Synovium CD20 expression is a potential new predictor of bone erosion progression in very-early arthritis treated by sequential DMARDs monotherapy -- a pilot study from the VErA cohort.

OBJECTIVE: Because available biomarkers (rheumatoid factors [RF], anti-cyclic citrullinated autoantibodies [anti-CCP2], erythrocyte sedimentation rate at 1st hour [ESR]/C-reactive peptide [CRP] and bone erosions) are insufficient to predict rheumatoid arthritis (RA) structural damage, to determine whether synovium expression of greater or equal to 1 markers could constitute new prognostic factor(s). METHOD: The study was conducted on 18 prospectively enrolled disease-modifying anti-rheumatic drug (DMARD)- and glucocorticoid-naïve, VErA cohort patients with very-early arthritis (median duration: 4months). Recorded at baseline were: clinical and biological (serum ESR, CRP, RF-isotypes, anti-CCP2, osteoprotegerin, receptor activator of nuclear κB-ligand [RANK-L] and cartilage oligomeric matrix protein [COMP] levels) data; synovium expression (HLA-DR, CD163, CD3, CD20, VEGF, osteoprotegerin, RANK-L, Bcl2 and global inflammation index) for a metacarpophalangeal joint-synovium biopsy. Baseline and 3-year hand-and-foot X-rays were graded with the van der Heijde-modified-Sharp score; the judgment criterion was its progression during follow-up. Pearson's product moment correlation statistics were used to test for association between paired samples. RESULTS: A baseline, a significant relationship was found between erosive damage and markers of B-cell activation, notably the synovium CD20 expression (r=0.68; P=0.0001). Quantified by the modified-Sharp erosion score variation, the 3-year structural damage progression was significantly correlated with: serum levels of RF-IgG (r=0.75; P=0.0003), -IgM (r=0.69; P=0.001), anti-CCP2 (r=0.53; P=0.02) and RANK-L (r=0.61; P=0.007); synovium CD20 expression (r=0.70; P=0.001). CONCLUSION: This analysis of the prognostic value of a large panel of synovium markers in a limited sample of prospectively followed, well-documented patients suggested that both synovial CD20 and serum RANK-L levels might be new predictors of structural damage progression in very-early RA.

Anatomical study and clinical relevance of the flexor superficialis synovial flap: an assessment of 31 hand dissections.

PURPOSE: The authors present an anatomical study of the flexor digitorum superficialis synovial flap and its clinical application for palmar soft tissue defects in hand trauma. METHODS: Green latex was injected into the brachial artery of thirty-one human upper limbs from corpses donated to science. Anatomical features of this pedicled flap were assessed: arterial vascularization, dimensions and covering surface. RESULTS: The anatomical support of this flap is the synovial tissue of the flexor tendons, and particularly the superficial layer of the synovial system, covering the flexor digitorum superficialis (FDS) tendons in the forearm. It is vascularized by four different arteries: a constant collateral branch of the ulnar artery, and three inconstant arterial supports: from collateral branches of the superficial palmar arch, from the radial artery, and from the vasa nervorum of the median nerve. The flap is harvested from proximal to distal on the ulnar pedicle to cover the palmar soft tissue defects of the hand. A clinical application of this synovial flap is presented via a case report for covering a palmar skin defect secondary to a hand injury. CONCLUSIONS: The synovial flap contains a constant ulnar pedicle and could be considered a useful alternative to cover palmar soft tissue defects.

The risk of pulmonary aspiration in patients after weight loss due to bariatric surgery.

BACKGROUND: We conducted a study including patients with gastric banding or gastroplasty who previously underwent plastic or functional surgery to assess the risk of pulmonary aspiration. METHODS: A retrospective case-control study was performed including all patients undergoing a plastic or functional surgery over a 5-yr period (2000-2005) at Rouen University Hospital. Two groups were defined: the postbariatric group included patients who previously had bariatric surgery (laparoscopic adjustable gastric banding or Mason's vertical gastroplasty) before undergoing the plastic surgery; all other patients were assigned to the control group. Data included all anesthetic management and were recorded in the hospital computer database. The incidence of pulmonary aspiration was the outcome variable. RESULTS: One hundred ninety-eight plastic and functional operations (66 cases and 132 controls) were performed. Pulmonary aspiration was significantly (P<0.006) higher in the postbariatric group (4 patients: 6%) than in the nonbariatric group (0 patient). For this complication, all patients had previously undergone gastric banding. One patient who did not receive prokinetic prophylaxis required intensive care for severe pulmonary alteration. CONCLUSION: The risk of perioperative pulmonary aspiration in a patient after weight loss due to gastric banding was considered significant.

The gracilis musculocutaneous flap: vascular supply of the muscle and skin components.

UNLABELLED: In reconstructive techniques, the use of the composite gracilis skin flap may be complicated by a total or partial necrosis of the cutaneous paddle. Our study was aimed to describe the vascular anatomy of the gracilis muscle and the related skin, in order to have a better understanding of the skin's blood supply, and to help in determining a safer cutaneous paddle during transfer. MATERIALS AND METHODS: We performed a detailed anatomical description of the gracilis vessels on 32 human cadavers' thighs. Selective injections of methylene blue and then colored fluid latex were carried out in the principal pedicle of the gracilis, to color and to measure the perforator vessels and the associated cutaneous paddle. The contour and the anatomical situation of the paddles were digitized in order to have precise data and to try to model a standard theoretical skin paddle. RESULTS: The 32 dissections showed that the principal pedicle of the gracilis originated mainly from the adductor artery (26/32), it penetrated into the muscle 92.8 mm (78-114) below the pubis with a small dispersion of the values that assessed a rather reliable parameter of location. Each muscle had 1-6 perforators (at mean 3.78); 80% of these perforators had their exits from the opposite side to the principal pedicle, included within a 60 mm length of muscle. A skin paddle was quite constantly colored (31/32), located over the proximal half of the muscle with a complex design. Its mean dimensions of length and width were 110 (72-158) and 91.4 mm (65-144), respectively. The computerized surface of the paddle was at a mean of 79.5 cm(2) (42.4-139.3), and it was significantly correlated to the number of the perforators from the muscle. DISCUSSION: Our quantitative values concerning the skin paddle related to the perforator arteries may be of significant interest to the surgeon who aims to harvest a composite musculocutaneous gracilis flap, in order to improve its reliability by reducing the risk of cutaneous necrosis.