Intention-to-treat approach to data from randomized controlled trials: a sensitivity analysis

The intention-to-treat (ITT) approach to randomized controlled trials analyzes data on the basis of treatment assignment, not treatment receipt. Alternative approaches make comparisons according to the treatment received at the end of the trial (as-treated analysis) or using only subjects who did not deviate from the assigned treatment (adherers-only analysis). Using a sensitivity analysis on data for a hypothetical trial, we compare these different analytical approaches in the context of two common protocol deviations: loss to follow-up and switching across treatments. In each case, two rates of deviation are considered: 10% and 30%. The analysis shows that biased estimates of effect may occur when deviation is nonrandom, when a large percentage of participants switch treatments or are lost to follow-up, and when the method of estimating missing values accounts inadequately for the process causing loss to follow-up. In general, ITT analysis attenuates between-group effects. Trialists should use sensitivity analyses on their data and should compare the characteristics of participants who do and those who do not deviate from the trial protocol. The ITT approach is not a remedy for unsound design, and imputation of missing values is not a substitute for complete, good quality data.

Properties of Strains of Sweet potato feathery mottle virus and Two Newly Recognized Potyviruses Infecting Sweet Potato in the United States

Some biological and molecular properties of six potyvirus isolates (LSU-1, -2, -3, and -5; 95-2; and 95-6) from sweet potato (Ipomoea batatas) were evaluated. Isolates LSU-1 and -3 and 95-2 were transmitted by Aphis gossypii and Myzus persicae while LSU-2 and -5 were not transmitted by either aphid. The partial nucleotide sequence of the nuclear inclusion b (NIb) and the coat protein (CP) genes of these six isolates were compared with the corresponding sequences of 17 Sweet potato feathery mottle virus (SPFMV) strains and 18 other potyviruses. LSU-1 and -3 had high sequence similarity to the published sequences for Sweet potato virus G (SPVG), did not react with antisera to other known sweet potato viruses, and caused distinct symptoms. We propose to designate these two isolates as SPVG. This report documents the occurrence of this virus in the United States and provides the first characterization of its biological properties. LSU-2 and -5 were distinct in symptomatology; partial Nib, CP nucleotide, and derived amino acid sequence; and serology to other viruses. We propose to call this virus (LSU isolates 2 and 5) Ipomoea vein mosaic virus. The present study revealed a high degree of sequence similarity between 95-6 and the common strain of SPFMV, and between 95-2 and the russet crack strain of SPFMV. Results from this study suggest not only that at least two strains of SPFMV occur in the United States, but that two other potyviruses also are present.

Nondestructive evaluation of explosively welded clad rods by resonance acoustic spectroscopy

A resonance acoustic spectroscopy technique is assessed for nondestructive evaluation of explosively welded clad rods. Each rod is modeled as a two-layered cylinder with a spring-mass system to represent a thin interfacial layer containing the weld. A range of interfacial profiles is generated in a set of experimental samples by varying the speed of the explosion that drives the copper cladding into the aluminum core. Excellent agreement is achieved between measured and calculated values of the resonant frequencies of the system, through appropriate adjustment of the interfacial mass and spring constants used in the wave scattering calculations. Destructive analysis of the interface in the experimental specimens confirms that key features of the interfacial profile may be inferred from resonance acoustic spectroscopy analysis applied to ultrasonic measurements.

Series of incidents of Listeria monocytogenes non-invasive febrile gastroenteritis involving ready-to-eat meats

AIMS

A series of cases and outbreaks of febrile noninvasive gastrointestinal disease involving 31 identified cases was investigated in terms of the numbers and types of Listeria monocytogenes present in the suspect foods (ready-to-eat meats) and clinical samples from cases.

METHODS AND RESULTS

Foods and faecal samples involved in the incidents were tested for the presence and number of L. monocytogenes. Isolates were typed by macrorestriction analysis using pulsed-field gel electrophoresis. The foods contained high levels of L. monocytogenes, in one case 1.8 x 10(7) g-1. Faecal samples contained L. monocytogenes for up to 15 d after the contaminated food was consumed. All isolates from the food and faecal samples were of serotype 1/2 and were indistinguishable from one another by macrorestriction typing.

CONCLUSIONS

It is likely that the meats were contaminated either during their manufacture after they had been cooked or by underprocessing. The long shelf lives on these products would have allowed the contaminating L. monocytogenes to grow to the high numbers measured in this study, causing food poisoning as described.

SIGNIFICANCE AND IMPACT OF THE STUDY

Outbreaks of febrile noninvasive listeriosis are relatively rare. This report adds ready-to-eat meats to the range of foods that have acted as vehicles for such outbreaks.

Viral hepatitis in South African healthcare workers at increased risk of occupational exposure to blood-borne viruses

The prevalence of hepatitis A, B and C antibodies was measured in a group of healthcare workers (HCWs) at increased risk of occupational acquisition of blood-borne viruses (N=402) from a large, urban referral hospital in South Africa. The aims of this study were to determine the immunity of HCWs to these agents and to recommend policy for the protection of HCWs against occupational exposure to viral hepatitis in this country. Race, sex and age were shown to be important factors influencing the presence of hepatitis A (HAV) antibodies. Most black HCWs (96.2%) are protected from HAV infection. Females have significantly higher HAV antibodies compared with males and antibodies increase with increasing age. Hepatitis B antibodies (anti-HBs) were found in 30.6% of HCWs. Anti-HBs levels were significantly associated with a past history of HBV vaccination. However, only a small proportion of HCWs (21.2%) could remember ever being immunized against HBV. For those individuals that did receive HBV vaccination (N=83), the mean number of years since their last vaccine was 6.2 years (SD +/- 3.5). HCV antibodies were found in 1.8% of HCWs at increased risk of occupational exposure. It was not possible to define whether these infections were occupationally acquired but genotyping of the HCV (in two of seven cases) showed genotype 5, the predominant South African genotype. New recommendations for the prevention of viral hepatitis in HCWs in South Africa are made, including pre-employment screening for HAV based on self-selection criteria, universal anti-HBs screening with HBV booster vaccination. HCV recommendations are based on appropriate education of HCWs about this infection and its prevention and a standardized post-exposure testing protocol.

Mutation of N304 to leucine in Streptomyces clavuligerus deacetoxycephalosporin C synthase creates an enzyme with increased penicillin analogue conversion

Superimposition of deacetoxycephalosporin C synthase (DAOCS) and isopenicillin N synthase (IPNS) structures revealed that R74, R160, R266 and N304 are strategically located in the catalytic cavity of Streptomyces clavuligerus DAOCS (scDAOCS) and are crucial for orchestrating different substrates. Substitutions at these sites to a hydrophobic leucine residue were expected to stabilize the hydrophobic substrate bound state. Substantial improvements in the biotransformation of penicillin G, ampicillin and amoxicillin to their respective cephalosporin moieties were observed using the N304L mutant scDAOCS. Thus, our results have demonstrated the enhancement of scDAOCS activity via critical computational analysis and site-directed mutagenesis of endogenous ligands.

Nurses' perceptions of physiotherapists as rehabilitation team members

OBJECTIVE

To investigate nurses' perceptions of physiotherapists as members of the rehabilitation team. This study arose from the current emphasis that is placed on good multidisciplinary teamwork for effective rehabilitation and the awareness that different team members often have different perceptions of their respective roles within the team.

DESIGN

Semi-structured interviews, the results of which were then subject to content analysis.

SETTING AND SUBJECTS

Experienced rehabilitation nurses in two rehabilitation wards within a National Health Service Trust.

RESULTS

Nurses perceived the role of physiotherapists as being concerned with mobility and movement, and valued the therapists' knowledge and skills in these areas. They felt, however, that physiotherapists had insufficient understanding of the demands and pressures of nursing practice and lacked recognition of the nurses' professional autonomy in decision-making in rehabilitation. Nurses viewed nursing and physiotherapy as two quite distinct and different roles within rehabilitation, despite some role overlap. Physiotherapy was perceived as specific and measurable, while nursing was perceived as generalized and undefined. These perceptions extended to their views on patient-staff interactions and organizational structures. Some of the differences, such as organizational structures, created barriers to rehabilitation. Others, such as physiotherapy expertise in mobility, were valued for their contribution to rehabilitation. Areas were identified where the two professions can assist each other in professional skills.

CONCLUSION

Nurses valued the role and contribution of physiotherapists, but identified areas in which barriers existed to effective interprofessional working, particularly in relation to organizational factors and interprofessional relationships.

The effect of introduction of universal childhood hepatitis B immunization in South Africa on the prevalence of serologically negative hepatitis B virus infection and the selection of immune escape variants

The effect of universal hepatitis B vaccination on the prevalence of serologically negative hepatitis B virus infection (HBV) and the emergence of HBsAg variants is unknown. We prospectively studied two different cohorts of 12--24 month old children in South Africa. They consisted of the unvaccinated children (n=459) born before the introduction of universal vaccination and the vaccinated children (n=1213) between 1 and 2 years after the introduction of the vaccination program. The frequency of detecting HBV DNA by PCR was reduced from 6.5% in unvaccinated children to 0.3% in vaccinated children (P<0.00001). There were no unique amino acid substitutions within the major hydrophilic region of the S sequence in both pre- and post-vaccination samples. Universal childhood vaccination reduced the frequency of serologically negative HBV infection and did not necessarily lead to selection of escape variants.

Differential assembly of rat purinergic P2X7 receptor in immune cells of the brain and periphery

ATP-gated P2X(7) purinoceptors are found in most immune cells of the periphery and the brain where their activation leads to multiple downstream events such as cell permeabilization, apoptosis, and/or cytokine release. P2X(7) receptors do not form heteromeric receptors with any of the other six P2X subunits, and it is not known what type of homomeric assemblies the P2X(7) subunit makes. We constructed and purified an ectodomain protein of the rat P2X(7) receptor (amino acids 60-323) and used this to generate a monoclonal antibody (Ab) with which to probe P2X(7) receptors in central and peripheral immune cells. In HEK cells expressing rat P2X(7) receptors, the Ab increased the maximum current evoked by BzATP by 3-8-fold with a 5-fold leftward shift in EC(50) concentration. This Ab recognized only a non-denatured, multimeric form of the receptor on blue native-PAGE but did not recognize the denatured form on SDS-PAGE. A C-terminal polyclonal P2X(7) Ab recognized both monomeric subunits on SDS-PAGE and a multimeric complex on blue native-PAGE in this heterologous expression system. With Western blotting using these two Abs, native P2X(7) receptors in peritoneal macrophage and bone marrow cells are shown to exist as a strongly bound multimeric complex, whereas P2X(7) receptors in brain glia and/or astrocytes appear to form only as monomeric subunits.

The invariant F283 and its strategic position in the hydrophobic cleft of Streptomyces jumonjinensis isopenicillin N synthase active site are functionally important

Isopenicillin N synthase (IPNS) and related non-haem iron-binding enzymes including deacetoxycephalosporin C synthase (DAOCS) are proposed to have structurally similar active centers. Sequence alignment and computational structural analyses of predicted structures revealed 11 highly conserved hydrophobic amino acid residues in 134 IPNS-related enzymes form a contiguous hydrophobic patch in the IPNS active center, wherein F283 is strategically positioned. The investigation of single and double mutations at F283, adjacent (L284) and proximal sites (N285 and S216) of Streptomyces jumonjinensis IPNS advocate the explicit importance of the phenyl ring at position 283. A similarly placed phenylalanine (F264) in DAOCS was found to be also crucial for its enzyme activity.

Inhaled corticosteroids decrease vascularity of the bronchial mucosa in patients with asthma

BACKGROUND

Increased vascularity in airway mucosa is a distinctive feature of airway remodelling in asthma. While corticosteroids have proved most effective in modifying airway inflammation, the effect of inhaled corticosteroids on increased airway mucosal vascularity in asthmatics has been little studied.

OBJECTIVE

We examined the effect of inhaled corticosteroid on airway vascularity in bronchial biopsy specimens taken from asthmatic patients.

SUBJECTS AND METHODS

We studied bronchial biopsies from 28 asthmatic patients before and after treatment with inhaled beclomethasone dipropionate (BDP) 800 microg/daily, or placebo, for 6 months in a double-blind manner. Biopsy specimens were evaluated for number of vessels and percentage of area occupied by vessels, using computerized image analysis after staining for type IV collagen in vessel walls. Specimens were also examined for extent of collagen III in the subepithelial basement membrane. In addition, we compared asthmatic specimens with biopsy specimens taken from non-asthmatic control subjects.

RESULTS

There was a significant increase in number of vessels (P < 0.01) and percent vascularity (P < 0.001) in the submucosa of asthmatic patients compared with control subjects. After 6 months of treatment, we observed significant improvements in forced expiratory volume in 1 s (FEV1), FEV1% and airway responsiveness (P < 0.05, each) in the BDP treatment group compared with the placebo group. This was accompanied by significant decreases in both vessel number and percent vascularity in the airways of BDP-treated patients (P < 0.05, each). We also observed a significant correlation between change in percent vascularity and change in collagen III thickness in the BDP-treated patients (rs = 0.90, P < 0.001). Furthermore, the change in percent vascularity was inversely correlated with both FEV1 (rs = -0.49, P < 0.05) and airway responsiveness (rs = -0.36, P < 0.05).

CONCLUSION

These findings suggest that inhaled corticosteroid treatment of asthma reduced airway wall vascularity during airway remodelling.

'You'll never walk alone': CCTV surveillance, order and neo-liberal rule in Liverpool city centre

This paper is concerned to chart the establishment and uses of CCTV within the location of Liverpool city centre. In doing this the paper seeks to contextualize CCTV within contemporary 'partnership' approaches to regeneration which are reshaping the material and discursive form of the city. Thus CCTV schemes along with other security initiatives are understood as social ordering strategies emanating from within locally powerful networks which are seeking to define and enact orderly regeneration projects. In focusing on the normative aspects of CCTV, the paper raises questions concerning the efficacy of understanding contemporary forms of 'social ordering practices' primarily in terms of technical rationalities while neglecting other, more material and ideological processes involved in the construction of social order.

Confidentiality within physiotherapy: perceptions and attitudes of clinical practitioners

OBJECTIVES

This study examined the issue of confidentiality in relation to i) undergraduate curriculum content in physiotherapy, and ii) the awareness, experiences and attitudes of clinical physiotherapists.

DESIGN

Postal survey of universities and focus group interviews with physiotherapists.

SETTING

Twenty-five universities in the UK and Ireland and 44 therapists in five hospitals in southern England.

RESULTS

The survey of universities indicated that legal and ethical aspects of confidentiality featured in virtually all preregistration courses that responded. However, whereas its inclusion was rated as extremely important, the degree of coverage of confidentiality varied considerably between courses. Within the focus groups, 35 informants recollected coverage of confidentiality in their preregistration education, and 12 in postregistration in-service training; in neither case was this coverage in great detail. Informants identified environmental factors and working practices as barriers to preserving confidentiality. Disclosure to others also gave rise to difficulties. Informants were only aware in general terms of the relevant sections of the Chartered Society of Physiotherapy's Rules of Professional Conduct.

CONCLUSIONS

Aspects of hospital-based physiotherapy practice were seen to create specific problems in relation to confidentiality. More detailed sources of education and guidance on this issue appear to be required.

Whitefly Transmission of Sweetpotato chlorotic stunt virus

The genus Crinivirus of the plant virus family Closteroviridae include members that are bipartite and whitefly-transmitted (2). The Crinivirus, Sweetpotato chlorotic stunt virus (SPCSV), was described from sweetpotato (Ipomoea batatas) in Nigeria (1). Vector transmission studies of SPCSV were conducted using two whitefly species, the sweetpotato whitefly (Bemisia tabaci biotype B) and the bandedwinged whitefly (Trialeurodes abutilonea). Whitefly colonies were reared in the laboratory on cotton plants in plexiglass cages. To evaluate transmission efficiency, single whiteflies were used in all experiments. Whiteflies were given 2-day acquisition access periods on I. batatas cv. White Bunch co-infected with SPCSV and Sweetpotato feathery mottle virus (SPFMV). Single whiteflies were then placed on individual healthy I. nil cv. Scarlet O'Hara seedlings for 2-day inoculation access periods. Plants then were sprayed with imidacloprid insecticide and placed in the greenhouse. Four independent tests were performed with each whitefly species. Seven to 10 days after exposing test plants to B. tabaci, 6 of 35, 4 of 28, 5 of 30, and 3 of 25 I. nil plants showed symptoms that consisted of leaf distortion and yellowing. In similar experiments conducted with T. abutilonea, 1 of 33, 0 of 32, 1 of 30, and 2 of 28 I. nil plants showed symptoms. Two weeks after inoculations, reverse transcription- polymerase chain reaction assays were performed with all 22 symptomatic and five randomly selected symptomless plants using primers that amplify the SPCSV heat shock protein 70 (HSP70) homolog gene fragment (446 bp). All 22 symptomatic plants were positive while the five symptomless plants tested were negative. Lower transmission rates were obtained with T. abutilonea (3.2%) when compared with B. tabaci (15.2%). These two whiteflies are present in sweetpotato fields in Louisiana and may play an important role in the spread of SPCSV. This represents the first report of transmission of SPCSV by the bandedwinged whitefly References: (1) S. Winter et al. Phytopathology 82:869-875, 1992. (2) G. C. Wisler et al. Plant Dis. 82:270-280, 1998.

Ratings of perceived exertion in braille: validity and reliability in production mode

OBJECTIVES

(a) To assess the validity and reliability of producing and reproducing a given exercise intensity during cycle ergometry using a braille version of Borg's standard 6-20 rating of perceived exertion (RPE) scale, and (b) to determine whether the exercise responses of blind participants, at a given produced RPE, were similar to those reported in recognised guidelines for sighted subjects.

METHODS

Ten healthy registered blind volunteer participants (four women, six men; mean (SD) age 23.2 (9.0) years) performed an initial graded exercise cycle test to determine maximal heart rate (HRMAx) and maximal oxygen uptake (VO2MAX). Three trials of three exercise bouts at RPEs 9, 11, and 13 were then performed in random order on three separate days of the same week, with expired air and heart rate measured continuously. Each exercise bout was followed by 10 minutes of rest. The validity of the scale as a means of producing different exercise intensities was assessed using a two factor (RPE x trial) repeated measures analysis of variance. Intertrial reliability was assessed using intraclass correlation coefficients (ICC) and the bias +/-95% limits of agreement (95%LoA) procedure.

RESULTS

Participants reported no difficulty in using the braille RPE scale. When asked to produce exercise intensities equating to RPE 9, 11, and 13, they elicited mean %VO2MAX values of 47%, 53%, and 63% respectively. Analysis of variance showed no significant differences in either %HRMAx or %VO2MAX between trials at each of the three RPEs, but there was a significant difference (p<0.001) in both %HRMAx and %VO2MAX between the three RPE levels. All pairwise comparisons of the three different RPEs were significantly different (p<0.016). The ICC between the second and third trial for %HRMAx was significant (p <0.05) for all three RPEs. Similarly for %VO2MAX, the ICC was significant for RPE 9 and 11 but not 13. The 95%LoA decreased for both %HRMAx and %VO2MAX with each successive trial.

CONCLUSIONS

Blind participants were successful in using a braille RPE scale to differentiate exercise intensity on a cycle ergometer. In every trial at RPE 13, all participants achieved %HRMAX and %VO2MAX levels, which fell within the recommendedrange for developing cardiorespiratory fitness. Using %HRMAx as a judge of intertrial reliability, the participants were able to repeat similar exercise intensities after two trials at each of the three RPEs (9, 11,13). The same was true for RPE 9 and 11, when %VO2MAX was used as a judge, but further trials were required to achieve similar reliability at RPE 13. A braille RPE scale can be used by healthy blind people during cycle ergometry, with similar effect to the visual analogue scale recommended for use in healthy sighted people.

Improving return-to-work strategies in the United States disability programs, with analysis of program practices in Germany and Sweden

The General Accounting Office (GAO) has made recommendations for improving the disability programs by citing practices that have been successful in Germany, Sweden, and the private sector. This issue is important in the United States because the number of disability beneficiaries is growing rapidly, program costs are increasing proportionately, and few disability recipients are leaving the disability rolls to resume work activity. GAO points out that the estimated lifetime savings for removing an additional 1 percent of the disabled beneficiaries from the rolls of the Disability Insurance (DI) and the Supplemental Security Income (SSI) programs each year will ultimately reach $3.0 billion. GAO cites three specific practices as showing the most promise for returning the disabled to work. They are (1) intervening as soon as possible after a disabling event to promote and facilitate return to work, (2) identifying and providing necessary return-to-work assistance and managing cases to achieve return-to-work goals, and (3) structuring cash and health benefits to encourage people with disabilities to return to work. This article examines these suggestions to improve the rate of rehabilitation of disabled workers using research by experts on return-to-work practices in Germany, Sweden, and the United States. Experts caution that any consideration of borrowing practices from other countries needs to take into account the unique economic, social, and political elements in each country. Although other countries appear to be very successful in their rehabilitation programs, practices that are successful in one country may not necessarily work well in another. Countries have different definitions of disability and payment structures. The existence of temporary and partial awards in Germany and Sweden may ensure a number of easily rehabilitated individuals, while the U.S. vocational rehabilitation (VR) agencies have been mandated to focus on only the most severely disabled individuals. Public expenditures for vocational rehabilitation, work for the disabled, and disability benefits are much higher as a percentage of gross domestic product in Germany and Sweden than they are in the United States. Compared with the United States, Germany spent twice as much for VR, and Sweden spent 2.6 times more. Impediments to GAO's suggestions include divergent goals of the Social Security program and VR agencies, lack of availability of VR services, the timing of VR referral (which is significantly later than the onset of the disability), and little incentive for return to work built into the payment structure. The Work Incentives Improvement Act of 1999 is currently being considered by a Congressional conference committee. The bill would establish a Ticket to Work and Self-Sufficiency program and would require or authorize the Social Security Administration to demonstrate and evaluate different ways of encouraging return to work. In designing these demonstrations, early intervention after a potentially disabling illness or injury is an approach that merits serious attention.

Mutational evidence supporting the involvement of tripartite residues His183, Asp185, and His243 in Streptomyces clavuligerus deacetoxycephalosporin C synthase for catalysis

Deacetoxycephalosporin C synthase (DAOCS) is a non-heme iron-binding and alpha-ketoglutarate dependent enzyme involved in catalyzing the biosynthesis of cephalosporins and cephamycins, antibiotics more potent than penicillins. In the crystal structure complex of Streptomyces clavuligerus DAOCS (scDAOCS), it was proposed that histidine-183, aspartate-185, and histidine-243 are putative iron-binding ligands. However, coordinates proposed for crystal structures of proteins may not definitely comply with catalysis. Hence, site-directed mutagenesis was done to replace each of these amino acid residues with leucine. The constructed expression vectors bearing the mutations were found to express the respective scDAOCS mutant enzymes at high levels in Escherichia coli BL21(DE3). Through enzymatic assays, it was shown that while the wildtype enzyme could convert penicillin to a more active cephalosporin, the substitution of the three proposed iron-binding sites of scDAOCS completely abolished the same activity in the respective mutant enzymes. Thus, these results clearly indicate that histidine-183, aspartate-185, and histidine-243 of scDAOCS are essential for the ring expansion activity.

First Report on Natural Occurrence of Tomato Spotted Wilt Tospovirus in Basil (Ocimum basilicum)

Virus-like symptoms were observed on basil plants (Ocimum basilicum L. 'Mrs. Burns Lemon' [MBL]) growing in containers and a demonstration plot at the Louisiana State University Burden Research Plantation, Baton Rouge, during July 1998. Symptoms consisted of ring spots, leaf distortion, and severe mosaic. Mechanical transmission of the suspect virus by sap inoculation from infected MBL to basil cvs. MBL, Aussie Sweet, Cinnamon, Siam Queen, and Sweet Dani was successful. Symptoms were similar to those on infected MBL. Nicotiana benthamiana Domin. reacted with local chlorotic spots followed by severe yellows, necrosis, and death. Electron microscopy of thin sections of infected basil revealed virus inclusions but no virus particles. However, infected N. benthamiana revealed the presence of 82-nm membrane-bound particles in the cytoplasm. The virus was identified from basil and N. benthamiana as the common strain of tomato spotted wilt tospovirus (TSWV) by enzyme-linked immunosorbent assay (Agdia, Elkhart, IN). An outbreak of thrips insects during the summer drought in 1998 was probably responsible for the occurrence of TSWV in basil. This is the first report of the occurrence of TSWV in basil (1). Reference: (1) A. A. Brunt et al., eds. 1996. Plant Viruses Online: Descriptions and Lists from the VIDE Database. Published online by Australian National University, Canberra.

Physical and other non-pharmacological interventions for fibromyalgia

There is little empirical evidence for the effectiveness of physical and other non-pharmacological approaches to the management of fibromyalgia. Although a number of studies have been conducted into such approaches, many of these are uncontrolled, and relatively few randomized controlled trials of appropriate size and methodological rigour have been carried out. This chapter provides an overview of the evidence available under the following headings: exercise, EMG biofeedback training, electrotherapy and acupuncture, patient education and self-management programmes, multimodal treatment approaches, and other interventions. It is hard to reach firm conclusions from the literature, owing to the variety of interventions that have been evaluated and the varying methodological quality of the studies concerned. Nonetheless, in terms of specific interventions, exercise therapy has received a moderate degree of support from the literature, and has been subjected to more randomized studies than any other intervention. In contrast, there is little or no evidence available for most types of electrotherapy. In terms of overall management strategies, a multimodal programme of management, including physical, psychological and educational components and delivered in a multidisciplinary setting, has gained some support from descriptive and experimental studies, and accords with current understanding of the aetiology and clinical features of fibromyalgia. There is a clear need for further systematic evaluation of the effectiveness of non-pharmacological treatment approaches in fibromyalgia.

Inhaled corticosteroids decrease subepithelial collagen deposition by modulation of the balance between matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 expression in asthma

BACKGROUND

Bronchial asthma is characterized by airway wall remodeling. Matrix metalloproteinases (MMPs) are members of a family of proteolytic enzymes that degrade the extracellular matrix and that restrain the effects of their tissue inhibitors (TIMPs). Treatment with inhaled corticosteroids may prevent airway remodeling in asthma. However, the effects of corticosteroid treatment on MMPs and TIMPs in asthma are unknown.

OBJECTIVE

We examined the effects of inhaled beclomethasone dipropionate (BDP) on the expression of MMP-9 and TIMP-1 and subepithelial collagen deposition in bronchial biopsy specimens from 30 subjects with asthma.

METHODS

Inhaled BDP, 800 microg daily, or placebo was administered for 6 months in a double-blind, parallel-group study, and bronchial biopsies were performed before and after treatment. Biopsy specimens were examined for extent of collagen type III in the subepithelial basement membrane by means of immunohistochemistry, and expression of both epithelial and submucosal MMP-9 and TIMP-1 was quantitated. Numbers of inflammatory cells were also determined.

RESULTS

We observed significant decreases in collagen type III deposition (P <.01) and the expression of submucosal MMP-9 (P <.01) and a significant increase in the expression of submucosal TIMP-1 (P <.05) in the BDP group. Significant correlations were found between the subepithelial collagen type III deposition and epithelial (r (s ) = 0.37, P <.05) and submucosal expression of MMP-9 (r (s ) = 0.47, P <.01). Additionally, the number of many inflammatory cells and myofibroblasts in airway mucosa were significantly decreased in the BDP group.

CONCLUSION

Our findings suggest that corticosteroid treatment of asthma can reduce subepithelial collagen deposition by downregulation of MMP-9 expression and upregulation of TIMP-1 expression.

Preimmunization epidemiology of hepatitis B virus infection in South African children

The prevalence of hepatitis B surface antigen (HBsAg) was determined in a community-based, cross-sectional, age-stratified sample of children from 0 to 6 years of age (n = 2,299) from the Eastern Cape Province of South Africa. The purpose of the study was to investigate the epidemiology and the age of acquisition of hepatitis B virus (HBV) infection in children, thus providing a preimmunization baseline measure of this infection in the population targeted for HBV immunization in South Africa. Overall, 10.4% (95% CI, 9.2-11.7) of the children tested were HBsAg-positive. There was a high rate of positivity in the 0-6- and 7-12-month age groups at 8.1% (95% CI, 5.5-11.7) and 8.9% (95% CI, 6.1-12.7), respectively, suggesting a higher rate of early acquisition of this infection than previously reported in South Africa. The proportion of HBsAg-positive children increased significantly with increasing age (chi2trend = 5.9, df = 1, P = 0.02), reaching 15.7% in the 61-72-month age group. This is the highest rate of HBV infection reported in community-based children from South Africa, indicating a significant burden of this infection. The difference in HBsAg prevalence between urban and rural children was not statistically significant (chi2 = 0.32, df = 1, P = 0.57). There was also no difference in positivity between males (10.5%; 95% CI, 8.7-12.5) and females (9.8%; 95% CI, 8.1-11.7), (chi2 = 0.006, df = 1, P = 0.94). This study provides the most recent preimmunization, community-based baseline investigation of the epidemiology of HBV infection in children targeted for universal immunization in South Africa.

Treatment options for regional musculoskeletal pain: what is the evidence?

Decisions about the best treatment options for patients with regional musculoskeletal pain must be made despite a lack of clear diagnostic criteria, an absence of robust outcome measures by which to assess response, and a paucity of evidence from high-quality randomized controlled trials. Although the randomized controlled trial is considered to be the 'gold standard' research design, it does not lend itself easily to the evaluation of all management strategies. This chapter explores these issues from a research perspective and reviews the various types of evidence available to help practitioners make informed decisions. The current evidence from systematic reviews in this area is summarized in the final part of the chapter.

Effect of AA-2414, a thromboxane A2 receptor antagonist, on airway inflammation in subjects with asthma

BACKGROUND

Asthma is a chronic inflammatory disease of the airways. The chemokines are potent chemoattractants for eosinophils and other types of cells associated with allergic inflammation. AA-2414, a new thromboxane A2 receptor antagonist, reduces bronchial hyperresponsiveness in asthmatic subjects, but its mechanism of action is unclear.

OBJECTIVE

We tested the hypothesis that the beneficial effects of AA-2414 in asthma result from reduction in the number of inflammatory cells infiltrating the airway associated with inhibition of chemokine release.

METHODS

We studied bronchial biopsy specimens from 31 asthmatic subjects before and after oral treatment with AA-2414 (80 mg/day) or matched placebo for 4 months in a double-blind manner. Biopsy specimens were examined by immunohistochemistry. Each subject recorded symptom score and peak expiratory flow (PEF). Lung function and bronchial responsiveness to methacholine were measured before and after treatment.

RESULTS

After treatment, significant improvements in symptom score (P <.05), PEF (P <.01), diurnal variation of PEF (P <.01), and bronchial responsiveness (P <.01) were observed in the AA-2414 group compared with the placebo group. These improvements were accompanied by a significant decrease in the number of submucosal EG2(+) eosinophils (P <.05). There was also a reduction in the number of cells expressing RANTES (P <.05) and macrophage inflammatory protein (MIP)-1alpha (P <.05) in the epithelium and of cells expressing monocyte chemotactic protein-3 (P <.01), RANTES (P <.05), MIP-1alpha (P <.01), and eotaxin (P <.01) in the submucosa in the AA-2414 treatment group. A significant correlation was found between the number of EG2(+) eosinophils and numbers of monocyte chemotactic protein-3(+) (rs = 0.52, P <.005), MIP-1alpha+ (rs = 0.34, P <.05), and eotaxin+ cells (r s = 0.47, P <.01) in the submucosa. There was a significant negative correlation between the increase in bronchial responsiveness and the change in number of submucosal EG2(+) cells (rs = -0.65, P <.001).

CONCLUSIONS

These findings suggest that AA-2414 treatment of patients with asthma may inhibit activated eosinophil infiltration in part by modulating the expression of chemokines in bronchial tissues.

Statistical Inference by Confidence Intervals: Issues of Interpretation and Utilization

This article examines the role of the confidence interval (CI) in statistical inference and its advantages over conventional hypothesis testing, particularly when data are applied in the context of clinical practice. A CI provides a range of population values with which a sample statistic is consistent at a given level of confidence (usually 95%). Conventional hypothesis testing serves to either reject or retain a null hypothesis. A CI, while also functioning as a hypothesis test, provides additional information on the variability of an observed sample statistic (ie, its precision) and on its probable relationship to the value of this statistic in the population from which the sample was drawn (ie, its accuracy). Thus, the CI focuses attention on the magnitude and the probability of a treatment or other effect. It thereby assists in determining the clinical usefulness and importance of, as well as the statistical significance of, findings. The CI is appropriate for both parametric and nonparametric analyses and for both individual studies and aggregated data in meta-analyses. It is recommended that, when inferential statistical analysis is performed, CIs should accompany point estimates and conventional hypothesis tests wherever possible.

Prevalence of hepatitis C virus antibodies and genotypes in asymptomatic, first-time blood donors in Namibia

Reported is the prevalence of hepatitis C virus (HCV) in Namibia as determined using a third-generation enzyme-linked immunosorbent assay (ELISA) on samples of blood collected from all asymptomatic, first-time blood donors between 1 February and 31 July 1997 (n = 1941). The HCV seroprevalence was 0.9% (95% confidence interval (CI): 0.5-1.5%) and no associations were detected between a positive HCV serostatus and the person's sex, region of residence, or previous hepatitis B exposure or hepatitis B carrier status, as determined by hepatitis B surface antigen (HBsAg). The only significant association in a logistic regression model was an increase in HCV positivity with increasing age (P = 0.04). Viral RNA was amplified from 2 out of 18 (11.1%) specimens that were ELISA positive. Genotyping of these specimens, by restriction fragment length polymorphism (RFLP), showed the presence of genotypes 5 and 1a. The positive predictive value of using HBsAg positivity as a surrogate screening marker for HCV in Namibian blood donors was poor (1.6%), with low sensitivity (16.7%) and specificity (89.3%), and detecting only 3 out of 18 serologically HCV-positive specimens. The results of this first study of the prevalence and epidemiology of HCV infection in Namibia suggest that donor blood should be screened for HCV by ELISA in order to prevent the transmission of hepatitis C virus.

Detection of a Geminivirus Infecting Sweet Potato in the United States

In 1994, a sweet potato sample showing leaf curl symptoms was collected from the field in Louisiana. When graft-inoculated, Ipomoea nil cv. Scarlett O'Hara reacted with severe leaf distortion and chlorosis symptoms. I. aquatica reacted with a bright yellow mottle. The virus isolated was designated the United States isolate of sweet potato leaf curl virus (SPLCV-US). It was transmitted to I. nil by the sweet potato whitefly, Bemisia tabaci biotype B. DNA probes prepared with component A of pepper Huasteco geminivirus, with an isolate of bean golden mosaic geminivirus from Guatemala, with an isolate of tomato mottle geminivirus from Florida, and with an isolate of tomato yellow leaf curl geminivirus from the Dominican Republic (TYLCV-DR) hybridized with a 2.6-kb DNA band present in DNA extracts from plants infected with SPLCV-US. Probes prepared with the B component of these geminiviruses did not hybridize with these DNA extracts. We were unable to amplify SPLCV-US DNA products by polymerase chain reaction (PCR) in quantities that could be visualized by ethidium bromide staining. However, Southern blots from amplifications with primers AV494/AC1048 revealed PCR products of approximately 600 bp and 550 bp when hybridized with the TYLCV-DR probe. These results were consistently obtained from infected I. cordatotriloba and less consistently from I. aquatica or I. setosa. Fibrillar inclusions were occasionally seen, and granular aggregates of viruslike particles were observed in the nucleus of infected I. cordatotriloba. These results suggest that the virus isolated from sweet potato with leaf curl symptoms belongs to the geminivirus group.

[Rheumatoid nodule diagnosed by thoracoscopy using flexible fiberoptic bronchoscope]

A 51-year-old man had been treated at a nearby hospital since 1993 for rheumatoid arthritis. Right pectoralgia developed in December 1994, and the patient consulted a nearby hospital, which detected right pleural effusion retention was pointed out on chest x-ray films. The patient was referred and admitted to our hospital. Rheumatic pleurisy was suspected because of a high serum rheumatoid factor(RF)level and high RF and high rheumatoid arthritis hemagglutination levels in the pleural effusion. However, due to a high adenosine deaminase level in the pleural effusion tuberculous pleurisy could not be ruled out. After drainage through a trocar catheter, the thoracic cavity was examined by thoracoscopy through the site of catheter insertion. As a result, sporadic bluish white nodular lesions were observed on the pleura. Granuloma formations presenting a palisade arrangement of giant cells were also observed, and pathologically diagnosed as rheumatoid nodules, thus providing the basis for a diagnosis of rheumatic pleurisy. Treatment with an increased dose of prednisolone achieved a rapid remission of the pleural effusion. Our experience underscored the usefulness of thoracoscopy as a means diagnosing of rheumatic pleurisy.

Bronchial subepithelial fibrosis and expression of matrix metalloproteinase-9 in asthmatic airway inflammation

BACKGROUND

Bronchial asthma is characterized by airway structural changes, including mucosal inflammation and subepithelial collagen deposition. An imbalance between the matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) is thought to play a critical role in the synthesis or degradation of the extracellular matrix of the airway architecture. However, the relationship between subepithelial basement membrane thickness and these enzymes in asthma has not been determined.

OBJECTIVE

We compared the thickness of collagen and tenascin deposition and the expression of MMP-9 and TIMP-1 in bronchial biopsy specimens from subjects with asthma and control subjects.

METHODS

Bronchial biopsy specimens were obtained from 25 subjects with asthma and 10 healthy control subjects to estimate the extent of collagen and tenascin deposition in subepithelial reticular basement membrane by immunohistochemical staining. Using a computer-assisted image analysis system, we quantitated expression of both epithelial and submucosal MMP-9 and TIMP-1. The numbers of inflammatory cells were also determined.

RESULTS

Subjects with asthma exhibited greater thickness of collagen III (P <.01), collagen V (P <.01), and tenascin (P <.01) deposition in reticular basement membrane than did control subjects. The proportions of epithelium and submucosa immunoreactive to MMP-9 and TIMP-1 were significantly higher in the subjects with asthma than in the control subjects (each P <.001). Submucosal expression of MMP-9 was significantly higher than that of TIMP-1 in subjects with asthma (P <.01). Significant correlations were found between the number of myofibroblasts and thicknesses of collagen III (rs = 0. 70, P <.001), collagen V (rs = 0.67, P <.001), and tenascin (rs = 0. 58, P <.01) in subjects with asthma. On the other hand, the number of eosinophils was correlated with degree of mucosal expression of MMP-9 (rs = 0.43, P <.05) and TIMP-1 (rs = 0.69, P <.001). In subjects with asthma, a significant inverse correlation was found between subepithelial fibrosis and FEV1 (type III collagen, rs = -0. 89, P <.001; type V collagen, rs = -0.90, P <.001; tenascin, rs = -0. 88, P <.001), and airway responsiveness (type III collagen, rs = -0. 59, P <.01; type V collagen, rs = -0.47, P <.05; tenascin, rs = -0. 48, P <.05).

CONCLUSION

These findings suggest that collagen III, collagen V, and tenascin deposition in basement membrane in subjects with bronchial asthma are associated with increased expression of MMP-9, which may be produced by eosinophils, and that airway remodeling in subjects with asthma may be related to air-flow obstruction and airway hyperresponsiveness.

A survey of UK manual therapists' practice of and attitudes towards manipulation and its complications

BACKGROUND AND PURPOSE

Little is known about the practice of manipulation by UK physiotherapists. This study was conducted to discover current practice of, and attitudes towards, manipulation among UK manipulative therapists.

METHODS

A postal questionnaire was sent to 300 UK manipulative therapists who were members of two professional associations representing differing approaches to manual therapy: the Society of Orthopaedic Medicine (SOM) and the Manipulation Association of Chartered Physiotherapists (MACP).

RESULTS

A 50% response rate was achieved and 129 respondents identified themselves as 'users' of manipulation. Anxiety about possible complications was a prominent reason adduced by 'non-users' and 'partial users' for their avoidance of manipulative procedures. The thoracic spine was the region most often manipulated, followed by the lumbar spine. Nineteen per cent of users had encountered complications from manipulation, which were most common in the cervical region and were predominantly non-serious. The majority of SOM members and a minority of MACP members used generalized cervical rotary manipulations--thought by some to be potentially dangerous. Attitudes to manipulation were generally positive, although overall respondents were uncertain as to whether its benefits outweighed its risks. Members of the SOM emerged as more frequent users of manipulation and as less conservative in their attitudes to certain aspects of manipulation.

CONCLUSIONS

Allowing for possible under-reporting or other response biases, spinal manipulation emerged as a relatively safe and widely practised technique among this sample.

Growth of preterm infants with cystic periventricular leukomalacia

Etiology of the high rates of growth failure in children with cerebral palsy (CP) remains unclear. The purpose of this study was to evaluate the relation between growth failure in preterm infants with cystic periventricular leukomalacia (CPVL) and neonatal health complications. The population consisted of all preterm infants (51) with a gestational age of <33 weeks who were admitted to the Children's Hospital of Buffalo from 1988 to 1993 and who had CPVL. Out of the 41 survivors with CPVL who were followed, 39 developed CP and 18 developed growth failure during infancy. At the time of greatest growth failure, the majority (72%) of infants had signs of undernutrition as defined by the Waterlow (1972) classification. Oral feeding impairment was the sole risk factor for the occurrence of growth failure. Undernutrition appears to be important in the occurrence of growth failure in preterm infants with CPVL and CP.

Collecting and analysing qualitative data: issues raised by the focus group

The focus group has gained considerable popularity as a means of gathering qualitative data in nursing research. This paper examines some of the methodological issues raised by the collection and analysis of focus group data. In respect of data collection, the role of the focus group moderator and the method of recording data are crucial considerations. In particular, the moderator's personal skills and attributes have a considerable influence on the nature and quality of the data gathered. When analysing the data, three principal issues arise. First, it is difficult, and probably misguided, to attempt to infer an attitudinal consensus from focus group data. An apparent conformity of view is an emergent property of the group interaction, not a reflection of individual participants' opinions. Second, measuring strength of opinion from focus group data is problematic. The indicators used to measure attitudes in orthodox survey research are largely inapplicable to the context of focus groups. When comparing data from different focus groups, inferences may be drawn as to the presence of absence of certain views or issues across groups, but not in terms of their relative strength. Third, both methodological and epistemological objections can be raised against attempts to generalize from focus group data. Theoretical generalization is likely to be more feasible than empirical generalization, and if the latter is considered fruitful, it is likely to be of a provisional nature. The effective use of focus groups as a means of gathering qualitative data in nursing research requires due attention to problematic methodological issues such as those explored in this paper.

GB virus C prevalence in blood donors and high risk groups for parenterally transmitted agents from Gauteng, South Africa

The prevalence of GBV-C infection in voluntary blood donors and in groups at high risk for parenteral exposure to infectious agents was studied. The high risk groups included chronic renal failure patients on haemodialysis, renal transplant patients and haemophiliacs from Gauteng. The presence of GBV-C RNA in these populations was determined using reverse transcription polymerase chain reaction (RT-PCR) in the 5' non-coding region (NCR) of the virus. Of the blood donors, 11.1% (95% CI 7.6, 15.8) were positive, whereas 23.8% (95% CI 12.6, 40.2) of haemodialysis patients and 23.5% (95% CI 15.9, 33.3) of the haemophiliacs were infected with GBV-C. The highest proportion of infection was in the renal transplant patients, where 41.2% (95% CI 35.1, 47.7) were found to have circulating GBV-C RNA. Serological markers for hepatitis B (HBV) and hepatitis C viruses (HCV) were also measured as indicators of other hepatitis viruses with important parenteral transmission routes. Of the GBV-C positive blood donors, 3.6% were also HBsAg positive and none were positive for HCV. The GBV-C positive patients on haemodialysis were not positive for either HBsAg or antibodies to HCV, but had evidence of past infection with HBV since 40% were anti-HBc positive. The greatest proportion of HCV positives was in the haemophiliac group, 91.3%, none of these were HBsAg positive but 39.1% had anti-HBc. In the GBV-C positive renal transplant patients, 4% had HBsAg, 13.3% had anti-HBc and 2.1% had antibodies to HCV. This is the first report describing the prevalence of GBV-C in South African populations.

GB virus C prevalence in blood donors and high risk groups for parenterally transmitted agents from Gauteng, South Africa

The prevalence of GBV-C infection in voluntary blood donors and in groups at high risk for parenteral exposure to infectious agents was studied. The high risk groups included chronic renal failure patients on haemodialysis, renal transplant patients and haemophiliacs from Gauteng. The presence of GBV-C RNA in these populations was determined using reverse transcription polymerase chain reaction (RT-PCR) in the 5' non-coding region (NCR) of the virus. Of the blood donors, 11.1% (95% CI 7.6, 15.8) were positive, whereas 23.8% (95% CI 12.6, 40.2) of haemodialysis patients and 23.5% (95% CI 15.9, 33.3) of the haemophiliacs were infected with GBV-C. The highest proportion of infection was in the renal transplant patients, where 41.2% (95% CI 35.1, 47.7) were found to have circulating GBV-C RNA. Serological markers for hepatitis B (HBV) and hepatitis C viruses (HCV) were also measured as indicators of other hepatitis viruses with important parenteral transmission routes. Of the GBV-C positive blood donors, 3.6% were also HBsAg positive and none were positive for HCV. The GBV-C positive patients on haemodialysis were not positive for either HBsAg or antibodies to HCV, but had evidence of past infection with HBV since 40% were anti-HBc positive. The greatest proportion of HCV positives was in the haemophiliac group, 91.3%, none of these were HBsAg positive but 39.1% had anti-HBc. In the GBV-C positive renal transplant patients, 4% had HBsAg, 13.3% had anti-HBc and 2.1% had antibodies to HCV. This is the first report describing the prevalence of GBV-C in South African populations.

Instant electronic imaging systems are superior to Polaroid at detecting sight-threatening diabetic retinopathy

Polaroid photography in diabetic retinopathy screening allows instant image availability to enhance the results of ophthalmoscopy. Retinal cameras are now being developed which use video/digital imaging techniques to produce an instant enlarged retinal image on a computer monitor screen. We aimed to compare one such electronic imaging system, attached to a Canon CR5 45NM, with standard Polaroid retinal photography. Two hundred and thirteen eyes from 107 diabetic patients were photographed through dilated pupils by both systems in random order and the images were analysed blind. Diabetic retinopathy was present in 58 eyes of which 55/58 (95%) were detected on the electronic image and only 49/58 (84%) on the Polaroid. Of 34 eyes requiring ophthalmologist referral according to standard European criteria, 34/34 (100%) were detected on the electronic image and only 24/34 (71%) on the Polaroid. Side by side comparisons showed electronic imaging to be superior to Polaroid at lesion detection. Using linear analogue scales, the patients assessed the electronic imaging photographic flash as less uncomfortable than the Polaroid equivalent (p < 0.0001). Other advantages of electronic imaging include: ready storage of the images with other patient clinical data on the diabetes computerized register/database; potential for image enhancement and analysis using image analysis software and electronic transfer of images to ophthalmologist or general practitioner. Electronic imaging systems represent a potential major advance for the improvement of diabetic retinopathy screening.

Respect for autonomy: issues in neurological rehabilitation

OBJECTIVE

To examine the ethical principle of respect for autonomy within the context of neurological rehabilitation.

DISCUSSION

The nature of the principle of respect for autonomy is examined, and specific difficulties to which it may give rise in this area of practice are identified. These concern difficulties of communication with neurologically impaired patients, issues of competence related to patient decision-making, problems of consensus between patient and professional, and the role of the patient's family in the rehabilitation process.

CONCLUSION

A number of strategies, based on a client-centred model of practice, are suggested which may counteract these difficulties and assist in respecting the patient's autonomy to the appropriate degree, while seeking to attain high-quality clinical outcomes.

A critical appraisal of the role of triangulation in nursing research

Triangulation is a research strategy that has received considerable practical and theoretical interest in nursing research. However, despite its popularity, triangulation raises a number of problematic methodological and philosophical issues. Four such issues are discussed in this paper. First, it is argued that triangulation is not always a necessary ingredient of a research project, as some questions, framed in fairly specific terms, may be adequately answered with the use of a single method. Second, triangulation is often advanced as a means of securing the validity of data; however, this claim often makes unwarranted assumptions as to the criterial status of one method in relation to others. To the extent that triangulation does secure validity, this is likely to be in respect of content validity (i.e. the scope of findings) rather than, as is often suggested, criterion-related validity (i.e. the 'accuracy' of findings). Third, the bringing together of quantitative and qualitative methods in triangulation tends to ignore fundamental questions as to whether data generated by methods that come from divergent epistemological frameworks can meaningfully be combined. Finally, the use of different theoretical frameworks, in theory triangulation, mistakes the true nature of a theory and overlooks the distinctness and incommensurability of different theoretical perspectives. In conclusion, nurse researchers should approach triangulation in a cautious and critical way, with due regard to the rather dubious assumptions upon which it frequently rests.

Functional analysis of a conserved aspartate D218 in Cephalosporium acremonium isopenicillin N synthase

Isopenicillin N synthase (IPNS) is instrumental in the catalytic conversion of a tripeptide precursor delta-(L-alpha-aminoadipyl)-L-cysteinyl-D-valine to a bioactive intermediate isopenicillin N in the beta-lactam antibiotic biosynthetic pathway. It has recently been shown that this reaction is dependent on a conserved aspartate, D214, in a bacterial Streptomyces jumonjinensis IPNS. Thus, this study was carried out to provide the experimental evidence for the involvement of a similarly conserved aspartate residue, D218, in a fungal Cephalosporium acremonium IPNS (cIPNS). Initially, alteration of the aspartate residue to generate the mutant D218L cIPNS protein was achieved by site-directed mutagenesis. Subsequent enzyme assays indicated that the catalytic property of the mutant protein was lost, attesting to the need for the corresponding conserved aspartate to maintain IPNS functionality. It is also evident from the observed results that site-directed mutagenesis of this particular aspartate residue in cIPNS can affect its solubility. It is therefore important to take these potential changes into consideration when site-directed mutant proteins are analysed for catalytic function.

Desensitization of the P2X(2) receptor controlled by alternative splicing

P2X receptors are ion channels gated by extracellular ATP. We report here cloning of a P2X(2) receptor splice variant (P2X(2-2)) carrying a 207 bp deletion in the intracellular C-terminus and the analysis of the corresponding genomic structure of the P2X(2) gene. P2X(2-2) is as highly expressed as the original P2X(2) sequence in various tissues. ATP-activated currents mediated by heterologous expressed P2X(2) or P2X(2-2) receptors showed significant differences in desensitization time constants and steady-state currents in the continuous presence of ATP. These results imply functional differences between cells differentially expressing these P2X(2) isoforms.