Application of seven different clay types in sorbent-modified biodegradability studies with cationic biocides.

The cationic surfactants cetyltrimethylammonium bromide (CTAB) and cetylpyridinium chloride (CPC) can exert inhibitory effects on micro-organisms responsible for their biodegradation. However, under environmentally relevant exposure scenarios the presence of and sorption to organic and inorganic matter can lead to significant reduction of inhibitory effects. In our studies we investigated silica gel and seven clays as inert sorbents to mitigate these inhibitory effects in a 28 day manometric respirometry biodegradation test. CTAB was not inhibitory to the used inoculum, but we did observe that seven out of eight sorbents increased maximum attainable biodegradation, and four out of eight decreased the lag phase. The strongly inhibitory effect of CPC was successfully mitigated by most sorbents, with five out of eight allowing >50% biodegradation within 28 days. Results further indicate that bioaccessibility of the sorbed fractions in the stirred manometric test systems was higher than in calmly shaken headspace test systems. Bioaccessibility might also be limited depending on characteristics of test chemical and sorbent type, with montmorillonite and bentonite apparently providing the lowest level of bioaccessibility with CPC. Clay sorbents can thus be used as environmentally relevant sorbents to mitigate potential inhibitory effects of test chemicals, but factors that impede bioaccessibility should be considered. In addition to apparently increased bioaccessibility due to stirring, the automated manometric respirometry test systems give valuable and highly cost-effective insights into lag phase and biodegradation kinetics; information that is especially relevant for test chemicals of gradual biodegradability.

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery.

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery.

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

Low temperature traps myosin motors of mammalian muscle in a refractory state that prevents activation.

Myosin motors in the thick filament of resting striated (skeletal and cardiac) muscle are trapped in an OFF state, in which the motors are packed in helical tracks on the filament surface, inhibiting their interactions with actin and utilization of ATP. To investigate the structural changes induced in the thick filament of mammalian skeletal muscle by changes in temperature, we collected x-ray diffraction patterns from the fast skeletal muscle extensor digitorum longus of the mouse in the temperature range from near physiological (35°C) to 10°C, in which the maximal isometric force (T 0) shows a threefold decrease. In resting muscle, x-ray reflections signaling the OFF state of the thick filament indicate that cooling produces a progressive disruption of the OFF state with motors moving away from the ordered helical tracks on the surface of the thick filament. We find that the number of myosin motors in the OFF state at 10°C is half of that at 35°C. At T 0, changes in the x-ray signals that report the fraction and conformation of actin-attached motors can be explained if the threefold decrease in force associated with lowering temperature is due not only to a decrease in the force-generating transition in the actin-attached motors but also to a twofold decrease in the number of such motors. Thus, lowering the temperature reduces to the same extent the fraction of motors in the OFF state at rest and the fraction of motors attached to actin at T 0, suggesting that motors that leave the OFF state accumulate in a disordered refractory state that makes them unavailable for interaction with actin upon stimulation. This regulatory effect of temperature on the thick filament of mammalian skeletal muscle could represent an energetically convenient mechanism for hibernating animals.

Sorbent-modified biodegradation studies of the biocidal cationic surfactant cetylpyridinium chloride.

Biodegradability studies for the cationic surfactant cetylpyridinium chloride (CPC) are hampered by inhibitory effects on inoculum at prescribed test concentrations (10-20 mg organic carbon/L). In this study, we used 14C labeled CPC in the 28 d Headspace Test (OECD 310) and demonstrated that CPC was readily biodegradable (10->60% mineralization within a 10 day window) at test concentrations 0.006-0.3 mg/L with CPC as single substrate. Biodegradation efficiency was comparable over this concentration range. CPC inhibited degradation at 1 mg/L and completely suppressed inoculum activity at 3 mg/L. In an extensive sorbent modified biodegradation study we evaluated the balance between CPC bioaccessibility and toxicity. A non-inhibitory concentration of 0.1 mg/L CPC was readily biodegradable with 83% sorbed to SiO2, while biodegradation was slower when 96% was sorbed. SiO2 mitigated inhibitory effects of 1 mg/L CPC, reaching >60% biodegradation within 28 d; inhibitory effects were also mitigated by addition of commercial clay powder (illite) but this was primarily reflected by a reduced lag phase. At 10 mg/L CPC SiO2 was still able to mitigate inhibitory effects, but bioaccessibility seemed limited as only 20% biodegradation was reached. Illite limited bioaccessibility more strongly and was not able to sustain biodegradation at 10 mg/L CPC.

Toxicity mitigation and bioaccessibility of the cationic surfactant cetyltrimethylammonium bromide in a sorbent-modified biodegradation study.

Biodegradation potential of cationic surfactants may be hampered by inhibition of inoculum at concentrations required to accurately measure inorganic carbon. At >0.3 mg/L cetyltrimethylammonium bromide (CTAB) negatively impacted degradation of the reference compound aniline. We used silicon dioxide (SiO2) and illite as inorganic sorbents to mitigate toxicity of CTAB by lowering freely dissolved concentrations. In an OECD Headspace Test we tested whether 16.8 mg/L CTAB was readily biodegradable in presence of two concentrations of SiO2 and illite. SiO2 adsorbed 85% and 98% CTAB, resulting in concentrations of 2.5 and 0.34 mg/L, mineralized to CO2 >60% within 16 and 23 d, respectively. With 89% and 99% sorbed to illite, 60% mineralization was reached within 9 and 23 d, respectively. However, higher sorbent concentrations increased time needed to reach >60% mineralization. Thus, desorption kinetics likely decreased bioaccessibility. It is therefore essential to determine appropriate concentrations of mitigating sorbents to render a Headspace Test based on carbon analysis suitable to determine ready biodegradability of compounds which might inhibit inoculum. This would avoid use of expensive radiolabeled compounds. However, high sorbent concentrations can reduce bioaccessibility and limit degradation kinetics, particularly for relatively toxic substances that require strong mitigation.

Visual failure in the elderly and dysphagia.

A 91-year-old man presented with a history of acute dysphagia. Clinical examination found reduced oxygen saturations and lung basal crepitations. Blood tests revealed mild anaemia, leukocytosis and acute renal failure. Chest X-ray demonstrated two oesophageal foreign bodies (FBs) and consolidation at the left lung base. Dysphagia resolved following the removal of two coins at oesophagogastroduodenoscopy, the man did not recall ingesting coins. His coin ingestion was attributed to poor visual acquity and he was referred for eye examination and advised to keep coins separate from food and medication. Children and the aged are likely to swallow FBs; causes of ingestion include reduced ability to chew and/or distinguish between objects. Most FBs pass spontaneously, however those that become stuck are likely to impact in the oesophagus. It is important to consider visual acuity for both compliance with medication and to prevent ingestion of FBs.

Loss of MTBP expression is associated with reduced survival in a biomarker-defined subset of patients with squamous cell carcinoma of the head and neck.

BACKGROUND: Recent genetic studies have implicated p53 mutation as a significant risk factor for therapeutic failure in squamous cell carcinoma of the head and neck (SCCHN). However, in a recent meta-analysis in the literature of p53 from major anatomical subsites (larynx, oral cavity, oropharynx/hypopharynx), associations between patient survival and p53 status were ambiguous. METHODS: The authors examined a cohort of SCCHNs using a previously developed biomarker combination that likely predicts p53 status based on p53/MDM2 expression levels determined by immunohistochemistry (IHC). In addition, the authors generated and validated an antibody to MTBP (an MDM2 binding protein that alters p53/MDM2 homeostasis and may contribute to metastatic suppression) and have incorporated data for MTBP expression into the current analyses. RESULTS: Analysis of expression data for p53 and MDM2 in 198 SCCHN patient samples revealed that the biomarker combination p53 + ve/MDM2-low (likely indicative of p53 mutation) was significantly associated with reduced overall survival (log-rank P = .035) and was an independent prognostic factor (P = .013; HR, 1.705; 95% CI, 1.12-2.60); thus, these data were compatible with earlier genetic analyses. By using IHC for p53 and MDM2 to dichotomize patients, the authors found that loss of MTBP expression was significantly associated with reduced survival (log-rank P = .004) and was an independent prognostic factor (P = .004; HR, 2.78; 95% CI, 1.39-5.54) in p53 + ve/MDM2-low patients. CONCLUSIONS: These results represent the first examination of MTBP expression in human tissues and provide evidence for a p53 status-dependent role for MTBP in suppressing disease progression in SCCHN patients as well as confirming a role for p53 pathway function in delaying disease progression.

X-ray solution scattering studies of the structural diversity intrinsic to protein ensembles.

It is becoming increasingly clear that characterization of the protein ensemble-the collection of all conformations of which the protein is capable-will be a critical step in developing a full understanding of the linkage between structure, dynamics, and function. X-ray solution scattering in the small angle (SAXS) and wide-angle (WAXS) regimes represents an important new window to exploring the behavior of ensembles. The characteristics of the ensemble express themselves in X-ray solution scattering data in predictable ways. Here we present an overview of the effect that structural diversity intrinsic to protein ensembles has on scattering data. We then demonstrate the observation of these effects in scattering from four molecular systems; myoglobin; ubiquitin; alcohol dehydrogenase; and HIV protease; and demonstrate the modulation of these ensembles by ligand binding, mutation, and environmental factors. The observations are analyzed quantitatively in terms of the average spatial extent of structural fluctuations occurring within these proteins under different experimental conditions. The insights which these analyses support are discussed in terms of the function of the various proteins.

Myosin head orientation: a structural determinant for the Frank-Starling relationship.

The cellular mechanism underlying the Frank-Starling law of the heart is myofilament length-dependent activation. The mechanism(s) whereby sarcomeres detect changes in length and translate this into increased sensitivity to activating calcium has been elusive. Small-angle X-ray diffraction studies have revealed that the intact myofilament lattice undergoes numerous structural changes upon an increase in sarcomere length (SL): lattice spacing and the I(1,1)/I(1,0) intensity ratio decreases, whereas the M3 meridional reflection intensity (I(M3)) increases, concomitant with increases in diastolic and systolic force. Using a short (∼10 ms) X-ray exposure just before electrical stimulation, we were able to obtain detailed structural information regarding the effects of external osmotic compression (with mannitol) and obtain SL on thin intact electrically stimulated isolated rat right ventricular trabeculae. We show that over the same incremental increases in SL, the relative changes in systolic force track more closely to the relative changes in myosin head orientation (as reported by I(M3)) than to the relative changes in lattice spacing. We conclude that myosin head orientation before activation determines myocardial sarcomere activation levels and that this may be the dominant mechanism for length-dependent activation.

A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE).

BACKGROUND: The General Medical Council states that teaching doctors and students is important for the care of patients. Our aim was to deliver a structured teaching program to final year medical students, evaluate the efficacy of teaching given by junior doctors and review the pertinent literature. METHODS: We developed a revision package for final year medical students sitting the Objective Structured Clinical Examination (OSCE). The package was created and delivered exclusively by recent medical graduates and consisted of lectures and small group seminars covering the core areas of medicine and surgery, with a focus on specific OSCE station examples. Students were asked to complete a feedback questionnaire during and immediately after the program. RESULTS: One hundred and eighteen completed feedback questionnaires were analysed. All participants stated that the content covered was relevant to their revision. 73.2% stated that junior doctors delivered teaching that is comparable to that of consultant - led teaching. 97.9% stated the revision course had a positive influence on their learning. CONCLUSIONS: Our study showed that recent medical graduates are able to create and deliver a structured, formal revision program and provide a unique perspective to exam preparation that was very well received by our student cohort. The role of junior doctors teaching medical students in a formal structured environment is very valuable and should be encouraged.

X-ray diffraction evidence for myosin-troponin connections and tropomyosin movement during stretch activation of insect flight muscle.

Stretch activation is important in the mechanical properties of vertebrate cardiac muscle and essential to the flight muscles of most insects. Despite decades of investigation, the underlying molecular mechanism of stretch activation is unknown. We investigated the role of recently observed connections between myosin and troponin, called "troponin bridges," by analyzing real-time X-ray diffraction "movies" from sinusoidally stretch-activated Lethocerus muscles. Observed changes in X-ray reflections arising from myosin heads, actin filaments, troponin, and tropomyosin were consistent with the hypothesis that troponin bridges are the key agent of mechanical signal transduction. The time-resolved sequence of molecular changes suggests a mechanism for stretch activation, in which troponin bridges mechanically tug tropomyosin aside to relieve tropomyosin's steric blocking of myosin-actin binding. This enables subsequent force production, with cross-bridge targeting further enhanced by stretch-induced lattice compression and thick-filament twisting. Similar linkages may operate in other muscle systems, such as mammalian cardiac muscle, where stretch activation is thought to aid in cardiac ejection.

Isolated lower limb medium-vessel vasculitis: a new entity?

A 47-year-old female was referred with bilateral ischaemic lesions affecting her toes with associated gangrene. Systemic examination was normal and her medical history was unremarkable. Close examination of the hands revealed splinter haemorrhages. Her feet were dusky in colour and the toes were dark and weeping, each becoming gangrenous, with erythema around the metatarsal phalangeal joint. Dorsalis pedis and posterior tibial pulses were intact with strong Doppler signals. Investigations for surgical pathology and malignancy were all negative as were routine blood tests and tests for autoimmune and viral markers. Vasculitis was diagnosed when her toes showed improvement with steroids, however, attempts to reduce the steroid dose were unsuccessful and azathioprine was introduced. Despite immunosuppression and immunomodulators, her toes deteriorated and were amputated. Histology revealed findings consistent with a medium-vessel vasculitis which antineutrophil cytoplasmic antibody was negative. A similar vasculitis has not been formally reported in the literature.

Structure of flexible filamentous plant viruses.

Flexible filamentous viruses make up a large fraction of the known plant viruses, but in comparison with those of other viruses, very little is known about their structures. We have used fiber diffraction, cryo-electron microscopy, and scanning transmission electron microscopy to determine the symmetry of a potyvirus, soybean mosaic virus; to confirm the symmetry of a potexvirus, potato virus X; and to determine the low-resolution structures of both viruses. We conclude that these viruses and, by implication, most or all flexible filamentous plant viruses share a common coat protein fold and helical symmetry, with slightly less than 9 subunits per helical turn.

Molecular crowding inhibits intramolecular breathing motions in proteins.

In aqueous solution some proteins undergo large-scale movements of secondary structures, subunits or domains, referred to as protein "breathing", that define a native-state ensemble of structures. These fluctuations are sensitive to the nature and concentration of solutes and other proteins and are thereby expected to be different in the crowded interior of a cell than in dilute solution. Here we use a combination of wide angle X-ray scattering (WAXS) and computational modeling to derive a quantitative measure of the spatial scale of conformational fluctuations in a protein solution. Concentration-dependent changes in the observed scattering intensities are consistent with a model of structural fluctuations in which secondary structures undergo rigid-body motions relative to one another. This motion increases with decreasing protein concentration or increasing temperature. Analysis of a set of five structurally and functionally diverse proteins reveals a diversity of kinetic behaviors. Proteins with multiple disulfide bonds exhibit little or no increase in breathing in dilute solutions. The spatial extent of structural fluctuations appears highly dependent on both protein structure and concentration and is universally suppressed at very high protein concentrations.

Skeletal muscle performance determined by modulation of number of myosin motors rather than motor force or stroke size.

Skeletal muscle can bear a high load at constant length, or shorten rapidly when the load is low. This force-velocity relationship is the primary determinant of muscle performance in vivo. Here we exploited the quasi-crystalline order of myosin II motors in muscle filaments to determine the molecular basis of this relationship by X-ray interference and mechanical measurements on intact single cells. We found that, during muscle shortening at a wide range of velocities, individual myosin motors maintain a force of about 6 pN while pulling an actin filament through a 6 nm stroke, then quickly detach when the motor reaches a critical conformation. Thus we show that the force-velocity relationship is primarily a result of a reduction in the number of motors attached to actin in each filament in proportion to the filament load. These results explain muscle performance and efficiency in terms of the molecular mechanism of the myosin motor.

Detection of functional ligand-binding events using synchrotron x-ray scattering.

Small-molecule ligands that change the structure of a protein are likely to affect its function, whereas those causing no structural change are less likely to be functional. Wide-angle x-ray scattering (WAXS) can be easily carried out on proteins and small molecules in solution in the absence of chemical tags or derivatives. The authors demonstrate that WAXS is a sensitive probe of ligand binding to proteins in solution and can distinguish between nonfunctional and productive binding. Furthermore, similar ligand-binding modes translate into similar scattering patterns. This approach has high potential as a novel, generic, low-throughput assay for functional ligand binding.

Interfilament spacing is preserved during sarcomere length isometric contractions in rat cardiac trabeculae.

It is generally assumed that the myofilament lattice in intact (i.e., nonskinned) striated muscle obeys constant volume. However, whether such is the case during the myocardial contraction is unknown. Accordingly, we measured interfilament spacing by x-ray diffraction in ultra-thin isolated rat right ventricular trabeculae during a short 10 ms shuttered exposure either just before electrical stimulation (diastole), or at the peak of the contraction (systole); sarcomere length (SL) was held constant throughout the contraction using an iterative feedback control system. SL was thus varied in a series of SL-clamped contractions; the relationship between SL and interfilament spacing was not different between diastole and systole within 1%; this was true also over a wide range of inotropic states induced by varied [Ca(2+)](o). We conclude that the cardiac myofilament lattice maintains constant volume, and thus constant interfilament spacing, during contraction.

Cost-effective EMCCD-based detector for time-resolved biological SAXS applications.

Third generation synchrotron sources such as the Advanced Photon Source at Argonne National Laboratory, Argonne, IL, are outstanding tools for X-ray diffraction and scattering studies of non-crystalline biological materials. However, these studies are hindered by the lack of adequate detectors that can provide multiple frames of detailed structural information on the required millisecond time scale at the extremely high count rates available at the APS. RMD is developing a cost effective detector for time-resolved small angle X-ray scattering, using a cooled, 512x512 pixel electron multiplying CCD (EMCCD). This paper describes the detector design, its efficacy for time-resolved SAXS studies, and its imaging performance with frame rates of 30 to 500 fps.