Evolution of the P-type II ATPase gene family in the fungi and presence of structural genomic changes among isolates of Glomus intraradices.

BACKGROUND: The P-type II ATPase gene family encodes proteins with an important role in adaptation of the cell to variation in external K+, Ca2+ and Na2+ concentrations. The presence of P-type II gene subfamilies that are specific for certain kingdoms has been reported but was sometimes contradicted by discovery of previously unknown homologous sequences in newly sequenced genomes. Members of this gene family have been sampled in all of the fungal phyla except the arbuscular mycorrhizal fungi (AMF; phylum Glomeromycota), which are known to play a key-role in terrestrial ecosystems and to be genetically highly variable within populations. Here we used highly degenerate primers on AMF genomic DNA to increase the sampling of fungal P-Type II ATPases and to test previous predictions about their evolution. In parallel, homologous sequences of the P-type II ATPases have been used to determine the nature and amount of polymorphism that is present at these loci among isolates of Glomus intraradices harvested from the same field. RESULTS: In this study, four P-type II ATPase sub-families have been isolated from three AMF species. We show that, contrary to previous predictions, P-type IIC ATPases are present in all basal fungal taxa. Additionally, P-Type IIE ATPases should no longer be considered as exclusive to the Ascomycota and the Basidiomycota, since we also demonstrate their presence in the Zygomycota. Finally, a comparison of homologous sequences encoding P-type IID ATPases showed unexpectedly that indel mutations among coding regions, as well as specific gene duplications occur among AMF individuals within the same field. CONCLUSION: On the basis of these results we suggest that the diversification of P-Type IIC and E ATPases followed the diversification of the extant fungal phyla with independent events of gene gains and losses. Consistent with recent findings on the human genome, but at a much smaller geographic scale, we provided evidence that structural genomic changes, such as exonic indel mutations and gene duplications are less rare than previously thought and that these also occur within fungal populations.

Role of AP-1 family members in lymphomagenesis

Constitutive activation of the nuclear factor-KB (NF-KB) transcriptional pathway is the main characteristic of the activated B-cell-like (ABC) subtype of diffuse large B- cell lymphoma (DLBCL). This has been attributed to oncogenic mutations in the CARMA1, CD79A/B, MyD88 or RNF31 signaling proteins, which control NF-kB activation at different levels. Since several of these mutations lead to a state that mimics chronically antigen receptor-stimulated B-cells, and since the antigen receptor also triggers other transcription pathways, these might be important in ABC DLBCL malignancy too. In this study we analyzed whether abnormal expression and activity of members of the AP-1 transcription factor family could contribute to the pathogenesis of ABC DLBCL. Here, we identified activation of Jun as well as ATF members of the dimeric AP-1 transcription factor family, as a hallmark of ABC but not of germinal center B- cell-like (GCB) DLBCL cell lines. ABC DLBCL cell lines harbored an upregulated expression of c-Jun, JunB, JunD and ATF3 proteins. We could show that the upregulation of c-Jun, JunB and ATF3 was dependent on constitutive BCR and MyD88 signaling. Since AP-1 transcription factors need to dimerize to be active, Jun binding partners were investigated and we could demonstrate the presence of several ATF/Jun heterodimers (including c-Jun/ATF2, c-Jun/ATF3, c-Jun/ATF7, JunB/ATF2, JunB/ATF3, JunB/ATF7, JunD/ATF2, JunD/ATF3 and JunD/ATF7 heterodimers). The disruption of ATF/Jun heterodimers by A-Fos, a dominant negative form of Jun members, was toxic to ABC but not to GCB DLBCL cell lines. Finally, ATF3 immunohistochemistry on DLBCL patient samples revealed that samples classified as non-GCB had more intense and preferentially nuclear staining of ATF3, which could be of diagnostic relevance since the histological classification of the ABC and GCB DLBCL subtypes is difficult in clinical practice. In conclusion, we could show that ABC DLBCL are not only addicted to NF-KB signaling, but also to signaling by some members of the AP-1 transcription factor family. Thus, the AP-1 pathway might be a promising therapeutic target for the treatment of ABC DLBCL. Additionally, monitoring ATF3 levels could improve the diagnosis of ABC DLBCL by IHC. -- L'activation constitutive du facteur de transcription NF-KB est l'une des caractéristiques principales des lymphomes B du type ABC-DLBCL. Cette addiction est dépendante de mutations oncogéniques de CARMA1, CD79A/B, MyD88 et RNF31 qui contrôlent NF-KB à différents niveaux. Etant donné que la plupart de ces mutations mène à un état d'activation chronique du récepteur des cellules B (BCR) et que le BCR active d'autres voies de signalisation, d'autres facteurs de transcription pourraient être impliqués dans la lymphomagénèse des ABC-DLBCL. Dans cette étude, nous nous sommes demandé si les membres de la famille du facteur de transcription AP-1 contribuaient à la pathogénèse de ce type de lymphome. Dans des lignées cellulaires de lymphomes du type ABC-DLBCL en comparaison avec le type GCB-DLBCL, nous avons pu identifier une activation anormale de plusieurs membres de la famille Jun et ATF, deux sous-familles du facteur de transcription AP-1. Les lignées cellulaires dérivées de lymphomes du type ABC-DLBCL surexpriment les facteurs de transcription c-Jun, JunB, JunD et ATF3. Leur surexpression dépend de l'activation constitutive de la voie du BCR et de MyD88. Etant donné qu'AP-1 requiert la formation de dimères pour être actif, nous nous sommes intéressés aux partenaires d'interactions de c-Jun, JunB et JunD et avons pu montrer la formation de plusieurs hétérodimères Jun/ATF (incluant les hétérodimères c-Jun/ATF2, c-Jun/ATF3, c-Jun/ATF7, JunB/ATF2, JunB/ATF3, JunB/ATF7, JunD/ATF2, JunD/ATF3 et JunD/ATF7). Lorsque l'on empêche la formation de ces hétérodimères avec A-Fos, un dominant négatif des membres Jun, la survie des lignées cellulaires du type ABC-DLBCL est diminuée, tandis que les lignées cellulaires GCB-DLBCL ne sont pas affectées. Pour finir, des immunohistochimies (IHC) pour ATF3 sur des échantillons de patients classifiés comme GCB et non-GCB ont pu montrer une coloration d'ATF3 nucléaire et beaucoup plus intense que les échantillons du type GCB. Ainsi, ATF3 pourrait être potentiellement utile en clinique pour différencier le sous type non-GCB des GCB. En conclusion, nous avons pu montrer que les lymphomes du type ABC- DLBCL ne présentent pas uniquement une addiction à NF-KB, mais également de certains membres de la famille de facteur de transcription AP-1. Par conséquent, AP- 1 pourrait être une cible thérapeutique prometteuse pour le développement de futures stratégies. En outre, la détermination des niveaux d'ATF3 par IHC pourraient améliorer le diagnostic des patients du type ABC DLBCL.

Patient expectations at a multicultural out-patient clinic in Switzerland.

BACKGROUND: Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging. OBJECTIVES: The aim of the study was to compare health care expectations of Swiss and immigrant patients attending the out-patient clinic of a Swiss university hospital and to assess physicians' ability to identify their patients' expectations. METHODS: Over a 3-month period, all patients attending the out-patient clinic at a Swiss university hospital were requested to complete pre-consultation surveys. Their physicians were requested to complete post-consultation surveys. Outcome measures were patients' self-rated health, resort to prior home treatment, patients' expectations of the consultation, physicians' perception of their patients' expectations and agreement between patients and physicians. RESULTS: We analysed 343 questionnaires completed by patients prior to their consultation (> 50% immigrants) and 333 questionnaires completed by their physicians after the consultation. Most expectations were shared by all patients. Physicians had inaccurate perceptions of their patients' expectations, regardless of patients' origin. CONCLUSIONS: Our study found no evidence that immigrant patients' expectations differed from those of Swiss patients, nor that physicians had more difficulty identifying expectations of immigrant patients. However, physicians in our study were generally poor at identifying patients' expectations, and therefore inter-group differences may be difficult to detect. Our results point to the need to strengthen physicians' general communication skills which should then serve as a foundation for more specific, cross-cultural communication training.

The family alliance assessment scales : steps toward validity and reliability of an observational assessment tool for early family interactions

We present the first steps in the validation of an observational tool for father-mother-infant interactions: the FAAS (Family Alliance Assessment Scales). Family-level variables are acknowledged as unique contributors to the understanding of the socio-affective development of the child, yet producing reliable assessments of family-level interactions poses a methodological challenge. There is, therefore, a clear need for a validated and clinically relevant tool. This validation study has been carried out on three samples: one non-referred sample, of families taking part in a study on the transition to parenthood (normative sample; n = 30), one referred for medically assisted procreation (infertility sample; n = 30) and one referred for a psychiatric condition in one parent (clinical sample; n = 15). Results show that the FAAS scales have (1) good inter-rater reliability and (2) good validity, as assessed through known-group validity by comparing the three samples and through concurrent validity by checking family interactions against parents' self-reported marital satisfaction.

Parents living with HIV in a high-income country: do patients need specific support?

The number of HIV-infected persons with children and caregiving duties is likely to increase. From this statement, the present study was designed to establish how HIV infected caregivers organise their parenting routines and to determine their support needs. A further aim was to ascertain caregivers' perception of conspicuous behaviours displayed by their children. Finally, it sought to determine the extent to which the caregivers' assessment of their parenting activity is influenced by the required support and their children's perceived conspicuous behaviours. The study design was observational and cross-sectional. Sampling was based on the 7 HIV Outpatient Clinics associated with the national population-based Swiss HIV Cohort Study. It focused on persons living with HIV who are responsible for raising children below the age of 18. A total of 520 caregivers were approached and 261 participated. An anonymous, standardised, self-administered questionnaire was used for data collection. The data were analysed using descriptive statistical procedures and backward elimination multiple regression analysis. The 261 respondents cared for 406 children and adolescents under 18 years of age; the median age was 10 years. The caregivers' material resources were low. 70% had a net family income in a range below the median of Swiss net family income and 30% were dependent on welfare assistance. 73% were undergoing treatment with 86% reporting no physical impairments. The proportion of single caregivers was 34%. 92% of the children were living with their HIV infected caregivers. 80% of the children attended an institution such as a school or kindergarten during the day. 89% of the caregivers had access to social networks providing support. Nevertheless, caregivers required additional support in performing their parenting duties and indicated a need for assistance on the material level, in connection with legal problems and with participation in the labour market. 46% of the caregivers had observed one or more conspicuous behaviours displayed by their children, which indicates a challenging situation. However, most of these caregivers assessed their parenting activity very favourably. Backward elimination multiple regression analysis indicated that a smaller number of support needs, younger age of the eldest child and fewer physical impairments on the part of the caregiver enhance the caregivers' assessment of their parenting activity. Physicians should speak to caregivers living with HIV about their parenting responsibilities and provide the necessary scope for this subject in their consultation sessions. Physicians are in a position to draw their patients' attention to the services available to them.

Failure to thrive in a girl born into a family affected by familial dysalbuminemic hyperthyroxinemia

Autosomal dominant familial dysalbuminemic hyperthyroxinemia (FDH)is characterized by modified human serum albumin (HSA) inducing asubstantially higher affinity for thyroxine (T4). Histidin or prolinsubstitution on residue R218 produces localized conformationalchanges of HSA creating additional room for T4 binding, leadingto 14-20 fold normal total T4 (TT4) levels. Affected individuals areconsidered euthyroid. Our patient is an 18 months-old swiss girl bornto a mother known for the rare R218P mutation in the HSA gene.She presented with severe failure to thrive (height -2.92 SD, weight-3.6 SD), habitual hip dislocation without anatomical anomaly, latefontanelle closing and protruding ears. Psychomotor development isslightly retarded. Thyroid function testing confirmed extremely high TT4(1446.0 nmol/l) levels, which are similar to her brother's values (1534.4nmol/l and 1757.6 nmol/l respectively). Free T4 seems slightly elevated(26 pmol/l), probably due to methodological reasons. TSH (0.92 mU/l),free T3 (4.4 pmol/l) and thyroxin binding globulin (32 mg/l) are withinthe normal range. Her two half-brothers, affected by the samemutation, are now 18.7 (P1) and 16.6 (P2) years old and wereoriginally described by S. Pannain et al. in 2000. Both werecharacterized by growth retardation (-2.1 and -2.2 SD) before the ageof 4 years. P1 has reached a normal adult height (-0.4 SD) and P2has caught up to normal growth (-0.68 SD) with moderate bonematuration delay. Pubertal development and anterior pituitary functionare adequate. Primary growth and developmental retardation in thefirst years of life with adequate catch-up seem to be a distinctcharacteristic in FDH with R218P mutation. Hip dislocation is typicallyseen in other situations associated to thyroid disorders, like Downsyndrome. These findings might be explained by altered early thyroidhormone utilization in children with FDH.

Remorins form a novel family of coiled coil-forming oligomeric and filamentous proteins associated with apical, vascular and embryonic tissues in plants.

Remorins form a superfamily of plant-specific plasma membrane/lipid-raft-associated proteins of unknown structure and function. Using specific antibodies, we localized tomato remorin 1 to apical tissues, leaf primordia and vascular traces. The deduced remorin protein sequence contains a predicted coiled coil-domain, suggesting its participation in protein-protein interactions. Circular dichroism revealed that recombinant potato remorin contains an alpha-helical region that forms a functional coiled-coil domain. Electron microscopy of purified preparations of four different recombinant remorins, one from potato, two divergent isologs from tomato, and one from Arabidopsis thaliana , demonstrated that the proteins form highly similar filamentous structures. The diameters of the negatively-stained filaments ranged from 4.6-7.4 nm for potato remorin 1, 4.3-6.2 nm for tomato remorin 1, 5.7-7.5 nm for tomato remorin 2, and 5.7-8.0 nm for Arabidopsis Dbp. Highly polymerized remorin 1 was detected in glutaraldehyde-crosslinked tomato plasma membrane preparations and a population of the protein was immunolocalized in tomato root tips to structures associated with discrete regions of the plasma membrane.

Compétences en soins patiatifs : que faut-il savoir faire en tant que médecin [Competencies in palliative care : what should the physicians be able to do?]

Palliative patients (patients with progressive incurable illnesses) have a number of needs, early and late in their illness trajectories. This article highlights some of the most important competencies required by physicians to address these needs. They cover a broad spectrum of domains and include pain and symptom management, communication, disclosure, prognostication, and psychological, social and spiritual needs. All physicians, generalists and specialists alike, should possess the basic competencies but should also recognize that some patients, especially those not responding to initial strategies, require timely referrals to specialized palliative care teams.

Double-blind comparison of indapamide with a placebo in hypertensive patients treated by practicing physicians.

The antihypertensive effect of indapamide (2.5 mg/day) was compared to that obtained with a placebo in a controlled trial carried out by 11 physicians in their private practice. Thirty-one patients with uncomplicated essential hypertension were included. After a run-in period of 3 weeks without any treatment, either indapamide (n = 16) or a placebo (n = 15) were administered for 8 weeks in double-blind fashion. Blood pressure decreased in both groups. In patients treated with indapamide, systolic pressure was significantly lower than in those given the placebo at 3 out of the 4 follow-up visits; diastolic pressure, however, was significantly lower only at the end of the trial. Both the active drug and the placebo were well tolerated. No significant change in body weight, plasma potassium and uric acid occurred during the study in either group of patients. It appears therefore that indapamide, at a dose which apparently has no major diuretic effect, may be useful for practitioners in managing patients with mild to moderate hypertension.