Artery first approach for resecting ganglioneuroma encasing superior mesenteric artery

Publication date: Available online 17 June 2017
Source:Medical Journal Armed Forces India
Author(s): Jayant Kumar Banerjee, Ramanathan Saranga Bharathi, Rajat Jagani, Giriraj Singh




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Functional outcome after arthroscopic management of traumatic recurrent dislocation shoulder using Bankart repair and Remplissage techniques

Publication date: Available online 17 June 2017
Source:Medical Journal Armed Forces India
Author(s): Munish Sood, Amresh Ghai
BackgroundRecurrent dislocation shoulder is one of the common shoulder injuries encountered by the orthopedic surgeon in clinical practice. Bankart repair using the arthroscopic method has become one of the standard techniques in the management of recurrent dislocation shoulder. Remplissage technique can be used as adjunct to Bankart repair in certain conditions.MethodIn this case series, we have assessed the functional outcome and return to activity at midterm follow-up after arthroscopic management.Results51 patients with traumatic shoulder dislocation were operated using the shoulder arthroscopic technique. Rowe score improved significantly at the latest follow-up. No major complication was noticed in our case series.ConclusionThe shoulder arthroscopy procedure requires special instrumentation and expertise. We believe that this is a less invasive and safe procedure and provides an additional tool in the management of instabilities including in cases of complex recurrent dislocation of the shoulder.



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The psychological morbidity in the long term after war related bilateral lower limb amputation

Publication date: Available online 17 June 2017
Source:Medical Journal Armed Forces India
Author(s): Batool Mousavi, Mehdi Masoumi, Mohammadreza Soroush, Shekoufe Shahriar, Ali Firoozabadi
BackgroundTo determine the psychological morbidity in the long term after war related bilateral lower limb amputation.MethodsMental health status was determined by the Symptom Checklist-90-R (SCL-90-R) and a structured psychiatrist interview using Structured Clinical Interview for DSM Disorders-IV (SCID-IV) in 327 male amputees. The survey was 22.3 (SD=3.9) years after amputation. A one-sample t-test was conducted to compare our results with a survey carried out in a rural Iranian population.ResultsThe mean age of the participants was 42 years (SD=6.3). Only 22 persons had psychiatric diagnosis and were under treatment. The most common problems on SCL-90-R were somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, and depression. Global severity index (GSI) of the bilateral lower limb amputees (BLLA) (0.88±0.63) was significantly higher than Iranian population (0.35±0.28) (p<0.001). BLLA had significantly higher scores in all subscales of Scl-90-R compared with general population (p<0.001). Of the total amputees about 39.1% (128 out 327) diagnosed with at least one psychiatric disorder in psychiatrist interview. About 83.9% (N=115) of the psychiatrist diagnosed disorders were new cases. Mood disorders 37.3% (depression 28.7%) and anxiety disorders 12.2% (obsessive compulsive disorder 9.8%) were the most common disorders in the study group. There was not any relationship between demographic variables and mental disorder (p>0.05).ConclusionThe high prevalence and especially the large proportion of undiagnosed mental disorders high-light the need for targeted and appropriate psychological interventions in this vulnerable population.



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Brain stem death certification protocol

Publication date: Available online 17 June 2017
Source:Medical Journal Armed Forces India
Author(s): Vikas Srivastava, Monish Nakra, Anand Shankar K., Pawan Dhull, R. Ramprasad, N.S. Lamba
Transplantation of Human Organs is guided by laid down specific Laws in India. The organs which are targeted to be transplanted are liver, kidney and cornea. The waiting list is enormous but the donor pool is meagre. This document has been made with a view that the donor pool can be enlarged by identifying patients who are 'Brain Dead' while still not having 'Cardiac Death'. The steps include the prerequisite conditions which must be satisfied by patients who have suspicion of being brain dead, detailed examination of the patient, confirmation of the Brain Death and Counselling of the relatives for organ donation.



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TLR-Induced Murine Dendritic Cell (DC) Activation Requires DC-Intrinsic Complement [INNATE IMMUNITY AND INFLAMMATION]

Induction of proinflammatory T cell immunity is augmented by innate dendritic cell (DC) maturation commonly initiated by TLR signaling. We demonstrate that ligation of TLR3, TLR4, and TLR9 induces murine DC production of complement components and local production of the anaphylatoxin C5a. In vitro, ex vivo, and in vivo analyses show that TLR-induced DC maturation, as assessed by surface phenotype, expression profiling by gene array, and functional ability to stimulate T cell responses, requires autocrine C3a receptor and C5a receptor (C3ar1/C5ar1) signaling. Studies using bone marrow chimeric animals and Foxp3-GFP/ERT2-Cre/dTomato fate-mapping mice show that TLR-initiated DC autocrine C3ar1/C5ar1 signaling causes expansion of effector T cells and instability of regulatory T cells and contributes to T cell–dependent transplant rejection. Together, our data position immune cell–derived complement production and autocrine/paracrine C3ar1/C5ar1 signaling as crucial intermediary processes that link TLR stimulation to DC maturation and the subsequent development of effector T cell responses.

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Enhanced Effector Functions Due to Antibody Defucosylation Depend on the Effector Cell Fc{gamma} Receptor Profile [IMMUNOTHERAPY AND VACCINES]

Abs of the IgG isotype are glycosylated in their Fc domain at a conserved asparagine at position 297. Removal of the core fucose of this glycan greatly increases the affinity for FcRIII, resulting in enhanced FcRIII-mediated effector functions. Normal plasma IgG contains ~94% fucosylated Abs, but alloantibodies against, for example, Rhesus D (RhD) and platelet Ags frequently have reduced fucosylation that enhances their pathogenicity. The increased FcRIII-mediated effector functions have been put to use in various afucosylated therapeutic Abs in anticancer treatment. To test the functional consequences of Ab fucosylation, we produced V-gene–matched recombinant anti-RhD IgG Abs of the four different subclasses (IgG1–4) with and without core fucose (i.e., 20% fucose remaining). Binding to all human FcR types and their functional isoforms was assessed with surface plasmon resonance. All hypofucosylated anti-RhD IgGs of all IgG subclasses indeed showed enhanced binding affinity for isolated FcRIII isoforms, without affecting binding affinity to other FcRs. In contrast, when testing hypofucosylated anti-RhD Abs with FcRIIIa-expressing NK cells, a 12- and 7-fold increased erythrocyte lysis was observed with the IgG1 and IgG3, respectively, but no increase with IgG2 and IgG4 anti-RhD Abs. Notably, none of the hypofucosylated IgGs enhanced effector function of macrophages, which, in contrast to NK cells, express a complex set of FcRs, including FcRIIIa. Our data suggest that the beneficial effects of afucosylated biologicals for clinical use can be particularly anticipated when there is a substantial involvement of FcRIIIa-expressing cells, such as NK cells.

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Access Guide to Antigen Receptor Genes [PILLARS OF IMMUNOLOGY]

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