Avulsion fracture of peroneus longus tendon at the first metatarsal insertion: a case report : P16

Introduction: Isolated avulsion fracture at the plantar lateral base of the first metatarsal (M1) is very rare. Case report: A 35 year old overweight woman sustained an eversion strain of her right foot. Despite pain along M1 she was able to continue walking for three days before presenting to her family doctor. Swelling on the plantar aspect of the foot was noticed, there was also pain at eversion of the foot and extension of the ankle. Plain X-ray showed no abnormalities. A MRI showed minimal bone bruise at the basis of M1 and a partial rupture of the peroneus longus tendon at its insertion. The patient was allowed to walk with partial weight bearing with a soft ankle brace. After 6 months she presented at our hospital because of persistent pain. There was still a painful insertion of the peroneus longus but active plantarflexion of M1 was possible. Plain X-rays were poorly contributive except for a discrete flattening of the longitunal arch. CT-scan showed a non displaced fracture at the M1-basis. A protocol with partial weight-bearing in a short-leg cast and partial weight-bearing orthosis each for 6 weeks was unsuccessfully attempted. Therefore, an excision of the non healed bone fragment at the basis of M1 and a first tarsometatarsal joint arthrodesis were performed. Postoperatively the patient wore a partial weight-bearing short leg cast for 6 weeks followed by a weight-bearing short leg cast for 6 weeks with favourable outcome. Discussion: Initial internal fixation has been reported to lead to good results [1, 2]. In our case the conservative treatment failed and leaded to non union. At that time we considered as too risky (overweight) to excise the fragment and reattach the peroneus longus tendon. Therefore, we excised the fragment and fused the first tarsometatarsal joint. This procedure allowed, at least partially, to compensate for the function of the peroneus longus tendon. 1 Murakami T, et al. Avulsion fracture of the peroneus longus at the first metatarsal insertion: a case report. Br J Sports Med. 2004. 2 Kwak HY, and Bae SW. Isolated avulsion fracture at the plantar lateral base of the first metatarsal: a case report. Foot Ankle Int 2000.

Differential insertion of GPI-anchored GFPs into lipid rafts of live cells.

Partitioning of proteins in cholesterol and sphingolipid enriched plasma membrane microdomains, called lipid rafts, is critical for many signal transduction and protein sorting events. Although raft partitioning of many signaling molecules remains to be determined, glycosylphosphatidyl-inositol (GPI)-anchored proteins possess high affinity for lipid rafts and are currently exploited as markers to investigate fundamental mechanisms in protein sorting and signal transduction events. In this study, we demonstrate that two recombinant GPI-anchored green fluorescent proteins (GFP-GPIs) that differ in their GPI signal sequence confer distinct localization in plasma membrane microdomains. GFP fused to the GPI signal of the decay accelerating factor GFP-GPI(DAF) partitioned exclusively in lipid rafts, whereas GFP fused to the GPI signal of TRAIL-R3, GFP-GPI(TRAIL-R3), associated only minimally with microdomains. In addition, we investigated the unique ability of purified GFP-GPIs to insert into membrane microdomains of primary lymphocytes. This cell surface painting allows rapid, stable, and functional association of the GPI-anchored proteins with the target cell plasma membrane. The distinct membrane localization of the two GFP-GPIs was observed irrespective of whether the GPI-anchored molecules were painted or transfected. Furthermore, we show that painted GFP-GPI(DAF) was totally dependent on the GPI anchor and that the membrane insertion was increased by the addition of raft-associated lipids such as cholesterol, sphingomyelin, and dipalmitoyl-phosphatidylethanolamine. Thus, this study provides evidence that different GPI signal sequences lead to distinct membrane microdomain localization and that painted GFP-GPI(DAF) serves as an excellent fluorescent marker for lipid rafts in live cells.

Ex-PRESS R-50 miniature glaucoma implant insertion under the conjunctiva combined with cataract extraction

Rapport de synthèse : Le glaucome à angle ouvert est une neuropathie optique chronique progressive pour laquelle de nombreux traitements tant médicaux que chirurgicaux ont été proposés. La prise en charge chirurgicale s'articule principalement autour de deux chirurgies filtrantes, la trabéculectomie et la sclérectomie profonde avec implant de collagène. Cependant, les complications postopératoires de ces deux interventions étant relativement fréquentes, la recherche s'est orientée vers des traitements alternatifs dont la mise en place de micro-drains. Ces implants de drainage diminuent la pression intraoculaire en créant un court-circuit du flux d'humeur aqueuse de la chambre antérieure vers l'espace sous-conjonctival avec formation d'une bulle de filtration. L'implant Ex-PRESS R-50 est un implant miniature (2.5 mm de long pour 400 µm de diamètre) en acier inoxydable et biocompatible. La présente étude s'est proposée d'étudier l'efficacité et la sécurité de l'implant miniature Ex-Press R-50 lors d'une opération combinée cataracte-glaucome. Trente-cinq yeux de 35 patients (âge moyen: 75 ans) ont été inclus dans l'étude. Tous les patients ont bénéficié d'une opération de la cataracte par phacoemulsification et mise en place d'un implant de chambre postérieure suivie de l'implantation du micro-drain. Les pressions intraoculaires préopératoires et postopératoires, la meilleure acuité visuelle corrigée, le nombre de médicaments anti-glaucomateux ainsi que le type et le nombre de complications ont été évalués mensuellement puis tous les 6 mois pendant 4 ans. Le succès total a été défini par une pression postopératoire finale inférieure à 18mmHg sans traitement médical associé, le succès partiel par une pression postopératoire finale inférieure à 18mmHg avec ou sans traitement médical associé.. Le suivi moyen a été de 36.9 mois avec une baisse de la pression intraoculaire significative d'environ 25%. Une augmentation de l'acuité visuelle a été observée après l'opération de la cataracte et le nombre de médicaments anti-glaucomateux a été réduit de 57%. Dix patients ont bénéficié d'un traitement supplémentaire de la bulle de filtration par injection d'anti-métabolite (mitomycine C). Nous avons observé 8 complications majeures (4 érosions conjonctivales et 4 obstructions de l'orifice interne du micro-drain), toutes suivies de l'ablation de l'implant et de la réalisation d'une chirurgie classique du glaucome. En se basant sur les courbes de Kaplan-Meier à 48 mois, le taux de succès total était de 32.7% et le succès partiel de 53.7%. Nous pouvons conclure suite à ce travail que l'implant miniature Ex-PRESS R-50 est associé à un nombre trop élevé de complications, même si les cas non compliqués ont bénéficié d'une baisse significative de la pression intraoculaire. La modification de l'architecture du micro-drain ainsi que de la technique chirurgicale devrait augmenter le taux de succès.

Avulsion fracture of the peroneus longus tendon insertion at the base of the first metatarsal: report of a case.

Isolated avulsion fracture of the peroneus longus tendon insertion at the base of the first metatarsal is very rare. Similar to most avulsion fractures that result from excessive strain at a tendon or ligament insertion, this type of injury is caused by the strong tension exerted by the peroneus longus tendon. The mechanisms leading to this lesion and treatment options are not clearly defined. We present the case of an isolated minimally displaced intra-articular avulsion fracture at the plantar lateral base of the first metatarsal. Faced with a painful non-union following conservative treatment we considered excision of the bony fragment and first tarsometatarsal arthrodesis. This leads to a favourable functional outcome.

Characterization of OsMIK in a rice mutant with reduced phytate content reveals an insertion of a rearranged retrotransposon.

The rice low phytic acid (lpa) mutant Os-lpa-XS110-1(XS-lpa) has ~45 % reduction in seed phytic acid (PA) compared with the wild-type cultivar Xiushui 110. Previously, a single recessive gene mutation was shown to be responsible for the lpa phenotype and was mapped to a region of chromosome 3 near OsMIK (LOC_Os03g52760) and OsIPK1 (LOC_Os03g51610), two genes involved in PA biosynthesis. Here, we report the identification of a large insert in the intron of OsMIK in the XS-lpa mutant. Sequencing of fragments amplified through TAIL-PCRs revealed that the insert was a derivative of the LINE retrotransposon gene LOC_Os03g56910. Further analyses revealed the following characteristics of the insert and its impacts: (1) the inserted sequence of LOC_Os03g56910 was split at its third exon and rejoined inversely, with its 5' and 3' flanking sequences inward and the split third exon segments outward; (2) the LOC_Os03g56910 remained in its original locus in XS-lpa, and the insertion probably resulted from homologous recombination repair of a DNA double strand break; (3) while the OsMIK transcripts of XS-lpa and Xiushui 110 were identical, substantial reductions of the transcript abundance (~87 %) and the protein level (~60 %) were observed in XS-lpa, probably due to increased methylation in its promoter region. The above findings are discussed in the context of plant mutagenesis, epigenetics and lpa breeding.

Colorectal polypectomy during insertion and withdrawal or only during withdrawal? A randomized controlled trial.

BACKGROUND AND STUDY AIMS: Removal of colorectal polyps is routinely performed during withdrawal of the endoscope. However, polyps detected during insertion of the colonoscope may be missed at withdrawal. We aimed to evaluate whether polypectomy during both insertion and withdrawal increases polyp detection and removal rates compared with polypectomy at withdrawal only, and to assess the duration of both approaches. PATIENTS AND METHODS: Patients were included into the study when the first polyp was detected, and randomized into two groups; in group A, polyps ≤ 10 mm in diameter were removed during insertion and withdrawal of the colonoscope, while in group B, these polyps were removed at withdrawal only. Main outcome measures were duration of colonoscopy, number of polyps detected during insertion but not recovered during withdrawal, technical ease, patient discomfort, and complications. RESULTS: 150 patients were randomized to group A and 151 to group B. Mean (± standard deviation [SD]) duration of colonoscopy did not differ between the groups (30.8 ± 15.6 min [A] vs. 28.5 ± 13.8 min [B], P = 0.176). In group A 387 polyps (mean 2.58 per colonoscopy) were detected and removed compared with 389 polyps detected (mean 2.58 per colonoscopy) in group B of which 376 were removed (13 polyps were missed, mean size [SD] 3.2 [1.3] mm; 7.3 % of patients). Patient tolerance was similar in the two groups. CONCLUSIONS: Removal of polyps ≤ 10 mm during withdrawal only is associated with a considerable polyp miss rate. We therefore recommend that these polyps are removed during both insertion and withdrawal.

Pratiques d'utilisation et d'appropriation d'un dispositif d'aide à l'insertion : le cas du contrat emploi-solidarité

C'est à travers l'analyse d'une politique publique d'aide à l'emploi (le contrat emploi solidarité) que nous avons exploré les mécanismes d'insertion professionnelle d'hommes et de femmes privés d'emploi. La sur-représentation des femmes dans ce dispositif, comme dans ceux les plus éloignés de l'emploi, nous a amené à inscrire notre raisonnement dans une problématique de rapports sociaux de sexe. C'est-à-dire que nous faisons l'hypothèse que les pratiques des opérateurs de terrain s'appuyant sur les assignations de sexe, produisent un traitement différencié des politiques d'insertion entre les hommes et les femmes. Celui-ci se caractérise notamment par la non prise en compte des difficultés et des besoins spécifiques des femmes et par une absence de novation dans les formations qui leur sont proposées. Les logiques institutionnelles ainsi à l'oeuvre contribuent implicitement à un renforcement des inégalités entre les sexes et à une reproduction de la division sexuelle du travail déjà observée sur le marché de l'emploi

Biosynthesis of pyochelin and dihydroaeruginoic acid requires the iron-regulated pchDCBA operon in Pseudomonas aeruginosa.

The high-affinity siderophore salicylate is an intermediate in the biosynthetic pathway of pyochelin, another siderophore and chelator of transition metal ions, in Pseudomonas aeruginosa. The 2.5-kb region upstream of the salicylate biosynthetic genes pchBA was sequenced and found to contain two additional, contiguous genes, pchD and pchC, having the same orientation. The deduced amino acid sequence of the 60-kDa PchD protein was similar to those of the EntE protein (2,3-dihydroxybenzoate-AMP ligase) of Escherichia coli and other adenylate-forming enzymes, suggesting that salicylate might be adenylated at the carboxyl group by PchD. The 28-kDa PchC protein showed similarities to thioesterases of prokaryotic and eukaryotic origin and might participate in the release of the product(s) formed from activated salicylate. One potential product, dihydroaeruginoate (Dha), was identified in culture supernatants of iron-limited P. aeruginosa cells. The antifungal antibiotic Dha is thought to arise from the reaction of salicylate with cysteine, followed by cyclization of cysteine. Inactivation of the chromosomal pchD gene by insertion of the transcription and translation stop element omega Sm/Sp abolished the production of Dha and pyochelin, implying that PchD-mediated activation of salicylate may be a common first step in the synthesis of both metabolites. Furthermore, the pchD::omega Sm/Sp mutation had a strong polar effect on the expression of the pchBA genes, i.e., on salicylate synthesis, indicating that the pchDCBA genes constitute a transcriptional unit. A full-length pchDCBA transcript of ca. 4.4 kb could be detected in iron-deprived, growing cells of P. aeruginosa. Transcription of pchD started at tandemly arranged promoters, which overlapped with two Fur boxes (binding sites for the ferric uptake regulator) and the promoter of the divergently transcribed pchR gene encoding an activator of pyochelin biosynthesis. This promoter arrangement allows tight iron-mediated repression of the pchDCBA operon.

Target joining of duplicated insertion sequence IS21 is assisted by IstB protein in vitro.

Tandemly repeated insertion sequence IS21, located on a suicide plasmid, promoted replicon fusion with bacteriophage lambda in vitro in the presence of ATP. This reaction was catalyzed in a cell extract containing the 45-kDa IstA protein (cointegrase) and the 30-kDa IstB helper protein of IS21 after both proteins had been overproduced in Escherichia coli. Without IstB, replicon fusion was inefficient and did not produce the 4-bp target duplications typical of IS21.

Membrane insertion and antibody recognition of a glycosylphosphatidylinositol-anchored protein: an optical study.

The kinetics of binding of a glycolipid-anchored protein (the promastigote surface protease, PSP) to planar lecithin bilayers is studied by an integrated optics technique, in which the bilayer membrane is supported on an optical wave guide and the phase velocities of guided light modes in the wave guide are measured. From these velocities, the optical parameters of the membrane and PSP layers deposited on the waveguide are determined, yielding in particular the mass of PSP bound to the membrane, which is followed in real time. From a comparison of the binding rates of PSP and PSP from which the lipid moiety has been removed, it is shown that the lipid moiety plays a key role in anchoring the protein to the membrane. Specific and nonspecific binding of antibodies to membrane-anchored PSP is also investigated. As little as a fifth of a monolayer of PSP is sufficient to suppress the appreciable nonspecific binding of antibodies to the membrane.