Howard County General Hospital

About: Howard County General Hospital is a healthcare organization based out in Columbia, Maryland, United States. It is known for research contribution in the topics: Community hospital & Population. The organization has 87 authors who have published 139 publications receiving 8396 citations. The organization is also known as: HCGH.

Nitric oxide synthase and neuronal NADPH diaphorase are identical in brain and peripheral tissues.

Abstract: NADPH diaphorase staining neurons, uniquely resistant to toxic insults and neurodegenerative disorders, have been colocalized with neurons in the brain and peripheral tissue containing nitric oxide synthase (EC 11423-), which generates nitric oxide (NO), a recently identified neuronal messenger molecule In the corpus striatum and cerebral cortex, NO synthase immunoreactivity and NADPH diaphorase staining are colocalized in medium to large aspiny neurons These same neurons colocalize with somatostatin and neuropeptide Y immunoreactivity NO synthase immunoreactivity and NADPH diaphorase staining are colocalized in the pedunculopontine nucleus with choline acetyltransferase-containing cells and are also colocalized in amacrine cells of the inner nuclear layer and ganglion cells of the retina, myenteric plexus neurons of the intestine, and ganglion cells of the adrenal medulla Transfection of human kidney cells with NO synthase cDNA elicits NADPH diaphorase staining The ratio of NO synthase to NADPH diaphorase staining in the transfected cells is the same as in neurons, indicating that NO synthase fully accounts for observed NADPH staining The identity of neuronal NO synthase and NADPH diaphorase suggests a role for NO in modulating neurotoxicity

Human heart: tagging with MR imaging--a method for noninvasive assessment of myocardial motion.

Abstract: Specified regions of the myocardium can be labeled in magnetic resonance (MR) imaging to serve as markers during contraction. The technique is based on locally perturbing the magnetization of the myocardium with selective radio-frequency (RF) saturation of multiple, thin tag planes during diastole followed by conventional, orthogonal-plane imaging during systole. The technique was implemented on a 0.38-T imager and tested on phantoms and volunteers. In humans, tags could be seen 60-450 msec after RF saturation, thus permitting sampling of the entire contractile phase of the cardiac cycle. Tagged regions appear as hypointense stripes, and their patterns of displacement reflect intervening cardiac motion. In addition to simple translation and rotation, complex motions such as cardiac twist can be demonstrated. The effects of RF pulse angle, relaxation times, and heart rate on depiction of the tagged region are discussed.

Association of Cytochrome P450 2C19 Genotype With the Antiplatelet Effect and Clinical Efficacy of Clopidogrel Therapy

Abstract: Context Clopidogrel therapy improves cardiovascular outcomes in patients with acute coronary syndromes and following percutaneous coronary intervention by inhibiting adenosine diphosphate (ADP)–dependent platelet activation. However, nonresponsiveness is widely recognized and is related to recurrent ischemic events. Objective To identify gene variants that influence clopidogrel response. Design, Setting, and Participants In the Pharmacogenomics of Antiplatelet Intervention (PAPI) Study (2006-2008), we administered clopidogrel for 7 days to 429 healthy Amish persons and measured response by ex vivo platelet aggregometry. A genome-wide association study was performed followed by genotyping the loss-of-function cytochrome P450 (CYP) 2C19*2 variant (rs4244285). Findings in the PAPI Study were extended by examining the relation of CYP2C19*2 genotype to platelet function and cardiovascular outcomes in an independent sample of 227 patients undergoing percutaneous coronary intervention. Main Outcome Measure ADP-stimulated platelet aggregation in response to clopidogrel treatment and cardiovascular events. Results Platelet response to clopidogrel was highly heritable (h 2 = 0.73; P −13 for rs12777823, additive model). The rs12777823 polymorphism was in strong linkage disequilibrium with the CYP2C19*2 variant, and was associated with diminished clopidogrel response, accounting for 12% of the variation in platelet aggregation to ADP (P = 4.3 × 10 −11 ). The relation between CYP2C19*2 genotype and platelet aggregation was replicated in clopidogrel-treated patients undergoing coronary intervention (P = .02). Furthermore, patients with the CYP2C19*2 variant were more likely (20.9% vs 10.0%) to have a cardiovascular ischemic event or death during 1 year of follow-up (hazard ratio, 2.42; 95% confidence interval, 1.18-4.99; P = .02). Conclusion CYP2C19*2 genotype was associated with diminished platelet response to clopidogrel treatment and poorer cardiovascular outcomes.

Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy.

Abstract: Mortality associated with pancreaticoduodenectomy (PD) has decreased dramatically to less than 5% over the past 2 decades in high-volume centers,1–6 but persistent high morbidity rates have remained an important concern for patients, healthcare providers, and payers. While mortality is an objective and easily quantifiable outcome parameter, morbidity is only poorly defined, and this shortcoming has severely hampered conclusive comparisons among centers and within the same institution over time.7–9 Similarly, the identification of risk factors related to specific complications has been difficult. Recognizing this deficiency, there has been several recent attempts to define specific complications related to PD such as pancreatic fistula, either by individual groups10–14 or through consensus statements from a few experts.15 Although important, these definitions have focused only on one specific complication (pancreatic fistula), and typically lack a severity grading system. For example, when a pancreatic fistula is defined as the persistent drainage of amylase-rich fluid during the postoperative course or as radiologic evidence of pancreatic anastomotic disruption, no distinction is made between the minimal criteria and more severe manifestation leading to reoperation or even death. An attempt was recently made by a group of experts in pancreas surgery to grade pancreatic fistula by severity,15 but the grading system is complex, includes multiple subjective criteria, and is not applicable to other types of complications. Therefore, there is persistent need for the availability of a reproducible, simple, and widely acceptable system to grade all complications following PD. A previously reported grading system7–9 was recently revisited and validated in a large cohort of patients undergoing general surgery. An international survey confirmed the simplicity and reproducibility of the new grading system.16 This classification was recently adopted by the International Transplantation Society17 to prospectively monitor the outcome of living liver donors. A key feature facilitating the use of the grading system is that it mostly relies on the therapies used to correct negative events. This is crucial to minimize down grading of complications as even nursing notes can be used to secure appropriate grading in retrospective analyses. Another attractive aspect of the new classification is that it considers the patient perspective through a strong emphasis on long lasting disability. Such a grading system can be adapted to any complication as long as the minimal criteria to define each specific complication are well described and widely accepted. We adapted this novel classification of complications by severity16 to a large cohort of patients, who underwent a PD at Johns Hopkins Hospital, a high-volume center with the availability of a comprehensive database. We used the well-established Johns Hopkins definitions for pancreatic fistula and delayed gastric emptying (DGE),18,19 and stratified them according to severity criteria. Of importance, the John Hopkins definition of pancreatic fistula is consistent with a recent consensus statements.15 The primary aims of the study were to evaluate the feasibility of grading each recorded complication in the database according to the novel classification system, to present specific complications by severity, and to identify risk factors. A secondary aim was to test the novel classification system in comparing the incidence and severity of one type of complication, pancreatic fistula, with a previous series of patients in the same institution. Finally, an attempt was made to evaluate the impact of complications on long-term survival.

Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study.

Abstract: Knowledge of age-related distribution patterns of cellular and fatty marrow is critical to the interpretation of magnetic resonance (MR) imaging studies. To determine such patterns, the authors retrospectively evaluated 70 examinations each of the skull, cervical spine, thoracic spine, lumbar spine, pelvis, and proximal femur (420 examinations) in patients without known bone marrow abnormality who ranged in age from 6 months to older than 70 years. Two to four distinct patterns were identified in each anatomic area on spin-echo images obtained with a short repetition time and a short echo time. The relative frequency of the patterns for different age groups is consistent with the known physiologic conversion from cellular to fatty marrow with advancing age. Knowledge of these patterns should help in the interpretation of MR images of the axial skeleton.