Providers' perspectives on the reproductive decision-making of BRCA-positive women.

BACKGROUND: Reproductive decision-making is difficult for BRCA-positive women. Our objective was to assess the complexities of decision-making and identify decisional supports for patients and providers when discussing reproductive options prior to risk-reducing salpingo-oophorectomy (RRSO). METHODS: This study was of qualitive design, using data collection via semi-structured interviews conducted from November 2018 to October 2020. Individuals were included if they were identified to provide care to BRCA-positive women. In total, 19 providers were approached and 15 consented to participate. Providers were recruited from three clinics in Toronto, Ontario located at academic centers: [1] A familial ovarian cancer clinic, [2] A familial breast cancer clinic and [3] A fertility clinic, all of which treat carriers of the BRCA1/BRCA2 genetic mutation. The interview guide was developed according to the Ottawa Decision Support Framework and included questions regarding reproductive options available to patients, factors that impact the decision-making process and the role of decisional support. Interviews were transcribed and transcripts were analyzed thematically using NVIVO 12. RESULTS: Providers identified three major decisions that reproductive-aged women face when a BRCA mutation is discovered: [1] "Do I want children?"; [2] "Do I want to take the chance of passing on this the mutation?"; and [3] "Do I want to carry a child?" Inherent decision challenges that are faced by both providers and patients included difficult decision type, competing options, scientifically uncertain outcomes, and challenging decision timing. Modifiable decisional needs included: inadequate knowledge, unrealistic expectations, unclear values and inadequate support or resources. Identified clinical gaps included counselling time constraints, lack of reliable sources of background information for patients or providers and need for time-sensitive, geographically accessible, and centralized care. CONCLUSION: Our study identified a need for a patient information resource that can be immediately provided to patients who carry a BRCA genetic mutation. Other suggestions for clinical practice include more time during consultation appointments, adequate follow-up, value-centric counseling, access to psychosocial support, and a specialized decisional coach.

Understanding umbilical venous catheter insertion practices through a prospective multicenter observational study.

OBJECTIVE: To understand practices of umbilical venous catheter (UVC) insertion in tertiary level neonatal intensive care units (NICU) and investigate the outcomes of subsequent attempts following a failed initial attempt. STUDY DESIGN: Prospective, multi-center observational study of UVC insertions at tertiary level NICUs between March 2019 and January 2020. RESULTS: Of the 101 UVCs inserted at 4 centers, seventy-two (71%) were central at the first attempt and 50% were central at subsequent attempts. Patients with at least 1 failed attempt at insertion were less likely to have a centrally placed UVC (p = .009). Manipulations were less likely to be required when UVC was centrally placed during the first attempt. Maneuvers such as posterior liver mobilization used during insertion were likely to be associated with successful central placement of UVC (p = .0243). The time to complete the procedure was significantly less when the UVC was central at the first attempt (34.2 ± 20.2 vs 46.9 ± 33.8) (p = .0292). Gestational age, birth weight, and age of the baby at the insertion of the UVC, experience of the provider, and type of catheter were comparable among groups. The Shukla formula was most commonly used by providers to measure the depth of UVC placement. CONCLUSION: Repetitive attempts and manipulations were less likely to be beneficial in the successful central placement of UVC in neonates. Additionally, repetitive attempts at insertion prolonged the overall duration of the procedure.

Patient engagement study to identify and improve surgical experience.

BACKGROUND: Patient engagement is the establishment of active partnerships between patients, families, and health professionals to improve healthcare delivery. The objective of this project was to conduct a series of patient engagement workshops to identify areas to improve the surgical experience and develop strategies to address areas identified as high priority. METHODS: Faculty surgeons and patients were invited to participate in three in-person meetings. Evaluation included identifying and developing strategies for three priority areas to improve the surgical experience and level of engagement achieved at each meeting. RESULTS: Sixteen faculty surgeons and 32 patients participated. Some 63 themes to improve the surgical experience were identified; the three highest-priority themes were physician communication, discharge process, and expectations at home after discharge. Individual improvement strategies for these three prioritized themes (12, 36 and 6 respectively) were used to develop a formal strategic plan, and included a physician communication survey, discharge process worksheet and video, and guideline regarding what to expect at home after discharge. Overall, the level of engagement achieved was considered high by over 85 per cent of the participants. CONCLUSION: A high level of patient engagement was achieved. Priorities were identified with patients and surgeons to improve surgical experience, and strategies were developed to address these areas.

Serum-free light chains adjusted for renal function are a potential biomarker for post-transplant lymphoproliferative disorders.

Post-transplant lymphoproliferative disease (PTLD) is a serious complication of solid organ transplantation. As early diagnosis remains challenging, we investigated the utility of serum-free light chain (FLC) and heavy chain/light chain pairs (HLC) as diagnostic biomarkers. Pre-treatment serum FLC and HLC levels were measured in 20 patients at their first diagnosis of B cell PTLD and in 14/20 patients during follow-up. Results were compared to serum FLC/HLC levels of 90 matched PTLD-free transplanted controls. Renal dysfunction was common in both cohorts, and combined FLC levels were often elevated above the conventional upper limit of normal (45.7 mg/L). Combined FLC levels were higher in patients with PTLD than in transplant controls (p = 0.013), and levels above the conventional ULN were associated with PTLD (OR 3.2, p = 0.05). Following adjustment to cystatin C as a marker of renal function an even stronger association was found for a (dimensionless) threshold value of 37.8 (OR 8.9, p < 0.001). In addition, monoclonal proliferation (abnormal FLC ratio, using an established renal range cutoff) was more common in PTLD than in controls (3/20 vs. 2/90, p = 0.04). Following therapy, at the time of protocolised restaging, patients experiencing subsequent sustained complete remission displayed lower FLC levels than those not experiencing such remission (p = 0.053). No relationship with HLC results was seen. Elevated polyclonal FLC levels (especially when adjusted for renal function) and monoclonal proliferation are a potential biomarker for PTLD diagnosis and disease surveillance. However, prospective validation is necessary before FLC measurement should be incorporated in follow-up of transplant recipients and PTLD management.

Tissue Factor Pathway Inhibitor Gene Polymorphism -33T → C Predicts Improved Disease-Free Survival in Colorectal Cancer.

BACKGROUND: Tissue factor pathway inhibitor (TFPI) is an anticoagulant with antimetastatic properties. The homozygous CC polymorphism of TFPI (-33T â†’ C) is associated with higher TFPI levels and lower venous thromboembolism risk. This study was the first to evaluate the impact of this polymorphism on disease-free survival (DFS) in cancer patients after curative resection. METHODS: A prospectively maintained tumor bank with clinical data was used to identify patients who underwent curative surgery for colorectal cancer between 1994 and 2006. Germline DNA was extracted from formalin-fixed, paraffin-embedded normal colonic mucosa. Single nucleotide polymorphisms for TFPI (-33T â†’ C), factor V Leiden (G1691A), and prothrombin (G20210A) were determined by polymerase chain reaction. Survival analysis was described using the Kaplan-Meier method. Multivariable regression analysis was performed using the Cox proportional hazard model. RESULTS: Of the 127 patients identified, the CC genotype was found in 11 %. Venous thromboembolism incidence was 18 % in the TT/TC (wild type/heterozygous) genotypes and 7 % in the CC genotype (p = 0.46). The CC genotype was associated with superior DFS (hazard ratio 0.34, 95 % confidence interval 0.14-0.84; p = 0.02) with 5-year DFS of 63 vs. 24 % for CC vs. TT/TC, respectively. In multivariate analysis, CC polymorphism (hazard ratio 0.28, p = 0.008) was independently associated with improved DFS. The prevalence of factor V Leiden (0.8 %) and prothrombin (1.6 %) polymorphisms was too low to detect interaction with TFPI polymorphism or DFS. CONCLUSIONS: These findings indicate that the inherited anticoagulant homozygous -33T â†’ C TFPI polymorphism may protect against colon cancer recurrence and suggests a mediating role for the coagulation system in cancer outcomes.

A Review of the Effectiveness of Breast Surgical Oncology Fellowship Programs Utilizing Kirkpatrick's Evaluation Model.

It has been 10 years since the first class of Society of Surgical Oncology (SSO) fellowship trained Breast Surgical Oncologist entered practice. To date, there has been no publications examining the effectiveness of these training programs that are today throughout North America and Europe. This evaluative review examines the effectiveness of these fellowship training programs through the lens of the Kirkpatrick Evaluation Model. An extensive review of the literature was performed, and articles were categorized to capture how fellows are reacting to the program, what they are learning, and how the program is effecting their career path and impacting their patients. We can conclude that there is both direct and indirect evidence to support the effectiveness of this training program, but there is a paucity of direct evidence as one progresses from a level 1 Kirkpatrick analysis to a level 4. This review sets the framework for program evaluation in surgical fellowships and should encourage stakeholders to constantly evaluate the impact their program is having on trainees and oncology patients.

Temporary anion states of three herbicide families.

Electron scattering studies are used to locate the energies of temporary negative ion states of three chloro-substituted molecular families of herbicidal importance: salicylic and phenoxyacetic acids and acetamides. The correlation between these energies and the computed virtual orbital energies of the compounds is examined and used to put the latter on an absolute energy scale. Such scaling of orbital energies permits the anion states of other members of these families, for which experimental data may not be available, to be estimated from the calculated orbital energies. Studies of electron reduction rates often rely on calculated LUMO energies as molecular descriptors. The use of measured anion energies as well as appropriately scaled orbital energies should serve to improve such studies in these and in related herbicides.

Desenvolvimento da camomila, rendimento e qualidade do óleo essencial em diferentes idades de colheita / Development of chamomile and essential oil yield and quality at different harvesting times

A camomila é uma planta herbácea, anual e aromática com várias propriedades medicinais. No Brasil, vem sendo cultivada em área representativa na região Sul devido, principalmente, às exigências climáticas da espécie, e por ter sido introduzida por imigrantes europeus nesta região. A colheita da camomila é realizada em várias colheitas, contudo, a idade adequada da planta para o início desta atividade, objetivado a maior produção de capítulos florais, bem como o rendimento e qualidade de óleos essenciais, ainda não foi determinada para a espécie. Neste trabalho, investigou-se o efeito de diferentes épocas de colheita no desenvolvimento de capítulos florais e no acúmulo e qualidade do óleo essencial da camomila. O experimento foi conduzido no município de Piraquara (PR). O delineamento experimental foi inteiramente casualizado, com cinco tratamentos (85, 92, 99, 106 e 113 dias após a emergência das plântulas) e cinco repetições. Após cada colheita, avaliou-se o acúmulo de massa seca de capítulos, rendimento, produção e composição do óleo essencial. A extração de óleo foi realizada por hidrodestilação e as amostras analisadas por cromatografia gasosa. Concluiu-se que aos 85 dias após a emergência (DAE) os capítulos apresentaram maior rendimento de óleo. Porém, após três semanas ocorreu a maior produção de massa de capítulos, resultando em maiores médias de produtividade de óleo essencial. A partir de 113 DAE houve redução do rendimento de óleo essencial e no teor de alguns constituintes.

Chamomile is an aromatic herb with many medicinal properties. In Brazil, it is cultivated on an extensive area in the Southern region mainly because of its climatic conditions for this culture. Chamomile harvesting is done by several cuttings of the entire plant, but the ideal starting point of this activity to obtain high production of flower heads has not been determined. This work investigated the effect of the harvesting period of chamomile on flower head development and essential oil accumulation. The experiment was carried out at field conditions in Piraquara, Paraná, Brazil. The experimental design was completely randomized with five treatments (85, 92, 99, 106 and 113 days after emergency) and five replications. After each harvest, dry mass accumulation and essential oil yield and quality were evaluated. Essential oil extraction was performed by hydrodistillation, and the sample was analyzed by gas chromatography. When harvested 85 days after emergency, the flower heads presented the highest essential oil content, but three weeks later the highest flower head dry mass was obtained, which resulted on great essential oil productivity. From 113 days after emergency, there is a reduction in essential oil yield and production.

Desenvolvimento vegetativo e produção de óleo essencial de patchouli (Pogostemon cablin (Blanco) Benth. ) após a aplicação de ácido giberélico e extrato de alga marinha / Development and essential oil production of Pogostemon cablin (Blanco) Benth. patchouli after applying gibberellic acid and seaweed extract

Pogostemon cablin (Blanco) Benth., comumente conhecido como patchouli, é uma espécie aromática utilizada pela indústria de perfumes devido a fragrância amadeirada e propriedade fixadora do óleo essencial. Fatores que afetam o teor dos constituintes do óleo essencial devem ser avaliados visando obter matéria prima de melhor qualidade. O experimento foi conduzido em casa de vegetação com delineamento inteiramente casualizado em esquema fatorial 2x3 e 4 repetições, sendo dois níveis de giberelina (0 e 200 mg L-1) e três níveis de extrato de alga marinha (0, 15 e 30 mg L-1). A aplicação dos reguladores vegetais foi realizada 30 dias após o plantio das mudas, e a avaliação do experimento deu-se 45 dias após a aplicação dos tratamentos. Não houve diferença significativa para a altura das plantas, a concentração de extrato de alga marinha de 15 mg L-1 promoveu aumento no número de folhas em relação à testemunha e a concentração de 30 mg L-1 promoveu decréscimo. Em relação à área foliar e ao número de folhas houve relação inversa para os níveis de extrato de alga marinha, onde o tratamento com maior concentração do regulador resultou em aumento da área foliar e redução do número de folhas. O teor de óleo essencial foi superior após a aplicação de 15 mg L-1 de extrato alga marinha isoladamente ou combinado com GA3. A produtividade do óleo essencial também aumentou com a aplicação 15 mg L-1 de extrato de alga marinha e quando utilizado somente GA3. A utilização de extrato de alga marinha aumentou a concentração de patchoulol no óleo essencial.

Pogostemon cablin (Blanco) Benth., commonly known as patchouli, is an aromatic species used by the perfume industry due to its woody fragrance and the fixative characteristic of its essential oil. Factors affecting the content of the constituents of essential oils should be evaluated in order to obtain raw materials with better quality. The experiment was carried out in a greenhouse in a completely randomized 2x3 factorial arrangement and four replications, with two levels of gibberellin (0 and 200 mg L-1) and three levels of seaweed extract (0, 15 and 30 mg L-1). Plant regulators were applied thirty days after planting the seedlings; the experiment was evaluated forty-five days after the treatments. There was no significant difference in plant height; the 15 mg L-1 concentration of seaweed extract promoted an increase in the number of leaves in relation to the control; and the 30 mg L-1 concentration promoted a decrease. In relation to leaf area and leaf number, there was an inverse relationship for the seaweed extract levels, in which the treatment with higher a concentration of the regulator resulted in an increased leaf area, reducing the number of leaves. The essential oil content was higher after applying 15 mg L-1 of seaweed extract alone or combined with GA3. The yield of essential oil also increased by applying 15 mg L-1 of seaweed extract and when only GA3 was used. The use of seaweed extract increased the patchoulol concentration in the essential oil.

Teor e composição de óleo essencial de rizomas de gengibre (Zingiber officinale Roscoe) após diferentes períodos de secagem / Essential oil yield and composition of ginger (Zingiber officinale Roscoe) rhizomes after different drying periods

A produção de gengibre no Paraná concentra-se no município de Morretes, ocupando uma área de plantio de aproximadamente 300 ha. O objetivo deste trabalho foi avaliar o teor e a composição do óleo essencial de rizomas de gengibre produzidos em Morretes e submetidos a diferentes períodos de secagem em temperatura ambiente. O delineamento experimental foi inteiramente casualizado, em esquema fatorial 5 x 5, com quatro repetições (quatro plantas por repetição), avaliando cinco procedências e cinco períodos de secagem a temperatura ambiente (0, 15, 30, 45 e 60 dias). As extrações de óleo essencial foram realizadas por hidrodestilação em aparelho graduado Clevenger durante três horas e a análise dos constituintes foi realizada por meio de cromatografia em fase gasosa acoplada à espectrometria de massas. A secagem de rizomas de gengibre em temperatura ambiente por até 60 dias resultou na diminuição de teores de óleo essencial na maioria das procedências. Os constituintes geranial e o neral apresentaram maior concentração em todas as procedências e tiveram teores superiores com o aumento nos períodos de secagem. Os teores de geraniol e acetato de geranila foram inferiores após a secagem em todas as procedências, assim como eucaliptol, canfeno, zingibereno e β-bisaboleno na maioria das procedências.

Ginger production in Paraná State, Brazil, has predominated in Morretes Municipality, with around 300 ha cultivated area. The aim of this work was to evaluate the essential oil yield and composition of ginger rhizomes produced in Morretes and subjected to different drying periods at room temperature. Experimental design was completely randomized, in a 5x5 factorial arrangement, with four replicates (four plants each), five origins and five drying periods at room temperature (0, 15, 30, 45 and 60 days). The essential oil was extracted by hydrodistillation in a Clevenger-type device for 3h and the constituents were analyzed by gas chromatography-mass spectrometry (GC/MS). The drying of ginger rhizomes at room temperature for up to 60 days decreased the essential oil yield in most origins. Geranial and neral levels were higher in all origins and as drying periods were longer. Geraniol and geranyl acetate levels decreased after drying in all origins, as well as eucalyptol, camphene, zingiberene and β-bisabolene in most origins.

Assignments of normally unoccupied orbitals to the temporary negative ion states of several lanthanide NMR shift reagents and comments on resonance involvement in electron circular dichroism.

We have measured the total electron scattering cross sections of several NMR shift reagent molecules X(hfc)3, where X = Yb, Er, Eu and Pr, by means of electron transmission spectroscopy (ETS) to determine their vertical attachment energies. A strong low-energy resonance (<1 eV) is observed in all of the compounds except for Yb(hfc)3. We explain this anomaly in terms of the ground-state electron configuration of each molecule. Also, with the aid of restricted open-shell Hartree-Fock (ROHF) calculations on analogous molecules with truncated fluorocarbon chains, we have assigned specific normally unoccupied orbitals to the resonances observed in ETS. To our knowledge, these molecules are the largest for which this procedure has been successfully completed. Nolting et al. (J. Phys. B 1997, 30, 5491) have demonstrated that the above NMR shift reagents exhibit electron circular dichroism (ECD) between 1 and 10 eV. Using our new total cross section data, we comment on the possibility of resonance involvement in the generation of ECD.

Total dissociative electron attachment cross sections of selected amino acids.

Total dissociative electron attachment cross sections are presented for the amino acids, glycine, alanine, proline, phenylalanine, and tryptophan, at energies below the first ionization energy. Cross section magnitudes were determined by observation of positive ion production and normalization to ionization cross sections calculated using the binary-encounter-Bethe method. The prominent 1.2 eV feature in the cross sections of the amino acids and the closely related HCOOH molecule is widely attributed to the attachment into the -COOH pi* orbital. The authors discuss evidence that direct attachment to the lowest sigma* orbital may instead be responsible. A close correlation between the energies of the core-excited anion states of glycine, alanine, and proline and the ionization energies of the neutral molecules is found. A prominent feature in the total dissociative electron attachment cross section of these compounds is absent in previous studies using mass analysis, suggesting that the missing fragment is energetic H-.

Total dissociative electron attachment cross sections for molecular constituents of DNA.

Total cross sections for the dissociative electron attachment process are presented for the DNA bases thymine, cytosine, and adenine and for three compounds used as surrogates for the ribose and phosphate groups, tetrahydrofuran, 3-hydroxytetrahydrofuran, and trimethylphosphate, respectively. Cross section magnitudes are obtained by observation of positive ion production and normalization to ionization cross sections calculated elsewhere using the binary-encounter-Bethe method. The average cross section of the three bases is 3-10 times smaller than the effective cross section per nucleotide reported for single strand breaks in surface-bound supercoiled DNA. Consequently, damage to the bases alone does not appear to account for the major portion of the strand breaks. The presence of an OH group on the ribose surrogate considerably enhances its cross section. Model compounds in which protonation or OH groups are used to terminate bonds may therefore display larger cross sections than in DNA itself.

Vibrational Feshbach resonances in uracil and thymine.

Sharp peaks in the dissociative electron attachment (DEA) cross sections of uracil and thymine at energies below 3 eV are assigned to vibrational Feshbach resonances (VFRs) arising from coupling between the dipole bound state and the temporary anion state associated with occupation of the lowest sigma* orbital. Three distinct vibrational modes are identified, and their presence as VFRs is consistent with the amplitudes and bonding characteristics of the sigma* orbital wave function. A deconvolution method is also employed to yield higher effective energy resolution in the DEA spectra. The site dependence of DEA cross sections is evaluated using methyl substituted uracil and thymine to block H atom loss selectively. Implications for the broader issue of DNA damage are briefly discussed.

Bond breaking and temporary anion states in uracil and halouracils: implications for the DNA bases.

Low energy electrons are capable of breaking bonds in gas phase DNA bases by means of the dissociative electron attachment process. With the aid of new total scattering data in the halouracils and input from quantum chemical calculations, we describe the dipole bound and valence anion states in these compounds and present assignments for the two types of structure appearing in the cross sections. A clear distinction between the two mechanisms for bond breaking is necessary for an understanding of electron induced damage to DNA.

Mutational and computational analysis of the alpha(1b)-adrenergic receptor. Involvement of basic and hydrophobic residues in receptor activation and G protein coupling.

To investigate their role in receptor coupling to G(q), we mutated all basic amino acids and some conserved hydrophobic residues of the cytosolic surface of the alpha(1b)-adrenergic receptor (AR). The wild type and mutated receptors were expressed in COS-7 cells and characterized for their ligand binding properties and ability to increase inositol phosphate accumulation. The experimental results have been interpreted in the context of both an ab initio model of the alpha(1b)-AR and of a new homology model built on the recently solved crystal structure of rhodopsin. Among the twenty-three basic amino acids mutated only mutations of three, Arg(254) and Lys(258) in the third intracellular loop and Lys(291) at the cytosolic extension of helix 6, markedly impaired the receptor-mediated inositol phosphate production. Additionally, mutations of two conserved hydrophobic residues, Val(147) and Leu(151) in the second intracellular loop had significant effects on receptor function. The functional analysis of the receptor mutants in conjunction with the predictions of molecular modeling supports the hypothesis that Arg(254), Lys(258), as well as Leu(151) are directly involved in receptor-G protein interaction and/or receptor-mediated activation of the G protein. In contrast, the residues belonging to the cytosolic extensions of helices 3 and 6 play a predominant role in the activation process of the alpha(1b)-AR. These findings contribute to the delineation of the molecular determinants of the alpha(1b)-AR/G(q) interface.

Characterization of chemokine receptors.

This unit describes the procedures for measuring binding of a radiolabeled chemokine to chemokine receptors in cells or cell membranes. The whole-cell binding assay can be used for both purified leukocytes as well as transfected cell lines expressing chemokine receptors. Two basic protocols are described. The first is applicable to all cells expressing chemokine receptors, both primary cultures as well as recombinantly transfected cell lines expressing a single chemokine receptor. The second is used principally for transfected cell lines and measures chemokine binding to cell membranes using scintillation proximity assay (SPA) methodology, but does not require washing steps and thus is applicable to automated high-throughput screening strategies. An alternative procedure is also described which also uses SPA methodology to measure GTP-gamma-S binding to chemokine receptors in cell membranes. The two basic protocols can be used to determine the binding of compounds to chemokine receptors, while the alternate protocol determines the effects of compounds on the chemokine-stimulated activation of the receptor.

Binding properties of beta-blockers at recombinant beta1-, beta2-, and beta3-adrenoceptors.

The human heart contains at least four distinct beta-adrenoceptor subtypes, three of which have been cloned. However, the binding properties of beta-blockers to the different beta-adrenoceptor subpopulations are not yet thoroughly characterized. Human beta1-, beta2- and beta3-adrenoceptors were expressed in COS-7 cells and [125I]iodocyanopindolol saturation binding, and competition experiments with commonly used beta-blockers were performed in the respective membrane preparations. Atenolol and metoprolol were about fivefold selective for beta1- versus beta2- and beta3-adrenoceptors. Bisoprolol was approximately 15-fold selective for beta1- versus beta2- and approximately 31-fold selective for beta1- versus beta3-adrenoceptors. Carvedilol was nonselective for any beta-adrenoceptor subtype. We conclude that the beta1-selectivities of atenolol, metoprolol, and bisoprolol are lower in COS cell membranes compared with previous investigations performed in native membranes. All beta-blockers investigated bind to beta3-adrenoceptors. Differential binding properties to beta3-adrenoceptors might imply different responses as to body weight, cardiac contractility, heart rate, and growth regulation. This might imply differential indications for the drugs investigated.

Mutational analysis of the highly conserved arginine within the Glu/Asp-Arg-Tyr motif of the alpha(1b)-adrenergic receptor: effects on receptor isomerization and activation.

We have suggested previously that both the negatively and positively charged residues of the highly conserved Glu/Asp-Arg-Tyr (E/DRY) motif play an important role in the activation process of the alpha(1b)-adreneric receptor (AR). In this study, R143 of the E/DRY sequence in the alpha(1b)-AR was mutated into several amino acids (Lys, His, Glu, Asp, Ala, Asn, and Ile). The charge-conserving mutation of R143 into lysine not only preserved the maximal agonist-induced response of the alpha(1b)-AR, but it also conferred high degree of constitutive activity to the receptor. Both basal and agonist-induced phosphorylation levels were significantly increased for the R143K mutant compared with those of the wild-type receptor. Other substitutions of R143 resulted in receptor mutants with either a small increase in constitutive activity (R143H and R143D), impairment (R143H, R143D), or complete loss of receptor-mediated response (R143E, R143A, R143N, R143I). The R413E mutant displayed a small, but significant increase in basal phosphorylation despite being severely impaired in receptor-mediated response. Interestingly, all the arginine mutants displayed increased affinity for agonist binding compared with the wild-type alpha(1b)-AR. A correlation was found between the extent of the affinity shift and the intrinsic activity of the agonists. The analysis of the receptor mutants using the allosteric ternary complex model in conjunction with the results of molecular dynamics simulations on the receptor models support the hypothesis that mutations of R143 can drive the isomerization of the alpha(1b)-AR into different states, highlighting the crucial role of this residue in the activation process of the receptor.