Inside-out Technique Research Articles

Isoliquiritigenin, a flavonoid from licorice, relaxes guinea-pig tracheal smooth muscle in vitro and in vivo: Role of cGMP/PKG pathway

Licorice root is used to treat asthma as a component of Shaoyao-Gancao-tang, a traditional Chinese medicine formula. In this study, we investigated the tracheal relaxation effects of isoliquiritigenin, a flavonoid isolated from the roots of Glycyrrhiza glabra (a kind of Licorice), on guinea-pig tracheal smooth muscle in vitro and in vivo. The tension changes of isolated tracheal rings were isometrically recorded on a polygraph. The large-conductance Ca 2+-activated K + channels (BK Ca) were measured by inside-out patch-clamp techniques and intracellular Ca 2+ concentrations ([Ca 2+] i) were tested by microfluorometric method in guinea-pig tracheal smooth muscle cells (TSMCs). Isoliquiritigenin produced concentration-dependent relaxation in isolated guinea-pig tracheal rings precontracted with acetylcholine, KCl, and histamine. Pretreatments with charybdotoxin, ODQ and KT5823 attenuated the relaxation induced by isoliquiritigenin. Isoliquiritigenin significantly increased intracellular cGMP level in cultured TSMCs and inhibited the activity of phosphodiesterase (PDE) 5 in human platelets. Moreover, isoliquiritigenin increased by 9-fold the probability of BK Ca channel openings of TSMCs in inside-out patches and markedly reduced [Ca 2+] i rise induced by acetylcholine in TSMCs, pretreatment with KT5823 attenuated above two responses to isoliquiritigenin. In vivo experiment isoliquiritigenin significantly prolonged the latency time of histamine–acetylcholine aerosol-induced collapse and inhibited the increase of lung overflow induced by intravenously administered histamine dose-dependently. These data indicate that isoliquiritigenin relaxes guinea-pig trachea through a multiple of intracellular actions, including sGC activation, inhibition of PDEs, and associated activation of the cGMP/PKG signaling cascade, leading to the opening of BK Ca channels and [Ca 2+] i decrease through PKG-dependent mechanism and thus to tracheal relaxation.

Transobturator tapes for stress urinary incontinence: Results of the Austrian registry

We established a voluntary registry to collect data on the perioperative course of transobturator tape operations for stress incontinence. Forty-seven centers completed a 1-page, 15-item questionnaire per procedure. Data on a total of 2543 operations with 11 different tape systems were collected. Intraoperative complications were noted for 120 procedures (4.7%). These included 85 cases of increased bleeding (3.3%), 10 vaginal perforations (0.4%), 10 bladder perforations (0.4%), and 2 urethral perforations. Reoperations attributable to the tape procedure were reported for 57 patients (24 tapes cut or loosened for voiding dysfunction, 11 vaginal erosions, 7 abscesses with erosions). One patient was reoperated at 14 days for a retropubic hematoma. There were no reports of bowel or major vessel injuries or mortality. Significant postoperative pain was reported for 12 patients (0.5%), although this was not specifically asked for in the questionnaire. Significant complications with transobturator tapes are uncommon. Bladder perforations occurred more frequently with outside-in than with inside-out techniques. Vaginal erosions, abscesses, and pain may be more common with transobturator than with retropubic tapes, and this may be due to the structure of the tapes rather than to the route of passage.

Prevention of Lower Eyelid Malposition After Blepharoplasty

To determine the position of the lower eyelid and lateral canthus after release of the lower eyelid retractors with the "inside-out technique" by measuring the marginal reflex distance 2 (MRD2) and using the lateral canthal rounding scale. Retrospective analysis. Of the 171 patients who underwent inside-out blepharoplasty, 78 were followed up for 3 months. Preoperative MRD2 was 0.942 pixels. Postoperatively, the modified MRD2 was 0.903. Although the score of the modified MRD2 was found to decrease postoperatively, the decrease was not statistically significant (P < .07). The lateral rounding scale reviewed an average preoperative score of 2.04 and a postoperative score of 1.99. There was no statistical difference between pre- and postoperative observations based on a 1-tailed t test. No complications were reported. Using photographic analysis, the study found no difference in lateral canthal shape or MRD2 before and after surgery in patients who underwent inside-out blepharoplasty.

Modulation of human cardiovascular outward rectifying chloride channel by intra- and extracellular ATP

The macroscopic volume-regulated anion current (VRAC) is regulated by both intracellular and extracellular ATP, which has important implications in signaling and regulation of cellular excitability. The outwardly rectifying Cl(-) channel (ORCC) is a major contributor to the VRAC. This study investigated the effects of intracellular and extracellular ATP on the ORCCs expressed in the human cardiovascular system. With inside-out single-channel patch-clamp techniques, ORCCs were recorded from myocytes isolated from human atrium and septal ventricle and from primary cells originating from human coronary artery endothelium and human coronary artery smooth muscle. ORCCs from all of these tissues had similar biophysical properties, i.e., they were outwardly rectifying in symmetrical Cl(-) solutions, exhibited a slope conductance of approximately 90-100 pS at positive potentials and approximately 22 pS at negative potentials, and had a high open probability that was independent of voltage or time. The presence of ATP at the cytosolic face of the membrane increased the number of patches that contained functional ORCC but had no effect on gating. In contrast, "extracellular" ATP (in pipette solution) had no effect on the proportion of patches in which ORCC was detected but strongly reduced the open probability by increasing the closed dwell time. The potency order for nucleotides to affect gating was ATPgammaS > ATP = UTP > ADP > AMP, which suggests that a negatively charged phosphate group is involved in ORCC block. Our findings are consistent with a role of ORCC in the human cardiovasculature (atrium, ventricle, and coronary arteries). Regulation of ORCC by extracellular ATP suggests that this channel may have an important role in maintaining electrical activity and membrane potential under conditions in which extracellular ATP levels are elevated, such as with ATP release from nerve endings or during pathophysiological conditions.

All-Inside Suture Technique Using Anterior Portals in Posterior Horn Tears of Lateral Meniscus

Methods for the repair of meniscal tears include inside-out, outside-in, and all-inside techniques. In this article an all-inside technique is proposed for the posterior horn of the lateral meniscus that takes advantage of the capacious posterolateral recess when the knee is flexed. A device consisting of a large needle with a buttonhole in the tip (previously used for inside-out suture of the medial meniscus) is used. This technique uses only anterior portals (anteromedial and anterolateral portals and an accessory lateral or transpatellar tendon portal). The arthroscope is inserted through the accessory portal. Once the tear has been located and its edges refreshed, the suture device is placed anterolaterally. The tip of the needle is loaded with suture and passed through both sides of the tear and into the posterolateral recess of the knee (without exiting the capsule). The suture tail is recovered with the use of a suture retriever through the anteromedial portal. Next, the suture retriever is inserted through the anterolateral portal to once again retrieve and shuttle the tail before completion of an arthroscopic knot. In addition to the ease of the technique, use of this simple, reusable device adds the benefit of low cost when compared with other techniques.

Transobturator surgery for female stress incontinence: a comparative anatomical study of outside‐in vs inside‐out techniques

OBJECTIVE To assess the specific risks of injury to neural and vascular structures inherent in two approaches to transobturator surgery for inserting a suburethral sling, i.e. the outside-in (standard technique) and inside-out approaches. MATERIALS AND METHODS The study comprised seven cadavers, providing 14 obturator regions. Five specimens had a tape inserted outside-in on one side, and inside-out on the other; of the remaining two cadavers, one had an inside-out tape and one an outside-in tape, bilaterally. After tape insertion, the cadavers were dissected. Particular attention was paid to the distances between the tape and the deep external pudendal vessels, and between the tape and the posterior branch of the obturator nerve. RESULTS With the inside-out technique, the safety margins were reduced, and the external pudendal vessels and the posterior branch of the obturator nerve were at greater risk of injury. CONCLUSION The two techniques are not equivalent, with a lower risk of injury to vascular and nerve structures with the outside-in technique.

Modified Posterior Portals for Hindfoot Arthroscopy

The purpose of this study was to determine the course and safe distances achieved with modified coaxial portals for hindfoot arthroscopy and report the clinical results. We used 30 embalmed cadaveric ankle specimens and 10 fresh-frozen ankle specimens for anatomic measurements and trial operations. The posteromedial portal via the posterior tibial tendon sheath was first established. The posterolateral portal was subsequently created immediately behind the posterior border of the lateral malleolus and anterior to the peroneal tendons via an inside-out technique. The coaxial portals were finally established with cannulas left in place. In the clinical series, posterior ankle arthroscopy was performed on 18 ankles in 15 patients. All patients were evaluated for any complications with a mean follow-up of 38 months. The posterior tibial nerve, posterior tibial artery, and peroneal artery were located a mean distance of 8.7 mm, 10.1 mm, and 12.9 mm, respectively, from the near edge of the Kirschner wire as a reference to the coaxial portals. The sural nerve and lesser saphenous vein were at greater distances of 27.6 mm and 28.3 mm, respectively. The mean West Point score at the time of the latest follow-up was 91.5 points (range, 76 to 100 points), and there were 9 excellent results, 3 good results, and 1 fair result. No patients showed any complications related to the modified coaxial portals. The modified coaxial portals seemed to have large distances to the neurovascular structures in our anatomic study. Clinically, this technique was safe, effective, and reproducible. Level IV, therapeutic case series.

Arthroscopic all-inside repair of Palmer type 1B triangular fibrocartilage complex tears: a technical note

Arthroscopic repair of peripheral dorso-ulnar triangular fibrocartilage complex (TFCC) lesions is now a preferred method. Both outside-in and inside-out techniques are commonly performed for repairing Palmer type 1B TFCC tear. But these techniques have disadvantages of making an additional skin incision to tie knots subcutaneously over the capsule. We performed an arthroscopic all-inside repair technique of Palmer type 1B TFCC tears, which is a modified method of the outside-in technique using a spinal needle. This all-inside technique is as simple as previously described arthroscopic techniques and also has advantages of vertical mattress suture and no additional incision. We recommend this technique as a useful alternative to the others for repairing Palmer type 1B TFCC tear.

Replacement of the Meniscus with a Collagen Implant (CMI).

Replacement of an almost completely absent medial meniscus with a collagen implant (CMI), reconstruction of form and function of the medial meniscus, delay of the development of arthrosis deformans. Subtotal degenerative or traumatic loss of the medial meniscus, stable meniscal periphery, stable anterior and posterior meniscal insertions, joint with stable ligaments. Complete loss of the medial meniscus. Untreated knee ligament instability. Extreme varus deformity. Extensive cartilaginous damage, i.e., levels IV and VI as described by Bauer and Jackson. Advanced unicompartmental or generalized arthrosis. Replacement of the lateral meniscus. Standard anterior arthroscopy portals. Resection of the medial meniscus leaving a complete and stable outer rim. Revitalization of the periphery to promote healing. Measurement of defect size. Insertion and fixation of the CMI with nonresorbable suture material in inside-out technique. Postoperative knee brace with limited motion in extension/flexion of 0/0/60° until week 4, 0/0/90° until week 6. Coutinuous passive motion within the limits of motion from the 1st postoperative day, actively assisted physiotherapy. No weight bearing for 6 weeks, then increased weight bearing for 2 weeks until full weight bearing is achieved. Cycling can commence from 3 months postoperatively. Full sporting activity after 6 months. 60 patients (19-68 years, average 41.6 years) with subtotal loss of the medial meniscus and varus morphotype were treated from January 2001 to May 2004 as part of a prospective, randomized, arthroscopically controlled study. The sample consisted of 30 patients with high tibial valgus osteotomy combined with implantation of a CMI, and 30 patients with valgization correction osteotomy only. The CMI had to be removed from one patient because of a dislocation. Evaluation on the Lysholm Score, IKDC (International Knee Documentation Committee), and subjective pain data revealed only slight, nonsignificant differences for 39 patients after 24 months (CMI and correction n = 23; correction only n = 16). The chondroprotective effect of the CMI in the long term remains to be seen.

Transobturator suburethral tapes in the management of urinary incontinence: success, safety and impact on sexual life

This study aims to assess transobturator tension-free vaginal tapes (TOT) in regard to subjective cure rates, patient satisfaction, long-term morbidity and impact on patients’ sexual life. It also aims to compare the safety profile of two TOTs: Obtape (outside-in technique) vs. TVT-O (inside-out technique). This is a retrospective study of all patients who had a TOT procedure for the management of urodynamic stress incontinence (USI) in a tertiary referral centre between July 2002 and January 2005. All patients identified from theatre records were sent an anonymous validated assessment questionnaire including the urinary domain of Birmingham Bowel and Urinary Symptoms Questionnaire, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Sexual Impact Questionnaire and a visual analogue scale (VAS) to assess patients’ satisfaction. Case notes were examined to ascertain preoperative urodynamic diagnosis and perioperative complications. Two hundred and seventy-six women were identified from theatre records: 94 patients underwent TVT-O and 182 underwent Obtape . Mean age was 49 (range 34–78) years, and mean parity was two (range: 0–6). There was no difference between groups in regard to body mass index, urodynamic diagnosis and previous incontinence surgery. Intraoperative complications included bladder injury 0.4%, urethral injury 0.7%, lateral vaginal tears 4.3% and blood loss >200 ml in 5.4%. There was no statistically significant difference in intraoperative (p = 0.2) and early postoperative (p = 0.65) complications between groups. Late postoperative complications were mainly related to the tape material and included de novo urgency (6.9%), vaginal erosions (5.1%) and ischiorectal abscess (1.1%). A significantly higher rate of late postoperative complications occurred in the Obtape group (p = 0.047). Median follow-up was 28 ± standard deviation (SD) 4.8 (range 10–40) months. Subjective success rate, defined as absent or occasional episodes of incontinence according to the ICIQ-SF was 86% in the USI group compared with 52.4% in the mixed incontinence group (p < 0.001). Following the operation, there was no significant change in patients’ sexual life as regards frequency of intercourse and pleasure and/or pain during penetration (p = 1.000), whereas there was significant decrease in coital incontinence (p < 0.0001). TOT is a relatively safe procedure in the treatment of USI and is associated with a high subjective success rate with a median follow-up of 28 months. Coital incontinence is likely to be cured, and the vast majority of women described an improvement or no change in their sexual life following the TOT procedure. There was no significant difference in the complication rates between the outside-in vs. the inside-out techniques; however, significantly more “tape-related complications” occurred in the Obtape group.

Risk to the Lateral Geniculate Artery During Arthroscopic Lateral Meniscal Suture Passage

The purpose of this study was to evaluate the risk of lateral geniculate artery injury during suture passage through the lateral meniscus. Sutures were passed via inside-out and outside-in techniques in 11 embalmed cadaveric knees. The number of punctures of the lateral geniculate artery and quantitative distances of needle penetrations were measured. The lateral geniculate artery was punctured 7 times during inside-out passes through the junction of the middle and anterior third of the meniscus and 8 times during passes through the body of the middle third of the meniscus. During outside-in passes, there were 5 punctures when passing anterior to the lateral collateral ligament and 4 punctures when posterior to the ligament. The lateral geniculate artery is in close proximity to the lateral meniscus and is punctured often during in vitro inside-out meniscal repair in the embalmed cadaver model. Methods of meniscal repair that do not violate the lateral geniculate artery may offer improved rates of healing and should be further evaluated.

Isoflurane Activates Sarcolemmal Adenosine Triphosphate-sensitive Potassium Channels in Vascular Smooth Muscle Cells

Recent evidence indicates that vascular adenosine triphosphate-sensitive potassium (K(ATP)) channels in vascular smooth muscle cells are critical in the regulation of vascular tonus under both physiologic and pathophysiologic conditions. Studies of the interaction of volatile anesthetics with vascular K(ATP) channels have been limited. In the current study, the authors investigated the molecular mechanism of isoflurane's action on vascular K(ATP) channels. Electrophysiologic experiments were performed using cell-attached and inside-out patch clamp techniques to monitor native vascular K(ATP) channels, and recombinant K(ATP) channels comprised of inwardly rectifying potassium channel subunits (Kir6.1) and the sulfonylurea receptor (SUR2B). Isometric tension experiments were performed in rat thoracic aortic rings without endothelium. Application of isoflurane (0.5 mM) to the bath solution during cell-attached recordings induced a significant increase in K(ATP) channel activity, which was greatly reduced by pretreatment with a selective inhibitor of protein kinase A (PKA), Rp-cAMPS (100 microM). In inside-out patches, isoflurane did not activate K(ATP) channels. Isoflurane significantly activated wild-type recombinant SUR2B/Kir6.1 in cell-attached patches. Isoflurane-induced activation of wild-type channels was diminished in the PKA-insensitive mutant SUR2B-T633A/Kir6.1, SUR2B-S1465A/Kir6.1, and SUR2B/Kir6.1-S385A. In addition, the authors demonstrated that isoflurane-induced PKA activation was associated with isoflurane-induced decreases in isometric tension in the rat aorta. These results indicate that isoflurane activates K(ATP) channels via PKA activation. PKA-dependent vasodilation induced by isoflurane also was observed in isometric tension experiments. Analysis of expressed vascular-type K(ATP) channels suggested that PKA-mediated phosphorylation of both Kir6.1 and SUR2B subunits plays a pivotal role in isoflurane-induced vascular K(ATP) channel activation.

The Axillary Pouch Portal: A New Posterior Portal for Visualization and Instrumentation in the Inferior Glenohumeral Recess

Arthroscopic access to the inferior glenohumeral recess is necessary in several surgical procedures on the shoulder. Posteroinferior portals described for access to this region may pose a theoretic risk to the posterior neurovascular structures (outside-in technique) and to the articular cartilage (inside-out technique). The first author (D.N.B.) has devised a new posterior portal that permits direct linear access to the entire inferior glenohumeral recess. The portal is placed higher and more lateral compared with the previously described portals; this places it further away from the posterior neurovascular structures and facilitates linear access to the axillary pouch. The portal is created via an outside-inside technique, with a spinal needle to ascertain the correct portal site and angulation. The portal is placed at a mean distance of 20.45 ± 4.9 mm (range, 15 to 35 mm) directly inferior to the lower border of the posterolateral acromial angle and 21.3 ± 2 mm (range, 20 to 25 mm) lateral to the posterior viewing portal. The spinal needle or cannula is angulated medially at a mean of 30.6° ± 4.7° (range, 25° to 40°) in the axial plane and slightly inferiorly (mean, 2°; range, 20° superiorly to 20° inferiorly). Use of 30° and 70° arthroscopes through the axillary pouch portal facilitates visualization of the entire recess and of the humeral attachment of the inferior glenohumeral ligament complex for evaluation of humeral avulsion of the glenohumeral ligament lesions. The portal also permits instrumentation in combination with the standard posterior or anterosuperior viewing portal for removal of loose bodies, synovectomy, capsular shrinkage, capsulotomy, and anchor placement in the posteroinferior glenoid rim.

Arthroscopically Assisted Percutaneous Repair of Fresh Closed Achilles Tendon Rupture by Kessler's Suture

Background Achilles tendon ruptures are difficult to repair, and the healing rate is low due to this structure's anatomic and physiological characteristics. It is essential to develop new techniques to increase the healing rate and decrease the rate of complications. Objective To propose and evaluate a new percutaneous method of repairing fresh closed Achilles tendon ruptures by Kessler's suture under arthroscopy. Study Design Case series; Level of evidence, 4. Methods Twenty patients were followed at least 12 months in this study. First, the torn ends of the Achilles tendon were debrided during arthroscopy. Then percutaneous repair of the Achilles tendon was performed using Kessler's suture by an inside-out technique. All cases were followed up for an average range of 21 months (range, 12-36 months). All patients were evaluated by clinical examination, magnetic resonance imaging, and the Lindholm scale. Results The torn ends were well aligned and sutured after the debridement under arthroscopy. According to the Lindholm scale, excellent results were seen in 15 cases and good in 5 cases. No patients had complications such as nerve injury, infection, or re-rupture at follow-up. Magnetic resonance imaging results showed that the ruptured Achilles tendons were repaired and remodeled very well in all patients. Conclusion The present method is an effective surgical technique for repair of a closed rupture of the Achilles tendon. The short-term follow-up results were good, and recovery time was short. Few complications were found in our study cases.

Anatomic Comparison of Two Transobturator Tape Procedures

Both outside-in and inside-out methods are available for transobturator tape placement. Our objective was to compare these methods regarding proximity of the tape to the obturator canal and ischiopubic ramus. Using seven fresh frozen cadavers, transobturator tapes were placed using the inside-out (TVT-Obturator System, Gynecare, Ethicon Inc, Somerville, NJ) and outside-in (Monarc, American Medical Systems, Minnetonka, MN) methods bilaterally in each cadaver. We dissected to the level of the obturator membrane and measured the distance from the closest aspect of the obturator canal and ischiopubic ramus to each tape. Transobturator tapes placed by using the inside-out technique were significantly closer to the obturator canal than with the outside-in method (mean distances: 1.3+/-0.44 cm compared with 2.3+/-0.41 cm, respectively, P<.001); the greater proximity of the inside-out method was noted in all dissections. Tapes placed with the inside-out method were also farther from the ischiopubic ramus than those placed with the outside-in approach (mean distances: 0.39+/-0.44 cm compared with 0.04+/-0.13 cm, respectively, P=.008). When distances between the tapes relative to the obturator canal were further analyzed according to left or right side, the difference between methods was maintained. Additionally, the distances were consistently farther from the obturator canal on the left side than on the right side regardless of transobturator tape approach. The outside-in technique results in the mesh being placed farther from the obturator canal and closer to the ischiopubic ramus, theoretically reducing the risk of neurovascular injury. II.

Arthroscopic Treatment of Symptomatic Discoid Meniscus in Children: Classification, Technique, and Results

The purpose of this study was to review the operative results of children and young adults treated arthroscopically for symptomatic discoid lateral menisci. The medical records and radiographic studies of 27 consecutive patients (30 knees) who underwent arthroscopic treatment for symptomatic discoid meniscus between 1998 and 2002 were reviewed. The mean patient age was 10.1 years (range, 3 to 20 years), with 19 female and 8 male patients. The mean duration of symptoms before surgery was 13.9 months, with 28 knees (93%) having pain and 20 knees (67%) having mechanical symptoms. All patients were treated arthroscopically. Arthroscopic saucerization was successful in 28 of 30 knees. In 2 cases with large complex tears meniscal salvage was not possible and a complete arthroscopic meniscectomy was performed. Operative classification of the menisci revealed 22 complete (4 Wrisberg type) and 8 incomplete discoid menisci, with meniscal tears being present in 23 of 30 (77%). Meniscal instability was noted in 77% of knees (23 of 30), with anterior horn instability in 53% (n = 16), posterior instability in 16% (n = 5), and combined anterior and posterior instability in 6% (n = 2). All cases of anterior horn instability were treated with an outside-in arthroscopic repair technique, whereas all cases of posterior horn instability were treated with meniscal repair via an inside-out arthroscopic technique. Twenty-one patients (23 knees) had full follow-up of greater than 1 year. For these 21 patients, the mean length of follow-up was 37.4 months (range, 12 to 77 months), and at final follow-up, all patients exhibited full knee flexion beyond 135 degrees. Three patients reported residual knee pain, and four reported intermittent mechanical symptoms. At final follow-up, 2 patients felt that their activity level remained partially limited. Our results show the short-term efficacy of arthroscopic saucerization and repair to the capsule in selected cases of symptomatic discoid menisci. On the basis of this experience and other recent reports documenting a high rate of anterior horn instability, an arthroscopic classification system for discoid lateral menisci is proposed. Menisci are classified as complete or incomplete discoid and are then subclassified based on the presence of instability as a result of deficient capsular attachment and, finally, based on the location of the absent capsular attachment. Level IV, therapeutic case series.

Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study

To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension-free vaginal tape (TOT) procedure. Retrospective cohort study. Tertiary referral urogynaecology centre. 390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006. Early cases were identified from theatre records and a case note review performed. From May 2005 (n = 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer's exact test. Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the 'outside-in' and 'inside-out' techniques. 241 women underwent TOT outside-in technique and 148 of them underwent inside-out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside-in group, although this difference did not reach significance (P = 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures. LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside-in technique. Intraoperative cystoscopy should be considered only in selected cases.

Metabolic regulation of sodium–calcium exchange by intracellular acyl CoAs

The sodium-calcium exchanger (NCX) is a critical mediator of calcium homeostasis. In the heart, NCX1 predominantly operates in forward mode to extrude Ca(2+); however, reverse-mode NCX1 activity during ischemia/reperfusion (IR) contributes to Ca(2+) loading and electrical and contractile dysfunction. IR injury has also been associated with altered fat metabolism and accumulation of long-chain acyl CoA esters. Here, we show that acyl CoAs are novel, endogenous activators of reverse-mode NCX1 activity, exhibiting chain length and saturation dependence, with longer chain saturated acyl moieties being the most effective NCX1 activators. These results implicate dietary fat composition as a plausible determinant of IR injury. We further show that acyl CoAs may interact directly with the XIP (exchanger inhibitory peptide) sequence, a known region of anionic lipid modulation, to dynamically regulate NCX1 activity and Ca(2+) homeostasis. Additionally, our findings have broad implications for the coupling of Ca(2+) homeostasis to fat metabolism in a variety of tissues.

Short-range Molecular Rearrangements in Ion Channels Detected by Tryptophan Quenching of Bimane Fluorescence

Ion channels are allosteric membrane proteins that open and close an ion-permeable pore in response to various stimuli. This gating process provides the regulation that underlies electrical signaling events such as action potentials, postsynaptic potentials, and sensory receptor potentials. Recently, the molecular structures of a number of ion channels and channel domains have been solved by x-ray crystallography. These structures have highlighted a gap in our understanding of the relationship between a channel's function and its structure. Here we introduce a new technique to fill this gap by simultaneously measuring the channel function with the inside-out patch-clamp technique and the channel structure with fluorescence spectroscopy. The structure and dynamics of short-range interactions in the channel can be measured by the presence of quenching of a covalently attached bimane fluorophore by a nearby tryptophan residue in the channel. This approach was applied to study the gating rearrangements in the bovine rod cyclic nucleotide-gated ion channel CNGA1 where it was found that C481 moves towards A461 during the opening allosteric transition induced by cyclic nucleotide. The approach offers new hope for elucidating the gating rearrangements in channels of known structure.

All-Inside Meniscal Repair Using a New Flexible, Tensionable Device

Background A new generation of flexible all-inside meniscal repair devices is available, but clinical studies with these devices are lacking. Hypothesis The RapidLoc has an intermediate-term meniscal healing rate that is equivalent to literature reports of inside-out suture technique in patients undergoing concurrent anterior cruciate ligament reconstruction. Study Design Case series; Level of evidence, 4. Methods Retrospective analysis was performed for 75 meniscal tears in 66 consecutive patients undergoing anterior cruciate ligament reconstruction who underwent meniscal repair with the RapidLoc. Patients with at least 2 years’ follow-up were evaluated for symptoms suggestive of a meniscal tear and were assessed with the International Knee Documentation Committee form and the Knee Disorders Subjective History visual analog scale. Subjects were asked to return for a clinical examination to include evaluation for an effusion and joint line tenderness as well as McMurray test and KT-1000 arthrometry readings. Patients with symptoms consistent with meniscal repair failure underwent magnetic resonance arthrography and repeat arthroscopy. Results Twenty patients with 21 meniscal tears were excluded, resulting in 54 meniscal tears in 46 patients. At a mean follow-up of 34.8 months, the clinical success rate for meniscal repair was 90.7% (49/54), with 5 failures requiring meniscectomy. Univariate analysis revealed predictive variables for failure: bucket-handle configuration, multiplanar tears, tear length greater than 2 cm, and chronicity longer than 3 months. Nonpredictive variables included compartment, zone, ligament graft choice, gender, age, follow-up, and visual analog scale score. Analysis of healed patients revealed a negative correlation between chronicity of tear and International Knee Documentation Committee score. Conclusions The RapidLoc has an acceptable intermediate-term clinical healing rate in patients undergoing concurrent anterior cruciate ligament reconstruction. Predictive variables for failure should be considered during operative decision making.