Dynamic MR imaging patterns of cerebral fat embolism: a systematic review with illustrative cases.

Different MR imaging patterns of cerebral fat embolism have been reported in the literature without a systematic review. Our goal was to describe the patterns, explore the relationship between disease course and the imaging patterns, and discuss the underlying mechanism. We reveal 5 distinctive MR imaging patterns: 1) scattered embolic ischemia occurring dominantly at the acute stage; 2) confluent symmetric cytotoxic edema located at the cerebral white matter, which mainly occurs at the subacute stage; 3) vasogenic edematous lesions also occurring at the subacute stage; 4) petechial hemorrhage, which persists from the acute to the chronic stage; and 5) chronic sequelae, occurring at late stage, including cerebral atrophy, demyelinating change, and sequelae of infarction or necrosis. Underlying mechanisms of these imaging patterns are further discussed. Recognition of the 5 evolving MR imaging patterns of cerebral fat embolism may result in adjustment of the appropriate management and improve the outcome.

A versatile method for treating intracranial wide-neck aneurysms: catheter-assisted technique of three variations.

Successful management of aneurysms of complex morphology depends primarily on adjunct use of balloons or stents. However, these two methods are technically demanding and have higher complication rates. As an alternative to these two techniques, we have used a catheter-assisted technique with a number of cases. It is simple, versatile, and less demanding technically. This technique should be considered as an alternative strategy in cases of wide-necked aneurysms.

Mechanism of asynchronous Ca(2+) waves underlying agonist-induced contraction in the rat basilar artery.

BACKGROUND AND PURPOSE: Uridine 5'-triphosphate (UTP) is a potent vasoconstrictor of cerebral arteries and induces Ca(2+) waves in vascular smooth muscle cells (VSMCs). This study aimed to determine the mechanisms underlying UTP-induced Ca(2+) waves in VSMCs of the rat basilar artery. EXPERIMENTAL APPROACH: Isometric force and intracellular Ca(2+) ([Ca(2+)](i)) were measured in endothelium-denuded rat basilar artery using wire myography and confocal microscopy respectively. KEY RESULTS: Uridine 5'-triphosphate (0.1-1000 micromol.L(-1)) concentration-dependently induced tonic contraction (pEC(50) = 4.34 +/- 0.13), associated with sustained repetitive oscillations in [Ca(2+)](i) propagating along the length of the VSMCs as asynchronized Ca(2+) waves. Inhibition of Ca(2+) reuptake in sarcoplasmic reticulum (SR) by cyclopiazonic acid abolished the Ca(2+) waves and resulted in a dramatic drop in tonic contraction. Nifedipine reduced the frequency of Ca(2+) waves by 40% and tonic contraction by 52%, and the nifedipine-insensitive component was abolished by SKF-96365, an inhibitor of receptor- and store-operated channels, and KB-R7943, an inhibitor of reverse-mode Na(+)/Ca(2+) exchange. Ongoing Ca(2+) waves and tonic contraction were also abolished after blockade of inositol-1,4,5-triphosphate-sensitive receptors by 2-aminoethoxydiphenylborate, but not by high concentrations of ryanodine or tetracaine. However, depletion of ryanodine-sensitive SR Ca(2+) stores prior to UTP stimulation prevented Ca(2+) waves. CONCLUSIONS AND IMPLICATIONS: Uridine 5'-triphosphate-induced Ca(2+) waves may underlie tonic contraction and appear to be produced by repetitive cycles of regenerative Ca(2+) release from the SR through inositol-1,4,5-triphosphate-sensitive receptors. Maintenance of Ca(2+) waves requires SR Ca(2+) reuptake from Ca(2+) entry across the plasma membrane via L-type Ca(2+) channels, receptor- and store-operated channels, and reverse-mode Na(+)/Ca(2+) exchange.

Primary stabbing headache in a headache clinic.

Primary stabbing headache (PSH) is a short-lasting but troublesome headache disorder which has been known for several decades. We surveyed and registered consecutive patients with PSH in a headache clinic in Taiwan. A total of 80 patients (24 M/56 F, 53.2 +/- 16.2 years) were enrolled in our study. Migraine was reported in 20 (25%) patients and was less common in those with PSH onset at >50 years than those with onset at <50 years (14% vs. 38%, P = 0.02). The headache was unilateral in 59% of the patients and always in a fixed area in 36%. The head pain frequently involved extratrigeminal regions (70%) and in 30 patients (38%) was accompanied by jolts, i.e. head or body movements. Indomethacin was effective (74%) in patients who received it. Our study showed primary stabbing headache was a common and easily treated headache disorder in headache clinic. However, 70% of our patients could not fulfil criterion A 'exclusively or predominantly in the distribution of the first division of the trigeminal nerve' and 15% could not fulfil criterion C 'no accompanying symptoms' of the International Classification of Headache Disorders-II criteria proposed for PSH.

Structure determination of the hexagonal quasicrystal approximant micro'-(Al,Si)4Cr by the strong reflections approach.

A number of different crystalline phases have been found in Al-rich Al-Cr-Si alloys by transmission electron microscopy (TEM). Among these, the new hexagonal phase micro'-(Al,Si)(4)Cr (a=2.01 and c=1.24 nm) often found coexisting with the hexagonal micro-(Al,Si)(4)Cr (a=1.998 and c=2.4673 nm, isostructural with micro-Al(4)Mn) and also with the hexagonal lambda-(Al,Si)(4)Cr (a=2.839 and c=1.239 nm, isostructural with lambda-Al(4)Mn). It is evident from their electron diffraction patterns that the structures of these three phases are related. The strong reflections in all three are distributed in a similar way. They all exhibit a pseudo-icosahedral symmetry. The structure factor amplitudes and phases for the strong reflections of the micro' phase could therefore be adopted from those of the lambda phase, according to the strong reflections approach. A structure model of the micro' phase is thus deduced from the known lambda-Al(4)Mn. micro' consists of chains of 3+3 or 4+2 interpenetrated icosahedra along the 100 directions. Similar to the lambda phase, there are two flat layers (F) and four puckered layers (P) in each unit cell of micro', stacked along the c-axis in a sequence of PFP(PFP)' where the (PFP)' block is related to the PFP block by a 6(3) screw.

Structure model for the tau(mu) phase in Al-Cr-Si alloys deduced from the lambda phase by the strong-reflections approach.

There are very obvious common features in the electron diffraction patterns of the lambda and tau(mu) phases in the Al-Cr-Si system. The positions of the strong reflections and their intensity distributions are similar for the two structures. The relation of the reciprocal lattices of the lambda and tau(mu) phases is studied. By applying the strong-reflections approach, the structure factors of tau(mu) are deduced from the corresponding structure factors of the known lambda phase. Rules for selecting reflections for the strong-reflections approach are described. Similar to that of lambda, the structure of tau(mu) contains six layers stacked along the c axis in each unit cell. There are 752 atoms in each unit cell, 53 of them are unique. The corresponding composition of the tau(mu) model is Al(3.82 - x)CrSi(x). Simulated electron diffraction patterns from the structure model are in good agreement with the experimental ones. The arrangement of interpenetrated icosahedral clusters in the tau(mu) phase is discussed.

Fondaparinux: a potential new therapy for HIT.

Heparin has been the mainstay of treatment and prevention of venous and arterial thromboembolism for many years. Its use, however, is associated with a serious and potentially fatal immunological drug reaction termed heparin-induced thrombocytopenia (HIT). Current treatment consists of discontinuing heparin therapy and the administration of an alternate anticoagulant (e.g. danaparoid, lepirudin, bivalirudin or argatroban). Fondaparinux is a novel synthetic heparin pentasaccharide capable of inhibiting factor Xa via the action of antithrombin (AT) but devoid of anti-factor IIa (thrombin) activity. Although the drug is identical in structure to the pentasaccharide domain found on unfractionated heparin (UH), it is too small to be recognized by the majority of heparin-reactive antibodies. It is theoretically an excellent candidate agent for the treatment of HIT. Currently, fondaparinux is licensed for orthopaedic venous thromboprophylaxis but not for the treatment of HIT. Successes in the use of fondaparinux in the treatment of HIT, as demonstrated in recent published case reports, warrant further study in larger controlled trials for this indication.

Distinct temporal activity patterns in the rat M1 and red nucleus during skilled versus unskilled limb movement.

The mammalian motor system contains multiple interconnected supraspinal networks, but little is known about their relative roles in producing different movements and behaviors, particularly given their apparently fused activity in primates. We tested whether the task context, as well as using a phylogenetically older mammal, rats, could distinguish the separate contributions of these networks. We obtained simultaneous multi-single neuron recordings from the forelimb motor cortex and magnocellular red nucleus as rats performed two contextually different, but kinematically similar, forelimb reach-like tasks: highly learned, skilled reaching for food through a narrow slot, a task requiring extensive training, versus the swing phases of treadmill locomotion. In both the M1 and the mRN, large subpopulations of neurons peaked in their spike firing rates near the onset and the end of the swing phase during treadmill locomotion. In contrast, neural subgroups in the two areas displayed different temporal sequences of activity during the skilled reaching task. In the mRN, the majority of task-modulated neurons peaked in their firing rate in the middle of the reach when the rat was preparing to project the arm through the slot, whereas large subgroups of M1 neurons displayed elevated firing rates during the initial and terminal phases of the reach. These results suggest that motor-behavioral context can alter the degree of overlapping activity in different supraspinal sensorimotor networks. Moreover, results for the skilled reaching task in rats may have highlighted a distinct processing role of the rubral complex: adapting natural muscle synergies across joints and limbs to novel task demands, in concert with cortically based learning.

Ultrastructure of airway smooth muscle.

There is an abundance of ultrastructural data in the literature on vascular, visceral, and other smooth muscles; such data on airway smooth muscle, however, are conspicuously missing. Here we present a series of electron micrographs depicting contractile and cytoskeletal elements as well as organelles in porcine trachealis. Myosin thick filaments are present in the relaxed muscle; thick filament density increases substantially when the muscle is activated. Actin thin filaments are present in large excess over the thick filaments; the thin/thick filament ratio is about 31/1 in the relaxed state; this ratio is reduced to about 22/1 when the muscle is activated. The sarcoplasmic reticulum is often found associated with caveolae and mitochondria. Cells within a bundle are well connected by intermediate and gap junctions. The results demonstrate that quantitative morphological analysis of ultrastructure of airway smooth muscle fixed under different functional states is possible and will be essential in elucidating the structural basis of adaptation and contraction of the muscle.

Three-dimensional reconstruction of the nu-AlCrFe phase by electron crystallography.

The three-dimensional (3D) structure of the huge quasicrystal approximant nu-AlFeCr (space group P6(3)/m, a = 40.687 and c = 12.546 A) was solved by electron crystallography. High-resolution transmission-electron-microscopy (HREM) images and selected-area electron diffraction patterns from 13 different zone axes were combined to give a 3D potential map. 124 out of 129 unique atoms were found in the 3D map. Procedures for ab initio structure determination by 3D reconstruction are given. It is demonstrated that 3D reconstruction from HREM images is very powerful for solving structures--even very complicated ones. There is no limit in terms of the number of unique atoms in a structure that can be solved by 3D reconstruction.

Myosin light chain phosphorylation facilitates in vivo myosin filament reassembly after mechanical perturbation.

Phosphorylation of the 20-kDa regulatory myosin light chain (MLC) of smooth muscle is known to cause monomeric myosins in solution to self-assemble into thick filaments. The role of MLC phosphorylation in thick filament formation in intact muscle, however, is not clear. It is not known whether the phosphorylation is necessary to initiate thick filament assembly in vivo. Here we show, by using a potent inhibitor of MLC kinase (wortmannin), that the MLC phosphorylation and isometric force in trachealis muscle could be abolished without affecting calcium transients. By measuring cross-sectional densities of the thick filaments electron microscopically, we also show that inhibition of MLC phosphorylation alone did not cause disassembly of the filaments. The unphosphorylated thick filaments, however, partially dissolved when the muscle was subjected to oscillatory strains (which caused a 25% decrease in the thick filament density). The postoscillation filament density recovered to the preoscillation level only when wortmannin was removed and the muscle was stimulated. The data suggest that in vivo thick filament reassembly after mechanical perturbation is facilitated by the cyclic MLC phosphorylation associated with repeated stimulation.

Myosin thick filament lability induced by mechanical strain in airway smooth muscle.

Airway smooth muscle adapts to different lengths with functional changes that suggest plastic alterations in the filament lattice. To look for structural changes that might be associated with this plasticity, we studied the relationship between isometric force generation and myosin thick filament density in cell cross sections, measured by electron microscope, after length oscillations applied to the relaxed porcine trachealis muscle. Muscles were stimulated regularly for 12 s every 5 min. Between two stimulations, the muscles were submitted to repeated passive +/- 30% length changes. This caused tetanic force and thick-filament density to fall by 21 and 27%, respectively. However, in subsequent tetani, both force and filament density recovered to preoscillation levels. These findings indicate that thick filaments in airway smooth muscle are labile, depolymerization of the myosin filaments can be induced by mechanical strain, and repolymerization of the thick filaments underlies force recovery after the oscillation. This thick-filament lability would greatly facilitate plastic changes of lattice length and explain why airway smooth muscle is able to function over a large length range.

Surface reaction of stoichiometric and calcium-deficient hydroxyapatite in simulated body fluid.

In the present study, the immersion behavior of two kinds of sintered HA with different Ca/P ratios in two different extracellular simulated solutions (Tris buffer and Hank's solutions) was investigated and compared. Results indicated that an as-received Ca-deficient HA (FHA) had a lower Ca/P ratio, larger linear shrinkage and higher density than a stoichiometric HA (MHA). When FHA powder was calcined at 900 degrees C, its Ca-deficient apatite structure was unstable and a significant amount of beta-TCP phase was formed. When heated to 1250 degrees C in air, the highly crystalline apatite structure of MHA was still stable without any noticeable decomposition. The FTIR spectra indicated that both immersed MHA and FHA in Hank's solution were gradually covered with a layer of precipitated apatite during immersion. When immersed in Tris buffer solution, neither HA showed significant changes in their FTIR spectra. SEM observation indicated that the precipitation rate on immersed FHA surface was much higher than that on MHA surface when immersed in Hank's solution. The weight loss and pH data confirmed the higher dissolution rate of FHA than MHA in Hank's solution.

Direct observation of molecular images of lanthanide phthalocyanines: III. Structural defects.

The crystal imperfections in thin films of lanthanide phthalocyanines (LnPc2H, Ln = Nd, Tb, Er, Tm, Yb, and Lu) grown expitaxially on KCl have been observed by molecular imaging. Grain and twin boundaries, stacking faults, point defects, vacancies, mosaic structures, and sometimes even some amorphous islands exist in the well-crystallized specimens. Combined with the results reported earlier, the packing characteristics of planar LnPc2H molecules can be well understood.

High-resolution electron microscopic investigation of supported platinum particles reduced at high temperatures.

High-resolution electron microscopy has been used to characterize the platinum particles supported on TiO2 or ZnO. After reduction at elevated temperatures, the metallic particles display a regular, faceted shape, and several superstructures, Pt3 Ti(C), Pt3 Ti(H), PtTi, and PtZn, have been found. These results, which may involve strong metal-support interaction, have been confirmed by optical diffraction and image simulation.

Structural studies of lanthanide phthalocyanines by high-resolution electron microscopy.

Epitaxial films of lanthanide phthalocyanines (LnPc2H, Ln = Nd, Tb, Er, Tm, Yb, or Lu) formed on a KCl or NaCl crystal have been studied by means of high-resolution electron microscopy. These complexes are isomorphous and have both tetragonal and base-centered orthorhombic structures. Though radiation damage makes it difficult to study these beam-sensitive materials by electron microscopy, the behaviors of thin film growth and details of structural defects can still be identified at the molecular level.

Quasicrystals and noncrystallographic symmetry.

New findings on quasicrystals with icosahedral, octagonal, decagonal, and dodecagonal symmetries obtained recently in the Beijing Laboratory of Electron Microscopy, Chinese Academy of Sciences, are presented. Special emphasis is put on the relation between quasicrystalline and crystalline structures. The important role played by electron diffraction and high-resolution electron microscopy in revealing these quasiperiodic structures is pointed out.

Coactivation of synergistic muscles of different fiber types in fast and slow contractions.

The electrical activity of four pairs of synergistic muscles-the long head of triceps brachii and anconeus, lateral gastrocnemius and soleus, the long and short heads of biceps brachii, and rectus femoris and vastus medialis-was studied during isometric contractions of varying speed. Each muscle pair consists of a two-joint muscle and a one-joint muscle. Two of the one-joint muscles, anconeus and soleus, are composed predominantly of red muscle fibers and are called red muscles; all the remaining muscles are composed predominantly of pale fibers and are therefore called pale muscles. Synergistic pairs of muscles in which the muscles are both pale become active simultaneously in movement of all speeds. No difference in usage of such muscles was found as a function of movement speed. In synergistic muscle pairs composed of a red and a pale muscle, a slow movement was always initiated by the red muscle, whose electrical activity predominated throughout the movement. In a rapid movement, the pale muscle could be initially most active. However, movements of equal speed could be initiated by the red muscle. Thus the speed of a contraction is a necessary but not a sufficient condition for reversals of muscle activation.

Modification of valinomycin-mediated bilayer membrane conductance by 4,5,6,7-tetrachloro-2-methylbenzimidazole.

The compound 4,5,6,7-tetrachloro-2-methylbenzimidazole (TMB), has been found to markedly modify the steady-state valinomycin-mediated conductance of potassium (K+) ions through lipid bilayer membranes. TMB alone does not contribute significantly to membrane conductance, being electrically neutral in solution. In one of two classes of experiments (I), valinomycin is first added to the aqueous phases, then changes of membrane conductance accompanying stepwise addition of TMB to the water are measured. In a second class of experiments (II), valinomycin is added to the membrane-forming solution, followed by TMB additions to the surrounding water. In both cases membrane conductance shows an initial increase with increasing TMB concentration which is more pronounced at lower K+ ion concentration. At TMB concentrations in excess of 10(-5) M, membrane conductance becomes independent of K+ ion concentration, in contrast to the linear dependence observed at TMB concentrations below 10(-7) M. This transition is accompanied by a change of high field current-voltage characteristics from superlinear (or weakly sublinear) to a strongly sublinear form. All of these observations may be correlated by the kinetic model for carrier-mediated transport proposed by Läuger and Stark (Biochim. Biophys. Acta 211:458, 1970) from which it may be concluded that valinomycin-mediated ion transport is limited by back diffusion of the uncomplexed carrier at high TMB concentrations. Experiments of class I reveal a sharp drop of conductance at high (greater than 10(-5) M) TMB concentration, not seen in class II experiments, which is attributed to blocked entry of uncomplexed carrier from the aqueous phases. Valinomycin initially in the membrane is removed by lateral diffusion to the surrounding torus. The time dependence of this removal has been studied in a separate series of experiments, leading to a measured coefficient of lateral diffusion for valinomycin of 5 x 10(-6) cm2/sec at 25 degrees C. This value is about two orders of magnitude larger than the corresponding coefficient for transmembrane carrier diffusion, and provides further evidence for localization of valinomycin in the membrane/solution interfaces.