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.

Reconstruction of the lower back wound with delayed infection after spinal surgery:A case report

BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

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.

留置鼻胃管对扁桃体术后创面缝合伤口的影响

扁桃体切除术最常见的并发症是术后出血,术中缝合腭舌弓、腭咽弓封闭术腔,可减少术后出血。然而缝合的腭舌弓、腭咽弓经常自行裂开,如何尽量减少扁桃体术后创面缝合伤口裂开是值得关注的问题。本研究通过回顾分析我院156例全麻下行传统扁桃体切除术或低温等离子扁桃体切除术并且行术中缝合腭舌弓、腭咽弓封闭术腔的病例,探讨术中留置鼻胃管对扁桃体术后创面缝合伤口的影响以及患者术后疼痛程度。

Epigenetic Factors Altered in Dehisced Anther Correlated to Seed Dormancy in <i>Paris polyphylla</i>var. Yunnanensis

Paris polyphylla var. yunnanensis (Franch.), one of the best-known medicinal plants in China, has a dehiscent anther which physiologically work in pollination, however, the dehiscent anther always closes in response to darkness every day, and watering or raining every time. To explore this frequently closing and its unkown physiology, next-generation sequencing was performed, and the transcriptome was de novo assembled. RNA-sequencing was carried out in 15 samples including seven openning samples, four closed samples owing to darkness or watering, and tissue samples (leaf, petal, calyx, and stigma) were used for control. We obtained 72.75 GB data, assembled into 79,815 unigenes. Differentially expressed unigenes (DEGs) between opened and closed anther samples were 6231 and the DEGs between anther and control samples were 2831. Comparation between the two DEGs by KEGG enrichment showed that “plant hormone signal transduction” pathway is the most significant pathway for DEGs from closing anther vs. opening anther, and expression model of DEGs in the pathway might elicit change in germination and seed dormancy. Further examination of the action of the signal pathway on physiology showed “chromatin binding” function was prominent in “DNA binding” function of annotated DEGs between opened and closed anthers, of the 215 “chromatin binding” unigenes, 120 were involved in epigenetic silencing, and 50 of the epigenetic unigenes were directly related to germination or seed dormancy, strongly correlating anther closing to epigenetic modification and seed dormancy. These results were verified that at least three auxins involved in seed dormancy showed same expression patterns occurred in abnormal closing anther and seed embryo in Paris polyphylla var. yunnanensis. In conclusion, the information from transcriptome point out that frequent abnormal closing of dehiscent anthers possibly transfer the impact on seed dormancy, and epigenetic modification happened in closing may be the cause.

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.

Early Repair of Sternal Instability Prevents Mediastinitis

Background: Discharge due to superficial wound infection and sternal dehiscence are the common complications of median sternotomy. This condition leads to mediastinitis. Mediastinitis is a serious condition which increases morbidity, mortality and hospital costs. The correct time for surgical treatment is contraversial in cases who have sternal dehiscence and discharge due to superficial infection. In this study, patients received sternal stabilization as soon as a diagnosis was made and monitored for the development of mediastinitis. Methods: Among the 1440 patients who had undergone elective CABG, a total of 85 patients who developed sternal dehiscence and superficial wound discharge were included in this study. These patients were re-operated on as soon as diagnosed and early sternal stabilization was provided. Results: The ratio of overall dehiscence was 5.9%. Mediastinitis developed in only 2 of the 85 patients. These patients were treated with VAC (Vacuum Assisted Closure) therapy. The ratio of overall mediastinitis was 0.13. Mediastinitis-related mortality was not detected. Conclusion: The ratio of mediastinitis decreases when patients who have discharge due to sternal dehiscence and superficial wound infection are immediately reviewed without waiting for the results of conventional methods such as antibiotic treatment and chest binder support.

Systematic review of the negative pressure wound therapy in kidney transplant recipients

AIM To review negative pressure wound therapy(NPWT) as animportant addition to the conventional methods of wound management.METHODS A systematic review, performed by searching the PubM ed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation(KT) patients(range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.RESULTS No complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.CONCLUSION Negative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.

Cataract surgery on post radial keratotomy patients

This study aims to evaluate and to compare three different approaches of cataract surgery to patients with previous radial keratotomy（RK）, and to analyze the mechanical properties of the cornea after cataract surgery. Three groups of patients, each one including 8 eyes of patients with 16 RK incisions. The first group includes eyes with the first cataract incision superiorly, the second group in the temporal area, the third group in temporal area and a precautionary stabilizing suture across the RK incision adjacent to the main tunnel. In the first group intraoperative dehiscence occurred in three eyes（37.5%）： it required immediate application of a suture. In the second group dehiscence occurred intraoperatively in two radial scars（20%）： it required immediate application of a suture. In the third group, no intraoperative dehiscences were observed. The stabilizing suture of the RK incision works safer, with a lower risk of dehiscences and less postoperative astigmatism.

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.

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.

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.

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.

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.

Cesarean scar abscess: A case report and a review of the literature

Cesarean section and the resultant Cesarean scar are known to be associated with obstetric complications in subsequent pregnancies. Cesarean scar is also associated with gynecological conditions that can adversely affect the patient’s quality of life. We describe a very rare case of Cesarean scar abscess that developed 8 years after a Cesarean delivery, which was managed by emergency hysterectomy.