A small regulatory element from chromosome 19 enhances liver-specific gene expression

Tissue-specific promoters for gene therapy are typically too big for adeno-associated virus (AAV) vectors; thus, the exploration of small effective non-viral regulatory elements is of particular interest. Wild-type AAV can specifically integrate into a region on human chromosome 19 termed AAVS1. Earlier work has determined that a 347 bp fragment (Chr19) of AAVS1 has promoter and transcriptional enhancer activities. In this study, we further characterized this genetic regulation and investigated its application to AAV gene therapy in vitro and in vivo. The Chr19 347 bp fragment was dissected into three regulatory elements in human embryonic kidney cells: (i) TATA-independent promoter activity distributed throughout the fragment regardless of orientation, (ii) an orientation-dependent insulator function near the 5' end and (iii) a 107 bp enhancer region near the 3' end. The small enhancer region, coupled to the mini-CMV promoter, was used to drive the expression of several reporters following transduction by AAV2. In vivo data demonstrated enhanced transgene expression from the Chr19-mini-CMV promoter cassette after tail vein injection primarily in the liver at levels comparable to the chicken beta-actin promoter and higher than the liver-specific TTR promoter (>2-fold). However, we did not observe this increase after muscle injection, suggesting tissue-specific enhancement. All of the results support identification of a small DNA fragment (347 bp) from AAV Chr19 integration site capable of providing efficient and enhanced liver-specific transcription when used in recombinant AAV vectors.

Where, what, why: Mr. Q on the Web

John Naisbitt, in his 1982 book "Megatrends," postulated an important characteristic of our information and knowledge society: "We are drowning in information but starved for knowledge." Today, in the age of the Information and Knowledge society, we are faced with this problem every single day, because Web searches and information selection are highly time-consuming activities. Internet search engines attempt to employ intelligent search algorithms in order to optimize their search results. Nevertheless, the question remains how "qualitative knowledge" can be selected, ie, knowledge needed for supporting decisions in medicine and dentistry. Semantic search engines are one current approach to this problem. For this reason, a project entitled "Mr. Q, your personal Web Assistant" has been initiated and will be introduced in this paper.

Predictive flavor symmetries of the neutrino mass matrix

Here we propose an A(4) flavor symmetry model that implies a lower bound on the neutrinoless double beta decay rate, corresponding to an effective mass parameter M{ee} > or similar to 0.03 eV, and a direct correlation between the expected magnitude of CP violation in neutrino oscillations and the value of sin{2}theta{13}, as well as a nearly maximal CP phase delta.

Effect of the WHI study on the attitude of Israeli gynecologists to hormonal therapy during menopause

OBJECTIVE

To evaluate the attitude of Israeli gynecologists to the use of hormonal therapy (HT) during menopause consequent to the recent publication of the Women's Health Initiative (WHI) study.

DESIGN

Gynecologists present at the annual convention of the Israeli Society of Obstetrics and Gynecology in the community were asked to complete a 5-item questionnaire on their opinions regarding hormone therapy (HT) use in light of the WHI study.

RESULTS

Ninety-five percent of the physicians believed that HT is still a legitimate treatment modality during menopause, although almost 40% would now limit it to the management of climacteric symptoms. As a result of the WHI study, 65% of the physicians recommended cessation of HT use in up to 30% of their treated postmenopausal patients. The responders estimated that about 40% of their patients using HT ceased treatment on their own initiative following publication of the WHI study.

CONCLUSIONS

Both physicians and patients were clearly influenced by the WHI study. Today, HT is being reserved by most gynecologists in Israel for the treatment of menopausal symptoms and is not being used as a preventive measure against future complications of heart disease and osteoporosis.

Efficacy and safety of standard versus low-dose Femarelle (DT56a) for the treatment of menopausal symptoms

OBJECTIVE

In a previous study treatment with a daily standard dose of Femarelle (644 mg/day) resulted in a significant elevation in bone mineral density (BMD) while a reduced dose resulted in a decrease in BMD. The aim of the current study was to examine the efficacy and safety of the two doses of Femarelle in the treatment of menopausal symptoms.

MATERIALS AND METHODS

Eighty healthy postmenopausal women were randomly allocated to receive either the standard dose (SD) or low dose (LD) of Femarelle (644 mg/day vs 344 mg/day). A detailed medical history was taken on enrollment, followed by a physical examination, pelvic ultrasound, and sex hormone and lipid profiles. A detailed Kupperman index for each patient was completed. These measures were repeated every three months for 12 months.

RESULTS

In both groups there was a significant reduction in the Kupperman index following 12 weeks of treatment, which was sustained throughout the 12 months of treatment (p < 0.01). Seventy-six percent of the patients in the SD group reported a decrease in vasomotor symptoms and seventy eight % in the LD group (NS). This decrease was sustained following 12 months of treatment. There was no change in TSH and sex hormone levels or endometrial thickness during the study period.

CONCLUSIONS

In the current study we found that menopausal symptoms were reduced similarly by LD and SD, however for the combined treatment of menopausal symptoms and osteoporosis the standard dosage of 644 mg/day of Femarelle is needed.

Current approach to fracture prevention in postmenopausal osteoporosis

The prevention and management of osteoporosis are becoming increasingly prominent concerns as the number of postmenopausal women reaching old age continues to grow. Often the first sign of osteoporosis is a fractured bone. It is important that women with low bone density be identified as early as possible and measures taken to reverse the process. These include proper diet and exercise, supplements of calcium and vitamin D, and in cases with proven osteoporosis, antiresorptive or anabolic agents to improve bone strength. Women should also be cautioned to avoid falling as much as possible.

Significant dominance of fibrinogen over immunoglobulins, C-reactive protein, cholesterol and triglycerides in maintaining increased red blood cell adhesiveness/aggregation in the peripheral venous blood: a model in hypercholesterolaemic patients

BACKGROUND

It is not clear what is the relative importance of fibrinogen, immunoglobulins, highly sensitive C-reactive protein (hs-CRP), cholesterol and triglyceride concentrations on the appearance of aggregated red blood cells in the peripheral blood.

DESIGN

Six hypercholesterolaemic patients undergoing regular LDL apheresis that were examined repeatedly before and following the procedure.

RESULTS

We determined the degree of erythrocyte adhesiveness/aggregation in relation to the concentration of the above-mentioned macromolecules in 80 samples. In a linear logistic regression the respective R2 values for fibrinogen, total cholesterol, triglycerides, hs-CRP, IgG, IgM and IgA were 0.45 (P<0.0001), 0.2 (P<0.0001), 0.02 (P=0.02), 0.001 (P=NS) and 0.002 (P=NS), respectively. We further analyzed the potential of ApoA, ApoB and Lpa to participate in red cell adhesiveness/aggregation and found them to be not significant.

CONCLUSIONS

In a milieu of adhesive macromolecules, lipids and inflammation-sensitive proteins including fibrinogen, total cholesterol, triglycerides, hs-CRP and immunoglobins G, M and A, fibrinogen has a dominant role in maintaining the red blood cell adhesiveness/aggregation in the peripheral venous blood. These findings are relevant for the research directed at finding new apheretic modalities to reduce the degree of red blood cell adhesiveness/aggregation in the peripheral blood.

Cytomegalovirus (CMV) and human immunodeficiency virus (HIV) burden, CMV end-organ disease, and survival in subjects with advanced HIV infection (AIDS Clinical Trials Group Protocol 360)

We undertook a prospective study to analyze cytomegalovirus (CMV) end-organ disease (EOD) in subjects with advanced human immunodeficiency virus (HIV) infection. Of 403 individuals without prior CMV EOD who were followed up for a median of 151 weeks, 56 died and 21 developed CMV EOD. Twenty of the subjects with CMV EOD had CD4 cell counts of < or =50 cells/mm3 and HIV RNA level of >10,000 copies/mL of plasma at baseline; in these 20 subjects, an increase of CMV DNA level to greater than the quantification limits was associated with CMV EOD. A CD4 cell count of < or =100 cells/mm3 and an HIV RNA level of >10,000 copies/mL of plasma at baseline, a CMV DNA level of >200 copies/mL of blood during follow-up, or development of CMV EOD were all associated with decreased survival. HIV-infected subjects with CD4 cell counts of < or =50 cells/mm3 and HIV RNA levels of >10,000 copies/mL of plasma should have blood fractions screened for CMV DNA; if CMV DNA is detected, CMV prophylaxis might be considered.

New advanced operational regime on the W7-AS stellarator

A promising new plasma operational regime on the Wendelstein stellarator W7-AS has been discovered. It is extant above a threshold density and characterized by flat density profiles, high energy and low impurity confinement times, and edge-localized radiation. Impurity accumulation is avoided. Quasistationary discharges with line-averaged densities n(e) to 4 x 10(20) m(-3), radiation levels to 90%, and partial plasma detachment at the divertor target plates can be simultaneously realized. Energy confinement is up to twice that of a standard scaling. At B(t) = 0.9 T, an average beta value of 3.1% is achieved. The high n(e) values allow demonstration of electron Bernstein wave heating using linear mode conversion.

Distributed laser refrigeration

A 250-mum-diameter fiber of ytterbium-doped ZBLAN (fluorine combined with Zr, Ba, La, Al, and Na) has been cooled from room temperature. We coupled 1.0 W of laser light from a 1013-nm diode laser into the fiber. We measured the temperature of the fiber by using both fluorescence techniques and a microthermocouple. These microthermocouple measurements show that the cooled fiber can be used to refrigerate materials brought into contact with it. This, in conjunction with the use of a diode laser as the light source, demonstrates that practical solid-state laser coolers can be realized.

Three-dimensional supramolecular organization of the extracellular matrix in human and rabbit corneal stroma, as revealed by ultrarapid-freezing and deep-etching methods

The present work was carried out to clarify the three-dimensional fine structure of extracellular matrix in the cornea, using ultrarapid-freezing and deep-etching methods for electron microscopy. Fresh and glutaraldehyde-fixed samples of human and rabbit posterior corneas were ultrarapidly-frozen onto a copper block cooled by liquid helium or liquid nitrogen, freeze-fractured, deeply etched for 8-10 min and rotary replicated with platinum-carbon. Replicas were examined in a transmission electron microscope equipped with a tilting device. Only structures with repeatedly observed, similar architectural profiles free from ice crystal damage, were taken into account. The very recognizable major collagen fibrils revealed 8-10 nm subfibrils running helically along the fibril long axis. The other extracellular matrix components consisted of: (1) 8-12 nm interfibrillar bridging filaments, frequently ornamented with globular domains, joining neighbouring collagen fibrils like steps of a ladder; (2) 10-20 nm filaments with relatively large globular domains, running on the surface of collagen fibrils along their long axes, and projecting finger-like structures into interfibrillar spaces sometimes attaching to adjacent collagen fibrils; (3) 10-15 nm beaded filaments with a periodicity of 75-110 nm, forming extended networks, especially at the interlamellar interfaces; and (4) 8-14 nm straight or sinuous strands consisting of 4-6 nm repeating subunits or modules, forming extended sheets by lateral association at the Descemet's membrane/stroma interface. In the light of the information available from studies on the localization of extracellular matrix components in the cornea, and by reference to the structural models of extracellular matrix molecules and macromolecular assemblies, we have related the deep-etched extracellular matrix structures described above to: (1) proteoglycans; (2) fibril-associated collagens with interrupted triple helices or FACIT collagens; (3) type VI collagen; and (4) fibronectin, respectively.

[Guilt and subjective feelings of guilt in the context of separation and divorce]

In this paper the vicissitudes of guilt and responsibility and development and function of guilt feelings are discussed in the context of the typical family dynamics in cases of divorce (delegation, claiming of loyalty, parentification). The "guilt" of the parents is often transformed to the feeling of guilt of the children in the sense of a traumatic feeling of guilt. This happens especially when sufficient mourning is not possible. Feelings of guilt by reason of the mere existence of the child (basic feelings of guilt) and the oedipal and other feelings of guilt out of rivalry can be reinforced (feelings of guilt out of vitality). Strivings for separation may be connected with guilt by the children (feelings of guilt regarding separation). The recognition of the adults' responsibility (especially choice of partners, functionalization of the child to facilitate the separation from the own parents, to maintain the image of an intact family or the struggle for power at the cost of the children) diminishes the feelings of guilt of the children.

Plasma population pharmacokinetics and penetration into cerebrospinal fluid of indinavir in combination with zidovudine and lamivudine in HIV-1-infected patients

OBJECTIVES

To evaluate plasma population pharmacokinetics and penetration into cerebrospinal fluid (CSF) by indinavir (IDV) in HIV-infected individuals receiving IDV, zidovudine and lamivudine.

METHODS

Plasma population pharmacokinetic analysis was performed on 805 IDV plasma values from 171 patients, using a non-linear mixed-effects modeling approach. CSF data from 19 patients were analyzed using an individual approach.

RESULTS

Mean individual Bayesian estimates for oral clearance (CL) and volume of distribution (V) by the final model that incorporated interoccasion variability were 0.75 l/h per kg [coefficient of variation (CV) 54.8%] and 1.74 l/kg (CV 82.7%), respectively. Mean model-predicted plasma IDV level at 8 h, maximal level, area under the plasma level-time curve up to 8 h and plasma half-life were 0.42 micromol/l (CV 57.5%), 9.51 micromol/l (CV 47.3%), 29.56 micromol/l x h (CV 46.9%) and 1.50 h (CV 20.9%), respectively. The mean IDV CSF level was 0.11 micromol/l (CV 49.7%) and the mean CSF:plasma concentration ratio was 0.017.

CONCLUSIONS

Population estimates of pharmacokinetic parameters of IDV and its CSF penetration were in excellent agreement with previously reported data from individual analyses. Intraindividual interoccasion variability of IDV pharmacokinetics was estimated to be of similar order of magnitude to its interindividual variability, which may affect response to long-term antiretroviral therapy involving IDV. CSF levels of IDV exceeded its in vitro 95% inhibitory concentration of HIV replication. Given that CSF is virtually free of protein, viral suppression in the central nervous system should be achievable with an IDV-containing regimen.

Verification of the drug history given by potential blood donors: results of drug screening that combines hair and urine analysis

BACKGROUND

Besides modern virus-screening methods, the avoidance of transfusion transmission of viral diseases is based on the best possible selection of healthy donors. Unfortunately, most of the relevant behavior-related risk factors are not accessible to objective verification. Drug screening can be used to validate a defined section of donor statements. It may be assumed that donors who conceal drug consumption may also conceal other relevant risk factors.

STUDY DESIGN AND METHODS

Hair and urine samples from 186 young potential donors who denied having consumed drugs were investigated by gas chromatography with mass selective detection and a urine fluorescence polarization immunoassay for cannabinoids, amphetamine and amphetamine derivatives, cocaine, and opiates.

RESULTS

Ten potential donors with 14 positive results on hair and urine analyses (6x cannabinoids, 4x cocaine, 1x opiates, 3x dihydrocodeine) could be identified in the population investigated.

CONCLUSIONS

The donor history is not adequate for identifying potential donors with risk factors. Deliberately false statements concerning risk factors are a clear breach of trust between the blood bank and potential donors. These unreliable donors represent an incalculable risk for the transfusion recipient. Therefore, it is appropriate to validate donor statements about drug consumption by random hair and urine analyses and to exclude from the donor pool all persons revealed as drug users.

In search of the elusive zonal flow using cross-bicoherence analysis

We show that the modulational instability growth rate of zonal flows is determined directly from the quasilinear wave kinetic equation. We also demonstrate the relation between zonal-flow growth and the cross bispectrum of the high-frequency drift-wave-driven Reynolds stress and the low-frequency plasma potential by explicit calculation. Experimental measurements of the spatiotemporal evolution of the spectrum integrated bicoherence at the L-->H transition near the edge shear layer indicate a modification in the nonlinear phase coupling, which might be linked to the generation of sheared ExB flows.