Glycemic control and neonatal outcomes in women with gestational diabetes mellitus treated using glyburide, metformin, or insulin: a pairwise and network meta-analysis

AIMS

We aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in gestational diabetes mellitus (GDM).

METHODS

We searched for randomized controlled trials that compared glyburide, metformin, and insulin in GDM. Data regarding glycemic control and neonatal safety were collected and analyzed in pairwise and network meta-analyses.

RESULTS

A total of 4533 individuals from 23 trials were included. Compared with glyburide, metformin reduced 2-h postprandial blood glucose (2HPG) to a greater extent (standard mean difference (SMD) 0.18; 95% credible interval (CI) 0.01, 0.34). There were significantly lower prevalence of neonatal hypoglycemia (risk difference (RD) - 0.07; 95%CI - 0.11, - 0.02) and preeclampsia (RD - 0.03; 95%CI - 0.06, 0) in the metformin group than in the insulin group. The metformin group had significantly lower birth weight (SMD - 0.17; 95%CI - 0.25, - 0.08) and maternal weight gain (SMD - 0.61; 95%CI - 0.86,- 0.35) compared with the insulin group. Network meta-analysis suggested that metformin had the highest probability of successfully controlling glycemia and preventing neonatal complications.

CONCLUSIONS

The present meta-analysis suggests that metformin may be as effective as insulin for glycemic control and is the most promising drug for the prevention of neonatal and maternal complications.

Secretions released from mesenchymal stem cells improve spermatogenesis restoration of cytotoxic treatment with busulfan in azoospermia mice

This study aimed at the efficacy of sequential treatment of bone marrow-derived mesenchymal stem cell secretion for busulfan-treated azoospermia in mice. The conditioned media (CM) was obtained from bone marrow mesenchymal stem cells (MSCs) or 293 cells. Chemically induced azoospermia mice received 200 μl MSC-CM or 293-CM twice a week intravenously for three consecutive weeks. The histological assessment of spermatogenic recovery quantifying the expression of meiosis-associated genes, and Sertoli cell barrier functional factors were assessed. The characteristics of TM4 cells (Sertoli cell line) after pre-incubation of MSC-CM in vitro were also obtained. The MSC-CM group had the most spermatogenic colonies among the three groups (p < .05), but no spermatids were seen. Expressions of the meiosis-associated genes Dazl, Vasa, Miwi, Stra8, CyclinA1, Pgk2 and Scp3 in MSC-CM testis were remarkably higher compared with 293-CM and busulfan groups respectively (p < .05). The levels of Sertoli cell barrier functional factors, for example ICAM-1 and N-cadherin, were significantly increased during MSC-CM treatment (p < .05). Moreover, pre-incubation of MSC-CM particularly accelerated the CD54 (ICAM-1) and CD44 expressions of TM4 cells and promoted cell inherent adhesion. MSC-CM treatment can significantly improve the short-term restoration of spermatogonial structures of chemically induced azoospermia related to facilitating Sertoli cell adhesion integrity.

Role of anti-Müllerian hormone and testosterone in follicular growth: a cross-sectional study

BACKGROUND

Anti-Müllerian hormone (AMH) is now considered the best serum biomarker of ovarian reserve, while basal sex hormones are classic markers used for assessing ovarian reserve. The interaction between AMH and sex hormones are complicated and not sufficiently addressed. In this study, we took diminished ovarian reserve (DOR) and polycystic ovarian syndrome (PCOS) as two extremes of ovarian reserve (deficient and excessive respectively) to investigate the role of AMH and sex hormones in follicular growth.

METHODS

A retrospective cross-sectional survey was performed. The patients assessed AMH and basal sex hormones in the Second Hospital of Zhejiang University from April 2016 to March 2019 were involved in this study. Serum AMH and sex hormone concentrations were tested with electrochemiluminescence method. Stepwise linear regression and binary logistic regression was used to determine the predictors of AMH level and to explore the involved factors determining DOR and PCOS.

RESULTS

In the present study, we found that age and follicle-stimulating hormone (FSH) were main negative correlation factors, and luteinizing hormone (LH) and testosterone (T) were main positive factors of AMH. In DOR group, age, FSH and estradiol (E₂) increased and T decreased, while in PCOS group, LH and T increased. Binary logistic regression found that age, weight, FSH, E₂, and T were the significant factors which independently predicted the likelihood of DOR, and that age, body mass index (BMI), AMH, LH, and T predicted the likelihood of PCOS.

CONCLUSIONS

Our study demonstrated that age, FSH, and T were factors that most closely correlated with AMH level, and T was involved in both DOR and PCOS. Since DOR and PCOS are manifested with insufficient AMH and excessive AMH respectively, it is suggested that total testosterone correlated with AMH closely and plays an important role in follicular growth. More attention should be given to testosterone level during controlled ovarian hyperstimulation (COH) process.

Mesenchymal stem cell-secreted factors delayed spermatogenesis injuries induced by busulfan involving intercellular adhesion molecule regulation

The present study was designed to investigate the therapeutic effect of bone marrow MSC-derived factors on gonadotropic toxicity induced by busulfan in vivo. The conditioned media (CM) was obtained from MSCs in serum-free incubation for 48 hr and concentrated ~25-fold by ultrafiltration. The CM of HEK 293 cells was treated as control (293-CM). MSC-CM was injected into busulfan mice via caudal veins after 1 day of busulfan treatment for 2 weeks (200 μl per dose/twice weekly）. Compared to the 293-CM group, testicular injury was delayed in MSC-CM group, including reduced vacuolations of cells in the basal compartment of the seminiferous epithelium and detachment of cells from basement membrane. Apoptotic spermatogenic cells were significantly decreased in MSC-CM group (p ＜ 0.05). Interesting N-cadherin，ICAM-1 and P-cadherin expressions significantly increased in MSC-CM group, while occludin, ZO-1 and connexin 43 expressions showed no difference among MSC-CM, 293-CM and busulfan groups. Present results suggest MSC-secreted factors protect spermatogenesis impairment after busulfan treatment by reducing the apoptosis of spermatogenic cells and enhancing intercellular adhesion molecule expressions.

Construction of implantation failure related lncRNA-mRNA network and identification of lncRNA biomarkers for predicting endometrial receptivity

Insufficient endometrial receptivity is a major factor leading to implantation failure (IF), and the traditional way of morphological observation of endometrium cannot determine the condition of receptivity sufficiently. Considering that long-noncoding RNAs (lncRNAs) regulate endometrial receptivity and competing endogenous RNA (ceRNA) mechanism works in plenty of biological processes, ceRNA is likely to function in the pathology of IF. In the present study, we aim to construct an implantation failure related lncRNA-mRNA network (IFLMN), and to identify the key lncRNAs as the candidates for predicting endometrial receptivity. The global background network was constructed based on the presumed lncRNA-miRNA and miRNA-mRNA pairs obtained from lncRNASNP and miRTarBase. Differentially expressed genes (DEGs) of IF were calculated using the data of GSE26787, and then re-annotated as differentially expressed mRNAs (DEMs) and lncRNAs (DELs). IFLMN was constructed by hypergeometric test, including 255 lncRNA-mRNA pairs, 10 lncRNAs, and 212 mRNAs. Topological analysis determined the key lncRNAs with the highest centroid. Functional enrichment analyses were performed by unsupervised clustering, GO classification, KEGG pathway, and co-expression module analyses, achieving six key lncRNAs and their ceRNA sub-networks, which were involved in immunological activity, growth factor binding, vascular proliferation, apoptosis, and steroid biosynthesis in uterus and prepared endometrium for embryo implantation. Sixteen endometrial samples were collected during mid-luteal phase, including 8 recurrent implantation failure (RIF) or recurrent miscarriage (RM) women and 8 controls who conceived successfully. Quantitative real-time PCR was performed to compare the expression of the above six lncRNAs, which validated that the expression of all these lncRNAs was significantly elevated in endometrium of RIF/RM patients. Further studies are needed to investigate the underlying mechanism, and the lncRNAs may be developed into predictive biomarkers for endometrial receptivity.

Expression of VP1 protein of serotype A and O of foot-and-mouth disease virus in transgenic sunnhemp plants and its immunogenicity for guinea pigs

Recently, transgenic plants expressing immunogenic proteins of foot-and-mouth disease virus (FMDV) have been used as oral or parenteral vaccines against foot-and-mouth disease (FMD). They exhibit advantages like cost effectiveness, absence of processing, thermostability, and easy oral application. FMDV VP1 protein of single serotype has been mostly used as immunogen. Here we report the development of a bivalent vaccine with tandem-linked VP1 proteins of two serotypes, A and O, present in transgenic forage crop Crotalaria juncea. The expression of the bivalent protein in the transgenic plants was confirmed by Western blot analysis. Guinea pig reacted to orally or parenterally applied vaccine by humoral as well as cell-mediated immune responses including serum antibodies and stimulated lymphocytes, respectively. The vaccine protected the animals against a challenge with the virus of serotype A as well as O. This is the first report on the development of a bivalent FMD vaccine using a forage crop.

KEYWORDS

foot-and-mouth disease; sunnhemp; Agrobacterium tumefaciens; FMDV-VP1 gene; serotype O and A; in planta transformation; transgenic plants; bivalent vaccine.

Haemolytic effects of hypo-osmotic salt solutions on human erythrocytes

BACKGROUND

While it is well known that hypotonic solutions of sodium chloride induce hemolysis, the effects of other salt solutions on human erythrocytes have not been well documented.

OBJECTIVE

The study is to compare the effects of other salt solutions on human red cells.

METHODS

Iso-osmotic and hypo-osmotic solutions of various salts were prepared after taking into account their molecular weight and osmotic pressure. Five healthy volunteers between the age of 22-30 years were randomly selected and ten blood samples were collected from them. The study was conducted from January 2009 to February 2009. Blood was collected from subjects by venepuncture into heparinised tubes. 20 fl of blood was pipetted into 1 ml of each solution and incubated for one hour at 37°C in a water bath. The solutions were centrifuged and the colour of the supernatant was read in a spectrophotometer. Supernatant from blood added to distilled water was considered 100% hemolysed.

RESULTS

Iso-osmotic salt solutions were free of hemolysis. Among chloride salts, sodium chloride showed the least hemolysis and potassium chloride and nickel chloride resulted into greater hemolysis. Among potassium salts, potassium bromate caused highest amount of hemolysis whereas potassium sulphate showed the least.

CONCLUSION

The significant differences in hemolytic pattern in hypo-osmotic salts solutions suggest that the hypo-osmotic stress causes morphological changes in red cells that alter their permeability to various ions leading to hemolysis. This probably occurs through opening of volume sensitive channels.

Ultrasound for Screening Fetal Malformations— Has 3-D Made a Difference?

Ultrasonography as a universal screening tool augers well for detection of most of in utero congenital abnormalities, particularly with help of color Doppler, 3-D and 4-D scanning. Argument against universal screening is existing anomalies, not detected by USG, manifesting during childhood. Despite many variables of cost and ethics, poorly trained sonographer, it can be ardently stated that a routine scan is warranted for each pregnancy but only if well-performed at the least, level scan II.

4-aminopyridine-induced contracture in frog ventricle is due to calcium released from intracellular stores

The aim of the study is to demonstrate the presence of intracellular calcium store in frog ventricle based on contractures induced by 4-aminopyridine in calcium-free media. Frog-ventricular strips were subjected to field stimulation at 0.2 Hz and the force of contraction was recorded after stabilization. The preparation was then kept quiescent for some time in solutions with different sodium concentrations, containing 0 or 1 mmol/L calcium. Caffeine, 4-aminopyridine (4-AP), or tetraethylammonium chloride was then added. Frog skeletal muscle preparations were used as positive controls for the caffeine experiments. Frog ventricular preparations did not develop contractures (sustained contractions) in the presence of caffeine (25 mmol/L), while frog skeletal muscle preparations developed caffeine-induced contractures. However, 4-AP (16 mmol/L) was able to induce contractures in quiescent frog ventricular preparations, even when they were superfused with calcium-free solution. 4-AP contractures in frog ventricle were seen in the presence of nifedipine also. Amplitude of 4-AP evoked contractures in frog ventricle were much larger in low sodium (30 mmol/L) and sodium-free (sodium substituted by lithium) solutions than in normal sodium solution, suggesting that the route of extrusion of the cytosolic calcium (released from intracellular stores by 4-AP) is the sodium calcium exchanger, which gets reversed in low sodium solutions. Tetraethylammonium chloride (TEA) was not able to induce contractures in frog ventricle suggesting that the contracture evoked by 4-AP is not due to its potassium channel blocking effect. In quiescent frog skeletal muscle preparations, caffeine as well as 4-AP induced contractures in calcium-free solutions. We therefore conclude that there is a caffeine-insensitive, 4-AP sensitive intracellular calcium store in the frog ventricle.

Oligodendroglial tumor chemotherapy using "decreased-dose-intensity" PCV: A Singapore experience

The authors propose "decreased-dose-intensity" PCV (procarbazine, lomustine [CCNU], and vincristine) chemotherapy for Asian patients with oligodendroglial tumors. In this study, all seven patients with oligodendroglioma (OD) and eight with anaplastic oligodendroglioma (AO) had objective responses or stable disease. Median progression-free survival was greater than 29 months (OD) and 36.5 months or greater (AO); 86% of patients with OD and 63% with AO remain progression-free. Twenty-four Common Toxicity Criteria Grade 3/4 adverse events were noted.

Chlamydia pneumoniae expresses genes required for DNA replication but not cytokinesis during persistent infection of HEp-2 cells

Chlamydia pneumoniae causes community-acquired pneumonia and is associated with several chronic diseases, including asthma and atherosclerosis. The intracellular growth rate of C. pneumoniae slows dramatically during chronic infection, and such persistence leads to attenuated production of new elementary bodies, appearance of morphologically aberrant reticulate bodies, and altered expression of several chlamydial genes. We used an in vitro system to further characterize persistent C. pneumoniae infection, employing both ultrastructural and transcriptional activity measurements. HEp-2 cells were infected with C. pneumoniae (TW-183) at a multiplicity of infection of 3:1, and at 2 h postinfection gamma interferon (IFN-gamma) was added to the medium at 0.15 or 0.50 ng/ml. Treated and untreated cultures were harvested at several times postinfection. RNA was isolated and reverse transcribed, and reverse transcription (RT)-PCR analyses targeting primary transcripts from chlamydial rRNA operons as well as dnaA, polA, mutS, minD, ftsK, and ftsW mRNA were done. Some cultures were fixed and stained for electron microscopic analysis, and a real-time PCR assay was used to assess relative chlamydial chromosome accumulation under each culture condition. The latter assays showed that bacterial chromosome copies accumulated severalfold during IFN-gamma treatment of infected HEp-2 cells, although less accumulation was observed in cells treated with the higher dose. Electron microscopy demonstrated that high-dose IFN-gamma treatment elicited aberrant forms of the bacterium. RT-PCR showed that chlamydial primary rRNA transcripts were present in all IFN-gamma-treated and untreated cell cultures, indicating bacterial metabolic activity. Transcripts from dnaA, polA, mutS, and minD, all of which encode products for bacterial chromosome replication and partition, were expressed in IFN-gamma-treated and untreated cells. In contrast, ftsK and ftsW, encoding products for bacterial cell division, were expressed in untreated cells, but expression was attenuated in cells treated with low-dose IFN-gamma and absent in cells given the high dose of cytokine. Thus, the development of persistence included production of transcripts for DNA replication-related, but not cell division-related, genes. These results provide new insight regarding molecular activities that accompany persistence of C. pneumoniae, as well as suggesting requirements for reactivation from persistent to productive growth.

Expression of Chlamydia trachomatis genes encoding products required for DNA synthesis and cell division during active versus persistent infection

During persistent infection, the intracellular bacterial pathogen Chlamydia trachomatis is viable but severely attenuates the production of new, infectious elementary bodies (EBs). To investigate the reasons for this lack of new EB output, we analysed the expression of chlamydial genes encoding products required for DNA replication and cell division, using in vitro models of active versus persistent infection and synovial tissue samples from patients with chronic Chlamydia-associated arthritis. Hep-2 cells were infected with K serovar C. trachomatis and harvested at t = 0-48 h post-infection (p.i; active). Human monocytes were infected similarly and harvested at t = 1-7 days p.i. (persistent). RNA preparations from infected/uninfected cells and patient samples were subjected to reverse transcription-polymerase chain reaction (RT-PCR) targeting polA, dnaA, mutS and parB mRNA, related to chlamydial DNA replication/segregation; these were expressed in infected Hep-2 cells from 11 to 48 h p.i; ftsK and ftsW, related to cell division, were expressed similarly. Real-time PCR analyses demonstrated that significant accumulation of chlamydial chromosome began at about 12 h p.i. in infected Hep-2 cells. In infected human monocytes, polA, dnaA, mutS and parB mRNA were produced from days 1-7 p.i. and were weakly expressed in patient samples. Real-time PCR indicated the continuing accumulation of chlamydial chromosome during the 7 day monocyte infection, although the rate of such accumulation was lower than that occurring during active growth. However, transcripts from ftsK and ftsW were detected only at 1 day p.i. in infected monocytes but not thereafter, and they were absent in all patient samples. Thus, genes whose products are required for chlamydial DNA replication are expressed during persistence, but transcription of genes whose products are required for cytokinesis is severely downregulated. These data explain, at least in part, the observed attenuation of new EB production during chlamydial persistence.

Nonarticular proximal tibia fractures: treatment options and decision making

Nonarticular proximal-third fractures account for 5% to 11% of tibial shaft injuries and occur as a result of a variety of mechanisms. Treatment is more challenging than for more distal fractures, and the rates of compartment syndrome and arterial injury are higher, especially for displaced fractures. Closed management often leads to varus malunion, especially when the fibula is intact. Closed treatment should therefore be reserved for nondisplaced or minimally displaced fractures with little soft-tissue injury. Plating of the proximal tibia has become a less popular alternative because of the high incidence of infection and fixation failure. However, judicious use of lateral plates as an adjunct to medial external fixation in comminuted fractures can be effective. External fixation remains the most versatile method. It is indicated for fractures with short proximal fragments and in cases of extensive soft-tissue injury that would preclude use of other surgical techniques. Temporary joint-spanning external fixation has a role in the initial management of certain fracture patterns, particularly when accompanied by severe soft-tissue injury. Although intramedullary nailing can lead to valgus malunion in a sizable percentage of patients with this injury, it can be useful for stabilizing fractures with proximal fragments longer than 5 to 6 cm. Placing the entry portal more proximal and lateral, locking in extension, and using specific techniques, such as blocking screws, can improve alignment after nailing. Use of an algorithm that takes into account the severity of soft-tissue injury, the length of the fracture fragment, and the degree of fracture stability allows effective decision making among current treatment techniques.

Calmodulin mediated activation of acetyl-CoA carboxylase during aflatoxin production by Aspergillus parasiticus

The relevance of Ca2+-calmodulin-mediated processes in channelling acetate for aflatoxin formation was investigated by studying the influence of trifluoperazine (an anticalmodulin agent) on [14C]-acetate incorporation and activity of acetyl-CoA carboxylase in Aspergillus parasiticus NRRL 2999. Culturing the organism in presence of 0.14 mmol l-1 trifluoperazine resulted in 55% decrease of [14C]-acetate incorporation into aflatoxin B1, along with an 80% decrease in acetyl-CoA carboxylase activity at periods corresponding to maximal aflatoxin production. Concomitant decrement (35%) in the activity of glucose-6-phosphate dehydrogenase indicated decreased availability of reduction potential (NADPH) required for aflatoxin biosynthesis. The ability of calmodulin to activate and trifluoperazine to inhibit acetyl-CoA carboxylase activity in a dose-dependent manner was also noted under in vitro conditions. The combined results suggest calmodulin-mediated activation of acetyl-CoA carboxylase as an important event for aflatoxin production.

Clinical evaluation of the Alta hip bolt in peritrochanteric hip fractures

We reviewed the clinical and radiographic results of 58 patients with peritrochanteric fractures treated with the Alta hip bolt (a sliding compression device that inserts a dome plunger in the femoral head instead of a hip screw). This group was compared with a group of 53 patients treated with conventional hip screws. Three patients (5.2%) treated with the Alta hip bolt and three patients (5.7%) treated with conventional hip screw had failure of fixation. Failure of fixation consistently occurred in patients with unstable fracture patterns or significant osteopenia. There were no cases of bolt cut-out in stable intertrochanteric fractures. We conclude that the Alta hip bolt performs as well as sliding hip screws in peritrochanteric fractures, but the additional learning curve and increased cost do not justify its routine use at this point in time.

Irreducible superior dislocation of the patella requiring open reduction

The authors describe a case of superior dislocation of patella that was irreducible by closed methods. Extensive review of the literature revealed that this is the first case reported in which an open reduction was needed to reduce a superior dislocation of the patella to unlock the osteophytes, which were blocking the closed reduction.

Results of arthroscopic versus open Bankart suture repair

The purpose of this study was to compare patients with anterior shoulder instability who were treated with an open Bankart procedure with those treated with an arthroscopic procedure. During a 3-year period, 43 patients (44 shoulders) were surgically treated. Thirty-four patients were available for followup. Eighteen shoulders had open Bankart procedure, and 16 shoulders were treated arthroscopically. Capsular laxity can be better assessed with the open procedure. A Bankart lesion was found in all the patients in both series. Average followup for Group 1 was 34 months, and for Group 2, it was 23 months. Group 1 had 83% good to excellent results with no recurrent dislocation or reoperation. Group 2 had 50% good to excellent results, and 50% fair to poor results with 3 recurrent dislocations and 4 recurrent subluxations that required second operation. The average loss of external rotation in Group 1 was not significantly greater than that in Group 2. Sixteen patients in Group 1 and 8 patients in Group 2 were able to return to their primary work or sport. Results of arthroscopic Bankart repair do not equal those of the open Bankart procedure for the rate of recurrence and postoperative range of motion. The followup reported is short, and more dislocations can be anticipated with longer followup.

Bacterial lipopolysaccharide induces diarrhoea in caecectomized mice

Castor oil, lipopolysaccharide of Escherichia coli, and endotoxin of Salmonella typhimurium were used for inducing diarrhoea in sham operated or caecectomized mice. Copious diarrhoea was induced by lipopolysaccharide (LPS) in caecectomized mice. Characteristics of diarrhoea induced by castor oil were not different between the two groups. It is concluded that caecectomized mice may be a good model to study lipopolysaccharide-induced diarrhoea.

Rhizobium meliloti lacking mosA synthesizes the rhizopine scyllo-inosamine in place of 3-O-methyl-scyllo-inosamine

The Rhizobium meliloti Rm220-3 mos locus producing the rhizopine scyllo-inosamine (SI) in nodules is shown to consist of three ORFs (ORF1, mosB and mosC) arranged in an operon structure. This differs from the R. meliloti L5-30 mos locus, which produces 3-O-methyl-scyllo-inosamine (3-O-MSI), by the complete absence of mosA. The deletion covers a region of 1235 nt and includes the entire mosA gene as well as the sequence both upstream and downstream. As a result, Rm220-3 mos ORF1 shares a 5' region common with L5-30 ORF1 but includes an additional 10 bp insertion and a section in the L5-30 mosA and mosB intercistronic region. Antibodies against L5-30 Mos proteins detected MosB and MosC proteins in Rm220-3-induced nodules but no translation product for either ORF1 or mosA was detected. A construct prepared from the L5-30 mos locus which has a truncated mosA gene produces SI rather than 3-O-MSI, confirming this gene is involved in a methylation step in the production of 3-O-MSI. Further, changes made to this ORF result in reduced levels of the rhizopine.

Does phosphorylation affect transport of inorganic phosphate?

1. This study investigated the effects of fructose and 2-deoxyglucose on the uptake and release of phosphate from everted intestinal sacs of mice. 2. Both the sugars significantly decreased the release of phosphate without affecting the uptake. 3. Succinate and fumarate were able to partially reverse the inhibition of phosphate release exerted by fructose but not that exerted by 2-deoxyglucose. 4. Pre-loading with mannoheptulose, a known inhibitor of hexokinase, improved the release of phosphate in the presence of either of these sugars. 5. Adrenaline, known to inhibit phosphorylation of 2-deoxyglucose, reduced the inhibition exerted by this sugar on phosphate release. 6. These results indicate that the inhibition of phosphate release caused by these sugars may be due to the trapping of free phosphate during their metabolism in the gut wall.

Role of sodium-potassium ATPase in phosphate transport by the everted sacs of mouse intestine

1. This study investigated the uptake and release of phosphate from everted intestinal sacs of mice. 2. When the activity of sodium-potassium ATPase was altered (by changing the cationic concentrations in the medium by the addition of ouabain and the manipulation of metabolism by the use of selective inhibitors or stimulants), the release of phosphate appeared to be much more affected by the changes than the uptake of phosphate. 3. A small sodium gradient allowed uptake to be maintained. The addition of ouabain in the presence of an attenuated gradient significantly reduced the uptake and release of phosphate. The inhibitory effect of ouabain on phosphate release was partly reversed by an increase in the potassium concentration in serosal fluid. 4. These results indicate a role for sodium-potassium ATPase in phosphate release from the intestine.

Repair of a glenoid fracture using a powered stapler

Scapular fractures account for only 1% of all fractures, and displaced intra-articular glenoid fractures are very rare. This report describes the operative treatment of a displaced intra-articular fracture of the glenoid in a 33-year-old man. The fracture was repaired by open reduction and internal fixation, using a pneumatically powered stapler for initial stabilization of the fracture fragment and anatomic reduction of the articular surface.

Further analysis of a transcript nested within the actin 5C gene of Drosophila melanogaster

Previously we uncovered a 0.45-kb transcript within the 3' end transcribed untranslated region (3'UTR) of actin gene at 5C3-4 (act5C) of Drosophila melanogaster. We report here that its sequence bears no similarity to the known DNA or protein sequences. This and act5C transcripts are loaded on different polyribosomal classes. Gel retardation experiments performed with this fragment and several others from act5C reveal no DNA binding activity. The 0.45-kb transcript, initially isolated from different developmental stages of D. melanogaster embryogenesis, is also expressed in Drosophila Kc tissue culture cells, which will be used in transformation experiments designed to identify regulatory features of the nested gene and its possible interaction at some level with its "host" act5C gene.

Metabolic basis of catecholamine-induced water transport in everted gut sacs of mouse

1. Catecholamine-induced water transport was measured using an everted gut sac technique. Adrenaline, noradrenaline and isoprenaline induce dose-dependent increases in water transport by the proximal intestinal sacs. Use of selective adrenergic agents revealed the possible involvement of alpha 1- and beta 2-receptors in mediation of catecholamine stimulation of water transport in this segment. 2. Inhibition of glycolysis reduced the effect mediated through alpha 1-receptors, while the inhibition of oxidative phosphorylation blocked the beta 2-receptor mediated increase in water transport. 3. Basal transport of water was also significantly reduced by inhibition of glycolysis but was significantly elevated by blockage of oxidative phosphorylation. 4. Suppression or stimulation of glycolysis was paralleled by similar changes in lactic acid release from the gut wall. 5. It is concluded that the energy for the catecholamine-induced water transport is contributed by glycolysis and oxidative phosphorylation coupled to alpha 1- and beta 2-receptors, respectively. Under basal conditions water transport is mainly dependent on glycolysis in the segment of intestine examined.

A comparative analysis of Giliberty, Bateman, and Universal femoral head prostheses. A long-term follow-up evaluation

This study compares four different types of bipolar hip prostheses used from 1977 to 1984. The devices studied were the Giliberty I and II hip prostheses, the Bateman I prosthesis, and the Universal Hip Replacement (UHR) prosthesis. The surgical indications for prosthetic hip replacement in all cases were displaced subcapital hip fractures (Garden Types 3 and 4). Postoperative evaluation included D'Aubigńe's hip rating system and roentgenograms to assess prosthetic placement, dislocation, disassembly of the components, and the presence of inner and outer bearing motion of the prostheses. Results of the study revealed intact inner bearing motion in all of the devices investigated in the immediate postoperative period. The UHR prosthesis demonstrated a statistically significant lower incidence of dislocation and no incidence of prosthesis disassembly. This study demonstrates the superiority of the bipolar prosthesis when compared to published results of the so-called unipolar prosthesis and also suggests superiority of the design and function of the UHR prosthesis when compared to the Bateman I and Giliberty prostheses. Longer follow-up evaluation is needed to assess the effects of a functioning bipolar prosthesis on acetabular wear.

Dislocations following arthroplasties of the hip. Incidence, prevention, and treatment

Three methods of avoiding postoperative prosthetic dislocation following total or bipolar hip arthroplasty are described; each approach is recommended for a specific population. The anterior surgical approach was utilized for bipolar hip endoprosthetic arthroplasty in 62 minimal or bed-to-chair ambulators with established flexion contractures about the hip. Two of these patients subsequently experienced a prosthetic dislocation, one of which was secondary to infection. An additional 98 patients who underwent arthroplasty using the posterior approach wore a knee immobilizer postoperatively, without incidence of prosthetic dislocation. A modification of Wilke boot casting was utilized for four patients following reduction of a dislocated hip prosthesis. The cast consisted of a short cylinder cast on the affected extremity connected by a cross bar to a short leg cast on the contralateral leg. The casts controlled rotation, were well tolerated, and resulted in no redislocations. We therefore recommend the anterior approach in minimal ambulatory patients who are to undergo total bipolar hip arthroplasty. When the posterior approach is used in hip replacement procedures, we have found that postoperative use of a knee immobilizer helps prevent dislocation. Following reduction of a dislocated hip prosthesis, a modification of the Wilke boot cast that does not immobilize the affected ankle can be used.

Subtrochanteric fractures. A retrospective analysis

In a retrospective review of 107 patients treated during an eight-year period for subtrochanteric fractures, the average follow-up period was 25.5 months (range, six to 96 months). Comparisons of fracture patterns, fixation devices, and complications of osteosynthesis were made in an attempt to identify fixation devices that are best suited for the treatment of this difficult orthopedic problem. The Seinsheimer system of classification was used, and the fracture at risk was identified. Long spiral fractures with associated butterfly fragments in the osteopenic bone of elderly patients occurred most frequently, with complications of osteosynthesis and inherent instability. Despite the theoretic biomechanical advantages offered by the intramedullary systems, follow-up observations showed better results in patients with treatment by extramedullary devices.

A comparative analysis of Ender's-rod and compression screw and side plate fixation of intertrochanteric fractures of the hip

The purpose of this study is to compare the results of compression screw fixation and Ender's rods in the treatment of intertrochanteric fractures of the hip. A retrospective analysis of 77 cases of both unstable and stable cases of intertrochanteric fractures showed a higher incidence of complications in the Ender's group; these included backing out, distal femur fracture, need for a secondary procedure, external rotation deformity, and knee pain. Indications for the use of Ender's rods may be found among patients with burns, soft-tissue injuries of the proximal thigh, and patients refusing blood transfusions. Wiring of the distal ends of Ender's rods prevents backing out of the rods. Dacron tape has also been successfully used to prevent the distal ends of the rods from backing out in the last six of the 77 cases. The compression hip screw is a preferred treatment of choice in both stable and unstable intertrochanteric fractures.

Distal screw targeting of interlocking nails

Successful placement of the distal interlocking screws into the Grosse-Kempf nail is a demanding procedure due in part to deformation of the nail during insertion and to inaccuracy of the targeting device supplied with the system. The authors suggest an alternative approach. After placement of the nail in a tibia or femur, a Kirschner wire (K-wire) is directed through the distal transfixation hole under fluoroscopic control. A second Grosse-Kempf nail is placed alongside the limb with the K-wire passing through the corresponding distal hole. The more proximal hole on the nail serves as a targeting guide for a more proximal wire. Once correct placement of the wires is confirmed roentgenographically, the near cortex is opened with a cannulated drill passed over the wires. The wires are removed, the opposite cortices are drilled, and the screws are placed. In 25 consecutive distally locked nailings (eight tibiae and 17 femora), the technique was easily mastered, decreasing the roentgenogram exposure when compared to freehand techniques.

Transcriptional activity at the 3' end of the actin gene at 5C on the X chromosome of Drosophila melanogaster

Polyribosomal poly(A)+ RNA from stage-specific embryos of Drosophila melanogaster was analyzed by Northern hybridizations to determine the transcription at the 5C actin gene (act5C) and to establish whether these mRNAs are used in translation. A 3' end probe, which contains 30 nucleotides of the actin coding sequence as well as 3'-end-adjacent sequence, hybridizes in addition to the act5C transcript to a smaller transcript 450 nucleotides long. Hybridizations with the 3' end strand-specific probes show that this transcript has the same orientation as the actin gene. This transcript is temporally coexpressed with the act5C gene over most of the developmental stages examined. S1 nuclease mapping and primer extension experiments place its 5' end about 20 nucleotides upstream from the actin translation termination signal. Furthermore, the transcript appears to translate in an in vitro translation system into a protein of 7.4 kDa, as expected from the size of the open reading frame. The data suggest, but do not prove, that the 3'-end-transcribed but untranslated region of act5C may be involved in actin gene expression.

Traumatic dislocation and fracture dislocation of the hip. A long-term follow-up study

Of 84 fracture dislocations of the hip reviewed, 73 were posterior fracture dislocations, nine were central, and two were obturator. Fifty-five were followed from one to 30 years (average, 4 1/2 years). The patients' ages ranged from three to 83 years (average, 33.1 years). All had primary attempt at closed reduction, with 15 treated with subsequent open reduction (six immediate and nine delayed). Satisfactory results were obtained in 42% of hips treated with closed reduction and 40% of those treated with open reduction. Statistical analysis of the results was done. A stable closed reduction produced results as satisfactory as open reduction. When followed for a sufficiently long time interval, severe fracture dislocations, regardless of treatment mode, caused unsatisfactory results.

A spontaneous relocation of a dislocated Neer prosthesis. Occurs with recovery of brachial plexus lesion

A 52-year-old man incurred a brachial plexus injury with a two-part anterior fracture dislocation of the shoulder. The fracture was converted to a four-part fracture dislocation during attempts to reduce the initial lesion in a closed fashion. The four-part fracture dislocation was treated with a Neer humeral head replacement. Postoperatively, the prosthesis gradually dislocated inferiorly and relocated spontaneously with the recovery of the brachial plexus lesion.

Synovial osteochondromatosis. Computerized axial tomography, frozen section and arthrography in diagnosis and management

This is believed to be the first report in the orthopaedic literature on the value of computerized axial tomography in the diagnosis of synovial osteochondromatosis. The disease, rare in young children, is described in a young girl in whom it was first diagnosed at the age of nine and who was followed for 11 years. The role of CAT scan and arthrogram in the diagnosis and management of the disease and of frozen section histology in determining its surgical correction are discussed.

Treatment of recurrent anterior dislocation of the shoulder by duToit Staple capsulorrhaphy. Results of long-term follow-up study

DuToit Staple Capsulorrhaphy was performed on 79 patients during a period of ten and one-half years. Sixty-five patients were followed for an average period of nine years (26 months to ten and one-half years). Separation of the glenoid labrum from the glenoid rim was noted in 94% of the cases. A markedly lax and redundant capsule was noted in 6% of the cases. A bucket-handle tear of the glenoid labrum was noted in 4% of the cases. Fracture of the anterior rim of the glenoid was noted in 6% of the cases. There was one recurrence of dislocation (1.78%); 94% were rated as excellent; 4% were rated good; and 2% were rated poor. Out of 70% of the patients who were participating in athletic activities, 58% returned to athletic activities after surgical repair. Stapling the glenoid labrum to the glenoid is an effective method of treatment of recurrent anterior dislocation of the shoulder.

The treatment of chronic slipped capital femoral epiphysis by biplane osteotomy

Thirty-two biplane osteotomies in thirty patients were performed for the treatment of chronic slipped capital femoral epiphysis during a fourteen-year period at the Jersey City Medical Center. Twenty-seven patients (twenty-nine hips) were followed for two and a half to fourteen years. The correction obtained at surgery was maintained in all of the patients. Although two patients had had narrowing of the hip joint preoperatively and one had narrowing postoperatively, this had resolved at an average of three years postoperatively. Improvement in the range of motion was noted. In twenty patients the limb lengths were equal, in three the involved limb was longer, and in four patients the limb was shorter postoperatively. One patient had a slight subluxation of the femoral head due to an excessive valgus correction at the time of surgery, and one patient had delayed union of the osteotomy site which went on to satisfactory healing. No patients had avascular necrosis of the femoral head or symptoms of degenerative arthritis at follow-up. Preoperative joint-space narrowing did not appear to be a contraindication to this procedure.

Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation

One hundred sixty-two cases of unstable intertrochanteric fractures treated by anatomic reduction and compression hip screw fixation were reviewed. One hundred twenty-four of these patients were followed up for an average of 19.2 months. Loss of fixation, with varus angulation of the fracture, occurred in five patients, a 4% incidence of failure. One hundred ten patients were bearing full weight an average of three weeks after operation. Fracture healing occurred an average of 18 weeks after operation. After compression was applied, 90% of the fractures moved into medial displacement position. Eight percent of the fractures laterally displaced; 2% of the fractures maintained their anatomic alignment. Nonanatomic reduction, e.g., stable reduction accomplished by displacement osteotomy (after Dimon and Hughston), has no advantage over anatomic reduction and fixation by a compression hip screw. The advantages of the latter technique are that weight-bearing can be started early, the device can be used for stable and unstable intertrochanteric fractures with identical technique, and fixation is rigid and allows for compression of the fracture site, while maintaining alignment.

Ruptures of the extensor mechanism of the knee joint

The cases of thirty-four patients with thirty-six ruptures of the quadriceps tendon and of thirty-three patients with thirty-six ruptures of the patellar ligament were studied. The ruptures of the patellar ligament occurred in patients forty years old and younger, while the quadriceps tendon ruptures occurred in older patients. Twenty-eight ruptures (38 per cent) were misdiagnosed initially. When treated without delay, end-to-end suture was found to give a satisfactory repair of the ruptured quadriceps tendons and patellar ligaments, although supplemental external fixation was needed in the latter type of injury. A pins-and-wires technique was found to give the best results in delayed repairs of the patellar ligament, while a variety of repair techniques was used in delayed repairs of the quadriceps tendon. The results of immediate repair at both sites definitely were better than those of late repair.

Type of adrenoceptors involved in induction by adrenaline of hepatic alkaline phosphatase in mice in vivo

Study of adrenoceptor agonist drugs in hepatic alkaline phosphatase induction in mice in vivo revealed, that beta-receptor are involved in this process. Use of selective blocking drugs showed that beta 2-receptors may be responsible for the induction.

Irreducible dislocation of the metatarsophalangeal joints of the foot

An unusual dislocation of the metatarsophalangeal joints of the third, fourth, and fifth toes with fractures of the neck of the second metatarsal bone occurred in a 23-year-old man. Hyperextension of the metatarsophalangeal joints is the mechanism of injury and is substantiated by the anatomic investigation. The metatarsal head is trapped between the fibrocartilaginous plate on the plantar surface of the foot, the dorsal capsule and deep transverse metatarsal ligament on the dorsal surface, the flexor tendons on the lateral aspect and the lumbrical tendons on the medial aspect. Division of the fibrocartilaginous plate, the deep transverse ligament and the dorsal capsule facilitates reduction of dislocation.

Bilateral simultaneous rupture of the quadriceps tendons

Bilateral simultaneous rupture of the quadriceps tendons is very rare and occurred in an 82-year-old man. This may be the fifth case to have been reported in the English literature. Only minor stress on extensor mechanisms preceded the ruptures. Interrupted mattress sutures restored muscle continuity and function. A "pull-out" wire system was not used for protection of healing muscles because adequate amount of tissue mass was available for approximation. Excellent results require intensive postoperative physical therapy. Old age of the patient should not be a deterrent to surgical treatment in carefully selected individuals.

An unusual complication of fracture of the lower femur

False aneurysm is an unusual complication following fracture of the lower femur. Diagnosis is difficult, and in the case reported arteriography was performed despite failure to appreciate any pulsatile component to the swelling.