The small heat shock proteins αB-crystallin and Hsp27 suppress SOD1 aggregation in vitro

Amyotrophic lateral sclerosis is a devastating neurodegenerative disease. The mechanism that underlies amyotrophic lateral sclerosis (ALS) pathology remains unclear, but protein inclusions are associated with all forms of the disease. Apart from pathogenic proteins, such as TDP-43 and SOD1, other proteins are associated with ALS inclusions including small heat shock proteins. However, whether small heat shock proteins have a direct effect on SOD1 aggregation remains unknown. In this study, we have examined the ability of small heat shock proteins αB-crystallin and Hsp27 to inhibit the aggregation of SOD1 in vitro. We show that these chaperone proteins suppress the increase in thioflavin T fluorescence associated with SOD1 aggregation, primarily through inhibiting aggregate growth, not the lag phase in which nuclei are formed. αB-crystallin forms high molecular mass complexes with SOD1 and binds directly to SOD1 aggregates. Our data are consistent with an overload of proteostasis systems being associated with pathology in ALS.

Extracellular aggregated Cu/Zn superoxide dismutase activates microglia to give a cytotoxic phenotype

A large body of literature suggests that amyotrophic lateral sclerosis (ALS) pathology is intimately linked with neuroinflammation, specifically activation and recruitment of microglia and astrocytes. The actual cause of gliosis is unclear. Extracellular Cu/Zn superoxide dismutase (SOD1) has recently been shown to activate microglia in a CD14 dependant mechanism providing one potential pathway by which glial cells become activated. As protein inclusions are thought to be an important part of ALS pathology and are associated with all forms of ALS, we sought to determine if aggregated SOD1 would activate microglia. Recombinant SOD1 was aggregated and this, or monomeric forms of SOD1 were then added to EOC.13 microglial cells or primary microglial cells in culture. Although monomeric mutant SOD1 has been shown to promote microglial activation in the past, we found that aggregated SOD1 was able to much more efficiently activate microglia in culture when compared with the unaggregated form of mutant SOD1. In addition to CD14 dependant pathways, aggregated SOD1 also bound to the surface of glial cells and was internalized in a lipid raft and scavenger receptor dependent manner. We have for the first time shown that aggregated mutant SOD1 potently activates microglia. These results suggest that there may be a potential link between protein aggregation and microglial activation in ALS.

Deep brain stimulation in ireland for Parkinson's disease and essential tremor

Deep brain stimulation (DBS) is highly effective neurosurgery for idiopathic Parkinson's disease (IPD), essential tremor (ET) and primary dystonia. DBS involves stereotactic surgical implantation of a battery-operated stimulator into deep brain nuclei. Irish patients are referred abroad for DBS and have to travel repeatedly for pre and post-operative care resulting in stress, anxiety and hardship. Safe pre and post-operative care of these complex, ageing patients is compromised by the absence of a DBS service in Ireland. Moreover, both DBS surgery and the subsequent post-operative care abroad incurs substantial cost to the state. The Dublin Neurological Institute at the Mater Misericordiae University Hospital (DNI) is a non-profit institute for the care of patients with neurological diseases. The DNI developed, in collaboration with the Mater Private Hospital (MPH) and the Walton Centre, Liverpool, a DBS programme in 2008/2009. We performed DBS at the Mater Campus on three carefully selected patients from a cohort of movement disorder patients attending the DNI and continue to provide pre-operative assessment and post operative care for patients following DBS in Ireland and abroad.

A rare event sampling method for diffusion Monte Carlo using smart darting

We identify a set of multidimensional potential energy surfaces sufficiently complex to cause both the classical parallel tempering and the guided or unguided diffusion Monte Carlo methods to converge too inefficiently for practical applications. The mathematical model is constructed as a linear combination of decoupled Double Wells [(DDW)(n)]. We show that the set (DDW)(n) provides a serious test for new methods aimed at addressing rare event sampling in stochastic simulations. Unlike the typical numerical tests used in these cases, the thermodynamics and the quantum dynamics for (DDW)(n) can be solved deterministically. We use the potential energy set (DDW)(n) to explore and identify methods that can enhance the diffusion Monte Carlo algorithm. We demonstrate that the smart darting method succeeds at reducing quasiergodicity for n ≫ 100 using just 1 × 10(6) moves in classical simulations (DDW)(n). Finally, we prove that smart darting, when incorporated into the regular or the guided diffusion Monte Carlo algorithm, drastically improves its convergence. The new method promises to significantly extend the range of systems computationally tractable by the diffusion Monte Carlo algorithm.

Environmental Applications of Xanes: Speciation of Tc In Cement After Chemical Treatment and Se After Bacterial Uptake

XANES (X-ray Absorption Near Edge Spectroscopy) has been employed to evaluate the efficacy of a process designed to encapsulate and reduce TcO4-in cement matrices, thereby immobilizing Tc. The oxidation state of Se following bioremediation of Se by bacteria has also been determined by XANES. The XANES measurements were performed at the Stanford Synchrotron Radiation Laboratory (SSRL) and the National Synchrotron Light Source (NSLS) at the respective K edges of Tc (21.0 keV) and Se (12.7 keV). Comparison of the XANES spectra of Tc in untreated cement to Tc in slag treated cement and to the chemical shifts of reference materials, shows that the oxidation state of Tc is the same in both cements. Thus, the addition of a reducing agent to the cement formulation does not significantly reduce the TcO4-. The common soil bacterium,Bacillus subtilis, is known to incorporate Se on or within the cell wall when exposed to a Se(IV) solution. The Se XANES spectra ofB. subtilis, as well as bacillus isolated from selenium rich soil, show that the organisms reduce selenite to the red allotrope of elemental Se.

Exploring the needs and expectations of women presenting for hysterosalpingogram examination following a period of subfertility: a qualitative study

AIMS

This study examines women's experience of healthcare following the referral for hysterosalpingography (HSG) after a period of subfertility. These otherwise fit and healthy women enter the healthcare system and their only problem is a failure to become pregnant. They find themselves trying to negotiate a system designed for sick people. Previous research in this field consists mainly of studies comparing HSG to other diagnostic studies. The study aims to address the underlying issues that women have at the start of their subfertility investigations.

METHODS

This qualitative study uses grounded theory methodology. Interviews with women were undertaken immediately prior to their HSG examination. Ten women were interviewed using 12 core questions. Each woman had a diagnosis of primary subfertility. Each was asked how they were coping with the uncertainty of their fertility. They were asked about their expectations of the HSG examination, the importance of HSG and what methods were available to them to reduce any anxiety experienced. Data analysis was undertaken after each interview.

RESULTS

Presently, HSG is seen by healthcare providers as a routine outpatient examination at the start of subfertility investigations. In contrast to this, it was discovered at interview that HSG was seen by the women as a defining moment that would signpost their future treatment options to become pregnant. Women reported receiving little support from health care providers, and that written information given did not fulfil all of their needs. Often written information alone heightened anxiety, and this written information needs to be tailored to a specific set of circumstances. The literature review noted that anxiety can lead to mental health issues, but that properly focused, correctly given, timely information can reduce anxiety.

CONCLUSIONS

The implications of the findings are that if anxiety relating to treatment at this early stage can be managed effectively, it could minimise the possible physical and emotional trauma to the woman as her subfertility journey continues, thus at the same time preventing future anxiety related illness.

Length of stay in an Australian stroke rehabilitation unit: a pilot study

Aims

Length of stay (LOS) is an important consideration in rehabilitation, and it can be adversely affected by delayed discharge. The purpose of this prospective study was to document LOS, frequency of discharge delay, reasons for discharge delay and its impact on LOS.

Methods

Ninety-eight inpatients in a stroke rehabilitation unit were included in the study.

Findings

Sixty (61%) patients had a LOS that exceeded the Australasian Rehabilitation Outcomes Centre (AROC) benchmark LOS according to the Australian National Sub-acute and Non-acute Patient classification system. Twenty-five (26%) patients had delayed discharge resulting in a total delay of 886 days, with most of these related to delays in the provision of community services. When patients with discharge delay were factored out of analyses, LOS was still longer than AROC benchmark figures for 39 (57%) of the 69 patients without discharge delay.

Conclusions

The LOSs of the majority of patients included in this study were longer than the AROC benchmark figures, even when patients with discharge delay were factored out. Initiatives to address this problem include the implementation of a proactive computerized tool that will provide target LOSs and enable reasons for excessive LOS to be more closely examined.

Expansion of the Spectrum of FLNA Mutations Associated with Melnick-Needles Syndrome

Melnick-Needles syndrome (MNS) is a rare X-linked bone dysplasia characterised by facial dysmorphology and radiographic abnormalities [Melnick and Needles, 1966;97:39-48]. Previously, all published cases of MNS were associated with only 4 mutations [Robertson et al., 2003;33:487-491; Santos et al., 2010;152A:726-731], all localised within exon 22 of FLNA, the gene encoding the cytoskeletal protein filamin A. Here we report 3 new mutations in FLNA that are associated with MNS. One affected member of the first family with the mutation p.Y1229S presented with a stroke while this patient's daughter, previously known to be affected from a young age, developed multiple sclerosis. A second unrelated patient with a typical phenotype is shown to have the mutation c.1054G>T (p.G352W) within exon 7 of FLNA. A third individual with an atypical presentation but radiological findings very similar to those seen in classic MNS has a deletion likely to affect residues within repeat domain 14. These findings indicate that the mutational spectrum for MNS is wider than previously appreciated and has implications for genetic testing strategies employed to confirm a diagnosis of this rare disorder.

Alterations in corticostriatal synaptic plasticity in mice overexpressing human alpha-synuclein

Most forms of Parkinson's disease (PD) are sporadic in nature, but some have genetic causes as first described for the alpha-synuclein gene. The alpha-synuclein protein also accumulates as insoluble aggregates in Lewy bodies in sporadic PD as well as in most inherited forms of PD. The focus of the present study is the modulation of synaptic plasticity in the corticostriatal pathway of transgenic (Tg) mice that overexpress the human alpha-synuclein protein throughout the brain (ASOTg). Paired-pulse facilitation was detected in vitro by activation of corticostriatal afferents in ASOTg mice, consistent with a presynaptic effect of elevated human alpha-synuclein. However basal synaptic transmission was unchanged in ASOTg, suggesting that human alpha-synuclein could impact paired-pulse facilitation via a presynaptic mechanism not directly related to the probability of neurotransmitter release. Mice lacking alpha-synuclein or those expressing normal and A53T human alpha-synuclein in tyrosine hydroxylase-containing neurons showed, instead, paired-pulse depression. High-frequency stimulation induced a presynaptic form of long-term depression solely in ASOTg striatum. A presynaptic, N-methyl-d-aspartate receptor-independent form of chemical long-term potentiation induced by forskolin (FSK) was enhanced in ASOTg striatum, while FSK-induced cAMP levels were reduced in ASOTg synaptoneurosome fractions. Overall the results suggest that elevated human alpha-synuclein alters presynaptic plasticity in the corticostriatal pathway, possibly reflecting a reduction in glutamate at corticostriatal synapses by modulation of adenylyl cyclase signaling pathways. ASOTg mice may recapitulate an early stage in PD during which overexpressed alpha-synuclein dampens corticostriatal synaptic transmission and reduces movement.

Incentive spirometry decreases respiratory complications following major abdominal surgery

Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery. Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery. Exercises aimed at maximising inspiratory effort are the most beneficial for the patients. The incentive spirometer is a handheld device that patients use to achieve effective inspiration. In a nonrandomised pilot study of 263 patients we have found that the addition of the incentive spirometer, as part of an intensive post-operative physiotherapy programme, decreased the occurrence of pulmonary complications (6 vs 17%, p = 0.01) and length of stay on the surgical high dependency unit (3.1 vs 4 days p = 0.03). The two groups were comparable when age, sex, smoking history, the need for emergency surgery and post-operative analgesia were compared.

Screening for social difficulties in cancer patients: clinical utility of the Social Difficulties Inventory

Guidelines for psychosocial support have been developed, but there are no standard approaches in routine oncology practice to identify patients experiencing social difficulties. We have designed and evaluated a Social Difficulties Inventory (SDI) to identify patients requiring further assessment and, where appropriate, referral to support services. The purpose of this study was to develop a clinically meaningful SDI scoring system with guidance for oncology staff. Out of 189 patients, 183 completed the SDI and were interviewed by a social work researcher who scored the SDI independently. Comparison of patient/interviewer assessment was good (intraclass correlation 0.61, 95% confidence interval: 0.51, 0.70). Using top 10% of interviewer social distress (SD) scores to indicate 'SD case', the best 'cut-point' was a patient score of > or =10 (sensitivity=0.80; specificity=0.76; 56 out of 183 'cases'). Out of 127 patients, 72 with SD score <10 had individual SDI item rated at a higher level. Following interview, 32 patients were referred to specialist services, 46 given information and 112 had no action taken. An interpretation algorithm developed includes SD score, individual SDI item rating, and an additional general question, illustrated using four case scenarios. In conclusion, general guidance for interpreting the SDI has been developed to enhance health-care professional/patient consultations with a view to identifying patients who may benefit from support, advice or intervention.

A role for iron in Wnt signalling

There is an emerging body of evidence implicating iron in carcinogenesis and in particular colorectal cancer, but whether this involves Wnt signalling, a major oncogenic signalling pathway has not been studied. We aimed to determine the effect of iron loading on Wnt signalling using mutant APC (Caco-2 and SW480) and wild-type APC (HEK-293 and human primary fibroblasts) containing cell lines. Elevating cellular iron levels in Caco-2 and SW480 cells caused increased Wnt signalling as indicated by increased TOPFLASH reporter activity, increased mRNA expression of two known targets, c-myc and Nkd1, and increased cellular proliferation. In contrast wild-type APC and beta-catenin-containing lines, HEK 293 and human primary fibroblasts were not responsive to iron loading. This was verified in SW480 cells that no longer induced iron-mediated Wnt signalling when transfected with wild-type APC. The cell line LS174T, wild type for APC but mutant for beta-catenin, was also responsive suggesting that the role of iron is to regulate beta-catenin. Furthermore, we show that E-cadherin status has no influence on iron-mediated Wnt signalling. We thus speculate that excess iron could exacerbate tumorigenesis in the background of APC loss, a common finding in cancers.

What difference does a neurologist make in a general hospital? Estimating the impact of neurology consultations on in-patient care

BACKGROUND

To determine the impact of neurological consultations on the care of hospital in-patients and to ascertain patients' perceptions, referrals were prospectively recorded over a 6-month period. The neurology team's view and changes suggested to management were documented. All referred patients' notes were reviewed at 6 months and the impact of a neurology referral was determined.

RESULTS

Two hundred and fifty-four (254) referrals were seen. There was a significant change in diagnosis in 55%, and in management in nearly 70%. Neurological referral facilitated earlier discharge for 65% patients. Thirty-seven of 163 patients contacted at 6 months did not know they were seen by a neurologist. Of those who knew, 57% felt referral had aided in their diagnosis and 86% felt it had aided treatment.

CONCLUSIONS

Neurological consultations can make a significant difference to in-patient management. Early referral may lead to early discharge. Patient satisfaction was high but not without criticism.

Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass

BACKGROUND

Over the past 20 years, there has been an ongoing discussion about the importance of gastric pouch size as a key factor influencing weight loss after bariatric surgery. This analysis aimed to determine the relationship between initial gastric pouch size and excess weight loss (EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB).

METHODS

Between August 2002 and March 2005, 320 LRYGB were performed at Yale New Haven Hospital. The patients' demographics were entered into a longitudinal, prospective database. Upper gastrointestinal series were routinely performed on postoperative day 1. Pouch size was measured as area (cm2) on an anteroposterior radiograph at maximum pouch distention. Linear regression analysis was performed to determine the association between pouch size and weight loss at 6 and 12 months postoperatively. Adjustments were made for age, gender, and preoperative body mass index (BMI).

RESULTS

The mean age of the patients was 41.2 years. Of the 320 study patients, 261 were women (81.6%) and 59 were men (18.4%). The mean preoperative BMI was 51.1 kg/m2; the mean 6-month EWL was 50.5%; the mean 12-month EWL was 62.5%; and the mean pouch size was 63.9 cm2. A statistically significant, negative correlation between pouch size and EWL was found at 6 months (beta = -0.241; p < 0.01) and at 12 months (beta = -0.302; p < 0.02). The findings show that male gender (beta = 0.147; p < 0.04) and preoperative BMI (beta = 0.190; p < 0.01) are positively correlated with pouch size.

CONCLUSION

The analysis demonstrates that initial gastric pouch size is not the only significant component for successful weight loss after LRYGB. Male gender and increased preoperative BMI were identified as factors predicting pouch size. Efforts to standardize small pouch size for all patients seems important to the success of surgical therapy for morbid obesity.

Best evidence topic report. The relationship between post-traumatic stress disorder and affective disorder

A short-cut review was carried out to establish whether the presence of affective disorder in victims of assault alters the chances of developing post-traumatic stress disorder (PTSD). In all, 133 papers were found using the reported searches, of which 8 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that PTSD and affective disorder are related and often occur at the same time.

Hypotensive Resuscitation in Patients with Ruptured Abdominal Aortic Aneurysm

BACKGROUND

The technique of hypotensive resuscitation in haemorrhagic shock involves resuscitation to below normotensive blood pressures achieving the minimum perfusion pressure that will adequately perfuse vital organs until definitive arrest of haemorrhage.

AIM

To summarise the evidence for the use of hypotensive resuscitation in patients with uncontrolled haemorrhagic shock and ruptured abdominal aortic aneurysm (AAA).

METHODS

A MEDLINE (1966-2004) and Cochrane library search for articles relating to hypotensive resuscitation was undertaken; see text for further details.

RESULTS

Several animal studies exist using an abdominal aortotomy model of ruptured AAA. These have demonstrated improved tissue perfusion, decreased blood loss and improved survival associated with hypotensive resuscitation compared with aggressive resuscitation. There are several human studies advocating delayed rather than immediate resuscitation in trauma patients but careful review of the literature reveals no prospective studies of hypotensive resuscitation in patients with ruptured AAA.

CONCLUSIONS

Animal studies demonstrate superiority of hypotensive resuscitation over aggressive resuscitation but further research is required to assess its efficacy in patients with ruptured AAA.

Increased extensin levels in Arabidopsis affect inflorescence stem thickening and height

Extensins are hydroxyproline-rich glycoproteins which are abundant in the cell walls of higher plants and whose precise function has been the subject of much speculation. In order to investigate this, transgenic A. thaliana plants were generated containing the Arabidopsis Atext1 extensin coding sequence under the transcriptional control of the strong constitutive CaMV 35S promoter. Northern analysis and RT-PCR identified transgenics with high constitutive levels of Atext1 mRNA. Hydroxyproline assays confirmed that transgenic plants which over-expressed Atext1 contained high levels of hydroxyproline-rich protein. Phenotypic analysis of the transgenics showed that there were no significant phenotypic effects on the timing of different developmental stages or on the general form of the plant. However, transgenics with high extensin levels showed an enhanced increase in stem thickness, with an indirect effect on stem height. This effect, is, however, rather small, with a reduction in height of between 5-8% depending on the transgenic line being analysed.

Allosensitization in Patients Receiving Multiple Blood Transfusions

Extended antigen (C, E, K) matching decreased the incidence of alloantibody (alloAB) and autoantibody (autoAB) formation, in addition to eliminating transfusion reactions in the multiply transfused sickle cell disease patients. AlloAB formation possibly transforms the immune system into a hyperactive state leading to further and earlier alloAB and autoAB formation. However, additional CEK matching results in marked overuse of Rh-negative packed red blood cell (pRBC) units, 30 minutes' extra time of a skilled technologist, and 153 dollars extra CEK reagent cost per unit to find CEK-matched pRBCs for every transfusion for these multiply transfused patients.

A review of emergency equipment carried and procedures performed by UK front line paramedics on paediatric patients

OBJECTIVES

In 1997 a review of paramedic practice upon adult patients in the UK found many inconsistencies and deficiencies in basic care. A follow up review in 2002 identified widespread improvement in provision of equipment and skills to provide basic and advanced life support.Paediatric care was not assessed in either review. The authors conducted this study to identify current standards of care in paediatric paramedic practice and areas of potential improvement.

METHOD

A questionnaire designed to determine what equipment and skills were available to paramedics for the management of common or serious paediatric emergencies was sent to chief executives of the 32 NHS Ambulance Trusts in England and Wales.

RESULTS

The trend of expanding and standardising practice among adult patients has not extended to paediatric practice despite national guidelines from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). Furthermore there are some serious failings in the provision of care and skills. Many Trusts have not adopted JRCALC guidelines for the management of life threatening paediatric emergencies such as asthma, meningitis, and fluid replacement in hypovolaemia.

CONCLUSIONS

Ambulance Trusts not meeting standards set out in the JRCALC guidelines must address their areas of deficiency. Failure to do so endangers children's lives and leaves Trusts open to criticism.

The nasopharyngeal airway: dispelling myths and establishing the facts

The nasopharyngeal airway (NPA) is a simple airway adjunct used by various healthcare professionals. It has some advantages over the oropharyngeal airway (OPA) but despite this it appears to be used less frequently. This may be due to fears over intracranial placement in cases of possible basal skull fracture. This fear, promulgated by training, is based solely on two single case reports and relative risk needs to be put into clinical context. Widely taught methods of sizing NPAs are based upon the width of the patient's nostril or little finger, MRI data demonstrate that these methods are inaccurate. Ideal NPA length measured at nasal endoscopy correlates with subject height, this is independent of subject sex, and is a far more accurate determinant and easy to use in the clinical setting. Average height females require a Portex size 6 NPA and average height males a size 7 Portex NPA. This knowledge provides a rapid method of NPA selection.