Growth patterns and outcomes of growth hormone therapy in patients with acrodysostosis

INTRODUCTION

Severe short stature is a feature of acrodysostosis, but data on growth are sparse. Treatment with recombinant human growth hormone (rhGH) is used in some centers to increase final height, but no studies have been published so far. Our objective was to conduct a multicenter, retrospective, cohort study to investigate growth in individuals with both types of acrodysostosis, treated with rhGH or not; we used the new nomenclature to describe acrodysostosis, as this disease belongs to the large group of inactivating PTH/PTHrP signaling disorders (iPPSD); acrodysostosis refers to iPPSD4 (acrodysostosis type 1 due to PRKAR1A mutations) and iPPSD5 (acrodysostosis type 2, due to PDE4D mutations).

METHODS

We present auxological data from individuals with genetically characterized iPPSD4, and participants with clinical features of iPPSD5.

RESULTS

We included 20 and 17 individuals with iPPSD4 and iPPSD5, respectively. The rhGH-treated iPPSD4 patients (n = 9) were smaller at birth than those who did not receive rhGH (median - 2.2 SDS vs. - 1.7 SDS); they showed a trend to catch-up growth during rhGH therapy (median 0.5 SDS in the first year). The rhGH-treated patients (n = 5) reached a better final height compared to those who did not receive rhGH (n = 4) (median - 2.8 SDS vs. - 3.9 SDS), suggesting that rhGH is efficient to increase height in those patients. The difference in target height to final height ranged between 1.6 and 3.0 SDS for iPPSD4 not treated with rhGH (n = 4), 2.1-2.8 SDS for rhGH-treated iPPSD4 (n = 5), 0.6-5.5 SDS for iPPSD5 not treated with rhGH (n = 5) and 2.5-3.1 for rhGH-treated iPPSD5 (n = 2).

CONCLUSION

Final height may be positively influenced by rhGH in patients with acrodysostosis/iPPSD. Our rhGH-treated cohort started therapy relatively late, which might explain, at least in part, the limited effect of rhGH on height.

Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

Perineal pain and dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy.

METHODS

Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception - December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or dyspareunia in women with SVB.

RESULTS

Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4-10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced dyspareunia whether perineal trauma existed or not.

CONCLUSIONS

Women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.

Molecular characterization of infectious bursal disease virus (IBDV) isolated in Argentina indicates a regional lineage

In Argentina, classical vaccines are used to control infectious bursal disease virus (IBDV); however, outbreaks of IBDV are frequently observed. This could be due to failures in the vaccination programs or to the emergence of new strains, which would be able to break through the protection given by vaccines. Hence, genetic characterization of the viruses responsible for the outbreaks that occurred in recent years is crucial for the evaluation of the control programs and the understanding of the epidemiology and evolution of IBDV. In this study, we characterized 51 field samples collected in Argentina (previously identified as IBDV positive) through the analysis of previously identified apomorphic sequences. Phylogenetic analysis of regVP2 showed that 42 samples formed a unique cluster (Argentinean lineage), seven samples were typical classical strains (one of them was a vaccine strain), and two belonged to the very virulent lineage (vvIBDV). Interestingly, when the analysis was performed on the regVP1 sequences, the field samples segregated similarly to regVP2; thus, we observed no evidence of a reassortment event in the Argentinean samples. Amino acid sequence analysis of regVP2 showed a particular pattern of residues in the Argentinean lineage, particularly the presence of T272, P289 and F296, which had not been reported before as signature sequences for any IBDV phenotype. Notably, the residue S254, characteristic of the antigenic variant, was not present in any of the Argentinean samples.

Phylogenetic analysis of bluetongue virus serotype 4 field isolates from Argentina

Bluetongue is an insect-transmitted viral disease of ruminant species, which represents a major barrier to the international trade of animals and their products. Bluetongue virus (BTV) has a genome composed of ten linear segments of dsRNA, which code for at least ten different viral proteins. In South America, serological evidence for the presence of BTV has been found in Peru, Argentina, Brazil, Ecuador and Chile. Brazil and Argentina are the only South American countries where BTV has been isolated. In Brazil, only one BTV isolate, serotype 12, has been reported, whereas in Argentina five BTV serotype 4 isolates have been obtained from cattle without clinical signs. Three of these five isolates were isolated during 1999–2001, whereas two of them were obtained as part of the present work. This study describes sequence comparisons and phylogenetic analyses of segment (Seg)-2, Seg-3, Seg-6, Seg-7 and Seg-10 of the first Argentinian field isolates of BTV. The analysis of Seg-2 and Seg-6 resulted in a single cluster of Argentinian sequences into the serotype 4 clade. In addition, the Argentinian sequences grouped within the nucleotype A clade, along with reference strains. The analysis of Seg-3, Seg-7 and Seg-10 showed that the Argentinian isolates grouped into the western topotype, indicating that the circulating virus had an African/European origin. Phylogenetic analysis revealed that the Argentinian sequences present a South American genetic identity, suggesting an independent lineage evolution.

Dynamic analysis of the righting reflex in toads; recovery after hemilabyrinthectomy

Static and dynamic measurements of the righting reflex were performed in intact toads (Bufo arenarum platensis) and at different stages of recovery from hemilabyrinthectomy. Reflex activity was evaluated by the toad's capacity to maintain a horizontal head position while rolled sideways. Static data were obtained from frontal photographs. In dynamic experiments platform position (stimulus) was measured through a potentiometer, while a linear accelerometer glued to the cranium was used to record head tilts. The dynamic study included a linear systems analysis using sinusoids of 0.5-3 Hz with rolls of up to 30° to each side. Hemilabyrinthectomy produced a head tilt towards the lesioned side, and gain decay and phase lag increase in the dynamic response. All postural defects recovered progressively within 30-60 days as already described in other species. Nevertheless, the tonic head deviation produced by dynamic stimuli of frequencies above 1 Hz did not recover. This remnant defect has not been observed in previous studies in which only static observations were performed. The involvement of a frequency-dependent rectifying mechanism in postural compensation is discussed.

Comparison of measurements of the transverse diameter and perimeter of the fetal thymus obtained by magnetic resonance and ultrasound imaging

PURPOSE

To compare measurements of the fetal thymus obtained by magnetic resonance imaging (MRI) and ultrasound (US).

MATERIALS AND METHODS

Written informed consent was obtained from the patients that participated in this Institutional Review Board-approved observational study. The study population consisted of 17 pregnant women carrying fetuses between 21 and 34 weeks of gestation with suspected abnormalities. The transverse diameter and perimeter of the thymus were measured in these fetuses at the level of an axial view of the thorax that includes the pulmonary, aorta, and superior vena cava. The degree of agreement between MRI and US measurements was determined using Lin's concordance correlation coefficient and Bland-Altman analysis.

RESULTS

The mean (standard deviation, SD) gestational age at the time of the prenatal evaluation was 28.4 weeks (3.6). The thymus was measured by MRI and US in all cases. Comparison of the measurements from these two imaging modalities demonstrated a relatively good reproducibility with no evidence of systematic error.

CONCLUSION

MRI and US measurements of the fetal thymus during the second half of pregnancy are comparable. This finding suggests that MRI can become a useful adjuvant to US for assessment of the fetal thymus.

Experimental reactivation of equine herpesvirus-3 following corticosteroid treatment

State of latency, well known for several herpesviruses, has been proposed for equine herpesvirus-3 (EHV-3) and supported by epidemiological observations. No detailed assessment about reactivation, patterns of excretion and reexcretion has been formally reported. An experimental reactivation study by corticosteroid treatment in previously naturally infected horses was therefore carried out. Two polo mares with clinical and virologically confirmed history of equine coital exanthema were injected with dexamethasone and prednisolone on 3 successive days. Clinical signs, body temperature and clinical samples for virological and serological studies were obtained daily. Mares did not show any systemic clinical signs or hyperthermia. EHV-3 shedding, seroconversion and the presence of a small lesion were observed in one of the mares under study 2 weeks after corticosteroid treatment. The results demonstrate that this virus exhibits a latency-reactivation behaviour similar to that of other alpha herpesviruses. Reactivation of latency may have an important bearing on the appearance of clinical signs in mares and/or stallions during the breeding season without the actual evidence of transfer from mare to stallion or vice versa.

Identification of personal factors that determine work outcome for adults with intellectual disability

BACKGROUND

Access to employment for people with intellectual disability (ID) has become a social priority. The aim of the present study is to try to determine which variables [sociodemographic variables, intelligence quotient (IQ), presence or absence of a psychiatric disorder, functioning, self-determination, and behavioural problems] could most reliably account for access to remunerated employment of people with ID.

METHODS

Two groups of people with ID participated in this study: (1) 69 workers in a sheltered-employment programme; and (2) 110 clients of programmes in sheltered workshops. Both programmes were run by the Pardo-Valcarce Foundation in Madrid (Spain). The following variables were assessed for every participant: IQ, functioning, behavioural problems, self-determination and presence of psychiatric symptoms. A binary logistic regression analysis was carried out in order to identify the variables that best explained work outcome (sheltered workshop programme vs. sheltered employment programme).

RESULTS

Although IQ showed no significant differences between the two groups of participants, the remaining variables did: behavioural problems, functioning, psychiatric symptoms and self-determination significantly explained work outcome. As for sociodemographic variables, whereas gender did not show any significant relationship with the labour status of the participants, significant differences were found when considering variables such as age and pension benefits.

CONCLUSIONS

All the main variables considered, except IQ, turned out to be significant. Our findings should be considered encouraging, as they apparently show that both personal and social efforts can help individuals to overcome their low intellectual functioning in order to achieve access to employment. Such study highlights the importance of a prior psychopathological evaluation and efforts to enhance self-determination in order to improve work inclusion for people with ID.

Validation of the Subjective and Objective Family Burden Interview (SOFBI/ECFOS) in primary caregivers to adults with intellectual disabilities living in the community

BACKGROUND

There is little information on the psychometric properties of instruments for assessing family care burden in adults with intellectual disabilities (ID). The aim of this study is therefore to analyse the usefulness of the 'Subjective and Objective Family Burden Interview' (SOFBI) in the assessment of principal caregivers in Spain.

METHODS

The SOFBI was administered to 166 principal caregivers of adults with ID in a vocational centre. The psychometric analysis included: internal consistency, inter-rater and test-retest reliability, construct validity, convergent validity with the World Health Organization's Disability Assessment Schedule II, and feasibility.

RESULTS

The Cronbach's alpha was 0.88 for the overall interview and always above 0.7 in the quantitative subdomains. The Kappa coefficients for test-retest were between 0.5 and 0.8, whereas inter-rater agreement was nearly perfect. Maximum-likelihood factor analysis showed four well-defined factors, which fitted the previously designed domains. Feasibility was also good.

CONCLUSIONS

The SOFBI is a multi-domain, modular instrument which is feasible, reliable and valid for measuring the burden of family caregivers to adults with ID living in the community.

Predictors of compliance with psychological interventions offered in the community

BACKGROUND

This study sought to evaluate the acceptance of two brief psychological interventions for depressed individuals, contacted through a community survey, and to look for predictors of adherence at the patient level.

METHOD

The authors used data from the Outcomes of Depression International Network (ODIN) study, which included a randomized controlled trial in which depressed individuals from five European countries, and nine geographical areas were assigned to one of three groups: individual problem-solving treatment, group psychoeducation, or control group. In this analysis, we included all of the individuals who had been assigned to one of the psychological interventions. Compliance with intervention was defined in two different ways. Multiple logistic regression was used to see which variables might predict an individual's compliance with psychological treatment.

RESULTS

Psychological intervention was offered to 236 subjects. Treatment was completed by 128 subjects and not by 108 (compliance definition A). Three variables were found to have an effect on compliance A: the presence of a confidant, the use of antidepressant medication during the previous 6 months, and the previous use of any social or health services. On the other hand, 164 subjects had agreed to at least start the treatment, and 72 had not (compliance definition B). The three factors associated with compliance B were presence of a confidant, previous use of services, and the 'desire for change' score.

CONCLUSIONS

Social support and previous use of services are the main predictors of compliance with a psychological treatment in depressed individuals from the community. Implications for clinical practice and community programs are discussed.

Changes, trends and challenges of medical education in Latin America

This paper briefly reviews the current situation of Latin American medical schools and the search to improve the quality and professionalism of medical education through the region. Institutional evaluation and accreditation programs based on nationally ongoing developing standards have been accepted, now optimized and complemented by the framework of the Global & International Standards of Medical Education working jointly with the WFME. More recently, the process has evolved to look into the quality of the outcomes of the medicals as seen by examinations implemented at the end of medical studies and the initiation of medical practice. In addition, there is vision for the application of new programs such as the global minimum essential requirements advanced by the Institute for International Medical Education (IIME). The PanAmerican Federation of Associations of Medical Schools (PAFAMS), an academic, non-governmental organization, is fostering the exchange of ideas and experiences among members, associations and affiliated medical schools geared to focus on the quality and professionalism of the graduates of medical schools in Latin America. These actions also aim to consolidate databases of information on medical education and innovative endeavors in continuing professional education and development through e-learning projects in the region.

High-resolution proteomic mapping in the vertebrate central nervous system: close proximity of connexin35 to NMDA glutamate receptor clusters and co-localization of connexin36 with immunoreactivity for zonula occludens protein-1 (ZO-1)

Combined confocal microscopy and freeze-fracture replica immunogold labeling (FRIL) were used to examine the connexin identity at electrical synapses in goldfish brain and rat retina, and to test for "co-localization" vs. "close proximity" of connexins to other functionally interacting proteins in synapses of goldfish and mouse brain and rat retina. In goldfish brain, confocal microscopy revealed immunofluorescence for connexin35 (Cx35) and NMDA-R1 (NR1) glutamate receptor protein in Mauthner Cell/Club Ending synapses. By FRIL double labeling, NR1 glutamate receptors were found in clusters of intramembrane particles in the postsynaptic membrane extraplasmic leaflets, and these distinctive postsynaptic densities were in close proximity (0.1-0.3 microm) to neuronal gap junctions labeled for Cx35, which is the fish ortholog of connexin36 (Cx36) found at neuronal gap junctions in mammals. Immunogold labeling for Cx36 in adult rat retina revealed abundant gap junctions, including several previously unrecognized morphological types. As in goldfish hindbrain, immunogold double labeling revealed NR1-containing postsynaptic densities localized near Cx36-labeled gap junction in rat inferior olive. Confocal immunofluorescence microscopy revealed widespread co-localization of Cx36 and ZO-1, particularly in the reticular thalamic nucleus and amygdala of mouse brain. By FRIL, ZO-1 immunoreactivity was co-localized with Cx36 at individual gap junction plaques in rat retinal neurons. As cytoplasmic accessory proteins, ZO-1 and possibly related members of the membrane-associated guanylate kinase (MAGUK) family represent scaffolding proteins that may bind to and regulate the activity of many neuronal gap junctions. These data document the power of combining immunofluorescence confocal microscopy with FRIL ultrastructural imaging and immunogold labeling to determine the relative proximities of proteins that are involved in short- vs. intermediate-range molecular interactions in the complex membrane appositions at synapses between neurons.

Connexin35 mediates electrical transmission at mixed synapses on Mauthner cells

Auditory afferents terminating as "large myelinated club endings" on goldfish Mauthner cells are identifiable "mixed" (electrical and chemical) synaptic terminals that offer the unique opportunity to correlate physiological properties with biochemical composition and specific ultrastructural features of individual synapses. By combining confocal microscopy and freeze-fracture replica immunogold labeling (FRIL), we demonstrate that gap junctions at these synapses contain connexin35 (Cx35). This connexin is the fish ortholog of the neuron-specific human and mouse connexin36 that is reported to be widely distributed in mammalian brain and to be responsible for electrical coupling between many types of neurons. Similarly, connexin35 was found at gap junctions between neurons in other brain regions, suggesting that connexin35-mediated electrical transmission is common in goldfish brain. Conductance of gap junction channels at large myelinated club endings is known to be dynamically modulated by the activity of their colocalized glutamatergic synapses. We show evidence by confocal microscopy for the presence of the NR1 subunit of the NMDA glutamate receptor subtype, proposed to be a key regulatory element, at these large endings. Furthermore, we also show evidence by FRIL double-immunogold labeling that the NR1 subunit of the NMDA glutamate receptor is present at postsynaptic densities closely associated with gap junction plaques containing Cx35 at mixed synapses across the goldfish hindbrain. Given the widespread distribution of electrical synapses and glutamate receptors, our results suggest that the plastic properties observed at these identifiable junctions may apply to other electrical synapses, including those in mammalian brain.

Short-range functional interaction between connexin35 and neighboring chemical synapses

Auditory afferents terminating as mixed, electrical, and chemical, synapses on the goldfish Mauthner cells constitute an ideal experimental model to study the properties of gap junctions in the nervous system as well as to explore possible functional interactions with the other major form of interneuronal communication--chemically mediated synapses. By combining confocal microscopy and freeze-fracture replica immunogold labeling (FRIL), we found that gap junctions at these synapses contain connexin35 (Cx35), the fish ortholog of the neuron-specific human and mouse connexin36 (Cx36). Conductance of gap junction channels at these endings is known to be dynamically modulated by the activity of their co-localized chemically mediated glutamatergic synapses. By using simultaneous pre- and postsynaptic recordings at these single terminals, we demonstrate that such functional interaction takes place in the same ending, within a few micrometers. Accordingly, we also found evidence by confocal and FRIL double-immunogold labeling that the NR1 subunit of the NMDA glutamate receptor, proposed to be a key regulatory element, is present at postsynaptic densities closely associated with gap junction plaques containing Cx35. Given the widespread distribution of Cx35- and Cx36-mediated electrical synapses and glutamatergic synapses, our data suggest that the local functional interactions observed at these identifiable junctions may also apply to other electrical synapses, including those in mammalian brain.

[Molecular characterization of aphthous fever virus isolated during the years 1993-1994 in Argentina]

Nucleotide sequence and phylogenetic analysis of the VP1 structural protein have been used extensively as diagnostic and epidemiological tools for foot and mouth disease virus (FMDV). In this report we have applied this methodology to the analysis of the VP1 coding sequence from FMDV strains isolated in Argentina during 1993-1994. The results demonstrated that the field isolates were related to the vaccine strains used at that time. However the involvement of the vaccine virus appeared to be different for outbreaks caused by FMD viruses type O or C. These data provide a database essential for determining the origin of new epizootics.

[Expression and characterization of 2 bovine viral diarrhea virus structural proteins (]BVDV)]

The BVDV glycoproteins gp48 and gp53 were expressed in the baculovirus eukaryotic system. Both recombinant proteins were recognized in western blot analysis by monoclonal antibodies and polyclonal serum. Immunofluorescent test demonstrated that gp53 was localized on the cell surface whereas gp48 was in the cytoplasm. The expressed proteins were extracted by non-denaturing detergent treatment. Rabbit antiserum raised against gp53 recombinant protein efficiently neutralized the virus. These results demonstrate that the recombinant proteins have immunological properties similar to those of the native viral protein and that they can be useful as diagnostic reagents.

Properties and plasticity of paired-pulse depression at a central synapse

Synaptic depression was studied at the axo-axonic connection between the goldfish Mauthner axon and identified cranial relay interneurons using simultaneous presynaptic and postsynaptic recordings and a paired-pulse stimulus paradigm. We used interstimulus intervals (ISIs) ranging from 10 msec to 1 sec and a cycle time of approximately 5 sec. Depression (Delta EPSP/EPSP1) was maximal at the shorter intervals (80%) and decreased exponentially with a tau approximately 400 msec (360 +/- 107 msec, mean +/- SD). We found the amplitudes of the first and second EPSP were not correlated, indicating the magnitude of depression does not depend on the amount of transmitter released by the conditioning stimulus. At short ISIs, the latency of EPSP2 was 23% longer than that of EPSP1 and recovered to control with tau approximately 400 msec, whereas rise time and decay time were not altered significantly. The latency distribution, which is determined by the timing of the first quantum released each trial, was used to derive alpha(t), the rate of evoked exocytosis after an action potential. alpha(t) was biphasic, and both components were consistently delayed during depression. Presynaptic manipulations of putative intracellular regulatory pathways, such as Ca(2+) and GTPgammaS injections, preferentially affected the amplitude of EPSP1 or EPSP2. These results are not consistent with simple depletion of the available pool of synaptic vesicles as the major mechanism underlying depression. They rather suggest that it is attributable to a modification or refractoriness of the release process and that there may be multiple pathways subserving evoked exocytosis.

Nerve injury induces gap junctional coupling among axotomized adult motor neurons

Neonatal spinal motor neurons are electrically and dye-coupled by gap junctions, but coupling is transient and disappears rapidly after birth. Here we report that adult motor neurons become recoupled by gap junctions after peripheral nerve injury. One and 4-6 weeks after nerve cut, clusters of dye-coupled motor neurons were observed among axotomized, but not control, lumbar spinal motor neurons in adult cats. Electrical coupling was not apparent, probably because of the electrotonic distance between dendrodendritic gap junctions and the somatic recording location. Analyses of gap junction protein expression in cat and rat showed that the repertoire of connexins expressed by normal adult motor neurons, Cx36, Cx37, Cx40, Cx43, and Cx45, was unchanged after axotomy. Our results suggest that the reestablishment of gap junctional coupling among axotomized adult motor neurons may occur by modulation of existing gap junction proteins that are constitutively expressed by motor neurons. After injury, interneuronal gap junctional coupling may mediate signaling that maintains the viability of axotomized motor neurons until synaptic connections are reestablished within their targets.

The loading domain of the erythromycin polyketide synthase is not essential for erythromycin biosynthesis in Saccharopolyspora erythraea

6-Deoxyerythronolide B synthase (DEBS) is a large multifunctional enzyme that catalyses the biosynthesis of the erythromycin polyketide aglycone. DEBS is organized into six modules, each containing the enzymic domains required for a single condensation of carboxylic acid residues which make up the growing polyketide chain. Module 1 is preceded by loading acyltransferase (AT-L) and acyl carrier protein (ACP-L) domains, hypothesized to initiate polyketide chain growth with a propionate-derived moiety. Using recombinant DNA technology several mutant strains of Saccharopolyspora erythraea were constructed that lack the initial AT-L domain or that lack both the AT-L and ACP-L domains. These strains were still able to produce erythromycin, although at much lower levels than that produced by the wild-type strain. In addition, the AT-L domain expressed as a monofunctional enzyme was able to complement the deletion of this domain from the PKS, resulting in increased levels of erythromycin production. These findings indicate that neither the initial AT-L nor the ACP-L domains are required to initiate erythromycin biosynthesis; however, without these domains the efficiency of erythromycin biosynthesis is decreased significantly. It is proposed that in these mutants the first step in erythromycin biosynthesis is the charging of KS1 with propionate directly from propionyl-CoA.

Acyltransferase domain substitutions in erythromycin polyketide synthase yield novel erythromycin derivatives

The methylmalonyl coenzyme A (methylmalonyl-CoA)-specific acyltransferase (AT) domains of modules 1 and 2 of the 6-deoxyerythronolide B synthase (DEBS1) of Saccharopolyspora erythraea ER720 were replaced with three heterologous AT domains that are believed, based on sequence comparisons, to be specific for malonyl-CoA. The three substituted AT domains were "Hyg" AT2 from module 2 of a type I polyketide synthase (PKS)-like gene cluster isolated from the rapamycin producer Streptomyces hygroscopicus ATCC 29253, "Ven" AT isolated from a PKS-like gene cluster of the pikromycin producer Streptomyces venezuelae ATCC 15439, and RAPS AT14 from module 14 of the rapamycin PKS gene cluster of S. hygroscopicus ATCC 29253. These changes led to the production of novel erythromycin derivatives by the engineered strains of S. erythraea ER720. Specifically, 12-desmethyl-12-deoxyerythromycin A, which lacks the methyl group at C-12 of the macrolactone ring, was produced by the strains in which the resident AT1 domain was replaced, and 10-desmethylerythromycin A and 10-desmethyl-12-deoxyerythromycin A, both of which lack the methyl group at C-10 of the macrolactone ring, were produced by the recombinant strains in which the resident AT2 domain was replaced. All of the novel erythromycin derivatives exhibited antibiotic activity against Staphylococcus aureus. The production of the erythromycin derivatives through AT replacements confirms the computer predicted substrate specificities of "Hyg" AT2 and "Ven" AT and the substrate specificity of RAPS AT14 deduced from the structure of rapamycin. Moreover, these experiments demonstrate that at least some AT domains of the complete 6-deoxyerythronolide B synthase of S. erythraea can be replaced by functionally related domains from different organisms to make novel, bioactive compounds.

Nucleotide sequence of the ermE distal flank of the erythromycin biosynthesis cluster in Saccharopolyspora erythraea

A 7023 nucleotide BamHI fragment immediately upstream of the eryK gene of the erythromycin (Er) biosynthesis cluster in Saccharopolyspora erythraea was sequenced. Computer-assisted analysis of this sequence reveals the existence of seven ORFs that display the codon preferences typical of actinomycete genes. Six of these show homology to known genes: an esterase, a transposase, a peptidyl-prolyl cis-trans isomerase, a subtilisin inhibitor-like protein, and two genes involved in bacterial cell wall biosynthesis. All the ORFs are transcribed toward the Er biosynthetic gene cluster (in the same direction as eryK). From the predicted functions of the putative ORF products none of these genes appear to be involved in the biosynthesis of Er. The eryK gene thus most likely defines one end of the Er biosynthetic gene cluster.

[Results of preoperative autotransfusion with ferrous ascorbate prophylaxis in orthopedic surgery patients]

PURPOSE

Restrictive erythropoiesis caused by iron deficiency may hinder pre-deposit autotransfusion in surgical procedures. In order to evaluate the response to prophylactic ferrous ascorbate, a prospective study was conducted on patients subjected to orthopaedic surgery and autotransfusion.

PATIENTS AND METHODS

Sixty-eight patients were included in the study: hip prostheses 67%, knee prostheses 25%, other procedures 7.4%. Their mean age was 61.3 +/- 10.2 years, and there were 42% male and 57% female. A mean of 2.8 +/- 0.6 units (450 mL) of blood were drawn to each patient in a month. Starting one week before their first blood donation and up to 2 months after surgery, each patient received 99 mg elementary iron per days as oral ferrous ascorbate. Blood cell counts were done at the beginning of the programme and after the first, second, third and fourth blood withdrawal, as well as one month after finishing the treatment. A survey of iron profile including serum iron, total iron binding capacity, transferrin saturation, serum ferritin and free erythrocyte protoporphyrin was carried out at onset and end of the programme in each patient. All data were analysed with the SPSS-PC 4.0 statistical programme.

RESULTS

Haemoglobin rates decreased in every control, returning to values close to the initial ones by the end of the programme (mean figures are as follows: 14.63; 13.17; 12.70; 11.88; 14.11 g/dL); and similar changes were seen with respect to the other parameters of blood. The initial and final values for ferritin were 157.32 and 91.06 ng/mL, respectively, and no significant changes were appreciated in the other data from the iron profile, regardless of the number of blood units collected in a given case. Minor intolerance to ferrous ascorbate appeared in 11% of the patients. No significant differences with control patients were seen regarding hospitalization (16.54 vs 19.82 days) or postoperative fever (14.1% vs 17.11%).

CONCLUSIONS

As opposed to others, we feel that iron treatment should be maintained up to 2 months after surgery since better results are thus attained. Recombinant erythropoietin is more expensive a method. Ferrous ascorbate is better tolerated than ferrous sulphate plus additives.

Regulation of synaptic strength at mixed synapses: effects of dopamine receptor blockade and protein kinase C activation

Previous studies of the mixed excitatory synapses between eighth nerve afferents and the lateral dendrite of the goldfish Mauthner (M-) cell have shown that synaptic strength is enhanced for an hour or longer following either repeated brief tetanizations or local extracellular applications of dopamine. Both the initial electrotonic coupling potential, mediated via current flow through gap junctions, and the subsequent chemically mediated excitatory postsynaptic potentials (EPSPs) are potentiated. Different second messenger pathways are implicated in the postsynaptic induction of these potentiations, with a Ca2+ influx presumably triggering the activity dependent long-term potentiations (LTP) and dopamine acting via a cAMP dependent pathway. Experiments performed to determine whether the LTP involves a stimulus-induced release of dopamine or requires a background level of dopamine receptor activation suggest neither is the case, as tetanization in the presence of a D1 receptor antagonist, which blocks the dopamine effects, produced an LTP comparable to that in the absence of the blocker. The effects of Ca2+ are presumably not due to protein kinase C (PKC) activation, since phorbol esters had no effect on the mixed excitatory synaptic responses, although they did enhance the frequency of spontaneously occurring inhibitory PSPs.

A hydroxylase-like gene product contributes to synthesis of a polyketide spore pigment in Streptomyces halstedii

A gene, schC, adjacent to the sch gene cluster encoding the biosynthesis of a polyketide spore pigment in Streptomyces halstedii was sequenced. Its deduced product resembled flavin adenine nucleotide-containing hydroxylases involved in the biosynthesis of polycyclic aromatic polyketide antibiotics and in catabolic pathways of aromatic compounds. When schC was disrupted, the normally green spores of S. halstedii became lilac. An schC-like gene was located in an equivalent position next to a large gene cluster (whiE) known to determine spore pigment in Streptomyces coelicolor A3(2).

Hybridization and DNA sequence analyses suggest an early evolutionary divergence of related biosynthetic gene sets encoding polyketide antibiotics and spore pigments in Streptomyces spp

The whiE gene cluster of Streptomyces coelicolor, which is related to gene sets encoding the biosynthesis of polycyclic aromatic polyketide antibiotics, determines a spore pigment. Southern blotting using probes from three different parts of the whiE cluster revealed related gene sets in about half of a collection of diverse Streptomyces strains. A 5.2-kb segment of one such cluster, sch, previously shown to determine spore pigmentation in Streptomyces halstedii, was sequenced. Seven open reading frames (ORFs), two of them incomplete, were found. Six of the ORFs resemble the known part of the whiE cluster closely. The derived gene products include a ketosynthase (= condensing enzyme) pair, acyl carrier protein and cyclase, as well as two of unidentified function. The seventh ORF diverges from the main cluster and encodes a protein that resembles a dichlorophenol hydroxylase. Comparison with sequences of related gene sets for the biosynthesis of antibiotics suggests that gene clusters destined to specify pigment production diverged from those destined to specify antibiotics early in the evolution of the Streptomyces genus.

Dopamine enhances both electrotonic coupling and chemical excitatory postsynaptic potentials at mixed synapses

The transmitter dopamine reduces electrotonic coupling between retinal horizontal cells and increases their sensitivity to glutamate. Since in other systems single afferents establish mixed electrotonic and chemical excitatory synapses with their targets, dopamine might be expected there to depress one component of excitation while enhancing the other. This hypothesis was tested by applying dopamine locally in the vicinity of the lateral dendrite of the goldfish Mauthner cell (M cell) and monitoring the composite electrotonic and chemical excitatory postsynaptic potentials and currents evoked by ipsilateral eighth nerve stimulation. Dopamine produces persistent enhancements of both components of the postsynaptic response while it also increases input conductance. All these dopamine actions are prevented by superfusing the brain with saline containing the dopamine D1 receptor antagonist SCH-23390. Postsynaptic injections of the cAMP-dependent protein kinase inhibitor (Walsh inhibitor, or PKI5-24) block the dopamine-induced changes in synaptic transmission, implicating a cAMP-dependent mechanism. Furthermore, there is a dopaminergic innervation of the M cell, as demonstrated immunohistochemically with antibodies against dopamine and the rate-limiting enzyme in its synthetic pathway, tyrosine hydroxylase. Varicose immunoreactive fibers lie in the vicinity of the distal part of the lateral dendrite between the large myelinated club endings that establish the mixed synapses. As determined with electron microscopy, the dopaminergic fibers contain small vesicles, and they do not have synaptic contacts with either the afferents or the M cell, remaining instead in the synaptic bed. Taken together, these results suggest that dopamine released at a distance from these terminals increases the gain of this primary sensory input to the M cell, most likely through a phosphorylation mechanism.

Cloning and disruption of a fragment of Streptomyces halstedii DNA involved in the biosynthesis of a spore pigment

A 5.2-kb BamHI fragment of Streptomyces halstedii was cloned by homology to the actI-carrying fragment which codes for part of the actinorhodin polyketide synthase of Streptomyces coelicolor A3(2). Gene disruption using the integrative plasmid vector, pGM160, and gene replacement experiments using a fragment mutated by introducing a cassette containing the gene encoding thiostrepton resistance, showed that the alteration of this region in the chromosome of S. halstedii caused sporulating colonies to remain white instead of taking on the typical green colour of sporulating wild-type colonies. This suggests that this fragment is involved in the biosynthesis of a spore pigment. In addition, the BamHI fragment complemented the whiE mutation of S. coelicolor C107 which confers to this mutant a white phenotype, indicating that both pigments could have a similar biosynthetic origin.

Regeneration of the eight cranial nerve. I. Anatomic verification in the bullfrog

The regenerative capacity of the eight cranial nerve of the bullfrog, Rana catesbeiana, was investigated. The nerve was sectioned between the ganglion and the brain stem in 16 experimental animals. Horseradish peroxidase was extracellularly injected distal to the site of the nerve section five or more weeks postoperatively. Labeled fibers were identified histologically and their central nervous system projections studied. The findings were as follows: 1. The eight cranial nerve of the bullfrog regenerated after preganglionic axotomy. 2. Fibers of all sizes regenerated. The regenerated fibers in the nerve were disorderly at the site of nerve section. Most fibers entered the brain stem and formed a vestibuloauditory tract, although some "escaped" and coursed along the brain stem. 3. The regenerated vestibuloauditory tract was situated more laterally than normal, with thick and thin fibers intermixed. 4. Regenerated tertiary fibers were long and tortuous and had unusual trajectories. 5. All vestibuloauditory nuclei received thick and thin afferent fibers.