Simultaneous complementary idiotypic responses: absence of reciprocal regulation

Complementary antibodies, i.e. antibodies having combining site structures which are at least partially directed against each other, were induced in A/He mice by immunization with phosphorylcholine (Pc) coupled to keyhole limpet hemocyanin or with the Pc-binding IgA myeloma protein, HOPC-8 (H8). Both responses were monitored by enumerating plaque-forming cells and assaying serum antibody levels to Pc and H8. Prior immunization with H8 markedly suppressed subsequent immunization with Pc and vice versa; neither plaque-forming cell response was diminished, however, when mice were immunized simultaneously with Pc and H8. Experiments were designed to determine if the absence of reciprocal regulation was due to change in idiotypes. This was determined by measuring inhibition of plaque formation using complementary antibody. Plaque formation by cells was equally inhibited by high dilutions of the appropriate complementary antibody whether cells were from mice immunized with one, the other, or both antigens. Thus, the absence of regulation could not be accounted for by emergence of different idiotypes. Interestingly, sera from mice immunized to have high responses to both antigens were relatively ineffective in inhibiting plaque formation or suppressing immunization to Pc. However, such sera contained complexes of the complementary antibodies; apparently antibody to Pc in such sera quenches or neutralizes the activity of anti-H8 antibody. But the formation of complexes, at least measurable levels of circulating complexes, must be a result rather than the cause for the absence of reciprocal regulation, since regulation was also absent when immunization to Pc was manipulated so that responses were too low to result in detectable levels of circulating antibody to Pc. It is proposed that simultaneous complementary responses may occur in nature to other antigens and antibodies, and that such simultaneous responses may cause pathologic changes

Ergebnisse der arthroskopischen subacromialen Dekompression bei Rotatorenmanschettenläsionen und Tendinosis calcarea nach 1 bis 5 Jahren

In der vorliegenden Arbeit wurden 51 Patienten, bei denen eine arthroskopische subacromiale Dekompression durchgeführt wurde, in einem Zeitraum von 1-5 Jahren postoperativ nachuntersucht. Neben dem klinischen und dem sonographischen Befund wurde das subjektive und objektive Befinden anhand spezifischer Scores ermittelt (Constant und Murley Score, UCLA-Rating-Scale, modifizierter SF-36 Score). Die operative Therapie wurde gegebenenfalls durch eine Kalkdepotentfernung oder eine offene oder arthroskopische Naht der Rotatorenmanschette erweitert. Der Constant und Murley Score verbesserte sich postoperativ von 32,5 auf durchschnittlich 76,5 Punkte. Die UCLA-Rating-Scale stieg von 9,8 auf 27,8 Punkte im Durchschnitt. 78,4% der Patienten waren mit dem Ergebnis der Operation zufrieden. Auch im modifizierten SF-36 Score zeigten alle Kategorien Verbesserungen im Vergleich zu vor der Operation. Die Patienten, bei denen eine partielle oder komplette Ruptur der Rotatorenmanschette festgestellt wurde, lag mit 72 Punkten im Constant-Score und 25,8 Punkten in der UCLA-Rating-Scale leicht unter denen des Gesamtkollektives. Nur 65% der Patienten waren mit dem Ergebnis der Operation zufrieden. Lag bei den Patienten ein Kalkdepot vor, wurde ein durchschnittlicher Score nach Constant und Murley von 74,1 Punkten erreicht, in der UCLA-Rating-Scale wurden durchschnittlich 27,4 Punkte erzielt. 75% der Patienten gaben an, zufrieden mit dem Ergebnis der Operation zu sein. Ein signifikanter Unterschied wurde bezüglich der Dominanz des Armes erreicht. Während im Constant-Score nur 73,8 Punkte und in der UCLA-Rating-Scale 26,5 Punkte erreicht wurden, wenn der dominante Arm betroffen war, erzielten die Patienten, deren nicht-dominanter Arm der Erkrankte war, einen durchschnittlichen Constant-Score von 82,8 Punkten und einen UCLA-Score von 31,1 Punkten. Alle Patienten, deren nicht-dominanter Arm operiert wurde, waren mit dem Ergebnis der Operation zufrieden. Dagegen gaben nur 69,4% der Patienten, deren dominanter Arm betroffen war an, ein befriedigendes Ergebnis mit der Operation erreicht zu haben. Bei der sonographischen Untersuchung wurde bei 8 Patienten eine Ausdünnung der Rotatorenmanschette festgestellt. 11 Patienten wiesen sonographische Hinweise auf eine Partialruptur der Rotatorenmanschette auf. Bei 14 Personen im Patientenkollektiv wurde eine oberflächlich unregelmäßige Struktur der Rotatorenmanschette gefunden. Nur bei 23 der Patienten wurde bei der Sonographie eine intakte Rotatorenmanschette ohne pathologischen Befund gefunden. Allerdings konnte vom postoperativen sonographischen Befund nicht auf das Ergebnis der Operation geschlossen werden, da die Patienten mit sonographischen Nachweis einer Partialruptur der Rotatorenmanschette keinen signifikanten Unterschied in ihren Ergebnissen bezüglich des Gesamtkollektives aufwiesen. Unsere Studie zeigt, dass sowohl bei Rotatorenmanschettenläsionen, als auch bei Tendinosis Calcarea befriedigende Ergebnisse mit der arthroskopischen subacromialen Dekompression, die gegebenenfalls mit einer Kalkdepotentferung bzw. mit einer Rotatorenmanschettennaht kombiniert wird, erreicht werden können. Die Dominanz des Armes scheint Einfluss auf das Ergebnis der Operation zu haben und die postoperativen sonographischen Befunde liefern zwar wichtige Informationen für ein mögliches schlechtes Ergebnis, korrelieren jedoch häufig nicht mit dem subjektiven und objektiven Befund des Patienten.Purpose of this study is to evaluate the results of arthroscopic subacromial decompression after 1-5 years. 51 Patients were examined after arthroscopic surgery by clinical examination, clinical scores (Constant and Murley Score, UCLA-Rating-Scale, modified SF-36 Score) and ultrasound. The postoperative CM-Score improved from 32.5 up to 76.5 points, the UCLA Score from 9.8 to 27.8 points. 78.4% of the patients were satisfied with the surgery. The mod. SF-36 Score improved in every category. Patients with a partial- or full-thickness tear of the rotator cuff showed 72 Points in the CM-Score and 25.8 points in the UCLA-Score. Only 65% of the patients were satisfied with the surgery. Patients with a calcific deposit showed postoperatively 74.1 points in the CM-Score and 27.4 points in the UCLA-Score. 75% Patients were satisfied with the surgery. There was a significant difference in the outcome of patients with involved dominant or non-dominant arm. CM-Score and UCLA-Score showed 73.8 and 26.5 points in patients with involved dominant side and 69.4% were satisfied with the surgery. If the non-dominant side was affected they achieved 82.2 and 31.1 points and 100% of them were satisfied. The postoperative ultrasound showed thinning of the rotator cuff in 8 patients, 11 had signs of a partial-rotator cuff tear and 14 Patients had superficial structural changes. Only 23 patients showed no pathologic signs with a normal rotator cuff. But there was no connection between the results of the ultrasound and clinical outcome. Our study showed good results after arthroscopic subacromial decompression eventually combined with removal of calcific deposits or arthroscopic or open rotator cuff repair. Dominance of the affected side seems to be important for the clinical outcome and postoperative ultrasound might be helpful to find a reason for a poor result but often there is no connection between changes in the ultrasound and the postoperative outcome

Dibromidotris(dimethyl­amine)magnesium(II)

The Mg centre in the title compound, [MgBr2(C2H7N)3], is penta­coordinated in a trigonal-bipyramidal mode with the two Br atoms in axial positions and the N atoms of the dimethyl­amine ligands in equatorial positions. The MgII centre is located on a crystallographic twofold rotation axis. The crystal structure is stabilized by N—H⋯Br hydrogen bonds. The N atom and H atoms of one dimethylamine ligand are disordered over two equally occupied positions

Assessing exhibition swine as potential disseminators of infectious disease through the detection of five respiratory pathogens at agricultural exhibitions

International audienceAbstractWidespread geographic movement and extensive comingling of exhibition swine facilitates the spread and transmission of infectious pathogens. Nasal samples were collected from 2862 pigs at 102 exhibitions and tested for five pathogens. At least one pathogen was molecularly detected in pigs at 63 (61.8%) exhibitions. Influenza A virus was most prevalent and was detected in 498 (17.4%) samples. Influenza D virus was detected in two (0.07%) samples. More than one pathogen was detected in 165 (5.8%) samples. Influenza A virus remains a top threat to animal and human health, but other pathogens may be disseminated through the exhibition swine population

Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up

Background: The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial. Purpose/Hypothesis: The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya. Results: The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients. Conclusion: Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair

Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis

AbstractBackground Unloading knee braces can provide good short-term pain relief for some patients with unicompartmental osteoarthritis (UOA). Their cost is relatively small compared with surgical interventions. However, no previous studies have reported their use over a duration of 5 years or more.Methods Up to 8 years of prospective data were collected from 63 patients who presented with UOA. After conservative management with analgesia and physiotherapy, patients were offered an unloading brace. EQ-5D (EuroQol five dimensions) questionnaires were collected at baseline and after wearing the brace. Cost and quality-adjusted life years (QALYs) were compared with a total knee replacement (TKR) with an 8-month waiting duration and 8 years of results.Results Patients experienced a mean increase in EQ-5D of 0.42 with an average duration of wear of 26.1 months resulting in an increase of 0.44 in QALYs with a mean cost of £625. The adoption of an unloader knee brace was found to be a short-term cost-effective treatment option with an 8-month incremental cost effectiveness ratio of £9599. Compared with no treatment, the unloader knee brace can be considered cost effective at 4 months or more. At 8 years follow-up, the unloader knee brace demonstrated QALYs gain of 0.43 and with an incremental cost-effectiveness ratio of -£6467 compared with TKR.Conclusion Unloading knee braces are cost effective for the management of UOA. These findings strongly support the undertaking of further research into the long-term impact of unloading knee brace. The unloader knee brace has benefits to the National Health Service for capacity, budget, waiting list duration, frequency of surgery and reducing the required severity of surgical intervention