P909 Diagnostic evaluation of rheumatic heart disease in aborigonal population

Background

Among Indigenous Australians, rates of Acute Rheumatic Fever (ARF) continue to be among the highest in the world. Diagnosis remains a clinical decision based on identification of major and minor manifestations of the illness. Treatment involves lengthy prophylaxis and should continue for a minimum of 10 years.

ARF can cause permanent damage to the heart known as rheumatic heart disease (RHD).

We therefore utilised echocardiography as a diagnostic tool incorporating Tissue Quantification Backscatter expressed in decibels (dB) and global LV work efficiency estimated from left ventricle (LV) pressure-strain loops to identify rheumatic changes of the Mitral Valve and help improve early diagnosis of RHD.

Method

Data from patients with suspected RHD (n = 14), and age matched controls (n = 10) underwent Mitral Valve Backscatter Analysis (MVBS). MVBS was expressed as a ratio % (MVBS ratio %) by dividing the average MVBS and the average blood pool value expressed in decibels (dB). Furthermore LV function was utilised via 2D longitudinal strain and indices of myocardial work were derived.

Result

MVBS ratio % was significantly higher in the control group as compared to the RHD group (p = 0.001) (fig1). Of the RHD group echocardiography parameters showed there were no significant mitral valve stenosis or regurgitation. Correlates of LV function included: Global work Index (GWI), Global longitudinal Strain (GLS) and Global work efficiency (GWE). Of the above correlates the control group showed Backscatter vs GLS (r= -0.89, p = 0.001), the RHD group: Backscatter vs GLS (r = 0.52. p = 0.12). Within the RHD group the ratio vs GWE (r= 0.57, p = 0.09) these results showed a trend to significance.

Conclusions

Currently diagnosis of RHD remains a clinical decision based on the identification of major and minor manifestations. In addition treatment involves prophylaxis injections for a minimum of ten years. Of this group there were no significant echocardiography changes, rather clinical manifestation to derive RHD.

This study shows that calibrated MVBS ratio % and determinants of myocardial work may be a promising quantitative tool to detect early manifestation of RHD potentially aiding an early treatment plan and thus reducing the clinical burden of monthly penicillin injections for a ten year period.

Abstract P909 Figure. RHD and Myocardial correlates

Vitamin D insufficiency in internal medicine residents

Medical residents may be vulnerable to low vitamin D status because of long work hours and lack of sun exposure. We conducted a prospective cohort study to measure serum 25-hydroxyvitamin D concentrations among internal medicine residents, document seasonal variation in vitamin D status, and assess risk factors for inadequate vitamin D stores. Dietary intake of calcium and vitamin D, lifestyle characteristics, and serum concentrations of 25(OH)-vitamin D and intact parathyroid hormone (iPTH) were measured in 35 resident volunteers before and after the winter season. A total of 63-69% of medical residents consumed <400 IU/day of vitamin D; 61-67% consumed <1000 mg/day of calcium. Twenty-five (74%) had lower serum 25(OH)-vitamin D concentrations and 23 (68%) had higher serum iPTH in the spring than in the fall. Nine (26%) residents had serum concentrations of 25(OH)-vitamin D of <20 ng/mL in the fall; and sixteen (47%) in the spring. Seven residents (20%) had serum concentrations of 25(OH)-vitamin D of <20 ng/mL at both time-periods; Eighteen residents (51.4%) had 25(OH)-vitamin D levels of <20 ng/mL for at least one of the time-periods. Medical residents are at risk for hypovitaminosis D, particularly during the winter months and should be aware of the need to supplement their vitamin D stores. Insufficient vitamin D status and inadequate vitamin D intake may have long-term implications for bone health in these individuals. Increased educational efforts to promote healthy dietary and lifestyle choices that allow attainment and maintenance of skeletal health are appropriate in this population.

Predictors of bone mass by peripheral quantitative computed tomography in early adolescent girls

This cross-sectional study used peripheral quantitative computed tomography (pQCT) to evaluate the influences of age, body size, puberty, calcium intake, and physical activity on bone acquisition in healthy early adolescent girls. The pQCT technique provides analyses of volumetric bone mineral density (vBMD) (mg/cm(3)) for total as well as cortical and trabecular bone compartments and bone strength expressed as polar strength strain index (mm(2)). Bone mass of the nondominant distal and midshaft tibia by pQCT and lumbar spine and hip by dual X-ray absorptiometry (DXA) were measured in 84 girls ages 11-14 yr. Pubertal stage, menarche status, anthropometrics, and 3-d food intake and physical activity records were collected. Total and cortical bone mineral content and vBMD measurements by pQCT were significantly related to lumbar spine and femoral neck BMD measurements by DXA. We did not note any significant determinants or predictors for trabecular bone mass. Body weight was the most important predictor and determinant of total and cortical bone density and strength in healthy adolescent girls. Menarche, calcium intake, height, body mass index, and weight-bearing physical activity level age were also identified as minor but significant predictors and determinants of bone density and strength. Bone measurements by the pQCT technique provide information on bone acquisition, architecture, and strength during rapid periods of growth and development. Broader cross-sectional studies using the pQCT technique to evaluate the influence of age, gender, ethnicity, puberty, body size, and lifestyle factors on bone acquisition and strength are needed.

Spontaneous mutation at the mtr locus in neurospora: the molecular spectrum in wild-type and a mutator strain

Sequence analysis of 34 mtr mutations has yielded the first molecular spectrum of spontaneous mutants in Neurospora crassa. The great majority of the mutations are base substitutions (48%) or deletions (35%). In addition, sequence analysis of the entire mtr region, including the 1472-base pair open reading frame and 1205 base pairs of flanking DNA, was performed in both the Oak Ridge and Mauriceville strains of Neurospora, which are known to be divergent at the DNA level. Sixteen sequence differences between these two strains have been found in the mtr region, with 13 of these in DNA flanking the open reading frame. The differences consisted of base substitutions and small frameshifts at monotonic runs. This set of sequence differences has allowed a comparison of mutations in unselected DNA to those mutations that produce a phenotypic signal. We have isolated a mutator strain (mut-1) of Neurospora in which the spontaneous mutation rate at various loci is as much as 80-fold higher than in the non-mutator (wild type). Twenty-one mtr mutations in the mutator background have been sequenced and compared to the non-mutator spectrum, revealing a striking increase in -1 frameshift mutations. These frameshifts occur exclusively within or adjacent to monotonic runs and can be explained by small slippage events during DNA replication. This argues for a role of the mut-1 gene in this process.

Spontaneous mutation at the mtr locus of Neurospora: the spectrum of mutant types

We have isolated 135 strains of Neurospora which have mutations at the mtr locus resulting from independent spontaneous events. mtr is the structural gene for the neutral amino acid permease. The mutants have been characterized by their reversion behavior (both spontaneous and induced) and by hybridization studies of restriction digests of their DNA. About half of the mutants (54%) appear to result from single base-pair substitutions. Thirty-four percent have deletions, including some which extend into neighboring genes. Most of the remaining mutants have insertions. Several of the insertions are tandem duplications of 400-1000 bp and these mutants are unstable, reverting to mtr+ with a high frequency. When tandem-duplication mutants go through a cross, they are modified: the mutant progeny are fully stable. This modification is probably due to RIP (repeat-induced point mutation). This process has an important bearing on the comparison of germinal to somatic mutation.

Repair-resistant mutation in Neurospora

Chronic UV treatment produces severalfold fewer mutations in Neurospora conidia than does the same total dose of acute UV. Experiments were designed to determine the conditions required for chronic UV mutagenesis. Measurement of the coincidence frequency for two independent mutations revealed the existence of a subset of cells which are mutable by chronic UV. Analysis of forward mutation at the mtr locus showed that the genetic alterations produced by chronic UV were virtually all point mutants, even though the assay system could detect alterations or deletions extending into neighboring genes. A significant fraction of the mutants produced by acute UV were multigenic deletions. The size of the dose-rate effect (acute UV mutation frequency divided by chronic UV mutation frequency) was compared for several different mutation assay systems. Forward mutations (recessive lethals and mtr) gave values ranging from four to nine. For events which were restricted to specific molecular sites (specific reversions and nonsense suppressor mutations), there was a wider range of dose-rate ratios. This suggests that chronic UV mutation may be restricted to certain molecular sequences or configurations.

Excision of pyrimidine dimers from the DNA of Neurospora

Germinated conidia of Neurospora have been monitored for their ability to excise pyrimidine dimers. Dimer concentration was measured in DNA extracted immediately after UV treatment, and it was compared to that of DNA from cells which had a post-UV incubation before extraction. Two methods were used to assay dimer level in DNA: measurement of the number of single-strand breaks (as revealed in alkaline sucrose gradients) produced by a dimer-specific endonuclease; monitoring the ability to compete for binding to dimer-specific antibodies in a radioimmunoassay. Both methods showed efficient excision of dimers by wild-type and by uvs-2, even though an earlier study had reported that uvs-2 was unable to excise dimers. UV-induced mutation shows a dose-rate effect: acute UV yields several times as many mutations as does the same dose of chronic UV. There is a parallel effect on dimer accumulation. The concentration of dimers at the conclusion of the UV treatment shows a strong correlation with the resultant mutation frequency.

[What has become of them? The careers of the physically handicapped--a model study]

The study deals with the vocational careers of 102 cerebral palsied young people who had ceased to attend the educational and therapeutic programmes provided by the Nuremberg "Day Centre for Physically Disabled Children", following varying periods of service utilization between 1973 and 1978. Of the study group total, 19 are mildly disabled, 40 moderately, and 43 severely disabled. Of 23 persons who were fully integrated vocationally at the time of study, 19 (i.e. 84 percent) are moderately to severely disabled. Tabular information included shows that achievement of full occupational integration is determined less by disability severity than by intellectual potential. It also becomes clear that earliest possible transition from special schooling to mainstream education will be of advantage to the vocational opportunities available to the individual.

A dose-rate effect in UV mutagenesis in neurospora

A simple system for screening a large number of genes for recessive lethal mutations has been used to study dose-rate effects on UV-induced mutation. Acute UV produced 4 times as many mutations as did the same dose given at chronic rate. Chronic UV at 0 degree gave as many mutations as acute UV; this indicates that the prevention of mutation during chronic treatment at 22 degrees results from metabolic repair activities. In a strain which lacked excision repair, acute UV produced twice as many mutations as chronic; this suggests that the dose-rate effect seen in repair-proficient Neurospora results from the action of the excision-repair system as well as from some other repair system.

Induced repair of genetic damage in Neurospora

Repair of genetic damage in Neurospora has been studied using a procedure in which one strain is exposed to a potentially lethal dose of UV before being joined in a heterokaryon with an undamaged strain. We have monitored the ability of the second strain to rescue the first. The extent of rescue is greatly enhanced when the rescuing strain has itself received a small, nonlethal dose of UV, thus demonstrating an inducible repair system.--The experiment was modified by substituting X rays or nitrous acid for UV as either the damaging agent or the inducing agent. In every combination, induced rescue was observed.--Three repair-deficient mutants (uvs-2, uvs-3 and uvs-6) were substituted for wild type (uvs+) as the rescuing component to find out whether any of them lacked the inducible repair system. Both uvs-2 and uvs-6 demonstrated inducible repair; uvs-3 showed none, but gave a high level of repair without induction, suggesting that it is a regulation (derepressed) mutant of an inducible repair system.

[Studies on the resistance to bacteria at the university department for gynaecology in Bern, Switzerland (author's transl)]

The sensitivity studies of 706 cases from January 1, 1973 to December 31, 1977, at the University department of Gynaecology in Bern, Switzerland, were reviewed. The sensitivity studies were classified as to type of bacteria, site of infection and source of infection (hospital acquired or non-hospital acquired). The sensitivity of the bacteria to several antibacterial drugs was tested. E-coli was the leading cause of infection in 46.9% of the cases. The most frequent site of infection for both hospital acquired and non-hospital acquired infection was the urine. The number of hospital acquired infections was twice as high as the number of infections acquired outside of the hospital. No significant change in the sensitivity during the time of review was noted.

Analysis of lethal events induced by ultraviolet in a heterokaryon of Neurospora

The relative frequencies of heterokaryons and the two kinds of homokaryons have been scored among colonies from conidia harvested from a heterokaryon and treated with UV, in order to determine which kinds of lethal mutations were induced. Recessive lethal mutations were scored directly. The pattern of surviving types indicated that recessive lethals and mitotic lethals (events destroying whole nuclei) occurred with similar frequencies. But the absolute frequency of these mutations was not sufficient to account for the observed kill, suggesting that dominant lethals and/or cytoplasmic lethals were also induced at a similar rate.

Nuclear division cycle in germinating conidia of Neurospora crassa

A temperature-sensitive mutant has been shown to be blocked at a specific point in the nuclear division cycle: just before the initiation of DNA synthesis at the time when the spindle pole bodies have duplicated but not separated. The metabolic activities of conidia of this mutant strain at the nonpermissive temperature have led us to conclude that the nuclei in a population of dormant conidia are arrested at various points in the nuclear division cycle. This conclusion is substantiated by the activities of conidia in the presence of the inhibitory drugs cycloheximide and hydroxyurea. In each inhibitory situation we observed that some, but not all, of the conidia were able to accomplish DNA synthesis and/or nuclear division.

Marker effects in the genetic transduction of tryptophan mutants of E. coli

Recombination frequencies have been determined in crosses involving 28 mutant strains for 20 of which the site of the alteration is known from studies of amino-acid substitutions in the protein products. Three of these mutants showed especially high frequencies of recombination when crossed to other single mutants or when crossed to a strain carrying two alterations at opposite ends of the trpA gene. There is no obvious molecular explanation of the high recombination of these three mutants. They include one missense mutant, one amber and one ochre. The low-frequency recombination mutants include all these same classes as well as frameshift mutants. There is nothing unique about the intragenic location of the high-recombination mutants; in each case there is at least one low-recombination mutant in the same codon.-Crosses involving mutants which were isolated in an altered wild type have shown that the behavior of a high-recombination mutant does not result from its molecular configuration alone, but from its combination with the homologous wild-type sequence from the other parent.-Several lines of evidence indicate that recombination in this system frequently involves closely-spaced double exchanges (about 40 codons apart).