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The time of appearance of minor mutations was 312 (160–418) days p/s and 349 (240–415) days p/s for reverse and escape mutations, respectively (p = 0.031), while appearance of transient mutations did not differ significantly between reverse mutations and escape mutations from the wild type.
Persistent mutations (yellow lightning bolt) have likely swept through the population, whereas transient mutations (pink lightning bolt) have not.
We chose 1973 genetic locus X strain combination (523 unique sites across nine patients) for iPLEX genotyping as either (1) persistent within their time course (605 sites), (2) background mutations (1263 sites), or (3) transient mutations (105 sites).
Our pedigree-based estimate of the mutation rate is consistent with the short-term elevation of rate estimates caused by the presence of transient mutations, a phenomenon that has been observed in pedigree studies of humans and other mammals [ 21].
Persistent mutations (yellow lightning bolt) have risen in the population to a frequency that they are repeatedly sampled (large circles) whereas transient mutations (pink lightning bolt) have not (small circle).
Background mutations (purple) exist in the all isolates; persistent mutations (yellow) are not in the progenitor, but found in all subsequent isolates after their first occurrence; transient mutations (pink) are not in the progenitor and only in some later isolates; recurrently polymorphic genes contain persistent mutations that occur in the same gene in more than one patient (black box).
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A mutation was considered transient if its frequency subsequently decreased below 100% for complete mutations, or below 50% for dominant mutations, or if minor mutations disappeared over the observation period; e.g, a minor transient mutation is outlined at position 419 in Figure 2B.
These include a) mutations in mitochondrial DNA, b) the induction of a transient mutator phenotype, resulting in mutations in the nuclear genome, and c) increased amounts of reactive oxygen species (ROS) in gastric epithelial cells that induce oxidative damage in the DNA coupled to the decrease of repair activity [ 6, 7].
One strain carries the mutation 37 in ogt but no mutation in mutT4, a reversion that might have occurred after a transient mutator phenotype.
In patients with NDM, we identified a causative mutation in 11 cases with permanent diabetes (7 KCNJ11 and 4 INS) (3,4; and the frequent KCNJ11/R201H mutation in a patient born in September 2010) and 7 with transient diabetes (mutations: ABCC8/S459R, ABCC8/R1380C, ABCC8/V1523M, KCNJ11/R50Q (twice), KCNJ11/E229K, and 1 case with UDP6).
Two sequential transient escape mutations from the wild type were evident at position 244.
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