[Development of a questionnaire concerning the knowledge of COPD]. / Développement d'un questionnaire de connaissances sur la BPCO.

INTRODUCTION: The level of a patient's knowledge about his disease and its treatment is an essential part of an educational assessment. It is useful therefore to make use of a rapid, easy and valid method to collect the information necessary to develop an educational programme adapted to the needs of the patient. The aim of this study is to validate, in a structured way, a knowledge questionnaire on chronic obstructive pulmonary disease (COPD). METHODS: Following a revue of the literature an initial questionnaire was constructed. It included of four domaines: biomedical aspects; symptoms and signs of severity; general knowledge and treatments. The questionnaire was tested on 35 subjects with COPD in order to assess its clarity and comprehensibility. It was reviewed and modified in both content and format by 11: French experts. The reproducibility was studied by repeat testing. RESULTS: The first version of the questionnaire developed by the working party consisted of 50 items. It was reduced to 41 items after interviews with 35 COPD patients and evaluation by 11 experts. The questionnaire appeared to be reproducible: mean concordance 79.5%; minimum 53.3%; maximum 100% and intra-class correlation coefficient 0.53. CONCLUSION: This study lead to the development of a French language COPD knowledge questionnaire.

Conservation of a variant-specific surface antigen gene in different trypanosome species and sub-species.

In Trypanosoma brucie brucie, T. b. rhodesiense, T. b. gambiense and T. evansi, the variant-specific antigen (VSA) genes are organized in families of related sequences, one of which is duplicated when expressed. Some of these VSA sequences appear to be conserved in the different species and sub-species: restriction mapping of isotypic genes of AnTat 1.8 VSA (from T. b. brucei) reveals extensive homology in T. b. rhodesiense, T. b. gambiense and T. evansi, although the genetic surrounding differs in each case. By contrast, the AnTat 1.1 sequence (also from T. b. brucei) appears to be absent from T. b. gambiense DNA.

Quality of life in lung cancer: does disclosure of the diagnosis have an impact?

BACKGROUND: Quality of life (QOL) is an important component of evaluation in oncology. Usually, QOL is used in phase III studies to compare two treatments. The aim of this trial was to evaluate the impact of the disclosure of the diagnosis of cancer on QOL by using the European Organisation for Research and Treatment of Cancer core Quality of Life Questionnaire (EORTC QLQ)-C30 questionnaire and the supplemental lung cancer-specific module QLQ-LC13. PATIENTS AND METHODS: Patients hospitalised for exploration of an abnormal chest X-ray, with no previous history of cancer, a performance status < or =2, and able to fulfil the questionnaire were eligible. The patients answered the questionnaire two times: before (Q1) and after (Q2) the disclosure of the diagnosis. RESULTS: Seventy patients answered at Q1 and Q2. After the disclosure, some scores deteriorated: arm pain (P=0.009), physical functioning (P=0.01), role functioning (P=0.008), emotional functioning (P=0.0001) and social functioning (P=0.012), whereas the patients' own assessment of global QOL (item global QOL in functioning scales) did not show the same evolution. CONCLUSION: Disclosure of the diagnosis had an impact on social and emotional QOL. Patients with lung cancer need psychological support at the beginning of their disease.

[Validation of an asthma knowledge questionnaire]. / Validation d'un questionnaire de connaissances sur l'asthme.

INTRODUCTION: A patient's knowledge of his disease and its treatment is an essential part of the evaluation of an educational process. It is useful therefore to use a rapid, easy and valid means of collecting the information necessary to produce an educational programme adapted to the needs of the patient. METHODS: Following a review of the literature an initial questionnaire was constructed. It included four domains: biomedical, signs and symptoms of severity, general knowledge and treatment. The questionnaire was administered to 73 asthmatics in order to assess its clarity and comprehensibility. It was then reviewed and modified in both format and content by 10 French experts. The revised questionnaire was completed by 108 asthmatics distributed throughout 10 French respiratory centres, a group of 83 non-asthmatic subjects and 203 sixth year medical students at the Bordeaux University School of Medicine. RESULTS: The mean scores were: 19 for the non-asthmatics (range 2-36), 25.7 for the asthmatics (range 4-38) and 32.9 for the students (range 17-40), p 0.0001. The questionnaire was shown to be discriminating with good reliability and reproducibility: alpha Cronbach coefficient=0.82; intra-class correlation coefficient=0.70. CONCLUSIONS: This study has validated a French language asthma knowledge questionnaire.

Structure and expression of a Trypanosoma brucei gambiense variant specific antigen gene.

The expression-linked copy of the T. b. gambiense variant specific antigen gene LiTat 1.6 is transposed in a 20 kb DNA region devoid of restriction sites, located near a chromosome end. This expression site is very similar to that of T. b. brucei variants 117, 118 (1) and AnTat 1.8. In the basic copy, the transposable element (TE) is flanked by repetitive sequences; it includes the gene copy as well as a sequence of 0.9 to 2.1 kb (probably around 1.1 kb) long, upstream from the gene. Probes derived from the 5' part of the TE specifically reveal three polyadenylated transcripts of 4.2, 1.45 and 0.85 kb, respectively, distinct from the 2.1 kb mRNA. The amount of the 4.2 kb sequence is probably less than 0.01% of total trypanosome RNA. Whereas the mRNAs coding for the three isotypic antigens AnTat 1.8 (T. b. brucei), 12.2 (T. b. rhodesiense) and 3.3 (T. evansi) are recognized by LiTat 1.6 probes extending into the 3' half of the transposed sequence, the 5' genomic probes do not hybridize with any of these RNAs. These observations suggest that the LiTat 1.6 gene could be first transcribed in a large precursor molecule. This precursor would be rapidly processed, loosing a large portion of less conserved sequence from its 5' half. Our data are compatible with a model in which the promoter would be provided by the expression site.

Analysis of the DNA and RNA changes associated with the expression of isotypic variant-specific antigens of trypanosomes.

Using specific (32P) labelled cDNA probes, we compared the mRNAs and the genomic DNA sequences coding for the synthesis of two pairs of serologically related variant-specific antigens (VSAs) of trypanosomes: AnTat 1.1 and AnTat 1.1b, both from the strain 1125 of T.b.brucei and AnTat 1.8 and LiTat 1.6 from T.b.brucei and T.b. gambiense, respectively. Within each pair, large similarities were observed in the coding sequence, except in the 3' region which appears to be highly variable. However, a low level of cross-hybridization can be detected between all sequences, in the 3' region only. The expression of these VSAs is linked to a similar duplication-transposition mechanism. The insertion locus of the transposition unit is the same both in AnTat 1.1 and AnTat 1.1b DNAs. In both pairs, the transposition unit seems to comprise at least about 200 bp upstream of the 5' extremity of the coding sequence. The significance of these results, regarding the structure and synthesis of the VSAs, is discussed.

The expression-linked copy of a surface antigen gene in Trypanosoma is probably the one transcribed.

The antigenic specificity of the living trypanosome seems to be determined by the protein component of a unique glycoprotein species covering the whole surface of the parasite. During chronic infection, a single clone of trypanosomes may successively express a large repertoire of different variable antigen types (VATs). There are probably as many genes as variant-specific antigens (VSAs) (see refs 1-3 for reviews). The expression of the genes coding for the synthesis of these antigens is linked to genomic rearrangements involving duplication of the coding sequence and transposition of the additional copy. The regulation of the expression of the VSA genes is operated at the transcriptional level. It can thus be supposed that their transcription depends on the presence of the additional, transposed copy. We report here that this additional copy is in a chromatin configuration highly sensitive to pancreatic deoxyribonuclease, suggesting that it is the transcribed one.

Immunological purification and partial characterization of variant-specific surface antigen messenger RNA of Trypanosoma brucei brucei.

Polyadenylated RNA isolated from total polyribosomes of two variable antigen types (VATs) of T. brucei brucei were shown to program the synthesis, in mRNA-dependant reticulocyte lysates, of a wide variety of polypeptides. After immunoprecipitation of these cell-free products with an homologous antiserum raised against purified variant-specific surface antigen (VSSA), a major electrophoretic band was apparent on fluorography. It was confirmed that this band corresponds to the variable antigen since only an excess of purified homologous antigen will provoke competition. The apparent molecular weight of the in vitro synthesized antigen is about 63,000 daltons. The VSSA mRNA has been found in membrane-bound polyribosomes and a 15 fold immunological purification of this mRNA has been obtained, using partially purified anti-VSSA IgG in conjunction with inactivated Staphylococcus aureus.

Cloning and characterization of DNA sequences complementary to messenger ribonucleic acids coding for the synthesis of two surface antigens of Trypanosoma brucei.

Full length double-stranded complementary DNAs (ds cDNAs) could be synthesized on mRNAs enriched in sequences coding for the synthesis of the variant specific antigens (VSAs) AnTat 1.1 and AnTat 1.8 from Trypanosoma brucei brucei. The size of these ds cDNAs is about 1700 and 1850 base pairs for AnTat 1.1 and AnTat 1.8 respectively. The ds cDNAs were cloned in the plasmid pBR322; two clones harboring a copy of each coding sequence were selected. Both the hybrid-arrested translation and the positive hybridization elution methods confirmed that these recombinants contain VSA-specific inserts. A restriction map was constructed in each case. The two sequences seem to be inserted in a reversed 3'--5' orientation, respective to the plasmid polarity. The AnTat 1.8 cloned sequence is a palindrome probably due to a cloning artefact. Hybridization of the cloned DNAs with "Northern" blots of total or poly(A)+ RNA revealed in each case a single, specific band. The expression of these VSA genes appears thus to be regulated at the transcriptional level.