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PubMed2000

[Interdisciplinary consensus on diagnosis and therapy of testicular tumors. Results of an update conference based on evidence-based medicine. German Testicular Cancer study Group (GTCSG)].

BACKGROUND: An "Interdisciplinary Consensus Statement on the Diagnosis and Therapy of Testicular Tumors" was prepared in 1996 by the "Interdisciplinary Testicular Tumor Working Group" (IAH) with input from representatives from diagnostic and therapeutic disciplines of various working groups of the German Cancer Society (Strahlenther Onkol 1997;173:397-406). In 1998 the IAH met again together with the "Testicular Tumor Working Party" of the Urooncology Working Group (AUO) and formed the "German Testicular Cancer Study Group" (GTCSG). Defined and accepted interdisciplinary standards from the initial meeting were revised based on current scientific developments and clinical results. This cooperating effort increased the quality of the initial recommendations and helped to put the recommendations for diagnosing and treating testicular tumor on a broader scientific basis. METHODS: According to the principles of "evidence-based medicine" (EBM), the Consensus from 1996 was modified, based on the current level of evidence from the published literature. The methodological process and evaluation criteria used were that of the "Cochrane Collaboration". RESULTS: An "Interdisciplinary Update Consensus Statement" summarizes and defines the diagnostic and therapeutic standards according to the current scientific practices in testicular cancer. For 21 separate areas scientifically based decision criteria are suggested. For treatment areas where more than one option exist without a consensus being reached for a preferred strategy, such as in seminoma in clinical Stage I or in non-seminoma Stages CS I or CS IIA/B, all acceptable alternative strategies with their respective advantages and disadvantages are presented. This "Interdisciplinary Update Consensus" was presented at the 24th National Congress of the German Cancer Society on March 21st and subsequently evaluated and approved by the various German scientific medical societies.

Evidence-Based Medicine↗
PubMed2006

Consensus guidelines on sedation and analgesia in critically ill children.

OBJECTIVE: The United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group is a multi-disciplinary expert panel created to produce consensus guidelines on sedation and analgesia in critically ill children and forward knowledge in these areas. Sedation and analgesia are recognised as important areas of critical care practice and adult clinical practice guidelines in these fields remain amongst the most popular of those produced by the Society of Critical Care Medicine. However, similar clinical practice guidelines have not previously been produced for the critically ill paediatric patient. DESIGN: A modified Delphi technique was used to allow the Working Group to anonymously consider draft recommendations in three Delphi rounds with predetermined levels of agreement. This process was supported by a total of four consensus conferences. Once consensus had been reached, a systematic review of the available literature was carried out. OUTCOME: A set of consensus guidelines was produced including 20 key recommendations, 10 relating to the provision of analgesia and 10 relating to the sedation of critically ill children. An evaluation of the existing literature supporting these recommendations is provided. CONCLUSIONS: Multi-disciplinary consensus guidelines for maintenance sedation and analgesia in critically ill children have been successfully produced and are supported by levels of evidence (excluding sedation and analgesia for procedures and excluding neonates). The working group has highlighted the paucity of high-quality evidence in these important clinical areas and this emphasises the need for further randomised clinical trials in this area.

Analgesia↗
PubMed2007

European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography.

Rapid clinical dissemination of CT colonography (CTC) is occurring in parallel with continued research into technique optimisation and diagnostic performance. A need exists therefore for current guidance as to basic prerequisites for effective clinical implementation. A questionnaire detailing CTC technique, analysis, training and clinical implementation was developed by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) CTC committee and circulated to all faculty members of previous ESGAR "hands-on" CTC training courses. Responses were collated and a consensus statement produced. Of 27 invited to participate, 24 responded. Reasonable consensus was reached on bowel preparation, colonic distension, patient positioning, use of IV contrast and optimal scan parameters. Both primary 2D and primary 3D analysis were advocated equally, with some evidence that more experienced readers prefer primary 2D. Training was universally recommended, although there was no consensus regarding minimum requirements. CTC was thought superior to barium enema, although recommended for screening only in the presence of validated local experience. There was consensus that polyps 4 mm or less could be ignored assuming agreement from local gastroenterological colleagues. There is increasing consensus amongst European experts as to the current best practice in CTC.

Advisory Committees↗
PubMed2004

Comparison of fetal heart rate baseline estimation by SisPorto 2.01 and a consensus of clinicians.

OBJECTIVE: Fetal heart rate (FHR) baseline estimation is considered one of the most difficult aspects of computer analysis of cardiotocographs, and a pre-requisite for the remaining evaluation. This study aimed at comparing FHR baselines assigned by SisPorto 2.01 with those estimated by a consensus of three clinicians. STUDY DESIGN: A prospective evaluation of 300 consecutively acquired FHR tracings was undertaken, 150 from antepartum high-risk pregnancies and 150 from unselected intrapartum cases. Tracings were presented to three experienced clinicians for individual FHR baseline estimation and were processed by the SisPorto 2.01 program. Clinicians were asked to follow a previously described baseline definition, and cases where differences in estimation exceeded 3 bpm were re-evaluated at a consensus meeting. In the remaining cases, the average of the three estimations was considered the consensus value. Agreement between SisPorto 2.01 and the consensus of clinicians was evaluated using the kappa statistic, the proportions of agreement, the intra-class correlation coefficient, and the limits of agreement. RESULTS: Differences < or =3 bpm occurred in 89% of antepartum and 81% of intrapartum cases. No differences exceeding 10 bpm occurred in the antepartum, while in the intrapartum these were found in 1% of cases. Maximum difference between computer and clinicians was 8 bpm in the antepartum and 15 bpm in the intrapartum. Kappa statistics, proportions of agreement and correlation coefficients in the antepartum were 0.97, 0.97 and 0.98, respectively. In the intrapartum, they were 0.87, 0.89 and 0.95. Limits of agreement were -3.22 and 5.22 in the antepartum (mean difference: 1.0; standard deviation: 2.16) and -6.45 and 7.07 in the intrapartum (mean difference: 0.13; standard deviation: 3.45). CONCLUSION: An excellent agreement was found between SisPorto 2.01 and a consensus of clinicians in estimation of FHR baselines both in the antepartum and in the intrapartum.

Adult↗
PubMed2006

A comparison of two consensus methods for classifying morbidities in a single professional group showed the same outcomes.

OBJECTIVE: To investigate whether consensus differs when reached by the Nominal or the Delphi method. STUDY DESIGN AND SETTING: Seventeen general practices from North Staffordshire, England were randomly allocated to Delphi (postal feedback only) or Nominal group (also had group discussion). General practitioners classified 56 morbidities according to four scales of severity (chronicity, time course, health care use, patient impact) in two consensus rounds. Consensus outcomes were assessed by between-group comparison of severity scores at baseline and follow-up rounds, and consensus process by within-group change in the variance of severity scores between the two rounds. RESULTS: Consensus rounds were completed by 21 out of 35 Nominal GPs and 23 out of 43 Delphi GPs. Baseline scores for three of the four severity scales were significantly higher for Nominal compared to Delphi GPs, but there were no differences at follow-up. Between the two rounds, variance reduced within the Nominal and Delphi group, respectively, by 61% and 35% (chronicity), 40% and 62% (time course), 42% and 36% (health care use), and 19% and 38% (patient impact). CONCLUSION: The Nominal and Delphi methods did not result in different outcomes and we conclude that either method can be used in health services research.

Consensus↗
PubMed2004

Detection of HIV-1-specific CTL responses in Clade B infection with Clade C Peptides and not Clade B consensus peptides.

The variability of HIV-1 sequences within and between persons in vivo complicates immunologic screening with a fixed sequence, and using peptides based on consensus sequences therefore has become a common practice for pathogenesis and vaccine studies. Here, we screen a cohort of HIV-1-infected persons in the United States for CD8+ T lymphocyte (CTL) responses using Gag peptides based on the Clade C primary isolate DU422 and the consensus sequence for Clade B. Surprisingly, the DU422 and Clade B consensus peptides are similar in sensitivity, but many responses are detected only by one set or the other. About equal numbers of discordantly detected responses are specific to consensus Clade B peptides as DU422 peptides. A minority of discordant detection is due to the varying frames of the peptide sets and therefore a technical artifact; the majority is due to sequence differences. This lack of superiority of the Clade B consensus peptides to detect CD8+ T lymphocyte responses is an unexpected finding that suggests that detection of HIV-1-specific cellular immunity with these peptides may be significantly insensitive and raises questions as to whether screening with a single sequence adequately reflects responses to the viral swarm in vivo.

Adult↗
PubMed2003

A structured literature review to determine the use of the American Society for Therapeutic Radiology and Oncology consensus definition of biochemical failure.

OBJECTIVES: The American Society for Therapeutic Radiology and Oncology consensus definition (ACD) of biochemical failure after radiotherapy for prostate cancer requires three consecutive prostate-specific antigen increases from a nadir value. The members of the Consensus Panel recognized that the timing and frequency of prostate-specific antigen determinations could affect the comparability among different reports if this definition was used. For this reason, the Consensus Panel members recommended three guidelines for studies presented for publication (publication guidelines [PGs]). The present analysis examined the extent to which the ACD has been used in the peer-reviewed published literature and how frequently the PGs have been followed. METHODS: A structured literature review of 10 relevant journals was done. The inclusion criteria for the literature review required publication in calendar year 1999 or 2000; treatment with external beam radiotherapy and/or brachytherapy for previously untreated, nonmetastatic prostate cancer; and the use of a prostate-specific antigen-defined disease-free endpoint. A standardized checklist was created and completed by both of the authors. We independently reviewed each publication to determine whether the ACD of biochemical failure was used and whether the PGs were followed. Discrepancies between us were resolved by joint review of each publication in question to achieve a consensus. RESULTS: Fifty-seven articles met the inclusion criteria. The median number of patients in the articles reviewed was 302 (range 22 to 2222). The ACD was followed in 37 (64.9%) of 57 articles. None of the reviewed articles followed all three PGs. In five articles (8.7%), two of the three PGs were followed. The vast majority of the articles reviewed (52 of 57, 91.3%) followed one or none of the PGs recommended by the Consensus Panel. CONCLUSIONS: The ACD was used in two thirds of peer-reviewed published articles. The PGs were followed much less frequently. Consistent standards of reporting have not been uniformly applied to peer-reviewed manuscripts.

Brachytherapy↗
PubMed2002

Development of a list of consensus-approved clinical indicators of preventable drug-related morbidity in older adults.

BACKGROUND: Older patients (aged >65 years) may experience drug-related problems that, if unrecognized, can result in drug-related morbidities (DRMs). According to the literature, 49% to 76% of all DRMs may be preventable; however, there is little consensus as to which are preventable and which are not. OBJECTIVE: The aim of this study was to develop consensus-approved clinical indicators of preventable DRM (PDRM) in older adults. Geriatricians, clinical pharmacologists, general practitioners, and clinical pharmacists were included in the consensus-building process. METHODS: In 2001, a survey containing potential indicators of PDRM was prepared based on previous research and the input of 2 clinical pharmacists. The survey was administered concurrently via the Delphi technique to 2 separate specialist panels (6 geriatricians and 6 clinical pharmacologists) to generate clinical indicators of PDRMs in older adults. Subsequently, a focus group of 12 general practitioners (GPs) assessed these PDRM indicators in Nova Scotia, Canada. RESULTS: The specialist panels generated 58 consensus-approved clinical indicators of PDRMs in older adults after 2 rounds of the Delphi technique. The GPs agreed with 52 (90%) of these PDRM indicators. CONCLUSIONS: This study generated consensus-approved indicators of PDRMs in older adults, which could be used by health professionals to identify patients at risk for PDRMs. The indicators could also have a role in quality measurement systems and in epidemiologic research. Furthermore, the indicators could complement existing clinical indicators and establish an important link between patterns of care and clinical outcomes.

Adult↗
PubMed2000

The consensus concept for thermostability engineering of proteins.

Previously, sequence comparisons between a mesophilic enzyme and a more thermostable homologue were shown to be a feasible approach to successfully predict thermostabilizing amino acid substitutions. The 'consensus approach' described in the present paper shows that even a set of amino acid sequences of homologous, mesophilic enzymes contains sufficient information to allow rapid design of a thermostabilized, fully functional variant of this family of enzymes. A sequence alignment of homologous fungal phytases was used to calculate a consensus phytase amino acid sequence. Upon construction of the synthetic gene, recombinant expression and purification, the first phytase obtained, termed consensus phytase-1, displayed an unfolding temperature (T(m)) of 78.0 degrees C which is 15-22 degrees C higher than the T(m) values of all parent phytases used in its design. Refinement of the approach, combined with site-directed mutagenesis experiments, yielded optimized consensus phytases with T(m) values of up to 90.4 degrees C. These increases in T(m) are due to the combination of multiple amino acid exchanges which are distributed over the entire sequence of the protein and mainly affect surface-exposed residues; each individual substitution has a rather small thermostabilizing effect only. Remarkably, in spite of the pronounced increase in thermostability, catalytic activity at 37 degrees C is not compromised. Thus, the design of consensus proteins is a potentially powerful and novel alternative to directed evolution and to a series of rational approaches for thermostability engineering of enzymes and other proteins.

6-Phytase↗
PubMed2001

Differential crosstalk between estrogen receptor (ER)alpha and ERbeta and the thyroid hormone receptor isoforms results in flexible regulation of the consensus ERE.

Crosstalk between nuclear receptors is important for conversion of external and internal stimuli to a physiologically meaningful response by cells. Previous studies from this laboratory have demonstrated crosstalk between the estrogen (ER) and thyroid hormone receptors (TR) on two estrogen responsive physiological promoters, the preproenkephalin and oxytocin receptor gene promoter. Since ERalpha and ERbeta are isoforms possessing overlapping and distinct transactivation properties, we hypothesized that the interaction of ERalpha and beta with the various TR isoforms would not be equivalent. To explore this hypothesis, the consensus estrogen response element (ERE) derived from the Xenopus vitellogenin gene is used to investigate the differences in interaction between ERalpha and beta isoforms and the different TR isoforms in fibroblast cells. Both the ER isoforms transactivate from the consensus ERE, though ERalpha transactivates to a greater extent than ERbeta. Although neither of the TRbeta isoforms have an effect on ERalpha transactivation from the consensus ERE, the liganded TRalpha1 inhibits the ERalpha transactivation from the consensus ERE. In contrast, the liganded TRalpha1 facilitates ERbeta-mediated transactivation. The crosstalk between the TRbeta isoforms with the ERalpha isoform, on the consensus ERE, is different from that with the ERbeta isoform. The use of a TRalpha1 mutant, which is unable to bind DNA, abolishes the ability of the TRalpha1 isoform to interact with either of the ER isoforms. These differences in nuclear receptor crosstalk reveal an important functional difference between isoforms, which provides a novel mechanism for neuroendocrine integration.

Animals↗
PubMed2001

The application of a Dutch consensus diagnostic strategy for pulmonary embolism in clinical practice.

In The Netherlands, the 'Dutch consensus strategy' was formulated in 1993 as a diagnostic strategy for patients with suspected pulmonary embolism. Four years after its introduction, the application of this strategy was investigated. A questionnaire was sent to the hospital management and the departments of internal medicine and pulmonology of all Dutch hospitals. In total, 384 questionnaires were sent out. The response rates of the internists and pulmonologists were 63 and 65%, respectively. The specialists reported to have followed the consensus strategy in 75% of the patients seen the month prior to the questionnaire. However, analysis of only the last patient with the suspicion of pulmonary embolism revealed that the consensus strategy was followed in 55 of the 162 patients. As well, an overuse and an underuse of the different diagnostic facilities was documented. Furthermore almost a quarter of the patients were treated without an ascertained diagnosis, whereas 11% were not treated despite an improper exclusion of venous thrombo-embolism. Compared to a survey in 1994, the use of the 'Dutch consensus strategy' has not improved dramatically. In 34% of the patients, the consensus strategy was strictly followed (i.e. without any additional investigation); however in 67% of the patients a proper diagnosis was achieved. In any diagnostic strategy, two aspects should be considered. First the availability of the different facilities. Second the acceptance of the strategy by the physicians, involved in the diagnosis of patients with clinically suspected pulmonary embolism.

Algorithms↗
PubMed2003

Delphi as a method to establish consensus for diagnostic criteria.

BACKGROUND/OBJECTIVES: To achieve a consensus, among a panel of experts, on the best clinical criteria for the clinical diagnosis of carpal tunnel syndrome (CTS). METHODS: Experts rated the diagnostic importance of items from the clinical history and physical examination for CTS. The ratings were expressed on a 10-cm visual analog scale. The average and standard deviation of the scores for each item were returned to the panelists. The panel members evaluated the items a second time with knowledge of the group responses from the first round. The scores were standardized to minimize scaling variations and, after the second round, the items were ranked in order of importance assigned by the group. Cronbach's alpha was used as a measure of homogeneity for the rankings. Increasing homogeneity was considered to be an indication of consensus among the panelists. RESULTS: Cronbach's alpha increased from 0.86 after the first round to 0.91 after the second iteration. Panelists who were relative outliers on the first round demonstrated a much higher correlation with the entire group after the second round. CONCLUSIONS: Delphi is an effective method of establishing consensus for certain clinical questions. Cronbach's alpha was a useful statistic for measuring the extent of consensus among the panel members. Delphi was chosen from the possible methods of group process because of its inherent feasibility. The absence of a need by the panelists to meet in person removed any constraint on the geographic location of the panel members. In addition, the anonymous nature of Delphi was thought to be a key factor in avoiding a result that might be skewed by one or more persuasive panelists. Both of these characteristics were felt to be particularly important to the topic on which consensus was sought, the clinical diagnostic criteria for CTS. This movement in the opinions of some of the panelists appeared to result from the feedback of information describing the group opinion.

Carpal Tunnel Syndrome↗
PubMed2001

The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.

OBJECTIVE: i) To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians towards the recognition, assessment and management of dementing disorders; ii) to disseminate and evaluate the impact of these statements and guidelines built on these statements. OPTIONS: Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral; management of complications (especially behaviour problems and depression) and use of cognitive enhancing agents. POTENTIAL OUTCOMES: Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations, neuroimaging and referrals; appropriate use of cognitive enhancing agents. EVIDENCE: Authors of each background paper were entrusted to: perform a literature search, discover additional relevant material including references cited in retrieved articles; consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based upon this evidence, consensus statements were developed by a group of experts, guided by a steering committee of eight individuals from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems. VALUES: Recommendations have been developed with particular attention to the context of primary care and are intended to support family physicians in their ongoing assessment and care of patients with dementia. BENEFITS, HARMS AND COSTS: Potential for improved clinical care of individuals with dementia. A dissemination and evaluation strategy will attempt to measure the impact of the recommendations. RECOMMENDATIONS: See text. VALIDATION: Four other sets of consensus statements and/or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by relevant bodies in Canada.

Aged↗
PubMed2001

Recommendations of the Canadian Consensus Conference on Dementia--dissemination, implementation, and evaluation of impact.

BACKGROUND: Subsequent to the development of consensus statements on a clinical topic, it is vital to establish a plan for dissemination, implementation and evaluation of impact. Consensus statements can be used for both guiding continuing medical education (CME) and producing clinical practice guidelines (CPGs). Insufficient attention to dissemination can lead to a failure to change physician behaviour and improve patient outcomes. METHODS: A plan to disseminate the conclusions of the Canadian Consensus Conference on Dementia (CCCD) was developed. This plan was based on a literature review of CME and CPGs. A Medline search was performed on the dissemination and evaluation of the 1989 Canadian Consensus Conference on the Assessment of Dementia (CCCAD) and other published guides for physicians on dementia care. CCCD dissemination that has occurred to date (June, 2000) was reviewed in this paper. RESULTS: Lectures and unsolicited printed material are weak forms of CME. Small-group interactive CME that provides practice opportunities appears to be the most effective way to change physician behaviour. The ability of CPGs to change physician behaviour is uncertain. It appears that inadequate attention has been placed on CPG dissemination and implementation. The CCCAD had a modest impact on clinical practice in Canada. While dissemination of the conclusions of the CCCD has taken place, evaluation of the impact of the CCCD has yet to be done. Local initiatives utilizing the conclusions of the CCCD are on-going. CONCLUSIONS: Further work is needed on how to optimize the impact of consensus statements and CPGs. While dissemination of the CCCD has occurred, it is currently unknown whether it has led to any change in physician practices.

Canada↗
PubMed2000

What drove changes in the use of breast conserving surgery since the early 1980s? The role of the clinical trial, celebrity action and an NIH consensus statement.

BACKGROUND: Three important events in the history of breast cancer treatment occurred between 1983 and 1995: a large clinical trial, first lady Nancy Reagan's choice of mastectomy and the publishing of an NIH consensus statement. OBJECTIVE: To assess the effects of these events on use of breast conserving surgery (BCS). RESEARCH DESIGN: Data from the cohort study of the surveillance, epidemiology and end results (SEER) Program from 1983 to 1995 were divided into four periods: Baseline, Trial, Celebrity, and Consensus. SUBJECTS: Of the women, 169,466 diagnosed with early stage breast cancer in nine SEER areas. MEASURES: Monthly percentages of BCS. RESULTS: A linear regression model generated a separate intercept and slope term for four time periods, adjusting for demographic characteristics of breast cancer patients. For the Baseline, Celebrity and Consensus Periods, slopes indicated an increasing use of BCS which varied between 0.24% and 0.28% per month. Slopes for these three periods were not statistically different (p = 0.120). In contrast, there was no change in use of BCS during the trial period (p = 0.247). We tested the magnitude of discontinuity between periods. At the beginning of the trial, celebrity and consensus periods, there were increases in BCS of 5.54% (p < 0.001), -3.55% (p < 0.001), and 2.37% (p < 0.001), respectively. CONCLUSIONS: The use of BCS was substantially affected by the reports of a clinical trial of BCS and by celebrity action. These effects were abrupt but transient. The NIH consensus statement stimulated a small change in use of BCS and may be an important intervention for maintaining the increasing trend in use of BCS since the 1990s.

Adult↗
PubMed2001

Effect of a consensus statement on initial treatment for traumatic dental injuries.

The aim of this study was to investigate the influence of a consensus statement on dental practitioners' choice of initial treatment for traumatic dental injuries. Dental practitioners working at government dental clinics in eight cluster sample regions of mainland Tanzania were requested to participate in the study; that is, to record the treatment they provided to children aged 1-17 years seeking dental consultation after injury for a period of 12 months. Six months after the beginning of data collection, a consensus statement was introduced. After the dental practitioners received the consensus statement, the correct treatment they provided increased from 51% to 57%. The unnecessary treatments increased from 54% to 59%, while wrong treatments decreased from 55% to 42%. Only a small improvement was observed in the percentage of correct treatments, but there was a slightly significant improvement in the percentage of wrong treatments provided before and after introduction of the consensus statement. We conclude that the consensus statement had a slight influence on the dental practitioners' choice of initial treatment for dental trauma in the desired direction.

Adolescent↗
PubMed2007

What do you learn about someone over time? The relationship between length of acquaintance and consensus and self-other agreement in judgments of personality.

Theory and research examining length of acquaintance and consensus among personality judgments have predominantly examined each dimension of personality separately. In L. J. Cronbach's (1955) terminology, this trait-centered approach combines consensus on elevation, differential elevation, and differential accuracy in personality judgments. The current article extends D. A. Kenny's (1991, 1994) weighted average model (WAM)--a theoretical model of the factors that influence agreement among personality judgments--to separate out two of Cronbach's components of consensus: stereotype accuracy and differential accuracy. Consistent with the predictions based on the WAM, as length of acquaintance increased, self-other agreement and consensus differential accuracy increased, stereotype accuracy decreased, and trait-level or raw profile correlations generally remained unchanged. Discussion focuses on the conditions under which a relationship between length of acquaintance and consensus and self-other agreement among personality evaluations emerges and how impressions change over time.

Adult↗
PubMed1997

Identification and functional significance of a new class of non-consensus-type plastid promoters.

The promoter regions of most plastid transcription units have been reported to consist of prokaryotic -10 and -35-like consensus sequences. However, a few promoters with no homology to the consensus elements have also been characterized. A novel class of non-consensus plastid promoters--designated as non consensus type II (NC-II) promoters--that effect low-level constitutive expression of respective genes in photosynthetic as well as non-photosynthetic plastids is described in this paper. The abundance of NC-II promoter-derived transcripts remains unaltered even when light-grown seedlings are shifted to the dark. In contrast, transcripts from -10 and -35-like elements containing consensus type (CT) promoters accumulate to high levels in chloroplasts as compared with non-photosynthetic plastids of roots and cultured cells. Moreover, accumulation of these transcripts is greatly affected by light. The inhibition of plastid protein synthesis has no apparent effect on the abundance of the NC-II transcripts whereas levels of CT transcripts are greatly reduced. In vivo tagetitoxin (a plastid transcription inhibitor) treatment also reduces the levels of CT transcripts with no apparent inhibitory effect on the accumulation of NC-II transcripts. The accumulation of transcripts from both classes of promoters, however, is reduced when cytoplasmic protein synthesis is inhibited by in vivo treatment with cycloheximide. The results are suggestive of the possible existence of at least two distinctive systems for the synthesis and/or maintenance of plastid transcripts which differentiate between two classes of transcripts in a promoter-type specific manner.

Base Sequence↗