Referencing the trochlear groove based on three-dimensional computed tomography imaging improves the reliability of the measurement of the tibial tuberosity–trochlear groove distance in patients with higher grades of trochlea dysplasia

BackgroundTo determine whether 3D-CT imaging technique is valid and reproducible compared to conventional CT measurement technique (CCT) for the detection of a femoropatellar instability.MethodsPatients who had undergone surgery for femoropatellar instability (patellar instability group) between 2010 and 2016 (n = 37 knees of 35 patients) were retrospectively enrolled. For the matched control group, patients who had acute anterior cruciate ligament injury (< 4 weeks previously; n = 30) were recruited. Preoperative CT data had been obtained in all patients. Inter-rater reliability was calculated for both measurement protocols, and inter-method reliability was calculated between the two imaging modalities. The results are reported using intraclass correlation coefficients (ICCs) and Bland–Altman 95% limits of agreement.ResultsAll patients in the patellar instability group had femoral trochlear dysplasia (Dejour types A: four, B: 19, C: seven, and D: six), but no dysplasia was noted in the control group. In the patellar instability group, the CCT technique showed a poor inter-rater agreement (ICC = 0.74), and the 3D-CT technique still showed excellent inter-rater agreement (ICCs = 0.91). In the sub-analysis of the patellar instability group according to the trochlear dysplasia grade, ICCs were markedly decreased with severe trochlear dysplasia when using CCT technique; however, the 3D-CT technique could provide excellent reliability even with severe trochlear dysplasia.ConclusionThe 3D-CT imaging technique for the measurement of the TT–TG distance can be suggested as a better measurement technique for patellar instability patients with bone abnormality.     

Establishment of tooth blood supply and innervation is developmentally regulated and takes place through differential patterning processes

Teeth are richly supported by blood vessels and peripheral nerves. The aim of this study was to describe in detail the developmental time‐course and localization of blood vessels during early tooth formation and to compare that to innervation, as well as to address the putative role of vascular endothelial growth factor (VEGF), which is an essential regulator of vasculature development, in this process. The localization of blood vessels and neurites was compared using double immunofluorescence staining on sections at consecutive stages of the embryonic (E) and postnatal (PN) mandibular first molar tooth germ (E11‐PN7). Cellular mRNA expression domains of VEGF and its signaling receptor VEGFR2 were studied using sectional radioactive in situ hybridization. Expression of VEGF mRNA and the encoded protein were studied by RT‐PCR and western blot analysis, respectively, in the cap and early bell stage tooth germs, respectively. VEGFR2 was immunolocalized on tooth tissue sections. Smooth muscle cells were investigated by anti‐alpha smooth muscle actin (αSMA) antibodies. VEGF showed developmentally regulated epithelial and mesenchymal mRNA expression domains including the enamel knot signaling centers that correlated with the growth and navigation of the blood vessels expressing Vegfr2 and VEGFR2 to the dental papilla and enamel organ. Developing blood vessels were present in the jaw mesenchyme including the presumptive dental mesenchyme before the appearance of the epithelial dental placode and dental neurites. Similarly, formation of a blood vessel plexus around the bud stage tooth germ and ingrowth of vessels into dental papilla at E14 preceded ingrowth of neurites. Subsequently, pioneer blood vessels in the dental papilla started to receive smooth muscle coverage at the early embryonic bell stage. Establishment and patterning of the blood vessels and nerves during tooth formation are developmentally regulated, stepwise processes that likely involve differential patterning mechanisms. Development of tooth vascular supply is proposed to be regulated by local, tooth‐specific regulation by epithelial–mesenchymal tissue interactions and involving tooth target expressed VEGF signaling. Further investigations on tooth vascular development by local VEGF signaling, as well as how tooth innervation and development of blood vessels are integrated with advancing tooth organ formation by local signaling mechanisms, are warranted.     

A novel signal amplification technology for ELISA based on catalyzed reporter deposition. Demonstration of its applicability for measuring aflatoxin B1

In an earlier communication we have described a novel signal amplification technology termed Super-CARD, which is able to significantly improve antigen detection sensitivity in conventional Dot-ELISA by approximately 10⁵-fold. The method utilizes hitherto unreported synthesized electron rich proteins containing multiple phenolic groups which, when immobilized over a solid phase as blocking agent, markedly increases the signal amplification capability of the existing CARD method (Bhattacharya, R., Bhattacharya, D., Dhar, T.K., 1999. A novel signal amplification technology based on catalyzed reporter deposition and its application in a Dot-ELISA with ultra high sensitivity. J. Immunol. Methods 227, 31.). In this paper we describe the utilization of this Super-CARD amplification technique in ELISA and its applicability for the rapid determination of aflatoxin B₁ (AFB₁) in infected seeds. Using this method under identical conditions, the increase in absorbance over the CARD method was approximately 400%. The limit of detection of AFB₁ by this method was 0.1 pg/well, the sensitivity enhancement being 5-fold over the optimized CARD ELISA. Furthermore, the total incubation time was reduced to 16 min compared to 50 min for the CARD method. Assay specificity was not adversely affected and the amount of AFB₁ measured in seed extracts correlated well with the values obtained by conventional ELISA.     

Outbreak of a Systemic Form of Camelpox in a Dromedary Herd (Camelus dromedarius) in the United Arab Emirates

Camelpox virus (CMLV) is the causative agent of camelpox, which frequently occurs in the Old World camelids-rearing countries except for Australia. It has also been described in experimentally inoculated New World camelids. Camelpox outbreaks are often experienced shortly after the rainy season, which occurs twice a year on the Arabian Peninsula because of the increased density of the insect population, particularly mosquitos. A systemic form of camelpox outbreak in seven dromedary camels was diagnosed by histology, virus isolation, and PCR. A phylogenetic analysis using full length CMLV genomes of the isolated CMLV strains showed a single phylogenetic unit without any distinctive differences between them. The United Arab Emirates (UAE) isolate sequences showed phylogenetical relatedness with CMLV isolates from Israel with only minor sequence differences. Although the sequences of viruses from both countries were closely related, the disease manifestation was vastly different. Our study shows that the virulence is not only determined by genetic features of CMLV alone but may also depend on other factors such as unknown aspects of the host (e.g., age, overall fitness), management, and the environment.     

Visceral leishmaniasis: consequences to women in a Bangladeshi community

Visceral leishmaniasis (VL) or kala-azar (KA) affects the rural poor, causing significant morbidity and mortality. We examined the epidemiological and social impact of KA in an affected village in Bangladesh. A population-based survey of the village residents showed a case fatality rate of 14.7% among females and 5.3% among males. Before initiation of the study, female patients were ill longer than males before they received treatment. Future work needs to focus on understanding the implications of KA on women and to develop sustainable strategies for appropriate and timely access to treatment.     

Family-centered Care for Sick Newborns: A Thumbnail View

Family-centered care (FCC) for sick newborns is emerging as a paradigmatic shift in the practice of facility-based newborn care. It seeks to transforming a provider-centered model into a client-centered one and thus build a new therapeutic alliance. FCC is the cornerstone of continuum of care, imparting caregiving competencies to parents/caregivers both within institutions as well as after the discharge. This has potential gains for the newborn, family members, and facility-level staff. The initial model piloted in tertiary-care settings is now undergoing translation at five sites across the country; the outcomes are keenly awaited.     

Surveillance of hepatitis E virus in sewage and drinking water in a resettlement colony of Delhi: what has been the experience?

Hepatitis E virus infection is one of the major causes of hepatitis and has been responsible for many sporadic waterborne hepatitis epidemics. We studied 141 cases of viral hepatitis in the Gokulpuri area and collected the tap water, sewage water and serum samples from the individual cases of hepatitis in the community. Samples were analysed for the presence of hepatitis E virus (HEV) by RT-PCR, followed by sequencing. Forty-one out of 141 (29.08%) cases of viral hepatitis had evidence of HEV infection, detected by serology and/or RT-PCR. Six out of 141 (4.25%) sewage samples and 2 out of 141 (1.42%) drinking water samples were found to be positive for HEV RNA. The HEV isolates belonged to genotype 1. Evidence of HEV infection in sewage and drinking water samples indicates contamination of drinking water with sewage; good sanitary practice still remains a subject of alarm in the subcontinent.     

The Slippery Slope of Child Feeding Practices in India

National Family Health Survey 4 (NFHS-4) data shows a ten percentage point decline in timely complementary feeding rates in the backdrop of increases in breastfeeding indicators. There is large-scale decline in this indicator across all regions and states. An understanding of social determinants is critical for generating transformative ideas to address these challenges.