On-demand mobile hypertension training for primary health care workers in Nigeria: a pilot study

BACKGROUND

Only one out of every ten Nigerian adults with hypertension has their blood pressure controlled. Health worker training is essential to improve hypertension diagnosis and treatment. In-person training has limitations that mobile, on-demand training might address. This pilot study evaluated a self-paced, case-based, mobile-optimized online training to diagnose and manage hypertension for Nigerian health workers.

METHODS

Twelve hypertension training modules were developed, based on World Health Organization and Nigerian guidelines. After review by local academic and government partners, the course was piloted by Nigerian health workers at government-owned primary health centers. Primary care physician, nurse, and community health worker participants completed the course on their own smartphones. Before and after the course, hypertension knowledge was evaluated with multiple-choice questions. Learners provided feedback by responding to questions on a Likert scale.

RESULTS

Out of 748 users who sampled the course, 574 enrolled, of whom 431 (75%) completed the course. The average pre-test score of completers was 65.4%, which increased to 78.2% on the post-test (P < 0.001, paired t-test). Health workers who were not part of existing hypertension control programs had lower pre-test scores and larger score gains. Most participants (96.1%) agreed that the training was applicable to their work, and nearly all (99.8%) agreed that they enjoyed the training.

CONCLUSIONS

An on-demand mobile digital hypertension training increases knowledge of hypertension management among Nigerian health workers. If offered at scale, such courses can be a tool to build health workforce capacity through initial and refresher training on current clinical guidelines in hypertension and other chronic diseases in Nigeria as well as other countries.

Efficacy of self-management program associated with a spa therapy for knee osteoarthritis patients (GETT 2): a research protocol for a randomized trial

INTRODUCTION

Osteoarthritis is a chronic pathology that involves multidisciplinary management. Self-management for patients is an essential element, present in all international guidelines. During the time of the spa therapy, the patient is receptive to take the advantage of self-management workshops. The aim of this study is to assess the effects of 18 days spa therapy associated with a self-management intervention in patients with knee osteoarthritis in comparison with spa therapy alone on a priority objective, personalized and determined with the patient, chosen in the list of 5 objectives determined during the self-management initial assessment.

METHODS AND ANALYSIS

Two hundred fifty participants with knee osteoarthritis will participate to this multicenter, prospective, randomized, controlled study. All patients will benefit 18 days of spa therapy and patients randomized in the intervention group will participate to 6 self-management workshops. Randomization will be centralized. The allocation ratio will be 1:1. Data analysts and assessor will be blinded. The primary outcome is the effectiveness of the educational workshops associated with spa therapy in comparison with spa therapy alone on a priority objective, measured by Goal Attainment Scaling (GAS). The secondary outcomes are disability, health-related quality of life, and pain intensity.

ETHICS AND DISSEMINATION

Ethics were approved by the CPP Sud-Méditerranée II. The results will be disseminated in a peer-reviewed journal and disseminated at PRM, rheumatology, and orthopedics conferences. The results will also be disseminated to patients.

TRIAL REGISTRATION

Trial registration number NCT03550547. Registered 8 June 2018. Date and version identifier of the protocol. Version N°6 of March 12, 2018.

Calcium State-Dependent Regulation of Epithelial Cell Quiescence by Stanniocalcin 1a

The molecular mechanisms regulating cell quiescence-proliferation balance are not well defined. Using a zebrafish model, we report that Stc1a, a secreted glycoprotein, plays a key role in regulating the quiescence-proliferation balance of Ca²⁺ transporting epithelial cells (ionocytes). Zebrafish stc1a, but not the other stc genes, is expressed in a Ca²⁺ state-dependent manner. Genetic deletion of stc1a, but not stc2b, increased ionocyte proliferation, leading to elevated body Ca²⁺ levels, cardiac edema, body swelling, and premature death. The increased ionocyte proliferation was accompanied by an increase in the IGF1 receptor-mediated PI3 kinase-Akt-Tor signaling activity in ionocytes. Inhibition of the IGF1 receptor, PI3 kinase, Akt, and Tor signaling reduced ionocyte proliferation and rescued the edema and premature death in stc1a^–/– fish, suggesting that Stc1a promotes ionocyte quiescence by suppressing local IGF signaling activity. Mechanistically, Stc1 acts by inhibiting Papp-aa, a zinc metalloproteinase degrading Igfbp5a. Inhibition of Papp-aa proteinase activity restored ionocyte quiescence-proliferation balance. Genetic deletion of papp-aa or its substrate igfbp5a in the stc1a^–/– background reduced ionocyte proliferation and rescued the edema and premature death. These findings uncover a novel and Ca²⁺ state-dependent pathway regulating cell quiescence. Our findings also provide new insights into the importance of ionocyte quiescent-proliferation balance in organismal Ca²⁺ homeostasis and survival.

Involvement of the Spinal Cord in Primary Mitochondrial Disorders: A Neuroimaging Mimicker of Inflammation and Ischemia in Children

BACKGROUND AND PURPOSE

Little is known about imaging features of spinal cord lesions in mitochondrial disorders. The aim of this research was to assess the frequency, imaging features, and pathogenic variants causing primary mitochondrial disease in children with spinal cord lesions.

MATERIALS AND METHODS

This retrospective analysis included patients seen at Children's Hospital of Philadelphia between 2000 and 2019 who had a confirmed diagnosis of a primary (genetic-based) mitochondrial disease and available MR imaging of the spine. The MR imaging included at least both sagittal and axial fast spin-echo T2-weighted images. Spine images were independently reviewed by 2 neuroradiologists. Location and imaging features of spinal cord lesions were correlated and tested using the Fisher exact test.

RESULTS

Of 119 children with primary mitochondrial disease in whom MR imaging was available, only 33 of 119 (28%) had available spine imaging for reanalysis. Nineteen of these 33 individuals (58%) had evidence of spinal cord lesions. Two main patterns of spinal cord lesions were identified: group A (12/19; 63%) had white ± gray matter involvement, and group B (7/19; 37%) had isolated gray matter involvement. Group A spinal cord lesions were similar to those seen in patients with neuromyelitis optica spectrum disorder, multiple sclerosis, anti-myelin oligodendrocyte glycoprotein-IgG antibody disease, and leukoencephalopathy with brain stem and spinal cord involvement and lactate elevation. Group B patients had spinal cord findings similar to those that occur with ischemia and viral infections. Significant associations were seen between the pattern of lesions (group A versus group B) and the location of lesions in cervical versus thoracolumbar segments, respectively (P < .01).

CONCLUSIONS

Spinal cord lesions are frequently observed in children with primary mitochondrial disease and may mimic more common causes such as demyelination and ischemia.

Use of Co2+:MgAl2O4 transparent ceramics in passive Q-switching of an Er:Glass laser at 1.534 µm

We present the implementation of Co²⁺:MgAl₂O₄ transparent ceramics as passive Q-switching elements in an Er:Glass laser at 1.534 µm. Linearly polarized pulsed output was obtained by Brewster angle inclination of the material Q-switching plate relative to the laser axis. Separate pulses were ∼105 ns long (FWHM), exhibiting ∼6.2 kW peak power at near TEM₀₀ quality. Several fundamental sample properties important for laser intracavity operation were measured; thermo-optic coefficient dn/dT = ( - 3.8 ± 1) × 10^-5 °C^-1, thermal lensing factor L^-1d(nL)/dT = 2.59 × 10^-5 °C^-1, linear expansion coefficient α = (3.9 ± 0.6) × 10^-5 °C^-1, polarizability thermal coefficient ϕ = (7.2 ± 2.2) × 10^-5 °C^-1, and damage threshold ∼6.5 J/cm².

The Perirolandic Sign: A Unique Imaging Finding Observed in Association with Polymerase γ-Related Disorders

Pathogenic variants in the polymerase γ gene (POLG) cause a diverse group of pathologies known as POLG-related disorders. In this report, we describe brain MR imaging findings and electroencephalogram correlates of 13 children with POLG-related disorders at diagnosis and follow-up. At diagnosis, all patients had seizures and 12 had abnormal MR imaging findings. The most common imaging findings were unilateral or bilateral perirolandic (54%) and unilateral or bilateral thalamic signal changes (77%). Association of epilepsia partialis continua with perirolandic and thalamic signal changes was present in 86% and 70% of the patients, respectively. The occipital lobe was affected in 2 patients. On follow-up, 92% of the patients had disease progression or fatal outcome. Rapid volume loss was seen in 77% of the patients. The occipital lobe (61%) and thalamus (61%) were the most affected brain regions. Perirolandic signal changes and seizures may represent a brain imaging biomarker of early-onset pediatric POLG-related disorders.

The metalloproteinase Papp-aa controls epithelial cell quiescence-proliferation transition

Human patients carrying PAPP-A2 inactivating mutations have low bone mineral density. The underlying mechanisms for this reduced calcification are poorly understood. Using a zebrafish model, we report that Papp-aa regulates bone calcification by promoting Ca2+-transporting epithelial cell (ionocyte) quiescence-proliferation transition. Ionocytes, which are normally quiescent, re-enter the cell cycle under low [Ca2+] stress. Genetic deletion of Papp-aa, but not the closely related Papp-ab, abolished ionocyte proliferation and reduced calcified bone mass. Loss of Papp-aa expression or activity resulted in diminished IGF1 receptor-Akt-Tor signaling in ionocytes. Under low Ca2+ stress, Papp-aa cleaved Igfbp5a. Under normal conditions, however, Papp-aa proteinase activity was suppressed and IGFs were sequestered in the IGF/Igfbp complex. Pharmacological disruption of the IGF/Igfbp complex or adding free IGF1 activated IGF signaling and promoted ionocyte proliferation. These findings suggest that Papp-aa-mediated local Igfbp5a cleavage functions as a [Ca2+]-regulated molecular switch linking IGF signaling to bone calcification by stimulating epithelial cell quiescence-proliferation transition under low Ca2+ stress.

Prediction-based neural mechanisms for shielding the self from existential threat

The human mind has an automatic tendency to avoid awareness of its mortality. How this protective mechanism is implemented at the neuronal level is unknown. Here we test the hypothesis that prediction-based mechanisms mediate death-denial by shielding the self from existential threat. We provide evidence that self-specific predictive processes are downregulated during the perception of death-related linguistic stimuli and that this mechanism can predict fear-of-death. Using a magnetoencephalography visual mismatch paradigm, we show that the brain's automatic prediction response to deviancy is eliminated when death words and self-face representations are coupled, but remains present when coupled to other-face or to negative words. We further demonstrate a functional link between how death impacts self-image vs. Other-image, and show that it predicts fear-of-death. Finally, we confirm this effect in a behavioral active inference experiment showing that death-related words bias perceptual judgment on facial self and other morphed video clips. Together these results lay out, for the first time, a plausible neural-based mechanism of death-denial.

Comparison of psychometric properties between the Labin, a new electronic dynamometer, and the Jamar: Preliminary results in healthy subjects

Many instruments exist for measuring grip strength. The Jamar hydraulic hand dynamometer is currently the gold standard. The Labin is a prototype electronic dynamometer that can also measure maximum grip strength. The main objective was to compare the Labin dynamometer with the gold standard instrument, the Jamar, in a healthy population, and secondarily to compare discomfort during use. A single-center exploratory study was conducted. The subjects enrolled had to be aged between 20 and 60, be volunteers and give consent. The required number of subjects was 30. The subjects were positioned according to American Society of Hand Therapists recommendations. Maximum grip force was measured in kilograms using the mean of three successive trials. The first dynamometer used was chosen randomly. The handle's discomfort during use was rated on a simple verbal scale from 0 to 10. Thirty-four subjects were included. The concordance coefficient for peak torque between the Labin and Jamar dynamometers was 0.90 for the dominant hand and 0.83 for the non-dominant hand. The intraclass correlation coefficient for peak torque with the Labin was 0.81 [0.69; 0.89] for the dominant hand and 0.86 [0.76; 0.92] for the non-dominant hand. In our study, we have shown that the Labin prototype has acceptable validity and reproducibility. The Labin will need to be tested in pathological conditions next.

A walk on water: comparing the influence of Ai Chi and Tai Chi on fall risk and verbal working memory in ageing people with intellectual disabilities - a randomised controlled trial

BACKGROUND

Aquatic motor intervention has been found to be effective in reducing falls and improving verbal working memory among the general population. However, effects among older adults with intellectual disabilities (ID) have never been explored. The aim of this study was to examine the effects of aquatic motor intervention on fall risk and verbal working memory among older adults with ID.

METHODS

Forty-one older adults with mild to moderate ID (age: 50-66 years) were randomly assigned to 14 weeks of aquatic motor intervention (Ai Chi: N = 19) or identical on-land motor intervention (Tai Chi: N = 22). Fall risk, measured with the Tinetti balance assessment tool (TBAT), and verbal working memory, measured with the digit span forward test, were assessed pre-intervention, after 7 weeks of intervention and post-intervention.

RESULTS

Study results indicate positive effects of both aquatic and on-land motor intervention on TBAT fall risk score, while the aquatic motor intervention group improved TBAT fall risk score quicker as compared with the on-land motor intervention group. Moreover, the lower the pre-intervention TBAT score was, the higher the improvement. In addition, study findings support the positive effects of aquatic motor intervention on verbal working memory ability as measured with the digit span forward test.

CONCLUSIONS

Motor intervention, and particularly in an aquatic environment, can potentially reduce fall risk. Aquatic motor intervention may help to improve verbal working memory among older adults with ID.

Estimating summary statistics for electronic health record laboratory data for use in high-throughput phenotyping algorithms

We study the question of how to represent or summarize raw laboratory data taken from an electronic health record (EHR) using parametric model selection to reduce or cope with biases induced through clinical care. It has been previously demonstrated that the health care process (Hripcsak and Albers, 2012, 2013), as defined by measurement context (Hripcsak and Albers, 2013; Albers et al., 2012) and measurement patterns (Albers and Hripcsak, 2010, 2012), can influence how EHR data are distributed statistically (Kohane and Weber, 2013; Pivovarov et al., 2014). We construct an algorithm, PopKLD, which is based on information criterion model selection (Burnham and Anderson, 2002; Claeskens and Hjort, 2008), is intended to reduce and cope with health care process biases and to produce an intuitively understandable continuous summary. The PopKLD algorithm can be automated and is designed to be applicable in high-throughput settings; for example, the output of the PopKLD algorithm can be used as input for phenotyping algorithms. Moreover, we develop the PopKLD-CAT algorithm that transforms the continuous PopKLD summary into a categorical summary useful for applications that require categorical data such as topic modeling. We evaluate our methodology in two ways. First, we apply the method to laboratory data collected in two different health care contexts, primary versus intensive care. We show that the PopKLD preserves known physiologic features in the data that are lost when summarizing the data using more common laboratory data summaries such as mean and standard deviation. Second, for three disease-laboratory measurement pairs, we perform a phenotyping task: we use the PopKLD and PopKLD-CAT algorithms to define high and low values of the laboratory variable that are used for defining a disease state. We then compare the relationship between the PopKLD-CAT summary disease predictions and the same predictions using empirically estimated mean and standard deviation to a gold standard generated by clinical review of patient records. We find that the PopKLD laboratory data summary is substantially better at predicting disease state. The PopKLD or PopKLD-CAT algorithms are not meant to be used as phenotyping algorithms, but we use the phenotyping task to show what information can be gained when using a more informative laboratory data summary. In the process of evaluation our method we show that the different clinical contexts and laboratory measurements necessitate different statistical summaries. Similarly, leveraging the principle of maximum entropy we argue that while some laboratory data only have sufficient information to estimate a mean and standard deviation, other laboratory data captured in an EHR contain substantially more information than can be captured in higher-parameter models.

Intellectual developmental disorder with cardiac arrhythmia syndrome in a child with compound heterozygous GNB5 variants

Identification of a novel compound heterozygous of GNB5 in a patient with intellectual developmental disorder with cardiac arrhytmia (IDDCA), from non-consaguineous family. Three-dimensional modelling and in silico predictions suggest that GNB5 variants are causative of the phenotype, extending the number of IDDCA patients so far identified.

20: NASOPHARYNX MICROBIOME COMPOSITION VARIES OVER TIME IN PEDIATRIC ASTHMA

Purpose of Study

The application of next-generation sequencing (NGS) technology has shown that microbial communities in the respiratory airways (i.e., the microbiome) play a significant role in the onset, development and severity of asthma. However, little is known about their temporal dynamics (i.e., microbial succession), which poses a significant obstacle to identifying pulmotypes of disease and assessing inter-patient variation. Here, we couple NGS and 16S rRNA data to characterize the nasopharynx microbiome of children with asthma and determine its stability over time.

Methods Used

We collected nasal washes from 40 children with asthma enrolled in the AsthMaP-2 Project from two consecutive visits, six months apart. Total DNA was extracted and sequenced for the 16S-V4 rRNA gene region (∼250 bp) using the MySeq Illumina platform. Reads were analyzed in Mothur using the SILVAv119 reference database. Alpha diversity metrics and phylogenetic and count-base distance community indexes of beta diversity were compared across samples and time points. PCoA and NJ clustering analysis were used to assess community relatedness. Differences in alpha diversity and OTU abundance between sample pairs across time points were also compared.

Summary of Results

A mean of 27,479 clean 16S sequences corresponding to an average of 173 OTUs were sequenced and detected per sample, respectively. Representatives of Moraxella, Corynebacterium, Prevotella, Staphylococcus, Alloiococcus, Streptococcus, Peptoniphilus, Fusobacterium, and Haemophilus accounted for 36 to 99% of the reads across samples. These genera have been previously found in the nasopharynx of asthmatic and healthy children. A total of 61 OTUs from these genera were present in at least 50% of the samples (i.e., the nasal core microbiome). Significant differences in core microbiome composition were detected between sample pairs, but no directional trend (increase or decrease) was observed across sample pairs. Samples were randomly ordinated and did not cluster together.

Conclusions

Our analysis of nasal microbiomes in 40 asthmatic children revealed significant differences in composition within individuals over six months. Future cross-sectional microbiome studies need to be aware of short span temporal dynamics in nasal microbiota.

Abstract 327: An Emerging Public Health and Primary Care Strategy for Hypertension Management

Control and Prevention (CDC) and Centers for Medicare & Medicaid Services, with the goal of preventing one million heart attacks and strokes by 2017. To help achieve this goal, Million Hearts ® aims to increase by 10 million the number of persons in the United States whose blood pressure is under control. Self-measured blood pressure monitoring (SMBP) is one strategy for managing hypertension, a condition that now affects one in three American adults. This is a critical time for public health and primary care to promote tools that strengthen a system of care for treatment of chronic disease. In July 2012, the Agency for Healthcare Research and Quality (AHRQ) released a comparative effectiveness review that found strong evidence that SMBP plus additional clinical support is more effective than usual care in lowering blood pressure among patients with hypertension. Based on AHRQ’s review, CDC staff collaborated with partners and stakeholders to develop a series of guides on SMBP, Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners and Self-Measured Blood Pressure Monitoring: Action Steps for Clinicians (SMBP Action Steps) . SMBP Action Steps provide information, guidance, and resources for public health practitioners and clinicians to promote and implement SMBP plus additional clinical support to increase access to care and improve the quality of care for patients with hypertension. This presentation will provide an overview of SMBP Action Steps and highlight strategies and examples that public health practitioners and clinicians can use to work with care teams, patients, payers, and the public to promote more widespread implementation of and coverage for SMBP plus additional clinical support interventions.

Gardening for the mental well-being of homeless women

PURPOSE

To explore the perceptions of homeless women regarding their experience in a shelter-based garden project to promote mental wellness. Participants planted and tended the vegetable garden and prepared and ate the fruits of their labor.

DESIGN

A qualitative descriptive design with a conventional content analysis of narrative data.

METHOD

Data were gathered in semistructured interviews. Participants were homeless daytime shelter guests who had participated in at least eight gardening sessions over 4 weeks. The project was started in the fall of 2010 and the interviews were conducted over 2 months in the summer of 2011.

FINDINGS

Two polarized themes were identified in the narratives, clustering around negative and positive thoughts. The "dark" theme centered on marginalization and the oppressiveness of shelter life. The "light" theme centered on stress relief, feeling socially included, and personal change.

CONCLUSION

The gardening experience interrupted the participants' negative ruminations, offering stress relief and elements of social inclusion and self-actualization. Gardening is an inexpensive and positive intervention for a population with a high incidence of mental illness and distress.

ZONE BEHAVIOR OF ENZYMES : ILLUSTRATED BY THE EFFECT OF DISSOCIATION CONSTANT AND DILUTION ON THE SYSTEM CHOLINESTERASE-PHYSOSTIGMINE

1. The kinetics of the reversible combination of one enzyme center with one molecule of a substrate or inhibitor is treated as a true bimolecular instead of a pseudomonomolecular reaction. The general equations describing such a reaction are presented and analyzed algebraically and graphically. 2. A new term, "specific concentration," is introduced to denote the concentration of reactants in units equal to the dissociation constant. Its use makes the kinetic equations universally applicable to all reversible systems of the given type. 3. It is shown that such a system exhibits three "zones" of behavior. Each zone is characterized and shown to exhibit significant differences in the function relating the concentrations of the components of the system at equilibrium. The zone boundaries are rigorously defined in terms of the specific enzyme concentration, for the mathematical error tolerable with a given experimental accuracy; and approximate boundaries for practical use are proposed. 4. The classical treatment of enzyme kinetics is shown to be a limiting case valid only for low specific enzyme concentrations (zone A) and to be inapplicable in a number of systems whose dissociation constants are very small or whose molar enzyme concentrations are very great, and in which, therefore, the specific enzyme concentrations are large. See Table I for a summary of zone differences. 5. In an enzyme system containing substrate or inhibitor, dilution before determination of reaction velocities is shown to be a crucial operation, entailing large changes in the fraction of enzyme in the form of a complex. The changes in fractional activity or inhibition with dilution are shown to be a function of specific enzyme concentration, the dilution factor, and the fraction of enzyme initially in the form of complex. Equations are given permitting the calculation of the state of the system at any concentration. The errors introduced into physiological work by failure to take the dilution effect into account are pointed out. 6. Experimental data are presented showing that the system composed of serum cholinesterase and physostigmine behaves as predicted by the dilution effect equations. 7. Two other conclusions of practical pharmacological importance are drawn from the theory of zone behavior: (a) The finding that a biological response is a linear function of the dose of a drug does not necessarily mean that the reaction is irreversible, but only that if reversible, the reactant with which the drug combines has a high specific concentration. (b) If a tissue enzyme has a high specific concentration, all reversible inhibitors will be equally potent in combining with it, regardless of their relative potency in dilute systems; provided only that their dissociation constants are within certain broad limits. 8. It is shown how the type of analysis here applied to bimolecular reactions can be applied in toto to systems of the type E + nX ⇋ EX_n, where n molecules of substrate or inhibitor unite with one enzyme center. The zone boundaries and the magnitude of the dilution effect change with n, but the general characteristics of the zones are the same for all values of n. 9. Since the analysis is based only on mass law assumptions, it is applicable to any system that is formally analogous to the one here treated.

THE MECHANISM OF ENZYME-INHIBITOR-SUBSTRATE REACTIONS : ILLUSTRATED BY THE CHOLINESTERASE-PHYSOSTIGMINE-ACETYLCHOLINE SYSTEM

The mechanism of enzyme-inhibitor-substrate reactions has been analyzed from a theoretical standpoint and illustrated by data from the system cholinesterase-physostigmine-acetylcholine. This treatment is by no means limited to a single system but should be generally applicable to others of similar type. Competitive enzyme-inhibitor-substrate systems show the same characteristic "zones of behavior" already demonstrated for non-competitive systems by Straus and Goldstein. These zones, three in number, determine the mathematical function which relates activity of an enzyme to concentration of an added substrate or inhibitor or both. The effects of suboptimal substrate concentration in such systems have been considered, and the errors arising from various common simplifications of the descriptive equations have been pointed out. The zone behavior phenomenon has been shown to be useful in determining the number of molecules of substrate or inhibitor combining reversibly with a single enzyme center. The kinetics of competitive inhibition, dilution effect, combination of inhibitor or substrate with enzyme, and destruction of inhibitor or substrate by enzyme have been analyzed and experimentally verified, and absolute velocity constants have been determined. Theoretical conclusions have been discussed from the standpoint of their physiological significance. Specifically, it has been shown that: 1. The inhibition of cholinesterase by physostigmine is competitive. A single molecule of physostigmine or acetylcholine combines with one center of cholinesterase—n = 1; and the mechanism n = 2 has been. excluded. Numerical values of the constants for this system are as follows: K_I = 3.11 x 10^–8k₁ (combination) = 8.3 x 10⁵k₂ (dissociation) = 0.026 K_S = 1.25 x 10^–3k₃ (combination) = 260 k₄ (dissociation) = 0.32 2. No definitive value can be assigned to E, the molar concentration of enzyme centers, but in 4.54 per cent dog serum, E < 1.8 x 10^–8 (E_I' < 0.58). The system therefore operates in (or nearly in) zone A at this concentration. 3. Competitive displacement of inhibitor by substrate and vice versa introduces considerable error in the usual 20 minute determination of the activity of an inhibited enzyme, unless properly corrected for. 4. Dissociation of the enzyme-inhibitor complex on dilution proceeds moderately slowly so that the full corrections for dilution cannot be applied unless time has been allowed for full dissociation. 5. Combination of physostigmine with cholinesterase is slow at all but large concentrations of inhibitor. 6. The destruction of physostigmine or acetylcholine by cholinesterase follows the predicted curve; k_D for the destruction of physostigmine is found to be > 0.00182; k_D for acetylcholine destruction is > 3500. There is no reason to assume inhibition of destruction by excess substrate or inhibitor. 7. The common assumption that enzymatic activity follows (or nearly follows) a monomolecular course is true only under limited conditions, which have been here defined. It is not valid, as a rule, for the enzymatic destruction of an inhibitor (e.g., physostigmine) and its application to such a case may lead to erroneous conclusions about the reaction mechanism.

Expanding CEP290 mutational spectrum in ciliopathies

Ciliopathies are an expanding group of rare conditions characterized by multiorgan involvement, that are caused by mutations in genes encoding for proteins of the primary cilium or its apparatus. Among these genes, CEP290 bears an intriguing allelic spectrum, being commonly mutated in Joubert syndrome and related disorders (JSRD), Meckel syndrome (MKS), Senior-Loken syndrome and isolated Leber congenital amaurosis (LCA). Although these conditions are recessively inherited, in a subset of patients only one CEP290 mutation could be detected. To assess whether genomic rearrangements involving the CEP290 gene could represent a possible mutational mechanism in these cases, exon dosage analysis on genomic DNA was performed in two groups of CEP290 heterozygous patients, including five JSRD/MKS cases and four LCA, respectively. In one JSRD patient, we identified a large heterozygous deletion encompassing CEP290 C-terminus that resulted in marked reduction of mRNA expression. No copy number alterations were identified in the remaining probands. The present work expands the CEP290 genotypic spectrum to include multiexon deletions. Although this mechanism does not appear to be frequent, screening for genomic rearrangements should be considered in patients in whom a single CEP290 mutated allele was identified.

Thymosin beta4 enhances endothelial cell differentiation and angiogenesis

When human umbilical vein endothelial cells (HUVEC) differentiate into capillary-like tubes, there is a five-fold upregulation of the mRNA for thymosin beta4 (Tbeta4) (Grant et al. J Cell Sci 1995; 108: 3685-94 [1]) and this endogenous expression plays an important role in endothelial cell attachment to and spreading on matrix components. We now show that exogenous addition of thymosin beta4 (in the ng-microg range) to HUVEC in culture can induce several biological responses. These responses include increased tube formation in vitro. Additionally, exogenous thymosin beta4 enhances vascular sprouting in the coronary artery ring angiogenesis assay. Measurements of these vascular sprouts show a doubling of the vessel area (via increased branching) with as little as 100 ng of synthetic thymosin beta4. These processes appear to involve the binding of thymosin beta4 to an unknown cell surface receptor and internalization of the protein. This cell surface-binding appears not to be mediated through the thymosin beta4-actin binding domain LKTET. An increase in thymosin beta4 cytoplasmic staining in HUVEC exposed 10 microg of the peptide appears to occur without increased mRNA translation. In summary Tbeta4 induces an increase in cell-matrix attachment, proliferation, tube formation, internalization of the peptide and rearrangement of the actin cytoskeleton. The data now defines both an autocrine and paracrine role for thymosin beta4 in vessel formation.

Three-Dimensional Ultrastructural Karyotype Analysis from the Meiotic Parthenogenetic Nematode Heterodera betulae

Meiotic chromosome structure and function are described in the plant-parasitic nematode Heterodera betulae. Twelve synaptonemal complexes (SCs) were reconstructed from pachytene nuclei; therefore, n=12 is predicted for this species. Morphologically distinct sex chromosomes were not observed. Only one end of the SC is attached to the nuclear envelope, and there is no bouquet arrangement at pachytene. The structure of the SC in this meiotic parthenogenetic nematode was different than in other nematodes that reproduce via amphimixis; a striated central element with transverse filaments was not observed. Multiple SCs, or polycomplexes, were present in the nucleus. Recombination nodules were not observed. The centrioles were comprised of nine doublet microtubules connected by a ring, which is a distinct modification from the typical nine triplet microtubules without any interconnecting structure.

Meiotic Structures in the Animal-Parasitic Nematode Ascaris megalocephala: Synaptonemal Complexes, Recombination Nodules, and Centrioles

Two synaptonemal complexes (SCs) were present in the pachytene nuclei of Ascaris megalocephala. The SC was tripartite and comprised of two lateral elements (25 nm) with a striated central element (25 nm) and a central region of 65 nm. Spherical recombination nodules were observed to be associated only with the central element, although they are non-existent in the related A. lumbricoides var. suum (Goldstein, 1977). The SCs were attached to the nuclear envelope at only one end, while the other end was free in the nucleoplasm. This lack of bouquet formation of the chromosomes is consistent with all other nematodes studied. Morphologically distinct sex chromosomes were not observed, which differs from the presence of five Y-chromosomes present in A. lumbricoides var. suum (Goldstein and Moens, 1976). Centrioles (0.2 microm wide) reproduced by budding off the parental centriole. The centrioles consisted of nine singlet microtubules connected by an electron-dense proteinaceous ring. This structure is consistent with centrioles described in other nematodes, yet distinctly different from the centriole structure observed in most organisms in which it consists of nine triplet microtubules without any connecting ring. Multiple synaptonemal complexes, or polycomplexes, are found in A. megalocephala and A. lumbriocoides var. suum. They appear as stacked SC and are present inside the nucleus during zygotene and in the cytoplasm at pachytene.

Lymphoid apoptosis and myeloid hyperplasia in CCAAT displacement protein mutant mice

CCAAT displacement protein (cux/CDP) is an atypical homeodomain protein that represses expression of several developmentally regulated lymphoid and myeloid genes in vitro, including gp91-phox, immunoglobulin heavy chain, the T-cell receptor beta and gamma chains, and CD8. To determine how this activity affects cell development in vivo, a hypomorphic allele of cux/CDP was created by gene targeting. Homozygous mutant mice (cux/CDP(Delta HD/Delta HD)) demonstrated a partial neonatal lethality phenotype. Surviving animals suffered from a wasting disease, which usually resulted in death between 2 and 3 weeks of age. Analysis of T lymphopoiesis demonstrated that cux/CDP(Delta HD/Delta HD) mice had dramatically reduced thymic cellularity due to enhanced apoptosis, with a preferential loss of CD4(+)CD8(+) thymocytes. Ectopic CD25 expression was also observed in maturing thymocytes. B lymphopoiesis was also perturbed, with a 2- to 3-fold reduction in total bone marrow B-lineage cells and a preferential loss of cells in transition from pro-B/pre-BI to pre-BII stages due to enhanced apoptosis. These lymphoid abnormalities were independent of effects related to antigen receptor rearrangement. In contrast to the lymphoid demise, cux/CDP(Delta HD/Delta HD) mice demonstrated myeloid hyperplasia. Bone marrow reconstitution experiments identified that many of the hematopoietic defects were linked to microenvironmental effects, suggesting that underexpression of survival factors or overexpression of death-inducing factors accounted for the phenotypes observed. Tumor necrosis factor (TNF) levels were elevated in several tissues, especially thymus, suggesting that TNF may be a target gene for cux/CDP-mediated repression. These data suggest that cux/CDP regulates normal hematopoiesis, in part, by modulating the levels of survival and/or apoptosis factors expressed by the microenvironment.

Comparison of body weight and height of Israeli schoolchildren with the Tanner and Centers for Disease Control and Prevention growth charts

OBJECTIVE

To examine the suitability of the growth charts that are currently used in Israel and consider their replacement with a recent standard. In a sample of schoolchildren, the current Tanner and Whitehouse standards were compared with the new growth charts from the Centers for Disease Control and Prevention (CDC).

METHOD

A total of 746 Israeli healthy children (368 boys and 378 girls) aged 6 to 14 years were sampled from 2 super-regional schools (from the Jewish population). Height was measured using the Leicester height measure, and weight was measured using scales calibrated by the researchers.

RESULTS

In height, 75% of the boys and 81% of the girls fell in the 10th to 90th percentile range of the Tanner standards. In weight, 71% of the boys and 81% of the girls were in the 10th to 90th percentile range. Israeli boys were taller (chi2(1) = 30.53) and heavier (chi2(1) = 29.39), and girls were taller (chi2(1) = 13.81) than predicted by the Tanner standards. The CDC 10th to 90th percentile range included 81% of the boys and 83% of the girls for height and 78% of the boys and 81% of the girls for weight. The girls in our sample were slightly shorter (chi2(1) = 11.87) and lighter (chi2(1) = 9.52) than predicted from the CDC charts. Nevertheless, neither boys' nor girls' body mass index measures (kg/h2) differed from the CDC charts.

CONCLUSIONS

Our data suggest that the CDC growth charts are adequate for assessing Israeli children and slightly better than the current standard. Thus, in the absence of local standards, we recommend the use of the revised CDC growth charts, which include the additional body mass index measure.