Cloning and recombinant expression of a novel mouse-secreted phospholipase A2

Secreted phospholipases A2 (sPLA2s) form a class of structurally related enzymes that are involved in a variety of physiological and pathological effects including inflammation and associated diseases, cell proliferation, cell adhesion, and cancer, and are now known to bind to specific membrane receptors. Here, we report the cloning and expression of a novel sPLA2 isolated from mouse thymus. Based on its structural features, this sPLA2 is most similar to the previously cloned mouse group IIA sPLA2 (mGIIA sPLA2). As for mGIIA sPLA2, the novel sPLA2 is made up of 125 amino acids with 14 cysteines, is basic (pI = 8.71) and its gene has been mapped to mouse chromosome 4. However, the novel sPLA2 has only 48% identity with mGIIA and displays similar levels of identity with the other mouse group IIC and V sPLA2s, indicating that the novel sPLA2 is not an isoform of mGIIA sPLA2. This novel sPLA2 has thus been called mouse group IID (mGIID) sPLA2. In further contrast with mGIIA, which is found mainly in intestine, transcripts coding for mGIID sPLA2 are found in several tissues including pancreas, spleen, thymus, skin, lung, and ovary, suggesting distinct functions for the two enzymes. Recombinant expression of mGIID sPLA2 in Escherichia coli indicates that the cloned sPLA2 is an active enzyme that has much lower specific activity than mGIIA and displays a distinct specificity for binding to various phospholipid vesicles. Finally, recombinant mGIID sPLA2 did not bind to the mouse M-type sPLA2 receptor, while mGIIA was previously found to bind to this receptor with high affinity.

Malignant melanoma of the gallbladder: a case report

A 47-year-old woman with malignant melanoma in the gallbladder and brain is described. Evidence is offered that the tumor arose in the gallbladder, the main factor being the presence of "junctional change" and isolated melanocytes in the adjacent mucosa.

A new device for delayed hypersensitivity skin testing

A new device for assessment of delayed cutaneous hypersensitivity using seven standardized antigens (Multitest CMI) was compared to conventional intradermal testing with two recall antigens in 83 patients referred for nutritional support. Sixteen patients (19.3%) were anergic to Multitest CMI while four (4.8%) were anergic to conventional testing. Patients anergic to Multitest CMI had a higher complication (intraabdominal abscess, prolonged ileus, sepsis, pneumonia) than those who were immunocompetent by this test suggesting a group at greater risk. This interpretation is consistent with an increased specificity of Multitest CMI over conventional testing in the identification of clinically important anergy.

Antibiotic prophylaxis in non-perforated appendicitis of childhood: tetracycline lavage compared with peroperative intravenous cefuroxime and metronidazole

Eighty-four cases of non-perforated appendicitis in children were randomly allocated to receive either oxytetracycline lavage alone or oxytetracycline lavage plus peroperative intravenous metronidazole and cefuroxime. The wound infection rate with the oxytetracycline lavage alone was 4.4% compared with 7.7% when metronidazole and cefuroxime were added. These rates were not significantly different. This study supports the use of oxytetracycline lavage alone as effective prophylaxis against wound infection in non-perforated appendicitis of childhood.

Small bowel ulceration and perforation by a gallstone

Gallstone ileus is a well recognised entity and is responsible for approximately 3 per cent of intestinal obstructions. It is, however, quite rare for a gallstone to cause numerous ulcerations of the bowel mucosa and perforation especially in the absence of prior clinical or radiological signs of obstruction (1). We report a case of ulceration and perforation of the ileum by a gallstone and presenting as acute peritonitis rather than obstruction.

Malignant melanoma of the gallbladder: a case report

A 47-year-old woman with malignant melanoma in the gallbladder and brain is described. Evidence is offered that the tumor arose in the gallbladder, the main factor being the presence of "junctional change" and isolated melanocytes in the adjacent mucosa.

Functional Neurological Disorders in the medical education: An urgent need to fill the gaps

BACKGROUND

FND is a disabling disease that accounts for 5 to 10% of the reason for consultation in neurology. However, young physicians often say they have little or no training in their management.

AIM

The aim of the present study was to assess whether French junior neurologists, psychiatrists and physical and rehabilitation medicine (PRM) specialists received teaching on FND during their medical studies, including the residency, and to evaluate their knowledge and perception of the disorder.

METHODS

The survey was distributed by the means of a Google form questionnaire to specialist registrars and young specialists with the help of resident's organizations.

RESULTS

568 respondents from the 3 specialties were included in the study. Most respondents (72.4%) were specialists registrars. Almost half of the respondents (45.5%) answered they never received any teaching on FND, and only 20.5% of them knew the Hoover's sign, a positive sign specific of functional weakness. A large majority of respondents felt they were not sufficiently trained in FND (87.9%), and they did not have sufficient knowledge of these disorders (85.3%).

DISCUSSION

Better training would allow clinicians to make a diagnosis earlier, to better explain it to patients, and to limit the costs associated with diagnosis delays. A better training of clinicians about FND would also improve the prognosis of patients, as early diagnosis and good explanation is associated with a better prognosis.

CONCLUSION

This survey shows that there is a gap about FND in the training programs in the medical studies and during the specialization training of young doctors in France.

A map of the hCG beta-LH beta gene cluster

The beta-subunit of human chorionic gonadotropin (hCG beta) is reportedly encoded by as many as seven non-allelic genes or pseudogenes. Previous studies have identified a cluster of three hCG beta gene copies and the single-copy lutropin-beta subunit (LH beta) gene, but overlap of this cluster with two additional pairs of hCG beta genes has not been demonstrated, despite the isolation of 18 genomic clones. To define the number and organization of non-allelic hCG beta gene copies, genomic Southern blot analyses were performed using hCG beta cDNA and gene-flanking unique-sequence probes. The data show the linear arrangement of six genes (or pseudogenes) and show that the hCG beta-IH beta gene cluster is present in a single 58-kilobase EcoRI fragment. Our map of the cluster indicates which of the cloned hCG beta genes reflect somatic genotypes rather than recombinant artifacts and will thus permit investigation of factors regulating expression during gestation.

Recurrent acute appendicitis with erythema annulare centrifugum

Erythema annulare centrifugum (EAC), a chronic figurate eruption, occurred in a 28-year-old male physician several months following the onset of recurrent abdominal pain. Two months after the manifestation of EAC, another episode of abdominal pain culminated in appendectomy for perforated appendicitis. During his convalescence, the skin lesions faded and did not reappear. We propose that recurrent appendiceal inflammation caused both the episodic pain and the skin eruptions. Additionally EAC may be a sign of chronic infection, internal malignancy, or food allergy. Although truly chronic appendicitis is a disputed entity, recurrent, spontaneously resolving episodes of appendicitis occasionally do precede surgical appendicitis. The presence of EAC in a patient having recurrent abdominal pain should discourage a precipitant diagnosis of functional illness and prompt further investigation.

[Clinical pilot study on repeated use of heparin, vancomycin, colimycine locked flush solution for central intravenous implanted catheter in oncology]

With an anti-infectious and an antithrombotic prophylaxis aims, a locked flush solution including heparin and vancomycin, was used systematically for implantable venous access system for each patient, from january to april 1995. Since the 6th of april 1995, in order to widen the antibiotic spectrum on Gram negative bacteriae, we added colimycin at the flush solution. In 1995, 342 hospitalised patients held this type of venous access and received chemotherapy and/or radiochemotherapy for cancer. Two thousand six hundred thirty three manipulations were done, 575 with the first flush solution, 2058 with the second. During the year, 15 implantable access system (4.4%) were considered as infected, only 3 (0.9%) were removed, in the first period. THe infectious rate seemed to be stable, but the bacterial assessment to be modified between the two periods. The Gram negative bacterial infections seemed to decrease with colimycin addition (33% versus 50%). These results must be confirmed by a long term and/or randomized study.

Psychiatric burden in a cohort of adults with Niemann Pick type C disease: from psychotic symptoms to frontal lobe behavioral disorders

OBJECTIVES

To describe Niemann-Pick type C (NP-C) behavioral symptoms (focusing on psychotic symptoms) and its relation to frontal lobe functioning.

METHODS

We retrospectively reviewed medical charts of NP-C-patients followed in the Lysosomal Diseases reference center in Paris Pitié-Salpêtrière. We collected demographic data, psychiatric clinical manifestations, psychometric scales, and extended neuropsychological data including executive and behavioral frontal lobe functions evaluations.

RESULTS

Nineteen patients were included in the study with ten of them having experienced at least one acute psychotic episode, being inaugural for six of them. Most of the patients suffered from behavioral (15/17) and cognitive disorders (18/19) (including executive dysfunction (11/12), apathy (13/17), impaired social cognition (11/13) and stereotyped behaviors (5/10). For five patients, quality of life was significantly impaired by these abnormal behaviors. Concerning frontal neuropsychological evaluation, Facial emotion recognition was by far the most performed neuropsychological test (n = 8) and the score was always abnormal. It is noteworthy that psychotic symptoms were often drug resistant (8/9) and that Miglustat was associated with a better control of psychotic symptoms.

CONCLUSIONS

We report a high frequency of psychiatric symptoms in NP-C encompassing acute psychotic manifestations, often presenting early in the course of the disease with atypical features. We also report disabling behavioral manifestations related to frontal dysfunction.