In-vitro and in-vivo evaluation for the bio-natural Alginate/nano-Hydroxyapatite (Alg/n-HA) injectable hydrogel for critical size bone substitution

Currently, bio-natural injectable hydrogels are receiving a lot of attention due to their ability to control, adjust, and adapt to random bone defects, in addition, to their ability to mimic the composition of natural bones. From such a viewpoint, this study goal is to prepare and characterize the injectable hydrogels paste based on the natural alginate (Alg) derived from brown sea algae as a polysaccharide polymer, which coupled with nano biogenic-hydroxyapatite (n-HA) prepared from eggshells and enriched with valuable trace elements. The viscosity and mechanical properties of the paste were investigated. As well as the in-vitro study in terms of water absorption and biodegradability in the PBS, biocompatibility and the capability of the injectable Alginate/n-Hydroxyapatite (Alg/n-HA) to regenerate bone for the most suitable injectable form. The injectable hydrogel (BP -B sample) was chosen for the study as it had an appropriate setting time for injecting (13 mins), and suitable compressive strength reached 6.3 MPa. The in vivo study was also carried out including a post-surgery follow-up test of the newly formed bone (NB) in the defect area after 10 and 20 weeks using different techniques such as (SEM/EDX) and histological analysis, the density of the newly formed bone by Dual x-ray absorptiometry (DEXA), blood biochemistry and the radiology test. The results proved that the injectable hydrogels Alginate/n-Hydroxyapatite (Alg/n-HA) had an appreciated biodegradability and bioactivity, which allow the progress of angiogenesis, endochondral ossification, and osteogenesis throughout the defect area, which positively impacts the healing time and ensures the full restoration for the well-mature bone tissue that similar to the natural bone.

A split-mouth randomized controlled trial to compare the rate of canine retraction after a soft tissue procedure compared against a corticotomy procedure for accelerated tooth movement

Background and Aim

Various methods to accelerate the orthodontic tooth movement have been used, among which corticotomy is considered to be the most common one. The suggested reasoning for such acceleration was the regional acceleratory phenomenon (RAP). Since the RAP is a property of both the hard and soft tissues, we designed a soft tissue flap procedure to compare the effects with the conventional corticotomy procedure. A split-mouth study was conducted where the two procedures were assessed in a single participant.

Patients and Methods

The total sample size was calculated to be 40 with 20 participants in each group. The rate of tooth movement was the primary outcome measure, and the secondary outcomes were dentoalveolar changes, which were studied in both the conventional corticotomy and the flap-only procedure based on a cone-beam computed tomography (CBCT) wherein the alveolar bone density (BD) around canines, tipping, and rotational changes in canines, premolars, and molars were assessed.

Results

Corticotomy resulted in greater canine angulation, lesser canine rotation and premolar rotation, and greater molar rotation compared with flap elevation, but these differences were statistically insignificant.

Conclusion

Though the corticotomy resulted in higher BD, the differences were statistically insignificant. There was no significant difference in the rate of space closure assessed by the two techniques compared.

WHO informal consultation on revision of guidelines on evaluation of similar biotherapeutic products, virtual meeting, 30 June – 2 July 2021

The WHO informal consultation was held to promote the revision of WHO guidelines on evaluation of similar biotherapeutic products (SBPs) adopted by the Expert Committee on Biological Standardization (ECBS) in 2009. It was agreed in the past consultations that the evaluation principles in the guidelines are still valid, but a review was recommended to provide more clarity and case-by-case flexibility. The opportunity was therefore taken to review the experience and identify areas where the current guidance could be more permissive without compromising its basic principles, and where additional explanation could be provided regarding the possibility of reducing the amount of data needed for regulatory approval. The meeting participants applauded the leading role taken by the WHO in providing a much-needed streamlined approach for development and evaluation of SBPs which will provide efficient and cost-effective product development and increase patient access to treatments. It was recognized that the principles as currently described in the draft WHO guidelines are based on sound science and experience gained over the last fifteen years of biosimilar approvals. However, since these guidelines when finalised will constitute the global standard for biosimilar evaluation and assist national regulatory authorities in establishing revised guidance and regulatory practice in this complex area, it was felt that further revision and clarity on certain perspectives in specific areas was necessary to dispel uncertainties arising in the current revised version. This report describes the principles in the draft guidelines, including topics discussed and consensus reached.

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WHO guidelines serve as a basis for the development of national regulatory framework for biosimilars.

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Revision of guidelines is to provide more flexibility and clarification on data required for regulatory approval.

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Revised guidelines would contribute to improving consistency on regulatory decision and patient access to treatments.

Thromboembolic risk is potentially reduced in mitral stenosis shortly after percutaneous mitral valvotomy

Background

Rheumatic mitral stenosis (MS) is a problem in the developing countries. Left atrium (LA) and appendage (LAA) dysfunction are considered determinant factors for thrombus formation even in patients with sinus rhythm (SR). Percutaneous mitral valvotomy (PMV) is a well accepted therapeutic option. However, no available data considers patients with SR as a low risk group for the development of thrombus.

Purpose

Studying short term impact of PMV on P wave morphology, NT-pro BNP as well as LAA properties in patients with MS and SR.

Methods

A prospective study was conducted in a tertiary University hospital including 41 patients with symptomatic uncomplicated MS having favorable morphology with sinus Rhythm. P wave duration, amplitude and dispersion, NT-pro BNP, transthoracic and transesophageal echocardiography were carried out directly before and 1 month following PMV. Student t-test was used to compare the variables before and after PMV. Correlation was calculated using Pearson's correlation and multivariate regression analysis was used for prediction of unfavorable outcomes.

Results

After PMV, 36 (87.8%) patients had a favorable outcome manifested with improvement of NYHA class, valve area, estimated systolic pulmonary artery pressure (sPAP) as well as grade of spontaneous echo contrast (SEC). P wave duration, P wave amplitude and P wave dispersion decreased after PMV (14.97±2.65 vs. 13.21±2.36 ms, 4.01±1.01 vs. 2.51±0.71 ms and 4.01±1.01 vs. 2.51±0.71mv; P<0.001 respectively). NT pro-BNP also reduced (2.90±2.19 vs. 2.01±1.31 Pg/L; P<0.001). TEE PW of LAA showed increase of early (E LAA) and late (A LAA) emptying velocities after PMV (41.70±19.50 vs. 48.82±20.18 and 31.31±21.99 vs. 38.48±19.86 cm/s; P<0.001 respectively). By TDI, late wall motion (LAA A) velocity increased (7.41±2.50 vs. 8.23±3.01 cm/s; P<0.001) with an improvement of LAA ejection fraction post procedural (50.80±13.11 vs. 55.75±10.12%; P<0.001). Negative correlation between LAA EF and P wave amplitude (r=−0.40; P<0.001) as well as a correlation between reduction in NT pro-BNP and the improvement of both LAA A velocity and E LAA wave were noticed (r=0.55; P=0.02 and 0.01 respectively). The grade of SEC was negatively correlated with E LAA (r=−0.55, P=0.02). Only 5 patients (12.2%) had an unfavorable outcome. Four patients had severe mitral regurge (7.8%), only one patient (2.4%) was indicated for surgery. AF developed in one patient (2.4%). The grade of SEC remains the same in 3 patients (7.3%). Both baseline estimated sPAP and Wilkins score were predictors for unfavorable outcome; sPAP (odd's ratio= 4.08; 95% CI=1.01- 7.17; P=0.04); Wilkins score (odd's ratio= 1.59; 95% CI=1.22- 5.98; P=0.01).

Conclusion

PMV has a favorable rapid impact on LA and LAA properties in patients with MS and SR. Our data suggests that PMV could potentially contribute to lowering the risk of future thromboembolic events in those patients.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Assiut University Hospital

The prognostic value of cardiac magnetic resonance in assessment of right ventricular function after percutaneous balloon mitral valvuloplasty

Background

Mitral stenosis (MS) results in right ventricular (RV) dysfunction secondary to chronic pulmonary hypertension. Poor outcomes have been reported in patients with persistent chronic RV dysfunction. Persistence RV dysfunction can affect the clinical improvement after percutaneous balloon mitral valvuloplasty (PBMV). Cardiac Magnetic Resonance (CMR) is emerged as a highly sensitive technique for assessment of RV function (RVF).

Purpose

To investigate RV function 3 months after PBMV using a variety of robust parameters associated with prognosis.

Methods

A prospective observational study was conducted in a tertiary University hospital included 31 patients with symptomatic uncomplicated MS with favorable morphology and having sinus rhythm who underwent PBMV. All patients were subjected to TTE and CMR examination 24 hours directly before and 3 months after PBMV for assessment of RV size and function.

Results

CMR showed reduced RV myocardial mass (36.1±6.1 vs 28.0±5.4g, P<0.001), RV end-diastolic volume (RV EDV) (123.5±31.3 vs 109.5±22.7 ml, P=0.03) and TR regurgitant fraction (19.6±8.6 vs 14.7±4.9%, P<0.001) On the other hand, there were increase in each of RV ejection fraction (60.0±10.4 vs 63.13±7.8%, P<0.001), RV stroke volume (SV) (50.2±15.1 vs 33.2±12.2 ml, P<0.001) and RV stroke index (44.2±7.7 vs 50.3±8.6 ml/beat/m2 <0.001). TTE showed improved systolic RV function parameters measured by fractional area change (42.1±7.8 vs 51.7±5.4%, P<0.00), Tei Index (0.6±0.1 vs 0.5±0.1, P<0.001) and TAPSE (22.2±3.3 vs 25.7±5.1 mm, P=0.04). Among RV diastolic parameters, there were an increase in TV-TDI E' (12.0±3.0 vs 14.0±2.0 cm/s, P<0.001), TV-TDI A' (13.0±3.0 vs 11.0±2.0 cm/s, P<0.001) and TV-TDI E'/A' (1.0±0.5 vs 1.3±0.3, P<0.001) with significantly decreased RV wall thickness (5.7±0.7 vs 4.3±0.8 mm P<0.001) 3 months after PBMV. Among patients who showing improved RV parameters by TTE, ten patients (32,3%) showed non improved RV end systolic volume, EDV, SV and stroke index by CMR.

Conclusion

Follow-up of RV function by TTE after PBMV yielded nearly similar results compared to CMR. However, CMR identified a subgroup of patient with persistent RV dysfunction 3 months after PBMV. That contributes to define the role of cardiac MRI in the evaluation of the prognosis in patients with MS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Assiut University hospital and Al Orman Institute

Metabolic-associated fatty liver disease and autoimmune hepatitis: an overlooked interaction

INTRODUCTION

Metabolic-associated fatty liver disease (MAFLD) is the most common liver disease globally, and affects about a quarter of the general population. Autoimmune hepatitis (AIH) is a severe (sometimes fatal) liver disease that affects children and adults, with a rising prevalence. Thus, not surprisingly, both conditions can frequently coexist, with potential synergistic impact on the course of the disease and response to therapy of both entities.

AREAS COVERED

In this work, the authors aimed to provide a narrative updated review on this interaction, diagnosis, and management of MAFLD/AIH and the current challenges.

EXPERT OPINION

Clarifying the nature of the complex interaction between the two diseases was hampered by a myriad of factors, particularly the previous diagnosis of exclusion for fatty liver disease associated with metabolic dysfunction. The recent redefinition of fatty liver disease that led to the development of positive diagnostic criteria for MAFLD has the premise to help in circumventing some of these challenges.

Evaluation of Ti/Al alloy coated with biogenic hydroxyapatite as an implant device in dogs' femur bones

The main target of the present research was a full assessment of the toxicity effects and biocompatibility of a Ti/Al-alloy device coated with biogenic hydroxyapatite (bHA) when implanted in dogs in comparison with those of an uncoated Ti/Al-alloy device. The coating of the alloy was carried out using controlled high-velocity suspension flame spray (HVSFS) technique. Both coated and uncoated devices were implanted in dogs' femur bones for different time periods (45 days and 90 days). Bone-formation ability and healing were followed up, and blood analysis was performed, at Time zero (immediately post surgery), and then at 3 days, 45 days, and 90 days post surgery. Bone mineral density checks, radiological scans of the femur bone, and histological analysis were also conducted. The in-vivo study results proved that implantation of a device made from bHA-coated Ti/Al alloy in dogs' femur bones is completely safe. This is due to the high osteoconductivity of the coated alloy, which enables the formation of new bone and a full connection between new and original bone material. At 90 days post surgery, the coated alloy had been completely digested within the original bone; thus, it appeared as a part of the femur bone and not as a foreign body. Both the scanning electron microscopy with energy-dispersive X-ray and histology analysis findings affirmed the results. Furthermore, the blood tests indicated no toxicity effects during the 90 days of implantation.

Effects of Long-Acting Testosterone Undecanoate on Behavioral Parameters and Na + , K+-ATPase mRNA Expression in Mice with Alzheimer`s Disease

Previous studies have shown that testosterone attenuates stress-induced mood dysfunction and memory deterioration. However, the exact mechanism is still unknown. This study was conducted to investigate the role of long-term testosterone undecanoate on the behavioral responses in AD induced by AlCl3 + D-galactose administration and the possible alteration of the gene expression level of the Na/K ATPase pump. Adult male mice received AlCl3 in drinking water (10 mg/kg/day) and (D-gal 200 mg/kg/day), subcutaneously for 90 consecutive days, then received a single intramuscular (I.M) injection of castor oil (vehicle) on day 91, while treated groups received a single I.M injection of either low (100 mg/kg/45 days) or high dose (500 mg/kg/45 days) respectively of long-acting testosterone undecanoate on day 91. The time spent in the interaction zone during the open field test, preference index to novel objects in the novel object recognition test, spontaneous alternation percentage (SAP) in Y-maze test, and escape latency time in the Morris water maze test were used to measure the locomotor activity, long-term memory, and spatial memory in mice, respectively. The results showed that testosterone undecanoate treatment improved locomotor activity, improved preference to novel objects, improved spatial memory, and reversed anxiety and depression induced by AlCl3 + D-galactose administration in male mice, suggesting the enhancement of behavioral and memory functions brought by testosterone treatment. Moreover, testosterone undecanoate treatment did alter gene expression levels of Na/K ATPase isoforms in the brain hippocampus. In most cases, altered gene expression was significant and correlated with the observed behavioral changes. Taken together, our findings provide new insight into the effects of long-acting testosterone undecanoate administration on locomotor activity, long-term memory, anxiety, and spatial memory in male mice with Alzheimer's disease.

Severe preeclampsia is associated with postpartum diastolic dysfunction and non-dipping blood pressure profile pattern

Background

Left ventricular diastolic dysfunction and non-dipping profile, detected by ambulatory blood pressure monitoring (ABPM), are two features recorded to be associated with sustained hypertension. Both are predictors of an increased cardiovascular morbidity later in life. Complete normalization of blood pressure (BP) in preeclampsia is detected over a variable period of time.

Methods

A prospective cohort study was conducted in a tertiary university hospital including normotensive women with a history of preeclampsia in the current pregnancy enrolled within the first week postpartum. All cases were subjected to 24 h-ABPM and 2D trans-thoracic echocardiography three months post postpartum concomitantly with a clinical evaluation. Chi2-test was used to compare the qualitative data while student t-test was used to compare the quantitative data. Multivariate regression analysis was used for prediction of non-dippers and diastolic dysfunction in our cohort.

Results

Hundred twenty eight women were included in the study. Their mean age was 28.6±5.1 years and the mean basal BP was 123.1±6.4/74.6±5.9 mm Hg. Out of the studied women, 90 (70.3%) women were dippers and 38 (29.7%) women were non-dippers. It was noticed that diastolic dysfunction was presented in 28 (73.7%) of non-dippers while none of dippers had diastolic dysfunction. Women with severe preeclampsia had higher frequency of non-dipper (35.5% vs. 24.2%; P=0.02) and diastolic dysfunction (29% vs. 15%; P=0.01) in comparison to those women with mild preeclampsia. Severe preeclampsia and previous history of preeclampsia were significant predictors for non-dipping status (OR=1.1, 95% CI: 0.05–10.56 and 1.4, 95% CI: 0.30–4.26 respectively, R2 = 0.7; P<0.001). They were also predictors for diastolic dysfunction in our studied population (OR = 1.6, 95% CI: 1.1–2.2 and 1.3, 95% CI: 1.2–2.2 respectively, R2 = 0.6; P<0.05).

Conclusion

Women with a history of preeclampsia have the risk for developing cardiovascular events later in life. The severity and recurrence of preeclampsia were significant predictors for both non-dipping profile and diastolic dysfunction.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Orman Heart Hospital-Assiut University; Women Health Hospital-Assiut University

Influence of the thermal treatment on the characteristics of porous geopolymers as potential biomaterials

Highly porous sodium geopolymer structures were successfully produced through the chemical direct foaming approach at ambient temperature. The impact of the thermal treatment, as well as the influence of various additions of hydrogen peroxide, as a foaming agent, on the porosity, microstructure and mechanical characteristics of the produced geopolymers was investigated. The evaluation of bioactivity was carried out by assessing the formation of an apatite layer on the samples' surface, using scanning electronic microscopy and inductively coupled plasma spectrometry for the simulated body fluid solution, in which the geopolymer samples were kept up to 28 days. In addition, the biodegradability was estimated through the weight change of the samples and pH-measurements. The results demonstrated that the geopolymer foams, produced using 4.5 vol% H₂O₂ and heat-treated at 500 °C for 1 h, possessed a high open porosity (71 vol %), excellent compressive strength (3.56 ± 0.27 MPa), and suitable chemical stability. The pH value of SBF solutions, in which these geopolymers were immersed for 28 days, remained close to the physiological one. The in vitro study indicated that the developed geopolymer foams possessed bioactivity, as demonstrated by the formation of apatite particles on their surface after immersion in the simulated body fluid solution for 28 days.

Investigation the impact of ZTA addition on the properties of nano biogenic hydroxyapatite

The target of the recent study is to achieve a significant inexpensive and eco-friendly way for getting ZTA/HA composites, based on the nano-HA derived from the eggshell biogenic source. Combining simultaneously the porous structure; which is considered as a bone formation key, with developed mechanical properties and adequate biocompatibility, is another purpose of this study. Furthermore, the impact of ZTA addition from 10-30 mass-%, fabricated by uniaxial pressing and sintering at 1200-1300 °C for 2 h, on the physical and mechanical properties, microstructure and phase composition of ZTA/HA composite bodies was investigated. The results demonstrated that the increasing of ZTA content increases the bodies' apparent porosity and decreases the bulk density due to the decomposition of HA into β-TCP. Where the formation of β-TCP possessed the predominant impact on the mechanical properties of the sintered ZTA/HA composites. ICP, SEM, EDX and thin film XRD results of composites containing 20 mass-% ZTA affirmed the excellent bioactivity of the bodies.

Circulating Tumor Cells and Cancer Stem Cells: Clinical Implications in Nonmetastatic Breast Cancer

Purpose

Despite the therapeutic advances, disease recurrence remains an ever-present threat to the health and well-being of breast cancer survivors. Assessment of circulating tumor cells (CTCs) and cancer stem cells (CSCs) during and after treatment may be of value in refining treatment.

Methods

Three 5 mL blood samples were taken from each patient: the first, at diagnosis; the second, after completion of neoadjuvant anthracyclin-based chemotherapy; and the third, a month after surgery and completion of adjuvant radiotherapy. The absolute numbers of CTCs were identified as CD45-cytokeratin+ cells. CTCs per 5 mL of blood were determined by recording all events in the whole suspension. CSCs were identified as cytokeratin⁺CD44⁺CD24-/CD45- cells. The CSCs were expressed as a percentage of CTCs.

Results

Univariate analysis identified the measurements of baseline CTCs and CSCs, taken after chemotherapy and one month after the cessation of radiotherapy, as prognostic factors for both four-year disease-free survival and four-year overall survival. Multivariable analysis identified the third measurement of CSCs, taken one month after the completion of radiotherapy, as the only independent prognostic factor for the four-year disease-free survival (P < 0.002, hazard ratio [HR] = 1.231, 95% CI 1.077–1.407). The initial CTC measurement was the one factor that reached significance on multivariate analysis (P < 0.03, HR 1.969, 95% CI 1.092–3.551) for the four-year overall survival. Correlation was higher between CTC and CSC counts at diagnosis (r = 0.654, P < 0.001) than after chemotherapy (r = 0.317, P < 0.03), because of the more rapid decrease in the mean CTC count with chemotherapy.

Conclusion

The CTC count could be suitable as one of the measures for monitoring response to chemotherapy, while persistence of CSC after cessation of the treatment of nonmetastatic breast cancer, except hormonal therapy when indicated, may be a reason to consider additional therapy in the future. These findings need confirmation in larger randomized trials.

[Effectiveness and Cost-Effectiveness of Daily School Sport in the Primary School--Project: "fit for pisa"]

The "fit for pisa" intervention implemented daily physical education at five primary schools in Göttingen. The results of the evaluation show an increase in physical activity among the students participating in the programme. At the same time sedentary behaviour, like watching television, decreased remarkably. In the long run the promotion of an active lifestyle had improved the body mass index. The study emphasises the need for government funding to implement the programme across the country.

Grey water characteristics and treatment options for rural areas in Jordan

Low water consumption in rural areas in Jordan had resulted in the production of concentrated grey water. Average COD, BOD and TSS values were 2568mg/l, 1056mg/l and 845mg/l, respectively. The average grey water generation was measured to be 14L/c.d. Three different treatment options were selected based on certain criterions, and discussed in this article. The examined treatment systems are septic tank followed by intermittent sand filter; septic tank followed by wetlands; and UASB-hybrid reactor. Advantages and disadvantages of each system are presented. It was concluded that UASB-hybrid reactor would be the most suitable treatment option in terms of compactness and simplicity in operation. The volume of UASB-hybrid reactor was calculated to be 0.268m(3) with a surface area of 0.138m(2) for each house having 10 inhabitants on average. Produced effluent is expected to meet Jordanian standards set for reclaimed water reuse in irrigating fruit trees.

[Acute osteomyelitis in children: early MRI diagnosis]

PURPOSE

To assess the value of MRI for early diagnosis of osteomyelitis in children presenting with sepsis and acute onset of musculoskeletal pain.

MATERIALS AND METHODS

MRI including fat suppressed T2W, and fat suppressed pre- and postcontrast T1W sequences was performed within 48 hours of admission in 26 children with clinical (fever and acute musculoskeletal pain) and biological (elevated WBC count and ESR in all cases, and elevated CRP in 12 patients) suspicion of acute osteomyelitis. None of the patients had sickle cell disease.

RESULTS

MRI was normal in 7 children (26%). Bone marrow signal abnormality was noted in 19 cases (74%) consistent with acute osteomyelitis in 18 cases and metastatic neuroblastoma in 1 case.

CONCLUSION

MRI is useful for evaluation of children presenting with sepsis and acute musculoskeletal pain, early diagnosis of osteomyelitis and to prevent unnecessary hospital admission and work-up.

Identification of the autophosphorylation sites and characterization of their effects in the protein kinase DYRK1A

Protein kinases of the DYRK ('dual-specificity tyrosine-regulated kinase') family are characterized by a conserved Tyr-Xaa-Tyr motif (Tyr-319-Tyr-321) in a position exactly corresponding to the activation motif of the mitogen-activated protein kinase (MAP kinase) family (Thr-Xaa-Tyr). In a molecular model of the catalytic domain of DYRK1A, the orientation of phosphorylated Tyr-321 is strikingly similar to that of Tyr-185 in the known structure of the activated MAP kinase, extracellular-signal-regulated kinase 2. Consistent with our model, substitution of Tyr-321 but not of Tyr-319 by phenylalanine markedly reduced the enzymic activity of recombinant DYRK1A expressed in either Escherichia coli or mammalian cells. Direct identification of phosphorylated residues by tandem MS confirmed that Tyr-321, but not Tyr-319, was phosphorylated. When expressed in COS-7 cells, DYRK1A was found to be fully phosphorylated on Tyr-321. A catalytically inactive mutant of DYRK1A contained no detectable phosphotyrosine, indicating that Tyr-321 is autophosphorylated by DYRK1A. MS identified Tyr-111 and Ser-97 as additional autophosphorylation sites in the non-catalytic N-terminal domain of bacterially expressed DYRK1A. Enzymic activity was not affected in the DYRK1A-Y111F mutant. The present experimental data and the molecular model indicate that the activity of DYRK1A is dependent on the autophosphorylation of a conserved tyrosine residue in the activation loop.

Protein kinase CK2 is involved in G2 arrest and apoptosis following spindle damage in epithelial cells

p53 undergoes phosphorylation on several residues in response to cellular stresses that include UV and ionizing radiation, however the influence of spindle damage on this parameter is relatively unclear. Consequently, the effect of nocodazole on serine 392 phosphorylation was examined in two epithelial cell lines. We show that this process is dependent upon the stepwise activation of p38 mitogen-activated protein kinase (p38 MAPK) and protein kinase casein kinase 2 (CK2). Furthermore, this activation correlated with the biochemical regulation of the maturation-promoting factor (MPF, cdc2/cyclin B), as both DRB and antisense depletion of CK2, as well as SB203580 were associated with an inhibition of its activation in response to nocodazole. Strikingly, when the cell cycle characteristics of nocodazole treated cells were examined, we observed that depletion or inhibition of the catalytic subunit of CK2, in the presence of microtubule inhibitors, resulted in a compromise of the G2 arrest (spindle checkpoint). Furthermore, CK2-depleted, nocodazole treated cells demonstrated a dramatic reduction in the apoptotic cell fraction, confirming that these cells had been endowed with oncogenic properties. These changes were observed in both HeLa cells and HCT116 cells. We also show that this effect is dependent on the presence of functional wild-type p53, as this phenomenon is not apparent in HCT116 p53(-/-) cells. Collectively, our results indicate two novel roles for CK2 in the spindle checkpoint arrest, in concert with p53. Firstly, to maintain increased cyclinB/cdc2 kinase activity, as a component of G2 arrest, and secondly, a role in p53-mediated apoptosis. These findings may have implications for an improved understanding of abnormalities of the spindle checkpoint in human cancers, which is a prerequisite for defining future therapies.

How was this story told in the mother tongue? An integrative perspective

Most of the psychoanalytic literature on the mother tongue has focused on the clinical therapeutic encounter. The authors applied findings from therapy research using the Thematic Apperception Test (TAT) to tease out differences and similarities in how stories are told in the mother tongue versus the acquired language. This projective test provides a rich medium to explore the individual's inner world, fantasies, thoughts, wishes, sense of self, and self-in-relation-to-other via a narrative that is spontaneously produced in response to standardized stimuli. The TAT was administered to four participants in both the mother tongue and the acquired language. The narratives were then analyzed using two different rating systems. Differences in sense of self, self-in-relation-to-other, and level of pathology were identified using one participant's narratives. Although no global generalizations can be made from one study, the authors suggest that people tell their story differently when speaking in the mother tongue versus the acquired language.

[Unusual radiologic signs of bone echinococcosis in children]

The authors report 2 cases of 2 children aging 11 and 12-years-old presenting hydatitosis in the upper extremity of 2 long bones femur and tibia. In 2 cases, radiological appearances were atypical. In the femur, plain radiographs revealed multiple lucencies, irregular, located in the superior extremity with a periostal reaction. The CT scan confirmed these data and showed a cortical rupture, extension to soft tissue with contrast enhancement. In the tibia, plain radiographys showed delimitated lucencies, confluent with a rim condensation in the proximal epiphyseal-metaphyseal area. Echography and CT are helpful when radiological appearances are unusual.

A selective phosphodiesterase IV inhibitor, rolipram blocks both withdrawal behavioral manifestations, and c-Fos protein expression in morphine dependent mice

We investigated the effect of rolipram, a selective phosphodiesterase IV inhibitor, on morphine dependence in mice. The withdrawal manifestations were significantly reduced in mice that were treated with rolipram in combination with morphine repeatedly, compared to the mice treated with morphine and saline. Immunohistochemical study of c-Fos protein revealed a significant increase in the protein expression, 1 h after naloxone induced withdrawal manifestations. A combination of rolipram and morphine treatment for 5 days prevented the increase of c-Fos protein expression. Acute rolipram treatment prior to the naloxone challenge had no effect. Repeated treatment with rolipram itself had no effect either on behavior, or on c-Fos protein expression. These results suggest that chronic rolipram treatment in combination with morphine in mice will abolish the development of morphine dependence and the expression of c-Fos protein induced by naloxone challenge.

Protein-protein interactions in receptor activation and intracellular signalling

We review here signalling complexes that we have defined using X-ray analysis in our laboratory. They include growth factors and their receptors: nerve growth factor (NGF) and its hetero-hexameric 7S NGF storage complex, hepatocyte growth factor/scatter factor (HGF/SF) NK1 dimers and fibroblast growth factor (FGF1) in complex with its receptor (FGFR2) ectodomain and heparin. We also review our recent structural studies on intracellular signalling complexes, focusing on phosducin transducin GPry, CK2 protein kinase and its complexes, and the cyclin D-dependent kinase, Cdk6, bound to the cell cycle inhibitor p19INK4d. Comparing the structures of these complexes with others we show that the surface area buried in signalling interactions does not always give a good indication of the strength of the interactions. We show that conformational changes are often important in complexes with intermediate buried surface areas of 1500 to 2000 A2, such as Cdk6INK4 interactions. Some interactions involve recognition of continuous epitopes, where there is no necessity for a tertiary structure and very often the binding conformation is induced during the process of interaction, for example phosducin binding to the betagamma subunits (Gtbetagamma) of the heterotrimeric G protein transducin.

Stress-induced activation of protein kinase CK2 by direct interaction with p38 mitogen-activated protein kinase

Protein kinase CK2 has been implicated in the regulation of a wide range of proteins that are important in cell proliferation and differentiation. Here we demonstrate that the stress signaling agents anisomycin, arsenite, and tumor necrosis factor-alpha stimulate the specific enzyme activity of CK2 in the human cervical carcinoma HeLa cells by up to 8-fold, and this could be blocked by the p38 MAP kinase inhibitor SB203580. We show that p38alpha MAP kinase, in a phosphorylation-dependent manner, can directly interact with the alpha and beta subunits of CK2 to activate the holoenzyme through what appears to be an allosteric mechanism. Furthermore, we demonstrate that anisomycin- and tumor necrosis factor-alpha-induced phosphorylation of p53 at Ser-392, which is important for the transcriptional activity of this growth suppressor protein, requires p38 MAP kinase and CK2 activities.

Cognitive dysfunction in obsessive-compulsive disorder

OBJECTIVE

Assessment of cognitive functions among obsessive-compulsive disorder (OCD) patients would help in understanding the neurobiology and brain areas involved in that disorder. The objective of this work was to study the cognitive dysfunction in OCD patients and to identify its correlation with both the clinical picture and the severity of the disorder.

METHOD

Neuropsychological and electrophysiological event-related potentials were tested in 30 OCD patients and compared with 30 normal volunteers of a matched gender, age and education.

RESULTS

Results showed a defective visuospatial recognition, which worsens with chronicity, deteriorated set-shifting abilities, overfocused attention to irrelevant stimuli and delayed selective attention to relevant tasks. Mild cases showed better selective attention than severe cases. Obsessive cases had a defective visual memory, while compulsive cases had delayed perception of task relevant stimuli. Mixed cases showed disturbed information-processing both early and late.

CONCLUSION

OCD patients have a characteristic pattern of cognitive dysfunction that differs among patients of varied severity, chronicity and symptom type. We suggest a striatofrontoparietal neural pathophysiology. OCD seems to be a heterogeneous disorder, both clinically and pathophysiologically.

Characterization of an activated ribosomal S6 kinase variant from maturing sea star oocytes: association with phosphatase 2A and substrate specificity

Two ribosomal protein S6 kinases (i.e., pp52(S6K) and pp70(S6K)) of the p70 S6 kinase family were markedly activated during meiotic maturation of Pisaster ochraceus sea star oocytes. A rapid protocol was developed for the purification from the oocyte cytosol of pp52(S6K) by approximately 50,000-fold with a specific enzyme activity of 1.6 micromol per min per mg. The purified enzyme apparently featured the N- and C-terminal regions of pp70(S6K) as it immunoreacted with antibodies directed to peptides patterned after these amino acid sequences in mammalian pp70(S6K). pp52(S6K) was inhibited by fluoride (IC(50) approximately 60 mM), but was relatively insensitive to beta-glycerolphosphate, EGTA, dithiothreitol, spermine, heparin, NaCl, and metal ions such as Mn(2+), Zn(2+), and Ca(2+). The consensus sequence for substrate phosphorylation was determined to be RXXSXR, which was partially distinct from mammalian p70(S6K) in its requirement for an amino-terminal arginine. Phosphorylation of ribosomal protein S6 by p52(S6K) occurred exclusively on serine on at least five tryptic peptides. Inhibition of sea star p52(S6K) phosphotransferase activity after treatment with protein serine/threonine phosphatases confirmed that p52(S6K) was still regulated by phosphorylation. The sea star S6 kinase was purified to near homogeneity with the regulatory and catalytic subunits of protein-serine phosphatase 2A and the heat shock protein 60. The association of an S6 kinase with phosphatase 2A was confirmed by coimmunoprecipitation of S6 kinase activity with phosphatase 2A-specific antibodies. The purified S6 kinase and the sea star oocyte system will be useful for analysis of upstream and downstream signaling events that lead to phosphorylation of the S6 protein and other targets.

Staging the axilla in breast cancer: an audit of lymph-node retrieval in one U.K. regional centre

AIMS

Many surgeons undertake a level 1 axillary dissection in patients with invasive breast cancer. This dissection yields a variable number of lymph nodes for histological study. In this study, we report the consequences of this policy for staging of the axilla.

METHODS

Between January 1995 and December 1995, 236 patients with a diagnosis of invasive breast cancer underwent axillary surgery.

RESULTS

A median of eight nodes was identified (range 0-30). In only 11 patients less than four nodes were identified. An increase in the number of nodes harvested was associated with a higher proportion of node-positive patients and a higher number of metastatic nodes identified.

CONCLUSIONS

We concluded that a standardized approach to axillary dissection consistently yields an adequate sample of lymph nodes for staging purposes. Most importantly, larger node samples yield higher detection rates for metastasis. This has a significant bearing on patient selection for adjuvant chemotherapy when compared with more limited sampling practices, including solitary sentinel node detection and biopsy.

Agenesis of corpus callosum, hypertrophic pyloric stenosis and Hirschsprung disease: coincidence or common etiology?

This article reports a full-term infant with Hirschsprung disease (HD) who was diagnosed to have hypertrophic pyloric stenosis (HPS) and agenesis of corpus callosum (ACC). Pyloric stenosis is known to be associated with HD. To our knowledge, the combination of Hirschsprung disease, hypertrophic pyloric stenosis and agenesis of corpus callosum has not been reported previously. We believe these three conditions are due to an underlying pathophysiologic mechanism.

Clinicoradiological diagnosis of benign osteoblastoma of the spine in children

Three cases of benign osteoblastoma of the spine in children are reported, diagnosed on the basis of clinicoradiological findings and confirmed at surgery and by histopathology. The authors feel that in all cases of painful scoliosis and painful torticollis, a careful search should be made for any suspicious area of sclerosis, especially in the posterior elements of the vertebrae, and all the positive or suspected cases should undergo nuclear bone scanning. All patients whose bone scan is positive should be subjected to computed tomography for differential diagnosis between osteoid osteoma and benign osteoblastoma.

Schistosomiasis and sarcoma of the urinary bladder

A young male patient with schistosomiasis and sarcoma of the urinary bladder is presented. Total cystectomy followed by radiotherapy was performed. The gross appearance, microscopic findings of the tumor and an outline of the disease are discussed.

Congenital absence of the mammary gland

Tc-99m pertechnetate is known for its uptake and excretion by the mammary gland. Generally, lactating women are not advised to have any radioisotopic studies. If it is necessary to have one, it is recommended that they do not breast-feed their children for at least 24 hours. Congenital absence of the mammary gland is a rare condition. This case was accidently discovered. Nuclear medicine physicians should be aware of the value of clinical examination of patients, and that not every absent or asymmetric breast shadow is due to surgical resection.