Macrophage Activation Syndrome Presented in a Case of Neonatal Lupus

Macrophage activation syndrome (MAS) is a potentially life-threatening complication in many autoimmune diseases. Early recognition and intervention are essential for a favorable outcome. Neonatal lupus, an acquired autoimmune disease in neonates caused by the transplacental passage of maternal autoantibodies, is rare and usually self-limited. Herein, we report a case of MAS in a patient with neonatal lupus, which improved with intravenous immunoglobulin.

Macrophage Activation Syndrome Presented in a Case of Neonatal Lupus

Macrophage activation syndrome (MAS) is a potentially life-threatening complication in many autoimmune diseases. Early recognition and intervention are essential for a favorable outcome. Neonatal lupus, an acquired autoimmune disease in neonates caused by the transplacental passage of maternal autoantibodies, is rare and usually self-limited. Herein, we report a case of MAS in a patient with neonatal lupus, which improved with intravenous immunoglobulin.

Interleukin-17 Enhances Germinal Center Formation and Immunoglobulin G1 Production in Mice

OBJECTIVE: Interleukin (IL)-17 is a pro-inflammatory cytokine that has pleiotropic effects on multiple target cells and thereby contributes to the development of immune-mediated inflammatory disorders. However, the role of IL-17 in the humoral immune response has not been clearly elucidated. METHODS: Mice deficient in IL-17A (IL-17A knockout [KO] mice) and wild type (WT) C57BL/6 mice were compared. Distinct B cell (mature/precursor and marginal zone/follicular) and plasma cell populations were compared using fluorescence-activated cell sorting (FACS) and confocal immunostaining. Immunoglobulin production was assessed by enzyme-linked immunosorbent assay. RESULTS: There was no difference in B cell and plasma cell populations between IL-17A KO and WT mice. However, after T cell-dependent antigen challenge, IL-17A KO mice produced lower levels of immunoglobulin (Ig)G1 than wild-type animals. IL-17A KO mice also showed reduced germinal center (GC) formation and lower expression of activation-induced cytidine deaminase, the essential enzyme for class switch recombination (CSR). IL-17 had no effect on the proliferation or survival of naïve B cells in in vitro functional studies. However, IL-17 treatment promoted naïve B cell differentiation into plasma cells in synergy with IL-4, although IL-17 alone had no effect. CONCLUSION: Our findings suggest that IL-17 contributes to the humoral immune response by enhancing GC formation, CSR to IgG1, and plasma cell differentiation in synergy with IL-4.

Correlation between Operation Result and Patient Satisfaction of Nasal Bone Fracture

BACKGROUND: Many authors have evaluated the post-reduction result of nasal bone fracture through patient satisfaction or postoperative complications. However, these results are limited because they are subjective. The aim of this study was to correlate an objective operation result with patient satisfaction and postoperative complications according to the type of nasal bone fractures. METHODS: Our study included 313 patients who had isolated nasal bone fractures and had undergone a closed reduction. Postoperative outcomes were evaluated objectively using computed tomographic (CT) images, while patient satisfaction was evaluated one month after the operation. The correlation of the operation result with patient satisfaction was then evaluated. RESULTS: The correlation between the operation result and patient satisfaction was highest for the lateral impact group type I (LI) type of fracture and lowest for the comminuted fracture group (C) type of fracture. However, there were no statistically significant differences in correlation between the overall result and patient satisfaction by fracture type. The complication rate of lateral impact group type II (LII), C, and frontal impact group type I (FI) fractures were statistically significantly higher than that of frontal impact group type II (FII) and LI fractures. There were no statistically significant relationships between the prevalence of complications and septal fracture or deviation according to the fracture type. In the total group, however, there was a statistically significant difference in complication rate by septal fracture. CONCLUSION: We found that the CT outcomes correlated with patient satisfaction. The complication rate of LII, C, and FI fractures were statistically significantly higher than that of FII and LI fractures. Septal fracture/deviation increased the postoperative complication in the total group.

Objective Outcomes of Closed Reduction According to the Type of Nasal Bone Fracture

BACKGROUND: Nasal fractures have a tendency of resulting in structural or functional complications, and the results can vary according to the type of nasal bone fracture. The aim of this study was to evaluate the objective postoperative results according to the type of nasal bone fractures. METHODS: We reviewed 313 patients who had a closed reduction of nasal bone fracture. The classification of nasal bone fracture by Stranc and Robertson was used to characterize the fracture type: frontal impact group type I (FI), frontal impact group type II (FII), lateral impact group type I (LI), lateral impact group type II (LII), and comminuted fracture group (C). For each patient, we tried to use the same axial image section of computed tomographic (CT) scans before and immediately after operation. Postoperative outcomes were classified into 4 grades: excellent (E), good (G), fair (F), and poor (P). We also analyzed postoperative complications by fracture type. RESULTS: Regarding the postoperative CT images, 189 subjects showed E results, 99 subjects showed G, 18 subjects showed F, and 7 subjects showed P reduction. The rate of operation results graded as E by each fracture type was 66.67% in FI, 52.0% in FII, 64.21% in LI, 62.79% in LII, and 21.74% in C. Complications of FI (7.14%), LII (13.95%), and C (13.04%) groups occurred more than in the FII (4.00%) and LI (4.21%) groups. CONCLUSION: It seems that the operation result by fracture type was better in the FI, LI, and LII type than the FII and C type; after one month, however, LII type showed more complications than other types. The septal fracture can be thought to affect early reduction results in nasal bone fractures.

Acute Horseshoe Abscess of the Hand after Local Steroid Injection: A Case Report

The differential diagnosis of hand infections is difficult because hand infections can manifest with variable clinical presentations due to the unique anatomic structures of the hand, and the significance of these infections is often overlooked. A horseshoe abscess is a rare type of deep space infection that can occur due to extension of infection through communications between the deep spaces of the hand. Although horseshoe abscesses are well known due to their anatomic characteristics, there are few clinical reports of such occurrences. Such a case has not been reported in the Korean literature. Here we report a case of horseshoe abscess of the hand after local steroid injection.

Clear Cell Chondrosarcoma of the Tibia Diaphysis: A Case Report / 대한골관절종양학회지

Clear cell chondrosarcoma is a very rare malignant bone tumor that shows a strong predilection for the epiphysis or metaphysis of long bones. Many studies have reported that the proximal end of the femur is the most commonly affected site, followed by the proximal end of the humerus. Histopathologically, tumor cells of this type have centrally located round nucleoli with clear cytoplasm and a distinct cytoplasmic membrane. Generally, clear cell chondrosarcomas is not confused with conventional chondrosarcomas. However, when it involves the diaphysis in long bones, diagnosis can be hindered, as only three reports of this exist in the literature. We report herein an unusual case of clear cell chondrosarcoma of the tibial diaphysis in a 42-year-old male.

In vivo action of IL-27: reciprocal regulation of Th17 and Treg cells in collagen-induced arthritis

Interleukin (IL)-27 is a novel cytokine of the IL-6/IL-12 family that has been reported to be involved in the pathogenesis of autoimmune diseases and has a pivotal role as both a pro- and anti-inflammatory cytokine. We investigated the in vivo effects of IL-27 on arthritis severity in a murine collagen-induced arthritis (CIA) model and its mechanism of action regarding control of regulatory T (Tregs) and IL-17-producing T helper 17 (Th17) cells. IL-27-Fc-treated CIA mice showed a lower severity of arthritis. IL-17 expression in the spleens was significantly decreased in IL-27-Fc-treated CIA mice compared with that in the CIA model. The Th17 population was decreased in the spleens of IL-27-Fc-treated CIA mice, whereas the CD4+CD25+Foxp3+ Treg population increased. In vitro studies revealed that IL-27 inhibited IL-17 production in murine CD4+ T cells, and the effect was associated with retinoic acid-related orphan receptor gammaT and signal transducer and activator of transcription 3 inhibition. In contrast, fluorescein isothiocyanate-labeled forkhead box P3 (Foxp3) and IL-10 were profoundly augmented by IL-27 treatment. Regarding the suppressive capacity of Treg cells, the proportions of CTLA-4+ (cytotoxic T-lymphocyte antigen 4), PD-1+ (programmed cell death protein 1) and GITR+ (glucocorticoid-induced tumor necrosis factor receptor) Tregs increased in the spleens of IL-27-Fc-treated CIA mice. Furthermore, in vitro differentiated Treg cells with IL-27 exerted a more suppressive capacity on T-cell proliferation. We found that IL-27 acts as a reciprocal regulator of the Th17 and Treg populations in CD4+ cells isolated from healthy human peripheral blood mononuclear cells (PBMCs), as well as from humans with rheumatoid arthritis (RA) PBMCs. Our study suggests that IL-27 has the potential to ameliorate overwhelming inflammation in patients with RA through a reciprocal regulation of Th17 and Treg cells.

Grape seed proanthocyanidin extract ameliorates monosodium iodoacetate-induced osteoarthritis

Osteoarthritis (OA) is an age-related joint disease that is characterized by degeneration of articular cartilage and chronic pain. Oxidative stress is considered one of the pathophysiological factors in the progression of OA. We investigated the effects of grape seed proanthocyanidin extract (GSPE), which is an antioxidant, on monosodium iodoacetate (MIA)-induced arthritis of the knee joint of rat, which is an animal model of human OA. GSPE (100 mg/kg or 300 mg/kg) or saline was given orally three times per week for 4 weeks after the MIA injection. Pain was measured using the paw withdrawal latency (PWL), the paw withdrawal threshold (PWT) and the hind limb weight bearing ability. Joint damage was assessed using histological and microscopic analysis and microcomputerized tomography. Matrix metalloproteinase-13 (MMP13) and nitrotyrosine were detected using immunohistochemistry. Administration of GSPE to the MIA-treated rats significantly increased the PWL and PWT and this resulted in recovery of hind paw weight distribution (P < 0.05). GSPE reduced the loss of chondrocytes and proteoglycan, the production of MMP13, nitrotyrosine and IL-1beta and the formation of osteophytes, and it reduced the number of subchondral bone fractures in the MIA-treated rats. These results indicate that GSPE is antinociceptive and it is protective against joint damage in the MIA-treated rat model of OA. GSPE could open up novel avenues for the treatment of OA.

Grape seed proanthocyanidin extract ameliorates monosodium iodoacetate-induced osteoarthritis

Osteoarthritis (OA) is an age-related joint disease that is characterized by degeneration of articular cartilage and chronic pain. Oxidative stress is considered one of the pathophysiological factors in the progression of OA. We investigated the effects of grape seed proanthocyanidin extract (GSPE), which is an antioxidant, on monosodium iodoacetate (MIA)-induced arthritis of the knee joint of rat, which is an animal model of human OA. GSPE (100 mg/kg or 300 mg/kg) or saline was given orally three times per week for 4 weeks after the MIA injection. Pain was measured using the paw withdrawal latency (PWL), the paw withdrawal threshold (PWT) and the hind limb weight bearing ability. Joint damage was assessed using histological and microscopic analysis and microcomputerized tomography. Matrix metalloproteinase-13 (MMP13) and nitrotyrosine were detected using immunohistochemistry. Administration of GSPE to the MIA-treated rats significantly increased the PWL and PWT and this resulted in recovery of hind paw weight distribution (P < 0.05). GSPE reduced the loss of chondrocytes and proteoglycan, the production of MMP13, nitrotyrosine and IL-1beta and the formation of osteophytes, and it reduced the number of subchondral bone fractures in the MIA-treated rats. These results indicate that GSPE is antinociceptive and it is protective against joint damage in the MIA-treated rat model of OA. GSPE could open up novel avenues for the treatment of OA.

IL-23 P19 Expression Induced by IL-17 and IL-1beta in Rheumatoid Arthritis Synovial Mononuclear Cells

Interleukin-23 (IL-23) is a novel pro-inflammatory cytokine which has been implicated to play a pathogenic role in rheumatoid arthritis (RA). This study was undertaken to investigate the IL-23 inductive activity of the proinflammatory cytokine IL-17, IL-1 beta and tumor necrosis factor (TNF-alpha) in RA synovial fluid mononuclear cells (SFMC). Expression of IL-23p19, IL-17, IL-1 beta and TNF-alpha in joint was examined by immunohistochemistry (IHC) of patients with RA and osteoarthritis (OA). The effects of IL-17 and IL-1 beta on expression of IL-23p19 in human SFMC from RA patients were determined by reverse transcriptase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). IL-23p19 was expressed in the RA fibroblast like synoviocyte (FLS), but not from OA FLS. Similar to the protein expression, IL-23p19 mRNA could be detected by RT-PCR in RA SFMC. IL-17 and IL-1 beta could induce RA SFMC to produce the IL-23p19. The effects of IL-17 were much stronger than IL-1 beta or TNF-alpha. These responses were observed in a dose- responsive manner. In addition, IL-17 or IL-1 beta neutralizing antibody down-regulated the expression of IL-23p19 induced by LPS in RA-SFMC. Our results demonstrate that IL-23p19 is overexpressed in RA synovium and IL-17 and IL-1 beta appears to upregulate the expression of IL-23p19 in RA-SFMC.

IL-23 P19 Expression Induced by IL-17 and IL-1beta in Rheumatoid Arthritis Synovial Mononuclear Cells

Interleukin-23 (IL-23) is a novel pro-inflammatory cytokine which has been implicated to play a pathogenic role in rheumatoid arthritis (RA). This study was undertaken to investigate the IL-23 inductive activity of the proinflammatory cytokine IL-17, IL-1 beta and tumor necrosis factor (TNF-alpha) in RA synovial fluid mononuclear cells (SFMC). Expression of IL-23p19, IL-17, IL-1 beta and TNF-alpha in joint was examined by immunohistochemistry (IHC) of patients with RA and osteoarthritis (OA). The effects of IL-17 and IL-1 beta on expression of IL-23p19 in human SFMC from RA patients were determined by reverse transcriptase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). IL-23p19 was expressed in the RA fibroblast like synoviocyte (FLS), but not from OA FLS. Similar to the protein expression, IL-23p19 mRNA could be detected by RT-PCR in RA SFMC. IL-17 and IL-1 beta could induce RA SFMC to produce the IL-23p19. The effects of IL-17 were much stronger than IL-1 beta or TNF-alpha. These responses were observed in a dose- responsive manner. In addition, IL-17 or IL-1 beta neutralizing antibody down-regulated the expression of IL-23p19 induced by LPS in RA-SFMC. Our results demonstrate that IL-23p19 is overexpressed in RA synovium and IL-17 and IL-1 beta appears to upregulate the expression of IL-23p19 in RA-SFMC.