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Development and determinants of dynamic obstruction to left ventricular outflow in young patients with hypertrophic cardiomyopathy.

BACKGROUND: To study the development of dynamic subaortic obstruction in young patients with hypertrophic cardiomyopathy (HCM), serial echocardiograms were retrospectively analyzed in a group of 26 consecutive children with this disease who showed no evidence of dynamic outflow obstruction at their initial evaluation (age, 11 +/- 3 years). METHODS AND RESULTS: After a follow-up of 3-12 years (mean, 7 +/- 3 years), seven of the 26 patients (27%) developed echocardiographic evidence of subaortic obstruction, i.e., marked systolic anterior motion (SAM) of the mitral valve with mitral-septal apposition and increased left ventricular outflow tract systolic velocities (3.8 +/- 0.3 m/sec; range, 3.1-4.5). Patients who developed SAM had smaller transverse dimension of the left ventricular outflow tract and more anteriorly displaced mitral valve when initially evaluated than did patients without development of SAM (outflow tract dimension, 19.1 +/- 4 versus 24.6 +/- 4 mm; mitral valve position index, 1.07 +/- 0.2 versus 0.73 +/- 0.3; each p less than 0.02). In patients with development of SAM, the already reduced outflow tract dimension decreased further during follow-up, and the mitral valve became even more anteriorly displaced within the left ventricular cavity. These developmental alterations in outflow tract size were associated with increases in left ventricular wall thickness, particularly of the basal anterior septum (11.0 +/- 8 mm; 72 +/- 33%) compared with control patients with HCM who did not develop SAM (3.0 +/- 3 mm; 17 +/- 10%; p less than 0.05). CONCLUSIONS: Development of subaortic obstruction in young patients with HCM results from a process of dynamic remodeling of left ventricular geometry over several years and is characterized by progressive narrowing of the outflow tract with anterior displacement of the mitral valve and disproportionate thickening of the basal anterior ventricular septum.

Cardiomyopathy, Hypertrophic↗

Separation crisis in a family with a borderline adolescent.

The case discussed illustrates the crisis value of separation strivings in borderline families. Dynamic and interpersonal issues were approached from a focus on (a) patterns of projective identification; (b) parental definitions interfering with the child's ego structure formation; and (c) the deterioration of a borderline personality toward frankly schizophrenic functioning under the double pressure of the developmental task of separation and binding parental maneuvers.

Adult↗

Cocaine dependence treatment on an inpatient detoxification unit.

A psychoanalytic-developmental treatment model includes individual and group psychotherapy which enables compulsive freebase cocaine smokers to articulate explanations for their drug dependence. Relapse prevention education includes recommendations for aftercare treatment. Psychosocial history and DSM-III diagnostic data (N = 31) reveals histories of dysfunctional family dynamics, high rates of depressive disorders, and personality disorders. A case history illustrates application of our treatment model and problems in currently available post-detox treatment. Residential therapeutic communities (TCs) need to offer variable program lengths and specialized crack residences in therapeutic milieus with trained clinical staff. TC programs should offer inpatient psychotherapy, family therapy, and provide direct entrance into program affiliated outpatient services. Recommendations for outpatient services include adjuncts to established anonymous self-help group networks in order to reduce changes of relapse.

Adolescent↗

Muscle building; mechanisms of myotube guidance and attachment site selection.

The complex muscle patterns of higher organisms arise as migrating myoblasts are guided toward and connect with specific attachment sites. We review here the current understanding of myotube migration, focusing on its dynamic nature and the few molecular cues that have been identified to date. Much of this knowledge comes from studies in Drosophila, where powerful methods for in vivo imaging and genetic manipulation can be used to tackle this important but largely unsolved problem in developmental biology.

Animals↗

Changes in family financial circumstances and the physical health of married and recently divorced mothers.

This study investigates how divorce followed by single parenthood undermines the long-term physical health of rural mothers using four waves of survey data collected in Iowa, USA from 336 married and 80 divorced mothers during a 10-year period. Findings generally support the hypothesized pathways in that single-parenthood creates financial difficulties for rural mothers. Furthermore, this financial adversity is linked to self-assessed physical health trajectories that then contribute to change in morbidity. This reflects the developmental course of morbidity during the middle years. Methodologically, this extends existing research on the association between women's marital status and well being by explicitly examining individual trajectories of change in family financial strain and physical health, as well as by examining the dynamic association between both during the middle years.

Adult↗

Reduction of microtubule catastrophe events by LIS1, platelet-activating factor acetylhydrolase subunit.

Forming the structure of the human brain involves extensive neuronal migration, a process dependent on cytoskeletal rearrangement. Neuronal migration is believed to be disrupted in patients exhibiting the developmental brain malformation lissencephaly. Previous studies have shown that LIS1, the defective gene found in patients with lissencephaly, is a subunit of the platelet-activating factor acetylhydrolase. Our results indicated that LIS1 has an additional function. By interacting with tubulin it suppresses microtubule dynamics. We detected LIS1 interaction with microtubules by immunostaining and co-assembly. LIS1-tubulin interactions were assayed by co-immunoprecipitation and by surface plasmon resonance changes. Microtubule dynamic measurements in vitro indicated that physiological concentrations of LIS1 indeed reduced microtubule catastrophe events, thereby resulting in a net increase in the maximum length of the microtubules. Furthermore, the LIS1 protein concentration in the brain, measured by quantitative Western blots, is high and is approximately one-fifth of the concentration of brain tubulin. Our new findings show that LIS1 is a protein exhibiting several cellular interactions, and the interaction with the cytoskeleton may prove to be the mode of transducing a signal generated by platelet-activating factor. We postulate that the LIS1-cytoskeletal interaction is important for neuronal migration, a process that is defective in lissencephaly patients.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗

Hearing voices: the fate of the analyst's identifications.

Using detailed clinical examples, the author illustrates the function of conscious and unconscious identifications with former training analysts, supervisors, teachers, and theorists in the mind of the working analyst. As compromise formations, analytic identifications are the product of loving and aggressive wishes, defenses against those wishes, and self-punitive trends that accompany the analyst in the work. The analyst's stance at any given moment has an identificatory history that may become conscious at certain times with certain patients. While the analyst's identifications modify over time, following a predictable developmental path, they are never fully given up, but consciously and unconsciously remain an active part of the analyst's inner life. During the clinical hour they are responsive to both the analyst's and the patient's conflicts, and they coexist in a dynamic reciprocal relationship with the patient's inner life.

Conflict, Psychological↗

The lived experience of staying healthy in rural African American families.

Decreased government spending for public health programs and increased government expectations that consumers should take responsibility for self-care and health promotion activities are current trends (Lee & Estes, 1990; Naisbitt, 1984). The purpose of this study was to reveal through phenomenological analysis the meaning of staying healthy for the participants. Staying healthy emerged as a dynamic response to life events that involved activity and relatedness in synchrony with life's rules and emotional tranquility. The findings confirm that phenomenological research can reveal the meaning of health within the context of culture and support the conceptualization of health as a developmental process for African American families.

Adaptation, Psychological↗

Fetal Behavioral Development: Measurement of Habituation, State Transitions, and Movement to Assess Fetal Well Being and to Predict Outcome

> Objective: This paper describes the deliberations of an interdisciplinary group of clinical and basic scientists who met at the National Institute of Child Health and Human Development to discuss the potential role of fetal behavior in assessing fetal well being and predicting neonatal outcome. The conference focused on three aspects of fetal behavior: 1) habituation; 2) state transitions; and 3) movement. Methods: The participants consisted of 25 leaders in the fields of obstetrics, perinatal medicine, neonatology, developmental psychobiology, developmental neuroscience, developmental psychology, ethology, and mathematics. The meeting was divided into three parts. In each of these a plenary speaker (a recognized expert in his field) began the session with an overview of the scientific theme. Two respondents, with research expertise in fetal research (animal models or human fetuses) followed with remarks on the plenary talk and comments based on their own studies. At the conclusion of these comments, the participants met in small groups to discuss the plenary proceedings and their implications for assessing human fetal well being and predicting outcome. At the conclusion of the small group deliberations all of the participants reconvened in a plenary session. During this part of the meeting a rapporteur from each small group summarized their discussions. Results and Conclusions: 1) Fetal habituation: there was a general consensus that research on this aspect of fetal behavior may have a high payoff for assessing human fetal well being and predicting neonatal outcome. 2) Behavioral state transitions: participants agreed that transitions afford investigators with an indication of when (timing) and how (models) behavior changes within and between developmental periods. Knowledge of transitions during development allows for tracking of behaviors that may be necessary for the fetus to adapt to its in utero environment or prepare for its postnatal life. 3) Chaos theory and fetal movement: participants concluded that non-linear dynamics systems analysis models could be useful to analyze "noise" within a measurement system; better define time scales; and increase resolution and thereby better identify "signals."

Journal Article↗

Marital/family developmental theory as a context for understanding and treating inhibited sexual desire.

In this article, the author offers a theoretically based, heuristic model for understanding the etiology and maintenance of inhibited sexual desire (ISD) within the context of a developing relationship system. Empirical studies of premarital relationship formation, progression and maintenance form the basis of this discussion. The interplay of intrapersonal and interactional dynamics is highlighted. Emphasis is placed upon understanding ISD according to social exchange formulations of premarital and marital behavior. Particular attention is given to the interactants' nonverbalized rules and implicitly held expectations for the sexual exchange process. Guidelines for assessment are offered and implications for intervention are drawn.

Courtship↗

Structural polarity and dynamics of male germline stem cells in the milkweed bug (Oncopeltus fasciatus).

The male germline stem cells (GSCs) of the milkweed bug present an extraordinary structural polarity that is, to our knowledge, unequalled by any other type of stem cells. They consist of a perikaryon and numerous projections arising from the cell pole directed toward the apical cells, the proposed niche of the GSCs. The projections can traverse a considerable distance until their terminals touch the apical cells. From hatching until death, the GSC projections undergo conspicuous changes, the sequence of which has been deduced from observations of all developmental stages. Projection formation starts from lobular cell protrusions showing trabecular ingrowths of the cell membrane. Finger-like projections result from a process of growth and "carving out". The newly formed projections contain mostly only free ribosomes other than a few mitochondria. A stereotyped degradation process commences in the projection terminals: profiles of circular, often concentric, cisternae of rough endoplasmic reticulum appear and turn into myelin bodies, whereas mitochondria become more numerous. The cytoplasm vesiculates, lysosomal bodies appear, and mitochondria become swollen. At the same time, the projection terminals are segregated by transverse ingrowths of the cell membrane. Finally, autophagic vacuoles and myelin bodies fill the segregated terminals, which then rupture. Simultaneously, new projections seem to sprout from the perikaryon of the GSCs. These dynamics, which are not synchronized among the GSCs, indicate that a novel type of signal exchange and transduction between the stem cells and their niche is involved in the regulation of asymmetric versus symmetric division of GSCs.

Animals↗

The developmental and neural determinants of the effects of estrogen on feeding behavior in the rat: a theoretical perspective.

Conceptually, the neural regulation of feeding behavior is proposed to be a function of the activities of a long-term (day to day) and a short-term (meal to meal) control system. Although these two control systems are presumably involved in a continuous and dynamic interaction, they can be behaviorally and anatomically separated by specific regulatory challenges and brain lesions. Utilizing this general regulatory model for the hypothalamic control of feeding behavior, the effects of estrogen on a variety of behavioral indices of energy regulation are reviewed and discussed. The effects of ovarian hormones on the feeding behavior of both prepubertal and adult female rats when faced with a series of regulatory tests shown to provide specific information about the long- and short-term control of feeding behavior leads to the following conclusions. Modulation of feeding behavior by ovarian hormones is detectable well before the time of puberty in the female rat and is expressed in terms of a 4-day periodicity that is very similar to adult animals. Estrogen appears to modulate feeding behavior primarily by modifying the long-term control of feeding behavior or else the manner in which nutrients are integrated into this long-term system. It is further proposed that estrogen acts upon metabolically specific and unique neural elements in the hypothalamus whose function is to translate error signals derived from the long-term integration of body nutrients into appropriate readjustments in feeding behavior. Although this dual-regulatory model for the hypothalamic control of feeding behavior can account for the majority of the effects of estrogen on feeding behavior, further studies suggest that an "extrahypothalamic" mechanism must mediate certain aspects of the neural control of feeding behavior as well as the behavioral effects of estrogen. Specifically, the present model system can account for the role of carbohydrates in the neural control of feeding behavior, but fats and possibly proteins can modify feeding behavior independent of the hypothalamus. Likewise, estrogen can influence the efficiency with which nutrient loads of fats and proteins can modify subsequent feeding behavior and therefore this proposed "extrahypothalamic" mechanism may mediate those effects of estrogen on feeding behavior that cannot be accounted for by the present dual-regulatory model.

Afferent Pathways↗

A dynamic epicardial injury response supports progenitor cell activity during zebrafish heart regeneration.

Zebrafish possess a unique yet poorly understood capacity for cardiac regeneration. Here, we show that regeneration proceeds through two coordinated stages following resection of the ventricular apex. First a blastema is formed, comprised of progenitor cells that express precardiac markers, undergo differentiation, and proliferate. Second, epicardial tissue surrounding both cardiac chambers induces developmental markers and rapidly expands, creating a new epithelial cover for the exposed myocardium. A subpopulation of these epicardial cells undergoes epithelial-to-mesenchymal transition (EMT), invades the wound, and provides new vasculature to regenerating muscle. During regeneration, the ligand fgf17b is induced in myocardium, while receptors fgfr2 and fgfr4 are induced in adjacent epicardial-derived cells. When fibroblast growth factors (Fgf) signaling is experimentally blocked by expression of a dominant-negative Fgf receptor, epicardial EMT and coronary neovascularization fail, prematurely arresting regeneration. Our findings reveal injury responses by myocardial and epicardial tissues that collaborate in an Fgf-dependent manner to achieve cardiac regeneration.

Animals↗

Analysis of polysomal mRNA populations of mouse oocytes and zygotes: dynamic changes in maternal mRNA utilization and function.

Transcriptional activation in mammalian embryos occurs in a stepwise manner. In mice, it begins at the late one-cell stage, followed by a minor wave of activation at the early two-cell stage, and then the major genome activation event (MGA) at the late two-cell stage. Cellular homeostasis, metabolism, cell cycle, and developmental events are orchestrated before MGA by time-dependent changes in the array of maternal transcripts being translated. Many elegant studies have documented the importance of maternal mRNA (MmRNA) and its correct recruitment for development. Many other studies have illuminated some of the molecular mechanisms regulating MmRNA utilization. However, neither the complete array of recruited mRNAs nor the regulatory mechanisms responsible for temporally different patterns of recruitment have been well characterized. We present a comprehensive analysis of changes in the maternal component of the zygotic polysomal mRNA population during the transition from oocyte to late one-cell stage embryo. We observe global transitions in the functional classes of translated MmRNAs and apparent changes in the underlying cis-regulatory mechanisms.

Animals↗

Developmental segregation of spinal networks driving axial- and hindlimb-based locomotion in metamorphosing Xenopus laevis.

Amphibian metamorphosis includes a complete reorganization of an organism's locomotory system from axial-based swimming in larvae to limbed propulsion in the young adult. At critical stages during this behavioural switch, larval and adult motor systems operate in the same animal, commensurate with a gradual and dynamic reconfiguration of spinal locomotor circuitry. To study this plasticity, we have developed isolated preparations of the spinal cord and brainstem from pre- to post-metamorphic stages of the amphibian Xenopus laevis, in which spinal motor output patterns expressed spontaneously or in the presence of NMDA correlate with locomotor behaviour in the freely swimming animal. Extracellular ventral root recordings along the spinal cord of pre-metamorphic tadpoles revealed motor output corresponding to larval axial swimming, whereas postmetamorphic animals expressed motor patterns appropriate for bilaterally synchronous hindlimb flexion-extension kicks. However, in vitro recordings from metamorphic climax stages, with the tail and the limbs both functional, revealed two distinct motor patterns that could occur either independently or simultaneously, albeit at very different frequencies. Activity at 0.5-1 Hz in lumbar ventral roots corresponded to bipedal extension-flexion cycles, while the second, faster pattern (2-5 Hz) recorded from tail ventral roots corresponded to larval-like swimming. These data indicate that at intermediate stages during metamorphosis separate networks, one responsible for segmentally organized axial locomotion and another for more localized appendicular rhythm generation, coexist in the spinal cord and remain functional after isolation in vitro. These preparations now afford the opportunity to explore the cellular basis of locomotor network plasticity and reconfiguration necessary for behavioural changes during development.

Animals↗

Dynamic posttranscriptional regulation of epsilon-globin gene expression in vivo.

Functional studies of embryonic epsilon-globin indicate that individuals with beta thalassemia or sickle cell disease are likely to benefit from therapeutic, transcriptional derepression of its encoding gene. The success of epsilon-globin gene-reactivation strategies, however, will be tempered by the stability that epsilon-globin mRNA exhibits in developmental stage-discordant definitive erythroid progenitors. Using cell culture and transgenic mouse model systems, we demonstrate that epsilon-globin mRNA is modestly unstable in immature, transcriptionally active erythroid cells, but that this characteristic has relatively little impact on the accumulation of epsilon-globin mRNA at subsequent stages of terminal differentiation. Importantly, the constitutive stability of epsilon-globin mRNA increases in transgenic mouse models of beta thalassemia, suggesting that epsilon- and beta-globin mRNAs are coregulated through a shared posttranscriptional mechanism. As anticipated, relevant cis-acting determinants of epsilon-globin mRNA stability map to its 3' UTR, consistent with the positioning of functionally related elements in other globin mRNAs. These studies demonstrate that posttranscriptional processes do not pose a significant practical barrier to epsilon-globin gene reactivation and, moreover, indicate that related therapeutic strategies may be particularly effective in individuals carrying beta-thalassemic gene defects.

Animals↗

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