Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures.

OBJECTIVE: The aim of the study was to evaluate inter-observer reliability and intra-observer reproducibility between the three-column classification and Schatzker classification systems using 2D and 3D CT models. MATERIALS AND METHODS: Fifty-two consecutive patients with tibial plateau fractures were evaluated by five orthopaedic surgeons. All patients were classified into Schatzker and three-column classification systems using x-rays and 2D and 3D CT images. The inter-observer reliability was evaluated in the first round and the intra-observer reliability was determined during the second round 2 weeks later. RESULTS: The average intra-observer reproducibility for the three-column classification was from substantial to excellent in all sub classifications, as compared with Schatzker classification. The inter-observer kappa values increased from substantial to excellent in three-column classification and to moderate in Schatzker classification The average values for three-column classification for all the categories are as follows: (I-III) k2D = 0.718, 95% CI 0.554-0.864, p < 0.0001 and average 3D = 0.874, 95% CI 0.754-0.890, p < 0.0001. For Schatzker classification system, the average values for all six categories are as follows: (I-VI) k2D = 0.536, 95% CI 0.365-0.685, p < 0.0001 and average k3D = 0.552 95% CI 0.405-0.700, p < 0.0001. The values are statistically significant. CONCLUSION: Statistically significant inter-observer values in both rounds were noted with the three-column classification, making it statistically an excellent agreement. The intra-observer reproducibility for the three-column classification improved as compared with the Schatzker classification. The three-column classification seems to be an effective way to characterise and classify fractures of tibial plateau.

Selection of sites for field trials of genetically engineered mosquitoes with gene drive.

Novel malaria control strategies using genetically engineered mosquitoes (GEMs) are on the horizon. Population modification is one approach wherein mosquitoes are engineered with genes rendering them refractory to the malaria parasite, Plasmodium falciparum, coupled with a low-threshold, Cas9-based gene drive. When released into a wild vector population, GEMs preferentially transmit these parasite-blocking genes to their offspring, ultimately modifying a vector population into a nonvector one. Deploying this technology awaits ecologically contained field trial evaluations. Here, we consider a process for site selection, the first critical step in designing a trial. Our goal is to identify a site that maximizes prospects for success, minimizes risk, and serves as a fair, valid, and convincing test of efficacy and impacts of a GEM product intended for large-scale deployment in Africa. We base site selection on geographic, geological, and biological, rather than social or legal, criteria. We recognize the latter as critically important but not as a first step in selecting a site. We propose physical islands as being the best candidates for a GEM field trial and present an evaluation of 22 African islands. We consider geographic and genetic isolation, biological complexity, island size, and topography and identify two island groups that satisfy key criteria for ideal GEM field trial sites.

Evaluation of Precipitation Vertical Profiles Estimated by GPM-Era Satellite-Based Passive Microwave Retrievals.

Precipitation estimation based on passive microwave (MW) observations from low-Earth-orbiting satellites is one of the essential variables for understanding the global climate. However, almost all validation studies for such precipitation estimation have focused only on the surface precipitation rate. This study investigates the vertical precipitation profiles estimated by two passive MW-based retrieval algorithms, i.e., the emissivity principal components (EPC) algorithm and the Goddard profiling algorithm (GPROF). The passive MW-based condensed water content profiles estimated from the Global Precipitation Measurement Microwave Imager (GMI) are validated using the GMI + Dual-Frequency Precipitation Radar combined algorithm as the reference product. It is shown that the EPC generally underestimates the magnitude of the condensed water content profiles, described by the mean condensed water content, by about 20%-50% in the middle-to-high latitudes, while GPROF overestimates it by about 20%-50% in the middle-to-high latitudes and more than 50% in the tropics. Part of the EPC magnitude biases is associated with the representation of the precipitation type (i.e., convective and stratiform) in the retrieval algorithm. This suggests that a separate technique for precipitation type identification would aid in mitigating these biases. In contrast to the magnitude of the profile, the profile shapes are relatively well represented by these two passive MW-based retrievals. The joint analysis between the estimation performances of the vertical profiles and surface precipitation rate shows that the physically reasonable connections between the surface precipitation rate and the associated vertical profiles are achieved to some extent by the passive MW-based algorithms.

Interaction analyses of human monocytes co-cultured with different forms of Aspergillus fumigatus.

Monocytes play a major role in the cellular defence against Aspergillus fumigatus in immunocompromised patients. To obtain a better understanding of the mechanisms involved in this interaction, phagocytosis and gene expression profiling of human monocytes was carried out after incubation with A. fumigatus resting, swollen and germinating conidia and hyphae (for 3, 6 and 9 h). The majority of monocytes phagocytosed up to three conidia during the first 3 h of incubation. Microarray analysis showed an increased expression level of immune-relevant genes, which was dependent on the germination state of the fungus and the incubation period. Among these genes, those encoding interleukin-8, macrophage inflammatory protein 3-alpha (CCL20) and monocyte chemotactic protein-1 (CCL2) were found to be potential key regulators involved in the A. fumigatus-induced immune response. In addition, A. fumigatus was found to be an inducer of the genes encoding urokinase type plasminogen activator (uPA), urokinase type plasminogen activator receptor (uPAR),plasminogen activator inhibitor (PAI), pentraxin-3 (PTX3) and intercellular adhesion molecule-1 (ICAM-1), which, in combination, may contribute to thrombosis and local lung tissue injury.

Aspergillus fumigatus antigens activate innate immune cells via toll-like receptors 2 and 4.

Invasive aspergillosis (IA) is a leading cause of mortality in haematological patients. Appropriate activation of the innate immune system is crucial for the successful clearance of IA. Therefore, we studied the Aspergillus fumigatus-mediated activation of human granulocytes and monocyte-derived immature dendritic cells (DCs), as well as murine bone marrow-derived DCs (BMDCs) from wild type, toll-like receptor (TLR)4-deficient, TLR2 knockout, and TLR2/TLR4 double deficient mice. Aspergillus fumigatus antigens induced the activation and maturation of immature DCs as characterized by CD83 expression, upregulation of major histocompatibility complex and co-stimulatory molecules. Moreover, fungal antigens enhanced the phagocytosis and production of interleukin (IL)-8 in granulocytes. The release of IL-12 by BMDCs in response to A. fumigatus antigens was dependent on the expression of TLR2, whereas the release of IL-6 was dependent on the expression of functional TLR4 molecules. The protein precipitate of A. fumigatus supernatant provided strong stimulation of DCs and granulocytes, indicating that a factor secreted by A. fumigatus might activate innate immune cells. In conclusion, A. fumigatus antigens induced the activation of DCs and granulocytes. Our results indicated that this activation was mediated via TLR2 and TLR4. Future studies are needed to assess the clinical impact of these findings in patients at high risk for IA.