Association of maternal killer-cell immunoglobulin-like receptors and parental HLA-C genotypes with recurrent miscarriage

BACKGROUND

The natural killer (NK) cells at the site of placentation express killer-cell immunoglobulin-like receptors (KIR) that can bind to human leukocyte antigen (HLA)-C molecules on trophoblast cells. Both these gene systems are polymorphic and an association of particular maternal KIR/fetal HLA-C genotypes has been shown in pre-eclampsia. Pre-eclampsia and recurrent miscarriage (RM) share the pathogenesis of defective placentation and therefore we have now genotyped couples with RM.

METHODS AND RESULTS

DNA was obtained from the male (n = 67) and female (n = 95) partners of couples with three or more spontaneous miscarriages and genotyped for HLA-C groups and 11 KIR genes using the PCR-sequence-specific primer method (SSP). The frequency of the HLA-C2 group was increased in both parents (reaching significance only in the male partners, P = 0.018) compared with a parous control population. The KIR gene frequencies of the male partners were similar to controls, but the women had a high frequency of KIR AA haplotypes that lack activating KIR. In particular, the activating KIR for HLA-C2 groups (KIR2DS1) was significantly lower in these women (P = 0.00035, odds ratio 2.63, confidence interval 1.54-4.49).

CONCLUSIONS

This is the first report to identify a genetic male factor that confers risk in RM. These findings support the idea that successful placentation depends on the correct balance of NK cell inhibition and activation in response to trophoblast.

Injuries in women's professional soccer

OBJECTIVE

The injury data from the first two seasons of the Women's United Soccer Association (WUSA) were analysed to determine the injury incidence, anatomic location of injuries, and relation of player position.

METHODS

Injury data on 202 players from eight teams during the first two seasons of the WUSA were prospectively collected and analysed.

RESULTS

A total of 173 injuries occurred in 110 players with an overall injury incidence rate of 1.93 injuries per 1000 player hours. The incidence of injury during practice and games was 1.17 and 12.63 per 1000 player hours, respectively. Of the injuries 82% were acute and 16% were chronic. Most of the injuries (60%) were located in the lower extremities. Strains (30.7%), sprains (19.1%), contusions (16.2%), and fractures (11.6%) were the most common diagnoses and the knee (31.8%) and head (10.9%) were the most common sites of injury. Anterior cruciate ligament (ACL) injuries accounted for 4.6% of all injuries and the incidence of ACL tears was 0.09 per 1000 player hours (practice 0.04, game 0.90). Midfielders suffered the most injuries (p<0.007).

CONCLUSION

We conclude that the injury incidence in the WUSA is lower than the 6.2 injuries per 1000 player hours found in the corresponding male professional league (Major League Soccer); however, knee injuries predominate even in these elite female athletes.

Structural analysis of human immunodeficiency virus type 1 Gag protein interactions, using cysteine-specific reagents

We have examined structural interactions of Gag proteins in human immunodeficiency virus type 1 (HIV-1) particles by utilizing cysteine mutagenesis and cysteine-specific modifying reagents. In immature protease-minus but otherwise wild-type (wt) particles, precursor Pr55Gag proteins did not form intermolecular cystines naturally but could be cross-linked at cysteines, and cross-linking appeared to occur across nucleocapsid (NC) domains. Capsid (CA) proteins in wt mature viruses possess cysteines near their carboxy termini at gag codons 330 and 350, but these residues are not involved in natural covalent intermolecular bonds, nor can they be intermolecularly cross-linked by using the membrane-permeable cross-linker bis-maleimido hexane. The cysteine at gag codon 350 (C-350) is highly reactive to thiol-specific modifying reagents, while the one at codon 330 (C-330) appears considerably less reactive, even in the presence of ionic detergent. These results suggest that the HIV-1 CA C terminus forms an unusually stable conformation. Mutagenesis of C-350 to a serine residue in the mutant C350S (C-350 changed to serine) virtually eliminated particle assembly, attesting to the importance of this region. We also examined a C330S mutant, as well as mutants in which cysteines were created midway through the capsid domain or in the C-terminal section of the major homology region. All such mutants appeared wt on the basis of biochemical assays but showed greatly reduced infectivities, indicative of a postassembly, postprocessing replicative block. Interestingly, capsid proteins of mature major homology region mutant particles could be cysteine cross-linked, implying either that these mutations permit cross-linking of the native C-terminal CA cysteines or that major homology regions on neighbor capsid proteins are in close proximity in mature virions.

Resuscitation with Diaspirin Crosslinked Hemoglobin in a pig model of hemorrhagic shock

The efficacy of Diaspirin Crosslinked Hemoglobin (DCLHb) as a resuscitative fluid in hemorrhagic shock was compared to another colloid solution (human serum albumin, HSA) and a crystalloid solution (Lactated Ringer's, LR). Hemorrhage (35 mL/kg) was followed by isovolemic exchange then volume replacement. This modeled the clinical situation where resuscitative fluids are administered prior to stopping the hemorrhage, the hemorrhage is stopped, then blood volume is restored. Four combinations of resuscitative fluids were evaluated during isovolemic exchange: volume replacement: DCLHb:LR, HSA:LR, HSA:HSA and LR:LR. All doses were 10 mL/kg:35 mL/kg except LR:LR which was 10 mL/kg:125 mL/kg. Volume replacement was followed by a stabilization period and reinfusion of shed blood (35 mL/kg). MAP increased most rapidly using DCLHb (from 48 to 102 mmHg after 10 min of isovolemic exchange) and was maintained for at least 2 hours. Arterial oxygen content and acid-base status were significantly improved after resuscitation with DCLHb:LR vs. other resuscitative therapies. In conclusion, DCLHb:LR was an effective resuscitative therapy in treatment of hemorrhagic shock.

Family involvement in the nursing home

The focus of this study was the influence of preestablished family behavior patterns, family orientation of nursing home policies, and practices and caregiver and elder characteristics on the family members' expectations for involvement in the nursing home and the actual involvement 6 months later. The conceptual model was based on findings of Montgomery's nursing home study and open systems principles applicable to families. Data were collected through telephone interviews with 216 family members of residents in 24 nursing homes in southern Michigan. Regression analyses revealed that measures of preestablished patterns of family behavior accounted for 19% to 31% of variance in measures of expected family involvement. Expected family involvement, resident activities of daily learning (ADL), and caregiver relationship accounted for 11% to 23% of variance in measures of actual family involvement. Opportunity for family leadership in resident care had a mild effect of moderating the amount of family direct care and learning activities in the nursing home.

Infectious disease patterns in the Waorani, an isolated Amerindian population

The Waorani Indians of eastern Ecuador provide a unique opportunity for studying exposure of an isolated human population to various infectious disease agents. Using serologic tests to determine antibody prevalence, skin test data, and stool examination for parasites, we have been able to construct a profile of infectious diseases which are endemic, and others which have been introduced into the Waorani population. These findings are compared with similar data reported from elsewhere in the Amazon. Serologic studies demonstrating the presence of antibody to measles and poliovirus type 3 after vaccination indicate that the Waorani respond normally to viral challenge with these agents. The question of genetic inability among aboriginal Amerindians to respond to viral agents is discussed. Finally, general recommendations are made regarding the future health care of the Waorani.

Carotid Stump Syndrome: Outcome from Surgical Management

OBJECTIVES

in patients with occluded internal carotid arteries the carotid stump is a potential source of microemboli resulting in the persistence of retinal or cerebral ischaemic symptoms. We report 25 patients who had persistent cerebral and retinal ischaemic symptoms with an occluded ipsilateral ICA and a carotid stump who underwent surgical exclusion of the stump.

METHODS

between January 1988 and January 1998, 332 patients underwent carotid endarterectomy. Twenty-five patients (20 males: five females; mean age 58.9 (range 44-78 years)) had carotid stump exclusion. Indications for surgery were transient ischaemic attack (22), amaurosis fugax (eight) and cerebrovascular accident (13). Three patients had undergone contralateral carotid endarterectomy and 12 had significant contralateral stenosis. Twenty patients were being treated with aspirin and four with warfarin at the time of presentation.

RESULTS

the diagnosis of carotid stump was made in 22 patients by angiography. In the remaining three patients duplex alone was diagnostic in two patients. In the third case duplex was combined with magnetic resonance angiography (MRA) to confirm the diagnosis. Stump exclusion was carried out by oversewing the ICA origin. All but one patient remained symptom free at follow-up.

CONCLUSION

carotid stump syndrome should be considered as a likely clinical entity in patients with an occluded ICA and persisting cerebral and retinal microembolic symptoms. Surgical exclusion of the carotid stump is a safe and effective method of treatment.

'Her cry is my cry': resettlement experiences of refugee women at risk recently resettled in Australia

OBJECTIVES

Refugee women entering resettlement countries on woman-at-risk visas represent a particularly vulnerable population. While their specific gender-based resettlement will likely differ from the general refugee population, little is known about their experiences of early resettlement, with which to inform resettlement policy and practice. This research aimed to explore lived experiences of recently resettled refugee women at risk in Australia.

STUDY DESIGN

Qualitative research used focus groups and a framework approach to identify and explicate common themes in participants' experience.

METHODS

Two focus groups with a purposive sample of African and Afghan refugee women at risk (N = 10), aged 22-53 years, were conducted in South East Queensland, Australia (October 2016), recruited with the assistance of a local resettlement service. Discussions were audiotaped, transcribed, and themes explicated.

RESULTS

Six superordinate themes emerged: (1) sentiment of gratitude; (2) sense of loneliness and disconnection; (3) feeling incapable; (4) experiencing distress and help-seeking; (5) experiencing financial hardship; and (6) anticipating the future.

CONCLUSIONS

Findings indicate that resettlement policy, programs, and practice that explicitly target the needs of women-at-risk refugees are warranted, including a longer period of active service provision with specific attention to strategies that address the women's social connection, self-efficacy, emotional well-being, and financial hardships.

Phleomycin-stimulated degradation of deoxyribonucleic acid in Escherichia coli

Phleomycin stimulates the degradation of DNA by energy-dependent endonuclease and exonuclease reactions in Escherichia coli rec(+) cells and in recB(-) and recC(-) cells that lack an adenosine triphosphate-dependent nuclease functioning in the repair of ultraviolet (UV) lesions. Exonuclease activity is blocked in T4 phage-infected cells. The endonuclease reaction produces 10(7)-dalton segments resembling those produced in colicin E2-treated cells. These differ from the random-sized segments produced in UV-irradiated cells, or the 10(6)-dalton segments made in T4 phage-infected cells. A mutant selected for phleomycin tolerance is cross-tolerant to colicin E2, and some mutants selected for colicin E2 tolerance are cross-tolerant to phleomycin. On the basis of these cross-tolerances and the similarities between the effects of phleomycin and E2-stimulated nucleases, the suggestion is made that both agents may stimulate the same nuclease reactions in E. coli cells.

Exploring opportunities for collaboration between the corporate sector and the dental education community

The ultimate purpose of both dental industry and dental education is to improve the oral health of the public. This report provides background information on the different roles and objectives of the dental industry and dental education communities, the different operating environment of each sector and also areas of common interest where collaboration will be of mutual benefit. The report addresses five areas for potential collaboration between the dental industry and the dental education communities: 1. Contribution to joint activities. 2. Effectiveness and efficiency. 3. Workforce needs. 4. Middle- and low-income countries. 5. The future of International Federation of Dental Educators and Associations (IFDEA). The traditional areas of support and their limitations that have been provided by industry are outlined in the report and some new approaches for collaboration are considered. Industry-based research has been an important factor in developing new products and technologies and in promoting oral health. However there is a need to facilitate the introduction of these developments at an early stage in the education process. Industry has to operate in an efficient manner to remain competitive and maximise its returns and therefore survive. The academic sector operates in a different environment and under different governance structures; although some trends are noted towards adoption of greater efficiency and financial accountability similar to industry. Opportunities to jointly develop best business practices should be explored. Industry has responded well to the oral health needs of the public through the development of new products and technologies. The education community needs to respond in a similar way by examining different healthcare delivery models worldwide and developing programmes to train members of the dental team to cater for future needs and demands of communities in different regions of the world. The reputation of industry-based scientists and clinicians is high, and their role in contributing to the dental education process in practical ways needs to be explored and further developed. Closer relationships between industry scientists and faculty and students could assist industrys need and desire to develop new technologies for the broader dental care system. The corporate sector can play a key role in the future success of IFDEA by providing support and expertise in developing areas such as regional leadership institutes, a Global Faculty and Network and in collaborating in developing continuing education programmes as well as involvement in its governance. Thirteen recommendations are made in the report. These are considered to be important initial steps in developing the already strong relationship between the education and corporate sectors. Partnership and collaborating more effectively along the lines suggested should, almost certainly, generate mutually beneficial outcomes, whilst serving over the long term to elevate the publics oral health status on a global basis.

Resuscitation with increasing doses of diaspirin crosslinked hemoglobin in swine

This study examined the effects of administering 0.5, 4, 10, and 30 mL/kg of Diaspirin Crosslinked Hemoglobin (DCLHb) in a swine model of non-lethal hemorrhagic shock. Thirty unanesthetized animals were bled (30 mL/kg, 1 mL/kg/min) and either recovered without treatment (Untreated Control, UC) or infused with 10 g/dL DCLHb (0.5, 4.0, 10 or 30 mL/kg at 1 mL/kg/min) or Lactated Ringer (LR, 90 mL/kg at 3 mL/kg/min). DCLHb caused dose-related increases in MAP. Both the 10 and 30 mL/kg doses of DCLHb increased MAP more than UC or LR. Lower doses of DCLHb and LR had effects on MAP similar to UC. After hemorrhage, CO increased in all groups. The effect of DCLHb on CO was dose-related. Only LR and 30 mL/kg of DCLHb transiently (through 90 min) increased CO more than UC. CO in animals given lower doses of DCLHb was comparable to UC. DCLHb (10 and 30 mL/kg) improved base excess and lactate concentrations, two indices of global perfusion, more rapidly and to a greater extent than either UC or LR. In this swine model of hemorrhage, even small doses of DCLHb exerted measurable beneficial effects on blood pressure and perfusion.

Effects of intravenous infusions of diaspirin cross-linked hemoglobin (DCLHb) on sheep

The purpose of this study was to compare the cardiopulmonary, hematologic, and immunologic responses of unanesthetized sheep to single, "topload", intravenous infusions of either 10 mL/Kg or 40 mL/Kg of Diaspirin Cross-Linked Hemoglobin, 10 mL/Kg or 40 mL/Kg of a Human Serum Albumin (HSA) solution oncotically adjusted with human serum albumin to approximately match the oncotic pressure of the DCLHb, or 10 mL/Kg of Erythrocyte Hemolysate solution prepared in a manner similar to that commonly described in the literature and referred to as "stroma free hemoglobin". Solutions were infused at a rate of 1 mL/Kg/minute and animals were monitored for 72 hours after infusion. These studies demonstrated that in sheep infusion of either DCLHb or HSA solutions was well tolerated and did not produce a significant increase in plasma C3a levels, an increase in the plasma concentration of thromboxane B2, or unexpected fluid shifts. In contrast, infusion of the Erythrocyte Hemolysate produced a greater than 10-fold increase in plasma C3a concentrations, a greater than 6000-fold increase in plasma TxB2 concentration, significant fluid shifts, and changes in a variety of other parameters consistent with induction of a dramatic inflammatory response. These results indicate that appropriately prepared and purified DCLHb solutions do not elicit an inflammatory reaction in sheep.

Role of the N-terminal 118 amino acids in the processing of the rat renal mitochondrial glutaminase precursor

Rat renal mitochondrial glutaminase (GA) is synthesized as a 74-kDa cytosolic precursor that is translocated into mitochondria and processed via a 72-kDa intermediate to yield a 3:1 ratio of mature 66- and 68-kDa subunits, respectively. The 66-kDa subunit is derived by removal of a 72-amino-acid presequence. The structural determinants necessary for translocation and proteolytic processing were further delineated by characterizing the processing of different chimeric constructs formed by fusing various segments of the N-terminal sequence of the GA precursor to chloramphenicol acetyl transferase (CAT). GA1-118 CAT is translocated and processed in isolated rat liver mitochondria or cleaved by purified mitochondrial processing peptidase (MPP) to yield an intermediate peptide and two mature subunits that are analogous to the products of processing of the GA precursor. The two reactions also occur with kinetics which are similar to those observed for processing of the GA precursor. Thus, all of the information required for the translocation and synthesis of the mature subunits of GA reside in the N-terminal 118 amino acids of the GA precursor. In contrast, GA1-72 CAT, a construct that contains the GA presequence fused to CAT, is apparently translocated and processed less efficiently. It yields only two peptides that are analogous to the intermediate and 68 kDa forms of GA. In addition, GA1-31 CAT associates with mitochondria but is not proteolytically processed and GA1-31,73-118 CAT is slowly translocated and processed to a single peptide that is analogous to the 66 kDa form of GA. The latter results suggest that the MPP cleavage reactions which yield the GA intermediate and the 66-kDa subunit depend primarily on information that is present C-terminal to the respective sites of cleavage.

Vitamin A provision for preterm infants: are we meeting current guidelines?

BACKGROUND

Preterm infants have reduced liver stores of vitamin A at birth compared to term born infants. Current guidelines recommend an intake of 700-1500 IU/kg/day vitamin A, and there is evidence to support higher doses for infants with significant lung disease. The importance of appropriate early nutrition for preterm infants is increasingly becoming apparent.

OBJECTIVES

To examine whether preterm infants admitted to a UK neonatal unit received the currently recommended amounts of vitamin A during the first 4 weeks of life, and to identify the feeding patterns associated with optimal vitamin A intake.

DESIGN

Retrospective case note review.

SETTING

UK tertiary neonatal unit.

POPULATION

36 preterm infants with a median gestation of 30 weeks (range 26-33 weeks) and median birth weight of 1305 g (range 880-1800 g).

MAIN OUTCOME MEASURE

Mean daily total intake of vitamin A in each of the first 4 weeks of life.

RESULTS

Despite a policy of introducing intravenous lipid supplemented with fat soluble vitamins on day 2, only four infants (11%) consistently met the recommended daily intake of vitamin A during the first 2 weeks of life. Adequacy of vitamin A intake in the first 2 weeks of life was not predicted by gestation or pattern of feeding.

CONCLUSION

Recommendations for intravenous vitamin A supplementation in parenterally fed preterm infants require revision. Intravenous lipid with added fat soluble vitamins should be started as soon as possible after birth, and consideration given to early oral vitamin A supplementation in those infants tolerant of enteral feeds.

Acromegaly secondary to growth hormone releasing hormone secretion

BACKGROUND

Acromegaly secondary to growth hormone releasing hormone (GHRH) secretion is exceptionally rare.

AIM

To report a case of acromegaly diagnosed in 1984 and assumed to be pituitary in origin. Sixteen years later, the cause was found to be a GHRH secreting neuroendocrine pancreatic tumour.

METHOD

A case report.

CONCLUSION

Although ectopic GHRH production is very rare, endocrinologists should be aware of this possibility in acromegaly patients if a pituitary tumour was not detected using pituitary imaging.

Genetic Control of Male Fertility in Higher Plants

Male development in higher plants is a complex process which requires the correct spatial and temporal expression of a large number of male fertility genes. They include the genes required for the structure of the male organs, as well as genes required for male gamete development. Male-sterile mutants, impaired in male fertility functions, have helped to identify a number of these genes in various plant species including Arabidopsis thaliana, the model crucifer. In A. thaliana, once these genes are mapped, they can be cloned by chromosome walking. Alternative strategies of cloning will be facilitated by the isolation of similar mutants by tagging with transposable elements, T-DNA, or by mutagen-induced deletion. Once the genes required for male fertility are cloned and their wild type function identified, an understanding of the molecular basis of male fertility is likely to result. The combination of genetic dissection and the modern techniques of genome manipulation have made such a goal feasible.