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G Gacon

Publications and source records attributed to G Gacon.

At least 19 recordsLinked to original sources

Tat1, a novel sulfate transporter specifically expressed in human male germ cells and potentially linked to rhogtpase signaling.

RhoGTPases (Rho, Rac, and Cdc42) are known to regulate multiple functions, including cell motility, adhesion, and proliferation; however, the signaling pathways underlying these pleiotropic effects are far from fully understood. We have recently described a new RhoGAP (GTPase activating protein for RhoGTPases) gene, MgcRacGAP, primarily expressed in male germ cells, at the spermatocyte stage. We report here the isolation, through two-hybrid cloning, of a new partner of MgcRacGAP, very specifically expressed in the male germ line and showing structural features of anion transporters. This large protein (970 amino acids and a predicted size of 109 kDa), we provisionally designated Tat1 (for testis anion transporter 1), is closely related to a sulfate permease family comprising three proteins in human (DRA, Pendrin, and DTD); it is predicted to be an integral membrane protein with 14 transmembrane helices and intracytoplasmic NH(2) and COOH termini. In situ hybridization studies demonstrate that Tat1 and MgcRacGAP genes are coexpressed in male germ cells at the spermatocyte stage. On testis sections, Tat1 protein can be immunodetected in spermatocytes and spermatids associated with plasma membrane. Two-hybrid and in vitro binding assays demonstrate that MgcRacGAP stably interacts through its NH(2)-terminal domain with the Tat1 COOH-terminal region. Expression of Tat1 protein in COS7 cells generates a 4,4'-diisothiocyano-2,2'-disulfonic acid stilbene and chloride-sensitive sulfate transport. Therefore we conclude that Tat1 is a novel sulfate transporter specifically expressed in spermatocytes and spermatids and interacts with MgcRacGAP in these cells. These observations raise the possibility of a new regulatory pathway linking sulfate transport to Rho signaling in male germ cells.

Amino Acid Sequence↗

[Metaphyseal and diaphyseal modular femoral stems implanted without cement].

PURPOSE OF THE STUDY: We assessed outcome after total hip arthroplasty (THA) using a dual metaphyseal-diaphyseal modular femoral stem with hydroxyapatite coating on the metaphyseal portion only. Implanted without cement, this stem was adaptable to all the anatomic morphotypes defined by the Noble canal flare index. MATERIAL AND METHODS: THA was performed in 116 patients (124 hips), mainly for degenerative joint disease (80% for dysplasia). Mean age was 61.2 years. Follow-up was 6.9 years (72-108 months). RESULTS: There were no preoperative complications excepting 3 cases of neck fissuration without clinical consequence. There was no trochanteric fracture. We had two early and one late dislocations. The Postel Merle d'Aubigné score improved from 8.09 to 17.27. Clinical outcome was not influenced by patient age, weight or morphotype. Radiologically, signs of bone ingrowth were found in more than 80% of the cases. Lucent lines were seen in only 3 cases. There was a single case of migration. No revision was needed among the cases with ossifications (23%, 22% Brooker I) and no femur revisions were required. There was no mechanical problem involving the metaphyseal-epiphysial junction. DISCUSSION: The dual metaphyseal-diaphyseal modular stem was found to be a safe and effective implant adaptable to all anatomic variations of the femur and providing good primary stability. In our series, 58% of the femurs were "standard" but for one-third of the femurs, the modular stem enabled implantation without cement, particularly in young adults with a dysplasic or funnel-shaped femur. CONCLUSION: The dual metaphyseal-diaphyseal modular stem was found to be most useful for optimizing total hip arthroplasty without cement.

Activities of Daily Living↗

[Single-compartment knee arthroplasty prosthesis and idiopathic necrosis of the medial tibia surface].

PURPOSE OF THE STUDY: Idiopathic necrosis of the medial articular surface of the tibia is exceptional. Diagnosis is quite difficult and often made late. Among the different treatments proposed, we preferred single-compartment arthroplasty. MATERIAL AND METHODS: We report 8 cases in women with a mean age of 71.1 years. Diagnosis was suspected due to drug-resistant knee pain, particularly frequent at night, initially with radiographically normal knees. The first radiographic signs, seen 3 months after the onset of pain, were pathognomonic for osteonecrosis evidencing subchondral defects of the tibial surface with a dense peripheral rim and apparently "sequestered" in a notch. Bone scintigraphy evidenced intense uptake in the medial compartment. MRI confirmed the diagnosis evidencing a band of low intensity signals completely surrounding a sequestered zone reaching the cortical. This band was stable and irreversible. In 5 cases CT scan and in 3 cases tomography identified the width and height of the necrotic area that was limited to the medial compartment in all cases. All patients were treated with a single compartment implant. The diagnosis of necrosis was confirmed at pathology. RESULTS: At 4,6 years of mean follow up all patients had an excellent outcome, "forgetting" their knee. No lucent lines developed along the femoral or tibial implants. DISCUSSION: Necrosis of the medial articular surface of the tibia is exceptional and often diagnosed late by bone scintigraphy or MRI. Surgical treatment is usually based on tibial osteotomy for valgisation or a single or three-compartment prosthesis. In our 8 cases, the necrosis was limited to the medial compartment, warranting our therapeutic option.

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[Osteolysis after total knee prosthesis].

PURPOSE OF THE STUDY: The aim of our work was to study X-rays showing osteolysis after 5 years and more in 122 prosthesis and to try and assess such complication, often described in the United States but seldom in Europ. MATERIAL: We are dealing here with 122 retaining posterior cruciate ligament, mostly cementless prothesis implanted between 1985 and 1992 84 chromium-cobalt prosthesis (PCA and Themis) implanted in 34 males and 88 females with an average age of 67 (45-81), 87,7 p. 100 had femoral cementless components and 70 p. 100 tibial cementless components. METHODS: All patients were examined and had X-rays at an average of 6,9 years. Specially considered were X-rays showing a possible osteolysis. We looked for possible complication (external laxity, anterior femoral dislocation and polyethylene wear), assessment of the mechanical axis and for clinical results (Hungerford score) RESULTS: Revisions: 19 arthroplasties were revised for PE wear tibial loosening metallosis or patella problems The postoperative score according to Hungerford was 84,5 p. 100 for PCA prosthese and 87 p.100 for the Themis. On the X-rays were only few osteolysis to be found: 9 cases (7,3 p. 100). For the PCA series: 3 femoral osteolysis, 1 tibial at 12 years, and one patellar osteolysis. For the Themis series: no femoral osteolysis, 3 tibial and one patellar osteolysis. Osteolysis are apparent on X-rays in profile for the femur and the patella, and in both profile and frontal X-rays for the tibia. Clinicaly 4 osteolysis really asymptomatic were not re-operated. 5 were revised: one 11 years later for femoral and tibial loosening, two for a patellar loosening, the other two patients had to be reoperated on for metallism (titanium's femoral component) and for those two instances osteolysis were discovered during the complication. DISCUSSION: Osteolysis after TKA appears unusual in our experience without bearing on frequency finded by american authors with a lesser follow-up (Engh 11,1 p. 100 after 4,5y, Peters 16 p. 100 after 2,9 y, Robinson 9,18 p. 100 after 4,6 y). American litteratur analysis shows that the important number of osteolysis is due to: - either to dual-metal using (Co-Cr component with Titanium screws for exemple), - or bad quality of polyethylene (compressed), - or a bad design of former prosthesis. CONCLUSION: Interface illness, linked to the production of wear debris, osteolysis after total knee arthroplasty is rarer than after a hip one, probably because size of debris is different, larger in knee than in hip. It is likely that the improvement of PE quality, design of prosthesis, as well as a better knowledge of osteolysis mechanism will allow to delay this complication wich is in a long term ineluctable.

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Structure and expression of murine mgcRacGAP: its developmental regulation suggests a role for the Rac/MgcRacGAP signalling pathway in neurogenesis.

Rho-family GTPases regulate a wide range of biological functions including cell migration, cell adhesion and cell growth. Recently, results from studies in vivo in Drosophila, mouse and humans have demonstrated the involvement of these GTPases in mechanisms controlling neuronal differentiation and the development of the central nervous system (CNS). However, the signalling pathways underlying these functions and the proteins directly regulating RhoGTPases in developing neurons are poorly defined. Here we report the structure and expression pattern of the murine orthologue of mgcRacGAP, a human gene encoding a RacGTPase partner expressed in male germ cells [Touré, Dorseuil, Morin, Timmons, Jegou, Reibel and Gacon (1998) J. Biol. Chem. 273, 6019-6023]. In contrast with that from humans, murine mgcRacGAP encodes two distinct transcripts. Both are developmentally regulated. A 2.2 kb transcript is strongly expressed in mature testis and is up-regulated with spermatogenesis. A 3 kb RNA is predominant in the embryo and is expressed primarily in the CNS during the neurogenic phase, decreasing after birth. In situ hybridization analysis in embryonic-day 14.5 mouse embryos demonstrates a preferential expression of mgcRacGAP in the proliferative ventricular zone of the cortex. In addition to the expression of mgcRacGAP in male germ cells already reported in humans and suggesting an involvement in spermatogenesis, we characterize an embryonic transcript whose expression is closely correlated with neurogenesis. This result addresses the question of the role of Rac/MgcRacGAP pathway in neuronal proliferation.

Amino Acid Sequence↗

MgcRacGAP, a new human GTPase-activating protein for Rac and Cdc42 similar to Drosophila rotundRacGAP gene product, is expressed in male germ cells.

In a search for new partners of the activated form of Rac GTPase, we have isolated through a two-hybrid cloning procedure a human cDNA encoding a new GTPase-activating protein (GAP) for Rho family GTPases. A specific mRNA of 3.2 kilobases was detected in low abundance in many cell types and found highly expressed in testis. A protein of the predicted size 58 kDa, which we call MgcRacGAP, was detected in human testis as well as in germ cell tumor extracts by immunoblotting with antibodies specific to recombinant protein. In vitro, the GAP domain of MgcRacGAP strongly stimulates Rac1 and Cdc42 GTPase activity but is almost inactive on RhoA. N-terminal to its GAP domain, MgcRacGAP contains a cysteine-rich zinc finger-like motif characteristic of the Chimaerin family of RhoGAPs. The closest homolog of MgcRacGAP is RotundRacGAP, a product of the Drosophila rotund locus. In situ hybridization experiments in human testis demonstrate a specific expression of mgcRacGAP mRNA in spermatocytes similar to that of rotundRacGAP in Drosophila testis. Therefore, protein sequence similarity and analogous developmental and tissue specificities of gene expression support the hypothesis that RotundRacGAP and MgcRacGAP have equivalent functions in insect and mammalian germ cells. Since rotundRacGAP deletion leads to male sterility in the fruit fly, the mgcRacGAP gene may prove likewise to play a key role in mammalian male fertility.

Amino Acid Sequence↗

Enhanced apoptosis in the thymus of transgenic mice expressing constitutively activated forms of human Rac2GTPase.

Rac proteins constitute a subgroup of the Rho family of small GTPases and include Rac1, which is expressed ubiquitously, and Rac2, a highly homologous protein only expressed in myelo-monocytic and lymphoid cell lineages. In fibroblasts, Rac1 plays a crucial role in control of actin cytoskeleton organisation, cell growth and Ras-induced transformation. In phagocytes, Rac1 and Rac2 regulate a specific enzymatic complex, NADPH oxidase. These multiple functions have been ascribed to Rac proteins only on the basis of cell culture and in vitro biochemical studies. To examine the role of Rac2 in vivo in a T cell lineage, we have expressed either wild-type or constitutively-activated forms of human Rac2 (Rac2V12 and Rac2L61) in transgenic mice under control of the thymus specific lck proximal promoter. We report here a striking atrophy of the thymus in mice expressing even low levels of either of the activated mutants of Rac2, while expression of Rac2wt has no effect. This phenotype is correlated with a marked decrease in the number of double positive (CD4+ CD8+) and single positive (CD4+ CD8- and CD8+ CD4-) thymocytes. Cellular and molecular analyses demonstrate that this defect is due to an increase in apoptosis among thymocytes. As Rac2 is normally expressed in thymocytes and activated T cells, we propose that Rac2 dependent pathways could play an important role in control of growth and death of T cells.

Animals↗

[Signal transduction by Rac small G proteins in phagocytes].

Rac1 and Rac2 are 92% homologous cytosolic small GTPase proteins. Both Rac1 and Rac2 have been implicated with NADPH oxidase activation in vitro, however, Rac2 is largely predominant in human phagocytes. NADPH oxidase is a plasma membrane enzyme of phagocytes, generating superoxide anions which serve as bactericidal agents. Activation of this multimolecular enzyme, minimally requires assembly at the membrane with flavocytochrome b258 of cytosolic components p47phox, p67phox and Rac proteins. Using the yeast two hybrid system, we provide data demonstrating in vivo interactions between human p47phox, p67phox, and Rac proteins. Rac proteins interact with p67phox in a GTP-dependent manner, but do not interact with p47phox. Moreover, Rac effector site mutants which are known to be inactive in NADPH oxidase lose their interaction with p67phox. Finally, we observe that p67phox interacts six fold better with Rac2 than with Rac1. We also show a strong intracellular interaction between p47phox and p67phox. These results indicate that activated Rac, and particularly Rac2, can regulate superoxide production by NADPH oxidase of phagocytic cells through direct interaction with p67phox subunit. Recently published data suggest that Rac proteins could transduce mitogenic signals in non-phagocytic cells through superoxide production by a phagocytic-related NADPH oxidase enzymatic system which remains to be determined. NADPH oxidase regulation by Rac proteins in phagocytes could then be used as a model to understand the molecular mechanisms underlying Rac functions in various cell types.

GTP-Binding Proteins↗

[Two stages reimplantation for infection after knee arthroplasty. Apropos of a series of 29 cases].

PURPOSE OF THE STUDY: The purpose of this work was to precise diagnosis and treatment of infected total knee arthroplasty with two stage reimplantation. MATERIAL: 29 infected total knee arthroplasties were operated between 1984 and 1994 and included in this study (mean F.U. 3.5 Y). There were 20 females and 9 males, mean age 70 (46-83). The original arthroplasty was done for OA in 28 patients, RA in one. The arthroplasties were: UHK 2, Bicompartmental 2, Tricompartmental 19. 20 TKA were cementless. 14 patients showed one or several risk factors. Infection was diagnosed in 1 of 2 ways: preoperative aspiration or culture of surgical specimen. There were 12 staphylococcus epidermidis, 8 staphylococcus aureus, streptococcus (n = 2) acinetobacter (n = 2), peptococcus (n = 1) pseudomonas (n = 1), gemella morbidellum (n = 1). 6 were non identified. METHOD: The protocol for two stage reimplantation began with components and cement removal. A synovectomy was performed. The knee cavity was filled with antibiotic cement spacer and the wound was closed. The leg was placed in a splint. All patients underwend a continued antibiotic therapy, specific in 20 cases with isolated organisms. A total knee arthroplasty was performed, using a total posterior cruciate substituting prosthesis, 6 to 8 weeks after components removal (2-24). All patients received parenteral antibiotics after reimplantation for not less than 2 months (2-6). RESULTS: Infection was eradicated in 24 cases, 22 in one time, 2 bad second debridement. At last follow-up the average Hungerford score was 75.6/100, the average Knee society knee score was 80 and the average functional score was 70. Mean range of flexion was 95 degrees. 6 patients had recurrent infection and poor result. They underwent arthrodesis. 5 of the 6 patients had solid mature fusion at last follow-up. DISCUSSION: The results of two stage reimplantation for infected total knee replacement showed that this is the method of choice for infection treatment and acceptable function restoration. As other authors, we get a good success rate (82 per cent). Functional result was better with identified microorganisms, but we did not find any correlation with organisms type or infection length. Punction and bone scanning are of great help for diagnosis in difficult chronical cases. Organism identification is fundamental for infection duration. Staphylococcus epidermidis was the most frequent identified organism. New procedures using articulated cement spacer may improve functional results.

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The Rac target NADPH oxidase p67phox interacts preferentially with Rac2 rather than Rac1.

NADPH oxidase is a plasma membrane enzyme of phagocytes generating superoxide anions which serve as bactericidal agents. Activation of this multimolecular enzyme minimally requires assembly at the membrane with flavocytochrome b558 of cytosolic components p47phox, p67phox, and Rac proteins. Rac1 and Rac2 are 92% homologous cytosolic small GTPase proteins. Both Rac1 and Rac2 have been implicated with NADPH oxidase activation in vitro; however, Rac2 is largely predominant in human phagocytes. Here, using the yeast two-hybrid system, we provide data demonstrating in vivo interactions between human p47phox, p67phox, and Rac proteins. Rac proteins interact with p67phox in a GTP-dependent manner, but do not interact with p47phox. Moreover, Rac effector site mutants, which are known to be inactive in NADPH oxidase, lose their interaction with p67phox; Rac2L61 mutant, which has an increased NADPH oxidase affinity, shows an increased affinity for p67phox. Finally, we observe that p67phox interacts 6-fold better with Rac2 than with Rac1. We also show a strong intracellular interaction between p47phox and p67phox. These results indicate that activated Rac can regulate NADPH oxidase by interacting with p67phox and that Rac2 is the main p67phox-interacting GTPase in human cells.

Amino Acid Sequence↗

Bridging Ral GTPase to Rho pathways. RLIP76, a Ral effector with CDC42/Rac GTPase-activating protein activity.

Ra1A and Ra1B are GTPases of unknown function and are activated by proteins, Ra1GDS, that interact with the active form of another GTPase, Ras. To elucidate Ral function, we have searched for proteins interacting with an activated form of Ra1A using the two-hybrid method and a Jurkat cell library. We have identified a partial cDNA encoding a protein, RLIP1, which binds to activated Ra1A and this binding requires an intact effector domain of Ra1A. Biochemical data with purified Ra1A confirm the genetic results. This protein also bears a region of homology with GTPase-activating protein (GAP) domains that are involved in the regulation of GTPases of the Rho family and, indeed, RLIP1 displays a GAP activity acting upon Rac1 and CDC42, but not RhoA. This GAP region is not required for RLIP1 binding to Ra1. The whole cDNA was cloned, and it encodes a 76-kDa polypeptide, RLIP76, which also binds RalA. The Rho pathway is involved in membrane and cytoskeleton modifications after mitogenic stimulation and acts in parallel to and synergistically with the Ras pathway. We propose that these pathways are linked through a cascade composed of Ras --> Ra1GDS --> Ra1 --> RLIP76 --> CDC42/Rac1/Rho, allowing modulation of the Rho pathway by the Ras pathway.

ATP-Binding Cassette Transporters↗

[Uncemented knee prosthesis. Results apropos of 58 cases with a minimum of 5-year follow-up].

PURPOSE OF THE STUDY: The aim of this study was to evaluate, after at least 5 year's follow-up, the results of 64 PCA (TM) cementless total knee prostheses. MATERIAL: From 1984 to 1988, 13 male and 45 female patients (a total of 64 prostheses including 6 bilateral) received PCA Primary prostheses. Both femoral and tibial components were implanted without cement. Mean age of patients was 68.9 years (range: 35-81); mean patient height was 164.41 cm and mean weight 76.74 Kg. The most frequent pathology was gonarthrosis: 43 cases of medial gonarthrosis and 15 of lateral gonarthrosis. There were 4 cases of rheumatoid arthritis and two post-traumatic degenerative arthritis. 52 knees were free of any previous surgical procedure. Of the 64 prostheses and the 58 patients: 6 died and 2 were lost to follow-up; 56 knees were reviewed. The longest follow-up is 9 years for an average of 6.8 years. METHODS: Prosthetic review included clinical evaluation (Hungerford score based on 100 points, ISK rate based on 200 points) and complete radiological evaluation enabling the postoperative position of the implants to be examined. Radiolucencies were examined according to Ewald. X-ray study of polyethylene wear was performed based on the distance between the prosthetic condyle to the height of the metal tibial plateau. All patients were operated on by the same surgeon using the same procedure, and the same postoperative outcome. RESULTS: There were no local postoperative complications or any early reoperations. PHlebitis occurred in 12 per cent of cases. With the exception of 8 patients who were reoperated due to mechanical complications, the Hungerford score raised from 37.5 preoperatively to 88.3 postoperatively. The results of 43 of the 48 patients were rated good or excellent. The 200 point score rating gave 91 per cent of good and excellent results for knee examination, and 69 per cent of good and excellent results for knee function. Mean flexion angle was 107.8 degrees mean pain scored 45/50. Radiologically 75 per cent of operated patients had postoperative varus or valgus in the range 0-5 degrees as against 24 per cent preoperatively. The study of edge defects revealed the absence of any radiological abnormality on the femoral lateral projection in 85 per cent of cases, and the absence of abnormality on the tibial anteroposterior and lateral projections in more than 60 per cent of cases. X-ray study of polyethylene wear was conducted on 49 cases: polyethylene wear was observed radiologically in 1 of 4 cases. There was no correlation between polyethylene wear and polyethylene thickness, postoperative axes, body weight or clinical results. 8 patients had to be reoperated due to mechanical complications: 2 because of a tilting tibial plateau (due to a technical fault), 4 because of polyethylene wear and 2 because of patellar loosening (uncemented metal-back patellar implant). DISCUSSION: The implantation of femoral and tibial components of cementless PCA Primary fitted seems very satisfactory. With longer follow-up, we noted no tibial or femoral osteolysis signs such as those described by Engh, Peters or Berry in the USA. Stability of mid term radiographical results was commonly observed throughout our study. Only 5 very slight lateral displacements were noted: 3 cases of secondary LCP insufficiency with tibial posterior subluxation; in 2 cases the cause was R.A. CONCLUSION: The implantation of uncemented PCA Primary prosthesis caused non complications with respect to the femur. Regarding the tibia, only two reoperations were required because of tibial fixation failure due to a technical fault. The use of a hybrid prosthesis is not required. The microbeads used in PCA are effective but current availability of other materials promoting better bone growth (such as hydroxyapatite, titanium mesh) allows safe implantation of uncemented prostheses. PCA Primary polyethylene wear seems to develop steadily. This is why it should be replaced by the less

Adult↗

The small GTP-binding protein rac is not recruited to the plasma membrane upon NADPH oxidase activation in human neutrophils.

Superoxide generation by phagocytic cells requires assembly of the enzymatic complex NADPH oxidase, consisting of membranous and cytosolic components which translocate to the plasma membrane upon cell activation. Two highly homologous cytosolic small GTP-binding proteins, rac1 and rac2, have recently been implicated in the activation of NADPH oxidase. We report that, in resting neutrophils, the amount of rac detectable in the plasma membrane-enriched fraction accounted for 1.5% of the cytosolic protein. When the O2- generation was induced by stimulating neutrophils with PMA, fMLP or opsonized zymosan rac proteins were not recruited at the plasma membrane as analysed by immunoblot or immunofluorescence assays. We conclude that rac proteins do not assemble with the NADPH oxidase complex in the plasma membrane, and we propose that they might instead transduce translocation signals to the other cytosolic components.

Cell Adhesion↗

Regulation of p56lck kinase expression and control of DNA synthesis in activated human B lymphocytes.

In this study, we analyzed the expression and regulation of src kinase p56lck expression during human B lymphocyte activation. We show that upon mitogenic stimulation with anti-IgM antibodies and interleukin-2, specific mRNA for p56lck becomes detectable in B cells after 24 h of activation and is followed by an increase in p56lck protein expression on days 2 and 3. This up-regulation is specific for p56lck since expression of other src kinases such as fyn, lyn, or yes was not modified. Furthermore, immune complex kinase assays show that p56lck protein expressed on day 2 is associated with kinase activity. Experiments using lck-specific antisense oligonucleotides show that the G0-G1 transition does not require p56lck, whereas DNA synthesis is dependent upon its expression. Thus, our data demonstrate that p56lck expression is up-regulated during human B cell stimulation and this kinase plays an important role during the control of late steps of B lymphocyte activation such as S phase entry.

B-Lymphocytes↗

An insulinoma nuclear factor binding to GGGCCC motifs in human insulin gene.

Cell specific expression of the insulin gene is achieved through transcriptional mechanisms operating on 5' flanking DNA elements. In the enhancer of rat I insulin gene, two elements, the Nir and Far boxes, located at positions -104 and -233 respectively and containing the same octameric motif are essential for B cell specific transcription activity. Homologous sequences are present in the human insulin gene. While studying the binding of nuclear proteins from insulinoma cells to the -258/+241 region of the human insulin gene, we observed a previously undetected protein binding site in the intron I region between nucleotides +160 and +175. The binding activity was present in insulin producing cells such as RIN and HIT insulinoma cells but not in fibroblasts or insulin negative fibroblast x RIN hybrid cells. DNAse I footprinting and gel retardation/methylation interference experiments allowed us to define the core binding site of the intron binding factor as a GGGCCC hexamer. This factor is also capable to bind to a related sequence, contiguous to the Far-like element in rat and human insulin genes. The binding of the GGGCCC binding factor in this critical region of the insulin gene enhancer may participate in the regulation of insulin gene expression.

Animals↗

[Reoperation after failure of unicompartmental knee prosthesis. Therapeutic strategy and results based on 40 cases].

Forty revisions for failure of unicompartmental knee prostheses were assessed. Twenty-eight women and twelve men (mean age: 67 years) were reoperated. Failure of an medial single-compartment prosthesis was involved in 35 cases, of a lateral prosthesis in 5 cases. The initial prostheses had been cemented in 19 cases and uncemented in 21 cases. Preoperative functional conditions were assessed by Hungerford's functional score and a 200-points score. The radiological study before revision showed 35 cases of varus distortion; in 12 of these, the varus distortion exceeded 10 degrees. Rather than studying the causes for failure of the single-compartment prosthesis, it seemed more useful to try to define the adequate reoperation procedure strategy and analyze its results. Our procedure aimed at solving the following difficulties: surgical approach: the same incision as in the initial operation was performed, the primary prosthesis was removed and a two-stage treatment was justified in cases of infection, metallosis involved complete removal of debris, the problem of bone-recutting and, chiefly, the problem of residual bone defect requiring bone-graft. Bone-recutting was performed with the tibial and femoral elements of the primary prosthesis still in place and using the ancillary equipment of the new prosthesis. Bone defects involved the femur as often (14 cases) as the tibia (12 cases); tibial bone defects occurred more frequently with cemented prostheses (9 cases) than with uncemented prostheses (3 cases). Femoral graft being relatively easier to perform one of the two major difficulties in our strategy was the achievement of a tibial graft.(ABSTRACT TRUNCATED AT 250 WORDS)

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