Virus‐encoded ectopic CD74 enhances poxvirus vaccine efficacy

Vaccinia virus (VV) has been used globally as a vaccine to eradicate smallpox. Widespread use of this viral vaccine has been tempered in recent years because of its immuno‐evasive properties, with restrictions prohibiting VV inoculation of individuals with immune deficiencies or atopic skin diseases. VV infection is known to perturb several pathways for immune recognition including MHC class II (MHCII) and CD1d‐restricted antigen presentation. MHCII and CD1d molecules associate with a conserved intracellular chaperone, CD74, also known as invariant chain. Upon VV infection, cellular CD74 levels are significantly reduced in antigen‐presenting cells, consistent with the observed destabilization of MHCII molecules. In the current study, the ability of sustained CD74 expression to overcome VV‐induced suppression of antigen presentation was investigated. Viral inhibition of MHCII antigen presentation could be partially ameliorated by ectopic expression of CD74 or by infection of cells with a recombinant VV encoding murine CD74 (mCD74‐VV). In contrast, virus‐induced disruptions in CD1d‐mediated antigen presentation persisted even with sustained CD74 expression. Mice immunized with the recombinant mCD74‐VV displayed greater protection during VV challenge and more robust anti‐VV antibody responses. Together, these observations suggest that recombinant VV vaccines encoding CD74 may be useful tools to improve CD4⁺ T‐cell responses to viral and tumour antigens.     

Laparoscopic Features and Repair of a Combined left Spigelian Hernia and left Morgagni Diaphragmatic Hernia

Both Spigelian and Morgagni hernias cause serious morbidity so early diagnosis and timely treatment are necessary. These two types of hernia are more commonly found on the right side of patients. They are rare individually in adults and even rarer in combination. So far, an association between the two hernias has only been reported on the right. We describe the first case of a Spigelian hernia and a Morgagni hernia in a 62-year-old woman, both occurring on the left side. Our accompanying video describes several laparoscopic features that will help lead to early detection and diagnosis.     

Expression of nuclear receptors of gingiva in polycystic ovarian syndrome: a preliminary case study

Oestrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In females, during puberty, ovulation and pregnancy, there is an increase in the production of sex steroid hormones, which results in increased gingival inflammation, characterized by gingival enlargement, increased bleeding and crevicular fluid flow. This article presents a case of a patient who presented with a complaint of gingival swelling and spontaneous bleeding that persisted for more than two months. Her health history documented the recently diagnosed presence of polycystic ovarian syndrome. Clinical examination revealed enlarged painful gingival tissues, which bled when touched. After completion of Phase I therapy, the enlargement did not subside and a biopsy sample was taken. This was compared with another patient who had the same health condition but did not show any gingival enlargement. Testing of tissue samples for oestrogen and progesterone receptors showed the first patient to be positive for oestrogen receptors but negative for progesterone, whereas the control was negative for both. Positive oestrogen receptors suggest that polycystic ovarian syndrome has some effect on the periodontium. The dental consequences of this condition, highly prevalent among young females, are typically ignored. Further studies warrant establishment of a clinical association and future diagnosis.     

Calf hematoma mimicking thrombophlebitis: sonographic and computed tomographic appearance

Five patients with calf hematomas presented with signs and symptoms suggesting thrombophlebitis, obscuring the correct diagnosis. Venography showed no venous thrombosis; further diagnostic studies using ultrasound and/or computed tomography provided the correct diagnosis in all patients. Ultrasound showed a hypoechoic mass clearly demarcated from surrounding soft tissue, while computed tomography showed a well-defined mass whose density depended on the age of the hematoma.