Sonographic Assessment of the Umbilical Cord

The umbilical cord is not an inert structure, suspended between the fetus and placenta, but it plays an active role and it is involved in several processes afflicting the feto-placental unit. Its study has to be regarding not only its morphology and morphometry, and the impendance of blood flow by Doppler waveform analysis, but it includes also an analysis of the coiling type and the amount of the Wharton Jelly. The umbilical cord has been considered like an important and huge source of informations, useful to assess the well-being of the fetus and the outcome of pregnancy. The standardization of ultrasound techniques is the first step to speak the same language and make the study of this structure a fundamental part of well-being fetus assessment. This article is carefully focused on morphologic, morphometric and functional ultrasound examination of umbilical cord and suggests that any anomaly detected should provide an indication for an intense fetal follow-up, useful for early helpful therapy, preventing serious complication for the pregnancy.

[Acute "difficult" gastrointestinal bleeding]

Gastrointestinal bleeding with its point of origin outside the reach of conventional gastro- and colonoscopy represents an extraordinary diagnostic and therapeutic challenge. Bleeding may originate from the small bowel distal to the duodenojejunal junction (middle gastrointestinal bleeding) or from the biliary tree (haemobilia) or from the pancreatic ductal system (haemosuccus pancreaticus). This particular type of gastrointestinal bleeding is often intermittend and caused by a variety of different pathologies. Angiography is the diagnostic method of choice for further investigation. It allows precise localization of the bleeding site and simultaneous interventional therapy (embolization/coiling). The importance of further diagnostic modalities such as scintigraphy, capsule endoscopy, push-enteroscopy and double-balloon-enteroscopy is discussed.

[Diagnosis and treatment of carotid cavernous fistulas]

This article provides an overview on the actual state of the interventional neuroradiological management of carotid cavernous fistulas depending on their anatomy and pathophysiology. The results are based on our experience gained during the treatment of patients with complex CCF during the last 15 years. Indications, procedures, and results of transarterial, transvenous and combined arteriovenous approaches for balloon occlusion, embolization, coiling and stenting of these lesions are discussed. Progress in this field is constant so that new technical advances are expected to improve the safety and to expand the indications for these procedures in the future.

The umbilical cord in Cantrell: Pentalogy or Hexalogy?

Objective: Pentalogy of Cantrell (PC) is a rare congenital defect associated with five midline anomalies. The type of cardiac malformation and the size of the abdominal wall defect is often responsible for the high mortality. Of interest, the embryonic period in which PC develops is similar to that of the umbilical cord’s (UC) formation. The aim of the following study was to investigate the relationship between UC anomalies and PC. Methods: Charts of four cases with PC from 2002–08 were retrospectively reviewed for associated UC anomalies. UC anomalies were defined as single umbilical artery (SUA), short cord (during 1st trimester less than CRL or less than 30cm at term) or atypical UC coiling pattern. Results: We identified four cases: 3 singletons and one monochorionic diamniotic twin pregnancy with TRAP sequence. All cases showed a normal karyotype. All but one demonstrated the classical pulsatile omphalocele with ectopia cordis and all others anomalies of PC. One case was characterized by a major cranial omphalocele without ectopia cordis and no UC anomaly. This fetus was delivered by Cesarean at term and successfully operated on d1. In all other cases the parents requested ToP. Among the three cases with ectopia cordis, two had a short UC with SUA and one a short three-vessel cord; all these three UC were markedly uncoiled. Conclusions: Our data suggest a strong association between Cantrell and the development of the UC, in particular in cases with ectopia cordis. One might speculate that hemodynamic alterations of the feto-placental blood flow because of the cardiac malformation or structural changes at the umbilical ring (omphalocele) influence the development of the UC. More observations are needed to decide if Cantrell is a ‘‘hexalogy’’ instead of pentalogy.

Supramolecular Organization of Heptapyrenotide Oligomers—An in Depth Investigation by Molecular Dynamics Simulations

We present a molecular modeling study based on ab initio and classical molecular dynamics calculations, for the investigation of the tridimensional structure and supramolecular assembly formation of heptapyrenotide oligomers in water solution. Our calculations show that free oligomers self-assemble in helical structures characterized by an inner core formed by π- stacked pyrene units, and external grooves formed by the linker moieties. The coiling of the linkers has high ordering, dominated by hydrogen-bond interactions among the phosphate and amide groups. Our models support a mechanism of longitudinal supramolecular oligomerization based on interstrand pyrene intercalation. Only a minimal number of pyrene units intercalate at one end, favoring formation of very extended longitudinal chains, as also detected by AFM experiment. Our results provide a structural explanation of the mechanism of chirality amplification in 1:1 mixtures of standard heptapyrenotides and modified oligomers with covalently linked deoxycytidine, based on selective molecular recognition and binding of the nucleotide to the groove of the left-wound helix.

High-flow venous pouch aneurysm in the rabbit carotid artery: A model for large aneurysms.

BACKGROUND AND PURPOSE Currently one of the most widely used models for the development of endovascular techniques and coiling devices for treatment of aneurysm is the elastase-induced aneurysm model in the rabbit carotid artery. Microsurgical techniques for creating an aneurysm with a venous pouch have also been established, although both techniques usually result in aneurysms less than 1 cm in diameter. We investigated whether an increase in blood flow toward the neck would produce larger aneurysms in a microsurgical venous pouch model. MATERIALS AND METHODS Microsurgical operations were performed on 11 New Zealand white rabbits. Both carotid arteries and the right jugular vein were dissected, and the right carotid artery was temporarily clipped followed by an arteriotomy. The left carotid artery was also clipped proximally, ligated distally, and sutured onto the proximal half of the arteriotomy in the right carotid artery. The venous graft was sutured onto the distal half of the arteriotomy. Digital subtraction angiography was also performed. RESULTS Angiography showed patent anastomosed vessels and aneurysms in the seven surviving rabbits. Mean aneurysm measurements among surviving rabbits with patent vessels were: 13.9 mm length, 9.3 mm width, and neck diameter 4.7 mm. The resulting mean aspect ratio was 3.35 and the mean bottleneck ratio was 3.05. CONCLUSION A large venous graft and increased blood flow toward the base of the aneurysm seem to be key factors in the creation of large venous pouch aneurysms. These large aneurysms allow testing of endovascular devices designed for large and giant aneurysms.

Percutaneous embolization of arteriovenous malformations at the plantar aspect of the foot

Peripheral arteriovenous malformations (AVM) remain most challenging among various congenital vascular malformations to be treated. Here we present three illustrative patients with Yakes type IIIb and type IV AVM at the plantar aspect of the foot who were successfully treated by minimally invasive embolization. The value of the Yakes AVM classification system to guide the therapeutic decision making by directing specific therapeutic procedures to specific AVM types defined by their angioarchitecture is demonstrated. Direct percutaneous AVM puncture with coiling of aneurysmal outflow vein and subsequent ethanol embolization is shown. Finally, the report illustrates that several AVM types can coexist.

Stable isotope record of planktonic foraminifera from sediment core MD96-2085

A high-resolution (~4-5cm/kyr) giant piston core record (MD962085) retrieved during an IMAGES II-NAUSICAA cruise from the continental slope of the southeast Atlantic Ocean reveals striking variations in planktonic foraminifer faunal abundances and sea-surface temperatures (SST) during the past 600 000 yr. The location and high-quality sedimentary record of the core provide a good opportunity to assess the variability of the Benguela Current system and associated important features of the ocean-climate system in the southeast Atlantic. The planktonic foraminifer faunal abundances of the core are dominated by three assemblages: (1) Neogloboquadrina pachyderma (right coiling) + Neogloboquadrina dutertrei, (2) Globigerina bulloides, and (3) Globorotalia inflata. The assemblage of N. pachyderma (right coiling) + N. dutertrei shows distinctive abundance changes which are nearly in-phase with glacial-interglacial variations. The high abundances of this assemblage are associated with major glacial conditions, possibly representing low SST/high nutrient level conditions in the southwestern Africa margin. In contrast, the G. bulloides and G. inflata assemblages show greater high-frequency abundance change patterns, which are not parallel to the glacial-interglacial changes. These patterns may indicate rapid oceanic frontal movements from the south, and a rapid change in the intensity of the Benguela upwelling system from the east. A single episode of maximum abundances of a polar water species N. pachyderma (left coiling) occurred in the beginning of stage 9 (~340-330 kyr). The event of the maximum occurrence of this species shown in this record may indicate instability in the Benguela coastal upwelling, or the Antarctic polar front zone position. A winter season SST estimate using transfer function techniques for this record shows primarily glacial-interglacial variations. The SST is maximal during the transitions from the major glacial to interglacial stages (Terminations I, II, IV, V), and is associated with the abundance maxima of a warm water species indicator Globigerinoides ruber. Cross-spectral analyses of the SST record and the SPECMAP stack reveal statistically significant concentrations of variance and coherencies in three major orbital frequency bands. The SST precedes changes in the global ice volume in all orbital frequency bands, indicating a dominant southern Hemispheric climate effect over the Benguela Current region in the southeast Atlantic.

Planktonic foraminifera fluxes and stable isotope ratios in the Irminger Sea

Past water column stratification can be assessed through comparison of the d18O of different planktonic foraminiferal species. The underlying assumption is that different species form their shells simultaneously, but at different depths in the water column. We evaluate this assumption using a sediment trap time-series of Neogloboquadrina pachyderma (s) and Globigerina bulloides from the NW North Atlantic. We determined fluxes, d18O and d13C of shells from two size fractions to assess size-related effects on shell chemistry and to better constrain the underlying causes of isotopic differences between foraminifera in deep-sea sediments. Our data indicate that in the subpolar North Atlantic differences in the seasonality of the shell flux, and not in depth habitat or test size, determine the interspecies Delta d18O. N. pachyderma (s) preferentially forms from early spring to late summer, whereas the flux ofG. bulloides peaks later in the season and is sustained until autumn. Likewise, seasonality influences large and small specimens differently, with large shells settling earlier in the season. The similarity of the seasonal d18O patterns between the two species indicates that they calcify in an overlapping depth zone close to the surface. However, their d13C patterns are markedly different (>1 per mil). Both species have a seasonally variable offset from d13CDIC that appears to be governed primarily by temperature, with larger offsets associated with higher temperatures. The variable offset from d13CDIC implies that seasonality of the flux affects the fossil d13C signal, which has implications for reconstruction of the past oceanic carbon cycle.

Quantitative coccolithophore analyses in sediment core MD01-2446

Quantitative coccolithophore analyses were performed in core MD01-2446, located in the mid-latitude North Atlantic, to reconstruct climatically induced sea-surface water conditions throughout Marine Isotope Stages (MIS) 14-9. The data are compared to new and available paleoenvironmental proxies from the same site as well as other nearby North Atlantic records that support the coccolithophore signature at glacial-interglacial to millennial climate scale. Total coccolithophore absolute abundance increases during interglacials but abruptly drops during the colder glacial phases and deglaciations. Coccolithophore warm-water taxa (wwt) indicate that MIS11c and MIS9e experienced warmer and more stable conditions throughout the whole photic zone compared to MIS13. MIS11 was a long-lasting warmer and stable interglacial characterized by a climate optimum during MIS11c when a more prominent influence of the subtropical front at the site is inferred. The wwt pattern also suggests distinct interstadial and stadial events lasting about 4-10 kyr. The glacial increases of Gephyrocapsa margereli-G. muellerae 3-4 µm along with higher values of Corg, additionally supported by the total alkenone abundance at Site U1313, indicate more productive surface waters, likely reflecting the migration of the polar front into the mid-latitude North Atlantic. Distinctive peaks of G. margereli-muellerae (> 4 µm), C. pelagicus pelagicus, Neogloboquadrina pachyderma left coiling, and reworked nannofossils, combined with minima in total nannofossil accumulation rate, are tracers of Heinrich-type events during MIS12 and MIS10. Additional Heinrich-type events are suggested during MIS12 and MIS14 based on biotic proxies, and we discuss possible iceberg sources at these times. Our results improve the understanding of mid-Brunhes paleoclimate and the impact on phytoplankton diversity in the mid-latitude North Atlantic region.

Organic matter C and N composition and N. pachyderma stable isotope ratios of ODP Hole 188-1166A sediments

We report the results of downhole stable isotopic (d13Corg [organic carbon] and d15N) and elemental measurements (total organic carbon [TOC], total nitrogen [TN], and carbon/nitrogen [C/N]) of sedimentary organic matter (SOM) along with stable isotopic measurements (d18O and d13C) of left-coiling Neogloboquadrina pachyderma planktonic foraminifers from Ocean Drilling Program Site 1166. TOC and TN measurements indicate a large change from organic-rich preglacial sediments with primary organic matter to organic-poor early glacial and glacial sediments, with mainly recycled organic matter. Results of the stable isotopic measurements of SOM show a range of values that are typical of both marine and terrestrial organic matter, probably reflecting a mixture of the two. However, C/N values are mostly high (>15), suggesting greater input and/or preservation of terrestrial organic matter. Foraminifers are only present in glacial/glaciomarine sediments of latest Pliocene to Pleistocene age at Site 1166 (lithostratigraphic Unit I). The majority of this unit has d13Corg and TOC values that are similar to those of glacial sediments recovered at Site 1167 (lithostratigraphic Unit II) on the slope and may have the same source(s). Although the low resolution of the N. pachyderma (s.) d18O and d13C data set precludes any specific paleoclimatic interpretation, downcore variations in foraminifer d18O and d13C values of 0.5 per mil to 1 per mil amplitude may indicate glacial-interglacial changes in ice volume/temperature in the Prydz Bay region.

The Fohsella chronocline in middle Miocene sediments from the Ontong Java Plateau, Pacific Ocean

Micropaleontologists have traditionally recognized the mid-Miocene Fohsella lineage as a flagship for phyletic gradualism within the planktic foraminifera. However, study of a deep-sea record from the western equatorial Pacific (ODP Site 806) reveals that coiling ratios within this clade suddenly (<5 kyr) shift after a prolonged, ancestral state of near randomness (~50%) to a transient phase (13.42-13.43 Ma) of dextral dominance (~75%) immediately following the first common occurrence of keeled fohsellids. This brief period of dextral dominance was abruptly (<5 kyr) succeeded by an irreversible change to sinistral dominance (~96%). Fohsellid abundances decline markedly through the interval in which the sinistral preference is established. The shift to sinistrality (13.42 Ma) predated the deepening of fohsellid depth ecology by ~240-488 kyr, indicating that these two events were unrelated. This view is supported by a lack of delta 18O evidence for depth-habitat differences between the two chiral forms, which refutes the notion that sinistral fohsellids were "pre-adapted" for ensuing hydrographic change because they occupied a deeper depth habitat than their dextral counterparts. Planktic foraminiferal assemblages become strongly oligotrophic in character through the interval in which the fohsellid delta 18O increase is recorded, indicating that the migration to deeper depths was fostered by an expansion of the mixed layer in the western equatorial Pacific. Salient aspects of this brief, but conspicuous faunal change are a marked increase in the abundance of symbiont-bearing globigerinoidids, a concomitant collapse of local Jenkinsella mayeri/siakensis populations, and reduced fohsellid abundances. The rapid and permanent nature of the Fohsella sinistral shift provides a distinct, unequivocal datum that may prove useful for correlating mid-Miocene sections throughout the Caribbean Sea and tropical regions in the western sectors of the Pacific and Atlantic. The coiling ratio changes that occurred during the evolution of the Fohsella chronocline probably reflect changing population dynamics between cryptic genotypes with different coiling preferences.

Planktonic foraminifera and stable isotopic record of sediments from the east Sea of Korea

Foraminiferal assemblage and stable isotopic data are presented for three Quaternary piston cores from Ulleung Basin, East Sea of Korea ((ESK) Japan Sea) near the Korean Peninsula. Major changes in both temperature and salinity strongly affected surface and deep waters of the ESK during the transition from the Last Glacial Maximum (LGM) to the middle Holocene. Local environmental effects dominated during the LGM and the Bølling/Allerød (B/A) when the ESK became semi-isolated from the Pacific Ocean. Regional/global influences dominated following the B/A, after sufficient reconnection with the Pacific. This is reflected in the foraminiferal d18O record which was largely salinity-controlled before the Younger Dryas (YD) and temperature-controlled after the YD. Paleoceanographic changes in the ESK during the last deglaciation reflect sequential reconnection with the Pacific Ocean, through gateways, first (B/A) in the north (Tsugaru Strait) and later (Holocene) in the south (Korea Strait).

Benthic and planktonic foraminifera in the Japan Sea

Biostratigraphy and paleoenvironmental history of deep and surficial waters of the Japan Sea are addressed using sequences recovered from the floor of the backarc basin. The study is divided into two parts: (1) foraminifer biostratigraphy and paleoenvironmental assessment of sedimentary sequences recovered from above igneous basement at the four sites and (2) detailed planktonic foraminifer paleoenvironmental analysis of Quaternary and Pliocene sequences from Sites 794 and 797 in the Yamato Basin. A total of 253 samples were examined for the foraminifer biostratigraphy and 325 samples for the detailed paleoenvironmental study of Quaternary and Pliocene sequences. Low abundance and sporadic occurrence of foraminifers limited interpretation of results. Foraminifer-bearing intervals were correlated where possible to diatom and calcareous nannofossil zonations, and the sequences were successfully assigned to the foraminifer zonation of Matsunaga. Unfortunately, extensive barren intervals and sporadic occurrences of planktonic foraminifers prevented zonation of Quaternary and Pliocene intervals, although some interesting conclusions about paleoenvironment were possible and are listed below. A sequence of Neogene (sensu lato) paleoenvironmental events were identified: (1) deepening of the Yamato basins to middle bathyal depths by the early to middle Miocene, an event contemporaneous with the age of some deep basins known from uplifted sections adjacent to the Japan Basin; (2) cooling of the Japan Sea in the early middle Miocene; (3) oxygenation of deep waters in the late Miocene; (4) further cooling of surficial water masses between the Olduvai Subchron and the Brunhes/Matuyama Boundary; and (5) extermination of lower middle bathyal faunas and replacement by upper middle bathyal faunas near the base of the Quaternary.

Morphology and size of Neogloboquadrina pachyderma in the North Atlantic

The variability in size and shape of shells of the polar planktonic foraminifer Neogloboquadrina pachyderma have been quantified in 33 recent surface sediment samples throughout the northern Atlantic Ocean and correlated with the properties of the ambient surface waters. The aim of the study was to determine whether any of the morphological features could be used to reconstruct sea surface properties in the polar realm of the North Atlantic, where most paleotemperature proxies appear to fail. The analyses revealed that shell morphology is only weakly controlled by habitat properties, whereas shell size showed a strong correlation with sea surface temperature. The regression of mean shell size on sea surface temperature revealed the presence of two trends among the sinistrally coiled shells: a continuous increase in shell size with decreasing SST in sediments deposited under polar water masses and a continuous increase in shell size with increasing SST in samples from transitional waters. The second trend mirrors the trend observed for dextrally coiled shells, which are frequent in the same samples and signal the presence of N. incompta. The identical mean shell size trends among the sinistral and dextral specimens in the temperate samples confirms the results of earlier genetic studies which indicated the existence of a small but distinct proportion of opposite coiling in N. incompta, to which the sinistral shells in the temperate samples could be attributed. The linear correlation between mean shell size and sea surface temperature in the polar domain (summer SST < 9 °C) has been used to develop an empirical formula for the reconstruction of past sea surface temperatures from shell sizes in fossil samples. The standard error of the residuals of the linear regression is 2.36 °C (1 sigma), which implies a much larger error than for most paleothermometers, but enough precision to allow resolution between results by individual paleothermometers in the polar domain. The resulting regression model has been applied on two sediment cores spanning the interval from the Last Glacial Maximum (LGM) to the present day. The results from core PS1906-1 are consistent with ice-free conditions during the LGM in the Norwegian Sea. The SST estimates for the LGM inferred from N. pachyderma shell size are similar or slightly higher than those for the latest Holocene. The results do not indicate anomalously high SST during the glacial and the LGM reconstructions thus appear more consistent with the results from foraminiferal transfer functions and geochemical proxies. Both sediment cores show the highest reconstructed SST during the early Holocene insolation optimum.