Phenotypic variation in a large Swedish pedigree due toSNCAduplication and triplication

BACKGROUND

The "Lister family complex," an extensive Swedish family with autosomal dominant Parkinson disease, was first described by Henry Mjönes in 1949. On the basis of clinical, molecular, and genealogic findings on a Swedish and an American family branch, we provide genetic evidence that explains the parkinsonism in this extended pedigree.

METHODS

Clinical methods included a detailed neurologic exam of the proband of the Swedish family branch, MRI, and ([123]I)-beta-CIT SPECT imaging. Genomic analysis included alpha-synuclein sequencing, SNCA real-time PCR dosage, chromosome 4q21 microsatellite analysis, and high-resolution microarray genotyping. The geographic origin and ancestral genealogy of each pedigree were researched in the medical literature and Swedish Parish records.

RESULTS

The proband of the Swedish family branch presented with early dysautonomia followed by progressive parkinsonism suggestive of multiple system atrophy. Molecular analysis identified a genomic duplication of <0.9 Mb encompassing alpha-synuclein and multimerin 1 (SNCA-MMRN1), flanked by long interspersed repeat sequences (LINE L1). Microsatellite variability within the genomic interval was identical to that previously described for a Swedish American family with an alpha-synuclein triplication. Subsequent genealogic investigation suggested that both kindreds are ancestrally related to the Lister family complex.

CONCLUSION

Our findings extend clinical, genetic, and genealogical research on the Lister family complex. The genetic basis for familial parkinsonism is an SNCA-MMRN11 multiplication, but whereas SNCA-MMRN1 duplication in the Swedish proband (Branch J) leads to late-onset autonomic dysfunction and parkinsonism, SNCA-MMRN1 triplication in the Swedish American family (Branch I) leads to early-onset Parkinson disease and dementia.

Study of saturation of CR39 nuclear track detectors at high ion fluence and of associated artifact patterns

The occurrence of saturation in CR39 solid state nuclear track detectors has been systematically studied as a function of the incident ion (alpha particles and laser-accelerated protons) fluence and the etching time. When overexposed (i.e., for fluences above approximately 10(8) particles/cm(2)) and/or overetched, the CR39 detectors enter a saturated regime where direct track counting is not possible anymore. In this regime, optical measurements of saturated CR39 detectors become unreliable as well, since the optical response of the saturated detectors with respect to the ion fluence is highly nonlinear. This nonlinear optical response is likely due to scattering from the surface of irregular clumping patterns which have a diameter approximately 20 microm, i.e., ten times larger than the diameter of individual tracks. These patterns, which aggregate many individual tracks, are observed to develop in highly saturated regimes. For fluences typical of high energy short pulse laser experiments, saturation occurs, inducing the appearance of artifact ringlike structures. By careful microscopic analysis, these artifact ring patterns can be distinguished from the genuine rings occurring below saturation and characteristic of low energy laser accelerated proton beams.

Cervical atypical mycobacterial lymphadenitis in childhood: findings on sonography

PURPOSE

To describe the sonographic appearance of cervical lymph nodes in twelve children with histopathologically confirmed atypical mycobacterial lymphadenitis.

MATERIALS AND METHODS

Sonography of cervical lymph nodes was performed with a real-time linear scanner using a 13 MHz probe. Sonographic findings were retrospectively reviewed in 9 girls and 3 boys age 1.7 to 10.7 years (median age, 3.7 years), with cervical lymphadenopathy at initial presentation.

RESULTS

Strong echoes within the lymph nodes were found in 4 (33 %) of the children, corresponding to calcifications on histopathological examination. Loss of regular nodal shape with circumscript polypoid spread of nodal masses into the subcutaneous tissue was found in 6 (50 %) patients; at least 1 of these 2 features was noted in 10 (83 %) of our 12 patients. At surgery, abscess formation was found in 8 (67 %) children.

CONCLUSION

When nodal calcifications and spread of nodal masses into the subcutaneous tissue are found in patients with cervical lymphadenopathy, the examiner should maintain a high level of clinical suspicion for atypical mycobacterial lymphadenitis. Contrary to other causes of cervical lymphadenopathy, total surgical excision is the treatment of choice. Identification of these patients prior to surgery is therefore of utmost importance. Our data suggest that sonography could serve as an easy non-invasive method for this purpose.

The national neonatal screening programme for congenital toxoplasmosis in Denmark: results from the initial four years, 1999-2002

AIMS

To describe the outcome of four years' nationwide neonatal screening for congenital toxoplasmosis in liveborn newborns.

METHODS

Congenital toxoplasmosis was diagnosed if specific Toxoplasma gondii IgM antibodies were detected in eluate from the PKU Guthrie filter paper card from a child. Infants diagnosed with congenital toxoplasmosis were examined for intracranial and retinal lesions and treated for three months with sulphadiazine, pyrimethamine, and folinic acid continuously.

RESULTS

Eluates from PKU-cards from 262 912 newborns were analysed. The birth prevalence of congenital toxoplasma infection was 2.1 per 10 000 liveborns. Congenital toxoplasmosis was suspected in 96 infants and confirmed in 55. Forty seven children were examined for intracranial and retinal lesions soon after birth; 12 had clinical signs at this first examination. Of these, 5 had intracranial calcifications, 2 had retinochoroidal lesions, 4 had intracranial calcifications and retinochoroidal lesions, and 1 had hydrocephalus, intracranial calcifications, and retinochoroidal lesions. Ninety four eyes were examined soon after birth; there were central retinochoroidal lesions in 9. Two children had macular lesion of both eyes, five had macular lesions of one eye. At 1 year of age, 10/68 eyes had central lesions, and at 3 years of age, 5/32 had central lesions. Thus new retinochoroidal lesions developed in three eyes in the observation period.

CONCLUSIONS

Neonatal screening is feasible for diagnosing children with congenital toxoplasmosis at birth in low endemic areas. Retinochoroiditis with macular lesion was diagnosed in 9.6% of the eyes at birth and in 15.6% of the eyes examined at 3 years of age.

Analytical model for ion acceleration by high-intensity laser pulses

We present a general expression for the maximum ion energy observed in experiments with thin foils irradiated by high-intensity laser pulses. The analytical model is based on a radially confined surface charge set up by laser accelerated electrons on the target rear side. The only input parameters are the properties of the laser pulse and the target thickness. The predicted maximum ion energy and the optimal laser pulse duration are supported by dedicated experiments for a broad range of different ions.

Analysis of German package inserts

OBJECTIVE

Package inserts have an important impact on patients compliance and thus on the effectiveness of drug use. Despite efforts of the European or national regulatory authorities and manufacturers to improve the readability and comprehensiveness of package inserts, they are still the subject of critical discussion.

MATERIAL AND METHODS

68 German package inserts were chosen for a detailed analysis of their quality and suitability based on a set of 104 quality criteria developed prior to the survey.

RESULTS

In many cases package inserts available on the German drug market did not include important information or were difficult to read or understand. In 73.5% of cases, the daily maximum dose was missing and 63.2% gave no information on the measures to take for each of the interactions. 66.2% of package inserts provided no instructions about the correct storage and 58.8% gave no instructions on the appropriate storage temperature. In 13 cases, dosage instructions were provided only in milligrams of active substance instead of a number of tablets or volume of liquid. 98.5% of the 68 package inserts included non-quantifiable statements such as "high dosage" or "take 2 - 4 tablets, 1 - 3 times daily". 97.1% contained repetitious information, 83.8% included advertising elements and 8.8% contained contradictory information.

CONCLUSION

Package inserts must be optimized and tested by selected groups of patients prior to approval of the drug. This will avoid misunderstandings and lack of information and ensure that use of the drug will give the best possible outcome and avoid safety risks.

Transverse characteristics of short-pulse laser-produced ion beams: a study of the acceleration dynamics

We report on first measurements of the transverse characteristics of laser-produced energetic ion beams in direct comparison to results for laser accelerated proton beams. The experiments show the same low emittance for ion beams as already found for protons. Additionally, we demonstrate that the divergence is influenced by the charge over mass ratio of the accelerated species. From these observations we deduced scaling laws for the divergence of ions as well as the temporal evolution of the ion source size.

The African warbler genus Hyliota as a lost lineage in the Oscine songbird tree: Molecular support for an African origin of the Passerida

The African genus Hyliota includes three or four species of warbler-like birds of uncertain phylogenetic affinities, as it has historically been placed in different avian families that are now known to represent unrelated lineages: Malaconotidae (bush-shrikes), Platysteiridae (batises and wattle-eyes), Muscicapidae (Old World flycatchers) and Sylviidae (Old-World Warblers). To assess the affinities of Hyliota we sequenced a mitochondrial protein-coding gene (ND2, 1018bp) and a nuclear intron (myoglobin intron-2, 685bp). Our analyses suggest that all previous hypotheses concerning the affinities of Hyliota are erroneous. Instead, Hyliota represents a basal branch in the Passerida radiation with no close relatives. Our results, which also include analyses of relationships among other of other atypical songbird genera, lend support to an African origin of the Passerida songbird radiation.

Measurements of UV-generated free radicals/reactive oxygen species (ROS) in skin

Free radicals/reactive oxygen species (ROS) generated in skin by UV irradiation were measured by electron spin resonance (ESR). To increase the sensitivity of measurement the short life free radicals/ROS were scavenged and accumulated by using the nitroxyl probe 3-carboxy-2,2,5,5-tetrametylpyrrolidine-1-oxyl (PCA). The spatial distribution of free radicals/ROS measured in pig skin biopsies with ESR imaging after UV irradiation corresponds to the intensity decay of irradiance in the depth of the skin. The main part of free radicals/ROS were generated by UVA (320-400 nm) so that the spatial distribution of free radicals reaches up to the lower side of the dermis. In vivo measurements on human skin were performed with a L-band ESR spectrometer and a surface coil integrating the signal intensities from all skin layers to get a sufficient signal amplitude. Using this experimental arrangement the protection of UVB and UVA/B filter against the generation of free radicals/ROS in skin were measured. The protection against ROS and the repair of damages caused by them can be realized with active antioxidants characterized by a high antioxidative power (AP). The effect of UV filter and antioxidants corresponding to their protection against free radicals/ROS in skin generated by UVAB irradiation can be quantified by the new radical sun protection factor (RSF). The RSF indicates the increase of time for staying in the sun to generate the same number of free radicals/ROS in the skin like for the unprotected skin. Regarding the amount of generated free radicals/ROS in skin as an biophysical endpoint the RSF characterizes both the protection against UVB and UVA radiation.

Dynamics of electric fields driving the laser acceleration of multi-MeV protons

The acceleration of multi-MeV protons from the rear surface of thin solid foils irradiated by an intense (approximately 10(18) W/cm2) and short (approximately 1.5 ps) laser pulse has been investigated using transverse proton probing. The structure of the electric field driving the expansion of the proton beam has been resolved with high spatial and temporal resolution. The main features of the experimental observations, namely, an initial intense sheath field and a late time field peaking at the beam front, are consistent with the results from particle-in-cell and fluid simulations of thin plasma expansion into a vacuum.

[An example for a practice-oriented curriculum in social medicine under conditions of the new medical licensing regulations. Experiences with practiced-oriented teaching and possibilities for including practical issues in the teaching syllabus of medicine after the introduction of new medical licensing regulations]

Experience with teaching medical students the subject of Social Medicine shows that their interest can be greatly improved by including practical issues such as interviewing chronically ill patients at home, or visiting patient counselling services in the community. With the introduction of the new licensing regulations for physicians, there will be only one final examination and the medical faculties will now have to conduct the examinations themselves. In order to create legal confidence in the results, sufficient homogeneity of the teaching syllabus in Vocational and Social Medicine courses as well as in the new Health Economics courses must be assured for all students. The merger of the two medical faculties of the Free University and the Humboldt University in Berlin have increased student numbers to 400 per semester, so that 20 groups will have to be taught simultaneously. This situation makes excursions to patients or to community facilities nearly impossible. Potential alternatives to allow inclusion of practical issues in the course, even under the new circumstances, are the use of problem-based learning techniques (PBL) such as the creation of theoretical cases dealing with special problems of Social Medicine or the use of standardised patients.

Phylogenetic relationships of the African bush-shrikes and helmet-shrikes (Passeriformes: Malaconotidae)

The African bush-shrikes and helmet-shrikes (Malaconotidae sensu [A Complete Checklist of the Birds of the World, third ed., Helm Editions, London, 2003]) include 10 genera and 52 species of predatory passerine birds for which monophyly, sister-group, and inter-generic relationships are disputed. To resolve their relationships, we analyzed 2313 bp of sequence data obtained from two nuclear introns (myoglobin intron-2, beta-fibrinogen intron-5) and a mitochondrial protein-coding gene (ND2) using parsimony, maximum likelihood, and Bayesian inference. A strongly supported clade that included representatives of the Malaconotidae, Platysteiridae, and Vangidae was found in all analyses. Three main groups emerged within this clade but relationships between these three groups were always poorly supported. The first group included the helmet-shrikes (Prionops), flycatcher-shrikes (Bias and Megabyas), and vangas (Cyanolanius and Pseudobias), currently placed in the families Malaconotidae, Platysteiridae, and Vangidae, respectively. The second group consisted of four Platysteiridae genera (Lanioturdus, Batis, Platysteira, and Dyaphorophyia), with the remaining Malaconotidae genera ('core malaconotids') forming the last group. Two main clades emerged within the 'core malaconotids,' with the position of the genus Nilaus being variable. The first clade included Malaconotus, Dryoscopus, Bocagia, and Tchagra and the second Chlorophoneus, Laniarius, Rhodophoneus, and Telophorus. Monophyly of the genus Chlorophoneus was never recovered, a result that is consistent with morphological data.

Comparison of laser ion acceleration from the front and rear surfaces of thin foils

The comparative efficiency and beam characteristics of high-energy ions generated by high-intensity short-pulse lasers (approximately 1-6 x 10(19) W/cm2) from both the front and rear surfaces of thin metal foils have been measured under identical conditions. Using direct beam measurements and nuclear activation techniques, we find that rear-surface acceleration produces higher energy particles with smaller divergence and a higher efficiency than front-surface acceleration. Our observations are well reproduced by realistic particle-in-cell simulations, and we predict optimal criteria for future applications.

Plasma devices to guide and collimate a high density of MeV electrons

The development of ultra-intense lasers has facilitated new studies in laboratory astrophysics and high-density nuclear science, including laser fusion. Such research relies on the efficient generation of enormous numbers of high-energy charged particles. For example, laser-matter interactions at petawatt (10(15) W) power levels can create pulses of MeV electrons with current densities as large as 10(12) A cm(-2). However, the divergence of these particle beams usually reduces the current density to a few times 10(6) A cm(-2) at distances of the order of centimetres from the source. The invention of devices that can direct such intense, pulsed energetic beams will revolutionize their applications. Here we report high-conductivity devices consisting of transient plasmas that increase the energy density of MeV electrons generated in laser-matter interactions by more than one order of magnitude. A plasma fibre created on a hollow-cone target guides and collimates electrons in a manner akin to the control of light by an optical fibre and collimator. Such plasma devices hold promise for applications using high energy-density particles and should trigger growth in charged particle optics.

Defizite und Perspektiven einer geschlechtergerechten Gesundheitsversorgung an den Beispielen KHK und psychische Störungen

Gender differences in health care are controversially discussed. Results show superfluous, insufficient or inappropriate health care of female and male patients. Many publications show that women are not sufficiently included in clinical trials and therefore data are not useful for analysing gender differences. Survey data like the German National Health Interview and Examination Survey 1998 (Bundes-Gesundheits survey 1998) can be used alternatively to analyse gender specific issues. This survey was used to show possible age and gender differences in prevalence, drug usage and health counselling of female and male patients with coronary heart disease and mental disorders. The number of physician attendances differs in sex and age group in both groups of illnesses. Women have higher number of physician consultations than men and the elderly more than the younger persons. For elderly women with coronary heart disease the control of blood cholesterol levels seems to be poorer than in men. Men get more health counselling from their doctors than women. The results emphasize the importance of considering gender differences in medical research.

[Uncorrected transposition of the great arteries and large ventricular septum defect perioperative management of a caesarean section]

Patients with congenital cyanotic heart disease are a challenge to the anaesthetist due to the individual haemodynamic characteristics. Maintaining a balance between systemic and pulmonary-vascular resistance is crucial. Here we outline the successful perioperative management of a 24-year-old female with uncorrected transposition of the great arteries (D-TGA) and large septal defect of the ventricle (functionally single ventricle). She was transferred to our perinatologic centre in the 32nd week of pregnancy with symptoms of increasing cardial insufficiency. The peripartum management was agreed upon at an interdisciplinary conference and caesarean section was performed in the 35th week of pregnancy with epidural anaesthesia and no significant problems. Due to hypercoagulability and the risk of "paradoxical" embolism, low molecular weight heparin was given for 6 weeks post partum. The infant was underweight and was admitted to the neonatal intensive care unit, where she made a satisfactory progress.