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PubMed2003

Relation between body weight and health-related quality of life among the elderly in Spain.

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain. RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease. RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5-24.9 kg/m(2)), frequency of suboptimal physical functioning was higher among obese subjects (BMI>or=30 kg/m(2)), both male (OR: 1.91; 95% CI: 1.22-3.00) and female (OR: 2.58; 95% CI: 1.59-4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25-29.9 kg/m(2)) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60-74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women). CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

Aged↗

PubMed2006

[Favourable results of a rehabilitation programme with cognitive behavioural therapy and graded physical activity in patients with the chronic-fatigue syndrome].

OBJECTIVE: To determine whether a specific course of interdisciplinary rehabilitation might lead to clinically significant changes in fatigue, experienced disability and physical function in patients with the chronic-fatigue syndrome (CFS). DESIGN: Prospective and uncontrolled. METHOD: 'Het Roessingh', a rehabilitation centre in Enschede, the Netherlands, has developed an interdisciplinary clinical rehabilitation programme for patients with CFS in cooperation with the 'Nijmeegs Kenniscentrum Chronische Vermoeidheid' [Chronic-Fatigue Knowledge Centre] in Nijmegen, the Netherlands. In this programme, physical, mental and social activities are gradually increased on the basis of cognitive behavioural principles and graded activity. Of the 127 successive persons who enrolled for the therapy during the period from August 2000 to December 2004, 99 fulfilled the inclusion criteria; they had a median duration of symptoms of 6 years. The results of treatment were evaluated by a measurement with the 'Checklist individuele spankracht' [Checklist individual muscle tone] before and after treatment and the scores on the 'Patiëntspecifieke beperkingen' [Patient-specific disability] and the Short form-36. The measured data were complete in 74 patients. RESULTS: Before rehabilitation, the levels of fatigue, disability and distress were high. After treatment, the studied population showed significant improvement in fatigue, experienced disability and physical function. The magnitude of the improvement was generally 'average'. At the end of treatment, 70% of the patients were clinically less fatigued, 68% experienced less disability and 55% functioned better physically. In 34% the level of fatigue was normalised after treatment, but 9.5% of the patients was more fatigue. CONCLUSION: The rehabilitation programme offered for CFS led to significant improvements in function and fatigue.

Adult↗

PubMed2004

Physical and functional interactions among RNase E, polynucleotide phosphorylase and the cold-shock protein, CsdA: evidence for a 'cold shock degradosome'.

Escherichia coli contains at least five ATP-dependent DEAD-box RNA helicases which may play important roles in macromolecular metabolism, especially in translation and mRNA decay. Here we demonstrate that one member of this family, CsdA, whose expression is induced by cold shock, interacts physically and functionally with RNase E. Three independent approaches show that after a shift of cultures to 15 degrees C, CsdA co-purifies with RNase E and other components of the RNA degradosome. Moreover, functional assays using reconstituted minimal degradosomes prepared from purified components in vitro show that CsdA can fully replace the resident RNA helicase of the RNA degradosome, RhlB. In addition, under these conditions, CsdA displays RNA-dependent ATPase activity. Taken together, our data are consistent with a model in which CsdA accumulates during the early stages of cold acclimatization and subsequently assembles into degradosomes with RNase E synthesized in cold-adapted cultures. These findings show that the RNA degradosome is a flexible macromolecular machine capable of adapting to altered environmental conditions.

Adaptation, Physiological↗

PubMed2003

Psychosocial adjustments 5 years after burn injury.

The present study investigates factors influencing the quality of life and social reintegration of burn victims. A study concept was developed to assess the functional and aesthetic long-term outcomes of burn victims. Objective data from a clinical examination was correlated with subjective data from completed questionnaires. The success of social rehabilitation was documented and an indicative profile of life quality evaluated. This profile could prompt early intervention if found necessary. Ninety-two patients were examined 5.4+/-1.1 years after trauma in relation to three factors: physical functions, localization of the burn injuries and extent of the body surface area burned. Physical functioning allows the best predictions for successful rehabilitation, because all areas of life quality are affected by it. Localization of burns in the face and hands creates disadvantages in social reintegration. Of less value in prediction is the extent of the body surface area burned, which is only closely linked to occupational rehabilitation and directly correlates to physical functional limitations. Our correlation showed, that even slight functional limitations were linked to severe depressions, similar to the values found with patients with serious functional impairment. Interdisciplinary cooperation between plastic surgeons and psychosomatic specialists will optimize early intervention with patients exposed to social maladaptation.

Adaptation, Psychological↗

PubMed1994

Job strain and health-related quality of life in a national sample.

OBJECTIVES: Studies of the health effects of job strain have focused on morbidity and mortality as outcomes. This is the first study to examine the relationship of job strain to more comprehensive health status measures that encompass health-related quality of life. METHODS: In a national cross-sectional survey, 1319 working men and women, aged 18 through 64 years, completed a modified version of the Job Content Questionnaire that classified workers' jobs into four categories: high strain, passive, low strain, and active. Subjects also completed the Medical Outcomes Study Short-Form Health Survey and a health distress scale. Logistic regression analyses were employed that controlled for age, race/ethnicity, gender, and education. Both work and nonwork variables were included. RESULTS: Job strain was significantly associated with five of nine components of health-related quality of life: physical functioning, role functioning related to physical health, vitality, social functioning, and mental health. Job strain made a modest yet statistically significant contribution beyond the effects of chronic illness and psychosocial variables. CONCLUSIONS: The results provide justification for further investigating the role of job strain as an independent risk factor for health-related quality of life.

Adolescent↗

PubMed2006

[Effect of lamivudine treatment on the quality of life of chronic hepatitis B].

OBJECTIVE: To assess the quality of life of 3 types of chronic hepatitis B before and after the treatment of lamivudine, and to find an ideal way of medical treatment for chronic hepatitis B. METHODS: One hundred and fifty patients with chronic hepatitis B were investigated in this study, among whom 5 1 were in mild state illness, 53 were middle-range and the other 46 were severe. The quality of life of the patients was assessed by the quality of life questionnaire (SF-36). The marks of questionnaire were compared before and after the use of lamivudine to assess its comprehensive curative effect on chronic hepatitis B. RESULTS: The total score of SF-36, score of physical function, role-physical, mental health, social function, bodily pain and vitality were significant different before and after the treatment. Statistically significant differences were found among the 3 types of chronic hepatitis B before and after the treatment. CONCLUSION: The quality of life of patients with chronic hepatitis B can be improved by using lamivudine. Assessment of quality of life may be taken as an important index in treating chronic hepatitis B.

Female↗

PubMed1997

Impact of portable APD on patient perception of health-related quality of life.

We assessed the impact of the introduction of a portable automated peritoneal dialysis (APD) system (Homechoice, Baxter Healthcare) on health-related quality of life (HRQOL). We evaluated HRQOL in 26 patients using the RAND 36-item Health Survey 1.0, which measures physical functioning, role limitations (physical and emotional), social functioning, emotional well-being, pain, energy, and general health perceptions. Questionnaires were administered prior to changing to the new system and 3 months later. Kt/V and albumin levels were measured at both time points. Eight patients had been on continuous ambulatory peritoneal dialysis (CAPD), and 18 had been using other APD systems (PacXtra, Baxter and AMP80, Fresenius). Kt/V increased significantly (p = 0.026); albumin was unchanged (p = 0.09). There was an improvement in the pain score (p = 0.079), although this did not reach statistical significance in the overall sample. Subgroup analysis showed that most of the improvement was from the group that had used the AMP80. No other statistically significant differences were found overall in the domains of HRQOL. Questioning of a random sample of patients indicated that perceived advantages of the new system were ease of setup and portability within the home. Neither of these translated into improvement in role-functioning domains of HRQOL. The improvement in pain score may reflect the capacity of newer cyclers to switch from drain to fill after a set proportion of dialysate has drained, leaving the patient empty for less of the time. Portable APD systems did not bring about predicted improvements in HRQOL. The HRQOL instrument may be insensitive, but technologically convenient advances may have limited impact on HRQOL due to its multifactorial nature.

Attitude to Health↗

PubMed1996

Correlation of measured range of hip motion following total hip arthroplasty and responses to a questionnaire.

Twenty-eight patients (with 30 primary and 8 revision total hip arthroplasties) completed a standardized questionnaire containing the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and Harris hip score questions prior to an office visit a minimum of 1 year after surgery. The range of hip motion measured by an orthopaedic surgeon was compared with the responses to questions on stiffness and function as well as with global scores in the WOMAC osteoarthritis index. Patient responses to the questions asking if they could cut their toenails on the operated side and the Harris hip score question asking if they could put on socks and tie a shoe correlated significantly with postoperative hip motion (P < .005). The WOMAC global pain and stiffness scores did not correlate with range of motion. The WOMAC physical function score correlated significantly only with hip flexion (P < .05). Of the WOMAC physical function questions, difficulty bending to pick an object off the floor (P < .05) and getting on and off the toilet (P < .05) correlated with the sum of the range of motion in all planes and weighted Harris hip score range of motion calculation. These data suggest that the points allocated in the Harris hip score for range of motion can be estimated reasonably accurately from questionnaire or phone response to a series of questions on a standardized questionnaire. The question on ability to cut toenails or the Harris hip score question regarding ability to put on socks and tie a shoe correlated with the most individual planes of motion, but several WOMAC physical function questions also correlated with total and weighted range of motion calculations.

Activities of Daily Living↗

PubMed2005

C/EBPalpha functionally and physically interacts with GABP to activate the human myeloid IgA Fc receptor (Fc alphaR, CD89) gene promoter.

Human Fcalpha receptor (Fc alphaR; CD89), the receptor for the crystallizable fragment (Fc) of immunoglobulin A (IgA), is expressed exclusively in myeloid cells, including granulocytes and monocytes/macrophages, and is considered to define a crucial role of these cells in immune and inflammatory responses. A 259-base pair fragment of the FCAR promoter is sufficient to direct myeloid expression of a reporter gene and contains functionally important binding sites for CCAAT/enhancer-binding protein alpha (C/EBPalpha) (CE1, CE2, and CE3) and an unidentified Ets-like nuclear protein. Here, we show that the Ets-binding site is bound by a heterodimer composed of GA-binding protein alpha (GABPalpha), an Ets-related factor, and GABPbeta, a Notch-related protein. Cotransfection of GABP increased FCAR promoter activity 3.7-fold through the Ets-binding site. GABP and C/EBPalpha synergistically activated the FCAR promoter 280-fold. Consistent with these observations, in vitro binding analyses revealed a physical interaction between the GABPalpha subunit and C/EBPalpha. This is the first report demonstrating both physical and functional interactions between GABP and C/EBPalpha and will provide new insights into the molecular basis of myeloid gene expression.

Antigens, CD↗

PubMed1996

Assessing functional disability and health status of women with fibromyalgia: validation of a Hebrew version of the Fibromyalgia Impact Questionnaire.

OBJECTIVE: To validate a translated version of the Fibromyalgia Impact Questionnaire (FIQ) to be used by Hebrew speaking populations. METHODS: We administered the FIQ to 100 women with fibromyalgia (FM). The FIQ measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. All patients were asked about the presence and severity (assessed by visual analog scale) of relevant FM symptoms (pain, fatigue, anxiety, etc.); a count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha coefficient of reliability. To assess content validity a cutoff criterion of > or = 25% impairment responses was set to indicate a valid item. Construct validity of the FIQ was evaluated by correlating the physical functioning score as well as the separate items with measures of symptom severity, count of tender points, and tenderness thresholds. RESULTS: Test-retest reliability was r = 0.96 for physical functioning, and 0.80-0.96 for other items of FIQ. Internal consistency was alpha = 0.93 at Time 1 and 0.86 at Time 2. Seventeen of 19 items of the FIQ met the > or = 25% criterion. Significant moderate to high correlations were obtained between the FIQ items and severity symptoms, point count, and tenderness threshold. CONCLUSION: The FIQ is a reliable and valid instrument for measuring functional disability and health status in Israeli women with FM.

Disability Evaluation↗

PubMed1995

Physical and functional interactions between p53 and cell cycle co-operating transcription factors, E2F1 and DP1.

One way in which wild-type p53 is able to regulate cell cycle progression is thought to be via the induction of its downstream target gene Waf1/CIP1, thus indirectly regulating the transcriptional activity of E2F. The E2F transcription factors are known to be key effectors of the cell cycle. We report here that there is a physical and functional interaction between p53 and two of the components of the E2F transcription factors, E2F1 and DP1. The expression of wild-type p53 can inhibit the transcriptional activity of E2F, and the expression of both E2F1 and DP1 can also downregulate p53-dependent transcription. The transcriptional activity of p53 is known to be inhibited by the direct binding of mdm2, but we demonstrate here that both E2F1 and DP1 can inhibit p53 transcriptional activity independently of mdm2. Detailed studies of protein-protein interactions have provided evidence that E2F1 and its co-operating factor DP1 can complex with p53 both in vitro and in vivo.

Animals↗

PubMed2002

[Evaluation of the burdens of rheumatoid arthritis and osteoarthritis: a questionnaire survey in Japan Rheumatism Foundation registered rheumatologists].

OBJECTIVES: To evaluate the burdens of rheumatoid arthritis (RA) and osteoarthritis (OA), focusing on quality of life (QOL). METHODS: A questionnaire survey was conducted with 3407 qualified doctors of Japan Rheumatism Foundation (response rate 20%). Subjects were asked to assume three patient groups characterized by treatment status (outpatient, inpatient with inactive treatment and inpatient with active treatment) and to answer the questions about (1) percent distributions of the groups a decade ago and today and (2) QOL, including physical functions, daily living activities and social activities, of each group. RESULTS: More than 70% of patients with RA and OA were included in the outpatient group, who had problems in social activities rather than in physical functions and daily living activities. During the last decade, percentage of he outpatient group was increased, while those of the inpatient groups were decreased, and QOL of patients with RA and OA was improved. Compared with OA, RA showed lower percentages of the inpatient groups and greater losses in physical functions, daily living activities and social activities. Accordingly, the burden of RA was greater than that of OA. CONCLUSIONS: In order to improve QOL and reduce the burden of RA, not only development of effective treatment but also assistance to social activities of the patients is required.

Activities of Daily Living↗

PubMed2004

Do anti-TNF agents have equal efficacy in patients with rheumatoid arthritis?

Tumor necrosis factor (TNF) antagonists have dramatically improved the outcomes of rheumatoid arthritis (RA). Three agents currently available in the USA--infliximab, etanercept, and adalimumab--have been designed to modify the biologic effects of TNF. Infliximab and adalimumab are monoclonal antibodies, and etanercept is a soluble protein. The pharmacokinetic and pharmacodynamic properties of each differs significantly from those of the others. All three agents are effective and safe, and can improve the quality of life in patients with RA. Although no direct comparisons are available, clinical trials provide evidence that can be used to evaluate the comparative efficacy of these agents. Infliximab, in combination with methotrexate, has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, prevent joint erosions and joint-space narrowing, and improve physical function for up to 2 years. Etanercept has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, and slow the rate of joint destruction, and might improve physical function. Etanercept is approved with and without methotrexate for patients who have demonstrated an incomplete response to therapy with methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs), as well as for first-line therapy in early RA, psoriatic arthritis, and juvenile RA. Adalimumab relieves the signs and symptoms of RA with and without methotrexate and other DMARDs, decreases total joint score progression, prevents joint erosions and joint-space narrowing in combination with methotrexate, and might improve physical function. When selecting a TNF antagonist, rheumatologists should weigh evidence and experience with specific agents before a decision is made for use in therapy.

Animals↗

PubMed2001

Timing of quality of life (QoL) assessments as a source of error in oncological trials.

AIM OF THE STUDY: To produce an empirical estimate of the nature and magnitude of the error produced by incorrect timing quality of life (QoL) measurements in patients receiving chemotherapy. DESIGN: In a multicentre trial, 283 patients were randomized to receive either docetaxel (T) or sequential methotrexate and 5-fluorouracil (MF). The QoL was assessed at baseline and before each treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The study design was retrospective. Data were analysed using t-tests. RESULTS: Erroneous timing affected the QoL findings in both treatment arms. At baseline, there were statistically significant differences in the MF group on the nausea/vomiting scale, with ill-timed assessment showing more symptoms, and in the T group on the physical functioning scale with ill-timed assessments indicating better QoL. The mean scores of correct vs. incorrect timings over the first 14 cycles showed statistically significant differences on several scales. In the MF group, ill-timed assessments indicated significantly worse physical functioning and global QoL, and significantly more of the following symptoms: fatigue, nausea/vomiting, insomnia, appetite loss, and constipation. In the T group, ill-timed assessment showed better physical functioning, less dyspnoea and more insomnia than correctly timed assessments. The reasons for erroneous timing were not always detectable retrospectively. However, in some cases the MF group, being in standard treatment, seemed to have followed a clinical routine not involving the active participation of the study nurse responsible, whereas patients in the experimental T group were more consistently taken care of by the study nurses. CONCLUSIONS: Incorrect timing of QoL assessments in oncological trials jeopardises both the reliability of the QoL findings within treatment and the validity of QoL outcome comparisons between treatments. This issue should be emphasized in the planning of both the study design and clinical routines.

Activities of Daily Living↗

PubMed2001

Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial.

OBJECTIVE: To assess the effectiveness of physical therapy, given either as an individually attended treatment or in a small group format, in terms of pain, physical function, and health related quality of life for patients with osteoarthritis (OA) of the knee. METHODS: After 2 baseline assessments, 126 patients were randomized into one of 3 allocation arms: individual treatments (n = 43), small group format program (n = 40), and waiting list control (n = 43). After reassessment at 8 weeks, patients allocated to waiting list control were randomized into one of the 2 active treatment arms. Assessments included both self-report measures (WOMAC, SF-36) and objective measures of physical performance (gait analysis and muscle strength). RESULTS: Both physical therapy treatment allocations resulted in significant improvements in pain, physical function, and health related quality of life above the control group (standardized response mean 0.36 to 0.65). Improvements in the self-report measures were substantiated by significant correlated improvements in knee extensor strength and fast walking speed (rho 0.36-0.42). There were no significant differences in effectiveness between the 2 physical therapy allocations for any of the measured outcomes. Improvements gained were maintained for at least 2 months. Responsiveness to treatment was modified by loss of medial joint space width, the interaction being significant for physical function, gait, and knee extensor strength. CONCLUSION: Physical therapy, either as an individually delivered treatment or in a small group format, is an effective intervention for patients with knee OA. Responsiveness to this 8 week intervention was modified by loss of medial joint space width.

Aged↗

PubMed2006

Predictors of driving exposure and avoidance in a field study of older drivers from the state of Maryland.

Using structural equation modeling techniques, this study examines causal models of driving avoidance and exposure among older adults. Prior studies have revealed that past incidence of falls, Useful Field of View (UFOV) test performance, and Trails Making test performance are predictive of subsequent motor vehicle crash involvement [Owsley, C., Ball, K., McGwin Jr., G., Sloane, M.E., Roenker, D.L., White, M.F., Overley, E.T., 1998. Visual processing impairment and risk of motor vehicle crash among older adults. J. Am. Med. Assoc. 279 (14), 1083-1088; Sims, R.V., McGwin, G., Pulley, L., Roseman, J.M., 2001. Mobility impairments in crash-involved older drivers. J. Aging Health 13 (3), 430-438; Stutts, J.C., 1998. Do older drivers with visual nd cognitive impairments drive less? J. Am. Geriatr. Soc. 46, 854-861]. Data analyses used these indices, along with age, health, measures of physical functioning, and additional measures of cognitive functioning, to examine driving exposure and avoidance behaviors. A field sample of 4,234 drivers, 55 years of age and older, were recruited from the Maryland Motor Vehicles Administration after renewing their driver's licenses. A performance-based assessment, which included the Gross Impairment Screening battery and task 2 of the UFOV test, was completed by participants. A sub-sample of participants (n=815) were interviewed by telephone about their health and mobility 3-6 months following the initial assessment at a renewal center. In addition to age and gender, latent variables for health status, physical functioning, cognitive functioning, driving exposure, and driving avoidance were created. Direct and indirect causal paths were specified. Age, gender, health status, and cognitive functioning had direct effects on both driving exposure and driving avoidance; physical functioning did not have a direct effect on driving exposure or avoidance. The implications of these findings are discussed as they relate to designing interventions to promote mobility.

Accidents, Traffic↗

PubMed1994

Validation and use of performance measures of functioning in a non-disabled older population: MacArthur studies of successful aging.

Assessment of physical functioning in older persons has generally focused on identifying and characterizing subjects at the disabled end of the functional spectrum. This paper examines the validity of objective, standardized performance measures of physical functioning in characterizing the hierarchy of functioning in non-disabled, higher functioning older persons. Data are from 1192 participants aged 70-79 years in The MacArthur Research Network on Successful Aging Field Study. Participants were drawn from three community-based populations and represented the upper tertile of functioning, based on cognitive and physical screening assessments. The cohort showed a great deal of heterogeneity on most of the performance measures of functioning that were used. Several analyses provided evidence that this variability was not random and that the performance measures were valid measures of functioning in this cohort: 1) individual performance measures showed a moderate degree of correlation with each other; 2) a summary measure of performance showed an association with chronic diseases and other factors known to be associated with health status; and 3) a larger group than expected by chance alone was found to be functioning at the very highest level.

Age Distribution↗

PubMed2003

A physical and functional interaction between Escherichia coli FtsK and topoisomerase IV.

FtsK and topoisomerase (Topo) IV are both involved in chromosome segregation in Escherichia coli. The former protein resides at the septal ring and is required for resolution of chromosome dimers. The latter protein is the chromosomal decatenase. We have demonstrated recently that Topo IV activity is concentrated at the septal proximal regions of the nucleoids late in the cell cycle. Here we demonstrate that FtsK and Topo IV physically and functionally interact. Topo IV was recovered in immunoprecipitates of FtsK. Two-hybrid analysis and immunoblotting showed that this interaction was mediated by the ParC subunit of Topo IV. In addition, we show that the C-terminal motor domain of FtsK stimulates the decatenation activity of Topo IV but not that of DNA gyrase, the other type II topoisomerase in the cell. Topo IV and FtsK appear to cooperate in the cell as well. Rescue of a parE temperature-sensitive mutation by overproduction of DnaX, which leads to stabilization of the temperature-sensitive Topo IV, required both the C-terminal domain of FtsK and dif, whereas rescue by overproduction of Topo III, which bypasses Topo IV function, did not. The interaction between FtsK and Topo IV may provide a means for concentrating the latter enzyme at the cell center.

Arabinose↗