Anterior cruciate ligament reconstruction: Magnetic resonance imaging and factors influencing outcome

Purpose

This study was conducted to determine the magnetic resonance imaging (MRI) findings in cases of complications following anterior cruciate ligament (ACL) reconstructive surgery, and to correlate these complications with their possible etiological factors based on clinical and radiological criteria.

Methods

The study included 48 symptomatic patients (40 males and 8 females) after arthroscopic ACL reconstruction in the period between 2006 and 2008. Clinical evaluation of the patients was performed using the International Knee Documentation Committee scoring system (IKDC). MRI was performed using 1.5 T dedicated system and a standard imaging protocol. The scans were then reviewed by two senior radiologists for the assessment of integrity of the reconstructed ligament and the presence of related complications. The findings were then analyzed and correlated with the clinical evaluation.

Results

Tunnel widening was the most common MRI finding seen, as it was present in 42 patients (87.5%). The detected post reconstructive complications encountered in our patients included graft tear in 34 patients (70.83%), impingement in 12 patients (25%), osteoarthritis in six patients (12.5%), cystic degeneration in two patients (4.16%), and Cyclops lesion in two patients (4.16%).

Conclusions

MRI is a valuable imaging modality for assessment of post ACL reconstructive complications, as it is useful in demonstrating tunnel positioning, graft integrity and other soft tissue structures of the knee. It also helps in identifying possible underlying causes and predisposing factors for ACL graft failure.     

Effect of iron deficiency anemia and its treatment on cell mediated immunity

Iron deficiency anemia (IDA) is one of the most prevalent micronutrient deficiencies particularly in the developing countries. While there is evidence of an altered immune profile in iron deficiency, the exact immunoregulatory role of iron is not known. Knowledge particularly in children, who are vulnerable to iron deficiency and infection, is lacking. We aimed to study the effects of IDA and its treatment with oral iron supplementation on cell-mediated immunity. The levels of T-lymphocytes, their CD4⁺, CD8⁺ and CD1a⁺ subsets, transferrin receptor (CD71) and serum ferritin were evaluated in 40 iron-deficient and 40 healthy children. The impact of oral iron supplementation for three months on the same parameters was also noted in children with IDA. The level of mature T-lymphocytes (CD4⁺ and CD8⁺) was significantly lower (P<0.001) while that of the immature T-cells (CD1a⁺) was significantly higher (p<0.001) in IDA children compared to the control. The mature T-cell count was significantly improved after iron therapy. In spite of significant reduction in the immature T-cells (CD1a⁺) level after iron supplementation, it was significantly higher than the control. The present study demonstrated that T-lymphocytes maturation was defective in IDA and improved partially after 3 months of iron supplementation. Therefore, longer time of iron therapy may be required to induce complete maturation of T-lymphocytes.     

Potential value of circulatory microRNA10b gene expression and its target E‐cadherin as a prognostic and metastatic prediction marker for breast cancer

BackgroundBreast cancer (BC) is the leading cause of cancer death in women worldwide. Most BC studies on candidate microRNAs were tissue specimen based. Recently, there has been a focus on the study of cell‐free circulating miRNAs as promising biomarkers in (BC) diagnosis and prognosis. Therefore, we aimed to investigate the circulating levels of miR‐10b and its target soluble E‐ cadherin as potentially easily accessible biomarkers for breast cancer.MethodsSixty‐one breast cancer patients and forty‐eight age‐ and sex‐matched healthy volunteers serving as a control group were enrolled in the present study. Serum samples were used to assess miRNA10b expression by TaqMan miRNA assay technique. In addition, soluble E‐cadherin expression level in serum was determined using ELISA technique.ResultCirculating miR‐10b expression level and serum sE‐cadherin was significantly upregulated in patients with BC compared to controls. Moreover, serum miR‐10b displayed progressive up‐regulation in advanced stages with higher level in metastatic compared to non‐metastatic BC. Additionally, the combined use of both serum miR‐10b and sE‐cadherin revealed the highest sensitivity and specificity for detection of BC metastasis (92.9% and 97.9% respectively) with an area under curve (AUC) of 0.98, 95% CI (0.958–1.00).ConclusionOur data suggest that circulating miR‐10b could be utilized as a potential non‐invasive serum biomarker for diagnosis and prognosis of breast cancer with better performance to predict BC metastasis achieved on measuring it simultaneously with serum sE‐cadherin. Further studies with a large cohort of patients are warranted to validate the serum biomarker for breast cancer management.     

A comparative study of two angiogenic factors: vascular endothelial growth factor and angiogenin in induced sputum from asthmatic children in acute attack

BACKGROUND: Angiogenesis is a prerequisite for airway remodeling in bronchial asthma. Several factors may play important roles in inflammation and angiogenesis through effects on inflammatory cell infiltration or neovascularization. OBJECTIVES: (1) To determine the levels of vascular endothelial growth factor (VEGF) and angiogenin in sputum supernatants of asthmatic children during the acute attack and 6 weeks after start of therapy; and (2) to correlate their levels with the degree of asthma severity. SUBJECTS AND METHODS: Twenty asthmatic children with acute attack (mean age, 9.6 +/- 3.5 years [+/- SD]) and 12 sex- and age-matched healthy control children were enrolled in the study. Sputum supernatants were collected for determination of VEGF and angiogenin levels. Serum samples were withdrawn for IgE measurement. The above tests were performed using an enzyme-linked immunosorbent assay. The FEV1 was measured using spirometry. VEGF, angiogenin, and FEV1 estimations were repeated for asthmatic children 6 weeks after start of therapy. RESULTS: During the acute attack, asthmatic children had significantly higher levels of VEGF and angiogenin than in healthy control children (p < 0.001). VEGF and angiogenin levels showed more elevation with increase in asthma severity (p < 0.001). A significant positive correlation existed between both angiogenic factors (r = 0.98, p < 0.001). A negative significant correlation was found between FEV1 percentage of predicted and both VEGF (r = -0.99, p < 0.001) and angiogenin (r = -0.97, p < 0.001). A nonsignificant correlation was found between serum IgE and sputum VEGF (r = 0.09, p > 0.05). Although there was a significant decrease in the levels of both VEGF and angiogenin after 6 weeks of treatment with corticosteroid inhalation therapy, the levels did not reach normal control levels (p < 0.001 and p < 0.05, respectively). CONCLUSIONS: Our results show that both VEGF and angiogenin levels were elevated in children with acute asthma. The study also suggests that increased severity of bronchial asthma in children is associated with the expression of both angiogenic factors, which are implicated in asthma pathogenesis. After 6 weeks of therapy, the levels of both angiogenic factors showed significant decrease.     

High epidermal growth factor receptor amplification rate but low mutation frequency in Middle East lung cancer population

Epidermal growth factor receptor (EGFR) exon 18-21 mutations were shown to be highly predictive of response to gefitinib (Iressa) therapy in lung cancer. Studies on Western and Japanese lung cancers have indicated substantial differences in the EGFR mutation frequency between these populations. To investigate the prevalence of EGFR in another distinct ethnic group, EGFR alterations were studied in 47 consecutive non small cell lung cancers from Saudi Arabia by immunohistochemistry, fluorescence in situ hybridization, and DNA sequencing. Detectable EGFR expression was seen in 69.8% of 43 interpretable cancers. Epidermal growth factor receptor amplification, present in 15.3% of 39 analyzable cancers, was strongly associated with high levels of EGFR expression (P = .0047). Only 1 exon 18-21 mutation was seen among 34 lung cancers that could be successfully sequenced. It is concluded that EGFR exon 18-21 mutations are rare in Middle East patients with lung cancer and occur in a similar range as in Western patients. The remarkable high rate of EGFR gene amplifications could potentially facilitate studies on the predictive role of gene copy number changes for response to anti-EGFR therapies in Middle East patient sets.     

Influence of type of final restoration on the fracture resistance and fracture mode of endodontically treated premolars with occluso-mesial cavities

IntroductionThe aim of this study was to compare the fracture resistance of endodontically treated premolars after the application of three restorative materials (i.e., direct composite, indirect composite, and computer aided design/computer aided manufacturing CAD/CAM ceramic inlays) to restore a conservative occluso-mesial cavity preparation.Materials and methodssixty sound maxillary premolars were divided into four experimental groups; group A: the control group, where neither root canal treatment nor preparation were performed; group B: teeth were restored with a direct Filtek Z250 composite restorative material; group C: teeth were restored with an indirect inlay Filtek Z250 composite restorative material; group D: teeth were restored with IPS E.Max CAD/CAM monolithic ceramic inlays. Access cavities and root canal treatment procedures were conducted using standard techniques. Then, the cavities were restored with direct composite restorative materials following manufacturer’s instructions. Each group received mesial-occlusal cavities and restored according to the designated group.Teeth from all groups were exposed to a thermocycling regimen of 500 cycles in water baths at 5–55 °C. Then, each specimen was mounted on a special fixture on a computer controlled Instron Universal Testing Machine. An axial compressive load was applied to the palatal cusp up to failure at an angle of 45°. The force was applied at the rate of 2 mm/min until visible or audible evidence of fracture was observed. The force at fracture was measured in MPa, and the fracture mode was recorded as either favorable [restorable adhesive fracture above the cemento-enamel junction (CEJ)] or unfavorale (non-restorable fractures under CEJ). The obtained data were analyzed using the SPSS version 21.0 statistical software. One-way ANOVA and Tukey's test were used to compare the mean values of maximum load of the four groups. Pearson's Chi-square test was used to compare the distribution of failure mode among the four groups. The p-value of ≤ 0.05 was used to report the statistical significance of results.