Could the miniaturize techonologies improve patients adherence and assure better quality of life?

Background

From 2000 to today, the use of information technology in the medical field is increasingly widespread, reaching a new milestone following the COVID 19 syndemia. It is increasingly evident that wireless monitoring allows patients to be followed more easily, detecting complications early at home and allowing to limit the contagion of healthcare personnel by reducing the interaction with patients in hospital rooms

Methods

A pilot Multicenter Open-label Randomized Controlled Trial (RCT) was performing comparing wearable wireless vital parameters continuous monitoring (WVPCM) system and regular monitoring. Data were collected to provide a clinical-economic impact (costs, program effectiveness and QALY gains) of complex patients (CPs) discharged from Internal Medicine Units. Cost were estimated by mean of the identification, measuring and valorisation of the resources uptake.

Results

143 patients (37 M/38 F, mean age: 78.7 years). Major complications: respiratory failure detection (6,5 vs 3,8); reduction of sudden deaths (9.3% vs 16% experimental); care-related infections (6,5 vs 7,5), glycemic decompensation (4,3 vs 1,9). Hospital readmission within 21 days were 7% vs 11%. Relevant cost driver was time spent by nurses: 58 minutes/day/patient (vs 132) allow to save €54-90/patient. One way and multiway sensitivity analyses confirmed the robustness of our results with nearly 99% of the replications involved

Conclusions

WVPCM, detecting early complication during the post-discharge CPs monitoring, may facilitate a timely response ensuring a more appropriate management of complex patients seen (>25% of total admissions), reduce the time to diagnosis, improve efficiency/efficacy of disease management and reduce unnecessary clinic visits and hospital (re)admissions. The miniaturized technologies can improve patient adherence and assure better quality of life. WVPCM allows patients to be sent home safely and to effectively integrate Hospital and Community services.

Key messages

Wearable wireless vital parameters continuous monitoring (WVPCM) system reduce time and cost of nursing.

Wearable wireless vital parameters continuous monitoring (WVPCM) system can detect early complication improve patient adherence and assure better quality of life.

AB0039 ROLE OF MESENCHYMAL STEM CELLS ISOLATED FROM DENTAL PULP (DPSCS) IN IMMUNOREGULATION PROCESSES MEDIATED BY PROGRAMMED DEATH-LIGAND 1 (PD-L1)

Background:

Stem cells isolated from dental pulp (DPSCs) are characterized by a high rate of proliferation, low immunogenicity and a high ability to differentiate in different lineages (i.e. osteogenic, chondrogenic, adipogenic, myogenic and neural commitment). Their multipotency can be attributed to the peculiar embryological origin from the neural crest. DPSCs represent a promising stem cell resource since they hold a low ethical impact and can be easily isolated through routine dental procedures. These cells own immuno-modulatory properties, exerted through the activation of different mechanisms, including the Fas / FasL pathway, as well as through the release of soluble factors. Currently, other molecular mechanisms are under consideration such as PD-1 / PD-L1 (Programmed Death 1 and its Ligand) which are supposed to be involved in the induction and / or maintenance of immune tolerance.

Objectives:

The aim of this research was to investigate whether the stimulation of PD-L1 in DPSCs can affect the immunomodulatory effects of these stem cells on peripheral blood mononuclear cells (PBMCs). Furthermore, the expression of PD-L1 was also assayed after the induction of osteogenic differentiation of DPSCs in order to evaluate a possible application of DPSCs in autoimmune inflammatory osteo-erosive diseases.

Methods:

Immuno-selection was performed on DPSCs, isolated from waste material, against the stemness markers c-Kit and STRO-1, to obtain a pure stem cell population. Then, STRO-1+/c-Kit+ DPSCs, were co-cultured either directly and indirectly with peripheral blood mononuclear cells (PBMCs) from healthy adult donors, previously activated by anti-CD3 and anti-CD28 antibodies. Co-cultures of PBMCs with amniotic fluid stem cells (AFSCs) and bone marrow mesenchymal stem cells (BM-MSCs) were also set up. The expression of PD-1 in PBMCs as well as of PD-L1 in DPSCs, AFSCs, BM-MSCs and PBMCs, was evaluated by Western Blot (WB) and immunofluorescence (IF) analyses, before and after osteogenic differentiation. Osteogenic differentiation of DPSCs, after 30 days of induction, was verified by IF and WB, of osteopontin, osteocalcin and RUNX2 markers. Interleukin-2 (IL-2) expression levels in PBMCs were analyzed by Real-Time PCR analysis.

Results:

Our data highlight that, after direct and indirect co-culture with activated PBMCs, PD-L1 expression was up-regulated not only in DPSCs, but also in BM-MSCs and AFSCs (Figure 1), thus suggesting that 1) this is a common ability of mesenchymal stem cells and 2) this event can be also mediated by soluble factors release. Moreover, when evaluating the effects of DPSCs co-culture on PBMCs an increased expression of cleaved caspase 3 was observed, together with a decreased expression of IL-2 - a growth factor essential for the proliferation and survival of T cells (Figure 2). These findings showed how DPSCs can modulate the immune system by PD-L1 up-regulation. On the other hand, it is noteworthy that, after reaching osteogenic commitment, DPSCs down-regulated the expression of PD-L1, allowing to hypothesize that PD-L1 expression is strictly related to the maintenance of stemness.

Figure 1.Figure 2.

Conclusion:

Taken together, our findings suggest that the expression of PD-L1 in DPSCs is involved in the modulation of immune response and pave the way for further investigations on the role of PD-1/PD-L1 pathway in controlling inflammation and immune response when applied to the treatment of autoimmune inflammatory diseases.

References:

[1]Keir ME, et al. PD-1 and its ligands in tolerance and immunity. Annu Rev Immunol. 2008

Disclosure of Interests:

None declared

Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series

BACKGROUND

First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease.

PURPOSE

To analyse the surgical outcome of patients with CD who underwent TSS in our Centre.

METHODS

Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016.

RESULTS

We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5%, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82% vs 50%, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8% vs 71% p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87% vs 55%, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7% of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome.

CONCLUSION

Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.

The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk

In western countries, the process of "ageing of the population" is increasingly forcing clinical medicine to find answers for pathologies affecting the elder segments of our community. In this respect, pituitary adenomas often raise difficult questions on surgical indications, since little is known about postoperative morbidity and mortality in elderly patients. The transsphenoidal endonasal approach (TNS), which is considered the gold standard for surgical resection of the majority of functioning and non-functioning pituitary adenomas, is supposed to be a low morbidity and mortality procedure in adult patients. However, only a few contradicting data are available in the literature about elderly patients. In this paper we retrospectively analyze a cohort of 43 consecutive patients aged more than 65 years, operated on for pituitary adenomas at our Institution in the years 1998-2007. These patients were treated by transsphenoidal endonasal approach (TNS) for resection of non-functioning pituitary adenomas (n = 31), GH-secreting adenomas (n = 4) and ACTH-secreting adenomas (n = 8). Clinical records reported a macroadenoma with tumour-related mass symptoms in about 80 % of patients; single or multiple pituitary deficits were present in 44 % of patients. Regarding comorbidities, cardiac disease was the most frequently observed (86 %); assessment of anaesthesiological risk indicated a moderate to severe ASA score in most patients, 11 % showing a 4-5 score. On the basis of current criteria, our retrospective analysis revealed that cure was achieved in 54 % of patients. The outcome was similar to that observed in the general population of patients undergoing transphenoidal surgery in our centre, without differences in the rate of surgical and endocrinological cure, minor and major surgical complications and hospitalization duration. In particular, no significant anaesthesiological complications were observed and no patient developed either permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. In conclusion, in specialized centres the surgical treatment of pituitary adenomas via the transsphenoidal route can be a safe and effective procedure even in elderly patients.

Predictive value of inferior fronto-occipital fasciculus (IFO) DTI-fiber tracking for determining the extent of resection for surgery of frontal and temporal gliomas preoperatively

AIM

This work reports the analysis of the relationship between inferior fronto-occipital fasciculus (IFO), neoplastic lesions and surgical resection, in patients operated for gliomas located in the frontal, temporal and insular lobes of the dominant hemisphere. Aim of the study is evaluating the predictive value of inferior fronto-occipital fasciculus DTI-fiber tracking (FT) for determining the extent of resection preoperatively.

METHODS

We selected 38 cases affected by lesions located in the frontal, temporal and insular lobes of the dominant hemisphere, which were related to the trajectory of the IFO. For each patient preoperative and postoperative MR images and DTI-FT were loaded into the neuronavigation system and merged; volumetric scan analysis was used for establishing tumor location and topography, as well as the volume of the lesion and of the residual tumor. All preoperative fiber tracking datasets were evaluated and the position of the tract (IFO) compared to the tumor was recorded. Postoperative MR scans were then compared with DTI-FT, in order to evaluate the correspondence between the resection boundaries and the trajectory of the fiber tract.

RESULTS

Amongst the cases in which the IFO was inside the lesion, we found only incomplete resections (5 subtotal and 6 partial resections), while considering the cases in which the IFO was located outside the tumor, it was possible to perform a relevant (total/subtotal) resection in 18 of them (78%).

CONCLUSION

FT of the inferior frontal-occipital fasciculus predicts the possibility and the extent of the resection for a frontal, temporal and/or insular lesion of the dominant hemisphere.

Bilateral intracavernous carotid artery aneurysms presenting as abducens nerve palsy: case report

Bilateral intracavernous carotid artery aneurysms are very rare and can be usually observed in patients with multiple intracranial aneurysms. Here we present the case of a 73 year-old woman who experienced worsening diplopia due to progressive bilateral paresis of the lateral rectus muscles. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations showed bilateral roundish parasellar and intracavernous masses, with homogeneous contrast-enhancement and absence of subarachnoid haemorrhage (SAH). Cerebral angiography revealed bilateral aneurysms of the intracavernous carotid artery. Once considered the age of the patient, the anatomical features of the aneurysms and the risks of traditional or endovascular surgery, we decided not to proceed to any treatment other than the orthoptic correction of the diplopia and the careful correction of arterial hypertension. We provide a brief review of the literature on bilateral intracavernous aneurysms and a discussion about their treatment.

Rasmussen's encephalitis: early characteristics allow diagnosis

OBJECTIVE

To identify early manifestations of Rasmussen encephalitis (RE) that can prompt early and reasonably secure diagnosis, allowing medical or surgical therapies at an early stage when they may be more effective in slowing the disease.

METHODS

The authors studied 12 patients with clinical and neuropathologic diagnosis of RE, followed from disease onset, assessing clinical history, imaging, and EEG and focusing on early characteristics. Anti-GluR3 antibody assays were also considered in 11 patients.

RESULTS

By 4 months from first symptoms, all cases had 1) refractory focal seizures with a predominant motor component, 2) slow focal activity on EEG contralateral to the motor manifestations, and 3) focal contralateral white matter hyperintensity with insular cortical atrophy on neuroimaging. Less constant or later findings were epilepsia partialis continua, oligoclonal bands, and serum anti-GluR3 antibodies.

CONCLUSIONS

The association of partial seizures with focal EEG and neuroimaging changes allows a tentative diagnosis of RE 4 to 6 months after first symptoms.

Bacteriophage P2: recombination in the superinfection preprophage state and under replication control by phage P4

Genetic crosses (mixed infection, lytic cycle) with bacteriophage P2 are known to give extremely low recombination frequencies, and these are unaffected by the recA status of the host bacterium. We now show the following: (1) the satellite bacteriophage P4, which interacts with P2 in a number of ways, but is quite different from it in terms of DNA replication and its control, is clearly dependent on the host recA+ function for recombination; (2) a chimeric phage (Lindqvist's P2/P4 Hy19), in which P2 replication early genes have been replaced by those of P4, recombines in a recA+-dependent manner; (3) immunity-sensitive P2 phages, in mixed infections of P2-immune bacteria, and hence blocked in their replication, recombine in a recA+-dependent manner; (4) an analysis of the distribution of exchanges based on a simple model confirms that in mixed infections of sensitive cells (where P2 is actively multiplying) recombinational exchanges tend to be statistically clustered in a segment of the chromosome containing the origin of replication, and also shows that, under conditions in which P2 DNA replication is blocked, the distribution of exchanges correlates well with the physical distances between markers on the P2 DNA.

Localization of a recessive juvenile cataract mutation to proximal chromosome 7 in mice

OBJECTIVE

To localize the chromosomal position of a novel cataract mutation (juvenile recessive cataract; jrc) in mice.

METHODS

A mapping population was developed by crossing cataract males (albino MH) to wild-type females (black C57BL/6J). F1 females were backcrossed to albino MH males with cataracts.

RESULTS

The results were consistent with a model of a single autosomal recessive gene [153 cataract, 169 wild-type; chi2 = 0.8, 1 degree of freedom (d.f.), p > 0.35]. Linkage with the albino (tyrosinase; Tyr) locus was evident (chi2 = 61.5, 1 d.f., p < 0.0001), implicating chromosome 7 as the location of jrc. Recombination percentages (+/- SE) between jrc and D7Mit340 (1.2 cM location), D7Mit227 (16.0 cM) and D7Mit270 (18.0 cM) were 17.1 +/- 2.1, 3.7 +/- 1.1 and 6.2 +/- 1.3%, respectively. Multi-point mapping determined that the most likely order of these loci is D7Mit340 - jrc - D7Mit227 - D7Mit270 - Tyr. Although animals with the mutant phenotype appeared to have little or no sense of sight, their growth was not different (p >0.20) from that of normal mice.

CONCLUSION

The jrc mutation model may be useful in the study of the genetics of cataracts in other animal species, including humans.

Bacteriophage-like particles associated with the gene transfer agent of methanococcus voltae PS

The methanogenic archaeobacterium Methanococcus voltae (strain PS) is known to produce a filterable, DNase-resistant agent (called VTA, for voltae transfer agent), which carries very small fragments (4400 bp) of bacterial DNA and is able to transduce bacterial genes between derivatives of the strain. Examination by electron microscopy of two preparations of VTA that were concentrated and partially purified by different methods showed virus-like particles with isometric heads, about 40 nm in diameter, and with 61 nm long tails. These particles co-sedimented with the minute bacteriophage &phi;X174 in a sucrose density gradient.

Prospective study of first-line vigabatrin monotherapy in childhood partial epilepsies

This was a prospective open comparative pilot study to assess the efficacy and tolerability of first-line vigabatrin monotherapy in childhood partial epilepsies. Two groups of patients were recruited over the same period. The vigabatrin monotherapy group comprised 40 patients (18 male, 22 female; mean age at last visit 7.5 years); the comparative carbamazepine monotherapy group comprised 40 consecutive clinic patients (22 male, 18 female; mean age at last visit 7.8 years). Seizures disappeared in 82% of vigabatrin patients and in all carbamazepine patients with idiopathic partial epilepsy, and in 50% of vigabatrin patients and 55% of carbamazepine patients with symptomatic partial epilepsy. Interictal EEG abnormalities decreased in vigabatrin patients more than in carbamazepine patients (P < 0.05). Tolerability was good in vigabatrin patients, but four out of 37 showed mild irritability by the end of the trial. Persistent sedation was observed in eight of the 40 patients receiving carbamazepine. No patient had drug therapy discontinued because of side-effects. During vigabatrin long-term monotherapy, efficacy and good clinical tolerability were maintained. These results suggest that vigabatrin may be an alternative first-line treatment for childhood partial epilepsies. Further blinded comparative randomized trials are needed.

Transduction-like gene transfer in the methanogen Methanococcus voltae

Strain PS of Methanococcus voltae (a methanogenic, anaerobic archaebacterium) was shown to generate spontaneously 4.4-kbp chromosomal DNA fragments that are fully protected from DNase and that, upon contact with a cell, transform it genetically. This activity, here called VTA (voltae transfer agent), affects all markers tested: three different auxotrophies (histidine, purine, and cobalamin) and resistance to BES (2-bromoethanesulfonate, an inhibitor of methanogenesis). VTA was most effectively prepared by culture filtration. This process disrupted a fraction of the M. voltae cells (which have only an S-layer covering their cytoplasmic membrane). VTA was rapidly inactivated upon storage. VTA particles were present in cultures at concentrations of approximately two per cell. Gene transfer activity varied from a minimum of 2 x 10(-5) (BES resistance) to a maximum of 10(-3) (histidine independence) per donor cell. Very little VTA was found free in culture supernatants. The phenomenon is functionally similar to generalized transduction, but there is no evidence, for the time being, of intrinsically viral (i.e., containing a complete viral genome) particles. Consideration of VTA DNA size makes the existence of such viral particles unlikely. If they exist, they must be relatively few in number;perhaps they differ from VTA particles in size and other properties and thus escaped detection. Digestion of VTA DNA with the AluI restriction enzyme suggests that it is a random sample of the bacterial DNA, except for a 0.9-kbp sequence which is amplified relative to the rest of the bacterial chromosome. A VTA-sized DNA fraction was demonstrated in a few other isolates of M. voltae.

Genetic transformation in the methanogen Methanococcus voltae PS

Mutations causing requirements for histidine, purine, and vitamin B12 were obtained in strain PS of Methanococcus voltae (archaebacteria) upon irradiation with UV or gamma rays. The first two mutations were shown to revert at low frequencies and were used to demonstrate the occurrence of transformation with homologous, wild-type DNA. The transformation rates obtained for these presumably chromosomal markers were in the range of 2 to 100 transformants per microgram of DNA. Mutants resistant to 2-bromoethanesulfonate and to 5-methyl-DL-tryptophan were also isolated.

Immunity repressor of bacteriophage P2. Identification and DNA-binding activity

The product of gene C of the temperate bacteriophage P2, the immunity repressor, can be detected as a unique band eluting from phosphocellulose columns at 0.12 M-potassium phosphate when differentially labelled with a radioactive amino acid: the band is absent when phages that either have lost gene C through deletion or carry a suppressor-sensitive mutation in the gene are used. The repressor in its monomeric form is about 11,000 in molecular weight. At near physiological salt concentrations, the form predominantly recovered is the dimer. In filter-binding assays, the partially purified repressor binds wild-type P2 DNA strongly. It does not bind DNA of P2 vir94, a deletion that removes all the genetic elements involved in the regulation of lysogeny; it also does not bind, or binds inefficiently, DNA of P2 vir3, a mutation in the operator that controls the early replicative functions of P2. At the concentrations employed, the dimer is the active form in binding. The P2 repressor clearly differs in several features from the well-studied immunity repressor of bacteriophage lambda.

DNA fusion product of phage P2 with plasmid pBR322: a new phasmid

The chromosome of the temperate bacteriophage P2 and that of the plasmid pBR322 have been joined in vitro after treatment with restriction endonuclease EcoRI. The fusion product - a phasmid - can behave as a plasmid, as a phage and as a prophage. It can replicate its DNA under the control of either the specific replication mechanism of the parent phage in a polA mutant or that of the parent plasmid in a rep mutant. Several interesting interactions between the two replication modes are indicated. In particular, phage particles may be produced even when the phage mode of DNA replication is blocked, and this throws new light on the involvement of the early gene A in the regulation of late gene expression in phage P2.

[Remote results and critical review of the use of the Sparks-Mandril prosthesis]

Long-term clinical results and pathologic features, both macroscopic and microscopic, of 24 Sparks-Mandril grafts as femoro-popliteal substitutes are reviewed. High rate of complications and low percentage of patency are stressed. Further use of this graft is not recommended.

[Use of the human umbilical vein as a vascular prosthesis. Experimental study]

The possible use of the human umbelical vein as a vascular transplant, following appropriate chemico-physical treatment is discussed. The properties of this new prosthesis have been studied on the basis, first, of physical and dynamic tests and, thereafter, following experimental intervention on 12 dogs in which a segment of the abdominal aorta was replaced. The animals were angiographed at varying times from the operation, up to a maximum of 8 months, and finally sacrificed for thorough histological study using various techniques.

Recombination in bacteriophage P2: recA dependent enhancement by ultraviolet irradiation and by transfection with mixed DNA dimers

Bacteriophage P2 is known for its exceptionally low rate of spontaneous (non-integrative) recombination, which however may be stimulated by ultraviolet irradiation of the phage. We show here that ligated dimers, made in vitro from mixtures of DNAs of two P2 mutants, upon transfection of lysozyme-spheroplasts give origin to recombinants at high frequency. While spontaneous P2 recombination occurs independently of the main recombination pathway of the bacteria, P2 recombinant formation following either ultraviolet irradiation or transfection with DNA dimers requires at least some element of such a pathway, since it is absent or greatly reduced in recA- bacteria or spheroplasts. It would seen that, in the course of its lytic development, P2 deploys a mechanism that inhibits the main recombination pathway of the host cell, or assumes DNA configurations refractory to it.

Further physical characterization of deletion and substitution mutants affecting the control of lysogeny in bacteriophage P2

A deletion of phage P2, del6 (L.E. Bertani, 1980), thought to remove the structural gene int, and a deletion/substitution, vir94, thought to remove genes int, C and cox, were mapped by electron microscopy, using the heteroduplex technique. Four independent deletion/substitution mutations, all affecting the regulatory region of P2, were compared in all possible combinations with the same technique: two showed sequence homology in their substitution DNA. The results confirm the model proposed for the origin of these mutants, analogous to that for the origin of transducing variants in phage lambda, but suggest in first approximation that the exchange between the P2 DNA and the chromosome of the host bacterium may occur at several different bacterial sites. A map of the regulatory region of P2, based on all data available from the study of deletions and insertions, is presented.

Tandem pentuplication of a DNA segment in a derivative of bacteriophage P2: its use in the study of the mechanism of DNA annealing

From a tandem duplication mutant of phage P2, triplication, quadruplication and pentuplication forms were derived. They were recognized by decreased virion heat stability resulting from the increase in DNA content, and were confirmed by electron microscope heteroduplex mapping. These forms of partially repeated DNA are quite stable in P2 because of the low level of recombination typical of this phage. Under conditions normally employed for full DNA renaturation, these high order repeat chromosomes gave often incomplete renaturation over the repeated segments. Based on current models for DNA renaturation, several predictions were made and tested. The results, although not quantitatively exhaustive, indicated that base pairing proceeding from a nucleation site was sufficiently slow to allow a second nucleation to occur with a fair probability over a length of a few thousand base pairs.

Defective particle assembly in wild type P2 bacteriophage and its correction by the lg mutation

The mutation lg of phage P2 has been located on the genetic map of P2 to the right of, and closely linked to, the del2 deletion, probably within tail gene F. The lg mutation causes larger burst sizes, compared with the wild type, especially at high incubation temperatures. The frequency of defective particles is lower in preparations of P2 lg than in those of wild type P2. It seems that the mutation lg improves the efficiency of particle assembly.

Structure and position of a complex chromosomal aberration in bacteriophage P2

The P2 phage mutation vir56, like the previously studied vir22, is the result of an unequal replacement of a chromosome segment with non-homologous DNA. The end positions of the replacements are essentially the same in the two mutants, whereas the lengths of the replacements are quite different. A third chromosomal aberration, del3, has similar structure and position. These results strengthen the suggestion that the left ends of these three aberrations coincide with the point of exchange in integrative recombination.

Deletions in bacteriophage P2. Circularity of the genetic map and its orientation relative to the DNA denaturation map

Several types of viable chromosomal deletions of bacteriophage P2 were isolated. One type gives the immunity insensitive phenotype and may extend to the genes for the immunity repressor (C) and for integrative recombination (int). Two other types delete genes (old and fun) known to be active in the lysogenic state. For such deletion mutants the relationship between particle density and DNA length was established. The deletions were located in respect to previously mapped genes and the results were compared with electron microscopical studies (by Inman and collaborators) of the P2 chromosome. It is concluded that the best representation of the genetic map of P2 is circular. The cohesive ends of the linear P2 DNA molecule are most likely formed between genes old and Q. Except for the neighborhood of gene old, the previously published, linear genetic map of P2 (Lindahl) is colinear with the melting map of the P2 chromosome (Inman). Preliminary evidence for some specific recombination event often accompanying integrative recombination between phage chromosomes is presented.

Removal of unwanted proteins from cell extracts by means of antiserum

The efficiency of removal of soluble proteins in cell-free bacterial extracts by means of antiserum from rabbits immunized with similar extracts was measured. Precipitation followed by Sephadex gel-chromatography was used. Up to 80% (exceptionally 90%) removal could be obtained. The method might be applied to enrichment for "foreign" cell-extract components, for example, viral products in virus infected cells. Tests for the specificity of the method are also presented.

Constitutive expression of bacteriophage P2 early genes resulting from a tandem duplication

A tandem-duplication mutant of bacteriophage P2 was isolated. Physically, its particles are characterized by a higher buoyant density and lower heat stability than the wild type, both consequences of increased DNA content. Genetically, the mutant is easily recognized by its insensitivity to control by the immunity-specific repressor. The duplication covers part of gene B, necessary for phage DNA replication. To explain the immunity-insensitivity of the duplication it is proposed that the promoter, but not the operator site, in the early gene operon is duplicated in this mutant. By crosses with a gene-B mutant, a recombinant carrying a heterozygous duplication was isolated.

[Free aminoacids and cerebral lipids in the rat following porto-cava anastomosis]

Free aminoacids and cerebral lipids were studied in rats following porto-cava anastomosis with total deviation of the portal flow. No difference in lipid pattern with respect to the controls was noted after 1 month. Changes in free aminoacids, however, were observed, including a significant increase in gamma-aminobutyric acid (GABA) and a significant decrease in glutamic acid. The meaning of these results with respect to the pathogenesis of porto-cava encephalopathy is discussed.