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Renovascular hypertension from segmental renal artery stenosis: importance of segmental renal vein renin sampling.

We report a case of severe hypertension in a girl with no evidence of parenchymal renal disease. Arteriography revealed segmental stenosis and a saccular aneurysm affecting a branch of the left renal artery. Segmental renal vein renin sampling demonstrated a markedly increased rate of renin secretion from the ischemic portion of the left kidney. Partial nephrectomy resulted in normalization of the blood pressure. The resected kidney showed striking hyperplasia of the juxtaglomerular apparatus and medial fibromuscular dysplasia as the etiology of the arterial stenosis. This case emphasizes the value of segmental renin vein sampling in the evaluation of pediatric hypertension and illustrates the high cure rate obtained by surgical correction.

Adolescent↗

[Ultrasound of segment distraction and callus formation in reconstruction of the mandible. Value of surgical ultrasound of callus distraction of vascularized ilial crest transplants and mandibular segments in a previously irradiated area].

PURPOSE: B-scan ultrasonography (US) was applied in patients subjected to callus distraction for bone formation at the interface of mandibular segments and vascularised bone grafts. METHODS: This study consisted of 7 patients requiring further surgical augmentation to allow for prosthetic treatment. All patients had been preoperatively irradiated percutaneously in the region of the primary oral squamous cell carcinoma up to an isodose of 60-75.5 Gy. Ablative surgery was then performed, including discontinuity resection of the mandible. Vascularised iliac crest grafts had been chosen due to poor healing conditions in the irradiated recipient site. For callus distraction, a distraction device was inserted in both the mandibular segment and the bone graft. Subsequently, osteotomy was performed, and distracting forces were applied to the segments. For US, a small-part applicator was used (7.5 MHz). RESULTS: US gives a true estimation of the distraction length, actually achieved at the time of investigation. The applicator can be easily adjusted to the area of interest. Application is safe and easy, the results are reliable, and the procedure can be carried out without affecting the hygiene of the wound after surgical intervention. In addition, US enables the supervising surgeon to detect zones of calcification in the area of callus distraction at an earlier point than can be detected by standard x-ray documentation, thus facilitating control of the therapy. CONCLUSION: US is highly recommended for routine application in callus distraction of the mandible. X-ray documentation is a "must".

Bone Transplantation↗

Integration of Shaker-type K+ channel, KAT1, into the endoplasmic reticulum membrane: synergistic insertion of voltage-sensing segments, S3-S4, and independent insertion of pore-forming segments, S5-P-S6.

KAT1 is a member of the Shaker family of voltage-dependent K(+) channels, which has six transmembrane segments (called S1-S6), including an amphipathic S4 with several positively charged residues and a hydrophobic pore-forming region (called P) between S5 and S6. In this study, we systematically evaluated the function of individual and combined transmembrane segments of KAT1 to direct the final topology in the endoplasmic reticulum membrane by in vitro translation and translocation experiments. The assay with single-transmembrane constructs showed that S1 possesses the type II signal-anchor function, whereas S2 has the stop-transfer function. The properties fit well with the results derived from combined insertion of S1 and S2. S3 and S4 failed to integrate into the membrane by themselves. The inserted glycosylation sequence at the S3-S4 loop neither prevented the translocation of S3 and S4 nor impaired the function of voltage-dependent K(+) transport regardless of the changed length of the S3-S4 loop. S3 and S4 are likely to be posttranslationally integrated into the membrane only when somewhat specific interaction occurs between them. S5 had the ability of translocation reinitiation, and S6 had a strong preference for N(exo)/C(cyt) orientation. The pore region resided outside because of its lack of its transmembrane-spanning property. According to their own topogenic function, combined constructs of S5-P-S6 conferred the membrane-pore-membrane topology. This finding supports the notion that a set of S5-P-S6 can be independently integrated into the membrane. The results in this study provide the fundamental topogenesis mechanism of transmembrane segments involving voltage sensor and pore region in KAT1.

Animals↗

Entrance port for Na(+) and K(+) ions on Na(+),K(+)-ATPase in the cytoplasmic loop between trans-membrane segments M6 and M7 of the alpha subunit. Proximity Of the cytoplasmic segment of the beta subunit.

Based on the following observations we propose that the cytoplasmic loop between trans-membrane segments M6 and M7 (L6/7) of the alpha subunit of Na(+),K(+)-ATPase acts as an entrance port for Na(+) and K(+) ions. 1) In defined conditions chymotrypsin specifically cleaves L6/7 in the M5/M6 fragment of 19-kDa membranes, produced by extensive proteolysis of Na(+),K(+)-ATPase, and in parallel inactivates Rb(+) occlusion. 2) Dissociation of the M5/M6 fragment from 19-kDa membranes is prevented either by occluded cations or by competitive antagonists such as Ca(2+), Mg(2+), La(3+), p-xylylene bisguanidinium and m-xylylene bisguanidinium, or 1-bromo-2,4, 6-tris(methylisothiouronium)benzene and 1,3-dibromo-2,4,6-tris (methylisothiouronium)benzene (Br(2)-TITU(3+)). 3) Ca(2+) ions raise electrophoretic mobility of the M5/M6 fragment but not that of the other fragments of the alpha subunit. It appears that negatively charged residues in L6/7 recognize either Na(+) or K(+) ions or the competitive cation antagonists. Na(+) and K(+) ions are then occluded within trans-membrane segments and can be transported, whereas the cation antagonists are not occluded and block transport at the entrance port. The cytoplasmic segment of the beta subunit appears to be close to or contributes to the entrance port, as inferred from the following observations. 1) Specific chymotryptic cleavage of the 16-kDa fragment of the beta subunit to 15-kDa at 20 degrees C (Shainskaya, A., and Karlish, S. J. D. (1996) J. Biol. Chem. 271, 10309-10316) markedly reduces affinity for Br(2)-TITU(3+) and for Na(+) ions, detected by Na(+) occlusion assays or electrogenic Na(+) binding, whereas Rb(+) occlusion is unchanged. 2) Na(+) ions specifically protect the 16-kDa fragment against this chymotryptic cleavage.

Amino Acid Sequence↗

Comparison between abnormalities in segmental endocardial motion and abnormalities in segmental wall thickening after anterior myocardial infarction. A cine-magnetic resonance study.

In this study, two patterns of regional contract on of the left ventricle have been studied: endocardial motion and wall thickening, in order to check which of these was the most affected after myocardial infarction. The clinical relevance of this comparison was to assess which parameter of the regional contraction abnormality would best depict the severity of the infarction. Long axis cine-magnetic resonance slices were used to assess segmental systolic left ventricular endocardial motion and segmental systolic wall thickening in 39 normal subjects and in 30 patients at the chronic stage of an anterior myocardial infarction. In the group of normal subjects, endocardial motion and wall thickening showed significant regional heterogeneity. Overall endocardial motion was greater than overall wall thickening: 9.5 +/- 2.0 mm vs 7.1 +/- 1.8 mm. P = 4 x 10(-12) (3.1 +/- 1.2 mm vs 2.0 +/- 0.7 mm, P = 9 x 10(-5) after infarction). A significant linear correlation was found between these two parameters. In the infarction group, abnormality scores for endocardial motion and for wall thickening were calculated. These scores were defined as the average values exceeding the mean minus two standard deviations of the normal range for segments corresponding to the antero-septal-apical walls. The abnormality score for endocardial motion greater than the abnormality score for wall thickening: 0.31 +/- 0.12 vs 0.20 +/- 0.07, P = 9 x 10(-4). We conclude that, in clinical practice, endocardial motion is affected to a greater degree by myocardial infarction than is wall thickening and therefore constitutes a more discriminant index in the assessment of post-infarction patients.

Adult↗

Molecular characterization of the Prospect Hill virus M RNA segment: a comparison with the M RNA segments of other hantaviruses.

Complementary DNA representing the genomic M RNA segment of the Prospect Hill (PH) Hantavirus was cloned and its nucleotide sequence determined. The PH virus M RNA segment is 3707 nucleotides in length and has a long open reading frame in the viral complementary-sense RNA with a coding capacity of 1142 amino acids. The predicted gene product of the PH virus M segment was compared with the corresponding gene products of Hantaan virus strain 76-118 (Hantaan), Sapporo rat virus strain SR-11 (SR) and Puumala virus strain Hällnäs B1 (Hällnäs). The amino acid sequence identities between the G1 and G2 proteins of PH virus and Hällnäs virus are respectively 74% and 79%. In contrast, the amino acid sequence similarities between the G1 proteins of PH virus and SR virus or Hantaan virus are only 50%. However the G2 proteins of SR and Hantaan viruses were more closely related to the G2 protein of PH virus with amino acid sequence similarities of approximately 62%. The G1 proteins of all four viruses had three potential asparagine-linked glycosylation sites conserved and there was one conserved site in the G2 proteins. Hydrophilicity plots of the four virus glycoproteins were very similar. The region of greatest hydrophilicity was conserved in the Hällnäs, SR and Hantaan viruses, and was located near the C terminus of the G1 protein, whereas the region of greatest hydrophilicity in the PH virus glycoprotein precursor is located closer to the N terminus of the G1 protein. Our data demonstrate that despite differences in the serotypic profiles and virulence of PH and Hällnäs viruses, their G1 and G2 proteins are closely related. We conclude that PH and Hällnäs viruses may have evolved along a separate evolutionary pathway in the Hantavirus genus from that of SR and Hantaan viruses.

Amino Acid Sequence↗

Prediction of left main coronary artery obstruction by 12-lead electrocardiography: ST segment deviation in lead V6 greater than or equal to ST segment deviation in lead V1.

BACKGROUND: Acute coronary syndrome (ACS) resulting from culprit lesion in left main coronary artery (LMCA) can cause rapid hemodynamic deterioration. It is important to identify these patients early to facilitate timely revascularization. ST segment elevation in aVR greater than or equal to V(1) (aVR-V(1)>or= 0) has been suggested as a sensitive predictor of LMCA disease. As a result of balanced forces, we hypothesized that ST deviation in V(6) greater than or equal to ST deviation in V(1) (V(6)-V(1)>or= 0) might be a good determinant of LMCA disease. METHODS: We compared admission 12-lead ECGs of ACS resulting from culprit LMCA lesion (n = 75, group I) with ACS resulting from culprit left anterior descending lesion (n = 81, group II). Group I was selected over a period of 10 years. We compared V(6)-V(1)>or= 0 to aVR-V(1)>or= 0 in both groups. We also looked at ratios of ST deviations in V(6),V(1) (V(6)/V(1)>or= 1) and aVR,V(1) (aVR/V(1)>or= 1) in patients where ST segment in V(1) was not isoelectric (group I = 54 and group II = 55). RESULTS: ST deviation in V(6) was significantly greater in group I as compared to group II (P < 0.001). The reliabilities of V(6)-V(1)>or= 0, V(6)/V(1)>or= 1, aVR-V(1)>or= 0, and aVR/V(1)>or= 1 in predicting LMCA disease were determined. CONCLUSION: This is the largest series of ECG analysis on ACS resulting from culprit LMCA lesion. V(6)-V(1)>or= 0 and V(6)/V(1)>or= 1 were more sensitive in predicting LMCA as culprit vessel in comparison to previously reported greater ST segment elevation in aVR than V(1).

Aged↗

In vitro perfusion of chinchilla thin limb segments: segmentation and osmotic water permeability.

The thin limb segments of the long loop of Henle are thought to play important roles in the urinary concentrating mechanism. In this study, we present new approaches to the identification, dissection, and in vitro perfusion of individual thin limb segments from all levels of the chinchilla renal medulla, including the deepest portions of the papilla. We have applied these techniques to the investigation of the osmotic water permeability along the chinchilla long loop of Henle. The results demonstrate that the osmotic water permeability of the thin descending limb is not uniformly high along its length, as previously thought, but that the distal 20% of the long-loop descending limb has a very low water permeability (approximately 50 microns/s). The transition to the low water permeability region of the thin descending limb is accompanied by a relatively abrupt change in morphology (increased cellularity and decreased diameter) that is readily perceptible in the perfused segments and even in the dissection dish. In contrast, the upper part of the chinchilla long-loop thin descending limb had an extremely high osmotic water permeability (greater than 2,000 microns/s) as observed in other species. Thin ascending limbs from deep in the inner medulla had water permeabilities that were indistinguishable from zero, as previously found in thin ascending limbs from near the inner-outer medullary junction. The presence of a low-water-permeability portion of the long-loop thin descending limb in chinchilla may have important implications with regard to the inner medullary concentrating process. A relatively low osmotic water permeability (397 microns/s) was also found in the deep inner medullary portion of the thin descending limb from the rat.

Animals↗

Congenital thoracic cord segmental amyelia: a rare manifestation of segmental spinal dysgenesis.

Segmental spinal dysgenesis (SSD) is a rare congenital abnormality in which a segment of the spine and spinal cord fails to develop properly. We report a case of a 4-year-old female child who was born prematurely with a permanent neurological deficit in the lower limbs and sphincter incontinence. Radiological investigations revealed segmental agenesis of the thoracic spinal cord (D8-D11 vertebral levels) with an associated vertebral bony anomaly. The pathogenesis of this rare form of SSD syndrome is discussed and the relevant literature is briefly reviewed.

Child, Preschool↗

Effect of ST segment measurement point on performance of standard and heart rate-adjusted ST segment criteria for the identification of coronary artery disease.

BACKGROUND: Recent reports critical of the performance of heart rate-adjusted indexes of ST depression during exercise electrocardiography have used J-point rather than ST segment measurements. However, no standard exists for the optimal time after the J-point at which to measure ST segment deviation. METHODS AND RESULTS: To assess the effect of ST segment measurement position on performance of standard exercise electrocardiographic criteria, the delta ST segment/heart rate (delta ST/HR) index, and the ST segment/heart rate (ST/HR) slope for the detection of coronary artery disease, the exercise electrocardiograms of 50 clinically normal subjects and 80 patients with known or likely coronary disease were analyzed using ST depression measured at both the J-point and at 60 msec after the J-point (J + 60). A positive exercise electrocardiogram by standard criteria, defined as 0.1 mV or more of additional horizontal or downsloping ST depression at end exercise, had a specificity of 96% when ST depression was measured at either the J-point or J + 60. There was no difference in sensitivity of standard electrocardiographic criteria at J + 60 and J point (both 59%, p = NS). However, at matched specificity of 96%, the delta ST/HR index and ST/HR slope calculated using ST depression at J + 60 were significantly more sensitive (90% and 93%) than when calculated using J-point depression (64% and 61%, each p less than 0.001). Comparison of areas under respective receiver operating characteristic curves confirmed the superior performance of J + 60 as opposed to J-point measurements for both the delta ST/HR index (0.98 versus 0.89, p = 0.006) and the ST/HR slope (0.96 versus 0.87, p = 0.007) and also demonstrated modestly improved overall test performance for standard electrocardiographic criteria using J + 60 measurements (0.88 versus 0.82, p = 0.001). CONCLUSIONS: Use of J-point measurements significantly degrades performance of heart rate-adjusted indexes of ST depression but has less effect on standard criteria.

Angina Pectoris↗

Delineation of segmental liver anatomy. Comparison of ultrasonography, spiral CT and MR imaging for preoperative localization of focal liver lesions to specific hepatic segments.

PURPOSE: The purpose of this study was to determine the ability of noninvasive imaging methods to localize focal liver lesions to specific hepatic segments. MATERIAL AND METHODS: In a prospective study we evaluated 24 patients with hepatic masses with ultrasonography (US), spiral CT and MR imaging. RESULTS: The primary segmental location of the lesions was correct with US in 15 of 24 patients (63%), with CT in 21 of 24 patients (88%) and with MR imaging in 17 of 22 patients (77%). The full extent of the lesions was correctly described with US in 9 of 24 patients (38%), with CT in 16 of 24 patients (67%) and with MR in 12 of 22 patients (55%). CONCLUSION: Among the noninvasive imaging methods, CT provides the best information for determining the segmental location and planning the surgical approach to hepatic resections.

Contrast Media↗

Formation of corneal endothelium is essential for anterior segment development - a transgenic mouse model of anterior segment dysgenesis.

The anterior segment of the vertebrate eye is constructed by proper spatial development of cells derived from the surface ectoderm, which become corneal epithelium and lens, neuroectoderm (posterior iris and ciliary body) and cranial neural crest (corneal stroma, corneal endothelium and anterior iris). Although coordinated interactions between these different cell types are presumed to be essential for proper spatial positioning and differentiation, the requisite intercellular signals remain undefined. We have generated transgenic mice that express either transforming growth factor (alpha) (TGF(alpha)) or epidermal growth factor (EGF) in the ocular lens using the mouse (alpha)A-crystallin promoter. Expression of either growth factor alters the normal developmental fate of the innermost corneal mesenchymal cells so that these cells often fail to differentiate into corneal endothelial cells. Both sets of transgenic mice subsequently manifest multiple anterior segment defects, including attachment of the iris and lens to the cornea, a reduction in the thickness of the corneal epithelium, corneal opacity, and modest disorganization in the corneal stroma. Our data suggest that formation of a corneal endothelium during early ocular morphogenesis is required to prevent attachment of the lens and iris to the corneal stroma, therefore permitting the normal formation of the anterior segment.

Animals↗

Lamina IV-VI neurones of the second sacral segment projecting to the sixth cervical segment of the cat's spinal cord.

Cervical projections of neurones located in the second sacral segment of the spinal cord were electrophysiologically investigated in 12 adult cats under alpha-chloralose anaesthesia. Extracellular or intracellular antidromic potentials from 41 neurons following stimulation of their axons in the spinal grey matter in the C6 segment brought evidence of sacro-cervical connections. Cell bodies of the investigated neurones were found mainly in the medial part of laminae IV, V and VI. Axons of these neurones ran in lateral funiculi, mostly in their dorsal parts (dlf). Most of the axons (26) ascended bilaterally. Fibres of 15 cells ran unilaterally--on the ipsilateral (13) or the contralateral side (2). Conduction velocities of axons measured between S2 and C6 segments were in the range from 38.4 to 69.1 m/s. It is suggested that these neurones may play an important role in movement coordination between hindlimbs and forelimbs.

Animals↗

Identifying new patient prospects: efficacy of usage segmentation. For some health care services, usage-based segmentation schemes can be wasteful and ineffective.

Even though there is intuitive appeal in identifying the user profile for a given service and then targeting similar nonusers, this approach can be very misleading when marketing health care services with low market penetration. If usage segmentation is employed without checking other indicators of latent demand and perceived barriers to use, significant misallocation of marketing resources is likely to occur. Confidentiality and embarrassment can be significant barriers to use by segments that are excellent patient prospects. In this study of mental and behavioral care, females and non-whites were found to be more concerned with confidentiality than were members of the user group. Lack of awareness can be a much bigger impediment to adoption than negative attitudes. Health care marketers need to design communications that not only increase awareness and familiarity for services with low market penetration, but also address other issues of concern to highly receptive segments.

Adult↗

Multilead ST-segment monitoring in patients with acute coronary syndromes: a consensus statement for healthcare professionals. ST- Segment Monitoring Practice Guideline International Working Group.

BACKGROUND: ST-segment monitoring is underused by healthcare professionals for patients with acute coronary syndromes treated in emergency departments and intensive care units. OBJECTIVE: To provide clinically practical consensus guidelines for optimal ST-segment monitoring. METHODS: A working group of key nurses and physicians met in Dallas, Tex, in November 1998. RESULTS: Consensus was reached on who should and should not have ST monitoring, goals and time frames for ST monitoring in various diagnostic categories, what electrocardiographic leads should be monitored, what equipment requirements are needed, what strategies improve accuracy and clinical usefulness of ST monitoring, and what knowledge and skills are required for safe and effective ST monitoring. CONCLUSIONS: Because changes in the ST segment can shift among various electrocardiographic leads in the same person over time owing to different ischemic mechanisms, 12-lead ST monitoring is recommended. Recommended monitoring times are as follows: myocardial infarction or unstable angina, 24 to 48 hours or until patient is event-free for 12 to 24 hours; chest pain prompting a visit to an emergency department, 8 to 12 hours; catheter-based interventions with less definitive interventional outcomes requiring monitoring in an intensive unit, 6 to 12 hours; and cardiac surgery or noncardiac surgery in patients with coronary disease or risk factors, 24 to 48 hours. An ST measurement point of J + 60 ms makes it unlikely that measurement will coincide with the upslope of the T wave, even in patients with sinus tachycardia. Accurate and consistent lead placement and careful electrode and skin preparation are imperative to improve the clinical usefulness of ST monitoring.

Acute Disease↗

Segmental bronchial atresia of the left upper lobe treated with segmental resection under video-assisted thoracic surgery.

We report our experience of segmental bronchial atresia managed with segmental resection under video-assisted thoracic surgery. A 23-year-old woman reporting a cough, dyspnea, and back pain underwent segmental resection in which a stapling device was used under video-assisted thoracic surgery. Her postoperative course was uneventful with minimal pain and a disappearance of preoperative symptoms after surgery. Once an accurate preoperative diagnosis can be established, video-assisted thoracic segmentectomy together with the use of a stapling device is considered to be feasible.

Adult↗

[Construction of chromosome segment substitution lines carrying overlapping chromosome segments of the whole wild rice genome and identification of quantitative trait loci for rice quality].

Rice is one of the major staple cereal grains. Most of the important traits of crops are complex traits controlled by quantitative trait loci (QTL). Detection and genetic identification of QTLs can provide insights into molecular and biological mechanisms of development and physiology. Chromosome segment substitution lines (CSSLs) have been proposed as a simple and powerful way to identify QTLs. The demand for rice grain quality becomes increasingly important. The primary components of rice grain quality include appearance, milling and physico-chemical, cooking and eating quality. Most of these traits are complex and controlled by QTLs, so genetic characterization of these traits is more difficult than that of traits each controlled by a singular gene such as Waxy, which controls glutinousness of rice grain. We constructed 133 chromosome segment substitution lines (CSSLs) from backcross progenies (BC3F2) derived from a cross between Teqing (an O. sativa L. ssp. indica variety) as the recurrent parent and wild rice (O. rufipogon Griff.) as the donor parent. In this process, we carried out marker-assisted selection (MAS) by using 118 CAPS or SSR markers covering the whole rice genome (Figs.1, 2). Because phenotypic values of quality trait were significantly different between cultivar Teqing and wild rice, the CSSLs were used to identify QTLs for rice quality traits. Three appearance quality traits (head rice percentage, HRP; percentage of chalky rice grains, PCRG; transparency, TP) and five physico-chemical properties (gelatinization temperature, GT; gel consistency, GC; amylose content, AC; protein content, PC; fat content, FC) were scored using 133 CSSLs which substituted segments covering the whole genome of wild rice. A total of 15 QTLs for five of the eight traits mentioned above (HRP, PCRG, TP, PC and FC) were identified on nine chromosomes, and several QTLs affecting different quality traits were mapped in the same regions (Fig.3, Table 1).

Chromosomes, Plant↗

Exercise induced ST segment depression preceding ST segment elevation.

A case of exercise induced ST segment depression preceding ST segment elevation in precordial leads and persistent ST segment depression in inferior leads is reported. Such an exercise response should suggest significant fixed coronary stenosis in addition to coronary spasm.

Angina Pectoris, Variant↗