Tension Subdural Hygroma Following Resection of Posterior Fossa Tumour in a Child: A new clinico-radio-pathological entity.

Persistent hydrocephalus is common in children after resection of posterior fossa tumours. However, occurrence of subdural hygroma is very rare. We report the case of a 14-month-old child who presented at a paediatric neurology clinic in Muscat, Oman in 2021 who developed a tense subdural hygroma with stable hydrocephalus, in the early postoperative period, following posterior fossa tumour resection. We describe the distinctive clinical, radiological and pathological features associated with the development of a tense subdural hygroma. We also discuss the management by cerebrospinal fluid diversion, which includes either a ventriculoperitoneal or subduroperitoneal shunt. This unique condition is distinguished from external hydrocephalus by features that are critical to the management strategy.

Post-craniotomy leptomeningeal cyst: a new presentation of an old problem.

Leptomeningeal cyst (LMC) is a known complication of pediatric head injury but has not been described following a craniotomy other than for craniosynostosis. We present the case of a 20-month-old boy who underwent craniotomy for a traumatic epidural hematoma. There was an inadvertent tear of the dura which was repaired with a pericranial patch and dural sealant. The patient presented with a progressive surgical site swelling 5 months post-surgery and a CT scan revealed an LMC with elevation of the bone flap. He underwent re-exploration with watertight repair of the dural defect and rigid fixation of the bone flap. This iatrogenic LMC provides an opportunity to compare and confirm the pathogenesis vis a vis the more common spontaneous post-traumatic LMC. Our report highlights the importance of proper dural closure and bone fixation after craniotomy in children whose skulls are still growing.

Primary diffuse leptomeningeal primitive neuroectodermal tumor presenting as chronic meningitis.

Primary diffuse leptomeningeal primitive neuroectodermal tumor is a rare meningeal neoplasm which can masquerade as chronic meningitis. While the clinical presentation and radiological features may provide a clue to this condition, meningeal biopsy is essential to clinch the diagnosis. A high index of suspicion and a low threshold for re-evaluating cases of neuroinfection that do not respond to empirical therapy are essential in this scenario. We present the case of a nine year old boy who was initiated on antituberculous treatment for chronic meningitis with hydrocephalus. Meningeal biopsy revealed a primary diffuse leptomeningeal primitive neuroectodermal tumor.

Comparison of the efficacy of two doses of dexmedetomidine in attenuating the hemodynamic response to intubation in patients undergoing elective cardiac surgery: A randomized double-blinded study.

BACKGROUND AND AIMS: Transient tachycardia and hypertension associated with laryngoscopy and intubation may be hazardous to patients presenting for cardiac surgery. The α 2 agonist dexmedetomidine may blunt this stress response, but the optimal dose which will accomplish this without causing hypotension and bradycardia is not well established. The primary objective of this study was to compare the efficacy of two doses of dexmedetomidine (0.5 and 1 µg/kg) as a 15 min infusion in attenuating the hemodynamic stress response to laryngoscopy and endotracheal intubation in elective cardiac surgery. MATERIAL AND METHODS: Seventy six patients scheduled for elective cardiac surgery received a single preoperative dose of dexmedetomidine of either 0.5 µg/kg (low dose) or 1 µg/kg (high dose) as a 15-min infusion prior to induction. The hemodynamic response to laryngoscopy and endotracheal intubation (heart rate, systolic blood pressure, mean arterial pressure, and diastolic blood pressure) were recorded at different times. Independent sample t-test, Chi-square test of association, and repeated measures analysis of variance were used to analyze the collected data. RESULTS: The incidence of hypertension following intubation was significantly more in the low-dose group. Administration of 1 µg/kg dexmedetomidine was not accompanied by hypotension or bradycardia. CONCLUSION: Dexmedetomidine in a dose of 1 µg/kg is more effective than 0.5 µg/kg for attenuation of hemodynamic stress response to intubation in cardiac surgery. A more graded increase in the dose of dexmedetomidine may lead to an optimum dose in attenuating the hemodynamic response to intubation.

Peripheral neuron plasticity is enhanced by brief electrical stimulation and overrides attenuated regrowth in experimental diabetes.

Peripheral nerve regrowth is less robust than commonly assumed, particularly when it accompanies common clinical scenarios such as diabetes mellitus. Brief extracellular electrical stimulation (ES) facilitates the regeneration of peripheral nerves in part through early activation of the conditioning injury response and BDNF. Here, we explored intrinsic neuronal responses to ES to identify whether ES might impact experimental diabetes, where regeneration is attenuated. ES altered several regeneration related molecules including rises in tubulin, Shh (Sonic hedgehog) and GAP43 mRNAs. ES was associated with rises in neuronal intracellular calcium but its strict linkage to regrowth was not confirmed. In contrast, we identified PI3K-PTEN involvement, an association previously linked to diabetic regenerative impairment. Following ES there were declines in PTEN protein and mRNA both in vitro and in vivo and a PI3K inhibitor blocked its action. In vitro, isolated diabetic neurons were capable of mounting robust responsiveness to ES. In vivo, ES improved electrophysiological and behavioral indices of nerve regrowth in a chronic diabetic model of mice with pre-existing neuropathy. Regrowth of myelinated axons and reinnervation of the epidermis were greater following ES than sham stimulation. Taken together, these findings identify a role for ES in supporting regeneration during the challenges of diabetes mellitus.

Adhesion of acidic lipid vesicles by 21.5 kDa (recombinant) and 18.5 kDa isoforms of myelin basic protein.

Myelin basic protein (MBP) is thought to be responsible for adhesion of the intracellular surfaces of compact myelin to give the major dense line. The 17 and 21.5 kDa isoforms containing exon II have been reported by others to localize to the cytoplasm and nucleus of murine oligodendrocytes and HeLa cells while the 14 and 18.5 kDa isoforms lacking exon II are confined to the plasma membrane. However, we show that the exon II(-) 18.5 kDa form and a recombinant exon II(+) 21.5 kDa isoform both caused similar aggregation of acidic lipid vesicles, indicating that they should have similar abilities to bind to the intracellular lipid surface of the plasma membrane and to cause adhesion of those surfaces to each other. The circular dichroism spectra of the two isoforms indicated that both had a similar secondary structure. Thus, both isoforms should be able to bind to and cause adhesion of the cytosolic surfaces of compact myelin. The fact that they do not could be due to differences in post-translational modification in vivo, trafficking through the cell and/or subcellular location of synthesis, but it is not due to differences in their lipid binding.

Highly deiminated isoform of myelin basic protein from multiple sclerosis brain causes fragmentation of lipid vesicles.

Myelin basic protein (MBP) occurs as a number of charge isomers due to phosphorylation, deamidation, and deimination of arginine to citrulline. All of these modifications decrease the net positive charge of the protein and its ability to cause aggregation of negatively charged lipid vesicles. This is used as a model system for the ability of MBP to cause adhesion of the cytosolic surfaces of myelin. Therefore, the effect of two deiminated forms of MBP on lipid vesicles was compared with that of the unmodified, most positively charged isomer, C1, to determine how loss of positively charged arginines would affect the function of MBP. The deiminated forms were the isomer isolated from normal human brains, in which only 6 Arg are deiminated to citrulline (MBP-Cit(6)), and an isomer isolated from the brain of a patient who died with acute, fulminating multiple sclerosis (Marburg type), in which 18 of the 19 Arg were deiminated (MBP-Cit(18)). Whereas C1 caused aggregation of lipid vesicles, resulting in an increase in absorbance due to light scattering, MBP-Cit(18) caused a decrease in absorbance of the lipid vesicles. Size exclusion chromatography and negative staining electron microscopy showed that this was due to fragmentation of the large multilayered vesicles into much smaller vesicles. MBP-Cit(6) caused less aggregation of lipid vesicles than did C1. However, no fragmentation of the vesicles into smaller ones in the presence of C1 and MBP-Cit(6) was detected by size exclusion chromatography or electron microscopy. The membrane fragmentation caused by MBP-Cit(18) is dramatically different from the effects of other forms of MBP from normal brain and may indicate a pathogenic effect of this charge isomer, which may have contributed to the severity of the Marburg type of multiple sclerosis. Alternatively, the deimination may have been a secondary effect resulting from the disease process. Regardless of the role of MBP-Cit(18) in multiple sclerosis, the effect of this modification indicates that, when most of the arginines of MBP are modified to an uncharged amino acid, the protein acquires properties similar to an apolipoprotein; thus, it may take up an amphipathic structure when bound to lipid. A partly amphipathic character may also be related to the role of MBP-Cit(6) in normal immature myelin, where it is the predominant charge isomer.

Divalent cation-mediated interaction between cerebroside sulfate and cerebrosides: an investigation of the effect of structural variations of lipids by electrospray ionization mass spectrometry.

Divalent cations mediate a carbohydrate-carbohydrate association between the two major glycolipids, galactosylceramide (GalCer) and its sulfated form, cerebroside sulfate (CBS), of the myelin sheath. We have suggested that interaction between these glycolipids on apposed extracellular surfaces of myelin may be involved in the stability or function of this multilayered structure. A mutant mouse lacking galactolipids because of a disruption in the gene that encodes a galactosyltransferase forms myelin that initially appears relatively normal but is unstable. This myelin contains glucosylceramide (GlcCer) instead of GalCer. To better understand the role of GlcCer in myelin in this mutant, we have compared the ability of divalent cations to complex CBS (galactosyl form) with GlcCer or GalCer in methanol solution by using positive ion electrospray ionization mass spectrometry. Because both the alpha-hydroxylated fatty acid species (HFA) and the nonhydroxylated fatty acid species (NFA) of these lipids occur in myelin, we have also compared the HFA and NFA species. In addition to monomeric Ca2+ complexes of all three lipids and oligomeric Ca2+ complexes of both GalCer and GlcCer, Ca2+ also caused heterotypic complexation of CBS to both GalCer and GlcCer. The heterotypic complexes had the greatest stability of all oligomers formed and survived better at high declustering potentials. Complexes of CBS with GlcCer were less stable than those with GalCer. This was confirmed by using the free sugars and glycosides making up the carbohydrate headgroups of these lipids. HFA species of CBS and GalCer formed more stable complexes than NFA species, but hydroxylation of the fatty acid of GlcCer had no effect. The ability of GlcCer to also complex with CBS, albeit with lower stability, may allow GlcCer to partially compensate for the absence of GalCer in the mouse mutant.

Analysis of the membrane-interacting domains of myelin basic protein by hydrophobic photolabeling.

Myelin basic protein is a water soluble membrane protein which interacts with acidic lipids through some type of hydrophobic interaction in addition to electrostatic interactions. Here we show that it can be labeled from within the lipid bilayer when bound to acidic lipids with the hydrophobic photolabel 3-(trifluoromethyl)-3-(m-[125I]iodophenyl)diazirine (TID) and by two lipid photolabels. The latter included one with the reactive group near the apolar/polar interface and one with the reactive group linked to an acyl chain to position it deeper in the bilayer. The regions of the protein which interact hydrophobically with lipid to the greatest extent were determined by cleaving the TID-labeled myelin basic protein (MBP) with cathepsin D into peptides 1-43, 44-89, and 90-170. All three peptides from lipid-bound protein were labeled much more than peptides from the protein labeled in solution. However, the peptide labeling pattern was similar for both environments. The two peptides in the N-terminal half were labeled similarly and about twice as much as the C-terminal peptide indicating that the N-terminal half interacts hydrophobically with lipid more than the C-terminal half. MBP can be modified post-translationally in vivo, including by deamidation, which may alter its interactions with lipid. However, deamidation had no effect on the TID labeling of MBP or on the labeling pattern of the cathepsin D peptides. The site of deamidation has been reported to be in the C-terminal half, and its lack of effect on hydrophobic interactions of MBP with lipid are consistent with the conclusion that the N-terminal half interacts hydrophobically more than the C-terminal half. Since other studies of the interaction of isolated N-terminal and C-terminal peptides with lipid also indicate that the N-terminal half interacts hydrophobically with lipid more than the C-terminal half, these results from photolabeling of the intact protein suggest that the N-terminal half of the intact protein interacts with lipid in a similar way as the isolated peptide. The similar behavior of the intact protein to that of its isolated peptides suggests that when the purified protein binds to acidic lipids, it is in a conformation which allows both halves of the protein to interact independently with the lipid bilayer. That is, it does not form a hydrophobic domain made up from different parts of the protein.

Controlled hydrolysis of ceftiofur sodium, a broad-spectrum cephalosporin; isolation and identification of hydrolysis products.

Ceftiofur sodium is the salt of (6R,7R)-7-{[(2-amino-4-thiazolyl)-Z-(methoxyimino)acetyl]amino}-3-{[(2-+ ++furanylcarbonyl)thio]methyl}-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2- ene-2-carboxylic acid. This compound is very susceptible to acid, alkaline-, and enzyme-catalyzed hydrolysis, producing a number of unstable degradation products. In this report, we describe the preparation and identification of the hydrolysis products that are formed under controlled alkaline conditions. The primary hydrolysis product was desfuroyl ceftiofur, which is the most abundant metabolite in bovine blood. Desfuroyl ceftiofur was carefully oxidized with H2O2 to prepare the disulfide dimer, a urinary metabolite of ceftiofur sodium in the rat and cattle. Under acidic conditions, desfuroyl ceftiofur was converted to the corresponding thiolactone. The preparation of desacetyl cefotaxime, which is the oxygen analog of desfuroyl ceftiofur, is also described. Furoic acid was readily formed by hydrolytic cleavage of the thioester bond. Thiofuroic acid, formed by the less common cleavage on the alkyl side of the thioester bond, was also isolated.

Proton NMR study of peptides from myelin basic protein: evidence for Lys74-His77 interaction revealed from histidine line broadening.

Residues 69-84 of guinea pig myelin basic protein contain the encephalitogenic determinant for the Lewis rat. Insertion of histidine and glycine at positions 77 and 78 in bovine MBP greatly reduces the encephalitogenicity of the protein. Synthetic peptides analogous to this region of MBP containing glycine and histidine are encephalitogenic if they lack the N-terminal half, residues 69-74. However, if they contain both histidine plus the N-terminal half, encephalitogenicity is abolished, suggesting that an interaction of histidine with an amino acid in the N-terminal half changes the conformation or the properties of the peptide. This was investigated by measuring the 1H-NMR spectra of synthetic peptides analogous to this region of MBP, both containing histidine but with and without the N-terminal half. The major difference in the spectra of the two peptides was the pH dependence of line broadening of the histidine resonances. The histidine C2H and C4H resonances were broadened at intermediate pH values in both peptides. However, sharpening of the lines at high pH showed a different pH dependence in the two peptides. For the longer peptide containing the N-terminal half, the lines did not sharpen until the pH was increased above 10.2, coinciding with the pKa of Lys-74. Acetylation of this peptide caused the pH at which the lines began to sharpen to drop to 8.8. In the shorter peptide, lacking the N-terminal half and Lys-74, the lines also sharpened at pH 8.8. The greater broadening which persisted up above pH 10 for the longer peptide suggests slow exchange between two different conformations or environments of the histidine. One of these could be a conformation in which the deprotonated histidine hydrogen bonds with Lys-74. The Lys side-chain resonances indicated a decrease in rotational freedom above the pKa of histidine, consistent with this conclusion. Although this putative interaction between His and Lys-74 did not appear to have a significant effect on the overall conformation of the peptide, it could result in a reduction in encephalitogenicity by altering the properties of the peptide. This could affect processing and presentation of this determinant by antigen presenting cells.

Investigation of the calcium-mediated association between the carbohydrate head groups of galactosylceramide and galactosylceramide I3 sulfate by electrospray ionization mass spectrometry.

Calcium has been shown previously to cause aggregation of phosphatidylcholine/cholesterol liposomes containing galactosylceramide (GalCer) with similar liposomes containing cerebroside sulfate (galactosylceramide I3 sulfate) (CBS), suggesting that it mediates a carbohydrate-carbohydrate association between these two glycolipids. In order to determine if such an association occurs, the noncovalent complexes formed on addition of calcium chloride to GalCer and CBS in methanol were examined by positive and negative ion spray mass spectrometry. Monomeric Ca2+ complexes of both lipids were observed. In addition, Ca2+ also caused oligomerization of GalCer. Oligomerization of CBS anion was not seen, but dimers would not have been observed, as they would be neutral. However, Ca2+ caused heterotypic complexation of GalCer and CBS. Although these heterotypic complexes were of low abundance in methanol compared with the other monomeric and homotypic oligomeric positive ions formed at low declustering potentials, the heterotypic dimer [GalCer.CBS.Ca2+-H]+ had the greatest stability of all oligomers formed and was the only one to survive at high declustering potentials. Na+ did not cause oligomerization of GalCer in methanol indicating that the complexes of GalCer with Ca2+ are not caused by van der Waals interactions between the lipid moieties. GalCer and CBS are present in high concentrations in myelin. This Ca2+-mediated carbohydrate-carbohydrate interaction, which can bridge apposing bilayers, may be involved in adhesion of the extracellular surfaces of the myelin sheath.

Do the long fatty acid chains of sphingolipids interdigitate across the center of a bilayer of shorter chain symmetric phospholipids?

Novel cerebroside sulfate (CBS) spin labels containing long chain C24 or C26 fatty acids with a nitroxide spin label on the 22nd carbon were synthesized and used to investigate the ability of the long fatty acid chains of glycosphingolipids to interdigitate across the center of a non-interdigitated bilayer of phospholipids formed of symmetric saturated or unsaturated shorter fatty acid chain species, in the presence or absence of cholesterol. The motion of these long chain spin labels incorporated at 1 mole% in dimyristoylphosphatidylcholine (diC14-PC), dipalmitoylphosphatidylcholine (diC16-PC), distearoylphosphatidylcholine (diC18-PC), dibehenoylphosphatidylcholine (diC22-PC), spingomyelin (SM), 1-stearoyl-2-oleoylphosphatidylcholine (18:0.18:1-PC), and dimyristoylphosphatidylethanolamine (diC14-PE) was compared to that of CBS spin labels containing stearic acid spin labeled at the 5th carbon and at the 16th carbon. The results indicated that the C26 chain is interdigitated in the gel phase of diC14-PC, diC16-PC, SM, and possibly diC18-PC, but not diC14-PE, and the C24 chain may interdigitate in diC14-PC but not in the other phospholipids. Thus in order to interdigitate across the center of gel phase bilayers, the long acyl chain of the sphingolipid probably must be long enough to nearly span the phospholipid bilayer. The inability to interdigitate in diC14-PE is likely due to the close packing of this lipid in the gel phase. The C26 chain may also be interdigitated in these lipids in the presence of cholesterol at low temperatures. However, at physiological temperatures in the presence of cholesterol and in the liquid-crystalline phase of all the lipids, the results indicate that the long acyl chain of the glycosphingolipid is not interdigitated, but rather must terminate at the bilayer center. This may force the carbohydrate headgroup of the glycosphingolipid farther above the bilayer surface, allowing it to be recognized better by various carbohydrate binding ligands and proteins.

Thermotropic phase behavior of mixtures of long chain fatty acid species of cerebroside sulfate with different fatty acid chain length species of phospholipid.

The thermotropic phase behavior of asymmetric, long fatty acid chain species of cerebroside sulfate, C24-CBS and C26-CBS, with symmetric species of phosphatidylcholine (PC) containing fatty acid chains of 14-18 carbons in length (diC14-PC, diC16-PC, diC18-PC) and dimyristoylphosphatidylethanolamine (diC14-PE) in 0.1 M KCl was studied by differential scanning calorimetry. Novel cerebroside sulfate (CBS) spin labels containing long chain C24 and C26 fatty acid spin labels with the nitroxide group on the twenty-second carbon were used to study the lipid organization of the gel phases of these mixtures. The phase diagrams of all the mixtures indicated the presence of two immiscible gel phases at low CBS concentrations. All except the C26-CBS/diC14-PC mixture had eutectic phase behavior at low CBS concentrations suggesting that the long fatty acid chain of the CBS species had a destabilizing effect on the gel phase of most of the phospholipids. The C26-CBS/diC14-PC mixture had peritectic phase behavior at low CBS concentrations indicating a stabilizing effect of the CBS C26 acyl chain on diC14-PC. These results are consistent with the relative compatibility of the CBS acyl chain length with the bilayer thickness of the PC; only in the case of the C26-CBS/diC14-PC mixture is the acyl chain of CBS long enough to span the PC bilayer. At intermediate to high CBS concentrations, the CBS and phospholipid (PL) were miscible with the exception of the C24-CBS/diC18-PC combination, which had eutectic phase behavior over a wide concentration range. Thus when the PL acyl chain length was similar to the sphingosine chain length of CBS, CBS bilayers could accommodate symmetric phospholipid molecules better than phospholipid bilayers could accommodate asymmetric molecules of CBS. Use of the spin labels indicated that, at low temperatures and at intermediate to high CBS concentrations, all of the mixtures were in a triple chain mixed interdigitated gel phase which immobilized the spin label. This gel phase slowly transformed over a wide temperature range to a double chain partially interdigitated gel phase in which the spin labels had much more motion. This transformation could be detected as a broad low enthalpy transition by differential scanning calorimetry. In all cases the presence of phospholipid destabilized the mixed interdigitated phase. Stabilization of the partially interdigitated bilayer by intermolecular hydrogen bonding interactions must outweigh the destabilizing forces caused by disruptions in packing and van der Waals interactions between CBS molecules resulting from insertion of molecules of phospholipid into this type of bilayer.(ABSTRACT TRUNCATED AT 400 WORDS)

Interference of carbohydrates in the quantitation of protein-bound citrulline by amino acid analysis.

After cation-exchange chromatographic separation of the charge isomers of human myelin basic protein, the citrulline-containing component was purified from the unbound fraction by gel permeation chromatography. Sephadex G75 (superfine) resolved high- and low-molecular-weight contaminants from the 18.5K myelin basic protein. However, carbohydrates leached from the column material by the acidic eluant interfered with citrulline quantitation by amino acid analysis. It appears highly probable that during acid hydrolysis of the protein, glucose reacts with citrulline, the ureido group of the latter forming a condensation product with the sugar which subsequently undergoes further chemical degradation to products which are not easily identifiable. Methods for removing the interfering sugars prior to amino acid analysis are discussed.

Mixtures of semisynthetic species of cerebroside sulfate with dipalmitoyl phosphatidylcholine. Thermotropic phase behavior and permeability.

The phase behavior of mixtures of dipalmitoyl phosphatidylcholine (DPPC) with semisynthetic species of cerebroside sulfate (CBS) containing palmitic acid (C16:0-CBS) or lignoceric acid (C24:0-CBS) in 0.1 M KCl was studied using differential scanning calorimetry. DPPC and C16:0-CBS were miscible in all proportions in the gel phase above 10 mol% CBS and in the liquid-crystalline phase. However, C24:0-CBS was less miscible with DPPC over a wide concentration range in the gel phase. At high CBS concentrations it was probably also not entirely miscible with DPPC in the liquid-crystalline phase. Small amounts of both species of CBS lowered the transition temperature and enthalpy of DPPC, suggesting that they are more soluble in the liquid-crystalline phase of DPPC than the gel phase. The transition temperature at higher CBS concentrations was also less than expected, especially after cycling through the phase transition in the case of C24:0-CBS, suggesting that mixing with DPPC inhibited the intermolecular hydrogen bonding interactions and dehydration of CBS. In C24:0-CBS-DPPC mixtures several populations were present over a wide compositional range, including two solid-solid solutions of fixed composition. At high C24:0-CBS concentrations some C24:0-CBS also phase separated out of the mixture. Structural considerations suggested that the C24:0-CBS which is mixed with DPPC must be interdigitated into the DPPC bilayer. Other populations that are present may have a different structural organization. A fatty acid spin label in these mixtures was a little less ordered than in either lipid by itself. The permeability of these lipids, as well as the two asymmetric species 1-stearoyl-2-caproyl phosphatidylcholine and 1-stearoyl-2-myristoyl phosphatidylcholine (18:10PC and 18:14PC), to a water-soluble spin label tempocholine chloride was also measured. The studies with 18:10PC and 18:14PC indicated that both triple-chain mixed interdigitated bilayers and double-chain partially interdigitated bilayers can trap water-soluble substances and have low permeability. Both species of CBS could also entrap the spin label and had low permeability at 4 degrees C. However, they rapidly lost the entrapped compound when they transformed into their stable dehydrated phases or into the liquid-crystalline phase. Mixing with DPPC prevented both of these losses. These studies supported the conclusion that a significant amount of the CBS was mixed with the DPPC and that this mixing prevented the dehydration changes which CBS undergoes by itself.(ABSTRACT TRUNCATED AT 400 WORDS)