Effects of ageing and arthritic disease on nitric oxide production by human articular chondrocytes

Nitric oxide (NO) has been considered as an important mediator in inflammatory phases and in loss of cartilage. In inflammatory arthritis, NO levels are correlated with disease activity and articular cartilage is able to produce large amounts of NO with the appropriate inducing factor such as cytokines. The old animals are shown to have a greater sensitivity to NO than young animals. This study evaluated the basal production of NO in normal and OA-affected chondroyctes from young and old patients and compared the levels of NO formation in response to IL-1beta. The results showed that the basal levels were 7-fold higher in old chondrocytes than those of young cells. However, the IL-1beta induced NO production was seen to decrease with age. Aminoguianidine (AG), a competitive inhibitor of iNOS, inhibited NO formation completely in both chondrocytes from young and old individuals. However, at the same concentration of AG it caused partial inhibition of NO and iNOS formation in chondrocytes from OA-affected individuals. In addition, although the IL-1beta induced NO production was much lesser than that of young chondrocytes, the inhibition of collagen production by IL-1beta was prominent in old chondrocytes and OA-affected chondrocytes. These results suggest that age-related differences in the regulation of NO production and collagen production, which may affect the ageing cells and osteoarthritic changes in some way.

Magnetic resonance imaging of reconstructed anterior cruciate ligament

After anterior cruciate ligament reconstruction with autologous patellar tendon, 23 patients who had clinically stable knees were studied prospectively with sequential magnetic resonance imaging 1, 2, 3, 6, and 12 months after surgery. The images of the anterior cruciate ligament were obtained with a 1.5 tesla magnetic resonance scanner in the oblique sagittal, coronal, and oblique axial planes. The cross-sectional area and signal intensity on the reconstructed anterior cruciate ligament were measured in an oblique axial image. The usefulness of the oblique axial image in evaluating the integrity of the reconstructed anterior cruciate ligament was seen. The result showed that the diameter of the graft increased by 70% of its initial size and the signal intensity of the reconstructed graft also showed a tendency to increase. In three patients, there was discontinuity in the graft direction on the oblique sagittal image, but on the oblique axial image there was no evidence of reconstructed anterior cruciate ligament rupture in the sequential images. This shows the value of the oblique axial image in evaluating the integrity of the reconstructed anterior cruciate ligament. Also, sufficient notchplasty in anterior cruciate ligament reconstruction may be needed to prevent graft impingement.

Clusterin expression during regeneration of pancreatic islet cells in streptozotocin-induced diabetic rats

AIMS/HYPOTHESIS

Beta-cell regeneration has been reported after islet injury in an animal model for diabetes. Recently, we showed up-regulation of clusterin after islet injury and suggested that clusterin might be involved in cytoprotection and in the regeneration of islet cells. The aim of this study was to investigate the correlation of clusterin expression with islet regeneration and its effect on islet cell replication.

METHODS

Streptozotocin was administrated to rats to induce various types of diabetes. Islet regeneration and clusterin expression were examined after islet injuries. Clusterin cDNA was transfected to MIN6 cells and their proliferation activity was measured by a [3H]thymidine-incorporation assay.

RESULTS

A diabetogenic dose of streptozotocin injected in rats provoked an immediate degeneration of beta cells. In this model, islets showed increased clusterin expression with extensive proliferation of alpha cells but showed poor beta-cell replication. A subdiabetogenic dose of streptozotocin, however, led to the proliferation of beta cells with clusterin up-regulation. In streptozotocin-treated neonatal rats, up-regulation of clusterin was noted during beta-cell proliferation. In all experimental models, clusterin was expressed in alpha cells in close correlation with islet cell proliferation, higher transcription of insulin mRNA and MAPKs activation. Cell replication was increased by 31 % in the MIN6 cells transfected by the clusterin cDNA.

CONCLUSION/INTERPRETATION

Up-regulation of clusterin in alpha cells might induce beta-cell proliferation and thus restore their population after islet injury. We suggest that clusterin could be considered as a growth factor-like molecule stimulating islet-cell proliferation by paracrine action.

Medial discoid meniscus completely coalesced with the anterior cruciate ligament

Medial discoid meniscus is an uncommon abnormality. To date, only a few reports have described the associated anomaly with discoid meniscus. However, there are no reports on medial discoid meniscus accompanied by an anomaly of the meniscus itself. The authors found that a medial discoid meniscus completely coalesced with the anterior cruciate ligament. This anomaly strongly supports the congenital development theory of discoid meniscus. Both magnetic resonance imaging and the arthroscopic findings are presented. The patient was treated successfully by saucerization of the discoid meniscus up to the torn edge. This was accomplished by closely cutting the meniscus around the anterior cruciate ligament with an electric cutter.

Controlling self-incompatibility by CO2 gas treatment in Brassica campestris: structural alteration of papillae cell and differential gene expression by increased CO2 gas

Self-imcompatibility is a controlling genetic mechanism to prevent self-pollination for Chinese cabbage (Brassica campestris), one of the major vegetable crops in Korea. To maintain inbred lines of the crop plant, a method in that high CO2 gas is treated to the pistils to overcome the self-incompatibility and thereby self-pollens can successfully make germination and fertilization has been widely used in seed companies. Despite the common utilization of this method, any molecular and cellular studies on how the self-incompatibility is removed from the Chinese cabbage plant have not been done. In this study, we show that the increased CO2 gas causes a structural alteration of the papillae cell and thereby the self-incompatibility is removed from the Chinese cabbage plant, allowing the self-pollens to germinate and penetrate the papillae cell. Also, gene expression in the pistil treated with CO2 gas was studied by DD/RT-PCR and reverse northern hybridization experiments. The results suggest that the failure in self-incompatible reaction resulted not only from the structural alteration of the papillae cell but also from change in the pistil component production that is either positively or negatively regulated by the environmental stimulation.

Cytoprotective effect of arginine deiminase on taxol-induced apoptosis in DU145 human prostate cancer cells

We purified and partially sequenced a cytostatic protein from the ASC-17D Sertoli cell-conditioned media (rSCCM) showing a molecular weight of 90 kDa with homodimeric composition. N-terminal amino acid analysis revealed that the protein was homologous to the arginine deiminase (ADI) of Mycoplasma arginini. We found ADI enzyme activity in rSCCM and the abolishment of the growth inhibitory effect by the supplement of L-arginine. Thus, we confirmed that the cytostatic activity in rSCCM was due to the depletion of extracellular L-arginine by ADI. Apparent increase of cell death or DNA fragmentation was not observed in DU145 cells cultured in the presence of ADI. Incubation of DU145 cancer cells with taxol resulted in a marked DNA fragmentation, whereas pretreatment with ADI or cycloheximide protected the cells from taxol-induced apoptosis. Preincubation of the cells with ADI inhibited S35-methionine incorporation into protein synthesis in a dose dependent manner. These data suggest that ADI-induced arginine depletion may inhibit protein synthesis, and result in the protection of apoptotic cell death that requires new protein synthesis.

Antisense oligonucleotide of clusterin mRNA induces apoptotic cell death and prevents adhesion of rat ASC-17D Sertoli cells

Clusterin has been known to play important roles in cell-cell and/or cell-substratum interactions. Recently we reported the transient expression of clusterin in pancreatic endocrine cells during the early developmental stages and suggested a role in aggregating the endocrine cells for islet formation. In the present study, we have investigated the involvement of clusterin in cell-substratum interaction by the inhibition of clusterin synthesis using antisense oligonucleotide. The expression of clusterin was transiently increased as early as 2-8 h after plating the ASC-17D Sertoli cells to the culture flask, which was the period of cell attachment. In addition, up-regulation of clusterin mRNA was so much greater when the Sertoli cells were plated on the petri dish for the bacterial culture instead of in a animal cell culture flask that therefore, the cells failed to attach to it. These findings suggested that interruption of cell to plate substratum interaction might lead to over-expression of clusterin from Sertoli cells to induce cell to cell aggregation or, perhaps, to re-establish attachment with the substratum. Transfection of ASC-17D Sertoli cells with a 20-base antisense oligonucleotide against clusterin mRNA resulted in extracellular release of LDH and DNA fragmentation. Sertoli cell death by antisense oligonucleotide of clusterin was sequence specific and dose dependent. Treatment of antisense oligonucleotide induced a marked reduction of synthesis for clusterin protein, but not for clusterin mRNA expression, suggesting the translational suppression of clusterin by antisense oligonucleotide. Further, microscopic observation showed that more noticeable cell death was induced by treating the antisense prior to plating the cells than by treating after cell attachment to the plate. From these results, we speculate that down-regulation of clusterin expression in the anchorage-dependent Sertoli cells prevents them from attaching to the plate, and therefore induces cell death.

Polyamine-depletion induces p27Kip1 and enhances dexamethasone-induced G1 arrest and apoptosis in human T lymphoblastic leukemia cells

Glucocorticoid-induced apoptosis is preceded by G1 arrest and supposed to be up-regulated by polyamine-depletion, which also induces G1, arrest. In CEM leukemia cells, dexamethasone showed an antileukemic effect by inducing G1 arrest and apoptosis. DFMO, which depleted cellular polyamines by inhibiting ornithine decarboxylase, induced G1 arrest but without apoptosis, though it enhanced dexamethasone-induced G1 arrest and apoptosis. The G1 arrest was associated with hypophosphorylation of pRb. Dexamethasone inhibited the increase of mutated p53 expression but had little effect on p2Wafl/Cip1 expression. The p27Kip1, level was increased by dexamethasone or and DFMO in line with the kinetics of G1 arrest. Therefore, the up-regulation of dexamethasone-induced apoptosis by polyamine-depletion may be associated with additive down-regulation of G1 progression via the p27Kip1-pRb pathtway.

Up-regulation of clusterin (sulfated glycoprotein-2) in pancreatic islet cells upon streptozotocin injection to rats

Clusterin is a heterodimeric glycoprotein which has been shown to play important roles in programmed cell death and/or in tissue reorganization not only during embryonic development but also in damaged tissues. Recently, we reported the transient induction of clusterin in pancreatic endocrine cells during early developmental stages of islet formation. In the present study, we have investigated the expression of clusterin in pancreatic tissue of streptozotocin-treated rats which were undergoing extensive islet tissue reorganization due to degeneration of insulin beta cells. Clusterin was found in endocrine cells identified as glucagon-secreting alpha cells at the periphery of the islet. Using immunoelectron microscopy, clusterin-positive cells showed the typical ultrastructural features of pancreatic alpha cells. In addition, colocalization of clusterin and glucagon in the same secretory granules was shown by double immunogold labeling. These results imply that clusterin is a secretory molecule having endocrine and/or paracrine actions in parallel with glucagon. Further, we noted that clusterin expression was increased in pancreatic alpha cells during the process of beta cell death upon streptozotocin injection. The increase was significant as early as 1-3 h after streptozotocin treatment prior to any morphological alteration of islet beta cell and any manifestation of hyperglycemia. The expression of clusterin was steady-stately up-regulated during the process of islet reorganization caused by streptozotocin-induced cytotoxic injury. Therefore, we suggest that clusterin might be considered as a molecule induced by both embryonic development and drug-induced reorganization of the endocrine pancreas. Since clusterin expression is up-regulated in alpha cells, but not in beta cells undergoing degeneration, it may play a protective role against the cytotoxic insult.

Transient expression of clusterin (sulfated glycoprotein-2) during development of rat pancreas

Clusterin has been known to play important roles not only in remodeling damaged tissues, but also in tissue reorganization during embryonic development. In the present study, we have investigated the expression of clusterin in the endocrine pancreas during embryonic development. Although a weak immunoreaction was detected in some pancreatic primordial cells at day 14 of gestation, distinct clusterin expression was identified by immunocytochemistry and Northern blot analysis at the 16th day of gestation. Clusterin-producing cells, which corresponded to insulin-containing cells, accounted for the major portion of the developing islet of Langerhans up to 18 days of gestation. Thereafter, clusterin-producing cells display similar distribution and morphological features to glucagon-producing cells. Clusterin expressed in the pancreas was shown by Western blot analysis to be a disulfide-linked heterodimer of 70 kDa with an alpha-subunit of 32 kDa. During early developmental stages, however, we found that proteolytic internal cleavage of the clusterin molecule occurred from the 18th day of gestation. Only one 70 kDa band on the 16th day and two bands (32 kDa and 70 kDa) on the 18th day of gestation were detected by Western blot analysis even in reducing conditions, while only a single 32 kDa band was detected on the second day after birth. The levels of clusterin mRNA in the pancreas transiently increased from the 16th day of gestation to the second day after birth, during the period when active cellular reorganization takes place to form the classic cellular features of the islet. Among various tissue (kidney, brain, liver, heart, lung and pancreas) the levels of clusterin mRNA were the highest in the pancreas from the 18th day of gestation to the second day after birth. In contrast, the lowest expression was observed in adult pancreatic tissue. The higher expression of clusterin in developing pancreas must indicate its involvement in tissue organization during development.

Tumors of the pancreas with osteoclast-like and pleomorphic giant cells: an immunohistochemical and ploidy study

BACKGROUND

Tumors of the pancreas with osteoclast-like giant cells are of uncertain histogenesis and aggressiveness. Their relationship, if any, to undifferentiated (anaplastic) carcinomas of the pancreas with pleomorphic giant cells is also not clear.

METHODS

Eleven tumors with osteoclast-like giant cells were studied by immunohistochemistry for epithelial and mesenchymal markers, as well as for a proliferation marker (Ki67) and p53 protein expression. Cytometric image analysis for nuclear DNA content was also performed. K-ras mutations were investigated by DNA sequence analysis.

RESULTS

Neoplastic, predominantly spindle-shaped cells and osteoclast-like giant cells were positive for mesenchymal markers CD68, LCA, and A1ACT. These spindle-shaped cells were also positive for human muscle actin. Spindle-shaped cells of seven tumors were also positive for epithelial markers carcinoembryonic antigen, epithelial membrane antigen, or keratin. Nine tumors contained a variable number of pleomorphic giant cells in addition to osteoclast-like giant cells. Pleomorphic giant cells were much less positive for mesenchymal markers than were osteoclast-like giant cells, but they were positive for some epithelial markers. A high percentage of spindle-shaped and pleomorphic giant cells were positive for Ki67. Diploid and aneuploid populations were present in varying proportions in both spindle cells and pleomorphic giant cells. The nuclei of osteoclast-like giant cells, however, were diploid and not proliferating. Spindle-shaped and pleomorphic giant cells were positive for p53 protein in 5 of 10 cases. Five of six tumors studied were positive for K-ras mutations.

CONCLUSION

The distinction between tumors with osteoclast-like giant cells and undifferentiated carcinomas with pleomorphic giant cells is often not clear-cut. Both types of tumors have mesenchymal and epithelial characteristics in varying proportions and may arise from an undifferentiated pancreatic stem cell. Long-term survival of two patients suggests that some tumors with osteoclast-like giant cells may have a better prognosis than the usual pancreatic ductal adenocarcinoma.

Effects of spinally and supraspinally injected 3-isobutyl-1-methylxanthine, cholera toxin, and pertussis toxin on cold water swimming stress-induced antinociception in the mouse

1. The cold (4 degrees C) water swimming stress (CWSS) for 3 min significantly increased the inhibition of the tail-flick response in ICR mice. 2. Pertussis toxin (PTX, 0.05-0.5 microgram) in mice pretreated intrathecally (IT) for 6 days attenuated the inhibition of the tail-flick response induced by CWSS. However, intracerebroventricular (ICV) pretreatment with PTX at the same doses did not affect CWSS-induced inhibition of the tail-flick inhibition. 3. 3-Isobutyl-1-methylxanthine (IBMX, 0.01-1 ng) in mice pretreated IT for 10 min dose-dependently attenuated the inhibition of the tail-flick response induced by CWSS. However, IBMX in mice ICV pretreated ICV at the same doses was not effective in attenuating the CWSS-induced inhibition of the tail-flick response. 4. Neither IT nor ICV pretreatment with cholera toxin (CTX, 0.05-0.5 microgram) for 24 hr affected the inhibition of the tail-flick response induced by CWSS. 5. The ICV or IT injection of PTX, CTX, or IBMX did not affect the basal tail-flick response latency. 6. It is concluded that spinal, but not supraspinal, PTX-sensitive G-proteins and cAMP phosphodiesterase may be involved in the antinociception produced by CWSS. However, neither spinal nor supraspinal CTX-sensitive G-proteins appear to be involved in mediating the antinociception induced by CWSS.

Neoplastic transformation of prostatic and urogenital epithelium by the polyoma virus middle T gene

Male transgenic mice expressing the polyomavirus middle T (PyV-MT) gene exhibited growth and developmental abnormalities in prostatic and other urogenital epithelium. Expression of PyV-MT was directed to these tissues by a novel, androgen-inducible expression vector based on the rat C3(1) gene. Epithelial growth disturbances (hyperplasia, dysplasia, and invasive carcinoma) were observed in the ventral and dorsal prostate, coagulating gland, epididymis, and vas deferens. The abnormalities were characterized by histological disorganization, nuclear pleomorphism, increased mitoses, and abnormal DNA content. Transgene transcription was detected in affected tissues, indicating that the C3(1)-based vector targeted androgen-sensitive urogenital tissues, especially the prostate. These results demonstrated that expression of a gene, the protein of which is known to interact with cellular proteins involved in signal transduction, dramatically disrupted urogenital growth and development.

Arthroscopic anatomy of the infrapatellar plica

The infrapatellar plicae, ligamentum mucosum, were examined by arthroscopy in 200 knees. They were classified into five patterns according to the characteristics of the morphologic findings: separate type in 121 cases (60.5%), split type in 27 cases (13.5%), vertical septum type in 21 cases (10.5%), and fenestra type in 2 cases (1.0%). The remaining 29 cases (14.5%) did not have any infrapatellar plica, which were defined as absent type. Hence, the incidence of the infrapatellar plica was 85.5% of the 200 knees examined. There was no significant difference between right and left knees in the distribution pattern of the plica types. The incidence of the infrapatellar plicae decreased as the age increased. Both knees showed the same pattern in the 9 of 16 cases in which a bilateral comparison of the infrapatellar plicae was made.

Involvement of supraspinal and spinal CCK receptors in the modulation of antinociception induced by cold water swimming stress in the mouse

We have previously reported that supraspinally and spinally located CCK receptors are involved in antagonizing supraspinally administered opioid-induced antinociception. Cold water swimming stress (CWSS) produces antinociception and opioid receptors are involved in CWSS-induced antinociception. The present study was designed to determine if supraspinal and spinal CCK receptors were involved in modulating the CWSS- induced antinociception. Antinociception was assessed by the tail-flick test. CWSS caused a profound inhibition of the tail-flick response. Various doses of CCK injected intracerebroventricularly (i.c.v.) or intrathecally (i.t.) alone did not show any antinociceptive effect. The i.c.v. or i.t. pretreatment with CCK (0.05-0.5 ng) dose dependently attenuated the CWSS- induced inhibition of the tail-flick response. In addition, i.c.v. pretreatment with lorglumide (0.1-10 pg) but not PD135,158 (1-100 pg) dose dependently reversed CCK's inhibition of the tail-flick response induced by CWSS. However, both lorglumide and PD135,158 injected i.t. reversed the antagonism of CCK against the inhibition of the tail-flick response induced by CWSS in a dose-dependent manner. Our results suggest that, at the supraspinal level, CCK(A) but not CCK(B) receptors may be involved in antagonizing the CWSS-induced antinociception. In the spinal cord both CCK(A) and CCK(B) receptors appear to be involved in antagonizing the CWSS-induced antinociception.

Paradoxical phenomena of the McMurray test. An arthroscopic investigation

We evaluated 200 patients who had a positive McMurray test and found atypical McMurray test results in 24 patients (12%). These patients revealed pain or clicking or both either in the medial compartment of the knee when the leg was internally rotated or in the lateral compartment of the knee when the leg was externally rotated. The authors analyzed these paradoxical findings at arthroscopic examination to identify the relationship between the type of meniscal tear and the direction of leg rotation that elicited the catching and displacement of the torn meniscal portion during the McMurray test. Contrary to conventional McMurray test findings, three different types of meniscal tears were found on the side of the knee where pain or a clicking sound occurred. The three types were 1) anteriorly based posterior oblique tears with anterior displacement of the meniscus, 2) bucket-handle tears in the posterior half of the menisci, and 3) peripheral detachment of discoid menisci in the posterior half of the torn portions.

The influence of reduced dietary fat absorption induced by orlistat on the pharmacokinetics of digoxin in healthy volunteers

To assess the influence of an orlistat-induced reduction in dietary fat absorption on the pharmacokinetics of digoxin, an open-label, placebo-controlled, randomized, two-way crossover study was performed in 12 healthy volunteers. Each subject received single 0.4-mg doses of digoxin (soft gelatin capsules) administered orally on the fourth day of orlistat (120 mg three times daily for 6 days) and placebo (three times daily for 6 days) treatment, separated by at least an 11-day washout period. Serial blood samples were collected before and at appropriate intervals after each digoxin dose to determine plasma concentrations of unchanged digoxin. The 90% confidence intervals for the ratio of geometric least-squares means (for Cmax, AUC0-48, AUC0-t, and AUC) and for the difference of arithmetic least-squares means (for tmax and lambda z) indicate that the pharmacokinetics of digoxin was not altered by treatment with orlistat. This results suggests that a approximately 30% reduction in dietary fat absorption will not change the efficacy of digoxin in cardiac patients.

Discoid lateral meniscus associated with anomalous insertion of the medial meniscus

Discoid lateral meniscus in the knee joint is common. From July 1990 through September 1992, the authors performed arthroscopy on 534 symptomatic knee joints. Seventy-seven knees of 72 patients had discoid lateral meniscus. Of the 77 knees treated, 4 (5.5%) had discoid lateral meniscus associated with anomalous insertion of the anterior horn of the medial meniscus into the anterior cruciate ligament. The discoid lateral meniscus was reshaped in the 4 knees, and followup was done from 12 to 24 months (average, 20 months) after surgery. The results were satisfactory, except for 1 patient who damaged his knee in a traffic accident. The authors concluded that this anatomic variant of the medial meniscus was not related to the patients' symptoms, but that reshaping the discoid lateral meniscus did relieve their symptoms.

The influence of volumetric tumor doubling time, DNA ploidy, and histologic grade on the survival of patients with intracranial astrocytomas

PURPOSE

To improve the prediction of individual survival in patients with intracranial astrocytomas through the analysis of volumetric tumor doubling time (VDt) and DNA ploidy.

METHODS

A pilot study was retrospectively conducted on a group of 25 patients with intracranial astrocytomas in whom recurrent and/or progressive disease was observed on serial contrast-enhanced CT or MR examinations. VDt was computed using two or more data points from a semilogarithmic plot of tumor volume versus time. Size-adjusted survival was calculated using a method based on VDt and initial tumor volume to decrease the lead time bias attributable to differing tumor sizes at presentation.

RESULTS

Slower VDt was associated with significantly longer survival and size-adjusted survival as determined by a univariate Cox proportional hazard analysis. Aneuploidy was a significant indicator of poor survival. Aneuploid and multiclonal astrocytomas had poor size-adjusted survivals compared with diploid astrocytomas. Grade IV astrocytomas had significantly poorer survival and size-adjusted survival compared with lower grades (I to III), which individually were not significantly correlated. However, grade IV histology was not a significant independent predictor of size-adjusted survival in a multivariate Cox model, whereas VDt and DNA ploidy remained significant. VDt also had a significant direct linear correlation to survival and size-adjusted survival.

CONCLUSIONS

VDt and DNA ploidy were more sensitive than histologic grading as indicators of individual survival. Initial tumor size needs to be considered when staging and assessing survival in patients with intracranial astrocytomas.

Genomic structure of the mouse delta opioid receptor gene

Using mouse delta opioid receptor (DOR) cDNA sequence to probe genomic libraries in bacteriophage lambda and P1 vectors, clones traversing the entire DOR coding sequence and 5' and 3' flanking regions were isolate. Genomic sequence encoding mature DOR message, including 5' and 3' untranslated sequence, is divided by two introns of 26 kb and 3 kb, resulting in the gene occupying 32 kb of chromosomal DNA. Multiple putative transcription initiation sites were located, by RNase protection assay, in TATA-less G+C rich sequence between 390 and 140 nucleotides upstream from the ATG translation start codon. A polyadenylation site was located 1.24 kb downstream from the TGA translation stop codon. Examination of 1.3 kb of 5'flanking sequence revealed potential binding sites for several known transcription factors including: Sp1, Ap-2, NF-kappa B, NF-IL6, and NGFI-B.

Genomic structure analysis of promoter sequence of a mouse mu opioid receptor gene

We have isolated mouse mu opioid receptor genomic clones (termed MOR) containing the entire amino acid coding sequence corresponding to rat MOR-1 cDNA, including additional 5' flanking sequence. The mouse MOR gene is > 53 kb long, and the coding sequence is divided by three introns, with exon junctions in codons 95 and 213 and between codons 386 and 387. The first intron is > 26 kb, the second is 0.8 kb, and the third is > 12 kb. Multiple transcription initiation sites were observed, with four major sites confirmed by 5' rapid amplification of cDNA ends and RNase protection located between 291 and 268 bp upstream of the translation start codon. Comparison of the 5' flanking sequence with a transcription factor database revealed putative cis-acting regulatory elements for transcription factors affected by cAMP, as well as those involved in the action of gluco- and mineralocorticoids, cytokines, and immune-cell-specific factors.

Arthroscopic intraarticular interference screw technique of posterior cruciate ligament reconstruction: one-incision technique

Posterior cruciate ligament (PCL) reconstruction using a bone-patellar tendon-bone graft with double incisions has been described in the literature. We present the single-incision technique that may aid the surgeon in performing difficult PCL reconstructions and reduce the possibility of injuring the knee extensor mechanism. By using three proper portals, we have shown that it is possible to make a femoral tunnel and engage a bone peg of the graft in the tunnel without any extensor damage and without disturbing the divergence angle of the bony tunnels. We have performed 22 such operations with successful results.

Congenital bilateral absence of the acromion. A case report

Complete bilateral absence of the acromion, a condition not previously reported by others, was discovered in a 31-year-old housewife who had shoulder pain. Clinically, no abnormal physical sign was noted in the patient except for mild superior translation of the humeral heads. Radiographs showed bilateral absence of the lateral aspect of each scapular spine and acromion. The lateral ends of both clavicles were hypertrophied with convex and blunt margins. Even in the absence of the acromion, there was no significant clinical dysfunction of the shoulder joint.