MRI Evaluation of Mullerian Duct Anomalies: Practical Classification by the New ASRM System.

Objective: To describe variable mullerian duct anomalies using magnetic resonance imaging (MRI) and to classify these anomalies according to the available classification systems, namely the American Fertility Society (AFS) system, the European Society of Human Reproduction and Embryology (ESHRE) system, and the new American Society for Reproductive Medicine (ASRM) system. Design: Retrospective chart review. Subjects: The pelvic MRI studies and the clinical records of 64 females with mullerian congenital anomalies were retrospectively reviewed between January 2010 and December 2021. The mean age was 22 years (age range 2-63 years). Main Outcome Measures: Detailed imaging findings were recorded, and the resulting mullerian anomalies were then classified according to the three classification systems of interest. Results: Variable mullerian anomalies were found among patients with multiple frequencies. Mullerian agenesis and hypoplasia were found in 12 patients (19%) and 16 patients (25%), respectively. Uterus didelphys was found in 5 patients (8%). Twelve (19%) patients had septate uterus, while 8 (12.5%) had a bicornuate anomaly. Unicornuate uterus was present in 7 patients (11%). Isolated vaginal anomaly was diagnosed in 4 patients (6%). Renal/urinary tract imaging was available for 27 (42%) patients, and accompanying urinary tract anomalies were noted in 10 of them (37%). Few ovarian and other extra-renal anomalies were observed. Conclusion: MRI could efficiently delineate the mullerian anomalies regardless of their complexity. Most of these anomalies were more efficaciously categorized by the ESHRE and the new ASRM systems, compared to the originally widely used AFS system. The new ASRM classification was found to be more practical as it is a modification of the original AFS system, using drawings with clear descriptions instead of symbols. This is particularly helpful in the radiological era, saving time and effort.

Relationship Between Vesicoureteric Reflux and Nephrocalcinosis in Children: A Case-Control Study at a Tertiary Medical Center in Saudi Arabia.

BACKGROUND:  Vesicoureteral reflux (VUR), one of the most common pediatric congenital urogenital abnormalities, refers to the abnormal backflow of urine from the urinary bladder back into the ureter or to the kidney. This causes urinary tract infections. Nephrocalcinosis (NC) refers to abnormal deposits of calcium within the renal parenchyma and/or in the renal cortex. Patients with NC are mostly asymptomatic and severe disease may progress to renal failure. Early diagnosis through examinations such as radiography, computed tomography, and ultrasonography, is crucial for therapeutic treatment. Ultrasonography is the preferred method for scanning and grading nephrocalcinosis in children, primarily because it emits no radiation. This study aimed to increase the body of knowledge regarding VUR and nephrocalcinosis by determining its prevalence and assessing the relationship between VUR and nephrocalcinosis in children presenting at our institution. ​​​​Methods:A case-control study was conducted using data from the medical records of 632 children younger than 14 years in a tertiary medical center in Riyadh, Saudi Arabia. Eligible participants were assigned to two groups: Group 1 consisted of 316 patients with VUR, while Group 2 consisted of 316 sex- and age-matched patients without VUR. The difference in the prevalence of nephrocalcinosis between the two groups was assessed. Frequency and percentage were used to present the categorical variables; Pearson product-moment correlation was utilized to establish the association between VUR and nephrocalcinosis. Statistical significance was established at p<0.05. ​​​​​Result: Only two cases in Group 1 were positive for nephrocalcinosis (0.63%, one male and one female), while four cases in Group 2 were positive for the condition (1.26%, two males and two females). There was no significant difference in the incidence of nephrocalcinosis between the two groups (p=0.873), indicating no relationship between VUR and nephrocalcinosis in children. CONCLUSION: There is no relationship between VUR and nephrocalcinosis in children under the age of 14 years.

Development and evaluation of The KIT: Keeping It Together™â€ for†Youth (the 'Youth KIT') to assist youth with disabilities in managing information.

BACKGROUND: This article presents findings from the development and evaluation of The KIT: Keeping It Together™â€…for Youth (the 'Youth KIT'). The Youth KIT is a resource intended to assist youth with disabilities during their teenage years and during the transition to adulthood to give information to others about themselves, get from others about themselves, and organize their own information to the best of their ability. METHODS: Thirty-six youth between the ages of 12 and 25 with physical and developmental disabilities were active participants in the development of the Youth KIT and partnered with a multidisciplinary team to conduct the qualitative evaluation. Focus groups and individual interviews were used in three phases of evaluation. RESULTS: The results of qualitative content analysis found the Youth KIT to be useful for a variety of youth in different contexts. The themes that emerged about the utility and impact of the Youth KIT were: (1) self-discovery for youth; and (2) the importance of the 'fit' between youth and mentors to support youth as they started to use the Youth KIT. CONCLUSION: Clinical implications for healthcare providers working with youth during the transition to adulthood include recognition that discussions about adult goals should be a continuous dialogue throughout adolescence rather than a 'special' conversation occurring at the time of discharge from paediatric services.

Factors affecting the process of obtaining informed consent to surgery among patients and relatives in a developing country: results from Pakistan.

Efforts have been made in Pakistan to create ethical guidelines for research and medical practice. This study explored the perceptions of and factors affecting the process of obtaining informed consent to surgery among inpatients and families at a tertiary-care hospital in Karachi. A random sample of 400 post-surgery adult patients answered a pre-tested, structured questionnaire. Overall, 233 patients (58.3%) had signed the surgery consent form themselves, while 167 relatives (41.7%) had signed on behalf of the patient. Perceived factors significantly associated with patients not signing the consent form themselves were: language used (adjusted OR = 4.6), medical terminology used (aOR = 2.7), insufficient time allocation (aOR = 3.8), cultural/traditional reasons (aOR = 1.5) and low education (aOR = 2.4). Inappropriate timing for taking consent and not being informed/asked about consent were not statistically significant factors. Health-care practitioners should encourage patients to sign the consent form themselves.

Factors affecting the process of obtaining informed consent to surgery among patients and relatives in a developing country: results from Pakistan

Efforts have been made in Pakistan to create ethical guidelines for research and medical practice. This study explored the perceptions of and factors affecting the process of obtaining informed consent to surgery among inpatients and families at a tertiary-care hospital in Karachi. A random sample of 400 post-surgery adult patients answered a pre-tested, structured questionnaire. Overall, 233 patients [58.3%] had signed the surgery consent form themselves, while 167 relatives [41.7%] had signed on behalf of the patient. Perceived factors significantly associated with patients not signing the consent form themselves were: language used [adjusted OR = 4.6], medical terminology used [aOR = 2.7], insufficient time allocation [aOR = 3.8], cultural/traditional reasons [aOR = 1.5] and low education [aOR = 2.4]. Inappropriate timing for taking consent and not being informed/asked about consent were not statistically significant factors. Health-care practitioners should encourage patients to sign the consent form themselves

Des efforts récents ont été réalisés au Pakistan en vue de créer des lignes directrices pour l'éthique en recherche et pratique médicales. La présente étude a évalué les perceptions relatives au processus d'obtention d'un consentement éclairé pour une intervention chirurgicale et les facteurs d'influence chez des patients hospitalisés et leur famille dans un hôpital de soins tertiaires à Karachi. Un échantillon aléatoire de 400 patients adultes postopératoires à répondu a un questionnaire prétesté et structure. Au total, 233 patients [58,3%] avaient signé eux-mêmes le formulaire de consentement à une intervention chirurgicale, tandis que 167 parents [41,7%] avaient signé pour le patient. Les facteurs perçus comme forte ment associés aux patients qui n'avaient pas signé eux-mêmes le formulaire de consentement étaient les suivants: la langue utilisée [OR ajusté = 4,6], la terminologie médicale utilisée [OR ajusté = 2,7], l'insuffisance du temps alloué [OR ajusté = 3,8], des raisons culturelles/traditionnelles [OR ajusté = 15] et un faible niveau d'études [OR ajusté = 2,4]. Un moment inopportun pour demander le consentement et 'absence d'information/d'interrogation à ce sujet n'étaient pas des facteurs statistiquement significatifs. Les professionnels de santé doivent encourager les patients à signer eux-mêmes le formulaire

لقد بذلت جهود مؤخراً في باكستان من أجل وضع دلائل إرشادية أخلاقية للبحوث والممارسة الطبية. وقد استكشفت هذهالدراسة التصورات عن عملية الحصول عى موافقة مسبقة عى عملية جراحية، والعواملَ التي تؤثر عى هذه العملية لدى مرضىداخلين وعائلاتهم في مستشفى للرعاية الثالثية في كراتي. ففي دراسة مستعرضة أجريت عام 2010 أجابت عينة عشوائية مكونة من 400مريض بالغ بعد الجراحة عى استبيان منظَّم تم اختباره مسبقاً. فكان ما إجماليه 233 مريضاً ) 58.3 %( قد وقَّعوا عى استمارة الموافقة عىالجراحة بأنفسهم، في حن وقَّع 167 من الأقارب ) 41.7 %( نيابة عن المريض. وكانت العوامل المتصوَّرة التي ارتبطت - بشكل ملحوظالمعدلة OR( المعدلة = 4.6 (، والمصطلحات الطبية المستخدمة OR( - بعدم توقيع المرضى عى استمارة الموافقة بأنفسهم: اللغة المستخدمةالمعدلة= OR( المعدلة = 1.5 (، والتعليم المنخفض OR( المعدلة = 3.8 (، وأسباب ثقافية/تقليدية OR( 2.7 (، وعدم كفاية الوقت المخصص =2.4 (. وكان التوقيت غر المناسب لأخذ الموافقة، وعدم الإبلاغ/السؤال عن الموافقة عاملَن غر مهمَّن إحصائياً. فينبغي أن يكون ممارسوالرعاية الصحية عى علم بالعوامل التي تؤثر في عملية الموافقة المسبقة، وأن يشجعوا المرضى عى التوقيع عى استمارة الموافقة بأنفسهم

Development of an outcome measurement system for service planning for children and youth with special needs.

AIM: This study described the process used in developing an outcome measurement framework for system planning to improve services for children and youth with special needs and their families in a Canadian province. The study reports the results of several parent-completed measures, which would be useful in service planning as well as the acceptability and utility of these measures for use by families and service centres. METHODS/RESULTS: Development of a theoretical framework, consultation with key stakeholders, testing the utility of selected outcome measures and initial dissemination of results were critical elements in the successful development of an outcome system. Consultation with stakeholders confirmed use of the International Classification of Functioning, Disability and Health and the child-within-family-within community model as theoretical frameworks while building valuable partnerships and identifying potential barriers to implementation. Pilot testing showed three outcome measures were feasible for families to complete and the measures provided information about services for children that was valuable to families as well as service providers. Gaps in service delivery were identified and the need for better communication between service providers and communities to facilitate integrated services was highlighted. CONCLUSION: The findings from this study can be used to implement an outcome measurement system for children with special needs and may serve as a resource for international researchers who are working to develop valid tools as well as outcome systems that are useful for system planning.

Mechanistic pathway for controlled extraction of guest molecule bound to herring sperm DNA using α-cyclodextrin.

trans-2-[4-(Dimethylamino)styryl]benzothiazole (DMASBT) is known to have dual emitting states where the locally excited (LE) state is responsible for fluorescence in less polar environment and in polar milieu fluorescence is from the twisted intramolecular charge transfer (TICT) state. This compound also undergoes minor groove binding to herring sperm DNA (hsDNA) evidenced by the absorption spectra before and after the binding process and an effect on DMASBT fluorescence by an anionic quencher. The binding occurs efficiently in a 1:1 manner, i.e. one guest molecule binds to one site on the hsDNA. Instead of following the DNA twist, the aromatic part seems to project outward. Thus, the bound molecule can be successfully extracted out from the DNA in a controlled way by the hydrophobic cavity of α-cyclodextrin (α-CD). The extraction starts even with a low concentration of α-CD and increases as the concentration is increased. Absorption, steady-state and time resolved fluorescence spectroscopic methods have been employed to explore the mechanistic pathway of binding of DMASBT to hsDNA. The mechanistic approach toward controlled extraction of the guest molecules from hsDNA by α-CD is reported and is expected to serve a significant purpose in treatment of drug overdose.

Fragmentation of molecule-induced gamma-cyclodextrin nanotubular suprastructures due to drug dosage.

The guest-host concentration has already been proved to be a very important factor in the drug delivery process. In the present work we demonstrate the formation of compound induced gamma-cyclodextrin nanotubular suprastructure. The nanotubes formed are found to be highly sensitive to the concentration of the guest molecule. The increasing concentration of the compound in solution initiates a competition toward their existence inside the core of the nanotubes affecting the extent of nanotubular cluster formation. The hydrogen bonding responsible for the building of the cyclodextrin nanotubes is found to be partially disrupted because of this increasing competition. The continuous replacement of the guest molecules inside the nanochannels is supposed to be responsible for the instability in some of the hydrogen bondings that develop during the primary and the secondary interactions between the formed nanotubes resulting into fragmentation of the suprastructures. The steady state and time-resolved fluorescence experiments coupled with fluorescence anisotropy and atomic force microscopy illustrate the guest concentration dependence of the formation of the gamma-cyclodextrin nanotubes.

Defining the different phases of premicellar aggregation using the photophysical changes of a surface-probing compound.

Photophysical changes of a cylindrical compound undergoing twisted intramolecular charge transfer may be used as a surface probe to study the different phases of premicellar aggregate formation. The probe molecule, trans-2-[4-(dimethylamino)styryl] benzothiazole (DMASBT), attaches itself to the premicellar and the micellar aggregates of cationic, anionic, and neutral surfactants in different orientations because of its dipolar nature in the excited state. The micelle formation is preceded by a few typical rearrangements of the surfactant molecules. These events need proper inspection that can only be done by compounds that sense environmental changes by residing in the vicinity of the surface of those aggregates. Steady-state and time-resolved fluorescence spectroscopy coupled with steady-state fluorescence anisotropy measurements serve as a very useful tool to monitor premicellar aggregate formation. The dipolar interaction of DMASBT with the surface of the aggregate and its extraordinary capability to sense the polarity of the environment make it a very efficient molecule to use for the purpose.

SU-8 polymer enclosed microchannels with interconnect and nanohole arrays as an optical detection device for biospecies.

We present for the first time the integration of nanohole arrays for surface plasmon resonance (SPR) sensing together with SU-8 polymer microfluidic channels containing special packaging structures for chip-to-chip and world-to-chip interconnect. Primary steps towards an optical biospecies detection device are presented including observing the effect of period on transmission peak location, examining new materials for the enclosed microchannels, and demonstrating nanohole array SPR transmission data through water contained in the microchannels. Additionally, the enclosed microchannels are integrated with interconnect structures that facilitate interfacing with macro-scale test equipment and microfluidic components and systems such as lab-on-a-chip. Results demonstrate the potential of the polymer microchannels with integrated nanohole arrays and interconnect as a packaged optical SPR detection device.

Pleomorphic adenoma of the breast. A case report and distinction from mucinous carcinoma.

Pleomorphic adenoma of the breast is a rare, benign tumor accounting for 68 cases in the literature. It is most commonly seen in postmenopausal women and is characterized by an admixture of epithelial and myoepithelial cells embedded in abundant myxomatous stroma. Its clinical and histologic appearance can be challenging and may lead to a misdiagnosis of invasive carcinoma. We report a case of mammary pleomorphic adenoma in an asymptomatic 59-year-old woman and briefly discuss its distinction from mucinous carcinoma through the use of special stains.

CXCR3 expression in human central nervous system diseases.

The CXCR3 chemokine receptor, expressed on activated T lymphocytes, is seen within the central nervous system (CNS) in inflammatory conditions where a T-cell response is prominent. However, the distribution of CXCR3 in parenchymal CNS cells is unknown. Using a monoclonal antibody against CXCR3 and post-mortem tissue of patients with and without CNS pathology, we have determined its expression pattern. CXCR3 was found in subpopulations of cells morphologically consistent with astrocytes, particularly reactive astrocytes, and in cerebellar Purkinje cells. It was also detected in arterial endothelial and smooth muscle cells, particularly in areas associated with atherosclerotic plaques. CXCR3-positive astrocytes were particularly prominent in the CNS of HIV-positive patients, in patients with Multiple Sclerosis (MS), in ischaemic infarcts and in astrocytic neoplasms. Immunofluorescence studies of mixed adult primary glial cultures and fetal glial cultures also showed expression of CXCR3 in astrocytes. CXCR3 mRNA was detected in Purkinje cells by in situ hybridization with a CXCR3-specific probe. Thus, the predominant expression of CXCR3 in reactive astrocytes may indicate that it plays a role in the development of reactive gliosis in a variety of infectious, inflammatory, vascular and neoplastic processes in the CNS. The relationship between CXCR3 expression in astrocytes to its expression in Purkinje cells, endothelial cells and smooth muscle cells is yet to be determined.

Cytology of melanotic schwannoma in a fine needle aspirate and pleural fluid. A case report.

BACKGROUND: Melanotic schwannoma (MS) is a rare pigmented neural tumor most commonly occurring in the paraspinal region and involving spinal nerve roots and sympathetic ganglia. Few case reports describe the fine needle aspiration (FNA) cytology of MS. We report an additional case and for the first time describe the cytologic findings of MS in pleural fluid. CASE: A 44-year-old man presented with a 9.0-cm paraspinal mass associated with multiple lung nodules. FNA cytology of the paraspinal mass showed solitary and syncytially arranged spindled cells, with prominent nucleoli and variable amounts of cytoplasmic brown pigment. In pleural fluid, prominent isolated single cells were rounded and had a signet ring cell morphology. Tumor cells in both the aspirate and pleural fluid expressed S-100 protein and HMB-45. CONCLUSION: The FNA cytology findings of MS correlate well with the histologic findings. In pleural fluid, however, the cells are epithelioid, and some have a signet ring morphology, mimicking adenocarcinoma.

Expression of multiple functional chemokine receptors and monocyte chemoattractant protein-1 in human neurons.

Functional chemokine receptors and chemokines are expressed by glial cells within the CNS, though relatively little is known about the patterns of neuronal chemokine receptor expression and function. We developed monoclonal antibodies to the CCR1, CCR2, CCR3, CCR6, CXCR2, CXCR3 and CXCR4 chemokine receptors to study their expression in human fetal neurons cultured from brain tissue as well as the clonally derived NT2.N human neuronal cell line (NTera 2/cl.D1). Specific monoclonal antibody labeling demonstrated expression of CCR2, CXCR2, CXCR3 and CXCR4 on neurons from both sources. Co-labeling studies revealed strong expression of CXCR3 and CXCR4 on both dendritic and axonal processes, with a weaker expression of CXCR2 and CCR2. Reverse transcriptase-polymerase chain reaction analysis of pure NT2.N neurons confirmed RNA expression for CCR2, CXCR2, CXCR3 and CXCR4. No changes in the neuronal labeling pattern of chemokine receptor expression were noted when NT2.N neurons were grown on a supporting layer of astrocytes, again consistent with similar patterns seen in primary human fetal brain cultures. Analysis of single-cell calcium transients revealed a robust response to stromal derived factor-1alpha (CXCR4) and melanocyte growth-stimulating activity (CXCR2), and variable response to monocyte chemoattractant protein-1 (CCR2) or interferon-gamma inducible protein-10 (CXCR3). Finally, we detected the release of monocyte chemoattractant protein-1 from pure cultures of NT2.N neurons, but not undifferentiated NT2 cells. These data indicate that individual neurons may not only co-express multiple functional chemokine receptors, but also that neurons themselves produce chemokines which may influence cellular function within the central nervous system.

Functional expression of the seven-transmembrane HIV-1 co-receptor APJ in neural cells.

APJ is a recently described seven-transmembrane (7TM) receptor that is abundantly expressed in the central nervous system (CNS). This suggests an important role for APJ in neural development and/or function, but neither its cellular distribution nor its function have been defined. APJ can also serve as a co-receptor with CD4 for fusion and infection by some strains of human immunodeficiency virus (HIV-1) in vitro, suggesting a role in HIV neuropathogenesis if it were expressed on CD4-positive CNS cells. To address this, we examined APJ expression in cultured neurons, astrocytes, oligodendrocytes, microglia and monocyte-derived macrophages utilizing both immunocytochemical staining with a polyclonal anti-APJ antibody and RT - PCR. We also analyzed the ability of a recently identified APJ peptide ligand, apelin, to induce calcium elevations in cultured neural cells. APJ was expressed at a high level in neurons and oligodendrocytes, and at lower levels in astrocytes. In contrast, APJ was not expressed in either primary microglia or monocyte-derived macrophages. Several forms of the APJ peptide ligand induced calcium elevations in neurons. Thus, APJ is selectively expressed in certain CNS cell types and mediates intracellular signals in neurons, suggesting that APJ may normally play a role in signaling in the CNS. However, the absence of APJ expression in microglia and macrophages, the prinicpal CD4-positive cell types in the brain, indicates that APJ is unlikely to mediate HIV-1 infection in the CNS.

Physiological significance of early deceleration time prolongation in asymptomatic elderly subjects.

BACKGROUND: Alterations in Doppler-derived diastolic filling patterns are common among elderly persons, but their physiological and prognostic significance remains uncertain, particularly in asymptomatic older persons without overt cardiac disease. This study was designed to determine whether early mitral inflow deceleration time (DT) prolongation is of physiological significance in asymptomatic elderly subjects. METHODS AND RESULTS: In 15 asymptomatic patients aged 60 to 93 years with no history of heart failure (HF) or edema, we performed two-dimensional and Doppler echocardiography and 60-minute head-out, isothermic water immersion to produce circulatory volume expansion. Plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured immediately before and after water immersion. Seven of 15 patients had a normal mitral early DT (160 to 240 milliseconds; group 1) and 8 of 15 patients had DT prolongation (> 240 milliseconds; group 2). Group 2 subjects had significantly smaller chamber sizes and increased relative wall thickness without increased left ventricular mass. Head-out water immersion produced greater increases in plasma ANP levels in group 2 subjects with longer DTs despite similar degrees of circulatory volume expansion in each group. In contrast, plasma BNP levels did not increase significantly with water immersion in either group. CONCLUSION: Early DT prolongation in asymptomatic elderly subjects is associated with increased relative wall thickness and enhanced ANP increments after central volume expansion. Such exaggerated responses suggest that, in the elderly, a prolonged DT has physiological significance and may represent a precursor to symptomatic diastolic HF, a condition known to be associated with advancing age.

Targeting of HIV- and SIV-infected cells by CD4-chemokine receptor pseudotypes.

Retroviral vectors containing CD4 and an appropriate chemokine receptor were evaluated for the ability to transduce cells infected with human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV). These CD4-chemokine receptor pseudotypes were able to target HIV- and SIV-infected cell lines and monocyte-derived macrophages in a manner that corresponded to the specificity of the viral envelope glycoprotein for its CD4-chemokine receptor complex. This approach could offer a way to deliver antiviral genes directly to HIV-infected cells in vivo and could provide an additional treatment strategy in conjunction with existing antiviral therapies.

Contralateral axillary lymph node metastasis as the first evidence of locally recurrent breast carcinoma.

BACKGROUND: Carcinoma of the breast infrequently presents initially as axillary adenopathy. In such cases, after biopsy proves the presence of metastatic carcinoma, the primary tumor generally is assumed to be in the ipsilateral breast, despite negative mammographic findings and the lack of a clinically palpable breast mass. METHODS: The authors recently studied a case of a 50-year-old woman in whom recurrent neuroendocrine carcinoma of the breast presented as a contralateral axillary lymph node metastasis. After mastectomy ipsilateral to the metastasis proved negative for tumor, a histologic comparison of the previous contralateral tumor with that in the lymph node was performed, followed by biopsy of the clinically and mammographically negative original lumpectomy site. RESULTS: Histologic and immunohistochemical studies proved that the original, metastatic, and locally recurrent tumors were identical, sharing unusual neuroendocrine features. The patient is currently disease free after chemotherapy. CONCLUSION: Contralateral mammary carcinoma should be considered in the workup of a patient who presents with evidence of an axillary lymph node metastasis. Locally recurrent breast carcinoma may be clinically and mammographically occult. Histologic review of prior biopsy material and comparison with current tissue is essential in proper patient management.

Effects of macrophage supernatants on mesangial cell migration and hillock formation.

There is considerable evidence suggesting a role for the macrophage (M phi) in the development of glomerulosclerosis (GS) and atherosclerosis, lesions which appear to be analogous. Migration of mesangial cells (MC), which are modified smooth muscle cells, may play a role in the pathogenesis of glomerular injury, and smooth muscle migration may play a role in the pathogenesis of atherosclerosis as well. We undertook the present study to determine the effects of M phi supernatants (M phi SN) on MC migration and formation of MC hillocks, which are considered an in vitro model of GS. By means of a migration assay using wounded cultures of confluent, growth-arrested MC, MC migration was found to be significantly enhanced by incubation with M phi SN at 24 hr (migration score: M phi SN, 24.3 +/- 1.3; control, 11.6 +/- 1.0, P < 0.001) as well as 48 hr incubation (migration score: M phi SN, 34.0 +/- 1.4; control, 15.4 +/- 1.4, P < 0.001). Enhanced MC migration following prolonged incubation with M phi SN was also shown using phase contrast microscopy and scanning electron microscopy. MC hillock formation was enhanced by M phi SN in a concentration-related manner as was hillock size. These data demonstrate that M phi SN can directly enhance MC migration and hillock formation, processes that may in part account for the observed role for the M phi in the development of mesangial expansion and GS as well as atherosclerosis.