Failure mechanisms of anterior cruciate ligament prostheses: in vitro wear study

Previous retrieval studies analyzing the cause of failure of anterior cruciate ligament (ACL) prostheses identified a wear mechanism. However, the relative importance of yarn on bone compared to yarn on yarn wear has not been clearly understood. Therefore, the objective of this study was to elucidate which type of wear is the dominant cause of clinical failure. A variety of ACL prosthetic structures were exposed to two in vitro tests: one for yarn on yarn and the other for a novel yarn on bone wear test system. The latter included the use of both smooth (uncut) and rough (cut) bone surfaces to simulate the conditions around the condyle and at the exit of the tibial tunnel, respectively. The damaged textile structures were viewed by SEM. The various fiber fracture morphologies were identified and classified for the two types of wear tests; for the smooth and rough bone surfaces; for the braided, knitted, woven, and twisted textile structures; and for the three types of fibers that were included: polyethylene terephthalate, polypropylene, and ultrahigh molecular weight polyethylene. The results confirmed that yarn on bone and yarn on yarn wear phenomena are associated with significantly different failure mechanisms. While the more aggressive rough (or cut) bone causes more rapid and intense fiber damage and faster ACL failure than the smooth (uncut) osseous surface, both abradants cause the same type of abrasive wear phenomenon. Differences in failure mechanisms were identified between the different textile structures and the different fiber types. By interpreting the damaged fiber images from clinically failed and retrieved ACL prostheses, we are now able to confirm that the predominant cause of synthetic ACL failure is yarn on bone abrasion. Improvements in future ACL prosthesis designs will only be possible by eliminating or minimizing the effect of this type of abrasive wear.     

Glutamine substitution at alanine1649 in the S4-S5 cytoplasmic loop of domain 4 removes the voltage sensitivity of fast inactivation in the human heart sodium channel

Normal activation-inactivation coupling in sodium channels insures that inactivation is slow at small but rapid at large depolarizations. M1651Q/M1652Q substitutions in the cytoplasmic loop connecting the fourth and fifth transmembrane segments of Domain 4 (S4-S5/D4) of the human heart sodium channel subtype 1 (hH1) affect the kinetics and voltage dependence of inactivation (Tang, L., R.G. Kallen, and R. Horn. 1996. J. Gen. Physiol. 108:89-104.). We now show that glutamine substitutions NH2-terminal to the methionines (L1646, L1647, F1648, A1649, L1650) also influence the kinetics and voltage dependence of inactivation compared with the wild-type channel. In contrast, mutations at the COOH-terminal end of the S4-S5/D4 segment (L1654, P1655, A1656) are without significant effect. Strikingly, the A1649Q mutation renders the current decay time constants virtually voltage independent and decreases the voltage dependences of steady state inactivation and the time constants for the recovery from inactivation. Single-channel measurements show that at negative voltages latency times to first opening are shorter and less voltage dependent in A1649Q than in wild-type channels; peak open probabilities are significantly smaller and the mean open times are shorter. This indicates that the rate constants for inactivation and, probably, activation are increased at negative voltages by the A1649Q mutation reminiscent of Y1494Q/ Y1495Q mutations in the cytoplasmic loop between the third and fourth domains (O'Leary, M.E., L.Q. Chen, R.G. Kallen, and R. Horn. 1995. J. Gen. Physiol. 106:641-658.). Other substitutions, A1649S and A1649V, decrease but fail to eliminate the voltage dependence of time constants for inactivation, suggesting that the decreased hydrophobicity of glutamine at either residues A1649 or Y1494Y1495 may disrupt a linkage between S4-S5/D4 and the interdomain 3-4 loop interfering with normal activation-inactivation coupling.     

Calmodulin point mutations affect Drosophila development and behavior

Calmodulin (CAM) is recognized as a major intermediary in intracellular calcium signaling, but as yet little is known of its role in developmental and behavioral processes. We have generated and studied mutations to the endogenous Cam gene of Drosophila melanogaster that change single amino acids within the protein coding region. One of these mutations produces a striking pupal lethal phenotype involving failure of head eversion. Various mutant combinations produce specific patterns of ectopic wing vein formation or melanotic scabs on the cuticle. Anaphase chromosome bridging is also seen as a maternal effect during the early embryonic nuclear divisions. In addition, specific behavioral defects such as poor climbing and flightlessness are detected among these mutants. Comparisons with other Drosophila mutant phenotypes suggests potential CAM targets that may mediate these developmental and behavioral effects, and analysis of the CAM crystal structure suggests the structural consequences of the individual mutations.     

A conserved functional domain of Drosophila coracle is required for localization at the septate junction and has membrane-organizing activity

The protein 4.1 superfamily is comprised of a diverse group of cytoplasmic proteins, many of which have been shown to associate with the plasma membrane via binding to specific transmembrane proteins. Coracle, a Drosophila protein 4.1 homologue, is required during embryogenesis and is localized to the cytoplasmic face of the septate junction in epithelial cells. Using in vitro mutagenesis, we demonstrate that the amino-terminal 383 amino acids of Coracle define a functional domain that is both necessary and sufficient for proper septate junction localization in transgenic embryos. Genetic mutations within this domain disrupt the subcellular localization of Coracle and severely affect its genetic function, indicating that correct subcellular localization is essential for Coracle function. Furthermore, the localization of Coracle and the transmembrane protein Neurexin to the septate junction display an interdependent relationship, suggesting that Coracle and Neurexin interact with one another at the cytoplasmic face of the septate junction. Consistent with this notion, immunoprecipitation and in vitro binding studies demonstrate that the amino-terminal 383 amino acids of Coracle and cytoplasmic domain of Neurexin interact directly. Together these results indicate that Coracle provides essential membrane-organizing functions at the septate junction, and that these functions are carried out by an amino-terminal domain that is conserved in all protein 4.1 superfamily members.     

Characterization of the breakpoints in unbalanced t(5;11)(p15;p15) constitutional chromosome translocations in two patients with beckwith-wiedemann syndrome using fluorescence in situ hybridisation

Although the majority of patients with Beckwith-Wiedemann syndrome (BWS) have a normal karyotype, the study of those rare patients with a cytogenetic abnormality has given considerable insight into the genetics of this condition. The karyotypic abnormalities found include partial chromosome duplications of paternal origin and maternally derived translocations which usually involve the 11p15 region and provide one of the lines of evidence for the location of the BWS gene(s). Because the extent of the duplicated region in these patients is variable, the phenotypic expression of BWS is presumably due to the presence of a common duplicated region. Two unrelated patients with BWS were both noted to have a similar unbalanced t(5;11)(p15;p14) translocation. The parents in both families were unaffected but both fathers carried a balanced translocation involving the same chromosomes. Since the extent and nature of the duplication apparently determines the complex phenotypes seen in these patients, we undertook a detailed analysis of the extent of the triplicated region using fluorescent in situ hybrisation (FISH). Despite having markedly different phenotypes and presenting in disimilar ways the two patients had apparently identical duplication breakpoints.     

A longitudinal study of schoolchildren's experience in the North Carolina Dental Medicaid Program, 1984 through 1992

OBJECTIVES: This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. METHODS: Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment files from 1984 through 1992. RESULTS: Half of Medicaid-enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. CONCLUSIONS: Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care.     

Effect of topical oral G-CSF on oral mucositis: a randomised placebo-controlled trial

Oral mucositis is a dose-limiting toxicity of intensive chemotherapy. It is caused directly by the cytotoxic effect of chemotherapeutic agents and indirectly by sustained neutropenia. Severe oral mucositis is an important predisposing factor for life-threatening septic complications during aplasia. It also reduces quality of life. At present, no effective causal prophylaxis or treatment against oral mucositis is established. We performed a prospective randomised placebo-controlled trial using topical oral r-metHuG-CSF (filgrastim) in high-grade lymphoma patients treated according to the B-NHL protocol, which contains high-dose methotrexate and causes severe oral mucositis (WHO grades I-IV) in >50% of patients. Between August 1996 and July 1997, a total of 32 chemotherapy cycles were documented in eight patients (four male, four female). Mucosal erythema and ulceration were recorded. All patients assessed their oral pain and impact on swallowing daily, using a subjective scale from no to maximal discomfort (1-10). In addition, oral mucositis was assessed according to the WHO score. Filgrastim was administered in 16 cycles as a viscous mouthrinse (carboxymethylcellulose 2%, oleum citrii) 4 x 120 microg/day from days 10 to 16. Sixteen cycles were given to control patients, of these 14 with placebo, and another two cycles with no treatment. Severe mucositis (WHO grade III/IV) was documented in 21 of 32 cycles (65.5%). A difference of borderline significance was observed for the reduction of maximum severity of oral mucositis between G-CSF vs placebo (P = 0.058), with a reduction of WHO grade IV of 50% (four G-CSF vs eight control). The number of days in hospital was reduced significantly in the G-CSF group (P = 0.02). In conclusion, topical oral G-CSF mouthrinses may be beneficial to reduce oral mucositis.