Tillaux fracture in adults - Case report and review of literature.

Avulsion fractures of the distal tibia resulting from anterior inferior tibiofibular ligament are known as Tillaux fractures. This injury is usually seen among adolescents as a Salter Harris type 3 epiphysiolisis in relation to bone weakness in distal tibia due to ephiphyseal closure. Regarding adult patients, this pattern of fracture become such an atypical one due to supposed failure of ligament previous to bone, avoiding avulsion. However, some cases have been described in recent decades.The purpose of the present study is to present an adult Tillaux case and add an exhaustive review of literature regarding mechanism of injury, associated lesions, treatment, postoperative care and follow up. LEVEL OF EVIDENCE: Level V.

FDG-PET parameters predicting mediastinal malignancy in lung cancer.

BACKGROUND: Staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC) is mandatory. The maximum Standard Uptake Value (SUVmax) obtained using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is the best non-invasive technique available for this evaluation, but its performance varies from center to center. The aim of the present study was to identify FDG-PET predictors of mediastinal malignancy that are able to minimize intercenter variability and improve the selection of subsequent staging procedures. METHOD: A multicenter study of NSCLC patients staged through FDG-PET and endobronchial ultrasonography with needle aspiration (EBUS-NA) was performed using therapeutic surgery with systematic nodal dissection as gold standard. Intercenter variability and predictive power for mediastinal malignancy of different FDG-PET measures were assessed, as well as the role of these measures for selecting additional staging procedures. RESULTS: One hundred and twenty-one NSCLC patients, of whom 94 (72%) had ≥1 hypermetabolic spots in the mediastinum, were included in the study. Mean SUVmax of the primary tumor was 12.3 (SD 6.3), and median SUVmax of the highest hypermetabolic spots in the mediastinum was 3.9 (IQR 2.4-7). Variability of FDG-PET measures between hospitals was statistically significant (p = 0.016 and p < 0.001 respectively), but lost significance when SUVmax in the mediastinum was expressed as a ratio or a subtraction from the primary tumor (SUVmax mediastinum/tumor, p = 0.083; and SUVmax mediastinum - tumor, p = 0.428 respectively). SUVmax mediastinum/tumor showed higher accuracy in the ROC analysis (AUC 0.77 CI 0.68-0.85, p < 0.001), and showed predictive power for mediastinal malignancy when using a 0.4 cutoff (OR 6.62, 95%CI 2.98-14.69). Sensitivities and negative predictive values of clinical staging through EBUS-NA attained values ranging between 57% and 92% after FDG-PET, which improved with additional techniques when the tumor had a diameter >3 cm and/or a SUVmax mediastinum/tumor ratio >0.4. CONCLUSION: The SUVmax mediastinum/tumor ratio is a good predictor of regional tumor extension in NSCLC. This measure is not influenced by intercenter variability and has an accuracy of over 70% for the identification of malignancy when using a 0.4 cutoff.

Antiresorptive treatment, when initiated after a first hip fracture, may not protect of a second contralateral episode in elderly population: A study with 685 patients.

INTRODUCTION: Osteoporosis predisposes for a higher risk of hip fracture and its treatment is frequently underprescribed. Our purpose was to assess the relation between having a second hip fracture and receiving osteoporosis treatment. Also to assess the relation between this second fracture and using central nervous system drugs or being institutionalised. PATIENTS AND METHODS: We reviewed all the patients that were admitted to our hospital with an osteoporotic proximal femoral fracture between September 2009 and February 2011. We identified 685 patients, 74 of which presented a contralateral fracture. We evaluated if they were receiving osteoporosis treatment or taking any medication that could affect the central nervous system and if they were institutionalised. RESULTS: A 10.8% of patients had a second fracture and the mean time between the two of them was 20 months (1-122). There was a clear female predominance (76.35%). The mean age at occurrence of the primary fracture was 83.02 years and 85 for the second. A 90.8% did not follow any type of osteoporosis medication before the first fracture. A 50.9% did not receive central nervous system drugs and 79.1% lived at home at the time of the first fracture. 12.8% of the patients that did not follow the osteoporosis treatment, had a contralateral fracture, 3% more than those that did follow some kind of treatment, but this difference was not significant (p=0.2). DISCUSSION: We identified a similar number of patients undergoing osteoporotic treatment as registered in literature. There was no significant difference between suffering a second hip fracture and following osteoporosis treatment, using psychotropic drugs or being institutionalised.

Reproductive long-term effects, endocrine response and fatty acid profile of rabbit does fed diets supplemented with n-3 fatty acids.

The effect of a diet enriched with polyunsaturated n-3 fatty acids (PUFA) on endocrine, reproductive, and productive responses of rabbit females and the litters has been studied. Nulliparous does (n=125) were fed ad libitum from rearing to second weaning two diets supplemented with different fat sources: 7.5g/kg lard for the control diet (group C; n=63) or 15g/kg of a commercial supplement containing a 50% ether extract and 35% of total fatty acids (FAs) as PUFA n-3 (Group P; n=62). Dietary treatments did not affect apparent digestibility coefficients of nutrients, or reproductive variables of does including milk production, mortality and average daily gain of kits over two lactations. However, on Day 5 and 7 post-induction of ovulation, progesterone of Group P tended to increase to a greater extent than in does of Group C. Total PUFAs, n-6 and n-3 and eicosapentanoic (EPA) contents were greater in adipose tissues of does in Group P than in Group C. Docosapentaenoic acid (DPA), EPA, and docosahexaenoic acid (DHA) concentrations were greater in peri-ovarian than in scapular fat with abdominal fat being intermediate in concentration. In PUFA supplemented does, kit mortality at the second parturition tended to be less than in control does. Also, kits born to does of the PUFA-supplemented group weighed more and were of greater length than from does of control group. In conclusion, effectiveness of dietary intervention on reproductive and performance response is greater in the second parity, which suggests an accumulative long-term beneficial effect of n-3 FA supplementation in reproductive rabbit does.

Dietary fatty acid enrichment increases egg size and quality of yellow seahorse Hippocampus kuda.

Seahorses populations in the wild have been declining and to restore them a better knowledge of seahorse reproduction is required. This study examines the effect of dietary quality on seahorse fecundity and egg quality. Two different diets were tested with Hippocampus kuda females: frozen mysis (control) and frozen mysis enriched with a liposome spray containing essential fatty acids. Diets were given to females (two groups of five) over a seven week period. After this period, males (fed the control diet) and females were paired and the eggs dropped by the females were collected. Fatty acid profile were analysed and eggs were counted and measured. Results showed that females fed on enriched mysis had larger eggs and that these had a higher content of total polyunsaturated fatty acids. The size of the egg was especially affected in the first spawn, where egg size for females fed the enriched diet was significantly higher than the egg size from control females. This effect was reduced in the following spawning where no significant differences were found. Egg size is an important quality descriptor as seahorse juveniles originating from smaller eggs and/or eggs of poor quality will have less chances of overcoming adverse conditions in the wild and consequently have lower survival and growth rates. This study shows that enriching frozen mysis with polyunsaturated fatty acids increases egg size and egg quality of H. kuda.

A role for the tyrosine kinase ACK1 in neurotrophin signaling and neuronal extension and branching.

Neurotrophins are involved in many crucial cellular functions, including neurite outgrowth, synapse formation, and plasticity. Although these events have long been known, the molecular determinants underlying neuritogenesis have not been fully characterized. Ack1 (activated Cdc42-associated tyrosine kinase) is a non-receptor tyrosine kinase that is highly expressed in the brain. Here, we demonstrate that Ack1 is a molecular constituent of neurotrophin signaling cascades in neurons and PC12 cells. We report that Ack1 interacts with Trk receptors and becomes tyrosine phosphorylated and its kinase activity is increased in response to neurotrophins. Moreover, our data indicate that Ack1 acts upstream of the Akt and MAPK pathways. We show that Ack1 overexpression induces neuritic outgrowth and promotes branching in neurotrophin-treated neuronal cells, whereas the expression of Ack1 dominant negatives or short-hairpin RNAs counteract neurotrophin-stimulated differentiation. Our results identify Ack1 as a novel regulator of neurotrophin-mediated events in primary neurons and in PC12 cells.

Función de los músculos respiratorios en las enfermedadesneuromusculares / The function of respiratory muscles in neuromuscular diseases

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[Metabolic activity of the external intercostal muscle of patients with COPD]. / Actividad metabólica del músculo intercostal externo en pacientes con EPOC.

INTRODUCTION: The external intercostal muscle is a relevant contributor to ventilatory work in situations of overloading. Like other respiratory muscles, the external intercostal muscle seems to undergo a process of structural remodeling to adapt to a situation of functional disadvantage. However, findings from published studies of morphology have differed to a certain degree. On the one hand, the proportion of fibers involved in anaerobic metabolism increases; on the other hand, the number of capillaries also increases, an occurrence that would facilitate aerobic metabolism. OBJECTIVE: This study was designed to analyze the activity of several key enzymes involved in the principal metabolic pathways in the external intercostal muscles of patients with COPD. METHODOLOGY: We studied 6 patients with COPD (65 +/- 8 years, BMI 23 +/- 3 kg/m2, FEV1 51 +/- 9% ref, RV 184 +/- 38% ref, PaO2 81 +/- 10 mmHg) and 6 control subjects matched for age and anthropometric variables but with normal lung function. External intercostal muscle samples were taken from each patient (fifth intercostal space, non-dominant side). The samples were treated by conventional spectrophotometry to determine enzyme activity as follows: citrate synthase (CS, Krebs cycle), phosphofructokinase (PFK, by common glycolysis), lactate dehydrogenase (LDH, anaerobic glycolysis) and creatine phosphokinase (CPK, use of energy reserves). RESULTS: Patients with COPD showed greater PFK enzyme activity (93 +/- 25 versus 44 +/- 9 micromol/min/g of fresh weight; p = 0.001) and LDH (308 +/- 42 versus 231 +/- 29 micromol/min/g; p < 0.01) than did control subjects. However, CS and CPK activity was similar in both groups (82 +/- 31 versus 90 +/- 20 micromol/min/g and 4017 +/- 1734 versus 3048 +/- 464 micromol/min/g, respectively), although the latter displayed noteworthy dispersion of values among COPD patients, with levels in some patients being three-fold greater than in controls. RV was directly related to glycolytic enzyme activity (with PFK, r = 0.716, p < 0.01; with LDH r = 0.697, p < 0.05) and PFK and LDH also correlated with each other (r = 0.737, p < 0.01). CONCLUSIONS: Based on the enzyme activity studied, oxidative activity seems to be conserved in the external intercostal muscle of patients with COPD. Activity in the glycolytic pathway seems to increase and the increase is proportional to the severity of COPD. These findings are probably the expression of a combination of adaptive structural factors.

Actividad metabólica del músculo intercostal externo en pacientes con EPOC / Metabolic activity of the external intercostal muscle of patients with COPD

INTRODUCCIÓN: El músculo intercostal externo (IE) contribuye de forma relevante al esfuerzo ventilatorio en situaciones de sobrecarga. Como otros músculos respiratorios, el IE parece participar en un proceso de remodelación estructural, para adaptarse a una situación funcional desventajosa. Sin embargo, los estudios morfológicos publicados ofrecen resultados hasta cierto punto divergentes. Por un lado, aumenta la proporción de fibras de metabolismo anaerobio, mientras que por otro se incrementa el número de capilares, lo que facilitaría el uso de un metabolismo de tipo aerobio.OBJETIVO: Este estudio se diseñó para analizar la actividad de diferentes enzimas clave, correspondientes a las principales vías metabólicas, en el IE de pacientes con enfermedad pulmonar obstructiva crónica (EPOC).METODOLOGÍA: Se estudiaron 6 pacientes con EPOC (65 ñ 8 años; índice de masa corporal [IMC]: 23 ñ 3 kg/m2; FEV1: 51 ñ 9 por ciento ref., volumen residual [RV: 184 ñ 38 por ciento ref.; PaO2: 81 ñ 100 mmHg) y 6 sujetos control, apareados por edad y características antropométricas, pero con función pulmonar normal. En todos ellos se procedió a la toma de muestras del IE (quinto espacio intercostal, lado no dominante), que fueron procesadas para la determinación de las siguientes actividades enzimáticas por espectrofotometría convencional: citratosintetasa (CS, ciclo de Krebs), fosfofructocinasa (PFK, vía glucolítica común), lactodeshidrogenasa (LDH, glucólisis anaerobia) y creatinfosfocinasa (CPK, uso de reservas energéticas).RESULTADOS: Los pacientes con EPOC presentaron mayor actividad de las enzimas PFK (93 ñ 25 frente a 44 ñ 9 µmol/min/g de peso en fresco; p = 0,001) y LDH (308 ñ 42 ante 231 ñ 29 µmol/min/g; p < 0,01) que los sujetos control. Por el contrario, las actividades de CS y CPK fueron similares (82 ñ 31 frente a 90 ñ 20 µmol/min/g, y 4.017 ñ 1.734 ante 3.048 ñ 464 µmol/min/g, respectivamente), aunque la segunda presentaba una dispersión muy notable de valores en los pacientes con EPOC, que en algunos casos triplicaban a los de los controles. El RV se correlacionó directamente con la actividad de las enzimas glucolíticas (con PFK, r = 0,716, p < 0,01; con LDH, r = 0,697, p < 0,05), que también se correlacionaban entre sí (r = 0,737, p < 0,01).CONCLUSIONES: A tenor de las actividades enzimáticas estudiadas, la actividad oxidativa parece conservada en el IE de sujetos con EPOC. Por su parte, la actividad de la vía glicolítica parece hallarse aumentada, y este aumento es proporcional a la gravedad de la EPOC. Estos resultados son probablemente la expresión del efecto combinado de diversos factores estructurales de carácter adaptativo. (AU)

Polyamine metabolism and osmotic stress. I. Relation to protoplast viability.

Cereal leaves subjected to the osmotica routinely used for protoplast isolation show a rapid increase in arginine decarboxylase activity, a massive accumulation of putrescine, and slow conversion of putrescine to the higher polyamines, spermidine and spermine (HE Flores, AW Galston 1984 Plant Physiol 75: 102). Mesophyll protoplasts from these leaves, which have a high putrescine:polyamine ratio, do not undergo sustained division. By contrast, in Nicotiana, Capsicum, Datura, Trigonella, and Vigna, dicot genera that readily regenerate plants from mesophyll protoplasts, the response of leaves to osmotic stress is opposite to that in cereals. Putrescine titer as well as arginine and ornithine decarboxylase activities decline in these osmotically stressed dicot leaves, while spermidine and spermine titers increase. Thus, the putrescine:polyamine ratio in Vigna protoplasts, which divide readily, is 4-fold lower than in oat protoplasts, which divide poorly. We suggest that this differing response of polyamine metabolism to osmotic stress may account in part for the failure of cereal mesophyll protoplasts to develop readily in vitro.