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The purpose of this study was to compare the magnitude of compressive force across the posterior facet of the subtalar joint between 2 different screw orientations in a simulated subtalar fusion model fixated with cannulated 7.3-mm screws. Eight paired fresh, frozen cadaver feet were used. Before testing, the bone mineral density of the calcanei and tali was measured with dual energy x-ray absorptiometry to ensure comparable bone mineral density. The paired cadaver calcanei and tali were noted to have less than .05 g/cm(2) difference in bone mineral density. The paired specimens were each randomly assigned to 1 of 2 methods of fixation across the subtalar joint: a plantar approach, where the screw was oriented vertically from the plantar aspect of the calcaneus, distal to the tuberosity; and a posterior approach, where the screw was oriented obliquely from the posterior calcaneal tuberosity. A load-sensing washer was placed under the cancellous screw head before insertion of the screw to measure the magnitude of the compression force across the simulated fusion site. The mean compression force for the posterior-to-anterior approach was 581 N, with a standard deviation of 242 N. The mean force for the plantar-to-superior approach was 604 N, with a standard deviation of 276 N. The compression force obtained by the 2 approaches was not significantly different (P = .74). The plantar-to-superior fixation technique represents an alternative subtalar arthrodesis technique to the posterior-to-anterior approach, potentially allowing one to revise a previously failed arthrodesis when the standard fixation techniques cannot be applied.

Several Gram-negative pathogens deploy type III secretion systems (TTSSs) as molecular syringes to inject effector proteins into host cells. Prior to secretion, some of these effectors are accompanied by specific type III secretion chaperones. The Yersinia enterocolitica TTSS chaperone SycT escorts the effector YopT, a cysteine protease that inactivates the small GTPase RhoA of targeted host cells. We solved the crystal structure of SycT at 2.5 angstroms resolution. Despite limited sequence similarity among TTSS chaperones, the SycT structure revealed a global fold similar to that exhibited by other structurally solved TTSS chaperones. The dimerization domain of SycT, however, differed from that of all other known TTSS chaperone structures. Thus, the dimerization domain of TTSS chaperones does not likely serve as a general recognition pattern for downstream processing of effector/chaperone complexes. Yersinia Yop effectors are bound to their specific Syc chaperones close to the Yop N termini, distinct from their catalytic domains. Here, we showed that the catalytically inactive YopT(C139S) is reduced in its ability to bind SycT, suggesting an ancillary interaction between YopT and SycT. This interaction could maintain the protease inactive prior to secretion or could influence the secretion competence and folding of YopT.

Appropriate wound management is an important component in determining the outcome of surgical procedures. Increased edema can complicate postoperative results by causing wound dehiscence and increasing inflammation, and, thereby, patient discomfort. In addition, inappropriate wound management can lead to hematoma formation that increases the risk of infection and patient discomfort. These issues are likely more pertinent in high-energy trauma; however, they are also relevant in elective surgery. Results are dependent on postoperative treatment (ie, rest, ice, elevation, antiinflammatories); however, the authors believe edema control can be further facilitated by the application of a foam compression dressing.

The flagellum is believed to be the common ancestor of all type III secretion systems (TTSSs). In Yersinia enterocolitica, expression of the flagellar TTSS and the Ysc (Yop secretion) TTSS are inversely regulated. We therefore hypothesized that the Ysc TTSS may adopt flagellar motor components in order to use the pathogenicity-related translocon in a drill-like manner. As a prerequisite for this hypothesis, we first tested a requirement for the proton motive force by both systems using the protonophore carbonyl cyanide m-chlorophenylhydrazone (CCCP). Motility as well as type III-dependent secretion of Yop proteins was inhibited by CCCP. We deleted motAB, which resulted in an immotile phenotype. This mutant, however, secreted amounts of Yops to the supernatant comparable to those of the wild type. Translocation of Yops into host cells was also not affected by the motAB deletion. Virulence of the mutant was comparable to that of the wild type in the mouse oral infection model. Thus, the hypothesis that the Ysc TTSS might adopt flagellar motor components was not confirmed. The finding that, in addition to consumption of ATP, Ysc TTSS requires the proton motive force is discussed.

Purpose: Several investigations have demonstrated that significant biologic effects can occur in animals, animal cells, immortalized human cell lines, and primary human cells after exposure to doses of ionizing radiation in the low-dose, < or =1-10 cGy region (LDIR). However, little information is available as to how these and other observations pertain to human responses to LDIR, though such knowledge is required for reducing the uncertainty of assessing human risks due to these exposures. We therefore undertook these translational studies to begin the development of a unique data set of human cellular responses to LDIR as measured by gene expression changes when exposure occurs to a normal tissue with its complex cellular mixture and three-dimensional architecture., Methods and Materials: Using full-thickness human skin resected during esthetic surgery, we obtained biopsy cores and exposed the tissue to LDIR ex vivo. Gene expression changes in five core regulatory genes were assessed by real-time RT-PCR., Results: Results indicate that skin is a good biologic model for assessing LDIR in humans, though meticulous attention to sample processing is necessary. LDIR does produce changes in gene expression, though time- and dose-response relationships may be complex., Conclusion: These proof-of-principle studies have provided a crucial initial step toward validation of LDIR risk assessment models in humans. We have demonstrated the feasibility of this approach and provide initial evidence that ionizing radiation exposures as low as 1 cGy are biologically active in human skin.

Mineral trioxide aggregate is a recently introduced dental material. It may be used to seal perforations, make retrograde fillings in root-end resections, seal open apices, or cap vital pulps. In this review of the literature, physical, chemical, and biologic properties of MTA are discussed. Studies have suggested that MTA provides a better seal than formerly used materials such as IRM, amalgam, and Super-EBA. Further, MTA has low cytotoxicity and excellent biocompatibility. In vivo studies demonstrated a beneficial effect of MTA on pulpal and periodontal regeneration. Although controlled randomized clinical trials are still missing, MTA appears to be a suitable material to tightly seal dental hard tissues from the periodontium, or to cap the exposed pulp.

Mineral trioxide aggregate (MTA) has been used in dentistry for the last five to eight years. Because of its high biocompatibility, its good sealing ability, and the fact that cemental tissues grow on this material, it has a relatively wide range of applications in endodontics. MTA may be used to cap exposed vital pulps, to seal open apices or perforations, or as a retro-filling material in apical surgery. These applications are presented in the current article, and discussed based on case reports.

Modern, biologic root canal therapy should be performed with suitable irrigating solutions and intracanal medicaments. The goal of endodontic treatment is to free the treated tooth from infection and prevent reinfection as thoroughly as possible by means which do not put the organism at risk. In this review of the literature, an evidence-based concept for irrigation and medication of root canal systems is presented. Irrigants and medicaments are discussed with respect to their antimicrobial, tissue-dissolving and endotoxin-decontaminating capacity in relation to their systemic toxicity. Recent findings pertaining to interactions of root canal medicaments and irrigating solutions and their impact on a sound irrigating and medicating concept are discussed.

The authors review various pedal conditions affecting the rearfoot, including plantar fasciitis, Achilles tendon pathology, fractures, arthritides, coalitions, and tumors. Various diagnostic imaging modalities such as routine radiography, radionuclide bone scanning, computed tomography, and magnetic resonance imaging are discussed.

Percutaneous axial extensometers were mounted on the medial cortex of the midtibial diaphysis in seven male volunteers and the effect of three different shoes on in vivo peak-to-peak axial compression-tension strains measured during dynamic loading. Zohar shoes had lower axial strains and strain rates during treadmill walking than Nike Air Max running shoes or Israeli infantry boots. During running on a running track, there was no statistically significant difference between the axial strains or strain rates between the shoes tested. Shoe gear can modify tibial strains and strain rates that contribute to the development of tibial stress fractures.

Weakness in the musculotendinous barrier of the abdominal wall leads to inguinal herniation. Fiber degeneration by increased metabolism has been described recently as a causative factor. In previous investigations heightened elastase was detected in abdominal aneurysms. In order to investigate a possible relationship between hernias and abdominal aneurysms, patients scheduled for infrarenal aneurysm repair were examined for history of inguinal hernia. The prevalence of inguinal hernias (n = 49; 41%, p less than .001) in 119 patients with abdominal aneurysms was significantly elevated, compared to 81 patients with aortic occlusive disease (n = 15; 18.5%) and 298 patients with coronary artery disease (n = 54; 18.1%). Additionally, the number of patients with recent hernia repair (n = 19; 16%) or still awaiting repair (n = 11; 9%) was very high in the patient group with abdominal aortic aneurysms. Smoking habits were not different among all groups. We conclude that the prevalence of inguinal hernias in patients with abdominal aortic aneurysms is high compared with those with peripheral arterial occlusive disease or coronary atherosclerosis. These findings indicate a systemic fiber degeneration.

Aortic elastase and aortic collagenase were assayed in 38 patients who underwent an operation for thoracic or infrarenal aneurysm or infrarenal aortic occlusive disease and in 15 control patients (heart or kidney donors). Elastase was elevated in normal aortas of the infrarenal region (1.10 milliunits per gram, p less than 0.05), and in atherosclerotic descendens aneurysms (1.24 milliunits per gram, p less than 0.05), compared with the ascending aorta, when normal; aneurysmatic specimens revealed similar low elastolytic activities (0.10 milliunits per gram). The highest elastase content was found in infrarenal aneurysms (4.65 milliunits per gram). Collagenase assays yielded no significant differences, although higher activities were extracted from aortas of the infrarenal region. Coexistent atherosclerosis and wall destruction were evaluated by macroscopic and histologic investigation. All infrarenal specimens demonstrated severe atherosclerotic wall degeneration with depletion of elastic fibers. As the atherosclerotic specimens did not differ from normal aortas by protease assay, the higher elastase of infrarenal samples compared with the thoracic aorta suggests a more rapid fiber metabolism in the infrarenal region. The significantly elevated elastolytic activity of infrarenal aneurysms points to the decisive role of elastase in infrarenal aneurysm formation.