Enabling large-scale screening of Barrett's esophagus using weakly supervised deep learning in histopathology

Timely detection of Barrett's esophagus, the pre-malignant condition of esophageal adenocarcinoma, can improve patient survival rates. The Cytosponge-TFF3 test, a non-endoscopic minimally invasive procedure, has been used for diagnosing intestinal metaplasia in Barrett's. However, it depends on pathologist's assessment of two slides stained with H&E and the immunohistochemical biomarker TFF3. This resource-intensive clinical workflow limits large-scale screening in the at-risk population. To improve screening capacity, we propose a deep learning approach for detecting Barrett's from routinely stained H&E slides. The approach solely relies on diagnostic labels, eliminating the need for expensive localized expert annotations. We train and independently validate our approach on two clinical trial datasets, totaling 1866 patients. We achieve 91.4% and 87.3% AUROCs on discovery and external test datasets for the H&E model, comparable to the TFF3 model. Our proposed semi-automated clinical workflow can reduce pathologists' workload to 48% without sacrificing diagnostic performance, enabling pathologists to prioritize high risk cases.

Deep learning for the prediction of clinical outcomes in internet-delivered CBT for depression and anxiety

In treating depression and anxiety, just over half of all clients respond. Monitoring and obtaining early client feedback can allow for rapidly adapted treatment delivery and improve outcomes. This study seeks to develop a state-of-the-art deep-learning framework for predicting clinical outcomes in internet-delivered Cognitive Behavioural Therapy (iCBT) by leveraging large-scale, high-dimensional time-series data of client-reported mental health symptoms and platform interaction data. We use de-identified data from 45,876 clients on SilverCloud Health, a digital platform for the psychological treatment of depression and anxiety. We train deep recurrent neural network (RNN) models to predict whether a client will show reliable improvement by the end of treatment using clinical measures, interaction data with the iCBT program, or both. Outcomes are based on total improvement in symptoms of depression (Patient Health Questionnaire-9, PHQ-9) and anxiety (Generalized Anxiety Disorder-7, GAD-7), as reported within the iCBT program. Using internal and external datasets, we compare the proposed models against several benchmarks and rigorously evaluate them according to their predictive accuracy, sensitivity, specificity and AUROC over treatment. Our proposed RNN models consistently predict reliable improvement in PHQ-9 and GAD-7, using past clinical measures alone, with above 87% accuracy and 0.89 AUROC after three or more review periods, outperforming all benchmark models. Additional evaluations demonstrate the robustness of the achieved models across (i) different health services; (ii) geographic locations; (iii) iCBT programs, and (iv) client severity subgroups. Results demonstrate the robust performance of dynamic prediction models that can yield clinically helpful prognostic information ready for implementation within iCBT systems to support timely decision-making and treatment adjustments by iCBT clinical supporters towards improved client outcomes.

Artificial intelligence in healthcare: transforming the practice of medicine

Artificial intelligence (AI) is a powerful and disruptive area of computer science, with the potential to fundamentally transform the practice of medicine and the delivery of healthcare. In this review article, we outline recent breakthroughs in the application of AI in healthcare, describe a roadmap to building effective, reliable and safe AI systems, and discuss the possible future direction of AI augmented healthcare systems.

Evaluation of Deep Learning to Augment Image-Guided Radiotherapy for Head and Neck and Prostate Cancers

IMPORTANCE

Personalized radiotherapy planning depends on high-quality delineation of target tumors and surrounding organs at risk (OARs). This process puts additional time burdens on oncologists and introduces variability among both experts and institutions.

OBJECTIVE

To explore clinically acceptable autocontouring solutions that can be integrated into existing workflows and used in different domains of radiotherapy.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement study used a multicenter imaging data set comprising 519 pelvic and 242 head and neck computed tomography (CT) scans from 8 distinct clinical sites and patients diagnosed either with prostate or head and neck cancer. The scans were acquired as part of treatment dose planning from patients who received intensity-modulated radiation therapy between October 2013 and February 2020. Fifteen different OARs were manually annotated by expert readers and radiation oncologists. The models were trained on a subset of the data set to automatically delineate OARs and evaluated on both internal and external data sets. Data analysis was conducted October 2019 to September 2020.

MAIN OUTCOMES AND MEASURES

The autocontouring solution was evaluated on external data sets, and its accuracy was quantified with volumetric agreement and surface distance measures. Models were benchmarked against expert annotations in an interobserver variability (IOV) study. Clinical utility was evaluated by measuring time spent on manual corrections and annotations from scratch.

RESULTS

A total of 519 participants' (519 [100%] men; 390 [75%] aged 62-75 years) pelvic CT images and 242 participants' (184 [76%] men; 194 [80%] aged 50-73 years) head and neck CT images were included. The models achieved levels of clinical accuracy within the bounds of expert IOV for 13 of 15 structures (eg, left femur, κ = 0.982; brainstem, κ = 0.806) and performed consistently well across both external and internal data sets (eg, mean [SD] Dice score for left femur, internal vs external data sets: 98.52% [0.50] vs 98.04% [1.02]; P = .04). The correction time of autogenerated contours on 10 head and neck and 10 prostate scans was measured as a mean of 4.98 (95% CI, 4.44-5.52) min/scan and 3.40 (95% CI, 1.60-5.20) min/scan, respectively, to ensure clinically accepted accuracy. Manual segmentation of the head and neck took a mean 86.75 (95% CI, 75.21-92.29) min/scan for an expert reader and 73.25 (95% CI, 68.68-77.82) min/scan for a radiation oncologist. The autogenerated contours represented a 93% reduction in time.

CONCLUSIONS AND RELEVANCE

In this study, the models achieved levels of clinical accuracy within expert IOV while reducing manual contouring time and performing consistently well across previously unseen heterogeneous data sets. With the availability of open-source libraries and reliable performance, this creates significant opportunities for the transformation of radiation treatment planning.

A Machine Learning Approach to Understanding Patterns of Engagement With Internet-Delivered Mental Health Interventions

IMPORTANCE

The mechanisms by which engagement with internet-delivered psychological interventions are associated with depression and anxiety symptoms are unclear.

OBJECTIVE

To identify behavior types based on how people engage with an internet-based cognitive behavioral therapy (iCBT) intervention for symptoms of depression and anxiety.

DESIGN, SETTING, AND PARTICIPANTS

Deidentified data on 54 604 adult patients assigned to the Space From Depression and Anxiety treatment program from January 31, 2015, to March 31, 2019, were obtained for probabilistic latent variable modeling using machine learning techniques to infer distinct patient subtypes, based on longitudinal heterogeneity of engagement patterns with iCBT.

INTERVENTIONS

A clinician-supported iCBT-based program that follows clinical guidelines for treating depression and anxiety, delivered on a web 2.0 platform.

MAIN OUTCOMES AND MEASURES

Log data from user interactions with the iCBT program to inform engagement patterns over time. Clinical outcomes included symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder-7 [GAD-7]); PHQ-9 cut point greater than or equal to 10 and GAD-7 scores greater than or equal to 8 were used to define depression and anxiety.

RESULTS

Patients spent a mean (SD) of 111.33 (118.92) minutes on the platform and completed 230.60 (241.21) tools. At baseline, mean PHQ-9 score was 12.96 (5.81) and GAD-7 score was 11.85 (5.14). Five subtypes of engagement were identified based on patient interaction with different program sections over 14 weeks: class 1 (low engagers, 19 930 [36.5%]), class 2 (late engagers, 11 674 [21.4%]), class 3 (high engagers with rapid disengagement, 13 936 [25.5%]), class 4 (high engagers with moderate decrease, 3258 [6.0%]), and class 5 (highest engagers, 5799 [10.6%]). Estimated mean decrease (SE) in PHQ-9 score was 6.65 (0.14) for class 3, 5.88 (0.14) for class 5, and 5.39 (0.14) for class 4; class 2 had the lowest rate of decrease at -4.41 (0.13). Compared with PHQ-9 score decrease in class 1, the Cohen d effect size (SE) was -0.46 (0.014) for class 2, -0.46 (0.014) for class 3, -0.61 (0.021) for class 4, and -0.73 (0.018) for class 5. Similar patterns were found across groups for GAD-7.

CONCLUSIONS AND RELEVANCE

The findings of this study may facilitate tailoring interventions according to specific subtypes of engagement for individuals with depression and anxiety. Informing clinical decision needs of supporters may be a route to successful adoption of machine learning insights, thus improving clinical outcomes overall.

Screening for rectal chlamydia infection in a genitourinary medicine clinic

Our department has been offering routine rectal chlamydia testing to all individuals reporting ano-receptive sex since 2002. We wanted to determine the prevalence of rectal chlamydia and if there were any factors associated with a positive diagnosis. A retrospective case-notes analysis was performed of all individuals tested for rectal chlamydia from November 2002 until March 2005. In total, 1187 case-notes were examined. Overall, the prevalence of chlamydia infection was 8.5%; in asymptomatic individuals, it was 5.1%. There was a positive association with chlamydia infection in patients who were HIV-positive, those who reported rectal symptoms and from samples in which microscopy of a rectal smear demonstrated >10 polymorphonuclear cells/high power field. The findings support our continuing to offer rectal chlamydia screening to patients attending our service. Chlamydia trachomatis infection should be considered as a possible diagnosis in patients who present with rectal symptoms outside a genitourinary medicine clinic setting.

RANK/RANKL/OPG signaling pathways in necrotic jaw bone from bisphosphonate-treated subjects

Osteonecrosis of the jaw (ONJ) is a chronic complication affecting long-term bisphosphonate-treated subjects, recognized by non-healing exposed bone in the maxillofacial region. The pathophysiological mechanism underlying ONJ has not been fully elucidated. The aim of the present study was to investigate the role of RANK/RANKL/OPG signaling pathway and, in parallel, to evaluate angiogenic and matrix mineralization processes in jaw bone necrotic samples obtained from bisphosphonate-treated subjects with established ONJ. Necrotic bone samples and native bone samples were processed for Light and Field Emission in Lens Scanning Electron Microscope (FEISEM) analyses, for Real-Time RT-PCR to evaluate the gene expression of TNFRSF11A (RANK), TNFSF11 (RANKL), and TNFSF11B (OPG) and for immunohistochemical analyses of VEGF and BSP expression. Morphological analyses performed by Light microscope and FEISEM show empty osteocytic lacunae and alteration of lamellar organization with degradation of the mineralized bone matrix in necrotic bone samples. A significant increase in TNFRSF11A, TNFSF11, TRAF6 and NFAT2 gene expression, and a reduction of TNFSF11B gene transcription level compared is also showed in necrotic bone compared to control samples. No significant difference of VEGF expression is evidenced, while lower BSP expression in necrotic bone compared to healthy samples is found. Even if the pathogenesis of bisphosphonate-associated ONJ remains unknown, a link between oral pathogens and its development seems to exist. We suppose lipopolysaccharide produced by bacteria colonizing and infecting necrotic bone and the surrounding viable area could trigger RANK/RANKL/OPG signaling pathway and, in this context, osteoclasts activation could be considered as a protective strategy carried out by the host bone tissue to delimitate the necrotic area and to counteract infection.

Genotypic testing on HIV-1 DNA as a tool to assess HIV-1 co-receptor usage in clinical practice: results from the DIVA study group

PURPOSE

We have developed a sequencing assay for determining the usage of the genotypic HIV-1 co-receptor using peripheral blood mononuclear cell (PBMC) DNA in virologically suppressed HIV-1 infected patients. Our specific aims were to (1) evaluate the efficiency of V3 sequences in B versus non-B subtypes, (2) compare the efficiency of V3 sequences and tropism prediction using whole blood and PBMCs for DNA extraction, (3) compare the efficiency of V3 sequences and tropism prediction using a single versus a triplicate round of amplification.

RESULTS

The overall rate of successful V3 sequences ranged from 100 % in samples with >3,000 copies HIV-1 DNA/10(6) PBMCs to 60 % in samples with <100 copies total HIV-1 DNA /10(6) PBMCs. Analysis of 143 paired PBMCs and whole-blood samples showed successful V3 sequences rates of 77.6 % for PBMCs and 83.9 % for whole blood. These rates are in agreement with the tropism prediction obtained using the geno2pheno co-receptor algorithm, namely, 92.1 % with a false-positive rate (FPR) of 10 or 20 % and of 96.5 % with an FPR of 5.75 %. The agreement between tropism prediction values using single versus triplicate amplification was 98.2 % (56/57) of patients using an FPR of 20 % and 92.9 % (53/57) using an FPR of 10 or 5.75 %. For 63.0 % (36/57) of patients, the FPR obtained via the single amplification procedure was superimposable to all three FPRs obtained by triplicate amplification.

CONCLUSIONS

Our results show the feasibility and consistency of genotypic testing on HIV-1 DNA tropism, supporting its possible use for selecting patients with suppressed plasma HIV-1 RNA as candidates for CCR5-antagonist treatment. The high agreement between tropism prediction by single and triple amplification does not support the use of triplicate amplification in clinical practice.

Is normal beta-hCG regression curve helpful in the diagnosis of persistent trophoblastic disease?

OBJECTIVE

The aim of this study was to evaluate the probable usefulness of normal beta-human chorionic gonadotropin (beta-hCG) regression curve in the diagnosis of persistent trophoblastic disease (PTD).

METHODS

A log-value regression curve was developed from the means and 95% confidence limits of serial weekly serum beta-hCG titers of 43 patients with uneventful complete hydatidiform moles and 14 patients, who were previously confirmed as PTD.

RESULTS

All 14 PTD patients (100%) had abnormal values, beyond normal range, within 4 weeks. beta-hCG was in its upper values, compared to normal regression curve at 2.29 +/- 0.19 weeks. This was earlier than plateau or rise detection at 4.21 +/- 0.33 weeks (P < 0.001). Within 3 weeks of evacuation, 13 of 14 (92.86%) PTD patients' beta-hCG values exceeded the normal range, whereas only six of 14 (42%) showed a rise or plateau.

CONCLUSION

Our finding indicates that the normal beta-hCG regression curve may be useful for quicker detection of PTD than the plateau or rise of level.

Is normal β-hCG regression curve helpful in the diagnosis of persistent trophoblastic disease?

Objective

The aim of this study was to evaluate the probable usefulness of normal β-human chorionic gonadotropin (β-hCG) regression curve in the diagnosis of persistent trophoblastic disease (PTD).

Methods

A log-value regression curve was developed from the means and 95% confidence limits of serial weekly serum β-hCG titers of 43 patients with uneventful complete hydatidiform moles and 14 patients, who were previously confirmed as PTD.

Results

All 14 PTD patients (100%) had abnormal values, beyond normal range, within 4 weeks. β-hCG was in its upper values, compared to normal regression curve at 2.29 ± 0.19 weeks. This was earlier than plateau or rise detection at 4.21 ± 0.33 weeks (P < 0.001). Within 3 weeks of evacuation, 13 of 14 (92.86%) PTD patients' β-hCG values exceeded the normal range, whereas only six of 14 (42%) showed a rise or plateau.

Conclusion

Our finding indicates that the normal β-hCG regression curve may be useful for quicker detection of PTD than the plateau or rise of level.

Long term effects of the palatal plate therapy for the orofacial regulation in children with Down syndrome

The objective of this study was to evaluate long term effects of orofacial regulation therapy with modified Castillo-Morales palatal plate on 68 Down children that attended our Unit from 1992 to 2001. Corrections obtained with palatal plate therapy were evaluated according to the following parameters: spontaneous lingual protrusion based on three level scale, position "open mouth", labial hypotonia and sialorrhea. The results showed distinct improvement in nearly all of the parameters compared to initial conditions.

Ca(2+)-dependent interaction of triadin with histidine-rich Ca(2+)-binding protein carboxyl-terminal region

A direct binding of HRC (histidine-rich Ca(2+)-binding protein) to triadin, the main transmembrane protein of the junctional sarcoplasmic reticulum (SR) of skeletal muscle, seems well supported. Opinions are still divided, however, concerning the triadin domain involved, either the cytoplasmic or the lumenal domain, and the exact role played by Ca(2+), in the protein-to-protein interaction. Further support for colocalization of HRC with triadin cytoplasmic domain is provided here by experiments of mild tryptic digestion of tightly sealed TC vesicles. Accordingly, we show that HRC is preferentially phosphorylated by endogenous CaM K II, anchored to SR membrane on the cytoplasmic side, and not by lumenally located casein kinase 2. We demonstrate that HRC can be isolated as a complex with triadin, following equilibrium sucrose-density centrifugation in the presence of mM Ca(2+). Here, we characterized the COOH-terminal portion of rabbit HRC, expressed and purified as a fusion protein (HRC(569-852)), with respect to Ca(2+)-binding properties, and to the interaction with triadin on blots, as a function of the concentration of Ca(2+). Our results identify the polyglutamic stretch near the COOH terminus, as the Ca(2+)-binding site responsible, both for the acceleration in mobility of HRC on SDS-PAGE in the presence of millimolar concentrations of Ca(2+), and for the enhancement by high Ca(2+) of the interaction between HRC and triadin cytoplasmic segment. (c)2001 Elsevier Science.

Phosphorylation of the triadin cytoplasmic domain by CaM protein kinase in rabbit fast-twitch muscle sarcoplasmic reticulum

Skeletal muscle triadin is a sarcoplasmic reticulum (SR) membrane protein that had been shown to interact structurally and functionally at the cytoplasmic domain (amino acid residues 1-47) with the ryanodine receptor (RyR1), and to undergo phosphorylation by endogenous calmodulin protein kinase (CaM K II) in isolated terminal cisternae from rabbit fast-twitch muscle. Here we show that triadin cytoplasmic domain expressed as glutathione-S-transferase fusion protein, is a substrate of the protein kinase. This finding is corroborated by identification of a specific consensus sequence in the deduced amino sequence between residue 34 and 37 of triadin. Confirming the regulatory features of CaM K II, we show the phosphorylation of triadin cytoplasmic segment by the kinase, when converted to the autonomous form. We propose that triadin modulates RyR1 in a phosphorylation-dependent manner.

Targeting of calsequestrin to the sarcoplasmic reticulum of skeletal muscle upon deletion of its glycosylation site

The glycoprotein calsequestrin (CS) is segregated to the junctional sarcoplasmic reticulum (jSR) and is responsible for intraluminal Ca(2+) binding. A chimeric CS-hemoagglutinin 1 (HA1), obtained by adding the nine amino acid viral epitope hemoagglutinin to the carboxy terminal of CS and shown to be correctly segregated to skeletal muscle jSR [A. Nori, K. A. Nadalini, A. Martini, R. Rizzuto, A. Villa, and P. Volpe (1997). Chimeric calsequestrin and its targeting to the junctional sarcoplasmic reticulum of skeletal muscle. Am. J. Physiol. 272, C1420-C1428] lends itself as a molecular tool to investigate the targeting domains of CS. A putative targeting mechanism of CS to jSR implies glycosylation-dependent steps in the endoplasmic reticulum (ER) and Golgi complex. To test this hypothesis, CS-HA1DeltaGly, a mutant in which the unique N-glycosylation site Asn316 was changed to Ile, was engineered by site-directed mutagenesis. The mutant cDNA was transiently transfected in either HeLa cells, myoblasts of rat skeletal muscle primary cultures, or regenerating soleus muscle fibers of adult rats. The expression and intracellular localization of CS-HA1DeltaGly was studied by double-labeling epifluorescence by means of antibodies against either CS, HA1, or the ryanodine receptor calcium release channel. CS-HA1DeltaGly was expressed and retained to ER and ER/sarcoplasmic reticulum of HeLa cells and myotubes, respectively, and expressed, sorted, and correctly segregated to jSR of regenerating soleus muscle fibers. Thus, the targeting mechanism of CS in vivo appears not to be affected by glycosylation-that is, the sorting, docking, and segregation of CS are independent of cotranslational and posttranslational glycosylation or glycosylations.

Site-directed mutagenesis and deletion of three phosphorylation sites of calsequestrin of skeletal muscle sarcoplasmic reticulum. Effects on intracellular targeting

Calsequestrin (CS) is segregated to the junctional sarcoplasmic reticulum (jSR) of skeletal muscle fibers and is responsible for intraluminal Ca(2+) binding. A chimeric CS-HA1, obtained by adding the nine-amino-acid viral epitope hemagglutinin (HA1) to the carboxy-terminal of CS and shown to be correctly segregated to skeletal muscle jSR in vivo (A. Nori, K. A. Nadalini, A. Martini, R. Rizzuto, A. Villa, and P. Volpe, 1997, Am. J. Physiol. 272, C1420-C1428), is mutagenized in order to identify domains of CS involved in targeting. Since a putative targeting mechanism of CS implies phosphorylation-dependent steps in the endoplasmic reticulum (ER) and/or Golgi complex, five CS-HA1 mutants disrupting the three phosphorylation sites of CS (Thr(189), Thr(229), and Thr(353)) were engineered by either site-directed mutagenesis or deletion: CS-HA1DeltaP1 (Thr(189) --> Ile); CS-HA1DeltaP2 (Thr(229) --> Asn); CS-HA1DeltaP1,2; in which Thr(189) and Thr(229) were changed to Ile and Asn, respectively; and CS-HA1Delta14(COOH) and CS-HA1Delta49 (COOH), in which 14 residues (Glu(354)-Asp(367)) and 49 residues (Asp(319)-Asp(367)), respectively, were deleted at the carboxy-terminal. Mutant cDNAs were transiently transfected in either HeLa cells, cultured myoblasts of rat skeletal muscle, or regenerating soleus muscle fibers of adult rats. Each CS-HA1 mutant was identified by Western blot as a single polypeptide of the predicted molecular weight. The intracellular localization of CS-HA1 mutants was studied by immunofluorescence using specific antibodies against either CS or HA1. CS-HA1 mutants colocalized with ER markers, e.g., calreticulin, and partially overlapped with Golgi complex markers, e.g., alpha-mannosidase II, in HeLa cells and myotubes. CS-HA1 mutants were expressed and retained in ER and ER/SR of HeLa cells and myotubes, respectively, and correctly segregated to jSR of regenerating soleus muscle fibers. Thus, the targeting mechanism of CS in vivo is not affected by phosphorylation(s); i.e., sorting and segregation of CS appear to be independent of posttranslational phosphorylation(s).

Targeting of calsequestrin to sarcoplasmic reticulum after deletions of its acidic carboxy terminus

Calsequestrin (CS) is the Ca(2+) binding protein of the junctional sarcoplasmic reticulum (jSR) lumen. Recently, a chimeric CS-HA1, obtained by adding the nine-amino-acid viral epitope hemagglutinin (HA1) to the COOH terminus of CS, was shown to be correctly segregated to the sarcoplasmic reticulum [A. Nori, K. A. Nadalini, A. Martini, R. Rizzuto, A. Villa, and P. Volpe. Am. J. Physiol. 272 (Cell Physiol. 41): C1420-C1428, 1997]. A putative targeting mechanism of CS to jSR implies electrostatic interactions between negative charges on CS and positive charges on intraluminal domains of jSR integral proteins, such as triadin and junctin. To test this hypothesis, 2 deletion mutants of chimeric CS were engineered: CS-HA1DeltaGlu-Asp, in which the 14 acidic residues [-Glu-(Asp)(5)-Glu-(Asp)(7)-] of the COOH-terminal tail were removed, and CS-HA1Delta49(COOH), in which the last, mostly acidic, 49 residues of the COOH terminus were removed. Both mutant cDNAs were transiently transfected in HeLa cells, myoblasts of rat skeletal muscle primary cultures, or regenerating soleus muscle fibers of adult rats. The expression and intracellular localization of CS-HA1 mutants were studied by epifluorescence microscopy with use of antibodies against CS or HA1. CS-HA1 mutants were shown to be expressed, sorted, and correctly segregated to jSR. Thus short or long deletions of the COOH-terminal acidic tail do not influence the targeting mechanism of CS.

Fatty acyl-CoA-acyl-CoA-binding protein complexes activate the Ca2+ release channel of skeletal muscle sarcoplasmic reticulum

We previously reported that fatty acyl-CoA esters activate ryanodine receptor/Ca2+ release channels in a terminal cisternae fraction from rabbit skeletal muscle [Fulceri, Nori, Gamberucci, Volpe, Giunti and Benedetti (1994) Cell Calcium 15, 109-116]. Skeletal muscle cytosol contains a high-affinity fatty acyl-CoA-binding protein (ACBP) [Knudsen, Hojrup, Hansen, H.O., Hansen, H.F. and Roepstorff (1989) Biochem. J. 262, 513-519]. We show here that palmitoyl-CoA (PCoA) in a complex with a molar excess of bovine ACBP causes a discrete Ca2+ efflux or allows Ca2+ release from the Ca2+-preloaded terminal cisternae fraction by sub-optimal caffeine concentrations. Both effects were abolished by elevating the free [Mg2+] in the system, which inhibits the Ca2+ release channel activity. Sensitization towards caffeine was a function of both the concentration of the complex and the [PCoA]-to-[ACBP] ratio. In all experimental conditions the calculated free [PCoA] was no more than 50 nM, and such concentrations by themselves were inactive on Ca2+ release channels. The KD for PCoA binding was approx. 2 nM for bovine and yeast ACBP, and slightly higher (8 nM) for rat ACBP. The PCoA-rat ACBP complex behaved in the same manner as the PCoA-bovine ACBP complex, whereas the ester complexed with yeast ACBP was more active in activating/sensitizing Ca2+ efflux. A non-hydrolysable analogue of PCoA bound to (bovine) ACBP also sensitized the Ca2+ release channel towards caffeine. These findings indicate that fatty acyl-CoA-ACBP complexes either interact directly with one or more components in the terminal cisternae membranes or, through interaction with the component(s), donate the fatty acyl-CoA esters to high-affinity binding sites of the membrane, thus affecting (and possibly regulating) Ca2+ release channel activity.

Chimeric calsequestrin and its targeting to the junctional sarcoplasmic reticulum of skeletal muscle

Calsequestrin (CS) is the junctional sarcoplasmic reticulum (jSR) Ca2+ binding protein responsible for intraluminal Ca2+ storage. The targeting mechanisms of CS to the jSR are yet to be unraveled. The nine-amino acid epitope of the influenza virus hemoagglutinin (referred to as HA1) was added at the COOH-terminal of CS by polymerase chain reaction cloning. The HA1-tagged CS cDNA was transiently transfected in either HeLa cells, myogenic cell lines, such as C2 and L8 cells, myoblasts of rat skeletal muscle primary cultures, or regenerating soleus muscle fibers of adult rats. The expression and intracellular localization of chimeric CS-HA1 were monitored by epifluorescence and confocal microscopy using either anti-CS antibodies or anti-HA1 antibodies. About 30% of transfected HeLa cells and 20-40% of myogenic cells expressed CS-HA1 into intracellular compartments, such as the perinuclear cisternae of endoplasmic reticulum (ER). Myoblasts of newborn rat skeletal muscles were first transfected and subsequently stimulated to differentiate into myotubes. CS-HA1 was detected in approximately 20% of transfected myotubes and did not affect CS distribution in myotubes. In the soleus muscle of adult rat, intramuscular injection of bupivacaine induced necrosis followed by regeneration. In vivo transfection of HA1-tagged CS cDNA in regenerating skeletal muscles determined expression in a few skeletal muscle fibers; CS-HA1 was localized only in jSR, as judged by confocal microscopy of longitudinal sections. The present results show that chimeric CS-HA1 is correctly sorted to ER/SR compartments and that the free COOH-terminal is not requested for sorting, retention, and segregation of CS to the SR.

[Primary Ewing's sarcoma of the mandible. A clinico-pathological and immunohistochemical case study]

A rare case of Ewing's sarcoma, originating in the mandible, is reported. The symptomatologic and radiological aspects is often aspecific. For this reason the diagnostic-therapeutic routine is presented and the difficulty of clinical diagnosis is accentuated. In these cases it may be appropriate to make use of immunohistochemical analysis such as the research of markers like the NSE (Neuro-Specific Enolase). This will be useful to reach an accurate preoperative diagnosis and in order to adopt a correct therapeutic protocol.

Biochemical and functional heterogeneity of rat cerebrum microsomal membranes in relation to SERCA Ca(2+)-ATPases and Ca2+ release channels

Rat cerebrum microsomes were subfractionated on isopycnic linear sucrose (20-42%) density gradients. The Ca2+ loading/release properties and the distribution of intracellular Ca2+ store channels, inositol 1,4,5-trisphosphate (IP3) receptor and ryanodine (Ry) receptor, and SERCA pumps, were monitored in each subfraction by ligand binding and 45Ca2+ loading/release assays. Three different classes of vesicles were identified: (i) heavy density vesicles with high content of Ry receptors and Ca2+ pumps and high thapsigargin (TG)-sensitivity of Ca2+ loading; (ii) intermediate sucrose density vesicles with high content of IP3 receptor, high IP(S)3-sensitivity of Ca2+ loading and low content of Ry receptors; and (iii) light sucrose density vesicles with high content of Ry receptors, low content of IP3 receptors and low content of SERCA pumps highly sensitive to TG. Isolation of molecularly heterogeneous rat cerebrum microsomes and identification of specific Ca2+ loading/release properties support the presence of multiple, potentially active, heterogeneous rapidly exchanging Ca2+ stores in rat cerebrum.

Fatty acyl-CoA esters induce calcium release from terminal cisternae of skeletal muscle

The effect of palmitoyl-CoA (PCoA) on Ca2+ fluxes in unfractionated SR, longitudinal tubules (LSR) and terminal cisternae (TC) subfractions, obtained from rabbit fast-twitch skeletal muscles, was investigated. After MgATP-dependent Ca2+ preloading, PCoA released Ca2+ from unfractionated SR and TC, but not from LSR. Both the extent and the rate of PCoA-induced Ca2+ release from TC were increased in a dose-dependent manner, the half-maximal effect being attained at [PCoA] of approximately 6 microM. Ruthenium red, a Ca2+ release channel blocker, completely inhibited PCoA-induced Ca2+ release, whereas caffeine, a Ca2+ release channel agonist, depleted TC of Ca2+ and prevented the PCoA action. Scatchard plot analysis of [3H]-ryanodine binding showed that PCoA increased the affinity without affecting Bmax. The action of PCoA was mimicked by a nonhydrolysable analog. The present results indicate that PCoA interacts and opens the Ca2+ release channel (ryanodine receptor) of TC and that the mechanism of action involves binding rather than hydrolysis.

The endoplasmic reticulum-sarcoplasmic reticulum connection. II. Postnatal differentiation of the sarcoplasmic reticulum in skeletal muscle fibers

The postnatal differentiation of sarcoplasmic reticulum (SR) of rabbit skeletal muscles (the slow-twitch soleus and the fast-twitch adductor muscles) was monitored between Days 1 and 12 by following on Western blots the expression and accumulation of molecular markers specific not only for the muscle endomembrane system, i.e., calsequestrin (CS) and the ryanodine-sensitive Ca2+ release channel, but also for the endoplasmic reticulum (ER) at large, i.e., BiP, calnexin (CN) and calreticulin. Our results demonstrate that SR development, documented by the increase of the SR fractional volume, terminal cisternae proliferation, and reorientation of triads, is accompanied by the accumulation of the SR-specific proteins and also of CN, with no change of the other ER general markers. Moreover, the distribution of two of the markers, BiP and CS, was investigated by immunocytochemistry at both the light and the electron microscope level. At Day 1 CS was found to be concentrated both within the few recognizable triad terminal cisternae and within the lumen of numerous, apparently discrete cisternae and tubules, widely scattered throughout both the contractile and the subplasmalemmal areas of the cytoplasm. These structures remain evident until Day 12, when most triad junctions have acquired proper configuration, composition and orientation. BiP, on the other hand, appears widely distributed within the ER/SR of the fibers. From the early stages of postnatal development it does colocalize with the Ca2+ binding protein in the lumen of the CS-rich structures and appears also within the longitudinal SR and the conventional ER cisternae.

Multiple/heterogeneous Ca2+ stores in cerebellum Purkinje neurons

1. The rapid and transient redistribution of Ca2+ from intracellular membrane-bound compartments (stores) is a key event of cell activation. 2. The cytological nature and molecular composition of such Ca2+ stores have been the object of intense investigation in recent years. 3. Here we review: (a) the current knowledge on intracellular Ca2+ stores of Purkinje neurons at the functional, biochemical, molecular, morphological and ultrastructural level; and discuss: (b) the relationship between Ca2+ stores and the endoplasmic reticulum, and (c) the occurrence of multiple/heterogeneous Ca2+ stores.

[Dental pathology in malformation syndromes: the methodology and intervention timing]

Due to the complexity and potential vulnerability of the cranio-facial area (skull, face, nose, oral cavity), specific alterations of this region are associated to genetic and acquired malformations in a high percentage of cases (75%). Often, the specificity and extent of the pathological symptoms occurring in the cranio-facial area are the dominant aspects of the malformation syndrome according to which it is classified. When multiple development anomalies in a newborn suggest the existence of a syndrome, the patient should be placed in the care of a pediatrician, who, together with a team of specialists, will follow the child and face the various problems related to the syndrome at the right time. The frequent marked involvement of the craniofacial area in malformation syndromes suggests the opportunity of a specialist methodology to standardize odontostomatological therapy.

Intracellular Ca2+ stores of rat cerebellum: heterogeneity within and distinction from endoplasmic reticulum

Rat cerebellum microsomes were subfractionated on isopycnic linear sucrose (20-42%)-density gradients. The distribution of endoplasmic reticulum (ER) markers (RNA, signal-sequence receptor alpha, calnexin, calreticulin, the immunoglobulin-binding protein Bip) and markers of intracellular rapidly exchanging Ca2+ stores [Ca2+ channels sensitive to either Ins(1,4,5)P3 or ryanodine) was investigated biochemically and immunologically. The comparison indicates that: (a) vesicles bearing the InsP3 receptor were separated from those bearing the ryanodine receptor; (b) ER markers, i.e. Bip, calnexin, signal-sequence receptor alpha, RNA, did not sediment as either InsP3 or ryanodine receptors did; (c) calreticulin, an intralumenal low-affinity high-capacity Ca(2+)-binding protein, had a widespread distribution, similar to that of Bip and calnexin, and was present in Purkinje, granule, Golgi and stellate neurons, as indicated by immunofluorescent labelling of cerebellum cortex cryosections. The present results show that the ER is not a homogeneous entity, and that Ca2+ stores are heterogeneous insofar as InsP3 receptors and ryanodine receptors are segregated, either to discrete intracellular organelles or to specialized ER subcompartments.

The endoplasmic reticulum-sarcoplasmic reticulum connection: distribution of endoplasmic reticulum markers in the sarcoplasmic reticulum of skeletal muscle fibers

The skeletal muscle sarcoplasmic reticulum (SR) was investigated for the presence of well-known endoplasmic reticulum (ER) markers: the lumenal protein BiP and a group of membrane proteins recognized by an antibody raised against ER membrane vesicles. Western blots of SR fractions revealed the presence of BiP in fast- and slow-twitch muscles of the rabbit as well as in rat and chicken muscles. Analyses of purified SR subfractions, together with cryosection immunofluorescence and immunogold labeling, revealed BiP evenly distributed within the longitudinal SR and the terminal cisternae. Within the terminal cisternae BiP appeared not to be mixed with calsequestrin but to be distributed around the aggregates of the latter Ca2+ binding protein. Of the various membrane markers only calnexin (91 kDa) was found to be distributed within both SR subfractions, whereas the other markers (apparent molecular masses of 64 kDa and 58 kDa and a doublet around 28 kDa) were concentrated in the terminal cisternae. These results suggest that the SR is a specialized ER subcompartment in which general markers, such as the ones we have investigated, coexist with the major SR proteins specifically responsible for Ca2+ uptake, storage, and release. The differential distribution of the ER markers reveals new aspects of the SR molecular structure that might be of importance for the functioning of the endomembrane system.

Diagnostic CT scan findings in an adult case of acute disseminated leuco-encephalitis

A complex neurological syndrome, which rapidly appeared in a 54-year-old woman, created strong diagnostic difficulties. In fact, while the carotid-angiography was negative and CSF not significant, the scintigraphy suggested a multifocal metastatic or infarctual pathology. The CT scan easily allowed us to resolve the diagnostic problem, showing in the oval centres numerous enhanced areas which were consistent with a disseminated leuco-encephalitis. This case confirmed the opinion of the authors that CT scan may usefully contribute to the diagnosis of the demyelinating disorders of CNS.

Effects of intravenous infusion of glycerol on regional cerebral blood flow in cerebral infarction

Regional cerebral blood flow and its autoregulation after intravenous glycerol infusion have been studied in eight patients in the acute phase of cerebral infarction. Glycerol seems to improve the cerebral blood flow in the damaged region but does not seem to restore autoregulation.

[Primary malignant tumor of the liver in children]

Primary malignant tumours of the liver in children are rare. They occur in more than 50% of cases before the age of 2 years. The clinical signs are very often limited to a large mass in the right hypochrondrium. A search for alphafoetoprotein and arteriography are the most useful investigations for diagnosis. The pathology leads one to distinguish hepatoblastomas and hepatocarcinomas. The prognosis in these tumours remains poor for, in spite of progress in liver surgery, a cure is rarely possible. It is important for doctors to recognize the existence of this tumour pathology in order to give a chance for surgery to succeed in these young children. To illustrate this, 5 cases from Besançon are reported here.