Search

The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site (https://www.scmr.org) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.

Background & Aims Tenofovir disoproxil fumarate (TDF) is the preferred treatment to prevent maternal transmission of HBV, owing to its efficacy and safety. However, data are lacking on the long-term safety outcomes in children following fetal exposure to TDF. Methods Children participating in a prospective, multisite trial of maternal TDF treatment during late pregnancy were recruited for follow-up visits once a year. Growth parameters, serum biochemistry, HBV serology, and bone mineral density (BMD) by dual-energy x-ray absorptiometery scan were measured. Results One hundred and twenty-eight children, 71 in the TDF and 57 in the control group, completed 255 follow-up visits at the age of 2 to 7 (median, 4.08) years. No differences in z-scores for weight-for-age (0.26 ± 0.90 vs. 0.22 ± 0.99, p = 0.481), z-scores for height-for-age (0.20 ± 1.02 vs. 0.25 ± 0.98, p = 0.812), and estimated glomerular filtration rate (169.12 ± 50.48 vs. 169.06 ± 34.46 ml/min/1.73m2, p = 0.479) were detected. After adjustment for age, sex and HBV status by multiple linear regression, children in the TDF and control group had comparable levels of serum calcium, phosphorus, bone-specific alkaline phosphatase, calcidiol and BMD of lumbar spines (0.55 ± 0.01 vs. 0.57 ± 0.01 g/cm2, p = 0.159) and left hip (0.56 ± 0.01 vs. 0.56 ± 0.01 g/cm2, p = 0.926). Conclusions Children of HBV-infected mothers who did or did not receive tenofovir disoproxil fumarate treatment during late pregnancy had comparable long-term growth, renal function, and bone development up to 6–7 years after delivery. Clinical trial number NCT01312012 ( ClinicalTrials.gov ) Lay summary Currently there are insufficient long-term safety data in children born to mothers who took antiviral agents during pregnancy to prevent mother-to-infant transmission of hepatitis B virus (HBV). In this study, we found that children of HBV-infected mothers who did or did not receive tenofovir disoproxil fumarate treatment during late pregnancy had comparable long-term growth, renal function, and bone development up to 6-7 years after delivery.

The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). Case of the week is a case series hosted on the SCMR website (https://www.scmr.org) that demonstrates the utility and importance of CMR in the clinical diagnosis and management of cardiovascular disease. Each case consists of the clinical presentation and a discussion of the condition and the role of CMR in diagnosis and guiding clinical management. The cases are all instructive and helpful in the approach to patient management. We present a digital archive of the 2020 Case of the Week series of 11 cases as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.

Aims To explore in psychosis patients their subjective perceptions on the definition of relapse, the costs involved, the potential risk and protective factors for relapse, the effect of medication and the consequences of relapse. Method Sixteen patients who had previously enrolled into a randomized controlled trial of medication discontinuation during first-episode psychosis were interviewed after 10 years. Results Patients had a broader definition of the criteria of relapse, extending from medication discontinuation to family support. Although most agreed that taking antipsychotics is effective in preventing relapse, most have negative views on them. All patients predicted their risk of relapse to be less than 50% and they were generally optimistic about the future. Conclusion These findings have implications for development of effective medication compliance and relapse prevention programmes in psychosis.

Root functional traits (RFTs) are crucial for understanding nutrient cycling processes. However, seasonal variation of RFTs and their potential changes in root foraging pattern have been almost ignored in field studies. In this work, belowground net primary production (BNPP, g m−2), root length density (RLD, km m−2), specific root length (SRL, m g−1), root N concentration and C/N ratio in defoliated grass-clover swards of different sward ages and receiving different cattle slurry levels were investigated for 2 years. All measured RFTs showed significant seasonal variation: in general, seasonal variation was most marked between primary growth period (until heading stage of perennial ryegrass) and subsequent regrowth periods following defoliation; meanwhile, the rooting pattern also differed. These phenomena were not affected by current management or sward composition, but were correlated with plant C availability. Daily BNPP and RLD rates varied 7- to 8-fold in the growing season. Moreover, BNPP and RLD were asynchronous due to seasonal variation in SRL. Rooting pattern and the relationship with shoot phenology are discussed. We conclude that root functional traits vary with season; thus, roots which develop in different seasons may be involved in belowground nutrient cycling processes with different turnover characteristics; trade-off among traits may also involve temporal variation. Root-C related investigations in grass-clover swards should include root mass sampling rather than use of root length observations alone.

Summary Background The long-term consequences of discontinuing antipsychotic medication after successful treatment of first-episode psychosis are not well studied. We assess the relation between early maintenance therapy decisions in first-episode psychosis and the subsequent clinical outcome at 10 years. Methods This is a 10 year follow-up study, spanning Sept 5, 2003, to Dec 30, 2014, of a randomised, double-blind trial in seven centres in Hong Kong in which 178 patients with first-episode psychosis with full positive symptom resolution after at least 1 year of antipsychotic treatment were given maintenance treatment (n=89; oral quetiapine 400 mg daily) or early treatment discontinuation (n=89; placebo) for 12 months. After the trial, patients received naturalistic treatment. Overall this cohort of patients will have received about 3 years of treatment before entering the follow-up phase of the study: about 2 years of maintenance treatment before study entry and 1 year of treatment in the trial. The primary outcome of this follow-up was the proportion of patients in each group (including those for whom direct follow-up was not available) with good or poor long-term clinical outcomes at 10 years, with poor outcome defined as a composite of persistent psychotic symptoms, a requirement for clozapine treatment, or death by suicide. The randomised trial was registered with ClinicalTrials.gov, number NCT00334035, and the follow-up study was registered with ClinicalTrials.gov, number NCT01926340. Findings Poor 10 year clinical outcome occurred in 35 (39%) of 89 patients in the discontinuation group and 19 (21%) of 89 patients in the maintenance treatment group (risk ratio 1·84, 95% CI 1·15–2·96; p=0·012). Suicide was the only serious adverse event that occurred in the follow-up phase (four [4%] patients in the early discontinuation group vs two [2%] in the maintenance group). Interpretation In patients with first-episode psychosis with a full initial response to treatment, medication continuation for at least the first 3 years after starting treatment decreases the risk of relapse and poor long-term clinical outcome. Funding Food and Health Bureau, Research Grants Council of Hong Kong, and AstraZeneca.

Background Individuals with first-episode psychosis (FEP) have markedly elevated risk for suicide. Previous research on suicidality in early psychosis mainly focused on attempted and completed suicide. Data regarding risk factors for suicidal ideation, which is a common antecedent and predictor of suicide attempt, were limited. This study aimed to examine the prevalence of suicidal ideation and its relationships with clinical, neurocognitive and psychological factors in FEP patients. Method Eighty-nine Chinese patients aged 15 to 25 years presenting with FEP to specialized early intervention service were recruited. A comprehensive set of assessments examining pre-treatment illness characteristics, symptom severity, neurocognitive function, and psychological factors were administered. Current suicidal ideation and history of suicide attempt were systematically evaluated. Results Approximately 42% of patients expressed suicidal ideation after service entry. Univariate regression analyses found that suicidal ideation was significantly associated with past suicide attempt, depressive symptoms, emotion expressivity, hopelessness, future expectation, attentional impulsiveness, internal and external locus of control, and the likelihood of endorsing fear of social approval and survival and coping beliefs as reasons for living. Final multivariate model showed that previous suicide attempt, depression, less severe diminished expression, greater degree of hopelessness and lower level of internal locus of control independently predicted suicidal ideation. Conclusions Suicidal ideation was prevalent in FEP patients. Our findings implied that close monitoring and prompt intervention of those potentially modifiable risk factors for suicidal ideation including depression, hopelessness and perceived inadequate personal control may reduce suicide risk in the early course of psychotic illness.

The study evaluated the safety of reclaimed water using health risk assessment and biotoxicity tests. The reclaimed water was produced from reverse osmosis and used in industrial and miscellaneous purposes. The health risk assessment was conducted based on the concentrations of detectable pollutants in reclaimed water in a hypothetical scenario. The estimated carcinogenic and non-carcinogenic risks are lower than the generally accepted level. Biotoxicity evaluation included three genotoxicity tests, a chronic toxicity test using medaka fishes, and a subchronic toxicity test using mice. The reclaimed water is not genetically toxic, and does not cause significant chronic effects on these model organisms. These results confirm the safety of using reclaimed water from municipal wastewater treatment plants.

Background Cardiovascular magnetic resonance (CMR) is ideal for assessing patients with repaired aortic coarctation (CoA). Little is known on the relation between long-term complications of CoA repair as assessed by CMR and clinical outcome. We examined the prevalence of restenosis and dilatation at the repair site and the long-term outcome in patients with repaired CoA. Methods and results CMR imaging and clinical data for adult CoA patients (247 patients aged 33.0±12.8years, 60% male), were analyzed. The diameter of the aorta at the repair site was measured on CMR and its ratio to the aortic diameter at the diaphragm (repair site-diaphragm ratio, RDR) was calculated. Restenosis (RDR≤70%) was present in 31% of patients (and significant in 9% [RDR 150%) in 13.0%. A discrete aneurysm at the repair site was observed in 9%. Restenosis was more likely after resection and end–end anastomosis, whereas dilatation after patch repair. Systemic hypertension was present in 69% of patients. Of the hypertensive patients, blood pressure (133±20/73±10mmHg) was well controlled in 93% with antihypertensive therapy. Mortality rate over a median length of 5.9years was low (0.69% per year, 95% CI: 0.33–1.26), but significantly higher than age-matched healthy controls (standardised mortality ratio 2.86, CI 1.43–5.72, p Conclusion Restenosis or dilatation at the CoA repair site as assessed by CMR is not uncommon. Medium term survival remains good, however, albeit lower than in the general population. Life-long follow-up and optimal blood pressure control are likely to secure a good longer term outlook in these patients.

We sought to improve understanding of the diastolic prolongation of forward flow seen through a unilateral branch pulmonary artery (PA) stenosis.Of patients studied by cardiovascular magnetic resonance (CMR) for congenital heart disease, we reviewed right and left PA flow to find 10 cases with a diastolic prolongation of flow in a stenosed branch PA. They were aged 20 years (median, range = 14-40 years, 7 males). Seven had transposition of the great arteries corrected by arterial switch (TGA-AS) and 3 had repaired tetralogy of Fallot (rToF). All had at least moderate unilateral stenosis and competent pulmonary valves. For comparison, we identified 10 patients with unilateral stenosis and at least moderate pulmonary regurgitation, 9 rTOF and 1 TGA-AS, aged 23.5 years (range = 14-42 years, 6 males). Flow in each PA was measured, and in 10 healthy volunteers aged 27 years (range = 20-42 years, 5 males). The curves of flow through stenosed and non-stenosed arteries were averaged for each patient group and compared with those from controls. In competent pulmonary valve patients, the minimum diameters of the stenosed versus non-stenosed branches were as follows (median [range]): 4 [3-8] mm versus 13.5 [10-28] mm, p0.001, although their flows differed a little: 2.5 [1.5-6.8] L/min versus 3.2 [1.2-8.8] L/min, p=0.6. No diastolic tail was identifiable in the patients with unilateral PA stenosis and pulmonary regurgitation, where stenosed versus non-stenosed diameters were 7 [4-12] mm versus 20.5 [13-33] mm, p0.001, and flows differed: 1.3 [0.4-2.9] L/min versus 3.8 [3.0-5.0] L/min, p0.001. No controls showed stenosis or diastolic tail.Beyond a competent pulmonary valve, flow through a unilateral PA stenosis, although limited in systole, can continue into diastole, maintaining flow to the lung.

Ebstein's anomaly involves both the right ventricle (RV) and tricuspid valve.The functional RV and tricuspid orifice were traced from magnetic resonance images in 29 adult Ebstein patients and 9 normal subjects and reconstructed for visualization and measurement of regional RV size, function, and shape at 20 cross sections, and inlet and outflow tract ejection fractions (EFs).The RV in Ebstein's had RV dilation (end diastolic volume index 179 ± 69 vs. 84 ± 22 ml/m(2) in normals, p0.001) and global dysfunction (EF 45 ± 8 vs. 55 ± 5% in normals, p0.001). Longitudinal contraction was preserved (26 ± 13 vs. 26 ± 4 mm in normals) and correlated more weakly with EF than short axis fractional shortening (r=0.44 vs. r=0.71, p0.05 for both). The apical region in Ebstein's RV was enlarged, rounded and contributed more than normal to the global stroke volume. However this contribution correlated inversely with global EF. In contrast slices in the basal region had normal cross sectional area and their function correlated directly with global EF. Inlet EF was depressed (46 ± 8% vs. 55 ± 6 in normals, p=.002); outflow tract EF was even more depressed (39 ± 14, p=0.019).The three dimensional shape of the RV in adult Ebstein patients was demonstrated. The Ebstein's RV remodels in diverse regional patterns rather than following a shape continuum. Changes at the apex and base had opposing effects on function. Global EF was supported more by short axis than longitudinal contraction.

Retromuscular ventral hernia repair with mesh is a durable technique. In this paper, we describe a novel technique which allows for significant mesh overlap via the retromuscular space in cases of massive ventral hernia.The retromuscular space is developed laterally, to the edge of the rectus sheath. The posterior rectus sheath is incised, dividing the posterior aponeurosis of the internal oblique. The dissection is carried out laterally between the internal oblique and the transversus abdominis muscle, creating space for a large mesh underlay.We have performed this technique successfully in 20 patients with a mean defect area of 223 cm(2) and a mean mesh area of 698 cm(2). Three patients developed wound complications and none complained of long-term pain or abdominal wall deformity. There has been one recurrence due to technical error after a mean 12-month follow-up.This technique of dissection between the internal oblique and transversus abdominis muscles allows for the closure of large hernia defects. The mechanism is two-fold: (1) mobility for closure of the posterior rectus sheath, dorsal to the prosthetic; and (2) increased mobility of the rectus, internal, and external obliques, allowing reconstruction of the linea alba.

Background Exercise capacity relates to right ventricular (RV) volume overload in congenital heart disease and may improve after surgery. We herewith investigate the relation between exercise capacity, cardiac index, and RV volume overload due to tricuspid regurgitation (TR) in Ebstein's malformation and pulmonary regurgitation (PR) after repair of tetralogy of Fallot (rToF). Methods We measured cardiac index and tricuspid/pulmonary regurgitant fraction by cardiovascular magnetic resonance in patients with Ebstein's malformation (n=40) or rTOF (n=53) with at least moderate TR/PR and 24 healthy controls. Exercise tolerance was determined by peak oxygen consumption (peak VO 2 ) during cardiopulmonary exercise testing. Results TR and PR fraction were similar in Ebstein and rTOF patients (43±17% versus 39±12%, respectively). Cardiac index was reduced in Ebstein (2.7±0.6L/min/m 2 compared to controls 3.5±0.9L/min/m 2 , p 2 ). Multiple regression analysis revealed a significant correlation between peak VO 2 and cardiac index in Ebstein. Furthermore, peak VO 2 correlated with peak heart rate in both groups but not with regurgitation fraction. Conclusions Despite comparable amounts of regurgitation from a right sided heart valve in patients with Ebstein and rToF, reduction of cardiac index was observed only in the former group. Greater physiologic complexity and adverse ventricular interaction with chronotropic incompetence in Ebstein's malformation may account for this.

Stigma is a major factor causing delayed help-seeking and poor treatment adherence in patients with psychotic disorders. Previous research has mostly focused on chronic samples and the impact of culturally-relevant variables on both patients’ and their caregivers’ stigmatization is understudied. This study aimed to examine the relationships between various forms of stigma, “face concern”, and clinical characteristics in a group of Chinese first-episode psychosis (FEP) patients and their caregivers. Forty-four Hong Kong Chinese aged 15–54 years presenting with FEP to psychiatric services and their caregivers were recruited. Assessments on self-stigma, affiliate stigma, perceived public stigma, “face concern”, symptom severity and subjective quality of life (QoL) were conducted. Self-stigma of FEP patients was correlated with perceived public stigma, “face concern”, insight and psychological health of QoL. Multiple regression analysis revealed that perceived public stigma and “face concern” independently predicted self-stigma. Mediation analysis further suggested that “face concern” partially mediated the relationship between perceived public stigma and self-stigma. Caregivers’ affiliate stigma was significantly associated with higher levels of stress, and symptoms of depression and anxiety. Affiliate stigma did not correlate with perceived public stigma and “face concern”. Our results indicate a critical role of perceived public stigma and fear of losing face in determining self-stigma in Chinese patients with FEP. Caregivers with greater degree of affiliate stigma experience increased stress and emotional distress. Our findings highlight the importance to examine culturally specific factors that may contribute to the development of self-stigma in first-episode populations of different ethnicities.

Individuals with first-episode psychosis (FEP) have markedly elevated risk for suicide. Previous research investigating risk factors of suicidal behavior in FEP mainly focused on western populations. This study aimed to examine the prevalence, and pretreatment and early illness predictors of suicidal behavior in Chinese FEP patients.Seven hundred participants aged 15-25 years consecutively enrolled in a territory-wide treatment program for FEP in Hong Kong from July 2001 to August 2003 were studied. Baseline and 3-year follow-up variables were collected via systematic medical file review. Suicidal behavior evaluated in this study comprised suicide attempt and completed suicide.Seventy-four (10.6%) participants attempted suicide before treatment. Ten percent (n = 70) exhibited suicidal behavior and 1% (n = 7) committed suicide during 3-year follow-up. The majority of post-treatment suicidal behaviors (51.4%) occurred in the first year of follow-up. Jumping from a height was the most common method of committing suicide. Multivariate regression analysis indicated that previous suicide attempt, history of substance abuse and poorer baseline functioning were significantly associated with an increased risk for suicidal behavior after treatment initiation.In a large representative cohort of Chinese young FEP patients, the rates of suicidal behavior before and after treatment and risk factors for post-treatment suicidal behavior were comparable to the findings of previous research on early psychosis conducted in western populations. Close monitoring of high-risk patients with history of attempted suicide or substance abuse, and enhancement of psychosocial functioning may help reduce suicide risk in the early stage of psychotic illness.

Polymer alkyl-fullerene (P-C60) radical adducts produced by ultraviolet (UV) photoinitiated reactions between low-density polyethylene (LDPE) and C60 in the presence of benzophenone (BP) as a photoinitiator have been detected and identified for the first time by electron spin resonance (ESR) and confirmed by simulation analysis of the spectrum. A well-resolved ESR spectrum was recorded in situ upon UV irradiation of the LDPE/BP/C60 sample in the molten state (413 K). Detailed analysis of hyperfine structures shows that the observed spectrum is composed of three components: a broad singlet atg = 2.0025 from the C60 radical anion; an innermost pair of13C satellites; and a 12-line spectrum superposed on the broad singlet. The simulation analysis of the spectrum shows that the 12-line spectrum is due to the overlapping of two kinds of radical adducts of tertiary carbon-C60 (A) and secondary carbon-C60 (B), which have slightly differentg-values and almost the same integral intensity IA/IB (48.4/51.6). The spectrum simulated on the basis of the1H and13C hyperfine interaction parameters is in good agreement with the observed spectrum. These results provide positive evidence that the C60-bound LDPE materials can be obtained directly by a simple method of BP-photoinitiated reaction of the LDPE/C60 system.

El estres en ratas prenadas altera el patron de secrecion de corticosterona (COR) materna la cual, por via transplacentaria, produce una alteracion del eje Hipotalamo-Hipofiso-Adrenal (HHA) fetal. El estres prenatal producido durante la etapa critica de diferenciacion hipotalamica, esta relacionado con la disminucion de la fertilidad en las crias macho, por un aumento en el nivel de COR basal. Esta modificacion podria inducir cambios a largo plazo en el proceso de apoptosis testicular. Sin embargo, la estimulacion postnatal temprana mejora el comportamiento materno, revirtiendo las alteraciones producidas por el aumento de COR en las crias adultas. El objetivo fue investigar el efecto de la estimulacion postnatal temprana sobre el eje Hipotalamo-Hipofiso-Gonadal (HHG) en ratas macho estresadas prenatalmente (EP), por inmovilizacion cronica durante las dos ultimas semanas de la prenez. Se utilizaron crias de 3 meses de edad, que fueron divididas en 4 grupos: (a) individuos EP y sin estimulacion postnatal; (b) individuos EP con estimulacion postnatal; (c) individuos controles no estresados prenatalmente (CP) y sin estimulacion postnatal; y (d) individuos CP con estimulacion postnatal. En todos los grupos se midio COR, Testosterona (T) y Hormona Luteinizante (LH). Se determinaron la apoptosis y la Caspasa 3 testicular y el indice gonadosomatico. Se concluye que el estres prenatal por inmovilizacion aumenta los niveles de COR del eje HHA e inhibe el eje HHG obteniendo valores bajos de LH y T plasmaticas. Se observa disminucion del tamano testicular y aumento de la apoptosis de las celulas testiculares. Por otro lado, la estimulacion postnatal temprana se traduce en un aumento del cuidado materno hacia la cria, lo que revierte los efectos producidos por el estres prenatal sobre el eje HHG. Este efecto podria estar mediado por algun mecanismo independiente del eje HHA.

Background Since the introduction of consensus criteria for symptomatic remission in 2005, most first-episode studies focused on cross-sectional relationship between remission status and functional outcome. Predictive validity of the proposed remission definition was under-studied. Relationship of remission with subjective quality of life (QoL) was inadequately addressed with inconsistent findings being observed. Method One hundred and four Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. Socio-demographics, baseline clinical and functioning profiles were obtained. Psychopathological and functional reassessments were conducted at 6, 12 and 24 months. Subjective QoL was measured at 12 and 24 months. Symptomatic remission was operationally defined according to the consensus criteria developed by the Remission in Schizophrenia Working Group (RSWG), comprising both symptom-severity and 6-month duration components. Results At 12 months, 59.6% of patients achieved symptomatic remission. Remitted patients had significantly lower symptom severity, more favorable psychosocial functioning and better subjective QoL at 12 months than non-remitted counterparts. Attainment of remission at 12 months was significantly associated with fewer positive, negative, depressive and disorganization symptoms, higher levels of functioning and subjective QoL at 24 months. Linear regression analysis indicated that remission status independently predicted functional outcome even when the effects of educational level, baseline functioning and negative symptom scores were controlled for. Conclusion The operationally defined symptomatic remission formulated by the RSWG represented a clinically valid construct that was found to be closely related to both concurrent and longitudinal outcomes on psychopathology, functioning and subjective QoL in the early stage of schizophrenia.

The arterial switch operation (ASO) is currently the treatment of choice in neonates with transposition of the great arteries (TGA). The outcome in childhood is encouraging but only limited data for long-term outcome into adulthood exist.We studied 145 adult patients (age16, median 25 years) with ASO followed at our institution. Three patients died in adulthood (mortality 2.4/1000-patient-years). Most patients were asymptomatic and had normal left ventricular function. Coronary lesions requiring interventions were rare (3 patients) and in most patients related to previous surgery. There were no acute coronary syndromes. Aortic root dilatation was frequent (56% patients) but rarely significant (45 mm in 3 patients, maximal-diameter 49 mm) and appeared not to be progressive. There were no acute aortic events and no patient required elective aortic root surgery. Progressive neo-aortic-valve dysfunction was not observed in our cohort and only 1 patient required neo-aortic-valve replacement. Many patients (42.1%), however, had significant residual lesions or required reintervention in adulthood. Right ventricular outflow tract lesions or dysfunction of the neo-pulmonary-valve were frequent and 8 patients (6%) required neo-pulmonary-valve replacement. Cardiac interventions during childhood (OR 3.0, 95% CI 1.7-5.4, P0.0001) were strong predictors of outcome (cardiac intervention/significant residual lesion/death) in adulthood.Adult patients with previous ASO remain free of acute coronary or aortic complications and have low mortality. However, a large proportion of patients require re-interventions or present with significant right sided lesions. Life-long cardiac follow-up is, therefore, warranted. Periodic noninvasive surveillance for coronary complications appears to be safe in adult ASO patients.

Summary Diastolic prolongation of forward flow, or diastolic tail is present in unilateral branch pulmonary artery stenosis in patients after the arterial switch operation for transposition of the great arteries and after repair for tetralogy of Fallot. Interestingly, as a result of a diastolic tail, flow through the stenosed artery is comparable to that in the non-stenosed artery and therefore the impact of stenosis may be relieved. Background Diastolic prolongation of forward flow, or diastolic tail, is known as an indicator of the hemodynamic impact of aortic coarctation or recoarctation. We have observed similarly tailed flow curves in unilaterally stenosed branch pulmonary arteries (PA) of patients with transposition of the great arteries corrected by arterial switch (TGA-AS) and after repair of tetralogy of Fallot (rToF). We are not aware that this has been described before. We aimed to improve understanding of the nature and possible clinical implications of this pathophysiological finding. Methods Our clinical cardiovascular magnetic resonance (CMR) reports on TGA-AS and rTOF patients of the last five years (200 and 350, respectively) were searched for the above finding. It had been noticed from the appearances of cine images and through-plane velocity acquisitions aligned with or transecting, respectively, the right and left PAs. Diastolic tail was confirmed by clear discrepancy between the curves of stenosed and non-stenosed PA flow (Figure 1A). CMRtools was used to measure the volume of flow through each branch PA. The branch PA flow curves of 10 healthy volunteers aged 28 ±5 years, 6 male, were studied for comparison. Results

We previously found reduction of cardiac index (CI) in patients with tricuspid regurgitation (TR) due to Ebstein anomaly, but not in patients with comparable right ventricular (RV) volume loading due to pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (rTOF). We postulated that the difference may be attributable to impaired left ventricular (LV) filling caused by leftward bulging of the atrialized portion of the RV in Ebstein patients.

Methods CMR scans of patients with Noonan’s syndrome referred for imaging were analyzed. All patients were imaged on a 1.5T MRI. RV volumes were generated from SSFP cines and normalized to gender, body surface area and age. Phase contrast velocity mapping was used to assess pulmonary and aortic flow. The prevalence of concomitant cardiovascular abnormalities was also assessed. Results Thirty two consecutive patients (age 29 (20 - 50), (median (IQR); male 69%) were studied. Prior intervention for MPA or PV stenosis was performed in 15 (47%) patients and data was compared to 17 (53%) Noonan’ sp atients without MPA or PV intervention. Pulmonary regurgitation was more prevalent (73% vs. 33%, c 2 = 8.4; p = 0.037) and severe (regurgitant fraction 26.4±5% (mean ± SEM) vs. 6.5 ± 3%; p

This journal suppl. entitled: Abstracts of the 4th Biennial Schizophrenia International Research Conference

Summary Pseudomonas aeruginosa pneumonia usually results from a deficit of the innate immune system. To investigate whether inflammatory signalling by airway epithelial cells provides a pivotal line of defence against P. aeruginosa infection, we utilized two separate lines of inducible transgenic mice that express a constitutive activator of the nuclear factor kappa-B (NF-κB) pathway (IKTA) or a dominant inhibitor of NF-κB (DNTA) in airway epithelial cells. Compared with control mice, IKTA mice showed an enhanced host response to P. aeruginosa infection with greater neutrophil influx into the lungs, increased expression of Glu-Leu-Arg-positive (ELR+) CXC chemokines macrophage inflammatory protein-2 and keratinocyte chemoattractant (KC), superior bacterial clearance and improved survival at 24 h after infection. Neutrophil depletion abrogated the improvement in host defence identified in IKTA mice. In contrast, DNTA mice showed impaired responses to P. aeruginosa infection with higher bacterial colony counts in the lungs, decreased neutrophilic lung inflammation and lower levels of KC in lung lavage fluid. DNTA mice given recombinant KC at the time of P. aeruginosa infection demonstrated improved neutrophil recruitment to the lungs and enhanced bacterial clearance. Our data indicate that the NF-κB pathway in airway epithelial cells plays an essential role in defence against P. aeruginosa through generation of CXC chemokines and recruitment of neutrophils.

5-1 Advantages and Disadvantages of Robotics for Rehabilitation of Stroke Patients One may find that robotics provides an integral solution to the treatments and objective assessments of some neurological diseases such as stroke. The robots can perform repeated treatment protocols without the need of continuous involvement of therapists. A robot can save therapists' arduous efforts by helping with heavy, challenging and repetitious movements. Physical strain and professional injury in therapists can be minimized. It is cost-effective to strengthen some basic elements, such as muscle strength, range of motion, and sensorimotor coordination, in preparation for higher skill-level movement patterns on a mass-practice basis. Robotic therapy techniques can mimic appropriate functional kinematics or apply novel patterns of force with precision, such as isokinetic contraction, that are potentially effective for muscle strengthening. More advanced robots can even provide tactile feedback that kinetically and kinematically corrects the impaired movements. Data collected during the robot training sessions can be quantified with ease to complement the subjective and qualitative observation of clinicians.

Objectives To establish normative data for the width of the fetal cavum septi pellucidi at various gestational ages. Subjects and methods A total of 608 consecutive fetuses between 19 and 42 gestational weeks were included in this prospective study. The largest width of the cavum septi pellucidi was measured by two-dimensional ultrasound. Piecewise regression analysis was used to study the relationships between the width of the fetal cavum septi pellucidi, gestational age and biparietal diameter. Results The fetal cavum septi pellucidi width increased gradually between 19 and 27 weeks of gestation and then plateaued between 28 weeks and term. Regression analysis revealed significant associations between cavum septi pellucidi width and gestational age, and cavum septi pellucidi width and biparietal diameter. Conclusions The present study provides normative data for fetal cavum septi pellucidi width and useful information about the development of the midline brain structure in the fetus. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology

Turbulent blood flow caused by arterial stenosis can induce platelet activation and aggregation, which subsequently participate in arterial thromboembolic events.To test the hypothesis that platelet activation (expressed by CD62p) is enhanced in cerebral vs systemic circulation in patients with severe internal carotid artery (ICA) stenosis.Platelet CD62p expression was prospectively measured using flow cytometry in 35 consecutive symptomatic patients with severe ICA stenosis and in 20 at-risk control subjects who underwent both coronary and cerebral angiographic studies due to angina pectoris and suspicious vertebral artery or intracranial artery stenosis. The CD62p expression was also evaluated in 20 healthy subjects. Blood samples were first drawn from the right internal jugular vein (cerebral circulation) and right femoral vein (systemic circulation) before extra- and intracerebral angiographic examination of both patients and at-risk control subjects and again at 40 minutes after ICA stenting. Clopidogrel was administered to the patients following the second blood sampling.Systemic CD62p expression was higher in patients than in both the healthy and at-risk control subjects (both p0.0001). Additionally, cerebral CD62p expression was higher in patients than in at-risk control subjects (p0.0001) prior to intervention. Moreover, CD62p expression was higher in cerebral circulation than in systemic circulation in the patients (p0.0001) before ICA stenting. However, CD62p expression was less enhanced in cerebral circulation than in systemic circulation after ICA stenting (p0.0001). Furthermore, CD62p expression was decreased after 3 months of follow-up (p0.0001).Compared to systemic CD62p expression, cerebral CD62p expression was more enhanced prior to ICA stenting and was less enhanced after ICA stenting in patients with severe ICA stenosis.

Ehrlichia chaffeensis is the causative agent of human monocytic ehrlichiosis, a disease that ranges in severity from asymptomatic infection to death. Only one isolate of E. chaffeensis has been made, the Arkansas strain, upon which all characterizations of the agent of human monocytic ehrlichiosis have been based. We report the isolation and characterization of a new strain of E. chaffeensis, the 91HE17 strain, which was cultivated from a patient with a nearly fatal illness. The new isolate grows best in culture with careful control of pH. The two isolates are nearly identical as determined by light and electron microscopy and have significant antigenic identity in fluorescent-antibody and immunoblot assays using polyclonal antisera and the E. chaffeensis-specific monoclonal antibody 1A9. Isolate 91HE17 had 99.9% nucleotide sequence identity with the Arkansas strain in the 16S rRNA gene. Parts of the Escherichia coli GroE operon homologs had identical restriction enzyme digestion patterns, and a 425-bp region of the GroEL gene had at least 99.8% sequence identity between the E. chaffeensis Arkansas and 91HE17 strains. Isolate 91HE17 lacked an epitope identified in E. chaffeensis Arkansas by the monoclonal antibody 6A1. This new E. chaffeensis isolate is very similar to the Arkansas strain and provides the opportunity to substantiate the existence of diversity among ehrlichiae which infect humans. Specific factors which differ among strains may then be compared to assess their potential contributions toward cellular pathogenicity and ultimately toward the development of disease in humans.

SUMMARY A case is reported in which an unexpected occlusal result arose following bimaxillary osteotomy for correction of a skeletal Class III discrepancy. In order to correct the occlusion, the mandible was protracted independently of the recently plated maxilla, by means of a fronto-sternal traction device.

Summary Complications of restenosis or dilatation at the site of repair may occur late after initial repair of coarctation of the aorta (CoA). Cardiovascular magnetic resonance (CMR) is becoming the choice of imaging of patients after CoA. Using CMR, we studied the relation between these complications and outcome inn patients with previous CoA repair, and found that significant stenosis or dilatation at the repair site is a predictor of adverse outcome. Background Cardiovascular magnetic resonance (CMR) is becoming the method of choice for assessing repaired CoA patients, especially for identifying important long-term sequelae of restenosis or dilatation at the repair site. We examined the prevalence of restenosis and dilatation at the site of aortic coarctation (CoA) repair and their relation to long-term outcome in patients with repaired CoA.

A 49-year-old man with Ebstein's malformation presented with a 2-year history of increasing dyspnoea. Transthoracic echocardiography showed severe tricuspid regurgitation, no tricuspid stenosis, and, in retrospect, evidence of a mass adjacent to the dysplastic tricuspid valve ( Panels A and B , arrowed). Imaging by cardiovascular magnetic resonance (CMR) confirmed Ebstein's malformation and showed …

The present experiment demonstrated that relatively high doses of acetazolamide (100 and 200 mg/kg s.c.) induced severe gastric hemorrhagic ulceration in rats. This ulceration was aggravated by oral administration of HC1, but was inhibited by NaHCO3. Further, the severity of ulceration was also decreased by pretreatment with methysergide, chlorpheniramine, or cimetidine. These protective effects were affirmed by an increase in serotonin and histamine released from the stomach after acetazolamide treatment. Acetazolamide injection also increased the protein level, but reduced the sialic acid content in the gastric secretion, indicating that the gastric mucosal barrier may have been damaged. Prostaglandin E2 content of the gastric mucosa was not affected by the drug; however, carbonic anhydrase activity was markedly reduced in a dose-dependent manner. Thus, it is suggested that the ulceration induced by acetazolamide is mainly due to the inhibition of carbonic anhydrase activity and mucus secretion. The increases in serotonin and histamine released may also have been contributing factors for gastric ulcer formation.

Background Right ventricular ejection fraction (RV-EF) has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function. We developed a cardiovascular magnetic resonance (CMR) tagging-based technique with a view to rapid and reproducible measurement of RV long axis function and applied it in patients with congenital heart disease. Methods We studied 84 patients: 56 with repaired Tetralogy of Fallot (rTOF); 28 with atrial septal defect (ASD): 13 with and 15 without pulmonary hypertension (RV pressure > 40 mmHG by echocardiography). For comparison, 20 healthy controls were studied. CMR acquisitions included an anatomically defined four chamber cine followed by a cine gradient echo-planar sequence in the same plane with a labelling pre-pulse giving a tag line across the basal myocardium. RV tag displacement was measured with automated registration and tracking of the tag line together with standard measurement of RV-EF. Results Mean RV displacement was higher in the control (26 ± 3 mm) than in rTOF (16 ± 4 mm) and ASD with pulmonary hypertension (18 ± 3 mm) groups, but lower than in the ASD group without (30 ± 4 mm), P < 0.001. The technique was reproducible with inter-study bias ± 95% limits of agreement of 0.7 ± 2.7 mm. While RV-EF was lower in rTOF than in controls (49 ± 9% versus 57 ± 6%, P < 0.001), it did not differ between either ASD group and controls. Conclusions Measurements of RV long axis displacement by CMR tagging showed more differences between the groups studied than did RV-EF, and was reproducible, quick and easy to apply. Further work is needed to assess its potential use for the detection of longitudinal changes in RV myocardial function.