Nonunion of a first rib fracture in a gymnast.

Isolated fracture of the first rib is uncommon, but has been reported to occur in sports such as basketball, baseball, and dancing. It has not been reported to occur in gymnasts. Usually, these fractures heal with an adequate period of rest. Rarely do first rib fractures become nonunions. They have been felt to be asymptomatic and are usually found incidentally on routine chest roentgenograms. Symptomatic nonunion of a first rib fracture has not been reported previously. Our patient did not respond to nonoperative treatment and required surgical intervention to alleviate her symptoms. We agree that most fractures of this type heal without complications. However, if a persistently symptomatic nonunion ensues, we suggest transaxillary resection of 90% or more of the first rib.

Polyphenol oxidase from hybrid poplar. Cloning and expression in response to wounding and herbivory.

The inducible expression of polyphenol oxidase (PPO), a presumed antiherbivore enzyme, was examined in hybrid poplar (Populus trichocarpa x Populus deltoides). Following mechanical wounding simulating insect damage, PPO activity increased dramatically in wounded and unwounded leaves on wounded plants beginning at 24 and 48 h, respectively. A hybrid poplar PPO cDNA was isolated and its nucleotide sequence determined. On northern blots, PPO transcripts were detected within 8 h of wounding, and reached peak levels at 16 and 24 h in wounded and unwounded leaves, respectively. Methyl jasmonate spray and feeding by forest tent caterpillar also induced PPO expression. The induction of PPO was strongest in the youngest four leaves, which were generally avoided by caterpillars in free feeding experiments. This wound- and herbivore-induced expression of PPO in hybrid poplar supports the defensive role of this protein against insect pests.

A Kunitz trypsin inhibitor gene family from trembling aspen (Populus tremuloides Michx.): cloning, functional expression, and induction by wounding and herbivory.

Three Kunitz trypsin inhibitor genes were isolated from trembling aspen (Populus tremuloides) by PCR and cDNA screening. Based on sequence similarity, they were grouped into two classes. Southern blots showed complex banding patterns and a high level of restriction fragment polymorphism between different aspen genotypes, suggesting that these trypsin inhibitors are members of a large, rapidly evolving gene family. One of the trypsin inhibitor genes, PtTI2. was over-expressed in Escherichia coli and its product shown to inhibit bovine trypsin in vitro. Both classes of PtTI genes are induced by wounding and herbivory, permitting rapid adaptive responses to herbivore pressure. The response appears to be mediated by an octadecanoid-based signaling pathway, as methyl jasmonate treatments induced the trypsin inhibitors. Wound-induced accumulation of trypsin inhibitor protein was also observed by western blot analysis. The pattern of expression, the apparent rapid evolution of TI genes, and the in vitro trypsin inhibitory activity are consistent with a role in herbivore defense. This work establishes the presence of a functional protein-based inducible defense system in trembling aspen.

Resident-preceptor retreat for re-evaluating a pharmacy residency program.

The organization of a resident-preceptor retreat as one component of a process to re-evaluate a pharmacy residency program is described. Changes in the ASHP standards for residency training and recommendations from a recent reaccreditation survey as well as recent changes in the health-care environment prompted a re-evaluation of the existing 24-month residency and degree program at The Ohio State University Hospitals. Three task forces were created to evaluate issues in seven areas of residency training. Members of the task forces, which consisted of current residents and staff members with preceptorial responsibilities, discussed the issues assigned to them during a retreat at a state park. Recommendations made at the retreat were assigned to individual task force members for implementation. Within nine months of the retreat, 15 of 17 recommendations had been implemented. A retreat involving both residents and preceptors can be an effective forum for discussing and critically evaluating a pharmacy residency program.