Neuroanatomical correlates of tube dependency and impaired oral intake after hemispheric stroke.

BACKGROUND AND PURPOSE Acute stroke patients with severely impaired oral intake are at risk of malnutrition and dehydration. Rapid identification of these patients is necessary to establish early enteral tube feeding. Whether specific lesion location predicts early tube dependency was analysed, and the neural correlates of impaired oral intake after hemispheric ischaemic stroke were assessed. METHODS Tube dependency and functional oral intake were evaluated with a standardized comprehensive swallowing assessment within the first 48 h after magnetic resonance imaging proven first-time acute supratentorial ischaemic stroke. Voxel-based lesion symptom mapping (VLSM) was performed to compare lesion location between tube-dependent patients versus patients without tube feeding and impaired versus unimpaired oral intake. RESULTS Out of 119 included patients 43 (36%) had impaired oral intake and 12 (10%) were tube dependent. Both tube dependency and impaired oral intake were significantly associated with a higher National Institutes of Health Stroke Scale score and larger infarct volume and these patients had worse clinical outcome at discharge. Clinical characteristics did not differ between left and right hemispheric strokes. In the VLSM analysis, mildly impaired oral intake correlated with lesions of the Rolandic operculum, the insular cortex, the superior corona radiata and to a lesser extent of the putamen, the external capsule and the superior longitudinal fascicle. Tube dependency was significantly associated with affection of the anterior insular cortex. CONCLUSIONS Mild impairment of oral intake correlates with damage to a widespread operculo-insular swallowing network. However, specific lesions of the anterior insula lead to severe impairment and tube dependency and clinicians might consider early enteral tube feeding in these patients.

(Appendix) Benthic foraminifera distribution of upper Creatceous and Paleocene at DSDP Hole 72-516F

Benthic foraminifers of the Coniacian-Santonian through the Paleocene were recovered from a continuous pelagic carbonate section from Hole 516F on the Rio Grande Rise. Sixty-five genera and 153 species have been identified, most of which have been reported from other localities. Bathyal depths are reflected in the benthic assemblages dominated by gavelinellids (Gavelinella beccariiformis, G. velascoensis), Nuttallides truempyi, and various gyroidinids and buliminids. Rapid subsidence during the Coniacian-Santonian from nearshore to upper to middle bathyal depths was followed by much reduced subsidence, with the Campanian-Paleocene interval accumulating at middle bathyal to lower bathyal depths. A census study based on detailed sampling reveals major changes in benthic faunal composition at the Cretaceous/Tertiary boundary transition. It was a time of rapid turnover, with the extinctions of numerous species and the introduction of many new species. Overall, species diversity decreases about 20%, and approximately one-third of latest Maestrichtian species do not survive to the end of the Cretaceous. This shift indicates a significant environmental change in the deep sea, the precise nature of which is not apparent from the foraminifers or their enclosing sediments.

(Table 2) Radiolaria species in nodule samples from the Clarion-Clipperton province, Pacific Ocean

Radiolaria were studied in 19 manganese nodules raised from the bottom. The nodules occurred mainly on the surface of thin Quaternary sediments covering Tertiary deposits of various ages (Middle Eocene to Early Miocene). Radiolaria in nodule cores and in inner and surface layers were studied. We found 85 radiolaria species and groups of species. Usually 1-4 to 6-19 radiolaria species were detected in each of the samples. Species belonging to Middle Eocene, Late Miocene to Early Oligocene, and Oligocene to Early Miocene were found. Rare Neogene species were revealed only in fractured surface layers. Age of the nodules is mainly Oligocene. Seismic waves cause sediment vibration, loosening disintegration, and removal of suspension by bottom currents. The vibration effect causes ancient nodules to float up to the surface of Quaternary sediment. This hypothesis suggests the reason for characteristics of the Clarion-Clipperton zone: regional stratigraphic hiatus, accumulation of residual fields of nodules, and the ''floating up'' of nodules to the surface of the Quaternary sediments.

Radiolarian biostratigraphy in the central Indian Ocean

Identifiable radiolarians of stratigraphic importance were recovered at eight of the sites drilled on Leg 115. The assemblages range in age from Holocene to middle Eocene (Dictyoprora mongolfieri Zone, about 48 Ma). Faunal preservation is particularly good in two stratigraphic intervals: the Holocene through upper Miocene (0-9 Ma), and the lowermost Oligocene to middle Eocene (35-48 Ma). Fluctuating rates of silica accumulation at these drill sites during the Cenozoic reflect changing tectonic and paleoceanographic conditions. In particular, the gradual closure of the Indonesian and Tethyan seaways and the northward migration of the Indian subcontinent severely restricted zonal circulation and silica accumulation in tropical latitudes during the late Oligocene through middle Miocene. By the late Miocene the Indian subcontinent had moved sufficiently north of the equator to allow trans-Indian zonal circulation patterns to become reestablished, and biosiliceous sedimentation resumed. The composition of the radiolarian assemblages in the tropical Indian Ocean is closely comparable with that of the 'stratotype' sequences in the equatorial Pacific. However, there are some notable exceptions in Indian Ocean assemblages: (1) the scarcity of the genera Pterocanium and Spongaster in the Neogene; (2) the absence of the stratigraphically important Podocyrtis lineage, P. diamesa -> P. phyxis -> P. ampla, in the middle Eocene; and (3) the scarcity of taxa of the genus Dorcadospyris, with the exception of D. ateuchus. The succession of radiolarian events was tabulated for those stratigraphic intervals where the assemblages were well preserved. We identified 55 events in the middle Eocene to earliest Oligocene, and 31 events in the late Miocene to Holocene. The succession of events is closely comparable with that of the tropical Pacific. However, there are exceptions that appear to be real, rather than artifacts of sample preservation, mixing, and core disturbance.