Similar activation state of neutrophils in sputum of asthma patients irrespective of sputum eosinophilia.

Inflammatory phenotypes of asthma are associated with differences in disease characteristics. It is unknown whether these inflammatory phenotypes are reflected by the activation status of neutrophils in blood and sputum. We obtained peripheral blood and induced sputum from 21 asthma patients and stratified our samples based on sputum eosinophilia resulting in two groups (>3% eosinophils: n = 13, <3%: n = 8). Eosinophils and neutrophils from blood and sputum were analysed for expression of activation and degranulation markers by flow cytometry. Data were analysed by both classical, non-parametric statistics and a multi-dimensional approach, using principal component analysis (PCA). Patients with sputum eosinophilia were characterized by increased asthma control questionnaire (ACQ) scores and blood eosinophil counts. Both sputum neutrophils and eosinophils displayed an activated and degranulated phenotype compared to cells obtained from blood. Specifically, degranulation of all granule types was detected in sputum cells, combined with an increased expression of the activation markers (activated) Mac-1 (CD11b), programmed death ligand 1 (PD-L1) (CD274) and a decreased expression of CD62L. CD69 expression was only increased on sputum eosinophils. Surface marker expression of neutrophils was similar in the presence or absence of eosinophilia, either by single or multi-dimensional analysis. Sputum neutrophils were highly activated and degranulated irrespective of sputum eosinophilia. Therefore, we conclude that differences in granulocyte activation in sputum and/or blood are not associated with clinical differences in the two groups of asthma patients. The finding of PD-L1 expression on sputum granulocytes suggests an immunomodulatory role of these cells in the tissue.

Induction of pre-infection thread structures in the leguminous host plant by mitogenic lipo-oligosaccharides of Rhizobium.

Root nodules of leguminous plants are symbiotic organs in which Rhizobium bacteria fix nitrogen. Their formation requires the induction of a nodule meristem and the formation of a tubular structure, the infection thread, through which the rhizobia reach the nodule primordium. In the Rhizobium host plants pea and vetch, pre-infection thread structures always preceded the formation of infection threads. These structures consisted of cytoplasmic bridges traversing the central vacuole of outer cortical root cells, aligned in radial rows. In vetch, the site of the infection thread was determined by the plant rather than by the invading rhizobia. Like nodule primordia, pre-infection thread structures could be induced in the absence of rhizobia provided that mitogenic lipo-oligosaccharides produced by Rhizobium leguminosarum biovar viciae were added to the plant. In this case, cells in the two outer cortical cell layers containing cytoplasmic bridges may have formed root hairs. A common morphogenetic pathway may be shared in the formation of root hairs and infection threads.

Radiology of severe acute respiratory syndrome (SARS): the emerging pathologic-radiologic correlates of an emerging disease.

Severe acute respiratory distress syndrome (SARS) caused by SARS-associated coronavirus (SARS-CoV) is a systemic infection that clinically manifests as progressive pneumonia. During the initial phases of infection the virus causes pauci-inflammatory alveolar and interstitial edema that result in imaging abnormalities dominated by ground glass opacities (GGO). Severe SARS cases can develop radiologic and pathologic findings of diffuse alveolar damage. Although radiologic evidence of acute bronchiolitis is absent, SARS-CoV also infects ciliated airway epithelium, probably accounting for respiratory transmissibility of the virus. Radiologic recovery from SARS can be complete, but computed tomography images often show persistent GGO and reticular opacities, some of which reflect pathologic findings of fibrosis. Long-term follow-up imaging of survivors shows gradual decrease of GGO and reticulation with persistent air trapping in some patients. The latter is evidence of small airway disease that is not radiologically evident at the onset of the disease.

Visualization and measurement of flow velocity and flow reserve in aortocoronary saphenous vein bypass grafts by transesophageal echocardiography.

Transesophageal echocardiography was used to image bypass grafts and measure flow reserve in these conduits. Imaging and measurement of flow reserve were feasible in most patients.

Comparison of Doppler echocardiographic and hemodynamic indexes of left ventricular diastolic properties in coronary artery disease.

Transmitral flow velocity was measured by Doppler echocardiography in 15 patients with coronary artery disease simultaneously with high-fidelity recording of left ventricular pressure. Doppler echocardiographic recordings were also performed in 14 age- and heart rate-matched normal subjects. Statistically significant differences (p less than 0.05) in acceleration half-time (55.3 +/- 8.2 vs 70.4 +/- 14.9 ms), deceleration half-time (83.1 +/- 17.9 vs 109.5 +/- 18.1 ms), deceleration rate (4.9 +/- 0.9 vs 3.1 +/- 0.9 m/s2), peak velocity of early diastolic left ventricular inflow (E wave) (0.78 +/- 0.13 vs 0.61 +/- 0.13 m/s) and A/E ratio (0.74 +/- 0.20 vs 0.98 +/- 0.31) between normal subjects and patients were noted. There was no significant difference in peak velocity of atrial systolic flow (A wave) between normal subjects and patients. Correlation between transmitral flow indexes and hemodynamic indexes of left ventricular diastolic properties were poor, with r values ranging from 0.02 to 0.65. Significant correlations between deceleration rate versus maximal isovolumic left ventricular pressure decrease (maximum -dP/dt) and A wave versus maximum -dP/dt (p less than 0.05) were found (0.53 and 0.65, respectively). Deceleration rate was the most sensitive index of isovolumic relaxation assessed by hemodynamic methods, whereas the A/E ratio was a poor indicator of hemodynamic measurements of isovolumic relaxation. An abnormal deceleration rate had 100% specificity for detecting abnormal maximum -dP/dt, while abnormal acceleration half-time, deceleration half-time and A/E ratio had 80% specificity for detecting abnormal time constant. The deceleration rate, acceleration half-time, deceleration half-time and A/E ratio had a predictive value of 60 to 100% for the detection of abnormal maximum -dP/dt and time constant.

Hierarchic patterning: architectures beyond 'giant molecular wheels'.

Based on symmetry breaking steps under one-pot conditions, simple molybdenum oxide-based building blocks initially assemble to 'giant molecular wheels' in a fast process followed by further slower assembly processes leading stepwise to more complex mesoscopic architectures including spherical ones and finally to those with a size larger than 500 nm.

Cardiac MRI cine and color Doppler in valvular disease: correlative imaging.

Cardiac cine field echo MRI and color Doppler were performed in 13 patients with aortic regurgitation (n = 4) or multiple valvular diseases (n = 9). The size, shape, and direction of regurgitation jets correlated well. Color Doppler was better able to follow flow jets in oblique planes. Cine MRI was better able to evaluate patients with marked cardiac dilatation.

Hypersensitivity to warfarin in a patient with a mechanical aortic prosthesis.

The case of a patient with a prosthetic aortic valve and warfarin hypersensitivity is presented. On rechallenging the patient with warfarin, a spongiotic dermatitis with heavy superficial perivascular lymphocytic infiltrates with eosinophils was seen. The patient was finally discharged on aspirin therapy alone and is doing well to date. Warfarin hypersensitivity is rare, and only incidental reports exist regarding its incidence and management. It is conceivable that newer antiplatelet agents, whether alone or in combination with aspirin, will provide better control of thromboembolic events in patients with warfarin intolerance.

Posterior myocardial infarction complicated by rupture of the posteromedial papillary muscle.

A 61-year-old man was admitted with acute posterior myocardial infarction and, on physical examination, was shown to have a mitral regurgitation (MR) murmur. Transthoracic echocardiography (TTE) showed severe hypokinesis of the posterior wall and severe MR by color flow. Right heart catheterization with a balloon-tipped catheter revealed a pulmonary artery wedge pressure of 30 mmHg. No 'step-up' was seen in blood samples from the right atrium and right ventricle. On angiography, a subtotal occlusion of the mid circumflex artery was found which was angioplastied and stented. As the patient's clinical condition did not improve, he underwent transesophageal echocardiography (TEE) for further evaluation. This showed complete rupture of the posteromedial papillary muscle. The patient underwent urgent surgery with successful mitral valve replacement. The postoperative course was uncomplicated, and clinical improvement seen. This case report underscores the value of TEE in accurate preoperative diagnosis of papillary muscle rupture by providing preoperative anatomic details of the mitral valve apparatus and surrounding structures.

Space-occupying lesions in the right ventricle of a patient with antiphospholipid syndrome.

A 29-year-old woman presented with shortness of breath, vague chest pain, and prominent intermittent ejection systolic murmur. Transthoracic echocardiography showed a large mass in the right ventricular outflow tract. Transesophageal echocardiography demonstrated two masses that were adherent to the tricuspid valve and intermittently prolapsed through the pulmonary valve. Computed tomography of the chest corroborated the echocardiographic findings. Currently, there are no definitive guidelines regarding the optimal management of right heart thrombi in patients with antiphospholipid syndrome. Our patient did not respond to a standard dose of rt-PA used in the treatment of pulmonary embolus. She underwent successful surgical resection of the thrombi without complications.

Transthoracic and transesophageal echocardiography pre and post percutaneous mitral catheter balloon valvulotomy.

Catheter balloon valvulotomy (CBV) is useful in the relief of rheumatic mitral stenosis. Morphologic scoring of the mitral valve by transthoracic echocardiography is predictive of success with CBV. Horizontal plane transesophageal echocardiography can obtain high quality images of the mitral valve and left atrium, but its value with routine use in the pre and post CBV setting is unknown. We prospectively examined 14 patients with mitral stenosis, pre and post CBV, noting scores, complications of mitral stenosis, and complications of CBV. Mitral valve scoring was similar by TTE and TEE pre and post CBV, but TEE did tend to underestimate scores pre CBV. There was a single thrombus, it was detected only by TEE. Post CBV, both TTE and TEE detected one of two torn chordae. Of three patients with ASD's by colour flow mapping, TTE and TEE each detected two. Increases in mitral insufficiency post CBV were seen equally frequently by TTE and TEE. The increases appeared to be of a higher grade (NS) by TEE. TTE and TEE yielded complementary findings, pre and post CBV. Other than for the detection of thrombi through, the net clinical contribution of routine use of TEE appears small, and large series would be needed to establish its contribution.

Polyarteritis nodosa and myocardial infarction.

A 35-year-old man with a history of polyarteritis nodosa is presented. The patient presented with acute anterolateral myocardial infarction that was complicated by diffuse coronary artery aneurysms found during cardiac catheterization. The complication of acute myocardial infarction in a patient with diffuse coronary artery aneurysms associated with polyarteritis nodosa is rare.

Prolonged survival after massive pulmonary embolism in a patient with atrial septal defect and mass in the right ventricle.

Unless thrombolytic or surgical therapy is rapidly available, massive pulmonary embolism in both pulmonary arteries invariably results in instantaneous death. A patient is presented with congenital atrial septal defect and right ventricular thrombus who developed extensive bilateral pulmonary embolism with an apparently prolonged survival. The ante- and postmortem findings represent the unusual and interesting aspects of this particular case.

Platelet activation in patients with mitral valve prolapse.

An increased frequency of thromboembolic events in patients with mitral valve prolapse has been demonstrated. It has been suggested that this association may be related to increased systemic platelet activity. Beta-thromboglobulin (BTG) is a platelet specific protein secreted during the platelet release reaction, with BTG levels reflecting ongoing platelet activation. Plasma BTG levels were measured in 14 normal volunteers, 23 patients with mitral valve prolapse and nonthickened mitral leaflets (group 1) and 13 patients with mitral valve prolapse and thickened mitral leaflets (group 2). The BTG level was 8.1 +/- 4.6 ng/mL (mean +/- SD) in normal subjects, 9.6 +/- 5.5 ng/mL in the nonthickened mitral valve prolapse group and 10.0 +/- 5.7 ng/mL in thickened mitral valve prolapse group. There was no significant difference in the BTG levels between groups. Five patients with multiple valvular prolapse did not show elevation of BTG levels. The present study did not demonstrate increased BTG levels in neurologically asymptomatic mitral valve prolapse patients.

2-D echocardiographic analysis of interventricular septal motion: concept of an anterior and posterior part to the septum.

2-D echocardiography was performed in 50 patients with transmural anteroseptal (group 1) or inferior myocardial infarction (group 2). Twenty-four patients with myocardial infarction had diagnostic coronary arteriography. Twenty-five normal subjects served as controls. The interventricular septum was subdivided into proximal and distal halves. In the parasternal long axis view (PSLAX), interventricular septum asynergy was seen in 96% of patients of group 1 and none in group 2. In the apical four chamber view (A4C), the proximal interventricular septum was abnormal in 48% of group 2 patients, but only one patient in group 1. The distal half of the interventricular septum in the A4C was abnormal in 48% of patients in group 1 and 12% in group 2. Complete asynergy of the interventricular septum in the PSLAX view was seen in 80% of patients with proximal stenosis in the left anterior descending artery (LAD) in association with anteroseptal myocardial infarction. Distal asynergy in this view was noted in all patients with a stenosis distal to the first septal perforator. In conclusion, the PSLAX visualizes the anterior interventricular septum and demonstrates wall motion abnormalities associated with anteroseptal infarction; complete asynergy of the interventricular septum in the PSLAX view suggests an anteroseptal infarction with proximal LAD stenosis; the A4C visualizes the posterior interventricular septum and proximal wall motion abnormalities are seen in inferior infarction while distal septal wall motion abnormalities occur in anteroseptal or inferior infarction.

An unusual case of metastatic intracardiac plasmacytoma.

The authors report the case of a 36-year-old male who, following investigations for dyspnea, othopnea and peripheral cyanosis, was found to have metastatic intracardiac plasmacytoma. Diagnosis was made initially with transesophageal echocardiography and emergent cardiac surgery was performed. Postoperative transthoracic and transesophageal echocardiograms revealed residual masses in the right and left atrium. The patient was subsequently treated with systemic chemotherapy and was symptom-free within three months of treatment, with rapid decline of paraproteins in the serum and urine. This case of intracardiac metastatic plasmacytoma is deemed unique because cardiac involvement with multiple myeloma has not been studied in detail, largely due to the rarity of such a presentation.

Ultrasonic tissue characterization of acute canine myocardial infarction.

This study assessed changes in left ventricular texture on two-dimensional (2-D) echocardiography after experimental myocardial infarction. In 13 dogs, the left anterior descending coronary artery (LAD) was occluded for 3 h, followed by 1 h of reperfusion and sacrifice. Two-dimensional echocardiography was performed pre-LAD occlusion, 3 h post occlusion and 1 h after reperfusion by placing a 5 MHz transducer on the chest wall. After sacrifice, triphenyltetrazolium chloride staining was performed on 1 cm thick left ventricular cross-sectional slices. Five dogs served as controls (shams). Two-dimensional echocardiograms were digitized and in the region of left ventricular asynergy (area of myocardial infarction), and adjacent normal area, the mean pixel intensities (+/- SD) were calculated. There was no significant change in the mean pixel intensity from 0 through 4 h in the lateral (22.8 +/- 1.3 and 23.4 +/- 1.8) and anteroseptal (23.2 +/- 1.9 and 22.6 +/- 1.9) regions in sham operated dogs. In dogs undergoing LAD occlusion, the mean pixel intensity from the pre- to post occlusion period showed no significant change in the lateral (normal) area, 24.4 +/- 2.7 versus 24.7 +/- 2.9. In the area of wall motion abnormality (area of myocardial infarction) the mean pixel intensity increased from 25.4 +/- 2.7 to 33.7 +/- 4.5, P less than 0.01. There was no significant change in the mean pixel intensity between the 3 h post occlusion and post reperfusion period in either the lateral (normal) or anteroseptal areas of the left ventricle. The area of left ventricular asynergy corresponded to the area of myocardial infarction on triphenyltetrazolium chloride stain.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of early myocardial tissue changes in acute canine myocardial infarction by ultrasonic tissue characterization methods.

To determine the time after left anterior descending (LAD) artery occlusion in which myocardial texture changes first occur, two-dimensional echocardiograms on five sham operated dogs and eight dogs before and after proximal LAD occlusion were performed. Serial two-dimensional echocardiograms were performed every 15 mins by placing a 5 MHz transducer directly on the chest wall. The dogs were sacrificed at the end of the study and the area of myocardial infarction was confirmed by triphenyltetrazolium chloride staining. The two-dimensional echocardiogram images were digitized. The mean pixel intensity +/- SD in the area of myocardial infarction (region of asynergy) and a normally moving area (control region) equidistant from the transducer were calculated; thus, each dog served as its own control. In sham operated dogs, no significant changes in mean pixel intensity, skewness or kurtosis were observed. There was a significant increase (P less than 0.01) in mean pixel intensity in the infarcted regions (anteroseptal) compared to values obtained in the normally moving (lateral) regions at 30 mins (mean pixel intensity 25.2 +/- 2.1 versus 23.0 +/- 0.7, P less than 0.05); this difference persisted at 45 mins (mean pixel intensity 25.8 +/- 0.9 versus 22.6 +/- 0.5, P less than 0.01), 60 mins (mean pixel intensity 27.2 +/- 1.4 versus 22.8 +/- 0.8, P less than 0.01), 90 mins (mean pixel intensity 28.6 +/- 1.6 versus 22.5 +/- 0.9, P less than 0.01) and 180 mins (mean pixel intensity 28.7 +/- 1.8 versus 21.3 +/- 1.4, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Inaccuracy of Doppler estimates of pulmonary artery pressure using pulmonary flow acceleration time.

Pulsed Doppler echocardiography was used to estimate mean pulmonary artery pressure (PAP), mean pulmonary artery wedge pressure PAWP) and the changes in PAP and PAWP following intervention in an unselected population composed of 60 patients undergoing routine diagnostic cardiac catheterization. Simultaneous Doppler and strain gauge manometry recordings of PAP and PAWP were interpreted by independent observers in a blinded fashion. A first set of measurements was obtained before left ventricular angiography and a second soon after the injection of contrast dye. The mean Doppler PAP and PAWP were derived from acceleration time and calculated using previously published regression equations: PAP = -0.45 x AcT + 79, PAWP = 57 - 0.39 x AcT. At rest, PAP measurements by strain gauge manometry ranged from 13 to 45 mmHg with a mean of 24 +/- 10 (one standard deviation); PAWP ranged from 2 to 40 mmHg with a mean of 15 +/- 6. Following left ventricular angiography, the PAP ranged from 18 to 50 mmHg with a mean of 29 +/- 7; PAWP ranged from 6 to 45 mmHg with a mean of 20 +/- 7. The values obtained by pulsed Doppler before and after intervention correlated poorly with those obtained by strain gauge manometry (r = 0.09 and 0.26 for PAP; r = 0.03 and 0.25 for PAWP).(ABSTRACT TRUNCATED AT 250 WORDS)