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Molecular diagnosis. Classification, model selection and performance evaluation.

OBJECTIVES: We discuss supervised classification techniques applied to medical diagnosis based on gene expression profiles. Our focus lies on strategies of adaptive model selection to avoid overfitting in high-dimensional spaces. METHODS: We introduce likelihood-based methods, classification trees, support vector machines and regularized binary regression. For regularization by dimension reduction, we describe feature selection methods: feature filtering, feature shrinkage and wrapper approaches. In small sample-size situations efficient methods of data re-use are needed to assess the predictive power of a model. We discuss two issues in using cross-validation: the difference between in-loop and out-of-loop feature selection, and estimating model parameters in nested-loop cross-validation. RESULTS: Gene selection does not reduce the dimensionality of the model. Tuning parameters enable adaptive model selection. The feature selection bias is a common pitfall in performance evaluation. Model selection and performance evaluation can be combined by nested-loop cross-validation. CONCLUSIONS: Classification of microarrays is prone to overfitting. A rigorous and unbiased assessment of the predictive power of the model is a must.

Gene Expression Profiling↗

Morphometrical and microdensitometrical studies on phenylethanolamine-N-methyltransferase- and neuropeptide Y-immunoreactive nerve terminals and on glucocorticoid receptor-immunoreactive nerve cell nuclei in the paraventricular hypothalamic nucleus in adult and old male rats.

The phenylethanolamine-N-methyltransferase- and neuropeptide Y-immunoreactive nerve terminal profiles and the glucocorticoid receptor-immunoreactive nuclear profiles have been characterized in the parvocellular part of the paraventricular hypothalamic nucleus of the adult (3 month) and the old (24 month) male rat. The phenylethanolamine-N-methyltransferase-, neuropeptide Y- and glucocorticoid receptor-immunoreactive structures have been demonstrated by means of the indirect immunoperoxidase procedure and analysed in a quantitative way by means of morphometrical and microdensitometrical approaches using both semiautomatic and automatic image analysis. During aging there is (a) a marked reduction in the number of neuropeptide Y-immunoreactive profiles, a moderate reduction of phenylethanolamine-N-methyltransferase-immunoreactive profiles and a small reduction in the number of glucocorticoid receptor-immunoreactive profiles without a significant change in the evenness of distribution of such profiles as evaluated by means of Gini's index; (b) a loss of the significant correlation in the distribution of the glucocorticoid receptor- and phenylethanolamine-N-methyltransferase-immunoreactive profiles at the two most caudal levels analysed (A5150 and A5270 micron) while a significant correlation developed between these two distributions at a more rostral level (A5400 micron); (c) a substantial decline in the overlap area of the glucocorticoid receptor- and phenylethanolamine-N-methyltransferase-immunoreactive profiles at four out of five rostrocaudal levels analysed; (d) a marked reduction in the density-intensity of the neuropeptide Y-immunoreactive profiles and a small significant reduction in the density-intensity of the phenylethanolamine-N-methyltransferase-immunoreactive profiles without any associated changes in the intensity of the glucocorticoid receptor-immunoreactive profiles. Furthermore, three-dimensional reconstructions of the overall distribution of the glucocorticoid receptor-, phenylethanolamine-N-methyltransferase- and neuropeptide Y-immunoreactive structures have been made in the paraventricular hypothalamic nucleus of the adult male rat. The present results indicate a reduction of neuropeptide Y- and phenylethanolamine-N-methyltransferase-immunoreactive nerve terminal profiles in the parvocellular part of the paraventricular hypothalamic nucleus during aging. These results may in part reflect a loss of neuropeptide Y-like peptides in phenylethanolamine-N-methyltransferase-immunoreactive nerve terminals of the paraventricular hypothalamic nucleus, favouring our view that during aging the modulatory peptides may be lost, leading to a loss of

Aging↗

Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression.

Few studies have been specifically carried out to characterize the dimensional structure of the Hospital Anxiety and Depression Scale (HADS) and those that have, have yielded contradictory results. We have examined the factor structure and sensitivity to change of the HADS in a large French outpatient primary care population treated with sertraline for major depression (DSM-IV criteria). Factor analysis of the HADS was performed in 2669 outpatients and in subsamples using a principal component procedure with Varimax rotation. Concurrent change sensitivity of the HADS was compared with that for the Hamilton Depression Rating Scale (HDRS) after at least 45 days of sertraline treatment. Three distinct factors emerged from the HADS factor analysis: a "depression" factor and two separate anxiety subscales: "psychic anxiety" and "psychomotor agitation" whose mean reductions in scores from baseline were significantly correlated (0.36-0.45) with the reduction of the HDRS baseline score. These new data provide support for the use of the HADS's three-dimensional structure to measure improvement of selected symptoms of anxiety during antidepressant therapy.

Adult↗

Computer-assisted LISS plate osteosynthesis of proximal tibia fractures: feasibility study and first clinical results.

Fluoroscopy is the most common tool for the intraoperative control of long-bone fracture reduction. Limitations of this technology include high radiation exposure for the patient and the surgical team, limited visual field, distorted images, and cumbersome verification of image updating. Fluoroscopy-based navigation systems partially address these limitations by allowing fluoroscopic images to be used for real-time surgical localization and instrument tracking. Existing fluoroscopy-based navigation systems are still limited as far as the virtual representation of true surgical reality is concerned. This article, for the first time, presents a reality-enhanced virtual fluoroscopy with radiation-free updates of in situ surgical fluoroscopic images to control metaphyseal fracture reduction. A virtual fluoroscopy is created using the projection properties of the fluoroscope; it allows the display of detailed three-dimensional (3D) geometric models of surgical tools and implants superimposed on the X-ray images. Starting from multiple registered fluoroscopy images, a virtual 3D cylinder model for each principal bone fragment is constructed. This spatial cylinder model not only supplies a 3D image of the fracture, but also allows effective fragment projection recovery from the fluoroscopic images and enables radiation-free updates of in situ surgical fluoroscopic images by non-linear interpolation and warping algorithms. Initial clinical experience was gained during four tibia fracture fixations that were treated by LISS (Less Invasive Stabilization System) osteosynthesis. In the cases operated on, after primary image acquisition, the image intensifier was replaced by the virtual reality system. In all cases, the procedure including fracture reduction and LISS osteosynthesis was performed entirely in virtual reality. A significant disadvantage was the unfamiliar operation of this prototype software and the need for an additional operator for the navigation system.

Adult↗

Centrally fat-saturated three-dimensional magnetic resonance angiography of the abdomen using selective central fat-saturation of k-space.

PURPOSE: To assess the usefulness of centrally fat-saturated three-dimensional magnetic resonance (MR) angiography of the abdomen using an elliptical centric view order and selective placement of fat-saturation pulses in the central 30% portion of the k-space in terms of fat signal reduction, image contrast of post-contrast images, and breath-holding time. METHODS: Fat signal in abdomen and breath-holding time were compared between centrally fat-saturated three-dimensional sequence and partially fat-saturated three-dimensional sequence or conventional fat-saturated three-dimensional sequence. Abdominal contrast-enhanced centrally fat-saturated three-dimensional MR angiography was obtained at arterial and equilibrium phases, and image quality was quantitatively and visually evaluated. RESULTS: Centrally fat-saturated three-dimensional sequence suppressed fat signal, as did the conventional fat-saturated three-dimensional sequence, and the breath-hold was prolonged only by 1.5 seconds compared to the partially fat-saturated three-dimensional sequence. Contrast-enhanced centrally fat-saturated three-dimensional MR angiography provided abdominal MR arteriography with large signal difference between vessels and fat, while venous signal was insufficient at equilibrium phase. CONCLUSION: Abdominal contrast-enhanced centrally fat-saturated three-dimensional MR angiography using an elliptical centric view order and selective central fat-saturation of k-space reduced fat signal comparable to conventional fat-saturated three-dimensional sequence, and provided contrast-enhanced MR arteriography with high vascular contrast and minimum prolongation of breath-hold.

Abdomen↗

Influence of surface morphology on D2 desorption kinetics from amorphous solid water.

The influence of surface morphology/porosity on the desorption kinetics of weakly bound species was investigated by depositing D2 on amorphous solid water (ASW) films grown by low temperature vapor deposition under various conditions and with differing thermal histories. A broad distribution of binding energies of the D2 monolayer on nonporous and porous ASW was measured experimentally and correlated by theoretical calculations to differences in the degree of coordination of the adsorbed H2 (D2) to H2O molecules in the ASW depending on the nature of the adsorption site, i.e., surface valleys vs surface peaks in a nanoscale rough film surface. For porous films, the effect of porosity on the desorption kinetics was observed to be a reduction in the desorption rate with film thickness and a change in peak shape. This can be partly explained by fast diffusion into the ASW pore structure via a simple one-dimensional diffusion model and by a change in binding energy statistics with increasing total effective surface area. Furthermore, the D2 desorption kinetics on thermally annealed ASW films were investigated. The main effect was seen to be a reduction in porosity and in the number of highly coordinated binding sites with anneal temperature due to ASW restructuring and pore collapse. These results contribute to the understanding of desorption from porous materials and to the development of correct models for desorption from and catalytic processes on dust grain surfaces in the interstellar medium.

Journal Article↗

Drastic reduction of calsequestrin-like proteins and impaired calcium binding in dystrophic mdx muscle.

Although the reduction in dystrophin-associated glycoproteins is the primary pathophysiological consequence of the deficiency in dystrophin, little is known about the secondary abnormalities leading to x-linked muscular dystrophy. As abnormal Ca(2+) handling may be involved in myonecrosis, we investigated the fate of key Ca(2+) regulatory membrane proteins in dystrophic mdx skeletal muscle membranes. Whereas the expression of the ryanodine receptor, the dihydropyridine receptor, the Ca(2+)-ATPase, and calsequestrin was not affected, a drastic decline in calsequestrin-like proteins of 150-220 kDa was observed in dystrophic microsomes using one-dimensional immunoblotting, two-dimensional immunoblotting with isoelectric focusing, diagonal two-dimensional blotting technique, and immunoprecipitation. In analogy, overall Ca(2+) binding was reduced in the sarcoplasmic reticulum of dystrophic muscle. The reduction in Ca(2+) binding proteins might be directly involved in triggering impaired Ca(2+) sequestration within the lumen of the sarcoplasmic reticulum. Thus disturbed sarcolemmal Ca(2+) fluxes seem to influence overall Ca(2+) homeostasis, resulting in distinct changes in the expression profile of a subset of Ca(2+) handling proteins, which might be an important factor in the progressive functional decline of dystrophic muscle fibers.

Animals↗

Length-independent separation of DNA restriction fragments in two-dimensional gel electrophoresis.

When double helical DNA is exposed to conditions favoring partial melting in polyacrylamide gels, its electrophoretic mobility undergoes a sharp cooperative transition, resulting in a large reduction in mobility. In the present experiments, where the transition is effected at a uniform temperature of 60 degrees C in a concentration gradient of a urea-formamide mixture, each Eco RI fragment of lambda or E. coli DNA exhibits the mobility transition at a characteristic concentration of the denaturant. The sudden retardation of fragments moving toward higher denaturant concentration in the gradient results in a pattern of sharpened zones in order depending upon nucleotide sequence, rather than size, and only very slightly dependent upon the time after the last fragment has been retarded. When combined with length-dependent electrophoresis in agarose in the perpendicular direction, this system provides a two-dimensional separation of fragments. The resolving power of the system is demonstrated by the clear resolution of over 250 fragments of the Eco RI digest of E. coli DNA. Corresponding fragments from an isogenic lambda lysogen of E. coli are found in the same positions, and additional fragments unique to the lysogen are evident.

Coliphages↗

Detection of genomic alterations in human endometrial cancer by two-dimensional gel electrophoresis.

OBJECTIVE: The purpose of this study was to detect genomic alterations in human endometrial cancer by two-dimensional gel electrophoresis. STUDY DESIGN: With use of a newly developed two-dimensional gel electrophoresis assay, we scanned 19 high-risk DNA fragments for alterations in human endometrial hyperplasias and adenocarcinomas. This method includes cleaving of high-molecular-weight DNA, radioactive labeling, and separating DNA fragments by two-dimensional gel electrophoresis. By comparing the two-dimensional gel electrophoresis profile (spots) of neoplastic with normal endometrium, genetic alterations such as amplification, allelic loss, and hypermethylation or hypomethylation can be detected. RESULTS: Seven of 8 human endometrial adenocarcinoma (88%) and 1 of 2 hyperplasias (50%) revealed changes in spot density. The number of spots changed per specimen was 4. The median percentage of specimens with changes in an individual spot was 30%. Eleven spots had a reduction or loss of spot density, and 8 spots had an increase in spot density. CONCLUSION: By use of a novel two-dimensional gel electrophoresis assay, we identified genetic alterations in 50% of hyperplasias and 88% of endometrial adenocarcinomas.

Adenocarcinoma↗

Laboratory studies of electrochemical treatment of industrial azo dye effluent.

Removal of color and reduction of chemical oxygen demand (COD) in an industrial azo dye effluent containing chiefly reactive dyes were investigated under single-pass conditions at a dimensionally stable anode (DSA) in a thin electrochemical flow reactor at different current densities, flow rates, and dilutions. With 50% diluted effluent, decolorization was achieved up to 85-99% at 10-40 mA/ cm2 at 5 mL/min flow rate and 50-88% at 30-40 mA/ cm2 at high (10-15 mL/min) flow rates. The COD reduction was maximum (81%) at 39.9 mA/cm2 or above when solution-electrode contact time (Ct) was as high as 21.7 s/cm2 and decreased as Ct declined at a given current density. Cyclic voltammetric studies suggesting an indirect oxidation of dye molecules over the anode surface were carried out at a glassy carbon electrode. The effect of pH on decolorization and COD reduction was determined. An electrochemical mechanism mediated by OCl- operating in the decolorization and COD reduction processes was suggested. The effluent was further treated with NaOCI. The oxidized products from the treated effluents were isolated and confirmed to be free from chlorine-substituted products by IR spectroscopy. From the apparent pseudo-first-order rate data, the second-order rate coefficients were evaluated to be 2.9 M(-1) s(-1) at 5 mL/ min, 76.2 M(-1) s(-1) at 10 mL/min, and 156.1 M(-1) s(-1) at 15 mL/ min for color removal, and 1.19 M(-1) s(-1) at 5 mL/min, 1.79 M(-1) s(-1) at 10 mL/min, and 3.57 M(-1) s(-1) at 15 mL/min for COD reduction. Field studies were also carried out with a pilot-scale cell at the source of effluent generation of different plants corresponding to the industry. Decolorization was achieved to about 94-99% with azo dye effluents at 0.7-1.0 L/min flow costing around Indian Rupees 0.02-0.04 per liter, and to about 54-75% in other related effluents at 0.3-1.0 L/min flow under single-pass conditions.

Azo Compounds↗

Relation between diurnal variation of blood pressure and left ventricular mass in a Chinese population.

In western populations, patients with hypertension who have a nocturnal decrease in blood pressure (BP) may have less left ventricular (LV) hypertrophy and cardiovascular morbidity than those without a diurnal variation in BP. To further examine this association between nocturnal BP reduction and LV mass index, we studied 720 normotensives (< 140/90 mm Hg), 380 borderline hypertensives (140 to 159/90 to 94 mm Hg), and 582 hypertensives (> or = 160/95 mm Hg) from Taiwan and Quemoy island by using 24-hour ambulatory BP monitoring and 2-dimensional echocardiography to obtain LV mass index during a community-based cardiovascular survey. After controlling for age, sex, height, weight, daytime BP, and daytime heart rate, the nocturnal reduction of systolic BP was found to associate weakly with LV mass index, for the whole population (partial correlation coefficient = -0.06, p < 0.05), as well as for the patients with hypertension (partial correlation coefficient = -0.09, p < 0.05), but these associations were eliminated when 24-hour BP and heart rate were accounted for. The average and percent nocturnal decrease of systolic BP (mean +/- SD; mm Hg, [%]) of 3.2 +/- 5.9 (2.7 +/- 4.8%); 3.3 +/- 7.3 (2.4 +/- 5.4%); and 4.6 +/- 9.0 (3.0 +/- 6.1%) in normotensives, borderline hypertensives, and hypertensives, respectively, was smaller than that found in previous studies. Hence, in this large Chinese population, a small nocturnal BP drop was found and it was only weakly associated with LV mass index. These results emphasize the general need for ambulatory BP reference values based on internal controls.

Adult↗

Two-dimensional assessment of cytoarchitecture in the anterior cingulate cortex in major depressive disorder, bipolar disorder, and schizophrenia: evidence for decreased neuronal somal size and increased neuronal density.

BACKGROUND: Abnormalities of cortical neuronal organization and reductions in neuronal somal size have been reported in schizophrenia. The purpose of this investigation was to assess patterns of neuronal and glial distribution in the anterior cingulate cortex (ACC) in major depressive disorder (MDD), schizophrenia, bipolar disorder (BPD), and normal control subjects (15 subjects per group). METHODS: Estimates for neuronal somal and glial nuclear size and density were obtained. We employed two-dimensional morphometric analysis to examine the location of neurons and glia in a 1000-microm-wide strip of cortex. RESULTS: A decreased clustering of neurons was seen in BPD (p =.001). No other group differences were observed in the clustering of neurons, glia, or of neurons about glia. Neuronal somal size was reduced in layer 5 in schizophrenia (18%, p =.001), BPD (16%, p <.001), and MDD (9%, p =.01). Neuronal density was increased in layer 6 in BPD (63%, p =.004) and schizophrenia (61%, p =.006) and in layer 5 in MDD (24%, p =.018) and schizophrenia (33%, p =.003). CONCLUSIONS: The results of this study indicate that reduced neuronal somal size and increased neuronal density in cortical layers 5 and 6 of the ACC may be key features of schizophrenia, MDD, and BPD.

Adult↗

Kinetic mechanism of human glutathione-dependent formaldehyde dehydrogenase.

Formaldehyde, a major industrial chemical, is classified as a carcinogen because of its high reactivity with DNA. It is inactivated by oxidative metabolism to formate in humans by glutathione-dependent formaldehyde dehydrogenase. This NAD(+)-dependent enzyme belongs to the family of zinc-dependent alcohol dehydrogenases with 40 kDa subunits and is also called ADH3 or chi-ADH. The first step in the reaction involves the nonenzymatic formation of the S-(hydroxymethyl)glutathione adduct from formaldehyde and glutathione. When formaldehyde concentrations exceed that of glutathione, nonoxidizable adducts can be formed in vitro. The S-(hydroxymethyl)glutathione adduct will be predominant in vivo, since circulating glutathione concentrations are reported to be 50 times that of formaldehyde in humans. Initial velocity, product inhibition, dead-end inhibition, and equilibrium binding studies indicate that the catalytic mechanism for oxidation of S-(hydroxymethyl)glutathione and 12-hydroxydodecanoic acid (12-HDDA) with NAD(+) is random bi-bi. Formation of an E.NADH.12-HDDA abortive complex was evident from equilibrium binding studies, but no substrate inhibition was seen with 12-HDDA. 12-Oxododecanoic acid (12-ODDA) exhibited substrate inhibition, which is consistent with a preferred pathway for substrate addition in the reductive reaction and formation of an abortive E.NAD(+).12-ODDA complex. The random mechanism is consistent with the published three-dimensional structure of the formaldehyde dehydrogenase.NAD(+) complex, which exhibits a unique semi-open coenzyme-catalytic domain conformation where substrates can bind or dissociate in any order.

Aldehyde Oxidoreductases↗

The effect of leucocyte elastase on the immunoelectrophoretic behaviour of alpha 1-antitrypsin.

Two-dimensional immunoelectrophoresis and conventional sodium dodecyl sulphate-polyacrylamide gel electrophoresis was performed on various mixtures of purified alpha 1-antitrypsin (alpha 1AT) and leucocyte elastase (LE). The results confirm that alpha 1AT inhibits LE by the formation of enzyme-inhibitor complexes demonstrable by both techniques. The complexes break down with time and are not affected by pH in the presence of excess alpha 1AT. However, the breakdown is more rapid in the presence of excess enzyme only at pH values where LE remains active. The resultant products of the complex breakdown include inactivated LE and alpha 1AT that has undergone limited proteolysis. It is concluded that the presence or absence of alpha 1AT-enzyme complexes as demonstrated by two-dimensional immunoelectrophoresis must be interpreted with caution when studying alpha 1AT function in lung secretions. The absence of such complexes does not mean that previous interaction with enzyme has not occurred, thereby accounting for a reduction in alpha 1AT inhibitory capacity.

Electrophoresis, Polyacrylamide Gel↗

[Clinical experience with the Siremobil Iso-C(3D) imaging system in pelvic surgery].

In pelvic and acetabular surgery intraoperative control of reduction and implant position is sometimes hard to achieve with conventional C-arm technology. The Siemens C-arm Iso-C(3D) imaging system enables axial cuts and two- or three-dimensional reconstructions to be generated. Following the good experience in surgery of the spine and extremities, its clinical applicability in pelvic surgery was evaluated in 30 patients in a prospective clinical trial. In all 20 patients with acetabular fractures reduction quality and implant position could be well assessed. In one postoperative examination an intraarticular screw placement was evident, which intraoperatively was not as clear and was revised. In one procedure an intraarticular fragment was visualized, and was extracted in the same procedure. In one procedure the use of the Iso-C(3D) system enabled the approach to be limited. In all ten pelvic ring injuries the osseous structures in the posterior pelvic ring could be visualized with an adequate image quality. Reduction quality and implant position could be assessed in all open and closed procedures. On two occasions the SI screws were navigated based upon the Iso-C(3D) dataset. Overall the use of the Iso-C(3D) system was successful in all cases. Image quality, which is clearly inferior to that of CT, was sufficient for the assessment of reduction quality and implant position. One revision was indicated, and one avoided. However, in spite of its advantages in pelvic surgery, handling, sterile covering and data transfer need to be improved. For bilateral pelvic injuries the image size is too small.

Acetabulum↗

Products of enzymatic reduction of benzoyl-CoA, a key reaction in anaerobic aromatic metabolism.

Benzoyl-coenzyme A is the most common central intermediate of anaerobic aromatic metabolism. Studies with whole cells of different bacteria and in vitro had shown that benzoyl-CoA is reduced to alicyclic compounds, possibly via cyclohexadiene intermediates. This reaction is considered a 'biological Birch reduction'. We have elucidated by NMR techniques the structures of six products of [ring-13C6]benzoate reduction. The reaction is catalyzed by extracts from cells of a denitrifying Pseudomonas strain K172 anaerobically grown with benzoate and nitrate as sole carbon and energy sources. The assay mixture contained [ring-13C6]benzoate plus traces of [U-14C]benzoate, Mg2+, ATP, coenzyme A (CoA), and Ti(III) as reductant. The use of the multiply 13C-labelled precursor increases the sensitivity of NMR detection and allows the analysis of crude product mixtures by two-dimensional coherence transfer procedures such as total correlation 13C-NMR spectroscopy and 13C-filtered 1H-NMR spectroscopy. The time course of product formation is consistent with the following order of events. Benzoyl-CoA is formed from benzoate via benzoate-CoA ligase. The first ring reduction product observed is cyclohex-1,5-diene-1-carboxyl-CoA. The next intermediate is 6-hydroxycyclohex-1-ene-1-carboxyl-CoA which is derived from the diene by addition of water. Part of the diene seems to be reduced to cyclohex-1-ene-1-carboxyl-CoA which becomes hydrated to trans-2-hydroxycyclohexane-1-carboxyl-CoA; these two intermediates may be side products in vitro. The first non-cyclic intermediate formed by beta-oxidation is 3-hydroxypimelyl-CoA. This aliphatic C7 dicarboxylic acid is proposed to be oxidized via glutaryl-CoA and crotonyl-CoA to three molecules of acetyl-CoA and one molecule of CO2. A similar product pattern was observed in the benzoate-degrading phototrophic bacterium Rhodopseudomonas palustris. This indicates that the enzymatic reduction of benzoyl-CoA may be mechanistically similar in different anaerobes.

Acyl Coenzyme A↗

Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation: insights from 3-dimensional echocardiography.

BACKGROUND: Mechanistic insights from 3D echocardiography (echo) can guide therapy. In particular, ischemic mitral regurgitation (MR) is difficult to repair, often persisting despite annular reduction. We hypothesized that (1) in a chronic infarct model of progressive MR, regurgitation parallels 3D changes in the geometry of mitral leaflet attachments, causing increased leaflet tethering and restricting closure; therefore, (2) MR can be reduced by restoring tethering geometry toward normal, using a new ventricular remodeling approach based on 3D echo findings. METHODS AND RESULTS: We studied 10 sheep by 3D echo just after circumflex marginal ligation and 8 weeks later. MR, at first absent, became moderate as the left ventricle (LV) dilated and the papillary muscles shifted posteriorly and mediolaterally, increasing the leaflet tethering distance from papillary muscle tips to the anterior mitral annulus (P<0.0001). To counteract these shifts, the LV was remodeled by plication of the infarct region to reduce myocardial bulging, without muscle excision or cardiopulmonary bypass. Immediately and up to 2 months after plication, MR was reduced to trace-to-mild as tethering distance was decreased (P<0.0001). LV ejection fraction, global LV end-systolic volume, and mitral annular area were relatively unchanged. By multiple regression, the only independent predictor of MR was tethering distance (r(2)=0.81). CONCLUSIONS: Ischemic MR in this model relates strongly to changes in 3D mitral leaflet attachment geometry. These insights from quantitative 3D echo allowed us to design an effective LV remodeling approach to reduce MR by relieving tethering.

Acute Disease↗

Biological similarity theories: a comparison with the empirical allometric equations.

Twelve biological variables were submitted to dimensional analysis in accordance with the MLT-system of physics (M, mass; L, length; T, time). Each of these variables has a characteristic numerical value for the exponents alpha for mass, beta for length, and gamma for time. By means of Newton's reduction coefficient (chi), the three dimensions (MLT) can be expressed as power functions of body mass (Mb); the exponent (b) is the result of the combination of the three dimensional exponents (alpha, beta, gamma). By linear regression analysis of 203 allometric exponents (betaE) obtained from the literature, the following equation was found for the regression exponent (bR) (equation: see text). The estimated numerical coefficients (ki) for the three exponents (alpha, beta, gamma) of the basic dimensions (MLT) do not agree with those of the prevailing theories of biological similarity.

Animals↗