Rhythm in the speech of a person with right hemisphere damage: Applying the pairwise variability index

Although several aspects of prosody have been studied in speakers with right hemisphere damage (RHD), rhythm remains largely uninvestigated. This study compares the rhythm of an Australian English speaker with right hemisphere damage (due to a stroke, but with no concomitant dysarthria) to that of a neurologically unimpaired individual. The speakers' rhythm is compared using the pairwise variability index (PVI) which allows for an acoustic characterization of rhythm by comparing the duration of successive vocalic and intervocalic intervals. A sample of speech from a structured interview between a speech and language therapist and each participant was analysed. Previous research has shown that speakers with RHD may have difficulties with intonation production, and therefore it was hypothesized that there may also be rhythmic disturbance. Results show that the neurologically normal control uses a similar rhythm to that reported for British English (there are no previous studies available for Australian English), whilst the speaker with RHD produces speech with a less strongly stress-timed rhythm. This finding was statistically significant for the intervocalic intervals measured (t(8) = 4.7, p < .01), and suggests that some aspects of prosody may be right lateralized for this speaker. The findings are discussed in relation to previous findings of dysprosody in RHD populations, and in relation to syllable-timed speech of people with other neurological conditions.     

Fatal evolution of a huge right atrial free‐floating thrombus

Right atrial thrombus is a rare medical emergency that should be suspected in all cases of pulmonary embolism, and rapid action should be taken to ensure a timely, proper management.     

Falha de integridade dos elétrodos de desfibrilhação Riata e Riata ST: um problema atual

Riata and Riata ST silicone defibrillation leads are prone to externalization of conductors due to inside-out abrasion in the high-voltage system, causing structural damage which may be accompanied by electrical failure. These situations are easily detected by fluoroscopy or radiology and by inspection of intracardiac electrograms and/or measurement of impedance. However, older pulse generators do not automatically perform all the measurements needed to assess the integrity of the high-voltage electrical system, nor do they have patient notifier alerts in case of dysfunction.The authors describe the case of a patient in whom structural damage was detected on fluoroscopy during pulse generator replacement. They discuss the best strategy in these patients, considering current knowledge of this dysfunction.     

我国医疗告知义务履行中存在的问题与对策

目前我国医疗告知义务的履行中仍存在患者被动接受信息和只强调同意不注重知情等问题.这些问题的存在由“父权主义”观念的影响和在医疗告知义务履行中采用“客观标准”所造成的弊端所致,因此在医疗信息告知义务的履行中应摒弃“父权主义”观念和逐步采纳“主观标准”所倡导的以具体患者为中心的理念,同时还应在方法和技术层面进行创新,让患者能够获得和充分理解所需要的医学信息,使其能够根据自己的生活取向和价值观对治疗措施作出选择.     

老年患者行选择性右肝切除术后的肝功能评价

目的评价≥65岁老年患者行选择性右肝切除术后的肝功能情况。方法采用回顾性研究,分析行选择性右肝切除术（Ⅴ～Ⅷ段）的24例≥65岁老年患者和22例≤40岁患者的病历资料,统计两组患者的手术死亡、术后并发症和肝功能情况。结果≥65岁老年患者组手术死亡1人,术后严重并发症发生率为12.50％;而≤40岁患者组无手术死亡,术后严重并发症发生率为5.00％,两组手术死亡情况比较,差异无统计学意义（χ2=1.00,P＞0.05）,两组的严重并发症发生率经Fisher精确概率法检验,差异亦无统计学意义（P＞0.05）。≥65岁老年患者组需要术中或术后输血8例多于≤40岁患者组6例,但差异无统计学意义（χ2=0.20,P＞0.05）,且两组红细胞使用单位数及住院时间比较,差异均亦无统计学意义（t分别=1.04、1.32,P均＞0.05）。两组肝功能变化情况：术后在术后第2天内凝血酶原时间（PT）和总胆红素（TBS）指标变化最明显,PT明显下降,TBS明显上升;术后2～5 d变化缓慢,待术后第5天, PT明显上升,TBS缓慢下降,趋于术前水平。天冬氨酸转氨酶（AST）在术后第2天内迅速上升至最高点,γ谷氨酰胺转肽酶（GGT）缓慢下降至最低点;从第2天开始,AST逐渐下降,GGT缓慢上升至术前水平。丙氨酸转氨酶（ALT）与AST变化趋势一致,碱性磷酸酶（ALP）与GGT变化趋势一致。两组患者变化趋势基本一致。结论≥65岁老年患者行选择性右肝切除术后的肝功能情况与年轻患者（≤40岁）无明显差别。     

Endobronchial tuberculosis presenting as right middle lobe syndrome: clinical characteristics and bronchoscopic findings in 22 cases

PURPOSE: Endobronchial tuberculosis (EBTB) presenting as right middle lobe syndrome (RMLS) is an uncommon clinical condition. We investigated the clinical characteristics in patients with EBTB presenting as RMLS. PATIENTS AND METHODS: We retrospectively reviewed the records of 22 patients with EBTB presenting as RMLS who were diagnosed at our hospital from 2003 to 2006. RESULTS: Its occurrence was more common in females than males (F, 18; M, 4). The mean age was 70.3 +/- 8.5 years, and 17 patients were above the age of 65 years. Cough with sputum was the most common manifestation and 2 patients were asymptomatic. In bronchoscopic analysis, the most common finding was edematous-type EBTB, which was found in 15 patients, followed by actively caseating type in 6 and tumorous type in 1. Acid-fast bacilli (AFB) staining for bronchial washing fluid was positive in only 5 patients: 1 with edematous type and 4 with actively caseating type. Bronchoscopic biopsy showed chronic granulomatous inflammation in 16 patients. Follow-up chest X-ray after treatment showed complete disappearance of the lesion in 2 patients, more than 50% improvement in 5, less than 50% improvement in 5, and no change of lesion in 4. CONCLUSION: Edematous-type EBTB was the most common type of EBTB presenting as RMLS, and it usually occurred in elderly patients. Culturing for mycobacterium and histologic examination by bronchoscopy are necessary for proper diagnosis in these patients.     

Right-sided implantation and subpectoral position are predisposing factors for fracture of a 6.6 French ICD lead

Background: The Medtronic Sprint Fidelis (Medtronic Inc., Minneapolis, MN, USA) lead family is associated with an unacceptable incidence of premature lead failure. There are limited data on risk factors for lead fracture. We hypothesized that factors leading to potential increased forces on the lead related to device implantation or technique may be associated with premature lead failure. Methods: We reviewed the implant data from our group and identified 176 patients who received active fixation Medtronic Fidelis (Model 6931, single coil and Model 6949, dual coil) leads. Implant data, including age, sex, venous access site, implant side, implant location, and number of venous leads were reviewed. Hospital, pacemaker clinic, and Medtronic registration databases were reviewed for evidence of lead failure, replacement, or abandonment. Data was evaluated in univariate and multivariate regression analyses. Results: Of the 176 leads implanted, 10 (5.7%) were noted to develop malfunction. This presented as inappropriate shocks from sensed noise or elevated impedance measurements. Of the above noted implant features, only right‐sided (vs left‐sided) implant (hazard ratio [HR] 18.8, 95% confidence intervals [CI] 3.8, 93.3), and subpectoral implant (vs prepectoral; HR 14.31, 95% CI 3.2, 64.0) were predictive of lead failure in maximally adjusted models. Conclusions: We have identified both right‐sided implantation and subpectoral generator positioning as factors associated with premature lead malfunction in Fidelis active fixation leads. Clinical decisions regarding patient management should incorporate these findings in regard to lead replacement in high‐risk patients. (PACE 2012; 35:659–664)     

Interplay between Arrhythmias Originating in the Right Ventricular Outflow Tract and the Left Coronary Cusp

A 35‐year‐old man was referred for ablation of ventricular tachycardia with two different morphologies triggering each other. After elimination of the first arrhythmia in the right ventricular outflow tract, ablation of the second morphology was performed 8 mm below the left main stem after contrast injection into the left coronary cusp through the irrigated‐tip ablation catheter. (PACE 2012;35:e356–e357)     

Upper limb kinesthetic asymmetries: Gender and handedness effects

Proprioceptive and motor information contribute to movement representation; however, the equivalence of homologous contralateral sensorimotor processes as a function of gender and handedness has received little attention. The present work investigated asymmetry in contralateral reproductions of movements elicited by tendon vibration in right and left handed young adults of both genders. With eyes closed, illusions of elbow flexion movement elicited by a 100 Hz vibration applied to the distal tendon of the right or left triceps muscle were matched concurrently with the opposite limb. Overall, movement velocity was larger for females than males, asymmetric and handedness dependent in males. Conversely, consistent symmetry was found between left and right-handed females. These findings lead us to suggest that hand preference and gender contribute to differences in movement representation that may result from the combination of cortical structural differences and information processing specific to each hemisphere and gender.