Use of Biologics and Stem Cells for Wound Healing in the Horse

Treatment of skin wounds is a high priority in veterinary medicine because healthy uncompromised skin is essential for the well-being of horses. Stem cells and other biologic therapies offer benefits by reducing the need for surgical procedures and conventional antibiotics. Evidence from in vitro studies and small in vivo trials supports the use of equine stem cells and biologics for the treatment of acute and chronic cutaneous wounds. Larger clinical trials are warranted to better evaluate the regenerative and immunological responses to these treatments. Additionally, delivery methods and treatment schedules should be optimized to improve efficacy of these novel therapies.

The High-Risk Human Papillomavirus Type Influences the Tissue Microenvironment in Cervical Intraepithelial Neoplasia Grade 2

High-risk, cancer-causing human papillomavirus (HPV) types are associated with cervical precancer and cancer. A high proportion of high-risk HPV precancer lesions undergo immune-mediated regression. The purpose of this study was to determine if the tissue microenvironment of HPV16 and 18 (HPV16/18) cervical intraepithelial neoplasia grade 2 lesions differed from other high-risk types (HPV 'other'). Consistent with other studies, we found that progression to higher-grade disease was more frequent in HPV16/18 lesions when compared with HPV 'other' lesions. HPV16/18 lesions were significantly more likely to be indoleamine 2,3,-dioxygenase 1 (IDO1)-positive and were associated with reduced CD8 and FoxP3 T cells in the lesion. In the stroma, reduced Tbet- and CD32-positive cells and increased Blimp1-positive cells were significantly associated with HPV16/18 lesions when compared with HPV 'other' types. On analysis of the IDO1-positive tissues, lesional IDO1 was associated with significantly decreased numbers of CD4-, CD8-, and FoxP3-positive cells in the stroma compared with IDO1-negative tissues. These data suggest that IDO1 expression may impair infiltration of CD4, CD8, and FoxP3 cells into the stroma beneath the precancer lesion. Increased expression of IDO1 may contribute to immune avoidance and an increased frequency of disease progression in HPV16- and 18-positive lesions.

Characterisation of the immune microenvironment of cutaneous squamous cell carcinoma in immunosuppression

Cutaneous squamous cell carcinoma (cSCC) is a common cancer. Systemic immunosuppression with drugs such as Prednisone results in more aggressive disease. We hypothesise that more aggressive disease in immunosuppression is the result of immune changes in the tumour microenvironment. We characterised T cell, phagocytic and antigen presenting cell subsets in cSCC, and determined if these infiltrates were altered by immunosuppressive therapy. We found a dominant 'CD8 profile' in the centre of cSCC lesions, with CD8 cells correlating with Tbet, FoxP3, OX40 and 'M2-like' macrophages, whereas a 'Tbet and granulocyte profile' with associated inflammation predominated at the margin of the tumour. Individuals on systemic immunosuppressive therapy had lesions that were comparable in size, stage and number of vessels to immune competent individuals however the number of CD11c positive cells in the lesion centre was significantly reduced. We conclude that cSCC lesions are immunologically heterogeneous across the lesion and that systemically immunosuppressed individuals have reduced CD11c positive cells in the centre of the lesion. The role and detailed phenotype of CD11c positive cells in cSCC lesions warrants further investigation.

How real is a virtual interview? Perspectives of orthopaedic surgery residency directors

OBJECTIVE

As a result of COVID-19 pandemic, the 2021 US residency MATCH was devoid of the traditional in-person interviews. Herein, we assess the impact of Virtual Interviews (VIs) on resident selection, from the perspectives of Orthopedic Surgery (OS) Program Directors (PDs).

MATERIALS AND METHODS

A 14-item survey was sent to PDs of ACGME-accredited OS residencies. Questions were designed to assess the pros, cons, and robustness of VIs compared to their antecedent in-person format.

RESULTS

Forty-seven PDs responded to our survey. VIs antagonized PDs' ability to assess applicants' fit to program (76.6%), commitment to specialty (64%), and interpersonal skills (68.1%). This led to heavier dependence upon applicants' portfolios (64%). Almost all respondents (97.9%) found VIs to be more cost-efficient, saving a median of $3000 in interview-related expenses. Overall, only 8.5% of PDs were willing to conduct exclusive VIs in future cycles, compared to the majority in favor of dual formats (51.5%) or exclusive in-person interviews (40.4%).

CONCLUSIONS

VIs have been an overall success, making most PDs opt for dual interview formats in future cycles. How this technology is further implemented in the future remains to be seen.

Improved calendar disc scheduler for LTE advanced networks with HARQ

Long Term Evolution Advanced (LTE-A) is a broadband wireless technology that supports variety of services with different data rate. In order to achieve this the evolved Node B (eNB) uses different features provided in the 3GPP standards. Features like Carrier Aggregation (CA), Multiple input and Multiple output (MIMO) and Hybrid Automatic Repeat Request (HARQ) help to increase the throughput and spectral efficiency. In this paper, a novel two-level calendar disc algorithm with HARQ is introduced at the eNB for effectively scheduling real time and non-real time traffic with different service types. The algorithm also uses a burst profile management module that analyzes the current user profile and notifies the scheduler about the need to change in profile based on power boosting. The Calendar Disc Scheduler (CDS) is improved by adding HARQ retransmission index as a parameter in calculating the metric weight. The scheduler was tested for both adaptive and non-adaptive methods of HARQ in both synchronous and asynchronous modes. The proposed improved CDS scheduler was simulated with LTESim simulator and compared with calendar disc algorithm without HARQ improvements. Results show that the proposed scheduling method provides increased performance in terms of goodput, delay and spectral efficiency.

Skin antigen-presenting cells and wound healing: New knowledge gained and challenges encountered using mouse depletion models

The role of antigen-presenting cells in the skin immune system, in particular Langerhans cells and dendritic cells, has not been well defined. We recently published a study in 'Immunology' where we reported that the loss of langerin-positive cells in the skin accelerated wound repair in the Lang-DTR mouse. The study published here by Li, et al. reports delayed wound closure following depletion of CD11c-positive cells in the CD11c-DTR mouse. In this commentary, we attribute the differences between these results to several factors that differ between the studies including the depletion of different cell populations; differences in the age and the sex of mice; differences in antibiotic use between the studies; and differences in the location of the biopsies that were taken. Here, we describe the impact of these differences on wound healing and conclude that further standardization of the wound model, and further characterization of the specific cells that are depleted in these mice, is necessary to better understand how antigen-presenting cells contribute to wound healing.

Depletion of langerin+ cells enhances cutaneous wound healing

Langerin is a C-type lectin receptor that is expressed on Langerhans cells and langerin-positive dermal dendritic cells in the skin. Little is known about the function of langerin⁺ cells in wound healing. In this study, the effects of ablation of langerin⁺ cells on healing of a full-thickness excision wound were investigated using the langerin-DTR depletable mouse. Strikingly, depletion of langerin⁺ cells resulted in more rapid reduction in wound area. Accelerated wound healing in the langerin⁺ -cell-depleted group was characterized by enhanced neo-epidermis and granulation tissue formation, and increased cellular proliferation within the newly formed tissues. Accelerated healing in the absence of langerin⁺ cells was associated with increased levels of granulocyte-macrophage colony-stimulating factor, F4/80⁺ cells and blood vessels within the granulation tissue. These data support an inhibitory role for langerin⁺ cells during wound healing. Therapies that suppress langerin⁺ cells or their function may therefore have utility in progressing the healing of wounds in humans.

Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded?

AIM

To optimise follow-up by dismissing lesions on baseline ultrasound (US) if renal lesions conform to US criteria of an angiomyolipoma (AML).

METHOD AND MATERIALS

The present study was a 10-year retrospective review of patients who were found to have incidental hyperechoic renal lesions on US to ascertain the outcome from subsequent imaging, clinical encounters, and cancer registrations. Exclusions included renal calculi, tuberous sclerosis, Von-Hippel-Lindau, or a known cancer.

RESULTS

After excluding 39 patients, 1,493 patients were identified. One hundred and sixty had more than one lesion with 87 patients having bilateral lesions. Regardless of indication, 889 patients had subsequent imaging within 5 years (59.5%). The average size of all AMLs was 13.2 mm. In the group with lesions that were <10 mm (807), 438 had imaging follow-up with an average follow-up time of 1.5 years. Mean lesion size in this group was 7 mm, with an average increase of <0.5 mm on follow-up. No lesions were found to be malignant on subsequent imaging nor did any of these patients have a subsequent renal cancer diagnosis registered at local multidisciplinary team meetings.

CONCLUSION

No incidental subcentimetre hyperechoic renal lesion with imaging characteristics of an AML demonstrated significant growth or developed into a malignancy on follow-up.

PI-RADS version 2.1: one small step for prostate MRI

Multiparametric (mp) prostate magnetic resonance imaging (MRI) is playing an increasingly prominent role in the diagnostic work-up of patients with suspected prostate cancer. Performing mpMRI before biopsy offers several advantages including biopsy avoidance under certain clinical circumstances and targeting biopsy of suspicious lesions to enable the correct diagnosis. The success of the technique is heavily dependent on high-quality image acquisition, interpretation, and report communication, all areas addressed by previous versions of the Prostate Imaging-Reporting and Data System (PI-RADS) recommendations. Numerous studies have validated the approach, but the widespread adoption of PI-RADS version 2 has also highlighted inconsistencies and limitations, particularly relating to interobserver variability for evaluation of the transition zone. These limitations are addressed in the recently released version 2.1. In this article, we highlight the key changes proposed in PI-RADS v2.1 and explore the background reasoning and evidence for the recommendations.

The role of Langerhans cells in pathologies of the skin

Langerhans cells (LCs) are epidermal immune cells of myeloid origin. Although these cells were primarily thought to play a defensive role in the skin, evidence now indicates a diverse range of LC-mediated effects including the relay of viral antigens in herpes simplex infection, recruitment of eosinophils in atopic dermatitis and promotion of a Th17 response in Candida infection. LCs may have a protective or suppressive function in pathologies of the skin, with differing functions being driven by the skin milieu. Understanding LC function will help guide the development of interventions that modulate these cells for therapeutic benefit.

Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma

AIM

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer aims to downstage prior to definitive management. Repeat imaging assessment of the tumour post-therapy has implications for treatment. Our aim was to assess if the inferior mesenteric vein (IMV) diameter measured on CT can be used as a surrogate marker for evaluation of tumour response to neoadjuvant treatment.

METHOD

IMV diameter was assessed in patients with and without locally advanced rectal cancer, pre- and post-radiotherapy, to ascertain if IMV diameter is a surrogate marker of tumour response.

RESULTS

IMV diameter was 5.9 mm in patients with rectal cancer vs 4.7 mm in patients without (P = 0.0001). The baseline IMV diameter was significantly higher for cases with local lymphadenopathy [N0 5.2 mm vs N1/2 6 mm (P = 0.0059)] and extramural venous invasion (EMVI) [negative 5.4 mm vs positive 6.4 mm (P = 0.0001)]. Post-radiotherapy there was a significant decrease in the IMV diameter in cases with treatment response compared to non-responders: the percentage change in IMV diameter was a 17.54% decrease vs 1.39% increase (P = 0.0001). These results were reproduced on comparing between magnetic resonance tumour regression grades using ANOVA (P = 0.0001). There was also a significant decrease in IMV diameter when assessing lymph node (LN) and EMVI response vs non-responders (P = 0.0001 and 0.0001 respectively).

CONCLUSION

Patients with rectal cancer have a dilated IMV compared with patients without rectal cancer. We confirm that IMV diameter is a potential surrogate marker of LN status and EMVI at baseline. IMV diameter is also a marker of tumour, LN and EMVI response to chemoradiotherapy.

Kimura's disease: A case presentation of postauricular swelling

Kimura's disease (KD) is a rare chronic inflammatory disease of subcutaneous tissues and occurs predominantly in head and neck region. It is seen primarily in young Asian males. Typical clinical presentations are painless subcutaneous masses, regional lymph node enlargement, blood and tissue hypereosinophilia, and increased serum IgE levels. Here, we present a case of a 27-year-old female who presented with unilateral single nodular swelling in the right postauricular region. The diagnosis of KD was done based on characteristic histopathologic finding in conjunction with peripheral eosinophilia and increase in serum IgE levels.

Central mucoepidermoid carcinoma

Central mucoepidermoid carcinomas (MECs) are extremely rare tumors, comprising 2-3% of all MECs reported in the literature. We report a rare case of clear cell variant of central MEC with calcifications occurring in the left posterior mandible in a 37-year-old male patient.

Vascular malformations of central nervous system: A series from tertiary care hospital in South India

Aims and Objectives:

To describe clinicopathological features of surgically resected vascular malformations (VMs) of central nervous system (CNS).

Materials and Methods:

Histologically diagnosed cases of VMs of CNS during April 2010–April 2014 were included. Demographic data, clinical and radiological features were obtained. Hematoxylin and eosin slides were reviewed along with Verhoeff-Van Gieson (VVG), Masson's trichrome, periodic acid-Schiff, and Perls' stains. Morphologically, cavernomas and arteriovenous malformations (AVMs) were distinguished on the basis of vessel wall features on VVG and intervening glial parenchyma.

Results:

Fifty cases were diagnosed as VMs of CNS with an age range of 14–62 years. These included 36 cavernomas, 12 AVMs, 2 mixed capillary-cavernous angiomas. Most of the cavernoma patients (15/36) presented with seizures, whereas AVM patients (8/12) had a headache as the dominant symptom. Twenty-nine patients were reliably diagnosed on radiological features. Microscopic evidence of hemorrhage was seen in 24/36 cavernomas and 6/12 AVMs, as opposed to radiologic evidence of 10 and 4, respectively. Reactive gliosis was seen in 16 cavernomas.

Conclusions:

Histological features are important for classifying the VMs of CNS as there are no specific clinical and radiological features. Type of VM has a bearing on management, prognosis, and risk of hemorrhage.

Evaluation of palatal rugae pattern in establishing identification and sex determination in Nalgonda children

BACKGROUND

Establishing individual identification of a decedent only by dental means is a mammoth task in forensic odontology. Palatal rugae's uniqueness, its resistance to heat, and stability throughout life have been proved by its use as an alternative aid in individual identification where comparison of fingerprints and other records is difficult.

AIMS AND OBJECTIVES

The aim of the present study was to analyze the role of palatal rugoscopy in personal identification and sex determination of Nalgonda pediatric population.

MATERIALS AND METHODS

The study group consisted of 100 children having mixed dentition within the age range of 8-11 years, residing in Nalgonda district. Palatal rugae pattern, shape of the incisive papillae, length of the median palatal raphae, and shape of the dental arches were analyzed using Chi-square and Mann-Whitney tests between males and females.

RESULTS

Wavy and curved patterns appeared to be most prevalent in both males and females but with no significant difference. The number of primary rugae in females and secondary rugae in males, on left side of the palate, was significantly more than their counterparts (P < 0.05). When rugae unification was observed, diverging type was significantly more in males than in females. Parabolic dental arch form, elliptical type of incisive papilla, and medium length of median palatal raphae was observed in majority of the subjects.

CONCLUSION

The present study hypothesizes the uniqueness of the rugae in personal identification as no two palates showed similar type of rugae in either of the genders. The rugae pattern also contributes minimally towards sex determination as there was no significant difference observed between the two variables.

Is Abdominal Fat Distribution Measured by Axial CT Imaging an Indicator of Complications and Mortality in Acute Pancreatitis?

BACKGROUND

Obesity is an important risk-stratifying co-morbidity for many pathological conditions. Controversy exists about its influence in outcomes after acute pancreatitis (AP). This study assessed abdominal fat distribution (subcutaneous, retroperitoneal and intra-abdominal) measured using computer tomography (CT) images and related it to outcomes in patients with AP.

METHODS

The case notes of patients admitted with AP were identified from computerised records from 2008 to the 2013. Image analysis software was used to assess the individual abdominal fat distributions from CT images.

RESULTS

A total of 79 patients were included. There was no relationship between fat distribution and either severity of, or mortality from, AP. Fat distribution was not found to be an independent risk factor on multivariate analysis. There was, however, a positive correlation between retroperitoneal and intra-abdominal fat with APACHE II scores, Ranson and Glasgow score and Multiple Organ Dysfunction score (MODS) on various days following admission (r = 0.421, p = 0.0008; r = 0.469, p < 0.0001; r = 0.398, p = 0.007; r = 0.336, p = 0.011, respectively). On multiple logistical regression analysis, the only variables associated with mortality were Balthazar Severity Index, MODS and EWS with a p value of <0.0001, 0.0019 and 0.0481, respectively.

CONCLUSIONS

Obese patients have worse predicted outcomes as measured by the EWS, MODS and Ranson scores. Abdominal fat distribution, however, was not shown to be directly related to AP severity or mortality. The addition of fat parameters may be of use in prognostic CT severity index models, but from this data, it does not appear to be an independent risk factor of adverse outcome.

Dielectric Relaxation of NiFe2O4/Gd2O3 Core-Shell Nanoparticles

Gd2O3 encapsulated NiFe2O4 core-shell nano-particles (CSNPs) have been synthesized by chemical route. The phase formation of the materials is confirmed by X-ray diffraction analysis. The average particle size is found to be 60 nm by transmission electron microscope. The band gap of NiFe2O4/Gd2O3 CSNPs is obtained by UV-visible absorption spectroscopy. The observed band gap of 4.38 eV lies in between the individual band gap of Gd2O3 and NiFe2O4. The frequency-dependent dielectric relaxation of the material is investigated in the temperature range from 303 K to 543 K. The temperature dependent relaxation times are found to obey Arrhenius law having activation energy of 0.3 eV. The Nyquist plots of impedance data are analyzed by the RC equivalent circuit having a constant phase element. The dielectric relaxation is modelled by Havriliak-Negami technique in the electric modulus formalism. The frequency dependent conductivity spectra follow the double power law.

Mandibular aneurysmal bone cyst associated with cemento-ossifying fibroma - a case report

Aneurysmal bone cyst is an uncommon bone lesion which rarely occurs in craniofacial region. Among all the cystic lesions occurring in the jaws, aneurysmal bone cyst is infrequent and it more commonly occurs in the mandible. Most of the cases occur in the first two decades of life, with no gender predilection. Here, we are presenting a case of an aneurysmal bone cyst which occurred in the mandible of a twelve year old female patient.

In vitro Evaluation of Antibacterial Efficacy of Pineapple Extract (Bromelain) on Periodontal Pathogens

BACKGROUND

Periodontitis is an inflammatory disease resulting in the destruction of periodontal tissues. Various treatment modalities have been tried in the form of mechanical therapy and surgical therapy. Antimicrobial agents have been used as a monotherapy and as an adjunct with mechanical debridement. Various plant extracts have been used as antibacterial agents. Pineapple extract (bromelian) is one such agent. Hence this study was conducted to assess the antibacterial efficacy of bromelain on both aerobic and anaerobic periodontal microorganisms. The aim was to assess the antibacterial efficacy of bromelain on both aerobic and anaerobic periodontal microorganisms.

MATERIALS AND METHODS

Minimum inhibitory concentration (MIC) of bromelain was tested on isolated strains of Streptococcus mutans, Enterococcus fecalis Aggregatibacter actinomycetemcomitans (Aa), and Porphyromonas gingivalis (Pg) using serial dilution broth method.

RESULTS

S. mutans showed sensitivity at the lowest concentration of 2 mg/ml as compared to E fecalis (31.25 mg/ml) while Pgingivalis showed sensitivity at the lowest concentration of 4.15 mg/ml as compared to Aa (16.6 mg/ml).

CONCLUSION

Bromelain exerts an antibacterial effect against potent periodontal pathogens; hence, it may be used as an antibacterial agent. However, further trial has to be conducted to validate this result.

Traumatic rupture of arachnoid cyst with subdural hygroma

Intracranial arachnoid cysts developing in relation to the cerebral hemispheres and middle cranial fossa are usually incidental or asymptomatic. However, most of the clinically active cysts present with seizures because of chronic compression. Presentation as raised intracranial pressure due to cyst rupture into the subdural space is a rare clinical entity. We herein present a case of an asymptomatic arachnoid cyst with rupture into the subdural space bilaterally and presenting as raised intracranial pressure.

Infections and infestations of the gastrointestinal tract. Part 1: bacterial, viral and fungal infections

The purpose of this article is to review the imaging findings of various infections affecting the gastrointestinal tract. Barium examinations, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography all play an important role in the diagnostic workup of gastrointestinal tract infections. Knowledge of differential diagnosis, sites of involvement, and typical imaging features of different infections can help in accurate diagnosis and guide treatment.

Infections and infestations of the gastrointestinal tract. Part 2: parasitic and other infections

The purpose of this article is to provide a comprehensive review of the imaging findings of various parasitic infestations and other miscellaneous infections affecting the gastrointestinal tract. Barium examinations play an important role in the diagnostic workup of parasitic intestinal infections. Knowledge of differential diagnosis, sites of involvement, and imaging features of different infections and infestations can help in accurate diagnosis and guide treatment.

Pancreaticogastric fistula secondary to intraductal papillary mucinous neoplasia: a case report and review of the literature

Intraductal papillary mucinous neoplasms (IPMNs) are benign cystic lesions of the pancreas with recognised premalignant potential. An occasional feature of IPMNs is fistula formation to surrounding organs. This report describes a case of a pancreaticogastric fistula from a main duct IPMN that produced the complete resolution of the patient's symptoms.

Microbiological spectrum of brain abscess at a tertiary care hospital in South India: 24-year data and review

Intracranial abscesses are life-threatening infections that pose a diagnostic challenge not only to the neurosurgeon but also to the microbiologists. Detailed studies documenting the spectrum of infecting agents involved in brain abscesses are limited from India. Materials and Methods. This is a retrospective analysis of 352 samples from 1987 to 2010 analyzed at a tertiary care hospital in South India from 1987 to 2010, to document the changing trends with time. Results. The age of the patients ranged from 2 to 80 years, a larger number of males being affected. Otogenic infections were the most common cause while cryptogenic abscesses were 20%. Gram stain and culture positivity were 78% each. Gram-positive and negative facultative aerobes and obligate anaerobes were also on the rise. Unusual organisms, like Burkholderia pseudomallei, Salmonella typhi, Nocardia species, Cladosporium bantiana, Fonsecaea pedrosoi, Entamoeba histolytica, and Acanthamoeba were also isolated and/or detected from the brain abscesses aspirate or resected tissue. Summary. New and emerging pathogens associated with brain abscess, especially in immunosuppressed individuals, have renewed the necessity of an early detection, and it will be of great value in appropriate management of patients with brain abscess.