Agenesis of the hemidiaphragm: a rare presentation in an adult.

Unilateral diaphragmatic agenesis is a rare finding in adult patients. We report a case of unilateral agenesis of diaphragm in a 22-year-old male patient to highlight the fact that a rare entity of agenesis of diaphragm can have a misleading presentation in adulthood due to both pulmonary and abdominal symptoms.

Scattering of the fundamental shear horizontal guided wave by a part-thickness crack in an isotropic plate.

The interaction of the fundamental shear horizontal (SH0) guided mode with part-thickness cracks in an isotropic plate is studied as an extension within the context and general framework of previous work ["Short range scattering of the fundamental shear horizontal guided wave mode normally incident at a through thickness crack in an isotropic plate," J. Acoust Soc. Am. 122, 1527-1538 (2007); "Angular influence on scattering when the fundamental shear horizontal guided wave mode is incident at a through-thickness crack in an isotropic plate," J. Acoust. Soc. Am. 124, 2021-2030 (2008)] by the authors with through-cracks. The symmetric incidence case where the principal direction of the incident beam bisects the crack face at 90 degrees is studied using finite element simulations validated by experiments and analysis, and conclusions are inferred for general incidence angles using insights obtained with the through-thickness studies. The influence of the crack length and the monitoring distance on the specular reflection is first examined, followed by a study of the angular profile of the reflected field. With each crack length considered, the crack depth and operating frequencies are varied. For all crack depths studied, the trend of the results is identical to that for the corresponding through-thickness case and the values differ only by a frequency dependent scale factor. Theoretical analysis is used to understand the physical basis for such behavior and estimates are suggested for the scale factor--exact for the high-frequency scattering regime and empirical for the medium- and low-frequency regimes.

Angular influence on the scattering of fundamental shear horizontal guided waves by a through-thickness crack in an isotropic plate.

The angular influence on the scattering of cylindrical-crested waves of the fundamental shear horizontal (SH0) guided mode by through-thickness cracks in an isotropic plate is studied in the context of array imaging using ultrasonic guided waves. Finite element simulations are used to obtain trends which are subject to analytical study and experimental confirmation. The influence of the incidence angle on reflection behavior is first studied in terms of two complementary cases, that of normal incidence and that of specular reflection at various oblique incidence angles. The normal incidence study suggests that for a given incidence angle, the peak reflection is concentrated around the specular direction, while the oblique incidence studies show that maximum specular reflection occurs in the case of normal incidence. The variation of diffraction with both the angle of incidence and that of monitoring is then taken up and this shows that when the first diffraction from the crack edges can be separated, its angular dependence can be obtained from literature on similar bulk elastic wave scattering problems.

Short range scattering of the fundamental shear horizontal guided wave mode normally incident at a through-thickness crack in an isotropic plate.

Interaction of the fundamental shear horizontal mode with through-thickness cracks in an isotropic plate is studied in the context of low frequency array imaging for ultrasonic guided wave nondestructive evaluation with improved resolution. Circular wave fronts are used and the symmetric case where a line from the wave source bisects the crack face normally is considered. Finite element simulations are employed to obtain trends subject to analytical and experimental validation. The influence of the crack length and of the location of source and measurement positions on the specular reflection from the crack face is first examined. These studies show that low frequency short range scattering is strongly affected by diffraction phenomena, leading to focusing of energy by the crack in the backscatter direction. Study of the diffraction from the crack edges reveals contributions due to a direct diffraction at the edges and multiple reverberations across the crack length. A simple diffraction model is shown to adequately represent cracks up to moderate lengths, providing an easy means of estimating the far field of the waves. The presence of multiple diffraction components is quantitatively established and surface waves on the crack face are identified as equivalent to low frequency symmetric modes of rectangular ridge waveguides.

Growth temperature dependence of optical modal gain and loss in GaN:Eu active medium on Si.

The dependence of optical modal gain and loss on GaN:Eu growth temperature is reported. GaN:Eu thin films were grown on Si substrates with AlGaN transition and cladding layers at temperatures ranging from 600 degrees C to 850 degrees C. The modal gain and loss in the GaN:Eu layer were a strong function of the optically active Eu atomic concentration and of the interface quality between the active layer and the top cladding layer, which in turn depended on the growth temperature. Optimum optical properties of maximum modal gain of ~ 100 cm(-1) and minimum loss of ~ 46 cm(-1) were obtained for growth at 800 degrees C.

Prediction and structural characterization of an independently folding substructure in the src SH3 domain.

Previous studies of the conformations of peptides spanning the length of the alpha-spectrin SH3 domain suggested that SH3 domains lack independently folding substructures. Using a local structure prediction method based on the I-sites library of sequence-structure motifs, we identified a seven residue peptide in the src SH3 domain predicted to adopt a native-like structure, a type II beta-turn bridging unpaired beta-strands, that was not contained intact in any of the SH3 domain peptides studied earlier. NMR characterization confirmed that the isolated peptide, FKKGERL, adopts a structure similar to that adopted in the native protein: the NOE and 3JNHalpha coupling constant patterns were indicative of a type II beta-turn, and NOEs between the Phe and the Leu side-chains suggest that they are juxtaposed as in the prediction and the native structure. These results support the idea that high-confidence I-sites predictions identify protein segments that are likely to form native-like structures early in folding.

NMR chemical shift perturbation mapping of DNA binding by a zinc-finger domain from the yeast transcription factor ADR1.

Mutagenesis studies have revealed that the minimal DNA-binding domain of the yeast transcription factor ADR1 consists of two Cys2-His2 zinc fingers plus an additional 20 residues proximal and N-terminal to the fingers. We have assigned NMR 1H, 15N, and 13C chemical shifts for the entire minimal DNA-binding domain of ADR1 both free and bound to specific DNA. 1H chemical shift values suggest little structural difference between the zinc fingers in this construct and in single-finger constructs, and 13C alpha chemical shift index analysis indicates little change in finger structure upon DNA binding. 1H chemical shift perturbations upon DNA binding are observed, however, and these are mapped to define the protein-DNA interface. The two zinc fingers appear to bind DNA with different orientations, as the entire helix of finger 1 is perturbed, while only the extreme N-terminus of the finger 2 helix is affected. Furthermore, residues N-terminal to the first finger undergo large chemical shift changes upon DNA binding suggesting a role at the protein-DNA interface. A striking correspondence is observed between the protein-DNA interface mapped by chemical shift changes and that previously mapped by mutagenesis.

Phosphorylation on histidine is accompanied by localized structural changes in the phosphocarrier protein, HPr from Bacillus subtilis.

The histidine-containing protein (HPr) of bacterial phosphoenolpyruvate:sugar phosphotransferase system (PTS) serves a central role in a series of phosphotransfer reactions used for the translocation of sugars across cell membranes. These studies report the high-definition solution structures of both the unphosphorylated and histidine phosphorylated (P-His) forms of HPr from Bacillus subtilis. Consistent with previous NMR studies, local conformational adjustments occur upon phosphorylation of His 15, which positions the phosphate group to serve as a hydrogen bond acceptor for the amide protons of Ala 16 and Arg 17 and to interact favorably with the alpha-helix macrodipole. However, the positively charged side chain of the highly conserved Arg 17 does not appear to interact directly with phospho-His 15, suggesting that Arg 17 plays a role in the recognition of other PTS enzymes or in phosphotransfer reactions directly. Unlike the results reported for Escherichia coli P-His HPr (Van Nuland NA, Boelens R, Scheek RM, Robillard GT, 1995, J Mol Biol 246:180-193), our data indicate that phosphorylation of His 15 is not accompanied by adoption of unfavorable backbone conformations for active site residues in B. subtilis P-Ser HPr.

Demonstration of protein-protein interaction specificity by NMR chemical shift mapping.

Chemical shift mapping is becoming a popular method for studying protein-protein interactions in solution. The technique is used to identify putative sites of interaction on a protein surface by detecting chemical shift perturbations in simple (1H, 15N)-HSQC NMR spectra of a uniformly labeled protein as a function of added (unlabeled) target protein. The high concentrations required for these experiments raise questions concerning the possibility for non-specific interactions being detected, thereby compromising the information obtained. We demonstrate here that the simple chemical shift mapping approach faithfully reproduces the known functional specificities among pairs of closely related proteins from the phosphoenolpyruvate:sugar phosphotransferase systems of Escherichia coli and Bacillus subtilis.

Solution structure of the phosphocarrier protein HPr from Bacillus subtilis by two-dimensional NMR spectroscopy.

The solution structure of the phosphocarrier protein, HPr, from Bacillus subtilis has been determined by analysis of two-dimensional (2D) NMR spectra acquired for the unphosphorylated form of the protein. Inverse-detected 2D (1H-15N) heteronuclear multiple quantum correlation nuclear Overhauser effect (HMQC NOESY) and homonuclear Hartmann-Hahn (HOHAHA) spectra utilizing 15N assignments (reported here) as well as previously published 1H assignments were used to identify cross-peaks that are not resolved in 2D homonuclear 1H spectra. Distance constraints derived from NOESY cross-peaks, hydrogen-bonding patterns derived from 1H-2H exchange experiments, and dihedral angle constraints derived from analysis of coupling constants were used for structure calculations using the variable target function algorithm, DIANA. The calculated models were refined by dynamical simulated annealing using the program X-PLOR. The resulting family of structures has a mean backbone rmsd of 0.63 A (N, C alpha, C', O atoms), excluding the segments containing residues 45-59 and 84-88. The structure is comprised of a four-stranded antiparallel beta-sheet with two antiparallel alpha-helices on one side of the sheet. The active-site His 15 residue serves as the N-cap of alpha-helix A, with its N delta 1 atom pointed toward the solvent to accept the phosphoryl group during the phosphotransfer reaction with enzyme I. The existence of a hydrogen bond between the side-chain oxygen atom of Tyr 37 and the amide proton of Ala 56 is suggested, which may account for the observed stabilization of the region that includes the beta-turn comprised of residues 37-40. If the beta alpha beta beta alpha beta (alpha) folding topology of HPr is considered with the peptide chain polarity reversed, the protein fold is identical to that described for another group of beta alpha beta beta alpha beta proteins that include acylphosphatase and the RNA-binding domains of the U1 snRNP A and hnRNP C proteins.

Phosphorylation of serine-46 in HPr, a key regulatory protein in bacteria, results in stabilization of its solution structure.

The serine-phosphorylated form of histidine-containing protein (HPr), a component of the phosphoenolpyruvate:sugar phosphotransferase system from Bacillus subtilis, has been characterized by NMR spectroscopy and solvent denaturation studies. The results indicate that phosphorylation of Ser 46, the N-cap of alpha-helix-B, does not cause a conformational change but rather stabilizes the helix. Amide proton exchange rates in helix-B are decreased and phosphorylation stabilizes the protein to solvent and thermal denaturation, with a delta delta G of 0.7-0.8 kcal mol-1. A mutant in which Ser 46 is replaced by aspartic acid shows a similar stabilization, indicating that an electrostatic interaction between the negatively charged groups and the helix macrodipole contributes significantly to the stabilization.

Thrombolysis in left-sided prosthetic valve occlusion: immediate and follow-up results.

Thrombolytic therapy is used increasingly for prosthetic valve thrombosis. Fear of peripheral embolism has limited its use in left-sided valve occlusions. Thirty-eight patients with prosthetic valve occlusion were treated with thrombolytic agents on 44 occasions. Duration of thrombolytic therapy was individualized. Patients were followed up with clinical, echocardiographic, and cine-fluoroscopic evaluation. Average time from onset of symptoms to presentation was 9.7 days. The anticoagulation status was inadequate in 70% of instances. The majority (75%) were in functional class IV, 8 of them being in shock. Overall success was seen in 88.6%: immediate complete success in 18 and partial in 21. Nine of those with partial success had delayed opening of the leaflets. There were nine instances of rethrombosis and one instance of re-rethrombosis; 6 patients received repeat thrombolysis with success in 5. Seventy-six percent (29/38) of the patients were surviving at the time of reporting. In conclusion, the present study demonstrates the feasibility of thrombolytic therapy for left-sided prosthetic valve occlusion. Delayed opening is common in patients with initial partial success. Rethrombosis remains a major problem.

Surgical pathology of mitral valves--the Indian scene.

Of the 75 cardiac valves excised at surgery over a 2 year period, 54 were mitral valves. Using simple morphological criteria along with clinical data, the valves were assigned to 2 major groups, rheumatic and non-rheumatic. The group with rheumatic disease accounted for 90% of cases. Mitral stenosis, incompetence and combined stenosis with incompetence were encountered with equal frequency (38, 38 and 24%). Mitral insufficiency of rheumatic etiology, no longer considered to be a major problem in the west, continues to be frequent in India. An increased incidence of mitral regurgitation in young females is an important feature noticed in this series.

Tetralogy of Fallot with flap valve ventricular septal defect producing suprasystemic right ventricular pressure: echocardiographic observations.

Tetralogy of Fallot with restrictive ventricular septal defect and suprasystemic right ventricular pressure is an uncommon anomaly with high mortality rate. Very few such cases have been reported pre-operatively. This report describes echocardiographic features of five patients with restrictive ventricular septal defect due to flap valve in tetralogy of Fallot. In all the five cases, accessory or excessive tricuspid valve tissue obstructed the defect. Recognition of restrictive ventricular septal defect in tetralogy of Fallot is important because it appears to have poor prognosis.

Cockroach in right main bronchus--an unusual foreign body.

Foreign body aspiration in children is not a uncommon clinical problem. Usually the foreign body is of vegetable origin. It is distinctly uncommon to find a living organism like cockroach, especially a large one as a foreign body in respiratory tract. Here we report one such rare experience.

Clinicopathological study of thymomas--correlation of histologic subtype to myasthenia gravis and prognosis.

Thymoma is the most common primary tumor of anterior superior mediastinum. Sixty cases of thymomas over a 12 year period were analysed and the histologic subtype, according to Marino and Muller-Hermilink, classification was correlated with presence or absence of myasthenia gravis (MG) and capsular invasion. Thirty four patients had myasthenia gravis associated with thymoma and there was one case of pure red cell aplasia. There were 3 (1) predominantly cortical, 28 (20) cortical, 12 (9) mixed, 16 (4) medullary thymomas and 1 (0) thymic carcinoma (Figures in parenthesis indicate number of cases associated with MG). Capsular invasion was seen in 25 cases. Association with myasthenia gravis and capsular invasion were seen predominantly in cortical and mixed thymomas which were also associated with aggressive behaviour.

The use of a powdered polysaccharide hemostat (HemoStase) in live donor nephrectomies controls bleeding and reduces postoperative complications.

OBJECTIVE: This study assesses the use of microporous hemospheres (hemoStase) procedures to control bleeding and reduce associated unfavorable sequelae in live donor nephrectomy (LDN). METHODS: Forty-four consecutive patients who underwent LDN between January 2009 and August 2009 were included in this prospective study. HemoStase (CryoLife, Inc), Kennesaw, Georgia) was used topically in the kidney bed to avoid bleeding. We recorded intraoperative and postoperative bleeding control, re-exploration to control bleeding, surgical site fluid collection, infection, and postoperative wound complications. RESULTS: Hemostasis was achieved in all 44 (100%) patients, none of whom experienced postoperative bleeding, fluid collection, infection or required re-exploration of the surgical site. CONCLUSION: HemoStase is a safe, facile hemostatic agent that effectively controls bleeding and reduces associated postoperative complications in LDN cases.

A fast and safe living donor "finger-assisted" nephrectomy technique: results of 359 cases.

OBJECTIVE: To determine operative parameters and complications, using a modified approach to mini-incision living donor nephrectomy. METHODS: Three hundred fifty-nine consecutive living donor procedures were performed between October 2000 and November 2008 using the finger-assisted, mini-incision living donor nephrectomy. Patient demographics, intraoperative parameters, and postoperative complications were prospectively recorded, including operative time, blood loss, incision length, warm ischemia time, and intraoperative adverse events. RESULTS: Mean donor age was 44.2 +/- 12.3 years (range, 21-75 years), with an average body mass index of 28.2 +/- 5.3 kg/m(2) (range, 17.1-44.9 kg/m(2)). Right-sided donor nephrectomies were performed on 23 patients (6%), and 41 donors (11%) were found to have multiple renal arteries. Median incision length was 6.8 cm (range, 3.5-15 cm). Average operative time was 117 minutes (range, 50-265 minutes), with a median blood loss of 109 mL (range, 20-500 mL) and an average warm ischemia time of 4.5 minutes (range, 1.5-10 minutes). Four patients (1%) required perioperative blood transfusions. There were no other intraoperative complications, no patients required reexploration, and there were no donor deaths. Thirteen patients (4%) developed minor postoperative complications, including two incisional herniae, but no patients developed chronic wound pain, over a median follow-up period of 19 months (range, 2-97 months). CONCLUSION: This prospective series demonstrated that a modified approach to open mini-incision nephrectomy can result in a smaller incision length while maintaining patient safety, with few postoperative complications.