Communication between the transverse cervical nerve (C2,3) and marginal mandibular branch of the facial nerve: a cadaveric and clinical study.

Several branches of the facial nerve are known to anastomose with branches of the cervical plexus, other cranial nerves, and the trigeminal nerve. Communication between the sensory transverse cervical nerve (C2, 3) and marginal mandibular nerve is, however, less well known, and in a previous study of 86 neck dissections we reported a 2.3% incidence of anastomoses between them. In this prospective study, we meticulously searched for more examples using both formalin-fixed cadavers and neck dissections. A total of 102 necks were included (both sides of 36 cadavers (n=72 necks), and 30 patients who had neck dissection for the management of squamous cell carcinoma). We found communications between these nerves on one side of a cadaver and in one neck dissection. When combined with the numbers from our previous study, the overall incidence was 2.1% in 188 necks. The marginal mandibular nerve was inseparable from the anastomosis with the transverse cervical nerve, and the variant should not be forgotten if we are to reduce the chance of postoperative weakness of the lower lip, particularly when operative exposure is more limited (such as during removal of the submandibular gland).

Sleep: its importance and the effects of deprivation on surgeons and other healthcare professionals.

As clinicians, we sometimes fail to look after ourselves properly and do not regularly eat healthy foods or drink enough. Sleep is another factor that we often neglect. A lack of it can compromise our personal health and performance at work, and the "sleep debt" that results when this is chronic can take far longer to recover from than one might think. Now that junior doctors work more shift rotas and senior colleagues have onerous on-call responsibilities, we all need to be aware of the effects of sleep deprivation, which can lower the mood and motivation, weaken leadership, and result in more clinical errors. In this review we consider what might constitute enough sleep, the consequences of inadequate sleep, and how these might be addressed for surgeons.

Could exercise improve mental health and cognitive skills for surgeons and other healthcare professionals?

Workplace-related illness is common in the UK, and in healthcare more than five million working days over 10years have been lost as a result. Occupational stress is well known and can affect clinicians at any stage, yet many healthcare professionals continue to work with this or other psychological problems (including anxiety, chronic fatigue, and burnout) as they do not wish to let their colleagues down. Mental health issues might be dismissed, particularly in surgery, because there is a misconception that surgeons can cope better with stress than those working in other specialties, and are better protected from clinical burnout. The benefit of exercise on physical health is clear, but its role in the maintenance of good mental health and well-being should not be underestimated. As society adopts an increasingly sedentary lifestyle, exercise for many has a lower priority than other activities. In this article we give an overview of the mental health issues that might affect doctors and surgeons, and explore how exercise can benefit our well-being and clinical performance.

Can dietary supplements improve a clinician's well-being and health?

Many people use dietary supplements to improve their physical and mental well-being and their general health, but do not know if they really have any benefit. To our knowledge, little has been published on their use in the clinical environment, so we evaluated the evidence for their benefits in people whose work is physically and mentally challenging. Studies on nutrition and supplementation in athletes and military personnel have clearly shown that several compounds improve cognition, mental well-being, and physical performance. Based on this evidence, and with the many pressures faced by healthcare workers, as well as the need for concentration and endurance, some dietary supplements might be beneficial. Supplementation of a balanced diet with omega-3 fatty acids, vitamin B3, vitamin C and associated antioxidants, vitamin D, and protein, may improve a clinician's physical and mental health and their performance at work. Specific research is, however, needed to evaluate this more fully.

Variation in Responses to Sprint Training in Male Youth Athletes: A Meta-analysis.

The trainability of youths and the existence of periods of accelerated adaptation to training have become key subjects of debate in exercise science. The purpose of this meta-analysis was to characterise youth athletes' adaptability to sprint training across PRE-, MID-, and POST-peak height velocity (PHV) groups. Effect sizes were calculated as a measure of straight-line sprinting performance with studies qualifying based on the following criteria: (a) healthy male athletes who were engaged in organised sports; (b) groups of participants with a mean age between 10 and 18 years; (c) sprint training intervention duration between 4 and 16 weeks. Standardised mean differences showed sprint training to be moderately effective (Effect size=1.01, 95% confidence interval: 0.43-1.59) with adaptive responses being of large and moderate magnitude in the POST- (ES=1.39; 0.32-2.46) and MID- (ES=1.15; 0.40-1.9) PHV groups respectively. A negative effect size was found in the PRE group (ES=-0.18; -1.35-0.99). Youth training practitioners should prescribe sprint training modalities based on biological maturation status. Twice weekly training sessions should comprise up to 16 sprints of around 20 m with a work-to-rest ratio of 1:25 or greater than 90 s.

Maturational and social factors contributing to relative age effects in school sports: Data from the London Youth Games.

Few studies have investigated whether relative age effects (RAEs) exist in school sport. None have sought to test the competing maturational and social-agent hypotheses proposed to explain the RAE. We aimed to determine the presence of RAEs in multiple school sports and examine the contribution of maturational and social factors in commonplace school sports. We analyzed birth dates of n=10645 competitors (11-18 years) in the 2013 London Youth Games annual inter-school multisport competition and calculated odds ratio (OR) for students competing based on their yearly birth quarter (Q1-Q4). Multivariate logistic regression was used to determine the relative contribution of constituent year (Grade) and relative age in netball and football which used multiyear age groupings. In girls, RAEs were present in the team sports including hockey, netball, rugby union, cricket and volleyball but not football. In boys, RAEs were stronger in common team sports (football, basketball cricket) as well as athletics and rowing. In netball and football teams with players from two constituent years, birth quarter better-predicted selection than did constituent year. Relatively older players (Q1) from lower constituent years were overrepresented compared with players from Q3 and Q4 of the upper constituent years. RAEs are present in the many sports commonplace in English schools. Selection of relatively older players ahead of chronologically older students born later in the selection year suggests social agents contribute to RAEs in school sports.

Athletic performance and birth month: is the relative age effect more than just selection bias?

The aim of this study was to determine if month of birth affects performance in 3 tests of physical function in children and adolescents. We measured cardiorespiratory fitness, handgrip strength and lower-body power expressed them relative to (whole year) age then compared scores between calendar year birth-months. We also expressed test performance as the likelihood of achieving criterion-referenced fitness standards. There were significant main effects of birth-month for cardiorespiratory fitness (F=4.54, p<0.001), strength (F=6.81, p<0.001) and power (F=3.67, p<0.001). Children born in November were fitter and more powerful than those born at other times, particularly the summer months (April, May and June). October-born children were stronger than those born in all months except September and November. This relationship was evident despite controlling for decimal age and despite no significant inter-month differences in anthropometric characteristics.There is a clear physical advantage for those born in the autumn and this may explain some of the bias in sports selection attributed to the relative age effect, particularly when the British school-year (September) cut-off is used.

Hypomaturation amelogenesis imperfecta due to WDR72 mutations: a novel mutation and ultrastructural analyses of deciduous teeth.

BACKGROUND: Mutations in WDR72 have been identified in autosomal recessive hypomaturation amelogenesis imperfecta (AI). OBJECTIVE: to describe a novel WDR72 mutation and report the ultrastructural enamel phenotype associated with a different WDR72 mutation. METHODS: A family segregating autosomal recessive hypomaturation AI was recruited, genomic DNA obtained and WDR72 sequenced. Four deciduous teeth from one individual with a previously published WDR72 mutation, extracted as part of clinical care, were subjected to scanning electron microscopy, energy-dispersive X-ray analysis and transverse microradiography. RESULTS: A novel homozygous nonsense mutation, R897X, was identified in WDR72 in a family originating from Pakistan. Ultrastructural analysis of enamel from the deciduous teeth of an AI patient with the WDR72 mutation S783X revealed energy-dispersive X-ray analysis spectra with normal carbon and nitrogen peaks, excluding retention of enamel matrix protein. However, transverse microradiography values were significantly lower for affected teeth when compared to normal teeth, consistent with reduced mineralisation. On scanning electron microscopy the enamel rod form observed was normal, yet with inter-rod enamel more prominent than in controls. This appearance was unaltered following incubation with either α-chymotrypsin or lipase. CONCLUSIONS: The novel WDR72 mutation described brings the total reported WDR72 mutations to four. Analyses of deciduous tooth enamel in an individual with a homozygous WDR72 mutation identified changes consistent with a late failure of enamel maturation without retention of matrix proteins. The mechanisms by which intracellular WDR72 influences enamel maturation remain unknown.

Ultrastructural analyses of deciduous teeth affected by hypocalcified amelogenesis imperfecta from a family with a novel Y458X FAM83H nonsense mutation.

BACKGROUND: Nonsense mutations in FAM83H are a recently described underlying cause of autosomal dominant (AD) hypocalcified amelogenesis imperfecta (AI). OBJECTIVE: This study aims to report a novel c.1374C>A p.Y458X nonsense mutation and describe the associated ultrastructural phenotype of deciduous teeth. METHODS: A family of European origin from the Iberian Peninsula with AD-inherited AI was ascertained. Family members were assessed through clinical examination and supporting investigations. Naturally exfoliated deciduous teeth from 2 siblings were investigated by scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX) and transverse microradiography (TMR). RESULTS: On clinical and radiographic investigation the appearances of the affected deciduous and permanent teeth were consistent with hypocalcified AI with small focal areas of more normal looking enamel. DNA sequencing identified a novel c.1374C>A p.Y458X FAM83H nonsense mutation in affected, but not in either unaffected family members or unrelated controls. Exfoliated teeth were characterised by substantial post-eruptive enamel loss on gross examination. Irregular, poor quality enamel prisms were observed on SEM. These were coated in amorphous material. TMR and EDX confirmed reduced mineral and increased organic content in enamel, respectively. CONCLUSIONS: FAM83H nonsense mutations have recently been recognised as a cause of AD hypocalcified AI. We report a novel nonsense FAM83H mutation and describe the associated preliminary ultrastructural phenotype in deciduous teeth. This is characterised by poorly formed enamel rods with inappropriate retention of amorphous material, which is likely to represent retained organic matrix that contributes to the overall hypomineralised phenotype.

Subfilamentous protofibril structures in fibrous proteins: cross-linking evidence for protofibrils in intermediate filaments.

The packing of the constituent molecules in some fibrous proteins such as collagen and intermediate filaments (IF) is thought to consist of several hierarchical levels, the penultimate of which is the organization of subfilamentous units termed protofibrils. However, to date only indirect evidence, such as electron microscopic images of unraveling fibers or the existence of mass quanta, has been adduced in support of the existence of protofibrils. We have reexamined this issue in IF. Cross-links have been induced in trichocyte keratin, cytokeratin, and vimentin IF proteins. Using improved experimental conditions, several additional and reproducible cross-links have been characterized. Notably, many of these link between columns of molecular strands four apart on two-dimensional surface lattices. These data provide robust support for the concept of an 8-chain (4-molecule) protofibril entity in IF. Further, their positions correspond to the axial displacements predicted for protofibrils in the different types of IF. Also, the data are consistent with intact IF containing four protofibrils. In addition, the positions of these novel cross-links suggest that there are multiple possible groupings of four molecular strands to form a protofibril, suggesting a promiscuous association of molecules to form a protofibril. This may underlie the reason that organized elongated protofibrils cannot be visualized by conventional microscopic methods.

Epiplakin, a novel member of the Plakin family originally identified as a 450-kDa human epidermal autoantigen. Structure and tissue localization.

A 450-kDa human epidermal autoantigen was originally identified as a protein that reacted with the serum from an individual with a subepidermal blistering disease. Molecular cloning of this protein has now shown that it contains 5065 amino acids and has a molecular mass of 552 kDa. As reported previously this protein, which we call epiplakin, belongs to the plakin family, but it has some very unusual features. Epiplakin has 13 domains that are homologous to the B domain in the COOH-terminal region of desmoplakin. The last five of these B domains, together with their associated linker regions, are particularly strongly conserved. However, epiplakin lacks a coiled-coil rod domain and an amino-terminal domain, both of which are found in all other known members of the plakin family. Furthermore, no dimerization motif was found in the sequence. Thus, it is likely that epiplakin exists in vivo as a single-chain structure. Epitope mapping experiments showed that the original patient's serum recognized a sequence unique to epiplakin, which was not found in plectin. Immunofluorescence staining revealed the presence of epiplakin in whole sheets of epidermis and esophagus, in glandular cells of eccrine sweat and parotid glands and in mucous epithelial cells in the stomach and colon.

Quantitative comparison of the ability of hydropathy scales to recognize surface beta-strands in proteins.

Methods based on the use of hydropathy scales have been used widely to ascertain the secondary structures of proteins. However, over 100 such scales have been reported in the literature, and which of these is the most successful in terms of the prediction rate of the correct structure is not clear. This article, therefore, reports a comprehensive analysis of the relative success of hydropathy scales to locate beta-strands on the surfaces of proteins. The technique we used is based on the technique proposed by Fraser and Parry, but it includes a modification that allows a higher rate of successful prediction and a lower rate of overprediction. We used as a basis for assessing the predictions a database of sequence-unique structures that we previously established. Proteins 2001;42:243-255.

Residues in the 1A rod domain segment and the linker L2 are required for stabilizing the A11 molecular alignment mode in keratin intermediate filaments.

Both analyses of x-ray diffraction patterns of well oriented specimens of trichocyte keratin intermediate filaments (IF) and in vitro cross-linking experiments on several types of IF have documented that there are three modes of alignment of pairs of antiparallel molecules in all IF: A11, A22 and A12, based on which parts of the major rod domain segments are overlapped. Here we have examined which residues may be important for stabilizing the A11 mode. Using the K5/K14 system, we have made point mutations of charged residues along the chains and examined the propensities of equimolar mixtures of wild type and mutant chains to reassemble using as criteria: the formation (or not) of IF in vitro or in vivo; and stabilities of one- and two-molecule assemblies. We identified that the conserved residue Arg10 of the 1A rod domain, and the conserved residues Glu4 and Glu6 of the linker L2, were essential for stability. Additionally, conserved residues Lys31 of 1A and Asp1 of 2A and non-conserved residues Asp/Asn9 of 1A, Asp/Asn3 of 2A, and Asp7 of L2 are important for stability. Notably, these groups of residues lie close to each other when two antiparallel molecules are aligned in the A11 mode, and are located toward the ends of the overlap region. Although other sets of residues might theoretically also contribute, we conclude that these residues in particular engage in favorable intermolecular ionic and/or H-bonding interactions and thereby may play a role in stabilizing the A11 mode of alignment in keratin IF.

Surface beta-strands in proteins: identification using an hydropathy technique.

From a representative set of monomeric globular proteins with known three-dimensional structures, beta-strands with lengths > or = 5 amino acids have been identified and catalogued. By ascertaining the accessible surface areas of the constituent residues in these strands, and by checking whether the exposed/buried pattern is 80% or more similar to that in an idealized surface strand, a subset of structures can be delineated in which the beta-strands are all sited on the surface of the protein. The corresponding sequence data show that about 50% of the residues are apolar (Val, Ile, Leu, Phe, Tyr, Ala) and that the common occurrence of valine (14.3%), isoleucine (9.6%), and threonine (8.1%) is a characteristic feature. The frequencies of occurrence of those amino acids in the strands that face the aqueous environment and the interior have also been determined separately and show that most surface strands have a substructure of the form (apolar-X)(n), where X is approximately equally divided between apolar, charged, and hydrophilic residues. Using the frequency data thus obtained, allied with an algorithm to delineate potential surface beta-strands from characteristic hydropathy profiles, it is now possible to search through the sequences of proteins with unknown tertiary structures and make realistic predictions of the presence of this element of structure on the protein surface. In addition, new data are presented on the distribution of the various types of residues on the surface of proteins and in their interior. Significant differences were observed, not all of which have been identified previously. Furthermore, the distribution of the types of residue in a surface beta-strand was compared to that corresponding to the surfaces of all of the proteins in our database. Again, very characteristic differences were observed. These are helpful in recognizing the presence of surface beta-strands.

Human and Xenopus cingulin share a modular organization of the coiled-coil rod domain: predictions for intra- and intermolecular assembly.

The complete nucleotide and derived amino acid sequences of Homo sapiens cingulin cDNA (5143 bp) were determined by sequencing two distinct EST clones that showed significant sequence homology to Xenopus laevis cingulin. Protein sequence analysis indicates that the molecule contains two chains and has a tripartite structure with N-terminal (head) domains, a coiled-coil rod domain (length, 120 nm), and short C-terminal (tail) domains. Human and Xenopus cingulin heads are only 33% identical, yet a human cingulin N-terminal fragment still interacts with canine ZO-1 and ZO-2 in vitro. The rod domain contains two A and two B subdomains, though it lacks the third B subdomain present in Xenopus cingulin. The heptad substructures of Xenopus and human cingulins were further characterized by computer analysis and indicated that the two-stranded coiled-coil structure contained chains that were parallel and in axial register. Fast Fourier transform analysis and a scoring technique designed to recognize potential interactions between different supramolecular arrangements suggests that cingulin dimers may further assemble through antiparallel interactions between the last approximately 100 amino acids of the coiled-coil region. Cingulin mRNA ( approximately 5.2 kb) was detected by Northern blotting in epithelial tissues. A human cingulin EST was mapped to chromosome 1q21 using the UniGene database.

Coiled-coil trigger motifs in the 1B and 2B rod domain segments are required for the stability of keratin intermediate filaments.

Many alpha-helical proteins that form two-chain coiled coils possess a 13-residue trigger motif that seems to be required for the stability of the coiled coil. However, as currently defined, the motif is absent from intermediate filament (IF) protein chains, which nevertheless form segmented two-chain coiled coils. In the present work, we have searched for and identified two regions in IF chains that are essential for the stability necessary for the formation of coiled-coil molecules and thus may function as trigger motifs. We made a series of point substitutions with the keratin 5/keratin 14 IF system. Combinations of the wild-type and mutant chains were assembled in vitro and in vivo, and the stabilities of two-chain (one-molecule) and two-molecule assemblies were examined with use of a urea disassembly assay. Our new data document that there is a region located between residues 100 and 113 of the 2B rod domain segment that is absolutely required for molecular stability and IF assembly. This potential trigger motif differs slightly from the consensus in having an Asp residue at position 4 (instead of a Glu) and a Thr residue at position 9 (instead of a charged residue), but there is an absolute requirement for a Glu residue at position 6. Because these 13 residues are highly conserved, it seems possible that this motif functions in all IF chains. Likewise, by testing keratin IF with substitutions in both chains, we identified a second potential trigger motif between residues 79 and 91 of the 1B rod domain segment, which may also be conserved in all IF chains. However, we were unable to find a trigger motif in the 1A rod domain segment. In addition, many other point substitutions had little detectable effect on IF assembly, except for the conserved Lys-23 residue of the 2B rod domain segment. Cross-linking and modeling studies revealed that Lys-23 may lie very close to Glu-106 when two molecules are aligned in the A(22) mode. Thus, the Glu-106 residue may have a dual role in IF structure: it may participate in trigger formation to afford special stability to the two-chain coiled-coil molecule, and it may participate in stabilization of the two-molecule hierarchical stage of IF structure.

The intermediate filament protein consensus motif of helix 2B: its atomic structure and contribution to assembly.

Nearly all intermediate filament proteins exhibit a highly conserved amino acid motif (YRKLLEGEE) at the C-terminal end of their central alpha-helical rod domain. We have analyzed its contribution to the various stages of assembly by using truncated forms of Xenopus vimentin and mouse desmin, VimIAT and DesIAT, which terminate exactly before this motif, by comparing them with the wild-type and tailless proteins. It is surprising that in buffers of low ionic strength and high pH where the full-length proteins form tetramers, both VimIAT and DesIAT associated into various high molecular weight complexes. After initiation of assembly, both VimIAT and DesIAT aggregated into unit-length-type filaments, which rapidly longitudinally annealed to yield filaments of around 20 nm in diameter. Mass measurements by scanning transmission electron microscopy revealed that both VimIAT and DesIAT filaments contained considerably more subunits per cross-section than standard intermediate filaments. This indicated that the YRKLLEGEE-motif is crucial for the formation of authentic tetrameric complexes and also for the control of filament width, rather than elongation, during assembly. To determine the structure of the YRKLLEGEE domain, we grew crystals of peptides containing the last 28 amino acid residues of coil 2B, chimerically fused at its amino-terminal end to the 31 amino acid-long leucine zipper domain of the yeast transcription factor GCN4 to facilitate appropriate coiled-coil formation. The atomic structure shows that starting from Tyr400 the two helices gradually separate and that the coiled coil terminates with residue Glu405 while the downstream residues fold away from the coiled-coil axis.

Stat3-dependent induction of p19INK4D by IL-10 contributes to inhibition of macrophage proliferation.

We have previously reported that IL-10 inhibits proliferation of normal bone marrow-derived macrophages and of the monocyte/macrophage cell line J774. Activation of Stat3 was shown to be necessary and sufficient to mediate inhibition of proliferation. To investigate further the mechanism of growth arrest, we examined the effect of IL-10 on expression of cell cycle inhibitors. We found that IL-10 treatment increases expression of the cyclin-dependent kinase inhibitors p19INK4D and p21CIP1 in macrophages. IL-10 cannot induce p19INK4D expression or block proliferation when Stat3 signaling is blocked by a dominant negative Stat3 or a mutant IL-10Ralpha which does not recruit Stat3 in J774 cells, whereas p21CIP1 induction is not affected. An inducibly active Stat3 (coumermycin-dimerizable Stat3-Gyrase B), which suppresses J774 cell proliferation, also induced p19INK4D expression. Sequencing of the murine p19INK4D promoter revealed two candidate Stat3 binding sites, and IL-10 treatment activated a reporter gene controlled by this promoter. These data suggest that Stat3-dependent induction of p19INK4D mediates inhibition of proliferation. Enforced expression of murine p19INK4D cDNA J774 cells significantly reduced their proliferation. Use of antisense p19INK4D and analysis of p19INK4D-deficient macrophages confirmed that p19INK4D is required for optimal inhibition of proliferation by IL-10, and indicated that additional IL-10 signaling events contribute to this response. These data indicate that Stat3-dependent induction of p19INK4D and Stat3-independent induction of p21CIP1 are important components of the mechanism by which IL-10 blocks proliferation in macrophages.