A technotypological analysis of the Ahmarian and Levantine Aurignacian assemblages from Manot Cave (area C) and the interrelation with site formation processes.

For more than a century, prehistoric research has focused on cave sites and rock shelters, mostly because of good preservation of organic remains associated with stratified anthropogenic layers. Manot Cave in the Western Galilee, Israel offers the possibility of studying prehistoric assemblages in pristine condition because of the collapse of the cave entrance some 30 thousand years ago. Nine years of excavations have uncovered an Early Upper Paleolithic archaeological sequence. Area C, situated at the bottom of the talus, was exposed to fast and slow depositional and postdepositional processes affecting sediment accumulation. The central part of area C was selected for this study, as it was least disturbed. Following a technotypological analysis, and taking postdepositional processes into consideration, the assemblages were defined and assigned to the Levantine Aurignacian, and Ahmarian traditions. The two archaeological horizons are separated by a mixed horizon within which indicative artifacts of both traditions alternately appear. The Ahmarian assemblage, dated to 46-42 ka cal BP, fits within the northern Mediterranean Ahmarian sites, which technotypologically differs from and is currently dated earlier than the southern desert region Ahmarian sites. The main technotypological characteristics of the assemblage from the Levantine Aurignacian Horizon, dated to 38-34 ka cal BP, are comparable to those from Manot Cave area E layers V-VI, and Ksâr 'Akil levels VII-VIII. Yet, several technotypological elements seem more compatible with the unnamed assemblage from Ksâr 'Akil levels XI-XIII and possibly layer IX from area E.

Anatomical plasticity and sparing of function after spinal cord damage in neonatal cats.

Spinal cord damage in neonatal cats has different effects on different spinal pathways. Corticospinal projections exhibit anatomical plasticity, forming an aberrant pathway that bypasses the lesion. In contrast, brainstem-spinal pathways undergo massive retrograde degeneration. Neither of these responses occurs in adult cats. Sparing of motor function is found in cats operated on as neonates but not in cats operated on as adults, and appears to depend on the plasticity of the corticospinal tract.

Kawasaki syndrome in an adult: endomyocardial histology and ventricular function during acute and recovery phases of illness.

Kawasaki syndrome, an acute systemic inflammatory illness of unknown origin usually affecting children, may develop into a serious illness complicated by coronary artery aneurysms or myocarditis. This report describes an adult with Kawasaki syndrome studied by right ventricular endomyocardial biopsy and cardiac catheterization during the acute and recovery phases of illness. The initial biopsy specimen showed acute myocarditis and was associated with hemodynamic evidence of biventricular dysfunction, a severely depressed left ventricular ejection fraction and global hypokinesia. With time, there was spontaneous and rapid resolution of the inflammatory cell infiltrate with concurrent return to normal myocardial function. Right ventricular endomyocardial biopsy studies early in the course of the cardiac disease associated with Kawasaki syndrome may correlate with ventricular function and may be useful for monitoring immunosuppressive therapy in patients with this syndrome.

Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?

OBJECTIVES: We sought to investigate the potential benefit of thrombolytic therapy (TT) and intra-aortic balloon pump counterpulsation (IABP) on in-hospital mortality rates of patients enrolled in a prospective, multi-center Registry of acute myocardial infarction (MI) complicated by cardiogenic shock (CS). BACKGROUND: Retrospective studies suggest that patients suffering from CS due to MI have lower in-hospital mortality rates when IABP support is added to TT. This hypothesis has not heretofore been examined prospectively in a study devoted to CS. METHODS: Of 1,190 patients enrolled at 36 participating centers, 884 patients had CS due to predominant left ventricular (LV) failure. Excluding 26 patients with IABP placed prior to shock onset and 2 patients with incomplete data, 856 patients were evaluated regarding TT and IABP utilization. Treatments, selected by local physicians, fell into four categories: no TT, no IABP (33%; n = 285); IABP only (33%; n = 279); TT only (15%; n = 132); and TT and IABP (19%; n = 160). RESULTS: Patients in CS treated with TT had a lower in-hospital mortality than those who did not receive TT (54% vs. 64%, p = 0.005), and those selected for IABP had a lower in-hospital mortality than those who did not receive IABP (50% vs. 72%, p < 0.0001). Furthermore, there was a significant difference in in-hospital mortality among the four treatment groups: TT + IABP (47%), IABP only (52%), TT only (63%), no TT, no IABP (77%) (p < 0.0001). Patients receiving early IABP (< or = 6 h after thrombolytic therapy, n = 72) had in-hospital mortality similar to those with late IABP (53% vs. 41%, n = 64, respectively, p = 0.172). Revascularization rates differed among the four groups: no TT, no IABP (18%); IABP only (70%); TT only (20%); TT and IABP (68%, p < 0.0001); this influenced in-hospital mortality significantly (39% with revascularization vs. 78% without revascularization, p < 0.0001). CONCLUSIONS: Treatment of patients in cardiogenic shock due to predominant LV failure with TT, IABP and revascularization by PTCA/CABG was associated with lower in-hospital mortality rates than standard medical therapy in this Registry. For hospitals without revascularization capability, a strategy of early TT and IABP followed by immediate transfer for PTCA or CABG may be appropriate. However, selection bias is evident and further investigation is required.

Grafts of fetal central nervous system tissue rescue axotomized Clarke's nucleus neurons in adult and neonatal operates.

Many conditions are thought to contribute to neuron death after axotomy, including immaturity of the cell at the time of injury, inability to reestablish or maintain target contact, and dependence on trophic factors produced by targets. Exogenous application of neurotrophic factors and transplants of peripheral nerve and embryonic central nervous system (CNS) tissue temporarily rescue axotomized CNS neurons, but permanent rescue may require transplants that are normal targets of the injured neurons. We examined the requirements for survival of axotomized Clarke's nucleus (CN) neurons. Two months after hemisection of the spinal cord at the T8 segment, there was an ipsilateral 30% loss of neurons at the L1 segment in adult operates and a 40% loss in neonates. Transplants of embryonic spinal cord, cerebellum, and neocortex inserted into the T8 segment at the time of hemisection prevented virtually all of the cell death in both adults and neonates, but transplants of embryonic striatum were ineffective. None of the grafts prevented the somal atrophy of CN neurons caused by axotomy. Retrograde transport of fluoro-gold from the cerebellum demonstrated that 33% of all CN neurons at L1 project to the cerebellum, 50% of these died following a T8 hemisection, but all these projection neurons were rescued by a transplant of embryonic spinal cord. These results suggest that the rescue of axotomized CN neurons is relatively specific for the normal target areas of these neurons, but this specificity is not absolute and may depend on the distribution and synthesis of particular neurotrophic agents.

Plasticity of dorsal root and descending serotoninergic projections after partial deafferentation of the adult rat spinal cord.

Plasticity of dorsal root (DR) and descending serotoninergic (5-HT) projections following dorsal rhizotomy from L2 to S1 sparing L5 was studied by means of an intra-animal comparison in the adult rat spinal cord. Projections of the chronically and acutely spared root were compared by cholera-toxin conjugated horseradish peroxidase (CT-HRP) injected into the sciatic nerves as the transganglionic tracer. Projections in unoperated controls, operated controls (acute bilateral spared root), and in experimental animals (chronic spared root on one side and acute spared root on the other) were mapped and the density was measured with an image analysis system. Labeled DRG cells and motor neurons were counted to determine if there were differences in the delivery of the label between the two sides. Measurements of the area of the dorsal horn and, separately, of the superficial laminae were made to control for shrinkage. DR projections were symmetrical in operated and unoperated controls, but a significant increase in DR projection density was found from L6 to L3 in the dorsal horn and Clarke's nucleus at L1 on the chronic spared root side in animals in which an equal number of DRG cells was labeled on the two sides. Density of 5-HT immunoreactivity was symmetrical in controls. Ipsilateral to chronic spared root rhizotomy, the area fraction occupied by 5-HT projections increased in Clarke's nucleus and in the superficial dorsal horn of all partially deafferented segments except L5, the spared root segment. Partial deafferentation of the adult rat lumbosacral spinal cord may therefore elicit sprouting from the spared dorsal root and, outside of the dorsal root projection zone, sprouting from the spared descending 5-HT system. Plasticity of dorsal root projections and of 5-HT projections occur in different regions; in regions of the increased spared root projection, no increase in seen in 5-HT projections, suggesting that sprouting in the adult rat spinal cord is regulated, perhaps by competitive or hierarchical mechanisms.

Plasticity of spinal systems after unilateral lumbosacral dorsal rhizotomy in the adult rat.

Plasticity of spinal systems in response to lumbosacral deafferentation has previously been described for the cat, by using immunocytochemistry to demonstrate plasticity of tachykinin systems and degeneration methods to demonstrate plasticity of descending systems. In this study, we describe the response to lumbosacral deafferentation in the adult rat. Application of immunocytochemical methods to visualize tachykinins (predominantly substance P magnitude of SP), serotonin (5-HT), and dopamine B-hydroxylase (DBH), the synthesizing enzyme for norepinephrine, permits us to compare the response of SP systems in rat and cat spinal cord and to examine the response of two descending systems, serotoninergic and noradrenergic, to deafferentation. We used image analysis of light microscopic preparations to quantify the immunoreaction product in the spinal cord in order to estimate the magnitude, time course and localization of changes induced by the lesion. The distribution of SP, serotoninergic (5-HT), and noradrenergic staining in the spinal cord of rat is very similar to that of the cat. Unilateral lumbosacral rhizotomy elicits a partial depletion, followed by a partial replacement of tachykinin immunoreactivity in laminae I and II. This response was similar to that described for the cat, although characterized by a longer time course, and, as in the cat, is likely due to plasticity of tachykinin containing interneurons. The same lesion elicits no depletion but a marked and permanent increase in 5-HT immunoreactivity in laminae I and II, which develops more rapidly than the response by the SP system. These results indicate sprouting or increased production of SP and 5-HT in response to deafferentation. No change was seen in DBH immunoreactivity, indicating that the noradrenergic system does not show plasticity in response to deafferentation. Our results demonstrate that dorsal rhizotomy evokes different effects in different systems in the adult spinal cord of the rat and thus suggests that the response of undamaged pathways to partial denervation of their target is regulated rather than random.

[125I] triiodothyronine in the rat brain: evidence for neural localization and axonal transport derived from thaw-mount film autoradiography.

Previous thaw-mount light microscopic autoradiographic studies have shown that intravenously administered [125I] triiodothyronine is saturably concentrated and retained for at least 10 hours in discrete neural systems in the rat brain. To survey the brain more completely and to gain information about the time course of labeling, serial thaw-mount film autoradiograms were prepared from rat brains obtained at intervals through 48 hours after intravenous injection of high specific activity [125I] triiodothyronine. Parallel biochemical studies of whole brain homogenate extracts revealed that, at all time intervals, the label in the brain was mainly due to triiodothyronine itself (80%), or other organic iodocompounds (15%), but probably not due to free [125I] iodide (3%), which is rapidly transported out of the brain. The highly reproducible, well-defined labeling patterns seen on film indicated a widespread but selective localization of the hormone. At early times after intravenous injection of [125I] triiodothyronine, label was nonuniformly and prominently concentrated in selected regions of gray matter; evidence for saturability of hormone processing was obtained in competition studies with unlabeled triiodothyronine. Discrete labeling of fiber tracts (usually after 10 hours) left some regions of white matter conspicuously unlabeled. At 48 hours, many originally labeled gray regions showed markedly diminished or virtually complete loss of radioactivity, whereas others became newly or more prominently labeled. At that time, certain fiber tracts were also conspicuously labeled. The observed changing profiles of regional labeling over time are best explained by movement of the hormone from original sites of saturable incorporation in specific nuclei, to terminal fields, through the mechanism of axonal transport.

Internal transcardiac pericardiocentesis for acute tamponade.

If the catheter is still in the pericardium when tamponade is recognized during catheterization or electrophysiologic procedures, it can be used for definitive aspiration and relief of tamponade. This is physiologically beneficial to the patient, and psychologically beneficial to both patient and medical staff.

The use of behavioral methods to predict spinal cord plasticity.

The mechanisms underlying recovery of function following damage to the CNS, although suspected, are virtually unknown. After damage to the adult cat spinal cord, recovery of motor behavior depends on which systems have been interrupted and which remain intact. For example, following hemisection, overground (voluntary) and reflex locomotion recover and, although a normal kinematic pattern recovers, accurate placement of the limb during locomotion does not return to normal levels. This recovery is associated with lowering of thresholds for postural reflexes suggesting that increased afferent input may compensate for diminished descending control. In contrast, after unilateral loss of afferent input by lumbosacral deafferentation, (L1-S2 dorsal roots cut) overground locomotion recovers but a permanently abnormal kinematic pattern is used; reflex locomotion (bipedal locomotion on a treadmill) does not recover at all in the deafferented hindlimb. The specificity of the recovery suggests that increased input from descending pathways, which is required for overground but not reflex locomotion may compensate for loss of afferent input. Anatomical sequellae of these two lesion types have been examined. Studies after hemisection support the notion of a permanently increased dorsal root input as mapped by monoclonal antibody 'rat 102'. This is associated with a transient increase in GAP-43 labeling in the dorsal horn. In contrast, after deafferentation an increase is found in the descending serotonergic input to the deafferented side. These observations suggest that recovery of specific locomotor behavior can be used to predict compensatory changes in spared pathways. For the study of the effects of transplants, we have used complete spinal transections in newborn kittens with transplantation of E26 cat spinal cord into the transection site. The normal kitten develops overground locomotion beginning the end of the first week postnatal but reflex locomotion is delayed until the end of the second week. After transection on the first day of life, with or without a transplant, reflex locomotion begins precociously. Overground locomotion fails to develop in transection-only animals but does develop in animals with transection and transplant. This locomotion although clearly abnormal, shows postnatal development in terms of weight support and lateral stability. Furthermore, there is some indication of coordination between fore and hind limbs. These observations suggest that the transplants permit the development of some descending control although the anatomical correlates of this sparing/recovery of function are uncertain; the transplant rescues neurons caudal to the transection and also permits regeneration of some descending pathways into the transplant and caudally into host spinal cord.

Grafts and functional recuperation.

Plasticity of undamaged projections (axonal sprouting) in the adult and neonatal mammalian spinal cord has been documented many times. It has been associated, in some paradigms, with recovery of specific functions and motor behavior. This mutually occurring recovery of function appears to be enhanced by transplants of fetal tissue.

Differential recovery of bipedal and overground locomotion following complete spinal cord hemisection in cats.

We used behavioral assessment techniques to investigate the recovery of locomotion after spinal cord injury. Complete hemisec-tions were made at T13 and LI in the cat spinal cord. Observational and high-speed kinematic analyses of bipedal treadmill and overground locomotion were made from 1 to 5 weeks postoperatively. Both bipedal and overground locomotion showed partial recovery. The early stage of recovery was characterized by an increased range of joint movement in a proximal to distal progression. During later stages, hindlimb movements became more complex and interjoint coordination markedly improved. Overground locomotion recovered faster and to a greater extent than bipedal locomotion, as indicated by the time course of recovery, joint angular excursions and intralimb coordination. We propose that the recovery of bipedal locomotion may be more limited by reorganization of segmenta) sensory systems than overground locomotion, perhaps because alternate strategies for overground locomotion are available.

Locomotor recovery after unilateral hindlimb deafferentation in cats.

After hindlimb deafferentation, recovery of locomotor patterns may be distinguished from recovery of accurate movements. Cats were timed while crossing wide runways requiring that locomotion be present, and narrow runways which require that it also be accurate. Locomotion recovers soon after deafferentation and becomes almost normal in speed, although accuracy is still absent. This accuracy returns 10 days postoperatively. Ventral root afferents with cell bodies in dorsal root ganglia are unnecessary for recovery. Postural reflexes (and other non-topographic feedback) are used as cues for limb guidance after removal of that limb's topographic feedback. Anatomical experiments show that a thoracic root sprouts during the recovery period. This sprouting may increase the potency of postural reflexes. Although lower thoracic roots contribute to recovery, they are not essential. Ipsilateral descending system are essential, and represent the final common path for all recovery after deaffernting a hindlimb. Contralateral descending and afferent systems alone cannot mediate overground locomotion. Thus there is a difference between the systems which mediate overground locomotion and those used by animals in treadmill locomotion or with L-DOPA or clonidine or brain stem stimulation. The proposed mechanism underlying recovery of accurate locomotion is behavioral substitution which may be faciliated by collateral sprouting of relevant systems.

Interfering with inhibition may improve motor function.

Motor behavior not seen in newborn cats can be revealed by spinal transection and is therefore normally suppressed. Motor performance of these spinal kittens after reaching adulthood surpasses that of chronic adult-operated spinal cats but the latter display a significant improvement when GABAergic inhibition is blocked pharmacologically. Thus, inhibitory processes influence normal motor development as well as recovery of function after neurological damage.

Lack of sprouting and its presence after lesions of the cat spinal cord.

Degeneration methods were used to study the dorsal root and descending projections after chronic partial denervation of adult cat spinal cord. Conventional mapping methods were used, supplemented in some cases by densitometric measurements of the amounts of degeneration present. The amount of shrinkage of spinal gray matter in some sections was estimated by planimetric measurement. Two preparations were used: (1) partial unilateral rhizotomy in which all dorsal roots caudal to T4 were cut except L6 (spared root preparation); (2) complete unilateral deafferentation. The projection of L6 dorsal roots was examined in spared root preparations. T13 dorsal root projections were examined in deafferented preparations in which T13 was the lowest remaining root. The projection of descending systems was mapped in spared root and deafferented preparations. The spared root displayed an increased projection in the lateral portion of the dorsal horn, in the zona intermedia, Clarke's nucleus and in the base and reticular zone of nucleus gracilis. The lowest remaining root (T13) increased its projection to laminae VII and VIII and to the base and reticular zone of nucleus gracilis. In all cases, when an increased projection resulted from prior denervation, the increase never exceeded the boundaries of the normal projection. No sprouting was observed in those regions with the strictest topographical organization, the cell nests of nucleus gracilis or lamina IX of the spinal cord, even though these regions were partially denervated by the chronic lesions. Descending projections were increased on the experimental side of deafferented preparations12 but not of spared root preparations, suggesting that the presence of the spared root may prevent sprouting by descending systems. Because measurements of gray matter indicated that maximal sprouting occurred in segments showing least shrinkage (sprouting of L6 spared root into L6 segment), in this case shrinkage cannot account for the increased density of degeneration. These results suggest that certain conditions are important for the regulation of sprouting in the adult CNS. Firstly, sprouting is limited by a requirement for proximity and/or overlap. Secondly, the strictness of topographical localization within a particular region may limit the likelihood of sprouting into that region. Finally, a competitive or hierarchical relationship among the remaining systems may modify the capacity of a particular system to sprout.

Infant lesion effect: III. Anatomical correlates of sparing and recovery of function after spinal cord damage in newborn and adult cats.

We have demonstrated that sparing of tactile placing occurs after neonatal but not adult spinal cord damage and that the spared tactile placing of one limb depends on the corresponding (contralateral) sensorimotor cortex. In order to determine whether anatomical reorganization of the corticospinal or brainstem-spinal pathways also occurred which might account for the sparing of the tactile placing response, we used retrograde transport of horseradish peroxidase to map supraspinal neurons which project caudal to a spinal hemisection made either neonatally or in adulthood. The pattern of HRP labeling in the brainstem was identical in both the neonatal and adult operates. Neonatal operates, however, showed severe retrograde cell loss in brainstem nuclei which projected to the damaged side of the cord. This massive retrograde cell loss was not seen when lesions were made in the adult. In contrast, sparing of corticospinal projections and anatomical reorganization of the corticospinal tract were found after neonatal, but not adult spinal cord lesions. In adult operates, this lesion abolished HRP labeling in the contralateral sensorimotor cortex, while in all of the neonatal operates, HRP labeled cells were found throughout these cortical areas. The labeled cells had many characteristics in common with those of the normal CST. They were located in lamina V of cytoarchitectonic areas 4, 3, 1-2, and 5. Although the range of cell diameter was normal, the mean diameter of these spared neurons was below normal. Although the 'spared' CST may share many characteristics with the normal CST, its axons must have reached caudal segments of the cord by an abnormal pathway, since the normal route for the CST was destroyed by the lesion. The results indicate that two different regions of the CNS responded differently to the same neonatal lesion. Growing CST axons exhibited anatomical plasticity, contrasting with the retrograde death of the brainstem spinal tracts. We suggest that this difference between the two classes of pathways is due to the difference in time of their development. Only the latest developing pathways displayed anatomical sparing. The difference may also be seen in terms of the behavioral results. Only late-developing motor patterns were spared after neonatal lesions.

Consequences of damage to the sensorimotor cortex in neonatal and adult cats. I. Sparing and recovery of function.

Postural reflexes and locomotion were studied in order to assess the effects of unilateral sensorimotor cortical ablations in neonatal (1 day old) and adult cats. To document the infant lesion effect and to distinguish recovery from sparing of function, development of motor function was studied in neonatal operates and in normal littermates. Once neonatal operates achieved maturity, their motor performance was compared with that of chronic adult operates. The emergence of motor behavior during development in neonatal operates appeared to follow the same pattern as in normal animals although with a protracted time course and motor behavior did not attain the level of maturity of normal animals. Some deficits were not apparent immediately but evolved with time. Adult operates exhibited recovery of function of some behavior but neonatal operates exhibited greater recovery and sparing. Adult operates, like neonatal operates, were able to mask certain deficits by compensatory mechanisms. Kinematic analysis revealed that neonatal and adult operates often executed movements abnormally. It is hypothesized that somewhat different mechanisms underlie recovery in neonatal and adult operated animals.

Consequences of damage to the sensorimotor cortex in neonatal and adult cats. II. Maintenance of exuberant projections.

After chronic sensorimotor cortex ablations, sparing and greater recovery of function were seen in neonatally operated cats compared with adult operated cats. These results suggested that undamaged cortex in neonatal operates might display projections different from those of adult operates. Injections of horseradish peroxidase-wheat germ agglutinin (HRP-WGA) were made in ipsilateral parietal cortex adjacent to the sensorimotor cortex ablations or in the contralateral sensorimotor cortex. No changes in the projections of the parietal cortex were seen in operated cats or in the projections of the undamaged sensorimotor cortical projections of adult operates. In contrast, the intact sensorimotor cortex of neonatal operates exhibited crossed corticothalamic and corticorubral projections not present in normal or adult operated animals, whereas the corticospinal tract (CST) was unchanged by the ablations. Analysis of neurons within the ventroanterior-ventrolateral nuclear complex of the thalamus ipsilateral to the ablation showed that the surviving cells of neonatal operates were equal in number but were, on average, larger than those of normals and adult operates. Some neurons in neonatal operates were larger than any seen in adult operates and normals. Injections of HRP/WGA were also made into the sensorimotor cortex of normal newborn animals. Dense bilateral corticothalamic and corticorubral projections were present. The CST had extended to lumbar levels by the day of birth but projections to the grey matter were sparse. Thus, bilateral projections seen in neonatal operates probably represent retention of some exuberant projections present in normal neonatal animals. The CST which exhibited no exuberant projection was unchanged by the lesion. The crossed corticothalamic and corticorubral projections are likely to play a role in sparing and recovery of function particularly in sparing of contact placing.