Is Subtalar Joint Cartilage Resection Necessary for Tibiotalocalcaneal Arthrodesis via Intramedullary Nail? A Multicenter Evaluation.

Tibiotalocalcaneal arthrodesis with intramedullary nailing is traditionally performed with formal preparation of both the subtalar and ankle joints. However, we believe that subtalar joint preparation is not necessary to achieve satisfactory outcomes in patients undergoing tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. The primary aim of the present retrospective study was to evaluate the outcomes of patients who had undergone tibiotalocalcaneal arthrodesis with an intramedullary nail without formal subtalar joint cartilage resection. A multicenter medical record review was performed to identify consecutive patients. Pain was assessed using a visual analog scale, and osseous union at the tibiotalar joint was defined as bony trabeculation across the arthrodesis site on all 3 radiographic views. Progression of joint deterioration was evaluated across time at the subtalar joint, using a modified grading system developed by Takakura et al. Forty consecutive patients (aged 61.9 ± 12.9 years; 17 men) met the inclusion and exclusion criteria. Compared with the pain reported preoperatively (6.4 ± 2.7), a statistically significant decline was seen in the pain experienced after surgery (1.2 ± 1.8; p < .001). The mean time to consolidated arthrodesis at the ankle joint was 3.8 ± 1.5 months. A statistically significant increase in deterioration at the subtalar joint was observed across time [t(36) = -6.200, p < .001]. Compared with previously published data of subtalar joint cartilage resection, the present study has demonstrated a similar decline in pain, with a high rate of union, and also a decrease in operative time when preparation of the subtalar joint was not performed.

Adjuvant activity of a nontoxic mutant of Escherichia coli heat-labile enterotoxin on systemic and mucosal immune responses elicited against a heterologous antigen carried by a live Salmonella enterica serovar Typhimurium vaccine strain.

Systemic and mucosal antibody responses against both the major subunit of colonization factor antigen I (CFA/I) of enterotoxigenic Escherichia coli (ETEC) and the somatic lipopolysaccharide expressed by recombinant bivalent Salmonella vaccine strains were significantly enhanced by coadministration of a detoxified derivative with preserved adjuvant effects of the ETEC heat-labile toxin, LT((R192G)). The results further support the adjuvant effects of LT((R192G)) and represent a simple alternative to improve responses against passenger antigens expressed by orally delivered Salmonella vaccine strains.

Current perspectives on the molecular biology of the renal tissue kallikrein gene and the related tissue kallikrein gene family.

Renal tissue kallikrein is a member of the multigene family of serine proteases called the tissue kallikrein (KLK) gene family. This is a highly conserved family of genes, with a genomic structural organization that is identical for all these genes and other genes in the larger serine protease family, such as trypsin and chymotrypsin. These genes exhibit high sequence similarity both within and between species. However, there are clearly areas of sequence variability, which is most apparent in regions that form the substrate binding pocket of each enzyme and confers the substrate specificity of each individual enzyme. These genes are also often expressed in the same tissue, although each gene can have an individual tissue-specific pattern of expression. Similar patterns of diversity yet identity are also apparent in the regulation of kallikrein gene expression or enzyme activity. These similarities, and the fact that several of these gene families are located in tight clusters in the genome, support the notion that they have arisen by gene duplication. In this review, an overview of the molecular biology of the renal tissue kallikrein (KLK1) gene and the larger KLK gene family is given, highlighting the similarities yet diversity that is the hallmark of this family of genes, and how this knowledge has, and will, impact on our understanding of the role these enzymes play in normal physiological events and disease.

Glandular kallikrein gene expression in the human uterus.

1. Kallikrein enzyme activity has been previously reported in the uterus of several species and implicated in implantation and parturition. In order to provide further evidence for a local kallikrein-kinin system in this tissue, we wished to determine if the gene encoding kallikrein (KLK1) was expressed in the human uterus and determine the pattern of its expression across the menstrual cycle. 2. Reverse-transcriptase polymerase chain reaction (RT-PCR) of endometrial and myometrial total RNA coupled with Southern blot analysis showed that KLK1 was expressed in the human endometrium and myometrium. Endometrial expression of KLK1 was confirmed by DNA sequence analysis of the PCR products. Kallikrein was also localized by immunocytochemistry, primarily in the glandular epithelium of the endometrium. 3. Quantitative RT-PCR of 37 endometrial samples ranging from day 1 to 29 from across the menstrual cycle showed significantly higher KLK1 (kallikrein) expression from the mid proliferative to the early secretory phase compared with the late secretory and menstrual phases. 4. We have demonstrated for the first time that KLK1, the gene encoding glandular kallikrein, is expressed in the human uterus. The increase in endometrial KLK1 gene expression during the proliferative phase of the menstrual cycle suggests a role for kallikrein in the preparation of the endometrial lining for implantation.

Evidence for the effects of a superantigen in rheumatoid arthritis.

While studying the alpha beta T cell receptor repertoire in rheumatoid arthritis (RA) patients, we found that the frequency of V beta 14+ T cells was significantly higher in the synovial fluid of affected joints than in the peripheral blood. In fact, V beta 14+ T cells were virtually undetectable in the peripheral blood of a majority of these RA patients. beta-chain sequences indicated that one or a few clones dominated the V beta 14+ population in the synovial fluid of individual RA patients, whereas oligoclonality was less marked for other V beta's and for V beta 14 in other types of inflammatory arthritis. These results implicate V beta 14-bearing T cells in the pathology of RA. They also suggest that the etiology of RA may involve initial activation of V beta 14+ T cells by a V beta 14-specific superantigen with subsequent recruitment of a few activated autoreactive v beta 14+ T cell clones to the joints while the majority of other V beta 14+ T cells disappear.

Effects of a protein-free, synthetic surfactant on survival and pulmonary function in preterm lambs.

We have created a totally synthetic, protein-free surfactant (Exosurf) composed of dipalmitoylphosphatidylcholine, hexadecanol, and tyloxapol. We studied the effects of endotracheal instillation of Exosurf on survival and pulmonary function of preterm lambs delivered at 131 to 133 days gestation (term 148 days). Exosurf treatment was compared with instillation of surface-active material prepared from lung lavages of adult sheep and with no instillation. Lambs were delivered by cesarean section, paralyzed, and mechanically ventilated. The Exosurf group survived longer (80% alive at 11 hours) than did the no instillation group (30% alive at 11 hours) (P less than 0.05). There were no statistically significant differences between the Exosurf and sheep surfactant groups. We conclude that Exosurf, a synthetic surfactant, produces significant improvement in survival and pulmonary function in preterm lambs.