Importance of NK Cells in Cellular and Humoral Responses Triggered by Pneumococcus Vaccination.

INTRODUCTION: Despite the success of vaccination in reducing overall rate of pneumococcal pneumonia, Streptococcus pneumoniae is still held responsible for high mortality and modality rates worldwide. Our study aimed to investigate the potential role played by NK cells in immune response generated by pneumococcal vaccination, which could contribute to the development of more effective vaccines. METHODS: The study included mice with and without NK cell depletion which were immunized with pneumococcus polysaccharide-conjugated vaccine followed by pneumococcus polysaccharide vaccine (PPV). Serum samples and splenocytes were collected from mice sacrificed 4 weeks after the last PPV dose. Serum samples were used for antibody level quantification by ELISA assay, while splenocytes were treated with PPV in vitro before monitoring CD4+ T-cell subsets (TH1, TH2, and TH17) and cytokine (IFN-γ, IL-4, and IL-17) secretion levels by flow cytometry and ELISA analysis, respectively. RESULTS: Results demonstrated reduced pneumococcal IgG and TH1 cell levels due to NK cell depletion. Nevertheless, in contrast to these observations, IFN-γ secretion levels after in vitro PPV-23 treatment of splenocytes did not exhibit any statistically significant difference between the two mice groups. CONCLUSIONS: The data indicate a positive contribution of NK cells to both T-cell and B-cell responses triggered against pneumococcal vaccination. Further studies are required to confirm our data and investigate the potential benefit of NK cell targeting in promoting vaccine efficacy, especially in the elderly population who continues to be affected significantly by pneumococcal pneumonia.

The utility of standing knee radiographs for detection of lipohemarthrosis: comparison with supine horizontal beam radiographs.

OBJECTIVES: Lipohemarthrosis is a key finding in acute trauma patients and indicates an intra-articular fracture. The horizontal beam lateral radiography with supine position is known to be the best technique to demonstrate knee lipohemarthrosis. Our main purpose was to compare the sensitivity of supine and standing lateral knee radiographs to detect lipohemarthrosis. METHODS: In our retrospective study, consecutive patients with lipohemarthrosis on computed tomography of the knee between October 2019 and September 2021 were included. Fractured bone, the presence of lipohemarthrosis, and image quality in both standing and supine anteroposterior and lateral knee radiographs were evaluated. Interobserver reliability of the three observers was calculated. Fisher exact chi-square and z-proportion tests were used to compare lateral and anteroposterior knee radiographs. Krippendorff's Alpha and Kappa coefficients were used for inter-observer agreement. RESULTS: A total of 61 patients (38 men [62.3%], 23 women [37.7%]; mean age, 43 years ± 17 [standard deviation]) were included. The most common type of fracture was isolated tibial fractures (n = 32; 52.5%). The sensitivity of showing lipohemarthrosis of standing lateral knee radiographs (95.5%) was higher than supine lateral radiographs (38.5%) (p < 0.001). While non-optimal image quality did not affect lipohemarthrosis detection on lateral radiographs (p > 0.99), it caused a significant decrease in the diagnosis of lipohemarthrosis on anteroposterior radiographs (p = 0.036). We found a good-excellent interobserver agreement in lipohemarthrosis detection. CONCLUSIONS: Standing lateral radiographs have higher sensitivity than supine lateral radiographs in detecting lipohemarthrosis and are beneficial for detecting lipohemarthrosis which indicates the presence of occult-evident intraarticular fracture in patients with knee trauma. CLINICAL RELEVANCE STATEMENT: Standing lateral knee radiographs offer a useful method for reducing the misdiagnosis of the occult intra-articular fractures by showing the fat-fluid leveling more clearly. Its advantages may be more prominent when the advanced imaging modalities are limited. KEY POINTS: • Fat-fluid level (lipohemarthrosis) is an important radiographic sign to assess patients with acute trauma. It almost always indicates an intra-articular fracture. • Our retrospective study results support that lipohemarthrosis sign could be observed more frequently in standing lateral knee radiographs than in supine lateral radiographs. • Knee trauma patients, when available, should be evaluated with standing lateral radiographs for the diagnosis of lipohemarthrosis.

The evaluation of miR-1181 and miR-4314 as serum microRNA biomarkers for epithelial ovarian cancer diagnosis and prognosis.

AIM: Epithelial ovarian cancer (EOC) is the most ominous tumor of gynecological cancers due to its poor early detection rate and unfavorable prognosis. To date, there is no reliable screening method for the diagnosis of ovarian cancer at an early stage. MiRNAs are small non-coding RNA molecules, and their main function is to regulate gene expression. The present study compared the serum miR-1181 and miR-4314 levels in patients with EOC and healthy controls to measure the diagnostic and prognostic value as candidate biomarkers. MATERIALS AND METHODS: We collected serum samples from a total of 135 participants (69 patients with EOC and 66 healthy controls). Relative expressions of miR-1181 and miR-4314 were measured by quantitative real-time polymerase chain reaction assay (qPCR). RESULTS: The present study revealed that both serum miR-1181 and miR-4314 levels in patients with EOC were significantly increased compared to healthy controls for each marker. In addition, there was a significant relationship between miR-1181 and miR-4314 overexpressions and the stage and prognosis of the disease. Finally, patients with high expression levels of miR-1181 and miR-4314 had significantly shorter survival rates than those with low expression levels. CONCLUSION: The current study proposed that serum miR-1181 and miR-4314 could discriminate the EOC patients from healthy controls. In addition, both miR-1181 and miR-4314 may be predictive biomarkers for ovarian cancer prognosis. Further studies are needed to confirm the findings of the present study.

The relationship of proximal lateral collateral ligament hyperintensity with knee joint ligament and meniscus pathologies.

BACKGROUND: Hyperintensity in the proximal lateral collateral ligament (LCL) is often confusing. This appearance may be alone or accompany other pathologies. PURPOSE: To investigate the relationship between the signal intensity (SI) change in the proximal LCL and the knee joint pathologies. MATERIAL AND METHODS: The knee MRI scans taken between 2020 and 2022 were queried retrospectively. Patients with acute trauma, instability, knee surgery, or high-grade osteoarthritis were excluded. Included patients were divided into two groups as normal SI and increased SI according to proximal LCL. The difference in ligamentous and meniscal pathologies between the two groups was analyzed using a chi-square test. Inter-observer agreement analysis was performed on 50 randomly selected patients. RESULTS: A total of 351 patients (139 men [39.6%], 212 women [60.4%]; median age = 37 years; interquartile range = 67 years) were included. There were 114 (32.5%) LCLs with normal SI and 237 (67.5%) LCLs with increased SI. Normal SI and increased SI groups had a significant difference in terms of joint side, median age, patellar tendon SI, anterior cruciate ligament SI, and medial collateral ligament SI (P = 0.004, P = 0.004, P = 0.001, P = 0.011, P = 0.004, respectively). A significant difference between the results of two separate LCL examinations in coronal + axial and coronal-only planes (P <0.001). Inter-observer agreement was found to be good to excellent. CONCLUSION: Hyperintensity in the proximal LCL was more common on the right joint side, in older patients, and patients with hyperintensity in the proximal patellar tendon, anterior cruciate ligament, and medial collateral ligament. Evaluating the LCL only in the coronal plane overestimates the hyperintensity.

All-star approach to a small medical imaging dataset: combined deep, transfer, and classical machine learning approaches for the determination of radial head fractures.

BACKGROUND: Radial head fractures are often evaluated in emergency departments and can easily be missed. Automated or semi-automated detection methods that help physicians may be valuable regarding the high miss rate. PURPOSE: To evaluate the accuracy of combined deep, transfer, and classical machine learning approaches on a small dataset for determination of radial head fractures. MATERIAL AND METHODS: A total of 48 patients with radial head fracture and 56 patients without fracture on elbow radiographs were retrospectively evaluated. The input images were obtained by cropping anteroposterior elbow radiographs around a center-point on the radial head. For fracture determination, an algorithm based on feature extraction using distinct prototypes of pretrained networks (VGG16, ResNet50, InceptionV3, MobileNetV2) representing four different approaches was developed. Reduction of feature space dimensions, feeding the most relevant features, and development of ensemble of classifiers were utilized. RESULTS: The algorithm with the best performance consisted of preprocessing the input, computation of global maximum and global mean outputs of four distinct pretrained networks, dimensionality reduction by applying univariate and ensemble feature selectors, and applying Support Vector Machines and Random Forest classifiers to the transformed and reduced dataset. A maximum accuracy of 90% with MobileNetV2 pretrained features was reached for fracture determination with a small sample size. CONCLUSION: Radial head fractures can be determined with a combined approach and limitations of the small sample size can be overcome by utilizing pretrained deep networks with classical machine learning methods.

Ancillary findings in distinguishing between anterior cruciate ligament mucoid degeneration and sprain on MRI: a practical approach.

BACKGROUND: Imaging findings of both anterior cruciate ligament (ACL) sprain and mucoid degeneration overlap in some cases, which may cause errors in magnetic resonance imaging (MRI) evaluation. PURPOSE: To determine the ancillary findings on MRI in distinguishing between ACL sprain and mucoid degeneration, and also to obtain a diagnostic scheme. MATERIAL AND METHODS: MRI scans of 77 patients with ACL mucoid degeneration and 77 cases with ACL sprain were retrospectively evaluated to compare with regard to parameters of age, sex, side, the status of posterior cruciate ligament - medial collateral ligament - lateral collateral ligament, bone marrow edema, intraosseous cyst, subchondral sclerosis, chondromalacia, meniscus tear, effusion, and osteochondral body. A decision tree algorithm was created to predict pathology in ACL, whether it was a sprain or mucoid degeneration. RESULTS: The prevalence of female sex, femoral intraosseous cyst, tibial intraosseous cyst, subchondral sclerosis, femoral chondromalacia, tibial chondromalacia, medial meniscus tear, and lateral meniscus tear were significantly higher in the ACL mucoid degeneration group (P < 0.001, P = 0.016, P < 0.001, P = 0.003, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). The probability of being mucoid degeneration increased 41.2 times (95% confidence interval [CI] = 5.296-321.132) in cases with tibial intraosseous cyst and increased 1.05 times (95% CI = 1.010-1.080) with each one-year increase in age (P < 0.001 and P = 0.011, respectively). The decision tree algorithm had an overall accuracy of 79.2%. CONCLUSION: Ancillary findings are helpful in the diagnosis of suspicious cases for ACL mucoid degeneration and ACL sprain. The decision tree algorithm offers a practical and successful approach to this issue.

The effect of ulnar variance on the pisotriquetral joint.

BACKGROUND: Pisotriquetral joint (PTJ) disorders are an important cause of ulnar-sided wrist pain but are often underrecognized. Ulnar variance (UV) has been associated with several wrist pathologies. PURPOSE: To determine the effect of UV on PTJ in patients with trauma. MATERIAL AND METHODS: A total of 143 patients (77 men, 66 women; mean age=41.64 ± 18.07 years) were included. Patients with fractures, severe and high-energy trauma, arthritic conditions, avascular necrosis, congenital deformity, bone and soft-tissue tumors, suboptimal image quality, and incorrect joint position were excluded. UV and the amount of PTJ subluxation were evaluated using coronal and sagittal computed tomography images. RESULTS: PTJ subluxation was divided into five grades. A statistically significant difference was found between the presence of PTJ subluxation and sex (P = 0.045). PTJ subluxation was more common in men (46.8%) than in women (30.3%). There was no significant difference between the presence of PTJ subluxation and age (P = 0.758). The patients were also divided into three groups as positive, neutral, and negative UV. A statistically significant relationship was found between the UV and presence of PTJ subluxation (P = 0.01). PTJ subluxation was significantly less in the neutral (none=51.1%, present=48.9%; P < 0.05) and negative (none=77.8%, present=22.2%; P < 0.05) groups. CONCLUSION: PTJ subluxation was found to be less among the groups with neutral and negative UV in our study population. PTJ subluxation is more common in men while there is no relationship with age. UV and gender may be risk factors for PTJ subluxation by affecting force dynamics at the wrist joint.

The diagnostic value of magnetic resonance imaging-based texture analysis in differentiating enchondroma and chondrosarcoma.

OBJECTIVE: To assess the diagnostic performance of MRI-based texture analysis for differentiating enchondromas and chondrosarcomas, especially on fat-suppressed proton density (FS-PD) images. MATERIALS AND METHODS: The whole tumor volumes of 23 chondrosarcomas and 24 enchondromas were manually segmented on both FS-PD and T1-weighted images. A total of 861 radiomic features were extracted. SelectKBest was used to select the features. The data were randomly split into training (n = 36) and test (n = 10) for T1-weighted and training (n = 37) and test (n = 10) for FS-PD datasets. Fivefold cross-validation was performed. Fifteen machine learning models were created using the training set. The best models for T1-weighted, FS-PD, and T1-weighted + FS-PD images were selected in terms of accuracy and area under the curve (AUC). RESULTS: There were 7 men and 16 women in the chondrosarcoma group (mean ± standard deviation age, 45.65 ± 11.24) and 7 men and 17 women in the enchondroma group (mean ± standard deviation age, 46.17 ± 11.79). Naive Bayes was the best model for accuracy and AUC for T1-weighted images (AUC = 0.76, accuracy = 80%, recall = 80%, precision = 80%, F1 score = 80%). The best model for FS-PD images was the K neighbors classifier for accuracy and AUC (AUC = 1.00, accuracy = 80%, recall = 80%, precision = 100%, F1 score = 89%). The best model for T1-weighted + FS-PD images was logistic regression for accuracy and AUC (AUC = 0.84, accuracy = 80%, recall = 60%, precision = 100%, F1 score = 75%). CONCLUSION: MRI-based machine learning models have promising results in the discrimination of enchondroma and chondrosarcoma based on radiomic features obtained from both FS-PD and T1-weighted images.

A retrospective magnetic resonance imaging analysis of bone and soft tissue changes associated with the spectrum of tarsal coalitions.

We aimed to investigate the bone and soft tissue changes accompanying tarsal coalition (TC) and aimed to evaluate their association with the location and type of coalition. Ankle magnetic resonance imagings of 65 patients with TC were included. The relationship between the location and type of coalition and bone marrow edema, subchondral cysts, sinus tarsi syndrome, tarsal tunnel syndrome, posterior impingement syndrome, accessory bone, tibiotalar effusion, talar osteochondritis dissecans, ganglion cysts, and calcaneal spur were evaluated. Twenty-nine patients without coalition were selected as the control group, and the distribution of these variables between the two groups was analyzed. There were 33 females and 32 males in the coalition group (mean age: 42.0 ± 15.63 years), and 22 females and seven males in the control group (mean age: 44.79 ± 12.33 years). Coalition was most common in the talocalcaneal joint (n = 33, 50.8%), and the most common coalition type was non-osseous (n = 57, 87.6%). We find no significant difference between the pathologies defined in terms of coalition location and type. Sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts, and tibiotalar effusion were found to be more common in the coalition group (p = 0.028, p = 0.010, p = 0.023, and p = 0.006, respectively). The presence of coalition increased the probability of developing tarsal tunnel syndrome 9.91 times (95% CI: [1.25-78.59]; p = 0.029), and sinus tarsi syndrome 3.66 times (95% CI: [1.14-11.78]; p = 0.029). Tarsal coalition may predispose bone and soft tissue changes. In this study, sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts and tibiotalar effusion were found to be more common in the coalition group.

The Impact of Anemia-Related Early Childhood Caries on Parents' and Children's Quality of Life.

Background and Objectives: Today, oral diseases are well-known for their effects, not only on daily life but also on quality of life (QoL). Dental caries, especially early childhood caries (ECC), are considered a public health concern as regards their impact on the life quality of children and parents from multiple aspects. The present research was conducted to assess the effect of anemia on oral-health-related quality of life (OHRQoL) in terms of children and parents. Materials and Methods: The current study was performed in two independent stages. In the first stage, the Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS), and in the second stage, the Turkish version of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) were used to measure the effect of anemia-related dental caries among children and parents. SPSS and Jamovi software were used for all calculations, graphs and comparisons. Results: A total of 204 participants (child-parent pairs) were incorporated in the present study. A considerable number of children (81.5%) reported occasional or more frequent oral/dental pain. Secondly, the subscale scores were determined for child symptoms (2.25 ± 0.067), child function (6.8 ± 0.22), child psychology (3.87 ± 0.128), self-image and social interaction (1.74 ± 0.063), parental distress (3.82 ± 0.143), and family function (3.5 ± 0.121). Additionally, more than half of the parents (56.3%) responded "fair" for the health of their children's teeth, lips, jaws and mouth. Similarly, the child's overall well-being was stated as being affected "a lot" by the condition of their child's teeth, lips, jaws or mouth by half of the parents (49.5%). Conclusions: Anemia-related dental caries has a highly negative impact on the quality of life of children and parents according to both of the questionnaires. Therefore, children with high scores should be prioritized for preventive procedures and timely dental treatments.

Prolongation of Neoadjuvant Chemotherapy before Surgery: Seeking the Optimal Number of Cycles in Serous Ovarian Cancer.

AIM: The optimal number of neoadjuvant chemotherapy (NACT) cycles is unclear in epithelial ovarian cancer. Our study aimed to evaluate the effect of the number of NACT cycles before interval debulking surgery on survival. METHODS: Data of 221 patients with advanced-stage serous epithelial ovarian cancer (EOC) were retrospectively evaluated. The patients were divided into groups as who received 3 cycles of NACT (group A), 4-5 cycles of NACT (group B), and 6 cycles of NACT (group C). RESULTS: There were 67 (30%) patients in group A, 70 (32%) in group B, and 84 (38%) in group C. Median overall survival (OS) was 61 (range 43-79) months for group A, 44 (range 36-52) months for group B, and 39 (range 27-50) months for group C. In addition, median disease-free survival (DFS) was 23.1 (range 8.5-32.1) months for group A, 19.2 (range 10.1-28.4) months for group B, and 21.5 (range 16-27) months for group C. Patients receiving >3 NACT cycles had worse OS than patients who received 3 NACT cycles (for group A vs. B, p = 0.018; for group A vs. C, p = 0.049). However, in terms of DFS, patients receiving 3 NACT cycles had no statistically significant difference compared to patients who received >3 NACT cycles. CONCLUSIONS: Patients with advanced-stage serous EOC who received more than 3 cycles of NACT had poor OS. However, there was no statistical difference in terms of DFS. In addition, >3 cycles of NACT did not increase the probability of achieving complete cytoreduction at the time of surgery.

Investigation of ligament, bone, synovial and plica pathologies accompanied by common extensor tendon in patients with lateral overuse syndrome of the elbow using magnetic resonance imaging.

BACKGROUND: Tendinosis in the common extensor tendon and accompanying ligament, bone, and plica abnormalities can be observed on magnetic resonance imaging (MRI). PURPOSE: To determine whether there is a difference between accompanying abnormalities according to the degree of common extensor tendon injury. MATERIAL AND METHODS: Patients who underwent 1.5-T MRI tests with a prediagnosis of lateral overuse syndrome were retrospectively reviewed, and 56 patients who had an injury in the common extensor tendon (CET) were included. The degree of tendon and ligament injury, muscle signal change, bone marrow signal change, presence of joint effusion, and morphological features in the presence of plica were evaluated via MRI examinations of the elbow. RESULTS: Overall, 32, 16, and eight patients had mild, moderate, and severe CET damage, respectively. As the severity of CET damage increased, the presence of joint effusion, and the presence and degree of damage to the lateral ulnar collateral ligament (LUCL) and radial collateral ligament (RCL) increased. The radiohumeral (RH) plica area was significantly larger in the group with mild CET damage. There was no statistically significant correlation between the severity of CET damage and the end of RH plica with a blind-end, coverage of one-third or more of the radius, its signal, thickness, and presence of olecranon fold. CONCLUSION: As the severity of CET injury increases, damage to the LUCL, RCL, and the presence of effusion in the joint increases. RH plica should be evaluated in terms of concomitant pathology in patients with mild CET injuries on MRI.

The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study.

Endometrial cancer (EC) can coexist with gynaecological diseases including adenomyosis which can be defined as the location of endometrial cells within the myometrium. Our aim was to clarify the impact of adenomyosis on the clinical and survival outcomes of EC. We included the patients who underwent an operation for EC and had concurrent adenomyosis in this retrospective cohort study. All clinicodemographical and tumour characteristics with survival outcomes of the patients were analysed comparatively. A total of 763 patients who met the eligibility criteria were included. Of those, 591 patients in the non-adenomyosis group and 172 patients in the adenomyosis group were examined. Disease-specific survival (DSS) was significantly prolonged while progression-free survival (PFS) was not affected by the presence of adenomyosis (p = .004 vs. p = .161). However, adenomyosis did not remain as an independent prognostic factor for EC in multivariate analysis (p = .341). These patients with coexistent adenomyosis and EC have better clinicopathological characteristics and less advanced tumour. Although adenomyosis is associated with prolonged DSS, it has no prognostic importance for survival outcomes of the patients with EC.IMPACT STATEMENTWhat is already known on this subject? Endometrial cancer (EC) can coexist with other gynaecological diseases including uterine adenomyosis. Adenomyosis is typically diagnosed by the pathological evaluation of the uterus following hysterectomy, although diagnosis is possible with imaging methods However, the coexistence of adenomyosis and EC is controversial in the literature.What do the results of this study add? To the best of our knowledge, our study is the largest study performed at a single university hospital. All potential confounding factors including clinicodemographical characteristics of the patients, examination of histopathology slides by the experienced gynaecological pathologists, evaluation of all included factors that may affect the survival outcomes of EC by multivariate analysis were examined. Although adenomyosis is associated with prolonged disease-specific survival (DSS), it has no prognostic importance for survival outcomes of the patients with EC.What are the implications of these findings for clinical practice and/or further research? Women having coexistent adenomyosis and EC should be informed about the impact of adenomyosis on the survival outcomes of EC.

Comparing the effects of CAD/CAM nickel-titanium lingual retainers on teeth stability and periodontal health with conventional fixed and removable retainers: A randomized clinical trial.

OBJECTIVE: The objectives of this study were to evaluate the effect of a CAD/CAM nickel-titanium retainer on the stability of mandibular anterior teeth and periodontal health and to compare it with other retainers. SETTING/SAMPLE POPULATION: Sixty participants from both genders who had irregularities prior to orthodontic therapy and who had been treated with full-fixed appliance mechanotherapy were included in the study and randomly allocated into four groups: CAD/CAM NiTi, multi-stranded stainless steel, single-stranded nickel-free titanium and vacuum-formed removable retainer groups. The mean age of the participants at the end of the treatment was approximately 20 years. MATERIALS AND METHODS: Digital impressions were taken for all participants at three different times: immediately (T0 ), three months (T1 ) and six months (T2 ) after treatment. Irregularity index, inter-canine and inter-molar width, and arch length were recorded using software. Additionally, a full periodontal assessment was carried out at T2 . RESULTS: During the follow-ups, all groups showed some relapse in the lower anterior teeth. No statistical significance was found intergroup in terms of all measured values. Within the multi-stranded group, inter-canine width had decreased by 0.10 mm with a statistical significance (P = .048). An additional statistical significance with P = .045 was found within the single-stranded group regarding the increased arch length. The periodontal assessment results of the mandibular anterior teeth between groups did not show clinically significant differences. CONCLUSION: No statistical significance was found between the CAD/CAM retainer and other retainers regarding the clinical failure rate. Less plaque accumulation and gingival inflammation were observed in the CAD/CAM NiTi retainer group.

Serological screening of West Nile virus among blood donors in northern Cyprus.

BACKGROUND: West Nile virus (WNV) is a neurotropic arbovirus that can also be transmitted through blood transfusion. Even though its geographic distribution has been expanding, there has not yet been any epidemiological data on WNV in northern Cyprus. The aim of our study is to fill this gap by using donated blood samples. METHODS: Samples collected from the main government hospital blood bank in Nicosia were analyzed by anti-WNV enzyme-linked immunosorbent assay (ELISA) (immunoglobulin M [IgM] and immunoglobulin G [IgG]). Seropositive samples were subjected to plaque reduction neutralization test (PRNT) for confirmation and analyzed by ELISA IgG avidity test and reverse transcription real-time polymerase chain reaction (rRT-PCR). RESULTS: Of the 760 sera samples, 2 (0.3%) were IgM+ and 31 (4.1%) were IgG+. Neutralization activity was detected in none (0.0%) of the IgM+ and 26 (83.9%) of IgG+ donor specimens. ELISA IgG avidity test reported high avidity in 21 (67.7%) and low avidity in one (3.2%) IgG+ sample. PRNT-confirmed anti-WNV IgG+ samples exhibited only borderline (19.2%) or high avidity (80.8%) values. rRT-PCR results were negative for both IgM+ and IgG+ samples. CONCLUSION: Anti-WNV antibodies were detected in northern Cyprus among blood donors. The establishment of preventive measures and evaluation of the geographic extent of the WNV in northern Cyprus are highly recommended.

Unusual Cause of Lateral Elbow Pain: A Case Report of Anconeus Muscle Contusion.

The anconeus muscle is a small and minor functioning muscle located at the posterolateral elbow region. It helps forearm extension and tightening of the joint capsule. Despite its limited functions, pathologies of the anconeus muscle can mimic other abnormalities of the elbow joint. Here, we report a rare case of a traumatic anconeus muscle contusion in a 15-year-old boy due to falling during dance. MRI showed contusion in the anconeus muscle, as well as strain in the ulnar collateral ligament and edema in the coronoid process of the ulna. To our knowledge, this is the first described case of traumatic anconeus muscle contusion in the literature. The presence of long-lasting lateral elbow pain in trauma cases without fracture should alert clinicians to consider anconeus muscle abnormalities. MRI is the best modality for diagnosis in these cases.

The effect of splenectomy on the levels of PCV-13-induced memory B- and T cells.

AIM: Splenectomised patients are associated with lifelong risk of fatal overwhelming post-splenectomy infection (OPSI), which is mostly caused by Streptococcus pneumoniae. Today OPSI cases can still be reported even in patients with appropriate vaccination. In our study, the levels of vaccine-specific memory B- and T cells were compared between control and splenectomised patients to enlighten the underlying reason. MATERIALS AND METHODS: Five healthy and 14 post-traumatic splenectomised individuals were vaccinated with 13-valent pneumococcal conjugate vaccine (PCV-13) followed by 23-valent pneumococcal polysaccharide vaccine (PPV-23). The levels of memory B- and T cells were compared by ELISPOT analysis. RESULTS: Splenectomised patients generated reduced levels of memory IgG B cells in response to PCV-13 vaccination, while the memory IFN-γ T-cell levels were undetectable in asplenic patients. This was despite the detection of vaccine-induced memory T-cell levels in control patients, which were analysed simultaneously following the same experimental protocol. CONCLUSION: Our results suggest that spleen is important, but not essential, for survival and/or generation of memory IgG B cells. In contrast, it seems to be indispensable for PCV-13-specific memory TH 1-cell levels. Studies enhancing the levels of vaccine-induced memory cells and further enlightening the immune responses in asplenic individuals are required to develop more effective vaccination strategies against OPSI.

Anti-Pneumococcal Vaccine-Induced Cellular Immune Responses in Post-Traumatic Splenectomized Individuals.

PURPOSE: Splenectomy is associated with increased risk of overwhelming post-splenectomy infections despite proper anti-pneumococcal vaccination. As most studies concentrated on vaccination-induced humoral immunity, the cellular immune responses triggered in splenectomized patients are not yet well studied. The present study aims to investigate this area as it can contribute to the development of more effective vaccination strategies. METHODS: Five healthy and 14 splenectomized patients were vaccinated with pneumococcal conjugate polysaccharide vaccine (PCV) followed by pneumococcal polysaccharide vaccine according to the guidelines established by Advisory Committee on Immunization Practices. PBMC samples collected 0, 8, and 12 weeks after PCV immunization were in vitro stimulated with PCV. Levels of lymphoproliferation, TH cell differentiation, and cytokine release were assessed by carboxyfluorescein succinimidyl ester labeling, intracellular cytokine staining, and ELISA, respectively. RESULTS: While TH1-dominated immune response was detected in both groups, asplenic individuals generated significantly lower levels of TH1 cells following in vitro stimulation. Similarly, levels of IFN-γ, IL-4, and IL-17 release and lymphoproliferation were significantly lower in asplenic patients. CONCLUSIONS: According to our data, splenectomy negatively influences the levels of PCV-induced lymphoproliferation, TH1 differentiation, and cytokine release. Besides, PCV failed to induce TH17-dominant immune response which is crucial for protection against extracellular pathogens.

The effect of ulnar variance on scapholunate and capitolunate angles.

Background Ulnar variance (UV), which is measured using anteroposterior (AP) X-rays, is associated with the development of multiple wrist pathologies. The scapholunate angle (SLA) and capitolunate angle (CLA) are measured using lateral X-rays, and these can be used in the diagnosis of intercalated segmental instability. Purpose To determine the effect of UV on SLA and CLA. Material and Methods A total of 140 patients (73 women, 67 men; mean age, 37.8 ± 14.6 years; 95% confidence interval [CI], 35.4-40.3) were included in the study. Participants were excluded if they presented with fractures or malunions, any arthritic conditions, avascular necrosis, congenital deformities, or bone and soft tissue tumors. UV, SLA, and CLA were measured using AP and lateral wrist X-rays. Results Patients were grouped as positive, neutral, and negative UV. There was no statistically significant difference in mean ages, sex, and sides (left or right) between the UV groups ( P > 0.05). In addition, there was no statistically significant difference in the mean values of SLA and CLA between the UV groups ( P > 0.05). UV showed no statistically significant association with SLA and CLA (r = -0.064; P = 0.455, and r = 0.059; P = 0.485, respectively). However, there was a statistically significant association between SLA and CLA (r = -0.482; P < 0.001). Conclusion There is higher prevalence of neutral UV and no correlation between UV with respect to age and sex of patients in the local Turkish population. SLA and CLA are not affected by UV. There is a negative correlation between SLA and CLA.

Leishmaniasis in northern Cyprus: Human cases and their association with risk factors.

BACKGROUND & OBJECTIVES: Cyprus is located in the eastern part of the Mediterranean Region where leishmaniasis is endemic. The primary objective of this study was to investigate human visceral leishmaniasis (VL) in the northern region of Cyprus where presence of canine leishmaniasis (CanL) and sandflies has been documented in earlier studies. The secondary objective was to assess the association of leishmaniasis with demographic and epidemiological variables. METHODS: Intravenous blood samples were collected from 249 volunteers in Kyrenia district (located in the northern coastal region of Cyprus). Whole blood samples were tested for DNA of Leishmania spp by polymerase chain reaction (PCR), while serum samples were analyzed using direct agglutination test (DAT) and rK39 test. For evaluation of possible risk factors, a questionnaire was applied to the participants. RESULTS: Only three (1.2%) of 249 participants were found seropositive by DAT (n = 2) or rK39 test (n = 1). The remaining samples were negative in serology, and no PCR positivity was detected in any of the 249 participants. Seven individuals, including the seropositive cases, had a history of cutaneous leishmaniasis (CL). Seropositivity and CL were not significantly related with gender (M/F: 40.2/59.8%), age [Mean: 42.85 ± 17.45, Median: 40 (7-86)], occupation (Indoor/Outdoor: 84.7/12.9%), dog ownership (52.6%), and CanL history (5.3%). However, a statistical association was found between seropositivity and past CL infection. Also, a significant relation was observed between participants living in peripheral area (63.1%) and CL infection. Furthermore, leishmaniasis awareness (28.1%) among the study population was statistically correlated with past CL infection and dog ownership. INTERPRETATION & CONCLUSION: This study demonstrates the presence of leishmaniasis and highlight the need for implementation of efficient control measures on the northern coast of Cyprus.