Work problems and accommodations reported by persons who are postpolio or have a spinal cord injury

A number of studies have documented early functional declines in persons with a disability. The purpose of this study was to document (1) whether employees who are aging with their disability have experienced new work problems as a consequence of functional declines and (2) whether their work problems are being accommodated adequately. Ninety-six individuals with a disability (50 who are postpolio and 46 who had a spinal cord injury) were interviewed by phone. Each had worked at least 5 years postonset and was either currently working or unemployed for less than 5 years at the time of the interview. Forty-nine of the 50 persons who are postpolio reported they had experienced functional declines in recent years, and 41 of the 50 rated the severity of their disability greater than it was when they first began working. As a result of the functional declines they had experienced, most (90.9%) of their work problems were new and would not have been significant problems for them when they first began working. The situation was very different for the group with spinal cord injuries. Only a few members of that group had experienced functional declines that were causing new problems at work. A total of 480 work problems were reported by study participants. Three out of every eight problems did not have an accommodation satisfactory to the employee. The primary reason why a satisfactory solution was not provided was that no accommodation had been identified. Employers were generally supportive of the employee's need for accommodation; they paid for 59.1% of the accommodations that had a cost and refused to provide an accommodation for only 18 of the 480 problems.

Kinematics of the hind limb in trotting horses after induced lameness of the distal intertarsal and tarsometatarsal joints and intra-articular administration of anesthetic

OBJECTIVE

To identify hind limb and pelvic kinematic variables that change in trotting horses after induced lameness of the distal intertarsal and tarsometatarsal joints and after subsequent intra-articular administration of anesthetic.

ANIMALS

8 clinically normal adult horses.

PROCEDURE

Kinematic measurements were made before and after transient endotoxin-induced lameness of the distal intertarsal and tarsometatarsal joints and after intra-articular administration of anesthetic. Fourteen displacement and joint angle (metatarsophalangeal [fetlock] and tarsal joints) measurements were made on the right hind limb, sacrum, and the right and left tubera coxae. Kinematic measurements were compared by general linear models, using a repeated measures ANOVA. Post hoc multiple comparisons between treatments were evaluated with a Fisher least squared difference test at alpha = 0.05.

RESULTS

After lameness induction, fetlock and tarsal joint extension during stance decreased, fetlock joint flexion and hoof height during swing increased, limb protraction decreased, and vertical excursion of the tubera coxae became more asymmetric. After intra-articular administration of anesthetic, limb protraction returned to the degree seen before lameness, and vertical excursion of the tubera coxae became more symmetric.

CONCLUSIONS AND CLINICAL RELEVANCE

Increased length of hind limb protraction and symmetry of tubera coxae vertical excursion are sensitive indicators of improvement in tarsal joint lameness. When evaluating changes in tarsal joint lameness, evaluating the horse from the side (to assess limb protraction) is as important as evaluating from the rear (to assess pelvic symmetry).

Evaluation of an experimental milking pulsation system for effects on milking and udder health

This study was to test whether cows milked by an experimental pulsation method differed from cows milked with conventional pulsation milking in somatic cell count (SCC), intramammary infections (IMI) defined by milk bacteriological culture results, teat end condition, or milk flow rate. The study design was a 1-yr trial with a completely randomized block crossover. Holstein cows were blocked into 15 pairs of contemporaries. Both cows from each pair were milked with experimental pulsation and with conventional pulsation for 6 mo, in reverse order from each other. The SCC (217,000/ml) of experimentally milked cows was not significantly different from SCC of conventionally milked cows (175,000/ml). Mean milk flow rate was 5.2 lb/min (2.4 kg/min) for experimentally milked cows and 5.3 lb/min (2.4 kg/min) for conventionally milked cows, not significantly different. Differences among the experimentally and conventionally milked cows, respectively, in new (13.5 and 12.7%), chronic (12.9 and 8.9%), and negative (73.6 and 78.4%) quarter culture results were not significant. New IMI per 100 d of lactation were 1.50 and 1.46, and chronic IMI per 100 d were 1.85 and 1.27, for experimentally and conventionally milked cows, respectively. These IMI rates were not significantly different between pulsation types. There were more new Staphylococcus aureus IMI associated with conventional pulsation, but overall cases of Staph. aureus were similar between the two types of pulsation. Teat end scores for the experimentally and conventionally milked cows, respectively, were good (6.5 and 11.7%), intermediate (68.2 and 66.9%), and poor (25.3 and 21.4%), not significantly different. These results support previous studies, which have found that except for complete failure of pulsation, differences in pulsation characteristics apparently have little effect on milking and udder health.

Identification of a cyclohexylcarbonyl CoA biosynthetic gene cluster and application in the production of doramectin

The side chain of the antifungal antibiotic ansatrienin A from Streptomyces collinus contains a cyclohexanecarboxylic acid (CHC)-derived moiety. This moiety is also observed in trace amounts of omega-cyclohexyl fatty acids (typically less than 1% of total fatty acids) produced by S. collinus. Coenzyme A-activated CHC (CHC-CoA) is derived from shikimic acid through a reductive pathway involving a minimum of nine catalytic steps. Five putative CHC-CoA biosynthetic genes in the ansatrienin biosynthetic gene cluster of S. collinus have been identified. Plasmid-based heterologous expression of these five genes in Streptomyces avermitilis or Streptomyces lividans allows for production of significant amounts of omega-cyclohexyl fatty acids (as high as 49% of total fatty acids). In the absence of the plasmid these organisms are dependent on exogenously supplied CHC for omega-cyclohexyl fatty acid production. Doramectin is a commercial antiparasitic avermectin analog produced by fermenting a bkd mutant of S. avermitilis in the presence of CHC. Introduction of the S. collinus CHC-CoA biosynthetic gene cassette into this organism resulted in an engineered strain able to produce doramectin without CHC supplementation. The CHC-CoA biosynthetic gene cluster represents an important genetic tool for precursor-directed biosynthesis of doramectin and has potential for directed biosynthesis in other important polyketide-producing organisms.

Continuing education needs assessment for on-farm food safety services

OBJECTIVE

To identify the perceived market or client demand for dairy on-farm food safety services by veterinarians, the need for a food safety continuing education program, and the educational issues that might be addressed in an on-farm food safety curriculum.

DESIGN

Survey.

STUDY POPULATION

Consulting dairy veterinarians, government veterinarians located in California, and meat packers slaughtering cull dairy cows in California.

PROCEDURE

Results of a questionnaire supplied to veterinarians and telephone interviews with meat packer representatives were analyzed by use of univariate and multivariate logistic regression procedures.

RESULTS

Some meat packers considered the quality of incoming cull dairy cattle as a control point for food safety hazards. More than 50% of dairy and government-employed veterinarians believed that a current market for on-farm food safety services exists; > 85% believed that a potential market exists. Duration since graduation was negatively correlated with belief in a current market. Government-employed veterinarians were more likely to believe in a current market. Veterinarians were more likely to express a strong interest in offering on-farm food safety services if they believed a current market exists, indicated that they already offer such services, or listed residues and pathogens as the most important issues facing the dairy industry.

CONCLUSIONS AND CLINICAL RELEVANCE

Although a potential market for on-farm food safety services is perceived, veterinarians are unsure of their role in this area. new demands of meat packers slaughtering cull dairy cows may be the motivation practitioners need to broach the subject of food safety with clients.

Comparison of cancellous bone-derived cell proliferation in autologous human and fetal bovine serum

Conventionally, culture medium is supplemented with fetal bovine serum (FBS): such serum presents potential risks of foreign protein contamination and transmission of viral or prion-related disease if used in culture of cells intended for human reimplantation. As it has been suggested that a composite of cultured human cancellous bone-derived cells and a bone graft substitute may present a solution to the well-recognized complications and limited availability associated with harvest of fresh bone graft, this study aimed to compare the proliferative response of human cancellous bone-derived cells supplemented with FBS or autologous human serum (AHS) to determine whether AHS is a practical alternative. Explant cultures were established using greater trochanter trabecular bone from 10 consenting patients (aged 57-84) undergoing total hip arthroplasty. At the same time, serum was harvested. The cells were characterized by alkaline phosphatase expression and by in vitro mineralization in enhanced medium. At confluence, cells were aliquoted into multiwell plates and grown for 9 days in medium supplemented with 5%, 10%, 15%, or 20% AHS or 10% FBS. Proliferative response was determined by a crystal violet dye binding assay. There was no significant difference between proliferation in 5% AHS and 10% FBS. However, 10%, 15%, and 20% AHS all produced significantly greater proliferation than 10% FBS. The proliferative response was dose related. FBS is said to be rich in growth and attachment factors, which is why it is widely used in tissue culture. These results suggest that species specificity, even when using adult serum, outweighs these advantages. It should therefore be considered as a prerequisite for any program involving reimplantation of cultured human cells. Clinical trials of cultured human cancellous bone-derived cells have now begun.

Changes in kinematic variables observed during pressure-induced forelimb lameness in adult horses trotting on a treadmill

OBJECTIVE

To determine whether kinematic changes induced by heel pressure in horses differ from those induced by toe pressure.

ANIMALS

10 adult Quarter Horses.

PROCEDURE

A shoe that applied pressure on the cuneus ungulae (frog) or on the toe was used. Kinematic analyses were performed before and after 2 levels of frog pressure and after 1 level of toe pressure. Values for stride displacement and time and joint angles were determined from horses trotting on a treadmill.

RESULTS

The first level of frog pressure caused decreases in metacarpophalangeal (fetlock) joint extension during stance and increases in head vertical movement and asymmetry. The second level of frog pressure caused these changes but also caused decreases in stride duration and carpal joint extension during stance as well as increases in relative stance duration. Toe pressure caused changes in these same variables but also caused maximum extension of the fetlock joint to occur before midstance, maximum hoof height to be closer to midswing, and forelimb protraction to increase.

CONCLUSION AND CLINICAL RELEVANCE

Decreased fetlock joint extension during stance and increased head vertical movement and asymmetry are sensitive indicators of forelimb lameness. Decreased stride duration, increased relative stance duration, and decreased carpal joint extension during stance are general but insensitive indicators of forelimb lameness. Increased forelimb protraction, hoof flight pattern with maximum hoof height near midswing, and maximum fetlock joint extension in cranial stance may be specific indicators of lameness in the toe region. Observation of forelimb movement may enable clinicians to differentiate lameness of the heel from lameness of the toe.

A pilot study using magnetic resonance imaging to determine the pattern of muscle group recruitment by rowers with different levels of experience

OBJECTIVE

To determine whether it was possible using magnetic resonance imaging (MRI) to define the pattern of muscle recruitment in a specific sport (rowing) and to see whether there were differences in this pattern between athletes of different experience.

DESIGN AND METHOD

It has been shown that during vigorous exercise the water content of muscle increases transiently. This can be observed using MRI, where the prolonged T2 relaxation time of muscle can be demonstrated. In this study we have exploited the increase in signal seen in exercised muscle on short TI inversion recovery (STIR) sequences, to show how rowers of different experience use different muscle groups.

RESULTS

We have shown that trained athletes recruit selected muscle groups to carry out a given task, which they carry out more efficiently than untrained or less experienced athletes.

CONCLUSION

We have provided the basis of potential research to refine training methods, in order to develop specific muscle groups in athletes, in the hope of achieving a higher level of performance at an earlier stage in their training. We have also defined a technique that may be of clinical value in cases of muscle dysfunction.

Left ventricular diastolic dysfunction in patients with hypertension and preserved systolic function

OBJECTIVE

To assess prospectively diastolic function in hypertensive patients with preserved left ventricular function, particularly focusing on the limitation of the transmitral flow velocity curve alone to detect diastolic dysfunction.

PATIENTS AND METHODS

Comprehensive Doppler analysis was performed in 51 hypertensive patients with preserved left ventricular systolic function.

RESULTS

The ratio of the peak early diastolic filling wave velocity to the peak velocity of filling wave at atrial contraction was less than the age-adjusted mean value minus 2 SD in 16 patients, and the other 35 patients had a "normal" transmitral Doppler signal. However, the combined transmitral and pulmonary venous Doppler analysis revealed that 12 of these 35 patients had a "pseudonormal" pattern. The prevalence of diastolic dysfunction was estimated at 31% with use of transmitral Doppler alone but increased to 55% when comprehensive Doppler analysis was used (P < .05).

CONCLUSION

The presence of diastolic dysfunction has been frequently overlooked in hypertensive patients with transmitral Doppler analysis alone, and an assessment of diastolic function with a comprehensive Doppler analysis is needed in patients at risk for diastolic dysfunction.

Fibrin scaffold as an effective vehicle for the delivery of acidic fibroblast growth factor (FGF-1)

The effect of wound healing by fibrin and acidic fibroblast growth factor (FGF-1) in an in vivo model was evaluated in this study. Four full-thickness wounds were made on the dorsum of each rabbit (n = 5). Each of these wounds had different treatment groups: control, topical FGF-1 (100 microg/9 cm2), fibrin (2.0 mL at 60 mg/mL fibrinogen), and FGF-1 (100 microg/9 cm2)/fibrin. The animals were sacrificed at the end of 2 weeks. Histomorphometric analysis and mechanical testing were conducted to assess the healing response. FGF-1/fibrin treatment improved the mechanical properties of the healed tissue. Fibrin scaffold exhibited the desired tissue response, as demonstrated by the lack of inflammation, and was deemed an effective carrier for FGF-1.

Comparison of seven antibiotic treatments with no treatment for bacteriological efficacy against bovine mastitis pathogens

Milk culture results were retrospectively reviewed from 9007 cases of subclinical mastitis affecting cows housed in dairy herds located in New York and northern Pennsylvania. Cases included in this analysis had at least one mastitis pathogen isolated from the initial milk sample, were recultured within 1 mo, had permanent cow identification, and had records of whether mastitis was treated with an antibiotic or no treatment at all. Overall bacteriological cure rate for 21 mastitis pathogens was 68% (6097 of 9007). Antibiotic treated cases had a higher cure rate (75%) than did untreated cases (65%). Antibiotic treatments that significantly differed from the untreated cure rate of 65% were amoxicillin (82%), erythromycin (76%), cloxacillin (73%), and pirlimycin (44%). Cure rates for antibiotic treatments with cephapirin, hetacillin, or penicillin did not differ from the untreated cure rate. Agents for which some antibiotics were associated with increased cure rates compared with no treatment were Streptococcus agalactiae, streptococci other than Strep. agalactiae, and coagulase-negative staphylococci. The antibiotic most commonly associated with higher cure rates was amoxicillin. Most of the 21 mastitis agents showed no difference in bacteriologic cure rates between any of the 7 antibiotic treatments and no treatment.

Response to local anaesthetic injection as a predictor of successful hip surgery

AIM

To compare the outcome of hip therapy with the response to local anaesthetic into the hip.

MATERIALS AND METHODS

A retrospective hip arthrographic study of 60 patients complaining of hip pain was performed. The average age of the patients was 58 +/- 20 years with ratio of men to women of 11:19. Thirty-eight of these patients underwent local anaesthetic intracapsular injection. Twenty-three (61%) obtained relief from pain whereas two (5%) experienced worsened pain.

RESULTS

Of the 23 patients who experienced pain relief 17 (74%) had a positive post-operative course, in comparison with eight (44%) who had a positive post-operative course from the group where intra-articular local anaesthetic was not used. It was also noted that patients over 30 years of age had favourable post-operative results in the presence or absence of local anaesthetic testing.

CONCLUSION

These results indicate that hip arthrography with a pain relieving intracapsular local anaesthetic injection, is a positive post-operative prognostic factor in a patient group of disparate disorders. A positive response to local anaesthetic injection into a hip may predict which patients are likely to respond well to surgery. We advise alterations to the consent procedure to add a warning concerning the small risk of increased hip pain. If further studies were to confirm our results it may be wise to recommend that local anaesthetic intracapsular injection and judgement of its efficacy should precede many surgical procedures involving the hip.

Accuracy of digitization using automated and manual methods

BACKGROUND AND PURPOSE

Computerized 3-dimensional (3-D) motion measurement systems are used by those interested in human motion. The purposes of this study were (1) to determine the limits of accuracy in determining intersegmental angles during pendular motion at varying speeds and (2) to determine changes in accuracy introduced by autodigitization and digitization by experienced manual raters.

METHODS

Angular speed of a T-shaped pendulum was systematically increased by releasing the pendulum from 4 angles (0 degrees [no movement], 45 degrees, 90 degrees, and 120 degrees). Twelve reference angles calculated from markers placed on the pendulum were estimated over 20 frames for 10 trials at each release position.

RESULTS

Mean errors across trials and frames for intersegmental angles reconstructed by a 3-D motion measurement system were within +/- 1 degree across all release positions. An analysis of variance and a post hoc Tukey test revealed that the mean error for the autodigitized trials was larger than that for the manually digitized trials. For the autodigitized trials, the static trials (release position=0 degrees) produced less mean error than the trials with movement produced. The ICCs showed a high degree of consistency among all raters, ranging from .707 to .999.

CONCLUSION AND DISCUSSION

Our findings support the conclusion that under carefully controlled conditions, a 3-D motion measurement system can produce clinically acceptable measurements of accuracy across a range of angular speeds. Furthermore, acceptable accuracy is possible regardless of the digitization method.

MEK1 activation rescues Jurkat T cells from Fas-induced apoptosis

Although the protease cascade initiated by Fas (CD95, Apo-1) is well characterized, there remains little known about how kinase pathways may impact on Fas-mediated apoptosis. We recently observed that in T lymphocytes Fas strongly induced activation of JNK (c-Jun N-terminal kinase) but not of second messengers leading to activation of ERK (extracellular regulated kinase). Additionally, Fas-mediated apoptosis was significantly inhibited with PMA, a potent activator of the ERK signaling pathway. This suggested a model whereby activation of the ERK pathway might attenuate Fas-mediated apoptosis. This was confirmed in the current study by showing that activation of MEK1, the upstream regulator of ERK, reduces Fas-mediated apoptosis, whereas inhibition of MEK1 augments apoptosis by Fas. Furthermore, Fas-mediated apoptosis of Jurkat T cells is not affected by constitutively active or dominant negative variants that modulate the JNK pathway. These results demonstrate that Fas-induced JNK activation is not required for apoptosis by Jurkat T cells, but rather is more likely secondary to cell stress during the early phases of apoptosis. This is supported by the ability of the caspase blocker zVAD to inhibit both apoptosis and JNK activation by Fas.

Evaluation of prior photorefractive keratectomy in donor tissue

PURPOSE

To describe a case in which an eye donor had prior bilateral photorefractive keratectomies and to elucidate possible methods of evaluation and screening of donor tissue.

METHODS

Case report. A 62-year-old eye donor was reported to have received radial keratotomy before his death. Further investigation by the eye bank showed a history of photorefractive keratectomy (PRK), not radial keratotomy. The corneas were therefore not used for transplantation, and the eyes were evaluated by slit-lamp examination, photography, corneal topography, and histology.

RESULTS

Slit-lamp and photographic examination did not indicate the presence of PRK ablations. Corneal topography mapping with the TMS-1 was relatively ambiguous for identifying PRK flattening, while multiple data formatting of the cornea with the Orbscan resulted in the strongest suggestion of prior PRK. Histologic analysis showed central corneal thinning and loss of Bowman's membrane consistent with PRK.

CONCLUSIONS

In the absence of a positive donor history for PRK, current methods of screening donor tissue for prior PRK often are insufficient to exclude these corneas from use in transplantation. More refined placido imagery corneal topography or newer technologies such as the Orbscan may allow more sensitive and specific methods of donor tissue screening.

Evaluation of mild lameness in horses trotting on a treadmill by clinicians and interns or residents and correlation of their assessments with kinematic gait analysis

OBJECTIVE

To estimate sensitivity and accuracy of subjective evaluation of mild lameness in horses during treadmill locomotion and to correlate subjective evaluation with kinematic analysis.

ANIMALS

19 lame and 5 clinically normal horses.

PROCEDURE

Lameness was evaluated by subjective score and kinematic analysis before and after palmar digital nerve block (PDNB). Evaluations were made by 6 clinicians and 7 interns or residents. Within- and between-observer agreement analyses (kappa values) were calculated and compared, using a Student's t-test. Pearson's product-moment correlation coefficients were calculated between clinician's change in score and the change in kinematic variables after PDNB.

RESULTS

Within-observer agreement was within the range expected for conditions of moderate diagnostic difficulty. Within-observer agreement was higher for clinicians than for interns or residents. Between-observer agreement was acceptable for scores within 1 value of each other. Between-observer agreement of change in lameness score after PDNB was poor. When kinematic variables were ranked with each clinician's subjective change in score, only 2 were among the top 3 for the majority of clinicians. Asymmetry of vertical head movement between contralateral forelimb stance phases and the point of maximum hoof height during swing decreased as lameness subjectively improved.

CONCLUSION

Mild lameness may be difficult to evaluate during treadmill locomotion. Although clinicians were more repeatable in their subjective evaluation of lameness than interns or residents, they were not more reliable at detecting the true state of lameness.

CLINICAL RELEVANCE

Lack of agreement between clinician scoring of mild lameness emphasizes the need to use more objective measures for quantifying lameness.

Neuraxial opioids in labour

Neuraxial opioids were first used for labour analgesia in 1980 following the description of spinal cord opioid receptors in 1979. Via these receptors in the dorsal horn, opioids modulate both the visceral and the somatic pain of labour. The onset and duration of action of the individual opioid are determined primarily by its relative lipid solubility. Neuraxial opioids have a local anaesthetic sparing effect, allowing the use of lower concentrations of both agents while maintaining analgesia. As a sole agent, intrathecal opioids can be used to provide analgesia during the first stage of labour, especially in the high-risk parturient. They also have a role in the management of perineal pain and the provision of rapid-onset analgesia. Unfortunately maternal and neonatal side-effects can occur, the most important being respiratory depression.

Increased platelet responsiveness following coronary stenting. Heparin as a possible aetiological factor in stent thrombosis

AIMS

Platelet activation may be a determinant of thrombotic and restenotic complications following intracoronary stenting. In order to measure the effect of stenting on platelet activation antigen expression we used whole blood flow cytometry in 18 patients undergoing Palmaz-Schatz stenting (treated with full anticoagulation) and compared these with a group of 18 patients undergoing elective angioplasty. The effects of low molecular weight heparin and unfractionated heparin on platelet behaviour were also studied, both in vitro and in vivo to determine the contribution of prolonged heparin therapy to platelet activation following stenting.

METHODS AND RESULTS

Fibrinogen binding to activated GPIIb-IIIa, and surface expression of P-selectin, GPIb and GPIIb-IIIa antigens were measured in unstimulated peripheral blood samples (rest) and on stimulation with adenosine diphosphate (0.1-10 micromol x 1(-1)) and thrombin (0.02-0.16 U x ml(-1)). No changes were seen in resting samples following angioplasty or stenting. Agonist responsiveness was unaltered after angioplasty, but in stented patients antigen expression in response to thrombin was significantly reduced (P< or =0.04), whilst the adenosine diphosphate response was significantly increased (P=0.01). Similar effects were observed in patients with unstable angina treated with either low molecular weight heparin or unfractionated heparin in vivo. In vitro, both unfractionated and low molecular weight heparin inhibited thrombin-induced platelet activation, but stimulation of adenosine diphosphate responses was more marked with unfractionated than low molecular weight heparin.

CONCLUSIONS

There was a significant increase in platelet responsiveness to adenosine diphosphate following intracoronary stenting in patients treated with conventional anticoagulants. This was probably a consequence of treatment with heparin. Activation of platelets by heparin may explain the increased rate of stent thrombosis in patients treated with anticoagulant therapy. Low molecular weight heparins stimulate platelets less than unfractionated heparin.

Identification of a common low density lipoprotein receptor mutation (C163Y) in the west of Scotland

Familial hypercholesterolaemia (FH) is an autosomal codominant disorder characterised by high levels of LDL cholesterol and a high incidence of coronary artery disease. Our aims were to track the low density lipoprotein receptor (LDLR) gene in individual families with phenotypic FH and to identify and characterise any mutations of the LDLR gene that may be common in the west of Scotland FH population using single strand conformational polymorphism analysis (SSCP). Patient samples consisted of 80 heterozygous probands with FH, 200 subjects who were related to the probands, and a further 50 normal, unrelated control subjects. Tracking of the LDLR gene was accomplished by amplification of a 19 allele tetranucleotide microsatellite that is tightly linked to the LDLR gene locus. Primers specific for exon 4 of the LDLR gene were used to amplify genomic DNA and used for SSCP analysis. Any PCR products with different migration patterns as assessed by SSCP were then sequenced directly. In addition to identifying probands with a common mutation, family members were screened using a forced restriction site assay and analysed using microplate array diagonal gel electrophoresis (MADGE). Microsatellite D19S394 analysis was informative in 20 of 23 families studied. In these families there was no inconsistency with segregation of the FH phenotype with the LDLR locus. Of the FH probands, 15/80 had a mutant allele as assessed by SSCP using three pairs of primers covering the whole of exon 4 of the LDLR gene. Direct DNA sequencing showed that 7/15 of the probands had a C163Y mutation. Using a PCR induced restriction site assay for the enzyme RsaI and MADGE, it was determined that the C163Y mutation cosegregated with the FH phenotype in family members of the FH probands. This mutant allele was not present in any of the control subjects. Microsatellite analysis has proven useful in tracking the LDLR gene and could be used in conjunction with LDL cholesterol levels to diagnose FH, especially in children and young adults where phenotypic diagnosis can be difficult.

A World Wide Web site for low-density lipoprotein receptor gene mutations in familial hypercholesterolemia: sequence-based, tabular, and direct submission data handling

Familial hypercholesterolemia is an autosomal dominant inherited condition characterized by a mutation in the low-density lipoprotein receptor (LDLR) gene. A database has been set up on the World Wide Web for mutations in the LDLR gene.

Paracrine and autocrine regulation of vascular endothelial growth factor during tissue differentiation in the quail

The expression of vascular endothelial growth factor (VEGF) has been described to coincide both temporally and spatially with angiogenesis suggesting a role as a paracrine stimulator of endothelial cells. We have used digoxigenin labelled RNA probes to VEGF and the VEGF receptor-2 (Quek1) to investigate the relationship between VEGF expression and vascular events in quail embryos from day 1 to 13 of incubation. Furthermore, the effect of exogenously applied VEGF was studied in day 4 quail embryos using polyclonal anti-VEGF antibodies. Expression of VEGF mRNA was observed in day 1 and 2 embryos in regions of active angiogenesis and hemangiopoiesis. VEGF mRNA expression was found at high levels in the ventral aspect of the neural tube and Quek1 mRNA expression in the accompanying endothelial cells of day 3 embryos, suggesting a function in brain angiogenesis. However, in the neural tube, thyroid gland and cartilaginous skeleton VEGF mRNA was expressed at least 1 day before the ingrowth of vessels, suggesting that additional mechanisms are involved in control of angiogenesis. This is supported by the observation that application of VEGF165 into the midbrain induced dilatation of perineural vessels, while the intraneural vessels remained almost unaffected. Expression of VEGF mRNA was also observed at high levels in podocytes during all stages, indicative of its importance in glomerular development and function. The results of the present study indicate that as angiogenesis occurred in other tissues and organs (day 13 metanephros, dorsal third of the day 7 neural tube, skeletal muscle, and many mesodermal compartments), there was concurrent paracrine expression of VEGF mRNA and Quek1 mRNA. One noteable exception was the hepatocytes of the developing liver which appeared to remain VEGF-negative throughout the study. However, a small number of endothelial cells within liver sinuses, and additionally within the kidney and the elastic arteries, expressed VEGF mRNA. These results suggest that VEGF may also act as an autocrine mediator of angiogenesis, possibly as a result of localised tissue hypoxia.