Integrative multidisciplinary approaches by the Integrative Medicine Research Group (IMRG): a new frontier in cancer setting

This conference addresses the topic of integrative, multidisciplinary approaches to cancer settings according to evidence-based medicine. The multidisciplinary approach of the researchers involved characterizes this new and complex scenario. The Integrative Medicine Research Group (IMRG) has always been committed to the activities and dissemination of CAM in cancer patients, focusing on the safety and efficacy of these approaches. Thus, one of the main goals of IMRG is to demonstrate that CAM can support cancer patients during treatment and improve their quality of life and survival. In addition, IMRG's multidisciplinary network is ever vigilant in assessing the risks of interactions between cancer drugs and nutraceuticals. We hope that the integrative medicine approach can be transferred to the level of all chronic diseases, including oncology.

Adapted physical activity for breast cancer patients: shared considerations with two Olympic and world Italian sports champions

Breast cancer is a growing global public health concern. Thanks to the recent treatments progress, the survival rate of BC patients has significantly improved (88% of 5-year survival rate) and the number of cancer survivors has also increased. Notwithstanding these brilliant results, many BC patients have long-term side effects as pain, oedema, limited mobility, cancer related fatigue, etc. as a consequence of surgical, radiotherapy and medical treatments. For example, posture appears to be frequently altered after mastectomy, due to the impairment of the mobility of the arm caused by surgical scars. All these aspects negatively affect the health-related Quality of Life (QoL) of BC patients. Recent several randomized clinical trials have shown benefits of regular and appropriate physical activity (PA) during and after BC treatment, particularly in terms of benefits for health, reducing fatigue, improving strength levels, QoL and physical function. In this context, two types of sports have demonstrated their affinity and efficacy as treatment support during and after treatments for BC patients: fencing and rowing. Here we report considerations shared with two sport champions: the fencing Olympic gold medal Daniele Garozzo and the rowing World Champion Giovanni Ficarra, with the aim to find the adapted PA for BC patients.

Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future

Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a “female neurosurgery” and a “male neurosurgery” is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.

MALDI-MS profiling of serum O-glycosylation and N-glycosylation in COG5-CDG

Congenital disorders of glycosylation (CDG) are due to defective glycosylation of glycoconjugates. Conserved oligomeric Golgi (COG)-CDG are genetic diseases due to defects of the COG complex subunits 1-8 causing N-glycan and O-glycan processing abnormalities. In COG-CDG, isoelectric focusing separation of undersialylated glycoforms of serum transferrin and apolipoprotein C-III (apoC-III) allows to detect N-glycosylation and O-glycosylation defects, respectively. COG5-CDG (COG5 subunit deficiency) is a multisystem disease with dysmorphic features, intellectual disability of variable degree, seizures, acquired microcephaly, sensory defects and autistic behavior. We applied matrix-assisted laser desorption/ionization-MS for a high-throughput screening of differential serum O-glycoform and N-glycoform in five patients with COG5-CDG. When compared with age-matched controls, COG5-CDG showed a significant increase of apoC-III_0a (aglycosylated glycoform), whereas apoC-III₁ (mono-sialylated glycoform) decreased significantly. Serum N-glycome of COG5-CDG patients was characterized by the relative abundance of undersialylated and undergalactosylated biantennary and triantennary glycans as well as slight increase of high-mannose structures and hybrid glycans. Using advanced and well-established MS-based approaches, the present findings reveal novel aspects on O-glycan and N-glycan profiling in COG5-CDG patients, thus providing an increase of current knowledge on glycosylation defects caused by impairment of COG subunits, in support of clinical diagnosis. Copyright © 2017 John Wiley & Sons, Ltd.

Common peroneal nerve injuries in knee dislocations: results with one-stage nerve repair and tibialis posterior tendon transfer

We report our experience in the treatment of common peroneal nerve (CPN) palsy following knee dislocations: a twelve-year surgical series of 26 patients presenting with a traumatic injury of the lateral sciatic nerve and no spontaneous recovery is reviewed. From 1988 to 1991, we performed nerve surgery alone on 3 patients. Their results were highly disappointing and in none did we observe muscle recovery. Since 1991 nerve surgery was associated with a palliative procedure for 23 patients. Although at surgical exploration, severe nerve damage was found in 87% of these patients (thereby indicating the need for graft repair), the overall outcome was good, with a score of M3 on the BMRC scale in about 75% of the cases. These results suggest that the one-stage association of microsurgical nerve repair and tibialis posterior tendon transfer changed the destiny of these injuries.

The medial cord to musculocutaneous (MCMc) nerve transfer: a new method to reanimate elbow flexion after C5-C6-C7-(C8) avulsive injuries of the brachial plexus--technique and results

The aim of this paper is to report on our ample experience with the medial cord to musculocutaneous (MCMc) nerve transfer. The MCMc technique is a new type of neurotization which is able to reanimate the elbow flexion in multilevel avulsive injuries of the brachial plexus provided that at least the T1 root is intact. A series of 180 consecutive patients, divided into four classes according to the quality of hand function, is available for a long-term follow-up after brachial plexus surgery. The patients enrolled for the study have in common a brachial plexus palsy showing multiple cervical root avulsive injuries at two (C5-C6), three (C5-C6-C7) and four (C5-C6-C7-C8) levels. The reinnervation of the musculocutaneous nerve is obtained via an end-to-end transfer from two donor fascicles located in the medial cord. The selected fascicles are those directed principally to the flexor carpi radialis, ulnaris and, to a lesser degree, the flexor digitorum profundus. Under normal anatomic conditions, they are located in the medial cord, and their site corresponds to the inverted V-shaped bifurcation between the internal contribution of the median nerve and the ulnar nerve. The technique has no failure and no complications when the hand shows a normal wrist and finger flexion and a normal intrinsic function. In case of suboptimal conditions of the hand, the technique has proved technically more challenging, but still with 67% satisfactory results. In the four-root avulsive injuries, however, this method shows its limitations and an alternative strategy should be preferred when possible. EMG analysis shows a reinnervation in both the biceps and the brachialis muscles, explaining the high quality of the observed results. Moreover, this technique theoretically offers the possibility of a "second attempt" at a more distal level in case of failure of the first surgery. This procedure is quick, safe, extremely effective and easily feasible by an experienced plexus surgeon. The ideal candidate is a patient harbouring a C5-C6 avulsive injury of the upper brachial plexus with a normally functioning hand.

Identification of human tear fluid biomarkers in vernal keratoconjunctivitis using iTRAQ quantitative proteomics

BACKGROUND

Understanding and treating vernal keratoconjunctivitis (VKC) has been a challenge because the pathogenesis is unclear and antiallergic therapy often unsuccessful. The aim of the study was to analyze peptide profiles in human tears using mass spectrometry to elucidate compositional differences between healthy subjects and patients affected by VKC.

METHODS

Tears were collected from healthy subjects and VKC patients. Digested samples were treated with iTRAQ (isobaric tag for relative and absolute quantitation). Separation of tryptic peptides was realized using a MicroHPLC interfaced with a microfraction collector. MS and MS/MS mass spectra were performed using a MALDI TOF/TOF 4800 Applied Biosystem spectrometer. Protein Pilot™ software with Paragon™ algorithm v4.1.46 or GPS™ with Mascot engine was used as search engines with SwissProt or IPI human as the databases.

RESULTS

A significant number of peptides were examined, and 78 proteins were successfully identified. In all VKC samples, levels of serum albumin, transferrin, and hemopexin were found up to 100 times higher than control tear levels and correlated to the severity of disease. Hemopexin, transferrin, mammaglobin B, and secretoglobin 1D were found significantly over-expressed in VKC samples compared with the control samples. Tear samples from patients treated with topical cyclosporine or corticosteroids showed a dramatic reduction in these protein levels.

CONCLUSIONS

LC MALDI MS and isobaric tag for relative and absolute quantitation technique may be useful in the quantitative and qualitative characterization of the peptidoma of human tears. These techniques may identify target proteins to be used in the diagnosis and management of VKC and other inflammatory ocular surface conditions.

Bone Dysplasia as a Key Feature in Three Patients with a Novel Congenital Disorder of Glycosylation (CDG) Type II Due to a Deep Intronic Splice Mutation in TMEM165

Three patients belonging to two families presented with a psychomotor-dysmorphism syndrome including postnatal growth deficiency and major spondylo-, epi-, and metaphyseal skeletal involvement. Other features were muscular hypotrophy, fat excess, partial growth hormone deficiency, and, in two of the three patients, episodes of unexplained fever. Additional investigations showed mild to moderate increases of serum transaminases (particularly of aspartate transaminase (AST)), creatine kinase (CK), and lactate dehydrogenase (LDH), as well as decreased coagulation factors VIII, IX, XI, and protein C. Diagnostic work-up revealed a type 2 serum transferrin isoelectrofocusing (IEF) pattern and a cathodal shift on apolipoprotein C-III IEF pointing to a combined N- and O-glycosylation defect. Known glycosylation disorders with similar N-glycan structures lacking galactose and sialic acid were excluded. Through a combination of homozygosity mapping and expression profiling, a deep intronic homozygous mutation (c.792 + 182G>A) was found in TMEM165 (TPARL) in the three patients. TMEM165 is a gene of unknown function, possibly involved in Golgi proton/calcium transport. Here we present a detailed clinical description of the three patients with this mutation. The TMEM165 deficiency represents a novel type of CDG (TMEM165-CDG). This disorder enlarges the group of CDG caused by deficiencies in proteins that are not specifically involved in glycosylation but that have functions in the organization and homeostasis of the intracellular compartments and the secretory pathway, like COG-CDG and ATP6V0A2-CDG.

Deficiency of Subunit 6 of the Conserved Oligomeric Golgi Complex (COG6-CDG): Second Patient, Different Phenotype

We describe a 27-month-old girl with COG6 deficiency. She is the first child of healthy consanguineous Moroccan parents. She presented at birth with dysmorphic features including microcephaly, post-axial polydactyly, broad palpebral fissures, retrognathia, and anal anteposition. The clinical phenotype was further characterised by multiorgan involvement including mild psychomotor retardation, and microcephaly, chronic inflammatory bowel disease, micronodular liver cirrhosis, associated with life-threatening and recurrent infections due to combined T- and B-cell dysfunction and neutrophil dysfunction.Mutation analysis showed the patient to be homozygous for the c.G1646T mutation in the COG6 gene. She is the second reported patient with a deficiency of subunit 6 of the COG complex. Although both patients are homozygous for the same mutation, they present a markedly different clinical picture. Indeed immunodeficiency as well as inflammatory bowel disease has not been described previously in patients with any COG-CDG.

Two Argentinean Siblings with CDG-Ix: A Novel Type of Congenital Disorder of Glycosylation?

Congenital disorders of glycosylation (CDG) are genetic diseases caused by abnormal protein and lipid glycosylation. In this chapter, we report the clinical, biochemical, and molecular findings in two siblings with an unidentified CDG (CDG-Ix). They are the first and the third child of healthy consanguineous Argentinean parents. Patient 1 is now a 11-year-old girl, and patient 2 died at the age of 4 months. Their clinical picture involved liver dysfunction in the neonatal period, psychomotor retardation, microcephaly, seizures, axial hypotonia, feeding difficulties, and hepatomegaly. Patient 1 also developed strabismus and cataract. They showed a type 1 pattern of serum sialotransferrin. Enzymatic analysis for phosphomannomutase and phosphomannose isomerase in leukocytes and fibroblasts excluded PMM2-CDG and MPI-CDG. Lipid-linked oligosaccharide (LLO) analysis showed a normal profile. Therefore, this result could point to a deficiency in the dolichol metabolism. In this context, ALG8-CDG, DPAGT1-CDG, and SRD5A3-CDG were analyzed and no defects were identified. In conclusion, we could not identify the genetic deficiency in these patients yet. Further studies are underway to identify the basic defect in them, taking into account the new CDG types that have been recently described.

Long-standing mild hypertransaminasaemia caused by congenital disorder of glycosylation (CDG) type IIx

A 32 year-old asymptomatic male came to our attention with a 21-year history, documented elsewhere, of puzzling increases in his serum transaminase level. At first, very low serum ceruloplasmin level suggested Wilson disease. Two liver biopsies showed mild portal inflammation, steatosis and mild fibrosis. Further investigation revealed low levels of the glycoproteins AT III and clotting factor XI, leading to a diagnosis of congenital disorder of glycosylation (CDG) type II. Further studies as to the cause of this 'apparently new' CDG, are ongoing. On the basis of our data and a literature review, we suggest that subjects with asymptomatic hypertransaminasaemia be screened for CDG.

Clinical and biochemical features in a Congolese infant with congenital disorder of glycosylation (CDG)-IIx

We describe an infant girl with psychomotor retardation, growth retardation, mild facial dysmorphy, evidence of liver involvement and a type 2 pattern of serum sialotransferrins. Serum transferrin glycan analysis with MALDI-TOF showed an extremely altered N-glycan pattern with a large number of truncated asialoglycans pointing to a severely defective N-glycan processing. The basic defect in this patient with CDG-IIx has not yet been identified.

Borderline mental development in a congenital disorder of glycosylation (CDG) type Ia patient with multisystemic involvement (intermediate phenotype)

CDG Ia (phosphomannomutase deficiency) has a wide clinical spectrum with the most severe affected patients having multisystemic disease in addition to severe nervous system involvement. We report a patient with CDG Ia and an intermediate phenotype due to mild neurological impairment and borderline cognitive abilities despite the occurrence of typical extraneurological symptoms. These included liver involvement, coagulopathy and failure to thrive with enteropathy. Genotype analyses showed that he was compound heterozygous for T237R/C241S mutations. This observation underlines that the CDG Ia clinical spectrum may include intraindividual variability that might reflect different degrees of glycosylation abnormalities among distinct body compartments. CDG Ia should be considered in cases of unexplained liver involvement and/or enteropathy in patients with mild developmental delay and subtle neurological signs.

Transarticular repair of the brachial plexus. Case report

This paper illustrates the repair of a complex and unusually placed iatrogenic injury of the brachial plexus. The authors present the case of a 36-year old woman, musician (piano solista), with a dumbbell tumour of the brachial plexus. A general surgeon performed a gross total removal of the tumour, cutting it flush with the exit of the neuroforamen and this resulted in a severe upper brachial plexus injury. Four months later, the brachial plexus was repaired with a nerve graft, using a double extraforaminal and preforaminal approach via the transarticular route. The surgical procedure proved to be effective and without significant consequences for the patient.

Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases

AIM

Common peroneal nerve (CPN) injuries represent the most common nerve lesions of the lower limb and can be due to several causative mechanisms. Although in most cases they recover spontaneously, an irreversible damage of the nerve is also likely to occur. Nerve regeneration following CPN repair is poorer if compared to other peripheral nerves and this can explain the reluctant attitude of many physicians towards the surgical treatment of these patients. Among the several factors advocated to explain the poor outcome following surgery, it has been suggested that reinnervation might be obstacled by the force imbalance between the functioning flexors and the paralysed extensors that eventually results in the fixed equinism of the foot, due to the excessive contracture of the active muscles and the shortening of the heel cord. Therefore the early correction of these forces might favour nerve regeneration. Following such hypothesis, the authors treat irreversible CPN injuries performing a one-stage procedure of nerve repair and tibialis tendon transfer. We report our experience, describing the indications to surgical treatment, the operative technique and the postoperative clinical outcome correlated with the causative mechanisms of the injuries.

METHODS

A 62-patient series controlled over a period of 15 years with a post-traumatic palsy of the CPN is reported. All the patients underwent surgery. In open wounds, when a nerve transection was suspected, surgery was performed at emergency (2 cases). In closed injuries, operative treatment was advised when no spontaneous regeneration occurred 3-4 months after the injury. From 1988 till 1991, 9 patients were elected for surgery : in 6 cases treatment consisted of neuroma resection and nerve repair by means of a graft. In 3 patients it was performed only a CPN decompression at the fibular neck. Since 1991, surgical treatment has always consisted of nerve repair associated with a tendon transfer during the same procedure. Fifty-three patients were elected for surgery. Nerve repair was achieved by direct suture in 1 case and by means of a graft in 46 patients. Decompression of the CPN at the fibular neck was performed in 6 patients where nerve continuity was demonstrated.

RESULTS

In the first group of patients, nerve repair outcome was highly disapponting: no recovery in 5 cases, reinnervation occurred in 1 patient only (M1-2). CPN decompression was followed by complete recovery in 2 cases, no improvement was observed in 1 case. Nerve repair associated with tibialis tendon transfer dramatically improved the postoperative outcome: at 2 year follow-up, neural regeneration was demonstrated in 90% of the patients. Surgical outcome depends on the causative mechanisms of the lesion: sharp injuries and severe dislocations of the knee had an excellent recovery, while in crush injuries and gunshot wounds good recovery was less common.

CONCLUSION

Surgical treatment of CPN injuries can nowadays be highly rewarding. CPN palsies in open wounds should undergo surgical exploration at emergency. In close injuries with no spontaneous recovery within 4 months after the injury, patients should be advised to seek surgical treatment regardless the causative mechanism of the lesion. According to our experience, the association of a transfer procedure to nerve repair enhances neural regeneration, dramatically improving the surgical outcome of these injuries.

Identification of adulteration in water buffalo mozzarella and in ewe cheese by using whey proteins as biomarkers and matrix-assisted laser desorption/ionization mass spectrometry

A rapid and accurate method to identify bovine and ewe milk adulteration of fresh water buffalo mozzarella cheese by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS) is described. The differentiation among mozzarella made from water buffalo milk and from mixtures of less expensive bovine and, more recently, ewe milk with water buffalo milk is achieved using whey proteins, alpha-lactalbumin and beta-lactoglobulins as molecular markers. It is worth noting that the method proposed here is, to our knowledge, the first strategy able to characterize possible fraudulent additions of ewe milk in samples of water buffalo milk devoted to the production of water buffalo mozzarella cheese. In addition, a linear relationship was found between the relative response of the molecular ion and the abundance of the analysed whey proteins. This demonstrates that this approach can be used to determine the amount of bovine or ovine milk added to water buffalo milk employed for mozzarella cheese production. Furthermore, this method also appears suitable for the analysis of ewe cheese. Hence these findings open the way to a new field for mass spectrometry in the evaluation of possible fraudulence in dairy industry production.

Identification of adulteration in milk by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

The development is described of a rapid, simply and accurate analytical method aimed at evaluating both the presence of cow milk in either raw ewe and water buffalo milk samples employed in industrial processes and the addition of powdered milk to samples of fresh raw milk, using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS). The presence of adulteration is defined by evaluating the protein patterns coming from the most abundant whey proteins, alpha-lactalbumin and beta-lactoglobulin, used as molecular markers. As no pretreatment of the milk samples is required and owing to the speed and ease of use of MALDI-MS the proposed analytical protocol can be used as a routine strategy for the identification of possible adulteration of the raw fresh milk samples that the dairy industry receives from producers every day.

Aggressive fibromatosis (desmoid tumor) of the radial nerve: favorable resolution. Case report

Aggressive fibromatosis (desmoid tumor) of a peripheral nerve is a rarity. Isolated cases have been reported in which the tumor originated from neighboring structures and only secondarily invaded the nerves. The case described in this report is unusual because the tumor selectively invaded the patient's nerve fascicles, requiring removal and graft repair. The procedure was followed by an excellent clinical recovery and no recurrence as of the 6-year follow-up review.

Matrix-assisted laser desorption/ionization mass spectrometric peptide mapping of high molecular weight glutenin subunits 1Bx7 and 1Dy10 in Cheyenne cultivar

This study describes the verification of the cDNA-deduced amino acid sequences of high molecular weight glutenin subunits 1Dy10 and 1Bx7 in Cheyenne cultivar by direct matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS) analysis of their tryptic fragments omitting chromatographic pre-separation. These polypeptides have a conserved structure consisting of a long central repetitive domain that prevents the application of conventional sequencing procedures such as Edman degradation. The published sequence of subunit 1Dy10 contains 7 Lys and 13 Arg residues; thus the production of 21 tryptic peptides is expected. The cDNA-deduced sequence for 1Bx7 subunit includes 5 Lys and 15 Arg residues, but the presence of three Arg-Pro bonds, which are normally not cleaved by trypsin, predicts only 19 tryptic peptides. Three different matrices (DHB, SA and HCCA) in combination with the most compatible sample preparation procedures were used in order to obtain the maximum 1Dy10 and 1Bx7 sequence coverage. MALDI analysis of the 1Dy10 tryptic digest resulted in the identification of all 21 expected peptides. In the case of 1Bx7 MALDI analysis resulted in the identification of 17 of the 19 expected peptides, giving a sequence coverage of 99.3%. These results were sufficient to rule out glycosylation of the 1Dy10 and 1Bx7 proteins and to assess the absence of any other post-translational modification, to within the detection limits of the method.

Proteomics of gluten: mapping of subunit 1 Ax2* in Cheyenne cultivar by matrix-assisted laser desorption/ionization

This paper reports results on the verification of the 1Ax2* high molecular weight glutenin subunit sequence in Cheyenne cultivar. The gene sequence of the protein is known but recently some text changes have been made, and furthermore until now no characterization of post-translational modifications has been reported. The two published sequences, named I and II, differ in four residues at positions 23, 208, 475, and 611. The first sequence contains 20 Arg and 6 Lys residues, producing 26 tryptic fragments, since the Arg(109)-Pro(110) bond is generally not cleaved by trypsin. The second sequence contains 19 Arg and 6 Lys residues, producing 25 tryptic peptides, again because of the Arg(109)-Pro(110) bond. Both sequences generate two cyanogen bromide fragments. Matrix-assisted laser desorption/ionization analysis of the tryptic digest of the high-MW glutenin subunit 1Ax2* resulted in the identification of 24 out of the 26 expected peptides for sequence I, a sequence coverage of 99.5%. These results were sufficient to rule out sequence II and any protein glycosylation and any other post-translational modifications to within the detection limits of the method. It was found that the choice of matrix considerably influenced the sequence coverage in peptide mapping.

Sequencing of oligosaccharides by collision-induced dissociation matrix-assisted laser desorption/ionization mass spectrometry

A study of the collision-induced dissociation post-source decay (PSD) spectra of free oligosaccharides is presented. These spectra, when obtained with helium as collision gas, show (1,5)X fragments containing the reducing end sugar. The presence of these fragments permits Y ions and, consequently, B and C peaks to be identified. This is a common behaviour from which it has been possible to delineate a general method for the easy assignment of the peaks in PSD spectra of underivatized neutral sugars, allowing the sequence of a real unknown to be obtained.

Studies on the primary structure of short polysaccharides using SEC MALDI mass spectroscopy

The introduction of size-exclusion chromatography (SEC) analysis of polysaccharides prior to MALDI mass spectroscopy accounts for the determination of the molecular mass of the repeating unit when neutral homopolymers are investigated. In the case of natural polysaccharides characterised by more complicated structural features (presence of non-carbohydrate substituents, charged groups, etc.), this mass value usually is in agreement with more than one sugar composition. Therefore, it is not sufficient to give the correct monosaccharidic composition of the polysaccharide investigated. To solve this problem, MALDI spectra were recorded on the permethylated sample and post-source decay experiments were performed on precursor ions. In this way, the composition (in terms of Hex, HexNAc, etc.), size and sequence of the repeating unit were determined.

Use of hydroxyacetophenones as matrices for the analysis of high molecular weight glutenin mixtures by matrix-assisted laser desorption/ionization mass spectrometry

A selection of hydroxyacetophenones has been investigated as matrices for the analysis, by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS), of high molecular weight (HMW) glutenin mixtures from three wheat varieties. Mass spectra were obtained directly from the HMW glutenin extracts without any preliminary purification and separation steps. According to the quality of the mass spectra, obtained using different hydroxyacetophenones, it has been possible to classify the matrices on the basis of their suitability for the analyte properties. Only two of the matrices considered showed to be compatible with the HMW glutenin mixtures analysis, although a large amount of other highly complex protein mixtures are present. This study indicates that MALDI-MS, as a stand-alone technique, is particularly useful for the direct determination of the complete HMW subunits profile and their molecular weights. Copyright 1999 John Wiley & Sons, Ltd.

The structure of the exocellular polysaccharide from the cyanobacterium Cyanospira capsulata

The exocellular polysaccharide produced by the cyanobacterium Cyanospira capsulata has been subjected to partial acid hydrolysis and N-deacetylation-nitrous acid deamination. The oligosaccharides released have been isolated by weak anion exchange and aqueous size exclusion chromatography, and characterized by a combination of 1D and 2D nuclear magnetic resonance spectroscopy, mass spectrometry, sugar composition and linkage analyses. The polysaccharide has an octasaccharide repeating unit with the following structure: [formula: see text]

Three-dimensional MR myelography of traumatic injuries of the brachial plexus

PURPOSE

To determine the diagnostic accuracy of three-dimensional MR myelography in the evaluation of traumatic injuries of the brachial plexus.

METHODS

Twenty patients with clinical and electromyographic evidence of traumatic brachial plexopathy were examined with three-dimensional MR myelography, conventional cervical myelography, and CT myelography 1 to 9 months after trauma. Three-dimensional MR myelography was performed on a 1.5-T MR unit with a constructive interference in steady state (CISS) technique. For each patient, maximum intensity myelographic projections and multiplanar reconstruction reformatted 1-mm axial sections were obtained from the same 3-D data set. Three-dimensional MR myelographic findings were compared with findings at cervical myelography and CT myelography. Surgical findings were available for comparison in 13 patients.

RESULTS

Three-dimensional MR myelography enabled detection of meningoceles with avulsed or intact nerve roots, partial or complete radicular avulsions without disruption of the thecal sac, dural sleeve abnormalities, and dural scars. Assuming cervical myelography and CT myelography as the standards of reference, 3-D MR myelography showed 89% sensitivity, 95% specificity, and 92% diagnostic accuracy in the evaluation of nerve root integrity.

CONCLUSION

Three-dimensional MR myelography can show the majority of traumatic lesions that involve the proximal portion of the brachial plexus in a single rapid examination. On the basis of our findings, we propose this technique as a screening examination for patients with traumatic brachial plexus palsy.

Discrimination of isomeric oligosaccharides and sequencing of unknowns by post source decay matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

The PSD spectra of some isomeric oligosaccharides are investigated in order to study the fragmentation mechanisms. Results show that intense peaks are formed from one or more glycosidic linkage cleavages, while ring fragmentation produces very weak signals. Two analytical applications of post source decay (PSD) to the structural analysis of oligosaccharides are also illustrated: the discrimination of isomeric structures and the identification of a real unknown by combining PSD data with the linkage analysis results.

Brachial plexus injuries. Guidelines for management: our experience

In spite of the progress made by microneurosurgery, the treatment of brachial plexus injuries still remains a great challenge. This personal series of 49 patients with brachial plexus injuries (excluding tumours and thoracic outlet syndromes) is peculiar because the cases arose after the introduction in Italy of the law requiring all motorcyclists to wear a safety helmet. Our experience confirms that there has been a 32% increase in very severe almost irreparable injuries of the plexus in comparison with previous data reported in the literature. This is probably due to the higher rate of survival among severely-injured patients, although the possibility of a direct effect of the helmet on the plexus cannot be completely discarded. Our results confirm the good prognosis of the microsurgical repair of C5-C6 stretch injuries and infraclavicular lesions.