Effect of the use of earplugs and eye masks on the quality of sleep after major abdominal surgery: a randomised controlled trial

Significant sleep disturbance can occur following major abdominal surgery. We aimed to evaluate the effectiveness of earplugs and eye masks in improving sleep quality and patient satisfaction, reducing nursing demands and in the incidence of delirium in patients after major abdominal surgery. We conducted a randomised controlled trial in 100 patients undergoing major abdominal surgery. We randomly allocated participants to sleep with or without earplugs and eye masks on postoperative days 1-3. The primary outcome measure was sleep quality as measured by the Richards-Campbell Sleep Questionnaire. Secondary outcomes were patient satisfaction, frequency of nursing demand and incidence of delirium measured by the Neelon and Champagne Confusion Scale. Median (IQR [range]) sleep scores were 64 (38-74 [0-100] and 60 (44-82 [18-100]) for the control and intervention groups, respectively (p = 0.310). Age and Pittsburgh Sleep Quality Index scores were found to be significant factors affecting sleep quality. There were no differences in patient satisfaction, reduction in frequency of nursing demands or incidence of delirium on postoperative days 1-3 after major abdominal surgery. The compliance rate in the intervention group was 60-65%. This study has demonstrated that the use of earplugs and eye masks did not contribute to improvements in sleep quality. Of note, sleep quality was moderate, with higher age and worse baseline sleep quality contributing to worse sleep scores. More studies are needed to investigate interventions to improve sleep quality after major abdominal surgery.

The grapevine (Vitis vinifera) LysM receptor kinases VvLYK1-1 and VvLYK1-2 mediate chitooligosaccharide-triggered immunity

Chitin, a major component of fungal cell walls, is a well-known pathogen-associated molecular pattern (PAMP) that triggers defense responses in several mammal and plant species. Here, we show that two chitooligosaccharides, chitin and chitosan, act as PAMPs in grapevine (Vitis vinifera) as they elicit immune signalling events, defense gene expression and resistance against fungal diseases. To identify their cognate receptors, the grapevine family of LysM receptor kinases (LysM-RKs) was annotated and their gene expression profiles were characterized. Phylogenetic analysis clearly distinguished three V. vinifera LysM-RKs (VvLYKs) located in the same clade as the Arabidopsis CHITIN ELICITOR RECEPTOR KINASE1 (AtCERK1), which mediates chitin-induced immune responses. The Arabidopsis mutant Atcerk1, impaired in chitin perception, was transformed with these three putative orthologous genes encoding VvLYK1-1, -2, or -3 to determine if they would complement the loss of AtCERK1 function. Our results provide evidence that VvLYK1-1 and VvLYK1-2, but not VvLYK1-3, functionally complement the Atcerk1 mutant by restoring chitooligosaccharide-induced MAPK activation and immune gene expression. Moreover, expression of VvLYK1-1 in Atcerk1 restored penetration resistance to the non-adapted grapevine powdery mildew (Erysiphe necator). On the whole, our results indicate that the grapevine VvLYK1-1 and VvLYK1-2 participate in chitin- and chitosan-triggered immunity and that VvLYK1-1 plays an important role in basal resistance against E. necator.

Calcium is involved in the R Mc1 (blb)-mediated hypersensitive response against Meloidogyne chitwoodi in potato

Functional characterization of the Columbia root-knot nematode resistance gene R Mc1 ( blb ) in potato revealed the R gene-mediated resistance is dependent on a hypersensitive response and involves calcium. The resistance (R) gene R Mc1(blb) confers resistance against the plant-parasitic nematode, Meloidogyne chitwoodi. Avirulent and virulent nematodes were used to functionally characterize the R Mc1(blb)-mediated resistance mechanism in potato (Solanum tuberosum). Histological observations indicated a hypersensitive response (HR) occurred during avirulent nematode infection. This was confirmed by quantifying reactive oxygen species activity in response to avirulent and virulent M. chitwoodi. To gain an insight into the signal transduction pathways mediating the R Mc1(blb)-induced HR, chemical inhibitors were utilized. Inhibiting Ca(2+) channels caused a significant reduction in electrolyte leakage, an indicator of cell death. Labeling with a Ca(2+)-sensitive dye revealed high Ca(2+) levels in the root cells surrounding avirulent nematodes. Furthermore, the calcium-dependent protein kinase (CDPK), StCDPK4 had a higher transcript level in R Mc1(blb) potato roots infected with avirulent nematodes in comparison to roots infected with virulent M. chitwoodi. The results of this study indicate Ca(2+) plays a role in the R Mc1(blb)-mediated resistance against M. chitwoodi in potato.

Resistance genes against plant-parasitic nematodes: a durable control strategy?

Plant-parasitic nematodes are a major pest of all agricultural systems, causing extensive economic losses. Natural resistance (R) genes offer an alternative to chemical control and have been shown effectively to limit nematode damage to crops in the field. Whilst a number of resistant cultivars have conferred resistance against root-knot and cyst nematodes for many decades, an increasing number of reports of resistance-breaking nematode pathotypes are beginning to emerge. The forces affecting the emergence of virulent nematodes are complex, multifactorial and involve both the host and parasite of the plant-nematode interaction. This review provides an overview of the root-knot and cyst nematodeRgenes characterised to date, in addition to examining the evolutionary forces influencing nematode populations and the emergence of virulence. Finally, potential strategies to improveRgene durability in the field are outlined, and areas that would benefit from further research efforts are highlighted.

The Arabidopsis thaliana papain-like cysteine protease RD21 interacts with a root-knot nematode effector protein

The root-knot nematode Meloidogyne chitwoodi secretes effector proteins into the cells of host plants to manipulate plant-derived processes in order to achieve successful parasitism. Mc1194 is a M. chitwoodi effector that is highly expressed in pre-parasitic second-stage juvenile nematodes. Yeast two-hybrid assays revealed Mc1194 specifically interacts with a papain-like cysteine protease (PLCP), RD21A in Arabidopsis thaliana. Mc1194 interacts with both the protease and granulin domains of RD21A. PLCPs are targeted by effectors secreted by bacterial, fungal and oomycete pathogens and the hypersusceptibility of rd21-1 mutants to M. chitwoodi indicates RD21A plays a role in plant-parasitic nematode infection.

A Meloidogyne incognita effector is imported into the nucleus and exhibits transcriptional activation activity in planta

Root-knot nematodes are sedentary biotrophic endoparasites that maintain a complex interaction with their host plants. Nematode effector proteins are synthesized in the oesophageal glands of nematodes and secreted into plant tissue through a needle-like stylet. Effectors characterized to date have been shown to mediate processes essential for nematode pathogenesis. To gain an insight into their site of action and putative function, the subcellular localization of 13 previously isolated Meloidogyne incognita effectors was determined. Translational fusions were created between effectors and EGFP-GUS (enhanced green fluorescent protein-β-glucuronidase) reporter genes, which were transiently expressed in tobacco leaf cells. The majority of effectors localized to the cytoplasm, with one effector, 7H08, imported into the nuclei of plant cells. Deletion analysis revealed that the nuclear localization of 7H08 was mediated by two novel independent nuclear localization domains. As a result of the nuclear localization of the effector, 7H08 was tested for the ability to activate gene transcription. 7H08 was found to activate the expression of reporter genes in both yeast and plant systems. This is the first report of a plant-parasitic nematode effector with transcriptional activation activity.

Syncytia formed by adult female Heterodera schachtii in Arabidopsis thaliana roots have a distinct cell wall molecular architecture

• Plant-parasitic cyst nematodes form a feeding site, termed a syncytium, through which the nematode obtains nutrients from the host plant to support nematode development. The structural features of cell walls of syncytial cells have yet to be elucidated. • Monoclonal antibodies to defined glycans and a cellulose-binding module were used to determine the cell wall architectures of syncytial and surrounding cells in the roots of Arabidopsis thaliana infected with the cyst nematode Heterodera schachtii. • Fluorescence imaging revealed that the cell walls of syncytia contain cellulose and the hemicelluloses xyloglucan and heteromannan. Heavily methyl-esterified pectic homogalacturonan and arabinan are abundant in syncytial cell walls; galactan could not be detected. This is suggestive of highly flexible syncytial cell walls. • This work provides important information on the structural architecture of the cell walls of this novel cell type and reveals factors that enable the feeding site to perform its functional requirements to support nematode development.

RNA interference in plant parasitic nematodes: a summary of the current status

SUMMARYRNA interference (RNAi) has emerged as an invaluable gene-silencing tool for functional analysis in a wide variety of organisms, particularly the free-living model nematode Caenorhabditis elegans. An increasing number of studies have now described its application to plant parasitic nematodes. Genes expressed in a range of cell types are silenced when nematodes take up double stranded RNA (dsRNA) or short interfering RNAs (siRNAs) that elicit a systemic RNAi response. Despite many successful reports, there is still poor understanding of the range of factors that influence optimal gene silencing. Recent in vitro studies have highlighted significant variations in the RNAi phenotype that can occur with different dsRNA concentrations, construct size and duration of soaking. Discrepancies in methodology thwart efforts to reliably compare the efficacy of RNAi between different nematodes or target tissues. Nevertheless, RNAi has become an established experimental tool for plant parasitic nematodes and also offers the prospect of being developed into a novel control strategy when delivered from transgenic plants.

Analysing gene function after duplication

After gene duplication, mutations cause the gene copies to diverge. The classical model predicts that these mutations will generally lead to the loss of function of one gene copy; rarely, new functions will be created and both duplicate genes are conserved. In contrast, under the subfunctionalization model both duplicates are preserved due to the partition of different functions between the duplicates. A recent study provides support for the subfunctionalization model, identifying several expressed gene duplicates common to humans and mice that contain regions conserved in one duplicate but variable in the other (and vice versa). We discuss both the methodology used in this study and also how gene phylogeny may lead to additional evidence for the importance of subfunctionalization in the evolution of new genes.

The use of a simulated patient to assess clinical practice in the management of a high risk asthmatic

Actors were trained to simulate a young asthmatic woman in the high risk category. Sixty-four of the 195 general practitioners and family medicine registrars in Christchurch city agreed to take part in the study in which they would be consulted by a simulated patient remaining blind to identification of the patient, the time and the medical problem. The simulators were trained to record information from the consultation and rate doctor behaviour when presenting, as a new patient on transfer, for a repeat prescription of asthma medication. Forty-nine doctors had one consultation and of these 25 had a second. Consultation time averaged 15.6 minutes and waiting time 17.4 minutes. Practice nurses and physiotherapists were rarely utilised. There were no specialist referrals. Serum theophylline levels were estimated in 4%. The chest was examined in 39% of consultations, the peak flow in 59%, both in 30% and neither in 32%. Drug prophylaxis was encouraged in 62%, home peak flow meter monitoring was encouraged in 49%, smoking was discouraged in 41%, aerosol technique was checked in 1%, a crisis plan was provided in 57% and asthma education in 42%. Doctor behaviour and communication skills were rated highly except that clear instruction on follow up appointments was given in only 24%. The second consultation appeared to be a briefer rerun of the first, indicating episodic care rather than planned long term management. A number of issues were identified for further study and education.

The use of simulated patients in the assessment of actual clinical performance in general practice

This pilot study assessed a novel approach to the evaluation of clinical performance in the practice setting, using actors trained to simulate real patients. Thirteen general practitioner teachers, 10 family medicine training programme registrars, and 10 recent graduates of the FMTP were recruited. They agreed to be consulted by an unknown simulated patient. Two young patients with classical migraine were selected. Two young actors, a male and a female, were trained to simulate their symptomatology and history. A scoring system was devised to broadly assess a single general practice first consultation, and the simulators were trained to score. Eighty-five percent of respondents were willing to take part in a further study. Seventy-three percent had no suspicion at all that the patient was simulated. The average consultation time was 17 minutes (range 4-40). The average score was 67% (range 10-100%). The diagnosis was made in every case and a wide variety of treatments were prescribed. This appears to be a practical and acceptable method of assessing clinical performance.

Metabolism of Tritiated Gibberellins in d-5 Dward Maize: II. [H]Gibberellin A(1), [H]Gibberellin A(3), and Related Compounds

After 30 minutes of incubation of young leaf sections of d-5 maize (Zea mays L.) in [(3)H]gibberellin A(1) ([(3)H]GA(1)), the metabolite [(3)H]GA(8) was present in significant amounts, with a second metabolite, [(3)H]GA(8)-glucose ([(3)H]GA(8)-glu), appearing soon after. A third [(3)H]GA(1) metabolite, the polar uncharacterized conjugate [(3)H]GA(1)-X, took more than 1 hour to appear. The protein synthesis inhibitor cycloheximide inhibited the production of all [(3)H]GA(1) metabolites, indicating a possible protein synthesis requirement for [(3)H]GA(1) metabolism.By preincubating leaf sections in unlabeled GA(1) before exposure to [(3)H]GA(1) or by reducing the specific radioactivity of the [(3)H]GA(1) supplied, it was possible to reduce greatly the conversion of radioactive GA(1) to [(3)H]GA(8)-glu, without affecting conversion to [(3)H]GA(1)-X. Increasing the molar concentration of the [(3)H]GA(1) fed greatly increased the molar yield of [(3)H]GA(1)-X, whereas the molar yields of [(3)H]GA(8) and [(3)H]GA(8)-glu were much less affected.The principal metabolite of [(3)H]GA(3) was a very polar compound having chromatographic properties similar to those of the conjugate [(3)H]GA(1)-X produced from [(3)H]GA(1). The naturally occurring GAs [(3)H]GA(1), [(3)H]GA(3), and [(3)H]tetrahydroGA(3) were metabolized to a much greater extent than were the artifical derivatives [(3)H]ketoGA(1), [(3)H]GA(1)-methyl ester, and [(3)H]pseudoGA(1). Only [(3)H]GA(1) and [(3)H]GA(3), with their identical D ring structures, were converted to [(3)H]GA(1)-X type compounds; [(3)H]-ketoGA(1) and [(3)H]tetrahydroGA(3), with modified D rings, were not converted to this type of conjugate.

Metabolism of Tritiated Gibberellins in d-5 Dwarf Maize: I. In Excised Tissues and Intact Dwarf and Normal Plants

Metabolism of [(3)H]gibberellin A(1) ([(3)H]GA(1)) was followed in intact seedlings and excised apices and leaf tissue of both dwarf and normal (tall) plants of d-5 maize (Zea mays L.). The three metabolites produced were tentatively identified as [(3)H]GA(s), [(3)H]GA(s)-glucoside ([(3)H]GA(s)-glu), and [(3)H]GA(1)-X, an unknown.In 3-hour, pulse-labeling experiments with tissues of incubated, expanding leaves, more than 70% of the [(3)H]GA(1) taken up was metabolized to the three products within 12 to 15 hours. [(3)H]GA(1) fed to the roots of 7-day-old seedlings was readily translocated to the leaves, and all three metabolites were found in both roots and leaves. [(3)H]GA(1)-X was the major metabolite in roots, whereas in leaves the major metabolite was [(3)H]GA(s)-glu. There were no consistent differences in [(3)H]GA(1) metabolism between dwarf and normal plants, indicating that dwarfism in d-5 maize is not associated with modified GA(1) metabolism.In excised, mature leaf tissue, [(3)H]GA(1) metabolism was slower than in excised, young leaf tissue. Mature leaf tissues produced [(3)H]GA(s)-glu as by far the major metabolite, with [(3)H]GA(s) and [(3)H]GA(1)-X as minor metabolites. In contrast, in young leaves the three metabolites appeared sequentially in significant proportions: [(3)H]GA(8) first, followed by [(3)H]GA(s)-glu and, finally, [(3)H]GA(1)-X.