The genome of Citrus australasica reveals disease resistance and other species specific genes

BACKGROUND

The finger lime (Citrus australasica), one of six Australian endemic citrus species shows a high natural phenotypic diversity and novel characteristics. The wide variation and unique horticultural features have made this lime an attractive candidate for domestication. Currently no haplotype resolved genome is available for this species. Here we present a high quality, haplotype-resolved reference genome for this species using PacBio HiFi and Hi-C sequencing.

RESULTS

Hifiasm assembly and SALSA scaffolding resulted in a collapsed genome size of 344.2 Mb and 321.1 Mb and 323.2 Mb size for the two haplotypes. The nine pseudochromosomes of the collapsed genome had an N50 of 35.2 Mb, 99.1% genome assembly completeness and 98.9% gene annotation completeness (BUSCO). A total of 41,304 genes were predicted in the nuclear genome. Comparison with C. australis revealed that 13,661 genes in pseudochromosomes were unique in C. australasica. These were mainly involved in plant-pathogen interactions, stress response, cellular metabolic and developmental processes, and signal transduction. The two genomes showed a syntenic arrangement at the chromosome level with large structural rearrangements in some chromosomes. Genetic variation among five C. australasica cultivars was analysed. Genes related to defense, synthesis of volatile compounds and red/yellow coloration were identified in the genome. A major expansion of genes encoding thylakoid curvature proteins was found in the C. australasica genome.

CONCLUSIONS

The genome of C. australasica present in this study is of high quality and contiguity. This genome helps deepen our understanding of citrus evolution and reveals disease resistance and quality related genes with potential to accelerate the genetic improvement of citrus.

Pangenome analysis provides insight into the evolution of the orange subfamily and a key gene for citric acid accumulation in citrus fruits

The orange subfamily (Aurantioideae) contains several Citrus species cultivated worldwide, such as sweet orange and lemon. The origin of Citrus species has long been debated and less is known about the Aurantioideae. Here, we compiled the genome sequences of 314 accessions, de novo assembled the genomes of 12 species and constructed a graph-based pangenome for Aurantioideae. Our analysis indicates that the ancient Indian Plate is the ancestral area for Citrus-related genera and that South Central China is the primary center of origin of the Citrus genus. We found substantial variations in the sequence and expression of the PH4 gene in Citrus relative to Citrus-related genera. Gene editing and biochemical experiments demonstrate a central role for PH4 in the accumulation of citric acid in citrus fruits. This study provides insights into the origin and evolution of the orange subfamily and a regulatory mechanism underpinning the evolution of fruit taste.

Haplotype resolved chromosome level genome assembly of Citrus australis reveals disease resistance and other citrus specific genes

Recent advances in genome sequencing and assembly techniques have made it possible to achieve chromosome level reference genomes for citrus. Relatively few genomes have been anchored at the chromosome level and/or are haplotype phased, with the available genomes of varying accuracy and completeness. We now report a phased high-quality chromosome level genome assembly for an Australian native citrus species; Citrus australis (round lime) using highly accurate PacBio HiFi long reads, complemented with Hi-C scaffolding. Hifiasm with Hi-C integrated assembly resulted in a 331 Mb genome of C. australis with two haplotypes of nine pseudochromosomes with an N50 of 36.3 Mb and 98.8% genome assembly completeness (BUSCO). Repeat analysis showed that more than 50% of the genome contained interspersed repeats. Among them, LTR elements were the predominant type (21.0%), of which LTR Gypsy (9.8%) and LTR copia (7.7%) elements were the most abundant repeats. A total of 29 464 genes and 32 009 transcripts were identified in the genome. Of these, 28 222 CDS (25 753 genes) had BLAST hits and 21 401 CDS (75.8%) were annotated with at least one GO term. Citrus specific genes for antimicrobial peptides, defense, volatile compounds and acidity regulation were identified. The synteny analysis showed conserved regions between the two haplotypes with some structural variations in Chromosomes 2, 4, 7 and 8. This chromosome scale, and haplotype resolved C. australis genome will facilitate the study of important genes for citrus breeding and will also allow the enhanced definition of the evolutionary relationships between wild and domesticated citrus species.

Pathotyping Citrus Ornamental Relatives with Xanthomonas citri pv. citri and X. citri pv. aurantifolii Refines Our Understanding of Their Susceptibility to These Pathogens

Xanthomonas citri pv. citri (Xcc) and X. citri pv. aurantifolii (Xca) are causal agents of Citrus Bacterial Canker (CBC), a devastating disease that severely affects citrus plants. They are harmful organisms not reported in Europe or the Mediterranean Basin. Host plants are in the Rutaceae family, including the genera Citrus, Poncirus, and Fortunella, and their hybrids. In addition, other genera of ornamental interest are reported as susceptible, but results are not uniform and sometimes incongruent. We evaluated the susceptibility of 32 ornamental accessions of the Rutaceae family belonging to the genera Citrus, Fortunella, Atalantia, Clausena, Eremocitrus, Glycosmis, Microcitrus, Murraya, Casimiroa, Calodendrum, and Aegle, and three hybrids to seven strains of Xcc and Xca. Pathotyping evaluation was assessed by scoring the symptomatic reactions on detached leaves. High variability in symptoms and bacterial population was shown among the different strains in the different hosts, indicative of complex host–pathogen interactions. The results are mostly consistent with past findings, with the few discrepancies probably due to our more complete experimental approach using multiple strains of the pathogen and multiple hosts. Our work supports the need to regulate non-citrus Rutaceae plant introductions into areas, like the EU and Mediterranean, that are currently free of this economically important pathogen.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

Incorporating hydrology into climate suitability models changes projections of malaria transmission in Africa

Continental-scale models of malaria climate suitability typically couple well-established temperature-response models with basic estimates of vector habitat availability using rainfall as a proxy. Here we show that across continental Africa, the estimated geographic range of climatic suitability for malaria transmission is more sensitive to the precipitation threshold than the thermal response curve applied. To address this problem we use downscaled daily climate predictions from seven GCMs to run a continental-scale hydrological model for a process-based representation of mosquito breeding habitat availability. A more complex pattern of malaria suitability emerges as water is routed through drainage networks and river corridors serve as year-round transmission foci. The estimated hydro-climatically suitable area for stable malaria transmission is smaller than previous models suggest and shows only a very small increase in state-of-the-art future climate scenarios. However, bigger geographical shifts are observed than with most rainfall threshold models and the pattern of that shift is very different when using a hydrological model to estimate surface water availability for vector breeding.

Prior studies mapping climatologically suitable areas for malaria transmission have used relatively simple thresholds for precipitation. Here the authors show that when models incorporate hydrological processes a more complex pattern of malaria suitability emerges in Africa and future shifts in suitability are more pronounced.

The effects of land use and topographic changes on sediment connectivity in mountain catchments

Understanding the evolution of sediment connectivity associated with different land use and topographic changes is a prerequisite for a better understanding of sediment budgets and sediment transport processes. We used the Index of Sediment Connectivity (IC) developed by Cavalli et al. (2013) based on the original approach by Borselli et al. (2008) to study the effects of decadal-scale land use and topographic changes on sediment connectivity in mountain catchments. The input variables of the IC (i.e. land cover and topography) were derived from historical aerial photos using Structure from Motion-Multi View Stereo algorithms (SfM-MVS). The method was applied in different sub-catchments of the Upper River Cinca Catchment (Central Pyrenees), representative of three scenarios: (a) Land cover changes; (b) Topographic changes in agricultural fields (terracing); and (c) Topographic changes associated with infrastructure (road construction). In terms of land cover changes, results show that although connectivity is increased in some areas due to the establishment of new field crops, for most of the study area connectivity decreased due to afforestation caused by rural abandonment. Topographic changes due to the establishment of agricultural terraces affected connectivity to a larger degree than land cover changes. Terracing generally reduced connectivity due to the formation of flat areas in step-slopes, but in certain points, an increase in connectivity caused by the topographic convergence produced by terraces was observed. Finally, topographic changes associated with road construction greatly modified surface flow directions and the drainage network, resulting in changes in connectivity that may affect erosional processes nearby. The methodology used in this paper allows to study the effects of real decadal-scale land use and topographic changes on sediment connectivity and also evaluating and disentangling those changes. Furthermore, this approach can be a useful tool to identify potential risks associated with morphological and land use changes, involving road infrastructures.

Pathogenicity of Phyllosticta citricarpa Ascospores on Citrus spp

Citrus black spot, caused by Phyllosticta citricarpa, is one of the most important fungal diseases in many citrus-growing regions with hot and humid summers. Ascospores and conidia are known to contribute to epidemic development of the disease. However, pathogenicity testing has never been done for pure ascospores produced from fully characterized P. citricarpa isolates, due to the inability to induce the sexual state in vitro. Recently, an in vitro mating technique was developed to readily produce pure P. citricarpa ascospores for use in host inoculation studies. To test the pathogenicity of P. citricarpa ascospores, we inoculated Troyer citrange leaves and Murcott tangor fruit with ascospores produced in vitro from characterized P. citricarpa isolates. Typical symptoms of citrus black spot occurred. Recovery of P. citricarpa isolates from symptomatic lesions and their characterization using genetic markers enabled us to identify recombinant genotypes among the isolates recovered from ascospore inoculations and, as such, fulfill Koch's postulates for ascospores. We have also identified Troyer citrange seedlings as a potential model system for citrus black spot inoculation studies, because it allows typical symptoms of citrus black spot to be expressed with a much shorter latent period than on fruit. This will facilitate future studies of epidemiological aspects of P. citricarpa ascospores relative to conidia and improve our understanding of the citrus black spot pathosystem. The susceptibility of Troyer citrange seedlings will also facilitate experimenting with disease management methods, aimed at reducing the impact of citrus black spot.

BNNT-mediated irreversible electroporation: its potential on cancer cells

Irreversible lethal electroporation (IRE) is a new non-thermal ablation modality that uses short pulses of high amplitude static electric fields (up 1000 V/cm) to create irreversible pores in the cell membrane, thus, causing cell death. Recently, IRE has emerged as a promising clinical modality for cancer disease treatment. Here, we investigated the responses of tumour human HeLa cells when subjected to IRE in the presence of BNNTs. These consist of tiny tubes of B and N atoms (arranged in hexagons) with diameters ranging from a 1 to 3 nanometres and lengths < 2 μm. BNNTs have attracted wide attention because of their unique electrical properties. We speculate that BNNTs, when interacting with cells exposed to static electrical fields, amplify locally the electric field, leading to cell death. In this work, electroporation assays were performed with a commercial electroporator using the cell- specific protocol suggested by the supplier (exponential decay wave, time constant 20 ms) with the specific aim to compare IRE in absence and in presence of BNNTs. We observed that BNNTs have the capacity to decrease substantially the voltage required for IRE. When cells were pulsed at 800 V/cm, we observed a 2,2-fold reduction in cell survival in the presence of BNNTs compared to controls. We conclude that the death of the tumour cells exposed to IRE is strongly enhanced in the presence of BNNTs, indicating their potential therapeutic application.

Protein synthesis in the intestine of goldfish acclimatized to different temperatures

1. The incorporation of [(14)C]valine and [(3)H]threonine has been studied in mucosa of goldfish acclimatized to different temperatures. 2. [(14)C]Valine was incorporated more rapidly than [(3)H]threonine at acclimatization temperatures below 15 degrees ; this distinction disappeared at higher temperatures. 3. The rate of amino acid incorporation rose as the environmental temperature was increased. 4. The number of valine residues in mucosal protein fell and the number of methionine residues rose as the acclimatization temperature was raised. 5. The concentration of free methionine was closely related to the amount in protein in goldfish mucosa; both increased at higher acclimatization temperatures. 6. An attempt is made to show that these changes are integrated with possible homoeostatic mechanisms in the goldfish intestine.

Sodium-glucose interactions in the goldfish intestine

1. Everted sacs of goldfish intestine transfer glucose and water to their serosal surfaces and the total transfer is greater in the anterior intestine than in the intestinal bulb or rectum.2. Transmural potentials, with the serosa positive to the mucosa, were recorded from all parts of the goldfish intestine but were highest in the anterior intestine and the rectum. In both these areas the total potential was dependent partly upon the presence of glucose.3. Reducing the concentration of sodium bathing the mucosa of the anterior intestine reduced the glucose-evoked potential in a non-linear way. The steady-state potentials, with or without glucose, first increased and later decreased as the sodium concentration was further reduced.4. Reducing the concentration of glucose bathing the mucosa from 27 to 5 mM slightly increased the glucose-evoked potential. Further reduction of the glucose concentration caused the glucose-evoked potential to fall.5. Phlorrhizin inhibited the glucose-evoked potential. The degree of inhibition was proportional to the log concentration of phlorrhizin over the range 2 x 10(-7)-6 x 10(-5)M. The steady-state potential with glucose present was lower than when glucose was absent at phlorrhizin concentrations, 6 x 10(-6)-6 x 10(-5)M.6. The glucose-evoked potential increased rapidly over the temperature range 5-15 degrees C and more slowly from 15 to 30 degrees C. The steady-state potentials also increased with temperature, the rate of increase being greater when glucose was present. Below 15 degrees C the glucose-independent potential was higher and above 15 degrees C lower than the steady-state potential recorded with glucose present.7. These findings are discussed in terms of sodium-glucose interaction taking place at the luminal side of the mucosal cell, on the outside of the mucosal cell membrane.

Influence of cholecalciferol (vitamin D(3)) on the initial kinetics of the uptake of calcium ions by rat small-intestinal mucosa (Short Communication)

The uptake of Ca(2+) by isolated small-intestinal mucosa from vitamin D-depleted and -repleted rats was analysed for the effects of vitamin D on initial kinetics. The rapid association of Ca(2+) with the tissue, which is complete within 1min, was unaffected by the vitamin, whereas the subsequent, linear, uptake was significantly increased. Neither the tissue space accessible to inulin nor the permeability to thiourea was influenced by vitamin D treatment.

Influence of temperature acclimatization on the ionic activation of goldfish intestinal adenosine triphosphatase

1. An adenosine triphosphatase membrane system, dependent on Mg(2+) and activated further by Na(+)+K(+), was prepared from goldfish anterior intestine by differential centrifugation of homogenized intestinal scrapings. 2. The affinity of this preparation for Na(+) in the presence of K(+)+Mg(2+), for K(+) in the presence of Na(+)+Mg(2+) and for Mg(2+) alone, measured at 37 degrees , did not depend on the previous environmental temperature of the fish. When Na(+)+K(+) were added to preparations from 8 degrees -acclimatized fish the affinity for Mg(2+) increased; this was not seen with preparations from 30 degrees -acclimatized fish. 3. Part of the Mg(2+)-activated adenosine triphosphatase was inhibited by Na(+) and the amount of inhibition appeared to increase at high acclimatization temperatures. 4. This Na(+)-inhibited adenosine triphosphatase was separated from the (Na(+)+K(+))-activated enzyme by centrifugation on sucrose density gradients. 5. Preparations from 8 degrees -acclimatized fish contained less Mg(2+)-activated and more (Na(+)+K(+))-activated adenosine triphosphatase than did similar fractions from 30 degrees -acclimatized fish. 6. Acclimatization to different environmental temperatures might involve one form of adenosine triphosphatase changing to another. The origin of various membranes seen in microsomal fractions must, however, be established before this hypothesis can be tested further.

Fate of synthetic oxytocin analogues in the rat

The disappearance of phe(3)-oxytocin, val(3)-oxytocin and oxytocin from the circulation of male rats was shown to be due to qualitatively similar mechanisms, that is, it depends on uptake in the kidneys and organs of the splanchnic vascular area. However, compared to phe(3)-oxytocin and oxytocin (whose half-lives were essentially similar) val(3)-oxytocin took twice as long to reach half its initial blood concentration. In lactating rats the mammary glands probably participated in the uptake of phe(3)-oxytocin, but the rate of disappearance of val(3)-oxytocin was not different from that in non-lactating animals. In male nephrectomized rats without splanchnic circulation, phe(3)-oxytocin, unlike val(3)-oxytocin, was quickly distributed in a volume equal to two-thirds of the total body water. Using oxytocin as the standard, val(3)-oxytocin and phe(3)-oxytocin were more potent when assayed on a superfused uterus or on a rat uterus in vivo than when assayed by the pharmacopoeial method (1958) on the isolated uterus in an organ bath. The difficulties of assaying oxytocin analogues against oxytocin (or the international standard preparation) are discussed.

Extended IL10 haplotypes and their association with HIV progression to AIDS

Interleukin-10 (IL-10) is a pleiotropic cytokine with both immunosuppressive and immunostimulatory functions. Its roles in infections and autoimmunity may have resulted in selective pressures on polymorphisms within the gene, leading to genomic coexistence of several semi-conserved haplotypes involved with diverse pathogen interactions during genomic evolution. Previous studies focused either exclusively on promoter haplotypes or on individual SNPs. We genotyped 21 single nucleotide polymorphisms in the human IL10 gene and examined this variation compared to other mammalian species sequences. Haplotype heterogeneity in human populations is centered around 'classic' 'proximal' promoter polymorphisms: -592, -819 and -1082. High-producing GCC haplotypes are by far the most numerous and diverse group, the intermediate IL-10 producing ACC-inclusive haplotypes seem to be related most closely to the ancestral haplotype, and the ATA-inclusive haplotypes cluster a separate branch with strong bootstrap support. We looked at associations of corresponding haplotypes with HIV progression. A haplotype trend regression confirmed that individuals carrying the low-producing ATA-inclusive haplotypes in European Americans progress to AIDS faster, and most likely explain the role of IL10. Our findings are consistent with the hypothesis that existing polymorphisms in this gene may reflect a balance of historic adaptive responses to autoimmune, infectious and other disease agents.

Detecting AIDS restriction genes: from candidate genes to genome-wide association discovery

The screening of common genetic polymorphisms among candidate genes for AIDS pathology in HIV exposed cohort populations has led to the description of 20 AIDS restriction genes (ARGs), variants that affect susceptibility to HIV infection or to AIDS progression. The combination of high-throughput genotyping platforms and the recent HapMap annotation of some 3 million human SNP variants has been developed for and applied to gene discovery in complex and multi-factorial diseases. Here, we explore novel computational approaches to ARG discovery which consider interacting analytical models, various genetic influences, and SNP-haplotype/LD structure in AIDS cohort populations to determine if these ARGs could have been discovered using an unbiased genome-wide association approach. The procedures were evaluated by tracking the performance of haplotypes and SNPs within ARG regions to detect genetic association in the same AIDS cohort populations in which the ARGs were originally discovered. The methodology captures the signals of multiple non-independent AIDS-genetic association tests of different disease stages and uses association signal strength (odds ratio or relative hazard), statistical significance (p-values), gene influence, internal replication, and haplotype structure together as a multi-facetted approach to identifying important genetic associations within a deluge of genotyping/test data. The complementary approaches perform rather well and predict the detection of a variety of undiscovered ARGs that affect different stages of HIV/AIDS pathogenesis using genome-wide association analyses.

A nucleic acid sequence-based amplification assay for real-time detection of norovirus genogroup II

AIMS

To use molecular beacon based nucleic acid sequence-based amplification (NASBA) to develop a rapid, sensitive, specific detection method for norovirus (NV) genogroupII (GII).

METHODS AND RESULTS

A method to detect NV GII from environmental samples using real-time NASBA was developed. This method was routinely sensitive to 100 copies of target RNA and intermittent amplification occurred with as few as 10 copies. Quantitative estimates of viral load were possible over at least four orders of magnitude.

CONCLUSIONS

The NASBA method described here is a reliable and sensitive assay for the detection of NV. This method has the potential to be linked to a handheld NASBA device that would make this real-time assay a portable and inexpensive alternative to bench-top, lab-based assays.

SIGNIFICANCE AND IMPACT OF THE STUDY

The development of the real-time NASBA assay described here has resulted in a simple, rapid (<1 h), convenient testing format for NV. To our knowledge, this is the first example of a molecular beacon based NASBA assay for NV.

Three single-nucleotide polymorphisms in LPA account for most of the increase in lipoprotein(a) level elevation in African Americans compared with European Americans

BACKGROUND

The extent which universally common or population-specific alleles can explain between-population variations in phenotypes is unknown. The heritable coronary heart disease risk factor lipoprotein(a) (Lp(a)) level provides a useful case study of between-population variation, as the aetiology of twofold higher Lp(a) levels in African populations compared with non-African populations is unknown.

OBJECTIVE

To evaluate the association between LPA sequence variations and Lp(a) in European Americans and African Americans and to determine the extent to which LPA sequence variations can account for between-population variations in Lp(a).

METHODS

Serum Lp(a) and isoform measurements were examined in 534 European Americans and 249 African Americans from the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease Study. In addition, 12 LPA variants were genotyped, including 8 previously reported LPA variants with a frequency of >2% in European Americans or African Americans, and four new variants.

RESULTS

Isoform-adjusted Lp(a) level was 2.23-fold higher among African Americans. Three single-nucleotide polymorphisms (SNPs) were independently associated with Lp(a) level (p<0.02 in both populations). The Lp(a)-increasing SNP (G-21A, which increases promoter activity) was more common in African Americans, whereas the Lp(a)-lowering SNPs (T3888P and G+1/inKIV-8A, which inhibit Lp(a) assembly) were more common in European Americans, but all had a frequency of <20% in one or both populations. Together, they reduced the isoform-adjusted African American Lp(a) increase from 2.23 to 1.37-fold(a 60% reduction) and the between-population Lp(a) variance from 5.5% to 0.5%.

CONCLUSIONS

Multiple low-prevalence alleles in LPA can account for the large between-population difference in serum Lp(a) levels between European Americans and African Americans.

Single nucleotide polymorphisms and haplotypes in the IL10 region associated with HCV clearance

Hepatitis C virus (HCV) is an infectious blood-borne pathogen that usually persists as a chronic infection. However, approximately 15% of the time, patients can clear the virus, indicating that host differences could be critical in determining the course of HCV infection. The inflammatory response is crucial to resolving or failing to resolve an acute HCV infection. Some previous reports have implicated interleukin 10 (IL10) polymorphisms with successful anti-HCV therapy and natural viral clearance. We tested 54 single nucleotide polymorphisms (SNPs) in the IL10 region (+/-300 kb and 24 within the IL10 gene itself), which contains 13 genes including the IL10 immunomodulatory paralogs IL19, IL20, and IL24, for association with HCV clearance vs persistence. SNPs from two haplotype block regions, one at IL10 and the other from IL19/IL20, were associated with HCV clearance in African Americans (91 clearance cases and 183 chronically infected matched controls; P=0.05-0.002) while with expectation-maximization algorithm-reconstructed haplotypes, these associations remained (P=0.05-0.002). However, no significant associations were detected in European Americans (108 clearance and 245 chronic). Our results indicate that variants of the immunomodulatory IL10 and IL19/IL20 genes may be involved in natural clearance of HCV in the African-American population.

Comprehensive analysis of CDKN2A (p16INK4A/p14ARF) and CDKN2B genes in 53 melanoma index cases considered to be at heightened risk of melanoma

OBJECTIVE

Comprehensive analysis of the 9p21 locus including the CDKN2A, ARF, and CDKN2B genes in 53 individuals from melanoma index cases considered to be at heightened risk of melanoma.

METHODS AND RESULTS

Using a combination of DNA sequencing, gene copy number by real time quantitative PCR, linkage analysis, and transcript analysis in haploid somatic cell hybrids, we found no evidence for germline alteration in either coding or non-coding domains of CDKN2A and CDKN2B. However, we identified a p14ARF exon 1beta missense germline mutation (G16D) in a melanoma-neural system tumour syndrome (CMM+NST) family and a 8474 bp germline deletion from 196 bp upstream of p14ARF exon 1beta initiation codon to 11233 bp upstream of exon 1alpha of p16(INK4A) in a family with five melanoma cases. For three out of 10 families with at least three melanoma cases, the disease gene was unlinked to the 9p21 region, while linkage analysis was not fully conclusive for seven families.

CONCLUSIONS

These data reinforce the hypothesis that ARF is a melanoma susceptibility gene and suggest that germline deletions specifically affecting p14ARF may not be solely responsible for NST susceptibility. Predisposition to CMM+NST could either be due to complete disruption of the CDKN2A locus or be the result of more complex genetic inheritance. In addition, the absence of any genetic alteration in 50 melanoma prone families or patients suggests the presence of additional tumour suppressor genes possibly in the 9p21 region, and on other chromosomes.

Prospective risk of cancer in CDKN2A germline mutation carriers

BACKGROUND

The CDKN2A gene is the major known high-risk melanoma susceptibility gene. Susceptibility to other cancers has also been suggested. However, most studies examining the risks of other cancers classified individuals according to the family's CDKN2A mutation rather than determining individual mutation status. For non-population-based studies, risks could also be biased because of cancer occurrence prior to family ascertainment.

METHODS

We examined the risk of non-melanoma cancer in 117 mutation-positive and 136 mutation-negative members from 15 families that had at least two first degree relatives with melanoma and CDKN2A mutations restricting the analysis to the period after the families were ascertained (that is, the prospective period) and using individual mutation data. The families have been followed prospectively for 4-26 years starting in the 1970s.

RESULTS

Overall, there was no significant association for mutation-negative subjects (Obs/Exp = 0.3, 95% confidence interval (CI) 0.0 to 1.2) although this group had only two observed cancers. In contrast, mutation-positive subjects had a significantly increased risk for all cancers combined (Obs/Exp = 12/5.5 = 2.2, 95% CI 1.1 to 3.8) primarily because of digestive system tumours, particularly pancreatic cancer. No other organ systems or individual tumour sites showed significantly increased risks.

CONCLUSIONS

Differences in CDKN2A-non-melanoma cancer associations across studies may result from variation in genetic backgrounds, insufficient follow up, misclassification of mutation carriers, or the presence of other genetic and/or environmental risk factors in both CDKN2A mutation carriers and non-carriers. Larger sample sizes, prospective follow up, and individual mutation data will be required to understand these differences.

Evaluating association and transmission of eight inflammatory genes with Viliuisk encephalomyelitis susceptibility

Since the discovery of Viliuisk encephalomyelitis (VE) in 1887, scientists have tried to understand the natural history and aetiology of this endemic neurological disorder among the native Sakha population of Central Siberia. Familial aggregation and segregation analysis suggested a genetic influence on VE incidence. However, recent studies have implicated an unknown virus, possibly from the alpha herpesvirus family, as a possible cause for this disease. As VE is a neurological disease characterized by the inflammatory reactions systematically observed in the spinocerebellar fluid and in the brain tissue of deceased patients, we examined 17 single nucleotide polymorphisms (SNPs) across seven inflammation-related candidate gene regions, including chemokine receptors type 2 and 5 (CCR2/CCR5), interferon-gamma (IFN-gamma), interleukin-4 (IL-4), IL-6, IL-10, stromal cell-derived factor (SDF) and chemokine regulated upon activation, normal T-cell expressed and presumably secreted (RANTES). Our main objective was to analyse the degree of genetic association between VE and candidate genes that have been previously implicated in other inflammatory diseases. Samples were collected from 83 affected families comprising 88 verified VE cases, 156 family members, and an additional 69 unrelated, unaffected inhabitants of the same geographical area. This collection included substantially all of the cases that are currently on the VE Registry. The experimental design included both case-control and transmission/disequilibrium test (TDT)-based familial association analyses. None of 17 SNPs analysed was significantly associated with VE occurrence. Exclusion of these eight genes based on the lack of association has important implications for identifying the disease agent, as well as prescribing therapy and understanding Viliuisk encephalomyelitis.

Fraction of cases of acquired immunodeficiency syndrome prevented by the interactions of identified restriction gene variants

Previous research has demonstrated isolated effects of host genetic factors on the progression of human immunodeficiency virus type 1 (HIV-1) infection. In this paper, the authors present a novel use of multivariable methods for estimating the prevented fraction of acquired immunodeficiency syndrome (AIDS) cases attributable to six restriction genes after accounting for their epidemiologic interactions. The methods presented will never yield a prevented fraction above 1. The study population consisted of a well-characterized cohort of 525 US men with HIV-1 seroconversion documented during follow-up (1984-1996). On the basis of a regression tree approach using a Cox proportional hazards model for times to clinical AIDS, the combinations of genes associated with the greatest protection, relative to the lack of a protective genotype, consisted of: 1) C-C chemokine receptor 5 (CCR5)-Delta 32 and C-C chemokine receptor 2 (CCR2)-64I (relative hazard = 0.44); 2) interleukin 10 (IL10)-+/+ in combination with CCR5-Delta 32 or CCR2-64I (relative hazard = 0.45); and 3) IL10-+/+ in combination with stromal-derived factor (SDF1)-3 'A and CCR5 promoter P1/approximately P1 (relative hazard = 0.37). Overall, 30% of potential AIDS cases were prevented by the observed combinations of restriction genes (95% confidence interval: 7, 47). However, the combined effect was confined to the first 4 years following HIV-1 seroconversion. Additional research is needed to identify AIDS restriction genes with stronger and long-lasting protection to better characterize the genetic epidemiology of HIV-1.

Modelling molecular mechanisms controlling sequential gene expression in differentiating mammalian enterocytes

The gut epithelium represents a continuous developmental system in which cell proliferation in intestinal crypts is followed by the sequential expression of digestive and absorptive functions as enterocytes migrate out of crypts to the tips of intestinal villi. We have developed a mathematical model in the present work to mimic these sequential aspects of enterocyte differentiation. Using this model allows the characteristics of lactase expression to be ascribed to transcriptional control. In the case of a glucose transporter, however, it became necessary to assume an additional translational control that decreased exponentially as enterocytes migrated along villi. The suggestion that this type of modelling is useful in predicting which set of enterocytes is likely to use translation or transcription to control gene expression is also discussed.

Range of motion after arthroplasty for the stiff osteoarthritic knee

In 28 of 1656 total knee arthroplasties (TKAs) (1.7%) performed for osteoarthritis at this institution, the preoperative arc of motion was 60 degrees or less (average 47.5 degrees; range, 20-60 degrees). The outcome of 22 of the 28 TKAs (21 patients) is reported at a mean follow-up of 52.9 months (range, 24-144 months). Eighty-two percent of the cases were managed with standard soft-tissue releases and posterior cruciate-retaining implants and 18% with a cruciate-substituting design. The joint score rose from 28.8 to 82.2 and the Knee Society Score from 24.6 to 77 points. The mean postoperative arc of motion improved by 46 degrees-93.5 degrees. At latest follow-up, 68.2% of knees achieved maximal flexion of 90 degrees or more. Manipulation was performed in 22.7%. Complications were minimal. A functionally useful range of motion is possible after total knee arthroplasty in the majority of stiff osteoarthritic knees, often without the need for posterior cruciate substitution.

Dopamine D(3) receptor antagonists. 1. Synthesis and structure-activity relationships of 5,6-dimethoxy-N-alkyl- and N-alkylaryl-substituted 2-aminoindans

5,6-Dimethoxy-2-(N-dipropyl)-aminoindan (3, PNU-99194A) was found to be a selective dopamine D(3) receptor antagonist with potential antipsychotic properties in animal models. To investigate the effects of nitrogen substitution on structure-activity relationships, a series of 5,6-dimethoxy-N-alkyl- and N-alkylaryl-substituted 2-aminoindans were synthesized and evaluated in vitro for binding affinity and metabolic stability. The results indicate that substitution at the amine nitrogen of the 2-aminoindans is fairly limited to the di-N-propyl group in order to achieve selective D(3) antagonists. Thus, combinations of various alkyl groups were generally inactive at the D(3) receptor. Although substitution with an N-alkylaryl or N-alkylheteroaryl group yields compounds with potent D(3) binding affinity, the D(2) affinity is also enhanced, resulting in a less than 4-fold preference for the D(3) receptor site, and no improvements in metabolic stability were noted. A large-scale synthesis of the D(3) antagonist 3 has been developed that has proven to be reproducible with few purification steps. The improvements include the use of 3,4-dimethoxybenzaldehyde as a low-cost starting material to provide the desired 5,6-dimethoxy-1-indanone 5c in good overall yield (65%) and the formation of a soluble silyl oxime 17 that was reduced efficiently with BH(3).Me(2)S. The resulting amino alcohol was alkylated and then deoxygenated using a Lewis acid and Et(3)SiH to give the desired product 3 in good overall yield of ( approximately 65%) from the indanone 5c.

Saturation mutagenesis of 5S rRNA in Saccharomyces cerevisiae

rRNAs are the central players in the reactions catalyzed by ribosomes, and the individual rRNAs are actively involved in different ribosome functions. Our previous demonstration that yeast 5S rRNA mutants (called mof9) can impact translational reading frame maintenance showed an unexpected function for this ubiquitous biomolecule. At the time, however, the highly repetitive nature of the genes encoding rRNAs precluded more detailed genetic and molecular analyses. A new genetic system allows all 5S rRNAs in the cell to be transcribed from a small, easily manipulated plasmid. The system is also amenable for the study of the other rRNAs, and provides an ideal genetic platform for detailed structural and functional studies. Saturation mutagenesis reveals regions of 5S rRNA that are required for cell viability, translational accuracy, and virus propagation. Unexpectedly, very few lethal alleles were identified, demonstrating the resilience of this molecule. Superimposition of genetic phenotypes on a physical map of 5S rRNA reveals the existence of phenotypic clusters of mutants, suggesting that specific regions of 5S rRNA are important for specific functions. Mapping these mutants onto the Haloarcula marismortui large subunit reveals that these clusters occur at important points of physical interaction between 5S rRNA and the different functional centers of the ribosome. Our analyses lead us to propose that one of the major functions of 5S rRNA may be to enhance translational fidelity by acting as a physical transducer of information between all of the different functional centers of the ribosome.

Markers for mapping by admixture linkage disequilibrium in African American and Hispanic populations

Population linkage disequilibrium occurs as a consequence of mutation, selection, genetic drift, and population substructure produced by admixture of genetically distinct ethnic populations. African American and Hispanic ethnic groups have a history of significant gene flow among parent groups, which can be of value in affecting genome scans for disease-gene discovery in the case-control and transmission/disequilibrium test designs. Disease-gene discovery using mapping by admixture linkage disequilibrium (MALD) requires a map of polymorphic markers that differentiate between the founding populations, along with differences in disease-gene allele frequencies. We describe markers appropriate for MALD mapping by assessing allele frequencies of 744 short tandem repeats (STRs) in African Americans, Hispanics, European Americans, and Asians, by choosing STR markers that have large differences in composite delta, log-likelihood ratios, and/or I*(2) for MALD. Additional markers can be added to this MALD map by utilization of the rapidly growing single-nucleotide-polymorphism databases and the literature, to achieve a 3-10-cM scanning scale. The map will be useful for studies of diseases, including prostate and breast cancer, diabetes, hypertension, and end-stage renal disease, that have large differences in incidence between the founding populations of either Hispanics or African Americans.

Cementless cup fixation in total hip arthroplasty after 5-8 years

A series of 199 total hip arthroplasties was performed using a porous-coated, hemispherical press-fit acetabular cup. At a mean follow-up of 91.5 months 158 cups were available for clinical and radiological review. The mean age of the patients at the time of the index arthroplasty was 62.5 years. The mean Harris Hip score at final follow-up was 87.3. No shells were revised although eccentric polyethylene wear prompted liner replacement in two cases. Osteolysis was noted in six cases but predominantly in relation to the femoral stem. Focal pelvic osteolytic lesions were rare. All the cups were classified as stable on radiography.

Subcellular localization and targeting of glucocorticoid receptor protein fusions expressed in transgenic Arabidopsis thaliana

An animal system of inducible activation of protein fusions with the binding domain of glucocorticoid receptor (BDGR) was tested in Arabidopsis thaliana by monitoring dexamethasone (DEX)-induced nuclear targeting of reporter constructs. Two constructs containing green fluorescent protein (GFP), human homeobox protein Hanf-1 and Xenopus laevis BDGR were used, GFP/Hanf-1/BDGR and GFP/BDGR. The control construct contained GFP alone. In the absence of DEX both fusion proteins were uniformly distributed in the cytoplasm of root cells, but showed strong association with plastids in plant aerial parts. DEX treatment of roots prompted a strong and reversible nuclear accumulation of GFP/Hanf-1/BDGR, but not GFP/BDGR. Thus, in roots, the specific nuclear translocation of GFP/Hanf-1/BDGR was driven by Hanf-1 and tightly regulated by BDGR. However, in plant aerial parts treated with DEX, nuclear translocation of GFP/Hanf-1/BDGR was observed only in a few cases, and most part of the fusion protein was incorrectly and irreversibly targeted to plastids. Protease X digestion of isolated chloroplasts showed that BDGR fusion proteins were translocated into the chloroplast envelope and bound to envelope membranes, probably due to association with the chloroplast import apparatus. Thus, for efficient use of the glucocorticoid-inducible system in plants, it will be necessary to modify BDGR structure to prevent incorrect targeting of fusion proteins.

Culture and psychopharmacology

In this brief review the authors strive to provide a broad overview of various factors that impinge on psychopharmacotherapeutic practices. The literature revealed an impressive progress in research focusing on the delineation of the biologic mechanisms responsible for cross-ethnic variations in psychotropic metabolism and effects. With the field progressing at an accelerating pace, there is little doubt that in the coming decade clinicians will be provided with a detailed map showing the prevalence and distribution of genetic polymorphisms of most, if not all, of the drug-metabolizing enzymes, and clinicians also will have an overall picture on what these polymorphisms mean clinically. At the same time, clinicians should also start to have a good grasp on the meaning of the variations of the genes that encode therapeutic targets of psychotropics (e.g., neurotransmitter transporters and receptors). Such genetic fingerprinting, which will soon become a clinical reality, will provide tremendous help in ensuring that pharmacotherapies are increasingly more individually tailored, taking into consideration each patients genetic makeups that vary substantially across ethnic groups. As exciting as these new developments will be, they are dwarfed by the challenges ahead on the cultural side of the equation. Issues that are still awaiting further clarification include the following: How do we assess patients' beliefs and expectations related to psychotropic treatment? How do we minimize the communication gaps between patients and clinicians who are often from divergent sociocultural backgrounds? To what extent, and in what ways, do cultural (environmental) factors interact with biologic factors, and what might be the most efficient way to systematically assess such interactions? Data that have emerged in the past several decades clearly indicate the importance of culture and ethnicity in influencing patients' psychopharmacological response. It is expected that continuing progress in the near future will bring a better understanding on the way these cultural and biologic processes, separately and in interaction with each other, mediate treatment responses. Such knowledge will be crucial for the optimal pharmacotherapeutic care of for the majority of patients who will increasingly be of diverse ethnic and cultural backgrounds and will represent a significant contribution to the field of psychopharmacology as a whole.

Measurement of the rate of nu(e) + d --> p + p + e(-) interactions produced by (8)B solar neutrinos at the Sudbury Neutrino Observatory

Solar neutrinos from (8)B decay have been detected at the Sudbury Neutrino Observatory via the charged current (CC) reaction on deuterium and the elastic scattering (ES) of electrons. The flux of nu(e)'s is measured by the CC reaction rate to be straight phi(CC)(nu(e)) = 1.75 +/- 0.07(stat)(+0.12)(-0.11)(syst) +/- 0.05(theor) x 10(6) cm(-2) s(-1). Comparison of straight phi(CC)(nu(e)) to the Super-Kamiokande Collaboration's precision value of the flux inferred from the ES reaction yields a 3.3 sigma difference, assuming the systematic uncertainties are normally distributed, providing evidence of an active non- nu(e) component in the solar flux. The total flux of active 8B neutrinos is determined to be 5.44+/-0.99 x 10(6) cm(-2) s(-1).

Body mass index as a predictor of outcome in total knee replacement

The clinical and radiographic outcomes of 326 total knee replacements (TKR) in 285 osteoarthritic patients with body mass index (BMI) greater than 30 kg/m2 were compared with the results of a matched group of 425 TKR in 371 patients with BMI less than 30 kg/m2. At an average follow-up of 75.9 (48-144) months the Knee Society score (KSS) in the obese patients had increased by 41.9 points, and the joint score by 43.7. In the non-obese group the KSS rose by 40.2 points and the joint score by 42.6 points. Although patients with BMI greater than 40 kg/m2 achieved a lower final KSS the 'absolute improvement' appeared to be independent of BMI. Of the obese patient group 4.9% underwent a revision of their TKR, compared with 3.1% of the non-obese group. Although linear osteolysis (radiolucency) rates were comparable, focal osteolysis rates were 5 times those of control subjects when the BMI exceeded 40 kg/m2. Ten-year survivorship figures were similar for both obese and non-obese patients.

Physician incentives and the timing of cesarean sections: evidence from California

OBJECTIVES

The timing of cesarean sections is studied to examine how physician convenience and financial incentives play a role in the decision to perform a cesarean section.

METHODS

Using birth certificate and hospital financial data from California, the likelihood of cesarean sections being performed at particular times of day was examined, controlling for maternal characteristics and the mother's insurance coverage. Two diagnoses associated with cesarean sections are examined separately: fetal distress and prolonged/dysfunctional labor. The hypotheses are that cesarean sections performed for physician convenience are more likely to occur in the evening hours and that type of insurance will affect the incentive to perform cesarean sections to obtain leisure.

RESULTS

The probability of cesarean sections for patients insured by a group-model HMO is more stable during the course of a day than that for patients insured by all other insurance plans. Group-model HMO patients with previous cesarean sections are less likely to have cesarean sections in the evening hours and are less likely to be diagnosed with fetal distress or prolonged/dysfunctional labor.

CONCLUSIONS

The differences in cesarean sections and diagnosis rates between group-model HMO patients and other patients could arise from several mechanisms: group-model HMOs provide consistent financial incentives to their staff, they may be better able to guide physician practice, and they might provide staff support to physicians so there is less leisure-based incentive to perform cesarean sections. In contrast, nongroup-model HMOs do not appear to reduce the incentive of physicians to maximize leisure relative to traditional insurance.

Polymorphisms in inflammatory cytokines and Fcgamma receptors in childhood chronic immune thrombocytopenic purpura: a pilot study

Inflammatory cytokines and low-affinity Fcgamma receptor (FcgammaR) polymorphisms were investigated in 37 children with chronic immune thrombocytopenic purpura (cITP) and 218 controls. Genotype analysis included common variants in the regulatory regions of cytokines, TNF, LTA, IL1RN, IL1A, IL1B, IL4, IL6 and IL10, and structural variants of the low affinity FcgammaRs, FCGR2A, FCGR3A and FCGR3B. Associations were observed for TNF (P = 0.0032), LTA (P = 0.019), FCGR3A (P = 0.038) and FCGR3B (P = 0.0034). Two combinations of genotypes (TNF and FCGR3A; P = 0.0003, and LTA and FCGR3B; P = 0.011) were significantly associated with cITP. These results provide preliminary evidence that variant genotypes of FcgammaRs and cytokines contribute to cITP pathogenesis.

Psychosocial Predictors of Hypertension in Men and Women

BACKGROUND

Psychosocial stressors have been shown to predict hypertension in several cohort studies; patterns of importance, sex differences, and interactions with standard risk factors have not been fully characterized.

METHODS

Among 2357 adults in a population sample of Alameda County, California, free of hypertension in 1974, 637 reported in 1994 having ever used antihypertensive medication (27.9% of the men and 26.3% of the women). The effects of baseline psychosocial, behavioral, and sociodemographic factors on the incidence of treated hypertension were examined using multiple logistic regression.

RESULTS

Low education, African American race, low occupational prestige, worry about job stability, feeling less than very good at one's job, social alienation, and depressive symptoms each had significant (P<.05) age-adjusted associations with incident hypertension. Associations were weakened by adjustment for body mass index, alcohol consumption, smoking status, and leisure time physical activity, especially the associations of anomy and depression, which persisted in women but not in men. In multivariate models, job insecurity (odds ratio, 1.6), unemployment (odds ratio, 2.7), and low self-reported job performance (odds ratio, 2.1) remained independent predictors of hypertension in men, whereas low-status work (odds ratio, 1.3) was an independent predictor of hypertension in women.

CONCLUSIONS

In the general population, low occupational status and performance and the threat or reality of unemployment increase the likelihood of developing hypertension, especially among men, independent of demographic and behavioral risk factors. Psychological distress and social alienation may also increase hypertension incidence, especially in women, chiefly through an association with health risk behaviors.

Cloud Detection and Clearing for the Earth Observing System Terra Satellite Measurements of Pollution in the Troposphere (MOPITT) Experiment

The Measurements of Pollution in the Troposphere (MOPITT) instrument, which was launched aboard the Earth Observing System (EOS) Terra spacecraft on 18 December 1999, is designed to measure tropospheric CO and CH(4) by use of a nadir-viewing geometry. The measurements are taken at 4.7 mum in the thermal emission and absorption for the CO mixing ratio profile retrieval and at 2.3 and 2.2 mum in the reflected solar region for the total CO column amount and CH(4) column amount retrieval, respectively. To achieve the required measurement accuracy, it is critical to identify and remove cloud contamination in the radiometric signals. We describe an algorithm to detect cloudy pixels, to reconstruct clear column radiance for pixels with partial cloud covers, and to estimate equivalent cloud top height for overcast conditions to allow CO profile retrievals above clouds. The MOPITT channel radiances, as well as the first-guess calculations, are simulated with a fast forward model with input atmospheric profiles from ancillary data sets. The precision of the retrieved CO profiles and total column amounts in cloudy atmospheres is within the expected ?10% range. Validations of the cloud-detecting thresholds with the moderate-resolution imaging spectroradiometer airborne simulator data and MOPITT airborne test radiometer measurements were performed. The validation results showed that the MOPITT cloud detection thresholds work well for scenes covered with more than 5-10% cloud cover if the uncertainties in the model input profiles are less than 2 K for temperature, 10% for water vapor, and 5% for CO and CH(4).

Polygenic and multifactorial disease gene association in man: Lessons from AIDS

In an age when the majority of monogenic human disease genes have been identified, a particular challenge for the coming generation of human geneticists will be resolving complex polygenic and multifactorial diseases. The tools of molecular and population genetic association have much potential as well as peril in uncovering small cryptic genetic effects in disease. We have used a candidate gene approach to identify eight distinct human loci with alleles that in different ways influence the outcome of exposure to HIV-1, the AIDS virus. The successes in these gene hunts have validated the approach and illustrate the strengths and limitations of association analysis in an actual case history. The integration of genetic associations, well-described clinical cohorts, extensive basic research on AIDS pathogenesis, and functional interpretation of gene connections to disease offers a formula for detecting such genes in complex human genetic phenotypes.

Genetic restriction of HIV-1 pathogenesis to AIDS by promoter alleles of IL10

IL10 is a powerful TH-2 cell cytokine produced by lymphoid cells that limits HIV-1 replication in vivo, ostensibly by inhibiting macrophage/monocyte and T-cell lymphocyte replication and secretion of inflammatory cytokines (IL1, TNFalpha, IL6, IL8, and IL12). A genetic epidemiological scan of patients enrolled in AIDS cohorts for candidate gene-linked short tandem repeat polymorphisms revealed significant genotype associations for HIV-1 infection and progression to AIDS with markers adjacent to and tracking (by linkage disequilibrium) common single nucleotide polymorphic variants in the IL10 promoter region. Individuals carrying the IL10-5'-592A (IL10-5'A) promoter allele possibly were at increased risk for HIV-1 infection, and once infected they progressed to AIDS more rapidly than homozygotes for the alternative IL10-5'-592 C/C (IL10-+/+) genotype, particularly in the later stages of HIV-1 infection. An estimated 25-30% of long-term nonprogressors (who avoid clinical AIDS for 10 or more years after HIV-1 infection) can be attributed to their IL10-+/+ promoter genotype. Alternative IL10 promoter alleles are functionally distinct in relative IL10 production, in retention of an avian erythroblastosis virus transcription factor recognition sequence and in binding to specific putative nuclear transcription factors, suggesting a potential mechanism whereby IL10-5'A down-regulation of inhibitory IL10 facilitates HIV-1 replication in vivo, accelerating the onset of AIDS.

Results of all-polyethylene tibial components as a cost-saving technique

Since 1992, the authors have used an all polyethylene tibial component in relatively less active patients older than 70 years of age who present for primary total knee replacement. Results of 312 knee replacements performed between March 1992 and March 1998 are presented in the hopes of showing this technique as a viable cost saving measure. Three hundred twelve primary total knee replacements were performed by the same group of surgeons. Fourteen patients died before the first year postoperative evaluation, leaving an index group of 298 knees in 231 patients. All components were evaluated using the radiographic and clinical parameters of the Knee Society. Hospital for Special Surgery scores also were calculated. All patients were given the Short Form-36 Quality of Life Assessment preoperatively and annually postoperatively. Clinical scores showed dramatic improvement. There have been three revisions (0.7%) but none were for aseptic loosening. Radiographic review revealed 295 replacements with optimum fixation. To date, no patient has osteolysis. The cost differential was significant. The use of this type of tibial component has, to date, afforded excellent clinical and radiographic results. Additional followup is needed to show the longevity of these results and to monitor wear or subsidence of these prostheses. Should these results continue to prove satisfactory in this particular group of patients with relatively low physical demands, significant cost savings may be realized.

Delayed metabolism of human brain natriuretic peptide reflects resistance to neutral endopeptidase

Metabolism of natriuretic peptides is regulated by two degradative pathways: uptake by the clearance receptor (natriuretic peptide receptor C--NPR-C) and hydrolysis by neutral endopeptidase (NEP). Affinity studies favour a dominant role of NPR-C in hormone degradation in several species but do not account for the efficacy of NEP inhibitors in vivo, nor the uniquely prolonged half life (t((1/2))) of human brain natriuretic peptide (hBNP). Postulating that (1) delayed metabolism of hBNP reflects resistance to NEP and (2) interactions between NPR-C and NEP increase enzyme activity, we have used purified ovine and human NEP, plus ovine lung plasma membranes to study the relative importance of receptor and enzyme pathways. We have also related the findings to hormone metabolism in vivo. Binding affinities of atrial natriuretic peptide (ANP), hBNP and ovine BNP (oBNP) to oNPR-C were similar (K(d)=8-16 pM). In contrast, unlike ANP and oBNP, hBNP was not significantly degraded by purified oNEP or plasma membranes. Despite similar (and high) affinity of oNPR-C for oBNP and hBNP, the t((1/2)) of hBNP (12.7 min) was more than fourfold that of oBNP (2.6 min). Although we found no evidence for receptor-enzyme interaction, our results show that the delayed metabolism of hBNP reflects resistance to NEP. These findings have important implications for future treatment strategies in human disease.

Influence of CCR5 promoter haplotypes on AIDS progression in African-Americans

OBJECTIVES

To test the hypothesis that the CCR5 promoter variants in HIV-1-infected African-Americans affect the rate of progression to AIDS and to determine the extent of linkage disequilibrium between the CCR5P1 allele and the CCR5 59029A variant (referred to here as CCR5-2459A), both of which have been shown independently to accelerate AIDS progression in Caucasians.

DESIGN

We used survival analysis to assess the effects of CCR5 promoter variants in HIV-1 seroincident Caucasians and African-Americans.

SUBJECTS AND METHODS

Genotypes were determined for 806 Caucasians and 1067 African-Americans, which included 700 seroconverters, enrolled in four HIV/AIDS natural history cohort studies. These genotypes were used to determine linkage and haplotypes for CCR2 and CCR5 alleles. Survival analysis was used to assess the effect of CCR2, CCR5, and CCR5 promoter haplotypes on progression to AIDS in seroincident African-Americans.

RESULTS

A survey of Caucasians and African-Americans demonstrated complete linkage disequilibrium between CCR5P1 and CCR5-2459A sites. The composite CCR5P1 haplotype (including the CCR5-2459A allele) is shown to be associated with rapid progression to AIDS endpoints in both African-American and Caucasian cohorts, but the effect is recessive in Caucasians and dominant in African-Americans. This is probably due to the presence of modulating genes or as yet unidentified polymorphisms that may differ between racial groups.

Short tandem repeat methodology for genotypic identification of single-person versus multi-person use of syringes

OBJECTIVE

To develop laboratory methods to differentiate between single- versus multi-person use of syringes by injection drug users.

METHODS

Forensic short tandem repeat (STR) genetic analysis was undertaken to cross-validate a test panel of trace blood contents from syringes representing single- versus multi-person syringe use. Laboratory-simulated scenarios of needle sharing generated 34 syringe washes that were blinded for evaluation. Polymerase chain reaction was used to amplify the polymorphic STR locus D6S502 from blood trace contents in used syringes. Alleles were sized and quantified using a commercial gene sequencer. A statistical algorithm was developed to determine the number of alleles present in the amplified DNA fragments. Syringes with more than two expected alleles were considered to represent multi-person syringe use. Sensitivity, specificity and the kappa coefficient were calculated.

RESULTS

Allelic matrix-based analysis of alleles from the single STR successfully characterized single-use (n = 12) and multiple-use (n = 22) syringes with 68% sensitivity and 100% specificity upon re-analysis. The extent of agreement over and above chance (kappa = 0.6; P < 0.0001) indicated good agreement for differentiating single- versus multi-person syringe use.

CONCLUSIONS

These findings suggest that improved genotypic STR analysis of syringe material could be an adjunct to methods for validating self-reported needle sharing, conducting behavioral surveillance of needle-sharing behaviors, and evaluating interventions such as needle-exchange programs. Assays based on multiple STR loci will undoubtedly improve upon the promising results obtained from laboratory simulations of needle sharing.

Cementless hemispheric acetabular component in total hip replacement

A series of 198 total hip arthroplasties was performed using a porous-coated, hemispheric press-fit cup. One hundred and twenty-seven cups were available for clinical and radiological examination at mean follow-up of 10.6 years. The mean age at the index procedure was 61.2 years. The mean Harris hip score at final follow-up was 89.8. Three cups were revised for aseptic loosening and two liners were changed for eccentric wear and pelvic osteolysis. Nine additional patients showed mild or suspected osteolysis. Two cups were rated "fibrous" stable. There was no correlation between additional screw fixation of the press-fit cup and osteolysis or revision.

Proximally porous coated femoral stem in total hip replacement--5- to 13-year follow-up report

A series of total hip replacements was performed using a proximally porous coated, tapered femoral stem system. At a mean follow-up of 8.1 (5-13) years, 80 out of 107 hips were available for clinical and radiological examination. The mean age at the index procedure was 58.6 years. The mean Harris Hip Score at final follow-up was 91.7. Radiological ingrowth was observed in 77 femoral stems, 2 stems were fibrous stable and 1 stem was loose.

The impact of the Citibank, NA, health management program on changes in employee health risks over time

This study estimated the impact of the Citibank Health Management Program on changes in health risks among Citibank employees. McNemar chi-squared tests compared the probability of being at high risk for poor health when the first and last health-risk appraisal surveys were taken. Logistic regression controlled for baseline differences in subsequent analyses when those who participated in more intensive program features were compared with those who participated in less intensive features. Declines in risk were noted for 8 of 10 risk categories. Most changes were small, except those related to exercise habits, seatbelt use, and stress levels. For nine health risk categories, those who participated in more intensive program services were significantly more likely than others to reduce their health risks. Thus, the Citibank Health Management Program was associated with significant reductions in health risk.

Explaining drug spending trends: does perception match reality?

Several recent studies have made clear that drug expenditures are rising more rapidly than other health care spending. What has not been clear, however, is how much drug spending is driven by price rather than volume and whether volume increases are appropriate. This DataWatch takes a closer look at the components and drivers of drug spending using large claims databases from managed care and employer-sponsored health benefit plans. In both environments this study found volume, not price, to be the largest driver of drug spending for seven diseases studied. For four of the diseases, we review the clinical issues that may have influenced volume growth.

Supracondylar nailing of distal periprosthetic femoral fractures

Seven patients who sustained complex distal femoral fractures above total knee arthroplasties all treated by supracondylar (retrograde) femoral nailing were retrospectively evaluated. All the patients demonstrated uncomplicated postoperative follow-ups and returned to weight bearing between 2 and 3 months after surgery. No delayed healing occurred and alignment of the femur was satisfactory.