Fragility fractures of the acetabulum

There are limited epidemiological data dedicated to geriatric acetabular fractures. The incidence in individuals older than 60 years of age has more than doubled in the past three decades and expected to double further over the next 20 years. These fractures represent a challenging subset of acetabular trauma patients to treat. Conservative treatment is a valid option in those with minimal displaced fractures and a preserved congruent hip joint. Similarly the frail patient with multiple medical co-morbidities and those unlikely to tolerate surgical intervention should have appropriate analgesia and their fracture managed or ignored by watchful neglect. Surgical treatment options include percutaneous fixation or open reduction and internal fixation techniques. Good outcomes may be expected should a concentric reduction be achieved. Age-related involutional osteoporosis associated with fracture comminution and acetabular dome impaction complicate surgical fixation with higher complication rates and the need for further surgery recognised. Historically described as central fracture dislocations, stoved in hip or burst fracture, acute arthroplasty is advocated in the setting of femoral head damage and in significant acetabular impaction injuries. Controversy remains whether geriatric patients should be treated by open reduction and internal fixation or total hip arthroplasty either acute or delayed and needs to be assessed based on the patient and personality of the fracture.     

Paraxis is required for somite morphogenesis and differentiation in Xenopus laevis

Background : In most vertebrates, the segmentation of the paraxial mesoderm involves the formation of metameric units called somites through a mesenchymal‐epithelial transition. However, this process is different in Xenopus laevis because it does not form an epithelial somite. Xenopus somitogenesis is characterized by a complex cells rearrangement that requires the coordinated regulation of cell shape, adhesion, and motility. The molecular mechanisms that control these cell behaviors underlying somite formation are little known. Although the Paraxis has been implicated in the epithelialization of somite in chick and mouse, its role in Xenopus somite morphogenesis has not been determined. Results : Using a morpholino and hormone‐inducible construction approaches, we showed that both gain and loss of function of paraxis affect somite elongation, rotation and alignment, causing a severe disorganization of somitic tissue. We further found that depletion or overexpression of paraxis in the somite led to the downregulation or upregulation, respectively, of cell adhesion expression markers. Finally, we demonstrated that paraxis is necessary for the proper expression of myotomal and sclerotomal differentiation markers. Conclusions : Our results demonstrate that paraxis regulates the cell rearrangements that take place during the somitogenesis of Xenopus by regulating cell adhesion. Furthermore, paraxis is also required for somite differentiation. Developmental Dynamics 244:973–987, 2015. © 2015 Wiley Periodicals, Inc.     

In Silico identification of M. TB proteins with diagnostic potential

The development of a new tuberculosis (TB) vaccine has become one of the main objectives of the scientific community. Protein antigens have been widely explored as subunit TB vaccines, however lipid antigens could be equally important to be used or included in such a vaccine. The aim of this study was to demonstrate the potential of a liposome formulation composed of an extract of lipids from Mycobacterium smegmatis (Ms) as a TB vaccine candidate. We evaluated the immunogenicity of this formulation as well as the cross reactive response against antigens from Mycobacterium tuberculosis (MTb) in BALB/c mice. We determined the anti-liposome IgG response in sera from TB patients and from healthy subjects who displayed a positive (PPD+) or negative (PPD-) tuberculin skin test. A significant increase in anti-liposome IgG (p<0.05) was detected in animals immunized with Bacille Calmette-Guérin (BCG) compared with all groups, and in the group immunized with liposomes from Ms (LMs) compared to animals immunized with either LMs adjuvanted with aluminium (LMs-A) or the negative control group (phosphate buffered saline, PBS) respectively. With respect to the cross reactive response against a cocktail of cell wall antigens (CWA) from MTb, significantly higher IgG levels were observed in animals immunized with BCG and LMs compared to negative controls and either, aluminium-adjuvanted liposomes (LMs-A) or montanide (LMs-M) (p<0.05). Furthermore, the anti-liposome IgG response was significantly superior in sera from pulmonary TB patients compared to PPD+ and PPD- healthy subjects (p<0.001) suggesting the expression of these antigens in vivo during active MTb infection. The results obtained provide some evidence for the potential use of liposomes containing total lipid extracts of Ms as a TB vaccine candidate.

     

Primary squamous cell carcinoma of seminal vesicle: an extremely rare case report with literature review

Primary squamous cell carcinoma of seminal vesicle is extremely rare, and most cases regarding seminal vesicle tumors failed to address this kind of tumor. A 54-year-old male patient presented with intermittent painless visual hematuria for 6 months was hospitalized. Ultrasonography, computerized tomography and magnetic resonance imaging demonstrated a 4.4 cm × 3.6 cm × 3.0 cm mixed tumorous lesion in the left seminal vesicle. A transrectal needle biopsy revealed severe chronic inflammation. The mass was completely resected in a laparoscopic approach and was verified as a moderately differentiated squamous cell carcinoma in the seminal vesicle by post-surgical histopathological examination. The patient received totally 5 cycles of chemotherapy. A rectal metastasis was detected 7 months after the surgery.     

Maximizing the donor pool: left versus right laparoscopic live donor nephrectomy—systematic review and meta-analysis

Objective

To assess the current evidence regarding the efficiency, safety, and potential advantages of right-laparoscopic live donor nephrectomy (LLDN) compared with left-LLDN.

Materials and methods

We comprehensively searched PubMed, Embase, the Cochrane Library, and Web of Science to perform a systematic review and cumulative meta-analysis of a randomized controlled trial (RCT) and prospective and retrospective comparative studies assessing the two techniques.

Results

A single RCT and 28 comparative studies including a total of 32,426 cases were identified. Although left-LLDN was associated with lower delayed renal function [odds ratio (OR) 0.73; 95 % confidence interval (CI) 0.62, 0.87, p = 0.0003] and less thrombosis (OR 0.35; 95 % CI 0.13, 0.96, p = 0.04) in our meta-analysis, sensitivity analysis did not show any significant difference between the two groups. There were no other considerable differences between the two groups.

Conclusions

With enough surgical experience, right-LLDN can be performed with equivalent safety and efficacy. Although large-volume centers are routinely performing right-LLDN, there is under appreciation of the right side in smaller centers given the associated fear of poor outcomes and technically demanding procedure. Due to the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.     

Optimization of dosing for EGFR-mutant non-small cell lung cancer with evolutionary cancer modeling

Non-small cell lung cancers (NSCLCs) that harbor mutations within the epidermal growth factor receptor (EGFR) gene are sensitive to the tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib. Unfortunately, all patients treated with these drugs will acquire resistance, most commonly as a result of a secondary mutation within EGFR (T790M). Because both drugs were developed to target wild-type EGFR, we hypothesized that current dosing schedules were not optimized for mutant EGFR or to prevent resistance. To investigate this further, we developed isogenic TKI-sensitive and TKI-resistant pairs of cell lines that mimic the behavior of human tumors. We determined that the drug-sensitive and drug-resistant EGFR-mutant cells exhibited differential growth kinetics, with the drug-resistant cells showing slower growth. We incorporated these data into evolutionary mathematical cancer models with constraints derived from clinical data sets. This modeling predicted alternative therapeutic strategies that could prolong the clinical benefit of TKIs against EGFR-mutant NSCLCs by delaying the development of resistance.     

Cardiovascular rhythm effects of gamma recombinant DNA interferon

Summary Twenty patients receiving recombinant DNA gamma interferon were prospectively assessed for cardiac rhythm disturbances. All patients were evaluated with baseline electrocardiograms, pretreatment ambulatory monitoring and ejection fraction determination. Each patient was then monitored continuously during drug administration. Quantitative ventricular ectopy was not increased, nor were average heart rate, maximal heart rate, or quantitative supraventricular ectopy when comparing baseline to during therapy parameters. Complex cardiac ectopy and noteworthy cardiac events (NCE) were defined and identified in 2/20 (10%) patients pretreatment, and in 8/18 patients (44%) with normal baseline tracings during treatment (p = .02). This difference was not apparent when corrected for total days monitored pre and post treatment (p > .2). These consisted predominantly of nonsustained short duration ventricular tachycardia (seven of eight patients). We conclude that life threatening cardiac events are uncommon with gamma interferon therapy.The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecing the view of the Department of the Army or the Department of Deferoe.