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Biomedical subjects

R M Klein

Publications and source records attributed to R M Klein.

At least 19 recordsLinked to original sources
PubMed2006

Efficacy of MRI in classifying proximal focal femoral deficiency.

OBJECTIVE: To evaluate the efficacy of MRI in classifying PFFD and to compare MRI to radiographic classification of PFFD. DESIGN: Radiographic and MRI classification of the cases was performed utilizing the Amstutz classification system. PATIENTS: Retrospective evaluation of radiographs and MRI exams in nine hips of eight patients with proximal focal femoral deficiency was performed by two radiologists. RESULTS: The cases were classified by radiographs as Amstutz 1: n=3, Amstutz 3: n=3, Amstutz 4: n=1 and Amstutz 5: n=2. The classifications based on MRI were Amstutz 1: n=6, Amstutz 2: n=1, Amstutz 3: n=0, Amstutz 4: n=2 and Amstutz 5: n=0. Three hips demonstrated complete agreement. There were six discordant hips. In two of the discordant cases, follow-up radiographs of 6 months or greater intervals were available and helped to confirm MRI findings. Errors in radiographic evaluation consisted of overestimating the degree of deficiency. CONCLUSION: MRI is more accurate than radiographic evaluation for the classification of PFFD, particularly early on, prior to the ossification of cartilaginous components in the femurs. Since radiographic evaluation tends to overestimate the degree of deficiency, MRI is a more definitive modality for evaluation of PFFD.

Bone Diseases, Developmental↗
PubMed2006

The effects of illusory line motion on incongruent saccades: implications for saccadic eye movements and visual attention.

A complex neural problem must be solved before a voluntary eye movement is triggered away from a stimulus (antisaccade). The location code activated by a stimulus must be internally translated into an appropriate signal to direct the eyes into the opposite visual field, while the reflexive tendency to look directly at the stimulus must be suppressed. No doubt these extra processes contribute to the ubiquitous slowing of antisaccades. However, there is no consensus on the cognitive mechanisms that contribute to the antisaccade programme. Visual attention is closely associated with the generation of saccadic eye movements and it has been shown that attention will track an illusion of line motion. A series of experiments combined this illusion with a saccadic eye movement that was congruent (i.e. directed towards), or incongruent with (i.e. direct away from), a peripheral target. Experiment 1 showed that congruent saccades had faster reaction times than incongruent saccades. In contrast, Experiments 2 and 3 demonstrated that, with illusory line motion, incongruent saccades now had faster reaction times than congruent saccades. These findings demonstrate that an illusory phenomenon can accelerate the processing of an incongruent relative to a congruent saccade.

Adult↗
PubMed2006

Effects of oestrogen on trigeminal ganglia in culture: implications for hormonal effects on migraine.

Although migraine is more common in women than men and often linked to the menstrual cycle, few studies have investigated the biological basis of hormonal influences on the trigeminovascular system. In the present study we investigated the effect of physiological levels (10(-9) m) oestrogen on female rat trigeminal ganglia in vitro. Immunocytochemical analysis demonstrated the presence of oestrogen receptor-alpha in a predominantly cytoplasmic location and in neurites. Microarray analysis demonstrated that oestrogen treatment regulates several genes with potential relevance to menstrual migraine. The genes that were upregulated included synapsin-2, endothelin receptor type B, activity and neurotransmitter-induced early gene 7 (ania-7), phosphoserine aminotransferase, MHC-1b, and ERK-1. Down-regulated genes included IL-R1, bradykinin B2 receptor, N-tropomodulin, CCL20, GABA transporter protein, fetal intestinal lactase-phlorizin hydrolase, carcinoembryonic antigen-related protein, zinc finger protein 36, epsin 1 and cysteine string protein. Protein activity assays demonstrated that exposure of the cultured neurons to oestrogen leads to activation of ERK, which has been linked to inflammatory pain. Immunocytochemistry demonstrated that activated ERK was present in neurons containing peripherin, a marker of nociceptive neurons. Several of the genes in the present study may provide potential targets for understanding the association of oestrogen with migraine and other hormone-related orofacial pain.

Animals↗
PubMed2005

[Recurrent ventricular tachycardias following myocardial infarction: linear ablation strategy using an electroanatomical mapping system].

BACKGROUND AND AIM OF STUDY: The implantable cardioverter defibrillator (ICD) is the therapy of choice for patients with ventricular tachycardia (VT) after myocardial infarction. In some patients frequent ICD shocks occur, often resulting in clinical problems, if antiarrhythmic drugs insufficiently suppress them. Our aim was to describe electro-anatomical mapping and ablation techniques in patients with VTs, in which conventional strategy treatments have failed. PATIENTS AND METHODS: 17 patients (69.5 +/- 8 years, 12 male) were included. During 3 months before ablation the number of ICD shocks was 21 +/- 8 (mean +/- SD). Using an electro-anatomical mapping system (CARTO), activation mapping was performed in 12 patients during hemodynamically tolerable, stable VT. In 5 cases with "non-mappable" VT only voltage mapping during sinus rhythm was obtained. The aim was to characterize the underlying scar tissue precisely in order to modify the substrate with an individual strategic linear lesion, thus preventing re-induction of VT. RESULTS: Procedure time was 184 +/- 9 minutes, fluoroscopy time totalled 19 +/- 9 minutes. Lesion lines were established with 13 +/- 9 ablation pulses. In 15 patients (88 %) acute ablation of the VT was successful. During a follow-up of 8 +/- 7 months, 2 patients had a recurrence of the VT. Two patients developed a VT with a different morphology. In another case ventricular fibrillation occurred. No major complications were observed. CONCLUSION: Electro-anatomical mapping combined with an individual linear ablation strategy is a safe and effective method to prevent symptomatic VT in patients after myocardial infarction.

Aged↗
PubMed2004

[Curative therapy in symptomatic atrial ectopy].

A female patient without underlying heart disease was highly symptomatic from short runs of atrial ectopy. Sustained atrial tachycardia or atrial fibrillation never occurred. Due to ineffective pharmacological therapy, catheter ablation combined with electroanatomic mapping (CARTO) was performed effectively. Characteristics of ectopic atrial tachycardia and the electrophysiological techniques are described.

Adult↗
PubMed2004

Frequency and quantity of the parvovirus B19 genome in endomyocardial biopsies from patients with suspected myocarditis or idiopathic left ventricular dysfunction.

Parvovirus B19 (PB19) has been identified as a possible cause of myocarditis and heart failure in both children and adult patients. This study used real time PCR analysis, to determine the frequency and to quantify PB19 viral genomes in endomyocardial tissue samples from 80 adult patients with clinically suspected myocarditis or idiopathic left ventricular dysfunction and from 36 controls. Histological (Dallas classification) and immunohistological analyses were performed to detect myocardial inflammation in the endomyocardial biopsies.PB19 genomic DNA was found in nine of 80 patients (11.2%), 4 out of 31 (12.9%) patients with inflammatory infiltrates detected via immunohistological methods and 5 out of 49 (10.2%) patients with left ventricular dysfunction without myocardial inflammation. The copy numbers for PB19 DNA ranged between 30 and 3900 per microg of cellular DNA. Four patients with clinically suspected myocarditis had copy numbers for PB19 DNA of 70, 740, 3400 and 3900, respectively, per microg of cellular DNA in the endomyocardial biopsy. Five patients with idiopathic left ventricular dysfunction had copy numbers for PB19 DNA of 30, 38, 52, 58 and 90, respectively, per microg of cellular DNA in the endomyocardial biopsy. The amplicon of one of the nine positive PCR fragment was sequenced and was found to be fully identical in the highly conserved sequence of published Parvovirus B19 VP1/VP2 genes (NCBI gene bank). In all patients, acute myocarditis was excluded according to the Dallas classification. All biopsies of 36 controls with no history of myocarditis or recent viral infection were negative for myocardial inflammation and parvovirus B19 genomes. In summary, Parvovirus B19 DNA is present within the myocardium of patients with suspected myocarditis and idiopathic left ventricular dysfunction and can be detected and quantified in endomyocardial specimens via real time PCR.

Adult↗
PubMed2004

Identification and ablation of atypical atrial flutter. Entrainment pacing combined with electroanatomic mapping.

Differentiation between typical and atypical atrial flutter solely based upon surface ECG pattern may be limited. However, successful ablation of atrial flutter depends on the exact identification of the responsible re-entrant circuit and its critical isthmus. Between August 2001 and June 2003, we performed conventional entrainment pacing within the cavotricuspid isthmus in 71 patients with sustained atrial flutter. In patients with positive entrainment we considered the arrhythmia as typical flutter and treated them with conventional ablation of the cavotricuspid isthmus. As a consequence of negative entrainment we performed 3D-electroanatomic activation mapping (CARTO trade mark ). Conventional ablation of the right atrial isthmus was successful in all patients (n = 54) with positive entrainment. We performed electroanatomic mapping in the remaining 17 patients (14 male; age 60.9 +/- 16 years) resulting in the identification of 6 cases with typical and 11 cases with atypical flutter. Therefore, entrainment pacing was able to predict the true presence of typical atrial flutter in 91.5%. Atypical flutter was right sided in 4 patients and left sided in 7 cases. Electrically silent ("low voltage") areas probably demonstrating atrial myopathy were identified in all cases with left sided and in 2 patients with right sided flutter. In these patients targets for ablation lines were located between silent areas and anatomic barriers (inferior pulmonary veins, mitral respectively tricuspid annulus, or vena cava inferior). In 1 patient, the investigation was stopped due to variable ECG pattern and atrial cycle lengths. In the remaining cases, ablation was acutely successful. One patient, after surgical closure of a ventricular septal defect, demonstrated a dual-loop intra-atrial reentry tachycardia dependent on two different isthmuses. This arrhythmia required ablation of those distinct isthmuses to be interrupted. After a mean follow-up of 8.8 +/- 3.4 months, there was one patient with a recurrence of left-sided atrial flutter. Another patient developed permanent atrial fibrillation shortly after the procedure. Mean duration time of the procedure was 235.6 +/- 56.4 min (right atrium: 196 +/- 17.3 min; left atrium: 267.2 +/- 59.5 min), and average fluoroscopy time was 21.8 +/- 11.7 min (right atrium: 9.5 +/- 6 min; left atrium: 28.9 +/- 7 min). There was no incidence of serious complications associated with these procedures. In conclusion, conventional pacing in the cavotricuspid isthmus combined with electroanatomic mapping was an effective method to differentiate between typical and atypical atrial flutter. Electroanatomic mapping was a powerful tool both for identification of different atrial re-entrant circuits including their critical isthmuses as well as for effective application of individual ablation line strategies.

Adolescent↗
PubMed2004

[Clinical experiences with cooled radiofrequency ablation of ectopic atrial tachycardia employing an electroanatomic mapping system].

Due to its variable origin success for ablation of ectopic atrial tachycardia (EAT) has been difficult to achieve using conventional mapping and ablation strategies. In contrast, no information in the literature is available about the use of a nonfluoroscopic, 3-dimensional electroanatomic mapping system (CARTO) combined with the cooled ablation technology creating deeper lesions in experimental studies compared to standard catheters. In 20 consecutive patients (15 female; age 52.5 +/- 15.4 years), a single focus responsible for clinical EAT has been mapped. Twelve EATs were located in the right atrium, whereas 8 foci were left sided including 3 origins within a pulmonary vein (PV). Due to the reported development of PV stenosis in the ablative treatment of focal atrial fibrillation, direct ablation applied inside the PV was avoided. Instead, PV-disconnection achieved by the use of a Lasso trade mark catheter in 1 case and by circumferential ablation around the PV in 2 other patients was preferred. In 2 patients, ablation was not attempted because of an origin located directly in the area of the atrioventricular node. In another case, CARTO mapping was stopped due to persistent mechanical termination of the tachycardia with no possibility of reinduction. In the latter, ablation was performed in sinus rhythm at the earliest mapped site before terminating. Three weeks later another episode of EAT was noted in this patient. In the remaining 17 cases, ablation was associated with acute success and no recurrences of sustained tachycardia in all patients. Mean duration time was 192 +/- 53.3 min (right atrium 161 +/- 37.9 min; left atrium 229.6 +/- 46.2 min), and average fluoroscopic time was 22.8 +/- 9.7 min (right atrium 17.1 +/- 6.2 min; left atrium 29.8 +/- 8.9 min). There was no incidence of serious complications associated with this procedure. In conclusions, electroanatomical mapping including cooled ablation was a safe and feasible strategy in treating EATs. The benefit of this technique may imply the combination of both precise localization of the focus and effective applications of radiofrequency pulses, thereby minimizing acute failures or reablation. Due to the time consuming point by point data acquisition, the ability to generate precise maps demonstrating the earliest activation at their exact anatomical location can be limited by transient or persistent termination of the tachycardia.

Adult↗
PubMed2001

A model of saccade initiation based on the competitive integration of exogenous and endogenous signals in the superior colliculus.

Significant advances in cognitive neuroscience can be achieved by combining techniques used to measure behavior and brain activity with neural modeling. Here we apply this approach to the initiation of rapid eye movements (saccades), which are used to redirect the visual axis to targets of interest. It is well known that the superior colliculus (SC) in the midbrain plays a major role in generating saccadic eye movements, and physiological studies have provided important knowledge of the activity pattern of neurons in this structure. Based on the observation that the SC receives localized sensory (exogenous) and voluntary (endogenous) inputs, our model assumes that this information is integrated by dynamic competition across local collicular interactions. The model accounts well for the effects upon saccadic reaction time (SRT) due to removal of fixation, the presence of distractors, execution of pro- versus antisaccades, and variation in target probability, and suggests a possible mechanism for the generation of express saccades. In each of these cases, the activity patterns of "neurons" within the model closely resemble actual cell behavior in the intermediate layer of the SC. The interaction structure we employ is instrumental for producing a physiologically faithful model and results in new insights and hypotheses regarding the neural mechanisms underlying saccade initiation.

Humans↗
PubMed2001

Increased chemokine gene expression during aging in the murine brain.

Normal aging results in changes in the brain that contribute to the decline of various functions, including learning and memory. Mechanisms causing this decline have not been clearly established. Activation of microglia is associated with the normal aging process in rodents and primates. Microglial activation is regulated by chemokine gene expression, and activated microglia produce substances that can be detrimental to surrounding cells. In this study we determined whether changes in chemokine expression occur during normal aging in the mouse brain. RNA samples taken from the cortex, midbrain, hippocampus, and cerebellum of 4-, 10-, 21- and 30-month-old C57BL6/DBA2 mice were analyzed for changes in gene expression. RNase protection assays were used to examine a panel of chemokines. Increased expression of macrophage inflammatory protein (MIP)-1alpha, MIP-1beta, and RANTES occurred in all four regions of the brains in the oldest mice. These increases were first detectable at 21 months of age. Increases in MIP-1alpha, MIP-1beta, and RANTES protein levels were also detected in the brains of old mice, as measured by ELISA. Increased microglial activation in the brains of 30-month-old mice, as detected by immunohistochemistry using F4/80 antibodies, correlated with increases in chemokine expression. The observed increases in chemokine gene expression that occur in conjunction with increased microglial activation suggest that chemokines may contribute to the decreased brain function that occurs during normal aging.

Aging↗
PubMed2001

Histomorphological studies of the distal internal thoracic artery which support its use for coronary artery bypass grafting.

The use of the internal thoracic artery (ITA) for myocardial revascularization in coronary artery disease increased because of its relative immunity to atherosclerotic obstruction. This study investigated the distal part of the vessel, the region of anastomosis by means of histology to focus the visualization of this region of interest. The histological examination of arterial segments showed minor intimal thickening in 48 out of 100 patients. Twelve patients demonstrated a severe intimal thickening, the residual patients were without any changes. In 52% the elastic type dominated in the distal part. Hybrid and muscular patterns were found in 22 and 26%, respectively. The media could be classified into three different types: muscular, hybrid and elastic type. There was no correlation concerning the different histological type and the incidence of intimal thickening. No evidence whatsoever of atherosclerotic lesion was encountered in any of the investigated vessels. There is no limitation in the use of the distal part of the ITA for coronary artery revascularization.

Arteriosclerosis↗
PubMed2001

A review of the evidence for a disengage deficit following parietal lobe damage.

We review the literature on response times to ipsilesional and contralesional targets following spatial precues in patients with damage involving the left- and right-parietal lobes with the aim of appraising the 'disengage deficit' reported initially by Posner and colleagues (Posner MI, Cohen A, Rafal RD. Neural systems control of spatial orienting. Proceedings of the Royal Society of London, B 1982;298:187-98). The data of individual subjects from a sub-sample of studies were submitted to analyses of variance, and data from all studies meeting our selection criteria were submitted to meta-analytic procedures (Hunter JE, Schmidt FL. Methods of meta-analysis: correcting error and bias in research. Newberg Park: Sagge Publications, 1990). Findings from both types of analysis conducted on data from patients with right-hemisphere lesions indicate that: (1) the disengage deficit phenomenon is robust following peripheral cues, but not following central cues; (2) the disengage deficit is large at shorter cue-target stimulus onset asynchronies (SOAs), and decreases as SOA increases; (3) the disengage deficit is larger in patients with a diagnosis of hemispatial neglect; and (4) although the magnitude of the disengage deficit appears to increase with increases in lesion size, multilobar vs unilobar involvement did not significantly alter the pattern of the disengage deficit. We also show that responses to validly cued targets in the contralesional hemispace were significantly slower than for validly cued targets in ipsilesional hemispace. Similar, but usually smaller, effects were observed in patients with homologous left-hemisphere damage. The implications of these results for current models of the role of the parietal lobes in attentional orienting are discussed.

Animals↗
PubMed2001

Morphological differences of the internal thoracic artery in patients with and without coronary artery disease--evaluation by duplex-scanning.

OBJECTIVE: The internal thoracic artery is an established arterial graft for myocardial revascularisation, especially of the left anterior descending artery because of a higher patency rate compared to venous grafts. It has never been investigated, whether there are morphological differences in this vessel between patients with or without coronary artery disease or if they are comparable to morphological changes in the common carotid artery. METHODS: We investigated the internal thoracic artery and the common carotid artery of 24 patients (12 with coronary artery disease, 12 without coronary artery disease) with an ultrasonic system on both sides. The intima-media thickness and the diameter of both vessels were estimated. RESULTS: The intima-media-thickness of the internal thoracic artery was comparable in all patients, independent of the presence of a coronary artery disease (0.51+/-0.11 mm with coronary artery disease, 0.50+/-0.17 mm without coronary artery disease, P>0.05). Compared with this the intima-media-thickness of the common carotid artery was thicker in patients with coronary artery disease (0.84+/-0.13 mm with coronary artery disease, 0.73+/-0.07 mm without coronary artery disease, P< or or =0.014). There was no correlation between the thickness of the internal thoracic artery and the common carotid artery (r=0.018, P>0.05). CONCLUSIONS: It could be demonstrated for the first with non-invasive ultrasound, that the intima-media-complex of the internal thoracic artery is protected of the influence of arteriosclerosis. There are no morphological differences like the intima-media-thickness of the common carotid artery. The proven protective mechanism underlines the widespread use of the internal thoracic artery as a coronary artery bypass graft.

Aged↗
PubMed2001

Manipulations of the features of standard video lottery terminal (VLT) games: effects in pathological and non-pathological gamblers.

The present study was conducted to identify game parameters that would reduce the risk of abuse of video lottery terminals (VLTs) by pathological gamblers, while exerting minimal effects on the behavior of non-pathological gamblers. Three manipulations of standard VLT game features were explored. Participants were exposed to: a counter which displayed a running total of money spent; a VLT spinning reels game where participants could no longer "stop" the reels by touching the screen; and sensory feature manipulations. In control conditions, participants were exposed to standard settings for either a spinning reels or a video poker game. Dependent variables were self-ratings of reactions to each set of parameters. A set of 2(3) x 2 x 2 (game manipulation [experimental condition(s) vs. control condition] x game [spinning reels vs. video poker] x gambler status [pathological vs. non-pathological]) repeated measures ANOVAs were conducted on all dependent variables. The findings suggest that the sensory manipulations (i.e., fast speed/sound or slow speed/no sound manipulations) produced the most robust reaction differences. Before advocating harm reduction policies such as lowering sensory features of VLT games to reduce potential harm to pathological gamblers, it is important to replicate findings in a more naturalistic setting, such as a real bar.

Adult↗
PubMed2001

Influence of parafoveal processing on the missing-letter effect.

According to the parafoveal-processing hypothesis, letters are more often missed in function words than in content words because the former are more likely to be identified in the parafovea, where letter processing is not available. Contrary to previous demonstrations, more omissions occurred in function words than in content words when parafoveal processing was not available because words were displayed in column format, text was read through a 5-letter window, or words were presented 1 at a time on a computer screen. In all experiments, impeding parafoveal processing decreased omission rates for function but not for content words. In the last experiment, direct monitoring of eye movements revealed that, for both fixated and skipped words, letters in function words are missed more often than content words. These results are best interpreted within a model including the structural precedence hypothesis and stressing the importance of visual factors.

Analysis of Variance↗
PubMed2001

Multisensory prior entry.

Despite 2 centuries of research, the question of whether attending to a sensory modality speeds the perception of stimuli in that modality has yet to be resolved. The authors highlight weaknesses inherent in this previous research and report the results of 4 experiments in which a novel methodology was used to investigate the effects on temporal order judgments (TOJs) of attending to a particular sensory modality or spatial location. Participants were presented with pairs of visual and tactile stimuli from the left and/or right at varying stimulus onset asynchronies and were required to make unspeeded TOJs regarding which stimulus appeared first. The results provide the strongest evidence to date for the existence of multisensory prior entry and support previous claims for attentional biases toward the visual modality and toward the right side of space. These findings have important implications for studies in many areas of human and animal cognition.

Adolescent↗
PubMed2001

Negative priming for spatial location?

The term negative priming has been used to describe the deleterious consequences for performance when the current target shares properties with an ignored distractor from the previous trial. Location-based negative priming was first reported by Tipper, Brehaut, and Driver (1990) who used a prime-probe procedure wherein the task was to localize targets defined by their identity (shape). Design imbalances in this seminal study, and others, are illustrated and it is indicated how these might have contaminated the reported effects. The findings, from three experiments using an unbiased design, suggest that negative priming in the spatial location procedure may be more closely related to inhibition of return (IOR), or to the automatic attraction of attention by new objects, than to the concepts of distractor inhibition, episodic retrieval, and feature mismatch, which have traditionally been used to explain negative priming for spatial location.

Adult↗