aid of motion parallax actively produced by translatory head motion. Various combinations of surgical deafferentation of the cervical hair plate sensilla had no influence on the linearisation of head motion. However, the measurement of relative and absolute distance and the jump frequency were impaired by these interventions. From the results, it is concluded that the cervical hair plate sensilla are involved in the distance measurement mechanism, probably by allowing the nervous system to compare retinal image motion with head motion.

Side-to-side head movements to obtain motion depth cues: A short review of research on the praying mantis.

In the case of a visual field comprised of stationary objects, retinal image motion and motion parallax initiated by the observer can be used to determine the absolute and relative distance of objects. The principle is simple: when the observer moves, the retinal images of objects close to the eye are displaced more quickly-and through a larger angle-than are the retinal images of more distant objects. It is remarkable that not only in humans, but throughout the animal kingdom, from primates down to insects, retinal image motion and motion parallax generated with the aid of head movements is used as a means of distance estimation. In the case of praying mantids, translatory side-to-side movements of the head in a horizontal plane are performed to determine the jump distance to stationary objects. The relevant parameter for determining the distance to the object is the speed of retinal image motion. The motion of the head must, however, also be monitored. This requires a multisensory regulatory circuit. Motion parallax information seems to be mediated by a movement-detecting neuronal mechanism which is sensitive to the speed of horizontal image motion, irrespective of its spatial structure or direction.

A comparison of costs and efficacy of intranasal fluticasone propionate and terfenadine tablets for seasonal allergic rhinitis.

This paper compares cost-efficacy ratios for intranasal fluticasone propionate and terfenadine tablets within a sample of patients with seasonal allergic rhinitis symptoms due to mountain cedar allergy. Efficacy was assessed using secondary data analysis of patient ratings of symptoms and their overall assessment of response to treatment within a previously conducted clinical trial. Costs include direct costs of the drugs used for therapy. Patients with documented mountain cedar allergy who were 12 years of age or older (N = 232) had been randomized to either receive intranasal fluticasone propionate, terfenadine, or placebo. The cost-efficacy ratios for intranasal fluticasone propionate 200 micrograms once daily were more favorable than the ratios for terfenadine 60 mg twice daily. This relationship remained throughout the sensitivity analysis. Because intranasal fluticasone propionate is only available in a fixed package size, the number of efficacy-adjusted days of terfenadine therapy that could be purchased to reach break-even costs for a 30-day supply of fluticasone was calculated. Cost efficacy-adjusted days ranged from 11 to 18 days. If cost-efficacy adjustments are not conducted, the upper end of the range increases from 18 to 22 days, since 22 days of terfenadine could be purchased for the price of a 30-day supply of intranasal fluticasone propionate. Depending on which of the efficacy measures the reader believes, if patients use terfenadine for longer than 11 to 22 days, fluticasone propionate is the more cost-efficacious choice. Because most allergies are seasonal and allergy seasons typically last longer than 11 to 22 days, it is likely that fluticasone propionate will frequently be the more cost-efficacious choice in the patient population represented in this study.

A 12-week dose-ranging study of fluticasone propionate powder in the treatment of asthma.

Fluticasone propionate (FP) administered via metered-dose inhaler is a potent corticosteroid effective in the treatment of asthma. To evaluate the efficacy and safety of FP powder administered via a breath-activated inhaler (Diskhaler), a multicenter, double-blind, randomized, placebo-controlled, parallel-group study was conducted in adolescent and adult patients (n = 331) with mild-to-moderate asthma previously treated with beta 2-agonist therapy alone. Patients received FP powder 50, 100, or 250 micrograms or placebo twice daily for 12 weeks. FP-treated patients compared with placebo-treated patients had significantly (p < 0.001) greater improvements in morning predose forced expiratory volume in 1 sec (21-22% increase vs. 9%). Improvement in morning peak flow rate were also significantly (p < 0.001) greater with FP than with placebo (8-10% increase vs. 2% increase). There was also a significant overall treatment difference in the frequency of inhaled albuterol use (p < 0.001) and number of nighttime awakenings due to asthma (p = 0.005). There were no statistically significant difference among the FP treatment groups in any outcome measure. Physicians' global assessments also indicated significant (p < 0.001) differences in efficacy, with 67-74% of FP-treated patients rated as having "effective" or "very effective" treatment compared with 41% of placebo-treated patients. Significant beneficial effects of FP were observed in lung function and diary card parameters after just 1 week of treatment. Adverse events were similar across treatment groups and primarily related to local irritation. Effect on hypothalamic-pituitary-adrenal axis function was minimal. In summary, all three dosages of inhaled FP powder were well tolerated and improved various asthma-related variables. Improvements in pulmonary function, beyond those achieved with beta 2-agonist therapy alone, were maintained for the duration of the 12-week study.

The significance of head movements in distance discrimination in praying mantis larvae

1. When larvae of the praying mantis Polyspilota sp. and Tenodera sinensis want to leave an exposed position and can choose to move between stationary objects at different distances, they usually choose the nearest. Their ability to select the nearest object is greatest when the background has horizontal stripes and is least when it has vertical stripes. Object preference is based on a successive distance comparison, which may involve content-related memory processes. 2. Mantid larvae can determine the absolute distance to a stationary object. Vertical contrasting borders play an important role in this process. 3. Side-to-side head movements (peering) are directly involved in the distance measurement, as shown (i) by the peering behaviour itself and (ii) by the fact that mantids can be deceived in distance measurement by arbitrary movements of target objects during the peering movement. It is supposed that the distance measurement involves the larger and faster retinal image shifts that near, as opposed to more distant, objects evoke. 4. Mantid larvae can distinguish a black-and-white rectangle in the foreground from a black-and-white striped background, even when both are similar with respect to luminance, contrast and texture. The ability to distinguish between figures and background could be explained by motion parallaxes, i.e. by the fact that during peering movements the nearer object moves faster and by a larger angle than the background structure. 5. From birth onwards, even when the eyes have yet to develop foveal specialization, mantids are capable of this visually controlled behaviour.

Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis.

INTRODUCTION: Fluticasone propionate aqueous nasal spray, a new topical corticosteroid preparation, is effective when given as 200 micrograms once daily in patients (> 12 years of age) with seasonal allergic rhinitis. STUDY OBJECTIVE: To evaluate the efficacy and safety of fluticasone proprionate aqueous nasal spray in children aged 4 to 11 years with seasonal allergic rhinitis. STUDY DESIGN: Multicenter, randomized, double-blind, placebo-controlled, parallel-group. PATIENTS: Two hundred fifty children aged 4 to 11 years with moderate-to-severe nasal symptoms, a positive skin test reaction to a late-summer or autumn allergen, a history of seasonal allergic rhinitis, and documentation of an unsatisfactory response to conventional treatment. INTERVENTIONS: Children were randomly assigned to receive fluticasone propionate, either 100 micrograms or 200 micrograms, or placebo, given by intranasal spray once daily in the morning for 14 days. MEASUREMENTS AND RESULTS: Severity of nasal symptoms (obstruction, rhinorrhea, itching, and sneezing) was recorded on visual analog scales by investigators at weekly visits and by patients (or adult guardian) daily in the evening. According to investigator and patient ratings, both fluticasone propionate 100 micrograms/d and 200 micrograms/d lowered total nasal symptom scores when compared with placebo. Both dosages of fluticasone propionate were more effective than placebo on the basis of investigator-rated overall clinical evaluation of efficacy at the end of treatment, with significant improvement (as opposed to moderate or mild improvement, no change or worsening) noted in 21% to 29% of the active-treatment groups vs 9% in the placebo group. There were no significant differences between the two fluticasone propionate dosages in any efficacy measurement. Morning plasma cortisol concentrations and frequency of drug-related adverse events were similar in the fluticasone propionate and placebo groups. CONCLUSION: In children as young as 4 years, 100 micrograms of fluticasone propionate aqueous nasal spray given once daily is as effective as 200 micrograms given once daily, the usual adult dose for the treatment of seasonal allergic rhinitis. Both fluticasone propionate dosages were well tolerated and neither dosage appears to interfere with the hypothalamic-pituitary-adrenal axis in children.