Procyanidin B3 Prevents Articular Cartilage Degeneration and Heterotopic Cartilage Formation in a Mouse Surgical Osteoarthritis Model

Osteoarthritis (OA) is a common disease in the elderly due to an imbalance in cartilage degradation and synthesis. Heterotopic ossification (HO) occurs when ectopic masses of endochondral bone form within the soft tissues around the joints and is triggered by inflammation of the soft tissues. Procyanidin B3 (B3) is a procyanidin dimer that is widely studied due to its high abundance in the human diet and antioxidant activity. Here, we evaluated the role of B3 isolated from grape seeds in the maintenance of chondrocytes in vitro and in vivo. We observed that B3 inhibited H2O2-induced apoptosis in primary chondrocytes, suppressed H2O2- or IL-1ß−induced nitric oxide synthase (iNOS) production, and prevented IL-1ß−induced suppression of chondrocyte differentiation marker gene expression in primary chondrocytes. Moreover, B3 treatment enhanced the early differentiation of ATDC5 cells. To examine whether B3 prevents cartilage destruction in vivo, OA was surgically induced in C57BL/6J mice followed by oral administration of B3 or vehicle control. Daily oral B3 administration protected articular cartilage from OA and prevented chondrocyte apoptosis in surgically-induced OA joints. Furthermore, B3 administration prevented heterotopic cartilage formation near the surgical region. iNOS protein expression was enhanced in the synovial tissues and the pseudocapsule around the surgical region in OA mice fed a control diet, but was reduced in mice that received B3. Together, these data indicated that in the OA model, B3 prevented OA progression and heterotopic cartilage formation, at least in a part through the suppression of iNOS. These results support the potential therapeutic benefits of B3 for treatment of human OA and heterotopic ossification

Recommendations for the diagnosis of pediatric tuberculosis

Tuberculosis (TB) is still the world's second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease

Images in Medicine - Robinow syndrome

A 10-year Hispanic girl, born of unrelated parents (first child of a 36-year-old woman and a 42-year-old man), after a normal pregnancy, had presented with short stature and facial dysmorphism. There was no significant peri-natal history and family history was negative for birth defects and genetic disorders. Anthropometry at 6-months revealed weight of 4300 gms, height of 54 cms, and head circumference of 36 cms (all < 3rd centile). There was history of neonatal jaundice and recurrent respiratory infections in infancy and childhood. Examination revealed dysmorphic facial features (including macrocephaly, frontal bossing, hypertelorism (interpupillary distance of 7 cms), prominent eyes, down-slanting palpebral fissures, small nose, prominent philtrum, down turned angles of the mouth, crowded teeth and posteriorly rotated ears) (Figure 1), brachymelia with brachydactyly, camptodactyly (Figure 2), mid-thoracic scoliosis with hemivertebrae and rib crowding (Figure 3), and genital anomalies in the form of hypoplastic clitoris and labia majora. She had hypoplastic nails in all digits, hyperlaxity of joints in upper and lower limbs, with associated skin laxity. There was no evidence of any umbilical or abdominal wall anomalies and no associated organomegaly. She had a cleft palate that was repaired at the age of 2 years. Anthropometry (at age 10) revealed a height of 136.5 cms (25th-50th percentile), weight of 39.5 kg (75th-90th percentile), mesomelic dwarfism with UL: LL ratio of 1.6 and forearm brachymelia with arm to forearm ratio of 1.5: 1. She was Tanner stage I in terms of sexual maturity, had obvious neurological and developmental delay with a functioning I.Q at a 4-year-old level. Her bone age was 8 years 5 months at a chronologic age of 10 years. CT brain revealed an absent corpus callosum, while cardiac assessment did not reveal any associated anomalies. Endocrine work-up (Growth hormone, LH, FSH, oestrogen, progesterone, IGF-1, T3,T4, and, TSH) as well as immunological work up (T-cell and B-cell functions) was normal. A diagnosis of Robinow syndrome was made

Images in Medicine: Apert Syndrome

A 2 1/2 months old female child born of consanguineous marriage, presented with dysmorphic features and hand and foot deformities. Examination revealed craniofacial and limb dysmorphism in the form of brachycephaly, sutural fusion, open anterior fontanelle, hyperteleorism, malar hypoplasia, high arched palate with cleft palate, low set ears and syndactyly in all digits of hands and feet (Figure 1). There were no other associated congenital anomalies. Based on clinico-radiological evaluation a diagnosis of Apert syndrome was made

Case Report - The Cerebro-Costo-Mandibular Syndrome: 9-Year Follow-up of a Case

Cerebro-costo-mandibular syndrome (CCMS) is a rare multiple congenital anomaly with a low survival rate. There are few reports of long-term survival in this condition. We describe the findings and management of a 9-year-old survivor of CCMS, outline the importance of early intervention and multidisciplinary team approach. The child presented in the neonatal period in respiratory distress with classical features of the syndrome. Aggressive initial respiratory management was later followed up with an integrated multidisciplinary team approach. He has been carefully followed up for nine years now, illustrating well, the course of the syndrome

Surgical dislocation of the hip for the fixation of acetabular fractures

Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and femoral head, reduction of the fracture under direct vision and avoidance of intra-articular penetration with hardware. We report 60 patients with selected types of acetabular fracture who were treated using this approach. Six were lost to follow-up and the remaining 54 were available for clinical and radiological review at a mean follow-up of 4.4 years (2 to 9). Substantial damage to the intra-articular cartilage was found in the anteromedial portion of the femoral head and the posterosuperior aspect of the acetabulum. Labral lesions were predominantly seen in the posterior acetabular area. Anatomical reduction was achieved in 50 hips (93%) which was considerably higher than that seen in previous reports. There were no cases of avascular necrosis. Four patients subsequently required total hip replacement. Good or excellent results were achieved in 44 hips (81.5%). The cumulative eight-year survivorship was 89.0% (95% confidence interval 84.5 to 94.1). Significant predictors of poor outcome were involvement of the acetabular dome and lesions of the femoral cartilage greater than grade 2. The functional mid-term results were better than those of previous reports. Surgical dislocation of the hip allows accurate reduction and a predictable mid-term outcome in the management of these difficult injuries without the risk of the development of avascular necrosis