The empty pelvis syndrome: a core data set from the PelvEx collaborative

BACKGROUND

Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.

METHOD

Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.

RESULTS

One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.

CONCLUSIONS

EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.

Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

624 Targeting Type I arginine methyltransferases promotes T cell mediated antitumor immune responses

Background

Although immunotherapy produced dramatic clinical responses in a certain population of cancer patients, tumor cells can employ a variety of immunosuppressive measures to limit the immunotherapeutic efficacy. This highlights a great need to develop novel strategies to expand the clinical benefits of immunotherapy to a broader population of cancer patients. PRMTs have been described as vital regulators of immune responsive pathways in several cell types, but the immunoregulatory role of Type I PRMTs in the tumor microenvironment remains poorly understood.

Methods

In this study, we analyzed the correlation between Type I PRMT expression levels with the clinical outcome or immune signature. Gene expression changes were evaluated in a panel of immunogenic and non-immunogenic cancer cell lines with Type I PRMT inhibitor treatment. The antitumor and immunological effects of Type I PRMT inhibitor were evaluated in combination with checkpoint blockade in a panel of syngeneic tumor models.

Results

Using TCGA dataset analysis, increased mRNA expression levels of several Type I PRMTs were associated with poor clinical response and decreased immune infiltration in melanoma patients. Particularly, tumors with high expression of PRMT1, the major Type I PRMTs, displayed significantly reduced relapse-free survival (HR=1.891, p=0.038), and were associated with lower cytolytic score (logFC=-0.875, p=1.49e-08) and lower lymphocyte infiltration score (logFC=-0.783, p=0.00077). RNA-seq results showed that interferon signaling was significantly altered after Type I PRMT inhibitor treatment in 10 of 15 cell lines analyzed, with most related genes showing increased expression. In addition, VEGFA was downregulated by 25% or more in 7/8 human and 3/5 mouse cancer cell lines, and a moderate decrease in chromatin accessibility at the Vegfa promoter was observed in ATAC-seq data. Furthermore, Type I PRMT inhibitor combined with anti-PD1 treatment significantly extended the survival of tumor-bearing mice and delayed tumor growth in a panel of immunocompetent mouse models. Mechanistically, Type I PRMT inhibitor significantly increased the apoptotic sensitivity of tumor cells to autologous tumor-reactive T cells in vitro and the infiltration of total T cells (CD3+) in 3 of 4 tested tumor models and cytotoxic T cells (CD8+) in two tested tumor models in vivo.

Conclusions

Taken together, these data indicated that Type I PRMT inhibition exhibits immunomodulatory properties and synergizes with immune checkpoint blockade to induce durable antitumor responses in a T cell dependent manner. This study provides a rationale to combine Type I PRMT inhibitor with immune checkpoint blockade to maximize clinical benefits in cancer patients.

Acknowledgements

The authors would like to thank past and present members of the MDACC TIL lab for tumor/TIL processing and banking.

Contrasting the effects of phytase and pure myo-inositol on the performance, digestibility, blood and egg yolk inositol levels and digestion physiology of laying hens

ABSRACT1. An experiment was designed to compare the effects of supplementing laying hen diets with phytase and myo-inositol (inositol).2. Five diets were formulated: high balanced protein (HBP - 840 mg of Dlys/hen/day), HBP with inositol (HBP+I - 0.16%), reduced balance protein (RBP - 672 mg of Dlys/hen/day), RBP with inositol (RBP+I - 0.16%) and RBP with phytase (RBP+P - 3000 FTU/kg).3. Laying hen production, inositol concentrations, digestive tract morphology, amino acid digestibility and intestinal inositol transporters transcript abundance were evaluated. Data were analysed with a one-way ANOVA in SAS 9.4. Contrasts were used to assess the effect of protein, inositol, phytase and phytase vs. inositol. Differences were accepted when P ≤ 0.05.4. No effect on hen-day egg production or feed efficiency was found. However, feed intake and the incidence of abnormally shaped eggs were 0.77 g/h/d and 0.17% higher, respectively, in inositol treatments. Inositol decreased egg specific gravity from 1.088 to 1.0865.5. Inositol concentration in egg yolk was similar among HBP+I, RBP+I and RBP+P, and higher than for the HBP and RBP diet groups. Both gizzard and ileal digesta were enriched in inositol in all supplemented treatments, and phytase supplementation decreased the level of IP5 and IP6 in the gizzard and ileum. Generally, neither phytase or inositol affected amino acid digestibility.6. Inositol increased transcript abundance of alkaline phosphatase in the ileum, while phytase upregulated duodenal alkaline phosphatase and SMIT1, jejunal SMIT2 and reduced ileal HMIT and SMIT1 abundance.7. In conclusion, no effect of phytase or inositol was found for laying hen production performance or amino acid digestibility, but egg quality was reduced by inositol supplementation. Inositol concentration in egg yolk was similar among supplemented treatments.

Does the Pittsburgh Severity Score predict outcome in esophageal perforation?

Esophageal perforation is an uncommon and challenging surgical emergency associated with high rates of morbidity and mortality. At present, no consensus exists on optimal management of the condition. The Pittsburgh Severity Score (PSS) is a tool intended to stratify perforation severity and guide treatment. However, there is a paucity of literature examining the validity of the score or its application in a UK population. This study aims to validate the PSS and explore its use in stratifying patients with esophageal perforation into distinct subgroups with differential outcomes in an independent UK study population.All patients treated for esophageal perforation at Queen Elizabeth Hospital, Birmingham between September 2003 and October 2017 were included in this study. Cases were identified using a combination of ICD-10 and OPCS informatics search codes and prospective case collection. Data relating to the clinical presentation, diagnosis, management, and outcome of cases were recorded using a preformed data collection form. PSS predictive performance was assessed against five outcomes: rates of post-perforation and post-operative complications, in-hospital mortality, length of intensive care (ICU/HDU) stay, and total length of hospital stay.A total of 87 cases were identified, consisting of 48 (55%) iatrogenic perforations, 24 (28%) cases of spontaneous (Boerhaave's) perforation, and 15 perforations due to other etiologies (17%). Operative management was favored in this series, with 47% of all perforations being treated surgically. Overall in-hospital mortality was 13%, coupled with a median length of hospital stay of 24 days (interquartile range [IQR]: 12-49), of which a median of 2 days was spent in intensive care facilities (IQR: 0-14). A total of 46% of patients developed post-perforation complications, with 59% of the operatively managed cohort developing complications post-operatively.The PSS was not found to be significantly predictive of post-perforation complications (area under the ROC curve [AUROC]: 0.62, p = 0.053) or in-hospital mortality (AUROC: 0.69, p = 0.057) for the cohort as a whole. However, a subgroup analysis found the accuracy of the PSS to vary considerably by etiology, being significantly predictive of post-perforation complications within the subgroup of Boerhaave's perforations (AUROC: 0.86, p = 0.004).In conclusion, we found that the PSS has some utility in stratifying esophageal perforation severity and predicting specific patient outcomes. However, it appears to be of more value when applied to the subgroup of patients with Boerhaave's perforations.

Acetylation of CCAR2 Establishes a BET/BRD9 Acetyl Switch in Response to Combined Deacetylase and Bromodomain Inhibition

There continues to be interest in targeting epigenetic "readers, writers, and erasers" for the treatment of cancer and other pathologies. However, a mechanistic understanding is frequently lacking for the synergy observed when combining deacetylase and bromodomain inhibitors. Here we identify cell cycle and apoptosis regulator 2 (CCAR2) as an early target for acetylation in colon cancer cells treated with sulforaphane. N-terminal acetylation of CCAR2 diminished its interactions with histone deacetylase 3 and β-catenin, interfering with Wnt coactivator functions of CCAR2, including in cells harboring genetically encoded CCAR2 acetylation. Protein domain arrays and pull-down assays identified acetyl "reader" proteins that recognized CCAR2 acetylation sites, including BRD9 and members of the bromodomain and extraterminal domain (BET) family. Treatment with the BET inhibitor JQ1 synergized with sulforaphane in colon cancer cells and suppressed tumor development effectively in a preclinical model of colorectal cancer. Studies with sulforaphane+JQ1 in combination implicated a BET/BRD9 acetyl switch and a shift in the pool of acetyl "reader" proteins in favor of BRD9-regulated target genes. SIGNIFICANCE: These results highlight the competition that exists among the "readers" of acetylated histone and nonhistone proteins and provide a mechanistic basis for potential new therapeutic avenues involving epigenetic combination treatments.

European principles of inhibitor management in patients with haemophilia

Background

In spite of recent major advances in the understanding and treatment of inhibitor development in patients with haemophilia, multidisciplinary management of many of these patients remains suboptimal and highly heterogenous across Europe.

Methods

Following a series of multidisciplinary meetings and a review of the literature, the European haemophilia community of health professionals and patients jointly defined practical optimum standards for ensuring and harmonizing treatment and care for patients with an inhibitor.

Results

Ten complementary principles for the management of inhibitors in haemophilia have been developed, emphasizing the importance and benefits of a centralized, multidisciplinary, expert and holistic approach.

Conclusions

This document will serve as a benchmark to improve the multidisciplinary and practical management of patients with inhibitor. Implementation and adherence to each of these principles should have a major positive impact on the management and outcomes of patients developing an inhibitor.

Recent findings regarding calcium and phytase in poultry nutrition

Calcium (Ca) is an essential element for poultry and even a mild deficiency can lead to significant welfare and performance issues. As a result, it is often fed at levels in excess of requirement, partly as an insurance policy and, to some degree, because of its relatively low cost compared with other feed ingredients. However, when diets meet but do not exceed the phosphorus (P) requirements of the bird, a marginal Ca excess can interfere with P digestibility. This problem is exacerbated when phytases are used to provide some of the required P because Ca decreases the efficiency of phytate (IP6) hydrolysis in a dose-dependent manner. More recently, phytases have been used at very high doses (1500 FyTase units (FTU); ‘superdosing’) in commercial diets, to improve bird performance by removing as much of the dietary IP6 and lower esters of phytate (IP5, IP4, IP3 and IP2) as possible, all of which are considered anti-nutrients, and concomitantly producing as much inositol, a nutrient, as possible. In such a regimen, the ability of the phytase to degrade the lower phytate esters, namely IP4, IP3 and IP2, takes on greater importance than does simply releasing phytate P. Calcium has recently been shown to reduce the efficacy of hydrolysis of the lower phytate esters to a greater degree than the extent to which it decreases IP6 hydrolysis. As a result, Ca concentrations in the diet should be monitored frequently if the maximum value of a phytase is to be realised.

A European curriculum for nurses working in haemophilia

INTRODUCTION

Currently, there is no consensus on education required to develop haemophilia nursing. The aim was to develop a curriculum for haemophilia nurses that could be used as a resource in Europe. This could form a basis for continuous professional development and used in the preparation of specialized educational programmes.

METHODS

The EAHAD nurses working group set out to describe the skills and knowledge needed for a nurse to work in this specialty. This was considered at two levels: basic requirements and at a more advanced level. The working group acted as a focus group for this project drawing on existing specialist training, national role definitions, competencies and results of the EAHAD Nurses survey (2012). A template was populated with the knowledge base and the skills required.

RESULTS

Themes were analysed and information generated organized into domains: content of curriculum; learning outcomes, defined in terms of knowledge, skills, behaviour and attitudes; and suggestions for teaching methods. For curriculum content the following domains were identified: Applied biological science; treatment and management of haemophilia and associated disorders; genetic practice; care management of affected carriers and women; the impact of living with bleeding disorders; evidence base and applied research in haemophilia practice; and, the specialist role of the haemophilia nurse. Examples are given for teaching and learning process.

CONCLUSION

This curriculum is intended for use as a strategic resource to outline education for the haemophilia nurse and contribute to the standardization and benchmarking of haemophilia nursing care and thus to improvement in the quality of patient care.

The tumour suppressor gene WWOX is mutated in autosomal recessive cerebellar ataxia with epilepsy and mental retardation

We previously localized a new form of recessive ataxia with generalized tonic-clonic epilepsy and mental retardation to a 19 Mb interval in 16q21-q23 by homozygosity mapping of a large consanguineous Saudi Arabian family. We now report the identification by whole exome sequencing of the missense mutation changing proline 47 into threonine in the first WW domain of the WW domain containing oxidoreductase gene, WWOX, located in the linkage interval. Proline 47 is a highly conserved residue that is part of the WW motif consensus sequence and is part of the hydrophobic core that stabilizes the WW fold. We demonstrate that proline 47 is a key amino acid essential for maintaining the WWOX protein fully functional, with its mutation into a threonine resulting in a loss of peptide interaction for the first WW domain. We also identified another highly conserved homozygous WWOX mutation changing glycine 372 to arginine in a second consanguineous family. The phenotype closely resembled the index family, presenting with generalized tonic-clonic epilepsy, mental retardation and ataxia, but also included prominent upper motor neuron disease. Moreover, we observed that the short-lived Wwox knock-out mouse display spontaneous and audiogenic seizures, a phenotype previously observed in the spontaneous Wwox mutant rat presenting with ataxia and epilepsy, indicating that homozygous WWOX mutations in different species causes cerebellar ataxia associated with epilepsy.

Deferasirox (ICL670A) effectively inhibits oesophageal cancer growth in vitro and in vivo

BACKGROUND AND PURPOSE

Growing evidence implicates iron in the aetiology of gastrointestinal cancer. Furthermore, studies demonstrate that iron chelators possess potent anti-tumour activity, although whether iron chelators show activity against oesophageal cancer is not known.

EXPERIMENTAL APPROACH

The effect of the iron chelators, deferoxamine (DFO) and deferasirox, on cellular iron metabolism, viability and proliferation was assessed in two oesophageal adenocarcinoma cell lines, OE33 and OE19, and the squamous oesophageal cell line, OE21. A murine xenograft model was employed to assess the effect of deferasirox on oesophageal tumour burden. The ability of chelators to overcome chemoresistance and to enhance the efficacy of standard chemotherapeutic agents (cisplatin, fluorouracil and epirubicin) was also assessed.

KEY RESULTS

Deferasirox and DFO effectively inhibited cellular iron acquisition and promoted intracellular iron mobilization. The resulting reduction in cellular iron levels was reflected by increased transferrin receptor 1 expression and reduced cellular viability and proliferation. Treating oesophageal tumour cell lines with an iron chelator in addition to a standard chemotherapeutic agent resulted in a reduction in cellular viability and proliferation compared with the chemotherapeutic agent alone. Both DFO and deferasirox were able to overcome cisplatin resistance. Furthermore, in human xenograft models, deferasirox was able to significantly suppress tumour growth, which was associated with decreased tumour iron levels.

CONCLUSIONS AND IMPLICATIONS

The clinically established iron chelators, DFO and deferasirox, effectively deplete iron from oesophageal tumour cells, resulting in growth suppression. These data provide a platform for assessing the utility of these chelators in the treatment of oesophageal cancer patients.

WWOX, the common chromosomal fragile site, FRA16D, cancer gene

Gross chromosomal rearrangements and aneuploidy are among the most common somatic genomic abnormalities that occur during cancer initiation and progression, in particular in human solid tumor carcinogenesis. The loss of large chromosomal regions as consequence of gross rearrangements (e.g. deletions, monosomies, unbalanced translocations and mitotic recombination) have been traditionally associated with the existence of tumor suppressor genes within the areas affected by the loss of genetic material. The long arm of chromosome 16 was identified as being frequently associated with structural abnormalities in multiple neoplasias, that led us to focus attention on the detailed genetic dissection of this region resulting in the cloning of the putative tumor suppressor gene, WWOX (WW domain containing Oxidoreductase). Interestingly, the WWOX gene resides in the very same region as that of the common chromosomal fragile site 16D (FRA16D). The WWOX gene encodes a protein that contains two WW domains, involved in protein-protein interactions, and a short chain dehydrogenase (SDR) domain, possibly involved in sex-steroid metabolism. We have identified the WWOX WW domain ligand as the PPXY motif confirming the biochemical activity of this domain. WWOX normally resides in the Golgi and we will demonstrate that Golgi localization requires an intact SDR. Inactivation of the WWOX gene during tumorigenesis can occur by homozygous deletions and possibly mutation, however, aberrantly spliced forms of WWOX mRNA have been observed even when one allele is still intact. The aberrantly spliced mRNAs have deletions of the exons that encode the SDR and these WWOX protein isoforms display abnormal intracellular localization to the nucleus possibly functioning as dominant negative inhibitors of full length WWOX. Thus, generation of aberrant transcripts of WWOX may represent a novel mechanism to functionally inactivate WWOX without genomic alteration of the remaining allele. In this article we will review the cloning and identification of WWOX as the target of FRA16D. In addition, we will discuss the possible biochemical functions of WWOX and present evidence that ectopic WWOX expression inhibits tumor growth.

Localization of phospho-beta-dystroglycan (pY892) to an intracellular vesicular compartment in cultured cells and skeletal muscle fibers in vivo

beta-Dystroglycan is a ubiquitously expressed integral membrane protein that undergoes tyrosine phosphorylation in an adhesion-dependent manner. Tyrosine 892 is now thought to be the principal site for recognition by the c-Src tyrosine kinase; however, little is known about the regulation of this phosphorylation event in vivo. Here, we generated a novel monoclonal antibody probe that recognizes only tyrosine 892 phosphorylated beta-dystroglycan (pY892). We show that upon tyrosine phosphorylation, beta-dystroglycan undergoes a profound change in its sub-cellular localization (e.g., from the plasma membrane to an internal membrane compartment). One possibility is that the net negative charge at position 892 causes the redistribution of beta-dystroglycan to this intracellular vesicular location. In support of this notion, mutation of tyrosine 892 to glutamate (Y892E) is sufficient to drive this intracellular localization, while other point mutants (Y892F and Y892A) remain at the plasma membrane. Interestingly, our colocalization studies with endosomal markers (EEA1, transferrin, and transferrin receptor) suggest that these phospho-beta-dystroglycan containing internal vesicles represent a subset of recycling endosomes. At the level of these internal vesicular structures, we find that tyrosine phosphorylated beta-dystroglycan is colocalized with c-Src. In addition, we demonstrate that known ligands for alpha-dystroglycan, namely, agrin and laminin, are able to induce the tyrosine phosphorylation of beta-dystroglycan. Finally, we show that tyrosine phosphorylated beta-dystroglycan is also detectable in skeletal muscle tissue lysates and is localized to an internal vesicular membrane compartment in skeletal muscle fibers in vivo. The generation of a phospho-specific beta-dystroglycan (pY892) mAb probe provides a new powerful tool for dissecting the role of dystroglycan phosphorylation in normal cellular functioning and in the pathogenesis of muscular dystrophies.

Caveolin-3 directly interacts with the C-terminal tail of beta -dystroglycan. Identification of a central WW-like domain within caveolin family members

Caveolin-3, the most recently recognized member of the caveolin gene family, is muscle-specific and is found in both cardiac and skeletal muscle, as well as smooth muscle cells. Several independent lines of evidence indicate that caveolin-3 is localized to the sarcolemma, where it associates with the dystrophin-glycoprotein complex. However, it remains unknown which component of the dystrophin complex interacts with caveolin-3. Here, we demonstrate that caveolin-3 directly interacts with beta-dystroglycan, an integral membrane component of the dystrophin complex. Our results indicate that caveolin-3 co-localizes, co-fractionates, and co-immunoprecipitates with a fusion protein containing the cytoplasmic tail of beta-dystroglycan. In addition, we show that a novel WW-like domain within caveolin-3 directly recognizes the extreme C terminus of beta-dystroglycan that contains a PPXY motif. As the WW domain of dystrophin recognizes the same site within beta-dystroglycan, we also demonstrate that caveolin-3 can effectively block the interaction of dystrophin with beta-dystroglycan. In this regard, interaction of caveolin-3 with beta-dystroglycan may competitively regulate the recruitment of dystrophin to the sarcolemma. We discuss the possible implications of our findings in the context of Duchenne muscular dystrophy.

Interactions between dietary fat type and xylanase supplementation when rye-based diets are fed to broiler chickens 2. Performance, nutrient digestibility and the fat-soluble vitamin status of livers

1. The interactions between dietary fat type and xylanase supplementation of rye-based diets were investigated using a 2 x 2 factorial design in which a rye-based diet (610 g rye/kg) was combined with 100 g/kg of soya oil or beef tallow, with or without xylanase supplementation at 3000 IU/kg, and fed to 1-d-old male broilers for 35 d. Growth, nutrient digestibility and AMEN values were determined and the vitamin status of livers assessed at various ages. 2. There were significant interactions between crude fat and xylanase supplementation on the faecal digestibility of crude fat and crude protein. Fat digestibility was improved by xylanase in both fat type groups but to a greater extent for the tallow diets. However, the effects were found to be significant only for oleic, linoleic and linolenic acids. Similarly, protein digestibility and AMEN values were significantly improved by xylanase, but only for the tallow diet. 3. Ileal digestibility of nitrogen and amino acids also were affected by enzyme for both fat type diets, the effect generally being more pronounced for the tallow diet. 4. The deposition of the fat soluble vitamins A and E in livers was significantly increased by xylanase supplementation and was also better for soya oil than for tallow. 5. Xylanase supplementation increased the digestibility of insoluble pentosans whereas for the soluble pentosans the opposite effect was noted. 6. Without xylanase supplementation the tallow-based diet caused high mortality. Liveweight gain and the efficiency of food utilisation were greatest in the soya oil-based, xylanase-supplemented diet, followed by the unsupplemented soya oil-, supplemented tallow- and unsupplemented tallow-based diets.

Interactions between dietary fat type and xylanase supplementation when rye-based diets are fed to broiler chickens. 1. Physico-chemical chyme features

1. The interactions between fat type and xylanase supplementation of rye-based diets were investigated using a 2 x 2 factorial design in which a rye-based diet (610 g rye/kg) was combined with 100 g/kg of soya oil or beef tallow, with and without xylanase supplementation at 3000 IU/kg, and fed to 1-d-old male broilers. Food passage time, viscosity of digesta supernatant, xylanase activity and pH in different segments of the digestive tract were examined. 2. Food passage throughout the digestive tract was accelerated by enzyme addition regardless of fat type. The time taken for 50% of the marker to be excreted was reduced from 8.4 to 6.7 h in animals receiving the rye-soya oil diets and from 8.0 to 6.9 h with the rye-tallow diets. 3. Viscosity in the supernatant of the jejunal and ileal digesta was markedly decreased after enzyme addition. Viscosities were generally higher in the ileal than in the jejunal supernatant, and fell as the birds aged from 14 to 28 d. The effect of enzyme was also reduced in older chicks. There was not a clear effect of the fat source on viscosity. 4. Xylanase activity was still found at the end of the ileum in digesta of birds fed on the enzyme-supplemented diets but not in control animals. Xylanase activity was also detected in the caeca of all groups. 5. Significantly lower pH values were found in tallow-fed birds in some segments of the digestive tract. A significant increase in pH after enzyme addition was detected in the proximal ileum; this was independent of fat source.

Fibroblast growth factor receptor-1 (FGFR-1) is essential for normal neural tube and limb development

Fibroblast growth factor receptor-1 (FGFR-1) is a membrane-spanning tyrosine kinase that serves as a high-affinity receptor for fibroblast growth factors. It has recently been shown that FGFR-1 mutant embryos die during gastrulation displaying severe growth retardation and defective mesodermal structures. This early lethality has obscured functions of FGFR-1 that might occur later in development. To circumvent these embryonic defects, we generated chimeras by injecting FGFR-1-deficient (R1-/-) ES cells into wild-type blastocysts. We found that the fgfr-1 gene plays an important role after gastrulation and that it acts in a cell-autonomous fashion. Embryos with a high contribution of R1-/- cells replicate the FGFR-1 null phenotype and die during gastrulation. In contrast, the majority of embryos with a low contribution of R1-/- cells complete gastrulation and display malformations of posterior structures at later stages of embryogenesis. These abnormalities include truncation of embryonic structures, limb bud malformation, partial duplication of the neural tube, tail distortion, and spina bifida caused by the amplification of neural tissue in the posterior portion of the spinal cord. Thus, FGFR-1 plays a role in neurulation, suggesting that there may be a connection between FGFR-1-mediated signal pathways and neural tube defects, the most common malformations in the human central nervous system.

Early expression of D3 dopamine receptors in murine embryonic development

In order to determine whether the D2 and D3 dopamine receptors may have a role in prenatal development, we have studied the mRNA expression and distribution of these receptors during murine embryonic development. Using RT-PCR on RNA from embryos taken at progressive stages of development, we have shown that the D3 receptor is expressed significantly earlier than the D2 receptor, being detectable at day 9.5 post-conception (p.c.) compared with day 13.5 p.c. for the D2 subtype. We have also examined the mRNA distribution of the two receptors by whole mount in situ hybridisation. In agreement with the PCR assays, the D3 receptor was expressed earlier than the D2 subtype. D3 receptor transcripts were first detected at day 9.5 p.c. in the ventral aspect of the anterior neural tube, whereas D2 receptor transcripts first appeared a day later. By day 10.5-11.5 p.c. both D3 and D2 receptor transcripts were present in the developing forebrain, and later also in the branchial arches and along the prospective vertebral column. The early appearance of the D3 subtype in murine development and its predominance over the D2 subtype suggest that the D3 receptor may have a functional role in prenatal development.

Meningitis caused by Streptococcus pneumoniae showing high level resistance to penicillin

A case of meningitis caused by a strain of Streptococcus pneumoniae (SPn) showing high level resistance to penicillin is described. The patient responded to a combination of high dose penicillin and ceftriaxone. After reviewing the Australian situation and the world literature, we propose that empiric treatment of SPn meningitis in Australia should consist of high dose penicillin plus a third generation cephalosporin, with appropriate modification once the identification of the organism and its susceptibilities are confirmed.

Analysis of the Hoxd-3 gene: structure and localization of its sense and natural antisense transcripts

This study set out to investigate the structure and localized expression of the mouse homeobox-containing gene Hoxd-3. In addition to identifying a transcript of the type known from other Antennapedia (Antp)-like mammalian homeobox cDNAs, an antisense transcript was also detected. The antisense form of Hoxd-3 overlaps with 603 bp of the sense transcript including the homeobox. Active antisense transcription has been confirmed by RNA blot analysis with single-stranded probes and by the direction of splicing of an intron in the antisense transcript. The localized expression of sense and antisense transcripts was compared by in situ hybridization. Hoxd-3 expression was observed from 8.5 days p.c., in the neural tube with a sharp border in the hind brain at the level of rhombomeres 4-5. In contrast, the earliest antisense expression was detected at 10.5 days p.c. in cDNA libraries. At 12.5 days p.c., sense and antisense transcripts colocalized in the liver. The possible role of antisense homeobox transcripts during liver and the hematopoietic development is discussed.

Identification of fibroblast growth factor 9 (FGF9) as a high affinity, heparin dependent ligand for FGF receptors 3 and 2 but not for FGF receptors 1 and 4

Fibroblast growth factors (FGF) are multifunctional, heparin binding polypeptides that share structural similarity, but differ in their target cell specificity and expression pattern. Here we describe the cloning and expression of the mouse homologue of FGF9, and the use of a panel of soluble FGF receptors and genetically engineered cells to study its receptor binding specificity. FGF9 is found to bind with high affinity (kd: 0.25 nM) to FGFR3, for which a specific ligand has not yet been identified. FGF9 can also bind, albeit with a lower affinity, to FGFR2 but does not bind FGFR1 or FGFR4. There is no significant binding to either FGFR3 or FGFR2, expressed either as soluble receptors or in heparin sulfate deficient cells, in the absence of heparin. Moreover, receptor binding of FGF9 requires heparin in a manner specific to the receptor type. In conclusion FGF9 presents a unique case of ligand-receptor specificity and fulfills the criteria as a high affinity, heparin-dependent ligand for FGFR3.

Canola meal and diet acid-base balance for broilers

Experiments were undertaken to investigate the influence of dietary sulphur, calcium and altered anion-cation balance on the response of chicks fed soybean or canola meal diets.The addition of supplemental sulphur to a semi-purified soybean meal diet resulted in a marked decrease in feed intake and weight gain. Additional dietary calcium helped to alleviate the depression caused by excess dietary sulphur. Plotting dietary meq (ranging from −3.7 to +13.4) against weight gain suggested that anion–cation balance was responsible, in part, for the responses noted. Supplementing a canola meal semi-purified diet with sulphur, calcium and a mixture of potassium and sodium carbonate to alter diet anion–cation balance by 0, 10 and 20 meq confirmed that the interaction noted with dietary sulphur and calcium supplementation of soybean and canola meals diets is caused in large part by changes in anion–cation balance of the diet. Thus the present data confirm previous suggestions that part of the growth depression noted with canola meal supplemented diets is due to its high sulphur content and thus an altering of anion–cation balance. Key words: Broilers, canola meal, acid base balance, sulphur, sodium, calcium, potassium

Effect of splenectomy on HIV-related thrombocytopenia and progression of HIV infection in patients with severe haemophilia

Between May 1983 and September 1991 eleven patients with severe haemophilia underwent splenectomy for HIV-related thrombocytopenia. The sustained complete remission rate (platelets > 100 x 10(9)/l) was 82% over a mean follow-up period of 54 months. The group was compared with 22 age-matched non-thrombocytopenic HIV seropositive haemophiliacs who had not undergone splenectomy. Both groups had equivalent use of factor concentrate and there was no significant difference between the groups in terms of anti-retroviral treatment. Analysis of clinical progression of HIV infection and CD4 positive lymphocyte (CD4+) counts, for the time since splenectomy, revealed no significant difference in progression of HIV infection in the splenectomized group compared with the control group. It is concluded that splenectomy is an effective treatment for HIV-related thrombocytopenia and has no adverse effect on the progression of HIV infection.

Sulphur and calcium supplementation of soybean and canola meal diets

No significant difference in weight gain or feed:gain ratio was noted with 6-wk-old male broilers fed a practical type corn-soybean meal diet or a similar diet containing 25% canola meal. Supplementing the canola meal diet with 0.2% sulphur, however, did significantly reduce gain. A reduction in feed intake and total abdominal fat was noted with the canola-meal-supplemented diets as compared to the corn-soybean meal diets. In a second experiment, sulphur addition to a soybean meal, semi-purified, low-protein, low-calcium diet, resulted in weight gains and feed intakes similar to those noted in a canola meal diet with the same levels of sulphur fed to male broilers from 7 to 21 d of age. As sulphur was added to the soybean meal diet, there was a linear depression in weight gain and feed intake which was partially overcome by calcium supplementation. Sulphur appeared to exert its negative effect on performance by reducing feed intake rather than interfering with the efficiency of utilization of the diets. The present results suggest that high levels of inorganic sulphur in canola meal are a major factor in the reduced performance often reported with canola-meal-supplemented diets. Key words: Chickens, canola, sulphur, calcium, feed intake

Allografted keratinocytes used to accelerate the treatment of burn wounds are replaced by recipient cells

Cultured keratinocytes were used as allografts on burn wounds in two patients. In both patients successful covering of the wounds was obtained. DNA fingerprinting of the epidermis covering the wounds 21 days later showed that the cultured keratinocytes were replaced by the patients' cells.

Factors influencing the response of broiler chickens to calcium supplementation of canola meal

The present study was undertaken to investigate whether broiler chicks fed canola meal, as compared with diets of soybean meal, would respond to a higher level of supplemental calcium. Supplementing canola basal diets and soybean-meal basal diets with additional sulfur from sodium sulfate resulted in little or no change in broiler performance. However, supplementing diets with organic sulfur (cystine) caused a marked decrease in weight gain and feed intake, more severe with a canola diet than with a soybean-meal diet and which could be partially alleviated by increasing the calcium supplementation. A significant cystine-by-calcium interaction showed that feed intake dropped markedly, especially at the higher levels of calcium, as the levels of cystine supplementation increased. Part of the reduced performance, sometimes noted when diets supplemented with canola meal are used, may be due to a reduction in feed intake resulting from an interaction between dietary calcium and sulfur.

Purple urine bags

Purple urine drainage bags were found in 7 of 71 chronically catheterized elderly women. The purple staining of the bags is due to a violet discoloration (indirubin) of the plastic of the catheter bag and fine blue crystals of indigo in the urine. The colors are formed from the substrate indoxyl sulfate (indican) and all 7 patients had bacteria in the urine that would produce blue colonies on agar enriched with the urine (filter sterilized) of the patients involved. Organisms identified were Providencia or Klebsiella species. Indican excretion was higher in patients with purple urinary catheter bags than in controls.

Cobalt plaque versus enucleation for uveal melanoma: comparison of survival rates

Two hundred and twenty-three patients treated by cobalt plaque for uveal melanoma were compared with 416 patients treated by enucleation for uveal melanoma in terms of patient survival. The median follow-up time for the patients treated by cobalt plaque was 4.3 years. Kaplan-Meier survival curves were calculated up to five years following treatment based on time to tumour-related deaths. Cox's proportional hazards multivariate analysis was performed to determine which variables were related to melanoma-related deaths while controlling for age, size, and location of the tumours. Statistically significant predictive factors were location of tumour and largest tumour dimension. There was not a statistically significant difference in survival between patients treated by cobalt plaque and those treated by enucleation.