Strong evidence for age as the single most dominant predictor of medically supervised driving test-mini mental status test outcomes provide only weak but significant moderate additional predictive value.

BACKGROUND: With age, medical conditions impairing safe driving accumulate. Consequently, the risk of accidents increases. To mitigate this risk, Swiss law requires biannual assessments of the fitness to drive of elderly drivers. Drivers may prove their cognitive and physical capacity for safe driving in a medically supervised driving test (MSDT) when borderline cases, as indicated by low performance in a set of four cognitive tests, including e.g. the mini mental status test (MMST). Any prognostic, rather than indicative, relations for MSDT outcomes have neither been confirmed nor falsified so far. In order to avoid use of unsubstantiated rules of thumb, we here evaluate the predictive value for MSDT outcomes of the outcomes of the standard set of four cognitive tests, used in Swiss traffic medicine examinations. METHODS: We present descriptive information on age, gender and cognitive pretesting results of all MSDTs recorded in our case database from 2017 to 2019. Based on these retrospective cohort data, we used logistic regression to predict the binary outcome MSDT. An exploratory analysis used all available data (model 1). Based on the Akaike Information Criterion (AIC), we then established a model including variables age and MMST (model 2). To evaluate the predictive value of the four cognitive assessments, model 3 included cognitive test outcomes only. Receiver operating characteristics (ROC) and area under the curve (AUC) allowed evaluating discriminative performance of the three different models using independent validation data. RESULTS: Using N = 188 complete data sets of a total of 225 included cases, AIC identified age (p < 0.0008) and MMST (p = 0.024) as dominating predictors for MSDT outcomes with a median AUC of 0.71 (95%-CI 0.57-0.85) across different training and validation splits, while using the four cognitive test results exclusively yielded a median AUC of 0.55 (95%-CI 0.40-0.71). CONCLUSIONS: Our analysis provided strong evidence for age as the single most dominant predictor of MSDT outcomes. Adding MMST provides only weak additional predictive value for MSDT outcomes. Combining the results of four cognitive test used as standard screen in Swiss traffic medicine alone, proved to be of poor predictive value. This highlights the importance of MSDTs for balancing between the mitigation of risks by and the right to drive for the elderly.

[(Daytime-)Sleepiness at the Wheel: Conceptual Basics for the Evaluation of the Fitness to Drive]. / (Tages-)Schläfrigkeit am Steuer: begriffliche Grundlagen zur Beurteilung der Fahreignung.

(Daytime-)Sleepiness at the Wheel: Conceptual Basics for the Evaluation of the Fitness to Drive Abstract. The number of accidents that are caused because the driver fell asleep is most likely underestimated. Clear signs of sleepiness are either misinterpreted or ignored. Independent of whether sleepiness is caused by behavior or a medical condition, the short-term and maybe even long-term fitness-to-drive is not given. Despite clear criteria for sleepiness from guidelines, medical reports and practice use a number of paraphrasing and thus misleading terms. To improve clarity in reports and to prepare future research projects, we present our understanding of such terms and suggest a more selective overall use.

[Daytime Sleepiness in Patients with Restless Legs Syndrome: A Risk Factor for Traffic Accidents?] / Tagesschläfrigkeit bei Patienten mit Restless-Legs-Syndrom: Risikofaktor für Verkehrsunfälle?

Daytime Sleepiness in Patients with Restless Legs Syndrome: A Risk Factor for Traffic Accidents? Abstract. Restless legs syndrome (RLS) is a symptom complex of predominantly leg-focused paraesthesias and the associated increased urge to move. Since evening exacerbations are typical, many patients suffer from sleep disorders, which can lead to increased daytime fatigue in the long term. The present retrospective data analysis investigated a potentially relevant relationship between RLS and an increased incidence of traffic accidents due to daytime sleepiness in Swiss road traffic. A direct correlation between RLS and the occurrence of traffic accidents could not be found. Nevertheless, the question of increased daytime sleepiness should not be absent from any (traffic) medical discussion.

Acoustic Compressibility of Caenorhabditis elegans.

The acoustic compressibility of Caenorhabditis elegans is a necessary parameter for further understanding the underlying physics of acoustic manipulation techniques of this widely used model organism in biological sciences. In this work, numerical simulations were combined with experimental trajectory velocimetry of L1 C. elegans larvae to estimate the acoustic compressibility of C. elegans. A method based on bulk acoustic wave acoustophoresis was used for trajectory velocimetry experiments in a microfluidic channel. The model-based data analysis took into account the different sizes and shapes of L1 C. elegans larvae (255 ± 26 µm in length and 15 ± 2 µm in diameter). Moreover, the top and bottom walls of the microfluidic channel were considered in the hydrodynamic drag coefficient calculations, for both the C. elegans and the calibration particles. The hydrodynamic interaction between the specimen and the channel walls was further minimized by acoustically levitating the C. elegans and the particles to the middle of the measurement channel. Our data suggest an acoustic compressibility κCe of 430 TPa-1 with an uncertainty range of ±20 TPa-1 for C. elegans, a much lower value than what was previously reported for adult C. elegans using static methods. Our estimated compressibility is consistent with the relative volume fraction of lipids and proteins that would mainly make up for the body of C. elegans. This work is a departing point for practical engineering and design criteria for integrated acoustofluidic devices for biological applications.

Imaging the position-dependent 3D force on microbeads subjected to acoustic radiation forces and streaming.

Acoustic particle manipulation in microfluidic channels is becoming a powerful tool in microfluidics to control micrometer sized objects in medical, chemical and biological applications. By creating a standing acoustic wave in the channel, the resulting pressure field can be employed to trap or sort particles. To design efficient and reproducible devices, it is important to characterize the pressure field throughout the volume of the microfluidic device. Here, we used an optically trapped particle as probe to measure the forces in all three dimensions. By moving the probe through the volume of the channel, we imaged spatial variations in the pressure field. In the direction of the standing wave this revealed a periodic energy landscape for 2 µm beads, resulting in an effective stiffness of 2.6 nN m(-1) for the acoustic trap. We found that multiple fabricated devices showed consistent pressure fields. Surprisingly, forces perpendicular to the direction of the standing wave reached values of up to 20% of the main-axis-values. To separate the direct acoustic force from secondary effects, we performed experiments with different bead sizes, which attributed some of the perpendicular forces to acoustic streaming. This method to image acoustically generated forces in 3D can be used to either minimize perpendicular forces or to employ them for specific applications in novel acoustofluidic designs.

The natural diterpene tonantzitlolone A and its synthetic enantiomer inhibit cell proliferation and kinesin-5 function.

Tonantzitlolone A, a diterpene isolated from the Mexican plant Stillingia sanguinolenta, shows cytostatic activity. Both the natural product tonantzitlolone A and its synthetic enantiomer induce monoastral spindle formation in cell experiments which indicates inhibitory activity on kinesin-5 mitotic motor molecules. These inhibitory effects on kinesin-5 could be verified in in vitro single-molecule motility assays, where both tonantzitlolones interfered with kinesin-5 binding to its cellular interaction partner microtubules in a concentration-dependent manner, yet with a larger effect of the synthetic enantiomer. In contrast to kinesin-5 inhibition, both tonantzitlolone A enantiomers did not affect conventional kinesin-1 function; hence tonantzitlolones are not unspecific kinesin inhibitors. The observed stronger inhibitory effect of the synthetic enantiomer demonstrates the possibility to enhance the overall moderate anti-proliferative effect of the lead compound tonantzitlolon A by chemical modification.

Direct 2D measurement of time-averaged forces and pressure amplitudes in acoustophoretic devices using optical trapping.

Ultrasonic standing waves are increasingly applied in the manipulation and sorting of micrometer-sized particles in microfluidic cells. To optimize the performance of such devices, it is essential to know the exact forces that the particles experience in the acoustic wave. Although much progress has been made via analytical and numerical modeling, the reliability of these methods relies strongly on the assumptions used, e.g. the boundary conditions. Here, we have combined an acoustic flow cell with an optical laser trap to directly measure the force on a single spherical particle in two dimensions. While performing ultrasonic frequency scans, we measured the time-averaged forces on single particles that were moved with the laser trap through the microfluidic cell. The cell including piezoelectric transducers was modeled with finite element methods. We found that the experimentally obtained forces and the derived pressure fields confirm the predictions from theory and modeling. This novel approach can now be readily expanded to other particle, chamber, and fluid regimes and opens up the possibility of studying the effects of the presence of boundaries, acoustic streaming, and non-linear fluids.

Kinesin-5 Kip1 is a bi-directional motor that stabilizes microtubules and tracks their plus-ends in vivo.

In this study, we examined the anaphase functions of the S. cerevisiae kinesin-5 homolog Kip1. We show that Kip1 is attached to the mitotic spindle midzone during late anaphase. This attachment is essential to stabilize interpolar microtubule (iMTs) plus-ends. By detailed examination of iMT dynamics we show that at the end of anaphase, iMTs depolymerize in two stages: during the first stage, one pair of anti-parallel iMTs depolymerizes at a velocity of 7.7 µm/minute; during the second stage, ∼90 seconds later, the remaining pair of iMTs depolymerizes at a slower velocity of 5.4 µm/minute. We show that upon the second depolymerization stage, which coincides with spindle breakdown, Kip1 follows the plus-ends of depolymerizing iMTs and translocates toward the spindle poles. This movement is independent of mitotic microtubule motor proteins or the major plus-end binding or tracking proteins. In addition, we show that Kip1 processively tracks the plus-ends of growing and shrinking MTs, both inside and outside the nucleus. The plus-end tracking activity of Kip1 requires its catalytic motor function, because a rigor mutant of Kip1 does not exhibit this activity. Finally, we show that Kip1 is a bi-directional motor: in vitro, at high ionic strength conditions, single Kip1 molecules move processively in the minus-end direction of the MTs, whereas in a multi-motor gliding assay, Kip1 is plus-end directed. The bi-directionality and plus-end tracking activity of Kip1, properties revealed here for the first time, allow Kip1 to perform its multiple functions in mitotic spindle dynamics and to partition the 2-micron plasmid.

A chimeric kinesin-1 head/kinesin-5 tail motor switches between diffusive and processive motility.

Homotetrameric kinesin-5 motors are essential for chromosome separation and assembly of the mitotic spindle. These kinesins bind between two microtubules (MTs) and slide them apart, toward the spindle poles. This process must be tightly regulated in mitosis. In in vitro assays, Eg5 moves diffusively on single MTs and switches to a directed mode between MTs. How allosteric communication between opposing motor domains works remains unclear, but kinesin-5 tail domains may be involved. Here we present a single-molecule fluorescence study of a tetrameric kinesin-1 head/kinesin-5 tail chimera, DK4mer. This motor exhibited fast processive motility on single MTs interrupted by pauses. Like Eg5, DK4mer diffused along MTs with ADP, and slid antiparallel MTs apart with ATP. In contrast to Eg5, diffusive and processive periods were clearly distinguishable. This allowed us to measure transition rates among states and for unbinding as a function of buffer ionic strength. These data, together with results from controls using tail-less dimers, indicate that there are two modes of interaction with MTs, separated by an energy barrier. This result suggests a scheme of motor regulation that involves switching between two bound states, possibly allosterically controlled by the opposing tetramer end. Such a scheme is likely to be relevant for the regulation of native kinesin-5 motors.

Neck-linker length dependence of processive Kinesin-5 motility.

Processive motility of individual molecules is essential for the function of many kinesin motors. Processivity for kinesins relies on communication between the two heads of a dimeric molecule, such that binding strictly alternates. The main communicating elements are believed to be the two neck linkers connecting the motors' stalks and heads. A proposed mechanism for coordination is the transmission of stress through the neck linkers. It is believed that the efficiency of gating depends on the length of the neck linker. Recent studies have presented support for a simple model in which the length of the neck linker directly controls the degree of processivity. Based on a previously published Kinesin-1/Kinesin-5 chimera, Eg5Kin, we have analyzed the motility of 12 motor constructs: we have varied the length of the neck linker in the range between 9 and 21 amino acids using the corresponding native Kinesin-5 sequence (Xenopus laevis Eg5). We found, surprisingly, that neither velocity nor force generation depended on neck-linker length. We also found that constructs with short neck linkers, down to 12 amino acids, were still highly processive, while processivity was lost at a length of 9 amino acids. Run lengths were maximal with neck linkers close to the native Kinesin-5 length and decreased beyond that length. This finding generally confirms the coordinating role of the neck linker for kinesin motility but challenges the simplest model postulating a motor-type-independent optimal length. Instead, our results suggest that different kinesins might be optimized for different neck-linker lengths.

Directionality of individual kinesin-5 Cin8 motors is modulated by loop 8, ionic strength and microtubule geometry.

Kinesin-5 motors fulfil essential roles in mitotic spindle morphogenesis and dynamics as slow, processive microtubule (MT) plus-end directed motors. The Saccharomyces cerevisiae kinesin-5 Cin8 was found, surprisingly, to switch directionality. Here, we have examined directionality using single-molecule fluorescence motility assays and live-cell microscopy. On spindles, Cin8 motors mostly moved slowly (∼25 nm/s) towards the midzone, but occasionally also faster (∼55 nm/s) towards the spindle poles. In vitro, individual Cin8 motors could be switched by ionic conditions from rapid (380 nm/s) and processive minus-end to slow plus-end motion on single MTs. At high ionic strength, Cin8 motors rapidly alternated directionalities between antiparallel MTs, while driving steady plus-end relative sliding. Between parallel MTs, plus-end motion was only occasionally observed. Deletion of the uniquely large insert in loop 8 of Cin8 induced bias towards minus-end motility and affected the ionic strength-dependent directional switching of Cin8 in vitro. The deletion mutant cells exhibited reduced midzone-directed motility and efficiency to support spindle elongation, indicating the importance of directionality control for the anaphase function of Cin8.

The effect of monastrol on the processive motility of a dimeric kinesin-5 head/kinesin-1 stalk chimera.

Controlled activity of several kinesin motors is required for the proper assembly of the mitotic spindle. Eg5, a homotetrameric bipolar kinesin-5 from Xenopus laevis, can cross-link and slide anti-parallel microtubules apart by a motility mechanism comprising diffusional and directional modes. How this mechanism is regulated, possibly by the tail domains of the opposing motors, is poorly understood. In order to explore the basic unregulated kinesin-5 motor activity, we generated a stably dimeric kinesin-5 construct, Eg5Kin, consisting of the motor domain and neck linker of Eg5 and the neck coiled coil of Drosophila melanogaster kinesin-1 (DmKHC). In single-molecule motility assays, we found this chimera to be highly processive. In addition, we studied the effect of the kinesin-5-specific inhibitor monastrol using single-molecule fluorescence assays. We found that monastrol reduced the length of processive runs, but strikingly did not affect velocity. Quantitative analysis of monastrol dose dependence suggests that two bound monastrol molecules are required to be bound to an Eg5Kin dimer to terminate a run.

Load-dependent release limits the processive stepping of the tetrameric Eg5 motor.

Tetrameric motor proteins of the Kinesin-5 family are essential for eukaryotic cell division. The microscopic mechanism by which Eg5, the vertebrate Kinesin-5, drives bipolar mitotic spindle formation remains unknown. Here we show in optical trapping experiments that full-length Eg5 moves processively and stepwise along microtubule bundles. Interestingly, the force produced by individual Eg5 motors typically reached only approximately 2 pN, one-third of the stall force of Kinesin-1. Eg5 typically detached from microtubules before stalling. This behavior may reflect a regulatory mechanism important for the role of Eg5 in the mitotic spindle.

Back on track - on the role of the microtubule for kinesin motility and cellular function.

The evolution of cytoskeletal filaments (actin- and intermediate-filaments, and the microtubules) and their associated motor- and non-motor-proteins has enabled the eukaryotic cell to achieve complex organizational and structural tasks. This ability to control cellular transport processes and structures allowed for the development of such complex cellular organelles like cilia or flagella in single-cell organisms and made possible the development and differentiation of multi-cellular organisms with highly specialized, polarized cells. Also, the faithful segregation of large amounts of genetic information during cell division relies crucially on the reorganization and control of the cytoskeleton, making the cytoskeleton a key prerequisite for the development of highly complex genomes. Therefore, it is not surprising that the eukaryotic cell continuously invests considerable resources in the establishment, maintenance, modification and rearrangement of the cytoskeletal filaments and the regulation of its interaction with accessory proteins. Here we review the literature on the interaction between microtubules and motor-proteins of the kinesin-family. Our particular interest is the role of the microtubule in the regulation of kinesin motility and cellular function. After an introduction of the kinesin-microtubule interaction we focus on two interrelated aspects: (1) the active allosteric participation of the microtubule during the interaction with kinesins in general and (2) the possible regulatory role of post-translational modifications of the microtubule in the kinesin-microtubule interaction.

The E-hook of tubulin interacts with kinesin's head to increase processivity and speed.

Kinesins are dimeric motor proteins that move processively along microtubules. It has been proposed that the processivity of conventional kinesins is increased by electrostatic interactions between the positively charged neck of the motor and the negatively charged C-terminus of tubulin (E-hook). In this report we challenge this anchoring hypothesis by studying the motility of a fast fungal kinesin from Neurospora crassa (NcKin). NcKin is highly processive despite lacking the positive charges in the neck. We present a detailed analysis of how proteolytic removal of the E-hook affects truncated monomeric and dimeric constructs of NcKin. Upon digestion we observe a strong reduction of the processivity and speed of dimeric motor constructs. Monomeric motors with truncated or no neck display the same reduction of microtubule gliding speed as dimeric constructs, suggesting that the E-hook interacts with the head only. The E-hook has no effect on the strongly bound states of NcKin as microtubule digestion does not alter the stall forces produced by single dimeric motors, suggesting that the E-hook affects the interaction site of the kinesin.ADP-head and the microtubule. In fact, kinetic and binding experiments indicate that removal of the E-hook shifts the binding equilibrium of the weakly attached kinesin.ADP-head toward a more strongly bound state, which may explain reduced processivity and speed on digested microtubules.

Single fungal kinesin motor molecules move processively along microtubules.

Conventional kinesins are two-headed molecular motors that move as single molecules micrometer-long distances on microtubules by using energy derived from ATP hydrolysis. The presence of two heads is a prerequisite for this processive motility, but other interacting domains, like the neck and K-loop, influence the processivity and are implicated in allowing some single-headed kinesins to move processively. Neurospora kinesin (NKin) is a phylogenetically distant, dimeric kinesin from Neurospora crassa with high gliding speed and an unusual neck domain. We quantified the processivity of NKin and compared it to human kinesin, HKin, using gliding and fluorescence-based processivity assays. Our data show that NKin is a processive motor. Single NKin molecules translocated microtubules in gliding assays on average 2.14 micro m (N = 46). When we tracked single, fluorescently labeled NKin motors, they moved on average 1.75 micro m (N = 182) before detaching from the microtubule, whereas HKin motors moved shorter distances (0.83 micro m, N = 229) under identical conditions. NKin is therefore at least twice as processive as HKin. These studies, together with biochemical work, provide a basis for experiments to dissect the molecular mechanisms of processive movement.