Accuracy of contrast-enhanced CT and predictive factors for extracapsular spread in unknown primary head and neck squamous cell cancer.

AIM: To determine the accuracy of contrast-enhanced computed tomography (CECT) for nodal extracapsular spread (ECS) and identify predictive radiological signs and clinicopathological features for ECS in unknown-primary head and neck squamous cell cancer (UPHNSCC). MATERIALS AND METHODS: The CECT imaging of patients who underwent primary neck dissection for UPHNSCC during 2011-2015 was analysed. The largest pathological-looking node at each radiologically involved level was evaluated in consensus by two head and neck radiologists. Parameters included longest diameter, margin sharpness, haziness in adjacent fat, necrosis, and loss of fat plane with adjacent structures. Independent assessment was also made regarding the presence/absence of ECS. Findings and clinicopathological parameters were correlated with histopathology. RESULTS: Thirty-one patients with 39 neck levels had metastatic nodal involvement determined on CECT. Confirmed ECS was found at 26 levels in 23 patients. Sensitivity of radiological assessment for ECS by nodal level was 81-85% (95% confidence interval [CI]=65-93%) and specificity 46-54% (95% CI=19-81%); kappa 0.87. On univariate analysis based on the largest involved node per patient, longest diameter being ≥30 mm (p=0.007), haziness in adjacent fat (p=0.023), increasing age (p=0.006), and more advanced pathological nodal status (p=0.027) were statistically significantly associated with ECS. Haziness and increasing age were independent predictors on multivariate analysis (odds ratio [OR]=26.4 and 1.24). CONCLUSION: Expert assessment of ECS on CECT had good sensitivity with excellent interobserver agreement. A longest nodal diameter of ≥30 mm, haziness in the surrounding fat on CECT, advanced pathological nodal status, and advancing patient age were significantly associated with ECS in UPHNSCC patients, findings not previously reported.

Paediatric orbital cellulitis and the relationship to underlying sinonasal anatomy on computed tomography.

OBJECTIVE: To assess if there is an association between sinonasal anatomical variants and the risk of developing orbital cellulitis and associated complications, in children. METHODS: A retrospective case-control series was conducted, examining computed tomography confirmed sinonasal anatomical variants of septal deviation and concha bullosa in children who presented with periorbital cellulitis who went on to develop orbital cellulitis and abscesses. RESULTS: Thirty children had a Chandler score of 2 or greater on computed tomography. Mean age was seven years and there was relatively equal sex distribution. There was no association between presence of concha bullosa and side of disease (odds ratio = 1), and no statistically significant difference between septal deviation and ipsilateral orbital infection (p = 0.125). CONCLUSION: There was no statistical correlation between any sinonasal bony or cartilaginous anatomical variants on computed tomography and orbital complications of acute rhinosinusitis in our paediatric cohort. The findings do not support the theory that these anatomical variants predispose to orbital cellulitis occurring in these children, nor complications thereof.

Cervicofacial emphysema following Harmonic scalpel tonsillectomy: case report and comprehensive review of the literature.

BACKGROUND: Tonsillectomy is one of the most common surgical procedures performed worldwide. There are a handful of common complications, with bleeding being the most feared; however, rarer complications can present to a wide range of medical professionals. METHODS: A 12-year-old girl presented with cervicofacial emphysema following tonsillectomy. This paper discusses the case and the management adopted, and presents the findings of a comprehensive literature review. RESULTS: The patient made a full recovery, and was discharged after 3 days following conservative management with intravenous broad-spectrum antibiotics and supplemental low-flow oxygen. CONCLUSION: This paper presents the first reported case of cervicofacial emphysema following Harmonic scalpel tonsillectomy. Although this is an exceptionally rare complication, it is potentially serious and warrants further description to improve awareness.

The tracheostomy clinical nurse specialist: an essential member of the multidisciplinary team.

BACKGROUND: Tracheostomies are a common procedure within the specialties of otolaryngology and intensive care. The ENT department at Monklands Hospital has developed the position of tracheostomy clinical nurse specialist to improve the management of tracheostomy patients. There is evidence to support the development of a multidisciplinary team for the management of tracheostomy patients following intensive care unit treatment; however, the creation of a specific tracheostomy clinical nurse specialist position has not been widely endorsed in the literature. OBJECTIVE: This paper describes the role of the tracheostomy clinical nurse specialist, advocating this position within the multidisciplinary team.

NO vascular control in Duchenne muscular dystrophy.

A new investigation into Duchenne muscular dystrophy (DMD) pathogenesis suggests that at least part of the muscle degeneration observed in DMD patients may result from the reduced production of muscle membrane-associated neuronal nitric oxide synthase. This reduction may lead to impaired regulation of the vasoconstrictor response and eventual muscle damage.

Assembly of the dystrophin-associated protein complex does not require the dystrophin COOH-terminal domain.

Dystrophin is a multidomain protein that links the actin cytoskeleton to laminin in the extracellular matrix through the dystrophin associated protein (DAP) complex. The COOH-terminal domain of dystrophin binds to two components of the DAP complex, syntrophin and dystrobrevin. To understand the role of syntrophin and dystrobrevin, we previously generated a series of transgenic mouse lines expressing dystrophins with deletions throughout the COOH-terminal domain. Each of these mice had normal muscle function and displayed normal localization of syntrophin and dystrobrevin. Since syntrophin and dystrobrevin bind to each other as well as to dystrophin, we have now generated a transgenic mouse deleted for the entire dystrophin COOH-terminal domain. Unexpectedly, this truncated dystrophin supported normal muscle function and assembly of the DAP complex. These results demonstrate that syntrophin and dystrobrevin functionally associate with the DAP complex in the absence of a direct link to dystrophin. We also observed that the DAP complexes in these different transgenic mouse strains were not identical. Instead, the DAP complexes contained varying ratios of syntrophin and dystrobrevin isoforms. These results suggest that alternative splicing of the dystrophin gene, which naturally generates COOH-terminal deletions in dystrophin, may function to regulate the isoform composition of the DAP complex.

Molecular and genetic characterization of sarcospan: insights into sarcoglycan-sarcospan interactions.

Autosomal recessive limb girdle muscular dystrophies 2C-2F represent a family of diseases caused by primary mutations in the sarcoglycan genes. We show that sarcospan, a novel tetraspan-like protein, is also lost in patients with either a complete or partial loss of the sarcoglycans. In particular, sarcospan was absent in a gamma-sarcoglycanopathy patient with normal levels of alpha-, beta- and delta-sarcoglycan. Thus, it is likely that assembly of the complete, tetrameric sarcoglycan complex is a prerequisite for membrane targeting and localization of sarcospan. Based on our findings that sarcospan is integrally associated with the sarcoglycans, we screened >50 autosomal recessive muscular dystrophy cases for mutations in sarcospan. Although we identified three intragenic polymorphisms, we did not find any cases of muscular dystrophy associated with primary mutations in the sarcospan gene. Finally, we have identified an important case of limb girdle muscular dystrophy and cardiomyopathy with normal expression of sarcospan. This patient has a primary mutation in the gamma-sarcoglycan gene, which causes premature truncation of gamma-sarcoglycan without affecting assembly of the mutant gamma-sarcoglycan into a complex with alpha-, beta- and delta-sarcoglycan and sarcospan. This is the first demonstration that membrane expression of a mutant sarcoglycan-sarcospan complex is insufficient in preventing muscular dystrophy and cardiomyopathy and that the C-terminus of gamma-sarcoglycan is critical for the functioning of the entire sarcoglycan-sarcospan complex. These findings are important as they contribute to a greater understanding of the structural determinants required for proper sarcoglycan-sarcospan expression and function.

Biosynthesis of dystroglycan: processing of a precursor propeptide.

Dystroglycan is a cytoskeleton-linked extracellular matrix receptor expressed in many cell types. Dystroglycan is composed of alpha- and beta-subunits which are encoded by a single mRNA. Using a heterologous mammalian expression system, we provide the first biochemical evidence of the alpha/beta-dystroglycan precursor propeptide prior to enzymatic cleavage. This 160 kDa dystroglycan propeptide is processed into alpha- and beta-dystroglycan (120 kDa and 43 kDa, respectively). We also demonstrate that the precursor propeptide is glycosylated and that blockade of asparagine-linked (N-linked) glycosylation did not prevent the cleavage of the dystroglycan precursor peptide. However, inhibition of N-linked glycosylation results in aberrant trafficking of the alpha- and beta-dystroglycan subunits to the plasma membrane. Thus, dystroglycan is synthesized as a precursor propeptide that is post-translationally cleaved and differentially glycosylated to yield alpha- and beta-dystroglycan.

Membrane targeting and stabilization of sarcospan is mediated by the sarcoglycan subcomplex.

The dystrophin-glycoprotein complex (DGC) is a multisubunit complex that spans the muscle plasma membrane and forms a link between the F-actin cytoskeleton and the extracellular matrix. The proteins of the DGC are structurally organized into distinct subcomplexes, and genetic mutations in many individual components are manifested as muscular dystrophy. We recently identified a unique tetraspan-like dystrophin-associated protein, which we have named sarcospan (SPN) for its multiple sarcolemma spanning domains (Crosbie, R.H., J. Heighway, D.P. Venzke, J.C. Lee, and K.P. Campbell. 1997. J. Biol. Chem. 272:31221-31224). To probe molecular associations of SPN within the DGC, we investigated SPN expression in normal muscle as a baseline for comparison to SPN's expression in animal models of muscular dystrophy. We show that, in addition to its sarcolemma localization, SPN is enriched at the myotendinous junction (MTJ) and neuromuscular junction (NMJ), where it is a component of both the dystrophin- and utrophin-glycoprotein complexes. We demonstrate that SPN is preferentially associated with the sarcoglycan (SG) subcomplex, and this interaction is critical for stable localization of SPN to the sarcolemma, NMJ, and MTJ. Our experiments indicate that assembly of the SG subcomplex is a prerequisite for targeting SPN to the sarcolemma. In addition, the SG- SPN subcomplex functions to stabilize alpha-dystroglycan to the muscle plasma membrane. Taken together, our data provide important information about assembly and function of the SG-SPN subcomplex.

Progressive muscular dystrophy in alpha-sarcoglycan-deficient mice.

Limb-girdle muscular dystrophy type 2D (LGMD 2D) is an autosomal recessive disorder caused by mutations in the alpha-sarcoglycan gene. To determine how alpha-sarcoglycan deficiency leads to muscle fiber degeneration, we generated and analyzed alpha-sarcoglycan- deficient mice. Sgca-null mice developed progressive muscular dystrophy and, in contrast to other animal models for muscular dystrophy, showed ongoing muscle necrosis with age, a hallmark of the human disease. Sgca-null mice also revealed loss of sarcolemmal integrity, elevated serum levels of muscle enzymes, increased muscle masses, and changes in the generation of absolute force. Molecular analysis of Sgca-null mice demonstrated that the absence of alpha-sarcoglycan resulted in the complete loss of the sarcoglycan complex, sarcospan, and a disruption of alpha-dystroglycan association with membranes. In contrast, no change in the expression of epsilon-sarcoglycan (alpha-sarcoglycan homologue) was observed. Recombinant alpha-sarcoglycan adenovirus injection into Sgca-deficient muscles restored the sarcoglycan complex and sarcospan to the membrane. We propose that the sarcoglycan-sarcospan complex is requisite for stable association of alpha-dystroglycan with the sarcolemma. The Sgca-deficient mice will be a valuable model for elucidating the pathogenesis of sarcoglycan deficient limb-girdle muscular dystrophies and for the development of therapeutic strategies for this disease.

Caveolin-3 is not an integral component of the dystrophin glycoprotein complex.

The dystrophin-glycoprotein complex is a multi-subunit protein complex that spans the muscle plasma membrane (sarcolemma) and forms a link between the intracellular cytoskeleton and the extracellular matrix. Caveolin-3, the muscle specific form of caveolin, is also a major structural and regulatory integral membrane protein found at the sarcolemma. Oligomers of caveolin-3 form the structural framework for small membrane pockets known as caveolae. We directly examined whether caveolin-3 is an integral component of the dystrophin-glycoprotein complex by examining four common biochemical and cellular properties of proteins integrally bound to the dystrophin-glycoprotein complex. We found that caveolin-3 de-enriches with partial purification of the dystrophin-glycoprotein complex although a small amount of caveolin-3 is present. Sucrose gradient fractionation and laminin affinity chromatography completely separate this residual caveolin-3 from the core components of the dystrophin-glycoprotein complex. We also show that caveolin-3 expression at the sarcolemma is not reduced in patients with primary mutations in either dystrophin or the sarcoglycans. This data demonstrates that localization of caveolin-3 to the sarcolemma occurs independently of the dystrophin-glycoprotein complex and that caveolin-3 is not an integral component of the dystrophin-glycoprotein complex.

mdx muscle pathology is independent of nNOS perturbation.

In skeletal muscle, neuronal nitric oxide synthase (nNOS) is anchored to the sarcolemma via the dystrophin-glycoprotein complex. When dystrophin is absent, as in Duchenne muscular dystrophy patients and in mdx mice, nNOS is mislocalized to the interior of the muscle fiber where it continues to produce nitric oxide. This has led to the hypothesis that free radical toxicity from mislocalized nNOS may contribute to mdx muscle pathology. To test this hypothesis directly, we generated mice devoid of both nNOS and dystrophin. Overall, the nNOS-dystrophin null mice maintained the dystrophic characteristics of mdx mice. We evaluated the mice for several features of the dystrophic phenotype, including membrane damage and muscle morphology. Removal of nNOS did not alter the extent of sarcolemma damage, which is a hallmark of the dystrophic phenotype. Furthermore, muscle from nNOS-dystrophin null mice maintain the histological features of mdx pathology. Our results demonstrate that relocalization of nNOS to the cytosol does not contribute significantly to mdx pathogenesis.

Sarcospan, the 25-kDa transmembrane component of the dystrophin-glycoprotein complex.

The dystrophin-glycoprotein complex is a multisubunit protein complex that spans the sarcolemma and forms a link between the subsarcolemmal cytoskeleton and the extracellular matrix. Primary mutations in the genes encoding the proteins of this complex are associated with several forms of muscular dystrophy. Here we report the cloning and characterization of sarcospan, a unique 25-kDa member of this complex. Topology algorithms predict that sarcospan contains four transmembrane spanning helices with both N- and C-terminal domains located intracellularly. Phylogenetic analysis reveals that sarcospan's arrangement in the membrane as well as its primary sequence are similar to that of the tetraspan superfamily of proteins. Sarcospan co-localizes and co-purifies with the dystrophin-glycoprotein complex, demonstrating that it is an integral component of the complex. We also show that sarcospan expression is dramatically reduced in muscle from patients with Duchenne muscular dystrophy. This suggests that localization of sarcospan to the membrane is dependent on proper dystrophin expression. The gene encoding sarcospan maps to human chromosome 12p11.2, which falls within the genetic locus for congenital fibrosis of the extraocular muscle, an autosomal dominant muscular dystrophy.

Flexation of caldesmon: effect of conformation on the properties of caldesmon.

The contribution of the extended and bent forms of caldesmon to its function was investigated by examining chemically modified forms of this protein. The bent 'hairpin' form of caldesmon was enhanced between pH 6.0 and 8.0 and at low ionic strengths, as reported by an increase in excimer fluorescence of pyrene-labelled caldesmon under these conditions. The presence of nucleotides also produced significant conformational changes in caldesmon, as detected by fluorescence measurements and protease digestions. Titrations of pyrene caldesmon with actin, heavy meromyosin, and calmodulin resulted in a decrease in excimer fluorescence. The function of the bent form of caldesmon was investigated by using intramolecular 1-ethyl-3-(3-dimethylamino propyl) carbodiimide-crosslinked caldesmon. The inhibition of acto-S-1 ATPase activity by crosslinked caldesmon was less efficient compared with that by pyrene modified and control caldesmons. Caldesmon's ability to switch from an activator to an inhibitor of actin-activated ATPase of myosin was also affected by the folding. Cosedimentation experiments revealed normal binding of crosslinked caldesmon to smooth muscle myosin. These results indicate the importance of caldesmon's transition from extended to folded forms and suggest possible functional roles for these different forms of caldesmon.

Structural connectivity in actin: effect of C-terminal modifications on the properties of actin.

In this study, we use fluorescent probes and proteolytic digestions to demonstrate structural coupling between distant regions of actin. We show that modifications of Cys-374 in the C-terminus of actin slow the rate of nucleotide exchange in the nucleotide cleft. Conformational coupling between the C-terminus and the DNasal loop in subdomain II is observed in proteolytic digestion experiments in which a new C-terminal cleavage site is exposed upon DNasel binding. The functional consequences of C-terminal modification are evident from S-1 ATPase activity and the in vitro motility experiments with modified actins. Pyrene actin, labeled at Cys-374, activates S-1 ATPase activity only half as well as control actin. This reduction is attributed to a lower Vmax value because the affinity of pyrene actin to S-1 is not significantly altered. The in vitro sliding velocity of pyrene actin is also decreased. However, IAEDANS labeling of actin (also at Cys-374) enhances the Vmax of acto-S-1 ATPase activity and the in vitro sliding velocity by approximately 25%. These results are discussed in terms of conformational coupling between distant regions in actin and the functional implications of the interactions of actin-binding proteins with the C-terminus of actin.

Caldesmon, N-terminal yeast actin mutants, and the regulation of actomyosin interactions.

N-Terminal yeast actin mutants were used to assess the role of N-terminal acidic residues in the interactions of caldesmon with actin. The yeast actins differed only in their N-terminal charge: wild type, two negative charges; 4Ac, four negative charges; DNEQ, neutral charge; delta DSE, one positive charge. Caldesmon inhibition of actomyosin subfragment 1 ATPase was affected by alterations in the N-terminus of actin. This inhibition was similar for skeletal muscle alpha-actin and the yeast 4Ac and wild-type actins (80%), but much smaller for the neutral and deletion mutants (15%). However, cosedimentation experiments revealed similar binding of caldesmon to polymerized rabbit skeletal muscle alpha-actin and each yeast actin. This result shows that the N-terminal acidic residues of actin are not required for the binding of caldesmon to F-actin. Caldesmon-actin interactions were also examined by monitoring the polymerization of G-actin induced by caldesmon. Although the final extent of polymerization was similar for all actins tested, the rates of polymerization differed. Skeletal muscle and 4Ac actins had similar rates of polymerization, and the wild-type actin polymerized at a slower rate. The neutral and deletion mutants had even slower rates of polymerization by caldesmon. The slow polymerization of DNEQ G-actin was traced to a greatly reduced binding of caldesmon to this mutant G-actin when compared to wild-type and alpha-actin. MgCl2-induced actin polymerization proceeded at identical rates for all actins.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction of caldesmon and myosin subfragment 1 with the C-terminus of actin.

The interactions of caldesmon and S1 with the C-terminus of actin were examined in co-sedimentation experiments using proteolytically truncated actin. It is shown that removal of 6 residues from the C-terminus of actin reduces the binding of caldesmon by about 50% while improving the binding of S1 to actin. We also show that S1 protects actin's C-terminus from enzymatic cleavage. Both S1 and caldesmon binding to actin are decreased in the presence of an actin C-terminal peptide. These results emphasize the importance of the C-terminus of actin in binding to S1 and caldesmon.