A minimally invasive, field-applicable CRISPR/Cas biosensor to aid in the detection of Pseudogymnoascus destructans, the causative fungal agent of white-nose syndrome in bats

The accessibility to CRISPR/Cas (Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR-associated protein) genetic tools has given rise to applications beyond site-directed genome editing for the detection of DNA and RNA. These tools include precise diagnostic detection of human disease pathogens, such as SARS-CoV-2 and Zika virus. Despite the technology being rapid and cost-effective, the use of CRISPR/Cas tools in the surveillance of the causative agents of wildlife diseases has not been prominent. This study presents the development of a minimally invasive, field-applicable and user-friendly CRISPR/Cas-based biosensor for the detection of Pseudogymnoascus destructans (Pd), the causative fungal agent of white-nose syndrome (WNS), an infectious disease that has killed more than five million bats in North America since its discovery in 2006. The biosensor assay combines a recombinase polymerase amplification (RPA) step followed by CRISPR/Cas12a nuclease cleavage to detect Pd DNA from bat dermal swab and guano samples. The biosensor had similar detection results when compared to quantitative PCR in distinguishing Pd-positive versus negative field samples. Although bat dermal swabs could be analysed with the biosensor without nucleic acid extraction, DNA extraction was needed when screening guano samples to overcome inhibitors. This assay can be applied to help with more rapid delineation of Pd-positive sites in the field to inform management decisions. With further optimization, this technology has broad translation potential to wildlife disease-associated pathogen detection and monitoring applications.

COULD WHITE-NOSE SYNDROME MANIFEST DIFFERENTLY IN MYOTIS LUCIFUGUS IN WESTERN VERSUS EASTERN REGIONS OF NORTH AMERICA? A REVIEW OF FACTORS

White-nose syndrome (WNS) has notably affected the abundance of Myotis lucifugus (little brown myotis) in North America. Thus far, substantial mortality has been restricted to the eastern part of the continent where the cause of WNS, the invasive fungus Pseudogymnoascus destructans, has infected bats since 2006. To date, the state of Washington is the only area in the Western US or Canada (the Rocky Mountains and further west in North America) with confirmed cases of WNS in bats, and there the disease has spread more slowly than it did in Eastern North America. Here, we review differences between M. lucifugus in western and eastern parts of the continent that may affect transmission, spread, and severity of WNS in the West and highlight important gaps in knowledge. We explore the hypothesis that western M. lucifugus may respond differently to WNS on the basis of different hibernation strategies, habitat use, and greater genetic structure. To document the effect of WNS on M. lucifugus in the West most effectively, we recommend focusing on maternity roosts for strategic disease surveillance and monitoring abundance. We further recommend continuing the challenging work of identifying hibernation and swarming sites to better understand the microclimates, microbial communities, and role in disease transmission of these sites, as well as the ecology and hibernation physiology of bats in noncavernous hibernacula.

A review of bat hibernacula across the western United States: Implications for white-nose syndrome surveillance and management

Efforts to conserve bats in the western United States have long been impeded by a lack of information on their winter whereabouts, particularly bats in the genus Myotis. The recent arrival of white-nose syndrome in western North America has increased the urgency to characterize winter roost habitats in this region. We compiled 4,549 winter bat survey records from 2,888 unique structures across 11 western states. Myotis bats were reported from 18.5% of structures with 95% of aggregations composed of ≤10 individuals. Only 11 structures contained ≥100 Myotis individuals and 6 contained ≥500 individuals. Townsend’s big-eared bat (Corynorhinus townsendii) were reported from 38% of structures, with 72% of aggregations composed of ≤10 individuals. Aggregations of ≥100 Townsend’s big-eared bats were observed at 41 different caves or mines across 9 states. We used zero-inflated negative binomial regression to explore biogeographic patterns of winter roost counts. Myotis counts were greater in caves than mines, in more recent years, and in more easterly longitudes, northerly latitudes, higher elevations, and in areas with higher surface temperatures and lower precipitation. Townsend’s big-eared bat counts were greater in caves, during more recent years, and in more westerly longitudes. Karst topography was associated with higher Townsend’s big-eared bat counts but did not appear to influence Myotis counts. We found stable or slightly-increasing trends over time in counts for both Myotis and Townsend’s big-eared bats from 82 hibernacula surveyed ≥5 winters since 1990. Highly-dispersed winter roosting of Myotis in the western USA complicates efforts to monitor population trends and impacts of disease. However, our results reveal opportunities to monitor winter population status of Townsend’s big-eared bats across this region.

Epidemiology of in-hospital mortality in acute patients admitted to a tertiary-level hospital

BACKGROUND

Healthcare professionals may have difficulty in recognising the dying patient in acute care settings, and yet, this is essential if timely end-of-life care is to be provided. While approximately one-third of patients who pass away in-hospital are reviewed by the rapid response team (RRT), there is limited available research on other factors associated with mortality within the hospital setting.

AIMS

To describe the epidemiology of in-hospital mortality within a tertiary-level hospital, particularly in the context of RRT activation.

METHODS

We utilised the database extraction of demographic, admission and RRT activation data on acute patients discharged from an Australian acute tertiary hospital between 1 January 2009 and 31 December 2013. Analyses included simple descriptors, Chi-squared and non-parametric Kruskal-Wallis tests as appropriate.

RESULTS

Of the 44,297 patients discharged from our hospital, 1603 died during admission. The general medical, haematology/oncology and intensive care teams provided care for the majority of the patients who died. A small number of diagnoses had in-patient mortality rates of greater than 25%. These included respiratory failure, alcoholic liver disease, vascular disorders of the intestine, sepsis and aspiration pneumonia. Over 75% of patients who received a RRT call survived to hospital discharge; however, patients who received four or more RRT calls during admission had an in-hospital mortality rate of over 40%.

CONCLUSION

Acute in-patient mortality is unequally distributed throughout the hospital, and a small number of diagnoses has large associated in-patient mortality rates. Repeated involvement of the RRT is associated with in-patient mortality.

Timing of blood transfusion in relation to ICU admission-a single centre audit

There is growing concern that blood transfusion may be associated with adverse outcomes in critically ill patients. Timing of transfusion in relation to intensive care unit (ICU) stay may be important in designing and understanding transfusion studies. The objective of this study was to determine the timing of red blood cell transfusion in relation to admission to an Australian ICU and to describe associations with transfusion requirements. We undertook a retrospective, observational, single-centre cohort study of all patients admitted to the ICU at The Northern Hospital, Melbourne, Australia, between 1 January and 31 December 2008 in order to measure the timing of transfusion in relation to ICU admission and the demographic and outcome data of the cohort. 674 individual hospital admissions were analysed. Overall, 28% (188/674) of patients admitted to ICU received a red cell transfusion during their hospital stay. A total of 55 (28.5%) patients were transfused either before and/or after ICU discharge but never in the ICU. Thirty-five percent (258/741) of red cell units were transfused outside the ICU. The median number of red cell units transfused was three units per patient (interquartile range 1 to 5). There was no difference between transfused and non-transfused groups in either crude mortality or severity-adjusted mortality. In approximately one-third of ICU patients in our study transfusions occurred before admission to, and/or after discharge from, the ICU. This has implications for designing and interpreting transfusion studies in the ICU and requires confirmation in a multi-centre study.

Preoperative Estimated Glomerular Filtration Rate and RIFLE-Classified Postoperative Acute Kidney Injury Predict Length of Stay Post-Coronary Bypass Surgery in an Australian Setting

We investigated the influence of preoperative estimated glomerular filtration rate and postoperative acute kidney injury on outcomes after coronary bypass surgery in a local setting, with the focus on length of stay.

A retrospective analysis of prospectively collected data for 3302 consecutive patients who underwent coronary artery bypass graft surgery (June 1997 through to January 2007) at St Vincent's Public Hospital, Melbourne, was undertaken. Preoperative estimated glomerular filtration rate was calculated and categorised using US National Kidney Foundation cut-offs for chronic kidney disease (normal function; mild, moderate and severe dysfunction). Postoperative acute kidney injury was categorised using serum creatinine RIFLE criteria (no acute kidney injury, risk, injury and failure). Postoperative intensive care and hospital length of stay was determined.

The hazard ratios for time to hospital discharge up to one month decreased (indicating a longer length of stay) as severity of preoperative renal dysfunction category increased when compared to those with normal renal function: mild hazard ratio=1.02 (95% confidence interval: 0.91 to 1.15, P=0.70), moderate 0.87 (0.76 to 1.00, P=0.047), severe 0.47 (0.35 to 0.64, P < 0.001). Hazard ratios also decreased as severity of postoperative acute kidney injury category increased, when compared to those with no acute kidney injury: risk 0.67 (0.58 to 0.77, P <0.001), injury 0.52 (0.41 to 0.65, P <0.001), failure 0.35 (0.20 to 0.60, P <0.001).

The increasing severity of preoperative renal dysfunction and postoperative acute kidney injury were associated with increased hospital length of stay. This has implications for resource use, informed consent and case selection.

Haemophilus influenzae associated Guillain Barré Syndrome with thrombocytopenic purpura and hyperthermia

A 24-year-old female who had been intubated for respiratory distress was transferred to our intensive care unit, where a subsequent diagnosis of Guillain Barré Syndrome was made. Her only positive culture was Haemophilus influenzae from sputum. Despite having a severe form of the disease, with autonomic dysfunction and hyperthermia, she made a far better more rapid recovery than expected. We review the evidence that patients with Haemophilus influenzae associated Guillain Barré Syndrome recover more quickly than those with other causative agents. We also discuss the implications of thrombocytopenia in these patients and the management of hyperthermia in an intensive care unit setting.

Intravenous salbutamol: too much of a good thing?

OBJECTIVE

To review the evidence for the use of intravenous salbutamol, its systemic effects and the potential complications that may occur in patients with severe asthma.

DATA SOURCES

A review of articles reported on intravenous salbutamol in patients with acute asthma.

SUMMARY OF REVIEW

Intravenous salbutamol is recommended in the treatment of severe asthma when there is failure to respond to nebulised beta2-agonists. To date, however, there are no published trials that establish the efficacy or safety of the combination of inhaled salbutamol and a continuous intravenous salbutamol infusion over inhaled salbutamol alone for treatment of severe acute asthma. beta2-agonists have numerous systemic actions that may adversely affect patients with severe respiratory compromise. The most important of these is the potential for beta2-agonists to cause a lactic acidosis, which, by increasing respiratory demands, could precipitate respiratory failure.

CONCLUSIONS

Systemic salbutamol has metabolic effects that may worsen respiratory function in asthma and should not be given by intravenous infusion to asthma patients outside of clinical trials. For patients who fail to respond to inhaled beta2-agonists, ipratropium and systemic steroids, consideration should be given to other therapies such as non-invasive ventilation rather than increasing the dose of a drug that may paradoxically worsen respiratory function.

Transvenous liver biopsy via the femoral vein

AIM

To study the safety, effectiveness and diagnostic value of transvenous forceps biopsy of the liver in 54 patients with coagulopathy, gross ascites or morbid obesity and suspected liver disease in whom percutaneous liver biopsy was contraindicated.

MATERIAL AND METHODS

Forceps biopsy of the liver via the femoral vein was attempted in 54 adult patients with advanced liver disease of unknown aetiology who had coagulation disorders (41 cases), gross ascites (11 cases) or morbid obesity (two cases). In each patient two to six biopsies (average four) were taken using a radial jaw forceps inserted via the right or left femoral vein.

RESULTS

The procedure was successful in 53 cases. Hepatic vein catheterization failed in one patient. Adequate liver tissue for diagnosis was obtained in 84% of cases. One patient developed delayed haemorrhage at 12 h from a capsular leak that was undetected during the biopsy procedure. This patient required blood transfusions and laparotomy to control bleeding. There were no deaths in the 53 patients studied. Transient minor chest and shoulder pain was encountered during sheath insertion into a hepatic vein in 23 patients. Three patients developed a femoral vein haematoma, which resolved with conservative treatment.

CONCLUSION

Transvenous liver biopsy via the femoral vein is another safe, effective, simple alternative technique of biopsy when the percutaneous route is contraindicated.

Genetic locus required for antigenic maturation of Rhizobium etli CE3 lipopolysaccharide

Rhizobium etli modifies lipopolysaccharide (LPS) structure in response to environmental signals, such as low pH and anthocyanins. These LPS modifications result in the loss of reactivity with certain monoclonal antibodies. The same antibodies fail to recognize previously isolated R. etli mutant strain CE367, even in the absence of such environmental cues. Chemical analysis of the LPS in strain CE367 demonstrated that it lacked the terminal sugar of the wild-type O antigen, 2,3,4-tri-O-methylfucose. A 3-kb stretch of DNA, designated as lpe3, restored wild-type antigenicity when transferred into CE367. From the sequence of this DNA, five open reading frames were postulated. Site-directed mutagenesis and complementation analysis suggested that the genes were organized in at least two transcriptional units, both of which were required for the production of LPS reactive with the diagnostic antibodies. Growth in anthocyanins or at low pH did not alter the specific expression of gusA from the transposon insertion of mutant CE367, nor did the presence of multiple copies of lpe3 situated behind a strong, constitutive promoter prevent epitope changes induced by these environmental cues. Mutations of the lpe genes did not prevent normal nodule development on Phaseolus vulgaris and had very little effect on the occupation of nodules in competition with the wild-type strain.

Retraining the injured spinal cord

The present review presents a series of concepts that may be useful in developing rehabilitative strategies to enhance recovery of posture and locomotion following spinal cord injury. First, the loss of supraspinal input results in a marked change in the functional efficacy of the remaining synapses and neurons of intraspinal and peripheral afferent (dorsal root ganglion) origin. Second, following a complete transection the lumbrosacral spinal cord can recover greater levels of motor performance if it has been exposed to the afferent and intraspinal activation patterns that are associated with standing and stepping. Third, the spinal cord can more readily reacquire the ability to stand and step following spinal cord transection with repetitive exposure to standing and stepping. Fourth, robotic assistive devices can be used to guide the kinematics of the limbs and thus expose the spinal cord to the new normal activity patterns associated with a particular motor task following spinal cord injury. In addition, such robotic assistive devices can provide immediate quantification of the limb kinematics. Fifth, the behavioural and physiological effects of spinal cord transection are reflected in adaptations in most, if not all, neurotransmitter systems in the lumbosacral spinal cord. Evidence is presented that both the GABAergic and glycinergic inhibitory systems are up-regulated following complete spinal cord transection and that step training results in some aspects of these transmitter systems being down-regulated towards control levels. These concepts and observations demonstrate that (a) the spinal cord can interpret complex afferent information and generate the appropriate motor task; and (b) motor ability can be defined to a large degree by training.

Predictors of compliance with neuroleptic medication among inpatients with schizophrenia: a discriminant function analysis

OBJECTIVE

To identify clinically useful predictors of adherence to medication among persons with schizophrenia.

METHOD

We evaluated levels of compliance with neuroleptic medication among 32 consecutive admissions with DSM-III-R schizophrenia from a geographically defined catchment area using a compliance interview. We also assessed symptomatology, insight, neurological status and memory.

RESULTS

Less than 25% of consecutive admissions reported being fully compliant. Drug attitudes were the best predictor of regular compliance, symptomatology the best predictor of noncompliance, and memory the best predictor of partial compliance with neuroleptic medication.

CONCLUSIONS

These data emphasise the complexity of factors that influence whether a person adheres to his medication regimen. Furthermore, they suggest that these factors may vary within the same person over time.

A case management approach to immunizing patients at high risk for influenza

The influenza season affects not only the people afflicted with influenza, but the healthcare system as a whole. An estimated dollar 12 billion is the annual cost to care for these patients. An existing problem is that although there is an immunization for influenza, many patients at high risk are not immunized. This article will describe an innovative program of a large Midwest suburban hospital to immunize patients at high risk.

Identification of an ATP-binding cassette transporter for export of the O-antigen across the inner membrane in Rhizobium etli based on the genetic, functional, and structural analysis of an lps mutant deficient in O-antigen

For O-antigen lipopolysaccharide (LPS) synthesis in bacteria, transmembrane migration of undecaprenyl pyrophosphate-bound O-antigen oligosaccharide subunits or polysaccharide occurs before ligation to the core region of the LPS molecule. In this study, we identified by mutagenesis an ATP-binding cassette transporter in Rhizobium etli CE3 that is likely responsible for the translocation of the O-antigen across the inner plasma membrane. Mutant FAJ1200 LPS lacks largely the O-antigen, as shown by SDS-polyacrylamide gel electrophoresis and confirmed by immunoblot analysis. Furthermore, LPS isolated from FAJ1200 is totally devoid of any O-chain glycosyl residues and contains only those glycosyl residues that can be expected for the inner core region. The membrane component and the cytoplasmic ATP-binding component of the ATP-binding cassette transporter are encoded by wzm and wzt, respectively. The Tn5 transposon in mutant FAJ1200 is inserted in the wzm gene. This mutation resulted in an Inf- phenotype in bean plants.

Increased expression of GAD65 and GABA in pancreatic beta-cells impairs first-phase insulin secretion

The functional role of glutamate decarboxylase (GAD) and its product GABA in pancreatic islets has remained elusive. Mouse beta-cells express the larger isoform GAD67, whereas human islets express only the smaller isoform GAD65. We have generated two lines of transgenic mice expressing human GAD65 in pancreatic beta-cells (RIP7-hGAD65, Lines 1 and 2) to study the effect that GABA generated by this isoform has on islet cell function. The ascending order of hGAD65 expression and/or activity in beta-cells was Line 1 heterozygotes < Line 2 heterozygotes < Line 1 homozygotes. Line 1 heterozygotes have normal glucose tolerance, whereas Line 1 homozygotes and Line 2 heterozygotes exhibit impaired glucose tolerance and inhibition of insulin secretion in vivo in response to glucose. In addition, fasting levels of blood glucose are elevated and insulin is decreased in Line 1 homozygotes. Pancreas perfusion experiments suggest that GABA generated by GAD65 may function as a negative regulator of first-phase insulin secretion in response to glucose by affecting a step proximal to or at the K(ATP)(+) channel.

Prone ventilation--it's time

Prone positioning to improve oxygenation in acute lung injury was first reported over 20 years ago. Although this and several subsequent studies have shown that prone positioning improved oxygenation in the majority of patients, it has failed to become common practice in intensive care units. This paper reviews the mechanism by which prone positioning improves oxygenation and the clinical studies of its use to date.

An outbreak of hepatitis A among Irish haemophiliacs

BACKGROUND

An outbreak of hepatitis A (HAV) occurred in 1992 in Irish haemophilia A patients treated with high purity solvent-detergent (SD) treated factor VIII. Similar outbreaks were reported in Italy, Germany and Belgium. The aim of this study was to investigate the outbreak, and to test the hypothesis that it was caused by exposure to SD-treated factor VIII.

METHODS

A case-control study was started in early 1993. Haemophilia A cases with acute HAV (n = 29) were compared with haemophilia A controls for exposure to SD-treated factor VIII and other environmental factors. Details of factor VIII usage were obtained from the National Haemophilia Register and environmental data were obtained by a telephone-administered questionnaire. The response rate was approximately 90%.

RESULTS

The incidence of acute HAV infection among haemophilia A patients exceeded the notified national incidence of HAV by a factor of approximately 300. The incidence was higher in younger patients and those with more severe bleeding disorders. Contact with hepatitis, with children, and exposure to factor VIII were associated with increased risk. The association with factor VIII was the strongest risk factor after controlling for other factors (odds ratio = 27.6, 95% confidence interval [CI] 6.5-117.3). A dose-response effect was demonstrated.

CONCLUSIONS

Although person-to-person transmission is likely to have caused a few of the cases, the results of our investigation suggest that the major contributing factor was exposure to certain batches of SD-treated factor VIII.

Helicobacter pylori infection in elderly dyspeptic patients

The association between Helicobacter pylori (HP) and gastritis is well established. As there is evidence that HP infection increases with age we reviewed the clinicopathological records of 119 consecutive patients aged 65-85 years (mean 71.1 years) on whom gastroscopy had been performed for dyspeptic symptoms. All patients had two antral biopsies--one was assessed for histological evidence of gastritis and the other was independently assessed for evidence of HP infection. Thirty-six patients (30%) had duodenal ulceration, of whom 32 (89%) had an associated HP-positive gastritis. Forty-nine patients (41%) had antral gastritis without ulceration, of whom 38 (78%) were HP positive and 11 (22%) were HP negative. Ninety-one per cent of HP-negative gastritis patients had a history of recent ingestion of non-steroidal anti-inflammatory drugs (NSAID) compared with 29% of HP-positive gastritis patients. Ten patients (8%) had normal antral mucosa but had evidence of reflux oesophagitis (one of these patients was HP-positive). Nineteen patients (16%) had normal antral mucosa and normal endoscopic findings and one of these was HP positive. We conclude that HP infection is associated with the majority of cases of symptomatic gastritis in elderly patients. HP-positive gastritis is associated with the majority of duodenal ulcers. The most important cause of HP-negative gastritis is NSAID ingestion.

Identification and preliminary characterization of protein-cysteine farnesyltransferase

Ras proteins must be isoprenylated at a conserved cysteine residue near the carboxyl terminus (Cys-186 in mammalian Ras p21 proteins) in order to exert their biological activity. Previous studies indicate that an intermediate in the mevalonate pathway, most likely farnesyl pyrophosphate, is the donor of this isoprenyl group. Inhibition of mevalonate synthesis reverts the abnormal phenotypes induced by the mutant RAS2Val-19 gene in Saccharomyces cerevisiae and blocks the maturation of Xenopus oocytes induced by an oncogenic Ras p21 protein of human origin. These results have raised the possibility of using inhibitors of the mevalonate pathway to block the transforming properties of ras oncogenes. Unfortunately, mevalonate is a precursor of various end products essential to mammalian cells, such as dolichols, ubiquinones, heme A, and cholesterol. In this study, we describe an enzymatic activity(ies) capable of catalyzing the farnesylation of unprocessed Ras p21 proteins in vitro at the correct (Cys-186) residue. This farnesylating activity is heat-labile, requires Mg2+ or Mn2+ ions, is linear with time and with enzyme concentration, and is present in all mammalian cell lines and tissues tested. Gel filtration analysis of a partially purified preparation of protein farnesyltransferase revealed two peaks of activity at 250-350 kDa and 80-130 kDa. Availability of an in vitro protein farnesyltransferase assay should be useful in screening for potential inhibitors of ras oncogene function that will not interfere with other aspects of the mevalonate pathway.

The safety and efficacy of tripotassium dicitrato bismuthate (De-Nol) maintenance therapy in patients with duodenal ulceration

Seventy-one patients whose duodenal ulcers had healed after a 4-week treatment period with tripotassium dicitrato bismuthate (TDB) were randomly allocated to receive maintenance treatment with either one TDB swallow tablet nocte (equivalent to 120 mg Bi2O3) or an identical placebo. During 12 months of follow-up, no side-effects were reported by TDB-treated patients, blood bismuth levels did not rise above discontinuation threshold concentrations (greater than 50 micrograms/L in the first 6 months, or greater than 100 micrograms/L in the second 6 months), and there were no adverse effects on haematological or biochemical indices. Ulcer relapse was significantly less in TDB-treated patients (P less than 0.025). Cumulative relapse rates at 6 and 12 months were 51% and 66%, respectively, for placebo-treated patients and 26% and 31%, respectively, for those who received TDB. It is likely that TDB is a safe and effective maintenance treatment for patients with duodenal ulcer disease.

Risk factors in inflammatory bowel disease

A patient with inflammatory bowel disease may have several risk factors, including host defence and familial and environmental factors. Host defence factors include neutrophil and complement abnormalities and increased intestinal permeability. This may explain why elemental diets are effective treatment in Crohn's disease. Food is a major factor affecting the intestinal tract, and the considerable change in dietary habits during this century may explain why Crohn's disease has become more common. There is a geographic difference in the distribution of the disease. This could be due to difference in fish consumption. Fish oil has been shown to be effective in an uncontrolled study in the treatment of ulcerative colitis. This needs to be confirmed by ongoing controlled studies. Very few data have been published on the dietary habits of different countries. There is a need for a uniform dietary assessment that can be applied in a multicentre study. These studies would involve much co-operation but would yield important clues in the aetiology of inflammatory bowel disease.

Criteria of case definition in Crohn's disease and ulcerative colitis

The diagnosis of inflammatory bowel disease is usually made on a combination of clinical, radiologic, endoscopic, and histologic grounds. In the differential diagnosis, endoscopy and histologic evaluation of biopsy specimens can help to make a specific diagnosis. Site of disease is important in documentation and can determine drug choice and clinical course. Disease activity indices are important to assess a patient objectively, particularly in multicentre studies. There is poor correlation between disease activity indices and macroscopic and histologic findings. The Severity Activity Index for Crohn's disease has both clinical and laboratory variables and is a valuable tool for the definition of Crohn's disease. An ulcerative colitis activity index that correlates significantly with microscopic and macroscopic scores, using both clinical symptoms and laboratory findings, is proposed.

Linkage analysis in a family with dominantly inherited torsion dystonia: exclusion of the pro-opiomelanocortin and glutamic acid decarboxylase genes and other chromosomal regions using DNA polymorphisms

A search for the defective gene causing torsion dystonia has been carried out in a family manifesting an autosomal dominant mode of inheritance of this movement disorder. Complete neurologic examination and establishment of lymphoblast lines have been carried out for over 50 members. Linkage analysis, using cloned DNA sequences and restriction fragment length polymorphisms, was evaluated by the LOD score method with requisite assumptions for mode of inheritance, age-of-onset and incomplete gene penetrance. Genes for pro-opiomelanocortin and glutamic acid decarboxylase, which have been implicated in the etiology of the disease in rat models, were excluded as being responsible for the disease state in this family. Other regions of the genome were also excluded using DNA probes for other genes and random "unique" sequences.

Effect of NAD on Malate Oxidation in Intact Plant Mitochondria

Potato tuber mitochondria oxidizing malate respond to NAD(+) addition with increased oxidation rates, whereas mung bean hypocotyl mitochondria do not. This is traced to a low endogenous content of NAD(+) in potato mitochondria, which prove to take up added NAD(+). This mechanism concentrates NAD(+) in the matrix space. Analyses for oxaloacetate and pyruvate (with pyruvate dehydrogenase blocked) are consistent with regulation of malate oxidation by the internal NAD(+)/NADH ratio.