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Creation of an allosteric enzyme by domain insertion.

Two allosteric enzymes have been created by the covalent linkage of non-interacting, monomeric proteins with the prerequisite effector-binding and catalytic functionalities, respectively. This was achieved through a combinatorial process called random domain insertion. The fragment of the TEM-1 beta-lactamase gene coding for the mature protein lacking its signal sequence was randomly inserted into the Escherichia coli maltose-binding protein (MBP) gene to create a domain insertion library. This library's diversity derived both from the site of insertion and from a distribution of tandem duplications or deletions of a portion of the MBP gene at the insertion site. From a library of approximately 2 x 10(4) in-frame fusions, approximately 800 library members conferred a phenotype to E.coli cells that was consistent with the presence of bifunctional fusions that could hydrolyze ampicillin and transport maltose in E.coli. Partial screening of this bifunctional sublibrary resulted in the identification of two enzymes in which the presence of maltose modulated the rate of nitrocefin hydrolysis. For one of these enzymes, the presence of maltose increased k(cat) by 70% and k(cat)/K(m) by 80% and resulted in kinetic parameters that were almost identical to TEM-1 beta-lactamase. Such an increase in activity was only observed with maltooligosaccharides whose binding to MBP is known to induce a conformational change. Modulation of the rate of nitrocefin hydrolysis could be detected at maltose concentrations less than 1 microM. Intrinsic protein fluorescence studies were consistent with a conformational change being responsible for the modulation of activity.

Allosteric Regulation↗

Insertion kinetics of a denatured alpha helical membrane protein into phospholipid bilayer vesicles.

Membrane protein folding has suffered from a lack of detailed kinetic studies, particularly with regard to the insertion of denatured protein into lipid bilayers. We present a detailed in vitro kinetic study of the association of a denatured, transmembrane alpha helical protein with lipid vesicles. The mechanism of folding of Escherichia coli diacylglycerol kinase from a partially denatured state in urea has been investigated. The protein associates with lipid vesicles to give a protein, vesicle complex with an apparent association constant of 2 x 10(6) M(-1) s(-1). This association rate approaches the diffusion limit of the protein, vesicle reaction. The association of the protein with lipid vesicles is followed by a slower process occurring at observed rate of 0.031 s(-1), involving insertion into the bilayer and generation of a functional oligomer of diacylglycerol kinase. Protein aggregation competes with vesicle insertion. The urea-denatured protein monomers begin to aggregate as soon as the urea is diluted. This aggregation is faster than the association of the protein with vesicles so that most protein aggregates before it inserts into a vesicle. Increasing the vesicle concentration favours insertion of protein monomers, but at high vesicle concentrations monomers are primarily in separate vesicles and do not associate to form functional oligomers. Irreversible aggregation limits the yield of functional protein, while the data also suggest that lipid vesicles can reverse another aggregation reaction, leading to the recovery of correctly folded protein.

Diacylglycerol Kinase↗

Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard?

BACKGROUND/PURPOSE: Gastrostomy tube insertion is frequently performed in children. Percutaneous endoscopic gastrostomy (PEG) insertion, considered by many to be the "gold standard," is unavoidably associated with a risk of intestinal perforation and frequently requires a second anesthetic for its replacement with a low-profile "button." We hypothesized that a laparoscopic technique with low-pressure insufflation would yield comparable outcomes, a lower procedural complication rate, and require fewer anesthetics per patient. METHODS: A retrospective review of all surgeon-placed gastrostomy tubes (exclusive of those associated with fundoplication or other procedures) between January 2002 and December 2003 was undertaken. Data collected included type of procedure (PEG vs laparoscopic), indication, patient demographics (including neurologic comorbidity), operative time, complications (procedure-specific and nonspecific), and number of procedural anesthetics to "achieve" a low-profile tube. Groups were compared by univariate and multiple logistic regression analyses. RESULTS: One hundred nineteen gastrostomy tubes (26 laparoscopic = 21.8%) were inserted. The PEG and laparoscopic gastrostomy groups were comparable from the perspectives of age, size, indications for tube placement, and operative time. The complication rate after PEG placement was significantly higher than after LG (14% vs 7.7%; P = .023), and 72 (77.4%) of PEG patients required a second anesthetic for tube change. CONCLUSIONS: Laparoscopic gastrostomy tube insertion is safe and easy to perform, with outcomes comparable to that of PEG tube insertion. It obviates the need for a second procedural anesthetic and may emerge as the gold standard for gastrostomy tube placement.

Child↗

The "pull-back" technique for Nucleus 24 perimodiolar electrode insertion.

OBJECTIVE: To observe the influence of electrode pull-back after cochlear implant insertion of Nucleus 24 perimodiolar electrodes. STUDY DESIGN: In a prospective intraoperative study, we analyzed the impedances, neural response telemetry responses, and the spread of excitation after cochlear implant electrode insertion and compared these data to those obtained after a subsequent, controlled pull-back of the electrode. Postoperative depth of electrode insertion was controlled by x-ray. SETTING: Tertiary referral center. SUBJECTS: Six patients (4 male, 2 female; 18 to 69 years) were implanted with a Nucleus 24 (RCA) cochlear implant with a perimodiolar electrode. RESULTS: After a controlled pull-back, a significant decrease of the spread of excitation at the stimuli electrodes 5, 10, 15, and a nonsignificant decrease at stimuli electrode 20 compared to the recordings after the primary normal insertion procedure was found. The mean electric compound action potential amplitude was increased with an apical-to-basal tendency. Impedances remained unchanged by the pull-back. Mean insertion depth at the postoperative x-ray control was 372 degrees (+/- 10.2). CONCLUSION: Controlled cochlear implant electrode pull-back is a novel technique that optimizes objective intraoperative electrophysiological recordings in patients implanted with a Nucleus 24 perimodiolar cochlear implant by a greater approximation of the electrode to the modiolus.

Adolescent↗

Deep brain stimulation for chronic neuropathic pain: long-term outcome and the incidence of insertional effect.

We conducted a retrospective analysis of long-term results of deep brain stimulation (DBS) for the treatment of neuropathic pain. Twenty-one patients had electrodes implanted in the ventrocaudalis thalamic nucleus (Vc) (n=13) or in both Vc and periaqueductal/periventricular gray matter (PAG/PVG) (n=8). After insertion of the electrodes, 9 patients (43%) had a substantial reduction in pain scores in the absence of stimulation (insertional effect). The effects of stimulation were studied right after surgery or upon return of the patients' pain after electrode insertion (stimulation trials). Patients with a greater than 50% reduction in pain scores were implanted with a pulse generator (IPG). Of interest, patients who had an insertional effect had a trend towards a successful stimulation trial (p=0.08). Overall, 13 of the 21 patients operated (62%) had a successful stimulation trial and received an IPG (12 with electrodes in Vc and one in both Vc and PAG/PVG). Seven patients (33%) did not benefit from stimulation and had the electrodes removed. One patient experienced a prolonged insertional effect and has not required stimulation. Of the 13 patients that received an IPG, 8 discontinued stimulation during the first year of treatment. Only 5 patients maintained long-term benefit (4 with stimulation in Vc and one in both Vc and PAG/PVG). The relatively low efficacy of DBS for the treatment of neuropathic pain stresses the need for further investigation and the exploration of new surgical targets.

Adult↗

A new robotic needle insertion method to minimise attendant prostate motion.

BACKGROUND AND PURPOSE: The purpose of this study is to investigate the efficacy of a new needle insertion method (tapping instead of pushing) in reducing attendant tissue motion. This can be useful in applications where tissue motion due to needle insertion is problematic such as e.g. MRI-guided prostate brachytherapy and breast biopsies. In this study we will focus on prostate motion due to needle insertion. MATERIAL AND METHODS: Prostate motion due to needle insertion was measured in 30 patients, who were transperineally implanted with fiducial gold markers for position verification in prostate intensity modulated radiotherapy. In total 32 needles were manually pushed into the prostate and 29 were tapped with a prototype robotic system. The prostate motion in the cranio-caudal direction was measured on the video record of the ultrasound images. Differences in prostate motion between the two needle insertion methods were analysed making use of SPSS. RESULTS: The mean prostate motion was 5.6mm (range 0.3-21.6) when the needle was pushed and 0.9 mm (range 0-2.0) when the needle was tapped into the prostate (p<0.001). CONCLUSION: Prostate motion was significantly less when the needle was tapped into the prostate compared to when the needle was pushed. This result is important for the development of a tapping, MRI-guided, prostate implant robotic system.

Biopsy↗

Value of intraoperative true lateral radiograph of C2 pedicle for C1-2 transarticular screw insertion.

BACKGROUND CONTEXT: Transarticular C1-2 screws are widely used in posterior cervical spine instrumentation. Injury to the vertebral artery during insertion of transarticular Cl-2 screw remains a serious complication. Use of a computer-assisted surgery system decreases this complication considerably. However, this system encounters problems in ensuring complete accuracy because of positional variations during preoperative and intraoperative imaging generation. Therefore, intraoperative fluoroscopy still is one of the commonly used methods to guide insertion of transarticular Cl-2 screw. Evaluation of a true lateral radiographic view of the C2 pedicle for screw trajectory during C1-2 transarticular screw insertion may help to minimize this potential complication. PURPOSE: To evaluate the value of intraoperative true lateral radiograph of the C2 pedicle for screw trajectory during C1-2 transarticular screw insertion. STUDY DESIGN: To compare the height of the C2 pedicle area allowing instrumentation on true lateral view radiograph of the C2 pedicle and computed tomographic (CT) scan with multiplanar reconstruction. METHODS: Twenty embalmed human cadaveric cervical spine specimens were used to insert a total of 40 C1-2 transarticular screws using Magerl and Seemann technique. One side of the C2 transverse foramen was filled with radiopaque material (lead oxide) to simulate the artery and to demarcate the danger zone for better visualization on radiography. Measurements and calculation of the mean and standard deviation of the height of the area allowing instrumentation of the C2 pedicle were done on true lateral view radiograph of the C2 pedicle, the sagittal and 30 degrees sagittal views relative to the frontal plane passing exactly through the center of the C2 pedicle of CT scans. Student t test was applied to calculate the statistical significance of measured values. Statistical significance was defined as p or=.36. Using sagittal CT scan views, the height of pedicles was 7.71+/-0.7 mm (right) and 7.58+/-1.01 mm (left), p>or=.23. On 30 degrees sagittal CT scan views, the height of pedicles was 7.84+/-1.00 mm (right) and 7.76+/-1.02 mm (left), p>or=.27. The p value was >or=.78, >or=.56, and >or=.49 for true lateral radiographic view and sagittal CT scan view, true lateral radiographic view and 30 degrees sagittal CT scan view, and sagittal CT scan view and 30 degrees sagittal CT scan views, respectively. On lateral view of cervical spine, the decline angle of the transarticular screw was 51.3+/-0.50 degrees (right) and 50.68+/-0.41 degrees (left), p>or=.17. Mean decline angle was 51+/-0.43 degrees . On the anteroposterior (AP) view, radiograph median angle was 6.87+/-0.53 degrees (right) and 6.0+/-0.59 degrees (left), p>or=.25. Mean median angle was 6.44+/-0.62 degrees. CONCLUSIONS: True lateral radiographic views of the pedicles provide useful information for defining screw trajectory intraoperatively. Using this view along with AP and lateral view of cervical spine and preoperative three-dimensional CT scan may narrow the margin of error in this delicate area.

Aged↗

The Icsbp locus is a common proviral insertion site in mature B-cell lymphomas/plasmacytomas induced by exogenous murine leukemia virus.

ICSBP (interferon consensus sequence binding protein)/IRF8 (interferon regulatory factor 8) is an interferon gamma-inducible transcription factor expressed predominantly in hematopoietic cells, and down-regulation of this factor has been observed in chronic myelogenous leukemia and acute myeloid leukemia in man. By screening about 1200 murine leukemia virus (MLV)-induced lymphomas, we found proviral insertions at the Icsbp locus in 14 tumors, 13 of which were mature B-cell lymphomas or plasmacytomas. Only one was a T-cell lymphoma, although such tumors constituted about half of the samples screened. This indicates that the Icsbp locus can play a specific role in the development of mature B-lineage malignancies. Two proviral insertions in the last Icsbp exon were found to act by a poly(A)-insertion mechanism. The remaining insertions were found within or outside Icsbp. Since our results showed expression of Icsbp RNA and protein in all end-stage tumor samples, a simple tumor suppressor function of ICSBP is not likely. Interestingly, proviral insertions at Icsbp have not been reported from previous extensive screenings of mature B-cell lymphomas induced by endogenous MLVs. We propose that ICSBP might be involved in an early modulation of an immune response to exogenous MLVs that might also play a role in proliferation of the mature B-cell lymphomas.

Animals↗

Sleeping Beauty transposition in the mouse genome is associated with changes in DNA methylation at the site of insertion.

The Sleeping Beauty (SB) transposon (Tn) system is a nonviral gene delivery tool that has widespread application for transfer of therapeutic genes into the mammalian genome. To determine its utility as a gene delivery system, it was important to assess the epigenetic modifications associated with SB insertion into the genome and potential inactivation of the transgene. This study investigated the DNA methylation pattern of an SB Tn as well as the flanking genomic region at insertion sites in the mouse genome. The ubiquitous ROSA26 promoter and an initial part of the eGFP coding sequence in the SB Tn exhibited high levels of CpG methylation in transgenic mouse lines, irrespective of the chromosomal loci of the insertion sites. In contrast, no detectable CpG methylation in the endogenous mouse ROSA26 counterpart was observed in the same animals. Furthermore, significant hypomethylation was detected in neighboring chromosomal sequences of two unique SB Tn insertions compared to wild-type patterns. Taken together, these results suggest that SB Tn insertions into the mouse genome can be discriminated by DNA methylation machinery from an identical endogenous DNA sequence and can profoundly alter the DNA methylation status of the transgene cargo as well as flanking host genomic regions.

Animals↗

The medial rectus muscle insertion site in infantile esotropia.

The distance from the corneoscleral limbus to the insertion site of the medial rectus muscle was measured at several stages of medial rectus recession surgery in 20 patients (40 eyes) with infantile esotropia. Disinsertion of the medial rectus muscle resulted in a mean reduction in the distance from the muscle insertion site to the corneoscleral limbus of 0.903 mm (P less than .001), whereas the use of fixation forceps on the insertion to abduct the eye resulted in an additional mean reduction of 0.306 mm (P less than .01). The strabismus surgeon often uses the muscle insertion site as a reference point in determining the desired location for recessing a muscle. Our results suggest that this method of measurement is unreliable in infantile esotropia because the position of the medial rectus muscle insertion site varies considerably during surgery.

Child, Preschool↗

Long-term results of porcine valve insertion for pulmonary regurgitation following repair of tetralogy of Fallot.

Between January 1975 and January 1985, 49 patients, aged 2 to 20 years, underwent porcine valve insertion for control of pulmonary regurgitation following repair of tetralogy of Fallot. In 9 patients the valve was placed at the time of the repair; in the remaining 40, valve insertion was performed 2 to 5 years postoperatively. The primary indications for valve implantation included progressive cardiomegaly and evidence of right ventricular (RV) dilatation or dysfunction. Operative technique emphasized ample enlargement of the RV outflow tract and main pulmonary artery to allow for insertion of a large valve and prevention of turbulence or stenosis. There was 1 hospital death (2%). Follow-up is available on remaining patients 1 to 10 years postoperatively. Considerable prosthetic valvar stenosis or regurgitation occurred in 7 patients (14%) 3 to 8 years following insertion, including one after subacute bacterial endocarditis. The complication-free actuarial life was 82%, and the functional actuarial life was 84% at 10 years for the prosthesis. The data suggest that the porcine valve has a good long-term durability when inserted in the pulmonary position in pediatric patients.

Adolescent↗

Inhibitory and enhancing effects of insertion of central polypurine tract sequence on gene expression with vectors derived from human immunodeficiency virus type 1.

Reportedly, in human immunodeficiency virus type 1 (HIV) vectors, insertion of central polypurine tract (cPPT) increased expression of transgenes for a short period. To test this for a stable condition, we constructed a series of vectors carrying a Neo(r) gene as a stable marker driven by a synthetic thymidine kinase (hTK) promoter. Transduction efficiency was increased in about 2-fold and decreased in about 8-fold by insertion of the reported 178bp and our 282bp cPPTs, respectively. PCR analyses revealed that insertion of 282bp cPPT, but not 178bp cPPT, impaired integration, although it did not deteriorate nuclear transport much. Furthermore, we found that insertion of 282bp cPPT between hTK promoter and an upstream LTR sequence reduced reporter gene activity in about 5-fold. This inhibitory effect of 282bp cPPT may partly account for the observed decrease in transduction efficiency. We suggest that actual effect of cPPT insertion should be examined in each HIV vector.

Animals↗

Constitutive activity of membrane-inserted protein kinase C.

Incubation of purified protein kinase C (PKC) with phospholipid vesicles produced two populations of membrane-bound PKC: one population was dissociated by calcium chelation and the other was not. The second population appeared to be inserted into the membrane. The activity of membrane-inserted PKC was Ca2+-independent and was only modestly sensitive to phorbol esters. Insertion was caused by high calcium concentrations or by phorbol esters plus low calcium. These conditions correlated with those needed to activate PKC; insertion into the membrane may be a primary mechanism of PKC activation. PKC may be a long-term cell regulator which becomes inserted into the membrane upon appearance of the second messengers, calcium and diacylglycerol, and remains in an active membrane-bound state when the second messengers have been removed.

Calcium↗

Insertion of telomere repeat sequence decreases plasmid DNA condensation by cobalt (III) hexaammine.

Telomere repeat sequence (TRS) DNA is found at the termini of most eukaryotic chromosomes. The sequences are highly repetitive and G-rich (e.g., [C(1-3)A/TG(1-3)]n for the yeast Saccharomyces cerevisiae) and are packaged into nonnucleosomal protein-DNA structures in vivo. We have used total intensity light scattering and electron microscopy to monitor the effects of yeast TRS inserts on in vitro DNA condensation by cobalt (III) hexaammine. Insertion of 72 bp of TRS into a 3.3-kb plasmid depresses condensation as seen by light scattering and results in a 22% decrease in condensate thickness as measured by electron microscopy. Analysis of toroidal condensate dimensions suggests that the growth stages of condensation are inhibited by the presence of a TRS insert. The depression in total light scattering intensity is greater when the plasmid is linearized with the TRS at an end (39-49%) than when linearized with the TRS in the interior (18-22%). Circular dichroism of a 95-bp fragment containing the TRS insert gives a spectrum that is intermediate between the A-form and B-form, and the anomalous condensation behavior of the TRS suggests a noncanonical DNA structure. We speculate that under conditions in which the plasmid DNA condenses, the telomeric insert assumes a helical geometry that is similar to the A-form and is incompatible with packing into the otherwise B-form lattice of the condensate interior.

Base Sequence↗

T-shaped IUDs accommodate in their position during the first 3 months after insertion.

The objective of this study was to observe the position dynamics of the T-shaped intrauterine device (IUD) in the uterine cavity, from insertion to 90 days of use. IUD position was evaluated in 214 women by vaginal ultrasound, measuring the IUD-endometrium, IUD-myometrium, and IUD-fundus distances. The 90th percentile of the IUD-endometrium distance was 5, 6, and 8 mm at time of insertion, 30 and 90 days of use; 7, 9, and 10 mm for IUD-myometrium distance; and 23, 24, and 27 mm for IUD-fundus distance, respectively. Seventeen IUDs were classified as misplaced at insertion by using the 90th percentile of the IUD-myometrium distance as standard. Of these, only 6 remained misplaced after 90 days of use. On the other hand, 21 IUDs were beyond the 90th percentile at the 90-day observation, only 6 of which were considered misplaced at insertion. We conclude that the T-shaped IUD accommodates its position in the uterine cavity during the first 3 months following insertion, and that ultrasound evaluation of its position is not a good predictor of future evaluation.

Adult↗

Randomized trial of one versus two transcervical insertions of quinacrine pellets for sterilization.

OBJECTIVE: To determine the relative effectiveness of single vs. two transcervical monthly insertions of 252 mg of quinacrine for female sterilization. DESIGN: Controlled clinical study. SETTING: Family planning clinics of 6 academic centers. PATIENT(S): Sexually active reproductive-age women requesting sterilization. INTERVENTION(S): At each of six centers 70 and 30 women were randomly assigned to receive either one or two, respectively, monthly transcervical insertions to the fundus of 252 mg of quinacrine and 75 mg of diclofenac as pellets and they were followed for 1 year. MAIN OUTCOME MEASURE(S): Complications, side effects, and pregnancy failures. RESULT(S): There were no serious complications and side effects were transient and easily treated. There were 31 (7.4%) pregnancy failures in the single insertions group and 2 (1.1%) in the two insertions group, but with marked center variation. CONCLUSION(S): Quinacrine sterilization using two monthly insertions of 252 mg of quinacrine appears safe and reasonably effective.

Adult↗

What is the role of prosthesis insertion in esophageal carcinoma?

We review our experience with 13 patients in whom esophageal dilation was used for palliation of malignant esophageal obstruction and with five patients treated with esophageal prostheses for malignant esophagorespiratory fistula. Twelve of the 13 patients with dilation alone received satisfactory palliation and were able to eat a soft or regular diet. Four of five patients with esophagorespiratory fistulas had esophageal dilation followed by insertion of a esophageal prosthesis and received good palliation. Endoscopic insertion of esophageal prosthetic devices has become increasingly popular as a palliative procedure, despite lack of controlled trials either proving efficacy of this therapy or comparing it to radiation therapy with or without dilation of the esophagus. The reported mortality and morbidity rates for esophageal prosthesis insertion are higher than those reported for radiotherapy. There is little to suggest that prostheses are better than or even equal to radiotherapy alone or radiotherapy and bougienage. We review the reported series (greater than 2300 cases) of push-through prostheses insertions in esophageal cancer and compare prosthesis insertion to other therapy. The need for a carefully controlled trial of the different forms of therapy is emphasized, and guidelines for such a study are suggested.

Adenocarcinoma↗

Relative rates of insertion and deletion mutations in dinucleotide repeats of various lengths in mismatch repair proficient mouse and mismatch repair deficient human cells.

Microsatellites are DNA elements composed of short tandem repeats of 1-5bp. These sequences are particularly prone to frameshift mutation by insertion-deletion loop formation during replication. The mismatch repair system is responsible for correcting these replication errors, and microsatellite mutation rates are significantly elevated in the absence of mismatch repair. We have investigated the effect of varying the number of repeats in a (CA)n microsatellite on mutation rates in cultured mammalian cells proficient or deficient in mismatch repair. We have also compared the relative rates of single-repeat insertions and deletions in these cells. Two plasmid vectors were constructed for each repeat unit number (n=8, 17, and 30), such that the microsatellites, placed upstream of a bacterial neomycin resistance gene (neo), disrupted the reading frame of the gene in the (-1) or (+1) direction. Plasmids were introduced separately into the cells, where they integrated into the cellular genome. Mutation rates were determined by selection of clones with frameshift mutations in the microsatellite that restored the reading frame of the neo gene. We found that mutation rates were significantly higher for (CA)17 and (CA)30 tracts than for (CA)8 tracts in both mismatch repair proficient (mouse) and deficient (human) cells. A mutational bias favoring insertions was generally observed. In both (CA)17 and (CA)30 tracts, single-repeat insertion rates were higher than single-repeat deletion rates with or without mismatch repair; deletions of multiple repeat units (> or =8bp) were observed in these tracts, where as deletions this large were not found in the (CA)8 tract. Single-repeat mutations of both types were made at similar rates in (CA)8 tracts in human mismatch repair deficient (MMR-) cells, but single-repeat insertion rates were higher than single-repeat deletion rates in mouse mismatch repair proficient (MMR+) cells. Results of these direct studies on microsatellite mutations in cultured cells should be useful for refinement of mathematical models for microsatellite evolution.

Animals↗