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MCA
Terms modified by MCA Selected AbstractsRole of computerized morphometric analysis in diagnosis of effusion specimensDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2006B. Arora M.D. Abstract The present study was undertaken to compare morphometric analysis of cells in 100 effusion samples, with unaided cytological diagnosis. All the cases in the form of Leishman's stained smears were subjected to computerized-interactive morphometry (CIM) by usage of Image analysis software. On routine cytological examination, 44 cases were benign, 26 were malignant, and 30 cases were placed in "atypical" category. On morphometry, values for mean nuclear area (MNA) and mean cytoplasmic area (MCA) in benign cases were found to be 58.39 ± 12.22 ,m2 and 185.70 ± 43.69 ,m2, while for malignant cases were 120.12 ± 16.28 ,m2 and 274.65 ± 61.01 ,m2, respectively (P < 0.001, P < 0.001, highly significant). Significant differences were also noted among benign, atypical, and malignant cases for MNA (P < 0.001). The differences between atypical and malignant cases for N/C (nuclear/cytoplasmic) ratio were also found to be statistically significant (P < 0.001). Finally, 46 cases were found to be benign, 39 malignant, and 15 in the category of atypical cases. CIM helps in better and quicker sorting for malignant cells. MNA and N/C ratio are the most significant parameters in differentiating various cells in effusions. MCA constitutes as another useful parameter. Salient features of CIM, including their applications in the light of current study, are discussed. Diagn. Cytopathol. 2006;34:670,675. © 2006 Wiley-Liss, Inc. [source] Bacterial and mammalian-cell genotoxicity of mixtures of chlorohydroxyfuranones, by-products of water chlorinationENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 4 2004Jorma Mäki-Paakkanen Abstract The genotoxic responses of mixtures of four chlorohydroxyfuranones (CHFs), 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX), 3,4-dichloro-5-hydroxy-2(5H)-furanone (MCA), 3-chloro- 4-(chloromethyl)-5-hydroxy-2(5H)-furanone (CMCF) and 3-chloro-4-methyl-5-hydroxy-2(5H)-furanone (MCF), were compared with the genotoxicity of the individual compounds. Genotoxicity was evaluated in the Salmonella reversion assay (Ames test), the in vitro Chinese hamster ovary (CHO) cell Hprt mutation assay, and in the CHO chromosome aberration test. When tested individually, the concentrations of the chemicals that were chosen for the mixtures induced no or only a modest increase in the genotoxic effects, and caused little or no cytotoxicity. In the Ames test, the genotoxic responses caused by the mixtures of CHFs did not follow simple additivity. Synergism was observed with strains TA97 and TA98, and antagonism with strain TA100. In the CHO/Hprt mutation assay, the mutagenic response of the mixtures was inconsistent, with near additivity seen with a mixture of CHFs that resulted in 12% cell survival. In contrast, the four CHFs together consistently caused more structural chromosome damage (mainly chromatid-type breaks and exchanges) compared to the sum of net effects of the four CHFs tested alone. Also, a potentiating effect was consistently seen for the cytotoxicity of the CHF mixtures both in the CHO/Hprt mutation assay and the chromosome aberration test. The present results indicate that the genotoxic effects of CHF mixtures can be greater than additive. Such effects may be worth considering in the cancer risk assessment of chlorinated drinking water. Environ. Mol. Mutagen. 43:217,225, 2004. © 2004 Wiley-Liss, Inc. [source] Bilateral cerebral hemispheric infarction associated with sildenafil citrate (Viagra®) useEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2008K.-K. Kim Sildenafil citrate (Viagra®) is one of the frequently prescribed drugs for men with erectile dysfunction. We describe a 52-year-old man with bilateral middle cerebral artery (MCA) territory infarction after sildenafil use. He ingested 100 mg of sildenafil and about 1 h later, he complained of chest discomfort, palpitation and dizziness followed by mental obtundation, global aphasia and left hemiparesis. Brain magnetic resonance imaging documented acute bilateral hemispheric infarction, and cerebral angiography showed occluded bilateral MCA. Despite significant bilateral MCA stenosis and cerebral infarction, systemic hypotension persisted for a day. We presume that cerebral infarction was caused by cardioembolism with sildenafil use. [source] Time course of cerebral hemodynamics in cryptococcal meningitis in HIV-negative adultsEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2007W.-N. Chang To evaluate the cerebral hemodynamics in cryptococcal meningitis (CM) patients using non-invasive studies. Serial trans-cranial color-coded sonography (TCCS) and magnetic resonance angiography (MRA) studies were performed to measure the cerebral vasculopathy of 12 HIV-negative CM patients. With TCCS, 8 of the 22 middle cerebral arteries (MCAs) showed stenotic velocities, whereas the time-mean velocity (Vmean) of the 20 anterior cerebral arteries (ACAs), 22 posterior cerebral arteries (PCAs), and 12 basilar arteries (BAs) did not. In total, five patients had stenotic velocities, three of whom had bilateral M1 stenosis (<50%), whilst two had unilateral M1 stenosis (<50%). The Vmean of MCA increased from day 1 to day 35 and substantially decreased thereafter. The mean Pulsatility Index (PI) in the studied vessels was higher during the study period. A mismatch of the findings between TCCS and MRA studies were also demonstrated. There was a high incidence and a longer time-period of disturbed cerebral hemodynamics during the clinical course of CM. However, because of the limited case numbers for this study, further large-scale studies are needed to delineate the clinical characteristics and therapeutic influence of cerebrovascular insults in HIV-negative CM patients. [source] Cerebral vasomotor reactivity of bilateral severe carotid stenosis: is stroke unavoidable?EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2006A. Y. Gur We evaluated the cerebral hemodynamic features of severe bilateral carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. VMR was evaluated by recording the percentage differences in peak systolic blood flow velocity in each MCA and VA at baseline and by the Diamox test. Twenty-eight symptomatic (SCAS) and 31 asymptomatic (ACAS) patients with bilateral severe (>70%) internal carotid artery stenosis were studied. The mean MCA VMR% was 29 ± 26.9% in SCAS and 43.2 ± 26.8% in ACAS patients (P < 0.01). Their respective mean VA VMR% was 30.2 ± 36.5% and 39.6 ± 24.4% (P = NS). VMR% of the symptomatic MCA side in SCAS patients was significantly lower than the opposite side (20.5 ± 31.1% and 39.2 ± 37.9% respectively; P < 0.03). In contrast, the VA VMR% of both sides in SCAS patients remained similar (28.1 ± 39.3% and 34.6 ± 47.9% respectively; P = NS). VMR% of the MCA and VA in ACAS patients was also similar for both sides of bilateral carotid stenosis. The cerebral hemodynamic features differ between SCAS and ACAS patients with bilateral carotid occlusive disease in the anterior part of the circle of Willis. An independent cerebral vascular reserve capacity of the posterior circulation is proposed. [source] Candesartan pretreatment is cerebroprotective in a rat model of endothelin-1-induced middle cerebral artery occlusionEXPERIMENTAL PHYSIOLOGY, Issue 8 2009Adam P. Mecca Endogenous levels of angiotensin II (Ang II) are increased in the cortex and hypothalamus following stroke, and Ang II type 1 receptor blockers (ARBs) have been shown to attenuate the deleterious effects in animal stroke models using middle cerebral artery (MCA) intraluminal occlusion procedures. However, the endothelin-1 (ET-1)-induced middle cerebral artery occlusion (MCAO) model of cerebral ischaemia is thought to more closely mimic the temporal events of an embolic stroke. This method provides rapid occlusion of the MCA and a gradual reperfusion that lasts for 16,22 h. The aim of the present study was to evaluate whether systemic administration of an ARB prior to ET-1-induced MCAO would provide cerebroprotection during this model of ischaemic stroke. Injection of 3 ,l of 80 ,m ET-1 adjacent to the MCA resulted in complete occlusion of the vessel that resolved over a period of 30,40 min. Following ET-1-induced MCAO, rats had significant neurological impairment, as well as an infarct that consisted of 30% of the ipsilateral grey matter. Systemic pretreatment with 0.2 mg kg,1 day,1 candesartan for 7 days attenuated both the infarct size and the neurological deficits caused by ET-1-induced MCAO without altering blood pressure. This study confirms the cerebroprotective properties of ARBs during ischaemic stroke and validates the ET-1-induced MCAO model for examination of the role of the brain renin,angiotensin system in ischaemic stroke. [source] The effect of thiamine supplementation on tumour proliferationFEBS JOURNAL, Issue 15 2001A metabolic control analysis study Thiamine deficiency frequently occurs in patients with advanced cancer and therefore thiamine supplementation is used as nutritional support. Thiamine (vitamin B1) is metabolized to thiamine pyrophosphate, the cofactor of transketolase, which is involved in ribose synthesis, necessary for cell replication. Thus, it is important to determine whether the benefits of thiamine supplementation outweigh the risks of tumor proliferation. Using oxythiamine (an irreversible inhibitor of transketolase) and metabolic control analysis (MCA) methods, we measured an in vivo tumour growth control coefficient of 0.9 for the thiamine-transketolase complex in mice with Ehrlich's ascites tumour. Thus, transketolase enzyme and thiamine clearly determine cell proliferation in the Ehrlich's ascites tumour model. This high control coefficient allows us to predict that in advanced tumours, which are commonly thiamine deficient, supplementation of thiamine could significantly increase tumour growth through transketolase activation. The effect of thiamine supplementation on tumour proliferation was demonstrated by in vivo experiments in mice with the ascites tumour. Thiamine supplementation in doses between 12.5 and 250 times the recommended dietary allowance (RDA) for mice were administered starting on day four of tumour inoculation. We observed a high stimulatory effect on tumour growth of 164% compared to controls at a thiamine dose of 25 times the RDA. This growth stimulatory effect was predicted on the basis of correction of the pre-existing level of thiamine deficiency (42%), as assayed by the cofactor/enzyme ratio. Interestingly, at very high overdoses of thiamine, ,,2500 times the RDA, thiamine supplementation had the opposite effect and caused 10% inhibition of tumour growth. This effect was heightened, resulting in a 36% decrease, when thiamine supplementation was administered from the 7th day prior to tumour inoculation. Our results show that thiamine supplementation sufficient to correct existing thiamine deficiency stimulates tumour proliferation as predicted by MCA. The tumour inhibitory effect at high doses of thiamine is unexplained and merits further study. [source] Metabolic cold adaptation and developmental plasticity in metabolic rates among species in the Fundulus notatus species complexFUNCTIONAL ECOLOGY, Issue 5 2010Jacob Schaefer Summary 1.,In ectotherms, temperature and body size are the most influential and well studied variables affecting metabolic rate. Understanding mechanisms driving the evolution of metabolic rates is crucial to broader ecological theory. The metabolic cold adaptation hypothesis (MCA) makes predictions about the evolution of ectotherm metabolic rates and temperature-metabolic rate reaction norms. 2.,We examined intra and interspecific patterns in metabolic rate among populations in the Fundulus notatus species group (F. notatus, F. olivaceus and F. euryzonus). We ask if patterns of intra and interspecific variability in metabolic rate are consistent with the MCA and if metabolic rates in general are developmentally plastic. 3.,Support for the MCA was mixed among intra and interspecific tests. The northern population of F. olivaceus had increased metabolic rate and no difference in temperature sensitivity (slope of temperature-metabolic rate reaction norm). Northern populations of F. notatus had lower temperature sensitivity and no difference in overall metabolic rate. The southern coastal drainage endemic (F. euryzonus) had intermediate metabolic rates compared to southern populations of the other two more broadly distributed species. Metabolic rates were also developmentally plastic. Adults reared at warmer temperatures had lower metabolic rates after accounting for body size and temperature. 4.,Differences in thermal regimes explain some variability in metabolic rates among populations consistent with MCA. However, interspecific comparisons are not consistent with MCA and are likely influenced by species differences in ecology and life history strategies. [source] Proteomic identification of an upregulated isoform of annexin A3 in the rat brain following reversible cerebral ischemiaGLIA, Issue 16 2007Heike Junker Abstract We used proteomics to identify regulated proteins following cerebral ischemia in a rat model. Young rats were subjected to reversible middle cerebral artery (MCA) occlusion and proteins were extracted from the peri-infarcted and the corresponding contralateral area at days 3 and 14 postischemia. Proteins were analyzed by two-dimensional polyacrylamide gel electrophoresis followed by mass spectrometry. We report for the first time that an isoform of annexin A3 (ANXA3) was among the upregulated proteins in the postischemic rat brain. The results were confirmed by real-time PCR and by western blotting. Double- and triple-immunostaining with neuronal and microglia/macrophagic markers demonstrated that ANXA3 is produced by resting microglia in control tissue and by activated microglial/macrophage cells in the infarcted area. 3D-images of the infarcted area suggest that ANXA3 is associated with a phagocytic phenotype. Our study identifies ANXA3 as a novel marker of brain microglia, which should be of substantial value in future studies of microglial cells and its role in the postischemic brain. © 2007 Wiley-Liss, Inc. [source] Blood Flow Velocity and Pulsatility Index Differences in Patients With Unilateral MigraineHEADACHE, Issue 7 2001Oleg Y. Chernyshev MD Objective.,To evaluate blood flow velocity and pulsatility in unilateral migraine without aura during the headache-free period using transcranial Doppler (TCD) sonography. Methods.,Patients with unilateral headache were recruited during the headache-free period. Maximum mean flow velocity (MFV) and pulsatility index (PI) were measured in the middle cerebral (MCA) and basilar arteries. Controls were headache-free individuals without cerebrovascular disease. Results.,Twenty-five patients with right-sided migraine, 25 patients with left-sided migraine, and 19 controls were studied. The MCA PI was higher on the right headache side versus the left headache side (0.97 ± 0.2 versus 0.86 ± 0.1 cm/s, P = .02) and versus controls (0.9 ± 0.2 cm/s, NS). The basilar artery MFV was higher in patients with right-sided headache versus left-sided headache (39.5 ± 5.6 versus 34.7 ± 8.2 cm/s, P = .02) and versus controls (38.2 ± 8 cm/s, NS). No decrease in MFV with age was observed in patients with migraine. Conclusions.,Middle cerebral artery flow pulsatility and basilar artery velocity are higher in patients with right-sided migraine compared with left-sided migraineurs, during the headache-free period. Although these parameters were similar to controls, the differences found during the headache-free period in migraineurs may indicate vascular involvement predisposing to the unilateral headache recurrence. [source] A subgroup of intrahepatic cholangiocarcinoma with an infiltrating replacement growth pattern and a resemblance to reactive proliferating bile ductules: ,bile ductular carcinoma'HISTOPATHOLOGY, Issue 3 2007K Kozaka Aims:, The histogenesis and biological behaviour of peripheral intrahepatic cholangiocarcinoma (peripheral CC) remain unclarified. The aim of this study was to examine the growth pattern of peripheral CC (24 cases) in comparison with hepatocellular carcinoma (HCC, 27 cases) and metastatic colorectal adenocarcinoma (MCA, 24 cases). Methods and results:, Tumour/surrounding liver borders were classified as: (i) fibrous encapsulation, (ii) compressive growth, and (iii) infiltrating replacement. Nineteen of 24 peripheral CCs showed (iii), whereas 23 of 27 HCCs showed (i) and 17 of 24 MCAs showed (ii). In (iii), carcinoma cells infiltrated the surrounding liver without compression, and hepatic supporting vascular structures such as portal tracts were secondarily incorporated into the tumour. In (i) and (ii), the surrounding liver was compressed and no or few portal tracts were incorporated within the tumour. Fifteen of 24 peripheral CCs were composed of carcinoma cells resembling reactive bile ductules and these cells were positive for neural cell adhesion molecule (NCAM), a marker of proliferating bile ductules. The remaining nine peripheral CCs were composed of ordinary adenocarcinoma and negative for NCAM. Conclusions:, A subgroup of peripheral CCs with an infiltrating replacement growth pattern resembles reactive bile ductules and expresses NCAM. ,Bile ductular carcinoma' may be a better term for this subgroup. [source] Rapid detection of submicroscopic chromosomal rearrangements in children with multiple congenital anomalies using high density oligonucleotide arrays,,HUMAN MUTATION, Issue 5 2006Jeffrey E. Ming Abstract Chromosomal rearrangements such as microdeletions and interstitial duplications are the underlying cause of many human genetic disorders. These disorders can manifest in the form of multiple congenital anomalies (MCA), which are a significant cause of morbidity and mortality in children. The major limitations of cytogenetic tests currently used for the detection of such chromosomal rearrangements are low resolution and limited coverage of the genome. Thus, it is likely that children with MCA may have submicroscopic chromosomal rearrangements that are not detectable by current techniques. We report the use of a commercially available, oligonucleotide-based microarray for genome-wide analysis of copy number alterations. First, we validated the microarray in patients with known chromosomal rearrangements. Next, we identified previously undetected, de novo chromosomal deletions in patients with MCA who have had a normal high-resolution karyotype and subtelomeric fluorescence in situ hybridization (FISH) analysis. These findings indicate that high-density, oligonucleotide-based microarrays can be successfully used as tools for the detection of chromosomal rearrangement in clinical samples. Their higher resolution and commercial availability make this type of microarray highly desirable for application in the diagnosis of patients with multiple congenital defects. Hum Mutat 27(5), 467,473, 2006. © Published 2006 Wiley-Liss, Inc. [source] Identification of differentially methylated CpG islands in prostate cancerINTERNATIONAL JOURNAL OF CANCER, Issue 5 2004Yasushi Yamada Abstract Epigenetic change such as DNA methylation is one important mechanism for regulating gene expression as genetic change, such as mutation or loss of heterozygosity. Methylation of cancer-related genes has been shown to play an important role in carcinogenesis and tumor progression. Using methylated CpG island amplification (MCA)/representational difference analysis (RDA), we identified four CpG islands in neurotrophin tyrosine kinase receptor type 2 (NTRK2), Protocadherine Flamingo1 and MFPC (Methylated Fragments in Prostate Cancer) 7 and 8. Bisulfite sequencing revealed that 2 regions of NTRK2 as well as MFPC7 and MFPC8 were aberrantly methylated in prostate cancer cell lines, and COBRA showed that 48 (76.24%), 37 (58.7%) and 14 (22.2%) of 63 prostate cancer tissues were methylated, respectively, for these sites. On the other hand, none of 13 benign prostate samples were methylated, except for 1 (7.7%) with NTRK2. For NTRK2, mRNA expression was negative in prostate cancer cell lines (LNCaP and DU145) but was recovered on a methyltransferase inhibitor (5-Aza-CdR) treatment. The role of NTRK2 within NTRK remains unclear. Our results suggest that these 3 hypermethylated DNA fragments also may be markers of prostate cancer detection. © 2004 Wiley-Liss, Inc. [source] Support staff in community pharmacy: who are they and what do they want?INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2008Dr. Ellen I Schafheutle research fellow Objective To collect information on different categories of support staff, their deployment in community pharmacy, their levels of experience and qualifications, and their opinions on a number of topical issues, such as training and regulation. Method Two ,snapshot' surveys, one of community pharmacists, another of support staff employed by them. Three focus groups with support staff. Setting The surveys were conducted in community pharmacies in two primary care trusts (PCTs) in England. Two focus groups were conducted in one of the PCTs with respondents who had taken part in the survey; a third took place in a third PCT during the design phase. Key findings Medicines counter assistants (MCAs) formed the largest category of support staff (56%); 21% were dispensing assistants (DAs); 17% were pharmacy technicians (PTs). All community pharmacies employed at least one (60%), and often more than one MCA, but 20% had no DAs and 40% operated without a PT. Nearly all (93%) support staff were women, and about one-third worked part-time. More mature (40+ years) staff commonly only held an MCA qualification and were often not keen on further training. Younger staff held higher qualifications and were interested in further training and career progression. The majority of all categories of staff showed high levels of job satisfaction and loyalty to their employer. Most held positive views towards the regulation of support staff. Poor salaries were identified as potential barriers to further training and regulation, and pharmacists identified problems recruiting support staff. Conclusion Many different categories of support staff are employed in community pharmacies, although some operated without DAs or a PT. Support staff were generally satisfied with their jobs, but increasing requirements for formal qualifications and regulation of support staff, if not accompanied by adequate recognition and remuneration, may worsen recruitment problems. [source] The evidence-based supply of non-prescription medicines: barriers and beliefsINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2004Margaret C. Watson MRC fellow ABSTRACT Context The reclassification of prescription only medicines (POMs) to pharmacy only (P) and general sale list (GSL) status is ongoing in the UK. Pharmacy staff need support to ensure the appropriate supply of these non-prescription medicines (NPMs). Objective To investigate the type of evidence used in the decision to supply NPMs and the barriers associated with their supply. Methods A participant observation study was conducted in nine pharmacies in one area of Scotland (Grampian). In-depth interviews were conducted with one pharmacist and one medicine counter assistant (MCA) from each pharmacy to explore and compare their attitudes and beliefs towards evidence-based practice (EBP) and the supply of NPMs. Key findings Most consultations were product requests. Pharmacy staff had little awareness or understanding of the term EBP and no specific evidence was used in the majority of consultations. Pharmacists' attitudes towards EBP varied. Personal experience or feedback from customers were cited as evidence upon which treatment recommendations were based. Many barriers and problems were associated with the supply of NPMs. These included: lack of evidence; MCAs' self-perception of their role; questioning and communication skills; safety; and training needs. There was a gap between pharmacists' and MCAs' perceptions of who should be referred to the pharmacist. Many staff used the WWHAM mnemonic for questioning customers, but this was often used as a matter of rote rather than as a framework to engage the customer in a relevant and constructive consultation. The development of adequate communication skills to allow core information to be obtained to support decision making needs to be addressed. Conclusion An increased awareness of EBP and its role in quality care needs to be promoted to community pharmacists and MCAs. There is currently no formal continuing education provision or requirement for MCAs in the UK. Pharmacy staff, particularly MCAs, require continuing education on the supply of NPMs. [source] On-Pump Beating Heart Versus Hypothermic Arrested Heart Valve Replacement SurgeryJOURNAL OF CARDIAC SURGERY, Issue 2 2008Ümit Karadeniz M.D. Methods: Fifty valvular surgery patients were randomly assigned into three groups. Sixteen patients underwent beating heart valve replacement with normothermic bypass without cross-clamping the aorta, 17 patients underwent the same procedure with cross-clamping the aorta and retrograde coronary sinus perfusion, and the remaining 17 patients had conventional surgery with hypothermic bypass and cardioplegic arrest. Results: Two-channel electroencephalography (EEG) was recorded to assess changes in cerebral cortical synaptic activity and 95% spectral edge frequency values were recorded continuously. Bispectral monitoring was used to measure the depth of anesthesia. Blood flow rates in middle cerebral artery (MCA) were measured by transcranial Doppler (TCD). Reduction in spectral edge frequency (>50%) or bispectral index (BIS) (<20) or transcranial Doppler flow velocity (>50%) was detected in four patients in Group 1, five patients in Group 2, and three patients in Group 3. BIS or EEG values never reached zero, which indicates isoelectric silence during surgery. Gross neurological examinations were normal in all patients postoperatively. Conclusion: There is no difference regarding neurological monitoring results between on-pump beating heart and hypothermic arrested heart valve replacement surgery. Also no significant difference was encountered among the groups regarding the clinical outcomes. [source] Novel parameter for the diagnosis of distal middle cerebral artery stenosis with transcranial Doppler sonographyJOURNAL OF CLINICAL ULTRASOUND, Issue 8 2010Suk-Won Ahn MD Abstract Purpose Transcranial Doppler sonography (TCD) is commonly used for the diagnosis of middle cerebral artery (MCA) stenosis. However, TCD indices to predict distal MCA (M2) stenosis have not yet been established. We compared TCD and magnetic resonance angiography (MRA) to validate a new index for the diagnosis of M2 stenosis. Methods Consecutive patients who underwent TCD and MRA were included. Based on MRA, M2 stenosis was defined as >50% narrowing beyond the bifurcation area. TCD index of the M2/M1 ratio was defined as the ratio between the mean flow velocity (MFV) obtained at a depth of 30,44 mm (M2) and a depth of 45,65 mm (M1). Sensitivity and specificity of the M2/M1 ratio were calculated from the receiver operating characteristic curve. The diagnostic yield of elevated MFV (>80 cm/s) and asymmetry index of >30% for M2 stenosis were also investigated. Results Among the consecutive patients, 105 with M2 stenosis were compared with 123 without MCA stenosis. The M2/M1 ratio was significantly higher in the M2 stenosis group (1.10 versus 0.86, p < 0.001). Sensitivity and specificity for M2 stenosis were most satisfying when the M2/M1 ratio of 0.97 was adopted as the cutoff value. Diagnostic yield of the M2/M1 ratio was better than MFV or asymmetry index. Conclusions The M2/M1 ratio may be a highly specific parameter for assessing M2 stenosis with TCD. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:420,425, 2010 [source] Middle cerebral artery peak systolic velocity and ductus venosus velocity in the investigation of nonimmune hydropsJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2009Sedigheh Borna MD Abstract Purpose. This study was performed to investigate the cause of nonimmune hydrops fetalis by measuring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) and velocity waveforms of the ductus venosus (DV) with Doppler. Methods. This cross-sectional study was done on 19 pregnancies referred to three university teaching hospitals for further investigation of nonimmune hydrops fetalis in 2007 and 2008. The MCA-PSV and DV velocity waveforms were recorded in all fetuses. Anemia was investigated in cases with MCA-PSV values greater than 1.50 MoM (multiple of the median). Cardiovascular causes and chromosomal abnormalities were investigated in fetuses with abnormal DV velocity. Results. Four of 19 fetuses had MCA-PSV values greater than 1.50 MoM. The causes of anemia were cytomegalovirus, parvovirus B19 infections, congenital heart disease, and Turner syndrome. Four cases had reversed flow in the DV; three of them had congenital heart disease on echocardiography; and one had a normal echocardiogram, but an abnormal karyotype was detected. Conclusion. Assessment of the MCA-PSV and DV velocity waveforms during sonographic examination of fetuses with nonimmune hydrops fetalis may improve our knowledge about the etiology of this condition. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009 [source] Changes in blood flow velocity in the middle and anterior cerebral arteries evoked by walkingJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2002Krassen Nedeltchev MD Abstract Purpose Transcranial Doppler sonography (TCD) is an established method for assessing changes in blood flow velocity (BFV) coupled to brain activity. Our objective was to investigate whether walking induces measurable changes in BFV in healthy subjects. Methods Changes in BFV in both middle cerebral arteries (MCAs) of 40 healthy adult subjects during walking on a treadmill were measured using bilateral TCD. In 8 of the 40 subjects, 1 anterior cerebral artery (ACA) was monitored simultaneously with the contralateral MCA. The percentage increase in BFV (BFVI%) compared with the baseline velocity (V0), the percentage decrease in BFV (BFVD%) compared with the V0, and the normalized ACA-MCA ratio were analyzed. Results The overall mean (± standard deviation [SD]) V0 was 59.9 ± 11.6 cm/second in the left MCA and 60.1 ± 12.9 cm/second in the right MCA. Women had higher V0 values than men had. Walking evoked an initial mean overall BFVI% in both left (8.4 ± 5.1%) and right MCAs (9.1 ± 5.1%), followed by a decrease to below baseline values in 38 of 40 subjects. A statistically significant increase of the normalized ACA-MCA ratio was measured, indicating that changes in BFV in the ACA territory were coupled to brain activation during walking. Conclusions The use of functional TCD showed different changes in BFV in the ACAs and MCAs during walking. This method may be an interesting tool for monitoring progress in patients with motor deficits of the legs, such as paresis. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:132,138, 2002; DOI 10.1002/jcu.10047 [source] Assessment of theoretical methods for the calculation of methyl cation affinitiesJOURNAL OF COMPUTATIONAL CHEMISTRY, Issue 2 2008Y. Wei Abstract The methyl cation affinity (MCA; 298 K) of a variety of neutral and anionic bases has been examined computationally with a wide variety of theoretical methods. These include high-level composite procedures such as W1, G3, G3B3, and G2, conventional ab initio methods such as CCSD(T) and MP2, as well as a selection of density functional theory (DFT) methods. Experimental results for a variety of small model systems are well reproduced with practically all these methods, and the performance of DFT based methods are far superior in comparison to their MP2 analogs for these small models. For larger model, systems including motifs frequently encountered in organocatalysts, the performance deteriorates somewhat for DFT methods, while it improves significantly for MP2, rendering the former methods unreliable for common organic bases. Thus, MP2 calculations performed in combination with basis sets such as 6-31+G(2d, p) or larger, appear to offer a practical and reliable approach to compute MCAs of organic bases. © 2007 Wiley Periodicals, Inc. J Comput Chem, 2008 [source] The Mental Capacity Act 2005: implications for dietetic practiceJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2007C. Lyons Abstract The Mental Capacity Act (MCA) 2005 will be implemented in England and Wales in 2007 and have consequences for dietitians who work with people who may lack capacity to make specific decisions. This paper will explore issues arising from the introduction of the Act and considers the implications for dietitians involved in the delivery of clinical care, using enteral feeding as an illustrative example. If patients lack capacity to make specific decisions, dietitians will be required to record if, how and why they reached a decision, how they are involved in the decision making process and need to be able to justify their actions in relation to those decisions. This paper discusses the importance of dietitians' involvement in best interests decision making and considers the implications of decision making where people have drawn up a Lasting Power of Attorney. The role of such advance decisions is discussed and consideration is given to the potential compatibility of perspectives between the patient and family that may give rise to disputes. Dietitians may be well placed within multidisciplinary team working to ensure patients and their carers are part of the decision making process through effective communication and support for patients. Dietitians in England and Wales must consider the implications of the MCA upon their clinical practice and others outside these jurisdictions may like to reflect on the relevance of such developments in their own contexts. [source] Time-resolved contrast-enhanced MR angiography of intracranial lesionsJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2008Zhitong Zou MD Abstract Purpose To determine if contrast-enhanced (CE) MRI of intracranial lesions benefits from time-resolved MR angiography (MRA) during contrast agent injection. Materials and Methods For 126 patients with suspected intracranial lesions undergoing routine CE MRI at 3.0T (N = 88) or 1.5T (N = 38), time-resolved CE MRA (three-dimensional [3D] time-resolved imaging of contrast kinetics [TRICKS]) was performed during injection of the routine gadolinium (Gd) dose of 0.1 mmol/kg. Time to peak (TTP) enhancement of lesions as well as time to internal carotid artery (ICA), middle cerebral artery (MCA), superior sagittal sinus (SSS), and jugular vein enhancement were measured. Source and maximum intensity projection (MIP) images were reviewed to delineate the spatial relationship of lesions and the vasculature. Results In 61 patients (48%), additional important findings were detected on time-resolved MRA that were not seen on the routine CE protocol, including aneurysms (N = 6), arteriovenous malformations (N = 7), ICA stenoses (N = 2), vascular anomalies (N = 18), and relationships between lesions and vessels (N = 28). In addition, tumor TTP correlated with glioma grade (r = 0.87) and discriminated epithelial from nonepithelial meningiomas (P = 2.6 × 10,5). MRA added eight minutes to the total exam time. Conclusion Time-resolved MRA performed during contrast agent injection adds information to the routine brain CE MRI examination of intracranial lesions with only a small time penalty and no additional risk to the patient. J. Magn. Reson. Imaging 2008. © 2008 Wiley-Liss, Inc. [source] Reflections on ethics and MCA in environmental decisionsJOURNAL OF MULTI CRITERIA DECISION ANALYSIS, Issue 2 2001Felix Rauschmayer Abstract The aim of decision analysis is normative. Consequently, at least in public spheres, one has to reflect on its normative foundation. Multi-criteria analysis (MCA) uses aggregated evaluations on several criteria to recommend a decision. The claim for the adequacy of the recommended solution is usually based on the assumption that the interests of the decision-maker(s) are adequately assessed by the MC model (see, for example, Munda G. 1996. Cost,benefit analysis in integrated environmental assessment: some methodological issues. Ecological Economics19: 157,168). I argue that as a prerequisite to a normative foundation, the criteria have to reflect not only the interests but possibly all values stemming from normative arguments of the decision-maker(s). These arguments might differ substantially from each other. This is especially true for environmental decisions. The integration of values will result in changes of the MCA understanding, criteria building, and aggregation method, and will not be possible without analytical capacities of the decision analyst in ethics. Copyright © 2001 John Wiley & Sons, Ltd. [source] Sphingolipids in rat model of transient focal cerebral ischemia: implication for stroke injuryJOURNAL OF NEUROCHEMISTRY, Issue 2002M. Khan Lipids are essential for signal transduction in response to trauma leading to neurodegeneration. Ceramide is an important mediator of apoptosis and cell proliferation. We studied the involvement of ceramide/sphingomyelin pathway in rat brain (stroke model) after 45 min ischemia followed by 24-h reperfusion. Ischemia was performed through occlusion of right middle cerebral artery (MCA). The level of ceramide was found increased (70,100% in ischemic side of brain v/s contralateral side of brain). Sphingomyelin levels were also decreased by 20,25% in ischemic brain v/s contralateral side of brain. Increase in ceramide and decrease in sphingomyelin were in good agreement with observed apoptotic cell loss (TUNEL assay) and decrease in the level of cardiolipin (a mitochondrian specific phospholipids) in affected ischemic brain. N-acetyl cysteine (NAC), a therapeutic agent recognized as potent antioxidant provided protective effect. Pretreatment with NAC before ischemia reduced the infarct volume size, suppressed apoptosis, restored cardiolipin level and decreased the levels of free fatty acids. However, NAC did not normalize the ceramide level. These interesting observations raise a question about the role of ceramide and its relationship with apoptosis and oxidative stress in rat brain ischemia. Acknowledgements:, Supported by NIH grants NS-40144, NS-40810, NS-22576, NS-34741 and NS-37766. [source] Association of Pretreatment ASPECTS Scores with tPA-Induced Arterial Recanalization in Acute Middle Cerebral Artery OcclusionJOURNAL OF NEUROIMAGING, Issue 1 2008Georgios Tsivgoulis MD ABSTRACT BACKGROUND AND PURPOSE The Alberta Stroke Program Early CT-Score (ASPECTS) assesses early ischemic changes within the middle cerebral artery (MCA) and predicts poor outcome and increased risk for thrombolysis-related symptomatic ICH. We evaluated the potential relationship between pretreatment ASPECTS and tPA-induced recanalization in patients with MCA occlusions. SUBJECTS & METHODS Consecutive patients with acute ischemic stroke due to MCA occlusion were treated with standard IV-tPA and assessed with transcranial Doppler (TCD) for arterial recanalization. Early recanalization was determined with previously validated Thrombolysis in Brain Ischemia (TIBI) flow-grading system at 120 minutes after tPA-bolus. All pretreatment CT-scans were prospectively scored by trained investigators blinded to TCD findings. Functional outcome at 3 months was evaluated using the modified Rankin Scale (mRS). RESULTS IV-tPA was administered in 192 patients (mean age 68 ± 14 years, median NIHSS-score 17). Patients with complete recanalization (n= 51) had higher median pretreatment ASPECTS (10, interquartile range 2) than patients with incomplete or absent recanalization (n= 141; median ASPECTS 9, interquartile range 3, P= .034 Mann-Whitney U-test). An ASPECTS ,6 was documented in 4% and 17% of patients with present and absent recanalization, respectively (P= .019). Pretreatment ASPECTS was associated with complete recanalization (OR per 1-point increase: 1.54; 95% CI 1.06,2.22, P= .023) after adjustment for baseline characteristics, risk factors, NIHSS-score, pretreatment TIBI grades and site of arterial occlusion on baseline TCD. Complete recanalization (OR: 33.97, 95% CI 5.95,185.99, P < .001) and higher ASPECTS (OR per 1-point increase: 1.91; 95% CI 1.17,3.14, P= .010) were independent predictors of good functional outcome (mRS 0,2). CONCLUSIONS Higher pretreatment ASPECT-scores are associated with a greater chance of complete recanalization and favorable long-term outcome in tPA-treated patients with acute MCA occlusion. [source] Topographic Patterns of Small Subcortical Infarcts Associated with MCA Stenosis: A Diffusion-Weighted MRI StudyJOURNAL OF NEUROIMAGING, Issue 3 2006Xin Wang MD ABSTRACT Background and Purpose. Small subcortical infarcts (SSI, maximum lesion diameter ,2.0 cm) are usually considered as infarcts caused by small vessel disease. However, SSI can also be associated with large artery occlusive disease such as middle cerebral artery (MCA) stenosis. We performed a prospective study to investigate the relationship between MCA stenosis and SSI distribution and further to investigate the mechanism of SSI caused by MCA stenosis. Methods. Magnetic resonance angiography (MRA) and diffusion-weighed MRI (DWI) of consecutive acute ischemic stroke patients with recent SSI were studied. The distribution of acute infarcts on DWI was categorized as cortical infarct (CI), border zone infarct (BI), or perforating artery infarct (PAI). Results. Totally, 93 cases were recruited, among which 12 had single SSI with MCA stenosis (group 1) and 26 patients had multiple SSI with MCA stenosis (group 2), while 55 patients without MCA stenosis had single SSI (group 3). For patients with single SSI and MCA stenosis, 6 had BI and 6 had PAI; for patients with multiple SSI and MCA stenosis, 25 had BI, 4 had PAI and 9 had CI (compared with group1: P= .001); for patients with single SSI but without MCA stenosis, 20 had BI and 35 had PAI (compared with group1: P= .58). Conclusion. Multiple acute infarcts along the border zone are the commonest pattern in small infarcts with MCA stenosis, especially among those with multiple acute infarcts. Our data suggest that hemodynamic compromise and artery-to-artery embolism may be both important factors for infarcts in patients with MCA stenosis. [source] Importance of Jugular Valve Incompetence in Contrast Transcranial Doppler Ultrasonography for the Diagnosis of Patent Foramen OvaleJOURNAL OF NEUROIMAGING, Issue 3 2003M. Akif Topçuoglu MD ABSTRACT Transcranial Doppler (TCD) ultrasound with the intravenous injection of agitated saline as contrast (cTCD) is an effective method for detecting right-to-left intracardiac and extracardiac shunt (RLS); however, the sensitivity of cTCD in the diagnosis of RLS remains slightly less than that of transesophageal echocardiography, even in patients with adequate transtemporal ultrasonic bone windows. The authors present a case with cTCD underestimating RLS because of jugular valve incompetence in a 42-year-old man presenting with an episode of transient aphasia. Three weeks after transcatheter closure of a patent foramen ovale associated with an atrial septal aneurysm, he experienced 2 episodes of amaurosis fugax. Following a negative 45-minute embolus detection study with power M-mode TCD, the patient underwent a cTCD study with monitoring of the left middle cerebral artery (MCA), the anterior cerebral artery, and the submandibular extracranial internal carotid artery. A single microbubble (MB) was detected in the left MCA in only 1 of 5 studies; the remaining runs all failed to detect an RLS. Significant MB reflux was noted in the left internal jugular vein because of jugular valve incompetence. The authors conclude that incompetence of the jugular vein valve can result in a false negative cTCD study for RLS detection. [source] Residual Flow Signals Predict Complete Recanalization in Stroke Patients Treated With TPAJOURNAL OF NEUROIMAGING, Issue 1 2003Lise A. Labiche MD ABSTRACT Background. Residual blood flow around thrombus prior to treatment predicts success of coronary thrombolysis. The authors aimed to correlate the presence of residual flow signals in the middle cerebral artery (MCA) with completeness of recanalization after intravenous tissue plasminogen activator (TPA). Methods. The authors studied consecutive patients treated with intravenous TPA therapy who had a proximal MCA occlusion on pretreatment transcranial Doppler (TCD). Patients were continuously monitored for 2 hours after TPA bolus. Absent residual flow signals correspond to the thrombolysis in brain ischemia (TIBI) 0 grade, and the presence of residual flow signals was determined as TIBI 1-3 flow grades. Complete recanalization was defined as flow improvement to TIBI grades 4-5. Results. Seventy-five patients with a proximal MCA occlusion had median pre-bolus NIHSS 16 (85% with ,10 points). TPA bolus was given at 141 ± 56 minutes (median 120 minutes). Complete recanalization was observed in 25 (33%), partial in 23 (31%), and no early recanalization was seen in 27 (36%) patients within 2 hours after TPA bolus. Only 19% with absent residual flow signals (TIBI grade 0, n= 26) on pretreatment TCD had complete early recanalization. If pretreatment TCD showed the presence of any residual flow (TIBI 1-3, n= 49), 41% had complete recanalization within 2 hours of TPA bolus (P = .03). Conclusions. Patients with detectable residual flow signals before IV TPA bolus are twice as likely to have early complete recanalization. Those with no detectable residual flow signals have less than 20% chance for complete early recanalization with intravenous TPA and may be candidates for intra-arterial therapies. [source] Screening for Intracranial Stenosis With Transcranial Doppler: The Accuracy of Mean Flow Velocity ThresholdsJOURNAL OF NEUROIMAGING, Issue 1 2002Robert A. Felberg MD ABSTRACT Background. Patients with 50% intracranial arterial stenosis may require more intensive therapies for stroke prevention. Transcranial Doppler (TCD) is a convenient noninvasive screen for intracranial stenosis. The accuracy of different mean flow velocity (MFV) thresholds for determining the degree of stenosis remains uncertain. Methods. The authors prospectively compared the accuracy of TCD criteria and MFV thresholds to magnetic resonance, computed tomography, and digital subtraction angiography in patients with symptoms of recent or remote stroke or transient ischemic attack. Stenosis on angiography was measured as 0%, <50%, or ,50% diameter reduction. Results. Of 136 consecutive patients, 33 (24%) had distal internal carotid artery (ICA), middle cerebral artery (MCA), posterior cerebral artery, or basilar artery stenosis on angiography (14 patients [10%] were excluded due to incomplete TCD examinations, mainly from a lack of temporal windows). TCD showed 31 true-positive, 9 false-positive, 2 false-negative, and 94 true-negative studies. For all vessels, TCD had a sensitivity of 93.9% (confidence interval [CI] = 89%-98%), a specificity of 91.2% (CI = 87%-96%), a positive predictive value (PPV) of 77.5%, and a negative predictive value (NPV) of 97.9%. The trade-off in sensitivity and specificity for MCA MFV thresholds was as follows: MFV ,80 cm/s had a sensitivity of 100%, a specificity of 96.9% (CI = 94%-99%), a PPV of 84%, and an NPV of 100%. MFV,100 cm/s had a sensitivity of 100%, a specificity of 97.9% (CI = 96%-99%), a PPV of 88.8%, and an NPV of 94.9%. MFV,120 cm/s had a sensitivity of 68.7% (CI = 61%-78%), a specificity of 100%, a PPV of 100%, and an NPV of 94.9%. Reasons for false-positive findings include collateralization of flow in the presence of proximal ICA stenosis and prestenotic to stenotic MCA velocity ratios of 1:,2. Conclusion. TCD is both sensitive and specific in identifying ,50% intracranial arterial stenosis. A MFV threshold cutoff of 100 cm/s has an optimal sensitivity and specificity trade-off for ,50% MCA stenosis. To help avoid false-positive results, a prestenotic to stenotic MCA velocity ratio of 1:,2 should be used in addition to the MFV threshold. [source] Cerebral Hemodynamics Changes During Retrograde Brain Perfusion in DogsJOURNAL OF NEUROIMAGING, Issue 2 2001Alexander Y. Razumovsky PhD ABSTRACT The objective of this study was to examine cerebral hemodynamics changes during hypothermic circulatory arrest (HCA) with and without retrograde cerebral perfusion (RCP). Thirteen colony-bred hound dogs were placed on cardiopulmonary bypass (CPB) and cooled to 18°C. Five dogs underwent 2 hours of HCA without RCP and 8 with RCP. The animals were then rewarmed on CPB until normothermic and weaned. Cerebral blood flow velocity (CBFV) and Gosling Pulsatility Index (PI) in the middle cerebral artery (MCA) were studied using transcranial Doppler (TCD) ultrasound. At baseline and during pre- and postarrest CPB, there was anterograde direction of blood flow in the MCA. During HCA with RCP, there was retrograde direction of blood flow in the MCA. There was no difference in CBFV between pre-, during, and postarrest CPB in the group with RCP; however, there was significantly increased CBFV during postarrest CPB in the group without RCP compared to the dogs with RCP. Later, at 3 hours after postarrest CPB, there was decreased CBFV in all animals accompanied by increased PI (2.4 ± 0.4 and 2.2 ± 0.6 for animals with RCP and without RCP, respectively) and abnormal TCD waveform changes including decreased diastolic compartment and sharp systolic peak. During hypothermic circulatory arrest, RCP provides CBFV in the MCA comparable to MCA CBFV during CPB. HCA dogs without RCP showed immediate hyperemia on reperfusion. The decreased CBFV and increased PI at 1 hour after postarrest CPB could be an indicator of progressive ischemic injury due to the increased intracranial pressure despite the implementation of RCP. [source] | ||||||||||||||||||||||||||||||||||||||||