Effect of silver vanadate on the antibiofilm, adhesion and biocompatibility properties of denture adhesive

Aim: To evaluate the biological and mechanical properties of an adhesive with nanostructured silver vanadate (AgVO3). Materials & methods: Specimens in poly(methyl methacrylate) (PMMA) were treated with Ultra Corega Cream (UCCA) denture adhesive with or without AgVO3. Biofilms of Candida albicans, Candida glabrata and Streptococcus mutans were grown and the viable cells counted. Fluorescence microscopy was used. The viability of the VERO cell and adhesive strength were evaluated. Results: All concentrations of AgVO3 reduced the biofilm formation and showed no cytotoxic effect. At 5 min and 24 h, UCCA with 5 and 10% AgVO3 showed better performance, respectively. Conclusion: AgVO3 promoted the antibiofilm activity of the adhesive, with a positive effect on the adhesive strength, and was biocompatible.

A kinetic characterization of the gill V(H+)-ATPase from two hololimnetic populations of the Amazon River shrimp Macrobrachium amazonicum

This investigation examines the kinetic characteristics and effect of acclimation to a brackish medium (21 ‰S) on gill V(H+)-ATPase activity in two hololimnetic populations of M. amazonicum. We also investigate the cellular immunolocalization of the enzyme. Immunofluorescence findings demonstrate that the V(H+)-ATPase c-subunit is distributed in the apical pillar cells of shrimps in fresh water but is absent after acclimation to 21 ‰S for 10 days. V(H+)-ATPase activity from the Tietê River population is ≈50% greater than the Grande River population, comparable to a wild population from the Santa Elisa Reservoir, but is 2-fold less than in cultivated shrimps. V(H+)-ATPase activity in the Tietê and the Grande River shrimps is abolished after 21 ‰S acclimation. The apparent affinities of the V(H+)-ATPase for ATP (0.27 ± 0.04 and 0.16 ± 0.03 mmol L-1, respectively) and Mg2+ (0.28 ± 0.05 and 0.14 ± 0.02 mmol L-1, respectively) are similar in both populations. The absence of V(H+)-ATPase activity in salinity-acclimated shrimps and its apical distribution in shrimps in fresh water underpins the importance of the crustacean V(H+)-ATPase for ion uptake in fresh water.

Salinity-dependent modulation by protein kinases and the FXYD2 peptide of gill (Na+, K+)-ATPase activity in the freshwater shrimp Macrobrachium amazonicum (Decapoda, Palaemonidae)

The geographical distribution of aquatic crustaceans is determined by ambient factors like salinity that modulate their biochemistry, physiology, behavior, reproduction, development and growth. We investigated the effects of exogenous pig FXYD2 peptide and endogenous protein kinases A and C on gill (Na⁺, K⁺)-ATPase activity, and characterized enzyme kinetic properties in a freshwater population of Macrobrachium amazonicum in fresh water (<0.5 ‰ salinity) or acclimated to 21 ‰S. Stimulation by FXYD2 peptide and inhibition by endogenous kinase phosphorylation are salinity-dependent. While without effect in shrimps in fresh water, the FXYD2 peptide stimulated activity in salinity-acclimated shrimps by ≈50 %. PKA-mediated phosphorylation inhibited gill (Na⁺, K⁺)-ATPase activity by 85 % in acclimated shrimps while PKC phosphorylation markedly inhibited enzyme activity in freshwater- and salinity-acclimated shrimps. The (Na⁺, K⁺)-ATPase in salinity-acclimated shrimp gills hydrolyzed ATP at a V_max of 54.9 ± 1.8 nmol min^-1 mg^-1 protein, corresponding to ≈60 % that of freshwater shrimps. Mg²⁺ affinity increased with salinity acclimation while K⁺ affinity decreased. (Ca²⁺, Mg²⁺)-ATPase activity increased while V(H⁺)- and Na⁺- or K⁺-stimulated activities decreased on salinity acclimation. The 120-kDa immunoreactive band expressed in salinity-acclimated shrimps suggests nonspecific α-subunit phosphorylation by PKA and/or PKC. These alterations in (Na⁺, K⁺)-ATPase kinetics in salinity-acclimated M. amazonicum may result from regulatory mechanisms mediated by phosphorylation via protein kinases A and C and the FXYD2 peptide rather than through the expression of a different α-subunit isoform. This is the first demonstration of gill (Na⁺, K⁺)-ATPase regulation by protein kinases in freshwater shrimps during salinity challenge.

Biochemical Characterization and Allosteric Modulation by Magnesium of (Na+, K+)-ATPase Activity in the Gills of the Red Mangrove Crab Goniopsis cruentata (Brachyura, Grapsidae)

We provide a kinetic characterization of (Na⁺, K⁺)-ATPase activity in a posterior gill microsomal fraction from the grapsid crab Goniopsis cruentata. (Na⁺, K⁺)-ATPase activity constitutes 95% of total ATPase activity, and sucrose density centrifugation reveals an ATPase activity peak between 25 and 35% sucrose, distributed into two, partially separated protein fractions. The (Na⁺, K⁺)-ATPase α-subunit is localized throughout the ionocyte cytoplasm and has an M_r of ≈ 10 kDa and hydrolyzes ATP obeying cooperative kinetics. Low (V_M = 186.0 ± 9.3 nmol Pi min^-1 mg^-1 protein and K_0.5 = 0.085 ± 0.004 mmol L^-1) and high (V_M = 153.4 ± 7.7 nmol Pi min^-1 mg^-1 protein and K_0.5 = 0.013 ± 0.0006 mmol L^-1) affinity ATP binding sites were characterized. At low ATP concentrations, excess Mg²⁺ stimulates the enzyme, triggering exposure of a high-affinity binding site that accounts for 50% of (Na⁺, K⁺)-ATPase activity. Stimulation by Mg²⁺ (V_M = 425.9 ± 25.5 nmol Pi min^-1 mg^-1 protein, K_0.5 = 0.16 ± 0.01 mmol L^-1), K⁺ (V_M = 485.3 ± 24.3 nmol Pi min^-1 mg^-1 protein, K_0.5 = 0.9 ± 0.05 mmol L^-1), Na⁺ (V_M = 425.0 ± 23.4 nmol Pi min^-1 mg^-1 protein, K_0.5 = 5.1 ± 0.3 mmol L^-1) and NH₄⁺ (V_M = 497.9 ± 24.9 nmol Pi min^-1 mg^-1 protein, K_0.5 = 9.7 ± 0.5 mmol L^-1) obeys cooperative kinetics. Ouabain inhibits up to 95% of ATPase activity with K_I = 196.6 ± 9.8 µmol L^-1. This first kinetic characterization of the gill (Na⁺, K⁺)-ATPase in Goniopsis cruentata enables better comprehension of the biochemical underpinnings of osmoregulatory ability in this semi-terrestrial mangrove crab.

The lectin ArtinM activates RBL-2H3 mast cells without inducing degranulation

Mast cells are connective tissue resident cells with morphological and functional characteristics that contribute to their role in allergic and inflammatory processes, host defense and maintenance of tissue homeostasis. Mast cell activation results in the release of pro-inflammatory mediators which are largely responsible for the physiological functions of mast cells. The lectin ArtinM, extracted from Artocarpus heterophyllus (jackfruit), binds to D-manose, thus inducing degranulation of mast cells. ArtinM has several immunomodulatory properties including acceleration of wound healing, and induction of cytokine release. The aim of the present study was to investigate the role of ArtinM in the activation and proliferation of mast cells. The rat mast cell line RBL-2H3 was used throughout this study. At a low concentration (0.25μg/mL), ArtinM induced mast cell activation and the release of IL-6 without stimulating the release of pre-formed or newly formed mediators. Additionally, when the cells were activated by ArtinM protein tyrosine phosphorylation was stimulated. The low concentration of ArtinM also activated the transcription factor NFkB, but not NFAT. ArtinM also affected the cell cycle and stimulated cell proliferation. Therefore, ArtinM may have therapeutic applications by modulating immune responses due to its ability to activate mast cells and promote the release of newly synthesized mediators. Additionally, ArtinM could have beneficial effects at low concentrations without degranulating mast cells and inducing allergic reactions.

O Biomaterial Quitosana: Possibilidade Terapêutica para Cicatrização de Feridas Bucais

A quitosana é uma aminoglucopirananas obtida a partir de resíduos de exoesqueletos de crustáceos, que apresenta em sua composição propriedades imunomodeladora, anti-inflamatória, antimicrobiana, antioxidante, atoxicidade e biocompatibilidade. Devido a essas propriedades, foi estudada em diversas pesquisas, e então sendo hoje aplicada a fármacos cicatrizantes teciduais. Na Odontologia  a quitosana tem sido aplicada à infecções periodontais e naquelas resistentes ao tratamento endodôntico convencional. O presente estudo tem como objetivo avaliar o potencial cicatrizante da quitosana. Para tanto a literatura foi revisada por meio das bases de dados eletrônicas do Pubmed, Bireme e Medline, utilizando os descritores (inglês/português) Chitosan Wound Healing Biocompatible Materials e Dentistry. Foram encontrados 22 artigos compreendidos entre os anos de 2005 e 2016, no qual foram selecionados 11. Como critérios de inclusão foram selecionados artigos que relatassem sobre o uso da quitosana em cicatrização de feridas, e a relação da mesma com a Odontologia. Foram excluídos artigos de metodologia incompleta. Pode-se considerar, que o efeito cicatrizante dessa substância advém de sua capacidade de estimular macrófagos liberadores de IL-1, que por sua vez estimulam a proliferação de fibroblastos, influenciando a estrutura do colágeno tecidual. A verificação da possibilidade cicatrizante da quitosana para feridas bucais pode proporcionar a possibilidade de uma nova opção terapêutica possivelmente mais eficaz, eficiente e biocompatível.Palavras-chave: Biomateriais. Quitosana. Odontologia.

Decreased platelet responsiveness to clopidogrel correlates with CYP2C19 and PON1 polymorphisms in atherosclerotic patients

Clopidogrel and aspirin are the most commonly used medications worldwide for dual antiplatelet therapy after percutaneous coronary intervention. However, clopidogrel hyporesponsiveness related to gene polymorphisms is a concern. Populations with higher degrees of genetic admixture may have increased prevalence of clopidogrel hyporesponsiveness. To assess this, we genotyped CYP2C19, ABCB1, and PON1 in 187 patients who underwent percutaneous coronary intervention. Race was self-defined by patients. We also performed light transmission aggregometry with adenosine diphosphate (ADP) and arachidonic acid during dual antiplatelet therapy. We found a significant difference for presence of the CYP2C19*2 polymorphism between white and non-white patients. Although 7% of patients had platelet resistance to clopidogrel, this did not correlate with any of the tested genetic polymorphisms. We did not find platelet resistance to aspirin in this cohort. Multivariate analysis showed that patients with PON1 and CYP2C19 polymorphisms had higher light transmission after ADP aggregometry than patients with native alleles. There was no preponderance of any race in patients with higher light transmission aggregometry. In brief, PON1 and CYP2C19 polymorphisms were associated with lower clopidogrel responsiveness in this sample. Despite differences in CYP2C19 polymorphisms across white and non-white patients, genetic admixture by itself was not able to identify clopidogrel hyporesponsiveness.

Co-cultivation of Aspergillus nidulans Recombinant Strains Produces an Enzymatic Cocktail as Alternative to Alkaline Sugarcane Bagasse Pretreatment

Plant materials represent a strategic energy source because they can give rise to sustainable biofuels through the fermentation of their carbohydrates. A clear example of a plant-derived biofuel resource is the sugar cane bagasse exhibiting 60-80% of fermentable sugars in its composition. However, the current methods of plant bioconversion employ severe and harmful chemical/physical pretreatments raising biofuel cost production and environmental degradation. Replacing these methods with co-cultivated enzymatic cocktails is an alternative. Here we propose a pretreatment for sugarcane bagasse using a multi-enzymatic cocktail from the co-cultivation of four Aspergillus nidulans recombinant strains. The co-cultivation resulted in the simultaneous production of GH51 arabinofuranosidase (AbfA), GH11 endo-1,4-xylanase (XlnA), GH43 endo-1,5-arabinanase (AbnA) and GH12 xyloglucan specific endo-β-1,4-glucanase (XegA). This core set of recombinant enzymes was more efficient than the alternative alkaline method in maintaining the cellulose integrity and exposing this cellulose to the following saccharification process. Thermogravimetric and differential thermal analysis revealed residual byproducts on the alkali pretreated biomass, which were not found in the enzymatic pretreatment. Therefore, the enzymatic pretreatment was residue-free and seemed to be more efficient than the applied alkaline method, which makes it suitable for bioethanol production.

Effects of ammonia stress in the Amazon river shrimp Macrobrachium amazonicum (Decapoda, Palaemonidae)

We evaluate the effects of total ammonia nitrogen-N (TAN) exposure for 72h on (Na(+),K(+))- and V(H(+))-ATPase activities and on their subunit expressions in gills of the diadromous freshwater shrimp Macrobrachium amazonicum. Specific (Na(+),K(+))- and V(H(+))-ATPase activities increased roughly 1.5- to 2-fold, respectively, after exposure to 2.0mmolL(-1) TAN. Quantitative RT-PCR analyses revealed a 2.5-fold increase in V(H(+))-ATPase B subunit mRNA expression while (Na(+),K(+))-ATPase α-subunit expression was unchanged. Immunohistochemical analyses of the gill lamellae located the (Na(+),K(+))-ATPase throughout the intralamellar septal cells, independently of TAN concentration, while the V(H(+))-ATPase was located in both the apical pillar cell flanges and pillar cell bodies. Systemic stress parameters like total hemocyte count decreased by 30% after exposure to 2.0mmolL(-1) TAN, accompanied by increased activities of the oxidative stress enzymes superoxide dismutase, glutathione reductase and glucose-6-phosphate dehydrogenase in the gills. The stress responses of M. amazonicum to elevated TAN include increases in gill (Na(+),K(+))- and V(H(+))-ATPase activities that are accompanied by changes in oxidative stress enzyme activities, immune system effects and an increase in gill V(H(+))-ATPase gene expression. These findings likely underpin physiological effects in a crustacean like M. amazonicum that exploits multiple ecosystems during its life cycle, as well as under culture conditions that may significantly impact shrimp production by the aquaculture industry.

Synergistic stimulation by potassium and ammonium of K(+)-phosphatase activity in gill microsomes from the crab Callinectes ornatus acclimated to low salinity: novel property of a primordial pump

We provide an extensive characterization of the modulation by p-nitrophenylphosphate, Mg²⁺, Na⁺, K(+), Rb⁺, NH(4)(+) and pH of gill microsomal K⁺-phosphatase activity in the posterior gills of Callinectes ornatus acclimated to low salinity (21‰). The synergistic stimulation by K⁺ and NH(4)(+) of the K⁺-phosphatase activity is a novel finding, and may constitute a species-specific feature of K(+)/NH(4)(+) interplay that regulates crustacean gill (Na⁺, K⁺)-ATPase activity. p-Nitrophenylphosphate was hydrolyzed at a maximum rate (V) of 69.2 ± 2.8nmolPimin⁻¹mg⁻¹ with K(0.5)=2.3 ± 0.1mmolL(-1), obeying cooperative kinetics (n(H)=1.7). Stimulation by Mg²⁺ (V=70.1 ± 3.0nmolPimin⁻¹mg⁻¹, K(0.5)=0.88 ± 0.04mmolL⁻¹), K⁺ (V=69.6 ± 2.7nmolPimin⁻¹mg⁻¹, K(0.5)=1.60 ± 0.07mmolL⁻¹) and NH(4)(+) (V=90.8 ± 4.0nmolPimin⁻¹mg⁻¹, K(0.5)=9.2 ± 0.3mmol L⁻¹) all displayed site-site interaction kinetics. In the presence of NH(4)(+), enzyme affinity for K⁺ unexpectedly increased by 7-fold, while affinity for NH(4)(+) was 28-fold greater in the presence than absence of K⁺. Ouabain partially inhibited K⁺-phosphatase activity (K(I)=320 ± 14.0μmolL⁻¹), more effectively when NH(4)(+) was present (K(I)=240 ± 12.0μmolL⁻¹). We propose a model for the synergistic stimulation by K⁺ and NH(4)(+) of the K⁺-phosphatase activity of the (Na⁺, K⁺)-ATPase from C. ornatus posterior gill tissue.

Glycoconjugates and polysaccharides of fungal cell wall and activation of immune system

Glycoproteins, glycosphingolipids and polysaccharides exposed at the most external layers of the wall are involved in several types of interactions of fungal cells with the exocellular environment. These molecules are fundamental building blocks of organisms, contributing to the structure, integrity, cell growth, differentiation and signaling. Several of them are immunologically active compounds with potential as regulators of pathogenesis and the immune response of the host. Some of these structures can be specifically recognized by antibodies from patients’ sera, suggesting that they can be also useful in the diagnosis of fungal infections.

The opportunistic fungal pathogen Scedosporium prolificans: carbohydrate epitopes of its glycoproteins

Isolated from the mycelium of Scedosporium prolificans were complex glycoproteins (RMP-Sp), with three structurally related components (HPSEC). RMP-Sp contained 35% protein and 62% carbohydrate with Rha, Ara, Man, Gal, Glc, and GlcNH(2) in a 18:1:24:8:6:5 molar ratio. Methylation analysis showed mainly nonreducing end- of Galp (13%), nonreducing end- (9%), 2-O- (13%), and 3-O-subst. Rhap (7%), nonreducing end- (11%), 2-O- (10%), 3-O- (14%), and 2,6-di-O-subst. Manp units (13%). Mild reductive beta-elimination of RMP-Sp gave alpha-l-Rhap-(1-->2)-alpha-l-Rhap-(1-->3)-alpha-l-Rhap-(1-->3)-alpha-d-Manp-(1-->2)-d-Man-ol, with Man-ol substituted at O-6 with beta-d-Galp units, a related pentasaccharide lacking beta-d-Galp units, and beta-d-Galp-(1-->6)-[alpha-d-Manp-(1-->2)]-d-Man-ol in a 16:3:1w/w ratio. Traces of Man-ol and Rha-ol were detected. ESI-MS showed HexHex-ol and Hex(3-6)Hex-ol components. Three rhamnosyl units were peeled off successively from the penta- and hexasaccharide by ESI-MS-MS. The carbohydrate epitopes of RMP-Sp differ from those of the glycoprotein of Pseudallescheria boydii, a related opportunistic pathogen.

Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure

OBJECTIVE

Vacuum-assisted wound closure (VAC) exposes the wound bed to negative pressure, resulting in removal of edema fluid, improvement of blood supply, and stimulation of cellular proliferation of reparative granulation tissue. It has been used to treat open wounds in the extremities, open sternal wounds, pressure ulcers, and abdominal wall wounds. This study retrospectively reviewed instrumented spine fusions complicated by surgical wound infection and managed by a protocol including the use of VAC in order to evaluate the efficacy of applying vacuum therapy on patients with deep spine infections and exposed instrumentation.

METHODS

Twenty consecutive patients with deep wound infections after undergoing spinal fusion procedures were studied. There were 12 men and 8 women with an average age of 55 years (31-81 years). Eight patients had undergone concomitant anterior and posterior arthrodesis, nine patients had a posterior spinal fusion, and three patients had a transforaminal lumbar interbody fusion. Seven patients had a decompression with exposed dura. Sixteen patients presented with a draining wound within the first 6 weeks postoperatively (average 24 days). There were four patients who presented with back pain and temperature after 1 year postoperatively (average 3 years). All patients were taken to the operating room for irrigation and debridement followed by placement of the VAC with subsequent delayed closure of the wound.

RESULTS

There was an average of 1.8 (1-8) irrigation and debridement procedures prior to placement of the VAC. Once the VAC was initiated, there was an average of 2.2 (2-3) procedures until and including closure of the wound. The wound was closed an average of 7 days (5-14 days) after the placement of the initial VAC in the wound. All patients tolerated the VAC without adverse effects. All patients were kept on a 6-week course of intravenous antibiotic therapy. The average follow-up was 10 months (6-24 months). There were no cases of uncontrolled sepsis once the VAC was initiated. All patients achieved a clean closed wound without removal of instrumentation at a minimum follow-up of 6 months.

CONCLUSION

VAC therapy is an effective adjunct in closing complex deep spinal wounds with exposed instrumentation.

Supernumerary ring chromosome 20 in a mother and her child

The authors report a familial case of mosaicism for an extra ring 20, identified by fluorescence in situ hybridization (FISH), in a mother and her child. In spite of the fact that both patients had clinical abnormalities, the more severe phenotype present in the child was probably due to the higher percentage of abnormal cells. To our knowledge, this is the first report of a familial extra ring 20 mosaicism.

Pre-transplant prognostic factors for patients with high-risk leukemia undergoing an unrelated cord blood transplantation

From July 1995 to December 2001, 42 patients with leukemia aged 1-42 years underwent cord blood transplant (CBT) from unrelated, < or = 2 antigen HLA mismatched donors. In all, 26 patients were in < or = 2nd complete remission and 16 in more advanced phase. Conditioning regimens, graft-versus-host disease (GVHD) prophylaxis and supportive policy were uniform for all patients. The cumulative incidence of engraftment was 90% (95% CI: 0.78-0.91). The cumulative incidence of III-IV grade acute- and chronic-GVHD was 9% (95% CI: 0.04-0.24) and 35% (95% CI: 0.21-0.60), respectively. The 4-year cumulative incidence of transplant-related mortality (TRM) and relapse was 28% (95% CI: 0.17-0.47) and 25% (95% CI: 0.14-0.45), respectively. The 4-year overall survival (OS), leukemia-free survival (LFS) and event-free survival (EFS) were 45% (95% CI: 0.27-0.63), 47% (95% CI: 0.30-0.64) and 46% (95% CI: 0.30-0.62), respectively. In multivariate analysis, the most important factor affecting outcomes was the CFU-GM dose, associated with CMV serology (P=0.003 and 0.04, respectively) in influencing OS and with patient sex (P=0.008 and 0.03, respectively) in influencing LFS. Finally, CFU-GM dose was the only factor that affected EFS significantly (P=0.02). In conclusion, the infused cell dose expressed as in vitro progenitor cell growth is highly predictive of outcomes after an unrelated CBT and should be considered the main parameter in selecting cord blood units for transplant.

A molecular phylogeographic study based on DNA sequences from individual metacercariae of Paragonimus mexicanus from Guatemala and Ecuador

A molecular phylogeographic study of Paragonimus mexicanus collected from Guatemala and Ecuador was performed. Genomic DNA was extracted from individual metacercariae, and two gene regions (partial mitochondrial cytochrome c oxidase subunit 1 (CO1) and the second internal transcribed spacer of the nuclear ribosomal gene repeat (ITS2)) were amplified by the polymerase chain reaction (PCR). Sequences segregated in a phylogenetic tree according to their geographic origins. ITS2 sequences from Ecuador and Guatemala differed at only one site. Pairwise distances among CO1 sequences within a country were always lower than between countries. Nevertheless, genetic distances between countries were less than between geographical forms of P. westermani that have been suggested to be distinct species. This result suggests that populations from Guatemala and Ecuador are genetically differentiated perhaps at the level of subspecies.

Ergonomics, gerontechnology, and design for the home-environment

An ergonomic approach could improve the quality of life and activities in daily living. Gerontechnology reduces the effects of age-related impairments with technological devices and particular design for the home-environment. Physiological decline with increasing age renders the daily activities at home more difficult. This paper highlights some "common sense" and specific design suggestions in the entrance and kitchen, aimed to increase the self-sufficiency of elderly people. We suggest that gerontechnology may have a particular role in the improvement of comfort and safety for aged people.

Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management

The authors reviewed 817 instrumented lumbosacral fusions in adults and found an incidence of 3.2% deep wound infections. The primary focus of this study was the management of these infections, with particular attention to whether the implants needed to be removed. A consulting infectious disease specialist indicated that an acute infection of a low back fusion wound could not be healed without removal of the metallic implants. This opinion was in contrast to the authors' daily experience and prompted this study. The authors identified and reviewed 817 cases of instrumented posterior lumbosacral arthrodeses in adults. A detailed analysis of any case with a deep wound infection was performed and yielded and infection rate of 3.2% (26 patients). Of these, 24 achieved a clean, closed wound without removal of instrumentation through a protocol of aggressive debridement and secondary closure. Instrumentation removal is not necessary to obtain a clean, closed wound using an aggressive approach with early diagnosis, vigorous debridement in the operative room under general anesthesia, delayed primary or secondary closure, and appropriate antibiotic coverage.

Complications associated with pedicle screws

BACKGROUND

The safety and the effectiveness of pedicle-screw instrumentation in the spine have been questioned despite its use worldwide to enhance stabilization of the spine. This review was performed to answer questions about the technique of insertion and the nature and etiology of complications directly attributable to the screws.

METHODS

We performed a retrospective review of all of the pedicle-screw procedures that were done by us from January 1, 1984, to December 31, 1993. We inserted 4790 screws during 915 operative procedures on 875 patients; 668 (76.3 percent) of the patients had a lumbosacral arthrodesis. The mean duration of follow-up was three years (range, two to five years). The accuracy of screw placement was assessed on intraoperative, immediate postoperative, and follow-up radiographs with use of a technique that was developed by one of us (F. D.); this technique has yet to be validated to determine the prevalence of various types of error.

RESULTS

Of the 4790 screws, 4548 (94.9 percent) had been inserted within the pedicle and the vertebral body. One hundred and thirty-four (2.8 percent) of the screws had perforated the anterior cortex, and this was the most common type of perforation. One hundred and fifteen (2.4 percent) of the screws were associated with complications that could be ascribed to the use of pedicle screws. The most common problem was late-onset discomfort or pain related to a pseudarthrosis or perhaps to the screws; this problem was associated with 1102 (23.0 percent) of the screws, used in 222 (24.3 percent) of the procedures. The symptoms necessitated removal of the instrumentation with or without repair of the pseudarthrosis. A pseudarthrosis was found during forty-six (20.7 percent) of the 222 procedures. Irritation of a nerve root occurred after nine procedures (1.0 percent) and was caused by eleven screws (0.2 percent); it was more commonly caused by medially placed screws. Three patients had residual neurological weakness despite removal of the screws. Twenty-five screws (0.5 percent), used in twenty procedures (2.2 percent), broke. The screws that broke were of an early design. A pseudarthrosis was found in thirteen of twenty patients who had broken screws. Sixteen of the twenty patients had an exploration; three of them were found to have a solid fusion, and thirteen were found to have a pseudarthrosis. The remaining four patients had evidence of a solid fusion on radiographs and had no pain.

CONCLUSIONS

There are few problems associated with the insertion of screws, provided that the surgeon is experienced and adheres to the principles and details of the operative technique. Our review revealed a low rate of postoperative complications related to pedicle screws. The problem of late-onset pain may be related to the implants or to the stiffness of the construct; however, it is difficult to accurately identify its exact etiology.

Follicle cell proteasome activity and acid extract from the egg vitelline coat prompt the onset of self-sterility in Ciona intestinalis oocytes

In the hermaphrodite ascidian Ciona intestinalis, the egg vitelline coat (VC) controls gamete self-nonself discrimination. Oocytes, after germinal vesicle breakdown, can be fertilized by both self and nonself sperm. However, a barrier to fertilization by self sperm progressively develops in the VC in the 3 hours after germinal vesicle breakdown. During this period, follicle cells attached to the outer surface of the VC release self-sterility factors that bind to the VC. Within the follicle cells, these factors (possibly peptides) are thought to be shuttled to the cell membrane by an hsp70 homolog (Cihsp70). In fact, antibodies to hsp70 block the development of self-sterility. Proteasomes are central to the production of antigen peptides. Specific inhibition of proteasome activity with clasto-lactacystin beta-lactone (CLbetaL) prevented the onset of self-sterility, but had no effect once this process had started. CLbetaL did not block fertilization by nonself sperm. The self-sterility factors were removed from mature oocytes by exposure to acidified media, and their biological activity was transferred to immature oocytes treated with CLbetaL. The obvious high multiplicity of self-nonself recognition alleles involved in fertilization, and the involvement of an hsp70 and a proteasome in processing self-sterility factors, suggests that this system may be evolutionarily related to the vertebrate immune system.

Plasma membrane association and preliminary characterization of Drosophila sperm surface glycosidases

Previous studies have identified beta-N-acetylglucosaminidase (GlcNAc'ase) and (alpha-mannosidase activities on the Drosophila melanogaster sperm surface which may have a role in fertilization. The aim of this study was to investigate their linkage to the sperm plasma membrane. We verified that glycosidases are not peripherally adsorbed to the cell surface by evaluating their resistance to release by KI, by buffered salt solutions of high ionic strength or alkaline buffers. Glycosidases were released from the sperm surface by detergents and, only to a minor extent, by mild proteolysis. Differential detergent solubilization pointed out that Triton X-114 was the most effective releasing agent for GlcNAc'ase and CHAPS for mannosidase. No activity was released from the membrane by a phosphatidylinositol-specific phospholipase C (PI-PLC). The released forms were quite hydrophilic in phase separation experiments with Triton X-114. This finding indicates the presence of a hydrophobic domain limited to a single transmembrane helix or/and the presence of an extensive glycosylation. The use of a Con-A binding assay demonstrated that both the enzymes are glycosylated. The molecular weight of the released glycosidases estimated by gel filtration was 158 kDa for GlcNAc'ase and 317 kDa for mannosidase. These results suggest that Drosophila melanogaster GlcNAc'ase and mannosidase are mannosylated integral membrane proteins that would function as exoenzymes with their active sites accessible in the extracellular space.

Identification and developmental expression of Ci-isl, a homologue of vertebrate islet genes, in the ascidian Ciona intestinalis

Here we describe the cloning and expression pattern of Ci-isl, a homologue of vertebrate genes, in the ascidian. Early in development, Ci-isl expression occurs in the primordia of palps and brain vesicle, then in the tailbud embryo it is transiently extended to the notochord cells. At larva stage, the expression is down-regulated in the notochord, and it persists predominantly in the compartments of the nervous system. These observations indicate that also in invertebrates, islet genes show an expression pattern during differentiation of the nervous system.

Prenatal diagnosis of mosaicism for tetrasomy 18p: cytogenetic, fish and morphological findings

A case of mosaicism for tetrasomy 18p detected prenatally is reported. We believe this is the second case where fetal anomalies were found at autopsy.

Participation of sperm proteasome in fertilization of the phlebobranch ascidian Ciona intestinalis

Sperm proteasomes are thought to be involved in sperm binding to and in sperm penetration through the vitelline coat of the eggs of the stolidobranch ascidian Halocynthia roretzi. However, it is not known whether they are involved in the fertilization of eggs of other ascidians. Therefore, we investigated whether sperm proteasomes are also involved in the fertilization of the eggs of the primitive phlebobranch ascidian Ciona intestinalis. Fertilization of the eggs of C. intestinalis was potently inhibited by the proteasome inhibitors MG115 and MG132 but not by the cysteine protease inhibitor E-64-d. On the other hand, neither fertilization of the vitelline coat-free eggs nor sperm binding to the vitelline coat was inhibited by the two proteasome inhibitors at a concentration sufficient to inhibit fertilization of intact eggs. These results indicate that the proteasome plays an essential role in sperm penetration through the vitelline coat rather than in sperm binding to the coat or in sperm-egg membrane fusion. The proteasome activity, which was detected in the sperm extract using Suc-Leu-Leu-Val-Tyr-MCA as a substrate, was strongly inhibited by both MG115 and MG132, and was weakly inhibited by chymostatin, whereas neither leupeptin nor E-64-d inhibited the activity. The molecular mass of the enzyme was estimated to be 600-kDa by Superose 12 gel filtration, and the activity in sperm extract was immunoprecipitated with an anti-proteasome antibody. These results indicate that the proteasome present in sperm of C. intestinalis is involved in fertilization, especially in the process of sperm penetration through the vitelline coat, probably functioning as a lysin.

The hsp70 protein is involved in the acquisition of gamete self-sterility in the ascidian Ciona intestinalis

In the hermaphrodite ascidian Ciona intestinalis, gamete self-incompatibility is a mechanism that prevents self-fertilization and is based on the ability of the oocyte vitelline coat to distinguish and accept only heterologous spermatozoa. The onset of self-sterility occurs during oogenesis and involves or is controlled by the follicle cells. Gamete self-nonself discrimination, a process that can be likened to an immune recognition event, represents a useful model with which to study the evolution of self-nonself recognition. Hsp70 genes, which belong to the major histocompatibility complex (MHC) class III, are supposedly ancestors of the MHC class I and II genes, and chaperonins are known to be involved in antigen processing and presentation. We have isolated and characterized an hsp70 gene (Cihsp70) that is constitutively expressed during oogenesis in the follicle cells of previtellogenic and vitellogenic oocytes. Using a polyclonal antibody against Cihsp70 protein, we demonstrate that the expression of Cihsp70 is required for the switch from self-fertility to self-sterility. The functional involvement of Cihsp70 in gamete self-nonself recognition provides evidence for an ancestral MHC-like system in protochordates.

Reduced visual acuity in elderly people: the role of ergonomics and gerontechnology

Gerontology is the scientific study of the ageing process and special problems of aged people. Ergonomics is an applied science for optimizing performance and productivity and reducing the risks of injury, discomfort and illness. Gerontechnology is concerned with fundamental and applied research on the complex interaction of elderly people with technological products and the built environment. It has the potential to improve the capability of people confronted by the challenges of ageing. We suggest that gerontechnology may have a particular role in relation to the reduction of visual acuity, and can improve the comfort and safety of older people.

Ergonomic approach in aging: experimental procedures to assess cognitive and balance impairments

This brief commentary is focused on the experimental procedures employed in the evaluation of both cognitive and balance impairments of aging patients. This is an important ergonomic issue that might be used for research purposes. In fact, the corrected assessment of impairments during aging may favor the development of new integrated ergonomic strategies to ameliorate ADL together with the reduction of environmental risks.

Fine needle aspiration and frozen section diagnosis in the management of thyroid nodules

Fine needle aspiration (FNA) is a valuable technique in the evaluation of thyroid nodules. A total of 182 FNAs of the thyroid performed at the Sultan Qaboos University Hospital were reevaluated and 153 were found to be adequate (84%). The cytological results of FNA were divided into neoplastic and non-neoplastic groups. Subsequent histology was obtained in 53 patients with an intraoperative frozen actions (FS) in 27 patients. Papillary carcinoma was found to be the most common, accounting for 70% of these cases with histological follow-up in the neoplastic group. The utility of performing FNA in all thyroid nodules and an intraoperative frozen section only in selected cases is discussed.

Catatonia LSD induced?

The case of a patient who developed catatonia one week following Lysergic Acid Diethylamide (LSD) ingestion is presented. The psychosis developed two days after the intake. The catatonic syndrome resolved dramatically following one treatment of electroconvulsive therapy (ECT). This is perhaps the first case report of catatonia following the use of LSD. The need for a diagnostic category of organic catatonia is highlighted.

Deep venous thrombosis and pulmonary embolism after major reconstructive operations on the spine. A prospective analysis of three hundred and seventeen patients

We performed a prospective study of 317 patients in order to determine the prevalence of deep venous thrombosis after reconstructive operations on the spine; 126 of the patients were examined with duplex ultrasound assessments of the lower extremities to ensure that no asymptomatic thrombi were being missed. Thigh-high stockings and sequential pneumatic compression of the lower extremities were used, in all patients, for prophylaxis against venous thrombosis. No antiplatelet agents or anticoagulant medications were administered. There was no evidence of thrombosis on any of the duplex ultrasound studies. Subsequently, venous thrombosis developed and was treated successfully in one of the 126 tested patients and in one of the 191 untested patients, and a fatal pulmonary embolus developed in one of the untested patients. The over-all clinical prevalence of thrombotic complications was 0.9 per cent (three complications in 317 patients). All three of the patients who had clinical evidence of thrombosis had had an anterior lumbar procedure because of a degenerative disorder or trauma; however, we could not prove that this approach or these diagnoses were significant risk factors for thrombosis (p < 0.05). While it is possible that some thrombi may have escaped both clinical and ultrasonic detection, such thrombi apparently were not enough of a danger to warrant the use of intensive prophylactic procedures that are associated with more risk. On the basis of this prospective study, therefore, we think that routine screening for the detection of asymptomatic thrombosis in patients who have had a procedure on the spine is unwarranted.

High-pressure injection injuries of the hand: review of 25 patients managed by open wound technique

This article reviews the outcome of injury of the hand in 25 patients treated at our institution by the open wound technique: wide débridement, drainage, open packing, and delayed closure. The results obtained are superior to those reported in the literature: Among the patients, 84% of the involved hands or fingers were salvaged, 64% had essentially normal hand function at the time of final follow-up, and 92% were able to return to their previous jobs. We propose that aggressive treatment by the open wound technique improves the outcome of high-pressure injection injuries of the hand.

Evidence that metalloendoproteases are involved in gamete fusion of Ciona intestinalis, ascidia

The use of specific inhibitors and substrates of metalloendoproteases provides evidence that in many systems these enzymes are involved in membrane fusion events. In this study, we investigated whether metalloendoproteases are involved in Ciona sperm-egg fusion. In vitro fertilization assays with the metal chelator 1,10-phenanthroline, specific metalloendoprotease substrates, and the vital stain Hoechst 33342 suggested that a Zn(2+)-dependent metalloendoprotease(s) takes part in Ciona sperm-egg fusion. Furthermore, electrophysiological recordings showed that insemination carried out in the presence of either 1,10-phenanthroline or the substrate CBZ-Gly-Phe-NH2 fails to induce fertilization potential or any other change in membrane potential. These results support the hypothesis that in Ciona intestinalis, a metalloendoprotease(s) is functional in gamete fusion.

Purification and characterization of a vitelline coat lysin from Ciona intestinalis spermatozoa

In Ciona intestinalis a chymotrypsin-like activity is involved in sperm penetration of the egg vitelline coat. A chymotrypsin-like enzyme has been purified from spermatozoa by a protocol including ion exchange chromatography, gel filtration, and native polyacrylamide gel electrophoresis. The purified enzyme resulted homogeneous when analyzed by SDS-PAGE. The molecular weight of the chymotrypsin-like enzyme was estimated to be 35 kDa by gel filtration and 24 KDa by SDS-PAGE in nonreducing conditions. The pH optimum of the enzyme is 8.4 and its activity is enhanced by Ca2+. It shows the highest activity towards the synthetic substrate Suc-Ala-Ala-Pro-Phe-AMC. Furthermore, by electron microscopy, the purified enzyme affects the structure of egg vitelline coat, and thus it fulfills one of the criteria of a lysin.

Two cases of listeriosis

This is the second report of listeriosis in Sri Lanke. It is a disease with a changing clinical pattern. Most cases are from people at the extremes of age and from people with an underlying malignancy of the lymphoproliferative and renal transplant patients. But it is now being increasingly reported in previously healthy people. The two cases presented here are from previously healthy children. Both of them also manifested a rash which helped in the detection of the second case. A rash has not been described in the literature as characteristic or a common feature other than in neo-natal listeriosis.

Gamete self-discrimination in ascidians: a role for the follicle cells

Gamete self-incompatibility in the hermaphrodite tunicate Ciona intestinalis is a useful system with which to study self-nonself recognition. We have used in vitro fertilization of oocytes isolated from the gonad of Ciona intestinalis to identify the cellular source of self-sterility elements present on the egg envelopes. Here we show for the first time that self-discrimination, which occurs on the egg vitelline coat, is established there in late oogenesis and is contributed or controlled by products of the overlying follicle cells. The acquisition of self-sterility by the oocyte is prevented by the ionophore monensin, which suggests that the follicle cell self-sterility controlling factor is a glycoprotein.

Chymotrypsin-like enzymes are involved in sperm penetration through the vitelline coat of Ciona intestinalis egg

In Ciona intestinalis, sperm penetration through the egg vitelline coat is an essential event of fertilization. We investigated whether trypsin- and chymotrypsin-like enzymes are involved in this event. Inhibitors and peptide substrates for chymotrypsin-like enzymes blocked the overall process of fertilization in a concentration-dependent manner. The inhibitory activity was specifically exerted on the step of sperm penetration. Chymotrypsin-like protease activity was identified in spermatozoa with the fluorogenic synthetic substrate Suc-Ala-Ala-Phe-AMC, which was the most effective substrate in blocking sperm penetration. These data indicate that a chymotrypsin-like protease activity is a sperm lysin of Ciona intestinalis.

Microbiological agents associated with childhood diarrhoea in the dry zone of Sri Lanka

Between March and July, 1987, faecal specimens from 371 diarrhoeal children reporting to four hospitals in the district of Kurunegala, Sri Lanka and from 121 controls with other diseases were investigated for enteric pathogens. All specimens were tested for Shigella spp, Salmonella spp and enteropathogenic Escherichia coli (EPEC). In addition, parasitic pathogens, heat labile enterotoxigenic Escherichia coli (ETEC LT), Campylobacter and rotavirus were sought among subsamples of the cases and controls. One or more pathogens were detected in the faecal specimens of 53.7% of the diarrhoeal children and 19.6% of the controls (P less than 0.001). Rotavirus was the most frequently identified pathogen. Cases (21.9%) were more likely to be positive for rotavirus than controls (6.5%) (p less than 0.05). Among children with diarrhoea the peak prevalence of rotavirus occurred in the 6-11 months age group. Shigella spp were the second most frequently isolated pathogens and the single most common cause of diarrhoea in children over two years of age. Again, cases (16.4%) were more likely to be infected than controls (1.7%) (p less than 0.001). Salmonella spp were isolated from 7.5% of diarrhoeal children and 3.3% of the controls (p greater than 0.10). Other pathogens had prevalence rates of less than 5%. Vomiting was associated with rotavirus diarrhoea (p less than 0.001), and fever with shigellosis (p = 0.02). In view of the different transmission routes and characteristics of the most important pathogens detected in this study it appears unlikely that a single environmental intervention can solve the public health problem posed by diarrhoeal diseases in Sri Lanka.

Features of Turner's and DiGeorge's syndromes in a child with an X;22 translocation

We describe the clinical and cytogenetic findings in an infant who presented with the features of both Turner's and DiGeorge's syndromes associated with a unique translocation between chromosomes X and 22.

Magnetic resonance imaging in early diagnosis of Legg-Calvé-Perthes disease

Two male patients, aged 6 and 9 years, were suspected of having unilateral Perthes disease because of typical symptoms and clinical signs. Roentgenograms, including scintigraphy, were normal. Magnetic resonance imaging (MRI) showed definite avascular necrosis in the affected hip. Roentgenograms subsequently also became positive for Perthes disease. These two cases document the advantages of MRI in early diagnosis of Perthes disease prior to development of typical radiologic changes.

Age-related changes in composition and Ca2+-binding capacity of canine cortical bone extracts

The variable of age was used to study macromolecules in bone that may mediate in part the in vivo readily exchangeable calcium-binding capacity (VCa2+D). Organic components were extracted from nonmineralized bone with 4 M guanidine-HCl and from both nonmineralized and mineralized bone with 0.1 M EDTA. The composition of pup bone extracts demonstrated an enrichment in protein, hexuronate, sialic acid, organic phosphorus, and bound sulfate when compared with other age groups. In vitro calcium-binding studies identified low-affinity (Kd congruent to 10(-3) M) sites in both types of extracts; high-affinity sites (Kd congruent to 10(-5) M) were only evident in EDTA extracts of bone. Readily exchangeable calcium-binding capacity in vivo was found to decrease from pup (40.7 mM) to adolescent (11.1 mM) to the mature/old groups (2.6/1.2 mM); however, a large difference in low-affinity site number was only observed between pup and adolescent bone extracts. The overall organic composition of EDTA and guanidine-HCl extracts generally reflected the composition of total bone, which dropped dramatically on a dry weight basis from pup to adolescent groups. A similar pattern was observed with the number of low-affinity binding sites measured in vitro. In vitro binding data indicate that nonmineralized matrix of pup bone, extractable by 4 M guanidine-HCl, possesses enough capacity to accommodate approximately 40% of the readily exchangeable pool. As age progresses, other components of the blood-bone exchange process, such as vascularity, may reduce the readily exchangeable calcium pool size below the amount of low-affinity sites measured in vitro.