Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral vessels.

Major aortopulmonary collateral arteries (MAPCAs) provide significant issues during cardiopulmonary bypass, including flooding of the surgical field which requires significant blood volumes to be returned to the extracorporeal circuit via handheld suckers. This has been shown to be the major source of gaseous microemboli and is associated with adverse neurological outcome. Use of pH-stat has been previously shown to decrease the shunt through MAPCAs via an unknown mechanism. Here, we report the associated benefits of pH-stat in decreasing sucker usage and gaseous microemboli in a patient with known MAPCAs presenting for repair of tetralogy of Fallot and pulmonary atresia.

Clinical experience with Affinity Pixie oxygenation system in paediatric and infant patients.

INTRODUCTION: Great Ormond Street Children's Hospital undertakes over 500 open heart cardiothoracic procedures requiring cardiopulmonary bypass per year. Data from our centre show that many of our neonatal/paediatric patients require higher cardiac indexes than previously thought. We evaluated the new Pixie oxygenation system, rated from 0.1 L/min to 2 L/min, to determine if it could be used for these patients. METHODS: Between 2010 and 2012, 250 Pixie oxygenators were used on consecutive patients requiring correction of congenital cardiac defects. Data were collected on FiO2 requirements, oxygenator pressure drop and gaseous microemboli handling. Retrospective analysis was also undertaken on the procedures and demographics of all patients during 2011-2012 to determine the percentage of patients on whom the Pixie could be used. RESULTS: Analysis of the procedures undertaken at Great Ormond Street Hospital (GOSH) showed that 89% were in patients under 20 kg, requiring a flow rate of <2 L/min (at a base cardiac index of 2.8 L/min/m2). The maximum FiO2 required at 2.5 L/min was 85%. Gaseous microemboli were reduced by 82.5±9.9% and bubble volume was decreased by 94.3±8.4% from the 'venous' pre-oxygenator to the 'arterial' post-oxygenator. DISCUSSION: The Pixie oxygenator proved effective at flows up to 2.5 L/min, with air-handling capabilities comparable with other oxygenators. This represents a single oxygenator that could potentially be used to cover 89% of our surgical procedures. However, we believe that, for the smallest patients (i.e., < 2 kg), a smaller priming oxygenator should be used in order to limit unnecessary haemodilution in this vulnerable group.

Neural control of tuneable skin iridescence in squid.

Fast dynamic control of skin coloration is rare in the animal kingdom, whether it be pigmentary or structural. Iridescent structural coloration results when nanoscale structures disrupt incident light and selectively reflect specific colours. Unlike animals with fixed iridescent coloration (e.g. butterflies), squid iridophores (i.e. aggregations of iridescent cells in the skin) produce dynamically tuneable structural coloration, as exogenous application of acetylcholine (ACh) changes the colour and brightness output. Previous efforts to stimulate iridophores neurally or to identify the source of endogenous ACh were unsuccessful, leaving researchers to question the activation mechanism. We developed a novel neurophysiological preparation in the squid Doryteuthis pealeii and demonstrated that electrical stimulation of neurons in the skin shifts the spectral peak of the reflected light to shorter wavelengths (greater than 145 nm) and increases the peak reflectance (greater than 245%) of innervated iridophores. We show ACh is released within the iridophore layer and that extensive nerve branching is seen within the iridophore. The dynamic colour shift is significantly faster (17 s) than the peak reflectance increase (32 s), revealing two distinct mechanisms. Responses from a structurally altered preparation indicate that the reflectin protein condensation mechanism explains peak reflectance change, while an undiscovered mechanism causes the fast colour shift.

Incompatible ABO-plasma exchange and its impact on patient selection in paediatric cardiac transplantation.

OBJECTIVES: A decade ago, the first series of ABO-incompatible heart transplants was published, with surprising and extremely promising results; drastically reduced waiting list mortalities of infants listed for heart transplantation. Essential to the procedure was the process of plasma exchange transfusion, required to reduce isohaemagglutinin titres and facilitate the crossing of ABO blood group boundaries. Since then, Great Ormond Street Hospital, London has offered ABO-incompatible heart transplants to infants who potentially would die waiting for a suitable organ. We report the results of a decade of evolving plasma exchange experience and its impact upon patient selection. METHODS: A retrospective analysis was undertaken of all elective ABO-incompatible heart transplants at Great Ormond Street Children's Hospital from January 2001 until January 2011. Data were sought on underlying conditions and demographics of the patients, the isohaemagglutinin titre before and after plasma exchange and survival figures to date. RESULTS: Twenty-one patients underwent ABO-incompatible heart transplantation, ranging from 3 to 44 months, with preoperative isohaemagglutinin titres ranging from 0 to 1:32. All patients underwent a "3 times" plasma exchange before transplantation, requiring exchange volumes of up to 3209 mL. Postoperative isohaemagglutinin titres ranged from 0 to 1:16. One patient died of causes unrelated to organ rejection. CONCLUSIONS: Our data showed that eight patients (38.1%) were older than the previously suggested 12-month cut-off age. Using a combination of adult reservoir/paediatric oxygenator and extracorporeal circuit, ABO-incompatible plasma exchange transfusions can be undertaken safely using a simplified '3 times' method, reducing the circulating levels of isohaemagglutinins whilst providing minimal circuit size. This allows ABO-incompatible heart transplantation in a broader patient population than previously reported.

TMEM106B regulates progranulin levels and the penetrance of FTLD in GRN mutation carriers.

OBJECTIVES: To determine whether TMEM106B single nucleotide polymorphisms (SNPs) are associated with frontotemporal lobar degeneration (FTLD) in patients with and without mutations in progranulin (GRN) and to determine whether TMEM106B modulates GRN expression. METHODS: We performed a case-control study of 3 SNPs in TMEM106B in 482 patients with clinical and 80 patients with pathologic FTLD-TAR DNA-binding protein 43 without GRN mutations, 78 patients with FTLD with GRN mutations, and 822 controls. Association analysis of TMEM106B with GRN plasma levels was performed in 1,013 controls and TMEM106B and GRN mRNA expression levels were correlated in peripheral blood samples from 33 patients with FTLD and 150 controls. RESULTS: In our complete FTLD patient cohort, nominal significance was identified for 2 TMEM106B SNPs (top SNP rs1990622, p(allelic) = 0.036). However, the most significant association with risk of FTLD was observed in the subgroup of GRN mutation carriers compared to controls (corrected p(allelic) = 0.0009), where there was a highly significant decrease in the frequency of homozygote carriers of the minor alleles of all TMEM106B SNPs (top SNP rs1990622, CC genotype frequency 2.6% vs 19.1%, corrected p(recessive) = 0.009). We further identified a significant association of TMEM106B SNPs with plasma GRN levels in controls (top SNP rs1990622, corrected p = 0.002) and in peripheral blood samples a highly significant correlation was observed between TMEM106B and GRN mRNA expression in patients with FTLD (r = -0.63, p = 7.7 × 10(-5)) and controls (r = -0.49, p = 2.2 × 10(-10)). CONCLUSIONS: In our study, TMEM106B SNPs significantly reduced the disease penetrance in patients with GRN mutations, potentially by modulating GRN levels. These findings hold promise for the development of future protective therapies for FTLD.

Transmission diffraction-tomography system using a high-energy X-ray tube.

A high-energy bench-top energy dispersive X-ray diffraction (EDXRD) system for 3-dimensional mapping of the crystalline structure and phase transformations in steel is described, for which preliminary data and system development are presented here. The use of precision tungsten slit screens with up to 225 keV X-rays allows for diffraction through samples of 304 L austenitic stainless steel of thickness 3-10 mm, while sample positioning is carried out with a precision goniometer and translation stage system.

Cardiopulmonary bypass for surgical correction of congenital heart disease in children with sickle cell disease: a case series.

We present a series of three children with sickle cell disease aged 3 months, 3 weeks and 18 months, all presenting for cardiac surgery requiring cardiopulmonary bypass. The cardiac lesions were atrioventricular septal defect, transposition of the great arteries and ventricular septal defect, with sickle cell loads of 35%, 11% and 39% respectively at presentation. We calculated that the bypass circuit would provide sufficient volume to decrease sickle cell levels to safe values, so we decided to proceed to bypass without pre-operative exchange transfusion, and modified the bypass technique so as to avoid the likely stimulants of a sickle cell crisis. Haemoglobin S levels after the start of bypass were significantly lower than before bypass, and remained low throughout the case and into the second postoperative day. By adopting this approach, we feel that we achieved a successful outcome with minimal distress to the children and their families.

Conductance quantization at a half-integer plateau in a symmetric GaAs quantum wire.

We present data from an induced gallium arsenide (GaAs) quantum wire that exhibits an additional conductance plateau at 0.5(2e2/h), where e is the charge of an electron and h is Planck's constant, in zero magnetic field. The plateau was most pronounced when the potential landscape was tuned to be symmetric by using low-temperature scanning-probe techniques. Source-drain energy spectroscopy and temperature response support the hypothesis that the origin of the plateau is the spontaneous spin-polarization of the transport electrons: a ferromagnetic phase. Such devices may have applications in the field of spintronics to either generate or detect a spin-polarized current without the complications associated with external magnetic fields or magnetic materials.

Clinical, genetic, and neuropathologic characteristics of posterior cortical atrophy.

OBJECTIVE: To examine the clinical, genetic, and neuropathologic features of posterior cortical atrophy (PCA). DESIGN/METHODS: Using a broad definition of PCA as a syndrome with the insidious onset of visual dysfunction in the absence of primary ophthalmologic causes, the authors identified and then reviewed the presenting signs and symptoms, ApoE genotypes, tau haplotypes, and neuropathologic findings when available of PCA cases from two dementia research centers collected over the past 14 years. RESULTS: The authors identified 40 PCA cases. Their mean age at symptom onset was 60.5 +/- 8.9 years. There were twice as many women as men in the series. The principal types of visual impairment were simultanagnosia (82%) and visual field defect (47.5%). Acalculia, alexia, and anomia were also common. Insight was preserved in almost all (95%) early in the disorder. Neither apoE epsilon4 nor tau haplotype frequencies were different from typical Alzheimer disease (AD). Nine patients had died and underwent postmortem examination. Seven autopsied cases had AD pathology but when compared to typical AD, the neurofibrillary tangle (NFT) densities were significantly higher in Brodmann areas 17 and 18 (p < 0.05) and significantly lower in the hippocampus (p < 0.05). Two cases had corticobasal degeneration with maximal involvement of tau positive glial pathology in the posterior parietal lobe and Brodmann areas 17 and 18. CONCLUSIONS: PCA is a distinctive dementia syndrome in which the most pronounced pathologic involvement is in the occipitoparietal regions independent of the specific underlying pathology. AD was the most common pathologic cause, but its regional distribution differed from typical AD.

Imaging fractal conductance fluctuations and scarred wave functions in a quantum billiard.

We present scanning-probe images and magnetic-field plots which reveal fractal conductance fluctuations in a quantum billiard. The quantum billiard is drawn and tuned using erasable electrostatic lithography, where the scanning probe draws patterns of surface charge in the same environment used for measurements. A periodicity in magnetic field, which is observed in both the images and plots, suggests the presence of classical orbits. Subsequent high-pass filtered high-resolution images resemble the predicted probability density of scarred wave functions, which describe the classical orbits.

Cotton wool plaques in non-familial late-onset Alzheimer disease.

Cotton wool plaques (CWP) are large, ball-like plaques lacking dense amyloid cores that displace adjacent structures. They were first described in a Finnish kindred with early-onset Alzheimer disease (AD) with spastic paraparesis due to a presenilin-1 delta9 mutation. We describe a case of sporadic late-onset AD with numerous neocortical CWP as well as severe amyloid angiopathy and marked leukoencephalopathy, compared with 16 cases of late-onset AD with similar degrees of amyloid angiopathy and leukoencephalopathy. The cases were studied with histologic methods and with single and double immunostaining for beta-amyloid (Abeta), paired helical filaments-tau (PHF-tau), neurofilament (NF), glial fibrillary acidic protein (GFAP), HLA-DR, and amyloid precursor protein (APP). We found that CWP were well-circumscribed amyloid deposits infiltrated by ramified microglia and surrounded by dystrophic neurites that were immunopositive for APP, but only weakly for NF and PHF-tau. Abeta1-12 was diffuse throughout the CWP, while Abeta37-42 was peripherally located and Abeta20-40 more centrally located. Two of the 16 late-onset AD cases also had CWP, but they were also admixed with diffuse plaques and plaques with dense amyloid cores. Pyramidal tract degeneration was not a consistent finding or a prominent feature in any case. The results suggest that CWP are not specific for early-onset familial AD with spastic paraparesis.

A novel presenilin mutation (M233V) causing very early onset Alzheimer's disease with Lewy bodies.

Presenilin 1 mutations are the major cause of autosomal dominant Alzheimer's disease: here we identify a new missense mutation causing a methionine to valine change at codon 233. This codon is homologous to a pathogenic presenilin 2 mutation with the same base change (ATG to GTG) and amino acid change (M239V). This mutation causes disease with an exceptionally early onset age (approximately 30 years) in which pathological examination shows extensive Lewy bodies as well as plaques and tangles.

Presenilin mutations line up along transmembrane alpha-helices.

Presenilin 1 mutations are the major cause of autosomal dominant Alzheimer's disease. Here we present evidence that pathogenic mutations in putative transmembrane domains 1, 2, 3, 4 and 6 align along helical faces, thus supporting the view that these are indeed transmembrane domains, and suggesting that disruption of the alignment of these domains is responsible for the pathogenicity of the mutations.

Genetic analysis of synphilin-1 in familial Parkinson's disease.

alpha-Synuclein is present in Lewy bodies of patients with both sporadic and familial Parkinson's disease. However, pathogenic mutations Ala30Pro and Ala53Thr in alpha-synuclein are rare causes of disease. Synphilin-1 has been demonstrated to associate with alpha-synuclein and promote the formation of cytosolic inclusions in vitro. Two-point genetic linkage analysis of a dinucleotide repeat within the synphilin-1 gene initially implicated this locus as a cause of Parkinson's disease in three of nine families. However, subsequent haplotype, sequencing, and association analyses in these three families and an independent case-control series suggest that variability within the locus does not confer susceptibility to Parkinson's disease.

Down-regulation of Na-K-Cl cotransport by protein kinase C is mediated by protein phosphatase 1 in pigmented ciliary epithelial cells.

The role of protein phosphatases in the regulation of Na-K-Cl cotransport was examined in human pigmented ciliary epithelial (PE) cells. Both a 37 kDa form and a 72 kDa form of protein phosphatase 1 (PP1) could be immunologically detected. The protein phosphatase inhibitor calyculin A stimulated Na-K-Cl cotransport by 89 +/- 12% at 10 n M, whereas okadaic acid had no effect at concentrations less than 100 n M. Calyculin A had no significant effect on either Na-K ATPase or ouabain-insensitive, bumetanide-insensitive 86Rb+uptake. These data suggest that PP1 plays a role in the inhibition of Na-K-Cl cotransport in PE cells. Treatment of cells with phorbol 12-myristate, 13-acetate (PMA), a protein kinase C (PKC) activator caused an 82% inhibition of Na-K-Cl cotransport. When cells were first treated for 5 min with PMA, 10 n M calyculin A stimulated Na-K-Cl cotransport by 53% compared to 101% by calyculin A alone. Treatment of cells with PMA after stimulation of Na-K-Cl cotransport by calyculin A resulted in a prompt 56% drop in cotransport activity. These data suggest that maximal inhibition of Na-K-Cl cotransport by PKC requires PP1 activity, but that a part of PKCs inhibitory effect is independent of PP1. The effect of PKC activation on PP1 was further examined by determining PP1 activity in cells pretreated with PMA. PP1 activity increased 38+/-8% in cells exposed to 1 microM PMA for 5 min. This stimulation was blocked by 100 n M staurosporine or 1 microM bisindolylmaleimide, two PKC inhibitors. An isomer which does not activate PKC (4 alpha phorbol didecanoate), did not stimulate PP1 activity. Thus PKC activation leads to an increase in PP1 activity in PE cells. Pretreatment of cells with the protein kinase A (PKA) inhibitor PHI 14-22 resulted in a partial reduction in calyculin A stimulation of cotransport, suggesting that PP1 and PKA function in a kinase-phosphatase regulatory loop. To determine whether other protein kinases might also be involved, several protein kinase inhibitors were tested, including KT5823 (protein kinase G, type II-specific), KN62 (calmodulin activated kinase-specific) and ML7 (myosin light chain kinase-specific). None prevented activation of Na-K-Cl cotransport by calyculin A, suggesting that these kinases are not involved in the activation of Na-K-Cl cotransport.

Immunolocalization of the Na-K-Cl cotransporter in bovine ciliary epithelium.

PURPOSE: Recent evidence suggests that Na-K-Cl cotransport plays a major role in blood-to-aqueous anion transport across the ciliary body epithelium. The present study was undertaken to determine the location of the Na-K-Cl cotransporter in fixed sections of bovine eye. METHODS: Sections of paraformaldehyde-fixed adult and calf bovine eyes were treated with a monoclonal antibody to mammalian Na-K-Cl cotransporter and a fluorescent secondary antibody and examined under a fluorescent microscope. Na-K-Cl cotransporter protein was detected on immunoblots of dissected tissue and purified nonpigmented ciliary epithelial (NPE) and pigmented ciliary epithelial (PE) cells. RESULTS: Cotransporter immunofluorescence was most intense along the basolateral surfaces of the PE cells. Anterior pars plicata possessed the greatest PE immunofluorescence, and this diminished posteriorly toward the pars plana. Quantitation of immunofluorescence images indicated 7- to 10-fold more cotransporter protein in pars plicata PE than in pars plana PE. Diffuse cytoplasmic fluorescence was seen in the NPE cells, which was also brightest in anterior pars plicata. Immunoblots of separated PE and NPE cells from anterior pars plicata showed that PE contain four times more 170-kDa cotransporter protein than NPE. This confirmed fluorescence quantitation estimates. Cotransporter was barely detectable in cells isolated from pars plana in either cell layer. Immunoblots of the Na,K-ATPase catalytic (alpha) subunit in separated NPE and PE cells showed that NPE cells possessed approximately eight times more alpha subunit protein than PE. Immunofluorescence indicated a similar distribution of alpha subunits and indicated a basolateral membrane location for the subunit on both cell types. Na-K-Cl cotransporter fluorescence patterns showed more variability in adult animals than in calves, which may be related to aging and/or disease. Distinctive patterns of cotransporter fluorescence were also seen in the cornea, iris, and retina. CONCLUSIONS: Localization of the Na-K-Cl cotransporter to the plasma membrane on the blood side of the ciliary epithelium tight junctions supports a role for the Na-K-Cl cotransporter in ciliary epithelium as a chloride entry mechanism involved in blood-to-aqueous chloride transport. The concentration of Na,K-ATPase catalytic subunits on NPE basolateral membranes could provide net Na(+) efflux into the aqueous humor.

Catecholaminergic regulation of Na-K-Cl cotransport in pigmented ciliary epithelium: differences between PE and NPE.

Pigmented (PE) and nonpigmented (NPE) ciliary epithelial cells comprise the ciliary epithelium, the site of aqueous humor formation in the eye. In man, catecholamines increase the rate of aqueous humor formation, but the mechanism underlying these effects is not understood. Recent evidence suggests that Na-K-Cl cotransport plays a central role in blood-to-aqueous chloride transport across ciliary epithelium in cow and rabbit. We therefore investigated whether catecholamines stimulate Na-K-Cl cotransport in human PE cells. Na-K-Cl cotransporter protein was detected as a 170 kDa protein band on immunoblots. Immunofluorescence microscopy detected cotransporter on the basolateral membranes of the PE layer of ciliary epithelium from a human donor. Cotransporter immunofluorescence was also detected in cultured PE cells. Na-K-Cl cotransport activity measured as ouabain-insensitive bumetanide-sensitive(86)Rb uptake was stimulated by isoproterenol 1.6-fold, with an EC(50) = 28 n M and maximal stimulation at 1 microM. Other transport mechanisms involved in(86)Rb uptake were not affected. Stimulation by 1 microM isoproterenol was blocked by 10 n M ICI 118,551, a beta(2)-specific receptor antagonist, whereas the receptor subtype-specific antagonists yohimbine (alpha(2)), prazosin (alpha(1)) and atenolol (beta(1)) were ineffective. Norepinephrine stimulation (EC(50) = 280 n M) was also blocked by ICI 118,551. Dopamine stimulated Na-K-Cl cotransport 1.6-fold with an EC(50) = 14 microM. The dopamine effect could not be blocked by 10 microM SCH 23390, a D1-antagonist, but was abolished by ICI 118,551. Forskolin and CPT-cAMP stimulated Na-K-Cl cotransport 1.79- and 1.71-fold, respectively, whereas the inactive forskolin analogue 1,9-dideoxyforskolin had no effect. However, high concentrations of the PKA inhibitors PKI amide 14-22 and KT 5720 were needed to inhibit both PKA activity in cell lysates and isoproterenol stimulation of cotransport. This finding may indicate the presence of a novel PKA isoform in PE cells. Inhibitors of other protein kinases, including myosin light chain kinase, protein kinase G, calmodulin-dependent kinase and tyrosine kinase, were without effect on stimulated Na-K-Cl cotransport. When EC(50)s for catecholaminergic stimulations of Na-K-Cl cotransport in PE were compared to those in NPE, values within five-fold of one another were seen for isoproterenol and norepinephrine. In contrast, dopamine was 28-fold more potent in NPE than in PE. The data suggest that both PE and NPE possess beta(2)adrenergic receptors, but only NPE cells possess dopamine D1 receptors linked to Na-K-Cl cotransport.

Susceptibility locus for Alzheimer's disease on chromosome 10.

The apolipoprotein E (APOE) gene is the only genetic risk factor that has so far been linked to risk for late-onset Alzheimer's disease (LOAD). However, 50 percent of Alzheimer's disease cases do not carry an APOE4 allele, suggesting that other risk factors must exist. We performed a two-stage genome-wide screen in sibling pairs with LOAD to detect other susceptibility loci. Here we report evidence for an Alzheimer's disease locus on chromosome 10. Our stage one multipoint lod score (logarithm of the odds ratio for linkage/no linkage) of 2.48 (266 sibling pairs) increased to 3.83 in stage 2 (429 sibling pairs) close to D10S1225 (79 centimorgans). This locus modifies risk for Alzheimer's disease independent of APOE genotype.