A modified technique of internal bone transport

A modification of the technique of internal bone transport is presented. It decreases bone and soft tissue complications during bone transport, increases patient's comfort, the volume of the fixator is smaller and painful scarring is limited. Nine patients with a mean age of 23.9 years were treated with this technique. The aetiology was tumour, trauma or sequelae of infection. The mean bone loss was 7.2 cm in length. Transportation was achieved with a special pulley system. The mean follow-up time was 18.3 months. The external fixation time ranged from 5 to 13.2 months, the mean distraction index was 12.1 days/cm. The mean length of bone transport done was 6.3 cm. An excellent bone result was obtained in 4 cases, a good result in 4 cases and a fair result in one case. An excellent functional result was obtained in 2 lower extremity cases, a good result in 3 cases. Preoperative DASH scores of the upper extremity cases improved from a mean of 80.1 to a mean of 15.85. Complications were seen in 4 cases.     

Plasma level of soluble P-selectin in patients with rheumatic mitral stenosis and sinus rhythm undergoing percutaneous mitral balloon valvuloplasty

Objective To determine whether plasma level of soluble P-selectin (sP-selectin) increases in rheumatic mitral stenosis (MS) patients with sinus rhythm, who have scheduled for percutaneous mitral balloon valvuloplasty (PMBV), and to examine the effect of PMBV on sP-selectin level. Methods Twenty-six patients with MS and sinus rhythm (study group, 20 female, mean age 33 ± 8 years) and a well-matched control group composed of 21 healthy volunteers (15 female, mean age 35 ± 6 years) were enrolled in the study. In each patient left atrial (LA) thrombus was excluded by transesophageal echocardiography. sP-selectin levels were compared between study patients and controls, and between peripheral and LA blood. Changes in sP-selectin level 24 h and 4 weeks after PMBV were also analyzed. Results A significantly higher basal sP-selectin level was noted in study group. After PMBV, the mitral valve area (MVA) increased and the transmitral mean gradient decreased significantly. At 24th hour after PMBV, sP-selectin level decreased from 1080.38 ± 143.87 ng/ml to 960.00 ± 103.26 ng/ml (p < 0.0001) and at 4th-week follow-up it was decreased from 960.00 ± 103.26 ng/ml to 879.61 ± 98.16 ng/ml (p < 0.0001). No significant difference was found between peripheral and LA blood regarding the sP-selectin level. Correlation analysis between the difference in MVA measured 24-hour after and before PMBV and the difference in sP-selectin level measured 24-hour after and before PMBV showed a significant direct relationship between these variables. Conclusion This study suggests that in patients with MS and sinus rhythm sP-selectin level increases probably due to turbulent flow across the stenotic valve. After PMBV sP-selectin shows a progessive decline, which is directly correlated with the increase in MVA.     

In vitro proliferation of human osteogenic cells in presence of different commercial bone substitute materials combined with enamel matrix derivatives

Background

The immunological response to solid tumours is insufficient. Therefore, tumour specific antigens have been explored to facilitate the activation of the immune system. The cancer/testis antigen class of MAGE-A antigens is a possible target for vaccination. Their differential expression profiles also modulate the course of the cancer disease and its response to antineoplastic drugs.

Methods

The expression profiles of MAGE-A2, -A3, -A4, -A6 and -A10 in five own oral squamous cell carcinoma cell lines were characterised by rt-PCR, qrt-PCR and immunocytochemistry with a global MAGE-A antibody (57B) and compared with those of an adult keratinocyte cell line (NHEK).

Results

All tumour cell lines expressed MAGE-A antigens. The antigens were expressed in groups with different preferences. The predominant antigens expressed were MAGE-A2, -A3 and -A6. MAGE-A10 was not expressed in the cell lines tested. The MAGE-A gene products detected in the adult keratinocyte cell line NHEK were used as a reference.

Conclusion

MAGE-A antigens are expressed in oral squamous cell carcinomas. The expression profiles measured facilitate distinct examinations in forthcoming studies on responses to antineoplastic drugs or radiation therapy. MAGE-A antigens are still an interesting aim for immunotherapy.     

Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Camel Populations,Southern Jordan, 2014–2018

After the first detection of Middle East respiratory syndrome coronavirus (MERS-CoV) in camels in Jordan in 2013, we conducted 2 consecutive surveys in 2014–2015 and 2017–2018 investigating risk factors for MERS-CoV infection among camel populations in southern Jordan. Multivariate analysis to control for confounding demonstrated that borrowing of camels, particularly males, for breeding purposes was associated with increased MERS-CoV seroprevalence among receiving herds, suggesting a potential route of viral transmission between herds. Increasing age, herd size, and use of water troughs within herds were also associated with increased seroprevalence. Closed herd management practices were found to be protective. Future vaccination strategies among camel populations in Jordan could potentially prioritize breeding males, which are likely to be shared between herds. In addition, targeted management interventions with the potential to reduce transmission between herds should be considered; voluntary closed herd schemes offer a possible route to achieving disease-free herds.     

GDF 15 as an anti-apoptotic, diagnostic and prognostic marker in oral squamous cell carcinoma

Growth-differentiation factor 15 (GDF 15) is involved in tumor pathogenesis and its expression is increased in many types of cancers. Functional effects of GDF 15 on oncogenesis of oral squamous cell carcinoma (OSCC) remain unclear. Therefore, the aim of this study was to examine the apoptotic characteristics of GDF 15 in OSCC cell lines in vitro and to analyze serum GDF 15 concentrations as a diagnostic and prognostic tumor marker for OSCC in vivo. Caspase activity was assessed in OSCC cell lines with the Caspase-Glo 3/7 system. Serum GDF 15 concentrations from 64 patients with histopathological proven OSCC and from 30 healthy volunteers were measured using an enzyme-linked immunosorbent assay. In 21 patients, serum GDF 15 was also analyzed postoperatively. In vitro, treatment of OSCC cell lines with GDF 15 reduced Caspase 3/7 activity significantly (p<0.05). In vivo, serum GDF 15 concentrations of the OSCC patients in all stages of OSCC were significantly higher than those of the healthy subjects (p<0.0001). After surgery, GDF 15 concentrations declined significantly from 1545±774pg/ml preoperative to 953±438pg/ml postoperative (p=0.003). The median survival time of OSCC patients with GDF 15 levels below 875pg/ml was significantly higher than of OSCC patients with GDF 15 levels above or equal 875pg/ml (p=0.031). Determination of receiver operating characteristic curves (ROC) showed a respective area under the ROC curve (AUC) of 0.943. The anti-apoptotic effect of GDF 15 in OSCC cell lines was shown in vitro. In vivo, significant elevated serum GDF 15 levels with prognostic value in OSCC-patients were seen for the first time. The results indicate that GDF15 may be used as a potential marker for diagnosis and prognosis of this entity.     

Is there any relation between distal parameters of the femur and its height and width?

The purpose of this study was to reveal the association whether the distal morphometry of femur had a relation with femur height or width. Sixty-six adult (35 right and 31 left) dry femurs from Caucasians were used in this study. Computed tomography (CT) imaging was applied to obtain measurement values of the femur. Femur height (413.29 ± 28.40 mm) and width (29.86 ± 2.72 mm) were all checked one by one to determine the correlation with the parameters obtained. Both values exposed high rates of correlation with height (26 ± 2.34 mm) and width (20.85 ± 2.76 mm) of femur notch; also, measures of epicondylar, bicondylar and condylar diameters of femur were obtained. Measures were checked if there was a correlation with femur height and width. Differences displayed in distal morphometry of femur according to race and sex are due to other morphometric measures of femur rather than race and sex. We believe that displaying the high rates of correlation of distal morphometry of femur with femur height and width will be the factor which determines the selection and production of prosthesis among the long or short individuals of folks.     

Potential role of TNF alpha blockers in delaying the progression of hepato-renal syndrome

Hepatorenal syndrome occurs in patients with advanced liver cirrhosis and is associated with functional renal impairment and poor prognosis. These patients present a challenge to physicians and management strategies. Although various pharmacological therapies are available, large randomized controlled trials are required to determine which treatment modality is most effective to improve survival rates along with its dose and duration of treatment. The overproduction of tumor necrosis factor-alpha (TNF-alpha) has been postulated to play a role in progression of this disease, being associated with hyperdynamic circulation and inflammatory process. Moreover, increasing the levels of TNF-alpha during the course of hospitalization is suggested to be associated with increased mortality. Hence the role of TNF-alpha inhibitors, such as pentoxifylline, may prove to be become a new clinical pathway. Various randomized clinical trials have demonstrated a significant reduction in mortality in patients receiving pentoxifylline, in comparison to the control group. This survival rate benefit was associated with decrease in the incidence of hepatorenal syndrome in these patients. We propose a double-blinded trial to test the hypothesis, in which patients with advanced liver disease without evidence of hepatorenal syndrome are recruited. The control group receives the standard management while the case group receives standard management along with TNF-alpha blockers. If the cases develop hepatorenal syndrome at a significant duration later in comparison to the control group, our hypothesis will be confirmed. Our methodology is limited due to costs of TNF-alpha inhibitors in a developing country setup, hence it has only been proposed as a hypothesis. If the recommended trial confirms our hypothesis, we might see favorable outcomes and improved survival rates in patients with decompensated liver diseases.     

Long bone fracture detection in suspected child abuse: contribution of lateral views

Background  

ACR guidelines for routine skeletal survey for child abuse recommend only AP radiographs of the long bones; however, many institutions add lateral radiographs.