Functional neuroimaging of sex differences in autobiographical memory recall in depression.

BACKGROUND: Females are more likely than males to develop major depressive disorder (MDD). The current study used fMRI to compare the neural correlates of autobiographical memory (AM) recall between males and females diagnosed with MDD. AM overgenerality is a persistent cognitive deficit in MDD, the magnitude of which is correlated with depressive severity only in females. Delineating the neurobiological correlates of this deficit may elucidate the nature of sex-differences in the diathesis for developing MDD. METHODS: Participants included unmedicated males and females diagnosed with MDD (n = 20/group), and an age and sex matched healthy control group. AM recall in response to positive, negative, and neutral cue words was compared with a semantic memory task. RESULTS: The behavioral properties of AMs did not differ between MDD males and females. In contrast, main effects of sex on cerebral hemodynamic activity were observed in left dorsolateral prefrontal cortex and parahippocampal gyrus during recall of positive specific memories, and middle prefrontal cortex (mPFC), and precuneus during recall of negative specific memories. Moreover, main effects of diagnosis on regional hemodynamic activity were observed in left ventrolateral prefrontal cortex and mPFC during positive specific memory recall, and dorsal anterior cingulate cortex during negative specific memory recall. Sex × diagnosis interactions were evident in the dorsomedial prefrontal cortex, caudate, and precuneus during positive memory recall, and in the posterior cingulate cortex, insula, precuneus and thalamus during negative specific memory recall. CONCLUSIONS: The differential hemodynamic changes conceivably may reflect sex-specific cognitive strategies during recall of AMs irrespective of the phenomenological properties of those memories.

Neurophysiological correlates of autobiographical memory deficits in currently and formerly depressed subjects.

BACKGROUND: Individuals with major depressive disorder (MDD) tested in either the depressed (dMDD) or remitted phase (rMDD) recall fewer specific and more categorical autobiographical memories (AMs) compared to healthy controls (HCs). The current study aimed to replicate findings of AM overgenerality in dMDD or rMDD, and to elucidate differences in neurophysiological correlates of AM recall between these MDD samples and HCs. METHOD: Unmedicated participants who met criteria for the dMDD, rMDD or HC groups (n = 16/group) underwent functional magnetic resonance imaging (fMRI) while recalling AMs in response to emotionally valenced cue words. Control tasks involved generating examples from an assigned semantic category and counting the number of risers in a letter string. RESULTS: The results showed fewer specific and more categorical AMs in both MDD samples versus HCs; dMDDs and rMDDs performed similarly on these measures. The neuroimaging results showed differences between groups in the dorsomedial prefrontal cortex (DMPFC), lateral orbitofrontal cortex (OFC), anterior insula, inferior temporal gyrus and parahippocampus/hippocampus during specific AM recall versus example generation. During specific AM recall cued by positively valenced words, group differences were evident in the DMPFC, middle temporal gyrus, parahippocampus/hippocampus and occipital gyrus, whereas differences during specific AM recall cued by negatively valenced words were evident in the DMPFC, superior temporal gyrus and hippocampus. CONCLUSIONS: AM deficits exist in rMDDs, suggesting that these impairments constitute trait-like abnormalities in MDD. We also found distinct patterns of hemodynamic activity for each group as they recalled specific AMs, raising the possibility that each group used a partly unique strategy for self-referential focus during successful retrieval of specific memories.

Functional anatomy of autobiographical memory recall deficits in depression.

BACKGROUND: Major depressive disorder (MDD) is associated with deficits in recalling specific autobiographical memories (AMs). Extensive research has examined the functional anatomical correlates of AM in healthy humans, but no studies have examined the neurophysiological underpinnings of AM deficits in MDD. The goal of the present study was to examine the differences in the hemodynamic response between patients with MDD and controls while they engage in AM recall. METHOD: Participants (12 unmedicated MDD patients; 14 controls) underwent functional magnetic resonance imaging (fMRI) scanning while recalling AMs in response to positive, negative and neutral cue words. The hemodynamic response during memory recall versus performing subtraction problems was compared between MDD patients and controls. Additionally, a parametric linear analysis examined which regions correlated with increasing arousal ratings. RESULTS: Behavioral results showed that relative to controls, the patients with MDD had fewer specific (p=0.013), positive (p=0.030), highly arousing (p=0.036) and recent (p=0.020) AMs, and more categorical (p<0.001) AMs. The blood oxygen level-dependent (BOLD) response in the parahippocampus and hippocampus was higher for memory recall versus subtraction in controls and lower in those with MDD. Activity in the anterior insula was lower for specific AM recall versus subtraction, with the magnitude of the decrement greater in MDD patients. Activity in the anterior cingulate cortex was positively correlated with arousal ratings in controls but not in patients with MDD. CONCLUSIONS: We replicated previous findings of fewer specific and more categorical AMs in patients with MDD versus controls. We found differential activity in medial temporal and prefrontal lobe structures involved in AM retrieval between MDD patients and controls as they engaged in AM recall. These neurophysiological deficits may underlie AM recall impairments seen in MDD.

Density as an explanatory variable of movements and calf survival in savanna elephants across southern Africa.

1. Southern Africa's 'elephant problem' is often attributed to an overabundance of elephants (Loxodonta africana) in conservation areas. Paradoxically, the African elephant is listed as 'vulnerable' (IUCN Redlist) despite occupying a large geographical range and numbering about 600 000. How densities influence elephant populations is therefore important for conservation management decisions, particularly because a move towards non-equilibrium management of savannas implies a need for elephant populations to fluctuate in response to variation in intrinsic (demographic) and extrinsic (resource) factors. 2. A study on one of the world's largest elephant populations demonstrated that population regulation is driven by a spatial response to water availability, environmental stochasticity and density. The challenge remains to identify the demographic and behavioural variables that drive density dependence. 3. We evaluated whether the movements of elephant family groups from 13 populations across a wide resource gradient were explained by variability in primary productivity, rainfall and population density. We then assessed whether density-related movements explained variability in juvenile survival, hence inferring a spatially driven behavioural mechanism that may explain density-dependent population growth. We also analysed whether management actions modified this mechanism. 4. In the dry season, daily-displacement distances (DDDs) increased non-linearly with density, and declined with increased vegetation productivity and previous wet season rainfall. In the wet season, DDDs were primarily explained by vegetation productivity. 5. The survival of weaned calves (4-7 years) decreased with increasing dry season DDDs, but this did not hold for suckling calves (1-3 years) or sub-adults (8-11 years). 6. Fences and supplementary water modified the shape and strength of relationships between DDDs and densities, vegetation productivity and rainfall and negated the relationships between DDDs and weaned calf survival. 7. We suggest that density dependence in weaned calf survival is driven by the response of dry season roaming activities of family groups to variations in density, rainfall and the distribution of food. Fences and supplementary water that alter this mechanism may contribute to the relatively high population growth rates of some populations.

Reconstruction of Escherichia coli mrcA (PBP 1a) mutants lacking multiple combinations of penicillin binding proteins.

Previously, we constructed a set of mutants from which eight penicillin binding protein (PBP) genes were deleted in 192 combinations from Escherichia coli (S. A. Denome, P. K. Elf, T. A. Henderson, D. E. Nelson, and K. D. Young, J. Bacteriol. 181:3981-3993, 1999). Although these mutants were constructed correctly as determined by restriction mapping and the absence of relevant protein products, we recently discovered by PCR mapping that strains from which mrcA (PBP 1a) was deleted were also missing two neighboring genes of unknown function (yrfE and yrfF). We created a new deletion mutation in mrcA and reconstructed 63 strains lacking PBP 1a and other PBP mutant combinations. The new mrcA mutants do not exhibit mucoidy, phage resistance, temperature sensitivity, growth rate defects, or antibiotic resistance, suggesting that these phenotypes require the loss of either yrfE or yrfF alone or in combination with the absence of multiple PBPs.

Contributions of PBP 5 and DD-carboxypeptidase penicillin binding proteins to maintenance of cell shape in Escherichia coli.

Escherichia coli has 12 recognized penicillin binding proteins (PBPs), four of which (PBPs 4, 5, and 6 and DacD) have DD-carboxypeptidase activity. Although the enzymology of the DD-carboxypeptidases has been studied extensively, the in vivo functions of these proteins are poorly understood. To explain why E. coli maintains four independent loci encoding enzymes of considerable sequence identity and comparable in vitro activity, it has been proposed that the DD-carboxypeptidases may substitute for one another in vivo. We tested the validity of this equivalent substitution hypothesis by investigating the effects of these proteins on the aberrant morphology of DeltadacA mutants, which produce no PBP 5. Although cloned PBP 5 complemented the morphological phenotype of a DeltadacA mutant lacking a total of seven PBPs, controlled expression of PBP 4, PBP 6, or DacD did not. Also, a truncated PBP 5 protein lacking its amphipathic C-terminal membrane binding sequence did not reverse the morphological defects and was lethal at low levels of expression, implying that membrane anchoring is essential for the proper functioning of PBP 5. By examining a set of mutants from which multiple PBP genes were deleted, we found that significant morphological aberrations required the absence of at least three different PBPs. The greatest defects were observed in cells lacking, at minimum, PBPs 5 and 6 and one of the endopeptidases (either PBP 4 or PBP 7). The results further differentiate the roles of the low-molecular-weight PBPs, suggest a functional significance for the amphipathic membrane anchor of PBP 5 and, when combined with the recently determined crystal structure of PBP 5, suggest possible mechanisms by which these PBPs may contribute to maintenance of a uniform cell shape in E. coli.

Approaching the physiological functions of penicillin-binding proteins in Escherichia coli.

A rigid shell of peptidoglycan encases and shapes bacteria and is constructed and maintained by a diverse set of enzymes, among which are the penicillin-binding proteins (PBPs). Although a great deal has been learned about how these proteins synthesize and modify peptidoglycan, the physiological functions of the multitude of bacterial PBPs remain enigmatic. We approached this problem by combining PBP mutations in a comprehensive manner and screening for effects on biochemical processes involving the passage of proteins or nucleic acids across the cell wall. The results indicate that the PBPs or their peptidoglycan product do have significant biological functions, including roles in determination of cell shape, in phage resistance, in induction of capsule synthesis, and in regulation of autolysis.

Penicillin binding protein 5 affects cell diameter, contour, and morphology of Escherichia coli.

Although general physiological functions have been ascribed to the high-molecular-weight penicillin binding proteins (PBPs) of Escherichia coli, the low-molecular-weight PBPs have no well-defined biological roles. When we examined the morphology of a set of E. coli mutants lacking multiple PBPs, we observed that strains expressing active PBP 5 produced cells of normal shape, while mutants lacking PBP 5 produced cells with altered diameters, contours, and topological features. These morphological effects were visible in untreated cells, but the defects were exacerbated in cells forced to filament by inactivation of PBP 3 or FtsZ. After filamentation, cellular diameter varied erratically along the length of individual filaments and many filaments exhibited extensive branching. Also, in general, the mean diameter of cells lacking PBP 5 was significantly increased compared to that of cells from isogenic strains expressing active PBP 5. Expression of cloned PBP 5 reversed the effects observed in DeltadacA mutants. Although deletion of PBP 5 was required for these phenotypes, the absence of additional PBPs magnified the effects. The greatest morphological alterations required that at least three PBPs in addition to PBP 5 be deleted from a single strain. In the extreme cases in which six or seven PBPs were deleted from a single mutant, cells and cell filaments expressing PBP 5 retained a normal morphology but cells and filaments lacking PBP 5 were aberrant. In no case did mutation of another PBP produce the same drastic morphological effects. We conclude that among the low-molecular-weight PBPs, PBP 5 plays a principle role in determining cell diameter, surface uniformity, and overall topology of the peptidoglycan sacculus.

Escherichia coli mutants lacking all possible combinations of eight penicillin binding proteins: viability, characteristics, and implications for peptidoglycan synthesis.

The penicillin binding proteins (PBPs) synthesize and remodel peptidoglycan, the structural component of the bacterial cell wall. Much is known about the biochemistry of these proteins, but little is known about their biological roles. To better understand the contributions these proteins make to the physiology of Escherichia coli, we constructed 192 mutants from which eight PBP genes were deleted in every possible combination. The genes encoding PBPs 1a, 1b, 4, 5, 6, and 7, AmpC, and AmpH were cloned, and from each gene an internal coding sequence was removed and replaced with a kanamycin resistance cassette flanked by two res sites from plasmid RP4. Deletion of individual genes was accomplished by transferring each interrupted gene onto the chromosome of E. coli via lambda phage transduction and selecting for kanamycin-resistant recombinants. Afterwards, the kanamycin resistance cassette was removed from each mutant strain by supplying ParA resolvase in trans, yielding a strain in which a long segment of the original PBP gene was deleted and replaced by an 8-bp res site. These kanamycin-sensitive mutants were used as recipients in further rounds of replacement mutagenesis, resulting in a set of strains lacking from one to seven PBPs. In addition, the dacD gene was deleted from two septuple mutants, creating strains lacking eight genes. The only deletion combinations not produced were those lacking both PBPs 1a and 1b because such a combination is lethal. Surprisingly, all other deletion mutants were viable even though, at the extreme, 8 of the 12 known PBPs had been eliminated. Furthermore, when both PBPs 2 and 3 were inactivated by the beta-lactams mecillinam and aztreonam, respectively, several mutants did not lyse but continued to grow as enlarged spheres, so that one mutant synthesized osmotically resistant peptidoglycan when only 2 of 12 PBPs (PBPs 1b and 1c) remained active. These results have important implications for current models of peptidoglycan biosynthesis, for understanding the evolution of the bacterial sacculus, and for interpreting results derived by mutating unknown open reading frames in genome projects. In addition, members of the set of PBP mutants will provide excellent starting points for answering fundamental questions about other aspects of cell wall metabolism.

Statistical methodology: IX. survival analysis.

Survival analysis is a group of statistical methods used to analyze data representing the time to an event of interest, e.g., the duration of survival after an out-of-hospital cardiac arrest or the length of time a patient stays in the ED. Survival analysis properly accounts for patients who are lost to follow-up and for patients who have not yet experienced the event of interest at the end of the study's observation period (censored data). This article acquaints the reader with the terminology, methodology, and limitations of survival analysis. Specific methods discussed include life tables, the Kaplan-Meier product limit estimate, the log-rank test, and the multivariate Cox proportional hazards model.

Pediatric cardiopulmonary resuscitation: a collective review.

Little information is available about the effects of CPR in children, although it is known that the outcomes are dismal. Examples of unanswered questions include which advanced life support (ALS) procedures should be performed out-of-hospital, whether high-dose epinephrine improves survival, and the true prevalence of ventricular fibrillation as a presenting rhythm. Children differ from adults as to the cause and pathophysiology of cardiopulmonary arrest, but prehospital EMS and hospital resuscitation teams were initially designed for the care of adults. Because pediatric cardiopulmonary arrest is rare, prospective data are difficult to gather, and there are few large published studies. The purpose of this collective review was to review the current body of knowledge regarding survival rates and outcomes in pediatric CPR and, based on this review, to outline a course for future research.

Delayed diagnosis of splenic injury after falls from less than 10 feet.

Splenic injury is the most common abdominal organ injury in children who sustain blunt trauma and may result from apparently minor injuries. We present two cases of delayed diagnosis of splenic injury in children who fell from a moderate height of less than 10 feet. Careful physical examination and close follow-up with reevaluation are necessary to identify children with possible splenic injury after relatively minor blunt trauma.

Mutational analysis of slyD, an Escherichia coli gene encoding a protein of the FKBP immunophilin family.

slyD encodes a 196 amino acid polypeptide that is a member of the FKBP family of cis-trans peptidyl-prolyl isomerases (PPlases). slyD mutations affect plaque formation by the phage phiX174 by blocking the action of the phage lysis protein E. Here we describe the selection of a set of spontaneous slyD mutations conferring resistance to the expression of gene E from a plasmid. These mutations occur disproportionately in residues of SlyD that, based on the structure of the prototype mammalian FKBP12, make ligand contacts with immunosuppressing drug molecules or are conserved in other FKBP proteins. A wide variation in the plating efficiency of phiX174 on these E(R) strains is observed, relative to the parental, indicating that these alleles differ widely in residual SlyD activity. Moreover, it is found that slyD mutations cause significant growth rate defects in Escherichia coli B and C backgrounds. Finally, overexpression of slyD causes filamentation of the host. Thus, among the FKBP genes found in organisms across the evolutionary spectrum, slyD is unique in having three distinct drug-independent phenotypes.

AmpC and AmpH, proteins related to the class C beta-lactamases, bind penicillin and contribute to the normal morphology of Escherichia coli.

Two proteins that bind penicillin were observed in Escherichia coli infected with lambda phages 141, 142, 650, and 651 from the Kohara genomic library. These phages carry chromosomal DNA fragments that do not contain any known penicillin binding protein (PBP) genes, indicating that unrecognized gene products were exhibiting penicillin binding activity. The genes encoding these proteins were subcloned, sequenced, and identified. One gene was ampC, which encodes a chromosomal class C beta-lactamase. The second gene was located at about 8.5 min on the E. coli genomic map and is a previously uncharacterized open reading frame, here named ampH, that encodes a protein closely related to the class C beta-lactamases. The predicted AmpH protein is similar in length to AmpC, but there are extensive alterations in the amino acid sequence between the SXXK and YXN motifs of the two proteins. AmpH bound strongly to penicillin G, cefoxitin, and cephalosporin C; was temperature sensitive; and disappeared from cells after overnight incubation in stationary phase. Although closely related to AmpC and other class C beta-lactamases, AmpH showed no beta-lactamase activity toward the substrate nitrocefin. Mutation of the ampC and/or ampH genes in E. coli lacking PBPs 1a and 5 produced morphologically aberrant cells, particularly in cell filaments induced by aztreonam. Thus, these two members of the beta-lactamase family exhibit characteristics similar to those of the classical PBPs, and their absence affects cell morphology. These traits suggest that AmpC and AmpH may play roles in the normal course of peptidoglycan synthesis, remodeling, or recycling.

What is confidence? Part 1: The use and interpretation of confidence intervals.

Hypothesis testing and the P value it generates are overemphasized in statistical analyses published in medical journals. An alternative, the confidence interval (CI), offers significantly more information to readers interpreting results. There have been many authoritative calls for the report of CIs in place of P values, such as that of the International Committee of Medical Journal Editors, whose guidelines for statistical reporting give the following instructions: "When possible, quantify findings and present them with appropriate indicators of measurement error or uncertainty (such as confidence intervals)," and "Avoid sole reliance on statistical hypothesis testing, such as the use of P values, which fails to convey important quantitative information." In this article, part 1, we provide an overview of CIs for the clinician reading the medical literature. We describe the advantages of CIs and explain and illustrate their proper interpretation. In part 2, which follows this article, we provide added information important for clinical researchers, including a precise definition of CIs, a compact reference to methods for calculating CIs in common situations, and an explanation of the difference between CIs and probability intervals.

What is confidence? Part 2: Detailed definition and determination of confidence intervals.

In many cases, CIs should be reported in place of P values. The lower limit of a 95% CI is chosen such that the probability of obtaining the value observed in the trial or a greater value is .025 and the upper limit such that the probability of obtaining the value observed or a lesser value is also .025. CIs for data from most clinical trials may be calculated easily with the use of formulas given in this article. A 95% CI is not the same as a 95% probability interval. The 95% CI contains values statistically consistent with the data obtained, whereas a 95% probability interval has a 95% probability of containing the true value of interest.

Penicillin-binding proteins and induction of AmpC beta-lactamase.

In competition assays for radiolabeled penicillin, penicillin-binding proteins (PBPs) 4, 7a, and 7b showed very high affinities for strong inducers of AmpC beta-lactamase. Loss of PBP 4 resulted in diminished inducibility. This suggests that if PBPs are involved in induction of AmpC beta-lactamase, there is probably a redundancy in function among the different PBPs.

Decreased intracellular survival of an fkpA mutant of Salmonella typhimurium Copenhagen.

The fkpA gene of Salmonella typhimurium encodes a protein similar to the macrophage infectivity potentiator (Mip) proteins of Legionella pneumophila and Chlamydia trachomatis. Because Mip proteins enhance the ability of these intracellular pathogens to survive within macrophages and epithelial cells, we tested whether the product of the fkpA gene would have the same effect on the intracellular growth of a virulent strain of S. typhimurium. By a series of P22 transductions, the fkpA gene of S. typhimurium Copenhagen was replaced with the inactive fkpA1::omega-Cm gene from Escherichia coli, creating the mutant S. typhimurium KY32H1. The Copenhagen and KY32H1 strains were equally able to enter Caco-2 cells (an epithelial cell line) and J774.A1 cells (a macrophage-like cell line). However, compared to the parent, the fkpA mutant survived less well in both types of cells during the first 6 h after infection. The number of viable intracellular S. typhimurium Copenhagen bacteria remained constant 6 h after infection of Caco-2 cells, but the viability of S. typhimurium KY32H1 decreased significantly by 4 h postinfection. The fkpA mutant also exhibited a reduced ability to survive intracellularly in J774.A1 cells as little as 2 h postinfection. Complementation of the fkpA mutation by a plasmid-borne wild-type fkpA gene from E. coli restored the ability of S. typhimurium KY32H1 to grow normally in J774.A1 cells. Thus, expression of the mip-like fkpA gene confers on S. typhimurium Copenhagen properties analogous to those mediated by the Mip proteins in other intracellular pathogens, suggesting that this mechanism may play a role in the virulence and/or intracellular growth of numerous bacteria.

Isolation and amino acid sequence of a new 22-kDa FKBP-like peptidyl-prolyl cis/trans-isomerase of Escherichia coli. Similarity to Mip-like proteins of pathogenic bacteria.

We identified a periplasmic peptidyl-prolyl cis/trans-isomerase (PPIase) of the (FK506-binding protein (FKBP) type in Escherichia coli (FK506 represents a natural peptidomacrolide containing an acylated pipecolic acid residue). After purification to homogeneity, its complete amino acid sequence was determined by a combination of Edman degradation and electrospray mass spectrometry of the authentic protein and peptides generated by proteolysis. The molecular mass calculated from the amino acid sequence of the protein was 22,085.53 Da, which corresponded perfectly with the value of 22,084 +/- 1.47 Da as determined by mass spectrometry. The corresponding gene was cloned and analyzed, and Southern blot experiments revealed the existence of similar genes in various Gram-negative bacteria. The amino acid sequence of the novel FKBP22 shows similarity to Mip (macrophage infectivity potentiator)-like proteins produced by a number of pathogenic bacteria. However, FKBP22 is inhibited more strongly by FK506 than are other Mip-homologues, as indicated by the Ki value of 25 nM. The subsite specificity regarding the P1 position of the substrate resembles that for Mip-FKBP25 from Legionella pneumophila. The mature FKBP22 enzyme of 205 amino acids exists as a dimer in solution.

A simple gel electrophoretic method for analyzing the muropeptide composition of bacterial peptidoglycan.

The muropeptide composition of bacterial peptidoglycan is currently most efficiently determined by reverse-phase high-pressure liquid chromatography (HPLC). Though sensitive, the HPLC procedure is technically demanding and has been applied to a relatively small number of bacterial strains and species. We have found that fluorescence-assisted carbohydrate electrophoresis (FACE) is a simple, rapid method by which reducing muropeptides from multiple peptidoglycan samples can be visualized. Individual reducing muropeptides were covalently labeled with the fluorescent molecule 8-aminonaphthalene-1,3,6-trisulfonic acid, after which they were separated by electrophoresis through a 35% polyacrylamide gel and visualized by exposure to UV light. FACE detected the appropriate numbers of reducing muropeptides in the proper proportions for four bacteria: Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, and Yersinia enterocolitica. As little as 2 to 5 pmol per muropeptide was detected when the intensity of the fluorescent signal was measured with a charge-coupled device camera, at a level of sensitivity between 50 and 250 times higher than that of the classic HPLC technique. Thus, FACE may be used to identify interesting peptidoglycan samples prior to more-extensive analysis by HPLC, or FACE may eventually replace HPLC for some applications.