Evidence that ventrolateral thalamotomy may eliminate the supraspinal component of both pathological and physiological tremors

Ventrolateral (VL) thalamotomy produced a marked reduction of oscillations related to the supraspinal components of Parkinson's disease tremor (4-7 Hz) and physiological tremor (8-12 Hz). Finger tremor was examined in nine patients undergoing unilateral VL thalamotomy and in nine age-matched controls. In comparison to the preoperative state, the relative percentage of power within the 7.6-12.5 Hz band did not increase after the surgical procedure. Furthermore, the amount of absolute power within the 7.6-12.5 Hz band was much lower for post-surgical patients in comparison to matched controls when periods of tremor having equal amplitudes were compared. These results suggest that VL thalamotomy interrupts a common circuit involved in the supraspinal component of both physiological and pathological tremors. We provide evidence that the thalamus may be involved in circuits generating physiological tremor in humans.     

Cystic fibrosis and hypertelorism: a case report

This is a report of cystic fibrosis in association with multiple skeletal defects, including hypertelorism, in a consanguineous family in Sudan.     

Changes Across Time in the Temporal Responses of Auditory Nerve Fibers Stimulated by Electric Pulse Trains

Most auditory prostheses use modulated electric pulse trains to excite the auditory nerve. There are, however, scant data regarding the effects of pulse trains on auditory nerve fiber (ANF) responses across the duration of such stimuli. We examined how temporal ANF properties changed with level and pulse rate across 300-ms pulse trains. Four measures were examined: (1) first-spike latency, (2) interspike interval (ISI), (3) vector strength (VS), and (4) Fano factor (FF, an index of the temporal variability of responsiveness). Data were obtained using 250-, 1,000-, and 5,000-pulse/s stimuli. First-spike latency decreased with increasing spike rate, with relatively small decrements observed for 5,000-pulse/s trains, presumably reflecting integration. ISIs to low-rate (250 pulse/s) trains were strongly locked to the stimuli, whereas ISIs evoked with 5,000-pulse/s trains were dominated by refractory and adaptation effects. Across time, VS decreased for low-rate trains but not for 5,000-pulse/s stimuli. At relatively high spike rates (>200 spike/s), VS values for 5,000-pulse/s trains were lower than those obtained with 250-pulse/s stimuli (even after accounting for the smaller periods of the 5,000-pulse/s stimuli), indicating a desynchronizing effect of high-rate stimuli. FF measures also indicated a desynchronizing effect of high-rate trains. Across a wide range of response rates, FF underwent relatively fast increases (i.e., within 100 ms) for 5,000-pulse/s stimuli. With a few exceptions, ISI, VS, and FF measures approached asymptotic values within the 300-ms duration of the low- and high-rate trains. These findings may have implications for designs of cochlear implant stimulus protocols, understanding electrically evoked compound action potentials, and interpretation of neural measures obtained at central nuclei, which depend on understanding the output of the auditory nerve.     

Citizens' juries in planning research priorities: process, engagement and outcome

Background  Involving members of the public in setting priorities for health research in becoming increasingly common practice. One method used in public involvement exercises is the citizens' jury.
Objective  This article examines some challenges and benefits of citizens' juries, including issues relating to process, public engagement and outcome.
Design  In Bristol, UK, a citizens' jury was held with the aim of identifying local priorities for research into health and social care. This jury is used as an example through which key issues in public involvement and jury processes are explored.
Setting and Participants  The Bristol Citizens' Jury comprised 20 members of the public (`jurors'), an oversight panel and a steering group. The jurors met at 11 consecutive sessions during 2006 over a period of 16 weeks, which culminated in a written report. All the sessions were audio-recorded, five sessions were observed and video-recorded, and 16 jurors completed written feedback forms at the end of the jury process.
Findings and conclusion  In this article we discuss degree and timing of public involvement in the process of health research; the role of context; representation of communities; processes of deliberation and knowledge production; and how constraints of time and cost may affect public involvement. It was clear that jurors who took part in the Bristol Citizens' Jury were engaged and committed. This engagement may be related to jurors' belief in their ability to shape future research alongside concern about the relevance of the issues under discussion. Opposing emotions of tension and harmony are a crucial part of the deliberation process.     

Amniotic Fluid Insulin Values in Women with Gestational Diabetes as a Predictor of Emerging Diabetes Mellitus

Summary: Amniotic fluid insulin levels were estimated in 30 women with insulin-dependent diabetes, 216 with gestational diabetes and 27 with normal glucose tolerance. Results were correlated with birth-weight, incidences of fetal macrosomia and neonatal hypoglycaemia, and the risk of the mothers with gestational diabetes developing diabetes mellitus on follow-up.
The women with prepregnaney diabetes had significantly higher amniotic fluid insulin values and showed a significant correlation between raised liquor insulin values (>97th percentile) and hypoglycaemia in the infant (p = 0.039).
In the gestational diabetic pregnancies there were highly significant associations between elevated liquor insulin values and macrosomia (p <0.0045) and birth-weight (p <0.00004), and a weak correlation with neonatal blood glucose levels (p = 0.042).
Women with gestational diabetes who later developed permanent diabetes mellitus had higher mean amniotic fluid insulin levels than those whose glucose tolerance remained normal on follow-up (p ≤0.0072) and more of them had a level greater than the 97th percentile than those whose glucose tolerance remained normal (odds ratio 6.48, 95% confidence interval 1.51–27.8, p = 0.0094). However a high amniotic fluid insulin level was of less clinical value for detection of women destined to develop diabetes (7 of 25, 28%) than was the need for insulin therapy during pregnancy (18 of 39, 46%) .     

Intrauterine Insemination with Husband's Sperm: Comparison of Pregnancy Rates in Couples with Cervical Factor, Male Factor, Immunological Factor and Idiopathic Infertility

Summary: Intrauterine insemination with husband's sperm (IUI) is offered to couples with infertility due to various causes although there is no general agreement on which of these causes should be so treated. In this report 77 couples were diagnosed as having either cervical factor, male factor, immunological factor or unexplained infertility, insemination was performed 24–32 hours after a rapid rise in the serum LH level. Two of 16 pregnancies which resulted miscarried, 1 was ectopic and the remainder were full term. Eleven occurred in the cervical factor group, 3 in the immunological factor and only 1 in each of the male factor and unexplained infertility groups. The differences in the number of pregnancies between the cervical factor and male and unexplained infertility groups are significant but not between the groups with cervical and immunological factors. The majority of pregnancies (81%) were achieved in the first 4 cycles.
Patients with the cervical factor as the cause of their subfertility are likely to benefit from the IUI with their husband's sperm. The small number of patients with the immunological factor in this study does not allow for a conclusion. In our experience the male factor and unexplained infertility patients are unlikely to benefit from intrauterine insemination with husband's sperm.