Structural and immunologic correlates of chemically stabilized HIV-1 envelope glycoproteins

Inducing broad spectrum neutralizing antibodies against challenging pathogens such as HIV-1 is a major vaccine design goal, but may be hindered by conformational instability within viral envelope glycoproteins (Env). Chemical cross-linking is widely used for vaccine antigen stabilization, but how this process affects structure, antigenicity and immunogenicity is poorly understood and its use remains entirely empirical. We have solved the first cryo-EM structure of a cross-linked vaccine antigen. The 4.2 Å structure of HIV-1 BG505 SOSIP soluble recombinant Env in complex with a CD4 binding site-specific broadly neutralizing antibody (bNAb) Fab fragment reveals how cross-linking affects key properties of the trimer. We observed density corresponding to highly specific glutaraldehyde (GLA) cross-links between gp120 monomers at the trimer apex and between gp120 and gp41 at the trimer interface that had strikingly little impact on overall trimer conformation, but critically enhanced trimer stability and improved Env antigenicity. Cross-links were also observed within gp120 at sites associated with the N241/N289 glycan hole that locally modified trimer antigenicity. In immunogenicity studies, the neutralizing antibody response to cross-linked trimers showed modest but significantly greater breadth against a global panel of difficult-to-neutralize Tier-2 heterologous viruses. Moreover, the specificity of autologous Tier-2 neutralization was modified away from the N241/N289 glycan hole, implying a novel specificity. Finally, we have investigated for the first time T helper cell responses to next-generation soluble trimers, and report on vaccine-relevant immunodominant responses to epitopes within BG505 that are modified by cross-linking. Elucidation of the structural correlates of a cross-linked viral glycoprotein will allow more rational use of this methodology for vaccine design, and reveals a strategy with promise for eliciting neutralizing antibodies needed for an effective HIV-1 vaccine.

The transient intraluminal filament middle cerebral artery occlusion model as a model of endovascular thrombectomy in stroke

The clinical relevance of the transient intraluminal filament model of middle cerebral artery occlusion (tMCAO) has been questioned due to distinct cerebral blood flow profiles upon reperfusion between tMCAO (abrupt reperfusion) and alteplase treatment (gradual reperfusion), resulting in differing pathophysiologies. Positive results from recent endovascular thrombectomy trials, where the occluding clot is mechanically removed, could revolutionize stroke treatment. The rapid cerebral blood flow restoration in both tMCAO and endovascular thrombectomy provides clinical relevance for this pre-clinical model. Any future clinical trials of neuroprotective agents as adjuncts to endovascular thrombectomy should consider tMCAO as the model of choice to determine pre-clinical efficacy.

Neonatal renal vein thrombosis and prothrombotic risk

A case of extensive deep venous thrombosis in a four a day old infant was presented. Unusually this patient was shown to be heterozygous for three thrombophilia genes; Factor V Leiden, prothrombin and antithrombin gene mutations, the latter being novel.

CONCLUSION

There are no randomized controlled trials to guide management in deep venous thrombosis in the newborn but knowledge of the prothrombotic risk factors may help direct treatment.

The application of genetic markers for EBLV surveillance in European bat species

The United Kingdom has performed passive surveillance for European bat lyssaviruses (EBLVs) since 1987, and species-targeted surveillance since 2003. One critical component of these studies is the accurate identification of bats either submitted for testing or sampled in the field. Identification is dependent on numerous morphological characteristics. Whilst this is an effective means of bat identification, a number of problems remain with this approach. It relies on the experience of bat specialists and can lead to problems in differentiating members of the Myotis genus, particularly between Myotis mystacinus (whiskered bat) and Myotis brandtii (Brandt's bat), and between the most common species of the genus Pipistrellus. Furthermore, degradation of bats submitted for testing can also lead to problems in making an accurate species identification. Comparison of genetic sequence data could offer an alternative approach to differentiating bat species when morphological characterisation is not possible. Using tissue samples from UK resident bat species, sequence analysis of the mitochondrial DNA cytochrome b gene, and the beta-actin gene allowed for identification of many of the most common bat species in the UK, and genetic separation of two morphologically cryptic species. Application of this approach identified the species of a bat infected with EBLV-2 in Surrey as Myotis daubentoni (Daubenton's bat).

Passive surveillance (1987 to 2004) of United Kingdom bats for European bat lyssaviruses

Passive surveillance for European bat lyssaviruses (eblvs) in the uk began in 1987, and between 1987 and 2004, 4,883 bats of European origin (4,871 belonging to 17 UK resident species and 12 belonging to seven non-uk resident species) were tested. The proportions and numbers of each species submitted from different regions varied considerably, partly owing to inherent biases in the passive surveillance, and there were seasonal variations in the numbers, sex and age of the bats. Contact with cats was reported in approximately 30 per cent of the bats submitted. Daubenton's bat (Myotis daubentonii) was the only species found to be positive for lyssavirus infection, with four cases of eblv type 2 identified, in 1996, 2002, 2003 and 2004. No active infection with eblv type 1 was recorded.

EBLV-2 prevalence in the United Kingdom as determined by surveillance testing

Five cases of EBLV-2 have been detected in the UK since 1996, with all wildlife cases in the Daubenton's bat: one on the south coast in Sussex in 1996, one in Lancashire in 2002, another in 2003, one in Surrey in 2004 and a human fatality in Angus, Scotland, in 2002. As a result of the human case, a seroprevalence study, aimed primarily at the Daubenton's bat was conducted in 2003 in Scotland and at some sites in England. In Scotland, 198 Daubenton's, 20 Natterer's and 6 pipistrelles were caught at 19 sites and analysed, while in England 67 Daubenton, 2 Brandts/ Whiskered and 4 pipistrelle bats were analysed from four sites in Lancashire. Analysis of blood was performed by a modified fluorescent antibody virus neutralisation test (mFAVN) to determine antibody titre to EBLV-2. Ignoring those sites where we had a priori reason to expect infected bats, the overall seroprevalence was between 0.7-5.1 % (95 % confidence interval), with a maximum likelihood estimate of 2.2 %. Mouth swabs were taken and tested for virus genome by RT-PCR and live virus by tissue culture isolation. All of the PCR and isolation results were negative suggesting that none of the bats sampled were actively excreting virus. This suggests a low level of active infection in Britain and raises the possibility that bats may recover following exposure to EBLV-2.

Urokinase induced fibrinolysis in thromboelastography: a model for studying fibrinolysis and coagulation in whole blood

BACKGROUND

The contact system (CS) proteins, factor XII and prekallikrein are thought to have roles in blood coagulation and fibrinolysis. Recent research has suggested that the CS proteins might be more important in fibrinolysis and cell function than in coagulation. Most studies on fibrinolysis have used plasma or euglobulin assays, ignoring the influence of cellular elements of blood on the fibrinolytic process.

OBJECTIVE AND METHODS

In order to study both coagulation and fibrinolysis in whole blood (WB), we have developed a thromboelastography (TEG) assay to investigate both coagulation and fibrinolysis in the same blood sample. In this assay, named urokinase (UK) induced fibrinolysis in thromboelastography (UKIFTEG), TEG is performed on recalcified citrated WB in the presence of UK. Large variations in Ly60 (percentage lysis 60 min after clot formation) were obtained between different donors with the same UK concentration. The UKIFTEG assay was therefore performed using UK concentrations that gave Ly60 values in the approximate range of 20-40%.

RESULTS

The effect of CS activation was investigated in the presence or absence of celite (10 mg mL(-1) blood). Celite shortened the clotting time (CT), and increased Ly60 values. Factor XIIa (FXIIa) and plasma kallikrein (KK) produced concentration dependent reductions in CT (significant at concentrations of 1303 and 2600 ng mL(-1) blood, respectively) and increased Ly60 values (significant at concentrations of 652 and 1300 ng mL(-1) blood, respectively).

CONCLUSIONS

Our results show that CS activation and both FXIIa and KK produce reductions in clotting time and enhanced fibrinolysis in UKIFTEG.

The antigenic binding site(s) of antibodies to factor XII associated with the antiphospholipid syndrome

Phospholipid binding proteins, including factor XII (FXII), are known to be targeted by antiphospholipid antibodies (aPA). Factor XII antibodies (FXIIab) have been described in some patients with the antiphospholipid syndrome (APS) and have been shown to lead to reduced levels of FXII. The antigenic binding site(s) and the pathophysiological effects of FXIIab are unknown. In an attempt to elucidate the binding site of these antibodies, immobilized plasma kallikrein was used to cleave FXII into its 52-kDa heavy-chain (HCFXII) and 28-kDa light-chain (LCFXII) components. Plasma samples from 12 female patients with definite APS and FXIIab were investigated for the presence of antibodies to FXII, HCFXII and LCFXII. All but one patient's plasma reacted to FXII, HCFXII and LCFXII in a similar manner. One patient gave markedly reduced positivity to HCFXII and LCFXII, suggesting that the FXIIab in this patient had a higher affinity for the intact FXII molecule. To further investigate the antigenic binding site(s) of FXII, 150 biotinylated peptides of the known FXII sequence were synthesized using a Multipin(TM) peptide synthesis procedure. The IgG and IgM fractions of the 12 patients' plasma were purified by affinity chromatography. The synthesized peptides were captured on streptavidin plates and individual patients' purified FXIIab assayed against the peptides in a modified enzyme-linked immunosorbent assay (ELISA). Two regions were identified as possible antigenic binding site(s) for FXIIab: one in the growth factor domain and the other in the catalytic domain.

Single-nucleotide polymorphisms in the p53 pathway

A cell culture assay has been developed that detects and validates single-nucleotide polymorphisms (SNPs) in genes that populate the p53 pathway. One hundred thirteen EBV-transformed human B-lymphocyte cell lines obtained from a diverse population were employed to measure the apoptotic response to gamma radiation. Each cell line undergoes a reproducible, characteristic frequency of apoptosis, and the response of the population forms a normal distribution around a median of 35.5% apoptosis with a range from 12% to 58% apoptosis. Polymorphisms in the AKT1 and Perp genes significantly affect the frequency of apoptosis. The assay can detect both racial and sexual dimorphisms in these genes and has the ability to demonstrate epistatic relationships within the p53 pathway. The cell lines used in this assay provide biological materials to explore the molecular basis of the polymorphisms.

Teaching social skills to people with autism

The treatment of social skills deficits remains one of the most challenging areas in meeting the needs of people with autism. Difficulties in understanding social stimuli, in initiating and responding to social bids, and in appreciating the affect that is intrinsic to social interactions can be baffling for people with autism. Researchers and practitioners of applied behavior analysis have tried a variety of strategies for teaching social skills. This article examines a range of useful procedures for teaching social skills to people with autism, including skills that are adult mediated, peer mediated, and child-with-autism mediated. The authors also consider the potential of classwide interventions in inclusive settings, pivotal response training, and the use of scripts to teach social initiations.

Characterization of Escherichia coli type 1 pilus mutants with altered binding specificities

PCR mutagenesis and a unique enrichment scheme were used to obtain two mutants, each with a single lesion in fimH, the chromosomal gene that encodes the adhesin protein (FimH) of Escherichia coli type 1 pili. These mutants were noteworthy in part because both were altered in the normal range of cell types bound by FimH. One mutation altered an amino acid at a site previously shown to be involved in temperature-dependent binding, and the other altered an amino acid lining the predicted FimH binding pocket.

Peptide mimic of phosphorylcholine, a dominant epitope found on Streptococcus pneumoniae

Even in the age of antibiotics, Streptococcus pneumoniae causes significant morbidity, especially in the young, the elderly, and the immunocompromised. While a carbohydrate-based vaccine exists, it is poorly immunogenic in the at-risk populations. In mice, antibodies directed against phosphorylcholine (PC), an epitope present on the cell wall C polysaccharide of all pneumococcal serotypes, protect against infection. However, PC itself is a poor vaccine candidate. We report here peptide mimics of PC based on the anti-idiotypic interaction of T15 anti-PC antibodies. T15 antibodies, the dominant and protective idiotype induced in mice by PC immunization, self-associate via a 24-amino-acid region in the PC binding site (ASRNKANDYTTEYSASVKGRFIVS; peptide 1). Peptide 1 has been shown to bind in the PC binding site. We demonstrated that amino acid sequences derived from peptide 1 starting at amino acid 9, 11, or 13 inhibit PC binding. Therefore, we immunized mice with bovine serum albumin (BSA) conjugates of peptide 1 or either of two selected 12-mers. The 12-mer peptides were not immunogenic. Mice immunized with peptide 1-BSA developed an anti-PC response consisting mainly immunoglobulin G1 and expressed the T15 heavy chain. Nonetheless, neither BALB/c nor CBA/N mice were protected from lethal pneumococcal infections by immunization with peptide 1-BSA. Preliminary data suggest that peptide 1-BSA is not able to elicit the canonical T15 light chain, explaining the absence of protection. This idiotype-derived mimotope of PC is a useful tool for understanding immunologic cross-reactivity and learning to design T-cell-dependent vaccines for S. pneumoniae.

Reduced factor XII levels in patients with the antiphospholipid syndrome are associated with antibodies to factor XII

Antibodies to factor XII (FXII) have previously been identified in some patients who were lupus anti-coagulant-positive. The relationship between these antibodies and FXII levels appeared to be variable. The aim of the present study was to confirm the presence of antibodies to FXII in patients with well characterized antiphospholipid syndrome (APS) and to establish their potential effect on levels of FXII. Forty-two patients with APS were studied; 21 patients were found to have either immunoglobulin (Ig)G or IgM antibodies to FXII by enzyme-linked immunosorbent assay (ELISA) using a highly purified preparation of FXII (> 99% pure). Levels of FXII were statistically significantly lower (P = 0.02) in patients with antibodies to FXII when compared with patients without antibodies to FXII (median = 91 micro/dl, s.d. = 39.1, median = 122 micro/dl, s.d. = 41.1 respectively). Four of the 21 patients with antibodies to FXII were found to have FXII levels below the laboratory normal range. Antibodies to FXII are present in significant numbers of patients with APS and may lead to acquired FXII deficiency.

Neurotrophin receptor (p75) in the trigeminal thalamus of the rat: development, response to injury, transient vibrissa-related patterning, and retrograde transport

We report on the transient, patterned expression of p75 in the ventrobasal (VB) thalamus, the major thalamic relay for somatosensation. We immunostained the brains of developing rats ranging in age from embryonic day (E) 14.5 to postnatal day (PD) 15 with an antibody against p75. To compare p75 expression with the developing synaptic organization within VB, we also immunolocalized the synaptic-vesicle-associated protein, synaptophysin (SYN), on alternate sections. p75-immunoreactivity (IR) was dense and uniform in the ventroposterior medial nucleus (VPM) in the late embryonic and early postnatal periods (E 16.5 to PD 3). In contrast, from PD 4-10, p75-IR in the VPM was patterned, reminiscent of cytochrome-oxidase-stained barreloids, a characteristic feature of the VB in rodents. By PD 14, p75-IR in the VPM was no longer detectable. The ventroposterior lateral nucleus (VPL), in contrast, exhibited no p75-IR. No p75-IR was detected in the ventroposterior lateral nucleus (VPL) at any developmental stage in which VPM could be distinguished from VPL. Light, but clearly patterned SYN-IR, first detectable on PD 2-3, increased in intensity in both VPL and VPM through PD 15. Sectioning the infraorbital nerve on PD 0 resulted in blurred patterns of p75- and SYN-IR within VPM in PD 7-9 rat pups. Removing large portions of the somatosensory cortex on PD 0 resulted in subsequent greatly reduced p75- and SYN-IR within VB. To specify the source of the p75-IR terminals, we stereotaxically injected into the VPM of PD 4-5 rats a monoclonal antibody to p75. One to 2 days later, IR of retrogradely transported p75 antibodies could be traced within axons and cell bodies of neurons associated with the trigeminothalamic pathway through the caudal diencephalon and mesencephalon; labelling was confined to the contralateral trigeminal principal sensory nucleus. The observed, transiently patterned p75-IR in VPM the early postpartum period suggests a role for p75 in synaptogenesis and pattern formation.

Genetic characterization of Escherichia coli type 1 pilus adhesin mutants and identification of a novel binding phenotype

Five Escherichia coli type 1 pilus mutants that had point mutations in fimH, the gene encoding the type 1 pilus adhesin FimH, were characterized. FimH is a minor component of type 1 pili that is required for the pili to bind and agglutinate guinea pig erythrocytes in a mannose-inhibitable manner. Point mutations were located by DNA sequencing and deletion mapping. All mutations mapped within the signal sequence or in the first 28% of the predicted mature protein. All mutations were missense mutations except for one, a frameshift lesion that was predicted to cause the loss of approximately 60% of the mature FimH protein. Bacterial agglutination tests with polyclonal antiserum raised to a LacZ-FimH fusion protein failed to confirm that parental amounts of FimH cross-reacting material were expressed in four of the five mutants. The remaining mutant, a temperature-sensitive (ts) fimH mutant that agglutinated guinea pig erythrocytes after growth at 31 degrees C but not at 42 degrees C, reacted with antiserum at both temperatures in a manner similar to the parent. Consequently, this mutant was chosen for further study. Temperature shift experiments revealed that new FimH biosynthesis was required for the phenotypic change. Guinea pig erythrocyte and mouse macrophage binding experiments using the ts mutant grown at the restrictive and permissive temperatures revealed that whereas erythrocyte binding was reduced to a level comparable to that of a fimH insertion mutant at the restrictive temperature, mouse peritoneal macrophages were bound with parental efficiency at both the permissive and restrictive temperatures. Also, macrophage binding by the ts mutant was insensitive to mannose inhibition after growth at 42 degrees C but sensitive after growth at 31 degrees C. The ts mutant thus binds macrophages with one receptor specificity at 31 degrees C and another at 42 degrees C.

Age and IQ at intake as predictors of placement for young children with autism: a four- to six-year follow-up

The predictive power of age and IQ at time of admission to an intensive treatment program using applied behavior analysis were examined in a 4- to 6-year follow-up of educational placement. Twenty-seven children with autistic disorder who were between the ages of 31 and 65 months and had IQs on the Stanford Binet between 35 and 109 at time of admission to the Douglass Developmental Disabilities Center were followed up 4 to 6 years after they left the preschool. The results showed that having a higher IQ at intake (M = 78) and being of younger age (M = 42 months) were both predictive of being in a regular education class after discharge, whereas having a lower IQ (M = 46) and being older at intake (M = 54 months) were closely related to placement in a special education classroom. The results are interpreted as pointing to the need for very early intervention for children with Autistic Disorder. It is also emphasized that older children and those with lower IQs in the present study showed measurable gains in IQ from treatment. The data should not be taken to suggest that children older than 4 years of age do not merit high quality treatment.

Bivalency and epitope specificity of a high-affinity IgG3 monoclonal antibody to the Streptococcus group A carbohydrate antigen. Molecular modeling of a Fv fragment

The binding of Strep 9, a mouse monoclonal antibody (mAb) of the IgG3 subclass directed against the cell-wall polysaccharide of Group A Streptococcus (GAS), has been characterized. The intact antibody and proteolytic fragments of Strep 9 bind differently to GAS: the intact mAb and F(ab)2' have greater affinity for the carbohydrate epitope than the monomeric Fab or F(ab)'. A mode of binding in which Strep 9 binds bivalently to portions of the polysaccharide on adjacent chains on GAS is proposed. A competitive ELISA protocol using a panel of carbohydrate inhibitors shows that the branched trisaccharide, beta-D-GlcpNAc-(1-->3)-[alpha-L-Rhap-(1-->2)]-alpha-L-Rhap, and an extended surface are key components of the epitope recognized by Strep 9. Microcalorimetry measurements with the mAb and two synthetic haptens, a tetrasaccharide and a hexasaccharide, show enthalpy-entropy compensation as seen in other oligosaccharide-protein interactions. Molecular modeling of the antibody variable region by homology modeling techniques indicates a groove-shaped combining site that can readily accommodate extended surfaces. Visual docking of an oligosaccharide corresponding to the cell-wall polysaccharide into the site provides a putative model for the complex, in which a heptasaccharide unit occupies the site and the GlcpNAc residues of two adjacent branched trisaccharide units occupy binding pockets within the groove-shaped binding site.

One and one-half syndrome with supranuclear facial weakness: magnetic resonance imaging localization

OBJECTIVE

To provide clinicoanatomical correlation for a small pontine tegmental ischemic stroke producing the one and one-half syndrome associated with supranuclear facial weakness.

DESIGN

Case report.

SETTING

Tertiary care center.

PATIENT

A 70-year-old man developed left-sided facial weakness sparing the forehead, a left internuclear ophthalmoplegia, and a complete left horizontal gaze palsy immediately after percutaneous transluminal coronary angioplasty. Magnetic resonance imaging demonstrated a small lesion in the left paramedian aspect of the dorsal pontine tegmentum.

MAIN OUTCOME AND RESULTS

Electromyographic findings were consistent with supranuclear facial involvement. The patient had nearly complete recovery after 1 year.

CONCLUSIONS

To our knowledge, this is the first report of supranuclear facial weakness in association with the one and one-half syndrome. The location of the lesion provides evidence of the existence of corticofugal fibers that extend to the facial nucleus in the dorsal paramedian pontine tegmentum.

Antibodies to factor XII associated with lupus anticoagulant

Falsely low levels of factor XII (FXII) have been documented in patients who are lupus anticoagulant positive (LA+). In addition, we have previously noted a surprisingly high incidence (20.9%) of apparently true FXII deficiency in patients who were LA+. We have hypothesised that this may be partly due to the presence of antibodies to FXII. The aim of the present study was to investigate whether LA+ patient plasmas contain antibodies directed either against FXII or FXII in association with phospholipids. Plasma samples from 60 blood donors, all LA negative, and 51 LA+ patients were tested using ELISA assays employing purified FXII, phosphatidylserine (PS) and phosphatidylethanolamine (PE). We have identified seven patients whose plasma contained either IgG or IgM that reacted with purified FXII in the absence of PS or PE. When PS was included in the assay system four additional patient plasmas were shown to contain either IgG or IgM that reacted with FXII. The plasma of one patient contained IgG that reacted with FXII both in the presence and absence of PS. There was no reactivity to FXII with either IgG or IgM when PE was included in the assay system. Affinity purified IgG from three patients whose plasma reacted with FXII in the ELISA assay in the absence of PS, gave a positive reaction in an immunoblot assay. These results suggest that FXII antibodies are present in a significant proportion of LA+ patients and may lead to an erroneous diagnosis of FXII deficiency.

Effects of white clover content in the diet on herbage intake, milk production and milk composition of New Zealand dairy cows housed indoors

The effect of the proportion of clover in the diet (200, 500 or 800 g/kg total dry matter (DM) on milk production of cows housed indoors and fed on a mixture of perennial rye-grass and white clover was measured in mid (Expt I) and late (Expt II) lactation. Higher clover contents increased the nutritive value of the diets, resulting in increased energy and protein intakes. DM intakes of cows offered 500 or 800 g clover/kg DM diets ad lib. (Expt I and Expt II, Period 1) were not significantly different but were 11-17% greater (P < 0.05) than intakes of cows fed on 200 g clover/kg total DM diets. Cows offered restricted allowances (Expt II, Period 2) had similar intakes irrespective of diet. In Expt I cows fed on 500 or 800 g clover/kg DM diets ad lib. produced 30 or 33% respectively more milk (P < 0.05) than cows fed on 200 g clover/kg total DM diets. During Expt II, Period 1, cows fed on 500 or 800 g clover/kg DM diets ad lib. produced 18 or 16% more milk (P < 0.05) respectively than cows given 200 g clover/kg total DM diets. In both these experiments the increased milk yields were due to increased intake and the higher nutritive value of the high clover diets. There was no difference in the feed conversion efficiencies of cows if maintenance energy requirements were taken into account. However, cows on restricted allowances (Expt II, Period 2) showed no significant difference in milk yield, indicating that the effect of increased nutritive value was very slight. There were no consistent effects on milk fat, protein or lactose concentrations. Concentrations of blood and milk urea increased as the clover content of the diet increased (Expt 1 only), and this was associated with increased milk non-protein N and a decreased ratio of casein N: total N. Both trials indicated an optimum clover content in the diet for milk production of 600-700 g/kg total DM.

Evaluation of the Roche AMPLICOR MTB assay for the detection of Mycobacterium tuberculosis in sputum specimens from prison inmates

The reliability of the Roche Mycobacterium tuberculosis polymerase chain reaction (PCR) assay (AMPLICOR MTB) for the diagnosis of pulmonary tuberculosis was evaluated by testing expectorated sputum specimens from 187 inmates in Texas state prisons and comparing the results to culture and medical history. Of the 80 specimens that were culture positive for mycobacteria, 36 specimens from 16 patients grew M. tuberculosis. Forty-six specimens were smear positive for acid-fast bacilli (AFB), and of these, M. tuberculosis was isolated from 24. On initial testing, 52 specimens were PCR positive. Thirty-one of these 52 were culture positive for M. tuberculosis, and 21 were culture negative, resulting in a PCR sensitivity and specificity of 86.1 and 96.1%, respectively. After resolving discrepancies by review of the medical history and repeat testing, PCR sensitivity, specificity, and positive and negative predictive values, respectively, were 92.8, 99.8, 98.1, and 99.2%. For AFB smear-positive specimens, the sensitivity, specificity, and positive and negative predictive values, were 95.8, 100, 100, and 93.3, respectively; whereas, for AFB smear-negative specimens, these values were 87.5, 99.7, 95.5, and 99.4%, respectively. These results confirm the reliability of the AMPLICOR MTB assay for direct detection of M. tuberculosis in AFB smear-positive sputum specimens and suggest a potential role in evaluating AFB smear-negative sputum specimens.

Exploring the basis of peptide-carbohydrate crossreactivity: evidence for discrimination by peptides between closely related anti-carbohydrate antibodies

To investigate the molecular basis of antigenic mimicry by peptides, we studied a panel of closely related mAbs directed against the cell-wall polysaccharide of group A Streptococcus. These antibodies have restricted V-gene usage, indicating a shared mechanism of binding to a single epitope. Epitope mapping studies using synthetic fragments of the cell-wall polysaccharide supported this conclusion. All of the mAbs isolated crossreactive peptides from a panel of phage-displayed libraries, and competition studies indicated that many of the peptides bind at or near the carbohydrate binding site. Surprisingly, the peptides isolated by each mAb fell into distinct consensus-sequence groups that discriminated between the mAbs, and in general, the peptides bound only to the mAbs used for their isolation. Similar results were obtained with polyclonal antibodies directed against synthetic oligosaccharide fragments of the streptococcal cell-wall polysaccharide. Thus, the peptides appear to be specific for their isolating antibodies and are not recognized by the same mechanism as their carbohydrate counterparts.

The differential and temporal effects of antecedent exercise on the self-stimulatory behavior of a child with autism

The effects of two levels of exercise (walking versus jogging) in suppressing the self-stimulatory behavior of a five-year-old boy with autism were examined. The exercise conditions were applied immediately before periods of academic programming. Maladaptive self-stimulatory behaviors were separately tracked, enabling identification of behaviors that were more susceptible to change (e.g., physical self-stimulation and "out of seat" behavior) versus those that were more resistant (e.g., visual self-stimulation). Examination of temporal effects indicated a decrease in physical self-stimulation and "out of seat" behavior, but only for the jogging condition. In addition, sharp reductions in these behaviors were observed immediately following the jogging intervention and gradually increased but did not return to baseline levels over a 40 min period. Implications for further research and clinical intervention are discussed.

Tuberculosis outbreak in a Texas prison, 1994

In 1994 a Texas prison containing a population of mentally retarded inmates experienced a large tuberculosis outbreak. Fifteen cases of tuberculosis were identified (8 confirmed by positive cultures for Mycobacterium tuberculosis) and more than 100 inmates became infected. The culture-confirmed patients were infected with an identical strain of tuberculosis as demonstrated by polymerase chain reaction (PCR) based DNA fingerprinting technique. The prison followed standard tuberculosis infection control policies, but these controls were inadequate to prevent tuberculosis transmission in this special population. Two hundred and thirty inmates (119 inmates showing evidence of new tuberculosis infection or active disease and 111 healthy controls) were enrolled in the investigation. Inmate cell assignments, job duties, and educational classes were identified and medical chart reviews were conducted on all inmates. Tuberculosis transmission was associated with residing on the D Wing of the prison (OR = 25.84, P < 0.01), attending school in Classroom A (OR = 8.34, P = 0.01) and working on the prison utility work crew (OR = 2.52, P < 0.01). The index case in the outbreak had been prescribed 6 months of isoniazid (INH) chemoprophylaxis in 1988.

Localization of a yeast early Golgi mannosyltransferase, Och1p, involves retrograde transport

To analyze the mechanism of integral membrane protein localization in the early Golgi apparatus of Saccharomyces cerevisiae, we have used Och1p, a cis-Golgi mannosyltransferase. A series of influenza virus hemagglutinin (HA) epitope-tagged fusion proteins was constructed in which invertase is appended to the Golgi-luminal carboxy terminus of full-length Och1p. Several constructs included a Kex2p cleavage site between the Och1p and invertase moieties to monitor transit to the Kex2p-containing TGN. Cells expressing an Och1p-invertase fusion do not secrete invertase, but those expressing an Och1p-Kex2p site-invertase fusion protein secrete high levels of invertase in a Kex2p-dependent manner. The Och1p-Kex2p site-invertase fusion protein is cleaved with a half-time of 5 min, and the process proceeds to completion. Before cleavage the protein receives glycosyl modifications indicative of passage through the medial- and trans-Golgi, therefore cleavage occurs after ordered anterograde transport through the Golgi to the TGN. Transit to distal compartments is not induced by the invertase moiety, since noninvertase fusion constructs encounter the same glycosyltransferases and Kex2p as well. The Och1p-HA moiety, irrespective of whether it is generated by cleavage of the fusion protein in the TGN or synthesized de novo, is degraded with a half-time of about 60 min. Thus, the half-time of degradation is 12-fold longer than the time required to reach the TGN. At steady state, de novo-synthesized and TGN-generated HA epitope-tagged Och1p reside in a compartment with a buoyant density identical to that of wild-type Och1p and distinct from that of the vacuole or the TGN. Finally, och1 null cells that express an Ochlp fusion construct known to rapidly encounter the TGN glycosylate invertase to the same extent as wild-type cells, indicating that they have phenotypically wild-type Och1p activity. These results lead us to propose a model for Och1p-HA localization that involves movement to distal compartments, at least as far as the TGN, followed by retrieval to the cis compartment, presumably by vesicular transport.

Transferred nuclear Overhauser enhancement experiments show that the monoclonal antibody strep 9 selects a local minimum conformation of a Streptococcus group A trisaccharide-hapten

Transferred nuclear Overhauser enhancement (TRNOE) experiments have been performed to investigate the bound conformation of the trisaccharide repeating unit of the Streptococcus Group A cell-wall polysaccharide. Thus, the conformations of propyl 3-O-(2-acetamido-2-deoxy-beta-D-glucopyranosyl)-2-O-(alpha-L-rhamnopyran osyl)- alpha-L-rhamnopyranoside [C(A')B] (1) as a free ligand and when complexed to the monoclonal antibody Strep 9 were examined. Improved insights about the conformational preferences of the glycosidic linkages of the trisaccharide ligand showed that the free ligand populates various conformations in aqueous solution, thus displaying relatively flexible behavior. The NOE HNAc-H2A', which was not detected in previous work, accounts for a conformation at the beta-(1-->3) linkage with a phi angle of approximately 180 degrees. Observed TRNOEs for the complex are weak, and their analysis was further complicated by spin diffusion. With the use of transferred rotating-frame Overhauser enhancement (TRROE) experiments, the amount of spin diffusion was assessed experimentally, proving that all of the observed long-range TRNOEs arose through spin diffusion. Four interglycosidic distances, derived from the remaining TRNOEs and TRROEs, together with repulsive constraints, derived from the absence of TRROE effects, were used as input parameters in simulated annealing and molecular mechanics calculations to determine the bound conformation of the trisaccharide. Complexation by the antibody results in the selection of one defined conformation of the carbohydrate hapten. This bound conformation, which is a local energy minimum on the energy maps calculated for the trisaccharide ligand, shows only a change from a +gauche to a -gauche orientation at the psi angle of the alpha-(1-->2) linkage when compared to the global minimum conformation. The results infer that the bound conformation of the Streptococcus Group A cell-wall polysaccharide is different from its previously proposed solution structure (Kreis et al., 1995).

The effect of articular conformity and the size of the humeral head component on laxity and motion after glenohumeral arthroplasty. A study in cadavera

We used a cadaveric model to examine the mechanical effects of changes in the conformity of the articular surfaces and the size of the humeral head component in glenohumeral arthroplasty. The experimental system permitted a manual clinical examination of the glenohumeral joint while sensors monitored the humeroscapular position and orientation as well as the forces and torques applied by the examiner. Four preparations were compared: an anatomical humeroscapular preparation and three glenohumeral arthroplasty preparations (one with anatomically sized components and a radius of curvature of the glenoid that was four millimeters larger than that of the humeral head, one with anatomically sized components and a radius of curvature of the glenoid that was equal to that of the humeral head, and one with a non-anatomical, large humeral head component and a radius of curvature of the glenoid that was equal to that of the humeral head). All motions, including flexion, external and internal rotation, and maximum elevation, were diminished with use of the non-anatomical, large humeral head component. Laxity of the joint on drawer and sulcus tests was not affected by the conformity of the articular surfaces but was decreased significantly by implantation of the large humeral head component. The kinematics of the glenohumeral joint were not markedly altered by reduction of the uniformity between the articular surfaces of the prosthetic components. In all preparations, obligate displacement of the humeral head associated with a passive range of motion occurred at smaller angles with the large humeral head component.

Teaching children with autism to seek information: acquisition of novel information and generalization of responding

A time delay procedure was used to teach 3 children with autism to ask the question "What's that?" when novel stimuli were presented during an instructional task. Once the ability to ask the question was acquired, the children's ability to learn novel information by asking the question was assessed. The children were then taught to ask the question within a less structured context. All three studies used a multiple baseline across participants. Generalization was assessed in a different room, to a new person, and to novel stimuli. All of the children learned to ask the question within the instructional context, while on a walk in the school building, and to request information about three-dimensional objects. The acquisition of novel information was consistent for receptive and expressive tests for 2 of the children, with varied results for the 3rd. These studies indicate that children with autism can be taught to ask questions that lead to the acquisition of new information.

Dominant lethal mutations in the plasma membrane H(+)-ATPase gene of Saccharomyces cerevisiae

The plasma membrane H(+)-ATPase of Saccharomyces cerevisiae is an essential protein that is required to establish cellular membrane potential and maintain a normal internal pH. An Asp-378 to Asn substitution at the residue phosphorylated during catalysis is dominant lethal when the pma1-D378N mutation is expressed along with a wild-type plasma membrane H(+)-ATPase (PMA1) gene. Several mutations in the first two putative transmembrane domains are also dominant lethal. However, these dominant lethal mutants often appear to be innocuous, because they are frequently lost by gene conversion to the wild-type sequence during the process of introducing the mutant sequence and subsequently removing the wild-type gene. Loss of the mutation by gene conversion does not occur while introducing recessive lethal mutations. Cells carrying the wild-type PMA1 gene on the chromosome and a dominant lethal mutation under the control of a GAL1 promoter on a centromere-containing plasmid exhibit a galactose-dependent lethality. Indirect immunofluorescence staining using anti-Pma1 antibodies shows that induction of dominant lethal PMA1 mutations leads to the accumulation of a number of intensely staining cytoplasmic structures that are not coincident with the nucleus and its immediately surrounding endoplasmic reticulum. These structures also accumulate the endoplasmic reticulum protein Kar2. Expression of the dominant lethal protein also prevents transport of the wild-type ATPase to the plasma membrane.

In vivo quantification of the laxity of normal and unstable glenohumeral joints

The purpose of this study was to determine whether the magnitude of glenohumeral translation on clinical laxity tests could distinguish between clinically stable shoulders and shoulders with traumatic or atraumatic instability. Subjects included eight male volunteers with no history of symptoms of glenohumeral instability, eight patients with documented traumatic anterior instability and Bankart lesions, and eight patients with documented atraumatic multidirectional instability. The patients in the two instability groups had disabling instability that was refractory to nonoperative management and thus met the indications for surgical repair. All subjects were examined by an experienced shoulder surgeon using five standard manual tests: anterior drawer, posterior drawer, sulcus, push-pull, and fulcrum. The glenohumeral translations occurring during these laxity tests were quantitated with a spatial sensing system that had six degrees of freedom and was rigidly fixed to the scapula and humerus. The result showed substantial overlap in the translations found in members of the three groups for each of the laxity tests. Standard laxity tests demonstrate considerable translation in normal glenohumeral joints and do not reliably differentiate normal shoulders from those with two common forms of glenohumeral instability. This study suggests that assessment of the magnitude of glenohumeral translation on clinical laxity tests is not a specific test for the diagnosis of glenohumeral instability. Healthy subjects without symptoms may have as much translation as patients needing surgical repair for symptomatic shoulder instability. The need for and the type of surgical reconstruction for the unstable shoulder must be based on the patient's history and on duplication of the symptoms of instability on directed physical examination rather than on the magnitude of glenohumeral translation.

Community-based behavioral training approaches for people with mental retardation and mental illness

Challenges associated with behavioral training approaches for individuals with mental retardation and mental illness in the community are reviewed in this article. Family and nonfamily facilitated training are considered. Professional practice issues are reviewed, and justification for multifactor behavioral assessment is offered. Future research directions are discussed.

Arthroscopic labral repair to the glenoid rim

The purpose of this study was to develop a new arthroscopic approach for traumatic instability that effectively reattaches avulsed capsulolabral tissue to the glenoid articular rim with sutures. This technique does not depend on fixation devices, trans-scapular drilling, or implantation of suture anchors. We attached a three-dimensional position sensor and force and torque transducer to the humerus and scapula of eight normal cadaveric shoulders to measure the normal, surgically unstable (arthroscopic Bankart lesion), and repaired preparations. We assessed eight motion ranges and six laxity tests. Capsulolabral release increased all passive ranges and allowed significant translational increases on posterior drawer and crank testing. After repair, motion was never decreased and there were no differences in laxity relative to normal. Neurovascular structures were never at risk. Our arthroscopic repair provides anatomic reattachment and effective deepening of the glenoid con-cavity similar to that achieved by open repair. This new method restores joint stability, preserves motion, and can withstand forceful loads. Ongoing clinical trials will substantiate whether the technique is as safe and reliable as shown cadaverically.

Residual motion and function after glenohumeral or scapulothoracic arthrodesis

The purpose of this study was to characterize humerothoracic motion and function after glenohumeral or scapulothoracic arthrodesis and to compare those results with those from normal shoulders. We evaluated 12 shoulders in 11 patients at an average of 71 months after glenohumeral arthrodesis and seven shoulders in six patients at an average of 32 months after scapulothoracic arthrodesis. The residual motion of the unfused articulation was measured with a spatial position sensor. Various activities of daily living and standard clinical range-of-motion tests were performed. Nearly all humerothoracic motions were significantly decreased in patients after either type of shoulder arthrodesis. Patients with a glenohumeral fusion maintained their scapulothoracic motion at levels comparable with that of normal subjects. Residual glenohumeral extension and external rotation after scapulothoracic fusion were significantly decreased; internal rotation remained unchanged compared with motion in subjects with normal shoulders. Glenohumeral fusion decreased the patients' ability to perform personal care activities requiring extremes of internal rotation or elevation. Although glenohumeral arthrodesis limited total humerothoracic motion considerably, the majority of patients were improved functionally and were relatively free from pain. Most personal care activities were performed successfully by all patients with scapulothoracic fusion.

Inadvertent administration of rtPA to a patient with type 1 aortic dissection and subsequent cardiac tamponade

Administration of thrombolytic agents to patients with misdiagnosis of acute myocardial infarction can result in serious side effects. A case of aortic dissection that was misdiagnosed as acute myocardial infarction and received rtPA is reported. Within 1 hour of rtPA infusion, the patient developed cardiac tamponade. Type 1 aortic dissection was diagnosed by aortic angiogram. The patient underwent emergency resection of the dissection and evacuation of the pericardial and anterior mediastinal hematoma. Although he required massive transfusion of blood products intraoperatively, he is doing well 22 months after his surgery.

Convergent synthesis of an elusive hexasaccharide corresponding to the cell-wall polysaccharide of the beta-hemolytic Streptococcus group A

A convergent synthesis of a hexasaccharide corresponding to the cell-wall polysaccharide of the beta-hemolytic Streptococcus Group A is described. The strategy relies on the preparation of a key linear trisaccharide unit beta-D-GlcpNAc-(1-->3)-alpha-L-Rhap-(1-->2)-alpha-L-Rhap which has previously resisted our efforts. The trisaccharide functions both as a glycosyl acceptor and donor to give an elusive hexasaccharide. This fully functionalized unit can serve, in turn, as a glycosyl acceptor or donor for the synthesis of higher-order structures. Deprotection gives a hitherto unknown hexasaccharide for use as a hapten in immunochemical studies. The characterization of all compounds by high-resolution 1H and 13C NMR spectroscopy is also described.

Resolution of infantile Erb's palsy utilizing chiropractic treatment

OBJECTIVE

To present a case study of infantile Erb's palsy that responded to conservative chiropractic care.

CLINICAL FEATURES

A 5-wk-old infant boy suffered from a limp left arm. A clinical diagnosis of Erb-Duchenne palsy was made. Birth records were obtained to further substantiate the diagnosis.

INTERVENTION AND OUTCOME

The patient received specific chiropractic adjustments to the mid-cervical spine and muscle stimulation therapy with an upper extremity exercise program. The Erb's palsy resolved with only a mild residual "waiters tip" deformity within 2 months.

CONCLUSION

In this case, chiropractic adjustments with muscle stimulation therapy is suggested as an effective treatment for Erb's palsy. Further studies are required to better understand chiropractic's effectiveness in Erb's palsy cases.

Enhanced cytochrome-oxidase staining of the cuneate nucleus in the rat reveals a modifiable somatotopic map

Existing cytochrome oxidase (CO)-staining techniques were modified to enhance sensitivity and contrast in order to examine patterns of CO-activity in the dorsal column nuclei (DCN) of adult Long-Evans rats. Within a rostrocaudally limited region in the middle of the cuneate nucleus (CN) distinctive blotches of intense CO-activity were observed. The CO-staining was maximally differentiated approximately 0.3-0.7 mm caudal to the obex. No CO-blotches were observed anywhere else in the DCN. Transganglionic labelling (WGA-HRP) demonstrated that some of the CO-blotches in the rat CN are related to the terminal projection fields of primary afferents from the skin of the forepaws. The corresponding location of primary afferent termination fields and CO-staining patterns supports a tripartite rostrocaudal division in the rat CN, similar to that described by other investigators in cats, monkeys and raccoons. Comparing the patterns of CO-staining to (1) the cytoarchitecture (Nissl-stained sections), or to (2) the dendritoarchitecture (distribution of microtubule-associated protein 2 (MAP2) or to (3) the organization of retrogradely labelled (WGA-HRP/HRP) cuneothalamic cells, revealed no topographical organization corresponding to the CO-blotches. Postnatal (at least up to 11 days postpartum) forepaw deafferentation or removal disrupted the CO-staining pattern in the CN.

Rapid, synchronous, and stable induction of type 1 piliation in Escherichia coli by using a chromosomal lacUV5 promoter

Type 1 pili are filamentous proteinaceous appendages produced by certain members of the family Enterobacteriaceae. In Escherichia coli, the adhesive properties of these pili are due to the binding of at least one minor pilus component to mannose, a sugar common to cell surface molecules of many eukaryotic cells. The study of pilus assembly may be benefited by a rapid way of inducing pilus synthesis de novo. We describe herein the construction and characterization of a strain in which piliation can be rapidly induced by the addition of lactose or its analog isopropyl-beta-D-thiogalactopyranoside. This was accomplished by placing the chromosomal fimA gene (encoding the major structural subunit of pili) under lacUV5 promoter control. Further experiments suggested that transcription of genes downstream of fimA, whose products are required for normal pilus assembly and function, may also be controlled by the lacUV5 promoter. The construction described herein may have a variety of applications apart from aiding the study of pilus assembly since its adhesive properties can be rapidly and easily turned on and off.

Glenohumeral stability from concavity-compression: A quantitative analysis

The purpose of this research was to determine the degree to which compression of the humeral head into the glenoid concavity stabilizes it against translating forces. Ten normal fresh-frozen cadaver glenohumeral joints in which the labrum was preserved were used. A compressive load of 50 N was applied to the humeral head in a direction perpendicular to the glenoid surface. Increasing tangential forces were then applied until the head dislocated over the glenoid lip. The tangential force at dislocation was examined for eight different directions, 45° apart around the glenoid. Concavity-compression stability was then examined for an increased compressive load of 100 N. Finally, the protocol with 50 and 100 N of compressive load was repeated after the glenoid labrum was excised. Concavity-compression of the humeral head into the glenoid is a most efficient stabilizing mechanism. With the labrum intact the humeral head resisted tangential forces of up to 60% of the compressive load. The degree of compression stabilization varied around the circumference of the glenoid with the greatest magnitude superiorly and inferiorly. This may be attributed to the greater glenoid depth in these directions. Resection of the glenoid labrum reduced the effectiveness of compression stabilization by approximately 20%. These results indicate that concavity-compression may be an important mechanism for providing stability in the mid-range of glenohumeral motion where the capsule and ligaments are lax. The effectiveness is enhanced by the presence of an intact glenoid labrum.

Convergent synthesis of higher-order oligosaccharides corresponding to the cell-wall polysaccharide of the beta-hemolytic Streptococci group A. A branched hexasaccharide hapten

A convergent synthesis of a hexasaccharide corresponding to the cell-wall polysaccharide of the beta-hemolytic Streptococci Group A is described. The strategy relies on the preparation of a key branched trisaccharide unit alpha-L-Rhap-(1----2)-[beta-D-GlcpNAc-(1----3)]-alpha-L-Rhap which functions both as a glycosyl acceptor and donor. The hexasaccharide is obtained after only three glycosylation reactions. This fully functionalized unit can serve, in turn, as a glycosyl acceptor or donor for the synthesis of higher-order structures. Deprotection gives a hexasaccharide for use as a hapten in immunochemical studies. The characterization of all compounds by high resolution 1H- and 13C-n.m.r. spectroscopy is also described.

The role of the rotator interval capsule in passive motion and stability of the shoulder

The purpose of this study was to characterize the role of the capsule in the interval between the supraspinatus and subscapularis tendons with respect to glenohumeral motion, translation, and stability. We used a six-degrees-of-freedom position-sensor and a six-degrees-of-freedom force and torque-transducer to determine the glenohumoral rotations and translations that resulted from applied loads in eight cadaver shoulders. The range of motion of each specimen was measured with the capsule in the rotator interval in a normal state, after the capsule had been sectioned, and after it had been imbricated. Operative alteration of this capsular interval was found to affect flexion, extension, external rotation, and adduction of the humerus with respect to the scapula. Modification of this portion of the capsule also affected obligate anterior translation of the humeral head on the glenoid during flexion. Limitation of motion and obligate translation were increased by operative imbrication and diminished by sectioning of the rotator interval capsule. Passive stability of the glenohumeral joint was evaluated with the use of anterior, posterior, and inferior stress tests. Instability and occasional frank dislocation of the glenohumeral joint occurred inferiorly and posteriorly after section of the rotator interval capsule. Imbrication of this part of the capsule increased the resistance to inferior and posterior translation.

Laxity of the normal glenohumeral joint: A quantitative in vivo assessment

It is critical that surgeons comprehend the normal laxity of the glenohumeral joint (1) to assist them in diagnosing conditions of clinical instability and (2) to help define a therapeutic end point for the management of shoulders with excessive stiffness. In clinical practice this joint laxity is judged by standard manual tests. We report a quantitative study of the clinical in vivo laxity of the normal shoulders of eight male volunteers. To our knowledge this is the first time that the laxity revealed on standard manual clinical tests has been quantified in vivo. The relative motions of the humerus and scapula were determined with an electromagnetic spatial tracker. This device was pinned percutaneously to the humerus and scapula of each of eight normal male volunteers of ages 25 to 45 years. An experienced shoulder surgeon carried out standard manual clinical tests of glenohumeral laxity while the resulting displacements of the humeral head relative to the glenoid were measured. Spatial tracker data indicated that for each of the different tests, the positions of the glenohumeral and scapulothoracic joints were reproducible for a given subject and among subjects. Substantial glenohumeral translations were measured during those manual laxity tests in which the joint was not at the limit of its range of motion: the drawer test, 7.8 ± 4.0 mm anterior and 7.9 ± 5.6 mm posterior; the sulcus test, 10.6 ± 3.8 mm inferior; and the push-pull test, 9.0 ± 6.3 mm posterior. A minimal translation of 0.3 ± 2.5 mm was measured during the fulcrum test in which the glenohumeral ligaments were under tension. The observed translations were reproducible in each subject's shoulder. On the other hand, there was marked variability among subjects. Even though manual laxity tests are a standard part of the clinical evaluation of the shoulder, our finding that normal glenohumeral joints show substantial translations indicates that translation on clinical manual laxity testing is not in and of itself a sufficient indication for surgical stabilization.

A system for describing positions of the humerus relative to the thorax and its use in the presentation of several functionally important arm positions

The function of the shoulder is to position the arm with respect to the thorax. Humerothoracic positions are commonly described in terms of the degrees of humeral elevation in the sagittal plane (flexion) and/or the degrees of elevation in the coronal plane (abduction). This article proposes a more general system for describing positions of the arm based on the plane of humeral elevation and the angle of elevation within this plane. This system is used to present the humerothoracic positions used by eight normal subjects to perform several activities of daily living as well as those achieved in a range-of-motion examination of the shoulder. Eating, hair combing, and maximal elevation were all performed in a plane approximately 60° anterior to the coronal plane. Between reaching the perineum and washing the contralateral axilla, the humerus functioned in a range of planes extending over 180°.

Evidence for coupling between membrane and cytoplasmic domains of the yeast plasma membrane H(+)-ATPase. An analysis of intragenic revertants of pma1-105

A genetic approach was used to identify interacting portions of the plasma membrane H(+)-ATPase from Saccharomyces cerevisiae. The cellular sensitivity of the pma1-105 strain (S368F) to low external pH and to NH4+ was used to select intragenic revertants of two classes: phenotypically wild-type full revertants and partial revertants that were low pH-resistant but retained resistance to hygromycin B. All 10 full revertants had S368 restored. Among five partial revertants mapping to the original site within the phosphorylation domain, S368L and S368V were each found twice. One revertant contained an E367V substitution adjacent to the original S368F alteration. Four of 13 independently isolated second-site revertants mapped to one site, V289F, in the proposed phosphatase domain. Mutations within the proposed phosphatase and phosphorylation domains resulted in enzymes with increased vanadate sensitivity relative to the vanadate-insensitive S368F enzyme. These results suggest that sites S368, E367, and V289 contribute to a vanadate (Pi) binding domain or are able to interact with such a site within the catalytic domain. The remaining nine partial second-site revertants mapped to six sites within the putative transmembrane regions. Mutations within the transmembrane region had less of an effect on vanadate sensitivity. Most revertant enzymes showed small but significant increases in the rate of ATP hydrolysis relative to the S368F enzyme. Several enzymes no longer displayed the acid-sensitive pH-dependence seen in the S368F enzyme. These data provide novel evidence for an interaction between putative transmembrane helices 1-3 and 7 and the ATP hydrolytic portion of the enzyme.

Hardiness and social support as predictors of psychological discomfort in mothers of children with autism

Mothers of 60 children with autism participated in this study to measure the effects of social support and hardiness on the women's responses to the stressful demands of raising a child with a disability. MANOVA analysis indicated a significant main effect for hardiness, Wilks' lambda = .859, approx. F(2, 55) = 4.494, p less than .02. There were no main effects for social support, or for the interaction of social support and hardiness. In regression analyses, the best combination of predictors of depressive symptoms were the Commitment dimension on the Hardiness Questionnaire and the total score on the Interpersonal Support Evaluation List social support inventory, mult. R = .783, p less than .001. The best predictor of somatic complaints was total Hardiness score, mult. R = .698, p less than .01. There was a significant correlation between hardiness and perceived social support, r(57) = -.67, p less than .001. Results are discussed in terms of the relationship between perceived social support and hardiness and the potential buffering effect of these dimensions.