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European Journal of Nutrition -     

Meningitis and pneuomocephalus. A rare complication of external dacryocystorhinostomy

Meningitis due to fracture of the fovea ethmoidalis during external dacryocystorhinostomy is a rare complication. We report a case of pneumocephalus and meningitis in a 51-year-old female who underwent an external dacryocystorhinostomy (DCR). Although extracranial complications during or after external DCR have been well-described, only one case of meningitis has been reported in the literature. Physical examination, computerised tomography, lumbar puncture, and bacteriologic cultures were used to make the diagnosis. The patient responded well to antibiotic therapy. Her symptoms resolved immediately and she was discharged on the 21st post-operative day. This complication emphasises the importance of careful surgical technique and a thorough knowledge of regional anatomy, during DCR and similar procedures.     

1H editing of 2-deuterated exogenous and natural endogenous D-glucose in biological samples

A spin-echo based ¹H homonuclear pulse sequence, enabling the selective editing of homonuclear first-order J-multiplet types, is presented and analyzed. Its effectiveness in quantification applications is assessed. Its potential usefulness in the quantitative distinction between 2-deuterated and natural D -,glucose in biological samples is briefly discussed, with emphasis on studies of hexose metabolism conducted in vitro.     

Monkeys are perceptually tuned to facial expressions that exhibit a theta-like speech rhythm

Human speech universally exhibits a 3- to 8-Hz rhythm, corresponding to the rate of syllable production, which is reflected in both the sound envelope and the visual mouth movements. Artificial perturbation of the speech rhythm outside the natural range reduces speech intelligibility, demonstrating a perceptual tuning to this frequency band. One theory posits that the mouth movements at the core of this speech rhythm evolved through modification of ancestral primate facial expressions. Recent evidence shows that one such communicative gesture in macaque monkeys, lip-smacking, has motor parallels with speech in its rhythmicity, its developmental trajectory, and the coordination of vocal tract structures. Whether monkeys also exhibit a perceptual tuning to the natural rhythms of lip-smacking is unknown. To investigate this, we tested rhesus monkeys in a preferential-looking procedure, measuring the time spent looking at each of two side-by-side computer-generated monkey avatars lip-smacking at natural versus sped-up or slowed-down rhythms. Monkeys showed an overall preference for the natural rhythm compared with the perturbed rhythms. This lends behavioral support for the hypothesis that perceptual processes in monkeys are similarly tuned to the natural frequencies of communication signals as they are in humans. Our data provide perceptual evidence for the theory that speech may have evolved from ancestral primate rhythmic facial expressions.One universal feature of speech is its rhythm. Across all languages studied to date, speech typically exhibits a 3- to 8-Hz rhythm that is, for the most part, related to the rate of syllable production (1–4). This 3- to 8-Hz rhythm is critical to speech perception: Disrupting the auditory component of this rhythm significantly reduces intelligibility (5–9), as does disrupting the visual dynamics arising from mouth and facial movements (10). The exquisite sensitivity of speech perception to this rhythm is thought to be related to on-going neural rhythms in the neocortex. Rhythmic activity in the auditory cortex prevails in a similar 3- to 8-Hz (theta) frequency range (11–13), and the temporal signature of the neural rhythm (i.e., its phase) locks to the temporal dynamics of complex sounds such as speech (14–17). Importantly, speeding up speech so that it is faster than 8 Hz disrupts the ability of the auditory cortex to track speech (14, 16), whereas adding silent intervals to time-compressed speech can rescue comprehension when the interval frequency rate is matched to the theta range (18). Thus, the natural rhythm of speech seems to be linked to on-going neocortical oscillations.Given the importance of this rhythm in speech, understanding how speech evolved requires investigating the origins of its rhythmic structure and the brain’s sensitivity to it. One theory posits that the rhythm of speech evolved through the modification of rhythmic facial movements in ancestral primates (19). Such facial movements are extremely common in the form of visual communicative gestures. Lip-smacking, for example, is an affiliative signal observed in many genera of primates (20–22), including chimpanzees (23). It is characterized by regular cycles of vertical jaw movement, often involving a parting of the lips, but sometimes occurring with closed, puckered lips (24). Importantly, as a communication signal, lip-smacking is directed at another individual during face-to-face interactions (22, 25) and is among the first facial expressions produced by infant monkeys (26, 27). According to MacNeilage (19), during the course of speech evolution, such nonvocal rhythmic facial expressions were coupled to vocalizations to produce the audiovisual components of babbling-like (i.e., consonant-vowel–like) speech expressions.Although direct tests of such evolutionary hypotheses are difficult, we recently showed that the production of lip-smacking in macaque monkeys is, indeed, strikingly similar (likely homologous) to the orofacial rhythms produced during speech. For example, in contrast to chewing and other rhythmic orofacial movements, lip-smacking exhibits a speech/theta-like 3- to 8-Hz rhythm (24, 28, 29), and its developmental trajectory is the same as the trajectory leading from human babbling to adult consonant-vowel utterances (29). Moreover, an X-ray cineradiographic study of the dynamics of vocal tract elements (lips, tongue, and hyoid bone) during lip-smacking versus chewing showed that the differential functional coordination of these effectors during these behaviors parallels that of human speech and chewing (24). However, what about perception? At the neural level, we know that, as in humans, temporal lobe structures in the macaque monkey (e.g., auditory cortex, superior temporal sulcus) are sensitive to dynamic audiovisual vocal communication signals (28, 30–33) and that they exhibit rhythmic neural activity fluctuations in the theta range spontaneously (34) and in response to naturalistic stimuli (35). However, we do not know if monkeys are perceptually tuned to the species-typical rhythmicity in the same way that humans are perceptually most sensitive to natural speech rhythms.     

Risk factors for body composition abnormalities in systemic sclerosis

The aim of this study was to evaluate the body composition (BC), bone mineral density (BMD), and the food intake in women with systemic sclerosis (SSc) compared to a control group, in order to identify main risk factors for BC abnormalities in SSc. Sixty-one SSc women and 67 age- and gender-matched controls were included. Spine, femur, and total body BMD measurements were performed using dual-energy X-ray absorptiometry. BC measurements included total lean (LM), fat mass (FM), and relative skeletal muscle mass index (RSMI) assessment. The food intake was calculated from 3-day food records and transformed into energy and nutrients. The 61 SSc patients [30 with diffuse cutaneous disease (dcSSc) and 31 with limited cutaneous SSc (lcSSc)] had significantly lower body mass index (BMI), LM, and FM, as well as lower BMD values compared to controls. Besides, the group with dcSSc, but not those with lcSSc, showed significantly lower BC and BMD measurements than controls. There was a significant inverse correlation between disease duration and BMI, LM, and RSMI. The total energy, macronutrients, and essential amino acids intakes were similar between patients and controls. After multivariate analysis, longer disease duration was the only risk factor associated with sarcopenia (RSMI below 5.45 kg/m²; OR?=?1.36, 95 % CI 1.07–1.7). The present study showed an abnormal BC and a lower BMD, especially in dcSSc women, regardless of current food intake. Longer disease duration was associated with a higher risk of sarcopenia in SSc patients.     

Angiotensin‐II receptor 1 antagonist fetopathy – risk assessment,critical time period and vena cava thrombosis as a possible new feature

Aims

Angiotensin‐II receptor 1 antagonists (AT₁‐antagonists) may cause severe and even lethal fetopathy in late pregnancy. However, exposure still occurs in spite of warnings in package leaflets. This study aimed to assess the risk of fetopathy, the sensitive time window, and possible new symptoms in prospective as well as retrospective cases with AT₁‐antagonist treatment during the second or third trimester of pregnancy.

Methods

Patients were enrolled by the Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy between 1999 and 2011 through risk consultation. Symptoms defined as indicative of AT₁‐antagonist fetopathy were: oligo‐/anhydramnios, renal insufficiency, lung hypoplasia, joint contractures, skull hypoplasia and fetal/neonatal death.

Results

In 5/29 (17%) prospectively enrolled cases with AT₁‐antagonist exposure beyond the first trimester oligo‐/anhydramnios was diagnosed. Two infants showed additional symptoms of fetopathy. The risk is more than 30% if treatment continues beyond the 20th week of pregnancy. Oligo‐/anhydramnios was reversible after AT₁‐antagonist withdrawal. Among 16 retrospective case reports, three infants presented with a thrombosis of the inferior vena cava in the vicinity of the renal veins. Four out of 13 live births did not survive.

Conclusions

Our survey suggests that the risk increases with duration of AT₁‐antagonist treatment into late pregnancy and oligo‐/anhydramnios may be reversible after AT₁‐antagonist discontinuation. Thrombosis of inferior vena cava may be a new feature of AT₁‐antagonist fetopathy. AT₁‐antagonist medication during pregnancy constitutes a considerable risk and must be discontinued immediately. In case of indicative diagnostic findings in either the fetus or newborn, previous maternal AT₁‐antagonist exposure should be considered.