Mutation protocols share with sexual reproduction the physiological role of producing genetic variation within 'constraints that deconstrain'

Because the universe of possible DNA sequences is inconceivably vast, organisms have evolved mechanisms for exploring DNA sequence space while substantially reducing the hazard that would otherwise accrue to any process of random, accidental mutation. One such mechanism is meiotic recombination. Although sexual reproduction imposes a seemingly paradoxical 50% cost to fitness, sex evidently prevails because this cost is outweighed by the advantage of equipping offspring with genetic variation to accommodate environmental vicissitudes. The potential adaptive utility of additional mechanisms for producing genetic variation has long been obscured by a presumption that the vast majority of mutations are deleterious. Perhaps surprisingly, the probability for adaptive variation can be increased by several mechanisms that generate mutations abundantly. Such mechanisms, here called 'mutation protocols', implement implicit 'constraints that deconstrain'. Like meiotic recombination, they produce genetic variation in forms that minimize potential for harm while providing a reasonably high probability for benefit. One example is replication slippage of simple sequence repeats (SSRs); this process yields abundant, reversible mutations, typically with small quantitative effect on phenotype. This enables SSRs to function as adjustable 'tuning knobs'. There exists a clear pathway for SSRs to be shaped through indirect selection favouring their implicit tuning-knob protocol. Several other molecular mechanisms comprise probable components of additional mutation protocols. Biologists might plausibly regard such mechanisms of mutation not primarily as sources of deleterious genetic mistakes but also as potentially adaptive processes for 'exploring' DNA sequence space.

Sodium Bicarbonate and Time-to-Exhaustion Cycling Performance: A Retrospective Analysis Exploring the Mediating Role of Expectation

BACKGROUND

Research has shown that ingesting 0.3 g·kg^-1 body mass sodium bicarbonate (NaHCO₃) can improve time-to-exhaustion (TTE) cycling performance, but the influence of psychophysiological mechanisms on ergogenic effects is not yet understood.

OBJECTIVE

This study retrospectively examined whether changes in TTE cycling performance are mediated by positive expectations of receiving NaHCO₃ and/or the decline in blood bicarbonate during exercise.

METHODS

In a randomised, crossover, counterbalanced, double-blind, placebo-controlled design, 12 recreationally trained cyclists (maximal oxygen consumption, 54.4 ± 5.7 mL·kg·min^-1) performed four TTE cycling tests 90 min after consuming: (1) 0.3 g·kg^-1 body mass NaHCO₃ in 5 mL·kg^-1 body mass solution, (2) 0.03 g·kg^-1 body mass sodium chloride in solution (placebo), (3) 0.3 g·kg^-1 body mass NaHCO₃ in capsules and (4) cornflour in capsules (placebo). Prior to exercise, participants rated on 1-5 Likert type scales how much they expected the treatment they believe had been given would improve performance. Capillary blood samples were measured for acid-base balance at baseline, pre-exercise and post-exercise.

RESULTS

Administering NaHCO₃ in solution and capsules improved TTE compared with their respective placebos (solution: 27.0 ± 21.9 s, p = 0.001; capsules: 23.0 ± 28.1 s, p = 0.016). Compared to capsules, NaHCO₃ administered via solution resulted in a higher expectancy about the benefits on TTE cycling performance (Median: 3.5 vs. 2.5, Z = 2.135, p = 0.033). Decline in blood bicarbonate during exercise was higher for NaHCO₃ given in solution compared to capsules (2.7 ± 2.1 mmol·L^-1, p = 0.001). Mediation analyses showed that improvements in TTE cycling were indirectly related to expectancy and decline in blood bicarbonate when NaHCO₃ was administered in solution but not capsules.

CONCLUSIONS

Participants' higher expectations when NaHCO₃ is administered in solution could result in them exerting themselves harder during TTE cycling, which subsequently leads to a greater decline in blood bicarbonate and larger improvements in performance.

KEY POINTS

Ingesting 0.3 g·kg^-1 body mass sodium bicarbonate in solution and capsules improved time-to-exhaustion cycling performance Positive expectancy about the benefits of sodium bicarbonate and decline in blood bicarbonate were higher when sodium bicarbonate was administered in solution compared with capsules Improvements in time-to-exhaustion cycling performance for sodium bicarbonate administered in solution were related to expectancy and the enhanced extracellular buffering response.

A Double-Blind, Randomized, Placebo-Controlled Pilot Study examining an Oxygen Nanobubble Beverage for 16.1-km Time Trial and Repeated Sprint Cycling Performance

There is growing interest of ergogenic aids that deliver supplemental oxygen during exercise and recovery, however, breathing supplemental oxygen via specialist facemasks is often not feasible. Therefore, this study investigated the effect of an oxygen-nanobubble beverage during submaximal and repeated sprint cycling. In a double-blind, randomized, placebo-controlled study, 10 male cyclists (peak aerobic capacity, 56.9 ± 6.1 mL·kg-1·min-1; maximal aerobic power, 385 ± 25 W) completed submaximal or maximal exercise after consuming an oxygen-nanobubble (O2) or placebo (PLA) beverage. Submaximal trials comprised 30-min of steady-state cycling at 60% peak aerobic capacity and 16.1-km time-trial (TT). Maximal trials involved 4 × 30 s Wingate tests interspersed by 4-min recovery. Time-to-completion during the 16.1-km TT was 2.4% faster after O2 compared with PLA (95% CI = 0.7-4.0%, p = 0.010, d = 0.41). Average power for the 16.1-km TT was 4.1% higher for O2 vs. PLA (95% CI = 2.1-7.3%, p = 0.006, d = 0.28). Average peak power during the repeated Wingate tests increased by 7.1% for O2 compared with PLA (p = 0.002, d = 0.58). An oxygen-nanobubble beverage improves performance during submaximal and repeated sprint cycling, therefore may provide a practical and effective ergogenic aid for competitive cyclists.

Effects of post-exercise sodium bicarbonate ingestion on acid-base balance recovery and time-to-exhaustion running performance: a randomised crossover trial in recreational athletes

This study investigated the effect of post-exercise sodium bicarbonate (NaHCO₃) ingestion on acid-base balance recovery and time-to-exhaustion (TTE) running performance. Eleven male runners (stature, 1.80 ± 0.05 m; body mass, 74.4 ± 6.5 kg; maximal oxygen consumption, 51.7 ± 5.4 mL·kg^-1·min^-1) participated in this randomised, single-blind, counterbalanced and crossover design study. Maximal running velocity (v-V̇O_2max) was identified from a graded exercise test. During experimental trials, participants repeated 100% v-V̇O_2max TTE protocols (TTE1, TTE2) separated by 40 min following the ingestion of either 0.3 g·kg^-1 body mass NaHCO₃ (SB) or 0.03 g·kg^-1 body mass sodium chloride (PLA) at the start of TTE1 recovery. Acid-base balance (blood pH and bicarbonate, HCO₃^-) data were studied at baseline, post-TTE1, after 35 min recovery and post-TTE2. Blood pH and HCO₃^- concentration were unchanged at 35 min recovery (p > 0.05), but HCO₃^- concentration was elevated post-TTE2 for SB vs. PLA (+2.6 mmol·L^-1; p = 0.005; g = 0.99). No significant differences were observed for TTE2 performance (p > 0.05), although a moderate effect size was present for SB vs. PLA (+14.3 s; g = 0.56). Post-exercise NaHCO₃ ingestion is not an effective strategy for accelerating the restoration of acid-base balance or improving subsequent TTE performance when limited recovery is available. Novelty: Post-exercise sodium bicarbonate ingestion did not accelerate the restoration of blood pH or bicarbonate after 35 min. Performance enhancing effects of sodium bicarbonate ingestion may display a high degree of inter-individual variation. Small-to-moderate changes in performance were likely due to greater up-regulation of glycolytic activation during exercise.

A small dose of whey protein co-ingested with mixed-macronutrient breakfast and lunch meals improves postprandial glycemia and suppresses appetite in men with type 2 diabetes: a randomized controlled trial

Background

Large doses of whey protein consumed as a preload before single high-glycemic load meals has been shown to improve postprandial glycemia in type 2 diabetes. It is unclear if this effect remains with smaller doses of whey co-ingested at consecutive mixed-macronutrient meals. Moreover, whether hydrolyzed whey offers further benefit under these conditions is unclear.

Objective

The aim of this study was to investigate postprandial glycemic and appetite responses after small doses of intact and hydrolyzed whey protein co-ingested with mixed-nutrient breakfast and lunch meals in men with type 2 diabetes.

Design

In a randomized, single-blind crossover design, 11 men with type 2 diabetes [mean ± SD age: 54.9 ± 2.3 y; glycated hemoglobin: 6.8% ± 0.3% (51.3 ± 3.4 mmol/mol)] attended the laboratory on 3 mornings and consumed 1) intact whey protein (15 g), 2) hydrolyzed whey protein (15 g), or 3) placebo (control) immediately before mixed-macronutrient breakfast and lunch meals, separated by 3 h. Blood samples were collected periodically and were processed for insulin, intact glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP), leptin, peptide tyrosine tyrosine (PYY3-36), and amino acid concentrations. Interstitial glucose was measured during and for 24 h after each trial. Subjective appetite was assessed with the use of visual analog scales.

Results

Total postprandial glycemia area under the curve was reduced by 13% ± 3% after breakfast following the intact whey protein when compared with control (P < 0.05). Hydrolyzed whey attenuated early glucose after breakfast when compared with control (P < 0.05). Glycemia was improved postlunch after the intact whey protein only when compared with control (P < 0.05). Greater satiety was observed after the intact whey protein only after both meals when compared with control (P < 0.05). Insulin concentrations increased after both the intact and hydrolyzed whey protein, showing strong positive correlations with increases in valine and isoleucine (P < 0.05). Incretin and appetite regulatory hormone responses were similar across trials (P > 0.05).

Conclusions

The consumption of a small 15-g dose of intact whey protein immediately before consecutive mixed-macronutrient meals improves postprandial glycemia, stimulates insulin release, and increases satiety in men with type 2 diabetes. This trial was registered at www.clinicialtrials.gov as NCT02903199.

THE ORIGIN OF AN ORGAN: PHYLOGENETIC ANALYSIS OF EVOLUTIONARY INNOVATION IN THE DIGESTIVE TRACT OF FLIES (INSECTA: DIPTERA)

The cardia, a prominent digestive tract organ consisting of several specialized cell types, occurs throughout the "higher" or muscoid flies, division Schizophora of order Diptera. Phylogenetic analysis of cellular organization in 65 insect species from 36 families indicates that this organ originated within the order Diptera from ancestrally undifferentiated tissues. "Lower" flies, suborder "Nematocera," display little or no epithelial cell specialization at the corresponding site. Scorpionflies of the outgroup order Mecoptera are similarly unspecialized. Intermediate levels of cellular specialization occur in Tabanomorpha, Asilomorpha and Aschiza, dipteran taxa that diverge between "Nematocera" and Schizophora. The distribution of epithelial characteristics suggests that the cardia evolved through a sequence of simple tissue transformations, combining changes in epithelial configuration with local differentiation of cell structure and function. The evolution of locally specialized cell types implies the emergence of structural genes and regulatory mechanisms through the modification of an ancestral genome that had not supported such extensive differentiation. Comparison of localized gene expression in Drosophila melanogaster with that in other fly species having greater or lesser degrees of cell specialization may provide a practical model system for studying specific patterns of mutation associated with such evolutionary innovation.

Indirect selection of implicit mutation protocols

A hypothesis that mutability evolves to facilitate evolutionary adaptation is dismissed by many biologists. Their skepticism is based on a theoretical expectation that natural selection must minimize mutation rates. That view, in turn, is historically grounded in an intuitive presumption that "the vast majority of mutations are harmful." But such skepticism is surely misplaced. Several highly mutagenic genomic patterns, including simple sequence repeats, and transposable elements, are integrated into an unexpectedly large proportion of functional genetic loci. Because alleles arising within such patterns can retain an intrinsic propensity toward a particular style of mutation, natural selection that favors any such allele can indirectly favor the site's mutability as well. By exploiting patterns that have produced beneficial alleles in the past, indirect selection can encourage mutation within constraints that reduce the probability of deleterious effect, thereby shaping implicit "mutation protocols" that effectively promote evolvability.

Evolution of simple sequence repeats as mutable sites

Because natural selection is commonly presumed to minimize mutation rates, the discovery of mutationally unstable simple sequence repeats (SSRs) in many functional genomic locations came as a surprise to many biologists. Whether such SSRs persist in spite of or because of their intrinsic mutability-whether they constitute a genetic burden or an evolutionary boon--remains uncertain. Two contrasting evolutionary explanations can be offered for SSR abundance. First, suppressing the inherent mutability of repetitive sequences might simply lie beyond the reach of natural selection. Alternatively, natural selection might indirectly favor SSRs at sites where particular repeat-number variants have provided positive contributions to fitness. Indirect selection could thereby shape SSRs into "tuning knobs" that facilitate evolutionary adaptation by implementing an implicit protocol of incremental adjustability. The latter possibility is consistent with deep evolutionary conservation of some SSRs, including several in genes with neurological and neurodevelopmental function.

The complete genomes of Staphylococcus aureus bacteriophages 80 and 80α--implications for the specificity of SaPI mobilization

Staphylococcus aureus pathogenicity islands (SaPIs) are mobile elements that are induced by a helper bacteriophage to excise and replicate and to be encapsidated in phage-like particles smaller than those of the helper, leading to high-frequency transfer. SaPI mobilization is helper phage specific; only certain SaPIs can be mobilized by a particular helper phage. Staphylococcal phage 80α can mobilize every SaPI tested thus far, including SaPI1, SaPI2 and SaPIbov1. Phage 80, on the other hand, cannot mobilize SaPI1, and ϕ11 mobilizes only SaPIbov1. In order to better understand the relationship between SaPIs and their helper phages, the genomes of phages 80 and 80α were sequenced, compared with other staphylococcal phage genomes, and analyzed for unique features that may be involved in SaPI mobilization.

Has Simple Sequence Repeat Mutability Been Selected to Facilitate Evolution?

While adaptation and speciation begin with heritable variation, the underlying processes of mutation remain poorly understood. One particularly interesting source for prolific and adaptively meaningful variation is presented by the exceptionally high mutability of simple sequence repeats (SSRs: microsatellites and minisatellites). Frequent mutations at SSR sites alter the number of tandem repeats and create extensive polymorphism. Although most SSR variants are commonly presumed to be neutral, SSR variation has been shown to influence many biochemical, morphological, physiological, and behavioral characters, with at least a few examples offering evidence of response to selection. The type and degree of phenotypic variation depend upon each SSR's motif and on its location in exon, intron, or regulatory region, but the generation of abundant repeat-number variation is intrinsic to all of these repetitive sequences. Given the widespread distribution of SSRs within most genomes and their potential to modify almost any aspect of gene function, we believe that SSR mutability can facilitate evolutionary adaptation. Furthermore, we argue that the properties of SSRs allow natural selection to favor, indirectly, the mutability of these sites, in contrast to a conventional expectation that selection normally minimizes mutation rates by balancing the cost of deleterious mutations against the cost of replication fidelity. We believe that SSR mutability is not an "accident" of DNA replication, but has been adjusted and selected for this role. SSRs thus have a true biological function as general-purpose "tuning knobs" whereby mutations provide reversible adjustment for many quantitative and qualitative traits.

Simple sequence repeats as advantageous mutators in evolution

Simple sequence repeats (SSRs) often serve to modify genes with which they are associated. The influence of SSRs on gene regulation, transcription and protein function typically depends on the number of repeats, while mutations that add or subtract repeat units are both frequent and reversible. SSRs thus provide a prolific source of quantitative and qualitative variation. Over the past decade, researchers have found that this spontaneous variation has been tapped by natural and artificial selection to adjust almost every aspect of gene function. These studies support the hypothesis that SSRs, by virtue of their special mutational and functional qualities, have a major role in generating the genetic variation underlying adaptive evolution.

The costs and effects of introducing selectively trained radiographers to an A&E reporting service: a retrospective controlled before and after study

The costs and effects of introducing selectively trained radiographers reporting accident and emergency (A&E) radiographs of the appendicular skeleton in a district general hospital were assessed using a retrospective controlled before and after design. Reference standard reports were compared with a random stratified sample of 200 A&E and 200 general practitioner (GP) reports before and after the intervention. GP reports were used as a non-intervention, non-equivalent control group. An A&E specialist registrar judged whether incorrect A&E reports might have a clinically important effect on patient management. The effect of incorrect A&E reports on outcome was assessed by patient re-attendance to the hospital because of missed abnormalities. The annual, average and incremental costs of radiographers and radiologists reporting A&E radiographs were calculated and a sensitivity analysis was undertaken. The introduction of the radiographers resulted in a 1% (95% CI -7.9 to 5.9) fall in A&E radiograph reporting accuracy and 11% (95% CI -33.7 to 11.3) reduction of cases in which incorrect A&E reports might have a clinically important effect on patient management. Only two A&E reports (one before and one after the intervention) affected patient outcome in that a fracture missed at the first visit resulted in patient re-attendance to the X-ray Department. There was a saving of 361 pounds per annum to the X-ray Department. In conclusion this study provides further evidence that selectively trained radiographers can accurately report A&E plain radiographs and at no additional cost.

Radiographers and radiologists reporting plain radiograph requests from accident and emergency and general practice

AIM

To assess selectively trained radiographers and consultant radiologists reporting plain radiographs for the Accident and Emergency Department (A&E) and general practitioners (GPs) within a typical hospital setting.

METHODS

Two radiographers, a group of eight consultant radiologists, and a reference standard radiologist independently reported under controlled conditions a retrospectively selected, random, stratified sample of 400 A&E and 400 GP plain radiographs. An independent consultant radiologist judged whether the radiographer and radiologist reports agreed with the reference standard report. Clinicians then assessed whether radiographer and radiologist incorrect reports affected confidence in their diagnosis and treatment plans, and patient outcome.

RESULTS

For A&E and GP plain radiographs, respectively, there was a 1% (95% confidence interval (CI) -2 to 5) and 4% (95% CI -1 to 8) difference in reporting accuracy between the two professional groups. For both A&E and GP cases there was an 8% difference in the clinicians' confidence in their diagnosis based on radiographer or radiologist incorrect reports. For A&E and GP cases, respectively, there was a 2% and 8% difference in the clinicians' confidence in their management plans based on radiographer or radiologist incorrect reports. For A&E and GP cases, respectively, there was a 1% and 11% difference in effect on patient outcome of radiographer or radiologist incorrect reports.

CONCLUSION

There is the potential to extend the reporting role of selectively trained radiographers to include plain radiographs for all A&E and GP patients. Further research conducted during clinical practice at a number of sites is recommended.

Accident and emergency and general practitioner plain radiograph reporting by radiographers and radiologists: a quasi-randomized controlled trial

Two specially trained radiographers at York District Hospital have been reporting appendicular plain radiograph X-ray examinations for Accident and Emergency (A&E) patients since February 1995. This study explores the potential for further expanding their reporting role. This was achieved by assessing the two radiographers' and a group of consultant radiologists' ability to report on a retrospectively selected random stratified sample of 400 A&E and General Practitioner (GP) plain radiograph X-ray examinations for all body areas. Using receiver operating characteristic (ROC) curve analyses there was no statistically significant difference at the 5% level between the area under the ROC curves for the radiographers and consultant radiologists when reporting A&E or GP plain radiographs. It may be feasible to expand the reporting role of suitably trained radiographers to include plain radiograph X-ray examinations for all A&E patients and for GP patients, with no detriment to the quality of reports.

Electron beam computed tomographic scanning in preventive medicine

Undetected coronary atherosclerosis is present in the majority of patients suffering myocardial infarction or sudden death. Electron beam computed tomography affords noninvasive scanning of the heart to detect and measure coronary calcification. These data permit dramatically improved assessment of both short-term and future risk for cardiac and other events. Knowledge of this risk gives the physician an opportunity for timely and cost-effective interventions.

Dynamically heterogenous partitions and phylogenetic inference: an evaluation of analytical strategies with cytochrome b and ND6 gene sequences in cranes

ki ctes over whether molecular sequence data should be partitioned for phylogenetic analysis often confound two types of heterogeneity among partitions. We distinguish historical heterogeneity (i.e., different partitions have different evolutionary relationships) from dynamic heterogeneity (i.e., different partitions show different patterns of sequence evolution) and explore the impact of the latter on phylogenetic accuracy and precision with a two-gene, mitochondrial data set for cranes. The well-established phylogeny of cranes allows us to contrast tree-based estimates of relevant parameter values with estimates based on pairwise comparisons and to ascertain the effects of incorporating different amounts of process information into phylogenetic estimates. We show that codon positions in the cytochrome b and NADH dehydrogenase subunit 6 genes are dynamically heterogenous under both Poisson and invariable-sites + gamma-rates versions of the F84 model and that heterogeneity includes variation in base composition and transition bias as well as substitution rate. Estimates of transition-bias and relative-rate parameters from pairwise sequence comparisons were comparable to those obtained as tree-based maximum likelihood estimates. Neither rate-category nor mixed-model partitioning strategies resulted in a loss of phylogenetic precision relative to unpartitioned analyses. We suggest that weighted-average distances provide a computationally feasible alternative to direct maximum likelihood estimates of phylogeny for mixed-model analyses of large, dynamically heterogenous data sets.

Formalin instillation for refractory radiation-induced hemorrhagic proctitis. Report of 16 patients

PURPOSE

Our goal was to evaluate use of topical (4 percent) formalin in management of radiation-induced hemorrhagic proctitis, refractory to other methods of treatment. Specifically, we wished to determine its safety, ability to stop bleeding, and complications associated with therapy.

METHODS

Sixteen patients with radiation-induced hemorrhagic proctitis were treated with topical (4 percent) formalin. All had been previously treated with conservative regimens such as cautery, topical steroids, or laser, but these had failed. Five-hundred milliliters (ml) of a 4 percent formalin solution was instilled into the rectum in 50-ml aliquots. Each aliquot was kept in contact with rectal mucosa for approximately 30 seconds. Treatments were performed under local anesthesia in nine patients, sedation only in four, spinal in two, and general in one patient.

RESULTS

In 12 patients, bleeding stopped after a single formalin instillation; in 3, bleeding was considerably reduced but continued sporadically. One patient required three treatments before bleeding stopped. Four patients developed postoperative anal pain, of which one also had significant tenesmus and reduced capacity. Of these four patients, only two had significant anal pain and fissures that lasted longer than one month.

CONCLUSIONS

Topical (4 percent) formalin is safe and effective in treatment of radiation-induced hemorrhagic proctitis. A single treatment will stop bleeding in 75 percent of patients.

Molecular divergence and phylogeny: rates and patterns of cytochrome b evolution in cranes

Analyses of complete cytochrome b sequences from all species of cranes (Aves: Gruidae) reveal aspects of sequence evolution in the early stages of divergence. These DNA sequences are > or = 89% identical, but expected departures from random substitution are evident. Silent, third-position pyrimidine transitions are the dominant substitution type, with transversion comprising only a small fraction of sequence differences. Substitution patterns are not clearly manifested until divergence has reached a moderate level (> 3%), as expected for a stochastic process. Variation in the frequency of mismatch types among lineages decreases at larger divergences, but the level of bias does not decay. Divergence varies up to fivefold among gene regions but is not correlated with structural domain. All protein structural domains except extramembrane 4 display < 20% variable residues. Regions corresponding to putative functional domains show the excepted conservation of amino acids, although the C-terminal portion of the Q0 reaction center displays several nonconservative replacements. Phylogenetic analyses incorporating substitution asymmetries produced mixed results. Distances estimated with multiple parameters (transition, codon-position, composition, and pyrimidine-transition biases) yielded identical additive tree topologies with comparable bootstrap values, all consistent with uncontroversial species relationships. Maximum likelihood analysis incorporating these biases, as well as equally weighted parsimony analysis, produced similar results. Static, differential weighting for parsimony did not improve the phylogenetic signal but produced unusual trees with low bootstraps. The overall rate of nucleotide substitution varies slightly but significantly among cranes, and calibration of distances against fossil dates suggests divergence rates of 0.7%-1.7% per million years.

Magnetic resonance imaging of juxta-articular myxoma

We have described the MRI features of a juxta-articular myxoma. The imaging features are similar to those of intramuscular myxoma. The lesions are differentiated by their location.

Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods

This audit analysed the Tanner and Whitehouse II twenty bone (TW2) method of bone age assessment which was used in our department, and compared it with the Greulich and Pyle (GP) method. 50 previous bone ages were independently re-calculated by each of three registrars using both techniques, with the time taken to perform each assessment being recorded. For each method the interobserver variation was analysed in terms of the spread of results. The intraobserver variation in TW2 was determined by comparing the bone age originally reported with that subsequently calculated on the same film by the same registrar. The average spread of results was 0.74 years for TW2 method, and 0.96 years for the GP method and this difference is not statistically significant at the 5% level. The average intraobserver variation to TW2 was 0.33 years, but with 95% confidence limits of -0.87 to +1.53 years. The average time taken was 7.9 min for TW2 and 1.4 min for GP assessments. It was concluded that the GP method gave similar reproducibility and was faster than the TW2 method. Following clinical discussion the routine departmental bone age assessment method was changed from the TW2 to the GP method.

Interdisciplinary perceptions of the dietitian's legal responsibility for lethal dietary prescription errors for patients with end-stage renal disease

OBJECTIVE

To determine intergroup and intragroup consensus for interdisciplinary perceptions of dietitians' legal responsibility for lethal dietary prescription errors.

DESIGN

Survey research was conducted by a mail questionnaire containing four hypothetical cases in which the dietitian provides a lethal amount of dietary potassium for an anephric patient.

SETTING

Of the 90 New York State end-stage renal disease facilities contacted, 64 returned one or more questionnaires.

SUBJECTS/SAMPLES

Usable questionnaires were tabulated from 51 registered dietitians, 39 registered head nurses, and 43 physician-medical directors.

MEASURES

Consensus was recognized when 60% or more of the responses occurred in one extreme collapsed and dichotomized category of "yes" or "no" regarding the dietitian's legal responsibility.

STATISTICAL ANALYSES PERFORMED

Intergroup and intragroup consensus levels were compared by frequency, mean, standard deviation, and Scheffe test of differences.

RESULTS

The triad groups met varying levels of consensus on all four scenarios, with dissenting opinions by nurses on two scenarios. The dietitians and the physician-medical directors had mirror-image perceptions that the dietitian was not legally accountable for two cases of following foreseeably lethal dietary prescriptions "as written." Eight dietitians viewed the dietitian as legally nonculpable for causing a patient's death because of the dietitian's sole incompetence or carelessness in making a serious calculation error. Nurses met the highest levels of agreement and perceived the dietitian to be legally accountable for all four cases. The nurses, in contrast to the dietitians and physician-medical directors, held opinions of dietitian legal responsibility as consistent with the standard of care expectations of prudent health care professionals defined by professional malpractice jurisprudence.

APPLICATIONS/CONCLUSIONS

The data indicate that to protect both the patient and the professional, there is a notable need for greater understanding dietetics jurisprudence.

Religion and health relationships: A review

This review examines various studies showing the relation between religiosity (religious beliefs and/or practices) and health. It also includes church attendance and its relation to drug use. The role of the church in health promotion is discussed, with examples of church intervention model programs. Several attempts have been made to measure religiosity and religious commitment, but as yet little has been done to identify specific dimensions of religion as they relate to health behaviors. Even though the literature indicates that religion is generally associated with health behaviors, health status, and longevity, further research on the specifics of this relationship is needed.

Combined exfoliation and pigment dispersion syndrome

Both exfoliation syndrome and pigmentary dispersion syndrome can lead to secondary glaucoma. We treated five patients who had pigmentary dispersion and who subsequently developed exfoliation. In one patient who had bilateral pigment dispersion syndrome, the presence of exfoliation increased the difficulty of controlling intraocular pressure in the affected eye. In a monocular patient, exfoliation and pigmentary dispersion were concurrently present with characteristic defects of both pigmentary dispersion and exfoliation as seen by transillumination defects of the iris. A third patient had bilateral pigmentary dispersion and uncontrollable intraocular pressure in an eye with exfoliation. Despite argon laser trabeculoplasty, the pressure remained uncontrolled. Another patient had a filtering operation in the left eye, with gradually increasing intraocular pressure in the right eye. Exfoliation material complicated the pressure control in the unoperated on eye. Another patient had an eight-year history of glaucoma in the left eye for which filtering surgery was performed. Exfoliation was present in both eyes with controlled pressure in the filtered eye but uncontrolled pressure in the nonfiltered eye.

Phylogenetic diversity of cellular organization in the cardia of muscoid flies (Diptera: Schizophora)

In each of 30 dipteran species, representing 13 acalyptrate and 7 calyptrate families, the cardia is formed from specialized cells at the junction between foregut and midgut. Foregut epithelium forms the stomodeal valve; midgut epithelium envelops the valve to form the cardia's outer wall. Cytological characteristics within these epithelia differ from region to region and from species to species. Since the cardia secretes the peritrophic membrane, cardias with diverse patterns of cellular differentiation may be expected to produce peritrophic membranes with similarly diverse properties. Close relatives often share more details of cardia structure than do distantly related taxa. Within the monophyletic Calyptratae, a common pattern of cellular differentiation includes three distinct zones of columnar midgut cells enclosing a flanged stomodeal valve. Among species in the paraphyletic Acalyptratae, midgut typically includes a single zone of tall columnar cells, while the valve may be spheroidal, cylindrical, conical, or flanged. The correlation of phylogenetic distance with divergence in cardia organization implies a strong influence of ancestry upon current structure, regardless of current diet. However, at least some of the observed diversity in cardia structure is associated with dietary divergence. Calyptrate flies with derived blood-feeding behavior display cellular differentiation that is simplified from that seen in calyptrate relatives with less specialized feeding habits. This evolutionary modification suggests that cardia organization and hence peritrophic membrane structure can adapt to dietary changes, with possible significance for the spatial organization of digestive processes and interactions with ingested microorganisms.

Cellular organization and peritrophic membrane formation in the cardia (proventriculus) of Drosophila melanogaster

The peritrophic membrane of Drosophila melanogaster consists of four layers, each associated with a specific region of the folded epithelial lining of the cardia. The epithelium is adapted to produce this multilaminar peritrophic membrane by bringing together several regions of foregut and midgut, each characterized by a distinctively differentiated cell type. The very thin, electron-dense inner layer of the peritrophic membrane originates adjacent to the cuticular surface of the stomadeal valve and so appears to require some contribution by the underlying foregut cells. These foregut cells are characterized by dense concentrations of glycogen, extensive arrays of smooth endoplasmic reticulum, and pleated apical plasma membranes. The second and thickest layer of the peritrophic membrane coalesces from amorphous, periodic acid-Schiff-positive material between the microvilli of midgut cells in the neck of the valve. The third layer of the peritrophic membrane is composed of fine electron-dense granules associated with the tall midgut cells of the outer cardia wall. These columnar cells are characterized by cytoplasm filled with extensive rough endoplasmic reticulum and numerous Golgi bodies and by an apical projection filled with secretory vesicles and covered by microvilli. The fourth, outer layer of the peritrophic membrane originates over the brush border of the cuboidal midgut cells, which connect the cardia with the ventriculus.

On neuronal homology: a comparison of similar axons in Musca, Sarcophaga, and Drosophila (Diptera: Schizophora)

Thoracic axons occurring in Musca and Sarcophaga are similar to those previously reported in the giant fiber pathway of Drosophila. Serial section reconstruction of both species has shown that the cervical giant fiber descending from the brain into the thoracic ganglion and the thoracic motor axon innervating the tergotrochanteral muscle follow courses matching those of similar axons in Drosophila. Likewise in both Musca and Sarcophaga a thoracic axon establishes axoaxonal synapses onto dorsal longitudinal muscle motor neurons. This axon is similar in both course and synaptic configuration to the peripherally synapsing interneuron in Drosophila. Although these similarities suggest that the three axon pairs are homologous in all three fly species, Several differences are also observed. Thus this system of identified axons may be a useful model for investigating phylogenetic variation in specific neuronal form and connectivity.

Anatomy of the giant fibre pathway in Drosophila. I. Three thoracic components of the pathway

Activity in the flight muscles and jump muscles in Drosophila can be stimulated by excitation of a pair of giant fibres that enter the thoracic ganglion from the brain. Contrary to previous descriptions, these giant fibres are not themselves motor axons. Each giant fibre contacts both a large motor axon and an interneuron. The motor axon innervates the ipsilateral tergotrochanteral (jump) muscle. The interneuron synapses in turn with the motor neurons that innervate the contralateral dorsal longitudinal flight muscle. The output synapses of this interneuron occur directly onto the motor axons within a peripheral nerve. The unusual peripheral location for these interneuron synapses suggests that the interneuron may function to speed up activation of the motor axons by bypassing integration within the motor neurons' dendritic trees. The synapses are typical dipteran chemical synapses, with occasional reciprocal contacts from the motor axons back onto the interneuron. The interneuron-motor axon synapses may be especially useful for morphological studies of identified synaptic contacts because their peripheral location makes them extremely easy to locate and identify.

Superimposition reformatted CT for preoperative lesion localization and surgical planning

With computer reformatting techniques, it is possible to project any lesion into its proper position with respect to the reformatted midsagittal computed tomography (CT) plane, the reformatted biparietal CT plane, or any other useful reference plane. The calvarial contour depicted on the reformatted midsagittal CT image is exactly comparable to the calvarial contour seen on a true lateral skull radiograph, and the calvarial contour depicted on the reformatted biparietal CT image is exactly comparable to the biparietal calvarial contour seen on the standard frontal skull radiograph. Using simple geometric proportions, therefore, it is easy to transfer the projection of a lesion from the reformatted images onto true lateral and frontal skull radiographs to provide neurosurgeons and radiotherapists with frontal and lateral pictures of the lesion and the skull suitable for planning surgical incisions and radiation portals.

Choice of electrode in electromyography of the external urethral and anal sphincters

The needle, anal and catheter methods of performing simultaneous cystometry and pelvic floor electromyography were compared in 29 patients. Urethral sphincter electromyographic recordings consistently were satisfactory with a needle electrode, whereas the catheter surface electrode caused recording artifacts and was fragile. Anal sphincter electromyography was more reliable with a needle electrode than with an anal surface electrode.

Computed tomography of the lumbar thecal sac

With a high resolution modification of a translate--rotate body scanner (EMI CT5005), radiologists may now demonstrate the epidural fat, thecal sac, and axillary pouches of the lower thoracic, lumbar, and sacral spinal canal without using contrast agents. Preliminary results with a newer rotary motion scanner (EMI CT7070) suggest that this scanner achieves sequally good delineation of intracanalicular anatomy.

Development of high resolution computed tomography of the spinal cord

Computed tomography of the spinal cord was a natural development of total body scanning. Much time and effort was spent in order to visualize the spinal cord and the various conditions affecting it. This was achieved by using an EMI CT5005 scanner and a series of step by step modifications and improvements to obtain a very high degree of resolution. The large variety of intraspinal lesions seen at the Montreal Neurological Hospital allowed us, by selecting appropriate cases, to determine the value of CT of the spinal cord.

Anal stimulating electrodes in electromyography

The Continaid pelvic floor stimulating electrode is useful in reception of electromyographic signals, a use for which the device was not originally conceived. I believe there is money to be saved and some clinical problems can be avoided when this plug is substituted for some others now in clinical use.

Ureteroneocystostomy for bilateral ureteral obstruction in carcinoma of prostate

"Fish-mouth" ureteroneocystostomy was successful in a patient with bilateral ureteral obstruction secondary to locally invasive adenocarcinoma of the prostate. The complications of permanent intubation are avoided and renal function is restored.

Embryonal rhabdomyosarcoma of the prostate

Embryonal rhabdomyosarcoma of the prostate is typically a rare mesenchymal tumor of young boys, presenting with obstructive urinary symptoms or an abdominal mass. The origin is probably in undifferentiated mesenchymal cells that persist into adult life. Histologically, the tumor cells resemble normal muscle development in a 7 to 10-week fetus. Treatment is combined radical surgery and chemotherapy, and usually radiotherapy as well. The prognosis is extremely poor in all patients. Our case is added to the few in the literature in which this disease occurred in a man more than 50 years old.