Hypomorphic RAG deficiency: impact of disease burden on survival and thymic recovery argues for early diagnosis and HSCT

Patients with hypomorphic mutations in the RAG1 or RAG2 gene present with either Omenn syndrome or atypical combined immunodeficiency with a wide phenotypic range. Hematopoietic stem cell transplantation (HSCT) is potentially curative, but data are scarce. We report on a worldwide cohort of 60 patients with hypomorphic RAG variants who underwent HSCT, 78% of whom experienced infections (29% active at HSCT), 72% had autoimmunity, and 18% had granulomas pretransplant. These complications are frequently associated with organ damage. Eight individuals (13%) were diagnosed by newborn screening or family history. HSCT was performed at a median of 3.4 years (range 0.3-42.9 years) from matched unrelated donors, matched sibling or matched family donors, or mismatched donors in 48%, 22%, and 30% of the patients, respectively. Grafts were T-cell depleted in 15 cases (25%). Overall survival at 1 and 4 years was 77.5% and 67.5% (median follow-up of 39 months). Infection was the main cause of death. In univariable analysis, active infection, organ damage pre-HSCT, T-cell depletion of the graft, and transplant from a mismatched family donor were predictive of worse outcome, whereas organ damage and T-cell depletion remained significant in multivariable analysis (hazard ratio [HR] = 6.01, HR = 8.46, respectively). All patients diagnosed by newborn screening or family history survived. Cumulative incidences of acute and chronic graft-versus-host disease were 35% and 22%, respectively. Cumulative incidences of new-onset autoimmunity was 15%. Immune reconstitution, particularly recovery of naïve CD4+ T cells, was faster and more robust in patients transplanted before 3.5 years of age, and without organ damage. These findings support the indication for early transplantation.

Risk factors and outcomes associated with type of uterine rupture

PURPOSE

To identify risk factors associated with the occurrence of complete uterine rupture (CUR) in comparison to partial uterine rupture (PUR) to further investigate to what extent a standardized definition is needed and what clinical implications can be drawn.

METHODS

Between 2005 and 2017 cases with CUR and PUR at Charité University Berlin, Germany were retrospectively identified. Demographic, obstetric and outcome variables were analyzed regarding the type of rupture. Binary multivariate regression analysis was conducted to identify risk factors associated with CUR. In addition, the intended route of delivery (trial of labor after cesarean delivery (TOLAC) and elective repeat cesarean delivery (ERCD)), divided according to the type of rupture, was compared.

RESULTS

92 cases with uterine rupture were identified out of a total of 64.063 births (0.14%). Puerperal complications were more frequent in CUR (67.9 versus 41.1%, p = 0.021). Multiparity ≥ 3 was more frequent in CUR (31 versus 10.7%, p = 0.020). Factors increasing the risk for CUR were parity ≥ 3 (OR = 3.8, p = 0.025), previous vaginal birth (OR = 4.4, p = 0.011), TOLAC (OR = 6.5, p < 0.001) and the use of oxytocin (OR = 2.9, p = 0.036). After multivariate analysis, the only independent risk factor associated with CUR was TOLAC (OR = 7.4, p = 0.017).

CONCLUSION

TOLAC is the only independent risk factor for CUR. After optimized antenatal counselling TOLAC and ERCD had comparable short-term maternal and fetal outcomes in a high resource setting. A high number of previous vaginal births does not eliminate the risk of uterine rupture. A clear distinction between CUR and PUR is essential to ensure comparability among studies.

Impact of COVID-19 on gynaecological patient care: results of patient's survey with 327 patients

Purpose

The pandemic SARS-CoV-2 poses new and unprecedented challenges for health care systems on a national and global level. Although the current situation has been going on for more than 1 year, there is limited data on the impact of the pandemic on general hospital and medical practice care. This survey captures the perspective of patients with gynaecological diseases of this impact.

Methods

Using a paper-based questionnaire, 327 patients were asked about medical care and their experiences during the pandemic at the University Hospital Bonn and the University Hospital Charité Berlin. The study was performed from the 1st June to 30th September 2020.

Results

A total of 327 patients participated in the study: 156 stated to have been tested for coronavirus, and 1 patient reported a positive test. 41.3% of the patients felt insecure about the current situation, 30.4% were concerned about the risk of infection during the hospital stay. The pandemic-specific measures in hospitals and medical practices unsettled 6.8% of patients. 18.1% of patients feared that their gynaecological disease would not be treated adequately due to the pandemic. 55.7% of patients reported that their confidence in their physicians has increased during the pandemic.

Conclusion

The results show that patients’ confidence in the healthcare system and the physicians acting significantly increased during the COVID-19 crisis. Transparent and comprehensive information policy regarding actions and restrictions within the COVID-19 crisis eases patients concerns and improves patients’ confidence in their physicians, which is crucial for a successful treatment’s outcome.

The women in situation of gaslighting – risk identification in the work environment

Background

As a contemporary form of “workplace harassment' (WH) is reported gaslighting. Preston Ni, defines it as ‘A form of constant manipulation and brainwashing…' The phenomenon is presented as mainly affecting the woman in the workplace. The aim of the study is to determine and identify the risk of subjecting a woman in the workplace in Bulgaria to this form of psychological pressure gaslighting, in favor of building a risk reduction program cause.

Methods

Empirical sociological research (ESR) among working women for period of 10 years in Sofia (around 2 million citizens), Bulgaria. An anonymous survey of 2,000 working women between the ages of 30 and 65 was conducted. The questionnaire of the respondents with only more than 5 years of work experience are included.

Results

Of the surveyed 25% are between 30-40 years, about 47% are 41-50 years, about 25% are 51-60 years and about 3% are 61-65 years. The result of the study indicates that mostly women between 41 and 50 years are subjected to psychological pressure by a man at work (about 45%), about 15% - are 51-60 years, only about 5% of women 31-40 years, and less 2% over 61. All of them are described as introverted. Mostly women with a high level of education have remained mentally resistant to gaslighting - about 35% of respondents, and less than 5% of them have shown higher creativity against the background of psychological pressure. In almost 1/3 of those subjected to prolonged mental harassment, were diagnosed for the first time, including: Hashimoto's thyroiditis (5%); arterial hypertension (about 10%); ischemic disease (about 15%). Half of them are presented with depression.

Conclusions

Gaslighting is a hidden psychological violence against a female person based on hate speech and demonstration of power. Gaslighting is defined as a real risk among women, mostly of the introverted type. Emotional plasticity based on knowledge and smart has a positive effect in situation of gaslighting.

Key messages

Gaslighting can lead to lack of confidence, clinical depression, distress and related physical illnesses. Early risk detection provides advantages for early reduction and optimization of the corporate culture of the department and the institution and in favor of building a risk reduction program.

Workplace mobbing and organizational intelligence - healthcare risk management in a crisis

Issue

Mobbing is the old syndrome of the new age. A phenomenon of invisible systemic group pressure on a selected dissident victim and a visible harassment that sticks strongly in a crisis. A victim with a strong character, a person competent and leadership skills to a degree that exceeds another placed leader, as an expression of his fear and frustration. The presence of mobbing is always an expression of a bad organizational culture. The opportunities for risk reduction are based in the creation of a highly effective, tactical-strategic flexibility and creative program of control, mediation and modeling of the risk factors leading to mobbing.

Description of the problem

A particularly interesting scene for the manifestation of mobbing is the academic environment. The manifestation of mobbing leads to serious losses, social isolation and has health consequences on the attacked and subjected to emotional pressure member of the team. A creative scientist and charismatic teacher, a wonderful and eroded specialist does not go unnoticed by the more mediocre. Circles are formed with different scope and degrees of trust in the initiator of the mobbing, who generates and manages directly several with the role of accomplices and indirectly dozens to hundreds of cowardly and sufficiently obedient performers.

Results

Basic human rights are violated and the organizational culture of the institution is compromised through mobbing. A process of a cyclical nature in which only the victim changes. The implementation of a policy of zero tolerance for mobbing is a starting point, but it is not enough for a lasting solution to a problem with the volume and nature of a socio-economic disaster.

Lessons

Mobbing is a conflict of interest in which the better prepared fall victim to the more mediocre. Insufficiently good level of management at all levels in the institution leads to mobbing when a competent and eroded member of the team appears.

Key messages

No one is protected from mobbing in bad and destructive management. A mobbing risk reduction program is applicable to each prevention indication at each level.

Psychological assistance at disaster in Bulgaria - contemporary policies for health risk management

Issue

Health risk management (HRM) in Bulgaria is provided to citizens in emergencies, disasters, accidents and catastrophes (E&DAC). According to the legislation in the country, this is a part of the mandatory package of medical provision for the injured population (MPIP) and concerns any acute life-threatening condition (LTC). In the dynamically changing environment of E&DAC, a special form of health consequences among survivors are related to mental health (MeH).

Description of the problem

In practice, any serious E&DAC has a direct or indirect psychological impact. It can manifest itself acutely or remotely over time, puts the victims in temporary or permanent disability and is followed by serious social effects. A strategy has been proposed for inclusion in the obligatory package of MPIP in case of significant E&DAC and primary psychological assistance (PPA) for every citizen who has survived.

Results

In the country, PPАs to citizens for decades is an on-demand service provided mainly by the private sector. Within the BRC, a group has been formed to provide PPA with a modest resource capacity. The emotional citizens culture in the country is far from active demand for PPA in general and severely limited in resources and the MeH is not a priority. This system of public health care, based on withdrawal from the MeH, also exposes to increased risk of psycho-somatic and distress-provoked physical illnesses (PSDPPhI).

Lessons

Carrying out timely PPA for those in need changes the range of adverse mental effects, reducing them. Provides a better adaptive response to reduced risk of PTSD and PSDPPhI. A volume of preventive measures organized in stages over time gives a greater chance to a larger number of victims.

Key messages

The health of the nation is a complex program for controlling both the acute health problems at E&DAC and the protection of MeH. To provide modern sustainable policies for the implication of PPA in everyone who has seriously experienced E&DAC is resulted in good health practices.

Influence of migrant background on patient preference and expectations in breast and gynecological malignancies (NOGGO-expression V study): results of a prospective multicentre study in 606 patients in Germany

Background

An effective cross-cultural doctor-patient communication is vital for health literacy and patient compliance. Building a good relationship with medical staff is also relevant for the treatment decision-making process for cancer patients. Studies about the role of a specific migrant background regarding patient preferences and expectations are lacking. We therefore conducted a multicentre prospective survey to explore the needs and preferences of patients with a migrant background (PMB) suffering from gynecological malignancies and breast cancer to evaluate the quality of doctor-patient communication and cancer management compared to non-migrants (NM).

Methods

This multicentre survey recruited patients with primary or recurrence of breast, ovarian, peritoneal, or fallopian tube cancer. The patients either filled out a paper form, participated via an online survey, or were interviewed by trained staff. A 58-item questionnaire was primarily developed in German and then translated into three different languages to reach non-German-speaking patients.

Results

A total of 606 patients were included in the study: 54.1% (328) were interviewed directly, 9.1% (55) participated via an online survey, and 36.8% (223) used the paper print version. More than one quarter, 27.4% (166) of the participants, had a migrant background. The majority of migrants and NM were highly satisfied with the communication with their doctors.

First-generation migrants (FGM) and patients with breast cancer were less often informed about participation in clinical trials (p < 0.05) and 24.5% of them suggested the help of an interpreter to improve the medical consultation. Second and third-generation migrants (SGM and TGM) experienced more fatigue and nausea than expected.

Conclusions

Our results allow the hypothesis that training medical staff in intercultural competence and using disease-related patient information in different languages can improve best supportive care management and quality of life in cancer patients with migrant status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08731-6.

“The Green Sea Yard of Varna” – the innovative project in the focus of early child development

We present an innovative approach to early child development (ECD), designated as a priority for all societies. Traditional ECD services of the Bulgarian health system are predominantly medical or pedagogical provided by GPs and nurseries. This leaves space for interdisciplinary services based on the ideas of Françoise Dolto focused on child-parent relationships. The Green Sea Yard of Varna, Bulgaria, aims at providing accessible space for early socialization of children and preventive psychosocial services by experts in ECD.

The process oriented work combines: psychosocial accompaniment, social group & community work, psychoanalytic consultation with medical expertise. Specialists use direct observation, interviews, analysis of available information, hypothesis development. Questions to be answered: is there a recognized need for a space enhancing and stimulating the interaction between the three main subject in ECD child-parents-specialists; is there a need for a transitional space between the home and kindergarten enabling early child socialization; which are the most prevalent mental and behavioral problems and their earliest symptoms.

For 104 working days (December 2018-February 2020), 2 000 visits of 257 children have been performed, including 400 individual consultations of 51 children at risk. Smooth adaptation to nursery was experienced by 15,5% of children. The most prevalent problems are: insufficient to lacking parent-child verbal communication; delayed speech development; aggressive behavior towards peers.

The main lessons are: (1) There is a recognized by specialists, families and the community need for transitional spaces enabling children to experience first social encounters and concepts of social rules and norms; (2) the space stimulates both formal and informal quality communication between specialist and parents and mutual informal support between parents; (3) leading to a new view for the child as an autonomous person.

Key messages

The Green Sea Yard of Varna is the first innovative space for interdisciplinary approach to ECD, early socialization, care & prevention in our community fully applicable to other places and cultures. The project is in line with SDGs, contemporary scientific visions for the first 1000 days of a child's life and the WHO strategy for the prevention of child’s health in the family and in society.

Prevalence of depression among three cohorts of medical students

Background

Medical education is often related to serious distress for students, that affects negatively their mental well-being. Depression, poor academic performance, increased alcohol consumption, suicidal thoughts, are some of the detrimental effects of diminished mental health. Studies on depression in medical students reveal a higher prevalence (1.4-73.5%) than in the general population. This study aimed to assess and compare depression prevalence and severity in three cohorts of medical students in Bulgaria and Turkey.

Methods

We conducted a cross-sectional online survey with 257 Bulgarian and 288 foreign medical students from Medical University-Sofia, Bulgaria, and with 270 Turkish medical students from Ankara in the winter semester of 2019-2020 academic year. We used the Beck depression inventory (BDI) as valid and reliable instrument to assess depression. The students were categorised according to BDI scores in three groups: with mild depression (10- 18 points); moderate depression (19-29); severe depression (30- 63). Data were analysed with program product Python 3 (v3.6.9) with Pandas v0.25.3 and Scipy v1.4.1.

Results

Depressive symptoms reported 71.5% of Turkish students, 47.1% of Bulgarian and 48.7% of foreign medical students. The depression frequency among Turkish and Bulgarian medical students was significantly different (chi2 = 35.31; p = 0,001). Mean BDI scores were similar for Bulgarian medical students (11.0) and foreign medical students, studying in Bulgaria (11.6). Turkish medical students scored highest on BDI (15.3). Severe depression was detected in 5.6% of foreign, 4.3% of Bulgarian and 6.3% of Turkish students.

Conclusions

Depression prevalence was high in all studied medical students cohorts, with Turkish cohort affected most, probably because of cultural and curriculum differences.

Key messages

Support of student’s mental health should be an integral part of the educational policies of all Medical Universities worldwide. Depression among medical students has to be prevented by comprehensive approach.

Suínos dos Balcãs de Leste – uma raça suína autóctone Búlgara

O porco dos Balcãs de Leste (EBS) é a última raça suína indígena da Bulgária que resta. É um porco “tipo banha” fenotipicamente similar ao javali com uma excelente capacidade de adaptação a condições extensivas. Atualmente (2016) a população da raça é de 1114 porcas e 48 varrascos e por essa razão o EBS é considerado como “em perigo”. Esta raça habita partes florestais do país nas encostas do leste de Stara Planina Mt. (Os Balcãs) e Strandzha Mt. Da mesma forma que o porco selvagem, o porco EBS caracteriza-se pela sua maturidade tardia – a idade ao primeiro parto ulatrapassa os 500 dias. Durante a sua vida reprodutiva esta raça local tem, em média, 5,2 ninhadas. A prolificidade varia de 6 a 8 leitões nascidos vivos e 5-6 leitões desmamados. Os animais EBS atingem um peso corporal de 100kg com cerca de 14 meses. Os valores médios caracterizadores da qualidade da carcaça aos 100kg de peso são os seguintes: carcaça – 56,7kg (determinada após a remoção da pele, cabeça, pernas pelo curvilhão e chispe e todas as vísceras), total de carne com ossos – 41,8kg (73,4% da carcaça) e gordura – 15,08kg (26,6% da carcaça).

BRCA1 gene promoter methylation status in high-grade serous ovarian cancer patients--a study of the tumour Bank ovarian cancer (TOC) and ovarian cancer diagnosis consortium (OVCAD)

BACKGROUND

Mutations in BRCA1/2 genes are involved in the pathogenesis of breast and ovarian cancer. Inactivation of these genes can also be mediated by hypermethylation of CpGs in the promoter regions. Aim of this study was to analyse the clinical impact of BRCA1 promoter gene methylation status in a homogenous cohort of high-grade serous ovarian cancer (HGSOC) patients.

METHODS

The cohort included 257 primary HGSOC patients treated by cytoreduction and platinum-based chemotherapy. DNA was extracted from fresh frozen tissue samples. BRCA1 gene promoter methylation rate was assessed using polymerase chain reaction (PCR).

RESULTS

14.8% of patients presented hypermethylation within a selected region of the BRCA1 promoter. The rate of hypermethylation was significantly higher in younger patients (20.8% hypermethylation in the age group ⩽ 58 years versus 8.7% hypermethylation in the age group >58 years; p = 0.008). Optimal tumour debulking could be reached in 63% of patients, without significant differences in the extent of residual disease with respect to the methylation status. No impact of BRCA1 gene promoter methylation status on progression free- and overall-survival rates was found. No significant differences within BRCA1 promoter methylation status between primary and metastatic tissue could be observed. These results on BRCA1 promoter methylation status were also confirmed in a subgroup of 107 patients found negative for BRCA1 exon 11 mutations.

CONCLUSIONS

Our data suggest that BRCA1 methylation determines the earlier onset of HGSOC. Furthermore our study supports the idea that BRCAness is not only due to mutations but also to epigenetic changes in BRCA1 promoter gene.

Sofosbuvir and daclatasvir combination therapy in a liver transplant recipient with severe recurrent cholestatic hepatitis C

Recurrent HCV infection following liver transplantation can lead to accelerated allograft injury that is difficult to treat with interferon. The aim of this study is to describe the first ever use of an interferon-free, all oral regimen in a liver transplant recipient with severe recurrent HCV. A 54-year-old male with HCV genotype 1b developed severe cholestatic HCV at 6 months posttransplant with ascites, AST 503 IU/mL, alkaline phosphatase of 298 IU/mL, HCV RNA of 12 000 000 IU/mL, and histological cholestasis with pericellular fibrosis. Sofosbuvir, an HCV polymerase inhibitor (400 mg/day), and daclatasvir, an HCV NS5A replication complex inhibitor (60 mg/day), were co-administered for 24 weeks. Within 4 weeks of initiating treatment, serum HCV RNA levels became undetectable and liver biochemistries normalized with concomitant resolution of ascites. The patient achieved a sustained virological response with undetectable HCV RNA at 9 months posttreatment. During and following treatment, the daily dose and blood level of tacrolimus remained stable and unchanged. The rapid and sustained suppression of HCV replication in this liver transplant recipient provides great promise for the use of combination oral antiviral regimens in other immunosuppressed and interferon refractory HCV patients.

[Expression of activating and inhibitory receptors on peripheral blood natural killer cell subsets of women with reproductive failures]

It is now apparent that immunologic implantation failure and recurrent abortions are more than likely mediated through activation of natural killer (NK) cells. The NK cell activity is mediated by a balance between activating and inhibitory receptors upon recognition of MHC class I molecules. In this study, we investigated by flow cytometry the expression of activating and inhibitory receptors on NK cells of women with reproductive failures- recurrent spontaneous abortion (RSA) and implantation failures (IF). In women with implantation failures CD56+CD16+ NK cell subset was significantly increased (p = 0.017) and CD158a expressing NK cells was significantly decreased (p = 0.027). CD161-activating receptor expressing CD56+ NK cells were significantly decreased in women with RSA (p = 0.033). These data further support an imbalance in NK cell subsets in women with reproductive failures.

Serum sperm antibodies unrelated to mumps orchitis

In order to determine whether there is an association between mumps orchitis and serum sperm antibodies, we tested patients at the time orchitis was diagnosed (n = 7) and individuals who had had orchitis at least 1 month previously (n = 14). Data were compared with the results for a control group of blood donors (n = 20). Sperm antibodies were detected by the gelatin agglutination test of Kibrick, the tray agglutination test of Friberg and the ELISA. Clinically significant sperm antibody levels were not found in patients in the early stages of the disease. Four subjects tested post-disease were positive in the Friberg test and one was positive in the ELISA. One control serum was also positive in the latter test. Significant differences were not found between levels in patients in the early stages of the disease and levels in individuals post-disease, although the results of the Friberg test differed significantly between controls and former mumps orchitis cases. These data do not support the assumption of an involvement of humoral immunity against spermatozoa in mumps orchitis patients.

Nucleolin inhibits Hdm2 by multiple pathways leading to p53 stabilization

Nucleolin is a c-Myc-induced gene product with defined roles in ribosomal RNA processing and the inhibition of chromosomal DNA replication following stress. Here we find that changes in nucleolin protein levels in unstressed cells cause parallel changes in the amount of p53 protein. Alterations in p53 levels arise from nucleolin binding to the p53 antagonist Hdm2, resulting in the inhibition of both p53 ubiquitination and Hdm2 auto-ubiquitination. Nucleolin does not alter p53 ubiquitination by human papillomavirus E6, indicating that the effect is specific for Hdm2. Although the inhibition of ligase activity would be expected to stabilize Hdm2, we instead find that nucleolin also reduces Hdm2 protein levels, demonstrating that nucleolin inhibits Hdm2 using multiple mechanisms. Increases in nucleolin levels in unstressed cells led to higher expression of p21(cip1/waf1), a reduced rate of cellular proliferation, and an increase in apoptosis. Thus, nucleolin has a number of properties in common with the tumor suppressor ARF (alternate reading frame). We propose that nucleolin, like ARF, responds to hyperproliferative signals by upregulation of p53 through Hdm2 inhibition.

[Use of recombinant factor VIIa for the control of massive bleeding caused by uterine hypotonia in post-placental period]

We report our clinical opinion for recombinant activated factor VII (NovoSeven, Novo Nordisk, Copenhagen, Denmark) administration in puerperae with massive haemorrhage caused by uterine hypotonia. Four women with severe bleeding in post-placental period received NovoSeven in bolus IV. The blood loss and laboratory changes in hematology and haemostasis parameters are monitored. The right time of application and the mean effective dose of the medication are discussed. The bleeding was ceased in all cases. Decrease in values of Hb, Er and PTT was noted. The mean administered dose of 72 micrograms/kg BW was effective. The laboratory values showed tendency for improvement on the 24 hour after administration and normal levels on discharge. The use of recombinant factor VIIA in puerperae with severe bleeding in the postplacental period is effective and safe enough and could be an alternative to the extreme surgical procedures.

Effects of the antidepressant drug moclobemide on learning and memory in rats

Moclobemide is a well known drug with antidepressant action. The aim of this study was to investigate the effects of moclobemide on learning and memory processes in Sprague Dawley rats. Over a 5-day period, learning sessions with 30 trials per day and memory retention tests were performed. The conditioned responses (avoidances), the unconditioned responses (escapes) and the intertrial crossings were observed. An active avoidance test was carried out using a shuttle box. Two passive avoidance tests were used: step-through (using a light chamber) and step-down (using a platform). In the step-through passive avoidance test, the learning and retention sessions consisted of three trials each and the latency of reaction times (the rat remaining in the light chamber for more than 180 sec) was used as criterion. In the step-down passive avoidance test, learning and retention sessions consisted of two trials and the latency of reaction times (the rat remaining on the platform for 60 sec) was used as criterion. In the active avoidance tests, moclobemide dose-dependently increased the number of avoidances during learning sessions and maintained this number in memory retention tests. Moclobemide did not alter the number of escapes, but did increase motor activity. In the passive avoidance tests, moclobemide also increased the latency of reaction times in learning and short memory retrieval tests. These findings suggest that moclobemide improves learning and memory processes in active and passive avoidance tests and has a cognition-enhancing effect.

Changes in plantar pressures during bipedal stance with different stance width

We studied the influence of stance width and vision on the plantar pressures for the left and right foot during bipedal quiet standing on the pressure-sensitive insoles. The support widening shifted the left and right centers-of-foot-pressure (CFPs) laterally and forward (right foot), diminished SDs of: the left and right mean plantar pressures (MPPs), the anteroposterior and mediolateral displacements of left and right CFPs. It also decreased negative correlations between left and right MPPs and between mediolateral displacements of left and right CFP and increased positive correlation between anteroposterior displacements of left and right CFPs, more expressive with eyes-open. The later results suggested that support widening increased the weight of exploratory behaviour regarding anteroposterior equilibrium and decreased exploratory sway serving mediolateral equilibrium. Eyes' closure lead to a small left bias of the body-weight-bearing and forward shift of the left versus right CFP, thus suggesting that vision increased bilateral symmetry of stance.

[The use of SIT and ELISA to detect serum sperm antibodies in infertile patients]

The existence of natural sperm antibodies in fertile subjects requires the application of additional methods in certain cases of significant, but near to the borderline agglutinating titers, in order to distinguish between pathological and natural sperm antibodies. We applied the sperm immobilization test (SIT) of Isojima and an enzyme-linked immunosorbent assay (ELISA) with sera from infertile patients (n = 66) that have been positive in at least one of the agglutination methods of Kibrick and Friberg. The data were compared with the results for a control group of blood donors (n = 50). It was demonstrated that the positive, but low-titer sera in the test of Friberg were often highly positive in ELISA, while the high-titer sera displayed lower OD values. No such correlation was established by SIT. Probably, it would be practical to use ELISA in cases, where no convincing laboratory data exists for immunity against spermatozoa--relevant, but low agglutinating titers, which can be found in fertile subjects. Besides, SIT and ELISA can recognize antigen-antibody systems different from those identified by the agglutinating tests.

Presence of HLA-DR immunopositive cells in human fetal thymus

Several kinds of thymic cells express MHC class II antigens, including human-leukocyte-associated antigen-DR (HLA-DR) during postnatal development. The present study was focused on the detection and analysis of HLA-DR immunoreactivity in human fetal thymuses (6-7th month of gestation). Using monoclonal antibodies, indirect immunoperoxidase staining (IIP), immunogold electron microscopy (IGEM), enzyme-linked immunosorbent assay (ELISA) and flow cytometry, HLA-DR immunopositive (IP) thymic cells were found in samples studied. IIP and IGEM demonstrated the presence of HLA-DR IP stromal cells (SCs): epithelial cells (ECs), dendritic-like cells (DCs) and macrophages (MCs) as well as HLA-DR IP lymphocytes (Lys) in all thymic regions. HLA-DR immunoreactivity was more prominent in the medullary ECs (mECs) than in the cortical ECs (cECs). Strong staining of Hassall's corpuscles and the adjacent mECs was seen. The differences in the intracellular distribution of HLA-DR molecules were detailed by IGEM as a first attempt to analyse HLA-DR IP cells at ultrastructural level. ELISA data and two-colour flow cytometric analysis revealed the presence of HLA-DR IP and HLA-DR/CD3 double IP Lys in accordance with the immunocytochemical assays. The results presented enrich the information about HLA-DR IP components of the thymic microenvironment in developing human thymus and raise the question of their role during prenatal T cell differentiation and selection processes.

Haplotype analysis of hemochromatosis: evaluation of different linkage-disequilibrium approaches and evolution of disease chromosomes

We applied several types of linkage-disequilibrium calculations to analyze the hereditary hemochromatosis (hh) locus. Twenty-four polymorphic markers in the major histocompatibility complex (MHC) class I region were used to haplotype hh and normal chromosomes. A total of 169 hh and 161 normal chromosomes were analyzed. Disequilibrium values were found to be high over an unusually large region beginning 150 kb centromeric of HLA-A and extending nearly 5 Mb telomeric of it. Recombination in this region was approximately 28% of the expected value. This low level of recombination contributes to the unusually broad region of linkage disequilibrium found with hh. The strongest disequilibrium was found at locus HLA-H (delta = .84) and at locus D6S2239 (delta = .85), a marker approximately 10 kb telomeric to HLA-H. All disequilibrium methods employed in this study found peak disequilibrium at HLA-H or D6S2239. The cys282tyr mutation in HLA-H, a candidate gene for hh, was found in 85% of disease chromosomes. A haplotype phylogeny for hh chromosomes was constructed and suggests that the mutation associated with the most common haplotype occurred relatively recently. The age of the hh mutation was estimated to be approximately 60-70 generations. Disequilibrium was maintained over a greater distance for hh-carrying chromosomes, consistent with a recent mutation for hh. Our data provide a reasonable explanation for previous difficulties in localizing the hh locus and provide an evolutionary history for disease chromosomes.

Fine mapping of a replication origin of human DNA

A highly sensitive procedure was developed for the identification of the origin of bidirectional DNA synthesis in single-copy replicons of mammalian cells. The method, which does not require cell synchronization or permeabilization, entails the absolute quantification, by a competitive PCR procedure in newly synthesized DNA samples, of the abundance of neighboring DNA fragments distributed along a given genomic region. This procedure was utilized for mapping the start site of DNA replication in a 13.7-kb region of human chromosome 19 coding for lamin B2, which is replicated immediately after the onset of S phase in HL-60 cells. Within this region, DNA replication initiates in a 474-bp area corresponding to the 3' noncoding end of the lamin B2 gene and the nontranscribed spacer between this gene and the 5' end of another highly transcribed one. This localization was obtained both in aphidicolin-synchronized and in exponentially growing HL-60 cells.