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Viral strategies of translation initiation: ribosomal shunt and reinitiation.

Due to the compactness of their genomes, viruses are well suited to the study of basic expression mechanisms, including details of transcription, RNA processing, transport, and translation. In fact, most basic principles of these processes were first described in viral systems. Furthermore, viruses seem not to respect basic rules, and cases of "abnormal" expression strategies are quiet common, although such strategies are usually also finally observed in rare cases of cellular gene expression. Concerning translation, viruses most often violate Kozak's original rule that eukaryotic translation starts from a capped monocistronic mRNA and involves linear scanning to find the first suitable start codon. Thus, many viral cases have been described where translation is initiated from noncapped RNA, using an internal ribosome entry site. This review centers on other viral translation strategies, namely shunting and virus-controlled reinitiation as first described in plant pararetroviruses (Caulimoviridae). In shunting, major parts of a complex leader are bypassed and not melted by scanning ribosomes. In the Caulimoviridae, this process is coupled to reinitiation after translation of a small open reading frame; in other cases, it is possibly initiated upon pausing of the scanning ribosome. Most of the Caulimoviridae produce polycistronic mRNAs. Two basic mechanisms are used for their translation. Alternative translation of the downstream open reading frames in the bacilliform Caulimoviridae occurs by a leaky scanning mechanism, and reinitiation of polycistronic translation in many of the icosahedral Caulimoviridae is enabled by the action of a viral transactivator. Both of these processes are discussed here in detail and compared to related processes in other viruses and cells.

Animals↗

A study of component release from resin pit and fissure sealants in vitro.

OBJECTIVE: A recent study reported that an estrogenic chemical, bisphenol-A, was released from a fissure sealant. The aim of this study was to identify and quantify the major (or detectable) components released from any of seven commercially-available, light-cured pit and fissure sealants in vitro. METHODS: The fissure systems of ten extracted, third molar teeth were filled with sealant, light-activated and immersed in separate containers of distilled water. Separate, cylindrical stainless steel molds were filled with sealant which was then light-activated and immersed. Each mold or tooth with sealant was moved to a new container of water at defined times and each remaining water sample (eluate) then analyzed by high performance liquid chromatography (HPLC). RESULTS: Triethylene glycol dimethacrylate (TEGDMA) was present in all eluates from each of the sealants tested. 2,2-bis[4'-(2'-hydroxy-3'-methacryloyloxy)phenyl]propane (BisGMA) was detected at much lower levels (about one thousand-fold less) in eluates from one sealant only. Bisphenol-A was not detected in any eluates. The rates of TEGDMA and BisGMA release were highest on first immersion and decreased thereafter. The total amount of TEGDMA released was on the order of 0.25 mg per tooth. Most release occurred during the first day. SIGNIFICANCE: Because bisphenol-A release could not be detected from any of the seven sealants tested, these results call into question earlier concerns expressed about possible adverse effects of bisphenol-A released from resin sealants.

Air Pollutants, Occupational↗

Mortality among UK Gulf War veterans.

BACKGROUND: Armed forces personnel who served in the Gulf War report more current ill-health than those who were not deployed. There has been concern expressed that they may also experience higher mortality rates. METHODS: A retrospective cohort study was done including all 53462 UK Gulf War veterans (Gulf cohort) and a comparison group equivalent in size of personnel who were not deployed but matched for age, sex, rank, service, and level of fitness (Era cohort). Individuals were identified on central registers of the Office for National Statistics and information on death among cohort subjects, including cause of death, obtained. Follow-up extended from April 1, 1991 (the end of the Gulf War) until March 31, 1999. FINDINGS: There were 395 deaths among the Gulf cohort and 378 deaths amongst the Era cohort (mortality rate ratio [MRR] 1.05, 95% CI 0.91-1.21). Mortality from "external" causes was higher in the Gulf cohort (Gulf 254, Era 216; MRR 1.18 [0.98-1.42] while mortality from "disease-related" causes was lower (Gulf 122, Era 141; 0.87 [0.67-1.11]). The higher mortality rate from "external" causes in the Gulf cohort was principally due to higher mortality rates from accidents. There was, however, no excess of deaths recorded as suicide in the Gulf cohort. INTERPRETATION: This follow-up of veterans of the Gulf war has shown, 8 years after the end of the conflict, that although they have experienced higher mortality rates than a comparison cohort, the excess mortality rate is very small and does not approach statistical significance. The excess is related mainly to accidents rather than disease, a pattern that is consistent both with US veterans of the Gulf war and veterans from other conflicts.

Adult↗

WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care.

BACKGROUND: We undertook a multicentre randomised controlled trial that compared the standard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits. METHODS: Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randomly allocated to provide either the new model (27 clinics) or the standard model currently in use (26 clinics). All women presenting for antenatal care at these clinics over an average of 18 months were enrolled. Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further specific assessment or treatment were offered the basic component of the new model, and those deemed at higher risk received the usual care for their conditions; however, all were included in the new-model group for the analyses, which were by intention to treat. The primary outcomes were low birthweight (<2500 g), pre-eclampsia/eclampsia, severe postpartum anaemia (<90 g/L haemoglobin), and treated urinary-tract infection. There was an assessment of quality of care and an economic evaluation. FINDINGS: Women attending clinics assigned the new model (n=12568) had a median of five visits compared with eight within the standard model (n=11958). More women in the new model than in the standard model were referred to higher levels of care (13.4% vs 7.3%), but rates of hospital admission, diagnosis, and length of stay were similar. The groups had similar rates of low birthweight (new model 7.68% vs standard model 7.14%; stratified rate difference 0.96 [95% CI -0.01 to 1.92]), postpartum anaemia (7.59% vs 8.67%; 0.32), and urinary-tract infection (5.95% vs 7.41%; -0.42 [-1.65 to 0.80]). For pre-eclampsia/eclampsia the rate was slightly higher in the new model (1.69% vs 1.38%; 0.21 [-0.25 to 0.67]). Adjustment by several confounding variables did not modify this pattern. There were negligible differences between groups for several secondary outcomes. Women and providers in both groups were, in general, satisfied with the care received, although some women assigned the new model expressed concern about the timing of visits. There was no cost increase, and in some settings the new model decreased cost. INTERPRETATIONS: Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes. It could be implemented without major resistance from women and providers and may reduce cost.

Adult↗

Anaesthesia: the patient's point of view.

Patients scheduled for surgical procedures continue to express concerns about their safety, outcome, and comfort. All medical interventions carry risks, but the patient often considers anaesthesia as the intervention with the greatest risk. Many still worry that they will not wake up after their surgery, or that they will be awake during the operation. Such events have received attention from the media, but are very rare. Challenges to improve the comfort of patients continue, especially with regard to the almost universal problems of nausea, vomiting, and pain after surgery. A newer concern is that patients will develop some degree of mental impairment that may delay return to a full work and social lifestyle for days and weeks. Developments in technology, education, and training have had a major effect on anaesthetic practice, so that anaesthesia is increasingly regarded as safe for the patient. This article explores patients' concerns, and considers whether science and technology help to provide solutions to these complex difficulties.

Anesthesia↗

The hopes and fears of in utero gene therapy for genetic disease--a review.

Somatic gene delivery in utero is a novel approach to gene therapy for genetic disease. It is based on the concept that application of gene therapy vectors to the fetus in utero may prevent the development of early disease related tissue damage, may allow targeting of otherwise inaccessible organs, tissues and still expanding stem cell populations and may also provide postnatal tolerance against the therapeutic transgenic protein. This review outlines the hypothesis and scientific background of in utero gene therapy and addresses some of the frequently expressed concerns raised by this still experimental, potentially preventive gene therapy approach. We describe and discuss the choice of vectors, of animal models and routes of administration to the fetus. We address potential risk factors of prenatal gene therapy such as vector toxicity, inadvertent germ line modification, developmental aberration and oncogenesis as well as specific risks of this procedure for the fetus and mother and discuss their ethical implications.

Adult↗

Patients' and family members' perceptions of transfer from intensive care.

OBJECTIVE: To describe patients' and family members' perceptions of transfer from an intensive care unit (ICU). DESIGN: Qualitative component of a descriptive, cross-sectional survey. SETTING: Two university-affiliated tertiary care centres in western Canada. PARTICIPANTS: Fifty-three patients and 35 family members who had been transferred from a medical ICU within the previous 48 hours. MEASURES: Content analysis of responses to 3 open-ended questions relating to transfer from the ICU. RESULTS: Patients and family members had 3 major responses of transfer from the ICU: positive, neutral or ambivalent, and negative. Although some patients and family members perceived the transfer from the ICU as a sign of progress, many individuals expressed concern about the sudden and dramatic change in the level of care after transfer. CONCLUSION: Patients and family members perceived the transfer from the ICU as a significant and sometimes negative event.

Adult↗

Preliminary attempts to biolistic inoculation of grapevine fanleaf virus.

Biolistics has been studied to inoculate grapevine fanleaf virus (GFLV), a Nepovirus, to its natural woody host, Vitis sp., and its herbaceous host, Chenopodium quinoa. At first, bombardment conditions for in vitro and greenhouse grown plants were set using the uidA reporter gene. The infectious feature of the cartridges was then evaluated by studying infection of C. quinoa plants. Systemic infection was obtained with either GFLV particles or RNA extracts in experimental conditions which gave also the highest transient uidA gene expression. Concerning grapevine, our results indicate that extrapolation to this plant is difficult. In only 1 out of 8 independent bombardment experiments done with GFLV and 41B, we were able to detect the virus in freshly bombarded leaves. Similarly, later after bombardment, Pol mRNAs were detected once, at days 7 and 14 only. Incubating the plants in darkness, as suggested in the literature, or using Rupestris Saint Georges, an indicator for GFLV presence, did not yield any improvement. Finely, our observations suggest that detection of GFLV in bombarded grapevine tissues by immunological or molecular techniques remains a limiting factor, probably due to an excess of inhibitory compounds released during the biolistic process.

Base Sequence↗

Why are angiotensin converting enzyme inhibitors underutilised in the treatment of heart failure by general practitioners?

Treatment with angiotensin converting enzyme inhibitors confers significant morbidity and mortality benefits in patients with heart failure, yet previous studies have repeatedly shown that these drugs are underutilised in general practice. To investigate why this is the case, we conducted an anonymous questionnaire survey of 515 general practitioners in the Nottingham Health District. The response rate was 60.2%. We found that although 39.3% of respondents underestimated the poor prognosis associated with heart failure, 98% were aware of the prognostic benefits conferred by angiotensin converting enzyme inhibitors. However, 46.3% of respondents expressed concern about the potential adverse effects associated with angiotensin converting enzyme inhibitors, the main fears being hypotension and renal impairment. General practitioners who were concerned about adverse effects were significantly less likely to have initiated an angiotensin converting enzyme inhibitor for heart failure than those who were not (P<0.01). Further research is needed to identify which patients can safely be commenced on angiotensin converting enzyme inhibitors in general practice. In the meantime, general practitioners should be encouraged to refer patients whenever they are concerned about initiating angiotensin converting enzyme inhibitors in the community.

Angiotensin-Converting Enzyme Inhibitors↗

The second national survey of infection in hospitals: methods of data collection and overall impressions.

The Hospital Infection Society, in association with the Public Health Laboratory Service and the Infection Control Nurses Association, launched the Second National Prevalence Survey of Infection in Hospitals in 1993. On completion of the survey, 157 hospitals throughout the British Isles had taken part with approximately 37 000 patients surveyed. The survey in the Royal Hospitals Trust, Belfast, included all inpatients who were present in the wards on the survey day. Infection control nurses (ICNs) from a selected number of the other participating hospitals were sent questionnaires and asked about their methods of data collection, and their overall impression of the Second National Survey. All respondents received help in performing the survey, but only 10% provided prior training to ward staff before the survey visit. Sixty-five percent of respondents supplied information to the wards prior to the survey visit. In comparison with the questionnaire respondents, it was found that using a 'link' nurse to assist in data collection was much more efficient in relation to the time involved. Many ICNs expressed concern over the amount of time spent on this survey, although in general the value of such a survey was appreciated. Twenty-six percent of respondents indicated that they would not be willing to undertake a future survey.

Cross Infection↗

Creating reality or contributing to confusion? An exploratory study of client participation in student learning.

Changing trends in nurse education continue to highlight the theory-practice gap in student preparation. The development of courses such as Project 2000 has acknowledged the importance of integrating theory and practice in overcoming this phenomenon. As part of this process clients and patients have become more involved in student learning, particularly in the community. However educationalists and practitioners have expressed concerns about the effect of this development on the quality of patient care. Clients have participated actively in health visiting education since the 1960s and, as part of a wider study, research was undertaken to explore the implications of client participation in student learning. A case-study design was developed employing qualitative and quantitative methods of data collection, including confidential semi-structured interviews. For the purpose of this paper the discussion focuses on three major issues; the essential role of clients in the learning process, clients' perception of students' role in the practicum, and clients' perception of their role in the assessment process. The findings demonstrate that despite clients' willingness and commitment to participate in student learning important factors must be considered. These include not only the selection of clients, detailed briefing of students and clients and careful monitoring of the practice situation, but also the preparation of practitioners facilitating student learning. These findings are equally important for student learning in pre-registration programmes.

Attitude to Health↗

The effect of measles-mumps-rubella (MMR) immunization on the immune responses of previously immunized primary school children.

Current policies for measles control call for administration of a second dose of vaccine to immunize those who failed to respond to the initial dose and to boost the responses of those with low levels of antibody. However, there has been concern expressed publicly that reimmunization may have adverse immunologic consequences. To determine the effects of reimmunization on immune responses, primary school children (N=38, mean age=6.14+/-0.35 years) with documented previous measles-mumps-rubella vaccine (MMR) immunization during infancy 4-5 years earlier were studied before and 1 month after receiving MMR as a part of routine reimmunization in Beer-Sheva, Israel. A substantial number of children were seronegative to measles (24%), mumps (34%) and rubella (44%). On reimmunization all seroconverted to mumps and rubella and all but one (92%) seroconverted to measles. The geometric mean titer of measles virus neutralizing antibody increased from 171 to 724 and the greatest increases occurred in those with the lowest pre-immunization titers. Moderate increases in levels of total IgM, IgG and IgE were detected in those with increases in antibody to measles virus. After reimmunization leukocyte counts decreased significantly from (5.8 x 10(6))+/-2.3 to (3.4 x 10(6))+/-0.7 ml(-1) (P=0.0001). The percentages of both CD4(+) and CD8(+) T cells decreased while the CD4:CD8 ratio remained unchanged. The percentage of CD56(+) natural killer (NK) cells increased from 5.2+/-2.7 to 7.2+/-2.8 (P=0.01). Functional assays showed improved lymphoproliferation in response to stimulation with phytohemagglutinin and tetanus toxoid and stable NK lytic activity. Therefore, reimmunization was accompanied by decreased leukocyte counts, but leukocyte function was unchanged or improved.

Antibodies, Viral↗

Midwifery education for safe motherhood.

OBJECTIVE: To determine the useability (relevance, clarity and quality of content), applicability (ease of use) and accessibility (structure and form) of a series of new safe motherhood midwifery education modules. DESIGN: Questionnaire survey and focus group discussions, preceded by a two week clinical skills course and an eight day orientation to using the modules. SETTING: Nursing and midwifery education institutions, regional training centres, acute-care hospital facilities and community settings in Ethiopia, Fiji, Lesotho, Mozambique and Nepal. PARTICIPANTS: Thirty-six teachers, 82 midwives, nurse-midwives and auxiliary nurse-midwives from practice settings, and 60 post basic midwifery students. KEY FINDINGS: Overall it was found that the introductory information and the technical content of the modules were easy to understand and use as were the instructions for both teachers and students. The presentation of the material was orderly and easy to follow; the language was comprehensible; and the illustrations were appropriate, clear and facilitated teaching. The teachers found that they were able to use most of the teaching/learning methods, teach most of the skills in the modules, and use the guidelines for assessing competence. The main difficulties encountered included adherence to the recommended time frame for some of the classroom sessions; the limited availability of clinical cases for teaching the specific skills in the modules and time limitations in the clinical area for practising the skills; and the provision of transport for community visits, data to complete community profiles, and time to complete other planned community activities. The students identified the need for a set of learning materials which they could take with them for future reference, and both teachers and students expressed concern about resources to support, and legislation to cover, the application of the skills taught/learned. KEY CONCLUSIONS: The modules have the potential to strengthen and support the education of midwives in developing countries, enabling them to make motherhood safer and contribute to a reduction in maternal mortality by providing better midwifery care.

Adult↗

Broken kidney: traumatic fracture of a renal allograft.

Although many renal transplant recipients are protective of their grafts and often express concern about the possibility of traumatic injury, such injury has been reported only rarely. We describe a case report of a boy who sustained an injury to his renal allograft after a bicycle accident. Despite a dramatic anatomic abnormality seen on magnetic resonance imaging, he suffered only minor and self-limited symptomatic and clinical consequences. We reviewed the literature addressing traumatic injuries affecting renal allografts. The long-term consequences of such injuries on allograft function and survival are unknown.

Accidents, Traffic↗

Emergency contraception: an anomalous position in the family planning repertoire?

Emergency contraception (EC) can be used up to 72 h after sex to prevent pregnancy. Internationally there is wide variation in the availability of EC. In the USA it has only recently (1997) won approval from the FDA, while the UK and New Zealand have seen calls for over the counter availability. In recent years surveys, editorials and opinion pieces in medical journals have pointed out that increased access to EC could help to tackle the unwanted pregnancy rate, especially among teenagers, and concluded that lack of knowledge of EC is the major barrier to use. However, women in a UK study have expressed concerns that it is not safe to use the method repeatedly and cited general practitioners (GPs) as one of the sources of this belief, which contradicts the professional guidelines and the rationale for de-regulation. A subsequent study sought to seek the views of GPs about prescribing EC and explored reasons for the gap between the views of women using UK family planning services, GPs and professionals at the public policy level. Data from two studies are presented. In the first study, 53 women seeking emergency contraception were interviewed at two family planning clinics. In the second, semi-structured telephone interviews were completed with a random sample of 76 GPs from three English health authorities. Interviews were recorded, transcribed and thematic analysis was conducted using the constant comparative method. EC was rarely described, by users or GPs, as an acceptable contraceptive option. Consultations for emergency contraception were viewed by GPs as an important opportunity to discuss the woman's future contraceptive needs. Repeated use of EC was not encouraged and a discussion of contraceptive needs could range from a mild enquiry to quite forceful messages contrasting EC to 'regular' and 'proper' methods. The medical literature suggests that EC is underused because of a lack of awareness. Commentators have recommended educating health professionals and women about EC and increasing availability through de-regulation. The data presented in this paper show that British GPs are not enthusiastic about the de-regulation of EC, but the reasons are complex and related to concerns about planned contraception and sexual behaviour. It is suggested that it may be because EC is used after sex that it seems to occupy an uncomfortable place within the contraceptive repertoire.

Attitude↗

Contrasting effects of non-starch polysaccharide and resistant starch-based diets on the disposition and excretion of the food carcinogen, 2-amino-3-methylimidazo[4,5-f]quinoline (IQ), in a rat model.

It has commonly been believed that increasing fibre in the diet should reduce the incidence of cancers, especially those of the colon and rectum. The earliest definitions of dietary fibre restricted the term to plant cell walls in which non-starch polysaccharides are key chemical components. However, new definitions encompass a wider range of materials, including starches resistant to digestion in the colon (resistant starches). Nevertheless, most definitions require that "dietary fibres" show physiological effects considered beneficial against cancer, including enhanced laxation and faecal bulking. On theoretical grounds, such properties might be expected to dilute the concentration of any carcinogen present and move it more rapidly through the colon, thereby reducing bioavailability. We have compared the properties of two dietary fibre preparations that are primarily non-starch polysaccharides with two resistant starch preparations for effects on carcinogen disposition in a rodent model. Although both preparations enhanced laxation and faecal bulking, only the non-starch polysaccharide preparation reduced carcinogen biovailability. Indeed, carcinogen biovailability was significantly enhanced by resistant starch. We suggest that there may be fundamental differences in the manner by which non-starch polysaccharides or resistant starches affect carcinogen disposition, and express concern that the events seen with the resistant starches [RS] are unlikely to be beneficial with respect to protection against cancer by exogenous carcinogens. Furthermore, the data reveal that the observation of enhanced laxation and faecal bulking does not necessarily imply a reduction in carcinogen bioavailability.

Animals↗

The control of human locomotor pointing under restricted informational conditions.

Since a perception-action coupling type of control (Kugler, P.N. and Turvey, M.T., Information, Natural Law, and Self-Assembly of Rhythmic Movements, Erlbaum, Hillsdale, 1987, 481 pp.) continuously operates during locomotor pointing tasks (e.g. long jumping) (Montagne, G., Cornus, S., Glize, D., Quaine, F. and Laurent, M., A 'perception-action coupling' type of control in long-jumping. J. Motor Behav., (2000) in press), the information sources underlying this control have to be dealt with. Under the assumption that subjects use information about the first-order time remaining before they pass the target, we identify in the literature four different sources of information that specify this physical property. Only one of these sources is inevitably present under all possible environmental conditions containing at least a continuously visible target on the floor. This study aimed to test its sufficiency to perform a locomotor pointing task. The use of a virtual reality set-up permitted us to compare locomotor pointing executed with all four information sources or only with the aforementioned one. The likeness found between those two conditions, as far as the pointing performance and the mode of control are concerned, expresses the evoked sufficiency.

Biomechanical Phenomena↗

Treatment outcome, body image, and sexual functioning after orchiectomy and radiotherapy for Stage I-II testicular seminoma.

PURPOSE: Orchiectomy followed by infradiaphragmatic irradiation is the standard treatment for Stage I-II testicular seminoma in The Netherlands. Because body image and sexual functioning can be affected by treatment, a retrospective study was carried out to assess treatment outcome, body image, and changes in sexuality after orchiectomy and radiotherapy. METHODS AND MATERIALS: The medical charts of 166 patients with Stage I-II testicular seminoma were reviewed. A questionnaire on body image and current sexual functioning regarding the frequency and quality of erections, sexual activity, significance of sex, and changes in sexuality was sent to 157 patients (at a mean of 51 months after treatment). RESULTS: Seventy-eight percent (n = 123, mean age 42 years) completed the questionnaire. During irradiation, almost half of patients experienced nausea and 19% nausea and vomiting. Only 3 patients had disease relapse. After treatment, about 20% reported less interest and pleasure in sex and less sexual activity. Interest in sex, erectile difficulties, and satisfaction with sexual life did not differ from age-matched healthy controls. At the time of the survey, 17% of patients had erectile difficulties, a figure that was significantly higher than before treatment, but which correlated also with age. Twenty percent expressed concerns about fertility, and 52% found their body had changed after treatment. Cancer treatment had negatively influenced sexual life in 32% of the patients. CONCLUSIONS: Orchiectomy with radiotherapy is an effective and well-tolerated treatment for Stage I-II testicular seminoma. Treatment-induced changes in body image and concerns about fertility were detected, but the sexual problems encountered did not seem to differ from those of healthy controls, although baseline data are lacking.

Adolescent↗