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Regulators of G protein signaling: a bestiary of modular protein binding domains.

Members of the newly discovered regulator of G protein signaling (RGS) families of proteins have a common RGS domain. This RGS domain is necessary for conferring upon RGS proteins the capacity to regulate negatively a variety of Galpha protein subunits. However, RGS proteins are more than simply negative regulators of signaling. RGS proteins can function as effector antagonists, and recent evidence suggests that RGS proteins can have positive effects on signaling as well. Many RGS proteins possess additional C- and N-terminal modular protein-binding domains and motifs. The presence of these additional modules within the RGS proteins provides for multiple novel regulatory interactions performed by these molecules. These regions are involved in conferring regulatory selectivity to specific Galpha-coupled signaling pathways, enhancing the efficacy of the RGS domain, and the translocation or targeting of RGS proteins to intracellular membranes. In other instances, these domains are involved in cross-talk between different Galpha-coupled signaling pathways and, in some cases, likely serve to integrate small GTPases with these G protein signaling pathways. This review discusses these C- and N-terminal domains and their roles in the biology of the brain-enriched RGS proteins. Methods that can be used to investigate the function of these domains are also discussed.

Amino Acid Motifs↗

Modular extracorporeal liver support.

Modular extracorporeal liver support (MELS) is an integrative concept for the treatment of hepatic failure with appropriate extracorporeal therapy units tailored to suit the actual clinical needs of each patient. The CellModule is a specific bioreactor charged with primary human liver cells harvested from human donor livers found to be unsuitable for transplantation due to steatosis, cirrhosis, or traumatic injury. The DetoxModule enables albumin dialysis for the removal of albumin-bound toxins, reducing the biochemical burden of the liver cells and replacing the bile excretion of hepatocytes in the bioreactor. A DialysisModule for continuous venovenous hemofiltration can be added to the system if required in hepatorenal syndrome.

Bioreactors↗

The efficacy of an educational treatment program for patients with epilepsy (MOSES): results of a controlled, randomized study. Modular Service Package Epilepsy.

PURPOSE: To evaluate the efficacy of the educational program MOSES (Modular Service Package Epilepsy). It was developed to improve patients' knowledge and understanding about their epilepsy, its treatment, and psychosocial consequences. The program intends to improve patients' coping with the disease, to strengthen self-esteem, and to support patients to become experts in managing their epilepsy. METHODS: A controlled, randomized study design was used to examine the efficacy of MOSES. Patients from 22 epilepsy centers in Germany, Austria, and Switzerland were randomly allocated to either MOSES group (treatment group) or waiting-list group (control group). The 242 patients were aged from 16 to 80 years. The MOSES group (n = 113) completed the questionnaires immediately before the educational course (T1) and 6 months later (T2), and the control group (n = 129), 6 months before (T1) and immediately before (T2) the course. The questionnaires included generic instruments (SF-36, Rosenberg self-esteem Scale, von Zerssen Depression Scale), and epilepsy-specific scales (Restrictions in Daily Life, Epilepsy-Related Fears, Coping with Epilepsy and Adaptation). Depression was used as a moderator variable. Seizure frequency and satisfaction with therapy also were assessed. Multivariate analysis of variance (MANOVA) with repeated measurements and univariate analyses of variance were performed. RESULTS: The MANOVA showed that participants of the educational program improved significantly. Univariate analyses revealed improvements in knowledge (p < 0.001) and coping with epilepsy (p = 0.004), whereas important effects of MOSES on other epilepsy-specific measures and on generic questionnaires (SF-36, self-esteem) were not found. Participants of the MOSES program also improved in seizure outcome (p = 0.041) and became more satisfied with the therapy [better tolerability of antiepileptic drug (AED) therapy, fewer side effects; p = 0.014]. In addition, participants expressed being highly satisfied with the program. CONCLUSIONS: The study clearly indicates the need for patient education. Even patients with a long history of epilepsy and with additional handicaps or diseases benefitted from the MOSES program.

Adaptation, Psychological↗

Disassembly of a Howmedica modular resection system.

We report the postoperative disassociation of a Morse taper junction of a Howmedica Modular Resection system implanted after the resection of a malignant distal femoral bone tumor. The disassembly occurred without apparent trauma. This complication was managed by closed reduction under epidural anesthesia. This disassembly probably occurred because of decreased tension of the soft tissue around the prosthesis or an impaired locking mechanism.

Adult↗

Rare case of sciatic nerve palsy in a modular total hip arthroplasty.

A rare case of sciatic nerve palsy in an uncemented modular hip arthroplasty is described. We believe that a delay in recognizing liner dissociation causing granuloma was responsible for the nerve palsy. Delay in diagnosis can be avoided by a careful inspection of prereduction and postreduction radiographs.

Arthroplasty, Replacement, Hip↗

The effect of stem modularity and mode of fixation on tibial component stability in revision total knee arthroplasty.

The effect of stem length, diameter, and mode of fixation on the motion and stress transfer of a cemented tibial tray were evaluated for in 12 cadaver knees. There was a significant decrease in motion of the tibial tray with increasing press-fit stem length (75-150 mm) and increasing stem diameter (10-14 mm). Cemented tibial stems showed significantly less tray motion than uncemented stems. The short cemented stems produced tray stability equivalent to long press-fit stems. Although there was a trend for increased proximal tibial stress shielding with the use of cement and longer, wider stems, the trend was not statistically significant. Modular, press-fit stems can achieve tray stability similar to a smaller cemented stem and can avoid the potential problems with cement.

Adult↗

Radiographic wear measurements in a cementless metal-backed modular cobalt-chromium acetabular component.

Linear polyethylene wear was measured radiographically and correlated with direct measurements of wear from 21 of 24 liners retrieved at revision. An optical comparator was used to assess linear wear using the shadowgraph technique. Postoperative and prerevision radiographs were reviewed to measure the amount of linear wear radiographically. Seven radiographic methods described in the literature were used: 5 were manual techniques, and 2 techniques used a computer-assisted digitizer. Linear regression analysis showed that there was a statistically significant correlation between the radiographic measurements compared with the direct measurement for 4 of the 5 manual techniques but only 1 of the 2 computerized techniques. Based on these results, radiographic wear measurements of cementless, modular components should be considered qualitative rather than quantitative. There is a significant difference in the measurements obtained among various published techniques. The addition of computer digitization to enhance manual methodology does not improve accuracy.

Acetabulum↗

Treatment of the unstable total hip arthroplasty using modularity, soft tissue, and allograft reconstruction.

This is a retrospective analysis of a stepwise approach to the treatment of the unstable total hip arthroplasty. Thirty-two hips in 32 patients were analyzed 9 months to 7 years (average, 3.6 years) after reoperation for instability. Half of the patients underwent revisions of primary total hip arthroplasties, and the other half underwent multiple procedures. Of the patients, 26 dislocated posteriorly, 4 dislocated anteriorly, and 2 were multidirectional. The commonest cause for the dislocation was soft tissue deficiency (n = 17). Other common causes included anterior soft tissue impingement (n = 10), unsatisfactory head-to-neck ratio (n = 5), hypoanteversion of the socket (n = 4), and deficient abductor mechanism (n = 4). Multiple causes were present in 75% of the patients, with a combination of 2 (48%) or > or =3 (28%) factors of instability. Management of the instability by addressing the soft tissue and modification of modular components was successful in 25 patients and unsuccessful in 1 patient. Three unstable hips were treated successfully with an innovative soft tissue augmentation using an Achilles tendon-bone allograft.

Achilles Tendon↗

Primary cementless total hip arthroplasty using a modular femoral component: a minimum 6-year follow-up.

We evaluated 59 hips that underwent a primary total hip arthroplasty using an S-ROM modular femoral component at a mean follow-up of 101 months (range, 72-145 months). All cases showed radiographic evidence of bone ingrowth, and there were no femoral revisions for aseptic loosening. The Harris hip score improved from a mean of 40 preoperatively to 89 at final follow-up. Some degree of proximal femoral disuse atrophy from stress shielding occurred in 46 hips (78%), and some degree of femoral osteolysis occurred in 25 hips (42%). Only additional follow-up will reveal whether there is a consequence of both types of proximal femoral bone loss.

Adolescent↗

Posterior cruciate-retaining modular total knee arthroplasty: a 9- to 12-year follow-up investigation.

Between November 1988 and January 1991, 101 press-fit condylar (PFC; Johnson & Johnson, Raynham, MA) posterior cruciate-retaining total knee arthroplasties were performed in 75 patients. All tibial components were modular metal-backed, and all patellar components were all-polyethylene. All living patients were evaluated at an average 10.5 years (range, 9.5-11.8 years). Only 1 knee required revision (at 11.1 years after the procedure), and only 1 other knee had evidence of radiographic failure. The average range of motion was 1 degrees (range, 0 degrees -10 degrees ) to 110 degrees (range, 86 degrees -130 degrees ). At 10 years of follow-up, the probability of prosthesis survival was 100%, and at 12 years, the probability of prosthesis survival was 93.3% (endpoint defined as revision for any reason).

Aged↗

A modular distal fixation option for proximal bone loss in revision total hip arthroplasty: a 2- to 6-year follow-up study.

Proximal femoral bone deficiency in the failed total hip arthroplasty (THA) is addressed with difficulty using proximally fixed implants. The Link MP reconstruction hip stem is proximally modular but utilizes distal fixation. This series consists of 143 patients from 3 clinical sites. Of the patients, 81 were women. The average follow-up time was 40 months, and the average patient age was 67 years. The preoperative diagnoses included 108 cases of aseptic loosening and 14 periprosthetic fractures. Clinical follow-up of all patients included radiographic assessment of the hip. This study found a 97.2% survival rate. The average subsidence was 2.1 mm. The average postoperative Harris hip score was 92. Complications included 7 wound infections and 4 deep venous thromboses. We found that the Link MP hip stem allows successful revision THA reconstruction of the proximally compromised femur. Good to excellent functional restoration and pain relief is achievable.

Aged↗

A novel modular retention system for midfacial distraction osteogenesis.

Distraction osteogenesis of the midface offers new possibilities for the treatment of large sagittal discrepancies between the upper and lower jaws. The use of an extraoral halo-borne distractor, which allows free three-dimensional vector control, may cause problems in the connection between the midface and the distractor. To overcome these difficulties, we present a new modular retention system to gain bone anchorage whenever a toothborne appliance is not suitable. Distraction osteogenesis with an extraoral appliance is therefore possible even in edentulous elderly patients. We have used this system successfully in 11 patients.

Bone Plates↗

[Current developments in the German Perinatal Survey. Modular analysis tools operating on a database platform].

The introduction of the modified data set for quality assurance in obstetrics (formerly perinatal survey) in Lower Saxony and Bavaria as early as 1999 saw the urgent requirement for a corresponding new statistical analysis of the revised data. The general outline of a new data reporting concept was originally presented by the Bavarian Commission for Perinatology and Neonatology at the Munich Perinatal Conference in November 1997. These ideas are germinal to content and layout of the new quality report for obstetrics currently in its nationwide harmonisation phase coordinated by the federal office for quality assurance in hospital care. A flexible and modular database oriented analysis tool developed in Bavaria is now in its second year of successful operation. The functionalities of this system are described in detail.

Data Collection↗

[Education of children with epilepsy and their parents by the modular education program epilepsy for families (FAMOSES)--results of an evaluation study].

PURPOSE: The aim of the study was to evaluate the efficacy of the modular educational program for children with epilepsy and their parents (FAMOSES). This program was developed by an interdisciplinary project group to improve knowledge, coping, treatment outcome, emotional and practical adaptation to the condition. METHODS: A prospective, controlled, multi-center, pre-post study design was used to examine the efficacy of the program in the treatment group compared to the waiting group (control group). Questionnaires included epilepsy specific scales regarding knowledge, attitudes, restrictions in daily living, epilepsy related fears, coping with the chronic disease and generic instruments (quality of life, KINDL). 55 parents of the treatment group completed the questionnaires three months before the course and three months later; the corresponding waiting group included 48 parents. Respectively, 31 children, who participated in the program, completed the questionnaires immediately before the course and three months later; the corresponding waiting group included 19 children. RESULTS: Children, who attended the program, showed improvements in the domains perceived restrictions (significant, medium effect size), absence from school and seizure frequency. Not significantly greater compared to the control group were the improvements of knowledge, attitudes and fears regarding to the epilepsy. Parents of the treatment group showed significant enhancements in epilepsy specific knowledge (large effect size), attitudes toward the epilepsy, management of epileptic seizures and significant reductions of fears and restrictions of their child with epilepsy (small to medium effect sizes).

Adolescent↗

[An alternative treatment strategy in lumbar intervertebral disk damage using an SB Charité modular type intervertebral disk endoprosthesis].

At the Department of Orthopedics, Humboldt University School of Medicine, Charité Hospital, the three-piece disk endoprosthesis SB Charité of the modular type, which works according to the low-friction principle, has been developed combining the advantages of a beneficial effect on the patient's complaints by simultaneous distraction in the vertebral segment, and of achieving movement within the physiological range. So far, this disk endoprosthesis consisting of two cover plates made of implantat steel or titanium sheet, which are fixed without cement, as well as a moveable polyethylene sliding core being vertically adjustable, has been implanted in sixteen patients. The therapeutic results show that it is possible with this method to replace the nucleus pulposus, thus providing, in addition to conventional nucleotomy and segment fusion, another therapeutic alternative for lumbar disk lesions.

Adult↗

Modular organization of cellular networks.

We investigated the organization of interacting proteins and protein complexes into networks of modules. A network-clustering method was developed to identify modules. This method of network-structure determination was validated by clustering known signaling-protein modules and by identifying module rudiments in exclusively high-throughput protein-interaction data with high error frequencies and low coverage. The signaling network controlling the yeast developmental transition to a filamentous form was clustered. Abstraction of a modular network-structure model identified module-organizer proteins and module-connector proteins. The functions of these proteins suggest that they are important for module function and intermodule communication.

Cell Communication↗

Modular construction of a signaling scaffold: MORG1 interacts with components of the ERK cascade and links ERK signaling to specific agonists.

Signal transduction occurs by the reversible assembly of oligomeric protein complexes that include both enzymatic proteins and proteins without known enzymatic activity. These nonenzymatic components can serve as scaffolds or anchors and regulate the efficiency, specificity, and localization of the signaling pathway. Here we report the identification of MORG1 (mitogen-activated protein kinase organizer 1), a member of the WD-40 protein family that was isolated as a binding partner of the extracellular signal-regulated kinase (ERK) pathway scaffold protein MP1. MORG1 specifically associates with several components of the ERK pathway, including MP1, Raf-1, MEK, and ERK, and stabilizes their assembly into an oligomeric complex. MORG1 facilitates ERK activation when cells are stimulated with lysophosphatidic acid, phorbol 12-myristate 13-acetate, or serum, but not in response to epidermal growth factor. Suppression of MORG1 by short interfering RNA leads to a marked reduction in ERK activity when cells are stimulated with serum. We propose that MORG1 is a component of a modular scaffold system that participates in the regulation of agonist-specific ERK signaling.

Adaptor Proteins, Signal Transducing↗