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Limited-field radiation therapy in the management of early-stage breast cancer.

BACKGROUND: Several phase III trials have demonstrated equivalent long-term survival between breast conserving surgery plus radiation therapy and mastectomy in patients with early-stage breast cancer but have not provided information on the optimal volume of breast tissue requiring post-lumpectomy radiation therapy. Therefore, we examined the 5-year results of a single institution's experience with radiation therapy limited to the region of the tumor bed (i.e., limited-field radiation therapy) in selected patients treated with breast-conserving therapy and compared them with results of matched breast-conserving therapy patients who underwent whole-breast radiation therapy. METHODS: A total of 199 patients with early-stage breast cancer were treated prospectively with breast-conserving therapy and limited-field radiation therapy using interstitial brachytherapy. To compare potential differences in local recurrence rates based on the volume of breast tissue irradiated, patients in the limited-field radiation therapy group were matched with 199 patients treated with whole-breast radiation therapy. Match criteria included tumor size, lymph-node status, patient age, margins of excision, estrogen receptor status, and use of adjuvant tamoxifen therapy. Local-regional control and disease-free and overall survival were analyzed using the Kaplan-Meier method, and the statistical significance of differences between treatment groups was calculated using the log-rank test. All statistical tests were two-sided. RESULTS: Median follow-up for surviving patients was 65 months (range = 12-115 months). Five ipsilateral breast failures (i.e., recurrences) were observed in patients treated with limited-field radiation therapy. The cumulative incidence of local recurrence was 1% (95% confidence interval [CI] = 0% to 2.8%). On matched-pair analysis, the rate of local recurrence was not statistically significantly different between the patient groups (1% [95% CI = 0% to 2.4%] for the whole-breast radiation therapy patients versus 1% [95% CI = 0% to 2.8%] for the limited-field radiation therapy patients; P =.65). CONCLUSIONS: Limited-field radiation therapy administered to the region of the tumor bed has comparable 5-year local control rates to whole-breast radiation therapy in selected patients.

Adult↗

Vascular access survival and morbidity on daily dialysis: a comparative analysis of home and limited care haemodialysis.

BACKGROUND: Concerns about vascular access failure may have limited the widespread use of daily haemodialysis (DHD). We assessed the incidence and type of vascular access complications during DHD and other schedules, both at home and on limited care haemodialysis. METHODS: All patients were treated in a limited care and home haemodialysis unit with a stable caregiver team (November 1998-November 2002). Vascular access failure, surgical treatment, angioplasty and declotting were studied alone or in combination by univariate and multivariate models. We analysed the effects of age, sex, comorbidity, previous vascular events, schedule, setting of treatment (home, limited care), dialysis follow-up, vascular access (native vs prosthetic, first vs subsequent) and setting of vascular access creation. 'Intention to treat' and 'per protocol' analyses were performed. RESULTS: In 2160 patient-months (home dialysis: DHD 400 months, non-DHD 655 months; limited care: DHD 208 months; non-DHD 897 months), 57 adverse events occurred (27 failures), in which 30 were at home (nine DHD) and 27 were in limited care (five DHD). The probability of remaining free from adverse events at 6 and 12 months was 89% and 80% on DHD and 79% and 76% on other schedules ('intention to treat'). Univariate analyses revealed a significant difference for the setting of the vascular access creation (lower risk of vascular access complications in our centre) and sex (male sex was protective). Logistic regression and Cox analyses confirmed the role for the setting of the vascular access creation. CONCLUSIONS: Although DHD did not appear as a risk factor for vascular access morbidity or failure at home or in a limited care centre setting, the setting of vascular access creation may influence its success.

Adult↗

Selection of dichotomy limits for multifactorial prediction of arrhythmic events and mortality in survivors of acute myocardial infarction.

AIMS: To evaluate the predictive value and optimum dichotomy limits for different combinations of prognostic indicators for the prediction of arrhythmic events and cardiac mortality in post-infarction patients. BACKGROUND: Studies of new interventions based on risk stratification after myocardial infarction have often used a single variable as a predictor of risk. However, whether the dichotomy limits of these single variables, derived from univariate analyses, should be altered when such variables are combined for the prediction of risk after myocardial infarction has not been examined. METHODS: Left ventricular ejection fraction, signal-averaged electrocardiography, heart rate variability index, mean heart rate and ventricular extrasystole frequency were recorded pre-discharge in 439 survivors of their first myocardial infarction. Arrhythmic events and cardiac mortality were recorded during 1 year (range 1-6 years) follow-up. RESULTS: During follow-up for at least 1 year, there were 25 cardiac deaths and 23 arrhythmic events. Different optimum dichotomy limits were obtained for the prediction of cardiac mortality vs arrhythmic events, for different combinations of variables, for different selected levels of sensitivity and for different numbers of variables abnormal before identification of those at risk. The dichotomy limit of the heart rate variability index for the prediction of events appeared to be the least affected by the inclusion of other variables. For example, when predicting arrhythmic events using combinations of left ventricular ejection fraction and/or heart rate variability, the optimum dichotomy limits when each variable was used alone was 32% and 18 units respectively; 43% and 18 units when either left ventricular ejection fraction or heart rate variability are required to be abnormal, and 52% and 19 units when both are required to be abnormal before identification of those at risk of arrhythmic events. CONCLUSIONS: Dichotomy limits derived from univariate analyses do not optimally predict events when used in the multivariate setting. Risk stratification can be improved by using several variables in combination and is further improved by using dichotomy limits of these variables which are different from those used in or derived from univariate analyses.

Aged↗

Influence of background exposure on detection and determination limits for a TL dosimetry system based on LiF:Mg,Cu,P(GR-200A).

Thermoluminescence dosemeters are widely used to monitor personal doses. For these low dose range applications, it is important to determine the detection limit L(D) and the determination limit L(Q) of the dosimetric system. The influence of background exposure on these limits for LiF:Mg,Cu,P(GR-200A) based TL dosimetry was investigated. Both the conventional analysis and the glow curve analysis methods were used to determinate these limits. The detection limit L(D) was compared with the recording level and the investigation level. A systematic error can occur in the occupational dose evaluation when the detection limit L(D) is more than the recording level. It was found that the L(D) of the dosimetric system-based LiF:Mg,Cu,P(GR-200A) was less than the recording level for exposure time tau > or = 10 days considering an annual dose limit of 1 mSv for the public recommended in ICRP Publication 60.

Air↗

Quantifying stomatal and non-stomatal limitations to carbon assimilation resulting from leaf aging and drought in mature deciduous tree species.

Gas exchange techniques were used to investigate light-saturated carbon assimilation and its stomatal and non-stomatal limitations over two seasons in mature trees of five species in a closed deciduous forest. Stomatal and non-stomatal contributions to decreases in assimilation resulting from leaf age and drought were quantified relative to the maximum rates obtained early in the season at optimal soil water contents. Although carbon assimilation, stomatal conductance and photosynthetic capacity (V(cmax)) decreased with leaf age, decreases in V(cmax) accounted for about 75% of the leaf-age related reduction in light-saturated assimilation rates, with a secondary role for stomatal conductance (around 25%). However, when considered independently from leaf age, the drought response was dominated by stomatal limitations, accounting for about 75% of the total limitation. Some of the analytical difficulties associated with computing limitation partitioning are discussed, including path dependence, patchy stomatal closure and diffusion in the mesophyll. Although these considerations may introduce errors in our estimates, our analysis establishes some reasonable boundaries on relative limitations and shows differences between drought and non-drought years. Estimating seasonal limitations under natural conditions, as shown in this study, provides a useful basis for comparing limitation processes between years and species.

Journal Article↗

The collisional limit: an important consideration for membrane-associated enzymes and receptors.

Because of the proximity of many bound receptors or enzymes, a membrane surface may become uniformly reactive so that every collision between a ligand and the membrane particle results in a binding or catalytic event. At this limit (the collisional limit), the reaction rate depends on membrane particle (cell) concentration and is independent of receptor concentration. Many receptor systems display properties that satisfy the requirements of a collisionally limited reaction. These include the presence of many receptors per cell. The filling of only a few of these receptors often generates the maximum cellular response, and the remaining receptors have been referred to as spare receptors. However, many receptors are needed to produce the collisional limit, and spare receptors may represent nature's evolution toward a reaction that provides the maximum rate as well as the maximum sensitivity to a ligand. Since receptors or enzymes provided on small membrane fragments will not function at the collisional limit, properties of reconstituted enzymes or receptors may not be extrapolated to the physiological situation. The use of normal bimolecular kinetic or equilibrium equations is inappropriate for reactions limited by collision and can give unusual results that lead to inappropriate conclusions. Determination of whether the collisional limit applies to a membrane-bound system is important for understanding its properties and those of the physiological circumstance.

Animals↗

Health effects relevant to the setting of EMF exposure limits.

To date, electric and magnetic exposure limits for frequencies below 100 kHz have been based on vaguely defined neurobiological responses to electric fields induced in tissues in vivo by magnetic fields and on perceptual responses to external electric fields. Advances in tissue dosimetry, risk assessment methods, and biological research on stimulation thresholds and mechanisms are providing new bases for exposure limits. This paper reviews the historical basis for current electric and magnetic exposure limits in preparation for the development of the "next generation" of electric and magnetic occupational and public exposure guidelines. This is followed by an overview of reported neurobiological effects of electric and magnetic stimulation that should be considered in new exposure guidelines. For magnetic fields, there is stronger evidence for setting exposure limits to protect against adverse effects of nerve stimulation than for protecting against visual magnetophosphenes. Magnetophosphenes are not adverse, and the evidence that these perceptual responses of the eye are a precursor or surrogate for other adverse neurologic responses is weak. Rather than relying just on theoretical models to set exposure limits, data from human subjects exposed to pulsed magnetic fields should be used to estimate nerve stimulation thresholds. Such data can provide a solid basis for setting magnetic field exposure limits if uncertainties in the data and inter-individual variability are addressed. Research on sensory perception, spontaneous and evoked potentials, and epidemiologic studies of neuropsychiatric conditions in electric and magnetic exposed populations does not suggest a need for lower exposure limits. However, a report that a 60-mT magnetic field (below the threshold for peripheral nerve stimulation) produces prolonged alterations of brain excitability and "indisposure" of subjects should be investigated in future research.

Biophysical Phenomena↗

Relationship between prolonged and self-limited photoparoxysmal responses and seizure incidence: study and review.

Photoparoxysmal responses (PPRs) are generalized epileptiform abnormalities occurring during photic stimulation. Prolonged PPRs, which outlast the stimulus, can be distinguished from self-limited PPRs, which cease spontaneously or when the flashes stop. Reilly and Peters (1973) found a higher incidence of seizures in patients with prolonged, rather than self-limited, PPRs. More recently, Jayakar and Chiappa (1990) reported a similar seizure incidence in the prolonged and self-limited groups. In order to assess these discordant results, we reviewed EEG records performed in our laboratory from 1983 to 1988. Sixty-eight EEGs had PPRs (19 prolonged and 49 self-limited). Patients with PPRs had a significantly higher incidence of seizures than controls (total patients versus controls, p less than 0.001; prolonged subgroup compared to controls, p less than 0.001; self-limited subgroup versus controls, p less than 0.01). Comparing PPR groups, we found that a prolonged PPR was associated with a higher incidence of seizures than a self-limited response (p less than 0.05); however, patients with a prolonged PPR more often had other epileptiform abnormalities than the self-limited group (p less than 0.001). There was no difference in seizure incidence between the PPR groups when comparing patients whose EEGs also contained other epileptiform abnormalities. Meta-analysis suggests apparent differences among the three studies are superficial.

Adolescent↗

Effect of limited and standard reaming on cortical bone blood flow and early strength of union following segmental fracture.

OBJECTIVE: To quantitatively determine the extent to which limited and standard intramedullary reaming disrupts cortical circulation and to evaluate the effect on the biomechanical properties of the united fracture. DESIGN: Midshaft tibial osteotomies to create a 2.5-centimeter segment of diaphyseal bone were performed in ten adult dogs. Before insertion of a locked intramedullary nail, the tibia was reamed to either 7.0 millimeters (n = 5) or 9.0 millimeters (n = 5). Blood flow was measured using laser Doppler flowmetry during the nailing procedure and at eleven weeks postnailing. Bending stiffness and load to failure were determined for each healed tibia. RESULTS: Tibial blood flow was reduced for the limited and the standard ream groups by 63 percent (p = 0.002) and 83 percent (p = 0.0008), respectively. After canal reaming, perfusion was reduced to a greater extent in the standard ream group (p = 0.009). At eleven weeks postnailing, tibial perfusion increased to the same levels in both groups (p = 0.43) and returned to base-line values. Bending stiffness and load to failure were reduced after limited reaming (p = 0.002, p = 0.003) and standard reaming (p = 0.01, p = 0.002) were performed. Stiffness and load to failure were reduced to the same extent in both groups (p = 0.12, p = 0.25). CONCLUSIONS: Both limited reaming and standard reaming negatively affect diaphyseal cortical circulation. Limited reaming spares cortical perfusion compared with standard reaming at the time of nail insertion. No long-term advantage for limited reaming was demonstrated. Limited reaming may be advantageous acutely for the stabilization of tibial fractures in which the circulation is already compromised.

Animals↗

Physical fitness, physical activity, and functional limitation in adults aged 40 and older.

PURPOSE: A cohort of middle-aged and older men and women were followed for an average of 5.5 yr to examine the association between physical fitness, physical activity, and the prevalence of functional limitation. METHODS: The participants received medical assessments between 1980 and 1988 and responded to a mail-back survey regarding functional status in 1990. RESULTS: Among 3495 men and 1175 women over 40 yr of age at baseline, 350 (7.5%) reported at least one functional limitation in daily or household activities at follow-up. The prevalence of functional limitation was higher among women than men. Physically fit and physically active participants reported less functional limitation than unfit or sedentary participants. After controlling for age and other risk factors, the prevalence of functional limitation was lower for both moderately fit (odds ratio = 0.4, 95% CI = 0.2-0.6) and high fit men (odds ratio = 0.3, 95% CI = 0.2-0.4), compared with low fit men. Corresponding figures for women were 0.5 (0.3-0.7) and 0.3 (0.2-0.5) for moderately fit and high fit women. The association between physical activity and functional limitation was similar to the data for physical fitness. CONCLUSIONS: These data support a protective effect of physical fitness and physical activity on functional limitation among older adults and extend this protective effect to middle-aged men and women.

Adult↗

Airflow limitation during respiratory syncytial virus lower respiratory tract infection predicts recurrent wheezing.

BACKGROUND: Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is frequently followed by recurrent wheezing. Thus far no clinical risk factors have been identified to predict which infants will have wheezing episodes subsequent to RSV LRTI. OBJECTIVE: To determine clinical predictors for airway morbidity after RSV LRTI. METHODS: In a 1-year follow-up study we investigated the predictive value of auscultatory findings characteristic of airflow limitation (wheezing) during RSV LRTI for subsequent airway morbidity. Clinical characteristics, including the presence or absence of signs of airflow limitation, of hospitalized infants with RSV LRTI were prospectively recorded during 2 winter epidemics. During a 1-year follow-up period parents of 130 infants recorded daily airway symptoms. OUTCOME MEASURE: Recurrent wheezing defined as > or = 2 episodes of wheezing. RESULTS: Signs of airflow limitation during RSV LRTI were absent in 47 (36%) infants and present in 83 (64%) infants. Recurrent wheezing was recorded in 10 (21%) infants without signs of airflow limitation and in 51 (61%) with signs of airflow limitation during initial RSV LRTI (relative risk, 0.29, P < 0.001). In a multiple logistic regression model, airflow limitation during initial RSV LRTI proved independent from other clinical parameters, including age, parental history of asthma and smoke exposure. CONCLUSIONS: A sign of airflow limitation during RSV LRTI is the first useful clinical predictor for subsequent recurrent wheezing.

Auscultation↗

Mycophenolic acid in diabetic renal transplant recipients: pharmacokinetics and application of a limited sampling strategy.

Limited sampling strategies may be useful in optimizing therapeutic drug monitoring of mycophenolic acid (MPA). Their use, however, may be limited by several patient factors, including comorbidity. In this study the pharmacokinetics of MPA in diabetic and nondiabetic renal transplant recipients were compared, and it was evaluated whether a limited sampling strategy developed and validated for nondiabetic patients can also be used in diabetic patients. The pharmacokinetics of MPA were analyzed on days 7 and 11 after transplantation in 136 renal transplant patients, among whom 7 patients had diabetes. All patients received cyclosporine and corticosteroids as maintenance immunosuppressive therapy. A limited sampling strategy [AUC (mg x h/L) = 7.182 + 4.607 C0 + 0.998 C0.67 + 2.149 C2] was developed and validated for nondiabetic patients and was subsequently tested for its usefulness in diabetic patients. Diabetic renal transplant patients did not have significantly different dose-normalized MPA area under concentration-time curve (AUC), MPA clearance, or MPA maximum concentration (Cmax). However, in diabetic patients Tmax (time of Cmax, 1.59 hours) was higher than for nondiabetic patients (0.67 hours) on day 11 (P = 0.04). The developed and validated limited sampling strategy performed acceptably, estimating MPA AUC in nondiabetic patients with a mean bias of 0.2 mg x h/L (95% confidence interval from -1.3 to 1.6 mg x h/L). Applying the limited sampling strategy in diabetic patients revealed a mean bias of -1.5 (-5.7, 2.7 mg x h/L). In conclusion, although diabetic renal transplant patients exhibit increased Tmax, this does not affect the accuracy of the limited sampling strategy.

Adult↗

Serum procalcitonin differentiates inflammatory bowel disease and self-limited colitis.

BACKGROUND: The distinction between idiopathic inflammatory bowel disease (IBD) and infectious, usually self-limited enterocolitis is still a diagnostic dilemma. Procalcitonin (PCT) is the prohormone of calcitonin and is considered a specific marker of bacterial infection. The aim of this prospective study was to determine the value of PCT in differentiating flares of IBD from self-limited colitis. In addition, because standard laboratory inflammatory parameters are poorly correlated with disease activity in IBD, the relation between PCT levels and disease activity was investigated. METHODS: A total of 76 patients (26 Crohn's disease, CD; 25 ulcerative colitis, UC; and 25 patients with self-limited enterocolitis) were enrolled. Serum levels of PCT were measured by a sandwich immunoluminometric assay. C-reactive protein (CRP) levels, white blood cell counts, and stool cultures were obtained from all patients. Disease activity was assessed by the Crohn's disease activity index (CDAI) and the Truelove index for CD and UC, respectively. RESULTS: Patients with self-limited enterocolitis showed significantly higher PCT levels when compared with IBD patients (0.36 ng/mL, range 0.18-1.7 vs 0.10 ng/mL, range 0.08 0.5, p < 0.001). For a PCT value of > or =0.4, the sensitivity for self-limited colitis was 92% and specifity 96%. The positive predictive value (PPV) for self-limited colitis was 96%, whereas the negative predictive value (NPV) was 93%. In IBD patients, PCT levels were in the normal range although significantly higher in active disease when compared with inactive disease (0.13 ng/mL, range 0.08-0.5 vs 0.09 ng/mL, range 0.08-0.15, p < 0.001). This difference was less pronounced for CD (0.11 ng/mL, range 0.08-0.2 vs 0.09 ng/mL, range 0.08-0.15, p < 0.05) than for UC (0.14 ng/mL, range 0.08-0.5 vs 0.09 ng/mL, range 0.08-0.11, p < 0.01). In CD, PCT levels correlated significantly 0.5, p < 0.01). with the CDAI (r =0.05, p <0.01). CONCLUSIONS: The measurement of PCT offers two diagnostic options in IBD. Supranormal levels indicate self-limited enterocolitis. Furthermore, although within the normal range in IBD, PCT levels may serve as a new serological marker of disease activity.

Bacterial Infections↗

Limitation and withdrawal of intensive therapy at the end of life: practices in intensive care units in Mumbai, India.

OBJECTIVE: To describe the practices in intensive care units in Mumbai hospitals regarding limitation and withdrawal of care at the end of life. DESIGN: Review of prospectively collected data. SETTINGS: Intensive care units of four major hospitals (two private tertiary referral general hospitals, one mixed public and private cancer referral hospital, and one large public hospital). PATIENTS: Hospital and intensive care unit patients who died during the study period. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: We measured the percentage of hospital deaths occurring inside and outside intensive care units and the incidence of withholding intubation, withholding other therapy, and withdrawing therapy for deaths in the intensive care unit. The proportion of hospital deaths that occurred in an intensive care unit was 14% in the cancer hospital, 23% in the public hospital, and 58-73% in the two private hospitals (chi-square test for trends, p < .0001). Of the 143 deaths that occurred in intensive care unit, limitation of care occurred in 49 patients. Twenty-five percent of these patients were not intubated terminally, 67% were initially intubated and ventilated but failed to recover and subsequently had no further escalation of therapy, and 8% had withdrawal of therapy. Therapy was limited in 19% of deaths in the public hospital intensive care unit (odds ratio, 0.44; 95% confidence interval, 0.2-0.97) vs. 40%, 41%, and 50% of deaths in the other three intensive care units. CONCLUSIONS: Therapy is limited in a significant proportion of intensive care unit patients. Significant differences in the practice of limitation of therapy exist between public and private hospitals. Lack of access to a limited number of intensive care unit beds, especially in the public hospital, may constitute implicit limitation of care.

Cancer Care Facilities↗

Comparing alternative measures of functional limitation.

BACKGROUND: Functional limitation is a central concept in the disability process, but its operationalization has varied widely, making it impossible to compare results across studies. OBJECTIVE: Our goal is to systematically compare the effectiveness of alternative measures of functional limitations to predict disability and to provide guidelines for their standardization. DESIGN: Over 100 alternative scales of functional limitations are compared in regression models of disability. The Bayesian information criterion is used to compare the performance of measures. SUBJECTS: The subjects were 5,764 women, aged 37 to 68, from the Mature and Young Women's cohorts of the National Longitudinal Surveys. MEASURES: Scales are constructed from 9 indicators of activity limitations: (1) grasping, (2) lifting/carrying up to 10 pounds, (3) lifting/carrying heavy weights, (4) reaching, (5) sitting, (6) stairs, (7) standing, (8) stooping, and (9) walking. Respondents were asked whether they could perform the activity without difficulty, with difficulty, or could not perform it at all. The 4 disability outcomes include binary and ordinal measures of work limitation, a single ADL measure (bathing), and total number of ADLs. RESULTS: The 3 best scales used all 9 indicators. The top scale truncated values above 5, while the others logged the sum. Two scales were based on sums of binary indicators, while the third used 3 category indicators. CONCLUSIONS: Simple scales perform better than complex scales that separate upper and lower body limitations or weight some limitations more than others. Scales that transform higher values are preferable.

Activities of Daily Living↗

The influence of resources on perceived functional limitations among women with multiple sclerosis.

The purpose of this longitudinal investigation was to identify the effects of external resources (i.e., education, marriage, employment, social support, economic status) on the trajectory of perceived functional limitation among women with multiple sclerosis (MS). We hypothesized that these resources would have a long-term influence upon MS-related functional limitation. As part of a longitudinal study of health promotion and quality of life among persons with MS, we tested hypothesized relationships using data obtained at five time points, using repeated-measures MANOVA. We found that functional limitation scores increased over time for all participants. In general, women who were unemployed as a result of MS consistently had higher functional limitation scores, and employed women consistently had lower functional limitation scores. Women with lower social support scores consistently perceived greater functional limitation than those with higher social support scores. Women with lower perceived-economic-adequacy scores consistently had higher functional limitation scores than women with higher perceived-economic-adequacy scores. Nurses and other healthcare professionals are in an optimum position to observe and assess the resources of women with MS. They can use presence, listening, and observational skills to identify verbal and nonverbal cues of resource depletion. In addition, they can act as advocates for women with MS and speak out on policy issues and legislation at the local and national levels. Healthcare professionals can thus influence the presence of resources for those who are particularly vulnerable to resource loss, so they can participate successfully in work, recreational, and home environments.

Activities of Daily Living↗

Effects of phosphate limitation of growth on the cell-wall and lipid composition of Saccharomyces cerevisiae.

The phosphorus content of phosphate-limited Saccharomyces cerevisiae was only 71% of that of non-limited yeast. Walls prepared from phosphate-limited cells contained slightly less phosphorus than control walls. No evidence was obtained for the presence in these walls of uronic acid or succinyl residues. The carbohydrate content of walls of phosphate-limited yeast was less than that of non-limited walls, and this was reflected in a decreased glucan content. There was only a slight decrease in glucosamine content while the protein content increased. The major change in the lipid composition of phosphate-limited yeast was a decrease in both sterol esters and triacylglycerols. There was a decrease in total lipid content, but increased production of phosphatidylethanolamine and phosphatidylcholine. The phosphatidylserine content was decreased. These results suggest that there are fewer intracellular low-density vesicles in phosphate-limited yeast.

Carbohydrates↗

Haemin-binding proteins of Porphyromonas gingivalis W50 grown in a chemostat under haemin-limitation.

Porphyromonas gingivalis W50 was grown in a chemostat at pH 7.3 under haemin-limitation and haemin-excess at a constant mean doubling time of 6.9 h. Outer membranes (OM) were extracted from whole cells using EDTA and compared by SDS-PAGE. Haemin-limited cells expressed novel outer membrane proteins (OMPs) of mol. mass 115, 113 and 19 kDa when samples were solubilized at 100 degrees C. A 46 kDa OMP was observed in haemin-excess cells but not in those from haemin-limited conditions. Tetramethylbenzidine (TMBZ) staining of gels, after OM solubilization at 20 degrees C, was used to detect haemin-binding proteins (HBPs). HBPs were observed only in OM from haemin-limited cells. The major HBP (mol. mass 32.4 kDa) corresponded to a similar sized Kenacid-blue-stained protein which was not observed in haemin-excess-derived OM. Haemin-limited cells and OM displayed a ladder-like series of Kenacid-blue-stained proteins. Lighter TMBZ-stained proteins of mol. mass 51, 53, 56 and 60 kDa, with mobilities corresponding to those of silver-stained LPS components, were observed in haemin-limited OM. No soluble HBPs were detected extracellularly. The greater number of HBPs expressed by cells grown under haemin-limitation may reflect an additional cell surface receptor system for haemin acquisition under low environmental levels of this essential cofactor.

Bacterial Outer Membrane Proteins↗