Meniscal tear as potential steering factor for inflammation may aggravate arthritis: two case reports

The Effects of an Osteoarthritic Joint Environment on ACL Damage and Degeneration: A Yucatan Miniature Pig Model

Posttraumatic osteoarthritis (PTOA) arises secondary to joint injuries and is characteristically driven by inflammatory mediators. PTOA is often studied in the setting of ACL tears. However, a wide range of other injuries also lead to PTOA pathogenesis. The purpose of this study was to characterize the morphological changes in the uninjured ACL in a PTOA inflammatory environment. We retrospectively reviewed 14 ACLs from 13 Yucatan minipigs, 7 of which had undergone our modified intra-articular drilling (mIAD) procedure, which induced PTOA through inflammatory mediators. Seven ACLs were harvested from mIAD minipigs (PTOA) and seven ACLs from control minipigs with no cartilage degeneration (non-PTOA). ACL degeneration was evaluated using histological scoring systems. IL-1β, NF-κB, and TNF-α mRNA expression in the synovium was measured using qRT-PCR. PTOA minipigs demonstrated significant ACL degeneration, marked by a disorganized extracellular matrix, increased vascularity, and changes in cellular shape, density, and alignment. Furthermore, IL-1β, NF-κB, and TNF-α expression was elevated in the synovium of PTOA minipigs. These findings demonstrate the potential for ACL degeneration in a PTOA environment and emphasize the need for anti-inflammatory disease-modifying therapies following joint injury.

The use of eponyms in medical case reports: etymological, quantitative, and structural analysis

BACKGROUND

The present paper focuses on eponyms, that is, terms with proper names, in particular, derived from world mythologies, the Bible, and modern literature. The study highlights the significance of this terminological phenomenon in the English sublanguage of medicine and discusses its role in the process of writing medical case reports. The objectives of the research are to study the prevalence of eponyms in the English language in medical case reports and to analyze the etymology of the revealed terms. The deeper purpose of our study is to demonstrate that eponymic terms in general, and mythological and literary eponyms, in particular, are present in doctors' spoken and written discourse far more extensively than might seem at first glance. By drawing attention to this terminological phenomenon, we will provide relevant guidelines, which will ensure the correct use of eponyms by medical professionals who will deal with the genre of medical case reports.

METHODS

We studied the prevalence of these terms in the issues of Journal of Medical Case Reports (2008-2022) and classified them according to their etymological origin and frequency of use. The selected medical case reports were considered using the methods of quantitative examination, and structural, etymological, and contextual analyses.

RESULTS

We detected the major tendencies in using mythological and literary eponyms in medical case reports. We found a total of 81 mythological and literary eponyms, represented by 3995 cases of use in Journal of Medical Case Reports issues, and traced the etymology of their onomastic components. Hence, we delineated the five most prevalent sources of these terminological units: Greek mythology, Roman mythology, other world mythologies, the Bible, and fiction. The research revealed that modern medical case reports largely rely primarily on Greek mythology (65 eponyms, 3633 results), which is due to a rich informational and metaphorical arsenal of these ancient corpora of human knowledge. The group of eponyms rooted in Roman mythology ranks second, and these terms are much less prevalent in modern medical case reports (6 eponyms, 113 results). Four eponyms (88 results) represent other world mythologies (Germanic and Egyptian). Two terms with onomastic components come from the Bible (15 results), and four eponyms stem from modern literature (146 results). We also detected several widespread mistakes in the spelling of some mythological and literary eponyms. It is our opinion that the awareness of an eponym's etymology can effectively prevent and minimize the appearance of such errors in medical case reports.

CONCLUSIONS

The adequate use of mythological and literary eponyms in medical case reports is an effective way to share one's clinical findings with colleagues from all over the world, because these eponyms are internationally widespread and understood. Correct use of eponyms promotes the continuity of medical knowledge and ensures conciseness and brevity, which are indispensable features of medical case reports as a genre. Therefore, it is highly important to draw students' attention to the most prevalent mythological and literary eponyms, used in contemporary medical case reports, so they could use them appropriately, as well as with due awareness of the origin of these terms. The study also demonstrated that medicine and humanities are closely related and inherently interconnected areas. We believe that the study of this group of eponyms should be an integral component of doctors' training and continuing professional education. This will ensure the interdisciplinary and synergic approach in modern medical education, which in turn will promote the all-round development of future healthcare specialists, endowed not only with professional expertise, but also with extensive background knowledge.

Pathophysiological landscape of osteoarthritis

A sharp rise in osteoarthritis (OA) incidence is expected as over 25% of world population ages in the coming decade. Although OA is considered a degenerative disease, mounting evidence suggests a strong connection with chronic metabolic conditions and low-grade inflammation. OA pathology is increasingly understood as a complex interplay of multiple pathological events including oxidative stress, synovitis and immune responses revealing its intricate nature. Cellular, biochemical and molecular aspects of these pathological events along with major outcomes of the relevant research studies in this area are discussed in the present review. With reference to their published and unpublished work, the authors strongly propose synovitis as a central OA pathology and the key OA pathological events are described in connection with it. Recent research outcomes also have succeeded to establish a linkage between metabolic syndrome and OA, which has been precisely included in the present review. Impact of aging process cannot be neglected in OA. Cell senescence is an important mechanism of aging through which it facilitates development of OA like other degenerative disorders, also discussed within a frame of OA. Conclusively, the reviewers urge low-grade inflammation linked to aging and derailed immune function as a pathological platform for OA development and progression. Thus, interventions targeted to prevent inflammaging hold a promising potential in effective OA management and efforts should be invested in this direction.

Systems Based Study of the Therapeutic Potential of Small Charged Molecules for the Inhibition of IL-1 Mediated Cartilage Degradation

Inflammatory cytokines are key drivers of cartilage degradation in post-traumatic osteoarthritis. Cartilage degradation mediated by these inflammatory cytokines has been extensively investigated using in vitro experimental systems. Based on one such study, we have developed a computational model to quantitatively assess the impact of charged small molecules intended to inhibit IL-1 mediated cartilage degradation. We primarily focus on the simplest possible computational model of small molecular interaction with the IL-1 system-direct binding of the small molecule to the active site on the IL-1 molecule itself. We first use the model to explore the uptake and release kinetics of the small molecule inhibitor by cartilage tissue. Our results show that negatively charged small molecules are excluded from the negatively charged cartilage tissue and have uptake kinetics in the order of hours. In contrast, the positively charged small molecules are drawn into the cartilage with uptake and release timescales ranging from hours to days. Using our calibrated computational model, we subsequently explore the effect of small molecule charge and binding constant on the rate of cartilage degradation. The results from this analysis indicate that the small molecules are most effective in inhibiting cartilage degradation if they are either positively charged and/or bind strongly to IL-1α, or both. Furthermore, our results showed that the cartilage structural homeostasis can be restored by the small molecule if administered within six days following initial tissue exposure to IL-1α. We finally extended the scope of the computational model by simulating the competitive inhibition of cartilage degradation by the small molecule. Results from this model show that small molecules are more efficient in inhibiting cartilage degradation by binding directly to IL-1α rather than binding to IL-1α receptors. The results from this study can be used as a template for the design and development of more pharmacologically effective osteoarthritis drugs, and to investigate possible therapeutic options.

Modeling IL-1 induced degradation of articular cartilage

In this study, we develop a computational model to simulate the in vitro biochemical degradation of articular cartilage explants sourced from the femoropatellar grooves of bovine calves. Cartilage explants were incubated in culture medium with and without the inflammatory cytokine IL-1α. The spatio-temporal evolution of the cartilage explant's extracellular matrix components is modelled. Key variables in the model include chondrocytes, aggrecan, collagen, aggrecanase, collagenase and IL-1α. The model is first calibrated for aggrecan homeostasis of cartilage in vivo, then for data on (explant) controls, and finally for data on the IL-1α driven proteolysis of aggrecan and collagen over a 4-week period. The model was found to fit the experimental data best when: (i) chondrocytes continue to synthesize aggrecan during the cytokine challenge, (ii) a one to two day delay is introduced between the addition of IL-1α to the culture medium and subsequent aggrecanolysis, (iii) collagen degradation does not commence until the total concentration of aggrecan (i.e. both intact and degraded aggrecan) at any specific location within the explant becomes ≤ 1.5 mg/ml and (iv) degraded aggrecan formed due to the IL-1α induced proteolysis of intact aggrecan protects the collagen network while collagen degrades in a two-step process which, together, significantly modulate the collagen network degradation. Under simulated in vivo conditions, the model predicts increased aggrecan turnover rates in the presence of synovial IL-1α, consistent with experimental observations. Such models may help to infer the course of events in vivo following traumatic joint injury, and may also prove useful in quantitatively evaluating the efficiency of various therapeutic molecules that could be employed to avoid or modify the course of cartilage disease states.