Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip screw is not always successful, especially in osteoporotic fractures. Internal fixation in such a situation may achieve a satisfactory initial fracture site reduction, but late fracture collapse into varus during weight bearing, can lead to a high failure rate. Since 1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a solution in unstable ITFs by adding an anchoring ability to the lag screw.Methods: A series of 33 osteoporotic intertrochanteric fractures were operated with cement augmented dynamic hip screw. One patient lost to follow up. All patients were then allowed partial weight bearing walker aided ambulation under the guidance of physiotherapist on the second or third postoperative day. The patients were followed radio logically and clinically at regular intervals (1st month, than at 3rd month and then at 6th month interval after surgery). Results were graded as excellent (score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinical result was given according to Salvati and Wilson scoring.Results: Total 33 patients were taken for the study they were followed for minimum 6 months and at 6 months the clinical outcome was rated as per the Salvati and Wilson scoring system. One patient lost to follow-up. Final clinical results as evaluated by Salvati and Wilson scoring were; excellent in 24 cases (75%), good in 7 cases (21.88%), fair in 1 case (3.12%) and poor in 0 cases (0%). There were no non-union, AVN, implant failure and screw cut-out in our study.Conclusions: The surgical management of intertrochanteric fractures with PMMA augmented DHS provide a stable fixation with moderate pain free early mobilisation and better outcome in osteoporotic patients without the complications of superior screw cut-out, sliding collapse, and with the appropriate placement of bone cement along with proper amount (4-5 ml) of cement we can also reduce the cement related complications such as delayed healing, nonunion, heat necrosis and avascular necrosis

Comparative study of titanium elastic nailing versus hip spica in treatment of femoral shaft fractures in children

Background: There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children.Methods: Study was conducted at SMS Medical College, Jaipur (Rajasthan). Out of 90 Patients of diaphyseal fracture femur, 45were treated conservatively by spica cast and 45 were treated with TEN. Follow up done regularly up to twelve months of injury with taking into account, various parameters.Results: All diaphyseal fractures of femur healed, whether treated conservatively by spica cast or treated operatively with TEN. The time of union and weight bearing was less in operative group as comparative to spica cast group. Ten patients (22.22%) in spica group compared to three patients (6.66%) in operative group had malunion and two patients (4.4%) in spica group compared none in operative group had delayed union.Conclusions: Results of TEN turned out to be far superior to traction and spica cast treatment in paediatric femoral fractures. Rate of complications was far low with operative than conservative Treatment

Dodatak supranutritivnih doza cinkova sulfata i bakterija Bacillus firmus ubijenih toplinom u obrok rano odbijenih svinja: utjecaj na rast, funkciju neutrofila i upalne citokine

The objective of the study was to investigate the effect of supplementation of a supranutritional dose of zinc sulfate (ZnSO4) and Bacillus firmus derived bio-response modifier (BRM) on growth, blood neutrophil functions, pro-inflammatory and anti-inflammatory cytokine responses in early weanling piglets. In total, 45 piglets (age of 19.25 ± 0.84 days) were randomly divided into five groups: I (basal diet only), II (basal diet supplemented with ZnSO4), III (basal diet supplemented with BRM), IV (basal diet supplemented with ZnSO4 plus BRM) and V (basal diet without weaning from dam). The production of myeloperoxidase (MPO) and superoxide anion (O2-), and the concentration of transforming growth factor-β1 (TGF-β1) were markedly reduced, whereas the concentrations of intercellular adhesion molecule 1 (ICAM1), and monocyte chemoattractant protein 1 (MCP1) were significantly (P0.05) but a marked increase (P0,05), ali kod prasadi iz skupine II. i III. je 14. i 7. dana opaženo znakovito povišenje (P<0,05) ICAM1, MCP1, te sniženje koncentracije TGF-β1. U prasadi iz skupine IV dodavanje BRM i ZnSO4 u osnovnom obroku poboljšalo je MPO (2. dan) i O2- (7. dan), bez znakovitih promjena u rastu i koncentraciji citokina. Na kraju, zaključeno je da dodavanje kombinacije BRM i ZnSO4 u obroku potiče urođenu imunost prasadi što nije slučaj kada se ZnSO4 ili BRM dodaju zasebno. Rezultati ovog istraživanja pomoći će u formuliranju učinkovitog upravljanja hranidbom kod rano odbijene prasadi u krdu svinja

The differential contribution of the innate immune system to a good pathological response in the breast and axillary lymph nodes induced by neoadjuvant chemotherapy in women with large and locally advanced breast cancers

The tumour microenvironment consists of malignant cells, stroma, and immune cells. The role of adaptive immunity in inducing a pathological complete response (pCR) in breast cancer with neoadjuvant chemotherapy (NAC) is well studied. The contribution of innate immunity, however, is poorly documented. Breast tumours and axillary lymph nodes (ALNs) from 33 women with large and locally advanced breast cancers (LLABCs) undergoing NAC were immunohistochemically assessed for tumour-infiltrating macrophages (TIMs: M1 and M2), neutrophils (TINs), and dendritic cells (TIDCs) using labelled antibodies and semiquantitative methods. Patients’ blood neutrophils (n = 108), DCs (mDC1 and pDC), and their costimulatory molecules (n = 30) were also studied. Pathological results were classified as pCR, good (GPR) or poor (PRR). In breast and metastatic ALNs, high levels of CD163+ TIMs were significantly associated with a pCR. In blood, high levels of neutrophils were significantly associated with pCR in metastatic ALNs, whilst the % of mDC1 and pDC and expression of HLA-DR, mDC1 CD40, and CD83 were significantly reduced. NAC significantly reduced tumour DCs but increased blood DCs. PPRs to NAC had significantly reduced HLA-DR, CD40, and CD86 expression. Our study demonstrated novel findings documenting the differential but important contributions of innate immunity to pCRs in patients with LLABCs undergoing NAC

Modulation of T regulatory and dendritic cell phenotypes following ingestion of Bifidobacterium longum, active hexose correlated compound (AHCC®) and azithromycin in healthy individuals

The probiotic Bifidus BB536 (BB536), which contains Bifidobacterium longum, has been shown to have enhanced probiotic effects when given together with a standardized extract of cultured Lentinula edodes mycelia (AHCC®, Amino Up Co. Ltd., Sapporo, Japan). BB536 and AHCC® may modulate T cell and dendritic cell (DC) phenotypes, and cytokine profiles to favour anti-inflammatory responses following antibiotic ingestion. We tested the hypothesis that orally administered BB536 and/or AHCC®, results in modulation of immune effector cells with polarisation towards anti-inflammatory responses following antibiotic usage. Forty healthy male volunteers divided into 4 equal groups were randomised to receive either placebo, BB536, AHCC® or a combination for 12 days in a double-blind manner. After 7 days volunteers also received 250 mg azithromycin for 5 days. Cytokine profiles from purified CD3+ T cells stimulated with PDB-ionomycin were assessed. CD4+ CD25+ forkhead box P3 (Foxp3) expression and peripheral blood DC subsets were assessed prior to treatment and subsequently at 7 and 13 days. There was no difference in cytokine secretion from stimulated CD3+ T cells between treatment groups. Compared with baseline, Foxp3 expression (0.45 ± 0.1 vs. 1.3 ± 0.4; p = 0.002) and interferon-gamma/interleukin-4 (IFN-γ/IL-4) ratios were increased post-treatment in volunteers receiving BB536 (p = 0.031), although differences between groups were not significant. For volunteers receiving combination BB536 and AHCC®, there was an increase in myeloid dendritic cells (mDC) compared with plasmacytoid DC (pDC) counts (80% vs. 61%; p = 0.006) at post treatment time points. mDC2 phenotypes were more prevalent, compared with baseline, following combination treatment (0.16% vs. 0.05%; p = 0.002). Oral intake of AHCC® and BB536 may modulate T regulatory and DC phenotypes to favour anti-inflammatory responses following antibiotic usage

Ex vivo recovery and activation of dysfunctional, anergic, monocyte-derived dendritic cells from patients with operable breast cancer: critical role of IFN-alpha

Background Dendritic cells (DCs) play a crucial role in initiating effective cell-mediated immune responses, but are dysfunctional and anergic in breast cancer. Reversal of this dysfunction and establishment of optimal DC function is a key prerequisite for the induction of effective anti-cancer immune responses. Results Peripheral blood DCs (PBDCs) and lymph node DCs (LNDCs) generated in vitro from adherent cultures of peripheral blood monocytes (PBMs) and lymph node monocytes (LNMs), respectively, using the 4 cytokine conditioned medium (CCM) (GM-CSF+IL-4+TNF-α+IFN-α) or 3 CCM (GM-CSF+IL-4+TNF-α) demonstrated a significantly higher degree of recovery and functional capacity in a mixed lymphocyte DC reaction (MLDCR, p < 0.001), expressed significantly higher levels of HLA-DR, CD86, compared with 2 CCM (GM-CSF+IL-4) or medium alone generated DCs from PBMs and LNMs (p < 0.001). The PBDCs generated with 3 CCM or 4 CCM showed a significantly (p < 0.001) enhanced macropinocytotic capability (dextran particles) and induced increased production and secretion of interleukin-12p40 (IL-12p40) in vitro (p < 0.001), compared with PBDCs generated from monocytes using 2 CCM or medium alone. Lipopolysaccharide (LPS) stimulation of PBDCs generated with 4 CCM demonstrated enhanced secretion of IL-6 but not IL-12p70, compared with control DCs unstimulated with LPS (p < 0.001). Conclusion Dysfunctional and anergic PBDCs and LNDCs from patients with operable breast cancer can be optimally reversed by ex vivo culturing of precursor adherent monocytes using a 4 CCM containing IFN-α. Maximal immunophenotypic recovery and functional reactivation of DCs is seen in the presence of IFN-α. However, 4 CCM containing IFN-α generated-PBDCs, do not produce and secrete IL-12p70 in vitro

Epigenetic Basis of Diabetic Vasculopathy

Type 2 diabetes mellitus (T2DM) causes peripheral vascular disease because of which several blood-borne factors, including vital nutrients fail to reach the affected tissue. Tissue epigenome is sensitive to chronic hyperglycemia and is known to cause pathogenesis of micro- and macrovascular complications. These vascular complications of T2DM may perpetuate the onset of organ dysfunction. The burden of diabetes is primarily because of a wide range of complications of which nonhealing diabetic ulcers represent a major component. Thus, it is imperative that current research help recognize more effective methods for the diagnosis and management of early vascular injuries. This review addresses the significance of epigenetic processes such as DNA methylation and histone modifications in the evolution of macrovascular and microvascular complications of T2DM

Automatic leukocyte nucleus segmentation by intuitionistic fuzzy divergence based thresholding

The paper proposes a robust approach to automatic segmentation of leukocyte‟s nucleus from microscopic blood smear images under normal as well as noisy environment by employing a new exponential intuitionistic fuzzy divergence based thresholding technique. The algorithm minimizes the divergence between the actual image and the ideally thresholded image to search for the final threshold. A new divergence formula based on exponential intuitionistic fuzzy entropy has been proposed. Further, to increase its noise handling capacity, a neighborhood-based membership function for the image pixels has been designed. The proposed scheme has been applied on 110 normal and 54 leukemia (chronic myelogenous leukemia) affected blood samples. The nucleus segmentation results have been validated by three expert haematologists. The algorithm achieves an average segmentation accuracy of 98.52% in noise-free environment. It beats the competitor algorithms in terms of several other metrics. The proposed scheme with neighborhood based membership function outperforms the competitor algorithms in terms of segmentation accuracy under noisy environment. It achieves 93.90% and 94.93% accuracies for Speckle and Gaussian noises respectively. The average area under the ROC curves comes out to be 0.9514 in noisy conditions, which proves the robustness of the proposed algorithm