Discovery of new Toxoplasma gondii antigenic proteins using a high throughput protein microarray approach screening sera of murine model infected orally with oocysts and tissue cysts.

BACKGROUND: Toxoplasma gondii is an obligate intracellular protozoan parasite that causes congenital toxoplasmosis, as well as other serious clinical presentations in immune compromised humans. The parasite has also been recently linked to behavioral diseases in humans and other mammalian hosts. New antigens are being evaluated to develop a diagnostic kit for the diagnosis of acute infection or a protective vaccine. METHODS: In this study, we have focused on the discovery of new antigenic proteins from T. gondii genomic data using a high throughput protein microarray screening. To date, microarrays containing > 2870 candidate exon products of T. gondii have been probed with sera collected from patients with toxoplasmosis. Here, the protein microarrays are probed with well-characterized serum samples from animal models administered orally with oocysts or tissue cysts. The aim was to discover the antigens that overlap in the mouse profile with human antibody profiles published previously. For this, a reactive antigen list of 240 antigens recognized by murine IgG and IgM was identified using pooled sera from orally infected mice. RESULTS: Analyses of screening data have identified plenty of antigens and showed strong immunogenicity in both mouse and human antibody profiles. Among them, ROP1, GRA2, GRA3, GRA4, GRA5, GRA6, GRA7, GRA8, GRA14, MIC1, MIC2 and MAG1 have shown strong immunogenicity and used as antigen in development of vaccines or serological diagnostic assays in previous studies. CONCLUSION: In addition to the above findings, ROP6, MIC12, SRS29A and SRS13 have shown strong immunogenicity but have not been tested in development of a diagnostic assay or a vaccine model yet.

Genetic Resistance to Malaria Is Associated With Greater Enhancement of Immunoglobulin (Ig)M Than IgG Responses to a Broad Array of Plasmodium falciparum Antigens.

Background. People of the Fulani ethnic group are more resistant to malaria compared with genetically distinct ethnic groups, such as the Dogon people, in West Africa, and studies suggest that this resistance is mediated by enhanced antibody responses to Plasmodium falciparum antigens. However, prior studies measured antibody responses to <0.1% of P falciparum proteins, so whether the Fulani mount an enhanced and broadly reactive immunoglobulin (Ig)M and IgG response to P falciparum remains unknown. In general, little is known about the extent to which host genetics influence the overall antigen specificity of IgM and IgG responses to natural infections. Methods. In a cross-sectional study in Mali, we collected plasma from asymptomatic, age-matched Fulani (n = 24) and Dogon (n = 22) adults with or without concurrent P falciparum infection. We probed plasma against a protein microarray containing 1087 P falciparum antigens and compared IgM and IgG profiles by ethnicity. Results. We found that the breadth and magnitude of P falciparum-specific IgM and IgG responses were significantly higher in the malaria-resistant Fulani versus the malaria-susceptible Dogon, and, unexpectedly, P falciparum-specific IgM responses more strongly distinguished the 2 ethnic groups. Conclusions. These findings point to an underappreciated role for IgM in protection from malaria, and they suggest that host genetics may influence the antigen specificity of IgM and IgG responses to infection.

Hemiarthroplasty vs total shoulder replacement for rotator cuff intact osteoarthritis: how do they fare after a decade?

BACKGROUND: We compared hemiarthroplasty (HA) and total shoulder replacement (TSR) for the treatment of osteoarthritis at minimum of 10 years from primary arthroplasty. METHODS: Thirty-three patients (13 HA and 20 TSR) were intraoperatively randomized to HA or TSR after glenoid exposure and were assessed to a minimum of 10 years postoperatively. Apart from those who died, no patients were lost to follow-up. RESULTS: At 6 months and 1 year, the TSR patients had less pain than the HA patients (P < .05), and this became more apparent at 2 years postoperatively (P < .02). There were no statistically significant differences between the groups at 10 years with respect to pain, function, and daily activities. No patients in the HA group rated their shoulders as pain-free at 10 years; however, 42% of the surviving TSR patients rated their shoulders as pain-free at 10 years. Four HA patients were revised to TSR due to severe pain secondary to glenoid erosion. Two shoulders in the TSR group have been revised. Nine of the 13 HA patients (69%) and 18 of the 20 TSR patients (90%) remained in situ at death or at the 10-year review. CONCLUSION: TSR has advantages over HA with respect to pain and function at 2 years, and there has not been a reversal of the outcomes on longer follow-up. This longer-term review does not support the contention that HA will avoid later TSR complications, and in particular, an unacceptable rate of glenoid component failure.

An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine.

This is a retrospective study of 25 patients, looking at the outcome of open reduction and fixation of displaced anterior tibial spine avulsion fractures with absorbable and non-absorbable materials. The mean period of follow-up was 44 months (range, 21 to 88 months). The results of surgery were assessed clinically and radiologically. Outcome was evaluated by using the Lysholm knee scoring system. Anterior cruciate ligament laxity was assessed by using a KT-1000 arthrometer and range of movements with a goniometer. Overall, children did better than adults, but age per se did not appear to affect the final outcome. There was no significant difference between children fixed with absorbable or non-absorbable materials. Adults fixed with non-absorbable material had significantly better results than those fixed with absorbable material. Herbert screws had a tendency to migrate into the bone substance, and are best avoided. Protected early mobilisation in a knee brace was found to be safe and helped to regain early range of movements in the knee joint.

Post partum osteomyelitis due to Cryptococcus neoformans.

We report a case of Cryptococcus neoformans in a pregnant woman whose initially mild symptoms of infection deteriorated after delivery. This is the first reported case of C. neoformans osteomyelitis in pregnancy.

A case of elbow hyperextension leading to complete brachial artery rupture.

BACKGROUND: To our knowledge there are no cases in the literature of traumatic vascular injury of the brachial artery by elbow hyperextension without elbow dislocation based on either clinical or radiological evidence. CASE PRESENTATION: We present the first case of complete brachial artery rupture resulting from a hyperextension injury to an elbow, without dislocation. The history, early assessment and operative treatment with figures are presented. CONCLUSION: We advocate prompt clinical assessment by orthopaedic and vascular teams and early surgical exploration and repair.

Prevention of secondary osteoporotic fractures--why are we ignoring the evidence?

Osteoporosis is a major problem world-wide. In the UK, it costs the NHS about pound 1.7 billion per annum. Admission to orthopaedic units for treatment and rehabilitation with fractured necks of femur makes up a large proportion of the cost. The evidence suggests simple, cost-effective treatments can reduce fractures and re-fractures attributable to osteoporosis by up to 50%, and easy to follow guidelines exist. Our study, of a typical large district general hospital suggests that ideally placed orthopaedic surgeons are however not taking the opportunity to start these treatments or offer advice about this common condition. Commencing these treatments could prevent more than 7000 fractures per year in the UK.