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A Caenorhabditis elegans RNA polymerase II gene, ama-1 IV, and nearby essential genes.

The amanitin-binding subunit of RNA polymerase II in Caenorhabditis elegans is encoded by the ama-1 gene, located approximately 0.05 map unit to the right of dpy-13 IV. Using the amanitin-resistant ama-1(m118) strain as a parent, we have isolated amanitin-sensitive mutants that carry recessive-lethal ama-1 alleles. Of the six ethyl methanesulfonate-induced mutants examined, two are arrested late in embryogenesis. One of these is a large deficiency, mDf9, but the second may be a novel point mutation. The four other mutants are hypomorphs, and presumably produce altered RNA polymerase II enzymes with some residual function. Two of these mutants develop into sterile adults at 20 degrees but are arrested as larvae at 25 degrees, and two others are fertile at 20 degrees and sterile at 25 degrees. Temperature-shift experiments performed with the adult sterile mutant, ama-1(m118m238ts), have revealed a temperature-sensitive period that begins late in gonadogenesis and is centered around the initiation of egg-laying. Postembryonic development at 25 degrees is slowed by 30%. By contrast, the amanitin-resistant allele of ama-1 has very little effect on developmental rate or fertility. We have identified 15 essential genes in an interval of 4.5 map units surrounding ama-1, as well as four gamma-ray-induced deficiencies and two duplications that include the ama-1 gene. The larger duplication, mDp1, may include the entire left arm of chromosome IV, and it recombines with the normal homologue at a low frequency. The smallest deficiency, mDf10, complements all but three identified genes: let-278, dpy-13 and ama-1, which define an interval of only 0.1 map unit. The terminal phenotype of mDf10 homozygotes is developmental arrest during the first larval stage, suggesting that there is sufficient maternal RNA polymerase II to complete embryonic development.

Animals↗

Detection of antimitochondrial autoantibodies in immunofluorescent AMA-negative patients with primary biliary cirrhosis using recombinant autoantigens.

Antimitochondrial antibodies (AMA) are the serologic hallmark of primary biliary cirrhosis (PBC). However, depending on the clinical laboratory, from 5% to 17% of PBC patients are consistently AMA-negative, using native mitochondrial antigens and a variety of conventional assays including immunofluorescence (IMF) and enzyme-linked immunosorbent assay (ELISA). The major immunoreactive mitochondrial autoantigens are the E2 members of the 2-oxo-acid dehydrogenase complex family, including pyruvate dehydrogenase complex-E2 (PDC-E2), branched chain 2-oxo acid dehydrogenase complex-E2 (BCOADC-E2), and oxo-glutarate dehydrogenase complex-E2 (OGDC-E2); cDNAs of these proteins have now been cloned, sequenced, and their B-cell epitopes defined. In the present study, we cloned cDNAs encoding these proteins from human, not bovine, sources, and expressed the recombinant proteins in a newly developed ELISA that employs a unique Escherichia coli buffer, and compared the data with previous assays using both AMA-positive and -negative patients. Using this new assay and our criteria for positive as an optical density (OD) greater than 10 SD above the mean of control sera, the AMA-positive rate of 191 PBC sera was 94% (179 of 191) compared with 84% (161 of 191) by IMF. None of the 316 control sera were reactive. Using our recombinant assays, we focused attention on the 30 IMF-AMA-negative patients. Twenty-two of 30 (73%) of these patients were positive using this new ELISA. The group of 30 IMF-AMA-negative/ELISA-positive patients did not differ significantly from a comparable population of IMF-AMA-positive patients with respect to age, sex distribution, liver function tests, elevation of serum IgM, or pathologic stage.

Autoantibodies↗

AMA discharge from a psychiatric inpatient unit.

This study examines AMA discharges from a psychiatric inpatient unit. Such discharges are found to occur with greater frequency (p .005) among individuals with alcoholism and character disorders. The AMA patients do not, however, seem to form a homogeneous group in themselves. This study identifies two subgroups of AMA patients: the "early" AMA and the "late" AMA, depending upon their length of stay in the hospital prior to AMA discharge. The demographic, clinical and psychodynamic differences between the two sub-groups are discussed. Some practical recommendations are made in regard to the prevention and management of AMA discharge requests.

Adult↗

The ventilatory responses to hypoxia and hypercapnia in the Ama.

The ventilatory responses to hypoxia and hypercapnia of 5 Amas (Kachido) were compared with those of 5 controls of similar ages, physical characteristics and lung volumes. The responses to hypoxia and hypercapnia were analyzed by the equations originally proposed [a] by Lloyd et al. and [b] by Kronenberg et al. as follows: (See the formula in the text) The CO2-response slope in hyperoxia, D, of the Ama (1.820 +/- 0.441 liters . min-1 . Torr-1) was slightly higher than that of the control (1.148 +/- 0.586 liters . min-1 . Torr-1), but the difference was not significant. However, the slope of CO2-response in hypoxia at PETO2 = 44 Torr, S44, was almost the same in the two groups (Ama, 1.822 +/- 0.689 liters . min-1 . Torr-1; control, 1.742 +/- 0.902 liters . min-1 . Torr-1). The ratio of S44 to D was significantly lower (p greater than 0.05) in the Ama (1.039 +/- 0.377) than in the control (1.529 +/- 0.249). Comparing the hypoxic response in terms of the ventilation ratio (VR), the elevation of ventilation with augmentation of hypoxia in the Ama was exceeded by that in the control. Thus, it was suggested that the difference in the ventilatory response to hypoxia between the Ama (Kachido) and the control may have been derived from the respiratory adaptation of the Ama (Kachido) acquired by their daily diving activities.

Adaptation, Physiological↗

Interventions to improve the AMA-discharge rate for opiate-addicted patients.

1. The nursing staff of a chemical dependency unit were troubled by the unit's high against medical advice (AMA) discharge rate. Almost half (46%) the hospital's total AMA discharges (0.9%) were occurring on this 14-bed unit. 2. It was discovered that opiate-addicted patients comprised 26.5% of the unit's AMAs, while representing only 15% of total admissions. At one point, as high as 50% of the opiate-addicted patients were discharged AMA. 3. Many treatment issues and ethical dilemmas are encountered with AMA discharges, such as staff demoralization and debate over who should pay for AMA discharges. 4. Use of the Endicott-Watson Subjective/Objective Opiate Withdrawal Scale yielded a 60% improvement in the AMA discharge rate. When a community resource link was put into place, there was an additional 1% improvement, making the overall improvement rate 61%.

Ethics, Nursing↗

An evaluation of the Amputee Mobility Aid (AMA) early walking aid.

The most popular early walking aid (EWA) in the United Kingdom (UK) is the Pneumatic Post-Amputation Mobility aid or PPAM aid. A disadvantage of this device is that it does not allow a trans-tibial amputee to flex or extend the knee during walking. The Amputee Mobility Aid (AMA) was developed to allow knee movement, enabling trans-tibial amputees to practise a more natural gait. The benefits of using EWAs include early walking, reduction in post-operative oedema and improvement in patient morale. This pilot study investigated the pneumatic bag/stump interface pressures of the PPAM aid and the AMA. In addition, the range of motion of the knee on the amputated side and the mechanical knee of the AMA were compared. The AMA was found to have higher interface pressures than the PPAM aid during standing and similar pressures during supported walking. Subjects using the AMA did flex and extend their knee during walking but through a reduced range of motion. There were no significant differences between the angular movements of the AMA's mechanical knee and the patient's knee within it.

Aged↗

A follow-up study of 68 patients with anti-mitochondrial antibodies (AMA).

During the period 1976-83, anti-mitochondrial antibodies (AMA) were detected in 68 patients out of about 48 000 sera (0.14%) analyzed for a repertoire of autoantibodies at the Department of Immunology, University Hospital of Tromsø. Fifty-five of these patients were women, and only 10 had unequivocal primary biliary cirrhosis (PBC). At follow-up in 1984, 48 out of these 68 patients were accessible for complementary testing. The AMA test became negative in 17 of these 48 patients during the observation period. Eleven of these 17 had originally a titer of 50. Seven of the 31 patients with persistent AMA were without detectable liver pathology. One patient had antibodies against smooth muscle, one against cell nucleus, whereas 35 had an increased serum IgM level. In conclusion, most patients with AMA do not have obvious PBC, a low AMA titer is likely to be transient, and there is a strong association between AMA and an increased serum IgM level.

Adult↗

Identification of T-cell determinants in natural immune responses to the Plasmodium falciparum apical membrane antigen (AMA-1) in an adult population exposed to malaria.

AMA-1 of Plasmodium falciparum is a promising candidate antigen in malaria vaccine development. In this study, we have mapped the immunodominant T-cell determinants in this antigen by using synthetic peptides. From the amphipathic scores, 17 putative T-cell determinants were identified. Nine of the 17 peptides complementary to the putative T-cell determinants induced proliferation of peripheral blood mononuclear cells (PBMC) from Kenyan residents who had lifelong exposure to malaria; none of these peptides induced proliferation of PBMC from donors who were not previously exposed to malaria. This indicates that AMA-1 peptides were stimulating T cells that were previously primed by prior exposure to P. falciparum. Many positive responders showed reactivity to more than one peptide, and some of the potent proliferative T epitopes were found to be localized in the highly conserved regions of AMA-1, suggesting that it may be possible to induce T-cell memory that can recognize different variant forms of the parasite. This information on the natural immune responses against the AMA-1 vaccine antigen in clinically immune adults will be helpful in the development of an AMA-1 antigen-based malaria vaccine and may also guide testing of AMA-1-based vaccine formulations.

Adult↗

Molecular cloning and sequencing of ama-1, the gene encoding the largest subunit of Caenorhabditis elegans RNA polymerase II.

Two genomic sequences that share homology with Rp11215, the gene encoding the largest subunit of RNA polymerase II in Drosophila melanogaster, have been isolated from the nematode Caenorhabditis elegans. One of these sequences was physically mapped on chromosome IV within a region deleted by the deficiency mDf4, 25 kilobases (kb) from the left deficiency breakpoint. This position corresponds to ama-1 (resistance to alpha-amanitin), a gene shown previously to encode a subunit of RNA polymerase II. Northern (RNA) blotting and DNA sequencing revealed that ama-1 spans 10 kb, is punctuated by 11 introns, and encodes a 5.9-kb mRNA. A cDNA clone was isolated and partially sequenced to confirm the 3' end and several splice junctions. Analysis of the inferred 1,859-residue ama-1 product showed considerable identity with the largest subunit of RNAP II from other organisms, including the presence of a zinc finger motif near the amino terminus, and a carboxyl-terminal domain of 42 tandemly reiterated heptamers with the consensus Tyr Ser Pro Thr Ser Pro Ser. The latter domain was found to be encoded by four exons. In addition, the sequence oriented ama-1 transcription with respect to the genetic map. The second C. elegans sequence detected with the Drosophila probe, named rpc-1, was found to encode a 4.8-kb transcript and hybridized strongly to the gene encoding the largest subunit of RNA polymerase III from yeast, implicating rpc-1 as encoding the analogous peptide in the nematode. By contrast with ama-1, rpc-1 was not deleted by mDf4 or larger deficiencies examined, indicating that these genes are no closer than 150 kb. Genes flanking ama-1, including two collagen genes, also have been identified.

Amino Acid Sequence↗

Cardiovascular change in elderly male breath-hold divers (Ama) and their socio-economical background at Chikura in Japan.

The Ama have existed for more than 2000 years in Japan and Korea. They have been diving for seaweed and molluscs. Their traditional way of fishing, with goggles or a mask, but without a wetsuit, is still practised as a result of laws against overfishing. We investigated cardiovascular diving responses, expressed as heart rate (HR) reduction, peripheral vasoconstriction indicated by skin blood flow (SkBF) and mean arterial blood pressure (MAP) during breath-hold face immersion in a group of eight elderly male Ama at Chikura, Japan. Their data were compared to those from three other groups: a) elderly non-divers; b) young divers and c) young non-divers. Our previous studies have shown that young divers show a more pronounced bradycardia than young non-divers. The present study of elderly Ama and elderly non-divers was performed to investigate if this difference persists in old age. We found that, in spite of many years of diving experience, HR reduction of the elderly professional divers observed during face immersion did not differ from that of elderly non-divers, but it was much less pronounced than in the two younger groups. We conclude that even if a well-developed diving response at young age has been reduced to the level of non-divers, the Ama are still able to continue their work of diving in old age. Ama that has been a traditionally female occupation, is mostly practised by men at Chikura today. No young have been recruited for this profession. Therefore, the present Ama are senior and the traditional breath-hold diving will probably cease to exist in the near future. The probable reasons for these changes are discussed.

Adaptation, Physiological↗

Towards establishing comprehensive databases of cellular proteins from transformed human epithelial amnion cells (AMA) and normal peripheral blood mononuclear cells.

Databases of protein information derived from the analysis of two-dimensional gels have been established from transformed human amnion cells (AMA) and peripheral blood mononuclear cells (PBMCs). A total of 1781 [35S]methionine-labeled AMA proteins (1274 IEF, 537 NEPHGE) and a total of 1311 proteins from PBMC (948 IEF, 363 NEPHGE) were resolved and recorded using computerized (PDQ-SCAN and PDQUEST softwares) two-dimensional gel electrophoresis. AMA and PBMC proteins (total, 454: 301 IEF, 153 NEPHGE) were matched both manually and by the computer. Information entered in the AMA database (in most cases for some major proteins) includes: molecular weight, protein name, HeLa protein catalogue number, mouse protein catalogue number, nuclear proteins, phosphorylated proteins, distribution of proteins in Triton X-100 supernatants and cytoskeletons, proliferation- and transformation-sensitive proteins, cell cycle-specific proteins, mitochondrial proteins, proteins matched in normal human embryonal lung MRC-5 fibroblasts and PBMC cells, heat shock proteins, proteins affected by interferons, cytoskeletal proteins, and the presence of antibody against protein in human sera. Additional information has been entered for the cell cycle-regulated and DNA replication protein cyclin (PCNA). Information entered in the PBMC database includes molecular weight and potential markers for sorted populations of lymphocyte subtypes. For those proteins that have been matched to AMA proteins, information contained in some entries may be transferred from the AMA database.

Amnion↗

The impact of first-trimester screening on AMA patients' uptake of invasive testing.

OBJECTIVE: Prenatal testing for AMA includes invasive procedures such as CVS and amniocentesis, which have risks. We sought to determine the effects of first-trimester screening (FTS) on referrals for genetic counseling and patients' decisions to pursue invasive testing after FTS was offered in 2002. METHODS: We compared AMA patients presenting for prenatal care who underwent early genetic counseling (<13 weeks' gestation) from 2001 to those from 2003. Charts were reviewed for maternal age, gestational age, past obstetric history, prior CVS or amniocentesis, abnormal ultrasound findings and decision to proceed with invasive testing. The two groups were compared using Student t-test and chi-square tests. RESULTS: In 2001, 552 AMA women enrolled in prenatal care; 68 presented for early genetic counseling. In 2003, 728 AMA women enrolled in prenatal care; 172 presented for early genetic counseling. More counseled women chose genetic testing in 2003 than in 2001 (95% vs 79%, p<0.01). More patients elected an invasive procedure in 2001 compared to 2003 (71% vs 26%, p<0.01). CONCLUSION: Availability of FTS results in more AMA women having early prenatal genetic counseling and choosing some form of genetic testing. Such women are less likely to choose invasive tests than those without access to FTS.

Adult↗

Risk factors for AMA discharge from VA inpatient alcoholism treatment programs.

This study was designed to identify those risk factors associated with discharge from inpatient alcoholism treatment against medical advice (AMA) and the underlying reasons for these discharges. Data on the characteristics of patients and their index hospitalization were obtained from the systematic review of medical records for 186 alcoholics who were discharged AMA and 201 alcoholics who completed treatment. Comorbid medical diagnosis reduced the risk of AMA discharge by one quarter, whereas court referral to treatment reduced the risk by one half. A college education, vocational or other training, being employed, and having a history of previous AMA discharges significantly increased the risk. The most common reasons for AMA discharge, as perceived by treatment providers, were psychosocial problems, difficulties in the treatment program, and lack of interest in treatment. The clinical implications of these findings for the inpatient treatment of alcoholics are discussed.

Adult↗

The U.S. Preventive Services Task Force Guide to Clinical Preventive Services, Second Edition. AMA Council on Scientific Affairs.

A resolution, introduced by the American College of Preventive Medicine at the 1996 American Medical Association (AMA) Annual Meeting, asked the AMA to recommend to physicians the use of the United States Preventive Services Task Force's Guide to Clinical Preventive Services, Second Edition. In response to that resolution, the AMA's Council on Scientific Affairs has reviewed and evaluated this publication. The recommendations of the Council on Scientific Affairs on the use of the Guide to Clinical Preventive Services, Second Edition, by clinicians and medical educators are included in this report. These recommendations were adopted as AMA Policy at the AMA Annual Meeting in June 1997.

Government Publications as Topic↗

Fine-structure genetics of ama-1, an essential gene encoding the amanitin-binding subunit of RNA polymerase II in Caenorhabditis elegans.

A fine-structure genetic map has been constructed for ama-1 IV, an essential gene in Caenorhabditis elegans encoding the amanitin-binding subunit of RNA polymerase II. Sixteen EMS-induced recessive-lethal mutations have been positioned in the gene by determining their intragenic recombination frequencies with m118, a mutation that confers dominant resistance to alpha-amanitin. The 16 mutants, all isolated in the ama-1(m118) background, include 13 that are early larval lethals, and three that are mid-larval lethals, at 25 degrees. Six of the mutants exhibit temperature-dependence in the severity of their phenotype. Intragenic recombination between the lethal site and the parental resistance mutation was detected by means of resistance to amanitin. Recombinants were detected at frequencies as low as 2 X 10(-6). The segregation of the closely linked flanking markers, unc-17 and unc-5, revealed whether the lethal mutation was to the left or the right of m118. By adding the distances between the extreme left and right mutations, the ama-1 gene is estimated to be 0.011 map unit long, with m118 positioned 0.004 map unit from the left-most lethal mutation. To order the lethal mutations with respect to each other, viable heteroallelic strains were constructed using the free duplication, mDp1[unc-17(e113) dpy-13(+) ama-1(+)]. The heteroallelic strains were sensitive to amanitin, and recombination events between the lethal mutations were specifically selected by means of the dominant amanitin resistance encoded on the recombinant chromosome. The segregation of outside markers revealed the left-right order of the lethal mutations. The position of mutations within the gene is nonrandom. Functional domains of the ama-1 gene indicated by the various lethal phenotypes are discussed.

Alleles↗

In-vitro antibacterial activity of AMA-1080.

The in-vitro antibacterial activity of AMA-1080 against both Gram-positive and Gram-negative clinical isolates was studied in comparison with that of aztreonam, cefotaxime, ceftazidime and cefoperazone. AMA-1080 showed a potent antibacterial activity against Gram-negative bacteria, particularly, the strains of Enterobacteriaceae. In addition, AMA-1080 inhibited the strains of genus Pseudomonas at the low concentrations. However, AMA-1080 showed less active against Gram-positive bacteria. It was found that AMA-1080 was highly resistant to hydrolysis by both chromosomal and plasmid-mediated beta-lactamases.

Anti-Bacterial Agents↗

Cystic fibrosis on the Internet: a survey of site adherence to AMA guidelines.

OBJECTIVES: The Internet permits unprecedented and mostly unrestricted access to medical knowledge; however, concerns exist regarding viewer privacy, accountability of authorship, accuracy of information, and patient safety. To address these issues, the American Medical Association (AMA) has developed guidelines concerning web site content and visitor rights. Cystic fibrosis (CF) is the most common genetically inherited lethal disease in North America. Many Internet sites that provide information on CF have been developed, although adherence to validated guidelines for online health information is not required. The purpose of this study was to assess systematically web sites with content pertaining to CF for adherence to the published AMA guidelines. METHODS: The search term "cystic fibrosis" was entered into a commonly used search engine (Google), and the first 100 eligible sites were reviewed. Each site was examined for adherence to the AMA Guidelines for Medical and Health Information Sites on the Internet using a series of adapted questions. There were 15 questions divided into the following main categories: 1) site structure and viewer privacy, 2) author accountability, 3) scientific citation, and 4) patient safety. The number of positives for each question was tabulated. RESULTS: With respect to site structure, fewer than half (45%) of the reviewed sites indicated a date of last revision. Only 11 (11%) carried an explicit privacy policy. A responsible author or group was listed in only 43 (43%) of 100 sites. Presented data regarding CF was supported by references, sources, or expert review in only 38 (38%) of 100 sites. A medical disclaimer noting that information provided does not substitute for evaluation by a health care team was evident in only 37 (37%) sites. CONCLUSIONS: The majority of easily accessible CF informational web sites do not adhere to guidelines published by the AMA. Patients and families who use the Internet as a CF information resource should examine the web sites carefully and be familiar with the guidelines established by the AMA. Personal information is not protected, and few sites provide explicit privacy guarantees. Finally, CF care teams should inquire about Internet use by patients and families and be prepared to discuss findings from the Internet to heighten patient safety and awareness.

American Medical Association↗

Morbidity among airline pilots: the AMAS experience. Aviation Medicine Advisory Service.

BACKGROUND: Various cohort studies, military databases, and Federal Aviation Administration databases have characterized morbidity and disability in pilots. However, an overriding limitation of these studies is acquiring complete and accurate medical information from pilots with a profession, hobby, or aircraft investment to protect (6). The unique role of Aviation Medicine Advisory Service (AMAS) as pure pilot advocate with guaranteed patient confidentiality eliminates the aviator's need to conceal medical problems. Therefore, analyses of cases reported to AMAS might provide additional insight regarding the true prevalence of morbidity in airline pilots. METHODS: All AMAS cases of airline pilots and flight engineers from January 1996 through November 1999 were reviewed (n = 20,522). During that time, AMAS provided consultation to approximately 51 U.S. and Canadian airlines. Diagnoses were stratified by decades ranging from 20 to 69 yr of age. RESULTS: Notably, the five conditions most frequently inquired about at AMAS were similar to the major causes of long term disability found in a cohort of Air Canada pilots (5). Cardiovascular conditions accounted for almost 25% of the inquiries. However, the relative percentage especially in the older population was less than that reported previously. Interestingly, orthopedic and musculoskeletal cases (10-11%) rated second only to cardiovascular cases. CONCLUSIONS: These findings are limited by the inability to draw an exact reference population at risk, the use of proportional measures for description and the inherent difficulty in attempting to utilize an administrative index as an epidemiological tool. Further study addressing the impact of aviator nondisclosure of medical problems on the reported prevalence of disease among U.S. airline pilots may help target preventive efforts in the future.

Adult↗