A rice exocyst subunit gene SEC3A is required for anther dehiscence

Anther dehiscence controls optimal interaction between pollen and stigma,thereby determining the successful sexual reproduction.The regulators or mechanisms of this process remain elusive.Here,two CRISPR/Cas9 mutants of a rice exocyst subunit gene SEC3A,sec3a-1 and sec3a-2,showed anther indehiscence at anthesis and male sterility at maturity.Pollen viability and germination in the mutants were partly defective,whereas their female gametes undergone a normal development.Hybrid or self-pollinated seeds could be produced by artificial pollination,suggesting potential use of a weak sec3a mutant as a female line during hybrid breeding.SEC3A is widely expressed in various tissues,including anther walls.Further results showed an excessive IAA accumulation and no endothecium lignification in sec3a-1/2 anthers.Our findings suggest that SEC3A appears to regulate anther dehiscence by modulating auxin signaling,providing insights into regulation of anther dehiscence and function of exocyst in plants.

R2R3-type Lo MYB21 affects jasmonate-regulated development and dehiscence of anthers in lily(Lilium oriental hybrids)

Lilies are widely cultivated for cut flowers,but their large anthers carry a considerable amount of colored pollen that is dispersed easily.Studying the molecular mechanism of anther development and dehiscence could help solve this problem.LoMYB21,encoding a putative R2R3v-myb avian myeloblastosis viral oncogene homolog(MYB)transcription factor,was identified from oriental lilies(Lilium‘Siberia’).Real-time quantitative PCR analysis showed that LoMYB21 was mainly expressed in the anther,filament and stigma and had high expression during the late stages of lily anther development.LoMYB21 had transactivation activity and was located in the nucleus through yeast one-hybrid assays and transient expression in Nicotiana benthamiana.Suppression of LoMYB21 by virus-induced gene silencing(VIGS)in Lilium‘Siberia’led to anther indehiscence and reduced the expression of genes related to Jasmonate acid(JA)biosynthesis and signal transduction.Induction of LoMYB21 in DEX::LoMYB21 transgenic Arabidopsis caused procumbent inflorescences that became infertile,accompanied by higher expression of JA biosynthetic and signaling genes.These results demonstrated that JA content and signaling were abnormal in silenced lily and transgenic LoMYB21 Arabidopsis,which affected anther development.Our study indicated that LoMYB21 could regulate lily anther dehiscence through JA biosynthesis and signaling during the late stages of anther development.

Investigation of serum calcium and vitamin D levels in superior semicircular canal dehiscence syndrome: A case control study

Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group.Methods: This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period(2015-2019) compared to a gender and age matched control group. The main outcome of the study was adjusted calcium and Vitamin D levels between the two groups.Results: A total of 31 SSCD patients were recruited with a matched number of control patients. The mean Vitamin D level on the SSCD group was 44.8 nmoL/l(SD: 20.8) compared to 47.5 nmoL/l(SD: 27.4) on the control group(p = 0.702). Mean Adjusted calcium level was 2.34 mmoL/l(SD: 0.7) for SSCD compared to2.41 mmoL/l(SD: 0.11) for controls(p = 0.01), being within normal limits for both the SSCD and the control group.Conclusion: Our study did not identify a link between Vitamin D levels and presence of SSCD. Normal adjusted calcium values were found in both groups. Despite that a statistically significant lower calcium level was found in the SSCD group which could indicate that suboptimal levels of calcium may affect the micro-environment of the otic capsule at the SSC region.

An evidenced-based diagnostic tool for superior semicircular canal dehiscence syndrome

Purpose:To construct a symptoms-based prediction tool to assess the likelihood of superior canal dehiscence(SSCD)on high-resolution CT.Materials and methods:Mathematical modeling was employed to predict radiologic evidence of SSCD at a tertiary neurotology referral center.Results:A total of 168 patients were included,of which 118 had imaging-confirmed SSCD.On univariate analysis significant predictors of SSCD presence were:sound/pressure-induced vertigo(p?0.006),disequilibrium(p?0.008),hyperacusis(p?0.008),and autophony(p?0.034).Multivariate analysis enabled a 14-point symptom-weighted tool to be developed,wherein a score of6 raised the suspicion of SSCD(70%likelihood of being present),R2?0.853.Conclusions:The likelihood of SSCD on CT scan can be determined with a high degree of certainty based on symptoms recorded at presentation.Using the evidenced-based diagnostic tool validated herein,a score6 with any symptom combination justifies ordering a CT scan.

Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

Utilization of negative pressure wound therapy with instillation (NPWTi) for sternal dehiscence wounds secondary to sternal wound infection after surgery has become an accepted therapy. NPWTi accelerates wound healing through macrostrain, microstrain, and cyclic fluid instillation. Wounds benefit from additional superficial infection control with the removal of microorganisms, the release of proinflammatory mediators, stimulation of angiogenesis, as well as mechanical debridement. However, very few cases of utilizing NPWTi in the treatment of sternal wound infections have been reported in the literature. This case study describes the use of NPWTi with hypochlorous acid for the treatment of a sternal wound infection.

Mapping of QTLs for Dehiscence Length at Basal Part of Thecae in Rice Based on TD70/Kasalath RIL Population

A population of 240 recombinant inbred lines （RIL） was derived from a cross between Japonica rice cultivar TD70 and Indica cultivar Kasalath, and their linkage map including 141 SSR markers was used to locate the QTLs controlling the length of dehiscence at the basal part of thecae （LDBT）. Then, the correlations between LDBT and other agronomic traits of rice were analyzed. Two QTLs con- trolling LDBT were mapped on chromosome 6 and 8, respectively, qLDBT6 was mapped between RM3 and RM3628 markers on chromosome 6 with a LOD value of 3.23, contribution rate of 6.18% and additive effect of 17.74%. qLDBT8 was mapped between RM1376-RM4085 markers on chromosome 8 with a LOD value 2.95, contribution rate of 8.00% and additive effect of 20.09%. This domain probably had a relationship with the sterility of rice. The LDBT of RILs had extremely signifi- cant positive correlations with flag leaf width, 1 000-grain weight, grain width, grain length and grain thickness, but no significant correlations with other agronomic traits, such as plant height, heading date, tiller number, flag leaf length, average and the maximum temperature during heading period or rice.

Temporal bone anatomy characteristics in superior semicircular canal dehiscence

Introduction: Superior semicircular canal dehiscence(SCD) remains difficult to diagnose despite advances in high-resolution computed tomography(HRCT) imaging. We hypothesize possible associations between gross temporal bone anatomy and sub-millimeter pathology of the semicircular canals, which may supplement imaging and clinical suspicion. This pilot study investigates differences in gross temporal bone anatomic parameters between temporal bones with and without SCD.Methods: Records were reviewed for 18 patients referred to an otology clinic complaining of dizziness with normal caloric stimulation results indicative of non-vestibular findings. Eleven patients had normal temporal bone anatomy while seven had SCD. Three-dimensional reconstruction of every patient's temporal bone anatomy was created from patient-specific computational tomography images. Surface area(SA),volume(V), and SA to V ratios(SA:V) were computed across temporal bone anatomical parameters.Results: SCD temporal bones have significantly smaller V, and larger temporal bone SA. Mean(±SD) V was 21,484 ± 3,921 mm^3 in temporal bones without SCD and 16,343 ± 34,471 mm^3 for those with SCD. Their respective SA were 13,733 ± 1,603 mm^2 and 18,073 ± 3,002 mm^2.Temporal bone airspaces and lateral semicircular canals did not demonstrate significant differences where SCD was and was not present. Plots of MV_(warm)response against computed SCD temporal bone anatomic parameters(SA, V and SA:V) showed moderate to strong correlations:temporal bone SA:V(r= 0.64), temporal bone airspace V(r= 0.60), temporal bone airspace SA(r= 0.55), LSCC SA(r= 0.51), and LSCC-toTM Distance(r= 0.65).Conclusions: This analysis demonstrated that SCD is associated with decreased temporal bone volume and density. The defect in SCD does not appear to influence caloric responses.

Spontaneous wound dehiscence after penetrating keratoplasty

Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-yearold Caucasian woman presented to our cornea clinic with spontaneous wound dehiscence after her third penetrating keratoplasty(PKP) which was performed three years ago. An Ahmed glaucoma valve(New World Medical, Ranchos Cucamonga, CA) was inserted ten months after the third PKP, which successfully controlled intraocular pressure(IOP). At the examination, the last sutures were removed eight months ago and she was using flourometholone 0.1%(Sina Darou, Tehran, Iran)with a dose of once a day. There was one quadrant of wound dehiscence from 8 to 11 o`clock associated with anterior wound gape and severe corneal edema.Resuturing was performed for the patient. At the one month examination, the corneal edema was resolved and best corrected visual acuity was 20/200 mainly due to previous glaucomatous optic neuropathy. Caution about the prolonged use of corticosteroids is necessary. Topical immunosuppressives could be a promising choice in this field.

Successful Management of Wound Dehiscence after Total Knee Arthroplasty by Topically Using Recombinant Basic Fibroblast Growth Factor

Wound complications are estimated to be affected in about 9% of TKA patients, which may increase the risk of deep periprosthetic infection and results in re-operation, joint fusion, or amputation. Here we have reported a female patient who suffered wound rupture due to early post-operation mobilization and weight-bearing. The wound dehiscence was successfully managed by applying recombinant basic fibroblast growth factor-2 and anti-infective treatment without removing prosthetic joint.

Anther Dehiscence Disturbed by High Temperature and Water Stress Presented in Os DIR Gene Expression in Rice(Oryza sativa L.)

In future climates, rice could more frequently be subjected to simultaneous high temperature （HT） and water stress （WS） during sensitive developmental stages such as flowering. In this study, two rice genotypes were exposed to HT, WS and combined high temperature and water stress （WS ＋ HT） during flowering to quantify their response through anther dehiscence. Gene expression profiles of 15 selected OsDIRs revealed differences among stresses and between varieties. The targeted gene OsDIR-08, which was considered to be a HT stress candidate gene, was de- creasingly expressed from the 1st d to the 4th d under HT stress in Nagina 22 （N22） while increased in Moroberekan. Varies of the expression of OsDIR genes in stresses intuitively reflects on the lignin-staining at the anther dehisced sites, which implied a negative relationship between the lignin biosynthesis and OsDIRs＇ ex- pression. Anther dehiscence disturbed by HT and WS ＋ HT stress showed a nega- tive cumulative effect in HT sensitive variety Moroberekan but not in N22. Higher level of anther dehiscence in /V22 under HT and WS ＋ HT stress indicated its true tolerance of HT and to WS ＋ HT during anthesis. The differentially expressed of OsDIR（s） under various managed stresses caused the difference of the lignin-stain- ing at the anther dehisced site in N22, and thus transformed anther dehiscence correspondingly might be one of the main reasons for the tolerance.

The Effects of Vestibular Rehabilitation after Bilateral Superior Semicircular Canal Dehiscence: A Case Report

Background and Purpose: Despite the strong body of evidence for vestibular rehabilitation, research is lacking for effective clinical management of patients with superior semicircular canal dehiscence (SSCD) and endolymphatic hydrops (EH). The purpose of this case report is to describe the effects of physical therapy in the treatment of a patient diagnosed with bilateral SSCD. Case Description: The patient was a 56-year-old woman with a long-standing otologic history involving bilateral SSCD and EH. The patient’s body structure and function impairments include constant headaches, dizziness with head rotation and eye movements, sensitivity to sounds and lights, and instability during gait. Her activity limitations include lower extremity dressing, driving, and playing her flute. Her participation restrictions include taking part in social gatherings, going to church, driving longer than 30 minutes, playing with her dogs, and teaching flute lessons. Interventions: Specific interventions included vestibular habituation and adaptation exercises, balance and gait training, and patient education. Physical therapy services were provided for approximately 11 weeks with a frequency of two times per week. Outcomes: After eleven weeks of physical therapy, the patient made improvements on the Lower Extremity Functional Scale (43/80 to 52/80), the Dynamic Gait Index (19/24 to 24/24), the Dizziness Handicap Inventory (86/100 to 68/100), and the Sharpened Romberg (2 seconds to >30 seconds). The patient improved in all her activity limitations and participation restrictions. She was able to play her flute for 20-minute intervals, play with her dogs, partake in social gatherings, and drive for 5 hours without symptoms. The patient had plans to pursue surgical intervention within the next year. Discussion: For a patient with a complex otologic history and a current diagnosis of bilateral SSCD, vestibular rehabilitation was an effective management option. The information from this case can be used to guide the effective treatment of similar patients diagnosed with vestibular dysfunction.

A Prospective Study of Factors Influencing Wound Dehiscence after Midline Laparotomy

Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perforation peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial transforming growth factor-beta (TGF-beta). Methods: Hundred eligible adult patients with the diagnosis of perforation peritonitis who underwent emergency exploratory laparotomy were prospectively recruited. Forty five patients who developed midline abdominal wound dehiscence were compared with 55 patients without dehiscence. Results: The variables that were significantly associated with wound dehiscence include anemia, hypo proteinemia, duration of surgery, prolonged postoperative ileus, wound infection and postoperative pulmonary infection. Age, gender, jaundice, cause of peritonitis, wound contamination and types of surgery were non significant variables. The mean IAP value in the patients with dehiscence was significantly higher than “non-dehiscence” group (p = 0.000). The patients with wound dehiscence strongly expressed TGF-beta on the day of burst. Conclusion: The patients of peritonitis undergoing prolonged surgery in the presence of risk factors like anemia, hypo proteinemia, postoperative ileus, wound infection and postoperative pulmonary infection have high risk of abdominal wound dehiscence.

Combined application of Robicsek procedure and thermoreactive nitinol clips for treating a patient with sternal dehiscence

Postopereative sternal dehiscence is one of the most important complications of median sternotomy which may cause pulmonary dysfunction and mediastinitis. We are reporting a patient with sternal dehiscence after coronary artery bypass surgery that underwent application of thermoreactive nitinol clips in addition to Robicsek procedure. Using thermoreactive nitinol clips method together with Robicsek procedure may be a valuable technique for preventing recurrent sternal dehiscence for patients who are candidates of noninfective recurrent sternal dehiscence.

An Observational Study of Midline Abdominal Wound Closure Using Small Tissue Bites versus Large Tissue Bites with Reference to Surgical Site Infections and Wound Dehiscence

Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.

Prevention of Sternal Dehiscence Following Use of Bilateral Internal Mammary Arteries in OPCAB

Purpose: We harvested bilateral Internal Mammary Arteries and made LIMA-RIMA Y in all the patients undergoing OPCAB at our center irrespective of the presence or absence of various risk factors for sternal dehiscence. The purpose of this study was to find an effective way of sternal closure in patients undergoing OPCAB with both the Internal Mammary Arteries harvested for grafting. Method: The patients who did not have any risk factors were placed in group I and all of them had a standard six wire closure of sternotomy. The patients having any risk factors were placed in group II. The patients in group II were randomized by including every alternate patient from group II to subgroup II A and every other alternate patient from group II to subgroup II B. Patients in subgroup II A again had a standard closure of sternotomy while in patients of subgroup II B bilateral Robiscek repair and four-five interlocking figure of eight wires were used for closure of sternotomy. Results: The patients who had risk factors for sternal dehiscence had higher risk for sternal dehiscence as compared to patients without any risk factors if bilateral Internal Mammary Arteries were harvested for OPCAB. But if we used bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure then the rate of sternal complications in the patients with risk factors for sternal dehiscence was not more than the patients without risk factors. Conclusion: We can harvest bilateral Internal Mammary Arteries for OPCAB without fear of sternal complications even in patients with high risk for sternal dehiscence if we use bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure.

Anesthesia for bronchoscopic amniotic membrane grafting to treat non-healing bronchial dehiscence

Airway complications after lung transplantation remain a significant cause of morbidity and mortality. Many of these occur at the anastomotic sites, which are susceptible due to poor collateral circulation. Of the possible complications, bronchial dehiscence is particularly formidable. These cases have been successfully treated bronchoscopically with metallic stents, which likely promote healing through granulation tissue formation. However, limited options exist in cases where the dehiscence fails to heal following stent placement. Here, we present the case report of a 65-year-old male who developed bronchial dehiscence status post bilateral lung transplantation for idiopathic pulmonary fibrosis that failed to heal with simple stent placement. Eventually, the patient underwent amniotic membrane grafting with stenting as a novel therapy for non-healing bronchial dehiscence, for which we describe the anesthetic management. His anesthetic plan included inhalational induction with sevoflurane, propofol infusion for total intravenous anesthesia, rocuronium for muscle relaxation, and closed-circuit assisted ventilation. His existing tracheostomy was used as the airway for oxygenation and induction. In summary, our anesthetic plan for the lung transplant patient was effective; future amniotic membrane grafting for bronchial dehiscence through bronchoscopy may follow a similar technique. Ultimately, the choice of anesthesia in this patient population requires judicious consideration of the requirements of the procedure as well as the pathophysiology of the transplanted lung.

Posthorax^®Prevents Sternal Dehiscence and Instability: Preliminary Results of a Prospective Randomized Multicenter Trial

Aim: A Prospective Randomized Multicenter Trial is ongoing to evaluate Posthorax and prevention of sternal dehiscence/instability: clinical percept is optimistic for Posthorax use. The aim of this mono-center analysis is to give a preliminary result of Posthorax support vest after sternotomy. Methods: One hundred and eighty three cases elective patients were consecutive operated and included in this study conducted in our department since June 2009. Patients were randomized as following: 68 patients were treated with the Posthorax support vest and 115 received a standard bandage postoperatively. The primary endpoints were the Infective Events. Secondary endpoints included a composite of postoperative clinical variables and mortality. Results: The two groups are homogeneous for these characteristic except sex (more women in Control Group, p = 0.022). Operative data were comparable in both groups. Deep sternal infections occurred in four patients, all in Control Group (3.5% vs 0%, p = 0.153). At Follow up, we recorded 2 cases of superficial infection in the control group versus 0 (1.7%, p = 0.394) and 1 case of wound dehiscence always in Control Group versus 0 (0.9%, p = 0.628). Cumulative Infective Events are statistically more in Control Group (7 cases 6.1% versus 0 cases, p = 0.036*). According to the secondary endpoints, there were also no differences between the two compared groups except length of hospitalization (10.6 ± 4 days versus 13.4 ± 9.5, p = 0.019*). Conclusion: Preliminary results show the Posthorax sternum support vest as a valuable adjunct to prevent sternum-related complications: We record a statistical reduction of length of hospital stay and infective events using the support vest in a 3-month follow-up.

Development of a Risk Model for Abdominal Wound Dehiscence

Objectives: To identify independent risk factors for abdominal wound dehiscence and develop a risk model to recognize high risk patients. Methods: The samples studied were patients who underwent midline laparotomy in the department of surgery, SMHS Hospital Srinagar from March 2009 to April 2015. For each case of abdominal wound dehiscence, three controls were selected from a group of patients who had undergone open abdominal surgery as close as possible in time. Preoperative, perioperative, and postoperative variables and in-hospital mortality were studied for all patients. Cases were compared with controls using the chi-square test or the Mann-Whitney U-test for categorical or continuous data, respectively. Subsequently, multivariate stepwise logistic regression with backwards elimination test used to identify main independent risk factors of abdominal wound dehiscence. The resulting regression coefficients for the major risk factors were used as weights for these variables to calculate a risk score for abdominal wound dehiscence. Results: 140 cases of abdominal wound dehiscence were reported and compared with 420 selected controls. All variables that were significant in univariate analyses were entered in a multivariate stepwise logistic regression to determine which variables were significant independent risk factors. Major independent risk factors were male gender, chronic pulmonary disease, corticosteroid use, smoking, obesity, anemia, jaundice, ascites, and sepsis, type of surgery, postoperative coughing, and wound infection. Based on these findings, a risk model was developed. Conclusions: The model can give an estimate of the risk of abdominal wound dehiscence for individual patients. High-risk patients may be planned preventive wound closing with reinforcements as mesh.

Bilateral Superior Semicircular Canal Dehiscence without Signs of Vestibular Involvement about a Case

Superior semicircular canal dehiscence (SSCD) is a rare entity recently described whose typical clinical symptomatology is represented by dizziness triggered by a variation of pressure. We reported a case of SSCD which was diagnosed thanks to computed tomography (CT) scan of the petrous bone conducted systematically in front of mixed deafness with normal eardrum. The SSCD was bilateral and was revealed by mixed deafness on the left side and perception deafness on the right with a normal eardrum without the notion of vertigo. The cervical vestibular evoked myogenic potential (cVEMP) and an ultra-high resolution CT scan of the petrous bones in coronal and sagittal sections allowed the diagnosis. The SSCD should be considered in the presence of any conductive or mixed hearing loss with a normal eardrum. The CT scan in coronal and sagittal submillimetric sections allows the diagnosis.

Subtemporal Extradural Approach for Dehiscence of the Superior Semicircular Canal: Surgical Technique and Results in Three Consecutive Patients

We describe three patients with severe disabling symptoms of unilateral dehiscence of the superior semicircular canal (DSSC) who had surgical treatment. Each patient underwent a unilateral subtemporal extradural approach with resurfacing the DCCS. In all 3 patients, all symptoms were completely resolved and remained symptom free on the long term. There were no postoperative complications. Only one patient experienced a temporary CSF hypotension syndrome and some dizziness. The pseudo-conductive hearing loss improved or resolved in all patients. Surgical treatment should be considered in patients with severe, disabling DSSC symptoms. Surgical resurfacing of the DSSC is a safe and rewarding surgical technique. The long term success rate regarding the elimination of the pseudo-conductive hearing loss and resolution of vestibular symptoms outweigh the potential surgical risks of this technique in these patients.