bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of venous infarction after sacrificing middle-third superior sagittal sinus cortical bridging veins in a pediatric population
Authors: McNatt Sean A. , Sosa Ivan J. , Krieger Mark D. , McComb J. Gordon
Published: March 2011

Object

The interhemispheric transcallosal approach offers an excellent surgical corridor for the treatment of deep-seated midline lesions. The approach typically requires the sacrifice of one or more middle-third superior sagittal sinus (SSS) cortical bridging veins, which introduces the risk of venous infarction and associated neurological injury. The authors studied the incidence of venous infarcts following this operative approach in a pediatric population.

Methods

The authors performed a retrospective review of surgical cases involving pediatric patients treated at the Children's Hospital Los Angeles between 1990 and 2007, in which an interhemispheric transcallosal operative procedure was performed and one or more middle-third SSS cortical bridging veins were occluded. Postoperative MR imaging studies done 1–3 days following the procedure were analyzed and compared with preoperative studies.

Results

Sixty-three patients met the inclusion criteria. No patient developed MR imaging evidence of venous infarction.

Conclusions

The occlusion of one or more middle-third SSS cortical bridging veins related to the interhemispheric transcallosal approach resulted in no incidence of cerebral venous infarction in this pediatric population.
Patients with Chiari malformation Type I presenting with acute neurological deficits: case series
Authors: Yarbrough Chester K. , Powers Alexander K. , Park Tae Sung , Leonard Jeffrey R. , Limbrick David D. , Smyth Matthew D.
Published: March 2011

Object

A subset of patients with Chiari malformation Type I (CM-I) presented with acute onset of a neurological deficit. In this study the authors summarize their experience with these patients' clinical presentation, imaging results, timing of surgery, and outcome following decompression.

Methods

The authors reviewed clinical records, imaging studies, and operative notes from all patients undergoing posterior fossa decompression for CM-I at St. Louis Children's Hospital from 1990 to 2008. Of the 189 patients who underwent surgery, 6 were identified with the acute onset of a neurological deficit at presentation.

Results

All 6 children (age range 3–14 years, 3 boys and 3 girls) had either syringomyelia (5 patients) or T2 signal changes in the spinal cord (1 patient) and CM-I on initial MR imaging. Three patients presented after minor trauma (1 with paraparesis, 2 with sensory deficits). Three patients presented without a clear history of trauma (1 with abrupt onset of spontaneous dysphagia and ataxia, 2 with sensory deficits). Decompression was performed at a mean 7.7 ± 4.9 days after symptom onset (7.0 ± 1.6 days after neurosurgical evaluation). In 1 patient, symptoms had resolved by the time of surgery; in the remainder of the patients, clear improvements were noted within 2 weeks of surgery, with complete resolution of symptoms by 12 months postoperatively. Follow-up MR images were obtained in 4 patients, demonstrating improvement in the extent of the syrinx in each patient.

Conclusions

Children with CM-I and syringomyelia can develop acute spinal cord or bulbar deficits with relatively minor head or neck injuries. The prognosis for symptomatic improvement in the observed deficit is good, with each patient in our series showing resolution of deficits over time. However, based on this relatively limited experience, the authors suggest that patients who present with an acute neurological deficit and are found to have CM-I be managed with early posterior fossa decompression. Patients with CM-I and syringomyelia may be at higher risk of acute neurological deficit than those without a syrinx.
Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature
Authors: Mazur Marcus , Jost Gregory F. , Schmidt Meic H. , Bisson Erica F.
Published: March 2011

Object

Anterior decompression is an effective way to treat cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL); however, this approach is associated with an increased risk of a dural tear and resultant CSF leak because fusion of the dura with the ossified PLL is common in these cases. The authors review the literature and present an algorithm for treatment of CSF leaks in these patients.

Methods

A MEDLINE review was performed to identify papers related to CSF leak after anterior decompression for OPLL, and data were summarized to identify treatment options for various situations. A treatment algorithm was identified based on these findings and the experience of the authors.

Results

Eleven studies were identified that presented data on intra- and postoperative management of a CSF leak during ventral surgery for OPLL. The incidence of cervical dural tears and CSF leaks after anterior decompression procedures for OPLL ranged from 4.3% to 32%. Techniques including preventative measures, intraoperative dural repair with various materials, and postoperative drainage or shunt placement have all been used.

Conclusions

Although direct dural repair is the preferred treatment for CSF leak, this technique is not always technically possible. In these cases, intraoperative adjuncts in combination with postoperative measures can be used to decrease the pressure gradient across the dural tear.
The genetics of ossification of the posterior longitudinal ligament
Authors: Stetler William R. , La Marca Frank , Park Paul
Published: March 2011

Object

Ossification of the posterior longitudinal ligament (OPLL) is a pathological process of ectopic calcification with a preponderance for the cervical spine. Epidemiological and familial studies have both indicated predisposition; however, the genetic inheritance pattern and responsible genes for OPLL are still uncertain. The aim of this study was to evaluate and summarize the current understanding of the genetics underlying OPLL.

Methods

The authors reviewed epidemiological and genetic studies surrounding OPLL, with a particular focus on inheritance patterns and potential genes responsible for OPLL, using a PubMed database literature search.

Results

Despite an unclear inheritance pattern, there appears to be a strong familial link in patients with OPLL. Examination of these patterns using linkage analysis has shown multiple candidate genes that could be responsible for the inheritance of OPLL. Genes for collagen, nucleotide pyrophosphatase, transforming growth factors, and the vitamin D receptor have all been implicated. Additionally, multiple cytokines and growth factors, including bone morphogenetic proteins as well as other proteins and interleukins involved in bone development, have been shown to be abnormally expressed in patients with OPLL. In addition, multiple mechanical and metabolic factors such as hyperinsulinemia and obesity have been shown to be linked to OPLL.

Conclusions

Ossification of the posterior longitudinal ligament has a complex inheritance pattern. It does not appear that OPLL follows a simple, single-gene Mendelian inheritance pattern. Development of OPLL is more likely multifactorial in nature and develops in patients with a genetic predisposition from a variety of different mutations in various genes on various chromosomes. Additionally, environmental factors and interaction by other pathological disease processes, such as obesity and diabetes mellitus, may play a role in the development of OPLL in susceptible individuals.
Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization
Authors: Sugrue Patrick A. , McClendon Jamal , Halpin Ryan J. , Liu John C. , Koski Tyler R. , Ganju Aruna
Published: March 2011

Object

Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors. The role for surgical intervention and choice of anterior or posterior approach is controversial. The object of this study was to review the literature and present a single-institution experience with surgical intervention for OPLL.

Methods

The authors performed a retrospective review of their institutional experience with surgical intervention for cervical OPLL. They also reviewed the English-language literature regarding the epidemiology, pathophysiology, natural history, and surgical intervention for OPLL.

Results

Review of the literature suggests an improved benefit for anterior decompression and stabilization or posterior decompression and stabilization compared with posterior decompression via laminectomy or laminoplasty. Both anterior and posterior approaches are safe and effective means of decompression of cervical stenosis in the setting of OPLL.

Conclusions

Anterior cervical decompression and reconstruction is a safe and appropriate treatment for cervical spondylitic myelopathy in the setting of OPLL. For patients with maintained cervical lordosis, posterior cervical decompression and stabilization is advocated. The use of laminectomy or laminoplasty is indicated in patients with preserved cervical lordosis and less than 60% of the spinal canal occupied by calcified ligament in a “hill-shaped” contour.
Intracranial epidural abscess of odontogenic origin
Authors: Kanu Okezie Obasi , Ukponmwan Efosa , Bankole Olufemi , Olatosi John Olutola , Arigbabu Sarajudeen Oladele
Published: March 2011

Dental infection as a cause of epidural abscess is rare compared with other forms of intracranial suppurations. A 10-year-old boy was seen because of headaches and fever. There was no history of otitis media or sinusitis, but he had sought care for dental complaints. The patient was from an upper-middle-class family, was not immunocompromised, and had no other risk factor for a major infection. A CT brain scan confirmed a frontal epidural abscess. The patient underwent emergency surgery for evacuation of the epidural abscess, followed by antimicrobial therapy. His condition improved remarkably following surgery, with complete resolution of symptoms. He subsequently underwent extraction of 2 teeth following dental review. Dental infection as a cause of intracranial epidural abscess is rare, but should be considered when evaluating patients for intracranial infections. A review of the literature sheds light on the causal relationship and possible pathogenesis of this condition.
Surgical anatomy of the Guyon canal in children
Authors: Luz Marcus Alexandre Mendes , Marques Maria Julia , Neto Humberto Santo
Published: March 2011

Object

The anatomy of the Guyon canal is crucial for open and endoscopic surgeries for ulnar canal syndrome at the wrist level. It is also of interest for surgical treatment of carpal canal syndromes. Whereas the Guyon canal is largely described in adults, no studies exist in children. In the present study, the authors examined the Guyon canal in children.

Methods

Sectional anatomy was used. Thirty-two formalin-fixed cadavers (64 sides) were examined (age range 2–11 years). The hands were transversely cut into 2–3-mm-thick slices. Slices were placed in embedding medium, and transverse sections (10 μm thick) were stained with histological methods and photographed under a light microscope.

Results

The roof of the Guyon canal was attached to the flexor retinaculum laterally to the hamulus of the hamate bone. Thus, the radial boundary of the Guyon canal was lateral to the hamulus, which became part of the floor of the Guyon canal. An ulnar neurovascular bundle was found directly volar to the hamulus in 93.8% of the cases and slightly medial to the hamulus (to the ulnar side) in 6.2% of the cases. Proximally, the ulnar artery and nerve were sustained by the flexor retinaculum in direct apposition to the carpal canal.

Conclusions

In children, the Guyon canal displays an anatomical particularity regarding the topography of the ulnar artery and nerve that may be of relevance for intraoperative orientation and endoscopic navigation to avoid lesions to the ulnar nerve and artery in carpal and Guyon canal syndromes.
Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital
Authors: Rughani Anand I. , Lin Chih-Ta , Ares Wiliam J. , Cushing Deborah A. , Horgan Michael A. , Tranmer Bruce I. , Jewell Ryan P. , Florman Jeffrey E.
Published: March 2011

Object

Helmet use has been associated with fewer hospital visits among injured skiers and snowboarders, but there remains no evidence that helmets alter the intracranial injury patterns. The authors hypothesized that helmet use among skiers and snowboarders reduces the incidence of head injury as defined by findings on head CT scans.

Methods

The authors performed a retrospective review of head-injured skiers and snowboarders at 2 Level I trauma centers in New England over a 6-year period. The primary outcome of interest was intracranial injury evident on CT scans. Secondary outcomes included the following: need for a neurosurgical procedure, presence of spine injury, need for ICU admission, length of stay, discharge location, and death.

Results

Of the 57 children identified who sustained a head injury while skiing or snowboarding, 33.3% were wearing a helmet at the time of injury. Of the helmeted patients, 5.3% sustained a calvarial fracture compared with 36.8% of the unhelmeted patients (p = 0.009). Although there was a favorable trend, there was no significant difference in the incidence of epidural hematoma, subdural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, or contusion in helmeted and unhelmeted patients. With regard to secondary outcomes, there were no significant differences between the 2 groups in percentage of patients requiring neurosurgical intervention, percentage requiring admission to an ICU, total length of stay, or percentage discharged home. There was no difference in the incidence of cervical spine injury. There was 1 death in an unhelmeted patient, and there were no deaths among helmeted patients.

Conclusions

Among hospitalized children who sustained a head injury while skiing or snowboarding, a significantly lower number of patients suffered a skull fracture if they were wearing helmets at the time of the injury.
Ossification of the ligamentum flavum: a unique report of a Hispanic woman
Authors: Christiano Lana D. , Assina Rachid , Goldstein Ira M.
Published: March 2011

Ossification of the ligamentum flavum (OLF) is a disease of ectopic bone formation within the ligamentum flavum, which may result in mass effect and neurological compromise. The low thoracic region is the most common region of occurrence, and this is followed by the cervical, then lumbar, spine. The prevalence of OLF is significantly higher in the Japanese population compared with other nationalities and has a male preponderance. Ossification of the ligamentum flavum has been reported in association with the more common ligamentous pathological entities—ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis. These latter two conditions have been linked to several metabolic processes, and a possible genetic basis has been hypothesized. Here, the authors present a unique case of OLF of the cervical spine in a patient with idiopathic hypercalcemia.
Coronary Stenting in Diabetic Patients: Evaluation of Immediate Procedural Success & Adverse Outcomes
Authors: Hoque Md Harisul , Rahman Sufia , Siddique Md Abu , Ahsan Syed Ali , Ahmed CM , Zaman SM Mustafa , Sultan Md Ashraf Uddin
Published: March 2011

Diabetes mellitus (DM) itself increases the risk of Coronary Artery Disease (CAD) by 2-4 fold and in out country we are treating a good number of patients having CAD with DM. On the other hand several studies have reported increased risk of adverse outcomes following balloon angioplasty in diabetic cases. In this situation this study had been carried out at National Institute of Cardiovascular Diseases (NICVD) cath lab to determine the immediate procedural success & in-hospital adverse outcomes in this population. In our study 100 cases were enrolled. Out of which, 40 patients had type II DM & rest were non-diabetic.Diabetic patients were compared with non- diabetic and found no major difference between the two patient group except for a higher number of LCX (Left Circumflex) lesion in the non-diabetic (25% VS 35%, P value 0.038). The lone case of renal complication came from the diabetic group. No MACE (Major Adverse Cardiovascular or Cerebrovascular Events) or death was occur in this series. Angiographic, procedural and clinical success in diabetic was 97.5%, 97.5% & 95% respectively whereas 100% found in non-diabetic group at its all segment. But this results are statistically insignificant and P value is 0.4000 for angiographic success, 0.4000 for procedural success and 0.158 for clinical success. P value for hospital stays is also insignificant i.e. 0.250 (while p value of < 0.05 was considered significant). Therefore in the setting of diabetes mellitus the outcomes of the stenting procedure are quite encouraging. Key words: Coronary Stenting; Diabetic; Outcomes DOI: 10.3329/uhj.v6i1.7181University Heart Journal Vol.6(1) 2010 pp.3-8
The Outcomes of Percutaneous Coronary Intervention in Chronic Total Coronary Occlusion: A Single Center Report
Authors: Rahman AKM Fazlur , Salman Mohammad , Banerjee Sajal K , Anam Khairul , Rahman Mukhlesur , Ahmed Md Khurshed , Zaman SM Mustafa , Habib Ahsan , Siddique Md Abu , Haque KMHS Sirajul , Ahmed Choudhury Meshkat , Safiuddin Mohmmad , Jamiluddin Mir , Fatema Nilufar , Hoque Md Harisul
Published: March 2011

Chronic total occlusions (CTOs) are commonly found on diagnostic angiography, and successful percutaneous coronary intervention leads to an improvement in long-term survival rates. This study was done in the University Cardiac Center, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2005 to December 2009. The aim of this study was to examine the trends in angiographic success, clinical success, procedural success and in-hospital outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Total 60 patients (male: female, 11:1) with Mean age 48±10 years were studied. 36 (60%) patients had prior myocardial infarction and all of them had angina (CCS-III, IV). Mean length and reference diameter of the CTO lesion was 19.7±10.4 mm and 2.8±0.5 mm respectably. Clinical success, angiographic success and procedural success rate was (78.3%), (80.0%) and (66.7%) respectably. In hospital adverse outcomes were acute myocardial infarction (5.0%), acute left ventricular failure (6.7%) and malignant arrhythmias (VT, VF) (10.0%). PCI was failed in (11.7%) cases and there was acute in-stent thrombosis in (1.7%) cases. In conclusion it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions. Key words: Chronic total occlusions; In hospital adverse outcomes; Percutaneous coronary interventionDOI: 10.3329/uhj.v6i1.7183University Heart Journal Vol.6(1) 2010 pp.13-17
Ankle-Brachial Index predicts Coronary Artery Disease associated with Peripheral Arterial Disease
Authors: Habib SM Ahsan , Islam M Nazrul , Pasha Kamal , Alam Saleh Ahmed Nurul , Mohsin Khaled , Islam Khandakar Kamrul , Ullah Muhammad , Khalequzzaman Md , Siddique Md Abu
Published: March 2011

Most common cause of Peripheral Arterial Disease (PAD) is atherosclerosis. Atherosclerosis is a generalized disease, also involving coronary and carotid arteries. Often atherosclerotic coronary artery disease (CAD) is associated with PAD. This prospective observational study was conducted in the National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, during July 2004 to June 2005. Total 58 patients with PAD were included in the study. Patients were classified as group I having normal coronary artery, group II insignificant CAD (Left main <50% stenosis, others <70% stenosis) and group III, significant CAD (Left main ≥50% stenosis, others ≥70% stenosis). Ankle-brachial index was significantly low (0.75±0.25 Vs 0.37±0.40) in the patients with coronary artery disease (Group II and III) compare to non-CAD (P =0.001).This study suggests that ankle-brachial index (ABI) have significant relation with the presence of CAD. Key words: Ankle-Brachial Index; peripheral arterial disease DOI: 10.3329/uhj.v6i1.7186University Heart Journal Vol.6(1) 2010 pp.23-25
Chest Pain and Exercise Induced Ischemia with Angiographically Insignificant Coronary Arterial Disease: Clinical Presentation and Follow-Up
Authors: Ahmed Md Khurshed , Salman Mohammad , Sultan Md Ashraf Uddin , Siddique Md Abu , Haque KMHS Sirajul , Hoque Md Harisul , Khan Md Mizanur Rahman , Rahaman Mohammad Ferdous Ur , Anwar Shahed Mohammed
Published: March 2011

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 15-20%. ECG changes suggestive of myocardial ischemia during exercise also can be demonstrated in this subset of the patients. Total 58 patients (42 females) with mean age 42±7 years who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2005 to December 2009 were evaluated. The patients were recruited on the basis of presence of history of chest pain, with normal resting ECG and ischemia like ECG changes during exercise stress test. 32.8% patients had hypertension and 15.5% were diabetics, 19.0% had dyslipidemia and 6.9% had family history of ischemic heart disease. All the patients were having positive exercise stress test. Angiographic findings showed luminal irregularities in 29.3% patients, 15.5% patients had luminal stenosis less than 30% and rest had normal coronary angiogram. Follow up of the patients after one and six months of angiogram was done. After one month 63.8% patients remained symptomatic and after six months 63.3% patients remained symptomatic despite maximum medical management. The pathophysiology and appropriate management of this subset of the patients still remained a challenge for physicians. Optimum management of cardiovascular risk factors is very important issue in this group of patients.Key words: Angiography; Epicardial coronary arteries; Exercise stress test; Cardiovascular risk factors. DOI: 10.3329/uhj.v6i1.7187University Heart Journal Vol.6(1) 2010 pp.27-31
Biological Pacemaker
Authors: Das Uzzal Kanti , Ahsan Syed Ali , Patwary Mohammad Saifullah , Haque KMHS Sirajul , Zaman SM Mustafa , Hoque Md Harisul
Published: March 2011

Electronic cardiac pacemakers are the definitive treatment of sinoatrial node (SAN) dysfunction and high degree atrioventricular block. But they have limitations like limited battery life, need for lead implantation into heart and lack of response to autonomic and physiologic demands on the heart. Genetically engineered biological pacemakers could be a possible alternative to electronic pacemakers. The strategies include upregulation of β-1 adrenergic receptors, conversion of cardiomyocyte into pacemaker cells and stem cell therapy. Investigators created biological pacemakers in animal models by gene therapy targeting If current (HCN) and inward rectifier current (IkI) (Kir 2.1). They delivered pacemaker current gene into animal heart by using viral vectors and human mesenchymal stem cells (hMSC). The limitations noted are longevity and stability of pacemaker genes and the chance of migration and tumour formation after stem cells therapy. Key words: Sinoatrial node (SAN); HCN-2 gene; If current; inward rectifier current (Ikl); human embryonic stem cells. DOI: 10.3329/uhj.v6i1.7189University Heart Journal Vol.6(1) 2010 pp.35-36
Therapeutic Options for the Treatment of Pulmonary Hypertension
Authors: Tamanna Rownak Jahan
Published: March 2011

The therapy of pulmonary hypertension depends on the identification of underlying contributing factors. pulmonary arterial hypertension (PAH), which can be idiopathic or related to connective tissue disease, portal hypertension, HIV disease, ingestion of certain drugs or toxins, or congenital heart disease, had no specific therapy until recently. However, the past decade has seen remarkable progress, and these heretofore devastating and usually lethal forms of pulmonary hypertension now often respond to one form of therapy or another, leading to improved functional capacity and even survival. The following will consider the major pharmacotherapy’s now available for PAH and suggest a framework for therapeutic decision-making. Key word: Pulmonary hypertension DOI: 10.3329/uhj.v6i1.7193University Heart Journal Vol.6(1) 2010 pp.37-40
Combined Carotid Endarterectomy and Coronary Bypass Grafting: Risk versus Benefit - A Review
Authors: Hoque Rezwanul , Husain Sabrina Sharmeen , Rahman Zerzina , Ali Ashia , Nuruzzaman Mostafa , Alauddin Md
Published: March 2011

Carotid Endarterectomy (CEA) performed in combination with coronary artery bypass grafting (CABG) have also increased steadily since Bernhard and colleague’s initial report in 1972. Coexistence of symptomatic coronary artery disease and significant carotid artery stenosis ranges from 3.4% to 22%. The incidence of postoperative stroke after CABG ranges from 0.7% to 5%. Coronary revascularization in a patient with internal carotid artery stenosis more than 50% is associated with a postoperative stroke rate of 6%, which increases significantly to more than 16% when stenosis is more than 90%. To reduce the potential risk for postoperative stroke after CABG in patients with significant or symptomatic carotid artery stenosis, many surgeons have advocated combined CABG with unilateral carotid endarterectomy. However, clinical experience with the concomitant approach is conflicting. On the basis of the long-term results, it is estimated that simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass is a method safe enough to prefer its routine use with acceptable low operative risk and satisfactory long-term morbidity. The overall 30-day mortality of combined CABG with bilateral carotid endarterectomy was 6.1% and that was unrelated to primary cardiac or cerebrovascular events. Favorable outcome also supports the justification for performing concomitant coronary artery bypass grafting with bilateral carotid endarterectomies in selected patients. Key words: Carotid endarterectomy; Coronary Bypass Grafting. DOI: 10.3329/uhj.v6i1.7194University Heart Journal Vol.6(1) 2010 pp.41-44
Congenital Absence of Right Coronary Artery without any other Associated Anomalies - A Case Report
Authors: Taimur Syed Dawood Md , Khan Saidur Rahman , Haq M Maksumul , Mansur Mahbub , Haque Md Harisul , Sultan Md Ashraf Uddin
Published: March 2011

A 54 years gentleman presented with central compressive type of chest pain. He was newly diagnosed diabetic, dyslipidaemic. His ECG (electrocardiogram) showed features of anterior and inferior wall ischemia. Echocardiography revealed presence of regional wall motion abnormality. Exercise tolerance test was positive for provocable myocardial ischemia. Angiographic findings includes single coronary artery with congenital absence of RCA (Right coronary artery). Right coronary arterial territory was supplied by the terminal part of left circumflex coronary artery. Key Words: Congenital coronary; Right coronary artery (RCA); Single Coronary Artery. DOI: 10.3329/uhj.v6i1.7195University Heart Journal Vol.6(1) 2010 pp.45-47
A Forty Year Old Lady with Undiagnosed Lutembacher Syndrome - A Case Report
Authors: Rahman Muhammad Ashiqur , Rahman AKM Fazlur , Haque Tauhidul , Banarjee Sajal K , Hoque Md Harisul , Sultan Md Ashraf Uddin
Published: March 2011

A forty years widow having four children presented with palpitation, shortness of breath on exertion and chest pain. Her sufferings progressively increase in course of time. Her ECG shows complete Right Bundle Branch Block. Transthoracic echocardiography showed atrial septal defect of secundum type. Both the leaflets of the mitral valve were thickened with mild degree of diastolic doming. Key Words: Lutembacher Syndrome; Mitral Stenosis. DOI: 10.3329/uhj.v6i1.7198University Heart Journal Vol.6(1) 2010 pp.51-54
Inflammation and Tumor Microenvironment in Lymph Node Metastasis
Authors: Wu Xuesong , Takekoshi Tomonori , Sullivan Ashley , Hwang Sam T.
Published: March 2011

In nearly all human cancers, the presence of lymph node (LN) metastasis increases clinical staging and portends worse prognosis (compared to patients without LN metastasis). Herein, principally reviewing experimental and clinical data related to malignant melanoma, we discuss diverse factors that are mechanistically involved in LN metastasis. We highlight recent data that link tumor microenvironment, including inflammation (at the cellular and cytokine levels) and tumor-induced lymphangiogenesis, with nodal metastasis. Many of the newly identified genes that appear to influence LN metastasis facilitate general motility, chemotactic, or invasive properties that also increase the ability of cancer cells to disseminate and survive at distant organ sites. These new biomarkers will help predict clinical outcome and point to novel future therapies in metastatic melanoma as well as other cancers.
Cancer Stem-Like Cells Enriched in Panc-1 Spheres Possess Increased Migration Ability and Resistance to Gemcitabine
Authors: Yin Tao , Wei Hongji , Gou Shanmiao , Shi Pengfei , Yang Zhiyong , Zhao Gang , Wang Chunyou
Published: March 2011

Pancreatic cancer is one of the most lethal malignancies with poor prognosis. Previously, we found that a subpopulation of cancer stem cells (CSCs) in the Panc-1 pancreatic cancer cell line could propagate to form spheres. Here we characterized the malignant phenotypes of the pancreatic cancer stem CD44+/CD24+ cells, which were enriched under sphere forming conditions as analyzed by flow cytometry. These cells demonstrated increased resistance to gemcitabine and increased migration ability. Moreover, these cells exhibited epithelial to mesenchymal transition characterized by a decreased level of the epithelial marker E-cadherin and an increased level of the mesenchymal marker vimentin. Notably, abnormal expression of Bmi-1, ABCG2, Cyclin D1 and p16 were found in Panc-1 CSCs. Our results suggest that targeted inhibition of CSCs represents a novel therapeutic approach to overcome chemoresistance and metastasis of pancreatic cancer.
Dual-Scale Polymeric Constructs as Scaffolds for Tissue Engineering
Authors: Mota Carlos , Puppi Dario , Dinucci Dinuccio , Errico Cesare , Bártolo Paulo , Chiellini Federica
Published: March 2011

This research activity was aimed at the development of dual-scale scaffolds consisting of three-dimensional constructs of aligned poly(ε-caprolactone) (PCL) microfilaments and electrospun poly(lactic-co-glycolic acid) (PLGA) fibers. PCL constructs composed by layers of parallel microsized filaments (0/90° lay-down pattern), with a diameter of around 365 μm and interfilament distance of around 191 μm, were produced using a melt extrusion-based additive manufacturing technique. PLGA electrospun fibers with a diameter of around 1 μm were collected on top of the PCL constructs with different thicknesses, showing a certain degree of alignment. Cell culture experiments employing the MC3T3 murine preosteoblast cell line showed good cell viability and adhesion on the dual-scale scaffolds. In particular, the influence of electrospun fibers on cell morphology and behavior was evident, as well as in creating a structural bridging for cell colonization in the interfilament gap.
Development of Micro-Heaters with Optimized Temperature Compensation Design for Gas Sensors
Authors: Hwang Woo-Jin , Shin Kyu-Sik , Roh Ji-Hyoung , Lee Dae-Sung , Choa Sung-Hoon
Published: March 2011

One of the key components of a chemical gas sensor is a MEMS micro-heater. Micro-heaters are used in both semiconductor gas sensors and NDIR gas sensors; however they each require different heat dissipation characteristics. For the semiconductor gas sensors, a uniform temperature is required over a wide area of the heater. On the other hand, for the NDIR gas sensor, the micro-heater needs high levels of infrared radiation in order to increase sensitivity. In this study, a novel design of a poly-Si micro-heater is proposed to improve the uniformity of heat dissipation on the heating plate. Temperature uniformity of the micro-heater is achieved by compensating for the variation in power consumption around the perimeter of the heater. With the power compensated design, the uniform heating area is increased by 2.5 times and the average temperature goes up by 40 °C. Therefore, this power compensated micro-heater design is suitable for a semiconductor gas sensor. Meanwhile, the poly-Si micro-heater without compensation shows a higher level of infrared radiation under equal power consumption conditions. This indicates that the micro-heater without compensation is more suitable for a NDIR gas sensor. Furthermore, the micro-heater shows a short response time of less than 20ms, indicating a very high efficiency of pulse driving.
The First Appearance of Symmetry in the Human Lineage: Where Perception Meets Art
Authors: Hodgson Derek
Published: March 2011

Although symmetry may be important for understanding the selection of form in art over the historical period, this preference may have originally stemmed from certain basic perceptual mechanism that initially arose during prehistory. The first signs of an awareness to symmetry can be found in the archaeological record with the arrival of Acheulean handaxes, especially those dating from 500,000 years ago onwards, which are typified by a prodigious bilateral symmetry. As handaxes represent the earliest material record of an interest in symmetry by the human lineage, they provide a privileged means of understanding why this kind of form came to be valued by later human groups, particularly in relation to “art”. Although still controversial, the preference for symmetry at such an early date has been linked to various aspects of perception relating to enduring evolutionary factors. In this regard, it will be demonstrated how the preference for symmetrical Acheulean tools arose out of long standing perceptual correlates relating to ecological factors that predated the arrival of hominins.
The Fungi: 1, 2, 3 … 5.1 million species?
Authors: Blackwell Meredith
Published: March 2011

• Premise of the study: Fungi are major decomposers in certain ecosystems and essential associates of many organisms. They provide enzymes and drugs and serve as experimental organisms. In 1991, a landmark paper estimated that there are 1.5 million fungi on the Earth. Because only 70000 fungi had been described at that time, the estimate has been the impetus to search for previously unknown fungi. Fungal habitats include soil, water, and organisms that may harbor large numbers of understudied fungi, estimated to outnumber plants by at least 6 to 1. More recent estimates based on high‐throughput sequencing methods suggest that as many as 5.1 million fungal species exist.

• Methods: Technological advances make it possible to apply molecular methods to develop a stable classification and to discover and identify fungal taxa.

• Key results: Molecular methods have dramatically increased our knowledge of Fungi in less than 20 years, revealing a monophyletic kingdom and increased diversity among early‐diverging lineages. Mycologists are making significant advances in species discovery, but many fungi remain to be discovered.

• Conclusions: Fungi are essential to the survival of many groups of organisms with which they form associations. They also attract attention as predators of invertebrate animals, pathogens of potatoes and rice and humans and bats, killers of frogs and crayfish, producers of secondary metabolites to lower cholesterol, and subjects of prize‐winning research. Molecular tools in use and under development can be used to discover the world's unknown fungi in less than 1000 years predicted at current new species acquisition rates.
Factors influencing diversification in angiosperms: At the crossroads of intrinsic and extrinsic traits
Authors: Vamosi Jana C. , Vamosi Steven M.
Published: March 2011

Recent studies indicate that both key innovations and available area influence species richness in angiosperms. Available area has been observed to have the greatest effect, however, and appears to alter the “carrying capacity” of a lineage rather than alter diversification rates. Here, we review and weigh the evidence of predictors of angiosperm diversification and further dissect how area can place ecological limits on diversification of angiosperms, specifically addressing the following: (1) theoretical mechanisms by which particular intrinsic and extrinsic traits may affect diversification in angiosperm families; (2) evidence that the amount of available area determines the ecological limits on lineages; and (3) geographical distribution of diversification hotspots in angiosperms, concentrating on the effects of zygomorphy, noncontiguous area, and latitude. While we found that dispersal to numerous noncontiguous areas is most important in spurring diversification, diversification of tropical and zygomorphic families appears to be elevated by the generation of more species per given area.
The functional role of producer diversity in ecosystems
Authors: Cardinale Bradley J. , Matulich Kristin L. , Hooper David U. , Byrnes Jarrett E. , Duffy Emmett , Gamfeldt Lars , Balvanera Patricia , O'Connor Mary I. , Gonzalez Andrew
Published: March 2011

Over the past several decades, a rapidly expanding field of research known as biodiversity and ecosystem functioning has begun to quantify how the world's biological diversity can, as an independent variable, control ecological processes that are both essential for, and fundamental to, the functioning of ecosystems. Research in this area has often been justified on grounds that (1) loss of biological diversity ranks among the most pronounced changes to the global environment and that (2) reductions in diversity, and corresponding changes in species composition, could alter important services that ecosystems provide to humanity (e.g., food production, pest/disease control, water purification). Here we review over two decades of experiments that have examined how species richness of primary producers influences the suite of ecological processes that are controlled by plants and algae in terrestrial, marine, and freshwater ecosystems. Using formal meta‐analyses, we assess the balance of evidence for eight fundamental questions and corresponding hypotheses about the functional role of producer diversity in ecosystems. These include questions about how primary producer diversity influences the efficiency of resource use and biomass production in ecosystems, how primary producer diversity influences the transfer and recycling of biomass to other trophic groups in a food web, and the number of species and spatial /temporal scales at which diversity effects are most apparent. After summarizing the balance of evidence and stating our own confidence in the conclusions, we outline several new questions that must now be addressed if this field is going to evolve into a predictive science that can help conserve and manage ecological processes in ecosystems.
HCV Core Gene Polymorphisms Correlate with Liver Fibrosis but Not Sustained Virological Response in Patients with Genotype 1 Infection
Authors: Hsu Shih–Jer , Hsu Ching-Sheng , Liu Chen-Hua , Liu Chun-Jen , Chen Chi-Ling , Chen Pei-Jer , Chen Ding-Shinn , Kao Jia-Horng
Published: March 2011

Background

Amino acid (aa) substitutions in genotype 1 HCV core region (HCV-CR) serve as a negative predictor of treatment responses in Japanese chronic hepatitis C (CHC) patients. Whether this phenomenon could be extrapolated to non-Japanese patients remains unclear. We evaluated the effect of aa substitutions in HCV-CR on clinicopathological features and treatment responses in Taiwanese patients.

Methods

Clinical and serial virological data were collected from 147 consecutive Taiwanese HCV genotype 1 patients who received pegylated interferon plus ribavirin therapy. Quantification of HCV RNA and sequences of HCV-CR were determined by molecular methods.

Results

Of 147 patients, 90 (61.2%) attained rapid virological response (RVR) and 97 (66.0%) attained sustained virological response (SVR). Patients without aa substitutions in HCV-CR (coreWW) had a higher SVR than those with both aa70 and aa91 substitutions (coreMM; 70.5% versus 45.0%; P=0.039). Moreover, coreMM was associated with a higher γ-glutamyl transpeptidase level ( P=0.026) as well as more severe liver fibrosis ( P=0.027) than coreWW, and patients with aa70 substitution (coreMW) were associated with more severe liver steatosis and fibrosis than those without ( P=0.020 and P=0.002, respectively). In multivariate analyses, lower pretreatment body mass index, milder liver fibrosis, 48 weeks of treatment and RVR, but not aa substitutions in HCV-CR, predicted a higher SVR rate.

Conclusions

Although aa substitution in genotype 1 HCV-CR is associated with more severe liver fibrosis and might be a negative predictor of SVR in Taiwanese CHC patients with interferon-based therapy, RVR and other clinical factors outweigh its role in predicting SVR.
Frequency of Bone Marrow Lesions and Association with Pain Severity: Results from a Population-based Symptomatic Knee Cohort
Authors: IP STEPHEN , SAYRE ERIC C. , GUERMAZI ALI , NICOLAOU SAVVAKIS , WONG HUBERT , THORNE ANONA , SINGER JOEL , KOPEC JACEK A. , ESDAILE JOHN M. , CIBERE JOLANDA
Published: March 2011

Objective.

To evaluate the prevalence of bone marrow lesions (BML) and their association with pain severity in a population-based cohort of symptomatic early knee osteoarthritis (OA).

Methods.

Subjects with knee pain (n = 255), age 40–79 years, were evaluated by radiograph and magnetic resonance imaging (MRI) and classified into OA stages: no OA (NOA), preradiographic OA (PROA), and radiographic OA (ROA). BML were graded 0–3 (none, mild, moderate, severe) in 6 regions and defined as (1) BMLsum = the sum of 6 scores; and (2) BMLmax = the worst score at any region. Pain was assessed by the Western Ontario and McMaster Universities OA Index (WOMAC). Linear regression analysis was completed to assess the association of Total WOMAC Pain (primary outcome) versus BMLsum or BMLmax. Secondary outcomes were WOMAC Pain on Walking and WOMAC Pain on Climbing Stairs. All analyses were adjusted for age, sex, body mass index, OA stage, joint effusion, and meniscal damage.

Results.

BML were present in 11% of NOA, 38% of PROA, and 71% of ROA subjects (p < 0.001). No association was seen for BMLsum or BMLmax versus Total WOMAC Pain or Pain on Walking. However, BMLsum was associated with Pain on Climbing Stairs [regression coefficients (RC) = 0.09, 95% CI 0.00–0.18]. BMLmax was associated with Pain on Climbing Stairs, with the strongest association for severe BML (RC 0.60, 95% CI 0.04–1.17).

Conclusion.

BML were present in 38% of PROA and 71% of ROA subjects in this symptomatic knee cohort. BML were significantly associated with Pain on Climbing Stairs but not Total WOMAC or Pain on Walking.
Autosome-wide Copy Number Variation Association Analysis for Rheumatoid Arthritis Using the WTCCC High-density SNP Genotype Data
Authors: UDDIN MOHAMMED , STURGE MITCH , RAHMAN PROTON , WOODS MICHAEL O.
Published: March 2011

Objective.

Rheumatoid arthritis (RA) is a complex autoimmune rheumatic disease that is strongly influenced by genetic factors. Numerous genes are convincingly associated with RA, including genes in tumor necrosis factor signaling (TNF) and the nuclear factor-κB pathway. To date, except for genes within the HLA region, no data exist regarding potential copy number variations (CNV) involving RA-associated genes. We set out to identify genes affected by CNV that are associated with RA at a genome-wide level.

Methods.

Data from the Wellcome Trust Case Control Consortium (WTCCC) were used in our analyses. The initial WTCCC cohort genotyped 3004 controls and 1999 RA cases using the GeneChip 500k Mapping Array Set. We performed a comparative intensity analysis using the PennCNV algorithm, which uses a hidden Markov model to detect CNV. A total of 2271 controls and 1572 RA samples passed quality control criteria and were included for association analysis. Association analysis was performed in 2 phases: (1) to identify CNV that are < 1 Mb with a population frequency < 5%; and (2) to identify large CNV that are > 1 Mb. Fishers’ exact test was performed to quantify significance of the CNV.

Results.

We observed that the genome-wide CNV burden is 2-fold higher in patients with RA compared with controls. We identified 11 rare copy number variable regions with < 5% frequency that had an association with RA that reached a p < 1 × 10−4. These include TNFAIP3 and TNIP1, which has been implicated in association studies for RA, systemic lupus erythematosus, and psoriasis. We identified CNV involving IRF1, which functions as a transcription activator of genes induced by interferons; ALOX5AP and LCP2, involved in inflammatory mediation; B2M, an MHC-class I associated gene; and PRKCH, a gene involved in T cell signaling pathways. A 57 kb deletion with 1% frequency in RA cases at 7p21.3 was also observed. Six of these loci overlap with CNV catalogued in the Database of Genomic Variants.

Conclusion.

This is the first study to identify non-HLA RA-associated CNV using genome-wide analyses. Validation and functional significance of these deletions/duplications in RA and other autoimmune diseases need to be further investigated.
Prevalence of Vertebral Fractures by Semiautomated Morphometry in Patients with Ankylosing Spondylitis
Authors: MONTALA NURIA , JUANOLA XAVIER , COLLANTES EDUARDO , MUÑOZ-GOMARIZ ELISA , GONZALEZ CARLOS , GRATACOS JORDI , ZARCO PEDRO , FERNANDEZ SUEIRO JOSE LUIS , MULERO JUAN , TORRE-ALONSO JUAN CARLOS , BATLLE ENRIQUE , CARMONA LORETO
Published: March 2011

Objective.

Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton and characterized by ossification of the spinal disc, joints, and ligaments leading to progressive ankylosis. Vertebral osteoporosis is a recognized feature of AS. Studies have confirmed a moderate to high prevalence of vertebral fractures with extremely varying ranges in patients with AS. Our objective was to estimate the prevalence of vertebral fractures in a representative Spanish population of patients with AS using a validated semiquantitative method, MorphoXpress®.

Methods.

Patients were randomly selected from the 10 initial participating centers of the Spanish National Registry of Spondyloarthropathies (REGISPONSER) by consecutive sampling. All patients fulfilled the New York modified criteria for AS and had a baseline thoracolumbar radiograph. A prevalent vertebral fracture was defined according to the Genant classification criteria.

Results.

The estimated prevalence of vertebral fractures was 32.4% (95% CI 25.5%–39.3%). The majority of fractures were localized in the thoracic segment (n = 100; 82.%) and were mild (n = 79; 64.8%). In logistic regression analysis, age (odds ratio per year 1.05, 95% CI 1.03–1.08, p < 0.001), disease duration (OR per year 1.03, 95% CI 1.01–1.06, p = 0.011), Bath Ankylosing Spondylitis Functional Index score (OR per score 1.16, 95% CI 1.03–1.30, p = 0.015), Bath Ankylosing Spondylitis Radiographic Index-TS (OR per score 1.25, 95% CI 1.12–1.39, p < 0.001), and wall-occiput distance (OR per cm 1.15, 95% CI 1.08–1.23, p < 0.001) were all associated with prevalent fracture.

Conclusion.

Semiquantitative methods are needed to improve the diagnosis of vertebral fractures in AS in order to start early treatment and to avoid complications arising from osteoporosis.