Monitoring of plasma concentrations of dabrafenib and trametinib in advanced BRAFV600mut melanoma patients

BACKGROUND

Dabrafenib (D) and trametinib (T) improved survival in patients with BRAFV600^mut melanoma. High plasma concentration of D (PCD) is weakly associated with adverse events (AE). We investigated the relationship between PCD/T and tumour control or AE.

METHODS

We analysed PCD/T in patients treated with D+T for metastatic melanoma. We collected data of tumour response (RECIST 1.1) and AE (CTCAE 4.0) blinded to PCD/T results.

RESULTS

We analysed 71 D and 58T assays from 34 patients. High inter-individual variability of PCD (median: 65.0ng/mL; interquartile range (IQR) [4-945]) and of PCT (median: 8.6ng/mL; IQR [5-39]) was observed. We found a weak relationship between PCD and progression-free survival, taking follow-up time into account (hazard ratio 0.991; 95%CI, 0.981 to 1.000; P=0.06). However, no difference was observed between mean PCD/T of progressing patients (n=21; 125±183ng/mL and 9.3±3.6ng/mL, respectively) and responders (complete, partial or stable response) (n=13; 159±225ng/mL, P=0.58 and 10.6±24.4ng/mL, P=0.29, respectively). No significant relationship was found between PCD/T and most common AEs (fever, lymphopenia, CPK increase, and hepatic cytolysis), body mass index, or age. Mean CPT (n=16) was significantly higher for female subjects (n=18; 11.5±4.8ng/mL) than for male subjects (8.8ng/mL±2.9, P=0.01), but no difference was observed between sex and CPD (P=0.32).

CONCLUSION

Our study showed a weak relationship between PCD and progression-free survival, but no relationship between PCD/T and AE was found. Monitoring PCD and PCT alone is unlikely to be useful in assessing response to treatment.

Experimental and computational diagnosis of the fluxional nature of a benzene-1,3,5-tricarboxamide-based hydrogen-bonded dimer

Precise characterization of the hydrogen bond network present in discrete self-assemblies of benzene-1,3,5-tricarboxamide monomers derived from amino-esters (ester BTAs) is crucial for the construction of elaborated functional co-assemblies. For all ester BTA dimeric structures previously reported, ester carbonyls in the side chain acted as hydrogen bond acceptors, yielding well-defined dimers stabilized by six hydrogen bonds. The ester BTA monomer derived from glycine (BTA Gly) shows a markedly different self-assembly behaviour. We report herein a combined experimental and computational investigation aimed at determining the nature of the dimeric species formed by BTA Gly. Two distinct dimeric structures were characterized by single-crystal X-ray diffraction measurements. Likewise, a range of spectroscopic and scattering techniques as well as molecular modelling were employed to diagnose the nature of dynamic dimeric structures in toluene. Our results unambiguously establish that both ester and amide carbonyls are involved in the hydrogen bond network of the discrete dimeric species formed by BTA Gly. The participation of roughly 4.5 ester carbonyls and 1.5 amide carbonyls per dimer as determined by FT-IR spectroscopy implies that several conformations coexist in solution. Moreover, NMR analysis and modelling data reveal rapid interconversion between these different conformers leading to a symmetric structure on the NMR timescale. Rapid hydrogen bond shuffling between conformers having three (three), two (four), one (five) and zero (six) amide carbonyl groups (ester carbonyl groups, respectively) as hydrogen bond acceptors is proposed to explain the magnetic equivalence of the amide N-H on the NMR timescale. When compared to other ester BTA derivatives in which only ester carbonyls act as hydrogen bond acceptors, the fluxional behaviour of the hydrogen-bonded dimers of BTA Gly likely originates from a larger range of energetically favorable conformations accessible through rotation of the BTA side chains.

Probing halogen-halogen interactions in solution

Halogen-halogen interactions are a particularly interesting class of halogen bonds that are known to be essential design elements in crystal engineering. In solution, it is likely that halogen-halogen interactions also play a role, but the weakness of this interaction makes it difficult to characterize or even simply detect. We have designed a supramolecular balance that allows detecting BrBr interactions between CBr₃ groups in solution and close to room temperature. The sensitivity and versatility of the chosen platform have allowed accumulating consistent data. In halogenoalkane solvents, we propose estimates for the free energy of these weak halogen bond interactions. In toluene solutions, we show that the interactions between Br atoms and the solvent aromatic groups dominate over the BrBr interactions.

Catheterization of post-traumatic parotid duct sialocele

INTRODUCTION

Parotid duct sialocele is a salivary cavity arising at the expense of the parotid duct. Many cases of parotid sialocele have been published, but very few cases of parotid duct sialocele have been reported.

CASE REPORT

We report a case of post-traumatic parotid duct sialocele that was assessed by MR sialography. The parotid duct was catheterized via the oral cavity and the catheter was left in place for ten days. No recurrence was observed.

DISCUSSION

Published cases of parotid duct sialocele are rare, as only seven cases were identified in the literature. Several treatment options are available for sialocele involving the parotid gland or parotid duct. Subcutaneous injection of botulinum toxin is commonly used, with good results. Parotid duct catheterization has also been reported, mainly for parotid gland sialoceles. To the best of our knowledge, apart from the present case, the use of this technique for parotid duct sialocele has only been reported once before. This technique is minimally invasive, with very low morbidity and good results.

[Nasal polyposis and olfactory function: results of the surgical treatment]

INTRODUCTION

Hyposmia is a common cause of functional complaint in patients with nasal polyposis. The aim of the current study was to report the olfactory functional results after sinus surgery.

MATERIALS AND METHODS

A systematic review of the scientific literature was achieved in the Pubmed database.

RESULTS

Overall, 10 series published between 1989 and 2013, involving 959 patients, were selected. The surgery for nasal polyposis, adjuvant medical treatment, may allow olfactory improvement. The results are even better than surgery is as wide as possible and the evolutionary stage is low.

[Diagnosis and therapeutic pathways in head and neck cancers]

BACKGROUND

Cancers of uppers aero-digestives tracts represent, infrequency, the 5th cancer in the French population. Most of them (about 70%) are diagnosed at an advanced stage (stage III or IV) while they are associated with a poor prognosis (only 40% five year survival). The objective of our study was to analyze the care pathway of patients with cancers of uppers aero-digestives tracts in order to target efforts to improve the survival of these patients.

METHODS

It was a descriptive and retrospective study, on medical files, on the health care pathway of patients with cancers of uppers aero-digestives tracts cared in the Head and Neck surgery department of Val de Grâce in Paris and Percy in Clamart between January 2004 and December 2006. The patients were adults with squamous cell carcinoma of uppers aero-digestives tracts.

RESULTS

One hundred thirty-eight files of patients were analyzed. Fifty-five percent of patients were diagnosed at an advanced stage. On average patients have waited two months and twenty-one days before consulting a doctor for the first time. The time interval between the specialist consultation and the start of treatment was on average 7 weeks. The overall 5-year survival rate was 61%.

CONCLUSION

Squamous cell carcinoma of uppers aero-digestives tracts remains serious and has a poor diagnosis, even in a population with a high social-cultural level. The long time interval before the first consultation may be reduced by improving health education among the general practitioner (primary and secondary prevention), and by establishing health care public campaigns. This would allow earlier diagnosis, more conservative therapeutic opportunities and therefore a better prognosis.

MR Imaging of sclerosing cholangitis

MRCP is a non-invasive cholangiographic technique used in detection and characterization of bile ducts abnormalities. MRCP features of primary sclerosing cholangitis are randomly distributed annular strictures alternating with slightly dilated bile ducts. Secondary sclerosing processes including ascending, ischemic, caustic, AIDS-related, eosinophilic and autoimmune cholangitis can mimic PSC at MRCP.

[Diffusion-weighted MR imaging of liver pathology: principles and clinical applications]

Due to ongoing technological advances, the range of clinical applications for diffusion-weighted MR imaging has expanded to now include abdominal pathology. Current applications for liver pathology include two main directions. First, oncologic imaging with detection, characterization and follow-up of lesions. Second, evaluation of diffuse liver diseases, including hepatic fibrosis. The diagnostic impact and role of diffusion-weighted MR imaging remain under investigation, but appear promising. Because of its short acquisition time, sensitivity, and additional information it provides, diffusion-weighted MR imaging should be included in routine liver imaging protocols.

[Management of ear, nose, and throat diseases in district hospital centers in Madagascar]

The purpose of this report is to describe the experience of a specialized medico-surgical ENT team sent to hospital centers in Atalaha and Tulear, Madagascar by a nonprofit organization called "Terre rouge" from the Reunion Island. In three separate short-term missions, a total of 93 patients received care. Discussion focuses on the particular pathological, cultural, and pedagogical features of the Island and on the resources that were deployed during the missions. Providing ENT care in district hospitals in Madagascar requires adaptation to the difficult climatic conditions, poor hospital facilities (infrastructure, equip ment, and personnel), and advanced stage of diseases. To ensure continuous access to ENT care, it will be necessary to provide practical and didactic training for healthcare personnel in the country.

[Post-traumatic carotid cavernous fistula: report of two cases]

Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The authors reported the clinical presentation and therapeutic procedure of two cases. The physician has to be aware of this diagnosis when a patient is referred for a posttraumatic exophthalmia. The medical behaviour is multidisciplinary (ENT, ophthalmologist, radiologist and neurosurgeon). The imaging of choice is the angiography but angio-MRI and angio-CT can help to confirm the diagnosis. The endovascular embolization is the treatment of choice. It presents an acceptable risk of complication and a low risk of failure. In this paper the authors report 2 posttraumatic CCF cases treated with success by endovascular embolization.

[Cataract surgery and its impact on balance and autonomy in elderly]

PURPOSE

Cataract is a major cause of visual impairment among elderly. Cataract surgery improves visual afferencies and can have an impact on balance. The present study assessed the impact of cataract surgery upon balance and autonomy in elderly. We realized clinical examinations and objective tests the day before surgery and 2-months later.

METHODS

The initial cohort consisted of 66 patients that had to undergo a cataract surgery. Their mean age was 79 +/- 0.5. For logistic reasons, only 33 patients have been completely evaluated before and after surgery. Each patient underwent a history and examination that have assessed autonomy, walking, visual and then cochleo-vestibular functions including bone vibratory test and dynamic computerized posturography (Equitest).

RESULTS

After 2 months, cataract surgery had no incidence on balance. The fear of falling has stayed the same whereas the number of falls has been noticeably reduced by surgery. The overall score of Equitest has shown an increase in visual dependence after surgery. Although cataract surgery has no incidence on autonomy, it may improve the quality of life among older people by leisure activities recovery.

CONCLUSION

An early physical rehabilitation facilitated by visual improvement after surgery can also prevent visual dependence and autonomy loss. We recommend vestibular rehabilitation in elderly with major visual dependence.

Aerobic MTBE biodegradation in the presence of BTEX by two consortia under batch and semi-batch conditions

This study explores the effect of microbial consortium composition and reactor configuration on methyl tert-butyl ether (MTBE) biodegradation in the presence of benzene, toluene, ethylbenzene and p-xylenes(BTEX). MTBE biodegradation was monitored in the presence and absence of BTEX in duplicate batch reactors inoculated with distinct enrichment cultures: MTBE only (MO-originally enriched on MTBE) and/or MTBE BTEX (MB-originally enriched on MTBE and BTEX). The MO culture was also applied in a semi-batch reactor which received both MTBE and BTEX periodically in fresh medium after allowing cells to settle. The composition of the microbial consortia was explored using a combination of 16S rRNA gene cloning and quantitative polymerase chain reaction targeting the known MTBE-degrading strain PM1T. MTBE biodegradation was completely inhibited by BTEX in the batch reactors inoculated with the MB culture, and severely retarded in those inoculated with the MO culture (0.18+/-0.04 mg/L-day). In the semi-batch reactor, however, the MTBE biodegradation rate in the presence of BTEX was almost three times as high as in the batch reactors (0.48+/-0.2 mg/L-day), but still slower than MTBE biodegradation in the absence of BTEX in the MO-inoculated batch reactors (1.47+/-0.47 mg/L-day). A long lag phase in MTBE biodegradation was observed in batch reactors inoculated with the MB culture (20 days), but the ultimate rate was comparable to the MO culture (0.95+/-0.44 mg/L-day). Analysis of the cultures revealed that strain PM1T concentrations were lower in cultures that successfully biodegraded MTBE in the presence of BTEX. Also, other MTBE degraders, such as Leptothrix sp. and Hydrogenophaga sp. were found in these cultures. These results demonstrate that MTBE bioremediation in the presence of BTEX is feasible, and that culture composition and reactor configuration are key factors.

Imagerie des métastases intracrâniennes chez l’adulte

Intracranial metastases account for up to 35% of intracranial tumors in adult. They can involve any part of the central nervous system: brain, meninges and cranial nerves. Any systemic tumor can metastasize to the brain; the most common primaries include lung, breast and melanoma. Imaging plays a major role in the evaluation and management of patients with metastatic brain tumors. This article discusses optimal CT and MR imaging protocols and describes imaging features and distinguishing characteristics of cerebral and meningeal metastases.

Highly efficient production and characterization of T-DNA plants for rice ( Oryza sativa L.) functional genomics

We investigated the potential of an improved Agrobacterium tumefaciens-mediated transformation procedure of japonica rice ( Oryza sativa L.) for generating large numbers of T-DNA plants that are required for functional analysis of this model genome. Using a T-DNA construct bearing the hygromycin resistance ( hpt), green fluorescent protein ( gfp) and beta-glucuronidase ( gusA) genes, each individually driven by a CaMV 35S promoter, we established a highly efficient seed-embryo callus transformation procedure that results both in a high frequency (75-95%) of co-cultured calli yielding resistant cell lines and the generation of multiple (10 to more than 20) resistant cell lines per co-cultured callus. Efficiencies ranged from four to ten independent transformants per co-cultivated callus in various japonica cultivars. We further analysed the T-DNA integration patterns within a population of more than 200 transgenic plants. In the three cultivars studied, 30-40% of the T(0) plants were found to have integrated a single T-DNA copy. Analyses of segregation for hygromycin resistance in T(1) progenies showed that 30-50% of the lines harbouring multiple T-DNA insertions exhibited hpt gene silencing, whereas only 10% of lines harbouring a single T-DNA insertion was prone to silencing. Most of the lines silenced for hpt also exhibited apparent silencing of the gus and gfp genes borne by the T-DNA. The genomic regions flanking the left border of T-DNA insertion points were recovered in 477 plants and sequenced. Adapter-ligation Polymerase chain reaction analysis proved to be an efficient and reliable method to identify these sequences. By homology search, 77 T-DNA insertion sites were localized on BAC/PAC rice Nipponbare sequences. The influence of the organization of T-DNA integration on subsequent identification of T-DNA insertion sites and gene expression detection systems is discussed.

[Natural selection and medical triage: everyday realities]

Most emergency care facilities in tropical areas are inefficient, underequipped, and quickly overwhelmed by the ever-growing attendance. As a result, mortality is higher than in developed countries. To speak in terms of natural selection would be tantamount to a fatalistic admission of powerlessness to deal with the situation. In Africa, the gross imbalance between supply and demand makes it necessary to make hard choices in order to make the most effective use of available staff and equipment. The objective of medical triage is to allocate scarce facilities to those patients with the greatest chance of survival. However it is difficult to define precise rules for making such choices since they are strongly dependent on available resources, type of pathology, and level of medical skill. Prognostic indicators are ill-suited to emergency situation since they require not only clinical data but also and above all, in most cases, laboratory data which is not always available or justifiable. Experience is probably the best guarantee for reliable triage, which is philosophically difficult to accept but often unavoidable in everyday practice.

Effects of fumonisin B1 present in Fusarium moniliforme culture material on drug metabolising enzyme activities in ducks

The effects of fumonisin B1 (0, 5, 15 and 45 mg/kg/day), obtained from culture material of Fusarium moniliforme, on drug metabolising enzyme activities were investigated in four groups of five growing ducks by daily oral administration over 12 days. No lethality or sign of toxicosis occurred. The liver and kidney weights were increased, whereas microsomal and cytosolic tissue fractions were unaffected. Although the total microsomal P450 content was unaffected, benzphetamine, ethylmorphine, erythromycin N-demethylases and ethoxyresorufin O-deethylase activities were together increased (respectively by 114, 242, 57 and 27% with 5 mg/kg/day and 1024, 969, 200 and 147% with 45 mg/kg/day). By contrast, aminopyrine and nitrosodimethylamine N-demethylases, methoxyresorufin and pentoxyresorufin O-dealkylases, and UDP-glucuronyltransferase activities were only increased by using 45 mg/kg/day, whereas glutathione S-transferases activities remained unaffected.

Hearing status of French youth aged from 18 to 24 years in 1997: a cross-sectional epidemiological study in the selection centres of the army in Vincennes and Lyon

BACKGROUND

It is currently thought that young adults are at increasing risk of exposure to deleterious sources of noise. To test this possibility we have assessed hearing status of young French men aged between 18 and 24 years in 1997 and study risk factors of deafness in a cross-sectional epidemiological study at selection centres for aptitudes to National Service.

METHODS

During the time of the study, 1208 subjects were examined. For each subject, data of an interview, an otoscopy and audiograms were collected. We compared hearing thresholds between subjects with different noise exposures and we determined risk factors of deafness in this population.

RESULTS

The prevalence of hearing loss was 9% at medium frequencies (0.5-2 kHz) and 15% at high frequencies (4-8 kHz).We found that 60% of the subjects were regularly exposed to at least one source of loud noise. Acoustic trauma (6%) mostly explained hearing losses. Repeated episodes of otitis media in childhood (17%) also emerged as an important risk factor apparently due to increased sensitivity to noise. In subjects with antecedent of otitis media, hearing impairments were significant in personal stereo users (>1 hour per day) (p<0.001), in those who went to discos and rock concerts (>2 times per month) (p=0.01) and in those who worked in noisy places (p=0.01). In contrast, in subjects without antecedent of otitis, we found no difference in hearing thresholds between noise exposed and non noise exposed subjects.

CONCLUSIONS

Loud sound exposure is a true risk factor of early deafness in subjects that had had repeated episodes of otitis media in childhood. This study stresses the need for both prevention policies and information of health professionals and practitioners.

The distribution of T-DNA in the genomes of transgenic Arabidopsis and rice

Almost all the nuclear genes of four Gramineae (maize, wheat, barley, rice) and pea are located in DNA fractions covering only a 1-2% GC range and representing between 10 and 25% of the different genomes. These DNA fractions comprise large gene-rich regions (collectively called the 'gene space') separated by vast gene-empty, repeated sequences. In contrast, in Arabidopsis thaliana, genes are distributed in DNA fractions covering an 8% GC range and representing 85% of the genome. Here, we investigated the integration of a transferred DNA (T-DNA) in the genomes of Arabidopsis and rice and found different patterns of integration, which are correlated with the different gene distributions. While T-DNA integrates essentially everywhere in the Arabidopsis genome, integration was detected only in the gene space, namely in the gene-rich, transcriptionally active, regions of the rice genome. The implications of these results for the integration of foreign DNA are discussed.

Structure, organization and expression of two closely related novel Lea (late-embryogenesis-abundant) genes in Arabidopsis thaliana

We have isolated and sequenced a 9.5 kb genomic region from A. thaliana, located on chromosome 2, which contains two tandemly arranged closely related genes (AtM10 and AtM17) coding for a new family of LEA proteins. The deduced proteins have a molecular mass of 11 and 29 kDa, respectively, are extremely hydrophilic except at their N-termini and share 70% amino acid (aa) identity. A 47 aa motif containing a 6-cysteine domain is present once in AtM10 and four times in AtM17. The short intergenic region, the identical position of the intron and the overall sequence homology suggest that these two genes evolved through a duplication event. This conclusion is supported by the presence of two homologous strictosidine synthase-like (pseudo)genes downstream from AtM17 and AtM10. Expression studies, using AtM10 and AtM17 cDNAs, revealed that both transcripts accumulate exclusively in seeds from late embryogenesis until two days after imbibition. Expression of both genes in young seedlings is repressed during ABA, salt or drought treatment, whereas a cold stress induces the expression of AtM17 only. In situ hybridization revealed that AtM10 transcripts are detected throughout the embryo while those of AtM17 are more localized to cotyledon cells.

Expression and cellular localization of Atrab28 during arabidopsis embryogenesis

The maize abscisic acid (ABA)-responsive gene rab28 has been shown to be ABA-inducible in embryos and vegetative tissues, expression being mostly restricted to vascular elements during late embryogenesis. In the course of an expressed sequence tags (ESTs) programme, we have isolated an Arabidopsis thaliana gene, Atrab28, encoding the orthologue of maize rab28. The Atrab28 cDNA is 1090 bp long, including a poly(A)+ stretch, and encodes a polypeptide of 262 amino acids. Atrab28 antibody against the recombinant protein recognizes a polipeptide of about 30 kDa and pI 6, in close agreement with the predicted molecular mass and pI. As for maize rab28, expression studies with Atrab28 revealed high specificity for embryo tissues, transcription being stimulated by the transcriptional activator abi3. In contrast, Atrab28 was not induced in vegetative tissues by ABA, osmotic stress or dehydration. The expression of Atrab28 mRNA and the accumulation of Atrab28 protein was largely restricted to provascular tissues of mature embryos and in the seed coat outer tegument and embryo and silique epidermis, as revealed by in situ hybridization and immunocytochemistry with anti-Atrab28 antibodies.

[Sinus mucoceles and surgery in iatrogenic diseases]

The increasing number of mucocele cases treated by the authors during the past ten years coincide with the expansion of functional endoscopic sinus surgery (FESS). The aim of this study is to evaluate the iatrogenic characteristics of this surgery by analysing the locations, time of development and the potential pathogenic factors of sinus mucoceles. Forty-two sinus mucoceles were operated in our department. These mucoceles were most frequently found in the anterior ethmoido-frontal system. Eleven patients had a history of endonasal ethmoidectomy mainly due to nasal polyposis. The time of mucocele formation after initial FESS (< 22 months) seems to be shorter than after exonasal sinus surgery or trauma (< 10 years). Endoscopic and CT-scan revealed different types of sinus obstruction findings: nasofrontal duct occlusion due to a fibrosis and osteogenic scar tissue process, or anterior ethmoid synechia in the case of ethmoido-frontal sinus mucocele, uncinate process fragment or scar tissue duct occlusion as far as maxillary sinus mucocele were concerned. We conclude that there seems to be a correlation between the expansion of FESS and the increasing number of mucocele cases. However, in this context it has to taken into consideration, that our department treats a considerable number of sinus pathology. Anterior ethmoid seems to be a favourable area for sinus mucocele formation. In order to prevent mucocele, it is essential to carry out FESS with great precaution. If endonasal surgery is performed, particularly in the anterior ethmoid, a close endoscopic follow-up, completed by radiological examinations, where necessary, must be ensured.

[Traumatic perilymphatic fistula and sports]

In the past ten years four sportsmen with a traumatic perilymphatic fistula were treated. Three of these four patients were surgically treated: two of them underwent a labyrinthectomy and with one of them, the oval window was grafted. After the analysis of these cases, we have made a study of the literature. Careful attention to the patient history and accurate review of the recurrent vestibulocochlear symptomatology isolate a clinical "audiovestibular syndrome of perilymphatic fistule". There is lack of precise preoperatoire diagnostic test. Nevertheless, entire positionnal audiometric test is a reliable and easy to perform test. The medical management is based on bed rest during a reasonable period. Only patients with significant suggestive symptomatology are surgically explored . They sometimes need destruction of vestibular function without preservation of hearing.

[Pituitary abscess. A rare complication of sinusitis]

This report is of a pituitary abscess arising from chronic sinusitis. The MRI suggested a pituitary tumor with suprasellar extension and diagnosis was made operatively. Pituitary abscesses are rare entities. Despite the advent of MRI, diagnosis is often only made operatively.

[Necrotizing cervico-mediastinal cellulitis. Apropos of 3 cases]

OBJECTIVE

To outline the most appropriate treatment of descending necrotizing mediastinitis.

MATERIALS AND METHODS

Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived.

DISCUSSION

Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.

Influence of body temperature, with or without sedation, on energy expenditure in severe head-injured patients

OBJECTIVE

To quantify the effect of body temperature and sepsis on energy expenditure in head-injured patients.

DESIGN

Prospective, nonrandomized, observational study.

SETTING

Neurosurgical intensive care unit.

PATIENTS

Severe head-injured patients.

INTERVENTIONS

Use of an indirect calorimeter to measure energy expenditure.

MEASUREMENTS AND MAIN RESULTS

Mean arterial pressure (MAP), heart rate (HR), body temperature, and mean hourly energy expenditure were recorded. Twenty-four patients had 1,919 hourly measures of the above parameters. The measurement periods were divided into four groups, according to the anesthetic agents used for sedation: fentanyl and midazolam (group FM); fentanyl, midazolam, and curarization (group C); thiopental (group T); and no sedation (group NS). The energy expenditure/basal energy expenditure ratio (EE/BEE) was significantly lower in group T (1.20 +/- 0.15) than in group FM (1.32 +/- 0.24) or group C (1.32 +/- 0.20) and was significantly higher in group NS (1.60 +/- 0.33). There was a significant correlation between body temperature and EE/BEE (p < .0001, r2 = .27) only in sedated patients. Using the equation of the regression line to correct energy expenditure for differences in body temperatures between groups, the difference in energy expenditure between groups with sedation disappeared. This finding suggested that the low energy expenditure under thiopental was due only to hypothermia. Sepsis significantly increased energy expenditure independently of fever. There was a weak but statistically significant correlation between energy expenditure and HR (p<.01, r2 = .13) but not between energy expenditure and MAP.

CONCLUSIONS

Sedation had a major effect on energy expenditure. In sedated patients, body temperature was the main determinant of energy expenditure; the anesthetic agent used had little influence on the level of energy expenditure. Sepsis increased energy expenditure independently of fever, probably through hormonal changes.

cDNA sequence, genomic organization and differential expression of three Arabidopsis genes for germin/oxalate oxidase-like proteins

Wheat germin is a protein expressed during germination which possesses an oxalate oxidase activity. Germin-type oxalate oxidases have been extensively studied in monocotyledons (wheat and barley) where they are thought to have important functions for development, stress response and defence against pathogens. In contrast, almost nothing is known about the germin-like proteins found in dicotyledons, gymnosperms and myxomycetes. In this work, cDNA clones for three genes (ATGER1, ATGER2 and ATGER3) encoding germin-like proteins, initially characterized as expressed sequence tags (ESTs), from Arabidopsis thaliana cDNA libraries were further characterized. In addition, we isolated and sequenced a Brassica napus cDNA which was strongly homologous to the cDNA for ATGER1. Sequence analysis and secondary structure predictions of the proteins encoded by these cDNAs showed that they possess all the characteristic features of members of the germin family and of the germin/seed globulins/sucrose binding protein superfamily. Sequence comparisons and mapping demonstrated the existence of at least two different gene families in the A. thaliana genome encoding a minimum of three genes for germins. These three genes have been mapped in three different location on the Arabidopsis genome. By northern blot hybridizations we found that these genes are differentially regulated. ATGER1 was expressed during germination, like wheat germin, but also in leaves whereas ATGER2 transcripts were exclusively found in developing embryos, like wheat pseudo-germin. ATGER3 mRNAs were found in leaves and flowers and their abundance was shown to vary during the circadian cycle.

Identification of members of gene families in Arabidopsis thaliana by contig construction from partial cDNA sequences: 106 genes encoding 50 cytoplasmic ribosomal proteins

Partial cDNA sequencing to obtain expressed sequence tags (ESTs) has led to the identification of tags to about 8,000 of the estimated 20,000 genes on Arabidopsis thaliana. This figure represents four to five times the number of complete coding sequences from this organism available in international databases. In contrast to mammals, many proteins are encoded by multigene families in A. thaliana. Using ribosomal protein gene families as an example, it is possible to construct relatively long sequences from overlapping ESTs which are of sufficiently high quality to be able to unambiguously identify tags to individual members of multigene families, even when the sequences are highly conserved. A total of 106 genes encoding 50 different cytoplasmic ribosomal protein types have been identified, most proteins being encoded by at least two and up to four genes. Coding sequences of members of individual gene families are almost always very highly conserved and derived amino acid sequences are almost, if not completely, identical in the vast majority of cases. Sequence divergence is observed in untranslated regions which allows the definition of gene-specific probes. The method can be used to construct high-quality tags to any protein.

The Arabidopsis thaliana cDNA sequencing projects

Nearly 30000 Arabidopsis thaliana EST (Expressed Sequence Tags) have been produced by a French and an American consortium. Despite redundancy these sequences tag about half the expected Arabidopsis genes. Approximately 40% of the non-redundant EST can be assigned a putative function by simple homology search. This programme allowed the identification of a large number of genes which would have been very difficult to isolate by other classical techniques. It considerably stimulated many areas of plant biology by the rapid discovery a large number of genes, by revealing multigene families and by allowing the analysis of differential expression of the different members. Finally this programme facilitated construction of physical maps of the chromosomes and opened the way for complete sequencing of the Arabidopsis genome and comparative mapping of the major plant crops.

The Arabidopsis thaliana cDNA sequencing projects

Nearly 30000 Arabidopsis thaliana EST (Expressed Sequence Tags) have been produced by a French-American consortium. Despite redundancy, these sequences tag about half of the expected Arabidopsis genes. Approximately 40% of the non-redundant EST can be assigned a putative function by simple homology search. This programme allowed the identification of a large number of genes which would have been very difficult to isolate by other classical techniques. It considerably stimulated many areas of plant biology by the rapid discovery a large number of genes, by revealing multigene families and by allowing the analysis of differential expression of the different members. Finally this programme facilitated construction of physical maps of the chromosomes and opened the way for complete sequencing of the Arabidopsis genome and comparative mapping of the major plant crops.

Further progress towards a catalogue of all Arabidopsis genes: analysis of a set of 5000 non-redundant ESTs

Nearly 7000 Arabidopsis thaliana-expressed sequence tags (ESTs) from 10 cDNA libraries have been sequenced, of which almost 5000 non-redundant tags have been submitted to the EMBL data bank. The quality of the cDNA libraries used is analysed. Similarity searches in international protein data banks have allowed the detection of significant similarities to a wide range of proteins from many organisms. Alignment with ESTs from the rice systematic sequencing project has allowed the detection of amino acid motifs which are conserved between the two organisms, thus identifying tags to genes encoding highly conserved proteins. These genes are candidates for a common framework in genome mapping projects in different plants.

Sequencing and mapping the Arabidopsis genome: a weed model for real crops

Arabidopsis is a crucifer weed with a small genome of about 120 Mbp which has been chosen as a model species for plant molecular genetics. Four years ago, a consortium of nine French laboratories, including ours, initiated a project aimed at mapping the transcribed regions of the genome. The strategy employed was to systematically and randomly sequence cDNA clones isolated from libraries made from different tissues and organs of plants grown under various physiological conditions. The consortium released about 7,000 expressed sequenced tags (ESTs) in the dbEST database corresponding to approximately 3,500 unique genes. In the next phase of the programme, a YAC library with average inserts of 500 kbp has been prepared. We have now started to use the EST information to map the cDNA clones on these YACs. The most recent aspect of Arabidopsis sequencing is the ESSA (European Scientists Sequencing Arabidopsis) project, in which the aim is to describe 2.5 Mbp by the end of 1996. Genomic sequencing has revealed a very high gene density. Comparison of present genomic sequencing results with the EST data suggests that up to half of the genes might already be tagged with an EST. In collaboration with Carlos Quiros' group in Davis we have also analysed the conservation of a 30 kbp locus (Em 1, a late embryogenesis abundant protein gene) on chromosome 3 between Arabidopsis and several Brassica species. Progress on these various aspects will be reviewed. We shall also present some sequence comparisons between Arabidopsis and rice ESTs. These results suggest that it should be possible in the very near future to map a pool of common genes onto many different plant genomes. This should provide a common framework to integrate maps from different species and facilitate mapbased cloning of genes of agronomical importance.

A rapeseed cold-inducible transcript encodes a phosphoenolpyruvate carboxykinase

We have isolated a clone corresponding to a new cold-regulated gene from a cDNA library made from rapeseed (Brassica napus cv Samourai) cold-acclimated etiolated seedlings. Sequence analysis and homology searches showed that this clone encodes a protein highly homologous to the ATP-dependent phosphoenolpyruvate carboxykinase (PEPCK; EC 4.1.1.49) from Saccharomyces cerevisiae, Trypanosoma, Rhizobium sp., and Escherichia coli; we refer to the B. napus clone as BnPEPCK. A potential ATP-binding site existing in all PEPCK proteins was also found in BnPEPCK. Although there was a basal expression of BnPEPCK in seedlings grown at control, room temperature, the steady-state level of the transcripts increased at 4 degrees C and decreased to normal levels when the seedlings were returned to control temperature (22 degrees C). Using antibodies made against a recombinant histidine-BnPEPCK fusion protein, we demonstrated that BnPEPCK protein level is correlated with the accumulation of the BnPEPCK transcript.