Microswitch clusters to enhance adaptive responses and head control: A programme extension for three children with multiple disabilities

Purpose.?We assessed the possibility of extending adaptive responding and head control in three children with multiple disabilities through the use of microswitch clusters.

Method.?The children had previously learned to perform an adaptive hand response and to control head position during that response. They were now taught one or two new adaptive responses (foot lifting, leg touching, or vocalization) and to combine such responses with appropriate head position. Microswitch clusters served to ensure that an adaptive response was followed by positive stimulation only if it was combined with appropriate head position.

Results.?The results were positive with the children learning the new adaptive responses and combining them with appropriate head position. This performance was maintained during two- or three-month post-intervention checks. During these checks, the children were also successful in using the old adaptive hand response with appropriate head position.

Conclusions.?The use of microswitch clusters was effective to extend the level of adaptive responding and enhance appropriate head position during this responding. This outcome, which indicates a successful technical replication and procedural extension of previous work in the area, has positive practical implications for educational and occupational programmes for children with multiple disabilities.     

Microswitch clusters to support responding and appropriate posture of students with multiple disabilities: three case evaluations

Purpose:?This study extended the evaluation of microswitch clusters to support responding and appropriate posture with three students with multiple disabilities.

Method:?Initially, a baseline level was established for the target response selected for each student. Then, Intervention I was implemented to increase the frequency of that response through the presentation of favourite stimuli. During Intervention II, the response was followed by favourite stimuli only if the microswitch cluster detected it in combination with appropriate posture. Post-intervention checks were carried out within 2 or 3 months from the end of Intervention II.

Results and conclusions:?All students showed an increase in the frequency of the target response during Intervention I and in the percentage of times the response occurred in combination with appropriate posture during Intervention II. These changes lasted over time. The importance of microswitch clusters to enhance the performance of students with multiple disabilities was underlined.     

应用诱导缓解及干细胞疗法治疗急性早幼粒细胞白血病的治疗策略特点

目的:全反式维甲酸、砷剂(三氧化二砷、复方黄黛片)、化疗治疗的联合应用明显提高了急性早幼粒细胞白血病的完全缓解率,缓解后治疗则进一步提高了长期生存率,但治疗方案及治疗时间仍存在争议,本文对此进行综述。资料来源:应用计算机检索Medline和CNKI 1992-01/2007-02期间的相关文献,检索词为"白血病、早幼粒细胞、急性、治疗、干细胞、移植,leukemia,promyelocytic,acute,therapy,stem cells,transplantation"。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:与急性早幼粒细胞治疗相关。排除标准:重复研究。资料提炼:共收集到361篇相关文献,41篇文献符合纳入标准,排除的320篇文献为内容陈旧或重复的文献。资料综合:临床分别采用全反式维甲酸、三氧化二砷、复方黄黛片或化疗治疗急性早幼粒细胞白血病,全反式维甲酸、三氧化二砷、复方黄黛片完全缓解率达60%～98%,联合化疗可提高具有高危因素患者的缓解率达90%。联合用药进行完全缓解后治疗可降低复发率,提高无病生存率,但治疗时间短者,其复发率较高,以采用长程治疗(时间大于6年)者5年无病生存率高达48%,而造血干细胞移植者5年无病生存率更可达100%。结论:全反式维甲酸或砷剂单独应用及其联合化疗治疗急性早幼粒细胞白血病均可获得较高的完全缓解率,全反式维甲酸或砷剂联合化疗和造血干细胞移植可进一步降低复发率,提高完全缓解率,以长程治疗和干细胞移植疗效较好。     

Internal podalic version for neglected shoulder presentation with fetal demise

In modern obstetrics, the role of internal podalic version (IPV) is limited to delivery of the second twin. A retrospective study was conducted to assess the efficacy of IPV in singleton neglected shoulder presentation with fetal demise. Women with live fetuses, previous CS or contracted pelvis were excluded. The procedure involved repositioning the prolapsed hand under anaesthetic followed by breech extraction. 12 women were identified over a 19 month period and all underwent successful IPV. One woman had a postpartum haemorrhage. We conclude that, in singleton pregnancies with a transverse lie, IPV has a role to play in the delivery of dead fetuses.     

Enabling a person with multiple disabilities and minimal motor behaviour to control environmental stimulation with chin movements

Purpose: To assess whether a young man with multiple disabilities and minimal motor behaviour would learn to control environmental stimulation using chin movements and a mechanical microswitch. Method: The study was carried out according to an ABAB design in which A represented baseline and B intervention phases. The chin movements controlled the stimulation only during the intervention phases. A 2-month post-intervention check was conducted. Results: The man increased the frequency of his chin movements, thus increasing the level of environmental stimulation, during the intervention phases. This performance was maintained at the post-intervention check. Conclusion: The use of chin movements is a practical strategy for enabling individuals with minimal motor movements to control environmental stimulation. Future research should examine whether similar types of movements may enable some individuals to control voice-output communication devices.     

Influence of two different resection techniques (conventional liver resection versus anterior approach) of liver metastases from colorectal cancer on hematogenous tumor cell dissemination – prospective randomized multicenter trial

Background

Preoperative radiotherapy of the pelvic abdomen presents with complications mostly affecting the small bowel. The aim of this study was to define the features of early radiation-induced injury on small bowel.

Methods

54 mice were divided into two groups (36 irradiated and 18 sham irradiated). Animals were placed on a special frame and (in the radiated group) the exteriorized segment of ileum was subjected to a single absorbed dose of 19 or 38 Gy radiation using 6 MV high energy photons. Specimens were collected for histology, immunohistochemistry (IHC) and ELISA analysis after 2, 24 and 48 hours. Venous blood was collected for systemic leucocyte count in a Burker chamber.

Results

Histology demonstrated progressive infiltration of inflammatory cells with cryptitis and increased apoptosis. MIP-2 (macrophage inflammatory protein) concentration was significantly increased in irradiated animals up to 48 hours. No significant differences were observed in IL-10 (interleukin) and TNF-α (tumour necrosis factor) levels. IHC with CD45 showed a significant increase at 2 hours of infiltrating leucocytes and lymphocytes after irradiation followed by progressive decrease with time. Caspase-3 expression increased significantly in a dose dependent trend in both irradiated groups up to 48 hours.

Conclusion

Acute small bowel injury caused by local irradiation is characterised by increased apoptosis of crypt epithelial cells and by lymphocyte infiltration of the underlying tissue. The severity of histological changes tends to be dose dependent and may affect the course of tissue damage.     

Adnexal and cul-de-sac abnormalities: transvaginal sonography

Sixty-seven patients selectively chosen from 354 undergoing conventional transabdominal (TA) sonography for evaluation of a clinically suspected adnexal mass subsequently underwent transvaginal (TV) sonography either because the TA sonograms were technically suboptimal or because it was not possible to characterize with certainty an abnormality identified with TA sonography. TV sonography added diagnostically useful information in 25 of 28 patients with cystic pathologic changes in the adnexa uteri. Eight of 12 patients with tuboovarian abscess and nonspecific adnexal masses visualized with TA sonography had tube-shaped fluid collections characteristic of pyosalpinx identified with TV sonography. TV sonography added diagnostically useful information in all seven patients with diseases of the cul-de-sac (rectouterine fossa) and allowed differentiation of adnexal from primary uterine disease in three patients with TA sonograms on which findings were equivocal. It also expedited the diagnosis of a tubal pregnancy in ten of 14 patients and was useful in the detection of adhesions and perforated intrauterine devices. These results indicate that adjunctive TV sonography can provide important diagnostic information.     

Ca2+/calcineurin regulation of cloned vascular KATP channels: crosstalk with the protein kinase A pathway

Background and purpose:

Vascular ATP-sensitive potassium (K_ATP) channels are activated by cyclic AMP elevating vasodilators through protein kinase A (PKA). Direct channel phosphorylation is a critical mechanism, though the phosphatase opposing these effects is unknown. Previously, we reported that calcineurin, a Ca²⁺-dependent phosphatase, inhibits K_ATP channels, though neither the site nor the calcineurin isoform involved is established. Given that the type-2 regulatory (RII) subunit of PKA is a substrate for calcineurin we considered whether calcineurin regulates channel activity through interacting with PKA.

Experimental approach:

Whole-cell recordings were made in HEK-293 cells stably expressing the vascular K_ATP channel (K_IR6.1/SUR2B). The effect of intracellular Ca²⁺ and modulators of the calcineurin and PKA pathway on glibenclamide-sensitive currents were examined.

Key results:

Constitutively active calcineurin Aα but not Aβ significantly attenuated K_ATP currents activated by low intracellular Ca²⁺, whereas calcineurin inhibitors had the opposite effect. PKA inhibitors reduced basal K_ATP currents and responses to calcineurin inhibitors, consistent with the notion that some calcineurin action involves inhibition of PKA. However, raising intracellular Ca²⁺ (equivalent to increasing calcineurin activity), almost completely inhibited K_ATP channel activation induced by the catalytic subunit of PKA, whose enzymatic activity is independent of the RII subunit. In vitro phosphorylation experiments showed calcineurin could directly dephosphorylate a site in Kir6.1 that was previously phosphorylated by PKA.

Conclusions and implications:

Calcineurin Aα regulates K_IR6.1/SUR2B by inhibiting PKA-dependent phosphorylation of the channel as well as PKA itself. Such a mechanism is likely to directly oppose the action of vasodilators on the K_ATP channel.British Journal of Pharmacology (2009) 157, 554–564; doi:10.1111/j.1476-5381.2009.00221.x; published online 7 May 2009This article is commented on by Tammaro, pp. 551–553 of this issue and is part of a themed section on Endothelium in Pharmacology. For a list of all articles in this section see the end of this paper, or visit: http://www3.interscience.wiley.com/journal/121548564/issueyear?year=2009     

Post-pubescent to mature fathers: increase in progeny quality?

In the mouse, offspring born from mature fathers exhibit better behavioural performances (for spontaneous activity in both sex and learning capacity in males) than those born from post-pubescent fathers. These behavioural variations are not accompanied by other obvious modifications. They could correspond to what has been observed in man relating to the results in a psychometric test undergone by male progeny born from very young to mature fathers. These data and those which show a decrease in mental performance in rats and human males born from mature to senescent fathers suggest the participation of some genetic factors in these phenomena.