Noncoding mutations drive persistence of a founder preleukemic clone which initiates late relapse in T-ALL

ABSTRACT

T-ALL relapse usually occurs early but can occur much later, which has been suggested to represent a de novo leukemia. However, we conclusively demonstrate late relapse can evolve from a pre-leukemic subclone harbouring a non-coding mutation that evades initial chemotherapy.

Retrospective epidemiological analysis of SARS-CoV-2 wastewater surveillance and case notifications data - New South Wales, Australia, 2020

This epidemiological study analysed SARS-CoV-2 wastewater surveillance and case notifications data to inform evidence-based public health action in NSW. We investigated measures of association between SARS-CoV-2 RNA fragments detected in wastewater samples (n = 100) and case notifications (n = 1,367, as rates per 100,000 population) within wastewater catchment areas (n = 6); and evaluated the performance of wastewater testing as a population-level diagnostic tool. Furthermore, we modelled SARS-CoV-2 RNA fragment detection in wastewater given the case notification rate using logistic regression. The odds of a viral detection in wastewater samples increased by a factor of 5.68 (95% CI: 1.51-32.1, P = 0.004) with rates of one or more notified cases within a catchment. The diagnostic specificity of wastewater viral detection results was 0.88 (95% CI: 0.69-0.97); the overall diagnostic sensitivity was 0.44 (95% CI: 0.33-0.56). The probability of a viral detection result in wastewater exceeded 50% (95% CI: 36-64%) once the case rate within a catchment exceeded 10.5. Observed results suggest that in a low prevalence setting, wastewater viral detections are a more reliable indicator of the presence of recent virus shedding cases in a catchment, than non-detect results are of the absence of cases in a catchment.

Application of QMRA to prioritise water supplies for Cryptosporidium risk in New South Wales, Australia

A Quantitative Microbial Risk Assessment (QMRA) framework was applied to assess 312 drinking water supply systems across regional New South Wales (NSW). The framework was needed to support the implementation of a recommendation in the Australian Drinking Water Guidelines (ADWG) for appropriate treatment barriers to be operating in systems 'at risk' for Cryptosporidium. The objective was to prioritise systems so that those with the highest risk could be identified and addressed first. The framework was developed in a pilot study of 30 systems, selected to represent the range of water supplies across regional NSW. From these, source water categories were defined to represent local conditions with reference to the literature and Cryptosporidium risk factors. Values for Cryptosporidium oocyst concentration were assigned to the categories to allow quantification of the health risk from those water sources. The framework was then used to assess the risks in all 312 regional drinking water supply systems. Combining the disciplined approach of QMRA with simple catchment and treatment information and categorical risk outputs provided a useful and transparent method for prioritising systems for further investigation and potential risk management intervention. The risk rankings for drinking water supplies from this QMRA process have been used to set priorities for a large State Government funding program.

The relation between measures of explicit shame and borderline personality features in adolescent inpatients

BACKGROUND

Shame is a highly negative emotion frequently experienced by individuals with borderline personality disorder (BPD) as well as those with internalizing or externalizing psychopathology. However, few studies have examined whether shame is related to BPD above and beyond other psychopathology. Further, although feelings of shame peak during adolescence, coinciding with the onset of BPD, very few studies have examined the relationship between shame and BPD in adolescence. Therefore, the current study examined (1) whether levels of shame differ between adolescent psychiatric inpatients with and without BPD and (2) whether borderline personality pathology accounts for additional variance in the experience of shame above and beyond internalizing and externalizing psychopathology.

METHODS

Adolescent psychiatric inpatients (n = 184, 67% female, M age = 15.26) completed clinical interviews and self-report measures as well as self-report measures of three types of explicit shame: state-shame, shame-proneness, and trait-shame.

RESULTS

T-tests revealed that adolescents with BPD reported significantly higher levels of each type of explicit shame. In hierarchical regression models, borderline personality features explained significant additional variance in shame-proneness and trait-shame while controlling for age, gender, and internalizing and externalizing psychopathology.

LIMITATIONS

Our sample was limited by a lack of demographic diversity and healthy control group, and the study did not examine relations with unique internalizing/externalizing disorders or features of BPD.

CONCLUSIONS

Our findings contribute to growing evidence that shame is an important component of BPD, particularly during adolescence, and suggest that shame should be addressed in treatment.

Time and Temperature Kinetics for the Development of Volatile and Non-Volatile Flavor Compounds in Steaks

ObjectivesThe objective of this study was to utilize mass spectrometry (MS) instrumentation to define flavor differences in beef strip loin steaks cooked on five different surface temperatures.Materials and MethodsUSDA Select strip loins (n = 30) were selected from carcasses at a commercial major packing plant in Texas. After aging 14d, the loins were cut into 2.54 cm thick steaks, randomly assigned a grill surface temperature of 149, 177, 204, 232, or 260°C, individually vacuum-packaged and frozen at –10°C until analysis. Steaks were cooked on an electric flat top grill pre-heated to the corresponding temperature treatment. Steaks were turned at an internal temperature of 35°C and removed at 71°C (medium degree of doneness). Cubes (1.3cm × 1.3cm × steak thickness) representative of those served to a trained sensory panel were frozen and held at –80°C until further analysis. For GC/MS analysis, the samples were weighed and placed in a 473 mL glass jar with a Teflon lid held in a water bath at 60°C for 2h. The collection of volatiles from the headspace was done with a solid phase micro-extraction (SPME) sampler and a multi-dimensional GC/MS. For HPLC/MS-QTOF analysis, frozen samples were homogenized in a blender and 2 g were mixed with 8 mL acidified acetonitrile (0.1% formic acid). The supernatant was exposed to dSPE Enhanced Matrix Removal and dried with 3.5 g MgSO4. Samples were analyzed at a 1:5 dilution using reverse-phase chromatography on an Agilent 6545 LC/MS-QTOF with a gradient mobile phase in both positive and negative ion modes. Data were analyzed as linear and/or quadratic effects (P < 0.05) with grill surface temperature as the independent variable. Least squares means, discriminant analyses, and partial least squares regression analyses for compounds were calculated.ResultsBoth octane (gasoline aroma) and undecane (allspice aroma) increased (P < 0.02) linearly with grill temperature. With the exception of pentanal (fermented wine aroma), which decreased (P = 0.027) as grill temperature increased, all other aldehyde compounds increased (P < 0.05) linearly as the grill temperature increased. Pyrazines (roasted, coffee, and nutty aromas) and ketones (fruity, fatty aromas) generally increased (P < 0.03) as grill temperature increased. 2,3,5-trimethyl-6-ethyl pyrazine, 2,3-diethyl-5-methyl pyrazine, 2,5-dimethyl pyrazine and 3,5,-diethyl-2-methyl-pyrazine were only present when the grill temperature reached 260°C. Nonvolatile compounds (n = 247 positive ion and 140 negative ions) were identified. Significant (P < 0.05) patterns of increasing intensity with increased grill temperature were observed in sugar-amino derivatives such as betaine, 2-dimethylamino-5,6-dimethylpyrimidin-4-ol, and (S)-N-(4,5-dihydro-1-methyl-4-oxo-1H-imidazol-2-yl) alanine. A point of inflection was observed at a grill temperature of 232°C across a majority of increasing compounds, suggesting a critical temperature for the regulation of flavorful products from the Maillard reaction.ConclusionVolatile and nonvolatile compounds known to contribute to positive flavor attributes associated with the Maillard reaction are considerably influenced by grill surface temperature. It appears that a grill temperature from 204 to 232°C is optimal for generation of volatile and nonvolatile flavor compounds.

Evaluation of Beef Steak Exudate Differing in Quality Grade and Post-Mortem Aging Time

ObjectivesEvaluate absorbance and metabolite differences of beef exudate from raw beef steaks differing in quality grade and post-mortem aging time.Materials and MethodsUSDA Select (SE; n = 18) and USDA Choice (CH; n = 18) beef strip loins were aged for 7d, cut into 2.54 cm thick steaks, and randomly assigned a post-mortem aging duration of either 10 or 20d post-mortem (n = 72 total). Steaks were individually packaged on d7 and frozen on the assigned day at –20°C until time for analysis. Steaks were thawed for 24h at 4°C before 2 mL of exudate was collected from each bag on removal of the steak. The exudate was frozen at –80°C until further analysis. For analysis of absorbance, 0.5 mL of thawed exudate was diluted with 4.5 mL ultra-pure water and centrifuged. Then, 200 μL of the dilution was pipetted in triplicated onto a 96 well plate. Absorbance was read at a range of 350–700nm wavelengths. A dilution of 1:20 beef exudate: ultra-pure water was filtered and used for metabolite analysis. Using a HILIC column, 5 μL were injected into an organic mobile phase gradient and analyzed using an Agilent 6545 LC/MS-QTOF in positive mode. Data were analyzed using a two-factorial design with quality grade and post-mortem day of aging as fixed effects with an α of 0.05. Loin was included as a random effect. Least squares means, correlations, and principal component analysis were used to discriminate data.ResultsCH exudate had greater (P < 0.05) absorbance than SE at wavelength ranges of 350–404, 423–467, and 491–508 nm. For the range of 350–598nm, CH exudate tended (P < 0.10) to have a greater absorbance than SE exudate. No differences (P > 0.05) were detected at all other wavelengths analyzed between quality grade. Post-mortem aging had no effect (P > 0.05) on wavelength absorbance. Of the total metabolites present (n = 33) in the samples, no differences (P > 0.05) were observed among fixed effects. Only three metabolites exhibited a twofold change in expression, observed as a downregulation from SE to CH exudate. With age, nearly two-thirds of the metabolites (n = 19) tended to increase in intensity. Tritriacontyl octacosanoate was unique to SE exudates.ConclusionBeef exudate tends to be influenced by quality grade more than post-mortem aging duration. Accordingly, exudate samples from raw steaks may be classified by quality grade no matter the duration of aging time.

A-82 Neuropsychological Assessment in the Age of Technology: Comparing Traditional Paper versus Electronic Administration

Objective

As society becomes more interconnected with technology, it is important to examine how traditional “paper and pencil” administered neuropsychological tests can be utilized in digital electronic forms (e.g., computers, touch screen tablets, and smartphones). Literature has shown somewhat mixed outcomes for the validity of computerized tests. Gathering data electronically has been found to reduce human error in both test administration and in data collection itself. Digitizing carries benefits in the research field where electronic administration may make it possible to gather data on a larger scale numerically and geographically. However, in some conversions to digital versions of a task, changes may be made to the stimuli and procedure that might seemingly be benign, but could activate different cognitive responses, potentially compromising construct validity. This study examined the comparability of paper and electronic forms of the Stroop task, which is used widely and has been previously validated in paper form.

Method

Electronic Stroop tests were examined for concurrent validity with a paper version. Two touch-screen based apps were examined: BrainBaseline for the iPad and EncephalApp for smartphone. Young and older adults (n = 58) completed paper and an electronic version of the Stroop.

Results

Correlation analyses revealed a significant, but modest relationship between paper Stroop and the BrainBaseline version (r = .54; p = .001), while the EncephalApp correlation was non-significant (r = .44; p = .18).

Conclusions

These results need to be verified in a larger sample, but the implication is that some paper and electronic versions of cognitive tests are not necessarily interchangeable, and caution should be used.

C-26 Neuro-Exergaming for Older Adults with Mild Cognitive Impairment: A Single Bout of Interactive Physical and Cognitive Exercise (iPACES v2.5)

Objective

Mild Cognitive Impairment (MCI) may be a precursor Alzheimer’s disease and related dementias (ADRDs). Identifying effective interventions to prevent or remediate cognitive decline is imperative given the increasing older population. Prior research has shown benefits to cognition of physical exercise, but only a fraction of older adults actually achieve recommended levels. Researchers have explored the use of potentially more motivating exergames and found benefits above and beyond physical exercise alone, perhaps due to synergistic effects of physical and mental engagement. The current study attempts to replicate and extend prior research by examining the impact on cognition of a single bout of a neuro-exergame in which older adults engaged interactive Physical and Cognitive Exercise (iPACES v2.5).

Method

The iPACES neuro-exergame (v2.5) involves pedaling an under-table elliptical while playing an iPad-based videogame, which simulates an everyday function of independent living: running errands and retracing one’s path home. Eighteen older adults (mean age = 68.4 years old) were assessed pre- and post-exercise with neuropsychological tests of executive function (Stroop and Trails) as well as verbal memory (ADAS Word Recall).

Results

A repeated measures ANOVA (controlling for age) indicated significantly greater benefit to verbal memory for MCI participants in contrast with normative older adults (p = .008; Figure 1).

Conclusion

Further research is needed to confirm this finding in a larger sample, but it is consistent with some prior research on single bouts of exercise benefiting cognition of MCI more than normative older adults. Follow-up trials are needed to examine long-term use, factors affecting outcomes, and underlying mechanisms.

Very early lineage-specific chimerism after reduced intensity stem cell transplantation is highly predictive of clinical outcome for patients with myeloid disease

BACKGROUND

The importance of chimerism status in the very early period after hematopoietic stem cell transplantation is unclear. We determined PBMC and T-cell donor chimerism 50 days after transplantation and related this to disease relapse and overall survival.

METHODS

144 sequential patients underwent transplantation of which 90 had AML/MDS and 54 had lymphoma. 'Full donor chimerism' was defined as ≥99% donor cells and three patient groups were defined: 40% with full donor chimerism (FC) in both PBMC and T-cells; 25% with mixed chimerism (MC) within both compartments and 35% with 'split' chimerism (SC) characterised by full donor chimerism within PBMC and mixed chimerism within T-cells.

RESULTS

In patients with myeloid disease a pattern of mixed chimerism (MC) was associated with a one year relapse rate of 45% and a five year overall survival of 40% compared to values of 8% and 75%, and 17% and 60%, for those with SC or FC respectively. The pattern of chimerism had no impact on clinical outcome for lymphoma.

CONCLUSION

The pattern of lineage-specific chimerism at 50 days after transplantation is highly predictive of clinical outcome for patients with myeloid malignancy and may help to guide subsequent clinical management.

Untersuchungen zur Schwefelversorgung von Milchkühen in Deutschland

Gegenstand: Schwefelüber- und -unterversorgung kann bei Nutztieren zu Leistungsminderung und Erkrankungen führen. Über die Dia - gnostik der Schwefelversorgung in Milchviehherden ist allerdings wenig bekannt. Ziele der Studie waren, die alimentäre Schwefelversorgung deutscher Milchviehherden darzustellen, den Zusammenhang zwischen der Schwefelversorgung und Gesundheit und Leistung zu beurteilen, geeignete Probenmedien für die klinisch-chemische Labordia - gnostik zu bestimmen und Referenzwerte zur Beurteilung der Schwe - felversorgung in verschiedenen Untersuchungsmedien vorzuschlagen. Material und Methoden: Zwischen 2006 und 2014 wurden 569 Milchviehbetriebe beprobt. Von je 10 Tieren der Gruppen –3 bis 0, 0–1, 3–5 und 15–18 Wochen post partum (p. p.) (Betriebe > 200 Tiere) bzw. –3 bis 0, 0–5 und 6–20 Wochen p. p. (Betriebe ≤ 200 Tiere) wurden Blut-, Harn- und Haarproben gewonnen. Gepoolte Vollblut-, Serum-, Plasma-, Harn- und Haarproben (n = 5663) wurden mittels ICP-OESMethode analysiert. Die Schwefelkonzentration der Totalen Mischra - tion (TMR) der Vorbereiter (–3 bis 0 Wochen ante partum) wurden in einem zertifizierten Futtermittellabor bestimmt (n = 625). Ergebnisse: Die mediane Schwefelkonzentration in den Futterrationen betrug 2,3 g/kg TM. Schwefelunterversorgung (< 1,6 g/kg TM; 31% der Betriebe) und -überversorgung (> 4,0 g/kg TM; 11% der Betriebe) in den Futterrationen traten regelmäßig auf. Schwefelunterversorgung war mit verringerter Milchleistung (p < 0,001), Retentio secundinarum (OR = 1,74; p = 0,037), Gebärparese (OR = 2,68; p < 0,001) und Stillbrunst (OR = 2,56; p = 0,014) assoziiert. Positive Korrelationen fanden sich zwischen der Schwefelkonzentration in der TMR und den Schwefelkonzentrationen in Harn (r = 0,50), Serum (r = 0,17), Plasma (r = 0,18) und Vollblut (r = 0,16). Schlussfolgerung und klinische Relevanz: Die Diagnostik der Schwefelversorgung ist für praktische Tierärzte relevant und kann mittels TMR-Analyse und klinisch-chemischer Laborparameter erfolgen. Harn ist dabei als kurzfristiger, Serum, Plasma und Vollblut als mittelfristige und Haar als langfristiger Parameter für die Einschätzung der Schwefelversorgung zu werten.

Parent-adolescent concordance on the Revised Diagnostic Interview for Borderlines (DIB-R) and the Childhood Interview for Borderline Personality Disorder (CI-BPD)

While the degree of concordance between parent and adolescent self-report of internalizing and externalizing pathology is well studied, virtually nothing is known about concordance in borderline pathology and the implication of parent-adolescent discrepancies for outcomes. The present study aimed to (1) examine discrepancies between parents and adolescents on two interview-based measures of borderline personality disorder (BPD)-the Revised Diagnostic Interview for Borderlines (DIB-R²² ) and the Childhood Interview for Borderline Personality Disorder (CI-BPD²³ ); and (2) investigate the implications of discrepancies for clinical outcomes. Diagnostic concordance on the DIB-R and CI-BPD showed rates of 82% and 94% respectively, with lower concordance demonstrated for dimensionally scored variables. Standardized difference scores between adolescent and parent reports on both borderline measures were significantly correlated with few interview-based axis I diagnoses as reported by parents, but not adolescents themselves. Implications regarding the use of each measure for the assessment and diagnosis of borderline personality disorder are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Growth of elaborate microbial pinnacles in Lake Vanda, Antarctica

Microbial pinnacles in ice-covered Lake Vanda, McMurdo Dry Valleys, Antarctica, extend from the base of the ice to more than 50 m water depth. The distribution of microbial communities, their photosynthetic potential, and pinnacle morphology affects the local accumulation of biomass, which in turn shapes pinnacle morphology. This feedback, plus environmental stability, promotes the growth of elaborate microbial structures. In Lake Vanda, all mats sampled from greater than 10 m water depth contained pinnacles with a gradation in size from <1-mm-tall tufts to pinnacles that were centimeters tall. Small pinnacles were cuspate, whereas larger ones had variable morphology. The largest pinnacles were up to ~30 cm tall and had cylindrical bases and cuspate tops. Pinnacle biomass was dominated by cyanobacteria from the morphological and genomic groups Leptolyngbya, Phormidium, and Tychonema. The photosynthetic potential of these cyanobacterial communities was high to depths of several millimeters into the mat based on PAM fluorometry, and sufficient light for photosynthesis penetrated ~5 mm into pinnacles. The distribution of photosynthetic potential and its correlation to pinnacle morphology suggests a working model for pinnacle growth. First, small tufts initiate from random irregularities in prostrate mat. Some tufts grow into pinnacles over the course of ~3 years. As pinnacles increase in size and age, their interiors become colonized by a more diverse community of cyanobacteria with high photosynthetic potential. Biomass accumulation within this subsurface community causes pinnacles to swell, expanding laminae thickness and creating distinctive cylindrical bases and cuspate tops. This change in shape suggests that pinnacle morphology emerges from a specific distribution of biomass accumulation that depends on multiple microbial communities fixing carbon in different parts of pinnacles. Similarly, complex patterns of biomass accumulation may be reflected in the morphology of elaborate ancient stromatolites.

Transcript analysis in two alfalfa salt tolerance selected breeding populations relative to a non-tolerant population

With the growing limitations on arable land, alfalfa (a widely cultivated, low-input forage) is now being selected to extend cultivation into saline lands for low-cost biofeedstock purposes. Here, minerals and transcriptome profiles were compared between two new salinity-tolerant North American alfalfa breeding populations and a more salinity-sensitive western Canadian alfalfa population grown under hydroponic saline conditions. All three populations accumulated two-fold higher sodium in roots than shoots as a function of increased electrical conductivity. At least 50% of differentially expressed genes (p < 0.05) were down-regulated in the salt-sensitive population growing under high salinity, while expression remained unchanged in the saline-tolerant populations. In particular, most reduction in transcript levels in the salt-sensitive population was observed in genes specifying cell wall structural components, lipids, secondary metabolism, auxin and ethylene hormones, development, transport, signalling, heat shock, proteolysis, pathogenesis-response, abiotic stress, RNA processing, and protein metabolism. Transcript diversity for transcription factors, protein modification, and protein degradation genes was also more strongly affected in salt-tolerant CW064027 than in salt-tolerant Bridgeview and salt-sensitive Rangelander, while both saline-tolerant populations showed more substantial up-regulation in redox-related genes and B-ZIP transcripts. The report highlights the first use of bulked genotypes as replicated samples to compare the transcriptomes of obligate out-cross breeding populations in alfalfa.

Assessment of Minimal Residual Disease in Standard-Risk AML

BACKGROUND

Despite the molecular heterogeneity of standard-risk acute myeloid leukemia (AML), treatment decisions are based on a limited number of molecular genetic markers and morphology-based assessment of remission. Sensitive detection of a leukemia-specific marker (e.g., a mutation in the gene encoding nucleophosmin [NPM1]) could improve prognostication by identifying submicroscopic disease during remission.

METHODS

We used a reverse-transcriptase quantitative polymerase-chain-reaction assay to detect minimal residual disease in 2569 samples obtained from 346 patients with NPM1-mutated AML who had undergone intensive treatment in the National Cancer Research Institute AML17 trial. We used a custom 51-gene panel to perform targeted sequencing of 223 samples obtained at the time of diagnosis and 49 samples obtained at the time of relapse. Mutations associated with preleukemic clones were tracked by means of digital polymerase chain reaction.

RESULTS

Molecular profiling highlighted the complexity of NPM1-mutated AML, with segregation of patients into more than 150 subgroups, thus precluding reliable outcome prediction. The determination of minimal-residual-disease status was more informative. Persistence of NPM1-mutated transcripts in blood was present in 15% of the patients after the second chemotherapy cycle and was associated with a greater risk of relapse after 3 years of follow-up than was an absence of such transcripts (82% vs. 30%; hazard ratio, 4.80; 95% confidence interval [CI], 2.95 to 7.80; P<0.001) and a lower rate of survival (24% vs. 75%; hazard ratio for death, 4.38; 95% CI, 2.57 to 7.47; P<0.001). The presence of minimal residual disease was the only independent prognostic factor for death in multivariate analysis (hazard ratio, 4.84; 95% CI, 2.57 to 9.15; P<0.001). These results were validated in an independent cohort. On sequential monitoring of minimal residual disease, relapse was reliably predicted by a rising level of NPM1-mutated transcripts. Although mutations associated with preleukemic clones remained detectable during ongoing remission after chemotherapy, NPM1 mutations were detected in 69 of 70 patients at the time of relapse and provided a better marker of disease status.

CONCLUSIONS

The presence of minimal residual disease, as determined by quantitation of NPM1-mutated transcripts, provided powerful prognostic information independent of other risk factors. (Funded by Bloodwise and the National Institute for Health Research; Current Controlled Trials number, ISRCTN55675535.).

Acceptance of treatment for latent tuberculosis infection: prospective cohort study in the United States and Canada

SETTING

An estimated 300 000 individuals are treated for latent tuberculosis infection (LTBI) in the United States and Canada annually. Little is known about the proportion or characteristics of those who decline treatment.

OBJECTIVE

To define the proportion of individuals in various groups who accept LTBI treatment and to identify factors associated with non-acceptance of treatment.

DESIGN

Persons offered LTBI treatment at 30 clinics in 12 Tuberculosis Epidemiologic Studies Consortium sites were prospectively enrolled. Multivariate regression models were constructed based on manual stepwise assessment of potential predictors.

RESULTS

Of 1692 participants enrolled from March 2007 to September 2008, 1515 (89.5%) accepted treatment and 177 (10.5%) declined. Predictors of acceptance included believing one could personally spread TB germs, having greater TB knowledge, finding clinic schedules convenient and having low acculturation. Predictors of non-acceptance included being a health care worker, being previously recommended for treatment and believing that taking medicines would be problematic.

CONCLUSION

This is the first prospective multisite study to examine predictors of LTBI treatment acceptance in general clinic populations. Greater efforts should be made to increase acceptance among health care workers, those previously recommended for treatment and those who expect problems with LTBI medicines. Ensuring convenient clinic schedules and TB education to increase knowledge could be important for ensuring acceptance.

Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia

Epigenetic therapies demonstrate significant clinical activity in acute myeloid leukemia (AML) and myelodysplasia (MDS) and constitute an important new class of therapeutic agents. However hematological responses are not durable and disease relapse appears inevitable. Experimentally, leukemic stem/progenitor cells (LSC) propagate disease in animal models of AML and it has been postulated that their relative chemo-resistance contributes to disease relapse. We serially measured LSC numbers in patients with high-risk AML and MDS treated with 5'-azacitidine and sodium valproate (VAL-AZA). Fifteen out of seventy-nine patients achieved a complete remission (CR) or complete remission with incomplete blood count recovery (CRi) with VAL-AZA therapy. There was no significant reduction in the size of the LSC-containing population in non-responders. While the LSC-containing population was substantially reduced in all patients achieving a CR/CRi it was never eradicated and expansion of this population antedated morphological relapse. Similar studies were performed in seven patients with newly diagnosed AML treated with induction chemotherapy. Eradication of the LSC-containing population was observed in three patients all of whom achieved a durable CR in contrast to patients with resistant disease where LSC persistence was observed. LSC quantitation provides a novel biomarker of disease response and relapse in patients with AML treated with epigenetic therapies. New drugs that target this cellular population in vivo are required.

Increased fat mass and cardiac septal hypertrophy in newborn infants of mothers with well-controlled diabetes during pregnancy

BACKGROUND

Improved glycaemic control during pregnancy in mothers with type 1 diabetes (T1DM) and gestational diabetes (GDM) has resulted in a marked reduction of perinatal mortality and morbidity, but the prevalence of macrosomia is usually high.

OBJECTIVE

We used non-invasive anthropometric methods to estimate the body composition and the thickness of the interventricular heart septum in 18 infants of mothers with well-controlled T1DM, 10 infants of mothers with GDM and 28 infants of healthy control mothers matched for gestational age and mode of delivery.

METHODS

Skinfold measurements were obtained with a Harpenden calliper within 48 h after delivery. Echocardiography was also performed to measure the thickness of the interventricular septum. Cord blood was sampled for assays of C-peptide, leptin and IGF-I.

RESULTS

The rates of macrosomia (gestational age-adjusted birth weight >2 standard deviation score, SDS) were 56 and 30% in infants of mothers with T1DM and GDM, respectively, compared to 10% in control infants. The body fat content was 40% (0.2 kg) higher and the interventricular heart septum thickness was increased by 20% in both groups of infants of diabetic mothers. We found no associations between maternal levels of HbA1c during pregnancy and body composition or interventricular heart septum thickness. Cord levels of C-peptide and leptin were significantly higher in infants of T1DM mothers than in control infants. Cord leptin level was associated with birth weight SDS and percent body fat in infants of T1DM mothers. IGF-I was associated with percent body fat in infants of GDM mothers and control mothers. A multiple-regression analysis showed that 50% of the variation in body weight SDS could be determined, with IGF-I, leptin and C-peptide as independent variables.

CONCLUSION

Both fat mass and cardiac septal thickness are increased in newborn infants of women with T1DM and GDM in spite of efforts to achieve good glycaemic control during pregnancy.

Floral transmission of Erwinia tracheiphila by cucumber beetles in a wild Cucurbita pepo

Cucumber beetles, Acalymma vittatum (F.) and Diabrotica undecipunctata howardi (Barber), are specialist herbivores of cucurbits and the vector of Erwinia tracheiphila (E.F. Smith) Holland, the causative agent of wilt disease. Cucumber beetles transmit E. tracheiphila when infected frass falls onto leaf wounds at the site of beetle feeding. We show that E. tracheiphila also can be transmitted via the floral nectaries of Cucurbita pepo ssp. texana L. Andres (Texas gourd). Under field conditions, we found that beetles aggregate in flowers in the late morning, that these beetles chew the anther filaments that cover the nectaries in male flowers thereby exposing the nectary, and that beetle frass accumulates on the nectary. We use real-time polymerase chain reaction to show that most of the flowers produced during the late summer possess beetle frass containing E. tracheiphila. Greenhouse experiments, in which cultures of E. tracheiphila are deposited onto floral nectaries, show that Texas gourds can contract wilt disease through the floral nectaries. Finally, we use green fluorescent protein-transformed E. tracheiphila to document the movement of E. tracheiphila through the nectary into the xylem of the pedicel before the abscission of the flower. Together, these data show that E. tracheiphila can be transmitted through infected frass that falls on or near the floral nectaries. We hypothesize that the concentration of frass from many beetles in the flowers increases both exposure to and the concentration of E. tracheiphila and plays a major role in the dynamics of wilt disease in both wild populations and cultivated squash fields.

VHL mutation analysis in patients with isolated central nervous system haemangioblastoma

Haemangioblastomas of the CNS are a cardinal feature of von Hippel-Lindau (VHL) disease, a dominantly inherited multisystem familial cancer syndrome caused by germline mutation of the VHL tumour suppressor gene. We investigated the frequency of VHL mutations in 188 patients presenting with a single haemangioblastoma, no family history of VHL disease and no evidence of retinal or abdominal manifestations of the disease at the time of diagnosis. We found that approximately 4% of patients had a detectable VHL mutation and all of these cases presented age 40 years or less. Although the identification of a germline VHL mutation has important consequences for the patient (e.g. risk of further CNS and extra-CNS tumours) and their relatives, four patients had germline VHL missense mutations [C162Y, D179N and R200W (two patients)] that may represent haemangioblastoma-only and/or low penetrance mutations. Approximately 5% of patients without a detectable VHL mutation subsequently developed a further 'VHL type tumour' (in most cases a further CNS haemangioblastoma). These findings suggest that a subset of patients with apparently sporadic CNS haemangioblastoma will have a germline VHL mutation but may not be at risk for developing classical VHL disease and a further group may be mosaic for a germline VHL mutation that cannot be detected in blood cells.

The genome of black cottonwood, Populus trichocarpa (Torr. & Gray)

We report the draft genome of the black cottonwood tree, Populus trichocarpa. Integration of shotgun sequence assembly with genetic mapping enabled chromosome-scale reconstruction of the genome. More than 45,000 putative protein-coding genes were identified. Analysis of the assembled genome revealed a whole-genome duplication event; about 8000 pairs of duplicated genes from that event survived in the Populus genome. A second, older duplication event is indistinguishably coincident with the divergence of the Populus and Arabidopsis lineages. Nucleotide substitution, tandem gene duplication, and gross chromosomal rearrangement appear to proceed substantially more slowly in Populus than in Arabidopsis. Populus has more protein-coding genes than Arabidopsis, ranging on average from 1.4 to 1.6 putative Populus homologs for each Arabidopsis gene. However, the relative frequency of protein domains in the two genomes is similar. Overrepresented exceptions in Populus include genes associated with lignocellulosic wall biosynthesis, meristem development, disease resistance, and metabolite transport.

Carbohydrate-deficient transferrin in vitreous humour: a marker of possible withdrawal-related death in alcoholics

The possibility of performing reliable post-mortem analysis of carbohydrate-deficient transferrin (CDT) concentration in vitreous humour (VH) by using a commercial assay designed for serum analysis (CDTect(TM)) as well as the usefulness of VH-CDT as a marker of alcohol misuse and possible withdrawal-related death were evaluated in a forensic sample. Detectable VH-CDT was found in 20 of 21 alcoholic subjects and in two of seven controls. By using the detection limit of the CDTect(TM) method (VH-CDT = 5 U/l) as cut-off level for a positive test, the alcoholic group was significantly separated from the control group (P = 0.0024, Fisher's exact test). The sensitivity and specificity of the test was 95% and 71%, giving a positive and a negative predictive value of 91% and 83%, respectively. Time-dependent changes of VH-CDT in the dead body could not unequivocally be excluded, which must be considered when selecting cases suitable for VH-CDT analysis. We conclude that adding VH-CDT analysis to ordinary alcohol tests may become useful in forensic medicine for establishing the so-called 'alcoholic state', which may provide a tool in research dealing with the relation between alcohol withdrawal and various causes of death in alcoholics.

No foot in the door: an experimental study of employment discrimination against older workers

Pairs of testers, one aged 57 and one aged 32, applied for 102 entry-level sales or management jobs in the Washington, DC, metropolitan area. Although their credentials described them as equally qualified, the older applicants received less favorable responses from employers 41.2% of the time. Three quarters of these differences occurred before older applicants could fully present their qualifications. The negative employer assumptions about older workers implied by these differences in outcome were seldom explicitly stated.

Quality of life 20 and 30 years after surgery in patients operated on for tetralogy of Fallot and for atrial septal defect

Follow-up studies on patients operated on for congenital heart defects have shown good anatomical results and long-term survival. To date, there have been few studies on such patients with regard to long-term psychosocial outcome and quality of life. In this study, two cohorts of patients operated on before the age of 15 years, one for tetralogy of Fallot (TOF) and the other for atrial septal defect (ASD), were investigated 20 and 30 years after operation regarding quality of life. The combined cohort had a higher educational level than average. There was no connection between quality of life and physical health as judged from the New York Heart Association classification. The TOF group rated their quality of life higher than the ASD group, but both groups had lower figures at the 30-year than at the 20-year follow-up. Fewer patients in the TOF than in the ASD group considered that their lives were affected by the heart disease. It is concluded that the severity of the heart disease is not necessarily congruent with estimated quality of live and that mild heart defects, such as ASD, can have a considerable impact on later life quality. Surprisingly few TOF patients were affected negatively, a finding which might reflect development of a specific coping strategy in these patients during childhood.

Potentiation of Rho-A-mediated lysophosphatidic acid activity by hyperinsulinemia

We have shown previously that insulin promotes phosphorylation and activation of farnesyltransferase and geranylgeranyltransferase (GGTase) II. We have now examined the effect of insulin on geranylgeranyltransferase I in MCF-7 breast cancer cells. Insulin increased GGTase I activity 3-fold and augmented the amounts of geranylgeranylated Rho-A by 18%. Both effects of the insulin were blocked by an inhibitor of GGTase I, GGTI-286. The insulin-induced increases in the amounts of geranylgeranylated Rho-A resulted in potentiation of the Rho-A-mediated effects of lysophosphatidic acid (LPA) on a serum response element-luciferase construct. Preincubation of cells with insulin augmented the LPA-stimulated serum response element-luciferase activation to 12-fold, compared with just 6-fold for LPA alone (p < 0.05). The potentiating effect of insulin was dose-dependent, inhibited by GGTI-286 and not mimicked by insulin-like growth factor-1. We conclude that insulin activates GGTase I, increases the amounts of geranylgeranylated Rho-A protein, and potentiates the Rho-A-dependent nuclear effects of LPA in MCF-7 breast cancer cells.

Effects of insulin on prenylation as a mechanism of potentially detrimental influence of hyperinsulinemia

To investigate the cause and effect relationship between hyperinsulinemia and the increased amounts of farnesylated p21Ras, we performed hyperinsulinemic euglycemic clamps in normal weight volunteers as well as in normal mice and dogs. Insulin infusions significantly raised the amounts of farnesylated p21Ras in the white blood cells of humans, in liver samples of mice and dogs, and in aorta samples of mice. Obese hyperinsulinemic individuals and dogs (made hyperinsulinemic by surgical diversion of the pancreatic outflow from the portal vein into the vena cava) displayed increased amounts of farnesylated p21Ras before the hyperinsulinemic clamps. Infusions of insulin did not alter the already increased levels of farnesylated p21Ras in these experimental models. To further investigate the role of acquired insulin resistance in modulating insulin's effect on p21Ras prenylation, we induced insulin resistance in rats by glucosamine infusion. Insulin-resistant glucosamine-treated animals displayed significantly increased farnesylated p21Ras in response to insulin infusion compared to that in control saline-treated animals. Transgenic models of insulin resistance (heterozygous insulin receptor substrate-1 knockout mice, A-ZIP/F-1 fatless mice, and animals overexpressing glutamine:fructose-6-phosphate amidotransferase) contained increased amounts of farnesylated p21Ras. We conclude that hyperinsulinemia, either endogenous (a prominent feature of insulin resistance) or produced by infusions of insulin, increases the amounts of farnesylated p21Ras in humans, mice, and dogs. This aspect of insulin action may represent one facet of the molecular mechanism of the potentially detrimental influence of hyperinsulinemia.

Increased amounts of farnesylated p21Ras in tissues of hyperinsulinaemic animals

We have recently demonstrated that insulin activates farnesyltransferase (FTase) and thereby increases the amounts of cellular farnesylated p21Ras in 3T3-L1 fibroblasts, adipocytes and vascular smooth muscle cells. We postulated that hyperinsulinaemia might considerably increase the the cellular pool of farnesylated p21Ras available for activation by other growth factors. To examine the role of in vivo hyperinsulinaemia in regulating farnesylated p21Ras, we measured the amounts of farnesylated p21Ras in tissues of hyperinsulinaemic animals. Liver, aorta, and skeletal muscle of ob/ob mice, and mice made obese and hyperinsulinaemic by injection of gold-thioglucose contained greater amounts of farnesylated p21Ras than tissues of their lean normoinsulinaemic counterparts. Similarly, farnesylated p21Ras was increased (67 vs. 35 % in control animals, p<0.01) in the livers of hyperinsulinaemic Zucker rats (fa/fa). Reduction of hyperinsulinaemia by exercise training (2 h/day for 7-8 weeks) resulted in decreases in the amounts of farnesylated p21Ras in these animals. Increased farnesylated p21Ras in hyperinsulinaemic animals reflected increasing increments in the activity of FTase in ob/ob mice (2-fold increase) and fa/fa Zucker rats (3.5-fold increase), while the total amounts of Ras proteins remained unchanged. In contrast to insulin-resistant hyperinsulinaemic animals, denervated insulin-resistant rat soleus muscle (in the presence of normoinsulinaemia) showed normal amounts of farnesylated p21Ras. In summary, these data confirm increased amounts of farnesylated p21Ras in tissues of hyperinsulinaemic animals.

Effect of enteral nutritional products differing in carbohydrate and fat on indices of carbohydrate and lipid metabolism in patients with NIDDM

Non-insulin dependent diabetes mellitus (NIDDM) is associated with chronic hyperglycemia, which increases the risk of developing microvascular and macrovascular complications. Elevated triglyceride (TG) and VLDL cholesterol levels and low levels of HDL cholesterol have also been frequently reported in NIDDM patients. A diet high in complex carbohydrate and low in fat is typically recommended for management of NIDDM, however, this has recently been challenged by scientific reports of the benefits of dietary intakes high in monounsaturated fat. Thirty-two individuals with NIDDM were randomized to receive either Ensure with Fibre (30% fat) or a high monounsaturated fatty acid product, Glucerna (50% fat). These products were consumed for 28 days at > 80% of daily energy intake. Post-treatment, dietary compliance was verified by a higher plasma TG 18:1 n-9 (p < 0.001) in the Glucerna group and a higher plasma TG 18:2 n-6 (p < 0.001) in the Ensure with Fibre group. The postprandial rise in blood glucose levels, determined by fingerprick samples, was significantly lower (p < 0.01) in the Glucerna group. Trends of clinical interest were greater mean decreases in the Glucerna group compared to the Ensure with Fibre group in: fructosamine, 9.13 umol/L vs 0.14 umol/L; glucose, 1.61 mmol/L vs 0.63 mmol/L; and insulin, 46.0 pmol/L vs 12.6 pmol/L; respectively. However, overall, fasting plasma glucose, fructosamine, TG and cholesterol levels were not significantly different between groups. Thus, in these patients, the high monounsaturated fat diet and the standard diet were similar with regard to usual indicators of carbohydrate and lipid metabolism. A high monounsaturated fat diet appears to pose no risk to lipoprotein metabolism in NIDDM patients.

Effect of insulin on farnesyltransferase. Specificity of insulin action and potentiation of nuclear effects of insulin-like growth factor-1, epidermal growth factor, and platelet-derived growth factor

We have previously demonstrated that insulin activates farnesyltransferase (FTase) and augments the amounts of farnesylated p21 (Goalstone, M. L., and Draznin, B. (1996) J. Biol. Chem. 271, 27585-27589). We postulated that this aspect of insulin action might explain the "priming effect" of insulin on the cellular response to other growth factors. In the present study, we show the specificity of the effect of insulin on FTase. Insulin, but not insulin-like growth factor-1 (IGF-1), epidermal growth factor (EGF), or platelet-derived growth factor (PDGF), stimulated the phosphorylation of the alpha-subunit of FTase and the amounts of farnesylated p21. Even though all four growth factors utilized the Ras pathway to stimulate DNA synthesis, only insulin used this pathway to influence FTase. Insulin failed to stimulate FTase in cells expressing the chimeric insulin/IGF-1 receptor and in cells derived from the insulin receptor knock-out animals. Insulin potentiated the effects of IGF-1, EGF, and PDGF on DNA synthesis in cells expressing the wild type insulin receptor, but this potentiation was inhibited in the presence of the FTase inhibitor, alpha-hydroxyfarnesylphosphonic acid. We conclude that the effect of insulin on FTase is specific, requires the presence of an intact insulin receptor, and serves as a conduit for the "priming" influence of insulin on the nuclear effects of other growth factors.

A cultural transformation model for nursing

The rapidity and constancy of change, coupled with a culture of staff entitlement and passive and defensive leadership behaviors, prompted the development of an intensive plan for cultural transformation. The cultural transformation steps of leadership development, nominal group technique, quality improvement teams, and evaluation process are explored in detail. Lessons learned and outcomes obtained within the first 6 months after implementation are identified.

Effect of medium-chain triglycerides on calbindin-D9k expression in the intestine

These studies determined the effect of the saturated fat source in infant formula on the expression of calbindin-D9k (CaBP-9k). Piglets were fed from birth to 8 d with milk or formula containing saturated fatty acids as medium-chain triglycerides (MCT), coconut oil, palm oil (Palm 1), or synthesized triglycerides with 16:0 directed to the sn-2 position (Palm 2). Levels of intestinal CaBP-9k mRNA were significantly (P < 0.01) higher in piglets fed formula with MCT than in piglets fed the other formula or milk; and higher in piglets fed the Palm-1 than in piglets fed Palm-2 formula. This is the first evidence that MCT alter piglet intestinal CaBP-9k mRNA.