The law, the AMA, and partial-birth abortion. American Medical Association.
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Biomedical subjects
Publications and source records attributed to J E Hodgson.
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Seven classes of Streptomyces clavuligerus mutants defective in clavulanic acid (CLA) biosynthesis have been identified and used to clone the chromosomal DNA encoding eight CLA biosynthetic genes. The complete sequences of three and the partial sequences of two of these biosynthetic genes are reported, together with their known or predicted functions.
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We have cloned and sequenced the Staphylococcus aureus Oxford ileS gene which encodes isoleucyl-tRNA synthetase (Ile-RS), the target for the antibiotic mupirocin. The gene was identified by hybridisation to oligodeoxyribonucleotide probes derived from internal Ile-RS amino acid (aa) sequences. The 2754-bp open reading frame encodes a 918-aa protein of 105 kDa which is homologous to other known Ile-RS from Gram- bacteria, archaebacteria, yeast and protozoa. Motifs which have been implicated in the functioning of the active site are strongly conserved. The gene was engineered for high-level expression in Escherichia coli. Ile-RS overproduction was toxic to the E. coli host, the magnitude of its observed effects being strain-dependent.
The extended-spectrum, plasmid-borne beta-lactamase gene blaBIL-1, which was discovered in Escherichia coli, has been cloned. Unusually for a plasmid-borne beta-lactamase, blaBIL-1 encodes a novel class C enzyme and appears to have originated from the chromosomal ampC gene of Citrobacter freundii.
The nucleotide sequence of the ileS gene conferring high-level resistance to mupirocin in Staphylococcus aureus J2870 has been determined. The gene sequence is substantially different from that of the native ileS gene of S. aureus, indicating that high-level resistance to mupirocin results from the acquisition of a novel ileS gene.
The cosmid cloning vector pHC79 has been used to clone fragments of chromosomal DNA from the Streptomyces: S. clavuligerus, S. jumonjinensis and S. katsurahamanus. These strains all produce both the beta-lactam antibiotic, cephamycin and the beta-lactamase inhibitor, clavulanic acid. Although structurally related these two beta-lactams are known to be derived from different biosynthetic precursors. Hybridisation studies and restriction mapping have shown that the gene clusters encoding the two biosynthetic pathways are chromosomally adjacent in these strains, thus creating a 'super-cluster' of genes involved in both the production and enhancement of activity of a beta-lactam antibiotic.
A cosmid clone containing closely linked beta-lactam antibiotic biosynthetic genes was isolated from a gene library of Flavobacterium sp. SC 12,154. The location within the cluster of the DNA thought to contain the gene for delta-(L-alpha-aminoadipyl)-L-cysteinyl-D-valine synthetase (ACVS), the first step in the beta-lactam antibiotic biosynthetic pathway, was identified by a novel method. This DNA facilitated the isolation, by cross-hybridization, of the corresponding DNA from Streptomyces clavuligerus ATCC 27064, Penicillium chrysogenum Oli13 and Aspergillus nidulans R153. Evidence was obtained which confirmed that the cross-hybridizing sequences contained the ACVS gene. In each case the ACVS gene was found to be closely linked to other beta-lactam biosynthetic genes and constituted part of a gene cluster.
In an attempt to detect the presence, if any, of cervical chlamydial infection, we obtained endocervical smears from 1000 female patients attending the outpatient gynecologic and family planning clinics at Women's Hospital, Zheijiang Medical University, Hangzhou, People's Republic of China. Using direct immunofluorescent monoclonal antibody staining technique, we identified elementary bodies typical of the Chlamydia trachomatis organism in ten of the 1000 slides (1%). The only characteristic of statistical significance in this small group of infected women was the complaint of infertility for more than two years' duration, noted in six of the ten cases.
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Midtrimester abortion was successfully induced in 55 of 60 patients with continuous extraovular infusion of prostaglandin F2alpha (PGF2alpha) following the insertion of intracervical laminaria tents. Intravenous oxytocin was also used in 38 (63%) of the 60 patients. The mean induction-abortion time (IAT) was 11.72 hours +/- 1.06 SD). Abortion was completed in 40% within 8 hours, 80% within 16 hours, and 93% within 24 hours. The mean total dose of PGF2alpha was 41.9 mg. There was no significant difference in IAT between the parous patients (13.40 hours +/- 1.90 SD) and the nulliparous patients (10.41 hours +/- 1.13 SD). There was no apparent correlation between IAT and the stages of gestation (12 to 22 weeks). The five patients who failed to abort within 24 to 36 hours underwent uterine evacuation, which was easily accomplished because there was a marked degree of cervical dilatation. Side effects and complications of the technique were few. Endometritis occurred in three patients, two of whom had had intrauterine devices in situ until just prior to the procedure. It appears that this method has a high success rate, an acceptable safety factor, good patient tolerance, and relatively few side effects.
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Because the efficacy of prophylactic antibiotic therapy has yet to be established and because numerous variables often hamper studies of such therapy, the results of prophylactic antibiotic therapy were studied in a homogeneous gynecologic population. The patients were 4000 women undergoing first trimester abortions. The surgical procedure, the gynecologists' skill, and the hospital environment were relatively uniform, as was the patient age range. Two groups of 1000 patients each received tetracycline; the other 2000 patients served as controls. The complications associated with abortion were then analyzed in those receiving tetracycline and in the 2000 controls. Complications were less frequent among patients receiving tetracycline. This finding supports the argument of those who favor the prophylactic use of antibiotics in the management of various high-risk surgical problems.