Ligamentous anatomy of the distal clavicle

We describe the insertional variations of supporting ligaments of the acromioclavicular joint, especially with respect to gender. We analyzed 41 cadaveric clavicles (22 female and 19 male) with attached ligaments. The distance between the insertion of the trapezoid ligament and the distal end of the clavicle was not significantly different between sexes, although that of the conoid ligament and the mean anteroposterior width of the distal clavicle was significantly greater in men. Although there are significant sex-related differences in the insertional distances of the CC ligaments, resection of less than 11.0 mm should not violate the trapezoid ligament and less than 24.0 mm should not violate the conoid ligament in either sex in 98% of the general population. Resection of more than 7.6 mm of the distal clavicle in men and 5.2 mm in women, performed by an arthroscopic approach, may violate the superior acromioclavicular ligament.     

The role of β-hairpin conformation in ester hydrolysis peptide catalysts based on a TrpZip scaffold

To explore the role of peptide conformation on catalytic activity in the context of ester hydrolysis catalysts, pairs of sequences were designed that contained or lacked β-hairpin character. For the hydrolysis of para-nitrophenylacetate in aqueous media, we found small but consistent trends wherein His-containing sequences based on a TrpZip scaffold showed higher catalytic activity without β-hairpin character.

Peptide catalysts based on TrpZip scaffolds for the hydrolysis of para-nitrophenylacetate in aqueous media were found to have higher catalytic activity in sequences without β-hairpin character.     

Unjustified increase in cost of care resulting from U.S. Food and Drug Administration approval of Makena (17α-hydroxyprogesterone caproate)

U.S. Food and Drug Administration (FDA) approval of 17α-hydroxyprogesterone caproate for the indication of decreasing the risk of preterm delivery in those high-risk patients who previously had spontaneous preterm birth has come at considerable cost to the health care system. Weekly injections provided by compounding pharmacies starting at 16-20 weeks of gestation and continuing until 36 weeks currently cost the health care system $200 to $300 per pregnancy. This cost is significantly less than the costs associated with delivering and caring for preterm children. Makena, by KV Pharmaceutical, the same 17α-hydroxyprogesterone caproate product, is priced at $1,500 per injection, or a projected cost of $30,000 per pregnancy. With approximately 132,000 pregnancies being eligible for treatment annually, this increase in cost of 75-150 times what previously had been paid far exceeds the benefits derived from the FDA-approved Makena when compared with previously available compounded versions of 17α-hydroxyprogesterone caproate. This increased health care cost is not justified at this time. The price barrier to access imposed by KV Pharmaceutical actually could result in an increase in preterm deliveries over current rates. Actions are needed by the FDA, national societies, and the manufacturer to ensure that all high-risk patients continue to get the needed therapy to reduce the number of preterm births.     

Neonatal alcohol exposure produces more severe motor coordination deficits in high alcohol sensitive rats compared to low alcohol sensitive rats.

Prenatal exposure to alcohol can produce a number of behavioral alterations, including hyperactivity, learning deficits and motor impairments. However, the severity and nature of behavioral alterations varies markedly among children of women who drink during pregnancy. One important determinant of this variation may be genetic differences in the response to alcohol. Recently, we demonstrated that exposure to alcohol during development produced hyperactivity in rats bred for high alcohol sensitivity (HAS), but not in rats bred for low alcohol sensitivity (LAS). These lines were selectively bred for extremes in alcohol-induced "sleep time." The present study investigated the effects of ethanol exposure during development on motor coordination later in life in both HAS and LAS rats. Using an artificial rearing procedure, neonatal pups from each line were exposed to a binge-like alcohol treatment on postnatal days (PD) 4-9. Within each line, one group was exposed to ethanol (6.0 g/kg/day), one group served as an artificially reared control, and a third served as a normally reared control group. On PD 30, parallel bar motor performance was evaluated. Exposure to ethanol during development severely impaired motor performance in the HAS rats compared to their controls. In LAS rats, early ethanol exposure produced only mild and nonsignificant effects on motor performance. Thus, HAS rats were more vulnerable to ethanol-induced motor deficits compared to the LAS rats. Importantly, there were no differences in peak blood alcohol level between the lines, indicating that vulnerability to ethanol's teratogenic effects was not due to differences in metabolic rate. These results suggest that genetic differences in response to alcohol may serve as a predictor for susceptibility to ethanol's teratogenic effects.     

Effects of alcohol on cocaine lethality in rats: acute and chronic assessments

Cocaine and alcohol is a popular, yet toxic, drug combination that results in effects greater than that of either drug alone. The following experiment presents additional evidence that supports this position. Specifically, the lethal effects of acute (1 day) and chronic (4 days) alcohol (0.5 g/kg), cocaine (20, 30, or 40 mg/kg), or the respective alcohol/cocaine combinations were assessed in rats. For acute drug administration, lethality was only evident in those animals administered the combination of 0.5 g/kg alcohol and 40 mg/kg cocaine, supporting the position that the effects of combining alcohol and cocaine are greater than either drug alone. Chronic drug administration resulted in a weak sensitization to cocaine-induced lethality that was increased when alcohol was combined with cocaine. Together, this evidence suggests that combining alcohol and cocaine (acutely) can have lethal consequences in rats that are greater than either drug alone, effects that can be exacerbated with chronic use.     

Associations between CYP19A1 polymorphisms,Native American ancestry,and breast cancer risk and mortality: the Breast Cancer Health Disparities Study

The cytochrome p450 family 19 gene (CYP19A1) encodes for aromatase, which catalyzes the final step in estrogen biosynthesis and conversion of androgens to estrogens. Genetic variation in CYP19A1 is linked to higher circulating estrogen levels and increased aromatase expression. Using data from the Breast Cancer Health Disparities Study, a consortium of three population-based case–control studies in the United States (n = 3,030 non-Hispanic Whites; n = 2,893 Hispanic/Native Americans (H/NA) and Mexico (n = 1,810), we examined influence of 25 CYP19A1 tagging single-nucleotide polymorphisms (SNPs) on breast cancer risk and mortality, considering NA ancestry. Odds ratios (ORs) and 95 % confidence intervals (CIs) and hazard ratios estimated breast cancer risk and mortality. After multiple comparison adjustment, none of the SNPs were significantly associated with breast cancer risk or mortality. Two SNPs remained significantly associated with increased breast cancer risk in women of moderate to high NA ancestry (≥29 %): rs700518, OR_GG 1.36, 95 % CI 1.11–1.67 and rs11856927, OR_GG 1.35, 95 % CI 1.05–1.72. A significant interaction was observed for rs2470144 and menopausal status (p _adj = 0.03); risk was increased in postmenopausal (OR_AA 1.22, 95 % CI 1.05–1.14), but not premenopausal (OR_AA 0.78, 95 % CI 0.64–0.95) women. The absence of an overall association with CYP19A1 and breast cancer risk is similar to previous literature. However, this analysis provides support that variation in CYP19A1 may influence breast cancer risk differently in women with moderate to high NA ancestry. Additional research is warranted to investigate the how variation in an estrogen-regulating gene contributes to racial/ethnic disparities in breast cancer.     

Clostridium difficile infection in the community: a zoonotic disease?

Clostridium difficile infections (CDIs) are traditionally seen in elderly and hospitalized patients who have used antibiotic therapy. In the community, CDIs requiring a visit to a general practitioner are increasingly occurring among young and relatively healthy individuals without known predisposing factors. C. difficile is also found as a commensal or pathogen in the intestinal tracts of most mammals, and various birds and reptiles. In the environment, including soil and water, C. difficile may be ubiquitous; however, this is based on limited evidence. Food products such as (processed) meat, fish and vegetables can also contain C. difficile, but studies conducted in Europe report lower prevalence rates than in North America. Absolute counts of toxigenic C. difficile in the environment and food are low, however the exact infectious dose is unknown. To date, direct transmission of C. difficile from animals, food or the environment to humans has not been proven, although similar PCR ribotypes are found. We therefore believe that the overall epidemiology of human CDI is not driven by amplification in animals or other sources. As no outbreaks of CDI have been reported among humans in the community, host factors that increase vulnerability to CDI might be of more importance than increased exposure to C. difficile. Conversely, emerging C. difficile ribotype 078 is found in high numbers in piglets, calves, and their immediate environment. Although there is no direct evidence proving transmission to humans, circumstantial evidence points towards a zoonotic potential of this type. In future emerging PCR ribotypes, zoonotic potential needs to be considered.