Compartment pressure in nailed tibial fractures. A threshold of 30 mmHg for decompression gives 29% fasciotomies

During the past few years we have monitored tissue pressure in patients treated with intramedullary nailing of tibial shaft fractures. A value of 30 mmHg has been used as the threshold for fasciotomy. The purpose of this study was to evaluate this practice. Sixty-three patients were included in the series. Forty-three fractures were closed, 18 grade I (Gustilo) and two grade II. Tissue pressure measurements were performed in 43 patients. Eighteen legs were treated with decompressive fasciotomy, three on clinical findings alone, and 15 after measurement of a pressure higher than 30 mmHg. This gives a fasciotomy rate of 29%. At follow-up two patients were dead. All fractures were healed, and there were no major complications such as deep infection, extensive muscle necrosis, paresis or short-foot syndrome. Three fasciotomized patients had significantly reduced muscle strength compared with the contralateral leg.

Mutational analysis of PHEX gene in X-linked hypophosphatemia

Hypophosphatemic rickets is commonly an X-linked dominant disorder (XLH or HYP) associated with a renal tubular defect in phosphate transport and bone deformities. The XLH gene, referred to as PHEX, or formerly as PEX (phosphate regulating gene with homologies to endopeptidases on the X-chromosome), encodes a 749-amino acid protein that putatively consists of an intracellular, transmembrane, and extracellular domain. PHEX mutations have been observed in XLH patients, and we have undertaken studies to characterize such mutations in 46 unrelated XLH kindreds and 22 unrelated patients with nonfamilial XLH by single stranded conformational polymorphism and DNA sequence analysis. We identified 31 mutations (7 nonsense, 6 deletions, 2 deletional insertions, 1 duplication, 2 insertions, 4 splice site, 8 missense, and 1 within the 5' untranslated region), of which 30 were scattered throughout the putative extracellular domain, together with 6 polymorphisms that had heterozygosity frequencies ranging from less than 1% to 43%. Single stranded conformational polymorphism was found to detect more than 60% of these mutations. Over 20% of the mutations were observed in nonfamilial XLH patients, who represented de novo occurrences of PHEX mutations. The unique point mutation (a-->g) of the 5'untranslated region together with the other mutations indicates that the dominant XLH phenotype is unlikely to be explained by haplo-insufficiency or a dominant negative effect.

A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball

The purpose of this study was to examine gender differences in the incidence of anterior cruciate ligament (ACL) injuries in a population of high-level team handball players. We also wanted to examine injury mechanisms and possible risk factors for ACL injuries, including menstrual status. The study was done prospectively during the 1993-94, 1994-95, and 1995-96 seasons. We found 28 ACL injuries, 23 among women (incidence: 0.31 +/- 0.06 injuries per 1000 player hours) and 5 among men (0.06 +/- 0.03 inj./1000 h; P < 0.001 vs women; risk ratio: 5.0). Of the 28 injuries, 24 occurred during competition (0.91 +/- 0.19 inj./1000 h; women: 1.60 +/- 0.35 inj./1000 h; men: 0.23 +/- 0.13 inj./1000 h; P < 0.001 vs. women; risk ratio: 7.0) and 4 during training (0.03 +/- 0.02 inj./1000 h; P < 0.001 vs. competition; risk ratio: 29.9). Nearly all the injuries (n = 25) occurred in non-contact situations when the players performed high-speed plant-and-cut movements which they were well accustomed to. A reliable menstrual history could be obtained in 17 of the 23 cases among females. Five of the injuries occurred in the menstrual phase, 2 in the follicular phase, 1 in the early luteal phase and 9 in the late luteal phase (chi-square3 d.f. = 13.2; P < 0.01). The results suggest that there may be an increased risk of ACL injury during the week prior to or after the start of the menstrual period.

Baculovirus merozoite surface protein 1 C-terminal recombinant antigens are highly protective in a natural primate model for human Plasmodium vivax malaria

A successful anti-blood stage malaria vaccine trial based on a leading vaccine candidate, the major merozoite surface antigen-1 (MSP1), is reported here. The trial was based on Plasmodium cynomolgi, which is a primate malaria parasite which is highly analogous to the human parasite Plasmodium vivax, in its natural host, the toque monkey, Macaca sinica. Two recombinant baculovirus-expressed P. cynomolgi MSP1 proteins, which are analogous to the 42- and 19-kDa C-terminal fragments of P. falciparum MSP1, were tested by immunizing three groups of three animals each with either p42, p19, or both together. The vaccines were delivered subcutaneously in three doses at 4-week intervals with complete and incomplete Freund's adjuvants. Very high antibody titers were obtained against both vaccinating antigens as measured by enzyme-linked immunosorbent assay (10[6] and above) and against whole parasites as measured by indirect immunofluorescence assay (>10[5]), achieving, in most animals, about a 10-fold increase from the first to the last immunization. A blood stage challenge with P. cynomolgi parasites led, in three adjuvant-treated and three naive control animals, to blood infections which were patent for at least 44 days, reaching peak densities of 0.6 and 3.8%, respectively. In contrast, all except one of the nine animals in the three vaccinated groups were highly protected, showing either no parasitemia at all or transient parasitemias which were patent for only 1 or 2 days. When the three p19-vaccinated monkeys were rechallenged 6 months later, the protective efficacy was unchanged. The success of this trial, and striking analogies of this natural host-parasite system with human P. vivax malaria, suggests that it could serve as a surrogate system for the development of a human P. vivax malaria vaccine based on similar recombinant analogs of the P. vivax MSP1 antigen.

Polyamines regulate both transcription and translation of the gene encoding ornithine decarboxylase antizyme in mouse

The degradation of ornithine decarboxylase (ODC) is mediated by antizyme, a protein regulated by the end-products of ODC activity, the polyamines. High levels of polyamines induce a +1 ribosomal frameshift in the translation of the rat antizyme message leading to the expression of a full-length protein. We have studied whether the regulation of antizyme expression occurs only at the level of translation or whether polyamine levels also affect the transcription of the antizyme gene. Thus, we have cloned and sequenced the mouse homologues of the rat ODC-antizyme gene and cDNA. Northern blot analysis shows that although high concentrations of polyamines do not affect the steady-state levels of antizyme message in L1210 leukemia cells, polyamine depletion using 2-(difluoromethyl)ornithine [Orn(F2Me)] leads to a marked decrease in mRNA levels. Results of transient transfections of luciferase-reporter-gene constructs driven by antizyme promoter fragments in untreated and Orn(F2Me)-treated Balb/C 3T3 cells indicate that the transcription of the antizyme gene is altered upon polyamine depletion. The amount of antizyme protein on Western blots was also altered by polyamine depletion and addition, and the polysomal distribution of antizyme message suggests a general translational increase of the message when polyamine concentrations are high. These results indicate a role for polyamines in the transcriptional and translational regulation of ornithine decarboxylase antizyme.

Interference with DNA methyltransferase activity and genome methylation during F9 teratocarcinoma stem cell differentiation induced by polyamine depletion

When ornithine decarboxylase, the initial and highly regulated enzyme in polyamine biosynthesis, is irreversibly inactivated by alpha-difluoromethylornithine, F9 teratocarcinoma stem cells are depleted of putrescine and spermidine and as a result differentiate into a cell type which phenotypically resembles the parietal endoderm cells of the early mouse embryo. Simultaneously the level of decarboxylated S-adenosylmethionine (dcAdoMet), the aminopropyl group donor in spermidine and spermine synthesis, increases dramatically, as the aminopropyl group acceptor molecules (putrescine and spermidine) become limiting. When this excessive accumulation of dcAdoMet is prevented by specific inhibition of the AdoMet decarboxylase activity, the differentiative effect is counteracted, despite the fact that the extent of polyamine depletion remains almost identical. Therefore, it may be concluded that dcAdoMet plays an important role in the induction of differentiation. Moreover, this key metabolite acts as a competitive inhibitor of DNA methyltransferase and is therefore capable of interfering with the maintenance methylation of newly replicated DNA. During the course of F9 cell differentiation, the highly methylated genome is gradually demethylated, and its pattern of gene expression is changed. Our present findings, that the DNA remains highly methylated and that the differentiative process is counteracted when the build-up of dcAdoMet is prevented, provide strong evidence for a causative relation between the level of dcAdoMet and the state of DNA methylation as well as cell differentiation.

Effects of chronically elevated growth hormone levels on polyamine metabolism in elderly transgenic mice

The polyamines are ubiquitous, multifunctional aliphatic amines with roles in cell growth, proliferation, differentiation, and malignant development. After growth stimulation, rapid and transient changes occur in polyamine regulatory enzymes. In this respect, acute effects of growth hormone (GH) injection on polyamine metabolic enzymes have earlier been shown. The present investigation comprises studies of the effects on polyamine metabolism of constitutively elevated levels of circulating GH in elderly transgenic (tg+) mice, overexpressing bovine GH. Polyamine levels were found to be constitutively altered in the liver and kidney of tg+ mice. Less changes were found in the spleen and none in the brain. The cellular uptake of polyamines in the liver from tg+ mice showed an increase and considerable changes were observed in the activity of ornithine decarboxylase (ODC) in the liver and kidney and S-adenosylmethionine decarboxylase (AdoMetDC) in the liver. A conspicuous finding was the distribution pattern of ODC protein in the liver and both tg- and tg+ animals. The results show that the effects of chronically elevated GH levels are organ-dependent and complex, and differ from acute GH effects. Despite high ODC activity and polyamine levels in liver, these mice did not display any malignant transformation even at an advanced age, indicating that high ODC activity is not sufficient to induce tumorigenesis in vivo.

Expression of transforming growth factor-beta 1 in rat ventral prostate and Dunning R3327 PAP prostate tumor after castration and estrogen treatment

BACKGROUND

In normal prostate, TGF-beta 1 is associated to castration induced apoptosis. Combined castration and estrogen treatment, but not castration alone, induces apoptosis in the Dunning R3327 PAP adenocarcinoma.

METHODS

TGF-beta 1 expression in rat ventral prostate (VP) and Dunning R3327 PAP tumor was studied after castration and estrogen treatment, using competitive RT-PCR, in situ hybridization and immunohistochemistry.

RESULTS

TGF-beta 1 mRNA level was 6 times higher in the tumor than in the VP. Combined castration and estrogen treatment increased TGF-beta 1 mRNA levels in the tumor from day 3, while castration did not. The TGF-beta 1 expression was located in the epithelial cells.

CONCLUSIONS

The Dunning R3327 PAP tumor contains high levels of TGF-beta 1, which are further increased by combined castration and estrogen treatment. However, since this increase is not apparent until day 3, TGF-beta 1 probably does not contribute to the known induction of apoptosis in the tumor at day 1 after combined castration and estrogen treatment.

Different responses of skeletal muscle following sprint training in men and women

Six male and ten female physically active students performed 30-s sprint training on a cycle ergometer three times a week for 4 weeks, to investigate the training responses of skeletal muscle and to evaluate possible sex differences in this respect. Three repeated sprint tests with a 20-min rest in between were performed and muscle biopsies from the vastus lateralis muscle were taken before and after the training period. Mean power (average of sprint I-III) and type IIB cross-sectional fibre area increased only in the women (7% and 25% respectively) following sprint training, resulting in a decreased sex difference. There was an increase in total lactate dehydrogenase (LD) activity following sprint training in both sexes, although the levels were lower in the women both before and after training. Glycogen content increased and the activity of LD iso-enzyme 1 decreased in the women, but not in men. It was hypothesised that both the smaller areas of type II fibres and lower activity of LD generally seen in women may be due in part to less frequent activation of type II fibres in women than in men. If this were the case, the women should respond to sprint training (a type of training that activates type II fibres) to a relatively greater extent than men. That the observed increase in type IIB fibre area in response to sprint training was greater in the women than in men supported the hypothesis of the study. However, the results for LD activity, which showed a similar response in the men and the women, did not support the hypothesis.

Down-regulation of ornithine decarboxylase by an increased degradation of the enzyme during gastrulation of Xenopus laevis

The present study was designed to analyze the regulation of the levels of the polyamines and their biosynthetic enzymes during embryonic development of Xenopus laevis. The activity of ornithine decarboxylase (ODC), a rate-controlling enzyme in polyamine biosynthesis, is elevated until, during gastrulation, there is a precipitous drop in activity. This is not attributable to a decrease in ODC mRNA content and polysome profiles reveal no apparent decrease in ODC message associated with polysomes. ODC synthesis seems to be maintained at a low, relatively constant rate until neurulation whereupon ribosome loading of ODC mRNA increases. During gastrulation the rate of ODC degradation increases dramatically, which can account for the decrease in ODC. S-Adenosylmethionine decarboxylase (AdoMetDC), another rate-controlling enzyme in polyamine biosynthesis, shows a low and constant activity from cleavage to neurulation. Subsequently, the AdoMetDC activity increases dramatically. The changes in AdoMetDC activity parallel the changes in AdoMetDC mRNA levels, suggesting a transcriptional control of AdoMetDC expression during this development period. The activities of ODC and AdoMetDC produce a steady increase in putrescine and spermidine content of the embryo. The spermine content also increases until gastrulation, but then decreases until the tailbud stage.

Localization of S-adenosylmethionine decarboxylase in murine tissues by immunohistochemistry

S-adenosylmethionine decarboxylase (AdoMetDC), one of three key enzymes in polyamine biosynthesis, is present in minute concentrations in adult tissues, whereas increased AdoMetDC activity occurs in conjunction with differentiation and growth. The occurrence of AdoMetDC in tissues has earlier been studied by biochemical technique only. In this work, an antiserum against recombinant human AdoMetDC was used to investigate the localization of the enzyme in different mouse tissues. In all tissues studied, immunolabeling was seen in cytoplasm, while cell nuclei were negative. In the kidney, AdoMetDC immunoreactivity was confined to the inner part of the cortex; the outer part of the cortex and the medulla displayed only a weak AdoMetDC immunoreaction. In the cortex, renal tubules were strongly reactive, while renal corpuscules were weakly immunolabeled. In developing teeth, AdoMetDC immunoreactivity displayed a gradient of distribution, the immunolabeling intensity being increased from the cervical region to the tip of the cusps. In the incisor, post-secretory ameloblasts were strongly labeled. In the oral mucosa, epithelial cells demonstrated stronger immunolabeling than did cells of the subjacent connective tissue. As for muscle cells, immunoreactive material was confined to the periphery of the fibers. In vitro, treatment with DL-alpha-difluoromethylornithine (DFMO) or methylglyoxal bis-(guanylhydrazone) (MGBG) led to an increase in AdoMetDC. It can be concluded that antibodies to recombinant human AdoMetDC provide a tool for the immunohistochemical localization of AdoMetDC, and that the distribution of the enzyme in the tissues studied gives further support to the importance of polyamines in the development and functions of these organs.

Unchanged muscle function after bilateral femoral lengthening. A prospective study of 9 patients with a 2-year follow-up

We performed pre- and 2-3.5-year postoperative isokinetic knee-testing to assess thigh muscle function in 9 patients undergoing bilateral femoral lengthening by callotasis. The median femoral lengthening was 17 (12-18) percent. The angular testing velocities were 60 degrees/sec (strength) and 180 degrees/sec (endurance). Only small changes in muscle strength were found postoperatively. Except for peak torque at 60 degrees/sec on the last-operated side (median 2 years follow-up), there were no differences between the pre- and postoperative isokinetic measurements. There were 3 major complications, 2 fractures and 1 varus deformity. 2 patients had problems with patellar pain. All patients achieved normal range of motion. They judged the final result as very good and underlined the psychological effect and the practical advantages of being taller.

Non-hazardous organic solvents in the paraffin-embedding technique: a rational approach. Aliphatic monoesters for clearing and dewaxing: butyldecanoate

The aim of this study was to substitute hazardous compounds, used in tissue processing and dewaxing, with compounds having lowest possible toxicity and inflammability without impairing the morphology, staining characteristics, or diagnostic value of the tissue sections. All aromatic compounds and aliphatic hydrocarbons (e.g. alkanes, isoparaffins, petroleum distillates, etc.) were rejected, primarily due to their high vapour pressure. Based on a theoretical study of compounds used for clearing, a number of non-hazardous potential substitutes were chosen. The following experimental study narrowed the group to three unbranched, saturated, aliphatic monoesters containing 12-14 carbon atoms. On large-scale testing of these compounds, we found butyldecanoate to be the closest to an ideal substitute for aromatic and aliphatic hydrocarbons in the histology department: the section quality is at least equal to that obtained with xylene. For dewaxing, it is used at 30-35 degrees C. Butyldecanoate is not suitable as a pre-mounting agent. In practice, this is no problem as modern mounting agents permit mounting of coverslips directly from ethanol without impairing the appearance of the section in the microscope. Butyldecanoate has only a slight odour, insignificant vapour pressure (< 0.01 kPa at 20 degrees C), and does not present a fire hazard (flash point 134 degrees C). The introduction of this compound in the laboratory poses no health hazard, and the substance is biodegradable.

Cloning and sequencing of an intronless mouse S-adenosylmethionine decarboxylase gene coding for a functional enzyme strongly expressed in the liver

A genomic clone for a mouse S-adenosylmethionine decarboxylase (AdoMetDC) gene was isolated from a cosmid library. Surprisingly, the gene proved to be intronless. With the exception of three base substitutions (changing 2 amino acids in the deduced protein), the 1002-nucleotide sequence of the open reading frame was identical to that of mouse AdoMetDC cDNA. Moreover, the gene contained a poly(dA) tract at the 3' end and was flanked by 13-base pair direct repeats. Our findings suggest that this gene has arisen by retroposition, in which a fully processed AdoMetDC mRNA has been reverse transcribed into a DNA copy and inserted into the genome. By polymerase chain reaction, we positively identified the intronless gene in the mouse genome, and, by primer extension analysis, we proved the gene to be functional. Thus, its transcripts were found in many cell lines and tissues of the mouse and were particularly abundant in the liver. When the open reading frame of the intronless gene was expressed in Escherichia coli HT551, a strain with no AdoMetDC activity, it was found to encode a 38-kDa protein, corresponding to AdoMetDC proenzyme. Although the change of methionine 70 to isoleucine was close to the cleavage site at serine 68, this protein underwent proenzyme processing, generating a 31-kDa alpha subunit and an 8-kDa beta subunit. Importantly, the protein encoded by the intronless gene was functional, i.e. it catalyzed the decarboxylation of S-adenosylmethionine, and its specific activity was comparable with that of recombinant human AdoMetDC purified according to the same procedure.

Reliability of functional knee tests in normal athletes

Functional tests are used to determine functional limitations in patients with anterior cruciate ligament injuries. The reproducibility of 4 such functional tests was determined in 21 normal athletes. The athletes performed the four functional tests (figure 8, vertical jump, triple jump test and stairs hopple tests) twice, with an interval of mean 3.9 weeks (1-7 weeks). The reliability of the tests was determined from each tests' coefficient of variation (CV). The figure 8 test showed a significant difference between the 2 performances and the variation from test I to test II. The CV values ranged from 2.0% for the triple jump test to 7.7% for the vertical jump test. These findings do not support the reliability of the figure 8 test and the vertical jump test, but do support the reliability of the triple jump test and the stairs hopple test.

Can a regular leg extension bench be used in testing deficits of the quadriceps muscle during rehabilitation?

Fifty-nine people, 31 healthy subjects with no previous knee injuries and 28 who had undergone an intra-articular anterior cruciate ligament reconstruction 6-12 months prior to testing took part in the study. The subjects were randomly tested bilaterally on a Cybex 6000 isokinetic testing device (ITD) and on an ordinary leg extension bench (LEB). Strength and endurance were tested with both methods. The linear relationships for paired strength and endurance differences between ITD and LEB were found to be acceptable for the operated group. The LEB alone explained 57% and 38% of the ITD outcome for strength and endurance, respectively. The agreement between observed and predicted ITD values based on the LEB measurements was found satisfactory with a positive standardized agreement index. This indicates that the LEB can be used as a helpful tool in evaluation of quadriceps muscle strength deficits.

Muscle function after femoral shortening osteotomies at the subtrochanteric and mid-diaphyseal level. A follow-up study

Relative femoral shortening length at the subtrochanteric (ST) and mid-diaphyseal (MD) level was compared with isokinetic muscle strength more than 2 years postoperatively. For the ST level no upper limit for shortening length could be detected. For MD osteotomies the relative shortening length was negatively correlated to muscle strength. There was a significant difference at the MD level between those shortened more or less than 10%, indicating an upper limit of 10% of the femoral length for regaining normal muscle strength. For correction of leg length inequality and for shortening of unaccepted tallness, these results should be taken into account when choosing the level for osteotomy.

Muscle function after mid-shaft femoral shortening. A prospective study with a two-year follow-up

We performed isokinetic knee testing to assess thigh muscle function in ten patients (12 legs) before and after mid-shaft femoral shortening averaging 46 mm (27 to 70). Tests were at angular velocities of 60 degrees/sec and 180 degrees/sec, and were performed preoperatively and after 3, 6, 12 and 24 months. Isokinetic tests at two years showed a significant reduction in muscle function in both quadriceps and hamstrings, but recovery of function was significantly better for the hamstrings. There was a linear relationship with correlation of r2 = 0.31 to 0.86 between loss of muscle force at two years and the magnitude of shortening. Long-term loss of muscle force should be expected after a mid-shaft shortening of the femur of more than 10%.

Muscle function after mid-shaft femoral shortening. A prospective study with a two-year follow-up

We performed isokinetic knee testing to assess thigh muscle function in ten patients (12 legs) before and after mid-shaft femoral shortening averaging 46 mm (27 to 70). Tests were at angular velocities of 60 degrees/sec and 180 degrees/sec, and were performed preoperatively and after 3, 6, 12 and 24 months. Isokinetic tests at two years showed a significant reduction in muscle function in both quadriceps and hamstrings, but recovery of function was significantly better for the hamstrings. There was a linear relationship with correlation of r2 = 0.31 to 0.86 between loss of muscle force at two years and the magnitude of shortening. Long-term loss of muscle force should be expected after a mid-shaft shortening of the femur of more than 10%.

Development of resistance to hydroxyurea during treatment of human myelogenous leukemia K562 cells with alpha-difluoromethylornithine as a result of coamplification of genes for ornithine decarboxylase and ribonucleotide reductase R2 subunit

alpha-Difluoromethylornithine (DFMO), an enzyme-activated irreversible inhibitor of ornithine decarboxylase (ODC), was used to select two very highly drug-resistant cell lines, designated K562-DFMOr and V79-DFMOr. Both DFMO-resistant cell lines exhibited elevated ODC expression due to gene amplification. Moreover, the K562-DFMOr cells, but not the V79-DFMOr cells, had an elevated level of ribonucleotide reductase subunit R2 (R2) mRNA and an increased R2 gene copy number. By analysis of their electron paramagnetic resonance spectra, an increased level of the R2 protein was observed in the K562-DFMOr cells as compared to the wild type K562 cells. This is the first description of a DFMO-induced mutant cell line exhibiting coamplification of the genes for ODC and R2, and overexpression of their products. There was no coamplification of the N-myc protooncogene, which is located close to the ODC and R2 genes on human chromosome 2. The alterations exhibited by the K562-DFMOr cell line were shown to be stable for many passages and to convey resistance not only to DFMO but also to hydroxyurea, an inhibitor of ribonucleotide reductase and thus DNA replication. In the absence of the selective pressure exerted by DFMO, the V79-DFMOr cell line produced revertants by loss of ODC gene amplification within three passages. Coamplification of linked genes may turn out to be an important mechanism in the development of cross-resistance and should be considered when designing therapeutic strategies.

Fast twitch fibres may predict anaerobic performance in both females and males

The aim of the present study was to compare males and females with similar training backgrounds regarding the relationship between anaerobic performance and muscle characteristics and to test whether any of the analysed expressions of muscle characteristics could predict some of the difference in anaerobic performance between sexes. Subjects performed 30 s all-out sprints on a bicycle ergometer (Wingate test) and needle muscle biopsies were taken at rest. Peak and mean power were respectively 44% and 48% higher in males than in females. Activity of total lactate dehydrogenase (LD) was 33% higher and of M subunit of LD 38% higher in males. Anaerobic performance was directly related to the proportion of type II fibres, the relative M subunit activity or the activity of PFK in both males and females and the higher M subunit activity in males could predict some of the sex difference in anaerobic performance. It is suggested that anaerobic performance is directly related to fast contractile or/and anaerobic metabolic properties of skeletal muscle with no sex difference in this relationship. The difference in anaerobic performance between the sexes may partly be related to the sex difference in anaerobic metabolic properties of skeletal muscle.