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[In-vivo tracing of bone marrow stromal cell differentiating into chondrocytes by green fluorescent protein gene transfection].

AIM: To achieve highly efficient, stable and long-term expression of green fluorescent protein(GFP) reporter gene in bone marrow stromal cells(BMSCs) and to trace directly the distribution and differentiation of BMSCs in articular cartilage defects. METHODS: Recombinant RV-GFP expression vector was constructed and transfected into packaging cell PT67. After G418 screening and amplification, cell clones producing high level recombinant viruses were obtained and in-vitro expanded. The virus supernatant from infected PT67 cell culture was used to infect BMSCs directly. Autologous GFP-labeled BMSCs were seeded onto biodegradable polymer and implanted into porcine articular cartilage defects. 7 months later, the repaired tissue was evaluated by confocal microscope. RESULTS: The constructed recombinant expression vector RV-GFP was identified by restriction digestion. The transfection rates of PT67 cells reached 20%-50%, which reached 100% after G418 screening, bright green fluorescence could be seen under fluorescence microscope. BMSCs could be transfected successfully by the culture supernatant from infected PT67 cells and GFP was expressed efficiently in a long-term period. Confocal microscope revealed that GFP-labeled cells existed in many neocartilage lacunae after 7 months. CONCLUSIONS: The recombinant vector RV-GFP can provide a simple, sensitive and reliable tool to label BMSCs which can be used to study cytologic dynamic follow-up in-vivo. BMSCs can differentiate into chondrocytes and play an important role in repairing articular cartilage defects.

Animals↗

Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects.

Closure of large meningomyelocele wounds and defects always requires durable and safe coverage of the dural repair. A new technical method for the reconstruction of large thoracolumbar meningomyelocele defects is described in which bilateral musculocutaneous flaps are advanced and transposed medially in a V-Y sliding manner, based on the thoracolumbar perforatiors of the latissimus dorsi. This procedure provides a reliable, well-vascularized soft tissue coverage over the neural repair with minimum donor-site morbidity. Additionally, this method is particularly appropriate to the thoracolumbar area, as it preserves the lateral adjacent regions of the defect, for later alternative and/or reconstructive options.

Female↗

Chest wall reconstruction following resection of large primary malignant tumors.

Reconstructive procedures following radical resection of large primary malignant chest wall tumors (PMCWT) continue to evolve. Between 1982 and 1993, 32 consecutive patients (18 males/14 females) with a median age of 47 years (range, 12-77) underwent radical resection for large (median 10 +/- 5.4 cm) PMCWTs arising either from the bone (n = 15) or soft tissues (n = 17) of the chest wall. Nine (28%) had previous surgical resection before referral. Sixteen (50%) required extensive skin excision. Twelve sternectomies (5 total and 7 partial) and 20 lateral chest wall resections were performed. In this latter group, 16 patients (80%) had at least three ribs resected. Resection extended to the lung (10 wedge resections, 2 lobectomies and 1 pneumonectomy) in 13 patients, diaphragm in 3, abdominal wall in 2, brachiocephalic and subclavian vessels in 5, superior vena cava in 1 and upper limb in 1. Stability of the chest wall was obtained with prosthetic material in 27 patients, including Marlex (n = 21), polytetrafluoroethylene (PTFE) (n = 4) and polyglactin (n = 2) meshes. After sternectomy, six patients had a methyl methacrylate mesh reinforcement while soft tissue reconstruction was carried out using the pectoralis major muscle (PM), either alone with skin advancement (n = 8) or as a myocutaneous flap in three males (unilateral n = 2, bilateral n = 1) and by a latissimus dorsi (LD) myocutaneous flap in one female. Muscle transposition was used to reconstruct defects of the lateral chest wall and included 10 LD, 6 PM and 2 serratus anterior (SA) muscles, with associated advancement of the diaphragm in two cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Free bone flaps in esthetic and functional rehabilitation after segmental mandibulectomy. Apropos of 38 cases].

Development of microvascular free tissue transfers gives the surgeon the opportunity to realise complex reconstructions after segmental mandibular resections for tumor. We reviewed 38 cases of oromandibular reconstruction using various free bone grafts (25 fibula, 7 scapular, 3 iliac and 3 forearm free flaps). The mandibular defect was anterior in 24 cases, lateral in 9 cases and subtotal in 5 cases. In the post-operative course there were two total flap losses. Long-term esthetic results were excellent or good for 82% of the patients, 81% were able to eat a solid or a soft diet. The causes of esthetic or functional failures were studied as well as the specific interest of each donor site. The use of free bone flaps improved cosmetic and functional rehabilitation in cases of anterior mandibular defects. The secondary reconstructions or reconstructions of lateral bony defects were more disappointing. The free fibula flap allows reconstruction of wide bony defects. Scapular flap or forearm flap are indicated for smaller bony defects and in patients with severe peripheral vascular disease.

Adolescent↗

Listeners' impressions of speakers with lateral lisps.

This paper reports research conducted to determine whether the lateral lisp is a speech defect. The specific purpose of this research was to determine whether the lateral lisp calls adverse attention to the speaker. Two groups of broadcast communication students rates the concept "The Person Speaking" on a 49-scale semantic differential. One group performed the task after listening to a tape recording of a young woman reading contextual material with a simulated lateral lisp. The other group performed the task after listening to a recording of the same woman reading the material in a normal manner. Analyses of the scale values computed for the two conditions indicated that the lateral lisp called adverse attention to the speaker. A systematic replication was undertaken to assess the generality of this finding. The procedures of the original investigation were followed except that business administration students served as judges. The results replicated those of the original investigation. These data indicate that the lateral lisp is probably a speech defect and suggest that the practice of eliminating school speech services for children whose only speech difference is a lateral lisp should be reconsidered.

Adult↗

Prospective identification of myocardial stunning using technetium-99m sestamibi-based measurements of infarct size.

OBJECTIVES: We sought to prospectively identify patients with stunning and hyperkinesia at hospital discharge on the basis of mismatches between left ventricular (LV) function and infarct size as assessed by technetium-99m (Tc-99m) sestamibi perfusion tomographic imaging. BACKGROUND: Mechanical indexes of LV function may not accurately reflect myocardial damage after acute myocardial infarction (MI) because of myocardial stunning and compensatory hyperkinesia in noninfarct-related territories. Myocardial perfusion techniques are unaffected by these variables. METHODS: Eighty-four patients with acute MI underwent hospital admission and discharge Tc-99m-sestamibi tomographic imaging. Global LV ejection fraction (LVEF) was measured at hospital discharge and 6 weeks later. The perfusion defect size was quantified and expressed as a percentage of the LV. The discharge perfusion defect, which is a measure of infarct size, was used to predict the 6-week LVEF for each patient based on a previously reported regression equation. Patients were classified into one of three groups depending on whether their LVEF at hospital discharge fell within, above or below one standard error (6.8 LVEF points) of the predicted 6-week LVEF. RESULTS: There were 48 patients classified as having a "match" between function and infarct size; these patients demonstrated no significant change in LVEF at 6 weeks. There were 21 patients (25%) classified as "mismatch stunned" who had discharge LVEFs lower than those predicted by infarct size. These patients demonstrated a significant improvement in mean LVEF at 6 weeks (mean [+/-SD] discharge LVEF 0.41 +/- 0.08, 6-week LVEF 0.47 +/- 0.10; p = 0.003). Fifteen patients (18%) were classified as "mismatch-hyperkinetic." The mean LVEF for these patients significantly declined at 6 weeks (discharge LVEF 0.64 +/- 0.06, 6-week LVEF 0.58 +/- 0.09; p = 0.002). There was a marked increase in LVEF within the infarct zone (8 +/- 15 LVEF points; p = 0.03) for patients predicted to have stunning and a marked decline in LVEF outside the infarct zone (9 +/- 15 LVEF points; p = 0.06) in patients predicted to have hyperkinesia. Both discharge LVEF (p < 0.0001) and group classification (p = 0.005) were independent predictors of LVEF 6 weeks later. CONCLUSIONS: Perfusion imaging with Tc-99m-sestamibi can identify post-MI patients at hospital discharge in whom LV function is discordant with the measured infarct size. Patients with stunning have late increases in LVEF; patients with hyperkinesia have late decreases. This methodology, performed at discharge, is predictive of late changes in LV function.

Aged↗

Laparoscopic paravaginal repair plus burch colposuspension: review and descriptive technique.

The objective of this article was to review the available literature on laparoscopic Burch urethropexy cure rates and describe the authors' laparoscopic technique and experience with Burch urethropexy and paravaginal repair. A MEDLINE search (1991 to 1999) was performed for articles describing the laparoscopic Burch urethropexy using suture to elevate and stabilize the paraurethral tissue. Also a retrospective chart review of the authors' 171 consecutive patients between January 1997 and December 1999 was done. The laparoscopic Burch urethropexy and paravaginal repair is described using an open laparoscopic technique with 3 accessory ports for access. A transperitoneal approach is taken to gain access to the space of Retzius. The anterior vaginal wall and its paravaginal defects, if present, are identified. Nonabsorbable sutures are placed in a conventional fashion. The paravaginal repair is used for support of the anterior vaginal wall proximal to the urethral vesical junction and the Burch urethropexy distal to the vesical neck. An average of 6 sutures are used for the paravaginal repair and 4 sutures for the Burch urethropexy. Cystoscopy is performed to ensure no breech of lower urinary tract integrity. In all, 20 articles describing a laparoscopic Burch urethropexy and postoperative cure rate were identified. Cure rates ranged from 69% to 100%. A review of our experience revealed 130 of 171 patients had a Burch urethropexy and paravaginal repair, 23 of 171 patients a Burch urethropexy alone, and 18 of 171 patients a paravaginal repair alone. Of the authors' 171 patients, 4 (2.3%) had injury to the lower urinary tract during laparoscopic Burch urethropexy or paravaginal repair. All 4 injuries were cystotomies, 2 in patients with previous open retropubic urethropexies. No ureteral ligations or intravesical placement of suture was diagnosed. Other surgical parameters for the laparoscopic Burch uethropexy and paravaginal repair include an estimated blood loss of 50 mL, average hospital stay of less than 23 hours, and an average operative time of 70 minutes. All patients had their surgery completed via laparoscopy. The literature review and our personal experience suggests that the laparoscopic Burch urethropexy and paravaginal repair are safe and effective alternatives to traditional laparotomy for the treatment of genuine anatomic stress urine incontinence and cystourethrocele resulting from lateral vaginal wall defects.

Female↗

Reversibility of plexogenic pulmonary arteriopathy following banding of the pulmonary artery.

In 28 patients with congenital heart disease with a shunt and pulmonary hypertension, lung biopsy specimens were taken during a banding procedure of the pulmonary artery; then, in the same patients, lung tissue became available during correction of the cardiac defect some years later. In this way the regression of pulmonary vascular changes could be studied. Medial hypertrophy appeared to have a prominent tendency to regression. With intimal lesions, regression depended to a large extent on the type of lesion. Intimal thickening based on longitudinal smooth muscle tissue was almost completely reversible. Post-thrombotic intimal fibrosis was also potentially reversible. In plexogenic pulmonary arteriopathy, the earlier lesions, particularly cellular intimal proliferation, showed regression. Concentric-laminar intimal fibrosis regressed as long as it was mild, that is, occluding less than one fifth of the average arterial lumen. If more severe, there was no tendency to regression and often it even progressed. Changes like fibrinoid necrosis and plexiform lesions are ominous because of their tendency to progression. Since preoperative open lung biopsies now are often undertaken for evaluation of hypertensive pulmonary vascular disease, when corrective operability is dubious, these findings may serve as a guide in reporting on such biopsy specimens.

Adolescent↗

Medial plantar flap based distally on the lateral plantar artery to cover a forefoot skin defect.

The authors report a simple, single-step procedure to promote the distal transfer of the instep island flap for coverage of the submetatarsal weight-bearing zone. First described in 1991 by Martin et aI, this procedure remained unknown. As opposed to the medial plantar flap, this technique proposes an instep island flap based on the lateral plantar artery. The inflow and outflow of blood is assured by the anastomosis between the dorsalis pedis and lateral plantar vessels. This approach allows for the transfer of similar tissue and provides adequate coverage of the weight-bearing zone of the distal forefoot.

Adult↗

Transient pulmonary perfusion scintigraphic abnormalities in pulmonary air embolism.

A critically ill man suffered a respiratory arrest due to pulmonary air embolism after the exchange of central venous catheters over a guidewire. A pulmonary perfusion lung scan performed 90 min later demonstrated extensive perfusion defects which were interpreted as "high probability" for PTE. Pulmonary angiography 4.5 h later was normal. A second perfusion lung scan performed 24 h after the respiratory arrest was normal. Pulmonary air embolism can produce segmental (and larger) perfusion defects which may be indistinguishable from those caused by PTE. The rapid (24 h) resolution of the perfusion defects may help differentiate the two disorders.

Catheterization, Central Venous↗

Diagnosis and management of inadvertently placed pacing and ICD leads in the left ventricle: a multicenter experience and review of the literature.

Three patients from different centers with pacemaker or ICD leads endocardially implanted in the left ventricle are described. All leads, two ventricular pacing leads and one ICD lead, were inserted through a patent foramen ovale or an atrial septum defect. The diagnosis was made 9 months, 14 months, and 16 years, respectively, after implantation. All patients had right bundle branch block configuration during ventricular pacing. Chest X ray was suggestive of a left-sided positioned lead except in the ICD patient. Diagnosis was confirmed with echocardiography in all patients. One patient with a ventricular pacing lead presented with a transient ischemic attack at 1-month postimplantation. During surgical repair of the atrial septum defect 14 months later, the lead was extracted and thrombus was attached to the lead despite therapy with aspirin. The other patients were asymptomatic without anticoagulation (9 months and 16 years after implant). No thrombus was present on the ICD lead at the time of the cardiac transplantation in one patient. We reviewed 27 patients with permanent leads described in the literature. Ten patients experienced thromboembolic complications, including three of ten patients on antiplatelet therapy. The lead was removed in six patients, anticoagulation with warfarin was effective for secondary prevention in the four remaining patients. In the asymptomatic patients, the lead was removed in five patients. In the remaining patients, 1 patient was on warfarin, 2 were on antiplatelet therapy, and in 3 patients the medication was unknown. After malposition was diagnosed, three additional patients were treated with warfarin. In conclusion, if timely removal of a malpositioned lead in the left ventricle is not preformed, lifelong anticoagulation with warfarin can be recommended as the first choice therapy and lead extraction reserved in case of failure or during concomitant surgery.

Adolescent↗

The pathogenesis of Tourette's syndrome. A possible role for hormonal and excitatory neurotransmitter influences in brain development.

Tourette's syndrome (TS) is associated with prominent gender differences in clinical expression, tics with a sexual content, and a stabilization or improvement of symptoms after puberty. It is herein hypothesized that some tics can be viewed as inappropriately expressed (normally inhibited) fragments of primitive motor and vocal programs involved in reproductive activity. The brain regions involved in TS (basal ganglia and limbic system) are proposed to be counterparts in humans of those functioning in primitive reproductive behavior whose development and organization are under sex hormone control. It is further hypothesized that sex hormone action is mediated by excitatory neurotransmitter mechanisms such that an excessive trophic effect occurs early in development and a neurotoxic environment emerges later on. The defective gene in TS is hypothesized to influence these developmental processes. This hypothesis has implications for the investigation of the pathogenesis of TS and for experimental therapeutics of the disorder.

Amino Acids↗

Blepharospasm surgery. An anatomical approach.

Essential blepharospasm is an idiopathic, progressively debilitating disease leading to blindness. Years of forceful spasms result in brow ptosis, dermatochalasis, and, frequently, levator aponeurosis and lateral canthal tendon defects. Following standard neurectomy procedures, the facies droop, brow ptosis and dermatochalasis worsen, and ptosis and canthal tendon laxity suddenly become more evident. We describe a procedure involving meticulous extirpation of all accessible orbicularis oculi, procerus, corrugator superciliaris, and facial nerves in postorbicular fascia. This extirpation of eyelid protractors is combined with browplasty with fixation to frontalis and reinforcement of the levator aponeurosis to strengthen the retractors. Our technique opens the eye just as effectively as standard facial neurectomy procedures, simultaneously corrects associated anatomical deformities, and avoids facial paralysis. Gratifying results were obtained in 15 patients followed up for six to 38 months.

Aged↗

Adenoviral-mediated expression of antisense RNA to fibroblast growth factors disrupts murine vascular development.

Fibroblast growth factors (FGFs) are expressed in the developing embryo and are postulated to regulate embryonic and vascular growth. The goal of this study was to elucidate the role of basic fibroblast growth factor (FGF-2) in early murine embryonic cardiovascular development in the mouse embryo. Gestation day 7.5 embryos were harvested and placed in culture, and 12 hr later replication-defective adenovirus (0.5 x 10(6) plaque forming units) encoding either beta-galactosidase or antisense FGF-2 RNA was injected into the sinus venosus of the cultured embryos. Embryos receiving only replication-defective adenovirus expressing the beta-galactosidase gene continued to develop normally over the next 12 hr. In contrast, those receiving adenovirus encoding antisense FGF-2 RNA displayed marked morphogenetic abnormalities, including cessation of growth and abnormal yolk sac vascular development, even though the embryonic hearts continued to beat. Abnormal development of the yolk sac vasculature was confirmed by microangiography and by histologic examination. Coinjection of virus carrying FGF-2 cDNA in the sense orientation reversed the effects of antisense FGF-2 RNA expression. These results confirm the efficacy of the replication-defective adenovirus for targeting gene expression to the developing vasculature and provide evidence for a critical role of FGF in the normal vascular assembly in the early embryo. Cessation of embryonic growth on expression of antisense FGF-2 RNA was most likely attributable to failure of efficient circulation of the early embryonic blood cells from the yolk sac into the embryo.

Adenoviridae↗

The superposition of a temporally incoherent magnetic field inhibits 60 Hz-induced changes in the ODC activity of developing chick embryos.

Previously, we have shown that the application of a weak (4 microT) 60 Hz magnetic field (MF) can alter the magnitudes of the ornithine decarboxylase (ODC) activity peaks which occur during gastrulation and neurulation of chick embryos. We report here the ODC activity of chick embryos which were exposed to the superposition of a weak noise MF over a 60 Hz MF of equal (rms strength). In contrast to the results we obtain with a 60 Hz field alone, the activity of ODC in embryos exposed to the superposition of the incoherent and 60 Hz fields was indistinguishable from the control activity during both gastrulation and neurulation. This result adds to the body of experimental evidence which demonstrates that the superposition of an incoherent field inhibits the response of biological systems to a coherent MF. The observation that a noise field inhibits ODC activity changes is consistent with our speculation that MF-induced ODC activity changes during early development may be related to MF-induced neural tube defects at slightly later stages (which are also inhibited by the superposition of a noise field).

Animals↗

Cortical development and neuropathology in schizophrenia.

Epidemiological studies suggest that perturbations occurring during pregnancy can increase the incidence of schizophrenia among offspring. Examination of the neuropathology of the brains of some schizophrenics suggests that a defect in the later phases of cerebral cortical development, notably the last phases of neuronal migration and the establishment and refinement of patterns of cortical connections, may be involved. Most of these studies are conjectural, and the relationship between primary lesions and potential secondary retrograde and anterograde effects in the circuitry linking the prefrontal cortex, basal forebrain, mediodorsal thalamus and medial temporal cortex is unknown. Our hypothesis, based on neuromorphological and gene expression studies, is that a disturbance of migration or in the pattern of preprogrammed cell death in the subplate zone of the developing cerebral cortex causes a failure to establish normal patterns of connections in the overlying cortex. This compromised circuitry subsequently decompensates, leading to schizophrenic symptoms and activity-dependent manifestations of altered gene expression for neurotransmitter- and receptor-related molecules.

Cerebral Cortex↗

A Tourette-like syndrome following cardiopulmonary bypass and hypothermia: MRI volumetric measurements.

We present the case of an adolescent boy who developed a variety of simple and complex motor and vocal tics (Tourette-like syndrome), along with inattentiveness and obsessive-compulsive behaviors after cardiac surgery with cardiopulmonary bypass and profound hypothermia. A single photon emission computed tomography study 2 months after surgery showed reduced uptake in the left hemisphere and 2 years later a perfusion defect in the basal ganglia. Serial magnetic resonance imaging (MRI) studies were normal. Volumetric MRI studies were obtained 4 years after surgery and compared with published values for normal individuals and children with Tourette syndrome (TS), including subsets matched for age, sex, and handedness. Measurement of basal ganglia structures showed a right-dominant asymmetry of the caudate and putamen, in part similar to findings previously reported in patients with TS. Other volumetric abnormalities included a > 2-SD reduction of cortical gray matter, a small decrease of total cerebral volume, and increase in cerebral white matter. Although a variety of neurological problems may occur after cardiopulmonary bypass, to our knowledge this case represents the first report of a chronic tic disorder following cardiac surgery with cardiopulmonary bypass and hypothermia.

Attention Deficit Disorder with Hyperactivity↗

The betaL integrin subunit is necessary for gastrulation in sea urchin embryos.

Integrins are a family of cell adhesion molecules reported to mediate cellular interactions essential for normal embryonic morphogenesis. Here we describe a beta integrin subunit that is expressed during early embryogenesis in the sea urchin embryo and appears to be necessary for normal development. The deduced amino acid sequence of betaL is similar to vertebrate beta integrin subunits, but is most closely related to the sea urchin betaG subunit. Northern blots show that betaL is expressed at all stages with maximum expression beginning during gastrulation. Immunolocalization and in situ RNA hybridization show that in blastulae betaL is expressed in the blastoderm and by the ring of bottle cells in the vegetal plate during the initial phase of gastrulation. Presumptive secondary mesenchyme cells express high levels of betaL throughout elongation of the archenteron and in the pluteus betaL is expressed by blastocoelar cells, skeletal mesenchyme, and pigment cells. Antibodies and Fab fragments against betaL block spreading of dissociated embryonic cells on RGD (arginine-glycine-aspartate)-containing substrates. Treating embryos with anti-betaL antibodies blocks the initial phase of gastrulation and interferes with the organization of actin filaments. Prior to gastrulation, the antibodies cause thickening of the blastoderm and later in development defects in skeletal patterning result. Probing for antibody in treated embryos indicates that it penetrates the ectoderm to cells within the blastocoel and is actively endocytosed. We propose that betaL forms receptors that bind to RGD-containing ligands and anchors actin filaments. These receptors appear to be essential in several aspects of morphogenesis.

Amino Acid Sequence↗