PDZ-domain-mediated interaction of the Eph-related receptor tyrosine kinase EphB3 and the ras-binding protein AF6 depends on the kinase activity of the receptor

Eph-related receptor tyrosine kinases (RTKs) have been implicated in intercellular communication during embryonic development. To elucidate their signal transduction pathways, we applied the yeast two-hybrid system. We could demonstrate that the carboxyl termini of the Eph-related RTKs EphA7, EphB2, EphB3, EphB5, and EphB6 interact with the PDZ domain of the ras-binding protein AF6. A mutational analysis revealed that six C-terminal residues of the receptors are involved in binding to the PDZ domain of AF6 in a sequence-specific fashion. Moreover, this PDZ domain also interacts with C-terminal sequences derived from other transmembrane receptors such as neurexins and the Notch ligand Jagged. In contrast to the association of EphB3 to the PDZ domain of AF6, the interaction with full-length AF6 clearly depends on the kinase activity of EphB3, suggesting a regulated mechanism for the PDZ-domain-mediated interaction. These data gave rise to the idea that the binding of AF6 to EphB3 occurs in a cooperative fashion because of synergistic effects involving different epitopes of both proteins. Moreover, in NIH 3T3 and NG108 cells endogenous AF6 is phosphorylated specifically by EphB3 and EphB2 in a ligand-dependent fashion. Our observations add the PDZ domain to the group of conserved protein modules such as Src-homology-2 (SH2) and phosphotyrosine-binding (PTB) domains that regulate signal transduction through their ability to mediate the interaction with RTKs.

Epidemic keratoconjunctivitis outbreak at a tertiary referral eye care clinic

An outbreak of epidemic keratoconjunctivitis (EKC) occurred at a tertiary referral eye care clinic between late September and mid-November 1995. Before the outbreak, instruments were cleaned with 70% isopropyl alcohol and handwashing between patients was not routine. Infection control measures were implemented when the outbreak was recognized in mid-October. Control measures included triaging suspected cases to a separate waiting area, cohorting cases to a specific examining room, endorsing the use of gloves and handwashing during examinations of patients, and cleaning instruments with a buffered bleach solution. Thirty-six cases were diagnosed before the infection control measures were taken, and 3 cases were seen after the control measures were taken. Also, numerous secondary cases occurred in the community. No additional cases were diagnosed from DEcember to February 25, 1996. Acquisition of the infection was linked to visits to 4 of 20 physicians in the eye clinic with 61% of cases associated with visits to 1 of those 4 physicians. The use of diagnostic lenses applied directly to the eye was associated with infection (odds ratio = 2.83, 95% confidence interval = 0.79 to 10.4), although this did not reach statistical significance. The use of tonometers, ophthalmic solutions, or laser therapy was not associated with infection, and all environmental cultures were negative. This outbreak emphasizes the need for implementation of routine infection control guidelines to prevent nosocomial transmission of epidemic keratoconjunctivitis and stresses the need for appropriate disinfection of instruments.

Relationship between serum alkaline phosphatase and pyridoxal-5'-phosphate levels in hypophosphatasia

1. Hypophosphatasia is a disorder characterized by low serum levels of alkaline phosphatase (ALP) and a range of skeletal deformities. The levels of a number of phosphorylated metabolites, namely phosphoethanolamine and pyrophosphate, are characteristically raised. Levels of pyridoxal-5'-phosphate (PLP) have also been reported to be raised. 2. Hypophosphatasia is a rare disease and experience of measuring PLP in patients is lacking. We have had the chance to look at PLP levels in four families with hypophosphatasia, specifically to examine the quantitative relationship between ALP and PLP which has not been described before. 3. We confirmed that PLP levels are raised in hypophosphatasia and related to the disease severity. A significant negative linear relationship was found between the log PLP and log ALP (log PLP = 5.99-2.76 log ALP; r = -0.85, P < 0.001). 4. Measurement of PLP is simpler than some of the phosphorylated compounds, e.g. pyrophosphate. PLP may be a useful measure in patients with a suspected diagnosis of hypophosphatasia or for screening family members to detect potential heterozygotes and to monitor any response to therapy. 5. There did not appear to be any adverse clinical effects in relation to disturbed vitamin B6 metabolism in hypophosphatasia. 6. Vitamin B6 is used therapeutically in a number of conditions with monitoring of PLP levels. In these conditions PLP levels should be interpreted in conjunction with the prevailing serum ALP levels as the metabolism of these compounds is closely inter-related.

Deletion mapping defines three discrete areas of allelic imbalance on chromosome arm 8p in oral and oropharyngeal squamous cell carcinomas

Deletions on chromosome arm 8p, as defined by allelic imbalance, are a frequent event in many different types of malignant tumors, including those of the head and neck. These regions are thought to harbor tumor suppressor genes. In order to define a high-density deletion map of this chromosomal arm in oral and oropharyngeal squamous cell carcinomas, we have tested for allelic imbalance in 35 such tumors with 22 short tandem-repeat polymorphisms. Overall, 21 (60%) of the 35 tumors showed allelic imbalance at one or more loci on chromosome arm 8p. Interstitial deletions defined three discrete areas of deletion: at 8p23, 8p22, and 8p12-p21. Tumors of TNM stages II-IV showed a significantly higher frequency of allelic imbalance on 8p than did TNM stage I tumors. Our data suggest that there are least three tumor suppressor loci on chromosome arm 8p that may be implicated in oral carcinogenesis. Furthermore, inactivation of such genes may be associated with high-grade tumors.

Postural imbalance and vibratory sensitivity in patients with idiopathic scoliosis: implications for treatment

Sporadic research reports of decreased proprioception and balance problems have been reported in subjects with idiopathic scoliosis, yet these sensory motor deficits have not been addressed in conservative clinical management programs. The purpose of this study was to compare both balance reactions and vibratory sensitivity (as an estimate of proprioception) in patients with idiopathic scoliosis (N = 24) and age-matched controls (N = 24). Balance was measured by the ability to pass a series of simple static and complex sensory-challenged balance tasks. Vibratory thresholds were measured with the Bio-Thesiometer at the cervical spine, wrist, and foot. Compared with age-matched controls, regardless of curve severity or spinal fusion, the subjects with idiopathic scoliosis had similar simple static balance responses when the somatosensory system was stable (with or without vision or head turning), but they were significantly more likely to fail the complex, sensory-challenged balance tasks when the somatosensory system was challenged by an unstable position of the feet, particularly when the eyes were closed. The vibratory thresholds were similar in subjects with scoliosis and their age-matched controls, but individuals with moderate to severe scoliosis (> 25 degrees) had significantly higher vibratory thresholds than those with mild curves. These findings suggest there may be problems with postural righting in patients with idiopathic scoliosis, particularly when the balance task challenges the vestibular pathways. Although vibration sensitivity did not distinguish normal healthy individuals from individuals with idiopathic scoliosis, those with more severe scoliotic curves appear to have a high threshold to vibration. These balance and vibratory differences could either be interpreted as etiologic risk factors or as consequences of spinal asymmetry. In either case, given that curves can continue to progress even into the adult years, improving the ability to right the body with gravity could help maintain the balance of the spine despite structural asymmetry.

Science in the early Athenaeum: a mirror of crystallization

The Athenaeum, one of the most influential weekly magazines of Victorian Britain, was launched in 1828, towards the end of the period which saw the crystallization of science out of eighteenth-century natural philosophy and the differentiation of the individual sciences one from another. We examine the magazine's coverage of specific scientific areas in the year from May 1828 to April 1829, looking at what it defined as science and how it arrived at its definitions. The picture that emerges is complex, influenzed by editorial preferences as well as more clearly discernible objective criteria. But, at this stage, The Athenaeum appears to be opposed to opening up a gulf between the scientifically literate and the rest of its readership, reminding science of its debt to earlier endeavours.

Alendronate stimulation of nocturnal parathyroid hormone secretion: a mechanism to explain the continued improvement in bone mineral density accompanying alendronate therapy

The major effect of currently available antiresorptive therapy for osteoporosis is to slow or arrest bone loss. Although antiresorptive therapies demonstrate increases in bone mineral density, the effect is usually transient, and a plateau in bone mineral density usually emerges at 1 year. A unique and unexplained feature of treatment with the antiresorptive agent alendronate is continued, and steady improvement in bone mineral density occurs in years 2 and 3. We postulated that a potential mechanism for this unanticipated effect might be an exaggerated nocturnal increase in parathyroid hormone (PTH), which can act as an anabolic agent. We examined day-night levels and diurnal variation of PTH, serum calcium, ionized calcium, and markers of bone formation (osteocalcin) and resorption (N-telopeptide cross-links) over 24 hours in a randomly selected subset of 38 women (placebo: N = 13; mean age +/- SD, 69 +/- 3 years; alendronate: N = 25; mean age +/- SD, 69 +/- 3 years) who had completed 12 to 15 months of a larger (N = 120), randomized, double-blind, placebo-controlled trial with alendronate, 5 mg/day. By month 12, increases in the bone density of the spine (4.6%) and femoral neck (2.7%) were observed in the group treated with alendronate compared with placebo, (spine, 2.2%, p = .05; femoral neck, -0.2%, p < or = .05). Mean nocturnal PTH (10 PM-8 AM) was 21% higher (39 versus 32 pg/ml), and nocturnal serum calcium averaged 3% lower (8.7 versus 9.0 mg/dL) in the alendronate-versus-placebo group (both p < or = .05). Daytime levels (8 AM-10 PM) of PTH did not differ significantly between groups. We observed accompanying decreases in coupled markers of bone formation (osteocalcin, 38% lower, p < or = .01) and resorption (N-telopeptide cross-links, 50% lower, p < or = .01) in the alendronate group. Significant diurnal variations of PTH, serum calcium, and osteocalcin were present in both groups. We conclude that following 1 year of alendronate therapy, women have significant increases in bone mineral density and in nocturnal PTH levels, associated with decreases in nocturnal serum calcium and markers of bone turnover with maintenance of the diurnal variation. The nocturnal increase in PTH may mimic the anabolic effect of low-dose intermittent PTH administration to stimulate bone formation. Therefore, the increase might be a potential mechanism to explain the continued improvement in bone density following more than 1 year of alendronate therapy.

The effects of antenatal steroid use in premature rupture of membranes

We sought to determine if antepartum steroid treatment offers any clinical benefits to patients with premature rupture of membranes. One hundred and forty-five maternal-neonatal pairs were studied. Forty-five maternal-neonatal pairs with premature, preterm rupture of membranes received steroids during 24-35 weeks' gestation. One hundred maternal-neonatal pairs received no antenatal steroids. The 2 groups were identical with regard to gestational age at rupture of membranes, gravity, parity, race, fetal gender, socioeconomic status, smoking, and preterm labour risk factors. Study of the data revealed that maternal chorioamnionitis was less frequent in the steroid group (p < 0.001). Bronchopulmonary dysplasia (oxygen dependent at discharge at term gestational age) was less frequent in the steroid group (p < 0.05). The remainder of the data revealed no statistically significant differences in preterm delivery rate, necrotizing enterocolitis, respiratory distress syndrome, intraventricular haemorrhage rate or severity of haemorrhage, hospital days, latency to delivery, or ventilator days. Antepartum steroid use in preterm rupture of membranes appears to offer clinical benefit in premature infants by lessening the rate of bronchopulmonary dysplasia in those infants receiving antepartum steroids.

Developmental supervision in health visiting

Although supervision is supposed to be a helpful and supportive process, it is often seen as negative and critical. Meg Bond and Stevie Holland describe a developmental model of supervision, which can enhance health visitors' personal and professional development.

CATS: opportunities through open learning

Health visitors need time out from their routine workload and encouragement from managers to reflect on their role in relation to their clients' needs. This is particularly important in times of great change. Stevie Holland describes how the new HVA open learning packs, to be re-launched in September, can help this process, and how practitioners can use them to gain further professional and academic qualifications through the credit accumulation and transfer scheme.

Comparison of serum osteocalcin with total and bone specific alkaline phosphatase and urinary hydroxyproline:creatinine ratio in patients with Paget's disease of bone

Osteocalcin or bone Gla protein (BGP) is secreted by osteoblasts, and its serum concentration is elevated in a number of conditions with high bone turnover. A comparison of serum osteocalcin with total (TALP) and bone specific alkaline phosphatase (BALP) and urinary hydroxyproline/creatinine (OHP/Cr ratio) was performed in 13 patients with active Paget's disease of bone. BGP did not correlate significantly with either BALP or TALP, but did show a significant correlation with OHP/Cr ratio (r = 0.76; P < 0.01). BGP does not appear to be as sensitive a marker as BALP or TALP in Paget's disease.

Oral tolerance in humans. T cell but not B cell tolerance after antigen feeding

The purpose of this study was to investigate whether oral tolerance, defined as Ag-specific immunologic unresponsiveness after Ag feeding, could be induced in humans after prolonged Ag ingestion. Eight adult volunteers ingested a total dose of 0.5 g of keyhole limpet hemocyanin (KLH) followed by subcutaneous immunization with KLH. Eight controls received only the subcutaneous immunization. In the group fed KLH, there was a significant reduction in KLH-specific T cell proliferation (p = 0.04) and delayed skin test responses (p = 0.07) to KLH. KLH ingestion alone did not induce significant levels of Abs in either serum or secretions. However, after the subsequent subcutaneous immunization, the number of circulating IgG and IgM anti-KLH-producing cells, the titers of serum IgG, IgA, and IgM anti-KLH Abs, and the titers of IgA anti-KLH Abs in saliva and intestinal secretions were significantly greater in the KLH-fed group than in the nonfed group. We conclude that KLH feeding induced systemic T cell tolerance, but B cell priming, at both systemic and mucosal sites. These studies support the concept of using Ag feeding as a treatment for certain immune-mediated diseases.

Oral tolerance in humans. T cell but not B cell tolerance after antigen feeding

The purpose of this study was to investigate whether oral tolerance, defined as Ag-specific immunologic unresponsiveness after Ag feeding, could be induced in humans after prolonged Ag ingestion. Eight adult volunteers ingested a total dose of 0.5 g of keyhole limpet hemocyanin (KLH) followed by subcutaneous immunization with KLH. Eight controls received only the subcutaneous immunization. In the group fed KLH, there was a significant reduction in KLH-specific T cell proliferation (p = 0.04) and delayed skin test responses (p = 0.07) to KLH. KLH ingestion alone did not induce significant levels of Abs in either serum or secretions. However, after the subsequent subcutaneous immunization, the number of circulating IgG and IgM anti-KLH-producing cells, the titers of serum IgG, IgA, and IgM anti-KLH Abs, and the titers of IgA anti-KLH Abs in saliva and intestinal secretions were significantly greater in the KLH-fed group than in the nonfed group. We conclude that KLH feeding induced systemic T cell tolerance, but B cell priming, at both systemic and mucosal sites. These studies support the concept of using Ag feeding as a treatment for certain immune-mediated diseases.

Returning to practice

All too often health visitors seeking to return to practice following a career break are met with negative response, writes Stevie Holland. Here she recounts the words and experiences of some of the health visitors who enrolled on the HVA's open learning 'Return to practice' courses in recent years. The health visiting profession needs to encourage the enthusiasm and innovation of returners if it is to survive in today's political climate, she warns.

Approaching with care: violence at work (continuing education credit)

Violence against nurses, midwives and health visitors is much more common than is generally supposed or admitted. With care, by using appropriate strategies, violent and aggressive incidents can be prevented or managed, to minimise harm to all concerned. Staff support during and following an incident is vital.

Preparing for parent-held child health records

On 1 October 1992 health visitors in the Portsmouth and South Hampshire health district introduced parent-held child health records. The following reports by key participants in this major change in health visiting practice underline the importance of training to prepare staff for the challenge. Partnership between field staff and management is key if the principles of openness and trust underlying the concept of the parent-held record are to be implemented in practice.

A possible connection between an increased concentration of a cytochemically detectable substance in the hypothalamus of the spontaneously hypertensive rat and certain cerebral cholinergic disturbances

The hypothalamus of the spontaneously hypertensive rat (SHR) contains an increased concentration of a cytochemically detectable choline-like substance, the physicochemical properties of which are similar to the choline analogue dimethyl methylene immonium. In the hypothalamus of the adult SHR there is an increased turnover of acetylcholine in the cholinergic pressor posterior hypothalamic nucleus and the neurons of the dorsomedial cholinergic depressor nucleus are atrophic, possibly due to diminished cholinergic activity. Both of these changes are pressor. It is suggested that an increased hypothalamic content of a choline-like analogue might either be responsible for, or an indicator of, these abnormalities.

The health care Titanic: women and children first?

The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or-play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women.

Violence. Upping the ante. Interview by Cath Jackson

Handling a physical attack is 'just the tip of the volcano' says Stevie Holland, author of a radical new distance learning pack on 'Managing aggression' at work. Health visitors, school nurses and their managers need training in preventive strategies to defuse potentially violent situations. They should also be looking at their own attitudes to colleagues and clients and at the culture of the organisation within which they work.