Is neonatal neurological damage in the delivery room avoidable? Experience of 33 levels I and II maternity units of a French perinatal network

OBJECTIVE

To determine the frequency of avoidable neonatal neurological damage.

STUDY DESIGN

We carried out a retrospective study from January 1st to December 31st 2003, including all children transferred from a level I or II maternity unit for suspected neurological damage (SND). Only cases confirmed by a persistent abnormality on clinical examination, EEG, transfontanelle ultrasound scan, CT scan or cerebral MRI were retained. Each case was studied in detail by an expert committee and classified as "avoidable", "unavoidable" or "of indeterminate avoidability." The management of "avoidable" cases was analysed to identify potentially avoidable factors (PAFs): not taking into account a major risk factor (PAF1), diagnostic errors (PAF2), suboptimal decision to delivery interval (PAF3) and mechanical complications (PAF4).

RESULTS

In total, 77 children were transferred for SND; two cases were excluded (inaccessible medical files). Forty of the 75 cases of SND included were confirmed: 29 were "avoidable", 8 were "unavoidable" and 3 were "of indeterminate avoidability". Analysis of the 29 avoidable cases identified 39 PAFs: 18 PAF1, 5 PAF2, 10 PAF3 and 6 PAF4. Five had no classifiable PAF (0 death), 11 children had one type of PAF (one death), 11 children had two types of PAF (3 deaths), 2 had three types of PAF (2 deaths).

CONCLUSION

Three quarters of the confirmed cases of neurological damage occurring in levels I and II maternity units of the Aurore network in 2003 were avoidable. Five out of six cases resulting in early death involved several potentially avoidable factors.

Expression profiling of the Arabidopsis annexin gene family during germination, de-etiolation and abiotic stress

Annexins are a multigene family in most plant species and are suggested to play a role in a wide variety of essential cellular processes. In Arabidopsis thaliana there are eight different annexins (AnnAt1-8), which range from 29% to 83% in deduced amino acid sequence identity. As a first step toward clarifying the individual functions of these annexins, in this study we have used quantitative real time reverse transcription PCR to assess their differential expression in different tissues or after different stimuli. We determined which annexins are expressed during germination and early seedling growth by assaying annexin expression levels in dry and germinating seeds and in 7-day-old light-grown seedlings. Our results indicate that transcripts for all eight annexins are present in germinating seeds and that transcript levels for all the annexins increase by 7 days of normal growth. We assayed transcript levels in dark grown roots, cotyledons, and hypocotyls and found that the relative abundance of each annexin varied in these dark-grown tissues. We also examined the effects of red and far red light treatments on annexin expression in 5.5-day-old etiolated seedlings. Light treatments significantly altered transcript levels in hypocotyls and cotyledons for only two members of the gene family. Finally, we monitored annexin expression changes in response to a variety of abiotic stresses. We found that the expression of most of the Arabidopsis annexin genes is differentially regulated by exposure to salt, drought, and high- and low-temperature conditions, indicating a likely role for members of this gene family in stress responses.

PCDD/F and PCB concentrations in Arctic ringed seals (Phoca hispida) have not changed between 1981 and 2000

Concentrations of polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDF) and of non-ortho-, mono-ortho- and di-ortho-substituted polychlorinated biphenyls (NO-CB, MO-CB and DO-CB) were measured in blubber of ringed seals sampled at Holman, NWT, in 1981, 1991, 1996 and 2000. Total PCDD and PCDF concentrations were usually below approx. 10 and 5 pg/g wet wt., respectively, and did not change significantly between 1981 and 2000, although there were sporadic temporal differences in some congeners. Total NO-CB, MO-CB and DO-CB concentrations were below approx. 1 ng/g, 250 ng/g and 1 microg/g wet wt. respectively; none of the total PCB concentrations changed significantly over the sampling period. Neither PCDD nor PCDF concentrations differed between males and females, nor did they increase with age in male samples. MO-CB and DO-CB concentrations increased with age in males, but not in females, and concentrations of total MO-CB and DO-CB were usually lower in females than in males. Changes in the distribution of PCB congeners between the 1980s and the 1990s are consistent with atmospheric transport processes becoming increasingly important in the introduction of PCBs to the Arctic in recent years.

Genetic diversity of Frankia microsymbionts from the relict species Myrica faya (Ait.) and Myrica rivas-martinezii (S.) in Canary Islands and Hawaii

In the Western Canary Islands, Myrica faya and Myrica rivas-martinezii (Myricaceae) are phylogenetically close, endemic, actinorhizal species presumed to be remnants either of the European or the African Tertiary floras. Unisolated Frankia strains from field-collected nodules on Tenerife, Gomera, and La Palma Islands were compared by their rrs gene and 16S-23S intergenic spacer (IGS) restriction patterns. To compare the genetic diversity of Frankia strains from within and outside the host's native range, nodules of M. faya field plants were collected both in Canary Islands and in Hawaii, where this species is an exotic invasive. Myrica rivas-martinezii, endemic to the Canary Islands, was sparsely nodulated in the field. Frankia strains harbored in field-collected nodules of M. faya and M. rivas-martinezii belonged to the Elaeagnaceae strains' genetic cluster and exhibited a high degree of diversity. Frankia genotypes were specific to each host species. In the Canary archipelago, we found no relationship between site of collection and Frankia genotype for M. faya. The only exceptions were strains from site 2 in Tenerife, a location with a geological history different from the other sites sampled. Hawaiian and Canarian M. faya strains had no genotypes in common, raising questions concerning the origin of M. faya-infective Frankia in Hawaii. Nodular strains of M. rivas-martinezii from nursery plants were genetically characterized and shown to be divergent from the strains of field-collected nodules and belong to the Alnus-Casuarina strains cluster. This suggests Myrica may have the potential to nodulate with a broader range of Frankia genotypes under artificial conditions than has been detected in field-collected nodules.

Evolutionary perspective on annexin calcium-binding domains

Molecular systematic analysis of the annexin gene superfamily characterized the evolutionary origin, frequency and range of structural variation in calcium interaction domains that are considered intrinsic for membrane targeting and ion channel function. Approximately 36% of annexin repeat domains in an estimated 100 distinct subfamilies contained amino acid changes consistent with the functional loss of type two calcium-binding sites. At least 11% of annexin domains contained a novel K/H/RGD motif conserved in particular subfamilies and manifest in all phyla, apparently via convergent evolution. The first yeast annexin from Yarrowia lipolytica was classified in the ANXC1 subfamily with fungal and mycetozoan representatives. This clade had intact calcium-binding sites but disruption of the normally well-conserved, mid-repeat 4 region implicated in calcium channel regulation. Conversely, a tandem pair of novel annexins from the amphioxus Branchiostoma floridae resembled annexin A13 in gene structure and conserved the charged amino acids associated with the internal hydrophilic pore, but were devoid of external type 2 calcium-binding sites and incorporated K/RGD motifs instead, like annexin A9. The selective erosion of calcium-binding sites in annexin domains and the occurrence of alternate ligands in the same exposed, interhelical loops are pervasive features of the superfamily. This suggests greater complexity than previously appreciated in the mechanisms controlling annexin membrane interaction and calcium channel operation.

Nodular symbionts ofShepherdia,Alnus, andMyricafrom a sand dune ecosystem: trends in occurrence of soilborneFrankiagenotypes

A successional sand dune system along the Lake Michigan shoreline was chosen to study the impact of edaphic factors, vegetation cover, and topographic position on Frankia strain distribution and infectivity. On this site, three actinorhizal species, Myrica gale L., Alnus incana (L.) Moench subsp. rugosa (Du Roi) Clausen, and Shepherdia canadensis (L.) Nutt., grew in different communities. Soil samples were collected on plots devoid of actinorhizal plants and serially diluted to inoculate the three native host plants in a greenhouse study. Strains present in the nodules formed were then genetically characterized using PCR-RFLP of the 16S–23S intergenic spacer (IGS). An additional study site was included to estimate the impact of the sympatric presence of the three host species on soil infectivity and strain diversity. On this second site, soils used as inocula were collected in the rhizosphere of M. gale and S. canadensis. The M. gale and A. incana nodular strains belonged to an homogeneous cluster, whereas the S. cana densis nodular strains were separated into two distinct genetic clusters, irrespective of edaphic conditions and proximity to the host's root systems. A χ2analysis conducted on Shepherdia-infective strains showed the dominance of two distinct genotypes, with one of them being specific to newly formed dunes lacking plant cover and the other specific to older, stable dunes with dense vegetative cover.Key words: Frankia, Myrica, Shepherdia, Alnus, IGS 16S–23S, sand dunes.

PCB and PCDD/F totals, TEQs, and congener patterns in Korean coastal marine environments, 1987, 1988, 1990, and 1996-1999

Various mussel and oyster samples and select top sediment samples were taken over 27 industrial and pristine coastal sites form South Korea's west, south, and east coasts. Site-specific total PCB, PCDD/F, and organochlorine TEQ levels in biota were 1-306 ng/g ww, 3-9,400 pg/g ww, and 0.3-200 pg/g ww, respectively. Temporal trends showed a general decrease in total TEQ with an increase in TEQ contribution by PCDD/Fs at most locations over the past decade. Linear regression was used to establish a relationship between each contaminant total and the respective TEQ contribution. Principal component analysis was used to model the congener-specific PCB and PCDD/F data, and two three-component models were developed that describe the congener-specific patterns based on the variance between samples over the entire data set. Unique PCDD/F patterns were identified and discussed with respect to outliers identified in the previously established TEQ regressions and a distinct PCDD/F pattern was found that related to a single industrial source (i.e., steel mill). PCB patterns were explored in relation to those of common commercial mixtures of PCBs (i.e., Aroclors) and patterns were discussed with respect to TEQ. It was found that sites with relatively high PCB-TEQs showed an Aroclor 1254-like contamination.

Functional analysis of the human annexin A5 gene promoter: a downstream DNA element and an upstream long terminal repeat regulate transcription

Human annexin A5 is a ubiquitous protein implicated in diverse signal transduction processes associated with cell growth and differentiation, and its gene regulation is an important component of this function. Promoter transcriptional activity was determined for a wide 5' portion of the human annexin A5 gene, from bp -1275 to +79 relative to the most 5' of several discrete transcription start points. Transfection experiments carried out in HeLa cells identified the segment from bp -202 to +79 as the minimal promoter conferring optimal transcriptional activity. Two canonical Sp1 sites in the immediate 5' flanking region of a CpG island were required for significant transcription. Strong repressive activity in the distal promoter region between bp -717 to -1153 was attributed to the presence of an endogenous retroviral long terminal repeat, homologous with long terminal repeat 47B. The downstream sequence from bp position +31 to +79 in untranslated exon 1 was also essential for transcription, as its deletion from any of the plasmid constructs abolished activity in transfection assays. Electrophoretic mobility-shift assays, Southwestern-blot analysis and affinity chromatography were used to identify a protein doublet of relative molecular mass 35 kDa that bound an octanucleotide palindromic sequence in exon 1. The DNA cis-element resembled an E-box, but did not bind higher molecular mass transcription factors, such as upstream stimulatory factor or activator protein 4. The discovery of a downstream element crucial for annexin A5 gene transcription, and its interaction with a potentially novel transcription factor or complex, may provide a clue to understanding the initiation of transcription by TATA-less, multiple start site promoters.

Gas chromatography-mass spectrometry method for the simultaneous determination of wood extractive compounds in quaking aspen

We have developed a rapid gas chromatography-mass spectrometry (GC-MS) method for the detailed compositional analysis of 70 underivatized wood extractive components present in quaking aspen (Populus tremuloides Michx.). Forty-four compounds were unequivocally identified by retention time and mass spectral comparison with standards. An additional 26 chromatographic peaks were assigned to broad chemical classes using retention time and mass spectra features. The results were compared to the respective tert.-butyldimethylsilyl derivatized wood extractives profile, and it was determined that derivatization was unnecessary for the GC-MS analysis of the target compounds.

Diversity and specificity of Frankia strains in nodules of sympatric Myrica gale, Alnus incana, and Shepherdia canadensis determined by rrs gene polymorphism

The identity of Frankia strains from nodules of Myrica gale, Alnus incana subsp. rugosa, and Shepherdia canadensis was determined for a natural stand on a lake shore sand dune in Wisconsin, where the three actinorhizal plant species were growing in close proximity, and from two additional stands with M. gale as the sole actinorhizal component. Unisolated strains were compared by their 16S ribosomal DNA (rDNA) restriction patterns using a direct PCR amplification protocol on nodules. Phylogenetic relationships among nodular Frankia strains were analyzed by comparing complete 16S rDNA sequences of study and reference strains. Where the three actinorhizal species occurred together, each host species was nodulated by a different phylogenetic group of Frankia strains. M. gale strains from all three sites belonged to an Alnus-Casuarina group, closely related to Frankia alni representative strains, and were low in diversity for a host genus considered promiscuous with respect to Frankia microsymbiont genotype. Frankia strains from A. incana nodules were also within the Alnus-Casuarina cluster, distinct from Frankia strains of M. gale nodules at the mixed actinorhizal site but not from Frankia strains from two M. gale nodules at a second site in Wisconsin. Frankia strains from nodules of S. canadensis belonged to a divergent subset of a cluster of Elaeagnaceae-infective strains and exhibited a high degree of diversity. The three closely related local Frankia populations in Myrica nodules could be distinguished from one another using our approach. In addition to geographic separation and host selectivity for Frankia microsymbionts, edaphic factors such as soil moisture and organic matter content, which varied among locales, may account for differences in Frankia populations found in Myrica nodules.

Annexin A11 (ANXA11) gene structure as the progenitor of paralogous annexins and source of orthologous cDNA isoforms

The genomic organization of the annexin A11 gene was determined in mouse and human to assess its congruity with other family members and to examine the species variation in alternative splicing patterns. Mouse annexin A11 genomic clones were characterized by restriction analysis, Southern blotting, and DNA sequencing, and the homologous human gene (HGMW-approved gene symbol ANXA11) was deciphered from high-throughput genomic sequence with coanalysis of expressed sequence tags. Exons 6-15 of the tetrad core repeat region differ from annexins A7 and A13 but are spliced identically to other phylogenetic descendents, making annexin A11 the putative primary progenitor of up to nine paralogous human annexins. The 5' regions consist of untranslated exon 1, followed by an extensive intron 1 comprising almost half the total gene length of >40 kb, and additional GC-rich exons 2-5 encoding the proline- and glycine-rich amino-terminus. Distinct cDNA isoforms in cow and human were determined to be unique to each species and hence of dubious general significance for this gene's function. Multiple transcription start sites were revealed by primer extension analysis of the mouse gene, and transfection constructs containing the prospective promoter generated transcriptional activity comparable to that of the SV40 promoter. Internal repetitive elements and vicinal gene markers were mapped for the complete human annexin A11 gene sequence to characterize the surrounding genomic environment.

Cytomorphology of gastrointestinal stromal tumor: diagnostic role of aspiration cytology, core biopsy, and immunochemistry

Gastrointestinal stromal tumors (GISTs) comprise a heterogeneous group of neoplasms of the gastrointestinal tract previously referred to as leiomyomas, leiomyosarcomas, or schwannomas. GISTs derive from the interstitial cell of Cajal and, in addition to variable expression of smooth muscle and neural markers, they characteristically express CD34 and CD117. To our knowledge, the cytologic appearance of gastric neoplasms designated as GISTs has never been reported. We illustrate the fine-needle aspiration (FNA) cytology findings of a gastric stromal tumor having spindle cells with delicate cytoplasm and prominent nuclear palisading. Consistent core biopsy and immunochemistry findings further supported the diagnosis of GIST. Pathologic evaluation of the resected tumor confirmed the cytologic diagnosis. In the appropriate clinical and radiologic setting, a confident diagnosis of GIST can be established by FNA cytology and core biopsy. The roles of immunochemical stains and other ancillary techniques in reaching the correct diagnosis are addressed.

Cytomorphology of gastrointestinal stromal tumor: diagnostic role of aspiration cytology, core biopsy, and immunochemistry

Gastrointestinal stromal tumors (GISTs) comprise a heterogeneous group of neoplasms of the gastrointestinal tract previously referred to as leiomyomas, leiomyosarcomas, or schwannomas. GISTs derive from the interstitial cell of Cajal and, in addition to variable expression of smooth muscle and neural markers, they characteristically express CD34 and CD117. To our knowledge, the cytologic appearance of gastric neoplasms designated as GISTs has never been reported. We illustrate the fine-needle aspiration (FNA) cytology findings of a gastric stromal tumor having spindle cells with delicate cytoplasm and prominent nuclear palisading. Consistent core biopsy and immunochemistry findings further supported the diagnosis of GIST. Pathologic evaluation of the resected tumor confirmed the cytologic diagnosis. In the appropriate clinical and radiologic setting, a confident diagnosis of GIST can be established by FNA cytology and core biopsy. The roles of immunochemical stains and other ancillary techniques in reaching the correct diagnosis are addressed.

Novel human and mouse annexin A10 are linked to the genome duplications during early chordate evolution

We have identified and characterized a 12th subfamily of vertebrate annexins by systematic analysis of the primary structure, chromosomal mapping, and molecular evolution of unique cDNA and protein sequences from human and mouse. Distinctive features included rare expression, a codon deletion in conserved repeat 3, and an unusual ablation of the type II calcium-binding sites in tetrad core repeats 1, 3, and 4. The paralogy of novel annexin A10 (following revised nomenclature) was confirmed by FISH-mapping human ANXA10 to chromosome 4q33 and genetic linkage mapping mouse Anxa10 to midchromosome 8. Phylogenetic analysis established that the 5' and 3' halves of the annexin A6 octad are more closely related to annexins A5 and A10, respectively, than they are to each other. Molecular date estimates, paralogy linkage maps between human chromosomes 4 and 5, and annexin structural considerations led to the proposal that annexins A5 and A10 may have been the direct progenitors of annexin A6 octad formation via chromosomal duplication during the genome expansion in early chordates.

Human annexin 31 genetic mapping and origin

The cDNA encoding novel human annexin 31 was utilized for chromosomal mapping, structural comparison, and phylogenetic analysis to clarify its genetic relationship to other annexins. The ANX31 gene locus was mapped by fluorescence in situ hybridization to human chromosome 1q21, remote from ten other paralogous human annexins on different chromosomes but near the epidermal differentiation gene complex, the S100A gene cluster and a breast-cancer translocation region. Protein homology testing and characterization of incompletely processed expressed sequence tags identified annexin 2 as the closest extant homologue. Maximum likelihood analysis confirmed its most recent common ancestor with vertebrate annexin 2 and validated its classification, in order of discovery, as annexin 31. This subfamily was formed approx. 500-600millionyears ago, subsequent to the gene duplication that produced annexin 1. It has diverged relatively rapidly and extensively, and specifically in the well-conserved, functionally critical type II calcium-binding sites.

Mouse annexin V genomic organization includes an endogenous retrovirus

Mouse annexin V genomic clones were characterized by restriction analysis, Southern blotting and DNA sequencing. The entire gene spans close to 50 kb of the mouse genome and contains 14 exons ranging in size from 31 bp for exon 2 to 482 bp for exon 13 up to the polyadenylation site. Intron sizes range from 111 bp for intron 1b to more than 17 kb for intron 2. Non-coding exon 1 is present in two alternative forms separated by approx. 7.4 kb, and the two promoters associated with exons 1a and 1b are quite distinct. The upstream promoter has a TATA box and may direct the limited, tissue-specific expression of mRNA transcripts containing exon 1a. The downstream, TATA-less promoter has high G+C content, and exon 1b predominates among abundantly expressed mRNA species. The conservation of certain cis-elements, including Sp1, AP2, gamma-IRE and NF-IL6, in orthologous species of annexin V genes points to their possible role in trans-acting protein factor binding and gene regulation. Primer-extension analysis revealed multiple origins for transcription, with principal start sites 100-150 bp upstream of the ATG start codon in exon 2. Intron 4 was longer than that previously identified in the orthologous rat gene due to the integration of an apparently complete copy of the murine endogenous retrovirus element, MuERV-L. Phylogenetic analysis of annexin V from 12 species and the presence of neighbouring loci with paralogous counterparts linked to annexin VI pointed to the common ancestry of these genes via chromosomal duplication more than 600 million years ago.

Genetic complementation of rhizobial nod mutants with Frankia DNA: artifact or reality?

Two divergent reports have been published on the genetic complementation of rhizobial nod mutants using Frankia DNA. In 1991 putative Frankia cosmid library clones were reported to restore normal nodulation properties to Rhizobium leguminosarum biovar viciae nodD::Tn5, but no supporting sequence data were published. In 1992 a second group reported a failure to find any evidence of functional complementation of various rhizobial nod mutants by Frankia DNA (nodA, nodB and nodC). Complementation tests of nine NodR. leguminosarum bv. viciae or Sinorhizobium meliloti Tn5 mutants (nodA-, nodB-, nodC-, nodD-, nodF-, nodL-, nodH-) were thus performed using a Frankia gene library in pLAFR3 to clarify this situation. Rhizobial transconjugants obtained by tri-parental matings were screened for restoration of the nodulation phenotype on their host plants, Vicia sativa subsp. nigra or Medicago sativa. Nodulation was observed on plants inoculated with transconjugants of the R. leguminosarum bv. viciae nodC::Tn5 mutant. The Nod+ rhizobial transconjugants were isolated and analysed. The Nod+ phenotype of these transconjugants was found to be due to Tn5 excision/transposition. No functional complementation was found with any of the mutants used, suggesting that rhizobial complementation of nod mutants with Frankia DNA is unlikely to occur.

Expression profile and structural divergence of novel human annexin 31

Systematic analysis of expressed sequence tags in dbEST yielded an expression profile of the ten known human annexins and led to the discovery of a novel subfamily expressed mainly in differentiating tissues. Full-length cDNAs encoded a 338-amino acid protein with less than 40% identity to other annexins, an atypical amino acid composition, and an insertion and deletion in internal repeat 3. The most striking feature was a complete ablation of all four type II calcium-binding sites in the conserved tetrad core. Annexin 31 thus constitutes a unique, natural probe for investigating the role of membrane binding in annexin function.

Primary hepatic malignant neoplasms

Although metastatic disease is by far the most common form of neoplastic involvement of the liver, a variety of primary hepatic malignant neoplasms may develop from any of the cell types within the liver. Primary hepatic neoplasms include hepatocellular carcinoma, intrahepatic cholangiocarcinoma, biliary cystadenocarcinoma, and a variety of mesenchymal tumors. This article reviews the clinical presentation and pathology of these tumors and discusses their sonographic, CT scan, and MR imaging appearance.

Genomic locations of ANX11 and ANX13 and the evolutionary genetics of human annexins

We have reconstructed a molecular genetic history of human annexins to chronicle their origins and dispersal throughout the genome. This involved the completion of chromosomal mapping, determination of ancestral relationships, and estimation of gene duplication dates. Fluorescence in situ hybridization localized human annexin XI (ANX11) to 10q22.3-q23.1 and annexin XIII (ANX13) to 8q24.1-q24.2. Orthologous annexins showed minor rate variation when calibrated to species separation times given by the fossil record, but paralogous subfamilies have diverged at fivefold variable rates. The rates and extents of sequence divergence were used to predict a mean separation time of 450 million years between vertebrate annexins, although their common ancestor may have emanated from invertebrate stock. Annexins XIII and VII formed a phylogenetically early clade, and annexins II and VIa were the most divergent members of two distinct clades. ANX6 may have been created by tandem duplication about 500 million years ago (Mya) and duplicated again to form ANX5 400 Mya, whereas ANX4 and ANX8 are proposed to be sequential duplication products from annexin XI. Vertebrate annexins thus proliferated via a cascade of gene duplications in higher metazoa to form at least three diverging groups of ubiquitous and structurally related genes. These can be distinguished by their dispersed genomic locations as well as their individual patterns of expression and partially differentiated functions.

Sequence and chromosomal localization of mouse annexin XI

Mouse annexin XI (anx11)2 was cloned from a macrophage cDNA library and characterized by genetic linkage mapping, DNA sequencing, and structural comparison with other annexins. The Anx11 gene localized to mouse chromosome 14 in close linkage with the Rarb, Plau, and Wnt5a genes near the centromere and 1.8 cM distal from the Anx7 gene. The open reading frame was flanked by long, untranslated regions and encoded a 503-amino-acid protein with 93.1% identity to its human orthologue. Its 189-aa amino terminus corresponded to the widely expressed variant 1 of two possible, alternatively spliced forms. A previously described peptide from Aplysia brasiliana was identified as a closely related invertebrate homologue. Since annexin XI is known to be localized in the nucleus at certain stages of development, the identification of a region in tetrad repeats 3 and 4 resembling the "chromo box" domain may be relevant to a nuclear regulatory function of annexin XI. Knowledge of the mouse cDNA sequence and genetic map location will assist in the analysis of genomic organization and expression and provide a useful animal model to investigate gene function and hereditary phenotype for annexin XI.

Sinorhizobium medicae sp. nov., isolated from annual Medicago spp

The taxonomic position of isolates of a new genomic species (designated genomic species 2) obtained from several annual Medicago species and originating from different geographical locations was established through the results of phenotypic tests (including the results of auxanographic and biochemical tests and symbiotic properties) and 16S rRNA phylogenetic inferences. A comparison of the complete 16S rRNA sequence of a representative of genomic species 2 (strain A 321T [T = type strain]) with the 16S rRNA sequences of other members of the Rhizobiaceae and closely related taxa showed that genomic species 2 was phylogenetically related to Sinorhizobium meliloti, Sinorhizobium fredii, Sinorhizobium saheli, and Sinorhizobium teranga. The levels of sequence similarity and observed numbers of nucleotide substitutions in Sinorhizobium strains indicated that A 321T and S. meliloti exhibited the highest level of sequence similarity (99.7%), with four nucleotide substitutions and one deletion. The results of a numerical analysis based on data from 63 auxanographic and biochemical tests clearly separated genomic species 2 isolates from S. meliloti. Genomic species 2 isolates nodulated and fixed nitrogen with Medicago polymorpha, whereas S. meliloti isolates were ineffective and formed rudimentary nodules on this host plant. On the basis of phenotypic and 16S sequence analysis data, genomic species 2 isolates cannot be assigned to a previously described species. We propose that these isolates belong to a new species, Sinorhizobium medicae.

Insulin pump therapy: acceptable alternative to injection therapy

Initiation of insulin therapy is an exhilarating although anxiety-provoking experience for diabetic patients. It is, in a metaphysical sense, a time of rebirth. Patients are no longer victims of their diabetes but truly masters of it. No statement better illustrates how basic this change is than that of a patient who says, "What a difference it has made in my life to eat a meal because I want to, not because I have to." This article examines a means of insulin delivery that is growing in acceptance--insulin pump therapy.

Mouse annexin V chromosomal localization, cDNA sequence conservation, and molecular evolution

A full-length cDNA encoding mouse annexin V (ANX5) was cloned, sequenced, and utilized for chromosomal mapping. The gene lies on mouse chromosome 3 in close linkage with the fibroblast growth factor 2 (basic) gene and is syntenic with other genes known to have orthologous counterparts on human chromosome 4q. The open reading frame encoded a protein of 319 amino acids (aa), with 92-96% identity to ANX5 in other species. Internal repeat 3 of mouse ANX5 exhibited the highest level of nonconservative aa replacements with respect to other annexin subfamilies, but the greatest sequence conservation among ANX5 species members. This region may thus contain features that distinguish ANX5 from other annexins in properties or function. Phylogenetic analysis and homology testing of ANX5 members indicated that the 34-kDa annexin from Torpedo marmorata may also belong to this subfamily. Comparison of nine species of ANX5 led to an estimation of the unit evolutionary mutation rate at 1% aa replacements every 8 million years, comparable to other annexins.

Genomic heterogeneity of strains nodulating chickpeas (Cicer arietinum L.) and description of Rhizobium mediterraneum sp. nov

The genetic diversity of chickpea strains was studied by using 30 isolates obtained from nodules on chickpeas growing in uninoculated fields over a wide geographic range. The following taxonomic approaches were used: DNA-DNA relatedness analysis, restriction fragment length polymorphism analysis of the amplified 16S ribosomal DNA (rDNA) intergenic spacer (IGS), and total 16S rRNA sequence analysis. The division of chickpea-infective strains into two major phylogenetic groups (groups A and B) that has been described previously was confirmed by the polymorphism of the 16S IGS rDNA. We identified a total of five genomic species, including the previously described species Rhizobium ciceri. All of the group B strains except one were homogeneous and belonged to a single genomic species corresponding to R. ciceri. Group A was heterogeneous, containing three genomic species and five strains that remained unclassified, and its members had very different PCR restriction fragment length polymorphism profiles. The complete 16S rRNA sequences of strains representing the two major groups, R. ciceri UPM-Ca7T (T = type strain) and genomic species 2 strain UPM-Ca36T, exhibited 19 mismatches. Both of these strains belonged to the Rhizobium loti-Rhizobium huakuii branch; R. ciceri UPM-Ca7T was closely related to R. loti, and strain UPM-Ca36T was clearly separated from R. ciceri and closely related to R. huakuii. Thus, genomic species 2 could be distinguished from R. ciceri by its 16S rRNA sequence, by DNA relatedness data, by the polymorphism of the 16S IGS rDNAs, and by previously described multilocus enzyme electrophoresis results and phenotypic characteristics. Therefore, we propose that strains belonging to genomic species 2 should be classified in a new species, Rhizobium mediterraneum, and that strain UPM-Ca36 should be the type strain.

Eating disorders in India

Data on the nature and extent of major eating disorders, anorexia nervosa and bulimia is lacking in non-white, native populations of the developing world, leaving a gap in understanding the determinants of these disorders. In a study on 210 medical students examined by a two-stage survey method, 31 subjects were found to have distress relating to their eating habits and body size not amounting to criterion-based diagnosis of eating disorders. The characteristics of this eating distress syndrome are described in relation to the major eating disorders.

Nature and treatment of delusional parasitosis: a different experience in India

BACKGROUND

Delusional parasitosis has been described as a rare syndrome, often involving elderly women who respond poorly to treatment except to pimozide.

METHOD

Nineteen cases of delusional parasitosis given antipsychotic treatment other than pimozide were followed up and the responses assessed in a structured manner.

RESULTS

The frequency of the syndrome was higher than generally reported and the patients were younger and had been ill for a shorter period. There was good response to antipsychotic treatments using trifluoperazine, haloperidol, chlorpromazine, and electroconvulsive therapy, and 11 cases showed complete remission, five of them maintaining the recovery for more than 3 years.

CONCLUSIONS

Delusional parasitosis is not as rare as described: it does not need to be chronic, and can involve young patients. Antipsychotic treatments other than pimozide are equally effective in delusional parasitosis especially if the patients are young and seen early in the illness. The frequency and nature of the disorder observed could probably be due to regional cultural factors.

Rhizobium ciceri sp. nov., consisting of strains that nodulate chickpeas (Cicer arietinum L.)

The taxonomic status of 16 collection strains of chickpea (Cicer arietinum L.) rhizobia which were previously determined to belong to two groups (groups A and B) were compared with reference strains belonging to different genera and species of the family Rhizobiaceae. We used the following taxonomic, phylogenetic, and phenotypic characteristics and approaches to study these organisms: DNA homology, guanine-plus-cytosine content, restriction fragment length polymorphism of the amplified 16S-intergenic spacer rRNA gene, partial 16S rRNA sequencing, and auxanographic tests performed with 147 carbon sources. Similar groups of chickpea strains were identified by the different approaches. The chickpea strains were found to belong to the genus Rhizobium regardless of the phylogenetic group to which they belonged (group A or B). All strains fell into a tight cluster which included Rhizobium loti and Rhizobium galegae, and the group B strains were closely related to R. loti. An analysis of partial 16S ribosomal DNA sequences revealed identical nucleotide sequences for the slowly growing strains and fast-growing strains that were used as representatives of groups A and B, respectively, and these organisms fell into the Rhizobium-Agrobacterium lineage. When the sequences of these organisms were compared with the partial sequences of Rhizobium huakuii and R. loti, one- and two-nucleotide mismatches were observed, respectively, indicating that the chickpea rhizobia are closely related to these two species. The DNA-DNA hybridization data revealed that the chickpea rhizobia exhibited low levels of homology (less than 17%) to previously described Rhizobium and Bradyrhizobium species. Moreover, when we compared chickpea strains to R. loti and R. huakuii, the most closely related species as determined by the partial 16S rRNA sequence analysis, the homology values ranged from 21 to 52% and the delta Tm values were greater than 5 degrees C (delta Tm is the difference between the denaturation temperatures of the heterologous and homologous duplexes). These results confirmed that the rhizobia that nodulate chickpeas cannot be assigned to a previously described species. Within the chickpea rhizobia, the DNA homology values obtained when members of groups A and B were compared were less than 38%, indicating that the group A and group B organisms belong to different species. Furthermore, these organisms can be distinguished from each other by the results of phenotypic tests. We propose that the group B chickpea rhizobia should be assigned to a new species, Rhizobium ciceri; UPM-Ca7 is the type strain of R. ciceri.

Genotypic and phenotypic diversity of Rhizobium isolated from chickpea (Cicer arietinum L.)

The diversity of 16 strains of chickpea-infective rhizobia from various geographical origins was analysed using genotypic and phenotypic approaches. Multilocus enzyme electrophoresis was performed, and restriction fragment length polymorphisms of the amplified 16S + IGS (intergenic spacer) rRNA gene, assimilation of 147 carbon sources, antibiotic resistance, and tolerance to NaCl and extreme pH values and temperatures were tested. These approaches had different discriminating powers. Esterase polymorphisms gave a unique pattern for each strain, allowing this method to be used for strain fingerprinting. Genetic distances between strains were estimated. The three approaches used in this study yielded consistent results. They evidenced high heterogeneity among the strains, and made it possible to classify the strains into two clusters. Isozyme patterns for superoxide dismutase were particularly interesting, since they delineated the same two groups. The phenotypic tests clearly confirmed the existence of two genetic groups on the basis of 11 phenotypic characters. Owing to the large phylogenetic distance between the two groups of strains, the taxonomic status of chickpea-infective strains is discussed.

Comparison of contrast enhanced CT and Mn-DPDP enhanced MRI for detection of focal hepatic lesions. Initial findings

Twenty-nine patients with known or suspected focal hepatic disease were evaluated in a retrospective multi-institutional study comparing T1-weighted manganese (II) N,N'-dipyridoxylethylenediamine-N,N'-diacetate 5,5'-bis (phosphate) (DPDP) enhanced magnetic resonance imaging (MRI) with dynamic sequential bolus contrast enhanced computed tomography (DBCT) for the detection of focal liver lesions. The patients were divided into four dose groups, receiving 3, 5, 8, or 10 mumol/kg of Mn-DPDP, delivered either via intravenous bolus (0.25 ml/sec) or infusion (1 ml/sec). Each of three readers, with varying levels of expertise in interpreting hepatic MRI and CT studies, identified more lesions on the Mn-DPDP enhanced MRI than the contrast enhanced CT images. Mn-DPDP enhanced MRI depicted the presence of extensive metastatic disease not seen with DBCT in three patients with fatty liver. The most experienced MRI reader saw more lesions per patient on the Mn-DPDP enhanced MRI than with DBCT, while the opposite held true for the most experienced CT reader. The best single exam for detection of hepatic lesions may be determined by the experience of the reader.

Delusional parasitosis of body orifices - a cultural variant?

Predominant or specific involvement of the eyes, ears, nostrils, mouth, anus and urethra (the body orifices) has not previously been reported in the literature on delusional parasitosis. Their involvement in the cases reported here is discussed in the context of the Hindu religio-cultural belief system which attaches special significance to these organs in the personal quest for physical, mental and spiritual purity. The involvement of the ears, in particular, appears to be influenced by native healing methods.

Genomic heterogeneity among French Rhizobium strains isolated from Phaseolus vulgaris L

Levels of DNA relatedness between strains isolated from root nodules of Phaseolus vulgaris and reference strains of different Rhizobium species were determined by performing DNA-DNA hybridization experiments (S1 nuclease method). The nine strains examined were members of three genomic groups previously delineated by a restriction fragment length polymorphism analysis among strains isolated from P. vulgaris at different sites in France. In agreement with the results of the restriction fragment length polymorphism analysis, three genomic species were found. We confirmed that one of these species corresponded to Rhizobium leguminosarum since the strain examined was 100% related to the type strain of this species. The other two species were new genomic species which were less than 21% related to reference strains belonging to other Rhizobium species, including Rhizobium etli and Rhizobium tropici, and were 18% related to each other. As determined by an analysis of partial 16S ribosomal DNA sequences, each of the genomic species was found to belong to a lineage independent from the lineages of previously described Rhizobium species. Nevertheless, they were included in the group formed by the fast-growing Rhizobium species. Both genomic species 1 and genomic species 2 contained a majority of strains which were capable of nodulating both P. vulgaris and Leucaena leucocephala, like R. tropici. However, they also contained strains with a nodulation phenotype restricted to P. vulgaris, like R. leguminosarum bv. phaseoli and R. etli bv. phaseoli. Our data are the first evidence that in Europe species other than R. leguminosarum nodulate P. vulgaris.

Typing method for N2-fixing bacteria based on PCR-RFLP--application to the characterization of Frankia strains

DNA sequences of an intergenic spacer (IGS) and parts of genes in the nif cluster were amplified by the polymerase chain reaction (PCR) using two primers derived from nifD- and nifK-conserved sequences. The PCR products were cleaved by ten 4-base cutting restriction enzymes and the restriction patterns were used as fingerprints to type Frankia strains. The feasability of this PCR-RFLP method for typing Frankia strains was investigated on Frankia reference strains belonging mainly to the Elaeagnaceae infectivity group but also on new Frankia isolates and on other N2-fixing microorganisms. By modulating the stringency of the amplifications, we showed the method allowed to target either Frankia strains or the whole N2-fixing microbial community. DNA digestion patterns were used to estimate the sequence divergence between the Frankia nifD-K fragment. The estimated relationships deduced from these genotypic data correlated well with established Frankia taxonomic schemes.

rRNA gene restriction patterns as an epidemiological marker in nosocomial outbreaks of Staphylococcus aureus infections

rRNA gene restriction patterns (ribotyping) were compared with phage typing, serotyping, enterotoxins and exfoliatin production in the analysis of 26 Staphylococcus aureus strains isolated from two different nosocomial outbreaks. Total DNA was cleaved by EcoRI restriction endonuclease. After agarose gel electrophoresis and Southern transfer, the hybridization of the membranes was done with radiolabelled 16S rRNA gene from Bacillus subtilis inserted into a plasmid vector. Six to 13 fragments were visualized. A core of common fragments was discerned for all strains tested. A full correlation between ribotyping and conventional markers was observed in only one of the outbreaks studied. In both outbreaks, ribotyping proved helpful in characterizing otherwise untypable strains.

Enzyme polymorphism of Azorhizobium strains and other stem- and root-nodulating bacteria isolated from Sesbania rostrata

Relationships between bacterial groups nodulating Sesbania rostrata were evaluated through examination of electrophoretic polymorphism of esterases and metabolic enzymes. The following conclusions were drawn: (i) the differentiation of two genomic species within Azorhizobium strains and a group of non-identified strains (probably Rhizobium) was strongly supported by enzyme electrophoresis; (ii) esterases were more electrophoretically polymorphic than metabolic enzymes, since 35 and 11 electrophoretic types, respectively, were detected within the 57 strains studied; (iii) strains isolated from stem or root nodules were genetically very similar and could not be differentiated; (iv) six Azorhizobium strains isolated from plants growing in saline soils could not be grouped separately from the other strains, which might be attributed to the adaptation of azorhizobia to epiphytic conditions; and (v) a comparative study of esterase patterns of azorhizobia showed that strains isolated in the Philippines probably originated in northern Senegal, but did not reveal a clear separation between strains originating from northern and central Senegal.

Evidence that some Frankia sp. strains are able to cross boundaries between Alnus and Elaeagnus host specificity groups

Phenotypic and genotypic methods were used to prove the existence of Frankia strains isolated from an Elaeagnus sp. that are able to cross the inoculation barriers and infect Alnus spp. also. Repeated cycles of inoculation, nodulation, and reisolation were performed under axenic conditions. Frankia wild-type strain UFI 13270257 and three of its coisolates did exhibit complete infectivity and effectiveness on Elaeagnus spp. and Hippophaë rhamnoides and variable infectivity on Alnus spp. Microscopical observation of host plant roots showed that these strains are able to infect Alnus spp. by penetrating deformed root hairs. Reisolates obtained from nodules induced on monoxenic Alnus glutinosa, Alnus incana, and Elaeagnus angustifolia resembled the parent strains in host infectivity range, in planta and in vitro morphophysiology, isoenzymes, and nif and rrn restriction fragment length polymorphisms, thus fulfilling Koch's postulates on both host plant genera. Alnus and Elaeagnus group-specific polymerase chain reaction DNA amplifications, DNA-DNA hybridizations, and partial gene sequences coding for 16S rRNA provided evidence for the genetic uniformity of wild-type strains and their inclusion into one and the same genomic species, clearly belonging to the Elaeagnus group of Frankia species.

CT during arterial portography: diagnostic pitfalls

Computed tomography (CT) during arterial portography (CTAP) is an important technique for evaluating the liver before hepatic tumor resection. With this technique, most tumors are of low attenuation compared with that of enhancing parenchyma. At times, low-attenuation lesions are encountered that represent perfusion abnormalities rather than tumor deposits. These perfusion abnormalities can be categorized as (a) those resulting from improper technique; (b) those extending from hilum to capsule (straight-line sign), with or without an obstructing mass; (c) perihilar and periligamentous abnormalities; (d) subcapsular defects (linear or wedge shaped); and (e) those seen with cirrhosis or regenerating nodules. Adjuvant use of delayed CT, magnetic resonance imaging, and intraoperative ultrasound aids in characterization of these nontumorous defects, thereby improving specificity. The authors conclude that when potential candidates are evaluated for hepatic tumor resection, knowledge of the existence of the various diagnostic pitfalls of CTAP and their imaging characteristics is imperative to avoid inadvertent false results.

Hepatic biopsies and fluid drainages

Advances in cross-sectional imaging, as well as cytologic and histologic techniques, have led to an expansion of the radiologist's role in the diagnosis and treatment of various liver diseases. This article reviews the indications, contraindications, techniques, and results of hepatic biopsies and fluid drainage procedures performed with the aid of cross-sectional imaging.

Diagnosis of pancreatic transplant dysfunction: value of gadopentetate dimeglumine-enhanced MR imaging

Sixteen MR studies performed in four patients who had undergone combined pancreatic and renal transplantation were reviewed retrospectively to determine if dynamic gadopentetate dimeglumine-enhanced gradient-echo imaging is useful in the early diagnosis of pancreatic transplant rejection. The MR studies were performed between 3 days and 6 months after transplantation and consisted of T1- and T2-weighted spin-echo images as well as a gradient-echo image prior to administration of an IV bolus of gadopentetate dimeglumine (0.1 mmol/kg). After injection of gadopentetate dimeglumine, a static dynamic gradient-echo scan was obtained. Signal-intensity measurements were determined for each of the gradient-echo images and used to generate an enhancement curve. Because T2 values have previously been used as an objective indicator of rejection, the mean T2 of each pancreatic transplant was calculated also. The MR results were compared with clinical and laboratory data and/or percutaneous biopsy results. In six studies of normally functioning pancreatic allografts, the percent enhancement during the first minute of the enhancement curve was 98 +/- 23% (1 SD). In six episodes of acute dysfunction (rejection or infarction), the first-minute enhancement was 42 +/- 20%. In four cases of dysfunction, the finding of an abnormal enhancement curve preceded a significant drop in urinary amylase by 1-4 days. The calculated T2 value was prolonged in only two cases in which biopsy-proved pancreatic infarction had occurred. No prolongation of T2 was evident in four cases of rejection alone. These results suggest that mean T2 calculation at 1.5 T may not be a reliable indicator of pancreatic transplant rejection, but that gadopentetate dimeglumine-enhanced gradient-echo MR imaging of the pancreatic transplant may be a reliable early indicator of pancreatic transplant dysfunction.

Direct hepatic tumor injection in rats: can it be used for analysis of MR imaging contrast agent?

With a recently described rat model technique for direct hepatic injection of tumor cells for imaging research, there were concerns that the injection itself might produce lesions detectable with magnetic resonance (MR) imaging, thereby producing false-positive results. To examine this possibility, the authors prospectively studied 14 Sprague-Dawley rats after direct hepatic injection of cells from a rat hepatoma cell line. The rats were imaged with a variety of pulse sequences before and after intravenous injection of the contrast agent manganese dipyridoxal diphosphate at a dose of 8 mumol/kg. No intrahepatic lesions could be detected with MR imaging during the first 6 days after direct hepatic injection of the tumor cells. Therefore, the direct injection technique should be accurate for evaluating various MR imaging sequences and contrast agents for early hepatic tumor detection.

Carnitine deficiency associated with anticonvulsant therapy

Valproic acid therapy is known to be associated with carnitine deficiency in adult as well as young epileptic patients. In a study of the possible existence of such side-effects with other anticonvulsants, 76.5% of adult patients treated with valproate were deficient in serum free carnitine, with acylcarnitine levels significantly higher than in controls (p less than 0.01), while the carnitine deficiency rate in a group of patients treated with anticonvulsants other than valproate was 21.5%. Since in clinical practice only about one fifth of patients are treated with valproate, this means that about 15% of epileptics are carnitine deficient because of valproate treatment and 17% because of other anticonvulsants. The mechanisms and clinical and biological consequences of the carnitine deficiency associated with antiepileptic drugs other than valproate are not known.

Transfer of the inducible lac repressor/operator system from Escherichia coli to a vaccinia virus expression vector

Cis- and trans-acting elements of the Escherichia coli lac operon were transferred to vaccinia virus and used to regulate gene expression. A recombinant virus that constitutively expresses a modified lac repressor gene (lacI) was constructed. We calculated that each infected cell contained approximately 2 x 10(7) active repressor molecules (and 1-2 x 10(4) copies of the vaccinia virus genome). A strong vaccinia-virus late promoter was modified by insertion of the lac operator (lacO) at various positions. The ability of each modified promoter to regulate expression of beta-galactosidase was tested by transient assays in cells infected with wild-type or lacI-containing vaccinia virus. Placement of the lacO just downstream of the conserved TAAAT sequence of a late promoter was consistent with a minimal effect on basal expression and good repressibility, whereas basal expression was severely inhibited when lacO overlapped or preceded the TAAAT motif. A single recombinant vaccinia virus containing lacI and the beta-galactosidase gene under control of the optimal lacO promoter was constructed. In the absence of inducer, cells infected with this double recombinant virus synthesized little or no detectable beta-galactosidase. Addition of isopropyl beta-D-thiogalactoside restored expression to greater than 20% of the unrepressed level. This inducible vector system has potential applications for expression of heterologous and homologous genes.

Urinary excretion of D-glucaric acid in porphyria cutanea tarda

Twenty patients with porphyria cutanea tarda who had ingested no alcohol for at least 10 days before sampling were found to possess urinary D-glucaric acid levels similar to those of 30 clinically healthy controls. Correlation between urinary excretion of D-glucaric acid on the one hand and plasma or urinary porphyrin concentrations on the other was not statistically significant. These results suggest that the high urinary concentrations of D-glucaric acid found in porphyria cutanea tarda patients by Budillon et al. (Acta Hepato-Gastroenterol. 25 (1978) 267) may have been due to recent consumption of alcohol rather than to the porphyrin pathology.