Actual and projected gaps in the provision of residential aged care in New South Wales, Australia

ObjectiveThe need for residential care services will grow significantly over the coming years as the general population in Australia continues to age. The aim of this study was to assess the adequacy of residential care services across New South Wales (NSW), Australia, in relation to the current and predicted future aging population.MethodThis study was a secondary data analysis. Existing datasets were compiled for analysis by creation of a temporal geodatabase, with predicted population data from 2019 to 2029 linked to corresponding geographic zones.ResultsDemand for operational places was over capacity in 2019, at 101.5%. From 2019 to 2029, this will grow to 120.2% of 2019 capacity by 2024 and to 135.6% by 2029. An additional 25 800 operational places will be required by 2029 to meet targets. During the previous decade of 2008-18, operational places grew by only 11 502 places.ConclusionsNSW was not providing an adequate level of residential aged care and, under current allocations, this problem will worsen substantially over time, with flow-on impacts for the health sector. With aged care reform a current federal government focus, the results of this study may guide decisions that better support the provision of residential aged care.What is known about this topic?The recently completed Australian Royal Commission into aged care noted widespread system failure and highlighted the gaps in medical services that older Australians were experiencing.What does this paper add?This paper reports that demand for residential aged care places in NSW was already over capacity in 2019 and that the availability of places varies considerably across the state. Further, an additional 25 800 operational places are required by 2029 to meet government targets. If the growth rate from the past decade is maintained, this will result in a shortfall of 14 298 aged care places in NSW alone.What are the implications?Without significant increases in the current rate of growth for aged care places, the mainstream medical and health sectors will face significant additional pressures arising from unmet need in both older patients and their informal carers.

Influences of copper-potassium ion exchange process on the optical bandgaps and spectroscopic properties of Cr3+/Yb3+ co-doped in lanthanum aluminosilicate glasses

In this study, lanthanum aluminosilicate glasses with compositions of 45SiO2-20Al2O3-12.5LaF3-10BaF2-9K2O-1Cr2O3-2.5Yb2O3 (SALBK) were prepared using the conventional melting method and copper-potassium ion exchange process. Influences of the ion exchange process between copper and potassium on the visible, upconversion, and near-infrared luminescence spectra of Cr3+/Yb3+ co-doped under excitations of 343, 490, and 980 nm LD were investigated. The EDS analysis of SALBK glasses was measured to confirm the presence of atoms in the glasses. The values of direct and indirect bandgaps of Cr3+/Yb3+ co-doped SALBK glasses were calculated and analyzed. Besides, the energy exchange processes between Cu+, Cu2+ ions, and Cr3+, Yb3+ ions were also proposed and discussed.

[The State of The Jak/Stat Pathway Affects the Sensitivity of TumorCells to Oncolytic Enteroviruses]

A test of the sensitivity of seven colon cancer cell lines to a panel of 12 nonpathogenic human enteroviruses revealed significant differences in the ability of tumor cells to become infected and replicate different viral strains. Among the factors that can affect the sensitivity of cells to viruses are differences in the state of the mechanisms of antiviral protection, associated with a reaction to type I interferons. Using the two colon cancer cell lines CaCo2 and LIM1215 as a model, significant differences were revealed in the ability of cells to defend themselves against virus infection after 16 hours of treatment with 1000 units/mL of interferon-alpha. To study the effect of the state of the interferon response system, represented by the Jak/STAT signaling pathway, on the sensitivity of cells to different strains of enteroviruses, HEK293T cell lines were used. These are capable of supporting replication of each of the tested enteroviruses, as well as maintaining the ability to protect against viral infection after the treatment with interferon. Using the CRISPR/Cas9 system, HEK293T sublines with knockouts of the IFNAR1 and STAT2 genes were obtained. The sensitivity of control and knockout cells to infection with five strains of enteroviruses and the vesicular stomatitis virus was analyzed. It was noted that knockout of the IFNAR1 and STAT2 genes resulted in an increased sensitivity to all tested viruses. In knockout cells, the levels of reproduction of the vaccine derived of poliovirus type 1, Echoviruses 7 and 30, and Coxsackie viruses B5 and A7 were also significantly increased in comparison with the control HEK293T cells. Thus, deficiencies in the Jak/STAT signaling pathway in tumor cells lead to an overall increase in the sensitivity to oncolytic viruses.

Abstract P4-13-09: Clinical effectiveness of everolimus and exemestane in advanced breast cancer patients from Asia and Africa: First efficacy and updated safety results from the phase IIIb EVEREXES study

Background

BOLERO-2 phase III trial established the efficacy of everolimus (EVE) plus exemestane (EXE) for the treatment of postmenopausal patients with hormone receptor (HR)-positive, HER2-negative, advanced breast cancer (aBC). However, in this study only a minority (<10%) of patients were recruited from African and Asia Pacific countries. Considering the potential effects of ethnic and cultural differences on treatment effectiveness, it remains compelling to confirm the safety and efficacy profile of EVE+EXE in these populations.

Methods

EVEREXES is an open-label phase IIIb, single arm, multi-center trial, which from March 2013 to October 2014 enrolled 232 post-menopausal, HR-positive and HER2-negative, aBC patients previously treated with aromatase inhibitors, across 13 countries in Asia Pacific, Middle East, North and South Africa, with a significant majority of patients being of Asian ethnicity (196, 84.5%). Its primary objective was to investigate the safety and tolerability profile of EVE+EXE. Secondary objectives were the evaluation of efficacy (assessed by PFS, ORR, and CBR based on RECIST 1.1 criteria) and change in ECOG performance status.

Results

At data cut off of 31st of January 2015, at a median follow up of 11.7 months, median PFS for the ITT population was 9.5 months [9.2-11.6 months], based on local assessment, with the observation of 1 (0.4%) CR and 35 (15.4%) PR. Regarding safety and tolerability, a majority (81.1%) of grade (G) 1/2 adverse events (AEs) was reported. In particular, the following pattern was observed in terms of % of patients who developed G1/G2/G3 mTOR-inhibition induced AEs: stomatitis (36.1, 13.7, 10.6), rash (21.6/6.2/0), fatigue (10.6, 4.4, 2.2), hyperglycemia (6.2, 11.5, 7.0), weight decrease (7.5, 7, 0.9), pneumonitis (5.7, 7, 0.9). No Grade 4 AEs related to EVE+EXE treatment were observed, with exception of one case of non infectious pneumonitis (0.4%). Median dose intensity of everolimus was 9.2 mg/day.

Conclusions

Efficacy and safety results from EVEREXES trial further confirm the role of EVE+EXE for the treatment of HR+/Her2- advanced BC patients in Eastern countries. Results were consistent with data previously reported in BOLERO-2 trial.

Citation Format: Im Y-H, Uslu R, Lee KS, Nagarkar R, Sohn J, Sevinc A, Altundag K, Chang Y-C, Abdel-Razeq H, Im S-A, Jeong J, Park HY, Arpornwirat W, Bastick P, Le TH, Ocak Arikan O, Xue HL, Canatar A, Valenti R, Kim S-B. Clinical effectiveness of everolimus and exemestane in advanced breast cancer patients from Asia and Africa: First efficacy and updated safety results from the phase IIIb EVEREXES study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-09.

Genetic association between leg conformation in young pigs and sow longevity

Longevity is important in pig production with respect to both economic and ethical aspects. Direct selection for longevity might be ineffective because 'true' longevity can only be recorded when a sow has been culled or died. Thus, indirect selection for longevity using information from other traits that can be recorded early in life and are genetically correlated with longevity might be an alternative. Leg conformation has been included in many breeding schemes for a number of years. However, proving that leg conformation traits are good early indicators for longevity still remains. Our aim was to study genetic associations between leg conformation traits of young (5 months; 100 kg) Swedish Yorkshire pigs in nucleus herds and longevity traits of sows in nucleus and multiplier herds. Data included 97 533 animals with information on conformation (Movement and Overall score) recorded at performance testing and 26 962 sows with information on longevity. The longevity traits were as follows: stayability from 1st to 2nd parity, lifetime number of litters and lifetime number of born alive piglets. Genetic analyses were performed with both linear models using REML and linear-threshold models using Bayesian methods. Heritabilities estimated using the Bayesian method were higher than those estimated using REML, ranging from 0.10 to 0.24 and 0.07 to 0.20, respectively. All estimated genetic correlations between conformation and longevity traits were significant and favourable. Heritabilities and genetic correlations between conformation and longevity indicate that selection on leg conformation should improve sow longevity.

Comparison of experimental infection with northern and southern Vietnamese strains of highly pathogenic porcine reproductive and respiratory syndrome virus

The aim of this study was to compare the virulence of northern and southern Vietnamese strains of highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV) as assessed by the level of viral replication, gross and microscopical lung lesions and virus distribution in experimentally infected pigs. The northern and southern Vietnamese HP-PRRSV strains share 96.7% (non-structural protein 2) and 99.3% (open reading frame 5) nucleotide identity. On experimental challenge, approximately 50% of pigs infected with northern Vietnamese HP-PRRSV died, while death was not observed in any pigs infected with southern Vietnamese HP-PRRSV. Mean viral titres (expressed as log(10)TCID(50)/ml) were significantly (P <0.05) higher in sera and lungs from pigs infected with the northern Vietnamese HP-PRRSV than from those infected with the southern Vietnamese strain at multiple time points. Lung lesion scores and PRRSV antigen within pulmonary and lymphoid lesions were significantly (P <0.05) higher in pigs infected with northern Vietnamese HP-PRRSV than in those receiving southern Vietnamese HP-PRRSV at multiple time points. PRRSV antigens were observed in cardiac myocytes, gastric and renal tubular epithelial cells and astrocytes and microglia of white matter in the brain from pigs infected with the northern Vietnamese HP-PRRSV strain only. Thus, genetic similarity did not predict the degree of virulence of these strains. Northern Vietnamese HP-PRRSV was more virulent and had extended tissue tropism when compared with southern Vietnamese HP-PRRSV.

Assessment of a 27-kDa antigen in enzyme-linked immunosorbent assay for the diagnosis of fasciolosis in Vietnamese patients

Fasciolosis has emerged as an important zoonotic disease in many parts of the world. In recent years, an increasing number of human cases were reported in Vietnam. In this study, the 27-kDa component protein from the excretory/secretory production of adult Fasciola gigantica, purified by high performance liquid chromatography, was assessed in an enzyme-linked immunosorbent assay (ELISA) to detect antibodies against Fasciola spp. for diagnosis of human fasciolosis. The ELISA showed a high sensitivity (100%) and specificity (97.67%) when tested on patients with fasciolosis, other parasitic infections, cholangiocarcinoma and on healthy controls. The assay was applied for diagnosis on 143 patients in the Viet Duc-Hanoi hospital who presented with clinical signs of liver disease and lesions in their livers as shown by imaging techniques. Antibodies were found in 37 (25.9%) of these patients, of whom only 3 shed Fasciola eggs in their stools (2.1%). The excellent response to triclabendazole treatment of 37 sero-positive patients confirmed the diagnosis of fasciolosis. This study demonstrated the diagnostic potential for human fasciolosis of the 27-kDa antigen ELISA. Fasciolosis should be considered in the differential diagnosis of hepatic disease in Vietnam.

Hypertension and albuminuria in chronic kidney disease mapped to a mouse chromosome 11 locus

Chronic kidney disease (CKD) is a key cause of hypertension and a potent independent risk for cardiovascular disease. Epidemiological studies suggest a strong genetic component determining susceptibility for renal disease and, by inference, the associated cardiovascular risk. With a subtotal nephrectomy model of kidney disease, we found the 129S6 mouse strain to be very susceptible to the development of hypertension, albuminuria, and kidney injury, whereas the C57BL/6 strain is relatively resistant. Accordingly, we set out to map quantitative trait loci conferring susceptibility to hypertension and albuminuria using this model with F2 mice. We found significant linkage of the blood pressure trait to two loci. At D11Mit143, mice homozygous for the 129S6 allele had significantly higher systolic blood pressure than mice heterozygous or homozygous for the C57BL/6 allele. Similarly, at D1Mit308, there was an excellent correlation between genotype and the blood pressure phenotype. The effect of the chromosome 11 locus was verified with a separate cohort of F2 mice. For the albuminuria trait, a significant locus was found at D11Mit143, which overlaps the blood pressure trait locus. Our studies have identified a region spanning approximately 8 cM on mouse chromosome 11 that is associated with susceptibility to hypertension and albuminuria in CKD.

The phylogeny of the Schistosomatidae based on three genes with emphasis on the interrelationships of Schistosoma Weinland, 1858

Schistosomes are digenean flukes, parasitic of birds, mammals and crocodiles. The family Schistosomatidae contains species of considerable medical and veterinary importance, which cause the disease schistosomiasis. Previous studies, both morphological and molecular, which have provided a good deal of information on the phylogenetics of this group, have been limited in the number of species investigated or the type or extent of molecular data used. This paper presents the most comprehensive phylogeny to date, based on the sequences of 3 genes, complete ribosomal small subunit rRNA and large ribosomal subunit rRNA, and mitochondrial cytochrome oxidase 1, sequenced from 30 taxa including at least 1 representative from 10 of the 13 known genera of the Schistosomatidae and 17 of the 20 recognized Schistosoma species. The phylogeny is examined using morphological characters, intermediate and definitive host associations and biogeography. Theories as to the origins and spread of Schistosoma are also explored. The principal findings are that Ornithobilharzia and Austrobilharzia form a sister group to the Schistosoma; mammalian schistosomes appear paraphyletic and 2 Trichobilharzia species, T. ocellata and T. szidati, seem to be synonymous. The position of Orientobilharzia within the Schistosoma is confirmed, as is an Asian origin for the Schistosoma, followed by subsequent dispersal through India and Africa.

Revisiting the question of limited genetic variation within Schistosoma japonicum

Recent electrophoretic data have indicated that Schistosoma japonicum in mainland China may be a species complex, with the existence of a cryptic species being predicted from the analysis of schistosome populations from Sichuan province. To investigate the Sichuan form of S. japonicum, 4.9 kbp of mitochondrial DNA from each of three samples of the parasite from China (two from Sichuan and one from Hunan) and one from Sorsogon in the Philippines were amplified, sequenced and characterized. The sequence data were compared with those from the related South-east Asian species of S. mekongi (Khong Island, Laos) and S. mlayensis (Baling, Malaysia) and that from S. japonicm from Anhui (China). At both the nucleotide and amino-acid levels, the variation among the five S. japonicum samples was limited (< 1%). This was consistent with the conclusions drawn from previous molecular studies, in which minimal variation among S. japonicum populations was also detected. In contrast, S. mekongi and S. malayensis, species recognized as separate but closely related, differ from each other by about 10%, and each differs by 25%-26% from S. japonicum. Phylogenetic trees provided a graphic representation of these differences, showing all S. japonicum sequences to be very tightly clustered and distant from S. mekongi and S. malayensis, the last two being clearly distinct from each other. The results thus indicate no significant intra-specific genetic variation among S. japonicum samples collected from different geographical areas and do not support the idea of a distinct form in Sichuan.

Complete mitochondrial genomes confirm the distinctiveness of the horse-dog and sheep-dog strains of Echinococcus granulosus

Unlike other members of the genus, Echinococcus granulosus is known to exhibit considerable levels of variation in biology, physiology and molecular genetics. Indeed, some of the taxa regarded as 'genotypes' within E. granulosus might be sufficiently distinct as to merit specific status. Here, complete mitochondrial genomes are presented of 2 genotypes of E. granulosus (G1-sheep-dog strain: G4-horse-dog strain) and of another taeniid cestode, Taenia crassiceps. These genomes are characterized and compared with those of Echinococcus multilocularis and Hymenolepis diminuta. Genomes of all the species are very similar in structure, length and base-composition. Pairwise comparisons of concatenated protein-coding genes indicate that the G1 and G4 genotypes of E. granulosus are almost as distant from each other as each is from a distinct species, E. multilocularis. Sequences for the variable genes atp6 and nad3 were obtained from additional genotypes of E. granulosus, from E. vogeli and E. oligarthrus. Again, pairwise comparisons showed the distinctiveness of the G1 and G4 genotypes. Phylogenetic analyses of concatenated atp6, nad1 (partial) and cox1 (partial) genes from E. multilocularis, E. vogeli, E. oligarthrus, 5 genotypes of E. granulosus, and using T. crassiceps as an outgroup, yielded the same results. We conclude that the sheep-dog and horse-dog strains of E. granulosus should be regarded as distinct at the specific level.

Complete DNA sequence and gene organization of the mitochondrial genome of the liverfluke, Fasciola hepatica L. (Platyhelminthes; Trematoda)

The complete nucleotide sequence of the mitochondrial (mt) DNA molecule of the liverfluke, Fasciola hepatica (phylum Platyhelminthes, class Trematoda, family Fasciolidae), was determined. It comprises 14462 bp, contains 12 protein-encoding, 2 ribosomal and 22 transfer RNA genes, and is the second complete flatworm (and the first trematode) mitochondrial sequence to be described in detail. All of the genes are transcribed from the same strand. Of the genes typically found in mitochondrial genomes of eumetazoans, only atp8 is absent. The nad4L and nad4 genes overlap by 40 nt. Most intergenic sequences are very short. Two larger non-coding regions are present. The longer one (817 nt) is located between trnG and cox3 and consists of 8 identical tandem repeats of 85 nt, rich in G and C, followed by 1 imperfect repeat. The shorter non-coding region (187 nt) exhibits no special features and is separated from the longer region by trnG. The gene arrangement resembles that of some other trematodes including the eastern Asian Schistosoma species (and cyclophyllidean cestode species) but it is strikingly different from that of the African schistosomes, represented by Schistosoma mansoni. The genetic code is as inferred previously for flatworms. Transfer RNA genes range in length from 58 to 70 nt, their products producing characteristic 'clover leaf' structures, except for tRNA(S(UNC)) and tRNA(S(AGN)) lacking the DHU arm.

Mitochondrial gene content, arrangement and composition compared in African and Asian schistosomes

Complete sequences were obtained for the coding portions of the mitochondrial (mt) genomes of Schistosoma mansoni (NMRI strain, Puerto Rico; 14 415 bp), S. japonicum (Anhui strain, China; 14 085 bp) and S. mekongi (Khong Island, Laos; 14 072 bp). Each comprises 36 genes: 12 protein-encoding genes (cox1-3, nad1-6, nad4L, atp6 and cob); two ribosomal RNAs, rrnL (large subunit rRNA or 16S) and rrnS (small subunit rRNA or 12S); as well as 22 transfer RNA (tRNA) genes. The atp8 gene is absent. A large segment (9.6 kb) of the coding region (comprising 14 tRNAs, eight complete and two incomplete protein-encoding genes) for S. malayensis (Baling, Malaysian Peninsula) was also obtained. Each genome also possesses a long non-coding region that is divided into two parts (a small and a large non-coding region, the latter not fully sequenced in any species) by one or more tRNAs. The protein-encoding genes are similar in size, composition and codon usage in all species except for cox1 in S. mansoni (609 aa) and cox2 in S. mekongi (219 aa), both of which are longer than homologues in other species. An unexpected finding in all the Schistosoma species was the presence of a leucine zipper motif in the nad4L gene. The gene order in S. mansoni is strikingly different from that seen in the S. japonicum group and other flatworms. There is a high level of identity (87-94% at both the nucleotide and amino acid levels) for all protein-encoding genes of S. mekongi and S. malayensis. The identity between genes of these two species and those of S. japonicum is less (56-83% for amino acids and 73-79% for nucleotides). The identity between the genes of S. mansoni and the Asian schistosomes is far less (33-66% for amino acids and 54-68% for nucleotides), an observation consistent with the known phylogenetic distance between S. mansoni and the other species.

Molecular analysis of beta-thalassemia in South Vietnam

The high prevalence of beta-thalassemia in Southeast Asia is a major public health problem. Development of genetic counseling and prenatal diagnosis programs is a priority. To provide the groundwork for such programs in South Vietnam, we determined the spectrum of beta-thalassemia mutations in 35 severely affected patients and their relatives. We identified six different beta-thalassemia alleles (five beta(0) and one beta(+) mutations), in addition to the common mutation at codon 26 (GAG --> AAG) responsible for Hb E. These data provide insights into the distribution of beta-thalassemia alleles in the Vietnamese population.

A leucine zipper protein of mitochondrial origin

Sequence-specific DNA-binding proteins are characterised by short coiled-coil structural domains classified as zinc finger/RING finger, leucine zipper (L-Zip) or helix-loop-helix (HLH) motifs. The L-Zip proteins are defined by a pattern of at least four leucine (L) residues repeated every seventh amino acid that mediates protein dimerisation through the formation of parallel alpha-helical dimers. Usually the zipper is incorporated into a helix-loop-helix conformation called the basic helix-loop-helix-leucine zipper (bHLH/Zip). To date, all of the several hundred proteins reported as containing the L-Zip and/or bHLH/Zip motifs are nuclear-encoded. No leucine zipper polypeptide has, hitherto, been reported as mitochondrial in origin. Here we report such a polypeptide, the nicotinamide dehydrogenase subunit 4L (nad4L). We first identified this in human blood flukes of the genus Schistosoma (phylum Platyhelminthes; class Trematoda) but show that this is a common feature in other eucaryotes as well. Therefore, in addition to their well recognised role in oxidative phosphorylation, nad4L proteins may be pivotally involved in a range of other biological processes such as transcription and/or replication activation or as signal transmitters in communication with the nucleus and other cellular organelles. This may indicate a link between transcription regulation and respiration in mitochondria. We have also identified L-Zip-like motifs in nuoK, the procaryotic equivalent of the nad4L mitochondrial protein.

Functional MRI of human auditory cortex using block and event-related designs

fMRI of human auditory cortex response to sinusoidal tones of 200, 1000, and 3000 Hz was evaluated using block design and conventional and "silent" event-related designs. Conventional event-related fMRI revealed the timecourse of the BOLD response (approximately 5 sec to peak, approximately 4 sec full-width-half-max, and approximately 14 sec recovery to baseline). Both event-related, but not block, designs provided evidence for tonotopic organization in auditory cortex. Sources of low-frequency activation were more lateral and anterior than the sources of high-frequency activation (P < or = 0.05). In the block designs, repeated rapid stimulus presentation and the co-incidence of scanner noise preclude definition of tonotopic organization revealed in event-related approaches. Magn Reson Med 45:254-260, 2001.

Mitochondrial genomes of human helminths and their use as markers in population genetics and phylogeny

To date, over 100 complete metazoan mitochondrial (mt) genomes of different phyla have been reported. Here, we briefly summarise mt gene organisation in the Metazoa and review what is known of the mt genomes of nematodes and flatworms parasitic in humans. The availability of complete or almost complete mtDNA sequences for several parasitic helminths provides a rich source of genetic markers for phylogenetic analysis and study of genetic variability in helminth groups. Examples of the application of mtDNA in studies on Ascaris, Onchocerca, Schistosoma, Fasciola, Paragonimus, Echinostoma, Echinococcus and Taenia are described.

Application of micellar electrokinetic chromatography for the separation of retinoids

The applicability of micellar electrokinetic chromatography (MEKC) using sodium dodecylsulphate (SDS) as pseudo-stationary phase for the separation of five retinoids (retinol, retinal, retinyl acetate, retinyl palmitate, retinoic acid), was investigated. The effects of the acetonitrile content, the SDS concentration, the pH and the addition of Brij 35 to the background electrolyte on the migration behaviour of the retinoids were determined. It was found that the effective mobilities of retinol, retinal and retinyl acetate could be easily regulated through the ACN content and the SDS concentration of the BGE. The electrophoretic behaviour of the very hydrophobic retinyl palmitate was abnormal. Under various conditions this compound showed up as a late, very sharp peak. A strong indication was found that the retinyl palmitate forms a stable, charged complex with SDS during sample preparation. The mobility of the retinyl palmitate peak could be regulated, independently from the other peaks, through the Brij concentration of the BGE. Using a running buffer consisting of Tris buffer (pH 8), 20 mmol l(-1) SDS, 1 mmol l(-1) Brij 35 and 35% (v/v) acetonitrile, a complete separation of the five retinoids could be realised in less than 20 min.

What can knockout mice contribute to an understanding of hypertension?

The generation of knockout mice using homologous recombination in embryonic stem cells is a powerful tool for physiologic investigations. This experimental approach has provided unique insights into the study of hypertension. Studies using knockout mice have shed new light on blood pressure regulatory mechanisms, molecular mechanisms of end-organ injury, and genetic mechanisms for hypertension. With the development of more accessible approaches for carrying out sophisticated manipulation of the mouse genome, there will be continuing utility of this technique for future studies of hypertension.

Mitochondrial DNA sequences of human schistosomes: the current status

Sequences generated from the mitochondrial genome provide useful molecular markers for defining population groups, for tracing the genetic history of an individual or a particular group of related individuals, and for constructing deep-branch taxonomic phylogenies. There is every reason to believe that the mitochondrial genome will be as valuable in studies on flatworms, such as the human schistosomes, as it has been for other taxa. To date, however, our knowledge of mitochondrial genomes of flatworms remains limited, and this review summarises the currently available information. In particular, details of the recent sequence obtained for cloned Schistosoma mansoni mitochondrial DNA fragments spanning over half of the mitochondrial genome of this species are emphasised. This and other information, available as a result of the Schistosome Genome Project, provide the basis for obtaining the complete mitochondrial DNA sequence and gene order of S. mansoni and the other human schistosomes. The availability of complete mitochondrial DNA sequences from the different species will facilitate much more in-depth study of genetic diversity and host specificity in schistosomes and the interrelationships between the various forms infecting humans and between these and other flatworms.

Mitochondrial genes of Schistosoma mansoni

Two clones, totalling 8068 bp and spanning over half of the coding region of the mitochondrial genome of Schistosoma mansoni, have been sequenced. Complete sequences are presented of the large and small ribosomal RNA subunits, CO2, ND3, ND4, ND6 and ATPase 6 genes. Incomplete sequences were found for the CO1, ND2 and CytB genes. At least 10 tRNAs were also detected and alternative structures for some of these discussed. The gene order of S. mansoni is unique and differs from that of Fasciola hepatica, the only other trematode for which any information is available.

Further evaluation of the initial negative response in functional magnetic resonance imaging

The initial negative response (i.e., the dip) in the functional MR signal at stimulus onset has aroused much interest. Such a response is consistent with optical imaging data and can be potentially mapped to generate spatially more specific maps. However, there are still controversies regarding the exact origin of the initial response. In particular, experimental reports of its echo-time dependence have been inconsistent. Furthermore, several investigators have suggested the possibility of an apparent dip that may arise artifactually when the interstimulus interval (ISI) is not sufficiently long. The present study investigates the echo-time dependence of the initial response and the effect of the ISI on the initial response. Experimental results obtained at TEs of 21, 30, and 45 msec demonstrate that the initial dip has a TE dependence that is in agreement with a T2* contrast, and thereby consistent with a blood oxygenation level-dependent origin. At an ISI of 90 sec, a statistically significant initial negative response was detected and shown to be indistinguishable from that observed at an ISI of 45 sec, which was used in our previous studies, indicating that the initial negative response observed at 4 T is not a consequence of short ISI.

Human hippocampal long-term sustained response during word memory processing

Temporal behavior of activation associated with the neural substrate of human memory function was investigated during and after an auditorily instructed word memory task using multislice functional magnetic resonance imaging. The hippocampal formation, which is involved in human memory function, displayed a long-term sustained response that persisted significantly (approximately 90 s) beyond the duration of the memory task. This sustained period was approximately two-fold longer than the duration of the post-task activation observed in auditory areas and Broca's area, which are involved in the phonological loop of the verbal working memory. These observations suggest that the hippocampal memory processing involves sustained activation in the transitional function for the long-term memory over the working memory period.

4 T-fMRI study of nonspatial shifting of selective attention: cerebellar and parietal contributions

Regional blood oxygenation in the cerebellum and posterior cerebral cortices was monitored with functional magnetic resonance imaging (fMRI) at four Tesla while 16 normal subjects performed three tasks with identical visual stimulation: fixation; attention focused upon either stimulus shape or color and sustained during blocks of trials (sustained attention); and rapid, serial shifts in attention between stimulus shape or color within blocks of trials (shifting attention). The stimuli were displayed centrally for 100 ms followed by a central fixation mark for 900 ms. Each stimulus was either a circle or a square displayed in either red or green. Attention shifting required switching between color and shape information after each target detection and occurred on average once every three seconds. Subjects pressed a response key upon detecting the target; reaction time and response accuracy were recorded. Two protocols for T2*-weighted echo-planar imaging were optimized, one with a surface coil for the cerebellum alone and the other with a volume coil for imaging both cerebellum and posterior brain structures (parietal, occipital, and part of temporal cortices). Because fMRI of the cerebellum is particularly susceptible to cardiac and respiratory fluctuations, novel techniques were applied to isolate brain activation signals from physiological noise. Functional activation maps were generated for contrasts of 1) sustained attention to color minus fixation; 2) sustained attention to shape minus fixation; and 3) shifting attention minus sustained attention (to color and shape; i.e., summed across blocks of trials). Consistent with the ease of these tasks, subjects performed with >80% accuracy during both sustained attention and shifting attention. Analysis of variance did not show significant differences in false alarms or true hits across either attentional condition. A subgroup of subjects whose performance data were recorded during ten minutes of continuous practice did not show significant changes over time. Both contrasts between the conditions of sustained attention to color or to shape as compared with the fixation condition showed significant bilateral activation in occipital and inferior temporal regions (Brodmann areas 18, 19, and 37). The anterior medial cerebellum was also significantly activated ipsilateral to the finger used for responding. The principal comparison of interest, the contrast between the condition of shifting attention and the condition of sustained attention produced significant and reproducible activation: lateral cerebellar hemisphere (ansiform lobule: Crus I Anterior and Crus I Posterior; left Crus I Posterior); cerebellar folium; posterior superior parietal lobule (R and L); and cuneus and precuneus (R and L).

Methods for assessing accuracy and reliability in functional MRI

In this paper, methods for assessing the accuracy and the reliability of functional magnetic resonance imaging techniques are presented. First, a modified receiver operating characteristic analysis is described for evaluating the accuracy of fMRI studies. With this modified approach, the true positives or the activated pixels are estimated based on highly averaged experimental data acquired with the same stimulation/task. Unlike ROC analysis based on simulated activation data, the present approach can be applied to experimentally acquired data without simplifying the activation related changes. To assess the reliability of fMRI studies, the kappa statistic was adopted for evaluating the overall agreement of functional activation maps from repeated experiments in individual subjects. To demonstrate the utility of these techniques, both the ROC analysis and the reliability assessment were applied to quantitatively evaluate the improvement in accuracy and reliability of a retrospective technique for physiological noise reduction in fMRI.

Evaluation of the early response in fMRI in individual subjects using short stimulus duration

Optical imaging studies have provided evidence of an initial increase in deoxyhemoglobin following the onset of neuronal stimulation/activation and demonstrated that this initial increase could be spatially more specific to the site of neuronal activity. These studies also raised the possibility of improving the specificity of fMRI by selective mapping of this early response. Previous MR studies reported the observation of this early response but were limited in scope and not in full agreement. This paper presents a more extensive study that (a) demonstrates the initial signal decrease in individual subjects and (b) examines its dependence on stimulus duration and subject. Binocular visual stimulation experiments were performed on 14 subjects using echo-planar imaging (EPI) with high temporal resolution. An initial signal decrease was consistently observed in regions that were more localized than those displaying the delayed positive response. In agreement with previous fMRI and optical imaging findings, the maximum signal decrease was 1-2% and occurred at approximately 2 s after the onset of the stimulus, depending on the subject. For stimulus longer then 3.0 s, the temporal dynamics and the amount of signal change of the early response was essentially independent of the stimulus duration, while the delayed response and the post-stimulus undershoot increased both in terms of magnitude and rise time as the duration of the stimulus increased; this observation is concordant with the recent optical imaging study.

Outpatient bowel preparation for elective colon resection

To determine the safety and cost-effectiveness of outpatient preoperative bowel preparation with polyethylene glycol-electrolyte lavage solution, we retrospectively analyzed 726 cases of colectomy done by colon and rectal surgeons between July 1987 and July 1991. Included were 319 patients who had elective segmental or total abdominal colectomy with primary anastomosis. Patients who required protective proximal stoma were excluded. Patients requiring emergency surgery, colostomy closure, and restorative proctocolectomy were excluded. Patients were separated into two groups equally matched by age, sex, procedure done, and comorbidity: 145 had bowel preparation as outpatients and 174 as inpatients. Both groups had similar numbers of days hospitalized, days receiving nothing by mouth, and days requiring nasogastric intubation or gastrostomy tube, as well as similar postoperative complications. There was one wound infection, one anastomotic leak, and one death in each group. Cost of outpatient preparation was approximately $40. Cost of inpatient preparation, including a semiprivate room, was approximately $400. Outpatient preparation with polyethylene glycol-electrolyte lavage solution and oral antibiotics before elective colon resection can be done with equivalent safety and at a substantial cost savings.

Genetically variable triplet repeats in a RING-finger ORF of Helicoverpa species baculoviruses

Nucleotide sequence analysis of the Helicoverpa zea S-type nucleopolyhedrovirus (HzSNPV) genomic interval between the polh and iel genes has revealed an open reading frame (HOAR ORF) that contains a complex A 1-T rich triplet repeat region (RAT-repeats). HOAR ORF is predicted to encode an acidic, arginine residue rich. 712 aa protein, with a C3HC4 (RING-finger) zinc binding motif. RAT-repeats, distributed over 450 bp. consist of GAT. AAT, and GTT codons, correspond to Asp, Asn and Val residues which display an extreme codon bias not seen with nine other genes of this virus. A survey of four other (field) isolates of Helicoverpa sp. NPVs confirms a high incidence of mutation in the RAT-repeat region. A 158-bp conserved block, homologous to the pe38-ien promoter of AcMNPV, was identified upstream of HOAR ORF. The sub-region of the genome in which HOAR ORF is located is susceptible to rearrangement.

Altered ionic calcium and cell motion in ventricular myocytes after cutaneous thermal injury

Cutaneous thermal injury resulting in burns covering approximately 45% of the total body surface area initiates metabolic alterations which contribute to subsequent myocardial dysfunction. Alterations in calcium homeostasis have been proposed as one mechanism by which burn injury alters organ function. This study used fura-2 and time-resolved single cell fluorescence microscopy to examine stress-related alterations in intracellular calcium in isolated adult rat cardiac myocytes. Ventricular myocytes were isolated from rats given a full-thickness scald burn comprising 43% of the total body surface area and fluid resuscitated with lactated Ringer's by the Parkland formula; control animals were included for comparison. Burn trauma caused a significant increase in cardiac myocyte maximal (peak systolic) and minimal (diastolic) mean cytosolic free calcium concentration ([Ca2+]i) transient ratios when compared to [Ca2+]i transient ratios measured in control rats. Isoproterenol application altered the time course of the [Ca2+]i transients of normal myocytes but this response was not observed in myocytes from the thermally injured rats. In addition, isoproterenol application to normal myocytes produced a significant increase in the amplitude of cell edge motion (+50%) compared to the cell edge motion measured in myocytes without isoproterenol stimulation; however, this cell motion response did not occur after isoproterenol application to myocytes from thermally injured rats. Caffeine application increased the maximal and minimal [Ca2+]i transient ratios of all myocytes, regardless of a burn injury, and the time course of the [Ca2+]i transients from the two groups appeared similar in the presence of caffeine as the myocytes progressed to contracture. Our data suggest that burn-mediated alterations in calcium homeostasis contribute, in part, to the cardiac contractile dysfunction which occurs after burn injury.

Artifact reduction in EPI with phase-encoded reference scan

Echo-planar imaging is becoming widely used for various applications. However, because of inherent limitations, images obtained with EPI are often degraded by artifacts arising from the inconsistency between the odd and even echoes in the acquired data. Several correction techniques, including those based on reference measurement, have been previously reported. In this paper, a correction method based on phase-encoded reference measurement is described. This technique is demonstrated with experimental data obtained at 4 Tesla and compared with techniques that use nonphase-encoded reference scan. Results from experimental studies indicate that the present approach reduces the ghost intensity by a factor of 2-3.

Demonstration of efficacy of combining corticosteroids and colchicine in two patients with idiopathic sclerosing mesenteritis

Sclerosing mesenteritis is an uncommon condition of unknown etiology. It is likely to be the fibrous evolution of mesenteric panniculitis. It often has an indolent course but may be complicated by progressive bowel obstruction. The treatment of the symptomatic forms is not well established. The observations of two women (20 and 65 years old) with a relentless downhill course of biopsy-proved sclerosing mesenteritis are described. A treatment regimen with corticosteroid therapy (initially 1 mg/kg/day) and colchicine (1 mg/day) led, in both cases, to a rapid improvement. Abdominal computer tomography showed reduction in the tumor size. The combination of corticosteroids and colchicine is helpful in the management of symptomatic sclerosing mesenteritis. Follow-up with abdominal computed tomography is useful in evaluating the therapeutic impact.

Retrospective estimation and correction of physiological artifacts in fMRI by direct extraction of physiological activity from MR data

A physiological artifact reduction method based on extracting respiratory motion and cardiac pulsation directly from functional MR data is described. In fast low angle shot (FLASH), respiratory cycles are derived utilizing the phase of the center of a navigator echo, in echo-planar imaging (EPI) from the phase of the center k-space point. Cardiac cycles are determined from projections obtained from the navigator echo (FLASH) and the center k-space line (EPI). Because direct extraction of physiological parameters eliminates the need for external monitoring, the method can be more readily implemented. Experimental results illustrate that the technique provides effective compensation for physiology-related signal fluctuations in functional MRI and performs as well as the retrospective technique using external physiological monitoring.

Structural and functional properties of mutant Arg203Pro from yeast phosphoglycerate kinase, as a model of phosphoglycerate kinase-Uppsala

A pathological variant of human phosphoglycerate kinase, phosphoglycerate kinase-Uppsala, associated with chronic nonspherocytic hemolytic anemia has been found to differ from the normal enzyme by substitution of an arginine at position 206 (corresponding to position 203 in yeast) by a proline. In order to understand the structural and functional consequences of this mutation, the corresponding mutant in yeast phosphoglycerate kinase was constructed. The three-dimensional structure of this mutant was resolved at 2.9 A. Although the overall structure is not modified, small local changes were observed. The kinetic parameters of the mutant were not found to be greatly affected, the catalytic constant being lowered by only 10-20%. The most significant difference when compared with the wild-type enzyme is a decrease in stability by about 3 kcal/mol. The physiological implications of this instability are discussed.

Effects of different oxidative insults on intermediary metabolism in isolated perfused rat hearts

13C and 31P NMR were used to evaluate exogenous substrate utilization and endogenous phosphate metabolites in perfused rat hearts exposed to tert-butylhydroperoxide (tert-BOOH) and hydrogen peroxide (H2O2). Both reagents caused a reduction in developed pressure compared to controls and, in agreement with previous 31P NMR data, had different effects on intracellular high-energy phosphates and glycolysis. 13C Isotopomer analysis of tissue extracts showed that H2O2 and tert-BOOH also had significantly different effects on substrate utilization by the citric acid cycle. The contribution of exogenous lactate and glucose to acetyl-CoA was 43% in controls and increased to over 80% in the presence of either oxidant. With tert-BOOH, exogenous glucose and lactate were both significant contributors to acetyl-CoA (44 +/- 2 and 41 +/- 3%). However, with H2O2, exogenous lactate supplied a much higher fraction of acetyl-CoA (72 +/- 2%) than glucose (9 +/- 1%). Also, when [2-(13)C] glucose was supplied, accumulation of [2-(13)C] and [5-(13)C] fructose 1,6-bisphosphate was observed in the presence of H2O2, indicating inhibition of glyceraldehyde-3-phosphate dehydrogenase. These results indicate that despite this glycolytic inhibition, H2O2 increased the utilization of pyruvate precursors when lactate was present as an alternative carbohydrate substrate.

Retrospective estimation and correction of physiological fluctuation in functional MRI

Image-to-image fluctuation due to physiological motion is a major limitation to the accurate detection of neuronal activity with functional MRI. In this paper, a new and general technique for the estimation and compensation of the physiological effects is presented. By simultaneously monitoring the respiration and heart beat during the acquisition of imaging data, and retrospectively synchronizing the imaging data with physiological activity, physiological effects are estimated and removed. This technique does not rely on the periodicity of the respiration or the heart beat, does not affect the signal changes arising from neuronal activation, and is beneficial to images acquired with any speed. Experimental studies performed with FLASH and EPI sequences have demonstrated that the new technique is effective in reducing physiological fluctuation and improving the sensitivity of functional MRI and is generally applicable.

Long-term evaluation of immune status in leprosy patients undergoing multiple drug therapy

A long-term survey of leprosy patients of all clinical types, starting at the time of diagnosis, was carried out to monitor clinical, bacteriological and immunological parameters at regular intervals during multiple drug therapy (MDT). The patients were assigned to two groups for treatment following WHO guidelines: paucibacillary (PB) and multibacillary (MB). Immunoglobulin levels, specific antibodies, skin-test responses to different soluble mycobacterial antigens (new tuberculins), and in vitro proliferative responses to mitogens and to antigens were measured during treatment, as were clinical changes, the bacterial index, and clinical improvement. No exact relations between disease activity and IgM antibody levels, both IgM immunoglobulin and specific IgM antibody to a species-specific antigen (ND-O-BSA), could be seen for MB patients. Changes in in vitro cell-mediated immunity and skin-test response seemed to be more directly related to the bacterial load and could reflect the improvement of bacteriological and clinical parameters during MDT.

Effects of oxidant exposure on substrate utilization and high-energy phosphates in isolated rat hearts

The effects of a xanthine oxidase-mediated free radical-generating system containing purine and iron-loaded transferrin or solutions containing hydrogen peroxide and iron-loaded transferrin on substrate utilization and high-energy phosphates were evaluated by nuclear magnetic resonance (NMR) spectroscopy in isolated perfused rat hearts. Hearts were supplied with lactate, acetate, and glucose, and the contribution of each substrate to acetyl coenzyme A was measured in control hearts and in the presence of a free radical-generating system. Perfused hearts were monitored by 31P NMR, and tissue extracts were analyzed by 13C NMR. Free radicals decreased the phosphocreatine and beta-ATP peak areas and reduced contractile function. Under control conditions, lactate, acetate, and endogenous sources were the major contributors of acetyl coenzyme A units, with only 5% originating from glucose. In the presence of a xanthine oxidase-mediated free radical-generating system, the glucose contribution increased to 54%, while contributions from acetate and endogenous sources were significantly reduced. Both 13C and 31P NMR analyses showed no significant accumulation of glycolytic sugar phosphates, suggesting little inhibition of glyceraldehyde-3-phosphate dehydrogenase. The increased contribution of glucose to the tricarboxylic acid cycle relative to acetate and endogenous sources is consistent with activation of pyruvate dehydrogenase. In contrast, hearts exposed to a hydrogen peroxide-based free radical-generating system showed an increase in lactate utilization, a decrease in acetate utilization, and no change in glucose utilization compared with control hearts. Glycolytic sugar phosphates were found to accumulate, suggesting possible inhibition of glyceraldehyde-3-phosphate. Thus, different radicals or their metabolites may have varying effects on myocardial metabolism.

Transforming growth factor-beta is a renin secretagogue at picomolar concentrations

Transforming growth factor-beta s (TGF-beta s), a family of peptides, have many actions including modulating cellular growth, differentiation, and influencing steroidogenesis. Because both TGF-beta and renin are present in renal juxtaglomerular cells, we have examined the effects of these peptides on renin secretion using static incubations of rat renal cortical slices. We report here an effect of both TGF-beta 1 and -beta 2 on renin secretion. At low concentrations, both TGF-beta 1 (4 x 10(-12) M) and -beta 2 (8 x 10(-12) M) stimulate basal renin secretion (control, 100 +/- 4%; TGF-beta 1, 123 +/- 4%; TGF-beta 2, 124 +/- 5%; both P < 0.02 compared with control). However, at higher concentrations (2 x 10(-10) M), both peptides do not alter basal renin release. Our previous studies show that both prostaglandins and lipoxygenase (LO) products of arachidonic acid play an important dual regulatory role in renin secretion; therefore, we have examined the effects of both cyclooxygenase (CO) and LO inhibition in TGF-beta action.(ABSTRACT TRUNCATED AT 250 WORDS)

Disseminated histoplasmosis with glomerulonephritis mimicking Wegener's granulomatosis

Renal complications of disseminated histoplasmosis include chronic recurrent abcesses of the interstitium and urogenital tract. To our knowledge, glomerulonephritis has never been reported in histoplasmosis. We describe a case of proven histoplasmosis presenting with oral granulomatous ulceration and segmental glomerulonephritis that mimicked Wegener's granulomatosis (WG). All symptoms and renal parameters remitted under itraconazole treatment alone. In conclusion, glomerulonephritis may complicate the course of chronic disseminated histoplasmosis. Since it can masquerade as WG, systematic tissue staining for intracellular microorganisms should be done when WG is suspected.

Reconstitution of intestinal continuity after extended left colectomy

We wish to reintroduce an infrequently employed technique to re-establish intestinal continuity after extended resection of the left colon, transverse colon, and distal ascending colon. It involves bringing the proximal ascending colonic stump through the distal ileal mesenteric defect to reach the distal rectal stump in a tensionless fashion.

Excimer, Ho:YAG, and Q-switched Ho:YAG ablation of aorta: a comparison of temperatures and tissue damage in vitro

The adjacent thermal and mechanical tissue damage after normal-mode Ho:YAG (pulse length = 250 mus, lambda = 2.09 mum), Q-switched Ho:YAG (pulse length = 200 ns, lambda= 2.09 mum), and excimer (pulse length = 120 ns, lambda = 308 nm) pulsed laser irradiation of human thoracic aorta samples was studied in vitro. Surface temperatures were monitored during laser irradiation with an IR camera in air or a thermocouple in saline. Histological analysis of the irradiated sites was performed to assess thermal and mechanical damage to tissue surrounding the crater. The ablation of aortic tissue with any of the lasers resulted in a temperature buildup inside the tissue; this effect was most significant for the IR wavelength. Mechanical damage was observed in all cases but was most pronounced for the Q-switched Ho:YAG laser. Excimer ablation in air left behind a smooth surface; however, under saline the result was a much rougher surface.

Ia reflexes and EPSPs in human soleus motor neurones

The reflex responses of single motor units in the soleus muscle to electrical stimulation of the tibial nerve were recorded in human volunteers. A feature of the experiments was the stimulation paradigm used. In order to control the peri-stimulus firing rate, a computer triggered the stimulus isolator only when 2 interspike intervals of specified duration occurred in succession. In addition, the timing of the stimulus in relation to the preceding action potential was controlled in a manner similar to a conditioning/testing paradigm. The general pattern of response was an initial, "H-reflex" excitation at monosynaptic latency, followed first by a silent period due to the refractoriness of the motor neurone, then by other phases of reduced activity. When the stimulus intensity was increased, the intensity of the excitation and the duration of the silent period increased in parallel. When the pre-stimulus firing rate of the motor unit was varied, the amplitude of the H-reflex response. normalized to the number of stimulus trials, was similar at 6, 8 and 10 Hz, but was greater at 4 Hz in most units tested. These findings were consistent with a simple model of the events occurring at the cell membrane in this reflex which was proposed by Ashby and Zilm (1982a), although some modification of the model was necessary to account for the different response at 4 Hz. The improved stimulation paradigm enabled a direct estimate to be made of the amplitude and shape of the rising phase of the Ia EPSP in human motor neurones.