Integrative classification of morphology and molecular genetics in central nervous system malformations.

We propose a scheme to classify central nervous system (CNS) malformations that integrates morphology and genetics by using patterns of genetic expression as its basis. The precise genetic mutations are not necessary to know in all cases. The premises of this classification are (1) genetic expression in the neural tube follows gradients in the axes that are established at the time of gastrulation: vertical (dorsoventral and ventrodorsal); rostrocaudal; mediolateral.

Software approach to merging molecular with anatomic information.

Software image registration is a powerful and versatile tool that allows the fusion of molecular and anatomic information. Image registration can be applied to compare anatomic information with function, localize organs and lesions, and plan radiation therapy, biopsy, or surgery. Automatic volume-based image registration techniques have been devised for both linear and nonlinear image alignment.

June 2003: 33-year-old male with a frontal lobe mass.

The June 2003 COM. A 33-year-old male with a history of seizures was found to have an intra- and extra-axial frontal lobe mass. The histology of the resected tumor showed a meningioma with underlying meningioangiomatosis.

Mesenchymal stem cell injection induces cardiac nerve sprouting and increased tenascin expression in a Swine model of myocardial infarction.

Unlabelled: Stem Cell Induces Cardiac Nerve Sprouting.

Introduction: Mesenchymal stem cell (MSC) transplantation is a promising technique to improve cardiac function. Whether MSC can increase cardiac nerve density and contribute to the improved cardiac function is unclear.

Transesophageal echocardiographic evaluation of perioperative systolic murmur in aortic pathology.

Development of a new systolic murmur in patients following a Bental procedure with a prosthetic or homograft aortic valve usually indicates an aortic valve-related complication. Here, we report new etiologies of a loud systolic murmur in patients with aortic disease. One patient developed a new loud systolic murmur as an initial manifestation of acute type A aortic dissection without any complication, and two patients developed a loud systolic murmur as the major manifestation of aortic graft failure following aortic root surgery.

Diastolic function assessment incorporating new techniques in Doppler echocardiography.

Congestive heart failure (CHF) is the leading cause of cardiac morbidity and mortality from cardiovascular disease. Although left ventricular (LV) diastolic dysfunction occurs in all patients with systolic dysfunction and CHF, fully one third of patients have CHF due to isolated diastolic dysfunction. Despite this, the role of diastolic function in heart failure is underappreciated by many primary care physicians and even by cardiologists.

Selective atrionodal input ablation for induction of proximal complete heart block with stable junctional escape rhythm in patients with uncontrolled atrial fibrillation.

Background: The study tests the hypothesis that ablating all inputs to the atrioventricular (AV) node can result in complete heart block with stable junctional escape rhythm.

Methods And Results: We attempted atrionodal input ablation in 76 consecutive patients with uncontrolled atrial fibrillation. Fast and slow pathways were first ablated.

Mechanisms of plaque vulnerability and rupture.

Rupture of atherosclerotic plaque has been identified as the proximate event in the majority of cases of acute ischemic syndromes. Plaque rupture exposes thrombogenic components of the plaque, activating the clotting cascade and promoting thrombus formation. Future culprit lesions are difficult to identify, however, and angiographic assessment of stenosis severity is prone to underestimation.

Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants?

Objective: A wide variability in the incidence of severe retinopathy of prematurity (ROP) is reported by different centers. The altered regulation of vascular endothelial growth factor from repeated episodes of hyperoxia and hypoxia is 1 important factor in the pathogenesis of ROP. Strict management of O(2) delivery and monitoring to minimize these episodes may be associated with decreased rates of ROP.

When does a ganglion become a brain? Evolutionary origin of the central nervous system.

A brain, a neural structure located in the head, differs from a ganglion by the following characteristics: (1) a brain subserves the entire body, not just restricted segments; (2) it has functionally specialized parts; (3) it is bilobar; (4) commissures and neurons form the surface with axons in the central core; (5) interneurons are more numerous than primary motor or primary sensory neurons; and (6) multisynaptic rather than monosynaptic circuits predominate. A "cephalic ganglion" does not exist in any living animal and probably never occurred even in extinct ancestral species. It also is not a developmental stage in the ontogenesis of any vertebrate.

Increased expression of membrane type 3-matrix metalloproteinase in human atherosclerotic plaque: role of activated macrophages and inflammatory cytokines.

Background: Matrix metalloproteinases (MMPs) are thought to play a prominent role in atherogenesis and destabilization of plaque. Pericellularly localized membrane-type (MT)-MMPs activate secreted MMPs. We investigated the hypothesis that MT3-MMP is expressed in human atherosclerotic plaques and is regulated by locally produced inflammatory cytokines and oxidized low-density lipoprotein (Ox-LDL).

Are tidal volume measurements in neonatal pressure-controlled ventilation accurate?

Bedside pulmonary mechanics monitors (PMM) have become useful in ventilatory management in neonates. These monitors are used more frequently due to recent improvements in data-processing capabilities. PMM devices are often part of the ventilator or are separate units.

Simultaneous biatrial computerized mapping during permanent atrial fibrillation in patients with organic heart disease.

Introduction: Activation patterns during permanent atrial fibrillation (AF) in patients with organic heart diseases are unclear.

Methods And Results: We studied six patients with permanent AF and organic heart diseases undergoing surgery. The duration of AF averaged 4.

Thoracic veins and the mechanisms of non-paroxysmal atrial fibrillation.

Objective: The purpose of this article is to review the importance of thoracic veins in the maintenance of sustained (non-paroxysmal) atrial fibrillation (AF).

Methods: Thoracic veins, including the pulmonary veins (PVs), vein of Marshall (VOM) and the superior vena cava (SVC), have muscle sleeves that connect to the atria. It is well known that electrical activities can be recorded within these venous structures.

Pathophysiology of coronary thrombosis: role of plaque rupture and plaque erosion.

Coronary artery disease is the leading cause of death in much of the western world. Atherosclerotic plaques in the coronary arteries contribute to luminal obstruction leading to myocardial ischemia; however, abrupt coronary artery occlusion most frequently results from superimposition of a thrombus on a disrupted plaque, leading to the most serious clinical manifestations of coronary artery disease, ie, unstable angina, acute myocardial infarction, and sudden death. Plaque that have undergone disruption and, by inference, plaques at risk for disruption (vulnerable plaques), tend to demonstrate outward vessel remodeling, contain a large lipid core, thinned out fibrous cap, reduced collagen content, and increased inflammatory cell infiltration.

Increased expression of macrophage colony-stimulating factor after coronary artery balloon injury is inhibited by intracoronary brachytherapy.

Background: The mechanisms underlying the reduced neointimal proliferation (NP) by intracoronary brachytherapy (ICBT) are unknown. We hypothesized that ICBT inhibits NP by reducing expression of macrophage colony-stimulating factor (M-CSF).

Methods And Results: Thirty coronary arteries from 10 pigs were divided into 3 groups of 10 each: control (C), balloon injury (BI), and BI followed by ICBT (16 Gy at 0.

The role of approximate entropy in predicting ventricular defibrillation threshold.

Background: The role of myocardial tissue mass on ventricular defibrillation threshold (DFT) is unclear. We hypothesized that changes in tissue mass modulate DFT by changing ventricular fibrillation (VF) wavefront regularity (entropy).

Methods And Results: The right ventricles (RV) of seven farm pigs were isolated, superfused and perfused through the right coronary artery with oxygenated Tyrode's solution at 37 degrees C.

Early appearance of echo-contrast simulating an intracardiac shunt in a patient with liver cirrhosis and intrapulmonary shunting.

Time of appearance of agitated saline contrast in the left atrium is one of the distinguishing features between intracardiac and intrapulmonary shunt. We report a patient with hepatic cirrhosis who had intrapulmonary shunting and had appearance of peripheral venous saline contrast injection in the left heart chambers within 3 cardiac cycles after its appearance in the right heart chambers despite absence of an intracardiac shunt. Thus, time of appearance of saline contrast in the left heart chambers should not be the sole criterion to distinguish intracardiac from intrapulmonary shunt.

Rationale for the role of osteoclast-like cells in arterial calcification.

Atherosclerotic arteries frequently become calcified, and these calcium deposits are associated with a high risk of adverse clinical events. Descriptive studies suggest calcification is an organized and regulated process with many similarities to osteogenesis, yet the mechanism and its relationship to atherosclerosis remain largely unknown. In bone development and homeostasis, mineral deposition by osteoblasts and mineral resorption by osteoclasts are delicately balanced such that there is no overall gain or loss in bone mass.

Nonparasitic splenic cysts: pathogenesis, classification, and treatment.

Background: Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen, many being reported in anecdotal fashion. Early classifications of this disorder have been based on the presence or absence of an epithelial lining, indicating either a congenital or traumatic etiology. This criterion has led to confusion and mistaken reporting because the lining alone is not a reliable criterion.

Hepatocyte proliferation in health and in liver failure.

Mammalian liver possesses an extraordinary capacity for compensatory growth in response to conditions that induce cell loss by physical, infectious, or toxic injury. In normal animals and humans, it is a tightly regulated process of both hypertrophy and hyperplasia involving different liver cell populations and a finely tuned interplay between growth factors, cytokines, extracellular matrix components and other regulators. The regeneration response is maximal when two-thirds of the liver is resected.

Integrated web-based viewing and secure remote access to a clinical data repository and diverse clinical systems.

The advent of the World-Wide-Web protocols and client-server technology has made it easy to build low-cost, user-friendly, platform-independent graphical user interfaces to health information systems and to integrate the presentation of data from multiple systems. The authors describe a Web interface for a clinical data repository (CDR) that was moved from concept to production status in less than six months using a rapid prototyping approach, multi-disciplinary development team, and off-the-shelf hardware and software. The system has since been expanded to provide an integrated display of clinical data from nearly 20 disparate information systems.

Comparison of myocardial tissue Doppler with transmitral flow Doppler in left ventricular hypertrophy.

We sought to determine the most useful echocardiographic measurements for assessment of diastolic function in patients with left ventricular hypertrophy (LVH) and normal systolic function. We compared myocardial Doppler velocities of the basal inferoposterior wall with mitral inflow pulsed wave Doppler velocities in 11 healthy volunteers (age, 36 +/- 6 years), 25 patients (age, 64 +/- 14 years) without LVH, and 37 patients (age, 67 +/- 14 years) with LVH and otherwise normal echocardiograms. The discriminatory measurements were myocardial A-wave duration (120 +/- 18 versus 98 +/- 20 and 92 +/- 12 ms, P <.