Peptidoglycan (PGN), the major component of the cell wall of Gram-positive bacteria, activates the innate immune system of the host and induces the release of cytokines and chemokines. We investigated the signaling pathway involved in IL-6 production stimulated by PGN in rheumatoid arthritis synovial fibroblasts. PGN caused concentration- and time-dependent increases in IL-6 production. PGN-mediated IL-6 production was attenuated by TLR2 small interfering RNA and nucleotide-binding oligomerization domain 2 small interfering RNA. Pretreatment with PI3K inhibitor (Ly294002 and wortmannin), Akt inhibitor, and AP-1 inhibitor (tanshinone IIA) also inhibited the potentiating action of PGN. PGN increased the focal adhesion kinase (FAK), PI3K, and Akt phosphorylation. Stimulation of rheumatoid arthritis synovial fibroblast cells with PGN increased the accumulation of phosphorylated c-Jun in the nucleus, AP-1-luciferase activity, and c-Jun binding to the AP-1 element on the IL-6 promoter. PGN mediated an increase in the accumulation of phosphorylated c-Jun in the nucleus, AP-1-luciferase activity, and c-Jun binding to AP-1 element was inhibited by Ly294002, Akt inhibitor, and FAK mutant. Our results suggest that PGN increased IL-6 production in human synovial fibroblasts via the TLR2 receptor/FAK/PI3K/Akt and AP-1 signaling pathway.
Percutaneous vertebroplasty with polymethyl methacrylate is relatively safe, but it still should be proceeded under careful safeguard. The needle tip should not cross the medial border of the pedicle on the anteroposterior view before it has crossed the posterior cortex of the vertebral body on the lateral view. Good quality of image monitoring and clear visualization of cement should be helpful to prevent complications.
There are three methods for evaluation of dislocation of the distal radioulnar joint using computed tomography: the radioulnar line method, the epicenter method, and the congruity method. However, some patients who are clinically symptom-free have abnormal findings from computed tomography of the distal radioulnar joint according to the aforementioned criteria. In addition, these methods are qualitative, not quantitative definitions. Forty patients were included in this study. Computed tomography scans of the wrists were done. The variation of displacement of the distal radioulnar joint was measured. By the epicenter method, the 95% confidence interval (mean +/- 1.96 standard error) was from 0.0026 to 0.1114 in supination and from -0.1171 to 0.0446 in pronation. By the radioulnar line method, the 95% confidence interval was from 0.0026 to 0.0479 in supination and from -0.0065 to 0.0745 in pronation. By the modified radioulnar line method, the 95% confidence interval was from 0.1778 to 0.2752 in supination and from 0.0990 to 0.2310 in pronation. There was a wide range of the displacement of the distal radioulnar joint in patients with clinically normal wrists. The results can be regarded as reference points for normal variation of the distal radioulnar joint. This can help to differentiate the causes of internal derangement of the wrist.
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