Hip Bone Research Articles

Pelvic bone marrow dose-volume predictors of late lymphopenia following pelvic lymph node radiation therapy for prostate cancer

Background and purposeGiven the substantial lack of knowledge, we aimed to assess clinical/dosimetry predictors of late hematological toxicity on patients undergoing pelvic-nodes irradiation (PNI) for prostate cancer (PCa) within a prospective multi-institute study. Materials and methodsClinical/dosimetry/blood test data were prospectively collected including lymphocytes count (ALC) at baseline, mid/end-PNI, 3/6 months and every 6 months up to 5-year after PNI. DVHs of the Body, ileum (BMILEUM), lumbosacral spine (BMLS), lower pelvis (BMPELVIS), and whole pelvis (BMTOT) were extracted. Current analysis focused on 2-year CTCAEv4.03 Grade ≥ 2 (G2+) lymphopenia (ALC < 800/μL). DVH parameters that better discriminate patients with/without toxicity were first identified. After data pre-processing to limit overfitting, a multi-variable logistic regression model combining DVH and clinical information was identified and internally validated by bootstrap. ResultsComplete data of 499 patients were available: 46 patients (9.2 %) experienced late G2+ lymphopenia. DVH parameters of BMLS/BMPELVIS/BMTOT and Body were associated to increased G2+ lymphopenia. The variables retained in the resulting model were ALC at baseline [HR = 0.997, 95 %CI 0.996–0.998, p < 0.0001], smoke (yes/no) [HR = 2.9, 95 %CI 1.25–6.76, p = 0.013] and BMLS-V ≥ 24 Gy (cc) [HR = 1.006, 95 %CI 1.002–1.011, p = 0.003]. When acute G3+ lymphopenia (yes/no) was considered, it was retained in the model [HR = 4.517, 95 %CI 1.954–10.441, p = 0.0004]. Performances of the models were relatively high (AUC = 0.87/0.88) and confirmed by validation. ConclusionsTwo-year lymphopenia after PNI for PCa is largely modulated by baseline ALC, with an independent role of acute G3+ lymphopenia. BMLS-V24 was the best dosimetry predictor: constraints for BMTOT (V10Gy < 1520 cc, V20Gy < 1250 cc, V30Gy < 850 cc), and BMLS (V24y < 307 cc) were suggested to potentially reduce the risk.

Study on sex differences and potential clinical value of three-dimensional computerized tomography pelvimetry in rectal cancer patients.

Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors. However, the existing literature lacks standardized parameters for the pelvic region and soft tissues, which hampers the establishment of consistent conclusions. To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography (CT)-based three-dimensional (3D) reconstruction, providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery. We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer, and utilized CT data for 3D pelvic reconstruction. Specific anatomical points were carefully marked and measured using advanced 3D modeling software. To analyze the pelvic and soft tissue parameters, we employed statistical methods including paired sample t-tests, Wilcoxon rank-sum tests, and correlation analysis. The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters. Males demonstrated larger measurements in pelvic depth and overall curvature, smaller measurements in pelvic width, a larger mesorectal fat area, and a larger anterior-posterior abdominal diameter. By contrast, females exhibited wider pelvises, shallower depth, smaller overall curvature, and an increased amount of subcutaneous fat tissue. However, there were no significant sex differences observed in certain parameters such as sacral curvature height, superior pubococcygeal diameter, rectal area, visceral fat area, waist circumference, and transverse abdominal diameter. The reconstruction of 3D CT data enabled accurate pelvic measurements, revealing significant sex differences in both pelvic and soft tissue parameters. This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially "difficult pelvis", ultimately improving surgical outcomes. Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.

Multi-center Dose Prediction Using Attention-aware Deep learning Algorithm Based on Transformers for Cervical Cancer Radiotherapy

AimsAccurate dose delivery is crucial for cervical cancer volumetric modulated arc therapy (VMAT). We aimed to develop a robust deep-learning (DL) algorithm for fast and accurate dose prediction of cervical cancer VMAT in multicenter datasets and then explore the feasibility of the DL algorithm to endometrial cancer VMAT with different prescriptions. Materials and methodsWe proposed the AtTranNet algorithm for three-dimensional dose prediction. A total of 367 cervical patients were enrolled in this study. Three hundred twenty-two cervical patients from 3 centers were randomly divided into 70%, 10%, and 20% as training, validation, and testing sets, respectively. Forty-five cervical patients from another center were selected for external testing. Moreover, 70 patients of endometrial cancer with different prescriptions were further selected to test the model. Prediction precision was evaluated by dosimetric difference, dose map, and dose-volume histogram metrics. ResultsThe prediction results were all clinically acceptable. The mean absolute error within the body in internal testing was 0.66 ± 0.63%. The maximum |δD| for planning target volume was observed in D98, which is 1.24 ± 2.73 Gy. The maximum |δD| for organs at risk was observed in Dmean of bladder, which is 4.79 ± 3.14 Gy. The maximum |δV| were observed in V40 of pelvic bones, which is 4.77 ± 4.48%. ConclusionAtTranNet showed the feasibility and reasonable accuracy in the dose prediction for cervical cancer in multiple centers. The model can also be generalized for endometrial cancer with different prescriptions without any transfer learning.

Carcinoma cervix with synchronous isolated pelvic bone metastasis:a case report and review of literature

Carcinoma cervix with synchronous isolated pelvic bone metastasis:a case report and review of literature

Pelvic bone tumor segmentation fusion algorithm based on fully convolutional neural network and conditional random field

Background and objectivePelvic bone tumors represent a harmful orthopedic condition, encompassing both benign and malignant forms. Addressing the issue of limited accuracy in current machine learning algorithms for bone tumor image segmentation, we have developed an enhanced bone tumor image segmentation algorithm. This algorithm is built upon an improved full convolutional neural network, incorporating both the fully convolutional neural network (FCNN-4s) and a conditional random field (CRF) to achieve more precise segmentation. MethodologyThe enhanced fully convolutional neural network (FCNN-4s) was employed to conduct initial segmentation on preprocessed images. Following each convolutional layer, batch normalization layers were introduced to expedite network training convergence and enhance the accuracy of the trained model. Subsequently, a fully connected conditional random field (CRF) was integrated to fine-tune the segmentation results, refining the boundaries of pelvic bone tumors and achieving high-quality segmentation. ResultsThe experimental outcomes demonstrate a significant enhancement in segmentation accuracy and stability when compared to the conventional convolutional neural network bone tumor image segmentation algorithm. The algorithm achieves an average Dice coefficient of 93.31 %, indicating superior performance in real-time operations. ConclusionIn contrast to the conventional convolutional neural network segmentation algorithm, the algorithm presented in this paper boasts a more intricate structure, proficiently addressing issues of over-segmentation and under-segmentation in pelvic bone tumor segmentation. This segmentation model exhibits superior real-time performance, robust stability, and is capable of achieving heightened segmentation accuracy.

Importance of bone mineral density and comorbidity index for functionality

Background: Assessing elderly ambulatory patients at risk of osteoporotic fractures is crucial for achieving appropriate functioning, including daily activities, rehabilitation, lifestyle improvements, and dietary optimization. Aim: This study focuses on evaluating bone health and comorbidities in patients to predict osteoporotic fracture functionality, using multiple logistic regression and comparing cohorts for optimal operating points. Methods: A retrospective study was conducted at Prince Rashid bin Al-Hasan Military Hospital, Jordan, to examine the correlations and quality of patients' functionality statuses based on Age-adjusted Charlson Co-Morbidity Index (AACCI) and femoral hip bone mineral density (fH_BMD). The study categorized patients into two cohorts, with functional grades ranging from III-IV to I-II. The results were analyzed using statistical tests and confidence intervals. Results: A Multiple Logistic Regression model was developed to simulate the relationship between patients' Age-adjusted Charlson Co-Morbidity Index (AACCI) and femoral hip bone mineral density (fH_BMD) and their functionality statuses. The model was statistically significant, explaining variation in the dependent variable from 30%-40.2% depending on the reference method. It correctly classified 78.2% of cases, with the explained variation ranging from 30%-40.2% depending on the method used. Conclusion: A small, non-sponsored study found an exponential association between patients' femoral bone mineral density and their functionality status, with this correlation shifting to the right when the Age-adjusted Charlson Co-Morbidity Index is ≥4.

The role of bone remodeling in measuring migration of custom implants for large acetabular defects.

In revision total hip arthroplasty, achieving robust fixation is difficult and implant movement may occur over time. Bone may also rearrange around the implant as a result of mechanical loading, making the measurement of migration challenging. The study aimed to quantify changes in bone shape and implant position 1 year following acetabular reconstruction using custom three-dimensional-printed cups. This observational retrospective cohort study involved 23 patients with Paprosky type IIIB defects. Postop computed tomography scans taken within 1 week of surgery and at 1-year postsurgery were co-registered and analyzed. Three co-registration strategies were implemented including bone-to-bone and implant-to-implant. (1) Co-registration of the ipsilateral innominate bone (diseased anatomy) was used to measure changes in implant position. (2) Co-registration of the implant was carried out to quantify changes in the ipsilateral innominate bone shape. (3) Co-registration of the contralateral innominate bone (nondiseased anatomy) was performed to measure changes in the ipsilateral innominate bone shape and implant position. The median centroid distances (interquartile range [IQR]) were 2.3 mm (IQR: 3.7-1.7 mm) for changes in implant position, 2.4 mm (IQR: 3.6-1.6 mm) for changes in ipsilateral innominate bone shape, and 3.7 mm (IQR: 4.6-3.5 mm) for changes in ipsilateral innominate bone shape and implant position. Following acetabular reconstruction, implant movements and periprosthetic bone remodeling are physiological and of a similar extent. Surgeons and engineers should consider this when performing implant monitoring in these patients.

Limb salvage surgery for primary bone tumors: retrospective study in a tertiary care centre

Background: Limb salvage surgery is the standard of care for patients with primary bone tumors. The study retrospectively analyses a single center experience of use of endo-prosthesis for limb conservation in cases of primary bone tumors over a five-year period (2015-2020). Methods: Total of 34 histologically proven primary bone tumor were retrospectively studied which included 25 males and 9 females who received limb salvage surgery for bone tumors at department of surgical oncology, Rajiv Gandhi Government general hospital, Madras medical college, Chennai. Results: Median age at diagnosis was 23 years. Tumor localized to lower limb in 23 patients, and upper limb in 9 patients, pelvic bones in 3 cases. Tumors were malignant in 24 patients (70.4%) and benign in 10 patients (29.4%). The most common diagnosis was osteosarcoma17 patients (50%). The median resection length was 10 cm. High grade tumors (grade 2a and 2b and grade 3) was found in 14 cases (41.1%). 6 patients had prosthesis related complications. The mean follow-up was 5 years (range: 3-7). 27 (79.4%) patients of 34 were alive with the endo-prosthesis at the last follow-up. Conclusions: The custom mega prosthesis favored by us in most of the cases in limb sparing surgery for bone tumors results in satisfactory results in terms of local tumor control and limb function.

More rapid bone mineral density loss in older men with diabetes: The Osteoporotic Fractures in Men (MrOS) Study.

Type 2 diabetes mellitus (T2D) is associated with more rapid bone loss in women, but less evidence is available for men or those with prediabetes. To determine whether bone loss rate is affected by diabetes status in older men, we analyzed data from the Osteoporotic Fractures in Men (MrOS) study. The multisite MrOS study enrolled 5,994 men aged ≥65 years. Diabetes status was defined by self-report, diabetes medication use, or elevated fasting serum glucose at baseline. Hip bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DXA) at baseline and a follow-up visit after 4.6 ± 0.4 years. This analysis included 4095 men, excluding those without a follow-up DXA or with unknown diabetes status. Changes in hip BMD in participants with normoglycemia (NG), prediabetes, or T2D, excluding thiazolidinedione (TZD) users, were evaluated using generalized linear models (GLM). Diabetes medication use and BMD loss among those with T2D were also evaluated with GLM. In adjusted models, loss in hip BMD was greater in men with T2D (- 2.23%: 95% CI: -2.54 to -1.91; p<0.001) but not in men with prediabetes (-1.45%; 95% CI -1.63 to -1.26; p=0.33) compared to NG (-1.57%: 95% CI -1.73 to -1.41). Among men with T2D, TZD, insulin and sulfonylurea use were associated with greater hip BMD loss. Men with T2D, but not prediabetes, experienced an accelerated bone loss compared to participants with normoglycemia. More rapid bone loss predicts increased risk of fractures and mortality in broader populations.

Atypical Presentation of Metastatic Castrate-resistant Prostate Cancer in a Middle Aged African Male with Good Response to Radioligand Therapy.

Prostate cancer typically follows a characteristic pattern of metastatic spread to the pelvic lymph nodes and bone. Atypical patterns of metastasis are rare but have been documented. In African men, this disease tends to follow a more aggressive course, with the possibility of an atypical site of metastatic spread. We present a case of a 58-year- old African male with metastatic castrate-resistant prostate cancer who presented with both typical and atypical patterns of metastatic disease detected by a fluorine 18 prostate-specific membrane antigen positron emission tomography/computed tomography scan. This patient also had a good response to radioligand therapy.

Upaya Pemberdayaan Kader dan Ibu Hamil tentang Senam Hamil untuk Mengatasi Ketidaknyamanan Kehamilan pada Ibu Hamil di Posyandu Kinasih Banjarsari Surakarta

Pregnancy exercise is a form of structured exercise or exercise. Exercising on a regular basis will improve blood circulation, strengthen muscles and flex joints and can reduce common disorders during pregnancy such as aches, back pain, muscle stiffness, constipation, and reduce leg swelling. Doing pregnancy exercise regularly can reduce lower back pain, one of which is by kneeling, rotating the pelvic bones, bending the buttocks, bending the knees, chest. The purpose of this community service is that after receiving counseling it is hoped that pregnant women and Health Cadres members of Posyandu Kinasih, Banjarsari Subdistrict, Surakarta can apply and be able to provide education to pregnant women to carry out pregnancy exercise to overcome discomfort in pregnant women. The target of counseling activities about pregnancy exercise is all Health Cadres and pregnant women in the Banjarsari Village, Surakarta. The expected output of pregnancy exercise counseling activities for cadres and members of the Balita Kinasih Posyandu in Banjarsari Surakarta Village is an increase in knowledge and skills about pregnancy exercise for mothers and cadres. The results of community service are that after counseling cadres and pregnant women become more knowledgeable, understand about pregnancy exercise as evidenced in the results of the evaluation through the distribution of questionnaires, the average value of the level of knowledge is from 70% to 90%. Based on the implementation of community service, it can be concluded that there is an increase.

Nonalcoholic Fatty Liver Disease, Bone and Muscle Quality in Prolactinoma: A Pilot Study

Objective: Hyperprolactinemia has negative impacts on metabolism and musculoskeletal health. In this study, individuals with active prolactinoma were evaluated for nonalcoholic fatty liver disease (NAFLD) and musculoskeletal health, which are underemphasized in the literature.Methods: Twelve active prolactinoma patients and twelve healthy controls matched by age, gender, and BMI were included. Magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was used to evaluate hepatic steatosis and magnetic resonance elastography (MRE) to evaluate liver stiffness measurement (LSM). Abdominal muscle mass, and vertebral MRI-PDFF was also evaluated with MRI. Body compositions were evaluated by dual energy X-ray absorptiometry (DXA). The skeletal muscle quality (SMQ) was classified as normal, low and weak by using “handgrip strength/appendicular skeletal muscle mass (HGS/ASM)” ratio based on the cut-off values previously stated in the literature.Results: Prolactin, HbA1c and CRP levels were higher in prolactinoma patients (p<0.001, p=0.033 and p=0.035, respectively). The median MRI-PDFF and MRE-LSM were 3.0% (2.01-15.20) and 2.22 kPa (2.0-2.5) in the prolactinoma group and 2.5% (1.65-10.00) and 2.19 kPa (1.92-2.54) in the control group, respectively and similiar between groups. In prolactinoma patients, liver MRI-PDFF showed a positive and strong correlation with the duration of disease and traditional risk factors for NAFLD. Total, vertebral and pelvic bone mineral density was similar between groups, while vertebral MRI-PDFF tended to be higher in prolactinoma patients (p=0.075). Muscle mass and strength parameters were similar between groups, but HGS/ASM tended to be higher in prolactinoma patients (p=0.057). Muscle mass was low in 33.3% of prolactinoma patients and 66.6 of controls. According to SMQ, all prolactinoma patients had normal SMQ, whereas 66.6% of the controls had normal SMQ.Conclusion: Prolactinoma patients demonstrated similar liver MRI-PDFF and MRE-LSM to controls despite their impaired metabolic profile and lower gonadal hormone levels. Hyperprolactinemia may improve muscle quality in prolactinoma patients despite hypogonadism.

Radiological Anatomy of the Pelvis and Pelvic Limb of the Greater Cane Rat (Thryonomys swinderianus).

Greater cane rats (Thryonomys swinderianus) are now being captive reared and domesticated in the sub-Saharan Africa because of increase in their demand for biomedical research and traditional medicine and as a source of meat. This research was performed to provide the normal radiological anatomy of the pelvis and pelvic limb in greater cane rats for a reference in biomedical research, in anatomical studies, and in clinical use. Radiological examination of the pelvis and right pelvic limb was done in five greater cane rats. Radiological results were correlated with bones of the pelvis and right pelvic limb. The pelvic bone had a prominent caudoventral iliac spine. The pelvic symphysis was long and obturator foramina appeared teardrop-shaped elongated craniocaudally. The prominent major trochanter extended proximally higher than the femoral head. The middle third of the body of the tibia presented a very prominent tuberosity. In all specimens, the tarsal sesamoid bone was visualised. Mineralised popliteal sesamoid bone was not visualised. In male greater cane rats, the os penis was visualised. The lateral and medial menisci of the stifle joint were seen with ossicles. The first metatarsal bone was rudimentary with greater plantar divergence. Despite of the pelvic limb and pelvis of greater cane rats sharing anatomical structures with other rodents, it retains some exceptional anatomical features. Findings of this study will serve as a reference for anatomical studies, clinical veterinary practice, and in biomedical research.

3D-modeling from hip DXA shows improved bone structure with romosozumab followed by denosumab or alendronate.

Romosozumab treatment in women with postmenopausal osteoporosis increases bone formation while decreasing bone resorption, resulting in large BMD gains to reduce fracture risk within 1yr. DXA-based 3D modeling of the hip was used to assess estimated changes in cortical and trabecular bone parameters and map the distribution of 3D changes in bone parameters over time in patients from 2 randomized controlled clinical trials: FRAME (romosozumab vs placebo followed by denosumab) and ARCH (romosozumab vs alendronate followed by alendronate). For each study, data from a subset of ~200 women per treatment group who had TH DXA scans at baseline and months 12 and 24 and had provided consent for future research were analyzed post hoc. 3D-SHAPER software v2.11 (3D-SHAPER Medical) was used to generate patient-specific 3D models from TH DXA scans. Percentage changes from baseline to months 12 and 24 in areal BMD (aBMD), integral volumetric BMD (vBMD), cortical thickness, cortical vBMD, cortical surface BMD (sBMD), and trabecular vBMD were evaluated. Data from 377 women from FRAME (placebo, 190; romosozumab, 187) and 368 women from ARCH (alendronate, 185; romosozumab, 183) with evaluable 3D assessments at baseline and months 12 and 24 were analyzed. At month 12, treatment with romosozumab vs placebo in FRAME and romosozumab vs alendronate in ARCH resulted in greater increases in aBMD, integral vBMD, cortical thickness, cortical vBMD, cortical sBMD, and trabecular vBMD (P < .05 for all). At month 24, cumulative gains in all parameters were greater in the romosozumab-to-denosumab vs placebo-to-denosumab sequence and romosozumab-to-alendronate vs alendronate-to-alendronate sequence (P < .05 for all). 3D-SHAPER analysis provides a novel technique for estimating changes in cortical and trabecular parameters from standard hip DXA images. These data add to the accumulating evidence that romosozumab improves hip bone density and structure, thereby contributing to the antifracture efficacy of the drug.

Cochrane in CORR ®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures.

Cochrane in CORR ®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures.

How Does Customized Cutting Guide Design Affect Accuracy and Ergonomics in Pelvic Tumor Resection? A Study in Cadavers.

Customized cutting guides are technical aids that make primary pelvic bone tumor resection safer and more reliable. Although the effectiveness of such devices appears to be widely accepted, their conception and design remain varied. Two main designs have been reported: the heavier block-type customized cutting guides and the lighter patch-type customized cutting guides. As recent tools, there must be more evidence regarding the impact of design on their accuracy and ergonomics. Thus, an evaluation of their respective performances appears warranted. In a cadaver model, we assessed whether (1) a thinner, patch-type customized cutting guide design results in resections that are closer to the planned resections than the heavier block-type customized cutting guides, and (2) the patch-type customized cutting guide design is more ergonomic than the block-type customized cutting guide with improved usability in surgery (in terms of bulkiness, ease of placement, primary and secondary stability, and stability during cutting). We conducted an experimental study involving five fresh whole-body anatomic specimens (three women and two men with a median age of 79 years and median weight of 66 kg) by simulating six virtual tumors in three areas according to the Enneking classification (Zones I: iliac wing, II: periacetabular area, and I and IV: sacroiliac joint area). We compared the impact of the customized cutting guide's design on performance in terms of the resection margin accuracy using CT scan analysis (deviation from the planned margin at the closest point and the maximum deviation from the planned margin) and the intraoperative ergonomic score under conditions simulating those of an oncologic resection of a bone tumor (with a range of 0 to 100, with 100 being best). The patch customized cutting guides performed slightly better than the block customized cutting guides regarding deviation from the planned margin at the closest point, with median values of 1 mm versus 2 mm (difference of medians 1 mm; p = 0.02) and maximum deviation from the planned margin of 3 versus 4 mm (difference of medians 1 mm; p = 0.002). In addition, the patch design was perceived to be slightly more ergonomic than the block design, with a 92% median score versus 84% for the block design (difference of medians 8%; p = 0.03). We observed an equivalence in performance regarding accuracy and ergonomics, with slight advantages for patch customized cutting guides, especially in complex zones (Zone I and IV). Owing to a small cohort in a cadaver study, these results need independent replication. The patch-type customized cutting guide with thinner contact spots to the bone in specific areas and less soft tissue dissection might offer an advantage over a larger block design for achieving negative oncologic bony margins, but it does not address issues of soft tissue margins.

New Neogene fossil phocid postcranial material from the Atlantic (USA)

ABSTRACT To date, the phocid fossil record from the Western Atlantic includes representatives of the subfamilies Monachinae and Phocinae. New partial postcranial bones (humerus, innominate) of true seals from the Meherrin River, Murfreesboro, Hertford County, North Carolina, U.S.A. are morphologically examined in detail. The newly discovered postcranial bones are compared to representatives of other pinnipeds (Phocidae, Otariidae, and Odobenidae) and to representatives from other phocid subfamilies (Cystophorinae, Devinophocinae, Monachinae, and Phocinae). Detailed morphological analyses demonstrate characteristics that are known to be phocid-specific, such as: the humeral deltoid crest extending to half its length, becoming thinner towards the distal portion; short and flattened femur, with a diaphysis that is broader at its distal end; and absence of femoral lesser trochanter. Taxonomic assessment identified the humerus as Phocanella pumila (Subfamily Phocinae), and the three innominate bones (Subfamily Monachinae): Homiphoca capensis, Sarcodectes magnus, and a newly discovered genus and species Seronectes meherrinensis. In the same collection, a fossil femur from the Chesapeake Group, St. Marys Formation, Maryland-Virginia is identified as Homiphoca capensis (Subfamily Phocinae). This study further confirms the likely presence of adaptively diverse phocids from either the subfamily Monachinae or Phocinae in the same locality during the Miocene time.

Drying irreversibly affects the elastic behavior of pelvic cortical bone

Various studies have shown that the water content affects the elastic behavior of cortical bone. However, there is disagreement regarding the reversibility of the elastic behavior with rewetting. This study investigates this issue using an intrinsic approach, i.e., moisture manipulation and material testing were always carried out on the same specimen. The test results were then evaluated separately for each of several specimens.In total, 24 specimens of human cortical bone from the ischiopubic ramus were examined. The water content was varied in 11 steps, and the corresponding elastic moduli were determined using three-point bending tests within the elastic range. Moisture adjustment was achieved mainly using desiccators, accelerated by forced convection. Reference samples stored in the same manner were evaluated microscopically.The experiments confirmed the known correlation between water content reduction and stiffness increase of cortical bone. Complete drying increased the elastic modulus by about 83 %. By rewetting, the stiffness was significantly reduced again, though not only to the initial state, but even about 24 % below this. Thus, an irreversible alteration of the elastic behavior was observed. Decay of the reference samples was not observed. Therefore, decay is not the main reason for the significant loss of stiffness. In terms of the storage conditions for cortical bone specimens, an environment with 100 % relative humidity yielded the best match with the initial state. This storage method can therefore be recommended for biomechanical specimens used to determine in-vivo-like material parameters.

Pathology of the pelvic bones and its correction in bladder exstrophy

There are many studies regarding treatment methods for bladder exstrophy, but it is impossible to single out the only correct one. When treating bladder exstrophy, all defects can be eliminated separately, but the effect of such interventions will be incomplete. When analyzing the anatomy of patients with this pathology, pronounced splitting and divergence of the pelvic muscles is noted due to dysplasia and the wide position of the iliac and pubic bones. Due to the inferiority of the pelvic bones, the functions of all its organs are disrupted. Modern methods of radiation research have made it possible to better understand the main causes of such changes: outwardly rotated iliac bones, retroversion of the acetabulum and femur, shortened branches of the pubic bones, a backward curved acetabulum and flabby sacroiliac joint, increased distance between the triradial cartilages. Such changes are difficult to eliminate with soft tissue plastic surgery, so specialists who use osteotomy of the pelvic bones in the treatment of this pathology have more positive results. Since 1958, in the treatment of children with exstrophy of the bladder, osteotomy has been used in various versions, which makes it possible to restore the pelvic ring, improve the results of soft tissue plastic surgery and urinary continence. The authors noted a high rate of continence success in patients who underwent primary bladder closure without complications such as wound infection, dehiscence, or any degree of bladder prolapse. Thus, correction of the skeletal system serves as a basic element in the correction of bladder exstrophy.

Targeting TRPV1 for Cancer Pain Relief: Can It Work?

Chronic intractable pain affects a large proportion of cancer patients, especially those with metastatic bone disease. Blocking sensory afferents for cancer pain relief represents an attractive alternative to opioids and other drugs acting in the CNS in that sensory nerve blockers are not addictive and do not affect the mental state of the patient. A distinct subpopulation of sensory afferents expresses the capsaicin receptor TRPV1. Intrathecal resiniferatoxin, an ultrapotent capsaicin analog, ablates TRPV1-expressing nerve endings exposed to the cerebrospinal fluid, resulting in permanent analgesia in women with cervical cancer metastasis to the pelvic bone. High-dose capsaicin patches are effective pain killers in patients with chemotherapy-induced peripheral neuropathic pain. However, large gaps remain in our knowledge since the mechanisms by which cancer activates TRPV1 are essentially unknown. Most important, it is not clear whether or not sensory denervation mediated by TRPV1 agonists affects cancer progression. In a murine model of breast cancer, capsaicin desensitization was reported to accelerate progression. By contrast, desensitization mediated by resiniferatoxin was found to block melanoma growth. These observations imply that TRPV1 blockade for pain relief may be indicated for some cancers and contraindicated for others. In this review, we explore the current state of this field and compare the analgesic potential of TRPV1 antagonism and sensory afferent desensitization in cancer patients.