Immune profile and responses of a novel dengue DNA vaccine encoding an EDIII-NS1 consensus design based on Indo-African sequences.

The ongoing COVID-19 pandemic highlights the need to tackle viral variants, expand the number of antigens, and assess diverse delivery systems for vaccines against emerging viruses. In the present study, a DNA vaccine candidate was generated by combining in tandem envelope protein domain III (EDIII) of dengue virus serotypes 1-4 and a dengue virus (DENV)-2 non-structural protein 1 (NS1) protein-coding region. Each domain was designed as a serotype-specific consensus coding sequence derived from different genotypes based on the whole genome sequencing of clinical isolates in India and complemented with data from Africa. This sequence was further optimized for protein expression. In silico structural analysis of the EDIII consensus sequence revealed that epitopes are structurally conserved and immunogenic. The vaccination of mice with this construct induced pan-serotype neutralizing antibodies and antigen-specific T cell responses. Assaying intracellular interferon (IFN)-γ staining, immunoglobulin IgG2(a/c)/IgG1 ratios, and immune gene profiling suggests a strong Th1-dominant immune response. Finally, the passive transfer of immune sera protected AG129 mice challenged with a virulent, non-mouse-adapted DENV-2 strain. Our findings collectively suggest an alternative strategy for dengue vaccine design by offering a novel vaccine candidate with a possible broad-spectrum protection and a successful clinical translation either as a stand alone or in a mix and match strategy.

Secondary synovial chondromatosis of the shoulder.

Synovial chondromatosis is classified as either primary or secondary. Primary synovial chondromatosis results from a proliferation of chondrocytes in the synovial membrane leading to the formation of cartilaginous loose bodies. Secondary synovial chondromatosis is a rare condition characterized by the growth of separated particles from the articular cartilage or osteophytes in joint diseases. The present article aims to report the secondary chondromatosis of the shoulder and to discuss the clinical manifestations, pathogenesis, diagnosis, histological findings and management of this condition.

A severely displaced metaphyseal fracture of the proximal humerus with dislocation of the shoulder in a child.

Fracture of the proximal humerus metaphysis with coexistent dislocation of the shoulder in children is a rare injury. The injury often occurs as a consequence of high velocity trauma. Most fractures of the proximal humerus commonly associated with the epiphysis in children can be treated with closed reduction. We presented a case of 5-year-old girl who sustained this type of fracture- dislocation of the shoulder. Open reduction and internal fixation with multiple smooth K-wires was performed. At two years follow-up, the patient was pain free and regained full range of motion.

Hallux valgus deformity of foot with tumoral calcinosis: an unusual presentation.

Tumoral calcinosis is an uncommon disorder and characterized by development of calcified masses within the soft tissues near the large joints such as the hip, elbow, and shoulder and rarely occurs in the foot. We report a case of tumoral calcinosis at the first meta-tarso-phalangeal (MTP) joint of foot with hallux valgus deformity associated with bunion which required resection. Surgical excision of the calcific mass alone, without surgery to the minimal hallux valgus, resulted in resolution of symptoms, without recurrence of the lesion. Subsequently, speculative etiology, differential diagnostic considerations as well as the therapeutic interventions for tumoral calcinosis are discussed taking into consideration the current literature. We conclude that tumoral calcinosis should be considered in the differential diagnosis of a painful mass that develops in the small joints of the foot.

Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results.

INTRODUCTION: The purpose of this study was to determine the anatomical and clinical outcomes of a biceps-incorporating rotator cuff repair without detaching the biceps origin from the glenoid in a large or massive rotator cuff tear, in which the biceps tendon could be incorporated into the cuff defect and help to provide tendon healing and prevent upward migration of the humeral head. MATERIALS AND METHODS: Thirty-five consecutive patients with a mean age of 62 years (41-81 years) had primary arthroscopic repair of their large or massive rotator cuff in which biceps tendon incorporated into the cuff defect without detaching the biceps tendon from the glenoid was performed. Functional outcome was determined by the visual analog scale (VAS) for pain during motions, simple shoulder test (SST), the University of California, Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons scores (ASES) (mean follow-up, 24 months). The continuity of rotator cuff mechanism was evaluated using the magnetic resonance imaging (MRI) among all the patients after 2 years. RESULTS: At the final follow-up, mean VAS scores increased significantly from 7.1 to 2.0 points, ASES scores from 35 to 83, UCLA scores from 14 to 30, and SST scores from 4 to 9, respectively (p < 0.05). Moreover, the range of motion was significantly increased except the external rotation from preoperative 27° to postoperative 33° (p = 0.183). MRI evaluation showed that 22 of 35 patients (63%) had heeled tendons and 7 patients (20%) had partial re-tear. Of 35 patients, 6 (17%) had a complete re-tear. Only 3 of these 6 patients were not satisfied with the result. CONCLUSIONS: Using this simple biceps-incorporating rotator cuff repair technique, we achieved good clinical and moderate anatomical results, and prevent superior migration of the humeral head in a large or massive rotator cuff tear. LEVEL OF EVIDENCE: Level IV retrospective review.

Arthroscopic management of occult greater tuberosity fracture of the shoulder.

PURPOSE: The purpose of this retrospective study was to evaluate the early results of arthroscopic treatment in patients with missed occult greater tuberosity (GT) fracture of the humerus using the arthroscopic suture-bridge fixation technique. METHODS: Between January 2007 and August 2010, we used arthroscopic suture-bridge fixation in 15 cases of missed occult GT fractures, which were referred to our department with persistent symptoms following trauma, despite physical therapy. Occult GT fracture was diagnosed with bone marrow edema seen on magnetic resonance imaging in all patients. There were 13 male and 2 female patients with a mean age of 45 years (range 31-67 years). Mean time period until the surgery following the initial trauma was 4 months (1.5-12 months). For the measurement of clinical outcomes, we assessed the range of motion and evaluated the University of California, Los Angeles (UCLA) American Shoulder and Elbow Surgeons (ASES) scores and simple shoulder test (SST). RESULTS: The early clinical results were evaluated in these patients at a mean of 24 months (range 14-36 months) after surgery. All the patients were satisfied with the surgery. The mean UCLA, ASES, and SST scores improved from preoperative 15, 39, and 2 to postoperative 33, 91, and 11, respectively (P < .05). Mean forward flexion, abduction, external rotation at the neutral position, and internal rotation were improved to 159°, 155°, 24°, and L1, respectively, at the final follow-up. CONCLUSION: In the occult GT fracture with persistent shoulder symptoms, arthroscopic suture-bridge fixation and early rehabilitation showed excellent clinical outcomes on a short-term follow-up study. LEVEL OF EVIDENCE: Retrospective review, Level IV.

Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results.

INTRODUCTION: Partial articular surface of the rotator cuff tendon tears has been recognized as a source of treatable shoulder pain and a precursory pathology for full-thickness tendon tears. Arthroscopic rotator cuff repair is a possible surgical method of treatment. Recent data have shown that the treating partial-thickness rotator cuff repairs with transtendon technique shows good clinical outcome. The use of this technique enables the reconstitution of the tendon with complete reconstruction of its footprint without damaging its intact bursal part. In cases of high grade partial articular-sided degenerative rotator cuff tears (involving >50% of the tendon) in older patients, there is a possibility of poor healing or re-tear of the rotator cuff repair, which may be associated with poor tendon quality and substantial thinning of the rotator cuff, subsequently revision surgery in these patients will be demanding. METHODS: To mitigate these problems, we describe here a new arthroscopic transtendon repair technique with tenotomized long head biceps tendon augmentation for high grade partial articular rotator cuff tear with the goal of providing increase tendon healing, as well as to minimize the probability of failure of the construct and to improve the clinical outcomes. RESULTS: The clinical results of the first 39 consecutive patients are reported showing significant decrease in pain and improved shoulder scores, as well as the post-operative range of motion and with no cases of re-tear of the rotator cuff tendon.

Large batch production of Galactooligosaccharides using ß-glucosidase immobilized on chitosan-functionalized magnetic nanoparticle.

ß-glucosidase (BglA) immobilization from Thermotoga maritima on magnetic nanoparticles (MNPs) functionalized with chitosan (Cs) were efficiently investigated to improve lactose conversion and galactooligosaccharides (GOS) production. We used a batch method in order to improve the conversion of lactose to GOS. The efficiency and yield of immobilization were 79% and immobilized BglA was effectively recycled via a magnetic separation procedure through a batch-wise GOS with no activity lessening. Furthermore, analyses were done through screening kinetics of enzyme activity, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), Fourier transform infrared spectroscopy (FT-IR), and transmission electron microscopy (TEM). Proposed methodology of immobilization shows a potential application as it is stable which was proved through many methods including pH, temperature, heat treatment, storage, and kinetics of the enzyme. GOS and residual enzyme activity showed to be 28.76 and 40.44%, respectively. However, free enzyme synthesis of GOS yield was just 24% after 12 hr. This study proposed applying magnet in the immobilization process of BglA on Cs-MNPs to produce GOS as new method for immobilizing enzyme in a biostable and cost-efficient way. PRACTICAL APPLICATIONS: This paper focus on immobilization of BglA from T. maritima onto MNPs functionalized with CS to investigate their further possibility improving lactose conversion and GOS production. Interestingly, a successful immobilization of Tm-BglA on the substrates were achieved in Cs-MNPs. The obtained results from enzyme activity, SDS-PAGE, FT-IR, and TEM showed that the high binding capacity of BglA to Cs-MNPs was successfully obtained. Furthermore, the binding efficiency calculation indicated that the immobilized BglA-Cs-MNPs conserved 40.44% of its native activity at the end of its 6th repeated use. In addition, magnetic separation technique was successfully employed for reuse of the immobilized BglA for repetitive batch-wise GOS without significant loss of activity.

A prospective, randomized study of the effects of continuous ultrafiltration in hepatic patients after cardiac valve surgery.

OBJECTIVES: The use of continuous ultrafiltration may be effective in preventing the hepatic decompensation in cirrhotic patients after valvular heart surgery with cardiopulmonary bypass (CPB). The authors aimed to evaluate the effects of continuous ultrafiltration on the need for blood transfusion, liver function tests, duration of postoperative ventilatory support, and the length of the intensive care unit (ICU) stay in cirrhotic patients undergoing valvular heart surgery. DESIGN: A prospective, randomized double-blinded placebo study. SETTING: A single university hospital. PARTICIPANTS: Sixty cirrhotic patients scheduled for valvular surgery. INTERVENTIONS: After local ethics committee approval and informed consent, participants were divided into 2 groups. In the conventional ultrafiltration (CUF) group (n = 30), CPB was used with conventional ultrafiltration. In the continuous ultrafiltration group (n = 30), in addition to the same CUF procedure, modified ultrafiltration was used after CPB. MEASUREMENTS AND MAIN RESULTS: Perioperative liver function tests, hematocrit, platelet count, the postoperative ventilation time, ICU and hospital length of stay, complications, and mortality were recorded. After CPB, patients receiving continuous ultrafiltration had a shorter time to extubation, postoperative ventilation time and ICU and hospital length of stay (p < 0.01), lower bleeding (p < 0.01), greater rise in hematocrit (11.3% +/- 2.39% v 4.7% +/- 1.22%, p = 0.001) and platelet count (7.0 +/- 3.0 v 0.8 +/- 0.21 10(4)/micromL, p = 0.001), higher albumin levels (p < 0.001), and lower plasma levels of bilirubin, aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase (p < 0.02). There was no significant difference between the 2 groups in the dosage of nitroglycerin or epinephrine, morbidity, or mortality. CONCLUSIONS: The authors concluded that continuous ultrafiltration reduced postoperative bleeding and blood transfusions, improved liver function, and shortened the hospital stay in cirrhotic patients after valvular heart surgery.

Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture.

PURPOSE: The purpose of this retrospective study was to evaluate the early results of arthroscopic treatment in patients with comminuted, displaced greater tuberosity (GT) fractures using the arthroscopic double-row suture anchor fixation (ADSF) technique. METHODS: Between August 2004 and December 2007, we used the ADSF technique in 16 cases of isolated comminuted, displaced GT fractures. The early clinical results were evaluated in these patients at a mean of 24 months (range, 16 to 51 months) after surgery. There were 11 male and 5 female patients with a mean age of 56.5 years (range, 27 to 82 years). These 16 cases had at least 5 mm of displacement of the fracture fragments in any plane. For measurement of clinical outcomes, we assessed range of motion and evaluated the visual analog scale score; the University of California, Los Angeles (UCLA) rating scale; and the shoulder index of the American Shoulder and Elbow Surgeons. RESULTS: At final follow-up, the visual analog scale score improved from 9.4 (range, 8 to 10 points) to 1.2 (range, 0 to 4 points), the mean UCLA score improved to 31 points (range, 21 to 35 points) postoperatively, and the American Shoulder and Elbow Surgeons score improved to 88.1 points (range, 81.5 to 100 points). According to the UCLA score, there were 3 excellent results, 11 good results, and 2 poor results. Mean forward flexion was 148.7 degrees (range, 120 degrees to 170 degrees), mean abduction was 145 degrees (range, 120 degrees to 170 degrees), mean external rotation in the neutral position was 24 degrees (range, 10 degrees to 40 degrees), and internal rotation improved to the first lumbar vertebral level (from L3 to T7) at last follow-up. CONCLUSIONS: The early results of the ADSF technique used for displaced, comminuted GT fractures are encouraging, and arthroscopists should attempt to expand the indications for arthroscopic treatment of these fractures. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Spontaneous recurrent hemarthrosis of the knee joint in elderly patients with osteoarthritis: an infrequent presentation of synovial lipoma arborescens.

Synovial lipoma arborescens (SLA) is a rare, benign, fat-containing synovial proliferative lesion that is typically known to affect the knee joint in adults, although it has also been described in other joints. SLA usually presents as a painless swelling and recurrent joint effusion, and the laboratory test results, including aspirated synovial fluid, are usually normal. We present here two cases of SLA of the knee, which presented as spontaneous recurrent hemarthroses in elderly patients with osteoarthritis (OA) with bloody aspirated synovial fluid. Magnetic resonance imaging (MRI) and arthroscopic synovectomy suggested the diagnosis of SLA; the histopathologic examination confirmed the diagnosis. One year later, both patients remain symptom-free and report no new episodes of hemarthrosis. We postulate that SLA should be included in the differential diagnosis of patients with recurrent joint effusions with hemarthrosis in elderly patients with OA. The clinical presentation, MRI findings, and treatment of SLA are described, and the entity is briefly reviewed.

Thromboembolic complications after bilateral knee arthroscopic surgery patients.

Deep venous thrombosis and pulmonary embolism are rare complications after arthroscopic knee procedures. Most of the cases of thromboembolic complications reported to have involved unilateral knee arthroscopic patients; here, we report the cases of patients with bilateral knee arthroscopy. The patients were treated with anticoagulants and thrombolytics and subjected to necessary laboratory monitoring. All the patients recovered well after the treatment and were symptom-free during a 6-month follow-up. The purpose of this article was to increase the awareness of knee arthroscopists of this complication.

Surgical technique of harvesting vascularized superficial radial nerve graft.

We describe our surgical technique for harvesting the free vascularized superficial radial nerve graft based on the radial artery and its venae comitantes. Anatomy and preoperative preparation are also presented, as well as the indications and some contraindications.

Subacromial bony erosion: a rare presentation of pigmented villonodular synovitis of the shoulder.

Pigmented villonodular synovitis (PVNS) rarely affects the shoulder. We describe two cases of PVNS arising from the shoulder joint, which caused rotator cuff tears and sub-acromial bony erosion, and which were treated arthroscopically. Sub-acromial erosion is frequently associated with various glenohumeral joint disorders, but it has not been reported in association with PVNS. We believe PVNS should also be considered in the differential diagnosis of patients who present with sub-acromial erosion.

Arthroscopic fixation for a malunited greater tuberosity fracture using the suture-bridge technique: technical report and literature review.

Greater tuberosity of the humerus malunion is relatively uncommon, and open techniques are the treatment of choice in most cases. Recent advances in arthroscopic techniques for treatment of greater tuberosity fractures have produced promising results. The use of arthroscopic techniques for the treatment of proximal humerus malunion, however, has been reported only rarely in the literature. This case report describes the malunited greater tuberosity fracture treated arthroscopically using the suture-bridge technique.

Development of new SLAP lesion after the arthroscopic, isolated decompression of ganglion cyst of the shoulder.

Ganglion cysts of the shoulder are rare, and the pathogenesis is similar to that of meniscal cysts. We present details of two cases of isolated ganglion cyst of shoulder which were treated arthroscopically. Both patients following 1 year after the surgery, complained of nonspecific shoulder pain and magnetic resonance imaging revealed new SLAP lesion which was treated arthroscopically.

Elbow joint position sense following brachial plexus palsy treated with double free muscle transfer.

PURPOSE: Restoration of elbow flexion is the highest priority for brachial plexus reconstruction, and its reconstructive strategy is well established. The purpose of this article is to report elbow joint position sense (JPS) after double free muscle transfer (DFMT) for complete paralysis of brachial plexus. METHODS: Thirteen patients with complete brachial plexus paralysis who were treated with DFMT underwent evaluation of elbow JPS. JPS was measured as the subject's ability to actively reproduce a previously presented position of the elbow joint (target angle). We calculated the difference between target and reproduced angle and defined this as the absolute error (AE). Ten healthy control subjects participated in this study. RESULTS: In control subjects, mean AE measured 4 degrees +/- 1 degree at the target angle of 60 degrees and 4 degrees +/- 2 degrees at 80 degrees. After DFMT, patients' mean AE measured 5 degrees +/- 2 degrees at the target angle of 60 degrees and 5 degrees +/- 3 degrees at 80 degrees. There was no statistical difference between the control and DFMT groups at target angles of 60 degrees and 80 degrees. CONCLUSIONS: Patients with complete paralysis of the brachial plexus had evidence of elbow JPS after successful restoration of elbow flexion after DFMT. Although this study provides us with useful information regarding the perception of elbow JPS, further study is necessary to confirm the exact mechanism of perception of elbow JPS. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Vascularized pedicled bone graft for avascular necrosis of the capitate: case report.

Avascular necrosis of the capitate is a rare disorder of unknown etiology that causes wrist pain and limitation of function. We present a case of a 15-year-old boy successfully treated with vascularized pedicled bone graft from the dorsal aspect of the distal radius.

Calcific tendinitis of the biceps-labral complex: a rare cause of acute shoulder pain.

Calcific tendinitis most commonly affects the rotator cuff and has not been previously reported affecting the biceps-labral complex. We report a case of calcific tendinitis of the biceps-labral complex attachment, a rare cause of acute, severe shoulder pain. Clinically, it can be misdiagnosed as supraspinatus tendinitis or septic arthritis of the shoulder joint. Non-operative treatment failed to resolve the symptoms. Arthroscopic debridement of the calcific deposit resulted in resolution of symptoms. Knowledge of this clinical condition and its imaging features is crucial for a correct diagnosis of this uncommon cause of shoulder pain.