A giant right atrial myxoma-The growth rate and multi-modality imaging.

A young and healthy woman presented with progressive dyspnea on exertion. An echocardiogram showed a giant right atrial mass. Cardiac CT angiography provided the most accurate estimate for the tumor size, while 2-D echo, 2-D, and 3-D trans-esophageal echo underestimated the dimensions of the cardiac tumor when referenced by the surgical specimen. We also calculated the growth rate of the right atrial myxoma to be at least 1.2 mm per month based on a normal chest CT 54 months before her presentation. Surgical pathology confirmed typical features of cardiac myxoma in the right atrium.

Attachment style, social support and finding meaning among spouses of colorectal cancer patients: gender differences.

OBJECTIVES: The current study explores the relationship between attachment styles, social support, gender and finding meaning in caregiving among spousal caregivers of colorectal cancer patients. METHODS: Sixty caregivers (30 men and 30 women) were administered questionnaires assessing attachment styles, social support and finding meaning in caregiving, using a cross-sectional design. RESULTS: For male caregivers avoidance attachment is associated with their finding meaning, whereas for female caregivers social support is associated with their finding meaning. SIGNIFICANCE OF RESULTS: Psychological interventions for caregivers should take into consideration gender differences and might benefit from addressing the process of finding meaning in caregiving.

Analytical and numerical analyses of the micromechanics of soft fibrous connective tissues.

State of the art research and treatment of biological tissues require accurate and efficient methods for describing their mechanical properties. Indeed, micromechanics-motivated approaches provide a systematic method for elevating relevant data from the microscopic level to the macroscopic one. In this work, the mechanical responses of hyperelastic tissues with one and two families of collagen fibers are analyzed by application of a new variational estimate accounting for their histology and the behaviors of their constituents. The resulting close-form expressions are used to determine the overall response of the wall of a healthy human coronary artery. To demonstrate the accuracy of the proposed method, these predictions are compared with corresponding 3D finite element simulations of a periodic unit cell of the tissue with two families of fibers. Throughout, the analytical predictions for the highly nonlinear and anisotropic tissue are in agreement with the numerical simulations.

Fluid structure interaction with contact surface methodology for evaluation of endovascular carotid implants for drug-resistant hypertension treatment.

Drug-resistant hypertensive patients may be treated by mechanical stimulation of stretch-sensitive baroreceptors located in the sinus of carotid arteries. To evaluate the efficacy of endovascular devices to stretch the carotid sinus such that the induced strain might trigger baroreceptors to increase action potential firing rate and thereby reduce systemic blood pressure, numerical simulations were conducted of devices deployed in subject-specific carotid models. Two models were chosen--a typical physiologic carotid and a diminutive atypical physiologic model representing a clinically worst case scenario--to evaluate the effects of device deployment in normal and extreme cases, respectively. Based on the anatomical dimensions of the carotids, two different device sizes were chosen out of five total device sizes available. A fluid structure interaction (FSI) simulation methodology with contact surface between the device and the arterial wall was implemented for resolving the stresses and strains induced by device deployment. Results indicate that device deployment in the carotid sinus of the physiologic model induces an increase of 2.5% and 7.5% in circumferential and longitudinal wall stretch, respectively, and a maximum of 54% increase in von Mises arterial stress at the sinus wall baroreceptor region. The second device, deployed in the diminutive carotid model, induces an increase of 6% in both circumferential and longitudinal stretch and a 50% maximum increase in von Mises stress at the sinus wall baroreceptor region. Device deployment has a minimal effect on blood-flow patterns, indicating that it does not adversely affect carotid bifurcation hemodynamics in the physiologic model. In the smaller carotid model, deployment of the device lowers wall shear stress at sinus by 16% while accelerating flow entering the external carotid artery branch. Our FSI simulations of carotid arteries with deployed device show that the device induces localized increase in wall stretch at the sinus, suggesting that this will activate baroreceptors and subsequently may control hypertension in drug-resistant hypertensive patients, with no consequential deleterious effects on the carotid sinus hemodynamics.

Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience.

BACKGROUND: There is no widely adopted, easily applied method for distinguishing between adenomatous and nonadenomatous polyps during real-time colonoscopy. OBJECTIVE: To compare white light (WL) with narrow-band imaging (NBI) for the differentiation of colorectal polyps in vivo and to assess for a learning curve. DESIGN: A prospective polyp series. PATIENTS AND SETTING: A total of 302 patients referred for colonoscopy, between August 2006 and July 2007, to a single tertiary-referral center in the United States. INTERVENTION: Standard WL colonoscopy was performed with Olympus 180-series colonoscopes. Each detected polyp was first characterized by WL and then by NBI. Modified Kudo pit pattern and vascular color intensity (VCI) were recorded, and the histology was predicted. Endoscopists were given feedback every 2 weeks. MAIN OUTCOME MEASUREMENTS: Overall accuracy and sensitivity and specificity of endoscopic diagnosis by using WL alone and with NBI, as well as improvement in endoscopists' performance. RESULTS: A total of 265 polyps were found in 131 patients. Diagnostic accuracy was 80% with NBI and 77% with WL (P = .35). NBI performed better than WL in diagnosing adenomas (sensitivity 80% vs 69%, P < .05). Nonadenomatous polyps were more likely to have a "light" VCI compared with adenomas (71% vs 29%, P < .001). During the second half of the study, NBI accuracy improved, from 74% to 87%, and outperformed an unchanged WL accuracy of 79% (P < .05). CONCLUSIONS: Overall, NBI was not more accurate than WL in differentiating colorectal polyps in vivo; however, once a learning curve was achieved, NBI performed significantly better. Further refinements of an NBI pit-pattern classification and VCI scale are needed before broad application to clinical decisions regarding the necessity of polypectomy.

An Oct-1 binding site mediates activation of the gata2 promoter by BMP signaling.

The gata2 gene encodes a transcription factor implicated in regulating early patterning of ectoderm and mesoderm, and later in numerous cell-specific gene expression programs. Activation of the gata2 gene during embryogenesis is dependent on the bone morphogenetic protein (BMP) signaling pathway, but the mechanism for how signaling controls gene activity has not been defined. We developed an assay in Xenopus embryos to analyze regulatory sequences of the zebrafish gata2 promoter that are necessary to mediate the response to BMP signaling during embryogenesis. We show that activation is Smad dependent, since it is blocked by expression of the inhibitory Smad6. Deletion analysis identified an octamer binding site that is necessary for BMP-mediated induction, and that interacts with the POU homeodomain protein Oct-1. However, this element is not sufficient to transfer a BMP response to a heterologous promoter, requiring an additional more proximal cooperating element. Based on recent studies with other BMP-dependent promoters (Drosophila vestigial and Xenopus Xvent-2), our studies of the gata2 gene suggest that POU-domain proteins comprise a common component of the BMP signaling pathway, cooperating with Smad proteins and other transcriptional activators.

Hematopoiesis and retinoids: development and disease.

Retinoids function as activating ligands for a class of nuclear receptors that control gene expression programs for a wide range of tissues and organs during embryogenesis and throughout life. Over the years, three sets of observations have spurred interest in the function of retinoids with respect to development and disease of hematopoietic cells. Since the 1920s, epidemiological studies indicated altered hematopoiesis in vitamin A-deficient (VAD) human populations. More recently, the ability of retinoids to affect various aspects of hematopoietic development has been demonstrated in vitro. Finally, it was discovered that the gene encoding a retinoid receptor is a key target for chromosomal translocations that cause acute promyelocytic leukemia (APL). More recent investigations using targeted gene disruptions, VAD animal models, and mouse models of leukemia have continued to shed light on the function of the retinoid pathway in blood cells. It is now clear that retinoids are required for normal hematopoiesis during both yolk sac and fetal liver stages of hematopoiesis, while the pathway has at least modulatory functions for bone marrow derived progenitors. Studies of normal development and APL have provided complementary insight into the molecular control of blood cell differentiation. Here we review the evidence for retinoid requirements in hematopoiesis and also summarize current ideas regarding how this pathway is subverted in leukemia.