An MR phase imaging sequence with a very short echo time was used to assess blood velocity and flow at the renal artery bifurcation. Cardiac-gated MR imaging data were obtained in six healthy subjects in sagittal planes adjacent to the abdominal aorta and transverse planes above and below the renal artery bifurcation. Average renal artery flow rate was 23.8 +/- 9 mL/sec. A strong individual variability was found for the velocity profiles in the abdominal aorta during end-systolic regurgitation. Flow rate was also determined in three patients with reduced renal artery blood flow. Two patients received therapy with percutaneous transluminal angioplasty. The successful outcome was documented with MR imaging. A reliable assessment of renal artery flow with MR phase imaging is feasible. Measurement of the velocity profiles yields valuable insights in the complicated flow regime at the renal artery bifurcation.

Adult↗

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Sliding interleaved kY (SLINKY) acquisition: a novel 3D MRA technique with suppressed slab boundary artifact.

This work addresses the elimination of the slab boundary artifact (SBA) or venetian blind artifact in three-dimensional multiple overlapped thin slab acquisition (3D MOTSA) for magnetic resonance angiography (MRA). Our method uses a sliding-slab, interleaved kY (SLINKY) data acquisition strategy, equalizing flow-related signal intensity weighting across the entire slab dimension. This technique demodulates signal intensity changes along the slab direction and can essentially eliminate the SBA while retaining the same or better imaging time efficiency than that of conventional MOTSA, providing robustness to complicated flow patterns and thereby resulting in more accurate depiction of vascular morphology. In addition, this technique does not need specialized reconstruction and extra computation. The unique penalty of this technique is the sensitivity to phase inconsistency in the data. Both phantom and in vivo experiments verify the clinical significance of the technique. The new MRA images acquired with this imaging technique show highly reliable mapping of vascular morphology without the SBA and reduction of signal voids in complex/slow flow regions.

Artifacts↗

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Systematic assessment and evaluation of sliding interleaved kY (SLINKY) acquisition for 3D MRA.

In comparison with the conventional three-dimensional multiple overlapped thin slab acquisition (MOTSA) for magnetic resonance angiography (MRA), we have developed a novel sliding interleaved kY (SLINKY) acquisition technique, which can eliminate the slab boundary artifact (SBA) or venetian blind artifact without any a priori knowledge of blood flow. This work addresses the systematic assessment and evaluation of the SLINKY technique and verifies the advantages of SLINKY in the following several aspects: (a) scan time efficiency; (b) signal-to-noise ratio (SNR), and signal-difference-to-noise ratio (SDNR); (c) sensitivity to flow velocity range; (d) sensitivity to flow direction; (e) signal loss in slow/reversal flow regions; and (f) reconstruction efficiency and feasibility. Both phantom and in vivo experiments verify the clinical significance of the technique. The new MRA images acquired with this imaging technique in 31 volunteer/patient examinations show highly reliable mapping of vascular morphology without the SBA and reduction of signal voids in complex/slow flow regions.

Artifacts↗

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Implications of 'low' maternal serum alpha-fetoprotein levels: are maternal age risk criteria obsolete?

An association has been reported between 'low' maternal serum alpha-fetoprotein (MSAFP) and fetal chromosome abnormalities, notably Down syndrome. We suggest the predictive value be used for genetic counselling when a 'low' MSAFP is found, and present an illustrative risk table. It can also be seen that normal MSAFP in a woman may lower her age-related risks below that previously defined as 'high risk'. However, until good estimates of sensitivity and specificity are available from prospective, population based studies, patients should be told that any risk estimates are rough approximations. When good estimates are available, use of age risks alone may become obsolete.

Adult↗

PubMedDate not supplied

Epidemiology of low total plasma cholesterol concentration among young adults: the CARDIA study. Coronary Artery Risk Development in Young Adults.

BACKGROUND: Data on stability of plasma total cholesterol levels and its determinants among young adults are lacking. Knowledge of factors associated with low levels of plasma total cholesterol during young adulthood may help clarify the nature of associations between hypocholesterolemia and health or illness. METHODS: Tracking of plasma total cholesterol was investigated using data from the baseline (1985-1986), Year 5 (1990-1991), and Year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults Study. Lifestyle (including dietary), physiological, medical, and psychological correlates of plasma total cholesterol were examined cross-sectionally at baseline using ANCOVA and multivariate logistic regression. The attributes of participants with persistently low plasma total cholesterol level after 7 years (i.e., remaining below the 10th percentile of sex- and race-specific distributions) were also examined. RESULTS: The cohort in this analysis comprised 720 black men, 922 white men, 899 black women, and 944 white women who were between the ages of 18 and 30 years at baseline. Between 44 and 52% of those with plasma total cholesterol levels below the 10th percentile remained below the same percentile 7 years later. Among black men, a difference of 1 SD in age [3.7 years; odds ratio (OR) = 0.69; 95% CI = 0.52-0.91] and a difference of 1 SD in systolic blood pressure (10.5 mm Hg; OR = 0.73; 95% CI = 0.54-0.97) were independently associated with lower odds, respectively, of being in the lowest 10th percentile of the plasma total cholesterol distribution. Also among black men, current smoking and more calories from carbohydrates were associated with nonsignificantly higher odds of low total cholesterol level. Among white men, a 1 SD older age (3.4 years; OR = 0.78; 95% CI = 0.61-1.00) and a 1 SD higher physical fitness (118 sec; OR = 1.41; 95% CI = 1.09-1.82) predicted lower and higher odds, respectively, of low plasma total cholesterol. Among black women, a 1 SD difference in albumin (0.3 g/dL; OR = 0.80; 95% CI = 0.63-1.03) was related to lower odds of low plasma total cholesterol. Among white women, the factors independently associated with low plasma total cholesterol were body mass index (OR for a difference in 4.0 kg/m2 = 0.73; 95% CI = 0.54-1.00) and gamma-glutamyl transferase (OR for an increase in 9.6 IU/L = 0.41; 95% CI = 0.18-0.93). The independent predictive factors of stably low total cholesterol levels were age and uric acid among black men (both inversely related) and age, Framingham Type A Behavior (inversely), and calories from carbohydrates (positively related) among white men. CONCLUSION: Young adults with low plasma total cholesterol level have characteristics generally associated with good cardiovascular health. However, adverse attributes such as current cigarette smoking (notably among black men) may confound future associations between low total cholesterol and disease.

Adolescent↗

PubMedDate not supplied

Total parenteral nutrition during acute pancreatitis: clinical experience with 156 patients.

Over a 3-year period, 156 of 815 patients admitted to a single institution with acute pancreatitis received total parenteral nutrition (TPN) for 2,572 patient days. Seventy had "simple" acute pancreatitis (group I) and 86 (group II) developed local complex disease (pseudocyst, abscess, or necrotic gland). In groups I and II, respectively, days without oral intake (NPO) were 13.6 +/- 1.5 (SEM) and 24.0 +/- 2.1 (p less than 0.005), hospital days were 19.8 +/- 1.7 and 35.8 +/- 3.2 (p less than 0.005), and duration of TPN was 10.9 +/- 1.0 and 21.0 +/- 2.3 days (p less than 0.005). Thirty-three patients in group I and 53 in group II required exogenous insulin. Alteration of standard formulas was necessary in 87 patients, but cessation of therapy was necessary in only one instance. Twenty catheters were removed for suspected sepsis with only 3 confirmed cases. Fat-based formulas were well tolerated in 15% of patients. During TPN, body weight rose from 95.0 +/- 2.4% to 97.4 +/- 4.3% of ideal in group I and remained at 90.5 +/- 1.8% in group II. Albumin rose from 3.36 +/- 0.10 to 3.50 +/- 0.08 g/dl in group I and from 3.01 +/- 0.07 to 3.35 +/- 0.07 g/dl in group II. The entire cohort differed from 10 randomly chosen patients who did not receive TPN in terms of days NPO (2.8 +/- 0.3) and hospital days (5.5 +/- 0.6). Variables associated with prolongation of hospital stay and time NPO were number of prognostic criteria, local complex disease, and underlying chronic pancreatitis only in select groups. We conclude that during acute pancreatitis, TPN can be administered safely but with careful monitoring and we recommend early aggressive therapy in the subgroups noted above and when underlying malnutrition exists. In the borderline patient, TPN may be administered by peripheral vein until the severity of disease is manifest.

Acute Disease↗

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Effects of lisinopril and bisoprolol on lipoprotein metabolism in patients with mild-to-moderate essential hypertension.

The short- and long-term effects of the angiotensin-converting enzyme inhibitor lisinopril and the cardioselective beta-blocker bisoprolol on serum lipids, lipoproteins, apolipoproteins, and lipoprotein(a) (Lp[a]) levels were investigated in patients with mild-to-moderate essential hypertension. Fifty-two patients completed the 12-month, randomized, multicenter trial. After administration of lisinopril (10 to 20 mg/d; n = 24) and bisoprolol (2.5 to 10 mg/d; n = 28), systolic and diastolic blood pressures decreased significantly (P < 0.01) from baseline in both groups at 3, 6, and 12 months. The reduction in diastolic blood pressure was significantly (P < 0.05) greater in the lisinopril group than in the bisoprolol group only at 6 months. Heart rates dropped significantly in the bisoprolol group but not in the lisinopril group. No significant changes in lipids, lipoproteins, apolipoproteins, or Lp(a) levels were observed with either drug at 3, 6, or 12 months, and no significant differences were noted between the two drugs for these parameters. We conclude that lisinopril and bisoprolol are effective as antihypertensive drugs without adverse metabolic effects after short- and long-term treatment in patients with mild-to-moderate essential hypertension.

Adrenergic beta-Antagonists↗

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Accounting for covariate measurement error in a Cox model analysis of recurrence of depression.

When a covariate measured with error is used as a predictor in a survival analysis using the Cox model, the parameter estimate is usually biased. In clinical research, covariates measured without error such as treatment procedure or sex are often used in conjunction with a covariate measured with error. In a randomized clinical trial of two types of treatments, we account for the measurement error in the covariate, log-transformed total rapid eye movement (REM) activity counts, in a Cox model analysis of the time to recurrence of major depression in an elderly population. Regression calibration and two variants of a likelihood-based approach are used to account for measurement error. The likelihood-based approach is extended to account for the correlation between replicate measures of the covariate. Using the replicate data decreases the standard error of the parameter estimate for log(total REM) counts while maintaining the bias reduction of the estimate. We conclude that covariate measurement error and the correlation between replicates can affect results in a Cox model analysis and should be accounted for. In the depression data, these methods render comparable results that have less bias than the results when measurement error is ignored.

Aged↗

PubMedDate not supplied

Transfer of HLA antigens from stimulatory B cells to alloreactive T lymphocytes: a novel mechanism of "allospecific" autoregulation.

Explore the source record for details and available documents.

Antigens, CD19↗

PubMedDate not supplied

Localization and distribution of tissue type and urokinase type plasminogen activators and their inhibitors Type 1 and 2 in human and rhesus monkey fetal membranes.

Fetal membranes consist of 10 distinct layers including components of amnion, chorion and decidua, the latter being of maternal origin. They form mechanically integrated sheets capable of retaining amniotic fluid and play an essential role in protecting fetal growth and development in the pregnant uterus. The extracellular matrix, substrate for plasminogen activators (PAs), is an important supportive framework of the fetal membranes. Fetal membranes from women with preterm premature rupture of membranes may differ in their protease activity compared with normal membranes. To identify the presence of PAs and their inhibitors (PAI) and their possible role in the process of fetal membrane rupture, this study investigated the distribution and localization of both protein and mRNA for tissue (t) and urokinase (u) PA and their inhibitors type 1 (PAI-1) and type 2 (PAI-2) in amniochorion of human and rhesus monkey using conventional and confocal immunofluorescence microscopy. In situ hybridization analysis showed that the distribution and localization of mRNAs for tPA, uPA, PAI-1 and PAI-2 were similar in the fetal membranes of human and rhesus monkey; no obvious species difference was observed. Evidence of tPA mRNA was detected in amniotic epithelium, trophoblast cells and nearly all cells of the decidual layer. Strong expression of uPA mRNA was noted in the decidual cells which increased in intensity as the abscission point was approached. Weak staining in chorion laeve trophoblast was also detected. In situ hybridization experiments showed PAI-1 mRNA to be concentrated mainly in the decidual cells, some of which were interposed into the maternal-facing edge of the chorion laeve. Maximal labelling of the decidua occurred towards the zone of abscission. Weak expression of PAI-1 mRNA was also noted in some cells of the chorion laeve. The distribution of PAI-2 mRNA in amniochorion was also concentrated in the cells of the decidual layer, maximum expression of the mRNA was in the level of abscission. No detectable amount of mRNAs for tPA, uPA, PAI-1 and PAI-2 was found in the fibroblast, reticular and spongy layers. Distribution of the proteins of tPA, uPA and PAI-1 in the fetal membranes of these two species was consistent with the distribution of their mRNA. Anti-PAI-2 immunofluorescence was found to be strongly concentrated in the amniotic epithelium, but PAI-2 mRNA was negative in this layer, suggesting that the epithelium-associated PAI-2 is not of epithelial origin. These findings suggest that a local fibrinolysis in fetal membranes generated by precisely balanced expression of PAs and their inhibitors via paracrine or autocrine mechanisms may play an essential role in fetal membrane development, maturation and in membrane rupture. Following an analysis of the distribution and synthesis of activators and inhibitors it was found that they may play a role in abscission during the third stage of labour.

Adult↗

PubMedDate not supplied

Left ventricular diastolic function in young adults: the Coronary Artery Risk Development in Young Adults Study.

Doppler transmitral flow velocities have been used to assess left ventricular diastolic function. Associations of transmitral velocities with specific physiologic variables and cardiovascular risk factors have not been reported previously in a large population-based study of young adults. We performed Doppler analysis of left ventricular inflow in 3492 black and white men and women (aged 23 to 35 years) in the year-5 examination of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. First third filling fraction, peak flow velocity in early diastole (PFVE), peak flow velocity in late diastole (PFVA), and the PFVA/PFVE ratio were measured. Women had higher PFVE and PFVA than had men (PFVE: 0.81 +/- 0.13 m/sec versus 0.76 +/- 0.13 m/sec; PFVA: 0.47 +/- 0.11 m/sec versus 0.43 +/- 0.10 m/sec; both p < 0.001). Gender-specific multiple regression analyses showed that age, heart rate, systolic blood pressure, left ventricular percent fractional shortening, and body weight were independently and positively related to PFVA (all p < 0.001) in men and women. Age, heart rate, and forced expiratory lung capacity in 1 second were inversely related to PFVE and first third filling fraction (both p < 0.01). Left ventricular percent fractional shortening was positively related to PFVE and first third filling fraction (p < 0.001). Age, heart rate, and body weight were positively correlated with the PFVA/PFVE ratio (all p < 0.001). Height had weak negative associations with PFVA and PFVE in women only. These results suggest that, in young adults, Doppler measures of left ventricular diastolic filling are related to age, sex, body weight, blood pressure, heart rate, left ventricular systolic function, and lung function.

Adult↗

PubMedDate not supplied

Expression of urokinase, plasminogen activator inhibitors and urokinase receptor in pregnant rhesus monkey uterus during early placentation.

We have investigated plasmin mediated proteolysis associated with trophoblast invasion during early stages of pregnancy in the rhesus monkey. In situ hybridization and immunocytochemical localization were used to define the cellular and tissue distribution of urokinase plasminogen activator (uPA), plasminogen activator inhibitor type 1 (PAI-1) and 2 (PAI-2) and urokinase receptor in early monkey placenta and uterus. Our results indicate: (1) uPA is expressed in proliferating and invasive cytotrophoblast located in chorionic villi as well as in extravillous trophoblast associated with uterine arterioles. This raises the possibility that urokinase may play an important role in trophoblast invasion. (2) PAI-1 mRNA is specifically localized in two areas where invasive trophoblast cells encounter maternal tissue directly. The extravillous cytotrophoblast cells at the maternofetal junction express PAI-1 mRNA. The invasive endovascular trophoblast cells within the uterine arterioles also express PAI-1 mRNA. The location sensitive expression of PAI-1 mRNA at the maternofetal junction may imply a protective function of this protease inhibitor that might be induced through interaction with decidual cells. (3) Urokinase receptor antigen has also been found at the maternofetal junction and in endovascular trophoblast cells of the invaded maternal blood vessel. (4) PAI-2 immunoreactivity is found in association with cytotrophoblast cells in anchoring choronic villi suggesting its association with early placentation. In conclusion, we propose that the plasmin/plasminogen activator system may not only regulate extracellular matrix degradation, but also modify migration and invasive behaviour of extravillous trophoblast cells, during early placentation.

Animals↗

PubMedDate not supplied

Plasminogen activators and inhibitors are transcribed during early macaque implantation.

Plasminogen activators and inhibitors may be important early in primate implantation but evidence for this is sparse in non-human primates. We define the expression of urokinase type plasminogen activator (uPA), tissue-type plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1) and type 2 (PAI-2), the receptor for uPA (uPAR) and fibrin/fibrinogen in monkey implantation sites. In situ hybridization and immuno-histochemical localization of rhesus monkey implantation sites (day 15-16 postovulation) indicate: (1) uPA mRNA is localized to placental trophoblast, epithelial plaque and endometrial stroma. (2) tPA mRNA is mainly expressed in glandular cells of endometrium. (3) PAI-1 expression is linked to a specific population of trophoblasts that confront maternal cells, adding support to our view that it has a regulatory role in trophoblast invasion. (4) Localization of tPA antigen confirms that uterine glands are the major source of tPA and that it is also closely associated with fibrin(ogen) suggesting its possible function during implantation is fibrinolysis. (5) Unlike uPA mRNA, however, the distribution of uPA protein and its cell surface receptor uPAR suggests that it mediates trophoblast invasion and plays a significant role in angiogenesis. (6) PAI-2, the inhibitor associated with pregnancy in humans, was found in unidentified cells located specifically along the maternofetal junction. This localization adjacent to areas of cell death at the maternofetal junction implies that it may have a role as a protective curtain with anti-apoptotic function. In conclusion our results suggest that gene expression of PAs and PAIs in early implantation sites are tissue-specific, location-sensitive and function-related.

Animals↗