Demonstration of the extrinsic coagulation pathway in teleostei: identification of zebrafish coagulation factor VII

It is not known whether the mammalian mechanism of coagulation initiation is conserved in fish. Identification of factor VII is critical in providing evidence for such a mechanism. A cDNA was cloned from a zebrafish (teleost) library that predicted a protein with sequence similarity to human factor VII. Factor VII was shown to be present in zebrafish blood and liver by Western blot analysis and immunohistochemistry. Immunodepletion of factor VII from zebrafish plasma selectively inhibited thromboplastin-triggered thrombin generation. Heterologous expression of zebrafish factor VII demonstrated a secreted protein (50 kDa) that reconstituted thromboplastin-triggered thrombin generation in immunodepleted zebrafish plasma. These results suggest conservation of the extrinsic coagulation pathway between zebrafish and humans and add credence to the zebrafish as a model for mammalian hemostasis. The structure of zebrafish factor VIIa predicted by homology modeling was consistent with the overall three-dimensional structure of human factor VIIa. However, amino acid disparities were found in the epidermal growth factor-2/serine protease regions that are present in the human tissue factor-factor VIIa contact surface, suggesting a structural basis for the species specificity of this interaction. In addition, zebrafish factor VII demonstrates that the Gla-EGF-EGF-SP domain structure, which is common to coagulation factors VII, IX, X, and protein C, was present before the radiation of the teleosts from the tetrapods. Identification of zebrafish factor VII significantly narrows the evolutionary window for development of the vertebrate coagulation cascade and provides insight into the structural basis for species specificity in the tissue factor-factor VIIa interaction.

Indigenous property rights and river management

The presence of indigenous property rights and interests arising from the survival of native title in Australia presents unique issues in the management of rivers and riverine lands. Existing common law and statutory tidal and non-tidal rights are a complex overlay of public and private property rights which are themselves undergoing significant change through the commodification of many natural resources by Commonwealth and State governments, such as marine species stock and non-tidal water. The melding of indigenous values and management practices with existing management regimes for rivers and riverine lands offers considerable potential for both sustainability of resource utilisation, and respect and recognition of native title with resultant predicted benefits in the vexed area of compensation.

Motivational interviewing to enhance treatment initiation in substance abusers: an effectiveness study

Sixty individuals referred for a substance abuse evaluation by a child welfare worker were randomly assigned to either a standard evaluation or an evaluation enhanced by Motivational Interviewing techniques, each delivered in a single session. Participants who received the enhanced evaluation were significantly more likely to attend at least one additional treatment session after the initial evaluation (59% versus 29%). This finding suggests that comparatively inexpensive modifications of "standard" initial evaluations with substance-using parents may increase engagement of substance-abusing parents in treatment. Moreover, this study adds to an overwhelmingly positive literature supporting Motivational Interviewing with alcohol-using populations and extends prior findings to non-research community settings.

Congenital absence of a cervical pedicle: report of two cases and review of the literature

OBJECTIVE AND IMPORTANCE

The congenital absence of a cervical pedicle is a rare clinical entity. Patients with this anomaly tend to present with cervical pain or after a traumatic incident. Initial evaluations with conventional radiography frequently lead to misinterpretation and misguided intervention. We report two cases of absent cervical pedicles and describe the presentation, diagnosis, and treatment of these patients. Moreover, we review the literature on this clinical entity.

CLINICAL PRESENTATION

The first patient was a 4-year-old boy who presented with neck pain after falling off a trampoline. His neurological examination did not reveal any focal abnormalities, but radiographs were thought to be consistent with a right, C4-C5, unilateral, jumped facet. The second patient was a 27-year-old woman who presented with severe neck, back, and left upper extremity pain and paresthesias after an alleged incident of spousal abuse. Her neurological examination results were remarkable for left upper extremity weakness and hemibody sensory changes. Conventional radiographs were thought to reveal a left, C3-C4, unilateral, locked facet.

INTERVENTION

For both patients, reduction attempts were made with Gardner-Wells tongs and traction. After failure to achieve adequate reduction, evaluations using two-dimensional computed tomography confirmed congenitally absent cervical pedicles. Both patients were ultimately treated conservatively and experienced resolution of their presenting symptoms.

CONCLUSION

The congenital absence of a cervical pedicle is a rare entity that is frequently misdiagnosed. Diagnoses can be accurately confirmed with two-dimensional computed tomography. Conservative treatment resulted in successful management of this clinical entity.

Undetected hyperglycaemia among hospital in-patients

To assess the prevalence of previously undiagnosed hyperglycaemia consistent with a diagnosis of Diabetes Mellitus in a consecutive series of hospital in-patients. Retrospective case note review. University Teaching Hospital. 800 consecutive hospitalised patients aged over 50 years. The main outcome measures the prevalence of hyperglycaemia [corrected]. We searched the biochemistry laboratory computerised database for results of all biochemistry tests carried out during each patient's admission. The medical records of those with at least one plasma glucose value in the hyperglycaemic range (glucose > or =11.1 mmol/l and/or > or =7.0 mmol/l on casual and/or fasting measurements respectively) were reviewed by two observers using a standardised method and a check list for data collection.

The biochemical characterization of aggrecan from normal and tibial-dyschondroplastic chicken growth-plate cartilage

Tibial dyschondroplasia (TD) is a disorder of endochondral ossification characterized by the presence of an avascular, non-mineralized cartilage lesion extending from the growth plate into the metaphysis. Cells within the TD growth plate fail to differentiate to full hypertrophy, and instead appear to maintain a 'pre-hypertrophic' or 'transitional' status. Studies of the expression and distribution of cartilage matrix macromolecules in the TD growth plate have shown a marked decrease in the levels of aggrecan in the TD matrix. In the present study we compared the biochemical characteristics of the aggrecan molecules extracted from normal epiphyseal and TD cartilage. We have shown three major differences between normal and TD cartilage aggrecan. These are: (1) increase in molecular mass; (2) increase in the number of keratan sulphate chains; and (3) difference in the pattern of sulphation in TD aggrecan. Such changes in biochemical characteristics of the aggrecan monomers in TD cartilage may be associated with the lack of mineralization of the diseased cartilage. The present study provides a basis for further investigations into the importance of proteoglycans in normal and pathological bone development.

Transfusion errors in New York State: an analysis of 10 years' experience

BACKGROUND

While public focus is on the risk of infectious disease from the blood supply, transfusion errors also contribute significantly to adverse outcomes. This study characterizes such errors.

STUDY DESIGN AND METHODS

The New York State Department of Health mandates the reporting of transfusion errors by the approximately 256 transfusion services licensed to operate in the state. Each incident from 1990 through 1998 that resulted in administration of blood to other than the intended patient or the issuance of blood of incorrect ABO or Rh group for transfusion was analyzed.

RESULTS

Erroneous administration was observed for 1 of 19, 000 RBC units administered. Half of these events occurred outside the blood bank (administration to the wrong recipient, 38%; phlebotomy errors, 13%). Isolated blood bank errors, including testing of the wrong specimen, transcription errors, and issuance of the wrong unit, were responsible for 29 percent of events. Many events (15%) involved multiple errors; the most common was failure to detect at the bedside that an incorrect unit had been issued.

CONCLUSION

Transfusion error continues to be a significant risk. Most errors result from human actions and thus may be preventable. The majority of events occur outside the blood bank, which suggests that hospitalwide efforts at prevention may be required.

Secondary prevention following fractured neck of femur: a survey of orthopaedic surgeons practice

Fractured neck of femur is one of the most common reasons for hospital admission in the elderly population. Despite this little attention is given to the area of secondary prevention. To assess the variation in clinical practice among orthopaedic surgeons with regard to the use of secondary preventive measures in relation to fractured neck of femur. A postal survey using a self-completed questionnaire among all orthopaedic surgeons throughout the Republic of Ireland. The study questionnaire addressed unit information prophylaxis for deep venous thrombosis and investigation and secondary prevention of fractured neck of femur. It gave a clinical scenario of a 72-year old female who was admitted with a fractured neck of femur after a minor fall. A reminder was sent to the non-responders. Data were analysed using chi-squared test. The number of completed questionnaires returned was 89 giving a response rate of 66%. Of these 71(82.6%) reported that they would not initiate or recommend investigation of the extent of the underlying osteoporosis in the specific case upon which the questionnaire was based. With regard to the issue of secondary prevention 16(18%) stated that they would prescribe Vitamin D and 26(29%) would prescribe calcium supplements. 15(17%) would use bisphosphonates and 15(17%) would prescribe hormone replacement therapy. Only one respondent would use an external hip protector. There is an underuse of secondary preventive measures with regard to fractured neck of femur. There needs to be clear definition of roles and perhaps the development of agreed local protocols in order that patients with hip fractures do not miss out on potentially beneficial treatment. There is an underuse of secondary preventive measures with regard to fractured neck of femur. There needs to be clear definition of roles and perhaps the development of agreed local protocols in order that patients with hip fractures do not miss out on potentially beneficial treatment.

Disassembly of membrane-associated NSF 20S complexes is slow relative to vesicle fusion and is Ca(2+)-independent

N-ethylmaleimide-sensitive fusion protein (NSF) and its co-factor soluble NSF attachment protein (alpha)-SNAP) are essential components of the synaptic vesicle fusion machinery and form part of a structurally-conserved 20S protein complex. However, their precise function, relative to fusion itself, is not clear. Using a UV-activated cross-linking approach, we have measured the rate at which a single round of NSF-driven ATP hydrolysis leads to 20S complex disassembly within synaptic membranes. Although this rate is substantially faster than previous estimates of NSF-dependent ATP hydrolysis, it remains much lower than published rates for fusion of synaptic vesicles. Furthermore, the stability of 20S complexes is unaffected by Ca(2+) at concentrations that elicit rapid membrane fusion. We conclude that the ATPase activity of NSF does not contribute directly to vesicle fusion, but more likely plays an earlier role in the synaptic vesicle cycle.

Factor and subscale structure of a parental health locus of control instrument (parental health beliefs scales) for use in a mainland United States Puerto Rican community

This study was undertaken to determine whether the subscale structure of an instrument used to measure parental health locus of control is a valid representation of the concept of locus of control in the Puerto Rican community. Ethnocultural differences in values and attitudes may create different conceptualizations of questionnaire items, which may impact on the subscale factor loadings for these items. Four hundred and twenty parents of Puerto Rican ethnicity living in a mainland inner city community in the United States completed the Parental Health Beliefs Scales (PHBS) instrument, which was developed to measure parental locus of control regarding their children's health. Results were subject to exploratory factor analysis. The resultant factor structure was then compared to other published factor structures by confirmatory factor analysis. Exploratory factor analysis results show a new five factor solution. Compared to two previously published factor structures for this instrument, the new five factor structure has a better goodness of fit for this Puerto Rican study sample. Through item analysis, we were able to refine the final structure into a four factor, 15 item instrument. We conclude that the new factor structure for the PHBS creates an instrument with subscales that reflect Puerto Rican cultural beliefs and values, especially as it pertains to locus of control issues (e.g. respect of professionals, collectivism, and the importance of fate). When working with ethnocultural minority groups, the health services researcher needs to be certain that the research instruments used are culturally appropriate and sensitive.

How to defuse compliance time bombs. Part 2: Six hypothetical allegations. Panel discussion

In the second and final part of this series, a panel of legal experts discusses more hypothetical allegations against a fictional laboratory, including billing for additional indices, using expired reagents, and falsifying the results of employee competency tests. Learn how to handle these dilemmas before they explode into full-blown legal violations.

Formation and turnover of NSF- and SNAP-containing "fusion" complexes occur on undocked, clathrin-coated vesicle-derived membranes

Specificity of vesicular transport is determined by pair-wise interaction between receptors (SNAP receptors or SNAREs) associated with a transport vesicle and its target membrane. Two additional factors, N-ethylmaleimide-sensitive fusion protein (NSF) and soluble NSF attachment protein (SNAP) are ubiquitous components of vesicular transport pathways. However, the precise role they play is not known. On the basis that NSF and SNAP can be recruited to preformed SNARE complexes, it has been proposed that NSF- and SNAP-containing complexes are formed after SNARE-dependent docking of transport vesicles. This would enable ATPase-dependent complex disassembly to be coupled directly to membrane fusion. Alternatively, binding and release of NSF/SNAP may occur before vesicle docking, and perhaps be involved in the activation of SNAREs. To gain more information about the point at which so-called 20S complexes form during the transport vesicle cycle, we have examined NSF/SNAP/SNARE complex turnover on clathrin-coated vesicle-derived membranes in situ. This has been achieved under conditions in which the extent of membrane docking can be precisely monitored. We demonstrate by UV-dependent cross-linking experiments, coupled to laser light-scattering analysis of membranes, that complexes containing NSF, SNAP, and SNAREs will form and dissociate on the surface of undocked transport vesicles.

Surreptitious observation of responses to hypnotically suggested hallucinations: a test of the compliance hypothesis

Suggestions for arm levitation and for visual, auditory, tactile, and taste hallucinations were administered twice via audiotape to a group of high suggestible students and low suggestible simulators. During one of the administrations, participants were led to believe they were alone, but their behavior was surreptitiously recorded on videotape and observed on a video monitor. During the other administration, they were observed openly by an experimenter who had not been informed about group assignment. When unaware that they were being observed, simulators were significantly less responsive to suggestion and engaged in substantially more role-inappropriate behavior. In contrast, the responsiveness of nonsimulating students was not affected by the presence of an experimenter, and they exhibited little role-inappropriate behavior even when alone. These data indicate that the responses of suggestible individuals reflect internally generated changes in experience and are not due to simple intentional compliance (i.e., faking).

Structural characterisation of two forms of procyclic acidic repetitive protein expressed by procyclic forms of Trypanosoma brucei

A procyclic acidic repetitive protein (PARP) fraction was purified from long-term cultures of Trypanosoma brucei procyclic forms by a solvent-extraction and reverse phase chromatography procedure. The PARP fraction yielded small quantities of a single N-linked oligosaccharide with the structure Man alpha1-6(Man alpha1-3)Man alpha1-6(Man alpha1-3)Manbeta1-4GlcNAcbeta1-4GlcNAc (Man5GlcNAc2). Fractionation of PARP on Con A-Sepharose revealed that the majority (80 to 90%) of the PARP fraction did not bind to Con A and was composed of the parpA alpha gene product that contains repeats of -Glu-Pro-Pro-Thr- (GPEET-PARP) and that lacks an N-glycosylation site. This form of PARP has not been previously identified at the protein-level. The minor Con-A-binding fraction was shown to be rich in the previously described form of PARP, encoded by the parpAbeta and/or parpB alpha genes, that contains a -Glu-Pro- repeat domain (EP-PARP) and an N-glycosylation site. Analysis of longer and shorter-term cultures suggested that procyclic cells initially express predominantly EP-PARP that is gradually replaced by GPEET-PARP. Both forms of PARP were shown to contain indistinguishable glycosylphosphatidylinositol (GPI) membrane anchors, where the conserved GPI core structure is substituted by heterogeneous sialylated branched polylactosamine-like structures that are predicted to form a dense surface glycocalyx above which the polyanionic -Glu-Pro-Pro-Thr- and -Glu-Pro- repeat domains are displayed. The phosphatidylinositol (PI) component of the GPI anchor was shown to be a mixture of 2-O-acyl-myo-inositol-1-HPO4-(sn-1-stearoyl-2-lyso-glycerol) and 2-O-acyl-myo-inositol-1-HPO4-(sn-1-octadecyl-2-lyso-glycerol), where the acyl chain substituting the inositol ring showed considerable heterogeneity. Mass spectrometric and light scattering experiments both suggested an average mass of approximately 15 kDa for GPEET-PARP, with individual glycoforms ranging from about 12 kDa to 20 kDa, that is consistent with its amino acid and carbohydrate composition. A measured translational diffusion coefficient of 3.9 x 10(7) cm2 s(-1) indicates that this molecule has a highly elongated shape. The possible functions of these unusual glycoproteins are discussed.

Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product

BACKGROUND

Aspirin products are known to cause irritation and injury to the gastric mucosa. The belief that enteric-coated and buffered varieties are less likely to occasion major upper-gastrointestinal bleeding (UGIB) than plain aspirin was tested in data from a multicentre case-control study.

METHODS

550 incident cases of UGIB admitted to hospital with melaena or haematemesis and confirmed by endoscopy, and 1202 controls identified from population census lists, were interviewed about use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) during the 7 days before the onset of bleeding (cases) or interview (controls). Relative risks of UGIB for each type of aspirin used regularly (at least every other day) were calculated overall, and according to dose, by multiple logistic regression, with control for age, sex, marital status, date, education, cigarette smoking, alcohol use, and use of NSAIDs.

FINDINGS

The relative risks of UGIB for plain, enteric-coated, and buffered aspirin at average daily doses of 325 mg or less were 2.6, 2.7, and 3.1, respectively. At doses greater than 325 mg, the relative risk was 5.8 for plain and 7.0 for buffered aspirin; there were insufficient data to evaluate enteric-coated aspirin at this dose level. There were no important differences in risk attributable to the three aspirin forms according to bleeding site (gastric vs duodenal), or when users of NSAIDs were excluded.

INTERPRETATION

Use of low doses of enteric-coated or buffered aspirin carries a three-fold increase in the risk of major UGIB. The assumption that these formulations are less harmful than plain aspirin may be mistaken.

Type VI collagen is present in human and bovine vitreous

BACKGROUND

Heterotypic (mixed) collagen fibrils that contain collagen types II, IX and V/XI have previously been identified in vitreous gel. The purpose of this study was to determine whether vitreous gel also contains type VI collagen microfibrils, as they are widely distributed in other tissues where they may play an important structural role.

METHODS

Bovine and human vitreous gel was analysed by rotary shadowing electron microscopy after bacterial collagenase digestion and gel filtration chromatography. Bovine vitreous was extracted in 4 M guanidine hydrochloride, and following isopycnic centrifugation fractions were analysed by western blotting.

RESULTS

Type VI collagen microfibrils were identified by electron microscopy in human and bovine vitreous. Type VI collagen was identified by western blot analysis.

CONCLUSION

Type VI collagen is present in vitreous and may participate in the structural assembly of the vitreous gel.

What cost chronic pain?

Chronic non-malignant pain costs the American economy $40 billion a year. An attempt to quantify the total cost to the Irish economy of 95 patients attending a Multi-Disciplinary Pain Clinic was made. The cost to the Health Services was estimated and added to the amount of Social Welfare payments received and the lost earnings of each patient. The results indicated that the 95 patients cost 1.9 million pounds at the time of referral. A subgroup of 22 patients who were younger and unemployed, accounted for 1.5 million pounds. Allocation of resources to treat these patients is necessary.

The effects of hospital admission on drug prescribing in an elderly population

307 consecutive patients admitted to our unit were studied. The reasons for altering patients' drug regimens were noted. The price difference between the patients' drugs on admission to those on discharge was calculated. While over 40% of drugs regimens on admission were unchanged on discharge some adjustments were made in the remainder. The most common reason for stopping a drug was that the hospital physician could find no indication for its use. A 30.3% reduction in price of discharge drugs compared with drugs on admission was achieved.