YKL-40 is a recently discovered human glycoprotein which is related in amino acid sequence to the chitinase protein family. YKL-40 is a major secretory protein of human chondrocytes and synoviocytes, and could play a role in tissue remodelling. The aim of the study was to establish the serum YKL-40 level in normal subjects and to evaluate serum YKL-40 as a marker for osteoarthritis. Serum YKL-40 was 80 micrograms/l in healthy children (n = 476) and 102 micrograms/l in healthy adults (n = 260). No age or sex differences were found in serum YKL-40 in subjects younger than 70 yr, but thereafter serum YKL-40 increased significantly. Patients with late-stage osteoarthritis of the knee (n = 37) had significantly higher serum YKL-40 (1.5-fold; P < 0.01) compared to healthy age-matched subjects, whereas patients with early-stage osteoarthritis of the knee or recent torn cruciate ligaments or menisci did not have elevated serum YKL-40. The level of YKL-40 in serum and synovial fluid correlated significantly, and 10-fold higher values were found in synovial fluid. YKL-40 levels in serum and synovial fluid of patients with acute severe synovial inflammation were significantly higher (P < 0.05-P < 0.001) than those in patients with no, light or moderate synovitis of the knee joint. Furthermore, YKL-40 correlated significantly (P < 0.01) with the amino-terminal propeptide of type III procollagen, but not with serum C-reactive protein. Our data indicate that YKL-40 in synovial fluid and serum may reflect human articular cartilage degradation and the degree of synovial inflammation in the knee joint.

Objective-The objective of this study was to detail the topographical and zonal distribution of and subunits of the integrin superfamily in normal and osteoarthritic cartilage. Methods-Immunohistochemistry utilising antibodies towardsand subunits was performed on cryostat sections of human articular cartilage from macroscopically normal (n = 6) and osteoarthritic (n = 6) femoral heads. Samples of articular cartilage were obtained from 12 topographically distinct sites from each femoral head. Each section was divided into zones (superficial, middle, deep) and staining scores were recorded. Results-Normal cartilage stained for integrin subunits 1, 5, V, 1, 4, and 5, but not for 2, 3, 4, 6, 2, 3, and 6. Intact and non-intact residual cartilage from osteoarthritic femoral heads stained for 1, 2, 5, V, 1, 4, and 5. Staining was occasionally seen for 4 and 2, but not for 3, 6, 3, and 6. There was no topographical variation in the staining for any of the subunits in either normal or osteoarthritic cartilage. The only subunit that displayed a zonal variation was V; staining for this subunit was most pronounced in the superficial zone compared with the middle and deep zones. Conclusion-Chondrocytes in normal and osteoarthritic cartilage express the integrin subunits 1, 5, V, 1, 4, and 5. Chondrocytes in osteoarthritic cartilage, in addition, express the 2, 4, and 2 subunits. The v subunit is expressed by more chondrocytes in the superficial zone in comparison with cells in the deeper zones. None of the subunits display topographical variation in expression.

BackgroundTransfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision surgery.MethodsThe trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation was assessed using Timed Up and Go-test (TUG) and ability to walk was also assessed daily by a physiotherapist blinded to the allocation.ResultsFifty-three patients were able to perform the TUG and included in the analysis. The TUG could be completed in a median of 36 sec vs. 30 sec in the restrictive group and the liberal group, respectively (P = 0.02). The mean difference in TUG was 14.5 sec (95% CI 2.8-26.2 sec). No difference was found in the day patients could perform TUG or walk 10 meters. The Hb at the day of testing was 10.2 g/dL in the restrictive group and 9.9 g/dL in the liberal group. Only 26 patients received RBC.ConclusionsA Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing.

Background: Self-administered intramuscular injection of site enhancement oil (SEO) is a cosmetic and performance-enhancing procedure used to reshape muscles in the bodybuilder subculture, but its consequences and complications are only sporadically described.Methods: A systematic search in MEDLINE and EMBASE databases during the spring of 2009 and 2010. Internet searches were performed, and bodybuilder pharmacopoeias were consulted to describe SEO use and the clinical complications known.Results: One review and seven case reports were identified. Eight case reports describe oleomas caused by repeated intramuscular injections of anabolic steroids.Conclusions: SEOs cause sclerosing lipogranulomatosis and its progression may lead to lifelong complications. Thorough radiologic evaluation is important to plan surgical revisions in active phases. Also antibiotics, steroids, and compression therapy have been successful and should be employed at different stages.