Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Intérêt des tests psychométriques en consultation psychiatrique préopératoire chez des patients candidats à la chirurgie bariatrique en Martinique

Introduction

En France, 6,9 millions d’adultes sont obèses et le recours à la chirurgie bariatrique est en augmentation. L’évaluation psychiatrique est obligatoire [1] et il peut exister, nous semble-t-il, un biais de « non divulgation » [3] de symptômes dans le but d’obtenir « l’accord du psychiatre ». L’objectif principal de cette étude est de savoir s’il est utile de proposer des tests psychométriques en consultation psychiatrique préopératoire de chirurgie bariatrique en aide à la détection de comorbidités psychiatriques, et permettre ainsi l’amélioration de la prise en charge.

Methods

Étude monocentrique, anonyme, non interventionnelle visant à améliorer la prise en charge des patients candidats à la chirurgie bariatrique. Réalisée entre mars et octobre 2012. Inclusions des patients en deux temps : un premier temps avec un entretien clinique ouvert, un deuxième temps avec un entretien clinique structuré (MINI 5.0.0.).

Résultats

Vingt-huit patients inclus. La moyenne d’âge est de 37,2 ans, l’IMC moyen est de 43,2 kg/m2. Parmi les patients, 60,7 % présentaient au moins un trouble actuel ou passé au MINI contre 32,1 % en entretien clinique ouvert. Le MINI n’est pas significativement plus sensible que l’entretien clinique structuré pour la détection de l’ensemble des comorbidités psychiatriques (p = 0,2), par contre il est significativement plus sensible pour la détection des troubles anxieux (p = 0,02).

Conclusion

Prévalence d’au moins un trouble actuel ou passé proche des taux de la littérature scientifique [2] pour le MINI. Pour aider à la détection des comorbidités psychiatriques, en diminuant ce biais de « non divulgation », nous proposons un nouvel auto-questionnaire.

Environmental scenarii for the degradation of oxo-polymers

The fate of oxo-polymers in nature is strongly dependent on environmental conditions, mainly on the intensity and duration of sunshine, which vary with the season and the climate. In this work, we report the effect of different scenarii on the production and the molecular composition of oligomers released from oxo-biodegradable HDPE films. Under our experimental conditions, the duration of accelerated weathering corresponded to a period of 3 months to 3 years of exposure to outside conditions under temperate climate. In addition, the oligomers were extracted in three different solvents: i) water to mimics the natural environment; ii) acetone and chloroform to identify oligomers trapped in the polymer matrix. The combination of high-resolution mass spectrometry and ¹H NMR spectroscopy gives an extensive picture of the relative concentrations and the structural compositions of the extracted oligomers in the different tested conditions. In particular, the masses, the number of oxygen and carbon atoms could be determined for up to 2283 molecules. Globally the concentration and the size of oligomers increased with the duration of extraction, the level of aging of the polymer and the use of non-polar solvents. Surprisingly, the presence of highly oxidized molecules in acetone and chloroform extract, suggested an important swelling of HPDE films in these solvents and a better diffusion of these oligomers in the matrix. In nature, the biodegradability of oligomers could result from processes occurring both at the molecular (oxidation) and the macromolecular (diffusion and release) levels.

The anterior insula bidirectionally modulates cost-benefit decision-making on a rodent gambling task

Deficits in cost‐benefit decision‐making, as assessed in the Iowa Gambling Task (IGT), are commonly observed in neuropsychiatric disorders such as addiction. There is considerable variation in the maximization of rewards on such tasks, both in the general population and in rodent models, suggesting individual differences in decision‐making may represent a key endophenotype for vulnerability to neuropsychiatric disorders. Increasing evidence suggests that the insular cortex, which is involved in interoception and emotional processes in humans, may be a key neural locus in the control of decision‐making processes. However, the extent to which the insula contributes to individual differences in cost‐benefit decision‐making remains unknown. Using male Sprague Dawley rats, we first assessed individual differences in the performance over the course of a single session on a rodent analogue of the IGT (rGT). Rats were matched for their ability to maximize reward and received bilateral excitotoxic or sham lesions of the anterior insula cortex (AIC). Animals were subsequently challenged on a second rGT session with altered contingencies. Finally, animals were also assessed for instrumental conditioning and reversal learning. AIC lesions produced bidirectional alterations on rGT performance; rats that had performed optimally prior to surgery subsequently showed impairments, and animals that had performed poorly showed improvements in comparison with sham‐operated controls. These bidirectional effects were not attributable to alterations in behavioural flexibility or in motivation. These data suggest that the recruitment of the AIC during decision‐making may be state‐dependent and help guide response selection towards subjectively favourable options.

Characterization of oxidized oligomers from polyethylene films by mass spectrometry and NMR spectroscopy before and after biodegradation by a Rhodococcus rhodochrous strain

The objective of this work was to develop a new approach to assess the specificity and the efficiency of biodegradation of oxidized oligomers extracted from aged HDPE polyethylene films and to bring insight on the mechanisms occurring during biodegradation. ¹H NMR spectroscopy and LC Orbitrap™ mass spectrometry were combined together with data processing using Kendrick mass defect calculation and Van Krevelen Diagram. We showed that the molecular weight of extracted oligomers was lower than 850 Da with maximum chain length of 55 carbon atoms. The oligomers were divided into 11 classes of molecules with different oxidation state ranging from 0 to 10. All classes included series of chemically related compounds including up to 19 molecules. 95% of the soluble oligomers were assimilated by a strain of Rhodococcus rhodocchrous after 240 days of incubation. Large highly oxidized molecules completely disappeared while the other classes of molecules were still represented. Molecules containing 0-1 oxygen atom were less degraded. A strong shift to smaller molecules (<450 Da, 25 carbon atoms) was observed suggesting that longer molecules disappeared more rapidly than the smaller ones. It opens new perspectives on biodegradation processes as not only intracellular β-oxidation must be considered but also extracellular mechanisms leading to chain cleavages.

Impact of temperature on the dynamics of organic matter and on the soil-to-plant transfer of Cd, Zn and Pb in a contaminated agricultural soil

Predicting the soil-to-plant transfer of metals in the context of global warming has become a major issue for food safety. It requires a better understanding of how the temperature alters the bioavailability of metals in cultivated soils. This study focuses on one agricultural soil contaminated by Cd, Zn and Pb. DGT measurements were performed at 10, 20 and 30 °C to assess how the bioavailability of metals was affected by a rise in soil temperature. A lettuce crop was cultivated in the same conditions to determine if the soil-to-plant transfer of metals increased with a rise in soil temperature. A gradual decline in Cd and Zn bioavailability was observed from 10 to 30 °C, which was attributed to more intense complexation of metals in the pore water at higher temperatures. Together with its aromaticity, the affinity of dissolved organic matter (DOM) for metals was indeed suspected to increase with soil temperature. One main output of the present work is a model which satisfactorily explains the thermal-induced changes in the characteristics of DOM reported in Cornu et al. (Geoderma 162:65-70, 2011) by assuming that the mineralization of initial aliphatic compounds followed a first-order reaction, increased with soil temperature according to the Arrhenius law, and due to a priming effect, led to the appearance of aromatic molecules. The soil-to-plant transfer of Cd and Zn was promoted at higher soil temperatures despite a parallel decrease in Cd and Zn bioavailability. This suggests that plant processes affect the soil-to-plant transfer of Cd and Zn the most when the soil temperature rises.

Évaluation des bienfaits de l’acupuncture dans la prise en charge des sujets dépendants aux substances à l’aide des Échelles Visuelles Analogiques

Objectifs

L’acupuncture est de plus en plus utilisée en addictologie [1,2]. Au CHU de Martinique, les patients présentant des addictions aux substances en bénéficient depuis une quinzaine d’années. Notre étude permet d’évaluer les bienfaits subjectifs de l’acupuncture chez ces patients en utilisant les Échelles Visuelles Analogiques avant et après les séances.

Méthodes

Ces évaluations ont été proposées à l’ensemble des patients venus faire des séances d’acupuncture durant le mois de juillet 2012. Les patients ont côté sur une échelle entre 0 et 10 leurs fatigue, bien-être, stress/anxiété, détente, douleur physique avant et après les séances.

Résultats

Cent six fiches anonymes avant/après ont été analysées. Trente-cinq patients déclarent être abstinents, 53 déclarent être consommateurs réguliers d’une ou plusieurs substances (42 % alcool, 58 % tabac, 20 % crack, 38 % cannabis) et 18 sont données manquantes. L’ensemble des patients ont rapporté une diminution de leurs anxiété/stress (p = 0,0001), sensation de fatigue (p = 0,001) et douleur physique (p = 0,0001). Ils signalent également une amélioration de leur détente (p = 0,001) et de leur bien-être (p = 0,001).

Conclusion

Dans notre population, les séances d’acupuncture semblent améliorer les ressentis des patients dans plusieurs domaines. Il sera intéressant de poursuivre cette étude en étudiant non seulement les biais liés à la relaxation et aux croyances magico-religieuses mais aussi en étudiant différents paramètres objectifs comme la diminution de la consommation et le cardio feedback.

Live-cell migration and adhesion turnover assays

Fluorescence microscopy has revolutionized the way live-cell imaging is achieved. At the same time, it is also potentially harmful to a living specimen. Therefore, the specimen must be monitored for viability and health before, during, and after imaging sessions. Methods for monitoring cell viability and health will be discussed in this chapter. Another key to successful live-cell imaging is to minimize light exposure as much as possible. A summary of strategies for minimizing light exposure including maximizing the light throughput of the microscope and the sensitivity of light detection is presented. Various fluorescence microscopy techniques are presented with a focus on how the light is delivered to the sample (i.e., light density) and pros and cons for use with living specimens. The reader is also directed to other publications that go into these topics in more detail. Methods are described on how to prepare samples for single cell migration assays, how to measure cell migration rates (e.g., bright-field, semi-automated, and automated), and how to measure focal adhesion turnover rates. Details of how to correct images for background intensity and field-illumination uniformity artifacts for quantitative imaging are also described. Overall, this chapter will be helpful to scientists who are interested in imaging live specimens using fluorescence microscopy techniques. It will be of particular interest to anyone wanting to perform quantitative fluorescence imaging, and wanting to measure cell migration rates, and focal adhesion dynamics.

FC01-04 - Exposure to traumatic events and posttraumatic stress disorder symptoms in substance use disorder inpatients

Introduction

Exposure to traumatic events is common among individuals with substance use disorders (SUD). Self-medication hypothesis posits that substances are used to relieve distressing psychological symptoms. Moreover, few studies have assessed exposure to traumatic events and Posttraumatic stress disorder (PTSD) symptoms among samples suffering from addiction.

Objectives

To explore SUD inpatients exposure to serious traumatic events both directly (the participant himself) and/or indirectly (the family).

Aims

(i) to investigate the prevalence of co-morbid PTSD in SUD clinical inpatients;

(ii) to identify the characteristics, severity and types of trauma experienced;

(iii) to compare SUD patients with and without co-morbid PTSD on psychiatric variables.

Methods

This study compared two groups:

(1) those without PTSD,

(2) those with PTSD.

SUD inpatients reported traumatic experiences (Trauma History Questionnaire), PTSD

symptoms (PTSD CheckList-Specific), addiction severity (Addiction Severity Index), and psychiatric symptoms (M.I.N.I.). Khi square or T tests were conducted to compare rates between non-PTSD group (SUD-only; n = 27) and PTSD group (SUD-PTSD; n = 17).

Results

All participants (n = 44) reported having been exposed to one or more traumatic events and 17 (38.6%) met the criteria for probable current PTSD. Significant differences between the “PTSD” and “non-PTSD” groups were found on the crime cluster (p < .04), the composite score of Alcohol (p < .005), and psychiatric variables including depression (p < .001), psychotic syndromes (p < .02) and anxiety disorders (p < .0001).

Conclusions

This study highlights the prevalence of PTSD symptoms among SUD inpatients, and the importance of considering PTSD symptoms to improve quality of care for patients and their families.

Colocalisation of CD9 and mortalin in CD9-induced mitotic catastrophe in human prostate cancer cells

CD9, a member of the tetraspanin family of proteins, is involved in a variety of cellular interactions with many other proteins and molecules. Although CD9 has been implicated in cell fusion, migration and cancer progression, the detailed function of this protein is not completely understood and likely depends on interactions with different protein partners, which are not yet all known. Using co-immunoprecipitation and mass-spectrometric protein sequencing, we have identified in prostate cancer cells, a novel CD9 partner, the 75-kDa protein HSPA9B, also known as mortalin. We further show that introduction and overexpression of wild-type CD9 into human PC-3 prostate cancer cells induces mitotic catastrophe. We also demonstrate, by immunocolocalisation studies, the interaction of CD9 and mortalin in PC-3 cells undergoing mitotic catastrophe. Our results not only identified mortalin as a new CD9 partner, but also clarify the mechanisms by which CD9 may control prostate cancer progression.

Mechanism of copper mediated triple helix formation at neutral pH in Drosophila satellite repeats

The highly repeated Drosophila melanogaster AAGAGAG satellite sequence is present at each chromosome centromere of the fly. We demonstrate here how, under nearly physiological pH conditions, these sequences can form a pyrimidine triple helix containing T.A-T and CCu.G-C base triplets, stabilized by Cu2+ metal ions in amounts mirroring in vivo concentrations. Ultraviolet experiments were used to monitor the triple helix formation at pH 7.2 in presence of Cu2+ ions. Triplex melting is observed at 23 degrees C. Furthermore, a characteristic signature of triple helix formation was obtained by Fourier transform infrared spectroscopy. The stabilization of the C.G-C base triplets at pH 7.2 is shown to occur via interactions of Cu2+ ions on the third strand cytosine N3 atom and on the guanine N7 atom of the polypurine target strand forming CCu.G-C triplets. Under the same neutral pH conditions in absence of Cu2+ ions, the triple helix fails to form. Possible biological implications are discussed.

Characterization of polydimethylsiloxane rubber upon photochemical, thermal, salt-fog ageings and exposure to acid vapours

The changes in the chemical structure and the physical properties of a filled crosslinked polydimethylsiloxane rubber were monitored as a function of various ageing factors. The variables included photochemical, thermal, salt-fog ageings and exposure to acid vapours. Unaged and aged samples were studied by IR spectroscopy, hardness measurements, Differential Scanning Calorimetry (DSC) and thermogravimetric analysis (TGA) coupled with IR spectroscopy. No significant oxidation was detected after all ageings, except for nitric acid treatment. The presence of aluminium trihydrate was clearly identified as responsible for the observed chemical changes. Then an important vulnerability of this filled silicone rubber towards the cross-linking reactions provoked by usual ageings was also detected. The DSC-thermoporosimetry measurements of the mesh size distribution gave a comparison of cross-linking densities for each ageing. The complementary analysis with TGAIR allowed us to differenciate the thermal stability of the formulation after various ageings and to acquire new knowledge about thermal decomposition.

Vascular endothelial growth factor and signaling in the prostate: more than angiogenesis

In cloning tyrosine kinase genes in dog prostate cells, a fragment of the vascular endothelial growth factor (VEGF) receptor 1 or Flt-1 was sequenced. To test for a functional protein, Flt-1 antibodies were used to probe immunoprecipitated tyrosine phosphorylated proteins. Western blotting revealed a major 170-180 kDa band and a few bands below 116 kDa in dog prostate and human prostatic carcinoma PC-3 cells, with higher levels in PC-3. Similar results were obtained with human placental membranes used as a source of Flt-1. That the major Flt-1 tyrosine phosphorylated protein was likely VEGF-R1 and part of VEGF signaling pathways was shown by enhanced level of only this protein when PC-3 cells were exposed to VEGF. Accordingly specific cell surface receptor complexes, displaced by VEGF but not EGF and compatible with Flt-1 in size, were revealed by chemical cross-linking after 125I-VEGF binding. Similarly to the prostatic neuroproduct, gastrin-releasing peptide/bombesin, VEGF directly triggered the tyrosine phosphorylation of focal adhesion kinase and stimulated PC-3 cell motility. The titration of prostate tissue sections with VEGF-A antibodies revealed a confined staining in chromogranin A and/or serotonin positive neuroendocrine (NE) cells, including in primary tumors and lymph node metastases. Given that NE differentiation is associated with advanced disease, that NE cells are a significant source of VEGF in prostatic tumors, and that VEGF directly act on prostate cancer cells in vitro, VEGF-A may be more than angiogenic in prostate cancer and hence favor progression by affecting tumor cells.

Bipolar sensation seeking is associated with a propensity to abuse rather than to temperamental characteristics

OBJECTIVE

As some temperament profiles may be markers of genetic vulnerability traits, we aimed to compare sensation seeking in euthymic bipolar patients and in controls.

METHODS

One hundred ninety-four patients fulfilling DSM-IV diagnostic criteria for bipolar disorders (BP), 81% of whom presented type I BP, and 95 controls were included in this study. Euthymia was assessed using both the MADRS and Bech mania scales. Subjects were evaluated using the French abbreviated form of Zuckerman's Sensation Seeking Scale (SSS), which provide a total score (TS) and four subscores: Thrill and Adventure Seeking (TAS), Experience Seeking (ES), Disinhibition (Dis), and Boredom Susceptibility (BS).

RESULTS

SSS total score differed significantly between men (17.2 +/- 0.5) and women (15.3 +/- 0.6) (P = 0.02) and all the subscores were negatively correlated with age. On adjustment for sex and age, we found that bipolar patients had a high Dis score (P = 0.003). However, if the same analysis was performed with a lifetime history of alcohol abuse or dependence as a covariable, no such difference was found (P = 0.436). The SSS demonstrated a high degree of test-retest reliability (ICC = 0.91).

CONCLUSION

These results suggest that sensation seeking assessed with the SSS is not a temperament characteristic associated with bipolar disorders but is instead linked to a tendency towards alcohol abuse.

Antidepressant-induced mania in bipolar patients: identification of risk factors

BACKGROUND

Concerns about possible risks of switching to mania associated with antidepressants continue to interfere with the establishment of an optimal treatment paradigm for bipolar depression.

METHOD

The response of 44 patients meeting DSM-IV criteria for bipolar disorder to naturalistic treatment was assessed for at least 6 weeks using the Montgomery-Asberg Depression Rating Scale and the Bech-Rafaelson Mania Rating Scale. Patients who experienced a manic or hypomanic switch were compared with those who did not on several variables including age, sex, diagnosis (DSM-IV bipolar I vs. bipolar II), number of previous manic episodes, type of antidepressant therapy used (electroconvulsive therapy vs. antidepressant drugs and, more particularly, selective serotonin reuptake inhibitors [SSRIs]), use and type of mood stabilizers (lithium vs. anticonvulsants), and temperament of the patient, assessed during a normothymic period using the hyperthymia component of the Semi-structured Affective Temperament Interview.

RESULTS

Switches to hypomania or mania occurred in 27% of all patients (N = 12) (and in 24% of the subgroup of patients treated with SSRIs [8/33]); 16% (N = 7) experienced manic episodes, and 11% (N = 5) experienced hypomanic episodes. Sex, age, diagnosis (bipolar I vs. bipolar II), and additional treatment did not affect the risk of switching. The incidence of mood switches seemed not to differ between patients receiving an anticonvulsant and those receiving no mood stabilizer. In contrast, mood switches were less frequent in patients receiving lithium (15%, 4/26) than in patients not treated with lithium (44%, 8/18; p = .04). The number of previous manic episodes did not affect the probability of switching, whereas a high score on the hyperthymia component of the Semistructured Affective Temperament Interview was associated with a greater risk of switching (p = .008).

CONCLUSION

The frequency of mood switching associated with acute antidepressant therapy may be reduced by lithium treatment. Particular attention should be paid to patients with a hyperthymic temperament, who have a greater risk of mood switches.

Possible association between serotonin transporter gene polymorphism and violent suicidal behavior in mood disorders

BACKGROUND

Genes involved in the serotonin system are major candidates in association studies of suicidal behavior. In this case-control study we investigated whether the serotonin transporter (5-HTT) gene encoding the protein responsible for the reuptake of serotonin from the synapse after its release from serotonergic neurons is a susceptibility factor for suicidal behavior.

METHODS

A functional polymorphism of the 5-HTT gene (a 44-base pair insertion/deletion in the 5-HTT-linked polymorphic region [5-HTTLPR]) was studied in a population of 237 consecutive patients with affective disorder (unipolar or bipolar) and 187 control subjects. Ninety-nine patients had attempted suicide at least once, of whom 26 made a violent attempt.

RESULTS

No association was found between the "s" allele of the 5-HTTLPR and suicide attempt; however, there was a significant difference in allele distributions between patients who had made violent suicide attempts and control subjects.

CONCLUSIONS

A genetic variant of the 5-HTT gene may predispose individuals to violent suicidal behavior. The precise phenotype associated with the 5-HTT gene is unclear, and therefore further studies are required to replicate these findings.

Identification of two human nuclear proteins that recognise the cytosine-rich strand of human telomeres in vitro

Most studies on the structure of DNA in telomeres have been dedicated to the double-stranded region or the guanosine-rich strand and consequently little is known about the factors that may bind to the telomere cytosine-rich (C-rich) strand. This led us to investigate whether proteins exist that can recognise C-rich sequences. We have isolated several nuclear factors from human cell extracts that specifically bind the C-rich strand of vertebrate telomeres [namely a d(CCCTAA)(n)repeat] with high affinity and bind double-stranded telomeric DNA with a 100xreduced affinity. A biochemical assay allowed us to characterise four proteins of apparent molecular weights 66-64, 45 and 35 kDa, respectively. To identify these polypeptides we screened alambdagt11-based cDNA expression library, obtained from human HeLa cells using a radiolabelled telomeric oligonucleotide as a probe. Two clones were purified and sequenced: the first corresponded to the hnRNP K protein and the second to the ASF/SF2 splicing factor. Confirmation of the screening results was obtained with recombinant proteins, both of which bind to the human telomeric C-rich strand in vitro.

Temperament in bipolar illness: impact on prognosis

OBJECTIVE

The present study was designed to investigate the relations between temperament and outcome in bipolar illness.

METHODS

Seventy-two patients presenting with bipolar type I disorder were recruited from consecutive admissions and evaluated when euthymic. The criteria developed by Akiskal and Mallya (Criteria for the 'soft' bipolar spectrum: treatment implications. Psychopharmacol. Bull. 1987;23:68-73) were used to assess both depressive (DT) and hyperthymic temperaments (HT) in a dimensional approach.

RESULTS

Multiple regression analysis showed that a higher DT score or a lower HT score were significantly associated with a greater number of episodes. Furthermore, a higher DT score was strongly associated with a higher percentage of major depressive episodes. Conversely, a higher HT score was associated with a trend to manic rather than depressive episodes. Suicide attempts appeared more frequent in the history of patients presenting with higher DT scores.

CONCLUSIONS

Our findings strengthen the hypothesis that temperament is one of the main variables accounting for some features in the clinical evolution of bipolar disorder such as polarity of episodes. Furthermore, these findings are consistent with the hypothesis of a trait-state continuum between personality and affective episodes.

Exploring indicators of telephone nursing quality

To explore whether documentation, use of clinical guidelines, and nurse competency are the best indicators of quality telephone nursing, this study examined the relationship between these commonly cited indicators and the characteristics of a telephone nursing call. This study, done at a large health maintenance organization (HMO), found: accompanying symptoms played a major role in telephone nursing assessment; call length was related to documentation process and to number of visits to a health care facility after a call; nurses' interpersonal skills and ability to determine urgency of a call are related to the documentation process but not to outcomes of the call; time of a call is related to disposition; and disposition is related to number of visits after a call.

Regulated expression of focal adhesion kinase-related nonkinase, the autonomously expressed C-terminal domain of focal adhesion kinase

Focal adhesion kinase (FAK) has been implicated in cellular processes that control cell adhesion, migration, cell cycle progression, and apoptosis. FRNK (FAK-related nonkinase) is the autonomously expressed, noncatalytic C-terminal portion of FAK. When ectopically expressed in cells, FRNK has been shown to act as a negative regulator of FAK activity, inhibiting cell spreading, migration, and cell cycle progression. The mechanisms that regulate FRNK expression during embryonic development and the functional role of FRNK in normal cell homeostasis remain poorly understood. Herein we show that FRNK expression in chicken cells is directed by an alternative promoter residing within an intron of FAK, positioned 3' of the exon encoding sequences for the catalytic domain and 5' of the exon encoding sequences for the C-terminal domain of FAK (e.g., FRNK). Using probes specific for FRNK, we show that FRNK expression occurs early in chicken embryogenesis, being readily detected at day 3, 6, or 9. Late in embryogenesis, at day 18, FRNK is expressed in a tissue-specific manner, predominately in lung and intestine cells. Western blot analysis of mouse tissues with a FAK-specific antibody revealed the expression of FRNK in the mouse lung. Reverse transcriptase PCR analysis of mouse lung RNA revealed the presence of spliced FRNK mRNAs containing 5' untranslated sequences derived from a positionally conserved exon present in the mouse genome. FAK is the first example of a tyrosine kinase regulated by a domain under the control of an alternative intronic promoter. It is also the first example of a focal adhesion-associated protein regulated by such a mechanism and thus represents a novel means for the modulation of cell adhesion signaling.

Inhibition of gene expression by anti-sense C-5 propyne oligonucleotides detected by a reporter enzyme

Using a reporter plasmid containing the luciferase gene under the control of the insulin-like growth factor 1 (IGF-1) promoter region [including its 5' untranslated region (UTR)], we demonstrate that a 17-mer oligophosphorothioate containing C-5 propyne pyrimidines is able to inhibit luciferase gene expression in the nanomolar concentration range when the anti-sense oligonucleotide is targeted either to a coding sequence in the luciferase gene or to the 5' UTR of the gene for IGF-1. Inhibition was obtained independently of whether the plasmid and the anti-sense oligonucleotide were co-transfected or transfected separately into hepatocarcinoma cells. However, the efficiency of inhibition by the anti-sense oligonucleotides was 10-fold greater in the first case. The unmodified oligophosphorothioate targeted to the 5' UTR of IGF-1 did not inhibit luciferase gene expression at a 100-fold higher concentration unless its length was increased from 17 to 21 nt, in which case an inhibition of gene expression was obtained and an IC50 of 200 nM was observed.

Triplex formation by oligonucleotides containing 5-(1-propynyl)-2'-deoxyuridine: decreased magnesium dependence and improved intracellular gene targeting

Oligonucleotides capable of sequence-specific triple helix formation have been proposed as DNA binding ligands useful for modulation of gene expression and for directed genome modification. However, the effectiveness of such triplex-forming oligonucleotides (TFOs) depends on their ability to bind to their target sites within cells, and this can be limited under physiologic conditions. In particular, triplex formation in the pyrimidine motif is favored by unphysiologically low pH and high magnesium concentrations. To address these limitations, a series of pyrimidine TFOs were tested for third-strand binding under a variety of conditions. Those containing 5-(1-propynyl)-2'-deoxyuridine (pdU) and 5-methyl-2'-deoxycytidine (5meC) showed superior binding characteristics at neutral pH and at low magnesium concentrations, as determined by gel mobility shift assays and thermal dissociation profiles. Over a range of Mg2+ concentrations, pdU-modified TFOs formed more stable triplexes than did TFOs containing 2'-deoxythymidine. At 1 mM Mg2+, a DeltaTm of 30 degreesC was observed for pdU- versus T-containing 15-mers (of generic sequence 5' TTTTCTTTTTTCTTTTCT 3') binding to the cognate A:T bp rich site, indicating that pdU-containing TFOs are capable of substantial binding even at physiologically low Mg2+ concentrations. In addition, the pdU-containing TFOs were superior in gene targeting experiments in mammalian cells, yielding 4-fold higher mutation frequencies in a shuttle vector-based mutagenesis assay designed to detect mutations induced by third-strand-directed psoralen adducts. These results suggest the utility of the pdU substitution in the pyrimidine motif for triplex-based gene targeting experiments.