Naso-ethmoid-orbital fractures: classification and role of primary bone grafting

A detailed review of 80 patients with severe naso-ethmoid-orbital injuries has facilitated the classification of these injuries into five types. The recognition and diagnosis of each specific injury pattern will define the correct treatment choice in each instance. Special attention should be focused on injuries with comminution and bone loss in the medial wall and floor of the orbit, with loss of cartilaginous nasal support, and with orbital displacement and dystopia. An open, direct approach to these fractures with meticulous reduction, internal fixation, and repair of the medial canthal ligaments provides optimal repair. The use of craniofacial surgical techniques and immediate bone graft replacement of missing or severely damaged bone will allow reconstruction of even the most difficult injuries in one stage. Two hundred and eighteen primary bone grafts have been utilized in 49 patients. No significant complications with their use have occurred. The incidence of nasolacrimal system injury in naso-ethmoid-orbital injuries is less than suspected. Eight of 46 patients (17.4 percent) required a dacryocystorhinostomy for persistent nasolacrimal system obstruction. Immediate assessment or exploration of the nasolacrimal system is not performed. Delayed assessment and dacryocystorhinostomy resulted in the relief of nasolacrimal system obstruction in all cases.     

The use of miniplates in craniomaxillofacial surgery

Miniplates were used in craniomaxillofacial surgery for fixation in the skull, maxilla, and/or mandible in 74 patients with minimal or no intermaxillary wiring. Procedures included forehead and orbital repositioning, frontofacial advancement, Le Fort III and particularly Le Fort I osteotomies, as well as mandibular osteotomies and fracture repair. The miniplates provided stable fixation and, compared with other techniques, improved airway safety. The complication rate was low: there were no infections, but two plates (1 percent) became exposed in the buccal sulcus. Although application of miniplates lengthened surgery and increased the cost of the procedure, the savings in intensive care monitoring more than offset these costs. The stability of fixation minimizes the opportunity to reposition the fragments postoperatively with training elastics. Therefore, meticulous technique is mandatory, with particular emphasis on passive fitting of the plates and precise drilling of screw holes.     

The role of plant hormones during grafting

For millennia, people have cut and joined different plant tissues together through a process known as grafting. By creating a chimeric organism, desirable properties from two plants combine to enhance disease resistance, abiotic stress tolerance, vigour or facilitate the asexual propagation of plants. In addition, grafting has been extremely informative in science for studying and identifying the long-distance movement of molecules. Despite its increasing use in horticulture and science, how plants undertake the process of grafting remains elusive. Here, we discuss specifically the role of eight major plant hormones during the wound healing and vascular formation process, two phenomena involved in grafting. We furthermore present the roles of these hormones during graft formation and highlight knowledge gaps and future areas of interest for the field of grafting biology.     

The role of bone morphogenetic proteins in endochondral bone formation

Bone morphogenetic proteins (BMPs) were originally identified as proteins capable of inducing endochondral bone formation when implanted at extraskeletal sites. BMPs have diverse biological activities during early embryogenesis and various aspects of organogenesis. BMPs bind to BMP receptors on the cell surface, and these signals are transduced intracellularly by Smad proteins. BMP signal pathways can be inhibited by both extra- and intracellular mechanisms. As for skeletal development, genetic studies suggest that BMPs are skeletal mesoderm inducers. Recent studies of tissue-specific activation and inactivation of BMP signals have revealed that BMP signals control proliferation and differentiation of chondrocytes, differentiation of osteoblasts and bone quality. These findings may contribute not only to understanding of bone biology and pathology, but also to improvement of the clinical efficacy of BMPs.     

The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services

This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems—anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics—definitions of ‘killed in action’ and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance—clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes—unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments—can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma.     

The role of prostaglandins in bone in vivo

Prostaglandins of the E series, primarily E2 and E1, have the greatest activity in bone. Following discovery of their potent ability to stimulate bone resorption in vitro, clinical investigations have placed prostaglandins at sites of localized bone resorption associated with inflammatory or space occupying lesions in vivo. These studies have shown that prostaglandin production at such sites may be increased by cytokines such as interleukin-1 but the mechanisms by which prostaglandins stimulate bone resorption are not yet known. Observation of periosteal bone formation in patients given, pharmacological doses of prostaglandin has led to investigation of its bone forming activity. Young, growing rats have increased metaphyseal bone formation and this is accompanied by increased periosteal and endocortical bone formation in older animals. In the mature animals there is a generalized activation of remodelling with increased formation in the remodeling cycle. This is also seen in oophorectomized rats and results in repletion of the lost bone in this model of osteoporosis. In animal models of localized disuse osteopenia, prostaglandins are found to be elevated at the site of bone loss and prostaglandin inhibitors at least partially protect against the exaggerated resorption that occurs. This is also seen in models of orthodontic tooth movement, periodontitis and osteomyelitis. Prostaglandin synthesis inhibitors have been shown to delay healing of bone and this has led to limitations on their use clinically in some situations. Exogenously administered prostaglandins have been found to enhance periosteal callus formation, but healing is not uniformly enhanced. Prostaglandins have also been associated with hypercalcemia in certain animal tumors that model human hypercalcemia of malignancy but are probably most important in this condition as mediators in the localized resorption of bone at tumor sites. These in vivo studies have shown that prostaglandins are involved with increases in both bone formation and bone resorption. In vitro studies have shown that prostaglandins stimulate osteoblasts as well as osteoclastic bone resorption but understanding these effects under in vivo conditions will require further investigation.     

The primary role of murine bone marrow in the production of natural killer cells. A cytokinetic study

The normal steady state production of natural killer (NK) cells in the bone marrow and spleen was characterized with cytokinetic technics. We developed a protocol to enrich for NK cells in bone marrow and demonstrate that target binding can be used as a criterion for marrow NK cells if nonspecifically "sticky" cells are eliminated. The selected population of B cell-depleted bone marrow lymphoid cells was comprised mainly of lymphocytes, of which 80% were NK-1.1+. B cell-depleted bone marrow lymphocytes that bound to YAC-1 could be characterized as two populations on the basis of morphology and proliferative status: large, proliferating target-binding cells (TBC), of which 25% were in S phase of the mitotic cycle, and small postmitotic TBC. Pulse and chase studies indicated that the small TBC in bone marrow were derived from an immediate proliferating precursor, presumably the large TBC, which were, in turn, derived from a precursor population that was more rapidly proliferating. In contrast, few if any splenic TBC were labeled after a 30-min pulse with [3H]TdR and significant numbers of labeled TBC did not appear in the spleen until 2 or more days after the pulse label. Surprisingly, some of the splenic TBC were relatively long lived and survived 2 mo or longer. These studies are the first to directly characterize the production of NK cells in situ in normal marrow. We demonstrate that the marrow is the primary site of production of NK cells and that little, if any, proliferation of NK cells occurs in the periphery of unstimulated mice. The data suggest the existence in the bone marrow of at least three compartments in the NK lineage: a rapidly proliferating NK precursor population, a less rapidly proliferating population of large TBC, and a population of small postmitotic TBC.     

The primary pulmonary lymph node complex in paracoccidioidomycosis

A case of primary pulmonary lymph node complex in paracoccidioidomycosis is reported.     

The role of busulfan in bone marrow transplantation

High-dose busulfan is an important component in many conditioning protocols for hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT) in both adults and children. During the past 12y several studies have reported the wide inter-invidual variability in busulfan disposition. Age, disease status, hepatic function, circadian rhythmicity, drug interactions and bioavailability, were identified as factors contributing to the high inter-individual variability found in busulfan disposition. Traditionally, a standard busulfan dose of 4mg/kg/d for four days is used in most BMT/HSCT protocols. Many investigations have pointed out the pharmacodynamic relationship between a high busulfan systemic exposure and the occurrence of BMT related toxicity including hepatic veno-occlusive disease (VOD), interstitial pneumonia and alopecia in adult patients. However, studies in young patients have shown a high rate of graft failure and subsequently relapse which most probably is due to the low systemic exposure despite the standard dose schedule. In children and infants VOD was not observed with the standard doses. Increasing interest for the drug and new modification strategies for children led to higher rate of VOD and CNS toxicity when busulfans was administered according to the body surface area. More pharmacodynamic studies are required to establish the relation between the systemic exposure to busulfan and the therapeutic efficacy, especially in young children undergoing BMT or HSCT. In the present time an accurate and effective busulfan plasma level monitoring combined with dose adjustment based on the known pharmacological parameters may improve the clinical outcome for patients undergoing BMT.     

硫酸乙酰肝素在骨折愈合中的作用

硫酸乙酰肝素(heparan sulfate,HS)是由多个硫酸化结构的二糖基单位重复形成的线型多糖,并以共价键形式连接于核心蛋白质形成硫酸乙酰肝素蛋白聚糖,几乎所有动物细胞均可以合成硫酸乙酰肝素.硫酸乙酰肝素可与许多生物活性分子相结合,其中包括肝素结合性生长因子(heparin-binding growth factor,HSGF),比如成纤维细胞生长因子(basic fibroblast growth factor,FGF)、骨形态发生蛋白(bone morphogenetic protein,BMP)、β-转化生长因子(transforming growth factor-β,TGF-β)等.这些生长因子可促进骨的形成,但由于容易被蛋白酶降解失活而影响其临床效果,如大量使用可能导致肿瘤形成.硫酸乙酰肝素与生长因子结合可以保护生长因子免受蛋白酶降解并可促进生长因子与其受体结合,从而增强,延长生长因子的活性,并可能同时调控生长因子的信号传递,参与骨细胞的功能及活性的调节.近来在动物骨折模型中使用硫酸乙酰肝素可明显促进骨的愈合,因此硫酸已酰肝素有可能成为治疗骨折不愈合或延迟愈合的有利工具.     

生长抑素在初级伤害性信息传递中的作用

生长抑素是广泛存在于体内的一种抑制性调节肽。生长抑素及其受体存在于初级伤害性信息传递通路的各部分。在外周主要发挥抑制伤害性信息传递的作用,在脊髓水平主要影响热痛敏的形成。在初级伤害性信息传递通路中,生长抑素与其他递质、调质和神经生长因子存在相互作用。     

The complex role of adiponectin in chronic kidney disease

Although adiponectin, an adipocytokine released from adipose tissue, is thought to have anti-atherogenic, anti-inflammatory, and insulin-sensitizing effects, it appears that high, rather than low, circulating levels of adiponectin predict increased mortality in chronic kidney disease (CKD) patients in whom the circulating levels may rise to about three times higher than the levels in healthy subjects. As it could be hypothesized that in the uremic milieu high adiponectin levels reflect protein-energy wasting, lower residual renal function and/or volume overload, this may explain, at least in part, the observed paradoxical link between hyperadiponectinemia and poor outcome in CKD. To determine the biological consequences of high circulating adiponectin levels on carbohydrate and insulin metabolism as well as relations with cardiovascular function and mortality in the uremic milieu, further studies need to take into account both high-, and low-molecular weight adiponectin moieties as well as the role of adiponectin receptors. This brief review summarizes some of the recent advances in our understanding of the complex and context-sensitive role of this elusive and intriguing adipokine in the uremic milieu.     

The role of electrostatic interactions in calmodulin-peptide complex formation

The complex between calmodulin and the calmodulin-binding portion of smMLCKp has been studied. Electrostatic interactions have been anticipated to be important in this system where a strongly negative protein binds a peptide with high positive charge. Electrostatic interactions were probed by varying the pH in the range from 4 to 11 and by charge deletions in CaM and smMLCKp. The change in net charge of CaM from approximately -5 at pH 4.5 to -15 at pH 7.5 leaves the binding constant virtually unchanged. The affinity was also unaffected by mutations in CaM and charge substitutions in the peptide. The insensitivity of the binding constant to pH may seem surprising, but it is a consequence of the high charge on both protein and peptide. At low pH it is further attenuated by a charge regulation mechanism. That is, the protein releases a number of protons when binding the positively charged peptide. We speculate that the role of electrostatic interactions is to discriminate against unbound proteins rather than to increase the affinity for any particular target protein.     

The role of miRNAs in complex formation and control

microRibonucleic acid (miRNAs) are small regulatory molecules that act by mRNA degradation or via translational repression. Although many miRNAs are ubiquitously expressed, a small subset have differential expression patterns that may give rise to tissue-specific complexes. MOTIVATION: This work studies gene targeting patterns amongst miRNAs with differential expression profiles, and links this to control and regulation of protein complexes. RESULTS: We find that, when a pair of miRNAs are not expressed in the same tissues, there is a higher tendency for them to target the direct partners of the same hub proteins. At the same time, they also avoid targeting the same set of hub-spokes. Moreover, the complexes corresponding to these hub-spokes tend to be specific and nonoverlapping. This suggests that the effect of miRNAs on the formation of complexes is specific.     

The role of the Golgi complex in sulfate metabolism

This investigation was designed to determine if sulfate metabolism is the function of a particular cell organelle, or whether the site of sulfation varies, depending upon the type of cell and the class of sulfated compound. Rats and mice were injected intravenously with inorganic sulfate labeled with ³⁵S (H₂ ³⁵SO₄), and were then killed by vascular perfusion of fixative 5–30 min later. Several tissues were prepared for electron microscope autoradiography. 14 different types of specialized cells which incorporated the labeled sulfate were analyzed. In every case, the sulfate was initially detected in the smooth membranes and vesicles of the Golgi complex. Available evidence indicates that these cells were engaged in the synthesis of several different sulfated compounds, including mucopolysaccharides, glycoproteins, lipids, and steroids. These results lead to the generalization that the enzymes required for the transfer of inorganic sulfate to a variety of acceptor molecules are located in the Golgi complex.