Synovium and blood capillaries at the femoral attachment of anterior cruciate ligament are significantly abundant than those at the tibial attachment / Sinovial y capilares sanguíneos en la inserción femoral del ligamento cruzado anterior son significativamente más abundantes que los de la inserción tibial

SUMMARY: The anterior cruciate ligament (ACL) is a ligament that mainly controls the anterior and rotational mobility of the knee joint, and its surface is covered by a synovial membrane with large number of blood vessels. In general, nutritional supply to the ligament is from many capillaries in the adjacent synovium. However, statistical studies of the capillaries distributed to the ACL are insufficient. In this study, we examined cross-sectional histological images of the femoral attachment (femoral level), middle level of the tendon (middle level), and tibial attachment (tibial level) of the ACL and statistically analyzed blood capillary distribution among the three levels. The ACLs of 10 cadavers were divided into 5 equal sections, and 4mm-thick paraffin sections were made at the femoral level, middle level, and tibial level, and then hematoxylin-eosin (HE) staining were performed. The area of each transverse section was measured using Image-J 1.51n (U. S. National Institutes of Health, Bethesda, MD, USA). Fiber bundles of the ACL were relatively small and sparse in cross-sectional area at the femoral level and became larger and denser toward the tibial level. Many blood levels. The synovium at the attachment of ACL covered the surface of the fiber bundle and also penetrated deeply between the fiber bundles. In particular, the blood capillaries were densely distributed in the synovium at the femoral attachment rather than another two levels. Indeed, the number of capillaries were also most abundant in the femoral level. The cross-sectional ACL area at the femoral level is significantly small, however, the blood capillaries were most abundant. Therefore, when the ACL is injured, its reconstruction with preservation of the femoral ligamentous remnant may be clinically useful for remodeling of the grafted tendon.

El ligamento cruzado anterior (LCA) es un ligamento que controla principalmente la movilidad anterior y rotacional de la articulación de la rodilla, y su superficie está cubierta por una membrana sinovial con gran cantidad de vasos sanguíneos. En general, el suministro de nutrientes al ligamento proviene de muchos capilares en la sinovial adyacente. Sin embargo, los estudios estadísticos de los capilares distribuidos en el LCA son insuficientes. En este estudio, examinamos imágenes histológicas trans- versales de la inserción femoral (nivel femoral), el nivel medio del tendón (nivel medio) y la inserción tibial (nivel tibial) del LCA y analizamos estadísticamente la distribución de los capilares sanguíneos entre los tres niveles. Los LCA de 10 cadáveres se dividieron en 5 secciones iguales y se realizaron cortes en parafina de 4 µm de espesor a nivel femoral, medio y tibial, y luego se realizó tinción con hematoxilina-eosina (HE). El área de cada sección transversal se midió utilizando Image-J 1.51n (Institutos Nacionales de Salud de EE. UU., Bethesda, MD, EE. UU.). Los haces de fibras del LCA eran relativamente pequeños y escasos en el área de la sección transversal a nivel femoral y se hicieron más grandes y más densos hacia el nivel tibial. La membrana sinovial en la unión del LCA cubría la superficie del haz de fibras y también penetraba profundamente entre entre los haces de fibras. En particular, los capilares sanguíneos estaban densamente distribuidos en la unión femoral de la sinovial respecto a los otros dos niveles. De hecho, el número de capilares también fue más abundante a nivel femoral. El área transversal del LCA a nivel femoral era significativamente pequeña, sin embargo, los capilares sanguíneos fueron los más abundantes. Por lo tanto, cuando hay una lesión del LCA su reconstrucción con preservación del ligamento femoral remanente puede ser clínicamente útil para remodelar el tendón injertado.

MicroRNA-204/-211 deficiency aggravates synovial hyperplasia and inflammation in DMM-induced OA mice / 中国药理学通报

Aim To observe the effects of microRNA-204/-211 deficiency on osteoarthritis(OA) induced by medial meniscus amputation (DMM) in mice. Methods 12 C57BL/6J wild-type (WT) mice were randomly divided into sham operation groups and DMM groups, namely WT-control group and WT + DMM group. And twelve microRNA-204/-211 gene knockout (miR-204/-211-dKO) mice were randomly divided into sham operation groups and DMM groups, namely dKO group, and dKO + DMM group. The pain sensitivity of mice was measured by the von Frey test before sacrificing. Three months after the operation, the mice were sacrificed. The knee joints and dorsal root ganglion (DRG) were taken for detection. The subchondral bone structure was detected by micro-CT. Sections of knee joint tissue were stained with toluidine blue, PCNA, type Ⅱ collagen and immunohistochemistry. DRG tissues were detected for related pain factors and inflammatory factors by RT-qPCR. Results Compared with the mice in the WT-Control group, mice in the WT + DMM group showed typical OA symptoms such as osteophyte formation, subchondral osteosclerosis, and decreased pain thresholds. The expression of collagen Ⅱ in cartilage significantly decreased, while the expression of MMP13 significantly increased. The expression of inflammatory and pain-related factors in DRG significantly increased. At the same time, the OA phenotypes of mice in dKO + DMM were more obvious than that of mice in the WT + DMM group, indicating that miR-204/-211 deficiency aggravated the OA induced by DMM in mice. In particular, DMM did not cause synovial hyperplasia and synovial inflammation in WT mice, which could not completely represent the pathological characteristics of OA patients in clinical practice. However, miR-204/-211 deficiency significantly promoted synovial hyperplasia and synovial inflammation of knee joints in DMM mice. Conclusions After DMM operation, miR-204/-211 deficient mice showed not only typical OA phenotypes such as osteophyte formation, subchondral osteosclerosis, cartilage destruction and lower pain threshold, but also synovial hyperplasia and synovitis, which could better represent the pathological characteristics of clinical OA patients. MiR-204/-211 deficient mice with DMM can be used as a new OA model and an ideal animal model for screening anti-OA drugs.

The proliferation promoting effect of eIF2α on fibroblasts of rheumatoid arthritis synovium / 中华风湿病学杂志

Objective:To observe the expression characteristics of eukaryotic translation initiation factor 2α(eIF2α), and analyze its proliferation regulation effect on fibroblasts of rheumatoid arthritis synovium.Methods:The synovial tissues were collected in patients with rheumatoid arthritis(RA)(40 cases) and osteoarthritis(OA)(40 cases). EIF2α and proliferating cell nuclear antigen(PCNA) were detected by immunohistochemistry method. Fibroblast cell line of rheumatoid arthritis synovium(MH7A) were cultured to establish si-eIF2α group(siRNA-eIF2α plasmid transfection), vector transfection group and blank control group in vitro. PCNA was detected by Western blot method, cell proliferation activity was detected by CCK-8 method. χ2 test was performed on count data, two-sample t-test was performed on quantitative data, one-way analysis of variance (ANOVA) was performed to compare the means of more than two groups, regression equation was calculated by correlation regression analysis. Results:The positive rate of eIF2α was significantly higher in RA synovial fibroblasts than that of OA [52.5%(21/4) vs 20.00%(8/20), χ2=9.14, P=0.003]. Positive correlation was found between eIF2α and PCNA in RA ( Y=0.366 X+2.220, P=0.001) . Compared with blank control group and vector transfection group, cell proliferation activity decreased significantly in si-eIF2α group of MH7A cell line at 72 h [(0.65±0.08) vs (0.96±0.12) vs (1.09±0.06), F=4.52, P=0.022] and 96 h [(1.13±0.14) vs (1.42±0.97) vs (1.56±0.12), F=9.87, P=0.001) , PCNA expression decreased significantly [(0.84±0.15) vs (1.32±0.18) vs (1.28±0.14), F=5.22, P=0.012) . Conclusion:High expression of eIF2α can promote the proliferation of fibroblasts of RA synovium.

Extra-articular Extra-synovial Solitary Osteochondromatosis of the Ankle

ABSTRACT Synovial chondromatosis or osteochondromatosis is a benign neoplastic condition arising from synovial tissue of joints, tendon sheath and bursa. The commonly involved joints are the knee, hip, shoulder, elbow and ankle. According to the author's knowledge, only four cases have been reported in the English literature, describing the extra-articular synovial chondro-matosis around the ankle joint. The peculiarity of the index case lies in its subtle clinical and radiological presentations which can create a diagnostic dilemma.

Molecular mechanism of icariin effects on articular chondrocytes, subchondral bone and synovium in the treatment of osteoarthritis / 中国组织工程研究

BACKGROUND: Icariin is the main effective component of Epimedium, which functions to tonify the kidney, and strengthen tendons and bones. In recent years, a large number of studies have found that icariin plays a significant role in the treatment of osteoarthritis. OBJECTIVE: To review the research progress in the molecular mechanism of icariin in the treatment of osteoarthritis. METHODS: The first author used “Icariin, Osteoarthritis, Cartilage, Subchondral bone, Synovial membrane, synovium, Inflammation" as search words in English and Chinese to search PubMed, CNKI, WanFang, and VIP databases. According to the inclusion criteria and exclusion criteria, 42 articles were included for final analysis. RESULTS AND CONCLUSION: Icariin can promote the cartilage differentiation of bone marrow mesenchymal stem cells and enhance the proliferation of cartilage cells and osteoblasts, to inhibit the degradation of cartilage extracellular matrix, reduce the activity of osteoclasts and alleviate synovial inflammation caused by inflammatory factors. It is an effective treatment for osteoporosis. However, the optimal effective dose and concentration safety of icariin still need a large number of experimental studies. Currently, most of the experiments are still in animal and tissue cell experiments. Numerous clinical studies are needed to continue to explore its specific mechanism in order to provide evidence-based medical evidence for icariin in the treatment of osteoarthritis.

A Comprehensive Review on Rheumatoid Arthritis

Rheumatoid arthritis is an enduring inflammatory disease that is categorized by bumping off the joint and rigidity, bone and cartilage devastation all above the joints. It is an autoimmune disease or disease caused by factors like smoking, obesity, etc. Cytokines are the main inducers for rheumatoid arthritis which produce interleukin 1β and interleukin 6 factors that cause the devastation of synovium and cartilage present at the joints. The deformation of skeletal muscles is observed in an arthritic patient. The present review is a discussion on rheumatoid arthritis that includes etiology, pathology and pathogenesis, signs and symptoms, clinical complications, diagnosis, treatment, therapy, certain patents and applications. The patents include the development of numerous novel techniques for the management of rheumatoid arthritis and diseases associated with rheumatoid arthritis. The targets to treat rheumatoid arthritis are interleukins, tumor necrosis factor-alpha, sialoprotein I and several other factors. Different biomarkers are used for different types of rheumatoid arthritis and the mechanism also varies. Certain marketed formulations were enlisted. Recent trends in the management of rheumatoid arthritis arethe main concern of this article

Effect of acupotomy therapy on the expression of bcl-2/bax in synovial tissue of collagen-induced arthritis rats / 中国组织工程研究

BACKGROUND: It has been shown that acupotomy therapy can improve the symptoms of rheumatoid arthritis, reduce the swelling of the joints, and improve the function of the damaged joints in clinical practice. However, the specific mechanism has not been reported in animal experiments. OBJECTIVE: To observe the effect of acupotomy therapy on the expression of Bcl-2 and Bax in synovial tissue of collagen-induced arthritis rats. METHODS: Forty rats were prepared for the experiment. Ten of them were randomly selected as normal controls, and the other 30 rats were used to manufacture collagen-induced arthritis models via secondary immunization. After the modeling, 20 successful models were randomly selected for subsequent experiments and randomly divided into a model group and an acupotomy group, with 10 in each group. Normal group and model group remain untreated. The medial and lateral patellofemoral ligament, the tibial and fibular collateral ligament, the midpoint of the upper margin of the patella and the midpoint of the patellar ligament around the left knee joint were selected as points of acupotomy treatment, two of which were selected for each acupotomy session. Rats in the acupotomy group were treated once a week for 3 continuous weeks. The general condition of experimental rats was monitored daily, thickness of the left posterior toe was measured and arthritis index was evaluated. Hematoxylin-eosin staining was executed to observe the pathological morphology of the synovial tissue. Real-time quantitative PCR and immunofluorescence staining were implemented to measure gene expression and immunofluorescence intensity of Bcl-2 and Bax in synovial tissue, respectively. The study protocol was approved by the Animal Ethic Committee of Hubei University of Traditional Chinese Medicine with an approval No. 00127518. RESULTS AND CONCLUSION: Compared with the normal group, the thickness of the left posterior toe and arthritis index score of the model group were significantly increased (P 0.05). The expressions of Bcl-2 mRNA and Bcl-2/Bax mRNA were significantly reduced in the acupotomy group compared with the model group (P < 0.01, P < 0.01). Immunofluorescence detection indicated that the fluorescence intensity of Bcl-2/Bax in the acupotomy group was significantly reduced compared with the model group (P < 0.01). To conclude, the down-regulation of Bcl-2 expression and Bcl-2/Bax ratio in the synovial tissue may be one of its mechanisms for improving rheumatoid arthritis.

An insight into biomarkers of osteoarthritis synovium based on bioinformatics / 中国组织工程研究

BACKGROUND: Over 90% of patients with osteoarthritis suffer from synovial lesions, and the occurrence of synovitis may also promote cartilage degeneration. To explore the potential mechanisms of synovial lesions is beneficial to find precise treatment targets and achieve good long-term prognosis. OBJECTIVE: To identify candidate hub genes in the synovial tissues during the development of osteoarthritis by bioinformatics analysis, and to further provide new insights for osteoarthritis study. METHODS: The osteoarthritis synovial-associated chip data sets GSE82107, GSE12021, GSE55457, and GSE55235 were downloaded from the public database GEO, including 40 cases of osteoarthritic synovial tissue and 36 cases of normal synovial tissue. R software was used to screen differentially expressed genes using Gene ontology function enrichment and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, and hub genes are selected by STRING online analysis tool and Cytoscape software. RESULTS AND CONCLUSION: Total 447 differentially expressed genes were selected between osteoarthritis and healthy control, including 201 up-regulated and 246 down-regulated genes. These differentially expressed genes were mainly enriched in inflammatory response, regulations of extracellular matrix, collagen, blood vessel development, as well as MAPK signaling pathway, tumor necrosis factor signaling pathway, arachidonic acid metabolism. Eight hub genes were screened by analyzing the protein interactions, which included matrix metalloproteinase 9, interleukin 6, vascular endothelial growth factor A, JUN, prostaglandin peroxide enzyme 2, CXCL8, MYC, epidermal growth factor receptor. The hub genes selected by bioinformatics analysis such as vascular endothelial growth factor A, matrix metalloproteinase 9, JUN, and prostaglandin peroxidase 2 may be biomarkers for the diagnosis of osteoarthritis and potential targets for treatment.

Application and analysis of endoscopic surgery in treating carpal tunnel syndrome / 中国内镜杂志

Objective To investigate the clinical effect of endoscopic treatment of carpal tunnel syndrome (CTS) with subsynovial hyperplasia. Methods 37 cases (total 41 wrists) of CTS with subsynovial hyperplasia who accepted endoscopic treatment in our hospital were retrospectively analysised, all the transverse ligament of wrist were cutted off under endoscope and the hyperplastic subsynovial membrane arounding the superficial flexor tendon of finger. The changes of clinical symptoms and signs before and after operation were compared. Results According to Kelly classification, the overall excellent and good rate was 95.12%. After operation, the feel of numb and pain during night disappeared in all patients, the positive rate of Tinel and Phalen sign was both reduced to 2.44% (P < 0.05), and the mean value of two-point discrimination was reduced to (3.5 ± 0.9) mm. No serious complication occurred during treatment. Conclusion For the patients of CTS with subsynovial hyperplasia, to cut the transverse ligament tendon under endoscope and remove the subsynovial around the flexor tendon at the same time is a new and feasible surgical procedure with notable curative effect, which deserves clinical popularization.

Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report

Abstract Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Resumo Tumor de células gigantes tenossinovial do tipo difuso (TCGT-d) ou sinovite vilonodular pigmentada (SVP) é uma lesão localmente agressiva que afeta principalmente as articulações dos ossos longos. Tumor de células gigantes tenossinovial condroide (TCGTC) ou SVP com metaplasia condroide é um tipo distinto e raro de tumor sinovial que tem a predileção pela articulação temporomandibular (ATM). Nós relatamos um caso raro de TCGTC da ATM, inicialmente diagnosticado, equivocadamente, como disfunção temporomandibular (DTM). Uma mulher de 51 anos foi encaminhada ao cirurgião com a queixa principal de dor na ATM por 5 anos, e uma história de tratamento de DTM sem sucesso. O exame extrabucal revelou discreto aumento de volume preauricular e movimentação mandibular restrita. A radiografia panorâmica e a tomografia computadorizada evidenciaram destruição da fossa mandibular e côndilo. Histologicamente, o tumor era composto por células mononucleares grandes, com amplo citoplasma eosinofílico e núcleo sulcado, pequenas células histiocitoides, células multinucleadas semelhantes a osteoclastos, pigmentação acastanhada e áreas de metaplasia condroide. As características morfológicas e imuno-histoquímicas levaram ao diagnóstico final de TCGTC. A raridade desta lesão pode estar associada ao seu não reconhecimento, sendo casos diagnosticados como condroblastoma, condromatose sinovial ou condrossarcoma. A paciente recebeu reconstrução imediata e recorrência foi observada 22 meses após a intervenção inicial. TCGT-d e TCGTC da ATM podem apresentar sintomas similares à DTM, mas os clínicos devem diferenciar ambas as lesões por meio do exame clínico completo, exames de imagem e, quando necessário, avaliação histopatológica.

Expression of Fibrogenic Cytokine and Inflammatory Cytokine in Frozen Shoulder / 中国康复理论与实践

Objective To explore the role of fibrogenic cytokines and inflammatory cytokines in the pathogenesis of frozen shoulder. Methods From September, 2014 to April, 2016, 20 patients with frozen shoulder accepted arthroscopic surgery were included, ten of them were diagnosed as primary frozen shoulder (group A), the other ten were secondary frozen shoulder (group B). Other ten patients undergo-ing shoulder arthroscopy for instability (4 cases), rotator cuff injury (3 cases) and subacromial impingement (3 cases) were as the controls (group C). The mRNA levels of matrix metalloproteinase (MMP) 1, MMP3, tumour necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, IL-8, granulocyte-macrophage colony stimulating factor (GM-CSF) and M-CSF in synovium were analyzed with quantitative polymerase chain reaction. Results The expression of mRNA of MMP1, MMP3, TNF-α, IL-1, IL-6, IL-8, GM-CSF and M-CSF were more in group A and group B than in group C (P0.05). Conclusion The fibro-genic cytokines and inflammatory cytokines may play a role in the pathogenesis of frozen shoulder.

Effect of Wenhua Juanbi Recipe () on expression of receptor activator of nuclear factor kappa B ligand, osteoprotegerin, and tumor necrosis factor receptor superfamily member 14 in rats with collagen-induced arthritis / 中国结合医学杂志

<p><b>OBJECTIVES</b>To study the effect of Wenhua Juanbi Recipe (, WJR) on expression of receptor activator of nuclear factor kappa B ligand (RANKL), osteoprotegerin (OPG), and tumor necrosis factor receptor superfamily member 14 (TNFRSF14, also known as LIGHT) in rats with collagen-induced arthritis (CIA).</p><p><b>METHODS</b>CIA rats were generated by subcutaneous injection of bovine collagen type-II at the tail base. Sixty CIA rats were randomly assigned (10 animals/group) to: model, methotrexate (MTX)-treated (0.78 mg/kg body weight), and WJR-treated (22.9 g/kg) groups. Healthy normal rats (n=10) were used as the normal control. Treatments or saline were administered once daily by oral gavage. Rats were sacrifificed at day 28 post-treatment and knee synovium and peripheral blood serum were collected. Toe swelling degree and expression of RANKL, OPG, and LIGHT were determined by Western blot and immunohistochemistry.</p><p><b>RESULTS</b>Compared with the normal group, toe swelling degree was signifificantly increased in the model group (P<0.01). After treatment, toe swelling degree decreased signifificantly in the WJR and MTX groups compared with the model group (P<0.01). Compared with the normal group, expression of RANKL and LIGHT were signifificantly increased and OPG signifificantly decreased in peripheral blood and synovium of the model group (P<0.01). Conversely, RANKL and LIGHT expression were signifificantly reduced and OPG increased in the WJR and MTX groups compared with the model group (P<0.01). No statistically significant difference existed between WJR and MTX groups.</p><p><b>CONCLUSION</b>WJR likely acts by reducing RANKL expression and increasing OPG expression, thus inhibiting RANKL/RANK interaction and reducing LIGHT expression, thereby inhibiting osteoclast formation/activation to block bone erosion.</p>

Effects of ozoned water on joint synovium in knee osteoarthritis of rabbits / 临床麻醉学杂志

Objective To evaluate the effects of ozoned water on the synovial inflammation in rabbits with knee osteoarthritis.Methods Thirty-two rabbits were randomly and evenly divided into four groups by random number method.All the rabbits were made into osteoarthritis models except those in groups A and D.After the osteoarthritis models were made successfully,rabbits in groups C and D received intra-articular injection of ozoned water of 20 μg/ml (2 ml)once a week for three weeks,and the other two groups did not.The morphology of synovium was observed and the expres-sion levels of IL-6 and TNF-α in the synovium were compared among the four groups.Results In group A,there was no hyperemia,edema or cell hyperplasia in the synovium,and the synovium re-mained normol tissue structure.In group B,the synovial structure was damaged,with serious cell hyperplasia,masses of inflammatory cells invading,vascular proliferation and hyperemia,and signifi-cantly increased synovium thickness compared with the normal.In group C,synovial hyperemia and edema were improved,the inflammatory cells reduced,and the synovium thickness was thinner than that in group B.And the group D had no synovitis phenomenon.Compared with group A,the expres-sions of IL-6 and TNF-αwere slightly higher in group D,and they were significantly increased (P <0.05)in the other two groups.Compared with group B,the IL-6 and TNF-α contents of synovium were reduced (P < 0.05)in group C.Conclusion Injecting 2 ml ozoned water of 20 μg/ml into artic-ular cavity can significantly improve synovial inflammation and reduce the expression of IL-6 and TNF-αin the synovium,which does no damage normal synovium.

Review on long non-coding RNA DANCR enhances chondrogenic differentiation and proliferation of human synovium-derived mesenchymal stem cell / 医学研究生学报

Long non-coding RNA( LncRNA) is an RNA molecule that is longer than 200 nucleotides and is not translated into a protein.LncRNA DANCR has been identified in hepatocellular carcinoma ( HCC) and markedly increased stemness features of HCC cells to promote tumorigenesis.Recent studies show that DANCR contributes to the differentiation and proliferation of synovium-derived mesenchymal stem cell ( SMSCs) and may be as a key point for this process.This article reviews the role of long non-coding RNA DANCR in enhancing chondrogenic differentiation and proliferation of human SMSCs.

Intra-Articular Pigmentation of Synovium: An Unusual Cause

An unusual grayish brown discoloration of the synovium was found during a knee arthroscopy of a 72-year-old man. He also had similar pigmentation affecting the skin on the legs, arms, hands, and face. It was found he had been taking 400 mg of amiodarone hydrochloride daily for last 7 years. Amiodarone is known to cause a slate grey pigmentation of skin and cornea, but we believe this is the first report of amiodarone-induced pigmentation of the synovium. The arthroscopist should be aware of the possibility of drug-related synovial pigmentation and include this in differential diagnosis.

Ultrasound-Guided 50% Ethyl Alcohol Injection for Patients With Malleolar and Olecranon Bursitis: A Prospective Pilot Study

OBJECTIVE: To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. METHODS: Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. RESULTS: Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and symptoms. CONCLUSION: Ultrasound-guided alcohol injection could be an alternative therapeutic option before surgery in patients with chronic intractable malleolar and olecranon synovial proliferative bursitis.

Intra-articular injection of dexketoprofen in rat knee joint : Histopathologic assessment of cartilage & synovium.

Background & objectives: Effective pain control following outpatient surgical procedures is an important aspect of patient discharge. This study was carried out with an aim to investigate the histopathological effects of intra-articular dexketoprofen trometamol injection in knee joint on synovium and cartilage in an experimental rat model. Methods: In each of 40 rats, the right knee was designated as the study group and the left knee as the control group (NS group). Under aseptic conditions, 35 rats received an injection of 0.25 ml (6.25 mg) dexketoprofen trometamol into the right knee joint and an injection of 0.25 ml 0.9 per cent normal saline solution into the left knee joint. On the 1st, 2nd, 7th, 14th, and 21st days after intra-articular injection, rats in specified groups were sacrificed by intraperitoneal injection of 120 mg/kg sodium thiopental. Knee joints were separated and sectioned for histopathological examination. Inflammatory changes in the joints were recorded according to a grade scale. Results: No significant difference in terms of pathological changes both in synovium and cartilage was observed between the NS group and the study group on days 1, 2, 7, 14 and 21 after intra-articular injection of dexketoprofen or saline in the knee joint. Interpretation & conclusions: The findings showed no evidence of significant histopathological damage to the cartilage and synovia for a period up to 21 days following intra-articular administration of dexketoprofen trometamol in the knee joints of rats.

Anterior mediastinal synovial sarcoma: A case report and literature review / 解放军医学杂志

Objective To study the clinical manifestations, pathologic features, diagnosis, treatment and prognosis of primary synovial sarcoma in the anterior mediastinum. Methods A case of primary synovial sarcoma in the anterior mediastinum was reported. Clinical features, imaging manifestations, pathology features and therapeutic effect were analysed and the relevant literature was reviewed. Results A 48-year-male patient was admitted with complaint of right chest pain for 4 days. Chest computerized tomography revealed a large mass located at the right anterior mediastinum, and it was primarily diagnosed as invasive thymoma. Pathological examination by CT-guided percutaneous needle biopsy manifested that, under microscope, the tumor cells were short and spindle in shape forming a nest structure, suggested it was a thymoma. The patient then underwent resection of thymoma with removal of fat and connective tissue in the anterior mediastinum. During the operation the size of the tumor was 15cm × 15cm × 10cm, being located at the anterior mediastinum, and it tended to bleed. The diagnosis of primary monophasic synovial sarcoma in the mediastinum was confirmed by postoperative/pathology examination. Immunohistochemistry staining showed that the tumor cells were positive for the markers Bcl-2 and EMA, but negative for the markers CK (pan) and S100. The patient suffered from local recurrence with metastases to lung 4 months after surgery. The patient received 2 chemotherapeutic courses with ifosfamide, epirubicin and cisplatin. He died 6 months after surgery. Conclusion Primary synovial sarcoma in the anterior mediastinum is an extremely rare and highly malignant tumor with poor prognosis. The diagnosis depends on the pathological features, immunohistochemistry and RT-PCR. Radical resection combined with comprehensive treatment may improve the survival rate.

Detection of interleukin-17 and tumor necrosis factor-alpha and synovium pathological changes in patients with rheumatoid arthritis and significance / 中国医师进修杂志

ObjectiveTo investigate the levels of serum interleukin -17(1L-17) and tumor necrosis factor -alpha( TNF- α ) and synovium pathological changes in patients with rheumatoid arthritis ( RA ) and its clinical significance.MethodsThe levels of serum IL-17 and TNF- α in 50 patients with active phase of RA ( active phase of RA group),50 patients with stable phase of RA ( stable phase of RA group ) and 50 normal controls (NC group) were measured by enzyme-linked immunospecific assay(ELISA),and the synovium was detected by pathological examination.ResultsThe levels of serum IL- 17 and TNF- α in active phase of RA group [(42.60 ± 11.30),( 113.20 ± 13.11 ) mg/L]were significantly higher than those in stable phase of RA group [( 19.60 ± 5.75),( 14.50 ± 5.33) mg/L]and NC group [(7.40 ± 3.32),( 10.90 ± 2.24 ) mg/L](P ＜0.01 ),the level of serum IL-17 in stable phase of RA group was significantly higher than that in NC group ( P ＜ 0.05),but the level of TNF- α had no significant difference between stable phase of RA group and NC group ( P ＞ 0.05).The synovium was significantly different between RA patients and NC group.Conclusion IL-17 and TNF-α are more sensitive index for detecting the activity of RA and may play important rolesinmonitoring the therapeutic effects and prognosis of RA.

Synovial Lesions with Low Signal Intensities on T2-Weighted MR Image

Pigmented villonodular synovitis, synovial chondromatosis, long-standing rheumatoid arthritis, hemophilic arthropathy, chronic tophaceous gout, amyloid arthropathy, tuberculous arthritis, and hemangioma are the synovial diseases showing low signal intensity on T2-weighted image. Synovial deposition of hemosiderin, urate, and amyloid and fibrosis or caseous necrosis of hypertrophied synovium are known as the pathologic causes of T2 signal intensity. Because of the low incidence of the synovial lesions showing T2 low signal intensity, recognition of these diseases would be helpful for the exact diagnosis.