Subthalamic nucleus microinjections of 5-HT2 receptor antagonists suppress stereotypy in rats

The subthalamic nucleus (STN) is an important mediator of basal ganglia output. We studied the effects of STN microinjections of the serotonin-2 (5-HT2) antagonists clozapine, mesulergine and M100,907 on apomorphine-induced stereotypic activity in the rat. Each compound profoundly decreased the expression of stereotypic behavior, with particularly strong effects to reduce gnawing behavior. Because M100,907 does not have appreciable affinity for dopamine D1 and D2 receptors, and since all three agents are 5-HT2 antagonists, the current data suggest that basal ganglia output related to orofacial movements can be significantly modified by 5-HT2 receptors. The results suggest that antipsychotics with serotonergic properties may have direct actions on the STN that influence their potential to produce orofacial and other motor side effects.

Induction of cytotoxic T-cell responses following oral immunization with synthetic peptides encapsulated in PLG microparticles

CTL responses play a critical role in clearing viral infections. We have investigated the potential of poly(lactide-co-glycolide) (PLG) microparticles as an oral delivery system for peptides representing CTL epitopes from measles virus nucleoprotein. Oral administration of CTL epitopes encapsulated in 50:50 PLG microparticles, resulted in vivo priming of splenic peptide-specific CTL responses. However, the observed CTL lysis was low and cofeeding of encapsulated peptide with cholera toxin as a mucosal adjuvant did not result in any significant enhancement of the observed CTL responses. The pronounced immunostimulatory effect of microparticles, combined with their excellent tissue compatibility and biodegradability makes them a valuable delivery system for synthetic peptide immunogens. However, further work is needed to improve their efficiency via the oral route.

ADP ribosylation factor 1 mutants identify a phospholipase D effector region and reveal that phospholipase D participates in lysosomal secretion but is not sufficient for recruitment of coatomer I

The small GTP-binding protein, ADP-ribosylation factor 1 (ARF1) is essential for the formation of coatomer-coated vesicles from the Golgi and is also an activator of phospholipase D (PLD). Moreover, ARF1-regulated PLD is part of the signal-transduction pathway that can lead to secretion. In this study, substitution and deletion mutants of ARF1 were tested for their ability to activate PLD. These map the PLD effector region of ARF1 to the alpha2 helix, part of the beta2-strand and the N-terminal helix and its ensuing loop. ARF mutants with an increased or decreased ability to activate PLD showed similar characteristics when tested for their ability to stimulate secretion from HL60 cells. ARF1, deleted of the N-terminal 17 amino acid residues (Ndel17), did not support PLD activity or secretion, and neither did it inhibit the activity of wild-type myristoylated ARF1 (myrARF1). In contrast, Ndel17 effectively competed with wild-type myrARF1 to prevent coatomer binding to membranes. This appears to define a structural role for Ndel17, as it can bind a high-molecular mass complex in cytosol. In addition, ethanol has no effect on recruitment of coatomer to membrane. We conclude that the function of ARF-regulated PLD is in the signal-transduction pathway leading to secretion of lysosomal granules, and not as an essential component of ARF1-mediated coatomer binding.

Immune responses and protection obtained by oral immunization with rotavirus VP4 and VP7 DNA vaccines encapsulated in microparticles

Protective immune responses in mice were obtained after oral immunization with rotavirus DNA vaccines encapsulated in poly(lactide-co-glycolide) (PLG) microparticles. The DNA vaccines used encoded outer capsid proteins VP4 and VP7; proteins that are the basis for rotavirus serotyping and the generation of virus neutralizing antibodies. One dose of vaccine was given to BALB/c mice by oral gavage (75 microg DNA/mouse). Rotavirus-specific serum antibodies and intestinal IgA antibodies were detectable by 6 weeks postimmunization. After challenge with homologous murine rotavirus at 12 weeks postimmunization, fecal rotavirus antigen was reduced significantly in immunized mice compared with controls. Protective immunity also was generated by oral delivery of unencapsulated VP 7 DNA vaccine but to a lesser degree. These results demonstrate that the oral route is effective for generating protective immune responses with rotavirus DNA vaccines targeting neutralization antigens.

Tibial fracture during removal of a tibial intramedullary nail

SUMMARY

As tibial intramedullary nailing becomes the preferred treatment for tibial shaft fracture, removal of tibial nails will become more common. Removal of tibial intramedullary nails is not without complications, but a review of the literature found only one recent report of a fracture of the tibia during removal. A case report of a tibial fracture during removal of an Alta tibial nail is presented.

A Strategy for Improvement in Care at the End of Life: The VA Faculty Leaders Project

Given the commitment of the Veterans Health Administration (VA) to excellent, compassionate end-of-life and palliative care and the VA's extensive system of academic affiliations with the nation's medical schools, there may exist an opportunity to accelerate acceptance of state-of-the-art training for improved care for dying patients. Accordingly, the VA has initiated a project to develop strategies for implementation of benchmark curricula for end-of-life and palliative care. With the support of the Robert Wood Johnson Foundation, this initiative has been implemented in 30 internal medicine residency training programs affiliated with the VA nationally.

Spontaneous mutation, oxidative DNA damage, and the roles of base and nucleotide excision repair in the yeast Saccharomyces cerevisiae

The OGG1 gene of Saccharomyces cerevisiae encodes a DNA glycosylase that excises 7,8-dihydro-8-oxoguanine (8-OxoG). When compared to wild-type, ogg1 mutants show an increase in the frequency of GC to TA transversions, indicating a role for Ogg1 in the repair of 8-OxoG. Here we report an increased frequency of forward mutation to canavanine resistance in mutants defective in the nucleotide excision repair (NER) gene RAD14. This was not increased further in strains additionally defective in OGG1. However, when compared to strains solely defective in OGG1, ogg1radl4 mutants displayed an increase in spontaneous GC to TA transversions. Intriguingly, reversion of the lys1-1 ochre allele was not increased in rad14 mutants, suggesting that oxidative base damage may only represent a substrate for NER in certain regions of the genome. We also examined repair of oxidative DNA damage by transforming mutant strains with plasmid DNA treated with methylene blue plus visible light. Mutants defective in OGG1 showed no significant reduction in transformation efficiency compared with wild-type strains. In contrast, disruption of RAD14 reduced the efficiency of transformation, yet there was no further decrease in an ogg1rad14 mutant. This strongly supports a role for NER in the repair of oxidative base damage in yeast, and differs from similar experiments carried out in E. coli, where transformation efficiency is only reduced in mutants defective in both fpg and uvrA. Finally, the repair of Fpg-sensitive sites was examined at the MATalpha and HMLalpha mating type loci, and NER was found to play a role in their removal.

Epidermal growth factor receptor transmembrane domain: 2H NMR implications for orientation and motion in a bilayer environment

As part of a study of receptor tyrosine kinase behavior in membranes, we have collected extensive NMR data from three well-defined probe locations within the transmembrane region of the human EGF receptor. Spectra were obtained for selectively deuterated alanine residues in a series of peptides corresponding to the putative transmembrane domain (with short extramembranous extensions). Peptides were incorporated into fluid unsonicated liposomes of 1-palmitoyl-2-oleoylphosphatidylcholine (POPC) and POPC containing 33 mol % cholesterol to mimic common lipid composition of cell plasma membranes. The peptide concentration was in the range of 1-6 mol % relative to that of phospholipid. Data acquired at 35 degreesC have been analyzed quantitatively to determine their implications to receptor spatial orientation and dynamics. If it is presumed that the single transmembrane portion approximates an alpha-helix of 3.6 residues per turn, this helix was found to be tilted away from the membrane perpendicular, about which there was rapid axial diffusion. However, rotation about the peptide long axis was static on the NMR time scale of 10(-)4 s, and the peptide appeared to have a preferred direction(s) of lean. The results for this peptide, whose hydrophobic length is greater than the membrane hydrophobic thickness, were very similar between membranes of POPC and membranes of POPC containing 33 mol % cholesterol, despite considerable host matrix differences in thickness and order. Allowed values of peptide tilt occupied a narrow range: between 10 and 14 degrees in POPC and between 10 and 12 degrees in POPC/cholesterol. Although the existence of some preferred direction(s) of lean was demanded by the results, the direction of lean was not uniquely determined. We have interpreted these results, which were essentially unchanged at 65 degreesC, as reflecting the behavior of peptide monomers undergoing rapidly reversible peptide-peptide interactions. For transmembrane monomers, interference with rotation about the peptide long axis might be understood to arise from an energy benefit (in a tilted peptide) to prevention of particular amino acid side chains near the membrane surfaces from moving in and out of hydrophobic or hydrophilic environments. It will be desirable to test the conclusion of preferential lean of a monomeric receptor since such behavior could provide a mechanism for modulating monomer association with other species (i.e., signal transduction).

Protective immunity induced by oral immunization with a rotavirus DNA vaccine encapsulated in microparticles

DNA vaccines are usually given by intramuscular injection or by gene gun delivery of DNA-coated particles into the epidermis. Induction of mucosal immunity by targeting DNA vaccines to mucosal surfaces may offer advantages, and an oral vaccine could be effective for controlling infections of the gut mucosa. In a murine model, we obtained protective immune responses after oral immunization with a rotavirus VP6 DNA vaccine encapsulated in poly(lactide-coglycolide) (PLG) microparticles. One dose of vaccine given to BALB/c mice elicited both rotavirus-specific serum antibodies and intestinal immunoglobulin A (IgA). After challenge at 12 weeks postimmunization with homologous rotavirus, fecal rotavirus antigen was significantly reduced compared with controls. Earlier and higher fecal rotavirus-specific IgA responses were noted during the peak period of viral shedding, suggesting that protection was due to specific mucosal immune responses. The results that we obtained with PLG-encapsulated rotavirus VP6 DNA are the first to demonstrate protection against an infectious agent elicited after oral administration of a DNA vaccine.

Contributions of Na+/H+ exchanger isoforms to preimplantation development of the mouse

Previous work provided evidence of Na+/H+ exchanger activity in the apical domain of mouse trophectodermal plasma membranes that provides a route for entry of extracellular Na+ (Manejwala et al., 1989). This activity was hypothesized to contribute to the trans-trophectodermal Na+ flux that is required for blastocoel expansion. In the present work, we have used reverse transcriptase-polymerase chain reaction (RT-PCR) and immunocytochemistry to identify members of the Na+/H+ exchanger (NHE) family that are likely to participate in this process. When cDNA preparations from ovulated oocytes and several stages of preimplantation development were tested with PCR primers specific for the NHE-1, -2, -3, and -4 isoforms of the exchanger, only amplicons representing the NHE-1 and NHE-3 isoforms were detected. The identity of these amplicons was confirmed by direct sequencing. NHE-1 mRNA is present in oocytes and in all preimplantation stages, increasing threefold on a per embryo basis between the 4-cell and blastocyst stages. NHE-3 mRNA, on the other hand, was only detected in oocytes. Immunocytochemical analysis of blastocysts revealed that NHE-1 is localized in the basolateral domain of the trophectoderm, whereas NHE-3 is localized in the apical domain, a situation like that in epithelia of adult organs. We conclude that NHE-3, an oogenetic product that persists into the blastocyst stage, is the Na+/H+ exchanger isoform most likely to be involved in blastocoel expansion.

Panhandle PCR: a technical advance to amplify MLL genomic translocation breakpoints

Translocations involving a breakpoint cluster region of the MLL gene at chromosome band 11q23 are the most common molecular abnormalities in acute leukemias of infants and acute leukemias related to chemotherapy with DNA topoisomerase II inhibitors. Molecular cloning of MLL genomic breakpoints by PCR has previously been difficult because MLL has many translocation partners and several breakpoints involve unknown partner genes. We review a new approach to MLL genomic breakpoint cloning called panhandle PCR. By adding an oligonucleotide sequence to the unknown 3' partner gene that is complementary to a known 5' MLL sequence, we have been able to generate a genomic template with an intrastrand loop for PCR schematically shaped like a pan with a handle. The intrastrand loop contains the translocation breakpoint and unknown partner DNA, while the handle contains the known 5' sequence from MLL and a complement to that sequence. Primers both derived from MLL are used to amplify the breakpoint by panhandle PCR. Panhandle PCR offers the advantage of having specificity for the strand of interest at both primer annealing sites without requiring specific primers for the many partner genes of MLL. Panhandle PCR is a straightforward method that represents a technical advance in MLL genomic breakpoint cloning.

Sequence-related behaviour of transmembrane domains from class I receptor tyrosine kinases

2H NMR spectroscopy and freeze-fracture electron microscopy were used to compare the transmembrane domains of two Class I protein receptor tyrosine kinases (the EGF receptor and Neu/erbB-2) regarding overall behaviour in fluid lipid bilayer membranes. The 34-residue peptide, EGFRtm, was synthesised to contain the 23 amino acid hydrophobic stretch (Ile622 to Met644) thought to span the membrane of the human EGF receptor, plus the first 10 amino acids (Arg645 to Thr654) of the cytoplasmic domain. Deuterium probes replaced selected 1H nuclei at sites corresponding to Ala623, Met644, and Val650. The 38-residue peptide, Neutm, was synthesised having the 21 residue hydrophobic stretch (Ile660 to Ile680) calculated to span the membrane in rat Neu/erbB-2, plus residues Lys681 to Thr691 of the contiguous cytoplasmic domain. Deuterium probes replaced selected 1H nuclei at Ala661, Leu667, and Val676. A third peptide, Neutm*, was also prepared, corresponding to the transmembrane domain of a constitutively-activating Neu/erbB-2 transformant in which Val664 is replaced by Glu: it was deuterated in a manner identical to Neutm. Peptides were studied by 2H NMR spectroscopy at 1 mol% and 6 mol% in unsonicated fluid bilayers of 1-palmitoyl-2-oleoylphosphatidylcholine (POPC) and in POPC containing 33 mol% cholesterol, over the range 12 degrees to 65 degreesC. Overall motion was found to be different for each of the three peptides under a given set of conditions. EGFRtm spectra were characteristic of axially symmetric motion in membranes of POPC alone, and in POPC/cholesterol at 35 degreesC and above. In contrast, spectra of the transmembrane peptides, Neutm and Neutm*, were characteristic of significantly axially asymmetric motion under all conditions studied (and regardless of sample preparation method). Addition of 33% cholesterol to membranes was accompanied by spectral changes consistent with increased formation of peptide dimers/oligomers in all cases. The transformant peptide, Neutm*, showed greater spectral evidence of immobilisation than did the wild type - probably reflecting a greater tendency to form large oligomers. Sequence-related details within the transmembrane domains of Class I receptor tyrosine kinases appear to exert important control over their associations within membranes. Freeze-fracture electron microscopy of the NMR samples demonstrated their liposomal nature. Peptide-related intramembranous particles (IMPs) were present which likely represent oligomers of the transmembrane peptide. IMP size and distribution were similar under a given set of conditions for all three peptides, suggesting that the differences seen by NMR spectroscopy reflect structures smaller than the 2 nm resolution limit of freeze-fracture EM and peptide relationships within its 20 nm accuracy of identifying lateral position.

t(11;22)(q23;q11.2) In acute myeloid leukemia of infant twins fuses MLL with hCDCrel, a cell division cycle gene in the genomic region of deletion in DiGeorge and velocardiofacial syndromes

We examined the MLL genomic translocation breakpoint in acute myeloid leukemia of infant twins. Southern blot analysis in both cases showed two identical MLL gene rearrangements indicating chromosomal translocation. The rearrangements were detectable in the second twin before signs of clinical disease and the intensity relative to the normal fragment indicated that the translocation was not constitutional. Fluorescence in situ hybridization with an MLL-specific probe and karyotype analyses suggested t(11;22)(q23;q11. 2) disrupting MLL. Known 5' sequence from MLL but unknown 3' sequence from chromosome band 22q11.2 formed the breakpoint junction on the der(11) chromosome. We used panhandle variant PCR to clone the translocation breakpoint. By ligating a single-stranded oligonucleotide that was homologous to known 5' MLL genomic sequence to the 5' ends of BamHI-digested DNA through a bridging oligonucleotide, we formed the stem-loop template for panhandle variant PCR which yielded products of 3.9 kb. The MLL genomic breakpoint was in intron 7. The sequence of the partner DNA from band 22q11.2 was identical to the hCDCrel (human cell division cycle related) gene that maps to the region commonly deleted in DiGeorge and velocardiofacial syndromes. Both MLL and hCDCrel contained homologous CT, TTTGTG, and GAA sequences within a few base pairs of their respective breakpoints, which may have been important in uniting these two genes by translocation. Reverse transcriptase-PCR amplified an in-frame fusion of MLL exon 7 to hCDCrel exon 3, indicating that an MLL-hCDCrel chimeric mRNA had been transcribed. Panhandle variant PCR is a powerful strategy for cloning translocation breakpoints where the partner gene is undetermined. This application of the method identified a region of chromosome band 22q11.2 involved in both leukemia and a constitutional disorder.

The EGF receptor transmembrane domain: 2H NMR study of peptide phosphorylation effects in a bilayer environment

Phosphorylation events are considered to be key control points in receptor tyrosine kinase function. We have used wide-line 2H NMR spectroscopy to look for physical effects of phosphorylating a threonine residue within the cytoplasmic domain of the human EGF receptor, as sensed at a distant site in the transmembrane portion. Modifications were made to Thr654 (a cytoplasmic residue suggested to be involved in regulation of EGF binding and of cytoplasmic domain function), and effects were sought at Ala623 (near the extracellular membrane surface but within the membrane-spanning region). The study was carried out on synthetic peptides corresponding to the EGF receptor transmembrane domain plus 10 or 11 residues of the cytoplasmic domain, assembled into lipid bilayer membranes. Three peptides were compared that differed only at Thr654. This residue was alternately: nonphosphorylated but left as a (-)-charged C-terminus (-Thr654COO-), nonphosphorylated and with a neighboring amidated glycine residue as the C-terminus (-Thr654GlyCONH2), or phosphorylated and with a neighboring amidated glycine residue as the C-terminus (-Thr654PO4-GlyCONH2). Bilayer membranes were composed of 1-palmitoyl-2-oleoylphosphatidylcholine (POPC) or 2:1 POPC/cholesterol, containing 6 mol % peptide relative to phospholipid. The deuterated site, Ala623, was intrinsically conformationally sensitive; yet spatial orientation and motional order of the probe location were found not to be obviously influenced by phosphorylation.

Comparison of the immunological and protective responses elicited by microencapsulated formulations of the F1 antigen from Yersinia pestis

Purified native F1 antigen from Yersinia pestis was used to assess controlled-release vaccine delivery systems in poly(lactide-co-glycolide) (PLG) microparticles and liposomes. Antigen encapsulated in PLG microparticles induced high serum titres when injected i.p. in mice: mucosal IgA was also detected. Mice immunized with F1 in Alhydrogel or PLGs were protected against subcutaneous challenge with Y. pestis. F1 antigen surface-labelled onto liposome vesicles stimulated high serum titres in Balb/c mice and also induced a mucosal response: F1-labelled liposomes protected mice against challenge with up to 1 x 10(5) organisms. These findings indicate that a significant immune response is induced by immunizing with F1 formulated in PLGs and liposomes and that protection was achieved after only one dose.

Triggering in the mucopolysaccharidoses

Upper limb dysfunction, particularly in relation to skeletal dysplasia and median nerve dysfunction, is well recognized in the mucopolysaccharidoses and mucolipidoses. This is of increasing importance because bone marrow transplantation has dramatically improved survival without changing the musculoskeletal manifestations. Triggering at the A1 pulley and more distally has been described in these patients. We report two such cases and four other patients who were noted to have triggering at the carpal tunnel in association with carpal tunnel syndrome. Five of the six patients consented to surgical intervention with favorable outcomes.

Teledermatology in the Highlands of Scotland

A pilot study of telemedicine consultations of 51 dermatology patients showed that the technology worked well, with the diagnosis being able to be made in most patients and over half of the patients being able to be dealt with through this medium only. It could therefore have a valuable screening role. However, many of the patients, in spite of the obvious advantage of an immediate consultant opinion, felt it would be more appropriately used as a review technique.

Oral delivery of micro-encapsulated DNA vaccines

Oral delivery of vaccines is an attractive alternative to injection. It is a non-invasive procedure which allows access to the gut-associated lymphoid tissues (GALT). Immunisation at GALT results in mucosal immune responses, which may be of particular importance in protection against infection at mucosal surfaces, as well as systemic immune responses. Vaccine antigens can be protected in the gut by encapsulation in poly(DL-lactide-co-glycolide) (PLG) microparticles. Their uptake into the immune inductive tissues of the GALT is mediated by M cells, which selectively phagocytose particles less than 10 microns in diameter. We have developed a method for the PLG encapsulation of plasmid DNA. Encapsulated DNA, expressing the insect protein luciferase under the transcriptional control of the human cytomegalovirus immediate early promoter, was administered to mice by intraperitoneal injection or oral gavage. Intraperitoneal injection of encapsulated DNA elicited good serum IgG and IgM responses and a modest IgA response. Oral administration stimulated good serum antibody titres in all three classes, and in addition, significant levels of mucosal IgA. PLG encapsulation thus has the ability to protect plasmid DNA against degradation after administration, and to facilitate its uptake into appropriate cells for the subsequent expression and presentation of antigen, in such a way as to elicit both systemic and mucosal antibody responses. This may have major implications for the design of novel vaccines and delivery strategies.

Embryonic expression of the putative gamma subunit of the sodium pump is required for acquisition of fluid transport capacity during mouse blastocyst development

The sodium/potassium pump, Na+,K+-ATPase, is generally understood to function as a heterodimer of two subunits, a catalytic alpha subunit and a noncatalytic, glycosylated beta subunit. Recently, a putative third subunit, the gamma subunit, was cloned. This small protein (6.5 kD) coimmunoprecipitates with the alpha and beta subunits and is closely associated with the ouabain binding site on the holoenzyme, but its function is unknown. We have investigated the expression of the gamma subunit in preimplantation mouse development, where Na+, K+-ATPase plays a critical role as the driving force for blastocoel formation (cavitation). Using reverse transcriptase-polymerase chain reaction, we demonstrated that the gamma subunit mRNA accumulates continuously from the eight-cell stage onward and that it cosediments with polyribosomes from its time of first appearance. Confocal immunofluorescence microscopy revealed that the gamma subunit itself accumulates and is localized at the blastomere surfaces up to the blastocyst stage. In contrast with the alpha and beta subunits, the gamma subunit is not concentrated in the basolateral surface of the polarized trophectoderm layer, but is strongly expressed at the apical surface as well. When embryos were treated with antisense oligodeoxynucleotide complementary to the gamma subunit mRNA, ouabain-sensitive K+ transport (as indicated by 86Rb+ uptake) was reduced and cavitation delayed. However, Na+, K+-ATPase enzymatic activity was unaffected as determined by a direct phosphorylation assay ("back door" phosphorylation) applied to plasma membrane preparations. These results indicate that the gamma subunit, although not an integral component of Na+,K+-ATPase, is an important determinant of active cation transport and that, as such, its embryonic expression is essential for blastocoel formation in the mouse.

Panhandle polymerase chain reaction amplifies MLL genomic translocation breakpoint involving unknown partner gene

We used a new approach called panhandle polymerase chain reaction (PCR) to clone an MLL genomic translocation breakpoint in a case of acute lymphoblastic leukemia of infancy in which karyotype analysis was technically unsuccessful and did not show the translocation partner. Panhandle PCR amplified known MLL sequence 5' of the breakpoint and 3' sequence from the unknown partner gene from a DNA template with an intrastrand loop schematically shaped like a pan with a handle. The 7-kb panhandle PCR product contained the translocation breakpoint in MLL intron 8. The partner DNA included unique nonrepetitive sequences, Alu and mammalian apparent LTR-retrotransposon (MaLR) repetitive sequences, and a region of homology to expressed sequence tags. MaLR sequences have not been found before near leukemia-associated translocation breakpoints. The nonrepetitive sequences were not homologous to known partner genes of MLL. Screening of somatic cell hybrid and radiation hybrid lines by PCR and fluorescence in situ hybridization analysis of normal metaphase chromosomes mapped the partner DNA to chromosome band 4q21. Reverse transcriptase-PCR identified an MLL-AF-4 chimeric mRNA, indicating that panhandle PCR identified a fusion of MLL with a previously uncharacterized AF-4 intronic sequence. Panhandle PCR facilitates cloning translocation breakpoints and identifying unknown partner genes.

Socioeconomic and racial/ethnic factors affecting non-fatal medically attended injury rates in US children

OBJECTIVE

Using a representative survey of US children, the purpose was to evaluate separate effects of socioeconomic and racial/ethnic factors, including access to care, on medically attended non-fatal injury rates.

METHODS

Multivariate linear regression models were used to determine associations between injuries and health care coverage (insurance or Medicaid), having a place to go for care, race/ethnicity, maternal education, number of adults and children in the household, poverty, and urbanicity. The 1988 Child Health Supplement to the National Health Interview Survey included questions on medically attended injuries, and their cause, location, and effects on the child. Injury categories included total, consequential, occurrence at home or school, falls, and being struck or cut.

RESULTS

Lack of health care coverage was consistently associated with lower medically attended injury rates in non-Hispanic blacks or whites and Mexican-Americans, but affected total rates for each group differently due to unequal distribution of health care coverage. Injuries occurred about 40% more frequently to children and adolescents living in single adult households compared with two adult homes for all injury categories except for injuries occurring at school.

CONCLUSIONS

Preventive interventions targeted to specific populations based on assumptions that poverty, lack of education, or minority status result in greater risks for injuries require a closer look. Efficient targeting should address underlying factors such as differences in exposures and environments associated with single adult homes or recreational activities. Data sources used to target high risk populations for interventions need to address bias due to access to care.

Issues & trends affecting the nation's hospices

As the hospice industry has grown and moved from isolation into the health care system, it necessarily faces new issues. Some are definite, such as budget considerations; others are more theoretical--for instance, physician-assisted suicide--and thus may remain up for debate as hospice matures into an as-yet-unseen status.

Pilin C-terminal peptide binds asialo-GM1 in liposomes: a 2H-NMR study

Wideline 2H-NMR observations are described demonstrating the interaction of a synthetic peptide (PAK), representing residues 128-144 of the binding domain of pilin surface protein from Pseudomonas aeruginosa, with a complex glycosphingolipid thought to be its natural receptor. The receptor glycolipid (asialo-GM1) carried 2H probe nuclei on the terminal and next-to-terminal carbohydrate residues and was present as a minor component in fluid phosphatidylcholine liposomes. The peptide induced spectral changes that could be understood as arising from receptor motional changes, without receptor immobilization on the NMR time scale of 10(4) s-1. Spectral effects were reversed by reduction of the single peptide disulfide bond--a structural feature previously shown to be a determinant of PAK conformation (Campbell AP, McInnes C, Hodges RS, Sykes BD. 1995. Biochemistry 34:16255-16268). This is the first demonstration of PAK interaction with its epithelial cell receptor in liposomes.

Panhandle PCR strategy to amplify MLL genomic breakpoints in treatment-related leukemias

Panhandle PCR amplifies genomic DNA with known 5' and unknown 3' sequences from a template with an intrastrand loop schematically shaped like a pan with a handle. We used panhandle PCR to clone MLL genomic breakpoints in two pediatric treatment-related leukemias. The karyotype in a case of treatment-related acute lymphoblastic leukemia showed the t(4;11)(q21;q23). Panhandle PCR amplified the translocation breakpoint at position 2158 in intron 6 in the 5' MLL breakpoint cluster region (bcr). The karyotype in a case of treatment-related acute myeloid leukemia was normal, but Southern blot analysis showed a single MLL gene rearrangement. Panhandle PCR amplified the breakpoint at position 1493 in MLL intron 6. Screening of somatic cell hybrid and radiation hybrid DNAs by PCR and reverse transcriptase-PCR analysis of the leukemic cells indicated that panhandle PCR identified a fusion of MLL intron 6 with a previously uncharacterized sequence in MLL intron 1, consistent with a partial duplication. In both cases, the breakpoints in the MLL bcr were in Alu repeats, and there were Alu repeats in proximity to the breakpoints in the partner DNAs, suggesting that Alu sequences were relevant to these rearrangements. This study shows that panhandle PCR is an effective method for cloning MLL genomic breakpoints in treatment-related leukemias. Analysis of additional pediatric cases will determine whether breakpoint distribution deviates from the predilection for 3' distribution in the bcr that has been found in adult cases.

Oligomerization of the EGF receptor transmembrane domain: a 2H NMR study in lipid bilayers

During the course of a previous study by wideline 2H NMR, we noted spectral features suggesting the possibility of monitoring homodimer/oligomer interactions between transmembrane domains of the EGF receptor in lipid bilayers [Rigby, A. R., Shaw, G. S., Barber, K. R., & Grant, C. W. M. (1996) Biochemistry 35, 12591-12601]. In the present work this possibility was explored using the 34-residue peptide EGFRtm. The peptide sequence included the 23 amino acid hydrophobic stretch thought to span the membrane (Ile622-Met644 of the EGF receptor), plus the first 10 amino acids of the receptor's cytoplasmic domain (Arg645-Thr654). Selective deuteration was carried out at sites corresponding to Ala623, Met644, and Val650. Samples were studied from 12 to 65 degrees C by 2H NMR in fluid membranes having low peptide concentration (1 mol %) or high peptide concentration (6 mol %). Methyl groups proved to be technically particularly attractive probe locations. Reversible homodimer/oligomer interactions were detected in membranes of the common natural phospholipid 1-palmitoyl-2-oleoylphosphatidylcholine (POPC), without cholesterol. Effects on the EGF receptor transmembrane domain included alterations in peptide backbone motional order and/or conformation at the site of Ala623 within the membrane, and alterations in motional properties of the Val650 side chain in the cytoplasmic domain. There was little spectral evidence of stable oligomer formation except at the lowest temperature studied. Addition of 33% cholesterol to these membranes was accompanied by spectral changes consistent with the formation of more stable peptide oligomers, and by evidence that peptide-peptide interactions were sensed at all three probe locations. Peptide-peptide interactions remained easily reversible, particularly at higher temperatures. Freeze-fracture electron microscopy of the NMR samples demonstrated peptide-related intramembranous particles traversing the membranes. To our knowledge, this is the first electron microscopy description of receptor tyrosine kinases or their fragments in model membranes. In the presence of cholesterol, the peptide-related particles were generally larger, more sharply demarcated, and showed a tendency to cluster. These observations relate to models of receptor lateral association as an aspect of signal transduction, and to forces that may determine protein sorting and organization in cell membranes. We suggest that the cholesterol effects reflect a general phenomenon rather than one specific to the EGF receptor.

Globoside as a membrane receptor: a consideration of oligosaccharide communication with the hydrophobic domain

Recognition of macromolecules by glycosphingolipids is closely correlated with the nature of the glycolipid carbohydrate; however, it is also thought to be secondarily modulated by the structure of the single fatty acid. In the present work, we sought insight into what physical effect a change in this fatty acid has on the extramembranous portion of globosides at liposomal surfaces mimicking systems for which modulated receptor function has been recorded in the past. Protons of the exocyclic hydroxymethyl group on the terminal Gal residue of globotriaosylceramide (Gb3) were replaced with deuterium. In this location, the nonperturbing probe nuclei sampled cumulative conformational and orientational characteristics of the oligosaccharide chain at a sugar residue that is critical in specific binding of verotoxins. Deuterated Gb3 having 18:1 fatty acid was compared to the same species having 22:1 fatty acid, at 6.3 mol % in unsonicated bilayers of dipalmitoylphosphatidylcholine/cholesterol. Both produced narrow, apparently axially asymmetric 2H NMR spectra over a wide temperature range. Motional properties of the terminal sugar were measurably influenced by the fluidity of the host matrix; however, evidence was not found for conformational or orientational variation in this sugar brought about by the fatty acid alteration. In related experiments, acetate protons on the terminal N-acetyl galactosamine (GalNAc) residue of globotetraosylceramide (Gb4) were substituted with deuterium, and the natural fatty acid was replaced with 18:0 or 24:0 species deuterated at C2. Once again, species with short vs long fatty acid were examined for evidence of headgroup differences. Spectra of Gb4 were compared at 10 mol % in unsonicated fluid bilayers of 1-palmitoyl-2-oleoylphosphatidylcholine, and at 5 mol % in membranes containing 33 mol% cholesterol. Spectral splittings reflecting cumulative effects on conformation and order at the terminal deuterated sugar remained unchanged between species having 18:0 vs 24:0 fatty acid in POPC/cholesterol. In a pure POPC host matrix, there was clear evidence of a motional difference between the two--the longer chain Gb4 demonstrating spectral asymmetry--but the spectral width was unchanged. Transverse relaxation times, T2, were measured. Our findings appear to help correlate the conclusions of a number of workers dealing with the molecular basis of crypticity. We suggest that changes in glycolipid receptor function based on ceramide fatty acid variation have a major origin in the fatty acid's ability to determine the thermodynamics of interaction with the host matrix, as reflected in such parameters as glycolipid motional properties, local membrane curvature, and likely glycolipid time-dependent lateral associations. The result at low concentrations of glycolipid may often be only a subtly altered collective surface epitope, best detected by a specific recognition event.

Amplification of 4-9-kb human genomic DNA flanking a known site using a panhandle PCR variant

We present a method for the in vitro amplification of > 6.0 kb of DNA flanking a known site. This is accomplished by ligating an oligonucleotide to create an inverted repeat of a portion of the known sequence, followed by single-primer polymerase chain reaction (PCR) amplifications. This method generates a panhandle template following primer extension on the strand of interest. It does not involve template-directed extension from the ligated oligonucleotide, and it is carried out without DNA extractions. We have used this method to amplify 4.5-9.4 kb of DNA flanking the original primer annealing sites directly from human genomic DNA.

Carpal tunnel syndrome in the mucopolysaccharidoses and mucolipidoses

Children with a mucopolysaccharidosis or mucolipidosis suffer progressive disability of the hands, particularly in relation to dysfunction of the median nerve. This is an increasing problem because bone-marrow transplantation has dramatically improved survival without apparently changing the musculoskeletal manifestations. We have reviewed 48 children with these syndromes who required carpal tunnel decompression, recording symptoms, signs, radiological, electrophysiological and operative findings, histology and upper-limb function. In these children the carpal tunnel syndrome differs from that seen in adults. Symptoms are rare but signs such as decreased sweating, pulp atrophy, thenar wasting and manual clumsiness are much more common. At operation, the flexor retinaculum was thickened and a mass of white tenosynovium engulfed the flexor tendons. Most patients had some definite nerve constriction with a thickened epineurium. Functional improvement was seen after early decompression, with some benefit from simultaneous tendon release. Regular physiotherapy helped to maintain increased hand movement. We describe our assessment protocol, the physiotherapy and operative regime and the standard functional review which helps to maximise function in the hands and upper limbs of these children.

Poly(DL-lactide-co-glycolide)-encapsulated plasmid DNA elicits systemic and mucosal antibody responses to encoded protein after oral administration

We have developed a method for the encapsulation of plasmid DNA in poly(DL-lactide-co-glycolide) microparticles. Encapsulated DNA, expressing the insect protein luciferase under the transcriptional control of the human cytomegalovirus immediate early promoter, was administered to mice by intraperitoneal injection or oral gavage. Intraperitoneal injection of encapsulated DNA elicited good serum IgG and IgM responses, and a modest IgA response. Oral administration stimulated good serum antibody responses in all three classes, and in addition, significant levels of mucosal IgA. PLG encapsulation thus has the ability to protect plasmid DNA against degradation after administration, and to facilitate its uptake into appropriate cells for the subsequent expression and presentation of antigen, in such a way as to elicit both systemic and mucosal antibody responses. These findings may have major implications for the design of novel vaccines and delivery strategies.

An iterative and regenerative method for DNA sequencing

This paper presents, to our knowledge, the first iterative DNA sequencing method that regenerates the product of interest during each iterative cycle, allowing it to overcome the critical obstacles that impede alternative iterative approaches to DNA sequencing: loss of product and the accumulation of background signal due to incomplete reactions. It can sequence numerous double-stranded (ds) DNA segments in parallel without gel resolution of DNA fragments and can sequence DNA that is almost entirely double-stranded, preventing the secondary structures that impede sequencing by hybridization. This method uses ligation of an adaptor containing the recognition domain for a class-IIS restriction endonuclease and digestion with a class-IIS restriction endonuclease that recognizes the adaptor's recognition domain. This generates a set of DNA templates that are each composed of a short overhang positioned at a fixed interval with respect to one end of the original dsDNA fragment. Adaptor ligation also appends a unique sequence during each iterative cycle, so that the polymerase chain reaction can be used to regenerate the desired template-precursor before class-IIS restriction endonuclease digestion. Following class-IIS restriction endonuclease digestion, sequencing of a nucleotide in each overhang occurs by template-directed ligation during adaptor ligation or through a separate template-directed polymerization step with labeled ddNTPs. DNA sequencing occurs in strides determined by the number of nucleotides separating the recognition and cleavage domains for the class-IIS restriction endonuclease encoded in the ligated adaptor, maximizing the span of DNA sequenced for a given number of iterative cycles. This method allows the concurrent sequencing of numerous dsDNA segments in a microplate format, and in the future it can be adapted to biochip format.

Activity of L-phenylalanine ammonia-lyase in organic solvents

L-Phenylalanine ammonia-lyase (EC 4.3.1.5), (PAL) was shown to be active in a monophasic non-aqueous medium for the first time. Ultraviolet absorbance spectra of trans-cinnamic acid were shown to be similar in both water and n-octanol. High catalytic rates were observed only when the enzyme was placed in solvents containing high concentrations of water. PAL forward reaction was observed only when the water concentration in n-octanol exceeded 2.0% (v/v), which corresponds to a value of 0.8 in thermodynamic water activity (aw) terms. In n-octanol containing either 2.0 or 3.5% (v/v) H2O (and 2 mM L-phenylalanine), lyophilized and aw = 0.113 pre-equilibrated PAL powder exhibited catalytic rates 0.02 and 1.75% of the value observed in aqueous solution respectively. A freshly lyophilized (non-equilibrated) PAL preparation incubated in water-saturated n-octanol (measured [H2O] = 3.6% (v/v), L-phenylalanine concentration approximately 6.8 mM) gave catalytic activity values 17% of those observed in aqueous solution. This is the first demonstration of catalytic activity of an amino acid ammonia-lyase in monophasic organic solvent.

Displaced stress fracture of the femoral neck in an active amenorrhoeic adolescent

Female athletes in endurance sports are at risk of osteoporosis which predisposes them to femoral neck stress fractures. These require early diagnosis and treatment to avoid catastrophic consequences.

Oral delivery of poly(lactide-co-glycolide) encapsulated vaccines

The induction of mucosal immune responses by oral delivery of vaccines is highly desirable. However vaccines to be used in this context will require protection from degradation in the gut and the use of specialised vehicles for their delivery and presentation. Using the biodegradable and biocompatible polymer, poly(lactide-co-glycolide), we have encapsulated bacterial and viral proteins, synthetic peptides and plasmid DNA in microparticles, and compared the immune responses resulting from their oral and parenteral administration to mice. The successful induction of specific systemic and mucosal humoral immune responses, as well as cell-mediated immune responses, demonstrates the potential of this polymer formulation as a vehicle for the oral delivery of vaccines.

Epitope mapping and tagging by recombination PCR mutagenesis

We describe a rapid PCR method that directly inserts an epitope tag into an open reading frame (ORF) to facilitate protein detection. This project was performed within a varicella-zoster virus (VZV) system. In earlier work, we produced a monoclonal antibody (MAb 3B3) to one VZV ORF called gE. MAb 3B3 bound to its epitope under extreme denaturing conditions. To further characterize the epitope, we devised a technique that identified the epitope by its insertion into another protein of interest. The 3B3 epitope was mapped to 11 residues (residues 151-161; QRQYGDVFKGD) in the gE ectodomain by using the technique of recombination PCR. At the same time, the 3B3 epitope was inserted in-frame into another VZV protein for which no MAb was available. The end result, VZV gL3B3.11, was a unique construct possessing a 33-bp insertion that expresses gL-3B3 protein recognized by the MAb 3B3. The 3B3 epitope was verified to be both highly functional and stable. An important advantage of this recombination PCR method of epitope mapping and tagging is that the epitope sequence can be inserted anywhere along the nucleotide sequence of an ORF, regardless of existing restriction sites.

Mucosal immunization with a measles virus CTL epitope encapsulated in biodegradable PLG microparticles

The immunogenicity of a cytotoxic T cell epitope (CTL) representing residues 52-60 from measles virus (MV) nucleoprotein, encapsulated in poly(lactide-co-glycolide) (PLG) microparticles was evaluated after mucosal immunization. After intranasal administration of the encapsulated CTL epitope linked at the carboxyl terminus of two copies of a T-helper epitope (TT-NP6), peptide-specific and MV-specific CTL responses were detected in splenocytes. However, these responses were lower than the responses observed when the TT-NP6 peptide was administered intranasally in saline or using CTB as an adjuvant. Intranasal coadministration of the encapsulated TT-NP6 peptide with CTB did not result in any significant potentiation of the CTL responses. The effectiveness of biodegradable PLG microparticles for mucosal delivery of CTL epitopes, combined with their excellent tissue compatibility and biodegradability suggests that they represent a valuable delivery system for synthetic immunogens. However, further work is needed to define the requirements for effective absorption by the nasal epithelium.

Recurring digital fibroma of childhood

A case of recurring digital fibroma of childhood is presented. The natural history of this condition over several years is documented. The literature is reviewed, with particular reference to the management of the condition. Surgeons should be aware of the clinical features and the principles of management of this condition, as patients may be referred because of associated finger or toe deformities.

Minor influence of sialic acid on conformation of a membrane-bound oligosaccharide recognition site

Wideline 2H NMR spectroscopy was used to assess the conformational and orientational effects of N-acetylneuraminic acid (NeuAc) (sialic acid) as a component of a particular oligosaccharide chain at a bilayer membrane surface. For this purpose, three glycosphingolipids, sharing a neutral core tetrasaccharide and differing only in the number of sialic acid residues, were compared. The starting compound was GD1A, which has terminal sialic acid attached to the second and fourth sugars of its neutral tetrasaccharide core. GD1A was probe-labeled in a non-perturbing fashion on both of these sialic acid residues and on its single GalNAc residue by replacement of -COCH3 with -COCD3 giving [(d3NeuAc)2,d3-GalNAc]GA1a. This represents the most complex glycolipid to have been studied by 2H NMR spectroscopy at a bilayer membrane surface. The sialic acid residue on the fourth sugar from the membrane was subsequently removed to produce the glycolipid [d3NeuAc,d3GalNAc]GM1, deuterated at the two remaining amino sugars. The neutral glycolipid [d3GalNAc]asialo-GM1 was then generated by removal of the second sialic acid residue, leaving an uncharged species deuterated at one (internal) oligosaccharide chain site (GalNAc). The effect of sialic acid was futher examined by selective deuteration of GM1 and asialo-GM1 at C6 of the terminal Gal residue, giving [d2Gal]GM1 and [d2Gal]asialo-GM1. Spectra of the three glycosphingolipids were compared at 7.7 mol % in unsoncicated fluid bilayers of 1-palmitoyl-2-oleoylphosphatidylcholine containing 23 mol % cholesterol. For liposomes suspend in buffered salt solutions with 2 mM Ca2+, 2H NMR spectra demonstrated the presence of well defined average conformation for each oligosaccharide chain. This preferred average conformation persisted over a wide temperature range, consistent with there being a single major oligosaccharide conformer in each case. Spectral features arising from both deuterated amino sugar (GalNAc) of asialo-GM1 could be identified, little changed, in spectra of GM1 and GD1A. Similarly, deuterons in the terminal Gal residue of asialo-Gm1 produced the same spectrum seen for this residue in GM1. Our findings indicate that certain major conformational and orientational features of this complex oligosaccharide recognition site are preserved, within maximum angular deviation + or -5 degrees or less upon addition or removal of a sialic acid residue.

Biodegradable microparticles as a delivery system for measles virus cytotoxic T cell epitopes

Cytotoxic T-cell (CTL) responses are likely to be important for the clearance of a measles virus (MV) infection. To induce CTL responses. replicating vectors have generally been used but the use of such vectors in humans mav be problematic, and immunization with synthetic peptides may be more appropriate. We have investigated the potential of poly(lactide-co-glycolide)(PLG) microparticles as a delivery system for a CTL epitope representing residues 51-59 from MV nucleoprotein. After a single intraperitoneal injection in saline of the encapsulated epitope, CTL responses to the homologous peptide and MV were detected over a period of 4 months. Responses reached a maximum 30 days after priming and were maintained at high levels for 120 days. These responses were higher than those observed when the CTL epitope was administered in saline or as an emulsion in Incomplete Freund's Adjuvant. The pronounced immunostimulatory effect of microparticles, combined with their excellent tissue compatibility and biodegradability suggests that they represent a valuable delivery system for synthetic peptide immunogens.

Orally administered microencapsulated Bordetella pertussis fimbriae protect mice from B. pertussis respiratory infection

Fimbriae from Bordetella pertussis have been encapsulated in poly(lactide-co-glycolide) microparticles of a size appropriate for uptake by the immune inductive tissues of the gastrointestinal tract. Mice were immunized by oral gavage with a single dose of 10 micrograms of microencapsulated fimbriae. The resulting immune responses were compared with those resulting from intraperitoneal injection of mice with equivalent amounts of fimbriae absorbed onto alhydrogel. The examination of serum and mucosal secretions, collected over a 6-week period, for specific antifimbrial antibodies clearly demonstrated that only orally immunized animals mounted measurable immune responses in external secretions. Six weeks after immunization, all immunized animals were protected against intranasal challenge with live B. pertussis.

Poly(lactide-co-glycolide) microencapsulation of vaccine antigens

Fimbriae from Bordetella pertussis have been encapsulated in poly(lactide-co-glycolide) (PLG) microspheres of a size appropriate for oral administration. The binding of antibodies which react with conformational or linear fimbrial epitopes, to fimbriae released from microspheres, suggested that the process of was not detrimental to the native integrity of the protein. Mice were immunised by oral gavage with a single dose of microencapsulated fimbriae, or with fimbriae adsorbed onto alhydrogel and administered by intraperitoneal injection. The resulting immune responses in serum were comparable but only oral administration of microencapsulated fimbriae elicited specific immune responses in external secretions. Six weeks after immunisation, both groups of immunised animals were protected against challenge with live B. pertussis.

Multiple members of the connexin gene family participate in preimplantation development of the mouse

The connexin gene family, of which there are at least 12 members in rodents, encodes the protein subunits intercellular membrane channels (gap junction channels). Because of the diverse structural and biophysical properties exhibited by the different connexins, it has been proposed that each may play a unique role in development or homeostasis. We have begun to test this hypothesis in the preimplantation mouse embryo in which de novo gap junction assembly is a developmentally regulated event. As a first step, we have used reverse transcription-polymerase chain reaction (RT-PCR) to determine the connexin mRNA phenotype of mouse blastocysts, and have identified transcripts of connexins 30.3, 31, 31.1, 40, 43, and 45. Quantitative measurements indicated that all six of these connexin genes are transcribed after fertilization. They can be divided into two groups with respect to the timing of mRNA accumulation: Cx31, Cx43, and Cx45 mRNAs accumulate continuously from the two- or four-cell stage, whereas Cx30.3, Cx31.1, and Cx40 mRNAs accumulate beginning in the eight-cell stage. All six mRNAs were found to co-sediment with polyribosomes from their time of first appearance, indicating that all six are translated. The expression of Cx31.1 and Cx40 was examined by confocal immunofluorescence microscopy; whereas both could be detected in compacting embryos, only Cx31.1 could be seen in punctate membrane foci indicative of gap junctions. Taken together with other results (published or submitted), our findings indicate that at least four connexins (Cx31, 31.1, 43 and 45) contribute to gap junctions in preimplantation development. The expression of multiple connexin genes during this early period of embryogenesis (when there are only two distinct cell types) raises questions about the functional significance of connexin diversity in this context.

Microencapsulation of vaccines

Despite obvious successes in controlling most serious childhood infections, there is constant pressure to develop cheaper, safer, and more effective infant vaccination programs. However, any improvements to pediatric vaccines in the foreseeable future are likely to arise through the introduction of better adjuvants and delivery systems. For example, a single injection comprising primary and booster doses of vaccine would improve compliance in a cost-effective way by reducing the number of visits to clinics or medical centers. Equally, administering existing vaccines orally would remove the trauma of injection and the reliance on medical staff to perform the injections. Many vaccines are dependent on a cold chain; improving the stability of vaccines would help to reduce the cost of vaccination, To tackle such issues, researchers are borrowing ideas from other areas of the pharmaceutical industry to try to improve the performance of vaccines and reduce the cost of these important health-care interventions.