The evolving landscape of publishing in the field of pain: An automated bibliometric analysis from 1975 to 2020

BACKGROUND

The aims of this bibliometric analysis were (1) a longitudinal analysis of the publication landscape in the field of pain (1975-2020) and (2) to characterize the overall publication profiles for two selected journals: European Journal of Pain and PAIN® utilizing an automated approach.

METHODS

Database searches in Scopus extracted all journals with 'pain' in their title. For the two specific journals, papers were manually/automatically profiled into preclinical, human and translational studies.

RESULTS

A gross list of 64 journals in the field of pain consisting of both active and ceased journals in Scopus were included in this analysis which identified 62,565 papers with approximately 4000 papers published/year. These papers include 2759 and 9156 papers in Eur. J. Pain and PAIN®, respectively. Currently, there are 24 active 'pain' journals. Authors/paper increase from 2 to 7 indicating a development from mono-disciplinary to multi-disciplinary studies. The overall publication profiles assessing preclinical, human (experimental/clinical) and translational papers in Eur. J. Pain and PAIN® were almost similar (14%, 75% and 10% versus 26%, 63% and 10%). Papers have changed over the years from mono-disciplinary studies (e.g. behavioural studies) to multi-disciplinary studies (e.g. combined behavioural and cell studies). After optimization, the search model matched the manual screening by 100%, 98% and 96% for the preclinical, clinical and healthy volunteer categories.

CONCLUSIONS

Over the last 45 years, more than 60,000 pain-related papers have been published. Papers develop over the years from mono-disciplinary to multi-disciplinary studies. The overall publication profile including preclinical, human (experimental/clinical) and translational papers was almost similar in Eur. J. Pain and PAIN®.

SIGNIFICANCE

The bibliometric analysis of a pain journal provides information on which specific areas of research are published, how this may have changed over the years and how a journal is positioned compared with other journals in the field.

Plasma membrane H+-ATPases sustain pollen tube growth and fertilization

Pollen tubes are highly polarized tip-growing cells that depend on cytosolic pH gradients for signaling and growth. Autoinhibited plasma membrane proton (H+) ATPases (AHAs) have been proposed to energize pollen tube growth and underlie cell polarity, however, mechanistic evidence for this is lacking. Here we report that the combined loss of AHA6, AHA8, and AHA9 in Arabidopsis thaliana delays pollen germination and causes pollen tube growth defects, leading to drastically reduced fertility. Pollen tubes of aha mutants had reduced extracellular proton (H+) and anion fluxes, reduced cytosolic pH, reduced tip-to-shank proton gradients, and defects in actin organization. Furthermore, mutant pollen tubes had less negative membrane potentials, substantiating a mechanistic role for AHAs in pollen tube growth through plasma membrane hyperpolarization. Our findings define AHAs as energy transducers that sustain the ionic circuit defining the spatial and temporal profiles of cytosolic pH, thereby controlling downstream pH-dependent mechanisms essential for pollen tube elongation, and thus plant fertility.

Roles of plasma membrane proton ATPases AHA2 and AHA7 in normal growth of roots and root hairs in Arabidopsis thaliana

Plasma membrane H⁺ -ATPase pumps build up the electrochemical H⁺ gradients that energize most other transport processes into and out of plant cells through channel proteins and secondary active carriers. In Arabidopsis thaliana, the AUTOINHIBITED PLASMA MEMBRANE H⁺ -ATPases AHA1, AHA2 and AHA7 are predominant in root epidermal cells. In contrast to other H⁺ -ATPases, we find that AHA7 is autoinhibited by a sequence present in the extracellular loop between transmembrane segments 7 and 8. Autoinhibition of pump activity was regulated by extracellular pH, suggesting negative feedback regulation of AHA7 during establishment of an H⁺ gradient. Due to genetic redundancy, it has proven difficult to test the role of AHA2 and AHA7, and mutant phenotypes have previously only been observed under nutrient stress conditions. Here, we investigated root and root hair growth under normal conditions in single and double mutants of AHA2 and AHA7. We find that AHA2 drives root cell expansion during growth but that, unexpectedly, restriction of root hair elongation is dependent on AHA2 and AHA7, with each having different roles in this process.

Why do plants lack sodium pumps and would they benefit from having one?

The purpose of this minireview is to discuss the feasibility of creating a new generation of salt-tolerant plants that express Na+/K+-ATPases from animals or green algae. Attempts to generate salt-tolerant plants have focussed on increase the expression of or introducing salt stress-related genes from plants, bryophytes and yeast. Even though these approaches have resulted in plants with increased salt tolerance, plant growth is decreased under salt stress and often also under normal growth conditions. New strategies to increase salt tolerance are therefore needed. Theoretically, plants transformed with an animal-type Na+/K+-ATPase should not only display a high degree of salt tolerance but should also reduce the stress response exhibited by the first generation of salt-tolerant plants under both normal and salt stress conditions. The biological feasibility of such a strategy of producing transgenic plants that display improved growth on saline soil but are indistinguishable from wild-type plants under normal growth conditions, is discussed.

Activation of the LRR Receptor-Like Kinase PSY1R Requires Transphosphorylation of Residues in the Activation Loop

PSY1R is a leucine-rich repeat (LRR) receptor-like kinase (RLK) previously shown to act as receptor for the plant peptide hormone PSY1 (peptide containing sulfated tyrosine 1) and to regulate cell expansion. PSY1R phosphorylates and thereby regulates the activity of plasma membrane-localized H⁺-ATPases. While this mechanism has been studied in detail, little is known about how PSY1R itself is activated. Here we studied the activation mechanism of PSY1R. We show that full-length PSY1R interacts with members of the SERK co-receptor family in planta. We identified seven in vitro autophosphorylation sites on serine and threonine residues within the kinase domain of PSY1R using mass spectrometry. We furthermore show that PSY1R autophosphorylation occurs in trans and that the initial transphosphorylation takes place within the activation loop at residues Ser951, Thr959, and Thr963. While Thr959 and Thr963 are conserved among other related plant LRR RLKs, Ser951 is unique to PSY1R. Based on homology modeling we propose that phosphorylation of Ser951 stabilize the inactive conformation of PSY1R.

Hypoxia and loss of PHD2 inactivate stromal fibroblasts to decrease tumour stiffness and metastasis

Cancer-associated fibroblasts (CAFs) interact with tumour cells and promote growth and metastasis. Here, we show that CAF activation is reversible: chronic hypoxia deactivates CAFs, resulting in the loss of contractile force, reduced remodelling of the surrounding extracellular matrix and, ultimately, impaired CAF-mediated cancer cell invasion. Hypoxia inhibits prolyl hydroxylase domain protein 2 (PHD2), leading to hypoxia-inducible factor (HIF)-1α stabilisation, reduced expression of αSMA and periostin, and reduced myosin II activity. Loss of PHD2 in CAFs phenocopies the effects of hypoxia, which can be prevented by simultaneous depletion of HIF-1α. Treatment with the PHD inhibitor DMOG in an orthotopic breast cancer model significantly decreases spontaneous metastases to the lungs and liver, associated with decreased tumour stiffness and fibroblast activation. PHD2 depletion in CAFs co-injected with tumour cells similarly prevents CAF-induced metastasis to lungs and liver. Our data argue that reversion of CAFs towards a less active state is possible and could have important clinical implications.

Role of PGC-1α in exercise training- and resveratrol-induced prevention of age-associated inflammation

BACKGROUND/AIM

Age-related metabolic diseases are often associated with low-grade inflammation. The aim of the present study was to investigate the role of the transcriptional co-activator PGC-1α in the potential beneficial effects of exercise training and/or resveratrol in the prevention of age-associated low-grade inflammation. To address this, a long-term voluntary exercise training and resveratrol supplementation study was conducted.

EXPERIMENTAL SETUP

Three month old whole body PGC-1α KO and WT mice were randomly assigned to four groups: untrained chow-fed, untrained chow-fed supplemented with resveratrol, chow-fed voluntarily exercise trained and chow-fed supplemented with resveratrol and voluntarily exercise trained. The intervention lasted 12 months and three month old untrained chow-fed mice served as young controls.

RESULTS

Voluntary exercise training prevented an age-associated increase (p<0.05) in systemic IL-6 and adiposity in WT mice. PGC-1α expression was required for a training-induced prevention of an age-associated increase (p<0.05) in skeletal muscle TNFα protein. Independently of PGC-1α, both exercise training and resveratrol prevented an age-associated increase (p<0.05) in skeletal muscle protein carbonylation.

CONCLUSION

The present findings highlight that exercise training is a more effective intervention than resveratrol supplementation in reducing age-associated inflammation and that PGC-1α in part is required for the exercise training-induced anti-inflammatory effects.

Menopause is associated with decreased whole body fat oxidation during exercise

The purpose of this study was to examine if fat oxidation was affected by menopausal status and to investigate if this could be related to the oxidative capacity of skeletal muscle. Forty-one healthy women were enrolled in this cross-sectional study [premenopausal (n = 19), perimenopausal (n = 8), and postmenopausal (n = 14)]. Estimated insulin sensitivity was obtained from an oral glucose tolerance test. Body composition was measured by dual-energy X-ray absorptiometry and magnetic resonance imaging. Fat oxidation and energy expenditure were measured during an acute exercise bout of 45 min of ergometer biking at 50% of maximal oxygen consumption (Vo2 max). Muscle biopsies from the vastus lateralis of the quadriceps muscle were obtained before and immediately after the exercise bout. Postmenopausal women had 33% [confidence interval (CI) 95%: 12-55] lower whole body fat oxidation (P = 0.005) and 19% (CI 95%: 9-22) lower energy expenditure (P = 0.02) during exercise, as well as 4.28 kg lower lean body mass (LBM) than premenopausal women. Correction for LBM reduced differences in fat oxidation to 23% (P = 0.05), whereas differences in energy expenditure disappeared (P = 0.22). No differences between groups were found in mRNA [carnitine palmitoyltransferase I, β-hydroxyacyl-CoA dehydrogenase (β-HAD), peroxisome proliferator-activated receptor-α, citrate synthase (CS), pyruvate dehydrogenase kinase 4, peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α)], protein [phosphorylated AMP-activated protein kinase (AMPK), vascular endothelial growth factor, pyruvate dehydrogenase-1Eα, cytochrome oxidase I], or enzyme activities (β-HAD, CS) in resting skeletal muscle, except for an increased protein level of cytochrome c in the post- and perimenopausal women relative to premenopausal women. Postmenopausal women demonstrated a trend to a blunted exercise-induced increase in phosphorylation of AMPK compared with premenopausal women (P = 0.06). We conclude that reduced whole body fat oxidation after menopause is associated with reduced LBM.

Structural diversity of small molecule libraries

A novel method for assessing structural diversity is presented. Maximum common subgraph identity is used as the measure of similarity between two chemical structures. A conditional probability treatment of similarity distributions for libraries of chemical structures is used to define diversity. This evaluation method together with the evaluation of traditional physicochemical properties is used to assess a large number of chemical libraries and to understand structural differences between these.

[Tuberculosis and migration]

The decline of tuberculosis in many western countries has faded off in many countries in recent years because of migration of people from high-prevalence to low-prevalence areas. Tuberculosis in immigrants mirrors tuberculosis in the country of origin with a predominance of young people with a high incidence of extrapulmonary tuberculosis. Typically, the tuberculosis appears in the first five years after arrival. The impact of immigrant tuberculosis has been discussed in a number of recent publications. In Denmark the incidence of tuberculosis in immigrants now outnumbers the incidence in Danes. Screening for tuberculosis in immigrants is not obligatory and is only offered to asylum seekers under the care of the Danish Red Cross but could be considered in all immigrants from high-prevalence countries.

Ab initio protein folding simulations with genetic algorithms: simulations on the complete sequence of small proteins

Ab-initio folding simulations have been performed on three small proteins using a genetic algorithm- (GA-) based search method which operates on an all atom representation. Simulations were also performed on a number of small peptides expected to be independent folding units. The present genetic algorithm incorporates the results of developments made to the method first tested in CASP1. Additional operators have been introduced into the search in order to allow the simulation of longer sequences and to avoid the simulation of longer sequences and to avoid premature free energy convergence. Secondary structure information derived from a consensus of eight methods and Monte Carlo simulations on sets of homologous sequences has been used to bias the starting populations used in the GA simulations. For the fragment simulations, the results generally have approximately correct local structure, but tend to be too compact, leading to poor RMS error values. One of the three small protein structures has the topology and most of the general organization correct, although many of the details are incorrect.

Protein folding simulations with genetic algorithms and a detailed molecular description

We have explored the application of genetic algorithms (GA) to the determination of protein structure from sequence, using a full atom representation. A free energy function with point charge electrostatics and an area based solvation model is used. The method is found to be superior to previously investigated Monte Carlo algorithms. For selected fragments, up to 14 residues long, the lowest free energy structures produced by the GA are similar in conformation to the corresponding experimental structures in most cases. There are three main conclusions from these results. First, the genetic algorithm is an effective method for searching amongst the compact conformations of a polypeptide chain. Second, the free energy function is generally able to select native-like conformations. However, some deficiencies are identified, and further development is proposed. Third, the selection of native-like conformations for some protein fragments establishes that in these cases the conformation observed in the full protein structure is largely context independent. The implications for the nature of protein folding pathways are discussed.

A comparison of two murine monoclonal antibodies humanized by CDR-grafting and variable domain resurfacing

The variable domain resurfacing and CDR-grafting approaches to antibody humanization were compared directly on the two murine monoclonal antibodies N901 (anti-CD56) and anti-B4 (anti-CD19). Resurfacing replaces the set of surface residues of a rodent variable region with a human set of surface residues. The method of CDR-grafting conceptually consists of transferring the CDRs from a rodent antibody onto the Fv framework of a human antibody. Computer-aided molecular modeling was used to design the initial CDR-grafted and resurfaced versions of these two antibodies. The initial versions of resurfaced N901 and resurfaced anti-B4 maintained the full binding affinity of the original murine parent antibodies and further refinements to these versions described herein generated five new resurfaced antibodies that contain fewer murine residues at surface positions, four of which also have the full parental binding affinity. A mutational study of three surface positions within 5 A of the CDRs of resurfaced anti-B4 revealed a remarkable ability of the resurfaced antibodies to maintain binding affinity despite dramatic changes of charges near their antigen recognition surfaces, suggesting that the resurfacing approach can be used with a high degree of confidence to design humanized antibodies that maintain the full parental binding affinity. By comparison CDR-grafted anti-B4 antibodies with parental affinity were produced only after seventeen versions were attempted using two different strategies for selecting the human acceptor frameworks. For both the CDR-grafted anti-B4 and N901 antibodies, full restoration of antigen binding affinity was achieved when the most identical human acceptor frameworks were selected. The CDR-grafted anti-B4 antibodies that maintained high affinity binding for CD19 had more murine residues at surface positions than any of the three versions of the resurfaced anti-B4 antibody. This observation suggests that the resurfacing approach can be used to produce humanized antibodies with reduced antigenic potential relative to their corresponding CDR-grafted versions.

Genetic algorithms for protein structure prediction

Genetic algorithms are a general class of search methods that mimic natural gene-based optimization mechanisms. Mutation, cross-over and replication operations are performed on strings. When applied to structure prediction, each string describes a particular conformation of a protein molecule. There are many ways in which such search methods may be implemented. Recent results show potential for helping with protein structure prediction, but more data are needed before a complete assessment can be made.

[Tuberculosis in low prevalence countries. Back to the future?]

The incidence of tuberculosis has declined in all European countries in this century but in several countries the decline has come to a stop. Microscopy a.m. Ziehl-Neelsen and culture are still the mainstays in the diagnosis of tuberculosis but new DNA-technics such as PCR and RFLP are increasingly used. The tuberculin test is hitherto the only practically feasible test for identification of subjects infected with M. tuberculosis. BCG is the most used vaccine in the world but the protective mechanisms are not fully understood and the efficacy controversial. Immunotherapy with M. vaccae may be used as an adjuvant to chemotherapy. Few cases of tuberculosis are observed in AIDS-patients in Denmark. Modern standard treatment of tuberculosis comprises a six-month regimen with isoniazid, rifampicin, pyrazinamide and possibly ethambutol. Multidrug resistance in tuberculosis is rare in Western Europe. Chemoprophylaxis with isoniazid is debatable. Patients with smear-positive sputum may be infectious whereas patients with extrapulmonary tuberculosis normally pose no risk.

Confronting the problem of interconnected structural changes in the comparative modeling of proteins

Comparative models of three proteins have been built using a variety of computational methods, heavily supplemented by visual inspection. We consider the accuracy obtained to be worse than expected. A careful analysis of the models shows that a major reason for the poor results is the interconnectedness of the structural differences between the target proteins and the template structures they were modeled from. Side chain conformations are often determined by details of the structure remote in the sequence, and can be influenced by relatively small main chain changes. Almost all of the regions of substantial main chain conformational change interact with at least one other such region, so that they often cannot be modeled independently. Visual inspection is sometimes effective in correcting errors in sequence alignment and in spotting when an alternative template structure is more appropriate. We expect some improvements in the near future through the development of structure-based sequence alignment tools, side chain interconnectedness rotamer choice algorithms, and a better understanding of the context sensitivity of conformational features.

Ab initio structure prediction for small polypeptides and protein fragments using genetic algorithms

Ab initio folding simulations have been performed on three peptides, using a genetic algorithm-based search method which operates on a full atom representation. Conformations are evaluated with an empirical force field parameterized by a potential of mean force analysis of experimental structures. The dominant terms in the force field are local and nonlocal main chain electrostatics and the hydrophobic effect. Two of the simulated structures were for fragments of complete proteins (eosinophil-derived neurotoxin (EDN) and the subtilisin propeptide) that were identified as being likely initiation sites for folding. The experimental structure of one of these (EDN) was subsequently found to be consistent with that prediction (using local hydrophobic burial as the determinant for independent folding). The simulations of the structures of these two peptides were only partly successful. The most successful folding simulation was that of a 22-residue peptide corresponding to the membrane binding domain of blood coagulation factor VIII (Membind). Three simulations were performed on this peptide and the lowest energy conformation was found to be the most similar to the experimental structure. The conformation of this peptide was determined with a C alpha rms deviation of 4.4 A. Although these simulations were partly successful there are still many unresolved problems, which we expect to be able to address in the next structure prediction experiment.

Mutational and structural analysis of the lectin activity in binding domain 2 of ricin B chain

The study of the lectin binding sites of ricin B chain and of other homologous members of the small gene family that make up ricin-like molecules has revealed a number of key contact residues involved in sugar binding. In particular, on the basis of data generated by the X-ray crystallographic structure of ricin, comparisons of sequence homologies to other ricin-like molecules and substrate binding studies with these molecules, it has been proposed that His248 of Ricinus communis agglutinin (RCA) B chain may interfere with galactose binding in the second binding domain of that lectin. To test that hypothesis, single binding domain 2 (SBD2) of ricin B chain was expressed as a gene 3 fusion protein on the surface of fd phage to measure directly the effect of mutational changes on this binding site. Replacement of tyrosine with histidine at amino acid position 248 of SBD2 of ricin B chain was shown to reduce lectin activity. The sequences of RCA and ricin B chains were aligned and compared with the tertiary structure of ricin B chain to select various mutations that were introduced as controls in the study. One of these controls, Leu247 to Val247, displayed increased affinity for galactosides. The role of sequence changes is discussed in relation to the structural and functional divergence in these molecules.

Cavity mutants of Savinase. Crystal structures and differential scanning calorimetry experiments give hints of the function of the buried water molecules in subtilisins

The subtilisin molecule possesses several internal water molecules, which may be characterised as an integral part of the protein structure. We have introduced specific mutations (T71I, T71S, T71V, T71A and T71G) at position 71 in the subtilisin variant Savinase from Bacillus lentus. This position is involved in a hydrogen bonded network with several internal water molecules, forming a water channel. The water channel and most of the other internal water molecules are positioned in the interface between two half-domains of the subtilisin molecule. The data presented here indicate that the internal water molecules are structural, and may be the result of trapping during the folding process.

Antibody design: beyond the natural limits

Dissection of antibody-antigen interactions requires a knowledge of antibody structure, the ability to model accurately the conformation of antibody-combining sites, and an understanding of the energetic factors governing the interactions. When this understanding has reached the point where the molecular shape and chemical character of a combining site necessary to define a particular specificity and binding requirement can be designed, the antibody repertoire will have been extended 'beyond the natural limits'.

Humanization of murine monoclonal antibodies through variable domain resurfacing

Two murine monoclonal antibodies, N901 (anti-CD56) and anti-B4 (anti-CD19), were humanized by a process we call "resurfacing." A systematic analysis of known antibody structures has been used to determine the relative solvent accessibility distributions of amino acid residues in murine and human antibody variable (Fv) regions and has shown that the sequence alignment positions of surface amino acids for human and murine variable region heavy (VH) and light (VL) chains are conserved with 98% fidelity across species. While the amino acid usage at these surface positions creates surface residue patterns that are conserved within species, there are no identical patterns across species. However, surprisingly few amino acid changes need to be made to convert a murine Fv surface pattern to that characteristic of a human surface. Resurfacing was used to change the patterns of surface accessible residues in the Fv regions of the N901 and anti-B4 antibodies to resemble those found on the Fv regions of human antibody sequences. Two different procedures for selecting a human sequence were compared. For anti-B4, a data base of clonally derived human VL-VH sequence pairs was used, while for N901, sequences for VL and VH were independently selected from the Kabat et al. data base [Kabat, E. A., Wu, T. T., Reid-Miller, M., Perry, H. M. & Gottesman, K. S. (1991) Sequences of Proteins of Immunological Interest (DHHS, Washington, DC), 5th Ed.]. Resurfaced N901 and anti-B4 antibodies had apparent affinities for their cell surface ligands that were identical to those of their respective parent murine antibodies. These data provide evidence that, despite the differences in the surfaces of mouse and human Fv regions, it is possible to substitute one for the other while retaining full antigen binding affinity.

Comparison of surface accessible residues in human and murine immunoglobulin Fv domains. Implication for humanization of murine antibodies

Statistical analysis of a database of unique human and murine immunoglobulin heavy chain and light chain variable regions reveals that the precise patterns of exposed residues are different in human and murine antibodies, while most individual surface positions have strong preferences for a small number of residue types. Consideration of these surface patterns alone generates almost identical family groupings for light and heavy chain variable domain sequences to those produced by methods such as those of Kabat et al., where N-terminal framework sequences only are compared, or Tomlinson et al., in which entire variable region nucleotide sequences are used. This unexpected result suggests that the surfaces of V-regions are at least as well conserved as the core framework sequences. Furthermore, using these patterns of human and murine surface residues a novel method for the "humanization" of murine antibodies has been developed and tested.

BIOSITE: a program for the interactive comparison of aligned homologous protein sequences

A program, BIOSITE, providing for the interactive visual comparison of aligned homologous amino-acid sequences is presented, including an example of its application. The program allows for two types of comparison sequence to be generated: an 'identity' sequence and a 'difference' sequence. These may be used on subsets of sequences and in further comparisons to identify candidate sites involved in a distinct functional property. The program should prove a useful tool for biologists engaged in understanding sequence--function relationships.

[Smoking habits among Danish physicians, nurses and midwives in 1989]

Health staff play a central role in distribution of knowledge about the injurious effects of tobacco by influencing the smoking habits of the population. The danish council on smoking and health has therefore chosen health staff as one of the first targets for its activities. One of these was conduct of a questionnaire investigation among a representative section of Danish doctors, nurses and midwives about smoking habits and attitudes to the tobacco problem. The random sample consisted of 2,997 persons, of whom 2,606 (87%) replied to the question about daily smoking habits. In all of the age groups, the frequency of smoking was considerably lower among health staff than in the population as a whole, primarily because many had stopped smoking. The frequency among men was 23% for doctors as compared with 50% in the normal population (age 20-69 years) and 15% for female doctors, 29-30% for nurses and midwives as compared with 46% in the normal population. The frequency of smoking among doctors has decreased considerably since 1980. Very few heavy smokers were found among health staff, particularly among doctors, and many male doctors smoked pipes (47% of the smokers). Even though health staff smoke less than the rest of the population, attention must still be focussed on this group on account of its function for establishing opinions in the health sector.

Octapeptide segments from the amino terminus of glycophorin A contain the antigenic determinants of the M and N blood groups systems

Human red blood cells with phenotype N/N and M/M were tested in an agglutination assay with anti-N and anti-M antibodies, respectively. After incubation of the synthesized octapeptide (Leu-Ser-Thr-Thr-Glu-Val-Ala-Met) from the N-amino terminus of glycophorin A, with anti-N antibody, there was significant inhibition of the agglutination of the N-positive cells. There was also inhibition of the agglutination of the M-positive cells with anti-M antibody by the synthesized octapeptide (Ser-Ser-Thr-Thr-Gly-Val-Ala-Met) from the M-amino terminus of glycophorin A. There was no inhibition, however, of the agglutination of M-positive cells with anti-M antibodies by the N-amino terminal octapeptide. Likewise, the M-amino terminal octapeptide did not inhibit agglutination of N-positive cells with anti-N. Because the synthesized octapeptides contained no carbohydrate, the anti-N and anti-M specificity appears to be determined principally by the peptides themselves. Further studies with the use of chimeric peptides indicate that the amino terminal amino acid leucine of N-glycophorin A is a primary determinant of the N antigen, whereas the amino terminal serine of M-glycophorin A is a primary determinant for the M antigen.

Colo-pleural fistula

A case of non-traumatic colo-pleural fistula is recorded for the first time as the cause of a long-standing pleural empyema. The patient was treated with drainage, antibiotics and parenteral nutrition. The fistula was the result of a diverticulitis coli and/or a pancreatitis.

Colo-pleural fistula

A case of non-traumatic colo-pleural fistula is recorded for the first time as the cause of a long-standing pleural empyema. The patient was treated with drainage, antibiotics and parenteral nutrition. The fistula was the result of a diverticulitis coli and/or a pancreatitis.

Follow-up in general practice of patients treated for precancer of the cervix uteri

It is known that some patients with invasive cancer of the cervix uteri have previously had a positive vaginal cytology, which was not followed up. More recent investigations have also shown that invasive cancer has developed in patients who were treated for premalignant stages of cervical cancer, but who were not followed up adequately. In Denmark, these patients are advised to attend their practitioner for an annual check. The aim of the present study was to find out if 39 women, treated in a hospital for early cervical cancer, did in fact attend their practitioner for adequate follow-up. Fifteen per cent attended less frequently, and 21% more frequently than recommended, while 64% attended as per the schedule. Women who had undergone surgery for the early stages were significantly better attenders. Women over 30 years of age had a similar tendency, but the difference was not significant. It is suggested that, in the interest of more effective follow-up, registration should be computer-controlled.

Convulsions after treatment with pyrazinamide

A case is presented of a 2-year-old boy with pulmonary tuberculosis who developed convulsions during treatment which appeared to be caused by pyrazinamide.

Evaluation of an automated blood smear analyzer

The performance of a diff3 System prototype instrument that does automated leukocyte differential counts, erythrocytic morphology determinations, and leukocyte count and platelet count estimates, was compared with performance by laboratory personnel for a five-week period in an active general hospital. Using experienced supervisors as the referee method, this instrument performed as well as the routine laboratory staff in all aspects of leukocyte differential counting. With respect to erythrocytic morphology, estimates of hypochromia were inferior to those of the routine laboratory staff; comparisons of estimates of macrocytosis and polychromasia were not significantly different. Leukocyte and platelet numerical estimate performance by the diff3 System was not as good as that of automated cell-counting instruments, but categorization of platelet concentration as normal or abnormal did compare favorably with estimation by laboratory personnel. The flagging of abnormal slides by the instrument was comparable in sensitivity to that by the routine laboratory staff; however, specificity was less, with a significantly greater number of false positives obtained by use of the instrument.