Insomnia and sleep-disordered breathing in FKRP-related limb-girdle muscular dystrophy R9. The Norwegian LGMDR9 cohort study (2020)

Limb-girdle muscular dystrophy R9 (LGMDR9) is a progressive and disabling genetic muscle disease. Sleep is relevant in the patient care as it impacts on health, functioning, and well-being. LGMDR9 may potentially affect sleep by physical or emotional symptoms, myalgia, or sleep-disordered breathing (SDB) through cardiorespiratory involvement. The objective was to investigate the occurrence of insomnia and unrecognized or untreated SDB in LGMDR9, associated factors, and relationships with fatigue and health-related quality of life (HRQoL). All 90 adults in a Norwegian LGMDR9 cohort received questionnaires on sleep, fatigue, and HRQoL. Forty-nine of them underwent clinical assessments and 26 without mask-based therapy for respiration disorders additionally underwent polysomnography (PSG) and capnometry. Among 77 questionnaire respondents, 31% received mask-based therapy. The prevalence of insomnia was 32% of both those with and without such therapy but was significantly increased in fatigued respondents (54% vs 21%). Insomnia levels correlated inversely with mental HRQoL. Among 26 PSG candidates, an apnea-hypopnea index (AHI) ≥ 5/h was observed in 16/26 subjects (≥ 15/h in 8/26) with median 6.8 obstructive apneas and 0.2 central apneas per hour of sleep. The AHI was related to advancing age and an ejection fraction < 50%. Sleep-related hypoventilation was detected in one subject. Fatigue severity did not correlate with motor function or nocturnal metrics of respiration or sleep but with Maximal Inspiratory Pressure (r = - 0.46). The results indicate that insomnia and SDB are underrecognized comorbidities in LGMDR9 and associated with HRQoL impairment and heart failure, respectively. We propose an increased attention to insomnia and SDB in the interdisciplinary care of LGMDR9. Insomnia and pulmonary function should be examined in fatigued patients.

Segmental speckle tracking strain and strain rate in stable coronary artery disease

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Northern Norway Regional Health Authority

Background

It is known that patients with coronary artery disease (CAD) display reduced

global and regional strain and strain rate (SR). However, knowledge about segmental strain

and SR in stable CAD patients is still limited.

Purpose

The purpose of this study was to explore whether segmental strain and SR analyses

are different between patients with normal and stenotic coronary arteries among individuals

with chest-pain.

Methods

A total of 510 patients with chest pain, referred to coronary computed

tomography angiography (CCTA) and additional 102 patients with myocardial infarction (MI)

were prospectively included. All patients underwent transthoracic echocardiography (TTE)

with strain-rate analysis. All patients with CCTA-suspected CAD subsequently underwent

invasive CAG, as well as in all MI patients. Global longitudinal strain (GLS) and average for

segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (PLSR S),

peak early diastolic strain rate (PLSR E), post systolic shortening (PSS) measurements were analysed. Further, different cut-off values for reduced strain and SR

were used to define the percentage of functionally reduced segments between patients

with normal CAD (no CAD), MI, and stable CAD patients who were further treated by

percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).

Results

As shown in the table 1,  all average segmental strain and SR parameters differed

significantly between no CAD and MI groups. However, only PLSR E showed significant differences

between no CAD and PCI groups .  PLSR E, PLS and GLS showed significant differences between no CAD and CABG groups. The percentage of reduced segmental strain and SR

showed similar results. Regarding the percentage of pathological segments at different cut-off values, PLSR E showed the most significant difference between these four groups at a cut-off value 1.5 (p &lt; 0.001) (Figure 1).

Conclusion

Patients with MI or CABG display clearly reduced segmental strain and SR

values. However, in patients with chest-pain, segmental PLSR E seemed to be the only

indicator revealing subtle differences between patients with no CAD or those assigned to

PCI. The diagnostic value of PLSR E needs to be investigated in further studies. Abstract Table 1  Abstract Figure 1

Classic pattern dyssynchrony predicting outcome in patients with Fontan circulation

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Helse Nord, Norway

Background

Morbidity and mortality increase as Fontan patients age into adulthood. Limited studies have examined cardiac magnetic resonance and echocardiographic parameters to predict death and transplantation in children after Fontan operation.

Purpose

The aim of the study was to investigate echocardiographic parameters in adolescents and adults after Fontan operation including myocardial mechanics including classic pattern dyssynchrony (CPD) as predictors of transplantation or death.

Methods

In a cross-sectional retrospective study, strain analysis was performed on echocardiography studies performed between 2001 and 2014 of 110 patients with single ventricle physiology after the Fontan procedure. Strain curves were measured and visually assessed for the presence of CPD. The primary end point was death or transplantation after a follow-up period of 85 ± 35 months after echocardiography.

Results

Median age at date of echocardiography was 20, range 3 to 45 years. Of 110 patients 28 patients were transplanted. During the study-period 3 patients died after transplantation and 7 patients died without being transplanted. CPD was seen in 16 and protein losing enteropathy (PLE) in 21 of 110 patients. By multivariate-analysis, CPD (HR 9.4 CI 2.6-34.6), PLE (HR 10.6 CI 3.4-33.2); systolic blood pressure (HR 0.954 CI 0.913-0.996), systolic/diastolic duration ratio (HR 6.83 CI 1.33-35.0) and E wave deceleration time (HR 0.98 CI 0.97 - 0.99) were independently associated with the primary end point.

Conclusion

CPD, PLE, systolic and diastolic ventricular dysfunction are significantly associated with transplantation or death in Fontan operated patients. In selected patients, the presence of CPD may be a basis to investigate cardiac resynchronization therapy as a treatment strategy. Abstract Figure: Mortality in patients with CPD

A new approach to artefact detection and its effect on the normal range of segmental strain and strain rate values

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Helse Nord HNF1458-19

Background

Definition of normal ranges of myocardial segmental deformation are important in clinical studies and routine echocardiographic practice. It is known that artefacts hamper segmental strain and strain rate (S/SR) analysis.

Purpose

This study is based on a new approach for artefact detection. We intended to investigate to what degree different types of artefacts and their localization bias the result of measurements and to establish corrected normal ranges for segmental S/SR parameters.

Methods

The study is based on a collaboration project between the Russian cross-sectional study "Know your heart" and the Norwegian "Tromso-7" study. From 2207 participants we identified 840 individuals (511 females and 329 males, age range 40-79) with normal cardiac function by excluding left ventricular ejection fraction &lt;50%, moderate or severe valvular heart disease, LV- dilatation, pulmonary hypertension, Q-waves and bundle branch block signs on ECG, high blood pressure, history of heart attack, use of antihypertensive drugs or high level of NT-proBNP. End-systolic longitudinal epi- myo- and endocardial strain and peak systolic SR and diastolic SR E and SR A were assessed for the calculation of segmental normal ranges.

In addition to noise and foreshortening artefacts, we introduced a concept of "curve artefact" which can be defined as unphysiological strain curve shapes. Panel A of the figure shows examples of these curve artefacts, A: diastolic mismatch B: blunted curve, and C: floating curve. All strain curves were assessed for the presence of one of these unphysiological shapes and 2D images were visually assessed for the presence of noise, reverberations, or missing parts of the myocardium.

Results

The bar-chart for segmental strain demonstrates significantly reduced strain values at the presence of curve artefacts and increased strain at the presence of foreshortening. Normal ranges for basal septal, basal, medial, and apical segments excluding segments with artefacts and foreshortening are displayed in the table. The presence of curve artefacts matched the presence of noise or other 2D image artefacts in 88% of cases.

Conclusions

Strain artefacts result in systematically reduced peak-strain values. Thus, the detection and exclusion of curve artefacts seem to be an important measure for the correct interpretation of strain curves for a definition of normalcy and pathology. The selection of artefact-free strain curves reveals high strain and SR gradients increasing from epi to endocardial position and basal-septal towards apical segments. Abstract Figure. normal range  Abstract Figure. artefacts

Echocardiographic assessment of diastolic dysfunction in elderly patients with severe aortic stenosis before and after aortic valve replacement

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Helse Nord

Background

 The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS.

Purpose

The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures.

Methods

In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months.

Results

Pre- and postoperative values were septal e´; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e´ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e´19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively.  The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds according to the cut-off values of the table increased prediction of  NT-proBNP levels ≥ 500 ng/L with substantially increased specificity (&gt;85%).

Conclusion

Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6-12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Abstract Table Cut-off values for high ProBNP  Abstract Figure. Examples for diastolic parameters in AS

Left Ventricular Myocardial Segmentation in 3-D Ultrasound Recordings: Effect of Different Endocardial and Epicardial Coupling Strategies

Cardiac volume/function assessment remains a critical step in daily cardiology, and 3-D ultrasound plays an increasingly important role. Though development of automatic endocardial segmentation methods has received much attention, the same cannot be said about epicardial segmentation, in spite of the importance of full myocardial segmentation. In this paper, different ways of coupling the endocardial and epicardial segmentations are contrasted and compared with uncoupled segmentation. For this purpose, the B-spline explicit active surfaces framework was used; 27 3-D echocardiographic images were used to validate the different coupling strategies, which were compared with manual contouring of the endocardial and epicardial borders performed by an expert. It is shown that an independent segmentation of the endocardium followed by an epicardial segmentation coupled to the endocardium is the most advantageous. In this way, a framework for fully automatic 3-D myocardial segmentation is proposed using a novel coupling strategy.

First Report of Recombinant Potato virus Y Strains Infecting Potato in Jordan

Potato (Solanum tuberosum L.) is an important vegetable crop in Jordan, occupying second position after olives. In 2012, potatoes were planted on about 6,000 ha with a production of about 141,000 t (2). Potato virus Y (PVY) is a serious problem for potato production worldwide. Recombinant strains of the virus were reported to cause tuber necrotic ringspot disease (PTNRD) in many potato-growing regions of the world. In the last few years, a new recombinant PVY^NTN-NW that belongs to PVY^Z (3) has been reported in the neighboring Syria. It included three recombination patterns, SYR-I, SYR-II, and SYR-III, and caused severe PTNRD (1). Since PVY is easily transmitted from one region to another by aphid vectors and infected potato seeds, this study was initiated to investigate the possible occurrence of PVY strains in Jordan. In October 2013, 33 leaf samples were collected from symptomatic potato plants cv. Spunta from Wadi Rum, Jordan (GPS coordinates 29°31'37.76″ N, 35°42'48.75″ E), the largest potato-producing area in Jordan. Sampled plants displayed leaf mottling and yellowing, symptoms similar to those caused by PVY. All samples were tested for PVY by DAS-ELISA using the ELISA kit (monoclonal cocktail) developed by BIOREBA (Reinach, Switzerland) to detect all PVY isolates. Twenty-nine samples were found positive for PVY by ELISA. To confirm virus infection, total RNA was extracted from all ELISA-positive samples and used as template in uniplex RT-PCR using strain-specific primers (1). The band pattern of PCR amplicons showed that 12 samples were infected with PVY^NTN-NW genotype SYR-III and produced bands of 1,085, 441, and 278 bp. One sample was infected with PVY^NTN (A) and produced bands of 1,307, 633, and 441 bp, and one other sample was infected with PVY^NTN-NW genotype SYR-II and produced bands of 1,085 and 441 bp. Mixed infection with PVY^NTN-NW genotype SYR-III and PVY^NTN (B) was also detected in one sample producing bands of 278, 441, 1,085, and 1,307 bp. To confirm infection with the recombinant strains, PCR fragments of 278 bp amplified from three samples and 1,085 bp obtained from another three samples were directly sequenced and sequences were deposited in GenBank under accession numbers KJ159968, KJ159969, and KJ159970 for the 278-bp fragment and KJ159974, KJ159975, and KJ159976 for the 1,085-bp fragment. Sequence comparison with other PVY strains available in the NCBI database showed that the 278-bp fragment had the highest nucleotide sequence identity (100%) with PVY isolates SYR-III-A26 (AB461467) and SYR-III-2-4 (AB461457) from Syria. BLAST searches also showed that the 1,085-bp fragment shared 99% nucleotide identities with PVY isolates SYR-II-L3 (AB461482) and SYR-II-Be4 (AB461474) from Aleppo, Syria. To our knowledge, this is the first report of PVY recombinants in Jordan, and the first report of PVY^NTN-NW recombinants infecting potato crop outside Syria. Since Europe is the main supplier of potato seeds for farmers in Jordan and Syria, the introduction of PVY^NTN-NW to the region could have happened through infected potato seeds. Results of this study create new challenges for potato growers in Jordan as well as other countries in the region. References: (1) M. Chikh Ali et al. J. Virol. Methods 165:15, 2010. (2) FAO. http://faostat.fao.org/ (3) A. V. Karasev and S. M. Gray. Ann. Rev. Phytopathol. 51:571, 2013.

Diversity of citrus tristeza virus strains indicated by hybridization with cloned cDNA sequences

Cloned cDNA sequences 500-2000 base pairs long, derived from a severe citrus tristeza virus (CTV) isolate, were used to study sequence homology with RNA of nine other serologically indistinguishable CTV isolates which differed in their biological properties. Six of the nine CTV isolates hybridized positively with the tested cDNA clones, while three others hybridized differentially with these cDNA clones. The potential use of cloned viral sequences for typing of virus strains is discussed.

Molecular cloning of complementary DNA sequences of citrus tristeza virus RNA

Complementary DNA (cDNA) of citrus tristeza virus (CTV) RNA, synthesized using calf thymus DNA random primers, was converted to a double-stranded form and inserted into the PstI site of the Escherichia coli pBR322 plasmid by the G-C tailing method. Bacterial clones harbouring virus-specific sequences were detected by colony hybridization with a 32P-labelled viral RNA probe. Hybridization patterns of denatured virus RNA revealed the presence of three types of specific clones: those hybridizing with a distinct narrow band corresponding to the full-length virus RNA, those hybridizing with a broader band of virus RNA sequences, and those hybridizing with several distinct virus-related RNA bands. Similar patterns were obtained when these clones were hybridized to purified double-stranded RNA from CTV-infected plants. None of these cDNA clones hybridized with similarly treated preparations extracted from healthy plants. The origin of variation among the CTV clones is discussed.

A New Pathotype of Pepper mild mottle virus (PMMoV) Overcomes the L4 Resistance Genotype of Pepper Cultivars

The biological, serological, and molecular characteristics of a newly isolated L⁴ resistance-breaking isolate of Pepper mild mottle virus (PMMoV) were studied. The new pathotype of PMMoV is closely related to the Israeli pathotypes P_1,2 and P_1,2,3 of the virus; however, the mosaic symptoms caused by this new pathotype on pepper plants with an L⁴ genotype were more severe than the mild mosaic symptoms caused by other common pathotypes of the virus in susceptible plants. The predicted amino acid sequence of the putative coat protein (CP) of the newly described pathotype has two amino acid mismatches when compared with the CP of pathotype P_1,2, leucine to glutamine at position 47, and alanine to glycine at position 87. The CP of the new pathotype has one amino acid mismatch when compared with P_1,2,3, having alanine instead of glycine at position 87. Based on its biological characteristics, the new pathotype was designated P_1,2,3,4 of PMMoV-Is. A method is described for the differentiation among the three PMMoV pathotypes using restriction cleavage analysis of reverse-transcription polymerase chain reaction products made from virus-infected plants. An additional unique MnlI site in the CP gene of the newly isolated P_1,2,3,4 allows its distinction from the other two isolates, while BglI cleaved only products of the P_1,2 pathotype.

The DDX3 subfamily of the DEAD box helicases: divergent roles as unveiled by studying different organisms and in vitro assays

DDX3 (or Ded1p), the highly conserved subfamily of the DEAD-box RNA helicase family (40 members in humans), plays important roles in RNA metabolism. DDX3X and DDX3Y, the two human paralogous genes of this subfamily of proteins, have orthologous candidates in a diverse range of eukaryotes, from yeast and plants to animals. While DDX3Y, which is essential for normal spermatogenesis, is translated only in the testes, DDX3X protein is ubiquitously expressed, involved in RNA transcription, RNA splicing, mRNA transport, translation initiation and cell cycle regulation. Studies of recent years have revealed that DDX3X participates in HIV and hepatitis C viral infections, and in hepatocellular carcinoma, a complication of hepatitis B and hepatitis C infections. In the urochordates (i.e., Botryllus schlosseri) and in diverse invertebrate phyla (represented by model organisms such as: Drosophila, Hydra, Planaria), DDX3 proteins (termed also PL10) are involved in developmental pathways, highly expressed in adult undifferentiated soma and germ cells and in some adult and embryo's differentiating tissues. As the mechanistic and functional knowledge of DDX3 proteins is limited, we suggest assembling the available data on DDX3 proteins, from all studied organisms and in vitro assays, depicting a unified mechanistic scheme for DDX3 proteins' functions. Understanding the diverse functions of DDX3 in multicellular organisms may be particularly important for effective strategies of drug design.

AML1 deletion in adult mice causes splenomegaly and lymphomas

AML1 (RUNX1) encodes a DNA-binding subunit of the CBF transcription factor family and is required for the establishment of definitive hematopoiesis. AML1 is one of the most frequently mutated genes associated with human acute leukemia, suggesting that genetic alterations of the gene contribute to leukemogenesis. Here, we report the analysis of mice carrying conditional AML1 knockout alleles that were inactivated using the Cre/loxP system. AML1 was deleted in adult mice by inducing Cre activity to replicate AML1 deletions found in human MDS, familial platelet disorder and rare de novo human AML. At a latency of 2 months after induction, the thymus was reduced in size and frequently populated by immature double negative thymocytes, indicating defective T-lymphocyte maturation, resulting in lymphatic diseases with 50% penetrance, including atypical hyperplasia and thymic lymphoma. Metastatic lymphomas to the liver and the meninges were observed. Mice also developed splenomegaly with an expansion of the myeloid compartment. Increased Howell-Jolly body counts indicated splenic hypofunction. Thrombocytopenia occurred due to immaturity of mini-megakaryocytes in the bone marrow. Together with mild lymphocytopenia in the peripheral blood and increased fractions of immature cells in the bone marrow, AML1 deficient mice display features of a myelodysplastic syndrome, suggesting a preleukemic state.

DNA markers for identifying biotypes B and Q of Bemisia tabaci (Hemiptera: Aleyrodidae) and studying population dynamics

The two most widespread biotypes of Bemisia tabaci (Gennadius) in southern Europe and the Middle East are referred to as the B and Q-type, which are morphologically indistinguishable. In this study various DNA markers have been developed, applied and compared for studying genetic diversity and distribution of the two biotypes. For developing sequence characterized amplified regions (SCAR) and cleaved amplified polymorphic sequences (CAPS) techniques, single random amplified polymorphic DNA (RAPD) fragments of B and Q biotypes, respectively, were used. The CAPS were investigated on the basis of nuclear sodium channel and the mitochondrial cytochrome oxidase I genes (mtCOI) sequences. In general, complete agreement was found between the different markers used. Analysis of field samples collected in Israel for several years, using these markers, indicated that the percentage of the Q biotype tends to increase in field populations as time progresses. This may be attributed to the resistance of the Q biotype to neonicotinoids and pyriproxyfen and the susceptibility of the B biotype to these insecticides.

Characterization of a distinct carlavirus isolated from Verbena

Avirus was isolated from Verbena plants that bore virus-like symptoms. The virus, for which the name Verbena latent virus (VeLV) is proposed, was consistently isolated from these plants, both with and without disease symptoms. Electron microscopy studies of ultrathin sections of infected Verbena tissues revealed the presence of elongated flexuous virus particles, ca. 650 nm in length. Its experimental host range was limited to Verbena spp. and Nicotiana clevelandii. No inclusion bodies or specific cytopathological effects, were observed. Electrophoresis of dissociated purified virus preparation in sodium dodecyl sulfate-polyacrylamide gel revealed a major protein component with a molecular mass of 38.9 kDa. Polyclonal antibodies which could specifically bind to virus particles were produced. A portion of the viral RNA was cloned and sequenced; it comprised 2503 nucleotides and contained part of three open reading frames (ORFs) which from the 5' to the 3'-ends, potentially encode for 489 amino acids (ORF1), a 25.8-kDa protein (ORF2) and a 12-kDa protein (ORF3). Comparison of the predicted amino acid sequence with those of other plant viruses revealed 40-60% identity with several carlaviruses. In the light of particle morphology, absence of specific cytopathological effects in ultrathin sections, and genomic and serological properties, it is suggested that this virus belongs to the genus Carlavirus.

Cost-Effectiveness of tolterodine for patients with urge incontinence who discontinue initial therapy with oxybutynin: a Canadian perspective

BACKGROUND

Tolterodine is a novel muscarinic receptor antagonist for the treatment of overactive bladder.

OBJECTIVE

The purpose of this study was to examine the cost-effectiveness of tolterodine for patients with urge incontinence (UI) who discontinue initial therapy with oxybutynin in a Canadian setting.

METHODS

We compared 2 treatment strategies for the management of adult patients with UI: (1) generic oxybutynin with no further treatment for patients who discontinue and (2) generic oxybutynin with switch to tolterodine (2 mg BID) for patients who discontinue. We developed a 1-year Markov model (4-week cycle length) with transitions between disease states of normal, mild, moderate, and severe. Transition probabilities over 12 weeks were obtained from randomized trial data, and drug discontinuation rates were obtained from Quebec prescription claims data. Outcome measures were time in "normal" health state and quality-adjusted life-years (QALYs) using EuroQol-5D utility scores from a survey of Swedish patients with overactive bladder. Costs to the health care payer and patient out-of-pocket costs (in Canadian dollars) were included.

RESULTS

For patients who discontinue oxybutynin, the use of tolterodine is associated with approximately 6 months per year in a normal health or mild disease state, compared with approximately 3 months for those who do not receive further drug therapy after discontinuation. Tolterodine use resulted in an annual additional cost per patient of Can $163. The incremental cost per QALY was Can $9,982 and appeared to be robust to alternative model parameter assumptions.

CONCLUSION

Use of tolterodine in patients with UI who discontinue initial therapy with generic oxybutynin lies within currently accepted benchmarks for cost-effectiveness.

Differentiating PVY(NTN) from PVY(N) by annealing to reference RNA transcripts

A method for the differentiation of virus strains based on the shift in electrophoretic mobility of partially annealed RNA transcripts is described. Oppositely oriented RNA transcripts of the NTN- and N-strains of PVY, complementary at their 3'-end variable (strain-specific) region, were annealed to form a partial duplex which moved more slowly in gel than heterologous (NTN+N) unpaired transcripts. Thus, the two virus strains could be identified by annealing to a known reference transcript. The rate of duplex migration was correlated with transcript lengths and could be tightly controlled thereby. Thus, a higher degree of resolution was obtained than with transcript conformation polymorphism, which is empirical and unpredictable in nature.

Quality of life and costs associated with micronized progesterone and medroxyprogesterone acetate in hormone replacement therapy for nonhysterectomized, postmenopausal women

BACKGROUND

Because natural progesterone is poorly absorbed and rapidly metabolized, synthetic derivatives of progesterone, such as medroxyprogesterone acetate (MPA), are used in combination with estrogen in hormone replacement therapy. A micronized form of natural progesterone is available that is readily absorbed and reaches peak serum concentrations from 1 to 4 hours after administration.

OBJECTIVE

The purpose of this study was to compare the quality of life (QOL), menopausal symptoms, and costs associated with a natural micronized progesterone (MP) formulation versus MPA as add-on therapy to estrogen in hormone replacement for post-menopausal women.

METHODS

This prospective, multicenter, randomized, fixed-dose, open-label, parallel-group study enrolled postmenopausal, otherwise healthy, nonhysterectomized women 45 to 65 years of age who had been amenorrheic for > or =6 months and exhibited symptoms of estrogen deficiency. All women received 0.625 mg conjugated equine estrogens on days 1 to 25 of a 30-day cycle; on days 12 to 25, women were randomized to receive either MP 200 mg or MPA 5 mg; patients were followed for 9 months. QOL, the primary end point, was measured at baseline and months 3, 6, and 9 using the 36-Item Short-Form Health Survey (SF-36), the Nottingham Health Profile (NHP), and the condition-specific Women's Health Questionnaire (WHQ). Bleeding pattern, compliance, menopausal symptoms, and cost were evaluated as secondary end points. Costs (in 1997 Canadian dollars) were assessed from the societal perspective and included costs of study medication, hormone therapy monitoring, concomitant medication, outpatient resources, out-of-pocket expenses, and patient and caregiver time loss.

RESULTS

A total of 182 women were enrolled; 89 received MP and 93 received MPA. Improvements in climacteric symptoms were observed from baseline to month 9 for both treatments. Mean scores on all domains of the SF-36 at month 9 were greater than scores at baseline in both treatment groups but the increases were not statistically significant. All domains within the NHP and WHQ improved significantly over this period for both groups (P < or = 0.008). Only patients receiving MP showed specific improvements in the menstrual problems and cognitive domains of the WHQ. The difference in average 9-month cost per patient was not statistically significant, at Can 367 dollars +/- 120 dollars and Can 360 dollars +/- 369 dollars for patients receiving MP and MPA, respectively.

CONCLUSIONS

MP is a clinically effective, well-tolerated, and cost-comparable alternative to MPA.

Okra (Hibiscus esculentus)-A New Host of Turnip mosaic virus in Israel

In July 1999, Hibiscus esculentus plants, grown in garden plots in Galilee, Israel, exhibited chlorosis, vein clearing accompanied by necrosis, and growth reduction. All samples (n = 10) tested positive for Turnip mosaic virus (TuMV) in enzyme-linked immunosorbent assay (ELISA), using a polyclonal antibody produced in our laboratory against purified virus. Virus in crude sap extracted from symptomatic tissue was mechanically transmitted to Chenopodium quinoa, C. amaranticolor, Nicotiana tabacum Xanthi nc and White Burley, N. clevelandii, N. benthamiana, N. sylvestris, and N. rustica, all of which developed symptoms characteristic of TuMV infection (1). ELISA testing of leaf sap extracted from mechanically inoculated indicator plants gave a strong positive reaction to TuMV. Leaf dip preparations of H. esculentus were analyzed by transmission electron microscopy. Filamentous virus particles typical of a potyvirus were observed in samples from symptomatic leaves. General primer pairs, which cover the complete 3'-end of the potyvirus genome were used in a reverse transcription-polymerase chain reaction assay (RT-PCR), gave an expected amplification product of approximately 300 bp. The nucleotide sequence of the PCR product was 97% identical to the CP sequence of other TuMV, thus verifying TuMV infection of H. esculentus. This is the first report of H. esculentus infection by TuMV. Reference: (1) A. Gera et al. J. Phytopathol. 145:289-293, 1997.

Improved electrophoretic resolution of RNA transcripts by specific homologous oligonucleotide gel retardation

An improved procedure for the resolution of RNA transcripts by electrophoretic gel retardation, mediated by annealing to specific homologous oligonucleotiedes is described. The N and NTN strains of PVY served as a model system. Non-polymorphic but sequence-diverse RNA transcripts were copied from PCR products of the two virus strains. The transcripts were resolved by gel electrophoresis, because of the differential retardation effect caused by the binding of strain-specific homologous oligonucleotides. The two PVY strains were thus differentiated. Applicability of this method to virus strain differentiation in general is discussed.

Economic evaluation of a new acellular vaccine for pertussis in Canada

OBJECTIVE

Pertussis is a highly contagious infection affecting mainly children. Acellular pertussis vaccines were recently introduced in Canada based on evidence of improved safety and efficacy over whole cell vaccines, the current standard of care. The following study reports the economic impact of replacing the whole cell vaccine (wP) by a new acellular vaccine (aP) in the Ontario pertussis immunisation programme.

DESIGN

For a hypothetical cohort of 100,000 children from birth to the age of 8 years, the costs and consequences of pertussis vaccination with either aP or wP were compared. A decision analytical model was constructed for vaccine delivery, treatment of pertussis cases and vaccine adverse events, with analyses from the viewpoints of the Ontario Ministry of Health and society.

MAIN OUTCOME MEASURES AND RESULTS

The main outcomes were expected number of pertussis cases, hospitalisations, and workdays lost by parents. Data on vaccine effectiveness, pertussis incidence, and other parameters used in the model were from published literature. Costs were discounted at 5%, and extensive sensitivity analyses were undertaken. Over 8 years, in a cohort of 100,000 children, the introduction of aP would prevent 10,500 cases of pertussis, avoiding 504 hospital admissions and 73,500 days of work absence. For Ontario, healthcare cost savings over the same period would amount to 275,585 Canadian dollars ($Can), and societal savings to $Can9,752,864

Biological and Molecular Characterization of a New Carlavirus Isolated from an Aconitum sp

ABSTRACT A new virus was isolated from symptomless Aconitum napellus plants. The virus, for which the name Aconitum latent virus (AcLV) is proposed, has flexuous particles 640 nm in length. The experimental host range was limited to Nicotiana clevelandii. Electron microscopy studies of ultrathin sections of infected A. napellus tissues revealed the presence of elongated virus particles. No inclusion bodies characteristic of potyvirus infection were observed. AcLV was purified from naturally infected A. napellus by cesium chloride step gradient centrifugation. In sodium dodecyl sulfate-polyacrylamide gel electrophoresis of dissociated purified virus preparations, a major protein component with a molecular mass of 35 kDa was observed. Diagnostic antibodies that could specifically bind to virus particles were produced. The 5' terminus (620 nucleotides) of the viral RNA was cloned and sequenced. It comprised 71 nucleotides from the untranslated 5' terminus and 549 nucleotides of an open reading frame encoding 183 amino acids. Comparison of the predicted amino acid sequence with those of other plant viruses revealed 40 to 60% identity with several carlaviruses. Based on particle morphology, absence of inclusion bodies in ultrathin sections, the relative molecular weight of the coat protein, the nucleotide sequence, and predicted amino acid homology, it is suggested that this virus belongs to the carlavirus group.

Depsipeptide dendrimers

The convergent synthesis of a new class of chiral dendrimers is described. Owing to their structural resemblance to depsipeptides they are called depsipeptide dendrimers. The ex-chiral pool synthesis starts from (R,R)-, (S,S)-, and meso-tartaric acid as branching units and dipeptides or tripeptides consisting of glycine, (L)-alanine, and (L)-leucine as chiral-spacer building blocks. The key intermediates for the convergent assembly of such depsipeptide dendrimers are the peptide-tartaric acid conjugates 13a,b, 19a,b, 25, and 27, which contain either an unprotected C terminus of the peptide chain (13 a,b, 25) or two unprotected hydroxy groups within the tartaric acid termini. Dendra up to the third-generation, by using different combinations of stereoisomeric building blocks, were synthesized and completely characterized. Since this construction principle of chiral depsipeptide dendrimers allows for a wide variation of the length, the primary structure of the peptide spacer, and the configuration of both the amino acid and the tartaric acid moieties, access to new combinatorial libraries is conceptually provided.

Differentiation among isolates of prunus necrotic ringspot virus by transcript conformation polymorphism

A method based on differences in electrophoretic mobility of RNA transcripts made from polymerase chain reaction (PCR) products was used for differentiation among virus isolates. A T7 RNA polymerase promoter was attached to amplified prunus necrotic ringspot virus (PNRSV) sequences by PCR. The PCR products then served as a template for transcription. Single-stranded transcripts originated from different PNRSV isolates varied in electrophoretic mobility in polyacrylamide gels, presumably because of transcript conformation polymorphism (TCP). This procedure was applied for the differentiation of PNRSV isolates.

The use of short and long PCR products for improved detection of prunus necrotic ringspot virus in woody plants

The reverse transcriptase-polymerase chain reaction (RT-PCR) was used for detection of prunus necrotic ringspot virus (PNRSV) in dormant peach and almond trees by the application of two different pairs of primers yielding a short and a long product, respectively. The relative amount of the short (200 base pair, bp) product was higher than the longer (785 bp) product. PNRSV was detected better in plant tissues with a low virus concentration (e.g. dormant trees) by amplification of the short PCR product, whereas the long product was product was produced at higher virus titers. Simultaneous amplification of both short and long products was demonstrated using a three-primer mixture in a single reaction tube. In this assay, amplification of either PCR product indicated the presence of PNRSV-specific sequences in the plant tissue examined, thus covering a wide range of virus concentrations in a single test. Dilution of the RNA extracted from infected plant material resulted in a steep decline in the amplification of both short and long PCR products. In contrast, serial dilutions of the intermediate cDNA template differentially affected the amplification patterns: the relative amount of the short product increased whereas that of the long product decreased. These results may explain the preferential amplification of the short PCR product observed in samples containing low virus concentrations.

Complete RNA1 sequences of two UK isolates of barley mild mosaic virus: a wild-type fungus-transmissible isolate and a non-fungus-transmissible derivative

The complete RNA1 sequences of two isolates (fungus transmissible and non-fungus transmissible) of barley mild mosaic virus (BaMMV) were obtained. The two isolates' RNA1 sequences had very high sequence identity (99.3%), and of the 15 amino acid differences (out of 2258) between the putative polyproteins, 11 were conservative and unlikely to affect the structure or function of the protein. The remaining amino acid differences were thought unlikely to affect fungus transmission because they occur in the CI- and NIb-coding regions. This strongly suggests that the P73 protein of RNA2 (which has a 364-aa deletion in the non-fungus-transmissible isolate) is involved in fungus transmission of BaMMV.

Evaluation of linked PCR-transcription amplification procedure for bean yellow mosaic virus detection in gladioli

Bean yellow mosaic virus (BYMV) concentration in in-vitro cultured Gladiolus cormlets was low and impossible to detect by the commonly used diagnostic methods. The polymerase chain reaction (PCR) detected viral RNA in most infected cormlets but not in all. Additional amplification of the PCR products by transcription, using T7 RNA polymerase (PCR/T), resulted in virus detection in cases which otherwise went undetected. PCR products having a single polymerase promoter at one end served as a better template for T7 RNA polymerase, and yielded more transcripts of a particular orientation than a template containing promoters at both ends. Repeated cycles of PCR/T resulted in the production of a heterogeneous amplified material which correlated with a progressive decline in amplification rate. Therefore, only the first PCR/T cycle proved to be effective. The PCR/T procedure was shown to be better than other commonly used diagnostic methods including PCR.

Analysis of Ly-1+ B-cell populations and IgH rearrangements in "normal" spleens and in lymphomas of AKR/J and AKR Fv-1b mice

AKR mice are highly susceptible to development of spontaneous T-cell lymphoma. Thymus removal at the age of 1-3 months greatly reduces T-cell lymphoma. Lymphomas that have the characteristics of T- and/or B-cells occur sporadically in peripheral lymphoid tissues of old thymectomized AKR/J mice. These thymectomized mice were shown to carry dormant potential lymphoma cells. Transplantation of lymphoid cells from 8-12-month-old AKR/J mice, thymectomized at the age of 6 to 8 weeks, into intact or thymectomized young recipients yielded 80-100% Ly-1+ pre-B or B-cell lymphomas. In the AKR-Fv-1b congenic strain the Fv-1n allele of AKR/J mice was substituted with the Fv-1b allele, thereby limiting viral replication and spread of the endogenous N-tropic murine leukemia virus. As a result of this restriction in virus spread, AKR-Fv-1b mice develop a low spontaneous incidence (7%) of T-cell lymphomas and about 28% of Ly-1+ B-cell lymphomas at old age. In spleens of 15-18-month-old thymectomized AKR/J mice and intact AKR-Fv-1b mice, 30-60% of the B-cells were of the Ly-1+ B type. Analysis of the IgH locus in these normal old spleens and Ly-1+ B lymphomas indicated mono- or oligoclonality. One particular IgH rearrangement was identified in many individual old spleens and tumors. A second specific IgH rearrangement was found in some tumors. Possible mechanisms involved in the expansion of Ly-1+ clones and their progression into tumors are discussed.

A zucchini yellow mosaic virus coat protein gene mutation restores aphid transmissibility but has no effect on multiplication

An aphid-transmissible (AT) and two non-aphid-transmissible (NAT) isolates of zucchini yellow mosaic virus (ZYMV) were studied. The predicted amino acid sequences of the coat protein (CP) of the three virus isolates were analysed and compared. The NAT isolates differed from the AT isolate in having a Thr instead of an Ala residue at position 10 in the conserved Asp-Ala-Gly triplet in the N-terminal region of CP. Aphid transmissibility was restored in a progeny virus derived from an infectious clone of the ZYMV-NAT isolate in which Thr was changed back to Ala by site-directed mutagenesis. However this mutation did not have any effect on the multiplication rate in squash, which was significantly higher than that of the AT isolate. The involvement of this mutation in aphid transmission and virus multiplication is discussed.

Infectious in vitro RNA transcripts derived from cloned cDNA of the cucurbit potyvirus, zucchini yellow mosaic virus

A full-length cDNA clone of the RNA genome of the cucurbit potyvirus zucchini yellow mosaic virus (ZYMV) was constructed downstream from a bacteriophage T7 RNA polymerase promoter. A single extra guanosine residue not present in ZYMV RNA was added to the 5' and 3' ends. Capped (m7GpppG) ZYMV RNA transcripts were infectious in 10 of 91 Cucurbita pepo test plants; uncapped RNA transcripts were not infectious. The appearance of symptoms in plants inoculated with the infectious transcript was delayed for more than a week compared to plants inoculated with native viral RNA. The progeny virions recovered from infected plants had the same biological properties (aphid non-transmissibility and typical symptoms) as the parental virus. The progeny virions also reacted positively with ZYMV antiserum and ZYMV-specific probes by dot blot hybridization. The authenticity of the progeny virus was verified by identifying a specific molecular marker (C substituted for T in the 3' non-coding region) using nucleotide sequence analysis.

Cloning and mapping of the potato virus Y genome and its in vitro expression

Full-length cDNA of genomic RNA of potato virus Y (PVY) was cloned in one piece into a lambda vector. The order of the EcoRI and SalI fragments of the inserted cDNA was determined. This is the first report of the cloning of a long, expressible, potyvirus genome. The availability of such a clone is a prerequisite for any further study of the molecular biology of this group of viruses, as they are expressed into a self-processed primary polyprotein.

The effects of position cues on the appearance of stimulus elements in a bistable apparent movement display

A modified version of the Ternus display was used to assess the relative effects of element position cues on reports of group and end-to-end movement. In this display, two rows of stimulus elements are joined by connecting lines. In one version of the display, the connecting lines remain stationary across frames, facilitating the interpretation that the associated stimulus elements also remain stationary. In another version of the display, one end of the connecting lines shifts horizontally from frame to fame, facilitating the interpretation that the associated stimulus elements have also shifted. The experiment showed that when the connecting lines remain stationary, reports of end-to-end movement increase, regardless of the interstimulus interval (ISI) at which the frames alternate. When the connecting lines shift, reports of group movement increase, regardless of ISI. Theoretical interpretations of the results involving both relatively low-level motion signals and higher order perceptual influences are considered.

Nucleotide sequence of the zucchini yellow mosaic virus capsid-encoding gene and its expression in Escherichia coli

Zucchini yellow mosaic virus (ZYMV) RNA was purified and used as a template for the synthesis of cDNA. A partial restriction map covering 9.4 kb of the ZYMV genome was constructed from three clones designated ZYKS-22, ZYKS-16 and ZYKS-3. Sequencing the 3'-end region of the ZYMV genome indicates the presence of (A)48 chain. This is followed by an untranslated region of 210 nucleotides (nt) and a coding region of 837 nt corresponding to the putative virus coat protein (Cp) gene (cp). The predicted amino acid (aa) sequence of Cp derived from the cDNA showed about 50% to 62% homology with the known aa sequence for Cp of six other potyviruses. A construct of the putative cp was subcloned in frame with the lacZp gene promoter in a Bluescript plasmid and expressed in Escherichia coli cells. The fusion polypeptides (34 and 41 kDa), positively reacted in Western blots with an antiserum prepared against the native virus Cp.

Nucleotide sequence of the capsid protein gene of potato virus Y (PVY)

The nucleotide sequence of the 3' terminal region of potato virus Y (PVY) was determined. Starting with a poly(A) tail of 18 residues a non-coding region of 335 nucleotides precedes the region encoding for the virus coat protein (cp) 801 nucleotides long ending with a TGA. This region was located by comparing the predicted amino acid sequence with the one determined for the PVY capsid protein by Shukla et al. (1). Both sequences contained 267 amino acids sharing about 94% homology. They differ, however, at several positions presumably due to base transitions within their respective nucleotide sequences. Restriction endonuclease sites in and around the cp coding region were identified.

A new fused transcript in Philadelphia chromosome positive acute lymphocytic leukaemia

The leukaemic cells of more than 90% of chronic myelogenous leukaemia (CML) patients and of 10% of acute lymphocytic leukaemia (ALL) patients carry the t(9:22) (q34:q11) translocation which generates the Philadelphia chromosome (Ph1). In CML the abl gene is translocated from chromosome 9 to the centre of the bcr gene on chromosome 22 and this results in production of chimaeric bcr-abl RNA translated into a protein of relative molecular mass (Mr) 210,000 (210K). Our data indicate that in ALL abl is translocated into the 5' region of the bcr gene. The consequence of this is the expression of a fused transcript in which the first exon of bcr is linked to the second abl exon. This transcript encodes a 190K protein kinase.