Shank vessel injuries: the forgotten vascular injuries.

INTRODUCTION: Vascular injuries in branch vessels of the popliteal artery, such as the tibioperoneal trunk, and shank vessels, such as anterior, posterior tibial, and peroneal vessels, occur in both blunt and penetrating trauma. Their management has evolved significantly in the past few decades. While their incidence is variable, limb loss and morbidity remain significant. MATERIAL AND METHODS: Physical examination, along with measuring an Ankle-Brachial Index (ABI), is still sometimes all that is required for diagnosis and can expeditiously triage those that require urgent operation. Despite our technological advancements and newer algorithms for lower extremity vascular trauma, operative intervention and exposure still remain difficult and pose a great challenge for surgeons that normally do not operate on this area. CONCLUSIONS: Shank vessel injuries still comprise a significant proportion of combat and civilian vascular injuries, and modern advances have led to a dramatic decrease in amputation rates.

WEE1-like CDK tyrosine kinase mRNA level is regulated temporally and spatially in sea urchin embryos.

A cDNA from the sea urchin Strongylocentrotus purpuratus encodes a 624 amino acid polypeptide (WEE1S.purp) with a high degree of similarity to the Mik1 and Wee1 protein tyrosine kinases. These kinases act as negative regulators of mitosis by inactivating cyclin-dependent kinases (CDK). Wee1 activity varies during the cell-cycle, and is generated only when required. The pattern of WEE1S.purp mRNA expression was examined temporally and spatially in sea urchin embryos. Only a trace amount of WEE1S.purp mRNA is present in the egg and through the fifth cell cycle post-fertilization. During the next three cycles to the mid-blastula stage, its concentration rises transiently to 2.5 x 10(4) transcripts per embryo. Its developmental profile during this early period is the inverse of that reported for cyclin mRNAs, which are at a high level in the egg and through the fifth cell cycle, then decline upon further development. WEE1S.purp mRNA in the gastrula and pluteus stages becomes restricted to cells engaged in DNA replication, including the endoderm (gut), oral ectoderm, and arm rudiments. It is absent from the aboral ectoderm, which lacks cycling cells. In the pluteus larva of the species Lytechinus pictus, WEE1 mRNA was detected in the arm rudiments during cellular proliferation and arm elongation, but not after the completion of the arms. Putative regulatory motifs in the sea urchin Wee1-like cDNA suggest a capacity for rapid turnover of both its mRNA and protein: The WEE1S.purp mRNA 3' UTR contains 13 AUUUA pentamers, which have been characterized as determinants of mRNA lability; and the N-terminal domain of the predicted WEE1S.purp polypeptide is enriched in S/TP-containing, potential kinase-target sites, as well as high-value "PEST' sequences, associated with protein lability. The developmental appearance of WEE1S.purp mRNA may coincide with the introduction of a gap phase in the cell cycle. Its spatial pattern during embryogenesis appears to reflect distinct programs of regulated cell cycling in differentiating tissues.

Spatial regulation of SpMTA metallothionein gene expression in sea urchin embryos by a regulatory cassette in intron 1.

The SpMTA metallothionein (MT) gene of the sea urchin Strongylocentrotus purpuratus is restricted in its expression to the aboral ectoderm in gastrulae and pluteus larvae. The proximal 1.6 kb of the 5'-flanking region together with the 1.12-kb first intron of the SpMTA gene are sufficient for its correct cell-type specific expression in transgenic embryos. This restricted spatial expression is largely eliminated by deletion of an interior 405-bp region in the intron. Within this region is a 295-bp, genomically repetitive, transposon-like segment (Nemer et al., 1993), containing several sequence motifs highly homologous to posited regulatory elements in the promoters of other genes (Thiebaud et al., 1990). The P3A and P5 sites in this apparent regulatory cassette were shown through competition to bind with relatively high affinities the same nuclear factors, bound by their counterpart sites in the CyIIIa actin promoter.

Highly identical cassettes of gene regulatory elements, genomically repetitive and present in RNA.

A region in the first intron of a metallothionein-encoding gene of the sea urchin Strongylocentrotus purpuratus (SpMTA gene) regulates its 5' promoter activity. Within this region is a 290-bp cassette of six sequence motifs that are present in other genes in this species and posited to operate as regulatory elements. The cassette, present at high multiplicity in the genome, was used to screen genomic DNA clones. Of these, six diverse individuals were partially sequenced and found to have segments 94% identical to the 290-bp cassette in the SpMTA gene. Their next 80 bp diverged from the SpMTA sequence but were highly identical among the six non-SpMTA clones and contained an additional regulatory motif. These diverse clones thus contained 370-bp cassettes of an overall 94% sequence identity and an apparent content of seven regulatory elements. The regulatory cassettes were transposon-like, insofar as the termini of the highly identical regions consisted of 24- to 25-bp inverted repeats, bracketed by 6- to 9-bp direct repeats in the divergent regions. In addition to being in transcripts of the SpMTA intron, the cassette was found in other sea urchin embryo poly(A)+ RNAs, in eggs and embryos, and enriched in pluteus ectoderm. The cassette sequence was present in moderate abundance in transcripts in both sense and antisense orientation. We report the presence of a transposon-like cassette of regulatory elements that is also represented in RNA, which potentially could function differently from previously described transposons.

Combinatorial regulation by promoter and intron 1 regions of the metallothionein SpMTA gene in the sea urchin embryo.

The SpMTA metallothionein gene of the sea urchin Strongylocentrotus purpuratus is regulated developmentally, histospecifically, and by heavy-metal induction. The sequenced 5' flank of the gene can be divided into proximal, middle, and distal regions, each containing a pair of metal response elements (MREs). Canonical 7-bp core sequences are present in all except the middle-region MREs c and d, which contain 1-bp mismatches. Metal-induced expression in transgenic blastulae was increased with each consecutive addition of the middle and distal regions to a chimeric reporter gene construct containing the proximal SpMTA promoter region. Reduced metal induction through point mutation of the distal MREs e and f indicated that the MREs themselves were largely responsible for the transcriptional increase. These activities were further enhanced by SpMTA intron 1, but not when a specific interior region of the intron had been deleted. The atypical MREs c and d did not support induction by themselves, i.e., when present alone with mutated proximal MREs a and b. However, in the presence of intron 1, they were able to substitute for the nullified MREs a and b in the promotion of metal-induced expression. This capability suggests, furthermore, that these atypical MREs, in addition to responding to an intron 1 region, participate cooperatively with the canonical proximal MREs.

Structure, spatial, and temporal expression of two sea urchin metallothionein genes, SpMTB1 and SpMTA.

The metallothionein-B genes of the sea urchin Strongylocentrotus purpuratus encode a metallothionein (MT) isoform distinguishable from the MTA isoform. The MTB subfamily consists of at least two genes, MTB1 and MTB2, and possibly two to three others. The unique MTB1 and MTA genes have a high degree of identity but diverge in structural detail and expression. Transcripts of the MTA, MTB1, troponin C Spec 1, and CyIIIa actin genes begin simultaneously to accumulate at an early blastula stage. MTB1 mRNA becomes localized in the embryonic gut and oral ectoderm, whereas MTA, Spec 1, and CyIIIa actin mRNAs are spatially restricted to the aboral ectoderm. Several DNA elements are localized at the same positions in the MTB1 and MTA genes: these include respective CATA and TATA boxes, two metal response elements, and three distinct upstream DNA elements that are also present, and in the same order, in the Spec 1 gene promoter. A heptameric sequence, element A, is present at two sites each in the Spec 1 and CyIIIa actin genes, five sites in MTA, but only one site in MTB1. Most strikingly, the first intron of MTA contains elements not found in the MTB1 introns, including a consensus metal response element, an element A, and the P3A site demonstrated in the CyIIIa actin gene to be linked to the regulation of spatial expression.