Epidemiology and pathophysiology of falls in facioscapulohumeral disease.

BACKGROUND AND AIMS: Muscle weakness is a potentially important, yet poorly studied, risk factor for falls. Detailed studies of patients with specific myopathies may shed new light on the relation between muscle weakness and falls. Here falls in patients with facioscapulohumeral disease (FSHD) who suffered from lower limb muscle weakness were examined. This study provides insights into the prevalence, relevance and pathophysiology of falls in FSHD. METHODS: A validated questionnaire was used as well as a prospective 3 month follow-up to examine the prevalence, circumstances and consequences of falls in 73 patients with FSHD and 49 matched healthy controls. In a subgroup of 28 subjects, muscle strength was also examined and balance was assessed electrophysiologically using body worn gyroscopes. RESULTS: In the questionnaire, 30% of the patients reported falling at least once a month whereas none of the controls did. Injuries occurred in almost 70% of the patients. The prospective study showed that patients fell mostly at home, mainly due to intrinsic (patient related) causes, and usually in a forward direction. Fallers were unstable while climbing stairs, rising from a chair and standing with eyes closed whereas non-fallers had normal balance control. Frequent fallers had greater muscle weakness than infrequent fallers. CONCLUSION: These findings demonstrate the high prevalence and clinical relevance of falls in FSHD. The relation between muscle weakness and instability among fallers is also highlighted. Because patients fell mainly at home, fall prevention strategies should focus on home adaptations. As mainly intrinsic causes underlie falls, the impact of adopting balance strategies or balance training should be explored in this patient group.

Mechanistic studies of nitric oxide reactions with water soluble iron(II), cobalt(II), and iron(III) porphyrin complexes in aqueous solutions: implications for biological activity.

The reactions of nitric oxide and carbon monoxide with water soluble iron and cobalt porphyrin complexes were investigated over the temperature range 298-318 K and the hydrostatic pressure range 0.1-250 MPa [porphyrin ligands: TPPS = tetra-meso-(4-sulfonatophenyl)porphinate and TMPS = tetra-meso-(sulfonatomesityl)porphinate]. Large and positive DeltaS(double dagger) and DeltaV(double dagger) values were observed for NO binding to and release from iron(III) complexes Fe(III)(TPPS) and Fe(III)(TMPS) consistent with a dissociative ligand exchange mechanism where the lability of coordinated water dominates the reactivity with NO. Small positive values for Delta and Delta for the fast reactions of NO with the iron(II) and cobalt(II) analogues (k(on) = 1.5 x 10(9) and 1.9 x 10(9) M(-1) s(-1) for Fe(II)(TPPS) and Co(II)(TPPS), respectively) indicate a mechanism dominated by diffusion processes in these cases. However, reaction of CO with the Fe(II) complexes (k(on) = 3.6 x 10(7) M(-1) s(-1) for Fe(II)(TPPS)) displays negative Delta and Delta values, consistent with a mechanism dominated by activation rather than diffusion terms. Measurements of NO dissociation rates from Fe(II)(TPPS)(NO) and Co(II)(TPPS)(NO) by trapping free NO gave k(off) values of 6.3 x 10(-4) s(-1) and 1.5 x 10(-4) s(-1). The respective M(II)(TPPS)(NO) formation constants calculated from k(on)/k(off) ratios were 2.4 x 10(12) and 1.3 x 10(13) M(-1), many orders of magnitude larger than that (1.1 x 10(3) M(-1)) for the reaction of Fe(III)(TPPS) with NO.

Mechanistic studies on the reversible binding of nitric oxide to metmyoglobin.

The ferriheme protein metmyoglobin (metMb) in buffer solution at physiological pH 7.4 reversibly binds the biomessenger molecule nitric oxide to yield the nitrosyl adduct (metMb(NO)). The kinetics of the association and dissociation processes were investigated by both laser flash photolysis and stopped-flow kinetics techniques at ambient and high pressure, in three laboratories using several different sources of metMb. The activation parameters DeltaH, DeltaS, and DeltaV were calculated from the kinetic effects of varying temperature and hydrostatic pressure. For the "on" reaction of metMb plus NO, reasonable agreement was found between the various techniques with DeltaH(on), DeltaS(on), and DeltaV(on) determined to have the respective values approximately 65 kJ mol(-1), approximately 60 J mol(-1) K(-1), and approximately 20 cm(3) mol(-1). The large and positive DeltaS and DeltaV values are consistent with the operation of a limiting dissociative ligand substitution mechanism whereby dissociation of the H(2)O occupying the sixth distal coordination site of metMb must precede formation of the Fe-NO bond. While the activation enthalpies of the "off" reaction displayed reasonable agreement between the various techniques (ranging from 68 to 83 kJ mol(-1)), poorer agreement was found for the DeltaS(off) values. For this reason, the kinetics for the "off" reaction were determined more directly via NO trapping experiments, which gave the respective activation parameters DeltaH(off) = 76 kJ mol(-1), DeltaS(off) = approximately 41 J mol(-1) K(-1), and DeltaV(off) = 20 cm(3) mol(-1)), again consistent with a limiting dissociative mechanism. These results are discussed in reference to other investigations of the reactions of NO with both model systems and metalloproteins.

Synthesis and spectral characterization of sulfhydryl-reactive fluorescent probes.

We synthesized two sulfhydryl-reactive fluorescent probes, Br-ANT (2-amino-benzoic acid, 2-(bromoacetyl)hydrazide) and Br-MANT (N-[2-[(bromoacetyl)amino]ethyl]-2-(methylamino)benzamide). Br-ANT and Br-MANT contain an anthraniloyl and N-methyl anthraniloyl group, respectively, linked to the sulfhydryl-reactive bromoacetyl moiety. The cysteine adducts have absorption maxima at 323 and 326 nm, with molar extinction coefficients of 2100 and 2900 M-1 cm-1, for Br-ANT and Br-MANT, respectively, making these probes excellent acceptors for tryptophan. The absorption spectra and quantum yields were constant at pH levels useful for protein studies (pH 5-8). Quantum yields of Br-ANT and Br-MANT were 0.16 and 0.42, emission maxima were 432 and 440 nm, and fluorescence lifetimes were 1.3 and 7.8 ns, respectively. The emission of Br-ANT-Cys and Br-MANT-Cys shifted to shorter wavelengths with decreasing solvent polarity. Polarization values were maximal between 330 and 375 nm. Both probes reacted selectively and stoichiometrically with the single cysteine residue of a model protein. The labeled protein exhibited relatively long lifetimes (9-10 ns), suggesting that these probes will be generally useful for rotational studies.