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C Cryer

Publications and source records attributed to C Cryer.

29 records · Page 2Linked to original sources

The heart muscle's putative "secondary structure'. Functional implications of a band-like anisotropy.

Opinions are divided as to whether the rope-like secondary structure, which Torrent-Guasp dissected out of the myocardial body by the blunt unwinding technique (BUT) reveals some kind of functional compartmentation of the heart muscle. The myocardial fibres are aligned parallel to the fibre disruption (cleavage) plane, along which the band has been prepared but they are not necessarily aligned parallel to the long axis of the band. Inconsistencies in the myocardial rope model arise from the obligatory zones of transmural inflection, which are obvious in the base and the apex of both ventricles. They are, however, merely discernible in the midzone of the left ventricular cone. The investigator experienced in BUT knows that the cleavage plane is not unique. We doubt the assumption that the rope structure is the predominant stress transmission pathway, because the fibre strand peel-off technique (SPOT) delivers irregular fibre disruption planes which are definitely different from those which Torrent-Guasp prepares. The rope-like fibre arrangement could be just a redundant structure, a remnant of past developmental steps without, however, any functional implication to the human heart. On the other hand, peeling-off fibre strands from the ventricular wall produces deeply perforating, i.e., oblique transmurally grooved surfaces. Putative functions of force transmission in an oblique transmural direction are (1) ventricular dilation as a function of the variable inclination angle with respect to the epicardial surface, (2) monitoring of ventricular wall stress and ventricular size and (3) segmental stiffening which could serve other dependent segments as a punctum fixum.

Anisotropy↗

The heart's fibre alignment assessed by comparing two digitizing systems. Methodological investigation into the inclination angle towards wall thickness.

Myocardial contractile pathways which are not aligned strictly parallel to the heart's epicardial surface, give rise to forces which also act in the ventricular dilating direction. We developed a method which allows us to assess any fibre orientation in the three-dimensional myocardial weave. Decollagenized hearts were prepared by peeling-off fibre strands, following their main fibre orientation down to near the endocardium. In the subepicardium the strands followed a course more or less parallel to the epicardium, whereas from the mid-wall on they tended to dive progressively deeper into the wall. The preparation displays more or less rugged surfaces rather than smooth layers. The grooves and crests on the exposed surfaces were sequentially digitized by two methods: (1) Using a magnet tablet (3 Draw Digitizer System, Polhemus, Cochester VTO 5446, USA) on a dilated pig heart we manually followed the crests using a stylus, handling each groove and crest as an individual contractile pathway. (2) A constricted cow heart was digitized using a contact-free optical system (opto TOP, Dr. Breuckmann, Meersburg, Germany), which is based on the principle of imaging triangulation. Using specially developed software the inclination angles of selected crests and grooves with respect to the epicardial surface were calculated. The two digitizing methods yield comparable results. We found a depth- and side-specific weave component inclined to the epi-endocardial direction. This oblique netting component was more pronounced in the inner 1/3 of the wall than in the subepicardium. The inclination angle probably increases with increasing wall thickness during the ejection period. Manual digitizing is an easy and fast method which delivers consistent results comparable with those obtained by the cumbersome high resolution optical method. The rationales for the assessment of transmural fibre inclination are (1) the putative existence of dilating forces inherent in the myocardial weave and (2) the possible overproportional increase in the oblique transmural weave component during myocardial hypertrophy, which would entail a reduction in efficiency of ventricular performance in terms of haemodynamic work.

Animals↗

The assessment of intramural stress alignment on the beating heart in situ using micro-ergometry: functional implications.

The main local stress transmission pathways in the left ventricular base, midportion and apex in up to seven layers have been assessed in normal dog and porcine hearts, in hypertrophied dog hearts, and in three pig hearts having undergone a temporary left ventricular outflow stricture. The rotational sensitivity of needle force probes was used to determine the focal surface-parallel direction of the myocardial tension vector. In all places investigated the orientation of the force transmission pathways differs slightly from the morphologically determined fibre alignment. Vector rotation upon an axis normal to the epicardial surface is definitely tempered as compared to fibre rotation. Alterations in the force transmission pathways assessed in hypertrophied dog hearts by micro-ergometry qualitatively confirm structural remodelling in so far as an irregularity in the transmural rotation of the main stress vector was found. The measured disparities between the alignment of the myocardial fibre weave and the direction of stress transmission both in the normal and the diseased heart is widely individual, and hence, scattering of the data is marked. However, it must also be called into consideration that the measured orientation of force vectors is that at the moment of highest developed force, only. Further investigations will elucidate if discrepancies between that force vector and morphology are less pronounced when the vector is averaged over the entire heart cycle.

Animals↗

Inhomogeneities in wall stress measured by microergometry in the heart muscle in situ.

Microergometry is a method which we have developed as a tool to measure local mesh-tension within the myocardial weave at any measuring site of both ventricles and the septum on the beating heart in situ. In a mapping procedure on pig and dog hearts, both in control conditions and in the hypertrophied state after aortic banding, local mesh-tension was measured in several areas and in up to eight depths proceeding from the epicardium to the endocardium: Probe-to-fibre coupling is definitely more stable in the canine myocardium than in the porcine heart muscle, probably due to a more effective connective tissue fettering of the canine myocardial weave. The observed longitudinal gradient, with the highest tension in the base, of control dog hearts was levelled out in the hypertrophied hearts. Furthermore, in control dog hearts mesh-tension in the subepi- and subendocardial layers was higher than in the midlayers. This pronounced midlayerhypotension was smoothed in the hypertrophied hearts. Further studies will be dedicated to the question of whether the impact of ventricular size and shape on intersegmental stress transmission is determined by the Frank-Starling mechanism alone or whether protracted remodelling processes on the level of the local fibre weave cause slow coupling alterations.

Animals↗

The prevalence of anencephalus and spina bifida in New Zealand.

Despite the plethora of epidemiological research conducted on anencephalus and spina bifida, few of the studies have used multiple source case ascertainment and controlled for the effect of possible confounding factors. This paper reports the results from a study of the relationships between various risk factors and the prevalence of anencephalus and spina bifida in New Zealand during 1978-82, using case data obtained from multiple sources and a national cohort of births as the denominator. The rates of anencephalus and spina bifida in New Zealand were 0.78/1000 and 0.94/1000 total births, respectively. The rate of a neural tube defect (NTD) birth for Maori parents was less than for their non-Maori counterparts. Paternal ethnic origin and maternal ethnic origin made similar contributions to the model of anencephalus rates, but the results suggest that paternal ethnic origin is a less important risk factor in the prevalence of spina bifida. The rate of both NTD was high among female infants and low among births to women born in countries other than the British Isles and New Zealand. The rate of anencephalus showed a distinct north-south gradient, but there was no evidence of effects for maternal or paternal age, parity, urban-rural place of residence, nuptiality, social class or season of birth in the prevalence of either NTD in New Zealand.

Adult↗

Fallacies of international and national comparisons of disease occurrence in the epidemiology of neural tube defects.

Despite extensive research, little progress has been made in elucidating the etiologies of anencephalus and spina bifida. International and national distributions of disease occurrence have often been used as a basis for generating etiological hypotheses (e.g., potato blight, tea consumption, and zinc deficiency hypotheses). However, few of the epidemiological studies of neural tube defects (NTDs) have been conducted with scientific rigor in design, and most are of dubious validity, often with low precision in the estimates. This paper shows that the accepted geographic patterns of NTDs may be attributable to variations in the validity of studies used to describe these patterns. The nonuniformity in the duration and diligence of case ascertainment, the lack of a standardized nomenclature and classification, and the definition of the denominator remain principal problems in evaluating the epidemiology of NTDs. For example, the distinction between incidence and prevalence is not always made, and there is no consistency in the placement of the gestational boundary between late fetal deaths and spontaneous abortions. Findings are compared from studies conducted at different times, without due regard to the effect of secular trends, and using studies that have varying levels of case ascertainment. In etiological research, it is important to perform studies that are accurate and precise, but the literature used to define the spatial distribution of NTDs has often been accepted without due regard to the effect of these factors.

Anencephaly↗

Hip fractures: a future epidemic?

Recent studies from the United Kingdom and Sweden have demonstrated a dramatic rise in the number of people with hip fractures. It is our hypothesis that New Zealand is experiencing a similar rise in the number of hip fractures. The number of elderly people (over age 65 years) admitted to public hospitals in New Zealand over a 38-year period was reviewed. In people over age 75 years, we observed a disproportionate increase in the number of fractures compared with the increase in population. The highest risk group was women over age 85 years. Because of the differing age-specific fracture rates, the proportion of females over age 85 increased from 17% in 1950 to 40% by 1987. Through weighted regression analysis of fracture rate and population predictions, the projected number of fractures in the year 2001 and 2011 was predicted. By 2011 the number of people sustaining hip fractures will more than double. The proportion of the very elderly (85+) will increase from 40 to 65%.

Aged↗

Mass spectrometry of beta-lactam antibiotics with special reference to ionization by fast atom bombardment (FAB).

The mass spectral characteristics of the majority of penicillin and cephalosporin beta-lactam antibiotics in world-wide clinical use are presented and reviewed. Special attention is given to the spectra recorded under fast atom bombardment (FAB) conditions and novel data on many penicillins and cephalosporins are included. Mass spectrometry features of common degradation products of benzylpenicillin and of some synthetic intermediates are also presented. The data illustrate the value of FAB mass spectrometry in identifying members of this closely related group of antibiotics without need for derivatization.

Anti-Bacterial Agents↗

Interlaboratory standardization of enzyme results: the Richmond project.

Three concentrations of proficiency monitoring material and two concentrations of secondary standard calibrating material were prepared and stored frozen. The materials were prepared in buffer containing amylase from human saliva, aspartate aminotransferase from human liver, creatine kinase from human muscle, human serum albumin (20 g/L), and cofactors. The proficiency monitoring material was assayed by 10 methods in nine laboratories for 15 days to establish baseline performance. Each laboratory then used the secondary standard calibrating material to calibrate their instruments' responses to that of a standardization method, and repeated the assay of the proficiency monitoring material for 15 days. For amylase before calibration, between-laboratory mean values for the three concentrations of proficiency monitoring material were 29% lower than the standardization method, and the between-laboratory CV was 28%. After calibration the mean amylase values were 4% lower and the CV was 6%. For aspartate aminotransferase, the pre-calibration between-laboratory mean values were 24% higher than the standardization method (CV 14%) but only 3% higher (CV 6%) after calibration. CK activity deteriorated at storage temperatures above -70 degrees C. This study demonstrates that, by using a common secondary standard, laboratories can improve calibration of enzyme results.

Amylases↗