Colorectal adenomatous and serrated polyps in rural South Australia: who, why, what and where?

BACKGROUNDS

The adenoma-carcinoma and serrated pathways offer a window of opportunity for the removal of pre-malignant polyps and prevention of colorectal cancer (CRC) through the use of colonoscopy. The aim of this study was to investigate variation in polyp incidence in different age groups, gender and indications for undertaking colonoscopy. We also address histological types of polyps found and where in the bowel they are located.

METHODS

This study is based on the colonoscopy data collected prospectively over a one-year period in multiple South Australian rural centres, 24 general surgeons contributed to this study. All histopathology results were subsequently entered into the dataset.

RESULTS

A total of 3497 colonoscopies were performed, with a total of 2221 adenomatous and serrated polyps removed. Both serrated and adenomatous polyps were more common in the distal colon. Patients of male gender, aged 70 years and over and with an indication of polyp surveillance had higher adenoma and serrated polyp detection rates (ADR and SPDR). Patients aged 40-49 years old who underwent colonoscopy for positive faecal occult blood had an ADR and SPDR of 25.0% and 6.3%, respectively.

CONCLUSIONS

This study has shown variation in ADR and SPDR depending on age, gender and indication for colonoscopy. This variation will help further develop key performance indicators in colonoscopy. The high ADR and SPDR in patients aged 40-49 years old whom underwent colonoscopy for positive faecal occult blood may support lowering the age of commencement of CRC screening in Australia.

Quality of rural colonoscopy outperforms key performance indicators in a multi-centre prospective clinical study

BACKGROUND

High-quality colonoscopy is vital for the detection and removal of adenomatous polyps and early diagnosis of colorectal cancer. The aim of this study was to prospectively assess the quality and safety of colonoscopies performed in the non-metropolitan setting. Key performance indicators measured include completion, polypectomy and adenoma/serrated polyp detection rates, rate of adequate bowel preparation, withdrawal time and complications.

METHODS

Prospective data collection for all colonoscopies performed over a one-year period in seven non-metropolitan South Australian hospitals. Two general surgeons and twelve registrars working in rural South Australian hospitals (Mount Gambier, Millicent, Naracoorte, Port Lincoln, Port Augusta, Whyalla and Berri) contributed to this study.

RESULTS

In total 3497 colonoscopies were analysed. Complete colonoscopy was achieved in 96.1%. The adenoma detection and serrated polyp detection rates were 25.6% and 5.4% respectively. Cancer was detected in 71 patients (2%). Colonic perforation occurred in five patients (0.1%). There was no procedure-related mortality.

CONCLUSIONS

Colonoscopy performed in the non-metropolitan Australian setting outperforms key performance indicators set by national institutions. This is the first Australian prospective multi-centre study investigating the quality and safety of endoscopic procedures.

Transmission of Fusarium oxysporum f. sp. fragariae Through Stolons in Strawberry Plants

Fusarium wilt of strawberry, caused by the soilborne pathogen Fusarium oxysporum f. sp. fragariae, is a growing threat to the strawberry industry worldwide. Symptoms of the disease typically include stunting, wilting, crown discoloration, and eventual plant death. When Fusarium wilt was discovered in California, the disease was not known to occur anywhere else in North America. Long distance movement of the pathogen would most likely occur through transport of infected plants, which seems plausible if strawberry plants can sustain infections without showing symptoms of disease. The results of this study document that F. oxysporum f. sp. fragariae can move through stolons of infected mother plants and colonize first-generation daughter plants. The pathogen can also move through stolons from first to second-generation daughter plants. Daughter plants of both generations were always symptomless. The pathogen was recovered from both roots and petioles of infected daughter plants. Similar results were obtained for two cultivars known to be susceptible to Fusarium wilt, Albion and Monterey. Transmission through stolons from mother to daughter plants also occurred in the resistant cultivar, San Andreas, but less frequently than in Albion and Monterey.

Personality disorder in university students: a multitrait-multimethod matrix study

The present study examined the prevalence of personality disorders (PDs) in a sample of first-year university students. The three self-report measures used to assess personality disorders were the (a) Coolidge Axis II Inventory (CATI); (b) Millon Clinical Multiaxial Inventory-II (MCMI-II); and (c) Minnesota Multiphasic Personality Inventory-Personality Disorder Scale (MMPI-PD). The prevalence of PD was estimated by including the number of participants above the cut-off scores selected for each of the three PD instruments. The results indicate prevalence in the range of 0% to 16% for the males, and approximately 1% to 26% for the females. These findings generally confirm the prevalence range of 5% to 15% reported in other investigations of nonpatient samples. With few exceptions, the three tests are generally consistent in their estimates of PD prevalence of all the 11 personality disorders. The multitrait-multimethod matrix reveals that the disorders are generally positively correlated with each other on all the three tests, suggesting considerable construct overlap. Specifically, passive-aggressive and schizotypal disorders produce the most convergent correlations. On the MMPI-PD, however, schizoid is a relatively more discriminant disorder.

Left ventricular outflow tract obstruction after partial atrioventricular septal defect repair

BACKGROUND

Narrowing of the left ventricular outflow tract has been associated with partial atrioventricular septal defect (PAVSD) in about 3% of patients. Because of the predisposing anatomy, hemodynamically significant obstruction in the subaortic area may appear after repair of ostium primum atrial septal defects.

METHODS

From 1984 to 1998, 40 patients underwent surgical correction of PAVSD by patch closure. The mean age at the initial repair was 5.8 years (range 3 months to 22 years).

RESULTS

Nine patients had 12 subsequent operations for hemodynamically significant subaortic obstruction. The mean age at PAVSD repair was 17 months (3 to 42 months) (p < 0.001 compared with others). Follow-up work-up was obtained due to symptoms in 5 patients and an abnormal echocardiogram in 4 asymptomatic patients. Subaortic stenosis developed at a mean of 5 years (range 4 months to 10 years), and 6 or more years in 4 patients. The mean age at subaortic stenosis repair was 6 years (range 2 to 12 years). Nine patients underwent subaortic fibromuscular resection. Of these, 4 developed recurrent stenosis and 2 have undergone additional operations.

CONCLUSIONS

Left ventricular outflow tract obstruction after PAVSD repair may be more frequent than reported. Because of the progressive nature of the process, echocardiography should be utilized liberally on patients to uncover subclinical stenosis. Long-term follow-up is essential for diagnosis due to delayed appearance and lack of reliable clinical signs.

Antiretroviral therapy of pediatric HIV infection: making hope a reality

Over the past 3 years, the treatment and prognosis of HIV-1 infection have been revolutionized by a better understanding of the pathogenesis of HIV-1 infection, the ability to monitor viral replication and drug resistance in the host, and the availability of potent combination chemotherapy. While most of the studies that have led to this transformation have been done in adults, the results can be applied to the care of children. Data from trials of highly active antiretroviral therapy (HAART) in children are now being presented or published. Although the basic principles of antiretroviral therapy of HIV-1 infection do not differ between adults and children, there are important differences in the natural history of the disease and in issues related to medication administration and adherence to therapy. Progression of disease may be more rapid in children and is often very rapid in infants. Administration of medication to infants and children can be difficult, especially when the medication tastes bad. Finally, whereas an adult patient is free to decline therapy, however foolish such a decision may seem to the health-care professional, the failure to administer effective medication to a child for a condition that threatens serious morbidity or death constitutes medical neglect. In this review we will discuss the basic principles underlying pediatric antiretroviral therapy and address the issue of adherence, the major impediment to treatment success.

Predicting personality disorder traits with the Defense Style Questionnaire in a normal sample

This research examined the efficacy of the 40-item Defense Style Questionnaire (DSQ-40), measuring mature, neurotic and immature defense styles, to predict DSM-III-R personality disorders. The Coolidge Axis II Inventory, the Millon Clinical Multiaxial Inventory-II, and the MMPI personality disorder scales were used to measure 11 personality disorders in a nonclinical sample. The results show that most personality disorders are positively associated with the highly maladaptive immature defense style, and negatively associated with the mature defense style. Multiple regression analyses reveal that the combined variance accounted for by the defense styles range from 12% to 42% on the CATI, 3% to 42% on the MCMI-II, and 2% to 32% on the MMPI-PD. However, specific personality disorders cannot be predicted with the defense styles on any measure.

Efficacy of and adherence to highly active antiretroviral therapy in children infected with human immunodeficiency virus type 1

BACKGROUND

Clinical trials in adults have demonstrated the efficacy of highly active antiretroviral therapy (HAART) to suppress replication of HIV-1 to nondetectable levels, but lower success rates have been observed in practice. We sought to determine the efficacy of HAART in our population of HIV-1-infected children and to identify determinants of efficacy, especially the role of adherence to prescribed antiretrovirals.

METHODS

The viral load and CD4+ T cell responses of 72 children with perinatally acquired HIV-1 treated with HAART including a protease inhibitor for at least 90 days were examined retrospectively in relation to adherence, as measured by pharmacy records for the first 180 days of HAART.

RESULTS

Patients were defined as adherent if > or =75% of protease inhibitors and > or =75% of all antiretroviral prescriptions were filled. Of the 42 patients (58%) who were adherent, nondetectable viral loads were achieved and maintained in 22 (52%). A Kaplan-Meier plot showed a drop-off in patients maintaining a nondetectable viral load after 200 days. Higher initial viral load was the only pretreatment factor that identified adherent patients at risk for treatment failure. Only 3 (10%) nonadherent patients maintained a viral load of <400 copies/ml. The adherent group had a prompt and sustained increase in CD4+ T cell counts.

CONCLUSIONS

HAART can achieve control of viral replication in HIV-1-infected children who adhere to therapy. However, treatment failure is likely unless there is a high level of adherence. Nonadherence to therapy is common and might be the major impediment to successful treatment of children infected with HIV-1.

Molecular basis for the lack of mimicry of Brucella polysaccharide antigens by Ab2gamma antibodies

The crystal structure of the complex of an anti-Id Fab with an Fab specific for a Brucella polysaccharide antigen has previously been reported (Evans et al., 1994, J. Mol. Biol. 241, 691-705). To complement this study, the binding characteristics and immunological properties of this Ab2 and two others raised with a second anti-Brucella antibody were investigated, including quantitative kinetic measurements by surface plasmon resonance. The affinities of the Fabs from the Ab2s for the Ab1s were three orders of magnitude greater than those estimated for the antigen, but the Ab2s failed to induce antigen-binding Ab3s, that is, they were of the Ab2gamma type. The avidities of the Ab1s for antigen were however within one order of magnitude of their avidities for Ab2. Tests of 16 other anti-Brucella polysaccharide antibodies showed that the two idiotopes were not present in them, and in confirmation of the lack of a dominant idiotope, N-terminal sequencing of their H and L chains showed a wide variety of V genes were employed in the immune response to the Brucella polysaccharides. The failure of the Ab2 to induce antigen-reactive Ab3 thus appears to be due to neither intrinsic affinity nor idiotope frequency, but arises instead from structural reasons, for example, the incomplete penetration of the Ab2 into the binding-site cleft of the Ab1. The surface topography of polysaccharide antigens and their binding-sites thus appears to be especially difficult for Ab2s to mimic and will restrict their routine use as surrogates for T-cell independent polysaccharide antigens.

Post-translational processing of two alpha-amylase inhibitors and an arcelin from the common bean, Phaseolus vulgaris

Mass spectrometric methods were used to investigate the proteolytic processing and glycopeptide structures of three seed defensive proteins from Phaseolus vulgaris. The proteins were the alpha-amylase inhibitors alphaAI-1 and alphaAI-2 and arcelin-5, all of which are related to the seed lectins, PHA-E and PHA-L. The mass data showed that the proteolytic cleavage required for activation of the amylase inhibitors is followed by loss of the terminal Asn residue in alphaAI-1, and in all three proteins, seven or more residues were clipped from the C-termini, in the manner of the seed lectins. In most instances, individual glycoforms could be assigned at each Asn site, due to the unique masses of the plant glycopeptides. It was found that alphaAI-1 and alphaAI-2 differed significantly in their glycosylation patterns, despite their high sequence homology. These data complement the previous X-ray studies of the alpha1-amylase inhibitor and arcelin, where many of the C-terminal residues and glycopeptide residues could not be observed.

The wandering pacemaker: intraperitoneal migration of an epicardially placed pacemaker and femoral nerve stimulation

A premature child with congenital complete heart block had an epicardial single-chamber pacemaker implanted at 2 days of age. At 21 months of age, while sitting or standing, the patient's right anterior thigh muscles contracted at her pulse rate. Surgical exploration revealed a free-floating pacemaker in her peritoneum. A new dual-chamber pacemaker was implanted into the abdominal wall with resolution of the child's symptoms.

The threshold for air leak: stapled versus sutured human bronchi, and experimental study

BACKGROUND

Little is known about the integrity of staple-closure of the bronchus and its tolerance to normal mechanical stresses (cough, sneezing, etc.) in the immediate early post-operative period. There are few studies which tested the mechanical strength of stapled bronchial closure compared with manually closed bronchi using the threshold for fluid leak across the bronchial suture line which differs from air.

MATERIAL AND METHODS

Intact cadaveric tracheobronchial tree (n = 40) were selected, age range from 55 to 70, of which 60% were males. They were divided into two groups: group A, 20 left bronchi were closed with RLV 30 Ethicon 4.8 mm bronchial stapler; group B, 20 were closed with 4 0 Prolene simple interrupted sutures. All specimens were intubated with endotracheal tube and submerged under water before testing the immediate air leak with the standard 40 mm Hg inflation pressure. Inflation pressure was increased until air leak was detected. The stapled closures were resected and subjected to radiological examination.

RESULTS

No air leak was detected in any bronchus at 40 mmHg regardless of the closure technique. The median leakage pressure was significantly higher in the hand sutured bronchi compared to the stapled group (200 vs. 105 mmHg, respectively) and 50% (n = 10) leaked from multiple sites in the stapled group compared with leakage from one site only in group B, this difference was statistically significant P < 0.001. The radiological appearance of the staples maintained the B configuration, recommended by the manufacturer as a sign of sound application.

CONCLUSION

Hand sutured bronchi tolerated higher inflation pressure compared with the stapled ones before leaking air. Air leak at high pressure occurs in the presence of intact staples.

Double patch closure of ventricular septal defect with increased pulmonary vascular resistance

BACKGROUND

Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance is associated with significant morbidity and mortality. Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary vascular resistance.

METHODS

Eighteen children (mean age, 5.7 years) with a large VSD and elevated pulmonary vascular resistance (mean, 11.4 Wood units) underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and cardioplegic arrest. The routine VSD patch was fenestrated (4 to 6 mm) and on the left ventricular side of the patch, a second, smaller patch was attached to the fenestration along its superior margin before closure of the VSD.

RESULTS

All children survived operation and were weaned from inotropic and ventilator support within 48 hours postoperatively. Postoperative pulmonary artery pressures were significantly lower than preoperative values. One child died 9 months postoperatively.

CONCLUSIONS

Closure of a large VSD in children with elevated pulmonary vascular resistance can be performed with low morbidity and mortality when a flap valve double VSD patch is used.

Comorbidity of DSM-IV personality disorders in a nonclinical sample

The issue of comorbidity within the Axis II personality disorders was explored using a large sample of university students who were administered the Coolidge Axis II Inventory (CATI). Comorbidity patterns with this normal sample were compared with recent clinical data reported by several other researchers. The results confirm the high degree of comorbidity within Axis II and the similarity in the comorbidity patterns with clinical and nonclinical samples. With the CATI, a 30.4% comorbidity rate was obtained for Histrionic and Narcissistic Personality disorders (Pd). The paranoid, passive-aggressive and borderline personality disorder traits were comorbid with several other Pds. For Cluster A, there was low comorbidity except for Paranoid Pd and Schizotypal Pd. With Cluster B, the co-occurrence was moderate to strong. A moderate amount of interrelationship was obtained for the Cluster C Pds. The DSM-IV clusters were also strongly interrelated. An additional finding was the similarity between self-report and structured interview methodology in obtained personality disorder comorbidity.

The synthesis of sialylated oligosaccharides using a CMP-Neu5Ac synthetase/sialyltransferase fusion

Large-scale enzymatic synthesis of oligosaccharides, which contain terminal N-acetyl-neuraminic acid residues requires large amounts of the sialyltransferase and the corresponding sugar-nucleotide synthetase, which is required for the synthesis of the sugar-nucleotide donor, CMP-Neu5Ac. Using genes cloned from Neisseria meningitidis, we constructed a fusion protein that has both CMP-Neu5Ac synthetase and alpha-2,3-sialyltransferase activities. The fusion protein was produced in high yields (over 1200 U/L, measured using an alpha-2,3-sialyltransferase assay) in Escherichia coli and functionally pure enzyme could be obtained using a simple protocol. In small-scale enzymatic syntheses, the fusion protein could sialylate various oligosaccharide acceptors (branched and linear) with N-acetyl-neuraminic acid as well as N-glycolyl- and N-propionyl-neuraminic acid in high conversion yield. The fusion protein was also used to produce alpha-2,3-sialyllactose at the 100 g scale using a sugar nucleotide cycle reaction, starting from lactose, sialic acid, phosphoenolpyruvate, and catalytic amounts of ATP and CMP.

Role of paired basic residues in the expression of active recombinant galactosyltransferases from the bacterial pathogen Neisseria meningitidis

The lgtB gene encoding a beta-1,4-galactosyltransferase gene and the lgtC gene encoding an alpha-1,4-galactosyltransferase from the bacterial pathogen Neisseria meningitidis were cloned into an expression vector and overexpressed in Escherichia coli. Both genes expressed very well, but problems with C-terminal proteolysis were encountered with both proteins. The lgtC protein was initially isolated from extracts of recombinant E.coli as a truncated species that retained enzymatic activity, and was subsequently shown by mass spectrometry to be 19 residues shorter than the expected protein. A specific set of engineered C-terminal deletions was constructed to investigate their effect on the expression of lgtC. As many as 28 residues could be deleted with little effect on activity, and with the concomitant improvement of the overall expression up to fivefold over the full length protein. The lgtB protein was also proteolysed in extracts of normal E.coli strains into enzymatically inactive fragments lacking 28 or 41 C-terminal residues. This degradation could be prevented by expression in an ompT protease deficient strain of E.coli. The full length lgtB protein was not stable in soluble protein extracts from all recombinant strains, however a stable enzyme preparation could be achieved with the membrane fraction from cells of the ompT deficient strain expressing lgtB. Specific deletions of lgtB were also constructed, and 15 residues could be removed without loss of enzyme activity and also with the concomitant improvement of the overall expression up to twofold over the full length protein. Longer deletions produced protein but activity could not be detected in these recombinant strains. Examination of the glycosyltransferase sequences from a wide range of bacteria showed their C-terminal segments of approximately 50 amino acids frequently contained paired basic residues. Engineering of these segments may therefore be required as a general practice to produce these enzymes for use in the large scale chemi-enzymatic synthesis of carbohydrate-based therapeutics.

Impact of ultrafiltration on blood use for atrial septal defect closure in infants and children

BACKGROUND

Infants and children undergoing open cardiac operations have a high incidence of blood product transfusion. Ultrafiltration has been shown to reverse hemodilution and improve myocardial function and hemodynamics after cardiopulmonary bypass (CPB).

METHODS

The effect of ultrafiltration on the amount of blood transfusion and hospital charge in 39 consecutive patients who underwent elective atrial septal defect repair was examined. Patients in group I (n=26) had a conventional cardiopulmonary circuit prime with blood, whereas 13 patients had bloodless prime (group II). Ultrafiltration was used immediately after weaning from CPB in group II. The patients in group I received blood products after discontinuation of CPB to achieve a hematocrit of 30%. The amount of blood product used, hematocrit immediately after CPB and on arrival in intensive care unit, postoperative hemodynamics and saturations, total operating room charge, blood charge, hospital stay, and hospital charge were compared.

RESULTS

Mean body weight (15.8 kg in group I versus 17.5 kg in group II) and preoperative hematocrit values (35.6% in group I versus 34.2% in group II) were similar. Mean hematocrit immediately after CPB was 22% and 14% in group I and II, respectively (p < 0.0001). The mean hematocrit upon arrival to the intensive care unit was 34% in group I and 22% in group II (p < 0.0001). The amount of blood product transfusion was 32 mL/kg in group I and 3 mL/kg in group II patients (p < 0.0001). The patients in group II had significantly less blood bank charges; however, operating room charges and total hospital charges were similar between the two groups.

CONCLUSIONS

Elective atrial septal defect repair was performed with no blood product transfusion without increased morbidity or hospital stay. Ultrafiltration can be used to reverse hemodilution resulting from a bloodless CPB prime without an increase in hospital charge.

Celestin blister with obstruction

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Gender, age, and cultural differences in the Defense Style Questionnaire-40

The Defense Style Questionnaire-40 is a 40 item short form of the 88 item Defense Style Questionnaire. A cross-cultural comparison was made between a sample of 635 Canadian university students and an Australian sample of 388 subjects reported by Andrews, Singh, and Bond. Differences between the two samples were noted for several of the defense scales. These may be a reflection of differential socialization patterns in coping with stress for the two countries. Gender and age comparisons were made for the 20 defense scales. Some interesting differences were noted for gender on the suppression, pseudoaltruism, and isolation scales. The internal structure of defense styles was also found to have similarities and differences for males and females with the DSQ-40.

Characterization of a recombinant Neisseria meningitidis alpha-2,3-sialyltransferase and its acceptor specificity

The structure and specificity of the recombinant alpha-2,3-sialyltransferase from Neisseria meninigitidis are reported. This enzyme showed an unusual acceptor specificity in that it could use alpha-terminal and beta-terminal Gal residues as acceptors. In addition (beta1-->4)-linked and (beta1-->3)-linked terminal Gal served as acceptors. These properties distinguish the bacterial enzyme from the more widely investigated mammalian equivalents. The protein was expressed as a membrane-associated protein in Escherichia coli at a level of 750 U/l (approximately 250 mg/l). The protein could be extracted with buffers containing 0.2% Triton X-100 and purified to homogeneity using immobilized-metal-affinity chromatography. Electrospray-ionization mass spectrometry of peptides obtained by cleavage with cyanogen bromide and trypsin confirmed over 95% of the deduced amino acid sequence. When used for enzymatic synthesis in coupled reactions with recombinant CMP-Neu5Ac synthetase, the alpha-2,3-sialyltransferase could sialylate fluorescent derivatives of N-acetyllactosamine with N-acetylneuraminic acid, N-propionylneuraminic acid and N-glycoloylneuraminic acid.

Low molecular weight antigen arrays delete high affinity memory B cells without affecting specific T-cell help

An ongoing, T-cell dependent, secondary antibody response to an epitope can be suppressed in vivo by low molecular weight, soluble polymers, bearing multiple copies of the same epitope. This study illustrates that such suppressive T-cell independent antigen arrays target the epitope-specific, high affinity, memory B cells for long-term functional elimination. Splenocytes from hyperimmune unsuppressed donors, when adoptively transferred into irradiated recipients will readily reconstitute a secondary anti-hapten response after antigenic challenge. No such response was observed with splenocytes transferred from hyperimmune donors suppressed with antigen arrays. The extent of suppression depended on antigen array dose and duration of exposure in the donor animals. The suppressive antigen array carryover from the donors into the recipients was negligible and insufficient to account for the observed suppression. B cells from hyperimmune mice producing high affinity anti-fluorescein antibodies, generated by multiple fluoresceinated ovalbumin (FL-OVA) injections, were helped efficiently by T cells from hyperimmune donors, which were either unsuppressed or suppressed with antigen arrays. Accordingly, help from T cells, specific for the carrier protein remains intact after such suppression. Neither lipopolysaccharide (LPS), nor additional transferred carrier-primed T cells could reverse the unresponsiveness of adoptively transferred splenocytes from suppressed animals. Flow cytometry showed that the number of hapten-specific B cells was markedly reduced after suppression. Collectively, these data show that the long term elimination of an ongoing T-cell dependent antibody response by suppressive exogenous antigen arrays is due to the functional deletion of high affinity, antigen-specific B cells, even in the presence of adequate T-cell help. The long-term nature of such functional deletion strongly suggests physical deletion of the antigen-specific B cell population.

Cloning of the lipooligosaccharide alpha-2,3-sialyltransferase from the bacterial pathogens Neisseria meningitidis and Neisseria gonorrhoeae

The genes encoding the alpha-2,3-sialyltransferases involved in lipooligosaccharide biosynthesis from Neisseria meningitidis and Neisseria gonorrhoeae have been cloned and expressed in Escherichia coli. A high sensitivity enzyme assay using a synthetic fluorescent glycosyltransferase acceptor and capillary electrophoresis was used to screen a genomic library of N. meningitidis MC58 L3 in a "divide and conquer" strategy. The gene, denoted lst, was found on a 2. 0-kilobase fragment of DNA, and its sequence was determined and then used to design probes to amplify and subsequently clone the corresponding lst genes from N. meningitidis 406Y L3, N. meningitidis M982B L7, and N. gonorrhoeae F62. Functional sialyltransferase was produced from the genes derived from both L3 N. meningitidis strains and the N. gonorrhoeae F62. However, the N. meningitidis M982B L7 gene contained a frameshift mutation that renders it inactive. The expression of the lst gene was easily detected using the enzyme assay, and the protein expression could be detected when an immunodetection tag was added to the COOH-terminal end of the protein. Using the synthetic acceptor N-acetyllactosamine-aminophenyl-(6-(5-(fluorescein-carboxamido)-hexan oic acid amide), the alpha-2,3 specificity of the enzyme was confirmed by NMR examination of the reaction product. The enzyme could also use synthetic acceptors with lactose or galactose as the saccharide portion. This study is the first example of the cloning, expression, and examination of alpha-2,3-sialyltransferase activity from a bacterial source.

A normative study of the Coolidge Axis II Inventory

The Coolidge Axis-II Inventory (CATI) is a 200-item self-report inventory that is designed to measure DSM-IV personality disorders (PD's). Norms with a sample of 1,790 Canadian college students are compared with a US sample of 573 college students and 36 elderly subjects. Comparisons for the 11 DSM-IV personality disorder scales are made with several age groups and with gender. Some interesting similarities and differences were observed. With the Canadian sample, a gender difference was found on the antisocial scale. Age differences were found for on several PD scales in that younger respondents (17-24 years) scored higher than the older ones (25-57 years). This information is likely to be helpful to clinicians in monitoring age related behavioral changes in personality disorder.

Proteus mirabilis ambient-temperature fimbriae: cloning and nucleotide sequence of the aft gene cluster

Uropathogenic Proteus mirabilis produces at least four types of fimbriae. Amino acid sequences from two peptides, derived by tryptic digestion of the structural subunit of one type of these fimbriae, the ambient-temperature fimbriae, were determined: NVVPGQPSSTQ and LIEGENQLNYNA. PCR primers, based on these sequences and that of the N terminus, were used to amplify a 359-bp fragment. A cosmid clone, isolated from a P. mirabilis genomic library by hybridization with the 359-bp PCR product, was used to determine the nucleotide sequence of the atf gene cluster. A 3,903-bp region encodes three polypeptides: AtfA, the structural subunit; AtfB, the chaperone; and AtfC, the outer membrane molecular usher. No fimbria-related genes are evident either 5' or 3' to the three contiguous genes. AtfA demonstrates significant amino acid sequence identity with type 1 major fimbrial subunits of several enteric species. The 359-bp PCR product hybridized strongly with all Proteus isolates (n = 9) and 25% of 355 Escherichia coli isolates but failed to hybridize with any of 26 isolates among nine other uropathogenic species. Ambient-temperature fimbriae of P. mirabilis may represent a novel type of fimbriae of enteric species.

Purification of Mycobacterium bovis BCG Tokyo antigens by chromatofocusing, lectin-affinity chromatography, and hydrophobic interaction chromatography

A combination of chromatofocusing, lectin-affinity chromatography, and hydrophobic interaction chromatography resulted in a simple purification of protein antigens of Mycobacterium bovis BCG Tokyo culture filtrate. Identification was established on the basis of chromatographic separation, sodium dodecyl sulfate-polyacrylamide gel electrophoresis determination of molecular weights, and N-terminal amino acid determination. Chromatofocusing on PBE 94 accomplished the separation of BCG85B from other BCG85 complex antigens and partial separation of MPB64 and MPB70 antigens. Subsequently, MPB64 and MPB70 were completely separated on a high-performance liquid chromatography TSK Phenyl 5PW hydrophobic interaction chromatography column. This column also separated BCG85B from a 17-kDa protein with an N-terminal amino acid sequence of A-V-P-I-T-G-K-L-G-S-E-L-T-M-T-D-( )-V-G-Q, which is similar to the sequence of MPT63. Concanavalin A-Sepharose-affinity chromatography separated MPB64 from a 43- and 47-kDa doublet with an amino acid sequence of D-P-E-P-A-P-P-V-P-P-V-P-A-( )-A-A-S-P, which is similar to the sequence of MPT32 and which appears to be glycosylated.

Post-translational proteolytic processing and the isolectins of lentil and other Viciae seed lectins

Electrospray mass spectrometry was used to identify precisely the proteolytic cleavage points within, and at the C-termini of, the proprotein forms of four Viciae lectins that give rise to their two-chain forms. The lectins examined were the pea and lentil lectins, favin and the Lathyrus odoratus lectin, which represent each of the four genera in this tribe. The molecular mass data showed single beta-chain forms for each lectin, with masses consistent with the available sequence and glycopeptide data, indicating that each came from a single proprotein. In contrast, the pea, lentil and L. odoratus alpha-chains occurred in as many as five forms, due to multiple C-terminal cleavage points. Only favin showed a single alpha-chain form. The alpha-chain mass data were again consistent with the sequence information available, except for the lentil lectin alpha-chain which was re-determined by protein sequencing. The two isolectin forms of this protein were shown to arise from alpha-chain species with and without residue Lys53. The mass spectrum of concanavalin A was also examined and both the single-chain form and the two fragment forms showed no evidence of C-terminal heterogeneity.

Suppression of the antibody response to a polymorphic peptide from the platelet alloantigen integrin beta3 with low molecular weight antigen arrays

The allelic human platelet alloantigens PIA1/PIA2 are determined by a 33 Leu-Pro substitution in the second disulfide loop of the integrin beta3 subunit of the fibrinogen receptor, alphaIIb beta3 (GPIIb-IIIa). Alloantibodies to PIA1 cause neonatal alloimmune thrombocytopenia. We studied the suppression of specific Ab production to a disulfide-looped peptide spanning the polymorphic region of integrin beta3, 24AWCSDEALPLGSPRCD39 (LPL). Mice immunized with LPL coupled to OVA (LPL-OVA) produced Abs specific for LPL. When immunized animals were injected with low m.w. dextran heavily derivitized with LPL (Dex(low)LPL(high)), levels of Ab to LPL fell immediately and remained low 1 mo later. Both high affinity and total Abs were affected. Arrays with lower peptide density or a high m.w. backbone did not induce well sustained suppression. Abs to OVA were unaffected by the arrays. Naive mice given Dex(low)LPL(high) were tolerant to subsequent immunization with LPL-OVA. In transfer experiments, irradiated recipients of spleen cells or purified 8 cells from animals suppressed with Dex(low)LPL(high) did not respond to LPL-OVA. Spleen cells from suppressed animals did not suppress the response to LPL-OVA in recipients of immune B cells. These results demonstrate that peptide arrays, by a mechanism sensitive to molecular configuration, induce tolerance to peptide immunization and suppress an ongoing, high affinity Ab response. Peptide arrays induce the elimination or irreversible anergy of specific memory B cells and do not require a non-B spleen cell population to maintain suppression.

Suppression of the antibody response to a polymorphic peptide from the platelet alloantigen integrin beta3 with low molecular weight antigen arrays

The allelic human platelet alloantigens PIA1/PIA2 are determined by a 33 Leu-Pro substitution in the second disulfide loop of the integrin beta3 subunit of the fibrinogen receptor, alphaIIb beta3 (GPIIb-IIIa). Alloantibodies to PIA1 cause neonatal alloimmune thrombocytopenia. We studied the suppression of specific Ab production to a disulfide-looped peptide spanning the polymorphic region of integrin beta3, 24AWCSDEALPLGSPRCD39 (LPL). Mice immunized with LPL coupled to OVA (LPL-OVA) produced Abs specific for LPL. When immunized animals were injected with low m.w. dextran heavily derivitized with LPL (Dex(low)LPL(high)), levels of Ab to LPL fell immediately and remained low 1 mo later. Both high affinity and total Abs were affected. Arrays with lower peptide density or a high m.w. backbone did not induce well sustained suppression. Abs to OVA were unaffected by the arrays. Naive mice given Dex(low)LPL(high) were tolerant to subsequent immunization with LPL-OVA. In transfer experiments, irradiated recipients of spleen cells or purified 8 cells from animals suppressed with Dex(low)LPL(high) did not respond to LPL-OVA. Spleen cells from suppressed animals did not suppress the response to LPL-OVA in recipients of immune B cells. These results demonstrate that peptide arrays, by a mechanism sensitive to molecular configuration, induce tolerance to peptide immunization and suppress an ongoing, high affinity Ab response. Peptide arrays induce the elimination or irreversible anergy of specific memory B cells and do not require a non-B spleen cell population to maintain suppression.

Mass spectrometric analysis of genetic and post-translational heterogeneity in the lectins Jacalin and Maclura pomifera agglutinin

Jacalin and M. pomifera agglutinin are T-antigen specific lectins with alpha 4 beta 4 structures that show far greater micro-heterogeneity than plant lectins from other families, due to multiple genetic isoforms and post-translational processing. Electrospray mass spectrometry and combined liquid chromatography-electrospray mass spectrometry were used to characterize the various forms. For both lectins, the mass data were consistent with previous protein sequencing of the major alpha-chain species of 133 residues and three beta-chain species of 20 or 21 residues. In addition, for jacalin the mass of one minor alpha-chain species was consistent with a second of the four reported gene sequences. However, the glycopeptide alpha-chain form and one beta-chain form did not match any of the genes, suggesting a fifth gene remains to be found. For M. pomifera agglutinin, three more beta-chain forms were found, but all six could arise from only two genes, with additional post-translational proteolysis and post-translational substitution with an unidentified component of 106 Da creating the set of six forms. Only two alpha-chain forms were found also, with no glycosylation.

Patent ductus arteriosus ligation: are we doing better?

Limitation on health care resource use is stimulating critical evaluation of previous preoperative standards. We retrospectively reviewed the clinical and hospital financial records of all children admitted for patent ductus arteriosus ligation from July 1984 to April 1994 for age, perioperative length of stay, readmissions for postoperative surgical problem, and hospital charges adjusted to 1994 dollars. Patients with an isolated patent ductus arteriosus, greater than 3 months of age, without preoperative or postoperative complications were included in this study and stratified into two groups based on date of operation. Group I had operation before January 1, 1991, and group II had operation on or after January 1, 1991. Comparison of these two groups revealed a significant difference in perioperative length of stay (group I, 3.9 +/- 1.2 days [mean +/- standard deviation]; group II, 2.7 +/- 0.9 days; p < 0.0001) and in hospital charges (group I, $8,700 +/- $2,100; group II, $6,600 +/- $1,000; p < 0.0001). These data support the premise that children older than 3 months undergoing elective ligation of a patent ductus arteriosus have been treated with improved efficiency and less charge without an increase in postdischarge morbidity. Health care policy decisions have forced us to evaluate the standards of perioperative care more critically.

Pulmonary/systemic flow ratio in children after cavopulmonary anastomosis

OBJECTIVES

This study attempted to provide a formula for calculation of the pulmonary/systemic flow ratio in children after bidirectional cavopulmonary anastomosis.

BACKGROUND

With the bidirectional cavopulmonary anastomosis, only the superior vena cava blood is oxygenated by the lungs. The inferior vena cava flow recirculates into the systemic circulation. The ratio of these flows will determine systemic arterial saturation.

METHODS

According to the Fick principle, 1) Systemic cardiac output (liters/min) = Pulmonary venous flow + Inferior vena cava flow; 2) Systemic blood oxygen transport (ml/min) = Pulmonary venous blood oxygen transport + Inferior vena cava blood oxygen transport. By substituting the first equation into the second, Pulmonary/systemic flow ratio = (Systemic saturation - Inferior vena cava saturation)/(Pulmonary venous saturation - Inferior vena cava saturation).

RESULTS

We applied the third formula to data obtained from 34 catheterizations in 29 patients after bidirectional cavopulmonary anastomosis. Mean [+/- SD] age at operation was 1.70 +/- 1.43 years, and mean age at catheterization was 2.95 +/- 1.65 years. The pulmonary/systemic flow ratio calculated for all 29 patients was 0.58 +/- 0.09. Of 17 patients with aortography, 10 had systemic to pulmonary collateral vessels. Patients with collateral vessels had a significantly higher pulmonary/systemic flow ratio (0.61 +/- 0.07 vs. 0.53 +/- 0.07, respectively, p < 0.02) and systemic saturation (88 +/- 4% vs. 82 +/- 4%, respectively, p < 0.002) than those without collateral vessels. The pulmonary/systemic flow ratio in those patients with no collateral vessels was similar to the previously reported echocardiographically derived superior vena cava/systemic flow ratio in normal children.

CONCLUSIONS

The pulmonary/systemic flow ratio after bidirectional cavopulmonary anastomosis can be calculated. Pulmonary blood flow in these patients determines systemic saturation and accounts for the majority of venous return in young children.

C-terminal post-translational proteolysis of plant lectins and their recombinant forms expressed in Escherichia coli. Characterization of "ragged ends" by mass spectrometry

Electrospray mass spectrometry was used to accurately measure the molecular masses of single chain lectins from legume seeds and also of three recombinant lectins, expressed in Escherichia coli. The five single chain lectins, Erythrina corallodendron lectin, soybean and peanut agglutinins, Dolichos biflorus lectin, and Phaseolus vulgaris hemagglutinin E, all showed evidence of C-terminal proteolytic processing, in some cases to "ragged" ends, when their masses were compared to those expected from their cDNA sequences and their known carbohydrate chains. Recombinant forms of the lectins from E. corallodendron, soybean, and peanut also showed C-terminal trimming, but not to the same points as the natural forms. Discrepancies between the protein and cDNA sequences of the E. corallodendron lectin were resolved by combined liquid chromatography-mass spectrometry peptide mapping and protein sequencing experiments, and the presence of a second glycosylation site was demonstrated. Our data show that all of these lectins undergo C-terminal proteolytic processing of a readily attacked peptide segment. This trimming is frequently imprecise, and the resulting heterogeneity may be a major contributor to the appearance of isolectin forms of these proteins.

The fate of homograft conduits in children with congenital heart disease: an angiographic study

The use of homograft conduits in the repair of congenital heart disease is widely accepted. We reviewed the catheterization and angiographic data from 20 patients with homograft conduits. All conduits were to the pulmonary arteries. The age at operation was 4.7 +/- 5.6 years (mean +/- standard deviation) and at follow-up catheterization, 7.8 +/- 6.7 years. At implantation, conduit cross-sectional area and Z value were 219 +/- 96 mm2 and 3.5 +/- 1.8, respectively. At subsequent catheterization, the conduit diameters were measured in two projections at the shaft, annulus, valve opening, and insertion into the pulmonary artery. The transconduit gradient was 47 +/- 26 mm Hg. The cross-sectional areas were 149 +/- 56 mm2 at the shaft, 151 +/- 92 mm2 at the annulus, 108 +/- 116 mm2 at the valve opening, and 127 +/- 84 mm2 at the pulmonary artery insertion. The Z values were -0.9 +/- 2.5, -0.9 +/- 2.8, -3.8 +/- 4.0, and -2.0 +/- 3.4, respectively. The cross-sectional areas and the Z values at the levels of measurement were significantly smaller than the corresponding values at implantation. The change in cross-sectional areas and Z values exceeded what would be expected from growth alone. These data indicate that there is a decrease, with time, in the functional lumen of homograft conduits, and this may have implications for follow-up strategy after implantation.

Thermostabilization of the Bacillus circulans xylanase by the introduction of disulfide bonds

The thermostability of the 20 396 Da Bacillus circulans xylanase was increased by the introduction of both intra- and intermolecular disulfide bridges by site-directed mutagenesis. Based on the 3-D structure of the enzyme, sites were chosen where favourable geometry for a bridge existed; in one case, to obtain favourable geometry additional mutations around the cysteine sites were designed by computer modelling. The disulfide bonds introduced into the xylanase were mostly buried and, in the absence of protein denaturants, relatively insensitive to reduction by dithiothreitol. The mutant proteins were examined for residual enzymatic activity after various thermal treatments, and were assayed for enzymatic activity at elevated temperatures to assess their productivity. We have examined one of these mutants by X-ray crystallography. All of the disulfide bond designs tested increased the thermostability of the B. circulans xylanase, but not all enhanced the activity of the enzyme at elevated temperatures.

Molecular recognition of a Salmonella trisaccharide epitope by monoclonal antibody Se155-4

The binding site of monoclonal antibody Se155-4, which has been the object of successful crystallographic and antibody-engineering studies, is shown by solid-phase immunoassays to be complementary to a branched trisaccharide, alpha-D-Galp(1-->2) [alpha-D-Abep(1-->3)]-alpha-D-Manp(1, rather than to the tetrasaccharide repeating unit alpha-D-Galp(1-->2) [alpha-D-Abep(1-->3)]-alpha-D-Manp(1-->4) alpha-L-Rhap(1- of the bacterial antigen. Specificity for the 3,6-dideoxy-D-xylo-hexose (3,6-dideoxy-D-galactose) epitope present in Salmonella paratyphi B O-antigens was ensured by screening hybridoma experiments with glycoconjugates derived from synthetic oligosaccharides. Detailed epitope mapping of the molecular recognition by modified and monodeoxy oligosaccharide derivatives showed that complementary surfaces and three antibody-saccharide hydrogen bonds are essential for full binding activity. Both hydroxyl groups of the 3,6-dideoxy-D-galactose residue were obligatory for binding and consistent with the directional nature of their involvement in carbohydrate-protein hydrogen bonds; related tetrasaccharides built from the isomeric 3,6-dideoxyhexoses, 3,6-dideoxy-D-glucose, paratose, and 3,6-dideoxy-D-mannose, tyvelose were not bound by the antibody. Titration microcalorimetry measurements were consistent with the hydrogen-bonding map inferred from the crystal structure and suggest that the displacement of water molecules from the binding site accounts for the favorable entropy that accompanies binding of the native trisaccharide determinant. The protein sequences determined for the antibody VL and VH domains reveal somatic mutation of the VL germ line gene, implying that this antibody-binding site results from a mature antibody response.

Discrete subaortic stenosis after successful treatment of congenital aortic valve stenosis

Two cases of discrete subaortic obstruction which developed in a previously normal left ventricular outflow tract of patients with congenital valvar aortic stenosis are described. These examples emphasize the need for careful scrutiny of the etiology of recurrent postoperative left ventricular outflow tract obstruction.

A comparison of two xylanases from the thermophilic fungi Thielavia terrestris and Thermoascus crustaceus

Two thermophilic xylanases (xylanase II from Thielavia terrestris 255B and the 32-kDa xylanase from Thermoascus crustaceus 235E) were studied to determine if they had different and complementary modes of action when they hydrolysed various types of xylans. Partial amino acid sequencing showed that these two enzymes belonged to different families of beta-1,4-glycanases. Xylanase II achieved faster solubilization of insoluble xylan whereas the 32-kDa xylanase was more effective in producing xylose and short xylo-oligomers. An assessment of the combined hydrolytic action of the two xylanases did not reveal any co-operative action. The sugars released when the two thermophilic xylanases were used together were almost identical to those released when the 32-kDa xylanase acted alone. The two xylanases were able to remove about 12% of the xylan remaining in an aspen kraft pulp. This indicated that either one of these thermophilic enzymes may be useful for enhancing the bleaching of kraft pulps.

Amino acid sequence and thermostability of xylanase A from Schizophyllum commune

The amino acid sequence (197 residues) of xylanase A from the fungus, Schizophyllum commune, was determined by automated analysis of peptides from proteolytic and acid cleavage. The sequence is similar to two Trichoderma xylanases (approximately 56% identical amino acids), but also shows at least 40% identities with xylanases from Bacillus subtilis, B. pumilus and B. circulans. The conserved regions of the enzyme contain only two glutamic acid residues which implicates their possible involvement in catalysis. The disulfide bond in xylanase A is not conserved in this family. In spite of this, the B. subtilis xylanase was found to be more thermostable than xylanase A.

Transbronchial intubation of the right pleural space: a rare complication of nasogastric intubation with a polyvinylchloride tube--a case study

Inappropriate intubation of the tracheobronchial tree by a fine-bore nasogastric tube with a metal stylet is a well-known hazard. We report a pulmonary perforation and hydropneumothorax caused by a polyvinylchloride nasogastric tube without a stylet in a child of 13 months. The position of the tube was checked by auscultation before feeding. It would appear that the auscultatory method is inadequate in checking the correct placement of a nasogastric tube in young children. An ordinary nasogastric tube can cause pulmonary perforation.

Laboratory and clinical evaluation of conjugate vaccines composed of Staphylococcus aureus type 5 and type 8 capsular polysaccharides bound to Pseudomonas aeruginosa recombinant exoprotein A

The synthesis, standardization, and immunogenicity in young outbred mice and clinical evaluation in adult volunteers of investigational vaccines designed to induce serum antibodies to the type 5 and type 8 capsular polysaccharides (CPs) of Staphylococcus aureus are described. Conjugates composed of the type 5 CP and a sonicated preparation of a high-molecular-weight type 8 CP bound to a nontoxic recombinant protein derived from Pseudomonas aeruginosa exotoxin A (rEPA) were synthesized. The conjugates were nontoxic and elicited serum CP antibodies after two subcutaneous injections into young outbred mice; a third injection elicited a booster response. The lower-molecular-weight type 8 CP was not immunogenic in the mice, and the high-molecular-weight type 8 CP elicited low levels of antibodies without a booster effect. In the volunteers, neither the conjugates nor the type 8 CP alone caused significant local reactions or fever. The conjugates elicited type-specific antibodies of both the immunoglobulin M (IgM) and IgG classes after the first injection; a second injection 6 weeks later did not stimulate a booster effect. The high-molecular-weight type 8 CP alone, injected once only, elicited levels of IgG and IgM type-specific antibodies similar to those of the conjugate. The vaccine-induced CP antibodies were mostly of the IgG1 and IgG2 subclasses and had opsonophagocytic activity. The conjugates elicited IgG antibodies to the native exotoxin A with neutralizing activity. In summary, the type 5 and type 8 conjugates were safe and elicited biologically active antibodies to both the CP and rEPA components.

Protection of mice against Salmonella typhimurium with an O-specific polysaccharide-protein conjugate vaccine

Serious infections with salmonellae remain a threat in many human populations. Despite extensive study of salmonella infections in animals and clinical experience with killed cellular vaccines, there are no vaccines against serotypes other than Salmonella typhi licensed for human use. Serum antibodies to the O-specific polysaccharide (O-SP) of salmonellae protect mice against invasive infection. In order to render it immunogenic, we have conjugated the O-SP of Salmonella typhimurium to carrier proteins by various schemes. O-SP conjugated to tetanus toxoid (O-SP-TT) elicited antibodies in outbred mice after three subcutaneous injections without adjuvant. The O-SP alone elicited no detectable antibody. The antibody response to O-SP-TT was boosted by successive doses and consisted of immunoglobulin G (IgG) and IgM. Most mice only produced antibodies specific for the abequose (O:4 factor) region of the O-SP. Occasional animals also produced antibodies to the core oligosaccharide. Immunized mice were protected against intraperitoneal challenge with S. typhimurium, demonstrating a 160-fold increase in the 50% lethal dose. Passive immunization with conjugate-induced IgM or IgG also protected against challenge. These results indicate that an O-SP-TT conjugate, when given by a route and formulation acceptable for human use, protects mice against challenge with S. typhimurium.

The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer

BACKGROUND

The treatment and prognosis of non-small cell lung cancer, and assessment of the results of treatment, depend on accurate perioperative staging. The extent to which this is carried out in the United Kingdom is unknown.

METHODS

A postal questionnaire survey was undertaken in 1990 to determine the perioperative staging practices of cardiothoracic surgeons in the United Kingdom.

RESULTS

Replies from 77 surgeons, who between them performed about 4833 pulmonary resections a year for lung cancer, were analysed. Forty four per cent of surgeons, operating on 43% of the patients, do not perform computed tomography of the thorax or mediastinal exploration before surgery. They may therefore embark on a thoracotomy for stage III disease. At thoracotomy 45% of surgeons, operating on 40% of patients, do not sample macroscopically normal lymph nodes. They may therefore understage cases as N0/N1 when there is at least microscopic disease in mediastinal lymph nodes.

CONCLUSIONS

The staging of lung cancer in the United Kingdom in 1990 appears in many instances to be inadequate. There should be a more organised approach to perioperative staging so that prognosis may be assessed and comparisons between groups of patients can be made.

Mycobacterium paratuberculosis antigen D: characterization and evidence that it is a bacterioferritin

By using a combination of agarose and polyacrylamide gel electrophoresis, Mycobacterium paratuberculosis antigen D was resolved from a crude sonicated preparation of the organism and characterized as a component with a molecular mass of approximately 400,000 Da. While this component was composed mainly of protein, with unusually high proportions of glutamic acid and leucine, it was resistant to digestion with a number of proteolytic enzymes. Structural detail revealed by electron microscopy, amino acid sequence data, and the demonstration of a Soret band in its absorption spectrum indicated that antigen D was similar to an Escherichia coli bacterioferritin.

Chromatographic purification and characterization of antigens A and D from Mycobacterium paratuberculosis and their use in enzyme-linked immunosorbent assays for diagnosis of paratuberculosis in sheep

The protein antigens A and D were purified from culture filtrates and sonic extracts of laboratory strains of Mycobacterium paratuberculosis by salt precipitation and chromatography. The characterization of antigen A is shown here, and both antigens were evaluated along with lipoarabinomannan antigen in indirect enzyme-linked immunosorbent assays (ELISA) for the serodiagnosis of ovine paratuberculosis. After anion-exchange (DEAE-5PW) and hydrophobic (phenyl-5PW) chromatography using high-performance liquid chromatography, antigen A showed a prominant band in sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) at 31 kDa with small amounts of low-molecular-mass proteins but with no evidence of antigen D. A single precipitin arc was evident with purified antigen A in crossed immunoelectrophoresis. The determination of the N-terminal amino acid sequence showed a high degree of homology between the 31-kDa component of antigen A and antigens of the BCG85 complex of Mycobacterium bovis BCG, a total of 24 of 26 residues being identical to those of BCG85C. A prominant SDS-PAGE band at 400 kDa and a single crossed-immunoelectrophoresis arc was also evident for antigen D after gel filtration (Sephacryl S-200), anion-exchange (DEAE-Sephacel), and concanavalin A-Sepharose affinity chromatography. By ELISA, purified antigen A detected antibody in the sera of 18 of 22 paratuberculosis-infected sheep (82% sensitivity), whereas the purified antigen D detected antibody in all 22 infected animals (100% sensitivity). Combined ELISA results showed increased specificity with some loss in sensitivity.

Cloning, sequencing and expression of the Schwanniomyces occidentalis NADP-dependent glutamate dehydrogenase gene

The cloned NADP-specific glutamate dehydrogenase (GDH) genes of Aspergillus nidulans (gdhA) and Neurospora crassa (am) have been shown to hybridize under reduced stringency conditions to genomic sequences of the yeast Schwanniomyces occidentalis. Using 5' and 3' gene-specific probes, a unique 5.1 kb BclI restriction fragment that encompasses the entire Schwanniomyces sequence has been identified. A recombinant clone bearing the unique BclI fragment has been isolated from a pool of enriched clones in the yeast/E. coli shuttle vector pWH5 by colony hybridization. The identity of the plasmid clone was confirmed by functional complementation of the Saccharomyces cerevisiae gdh-1 mutation. The nucleotide sequence of the Schw. occidentalis GDH gene, which consists of 1380 nucleotides in a continuous reading frame of 459 amino acids, has been determined. The predicted amino acid sequence shows considerable homology with GDH proteins from other fungi and significant homology with all other available GDH sequences.

Atrioventricular septal defect repair in infants

From September 1984 through August 1989, 33 consecutive infants (mean age, 9 months; 13 male) received a single-stage intracardiac repair of complete atrioventricular septal defect. Preoperative evaluation of valvar morphology and function involved echocardiograms in 21% (7/33) and echocardiograms with cineangiograms in 79% (26/33). All infants operated on were included in the analysis. Patients with other complicating abnormalities were not excluded. All operations used a two-patch technique for closure of the atrioventricular septal defect in association with mitral valve repair. The newly formed septal leaflet of the mitral valve was repaired using unpledgeted interrupted sutures. Preoperative and postoperative echocardiograms were used to evaluate mitral valve regurgitation and left ventricular dysfunction as mild, moderate, or severe. The 30-day mortality was 6% (2/33). Follow-up ranged from 1 month to 60 months. Postoperative mitral valve insufficiency was mild in 84% versus 6% preoperatively, moderate in 3% versus 52% preoperatively, and severe in 13% versus 42% preoperatively. Mitral valve dysfunction necessitating reoperation occurred in 6% (2/31). Mitral valve function postoperatively was improved compared with preoperatively (p less than 0.001). The low 30-day operative mortality and the excellent late postoperative valvar function demonstrate the value of single-stage two-patch repair of atrioventricular septal defect early in life.