BRO beta-lactamase alleles, antibiotic resistance and a test of the BRO-1 selective replacement hypothesis in Moraxella catarrhalis

OBJECTIVES

The hypothesis that BRO-1 selectively replaced the BRO-2 isoform of the Moraxella catarrhalis BRO beta-lactamase was tested by examining the temporal distribution, antibiotic resistance and epidemiological characteristics of isolates from a long-term collection at a single locale.

METHODS

A rapid, one-step PCR assay conducted on 354 isolates spanning 1984-1994 distinguished bro alleles in over 97% of the beta-lactamase-producing isolates. Probes of dot blots were used to distinguish PCR failure from non-beta-lactamase-mediated penicillin resistance.

RESULTS

BRO-2 isolates comprised 0-10% of the population per year with no evidence of a decline over time. All beta-lactamase producers exceeded the clinical threshold for penicillin resistance. Bimodality of penicillin MICs for beta-lactamase producers was caused by variation within BRO-1 rather than differences between BRO-1 and BRO-2. Non-beta-lactamase factors also confer resistance to penicillin and may contribute to the BRO-1 bimodality. The 13 BRO-2 isolates were associated with diverse genotypes within which there was evidence of epidemiologically linked clusters. The exclusive association of BRO-2 with four unrelated genotypes suggested maintenance of BRO-2 by recurrent mutation or horizontal exchange.

CONCLUSIONS

The relative rarity of BRO-2 throughout the study, the absence of a declining temporal trend, and genetic diversity within BRO-2 all failed to support the hypothesis that BRO-2 was more common in the past and has been selectively replaced by BRO-1.

Status report on standard-setting work in the area of environmental radioactivity measurement

Environmental assessment studies are regularly commissioned to study the impact of radioactive substances on the environment and the public, in response to concern about the presence of such substances. The credibility of such studies relies on the quality and reliability of radionuclide analysis as well as the sample representativity of the radiological situation. The recent expansion from national stakeholders to those involving other states requires that activity measured in effluents or environmental samples in a country are reliable and reproducible so as to be accepted by all states potentially concerned by regional contamination. The standard-setting approach, based on consensus, seemed to lend itself to a settlement of technical aspects of potential dispute. This document describes standardization organizations, French and international, the standards published, as well as standardization work under way on the measurement of radionuclides found in environmental matrices.

Symptoms prevalence among office employees and associations to building characteristics

A cross-sectional study was performed in eight companies, comprising 32 buildings without previously recognized indoor air problems. Engineers filled in a technical questionnaire on building characteristics, floor surface materials, ventilation, cleaning procedures, heating and cooling. A total of 3562 employees returned questionnaires on individual factors, workload, perceived physical work environment, allergy and symptoms. Frequent symptoms were feeling of fatigue or heavy-headedness, eye irritation, and dry facial skin. Women reported symptoms more frequently than men. Employees with allergy had a 1.8-2.5 times risk of reporting a high score for general, skin, or mucosal symptoms. The risk of a high symptom score increased with daily visual display unit (VDU) work time. Passive smoking and psychosocial load were also relatively strong predictors of symptoms. Weekly cleaning as compared with a frequency of cleaning two to four times a week increased the risk of symptoms. Adjusted odds ratio for a high general symptoms score from infrequent cleaning was 1.5 (95%CI 1.1-2.0). A high ventilation flow or central ventilation unit filter EU7 vs. EU8 seemed to be associated with an increased risk of general symptoms. Absence of local temperature control increased the risk of mucosal symptoms.

Cell cycle checkpoint status in human malignant mesothelioma cell lines: response to gamma radiation

Knowledge of the function of the cell cycle checkpoints in tumour cells may be important to develop treatment strategies for human cancers. The protein p53 is an important factor that regulates cell cycle progression and apoptosis in response to drugs. In human malignant mesothelioma, p53 is generally not mutated, but may be inactivated by SV40 early region T antigen (SV40 Tag). However, the function of p53 has not been investigated in mesothelioma cells. Here, we investigated the function of the cell cycle checkpoints in six human mesothelioma cell lines (HMCLs) by studying the cell distribution in the different phases of the cell cycle by flow cytometry, and expression of cell cycle proteins, p53, p21(WAF1/CIP1) and p27(KIP1). In addition, we studied p53 gene mutations and expression of SV40 Tag. After exposure to gamma-radiation, HMCLs were arrested either in one or both phases of the cell cycle, demonstrating a heterogeneity in cell cycle control. G1 arrest was p21(WAF1/CIP1)- and p53-dependent. Lack of arrest in G1 was not related to p53 mutation or binding to SV40 Tag, except in one HMCL presenting a missense mutation at codon 248. These results may help us to understand mesothelioma and develop new treatments.

Working memory in ADHD: prefrontal/parietal connections

Current theories of dopaminergic and noradrenergic mechanisms, which are thought to be of importance in the regulation of attention are reviewed. A biphasic model of dopaminergic function is described, in which tonic dopamine exerts a suppressive influence on subcortical dopamine systems by altering tonic/phasic dopaminergic relationships. Noradrenergic mechanisms are of importance in modulating sensory processing at the prefrontal cortical level. The work of Silberstein and colleagues utilizing Steady-State Visually Evoked Potential, during the course of an A-X Continuous Performance Task enables examination of the spatial distribution and dynamics of electrical brain activity during the task. The maintenance of activation in the interval between A and X provides a measure of working memory, thought to be related to prefrontal-parietal activation, which is facilitated by administration of methylphenidate to children with ADHD, suggesting that working memory may be a core deficiency in children with ADHD. While tonic dopamine activity in ventral striatum/accumbens gates inhibitory activity, dorsolateral prefrontal-parietal connections allow maintenance of working memory required for goal completion.

Subcellular localization of the melanoma-associated protein Melan-AMART-1 influences the processing of its HLA-A2-restricted epitope

The peptide derived from the melanoma-associated protein Melan-A (Melan-A(26-35)/HLA-A2) is an attractive candidate for tumor immunotherapy but little is known about the intracellular processing of this antigen. Here we show that Melan-A is a single-pass membrane protein with an NH(2) terminus exposed to the lumen of the exocytic compartment. In transfected melanoma cells, Melan-A accumulates in the Golgi region. Inversion of the membrane topology leads to the retention of Melan-A in the endoplasmic reticulum. Most strikingly, melanoma cells expressing this form of Melan-A are more effectively recognized by specific CTL than those expressing either Melan-A in its native membrane orientation or Melan-A artificially localized in the cytosol. Our data are compatible with the notion that proteins retained in the endoplasmic reticulum are more efficiently degraded and produce more antigenic peptides.

Genetic and environmental influences on separation anxiety disorder symptoms and their moderation by age and sex

We estimated genetic and environmental influences on mother-rated DSM-III-R separation anxiety disorder (SAD) symptoms in 2043 3 to 18-year-old male and female twin pairs and their siblings (348 pairs) recruited from the Australian NH&MRC Twin Registry. Using DeFries and Fulker's (1985) multiple regression analysis, we found that genetic and shared environmental influences both contributed appreciably to variation in SAD symptoms (h2 = .47, SE = .07; c2 = .21, SE = .05) and were significantly moderated by both sex and age. Genetic influences were greater for girls than boys (h2 = .50 and .14, respectively), whereas shared environmental influences were greater for boys than girls (c2 = .51 and .21, respectively). Genetic influences increased with age. whereas shared environmental influences decreased with age. Shared environmental influences were greater in magnitude for twins than for nontwin siblings (c2 = .28 versus .13, respectively). Implications of these findings for theories of the cause of separation anxiety are discussed.

Timing, space and ADHD: the dopamine theory revisited

OBJECTIVE

The objective of this study was to review the dopamine theory of attention deficit hyperactivity disorder (ADHD) in terms of advances made over the last decade.

METHOD

'Hyper' and 'hypo' dopaminergic theories are discussed, as well as noradrenergic and neuropsychological findings in ADHD. A model incorporating both anterior and posterior attention systems, involved in orienting, inhibition, vigilance and working memory, is described. Neuropsychological studies of covert orienting are reviewed.

RESULTS

The dopamine theory is supported by neuroimaging, genetic and stimulant medication studies, which confirm an inhibitory dopaminergic effect at striatal/prefrontal level. Work in rodents and primates, as well as humans has shown that noradrenergic systems are also important in prefrontal regulation, in particular alpha(2A) noradrenergic agonists have a beneficial effect on cognitive tasks. Neuropsychological studies implicate posterior parietal mechanisms in the orienting of attention. Working memory may require integration of spatial and temporal information, involving anterior and posterior systems.

CONCLUSIONS

Anterior and posterior attention systems are involved in inhibition, working memory and orientation. Attention deficit hyperactivity disorder symptoms and subtypes are likely to reflect deficits in both inhibition and working memory, and may be heterogeneous. While the dopamine theory is supported by genetic and stimulant medication studies, the work of Arnsten and colleagues suggests a potential role for alpha(2) noradrenergic agonists such as guanfacine.

Structural evidence for Ta-tetramerization displacements in the charge-density-wave compound (TaSe4)2I from x-ray anomalous diffraction

We use the anomalous x-ray diffraction technique to investigate the nature of the tantalum displacement pattern in the modulated phase of the charge-density-wave compound (TaSe4)2I. In addition to the known acousticlike modulation, we find the first direct evidence for the condensation of opticlike Ta displacements along the metallic chains corresponding to an LLSS pattern of long and short in-chain Ta-Ta distances (Ta-tetramerization modes). This result confirms a previous model in which the interaction of the electronically coupled optic modes with long-wavelength acoustic shear modes leads to the condensation of a modulation of mixed character.

Genetic trends in a population evolving antibiotic resistance

The evolution of antibiotic resistance provides a well-documented, rapid, and recent example of a selection driven process that has occurred in many bacterial species. An exhaustive collection of Moraxella catarrhalis that spans a transition to chromosomally encoded penicillin resistance was used to analyze genetic changes accompanying the transition. The population was characterized by high haplotypic diversity with 148 distinct haplotypes among 372 isolates tested at three genomic regions. The power of a temporally stratified sample from a single population was highlighted by the finding of high genetic diversity throughout the transition to resistance, population numbers that remained high over time, and no evidence of departures from neutrality in the allele frequency spectra throughout the transition. The direct temporal analysis documented the persistence, antibiotic status, and haplotypic identity of strains undergoing apparent clonal expansions. Several haplotypes that were beta-lactamase nonproducers in early samples converted to producers in later years. Maintenance of genetic diversity and haplotype conversions from sensitive to resistant supported the hypothesis that penicillin resistance determinants spread to a diverse array of strains via horizontal exchange. Genetic differentiation between sample years, estimated by F(ST), was increasing at a rate that could cause complete haplotype turnover in less than 150 years. Widespread linkage disequilibrium among sites within one locus (copB) suggested recent mutation followed by clonal expansion. Nonrandom associations between haplotypes and resistance phenotypes provided further evidence of clonal expansion for some haplotypes. Nevertheless, the population structure was far from clonal as evidenced by a relatively low frequency of disequilibria both within sites at a second locus (M46) as well as between loci. The haplotype-antibiotic resistance association that was accompanied by gradual haplotype turnover is consistent with a hypothesis of genetic drift at marker loci with directional selection at the resistance locus.

Self-assembly of subnanometer-diameter single-wall MoS2 nanotubes

We report on the synthesis, structure, and self-assembly of single-wall subnanometer-diameter molybdenum disulfide tubes. The nanotubes are up to hundreds of micrometers long and display diverse self-assembly properties on different length scales, ranging from twisted bundles to regularly shaped "furry" forms. The bundles, which contain interstitial iodine, can be readily disassembled into individual molybdenum disulfide nanotubes. The synthesis was performed using a novel type of catalyzed transport reaction including C(60) as a growth promoter.

Effects of electric field reduction in visual display units on skin symptoms

OBJECTIVES

This study investigated the facial skin complaints of office workers before and after the static electric fields of a visual display unit were reduced.

METHODS

On the basis of a screening survey of 4556 office workers in 11 companies, 120 of 227 subjects reporting facial skin complaints were randomly selected to this double blind intervention study. Antistatic measures were used to reduce the static electric fields of the visual display unit in the intervention group but not in the control group, which worked with a visual display unit resembling that of the intervention group. Electric fields, dust concentration, health complaints, and psychological behavior tests were recorded before and after the intervention.

RESULTS

The intervention group reported statistically significantly fewer facial skin complaints than the control group. In the intervention group, among those with an office dust concentration of >58 microg/m3, a median reduction of 1.5 skin index points (scale 0-8) was achieved, whereas there was no change in the control group. In the regression model "group category" was still a significant variable after control for background factors. In addition, further linear regression analyses indicated that several static electric field parameters were predictors of the skin complaint reduction.

CONCLUSIONS

This field trial indicates that removing static electric fields from visual display units can probably help reduce the facial skin complaints of workers in offices with high dust concentrations.

Implications for Australia of the multimodal treatment study of children with attention-deficit/hyperactivity disorder

OBJECTIVES

This paper reviews the implications of the large-scale USA Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) by the MTA Cooperative group for planning of clinical services for children with attention deficit hyperactivity disorder in Australia.

METHOD

The MTA study findings of no significant difference between active medication treatment alone, and combined medication combined with behaviour therapy treatments, on core symptom outcomes, are examined. Service traditions, workforce issues, diagnostic and ethical and philosophical considerations are discussed in relation to their impact on service planning in Australia. Implications of pharmacogenomic research are examined. Ethical and philosophical questions are raised in relation to the use of stimulant medications for subthreshold symptoms and for socialization of children.

RESULTS

A critical evaluation of results reveals that combined treatments allow the use of lower medication doses, and that multimodal treatments are effective for comorbid symptoms. Completion of the Human Genome Project promises increasing technological advances. Arguments for and against a technological approach to child rearing are posited.

CONCLUSIONS

The MTA study raises not just service planning questions, but also important ethical and philosophical considerations about optimal degree of medicalization of services in an increasingly technological society. Child psychiatrists will be required to have an understanding of technological developments if they wish to contribute to future debates.

Exercise training with a heart device: a hemodynamic, metabolic, and hormonal study

PURPOSE

The mechanisms of the training-induced improvements in left ventricular assist (LVAD) patients are unknown.

METHODS

We measured the hemodynamic, gas exchange, and metabolic and hormonal effects of 6-wk exercise training in a cardiogenic shock patient who was assisted by an LVAD.

RESULTS

After training, the peak power and VO2 increased by 166% and 56%, respectively (80 W and 16.1 mL x min(-1) x kg(-1)), whereas the ventilatory drive decreased. Although the LVAD output increased little with exercise, the systemic cardiac output rose (adequately for the VO2) from 5.91 and 4.90 L x min(-1) at rest to 9.75 and 9.47 L x min(-1) at peak work rate, before and after training, respectively. Thus, the left ventricle ejected again through the aortic valve. Unloading and/or retraining resulted in a left ventricular filling pressure decrease. Although the right ventricular ejection fraction increased with exercise, it decreased again at the maximal load after training. For a given work rate the arterial lactate, the norepinephrine (NE) and epinephrine (E) concentrations fell after training, but the enhanced maximal work rate elicited higher NE and E concentrations (4396 and 1848 pg x mL(-1), respectively). The lack of right ventricular unloading might have kept the atrial natriuretic peptide higher after training, but the blood cyclic GMP and endothelin were lower after training.

CONCLUSION

In an LVAD patient, retraining returns the exercise capacity to the class III level by peripheral and left ventricular hemodynamic improvements, but the safety of maximal exercise remains to be proven in terms of right ventricular function and orthosympathetic drive.