Joint Pathology Research Articles

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction

ObjectiveTo analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. MethodsThis retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2. ResultsThe mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery. ConclusionsThe best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

Bilateral hip ochronosis, an unsuspected diagnosis in polyarticular pain: A case report

Alkaptonuria is a rare metabolic disorder characterized by the accumulation of homogentisic acid, leading to the deposition of blackish pigment in cartilage and soft tissue, known as ochronosis. This can mimic multiple joint pathologies and is a diagnosis of exclusion. We describe the case of a 52-year-old woman who had a total hip replacement after experiencing left hip pain for which oral medications were unable to provide relief. Unexpectedly, during the procedure, a blackish tissue was noticed. This led to a histological examination and the confirmation of the ochronosis diagnosis. The patient’s medical history revealed a number of malignancies, but no previous metabolic illness diagnoses. Subsequent follow-up revealed rapid-onset pain in other joints, leading to a similar diagnosis of polyarticular ochronosis in the right hip, knees, spine, and shoulders. This highlights how difficult it is to treat this condition. This case underscores the importance of considering ochronosis as a differential diagnosis in patients with chronic polyarticular pain. Current treatment consists of initial non-surgical measures, including physical therapy and analgesics. If there is no improvement, treatment would be joint arthroplasty. Awareness among orthopedic surgeons and histopathological examination of tissues is crucial for the accurate diagnosis and management of ochronosis.

Osseous pathologic changes in the thoracic region of the equine vertebral column: A descriptive post-mortem study in three breeds.

Data on equine thoracic pathology hardly exist in breeds other than Thoroughbreds. To describe pathological changes of the osseous thoracic vertebral column in Warmblood horses, Shetland ponies and Konik horses, and to compare prevalence and severity. Descriptive post-mortem study. Computed tomography was used to examine the thoracic vertebral column of 34 Warmblood horses, 28 Shetland ponies, and 18 Konik horses. Osteoarthritis (OA), periarticular osteolysis, osseous cyst-like lesions and fragments of articular processes (APJs), costovertebral and costotransverse joints, soft tissue mineralisation surrounding these joints, intervertebral disc (IVD) mineralisation, impingement of spinous processes (SPs) and spondylosis were scored. APJ aplasia (98%; 58/59) occurred in 14 Shetland ponies. OA predominated in Warmblood horses across all joints (45% vs. 29 and 32%, p < 0.001). OA and periarticular osteolysis were found in particular in the costotransverse joints (p < 0.001) across all breeds. Warmblood and Konik horses had more and severe soft tissue mineralisation than Shetland ponies (2.3%, score 1.5 and 3.2%, score 1.3, respectively, vs. 0.3%, score 0.9, p < 0.01). Mid location was most often affected with highest severity score (4.2%, 1.5, p < 0.001). Konik horses displayed the highest IVD mineralisation (20%, p < 0.001), which notably increased with age (p < 0.001) compared with Warmblood horses (4.5%) and Shetland ponies (1.1%). SPs impingement was absent in Shetland ponies, and most prevalent in Warmblood horses (11.2%, p < 0.001) compared with Konik horses (2.2%). Osseous cyst-like lesions, fragments and spondylosis were minimal in all breeds and nearly absent in Shetland ponies. Clinical histories and macroscopic and histologic examinations were unavailable. Distinct breed differences exist in prevalence and severity of thoracic vertebral column osseous pathologies. Costotransverse joint pathology is more common than APJ pathology in all breeds. Warmblood horses are prone to OA, spondylosis and SPs impingement; Konik horses exhibit significant IVD mineralisation, and Shetland ponies demonstrate a high prevalence of APJ aplasia. Periarticular osteolysis, osseous cyst-like lesions, fragments and soft tissue mineralisation are notably low in Shetland ponies.

The Influence of Pelvic Tilt and Femoral Torsion on Hip Biomechanics: Implications for Clinical Assessment and Treatment

Background: Hip biomechanics are crucial in understanding movement disorders and joint pathologies. Pelvic tilt and femoral torsion are key factors influencing hip function and stability. This review aims to elucidate their effects on acetabular orientation, hip range of motion (ROM), and associated compensatory mechanisms. Methods: A comprehensive search of databases, including PubMed, Scopus, and Pedro, was conducted. Studies were selected based on Population, Concept, and Context (PCC) criteria, focusing on those examining the relationship between pelvic tilt, femoral torsion, and hip biomechanics. Eight studies were included, utilizing methodologies such as CT imaging, musculoskeletal modeling, and gait analysis, covering populations ranging from asymptomatic adults to elderly women with pelvic retroversion. Results: The review identified significant effects of pelvic retroversion on acetabular anteversion and hip extension. Some studies found no correlation between pelvic index (PI) and acetabular orientation, while others reported a linear increase in acetabular anteversion with pelvic retroversion. Subjects with pelvic retroversion showed greater hip extension. Additionally, femoral anteversion was linked to increased internal rotation and altered hip joint contact forces during gait, with changes in hip ROM and force distribution. No relationship was found between femoral and acetabular anteversion in patients with hip osteoarthritis. Conclusions: Pelvic tilt and femoral torsion significantly affect hip biomechanics, influencing acetabular orientation, ROM, and compensatory mechanisms. Future studies should include symptomatic populations to explore these relationships further. These findings emphasize the critical need for individualized clinical assessments and further research on symptomatic populations to enhance our understanding of pelvic tilt and femoral torsion’s impact on hip biomechanics.

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

Less Common Mononeuropathies.

Uncommon mononeuropathies are challenging to diagnose as they can mimic joint pathology, radiculopathies, or plexopathies. They are less easily diagnosed due to unfamiliarity with their clinical presentation, knowledge of anatomy, and less commonly used diagnostic studies. A careful history, physical examination, and electrodiagnostic evaluation can help identify these neuropathies in a timely manner to administer the best treatment for resolution of symptoms. Recent advances in ultrasound and magnetic resonance techniques are used to confirm clinical suspicion of peripheral neuropathy by clearly depicting the anatomy and pathology as well as describing findings that mimic mononeuropathy. It is important for neurology, orthopedic, rheumatology, emergency, and primary care physicians to be familiar with less common mononeuropathies.

Effectiveness of Practical Skills Training on the Original Design Knee Joint Phantom

Background. Simulation training is a crucial aspect of intern training in Orthopedics surgery. Providing a practical and reproducible training environment, it helps interns avoid critical errors when working with future patients. Objective. The objective of our study was to design, manufacture, implement in education course and evaluate the effectiveness of a knee joint phantom for training knee joint puncture. Material and Methods. The knee joint phantom was created using Fusion 360 software and was printed using FDM technology on a Tevo Tarantula Pro printer with a Cura slicer with an insert container capable of repeated filling with various imitated liquids. To achieve a higher level of realism, the soft tissues were fully replicated. The phantom was fixed on two supports under the femoral and knee segments with a hinge, which provides the possibility of movements in the joint at different angles. 30 ordinators were involved in the study and divided into two groups: group I included 15 ordinators who conducted training on a knee model from the beginning of the 2nd year; group II consisted of 15 ordinators who conducted training from the beginning of the 1st year. The effectiveness of practical training was evaluated through statistical analysis of the results of OSCI, with a phantom being used. Results. The mean score was 3.9±2.7 and 4.8±2.8 in group I and group II, respectively, with the maximum possible result of 5.5, which indicates the effectiveness of simulation training with the help of a manufactured knee joint phantom. A small number of participants were included in the study, so no significant difference in learning outcomes between the comparison groups was established (p=0.09492). Conclusions. Simulation training with a knee phantom is an efficient method for educating orthopedic surgeons on how to perform manipulations on the knee joint. This training also aids in identifying those who have acquired the skill at a lower level. This approach can prevent potential errors when performing manipulations and minimize complications in the treatment of patients with knee joint pathology.

Can eye-tracking help to create a new method for X-ray analysis of rheumatoid arthritis patients, including joint segmentation and scoring methods?

Reading hand and foot X-rays in rheumatoid arthritis patients is difficult and time-consuming. In research, physicians use the modified Sharp van der Heijde Sharp (mvdH) score by reading of hand and foot radiographs. The aim of this study was to create a new method of determining the mvdH via eye tracking and to study its concordance with the mvdH score. We created a new method of quantifying the mvdH score based on reading time of a reader monitored via eye tracking (Tobii Pro Lab software) after training with the aid of a metronome. Radiographs were read twice by the trained eye-tracking reader and once by an experienced reference radiologist. A total of 440 joints were selected; 416 could be interpreted for erosion, and 396 could be interpreted for joint space narrowing (JSN) when read by eye tracking (eye tracking could not measure the time spent when two pathological joints were too close together). The agreement between eye tracking mvdH Sharp score and classical mvdH Sharp score yes (at least one erosion or JSN) versus no (no erosion or no JSN) was excellent for both erosions (kappa 0.97; 95% CI: 0.96-0.99) and JSN (kappa: 0.95; 95% CI: 0.93-0.097). This agreement by class (0 to 10) remained excellent for both erosions (kappa 0.82; 95% CI: 0.79-0.0.85) and JSN (kappa: 0.68; 95% CI: 0.65-0.0.71). To conclude, eye-tracking reading correlates strongly with classical mvdH-Sharp and is useful for assessing severity, segmenting joints and establishing a rapid score for lesions.

Clinical case of senesto-hypochondrical form of schizophrenia with implementation of pathological bodily sensations mainly in the orofacial area: problems of differential diagnosis at the early stages

The article presents a clinical case of the senesto-hypochondriacal form of schizophrenia, the implementation of violations of bodily perception within which for a long time was limited to the orofacial space against the background of orthodontic pathology. Prosopalgia is a transnosological syndrome characteristic of a heterogeneous group of disorders, the differential diagnosis of which, due to the peculiarities of the innervation of the facial area, can be difficult and requires special attention for the timely determination of their nosological affiliation and the initiation of adequate therapy. Interest in the clinical case is due to longlasting senestoalgic syndrome, similar in clinical picture to established pathology of the temporomandibular joint, which complicated the timely assessment of the patient’s condition and led to exacerbation of the mental disorder in the absence of psychopharmacological therapy. The article provides an analysis of the place of mental pathology in the formation and development of orofacial pain, both of a somatogenic nature and in the context of somatopsychic disorders, emphasizing the need for a comprehensive assessment of both the dental and mental status of such patients in order to formulate optimal approaches to treatment.

Knee joint pathology and efferent pathway dysfunction: Mapping muscle inhibition from motor cortex to muscle force

BackgroundDysfunction in efferent pathways after knee pathology is tied to long-term impairments in quadriceps and hamstrings muscle performance, daily function, and health-related quality of life. Understanding the underlying etiology is crucial for effective treatment and prevention of poor outcomes, such as post-traumatic osteoarthritis or joint replacement. ObjectivesTo synthesize recent evidence of efferent pathway dysfunction (i.e., motor cortex, motor units) among individuals with knee pathology. DesignCommentary. MethodWe summarize the current literature investigating the motor cortex, corticospinal tract, and motoneuron pool in individuals with three common knee pathologies: anterior cruciate ligament (ACL) injury, anterior knee pain (AKP), and knee osteoarthritis (OA). To offer a complete perspective, we draw from studies applying a range of neuroimaging and neurophysiologic techniques. ResultsAdaptations within the motor cortices, corticospinal tract, and motoneuron pool are present in those with knee pathology and underline impairments in quadriceps and hamstrings muscle function. Each pathology has evidence of altered motor system excitability and reduced volitional muscle activation and force-generating capacity, but few impairments were common across ACL injury, AKP, and OA studies. These findings underscore the central role of the motor cortex and motor unit behavior in the long-term outcomes of individuals with knee pathology. ConclusionsAdaptations in the efferent pathways underlie persistent muscle dysfunction across three common knee pathologies. This review provides an overview of these changes and summarizes key findings from neurophysiology and neuroimaging studies, offering direction for future research and clinical application in the rehabilitation of joint injuries.

Report of the German Society of Pathology Working Group on Bone, Joint, and Soft Tissue Pathology

Report of the German Society of Pathology Working Group on Bone, Joint, and Soft Tissue Pathology

L5-S1 facet joint pathology in pelvic ring injuries.

The authors believe that the L5-S1 facet joint injury in the setting of pelvic fractures is underappreciated by orthopedic traumatologists. The purpose of this study was to draw attention to the L5/S1 facet joint in the setting of pelvic ring injuries. This was a retrospective comparative study of all patients greater than or equal to 18years of age with an acute pelvic ring injury (AO/OTA 62 B to C) presenting to a single level I trauma center. The primary objective was to determine demographic and injury characteristics associated with L5-S1 facet joint injuries in patients with pelvic ring injuries. The secondary objective was to determine the proportion of L5-S1 facet joint injuries that were missed on initial radiographic workup. There were 476 patients included in the analysis, 53 (11.1%) of whom had an L5-S1 facet joint injury. Patients with an L5-S1 injury were more likely to be younger (44.1 vs. 53.2years, p = 0.001) and experience a high energy mechanism of injury (95.0% vs. 78.0%, p = 0.002). Certain injury patterns were associated with L5-S1 facet joint injuries: any sacral fracture (96.2% vs. 73.8%, p < 0.001), Denis zone 2 fractures (43.4% vs. 20.1%, p < 0.001), Denis zone 3 fractures (34.0% vs. 4.7%, p < 0.001), bilateral displaced sacral fractures (18.9% vs. 3.5%, p < 0.001), and L5 transverse process fractures (64.2% vs. 18.0%, p < 0.001). Only 16.0% of radiology reports identified an L5-S1 injury. Orthopedic traumatologists should scrutinize imaging for L5-S1 facet joint injuries in the presence of pelvic ring injuries, especially in patients with certain sacral fracture patterns.

Reactive oxygen species-sensitive fenofibrate-loaded dextran nanoparticles in alleviation of osteoarthritis

Osteoarthritis (OA) stands as a prevalent chronic joint pathology, emerging as a leading cause of disability on a global scale. However, the current therapeutic efficacy in OA treatment remains unsatisfactory. Chondrocyte ferroptosis has become to a critical target for OA treatment, while the fabrication of nanomedicines emerges as a promising strategy for OA treatment. Nevertheless, there exists a paucity of reported nanomedicine systems designed to combat chondrocyte ferroptosis for OA alleviation. In light of this, our study introduced a reactive oxygen species (ROS)-sensitive fenofibrate-loaded targeted nanoparticle (FN-CNPs) as a means of alleviating OA by suppressing chondrocyte ferroptosis. In vitro investigations demonstrated the FN-CNPs can achieve this through the reduction of lipid peroxidation and ROS levels, as well as the elevation of anti-ferroptosis markers (GPX4, FSP1, and ACSL3). Consequently, FN-CNPs exhibited significant anti-inflammatory effects and downregulated the expression of key catabolic mediators in vitro. Furthermore, in vivo studies underscored the ability of FN-CNPs to alleviate OA progression and protect cartilage. Collectively, these findings highlight the efficacy of FN-CNPs in mitigating OA progression by suppressing chondrocyte ferroptosis via regulating ROS levels, antioxidant systems and lipid metabolism of chondrocytes.

Pterocarya hupehensis Skan total flavones ameliorate rheumatoid arthritis in rats by suppressing formation of neutrophil extracellular traps

To investigate the therapeutic mechanism of Pterocarya hupehensis Skan total flavonoids (PHSTF) for rheumatoid arthritis (RA). Twenty-five male SD rats were randomly divided into normal control group, RA model group, PHSTF treatment (45 and 90 mg/kg) groups, and Tripterygium glycosides (TPG) tablet (10 mg/kg) group (n=5). Except for those in the normal control group, all the rats were subjected to collagen-induced arthritis (CIA) modeling using a secondary immunization method, after which PHSTF and TPG were administered via gavage once daily for 4 weeks. After the treatments, serum levels of TNF-α and IL-1β were measured using ELISA, and ankle joint pathologies were assessed with HE staining; the expression of citrullinated histone H3 (Cit-H3), a neutrophil extracellular trap (NET) marker, in the ankle joints was evaluated with immunohistochemistry. In primary cultures of rat peripheral blood neutrophils stimulated with phorbol ester (PMA), the effects of PHSTF (100 and 200 μg/mL) on the expressions of Cit-H3, peptidylarginine deiminase 4 (PADI4), neutrophil elastase (NE), and myeloperoxidase (MPO) were examined with Western blotting; immunofluorescence assay was used to observe Cit-H3 expression and NET formation in the cells. In the CIA rat models, PHSTF significantly alleviated ankle swelling, decreased serum levels of TNF-α and IL-1β, improved histopathological changes in the ankle joints, and reduced Cit-H3 expression in both the serum and ankle joint cartilage. In the isolated rat neutrophils, PHSTF showed no significant effect on cell viability but strongly inhibited PMA-induced NET release. PHSTF can alleviate RA by inhibiting the formation of NETs.

Low-Protein Diet Inhibits the Synovial Tissue Macrophage Pro-Inflammatory Polarization Via NRF2/SIRT3/SOD2/ROS Pathway in K/BxN Rheumatoid Arthritis Mice.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by pain, swelling, stiffness, and impaired function. Attenuating inflammation is a crucial objective in RA management. Diet and nutrition are believed to influence RA symptomatology, with a low-protein diet being one potential nutritional strategy, although its underlying mechanisms remain to be fully elucidated. In this research, serum derived from arthritic transgenic K/BxN mice was administered to naive mice to establish a K/BxN rheumatoid arthritis model. Physiological assessments and histological staining were performed to evaluate joint pathology. (Enzyme-linked immunosorbent assay) ELISA was used to measure inflammatory cytokines. Flow cytometry and immunofluorescence were applied to characterize macrophage phenotypes. Transcriptomic analysis elucidated molecular pathways under the effect of a low-protein diet and verified by immunoblotting. Mitochondrial reactive oxygen species (ROS) was detected by Mito-SOX. Protein expression was silenced through the application of siRNA transfection. Our results indicate that a low-protein diet significantly alleviates disease symptoms and decreases pro-inflammatory cytokine levels in synovial fluid. Furthermore, this dietary intervention inhibits M1 macrophage polarization while promoting a shift towards the M2 phenotype. Transcriptomic analysis revealed that the beneficial effects of the low-protein diet in alleviating rheumatoid arthritis are closely linked to the NRF2 pathway. In vitro, low protein treatment can promote the activity of NRF2 via inhibiting the ubiquitin mediated proteolysis and activate the NRF2/SIRT3/SOD2 pathway to inhibit the production of ROS, which will further inhibit the M1 macrophage polarization. NRF2 knockdown can abolish the effects of low-protein treatment, indicating that the inhibition of M1 polarization and the anti-inflammatory response induced by low-protein treatment are dependent on NRF2. In summary, our findings propose that low-protein diet can inhibit synovial macrophage M1 polarization via activating NRF2/SIRT3/SOD2 pathway to reduce mitochondrial ROS production. This mechanism effectively decreases synovial inflammation and alleviates RA symptoms.

Modern methods of radiation imaging of the pathology of the temporomandibular joint

Modern methods of radiation imaging of the pathology of the temporomandibular joint

Mechanism of Biqi capsules in the treatment of gout based on network pharmacology and experimental verification

Ethnopharmacological relevanceGout is a crystal-related arthropathy caused by monosodium urate (MSU) deposition, resulting from purine metabolism disorders and hyperuricemia (HUA). Gout belongs to the traditional medicine category of Bi syndrome. Biqi capsules (BQ) is a traditional Chinese medicine formula used to treat Bi syndrome. The BQ prescription is derived from the ancient prescription of Hua Tuo, a famous physician in the Han Dynasty. Aim of the studyTo study the effect and mechanism of BQ in treating acute gouty arthritis (AGA) and HUA. Materials and methodsAnalyzing BQ's signaling pathways for gout treatment via network pharmacology. The HUA model was induced orally with adenine and potassium oxonate. The rat AGA model was established by MSU injection. In vitro, MH7A and RAW 246.7 cells were treated with LPS and MSU. Serum uric acid, creatinine, and urea nitrogen levels were evaluated. Kidney and ankle joint pathology was observed via HE staining. Inflammatory signaling pathway proteins, epithelial-mesenchymal transition (EMT) pathway proteins, and uric acid metabolism-related proteins were detected by Western blot. Results1780 potential targets for gout treatment were identified, and 1039 target proteins corresponding to BQ's active ingredients were obtained. Pathway enrichment analysis revealed BQ improved gout mainly through inflammatory pathways. Experimental results showed BQ could reduce serum uric acid level and increase uric acid clearance rate by regulating the expression of adenosine deaminase (ADA), and organic anion transporter 1 (OAT1) and glucose transporter 9 (GLUT9) in HUA mice. BQ could improve renal function and injury by inhibiting the NLRP3 pathway in HUA mice' kidneys. Additionally, BQ could alleviate ankle joint swelling and synovial injury, inhibit the TLR4/NLRP3 pathway, and reduce levels of inflammatory factors including interleukin 6 (IL-6), interleukin 1β (IL-1β), and tumor necrosis factor-alpha (TNF-α) in AGA rats. The main component of BQ, brucine, could inhibit the activation of NLRP3/NF-κB pathway induced by MSU and reduce the expression level of inflammatory factors (IL-6, IL-1β, and TNF-α) in macrophages. Brucine could inhibit the activation of the EMT pathway and reduce the expression level of inflammatory factors (IL-6, TNF-α) in human fibroblast-like synoviocytes (MH7A cells) induced by MSU. ConclusionsBQ effectively reduced serum uric acid levels, improved kidney and joint damage, and ameliorated the inflammatory response caused by MSU. Its main component, brucine, effectively improved the inflammatory response and reduced the invasive ability of synoviocytes induced by MSU.

Evaluation of the feasibility of equine in-vivo ultrasound technique for the medial branch of the dorsal ramus of the cervical spinal nerves

Ultrasound-guided local anaesthesia is commonly used in veterinary orthopaedics for horses. This study aimed to assess an in vivo ultrasound technique for the medial branch of the dorsal branch of the cervical spinal nerves (MB-DBCSNs) in horses and compare the performance of clinicians with different experience levels. Ten healthy, skeletally mature horses were examined using radiographic and ultrasound (US) techniques in the cervical area (C3–C7). Four operators with varying experience conducted US examinations using a 10 MHz linear and 6 MHz curvilinear transducer over ten training sessions. The number of cervical nerves visualized was recorded. A chi-square test was used to analyse the impact of training, anatomical location, and operator experience on the identification of facet joints. Operator agreement was evaluated with Cohen’s K test. The operators assessed 80 MB-DBCSNs, with radiographs and identified 70 healthy and 10 pathological facet joints. Training significantly improved visualization success, reaching 90% in later sessions. Cranial facet joints (C3–C5) were more frequently visualized (81%) than caudal ones (C5–C7) were (59%). US performance was influenced by the operator’s skill, and agreement among operators ranged from slight to fair. Overall, practice improved cervical nerve visualization in vivo, particularly for cranial nerves, but the technique requires a long learning curve because of low levels of operator agreement.

Engineering exosomes derived from TNF-α preconditioned IPFP-MSCs enhance both yield and therapeutic efficacy for osteoarthritis

BackgroundThe pathogenesis of osteoarthritis (OA) involves the progressive degradation of articular cartilage. Exosomes derived from mesenchymal stem cells (MSC-EXOs) have been shown to mitigate joint pathological injury by attenuating cartilage destruction. Optimization the yield and therapeutic efficacy of exosomes derived from MSCs is crucial for promoting their clinical translation. The preconditioning of MSCs enhances the therapeutic potential of engineered exosomes, offering promising prospects for application by enabling controlled and quantifiable external stimulation. This study aims to address these issues by employing pro-inflammatory preconditioning of MSCs to enhance exosome production and augment their therapeutic efficacy for OA.MethodsThe exosomes were isolated from the supernatant of infrapatellar fat pad (IPFP)-MSCs preconditioned with a pro-inflammatory factor, TNF-α, and their production was subsequently quantified. The exosome secretion-related pathways in IPFP-MSCs were evaluated through high-throughput transcriptome sequencing analysis, q-PCR and western blot analysis before and after TNF-α preconditioning. Furthermore, exosomes derived from TNF-α preconditioned IPFP-MSCs (IPFP-MSC-EXOsTNF−α) were administered intra-articularly in an OA mouse model, and subsequent evaluations were conducted to assess joint pathology and gait alterations. The expression of proteins involved in the maintenance of cartilage homeostasis within the exosomes was determined through proteomic analysis.ResultsThe preconditioning with TNF-α significantly enhanced the exosome secretion of IPFP-MSCs compared to unpreconditioned MSCs. The potential mechanism involved the activation of the PI3K/AKT signaling pathway in IPFP-MSCs by TNF-α precondition, leading to an up-regulation of autophagy-related protein 16 like 1(ATG16L1) levels, which subsequently facilitated exosome secretion. The intra-articular administration of IPFP-MSC-EXOsTNF−α demonstrated superior efficacy in ameliorating pathological changes in the joints of OA mice. The preconditioning of TNF-α enhanced the up-regulation of low-density lipoprotein receptor-related protein 1 (LRP1) levels in IPFP-MSC-EXOsTNF−α, thereby exerting chondroprotective effects.ConclusionTNF-α preconditioning constitutes an effective and promising method for optimizing the therapeutic effects of IPFP-MSCs derived exosomes in the treatment of OA.Graphical

Quero usar corticosteroides numa articulação. O que considerar?

The use of intra-articular corticosteroids is frequent in joint pathology, particularly in osteoarthritis. Although it offers a temporary relief of pain, inflammation and function, their long-term safety and efficacy remain controversial. Particulate corticosteroids have a sustained release, while non-particulate corticosteroids have a faster onset of action but a shorter duration of effect. This narrative review highlights the importance of informed IAC selection based on pharmacokinetics, potential benefits, and cartilage risks.