Talocalcaneal coalition in a 15 year old female basketball player.

This case reports an adolescent athlete with activity related chronic bilateral dorsal foot pain and stiffness. A 15 year old competitive female basketball player presented to a chiropractor subsequent to an unsuccessful course of conservative treatment for posterior tibial dysfunction. The patient's plain films were incorrectly read as normal and a CT scan obtained by the radiologist called the findings bilateral osteoarthritis. The patient was awaiting a referral to a rheumatologist at the time of initial consultation with the chiropractor. Examination revealed limited subtalar mobility and review of the images revealed bilateral non-osseous talocalcaneal coalition. The patient was subsequently directed to a pediatric orthopedic surgeon and is scheduled for a resection of the coalition. Primary care practitioners should be aware of this uncommon, but not rare, variable clinical presentation as misdiagnosis and mismanagement could lead to suboptimal patient outcomes. To our knowledge this is the first case report of a patient with tarsal coalition published in chiropractic literature. In addition, this case is the first to report radiographic evidence of chronic mechanical stress to the second metatarsal associated with tarsal coalition.

Steroid hormones acutely regulate expression of a Nudix protein-encoding gene in the endometrial epithelium of sheep.

Steroid hormones regulate endometrial gene expression to meet the needs of developing embryos. Our hypothesis is that steroid hormones transiently induce expression of genes in the endometrial epithelium to make the uterine environment different between the earliest days of pregnancy. We identified one such gene product using differential display-polymerase chain reactions. The gene product that was strongly induced in ewes between day 3 and 6 of the estrous cycle was cloned and sequenced to identify it as encoding a member of the Nudix family of hydrolase enzymes. Northern blot analyses indicated that NUDT16 mRNA concentrations were elevated 10-fold in the endometrium of sheep from day 5 to 9 of the estrous cycle and returned to basal levels by day 11. In assays of RNA samples from 15 different tissues from an adult ewe, the concentrations of NUDT16 mRNA were greatest in endometrium. In situ hybridization localized NUDT16 mRNA exclusively to the endometrial epithelial cells of the glands and uterine lumen. In ovariectomized ewes, NUDT16 mRNA was induced by a regimen of alternating estrogen and progesterone therapy designed to mimic the hormonal experiences of a ewe at day 6 of the estrous cycle. The final estrogen treatment in the regimen was critical to the expression of NUDT16 as well as progesterone receptor and estrogen receptor-beta genes. Characterization of the NUDT16 gene identified putative steroid hormone response elements, which can now be investigated to understand its unique pattern of regulation in the earliest days of pregnancy.