Induction of tolerance to desiccation and cryopreservation in silver maple (Acer saccharinum) embryonic axes.

Twenty percent of of the world's flowering plants produce recalcitrant seeds (i.e., seeds that cannot withstand drying or freezing). We investigated whether the embryonic axis from the normally recalcitrant seeds of silver maple (Acer saccharinum L.) can be made tolerant to desiccation (10% water content) and low temperature (-196 degrees C, cryopreservation) by pretreatment with ABA or the compound tetcyclacis, which enhances endogenous ABA concentrations. Pretreatment of axes with both ABA and tetcyclacis increased germination after desiccation and freezing to 55% from a control value of zero. Pretreatment of axes with ABA and tetcyclacis increased the ABA content of the axes, as measured by enzyme-linked immunoassay, and stimulated the synthesis of storage and dehydrin-like proteins, believed to have a role in the desiccation tolerance of orthodox seeds.

Is G1 arrest in plant seeds induced by a p53-related pathway?

In mammals, p53 is crucial for inducing the genes that lead to G1 arrest following DNA damage, enabling DNA repair. However, the possibility that such a system exists in plants has attracted little attention. Even though some plant cDNA sequences with partial homology to p53 have been reported recently, there has been little analysis of how these molecules might relate to DNA damage. The lack of investigation into whether a DNA-damage-induced, p53-mediated G1-arrest pathway might exist in plants is remarkable given that plant DNA, like that of all organisms, is continually under the threat of attack.

Predicting length of stay after hip or knee replacement for rheumatoid arthritis.

OBJECTIVE: To identify predictors of the postoperative length of stay (LOS) after hip or knee replacement for rheumatoid arthritis (RA). METHODS: Demographic and clinical characteristics, medications, and postoperative course were abstracted from medical records of patients with RA who underwent total arthroplasties of the knee (TKA) or hip (THA) at our institution between 1987 and 1991. The relationship between these variables and the postoperative LOS was examined using life tables, linear regression, and multiple regression analyses. RESULTS: During the 5 years of the study, 137 patients with RA underwent 119 TKA and 105 THA. The average LOS was 16.9 +/- 8.7 days after THA and 19.5 +/- 11.4 days after TKA (p = 0.08). Significantly longer LOS was associated with age > or = 55 years, female sex, non-white ethnicity, poor functional status, known positive rheumatoid factor, use of bone cement, and operating room (OR) time longer than 6 hours. In a multivariate regression model, a preoperative Steinbrocker functional class 3 or 4 was associated with an increase in LOS of 3.98 days (95% confidence interval 0.78, 7.18) and 7.14 days (2.59, 11.69), respectively, while a known positive rheumatoid factor predicted an increase in LOS of 2.76 days (0.17, 5.35). Among operative factors, the use of bone cement was associated with a LOS that was longer by 3.50 days (0.80, 6.20), and each hour increase in OR time with a delay in discharge of 1.75 days (1.18, 2.33). Major postoperative wound complications increased LOS by 16.46 days (11.40, 21.52). CONCLUSION: Preoperative functional status is an important determinant of the rate of recovery of functional independence after surgery. Strategies for decreasing LOS after hip or knee replacements include optimization of preoperative functional status, early surgical intervention, and prevention of wound complications.

Characterization of seed storage proteins in Populus and their homology with Populus vegetative storage proteins.

We investigated the synthesis and accumulation of vegetative storage proteins (VSPs) in poplar plantlets and the homology between poplar seed storage proteins (SSPs) and VSPs. One-dimensional SDS polyacrylamide gel electrophoresis confirmed that both seed and vegetative storage proteins contained two predominant polypeptides of MW 32 and 36 kDa, but the subunit composition of the polypeptides differed. The 32- and 36-kDa polypeptides were highly abundant in basal leaves, stems, and roots of poplar plantlets. The 36-kDa subunit was synthesized in all plantlet tissues examined, but the 32-kDa subunit was not, suggesting that the 36-kDa polypeptide is a precursor of the 32-kDa polypeptide. The 36- and 32-kDa polypeptides of both SSPs and VSPs were glycosylated and both were found to be albumins. In addition, both polypeptides cross-reacted with a VSP antibody. Protein fingerprint patterns generated with two different proteolytic enzymes were identical for the 36-kDa polypeptide isolated from seeds or from stem tissue. Our study provides evidence that poplar SSPs and VSPs exhibit homology, and that expression is neither tissue-specific nor regulated solely by photoperiod.

Cross-cultural adaptation of a brief outcome questionnaire for Spanish-speaking arthritis patients.

OBJECTIVE: To cross-culturally adapt a brief self-assessment questionnaire to measure outcome among English- or Spanish-speaking patients with arthritis. METHODS: A questionnaire containing the following items was translated to Spanish: the 8 activities of daily living (ADL) question of the Modified Health Assessment Questionnaire; a question about the duration of morning stiffness; and a 10-point pain scale. Equivalence to the original English, test-retest reliability, and construct, criterion, and discriminant validity were determined on a population of patients with 4 clinical centers. RESULTS: English-Spanish equivalence and test-retest reliability of the questionnaire were almost perfect (intra-class correlation coefficients [ri] > or = 0.90 for each). Construct validity, measured by comparing questionnaire scores with an occupational therapist's evaluation, was also near-perfect in both languages (ri = 0.93 for English and 0.89 for Spanish). Both versions of the questionnaire correlated well with the physician-determined Steinbrocker functional class, as well as with the amount of pain, grip strength, and walking velocity. Patients with systemic lupus erythematosus, rheumatoid arthritis, osteoarthritis, and fibromyalgia differed significantly in their pain:ADL ratios, in both languages. CONCLUSIONS: The items of the Spanish questionnaire that we have adapted are equivalent to the original English versions. This questionnaire is suitable for studying Spanish-speaking subjects with arthritis in the US and elsewhere.

Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis.

OBJECTIVE: To identify risk factors for the occurrence of early wound complications following orthopedic surgery in patients with rheumatoid arthritis (RA). METHODS: We reviewed records of patients with RA undergoing joint surgery to identify predictors of the following early postoperative surgical outcomes: (1) prolonged drainage; (2) wound cellulitis; (3) wound dehiscence; (4) suture abscess; and (5) superficial or deep wound infection. RESULTS: During the study, 204 patients with RA underwent 119 total knee replacements, 105 total hip replacements and 143 procedures of other joints, for a total of 367 orthopedic surgeries. A total of 57 complications were observed (15.9%) of which 26 were considered major (7%). Of the 230 total arthroplasties of the hip, knee, shoulder or elbow, 3 were followed by early deep wound infections (1.3%). In univariate analysis, factors significantly related to the occurrence of complications included Hispanic ethnicity [relative risk (RR) 1.43, 95% confidence interval (CI) 1.16 to 1.78]. and preoperative use of azathioprine (RR 2.13, 95% CI 1.04 to 4.37). Complications were less frequent among patients given methotrexate, but the differences was not significant. Operative blood loss was inversely related to the occurrence of complications. In the multivariate model, the only significant predictors of complications were Hispanic ethnicity (RR 2.86, 95% CI 1.43 to 5.56) and operative blood loss (RR 0.50/liter lost, 95% CI 0.29 to 0.86). CONCLUSIONS: We were unable to demonstrate an independent effect of antirheumatic therapy at the time of surgery on the occurrence of postoperative wound complications. Our study suggests that patients with RA of Hispanic ethnicity may be at increased risk of developing postoperative wound complications following orthopedic surgery. Further study is necessary to explain the mechanism of increased complications in this population.

Occupational therapy management of a patient with severe polymyositis.

The purpose of this article is to illustrate with a case study the process through which a patient with polymyositis taking part in an occupational therapy program achieved functional improvement in spite of persistent muscle weakness. Although the focus is on the occupational therapy program, close monitoring of patient improvement or regression by the total rehabilitation team was essential in order to adjust the patient's weekly activity level for maximum benefit.

Resistive exercise in the rehabilitation of polymyositis/dermatomyositis.

OBJECTIVE: To determine the effect of a resistive exercise program in the rehabilitation of patients with polymyositis/dermatomyositis (PM/DM). METHODS: Five patients participated in a rehabilitation program that included resistive exercises. In 4 of the patients, these exercises were randomly alternated with nonresistive exercise. Each type of exercise was assigned for periods of 2 weeks, and at the end of each one, muscle strength was measured by means of manual muscle testing (MMT), an activities of daily living (ADL) score, and peak isometric torque (PIT) generated by muscle groups in the lower extremities. Creatine phosphokinase (CPK) levels were used to measure disease activity. The acute response to resistive exercise was studied in 4 of the patients by measuring serial levels of CPK following a session on an exercise bicycle. RESULTS: Of the 4 patients who participated in both types of exercises, 3 experienced increases in strength during both resistive and nonresistive exercise periods. The patient who participated only in resistive exercises had considerable improvements in muscle strength. One patient made no improvements in strength with either type of exercise. None of the patients experienced clinically significant elevations in CPK attributable to either type of exercise. Following a session of resistive exercise, the mean CPK elevation in 4 patients was 7.7%, returning to pre-exercise levels by 8 h in all cases. CONCLUSIONS: Patients with PM/DM may participate in a rehabilitation program which includes resistive exercises. Such programs may be accompanied by increased strength without clinically significant rises in serum levels of muscle enzymes.

Decreased bone mineral density in HLA-B27 positive members of a family with osteogenesis imperfecta.

We describe a family in which several members had osteogenesis imperfecta (OI) and/or were positive for HLA-B27. The proband, who had ankylosing spondylitis and OI, had severe osteoporosis with fractures continuing to occur in the late teens. Bone mineral density measurements in 5 family members and the proband, revealed more severe osteoporosis in those with positive HLA-B27.

Severe pancytopenia in a patient taking low dose methotrexate and probenecid.

A patient with rheumatoid arthritis developed life-threatening pancytopenia resulting from low dose oral methotrexate (MTX) toxicity potentiated by probenecid. Clinically significant drug interactions are not frequently cited as risk factors for MTX hematologic toxicity. As low dose MTX is gaining increasing popularity in rheumatologic practice, these potentially serious interactions should be considered.

Cardiac compression in rheumatoid pericarditis.

Rheumatoid pericarditis occurs in approximately one third of rheumatoid arthritis (RA) patients. However, clinically apparent rheumatoid pericarditis is infrequent. The authors found clinical pericarditis in 12 of 960 patients admitted for RA, 5 of whom had manifestations of cardiac compression. These 5 had longer duration of RA, worse functional class, and more extraarticular features than the patients without cardiac compression. Presenting features of cardiac compression included dyspnea, edema, chest pain, and pulsus paradoxus. Treatment of patients with cardiac compression due to rheumatoid pericarditis may include a trial of systemically administered corticosteroids, but this should not delay surgical intervention for impending tamponade. Pericardiocentesis should only be performed as an emergency, life-saving procedure. It may be followed by intrapericardiac injection of corticosteroids, but this does not prevent recurrence. Longer-lasting benefit is obtained by surgical decompression. Two-year mortality in patients with cardiac compression was 100%. The literature on the subject is reviewed.

Candida septic arthritis in rheumatoid arthritis.

We describe a patient with a 10-year history of rheumatoid arthritis who developed septic arthritis of the knee secondary to Candida albicans. Joint sterilization was obtained by debridement and 865 mg. of IV amphotericin B. We review 23 other cases of candidal arthritis in adults with specific reference to disease recognition and treatment.

Pseudothrombophlebitis in neuropathic arthropathy.

The pseudothrombophlebitis syndrome is a complication of large, ruptured, or dissecting popliteal cysts. We report a patient with neuropathic arthropathy of the knee and the pseudothrombophlebitis syndrome secondary to a dissecting popliteal cyst. This represents another form of arthritis associated with this syndrome.

Septic ischial bursitis in systemic lupus erythematosus presenting as a perirectal mass.

We describe a patient with systemic lupus erythematosus with dissection of a large ischial bursal cyst which presented as a perirectal mass. Dissecting bursal and articular synovial cysts are known to cause multiple complications including a number of "pseudosyndromes" such as pseudothrombophlebitis. The cyst in this case was initially thought to represent a perirectal abscess and we propose the term "pseudoperirectal abscess" to describe this condition. This cyst was found to be infected and required an extended course of antibiotics and bursectomy.

Acute myelocytic leukemia after the use of cyclophosphamide in the treatment of polyarteritis nodosa.

The use of cyclophosphamide has been associated with the delayed appearance of neoplasms. We report a woman who developed myelodysplastic syndrome leading to acute myelocytic leukemia, 4 years after receiving 13 g of cyclophosphamide over 6 months for severe polyarteritis nodosa. Cytogenetic abnormalities typical of damage induced by alkylating agents, including partial deletions of chromosomes 5 and 7, were present. This case represents the first reported occurrence of cyclophosphamide associated malignancy in polyarteritis nodosa.

Disability evaluation in arthritis patients.

During the working years, rheumatic conditions are the foremost cause of disability in the United States. Disability evaluation for Social Security applicants and Workers' Compensation patients is commonplace in orthopedic practices. Yet, formal education in this aspect of patient care is rare both during and after residency. Because of a lack of understanding and sophistication the physician who knows the patient better than any other evaluator often play a minor role in the determination of disability. Disability Evaluation Under Social Security--A Handbook for Physicians lists the medical criteria necessary for qualification. Severely disabled arthritis patients will not always fit into these various categories and may have to be considered under the rule of medical equivalency. Workers' Compensation statutes vary somewhat from state to state but generally include disability criteria. Familiarity with these criteria and the process involved will allow the orthopedist to communicate more meaningfully with administrators and will reduce much of the frustration and some of the cost inherent in this system. When subjective complaint (illness) is in excess of apparent organic pathology (disease), team evaluation under the direction of the treating physician will help sort out the dilemma and develop a treatment plan. One hopes that this will bring the illness more in line with the disease, and thus reduce the disability.

Prosthetic synovitis: clinical and histologic characteristics.

Our study of 20 patients correlates the clinical picture of each patient with the pathology of synovial tissue obtained at the time of revision arthroplasty. While 12 patients had rheumatoid arthritis and 8 had osteoarthritis, the histopathology was identical. Additionally, while 15 of the 20 had an etiology for the revision, 5 patients were revised for pain alone with no explanation other than the synovitis. The characteristic histologic findings included lining cell hyperplasia, vascular congestion, giant cells, brightly birefringent high density polyethylene chards and cysts that represented ghosts of methyl methacrylate debris.