The anatomy and function of a bilateral accessory flexor digitorum superficialis muscle: A case report and review of literature.

Anatomical variations of the flexor digitorum superficialis (FDS) include variations of the muscle belly and/or tendon. We present a case of a bilateral accessory FDS muscle and tendon. Dissection was performed in a male specimen (56 years), where an unusual variation was found: a bilateral accessory FDS muscle and tendon. The accessory FDS muscle belly originated at the medial epicondyle, between the tendinous portions of the FDS and flexor carpi radialis, with average dimensions of 70mm in length and 23mm in width. The accessory FDS muscle belly was innervated by the median nerve. After developing a strong tendon, with a length of 51mm (right) and 85mm (left) and width of approximately 9.5mm, the accessory FDS inserted into the dorsal muscle belly of the main FDS. To further analyze the variation, the left accessory FDS muscle and tendon were separated from the adjacent tissues at the elbow and kept attached at the wrist. On a custom jig, 10N were applied sequentially to the main and accessory FDS separately and then together to access their function. Loading of the main FDS muscle resulted in flexion of the fingers with accentuation of the ulnar rays. Loading of the accessory FDS caused flexion of all four long fingers. We described a rare case of an accessory flexor digitorum superficialis, which may assist surgeons with clinical decisions. Surgeons should be aware of variability in forearm anatomy.

Viscoelastic power law parameters of in vivo human brain estimated by MR elastography.

The noninvasive imaging technique of magnetic resonance elastography (MRE) was used to estimate the power law behavior of the viscoelastic properties of the human brain in vivo. The mechanical properties for four volunteers are investigated using shear waves induced over a frequency range of 10-50Hz to produce a displacement field measured by magnetic resonance motion-encoding gradients. The average storage modulus (µR) reconstructed with non-linear inversion (NLI) increased from approximately 0.95 to 2.58kPa over the 10-50Hz span; the average loss modulus (µI) also increased from 0.29 to 1.25kPa over the range. These increases were modeled by independent power law (PL) relations for µR and µI returning whole brain, group mean exponent values of 0.88 and 1.07 respectively. Investigation of these exponents also showed distinctly different behavior in the region of the cerebral falx compared to other brain structures.

Chronic Disease Management - The Patient's Perspective.

A paucity of data exists on Irish patients' perspective of chronic disease management. This study explores patients' views on what is the most appropriate setting for their chronic disease management, the advantages and disadvantages of these settings, and where they get information on their condition. Semi-structured qualitative interviews were carried out with 24 patients. Three main themes emerged: Current Care Model, Health Literacy and Treatment Burden. Patients believe that the GP-patient relationship plays a pivotal role in the provision of chronic disease management. Health literacy and psychosocial burden were found to impact significantly on the lives of patients with chronic disease(s).

Calibration of a two-color soft x-ray diagnostic for electron temperature measurement.

The two-color soft x-ray (SXR) tomography diagnostic on the Madison Symmetric Torus is capable of making electron temperature measurements via the double-filter technique; however, there has been a 15% systematic discrepancy between the SXR double-filter (SXRDF) temperature and Thomson scattering (TS) temperature. Here we discuss calibration of the Be filters used in the SXRDF measurement using empirical measurements of the transmission function versus energy at the BESSY II electron storage ring, electron microprobe analysis of filter contaminants, and measurement of the effective density. The calibration does not account for the TS and SXRDF discrepancy, and evidence from experiments indicates that this discrepancy is due to physics missing from the SXRDF analysis rather than instrumentation effects.

Suitability of poroelastic and viscoelastic mechanical models for high and low frequency MR elastography.

PURPOSE: Descriptions of the structure of brain tissue as a porous cellular matrix support application of a poroelastic (PE) mechanical model which includes both solid and fluid phases. However, the majority of brain magnetic resonance elastography (MRE) studies use a single phase viscoelastic (VE) model to describe brain tissue behavior, in part due to availability of relatively simple direct inversion strategies for mechanical property estimation. A notable exception is low frequency intrinsic actuation MRE, where PE mechanical properties are imaged with a nonlinear inversion algorithm. METHODS: This paper investigates the effect of model choice at each end of the spectrum of in vivo human brain actuation frequencies. Repeat MRE examinations of the brains of healthy volunteers were used to compare image quality and repeatability for each inversion model for both 50 Hz externally produced motion and ≈1 Hz intrinsic motions. Additionally, realistic simulated MRE data were generated with both VE and PE finite element solvers to investigate the effect of inappropriate model choice for ideal VE and PE materials. RESULTS: In vivo, MRE data revealed that VE inversions appear more representative of anatomical structure and quantitatively repeatable for 50 Hz induced motions, whereas PE inversion produces better results at 1 Hz. Reasonable VE approximations of PE materials can be derived by equating the equivalent wave velocities for the two models, provided that the timescale of fluid equilibration is not similar to the period of actuation. An approximation of the equilibration time for human brain reveals that this condition is violated at 1 Hz but not at 50 Hz. Additionally, simulation experiments when using the "wrong" model for the inversion demonstrated reasonable shear modulus reconstructions at 50 Hz, whereas cross-model inversions at 1 Hz were poor quality. Attenuation parameters were sensitive to changes in the forward model at both frequencies, however, no spatial information was recovered because the mechanisms of VE and PE attenuation are different. CONCLUSIONS: VE inversions are simpler with fewer unknown properties and may be sufficient to capture the mechanical behavior of PE brain tissue at higher actuation frequencies. However, accurate modeling of the fluid phase is required to produce useful mechanical property images at the lower frequencies of intrinsic brain motions.

An integrated data analysis tool for improving measurements on the MST RFP.

Many plasma diagnostics contain complementary information. For example, the double-foil soft x-ray system (SXR) and the Thomson Scattering diagnostic (TS) on the Madison Symmetric Torus both measure electron temperature. The complementary information from these diagnostics can be combined using a systematic method based on integrated data analysis techniques, leading to more accurate and sensitive results. An integrated data analysis tool based on Bayesian probability theory was able to estimate electron temperatures that are consistent with both the SXR and TS diagnostics and more precise than either. A Markov Chain Monte Carlo analysis to increase the flexibility of the tool was implemented and benchmarked against a grid search method.

Note: Effect of photodiode aluminum cathode frame on spectral sensitivity in the soft x-ray energy band.

Silicon photodiodes used for soft x-ray detection typically have a thin metal electrode partially covering the active area of the photodiode, which subtly alters the spectral sensitivity of the photodiode. As a specific example, AXUV4BST photodiodes from International Radiation Detectors have a 1.0 µm thick aluminum frame covering 19% of the active area of the photodiode, which attenuates the measured x-ray signal below ~6 keV. This effect has a small systematic impact on the electron temperature calculated from measurements of soft x-ray bremsstrahlung emission from a high-temperature plasma. Although the systematic error introduced by the aluminum frame is only a few percent in typical experimental conditions on the Madison Symmetric Torus, it may be more significant for other instruments that use similar detectors.

High-performance double-filter soft x-ray diagnostic for measurement of electron temperature structure and dynamics.

A new soft x-ray (SXR) T(e) and tomography diagnostic has been developed for MST that can be used for simultaneous SXR spectrum measurement, tomographically reconstructed emissivity, and reconstructed and line-of-sight electron temperature. The diagnostic utilizes high-performance differential transimpedance amplifiers (gain 10(5)-10(9)) to provide fast time response (up to 125 kHz), allowing for the study of plasma structure dynamics. SXR double-foil T(e) measurements are consistent with Thomson scattering. SXR brightness through a variety of filter thicknesses has been combined with charge exchange recombination spectroscopy (CHERS) impurity density measurements to determine the plasma energy spectrum. Magnetic pickup from the fluctuating magnetic fields in the plasma (B̃∼20 gauss at 10-20 kHz) has been dramatically reduced by improving the detector and housing design, so that nanoampere diode currents are now measured without interference from the substantial fluctuating magnetic field incident on the plasma facing surface of the probe.

Multiresolution MR elastography using nonlinear inversion.

PURPOSE: Nonlinear inversion (NLI) in MR elastography requires discretization of the displacement field for a finite element (FE) solution of the "forward problem", and discretization of the unknown mechanical property field for the iterative solution of the "inverse problem". The resolution requirements for these two discretizations are different: the forward problem requires sufficient resolution of the displacement FE mesh to ensure convergence, whereas lowering the mechanical property resolution in the inverse problem stabilizes the mechanical property estimates in the presence of measurement noise. Previous NLI implementations use the same FE mesh to support the displacement and property fields, requiring a trade-off between the competing resolution requirements. METHODS: This work implements and evaluates multiresolution FE meshes for NLI elastography, allowing independent discretizations of the displacements and each mechanical property parameter to be estimated. The displacement resolution can then be selected to ensure mesh convergence, and the resolution of the property meshes can be independently manipulated to control the stability of the inversion. RESULTS: Phantom experiments indicate that eight nodes per wavelength (NPW) are sufficient for accurate mechanical property recovery, whereas mechanical property estimation from 50 Hz in vivo brain data stabilizes once the displacement resolution reaches 1.7 mm (approximately 19 NPW). Viscoelastic mechanical property estimates of in vivo brain tissue show that subsampling the loss modulus while holding the storage modulus resolution constant does not substantially alter the storage modulus images. Controlling the ratio of the number of measurements to unknown mechanical properties by subsampling the mechanical property distributions (relative to the data resolution) improves the repeatability of the property estimates, at a cost of modestly decreased spatial resolution. CONCLUSIONS: Multiresolution NLI elastography provides a more flexible framework for mechanical property estimation compared to previous single mesh implementations.

Subzone based magnetic resonance elastography using a Rayleigh damped material model.

PURPOSE: Recently, the attenuating behavior of soft tissue has been addressed in magnetic resonance elastography by the inclusion of a damping mechanism in the methods used to reconstruct the resulting mechanical property image. To date, this mechanism has been based on a viscoelastic model for material behavior. Rayleigh, or proportional, damping provides a more generalized model for elastic energy attenuation that uses two parameters to characterize contributions proportional to elastic and inertial forces. In the case of time-harmonic vibration, these two parameters lead to both the elastic modulus and the density being complex valued (as opposed to the case of pure viscoelasticity, where only the elastic modulus is complex valued). METHODS: This article presents a description of Rayleigh damping in the time-harmonic case, discussing the differences between this model and the viscoelastic damping models. In addition, the results from a subzone based Rayleigh damped elastography study of gelatin and tofu phantoms are discussed, along with preliminary results from in vivo breast data. RESULTS: Both the phantom and the tissue studies presented here indicate a change in the Rayleigh damping structure, described as Rayleigh composition, between different material types, with tofu and healthy tissue showing lower Rayleigh composition values than gelatin or cancerous tissue. CONCLUSIONS: It is possible that Rayleigh damping elastography and the concomitant Rayleigh composition images provide a mechanism for differentiating tissue structure in addition to measuring elastic stiffness and attenuation. Such information could be valuable in the use of Rayleigh damped magnetic resonance elastography as a diagnostic imaging tool.

An octahedral shear strain-based measure of SNR for 3D MR elastography.

A signal-to-noise ratio (SNR) measure based on the octahedral shear strain (the maximum shear strain in any plane for a 3D state of strain) is presented for magnetic resonance elastography (MRE), where motion-based SNR measures are commonly used. The shear strain, γ, is directly related to the shear modulus, µ, through the definition of shear stress, τ = µÎ³. Therefore, noise in the strain is the important factor in determining the quality of motion data, rather than the noise in the motion. Motion and strain SNR measures were found to be correlated for MRE of gelatin phantoms and the human breast. Analysis of the stiffness distributions of phantoms reconstructed from the measured motion data revealed a threshold for both strain and motion SNR where MRE stiffness estimates match independent mechanical testing. MRE of the feline brain showed significantly less correlation between the two SNR measures. The strain SNR measure had a threshold above which the reconstructed stiffness values were consistent between cases, whereas the motion SNR measure did not provide a useful threshold, primarily due to rigid body motion effects.

A new double-foil soft x-ray array to measure T(e) on the MST reversed field pinch.

A soft x-ray (SXR) diagnostic to measure electron temperature on the Madison Symmetric Torus using two complementary methods is presented. Both methods are based on the double-foil technique, which calculates electron temperature via the ratio of SXR bremsstrahlung emission from the plasma in two different energy ranges. The tomographic emissivity method applies the double-foil technique to a tomographic reconstruction of SXR emissivity, creating a two-dimensional map of temperature throughout the plasma. In contrast, the direct brightness method applies the double-foil technique directly to the measured brightness and generates vertical and horizontal radial profiles. Extensive modeling demonstrates advantages and limitations in both techniques. For example, although the emissivity technique provides a two-dimensional mapping of temperature, its reliance on multiple tomographic inversions introduces some artifacts into the results. On the other hand, the more direct brightness technique avoids these artifacts but is only able to provide a radial profile of electron temperature.

Effects of frequency- and direction-dependent elastic materials on linearly elastic MRE image reconstructions.

The mechanical model commonly used in magnetic resonance elastography (MRE) is linear elasticity. However, soft tissue may exhibit frequency- and direction-dependent (FDD) shear moduli in response to an induced excitation causing a purely linear elastic model to provide an inaccurate image reconstruction of its mechanical properties. The goal of this study was to characterize the effects of reconstructing FDD data using a linear elastic inversion (LEI) algorithm. Linear and FDD phantoms were manufactured and LEI images were obtained from time-harmonic MRE acquisitions with variations in frequency and driving signal amplitude. LEI responses to artificially imposed uniform phase shifts in the displacement data from both purely linear elastic and FDD phantoms were also evaluated. Of the variety of FDD phantoms considered, LEI appeared to tolerate viscoelastic data-model mismatch better than deviations caused by poroelastic and anisotropic mechanical properties in terms of visual image contrast. However, the estimated shear modulus values were substantially incorrect relative to independent mechanical measurements even in the successful viscoelastic cases and the variations in mean values with changes in experimental conditions associated with uniform phase shifts, driving signal frequency and amplitude were unpredictable. Overall, use of LEI to reconstruct data acquired in phantoms with FDD material properties provided biased results under the best conditions and significant artifacts in the worst cases. These findings suggest that the success with which LEI is applied to MRE data in tissue will depend on the underlying mechanical characteristics of the tissues and/or organs systems of clinical interest.

Time-harmonic magnetic resonance elastography of the normal feline brain.

Imaging of the mechanical properties of in vivo brain tissue could eventually lead to non-invasive diagnosis of hydrocephalus, Alzheimer's disease and other pathologies known to alter the intracranial environment. The purpose of this work is to (1) use time-harmonic magnetic resonance elastography (MRE) to estimate the mechanical property distribution of cerebral tissue in the normal feline brain and (2) compare the recovered properties of grey and white matter. Various in vivo and ex vivo brain tissue property measurement strategies have led to the highly variable results that have been reported in the literature. MR elastography is an imaging technique that can estimate mechanical properties of tissue non-invasively and in vivo. Data was acquired in 14 felines and elastic parameters were estimated using a globo-regional nonlinear image reconstruction algorithm. Results fell within the range of values reported in the literature and showed a mean shear modulus across the subject group of 7-8 kPa with all but one animal falling within 5-15 kPa. White matter was statistically stiffer (p<0.01) than grey matter by about 1 kPa on a per subject basis. To the best of our knowledge, the results reported represent the most extensive set of estimates in the in vivo brain which have been based on MRE acquisition of the three-dimensional displacement field coupled to volumetric shear modulus image reconstruction achieved through nonlinear parameter estimation. However, the inter-subject variation in mean shear modulus indicates the need for further study, including the possibility of applying more advanced models to estimate the relevant tissue mechanical properties from the data.

Eosinophils in health and disease: the LIAR hypothesis.

Discussions of eosinophils are often descriptions of end-stage effector cells with destructive capabilities mediated predominantly by released cytotoxic cationic granule proteins. Moreover, eosinophils in the medical literature are invariably associated with the pathologies linked with helminth infections or allergic diseases such as asthma. This has led to an almost fatalist view of eosinophil effector functions and associated therapeutic strategies targeting these cells that would make even William of Ockham proud - eosinophil effector functions have physiological consequences that increase patient morbidity/mortality and 'the only good eosinophils are dead eosinophils'. Unfortunately, the strengths of dogmas are also their greatest weaknesses. Namely, while the repetitive proclamation of dogmatic concepts by authoritative sources (i.e. reviews, meeting proceedings, textbooks, etc.) builds consensus within the medical community and lower the entropies surrounding difficult issues, they often ignore not easily explained details and place diminished importance on alternative hypotheses. The goal of this perspective is twofold: (i) we will review recent observations regarding eosinophils and their activities as well as reinterpret earlier data as part of the synthesis of a new paradigm. In this paradigm, we hypothesize that eosinophils accumulate at unique sites in response to cell turnover or in response to local stem cell activity(ies). We further suggest that this accumulation is part of one or more mechanisms regulating tissue homeostasis. Specifically, instead of immune cells exclusively mediating innate host defence, we suggest that accumulating tissue eosinophils are actually regulators of Local Immunity And/or Remodeling/Repair in both health and disease - the LIAR hypothesis; (ii) we want to be inflammatory (pun intended!) and challenge the currently common perspective of eosinophils as destructive end-stage effector cells. Our hope is to create more questions than we answer and provoke everyone to spend countless hours simply to prove us wrong!

Cloned mice derived from embryonic stem cell karyoplasts and activated cytoplasts prepared by induced enucleation.

Our objective was to induce enucleation (IE) of activated mouse oocytes to yield cytoplasts capable of supporting development following nuclear transfer. Fluorescence microscopy for microtubules, microfilaments, and DNA was used to evaluate meiotic resumption after ethanol activation and the effect of subsequent transient treatments with 0.4 micro g/ml of demecolcine. Using oocytes from B6D2F1 (C57BL/6 x DBA/2) donors, the success of IE of chromatin into polar bodies (PBs) was dependent on the duration of demecolcine treatment and the time that such treatment was initiated after activation. Similarly, variations in demecolcine treatment altered the proportions of oocytes exhibiting a reversible compartmentalization of chromatin into PBs. Treatment for 15 min begun immediately after activation yielded an optimized IE rate of 21% (n = 80) when oocytes were evaluated after overnight recovery in culture. With this protocol, 30-50% of oocytes were routinely scored as compartmentalized when assessed 90 min postactivation. No oocytes could be scored as such following overnight recovery, with 66% of treated oocytes cleaving to the 2-cell stage (n = 80). Activated cytoplasts were prepared by mechanical removal of PBs from oocytes whose chromatin had undergone IE or compartmentalization. These cytoplasts were compared with mechanically enucleated, metaphase (M) II cytoplasts whose activation was delayed in nuclear transfer experiments using HM-1 embryonic stem cells. Using oocytes from either B6D2F1 or B6CBAF1 (C57BL/6 x CBA) donors, the in vitro development of cloned embryos using activated cytoplasts was consistently inferior to that observed using MII cytoplasts. Live offspring were derived from both oocyte strains using the latter, whereas a single living mouse was cloned from activated B6CBAF1 cytoplasts.

Clonal relationships in a shelter-associated outbreak of drug-resistant tuberculosis: 1983-1997.

SETTING: An outbreak of tuberculosis caused by Mycobacterium tuberculosis resistant to isoniazid and streptomycin (HS-resistant) was documented in Boston's homeless population in 1984. Isolate relatedness was confirmed at the time by phage typing. In the late 1990s, cases of HS-resistant tuberculosis in the homeless were also documented, confirmed by RFLP typing using IS6110. None of the phage typed isolates from the 1980s were viable for performing RFLP analysis. We attempted to determine, using mixed-linker PCR (M-L PCR) finger-printing, whether or not these cases were all due to the same strain of M. tuberculosis. DESIGN: Isolates from 10 HS-resistant patients-four non-viable isolates from the 1980s and six viable isolates from 1996-1997-were sent to the Centers for Disease Control and Prevention for M-L PCR fingerprinting. These results were combined with record reviews of older cases and an ongoing epidemiologic investigation. RESULTS: Eight of 10 of the isolates were clonal, and the other two were strongly suspected matches. Epidemiologic investigation determined that transmission continued to occur after the initial outbreak in 1984-1985, and that a streptomycin-monoresistant variant of the strain was also circulating. CONCLUSION: M-L PCR fingerprinting combined with epidemiology was able to document links between cases across 15 years.

Expression of IL-5 alters bone metabolism and induces ossification of the spleen in transgenic mice.

We have developed a transgenic mouse line, NJ.1638, which expresses high levels of IL-5 from T cells, with profound hematological consequences. Eosinophils comprise more than 60% of circulating white blood cells in these animals, with the total peripheral white blood cell counts increasing more than 40-fold relative to wild-type littermates. This extraordinary proliferative capacity is sustained by expanded sites of extramedullary hematopoiesis and is accompanied by multifocal, ectopic bone formation in the spleen. Histology of the splenic nodules revealed the presence of osteoid matrices and osteocytes trapped within mineralized trabecular plates. In addition, polarized light microscopy of calcified tissue sections revealed both woven bone and areas of organized lamellar bone. Morphometric assessments demonstrated that both the growth and mineralization of splenic bone occurred at rates nearly an order of magnitude higher than in skeletal bone. Skeletal bone metabolic parameters were also perturbed. We also observed heterotopic ossification of the spleen and perturbation of skeletal bone homeostasis following adoptive engraftment of transgenic marrow to wild-type recipients. These data suggest that IL-5 overexpression mediates bone formation through the mobilization of marrow-derived osteogenic progenitors and/or the inhibition of recruited osteoclasts.