Acceptability and Feasibility of the Plasma Separation Card for an Integrated Model of Care for HBV and HCV Screening Among People Attending HIV Clinics in Cameroon and Uganda.

BACKGROUND: Sub-Saharan African countries have a high burden of viral hepatitis and poor access to screening and care. The aim of this study was to evaluate the feasibility and acceptability of using the plasma separation card (PSC) for viral hepatitis B and C screening among people living with HIV (PLHIV) in Cameroon and Uganda. METHODS: This is a cross-sectional study carried out between 05/2021 and 03/2023 including 192 PLHIV in Cameroon (n = 104) and Uganda (n = 88). Basic sociodemographic variables and whole blood samples were collected. Adequate filling with blood of PSCs was used to determine feasibility together with participant responses to questions on acceptability. A logistic regression model was carried out to assess the relationship between PSC acceptability and factors of interest. RESULTS: 70% of participants reported PSC as an acceptable viral hepatitis screening tool, and it was significantly more accepted in Uganda than Cameroon (100% vs. 43.2%, p < 0.001). Similarly, 75% of PSCs had at least one spot sample filled and were viable for analysis, 99% were correctly filled in Uganda and 53.4% in Cameroon. Reported ease of method performance (aOR: 24.77 95% CI 2.97-206.42, p = 0.003) and reduced collection time (aOR: 3.73 95% CI 1.26-11.04, p = 0.017) were associated with greater odds of PSC acceptance. HBsAg + and anti-HCV + prevalence were 11.1% and 1.0%, respectively. CONCLUSIONS: In spite of country differences, overall, the PSC was reported as a feasible and acceptable viral hepatitis testing method. Acceptability and feasibility of the method must be explored in heterogeneous target communities and qualitative research to better understand country-specific barriers and facilitators should be carried out.

Serological evidence of virus infection in Eidolon helvum fruit bats: implications for bushmeat consumption in Nigeria.

Introduction: The Eidolon helvum fruit bat is one of the most widely distributed fruit bats in Africa and known to be a reservoir for several pathogenic viruses that can cause disease in animals and humans. To assess the risk of zoonotic spillover, we conducted a serological survey of 304 serum samples from E. helvum bats that were captured for human consumption in Makurdi, Nigeria. Methods: Using pseudotyped viruses, we screened 304 serum samples for neutralizing antibodies against viruses from the Coronaviridae, Filoviridae, Orthomyxoviridae and Paramyxoviridae families. Results: We report the presence of neutralizing antibodies against henipavirus lineage GH-M74a virus (odds ratio 6.23; p < 0.001), Nipah virus (odds ratio 4.04; p = 0.00031), bat influenza H17N10 virus (odds ratio 7.25; p < 0.001) and no significant association with Ebola virus (odds ratio 0.56; p = 0.375) in this bat cohort. Conclusion: The data suggest a potential risk of zoonotic spillover including the possible circulation of highly pathogenic viruses in E. helvum populations. These findings highlight the importance of maintaining sero-surveillance of E. helvum, and the necessity for further, more comprehensive investigations to monitor changes in virus prevalence, distribution over time, and across different geographic locations.

Biomechanical Assessment of Bicortical Suspension Device Fixation for Proximal Tibiofibular Joint Instability: Single Versus Double Device.

BACKGROUND: Bicortical suspension device (BCSD) fixation treats proximal tibiofibular joint (PTFJ) instability in both the anterolateral and posteromedial directions. However, biomechanical data are lacking as to whether this technique restores the native stability and strength of the joint. PURPOSE: To test (1) if BCSD fixation restores the native stability and strength and (2) if using 2 devices is needed. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen pairs of fresh-frozen cadaveric specimens were obtained. Six pairs were assigned to the control group and 10 matched pairs assigned for transection to model PTFJ and subsequent BCSD fixation (one specimen with 1-device repair and the other with 2-device repair). Joint stability and strength were assessed by translating the fibular head relative to the fixed tibia either anterolaterally or posteromedially. Control specimens received 20 cycles of 0- to 2.5-mm joint displacement tests (subfailure) and then proceeded to load to failure (5 mm). For the experimental group, cyclic tests were repeated after ligament resection and after fixation. Forces and stiffness at 2.5- and 5-mm displacement were recorded for comparisons of joint strength and stability at subfailure and failure loads, respectively. RESULTS: After repair of anterolateral instability, both the single- and double-device fixations successfully restored near-native states, with no significant differences as compared with the intact group for forces at subfailure load (P = .410) or failure load (P = .397). Regarding posteromedial instability, single-device repair did not restore forces to the near-native state at subfailure load (intact: 92.9 N vs single: 37.4 N; P = .001) or failure load (intact: 170.7 N vs single: 70.4 N; P = .024). However, the double-device repair successfully restored near-native posteromedial forces at both subfailure load (P = .066) and failure load (P = .723). CONCLUSION: For treatment of the most common form of PTFJ instability (anterolateral), this cadaveric study suggests that 1 BCSD is sufficient to restore stability and strength. The current biomechanical results also suggest that 2 devices are needed for restoring PTFJ posteromedial stability and strength. Using 2 devices addresses both types of instability and provides more PTFJ posteromedial stability. CLINICAL RELEVANCE: The results suggest that 1 device should be used for treating anterolateral instability and 2 devices used for posteromedial instability based on the biomechanical study.

Efficacy of bi-level erector spinae plane block versus bi-level thoracic paravertebral block for postoperative analgesia in modified radical mastectomy: a prospective randomized comparative study.

BACKGROUND: Postoperative analgesia in breast surgery is difficult due to the extensive nature of the surgery and the complex innervation of the breast; general anesthesia can be associated with regional anesthesia techniques to control intra- and post-postoperative pain. This randomized comparative study aimed to compare the efficacy of the erector spinae plane block and the thoracic paravertebral block in radical mastectomy procedures with or without axillary emptying. METHODS: This prospective randomized comparative study included 82 adult females who were randomly divided into two groups using a computer-generated random number. Both groups, Thoracic Paraverterbal block group and Erector Spinae Plane Block group (41 patients each), received general anesthesia associated with a multilevel single-shot thoracic paravertebral block and a multilevel single-shot erector spinae plane block, respectively. Postoperative pain intensity (expressed as Numeric Rating Scale), patients who needed rescue analgesic, intra- and post-operative opioid consumption, post-operative nausea and vomiting, length of stay, adverse events, chronic pain at 6 months, and the patient's satisfaction were recorded. RESULTS: At 2 h (p < 0.001) and 6 h (p = 0.012) the Numeric Rating Scale was significantly lower in Thoracic Paraverterbal block group. The Numeric Rating Scale at 12, 24, and 36 postoperative hours did not show significant differences. There were no significant differences also in the number of patients requiring rescue doses of NSAIDs, in intra- and post-operative opioid consumption, in post-operative nausea and vomiting episodes and in the length of stay. No failures or complications occurred in the execution of techniques and none of the patients reported any chronic pain at six months from the surgery. CONCLUSIONS: Both thoracic paravertebral block and erector spinae plane block can be effectively used in controlling post-mastectomy pain with no significant differences between the two blocks. TRIAL REGISTRATION: The study was prospectively registered on Clinicaltrials.gov (trial identifier NCT04457115) (first registration 27/04/2020).

Diagnostic sensitivity and specificity of immunohistochemistry for the detection of rabies virus in domestic and wild animals in South Africa.

We estimated the diagnostic sensitivity (DSe) and specificity (DSp) of an immunohistochemistry (IHC) protocol compared to the direct fluorescent antibody test (DFAT), which is the gold standard test for rabies diagnosis. We obtained brain samples from 199 domestic and wild animal cases (100 DFAT-negative, 99 DFAT-positive), by convenience sampling from 2 government-accredited rabies virus (RABV) testing laboratories in South Africa, between February 2015 and August 2017. Tissues that had been stored at 4-8°C for several days to weeks at the 2 accredited laboratories were formalin-fixed and paraffin-embedded. Nighty-eight cases tested IHC-positive using a polyclonal anti-RABV nucleoprotein antibody and a polymer detection system. The overall DSe and DSp for the RABV IHC test were 98% (95% CI: 93-100%) and 99% (95% CI: 95-100%), respectively. Domestic dogs accounted for 41 of 98 RABV IHC-positive cases, with the remainder in 4 domestic cats, 25 livestock, and 28 wildlife. Herpestidae species, including 7 meerkats and 9 other mongoose species, were the most frequently infected wild carnivores, followed by 11 jackals. Three cases in domestic dogs had discordant test results; 2 cases were IHC-/DFAT+ and 1 case was IHC+/DFAT-. Considering the implications of a false-negative rabies diagnosis, participating in regular inter-laboratory comparisons is vital, and a secondary or confirmatory method, such as IHC, should be performed on all submitted specimens, particularly negative cases with human contact history.

Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-analysis.

BACKGROUND: Focal cartilage lesions of the knee remain a difficult entity to treat. Current treatment options include arthroscopic debridement, microfracture, autograft or allograft osteochondral transplantation, and cell-based therapies such as autologous chondrocyte transplantation. Osteochondral transplantation techniques restore the normal topography of the condyles and provide mature hyaline cartilage in a single-stage procedure. However, clinical outcomes comparing autograft versus allograft techniques are scarce. PURPOSE: To perform a comprehensive systematic review and meta-analysis of high-quality studies to evaluate the results of osteochondral autograft and allograft transplantation for the treatment of symptomatic cartilage defects of the knee. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 2. METHODS: A comprehensive search of the literature was conducted using various databases. Inclusion criteria were level 1 or 2 original studies, studies with patients reporting knee cartilage injuries and chondral defects, mean follow-up ≥2 years, and studies focusing on osteochondral transplant techniques. Exclusion criteria were studies with nonknee chondral defects, studies reporting clinical outcomes of osteochondral autograft or allograft combined with other procedures, animal studies, cadaveric studies, non-English language studies, case reports, and reviews or editorials. Primary outcomes included patient-reported outcomes and failure rates associated with both techniques, and factors such as lesion size, age, sex, and the number of plugs transplanted were assessed. Metaregression using a mixed-effects model was utilized for meta-analyses. RESULTS: The search resulted in 20 included studies with 364 cases of osteochondral autograft and 272 cases of osteochondral allograft. Mean postoperative survival was 88.2% in the osteochondral autograft cohort as compared with 87.2% in the osteochondral allograft cohort at 5.4 and 5.2 years, respectively (P = .6605). Patient-reported outcomes improved by an average of 65.1% and 81.1% after osteochondral autograft and allograft, respectively (P = .0001). However, meta-analysis revealed no significant difference in patient-reported outcome percentage change between osteochondral autograft and allograft (P = .97) and a coefficient of 0.033 (95% CI, -1.91 to 1.98). Meta-analysis of the relative risk of graft failure after osteochondral autograft versus allograft showed no significant differences (P = .66) and a coefficient of 0.114 (95% CI, -0.46 to 0.69). Furthermore, the regression did not find other predictors (mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location) that may have significantly affected patient-reported outcome percentage change or postoperative failure between osteochondral autograft versus allograft. CONCLUSION: Osteochondral autograft and allograft result in favorable patient-reported outcomes and graft survival rates at medium-term follow-up. While predictors for outcomes such as mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location did not affect the comparison of the 2 cohorts, proper patient selection for either procedure remains paramount to the success and potentially long-term viability of the graft.

Adjustable-loop cortical suspension device for posterolateral corner reconstruction in the setting of fibular avulsion fracture: a case series and novel technique description.

INTRODUCTION: A novel technique using an adjustable-loop cortical suspension toggle device for reduction of a fibular head avulsion fracture (arcuate fracture) in posterolateral corner (PLC) reconstruction is described. Results of clinical follow-up are presented. MATERIALS AND METHODS: 9 patients were retrospectively identified who underwent posterolateral corner reconstruction using an adjustable-loop cortical suspension toggle device. Radiographic examination was used to evaluate the successful healing of the avulsed fibular head fragments post-operatively. RESULTS: 7 patients reported satisfactory results with their clinical outcome with no feelings of knee instability or objective instability on exam at final follow-up. Post-operative radiographs obtained > 6 months following reconstruction demonstrated well reduced and healed fracture in 5 of 6 patients, with 1 patient demonstrating maintained reduction but incomplete fracture union at 6 months. CONCLUSION: This novel surgical technique for PLC reconstruction with an avulsed fibular head fracture is a viable alternative to previously described methods. The majority of patients report subjective satisfaction with a stable knee post-operatively. LEVEL OF EVIDENCE: IV.

Editorial Commentary: External Fixation and/or Vascular Injury Is Associated With Postoperative Arthrofibrosis After Multiple-Ligament Knee Injury Reconstruction.

Patients with a body mass index over 30 do not have a significant increase in postoperative arthrofibrosis after multiple-ligament knee injury (MLKI) reconstruction compared with patients with a body mass index under 30. However, although this may be associated with the severity of injury, recent research has shown that patients who undergo external fixation at index surgery and/or who have vascular injury are at increased risk of requiring manipulation under anesthesia. This finding is clinically significant in that it is reassuring that stiffness requiring manipulation is no more likely to develop in obese patients than in non-obese patients after MLKI reconstruction. I have often believed that controlled arthrofibrosis can be somewhat beneficial in the management of MLKI and have advised patients over the years that a required manipulation in this case is not really a complication but more of a continuation of care. Stiffness after an MLKI surgical procedure is preferable to recurrent instability.

Epidemiological Interface of Sylvatic and Dog Rabies in the North West Province of South Africa.

Rabies is a viral zoonosis that causes an estimated 59,000 preventable human fatalities every year. While more than 120 countries remain endemic for dog-mediated rabies, the burden is the highest in Africa and Asia where 99% of human rabies cases are caused by domestic dogs. One such rabies-endemic country is South Africa where an estimated 42 preventable human deaths occur every year. Although canine rabies had been well described for most of the provinces in South Africa, the epidemiology of rabies within the North West Province had not been well defined prior to this investigation. As such, the aim of this study was to use nucleotide sequence analyses to characterise the extant molecular epidemiology of rabies in the North West Province of South Africa-with specific focus on the interface between dogs and sylvatic species. To this end, Rabies lyssavirus isolates originating from the North West Province were subjected to molecular epidemiological analyses relying on the Bayesian Markov Chain Monte Carlo methodology on two distinct gene regions, viz. the G-L intergenic region and partial nucleoprotein gene. Our results provided strong evidence in support of an endemic cycle of canine rabies in the East of the province, and three independent endemic cycles of sylvatic rabies spread throughout the province. Furthermore, evidence of specific events of virus spill-over between co-habiting sylvatic species and domestic dogs was found. These results suggest that the elimination of canine-mediated rabies from the province will rely not only on eliminating the disease from the dog populations, but also from the co-habiting sylvatic populations using oral rabies vaccination campaigns.

Superiorly and transversely orienting the bicortical suspension device provides optimal anterolateral stability to the proximal tibiofibular joint: a finite-element study.

PURPOSE: Instability of the proximal tibiofibular joint (PTFJ) can be treated with bicortical suspension (BCS) fixation. However, the ideal location, orientation, and configuration to apply one or two BCS devices are not clear. METHODS: A finite-element model of the PTFJ was created from a female adult's CT dataset. Anterior and posterior ligaments at the PTFJ were modeled and suppressed to simulate stable and unstable joints. Fifty-six models simulated 56 device placements along guiding tunnel lines that connect eight entry locations on the fibular head to seven exit points on the anteromedial tibia. Doubling device stiffness created 56 more models. Combing any two placements created 1176 double-device configurations which were categorized to be crossed, divergent or parallel. Displacement of the fibular head relative to the fixed tibia under 100 N anterolateral and posteromedial forces was assessed. RESULTS: Different placements had 2.1-27.9 mm translation with 0.7-8.9° internal rotation under anterolateral loading, and 1.8-5.2 mm translation with 6.1-7.9° external rotation under posteromedial loading. More transverse and superior orientations were associated with smaller anterolateral translation; more posterior and superior entry locations were associated with smaller internal rotation. The median (IQR) reductions in anterolateral translation by doubling device stiffness and by adding a second device were 0.8 (IQR 0.5-1.0) and 0.8 (IQR 0-6.1) mm, respectively. The type of double-device configurations had no significant effect on fibular motion. CONCLUSION: Surgeons should drill the guiding tunnel superiorly and transversely to ensure the optimal restoration of the PTFJ anterolateral stability.

Implementation of an Africa-specific donor health questionnaire for human immunodeficiency virus risk screening.

BACKGROUND AND OBJECTIVES: We had previously developed an Africa-specific donor health questionnaire (ASDHQ) based on local risk factors and designed a scoring scheme. This study assessed the performance of a new donor health questionnaire by comparing the human immunodeficiency virus (HIV) status in accepted versus deferred donors by ASDHQ and comparing the rate of risk deferrals with historical data. MATERIALS AND METHODS: Data were collected during a cross-sectional study conducted over 15 months at three referral-hospital-based blood services in Cameroon. ASDHQ was administered to blood donors aged 18-65 years in the same screening conditions as the routine questionnaire. The main outcomes of the study were ASDHQ sensitivity and specificity with regard to HIV laboratory testing as well as donor deferral rates for each of the routine screening algorithms and for ASDHQ. RESULTS: Overall, 71/11,120 (0.6%) were confirmed as HIV positive. The mean ASDHQ score was 95.80 ± 4.4 in HIV-negative donors and 94.80 ± 4.4 in HIV-positive donors (p = 0.05). The optimal cut-off provided by the receiver operating characteristic (ROC) curve for the best performance of ASDHQ was 95.04. Using this optimal cut-off, the ASDHQ sensitivity and specificity were 57% and 53%, respectively (area under curve = 0.58 [0.51, 0.64], p = 0.028). Using ASDHQ, the HIV prevalence was 0.7% in deferred donors and 0.6% in accepted donors. CONCLUSION: ASDHQ might be efficient only in specific conditions that maximize truthful donor responses, requiring each blood service to create an environment of trust and transparency to increase donor compliance and improve the accuracy of the questionnaire.

Current Trends in Orthobiologics: An 11-Year Review of the Orthopaedic Literature.

BACKGROUND: The use of "orthobiologics" or regenerative therapies in orthopaedic surgery has grown in recent years. Particular interest has been raised with regard to platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells. Although studies have analyzed outcomes after orthobiologic treatment, no study has analyzed how the literature as a whole has evolved. PURPOSE: To evaluate trends in platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cell publications and to assess how these might inform efforts to establish minimum reporting standards and forecast future use. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A database was compiled systematically using PubMed to identify articles published between 2009 and 2019 within 9 prominent orthopaedic journals and pertaining to the use of platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells in the treatment of musculoskeletal conditions. Included articles were classified as clinical, nonclinical (translational or basic science), or review, and a variety of study parameters were recorded for each. Additional queries were performed to identify articles that utilized minimum reporting standards. RESULTS: A total of 474 articles (132 clinical, 271 nonclinical, 71 review) were included, consisting of 244 (51.5%) platelet-rich plasma, 146 (30.8%) bone marrow aspirate, 72 (15.2%) adipose-derived cells, and 12 (2.5%) amniotic cells. The greatest annual increase in publications for each orthobiologic topic was from 2018 to 2019. The American Journal of Sports Medicine demonstrated the highest number of overall (34.2%) and clinical (50.0%) publications, and accounted for 44.3% of all platelet-rich plasma publications. The Journal of Orthopaedic Research accounted for the second highest overall number of publications (24.9%) and highest nonclinical publications (41.0%). Platelet-rich plasma accounted for 91.5% of all level 1 clinical studies, while much greater than half of bone marrow aspirate, adipose-derived cells, and amniotic cell publications were level 3 or lower. Out of the 207 articles that used some form of reporting protocol, 59 (28.5%) used an established algorithm and 125 (60.4%) used their own. CONCLUSION: Interest in orthobiologics continues to grow, as evidenced by an increasing trend in publications over an 11-year period. However, current reporting on orthobiologic formulations is largely heterogeneous, emphasizing the need for minimum reporting standards and higher-quality studies.

Intraoperative and Early (90-Day) Postoperative Complications and Associated Variables with Multiligamentous Knee Reconstruction: 15-year Experience from a Single Academic Institution.

PURPOSE: We sought to determine the rate of intraoperative and early postoperative (90-day) complications of multiligamentous knee reconstruction surgeries, both medical and surgical, and associated variables from the 15-year experience of a single academic institution. METHODS: Patients treated at a single academic institution between 2005 and 2019 who underwent multiligament knee surgery were identified. Inclusion criteria included intervention with 2+ ligament reconstructions performed concurrently, and more than 90 days postoperative follow-up. Exclusion criteria included revision ligamentous knee surgery. Patient demographics, mechanism of injury, and associated injuries of patients with intraoperative and postoperative complications, time from injury to multiligamentous knee reconstruction, and surgical data, including tourniquet time, procedure time, and type of procedures performed were retrospectively recorded. RESULTS: 301 knees in 296 patients met the eligibility criteria. There were 11 intraoperative complications in 9 knees (rate of 3%) and 136 postoperative complications in 90 knees (rate of 30%). Shorter time from injury to date of surgery was associated with arthrofibrosis (P = .001) and superficial wound infections (P = .015). Concurrent head injuries were associated with less complications (P = .029). Procedural time >300 minutes was associated with intraoperative blood transfusions (P > .05), deep infections (P = .003) and arthrofibrosis (P = .012). Inside-out meniscal repair was associated with superficial and deep infections (P = .006 and .0004). Tibial-based posterolateral corner (PLC) reconstruction was associated with symptomatic hardware (P = .037) and arthrofibrosis (P = .019) in comparison with fibular-based PLC reconstruction. Posterior cruciate ligament (PCL) reconstruction was associated with deep infections (P = .015), arthrofibrosis (P = .003), and postoperative blood transfusions (P = .018). CONCLUSION: Our 15-year data reveal there is a low intraoperative complication rate and high early postoperative complication rate with multiligamentous knee surgery. Surgeons should be wary of the increased intraoperative and postoperative complications associated with longer procedure times, inside-out meniscal repair, tibia-based PLC reconstruction, PCL reconstruction, and shorter time to surgery. LEVEL OF EVIDENCE: Case series: IV.

Serum Neutralization Profiles of Straw-Colored Fruit Bats (Eidolon helvum) in Makurdi (Nigeria), against Four Lineages of Lagos Bat Lyssavirus.

Lagos bat lyssavirus (LBV) comprising four lineages (A, B, C and D) can potentially cause the fatal disease rabies. Although LBV-B was initially isolated in Nigeria in 1956, there is no information on LBV lineages circulating in Nigeria. This study was undertaken for the first time to measure the neutralizing antibodies against four lineages of LBVs in straw-colored fruit bats (Eidolon helvum) in Makurdi, Nigeria. Serum samples (n = 180) collected during two periods (November 2017-March 2018 and November 2018-March 2019) from terminally bled bats captured for human consumption were tested using a modified fluorescent antibody virus neutralization (mFAVN) assay. A high proportion of bat sera (74%) neutralized at least one lineage of LBV (with reciprocal titers from 9 to >420.89) and most of them neutralized LBV-A (63%), followed by LBV-D (49%), LBV-C (45%) and LBV-B (24%). The majority of positive sera (75%, n = 100) neutralized multiple LBV lineages while the remaining 25% (n = 33) neutralized only a single lineage, i.e., LBV-A (n = 23), LBV-D (n = 8) and LBV-C (n = 2). None exclusively neutralized LBV-B. The results suggest that exposure to LBV is common in E. helvum and that LBV-A (but not LBV-B) is likely to be circulating in this region of Nigeria.

Comparable Subjective and Objective Clinical Outcomes After Fibular or Combined Tibial-Fibular-based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis.

INTRODUCTION: To compare subjective and objective outcomes of fibular and combined tibial-fibular (TF)-based posterolateral corner (PLC) reconstruction. METHODS: A systematic review of literature reporting outcomes of posterolateral corner reconstruction was conducted including outcome studies of surgically treated PLC injuries with a minimum 1-year follow-up, postoperative subjective and objective outcomes including the patient-reported outcome scorings of Lysholm score, International Knee Documentation Committee evaluation (subjective and objective), dial test, and varus stress radiographs. RESULTS: The 32 studies included comprised 40 cohorts: 12 cohorts (n = 350 knees) used a fibular-based technique, and 28 cohorts (n = 593 knees) used a combined TF-based technique. No statistically significant differences were found in patient-reported outcomes or objective clinical measurements comparing the two techniques using the Lysholm score (P = 0.204, τ2 = 3.46), International Knee Documentation Committee evaluation (subjective P = 0.21 τ2 = 15.57; objective P = 0.398), dial test (P = 0.69), or varus stress radiographs (P = 0.98, τ2 = 0.08). CONCLUSIONS: This study found no statistically significant differences in subjective or objective clinical outcome measurements after fibular-based versus combined TF-based PLC reconstruction. Further prospective evaluation comparing long-term clinical outcomes, complications, and surgical time may help to elucidate a preferred reconstructive technique.

Exploiting Pan Influenza A and Pan Influenza B Pseudotype Libraries for Efficient Vaccine Antigen Selection.

We developed an influenza hemagglutinin (HA) pseudotype library encompassing Influenza A subtypes HA1-18 and Influenza B subtypes (both lineages) to be employed in influenza pseudotype microneutralization (pMN) assays. The pMN is highly sensitive and specific for detecting virus-specific neutralizing antibodies against influenza viruses and can be used to assess antibody functionality in vitro. Here we show the production of these viral HA pseudotypes and their employment as substitutes for wildtype viruses in influenza neutralization assays. We demonstrate their utility in detecting serum responses to vaccination with the ability to evaluate cross-subtype neutralizing responses elicited by specific vaccinating antigens. Our findings may inform further preclinical studies involving immunization dosing regimens in mice and may help in the creation and selection of better antigens for vaccine design. These HA pseudotypes can be harnessed to meet strategic objectives that contribute to the strengthening of global influenza surveillance, expansion of seasonal influenza prevention and control policies, and strengthening pandemic preparedness and response.

Trends in serological markers of transfusion transmissible infections in blood donations at the Bamenda Hospital-based Blood Service, Cameroon.

OBJECTIVES: The rate and trend of transfusion transmissible infections (TTIs) in blood donations from 2012 to 2017 at the Bamenda Regional Hospital Blood Service (BRHBS), Cameroon was assessed. MATERIALS AND METHODS: A six-year retrospective study was conducted by reviewing the records of donors. Blood was screened for HIV, hepatitis B, hepatitis C and syphilis. Data was analyzed using IBM SPSS Statistics version 21. Differences in seropositivity rates for the four TTIs were analyzed using Chi2 test or Fisher's exact test where appropriate. Associations between sociodemographic characteristics and the TTIs markers were assessed using multiple logistic regression analysis. RESULTS: A total of 12,115 blood donations was included in the study and of these, the overall seropositivity rate of the four conventional TTIs markers was 10.5% (n=1,273). Of the seropositive cases, 23.8% (n=303) showed reactivity with at least two of the markers combined. When the markers were assessed individually, HBsAg recorded the highest seropositivity rate (4.7%), followed by anti-HIV and anti-syphilis (2.2%), and then by anti-HCV (1.7%). A significant decrease in the trend of the combined serological markers, HBsAg and anti-syphilis was observed over the years (P≤0.05). CONCLUSION: There is a decrease in seropositivity rates of TTIs markers in this blood service. Ongoing efforts toward the prevention of these infections is encouraged and should be intensified to improve blood safety.

Utilization of Orthobiologics by Sports Medicine Physicians: A Survey-based Study.

INTRODUCTION: Investigations are rapidly increasing into products referred to as orthobiologics and their utility in the nonsurgical and surgical treatment of diverse orthopaedic pathology. METHODS: Members (599) of the American Orthopaedic Society for Sports Medicine were sent a survey that assessed their usage, motivation for use, and perceived efficacy of the following orthobiologics: leukocyte-rich platelet-rich plasma, leukocyte-poor platelet-rich plasma (PRP-LP), bone marrow aspirate concentrate, amniotic membrane products, adipose-derived mesenchymal stromal cells, and umbilical cord-derived cells. Application of these orthobiologics for the following pathologies was assessed: osteoarthritis, muscle injuries, tendon injuries, ligament injuries, labral injuries, and focal articular cartilage tears. RESULTS: The survey was completed by 165 respondents (27.5%), of which 66.1% reported using at least one orthobiologic in their practice. Orthobiologic users reported the following: 71.6% are increasing their use, and 23.9% advertise their use. PRP-LP is the most commonly used orthobiologic for 76.1%, with 30% of PRP-LP users reporting use due to competitor utilization. The pathology most commonly treated with orthobiologics is osteoarthritis, for 71.6% of users, who primarily use PRP-LP in the knee joint. Leukocyte-rich platelet-rich plasma is the most popular orthobiologic in muscle, ligament, tendon, and labral injuries, whereas bone marrow aspirate concentrate is most popular for focal articular cartilage injuries. Primary orthobiologic-eligible groups were adults and recreational noncompetitive athletes. More than half (>50%) of orthobiologic users perceived all but umbilical cord-derived cells to be efficacious. CONCLUSION: Orthobiologics are used by a significant number of sports medicine physicians and are likely increasing in popularity. Among orthobiologics, platelet-rich plasmas are the most popular, and osteoarthritis is the pathology most likely to be treated. Orthobiologics are sometimes used for reasons other than clinical efficacy, especially competitor utilization, and physicians are disparate in their application of these products.