Fast maximum intensity projections of large medical data sets by exploiting hierarchical memory architectures.

Maximum intensity projections (MIPs) are an important visualization technique for angiographic data sets. Efficient data inspection requires frame rates of at least five frames per second at preserved image quality. Despite the advances in computer technology, this task remains a challenge. On the one hand, the sizes of computed tomography and magnetic resonance images are increasing rapidly. On the other hand, rendering algorithms do not automatically benefit from the advances in processor technology, especially for large data sets. This is due to the faster evolving processing power and the slower evolving memory access speed, which is bridged by hierarchical cache memory architectures. In this paper, we investigate memory access optimization methods and use them for generating MIPs on general-purpose central processing units (CPUs) and graphics processing units (GPUs), respectively. These methods can work on any level of the memory hierarchy, and we show that properly combined methods can optimize memory access on multiple levels of the hierarchy at the same time. We present performance measurements to compare different algorithm variants and illustrate the influence of the respective techniques. On current hardware, the efficient handling of the memory hierarchy for CPUs improves the rendering performance by a factor of 3 to 4. On GPUs, we observed that the effect is even larger, especially for large data sets. The methods can easily be adjusted to different hardware specifics, although their impact can vary considerably. They can also be used for other rendering techniques than MIPs, and their use for more general image processing task could be investigated in the future.     

Extended donor criteria: use of cardiac allografts after carbon monoxide poisoning

BACKGROUND: An increasing demand for cardiac allografts for the treatment of end-stage cardiac failure has led to a shift in the traditional views about donor criteria. The use of allografts exposed to high concentrations of carbon monoxide is still under discussion. The current literature on this topic is contradictory. We describe our experience with orthotopic cardiac transplantation, using cardiac allografts after carbon monoxide poisoning. METHODS: Between March 13, 1989 and August 1, 1996, 770 orthotopic heart transplantations were performed in our center. Within this period, we accepted five cardiac allografts from brain-dead, carbon monoxide-poisoned donors. Donor history showed carbon monoxide intoxication in all cases. At the time of organ explantation, donor hemodynamic parameters were feeble in all patients. RESULTS: The postoperative course was uneventful in three of the five recipients. The overall 3-year survival rate in this small group is 40%. Induction therapy or rescue therapy with mono/polyclonal antibodies was not necessary. Myocardial right-ventricular biopsies did not show any specific signs of carbon monoxide poisoning. CONCLUSIONS: In our opinion, cardiac allografts from donors exposed to carbon monoxide can be transplanted successfully in infants and adults, if there are no signs of severe hemodynamic dysfunction in the presence of a normal central venous pressure and low-dose support with catecholamines and there are no electrocardiographic changes in combination with elevated transaminase. With extended donor criteria, the hearts of carbon monoxide-poisoned victims could increase the number of suitable organs and lower the death rate of patients on the United Network for Organ Sharing and Eurotransplant International Foundation waiting lists.     

Effect of shigella enterotoxin 1 (ShET1) on rabbit intestine in vitro and in vivo

The purpose of this study was to identify the optimal knot construction for interrupted dermal sutures. A synthetic braided absorbable suture, sizes 3-0 and 5-0, was selected for this evaluation. With reproducible mechanical performance tests, we determined that the construction of secure knots without ears required one additional throw as compared with secure knots with 3-mm ears. The direction of applied tension did not alter knot security, with the exception of granny knots, which required an extra throw when tension was applied parallel to the suture loop. Because interrupted dermal knot construction is accomplished without knot ears and with an applied tension parallel to the wound, one additional throw must be added to the knot to ensure knot security.     

Construction of recombination-deficient strains of Streptococcus gordonii by disruption of the recA gene

Degenerate oligonucleotide primers were used in a polymerase chain reaction (PCR) to amplify a region of the recA sequence of Streptococcus gordonii Challis. The resulting PCR fragment was cloned into the suicide vector pAM6199 and introduced into strain Challis, giving rise to recombination-deficient strains in which the recA gene was specifically inactivated.     

Phosphoinositide 3-kinase induces scattering and tubulogenesis in epithelial cells through a novel pathway

Hepatocyte growth factor/scatter factor (HGF/SF) treatment of the Madin-Darby canine kidney epithelial cell line causes scattering of cells grown in monolayer culture and the formation of branching tubules by cells grown in collagen gels. HGF/SF causes prolonged activation of both the mitogen-activated protein (MAP) kinase extracellular signal-regulated kinase 2 (ERK2) and the phosphoinositide 3-OH kinase (PI 3-kinase) target protein kinase B (PKB)/Akt; inhibition of either the MAP kinase pathway by the MAP kinase/ERK kinase inhibitor PD98059 or the PI 3-kinase pathway by LY294002 blocks HGF/SF induction of scattering, although in morphologically distinct ways. Expression of constitutively activated PI 3-kinase, Ras, or R-Ras will cause scattering, but activated Raf will not, indicating that activation of the MAP kinase pathway is not sufficient for this response. Downstream of PI 3-kinase, activated PKB/Akt and Rac are both unable to induce scattering, implicating a novel pathway. Scattering induced by Ras or PI 3-kinase is sensitive to PD98059, as well as to LY294002, suggesting that basal MAP kinase activity is required, but not sufficient, for the scattering response. Induction of MDCK cell tubulogenesis in collagen gels by HGF/SF is inhibited by PD98059; expression of activated Ras and Raf causes disorganized growth in this system, but activated PI 3-kinase or R-Ras causes branching tubule formation similar to that seen with HGF/SF treatment. These data indicate that multiple signaling pathways acting downstream of Met and Ras are needed for these morphological effects; scattering is induced primarily by the PI 3-kinase pathway, which acts through effectors other than PKB/Akt or Rac and requires at least basal MAP kinase function. Elevated PI 3-kinase activity induces tubulogenesis, but total inhibition and excess activation of the MAP kinase pathway both oppose this effect.     

The muscular tissue of the vestibular folds of the larynx

The muscular tissue of the vestibular folds was investigated in plastinated serial sections of 32 normal adult larynges. Three muscular systems could be distinguished. A posterolateral muscle layer was found to be developed at the lateral margin of the posterior part of the vestibular fold. Its fibers extended in a sagittal direction, and their contraction probably resulted in an adduction of the entire tissue of the vestibular fold towards the midline. Within the anterior part of the vestibular fold, an anterolateral muscle sheet was seen to attach to the thyroid cartilage. An anteromedial muscular system consisted of scattered groups of muscle fibers situated medially and dorsally to the laryngeal ventricle and saccule. These fibers were presumed to exert a downward pressure on the vestibular folds, in addition to an adductor function. According to clinical experience, adductor movements of the vestibular folds can be trained, even in cases with a recurrent laryngeal nerve lesion, in order to produce a compensatory voice. Thus, the muscles of the vestibular folds are probably innervated by the superior laryngeal nerve.