Increased interleukin-26 in the peripheral joints of patients with axial spondyloarthritis and psoriatic arthritis, co-localizing with CD68-positive synoviocytes

Objectives: IL26 levels are elevated in the blood and synovial fluid of patients with inflammatory arthritis. IL26 can be produced by Th17 cells and locally within joints by tissue-resident cells. IL26 induces osteoblast mineralization in vitro. As osteoproliferation and Th17 cells are important factors in the pathogenesis of axial spondyloarthritis (axSpA), we aimed to clarify the cellular sources of IL26 in spondyloarthritis. Methods: Serum, peripheral blood mononuclear cells (n = 15–35) and synovial tissue (n = 3–9) of adult patients with axSpA, psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and healthy controls (HCs, n = 5) were evaluated by ELISA, flow cytometry including PrimeFlow assay, immunohistochemistry and immunofluorescence and quantitative PCR. Results: Synovial tissue of axSpA patients shows significantly more IL26-positive cells than that of HCs (p < 0.01), but numbers are also elevated in PsA and RA patients. Immunofluorescence shows co-localization of IL26 with CD68, but not with CD3, SMA, CD163, cadherin-11, or CD90. IL26 is elevated in the serum of RA and PsA (but not axSpA) patients compared with HCs (p < 0.001 and p < 0.01). However, peripheral blood CD4+ T cells from axSpA and PsA patients show higher positivity for IL26 in the PrimeFlow assay compared with HCs. CD4+ memory T cells from axSpA patients produce more IL26 under Th17-favoring conditions (IL-1β and IL-23) than cells from PsA and RA patients or HCs. Conclusion: IL26 production is increased in the synovial tissue of SpA and can be localized to CD68+ macrophage-like synoviocytes, whereas circulating IL26+ Th17 cells are only modestly enriched. Considering the osteoproliferative properties of IL26, this offers new therapeutic options independent of Th17 pathways

Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases

Abstract Background Several surgical options for the reconstruction of massive bone defects have been described and include biologic methods with autografts and allografts, and the use of tumor endoprostheses (total femoral replacement, TFR). Several types of modular TFR are available, but nevertheless unpredictable outcomes and high complication rates have been described from most authors. The present study aims to compare results after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients with and without malignant disease. Methods Retrospective chart review and functional investigation (Musculoskeletal Tumor Society (MSTS) score, Harris Hip Score (HHS), Oxford Knee Score (OKS), SF-12 Health Survey, and failure classification according to Henderson) of TFR cases from 1995 to 2011. Indications for TFR were malignant tumor resection from the femur (n = 9, Group A) or failure of a revision arthroplasty without history of malignant disease (n = 13, Group B). Results Thirty-six patients were treated during the study period, of whom 22 could be investigated clinically after a mean follow-up of 63 months. Overall failure rate for TFR was 59.1%, leading to 38 surgical revisions. The most common failure mechanisms were Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). Mean MSTS score out of 30 was 13 (range 1–25), with significantly higher scores in Group A (mean 19, range 3–25) than Group B (mean 9, range 1–15). Conclusion TFR is an established procedure to restore femoral integrity. However, complication rates are considerably high, and depend mainly on the age at initial reconstruction

Distal femoral replacement with the MML system: a single center experience with an average follow-up of 86 months

Abstract Background The aim of this study was to compare the functional outcomes and complication rates after distal femoral replacement (DFR) performed with the modular Munich-Luebeck (MML) modular prosthesis (ESKA/Orthodynamics, Luebeck, Germany) in patients being treated for malignant disease or failed total knee arthroplasty. Methods A retrospective review of patient charts and a functional investigation (involving Musculoskeletal Tumor Society Score [MSTS], American Knee Society Score [AKSS], Oxford Knee Score [OKS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Toronto Extremity Salvage Score [TESS], the 12-Item Short-Form [SF-12] Health Survey, and a failure classification system developed by Henderson et al.) of DFR cases from 2002 to 2015 were conducted. The indications for DFR were malignant tumor resection in the femur (n = 20, group A) or failure of revision total knee arthroplasty without a history of malignant disease (n = 16, group B). Results One-hundred and twenty-nine patients were treated during the study period. Of these, 82 were analyzed for complications and implant-survival. Further, 36 patients were available for functional assessment after a mean follow-up of 86 months (range: 24–154). There were 75 complications in total. The overall failure rate for DFR was 64.6% (53/82 patients). The most common failure mechanisms were type III (mechanical failure), followed by type I (soft tissue) and type II (aseptic loosening). The mean MSTS score (out of 30) was 17 for group A and 12 for group B. All the clinical outcome scores revealed an age-dependent deterioration of function. Conclusion DFR is an established procedure to restore distal femoral integrity. However, complication rates are high. Post-procedure functionality depends mainly on the patient’s age at initial reconstruction

Prognostic factors and outcome of Liposarcoma patients: a retrospective evaluation over 15 years

Abstract Background Soft tissue sarcomas are rare entities with over 50 histological subtypes. Liposarcoma (LS) is the most common neoplasm in this group; it is a complex neoplasm that is divided into different histological subtypes. Different therapy options, such as surgical resection, radiation, and chemotherapy, are available. Depending on the subtype, location, status of the resection margins and metastatic status, different therapy options are used. Therefore, the aim of this study was to determine the prognostic factors influencing the survival of patients affected by LS with consideration for the grading, histological subtype, state of the resection margin, size, location, metastases and local recurrence in a retrospective, single-centre analysis over 15 years. Methods We included 133 patients (male/female = 67/66) in this study. We recorded the histologic subtype, grade, TNM classification, localization, biopsy technique, tumour margins, number of operations, complications, radiation and dose, chemotherapy, survival, recrudescence, metastases and follow-up. Survivorship analysis was performed. Results We detected 56 (43%; 95%-CI 34.6–51.6%) atypical LS cases, 21 (16.2%; 95%-CI 9.8–22.5) dedifferentiated LS cases, 40 (30.8%; 95%-CI 22.8–38.7) myxoid LS cases and 12 (9.2%; 95%-CI 4.3–14.2) pleomorphic LS cases. G1 was the most common grade, which was followed by G3. Negative margins (R0) were detected in 67 cases (53.6%; 95%-CI 44.9–62.3) after surgical resection. Local recurrence was detected in 23.6% of cases. The presence of metastases and dedifferentiated LS subtype as well as negative margins, grade and tumour size are significant prognostic factors of the survival rates (p < 0.015). Conclusion Grading, LS subtype, negative margins after surgery, metastases and tumour size are independently associated with disease-specific survival, and patients with local recurrence had lower survival rates. We hope our investigation may facilitate a further prospective study and clinical decision-making in LS

Hyaluronic Acid Suppresses the Expression of Metalloproteinases in Osteoarthritic Cartilage Stimulated Simultaneously by Interleukin 1β and Mechanical Load - Fig 5

<p><b>(a)</b> Relative gene expression of MMP-1 in the 3 study groups: (1) 2ng/ml IL1ß + mechanical loading, (2) 2ng/ml IL1ß + mechanical loading + 1mg/ml HA, (3) 2ng/ml IL1ß + mechanical loading + 3mg/ml HA and the control; * indicates statistical significance with p<0,05; <b>(b)</b> Relative gene expression of MMP-2 in the 3 study groups: (1) 2ng/ml IL1ß + mechanical loading, (2) 2ng/ml IL1ß + mechanical loading + 1mg/ml HA, (3) 2ng/ml IL1ß mechanical loading + 3mg/ml HA and the control; * indicates statistical significance with p<0,05.</p

Numbers of viable bacteria in suspension incubated for 3 hours with novel antimicrobial sutures.

<p>An initial <i>S</i>. <i>aureus</i> concentration of 1.3 x 10⁸ cfu/ml was used for bacterial suspensions. Chlorhexidine- or octenidine-coated sutures showed a strong inhibition of pathogens in the surrounding suspensions. The triclosan-coated suture Vicryl^® Plus (VP) and the uncoated Gunze suture (G) were used as controls. Fatty acid-coated sutures (PA80, LA80) and commercial sutures without any drug content (V: Vicryl^®, R: PGA Resorba^®) were tested within the non-antimicrobial suture group. Significance levels are p<0.05 (*), p<0.01 (**) and p<0.001 (***); n.s.: not significant, n.a.: not applicable.</p

Photomicrographs of articular cartilage samples.

<p>(<b>a</b> and <b>b</b>) H&E stained sections of K&L2 and K&L4 cartilage samples upon stimulation with Il1ß and mechanical loading. (<b>c</b> and <b>d</b>) Safranin O stained sections of K&L2 and K&L4 cartilage samples upon stimulation with Il1ß and mechanical loading. (<b>e</b> and <b>f</b>) H&E stained sections of K&L2 and K&L4 cartilage samples upon additional administration of 1 mg/ml HA. (<b>g</b> and <b>h</b>) Safranin O sections of K&L2 and K&L4 cartilage samples upon additional administration of 1 mg/ml HA. Scale bar = 500 μm.</p

Numbers of adhered <i>S</i>. <i>aureus</i> colonies on sutures’ surfaces per cm sample after 3 hours of incubation in on average 1.3 x 10⁸ cfu/ml bacterial suspension.

<p>Viably adhered numbers of bacteria and their reductions compared to uncoated Gunze (G) suture. <b>Left</b> (up to dashed line): Sutures coated with antimicrobial substances, such as chlorhexidine-laurate (CL), chlorhexidine-palmitate (CP), octenidine-laurate (OL), and octenidine-palmitate (OP) each with the drug concentration 11, 22, and 33 μg/cm. Novel coated sutures were also compared to commercially available triclosan-containing Vicryl^® Plus (VP) suture. <b>Right</b>: Groups of sutures without active antimicrobial agents, uncoated Gunze (G), coated with fatty acids (PA80, LA80) and commercially available common resorbable sutures (V: Vicryl^®, R: PGA Resorba^®). Significance levels are p<0.05 (*), p<0.01 (**) and p<0.001 (***); n.s.: not significant, n.a.: not applicable.</p

Rating levels used for comparative antimicrobial suture evaluation.

<p>Rating levels used for comparative antimicrobial suture evaluation.</p