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PubMed2001

Cyclic and circadian variations in cardiovascular events.

The incidence of many biologic phenomena displays a reproducible and cyclic variation. Cardiovascular disease, the most common cause of death in the United States and other developed countries, also has an intrinsic variation in events. These events are more common in winter, at the beginning of each month, on Mondays (in working people), and during the early morning hours of each day. Recent meta-analyses have quantitated the excess risk of cardiovascular events in the hours around and just after awakening. Between 6 AM and noon, there is a 40% higher risk of heart attack, a 29% increased risk of cardiac death, and a 49% increased risk of stroke (compared with what would be expected if these events happened at random and were evenly distributed throughout the day). These observations have major consequences for emergency medical personnel and medical transport systems. The reasons for these observations are less clear. The circadian pattern of blood pressure (BP) and heart rate may be a major contributor, and long-term "hard end-point" studies designed to test specific pharmacologic interventions targeting the early morning rise in BP and heart rate are underway. Individuals who work night shifts and those whose BP has a different circadian pattern have a higher risk of cardiovascular events, but may be less likely to have an increased risk of cardiovascular events in the morning.

Blood Pressure↗
PubMed1999

Concepts of variation and normality in morphology: important issues at risk of neglect in modern undergraduate medical courses.

In anatomy, normality embraces a range of morphologies and includes those that are most common and others called variations which are less frequent but not considered abnormal. Variations ranging from subtle to remarkable affect every part of the human body. They may have important influences on predisposition to illness, symptomatology, clinical examination and investigation, and patient management including operative surgery. Recognition of variations enables clinicians to distinguish features which merit further investigation or treatment from those which do not. We believe the concepts of normality and variation should be introduced early in the medical course and that the dissecting laboratory is the ideal venue. Students who are able to examine several specimens or are privileged to dissect soon realize that each cadaver is unique. Knowledge of variations should be reinforced in several components of the medical course where physical examination, imaging investigations, surgical procedures, and autopsies are studied. Appreciation of the range of normality including variations matures as experience is gained over several years. Current trends in undergraduate courses--including reduced exposure to dissection and dissected specimens, increased use of plastic bones, models and computer-generated images, loss of experienced teachers, especially those who are medically qualified, and loss of morphological approach-- all conspire to defer the stage when students encounter variation. We are concerned that these trends will compromise the knowledge and understanding of variation required to start practicing medicine safely and competently.

Anatomy↗
PubMed2003

DRB1*1446 allele variations in the group-specific annealing sites of common amplification primers.

A cord blood unit from the Umbilical Cord Bank of Barcelona was initially typed by sequence-based typing (SBT) as DRB1* 0701. However, the subsequent confirmation by sequence-specific oligonucleotide probes (SSOP) revealed an unusual hybridization pattern that did not fit any of the known HLA-DRB1 alleles or allelic combinations. Molecular cloning and sequencing with primers located at introns 1 and 2 provided the definitive identification of a novel DRB1*1446 allele. It was similar to DRB1*1402 at exon 2 except for nucleotide substitutions at codons 10, 11 and 12 (from YST to LRK) that coincide with the 5'-end group specific site for the annealing of common amplification primers used by SBT and sequence-specific primers.

Alleles↗
PubMed2006

Common variants of multiple genes that control reverse cholesterol transport together explain only a minor part of the variation of HDL cholesterol levels.

It is assumed that the combined effects of multiple common genetic variants explain a large part of variation of high-density lipoprotein cholesterol (HDL-C) plasma levels, but little evidence exists to corroborate this assumption. It was our objective to study the contribution of multiple common genetic variants of HDL-C-related genes to variation of HDL-C plasma levels. A well-characterized cohort of 546 Caucasian men with documented coronary artery disease was genotyped for common functional variants in genes that control reverse cholesterol transport: ATP-binding cassette transporter A1, apolipoprotein A-I and apolipoprotein-E, cholesteryl ester transfer protein, hepatic lipase, lecithin : cholesterol-acyl transferase, lipoprotein lipase, and scavenger receptor class B type 1. Multivariate linear regression showed that these variants, in conjunction, explain 12.4% (95% confidence interval: 6.9-17.9%) of variation in HDL-C plasma levels. When the covariates smoking and body mass index were taken into account, the explained variation increased to 15.3% (9.4-21.2%), and when 10 two-way interactions were incorporated, this percentage rose to 25.2% (18.9-31.5%). This study supports the hypothesis that multiple, mildly penetrant, but highly prevalent genetic variants explain part of the variation of HDL-C plasma levels, albeit to a very modest extent. Multiple environmental and genetic influences on HDL-C plasma levels still have to be elucidated.

ATP Binding Cassette Transporter 1↗
PubMed2000

Anatomy of the cystic artery arising from the gastroduodenal artery and its choledochal branch--a case report.

Variations in the branching pattern of the common hepatic artery often occur and may be encountered during cholecystectomy. Variants of the cystic artery, its branches and relations with the biliary structures and blood vessels emphasise the importance of arterial dissection in biliary surgery. In this study, a rare variant of the cystic artery and its choledochal branch is described. The cystic artery arose from the gastroduodenal artery, passed anterior to structures in the free margin of lesser omentum and travelled a long distance before supplying the gall bladder. A long choledochal branch was noted accompanying the common bile duct. Surgical implications of this variation of the cystic and choledochal arteries are discussed.

Arteries↗
PubMed2006

Antigenic variation with a twist--the Borrelia story.

A common mechanism of immune evasion in pathogenic bacteria and protozoa is antigenic variation, in which genetic or epigenetic changes result in rapid, sequential shifts in a surface-exposed antigen. In this issue of Molecular Microbiology, Dai et al. provide the most complete description to date of the vlp/vsp antigenic variation system of the relapsing fever spirochaete, Borrelia hermsii. This elaborate, plasmid-encoded system involves an expression site that can acquire either variable large protein (vlp) or variable small protein (vsp) surface lipoprotein genes from 59 different archival copies. The archival vlp and vsp genes are arranged in clusters on at least five different plasmids. Gene conversion occurs through recombination events at upstream homology sequences (UHS) found in each gene copy, and at downstream homology sequences (DHS) found periodically among the vlp/vsp archival genes. Previous studies have shown that antigenic variation in relapsing fever Borrelia not only permits the evasion of host antibody responses, but can also result in changes in neurotropism and other pathogenic properties. The vlsE antigenic variation locus of Lyme disease spirochaetes, although similar in sequence to the relapsing fever vlp genes, has evolved a completely different antigenic variation mechanism involving segmental recombination from a contiguous array of vls silent cassettes. These two systems thus appear to represent divergence from a common precursor followed by functional convergence to create two distinct antigenic variation processes.

Antigenic Variation↗
PubMed2002

Chromosome 21: a small land of fascinating disorders with unknown pathophysiology.

In the year 2000 we celebrated the sequencing of the entire long arm of human chromosome 21. This achievement now provides unprecedented opportunities to understand the molecular pathophysiology of trisomy 21, elucidate the mechanisms of all monogenic disorders of chromosome 21, and discover genes and functional sequence variations that predispose to common complex disorders. All of that requires the functional analysis of gene products in model organisms, and the determination of the sequence variation of this chromosome.

Chromosome Aberrations↗
PubMed1986

Contingent negative variation and efficacy of beta-blocking agents in migraine.

Thirty-three patients with common migraine underwent contingent negative variation (CNV) recordings before receiving prophylactic beta-blocker treatment with either metoprolol (27 patients) or propranolol (6 patients) at mean daily dosages of 110 mg and 122 mg, respectively. After 3 months the therapeutic efficacy of the beta-blocker was assessed in each patient by means of a global severity score and compared with the initial CNV recordings. The mean clinical improvement was 62%. A significant positive correlation was found between CNV amplitude before prophylaxis and the clinical response to beta-blockers: patients with higher CNV tended to respond better to therapy. Eight of 10 patients with a CNV amplitude higher than -25 microV had a more than 50% reduction of the severity score--that is, a good or excellent response to the beta-blocking agent--whereas only 2 of 9 patients with an amplitude lower than -20 microV had a good response.

Adrenergic beta-Antagonists↗
PubMed2005

A simulation study to examine the effect of common motoneuron inputs on correlated patterns of motor unit discharge.

The influence of common oscillatory inputs to the motoneuron pool on correlated patterns of motor unit discharge was examined using model simulations. Motor unit synchronization, in-phase fluctuations in mean firing rates known as 'common drive', and the coefficient of variation of the muscle force were examined as the frequency and amplitude of common oscillatory inputs to the motoneuron pool were varied. The amount of synchronization, the peak correlation between mean firing rates and the coefficient of variation of the force varied with both the frequency and amplitude of the common input signal. Values for 'common drive' and the force coefficient of variation were highest for oscillatory inputs at frequencies less than 5 Hz, while synchronization reached a maximum when the frequency of the common input was close to the average motor unit firing rate. The frequency of the common input signal for which the highest levels of synchronization were observed increased as motoneuron firing rates increased in response to higher target force levels. The simulation results suggest that common low-frequency oscillations in motor unit firing rates and short-term synchronization result from oscillatory activity in different bands of the frequency spectrum of shared motoneuron inputs. The results also indicate that the amount of synchronization between motor unit discharges depends not only on the amplitude of the shared input signal, but also on its frequency in relation to the present firing rates of the individual motor units.

Action Potentials↗
PubMed2006

Viscoelastic behaviour aids extrusion from and reabsorption of the liquid phase into the digesta plug: creep rheometry of hindgut digesta in the common brushtail possum Trichosurus vulpecula.

Temporal variation in the rheometric properties of the proximal and distal colonic digesta of an arboreal marsupial folivore, the common brushtail possum, was examined to assess flow behaviour during peristalsis, segmentation and other aspects of intestinal motility. The time-dependent rheometric characteristics on application of a constant shear stress within the physiological range showed an initial elastic and subsequent viscoelastic phase, which fitted Burger's model of creep compliance. Similarly, the time-dependent rheometric characteristics on recovery from shear stress fitted with a generalised two-component Maxwell model of elastic and viscoelastic components for creep recovery. Differences in the relative magnitudes of the viscoelastic components during recovery from those during shear indicated that the physical properties of the digesta plug changed with sustained shear stress, a phenomenon, which is likely to result from extrusion of the liquid phase from the solid elements of the digesta plug. There was significant viscoelastic recovery during the initial 4 s following cessation of stress, which would allow for prompt concomitant reabsorption of the liquid phase into the digesta plug. This supports a hypothesis of alternate extrusion and reabsorption of the liquid phase of the digesta plug. This would promote both nutrient absorption across the intestinal wall (from liquid extrusion) and enzyme permeation and digestion (from liquid absorption into the plug). However, the presence of a slower component of viscoelastic recovery indicates that liquid phase reabsorption into the digesta plug is incomplete if the interval before a subsequent contraction is less than 150 s, in which case unreabsorbed liquid may be driven either orally or aborally. This would at least partly account for differences in retention times of liquid and solid phase digesta markers reported for the gastrointestinal tracts of numerous vertebrate species.

Animals↗
PubMed2004

Variation of the McKusick-Kaufman gene and studies of relationships with common forms of obesity.

Obesity is a prominent feature of the Bardet-Biedl syndrome (BBS), one subset of which, BBS6, is due to mutations in the chaperonin-like gene termed the McKusick-Kaufman syndrome (MKKS) gene. We tested whether variation in MKKS contributes to common and probably polygenic forms of obesity by performing mutation analysis of the coding region in 60 Danish white men with juvenile-onset obesity. Five variants were identified, including two synonymous mutations (Pro(39)Pro and Ile(178)Ile) and three nonsynonymous variants (Ala(242)Ser, Arg(517)Cys, and Gly(532)Val). Furthermore, the rare Ala(242)Ser was identified in two families and showed partial cosegregation with obesity. The Pro(39)Pro, Ile(178)Ile, and Arg(517)Cys variants are in complete linkage disequilibrium and defined a prevalent haplotype. In a case-control study, the Arg(517)Cys polymorphism allele prevalence was 11.4% [95% confidence interval (CI), 9.7-13.0] among 744 men with juvenile-onset obesity and 9.3% (CI, 7.9-10.7) among 867 control subjects (P = 0.048). However, among middle-aged men the allelic prevalence was 9.7% (CI, 7.9-11.4) among 523 obese men and 12.2% (CI, 10.8-13.6) among 1051 lean men (P = 0.037). In conclusion, it is unlikely that MKKS variants play a major role in the pathogenesis of nonsyndromic obesity, although in rare cases the A242S allele may contribute to obesity.

Adolescent↗
PubMed1999

Suppression mechanisms: themes from variations.

Suppressor analysis is a commonly used strategy to identify functional relationships between genes that might not have been revealed through other genetic or biochemical means. Many mechanisms that explain the phenomenon of genetic suppression have been described, but the wide variety of possible mechanisms can present a challenge to defining the relationship between a suppressor and the original gene. This article provides a broad framework for classifying suppression mechanisms and describes a series of genetic tests that can be applied to determine the most likely mechanism of suppression.

Animals↗
PubMed2000

Genetic susceptibility to thrombosis and its relationship to physiological risk factors: the GAIT study. Genetic Analysis of Idiopathic Thrombophilia.

Although there are a number of well-characterized genetic defects that lead to increased risk of thrombosis, little information is available on the relative importance of genetic factors in thrombosis risk in the general population. We performed a family-based study of the genetics of thrombosis in the Spanish population to assess the heritability of thrombosis and to identify the joint actions of genes on thrombosis risk and related quantitative hemostasis phenotypes. We examined 398 individuals in 21 extended pedigrees. Twelve pedigrees were ascertained through a proband with idiopathic thrombosis, and the remaining pedigrees were randomly ascertained. The heritability of thrombosis liability and the genetic correlations between thrombosis and each of the quantitative risk factors were estimated by means of a novel variance component method that used a multivariate threshold model. More than 60% of the variation in susceptibility to common thrombosis is attributable to genetic factors. Several quantitative risk factors exhibited significant genetic correlations with thrombosis, indicating that some of the genes that influence quantitative variation in these physiological correlates also influence the risk of thrombosis. Traits that exhibited significant genetic correlations with thrombosis included levels of several coagulation factors (factors VII, VIII, IX, XI, XII, and von Willebrand), tissue plasminogen activator, homocysteine, and the activated protein C ratio. This is the first study that quantifies the genetic component of susceptibility to common thrombosis. The high heritability of thrombosis risk and the significant genetic correlations between thrombosis and related risk factors suggest that the exploitation of correlated quantitative phenotypes will aid the search for susceptibility genes.

Adolescent↗
PubMedDate not supplied

Premenarchal athletic injury to the breast bud as the cause for asymmetry: prevention and treatment.

Some variation in breast size is normal and is common in most women. When this variation becomes large and appreciable asymmetry develops--greater than a one-cup size difference--the asymmetry often disrupts the patient's life. The etiology of most breast asymmetries is unknown; however, current theories on causes include endocrine, iatrogenic, and traumatic injury. The Tulane University Plastic Surgery Service recently evaluated two cases of breast asymmetries that developed after traumatic injury to the breast bud while the body was under increased physical stress. Both girls sustained injuries at approximately 10 to 11 years old (Tanner Stages I-II) while participating in gymnastics.

Adolescent↗
PubMed1992

Correlating genetic variation in carbon isotopic composition with complex climatic gradients.

Genetic variation in both carbon isotope discrimination and the proportions of leaf and photosynthetic twig tissues were observed in ecotypes of Hymenoclea salsola T.G., a common shrub in the deserts of the western United States, when grown under common garden conditions. These variations were correlated with climatic conditions in the habitats of origin through a model that described the leaf-to-air water vapor gradients experienced by plants during the growing season. Both carbon isotope discrimination and the proportion of leaves in the canopy were lower in plants derived from habitats with higher leaf-to-air vapor gradients, despite the fact that some of these sites received relatively high amounts of annual precipitation. These patterns were consistent with the notion that plants are able to maintain substantial control of water-use efficiency over large environmental gradients of temperature and moisture availability.

Carbon↗
PubMed1999

Sources of variation in plasma lipid and lipoprotein traits in a sample selected for health.

Substantial variation in plasma lipid, lipoprotein, and apolipoprotein B levels was found in a sample of healthy white collar workers aged 23-59 years (144 women, 371 men) devoid of most clinically identifiable manifestations of cardiovascular disease or major biochemical anomalies and for whom data were gathered in Montreal, Canada, in 1987. The nature of this variability was examined for each gender by means of a stepwise linear regression analysis using indices of biologic variation and behavioral traits. In women, age, height, and weight together accounted for approximately 10% and uric acid for another 7-10% of total cholesterol, low density lipoprotein (LDL) cholesterol, and apolipoprotein B level variation. In men, age alone accounted for 13-16% of the total variation in these traits while uric acid contributed only 3%. The additional contribution of behavioral traits was found to be at least double that associated with the indices of biologic variation for measures of very low density lipoprotein (VLDL) and high density lipoprotein (HDL) cholesterol in women and HDL cholesterol in men. After taking all of the above into account, genetic variation determined by the three common apo E alleles explained an additional 6% of LDL cholesterol variation in women and 3.5% in men. These results emphasize the range of variability in lipid, lipoprotein, and apolipoprotein values in healthy individuals as well as important gender differences in the contribution of biologic, behavioral, and genetic factors in this variability.

Adult↗
PubMed1996

Geographical variations in rates of ophthalmic surgery.

AIMS/BACKGROUND: Geographical variations in health care are common. There is, however, no simple explanation for why they arise. Variations in rates of ophthalmic surgery in the population aged 65 and over were investigated, with the aim of determining their cause. METHODS: Routine data sources were used to obtain the 1991-2 age and sex standardised rates for English health districts with an ophthalmic unit. Weighted least squares regression was used to study the relation between these rates and various factors describing the population and the provision of care. RESULTS: Surgery rates varied more than threefold. High rates of surgery were associated with high throughput and bed numbers (both p < 0.001), high proportions of day case surgery (p < 0.001), long waiting lists (p < 0.001), and a high number of theatre sessions (p = 0.002). Conversely, a high percentage of emergency admissions was associated with lower rates of surgery (p = 0.004). These six variables accounted for 58% of the variation. CONCLUSION: Geographical variations were found to exist, less than two thirds being explained by differences in the provision of care. The remaining variation may partly be attributed to private practice and the lack of consensus for many ophthalmic procedures (the 'surgical signature'), including a lowering of the threshold for surgery. These findings have implications for the planning of ophthalmic services.

Aged↗