Occupation and tongue cancer in Nordic countries

PURPOSE

Almost 200,000 tongue cancers were diagnosed worldwide in 2020. The aim of this study was to describe occupational risk variation in this malignancy.

METHODS

The data are based on the Nordic Occupational Cancer (NOCCA) study containing 14.9 million people from the Nordic countries with 9020 tongue cancers diagnosed during 1961-2005. The standardized incidence ratio (SIR) of tongue cancer in each occupational category was calculated using national incidence rates as the reference.

RESULTS

Among men, the incidence was statistically significantly elevated in waiters (SIR 4.36, 95% confidence interval (CI) 3.13--5.92), beverage workers (SIR 3.42, 95% CI 2.02-5.40), cooks and stewards (SIR 2.55, 95% CI 1.82-3.48), seamen (SIR 1.66, 95% CI 1.36-2.00), journalists (SIR 1.85, 95% CI 1.18-2.75), artistic workers (SIR 2.05, 95% CI 1.54-2.66), hairdressers (SIR 2.17, 95% CI 1.39-3.22), and economically inactive persons (SIR 1.57, 95% CI 1.42-1.73). Among women, the SIR was statistically significantly elevated only in waitresses (SIR 1.39, 95% CI 1.05-1.81). Statistically significant SIRs ≤ 0.63 were observed in male farmers, gardeners, forestry workers and teachers, and in female launderers.

CONCLUSIONS

These findings may be related to consumption of alcohol and tobacco, but the effect of carcinogenic exposure from work cannot be excluded.

Average demands and most demanding passages of national-level female soccer matches: do small- and large-sided games replicate match demands?

Introduction

This study aims to (1) determine the average and most demanding passage (MDP) load of national-level female soccer matches and (2) evaluate the relationship between average and MDP load during small-sided games (SSGs), large-sided games (LSGs), and matches.

Methods

A total of 37 national-level female soccer players from a single club senior team and the U18 team participated. The average and 1-, 3-, and 5-min MDP external (total, high-speed, and very-high-speed running distances, acceleration and deceleration distances, average metabolic power, and high-metabolic load distance) and internal loads (average heart rate, rate of perceived exertion) of the 29 league matches, ten 4 vs. 4 + goalkeepers SSGs, and six 8 vs. 8 + goalkeepers LSGs were analyzed by the Polar Team Pro player tracking system.

Results

In matches, the external load variables during 1-, 3-, and 5-min MDPs were 167%-1,165%, 135%-504%, and 126%-359%, of match average values, respectively. In LSGs, all external load variables reached higher average values compared with those during matches, except for the very-high-speed running distance; however, no variable reached higher values of 1-min MDP compared with those during the matches. In SSGs, the average acceleration and deceleration distances were higher compared with those during the matches.

Discussion

The findings from the present study suggest that LSGs and SSGs can be used to overload the average values of the selected external load variables compared with those during the matches; however, other training options must be explored to overload 1-min match MDPs.

Prognostic histological markers in oral tongue squamous cell carcinoma patients treated with (chemo)radiotherapy

Treatment of oral tongue squamous cell carcinoma (OTSCC) frequently includes surgery with postoperative radiotherapy (RT) or chemoradiotherapy (CRT). Resistance to RT or CRT remains a major clinical challenge and highlights the need to identify predictive markers for it. We included 71 OTSCC patients treated with surgery combined with RT or CRT. We evaluated the association between tumor budding, tumor-stroma ratio (TSR), depth of invasion (DOI), tumor-infiltrating lymphocytes (TILs), hypoxia-inducible factor-1alpha (HIF-1alpha) expression, octamer-binding transcription factor 4 (OCT4) expression, high-endothelial venules (HEVs), and disease-free survival (DFS) using uni- and multivariate analyses. No significant association was observed between the different histological and molecular markers (TSR, DOI, TILs, HEV, HIF-1alph, OCT4) and DFS. However, an associative trend between DOI, budding, and DFS was noted. Further studies with larger cohorts are needed to explore the prognostic value of DOI and budding for OTSCC patients treated with postoperative RT or CRT.

MRI safety wih abandoned or functional epicardial pacing leads

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): HUS Medical Imaging Center research grant

Background

The Heart and Rhythm Society’s consensus statement 2017 approves magnetic resonance imaging (MRI) with cardiac implantable electronic devices (CIED), but excludes patients with epicardial and abandoned leads. Potential safety hazards of an MRI with epicardial pacing leads include heating of the tip of the lead and induction of current in the pacing lead resulting in inappropriate cardiac stimulation. Only a few small studies of MRI safety with epicardial pacing leads have been published and adverse events have been rare. The clinical dilemma remains, whether performing an MRI on a patient with CIED and epicardial pacing leads is safe.

We have performed MRIs on patients with CIED and epicardial pacing leads when benefits have been considered to outweigh the risks after careful case-by-case evaluation following our institutional MRI with CIED safety protocol. 

Purpose

The aim of this study was to evaluate the safety of performing an MRI scan on patients with CIED and abandoned or functional epicardial pacing leads. 

Methods

All the clinically indicated MRI examinations conducted on adult patients with CIED and functional or abandoned epicardial leads (n = 24) performed in our hospital between November 2011 and October 2019 were included in this observational retrospective study. The data were retrospectively collected from electronic medical records. 

Results

Altogether 24 MRIs were performed to 16 patients with functional or abandoned epicardial pacing leads (Table). 93.8% (15/16) patients had congenital heart disease. Cardiac MRI was the most frequent examination (21/24, 91.7%). 66.7% of the MRI scans (16/24) were conducted on patients with functional epicardial pacing leads. In 5/24 (20.8%) MRIs, the patient was pacemaker-dependent.

A clinically significant event occurred in one MRI scan. This was transient elevation of the pacing lead threshold in a patient with functional epicardial ventricular pacing lead, that was implanted 29 years prior to the MRI. In another patient with 30-year-old functional epicardial pacing leads, clinically significant irreversible elevation in atrial pacing lead impedance was detected 6 months after the MRI and unlikely related to previous MRI examination.

None of the patients experienced sensations leading to cessation of the MRI scans. No clinically significant pacing lead parameter changes were detected after MRIs performed on patients with modern (implanted year 2000 or later) functional epicardial pacing leads or functional endocardial leads and abandoned epicardial leads. 

Conclusions

MRI examinations in patients with CIED and modern functional epicardial pacing leads were performed without detectable adverse events. Performing an MRI with old functional epicardial pacing leads may involve more risks.

Phantom based quality assurance for long-term stability and inter-scanner compatibility in T1, T2 and T2* measurements

Funding Acknowledgements

Type of funding sources: None.

Background

The quantitative measurement of T1, T2 and T2* relaxation parameters is prone to numerous physical variables related to scanner performance and installation environment. These variables include the presence of eddy currents, main magnetic field inhomogeneity and gradient field performance. Thus, it is important to verify that the measured relaxation parameters are inter-scanner compatible and there are no drift in the measured values over time.

Purpose

In this study, we produced a phantom for the relaxation parameter measurements. With the phantom, long-time stability and inter-scanner comparison of parameters were studied with preliminary quality assurance protocol.

Methods

A cylindrical quality assurance phantom with 16 inserts filled with ammonium iron(II) ((NH4)2Fe(SO4)2 · 6H2O) doped gel was produced. The (NH4)2Fe(SO4)2 concentrations were from 0,0119 mmol/g to 0,5498 mmol/g, corresponding to approximate T1 values of 10–1030 ms, T2 values of 16–78 ms and T2* values of 5–61 ms. The phantom was measured quarterly for a one-year period with three scanners from two different vendors to follow the scanner stability and inter-scanner compatibility. The used imaging sequences included T1 MOLLI -based sequence, T2 prep -based sequence, and multi-echo gradient echo sequence for T2* calculation. Simulated ECG signal with 60 beats per minute was used in the scanning to mimic a typical rest heart rate of an adult patient.

Results

The range of variation between scanners from average relaxation coefficient in T1 was -2% to 4% and in T2 and T2* measurements -7% to 5% and -32% to 18%, respectively. In long-term stability test, the range of variation from average relaxation coefficient in T1 was -1% to 2% and in T2 and T2* measurements -1% to 1% and -15% to 16%, respectively.

Conclusion(s)

There were significant differences in the measured T1, T2, and T2* relaxation coefficients in both inter-scanner and long-term stability. However, the detected variations were acceptable compared to the typical physiological uncertainties of the measured parameters but have to be taken into account when the reliability of the study is assessed.

Abstract Figure. Results and phantom image

CMR 4D flow underestimates peak systolic flow measurements in patients with severe aortic stenosis

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Helsinki University Hospital, Finland

Background

Aortic stenosis (AS) is the most prevalent valvular disease in the developed countries. 4D flow is an emerging cardiac magnetic resonance (CMR) imaging technique, which has been suggested to improve the evaluation of AS severity. The accuracy of peak flow measurement by 4D flow CMR in patients with severe AS has, however, remained unvalidated.

Purpose

We investigated the reliability of the novel 4D flow CMR technique in measuring transvalvular peak systolic flow in patients with severe aortic valve stenosis.

Methods

The study included 63 patients clinically evaluated for valve replacement due to severe symptomatic AS. All the patients underwent echocardiography, 2D phase-contrast and 4D flow CMR. CMR was performed on consecutive patients according to international guidelines. Mean age of the patients was 73.8 ± 11.5 years, mean aortic valve area 0.7 ± 0.2 cm², and 40 of the valves were tricuspid and 23 bicuspid. QFlow and QFlow 4D software were used for flow analyses. Bland-Altman analyses and Wilcoxon signed rank sum tests were performed using SPSS software.

Results

CMR 4D flow analyses underestimated peak flow values when compared with echocardiography (bias -1.1 m/s, limits of agreement ± 1.5 m/s) and with 2D flow analyses (bias -1.2 m/s, limits of agreement ± 1.7 m/s). The difference between values obtained by 4D flow (median 3.1 m/s, range 1.5 – 4.9 m/s) and echocardiography (median 4.3 m/s, range 2.1 – 6.1 m/s) as well as by 2D flow (median 4.3 m/s, range 2.0 – 8.4 m/s) were statistically significant (p < 0,001). The difference between 2D flow analyses and echocardiography remained statistically insignificant (bias 0.05 m/s, limits of agreement ± 1.6 m/s).

Conclusions

We found that 4D flow analysis significantly underestimates systolic peak flow values in patients with severe AS. This may be due to intra-voxel averaging of the narrow jets. In contrast to previous assumptions, traditional 2D flow technique may therefore outperform 4D flow in measuring valvular peak flow by CMR in patients with severe AS. This should be taken into consideration when assessing disease severity by CMR.

Abstract Figure. Peak systolic flow in AS patients (n = 63)

Effect of Sex Steroid Hormones on Tongue Cancer Cells In Vitro

BACKGROUND

Tongue cancer is more common in men than in women. Yet the effects of sex steroid hormones on the behaviour of oral tongue squamous cell carcinoma (OTSCC) are not well known. Matrix metalloproteinase 8 (MMP8) is expressed in OTSCC and can degrade estrogen receptors (ERs).

MATERIALS AND METHODS

Western blot was used to examine the levels of ERβ in OTSCC cell lines (HSC-3 and SCC-25). We evaluated the effects of estradiol and dihydrotestosterone (DHT) on HSC-3 and SCC-25 cell migration, invasion and viability. The effect of estradiol on the invasion of MMP8-overexpressing (MMP8⁺) and empty vector HSC-3 cells was examined using 3D spheroid invasion assay.

RESULTS

Both HSC-3 and SCC-25 cells expressed ERβ. In scratch assay, estradiol, but not DHT, reduced the migration and invasion of HSC-3 and SCC-25 cells. MMP8⁺ HSC-3 cells showed weaker invasion than empty vector cells, in line with previous reports. However, MMP8 overexpression did not alter the effect of estradiol on HSC-3 cell invasion in spheroid assay.

CONCLUSION

Estradiol inhibited the migration and invasion of OTSCC cells, whereas DHT had no effect. Our data suggest that MMP8 does not modulate the effect of estradiol in OTSCC cells. However, the sex difference in OTSCC incidence might partly be due to protective actions of estradiol in epithelial cell carcinogenesis.

Development and testing of a new electronic foot health promotion programme on nurses' foot self-care

Background

Nurses form the largest professional group in health care, and they spend most of their working day on their feet. From the perspective of work well-being, healthy feet are important to tolerate the physical demands of nursing work. However, little is known about how nurses’ foot self-care practices can be promoted with computerised interventions. The aim of this study was two-fold: to explore the preliminary effects of the electronic Foot Health Promotion Programme (FHPP) on foot self-care in nurses and to examine the usability of the programme.

Methods

A single group pretest-posttest design was used. The FHPP was targeted at nurses working in the operating theatre. The FHPP lasted for 4 weeks and focused on improving nurses’ knowledge and awareness of foot self-care through self-directed learning tasks. The primary outcome was knowledge of foot self-care. The secondary outcomes were foot health and work ability. Thirty-seven participants completed the study. The outcomes were assessed at baseline (April–June 2017) and 4 weeks (August–September 2017) after the intervention ended. The data were analysed statistically.

Results

Participants’ knowledge of foot self-care and foot health improved; however, the changes were not statistically significant. The FHPP was considered to be usable and has potential as a tool to increase knowledge of foot self-care among nurses.

Conclusions

The FHPP developed in this study is a newly developed potential tool to increase nurses’ knowledge of foot self-care. Application of the FHPP as part of occupational health care may enhance nursing personnel’s foot self-care and lower extremity health.

Trial registration

ClinicalTrials.gov NCT03116451, 17.4.2017.

A low-cost paper-based platform for fast and reliable screening of cellular interactions with materials

A paper-based platform was developed and tested for studies on basic cell culture, material biocompatibility, and activity of pharmaceuticals in order to provide a reliable, robust and low-cost cell study platform. It is based upon a paper or paperboard support, with a nanostructured latex coating to provide an enhanced cell growth and sufficient barrier properties. Wetting is limited to regions of interest using a flexographically printed hydrophobic polydimethylsiloxane layer with circular non-print areas. The nanostructured coating can be substituted for another coating of interest, or the regions of interest functionalized with a material to be studied. The platform is fully up-scalable, being produced with roll-to-roll rod coating, flexographic and inkjet printing methods. Results show that the platform efficiency is comparable to multi-well plates in colorimetric assays in three separate studies: a cell culture study, a biocompatibility study, and a drug screening study. The color intensity is quantified by using a common office scanner or an imaging device and the data is analyzed by a custom computer software without the need for expensive screening or analysis equipment.

Tumour-cell-derived complement components C1r and C1s promote growth of cutaneous squamous cell carcinoma

Background

The incidence of epidermal keratinocyte‐derived cutaneous squamous cell carcinoma (cSCC) is increasing worldwide.

Objectives

To study the role of the complement classical pathway components C1q, C1r and C1s in the progression of cSCC.

Methods

The mRNA levels of C1Q subunits and C1R and C1S in cSCC cell lines, normal human epidermal keratinocytes, cSCC tumours in vivo and normal skin were analysed with quantitative real‐time polymerase chain reaction. The production of C1r and C1s was determined with Western blotting. The expression of C1r and C1s in tissue samples in vivo was analysed with immunohistochemistry and further investigated in human cSCC xenografts by knocking down C1r and C1s.

Results

Significantly elevated C1R and C1S mRNA levels and production of C1r and C1s were detected in cSCC cells, compared with normal human epidermal keratinocytes. The mRNA levels of C1R and C1S were markedly elevated in cSCC tumours in vivo compared with normal skin. Abundant expression of C1r and C1s by tumour cells was detected in invasive sporadic cSCCs and recessive dystrophic epidermolysis bullosa‐associated cSCCs, whereas the expression of C1r and C1s was lower in cSCC in situ, actinic keratosis and normal skin. Knockdown of C1r and C1s expression in cSCC cells inhibited activation of extracellular signal‐related kinase 1/2 and Akt, promoted apoptosis of cSCC cells and significantly suppressed growth and vascularization of human cSCC xenograft tumours in vivo.

Conclusions

These results provide evidence for the role of tumour‐cell‐derived C1r and C1s in the progression of cSCC and identify them as biomarkers and putative therapeutic targets in cSCC.

What's already known about this topic?

The incidences of actinic keratosis, cutaneous squamous cell carcinoma (cSCC) in situ and invasive cSCC are increasing globally.

Few specific biomarkers for progression of cSCC have been identified, and no biological markers are in clinical use to predict the aggressiveness of actinic keratosis, cSCC in situ and invasive cSCC.

What does this study add?

Our results provide novel evidence for the role of complement classical pathway components C1r and C1s in the progression of cSCC.

What is the translational message?

Our results identify complement classical pathway components C1r and C1s as biomarkers and putative therapeutic targets in cSCC.

Linked Comment: https://doi.org/10.1111/bjd.18419.

https://doi.org/10.1111/bjd.18821 available online

Instruments measuring interprofessional collaboration in healthcare - a scoping review

Worldwide there is growing understanding of the importance of interprofessional collaboration in providing well-functioning healthcare. However, little is known about how interprofessional collaboration can be measured between different health-care professionals. In this review, we aim to fill this gap, by identifying and analyzing the existing instruments measuring interprofessional collaboration in healthcare. A scoping review design was applied. A systematic literature search of two electronic databases, Medline (PubMed) and CINAHL, was conducted in 03/2018. The search yielded 1020 studies, of which 35 were selected for the review. The data were analyzed by content analysis. In total, 29 instruments measuring interprofessional collaboration were found. Interprofessional collaboration was measured predominantly between nurses and physicians with different instruments in various health-care settings. Psychometric testing was unsystematic, focusing predominantly on construct and content validity and internal consistency, thus further validation studies with comprehensive testing are suggested. The results of this review can be used to select instruments measuring interprofessional collaboration in practice or research. Future research is needed to strengthen the evidence of reliability and validity of these instruments.

Grit blasted aggregates of hydroxyl apatite functionalized calcium carbonate in occluding dentinal tubules

Objectives

This study aimed to investigate the effects of using hydroxyl apatite functionalized calcium carbonate (FCC) particles on occluding dentinal tubules.

Methods

Dentine specimens extracted from eighteen human molars with exposed dentinal tubules were divided into three groups (n = 6/group): a) Cut surface with smear layer; b) EDTA (smear layer removed with 17% EDTA for 1 min); and c) Grit blasted functionalized calcium carbonate (FCC) with and air pressure of 280 kPa. Microscopic dentinal tubule occlusion, tubule diameter and tubule area were evaluated using scanning electron microscopy (SEM) before and after grit blasting. Biomineralization of specimens was carried out in a simulated body fluid (SBF). Elemental analysis of occluding materials was carried out using energy-dispersive X-ray spectroscopy (EDX). X-ray diffraction (XRD) analysis was performed to demonstrate the crystal structure of the biomineralized layer on dentine.

Results

FCC particles showed penetration into the dentinal tubules by breakage of their original particle shape and size. EDTA treated surface had higher number and larger size tubules than those with smear layer or grit blasted (p < 0.005). SEM-EDX analysis revealed mineral precipitation of calcium phosphate on the SBF immersed dentin specimens. XRD analysis showed typical crystal structure of hydroxyl apatite for the biomineralized surface layer on dentine.

Conclusions

Grit blasted FCC particles initially occluded effectively the opened dentinal tubules and biomineralization occurred in tubules primarily occluded by the FCC particles. However, in the optimal in vitro conditions in SBF, no difference between biomineralization was found between the grit blasted surface and the control surface.

Clinical significance

Several materials and methods have been established for treatment of dentinal hypersensitivity although a golden standard treatment has not been discovered. Grit blasted functionalized calcium carbonate has a potential to occlude and remineralize exposed dentinal tubules. This could offer a more biological approach on treatment of dentin hypersensitivity.

Sub-ppm electrical detection of hydrogen sulfide gas at room temperature based on printed copper acetate–gold nanoparticle composite films

This paper presents the sub-ppm level electrical detection of H₂S gas at room temperature using printed copper acetate–gold nanoparticle composite films either on (A) silver or (B) gold/AuNP electrodes.

Synthesis and in vitro phantom NMR and MRI studies of fully organic free radicals, TEEPO-glucose and TEMPO-glucose, potential contrast agents for MRI

Two organic radical contrast agents, TEMPO-Glc and TEEPO-Glc, were synthesized and their stabilities and contrast enhancing properties were tested with in vitro NMR and MRI experiments.

PKCalpha/beta I inhibitor Go6976 induces dephosphorylation of constitutively hyperphosphorylated Rb and G1 arrest in T24 cells

BACKGROUND

Rb functions as a key controller of the G(1)-S transition of the cell cycle, and its inactivation leads to a defective G(1) checkpoint. Bladder cancer frequently displays alterations in Rb such as constitutive hyperphosphorylation which results in inactive Rb and progression of cells to the S-phase. Several protein kinase C (PKC) inhibitors are currently undergoing clinical trials as anticancer drugs.

MATERIALS AND METHODS

T24 urinary bladder carcinoma cells, known to express hyperphosphorylated Rb, were treated with PKCα/βI inhibitor Go6976. The treated cells were subjected to cell cycle analysis, cell growth assay and Western blots for Rb and cdc2 phosphorylation.

RESULTS

The treatment resulted in Rb dephosphorylation at Ser 795 and Ser 807/811, and cdc2 dephosphorylation at Tyr15. Subsequent G(0/1) arrest and reduced proliferation rates were observed.

CONCLUSION

The results show that Go6976 can be used to restore constantly hyperphosphorylated and therefore constantly inactive Rb function in cancer cells.

The function of the hand after operations for obstetric injuries to the brachial plexus

Hand function was evaluated in 105 patients who had been operated on in early infancy for brachial plexus birth palsy. The mean follow-up after surgery was for 13.4 years (5.0 to 31.5). Fine sensation, stereognosis, grip and pinch strength and the Raimondi scale were recorded.

Fine sensation was normal in 34 of 49 patients (69%) with C5–6 injury, 15 of 31 (48%) with C5–7 and in 8 of 25 (32%) with total injury. Loss of protective sensation or absent sensation was noted in some palmar areas of the hand in 12 of 105 patients (11%). Normal stereognosis was recorded in 88 of the 105 patients (84%), whereas only 9 of the 105 (9%) had normal grip strength. The mean Raimondi scale scores were 4.57 (3 to 5) (C5–6), 4.26 (1 to 5) (C5–7) and 2.16 (0 to 5) in patients with total injury.

The location of impaired sensation was related to the distribution of the root injury. Avulsion type of injury correlated with poor recovery of hand function.

Tight junction components occludin, ZO-1, and claudin-1, -4 and -5 in active and healing psoriasis

BACKGROUND

Cells of the granular layer are interconnected by tight junctions (TJs) in normal epidermis. The structural proteins of epidermal TJs include occludin, ZO-1, and claudin-1 and -4.

OBJECTIVES

Our aim was to correlate the expression of TJ components with keratinocyte differentiation using psoriasis as a model of premature keratinization.

METHODS

The distribution of TJ proteins was evaluated in the skin of nine patients with psoriasis. Punch biopsies were taken from perilesional skin, from active psoriasis plaques, and from healed, previously lesional locations. The punch biopsies were analysed using indirect immunolabelling for ZO-1, occludin and claudin-1, -4 and -5. In addition, epidermal samples were analysed by reverse transcription-polymerase chain reaction for claudin-1, -4 and -5 mRNAs.

RESULTS

Claudin-5 was localized to the granular cell layers of normal control skin as well as perilesional and lesional psoriatic epidermis. This was unexpected, as previous studies have not detected claudin-5 in the epidermis. Occludin and ZO-1 were expressed in the granular cell layer in psoriatic perilesional epidermis. In the psoriasis plaques, ZO-1 and occludin were detected in a wider zone extending from the granular layer to the middle spinous cell layers. In healed psoriasis plaques, the expression of occludin and ZO-1 resumed a normal-looking profile, being restricted to the upper epidermis only. Claudin-1 and -4 did not show marked changes in psoriasis compared with normal skin.

CONCLUSIONS

The results demonstrate claudin-5 in normal epidermis and psoriatic skin, and abnormal distribution of occludin and ZO-1 in psoriasis plaques. Clinical healing of aberrant keratinization is associated with restoration of the normal distribution of occludin, ZO-1 and also involucrin.

Is there a role for PCR-SSCP among the methods for missense mutation detection of TP53 gene?

Mutation analysis methods have increased in variety during the past years. High-throughput microarray methods have especially increased in popularity. However, new methods require reference points, and not all of the methods are equal in sensitivity and specificity. Furthermore, the detection of unknown missense mutations, such as unknown TP53 mutations in human tumors, for clinical purposes requires great accuracy, which may be difficult to acquire with the current high-throughput methods. For these reasons, the classical methods, such as PCR-manual sequencing and PCR-SSCP, are still valuable and necessary.

p38α and p38δ mitogen-activated protein kinase isoforms regulate invasion and growth of head and neck squamous carcinoma cells

Recent studies indicate that the specificity of p38 mitogen-activated protein kinase (MAPK)-mediated cellular stress responses is determined by the expression pattern of the distinct p38 isoforms. Here, we have analysed the function of distinct p38 isoforms in the growth and invasion of head and neck squamous cell carcinomas (HNSCCs). Activation of p38 MAPK by arsenite resulted in inactivation of the ERK1,2 signaling pathway by dephosphorylation of MEK1,2 in primary human epidermal keratinocytes (HEKs), whereas in HNSCC cells this p38-mediated inhibition of the ERK1,2 pathway was absent. Quantitation of p38 pathway component mRNA expression in HNSCC cell lines (n=42) compared to HEKs (n=8) revealed that p38alpha and p38delta isoforms are predominantly expressed in both cell types and that MKK3 is the primary upstream activator expressed. Inhibition of endogenous p38alpha or p38delta activity by adenoviral delivery of corresponding dominant-negative p38 isoforms potently reduced MMP-13 and MMP-1 expressions, and suppressed the invasion of HNSCC cells through collagen. Dominant-negative p38alpha and p38delta inhibited squamous cell carcinoma (SCC) cell proliferation and inhibition of p38alpha activity also compromised survival of SCC cells. p38alpha and p38delta were predominantly expressed in HNSCCs (n=24) and nonneoplastic epithelium in vivo (n=6), with MKK3 being the primary upstream activator. Activation and expression of p38alpha and p38delta by tumor cells was detected in HNSCCs in vivo (n=16). Adenoviral expression of dominant-negative p38alpha or p38delta in cutaneous SCC cells potently inhibited their implantation in skin of severe combined immunodeficiency mice and growth of xenografts in vivo. Our results indicate that p38alpha and p38delta specifically promote the malignant phenotype of SCC cells by regulating cell survival, proliferation and invasion, suggesting these p38 MAPK isoforms as potential therapeutic targets in HNSCCs.

Activation of Smad signaling enhances collagenase-3 (MMP-13) expression and invasion of head and neck squamous carcinoma cells

Squamous cell carcinoma (SCC) cells of the head and neck specifically express collagenase-3 (matrix metalloproteinase-13 (MMP-13)), the expression of which correlates with their invasion capacity. Transforming growth factor-beta (TGF-beta) enhances MMP-13 and collagenase-1 (MMP-1) expression and invasion of SCC cells via p38 mitogen-activated protein kinase. Here, we have examined the role of Smad signaling in regulating MMP-13 expression and in invasion of head and neck SCC cells. Treatment with TGF-beta resulted in activation of Smad2 and Smad3 in SCC cells, but had no effect on their proliferation or viability. Basal activation of Smad3 and p38 was noted in SCC cells without exogenous TGF-beta stimulation, and adenoviral delivery of Smad7 and dominant-negative Smad3 inhibited p38 activation in these cells. Adenoviral overexpression of Smad3 augmented the upregulatory effect of TGF-beta on MMP-13 expression by SCC cells. Disruption of Smad signaling by adenoviral expression of kinase-defective TGF-beta type I receptor (activin-receptor-like kinase-5), Smad7, and dominant-negative Smad3 potently suppressed the basal and TGF-beta-induced expression of MMP-13 and MMP-1 in SCC cells, and inhibited their basal and TGF-beta-induced invasion through Matrigel and type I collagen. Adenoviral overexpression of Smad7 in cutaneous and oral SCC cells significantly inhibited their implantation in skin of SCID mice and growth of xenografts in vivo, as compared to LacZ adenovirus-transduced control cells. Together, these results show that Smad signaling plays an important role in promoting the invasive phenotype of human head and neck SCC cells by upregulating their collagenase expression.

Scoliosis after solid organ transplantation in children and adolescents

The occurrence of scoliosis in children after solid organ transplantation is not known. A total of 196 children, which is 93% of patients surviving kidney, liver and heart transplantation in our country, participated in a cross-sectional survey. All children were screened for rib hump, and those with clinically significant hump (over 6 degrees ) underwent radiographs of the spine. The occurrence of scoliosis was compared to data obtained from a previously published comparison group. Forty-three (21.9%) of the patients had scoliosis greater than 10 degrees , and 21 (10.7%) of them had curves greater than 20 degrees . The RR (95% CI) for scoliosis needing treatment (over 20 degrees ) was 17.0 (6.75-42.7) in the patients as compared with control population. The occurrence of scoliosis was 17.9% of the kidney, 13.6% of the liver and 51.7% of the heart transplant patients (p < 0.001). In a logistic regression model, heart transplantation (OR (95% CI) 7.27 (2.62-20.2)) and growth hormone treatment (3.98 (1.77-8.94)) were most significant risk factors for scoliosis. The risk of scoliosis is increased in patients with solid organ transplantation. Pediatricians treating these patients should be aware of this increased risk to diagnose early curves and to refer these patients to an orthopedic surgeon.

Keratinocytes cultured from patients with Hailey-Hailey disease and Darier disease display distinct patterns of calcium regulation

BACKGROUND

Hailey-Hailey disease (HHD) (OMIM 16960) and Darier disease (DD) (OMIM 124200) are dominantly inherited acantholytic skin diseases, respectively, caused by mutations in the genes encoding the Golgi secretory pathway Ca2+-ATPase (SPCA1, ATP2C1) and the sarco/endoplasmic reticulum Ca2+-ATPase type 2 (SERCA2, ATP2A2) genes.

OBJECTIVES

To investigate calcium regulation in keratinocytes cultured from patients with HHD and DD by measuring intracellular calcium resting levels and the cellular responses to ATP and thapsigargin.

METHODS

The study was carried out using keratinocyte cultures established from four patients with HHD and four with DD. Calcium concentrations were measured with fluorescence ratio imaging using fura-2 loading.

RESULTS

Control and HHD keratinocytes displayed approximately the same Ca2+ levels in resting phase, while DD keratinocytes showed elevated Ca2+ levels. Application of ATP caused less pronounced elevation of intracellular calcium concentration ([Ca2+]i) in both HHD and DD keratinocytes than in control cells. HHD keratinocytes did not lower their [Ca2+]i as efficiently as control keratinocytes after treatment with thapsigargin. In addition, DD keratinocytes were practically incapable of lowering their [Ca2+]i after treatment with thapsigargin.

CONCLUSIONS

The results demonstrate that the defects in SPCA1 and SERCA2 calcium ATPases result in distinct patterns of calcium metabolism. This is also supported by the different clinical features of the diseases.

Neurofibromatosis type 1 tumour suppressor gene expression is deficient in psoriatic skin in vivo and in vitro: a potential link to increased Ras activity

BACKGROUND

Neurofibromatosis type 1 (NF1) protein (neurofibromin) accelerates the inactivation of Ras-GTP in various cell types. Somatic mutations of the NF1 gene may lead to malignant transformation and uncontrolled proliferation. We have previously shown that NF1 protein expression is downregulated in psoriasis in vivo.

OBJECTIVES

To study the functional expression and distribution of NF1 mRNA and protein in vivo and in psoriatic and normal keratinocyte cultures.

METHODS

Immunohistochemistry and in situ hybridization were used to study NF1 gene and protein expression in psoriasis in vivo. Furthermore, Northern and in situ hybridizations, immunoblot and localization analyses were utilized to study NF1 mRNA and protein in vitro in keratinocyte cultures.

RESULTS

NF1 tumour suppressor gene expression was reduced in lesional psoriatic skin compared with perilesional and normal skin in vivo. The in vitro results showed that the levels of NF1 mRNA and protein were reduced in cultured psoriatic keratinocytes during cellular differentiation even after multiple passaging of the cells. Moreover, cultured nonlesional psoriatic keratinocytes were almost equally defective as lesional cells with respect to NF1 expression.

CONCLUSIONS

Our findings demonstrate that psoriatic keratinocytes maintain an altered phenotype and gene expression profile even when isolated from interaction with lymphocytes and fibroblasts, which are known to increase proliferation of keratinocytes. As NF1 protein is regarded as a Ras proto-oncogene regulator, the aberrant expression and distribution of NF1 protein and mRNA found in the present study may be causative to the previously described increased activation of Ras in psoriatic lesions, and relate to altered cellular behaviour.

Immunohistological distribution of the tight junction components ZO-1 and occludin in regenerating human epidermis

BACKGROUND

Molecular characterization of tight junction proteins during the past few years has provided novel methods for studying these specialized junctions. Tight junctions have recently been characterized in the granular cell layer of human epidermis, and the role of these junctions in the epidermal barrier is now being re-evaluated.

OBJECTIVES

To investigate the expression of tight junction components during the re-epithelialization of suction blisters and the regeneration of the corneal layer after tape stripping.

METHODS

Suction blisters were induced in eight healthy volunteers, and skin biopsies were taken 4 or 6 days afterwards. The restoration of epidermal barrier function was evaluated by measuring water evaporation (WE) from the wound area. Tape stripping was performed on three volunteers to remove the corneal layer. The tissues were immunolabelled using indirect immunofluorescence or the avidin-biotin method.

RESULTS

Prior to the biopsies, WE from the blister wounds was markedly elevated in comparison with normal skin. In the epidermis surrounding the blister, occludin and ZO-1 were expressed in the granular cell layer only. In the hyperproliferative zone adjacent to the border of the blister, the expression of ZO-1 was redistributed into several spinous cell layers, while occludin expression was restricted to the upper epidermis. In the leading edge of migrating keratinocytes, both proteins were expressed exclusively in the most superficial layer of keratinocytes. Double labelling for ZO-1 and involucrin showed expression of both proteins in the same layers of hyperproliferative keratinocytes, while the expression patterns were clearly different in the migrating keratinocytes.

CONCLUSIONS

Tight junctions of regenerating epidermis may provide a functional barrier prior to regeneration of the corneal layer.

Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases

BACKGROUND AND AIMS

The incidence of diabetic Charcot neuroarthropathy has increased. The purpose here was to study the current diagnostics and treatment of the Charcot foot.

MATERIALS AND METHODS

During a time period from 1994 to 2000, a total of 36 feet were diagnosed as cases of diabetic Charcot neuroarthropathies. A retrospective analysis of patient records and radiographs was undertaken. A review of the recent literature is presented.

RESULTS

29 cases were diagnosed in the dissolution stage, 2 in coalascence, and 5 in the resolution stage. The diagnostic delay averaged 29 weeks. Treatment with cast immobilisation ranged from 4 to 37 weeks (mean 11 weeks). A total of 14 surgical procedures were carried out on 10 patients: six exostectomies, four midfoot arthrodeses, one triple arthrodesis, one tibiocalcaneal arthrodesis and two below-knee amputations. A radiological fusion was achieved in two thirds of the attempted arthrodeses.

CONCLUSIONS

A physician should always consider the Charcot neuroarthropathy when a diabetic patient has an inflamed foot. In the absence of fever, elevated CRP or ESR, infection is a highly unlikely diagnosis, and a Charcot process should primarily be considered. The initial treatment of an inflamed Charcot foot consists in sufficiently long non-weightbearing with a cast, which should start immediately after the diagnosis. The prerequisites of successful reconstructive surgery are correct timing, adequate fixation and a long postoperative non-weightbearing period. In the resolution stage most Charcot foot patients need custom-molded footwear.

Effects of glucose on collagen mRNA levels and collagen secretion in EAhy 926 endothelial cell line

Diabetes mellitus (DM) is a complex metabolic disease associated with increased accumulation of extracellular matrix by endothelial cells and contributing to vascular complications of long-standing diabetes. On the other hand, DM is also associated with decreased accumulation of extracellular matrix in granulation tissue, which is suggested to be a consequence of impaired angiogenesis. The role of hyperglycemia in these situations is not fully understood. We examined the effects of high glucose concentrations on the gene expression and secretion of various collagens in cultured EAhy 926 endothelial cells. EAhy 926 endothelial cells expressed alpha1(I) collagen mRNA at a low level and small amount of the corresponding peptide was secreted from the cells; mRNA was not affected but peptide secretion was increased by elevated glucose concentration. mRNAs for type III and VI collagens were not detected in the endothelial cells. Furthermore, high glucose concentration in long term had no morphological effects on cultured endothelial cells but increased the expression of type IV collagen, which could rather be beneficial for angiogenesis in a healing wound. Our results suggest that high glucose concentration per se may contribute to increased accumulation of extracellular matrix in blood vessels but probably is not responsible for decreased angiogenesis and granulation tissue formation in diabetic patients.

The effects of sialic acid on the gene expression of fibrillar collagens: different changes in normal and fibrotic scar derived fibroblasts

OBJECTIVE

To investigate the effect of free sialic acid on collagen gene expression in fibroblasts.

DESIGN

Cell culture study.

SETTING

University hospital, Finland. CELL LINES: Human granulation tissue fibroblasts, human hypertrophic scar fibroblasts and human keloid fibroblasts.

INTERVENTIONS

Treatment of cell cultures with 3 microM, 30 microM and 300 microM N-acetyl-neuraminic acid.

MAIN OUTCOME MEASURES

The measurement of steady state level of mRNA for type I and type III collagen.

RESULTS

Fibroblast lines react dissimilarly under the influence of sialic acid. Granulation tissue fibroblasts showed decrease in the gene expression of type I and III collagen, while keloid fibroblasts contrastingly showed an increase. Hypertrophic scar derived fibroblasts showed no change.

CONCLUSIONS

Sialic acids may decrease collagen gene expression in granulation tissue and that disturbed wound healing in diabetics and smokers may in part be due to direct effect of sialic acids on fibroblasts. Sialic acids may in part induce keloid formation.

The effects of sialic acid on the gene expression of fibrillar collagens: different changes in normal and fibrotic scar derived fibroblasts

OBJECTIVE

To investigate the effect of free sialic acid on collagen gene expression in fibroblasts.

DESIGN

Cell culture study.

SETTING

University hospital, Finland. CELL LINES: Human granulation tissue fibroblasts, human hypertrophic scar fibroblasts and human keloid fibroblasts.

INTERVENTIONS

Treatment of cell cultures with 3 microM, 30 microM and 300 microM N-acetyl-neuraminic acid.

MAIN OUTCOME MEASURES

The measurement of steady state level of mRNA for type I and type III collagen.

RESULTS

Fibroblast lines react dissimilarly under the influence of sialic acid. Granulation tissue fibroblasts showed decrease in the gene expression of type I and III collagen, while keloid fibroblasts contrastingly showed an increase. Hypertrophic scar derived fibroblasts showed no change.

CONCLUSIONS

Sialic acids may decrease collagen gene expression in granulation tissue and that disturbed wound healing in diabetics and smokers may in part be due to direct effect of sialic acids on fibroblasts. Sialic acids may in part induce keloid formation.