P329 SEVERE ISOLATED MITRAL STENOSIS: ARE WE FACING DIFFERENT PHENOTYPES?

Introduction

The aim of the study was the evaluate the different characteristics between high gradients (HG) and low gradient (LG) mitral stenosis (MS) and, within the LG group those with high (LG–HF) or low flow (LG–LF). Moreover, we wanted to evaluated if there was any difference in overall complications and atrial fibrillation (AFib) incidence.

Methods

A total of 147 patients with isolated severe MS were retrospectively enrolled from the institutional echo database. Echocardiograms were read off line and clinical information were obtained from patients` records. Patients were divided into a group with HG (31 patients, mean MS gradient > 10 mmHg) and LG (116 patients, mean MS gradient ≤ 10 mmHg). The group of LG was then divided in low flow (Stroke volume index (SVi) ≤ 35 ml/m2, LF–LG: 68 patients) and in high flow (SVi > 35 ml/m2, HF–LG: 48 patients).

Results

The HG group was younger, although the difference did not reach statistical significance, higher percent of males (45% M vs 22% F, p = 0.02), higher heart rate (HR), left atrial volume, higher tricuspid regurgitation velocity and derived pulmonary artery systolic pressure (PASP), right ventricular fractional area changes (RV FAC) but similar RV longitudinal contraction. Moreover, the HG group had more severe MS calculated according to PHT. The group of LG was divided according to SVi: LF–LG compare to HG–MS had higher percent of females (45% F vs 13% M, p < 0.001), similar AFib (43% vs 32%, p=ns) and pre surgical complications (19% vs 16%, p=ns). LF–LG group had smaller LA volumes (LAV systole: 117±51 51 ml vs 148.6±38 ml, p < 0.0001), lower LV–S` (5.3±1.4 vs 6±1.6 cm/s, p = 0.004), lower tricuspid velocity regurgitation (TVR 2.47±0.5 vs 3.24±0.7 m/s, p < 0.0001), higher TAPSE/PASP (0.64±0.3 vs 0.45±0.29, p < 0.001), lower RV S` (9.79±2.01m/s vs 11.25±3.1 m/s, p = 0.01), higher RVFAC (38.5±9.6% vs 30.9±9.2%, p = 0.0005). The group of LG–LF had also less severe MS (1.3±0.6 cm2 vs 1.15±0.3 cm2, p < 0.01). The 3 groups of MS were similar in terms of cardiovascular risk factors.

Conclusion

Patients with HG MS were those with worst left ventricular involvement, higher PASP and lower RV function. However LF–LG MS were older and more females were included and even though they had smaller LA, lower values of PASP they had significantly higher percent of Afib and similar pre surgical complications. It could be speculated that LF–LG severe MS patients could be a different fenotype of the disease.

Parasitic prevalence in bat fauna captured from selected sites in northwestern Pakistan

Present study was conducted to record ecotoparasitic prevalence in bat fauna of the northwestern parts of Pakistan. A total of 204 bat specimens representing 14 species were captured during a two year survey, extending from June 2015 through May 2016. A species of soft ticks Argas vespertilionis was identified from 23 bat specimens. Similarly, members of the family Dermanyssoidae (dermanyssoid mites) were isolated from 10 bat specimens, that of Spinturnicidae (spinturnicid mites) from 3 and Streblidae (bat flies) from 2 bat specimens. These parasites were collected using entomological tweezers and were identified on morphological basis. Further studies on parasitic prevalence, molecular characterization of bat parasites and their control measures are recommended.

Description of Lutziella swatensis sp.n. (Trematoda: Dicrocoelidae) from Rattus rattus in Swat, Pakistan

A new species of the genus Lutziella (Rohde, 1966) Yamaguti, 1971 is described here and named Lutziella swatensis sp.nov. from the liver of rat (Rattus rattus L.). The new species is characterized by having body flat, smooth, longer than broad with maximum width at the level of the ovary, oral sucker with weak musculature, pharynx small; eosophagus long; caeca of irregular shape which bifurcate on the anterior border of the ovary in to unequal portions, acetabulum weakly muscular, post-testicular, testes lobed, cirrus pouch somewhat median, small in size containing winding seminal vesicle, prostatic complex and short ejaculatory duct. Genital pore median. Ovary post testicular, submedian; seminal receptacle overlapping ovary, laurer's canal present. Vitellaria follicular extending on each side from almost the level of testes to anterior portion of posterior half of the body. Uterus filled with eggs occupying most of the body, eggs oval rather small, numerous, brownish in colour, excretory vesicle tubular with terminal pore. Lutziella swatensis n. sp. is the second species of the genus known from Pakistan as well as the second species described from murid rodents in the world.

Evaluation of sulfadimidine, amprolium and triquen to treat coccidiosis in wild pigeons

Coccidiosis remains one of the major problems in poultry all over the world. Very limited data on anticoccidial drugs in wild pigeons is available. The current study was aimed to understand the comparative efficacy of sulfadimidine, amprolium and triquen in wild pigeons of Dir district, Pakistan suffering from coccidiosis. The faecal matter of wild pigeons were purchased from the local market for coccidian infection. Results revealed that 88.8% (16/18) were found infected with Eimeria spp. Three positive groups were treated with sulfadimidine (0.2mg/L), amprolium (25mg/L) and triquen. Sulfadimidine was most effective (45%) followed by amprolium (44.6%) while triquen (24.0%) showed less effectiveness against coccidiosis in pigeons. Number of oocysts were 79, 81 and 80 before treatment and 60, 44 and 44 after treatment with sulfadimidine, amprolium and triquen respectively. This study showed that sulphadimidine, amprolium and triquen could not significantly reduce the coccidiosis in pigeons. Further studies are required to clear the mechanism of anti-coccidial drugs in wild pigeons.

Morphometrics of the indian false vampire bat (Megaderma lyra) from district Jhelum, Pakistan

During the present study thirteen Megaderma lyra bats were observed roosting in dark, domed shaped room of Rohtas Fort, district Jhelum. Out of these, six specimens were captured from the roosting site, using hand net. All captured specimens were male. These bats were identified through their unique facial features, an erect and elongated nose-leaf, large oval ears that joined above the forehead and no tail. Mean head and body length of captured specimens was 80 mm, forearm length was 67 mm while average lengths of 3rd, 4th and 5th metacarpals were 51.73 mm, 55.17 mm and 60.42 mm, respectively. Mean skull length was 29.84 mm, breadth of braincase was 12.77 mm. Average Penis length of two specimens was 6.6 mm and total bacular length was 3.08 mm respectively. This is the first record of Megaderma lyra from district Jhelum.

A retrospective study of malignant melanoma from a tertiary care centre in Saudi Arabia from 2004 to 2016

BACKGROUND

Malignant melanoma is a well-known and commonly lethal tumour yet there exists scarce published information available from Saudi Arabia.

MATERIALS AND METHODS

This study examined the demographic, clinical, and histopathological profile of melanoma in a sample of Saudi patients over a period of 13 years. Medical records of 98 patients from 2004 to 2016 were retrieved from the Department of Pathology and Laboratory Medicine at King Faisal Specialist Hospital (KFSH), Riyadh, Saudi Arabia.

RESULTS

Forty two males and fifty six females (median age of 58 years) were analysed. Most cases were diagnosed in patients aged 50 years or above. The most common sites of occurrence were the extremities, especially the feet, followed by the head and neck, and then mucosal regions. Most mucosal melanomas were located in the mouth. The most common histopathological form was nodular melanoma (38 cases) followed by acral lentiginous melanoma (27 cases). Most of the cases were diagnosed in late diagnostic stages III and IV (59 cases) and most had higher Clark's level and stage V Breslow thickness. The cases with preceding history of xeroderma pigmentosum and dysplastic nevi tended to be diagnosed earlier. The most common mode of treatment was surgical resection. Patients on palliative treatment were older. Only 27/40 patients were confirmed to be alive and the rest were lost to follow-up.

CONCLUSION

Our data contrast with previously published studies from other parts of the world. Further work is needed to confirm our findings of female preponderance, common histological subtypes of nodular and acral melanomas, and the high involvement of oral mucosa in our Saudi patients.

Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan

Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective.

Success of active tuberculosis case detection among high-risk groups in urban slums in Pakistan

BACKGROUND

In Pakistan, patients with symptoms suggestive of tuberculosis (TB) seek care from a wide array of health care providers, many of whom do not notify cases to the National TB Programme (NTP).

SETTING

We evaluated an active case detection intervention in five randomly selected districts in urban slums of Sindh Province, Pakistan.

OBJECTIVE

To evaluate the increase in case notification of smear-positive TB by active case finding at community-based chest camps by engaging the private providers.

DESIGN

A cross-sectional study of TB case detection associated with a project using integrated intervention and chest camps.

RESULTS

From April 2011 to September 2012, the total number of clients seen in the camps was 165 280. Of all the attendees, 13 481 (12.7%) were examined by sputum smear microscopy. The proportion of smear-positive results was significantly higher among those from engaged private providers than among those referred from camps (OR 1.54, 95%CI 1.42-1.66). During the project, the total number of smear-positive TB notifications increased over the intervention period from 5158 to 8275.

CONCLUSION

Active case detection by engaging private providers and chest camps can significantly increase the number of smear-positive TB case notifications.

Infection of human papillomavirus (hpv) and epstein-barr-virus (ebv) and p53 overexpression in human gastric-carcinoma

To clarify the role of human papillomavirus (HPV) and Epstein-Barr virus (EBV) infection in gastric carcinogenesis in relation to overexpression of mutated p53 anti-oncogene, we used PCR to amplify DNA sequences of these viruses and immunohistochemistry to detect p53 overexpression in formaline-fixed, paraffin embedded blocks including 12 normal gastric and 51 gastric carcinoma specimens. HPV and EBV DNA were found in 17% and 0% of normal gastric tissues and in 45% and 27% of gastric carcinoma specimens, respectively. p53 overexpression was shown in 37% of gastric carcinoma specimens only. HPV infection rate was significantly higher in stage I gastric carcinomas as compared with stage IV carcinomas (p<0.03). p53 overexpression was significantly increased in well-differentiated adenocarcinomas as compared with poorly differentiated carcinomas (p<0.01). The rates of both HPV infection and p53 overexpression were significantly higher in gastric carcinomas without vascular invasion than in those with the invasion (p<0.02). No correlation was found between p53 overexpression and/or the presence of viral DNA (HPV/EBV) in regard to the depth of invasion, lymph node involvement, distant metastasis, and the location of the tumors. Our results suggest that some of the gastric carcinomas are associated with HPV and/or EBV infection and p53 mutations, and that all of these may be involved in the early stage of this malignancy. There was no correlation between HPV and or EBV infection and overexpression of p53 in gastric carcinoma.

Transperitoneal approach for radical nephrectomy: five years experience at Pakistan Institute of Medical Sciences, Islamabad, Pakistan

BACKGROUND

Renal cell carcinoma (RCC) comprises 85% of all renal neoplasms. Radical nephrectomy is the only hope of cure for patients with RCC. Role of chemotherapy and radiotherapy is very limited because of the chemo-radio resistant nature of these tumours. Several surgical approaches have been employed depending upon surgeon preference, size and location of the tumour. Objective of this study is to share the five years experience (from 1999 to 2004) of radical nephrectomy at Urology Department, Pakistan Institute of Medical Sciences (PIMS), that was performed through anterior sub costal trans-peritoneal incision.

METHODS

It was a descriptive type of study with convenient non probability sampling technique. 100 patients were included. Patients were assessed by their mode of presentation, laboratory investigations, intra-operative findings, control of renal pedicle, total operative time, blood loss, intra-operative and post operative complications. The observations were noted on a proforma and analysed on SPSS version 10.

RESULTS

Out of 100 patients, 64% were male and 36% were female with mean age of 58 years. Most common presentation was pain, present in 60% of patients. 88% of patients had normal renal function test. Average tumour size was 7.93 cm, diagnosed on ultrasonography (USG) and CT scan. Average time taken to get control of renal pedicle was 73.2 minutes. 20% of patients needed venacavatomy and thrombectomy, which was easier through this approach. Mean operative time was 129.44 minutes. Average blood loss was 274.2 ml. No intra-operative complications were seen. Mortality rate was 4%.

CONCLUSION

Radical nephrectomy is still the best option for treatment of renal cell carcinoma. There are various surgical approaches, however, anterior subcostal transperitoneal approach is more effective with early control of renal pedicle, less blood loss and minimal manipulation of the kidney thus minimizing the risk of embolism.

Impact of weather on presentation of kidney tumour: a thirteen years retrospective study

OBJECTIVE

Presentation of kidney tumor patients in-group gave birth to the hypothesis that oncogen exposure is influenced by the weather. Frequency and spectrum of renal tumors was also studied. Incidence of the tumor cannot be evaluated as we are lacking in data collection of pediatric population, inoperable cases and patients with bilateral renal tumors, who did not under go nephrectomies.

SUBJECTS AND METHODS

Case records of all patients who underwent nephrectomy at the Department of Urology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, between 1988 and 2000 were retrospectively analyzed. Histologically proven cases of renal cancer seen over 13 years period under review, were included in the study.

RESULTS

Between 1988 to 2000, 80 histologically proven cases of renal carcinoma were seen. The ages of the patients ranged from 10 to 80 years (median 55 years) with a male to female ratio of 2:1. The frequency of kidney tumor in different months was evaluated. Spring and end of summer season showed increase number of kidney tumor patients 27.50% and 30% respectively but it is not significant. This is a small study at one center and data from other centers may be conclusive. Histology showed renal cell carcinoma in 86.2%, squamous cell carcinoma in 3.75%, transitional cell carcinoma in 3.75%, Wilms' tumor and Non-Hodgkin's lymphoma in 1.25% each and undifferentiated in 2.5% cases. Invasiveness was found in 16.25% cases, 7.5% had renal vein involvement, 6.25% lymph node and 2.5% inferior vena cava. Side of involvement was right in 51.2% and left in 48.8% cases. Of the total urological malignancies that were seen during 13 years period under review, renal carcinoma was found in 12.4% cases. Of the total nephrectomies that were carried out during this period 24.5% were the cases of renal carcinoma. Hospital frequency of renal carcinoma was 2.28/100,000/year or 6.1 tumors per year.

CONCLUSION

Impact of weather could not be proved a causative factor for kidney tumor presentation. This study also indicates that although the frequency of renal carcinoma may be different from western countries but the spectrum of the disease is quite similar.

Locus for autosomal recessive nonsyndromic persistent hyperplastic primary vitreous

PURPOSE

To map the disease locus in a six-generation, consanguineous Pakistani family affected by nonsyndromic autosomal recessive persistent hyperplastic primary vitreous (arPHPV). All affected individuals had peripheral anterior synechiae and corneal opacities with variable degrees of cataract and a retrolenticular white mass behind the lens.

METHODS

Genomic DNA from family members was typed for alleles at more than 400 known polymorphic genetic markers, by polymerase chain reaction. Alleles were assigned to individuals, which allowed calculation of lod scores.

RESULTS

A maximum two-point lod score of 4.07 was obtained with marker D10S1225 with no recombination. Two recombinations with marker D10S208 and D10S537 localized the disease within a region of approximately 30 centimorgans (cM). However, homozygosity across the region refined the arPHPV locus to 13 cM.

CONCLUSIONS

Linkage analysis shows localization of nonsyndromic arPHPV to chromosome10q11-q21.

Iatrogenic injuries of renal pelvis and ureter following open surgery for urolithiasis

OBJECTIVE

To study the types of injuries of renal pelvis and ureter following open surgical procedures for urolithiasis and predisposing factors leading to such injuries and discuss various options for the management of iatrogenic injuries of the renal pelvis and ureter.

PATIENTS AND METHOD

Case files and available radiographs of the patients who were managed for ureteral and renal pelvic injuries were reviewed. Initial procedure, mode of injury and clinical course were noted.

RESULTS

The study consisted of 13 patients (9 males and 4 females). Age of the patients ranged from 18 to 65 years. Eight patients had injuries of renal pelvis or ureteropelvic junction and 5 patients got ureteral injuries. Primary management of ureteral and renal pelvic injuries was successful in 9 patients. Four patients required further surgery. Three out of 4 patients underwent nephrectomy and in 1 patient renal function deteriorated despite secondary pyeloplasty. Among 3 patients who had nephrectomy, one died postoperatively due to sepsis and haemorrhage.

CONCLUSION

Injuries of the renal pelvis and ureter have significant morbidity and even mortality. Peroperative recognition of these injuries and appropriate management can prevent the late sequele of these injuries such as stricture formation leading to progressive renal damage.

A new locus for autosomal recessive RP (RP29) mapping to chromosome 4q32-q34 in a Pakistani family

PURPOSE

To map the disease locus in a six-generation, consanguineous Pakistani family with autosomal recessive retinitis pigmentosa (arRP). All affected individuals had pigmentary retinopathy associated with symptoms of night blindness and the loss of peripheral visual fields by the age of 20 years, loss of central vision between the ages of 25 and 30 years, and complete blindness between the ages of 40 and 50 years.

METHODS

Genomic DNA from family members was typed for alleles at known polymorphic genetic markers using polymerase chain reaction. Alleles were assigned to individuals, which allowed calculation of LOD scores using the programs Cyrillic (http://www.cyrillicsoftware.com) and MLINK (Cherwell Scientific Publishing LTD:, Oxford, UK). The genes for membrane glycoprotein (M6a) and chloride channel 3 (CLCN3) were analyzed by direct sequencing for mutations.

RESULTS

A new locus for arRP (RP29) has been mapped to chromosome 4q32-q34. A maximum two-point LOD score of 3.76 was obtained for the marker D4S415, with no recombination. Two recombination events in the pedigree positioned this locus to a region flanked by markers D4S621 and D4S2417. A putative region of homozygosity by descent was observed between the loci D4S3035 and D4S2417, giving a probable disease interval of 4.6 cM. Mutation screening of two candidate genes, M6a and CLCN3, revealed no disease-associated mutations.

CONCLUSIONS

The results suggest that the arRP phenotype maps to a new locus and is due to a mutated gene within the 4q32-q34 chromosomal region.

Peripartal cardiomyopathy: problems in diagnosis and management

Peripartal cardiomyopathy is a rare form of heart disease in pregnancy with an unpredictable outcome. We describe one patient who presented in a decompensated state who was successfully managed with medical antifailure treatment. The etiology, management and future obstetric outcome are discussed.

Novel locus for autosomal recessive cone-rod dystrophy CORD8 mapping to chromosome 1q12-Q24

PURPOSE

To map the disease locus of a two-generation, consanguineous Pakistani family with autosomal recessive cone-rod dystrophy (arCRD). All affected individuals had night blindness, deterioration of central vision, photophobia, epiphora in bright light, and problems with color distinction. Fundoscopy revealed marked macular degeneration and attenuation of retinal vessels. Mild pigmentary changes were present in the periphery.

METHODS

Genomic DNA was amplified across the polymorphic microsatellite poly-CA regions identified by markers. Alleles were assigned to individuals that allowed calculation of LOD scores using the Cyrillic (Cherwell Scientific, Oxford, UK) and MLINK (accessed from ftp://linkage. rockefeller.edu/softeware/linkage/) software programs. The cellular retinoic acid-binding protein 2 (CRABP2), cone transducin alpha-subunit (GNAT2), potassium inwardly rectifying channel, subfamily J, member 10 (KCNJ10), genes were analyzed by heteroduplex analysis and direct sequencing for mutations.

RESULTS

A new locus for arCRD (CORD8) has been mapped to chromosome 1q12-q24. A maximum two-point LOD score of 4.22 was obtained with marker D1S2635 at recombination fraction of theta = 0.00. Two critical recombinations in the pedigree positioned this locus to a region flanked by markers D1S457 and D1S2681. A region of homozygosity was observed within the loci D1S442 and D1S2681, giving a probable critical disease interval of 21 cM. Mutation screening of the three candidate genes CRABP2, GNAT2, and KCNJ10 revealed no disease-associated mutations.

CONCLUSIONS

The findings therefore suggest that this phenotype maps to a new locus and is due to an as yet uncharacterized gene within the 1q12-q24 chromosomal region.

Severe autosomal dominant retinitis pigmentosa caused by a novel rhodopsin mutation (Ter349Glu). Mutations in brief no. 208. Online

Mutations in the rhodopsin gene are reported to be responsible for approximately 25% of all cases of autosomal dominant Retinitis pigmentosa (adRP). Affected individuals from a large family with an unusually severe form of adRP were screened for mutations in the rhodopsin gene. Direct sequencing of exon 5 revealed a TAA to GAA transversion at nucleotide 5276/codon 349, which was confirmed by Dde1 restriction digest analysis. This change would replace the normal termination codon with a glutamic acid residue (Ter-349-Glu, or X349E). The next predicted termination codon (TAA) lies 153bp downstream at nucleotides 5429 to 5431. Termination of transcription at this point would add an additional 51 amino-acid residues to the carboxy terminus of the rhodopsin molecule. This mutation is unique in producing a mutant rhodopsin in which all of the normal 348 amino-acid residues remain intact. It produces one of the most severe adRP phenotypes ever observed in a family with a rhodopsin mutation. In view of this the Ter-349-Glu mutation is worthy of further investigation to determine how the presence of this particular mutant opsin leads to rod photoreceptor degeneration.

A novel locus for Leber congenital amaurosis (LCA4) with anterior keratoconus mapping to chromosome 17p13

PURPOSE

A two-generation consanguineous Pakistani family with autosomal recessive Leber congenital amaurosis (LCA, MIM 204,000) and keratoconus was identified. All affected individuals have bilateral keratoconus and congenital pigmentary retinopathy. The goal of this study was to link the disease phenotype in this family.

METHODS

Genomic DNA was amplified across the polymorphic microsatellite poly-CA regions identified by markers. Polymerase chain reaction (PCR) products were separated by nondenaturing polyacrylamide gel electrophoresis. Alleles were assigned to individuals, which allowed calculation of LOD scores using the Cyrillic and MLINK software program. The retinal guanylate cyclase (RETGC-1, GDB symbol GUC2D) and pigment epithelium-derived factor (PEDF) genes were analyzed by heteroduplex analysis and direct sequencing for mutations in diseased individuals.

RESULTS

Based on a whole genome linkage analysis the first locus for this combined phenotype has been mapped to chromosome 17p13. Linkage analysis gave a two point LOD score of 3.21 for marker D17S829. Surrounding this marker is a region of homozygosity of 15.77 cM, between the markers D17S1866 and D17S960; however, the crossover for the marker D17S1529 refines the region to 10.77 cM within which the disease gene is predicted to lie. Mutation screening of the nearby RETGC-1 gene, which has been shown to be associated with LCA1, revealed no mutations in the affected individuals of this family. Similarly, another prime candidate in the region PEDF was also screened for mutations. The factor has been shown to be involved in the photoreceptor differentiation and neuronal survival. No mutations were found in this gene either. Furthermore, RETGC-1 was physically excluded from the critical disease region based on the existing physical map.

CONCLUSIONS

It is therefore suggested that this combined phenotype maps to a new locus and is due to an as yet uncharacterized gene within the 17p13 chromosomal region.

Glutathione-S-Transferase as a selective inhibitor of oncogenic ras-p21-induced mitogenic signaling through blockade of activation of jun by jun-N-terminal kinase

We have identified the intracellular detoxification enzyme, glutathione-S-transferase (GST), as a potent inhibitor of the activation of jun by its kinase, jun-N-terminal kinase (JNK), in vitro. All three major isozymes (alpha, mu, and pi) bind to JNK-jun complexes and inhibit activation of jun by JNK. We now find that GST inhibits JNK-induced oocyte maturation in vivo and strongly inhibits oocyte maturation induced by oncogenic ras-p21 protein, but not by insulin-activated normal cellular p21 protein. These results correlate with the finding that oncogenic, but not insulin-activated normal, p21 induces high levels of activated JNK. GST also strongly blocks induction of oocyte maturation by protein kinase C (PKC) which is a critical downstream target of oncogenic but not normal ras-p21. Thus, we have established a new function for GST as a potent physiological inhibitor of the ras-JNK-jun pathway.

Phenotype of autosomal recessive congenital microphthalmia mapping to chromosome 14q32

BACKGROUND

Congenital microphthalmia (OMIM: 309700) may occur in isolation or in association with a variety of systemic malformations. Isolated microphthalmia may be inherited as an autosomal dominant, an autosomal recessive, or an X linked trait.

METHODS

Based on a whole genome linkage analysis, in a six generation consanguineous family with autosomal recessive inheritance, the first locus for isolated microphthalmia was mapped to chromosome 14q32. Eight members of this family underwent clinical examination to determine the nature of the microphthalmia phenotype associated with this locus.

RESULTS

All affected individuals in this family suffered from bilateral microphthalmia in association with anterior segment abnormalities, and the best visual acuity achieved was "perception of light". Corneal changes included partial or complete congenital sclerocornea, and the later development of corneal vascularisation and anterior staphyloma. Intraocular pressure, as measured by Schiotz tonometry, was greatly elevated in many cases.

CONCLUSIONS

This combination of ocular defects suggests an embryological disorder involving tissues derived from both the neuroectoderm and neural crest. Other families with defects in the microphthalmia gene located on 14q32 may have a similar ocular phenotype aiding their identification.

Connexin 50 mutation in a family with congenital "zonular nuclear" pulverulent cataract of Pakistani origin

Inherited cataract is a clinically and genetically heterogeneous disease that most often presents as a congenital autosomal dominant trait. Here we report linkage of a three-generation family of Pakistani origin with autosomal dominant cataract "zonular nuclear" pulverulent type (CZNP) on chromosome 1q21.1. Genome wide-linkage analysis excluded all the known cataract loci except on chromosome 1q. Significantly positive 2-point lod score values (Z=3.01 at theta=0) were obtained for markers D1S305 and D1S2721, which are known to flank the gene for connexin 50 (Cx50) or gap junction protein alpha-8 (Gja8). Previously a mutation in this gene has been reported in a British family with zonular pulverulent cataract (CZP). Here we describe a second mutation (E48K) in connexin 50 that confirms the involvement of this gene in cataractogenesis.

A locus for autosomal recessive congenital microphthalmia maps to chromosome 14q32

Congenital microphthalmia (CMIC) (OMIM 309700) may occur in isolation or in association with a variety of systemic malformations. Isolated CMIC may be inherited as an autosomal dominant, an autosomal recessive, or an X-linked trait. On the basis of a whole-genome linkage analysis, we have mapped the first locus for isolated CMIC, in a five-generation consanguineous family with autosomal recessive inheritance, to chromosome 14q32. All affected individuals in this family have bilateral CMIC. Linkage analysis gave a maximum two-point LOD score of 3.55 for the marker D14S65. Surrounding this marker is a region of homozygosity of 7.3 cM, between the markers D14S987 and D14S267, within which the disease gene is predicted to lie. The genes for several eye-specific transcription factors are located on human chromosome 14q and in the syntenic region of mouse chromosome 12. However, both CHX10 (14q24.3), mutations of which give rise to CMIC in mouse models, and OTX2 (14q21-22) can be excluded as candidates for autosomal recessive congenital microphthalmia (arCMIC), since they map outside the critical disease region defined by recombination events. This suggests that arCMIC is caused by defects in a novel developmental gene that may be important or even essential in eye development.

Infection of human papillomavirus (HPV) and p53 over-expression in human female genital tract carcinoma

Inactivation of p53 gene products either by mutation or by complex formation with E6 oncoprotein encoded by high risk HPV appears to be a common event in cervical carcinogenesis. This study was designed to clarify this association in 41 primary cervical, 15 endometrial, 3 ovarian and one rectal carcinomas. Polymerase chain reaction analysis revealed presence of high risk HPV in 36 (88%) cervical, 5 (33%) endometrial and none of ovarian and rectal carcinomas. HPV 16 was found in 14 cervical carcinomas, HPV 18 in 19 cervical and 2 endometrial carcinomas and HPV 33 in 28 cervical and 5 endometrial carcinomas. Expression of tumor suppressor protein p53 by using polyclonal antibody CM-1, was detected in 28 (68%) cervical, 7 (47%) endometrial, 2 (66%) ovarian and one (100%) rectal carcinoma. Twenty six cervical and 3 endometrial carcinoma cases were positive for both high risk HPV and p53. We conclude that beside cervical carcinoma HPV infection is not uncommon in endometrial carcinoma and in our experimental design there is no inverse correlation between HPV infection and p53 over-expression in a variety of the tumors analysed in the present study.

Spectrophotometric titration of phenoxyl groups of sheep brain tubulin

Spectrophotometric titration of phenoxyl group of sheep brain tubulin carried out in 6M guanidine hydrochloride indicated 36 tyrosine residues per dimer of tubulin. A plot of log alpha/(1-alpha) versus pH showed that 26 residues titrated with apparent pK of 10.4 and 10 residues titrated with apparent pK of 11.0. The high pK value of tyrosine could be attributed to the possibility that the molecules containing tyrosine residues were not completely utilised as these residues could have been partially shielded from the solvent. Alternatively, they could have proximal negative charges.

A simple computer programme for biokinetic study of 99Tcm-radiopharmaceuticals

A simple programme has been written in GW BASIC to calculate the percentage activity of 99Tcm-radiopharmaceuticals in different tissues after biodistribution. The programme is efficient, easy to handle and produces a permanent record in terms of a final report.

Over-expression of p53 protein in human laryngeal carcinoma

We examined the expression of tumor-suppressor protein p53 in a variety of laryngeal carcinomas from 43 patients (25 primary, 13 metastatic and 5 recurrent cases), 13 normal laryngeal tissues and 7 benign laryngeal nodule biopsy specimens, using the polyclonal antibody CM-1. Previously we have reported a high incidence of ras mutations (51%) and human papillomavirus (HPV) infection (37%) in these laryngeal carcinomas. p53 protein was detected by immunohistochemistry in 65% of laryngeal carcinomas (60% of primary, 69% of metastatic and 80% of recurrent cases). No correlation was found between p53 over-expression and histological grading of the tumors. None of the specimens from normal larynx and laryngeal nodules revealed any detectable level of this protein. Furthermore, 11 (69%) of 16 HPV-positive cases and 17 (77%) of 22 cases with ras mutation showed variable grades of p53 expression. Twelve (71%) of 17 laryngeal carcinomas in current study having both p53 over-expression and ras mutation were moderately or poorly differentiated. Likewise, positivity for these 2 parameters was significantly increased in metastatic tumors (9 of 13 cases, 69%) as compared with primary and recurrent tumors (8 of 30 cases, 27%) (p < 0.01). Our results suggest that multiple factors are involved in this malignancy, and that the simultaneous over-expression of p53 and the presence of ras mutation may be related to the progression stage of laryngeal carcinoma.

ras gene mutations and HPV infection are common in human laryngeal carcinoma

To evaluate the role of ras activation and human papillomavirus (HPV) infection in laryngeal carcinoma, we analyzed tumor DNA from 43 cases, including 25 primary laryngeal tumors, 12 lymph-node and one skin metastases, and 5 recurrent laryngeal carcinomas. Thirteen normal laryngeal tissues and 7 benign laryngeal nodule biopsy specimens along with normal tissue surrounding laryngeal carcinoma in 2 cases were also included. The polymerase-chain-reaction technique was used to amplify DNA fragments containing codon 12 and 61 of H-, K- and N-ras, also HPV 16, 18 and 33 DNA, subsequently hybridized with sequence-specific oligonucleotides. DNA samples from 22 patients with laryngeal carcinoma revealed ras mutations (18 in N-ras codon 12, 6 in H-ras codon 61, and 3 in K-ras codon 61). Likewise, HPV DNA was found in 16 cases (HPV 16, 18 and 33 in 3 cases, 14 cases and 1 case respectively). ras mutations were significantly higher in metastatic tumors (10 of 13 cases) than in primary (11 of 25 cases) and recurrent laryngeal carcinomas (1 of 5 cases). HPV DNA was detected in 60% of recurrent, 44% of primary and 15% of metastatic tumors. Only 2 of the 13 normal laryngeal tissues and 1 out of 7 laryngeal nodule specimens were found to contain HPV DNA. These results suggest that ras activation, especially in N-ras codon 12.1 (GGT-->AGT) and HPV infection are 2 important factors in (multistage) laryngeal carcinogenesis. The ras mutation may be associated with metastatic ability of the tumor.

Presence of ras oncogene mutations and human papillomavirus DNA in human prostate carcinomas

The frequency of H-ras, K-ras, and N-ras mutations and the presence of high-risk human papillomavirus (HPV 16, 18, and 33) DNA were studied in 75 paraffin-embedded specimens obtained from 68 Japanese patients with a variety of prostate carcinomas by using polymerase chain reaction and DNA hybridization with sequence-specific oligonucleotides. Ten specimens each of normal and benign hyperplastic prostatic tissues from the same number of patients were also examined for this analysis. Of 68 carcinoma cases, ras gene mutations were present in 16 cases (24%) and HPV DNAs in 28 cases (41%). Eleven mutations were detected in codon 61 of H-ras, 4 in codon 12 of N-ras, and 2 in codon 61 of K-ras. HPV 16, 18, and 33 DNAs were found in 11, 17, and 5 cases, respectively. Eight of the 16 cases with ras mutation also harbored HPV DNAs. The frequency of ras mutations and the HPV infection increased in patients with advanced stages of the tumor and with the higher Gleason score. There was the predominant presence of H-ras codon 61.2 (CAG-->CTG) mutation and HPV 18 DNA in prostatic carcinomas metastasizing to the bone. None of the normal or benign hyperplastic prostatic specimens contained either ras mutation or HPV DNA. Our results suggest that ras gene mutations and HPV infections are relatively frequent, at least in prostate carcinoma of Japanese patients. These two factors appear to be related to the progression of the tumor. Moreover, H-ras codon 61.2 mutation and HPV 18 infection may have some predictive roles for bone metastasis in prostate carcinoma.

High frequency of human papillomavirus infection in carcinoma of the urinary bladder

BACKGROUND AND METHODS

The prevalence of type 6, 11, 16, 18, and 33 human papillomavirus (HPV) was investigated with the polymerase chain reaction (PCR) on formalin-fixed, paraffin wax-embedded material, including 48 neoplastic and 21 normal urinary bladder specimens. The PCR-amplified DNA were analyzed by gel electrophoresis and dot blot and Southern blot hybridization. Some tissues were tested further by nonisotopic in situ hybridization.

RESULTS

HPV DNA was detected in 39 (81%) of 48 carcinomas and 7 (33%) of 21 normal urinary bladder specimens. The presence of high-risk HPV (types 16, 18, and 33) was increased significantly in carcinoma cases (62%) as compared with normal specimens (14%) (P less than 0.01). Similarly, multiple HPV infections were significantly higher in carcinoma (60%) than in the normal tissues (5%) (P less than 0.01). The overall and high-risk HPV infections in both neoplastic and normal specimens were distributed almost equally in male and female patients. There was no significant correlation between positive results for HPV and histologic grades of the carcinoma.

CONCLUSIONS

These results demonstrate that the urinary bladder in both sexes is another site where infection with the common genital tract HPV may carry a risk of malignant transformation.

A study of the carboxyl groups of sheep brain tubulin

Tubulin was isolated from whole sheep brain by ammonium sulphate fractionation followed by ion exchange chromatography using DEAE-Sephadex in 10 mM sodium phosphate buffer pH 7.0. It was essentially free from contaminating proteins as shown by SDS-PAGE electrophoresis and was active by the criterion of colchicine binding. Hydrogen ion titration of the sheep brain tubulin was performed under native conditions. In the present study, only that pH range has been selected for analysis where carboxyl groups (most of which are located in the C-terminal regions of both the alpha- and beta- subunits) deprotonate. The results indicated the presence of 75 carboxyl groups per dimer upto pH 5.5. Of these, 46 titrated with a pK of 3.7 and the remaining 29 with a pK of 3.5.

Detection of HPV DNA in neoplastic and non-neoplastic cervical specimens from Pakistan and Japan by non-isotopic in situ hybridization

In order to determine the prevalence and type-specific distribution of human papillomavirus (HPV) in women from Pakistan, a country with a low cervical cancer rate (hospital-based data), and to compare these results with their counter-parts in Japan, we studied 56 non-neoplastic cervical tissues and 162 cervical carcinoma cases from both countries. HPV infection was defined by in situ hybridization in paraffin-embedded tissues using biotinylated HPV 6/11, 16 and 18 probes. The overall positivity rates in non-neoplastic and neoplastic cervical tissues from Pakistan were 33% and 88%, while in those from Japan the rates were 46% and 80%, respectively. High-risk HPVs (16 & 18) were found in 17% of the non-neoplastic specimens and in 69% of cervical carcinoma cases from Pakistan, while Japanese figures in this respect were 19% and 68%, respectively. No correlation was found between the type-specific distribution or prevalence of HPV and the geographic location of the cases examined in the 2 countries. However, in comparison to Japanese women, the incidence of HPV-16-positive cervical carcinoma in Pakistani women decreased significantly (p less than 0.05) in the oldest age group as compared to the youngest age group.