Correlation Between Patterns of Bone Marrow Edema and Their Associated Soft-Tissue Injuries, as seen on Magnetic Resonance Imaging of Knee joint in Patients with a Recent History of Trauma

Introduction: Bone bruise or bone marrow edema is a common innocuous finding in magnetic resonance imaging (MRI) knee ofpatients with trauma. The pattern of bone marrow edema provides insight into the mechanism of injury which, in turn, helps to evaluatethe injuries with a more discerning eye. Five basic mechanisms of knee injury which are commonly seen in MRI scan of knee traumapatients are pivot shift, dashboard injury, hyperextension, clip injury, and lateral patellar dislocation. Each of these mechanisms causescharacteristic bone marrow edema patterns and has associated soft-tissue injuries, following the musculoskeletal biomechanics.Aim: The purpose of this study is to assess the correlation between bone marrow edema patterns and associated soft-tissue injuries.Settings and Design: This is a cross-sectional study of 200 patients conducted at the Department of Radiodiagnosis andImaging, MGM Medical College and Associated Hospitals, Indore.Materials and Methods: MRI of 200 cases of recent knee injury was analyzed to determine bone marrow edema pattern. Thepattern of edema and soft-tissue injuries was plotted and analyzed to see a significant correlation.Statistical Analysis Used: Variables were expressed as percentages and comparison was done by Chi-square analysis. Twotailed P < 0.05 was considered statistically significant.Results: Significant correlation was seen between pivot shift injury and anterior cruciate ligament (ACL) tear, pivot shift injury andmedial meniscus tear, dashboard injury and posterior cruciate ligament (PCL) tear, lateral patellar dislocation and medial patellofemoralligament (MPFL) tear, and clip injury and medial collateral ligament (MCL) tear. Pivot shift was the most common bone marrowedema pattern, accounting for 55.5% of cases and hyperextension was the least common pattern, seen in only 3% of cases.Conclusion: The pattern of bone marrow edema can provide a road map to associated soft-tissue injuries which assist in finerevaluation and can help in creating better patient management outcomes.

Altered Tregs and oxidative stress in pregnancy associated lupus

Abstract Aim SLE is a systemic autoimmune disease generally affecting woman in the reproductive age. It is associated with an altered level of Tregs and oxidative stress while an increase in Tregs, and different antioxidant mechanisms to combat oxidative stress are essential for successful pregnancy. Hence, this study aims to determine the level of CD4+ and CD8+ Tregs and oxidative stress in pregnant lupus patients. Methods Ten healthy and 10 pregnant lupus volunteers from the North Indian population, within the age group of 20-30 years were enrolled in the study. All the patients were non-smokers, non-alcoholics and were not associated or undergoing therapy for any other disease. They had a SLEDAI of 37.4 ± 7.32 with 5.2 ± 1.93 years of disease duration. Oxidative stress was determined by measuring the enzyme activity of anti-oxidant enzymes (catalase, superoxide dismutase and glutathione peroxidase) and the level of reduced glutathione and lipids peroxidised, spectrophotometrically. Flowcytometry was performed for immunophenotyping to determine CD8+ and CD4+ Tregs. Results Elevated CD8+ Tregs and diminished CD4+ Tregs were observed in pregnant lupus patients. Oxidative stress was significantly increased as the activities of anti-oxidant enzymes and level of reduced glutathione was considerably diminished. There was a substantial increase in the amount of lipids peroxidised. Conclusion Pregnant lupus patients undergo considerable level of oxidative stress in comparison to healthy pregnant woman. The decreased level of CD4+ Tregs and an increase in CD8+ Tregs might be another important factor responsible for pregnancy associated complications. Hence, lupus leads to alterations in the necessary conditions for a successful pregnancy, which might eventually cause higher mortality, morbidity and associated complications.

Inflammatory cytokine levels in induced sputum and bronchoalveolar lavage fluid in pulmonary sarcoidosis.

BACKGROUND: The immune inflammatory process in patients with sarcoidosis is not only compartmentalized within the alveolar walls, but also involves the bronchial airways. Analysis of induced sputum has been used as a non-invasive tool for investigating the airways and may reflect the endobronchial and parenchymal inflammation in patients with sarcoidosis. This present study was designed to measure the soluble pro-inflammatory cytokine levels interleukin-1 (IL-1), interleukin-6 (IL-6), tumuor necrosis factor-alpha (TNF-alpha) and percentage of macrophages expressing these cytokines in induced sputum and bronchoalveolar lavage (BAL) fluid in patients with pulmonary sarcoidosis. METHODS: Sputum induction and BAL was carried out in 27 patients with newly diagnosed sarcoidosis. Control group consisted of six patients with a normal chest radiograph (three patients with carcinoma esophagus and three patients with doubtful history of hemoptysis). Induced sputum was also obtained from 10 non-smoking, non-atopic healthy controls. RESULTS: Percentage of macrophages expressing pro-inflammatory cytokines and soluble cytokine levels in induced sputum were higher in patients with sarcoidosis compared to both groups of controls. There was good correlation between IL-6 and TNF-alpha levels (r = 0.49, 0.58 p < 0.05) and percentage of macrophages expressing all three cytokines (r = 0.56-0.71, p < 0.01) between induced sputum and BAL fluid. Mild positive correlation between cytokine levels in sputum and age was also noted (r = 0.33-0.38, p < 0.05). CONCLUSIONS: Induced sputum may reflect changes in cytokine milieu in BAL in sarcoidosis.