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Unique structural determinants in the signal peptides of "spontaneously" inserting thylakoid membrane proteins.

A series of thylakoid membrane proteins, including PsbX, PsbY and PsbW, are synthesized with cleavable signal peptides yet inserted using none of the known Sec/SRP/Tat/Oxa1-type insertion machineries. Here, we show that, although superficially similar to Sec-type signal peptides, these thylakoidal signal peptides contain very different determinants. First, we show that basic residues in the N-terminal domain are not important, ruling out electrostatic interactions as an essential element of the insertion mechanism, and implying a fundamentally different targeting mechanism when compared with the structurally similar M13 procoat. Second, we show that acidic residues in the C-domain are essential for the efficient maturation of the PsbX and PsbY-A1 peptides, and that even a single substitution of the -5 Glu by Val in the PsbX signal peptide abolishes maturation in the thylakoid. Processing efficiency is restored to an extent, but not completely, by the highly hydrophilic Asn, implying that this domain is required to be hydrophilic, but preferably negatively charged, in order to present the cleavage site in an optimal manner. We show that substitution of the PsbX C-domain Glu residues by Val leads to a burial of the cleavage site within the bilayer although insertion is unaffected. Finally, we show that substitution of the Glu residues in the lumenal A2 loop of the PsbY polyprotein leads to a block in cleavage on the stromal side of the membrane, and present evidence that the PsbY-A2 signal peptide is required to be relatively hydrophilic and unable to adopt a transmembrane conformation on its own. These data indicate that, rather than being merely additional hydrophobic regions to promote insertion, the signal peptides of these thylakoid proteins are complex domains with uniquely stringent requirements in the C-domain and/or translocated loop regions.

Amino Acid Sequence↗

The sensor protein KdpD inserts into the Escherichia coli membrane independent of the Sec translocase and YidC.

KdpD is a sensor kinase protein in the inner membrane of Escherichia coli containing four transmembrane regions. The periplasmic loops connecting the transmembrane regions are intriguingly short and protease mapping allowed us to only follow the translocation of the second periplasmic loop. The results show that neither the Sec translocase nor the YidC protein are required for membrane insertion of the second loop of KdpD. To study the translocation of the first periplasmic loop a short HA epitope tag was genetically introduced into this region. The results show that also the first loop was translocated independently of YidC and the Sec translocase. We conclude that KdpD resembles a new class of membrane proteins that insert into the membrane without enzymatic assistance by the known translocases. When the second periplasmic loop was extended by an epitope tag to 27 amino acid residues, the membrane insertion of this loop of KdpD depended on SecE and YidC. To test whether the two periplasmic regions are translocated independently of each other, the KdpD protein was split between helix 2 and 3 into two approximately equal-sized fragments. Both constructed fragments, which contained KdpD-N (residues 1-448 of KdpD) and the KdpD-C (residues 444-894 of KdpD), readily inserted into the membrane. Similar to the epitope-tagged KdpD protein, only KdpD-C depended on the presence of the Sec translocase and YidC. This confirms that the four transmembrane helices of KdpD are inserted pairwise, each translocation event involving two transmembrane helices and a periplasmic loop.

Adenosine Triphosphatases↗

The plant aspartic proteinase-specific polypeptide insert is not directly related to the activity of oryzasin 1.

Many plant aspartic proteinases (APs) are different from animal and microbial APs in that they contain a polypeptide insert, approximately 100 amino acids in length, in the C-terminal region. To interpret the significance of this insert, we constructed an expression system for rice AP oryzasin 1 by linking a pro-oryzasin 1 downstream of glutathione S-transferase (GST). GST-proOS1 expressed the highest degree of hemoglobin-hydrolytic activity when treated at pH 3.3 and incubated for 24 h at room temperature. We carried out a similar experiment using an insert-lacking proOS1 mutant, GST-DeltaproOS1, as the fusion protein, and found it to show similar activity. This result indicates that the insert is not involved in the production of AP activity. We then investigated the autolysis of the two proteins by Western blot analysis. GST-proOS1 was autolyzed into 67- and 64-kDa fragments, while GST-DeltaproOS1 autolyzed to 54- and 52-kDa products. GST-DeltaproOS1 clearly produced two molecular species early in the autolytic process, and not later than 3 h from the start, but no such clear result was observed in the case of GST-proOS1. This suggests that, although the presence of the plant AP-specific insert does not influence the enzyme activity by itself, it apparently has an effect on the autolysis of OS1.

Amino Acid Sequence↗

Target concentration of propofol required to insert the laryngeal mask airway in children.

BACKGROUND: The aim of this prospective study was to determine the target concentration (CPRED) curves for laryngeal mask airway (LMA) insertion in children. METHODS: The CPRED of propofol required for insertion of the LMA was determined in 72 unpremedicated children, aged 3-10 years, ASA physical status I. CPRED was reached in 2 min according to a sequential allocation. LMA insertion was then performed by an experienced anaesthetist who was unaware of the concentration. Insertion conditions were noted as satisfactory (jaw relaxed, no coughing, gagging, swallowing or laryngeal spasm, minimal limb movement), excellent (no movement at all) or unacceptable if otherwise. RESULTS: The CPRED50 and CPRED90 were 7.86 microg.ml(-l)[95% confidence interval (CI) 6.46-9.26] and 10.71 microg.ml(-l) (95% CI 9.31-12.12), respectively, in the satisfactory group and 10.86 microg.ml(-l) (95% CI 10.14-11.57) and 13.71 microg.ml(-l) (95% CI 12.99-14.42) in the excellent group when calculations were based on Kataria's pharmacokinetics. These figures were increased 1.5-fold when calculations were based on Marsh's pharmacokinetics. With Schüttler's pharmacokinetics, CPRED50 were 4.62 microg.ml(-l) and 13.66 microg.ml(-l) for satisfactory and excellent groups, respectively. CONCLUSIONS: The target-controlled infusion technique for anaesthesia induction and insertion of the LMA was a safe and effective technique in our study.

Anesthesia, General↗

An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area.

Facet capsule injury has been hypothesised as a mechanism for neck pain. While qualitative studies have demonstrated the proximity of neck muscles to the cervical facet capsule, the magnitude of their forces remains unknown owing to a lack of quantitative muscle geometry. In this study, histological techniques were employed to quantify muscle insertions on the human cervical facet capsule. Computerised image analysis of slides stained with Masson's trichrome was performed to characterise the geometry of the cervical facet capsule and determine the total insertion area of muscle fibres into the facet capsule for the C4-C5 and C5-C6 joints. Muscle insertions were found to cover 22.4+/-9.6% of the capsule area for these cervical levels, corresponding to a mean muscle insertion area of 47.6+/-21.8 mm2. The magnitude of loading to the cervical facet capsule due to eccentric muscle contraction is estimated to be as high as 51 N. When taken in conjunction with the forces acting on the capsular ligament due to vertebral motions, these forces can be as high as 66 N. In that regard, these anatomical data provide quantitative evidence of substantial muscle insertions into the cervical facet capsular ligament and provide a possible mechanism for injury to this ligament and the facet joint as a whole.

Aged↗

Laparoscopical insertion of intraperitoneal catheters for intraperitoneal chemotherapy.

BACKGROUND AND METHODS: Eight patients (seven clinically negative stage Ill ovarian cancer and one peritoneal mesothelioma) respectively underwent second-look laparoscopy for staging, adhesiolysis and insertion of an intraperitoneal catheter and fixation of a portal. All patients had received six courses of cisplatin-paclitaxel-based chemotherapy intravenously. At the end of the laparoscopic staging, a 5-mm catheter was inserted under direct vision through a 5-mm trocar in the abdomen. A preaponevrotic forceps was used to grasp the catheter and bring it to the portal, which is located on the intercostal aponevrosis 2 or 3 cm above the laparoscope entry. RESULTS: Although previously operated, laparoscopy was possible in all patients and the catheters were easily inserted. All patients received intraperitoneal chemotherapy on the second postoperative day. We did not observe any complication after a mean follow-up of 12 months. CONCLUSIONS: Laparoscopic insertion of intraperitoneal catheters is a feasible and safe procedure but requires experience in laparoscopic surgery. In many cases it might preclude from performing non-useful laparotomies. It might help to reduce the hospital stay and the morbidity in relation to second-look laparotomies. Compared with the blind surgical technique of insertion of intraperitoneal catheters, this technique also allows intraabdominal staging. Nevertheless, further studies are necessary to confirm our results.

Aged↗

The relationship between Parson's tubercle and the insertion of the anterior horn of the medial meniscus.

PURPOSE: The purpose of this investigation was to correlate the anatomic characteristics of the third intercondylar tubercle of Parsons (TITP) with the insertional variations of the anterior horn of the medial meniscus using precise measurements in an anatomic cadaver study. Our hypothesis was that the height of the TITP would correlate with the degree of inferior insertion of the medial meniscus. TYPE OF STUDY: A cadaver study using a convenience sample. METHODS: Twenty unpaired proximal tibia specimens without advanced arthritis were analyzed with a coordinate measuring machine using a 0.479-mm diameter probe. A reference plane was created using 3 reproducible points on the tibial surface. Measurements from the TITP included another reference plane through its base, which was used to calculate its absolute height. The locations of the anterior- and inferior-most insertional points of the anterior horn of the medial meniscus were also determined. Correlations between the height of the TITP and age were also made. RESULTS: The overall height of the TITP was found to correlate with the degree of inferior insertion of the anterior horn of the medial meniscus (r =.52, P =.019). No correlation was found with the anterior placement of the meniscus (r =.12, P =.629) or with the age of the specimen (r =.14, P =.592). CONCLUSIONS: This absolute height of the TITP correlates with the inferior location of the insertion of the anterior horn of the medial meniscus. This association suggests a developmental relationship between 2 anatomic structures within the knee.

Adult↗

Anterior cruciate ligament tunnel placement: Comparison of insertion site anatomy with the guidelines of a computer-assisted surgical system.

PURPOSE: With the development of computer-assisted surgery (CAS) systems, the surgeon's ability to operate a CAS planning station will become essential. For example, default parameters in computed tomographic (CT) data are being used to place tunnels in anterior cruciate ligament (ACL) reconstruction. The goal of this study was to compare the location of the insertion sites in ACL reconstruction anatomically, via roentgenographic images and via CT scan data and to validate these tunnel placement parameters. TYPE OF STUDY: Cadaveric analysis. METHODS: Eight human cadaveric knees were marked with 6 copper wires 1 mm in diameter around the circumference of the insertions of the ACL. Using lateral roentgenograms and CT scans that were subsequently transferred to the CAS planning station, the tunnel locations were determined. These were based on a distance from the back of the condyle (location A) and from the roof of the notch (location B) on the femur and on a distance posterior from the tuberosity to the posterior margin along the tibial plateau, which is set as the CAS planning station's default. Locations according to roentgenograms and CT scans were then compared and the accuracy of the CAS planning station was assessed. RESULTS: Comparison of roentgenograms and CT revealed a femoral insertion at 27.5% +/- 3.2% and 26.9% +/- 3.5% (roentgenograms) and 26.6% +/- 1.9% and 26.3% +/- 2.4% (CT), respectively. The CAS planning station provided a tunnel location that was 1.3 +/- 1.0 mm (0.3 to 2.5 mm) away from the actual femoral ACL insertion. The tibial tunnel was placed according to the copper wire markers and was found to be at 46.2% +/- 2.8% (roentgenograms) and 45.4% +/- 2.1% (CT). No statistical differences between position in CT and roentgenograms could be detected (P >.05). CONCLUSIONS: The compared methodologies showed similar locations of the ACL insertions, assuring accurate preoperative planning with the CAS system. However, the CAS system requires adjustment to each individual knee anatomy.

Aged↗

The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications.

In a prospective multi-centre study involving 1132 peripheral venous catheters in three hospitals, the relationship between various measures of hand hygiene before insertion of peripheral venous catheters and the frequency of infectious complications', such as local reddening, swelling, pain, purulence and fever of unknown origin, were analysed. For documentation of the relevant data, special protocol forms, one for each catheter, were filled in at the time of insertion and removal of catheters. In comparison with simple hand washing, disinfection of hands before the insertion or wearing of gloves resulted in significantly fewer complications (relative risk 0.59 and 0.66, respectively). Normal hand washing was no better than no hand hygiene (relative risk 1.13), with regard to reduction of complications. This underlines the necessity of employing more effective measures of hand hygiene. The frequency of complications was dependent on the duration of peripheral venous catheterization. Catheters inserted in the operating room had a significantly lower risk of complications than catheters inserted on the ward or in the outpatient unit.

Aged↗

Thenar insertion of abductor pollicis longus accessory tendons and thumb carpometacarpal osteoarthritis.

Although the etiology of osteoarthritis of the thumb carpometacarpal (CMC) joint remains unclear, some theories have focused on variations in the local anatomy of the abductor pollicis longus tendon insertion. This cadaver study of 68 specimens analyzed the relationship between a thenar insertion of an accessory abductor pollicis longus tendon and the presence and severity of thumb CMC osteoarthritis. The joint cartilage surfaces were visually graded for degenerative changes. Thirty-five of 68 specimens (51%) had a thenar insertion, most frequently inserting on either the abductor pollicis brevis or opponens pollicis fascia or muscle belly. No significant association between a thenar insertion and thumb CMC arthritis was observed. Conversely, increasing age was noted to have a significant association with degenerative joint disease. Thus, these findings indicate that a thenar slip of the abductor pollicis longus tendon does not correlate with the presence or severity of CMC osteoarthritis.

Adolescent↗

Biomechanical evaluation of thumb opposition transfer insertion sites.

The optimal location for insertion of the transferred tendon in opposition transfer is controversial. The purpose of this study was to examine 4 commonly used insertion sites into the thumb and determine which maximizes thumb opposition. The flexor digitorum superficialis of the ring finger was used as a donor tendon and was attached in random order to the abductor pollicis brevis (APB) tendon, the APB and extensor pollicis longus, the flexor pollicis brevis (FPB) and dorsal radial extensor hood, and the ulnar extensor hood at the base of the proximal phalanx. As normal opposition was simulated, the minimum distance between the thumb and little finger and the pinch force were measured. The FPB and radial dorsal extensor hood site resulted in the statistically highest pinch force. The FPB and radial dorsal extensor hood and the APB sites had statistically smaller minimum distances between the thumb and little finger than the ulnar extensor hood site. A subjective evaluation of the 3-dimensional thumb path of motion revealed that the FPB and radial dorsal extensor hood site and the APB insertion site allowed the closest approximation of normal thumb opposition. This biomechanical study supports the use of the FPB and radial dorsal extensor hood insertion site or APB insertion site for opposition transfers.

Analysis of Variance↗

Vascular anatomy of the human flexor digitorum profundus tendon insertion.

The vascular anatomy of the flexor digitorum profundus (FDP) tendon insertion is described by using a vascular injection and modified Spalteholtz tissue clearing protocol in 36 human cadaver digits. A consistent dense palmar and dorsal vascular supply to the tendon at its insertion into the distal phalanx was observed based on sources from both the distal phalanx and the vinculum brevis profundus. Multiple palmar-dorsal vascular interconnections were seen between these spatially distinct vascular networks, a finding not observed previously in studies of the vascular anatomy of tendon or ligament insertions. Additionally a well-defined dorsal zone of hypovascularity was identified subjacent to the volar plate of the distal interphalangeal joint, within 1 cm of the tendon insertion. Recognition of the vascular supply to the FDP insertion at the distal phalanx permits further evaluation of the vascular, histologic, and cellular events after FDP tendon avulsion and improves the understanding of the biologic response mechanisms involved in bone-tendon healing.

Fingers↗

Maxillary sinus augmentation with deproteinated bovine bone and platelet rich plasma with simultaneous insertion of endosseous implants.

PURPOSE: To investigate the clinical applicability of using deproteinated bovine bone mixed with autologous platelet rich plasma (PRP) in human maxillary sinus augmentations in severely resorbed posterior maxillary alveolar processes with simultaneous insertion of endosseous dental implants. MATERIALS AND METHODS: Fifteen patients with less than 5 mm of residual alveolar bone height in the posterior maxillary alveolus underwent a total of 24 maxillary sinus augmentations. Seventy endosseous implants were inserted simultaneously in the grafted sinuses. The implants were uncovered and loaded 4 months after insertion and the sinus augmentation. An osseous biopsy specimen was obtained from the augmented maxillary sinus in 1 patient. In 3 patients, computed tomography scans of the grafted maxillae were obtained and the bone density quantified and compared with native bone density using SIMPlant 7 (Columbia Scientific, Columbia, MD) software 4 months postoperatively. RESULTS: Although a total of 5 implants in 4 patients were lost, this did not result in the loss of any of the restorations, for an overall success rate of 92.9 %. Follow-up for patients in this study after insertion of the permanent restoration was between 6 and 36 months. The bone biopsy from the patients showed evidence of viable new bone formation in close approximation to the xenograft. The bone density of the grafted bone was similar or exceeded the bone density of the surrounding native maxillary bone. CONCLUSION: Based on our clinical experience, we believe that the use of platelet rich plasma in combination with deproteinated bovine bone is effective for maxillary sinus augmentation with simultaneous insertion of endosseous dental implants in severely resorbed posterior maxillae.

Alveolar Bone Loss↗

Prospective comparison of nasal versus oral insertion of a thin video endoscope in healthy volunteers.

BACKGROUND AND STUDY AIMS: Attempts have been made to improve patient's tolerance of upper gastrointestinal endoscopy and to decrease the need for sedation, using thinner endoscopes and a nasal introduction route. We prospectively compared the oral and nasal routes in volunteers, using a thin prototype video endoscope. METHODS: Ten healthy volunteers underwent two upper gastrointestinal endoscopies in a random order on two different days, with the procedure being carried out by a single experienced endoscopist. Parameters assessed were the tolerance of scope insertion and the assessment of the entire procedure (0-10 scale), the method of insertion preferred by the volunteers, the completeness of the examination (assessed by an independent endoscopist), and the time required for the procedure. RESULTS: In one patient, nasal insertion failed, and she was excluded from further analysis. The insertion of the scope was easier via the oral route, as reflected in a shorter examination time (mean 165 vs. 210 seconds, p = 0.017) and patients' tolerance for the scope insertion (mean score: 8 for oral vs. 4 for nasal route; p = 0.03). On the other hand, gagging occurred more frequently during oral endoscopy (6/9 vs 1/9, p = 0.05). Three of the volunteers in each case preferred the oral or the nasal route, and three were not decided, in case of a repeated endoscopy. Similarly, the overall tolerance for the procedure did not between the two groups. CONCLUSION: Thin-diameter gastroscopes seem to improve patient's tolerance. In this small study in volunteers, nasal introduction showed no overall benefit over oral introduction. Modifications of the scope to achieve better nasal passage are necessary.

Adult↗

[Structure and function of the ventral vocal cord insertion. From the clinical viewpoint].

BACKGROUND: Spread of cancer at the ventral vocal fold insertion zone has been discussed controversially until today. One reason for this is the so far insufficient knowledge of the anatomical structure and function of the insertion zone. METHODS: The present study analyses the structures of laryngeal anterior commissure by means of histological, immunohistochemical and electron microscopical methods. Investigations are performed on vocal cords of 17 male and 13 female (aged 21-88 years) in three planes. RESULTS: The vocal ligament inserts at the anterior commissure via two characteristic structures: the noduli elastici, which consist of two different morphological zones, and the vocal ligament tendon, a dense mesh of connective tissue rich in sulfated glycosaminoglycans. In the lower part of noduli elastici collagen and elastic fibres form a meshwork around embedded cells; in the upper part fibres are running in parallel. The vocal ligament tendon is connected to the thyroidal cartilage or bone by fibrocartilage. This area lacks a perichondrium or periosteum. At the beginning of osteogenesis vessels of plica vocals penetrate the bony thyroidal skeleton and contact with extralaryngeal vessels. CONCLUSIONS: Connective tissue cells of the insertion zone and extracellular matrix components formed by these cells fulfil biomechanical functions by equalizing the different elastic moduli of tendon, cartilage or bone. Ventral spread of vocal fold carcinomas is made possible by the lack of periosteum in the insertion zone as well as ossification and associated vascularisation of the thyroid cartilage.

Adult↗

Factors affecting insertion time and patient discomfort during colonoscopy.

BACKGROUND: Successful colonoscopy depends on insertion of the instrument to the cecum, precise observation, and minimal patient discomfort during the procedure. The aim of this prospective study was to determine whether certain variables are associated with insertion time and patient discomfort during colonoscopy. METHODS: Nine hundred nine consecutive colonoscopic examinations performed by a single endoscopist in patients without obstructive disease of the colorectum were analyzed. Four liters of Colonlyte (Taejun, Seoul, Korea) were used for bowel cleansing, and meperidine (25 mg) was administered intramuscularly 10 minutes before the procedure. The degree of patient discomfort was assessed using a 5-level Likert scale. RESULTS: Among 909 study patients, colonoscopy was completed to the cecum in 876 patients (96.4%). The adjusted completion rate was 98% and mean insertion time for complete colonoscopy was 6.9+/-4.2 minutes. Colonoscopy caused less patient discomfort than barium enema or esophagogastroduodenoscopy. Multivariate logistic regression analysis demonstrated that inadequate bowel cleansing, advanced age, and constipation as an indication are independent factors associated with prolonged insertion time (>10 minutes). Female gender was the only independent factor associated with significant discomfort (> or = level 4) during colonoscopy. CONCLUSIONS: Among the factors affecting insertion time and patient discomfort during colonoscopy, unsatisfactory bowel preparation was the only correctable factor.

Adolescent↗

Does insertion of a rectal tube after colonoscopy reduce patient discomfort and improve satisfaction?

BACKGROUND: Distention of the colon is a major contributor to patient discomfort after colonoscopy. Some physicians and nurses believe insertion of a rectal tube relieves this discomfort and improves patient satisfaction with the procedure. This prospective, randomized, controlled trial assessed rectal tube insertion for reduction or prevention of abdominal bloating and discomfort after colonoscopy. METHODS: One hundred fifty-seven patients were prospectively randomized to groups with (n = 68) and without (n = 89) rectal tube insertion after colonoscopy. Patients were evaluated for bloating, discomfort, and pain before the procedure, at its conclusion, at discharge, and 24 hours later (by telephone). Satisfaction was also assessed at discharge and 24 hours later. RESULTS: There were no differences between groups with respect to age, gender, hospitalization status, comorbidity, or socioeconomic status. In both groups the cecum was reached in 90% of patients and procedure time was similar. There were no differences between the groups in abdominal bloating (patient and nurse assessment), abdominal discomfort, or satisfaction at any time point. There were no serious complications. The subgroup of patients who experienced more severe pain and discomfort, regardless of whether a rectal tube was inserted, was characterized by more complaints of bloating, more incomplete procedures, and a higher rate of previous abdominal operations. CONCLUSIONS: Insertion of a rectal tube after colonoscopy does not affect abdominal bloating, pain, or discomfort during recovery from the procedure or over the subsequent 24 hours, nor does it affect overall patient satisfaction.

Abdominal Pain↗

Is the angle of needle insertion influencing the created defect in human fetal membranes? Evaluation of the agreement between specialists' opinions and ex vivo observations.

OBJECTIVE: We sought to evaluate the agreement between the opinions of specialists in fetal medicine with ex vivo observations on the potential influence of the angle of needle insertion on the fluid leak through the created defect in human fetal membranes. STUDY DESIGN: Membranes from placentas of women who were delivered by elective cesarean were harvested, cut in pieces, and secured to the bottom of plastic tubes filled with Hartmann solution. They were punctured with 18-, 20-, or 22-gauge needles, with an angle of insertion of 90 degrees (group 1) or 45 degrees (group 2), and the flow rate (in milliliters per minute) through the created defect at a constant pressure of 150 mm H(2)O was measured. Fifty physicians performing amniocentesis at fetal medicine reference centers were interviewed about their impression and clinical attitude with respect to the angle of needle insertion at the time of amniocentesis. RESULTS: In the ex vivo study, puncture with a 45 degrees angle was associated with a significantly lower flow of fluid through the membrane defect for all needle sizes tested. Regarding survey answers, 82% of physicians try to perform amniocentesis with a given angle (ie, 90 degrees in the vast majority of cases). Among the reasons for doing so, minimizing membrane damage was mentioned in more than half of cases. CONCLUSION: These results provide evidence that the angle of needle insertion influences the type of defect and therefore the flow rate through human membranes. Membrane damage is a concern of a proportion of specialists while performing amniocentesis, but ex vivo observations do not agree with clinical assumptions on the potential influence of the angle of insertion.

Amniocentesis↗