SGI1-K, a variant of the SGI1 genomic island carrying a mercury resistance region, in Salmonella enterica serovar Kentucky

A multiple-antibiotic-resistant Salmonella enterica serovar Kentucky strain was found to contain SGI1-K, a variant form of the Salmonella genomic island 1 (SGI1) with an In4-type class 1 integron that contains only one cassette array, aacCA5-aadA7, and an adjacent mercury resistance module. Part of the 3'-conserved segment (3'-CS) of the integron, together with the inverted short segment from the right-hand end of the integron transposition module normally found between the 3'-CS and IS6100 in In4 family integrons, has been removed by an IS6100-mediated deletion. IRt, the right-hand inverted repeat found at the outer end of the integron, abuts a mercury resistance region instead of the usual SGI1 backbone segment. The mer module is a hybrid of those found in Tn501 and Tn21. This mer region and a further uncharacterized segment of at least 10 kb appear to have been incorporated between IRt and the SGI1 backbone. These findings demonstrate that the multidrug resistance region in SGI1 can incorporate new DNA segments in the same way as multiple antibiotic resistance regions in plasmids.

The dodecameric vanadium-dependent haloperoxidase from the marine algae Corallina officinalis: cloning, expression, and refolding of the recombinant enzyme

The dodecameric vanadium-dependent bromoperoxidase from Corallina officinalis has been cloned and over-expressed in Escherichia coli. However, the enzyme was found to be predominantly in the form of inclusion bodies. This protein presents a challenging target for refolding, both due to the size (768kDa) and quaternary structure (12x64kDa). Successful refolding conditions have been established which result in an increase in the final yield of active bromoperoxidase from 0.5mg to 40mg per litre of culture. The refolded protein has been characterised and compared to the native enzyme and was shown to be stable at temperatures of 80 degrees C, over a pH range 5.5-10 and in organic solvents such as ethanol, acetonitrile, methanol, and acetone. The novel refolding approach reported in this paper opens up the full potential of this versatile enzyme for use in large scale biotransformation studies.

The biomechanical response of spinal cord tissue to uniaxial loading

The spinal cord is an integral component of the spinal column and is prone to physical injury during trauma or more long-term pathological insults. The development of computational models to simulate the cord-column interaction during trauma is important in developing a proper understanding of the injury mechanism. Such models would be invaluable in seeking both preventive strategies that reduce the propensity for injury and identifying specific treatment regimes. However, these developments are hampered by the limited information available on the structural and mechanical properties of this soft tissue owing to the difficulty in handling this material in a cadaveric situation. The purpose of the present paper is to report the rapid deterioration in the quality of the tissues once excised, which provides a further challenge to the successful elucidation of the structural properties of the tissue. In particular, the tangent modulus of the tissue is seen to increase sharply over a period of 72 h.

Aquariums as reservoirs for multidrug-resistant Salmonella Paratyphi B

Multidrug-resistant Salmonella enterica serovar Paratyphi B dT+ isolates from patients with gastroenteritis were identical with isolates from their home aquariums. Matched isolates had identical phage types, XbaI and IS200 profiles, and Salmonella genomic island 1 (SGI1). Ornamental fish tanks are reservoirs for SGI1-containing S. Paratyphi B dT+.

Recombination between the dfrA12-orfF-aadA2 cassette array and an aadA1 gene cassette creates a hybrid cassette, aadA8b

Homologous recombination between closely related gene cassettes, such as aadA1 and aadA2, which are 89% identical, can create hybrid cassettes and hybrids of existing cassette arrays. A new cassette array, dfrA12-orfF-aadA8b, which was created by such a recombination event occurring within the aadA2 cassette in the dfrA12-orfF-aadA2 array, has been identified.

The genomic island SGI1, containing the multiple antibiotic resistance region of Salmonella enterica serovar Typhimurium DT104 or variants of it, is widely distributed in other S. enterica serovars

The global dissemination of the multiply-antibiotic-resistant Salmonella enterica serovar Typhimurium DT104 clone with the resistance genes located in a class 1 integron, here designated In104, within genomic island SGI1 is a significant public health issue. Here, we have shown that SGI1 and variants of it carrying different combinations of resistance genes are found in several Salmonella enterica serovars. These are serovars Cerro, Derby, Dusseldorf, Infantis, Kiambu, and Paratyphi B dT(+) isolated from human infections and serovar Emek from sewage effluent. Two new variants, SGI1-I and SGI1-J, both of which include the dfrA1-orfC cassette array, were identified.

New integron-associated gene cassette encoding a 3-N-aminoglycoside acetyltransferase

A fifth gene cassette containing an aacC gene, aacCA5, was found in an aacCA5-aadA7 cassette array in a class 1 integron isolated from a multiply drug resistant Salmonella enterica serovar Kentucky strain. The AacC-A5 or AAC(3)-Ie acetyltransferase encoded by aacCA5 is related to other AAC(3)-I enzymes and confers resistance to gentamicin.

Complex multiple antibiotic and mercury resistance region derived from the r-det of NR1 (R100)

The sequence of the 45.2-kb multidrug and mercury resistance region of pRMH760, a large plasmid from a clinical isolate of Klebsiella pneumoniae collected in 1997 in Australia, was completed. Most of the modules found in the resistance determinant (r-det), or Tn2670, region of NR1 (also known as R100), isolated from a Shigella flexneri strain in Japan in the late 1950s, were present in pRMH760 but in a different configuration. The location was also different, with the Tn2670-derived region flanked by the transposition module of Tn1696 and a mercury resistance module almost identical to one found in the plasmid pDU1358. This arrangement is consistent with a three-step process. First, the r-det was circularized via homologous recombination between the IS1 elements and reincorporated at a new location, possibly in a different plasmid, via homologous recombination between the 5'-conserved (5'-CS) or 3'-CS of the In34 integron in the r-det and the same region of a second class 1 integron in a Tn1696 relative. Subsequently, resolvase-mediated recombination between the res sites in the r-det and a second mercury resistance transposon removed one end of the Tn1696-like transposon and part of the second transposon. Other events occurring within the r-det-derived portion have also contributed to the formation of the pRMH760 resistance region. Tn2 or a close relative that includes the bla(TEM-1b) gene had moved into the Tn21 mercury resistance module with subsequent deletion of the adjacent sequence, and all four 38-bp inverted repeats corresponding to Tn21 family transposon termini have been interrupted by an IS4321-like element.

A dynamic investigation of the burst fracture process using a combined experimental and finite element approach

Spinal burst fractures account for about 15% of spinal injuries and, because of their predominance in the younger population, there are large associated social and healthcare costs. Although several experimental studies have investigated the burst fracture process, little work has been undertaken using computational methods. The aim of this study was to develop a finite element model of the fracture process and, in combination with experimental data, gain a better understanding of the fracture event and mechanism of injury. Experimental tests were undertaken to simulate the burst fracture process in a bovine spine model. After impact, each specimen was dissected and the severity of fracture assessed. Two of the specimens tested at the highest impact rate were also dynamically filmed during the impact. A finite element model, based on CT data of an experimental specimen, was constructed and appropriate high strain rate material properties assigned to each component. Dynamic validation was undertaken by comparison with high-speed video data of an experimental impact. The model was used to determine the mechanism of fracture and the postfracture impact of the bony fragment onto the spinal cord. The dissection of the experimental specimens showed burst fractures of increasing severity with increasing impact energy. The finite element model demonstrated that a high tensile strain region was generated in the posterior of the vertebral body due to the interaction of the articular processes. The region of highest strain corresponded well with the experimental specimens. A second simulation was used to analyse the fragment projection into the spinal canal following fracture. The results showed that the posterior longitudinal ligament became stretched and at higher energies the spinal cord and the dura mater were compressed by the fragment. These structures deformed to a maximum level before forcing the fragment back towards the vertebral body. The final position of the fragment did not therefore represent the maximum dynamic canal occlusion.

Determination of the trabecular bone direction from digitised radiographs

There is increasing evidence for monitoring the bone trabecular structure to explain, in part, the mechanical properties of bone. Despite the emergence of Computed Tomography, a radiograph is the standard format as it is cheap and used for assessing implant performance. Furthermore, various image-processing techniques developed to assess the trabecular structure from radiographs have regained interest owing to improvements in imaging equipment. This study assessed the precision and accuracy of the Co-occurrence and Run-length matrix, Spatial-frequency and Minkowski-fractal techniques to infer the trabecular direction from radiographs. Ten clinical images of femoral neck regions were obtained from digitised pelvic radiographs and subsequently analysed. These data were also used to generate synthetic images where the trabecular thickness, separation and directions were controlled in order to calculate the accuracy of the techniques. Additionally, a Laplacian noise was added in order to infer the precision of the techniques. All methods assessed the trabecular direction with a high degree of accuracy in these synthetic images including a single direction and no noise. However, only the Spatial-frequency and Co-occurrence matrix methods performed well on the clinical and heavily corrupted synthetic images. This demonstrated the possibility of inferring a linear trabecular direction in clinical conditions.

Comparison of the structure–activity relationships of the integron-associated recombination sites attI3 and attI1 reveals common features

Incorporation of gene cassettes into integrons occurs by IntI-mediated site-specific recombination between a 59-base element (59-be) site in the cassette and an attI site in the integron. While the 59-be sites share common features and are recognized by several different IntI recombinases, the sequences of attI sites are not obviously related and are preferentially recognized by the cognate IntI. To determine the features of attI sites that are required for recombination proficiency, the structure–activity relationships of a second attI site, the attI3 site from the class 3 integron, were examined. The attI3 site was confined to within a region consisting of 68 bp from the integron backbone and 15 bp from the adjacent cassette. This region includes four IntI3-binding sites, as assessed by gel shift and methylation interference studies. Two of the binding sites are inversely oriented and constitute a simple site that includes the recombination crossover point. The two additional binding sites appear to be directly oriented and one of them is essential for efficient recombination of the attI3 site with a 59-be, but not for recombination with a second full-length attI3 site, which occurs at 100-fold lower frequency. The fourth site enhances attI3 with 59-be recombination 10-fold. The finding that the organization and overall properties of attI3 are very similar to those of attI1 indicates that these features are likely to be common to all attI sites.

The IS1111 family members IS4321 and IS5075 have subterminal inverted repeats and target the terminal inverted repeats of Tn21 family transposons

IS5075 and IS4321 are closely related (93.1% identical) members of the IS1111 family that target a specific position in the 38-bp terminal inverted repeats of Tn21 family transposons and that are inserted in only one orientation. They are 1,327 bp long and have identical ends consisting of short inverted repeats of 12 bp with an additional 7 bp (TAATGAG) or 6 bp (AATGAG) to the left of the left inverted repeats and 3 bp (AGA) or 4 bp (AGAT) to the right of the right inverted repeat. Circular forms of IS5075 and IS4321 in which the inverted repeats are separated by abutting terminal sequences (AGATAATGAG) were detected. A similar circular product was found for the related ISPa11. Transposition of IS4321 into the 38-bp target site was detected, but a flanking duplication was not generated. The precisely reconstituted target site was also identified. Over 50 members of the IS1111 family were identified. They encode related transposases, have related inverted repeats, and include related bases that lie outside these inverted repeats. In some, the flanking bases number 5 or 6 on the left and 4 or 3 on the right. Specific target sites were found for several of these insertion sequence (IS) elements. IS1111 family members therefore differ from the majority of IS elements, which are characterized by terminal inverted repeats and a target site duplication, and from members of the related IS110 family, which do not have obvious inverted repeats near their termini.

In34, a complex In5 family class 1 integron containing orf513 and dfrA10

A complex class 1 integron, In34, found in a conjugative plasmid from a multidrug-resistant Klebsiella pneumoniae strain isolated in 1997 at a hospital in Sydney, Australia, was shown to have a backbone related to that of In2, which belongs to the In5 family. In In34, the aadB gene cassette replaces the aadA1a cassette in In2, and two additional resistance genes, dfrA10 and aphA1, that are not part of a gene cassette are present. The aphA1 gene is in a Tn4352-like transposon that is located in the tniA gene. The dfrA10 gene lies adjacent to a 2,154-bp DNA segment, known as the common region, that contains an open reading frame predicting a product of 513 amino acids (Orf513). Orf513 is 66 and 55% identical to the products of two further open reading frames that, like the common region, are found adjacent to antibiotic resistance genes. A 27-bp conserved sequence was found at one end of each type of common region. The loss of dfrA10 due to homologous recombination between flanking direct repeats and incorporation of the excised circle by homologous recombination were demonstrated. Part of In34 is identical to the sequenced portion of In7, which is from a multidrug-resistant Escherichia coli strain that had been isolated 19 years earlier in the same hospital. In34 and In7 are in plasmids that contain the same six resistance genes conferring resistance to ampicillin, chloramphenicol, gentamicin, kanamycin, neomycin, tobramycin, trimethoprim, and sulfonamides, but the plasmid backbones appear to be unrelated, suggesting that translocation of a multiple-drug-resistance-determining region as well as horizontal transfer may have occurred.

Integron-encoded IntI integrases preferentially recognize the adjacent cognate attI site in recombination with a 59-be site

Integrons have the capacity to capture small mobile elements known as gene cassettes, and this reaction is catalysed by integron-encoded IntI integrases. IntI integrases form a distinct family within the tyrosine recombinase superfamily and include a characteristic additional domain that is well conserved. Two different IntI enzymes were used to examine their ability to recognize heterologous attI sites in both integration and excision assays. IntI1 and IntI3 are 59% identical and catalyse both integrative and excisive recombination between a cassette-associated 59-be site and the cognate attI1 or attI3 site. Integrative recombination events involving a 59-be and a non-cognate attI site, attI2 and attI3 for IntI1 or attI1 and attI2 for IntI3, were detected extremely rarely. In cassette excision assays, the non-cognate attI3 site was recognized by IntI1, but attI1 was not well recognized by IntI3. The purified IntI1 and IntI3 proteins bound strongly only to their cognate attI site.

Class 1 integron containing a new gene cassette, aadA10, associated with Tn1404 from R151

The carbenicillin, gentamicin, kanamycin, streptomycin, spectinomycin, sulfonamide, and tobramycin resistance determinants found on Pseudomonas aeruginosa plasmid R151 have previously been shown to translocate to another plasmid, R388, and it was inferred that a transposon, Tn1404, carried the resistance determinants. Sequencing of the cassette array from the plasmid known as R388::Tn1404 revealed two known gene cassettes, oxa10 and aadB, and a previously unidentified cassette determining resistance to streptomycin and spectinomycin, here designated aadA10, in the order oxa10-aadB-aadA10. These cassettes replaced the dfrB2-orfA cassette array of R388, indicating that movement of the resistance determinants from R151 to R388 resulted from recombinational exchange between two class 1 integrons rather than transposition. The AadA10 protein is most closely related to AadA6 (85% identical) and AadA7 (80% identical). The aadA10 cassette found here has only a simple site containing a 7-bp spacer derived from attI1 in place of a 59-base element and is likely to represent a derivative of the complete cassette. IntI1-mediated deletion of the aadA10 cassette was not detected, indicating that this single simple site is either inactive or only weakly active.

Characterization of the class 3 integron and the site-specific recombination system it determines

Integrons capture gene cassettes by using a site-specific recombination mechanism. As only one class of integron and integron-determined site-specific recombination system has been studied in detail, the properties of a second class, the only known class 3 integron, were examined. The configuration of the three potentially definitive features of integrons, the intI3 gene, the adjacent attI3 recombination site, and the P(c) promoter that directs transcription of the cassettes, was similar to that found in the corresponding region (5' conserved segment) of class 1 integrons. The integron features are flanked by a copy of the terminal inverted repeat, IRi, from class 1 integrons on one side and a resolvase-encoding tniR gene on the other, suggesting that they are part of a transposable element related to Tn402 but with the integron module in the opposite orientation. The IntI3 integrase was active and able to recognize and recombine both known types of IntI-specific recombination sites, the attI3 site in the integron, and different cassette-associated 59-be (59-base element) sites. Both integration of circularized cassettes into the attI3 site and excision of integrated cassettes were also catalyzed by IntI3. The attI3 site was localized to a short region adjacent to the intI3 gene. Recombination between a 59-be and secondary sites was also catalyzed by IntI3, but at frequencies significantly lower than observed with IntI1, the class 1 integron integrase.

Characterization and movement of the class 1 integron known as Tn2521 and Tn1405

Two putative transposons, Tn2521 and Tn1405, carrying determinants for the PSE-4 beta-lactamase and for resistance to streptomycin, spectinomycin, and sulfonamides were previously isolated from the chromosome of Pseudomonas aeruginosa Dalgleish. Detailed mapping and determination of the complete sequence of Tn2521 revealed that it is a class 1 integron, here renamed In33, with a backbone structure identical to that of In4 from Tn1696. In33 contains two gene cassettes, blaP1 and aadA1, replacing the aacC1-orfE-aadA2-cmlA1 cassette array in In4. Although In33 does not include any transposition genes, movement of In33 (Tn2521) targeted to a single location in the IncP-1 plasmid R18-18 has been reported previously (M. I. Sinclair and B. W. Holloway, J. Bacteriol. 151:569-579, 1982). A 5-bp duplication of the target, which lies within the res site recognized by the ParA resolvase of R18-18, was present, indicating that the mechanism of movement was transposition. Together, these data indicate that class 1 integrons that are defective in self-transposition can move under appropriate circumstances. The Tn1405 isolate studied was found to represent only the cassette array of In33, which had replaced the cassette array in the recipient plasmid R388, probably by homologous recombination.

Efflux of chloramphenicol by the CmlA1 protein

The cmlA1 gene cassette contains the cmlA1 gene, that confers resistance to chloramphenicol, as well as a promoter and translational attenuation signals, and expression of cmlA1 is inducible by low concentrations of chloramphenicol. The CmlA1 protein encoded by cmlA1 was localised in the inner membrane. Active efflux of chloramphenicol, additional to the endogenous efflux from Escherichia coli cells, was observed when the cmlA1 gene was present and the production of CmlA1 had been preinduced with subinhibitory concentrations of chloramphenicol. Both endogenous and CmlA1-mediated export of chloramphenicol was driven by the proton-motive force.

Indications of disordered eating behaviour in adolescent patients with idiopathic scoliosis

We have investigated whether patients with adolescent-onset idiopathic scoliosis (AIS) are more likely to have a low body-weight. Measurements of weight, height and body mass index (BMI) were made in 44 young women with AIS and compared with age- and gender-adjusted normative data. The body mass criteria of the International Classification of Diseases for eating disorders was used to determine how many patients were within the range considered to be 'eating disordered'. Compared with the normative data, the AIS group did not differ significantly in terms of height, (p = 0.646), but they were significantly lighter (p < 0.001) and had significantly lower BMI scores (p < 0.001); 25% of the series had BMI scores which were within the range considered to be anorexic. The relationship between a diagnosis of AIS and low body-weight may indicate disordered eating and is thus a cause for concern, particularly in the light of the well-established relationship between eating psychopathology and osteoporosis. Aspects of organic health may need to be considered in addition to the cosmetic deformity.

Measurement of canal occlusion during the thoracolumbar burst fracture process

Post-injury CT scans are often used following burst fracture trauma as an indication for decompressive surgery. Literature suggests, however, that there is little correlation between the observed fragment position and the level of neurological injury or recovery. Several studies have aimed to establish the processes that occur during the fracture using indirect methods such as pressure measurements and pre/post impact CT scans. The purpose of this study was to develop a direct method of measuring spinal canal occlusion during a simulated burst fracture by using a high-speed video technique. The fractures were produced by dropping a mass from a measured height onto three-vertebra bovine specimens in a custom-built rig. The specimens were constrained to deform only in the impact direction such that pure compression fractures were generated. The spinal cord was removed prior to testing and the video system set up to film the inside of the spinal canal during the impact. A second camera was used to film the outside of the specimen to observe possible buckling during impact. The video images were analysed to determine how the cross-sectional area of the spinal canal changed during the event. The images clearly showed a fragment of bone being projected from the vertebral body into the spinal canal and recoiling to the final resting position. To validate the results, CT scans were taken pre- and post-impact and the percentage canal occlusion was calculated. There was good agreement between the final canal occlusion measured from the video images and the CT scans.

The effect of socket design, materials and liner thickness on the wear of the porous coated anatomic total hip replacement

The wear of joint replacement prostheses represents the greatest challenge to their continued development. Parameters such as polyethylene quality, liner thickness and metal backing have all been implicated as potential detractors in the search for the lowest-wearing socket. This study examined the effect of these parameters through an extensive study of the two versions of the porous coated anatomic (PCA) hip prosthesis (one-piece socket and snaplock socket). For the whole cohort the wear rate was found to be 88 (SE 10) mm3/year and the clinical wear factor was 2.00 (SE 0.28) x 10(-6) mm3/N m. When the two socket types were investigated individually, the wear factors found were 2.39 (SE 0.44) x 10(-6)mm3/N m and 0.99 (SE 0.25) x 10(-6) mm3/N m for the one-piece and snaplock, respectively. This illustrates that the metal backing per se does not predispose these sockets to rapid wear. The good wear performance of the snaplock liner may be attributed to the high quality of the ultra-high molecular weight polyethylene (UHMWPE) used and the shorter implantation period compared to that for the one-piece design. No correlation was found between the thickness of the liner and the clinical wear factor. Within the range of thicknesses tested here, UHMWPE thickness is not an influential parameter for the hip prosthesis and this is confirmed

Family of class 1 integrons related to In4 from Tn1696

The class 1 integron In28, found in the multidrug resistance transposon Tn1403, was found to be located in the res site of the backbone transposon and is flanked by a 5-bp direct duplication, indicating that it reached this position by transposition. In28 has a backbone structure related to that of In4, but has lost internal sequences, including the sul1 gene, due to an IS6100-mediated deletion. In28 also lacks the partial copy of IS6100 found in In4 and contains different gene cassettes, blaP1, cmlA1, and aadA1. In1, the class 1 integron found in the multidrug resistance plasmid R46, is also located in a putative res site and belongs to the In4 group. In1 has a shorter internal deletion than In28 and has also lost one end. Additional integrons with structures related to In4 were also found in databases, and most of them had also lost either one end or internal regions or both. Tn610 belongs to this group.

The production of novel sordarin analogues by biotransformation

The biotransformation of the fungal protein synthesis inhibitor sordarin is reported. Nine taxonomically diverse organisms supported the isolation and identification of twelve modified products. The structural diversity of the biotransformation products observed and their value in supporting further chemistry is discussed.

Efficiency of recombination reactions catalyzed by class 1 integron integrase IntI1

The class 1 integron integrase, IntI1, recognizes two distinct types of recombination sites, attI sites, found in integrons, and members of the 59-be family, found in gene cassettes. The efficiencies of the integrative version of the three possible reactions, i.e., between two 59-be, between attI1 and a 59-be, or between two attI1 sites, were compared. Recombination events involving two attI1 sites were significantly less efficient than the reactions in which a 59-be participated, and the attI1 x 59-be reaction was generally preferred over the 59-be x 59-be reaction. Recombination of attI1 with secondary sites was less efficient than the 59-be x secondary site reaction.

Transposons Tn1696 and Tn21 and their integrons In4 and In2 have independent origins

The first 13.6 kb of the mercury and multidrug resistance transposon Tn1696, which includes the class 1 integron In4, has been sequenced. In4 is 8.33 kb long and contains the 5'-conserved segment (5'-CS) and 2.24 kb of the 3'-conserved segment (3'-CS) flanking four integrated cassettes. The 3'-CS region is followed by one full copy and an adjacent partial copy of the insertion sequence IS6100 flanked, in inverse orientation, by two short segments (123 and 152 bp) from the outer right-hand end of class 1 integrons. This structure is representative of a distinct group of class 1 integrons that differs from In2, found in Tn21, and other related class 1 integrons. In4 does not include transposition genes but is bounded by characteristic 25-bp inverted repeats and flanked by a direct duplication of 5 bp of the target sequence, indicating that it was inserted by a transpositional mechanism. In4 lies between the resII and resI sites of a backbone mercury resistance transposon which is >99.5% identical to Tn5036. Although Tn21 and Tn1696 are both classified as members of the Tn21 subfamily of the Tn3 transposon family, the backbone mercury resistance transposons are only 79 to 96% identical. Tn21 also contains a region of about 0.7 kb not found in Tn1696. The integrons In2 and In4 carrying the antibiotic resistance genes have been inserted at different locations into distinct ancestral mercury resistance transposons. Thus, Tn21 and Tn1696 have independent histories and origins. Other transposons (Tn1403 and Tn1412) that include a class 1 integron also have independent origins. In all except Tn21, the integron is located within the res region of the backbone transposon.

Definition of the attI1 site of class 1 integrons

Integron-encoded integrases recognize two distinct types of recombination site: attI sites, found in integrons, and members of the 59-base element (59-be) family, found in the integron-associated gene cassettes. The class 1 integron integrase, IntI1, catalyses recombination between attI1 and a 59-be, two 59-be, or two attI1 sites, but events involving two attI1 sites are less efficient than the reactions in which a 59-be participates. The full attI1 site is required for high-efficiency recombination with a 59-be site. It is 65 bp in length and includes a simple site, consisting of a pair of inversely oriented IntI1-binding domains, together with two further directly oriented IntI1-binding sites designated strong and weak. However, a smaller region that contains only the simple site is sufficient to support a lower level of recombination with a complete attI1 partner and the features that determine the orientation of attI1 reside within this region. An unusual reaction between the attI1 site and a 59-be appears to be responsible for the loss of the central region of a 59-be to create a potential fusion of two adjacent gene cassettes.

The influence of femoral head surface roughness on the wear of ultrahigh molecular weight polyethylene sockets in cementless total hip replacement

A theoretical relationship was recently proposed relating the wear behavior of polymetric bearing materials articulating against hard counterfaces.(1) This model attempts to predict the influence of surface roughness on wear. Laboratory-based studies have been used to establish the validity of these relationships, but their application to the clinical situation has not been investigated fully. Forty-two retrieved PCA hip joints have been assessed. The total wear volume was calculated from the penetration measured using the shadowgraph method, and roughness of the articulating surfaces was recorded using noncontacting profilometry. The roughness of the explanted femoral heads was observed to increase (median S(a) - 10. 35 nm worn region, 3.05 nm peripheral region), while that of the acetabular liner fell dramatically (median S(a) - 41 nm worn region, 212 nm unworn region). No evidence of a relationship between the topography of the worn regions of the femoral head and that of the acetabular liner could be found. Similarly, the strength of the association between the surface roughness and the clinical wear factor was considerably poorer than that achieved in laboratory experiments. A number of reasons for this observation are proposed. Most deleterious was considered to be the inability of the roughness parameters to describe the damaging features of the surface adequately. Uncertainty as to when the surface of the component degrades during its life serves to introduce further doubt as to the application of the wear models in the clinical environment. In conclusion, this study fails to provide clinical evidence to substantiate the relationship between surface finish and wear rate. The adoption of standardized measurement parameters and techniques would facilitate the direct comparison of joint types and the selection of the most advantageous materials.

Transposon Tn21, flagship of the floating genome

The transposon Tn21 and a group of closely related transposons (the Tn21 family) are involved in the global dissemination of antibiotic resistance determinants in gram-negative facultative bacteria. The molecular basis for their involvement is carriage by the Tn21 family of a mobile DNA element (the integron) encoding a site-specific system for the acquisition of multiple antibiotic resistance genes. The paradigm example, Tn21, also carries genes for its own transposition and a mercury resistance (mer) operon. We have compiled the entire 19,671-bp sequence of Tn21 and assessed the possible origins and functions of the genes it contains. Our assessment adds molecular detail to previous models of the evolution of Tn21 and is consistent with the insertion of the integron In2 into an ancestral Tn501-like mer transposon. Codon usage analysis indicates distinct host origins for the ancestral mer operon, the integron, and the gene cassette and two insertion sequences which lie within the integron. The sole gene of unknown function in the integron, orf5, resembles a puromycin-modifying enzyme from an antibiotic producing bacterium. A possible seventh gene in the mer operon (merE), perhaps with a role in Hg(II) transport, lies in the junction between the integron and the mer operon. Analysis of the region interrupted by insertion of the integron suggests that the putative transposition regulator, tnpM, is the C-terminal vestige of a tyrosine kinase sensor present in the ancestral mer transposon. The extensive dissemination of the Tn21 family may have resulted from the fortuitous association of a genetic element for accumulating multiple antibiotic resistances (the integron) with one conferring resistance to a toxic metal at a time when clinical, agricultural, and industrial practices were rapidly increasing the exposure to both types of selective agents. The compendium offered here will provide a reference point for ongoing observations of related elements in multiply resistant strains emerging worldwide.

Characterisation of a chloramphenicol acetyltransferase determinant found in the chromosome of Pseudomonas aeruginosa

The open reading frame (ORF) in the Pseudomonas aeruginosa chromosome, whose product resembles the chloramphenicol acetyltransferases (CAT) belonging to the CATB family, was cloned and shown to confer resistance to chloramphenicol (Cm) in Escherichia coli. The determinant was therefore named catB7 and the corresponding protein CATB7. When the copy number and expression signals were identical, the catB7 gene conferred resistance to Cm at a level slightly lower than those of three other catB genes. CATB7 resembles other CATBs in that it acetylates Cm but not 1-acetoxy-Cm. For CATB7, the K(m) values for acetyl-CoA and Cm were 5.0-5.4-fold higher than the corresponding values for each of the three other CATB proteins (CATB1, CATB3 and CATB5) examined and the Vmax was 5-6 fold lower. Using PCR, the catB7 gene was found in all six P. aeruginosa strains examined but not in any other species of pseudomonad tested. Weak CAT activity was detected in crude cell extracts from five of the six P. aeruginosa strains. However, this activity did not correlate with the Cm susceptibility of the strains, indicating that catB7 is not likely to be the major determinant of intrinsic Cm resistance in P. aeruginosa.

Mobile gene cassettes and integrons in evolution

Integrons and the site-specific recombination systems encoded by them provide a simple mechanism for the addition of new genes to bacterial chromosomes. Although there is substantial divergence among the four known integron-encoded integrases, they all recognize the recombination sites, known as 59-base elements, that are associated with genes that are packaged in gene cassettes. In contrast, the integron-associated recombination sites, attl sites, are preferentially recognized by the cognate integrase.

The association between rates of wear in retrieved acetabular components and the radius of the femoral head

Current evidence suggests that loosening of the acetabular socket is related to the volume of ultra-high molecular weight polyethylene wear debris generated at the articulating surfaces, through a process of bone resorption. Therefore it is important that the rate of volumetric wear is minimized in an attempt to extend the useful life of the procedure. Laboratory evidence indicates that a reduction in sliding distance would be beneficial in achieving this target and may be attained by a reduction in femoral head radius. To investigate the relationship between femoral head size and the rates of both volumetric wear and penetration, 200 acetabular components were retrieved at the time of revision surgery. The joints had femoral heads ranging in size from 11.1 to 19.8 mm radius. For those sockets that were loose at revision surgery, a significant correlation was observed, between the rate of volumetric wear and the radius of the femoral head. For this cohort an increase in radius of 1 mm resulted in an increased rate of volumetric wear of 5.1 (SE 1.4) mm3/yr. However, the explained variance in the regression was low and exemplifies the multifactorial nature of the wear process. In particular, it is anticipated that the activity of the patient will have a significant effect on the rate at which the debris is produced. No significant correlation was observed between the rate of linear wear and femoral head radius. These results would indicate a benefit in using head sizes of a smaller radius, which generate debris at a reduced rate, and therefore require more time to accumulate large volumes of wear products.

The frictional behaviour of explanted PCA hip prostheses

The frictional characteristic of 22 explanted and two unused PCA total hip arthoplasties were assessed using the Durham hip simulator. The friction of the explanted joints was not found to be significantly different from that of the unused joints. In contrast, explanted Charnley joints often exhibit increased frictional characteristics. This discrepancy is accounted for by the lack of cement ingression in the PCA design.

Observations on the direction of wear in Charnley sockets retrieved at revision

The direction of wear in the acetabular socket has implications for the amount of debris that is generated during movement, for the magnitude of eccentric loading and for the incidence of impingement of the neck. We observed the direction of penetration with respect to a global co-ordinate system in 84 acetabular components retrieved at reoperation. The mean direction of wear relative to the open face of the sockets was found to be 37 degrees with a range from 0 degrees to 87 degrees. For those values determined using the inclination of the socket on the prerevision radiograph, the mean direction of penetration in the coronal plane had a lateral, rather than a medial, component. The mean angle was 84 degrees (SD 17 degrees) with respect to the horizontal. The angle of penetration was found to correlate significantly with the depth, in that the lateral component became larger as the wear progressed. There was also a significant correlation between the rate of penetration and the direction of wear. Despite the theoretical advantage of penetration in the superolateral direction, i.e., along the margin of the socket, in reducing the probability of impingement of the neck, no significant correlation was seen between the angle of penetration and the period of use in vivo. This may suggest that impingement of the femoral neck on the rim of the socket may not be the dominant factor in loosening of the socket but can still be important in a few cases.

Differences in the rates of penetration determined from radiographic and shadowgraphic measurements of acetabular sockets

A number of previous studies have observed a marked difference in the penetration depths recorded between direct and radiographic measurement, although no assessment of how these discrepancies affect the rates of penetration has been undertaken. In this report, the penetration depth of 95 sockets was determined from both prerevision radiographs and casts of the retrieved sockets using the uniradiographic and shadowgraphic techniques, respectively. It was observed that the mean discrepancy between the penetration rates derived from the two measurement methods was 0.046 (SE 0.017) mm yr(-1), which was significantly different from zero at P = .007. It was concluded that the penetration rates derived from this method of radiographic assessment seriously underestimated the true value as measured by a direct method by approximately 20%. As a consequence, the discrepancy in penetration rates between those sockets that are loose at revision surgery (direct measurement) and the general population of acetabular components (radiographic measurement) may not be as large as previously thought.

Prevalence of impingement in explanted Charnley acetabular components

: Impingement of the femoral neck against the rim of the socket bore has often been cited as one of the contributory factors in the acetabular loosening process. However, there has been little research on its clinical prevalence or on the effects of both linear wear and the diameter of the femoral neck. With this aim in mind, 74 Charnley prostheses were examined after being removed at revision surgery and the sockets interrogated for evidence of impingement. The probability of impingement was assessed using logistic regression analysis. A strong positive association was observed between penetration depth and impingement (chi2 = 12.8; P = 0.0004) regardless of differences in the femoral neck diameter. Further, the introduction of femoral components which comprised a reduced diameter neck had a positive effect, in that the 50% probability of impingement occurred at approximately 2 mm of penetration. For those components with standard necks, the 50% probability of impingement occurred at zero mm of penetration. If impingement is a problem then a reduced diameter neck would appear to be a solution in cutting rates of long-term loosening. However, whether or not this reduction in rim damage, and therefore impingement, is clinically significant in terms of loosening can only be fully assessed from long-term survival analysis and comparison with autopsy retrieved specimens.

Binding of the purified integron DNA integrase Intl1 to integron- and cassette-associated recombination sites

The site-specific recombinase Intl1, encoded by class 1 integrons, catalyses the integration and excision of gene cassettes by recognizing two classes of sites, the integron-associated attl1 site and the 59-base element (59-be) family of sites that are associated with gene cassettes. Intl1 includes the four conserved amino acids that are characteristic of members of the integrase family, and Intl1 proteins with single amino acid substitutions at each of these positions had substantially reduced catalytic activity, consistent with this classification. Intl1 was purified as a fusion protein and shown to bind to isolated attl1 or 59-be recombination sites. Binding to attl1 was considerably stronger than to a 59-be. Binding adjacent to the recombination cross-over point was not detected. A strong Intl1 binding site within attl1 was localized by both deletion and footprinting analysis to a 14 bp region 24-37 bp to the left of the recombination cross-over point, and this region is known to be critical for recombination in vivo (Recchia et al., 1994). An imperfect (13/15) direct repeat of this region, located 41-55 bp to the left of the recombination cross-over point, contains a weaker Intl1 binding site. Mutation of the stronger binding site showed that a single base pair change accounted for the difference in the strength of binding.

Discrepancy between penetration depths derived from radiographic and direct measurement of acetabular components

The most common technique for assessing penetration due to wear in acetabular components is with the aid of the most recent serial radiograph. This approach, which is often termed the uni-radiographic method, has been shown to underestimate the more reliable value of the penetration depth deduced from direct measurement of explanted sockets. In this article the causes of the discrepancies between the two data sets are explored. Ninety-six sockets were available from revision surgery for which both the penetration depth and angle could be measured using the shadowgraphic technique in both the coronal and wear planes. Further, the penetration depth for each of the sockets was also assessed from pre-revision X-rays. A significant discrepancy was observed between the penetration depths measured in the wear plane of the replica delta Pw and that measured from the radiograph, delta PX-ray. The discrepancy was greatest for loose sockets as opposed to those that were still fixed at revision surgery. Using the corresponding data from the shadowgraph measurements, it was possible to deduce that the errors have arisen from the radiographic measurement of wear in the coronal plane and the formula used in calculating delta PX-ray. If these errors (which cannot be calculated from the X-ray data alone) were taken into consideration, then the systematic bias between radiographic and shadowgraphic measurement was greatly reduced. The largest portion of the discrepancy was accounted for by wear occurring out of the plane of the radiograph, and this, in general, coincides with the coronal plane. Overall, these results indicate that the accurate measurement of wear from serial radiographs is not possible and that improved performance in terms of accuracy can only be achieved when a three-dimensional system is used. An alternative method for deducing the radiographic penetration depth is proposed which, theoretically, negates the error arising from the inaccuracy of the formula.

Wear in retrieved acetabular components: effect of femoral head radius and patient parameters

Forty-seven explanted Porous Coated Anatomic (PCA, Howmedica, Rutherford, NJ) cementless acetabular components were acquired at revision surgery. All the components articulated against CoCrMo femoral heads of 32-mm diameter. The penetration depth and angle were measured using the shadowgraph technique. The wear volume was then calculated using Kabo's formula. Using weighted linear regression analysis, the mean penetration rate and mean volumetric wear rate were calculated to be 0.23 (SE, 0.03) mm3/y and 96 (SE, 13) mm3/y, respectively. The creep component was not found to be significantly different from zero. The clinical wear factor, k(clinical), for this cohort was also calculated using linear regression analysis but with the assumption that creep was zero. The value found, k(clinical) = 1.93 (SE, 0.29) x 10(-6) mm3/N-m, was similar to those in previous studies involving cemented joints with a 22-mm femoral head diameter. The similar k(clinical) values of these substantially different joint types suggest that the high volumetric wear rate for the PCA joint can be attributed entirely to its larger head size and the younger, more active, patient profile. Fixation technique and metal backing seem not to influence the rate of wear.

Treatment of the wounded at Chipyong-ni

The battle fought by a U.S.-French force at Chipyong-ni in mid-February 1951 has been called the turning point of the Korean War, and may have been the first time that transfusions of whole blood were given as far forward as the regimental area during combat. The surgeon, or chief medical officer, of the United Nations force at Chipyong-ni describes this and other measures required by the tactical and medical situations there, and illustrates how they were made possible, in large part, because an important lesson learned during World War II had been applied: the surgeon had direct access to the commander as a member of his staff, and controlled the task force medical facilities.