Treatment of soft tissue problems about the elbow.

The treatment of soft tissue problems about the elbow should be directed toward early coverage and functional rehabilitation. The current study reviews some of the available treatment options, with emphasis on the treatment of large soft tissue defects. The role of prophylactic soft tissue coverage also is discussed. For large defects not extending more than 8 cm below the elbow and for prophylactic soft tissue coverage, the authors recommend the pedicled latissimus flap, which provides reliable coverage and a generous blood supply that promotes healing at the site of injury.

The management of bone defects of the forearm after trauma.

In summary, the authors believe that traumatic bone defects of the diaphyseal forearm, fewer than 6 cm in length, can be well managed with corticocancellous bone grafting, provided the patient has an adequate soft-tissue envelope. In cases of soft-tissue compromise, primary bone grafting is still the treatment of choice, combined with simultaneous soft-tissue coverage. This does not exclude the use of immediate primary shortening. Traumatic bone defects larger than 6 cm can best be managed with osteoseptocutaneous free fibular graft with excellent functional and cosmetic results. The creation of a one-bone forearm is rarely necessary, but remains a treatment option for an otherwise unsalvageable extremity. Osteo-articular defects can be more difficult to manage. Proximal osteo-articular defects of the radial head can be treated with excision or placement of a titanium radial head prosthesis. Distal osteo-articular defects may be better addressed in the case of radial bone loss by primary wrist fusion and, in the ulna, by a primary Darrach or Suave-Kapandji procedure.

Latissimus dorsi pedicle flap for coverage of soft tissue defects about the elbow.

Sixteen consecutive patients who were treated with a pedicled latissimus dorsi flap for complex soft tissue defects about the elbow were reviewed. The average defect size was 100 cm2. Thirteen of the 16 patients achieved stable wound healing with a single procedure. Three patients had partial necrosis of the latissimus and required additional coverage procedures. We recommend that the latissimus dorsi flap should not be routinely used to cover defects more than 8 cm distal to the olecranon. The flap should be closely monitored in the first 48 hours, drains should be routinely used at the recipient and donor sites, and the elbow should be maintained in an extended position for the first 5 days after the procedure. The latissimus dorsi flap may also have a prophylactic role in selected patients with compromised soft tissue coverage about the elbow. The pedicled latissimus flap can be performed under loupe magnification and requires no microsurgical skills or equipment.

Fructose 1,6-bisphosphate aldolase activity in leaves of a rice mutant selected for enhanced lysine.

Unknown proteins isolated from mutant tissues of rice (Oryza sativa L.) recovered from inhibitor selections were subsequently peptide microsequenced. Database searches putatively identified one peptide as fructose 1,6-bisphosphate aldolase (EC 4.1.2.13). Tissues of mutant rice, PI564784, and wild type (cv Calrose 76) tissues were evaluated for aldolase activity. Total enzyme activities were slightly lower in the mutant than the control but the differences were not significant. Although the mutant phenotype is for enhanced lysine and protein, we ascribe the small aldolase differences to physiological adjustments, rather than to DNA modifications of the aldolase gene(s). Homologies of rice peptides with aldolases from a range of species, as well as rice cell culture expressed sequence tags (ESTs) are presented. Some amino acids sequences are highly conserved. The mutant phenotype expressing stress proteins is not likely to be defined by a change in rice aldolases.

Export of ß-1,3-glucanase from mutant rice cells rechallenged and stressed with lysine plus threonine.

Mutant rice cells (Oryza sativa L.) grown in liquid suspension cultures exported greater quantities of protein and ß-glucanases than controls. These mutants were isolated from anther calli resistant to 1 mM lysine plus threonine (LT), regenerated and reestablished as cell suspension cultures from seeds. Cellular protein levels are genetically conditioned, and the levels of extracellular proteins and enzyme activities are inversely related to that of the cellular portions. The rechallenge of cells with 1 mM LT inhibited the expression of both ß-1,3-glucanases and ß-1,4-glucosidases but had no significant effect upon the levels of chitinase activity. Mutant cells were more sensitive than controls to stress caused by exogenous LT. In general, under exogenous LT stress the mutant/control ratio for extracellular glucanases increased as the assay conditions were changed from a basic to an acidic pH. The specific activity of ßglucanases was highest in media and lowest in cells. Both the mutant and control cells exported ß-glucanases into the suspension medium, but the level of activity in media was greater in that in which the mutant was suspended. The export was probably modulated by the internal protein levels which were highest in mutant cells without LT. Seedlings from mutants with enhanced lysine also had enhanced acidic ß-glucanase activity.

Factors influencing the outcome of closed tibial fractures treated with functional bracing.

One thousand consecutive closed diaphyseal tibial fractures, treated with prefabricated functional below-knee braces, were analyzed by statistical methods to determine factors predictive of final fracture outcome. Neither the age of the patient nor the location of the fracture influenced the speed of healing. In 95% of the fractures, the final shortening was < or = 12 mm. The mean final shortening was 4.28 mm, compared with mean initial shortening of 4.25 mm. This confirmed the authors' long-held hypothesis, that, in general, for closed, diaphyseal tibial fractures treated with functional bracing and graduated weightbearing ambulation, the final shortening does not increase beyond the initial one. Final angulatory deformity in any plane was < or = 6 degrees in 90% of patients. The presence of an intact fibula was a relative contraindication for functional fracture bracing because angulatory deformity was more likely to develop. The incidence of nonunion was 1.1%. The high union rate and low morbidity associated with functional bracing of closed tibial fractures suggest that the routine use of more expensive surgical treatments is difficult to justify. A clear understanding of the rationale of functional bracing, its indications and contradictions, and its clinical application protocol are essential for the attainment of satisfactory results.

Healing and remodeling of articular incongruities in a rabbit fracture model.

Healing of 0.5 or 1.0-millimeter step-off defects associated with displaced intra-articular fractures of the medial femoral condyle was examined in fifty-four adult New Zealand White rabbits. The rabbits were treated with either immobilization for three weeks, intermittent active motion, or continuous passive motion for seven days. At twelve weeks, the healing and remodeling of the step-off defects were examined with use of contact-pressure maps on pressure-sensitive film, light microscopy (with hematoxylin and eosin or safranin-O staining), and scanning electron microscopy. Macroscopically, the sharp profile that had been present initially with both sizes of step-off defect had rounded off; however, there was less residual incongruity with the 0.5-millimeter step-offs than with the 1.0-millimeter step-offs. Among step-off defects of the same size, the method of treatment had no discernible effect on the macroscopic appearance of the surface of the joint. With fresh step-offs (the control group), the contact pressure of the cartilage on the elevated side was approximately three times greater than that at a distance from the step-off. On the depressed side, an unloaded zone extended approximately three times the height of the step-off, with an average width of 3.4 millimeters for the 1.0-millimeter step-offs and 1.6 millimeters for the 0.5-millimeter step-offs. After healing and remodeling, the unloaded zone still averaged 2.5 millimeters in width for the 1.0-millimeter step-offs but had decreased to only 0.35 millimeter in width for the 0.5-millimeter step-offs. For seven of the nine 0.5-millimeter step-offs, the contact pressure in the previously unloaded zone ranged from 0.5 to 1.5 megapascals, with a mean of 0.8 megapascal (40 per cent of the normal mean contact pressure at this location). Under light microscopy, the cartilage on the elevated side of the healed step-offs had decreased in thickness, was displaced toward the defect and tapered toward the depressed side, and ended in a hypocellular tissue flap. In contrast, the cartilage on the depressed side had thickened as a result of hyperplasia of the chondrocytes and hypertrophy of the cartilage and had failed to establish continuity between the sides of the defect. There was a marked increase in the subchondral vascular bed and re-establishment of the subchondral plate. With the exception of the aforementioned hypocellular tissue flap, safranin O stained the cartilage on both levels of the step-off uniformly, which indicated the absence of glycosaminoglycan depletion.(ABSTRACT TRUNCATED AT 400 WORDS)

Rice protein mutant expressed in liquid suspension cultures: chitinases, ß-glucanases and other proteins.

A rice mutant with unique protein expression/ transport properties has been established as cells in liquid suspension and partially characterized. Mutants were originally recovered from anther calli grown for three cycles at inhibitory levels of lysine + threonine and one cycle of S-(2-aminoethyl)cysteine. Cell suspension cultures were started from high lysine-containing seeds regenerated from the inhibitor selections. Cultures of the mutant produce 2 times as much protein per unit weight as is produced by the control. Significant portions of the proteins are exported from the cells into the surrounding medium. The mutant also has 20% greater lysine content in the exported protein than the control. This cell suspension line should be particularly useful for biochemical and molecular studies on protein synthesis and processing phenomena in cereals.

Modification of amino acid composition of endosperm proteins from in-vitro-selected high lysine mutants in rice.

Endosperm protein mutants in rice may be recovered by biochemical selections with inhibitory levels of lysine and threonine. Among the phenotypes recovered from in vitro selections are lines with increased protein and percent lysine in the protein. This work was designed to identify changes in proteins of rice mutants and to further our understanding of the mechanisms of lysine plus threonine selections in rice. Among the most obvious amino acid changes in mutants was a higher lysine level in all protein solubility fractions and a decrease in tyrosine. Methionine and glutamate are reduced in some protein fractions. However, methionine is significantly higher in the mutant than the control in the glutelin fraction. Several other aspartate pathway amino acids are higher in the mutant than the unselected controls. Separation of proteins in SDS-PAGE gels showed shifts in the protein profiles in the mutants, including a decrease in the major 30 kDa low lysine globulin component, and an increase in several high-molecular-weight components, approximately 60-100 kDa. Increases in the lysine content of proteins of different solubility classes and different proteins within classes are detailed.

Segregation for endosperm lysine in F2, F 3 and F 4 progeny from a cross of in vitro-selected and unselected cultivar of rice.

Lysine is a limiting amino acid for optimal nutritional quality in rice grain. In vitro selections using inhibitory levels of lysine plus threonine or s-aminoethylcysteine allow the predictable recovery of variants with elevated levels of lysine and protein. These methods may generate useful starting germplasm for plant breeders. This study was conducted to define the genetics of lysine mutants in progeny from crosses of mutants derived from cells cultured in vitro in the presence of inhibitory levels of lysine plus threonine and s-(2-aminoethyl)-cysteine. In vitro selections produce a wide range of mutants, including endosperm mutants with elevated lysine and protein levels as well as mutants for high and low seed weights. Mutants were analyzed for lysine content by the endosperm half-seed method in which the halves without the embryo were ground and acid hydrolyzed for amino acid determinations. The halves with the embryos were preserved for later germination. In two different F2 populations derived from a cross of a selected mutant x M-101, a parental marker, there was an inverse relationship between seed weight and percent lysine in endosperm protein (R(2) 0.52 and 0.56). The F2 segregation patterns show that elevated lysine is inherited as a recessive gene and that increased lysine is correlated with decreased seed size. F3 and F4 data provide evidence for the transmission of high lysine genes to advanced germplasm in rice. This work supports our earlier conclusions that high lysine phenotypes can be recovered predictably from in vitro selections. The elevated lysine phenotypes are frequently, but not exclusively, associated with opaque seed. Some segregants from crosses produced increased lysine in plants with near normal seed weight and good fertility.

Increased Lysine and Seed Storage Protein in Rice Plants Recovered from Calli Selected with Inhibitory Levels of Lysine plus Threonine and S-(2-Aminoethyl)cysteine.

Experiments were designed to test whether variation in percent lysine in seed proteins could be recovered in plants regenerated from callus subjected to inhibitory levels of lysine plus threonine. Anther-derived callus was subjected to 1 millimolar lysine plus threonine for three successive passages and then once to the same concentration of S-(2-aminoethyl)cysteine. Plants were regenerated from the resistant callus. Plants recovered directly from tissue culture were normal in color, size and were 50% or less fertile. Second and third generation plants produced a wide range of variants including albinos, deep green plants both short and tall, and totally fertile as well as partially fertile plants. All regenerated plants produced chalky or opaque seed. One unique second generation line had 14% more lysine in seed storage proteins than the controls. This characteristic was transmitted to the next generation. The high lysine plants had reduced seed size with significantly higher levels of seed storage protein than the controls. The phenotypes recovered provide experimental materials for basic studies in protein synthesis and lysine metabolism and may become a source of material for rice breeding.

Variation for improved protein and yield from rice anther culture.

The anther culture technique is useful for the recovery of haploids which when doubled provide homozygosity. Additionally, beneficial as well as deleterious genetic and epigenetic changes are promoted by the in vitro procedures. The majority of plants recovered from anther calli of the cultivar 'Calrose 76' were similar to the starting cultivar but plants regenerated from microspore calli had a wider range of responses than controls for several characteristics. Plants with larger seeds, higher levels of seed protein, shorter stature and more highly tillered than the starting cultivar were obtained from selfed anther-derived plants. The data also support the concept that in vitro procedures including anther culture of specific cultivars of rice promoted the recovery of phenotypes with increased seed storage proteins.

Mapping of functional neural pathways by autoradiographic survey of local metabolic rate with (14C)deoxyglucose.

An enzymatic preparation from human brain converts tryptamine to tryptoline (9H-1,2,3,4-tetrahydropyrido(3,4-b)indole) in the presence of 5-methyltetrahydrofolic acid. Similarly, N-methyltryptamine and 5-hydroxytryptamine yield 1-methyltryptoline and 5-hydroxytryptoline, respectively. Neither in vitro nor in vivo formation of these compounds by human tissues has been described.