Objective To explore the effectivness of arthroscopic synovectomy in the treatment of pigmented villonodular synovitis (PVNS) of the knee. Methods A retrospective analysis was conducted on 13 patients with PVNS of the knee treated with arthroscopic synovectomy between June 2008 and December 2011, including 8 left knees and 5 right knees. There were 9 males and 4 females, aged 25-45 years (mean, 33 years). Of 13 patients, 5 had a history of trauma, and 8 had no history of trauma. The disease duration ranged from 4 months to 80 months (mean, 44 months). The preoperative Lysholm score was 45.3 ± 4.2, and International Knee Documentation Committee (IKDC) 2000 score was 46.8 ± 4.9. All patients underwent arthroscopic synovectomy and postoperative radiotherapy. Results The pathological examination proved PVNS in all cases. All incisions obtained healing by first intention after operation. There was no neurovascular injury or knee infection. The average follow-up period was 21.8 months (range, 12-30 months). The Lysholm score was 90.2 ± 7.4, and IKDC2000 score was 87.8 ± 3.8 at last follow-up, showing significant differences when compared with preoperative scores (t=22.64, P=0.00; t=24.32, P=0.00). No recurrence was observed during follow-up. Conclusion Arthroscopic synovectomy can be effective in the treatment of PVNS of the knee, and it has the merits of minimal invasion, rapid function recovery of the knee joint, and satisfactory results. So it is a safe, promising, and minimal invasive procedure in treatment of PVNS.
Objective To explore the method and outcome of knee resurfacing arthroplasty in treating late-staged diffuse pigmented villonodular synovitis (PVNS). Methods Between November 2002 and May 2009, 11 cases of late-staged diffuse PVNS were treated, including 3 males and 8 females with an average age of 51.2 years (range, 42-63 years). The diseaseduration was 2.5-10.0 years (mean, 5.2 years). Unilateral knee was involved in all patients, including 7 left knees and 4 right knees. Nine patients had a history of trauma and 2 cases had no obvious inducing factors. The range of motion was (90.1 ± 17.2)° and Hospital for Special Surgery Knee Score (HSS) was 68.9 ± 8.7. After synovectomy, knee resurfacing arthroplasty was performed in all patients. Results Superficial infection of the incision occurred in 1 case at 6 days postoperatively and was cured after debridement; other incisions healed by first intention. Limited flexion and extension, incomplete palsy of common peroneal nerve, and deep venous thrombosis occurred in 1 case respectively, and were cured or improved after symptomatic treatment. All the 11 cases were followed up 38 months on median (range, 13 to 102 months). Two cases developed chronic pain and were not given treatment. Recurrence occurred in 1 case 12 months postoperatively and recovered after synovectomy again. X-ray films showed no signs of loosening, sinking, and bone destruction. At last follow-up, the range of motion was (109.1 ± 18.6)° and HSS score was 86.7 ± 9.3, showing significant differences when compared with those before operation (P lt; 0.05). According to the HSS score system, the results were excellent in 6 cases, good in 3, fair in 1, bad in 1, and the excellent and good rate was 81.8%. Conclusion A combination of knee resurfacing arthroplasty and synovectomy for the treatment of late-staged diffuse PVNS is able to get a good cl inical results in restoration of function, improvememt of the l ife quality, and decrease of recurrence rate.
Objective To observe the effect of epithelial-mesenchymal transdifferentiation (EMT) of human retinal pigment epithelial (RPE) cells induced by vitreous humor in vitro. Methods The third to fifth passage cultured RPE cells were divided into two groups of treatment by 10% serum containing Dulbecco minimum essential medium (DMEM)/F12 medium (group A), or the same medium supplemented with 25% human vitreous (group B). The morphological changes were observed with a phase contrast microscrope. Cell migration, invasion and contractility were tested using a scratch wound assay, Transwell invasion assay and collagen gel contraction analysis. The expression levels of alpha;-smooth muscle actin (SMA) and Snail1 were detected by reverse transcriptase polymerase chain reaction (RT-PCR). Results The RPE cells in group A were flat and gathered together. The RPE cells in group B grew as a fan-shaped projection at one edge and cone-shaped tail at the opposite edge, or spindle-shaped, and appeared to separate. In group A, filamentous actin distributed mainly at the margin of the cells with the distribution an oval shape. In group B, filamentous actin reorganized and formed fan-like flat pseudopodia at one edge of the cells. Compared to group A, the migration and invasion of the cells increased significantly (t=14.190, 22.630; P＜0.05), but contractility decreased remarkably (t=6.221, P＜0.05) in group B. Compared to group A, the expression level of Snail1 mRNA increased significantly (t=3.218, P=0.032), but the expression level of alpha;-SMA mRNA decreased (t=3.990, P=0.016). Conclusions Vitreous humor can induce the EMT of RPE cells. Increasing cell migration, cell invasion, and expression of Snail1 mRNA as well as up-regulated cellsprime; contractility and expression of alpha;-SMA mRNA may be the mechanism.
Objective To observe the characteristics of spectraldomain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) in acute and chronic central serous chorioretinopathy (CSC).Methods Seven-three eyes of 67 patients with CSC diagnosed by slit-lamp microscopy, fundus photochromy, fundus fluorescein angiography (FFA) and indocyanine green angiography were enrolled in this study. All the patients were examined for FAF and SD-OCT. The patients were divided into acute CSC group (37 patients, 37 eyes) and chronic CSC group (30 patients,36 eyes) according to the clinical features and FFA images. According to the OCT feature in retinal detachment area, they were divided into three categories, which including intact, non-intact and atrophy outer segment, respectively. According to the FAF characteristics, they were divided into hyper-FAF, hypo-FAF and mixed type, respectively. The characteristics of SD-OCT and FAF of both acute and chronic CSC patients were evaluated and analyzed. Results In acute CSC group, 19 eyes (51.35%) were hypo-FAF, 18 eyes (48.65%) were hyper-FAF. In chronic CSC group, two eyes (5.56%) were hypo-FAF, 16 eyes (44.44%) were hyper-FAF, and 18 eyes (50.00%) were mixed type. There was significant difference between both groups (chi;2=31.872,P=0.000). The SD-OCT results showed that in acute group, 15 eyes (40.54%) were intact outer segment, 18 eyes (48.65%) were non-intact outer segment, and four eyes (10.81%) were atrophy outer segment. In chronic group, five eyes (13.89%) were intact outer segment, 17 eyes (47.22%) were non-intact outer segment, and 14 eyes (38.89%) were atrophy outer segment. There was significant difference between both groups (chi;2=10.572,P=0.005). Conclusions The FAF characteristics of acute and chronic CSC mainly manifests hypo-FAF and mixed type, respectively. The OCT characteristics of acute CSC mainly manifests intact outer segment and non-intact outer segment, but non-intact outer segment and atrophy outer segment in chronic CSC.
Objective To observe the clinical features of polypoidal choroidal vasculopathy (PCV) with retinal pigment epithelium (RPE) tears. Methods Twelve patients of PCV with RPE tears (12 eyes) were enrolled in this study. The patients included eight males and four females, with a mean age of 58.6 years (from 39 to 71 years old). All the patients were affected unilaterally, including eight right eyes and four left eyes. There were one eye with serous RPE detachment and 11 eyes with hemorhagic RPE detachment. All the patients were examined for fundus photography, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA), three patients were examined for optical coherence tomography (OCT). The location of RPE tear was classified as within vascular arcade, on vascular arcade, and outside vascular arcade. The shape of tear was classified as crescent, semilunar, or irregular. The features of fundus, FFA, ICGA and OCT were observed. Results Fundus examination presents a gray lesion in all eyes. The location of tear were within vascular arcade in four eyes (33.3%), on vascular arcade in five eyes (41.7%) and outside vascular arcade in three eyes (25.0%). The shape of tears were crescent (one eye, 8.3%), semilunar (ten eyes, 83.3%) or irregular (one eye, 8.3%). The RPE tear region present transimitted fluorescence of at the early stage of FFA and hyperfluorescence with a clear border at late stage. There was no leakage, and at the border of hyperfluorescence, blockage fluorescence of rolled and contracted RPE was present. In ICGA manifestation, transimitted fluorescence was found in RPE tear region at early stage, and a clear border was seen in nine eyes at late stage. There was also blockage fluorescence in ICGA of contracted RPE. In OCT manifestation, the RPE reflections were disappeared, and at the margin of tear, the contracted RPE present a dense rolled b reflection. Conclusions In PCV patients, RPE tears are semilunar and usually located within or around the vascular arcade. Fundus angiography shows transimitted fluorescence at the RPE tear region, and curl blockage fluorescence at the edges. OCT shows RPE reflection is disappeared in the tear region and a b reflection at the edges.
Objective To observe the characteristics of fundus autofluorescence （AF） distribution at the posterior pole in normal subjects. Methods Seventy-nine normal subjects （156 eyes）were studied. Confocal scanning laser ophthalmoscope (cSLO) HRA2 was used to obtain the AF average image at the posterior pole. The distance was calibrated by Digimizer image analysis system. With umbo as the center, the macula was divided into foveola, fovea, parafovea and perifovea areas which with the radius 175, 750, 1250 and 2750 mu;m respectively. Each area was further divided into inferior, superior, temporal and nasal quadrants by two radial lines angle of 90deg;, except for foveola. The AF intensity in four quadrants of different macular regions and optic disc were measured. The AF intensity in vertical and horizontal direction of umbo was also measured. Then the effects of age, eyes, and gender on AF intensity in four quadrants of different macular regions were analyzed. Results There were statistically significant differences in AF intensity among optic disc and four quadrants of macular regions （F=528.648, P＜0.05）. AF distribution was V-type in vertical direction and M-type in horizontal direction. There were statistically significant differences between age groups in foveola, inferior parafovea, temporal parafovea, inferior perifovea, superior perifovea and temporal perifovea （P＜0.01）. There were no statistically significant differences between the two eyes （P＞0.05）. Between genders group, there were statistically significant differences in foveola, superior fovea, inferior fovea, nasal fovea and temporal perifovea （P＜0.05）; no statistically significant differences in the other quadrants （P＞0.05）. Conclusions The distribution of AF intensity is inhomogeneous in macular regions and four quadrants of each region in normal subjects. AF intensity increases with aging. AF distribution is symmetrical in both eyes. There is probably no correlation between gender and AF intensity distribution.
Objective To observe the autofluorescence （AF） manifestation in related lesions of periphery retinopathy.Methods Sixty eyes of 42 patients with periphery retinopathy underwent the examination of Optomap fundus photograph (200deg;) and fundus fluorescein angiography (FFA). The HRAⅡ melaninrelated nearinfrared fundus autofluorescence (NIA, excitation 795 nm) and lipofuscinrelated fundus autofluorescence (FAF, excitation 488 nm) were measured for all the patients. The AF was recorded with nine images per second, and then a final AF image with 55deg; view and 822times;768 pixel was generated by the HRA. AF images can be valuable or valueless if there was or was not visible blood vessels and related retinal tissues on the image. AF from lesion regions can be normal or abnormal fluorescence comparing to the normal vascular and retinal tissue AF. The abnormal fluorescence was divided into no AF, weak AF and b AF relative to the background grayscale. The grading consistency of abnormal fluorescence based on FAF and NIA examination was comparatively analyzed. Results Valuable AF images were captured in 53/60 eyes （88.33%）and valueless AF images were captured in 7/60 eyes （11.67%）. Among 53 eyes with valuable AF image, NIA showed normal fluorescence in 28 eyes （52.83%），abnormal fluorescence with sheetlike, dotshaped or stripped in 25 eyes （47.17%）; FAF showed normal fluorescence in two eyes （3.77%）, abnormal fluorescence with sheetlike, scattered along vessels or pigments in 51 eyes （96.23%）. Twentyfive eyes with abnormal fluorescence were observed both in two examinations, including same grades in 18 eye （72.00%） and different grades in seven eyes （28.00%）. Conclusion The AF manifestation with different levels exists in related lesions of periphery retinopathy.
To investigate the characteristics of fundus autofluorescence (AF) in the leakage site of central serous chorioretinopathy (CSC). Methods Sixty-seven CSC patients (67 eyes) underwent fundus fluorescein angiography (FFA) examination with a confocal scanning angiography (HRA2). Autofluorescence was elicited by the wavelength of 488 nm. The patterns of autofluorescence corresponding to the leakage site on FFA were observed. All the enrolled patients were grouped by age (agele;45 in 47 eyes and age ＞45 in 20 eyes) and courses (acute CSC in 25 eyes and chronic or recurrent CSC in 42 eyes), the patterns of autofluorescence were analyzed respectively. Results There are 4 patterns of AF in the leakage site on FFA of CSC patients: no AF changes, punctuate hypo-AF, expanded hypo-AF or speckled AF, hyper-AF. The percentages of those patterns in all 67 eyes are 52.2%, 23.9%, 14.9% and 9.0% respectively. The percentages of those patterns in the group of age le;45 (n=47) are 55.3%, 23.4%, 14.9% and 6.3% respectively. The percentages of those patterns in the group of age ＞45 (n=20) are 45.0%, 25.0%, 15.0% and 15.0% respectively. The percentages of those patterns in acute CSC (n=20) are 80.0%, 16.0%, 4.0% and 0% respectively. The percentages of those patterns in chronic or recurrent CSC (n=42) are 35.7%, 28.6%, 21.4% and 14.3% respectively. Conclusion There are different patterns of fundus autofluorescence in different age and courses of CSC patients.
Objective To observe the effect of epidermal growth factor (EGF) on integrin alpha;5 expression and its influence on human retinal pigment epithelium (RPE) cells.Methods Human RPE cells were treated in vitro with 0.1,1.0,10.0,20.0 and 100.0 ng/ml of EGF, the mRNA and protein of integrin alpha;5 was measured by reverse transcription polymerase chain reaction（RT-PCR）and flow cytometry. Human RPE cells were cultured under 4 conditions including DMEM/F12,DMEM/F12+10 ng/ml EGF, DMEM/F12+10 ng/ml EGF+rabbit antihuman integrin alpha;5 antibody (1∶100)，DMEM/F12+10 ng/ml EGF+rabbit antihuman vimentin antibody (1∶100), and their proliferation and migration were measured by methylthiazole tetrazolium（MTT）and Boyden chamber.Results The integrin alpha;5 mRNA level of human RPE cells was not changed after 12 hours of EGF stimulation (F=0.618, P=0.687), however it was induced in a dosedependent manner after 24 and 48 hours of EGF stimulation (F=465.303, 212.340; P=0.000,0.000).The protein level of integrinalpha;5 was higher in 10 ng/ml EGF stimulation compared with the control group and 0.1 ng/ml group（P＜0.01）.MTT and Boyden chamber showed that the integrin alpha;5 expression increased the proliferation and migration of human RPE cells. Conclusion EGF can induce integrin alpha;5 expression,thus increase the proliferation and migration of human RPE cells.
Objective To investigate the possible effects of phosphorylated signal transduction and activator of transcription3 (STAT3) in the formation of choroidal neovascuarization (CNV) induced by photocoagulation in rats. Methods The CNV model in rats induced by photocoagulation was established, and the expression of phosphorylated STAT3 at the early stage in CNV were observed by immunofluorescence. To set up the hypoxia model, the specific inhibitor of Janus kinase 2 (JAK2), AG490 was mixed into cell culture fluid and then cultured for 0,1 hour,3,6,12,and 24 hours.Retinal pigment epithelial (RPE) cells proliferation activity were detected by flow cytometry (FCM).the expression of hypoxiainducible factor (HIF)1α and vascular endothelial grow factor (VEGF) mRNA were detected by reverse transcriptase polymerase chain reaction (RT-PCR); the expression of HIF1α protein was detected by Western blot; the content of VEGF in the supernatant of cell culture fluid was measured by enzyme linked immunosorbent assay (ELISA). Results Phosphorylated STAT3 highly expressed in CNV areas in rats 3 days after the photocoagulation. The proliferation activity of human RPE cells under hypoxia condition significantly decreased after inhibition of JAK2/STAT3 signal transduction pathway (t=1.472, 3.566,2.391,6.420; P=0.054,0.038,0.042,0.016). The expression of HIF-1α and VEGF mRNA increased gradually with increasing time of hypoxia;while the expression of HIF1α and VEGF mRNA and the activation of HIF1α protein in cultured human RPE cells with the JAK/STAT3 signal transduction pathway blocked by AG490 were suppressed obviously under hypoxia condition (t=0.07,0.02,0.01, P<0.05); the content of VEGF in RPE cells supernatant decreased significantly (t=1.330,1.106,2.828,7.742,5.610,6.894; P=0.082,0.063,0.014,0.002,0.016,0.011). Conclusion STAT3 may be involved in CNV formation, which may partly dependent on JAK2/STAT3 signal transduction pathway regulating the expression of HIF-1α and VEGF in RPE cells.