The greater of two multidigit integers could be chosen by (a) generating and comparing internal representations of the integers (holistic models), (b) sequentially comparing corresponding digits in the integers (sequential place-value models), or (c) simultaneously comparing corresponding digits (parallel place-value models).In Experiments 1 and 2, subjects chose the greater of 2 four-digit or 2 six-digit integers. As predicted by sequential place-value models, latencies did not depend on the number of unequal digits in the two numbers, and latencies increased linearly with the position of the leftmost unequal digits except when only the rightmost digits were unequal. In Experiment 3, latencies increased linearly for all positions when two letters were presented to the right of the integers. These results imply that multidigit integers are compared by sequentially comparing digits.

Prognostic and epidemiologic study, level III.

No abstract

Although animal studies have shown that the immunomodulator ipilimumab causes inflammation of the myocardium, clinically significant myocarditis has been observed only infrequently. We report a case of suspected acute coronary syndrome without a culprit lesion on cardiac angiography and takotsubo cardiomyopathy (TC)-like appearance on echocardiography in a patient with metastatic melanoma who received four standard doses of ipilimumab. Apical ballooning, hyperdynamic basal wall motion, systolic anterior motion of the mitral valve, and associated severe left ventricular outflow tract obstruction were present. Restaging with positron emission tomography-computed tomography done soon after discharge incidentally revealed increased fludeoxyglucose uptake in the apex. This case illustrates that a TC-like syndrome might be caused by autoimmune myocarditis after ipilimumab treatment although this was not biopsy-confirmed. Post-marketing surveillance should capture cardiac events occurring in patients treated with ipilimumab to better document and clarify a relationship to the drug, and biopsies should be considered. Physicians utilizing this novel agent should be aware of the potential for immune-related adverse events.

Therapeutic study, level II.

No abstract

These results refute the hypothesis that microbial infection plays a role in the pathogenesis of sciatica. It is possible that bacterial growth from discs reported in previous studies was at least partly related to contamination, which we painstakingly avoided by application of rigorous aseptic techniques.

No abstract