The complete genome assemblies of 19 insect pests of worldwide importance to agriculture

There are many insect pests worldwide that damage agricultural crop and reduce yield either by direct feeding or by the transmission of plant diseases. To date, control of pest insects has been achieved largely by applying synthetic insecticides. However, insecticide use can be seriously impacted by legislation that limits their use or by the evolution of resistance in the target pest. Thus, there is a move towards less use of insecticides and increased adoption of integrated pest management strategies using a wide range of non-chemical and chemical control methods. For good pest control there is a need to understand the mode of action and selectivity of insecticides, the life cycles of the pests and their biology and behaviours, all of which can benefit from good quality genome data. Here we present the complete assembled (chromosome level) genomes (incl. mtDNA) of 19 insect pests, Agriotes lineatus (click beetle/wireworm), Aphis gossypii (melon/cotton aphid), Bemisia tabaci (cotton whitefly), Brassicogethes aeneus (pollen beetle), Ceutorhynchus obstrictus (seedpod weevil), Chilo suppressalis (striped rice stem borer), Chrysodeixis includens (soybean looper), Diabrotica balteata (cucumber beetle), Diatraea saccharalis (sugar cane borer), Nezara viridula (green stink bug), Nilaparvata lugens (brown plant hopper), Phaedon cochleariae (mustard beetle), Phyllotreta striolata (striped flea beetle), Psylliodes chrysocephala (cabbage stem flea beetle), Spodoptera exigua (beet army worm), Spodoptera littoralis (cotton leaf worm), Diabrotica virgifera (western corn root worm), Euschistus heros (brown stink bug) and Phyllotreta cruciferae (crucifer flea beetle). For the first 15 of these we also present the annotation of genes encoding potential xenobiotic detoxification enzymes. This public resource will aid in the elucidation and monitoring of resistance mechanisms, the development of highly selective chemistry and potential techniques to disrupt behaviour in a way that limits the effect of the pests.

A near-chromosome level genome assembly of the European hoverfly, Sphaerophoria rueppellii (Diptera: Syrphidae), provides comparative insights into insecticide resistance-related gene family evolution

BACKGROUND

Sphaerophoria rueppellii, a European species of hoverfly, is a highly effective beneficial predator of hemipteran crop pests including aphids, thrips and coleopteran/lepidopteran larvae in integrated pest management (IPM) programmes. It is also a key pollinator of a wide variety of important agricultural crops. No genomic information is currently available for S. rueppellii. Without genomic information for such beneficial predator species, we are unable to perform comparative analyses of insecticide target-sites and genes encoding metabolic enzymes potentially responsible for insecticide resistance, between crop pests and their predators. These metabolic mechanisms include several gene families - cytochrome P450 monooxygenases (P450s), ATP binding cassette transporters (ABCs), glutathione-S-transferases (GSTs), UDP-glycosyltransferases (UGTs) and carboxyl/choline esterases (CCEs).

METHODS AND FINDINGS

In this study, a high-quality near-chromosome level de novo genome assembly (as well as a mitochondrial genome assembly) for S. rueppellii has been generated using a hybrid approach with PacBio long-read and Illumina short-read data, followed by super scaffolding using Hi-C data. The final assembly achieved a scaffold N50 of 87Mb, a total genome size of 537.6Mb and a level of completeness of 96% using a set of 1,658 core insect genes present as full-length genes. The assembly was annotated with 14,249 protein-coding genes. Comparative analysis revealed gene expansions of CYP6Zx P450s, epsilon-class GSTs, dietary CCEs and multiple UGT families (UGT37/302/308/430/431). Conversely, ABCs, delta-class GSTs and non-CYP6Zx P450s showed limited expansion. Differences were seen in the distributions of resistance-associated gene families across subfamilies between S. rueppellii and some hemipteran crop pests. Additionally, S. rueppellii had larger numbers of detoxification genes than other pollinator species.

CONCLUSION AND SIGNIFICANCE

This assembly is the first published genome for a predatory member of the Syrphidae family and will serve as a useful resource for further research into selectivity and potential tolerance of insecticides by beneficial predators. Furthermore, the expansion of some gene families often linked to insecticide resistance and selectivity may be an indicator of the capacity of this predator to detoxify IPM selective insecticides. These findings could be exploited by targeted insecticide screens and functional studies to increase effectiveness of IPM strategies, which aim to increase crop yields by sustainably and effectively controlling pests without impacting beneficial predator populations.

A scaffold-level genome assembly of a minute pirate bug, Orius laevigatus (Hemiptera: Anthocoridae), and a comparative analysis of insecticide resistance-related gene families with hemipteran crop pests

BACKGROUND

Orius laevigatus, a minute pirate bug, is a highly effective beneficial predator of crop pests including aphids, spider mites and thrips in integrated pest management (IPM) programmes. No genomic information is currently available for O. laevigatus, as is the case for the majority of beneficial predators which feed on crop pests. In contrast, genomic information for crop pests is far more readily available. The lack of publicly available genomes for beneficial predators to date has limited our ability to perform comparative analyses of genes encoding potential insecticide resistance mechanisms between crop pests and their predators. These mechanisms include several gene/protein families including cytochrome P450s (P450s), ATP binding cassette transporters (ABCs), glutathione S-transferases (GSTs), UDP-glucosyltransferases (UGTs) and carboxyl/cholinesterases (CCEs).

METHODS AND FINDINGS

In this study, a high-quality scaffold level de novo genome assembly for O. laevigatus has been generated using a hybrid approach with PacBio long-read and Illumina short-read data. The final assembly achieved a scaffold N50 of 125,649 bp and a total genome size of 150.98 Mb. The genome assembly achieved a level of completeness of 93.6% using a set of 1658 core insect genes present as full-length genes. Genome annotation identified 15,102 protein-coding genes - 87% of which were assigned a putative function. Comparative analyses revealed gene expansions of sigma class GSTs and CYP3 P450s. Conversely the UGT gene family showed limited expansion. Differences were seen in the distributions of resistance-associated gene families at the subfamily level between O. laevigatus and some of its targeted crop pests. A target site mutation in ryanodine receptors (I4790M, PxRyR) which has strong links to diamide resistance in crop pests and had previously only been identified in lepidopteran species was found to also be present in hemipteran species, including O. laevigatus.

CONCLUSION AND SIGNIFICANCE

This assembly is the first published genome for the Anthocoridae family and will serve as a useful resource for further research into target-site selectivity issues and potential resistance mechanisms in beneficial predators. Furthermore, the expansion of gene families often linked to insecticide resistance may be an indicator of the capacity of this predator to detoxify selective insecticides. These findings could be exploited by targeted pesticide screens and functional studies to increase effectiveness of IPM strategies, which aim to increase crop yields by sustainably, environmentally-friendly and effectively control pests without impacting beneficial predator populations.

The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study

BACKGROUND

Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing.

OBJECTIVES

To explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards.

RESEARCH DESIGN

Retrospective cohort.

PARTICIPANTS

All unscheduled admissions to an English hospital of people aged ≥75 with cognitive screening over 14 months.

MEASURES

The exposure was defined as deviation in staffing hours from the ward daily mean, averaged across the patient stay. Outcomes were mortality in hospital/within 30 days of discharge and 30-day re-admission. Analyses were stratified by CI.

RESULTS

12,544 admissions were included. Patients with CI (33.2%) were exposed to similar levels of staffing as those without. An additional 0.5 RN hours per day was associated with 10% reduction in the odds of death overall (odds ratio 0.90 [95% CI 0.84-0.97]): 15% in patients with CI (OR 0.85 [0.74-0.98]) and 7% in patients without (OR 0.93 [0.85-1.02]). An additional 0.5 NA hours per day was associated with a 15% increase in mortality in patients with no impairment. Readmissions decreased by 6% for an additional 0.5 RN hours in patients with CI.

CONCLUSIONS

Although exposure to low staffing was similar, the impact on mortality and readmission for patients with CI was greater. Increased mortality with higher NA staffing in patients without CI needs exploration.

Review and optimisation of foot radiography technique

INTRODUCTION

Radiography is an important tool in the diagnosis of trauma and diseases of the foot. Consistent image quality and anatomical appearances are essential to ensure that images are interpreted correctly and this study aims to evaluate current technique and use anthropomorphical phantoms in order to investigate the most optimal radiographic technique.

METHODS

A two part study was conducted. An electronic survey was administered in order to ascertain the current radiographic technique utilised within the United Kingdom (UK) National Health Service (NHS) and compare this with techniques published within radiographic positioning textbooks in common use within the UK. A phantom experiment also sought to identify the most appropriate angulation of the central beam to employ in order to optimally visualise the anatomy for standard non-trauma radiography of the foot. A relative visual grading analysis technique was used to assess radiographic quality.

RESULTS

The electronic survey was completed by 38% of departments (n = 69/182) and demonstrated wide inconsistencies in projections, centring points and beam angulations employed across the NHS. The most commonly employed techniques no longer match the majority of positions described in textbooks. The phantom experiment modelled the ability to accurately visualise anatomy with a variation of the central beam angulation. The results demonstrated that the most commonly described textbook techniques remain the most optimal for accurately visualising the anatomy of the foot.

CONCLUSION

This study has validated the radiographic techniques of the foot described in many of the key texts, however self-reported current practice has diverged from this textbook description.

IMPLICATIONS FOR PRACTICE

Reinforcement of fundamental principles will benefit the patient with increased image quality, improved diagnosis and improved consistency of images, particularly when patient care is transferred between centres.

Variation in pelvic radiography practice: Why can we not standardise image acquisition techniques?

INTRODUCTION

Pelvic radiographs remain an essential investigation in orthopaedic practice. Although it is recognised that acquisition techniques can affect image appearances and measurement accuracy, it remains unclear what variation in practice exists and what impact this could have on decision making.

METHOD

This was a cross sectional survey of UK radiology departments utilising an electronic tool. An introductory letter and link was distributed. Responses were received from 69 unique hospital sites within the specified timeframe, a response rate of 37.9%.

RESULTS

There was no consistent technique for the positioning of patients for pelvic radiographs. The distance varied between 90 and 115 cm and 10 different centering points were described. In relation to leg position, the feet are usually internally rotated (65 of 69 [94.2%]). Only 1 teaching hospital (1 of 69 [1.4%]) uses a weight-bearing position as standard. Orthopaedic calibration devices were not in routine use, with only 21 using on pelvic x-rays (30.4%). Further, the type of device and application criteria were inconsistent.

CONCLUSIONS

To our knowledge this is the first study to directly compare radiographic positioning across hospital sites. Our data demonstrated marked variation in technique for pelvis radiographs with associated implications for clinical decision making. Research is required to determine the standard technique and quality outcome measures to provide confidence in diagnostic interpretation particularly for serial radiographs.

Extension of Partial Gene Transcripts by Iterative Mapping of RNA-Seq Raw Reads

Many non-model organisms lack reference genomes and the sequencing and de novo assembly of an organism's transcriptome is an affordable means by which to characterize the coding component of its genome. Despite the advances that have made this possible, assembling a transcriptome without a known reference usually results in a collection of full-length and partial gene transcripts. The downstream analysis of genes represented as partial transcripts then often requires further experimental work in the laboratory in order to obtain full- length sequences. We have explored whether partial transcripts, encoding genes of interest present in de novo assembled transcriptomes of a model and non-model insect species, could be further extended by iterative mapping against the raw transcriptome sequencing reads. Partial sequences encoding cytochrome P450s and carboxyl/cholinesterase were used in this analysis because they are large multigene families and exhibit significant variation in expression. We present an effective method to improve the continuity of partial transcripts in silico that, in the absence of a reference genome, maybe a quick and cost-effective alternative to their extension by laboratory experimentation. Our approach resulted in the successful extension of incompletely assembled transcripts, often to full length. We experimentally validated these results \textit{in silico} and using real-time PCR and sequencing.

Biochemical evaluation of interactions between synergistic molecules and phase I enzymes involved in insecticide resistance in B- and Q-type Bemisia tabaci (Hemiptera: Aleyrodidae)

BACKGROUND

Metabolic resistance is an important consideration in the whitefly Bemisia tabaci, where an esterase-based mechanism has been attributed to pyrethroid resistance and over-expression of the cytochrome P450, CYP6CM1, has been correlated to resistance to imidacloprid and other neonicotinoids.

RESULTS

In vitro interactions between putative synergists and CYP6CM1, B and Q-type esterases were investigated, and structure-activity relationship analyses allowed the identification of chemical structures capable of acting as inhibitors of esterase and oxidase activities. Specifically, methylenedioxyphenyl (MDP) moieties with a polyether chain were preferable for optimum inhibition of B-type esterase, whilst corresponding dihydrobenzofuran structures were potent for the Q-esterase variation. Potent inhibition of CYP6CM1 resulted from structures which contained an alkynyl chain with a terminal methyl group.

CONCLUSIONS

Synergist candidates could be considered for field control of B. tabaci, especially to abrogate neonicotinoid resistance. © 2017 Society of Chemical Industry.

The interactions of piperonyl butoxide and analogues with the metabolic enzymes FE4 and CYP6CY3 of the green peach aphid Myzus persicae (Hemiptera: Aphididae)

BACKGROUND

Piperonyl butoxide (PBO) is a well-known insecticide synergist capable of interacting with phase 1 metabolic enzymes, specifically esterases and cytochrome P450s. In this study, structure-activity relationship analyses were used to characterise the interaction of around 30 analogues of PBO with the esterase FE4 and the P450 CYP6CY3 from insecticide-resistant Myzus persicae (Sulzer), in order to predict the synthesis of more potent inhibitors.

RESULTS

Enzyme inhibition studies were performed against esterase and oxidase activities and, together with in silico modelling, key activity determinants of the analogues were identified and optimised. Novel analogues were then designed and synthesised, some of which showed greater inhibition against both enzymatic systems: specifically, dihydrobenzofuran moieties containing an alkynyl side chain and a butyl side chain against FE4, and benzodioxole derivatives with a propyl/butyl side chain and an alkynyl ether moiety for CYP6CY3.

CONCLUSIONS

In vitro assays identified potential candidate synergists with high inhibitory potency. The in vivo confirmation of such results will allow consideration for a possible use in agriculture. © 2016 Society of Chemical Industry.

The use of substituted alkynyl phenoxy derivatives of piperonyl butoxide to control insecticide-resistant pests

BACKGROUND

Derivatives of piperonyl butoxide with alkynyl side chains were tested in vitro and in vivo against pyrethroid-resistant Meligethes aeneus and imidacloprid-resistant Myzus persicae.

RESULTS

Synergists with the alkynyl side chain were more effective inhibitors of P450 activity in vitro than piperonyl butoxide, and demonstrated high levels of synergism in vivo, with up to 290-fold synergism of imidacloprid against imidacloprid-resistant M. persicae.

CONCLUSIONS

These 'second-generation' synergists could overcome metabolic resistance in many pest species and possibly enable reduced rates of insecticide application in some cases. © 2016 Society of Chemical Industry.

Induced thiacloprid insensitivity in honeybees (Apis mellifera L.) is associated with up-regulation of detoxification genes

Honey bees, Apis mellifera, are markedly less sensitive to neonicotinoid insecticides containing a cyanoimino pharmacophore than to those with a nitroimino group. Although previous work has suggested that this results from enhanced metabolism of the former by detoxification enzymes, the specific enzyme(s) involved remain to be characterized. In this work, a pretreatment of honey bees with a sublethal dose of thiacloprid resulted in induced insensitivity to the same compound immediately following thiacloprid feeding. A longer pretreatment time resulted in no, or increased, sensitivity. Transcriptome profiling, using microarrays, identified a number of genes encoding detoxification enzymes that were over-expressed significantly in insecticide-treated bees compared with untreated controls. These included five P450s, CYP6BE1, CYP305D1, CYP6AS5, CYP315A1, CYP301A1, and a carboxyl/cholinesterase (CCE) CCE8. Four of these P450s were functionally expressed in Escherichia coli and their ability to metabolize thiacloprid examined by liquid chromatography-mass spectrometry (LC-MS) analysis.

The interactions between piperonyl butoxide and E4, a resistance-associated esterase from the peach-potato aphid, Myzus persicae Sulzer (Hemiptera: Aphididae)

BACKGROUND

It has been reported previously that piperonyl butoxide (PBO) can inhibit both P450 and esterase activity. Although the method by which PBO combines with cytochrome P450 has been identified, the way in which it acts as an esterase inhibitor has not been established. This paper characterises the interactions between PBO and the resistance-associated esterase in Myzus persicae, E4.

RESULTS

After incubation with PBO/analogues, hydrolysis of 1-naphthyl acetate by E4 is increased, but sequestration of azamethiphos is reduced. Rudimentary in silico modelling suggests PBO docks at the lip of the aromatic gorge.

CONCLUSIONS

PBO binds with E4 to accelerate small substrates to the active-site triad, while acting as a blockade to larger, insecticidal molecules. Structure-activity studies with analogues of PBO also reveal the essential chemical moieties present in the molecule.

The effect of a piperonyl butoxide/tau-fluvalinate mixture on pollen beetle (Meligethes aeneus) and honey bees (Apis mellifera)

BACKGROUND

Previous work has characterised pyrethroid resistance in pollen beetle (Meligethes aeneus F.) as principally an oxidative mechanism. Piperonyl butoxide (PBO) can synergise this resistance in the field, but its effects on the honey bee are thought to be unacceptable.

RESULTS

A field trial in Poland was conducted to show that a mixture of PBO and tau-fluvalinate at the registered rate gave increased and longer-lasting control of resistant pollen beetle. Four days after spraying with tau-fluvalinate, only 20% of pollen beetles were controlled, compared with 70% if the tau-fluvalinate/PBO mixture was used. No detriment to honey bee health was observed using the same mixture.

CONCLUSIONS

PBO, if used in conjunction with a pyrethroid of relatively low bee toxicity, can successfully overcome pyrethroid resistance in pollen beetle without incurring an increased loss of honey bees, even if they are present at the time of spraying.

Cooperative interactions between odorant-binding proteins of Anopheles gambiae

To understand olfactory discrimination in Anopheles gambiae, we made six purified recombinant OBPs and investigated their ligand-binding properties. All OBPs were expressed in bacteria with additional production of OBP47 in the yeast Kluveromyces lactis. Ligand-binding experiments, performed with a diverse set of organic compounds, revealed marked differences between the OBPs. Using the fluorescent probe N-phenyl-1-naphthylamine, we also measured the binding curves for binary mixtures of OBPs and obtained, in some cases, unexpected behaviour, which could only be explained by the OBPs forming heterodimers with binding characteristics different from those of the component proteins. This shows that OBPs in mosquitoes can form complexes with novel ligand specificities, thus amplifying the repertoire of OBPs and the number of semiochemicals that can be discriminated. Confirmation of the likely role of heterodimers was demonstrated by in situ hybridisation, suggesting that OBP1 and OBP4 are co-expressed in some antennal sensilla of A. gambiae.

A stable solid model for protein sulfenyl iodides

The first simple sulfenyl iodide that is a pure stable crystalline solid is reported. This product, ISCMe(2)CH(NHCbz)CONH-Ph-p-Cl(10), contains linkages that simulate the two peptide linkages vicinal to the -SI moiety in a protein sulfenyl iodide. Unlike typical simple sulfenyl iodides, solid 10 remains unchanged at ambient conditions for more than ten weeks; however, it is quite reactive in solution. Under proper circumstances, therefore, a sulfenyl iodide is proved to be a stable but highly reactive species. The model 10 and related compounds should afford prospects for better understanding of the unusual stabilities of certain protein sulfenyl iodides and of ways in which other such compounds may function in mediating iodination reactions in the thyroid gland.

Metabolic enzyme(s) confer imidacloprid resistance in a clone of Myzus persicae (Sulzer) (Hemiptera: Aphididae) from Greece

BACKGROUND

Previous studies have reported varying levels of resistance against imidacloprid in several insect species, including populations of the peach-potato aphid, Myzus persicae (Sulzer). These cases of resistance have been attributed to either target-site resistance or enhanced detoxification. In this study, a clone of M. persicae originating from Greece revealed a 60-fold resistance factor to imidacloprid.

RESULTS

The Greek clone is compared in terms of metabolic enzyme activity and synergism profiles with other M. persicae clones showing lower imidacloprid resistance.

CONCLUSION

A combination of in vitro biochemical assays and in vivo differential synergism studies using PBO and a close analogue EN 16/5-1 suggests that the mechanism conferring increased resistance in this clone is primarily due to enhanced oxidase activity.

Discrimination of alarm pheromone (E)-beta-farnesene by aphid odorant-binding proteins

OBPs have been recently demonstrated to be required for odour perception in insects and directly involved in odour discrimination. In aphids they might represent new interesting targets for the control of their population in agriculture. Based on sequence information available in the EST database, we have cloned four genes encoding odorant-binding proteins (OBP) in Acyrthosiphon pisum and homologous genes in other aphid species. Unlike OBPs from other orders of insects, that are greatly divergent, in aphids these proteins have been found to be highly conserved, with differences between species limited to only few amino acid substitutions. On the contrary, similarities between OBP sequences of the same species are poor with 31% or less of identical amino acids. Three selected OBPs (OBP1, OBP3 and OBP8) have been expressed in bacteria and purified. Ligand-binding experiments have shown similar behaviour of the three proteins towards several organic compounds, but also some significant selectivities. In particular, (E)-beta-farnesene, the alarm pheromone and its related compound farnesol exhibited good affinity to OBP3, but did not bind the other two proteins. We suggest that OBP3 could mediate response of aphids to the alarm pheromone.

An essential care course for healthcare assistants

There is growing consensus that healthcare assistants (HCAs) need access to professional training, education and support. The authors describe a short course designed to educate and support HCAs, focusing on the care of older people.

Skewed X-chromosome inactivation is associated with trisomy in women ascertained on the basis of recurrent spontaneous abortion or chromosomally abnormal pregnancies

An increase in extremely skewed X-chromosome inactivation (XCI) (> or = 90%) among women who experienced recurrent spontaneous abortion (RSA) has been previously reported. To further delineate the etiology of this association, we have evaluated XCI status in 207 women who experience RSA. A significant excess of trisomic losses was observed among the women who had RSA with skewed XCI versus those without skewed XCI (P=.02). There was also a significant excess of boys among live births in this group (P=.04), which is contrary to expectations if the cause of skewed XCI was only that these women carried X-linked lethal mutations. To confirm the association between skewed XCI and the risk of trisomy, an independent group of 53 women, ascertained on the basis of a prenatal diagnosis of trisomy mosaicism, were investigated. Only cases for which the trisomy was shown to be of maternal meiotic origin were included. The results show a significantly higher level of extreme skewing (> or = 90%) in women whose pregnancies involved placental trisomy mosaicism (17%) than in either of two separate control populations (n=102 and 99) (P=.02 compared with total control subjects). An additional 11 cases were ascertained on the basis of one or more trisomic-pregnancy losses. When all women in the present study with a trisomic pregnancy (n=103) were considered together, skewed XCI was identified in 18%, as compared with 7% in all controls (n=201) (P=.005). This difference was more pronounced when a cutoff of extreme skewing of 95% was used (10% vs. 1.5% skewed; P=.002). Maternal age was not associated with skewing in either the patient or control populations and therefore cannot account for the association with trisomy. Previous studies have shown that a reduced ovarian reserve is associated with increased risk of trisomic pregnancies. We hypothesize that the association between skewed XCI and trisomic pregnancies is produced by a common mechanism that underlies both and that involves a reduction of the size of the follicular pool.

An overview of insecticide resistance

Insecticide resistance poses a serious threat to current malaria control efforts. The Anopheles gambiae genome will enable identification of new resistance genes and will provide new molecular targets for the design of more effective insecticides.

Pain management 2: the use of pyschological approaches to pain

This article is the second of a two-part series looking at the psychological and social factors which affect pain perception. The first article (Vol 10(14): 903-11) examined neurophysiological and psychological factors of pain perception. This article considers the importance of the nurse-patient interaction in the management of patients' pain. It outlines the adoption of several psychological approaches which could be utilized by nurses when dealing with patients in pain. The need to encourage a feeling of control over pain is discussed in relation to the use of patient-controlled analgesia and the development of positive coping skills. The value of good communication skills is emphasized as being essential in encouraging patients in pain to utilize these psychological approaches.

Pain management 1: psychological and social aspects of pain

This two-part article presents psychological and social factors which affect pain perception and response and the implications of these for nursing practice. In this article, the complex interactions between neurophysiological and psychological factors are outlined and theories of pain perception and ways in which the pain experience can be modulated are presented. The role of psychological factors, attitudes, beliefs and expectations of both patient and practitioner, pain behaviours and ability to cope are discussed. In the second part, these are further elaborated with particular reference to the nurse-patient interaction. The use of psychological approaches to augment clinical practice, such as education, reduction of anxiety and improving coping ability, are suggested. Finally, the importance of communication skills in pain management is addressed.

Cell transplantation as future therapy for cardiovascular disease?: A workshop of the National Heart, Lung, and Blood Institute

Despite the development of improved therapies and the significant advances in the understanding of the basis of disease pathogenesis, millions of Americans continue to live with life-threatening cardiovascular diseases. Recent breakthroughs suggest exciting directions that are likely to produce more effective therapies for the treatment of cardiovascular disease. One such area, cell transplantation (grafting of healthy cells into the diseased heart), holds enormous potential as an approach to cardiovascular pathophysiology. Once thought to be a scientific long shot, cell transplantation is becoming recognized as a viable strategy to strengthen weak hearts and limit infarct growth. The technology could also be used for the long-term delivery of beneficial recombinant proteins to the heart, which is a strategy to complement molecular biology advances and provide an alternative strategy for gene therapy. On August 24, 1998, the National Heart, Lung, and Blood Institute convened a workshop to discuss the current status of this fast-moving line of research and to explore its promise for treating cardiovascular disease. The participants included basic and clinical researchers, with representatives from academic and commercial research settings. The workshop was designed to establish the state-of-the-art and to equate current research with practical clinical application. The group recommended short- and long-term goals to assist in realizing, in the most expedient manner, the potential utility of cell transplantation for the treatment of cardiovascular disease. A summary of the meeting discussions and recommendations for future areas of research is presented.

Inhibition of multiple phases of human immunodeficiency virus type 1 replication by a dithiane compound that attacks the conserved zinc fingers of retroviral nucleocapsid proteins

The human immunodeficiency virus type 1 (HIV-1) nucleocapsid p7 protein contains two retrovirus-type zinc finger domains that are required for multiple phases of viral replication. Chelating residues (three Cys residues and one His residue) of the domains are absolutely conserved among all strains of HIV-1 and other retroviruses, and mutations in these residues in noninfectious virions. These properties establish the zinc finger domains as logical targets for antiviral chemotherapy. Selected dithiobis benzamide (R-SS-R) compounds were previously found to inhibit HIV-1 replication by mediating an electrophilic attack on the zinc fingers. Unfortunately, reaction of these disulfide-based benzamides with reducing agents yields two monomeric structures (two R-SH structures) that can dissociated and no longer react with the zinc fingers, suggesting that in vivo reduction would inactivate the compounds. Through an extensive drug discovery program of the National Cancer Institute, a nondissociable tethered dithiane compound (1,2-dithiane-4,5-diol, 1,1-dioxide, cis; NSC 624151) has been identified. This compound specifically attacks the retroviral zinc fingers, but not other antiviral targets. The lead compound demonstrated broad antiretroviral activity, ranging from field isolates and drug-resistant strains of HIV-1 to HIV-2 and simian immunodeficiency virus. The compound directly inactivated HIV-1 virions and blocked production of infectious virus from cells harboring integrated proviral DNA. NSC 624151 provides a scaffold from which medicinal chemists can develop novel compounds for the therapeutic treatment of HIV infection.

Genesis, a winged helix transcriptional repressor with expression restricted to embryonic stem cells

A novel member of the winged helix (formerly HNF-3/Forkhead) transcriptional regulatory family, termed Genesis, was isolated and characterized. Putative translation of the complete cDNA revealed the winged helix DNA binding domain to be centrally located within the protein, with regions on either side that contain known transcriptional regulatory motifs. Extensive Northern analysis of Genesis found that the message was exclusively expressed in embryonic stem cells or their malignant equivalent, embryonal carcinoma cells. The Genesis transcript was down-regulated when these cells were stimulated to differentiate. DNA sequences that Genesis protein would interact with were characterized and were found to contain a consensus similar to that found in an embryonic stem cell enhancer sequence. Co-transfection experiments revealed that Genesis is a transcriptional repressor. Genesis mapped to mouse chromosome 4 in a region syntenic with human chromosome 1p31, a site of nonrandom abnormalities in germ cell neoplasia, neuroblastoma, and acute lymphoblastic leukemia. Genesis is a candidate for regulating the phenotype of normal or malignant embryonic stem cells.

Factors influencing nurses' analgesia decisions

The first article in this two-part series (Vol 5(13): 778-84) presented an empirical study of nurses' and patients' pain following surgery. Results indicate that nurses give consistently lower pain ratings for patient's pain than do patients. The main implication of this research is that nurses continue to underestimate the severity of pain suffered by patients postoperatively. This article considers a second empirical study, the objectives of which were to determine which methods nurses use to assess and monitor pain relief and which factors influence their decision to give or withhold analgesia. Results reveal that while nurses claim to rely on patients' self-reports of pain, the most influential factors in the decision whether or not to give analgesia are the dosage, type and frequency of drug prescribed. The main reason for withholding analgesia is that the patient reacted adversely to the medication. Student nurses placed more emphasis than trained nurses on the timing and amount of analgesia given. Nurses had a good knowledge of pain assessment tools, although few had used them.

Are nurses still underestimating patients' pain postoperatively?

This article presents an empirical study of nurses' and patients' assessment of patients' pain following surgery. The study aimed to replicate and extend previous research which indicated that nurses tend to underestimate patients' pain. The independent variables were type of operation, patient gender, time since surgery and nurses' experience. Results confirmed that nurses give consistently lower pain ratings than patients. The prediction that nurses' pain ratings would be influenced by the type of operation was not confirmed. Not surprisingly, pain ratings were lower on day four than on day one. The data failed to confirm previous findings that the more junior the nurses the greater pain they infer in their patients. The main conclusion of this research is that nurses continue to underestimate the severity of pain suffered by patients postoperatively.

An elaborate tension receptor system highlights sensory complexity in the hind leg of the locust

The tibia of each leg of the locust is moved by two antagonistic muscles, the extensor and flexor tibiae. A variety of sense organs on and in each leg provide feedback about this joint's position and movement and about forces acting on the exoskeleton and muscles. One such organ is a muscle tension receptor found within the flexor tibiae muscle of the mesothoracic leg. We now show that an apparently homologous multipolar receptor is present in the hind leg, but that here it is associated with a specialised flexor muscle, the accessory flexor. This muscle comprises 13 fibres, innervated by five of the thirteen motor neurones that innervate the main flexor muscle and, since these are slow motor units, the response properties of the receptor are constrained. The multipolar receptor attaches to the muscle fibres near their proximal insertion onto the femoral cuticle. It generally has four primary dendrites, which do not branch extensively within the muscle. We show that the receptor responds strongly to active, isometric contractions but only poorly to imposed changes of accessory flexor muscle length (i.e. passive changes in tibial position). It does not respond to tension generated by the main flexor muscle or by the extensor muscle. The tension receptor causes short-latency (0.9­1.8 ms) excitatory inputs onto the three common inhibitory motor neurones and longer-latency (3.7­8.1 ms) inhibitory inputs onto the slow extensor tibiae motor neurone. In quiescent animals, it causes excitatory inputs onto flexor tibiae motor neurones (2.2­3.8 ms) but, in more active animals, its inputs onto these neurones are often inhibitory, with delays of 6­10 ms. The slow nature of the accessory flexor muscle and the pattern of central connections of the receptor suggest that together they are involved in the control of slow movements or posture, potentially acting through a servomechanism.

THE POSITION-DEPENDENT NATURE OF POSTURAL RESISTANCE REFLEXES IN THE LOCUST

The resistance reflexes of tibial extensor and flexor muscles, of all six legs in the locust, show changes in gain at different femur­tibia angles (FTA). In all muscles the gain is high for small angles (near full flexion) and low for large angles (near full extension, approximately 160 °). An exception occurs in the mesothoracic flexor muscle, which shows two modes: one as above and another in which maximum gain occurs at 100­120 ° FTA. The position-dependent character is evident at each stage of the reflex pathway: motor neurone, non-spiking interneurone and femoral chordotonal organ (the afferent source of the reflex). We conclude that position-dependency originates from a decrease in the number of phasic femoral chordotonal organ neurones sensitive to joint movement as larger FTAs are approached. Position-dependency is only roughly correlated with the postural FTAs most commonly observed in the meso- and metathoracic legs of unrestrained resting locusts; no such correlation was evident for prothoracic legs. We propose that the major role of position-dependency is to allow resistance reflexes efficiently to counter torque introduced onto the femur­tibia joint by perturbations in the horizontal plane when the insect rests on a horizontal substratum and in the vertical plane when it rests on a vertical substratum.

Correlates of nonadherence to hypertension treatment in an inner-city minority population

OBJECTIVE

Adherence to treatment is a key factor in achieving blood pressure control among hypertensives. We examined correlates of nonadherence to hypertension treatment in an inner-city minority population.

METHODS

Subjects (n = 202) were interviewed as part of a case-control study of severe, uncontrolled hypertension conducted in two New York City hospitals in 1989-91. All subjects were African American or Hispanic. Self-reported nonadherence to drug treatment for hypertension was measured using a five-item scale, and the sample was dichotomized as more (n = 87) or less (n = 115) adherent. Multiple logistic regression analysis was used to adjust for demographic and other covariates.

RESULTS

Nonadherence was associated with having blood pressure checked in an emergency room (adjusted odds ratio [OR] = 7.9; 95% confidence interval [CI] = 1.75, 35.77; P < .01), lack of a primary care physician (adjusted OR = 2.9; 95% CI = 1.37, 6.02; P < .01), current smoking (adjusted OR = 2.4; 95% CI = 1.10, 5.22; P = .03), and younger age (adjusted OR = 1.03, 95% CI = 1.00, 1.06; P = .03).

CONCLUSIONS

Changing the locus of care for hypertension from emergency rooms to primary care physicians may improve adherence to hypertension treatment in minority populations.

Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population

BACKGROUND

Hypertensive emergency and urgent hypertension are the most severe forms of uncontrolled hypertension and are now seen predominantly in poor, minority populations. We studied the characteristics of the medical care received by patients with these conditions in order to identify risk factors for severe, uncontrolled hypertension.

METHODS

Using a case-control study design, we interviewed 93 patients with severe, uncontrolled hypertension who presented in the hospital emergency room and 114 control patients with hypertension; both groups were seen at two New York City hospitals from 1989 through 1991. All the patients were black or Hispanic. Multiple logistic-regression models were used to adjust for age, sex, race or ethnic background, education, smoking status, alcohol-related problems, and use of illicit drugs during the previous year.

RESULTS

After additional adjustment for lack of health insurance, severe, uncontrolled hypertension was found to be more common among patients who had no primary care physician (adjusted odds ratio, 3.5; 95 percent confidence interval, 1.6 to 7.7) and among those who did not comply with treatment for their hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 1.4 to 2.5). Lack of health insurance was marginally associated with severe, uncontrolled hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 0.8 to 4.6) after adjustment for lack of a primary care physician and noncompliance with antihypertensive treatment. Patients without a primary care physician and without health insurance were more likely to have their blood pressure checked and receive prescriptions for blood-pressure medications in emergency rooms than in physicians' offices or clinics.

CONCLUSIONS

Characteristics of both the health care system and patients' behavior are associated with severe, uncontrolled hypertension. Improving access to primary care physicians, through health insurance or other means, may be an effective strategy for improving control of hypertension in disadvantaged minority populations.

The effects of common movement and spatial separation on position- and motion-based judgements of relative movement

When common movement is superimposed on relative movement (changes in separation between two dots), relative movement thresholds increase nonlinearly as a function of initial dot separation. For large separation (greater than 2.0 deg), thresholds increase gradually with increased separation. It is shown that this reflects judgments based on perceived relative motion. For small separations (less than 2.0 deg), thresholds increase sharply with increased separation. It is shown that this reflects judgments based on perceived changes in relative position. Evidence is presented that superimposed common movement reduces sensitivity to relative movement by reducing sensitivity to relative motion. This provides a "window", in the range of small dot separations, for relative movement judgements to be based on the perception of changes in relative position, even though motion is perceived for individual dots.

Coadministration of dimethyl sulfoxide reduces cisplatin nephrotoxicity

The administration of dimethyl sulfoxide with cisplatin at a mole ratio of 200:1 results in a considerable reduction in the nephrotoxicity produced when cisplatin alone is administered to Sprague-Dawley rats at 7.5 mg/kg. Observed measures of nephrotoxicity which were significantly improved by the coadministration of cisplatin and DMSO over the values found for cisplatin alone include BUN, serum creatinine, creatinine clearance and histopathological evidence of renal damage. The weight loss associated with cisplatin administration was also significantly reduced by DMSO coadministration. The use of DMSO did not result in any observable loss in antitumor activity of cisplatin against the Walker 256 carcinosarcoma.

Evidence for the abstractive encoding of superficial position information in visual patterns

When presented a series of patterns inside a frame, subjects unintentionally retained information concerning the frame-relative location of the elements composing the patterns; they could use this superficial information to estimate the frequency with which the elements occurred at various locations within the frame. There were two aspects of the results that supported the hypothesis that this superficial element-location information was abstractively encoded and, therefore, retrievable independent of the patterns comprising the elements: (1) Correlations between actual and estimated frequency remained significant after the effects of pattern recall were partialled out, and (2) correlations were enhanced by assuming that the frequency estimate for each location was affected by the imprecise coding of position for elements falling in surrounding locations. Additional experiments indicated that an orienting task emphasizing pattern recall resulted in very inaccurate estimation of element-location frequency, and intentional instructions improved the precision of position coding for individual elements.

Potential antiradiation drugs containing no nitrogen, and related compounds

Capabilities are reported of di- and higher sulfides (RSnR') terminated by sulfinate functions [-S(O)O-] for protecting mice against otherwise lethal effects of ionizing radiation. With the use of congeners, structure-activity correlations are developed for the effects of esterification of the sulfinate function, of changing the length of the chain of sulfur atoms, of reduction to a mercapto sulfinate, and of changing the substituents R and R' to chiral and other types of groups. Neither a trisulfide nor a sulfinate by itself was significantly radioprotective. The key requirement for radio-protection in the series appears to be the presence of a sulfur function (-Sn-) from which a thiol can be engendered by a neighboring-group effect of an electron-donating group; sulfoxide functions may afford alternatives to sulfinate functions as such neighboring groups. The relevance of structure-activity relations to the chemical and biological mechanisms involved in the radioprotective activities is discussed.

A linkage analysis of the Gm locus and multiple sclerosis

We conducted linkage analyses of immunoglobulin G heavy chain marker (Gm) phenotypes and multiple sclerosis (MS) in 30 families, each having at least two first-degree relatives with definite/probable MS. These families yielded positive evidence for linkage to human leukocyte antigen (HLA) loci in previous analyses. In the present analysis, however, the results for Gm were negative. Most lod scores were negative, particularly at the smaller recombination values (theta). We explored the possibility of heterogeneity by subgrouping our data on the basis of specific HLA types (A3, B7) and Gm types (Gm1, Gm1,2) within the pedigrees. The results were again negative with no substantial differences in estimates of theta between subgroups.

Mutagenic and cell transformation activities of representative phosphorothioate esters in vitro

Five alkyl and five aryl phosphorothioates are ranked relative to parathion in effectiveness as base-pair mutagens in the Ames mutagenic assay. Three in each series were mutagenic. Two commercial insecticidal phosphates, included for comparison, were mutagenic. The mutagenic phosphorothioates contained a strong electron-withdrawing and/or a good leaving group, together with two other groups small enough to permit nucleophilic attack by a biomacromolecule on the electrophilic phosphorus atom. All but one of the phosphorothioates [i.e., O,O,O-tris(2,2,2-trifluoro)ethyl phosphorothioate, VI] required metabolic activation for mutagenicity to be manifested; hence most of the phosphorothioates per se evidently are not ordinarily sufficiently electrophilic to be mutagenic but must instead be transformed to more electrophilic oxygen-containing products. In evaluation for cell-transformation properties, methyl parathion was inactive, in contrast to VI. The phosphorothioates that were novel were synthesized by formation of the phosphite from the appropriate alcohol or phenol, followed by reaction of the phosphite with sulfur.