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minute while an individual is idle; it is suppressed during concentration and emotional excitement The fundamental role of swallowing is to move food from the mouth to the esophagus and thereby to begin the process of digestion, but it also serves to empty the oral cavity of saliva and prevent its entry into the respiratory tract Since the oropharynx is a shared conduit for breathing and swallowing, obligatory re exes exist to assure that breathing is held in abeyance during swallowing Because of this relationship and the frequency with which dysphagia and aspiration complicate neurologic disease, the neural mechanisms that underlie swallowing are of considerable importance to the neurologist and are described here The reader is also referred to other parts of this book for a discussion of derangements of swallowing consequent upon diseases of the lower cranial nerves (Chap 47), of muscle (Chap 48), and of the neuromuscular junction (Chap 53) Anatomic and Physiologic Considerations A highly coordinated sequence of muscle contractions is required to move a bolus of food smoothly and safely through the oropharynx This programmed activity may be elicited voluntarily or by re ex movements that are triggered by sensory impulses from the posterior pharynx Swallowing normally begins as the tongue, innervated by cranial nerve XII, sweeps food to the posterior oral cavity, and brings the bolus into contact with the posterior wall of the oropharynx As the food passes the pillars of the fauces, tactile sensation, carried through nerves IX and X, re exly triggers (1) the contraction of levator and tensor veli palatini muscles, which close the nasopharynx and prevent nasal regurgitation, followed by (2) the upward and forward movement of the arytenoid cartilages toward the epiglottis (observed as an upward displacement of the hyoid and thyroid cartilages), which closes the airway With these movements the epiglottis guides the food into the valleculae and into channels formed by the epiglottic folds and the pharyngeal walls The airway is closed by sequential contractions of the arytenoid-epiglottic folds, and below them, the false cords, and then the true vocal cords, which seal the trachea All of these muscular contractions are effected largely by cranial nerve X (vagus) The palatopharyngeal muscles pull the pharynx up over the bolus and the stylopharyngeal muscles draw the sides of the pharynx outward (nerve IX) At the same time, the upward movement of the larynx opens the cricopharyngeal sphincter A wave of peristalsis then begins in the pharynx, pushing the bolus through the sphincter into the esophagus These muscles relax as soon as the bolus reaches the esophagus The entire swallowing ensemble can be elicited by stimulation of the superior laryngeal nerve (this route is used in experimental studies) Re ex swallowing requires only medullary functioning and is known to occur in the vegetative and locked-in states as well as in normal and anencephalic neonates The integrated sequence of muscle activity for swallowing is organized in a region of brainstem that roughly comprises a swallowing center, located in the region of the NTS, close to the respiratory centers This juxtaposition ostensibly allows the re ned coordination of swallowing with the cycle of breathing Besides a programmed period of apnea, there is a slight forced exhalation after each swallow that further prevents aspiration The studies of Jean, Kessler and others (cited by Blessing), using microinjections of excitatory neurotransmitters, have localized the swallowing center in animals more precisely to a region adjacent to the termination of the superior laryngeal nerve.

CBOE CBOE interest-rate products are based on the underlying assets of US Treasury bills, 5-year US Treasury notes, 10-year US Treasury notes, and 30-year US Treasury bonds CBOE option products are derivative-based products trading on the current yield or yield to maturity of these underlying assets thus providing traders a means to utilize options for direct speculation or hedging of changes in interest rates based on changes in yield CBOT CBOT products are futures-based products trading on US Treasury bills, 2-year US Treasury notes, 5-year US Treasury notes, 10-year US Treasury notes, and 30-year US Treasury bonds as well as eurodollars, swaps, Fed funds, and London Interbank Offered Rate (Libor) These products provide the investor with the ability to trade or hedge the redemption value of the securities both now and in the future These products have signi cantly higher leverage than their CBOE cousins as the contract value represents from $100,000 to $1,000,000, depending on the contract The contracts have an option in each month and quarterly underlying contracts These contracts are traded by individuals, businesses, and institutions for speculation and hedging, and they make one of the most active and liquid markets in the world Many of these contracts involve physical delivery, which means that investors in these products must monitor the notice dates for the contracts involved and be prepared to roll to different contract months or deliver or take delivery of the physical instruments themselves

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