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Rheumatoid arthritis (RA) is a chronic, inflammatory systemic disorder of synovial joints and results in polyarthritis, chronical degeneration, and finally deformities and ankylosis in severe cases. Synovitis and pannus formation are results of inflammatory changes and lead into restriction in joint movement. Shoulders are among the later affected and larger joints and formation of synovitis in early active stages and pannus in later stages might be concluded with frozen shoulder and severe impairment in functionality. These late-term changes cannot be controlled with systemic or local anti-inflammatory agents and synovectomy is chosen in some cases. However, the results are not satisfactory and recurrence is common. In this case report, we presented a case of RA with severe shoulder pain, restricted movement due to synovial hypertrophy, and pannus formation which are resistant to local and systemic interventions and not suitable for surgical or chemical synovectomy. Microwave ablation (MWA) was performed successfully without any complication and she well responded in terms of DAS-28, functional, and pain scores. Range of motion and funcitonal restriction were recovered. This case report describes the use and promising results of MWA in RA with severe synovial hypertrophy and pannus formation even in the absence of active arthritis and effusion. MWA is a safe and minimally invasive technique that can be easily performed in coordinance of rheumatologists and interventional radiologists in proper cases. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The goal of this histological study was to assess the biocompatibility of vascular patches used in the repair of congenital heart defects. METHODS We examined tissue-engineered bovine (n = 7) and equine (n = 7) patches and autologous human pericardium (n = 7), all explanted due to functional issues or follow-up procedures. Techniques like Movat-Verhoeff, von Kossa and immunohistochemical staining were used to analyse tissue composition, detect calcifications and identify immune cells. A semi-quantitative scoring system was implemented to evaluate the biocompatibility aspects, thrombus formation, extent of pannus, inflammation of pannus, cellular response to patch material, patch degradation, calcification and neoadventitial inflammation. RESULTS We observed distinct material degradation patterns among types of patches. Bovine patches showed collagen disintegration and exudate accumulation, whereas equine patches displayed edematous swelling and material dissolution. Biocompatibility scores were lower in terms of cellular response, degradation and overall score for human autologous pericardial patches compared to tissue-engineered types. The extent of pannus formation was not influenced by the type of patch. Bovine patches had notable calcifications causing tissue hardening, and foreign body giant cells were more frequently seen in equine patches. Plasma cells were frequently detected in the neointimal tissue of engineered patches. CONCLUSIONS Our results confirm the superior biocompatibility of human autologous patches and highlight discernible variations in the changes of patch material and the cellular response to patch material between bovine and equine patches. Our approach implements the semi-quantitative scoring of various aspects of biocompatibility, facilitating a comparative quantitative analysis across all types of patches, despite their inherent differences. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to an open surgical aortic valve replacement (SAVR) for treating severe symptomatic aortic stenosis. Despite gaining widespread acceptance and approval for use in patients with high, moderate, and low surgical risk, the increasing use of TAVR has raised concerns about potential short- and long-term complications. We present the case of a 69-year-old female who underwent TAVR and subsequently presented to our outpatient cardiology clinic with progressively worsening dyspnea, orthopnea, and paroxysmal nocturnal dyspnea two years after the procedure. Echocardiography and stress testing revealed a recurrence of aortic stenosis, leading to a diagnosis of structural valve deterioration. The patient was subsequently scheduled for SAVR, which revealed commissural fusion, scarring, and unusual pannus formation that significantly narrowed the effective valve area, necessitating valve replacement. Despite requiring SAVR, two years after TAVR, the patient had a favorable postoperative course and outcome on follow-up. This case underscores the importance of continued surveillance and evaluation of patients who undergo TAVR, as they remain at risk for long-term complications such as structural valve deterioration. Proper management, including timely diagnosis and intervention, can lead to successful outcomes in such patients. This case underscores the importance of continued surveillance and evaluation of patients who undergo transcatheter aortic valve replacement, as they remain at risk for long-term complications such as structural valve deterioration. Proper management, including timely diagnosis and intervention, can lead to successful outcomes in such patients. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsThe prevalence of trachomatous inflammation—follicular (TF) in Papua New Guinea (PNG) suggests antibiotic mass drug administration (MDA) is needed to eliminate trachoma as a public health problem but the burden of trichiasis is low. As a result, WHO issued bespoke recommendations for the region. If ≥ 20% of 10–14-year-olds have both any conjunctival scarring (C1 or C2 or C3) and corneal pannus and/or Herbert’s pits, MDA should be continued. Equally, if ≥ 5% of that group have both moderate/severe conjunctival scarring (C2 or C3) and corneal pannus and/or Herbert’s pits, MDA should be continued.We identified 14 villages where > 20% of 1−9-year-olds had TF during baseline mapping undertaken 4 years and 1 month previously. Every child aged 10−14 years in those villages was eligible to be examined for clinical signs of corneal pannus, Herbert’s pits and conjunctival scarring. A grading system that built on existing WHO grading systems was used.Of 1,293 resident children, 1,181 (91%) were examined. Of 1,178 with complete examination data, only one (0.08%) individual had concurrent scarring and limbal signs.The WHO-predefined criteria for continuation of MDA were not met. Ongoing behavioural and environmental improvement aspects of the SAFE strategy may contribute to integrated NTD control. Surveillance methods should be strengthened to enable PNG health authorities to identify future changes in disease prevalence. [ABSTRACT FROM AUTHOR]

Background: Failure of mechanical prothesis after mechanical valve replacement is a dreadful complication. Pannus and thrombosis are common causes of dysfunction. Different strategic plans for management are available but current approach still needs more evidence. Methods: Retrospective study analysis data of patients operated secondary to mechanical valve obstruction (MVO) from July 2014 to December 2019. Preoperative, operative and post operative are collected and analyzed. Results: 27 patients were operated secondary to MVO. Mean age was 31±12 years. Majority of patients were female 15 (55.5 %) and most of patients in NYHA class III. TTE data showed persevered EF (50 ± 11). MVO differ according to obstructed valve, 15 patients with mitral valve thrombus, and 5 of them thrombus and pannus. In aortic valve obstruction, 12 patients were with pannus and 3 of them with thrombus. The commonest preoperative rhythm was sinus rhythm in 17 patients while AF in 10 patients. Mean bypass time was 117 ± 11 per/min while aortic cross clamp was 99 ± 12 per/min. Mitral valve replacement was done in 12 patients and, valve thrombectomy in 5 patients. In Aortic valve obstruction, 9 valve replacement were done and 3 excisions of the pannus. In the present study, the total bleeding was 635 ± 325 ml, and no cases re-explored. One case needed permeant pacing. Total ICU stay was 43 ± 12 hours while total hospital stay was 9.07 ± 1.5 days. Mortality was 2 patients; one patient was early secondary to NYHA status and acute heart failure. The 2 nd was late secondary to endocarditis. Early and mid-term follow up showed no pannus formation or reintervention with mean follow up period up to 36 months. Conclusions: MVO is serious and life-threatening complications. Urgent intervention is the clue. Conservative or surgical approach should be directed for each patient. Thrombolysis has limited role and restricted indications and should directed to critically ill and high-risk patient, while open thrombectomy and pannus excision has good early and mid-term outcome but still lack long term outcome and more evidence still needed. Surgery is the definitive treatment with documented good long-term outcome. [ABSTRACT FROM AUTHOR]

Introduction: Rheumatoid arthritis (RA) is a common health problem with a serious impact on quality of life. Hence, variable therapeutic regimens have been tested to ameliorate the symptoms and hinder the disease progression. Aim of the Work: To assess the therapeutic effect of ginger (GR) or glucosamine sulfate (GAS) separately versus their combined administration in a rat model of induced-RA. Materials and Methods: Sixty adult female albino rats were allocated into five groups; 20 rats were the control group I. RA was induced by a single intra-articular injection of 100 μL of Complete Freund’s Adjuvant (CFA) in the knee joints of the remaining forty rats, then distributed after 7 days into: RA group II, GR group III (received 400 mg GR/kg/day), GAS group IV (received 250 mg GAS/kg/day), and combined treatment group V. Treatment groups were euthanized after 28 days. Assessment of serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) was done. Right knee joints were dissected for gross macroscopic and scanning electron microscope (SEM) examinations. Left knee joints were processed for a histological examination by hematoxylin and eosin (H & E) and Masson’s trichrome stains. Results: In group V, serum levels of TNF-α and IL-6 restored nearly their control values. Gross and SEM examinations revealed mostly regular articular cartilage surfaces. Histologically, mostly smooth cartilage surfaces were observed with preserved joint space and distinct cartilage zones, in comparison to GR and GAS treated groups that exhibited limited surface irregularities and invasion of the joint space by pannus tissue, in some sections. Trichrome stained sections demonstrated a significant decline in percentage area of collagen within the pannus in group V as compared to RA group. Conclusion: The combined treatment enhanced the therapeutic effect of GR and GAS, thus resulted in the most prominent improvement in all assessed parameters. [ABSTRACT FROM AUTHOR]

Substitution of a defective heart valve with a prosthetic heart valve turns the native disease for prosthesis-related complications. One of the most serious and dreaded complications is prosthetic valve obstruction. It is either the result of a thrombus or pannus formation. For the evaluation of prosthetic valve obstruction, transthoracic echography and fluoroscopy provide functional information but may not provide information about the etiology of the obstruction, unlike multidetector computed tomography (MDCT) which allows a more precise etiological diagnosis to guide the therapeutic attitude. Here, we report a case of a mechanical prosthetic mitral valve obstruction in a 45-year-old patient in whom the diagnosis of pannus was retained on the basis of clinical, biological, and imaging data. The differentiation between thrombus and pannus is crucial because it conditions the therapeutic attitude. Advanced imaging specially MDCT options should be considered whenever mechanical prosthesis valve obstruction is suspected.

Rheumatoid arthritis (RA) is the most common chronic autoimmune disease worldwide. Although progress has been made in RA treatment in recent decades, remission cannot be effectively achieved for a considerable proportion of RA patients. Thus, novel potential targets for therapeutic strategies are needed. Semaphorin 5A (SEMA5A) plays a pivotal role in RA progression by facilitating pannus formation, and it is a promising therapeutic target. In this study, we sought to develop an antibody treatment strategy targeting SEMA5A and evaluate its therapeutic effect using a collagen-induced arthritis (CIA) model. We generated SYD12–12, a fully human SEMA5A blocking antibody, through phage display technology. SYD12–12 intervention effectively inhibited angiogenesis and aggressive phenotypes of RA synoviocytes in vitro and dose-dependently inhibited synovial hyperplasia, pannus formation, bone destruction in CIA mice. Notably, SYD12–12 also improved the Treg/Th17 imbalance in CIA mice. We confirmed through immunofluorescence and molecular docking that SYD12–12 integrated with the unique TSP-1 domain of SEMA5A. In conclusion, we developed and characterized a fully human SEMA5A-blocking antibody for the first time. SYD12–12 effectively alleviated disease progression in CIA mice by inhibiting pannus formation and improving the Treg/Th17 imbalance, demonstrating its potential for the RA treatment.

Rheumatoid arthritis is a chronic inflammatory systemic autoimmune disorder that affects the joints, but often also other organs. It is the most common inflammatory rheumatic disease. Patients with rheumatoid arthritis suffer from chronic joint pain, disability, and increased mortality. The joints affected are usually those of the limbs, hands, and feet. If rheumatoid arthritis is not controlled with appropriate medication, it gradually leads over the years to destruction and permanent deformation of the joints, due to erosion of the cartilage and bone. The result of the condition is the disruption of joint mobility, the irreversible functional disability, the impairment of the patient's productivity and quality of life. The disease requires long-term medical monitoring and appropriate medication to suppress the inflammatory process, prevent deformities and maintain patients' functionality. One of the effects of the disease is the appearance of pannus, which is an aggressive structure in the inflamed rheumatoid joint that invades the cartilage and bone, thus causing irreversible joint damage. This article focuses bibliographically on rheumatoid arthritis and pannus to reveal the relationship between them. [ABSTRACT FROM AUTHOR]

As neoplasias oculares representam uma crescente na rotina oftalmológica veterinária. O carcinoma de células escamosas (CCE) era descrito como rara em cães; porém, houve um aumento dos casos devido às diferentes etiologias. A presença de ceratites crônicas e a exposição à radiação ultravioleta são alguns desses fatores. O presente trabalho, teve como objetivo relatar a crioterapia, técnica que foi efetiva no tratamento do CCE. Foi atendido um cão de 13 anos, sem raça definida, em um centro veterinário em Londrina, Paraná, apresentando uma neoformação no olho direito. Ao exame oftálmico, não constatou nenhuma outra alteração. Os reflexos pupilares diretos e consensuais estavam presentes, assim como a pressão intraocular era de 12 mmHg. Realizou-se a biomicroscopia com a lâmpada de fenda que mostrou o aumento da espessura e vascularização da córnea superficial, com a neoformação infiltrando o epitélio e início estromal. Diante disso, o diagnóstico de CCE e a decisão de remoção da neoplasia. Assim, foi realizada uma ceratectomia lamelar associada à técnica da crioterapia, mediante a tarsorrafia temporária. A suspeita do carcinoma é feita com base morfológica macroscópica da lesão e sua localização; porém, o diagnóstico definitivo é pelo histopatológico com exame microscópico do tecido lesado. Conclui-se que pelo seu histórico, etiologias descritas e o exame histopatológico são fundamentais para o diagnóstico do CCE.

Aims We aimed to evaluate the efficacy of the measured effective orifice area (EOA)/reference EOA ratio in discriminating mechanical prosthetic aortic valve (PAV) obstruction. Methods and results This is a retrospective study of 193 mechanical PAV patients with an elevated mean transprosthetic pressure gradient (PG) over 20 mmHg or peak velocity over 3 m/s. Of those, 143 patients were objectively proven PAV obstruction with cardiac computed tomography or surgical inspection. The EOA was measured using the continuity equation, and the reference EOA values were obtained from previous guidelines. The measured/reference EOA ratio was significantly lower in the obstruction group (0.63 ± 0.18 vs. 0.86 ± 0.17; P < 0.001). The EOA ratio added incremental value for discriminating obstruction from the conventional parameters recommended in the guidelines. Receiver operating characteristic curve analysis revealed that the measured/reference EOA ratio discriminated PAV obstruction from those without obstruction [area under the curve (AUC), 0.840; 95% confidence interval, 0.783–0.898; P < 0.001]. A cutoff of 0.71 had 73.4% sensitivity and 82.0% specificity. The novel diagnostic algorithm adding the EOA ratio had similar accuracy to previous guideline algorithms, including reference EOA, and conventional Doppler parameters (AUC, 0.763 vs. 0.731; P = 0.309). In patients with a large PAV (≥23 mm), the novel algorithm had higher accuracy than the previous algorithm (AUC, 0.788 vs. 0.642; P = 0.019). Conclusion The ratio of measured/reference EOA adds incremental value over conventional Doppler parameters and might be helpful for distinguishing PAV obstruction. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate if supraumbilical midline vertical incision performed in patients with a hanging pannus (umbilicus at the level of the pubic bone) is a reasonable alternative to the Pfannenstiel in patients with body mass index (BMI) ≥ 50 kg/m 2 undergoing cesarean delivery. Study Design Retrospective cohort study in patients with BMI ≥ 50 kg/m 2 undergoing cesarean delivery at a single center from 2016 to 2020. Study groups were Pfannenstiel's versus supraumbilical vertical skin incision. If patients had a hanging pannus (umbilicus at the level of the pubic bone), vertical incisions were performed. Otherwise, Pfannenstiel's incision was performed. Decision for the incision was made prospectively. Primary outcome was a composite of need for blood transfusion, presence of immediate surgical complications, and presence of delayed surgical complications. Secondary outcomes included the individual components of the primary outcome, the median surgical blood loss, total operative time, time from skin incision to delivery of neonate, hysterotomy type, and neonatal outcomes. MedCalc 19.5.1 was used for analysis. Results A total of 103 patients with BMI ≥50 kg/m 2 were included. Of those, 68 (66%) had Pfannenstiel's and 35 (34%) had supraumbilical vertical incisions. There was no statistically significant difference in the incidence of the primary outcome (12 vs. 11%, p = 0.96). There was neither significant difference in immediate or delayed postoperative complications nor in neonatal outcomes. However, patients in the vertical midline incision group were more likely to have a classical hysterotomy (52%) compared with the Pfannenstiel group (6%; p < 0.05), increased overall median surgical blood loss (1,000 vs. 835 mL, p < 0.05), and increased total surgical time by a median of 30 minutes (p < 0.05). Conclusion In patients with super obesity and hanging pannus, performing a supraumbilical vertical midline incision offers a reasonable alternative to Pfannenstiel's incision, but patients should be counseled about the increased risk for classical hysterotomy and implications in future pregnancies. Key Points Patients with BMI >50 kg/m 2 were allocated to different incision types based on subcutaneous fat distribution pattern. If umbilicus was at level of pubic bone, supraumbilical vertical skin incision was made There were no significant differences between Pfannenstiel's and supraumbilical vertical incisions in terms of the composite outcome and immediate or delayed postoperative complications and neonatal outcomes. In patients with a hanging pannus, performing a supraumbilical vertical midline incision offers a reasonable alternative to Pfannenstiel's incision, but patients should be counseled about the increased risk for classical hysterotomy and subsequent implications in future pregnancies. [ABSTRACT FROM AUTHOR]

A ceratite superficial crônica é uma doença corneana inflamatória e progressiva que afeta cães, podendo levar à cegueira. É mais comum em algumas raças, entre elas o Pastor Alemão. A exposição a raios ultravioleta e altitudes elevadas parece estar relacionada ao desenvolvimento da doença. Os sinais clínicos incluem proliferação fibrosa no limbo temporal, vasos avançando em direção à córnea central e pigmentação corneana. A base imunomediada da doença é apoiada por características histopatológicas e resposta ao tratamento com imunossupressores tópicos. O diagnóstico é baseado em exame clínico, predisposição racial e resposta ao tratamento. No presente relato, o objetivo foi relatar um caso de ceratite superficial crônica em um Pinscher com características clínicas diferentes dos encontrados na literatura.

Retro-odontoid pseudotumors are rare inflammatory complications of atlantoaxial instability often associated with cervical degenerative disease and rheumatoid arthritis. While propagation of these lesions has been shown to cause spinal cord compression and cervical myelopathy, intradural extension has rarely been reported. In this manuscript and 2-dimensional illustrative intraoperative video, we demonstrate cervical decompression, removal of the intradural component, and stabilization with C1-2 instrumentation using a posterior approach. A 71-year-old patient presented with progressive cervical myelopathy. Preoperative imaging demonstrated a large retro-odontoid pannus causing severe spinal cord compression and an associated contrast-enhancing intradural lesion, in the absence of obvious C1-2 instability or fractures on computed tomography scan. C1-2 posterior decompression and fusion were performed with maximally safe intradural pannus resection and ventral dural reconstruction. Postoperatively, the patient experienced significant improvement in myelopathic symptoms. Imaging demonstrated good spinal cord decompression with complete intradural pannus resection and debulking of the extradural component. Our outcome in this rare complication suggests a posterior approach may be effective in treating similar patients. [ABSTRACT FROM AUTHOR]

Connective tissue growth factor (CTGF) has been recently acknowledged as an ideal biomarker in the early disease course, participating in the pathogenesis of pannus formation in rheumatoid arthritis (RA). However, existing approaches for the detection of or antagonist targeting CTGF are either lacking or unsatisfactory in the diagnosis and treatment of RA. To address this, we synthesized and screened high-affinity single-stranded DNA aptamers targeting CTGF through a protein-based SELEX procedure. The structurally optimized variant AptW2-1-39-PEG was characterized thoroughly for its high-affinity (KD 7.86 nM), sensitivity (minimum protein binding concentration, 2 ng), specificity (negative binding to other biomarkers of RA), and stability (viability-maintaining duration in human serum, 48 h) properties using various biochemical and biophysical assays. Importantly, we showed the antiproliferative and antiangiogenic activities of the aptamers obtained using functional experiments and further verified the therapeutic effect of the aptamers on joint injury and inflammatory response in collagen-induced arthritis (CIA) mice, thus advancing this study into actual therapeutic application. Furthermore, we revealed that the binding within AptW2-1-39-PEG/CTGF was mediated by the thrombospondin 1 (TSP1) domain of CTGF using robust bioinformatics tools together with immunofluorescence. In conclusion, our results revealed a novel aptamer that holds promise as an additive or alternative approach for CTGF-targeting diagnostics and therapeutics for RA. [ABSTRACT FROM AUTHOR]

Chronic superficial keratitis (CSK) is a progressive inflammatory condition of the eye (cornea) that can cause discomfort and blindness. Differential disease risk across dog breeds strongly suggests that CSK has a genetic basis. In addition to genetic risk, the occurrence of CSK is exacerbated by exposure to ultraviolet light. Genome-wide association analysis considered 109 greyhounds, 70 with CSK and the remainder with normal phenotype at an age over four years. Three co-located variants on CFA18 near the 5′ region of the Epidermal Growth Factor Receptor (EGFR) gene were associated with genome-wide significance after multiple-test correction (BICF2P579527, CFA18: 6,068,508, praw = 1.77 × 10−7, pgenome = 0.017; BICF2P1310662, CFA18: 6,077,388, praw = 4.09 × 10−7, pgenome = 0.040; BICF2P160719, CFA18: 6,087,347, praw = 4.09 × 10−7, pgenome = 0.040) (canFam4)). Of the top 10 associated markers, eight were co-located with the significantly associated markers on CFA18. The associated haplotype on CFA18 is protective for the CSK condition. EGFR is known to play a role in corneal healing, where it initiates differentiation and proliferation of epithelial cells that in turn signal the involvement of stromal keratocytes to commence apoptosis. Further validation of the putative functional variants is required prior to their use in genetic testing for breeding programs. [ABSTRACT FROM AUTHOR]

Objective: To investigate the therapeutic mechanism of Tujia medicine Toddalia asiatica alcohol extract (TAAE) for synovial pannus formation in rats with college-induced arthritis (CIA)., Methods: Sixty male SD rats were randomized into normal control group, CIA model group, TGT group, 3 TAAE treatment groups at low, medium and high doses ( n =10). Except for those in the normal control group, all the rats were subjected to CIA modeling using a secondary immunization method and treatment with saline, TGT or TAAE by gavage once daily for 35 days. The severity of arthritis was assessed using arthritis index (AI) score, and knee joint synovium pathologies were examined with HE staining. Serum levels of TNF-α, IL-6, and IL-1β were detected with ELISA; the protein expressions of PI3K, Akt, p-PI3K, p-Akt, VEGF, endostatin, HIF-1α, MMP1, MMP3, and MMP9 in knee joint synovial tissues were determined using Western blotting, and the mRNA expressions of TNF‑α, IL-6, IL-1β, VEGF, HIF-1α, PI3K, and Akt were detected with RT-PCR., Results: Treatment of CIA rat models with TAAE and TGT significantly alleviated paw swelling, lowered AI scores, and reduced knee joint pathology, neoangiogenesis, and serum levels of inflammatory factors. TAAE treatment obviously increased endostatin protein expression, downregulated p-PI3K, p-Akt, MMP1, MMP3, MMP9, VEGF, and HIF-1α proteins, and reduced TNF‑α, IL-6, IL-1β, PI3K, Akt, VEGF, and HIF-1α mRNA levels in the synovial tissues, and these changes were comparable between high-dose TAAE group and TGT group., Conclusion: TAAE can improve joint symptoms and inhibit synovial pannus formation in CIA rats by regulating the expressions of HIF-1α, VEGF, endostatin, MMP1, MMP3, and MMP9 via the PI3K/Akt signalling pathway.

The number of patients requiring heart valve surgery continues to increase with the growing life expectancy and expansion of both surgical and transcatheter valves. In patients with prosthetic heart valves (PHV), transthoracic echocardiography is the mainstay for initial assessment and serial surveillance. However, multimodality imaging, including three-dimensional transesophageal echocardiography, cardiac computed tomography, cardiac magnetic resonance, fluoroscopy, and nuclear imaging, is becoming more commonly used clinically to aid in diagnosis and to identify the mechanism of PHV dysfunction. This review aims to provide an updated overview of the use of multimodality imaging in evaluation of PHVs, to illustrate the imaging appearance of different complications, and to highlight a practical approach to help clinical decision making in challenging cases of PHV dysfunction. [ABSTRACT FROM AUTHOR]

Background‘Crowned dens syndrome' (CDS) is a special form of calcium pyrophosphate dihydrate deposition disease which is characterized radiologically by a halo-like or crown-like distribution in the periodontoid region and clinically by cervical pain. Herein, we will describe our experience of posterolateral epidural supra-C2-root approach (PESCA) for biopsy of retro-odontoid lesions in one surgical session after occipitocervical fixation and decompression in a patient with CDS and massive brainstem compression.Case PresentationA 70-year-old woman presented to our department with a 4-week history of progressive walking impairment, neck pain, neck rigidity, fever, dizziness, slight palsy of the left hand, and multiple fall episodes. Magnetic resonance imaging (MRI) of the craniovertebral junction (CVJ) and cervical spine revealed a lesion of the odontoid process and the retro-odontoid region with mainly solid components, as well as small cystic components, and brainstem compression and displacement. In first step, fusion surgery of the CVJ C0–C4 was performed with occiptocervical decompression. After fusion and decompression the lower lateral part of the C1 arc and the lateral superior part of the left side of the C2 arc were removed. The entry point was located directly above the superior part of the C2 root. A biopsy of the lateral portions of the lesions was obtained by bioptic forceps under microscope guidance. Pathologic examination of the mass revealed deposition of birefringent crystals compatible with calcium pyrophosphate. In addition to the clinical symptoms (especially neck pain), the diagnosis of CDS was made. Non-steroidal inflammatory drugs (NSAIDs) and colchicine (and later magnesium) were started. At follow-up examination 6 months after surgery, an MRI scan of the cervical spine revealed regression of the pannus and the cyst with replacement of the brainstem, clinical improvement of walking, and increased strength of the left hand.ConclusionsThis study demonstrates that PESCA can be used to obtain tissue for pathological analysis in one surgical sitting after fusion and decompression and that fusion, decompression, and PESCA (in the same session) together with subsequent conservative management could be a good alternative for the treatment of CDS.

Background:This study aimed to evaluate the clinical and surgical characteristics of patients who required reoperation after mechanical mitral valve replacement (MVR).Methods:We retrospectively identified 204 consecutive patients who underwent reoperation after mechanical MVR between 2009 and 2018. Patients were categorized according the reason for reoperation (perivalvular leakage, thrombus formation, or pannus formation). The patients' medical and surgical records were studied carefully and the rates of in-hospital complications were calculated.Results:The mean age was 51±12 years and 44% of the patients were male. The reasons for reoperation were perivalvular leakage (117 patients), thrombus formation (35 patients), and pannus formation (52 patients). The most common positions for perivalvular leakage were at the 6–10 o'clock positions (proportions of ≥25% for each hour position). Most patients had an interval of >10 years between the original MVR and reoperation. The most common reoperation procedure was re-do MVR (157 patients), and 155 of these patients underwent concomitant cardiac procedures. There were 10 in-hospital deaths and 32 patients experienced complications. The 10-year survival rate was 82.2 ± 3.9% in general, and the group of lowest rate was patients with PVL (77.5 ± 5.2%). The independent risk factors were “male” (4.62, 95% CI 1.57–13.58, P = 0.005) and “Hb

Purpose: Fibroblast-like synoviocytes (FLS) represent one of the principal effectors of joint damage in rheumatoid arthritis (RA). Recent discovery of the circulating fibrocyte, a potential precursor of FLS, has raised issues regarding the characterization of fibrocytes with respect to their morphology and their biological role. In this study, we evaluated the morphology of fibrocytes in vitro and their ability to produce different extracellular matrix (ECM) components in comparison with two populations of RA FLS: synovial fluid FLS (fd-FLS) and intimal lining FLS (td-FLS). We also studied the expression of ECM regulators and a set of cytokine receptors involved in the pathogenesis of RA. Materials and Methods: Fibrocytes were cultured from peripheral blood of patients with RA. FLS were cultured from synovial fluids and tissues. ECM proteins (collagen I (col I) and fibronectin), Matrix metalloproteinases (MMP) (MMP3, and MMP9), ECM regulators (β catenin, TCF4, and c-fos), and cytokine receptors (CXCR1, CXCR2, CXCR3, IL1RI, IL1RII, and IL6Rα) were analyzed using qRT-PCR and/or western blot. Results: Our results demonstrated that fibronectin and MMP3 levels were higher in FLS compared to fibrocytes. Although MMP9 was expressed in the three cell types, its level was greater in fibrocytes than in td/fd FLS. The three cell types expressed CXCR3, IL1RI, IL1RII, and IL6Rα, while the expression of CXCR1 and CXCR2 was restricted to fibrocytes. Conclusion: Our results demonstrated that fibrocytes express ECM molecules and cytokines receptors. The observed differences between fibrocytes and FLS may be due to their distinct functions or differentiation state during RA. Abbreviations: RA: Rheumatoid ArthritisFLS: fibroblast-like synoviocytestd: tissue derivedfd: fluid derivedSF: Synovial FluidWnt: WinglessMMP: Matrix MetalloproteinaseCIA: murine collagen induced arthritisECM: Extracellular matrixcol I: Collagen ITCF/LEF: T-cell factor/lymphoid enhancer-binding factorAP1: Activator Protein 1 [ABSTRACT FROM AUTHOR]

A 34-year-old woman was hospitalized with shortness of breath and chest tightness and pain. She had undergone aortic valve replacement for aortic stenosis at the age of 18 years. Transthoracic echocardiography showed left ventricular asynergy and a high aortic valve pressure gradient. Thus, structural valve deterioration was diagnosed. Coronary computed tomography and coronary angiography revealed left main trunk ostial stenosis that had caused acute anteroseptal myocardial infarction. Urgent surgery revealed pannus formation around the prosthetic valve and covering the ostium of the left main trunk. A Bentall procedure and coronary artery bypass grafting were performed. The postoperative course was uneventful. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) may not be a multifactorial disease; it can be hypothesized that RA is developed through a series of events following a triggering event, which is the emergence of a chemokine for neutrophils in the synovium. IL‐17A, secreted by infiltrated neutrophils, stimulates synoviocytes to produce CCL20, which attracts various CCR6‐expressing cells, including Th17 cells. Monocytes (macrophages) appear after neutrophil infiltration according to the natural course of inflammation and secrete IL‐1β and TNFα. Then, IL‐17A, IL‐1β, and TNFα stimulate synoviocytes to produce CCL20, amplifying the inflammation. Varieties of chemokines secreted by infiltrating cells accumulate in the synovium and induce synoviocyte proliferation by binding to the corresponding G protein‐coupled receptors, thus expanding the synovial tissue. CCL20 in this tissue attracts circulating monocytes that express both CCR6 and receptor activator of NF‐κB (RANK), which differentiate into osteoclasts in the presence of RANKL. In this way, pannus is formed, and bone destruction begins. [ABSTRACT FROM AUTHOR]

Odontoid pannus is an abnormal collection of degenerative or inflammatory tissue on the C1-dens joint that can result in severe spinal cord compression myelopathy. Treatment options vary depending on severity and etiology. In cases of severe cord compression, surgical management could be either through a purely posterior approach or in combination with an anterior decompression via endoscopic endonasal approach (EEA). This case presents a 77-year-old female who underwent posterior cervical fixation for odontoid pannus causing dramatic cervical myelopathy who failed to improve over a 6-month period and required anterior transodontoid pannus resection and decompression via EEA. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23176., Competing Interests: Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication., (© 2024, The Authors.)

Chronic superficial keratitis (CSK) is a progressive inflammatory condition of the eye (cornea) that can cause discomfort and blindness. Differential disease risk across dog breeds strongly suggests that CSK has a genetic basis. In addition to genetic risk, the occurrence of CSK is exacerbated by exposure to ultraviolet light. Genome-wide association analysis considered 109 greyhounds, 70 with CSK and the remainder with normal phenotype at an age over four years. Three co-located variants on CFA18 near the 5′ region of the Epidermal Growth Factor Receptor (EGFR) gene were associated with genome-wide significance after multiple-test correction (BICF2P579527, CFA18: 6,068,508, praw = 1.77 × 10−7, pgenome = 0.017; BICF2P1310662, CFA18: 6,077,388, praw = 4.09 × 10−7, pgenome = 0.040; BICF2P160719, CFA18: 6,087,347, praw = 4.09 × 10−7, pgenome = 0.040) (canFam4)). Of the top 10 associated markers, eight were co-located with the significantly associated markers on CFA18. The associated haplotype on CFA18 is protective for the CSK condition. EGFR is known to play a role in corneal healing, where it initiates differentiation and proliferation of epithelial cells that in turn signal the involvement of stromal keratocytes to commence apoptosis. Further validation of the putative functional variants is required prior to their use in genetic testing for breeding programs.

We experienced a case of surgical aortic valve re-replacement due to structural valve deterioration caused by pannus formation 4 years after transcatheter aortic valve replacement( TAVR). The patient underwent surgery because the mean transvalvular pressure gradient increased to 48 mmHg on echocardiography. Contrast-enhanced computed tomography (CT) was useful for predicting the site of adhesion to surrounding tissue preoperatively and exploring the presence of the pannus. Intraoperative findings showed the TAVR valve was covered with neointima except around the origins of the left and right coronary arteries and was firmly adhered to the surrounding tissues. As residual pannus was present in the subvalvular tissues, it was carefully removed. The explanted TAVR valve functioned well with good opening and closure. The postoperative course was uneventful. Pannus formation can result from mechanical stress. TAVR valves put significantly greater stress on the left ventricular outflow tract than surgical valves and may be more likely to cause pannus formation.

Prosthetic valve obstruction is a rare but potentially lethal complication. The most frequent causes are thrombus and pannus formation, in the absence of infectious data. Diagnosis is not always easy using cardiac CT scanning and in 46%-85% of cases thrombus and pannus coexist, complicating the diagnosis. A rapid diagnosis is essential to avoid a fatal outcome of this pathology whose mortality, despite correct treatment, is high., (Copyright © 2023 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Rheumatoid arthritis (RA) is the most common chronic autoimmune disease worldwide. Although progress has been made in RA treatment in recent decades, remission cannot be effectively achieved for a considerable proportion of RA patients. Thus, novel potential targets for therapeutic strategies are needed. Semaphorin 5A (SEMA5A) plays a pivotal role in RA progression by facilitating pannus formation, and it is a promising therapeutic target. In this study, we sought to develop an antibody treatment strategy targeting SEMA5A and evaluate its therapeutic effect using a collagen-induced arthritis (CIA) model. We generated SYD12–12, a fully human SEMA5A blocking antibody, through phage display technology. SYD12–12 intervention effectively inhibited angiogenesis and aggressive phenotypes of RA synoviocytes in vitro and dose-dependently inhibited synovial hyperplasia, pannus formation, bone destruction in CIA mice. Notably, SYD12–12 also improved the Treg/Th17 imbalance in CIA mice. We confirmed through immunofluorescence and molecular docking that SYD12–12 integrated with the unique TSP-1 domain of SEMA5A. In conclusion, we developed and characterized a fully human SEMA5A-blocking antibody for the first time. SYD12–12 effectively alleviated disease progression in CIA mice by inhibiting pannus formation and improving the Treg/Th17 imbalance, demonstrating its potential for the RA treatment. [Display omitted] • Novel fully human monoclonal antibodies specific to SEMA5A are developed using phage display technology. • The mAb SYD12-12 potently inhibits angiogenesis in vitro and in vivo. • The mAb SYD12-12 potently reduces the pathogenicity of FLS. • The mAb SYD12-12 inhibits pannus formation and restores Treg/Th17 imbalance in CIA mice. • SYD12-12 integrated with the unique TSP-1 domain of SEMA5A. [ABSTRACT FROM AUTHOR]

Objective: Pannus overgrowth is a chronic inflammatory process that can cause valve dysfunction and threaten the durability of prosthetic valves. Bileaflet mechanical mitral valve can be implanted in either an anatomical (parallel to the anatomical axis) or nonanatomical (perpendicular or oblique to the anatomical axis) orientation. The effect of the rotational orientation of the bileaflet mechanical mitral valve on excessive pannus enlargement is unknown. The present study compared the effect of bileaflet mechanical mitral valve orientation on pannus overgrowth., Methods: The study included patients who underwent bileaflet mechanical mitral valve replacement for rheumatic mitral valve stenosis. The pannus formation was confirmed by reexamining all transesophageal echocardiography images in the picture archiving and communication systems between May 2017 and April 2021. The primary aim of this study was the development of pannus overgrowth. Patients were divided into 2 groups based on their implantation orientation of the bileaflet mechanical mitral valve., Results: Pannus overgrowth was found in 26 patients (56.5%) in the anatomical orientation group and 71 patients (74.7%) in the nonanatomical orientation group ( P = 0.03). Anatomical orientation reduced the development of pannus overgrowth (odds ratio [OR] = 0.39, P = 0.04), and double left heart valve replacement increased the development of pannus overgrowth (OR = 2.73, P = 0.04)., Conclusions: Pannus overgrowth was less common in bileaflet mechanical mitral valves implanted in the anatomical orientation., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study aimed to explore the molecular mechanism of Juanbi Qianggu Formula(JBQGF), an empirical formula formulated by the prestigious doctor in traditional Chinese medicine, in the treatment of rheumatoid arthritis based on network pharmacology and cell function experiments. The main active components and targets of JBQGF were obtained through Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP) and Encyclopedia of Traditional Chinese Medicine(ETCM), and the core targets underwent functional enrichment analysis and signaling pathway analysis. Cytoscape 3.6.0 was used to construct a visualized &quot;active component-target-signaling pathway&quot; network of JBQGF. After screening, nine potential pathways of JBQGF were obtained, mainly including G protein-coupled receptor signaling pathway and tyrosine kinase receptor signaling pathway. As previously indicated, the fibroblast growth factor receptor 1(FGFR1) signaling pathway was highly activated in active fibroblast-like synoviocytes(FLS) in rheumatoid arthritis, and cell and animal experiments demonstrated that inhibition of the FGFR1 signaling pathway could significantly reduce joint inflammation and joint destruction in collagen-induced arthritis(CIA) rats. In terms of the tyrosine kinase receptor signal transduction pathway, the analysis of its target genes revealed that FGFR1 might be a potential target of JBQGF for rheumatoid arthritis treatment. The biological effect of JBQGF by inhibiting FGFR1 phosphorylation was preliminarily verified by Western blot, Transwell invasion assay, and pannus erosion assay, thereby inhibiting matrix metalloproteinase 2(MMP2) and receptor activator of nuclear factor-κB ligand(RANKL) and suppressing the invasion of fibroblasts in rheumatoid arthritis and erosive effect of pannus bone. This study provides ideas for searching potential targets of rheumatoid arthritis treatment and TCM drugs through network pharmacology.

Competing Interests: The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Background: Numerous studies have shown that elevated BMI is associated with adverse outcomes in THA; however, BMI alone does not adequately represent a patient's adipose and soft tissue distribution, especially when the direct-anterior approach is evaluated. Local soft tissue and adipose, especially in the peri-incisional region, has an unknown impact on patient outcomes after direct-anterior THA. Moreover, there is currently no known evaluation method to estimate the quantity of local soft tissue and adipose tissue. The current study introduced a new radiographic parameter that is measurable on supine AP radiographs: the abdominal pannus sign., Question/purpose: Are patients who have an abdominal pannus extending below the upper (cephalad) border of the symphysis pubis more likely to experience problems after anterior-approach THA that are plausibly associated with that finding, including infections resulting in readmission, wound complications resulting in readmission, fractures, or longer surgical time, than patients who do not demonstrate this radiographic sign?, Methods: Between 2015 and 2020, five surgeons performed 727 primary direct-anterior THAs. After exclusion criteria were applied, 596 procedures were included. Of those, we obtained postoperative radiographs in the postanesthesia care unit in 100% of procedures (596 of 596), and 100% of radiographs (596) were adequate for review in this retrospective study. The level of the pannus in relation to the pubic symphysis was assessed on immediate supine postoperative AP radiographs of the pelvis: above (pannus sign 1), between the upper and lower borders (pannus sign 2), or below the level of the pubic symphysis (pannus sign 3). In this study, we combined pannus signs 2 and 3 into a single group for analysis not only because there was a limited number of patients in each group, but also because there was no statistically significant difference between the two groups. Pannus sign 1 was identified in 82% of procedures (486 of 596), and pannus sign ≥ 2 was identified in 18% (110). We compared the groups (pannus sign 1 versus pannus sign ≥ 2) in terms of the percentage of patients who experienced problems within 90 days of THA that might be associated with that physical finding, including infections resulting in readmission including subcutaneous, subfascial, and prosthetic joint infections; wound complications resulting in readmission, defined as dehiscence or delayed healing; and all fractures, and we compared the groups in terms of surgical time-that is, the cut-to-close time., Results: Patients with a pannus sign of ≥ 2 were more likely than those with a pannus sign of 1 to have a postoperative infection (6.4% [seven of 110 procedures] versus 0.6% [three of 486], odds ratio 10.96 [95% confidence interval (CI) 2.83 to 42.38]; p < 0.01), wound complications (0.9% [one of 110] versus 0% [0 of 486] with an infinite odds ratio [95% CI indeterminate]; p = 0.18), and fractures (4.5% [five of 110] versus 0% [0 of 486], with an infinite odds ratio [95% CI indeterminate]; p < 0.01). The mean surgical time was longer in patients with a pannus sign of ≥ 2 than it was in those with a pannus sign of 1 (128 ± 25.3 minutes versus 118 ± 27.5 minutes, mean difference 10 minutes; p < 0.01)., Conclusion: Based on these findings, patients who have an abdominal pannus that extends below the upper (cephalad) edge of the pubic symphysis are at an increased risk of experiencing serious surgical complications. If THA is planned in these patients, an approach other than the direct-anterior approach should be considered. Surgeons performing THA who do not obtain supine radiographs preoperatively should use a physical examination to evaluate for this finding, and if it is present, they should use an approach other than the direct-anterior approach to minimize the risk of these complications. Future studies might compare the abdominal pannus sign using standing radiographs, which are used more often, with other well-documented associated risk factors such as elevated BMI or higher American Society of Anesthesiologists classification., Level of Evidence: Level III, retrospective cohort study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 by the Association of Bone and Joint Surgeons.)

The aim of this study was to determine the accuracy of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the detection of pannus and thrombus in left mechanical valve obstruction (LMVO) compared with surgical and histopathology findings., Materials and Methods: Patients with suspected LMVO on transthoracic echocardiography were enrolled consecutively. All patients underwent two-dimensional and three-dimensional TEE, and open-heart surgery to replace obstructed valves. Macroscopic and microscopic analysis of the excised masses was used as the gold standard for the diagnosis of thrombus and/or pannus., Results: Forty-eight patients [34 women (70.8%), age 49±13 years, New York Heart Association II: 68.8%, New York Heart Association III: 31.2%] were enrolled. In the diagnostic of thrombus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 89.2, 72.7, 85.4, 91.7, and 66.7%, respectively, compared with those of two-dimensional TEE (42.2, 66.7, 43.8, 95, and 7.1%, respectively). In the diagnosis of pannus, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of three-dimensional TEE were 53.3, 100, 85.4, 100, and 82.5%, respectively; compared with those of two-dimensional TEE (7.4, 90.5, 43.8, 50, and 43.2%, respectively). Receiver operating characteristic curves depict that the area under the curves of three-dimensional TEE was higher than the area under the curves of two-dimensional TEE in both diagnoses of thrombus and pannus (0.8560 vs. 0.7330, P =0.0427 and 0.8077 vs. 0.5484, P =0.005, respectively)., Conclusions: This study indicated that three-dimensional TEE had a higher diagnostic value than two-dimensional TEE in the detection of thrombus and pannus in patients with LMVO, and can be a reliable imaging modality to identify the causes of LMVO., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)