Comparison of intra-articular injection of parecoxib vs oral administration of celecoxib for the clinical efficacy in the treatment of early knee osteoarthritis

BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.

Efficacy of intra- tumor injection of Kang-Lai-Te in treating transplanted hepatoma in rats

BACKGROUND: Non-operative therapy takes an impor- tant position in comprehensive therapy of liver cancer. De- spite some effects by using ethanol, acetic acid and heat sa- line for intra-tumor injection in the treatment of liver canc- er, it is difficult to attain a complete cure but bring about injury to the liver to some extent. Hence, searching for other drugs for the local treatment of liver tumor is an im- portant option. This study was designed to set up rat mo- dels of transplanted liver cancer, intra-tumor injection of Kang-Lai-Te (KLT), and negative control (saline) and positive control (ethanol). The effect of intra-tumor injec- tion of KLT in treating transplanted hepatoma in rats and its advantages and disadvantages were assessed and the pos- sibility of its use in treating patients with liver cancer was evaluated. METHODS: Forty rats were divided into 4 groups ( G1, G2, G3 and G4, 10 rats in each group). Different drugs were injected into their implanted hepatoma (G1 with 0.2 ml saline as control, G2 with 10 mg KLT, G3 with 20 mg KLT, G4 with 0.2 ml ethanol). After 3 and 8 days, the hepa- toma volume (HV), the serum levels of albumin, alanine aminotransferase(ALT), aspartate aminotransferase alkaline phosphatase( ALP) and creatinine, as well as the expression of proliferation cell nuclear antigen (PCNA) in hepatoma were detected. RESULTS: After 3 days, the HVs were smaller in G3 and G4 than in G1 (P <0.05), the serum levels of albumin were higher in G2 and G3 than in Gl and G4 (P <0.05), the se- rum levels of ALT and AST were lower in G2 and G3 than in G4 (P<0.05), the serum levels of ALP was lower in G2 and G3 than in Gl and G4 (P <0. 05), the PCNA labeling indexes (PCNA LI) were lower in G2 and G3 than in Gl and GA (P <0.05). After 8 days, the HVs were smaller in G2, G3 and G4 than in Gl (P <0.05), and the differences of HVs among G2, G3 and G4 were not significant. The serum levels of ALP were lower in G1, G2 and G3 than in G4 (P <0.05), and the PCNA LI were lower in G3 than in Gl andG4 (P<0.05). CONCLUSION: Intra-tumor injection of KLT into implan- ted hepatoma is evidently effective, but it is less effective than ethanol. The effect of KLT on liver function is markedly lower than that of ethanol.

Interstitial tissue-specific gene expression in mouse testis by intra-tunica albuguineal injection of recombinant baculovirus

The purpose of this study is to establish a gene delivery system for interstitial tissue-specific protein expression in mice testes using modified recombinant baculovirus. Green fluorescent protein （GFP）-expressing recombinant baculovirus （GFP-baculovirus）, in which the insect cell-specific polyhedron promoter was replaced by the cytomegalovirus （CMV）-IE promoter, was used to transfect testicular cells in vitro, and for intra-tunica albuguineal injection of the interstitial tissue of the testis. GFP expression was monitored in frozen testes sections by fluorescence microscopy. Expression of GFP in testicular tissues was also assessed by reverse transcription polymerase chain reaction （RT-PCR）, and protein expression was assessed by Western blot. Testicular cells in vitro were infected efficiently by modified recombinant GFP-baculovirus. lntra-tunica albuguineal injection of GFP- baculovirus into the mouse testis resulted in a high level of GFP expression in the interstitial tissues. RT-PCR analysis clearly showed GFP gene expression in the testis, particularly interstitial tissues. Intra-tunica albuguineal injection of a modified baculovirus that encoded recombinant rat insulin-like growth factor binding protein （IGFBP）-5 resulted in an increase in IGFBP-5 in testis and semen. In conclusion, we have developed an efficient delivery system for gene expression in vivo in testicular cells, particularly cells of the interstitial tissue using intratunica albuguineal injection of a modified recombinant baculovirus. This method will be particularly relevant for application that requires gene delivery and protein expression in the testicular cells of the outer seminiferous tubule of the testis.

A mimic of soft tissue infection: intra-arterial injection drug use producing hand swelling and digital ischemia

BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed.METHODS: A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology.RESULTS: As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit.CONCLUSION: Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use.

Comparison of intra-pleural injection efficacy between Endostar and Bevacizumab combined with pemetrexed/cisplatin for the treatment of malignant pleural effusion in patients with epidermal growth factor receptor-/anaplastic lymphoma kinase-lung adenocarci

Objective To compare intra-pleural injection efficacy and safety between Endostar and bevacizumab combined with pemetrexed/cisplatin for the treatment of malignant pleural effusion in patients with epidermal growth factor receptor(EGFR)-/anaplastic lymphoma kinase(ALK)-lung adenocarcinoma. Methods Sixty-four pCVatients with EGFR-/ALK-lung adenocarcinoma with malignant pleural effusion(MPE) were admitted to the authors' hospital between January 2016 and June 2017. Patients were randomly divided into two groups: Endostar combined with pemetrexed/cisplatin(Endostar group); and bevacizumab plus pemetrexed/cisplatin(Bevacizumab group). They underwent thoracic puncture and catheterization, and MPE was drained as much as possible. Both groups were treated with pemetrexed 500 mg/m^2, intravenous drip(d1), cisplatin 37.5 mg/m^2 per time, intra-pleural injection(d1, d3). Patients in the Endostar group were treated with Endostar 30 mg per time, intra-pleural injection(d1, 3), and patients in the Bevacizumab group were treated with bevacizumab 5 mg/kg per time, intra-pleural injection(d1). Only one cycle of treatment was applied. MPE was extracted before treatment and on day 7 after treatment. The levels of vascular endothelial growth factor(VEGF) were determined using ELISA. Efficacy and side effects were evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST) version 1.1, and National Cancer Institute Common Terminology Criteria for Adverse Events(CTCAE) version 3.0 criteria. Results The objective response rates in the Endostar and Bevacizumab groups were 50.0% and 56.3%, respectively; there was no statistical difference between the groups(P > 0.05). After one cycle of treatment, the mean VEGF levels in MPE in both groups decreased significantly, and there was no significant difference in the degree of decline between the two groups(P > 0.05). In both groups, pre-treatment VEGF levels for patients achieving complete response were significantly higher than those for patients achieving stable disease + progressive disease(P < 0.05). No specific side effects were recorded. Conclusion Endostar and Bevacizumab demonstrated similar efficacy in controlling MPE in patients with EGFR-/ALK-lung adenocarcinoma through an anti-angiogenesis pathway, with tolerable side effects. The levels of VEGF in MPE could predict the efficacy of intra-pleural injection of anti-angiogenesis drugs.

Accidental Intra-Arterial Injection during Test Dose of Injection of Benzyl Penicillin: Complications and Management—A Case Report

An 18 years old female patient was given a test dose of Benzyl penicillin in the Antecubital Area on the right forearm by a staff nurse of the department. After the injection, the patient complained of severe pain in the right forearm distal to the injection site. This was followed by blanching of the right forearm and hand. She was immediately heparinised followed by other symptomatic treatments. After 12 hours, a bluish discoloration developed on the hand, both on dorsal and palmar aspect, sparing the thumb. This recovered with medication, except the late development of dry gangrene of the tip of distal phalanx of the little finger which got shrivelled later on. Color Doppler flow study, echocardiography, and CT angiography of the right upper limb were done. Understanding of the pathogenesis and prompt action can help in saving a limb. Education of the medical professionals involved in administering injection is necessary so that they become aware of abnormal course or anomalous anatomy of vessels of upper limb. This can help to prevent the complications.

Intra-articular delivery of tetramethylpyrazine microspheres with enhanced articular cavity retention for treating osteoarthritis

Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly cleared from the joint cavity after intra-articular injection and requires multiple injections to maintain efficacy. The aim of this study was to encapsulate TMP into poly(lactic-co-glycolic acid)(PLGA) microspheres to enhance the TMP retention in the joint, reducing injection frequencies and decreasing dosage. TMP microspheres were prepared by emulsion/solvent evaporation method. The intra-articular retention of the drug was assessed by detecting the drug concentration distributed in the joint tissue at different time points. The therapeutic effect of TMP microspheres was evaluated by the swelling of knee joints and histologic analysis in papain-induced OA rat model. The prepared freezedried microspheres with a particle size of about 10 μm can effectively prolong the retention time of the drug in the articular cavity to 30 d, which is 4.7 times that of the TMP solution.Intra-articular injection of TMP microspheres efficiently relieved inflammatory symptoms,improved joint lesions and decreased the depletion of proteoglycan. In conclusion, intraarticular injection of TMP loaded microspheres was a promising therapeutic method in the treatment of OA.

Changes in rheumatoid arthritis under ultrasound before and after sinomenine injection

BACKGROUND Rheumatoid arthritis(RA)is a prevalent clinical autoimmune disease that is commonly treated with diclofenac and methotrexate.In recent years,the application of traditional Chinese medicine in RA has received widespread attention;it promotes blood circulation,strengthens the immune system,and eliminates evil.The sinomenine preparation of Zhingqeng Fengtongning is studied as a possible treatment for patients with RA.AIM To explore the value of sinomenine injection into the articular cavity for the treatment of RA.METHODS A total of 94 patients with RA treated from January 2019 to January 2021 were selected and divided into the study and control groups with 47 patients each using a simple random number table method.Both groups received conventional treatment with diclofenac sodium and methotrexate tablets.The control group received diproxone and lidocaine by intra-articular administration while the study group received an intra-articular administration of the sinomenine preparation of Zhengqing Fengning and lidocaine.χ^(2) test was used to evaluate the therapeutic effect and synovial thickness,degree of pain through the visual analog scale(VAS),blood flow grade,arthroinflammatory indexes[rheumatoid factor(RF),C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)]before and after treatment in the two groups.RESULTS The total effective rate of the study group(93.62%)was higher than that of the control group(78.72%)(P<0.05).Before treatment,there were no significant differences between the two groups in terms of synovial thickness,VAS score,blood flow grading,levels of RF,and ESR(P>0.05).After treatment,the synovial thickness and VAS score were significantly lower(P<0.05)in the study group than in the control group(2.05±0.59 mm vs 2.87±0.64 mm and 2.11±0.62 vs 2.90±0.79 scores,respectively).The rate of blood flow at grade 0 in the study group(76.60%)was higher than that in the control group(57.45%),and the rate of blood flow at grade I(10.64%)was lower than that in the control group(31.91%)(P<0.05).Furthermore,the levels of RF(55.61±6.13 U/mL),CRP(11.43±3.59 mg/L),and ESR(29.60±5.56 mm/h)in the study group were lower than those in the control group(73.04±9.23 U/mL,15.07±4.06 mg/L,36.64±6.10 mm/h,respectively)(P<0.05).CONCLUSION Sinomenine administration of Zhengqing Fengtongning in the articular cavity with conventional treatment of RA can improve ultrasonographic blood flow and synovial thickness,reduce pain,regulate inflammation,and enhance therapeutic effect.

Intra-articular transplantation of porcine adipose-derived stem cells for the treatment of canine osteoarthritis: A pilot study

AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. Thepatient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis.RESULTS: Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment.CONCLUSION: Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.

Rejuvenation of Ovary and Thin Endometrium by Autologous PRP Injection in POR and Recurrent Implantation Failure

In India, the problem of infertility is growing and in the last 5 years, it has gone up to 20% - 30%. This ongoing prospective clinical study brings forth a novel, innovative, effective, simple, affordable, easily performed outpatient procedure (OP) and a promising therapeutic method in rejuvenating the Ageing Ovaries and Thin Endometrium, with autologous Platelet Rich Plasma (PRP). This clinical study proves to give a better result in rejuvenating Ovary and treating the Thin Endometrium. This pilot study included five women (28 - 44 years) with Poor Ovarian Response (POR), Premature Ovarian Insufficiency (POI) and Perimenopause and Thirty-nine women (22 - 43 years.) with recurrent implantation failure due to Thin Endometrium were subjected to autologous PRP instillation under Ultrasound Guidance, and Hysteroscopic guided PRP. After PRP, a significant output was obtained, with improved Anti Mullerian Hormone (AMH) and Antral Follicle Count (AFC) and out of five women three women conceived by Intra Cytoplasmic Sperm Injection (ICSI). PRP injected in women with Poor Ovarian Response found successful ovarian rejuvenation within 1 - 3 months and had a 60% of pregnancy rate, PRP into the endometrium had 53.8% successful pregnancies. We have not encountered any complications.

Continuous Intra-Articular Ropivacaine/Tramadol Combination Infusion Therapy Improves Postoperative Outcome of Total Knee Arthroplasty

Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.

Twenty-eight Cases of Diabetic Foot Ulcer and Gangrene Treated with the Chinese Herbal Medicine Combined with Injection of Ahylsantinfarctase

Since 1995, the Chinese herbal medicine for supplementing qi and activating blood circulation combined with injection of ahylsantinfarctase into the femoral artery has been used in 28 cases of diabetes complicated with gangrene and ulcer of the foot, with quite good therapeutic effects as reported in the following.……

Primary Combined Intra-articular and Extra-articular Synovial Osteochondromatosis of Shoulder: a Case Report

PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ectopic foci of cartilage canresult in painful joint effusion, and the generation of loosebodies can cause mechanical symptoms.2,3 The etiology ofprimary synovial chondromatosis remains unknown, butmetaplastic theory is the most popular hypothesis. Thecommonly involved joints are knee, elbow, and hip.^4 Theshoulder is a rare site of synovial chondromatosis2,3,5 andthe extra-articular involvement even rarer, with only fewcases presented in literature. This report presents a rarecase of primary combined intra-articular andextra-articular synovial chondromatosis of shoulder jointtreated with arthroscopy.

Operative vs nonoperative treatment of displaced intraarticular calcaneal fracture: A meta-analysis of randomized controlled trials

AIM: To investigate clinical efficacy of displaced intraarticular calcaneal fracture(DIACF) following operation and nonoperation. METHODS: Literature search was performed of Pub Med and Cochrane Library by two independent authors to identify randomized controlled trials(RCTs) comparing operative vs nonoperative treatment of DIACF from inception to December 31 st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or randomeffects models were adopted with P > 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS: Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job(P = 0.006). No statistical differences were found between the two groups in residual pain(P = 0.33), shoe fitting problems(P = 0.07), limited walking distance(P = 0.56) or secondary late arthrodesis(P = 0.38). However, operative treatment was associated with a higher complication rate(P = 0.003). Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems(P < 0.0001) in operative group, the two groups had similar complication rate in deep wound infection(P = 0.34),compartment syndrome(P = 0.46), thromboembolism(P = 0.32), reflex sympathetic dystrophy(P = 0.51) or traumatic arthritis secondary to DIACF(P = 0.43).CONCLUSION: Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.

Target Transfusion Intra-Articular Therapy for Osteoarthritic Joints

The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoarthritic joints. Serum modification was realized by preliminary prescription of a single-dose drug to the patient. Then, the patient’s blood was sampled in the period of its maximal saturation with the drug. Autoserum from such blood samples was injected thrice into the knee joints affected by osteoarthritis of the 2nd or 3rd stages. The value of treatment results after 4 - 6 months of described therapeutics shows a significantly better therapeutic effect in the experimental of patient’s group as compared with the control group. The effect is connected with pain diminishing, normalization of the tissue joint nutrition, suppression of the local inflammation, and improvement of cartilage lubrication.

TREATMENT OF RAT HEPATOMA BY LOCALLY INJECTION OF MURINE IL-12 RETROVIRUS PACKAGING CELL

Objective: To investigate the therapeutic effects of the murine IL-12 (mIL-12) retrovirus packaging cell line on hepatoma injected locally. Methods: The retrovirus vector encoding mIL-12 gene was constructed and transfected into packaging cell line PA317. The cells were then used to treat the rats with experimental orthotopic hepatoma at different time. The therapeutic effects, immune functions of the hosts, pathological and toxicological responses were documented. Results: the results showed that the mIL-12 retrovirus packaging cell line could significantly inhibit the growth of the hepatoma cells injected locally to the hepatoma. The early treatment made the rats survive long, while the medium or late stage treatment could prolong the life time of the rats compared with the bland control group or bland vector control group, though the rats did not survive. The number of NK cells and T cells increased significantly in the treatment group. The effects of the early treatment were superior to those of the medium and late stage treatment. Moreover, the transfection of IL-12 gene locally in the hepatoma tissue could make the hepatoma disappear from other liver lobe. This phenomenon demonstrated that IL-12 could activate the immune cells of the host to kill the untransfected tumor cells. This is very important for IL-12 to be used in gene therapy clinically. Meanwhile, the hepatoma would not recur in the rats that had survived more than 2 months from the early treatment after being re-challenged with tumor cells. Conclusion: the results showed that IL-12 gene injected locally in the hepatoma tissue could enhance the anti-tumor immunity of the host.

Intraarticular Nodular Fasciitis in the Knee Joint with <i>USP6</i>-Gene Rearrangement<br/>—A Case Report with Special Attention to Diagnostics of Intraarticular Lesions

Background: Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossificans. The presented case is of interest as this is a rare site of presentation of NF;so far only few single cases of intraarticular NF have been reported with documented USP6-gene rearrangement. Intraarticular neoplasias of the knee joint are rare;the most frequent being tenosynovial giant cell tumor (TSGCT). Given a nationwide annual incidence rate of 14 for the lower extremity and about 75% affecting the knee joint about 10 new cases involving the knee joint can be expected per 1 million persons/year. All other types of benign neoplasms are comparably rare while malignant intraarticular processes are extremely rare with most of them reported as single case studies. Aim: We report our case to emphasize the importance of preoperative diagnostics including the option of biopsy. Intraarticular malignant processes are extremely rare and frequently are operated on accidently with negative consequences for the patient. Tactics and techniques to treat benign processes depend on the correct pathologic diagnosis. Case presentation: The 38 year old man noticed slowly increasing swelling of his left knee joint after wakeboarding. Because of continuing discomfort 2 months later MRI diagnostic revealed, apart from retropatellar cartilage lesions, a popliteal mass compatible with a Baker cyst. The lesion of interest (later diagnosed as NF) was neither recognized by the radiologist nor the treating clinician. During the following 8 months the patient felt increasing swelling of the knee joint. The repeat MRI documented the crescent intraarticular solid synovial mass in the medial patellofemoral recess without signs of hemosiderin impregnation. A percutaneous sonographically guided 16G needle biopsy was performed. Histologically, bland myofibroblastic proliferation suggestive of nodular fasciitis (NF) was found. The next generation sequencing (NGS) demonstrated the presence of MYH9-USP6 gene fusion, confirming the diagnosis of NF. The lesion was excised under arthroscopic control. At 1 year follow-up the patient is asymptomatic. Conclusion: The case is of interest because of its rare pathology. The decision how to treat was based on pathologic biopsy diagnostics including the USP6-gene rearrangement. In view of similar presentation of the rare malignancies we also want to stress the importance of definitive diagnostics which generally are possible only through biopsy.

低剂量类固醇激素联合玻璃酸钠治疗粘连性肩关节囊炎的临床效果

目的比较低剂量类固醇激素、高剂量类固醇激素及低剂量类固醇激素联合玻璃酸钠治疗粘连性肩关节囊炎的效果。方法选取2020年12月至2021年12月我科收治的60例粘连性肩关节囊炎患者为研究对象,采用随机数字表法将其分为低剂量组、高剂量组和联合组,各20例。低剂量组给予关节腔内注射0.5 mL复方倍他米松注射液,高剂量组给予关节腔内注射1 mL复方倍他米松注射液,联合组给予关节腔内注射0.5 mL复方倍他米松注射液联合2.5 mL玻璃酸钠。比较三组的治疗效果。结果治疗后2、4、8、16周,三组的视觉模拟评分法(VAS)、肩关节疼痛与功能障碍指数(SPADI)评分低于治疗前(P<0.05);治疗后2、4、8、16周,联合组的VAS、SPADI评分低于低剂量组(P<0.05);治疗后2、4、8、16周,联合组和高剂量组的VAS、SPADI评分无明显差异(P>0.05)。治疗后2、4、8、16周,三组的肩关节外展活动度及肩关节外旋活动度大于治疗前(P<0.05);治疗后2、4、8、16周,三组的肩关节外展活动度及肩关节外旋活动度无明显差异(P>0.05)。结论低剂量类固醇激素联合玻璃酸钠可以缓解粘连性肩关节囊炎患者的疼痛,改善关节功能,其效果与高剂量类固醇激素相当,优于低剂量类固醇激素。

老年心肌梗死患者术中冠状动脉内注射重组人TNK组织型纤溶酶原激活剂对微循环的影响

目的探讨血栓抽吸联合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂对老年ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中冠状动脉微循环及心功能的影响。方法回顾性选取2021年1月至2023年10月于天津市第三中心医院就诊的并行急诊经皮冠状动脉介入治疗的老年ST段抬高型心肌梗死患者90例,根据经皮冠状动脉介入治疗术中介入策略不同分为单纯血栓抽吸组(抽吸组)46例和血栓抽吸联合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂组(联合组)44例。比较2组一般临床资料,术后90 min ST段回落指数≥70%比例,术后即刻心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级,术后TIMI心肌灌注分级,校正的TIMI血流帧数,心脏超声指标以及住院期间主要不良心血管事件及出血事件。结果联合组术后ST段回落≥70%、术后即刻TIMI血流分级3级、术后TIMI心肌灌注分级3级比例显著高于抽吸组,校正的TIMI血流帧数显著低于抽吸组(P<0.05);抽吸组术后1周的左心室射血分数显著低于联合组[(52.5±6.2)%vs(58.3±6.4)%,P<0.05],联合组术后1周左心室舒张末期内径显著低于抽吸组[(44.1±3.9)mm vs(51.9±2.5)mm,P<0.05];联合组住院期间主要不良心血管事件发生率显著低于抽吸组(20.5%vs 37.0%,P<0.05)。结论在应用抽吸导管的基础上配合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂可有效降低老年ST段抬高型心肌梗死患者冠状动脉内血栓负荷,改善心肌微循环灌注,降低住院期间主要不良心血管事件发生率且不增加出血风险。

小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者的效果

目的:分析小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者的效果。方法:选取2020年3月—2023年2月福建中医药大学附属第二人民医院收治的100例肩周炎患者。根据随机数表法将其分为研究组与参考组,各50例。参考组给予关节腔注射玻璃酸钠治疗,研究组在参考组基础上给予小针刀治疗。比较两组治疗前后肩关节功能、疼痛程度及临床疗效。结果:治疗后,研究组总有效率显著高于参考组,两组活动度、功能、肌力、症状评分均升高,研究组上述指标均高于参考组,研究组视觉模拟评分法(VAS)评分低于参考组,差异有统计学意义(P<0.05)。结论:小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者可以有效减轻疼痛程度,改善肩关节功能。