Fixation of os acromiale using polyester sutures: a novel surgical treatment.

BACKGROUND: Patients with unstable os acromiale often complain of shoulder pain. Numerous surgical treatment options have been introduced with inconsistent clinical results. In this study, a novel surgical treatment using polyester sutures to fix unstable os acromiale was introduced, and clinical results were reported. METHODS: We retrospectively studied 10 shoulders that were diagnosed with os acromiale from January 2014 to January 2016. All 10 cases were of the meso-acromion type. Except for the first case in our series, cases of os acromiale were fixed using polyester sutures arthroscopically. The standardized scores and visual analog scale (VAS) were recorded preoperatively and at each follow-up. A computed tomography (CT) scan was ordered at the follow-up of 12 months. RESULTS: The average follow-up length was 28.7 months, ranging from 26 to 33 months. The average Constant score before surgery was 40.50±4.53 points, which significantly improved to 75.60±5.17 points after surgery. The average VAS score was reduced from 5.20±1.14 points to 1.60±0.84. At the follow-up of 12 months, a CT scan was ordered. All the patients showed a bony union of the os acromiale. On the CT scan, two small pits could be seen on the medial and lateral side of the acromion, which indicated the level of the os acromiale. The position of the os acromiale was good, and no evident sclerosis was found on the edges of the fragments. CONCLUSIONS: Polyester sutures could provide reliable strength for the fixation of os acromiale without any irritation from hardware.

Clinical outcomes after absorbable suture fixation of patellar osteochondral fracture following patellar dislocation.

BACKGROUND: Osteochondral fracture (OCF) is one of the severe complications following a patellar dislocation. The appropriate fixation method for patients with OCF remains controversial. METHODS: Eighteen patients who had undergone surgery after a patellar dislocation were recruited retrospectively. Patellar OCF was fixed with an absorbable suture in an unreported method. The medial patellofemoral ligament (MPFL) was repaired or reconstructed if necessary. The Lysholm and Kujala knee scoring systems were used to evaluate the knee function. Imaging examinations were used to confirm the fracture healing. RESULTS: The mean period of follow-up was 36 months. All patients recovered well postoperatively without symptomatic complications. The Lysholm score and the Kujala score improved significantly from 37.6 (SD =6.8) and 45.9 (SD =6.4) preoperatively to 80.9 (SD =7.4) and 89.4 (SD =6.8) postoperatively at the latest follow-up, respectively. Imaging evidence including X-ray and MRI revealed good healing of the OCFs. CONCLUSIONS: This study showed satisfactory mid-term outcomes of OCF fixation using absorbable suture, which supports this method's potential to be a novel surgical method in the treatment of patellar OCF caused by a patellar dislocation.

High serum level of haptoglobin is associated with the response of 12 weeks methotrexate therapy in recent-onset rheumatoid arthritis patients.

BACKGROUND: We previously found, using microarray, haptoglobin (HP) expression signal was 5.1-fold increased in peripheral blood mononuclear cells (PBMCs) from methotrexate (MTX)-resistant rheumatoid arthritis (RA) patients. OBJECTIVES: To investigate whether serum levels of HP are associated with the response of 12 weeks MTX therapy in recent-onset RA patients. METHODS: Sixty-nine active RA patients with recent onset (< 24 months) were treated with MTX. Clinical variables, levels of HP messenger RNA (mRNA) in PBMCs and HP serum levels were tested at week 0 and week 12. RESULTS: After 12 weeks of MTX treatment, 34.7% of RA patients were categorized as responders according to European League Against Rheumatism (EULAR) response criteria (Week 12 Disease Activity Score of 28 joints [DAS-28] ≤ 3.2 and decrease > 1.2) and all others (65.2%) were defined as non-responders. The baseline HP mRNA in PBMCs from non-responders is significantly higher than those in responders (P < 0.05). Similar to mRNA expression, non-responders showed significantly elevated serum HP levels at baseline (369.9 ± 159.8 mg/dL) compared to those in responders (255.3 ± 143.9 mg/dL) (P = 0.01). Serum HP levels were decreased significantly from 255.3 ± 143.9 mg/dL at baseline to 186.4 ± 108.5 mg/dL at week 12 (P = 0.04) in responders, but remained at high levels in non-responders. CONCLUSIONS: High serum levels of HP at baseline are associated with inadequate response of 12 weeks MTX treatment in recent-onset RA patients. Further replication studies in larger samples are needed to validate HP as a potential predictive biomarker for response to MTX therapy in RA.

IL-29 enhances Toll-like receptor-mediated IL-6 and IL-8 production by the synovial fibroblasts from rheumatoid arthritis patients.

INTRODUCTION: We previously reported that IL-29, a newly described member of interferon (IFN) family, was overexpressed in blood and synovium of rheumatoid arthritis (RA) patients and triggered proinflammatory cytokine IL-6 and IL-8 mRNA expression in RA synovial fibroblasts (RA-FLS). This suggests that IL-29 has an important role in synovial inflammation. Toll-like receptors (TLRs) also activate RA-FLS to produce inflammatory mediators including tumor necrosis factor α (TNF-α) and IL-1ß in RA-FLS. Since the TLR family plays an early role in the innate immune response and the subsequent induction of the adaptive immune response, we hypothesize that IL-29 interacts with TLRs in RA inflammation. This study aimed to investigate the effect of IL-29 on TLR-mediated proinflammatory cytokine production in RA-FLS. METHODS: The mRNA level of IL-29 receptors (IL-28Rα and IL-10R2) in RA-FLS was determined by semi-quantitative RT- PCR. IL-6 and IL-8 mRNA expressions in RA-FLS were evaluated by real-time PCR after pre-incubation with IL-29 and subsequent stimulation with peptidoglycan (PGN, TLR2 ligand), or polycytidylic acid (poly(I:C), TLR3 ligand), or lipopolysaccharide (LPS, TLR4 ligand) . The production of TLR2, 3, and 4 in RA-FLS after IL-29 stimulation was also assessed by real-time PCR and flow cytometry. IL-29 mRNA and protein expression in RA-FLS after stimulation with PGN, poly(I:C), or LPS were measured by real-time PCR and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: The IL-29 receptor complex (IL-28Rα and IL-10R2) was identified in RA-FLS. IL-29 enhanced TLR-mediated IL-6 and IL-8 expression in RA-FLS. IL-29 upregulated expression of TLR2, 3 and 4 in RA-FLS. Exposure to PGN, poly(I:C) or LPS triggered IL-29 production by RA-FLS. CONCLUSIONS: We show for the first time that IL-29 enhances TLR-induced proinflammatory cytokine production in RA-FLS via upregulation of TLRs.

Interleukin-29 modulates proinflammatory cytokine production in synovial inflammation of rheumatoid arthritis.

INTRODUCTION: The immunoregulatory function of interleukin (IL)-29 has recently been recognized. However, little is known about the involvement of IL-29 in the pathogenesis of rheumatoid arthritis (RA). This study aimed to examine the expression profiles of IL-29 in blood, synovial fluid (SF) and synovium in RA patients and investigate the effect of IL-29 on cytokines production in RA synovial fibroblasts. METHODS: The transcript levels of IL-29 and its specific receptor IL-28Rα in peripheral blood mononuclear cells (PBMC) and synovium were determined by real-time reverse transcription-polymerase chain reaction (real-time PCR). The concentrations of IL-29 in serum and synovial fluid (SF) were quantified by enzyme-linked immunoassay (ELISA), and the correlation of serum IL-29 levels with disease activity in RA patients was investigated. Furthermore, the expression of IL-29 in RA synovium was examined by immunohistochemistry and double immunofluorescence analysis. Finally, the expression of IL-6, IL-8, IL-10, IL-17 and matrix metalloproteinase-3 (MMP-3) in synovial fibroblasts upon IL-29 stimulation was determined by real-time PCR. RESULTS: IL-29 and IL-28Rα mRNA expression in PBMC was significantly increased in patients with RA compared with healthy controls (HC). The serum levels of circulating IL-29 were higher in RA than those in HC. Increased IL-29 levels were detected in RA SF when compared with osteoarthritis (OA) SF. However, serum IL-29 levels showed no significant correlation with RA disease activity. IL-29 was mostly expressed in the lining region of RA synovium. Moreover, IL-29 was expressed predominately in synovial macrophages and fibroblasts. RA synovial fibroblasts exposed to IL-29 specifically upregulated IL-6, -8 and MMP-3 but downregulated IL-10. CONCLUSIONS: The findings in the present study indicate, for the first time, that IL-29 is dysregulated in patients with RA, which may contribute to the RA pathogenesis via inducing the production of proinflammatory cytokines, chemokines or matrix metalloproteinases in synovial fibroblasts.

[Effects of zuogui pill on the gene expressions of Type- II collagen and proteoglycan during the differentiation of mesenchymal stem cells towards chondrocytes].

OBJECTIVE: To study the effects of zuogui pill (ZP) contained serum on the gene expressions of type-II collagen and proteoglycan during the differentiation of mesenchymal stem cells (MSCs) towards chondrocytes. METHODS: MSCs isolated from rat bone marrow were in vitro induced differentiation towards chondrocytes and stimulated with high- (57 g/kg), middle- (28.5 g/kg), and low-dose (9.5 g/kg) ZP contained serums and serum of blank rats. The proliferation of MSCs was analyzed by CCK-8 method. The 3rd-passage MSCs were divided into the blank control group (by adding serum of the blank group rats), the induction control group (by adding the induction fluid and serum of the blank group rats), and the ZP contained serum group (by adding the induction fluid and middle-dose ZP contained serum). The expressions of type-II collagen and proteoglycan were determined using reverse transcriptase PCR, Real-time PCR, and immunohistochemistry. RESULTS: Compared with the blank control group, the proliferation of MSCs could be promoted by ZP contained serum at different doses (P < 0.05), with the most obvious effect shown in the middle-dose ZP contained serum group (P < 0.05). The mRNA and protein expressions of type-II collagen could be identified in the induction control group and the ZP contained serum group on the 21st day of the induction. Of them, the mRNA expression of type-II collagen in ZP contained serum groups was obviously higher than that of the induction control group. Results of Real-time PCR showed that on the 21st day of the induction, the mRNA expression quantitation of proteoglycan in ZP contained serum groups was about 16-fold and 3-fold of the levels on the 7th day and the 14th day (P < 0.05), obviously higher than those of the induction control group (P < 0.05). CONCLUSION: ZP contained serum could induce MSCs proliferation, the gene expressions of type- II collagen and proteoglycan, which might be one of its molecular bases for protecting the cartilage.

Altered expression of signaling genes in Jurkat cells upon FTY720 induced apoptosis.

FTY720, a novel immunosuppressant, has a marked activity in decreasing peripheral blood T lymphocytes upon oral administration. Recent investigations suggest that the action of FTY720 on lymphocytes may result from its ability to induce cell apoptosis. However, the cell signaling mechanism involved in the FTY720-induced cell apoptosis remains unclear. Here we examined the apoptotic signal pathways mediated by FTY720 in Jurkat cells using microarray analysis. The results showed that FTY720 can induce Jurkat cell apoptosis in a dose and time dependent manner as assessed by cell viability, Hoechst 33258 staining, Annexin V binding and DNA fragmentation tests. cDNA microarray analysis showed that 10 µM of FTY720 up-regulated 54 and down-regulated 10 genes in Jurkat cells among the 458 apoptotic genes examined following the 6 h incubation period. At least five-fold increased expression of modulator of apoptosis-1 (MOAP-1), vascular endothelial growth factor (VEGF), tumor necrosis factor receptor-associated factors (TRAF 6), Caspase 2 (CASP 2), E2F transcription factor 1 (E2F 1) and Casapse 5 (CASP 5) genes was observed in microarray analyses; these results were confirmed with reverse transcription polymerase chain reaction (RT-PCR) examination. Our findings suggest that the mitochondria related signaling pathways are the key pathways involved in the FTY720-induced apoptosis in Jurkat cells. And our results provide a new insight into the mechanism of FTY720, which allows us to draw the first simple diagram showing the potential pathways mediated by FTY720.

High adiponectin and adiponectin receptor 1 expression in synovial fluids and synovial tissues of patients with rheumatoid arthritis.

OBJECTIVES: The major objectives of this article are first to measure the levels of expression of adiponectin and its 2 receptors (adipoR1 and adipoR2) in the peripheral blood mononuclear cells and in the synovial compartment of rheumatoid arthritis (RA) patients, and second, to assess their pro-inflammatory potential. Osteoarthritis patients and healthy subjects served as controls. METHODS: Expression of adiponectin, adipoR1, and adipoR2 were assayed by real-time polymerase chain reaction, enzyme-linked immunosorbent assay, and immunohistology. The potential pro-inflammatory activity of adiponectin was studied by adding recombinant adiponectin to cultures of synovial fibroblasts. RESULTS: Immunohistology showed that numerous cells in the synovial biopsies of RA expressed adiponectin, adipoR1, and adipoR2. The synovial fibroblasts were distinctly rich in adiponectin. As expected, high adiponectin levels were present in the synovial fluids. In contrast to the synovial compartment, in peripheral blood mononuclear cells, only adipoR1 exceeded those of osteoarthritis and healthy subjects. When recombinant adiponectin was added to cultures of synovial fibroblasts, it induced up to 8.1- and 11.4-fold increase in the release of monocyte chemoattractant protein-1 and interleukin-6. CONCLUSIONS: The adiponectin adipokine axis might play a role in RA.

Proteomic analysis of human articular cartilage: identification of differentially expressed proteins in knee osteoarthritis.

OBJECTIVES: The mechanisms underlying the development of age related osteoarthritis (OA) remain unclear. To better understand the pathogenesis of OA and the molecular basis of progressive destruction of articular cartilage in OA, we compared the proteome of OA cartilage with that of normal cartilage. METHODS: After removal of proteoglycans and collagens, proteins extracted from either normal or OA knee joint cartilage were separated by two-dimensional gel electrophoresis (2-DE). The differentially expressed proteins in OA cartilage were chosen to be further identified by linear ion trap-Fourier transform ion cyclotron resonance mass spectrometry (LTQ-FT/MS). RESULTS: A total of 1436+/-49 or 1472+/-7 protein spots were resolved by 2-DE of normal or OA cartilage extractions, respectively. Sixteen spots from OA cartilage samples were found to have statistically significant changes in the amount of protein compared with normal samples. Of 16 spots, the identities of 14 proteins were unambiguously determined by LTQ-FT/MS. These OA associated proteins fell into five groups, including glycolysis and energy production (ADH, ADK, ENOA, KPYM and FR), signaling (ANNX-I, PEBP and TUB), Redox (PRDX3 and SODM), and cartilage matrix (COLL-I and COLL-VI). Interestingly, two novel RING (Really Interesting New Gene) domain-containing proteins, RF, Zn-RF, were identified, suggesting novel pathways of cartilage protein regulation. CONCLUSIONS: This study shows that 2-DE followed by LTQ-FT/MS can be successfully used to characterize the proteome of cartilage without in vitro culturing which could obfuscate physiological differences. The definition of unique OA-associated proteins described here provides significant mechanistic insights into OA by corroborating previously suggested mechanisms and by defining unique players with roles yet to be defined in disease pathogenesis.

Reduction of CD4 positive T cells and improvement of pathological changes of collagen-induced arthritis by FTY720.

FTY720 belongs to a new class of immunosuppressants. Little is known about its influence on T cell subtypes and pathological changes in arthritis. Here we illustrated the effect of FTY720 on peripheral T cell subsets and joint damage of collagen-induced arthritis rats. Rats were administered FTY720 or prednisone daily from day 0 to day 28. Body weight, hind paw swelling and arthritis index were measured. Bone destruction was determined by micro-computed tomography and histopathology, and T cell subsets were analyzed by flow cytometry and immunohistochemistry. The results showed that FTY720 inhibited the development of arthritis. Radiological analysis revealed that FTY720 treated collagen-induced arthritic rats had much less joint damage in comparison to untreated collagen-induced arthritic rats. Histological study showed that collagen-induced arthritic rats suffered from inflammatory cell infiltration and synovial hyperplasia in their joints, and FTY720 treatment clearly reduced these pathological changes. Immunohistochemical analysis showed that FTY720 treatment significantly decreased the number of CD4(+) T cells in the synovium of collagen-induced arthritic rats. Collagen-induced arthritic rats appeared to have more CD4(+), but not CD8(+) T cells in their peripheral blood than normal control rats. Following FTY720 treatment, peripheral blood CD3(+) and CD4(+) T cells in collagen-induced arthritic rats were significantly decreased. In conclusion, FTY720 is an effective compound in the treatment of collagen-induced arthritic rats and in reducing CD4(+) T cells in collagen-induced arthritic rats.