Treatment of Proximal Ulnar Stump after Darrach or Sauvé-Kapandji Procedure by Transfer of Insertion-Released Pronator Quadratus Pedicle.

Background: Treatment of the proximal ulnar stump with the Darrach or Sauvé-Kapandji (SK) procedure remains controversial. Ulnar wrist symptoms can result, and although many surgeons attribute these to ulnar stump instability, they can also be caused by radioulnar convergence or stump irritation. We present a novel surgical method for protecting the proximal ulnar stump and avoiding these complications. Methods: Our cases were five men and five women (mean age 72.0 years, range, 34-89). Mean follow-up duration was 41.7 months (range, 6-101 months). Radiological findings were osteoarthritis in five, rheumatoid arthritis of distal radioulnar joint in three, and ulnocarpal abutment syndrome in two. Pronator quadratus (PQ) was released from its insertion on the radius and transferred dorsally to cover the proximal ulnar stump. Postoperative ulnar wrist symptoms such as ulnar stump tenderness, forearm range of motion, and grip strength were compared with contralateral values. Dynamic radioulnar impingement was evaluated by Lee and Scheker's stress roentgenogram. Nine patients completed the Patient Rated Wrist Evaluation (PRWE) at final follow-up. Results: No patients reported ulnar wrist pain or tenderness at the proximal ulnar stump. Postoperative forearm range of motion recovered almost to contralateral values in cases without preoperative forearm contracture. In the two cases with contracture, postoperative pronation and supination recovered to more than their preoperative range. Grip strength averaged 86.4% (range, 66.7-103%) of the contralateral value at final follow-up. Lees and Scheker's stress roentgenogram revealed marked radioulnar impingement in one case, mild impingement in four cases and none in five, yet no patient complained of pain during the maneuver. The mean PRWE score was 34.7 points (range, 0-52.5 points). Conclusions: Insertion-released PQ pedicle transfer is an effective treatment option for the proximal ulnar stump after the Darrach or SK procedure.

An anatomic study of the structure and innervation of the pronator quadratus muscle.

The pronator quadratus muscle is composed of the superficial and deep heads. However, to date there is no consensus on the variations of each head. To add to this enigma, the innervation patterns of each head have not been thoroughly studied. The present study was conducted to clarify the structure and innervation of the pronator quadratus muscle by minute dissection of 46 forearms from 26 cadavers. The origin, insertion, shape, and direction of the muscle fascicles in each head were observed. The intramuscular distribution and the innervation patterns to each head were investigated. The attachment of the deep head was examined using Masson's trichrome staining technique. Each head consisted of various muscle fascicles which differed in shape and direction. The most distal muscle fascicle extended toward the head of the ulna. On microscopic study, this most distal fascicle was observed to reach the base of the ulnar styloid process. The nerves innervating the superficial head penetrated through the deep head and ran on the anterior surface of the radius from medial to lateral. This tendency was common to all of the forearms studied. We confirmed that each head of the pronator quadratus muscle consisted of various muscle fascicles. The attachment to the base of the ulnar styloid process is considered to be an important structure that prevents the head of the ulna from impacting against the carpal bones. Knowledge of the innervation pattern to each head is critical for preserving the function of the pronator quadratus muscle during surgery for distal radial fracture.

Bacterial effector modulation of host E3 ligase activity suppresses PAMP-triggered immunity in rice.

Pathogen effector proteins are delivered to host cells to suppress plant immunity. However, the mechanisms by which effector proteins function are largely unknown. Here we show that expression of XopP(Xoo), an effector of rice pathogen Xanthomonas oryzae pv. oryzae, in rice strongly suppresses peptidoglycan (PGN)- and chitin-triggered immunity and resistance to X. oryzae. XopP(Xoo) targets OsPUB44, a rice ubiquitin E3 ligase with a unique U-box domain. We find that XopP(Xoo) directly interacts with the OsPUB44 U-box domain and inhibits ligase activity. Two amino-acid residues specific for the OsPUB44 U-box domain are identified, which are responsible for the interaction with XopP(Xoo). Silencing of OsPUB44 suppresses PGN- and chitin-triggered immunity and X. oryzae resistance, indicating that OsPUB44 positively regulates immune responses. Thus, it is likely that XopP(Xoo) suppresses immune responses by directly interacting with and inhibiting a positive regulator of plant immunity.

Draft Genome Sequences of Cyclodextrin-Producing Alkaliphilic Bacillus Strains JCM 19045, JCM 19046, and JCM 19047.

Bacillus strains JCM 19045, JCM 19046, and JCM 19047 are alkaliphiles that produce ß-cyclodextrin from starch. They are related to Bacillus xiaoxiensis and Bacillus lehensis. The genome information for these three strains will be useful for studies of the physiological role of cyclodextrin and cyclodextrin production.

Simultaneous fractures of distal and proximal phalanges of the thumb, trapezium and carpal scaphoid of the ipsilateral hand: a case of very unusual combination of fractures.

Simultaneous multiple injuries of the thumb ray are rare. An unusual case of a simultaneous fracture of proximal and distal phalanges, trapezium and scaphoid is reported. The patient had an acceptable result six months after injury. This type of injury of the thumb ray may be a specific form of injury pattern caused by the mobile phone.