Two versus three magnesium screws for osteosynthesis of mandibular condylar head fractures: a finite element analysis.

OBJECTIVES: Previous finite element analyses (FEA) have shown promising results for using two titanium screws in treating mandibular condylar head fractures but limited mechanical stability of a two-screw osteosynthesis with magnesium screws. Given the potential benefits of magnesium screws in terms of biocompatibility and resorption, this study aimed to compare two- and three-screw osteosynthesis solutions for a right condylar head fracture (AO CMF type p) with magnesium screws with a FEA. MATERIALS AND METHODS: A previously validated finite element model simulating a 350 N bite on the contralateral molars was used to analyze von Mises stress within the screws, fragment deformation, and fracture displacement. All screws were modeled with uniform geometric specifications mirroring the design of Medartis MODUS® Mandible Hexadrive cortical screws. RESULTS: The three-screw configuration demonstrated lower values for all three parameters compared to the two-screw scenario. There was a 30% reduction in maximum von Mises stress for the top screw and a 46% reduction for the bottom screw. CONCLUSIONS: Fracture treatment with three magnesium screws could be a valuable and sufficiently stable alternative to the established treatment with titanium screws. Further studies on screw geometry could help improve material stability under mechanical loading, enhancing the performance of magnesium screws in clinical applications. CLINICAL RELEVANCE: The use of magnesium screws for osteosynthesis of mandibular condylar head fractures offers the benefit of reducing the need for second surgery for hardware removal. Clinical data is needed to determine whether the advantages of resorbable screw materials outweigh potential drawbacks in condylar head fracture treatment.

Interdisciplinary strategies for diagnosis and treatment of trigeminal neuralgia.

Temporary, sudden, shooting and recurrent unilateral facial pain in the supply area of one or more trigeminal nerve branches characterises trigeminal neuralgia. Innocuous stimuli trigger the pain, e.g. chewing, speaking or brushing teeth. In some patients, paroxysms superimpose on continuous pain. In aetiological terms, idiopathic, classic (due to neurovascular compression) and secondary trigeminal neuralgia (e.g. due to multiple sclerosis, brainstem ischaemia and space-occupying lesions) are defined. Many drugs may be efficacious, with carbamazepine being first-choice therapy. However, non-pharmacological and invasive procedures may also help. To reach the correct diagnosis and determine the best therapeutic measures, adequate pain characterisation and interdisciplinary collaboration are essential. We hereby present our experience of an interdisciplinary approach for the diagnosis and treatment of trigeminal neuralgia.

Two-screw osteosynthesis of the mandibular condylar head with different screw materials: a finite element analysis.

This study compared the biomechanical behavior of titanium, magnesium, and polylactic acid screws for two-screw osteosynthesis of mandibular condylar head fractures using finite element analysis. Von Mises stress distribution, fracture displacement, and fragment deformation were evaluated. Titanium screws performed the best in terms of carrying the highest load, resulting in the least fracture displacement and fragment deformation. Magnesium screws showed intermediate results, while PLA screws were found to be unsuitable with stress values exceeding their tensile strength. These findings suggest that magnesium alloys could be considered a suitable alternative to titanium screws in mandibular condylar head osteosynthesis.

Two-versus three-screw osteosynthesis of the mandibular condylar head: A finite element analysis.

Titanium screws are commonly used for osteosynthesis of mandibular condylar head fractures. Evidence suggests that the insertion of three screws may result in better fracture stability. Two screws only, on the other hand, could reduce adverse effects, mainly bone resorption. This study aimed to investigate the biomechanical differences in mandibular condylar head osteosynthesis with two versus three titanium screws using finite element analysis. A finite element model of the mandible with a right type P condylar head fracture fixed with two or three titanium screws was analyzed in ANSYS Mechanical. The geometry of the model assembly was constructed in ANSYS Spaceclaim. Biomechanical load boundary conditions were obtained from a validated musculoskeletal model in AnyBody Modeling System™. The preprocessing of the finite element model and mapping of the obtained boundary conditions was done in docq VIT. Fracture displacement, fragment deformation, von Mises stress distribution, and reaction forces within the screws were evaluated in ANSYS for three different loading scenarios. Finite element analysis showed similar results when comparing osteosynthesis with two versus three titanium screws for all three loading scenarios. Contralateral molar loading resulted in the highest stress on both the fracture and the screws with the maximum von Mises stress being found at the condylar neck. Stress concentration within the screws was found in the fracture gap and was higher in the lateral fragment. In all scenarios, maximum von Mises stress values were smaller when forces were distributed among three screws. However, stability was also adequate when two screws were used. Mandibular condylar head osteosynthesis with two titanium screws appears to provide sufficient fracture stability. Further clinical studies are needed to clarify the implications of these results.

Musical syntax is processed in Broca's area: an MEG study.

The present experiment was designed to localize the neural substrates that process music-syntactic incongruities, using magnetoencephalography (MEG). Electrically, such processing has been proposed to be indicated by early right-anterior negativity (ERAN), which is elicited by harmonically inappropriate chords occurring within a major-minor tonal context. In the present experiment, such chords elicited an early effect, taken as the magnetic equivalent of the ERAN (termed mERAN). The source of mERAN activity was localized in Broca's area and its right-hemisphere homologue, areas involved in syntactic analysis during auditory language comprehension. We find that these areas are also responsible for an analysis of incoming harmonic sequences, indicating that these regions process syntactic information that is less language-specific than previously believed.

Combination therapy in a xenograft model of glioblastoma: enhancement of the antitumor activity of temozolomide by an MDM2 antagonist.

OBJECTIVE Improvement in treatment outcome for patients with glioblastoma multiforme (GBM) requires a multifaceted approach due to dysregulation of numerous signaling pathways. The murine double minute 2 (MDM2) protein may fulfill this requirement because it is involved in the regulation of growth, survival, and invasion. The objective of this study was to investigate the impact of modulating MDM2 function in combination with front-line temozolomide (TMZ) therapy in GBM. METHODS The combination of TMZ with the MDM2 protein-protein interaction inhibitor nutlin3a was evaluated for effects on cell growth, p53 pathway activation, expression of DNA repair proteins, and invasive properties. In vivo efficacy was assessed in xenograft models of human GBM. RESULTS In combination, TMZ/nutlin3a was additive to synergistic in decreasing growth of wild-type p53 GBM cells. Pharmacodynamic studies demonstrated that inhibition of cell growth following exposure to TMZ/nutlin3a correlated with: 1) activation of the p53 pathway, 2) downregulation of DNA repair proteins, 3) persistence of DNA damage, and 4) decreased invasion. Pharmacokinetic studies indicated that nutlin3a was detected in human intracranial tumor xenografts. To assess therapeutic potential, efficacy studies were conducted in a xenograft model of intracranial GBM by using GBM cells derived from a recurrent wild-type p53 GBM that is highly TMZ resistant (GBM10). Three 5-day cycles of TMZ/nutlin3a resulted in a significant increase in the survival of mice with GBM10 intracranial tumors compared with single-agent therapy. CONCLUSIONS Modulation of MDM2/p53-associated signaling pathways is a novel approach for decreasing TMZ resistance in GBM. To the authors' knowledge, this is the first study in a humanized intracranial patient-derived xenograft model to demonstrate the efficacy of combining front-line TMZ therapy and an inhibitor of MDM2 protein-protein interactions.

Characterization of the submandibular gland microsomal calcium transport system.

Calcium accumulation by submandibular gland microsomes (first described by Selinger and Naim, ((1970) Biochim. Biophys. Acta 323, 337-341) has been further characterized. Accumulation was concentration dependent, had a Km of 25 microM added calcium and a Vmax of 12 nM calcium/mg protein per min. No accumulation was observed in the presence of either the calcium ionophore A23187, or the detergent Triton X-100 (0.05). The divalent cations Sr2+ and Mn2+ inhibited accumulation competitively with Ki values of 67 microM and 200 microM, respectively. The effect of various enzyme inhibitors were tested on the microsomal calcium transport system and it was found that chlorpromazine, trifluoperazine, and DIDS all inhibited. The mitochondrial transport inhibitors ruthenium red and CCCP had no effect on transport. Experiments directed at clarifying the cellular location of the system are described. It was found that the membrane vesicles responsible for transport show different purification properties than the membrane vesicles which contain the standard enzyme markers for total and rough endoplasmic reticulum, Golgi apparatus, plasma membrane, and lysosomes. These conclusions are based upon experiments using these properties for membrane purification, density, size, and electrophoretic mobility. Three possible explanations of the results are given and it is organelles. The significance of the results in: (1) understanding the biochemical properties of the submandibular gland microsomal calcium transport system, (2) clarifying the cellular location of the system, and (3) clarifying the function of the system in salivary secretion are discussed.

The Ca2+ transport mechanisms of mitochondria and Ca2+ uptake from physiological-type Ca2+ transients.

Mitochondria contain a sophisticated system for transporting Ca2+. The existence of a uniporter and of both Na+-dependent and -independent efflux mechanisms has been known for years. Recently, a new mechanism, called the RaM, which seems adapted for sequestering Ca2+ from physiological transients or pulses has been discovered. The RaM shows a conductivity at the beginning of a Ca2+ pulse that is much higher than the conductivity of the uniporter. This conductivity decreases very rapidly following the increase in [Ca2+] outside the mitochondria. This decrease in the Ca2+ conductivity of the RaM is associated with binding of Ca2+ to an external regulatory site. When liver mitochondria are exposed to a sequence of pulses, uptake of labeled Ca2+ via the RaM appears additive between pulses. Ruthenium red inhibits the RaM in liver mitochondria but much larger amounts are required than for inhibition of the mitochondrial Ca2+ uniporter. Spermine, ATP and GTP increase Ca2+ uptake via the RaM. Maximum uptake via the RaM from a single Ca2+ pulse in the physiological range has been observed to be approximately 7 nmole/mg protein, suggesting that Ca2+ uptake via the RaM and uniporter from physiological pulses may be sufficient to activate the Ca2+-sensitive metabolic reactions in the mitochondrial matrix which increase the rate of ATP production. RaM-mediated Ca2+ uptake has also been observed in heart mitochondria. Evidence for Ca2+ uptake into the mitochondria in a variety of tissues described in the literature is reviewed for evidence of participation of the RaM in this uptake. Possible ways in which the differences in transport via the RaM and the uniporter may be used to differentiate between metabolic and apoptotic signaling are discussed.

The rapid mode of calcium uptake into heart mitochondria (RaM): comparison to RaM in liver mitochondria.

A mechanism of Ca(2+) uptake, capable of sequestering significant amounts of Ca(2+) from cytosolic Ca(2+) pulses, has previously been identified in liver mitochondria. This mechanism, the Rapid Mode of Ca(2+) uptake (RaM), was shown to sequester Ca(2+) very rapidly at the beginning of each pulse in a sequence [Sparagna et al. (1995) J. Biol. Chem. 270, 27510-27515]. The existence and properties of RaM in heart mitochondria, however, are unknown and are the basis for this study. We show that RaM functions in heart mitochondria with some of the characteristics of RaM in liver, but its activation and inhibition are quite different. It is feasible that these differences represent different physiological adaptations in these two tissues. In both tissues, RaM is highly conductive at the beginning of a Ca(2+) pulse, but is inhibited by the rising [Ca(2+)] of the pulse itself. In heart mitochondria, the time required at low [Ca(2+)] to reestablish high Ca(2+) conductivity via RaM i.e. the 'resetting time' of RaM is much longer than in liver. RaM in liver mitochondria is strongly activated by spermine, activated by ATP or GTP and unaffected by ADP and AMP. In heart, RaM is activated much less strongly by spermine and unaffected by ATP or GTP. RaM in heart is strongly inhibited by AMP and has a biphasic response to ADP; it is activated at low concentrations and inhibited at high concentrations. Finally, an hypothesis consistent with the data and characteristics of liver and heart is presented to explain how RaM may function to control the rate of oxidative phosphorylation in each tissue. Under this hypothesis, RaM functions to create a brief, high free Ca(2+) concentration inside mitochondria which may activate intramitochondrial metabolic reactions with relatively small amounts of Ca(2+) uptake. This hypothesis is consistent with the view that intramitochondrial [Ca(2+)] may be used to control the rate of ADP phosphorylation in such a way as to minimize the probability of activating the Ca(2+)-induced mitochondrial membrane permeability transition (MPT).

Energy-dependent Mn2+ and Ca2+ uptake by the embryonic chick chorioallantoic membrane.

The chick chorioallantoic membrane is an epithelial tissue which actively transports large amounts of Ca2+ during embryonic development. In this paper Mn2+ uptake by the tissue was studied and compared to Ca2+ uptake in parallel experiments. The purpose of these experiments was to determine if Mn2+ could be used to gain more information about the Ca2+ transport system. It was found that Mn2+ uptake was reduced significantly under conditions that reduced Ca2+ uptake and that Mn2+, like Ca2+, was taken up preferentially by the ectodermal side of the tissue. Mn2+ uptake showed saturation kinetics with a Km of 0.33 MM. Mn2+ uptake was also competitively inhibited by Ca2+, and Ca2+ uptake inhibited by Mn2+. Electron microprobe studies showed that Mn2+ was localized in the ectoderm of the tissue in the same way as Ca2+. It was concluded from these studies that significant amounts of Mn2+ were accumulated by the active Ca2+ transport mechanism and that Mn2+ could be useful paramagnetic probe of divalent cation transport in this tissue.

An electron paramagnetic resonance study of Mn2+ uptake by the chick chorioallantoic membrane.

Mn2+ uptake in the chick chorioallantoic membrane, an embryonic epithelial tissue which transports Ca2+ in vivo was studied using electron paramagnetic resonance (EPR). Mn2+ was used as a paramagnetic analog for Ca2+, since there is evidence that Mn2+ is accumulated by the Ca2+ transport mechanism. After 1.5 h of uptake the EPR spectrum of the Mn2+ in the membrane indicated that 89% of the Mn2+ was in a spin-exchange form, indicating close packing of Mn2+. The Mn2+ spacing was estimated from the line width to be about 4.7 A. The remaining Mn2+ was very likely Mn2+ hexahydrate. At pH 7.4 the spin-exchange spectrum tended to broaden when uptake was inhibited, while at pH 5.0 the spin-exchange spectrum was completely abolished in the presence of inhibitors. The EPR spectrum of Mn2+ in the chorioallantoic membrane had a broader line width than that of Mn2+ in isolated mitochondria, suggesting that in this tissue mitochondria are not directly involved in divalent cation transport. These EPR studies support the concept that divalent cations are sequestered in high concentrations from the rest of the cell contents during transcellular active transport.

Potentiation of Carboplatin-Mediated DNA Damage by the Mdm2 Modulator Nutlin-3a in a Humanized Orthotopic Breast-to-Lung Metastatic Model.

Triple-negative breast cancers (TNBC) are typically resistant to treatment, and strategies that build upon frontline therapy are needed. Targeting the murine double minute 2 (Mdm2) protein is an attractive approach, as Mdm2 levels are elevated in many therapy-refractive breast cancers. The Mdm2 protein-protein interaction inhibitor Nutlin-3a blocks the binding of Mdm2 to key signaling molecules such as p53 and p73α and can result in activation of cell death signaling pathways. In the present study, the therapeutic potential of carboplatin and Nutlin-3a to treat TNBC was investigated, as carboplatin is under evaluation in clinical trials for TNBC. In mutant p53 TMD231 TNBC cells, carboplatin and Nutlin-3a led to increased Mdm2 and was strongly synergistic in promoting cell death in vitro. Furthermore, sensitivity of TNBC cells to combination treatment was dependent on p73α. Following combination treatment, γH2AX increased and Mdm2 localized to a larger degree to chromatin compared with single-agent treatment, consistent with previous observations that Mdm2 binds to the Mre11/Rad50/Nbs1 complex associated with DNA and inhibits the DNA damage response. In vivo efficacy studies were conducted in the TMD231 orthotopic mammary fat pad model in NOD.Cg-Prkdc(scid)Il2rg(tm1Wjl)/SzJ (NSG) mice. Using an intermittent dosing schedule of combined carboplatin and Nutlin-3a, there was a significant reduction in primary tumor growth and lung metastases compared with vehicle and single-agent treatments. In addition, there was minimal toxicity to the bone marrow and normal tissues. These studies demonstrate that Mdm2 holds promise as a therapeutic target in combination with conventional therapy and may lead to new clinical therapies for TNBC.

Mitochondrial calcium transport: mechanisms and functions.

Ca(2+)transport across the mitochondrial inner membrane is facilitated by transporters having four distinct sets of characteristics as well as through the Ca(2+)-induced mitochondrial permeability transition pore (PTP). There are two modes of inward transport, referred to as the Ca(2+)uniporter and the rapid mode or RaM. There are also two distinct mechanisms mediating outward transport, which are not associated with the PTP, referred to as the Na(+)-dependent and the Na(+)-independent Ca(2+)efflux mechanisms. Several important functions have been proposed for these mechanisms, including control of the metabolic rate for cellular energy (ATP) production, modulation of the amplitude and shape of cytosolic Ca(2+)transients, and induction of apoptosis through release of cytochrome c from the mitochondrial inter membrane space into the cytosolic space. The goals of this review are to survey the literature describing the characteristics of the mechanisms of mitochondrial Ca(2+)transport and their proposed physiological functions, emphasizing the more recent contributions, and to consider how the observed characteristics of the mitochondrial Ca(2+)transport mechanisms affect our understanding of their functions.

Cytosolic free calcium concentrations in avian growth plate chondrocytes.

Isolated avian growth plate chondrocytes convert the acetoxymethyl ester (AM) form of Fura-2 quickly and efficiently to the Ca2(+)-sensitive pentacarboxylic acid (FA) form. Control experiments indicate that the Kd for intracellular Fura-2/FA is very close to that of extracellular Fura-2/FA at the same ionic strength and pH and that the Fura-2/FA fluorescence from indicator converted by intracellular organelles is quite small. Correcting for the effects of extracellular Fura-2/FA and partial hydrolysis products has improved the accuracy of determination of intracellular [Ca2+] over earlier measurements in chondrocytes. Cytosolic [Ca2+] in isolated growth plate chondrocytes (containing cells from each maturational stage) is found to require approximately 9 hours to recover from the isolation process. After this recovery period, cytosolic [Ca2+] in these cells converges to approximately 70 nM regardless of the [Ca2+] of the recovery medium, suggesting regulation of cytosolic [Ca2+] to a set point. Chondrocytes that are separated into maturationally distinct fractions using countercurrent centrifugal elutriation show an increase in cytosolic [Ca2+] with cellular maturation. The least mature resting cells have a [Ca2+] near 57 nM, while the most mature hypertrophic cells are around 95 nM.

Activation of phosphoinositide metabolism by parathyroid hormone in growth plate chondrocytes.

Parathyroid hormone (PTH) is one of the most potent stimulators of growth plate chondrocyte mitogenesis that has been reported. However, study of the second messenger signaling mechanisms involved in the transduction of the hormone's effects on these cells is incomplete. Our data indicate that in addition to stimulating cyclic adenosine-3'5'-monophosphate metabolism, PTH also activates the phosphoinositide cascade, the pathway responsible for the generation of inositol-1,4,5-trisphosphate dependent Ca2+ signals. Our conclusion that PTH activates the phosphoinositide cascade is based on data that demonstrate: (1) the Ca2+ transients evoked by the hormone are dependent on intracellular Ca2+ stores; (2) the hormone stimulates the release of radiolabeled inositol from GPC plasma membranes; and (3) the hormone stimulates a greater than 8-fold increase in cytosolic inositol-1,4,5-trisphosphate pool size.

Dissociable brain mechanisms for inhibitory control: effects of interference content and working memory capacity.

In this study, event-related fMRI was used to examine whether the resolution of interference arising from two different information contents activates the same or different neuronal circuitries. In addition, we examined the extent to which these inhibitory control mechanisms are modulated by individual differences in working memory capacity. Two groups of participants with high and low working memory capacity [high span (HS) and low span (LS) participants, respectively] performed two versions of an item recognition task with familiar letters and abstract objects as stimulus materials. Interference costs were examined by means of the recent negative probe technique with otherwise identical testing conditions across both tasks. While the behavioral interference costs were of similar magnitude in both tasks, the underlying brain activation pattern differed between tasks: The object task interference-effects (higher activation in interference trials than in control trials) were restricted to the anterior intraparietal sulcus (IPS). Interference effects for familiar letters were obtained in the anterior IPS, the left postero-ventral and the right dorsolateral prefrontal cortex (PFC) as well as the precuneus. As the letters were more discernible than the objects, the results suggest that the critical feature for PFC and precuneus involvement in interference resolution is the saliency of stimulus-response mappings. The interference effects in the letter task were modulated by working memory capacity: LS participants showed enhanced activation for interference trials only, whereas for HS participants, who showed better performance and also lower interference costs in the letter task, the above-mentioned neuronal circuitry was activated for interference and control trials, thereby attenuating the interference effects. The latter results support the view that HS individuals allocate more attentional resources for the maintenance of task goals in the face of interfering information from preceding trials with familiar stimulus materials.

Brain responses during sentence reading: visual input affects central processes.

The effect of visual contrast on sentence reading was investigated using event-related brain potentials (ERPs). Under the low contrast condition semantic integration as reflected in the N400 ERP component was delayed to some degree. The left anterior negativity (LAN) reflecting initial syntactic processes, in contrast, seemed to change its characteristics as a function of visual input. In the high contrast condition the LAN preceded the P200 component whereas in the low contrast condition it was present after this component. These ERP-data from word-by-word sentence reading together with prior results from sentence listening suggest that the physical characteristics of the input must fall within a certain optimal range to guarantee ERP-effects of fast initial syntactic processes.

The relative timing of syntactic and semantic processes in sentence comprehension.

The functional primacy of syntactic over semantic processes was put to test in an auditory event-related brain potentials study using sentences in which the final words were semantically and/or syntactically incongruent with the prior context. Crucially, these words encoded the syntactically relevant word category information in the suffix, available only after the word stem which carried the semantic information. Semantic violations elicited an N400 and syntactic violations a biphasic LAN-P600 pattern. Words that were semantically and syntactically incongruent with the context evoked a biphasic LAN-P600 ERP pattern, but no N400. The similarity of the ERP pattern for the pure syntactic and the double violation condition provides strong evidence for a functional primacy of initial syntactic over lexical-semantic processes.

Differentiating ERAN and MMN: an ERP study.

In the present study, the early right-anterior negativity (ERAN) elicited by harmonically inappropriate chords during listening to music was compared to the frequency mismatch negativity (MMN) and the abstract-feature MMN. Results revealed that the amplitude of the ERAN, in contrast to the MMN, is specifically dependent on the degree of harmonic appropriateness. Thus, the ERAN is correlated with the cognitive processing of complex rule-based information, i.e. with the application of music-syntactic rules. Moreover, results showed that the ERAN, compared to the abstract-feature MMN, had both a longer latency, and a larger amplitude. The combined findings indicate that ERAN and MMN reflect different mechanisms of pre-attentive irregularity detection, and that, although both components have several features in common, the ERAN does not easily fit into the classical MMN framework. The present ERPs thus provide evidence for a differentiation of cognitive processes underlying the fast and pre-attentive processing of auditory information.

Human event-related brain potentials to auditory periodic noise stimuli.

Periodic noise is perceived as different from ordinary non-repeating noise due to the involvement of echoic memory. Since this stimulus does not contain simple physical cues (such as onsets or spectral shape) that might obscure sensory memory interpretations, it is a valuable tool to study sensory memory functions. We demonstrated for the first time that the processing of periodic noise can be tapped by event-related brain potentials (ERPs). Human subjects received repeating segments of noise embedded in non-repeating noise. They were instructed to detect the periodicity inherent to the stimulation. We observed a central negativity time-locked on the periodic segment that correlated to the subjects behavioral performance in periodicity detection. It is argued that the ERP result indicates an enhancement of sensory-specific processing.