Impact of speech rate on perception of vowel and consonant duration by bilinguals and monolinguals.

The perceptual boundary between short and long categories depends on speech rate. We investigated the influence of speech rate on perceptual boundaries for short and long vowel and consonant contrasts by Spanish-English bilingual listeners and English monolinguals. Listeners tended to adapt their perceptual boundaries to speech rates, but the strategy differed between groups, especially for consonants. Understanding the factors that influence auditory processing in this population is essential for developing appropriate assessments of auditory comprehension. These findings have implications for the clinical care of older populations whose ability to rely on spectral and/or temporal information in the auditory signal may decline.

Continuous Epidural Saline Infusion for the Treatment of Spontaneous Intracranial Hypotension.

OBJECTIVE: Spontaneous intracranial hypotension (SIH) is an increasingly recognized cause of orthostatic headache, but treatment strategies remain controversial. The epidural blood patch is a well-known and widely used treatment in patients with conservative treatment-resistant SIH, but symptoms may not improve even after multiple epidural blood patches, and resistant patients suffer from a lack of appropriate treatment options. Therefore, this study assessed the safety and efficacy of continuous epidural saline infusion (CESI) for SIH treatment. METHODS: CESI was performed in 11 consecutive patients affected by conservative treatment-resistant SIH. Patient characteristics were obtained by reviewing medical records retrospectively. Headache intensity was assessed using the numerical rating scale (NRS), and changes in NRS before and after treatment were recorded. RESULTS: The average treatment period for CESI was 21.3 ± 9.6 days, and the average follow-up period was 35.0 ± 30.2 months. CESI was without major complications or mortality, and no infections occurred, even without prophylactic antibiotics. The median NRS score before treatment was 10 points, improving to 5 points 1 day after infusion (P < 0.05), 2 points 1 week after infusion (P < 0.05), and 0 points at 3 months after infusion and the final follow-up. No patients have since experienced recurrence of orthostatic headaches. CONCLUSIONS: CESI appears to be a safe and well-tolerated procedure for SIH. Further experience may demonstrate this technique to be a viable treatment option for SIH.

Change of coagulation after NovoSeven® use for bleeding during cardiac surgery.

Objectives Recombinant activated factor VII has been used for the treatment of hemophilia, factor VII deficiency, and Glanzmann's thrombasthenia. Off-label uses have recently been increasing, and there are reports that recombinant activated factor VII is effective for the treatment of excessive bleeding during or after cardiovascular surgery. We retrospectively reviewed the effectiveness of recombinant activated factor VII and its influence on the coagulation system as a treatment for uncontrollable bleeding during cardiovascular surgery. Methods Between April 2009 and May 2015, recombinant activated factor VII was used to treat uncontrollable bleeding during cardiovascular surgery in 17 patients at our hospital. The indications for recombinant activated factor VII administration were critical uncontrollable bleeding during surgery and normal platelet and fibrinogen levels. Results Blood loss significantly decreased in every case after recombinant activated factor VII administration ( p < 0.05). No adverse thromboembolic events were encountered. The prothrombin time-international normalized ratio, activated partial thromboplastin time, fibrin degradation product and D-dimer levels decreased significantly after recombinant activated factor VII administration. One day later, all blood coagulation test values were almost within the normal ranges. Conclusions Recombinant activated factor VII has a strong hemostatic action, but it is necessary to exclude surgical bleeding to exhibit the hemostatic effect. Administration that does not comply with the indications for recombinant activated factor VII may lead to serious complications such as thromboembolism. In properly selected patients, recombinant activated factor VII is an effective agent for the treatment of uncontrollable bleeding during cardiovascular surgery.

[Efficacy of Recombinant Activated Factor VII for Intractable Bleeding after Cardiovascular Surgery].

UNLABELLED: Recombinant activated factor VII (rFVIIa) has been used for the treatment of hemophilia, factor VII deficiency, and Glanzmann's thrombasthenia. We retrospectively reviewed the effectiveness of rFVIIa for the treatment of uncontrollable bleeding after cardiovascular surgery. MATERIAL AND METHODS: Eight patients received rFVIIa for the treatment of uncontrollable bleeding after admission to the intensive care unit following cardiovascular surgery between April 2009 and July 2014. RESULTS: Blood loss was significantly decreased in 7 of the 8 cases after the administration of rFVIIa (p<0.05). No adverse thromboembolic events were encountered. The quantity of blood loss and prothrombin time-international normalized ratio(PT-INR), activated partial thromboplastin time(APTT), fibrin degradation products(FDP) and D-dimer levels decreased significantly after the administration of rFVIIa (p<0.05). The blood coagulation test values were almost within the normal range at 24 hours after administration. CONCLUSION: In appropriately selected patients, rFVIIa is an effective agent for the treatment of excessive bleeding after cardiovascular surgery.

[Invalid sensors judged by the BIS A-2000 monitors may display clinically acceptable BIS values on the external equipments].

The bispectral index (BIS) is widely used to measure anesthetic levels in the perioperative period. In our hospital, the BIS monitors (A-2000) are connected to bedside monitors and display BIS values on them through outside input. All datas on the bedside monitors are transmitted to anesthesia information management system automatically. We report cases that were impossible to measure BIS values with the displays of "Invalid Sensor" on the BIS A-2000 sensor, but BIS values were measurable on the bedside monitors. One possible reason is thought that the BIS Quatro Sensor transmits both EEG signals and sensor information to the BIS A-2000 monitor separately. BIS A-2000 monitors may process EEG signals and sensor information individually, and transfer BIS parameters to the external equipments, regardless of sensor information.

[Case of severe hypokalemia during emergency surgery caused by long-term administration of Shakuyaku-kanzo-to].

An 82-year-old female underwent emergency surgery for right femoral incarcerated hernia under general anesthesia. Anesthesia was induced and maintained with remifentanil and propofol. Her laboratory data showed severe hypokalemia (1.83 mEq x l(-1)) and metabolic alkalosis (HCO3 36.9 mmol x l(-1)). We suspected that the causes of such abnormalities were due to an endocrinological abnormality, but we could not ascertain the actual cause. Drip infusion of sodium chloride and saline solution infusion, to avoid supplying lactate or acetate, the source of bicarbonate ions, were chosen for palliative treatment. No adverse event occurred during surgery. After surgery, endocrinological functions were examined. Primary aldosteronism was ruled out because serum aldosterone and rennin activity were within normal ranges. The patient had been taking a Kampo preparation, Shakuyaku-kanzo-to, for two years. Glycyrrhizin, the main component of Shakuyaku-kanzo-to, has been reported to be a cause of pseudoaldosteronism by inhibiting the enzyme converting cortisol to cortisone. With these findings we confirmed that severe hypokalemia was induced by pseudoaldosteronism by long-term administration of Shakuyaku-kanzo-to.

Training English listeners to perceive phonemic length contrasts in Japanese.

The present study investigated the extent to which native English listeners' perception of Japanese length contrasts can be modified with perceptual training, and how their performance is affected by factors that influence segment duration, which is a primary correlate of Japanese length contrasts. Listeners were trained in a minimal-pair identification paradigm with feedback, using isolated words contrasting in vowel length, produced at a normal speaking rate. Experiment 1 tested listeners using stimuli varying in speaking rate, presentation context (in isolation versus embedded in carrier sentences), and type of length contrast. Experiment 2 examined whether performance varied by the position of the contrast within the word, and by whether the test talkers were professionally trained or not. Results did not show that trained listeners improved overall performance to a greater extent than untrained control participants. Training improved perception of trained contrast types, generalized to nonprofessional talkers' productions, and improved performance in difficult within-word positions. However, training did not enable listeners to cope with speaking rate variation, and did not generalize to untrained contrast types. These results suggest that perceptual training improves non-native listeners' perception of Japanese length contrasts only to a limited extent.

Neural processes involved with perception of non-native durational contrasts.

Neural processes underlying identification of durational contrasts were studied by comparing English and Japanese speakers for Japanese short/long vowel identification relative to consonant identification. Enhanced activities for non-native contrast (Japanese short/long vowel identification by English speakers) were observed in brain regions involved with articulatory-auditory mapping (Broca's area, superior temporal gyrus, planum temporale, and cerebellum), but not in the supramarginal gyrus. Greater activity in the supramarginal gyrus found for the consonant identification over short/long vowel identification by Japanese speakers implies that it is more important for phonetic contrasts differing in place of articulation than for vowel duration. These results support the hypothesis that neural processes used to facilitate perception depend on the relative contribution of information important for articulatory planning control.

Learning-induced neural plasticity associated with improved identification performance after training of a difficult second-language phonetic contrast.

Adult native Japanese speakers have difficulty perceiving the English /r-l/ phonetic contrast even after years of exposure. However, after extensive perceptual identification training, long-lasting improvement in identification performance can be attained. This fMRI study investigates localized changes in brain activity associated with 1 month of extensive feedback-based perceptual identification training by native Japanese speakers learning the English /r-l/ phonetic contrast. Before and after training, separate functional brain imaging sessions were conducted for identification of the English /r-l/ contrast (difficult for Japanese speakers), /b-g/ contrast (easy), and /b-v/ contrast (difficult), in which signal-correlated noise served as the reference control condition. Neural plasticity, denoted by exclusive enhancement in brain activity for the /r-l/ contrast, does not involve only reorganization in brain regions concerned with acoustic-phonetic processing (superior and medial temporal areas) but also the recruitment of additional bilateral cortical (supramarginal gyrus, planum temporale, Broca's area, premotor cortex, supplementary motor area) and subcortical regions (cerebellum, basal ganglia, substantia nigra) involved with auditory-articulatory (perceptual-motor) mappings related to verbal speech processing and learning. Contrary to what one may expect, brain activity for perception of a difficult contrast does not come to resemble that of an easy contrast as learning proceeds. Rather, the results support the hypothesis that improved identification performance may be due to the acquisition of auditory-articulatory mappings allowing for perception to be made in reference to potential action.

Olprinone, a phosphodiesterase III inhibitor, does not affect hypoxia-induced pial arteriolar dilatation in rabbits.

PURPOSE: Olprinone, a phosphodiesterase III inhibitor, is used for the treatment of heart failure or asthma. Such patients may suffer from hypoxia. However, the effect of olprinone on the cerebral vasodilator response to hypoxia remains unclear. METHODS: Rabbits were anesthetized and ventilated mechanically. The pial arteriolar diameter was determined using a cranial window and intravital microscopy. Hypoxia was induced twice in the same animal by reducing FIO(2) to 0.1. The first episode was induced during an infusion of saline, and the second during an infusion of saline (saline group; n = 8) or olprinone (1 microg x kg(-1) x min(-1), OLP1 group; n = 8 or 10 microg x kg(-1) x min(-1), OLP10 group; n = 8). The pial arteriolar responses to hypoxia were recorded and compared between the two episodes of hypoxia in each group. RESULTS: Blood gas data in the first hypoxic challenge were identical to those in the second challenge in each group. Pial arteriolar diameter increased significantly during hypoxia. In arterioles between 50-100 microm diameter, first and second hypoxia-induced pial arteriolar dilatation in OLP1 were 13 +/- 6% and 10 +/- 7% respectively (P = 0.574 ) and those in OLP10 were 16 +/- 6% and 15 +/- 7% respectively (P = 0.606). In arterioles between 25-50 microm, the results were the same as in arterioles between 50-100 microm. CONCLUSION: Olprinone does not affect the hypoxia-induced dilatation of pial arterioles in pentobarbital anesthetized rabbits.

Hemodynamic effects of oral clonidine premedication in lumbar epidural anesthesia.

Clonidine, an α2-adrenergic agonist, has a potent sympatholytic effect and augments the pressor effect of ephedrine during general anesthesia. We evaluated whether oral clonidine premedication would alter the hemodynamic changes and enhance the pressor response to intravenous ephedrine during epidural anesthesia in 35 adult patients. They were randomly administered either premedication with clonidine approximately 5 µg·kg-1 po (n=17) or no clonidine medication (n=18). After establishment of epidural anesthesia, the hemodynamic response to ephedrine iv was measured in the awake state at 1-min intervals for 10 min. Then, the same hemodynamic measurement was repeated in the asleep state induced with midazolam iv. There were no differences in blood pressure (BP) and heart rate values between groups during the onset of epidural anesthesia, except that BP before epidural anesthesia was lower in the clonidine group than the control group (P<0.05). The magnitude and duration of pressor responses to ephedrine were comparable between groups in awake and asleep states. In conclusion oral clonidine premedication 5 µg·kg-1 alters neither the hemodynamic changes nor the pressor response to intravenous ephedrine during epidural anesthesia.