Phytochemical prospection and evaluation of antimicrobial, antioxidant and antibiofilm activities of extracts and essential oil from leaves of Myrsine umbellata Mart. (Primulaceae).

The species Myrsine umbellata is a native plant of Brazil, whose barks are traditionally used in herbal medicine to treat liver disorders and combat leprosy. Therefore, the aim of the study was to identify the phytochemical prospection of ethanolic (EE) and acetonic (EA) extracts by colorimetric tests and by gas chromatography coupled to mass spectrometry (GC-MS) of the essential oil (EO) of M. umbellata leaves; evaluate the antimicrobial activity in front of standard ATCC strains by the broth microdilution technique; the antioxidant potential by DPPH reduction method and antibiofilm action by crystal violet assay and cell viability was determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) based on optical density. Phytochemical prospection of EE and EA detected the presence of free steroids, alkaloids, flavonoids (flavones, flavononoids, flavonols and xanthons) and tannins in both extracts (EE and EA) and saponins only in EE. In EO, the majority compounds identified were elixene, caryophyllene (E), spatulenol, d-Cadinene and aromadendrene. EA showed antimicrobial activity with MIC and MBC/MFC values ranging from 3.12 to 100 mg.mL-1, highlighting its efficiency on the Gram-positive strain S. epidermidis. EE showed antimicrobial potential in the range of 3.12 to 200 mg.mL-1, and the Gram-negative E. coli strain was the most susceptible. However, OE showed bacteriostatic potential against S. Typhimurium, S. Abaetetuba, P. aeruginosa, and S. epidermidis strains. The ability to sequester free radicals was evident in EA extract with antioxidant activity of 89.55% and in EE with 63.05%. The antibiofilm potential was observed in EE extract which eradicated the mature biofilm biomass of all tested bacteria with high activity (50% to 84.28%) and EO also showed antibiofilm effect on mature biofilm of UEL enteroaggregative E. coli, S. aureus and S. Enteritidis strains with biomass reduction percentage of 63.74%, 68.04% and 86.19%, respectively. These results indicate the potential of M. umbellata extracts and as a source of plant bioactivity for the development of new alternative strategies for the control of planktonic or biofilm-resistant microorganisms.

Cirugía bariátrica en adolescentes con obesidad severa: recomendaciones de la Rama de Nutrición, Sociedad Chilena de Pediatría / Bariatric surgery in adolescents with severe obesity: recommendations of the Nutrition Branch, Chilean Pediatric Society

Resumen: En los últimos años, la obesidad severa en adolescentes ha aumentado a nivel mundial y Chile no es la excepción a este fenómeno. Es conocido que esta condición aumenta exponencialmente los riesgos para la salud y se asocia a mortalidad prematura. Desde el año 2008, diversas guías de tratamiento de obesidad pediátrica han incluido a la cirugía bariátrica como una estrategia de tratamiento para adolescentes obesos severos seleccionados. Estos procedimientos han mostrado ser seguros y eficaces en adultos. Un cuerpo emergente de evidencia demuestra que, en centros especializados, en el corto y mediano plazo se obtendrían resultados similares en adolescentes. Sin embargo, en este grupo de pacientes, la cirugía bariátrica tiene implícitos otros riesgos inherentes a la etapa de desarrollo en que se encuentran, y los resultados y complicaciones especialmente de largo plazo en gran medida son aún desconocidos. Por lo anterior y para el logro de los resultados esperados, es muy importante que la selección de pacientes, la cirugía y el seguimiento, sean realizados por equipos multidisciplinarios calificados, en centros hospitalarios que cuenten con la infraestructura adecuada, siendo imprescin dible la adherencia de por vida al seguimiento médico y nutricional. El objetivo de este documento es presentar la postura de la Rama de Nutrición de la Sociedad Chilena de Pediatría (SOCHIPE) frente a las diversas aristas a considerar para la adecuada indicación de estos procedimientos en adolescentes obesos severos.

Abstract: In recent years, severe obesity in adolescents has been rising worldwide, and Chile is no exception to this phenomenon. This condition exponentially increases health risks and it is associated with prema ture mortality. Since 2008, several guidelines on pediatric obesity treatment have included bariatric surgery as a treatment strategy for certain severely obese adolescents. These procedures have proven to be safe and efficient in adults. Recent evidence shows that, when done in specialized centers, the re sults would be similar in adolescents in the short and medium term. Nonetheless, in this group of pa tients, bariatric surgery has risks related to their stage of development, and data on long-term results and complications are still lacking. Therefore, to achieve the expected results, the patient selection, surgery, and follow-up must be carried out by qualified multidisciplinary teams, in hospitals centers that have the appropriate infrastructure, It is essential for the patients a life-long adherence to medi cal and nutritional monitoring. The objective of this document is to present the position statement of the Nutrition Branch of the Chilean Society of Pediatrics on the different issues to be considered for the adequate indication of these procedures in severely obese adolescents.

[Bariatric surgery in adolescents with severe obesity: Recommendations of the Nutrition Branch, Chilean Pediatric Society]. / Cirugía bariátrica en adolescentes con obesidad severa: Recomendaciones de la Rama de Nutrición, Sociedad Chilena de Pediatría.

In recent years, severe obesity in adolescents has been rising worldwide, and Chile is no exception to this phenomenon. This condition exponentially increases health risks and it is associated with prema ture mortality. Since 2008, several guidelines on pediatric obesity treatment have included bariatric surgery as a treatment strategy for certain severely obese adolescents. These procedures have proven to be safe and efficient in adults. Recent evidence shows that, when done in specialized centers, the re sults would be similar in adolescents in the short and medium term. Nonetheless, in this group of pa tients, bariatric surgery has risks related to their stage of development, and data on long-term results and complications are still lacking. Therefore, to achieve the expected results, the patient selection, surgery, and follow-up must be carried out by qualified multidisciplinary teams, in hospitals centers that have the appropriate infrastructure, It is essential for the patients a life-long adherence to medi cal and nutritional monitoring. The objective of this document is to present the position statement of the Nutrition Branch of the Chilean Society of Pediatrics on the different issues to be considered for the adequate indication of these procedures in severely obese adolescents.

[Bariatric surgery in adolescents]. / Cirugía bariátrica en adolescentes.

The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At this stage of life, characterized by deep physical and emotional changes, and great vulnerability, severe obesity has few effective treatment options. In adolescents, the treatment results focused on lifestyle modifications are poor and the pharmacological options are very limited and ineffective. Bariatric Surgery (BS) has emerged as a via ble therapeutic option for a selected group of adolescents. The objective of this review is to update the current view regarding indications, contraindications, complications, and results of these procedures in the adolescent population.

Comparison of five methods for detection of carbapenemases in Enterobacterales with proposal of a new algorithm.

OBJECTIVES: The aim of this study was to evaluate the performance of five different carbapenemase tests and to develop an algorithm which will permit the detection of most common and rare carbapenemases in routine microbiology laboratories. METHODS: The immunochromatographic tests CARBA-5 (NG), RESIST-4 O.K.N.V. (Coris), the colorimetric ß-CARBA (BioRad), a newly developed carbapenem-inactivation method (CIM) supplemented with zinc (zCIM), and the Xpert Carba-R (Cepheid) were challenged with a collection of 189 molecularly characterized Enterobacterales isolates, including 146 carbapenemase producers (CPE): VIM (n = 48), OXA-48-like (n = 40), NDM (n = 29), KPC (n = 13), IMI (n = 9), IMP (n = 9), OXA-58 (n = 2), and GES (n = 2). RESULTS: The overall sensitivity/specificity values for the five carbapenemase detection tests were 84.2% (CI 77.6-89.2%)/100% (CI 91.8-100%) for RESIST-4, 88.2% (CI 82.1-92.4%)/100% (CI 91.8-100%) for CARBA-5, 88.2% (CI 82.1-92.4%)/100% (CI 91.8-100%) for Xpert Carba-R, 73.7% (CI 66.2-80.0%)/100% (CI 93.4-99.0%) for ß-CARBA, and 97.4% (CI 87.9-99.6%)/97.7% (CI 87.9-99.6%) for zCIM. The four common carbapenemases (KPC, OXA-48-like, NDM, and VIM) were detected with ≥97.6% sensitivity by all tests except for ß-CARBA (76.6% (CI 68.4-83.2%)). IMI and GES were only detected by zCIM (sensitivity 90.9% (CI 62.3-98.4%)). Based on these results a new algorithm was developed, consisting of an immunochromatographic assay as the first test followed by zCIM, which allows detection of 99.3% of all carbapenemases assessed. CONCLUSIONS: Except for ß-CARBA, all methods showed excellent sensitivity/specificity for the detection of the four most frequent carbapenemases. With the new algorithm, rare variants can also be detected. It is rapid, simple, and inexpensive and can be performed in any microbiology laboratory, as no PCR equipment is required.

Cirugía bariátrica en adolescentes / Bariatric surgery in adolescents

Resumen: La epidemia de obesidad afecta en forma transversal a todo el ciclo vital. En particular, en las últimas décadas se ha observado un incremento de la obesidad severa en adolescentes. En esta etapa de la vida caracterizada por profundos cambios físicos, emocionales y gran vulnerabilidad, la obesidad severa tiene pocas opciones efectivas de tratamiento. En adolescentes, los resultados del tratamiento centrado en modificaciones del estilo de vida son modestos y el arsenal farmacológico muy acotado y de poca efectividad. La Cirugía Bariátrica (CB) ha surgido como una opción terapéutica viable para un grupo seleccionado de adolescentes. El objetivo de esta revisión es presentar una visión actualizada respecto a indicaciones, contraindicaciones, complicaciones y resultados de estos procedimientos en población adolescente.

Abstract: The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At this stage of life, characterized by deep physical and emotional changes, and great vulnerability, severe obesity has few effective treatment options. In adolescents, the treatment results focused on lifestyle modifications are poor and the pharmacological options are very limited and ineffective. Bariatric Surgery (BS) has emerged as a via ble therapeutic option for a selected group of adolescents. The objective of this review is to update the current view regarding indications, contraindications, complications, and results of these procedures in the adolescent population.

Diagnóstico y tratamiento de las dislipidemias en niños y adolescentes: recomendaciones de la rama de nutrición de la sociedad chilena de pediatría / Dyslipidemia management in children and adolescents: recommendations of the nutrition branch of the chilean society of pediatrics

La prevalencia de dislipidemias ha aumentado en niños y adolescentes, muchas de ellas asociadas al incremento de la obesidad. Puesto que constituyen un factor de riesgo cardiovascular futuro, deben conocerse las bases de su tratamiento. En la gran mayoría de los pacientes, éste consiste en cambios de estilo de vida, con dieta específica y aumento de la actividad física, presentando habitualmente una respuesta favorable. Solo una minoría requiere tratamiento medicamentoso, el que debe ser realizado por especialista en el contexto de una evaluación completa del perfil de riesgo cardiovascular, con la inclusión del paciente y su familia. Sin embargo, la prevención de los factores de riesgo cardiovascular debe ser realizada por todos los miembros del equipo de salud. Este artículo presenta las recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría para el diagnóstico, tamizaje y tratamiento de las dislipidemias en la niñez.

The prevalence of dyslipidemia has dramatically increased in children and adolescents, and many of these cases are associated with increased obesity. As this condition represents cardiovascular risk in the future, the bases of its treatment should be widely known. In the vast majority of patients, there will be lifestyle changes, specific diet and increased physical activity, usually all of these resulting in a favorable response. Only a minority will require drug treatment, which must be prescribed by a specialist in the context of a comprehensive cardiovascular risk assessment, including the patient and his family. The prevention of cardiovascular risk factors should be performed by all members of the health team. This article presents the recommendations of the Nutrition specialists of the Chilean Society of Pediatrics for screening, diagnosis and treatment of dyslipidemia in childhood.

[Dyslipidemia management in children and adolescents: recommendations of the Nutrition Branch of the Chilean Society of Pediatrics]. / Diagnóstico y tratamiento de las dislipidemias en niños y adolescentes: recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría.

The prevalence of dyslipidemia has dramatically increased in children and adolescents, and many of these cases are associated with increased obesity. As this condition represents cardiovascular risk in the future, the bases of its treatment should be widely known. In the vast majority of patients, there will be lifestyle changes, specific diet and increased physical activity, usually all of these resulting in a favorable response. Only a minority will require drug treatment, which must be prescribed by a specialist in the context of a comprehensive cardiovascular risk assessment, including the patient and his family. The prevention of cardiovascular risk factors should be performed by all members of the health team. This article presents the recommendations of the Nutrition specialists of the Chilean Society of Pediatrics for screening, diagnosis and treatment of dyslipidemia in childhood.

Seguimiento en fase aguda de catpeteres electrodos de estimulación endocavitaria permanente: Comparación de tres modelos / Comparison of three brands of intracardiac pacemarker leads

Background: Electrode lead design and materials influence their performance, stability and manipulation characteristics. In our laboratory, we use straight intracardiac, active fixation, steroid eluting leads. These features are shared by three brands of pacemarker distributors. Aim: To compare the short term results of three brands of leads used in our laboratory in patients requiring the implant of a pacemarker of cardioverter. Material and methods: One hundred and four patients (mean age 70 years, 59 males) subjected to a pacemarker or cardioverter implant were studied and followed during the first three months post implant. In these patients, 49 Guidant Flextend® 4087 or 4088, 27 Saint Jude Tendril® 1488T and 10 Medtronic Capsurefix® 5076 leads were implanted in the right atrium and 60 Guidant Flextend® 4087 or 4088, 29 Saint Jude Tendril® 1488T and 19 Medtronic Capsurefix® 5076 leads were implanted in the right ventricle. Results: Implant parameters were adequate for all leads. A sub-acute rise in ventricular stimulation threshold was detected in one Flextrend® lead. Three atrial leads (two Flextend® and one Capsurefix®) and one Capsurefix® ventricular lead experienced an acute displacement. One patient with a Flextend® lead, had a cardiac tamponade caused by an atrial perforation. Conclusions: The three brands of leads tested can be successfully implanted with comparable parameters and without differences in the evolution of patients during the first three months.

Experiencia en el uso de un nuevo catéter electrodo de estimulación endocavitaria: Seguimiento a un año / Experience in the use of a new endocardial stimulation electrode

Background: Since February 2002, Flextend® electrode catheters are used at the Cardiovascular Unit of the Catholic University Clinical Hospital. These transvenous catheters have an IS-1 connector, silicone coating, active fixation and retractile helix with dexamethasone acetate. Aim: To report early and one year results using Flextend® catheters. Material and methods: Retrospective analysis of all patients that received an implant of a Flextend® catheter in the Unit. Results: Forty one Flextend® catheters were implanted in 24 patients, without acute displacement or clinical pericarditis. In 18 electrode catheters located in the right atrium the mean values for p wave, stimulation threshold and impedance at the moment of placement, were 2.9±1.4 mV, 0.8±0.4 V and 522±86 Ohms, respectively. The figures 24 hours after placement were 3.6±2.1 mV, 0.8±0.3 V and 612±69 Ohms, respectively. In 23 electrode catheters in the right ventricle, mean values at the moment of placement for R wave, stimulation threshold and impedance were 11.3±3.6 mV, 0.8±0.2 V and 756±108 Ohms, respectively. The figures 24 hours after placement were 3.6±2.1 mV, 0.8±0.3 V and 612±69 Ohms, respectively. In one patient, the stimulation threshold increased two months after placement and required a new intervention. Conclusions: Flextend® catheters ca be placed successfully with a low rate of complications and stable function parameters on follow up.

[Comparison of three brands of intracardiac pacemaker leads]. / Seguimiento en fase aguda de catpeteres electrodos de estimulación endocavitaria permanente: comparación de tres modelos.

BACKGROUND: Electrode lead design and materials influence their performance, stability and manipulation characteristics. In our laboratory, we use straight intracardiac, active fixation, steroid eluting leads. These features are shared by three brands of pacemaker distributors. AIM: To compare the short term results of three brands of leads used in our laboratory in patients requiring the implant of a pacemaker or cardioverter. MATERIAL AND METHODS: One hundred and four patients (mean age 70 years, 59 males) subjected to a pacemaker or cardioverter implant were studied and followed during the first three months post implant. In these patients, 49 Guidant Flextend 4087 or 4088, 27 Saint Jude Tendril 1488T and 10 Medtronic Capsurefix 5076 leads were implanted in the right atrium and 60 Guidant Flextend 4087 or 4088, 29 Saint Jude Tendril 1488T and 19 Medtronic Capsurefix 5076 leads were implanted in the right ventricle. RESULTS: Implant parameters were adequate for all leads. A sub-acute rise in ventricular stimulation threshold was detected in one Flextrend lead. Three atrial leads (two Flextend and one Capsurefix) and one Capsurefix ventricular lead experienced an acute displacement. One patient with a Flextend lead, had a cardiac tamponade caused by an atrial perforation. CONCLUSIONS: The three brands of leads tested can be successfully implanted with comparable parameters and without differences in the evolution of patients during the first three months.

Experiencia de plan piloto para pacientes del FONASA portadores de arritmias atendidos en el Hospital Clínico de la Pontificia Universidad Católica de Chile / Treatment of beneficiaries of the Chilean public health system with arrhythmias in a University Clinical Hospital

Background: The costs of medical care increase along with technological advances. Therefore, highly complex and expensive procedures should be performed in a limited number of institutions. Aim: To report the initial experience on electrophysiological studies performed to beneficiaries of a public health insurance system in Chile (FONASA). Material and methods: An agreement was reached between the Electrophysiology Unit of the Clinical Hospital of the Catholic University and FONASA, to perform electrophysiological studies at a minimal cost, that only considered disposable materials and hospital stay. Thirty patients with supraventricular arrhythmias or ventricular arrhythmias without an associated cardiopathy, were attended using this agreement at the unit. Results: In all treated patients, arrhythmias disappeared. Costs remained within the assigned budget, excepting occasional complementary tests. Conclusions: This pioneering experience demonstrated that it is possible that public health insurance systems can buy complex and expensive procedures to private hospitals.

Fulguración con radiofrecuencia de taquicardia ventricular después de corrección quirúrgica de Tetralogía de Fallot: Caso Clínico / Radiofrequency ablation of ventricular tachycardia in a patient after surgery for Tetralogy of Fallot: Case report

Ventricular tachycardia is one of the most feared complications after surgical repair of Tetralogy of Fallot and it is associated with sudden death. We report a 26 years old female with a history of surgical repair of Tetralogy of Fallot at age of 4 year-old, who developed sustained ventricular tachycardia despite antiarrhythmic drugs. She was successfully treated with radiofrequency catheter ablation. Radiofrequency catheter ablation is a valid treatment for these patients.

Dolor torácico y alteración del segmento ST en pacientes con vías accesorias aurículo-ventriculares: Report of three cases / Chest pain and ST segment abnormalities in patients with accessory atrioventricular pathways

We report three patients with pre-excitation syndrome that resembled an acute coronary syndrome. A 65 years old woman, consulting in the emergency room for palpitations and retrosternal pain. EKG showed regular tachycardia and ST depression that reverted spontaneously after an episode of vomiting. A subsequent EKG demonstrated a pre-excitation syndrome and the accessory pathway was fulgurated. A 18 years old male presenting with tachycardia and chest pain elicited during exercise. An EKG showed a pre-excitation syndrome and ST segment elevation in V2 and V3. A coronary angiogram was normal. The accessory pathway successfully fulgurated. A 63 years old woman that presented tachycardia while exercising. She was subjected to an electrical cardioversion. An electrophysiological study showed an accessory pathway that was successfully fulgurated.

Flutter auricular: Resultados inmediatos y alejados de la fulguración con radiofrecuencia del istmo cavo-tricuspídeo / Results of radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus for atrial flutter

Background: Radiofrequency ablation of the inferior vena cavatricuspid valve isthmus relieves atrial flutter in 95percent of cases. Aim: To evaluate the long term results of radiofrequency ablation of the inferior vena cavatricuspid valve isthmus in atrial flutter. Material and methods: Retrospective review of 86 patients with common atrial flutter, treated with radiofrequency ablation of the isthmus, while in sinus rhythm or flutter. Patients were contacted by telephone for a new clinical and electrocardiographic assessment, three to 40 months after the procedure. Results: Of all the patients treated, five died and five were lost from follow up, thus 76 patients (mean age 56 years, 58 males) were contacted for reassessment. At the moment of the procedure, 51percent had an underlying cardiac disease and 25percent had high blood pressure. All referred palpitations, 25percent had dyspnea, 84percent were receiving antiarrhythmic drugs and 33percent were on oral anticoagulants. Flutter was paroxystic in 83percent and chronic in 17percent. Fulguration was successful in all patients; one patient presented a high grade atrioventricular block as a complication of the procedure. At reassessment, 82percent of patients were in sinus rhythm, 16percent had atrial fibrillation and 2percent, an atypical flutter. Conclusions: Radiofrequency fulguration is a safe and effective treatment of atrial flutter.

Taquicardia recíproca de la unión auriculoventricular: características electrofisiológicas en un paciente con la variedad paroxística. Caso clínico / Paroxysmal tachycardia in a patient with a permanent form of junctional reciprocating tachycardia

Junctional reciprocating tachycardia is an atrioventricular reentrant tachycardia whose anterograde conduction occurs via the His Purkinje and the retrograde conduction via an accessory pathway with slow conduction. The most common form is incessant tachycardia but a paroxysmal form also exists. We report a 35 years old female with recurrent paroxysmal tachycardia, that underwent electrophysiological evaluation. A left posterolateral accessory pathway was documented. Reciprocating paroxysmal tachycardia was induced by electrical stimulation and a successful pathway ablation was performed (Rev MÚd Chile 2004; 132: 608-13).

Epidemiologia das dermatofitoses em instituições públicas da região de Araraquara - SP / Epidemiology of the dermatophytosis in public institutions of the region of Araraquara city - SP

As dermatofitoses são processos infecciosos de pele, pêlo e unhas muito comuns no mundo inteiro. Com o intuito de avaliar a epidemiologia das infecções causadas por estes fungos em Instituições Públicas de Araraquara, 105 amostras de indivíduos com suspeita clínica de dermatofitose foram examinadas no Laboratório de Micologia da Faculdade de Ciências Farmacêuticas, de agosto a dezembro de 2001 e, destas, 47 foram positivas para dermatófitos. Trichophyton rubrum foi a espécie prevalente (56,9%), seguida por Microsporum canis (17%), T. tonsurans (10,6%), T. mentagrophytes (8,5%) e Epidermophyton floccosum (4,3%). T. rubrum foi mais frequente nas lesões dos interdígitos (81,5%) e M. canis foi o principal envolvido nas lesões do couro cabeludo (58,3%). Portanto, houve predomínio de fungos antropofílicos e zoofílicos, respectivamente, dado este que está de acordo com as estatísticas dos estados brasileiros da região Sudeste e Sul, bem como de outras regiões do mundo em que estes fungos foram os mais frequentes isolados de tinha dos pés e do couro cabeludo. Neste estudo, foi também verificada elevada percentagem de T. tonsurans (41,7%) em tinha do couro cabeludo, dado este inédito na região Sudeste

Cáncer incidental de cérvix (CIC) / Incidental cervical cancer (ICC)

Ocasionalmentes luego de una histerectomía simple, aparece un cáncer de cuello uterino (CCU) como hallazgo incidental (CIC) a la Anatomía Patológica (AP). Esta entidad, es de alto riesgo de recidiva locorregional, por lo que requiere de un tratamiento complementario. Propósito: analizar retrospectivamente los resultados de Radioterapia (RTX) complementaria en mujeres con diagnóstico de CIC referidas al Hospital Las Higueras (HH) y Centro Onco-Radiológico Regional (CORR) y compararlos con similares a comunicados en la literatura. Se analizan 29 pacientes con diagnóstico de CIC, referidos a HH y CORR entre agosto 1988 y junio 2000, tratados complementariamente con radioterapia externa y/o intracavitaria. La sobrevida actuarial a 5 años fue de 86%. El control locorregional actuarial de la totalidad de la muestra fue de 86%. En 5/29 pacientes fallecidas, todas de CCU. De las 5 fallas a tratamiento, 4 con falla locorregional. Una, con histología carcinoma indiferenciado de células pequeñas, con control locorregional y falla distante a los 175 meses. La RTX complementaria es altamente efectiva en el tratamiento de CIC.

Twenty nine patients with proven invasive cervical cancer found after simple hysterectomy were treated with complementary external and/or intracavitary Radiotherapy, 5 year actuarial survival rate of 86%. Local and regional control was achieved in 25/29, 83%. One patient presented with a complication grade 2, no treatment related deaths.

The nuclear RPL4 gene encodes a chloroplast protein that co-purifies with the T7-like transcription complex as well as plastid ribosomes.

We have cloned and sequenced the cDNA and the gene coding for plastid ribosomal protein L4 (RPL4) from two higher plant species, spinach and Arabidopsis thaliana. Ribosomal protein L4 is one of the ribosomal proteins for which extraribosomal functions in transcriptional regulation has been demonstrated in prokaryotes. Sequence comparison of the two plant cDNAs and genes shows that the RPL4 gene has acquired a remarkable 3' extension during evolutionary transfer to the nuclear genome. This extension harbors an intron and codes for a glutamic and aspartic acid-rich amino acid sequence that resembles highly acidic C-terminal tails of some transcription factors. Co-purification of ribosomal protein L4 with plastid RNA polymerase and transcription factor CDF2 using different purification protocols as well as the surprising amino acid sequence of the L4 protein make it a likely candidate to play a role in plastid transcriptional regulation.

hcf5, a nuclear photosynthetic electron transport mutant of Arabidopsis thaliana with a pleiotropic effect on chloroplast gene expression.

A photosynthetic mutant of Arabidopsis thaliana, hcf5, was isolated by screening M2 seedlings for high chlorophyll fluorescence. Thylakoid morphology was strikingly abnormal, with large grana stacks and almost no stroma lamellae. Fluorescence induction kinetics, activity assays, and immunoblotting showed that photosystem II was absent. Polypeptides of the photosystem I complex, the Cyt b6/f complex, coupling factor, and the large subunit of ribulose-1,5-bisphosphate carboxylase/oxygenase were also severely depleted. However, the nuclear-encoded chlorophyll a/b light-harvesting complex polypeptides were unaffected. The rbcL transcript was present at very low levels, the pattern of transcripts from the polycistronic psbB-psbH-petB-petD operon was abnormal, and the mature psbH message was almost completely lacking. This suggests that the hcf5 locus may encode a product required for the correct expression of several chloroplast genes.