Early Necrosis Research Articles

Cytotoxicity of the Fusarium mycotoxin deoxynivalenol on mammalian and avian cell lines

Trichothecenes are mycotoxins that occur in grains and can lead to acute and chronic poisoning in animals and humans. Deoxynivalenol (DON) is a type B trichothecene affecting protein synthesis, immune system, leading to brain, blood and kidney disorders. The aim of this work was to evaluate in vitro the cytotoxicity and the pathological effects of DON in short-term experiments on cells from non-tumour and tumour permanent cell lines and to compare their sensitivity. Cell cultivation of BALB/c 3T3, DEC 99, MDA-MB-231, MCF-7 and Hela cells was performed. Quantitative and qualitative methods evaluating cytotoxicity on the base of statistical and morphological analyses for determining the impact on the viability and proliferative activity were used: Neutral Red Uptake (NRU) cytotoxicity test, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test and fluorescence microscopy. The cytotoxic effect of DON was assessed after an exposure period of 24 h. DON treatment induced significant alterations in the growth and morphology of the cells, involving early and late apoptosis and necrosis signs. Statistically significant decrease of the viability of all cell lines was established at concentrations of DON starting from 1.9 µg/mL to 3.7 µg/mL, the mean IC50 concentrations were calculated. According to the IC50 values the hierarchical order of cell lines’ sensitivity was determined.

Clinical Application of Shock Wave in the Treatment of Avascular Necrosis of the Femoral Head in the Early and Middle Stages.

In order to observe the clinical efficacy of shock waves in the treatment of avascular necrosis of the femoral head in the early and middle stages, a clinical application method of a shock wave in the treatment of avascular necrosis of the femoral head in the early and middle stages was proposed. The method combines the CT image segmentation technology to further segment the hip joint image, thereby speeding up the treatment speed and achieving a better treatment effect. Experimental results show that CT image segmentation takes 10.9 hours with an average time of 8 seconds, which is faster than other methods. The shock wave is an effective treatment method for early avascular necrosis of the femoral head, and this method will become one of the main methods for the clinical treatment of this kind of disease.

Role of Orth Biologics in Core Decompression for Femoral Head Preservation in Early Avascular Necrosis of Hip

Head preserving procedures for Early Avasculathe Necrosis of hip are invariably effective in early stage. Core decompression (CD) is mostly performed modality for early stages of AVN having different success rates. Current review aims at determining efficiency of Bone marrow aspirate concentrate, Platelet rich Plasma, Bone morphogenic proteins and combining it with Core Decompression for early AVN stage, before femoral head collapse. To preserve a femur head damaged by osteonecrosis, treatment options should be applied early in the disease process for best results. When the articular cartilage becomes deficient to nutrients, it become more difficult to save a particular femur head, and eventually bone destruction occur, affecting hip biomechanics; articular changes eventually develop, necessitating arthroplasty or arthrodesis. Other early treatment techniques has been identified & improved to improve femur head survival & delay replacement. Analysis of 20 studies published between 2011 and 2020 was done of which 6 were retrospective & 14 were prospective. PRP showed better survival and functional outcome, however 3 studies showed inconclusive evidence for its regular usage. BMAC enhanced efficiency of CD & cell increment or combination of PRP for growth stimulation. Concluding, CD and BMAC worked effectively that CD only before femoral head collapse. But, PRP need more evidences for extensive utilization. Adding PRP to BMAC or culturing it would increase potency of CD with BMAC. Less data is available to assess efficiency of BMP-7 & role of Intraosseous bisphosphonate therapy could be studied for inexpensive & better alternate.

EFFICACY OF CORE DECOMPRESSION AND AUTOLOGOUS CANCELLOUS BONE GRAFTING IN AVASCULAR NECROSIS OF FEMORAL HEAD

BACKGROUND: Avascular necrosis (AVN) of the femoral head is a disease that usually affects patients in the 20-50 year age group of life. The disease progresses with time and if left untreated, it may leads to complete deterioration of the hip joint. Various treatments modalities are available as non-surgical, core decompression alone or with autologous bone graft or PRP or bone marrow aspirate or vascularised bular graft, osteotomies and hip replacement. We planned to evaluate the efcacy of core decompression and autologous bone grafting in the management of AVN of the hip. MATERIALS AND METHODS- We performed a prospective study with 20 patients of 20-50 years age group having cat-arlet stage 1 [8 patients ] and 2a [12 patients]. The study period was from January 2018 to December 2019. All patients were treated with core decompression and autologous cancellous bone grafting. Pre-operative Harris hip score [HHS], plain radiograph and MRI were compared with postoperative ones at different time intervals. RESULTS- Average Follow Up Period Was 12 Months And Average Age Group Of Presentation Was 31.1 Years . Males Were More Affected And Most Common Causes Were Idiopathic And Steroid Use. Average Preoperative Hhs Was 56.20 And Postoperative Hhs Was 80.15. At The End Of 1 Year, 12 Patients Showed Remission, 6 Patients Showed Preoperative Stage While 2 Patients Progressed To Advanced Stage And Required Arthroplasty. CONCLUSION-core Decompression And Autologous Bone Grafting Is Effective Treatment Modality In Early Avascular Necrosis Of Femur Head In Terms Of Radiological And Clinical Results And Delaying Arthroplasty

Interleukin-23 receptor expressing γδ T cells locally promote early atherosclerotic lesion formation and plaque necrosis in mice.

Atherosclerosis is a chronic inflammatory disease of the vessel wall controlled by local and systemic immune responses. The role of interleukin-23 receptor (IL-23R), expressed in adaptive immune cells (mainly T-helper 17 cells) and γδ T cells, in atherosclerosis is only incompletely understood. Here, we investigated the vascular cell types expressing IL-23R and addressed the function of IL-23R and γδ T cells in atherosclerosis. IL-23R+ cells were frequently found in the aortic root in contrast to the aorta in low-density lipoprotein receptor deficient IL-23R reporter mice (Ldlr-/-Il23rgfp/+), and mostly identified as γδ T cells that express IL-17 and GM-CSF. scRNA-seq confirmed γδ T cells as the main cell type expressing Il23r and Il17a in the aorta. Ldlr-/-Il23rgfp/gfp mice deficient in IL-23R showed a loss of IL-23R+ cells in the vasculature, and had reduced atherosclerotic lesion formation in the aortic root compared to Ldlr-/- controls after 6 weeks of high-fat diet feeding. In contrast, Ldlr-/-Tcrδ-/- mice lacking all γδ T cells displayed unaltered early atherosclerotic lesion formation compared to Ldlr-/- mice. In both HFD-fed Ldlr-/-Il23rgfp/gfp and Ldlr-/-Tcrδ-/- mice a reduction in the plaque necrotic core area was noted as well as an expansion of splenic regulatory T cells. In vitro, exposure of bone marrow-derived macrophages to both IL-17A and GM-CSF induced cell necrosis, and necroptotic RIP3K and MLKL expression, as well as inflammatory mediators. IL-23R+ γδ T cells are predominantly found in the aortic root rather than the aorta and promote early atherosclerotic lesion formation, plaque necrosis, and inflammation at this site. Targeting IL-23R may thus be explored as a therapeutic approach to mitigate atherosclerotic lesion development.

Berberine increases the expression of cytokines and proteins linked to apoptosis in human melanoma cells

Melanoma is the most lethal form of skin cancer, and its incidence has increased considerably in the last decades. Melanoma presents difficult treatment with strong resistance of tumor cells, due to its extremely invasive nature with high capacity to metastases. Berberine (BBR), an isoquinoline alkaloid, is a molecule found in several medicinal plants, and has been studied in several diseases, demonstrating antimicrobial, antidiabetic and anti-inflammatory properties and anti-tumorigenic effects. In SK-MEL-28 cells, 50μM BBR treatment for 24h decreased cell viability by 50 percent. This concentration generated cell death both by early apoptosis and necrosis, with an increase in the DNA damage index. BBR increased (*p < 0.05) the proportion of cells in G1/G0 phase and decreased (###p < 0.005) the percentage of cells in S phase. The alcaloid increased (****p < 0.001) ROS production compared to untreated controls with an increase in activated caspase 3 and phosphorylated p53 protein levels. In addition, BBR significantly enhanced ERK as well as both pro- and anti-inflammatory cytokine expression compared to untreated controls. BBR has important antiproliferative effects and may be alone or in adjunct therapy a promising candidate for melanoma treatment, a cancer with great incidence and high lethality.

Apigenin Enhanced Radiation-Induced Apoptosis/Necrosis by Sensitization of LNCaP Prostate Cancer Cells to 6 MV Photon Beams.

Objective Whereas prostate cancer (PrCa) may be unresponsive or moderately responsive to radiation therapy (RT)- most common modality for treatment of PrCa- patients must receive a high dose of RT In order to achieve appropriate tumour control. However, this increase in radiation dose may lead to severe adverse effects in normal tissues. Sensitization of PrCa to radiation provides an alternate approach to improve the therapeutic efficacy of RT. This study aims to assess the radiosensitisation effect of apigenin (Api) on a prostate cancer cell line (LNCaP). Materials and Methods In this experimental study, LNCaP cells were treated with 0-80 µM Api to investigate its effect on LNCaP cell viability and determine its half-maximal inhibitory concentration (IC50). Next, the cells were divided into four groups: i. Control, ii. Cells treated with the IC50 concentration of Api, iii. Cells treated with 2 Gy ionizing radiation (IR), and cells co-treated with Api and IR. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, real-time polymerase chain reaction (PCR), and an Annexin V-FITC/PI assay were performed to assess cell survival, Bax and Bcl-2 expressions, and presence of apoptosis and necrosis. Results Api inhibited cell survival in a dose-dependent, but not time-dependent manner. Cells treated with Api had increased amounts of early apoptosis, late apoptosis, and secondary necrosis compared to the control group. This group also had decreased Bcl-2 gene expression and up-regulated Bax gene expression. Co-treatment with Api and IR significantly inhibited cell survival, and increased early apoptosis, late apoptosis and secondary necrosis compared to the other groups. There was a significant decrease in Bcl-2 gene expression along with up-regulation of Bax gene expression, and Bax/Bcl-2 ratio changes that favoured apoptosis. ConclusionApi inhibited PrCa cell survival and induced apoptosis as a single agent. In addition, Api significantly sensitized the LNCaP cells to IR and enhanced radiation-induced apoptosis.

RADT-21. DUAL FET PET-GUIDED SIB IN RADIOTHERAPY OF NEWLY DIAGNOSED GLIOBLASTOMA - A PILOT STUDY

Abstract BACKGROUND PET using FET is a valuable tool to determine the actual glioblastoma infiltration.The FET-PET examination can be performed using the dual-time point acquisition of FET . Infiltration defined in dual FET PET corresponds to the location and shape of the recurrence. The aim of this study was to evaluate safety and efficacy of simultaneous integrated boost based on dual FET PET combined with temozolomide TMZ for the postoperative treatment of GBM. METHODS AND MATERIALS In a prospective pilot study, 17 patients were enrolled. All patient presented an active tumor in postoperative PET imaging. The radiotherapy was performed as an FET-PET-based integrated-boost IMRT. The prescribed dose was 78 and 60 Gy (single dose 2.6 and 2.0 Gy, respectively). The progression-free survival (PFS) and overall survival (OS), toxicities and radiation necrosis rate were evaluated. RESULTS The median follow up was 37 months.Two patients were found to have uncontrolled seizures during radiation treatment and were not able to received treatment per protocol. Patients treated per protocol presented new or increased neurological deficits in 7/15 cases in a month after irradiation. In 4 patients radiation necrosis was confirmed in pathological report after re-surgery. Three patients were still alive after 26,28 and 38 months of follow up without progression and any signs of treatment related late toxicity. The 2-year survival rate was 43% in all patients treated per protocol. Median overall survival (OS) and disease-free survival (DFS) were 20 and 12 months, respectively. In a subgroup of MGMT methylated and unmethylated the median survival was 25 and 12 months. CONCLUSIONS Our dose escalation concept with a total dose of 78 Gy, based on FET-PET, have lead to promising survival results even within MGMT unmethylated subgroup. However rate of early toxicity and radiation necrosis is high.

The under-recognised effects of serious endoscopic complications on practitioners

The patient was fit and well, albeit recovering from an episode of jaundice due to choledocholithiasis. Biliary cannulation went smoothly; the pancreas was untouched. A straightforward sphincterotomy was performed and the stones were cleared. Rectal diclofenac was administered. The patient went home after 6 h of observation, but in the middle of the night, she developed severe abdominal pain. In the emergency room, her pulse rate ran high, with a tender abdomen and high amylase. Imaging showed early pancreatic necrosis.

Magnetic Resonance Imaging-Based Radiomics Models to Predict Early Extrapancreatic Necrosis in Acute Pancreatitis.

The aim of the study was to investigate radiomics models based on magnetic resonance imaging (MRI) for predicting early extrapancreatic necrosis (EXPN) in acute pancreatitis. Radiomics features were extracted from T2-weighted images of extrapancreatic collections and late arterial-phase images of the pancreatic parenchyma for 135 enrolled patients (94 in the primary cohort, including 47 EXPN patients and 41 in the validation cohort, including 20 EXPN patients). The optimal features after dimension reduction were used for radiomics modeling through a support vector machine. A clinical model, the MR severity index score, and extrapancreatic inflammation on MRI were evaluated. Twelve optimal features from the extrapancreatic collection images and 10 from the pancreatic parenchyma images were selected for modeling. The pancreatic parenchyma-based and extrapancreatic collection-based radiomics models showed good predictive accuracy in both the training and validation cohorts. The areas under the curve of the extrapancreatic collection-based radiomics model (0.969 and 0.976) were consistent with those of the pancreatic parenchyma-based model (0.931 and 0.921) for both cohorts and better than those of the clinical model and imaging scores for both cohorts. The MRI-based radiomics models of both the extrapancreatic collections and the pancreatic parenchyma had excellent predictive performance for early EXPN.

A novel device for treatment of osteonecrosis of femoral head: Feasibility and preliminary efficacy of animal study.

BackgroundInterruption of blood supply will lead to necrosis of body tissues, such as osteonecrosis of femoral head (ONFH). Vascularization has always been regarded as one of the biggest challenges in tissue engineering. In the current study, a novel device was proposed to reconstruct blood supply of necrotic femoral head.MethodsCryo-insult with liquid nitrogen method was adopted to establish the ONFH model. In experimental group, a novel scaffold carrying vascular bundle was implanted into the necrotic femoral head after decompression and the transplanted vascular bundles were anastomosed with the existing blood vessels around the hip. In control group, a traditional porous scaffold was inserted alone without vessels. Feasibility of this strategy was verified by animal experiments. Micro-CT analysis and histological evaluation were performed to investigate its preliminary efficacy.ResultsFeasibility of this innovative treatment strategy had been successfully verified in animal experiments. In the area of necrosis repair, more bone tissue grew into the scaffold in experimental group than the control group evaluated by Micro-CT (three months: 29.66% VS 20.35%, P＜0.05; six months: 30.47% VS 25.10%, P＜0.05) and histological analysis (24.71% VS 16.45%, P＜0.05 ​at three months; 31.01% VS 20.60%, P＜0.05 ​at six months). Implanted vascular bundles had the potential to branch out many branches in the osteonecrosis repair area to facilitate blood supply reconstruction and bone repair.ConclusionsThis study proposed a novel device with clinical application prospects in the treatment of ONFH. It has the potential to provide new possibilities for rebuilding the blood supply of femoral head and repairing osteonecrosis.Translational potential statementThe novel device proposed in this study has the potential to be applied to the treatment of early femoral head necrosis.

Management of Early Avascular necrosis of femoral head with Core Decompression and Platelet Rich Plasma infiltration

Various modalities available for the treatment of AVN range from conservative modalities like observation and non-weight-bearing mobilization, various pharmacological agents like Bisphosphonates, Enoxaparin are shown to be useful in some studies, Hyperbaric oxygen therapy to Surgical modalities like femoral head preserving procedures (core decompression with or without additional procedure, i.e. bone grafting, biologic adjuvants – Platelet Rich Plasma, Stem cells etc. and rotational osteotomies) and replacement surgeries. 20 patients of Early AVN who met inclusion criteria and operated with core decompression and PRP infiltration were included in this study. Out of 20 patients, 2 patients (10%) had superficial infections which healed on its own without any intervention, 5 patients (25%) had restriction of movements and 3 patients (15%) required replacement surgery. The mean pre-operative Harris Hip Score of our study was 64.3, and the mean post-operative Harris hip score of our study was 80.2. Out of 20 cases, 6 patients (30%) showed limitation of the progression of the disease, 3 (15%) patients progressed to the further stages of the disease and 11 patients (55%) had remission of the disease. The final outcome, on the basis of Harris Hip Score in 5 patients (25%), was excellent, 7 patients (35%) was good, 5 patients (25%) was fair, and in 3 patients (15%) was poor. Our study concludes that Core decompression along with PRP infiltration can be used as a good alternative for or in addition with traditionally performed core decompression and bone grafting.

A CASE OF NON-RESOLVING PNEUMONIA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Non-resolving pneumonia is defined as pneumonia with slow or incomplete resolution despite adequate appropriate antibiotic treatment. It is a common reason for pulmonary consultations & bronchoscopies in the hospital. Though occurrence is relatively rare, there are many reasons non-resolving pneumonia may develop. Often, they are caused by resistant organisms, mechanical airway obstructions, inappropriate antibiotic treatment, & inadequate duration of treatment. We present a rare case of non-resolving pneumonia, which led to irreversible respiratory failure. CASE PRESENTATION: A 68-year-old male with no significant past medical history presented with worsening dyspnea on exertion & cough productive of yellowish sputum for 5 weeks. In the ER, he reported fevers, night sweats, & unintentional 10-lb weight loss. Vitals showed tachycardia & hypoxia. Physical exam was positive for decreased breath sounds on the right with rhonchi. The patient had not seen a physician for many years. He reported smoking 1 pack per day for 50 years. Chest X-ray showed extensive opacification of the right hemithorax with a small pleural effusion, which suggested multi-lobar right lung pneumonia. The patient was started on empiric piperacillin-tazobactam & vancomycin. Sputum culture grew normal respiratory flora. Blood cultures remained negative. Extensive infectious workup was performed with all tests being negative. CTPA revealed airspace opacities within the right lung & fluid density within the right lung apex which is consistent with early lung necrosis. Bronchoscopy showed a normal bronchial tree. Bronchoalveolar lavage cytology showed no malignant cells. After 10 days of no clinical improvement, a repeat CT chest showed worsening right lung opacification, ground-glass opacities within the left upper lobe, & enlarged mediastinal lymph nodes. The patient continued to worsen clinically therefore underwent right limited thoracotomy & lung biopsy, which showed extensive adhesions with pleural & lung implants. Pathology revealed lung adenocarcinoma. The patient declined therapeutic chemotherapy treatment & opted to go home with hospice. DISCUSSION: This case emphasizes the importance of early recognition of non-resolving pneumonia, the proper diagnostic approach, & when to initiate further invasive workup. Evaluation of a patient with a slowly or incompletely resolved pneumonia starts with a careful history, physical examination, & review of the medical record CONCLUSIONS: Consideration of risk factors for delayed resolution should include age, comorbidities, the severity of pneumonia, & specific pathogens. If indicated, further evaluation should include CT chest to assess for findings suggestive of an alternative diagnosis. When pneumonia fails to resolve, bronchoscopy should be considered. Patients with a negative bronchoscopy examination should undergo further evaluation with lung biopsy to assess for malignancy REFERENCE #1: Jameson, J. L., Kasper, D. L., Longo, D. L., Fauci, A. S., Hauser, S. L., & Loscalzo, J. (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. DISCLOSURES: No relevant relationships by Luqman Baloch, source=Web Response No relevant relationships by Luqman Baloch, source=Web Response No relevant relationships by Adrienne DaGue, source=Web Response No relevant relationships by ayobami olaleye, source=Web Response

Clinical Evaluation of Percutaneous Head and Neck Fenestration and Artificial Bone Grafting for the Treatment of Early Femoral Head Necrosis

Clinical Evaluation of Percutaneous Head and Neck Fenestration and Artificial Bone Grafting for the Treatment of Early Femoral Head Necrosis

Evaluation of Cell Viability with a Single Fluorescent Probe Based on Two Kinds of Fluorescence Signal Modes

Accurate evaluation of cell viability is important for dosage tests of anticancer drugs, pathology, and numerous biological experiments. However, due to the serious insufficieny of fluorescent probes, which can distinguish various cell states, the study of cell viability is immensely limited. To resolve this issue, we design and synthesize a new probe ACD-E to monitor cell viability with two kinds of fluorescence signal modes, the first single fluorescent probe that can distinguish three different cell states and furnish accurate information in biological experiments. ACD-E can discriminate live and dead cells in a dual-color mode by evaluating cell mitochondrial esterase activity and can also discriminate live and early necrosis cells by determining mitochondrial viscosity in a "turn-on" mode in the near-infrared region. Significantly, the novel ACD-E can also distinguish cell viability in vivo. This work establishes a robust strategy for monitoring multiple cell states using a single fluorescent probe.

Early Cortical Laminar Necrosis on MRI

An 80-year-old man with chronic hypertension was admitted to the emergency department with consciousness disorders. The evolution was marked by a rapid worsening of his neurological condition. The patient was intubated and ventilated. The biological check-up revealed a blood glucose level of 0.2g/l. A brain scan was performed which was without abnormality. Two days after the normalization of the blood sugar level, the patient presented a late awakening. A brain MRI was performed which showed bilateral fronto-parietal laminar cortical areas in T2, Flair and diffusion hypersignal, T1 iso signal, and no hyposignal on T2 gradient echo sequence (Figure 1). The diagnostic of Cortical Laminar Necrosis was retained.

Clinical study on new risk assessment and prediction system for early osteonecrosis of the femoral head

To establish a risk assessment and prediction system for early osteonecrosis of the femoral head (ONFH) in order to predict the collapse risk. The risk assessment system for early necrosis and collapse of femoral head was established based on the combination of Steinberg stage, ABC typing and the proportion of the proximal sclerotic rim. Firstly, Steinberg stage system was applied. ABC typing was applied to predict risk in stage I, type C was risk free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. The classification of proximal sclerotic rim was first applied when the Steinberg stage was Ⅱ-Ⅲ, and type 2 was expected to be low risk. If the classification of proximal sclerotic rimwas type 1, then the ABC typing was applied, type C was risk-free, type B was low risk, type A and type BC were medium risk, type A-C and type AB were high risk. According to this prediction system, the collapse risk of femoral head in 188 cases(301 hips) were predicted by retrospective analysis. All the hips were enrolled at the out-patient department of orthopedic in Guang'anmen Hospital attached to China Academy of Chinese Medical Science. The consistency of the prediction results of three doctors and one doctor at different times were evaluated. Among them, 136 cases were male, 52 were female. 75 cases were single hip, 113 were double hip. The age of the patients wa 19 to 64(42.61±12.07) years. The natural course of disease was 0.33 to 5.00(3.62±1.93) years. 206 hips in 301 hips had collapsed, with a collapse rate of 68.44%. In the risk-free group, none hip had collapsed, with a collapse rate of 0%. In the low-risk group, 9 hip in 91 hips had collapsed, with a collapse rate of 9.89%. In the medium-risk group, 12 hip in 19 hips had collapsed, with a collapse rate of 63.16%. And in the high risk group, 185 hips in 190 hips had collapsed, with a collapse rate of 97.37%. They were significantly differences in their collapse rate (P=0.00) in the following order:high-risk group> medium-risk > low-risk group > risk-free group. The prediction value of the system was high (AUC=0.95, P=0.00). The results predicted by different doctors were consistent (ICC=0.94, P=0.00), and the results predicted by the same doctor at two different times were consistent (Kappa coefficient =0.90, P=0.00). The risk assessment and prediction system for early ONFH selects different methods to predict the risk of collapse according to the imaging characteristics of different stages, which is combines with the comprehensive assessment of multiple risk factors. The system is applicable to a wide range, simple operation and convenient for clinical application.

Extracorporeal Shockwave Therapy Modulates the Expressions of Proinflammatory Cytokines IL33 and IL17A, and Their Receptors ST2 and IL17RA, within the Articular Cartilage in Early Avascular Necrosis of the Femoral Head in a Rat Model.

Avascular necrosis (AVN) of the femoral head (AVNFH) is a disease caused by injury to the blood supply of the femoral head, resulting in a collapse with osteonecrosis and damage to the articular cartilage. Extracorporeal shockwave therapy (ESWT) has been demonstrated to improve AVNFH owing to its anti-inflammation activity, angiogenesis effect, and tissue regeneration in clinical treatment. However, there are still so many pieces of the jigsaw that need to be fit into place in order to ascertain the mechanism of ESWT for the treatment of AVNFH. The study demonstrated that ESWT significantly protected the trabecular bone volume fraction BV/TV (P < 0.01) and the trabecular thickness (P < 0.001), while in contrast, the trabecular number and trabecular separation were not significantly different after treatment as compared with AVNFH. ESWT protected the articular cartilage in animal model of AVNFH. The levels of IL1-β and IL33 were significantly induced in the AVNFH group (P < 0.001) as compared with Sham and ESWT groups and reduced in ESWT group (P < 0.001) as compared with AVNFH group. In addition, the expression of the receptor of IL33, ST2, was reduced in AVNFH and induced after ESWT (P < 0.001). The expression of IL17A was induced in the AVNFH group (P < 0.001) and reduced in the ESWT group (P < 0.001). Further, the expression of the receptor of IL17A, IL17RA, was reduced in the AVNFH group (P < 0.001) and improved to a normal level in the ESWT group as compared with Sham group (P < 0.001). Taken together, the results of the study indicated that ESWT modulated the expression of IL1-β, pro-inflammatory cytokines IL33 and IL17A, and their receptors ST2 and IL17RA, to protect against loss of the extracellular matrix in the articular cartilage of early AVNFH.

Magnetic resonance image diagnosis of femoral head necrosis based on ResNet18 network

PurposeIn order to enhance the practicability of the application of Magnetic Resonance Imaging (MRI) in the diagnosis of femoral head necrosis, combined with the convolutional neural network (CNN), we propose an automatic identification of femoral head necrosis model based on the ResNet18 network. MethodsIn order to verify that MRI has a higher detection rate for early femoral head necrosis, we collected 360 cases of femoral MRI and the same number of femoral CT. Combining this method with ResNet18, AlexNet, and VGG16, compare the clinical staging and typical signs of femoral head necrosis with 8 diagnostic methods. ResultsThe total detection rate of MRI combined with ResNet18 is as high as 99.27%, which is much higher than the other three comparison methods. The sensitivity is 97%, the specificity is 98.99%, and the accuracy is 98.23%. The difference is statistically significant. ConclusionThe automatic recognition femoral MRI model based on the ResNet18 network has a high detection rate for early femoral head necrosis, and can effectively detect bone marrow edema, line-like signs and other signs, providing a reliable reference for early treatment.

Short term effect of double channel decompression and bone grafting via greater trochanter combined with allograft fibula propping in the treatment of femoral head necrosis

To investigate the short-term clinical effect of double channel decompression and bone grafting through the greater trochanter combined with allograft fibula propping in the treatment of osteonecrosis of femoral head (ONFH). Twenty two patients (23 hips) with osteonecrosis of the femoral head were included from November 2017 to February 2019. According to Association Research Cirulation Osseous(ARCO) staging, there were 13 hips at stageⅡgroup, aged from 20 to 48 years old with an average of(32.5±8.5)years old;10 hips at stageⅢgroup, aged from 18 to 45 years old with an average of(32.7±8.6) years old. A single approach through the greater trochanterwas used for decompression, bone grafting and fibula support. Harris scoring system was used to evaluate the function of hip joint before and after implantation, and the anteroposterior and lateral X-ray films of hip joint were taken at 3, 6, 12 and 18 months after implantation to observe and analyze the progress of femoral head necrosis and regeneration. All patients were followed up, and the duration ranged from 12 to 18 months with an average of (14.6±2.1) months. Harris score of stageⅡand stageⅢpatients increased from 73.2± 5.5 and 66.5±3.4 to 87.6±8.7(P<0.001) and 77.2±14.0 (P<0.05) respectively. After 12 months, the X-ray film of all patients showed that 12 hips were improved at stageⅡgroup and 7 hips were improved at stageⅢgroup. The effect of double trochanteric decompression and bone grafting combined with fibular allograft propping in the treatment of early and middle stage avascular necrosis of the femoral head is good, especially suitable for young and middle aged patients with ARCOⅡstage avascular necrosis of the femoral head.