A framework for assessing the potential for a double dividend from a policy-induced reduction in alcohol consumption on the economy

OBJECTIVES

Tax policies targeted at reducing alcohol consumption are typically understood to be associated with economic losses, including in alcohol production and trade sectors. This study sought to determine whether the overall effect of reduced alcohol consumption might be positive once improvements in productivity associated with reduced alcohol-related consumption are considered.

STUDY DESIGN

This study used Computable General Equilibrium economic modelling.

METHODS

An economic modelling framework was developed for Scotland, which considered the fiscal and economic impacts of alcohol taxation and the economy-wide impacts. Simulation of hypothetical alcohol taxes and improvements in labour productivity calibrated on losses due to absenteeism and presenteeism in Scotland in 2017.

RESULTS

The long-run impacts of a five pence increase in taxation alone produce negative economic impacts on jobs and Gross Domestic Product in Scotland (1189 jobs and £71.12 million). These effects are reduced by half - but remain negative - when the revenues from such policy are recycled to the economy through government spending. A small improvement in labour productivity - equivalent to 4.95% of the total productivity gap from absenteeism and presenteeism estimated for Scotland - would be sufficient to turn the economic consequence non-negative.

CONCLUSIONS

The overall macroeconomic impact of policies targeted at alcohol consumption should include consideration of the potential productivity effect and that impact studies that do not include such mechanisms are likely to overstate the negative economic impacts of alcohol policies.

Distinctive Brain Malformations in Zhu-Tokita-Takenouchi-Kim Syndrome

BACKGROUND AND PURPOSE

Zhu-Tokita-Takenouchi-Kim syndrome is a severe multisystem malformation disorder characterized by developmental delay and a diverse array of congenital abnormalities. However, these currently identified phenotypic components provide limited guidance in diagnostic situations, due to both the nonspecificity and variability of these features. Here we report a case series of 7 individuals with a molecular diagnosis of Zhu-Tokita-Takenouchi-Kim syndrome, 5 ascertained by their presentation with the neuronal migration disorder, periventricular nodular heterotopia.

MATERIALS AND METHODS

Individuals with a molecular diagnosis of Zhu-Tokita-Takenouchi-Kim syndrome were recruited from 2 sources, a high-throughput sequencing study of individuals with periventricular nodular heterotopia or from clinical diagnostic sequencing studies. We analyzed available brain MR images of recruited individuals to characterize periventricular nodular heterotopia distribution and to identify the presence of any additional brain abnormalities.

RESULTS

Pathogenic variants in SON, causative of Zhu-Tokita-Takenouchi-Kim syndrome, were identified in 7 individuals. Brain MR images from these individuals were re-analyzed. A characteristic set of imaging anomalies in addition to periventricular nodular heterotopia was identified, including the elongation of the pituitary stalk, cerebellar enlargement with an abnormally shaped posterior fossa, rounding of the caudate nuclei, hippocampal malformations, and cortical anomalies including polymicrogyria or dysgyria.

CONCLUSIONS

The recurrent neuroradiologic changes identified here represent an opportunity to guide diagnostic formulation of Zhu-Tokita-Takenouchi-Kim syndrome on the basis of brain MR imaging evaluation.

Variants in ACTG2 underlie a substantial number of Australasian patients with primary chronic intestinal pseudo-obstruction

BACKGROUND

Primary chronic intestinal pseudo-obstruction (CIPO) is a rare, potentially life-threatening disorder characterized by severely impaired gastrointestinal motility. The objective of this study was to examine the contribution of ACTG2, LMOD1, MYH11, and MYLK mutations in an Australasian cohort of patients with a diagnosis of primary CIPO associated with visceral myopathy.

METHODS

Pediatric and adult patients with primary CIPO and suspected visceral myopathy were recruited from across Australia and New Zealand. Sanger sequencing of the genes encoding enteric gamma-actin (ACTG2) and smooth muscle leiomodin (LMOD1) was performed on DNA from patients, and their relatives, where available. MYH11 and MYLK were screened by next-generation sequencing.

KEY RESULTS

We identified heterozygous missense variants in ACTG2 in 7 of 17 families (~41%) diagnosed with CIPO and its associated conditions. We also identified a previously unpublished missense mutation (c.443C>T, p.Arg148Leu) in one family. One case presented with megacystis-microcolon-intestinal hypoperistalsis syndrome in utero with subsequent termination of pregnancy at 28 weeks' gestation. All of the substitutions identified occurred at arginine residues. No likely pathogenic variants in LMOD1, MYH11, or MYLK were identified within our cohort.

CONCLUSIONS AND INFERENCES

ACTG2 mutations represent a significant underlying cause of primary CIPO with visceral myopathy and associated phenotypes in Australasian patients. Thus, ACTG2 sequencing should be considered in cases presenting with hypoperistalsis phenotypes with suspected visceral myopathy. It is likely that variants in other genes encoding enteric smooth muscle contractile proteins will contribute further to the genetic heterogeneity of hypoperistalsis phenotypes.

Ovarian steroid cell tumor, not otherwise specified

Ovarian steroid cell tumours are rare virilizing tumours. They are three types of tumours of ovary which are characterized by steroid cell proliferation : Leydig cell tumour, steroid cell tumour, Not Otherwise Specified (NOS) and stromal luteoma. Here we present a case of 36 year old female, who presented with history of weight loss since last two and half months. There is history of amenorrhoea and hirsuitism. Her CA was 125: 11.4 IU/ml (0-35 U/mL). Blood Testosterone levels was elevated with value of 150 ng/ml (5.71-77 ng/ml). Serum Inhibin A, Inhibin B, FSH, LH and prolactin were within normal limits. The steroid cell tumour, NOS are mostly benign but few of them behave in malignant fashion. Hayes and Scully gave few histopathological features which favour malignant behavior. These tumours should be differentiated from leydig cell tumour by lack of cytoplasmic Reinkes' crystals as well as from other neoplasms like primary clear cell carcinoma, metastatic clear cell renal cell carcinoma and adrenocortical tumour.

Adenoid cystic carcinoma: a rare breast carcinoma

Adenoid cystic carcinoma is a rare neoplasm accounting for <0.1% of breast carcinomas. The mean age of presentation is fifth to sixth decade of life and it generally presents as a painful breast lump. The histological features are characteristic with cribriform and acinar pattern of basaloid cells. It is triple negative tumor with CD117 and p63 positivity and excellent prognosis.

Getting Ready for ICD-10 and Meaningful Use Stage 2

For the past 24 years, most developed countries have used the International Classification of Diseases, Tenth Revision (ICD-10) to report physician services. In the United States, physicians have continued to use the American Medical Association Current Procedural Terminology, Fourth Edition and the Healthcare Common Procedure Coding System. The ICD-10-Clinical Modification (CM) has approximately 4.9 times more codes than the International Classification of Diseases, Ninth Revision. ICD-10-CM allows for more specific descriptors of a procedure and is broken down by category, etiology, anatomic site, severity, and extension. ICD-10-CM is scheduled to be implemented by Medicare and commercial payers on October 1, 2015. In addition to ICD-10 implementation, physicians have to meet the requirements of the Meaningful Use Electronic Health Record Incentive Program. The Meaningful Use program is designed to promote the use of certified electronic health technology by providing eligible professionals with incentive payments if they meet the defined core and menu objectives of each stage of the program. All core measures must be met; however, providers can choose to meet a preset number of menu measures. Meaningful Use Stage 1 required eligible professionals to meet core and menu objectives that focused on data capture and sharing. Meaningful Use Stage 2 requires eligible professionals to meet core and menu objects that focus on advanced clinical processes for a full year in 2015. Stage 3 has been delayed until 2017, and core and menu measures that will focus on improving outcomes have not yet been defined. It is important for orthopaedic surgeons to understand the history of and techniques for the use of ICD-10-CM in clinical practice. Orthopaedic surgeons also should understand the requirements for Meaningful Use Stages 1 and 2, including the core objectives that must be met to achieve satisfactory attestation.

Measuring quality in orthopaedic surgery: the use of metrics in quality management

There has been a substantial shift in the assessment of outcomes in medicine, including orthopaedic surgery. The quality movement is redefining the delivery of health care. The effect of these changes on orthopaedic surgery and orthopaedic surgeons has been significant and will become increasingly important. Orthopaedic surgeons must become active participants in the quality movement by understanding the basic principles of the movement and how they apply to patient care. A clear understanding of the different agencies (governmental and private) that are leading these initiatives is also essential. Ultimately, active participation in the quality movement will enhance the care provided to patients with musculoskeletal disorders.

Genotype and clinical care correlations in craniosynostosis: findings from a cohort of 630 Australian and New Zealand patients

Craniosynostosis is one of the most common craniofacial disorders encountered in clinical genetics practice, with an overall incidence of 1 in 2,500. Between 30% and 70% of syndromic craniosynostoses are caused by mutations in hotspots in the fibroblast growth factor receptor (FGFR) genes or in the TWIST1 gene with the difference in detection rates likely to be related to different study populations within craniofacial centers. Here we present results from molecular testing of an Australia and New Zealand cohort of 630 individuals with a diagnosis of craniosynostosis. Data were obtained by Sanger sequencing of FGFR1, FGFR2, and FGFR3 hotspot exons and the TWIST1 gene, as well as copy number detection of TWIST1. Of the 630 probands, there were 231 who had one of 80 distinct mutations (36%). Among the 80 mutations, 17 novel sequence variants were detected in three of the four genes screened. In addition to the proband cohort there were 96 individuals who underwent predictive or prenatal testing as part of family studies. Dysmorphic features consistent with the known FGFR1-3/TWIST1-associated syndromes were predictive for mutation detection. We also show a statistically significant association between splice site mutations in FGFR2 and a clinical diagnosis of Pfeiffer syndrome, more severe clinical phenotypes associated with FGFR2 exon 10 versus exon 8 mutations, and more frequent surgical procedures in the presence of a pathogenic mutation. Targeting gene hot spot areas for mutation analysis is a useful strategy to maximize the success of molecular diagnosis for individuals with craniosynostosis.

Variant ataxia-telangiectasia presenting as primary-appearing dystonia in Canadian Mennonites

OBJECTIVE

To compare the phenotype of primary-appearing dystonia due to variant ataxia-telangiectasia (A-T) with that of other dystonia ascertained for genetics research.

METHODS

Movement disorder specialists examined 20 Canadian Mennonite adult probands with primary-appearing dystonia, as well as relatives in 4 families with parent-child transmission of dystonia. We screened for the exon 43 c.6200 C>A (p. A2067D) ATM mutation and mutations in DYT1 and DYT6. Clinical features of the individuals with dystonia who were harboring ATM mutations were compared with those of individuals without mutations.

RESULT

Genetic analysis revealed a homozygous founder mutation in ATM in 13 members from 3 of the families, and no one harbored DYT6 or DYT1 mutations. Dystonia in ATM families mimicked other forms of early-onset primary torsion dystonia, especially DYT6, with prominent cervical, cranial, and brachial involvement. Mean age at onset was markedly younger in the patients with variant A-T (n = 12) than in patients with other dystonia (n = 23), (12 years vs 40 years, p < 0.05). The patients with A-T were remarkable for the absence of notable cerebellar atrophy on MRI, lack of frank ataxia on examination, and absence of ocular telangiectasias at original presentation, as well as the presence of prominent myoclonus-dystonia in 2 patients. Many also developed malignancies.

CONCLUSION

Ataxia and telangiectasias may not be prominent features of patients with variant A-T treated for dystonia in adulthood, and variant A-T may mimic primary torsion dystonia and myoclonus-dystonia.

Acute Intermittent Porphyria in a Kumhar community of Western Rajasthan

OBJECTIVE

To know the current magnitude of the occurrence of Acute Intermittent Porphyria in Kumhar community of a part of Western Rajasthan.

MATERIAL AND METHODS

This is a cross sectional study of rural community of Kumhars of Bikaner district of Western Rajasthan. The households of kumhar community were approached. Besides recording other information and examination details, their urine samples were subjected to Watson-Schwartz Test.

RESULT

1237 subjects out of a total of 2385 kumhar population distributed among 20 randomly selected villages of Bikaner district could be studied. The prevalence of AIP was estimated to be 1.16%. (CI=0.012 +/- 0.0005), showing higher prevalence than the earlier reported studies. The cases exhibited varied symptomatology. Overall preponderance was in favor of females (2:1) and majority of cases (38.9%) were found in the age group of 20-29 years. Average age of manifestation was 24.5 +/- 4.8 years. A follow up was also done to know the disease consequences, if any.

CONCLUSIONS

The study finds higher prevalence of the disease and as such warrants a need for generating awareness among the families of cases in the specific caste group in the study area for early detection and better management of the disease.

Temperature affects the results of the glutaraldehyde test in the diagnosis of pulmonary tuberculosis

SETTING

Subjects attending the District Tuberculosis Clinic and a Teaching Hospital in Jodhpur were studied at the Desert Medicine Research Centre, Jodhpur.

OBJECTIVES

To confirm the effect of temperature on the results of the blood glutaraldehyde test (GT) and to examine the sensitivity and specificity of the restandardised test procedure.

DESIGN

Blood glutaraldehyde gelification time (BGGT) was compared, in the same blood samples, at 19, 22 and 25 degrees C and after storage at 1) room temperature and at 2) 2-8 degrees C for 3-5 h, using the paired t-test. After restandardisation of the procedure, the GT was carried out on 88 sputum culture-positive cases with pulmonary tuberculosis (PTB) and 182 controls. The technician was blinded to patient information.

RESULTS

BGGT significantly varied with the temperature of the water bath and the temperature at which blood samples were stored before testing. When the test was carried out in the water bath at 22 degrees C after storing blood for 3-5 h at 2-8 degrees C, as per the restandardised procedure, the specificity of GT was 96.2% (95 %CI 93.36-98.95) and the sensitivity was 84.1% (95%CI 76.45-91.73).

CONCLUSION

Restandardised GT is a reliable, simple, easy, rapid, inexpensive and user-friendly test for diagnosis of PTB which does not require sophisticated laboratory equipment.

Malaria outbreak in the Indira Gandhi Nahar Pariyojna command area in Jaisalmer district, Thar Desert, India

A focal outbreak of malaria occurred in the villages situated close to the main Indira Gandhi canal near Ramgarh in Jaisalmer district, western Rajasthan. Stagnation of water over a month's period in the main canal as well as long standing rain water in the form of expansive lakes near these villages formed vast breeding grounds for the vectors like Anopheles culicifacies, along with A. stephensi already breeding in the 'tanka' and 'beri' in the epidemichit villages. Rapid mass blood surveys along with other entomological and parasitological investigations were conducted in four of the ten affected villages, viz., Seuva, Raghwa, Raimala and Sadhna. A total of 992 specimens belonging to four vector species were sampled, namely, A. stephensi (47.4%), A. culicifacies (41.0%), A. subpictus (11.2%) and A. annularis (0.4%). Epidemiologically, about one-fourth of the examined persons were positive (SPR 25.5%), although Plasmodium falciparum dominated the parasitaemia (49.5%). Available data are indicative of changed malariological scenario in the Indira Gandhi Nahar Pariyojna command area, where epidemics are regular features every year.

Patient with a 22q11.2 deletion with no overlap of the minimal DiGeorge syndrome critical region (MDGCR)

The apparent lack of genotype/phenotype correlation in patients with the DiGeorge anomaly and velocardiofacial syndrome (DGA/VCFS; the "22q11 deletion syndrome") indicates a complex genetic condition. Most cases, whatever the phenotype, have a 1.5-3 Mb chromosomal deletion that includes the minimal DiGeorge critical region (MDGCR). Another potential critical region on 22q11 has been suggested based on two patients with distal deletions outside the MDGCR. We report on a patient with a VCFS phenotype who has a deletion, mapped by short tandem repeat polymorphic loci and fluorescence in situ hybridization analysis, distal to and not overlapping the MDGCR. This patient is deleted for several genes, including the T-box 1 gene (TBX1; a transcription regulator expressed early in embryogenesis) and catechol-O-methyltransferase (COMT; involved in neurotransmitter metabolism). We discuss the role these two genes may play in the clinical phenotype of the patient.

Persistent pregnanediol glucuronide secretion after gonadotrophin suppression indicates adrenal source of progesterone in premature ovarian failure

A 2-3 fold higher urinary pregnanediol glucuronide excretion has been observed in women with premature ovarian failure, compared with age-appropriate menopausal women. Progesterone, the precursor of urinary pregnanediol glucuronide, is a secretory product of either adrenal or ovarian origin. We postulated that suppression of pituitary gonadotrophin secretion by down-regulation with a long-acting gonadotrophin-releasing hormone agonist, leuprolide acetate, would decrease ovarian but not adrenal pregnanediol glucuronide. This would demonstrate a major difference in the ovarian hormonal milieu of these two groups of women. Four volunteers with premature ovarian failure collected daily first morning voided urine samples for 1 month prior to leuprolide acetate administration. Leuprolide acetate was then administered monthly for 3 months while continuing daily urinary collection. Luteinizing hormone (LH), follicle stimulating hormone (FSH), and pregnanediol glucuronide were measured in all samples and normalized for creatinine. Comparisons of pre- and post-median values for luteinizing hormone (LH), FSH, and pregnanediol glucuronide were made using the Wilcoxon rank sum test. This demonstrated significant suppression of both LH and FSH. Pregnanediol glucuronide, however, did not demonstrate a significant decline, strongly implying an adrenal source of the enhanced excretion. The decreased pregnanediol glucuronide noted in age-appropriate menopausal women compared with premature ovarian failure is likely to be a reflection of adrenal ageing.

Detrimental effect of hydrosalpinx fluid on the development and blastulation of mouse embryos in vitro

OBJECTIVE

To study the effects of human hydrosalpinx fluid on mouse embryo blastulation rate.

DESIGN

Comparison of mouse embryo blastulation rate in media containing increasing concentrations of hydrosalpinx fluid.

SETTING

Tertiary care center.

PATIENT(S)

Women undergoing laparoscopic evaluation or treatment for infertility noted to have hydrosalpinx or paratubal cyst.

INTERVENTION(S)

Exposure of mouse embryos to hydrosalpinx or paratubal cyst fluid collected during laparoscopy.

MAIN OUTCOME MEASURE(S)

Blastulation rate of mouse embryos.

RESULT(S)

Culture of mouse embryos at 0% (controls), 0.3%, 0.6%, and 0.9% hydrosalpinx fluid concentrations demonstrated significantly lower blastulation rate at each level compared with the controls.

CONCLUSION(S)

Hydrosalpinx fluid is highly embryotoxic.

The predictive value of first-trimester embryonic heart rates in infertility patients

OBJECTIVE

To analyze whether first-trimester embryonic (fetal) heart rates (FHR) are useful in predicting pregnancy outcome for infertility patients.

METHODS

Patients in a university-based reproductive endocrinology and infertility practice were studied prospectively. Infertile women who achieved clinical pregnancy underwent first-trimester transvaginal sonographic evaluation, and FHR in patients achieving viable pregnancies were compared with those experiencing fetal loss.

RESULTS

Overall, 99 pregnancies reached viability and 17 resulted in fetal loss before 20 weeks' gestation. Patient age, methods of conception, and number of previous fetal losses did not differ significantly between the two groups. A significant correlation (r = .70, P < .001) was found between increasing FHR levels and advancing gestational age in patients with viable pregnancies and, although to a weaker extent, patients who miscarried (r= .52, P < .05). A significantly higher number of viable pregnancies, compared with fetal losses, had FHR falling within one (70.7% compared with 41.2%, P < .025) and two (99.0% compared with 64.7%, P < .001) standard deviations of the mean for viable pregnancies at corresponding gestational ages. The majority of FHR of failing pregnancies fell below the individual reference ranges.

CONCLUSION

First-trimester FHR can help predict pregnancy outcome for infertility patients. Women with FHR outside the reference range from the mean for viable pregnancies at corresponding gestational ages may be at risk for eventual pregnancy loss.

Sonographic evaluation of biliary ascariasis

In a prospective 6-month study, sonographic diagnosis of biliary ascariasis was made in 14 patients; in nine patients, the diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and bile analysis, while in five patients, confirmation was obtained by proven intestinal infestation. No false-positive or false-negative cases were encountered. Ascariasis of the biliary tract was seen on ultrasound as echogenic, non-shadowing images, either as single or multiple strips, with visualization of the digestive tract of the worm as an anechoic inner tube, or as amorphous fragments. Follow-up sonograms helped in detection of worm expulsion following medical therapy in five patients, while endoscopic extraction of the worm was performed in four patients. In three patients, disappearance of the worm from the biliary tract was noted following a therapeutic sphincterotomy, and two patients detected to have a worm within the gall-bladder were operated on. In all patients, serial sonograms revealed disappearance of the worm, and the regression of biliary tract dilatation.

Growth kinetics of Escherichia coli and expression of a recombinant protein and its isoforms under heat shock conditions

Preinduction culture conditions were found to have significant impact on the expression and post-translational modification of a recombinant human protein in Escherichia coli under heat shock conditions (30 to 42 degrees C shift). Higher preinduction growth rates (micrograms) favored better cell viability, greater cell mass yields, and increased cloned gene expression during induction. Formation of recombinant protein isoforms (those containing N epsilon-modified lysine residues) exhibited an increasing trend with increasing micrograms. The different extents of post-translational modifications were suspected to be linked to the different concentrations of certain heat shock protein chaperones resulting from different micrograms. In view of the extensive involvement of E. coli heat shock proteins in cellular activities-including the synthesis, processing, modification, and degradation of proteins-at elevated temperatures, it is believed that micrograms dictated the cellular resources available for synthesizing the heat shock proteins required for cell survival, which in turn determined the ability of the cells to respond to the heat shock. With a higher micrograms both the synthesis of host proteins (as indicated by cell growth and survival) and the cloned gene expression were enhanced. The results demonstrate that there exists an intermediate micrograms for optimum production of the unmodified foreign protein in a heat shock environment. More importantly, they also illustrate the feasibility of improving the recombinant protein homogeneity in fermentation, thereby facilitating downstream processing.

Laparoscopic bilateral gonadectomy in a phenotypic woman with a form of Leydig cell hypoplasia

A 22-year-old phenotypic woman with an XY karyotype underwent laparoscopic gonadectomy after a comprehensive evaluation for primary amenorrhea. Pathology revealed primitive testicular support elements with absent Leydig cells bilaterally. This case illustrates the fact that, with a thorough preoperative workup, patients expressing various forms of male pseudohermaphroditism can now be treated appropriately by laparoscopy instead of laparotomy.

Evaluation of serum creatine kinase levels in ectopic pregnancy

OBJECTIVE

To analyze whether increased serum creatine kinase (CK) levels are useful in early detection of ectopic pregnancy (EP).

DESIGN

Prospective cohort study.

SETTING

Patients in a university-based reproductive endocrinology and infertility practice.

PATIENTS

Infertile women who achieved clinical pregnancy.

INTERVENTIONS

Serum CK with isoenzymes levels were drawn after sonographic evaluation in patients achieving clinical pregnancy.

MAIN OUTCOME MEASURES

Comparison of serum CK levels in patients with EP versus those with normal and abnormal intrauterine pregnancy (IUP), both separately and together as one group.

RESULTS

There was no significant difference in mean total CK levels for patients with EP (82.25 +/- 81.39 IU/L; conversion factor to SI unit, 1.00) versus normal IUP (62.54 +/- 44.79 IU/L), abnormal IUP (55.15 +/- 3.46 IU/L), or all IUP (60.87 +/- 40.72 IU/L). The mean gestational ages were similar in all three groups: EP, 46.78 +/- 6.65 days; normal IUP, 47.56 +/- 8.29 days; and abnormal IUP, 47.86 +/- 13.30 days.

CONCLUSION

Serum CK levels do not help to predict EP for infertility patients achieving conception. To assist in preventing maternal morbidity, a more discriminative test is needed to identify this condition early in gestation.

Cloning and expression of the gene encoding a novel proteinase from Tritirachium album limber

We have isolated the cDNA and the genomic clones encoding a novel serine proteinase, named proteinase T, from the fungus Tritirachium album Limber. The coding region of the gene is interrupted by two introns. The amino acid sequence of proteinase T as deduced from the nucleotide sequence is about 56% identical to that of proteinase K. Four cysteines are present in the mature proteinase, probably in the form of disulfide bonds. We have also purified the native proteinase from Tritirachium album Limber grown in the presence of 2% skim milk. Proteinase T is extremely stable at 50 degrees C. The thermal stability is not affected in the presence of 1% SDS either at pH 8.0 or 10.0. We have expressed the cDNA of proteinase T in Escherichia coli. The authenticity of the proteinase has been characterized by Western blotting and amino terminal analysis of the recombinant product. High level expression of proteinase T in E. coli as well as the refolding process to generate active proteinase will be discussed in detail.

Phosphate glass as a phosphate source in high cell density Escherichia coli fermentations

Polyphosphate glass (sodium hexametaphosphate, sodium polyphosphate, glassy) was identified and tested as a source of phosphate that supports growth of recombinant Escherichia coli to cell densities over 110 g dry wt/L. Polyphosphate glasses cost no more than sodium and potassium phosphates, are more soluble than any other inorganic phosphate source, and do not form metallophosphate precipitates when mixed with other nutrients in proportions found in fermentation medias. Using a typical fermentation medium, 40% higher cell densities were obtained using polyphosphate glass rather than orthophosphate. Polyphosphate glasses will allow more flexibility in designing and executing high cell density fermentations.

Elevated first-trimester serum relaxin concentrations in pregnant women following ovarian stimulation predict prematurity risk and preterm delivery

OBJECTIVE

To determine whether ovarian stimulation would result in higher circulating relaxin concentrations and whether this hyperrelaxinemia would be associated with prematurity.

METHODS

Two groups of women were studied: 1) women achieving pregnancy after ovarian stimulation (n = 114) and 2) women achieving pregnancy without treatment (n = 37). Serum was obtained at 6-12 weeks' gestational age; fetal number was determined by transvaginal ultrasound. Prematurity risk or preterm delivery was determined from the obstetric record. A specific human relaxin enzyme-linked immunosorbent assay was used to measure serum relaxin concentrations. Hyperrelaxinemia was defined as levels greater than 3 standard deviations above the weighted mean of levels in normal unstimulated singleton pregnancies at 6-12 weeks' gestation.

RESULTS

An association was found between prematurity risk or premature delivery and peripheral relaxin concentrations during weeks 6-12 of pregnancy in women having ovarian stimulation and in women having multiple gestations. Circulating relaxin concentrations greater than 16 ng/mL in women having ovarian stimulation and levels greater than 7 ng/mL in women who had multiple gestations predicted prematurity risk or premature delivery in 50% of the women.

CONCLUSIONS

These data demonstrate that after ovarian stimulation, some women have highly elevated circulating first-trimester relaxin concentrations. First-trimester hyperrelaxinemia identifies a group of women at risk for prematurity who can be monitored aggressively.

Preovulatory follicle number predicts corpora lutea number in early pregnancy

A moderately strong correlation was coefficient was obtained between the relationship of mature follicle number versus CL number by use of vaginal US. This suggests an accurate prediction of CL number, especially between 1 and 4 mature follicle number as determined by the LOWESS curve.

Characterization of two fluorescent tryptophans in recombinant human granulocyte-colony stimulating factor: comparison of native sequence protein and tryptophan-deficient mutants

In order to probe the role of the individual tryptophans of granulocyte-colony stimulating factor (G-CSF) in pH and guanidine HCl-induced fluorescence changes, site-directed mutagenesis was used to generate mutants replacing Trp118,Trp58, or both with phenylalanine. Neither Trp to Phe mutation affected the folding or activity of the recombinant G-CSF, and the material expressed in yeast behaved identically to that expressed in Escherichia coli. All of the G-CSF species responded to pH and guanidine HCl in qualitatively the same manner. Trp58 has a fluorescence maximum at 350 nm and is quenched to a greater extent by the addition of guanidine HCl, indicating that it is fully solvent-exposed. Trp118 has a fluorescence maximum at 344 nm, and is less solvent-accessible than Trp58. The analog in which both tryptophans have been replaced with phenylalanine shows only tyrosine fluorescence, with a peak at 304 nm which decreases with increasing pH. The intensity of the tyrosine fluorescence in this analog is much greater than that of the native sequence protein or single tryptophan mutants, indicating that energy transfer is taking place from tyrosine to tryptophan in these molecules. Below neutral pH the tyrosine fluorescence is much greater in the [Phe58]G-CSF than in the [Phe118]G-CSF, indicating that Trp58 might be a more efficient recipient of energy transfer from the tyrosine(s).

Phenotype of villous stromal cells in placentas with cytomegalovirus, syphilis, and nonspecific villitis

Villous stromal cells (VSC) play an important role in fetomaternal placental immune function. We studied the phenotype of VSC in infection by cytomegalovirus (CMV) and syphilis as well as nonspecific villitis and compared the findings with gestational age-matched controls. Monoclonal antibodies directed against total leukocytes, T cells, B cells, macrophages, dendritic cells, granulocytes and HLA-DR as well as polyclonal antibodies against S-100, alpha-1 antichymotrypsin, and lysozyme were used. In controls, the immunocytochemical response for each marker was either negative or weakly positive. In contrast, the VSC in CMV-infected and nonspecific villitis showed intense reactivity to various macrophage markers. In syphilis, reactivity with macrophage markers such as lysozyme and MAC387 were weaker, and reactivity to HLA-DR and S-100 was much stronger. Endothelial cells strongly expressed the monocyte/granulocyte marker CD15 in the diseased states, especially in syphilis, relative to controls. We conclude that the phenotype of VSC is altered in disease states and that the changes are dependent to some degree on the specific subset of chronic villitis.

Enhanced stability of subtilisin by three point mutations

This study was undertaken to characterize the effect of three point mutations made on aprA-subtilisin on the stability of the protein to both heat- and detergent-induced denaturation. Asparagine residues at positions 109 and 218 were replaced with serine residues to prevent the possible cyclization between these asparagines and the adjacent glycine residues and hence to increase the long-term stability. The effect of these substitutions on conformational stability was examined by thermal denaturation. At high calcium concentrations, the Ser109-substituted analog showed a 3 degrees C higher transition temperature than that of aprA-subtilisin, while the Ser218 substituted analog had a 4 degrees C higher transition temperature. The analog with both changes had a 7 degrees C higher transition temperature than that of the original aprA-subtilisin, indicating that the contributions of the individual mutations were additive. The analog with both mutations also exhibited increased stability in the presence of sodium dodecyl sulfate (SDS) when compared to aprA-subtilisin. In addition to the above two mutations, the asparagine at position 76, located in the high affinity Ca(2+) binding loop of subtilisin, was changed to aspartic acid. The effect of this mutation on the thermal stability of the protein was examined at different calcium concentrations. The analog with all three mutations exhibited little dependence on calcium concentration below 1 mM levels, while the proteins without the mutation at asparagine-76 displayed a strong dependence of melting temperature on Ca(2+) concentration in this range. At much higher calcium concentrations, the analog with three mutations showed an increase in stability similar to that observed with aprA-subtilisin. The analog with three mutations also exhibited greater stability to SDS-induced denaturation than both aprA-subtilisin and the Ser109- and Ser218-substituted analogs. The activation energy barrier for loss of structure in 1% SDS for the analog with all three mutations was increased over that for aprA-subtilisin by 16 kcal/ml. These results suggest that the mutation of asparagine-76 to aspartic acid increases the affinity of the primary Ca(2+) binding site.

Hydroxyethyl starch macromolecules reduce myocardial reperfusion injury

We assessed the value of a fraction of hydroxyethyl starch (HES Pz) in reducing the myocardial reperfusion injury in a canine open-chest model in which 1 hour of left anterior descending coronary artery occlusion was followed by 24 hours of reperfusion. Three treatment infusions (5% of blood volume) were compared: Ringer's lactate, serum albumin, and HES Pz (70% of the macromolecules between 100,000 and 1,000,000 d). When compared with Ringer's lactate and albumin, HES Pz significantly reduced the ratio of 24-hour infarct size to pretreatment area at risk (3% vs 19% and 16%, respectively) and myocardial water content (0.5% vs 3% and 1%). Potassium content differences between injured and normal myocardium were significantly less in the infarct regions of animals receiving HES Pz. In the canine model, HES Pz reduced 1-hour myocardial ischemia reperfusion injury significantly.

Yeast-derived recombinant human insulin-like growth factor I: production, purification, and structural characterization

Recombinant human insulin-like growth factor I (IGF-I) is efficiently expressed and secreted from Saccharomyces cerevisiae using a yeast alpha-factor leader to direct secretion. However, approximately 10-20% of the IGF-I was in a monomeric form, the remaining materials being disulfide-linked aggregates. When the purified material was subjected to reverse-phase high-performance liquid chromatography (rp-HPLC), it gave two doublet peaks, I and II. Upon reduction, doublet peaks I and II converged to one doublet peak. This suggests that peaks I and II result from different disulfide structures, and the doublet feature of each peak results from other causes. Different disulfide structures between peaks I and II were also suggested from the near UV circular dichroism of these proteins. Only the peak II was biologically active, indicating that peak II has the correct disulfide structure. Concanavalin A affinity chromatography of the purified peak II doublet showed binding of the subpeak with an earlier rp-HPLC retention time, indicating that it was glycosylated. Sequence analysis of tryptic peptides suggested that Thr29 was the site of glycosylation. Site-directed mutagenesis was used to convert Thr29 to Asn29. This substitution reduced, but did not eliminate IGF-I glycosylation, suggesting additional glycosylation sites. The site of carbohydrate addition was consistent with the model that O-glycosylations occur on hydroxyl amino acids near proline residues in beta-turns.

In situ hybridization analysis for cytomegalovirus in chronic villitis

Chronic villitis with villous lymphoplasmacytic, histiocytic infiltrate and stromal necrosis may have various etiologies. Infection with cytomegalovirus (CMV) is a frequent cause of such villitis, but the nuclear and cytoplasmic inclusions diagnostic of CMV are often not apparent. In this study placentas with chronic villitis were analyzed for CMV DNA by means of in situ hybridization. Of the eight cases of chronic villitis studied, three demonstrated inclusions diagnostic of CMV infection. On in situ hybridization, three additional cases had detectable CMV DNA. CMV was detected in endothelial, histiocytic, and fibroblastic cells and occasionally in the trophoblast. In cases with characteristic CMV inclusions, CMV DNA was often present in cells that lacked inclusions. CMV DNA was not detected in unremarkable placental tissue obtained from normal deliveries. It is concluded that CMV is commonly found in lymphoplasmacytic and histiocytic villitis and that in situ analysis for CMV is a rapid, easy, and sensitive way to detect the virus in placentas.

Macromolecules reduce abnormal microvascular permeability in rat limb ischemia-reperfusion injury

We studied the effect of iv administration of biodegradable macromolecules on microvascular permeability after ischemia-reperfusion injury in a rat gastrocnemius model. After 2 h of tourniquet ischemia of the rats' hind limb, groups of animals were given iv lactated Ringer's solution (RL), serum albumin 5%, or varying MW fractions of biodegradable macromolecules of hydroxyethyl starch (HES), glycogen, and dextran. At the conclusion of the 24-h reperfusion period, the rat gastrocnemius muscles were collected. Water and K+ differences between the ischemic and control muscles were compared. Rats given a 100,000 to 300,000-dalton fraction of HES had significantly decreased water content (5.1 +/- 3.4%) when compared to rats receiving RL (8.3 +/- 2.2, p less than .01), less than 100,000 dalton HES (8.3 +/- 3.2, p less than .05), less than 300,000 glycogen (7.9 +/- 2.5, p less than .01), or dextran 150,000 (8.3 +/- 1.5, p less than .05). Rats given 100,000 to 300,000-dalton HES also had significantly higher ischemic muscle K+ content as compared to the nontourniquet control (difference 14.2 +/- 9.7 mEq/g) than rats receiving any of the other solutions (range 32.5 to 39.3) except the 300,000 to 1,000,000-dalton fraction of HES. Regression analysis comparison of K+ difference to the histologic evaluation of the muscles on the criteria of polymorphonuclear infiltration and interstitial edema (0, best; 3, worst) had a Pearson correlation coefficient of r = .73. Reduction of abnormally increased microvascular permeability may be accomplished by the iv use of appropriate sized biodegradable macromolecules.

Comparison of changes in intestinal length and circumference after 90 per cent bypass and 90 per cent resection

Compensatory hypertrophy was compared in rats that had undergone 90 per cent small intestinal resection and rats that had undergone 90 per cent small intestinal bypass. Increases in intestinal length and circumference occurred rapidly in both groups and were virtually identical. Lengthening was more pronounced in the jejunum; increase in circumference was greater in the ileum. Increases in length and circumference of the appendix were seen in both experimental groups. These studies suggest that compensatory hypertrophy can occur in patients after either intestinal bypass or resection, and that patients with bypasses have a less difficult postoperative course because of their preexisting obesity.