Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill–Sachs and Bankart lesions: a systematic review and meta-analysis

Purpose The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. Methods PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. Results The proportion of Hill–Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill–Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01). Conclusion Higher proportions of Hill–Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill–Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. Level of evidence IV.

Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study

Abusive head trauma (AHT) and its most common variant, the shaken baby syndrome (SBS), are predominantly characterized by central nervous system-associated lesions. Relatively little data are available on the value of skeletal and skin injuries for the diagnosis of SBS or AHT. Thus, the present study retrospectively investigated 72 cases of living children diagnosed with the explicit diagnosis of SBS during medico-legal examinations at three German university institutes of legal medicine. The risk of circular reasoning was reduced by the presence of 15 cases with confession by perpetrators. Accordingly, the comparison with the 57 non-confession cases yielded no significant differences. Skeletal survey by conventional projection radiography, often incomplete, was found to be performed in 78% of the cases only. Fractures were found in 32% of the cases. The skull (43%) and ribs (48%) were affected most frequently; only 8% of the cases showed classic metaphyseal lesions. In 48% of the cases, healing fractures were present. Skin lesions (hematomas and abrasions) were found in 53% of the cases with the face (76%), scalp (26%), and trunk (50%) being the major sites. In 48% of the cases, healing skin lesions were observed. Nearly 80% of the cases with fractures also showed skin lesions. The data prove that SBS is frequently accompanied by other forms of physical abuse. Therefore, skeletal survey is indispensable and should always be done completely and according to existing imaging guidelines if child abuse is suspected.

Parasites, Bacteria, and Associated Pathological Changes in the Digestive System of Diurnal and Nocturnal Raptors in Central Italy

The knowledge of raptor pathogens and associated lesions may be extremely important to enhancing raptor conservation efforts and reducing pathogen spillover to humans and domesticated animals and vice versa. Parasite infections of the digestive system and associated bacteria and pathological changes were evaluated in deceased diurnal and nocturnal raptors in central Italy. Overall, the prevalence of parasites (nematodes, cestodes, trematodes, acanthocephalans, and protozoa) identified in the examined birds was 72.41%, and most of the positive raptors (71.42%) showed multiple parasite infections. Among bacteria, Salmonella typhimurium, Salmonella enterica subspecies diarizonae, Escherichia coli, Clostridium perfringens, Yersinia enterocolitica, and Pasteurella multocida were identified. The results obtained showed that both parasites and bacteria may cause severe lesions in the digestive system of diurnal and nocturnal raptors; parasites and bacteria may concur in causing these lesions; most severe lesions are caused by the interaction of multiple pathogens, both parasites and bacteria; and the same pathogen taxa are frequently associated with the same pathological changes. This study is the first report of S. typhimurium and S. enterica subspecies diarizonae in Buteo buteo, while Andracantha mergi, Spirocerca spp., Sarcocystis dispersa, Sarcocystis columbae, and Eumonospora spp. were recorded for the first time in Italy.

MULTIMODAL IMAGING OF CORNEAL NEOVESSELS: OCT ANGIOGRAPHY IN COMPARISON TO FLUORESCEIN ANGIOGRAPHY ON 10 EYES AND REVIEW OF THE LITERATURE

Introduction:The use of OCT angiography for the analysis of neovessels of the ocular surface is currently at the experimental stage. Through this work we evaluate the benefits of OCTA in the detection of corneal neovessels, their depth and surface, the signs suggestive of activity / quiescence in comparison to fluorescein angiography. Materials And Methods:10 patients (10 eyes) with corneal neovessels (CNV) were prospectively recruited to Ophthalmology B at the Rabat Specialty Hospital between June and September 2019. All patients received OCT A fluorescein angiography (AF) at two-week intervals. Results:The results of the OCT A matched the AF data by showing immature neovessel (NV) characteristics for the early-diffusing NVs, allowing the study of the structure : trunk, numbers of segments, and fractal divisions, the existence of apical loop. As well as the detection of the flow level, exudative phenomena and associated lesions in high resolution OCT B. Discussion:Few studies have evaluated the OCTA in the evaluation of NVC, the published articles analyze the feasibility and reproducibility of this technique. Our initial analyzes suggest that scans provide better penetration and resolution of NVCs, but this requires direct comparative studies between OCTA systems used to scan the same eyes. The learning curve seemed fast for this technique. Conclusion :The evaluation of antiangiogenic treatments and the risk of graft rejection, it should be noted when interpreting OCTA scans of the anterior segment that artifacts may appear in dense scars areas in addition to motion artifacts.Future software enhancements and optimization for anterior segment acquisition may reduce these artifacts even more and improve the resolution of the image.

Pathological findings in bycaught harbour porpoises (Phocoena phocoena) from the coast of Northern Norway

Due to little prior knowledge, the present study aims to investigate the health status of bycaught harbour porpoises from the northernmost Arctic Norwegian coastline. Gross, histopathological and parasitological investigations were conducted on 61 harbour porpoises (Phocoena phocoena phocoena) accidentally captured in fishing gear from February to April 2017 along the coast of Northern Norway. Most animals displayed a good nutritional status, none were emaciated. Pulmonary nematodiasis (Pseudalius inflexus, Halocercus invaginatus and Torynurus convolutus) was found in 77% and associated with severe bronchopneumonia in 33% of the animals. The majority (92%) had parasites in the stomach and intestine (Anisakis simplex sensu stricto (s. s.), Pholeter gastrophilus, Diphyllobothrium stemmacephalum, Hysterothylacium aduncum and Pseudoterranova decipiens s. s.). The prevalence of gastric nematodiasis was 69%. In the 1st stomach compartment A. simplex s. s. was found in 30% of the animals, causing severe chronic ulcerative gastritis in 23%. Campula oblonga infected the liver and pancreas of 90% and 10% of the animals, respectively, causing severe cholangitis/pericholangitis/hepatitis in 67% and moderate pancreatitis in 10% of the animals. Mesenteric and pulmonary lymphadenitis was detected in 82% and 7% of the animals, respectively. In conclusion, the major pathological findings in the investigated Arctic porpoises were parasitoses in multiple organs with associated severe lesions, particularly in the lung, liver and stomach. The animals were generally well nourished and most showed freshly ingested prey in their stomachs. The present study indicates that the harbour porpoises were able to tolerate the detected parasitic burden and associated lesions without significant health problems.

Human Papillomavirus (HPV)

HPV is extremely common worldwide and mainly transmitted through sexual contact; most people are infected with HPV shortly after onset of sexual activity. There are >200 types of HPV, of which at least 12 are cancer-causing (oncogenic or high-risk types). HPV is a causal factor for several anogenital and a subset of oropharyngeal cancers with 2 HPV types (16 and 18) causing 72% of all HPV-associated cancers. Cervical cancer is the fourth most common cancer among women globally with nearly 90% of the deaths occurring in low- and middle-income countries. Comprehensive cervical cancer control includes primary prevention (vaccination against HPV), secondary prevention (screening and treatment of pre-cancerous lesions) as well as treatment of invasive cervical cancer. The currently licensed vaccines are L1 VLP-based and prophylactic; they have been shown to be safe and highly effective in preventing HPV infections and HPV-associated lesions, precancer and cancer. Neutralizing antibodies are the mechanism of protection for prophylactic HPV VLP-based vaccines. Therapeutic HPV vaccines targeting the oncoproteins E6 and E7 are in clinical development.

Role of magnetic resonance imaging on fingers in diagnosis of post-traumatic tendon and ligament injuries

Background Magnetic resonance (MR) imaging is a powerful method for evaluating acute and chronic lesions of the stabilizing articular elements (volar plate and collateral ligaments) of the fingers and thumbs, the condition of tendons, the presence of a tear, the number of affected tendons, the extent of tendon retraction, and the presence of associated lesions. This study was done to clarify the value of magnetic resonance imaging (MRI) in assessment of trauma-related injuries of the tendons and ligaments of the fingers and subsequently positively affect the surgical decisions in such cases. Results This study included 42 patients (33 males and 9 females) with a mean age of 35 years. All of them had history of trauma. Male affection was 78.5%, while females constituted only 21.5%, striking right-sided-hand affection (92.9%). The most affected finger was the thumb. The most common affected sites were extending from the metacarpophalangeal (MCP) till the proximal interphalangeal (PIP). The tendons were affected in 42.9%; meanwhile, ligamentous affection represented 57.2%. The flexor tendon tear represented by 28.6%%, while extensor tendon tear occurred in 14.3%. The study also showed that partial thickness tear is represented by 66.7%, while complete thickness tear occurred in about 33.3%. Bone marrow edema and post-traumatic tenosynovitis occurred in about 14% of cases. Conclusions Magnetic resonance imaging is an essential technique to obtain a correct pre-surgical diagnosis. It is of utmost importance to possess an in-depth knowledge of finger radiological anatomy in detail, as well as the appearance of the different pathologic entities on MRI. It provides a great assessment of the tendons and ligaments tear by whether partial or complete, any associated marrow edema or bony fragment avulsion and the extent of retraction in cases of complete tear.

Topical Application of Temperature-Sensitive Gel Containing Caerin 1.1 and 1.9 Peptides on TC-1 Tumour-Bearing Mice Induced High-Level Immune Response in the Tumour Microenvironment

The development of topical cream drugs that increase the immune activation of tumour-infiltrating lymphocytes against tumour and chronic viral infection-associated lesions is of great immunotherapeutic significance. This study demonstrates that the topical application of a temperature-sensitive gel containing caerin 1.1 and 1.9 peptides reduces nearly 50% of the tumour weight of HPV16 E6/E7-transformed TC-1 tumour-bearing mice via improving the tumour microenvironment. Confocal microscopy confirms the time-dependent penetration of caerin 1.9 through the epidermal layer of the ear skin structure of mice. Single-cell transcriptomic analysis shows that the caerin 1.1/1.9 gel expands the populations with high immune activation level and largely stimulates the pro-inflammatory activity of NK and dendritic cells. Closely associated with INFα response, Cebpb seems to play a key role in altering the function of all Arg1hi macrophages in the caerin group. In addition, the caerin gel treatment recruits almost two-fold more activated CD8+ T cells to the TME, relative to the untreated tumour, which shows a synergistic effect derived from the regulation of S1pr1, Ccr7, Ms4a4b and Gimap family expression. The TMT10plex-labelling proteomic quantification further demonstrates the activation of interferon-alpha/beta secretion and response to cytokine stimulus by the caerin gel, while the protein contents of several key regulators were elevated by more than 30%, such as Cd5l, Gzma, Ifit1, Irf9 and Stat1. Computational integration of the proteome with the single-cell transcriptome consistently suggested greater activation of NK and T cells with the topical application of caerin peptide gel.

Novel Antigenic Targets of HPV Therapeutic Vaccines

Human papillomavirus (HPV) infection is the cause of the majority of cervical cancers and head and neck cancers worldwide. Although prophylactic vaccines and cervical cancer screening programs have shown efficacy in preventing HPV-associated cervical cancer, cervical cancer is still a major cause of morbidity and mortality, especially in third world countries. Furthermore, head and neck cancer cases caused by HPV infection and associated mortality are increasing. The need for better therapy is clear, and therapeutic vaccination generating cytotoxic T cells against HPV proteins is a promising strategy. This review covers the current scene of HPV therapeutic vaccines in clinical development and discusses relevant considerations for the design of future HPV therapeutic vaccines and clinical trials, such as HPV protein expression patterns, immunogenicity, and exhaustion in relation to the different stages and types of HPV-associated lesions and cancers. Ultimately, while the majority of the HPV therapeutic vaccines currently in clinical testing target the two HPV oncoproteins E6 and E7, we suggest that there is a need to include more HPV antigens in future HPV therapeutic vaccines to increase efficacy and find that especially E1 and E2 could be promising novel targets.