Structural basis for pterin antagonism in nitric-oxide synthase. Development of novel 4-oxo-pteridine antagonists of (6R)-5,6,7,8-tetrahydrobiopterin

Pathological nitric oxide (NO) generation in sepsis, inflammation, and stroke may be therapeutically controlled by inhibiting NO synthases (NOS). Here we targeted the (6R)-5,6,7,8-tetrahydro-l-biopterin (H(4)Bip)-binding site of NOS, which, upon cofactor binding, maximally increases enzyme activity and NO production from substrate l-arginine. The first generation of H(4)Bip-based NOS inhibitors employed a 4-amino pharmacophore of H(4)Bip analogous to antifolates such as methotrexate. We developed a novel series of 4-oxo-pteridine derivatives that were screened for inhibition against neuronal NOS (NOS-I) and a structure-activity relationship was determined. To understand the structural basis for pterin antagonism, selected derivatives were docked into the NOS pterin binding cavity. Using a reduced 4-oxo-pteridine scaffold, derivatives with certain modifications such as electron-rich aromatic phenyl or benzoyl groups at the 5- and 6-positions, were discovered to markedly inhibit NOS-I, possibly due to hydrophobic and electrostatic interactions with Phe(462) and Ser(104), respectively, within the pterin binding pocket. One of the most effective 4-oxo compounds and, for comparisons an active 4-amino derivative, were then co-crystallized with the endothelial NOS (NOS-III) oxygenase domain and this structure solved to confirm the hypothetical binding modes. Collectively, these findings suggest (i) that, unlike the antifolate principle, the 4-amino substituent is not essential for developing pterin-based NOS inhibitors and (ii), provide a steric and electrostatic basis for their rational design.

Rett syndrome: update of a 25 year follow-up investigation in Western Sweden--sociomedical aspects

Through 1998-1999 the Swedish research team have systematically mapped 45 of 54 females with Rett syndrome (RS) aged 5-57 years (Berg M. Uppföljning av flickor med Rett syndrom i Västsverige. Socialmedicinsk kartläggning, Stencilerad rapport, Sahlgrenska universitetssjukhuset, Göteborg, 1999; Läkartidningen (Swedish Medical Journal) 96 (1999) 5488). The emphasis is on the RS females' adjustment to grown-up living. At an adult age the large majority moved over to a Swedish type of small group home. We visited these girls in their group homes and got information about their adaptation to this special home situation. We noted their behaviour and contact with the staff and interviewed their parents. The results showed that the young women usually had adjusted well. The adjustment seemed to depend on the degree of planning before the girls moved from their parents to special group homes. These seem to provide a good environment for the RS females, in respect of both physical and social aspects. Although neuropaediatrics in Sweden today has advanced in RS knowledge, the result from this research shows that in Swedish society there is still a great ignorance of RS, even among medical professionals. In particular there is a gap of knowledge when the medical responsibility had to be transferred over to adult medicine. Many of the parents emphasized the great importance of how they were listened to by professionals in public medical and social services. It is essential that professionals always listen to information from parents and personal assistants.

Three decades of sociomedical experiences from West Swedish Rett females 4-60 years of age

Rett syndrome, today known as a worldwide important cause behind severe mental retardation in females, has been seen in Sweden since the 1960s (the senior author). This study gives population representative clinical and sociomedical follow-up data from West Sweden (1/4 of the population in Sweden). The series comprises 54 females diagnosed in 1971-1998, 5-60 years old, median age 20. Mortality in 1971-2000 was 18% (10/54), median age at death 20. Death usually had been sudden and unexpected. The sociomedical follow-up emphasized the adult group. The large majority had usually moved to small group homes, a good and well-accepted environment once the staff had learned the particularities of these so uniquely neurodevelopmentally disabled women.

Implementing information systems in health care organizations: myths and challenges

Successfully implementing patient care information systems (PCIS) in health care organizations appears to be a difficult task. After critically examining the very notions of 'success' and 'failure', and after discussing the problematic nature of lists of 'critical success- or failure factors', this paper discusses three myths that often hamper implementation processes. Alternative insights are presented, and illustrated with concrete examples. First of all, the implementation of a PCIS is a process of mutual transformation; the organization and the technology transform each other during the implementation process. When this is foreseen, PCIS implementations can be intended strategically to help transform the organization. Second, such a process can only get off the ground when properly supported by both central management and future users. A top down framework for the implementation is crucial to turn user-input into a coherent steering force, creating a solid basis for organizational transformation. Finally, the management of IS implementation processes is a careful balancing act between initiating organizational change, and drawing upon IS as a change agent, without attempting to pre-specify and control this process. Accepting, and even drawing upon, this inevitable uncertainty might be the hardest lesson to learn.

Swedish midwives' care of women who are at high obstetric risk or who have obstetric complications

OBJECTIVE

to describe how midwives experience the care of women who are at high obstetric risk or who have an obstetric complication during pregnancy, childbirth and early parenthood.

DESIGN

a qualitative approach using a phenomenological method.

PARTICIPANTS

10 Swedish midwives, recognised as highly skilled clinicians with at least five years of clinical experience in the studied context, from four different hospitals.

FINDINGS

the essence of midwifery when caring for women at high obstetric risk or with a manifested complication was defined as 'a struggle for the natural process'. Women's transition, physically as well as emotionally, during pregnancy, childbirth and early parenthood, was described as a genuinely natural process. The midwives' struggle consisted of encouraging and preserving this process within each woman. It was based on embodied knowledge and included a balancing between the medical and natural perspectives. Prerequisites, and therefore part of the struggle for the natural process, were sensitivity to the spontaneous, mutual interaction with the woman and enduring presence. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: the midwives' responsibility is to promote the natural process during pregnancy, childbirth and puerperium within every woman at high obstetric risk or with obstetric complications. The findings could serve as a basis for reflection on the professional role of midwives, and on the organisation of modern maternity care.

AAIR versus DDDR pacing in the bradycardia tachycardia syndrome: a prospective, randomized, double-blind, crossover trial

In 19 patients paced and medicated for bradycardia tachycardia syndrome (BTS), AAIR and DDDR pacing were compared with regard to quality of life (QoL), atrial tachyarrhythmia (AFib), exercise tolerance, and left ventricular (LV)function. Patients had a PQ interval < or = 240 ms during sinus rhythm, no second or third degree AV block, no bundle branch block, or bifascicular block. In DDDR mode, AV delay was optimized using the aortic time velocity integral. After 3 months, QoL was assessed by questionnaires, patients were investigated by 24-hour Holter, cardiopulmonary exercise testing (CPX) was performed, and LV function was determined by echocardiography. QoL was similar in all dimensions, except dizziness, showing a significantly lower prevalence in AAIR mode. The incidence of AFib was 12 episodes in 2 patients with AAIR versus 22 episodes in 7 patients with DDDR pacing (P = 0.072). In AAIR mode, 164 events of second and third degree AV block were detected in 7 patients (37%) with pauses between 1 and 4 seconds. During CPX, exercise duration and work load were higher in AAIR than in DDDR mode (423+/-127 vs 402+/-102 s and 103+/-31 vs 96+/-27 Watt, P < 0.05). Oxygen consumption (VO2), was similar in both modes. During echocardiography, only deceleration of early diastolic flow velocity and early diastolic closure rate of the anterior mitral valve leaflet were higher in DDD than in AAI pacing (5.16+/-1.35 vs 3.56+/-0.95 m/s2 and 69.2+/-23 vs 54.1+/-26 mm/s, P < 0.05). As preferred pacing mode, 11 patients chose DDDR, 8 patients chose AAIR. Hence, AAIR and DDDR pacing seem to be equally effective in BTS patients. In view of a considerable rate of high degree AV block during AAIR pacing, DDDR mode should be preferred for safety reasons.

Vasoactive treatment for hearing preservation in acoustic neuroma surgery

OBJECT

Delayed hearing loss following surgery for acoustic neuroma indicates anatomical and functional preservation of the cochlear nerve and implies that a pathophysiological mechanism is initiated during surgery and continues thereafter. Intraoperative brainstem auditory evoked potentials (BAEPs) typically demonstrate gradual reversible loss of components in these patients.

METHODS

Based on this BAEP pattern, a consecutive series of 41 patients with unilateral acoustic neuromas was recruited into a prospective randomized study to investigate hearing outcomes following the natural postoperative course and recuperation after vasoactive medication. Both groups were comparable in patient age, tumor size, and preoperative hearing level. Twenty patients did not receive postoperative medical treatment. In 70% of these patients anacusis was documented and in 30% hearing was preserved. Twenty-one patients were treated with hydroxyethyl starch and nimodipine for an average of 9 days. In 66.6% of these patients hearing was preserved and in 33.3% anacusis occurred.

CONCLUSIONS

These results are statistically significant (p < 0.05, chi2 = 5.51) and provide evidence that these surgically treated patients suffer from a disturbed microcirculation that causes delayed hearing loss following removal of acoustic neuromas.

Meeting patients' needs with patient information systems: potential benefits of qualitative research methods

This article reports on our pilot evaluation of an electronic patient information system for children with amblyopia and their parents. The aim was to investigate whether the information system would be able to improve the quality of care, as indicated by an improvement in the effectiveness and efficiency of care, and in an increase in patient satisfaction. In the pilot evaluation, we used qualitative research methods, exploring the impact of the information system on children and their parents, with the aim to find suitable indicators for a potential further, quantitative study. Yet we found that the system was little used and had marginal effects on the quality of care for children with amblyopia and their parents. It appeared that the main problem underlying this patient information system was that the needs of those people who actually would be using the system had never really been investigated. The designers had built their assumptions about these needs into the system. These appeared to be mistaken at so many levels that the system could not become a success. As a result of this pilot evaluation, the patient information project was thoroughly transformed. This study makes clear that a thorough exploration of user needs before building the system, using qualitative research methods, may be crucial because it can prevent mismatches and maximizes the chance that the eventual information system meets its most important aim: to enhance patient empowerment and improve the quality of care.

Characterization of Spiroplasma citri adhesion related protein SARP1, which contains a domain of a novel family designated sarpin

Transmission of the plant pathogen Spiroplasma citri by its leafhopper vector, Circulifer tenellus, involves adherence to and invasion of insect host cells. The S. citri adhesion related protein P89 (SARP1) was purified by immunoprecipitation using anti-SARP1 monoclonal antibodies. The protein's N-terminal amino acid sequence was determined and used to design a degenerate oligonucleotide. The labeled oligonucleotide hybridized to a 3.5 kb MboI fragment from S. citri DNA, which was then cloned and sequenced. Additionally, a 1.9 kb RsaI fragment of S. citri DNA, partially overlapping the MboI fragment, was isolated and characterized. Sequence analysis of the two clones revealed four open reading frames. ORF1 (675 bp) encodes the C-terminal part of a Soj-like protein. ORFs 1 and 2 were separated from ORFs 3 and 4 by a putative transcription termination site, indicated by a hairpin structure. ORF3 encodes an amphiphilic 798 amino acid long protein with a cleavable signal peptide and a predicted transmembrane helix near the C-terminus. The mature protein of 85.96 kDa has a calculated pI value of 5.5 and has an N-terminal amino acid sequence consistent with that determined from the purified SARP1. At the N-terminus of this protein is a region consisting of six repeats, each 39-42 amino acids, a motif belonging to a previously unrecognized family of repeats found in a variety of bacterial proteins. The taxonomically spotty presence of this 'sarpin' domain and the relationship of the repeats to each other suggests a convergent evolution in multiple lineages.

[Psychological profile of patients with COPD: contribution of Semiometry]

Patients with chronic bronchitis often ignore, or pretend to ignore, their disease and generally consult very late. The physician's advice is often quite vague and centered on smoking. One of the objectives of this study was to better understand the psychological profile of patients with chronic bronchitis in order to better apprehend the patient-physician relationship and therapeutic options. Semiometry was designed to overcome the problem encountered by physicians who would like to understand who their patients are without directly asking them. The concept is based on submitting very ordinary words to these subjects and asking them whether they like the word or not. An analysis of their responses allows a very deep understanding of their psychological profile. Briefly, the patient-physician relationship is quite difficult in COPD. The patient "brings" the disease to the physician, "putting" it in his hands and asking him to cure it without having to do anything concerning himself, his life or his behavior. The physician is called on to answer this challenge that can be expressed as "trying to get the patient to play the game without getting caught".

Mutations in the X-linked filamin 1 gene cause periventricular nodular heterotopia in males as well as in females

Periventricular heterotopia (PH) is a human neuronal migration disorder in which many neurons destined for the cerebral cortex fail to migrate. Previous analysis showed heterozygous mutations in the X-linked gene filamin 1 (FLN1), but examined only the first six (of 48) coding exons of the gene and hence did not assess the incidence and functional consequences of FLN1 mutations. Here we perform single-strand conformation polymorphism (SSCP) analysis of FLN1 throughout its entire coding region in six PH pedigrees, 31 sporadic female PH patients and 24 sporadic male PH patients. We detected FLN1 mutations by SSCP in 83% of PH pedigrees and 19% of sporadic females with PH. Moreover, no PH females (0/7 tested) with atypical radiographic features showed FLN1 mutations, suggesting that other genes may cause atypical PH. Surprisingly, 2/24 males analyzed with PH (9%) also carried FLN1 mutations. Whereas FLN1 mutations in PH pedigrees caused severe predicted loss of FLN1 protein function, both male FLN1 mutations were consistent with partial loss of function of the protein. Moreover, sporadic female FLN1 mutations associated with PH appear to cause either severe or partial loss of function. Neither male could be shown to be mosaic for the FLN1 mutation in peripheral blood lymphocytes, suggesting that some neurons in the intact cortex of PH males may be mutant for FLN1 but migrate adequately. These results demonstrate the sensitivity and specificity of DNA testing for FLN1 mutations and have important functional implications for models of FLN1 protein function in neuronal migration.

Sorption and desorption behavior of organotin compounds in sediment-pore water systems

Sediments contaminated with organotin compounds (OTs), in particular triorganotins (TOTs), are abundant in areas with high shipping activities. To assess the possible remobilization of these highly toxic compounds from such sediments, a profound understanding of their sorption/desorption behavior is necessary. In this work the extent and reversibility of sorption of OTs to sediments has been investigated using contaminated freshwater harbor sediments and two certified OT containing marine sediments. Experiments conducted with perdeuterated OTs showed that sorption of OTs to sediments is a fast and reversible process involving primarily particulate organic matter (POM) constituents as sorbents. The organic carbon-normalized sediment-water distribution ratios (DOC, expressed in L/kgOC) determined in the laboratory were consistent with in-situ DOCs obtained from OT concentrations measured in sediment and pore water samples from two dated sediment cores. For both butyl- and phenyltin compounds the log DOC values were in the range of 4.7-6.1, and the following sequence was observed: DOC (tri-OT) > or = DOC (di-OT) > or = DOC (mono-OT). However, the differences were much less pronounced than would have been expected for hydrophobic partitioning of the corresponding compounds into POM. These results support our hypothesis from earlier work with dissolved humic acids that OT sorption to sediments occurs primarily by reversible formation of (innerspere) complexes between the tin atom and carboxylate and phenolate ligands present in POM. Because of the high DOC values (i.e. log DOC > or = 4) the diffusion of OTs from deeper sediments to the surface will be rather slow, and thus a major release from undisturbed sediments is not expected. However, because OTs readily desorb, any resuspension of contaminated sediments (e.g., by the tide, storms or dredging activities) will lead to enhanced OT concentrations in the overlaying water column. Furthermore, in contrastto polycyclic aromatic hydrocarbons (PAH) where large fractions may be tightly bound (in)to soot or other carbonaceous materials, OTs will be more readily bioavailable due to the fast and reversible sorption/desorption behavior.

Wild birds as a possible natural reservoir of Borna disease virus

The natural reservoir of Borna disease virus (BDV) is unknown. In this paper, we show that mallards (Anas platyrhyncos) and jackdaws (Corvus monedula) can be subclinically infected carriers of this virus. From faecal samples collected at a bird pond, we were able to amplify fragments of the BDV p24 and p40 genes. Following cloning and sequencing, a phylogenetic analysis revealed that these birds carry strains of BDV closely related to but distinct from the reference strains BDV V and He/80. To our knowledge, this is the first confirmed finding of BDV in wild birds.

Arsenic contamination of groundwater and drinking water in Vietnam: a human health threat

This is the first publication on arsenic contamination of the Red River alluvial tract in the city of Hanoi and in the surrounding rural districts. Due to naturally occurring organic matter in the sediments, the groundwaters are anoxic and rich in iron. With an average arsenic concentration of 159 micrograms/L, the contamination levels varied from 1 to 3050 micrograms/L in rural groundwater samples from private small-scale tubewells. In a highly affected rural area, the groundwater used directly as drinking water had an average concentration of 430 micrograms/L. Analysis of raw groundwater pumped from the lower aquifer for the Hanoi water supply yielded arsenic levels of 240-320 micrograms/L in three of eight treatment plants and 37-82 micrograms/L in another five plants. Aeration and sand filtration that are applied in the treatment plants for iron removal lowered the arsenic concentrations to levels of 25-91 micrograms/L, but 50% remained above the Vietnamese Standard of 50 micrograms/L. Extracts of sediment samples from five bore cores showed a correlation of arsenic and iron contents (r2 = 0.700, n = 64). The arsenic in the sediments may be associated with iron oxyhydroxides and released to the groundwater by reductive dissolution of iron. Oxidation of sulfide phases could also release arsenic to the groundwater, but sulfur concentrations in sediments were below 1 mg/g. The high arsenic concentrations found in the tubewells (48% above 50 micrograms/L and 20% above 150 micrograms/L) indicate that several million people consuming untreated groundwater might be at a considerable risk of chronic arsenic poisoning.

Guidelines for appropriate care: the importance of empirical normative analysis

The Royal Dutch Medical Association recently completed a research project aimed at investigating how guidelines for 'appropriate medical care' should be construed. The project took as a starting point that explicit attention should be given to ethical and political considerations in addition to data about costs and effectiveness. In the project, two research groups set out to design guidelines and cost-effectiveness analyses (CEAs) for two circumscribed medical areas (angina pectoris and major depression). Our third group was responsible for the normative analysis. We undertook an explorative, qualitative pilot study of the normative considerations that played a role in constructing the guidelines and CEAs, and simultaneously interviewed specialists about the normative considerations that guided their diagnostic and treatment decisions. Explicating normative considerations, we argue, is important democratically: the issues at stake should not be left to decision analysts and guideline developers to decide. Moreover, it is a necessary condition for a successful implementation of such tools: those who draw upon these tools will only accept them when they can recognize themselves in the considerations implied. Empirical normative analysis, we argue, is a crucial tool in developing guidelines for appropriate medical care.

Do battery depletion indicators reliably predict the need for pulse generator replacement?

The aim of this study was to test the validity of battery depletion indicators to forecast end of service (EOS) in dual chamber pulse generators (PG). Two additional approaches for prediction of EOS were evaluated as well: the real-time telemetry of cell impedance and a battery stress test (BST) that used a transitory increase in pacing rate. The study population consisted of 119 patients with Intermedics dual chamber PG models Cosmos II and Relay, in which cell impedance had exceeded 2.5 k omega. The patients were followed in 6-month intervals. If the interrogation of the PG or the BST prompted the appearance of the intensified follow-up indicator (IFI), the next follow-up was scheduled within 2 months. PG replacement was performed on physician's discretion or immediately on appearance of the elective replacement indicator (ERI), regardless of the method of ERI provocation. During a period of 2 years/and 9 months, 33 patients underwent PG replacement. Out of 21 patients with positive ERI indicators, only 5 had positive warning indicators of approaching battery depletion in the preceding follow-up (IFI during BST, n = 4; ERI during BST n = 1). The majority of patients (n = 16, 76%) revealed ERI without prior activation of IFI, neither spontaneous nor during the BST. Four of these 16 ERI-positive patients had cell impedance values far below the ERI limits of the manufacturer. Based on battery depletion indicators, an exact prediction of EOS of dual chamber pacemakers is not possible. Measuring battery impedance allows for a statistical estimation of remaining service life but it may be misleading in the individual case. A BST that is based on a temporary increase of pacing rate is invalid in forecasting battery depletion. As activation of the ERI can trigger an abrupt change to the VVI backup mode, pacemaker dependent patients with low programmed basic pacing rates may be hemodynamically compromised by an unexpected activation of ERI. Close monitoring intervals and PG replacement before appearance of the ERI is recommended in those patients.

Isolation, expression, and characterization of fully functional nontoxic BiP/GRP78 mutants

Mammalian BiP/GRP78 and Escherichia coli DnaK belong to the highly conserved hsp70 family and function as molecular chaperones in the endoplasmic reticulum or the cytosol, respectively. Induction of murine BiP/GRP78 expression in E. coli leads to growth arrest and cell death, independent of the bacterial strain and vector used. Analysis of various BiP constructs and mutants shows that the dominant-lethal phenotype is induced specifically by the expression of the 13.7-kDa C-terminal domain and abolished by a single substitution in that region. Deletion of that region also results in nontoxic gene products that can be overexpressed and purified to homogeneity. The nontoxic mutants are highly expressed in E. coli, representing up to 20% of the soluble fraction. They are catalytically active, depolymerize upon binding ATP or synthetic peptide, and interact with the J-domain of the DnaJ-like accessory protein, MTJ1, with near wild-type affinity. Our data indicate that the cytotoxic effect encountered during overexpression of recombinant proteins can be caused by a single domain and can be alleviated by a specific mutation or deletion in that region without altering the catalytic properties of the enzyme.

Longevity of dual chamber pacemakers: device and patient related determinants

In 382 patients with three different dual chamber pulse generators, the median time interval to battery depletion was 98.3 months. Cox regression analysis revealed the following variables as significant predictors of battery longevity: programmed pacing rate, energy of the stimulation output, mode of stimulation (i.e., proportion of paced cycles in one or two chambers), battery capacity, and internal sensing current of the pacemaker. Although 27% of all patients died before the service life of the pacemaker was over and despite a rate of premature reoperations of 8.6%, the majority of pacemaker patients (55%) fully used the expected battery life span of the pulse generator. Patients who died before the pacemaker had reached its end of service were significantly older at implantation than patients who survived until pacemaker replacement. The vast majority (92%) of patients received another dual chamber pulse generator when replacement was required. These data underline the need for long-lasting dual chamber devices.

On-line flow sample stacking in a flow injection analysis-capillary electrophoresis system: 2000-fold enhancement of detection sensitivity for priority phenol pollutants

A flow injection analysis-capillary electrophoresis system has been used for on-line flow stacking of 11 US Environmental Protection Agency priority phenol pollutants. Samples containing low concentrations of phenols dissolved in deionised water are continuously delivered to the capillary opening by means of a peristaltic pump. The sample components stack at the boundary between the highly conductive separation electrolyte and the introduced sample. By selecting an appropriate electrolyte and stacking conditions the movement of the electrolyte solution inside the capillary can be reduced, thereby improving the stacking efficiency. The electrolyte used here contained 20 mM phosphate, 8% 2-butanol, and 0.001% hexamethonium bromide at pH 11.95, and the stacking was carried out at 2 kV for 240 s. These conditions allowed up to 2000-fold preconcentration of the selected phenols. No matrix removal was necessary.

Evaluation of liquid handling conditions in microplates

Liquid handling in higher density microplates (e.g., 1536-well microplates) for more efficient drug screening necessitates carefully selected and optimized parameters. The quality of a liquid handling procedure is dependent on the carryover rate of residual liquids during the pipetting process, the mixing behavior in the wells, foam and bubble formation, and evaporation. We compared and optimized these parameters in 96-, 384-, and 1536-well microplates, and herein we critically evaluate the performance of the CyBi-Well 96/384/1536 automated micropipetting device, which formed the basis of our evaluation studies.

The plasmid pcDNA3 differentially induces production of interferon-alpha and interleukin-6 in cultures of porcine leukocytes

An adjuvant effect of invertebrate DNA has been attributed to its relative high frequency of unmethylated CpG dinucleotides. Here we describe the interferon-alpha (IFN-alpha) and interleukin-6 (IL-6) inducing properties of a commonly used eukaryotic expression vector, pcDNA3, in porcine leukocytes. The magnitude of the cytokine response was compared to that induced by the synthetic ds RNA analogue poly(I):poly(C), inactivated preparations of Aujeszky's disease virus (ADV) and the Gram-negative bacteria Actinobacillus pleuropneumoniae. The plasmid, as well as poly(I):poly(C), required lipofectin to induce IFN-alpha production whereas both preparations induced IL-6 irrespective of preincubation with lipofectin. However, the nucleic acid-induced levels of IL-6 were low compared to those induced by A. pleuropneumoniae. The IFN-alpha response elicited by pcDNA3 in the presence of lipofectin was as high as, or higher than that induced by ADV. Interestingly, also A. pleuropneumoniae induced a substantial production of IFN-alpha when preincubated with lipofectin. Plasmid expression was not necessary for induction of IFN-alpha. Furthermore, the IFN-alpha inducing capacity of pcDNA3 was not reduced when the two predicted immunostimulatory sequences 5'AACGTT3' were deleted. Nor did the ability of the plasmid to induce IFN-alpha production decrease when the ampicillin resistance (ampR) gene was replaced with the kanamycin resistance (kanR) gene. However, methylation of all cytidines in CpG dinucleotides of pcDNA3 abolished the IFN-alpha inducing capacity. These in vitro results indicate an immunomodulatory role of bacterial DNA also in the pig. Unmethylated CpG dinucleotides are crucial for induction of IFN-alpha by the plasmid, but other CpG motifs than those within the 5'AACGTT3' sequences of the ampR gene contribute to this induction in porcine cells.

Low CD4(+) T cell responses to the C-terminal region of the malaria merozoite surface protein-1 may be attributed to processing within distinct MHC class II pathways

The C-terminal fragment of merozoite surface protein-1 (MSP-1) of the mouse malaria parasite Plasmodium chabaudi chabaudi (AS) stimulates a weak CD4 T cell response when compared to the response to a more structurally simple region of the molecule. The tertiary structure of the C-terminal region of MSP-1 is maintained by five disulfide bonds. A peptide from this region could only be processed and loaded onto newly synthesized MHC class II molecules, whereas a peptide from the structurally simple region was available for loading onto recycling MHC class II. CD4(+) T cell hybridomas took longer to recognize an epitope derived from the disulfide-bonded region whether native parasite or recombinant MSP-1 antigen was used. Reduction of disulfide bonds in the C-terminal region subsequently allowed peptides to be loaded onto recycling MHC class II and greatly enhanced the rapidity of the T cell response. These data demonstrate that differential processing occurs intramolecularly in MSP-1, which may be responsible for the observed weak CD4 T cell responses against this region. The consequences of this in vivo may be that limited T cell help is available for protective antibody production which has important implications for designing vaccines based on MSP-1.

Septal lead implantation for the reduction of paced QRS duration using passive-fixation leads

In 120 consecutive patients with standard pacing indications, we tested the feasibility of RV septal lead implantation technique guided by surface ECG and the degree to which this technique reduces paced QRS duration compared to RV apical stimulation when passive-fixation leads are used. During implantation, an ECG was recorded with a paper speed of 100 mm/s using the orthogonal Frank leads, and QRS was measured from the earliest to the latest deflection in any of the Frank leads. Pace-mapping of the septum was performed until QRS was minimal. The lead was attached, where QRS, pacing threshold, lead impedance, and EGM amplitude provided the best compromise. An average of 3.7 +/- 2.5 attempts (range 1-18, median 7) was needed until a final implantation site was found. There were no technical problems during implantation. QRS could be reduced by 5-55 ms (mean delta QRS 19 +/- 11 ms) in 83 (69%) of 120 patients. In 22 (18%) patients, QRS was identical with apical and septal pacing, and in 15 (13%) patients, QRS was 5-20 ms (10 +/- 4) longer despite septal stimulation. Average QRS was significantly shorter during septal pacing compared with apical pacing (151 +/- 20 vs 162 +/- 23 ms, P < 0.001). There was a tendency towards greatest QRS reduction when the high septum was stimulated (22 +/- 11 ms reduction) as compared with mid- (18 +/- 11 ms) or apical parts of the RV septum (16 +/- 10 ms). QRS reduction was most likely if apical QRS width was > 170 ms (P = 0.0002), and there was an inverse correlation between apical QRS and delta QRS (r = 0.53, P < 10(-7)). During a mean follow-up of 14 months, there was no pacing or sensing problem and no lead dislodgment occurred.