Obstacles in large-scale epidemiological assessment of sensory impairments in a Dutch population with intellectual disabilities.

BACKGROUND: A population-based epidemiological study on visual and hearing impairment was planned in a random sample of 2100 clients, drawn from a base population of 9012 users of Dutch residential and day-care intellectual disability (ID) services with the whole range of IDs. Stratification was applied for age 50 years and over and Down syndrome. Visual and hearing functions were assessed according to a standardized protocol, in cooperation with regular ophthalmologists and regional audiological centres. Anticipated obstacles in sample collection, random inclusion, informed consent, expertise of investigators, time and costs were eliminated by a careful preparation. However, inclusion and participation were incomplete. METHOD: In a descriptive retrospective design, we collected data from our study files on inclusion and participation as well as reasons for non-participation, to identify unanticipated obstacles for this kind of research. RESULTS: Consent was obtained for 1660 clients, and 1598 clients participated in the data collection (76% of intended sample of 2100). Inclusion and participation rates were especially lower in community-based care organizations, resulting in unintentional skewing of the sample towards more severe levels of ID. Complete and reliable data to diagnose visual impairment were obtained for 1358/1598 (85%) and to diagnose hearing impairment for 1237/1598 participants (77%). Unanticipated obstacles had to do with the quality of coordination within care organizations, with characteristics of screening methods, and with collaboration with the regular health care system. Assessments of visual function were more easy to organize than were those of hearing. Based on our current experience, practical recommendations are given for future multicentre research, especially in community-based settings.

Analysis of hearing loss after shunt placement in patients with normal-pressure hydrocephalus.

OBJECT: Following shunt placement for treatment of normal-pressure hydrocephalus (NPH), several patients suffered hearing loss. The authors undertook a study to analyze this outcome. METHODS: Sixteen patients in whom NPH was diagnosed were treated by placement of a ventriculoperitoneal shunt. Their hearing was assessed pre- and postoperatively by using pure tone audiometry. Two thirds of the ears tested showed a postoperative hearing loss of more than 10 dB. Recovery of the hearing loss occurred 6 to 12 weeks after shunt placement in 75% of the ears examined. CONCLUSIONS: Although shunt insertion for treatment of NPH results in a decrease in hearing, most of the loss can be recovered.

The click-evoked oto-acoustic emission, c-EOAE, in preterm-born infants in the post conceptional age range between 30 and 68 weeks.

Click-evoked otoacoustic emissions (cEOAEs) were repeatedly recorded in an operational sample of 144 very low birth weight (VLBW) infants. A subgroup of 22 was composed of all those babies in which at least 4 recordings were successfully done. The mean birth weight of this group was 1040 g, and the mean duration of assisted ventilation was 17 days. The OAE-recordings were done in the post conceptional age (PCA) range between 30 and 68 weeks. In relation to ear function screening it was shown that the EOAE was present in 95% of the ears at least once at any age, while it was present in all recordings in only 34%. From a longitudinal analysis of the recordings per infant it appeared that: (1) the OAE recorded was already present in one infant at the PCA of 29.4 weeks; (2) in most infants the level of the OAE varies strongly between recordings; (3) in each infant the OAE-level shows an increase with age, on average this growth amounts to 10 dB between the PCAs of 31 and 42 weeks; (4) there is no clearcut difference in the growth of high- and low-frequency components of the EOAE.

Galactose-binding site in Escherichia coli heat-labile enterotoxin (LT) and cholera toxin (CT).

The galactose-binding site in cholera toxin and the closely related heat-labile enterotoxin (LT) from Escherichia coli is an attractive target for the rational design of potential anti-cholera drugs. In this paper we analyse the molecular structure of this binding site as seen in several crystal structures, including that of an LT:galactose complex which we report here at 2.2 A resolution. The binding surface on the free toxin contains several tightly associated water molecules and a relatively flexible loop consisting of residues 51-60 of the B subunit. During receptor binding this loop becomes tightly ordered by forming hydrogen bonds jointly to the GM1 pentasaccharide and to a set of water molecules which stabilize the toxin:receptor complex.

Structure of partially-activated E. coli heat-labile enterotoxin (LT) at 2.6 A resolution.

Biological toxicity of E. coli heat-labile enterotoxin and the closely related cholera toxin requires that the assembled toxin be activated by proteolytic cleavage of the A subunit and reduction of a disulfide bond internal to the A subunit. The structural role served by this reduction and cleavage is not known, however. We have crystallographically determined the structure of the E. coli heat-labile enterotoxin AB5 hexamer in which the A subunit has been cleaved by trypsin between residues 192 and 195. The toxin is thus partially activated, in that it has been cleaved but the disulfide bond has not been reduced. The structure of the A subunit in the cleaved toxin is substantially the same as that previously observed for the uncleaved AB5 structure, suggesting that although such cleavage is required for biological activity of the toxin it does not by itself cause a conformational change.

Refined structure of Escherichia coli heat-labile enterotoxin, a close relative of cholera toxin.

Heat-labile enterotoxin (LT) from Escherichia coli is a bacterial protein toxin with an AB5 multimer structure, in which the B pentamer has a membrane binding function and the A subunit is needed for enzymatic activity. The LT crystal structure has been solved using a combination of multiple isomorphous replacement, fivefold averaging and molecular dynamics refinement. Phase combination using all these sources of phase information was of crucial importance for the chain tracing. The structure has now been refined to 1.95 A resolution, resulting in a model containing 6035 protein atoms and 293 solvent molecules with a crystallographic R-factor of 18.2% and good stereochemistry. The B subunits are arranged as a highly stable pentamer with a donut shape. Each subunit takes part in approximately 30 inter-subunit hydrogen bonds and six salt bridges with its two neighbors, whilst burying a large surface area. The A subunit has higher temperature factors and less well-defined secondary structure than the B subunits. It interacts with the B pentamer mainly via the C-terminal A2 fragment, which runs through the highly charged central pore of the B subunits. The pore contains at least 66 water molecules, which fill the space left by the A2 fragment. A detailed analysis of the contacts between A and B subunits showed that most specific contacts occur at the entrance of the central pore of the B pentamer, while the contacts within the pore are mainly hydrophobic and water mediated, with the exception of two salt bridges. Only a few contacts exist between the A1 fragment and the B pentamer, showing that the A2 fragment functions as a "linker" of the A and B parts of the protein. Interacting with the A subunit by the B subunits does not cause large deviations from a common B subunit structure, and the 5-fold symmetry is well maintained. A potential NAD(+)-binding site is located in an elongated crevice at the interface of two small sheets in the A1 fragment. At the back of this crevice the functionally important Arg7 makes a hydrogen bond connecting two strands, which seems to be conserved across the ADP-ribosylating toxin family. The putative catalytic residue (A1:Glu112) is located nearby, close to a very hydrophobic region, which packs two loops together. This hydrophobic region may be important for catalysis and membrane translocation.

Impaired speech perception in noise in patients with a normal audiogram.

Patients with normal hearing acuity but complaining of impaired speech perception in noisy conditions were submitted to a test battery including the measurement of the speech reception threshold in noise and central auditory tests. In 95% of the cases the complaint was corroborated by an abnormal speech reception threshold (SRT) in noise. Central auditory tests were abnormal in 65% of the patients. Auditory brainstem-evoked potentials were measured in some of these patients and showed normal results in almost all cases. No specific relationship could be found between an elevated SRT in noise or an abnormal central test result.

Active site structure of methylamine dehydrogenase: hydrazines identify C6 as the reactive site of the tryptophan-derived quinone cofactor.

To identify the reactive part of the orthoquinone function of the tryptophan-derived cofactor found in methylamine dehydrogenase (MADH), we have determined the crystal structures of MADH from Thiobacillus versutus inhibited by methylhydrazine and (2,2,2-trifluoroethyl)hydrazine. Extra electron density attached to C6 of the tryptophyl tryptophanquinone cofactor shows that this atom and not C7 is the reactive part of the ortho-quinone moiety. The density retained after hydrazine inhibition is much less extensive than expected, however, suggesting that partial breakdown of the inhibitors after reaction with the cofactor may take place. A detailed description is presented of the cofactor environment in an improved model of MADH which now includes information from the recently determined gene sequence of the cofactor-containing subunit [Ubbink, M., van Kleef, M.A.G., Kleinjan, D., Hoitink, C.W.G., Huitema, F., Beintema, J.J., Duine, J.A., & Canters, G.W. (1991) Eur. J. Biochem. 202, 1003-1012]. We hypothesize that Asp76 is responsible for proton abstraction from the alpha-carbon of the substrate during catalysis.

Lactose binding to heat-labile enterotoxin revealed by X-ray crystallography.

Recognition of the oligosaccharide portion of ganglioside GM1 in membranes of target cells by the heat-labile enterotoxin from Escherichia coli is the crucial first step in its pathogenesis, as it is for the closely related cholera toxin. These toxins have five B subunits, which are essential for GM1 binding, and a single A subunit, which needs to be nicked by proteolysis and reduced, yielding an A1-'enzyme' and an A2-'linker' peptide. A1 is translocated across the membrane of intestinal epithelial cells, possibly after endocytosis, upon which it ADP-ribosylates the G protein Gs alpha. The mechanism of binding and translocation of these toxins has been extensively investigated, but how the protein is orientated on binding is still not clear. Knowing the precise arrangement of the ganglioside binding sites of the toxins will be useful for designing drugs against the diarrhoeal diseases caused by organisms secreting these toxins and in the development of oral vaccines against them. We present here the three-dimensional structure of the E. coli heat-labile enterotoxin complexed with lactose. This reveals the location of the binding site of the terminal galactose of GM1, which is consistent with toxin binding to the target cell with its A1 fragment pointing away from the membrane. A small helix is identified at the carboxy terminus of A2 which emerges through the central pore of the B subunits and probably comes into contact with the membrane upon binding, whereas the A1 subunit is flexible with respect to the B pentamer.

Crystal structure of a cholera toxin-related heat-labile enterotoxin from E. coli.

Examination of the structure of Escherichia coli heat-labile enterotoxin in the AB5 complex at a resolution of 2.3A reveals that the doughnut-shaped B pentamer binds the enzymatic A subunit using a hairpin of the A2 fragment, through a highly charged central pore. Putative ganglioside GM1-binding sites on the B subunits are more than 20A removed from the membrane-crossing A1 subunit. This ADP-ribosylating (A1) fragment of the toxin has structural homology with the catalytic region of exotoxin A and hence also to diphtheria toxin.

Whole-body vibration and low-back pain. A review of epidemiologic studies.

This review presents a critical evaluation of the literature on health effects in long-term occupational exposure to whole-body vibration. To assess the relative weight of each epidemiologic study, a scoring procedure has been used, according to the quality of exposure data, effect data, study design and methodology. The most frequently reported adverse effects are: low-back pain, early degeneration of the lumbar spinal system and herniated lumbar disc. No study reached an adequate score on all criteria of evaluation. Nevertheless, because most studies show a strong tendency in a similar direction, it may be concluded that long-term exposure to whole-body vibration is harmful to the spinal system. The results do not yet permit firm conclusions on exposure-response relationships. Further epidemiologic research, particularly of high-risk groups, is needed.

The effect of dose loading and of double labelling with 57Co and 125I on the tissue distribution in animals.

Dose loading effects upon the performance of 57Co-bleomycin as a tumor localizing agent have been investigated in Rhabdomyosarcoma bearing Wag/Ry rats. The addition of non-radioactively labelled Co-bleomycin increased the relative uptake of 57Co-bleomycin in rapid growing tumors, but the addition of non-chelated bleomycin had no influence at all. In our experimental system, iodinated bleomycin generally labelled by reaction with ICl, was found to be an unsatisfactory tumor localizing agent. In order to combine the useful localizing properties of Co-bleomycin with the qualified detection properties of some iodine isotopes, we attempted to prepare bleomycin doubly labelled with Co and I. However, we were unable to prepare 57Co-125I-bleomycin by general labelling with ICl. This result indicates that both labels need the imidazole ring for the formation of a stable, labelled bleomycin.