ACL anatomy: Is there still something to learn? / [Artículo traducido] Anatomía del LAC: ¿queda algo por aprender?

BACKGROUND: The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE: The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS: The ACL consists of typeI (90%) and typeIII (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS: There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.

ACL anatomy: Is there still something to learn?

BACKGROUND: The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE: The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS: The ACL consists of type I (90%) and type III (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS: There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.

Chronic Achilles tendon rupture associated with rupture of the peroneus brevis tendon. A clinical case. / Rotura crónica del tendón de Aquiles asociada a rotura del tendón peroneus brevis. Caso clínico.

The treatment of a chronic rupture of the Achilles tendon remains difficult. Different techniques such as augmentation or plasties are used for restoring the gap in these ruptures. The combination of Achilles tendon rupture with other tendon ruptures may increase the difficulty in their treatment. We present a rare combination of a delayed Achilles tendon rupture and a peroneus brevis tendon rupture and its management. The importance of the presented case is the combination of both ruptures that adds difficulty to the surgical technique. A thorough analysis should be made of the magnetic resonance findings when planning a tendon transposition. To our knowledge, there are no reports of a simultaneous combination of an Achilles tendon rupture and a peroneus brevis tendon rupture.

Factores de mal pronóstico en la reparación del manguito rotador / Prediction data of poor outcome in shoulder surgery: rotator cuff injury

La patología y la cirugía del manguito rotador han experimentado en los últimos años un gran avance gracias a la artroscopia y a las técnicas de diagnóstico por la imagen que han colaborado así mismo en dicho avance. Sin embargo, no debemos olvidar que la anamnesis y la exploración física siguen siendo fundamentales. El objetivo de nuestro trabajo de revisión es detectar aquellos factores que pueden influir negativamente en la evolución del proceso desde la primera visita al paciente. También es valorada la información que aportan las pruebas complementarias para efectuar un planteamiento terapéutico y/o quirúrgico si procede

Objective: Looking for factors that can have negative influence in the evolution and treatment of the rotator cuff injuries of the shoulder. Material and method: We have done a review of different journal articles following the next parameters. Systemize clinical exploration, requested complementary explorations and a therapeutic planning. Results: The clinical exploration can detect data that indicates a bad evolution as restricted passive and active movement of the shoulder and a lost of strength of the external rotation of the limb. An early diagnose and treatment improve the results in the isolated ruptures of the rotator cuff. Associated instability with partial lessions of the rotator cuff on the joint side must be consider mainly in the young people. In the partial ruptures of the rotator cuff the subacromial decompression is not enough in the long term results. The rerupture of the rotator cuff is the most common complication of the rotator cuff repair

Isolation, identification and expression of a Fasciola hepatica cDNA encoding a 2.9-kDa recombinant protein for the diagnosis of ovine fasciolosis.

A 400-bp Fasciola hepatica cDNA clone was isolated from an expression library by immunological screening using rat sera taken 2 weeks after experimental infection. The nucleotide sequence of the cDNA revealed the presence of an open reading frame of 78 bp which encoded a 25 amino acid polypeptide with a predicted molecular weight of 2.9 kDa. This polypeptide was expressed in bacteria as a GST-fusion protein and used for the production of specific antigen. The 2.9 kDa recombinant protein (APS) was evaluated against sera from experimentally infected sheep using an indirect ELISA, and the results were compared to those obtained using F. hepatica excretory/secretory products (ESP). The pattern of IgG was very similar both against the recombinant and the native proteins, increasing early following the infection. After treatment with triclabendazole, the IgG response against the APS seroreverted to negative values, whereas it remained elevated against the ESP. We conclude that this recombinant protein could be used in diagnostic assays for the identification of recently infected sheep.

Clinical challenges and controversies in the management of HIV/HCV-coinfected individuals

The natural history of HIV infection has been dramatically changed by the highly active antiretroviral therapies, reducing complications, morbidity and mortality of the disease. Approximately 25% of persons infected with HIV are co-infected with hepatitis C, and some high risk populations have a prevalence of HCV of more than 75%. Liver disease has become one of the principal causes of morbidity and mortality in this population. Co-infection increases viremia of hepatitis C, with increase in fibrosis progression, cirrhosis and death related to hepatitis C. The permanent state of chronic immune activation related to the persistent hepatitis C virus favors transcription of HIV in infected cells and causes a more rapid destruction of T4 and absolute lymphocytes. In addition, the immunologic response after the start of highly active antiretroviral therapy for HIV is less than in mono-infected patients. The role of liver biopsy in the management of co-infected patients is controversial. Many of these patients, even with normal transaminases, show fibrosis in liver biopsy. Predictive factors for advanced fibrosis include male sex, alcohol consumption in excess of 50 grams per day, age over 35, and HIV infection of more than 15 years with CD4 lymphocytes less than 400/ mm3. The treatment of hepatitis C is limited and sustained viral response is less than 30% for genotypes 1 and 4. This response is even less in the more advanced stages of HIV and hepatitis C. The determination of when to start treatment and the increased toxicity when combining pegylated interferon plus ribavirin and antiretroviral medications makes the management of these patients more difficult. The development of more potent, safe and tolerated medications is required. Management strategies for patients unresponsive to conventional therapy are geared towards improving liver histology and delaying progression to cirrhosis, hepatocellular cancer and liver transplantation.

Isolation and immunological characterization of fatty acid binding protein isoforms from Fasciola hepatica.

A combination of molecular sieving chromatography and 2-step preparative isoelectric focusing showed that native Fh12, a fatty acid-binding protein isolated from Fasciola hepatica adult worms, is a protein complex of at least 8 isoforms with identical molecular mass but different isoelectric points. Using enzyme-linked immunosorbent assay (ELISA) and inhibition ELISA assays, immunological differences were observed between native (nFh12) and a recombinant molecule denoted rFh15 that was obtained after screening a cDNA library from F. hepatica adult worms with an anti-Fh12 monospecific polyclonal antibody. It was confirmed that in infected rabbits, antibodies to nFh12 appear by the second week postinfection, whereas antibodies to rFh15 appear much later, by 6 wk postinfection. Four acidic forms (Fh12(1-4)) showed more immunological identity with rFh15 than with nFh12, based on the observation that they inhibited ELISA activity by nearly 50% when they were added to the anti-rFh15 polyclonal antibody at 20 microg/ml of protein concentration. Moreover, the Fh12(1-4) isoforms were poorly reactive with sera from rabbits 2-4 wk postinfection. However, the 2 acidic forms, denoted Fh12(5) and Fh12(6), and the neutral/basic forms, denoted Fh12(7) and Fh12(8), showed more immunological identity with the native nFh12 molecule than with the recombinant rFh15 because they were highly reactive with sera of rabbits with early 2-wk F. hepatica infection and inhibited ELISA activity nearly 50% when they were quantitatively added to the anti-nFh12 polyclonal antibody. These results suggest that rFh15 could be one of the acidic forms of nFh12, and that it, in fact, may be one of the less immunogenic or immunoprotective members, or both, of the nFh12 protein complex.

Periodontitis de comienzo temprano / Early onset periodontitis

Las periodontitis de comienzo precoz han sido consideradas como un grupo de patologías de escaso interés clínico, debido a su baja prevalencia y a la dificultad de un correcto diagnóstico y tratamiento. Existen aspectos diferenciales con respecto al resto de periodontopatías, como son su agresividad, la tendencia familiar y un diagnóstico precoz relativamente sencillo

Periodontitis de comienzo temprano / Early onset periodontitis

Las periodontitis de comienzo precoz han sido consideradas como un grupo de patologías de escaso interés clínico, debido a su baja prevalencia y a la dificultad de un correcto diagnóstico y tratamiento. Existen aspectos diferenciales con respecto al resto de periodontopatías, como son su agresividad, la tendencia familiar y un diagnóstico precoz relativamente sencillo (AU)

Increased chitin synthesis in response to type II myosin deficiency in Saccharomyces cerevisiae.

We reported previously that the chitin content in cell walls of type II myosin-deficient Saccharomyces cerevisiae strains is increased relative to wild-type cells suggesting that increased chitin synthesis is induced in these strains. In the present study, we have performed enzyme activity assays for chitin synthases 1, 2, and 3 to determine the enzyme isoform(s) involved. To determine if transcriptional regulation is involved, we conducted quantitative mRNA assays of the corresponding chitin synthase genes. We show that the enzyme activities of all three chitin synthases increase substantially over the wild-type strain while eight- and twofold increases in the mRNA levels for chitin synthases 1 and 3 were detected. Increases in enzyme activities and mRNA levels were not proportional. We conclude that the enzyme activities for all three chitin synthases are elevated in this strain and that this increase is mediated mainly by a posttranslational mechanism(s). The heightened sensitivity to osmotic stress and the corresponding increase in cell wall chitin content reported in these strains are consistent with a compensatory "stress response" mechanism induced by abnormal cell wall assembly.

Molecular analysis of the Saccharomyces cerevisiae YHR076w gene.

Our results demonstrate that open reading frame (ORF) YHR076w on chromosome VIII of Saccharomyces cerevisiae that was previously described as a hypothetical gene is expressed. This ORF is transcribed as an mRNA of approximately 1,100 nucleotides. A 41.2-kDa polypeptide and three others predicted to be modified forms of Yhr076wp are detected by Western blot with a Yhr076wp-specific antibody. Promoter activity assays indicate that YHR076w transcription is regulated by carbon source and primarily by ethanol. Consistent with this observation, we have identified two potential ADR1 regulatory elements in the YHR076w upstream DNA region. Potential YAP1 and HSP elements are also identified in this region, suggesting other forms of regulation. YHR076w knockout strains do not exhibit any measurable growth or morphological phenotype under any conditions tested. However, increased YHR076w gene dosage confers a growth advantage to both wild-type and YHR076w knockout strains on 2% ethanol or 2% galactose medium in a low O2 growth environment. The fluorescence emitted by a Yhr076wp protein fusion to A. aquorin GFP colocalizes with the mitochondria in vivo.

N-borane-N-(trimethylsilyl)morpholine.

The title compound, C7H20BNOSi, features an N,N-disubstituted six-membered morpholine ring in a chair conformation, with the trimethylsilyl group in the equatorial position and the borane group in the axial position. The least-squares plane formed by the four C atoms of the morpholine ring has a mean deviation of 0.013 (2) A. The O and N atoms are 0.672 (2) and 0.650 (2) A above and below the plane, respectively.

Elevated expression of chitinase 1 and chitin synthesis in myosin II-deficient Saccharomyces cerevisiae.

To determine if the attached cells formed in Myosin II-deficient Saccharomyces cerevisiae result from deficient chitinase 1 (CTS1) expression, the activity of chitinase 1 was assayed. Secretion of this enzyme was not prevented by a MYO1 gene deficiency, and soluble and cell wall-associated Cts1p activity were increased approximately 5-fold and 20-fold, respectively, in these cells. The increase in soluble activity was correlated with an increase in enzyme levels. Likewise, intracellular chitinase activity was increased approximately 22-fold, and the chitin content of cell walls was elevated 2-fold. These data suggest that the origin of myo1-associated phenotypes is not due to deficient chitinase expression and may instead be due to a deregulation of cell wall metabolism in these cells.

Flow cytometry analysis of cell cycle in myosin II-deficient yeast.

OBJECTIVE: To determine whether cell cycle changes can be detected in myosin II-deficient cells using flow cytometry techniques. BACKGROUND: Although the primary role of myosin II (Myo1p) in the yeast Saccharomyces cerevisiae is in cytokinesis we have reported that this conventional myosin also appears to influence the regulation of cell wall metabolism as indicated by increases in the expression of chitin metabolizing enzymes in a null mutant of the MYO1 gene. The expression of these enzymes is known to be regulated in the cell cycle suggesting that cell cycle changes may alter their expression. METHODS: Flow cytometry was employed to assess the nuclear DNA content of logarithmic yeast cell cultures as a means of determining changes in the cell cycle of Myo1p-deficient cells. RESULTS: Significant changes were observed in the Myo1p-deficient strain suggesting that these cells are arrested in G2/M-phase of the cell cycle. CONCLUSIONS: Based on the results of this preliminary study, we propose a model in which the increased activity of chitin metabolizing enzymes may be explained by a mitotic arrest in these cells.

Sustained response to interferon in a patient with common variable immunodeficiency and hepatitis C.

Hepatitis C infection progresses faster in patients with hypogammaglobulinemia, often leading to death from liver failure within 10 yr of exposure. Response to interferon treatment has been poor in these patients. We report the case of a patient with common variable immunodeficiency and hepatitis C in whom a sustained biochemical and viral remission was obtained after treatment with interferon.

Idiopathic scoliosis instrumentation using the Lea Plaza sublaminar frame. A preliminary report.

We reviewed 28 patients with idiopathic scoliosis operated on using the segmental sublaminar instrumentation devised by Lea Plaza. The results at 2 years show that the spine is rebalanced and normal alignment in the sagittal plane is obtained. The biplanar correction of double curves averaged 64% with a loss of 10% at 2 years. The upper and lower limits of the fusion area must be determined accurately in relation to the pattern of the curve. Combined anterior and posterior arthrodesis is advised in flexible or rigid curves of more than 60 degrees in skeletally immature or mature patients respectively. In double curves over-correction of the primary curve behind its flexibility index, and inclusion of the mobile transitional segments in the fusion area produce decompensation in the frontal plane. One case of total loosening of the frame occurred, but there was no protrusion of the frame, no fractures of the laminae, no sepsis, no pseudarthrosis and no permanent neural damage.

In vivo phosphorylation of type II myosin in Saccharomyces cerevisiae.

Phosphorylation of the myosin heavy chain has been shown to be a key regulatory mechanism of several non-muscle myosins. In this study we present evidence demonstrating that the yeast type II myosin heavy chain is phosphorylated in vivo. Phosphorylation of serine residues was confirmed by direct metabolic labeling with [32P] and by indirect immunostaining of phosphoserine with a specific monoclonal antibody. Loss of immunoreactivity in a targeted deletion of the 26 amino acid carboxyl terminal segment of the type II myosin heavy chain suggests that the phosphorylation occurs at one or more serine residues located between residues 1903 and 1928.