Cardiac Masses

Magnetic Resonance Imaging (MRI) may be indicated in patients who have poor acoustic windows or in whom lesions are incompletely characterized by echocardiography. This unit presents a basic technique for evaluating cardiac masses, with optional contrast‐enhanced sequences for specific indications. The parameters are based on experience on a Siemens 1.5 T Vision or Symphony and should be altered accordingly for different field strengths and machines from different manufacturers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145216/1/cpmia1102.pd

Pericardial Disease

This unit presents a basic technique for evaluating non‐neoplastic disease of the pericardium with optional contrast‐enhanced sequences for evaluating suspected neoplastic disease. The parameters are based on experience on a Siemens 1.5 T Vision or Symphony and should be altered accordingly for different field strengths and machines from different manufacturers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145328/1/cpmia1101.pd

Fibulin-4 is essential for maintaining arterial wall integrity in conduit but not muscular arteries

Homozygous or compound heterozygous mutations in fibulin-4 (FBLN4) lead to autosomal recessive cutis laxa type 1B (ARCL1B), a multisystem disorder characterized by significant cardiovascular abnormalities, including abnormal elastin assembly, arterial tortuosity, and aortic aneurysms. We sought to determine the consequences of a human disease-causing mutation in FBLN4 (E57K) on the cardiovascular system and vascular elastic fibers in a mouse model of ARCL1B. Fbln4E57K/E57K mice were hypertensive and developed arterial elongation, tortuosity, and ascending aortic aneurysms. Smooth muscle cell organization within the arterial wall of large conducting vessels was abnormal, and elastic fibers were fragmented and had a moth-eaten appearance. In contrast, vessel wall structure and elastic fiber integrity were normal in resistance/muscular arteries (renal, mesenteric, and saphenous). Elastin cross-linking and total elastin content were unchanged in large or small arteries, whereas elastic fiber architecture was abnormal in large vessels. While the E57K mutation did not affect Fbln4 mRNA levels, FBLN4 protein was lower in the ascending aorta of mutant animals compared to wild-type arteries but equivalent in mesenteric arteries. We found a differential role of FBLN4 in elastic fiber assembly, where it functions mainly in large conduit arteries. These results suggest that elastin assembly has different requirements depending on vessel type. Normal levels of elastin cross-links in mutant tissue call into question FBLN4\u27s suggested role in mediating lysyl oxidase-elastin interactions. Future studies investigating tissuespecific elastic fiber assembly may lead to novel therapeutic interventions for ARCL1B and other disorders of elastic fiber assembly. 2017 © The Authors, some rights reserved

Four Dimensional MR Image Analysis of Dynamic Renography

A novel four dimensional image analysis approach including registration and segmentation of dynamic contrast enhanced renal MR images is presented. This integrated method is motivated by the observation of the reciprocity between registration and segmentation in 4D time-series images. Fully automated Fourier-based registration with sub-voxel accuracy and semi-automated time-series segmentation were intertwined to improve the accuracy in a multi-step fashion. We have tested our algorithm on several real patient data sets. Clinical validation showed remarkable and consistent agreement between the proposed method and manual segmentation by experts

Automatic 4-D Registration in Dynamic MR Renography

Dynamic contrast-enhanced 4-D MR renography has the potential for broad clinical applications, but suffers from respiratory motion that limits analysis and interpretation. Since each examination yields at least over 10 20 serial 3-D images of the abdomen, manual registration is prohibitively labor-intensive. Besides in-plane motion and translation, out-of-plane motion and rotation are observed in the image series. In this paper, a novel robust and automated technique for removing out-of-plane translation and rotation with sub-voxel accuracy in 4-D dynamic MR images is presented. The method was evaluated on simulated motion data derived directly from a clinical patient's data. The method was also tested on 24 clinical patient kidney data sets. Registration results were compared with a mutual information method, in which differences between manually co-registered time-intensity curves and tested time-intensity curves were compared. Evaluation results showed that our method agreed well with these ground truth data

Integrated Four Dimensional Registration and Segmentation of Dynamic Renal MR Images

In this paper a novel approach for the registration and segmentation of dynamic contrast enhanced renal MR images is presented. This integrated method is motivated by the observation of the reciprocity between registration and segmentation in 4D time-series images. Fully automated Fourier-based registration with sub-voxel accuracy and semi-automated time-series segmentation were intertwined to improve the accuracy in a multi-step fashion. We have tested our algorithm on several real patient data sets. Clinical validation showed remarkable and consistent agreement between the proposed method and manual segmentation by experts

Segmentation of 4D MR Renography Images Using Temporal Dynamics in a Level Set Framework

A novel 4D level set framework was developed to segment dynamic MR images into the cortex, medulla and collecting system. The novelty of the method is that it combines information from spatial anatomical structures and temporal dynamics. The accuracy of the fully automatic 4D level set algorithm was found to be comparable to manual segmentation performed by experts on renal anatomy. The algorithm requires less than one minute to automatically segment a single kidney 4D patient data set with more than 40 time points

Fibulin-4 is essential for maintaining arterial wall integrity in conduit but not muscular arteries.

Homozygous or compound heterozygous mutations in fibulin-4 (FBLN4) lead to autosomal recessive cutis laxa type 1B (ARCL1B), a multisystem disorder characterized by significant cardiovascular abnormalities, including abnormal elastin assembly, arterial tortuosity, and aortic aneurysms. We sought to determine the consequences of a human disease-causing mutation in FBLN4 (E57K) on the cardiovascular system and vascular elastic fibers in a mouse model of ARCL1B. Fbln4E57K/E57K mice were hypertensive and developed arterial elongation, tortuosity, and ascending aortic aneurysms. Smooth muscle cell organization within the arterial wall of large conducting vessels was abnormal, and elastic fibers were fragmented and had a moth-eaten appearance. In contrast, vessel wall structure and elastic fiber integrity were normal in resistance/muscular arteries (renal, mesenteric, and saphenous). Elastin cross-linking and total elastin content were unchanged in large or small arteries, whereas elastic fiber architecture was abnormal in large vessels. While the E57K mutation did not affect Fbln4 mRNA levels, FBLN4 protein was lower in the ascending aorta of mutant animals compared to wild-type arteries but equivalent in mesenteric arteries. We found a differential role of FBLN4 in elastic fiber assembly, where it functions mainly in large conduit arteries. These results suggest that elastin assembly has different requirements depending on vessel type. Normal levels of elastin cross-links in mutant tissue call into question FBLN4\u27s suggested role in mediating lysyl oxidase-elastin interactions. Future studies investigating tissuespecific elastic fiber assembly may lead to novel therapeutic interventions for ARCL1B and other disorders of elastic fiber assembly. 2017 © The Authors, some rights reserved

Intracellular retention of mutant lysyl oxidase leads to aortic dilation in response to increased hemodynamic stress

Heterozygous missense mutations in lysyl oxidase (LOX) are associated with thoracic aortic aneurysms and dissections. To assess how LOX mutations modify protein function and lead to aortic disease, we studied the factors that influence the onset and progression of vascular aneurysms in mice bearing a Lox mutation (p.M292R) linked to aortic dilation in humans. We show that mice heterozygous for the M292R mutation did not develop aneurysmal disease unless challenged with increased hemodynamic stress. Vessel dilation was confined to the ascending aorta although both the ascending and descending aortae showed changes in vessel wall structure, smooth muscle cell number and inflammatory cell recruitment that differed between wild-type and mutant animals. Studies with isolated cells found that M292R-mutant Lox is retained in the endoplasmic reticulum and ultimately cleared through an autophagy/proteasome pathway. Because the mutant protein does not transit to the Golgi where copper incorporation occurs, the protein is never catalytically active. These studies show that the M292R mutation results in LOX loss-of-function due to a secretion defect that predisposes the ascending aorta in mice (and by extension humans with similar mutations) to arterial dilation when exposed to risk factors that impart stress to the arterial wall

Associations between health-related self-efficacy and suicidality

© The Author(s). 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Abstract Background Few studies have focused on exploring the association of self-efficacy and suicidal behaviour. In this study, we aim to investigate the association between health-related self-efficacy and suicidality outcomes, including lifetime/recent suicidal ideation, suicidal attempts and future intent of suicide. Methods A computer-assisted telephone interview (CATI) system was used to draw potential respondents aged over 15 in Taiwan via telephone numbers, which were selected by a stratified proportional randomization method according to the distribution of population size in different geographic areas of Taiwan. We obtained available information on suicide behaviours for the analysis of 2110 participants. Logistic regression was applied to investigate the independent effect of health-related self-efficacy on life-time suicidal thoughts and attempts. Results Suicidality measured as suicide ideation and attempted suicide was reported as 12.6 and 2.7% respectively in the sample. Among those with suicide ideation, 9.8% had thoughts of future suicide intent. Female gender, low education, people living alone or separated, history of psychiatric disorders, substance abuse, poor self-rated mental health and physical health were associated with suicidality factors. Low health-related self-efficacy was associated with lifetime suicide ideation, prior suicide attempt and future suicidal intent. Among those with recent suicidal ideation, low health self-efficacy was independently associated with future suicide intent after adjustment of gender, age, education, marital status, substance abuse, psychological distress, poor mental and physical health. Conclusion Health-related self-efficacy was associated with suicide risks across different time points from prior ideation to future intention. Evaluation of the progress of self-efficacy in health may be long-term targets of intervention in suicide prevention strategies