Femoral Head Region Research Articles

Automatic 3D pelvimetry framework in CT images and its validation

In the field of spinal pathology, sagittal balance of the spine is usually judged by the spatial structure and morphology of pelvis, which can be represented by pelvic parameters. Pelvic parameters, including pelvic incidence, pelvic tilt and sacral slope, are therefore essential for the diagnosis and treatment of spinal disorders, however, it is a time-consuming and laborious procedure to measure these parameters by traditional methods. In this paper, an automatic measurement framework for pelvic CT images was proposed to calculate three-dimensional (3D) pelvic parameters with the support of deep learning technology. Pelvic images were first preprocessed, and 3D reconstruction was then performed to obtain 3D pelvic model by the Visualization Toolkit. DRINet was trained to segment the femoral head region in the pelvic images, and 3D sphere fitting was performed to locate the femoral heads. In addition, VGG16 was adopted to recognize images containing superior sacral endplate, and the plane growth algorithm was used to fit the plane so that the midpoint and normal vector of the superior sacral endplate could be obtained. Finally, 3D pelvic parameters were automatically calculated, and compared with manual measurements for 15 patients. The proposed framework automatically generated 3D pelvic models, and calculated two-dimensional (2D) and 3D pelvic parameters from continuous CT images. Experiments demonstrated that the framework can greatly speed up the calculation of pelvic parameters, and these parameters are accurate when compared with the manual measurements. In conclusion, the proposed framework demonstrates good performance on automatic pelvimetry measurement by incorporating deep learning technology, and can well replace the traditional methods for pelvic parameter measurement.

Ozone Improved Bone Dynamic of Female Rats Using Zoledronate.

The aim of this study was to analyze the effect of ozone (OZN) therapy on the dynamics of bone tissue in ovariectomized rats treated with zoledronic acid (ZOL). Female Wistar rats aged 6 months (n = 110) were subjected to bilateral ovariectomy (OVX). At month 3 post-OVX, 10 animals were euthanized to characterize the bone tissue architecture using microtomography (micro-CT). The remaining animals were divided into two groups: ZOL group, administered with ZOL (100 μg/kg body weight); saline (SAL) group (0.45 mL of SAL solution), both for 28 days. At month 3 post-treatment, 10 animals from each group were euthanized to characterize the bone architecture using micro-CT. The remaining animals were divided into the following groups: ZOL (n = 20), ZOL + OZN (n = 20); SAL (n = 20), and SAL + OZN (n = 20). The animals in ZOL + OZN and SAL + OZN groups were intraperitoneally administered with OZN (0.7 mg/kg body weight) once every 2 days. On days 30 and 60, six animals from each group were euthanized for analysis and structural characterization of bones in the femoral head and spine. Some samples of the femoral neck were subjected to biomechanical tests, while some samples were analyzed under a laser confocal microscope. The other samples collected from the femoral neck and spine were analyzed for area of neoformed bone and used for performing inflammatory cell and osteocyte counts. Data were submitted to statistical analysis considering a significance level of p < 0.05. Bone volume percentage and osteocyte and inflammatory cell counts were upregulated in the femoral head region of the ZOL + OZN group. Biomechanical analysis of the femoral neck revealed that the modulus of elasticity was similar between the ZOL and ZOL + OZN groups but differed significantly between the SAL and SAL + OZN groups. The positive areas for calcein and alizarin in the ZOL and ZOL + OZN groups were higher than those in the SAL and SAL + OZN groups. This suggested a positive synergistic effect of OZN and ZOL on the maintenance of bone mass and restoration of bone tissue vitality in ovariectomized rats.

Establishment of the multi-component bone-on-a-chip: to explore therapeutic potential of DNA aptamers on endothelial cells.

Background: Despite great efforts to develop microvascular bone chips in previous studies, current bone chips still lacked multi-component of human-derived cells close to human bone tissue. Bone microvascular endothelial cells (BMECs) were demonstrated to be closely related to the glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH). Tumor necrosis factor-alpha (TNF-α) aptamer has been proved to bind to its receptor and block cascade activities. Objective: There are two main objectives in this study: 1) to establish a multi-component bone-on-a-chip within the microfluidic system in vitro, 2) to explore the therapeutic potential of TNF-α aptamer on BMECs in the GC-induced ONFH model. Methods: Histological features of clinical samples were analyzed before BMECs isolation. The functional bone-on-a-chip consists of the vascular channel, stromal channel and structure channel. GC-induced ONFH model was established based on the multi-component of human-derived cells. Truncation and dimerization were performed on a previously reported DNA aptamer (VR11). BMECs apoptosis, cytoskeleton and angiogenesis status in the ONFH model were observed by the TUNEL staining and confocal microscope. Results: The multi-component of BMECs, human embryonic lung fibroblasts and hydroxyapatite were cultured within the microfluidic bone-on-a-chip. TNF-α was found up-regulated in the necrotic regions of femoral heads in clinical samples and similar results were re-confirmed in the ONFH model established in the microfluidic platform by detecting cell metabolites. Molecular docking simulations indicated that the truncated TNF-α aptamer could improve the aptamer-protein interactions. Further results from the TUNEL staining and confocal microscopy showed that the truncated aptamer could protect BMECs from apoptosis and alleviate GC-induced damages to cytoskeleton and vascularization. Conclusion: In summary, a microfluidic multi-component bone-on-a-chip was established with 'off-chip' analysis of cell metabolism. GC-induced ONFH model was achieved based on the platform. Our findings provided initial evidence on the possible potentials of TNF-α aptamer as a new type of TNF-α inhibitor for patients with ONFH.

Combined femoral and acetabular version and synovitis are associated with dGEMRIC scores in people with femoroacetabular impingement (FAI) syndrome.

This study sought to explore, in people with symptoms, signs and imaging findings of femoroacetabular impingement (FAI syndrome): (1) whether more severe labral damage, synovitis, bone marrow lesions, or subchondral cysts assessed on magnetic resonance imaging(MRI) were associated with poorer cartilage health, and (2) whether abnormal femoral, acetabular, and/or combined femoral and acetabular versions were associated with poorer cartilage health. This cross-sectional study used baseline data from the 50 participants with FAI syndrome in the Australian FASHIoN trial (ACTRN12615001177549) with available dGEMRIC scans. Cartilage health was measured using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score sampled at the chondrolabral junction on three midsagittal slices, at one acetabular and one femoral head region of interest on each slice, and MRI features were assessed using the Hip Osteoarthritis MRI Score. Analyses were adjusted for alpha angle and body mass index, which are known to affect dGEMRIC score. Linear regression assessed the relationship with thedGEMRIC score of (i) selected MRI features, and (ii) femoral, acetabular, and combined femoral and acetabular versions. Hips with more severe synovitis had worse dGEMRIC scores (partial η2 = 0.167, p = 0.020), whereas other MRI features were not associated. A lower combined femoral and acetabular version was associated with a better dGEMRIC score (partial η2 = 0.164, p = 0.021), whereas isolated measures of femoral and acetabular version were not associated. In conclusion, worse synovitis was associated with poorer cartilage health, suggesting synovium and cartilage may be linked to the pathogenesis of FAI syndrome. A lower combined femoral and acetabular version appears to be protective of cartilage health at the chondrolabral junction.

MsgeCNN: Multiscale geometric embedded convolutional neural network for ONFH segmentation and grading.

The incidence of osteonecrosis of the femoral head (ONFH) is increasing gradually, rapid and accurate grading of ONFH is critical. The existing Steinberg staging criteria grades ONFH according to the proportion of necrosis area to femoral head area. In the clinical practice, the necrosis region and femoral head region are mainly estimated by the observation and experience of doctor. This paper proposes a two-stage segmentation and grading framework, which can be used to segment the femoral head and necrosis, as well as todiagnosis. The core of the proposed two-stage framework is the multiscale geometric embedded convolutional neural network (MsgeCNN), which integrates geometric information into the training process and accurately segments the femoral head region. Then, the necrosis regions are segmented by the adaptive threshold method taking femoral head as the background. The area and proportion of the two are calculated to determine thegrade. The accuracy of the proposed MsgeCNN for femoral head segmentation is 97.73%, sensitivity is 91.17%, specificity is 99.40%, dice score is 93.34%. And the segmentation performance is better than the existing five segmentation algorithms. The diagnostic accuracy of the overall framework is 90.80%. The proposed framework can accurately segment the femoral head region and the necrosis region. The area, proportion, and other pathological information of the framework output provide auxiliary strategies for subsequent clinicaltreatment.

2D perfusion angiography: an alternative method to evaluate endovascular intervention for acute lower limb ischemia

BackgroundDespite advances in endovascular techniques to treat acute limb ischemia (ALI), evaluation of clinical outcomes for revascularization remains challenging, especially the accurate quantification of post-endovascular limb perfusion. This study aimed to investigate the accuracy and value of 2D perfusion angiography to evaluate endovascular intervention for ALI.MethodsA total of 47 patients with ALI were retrospectively analyzed. The transcutaneous oxygen partial pressure (TcPO2) was obtained using laser Doppler blood perfusion monitoring. The ankle-brachial index (ABI) and angiographic images were obtained before and after endovascular intervention. iFlow imaging was used to obtain color-coded images. Regions of interest (ROIs) at the femoral head, knee joint, and ankle joint were selected to obtain the time to peak (TTP). The differences in the TTP between the knee and femoral head regions (TTP difference in the knee area) and between the ankle and knee regions (TTP difference in the ankle area) were observed. The TTP, ABI, and TcPO2 between the complete response (CR), partial response (PR), no response (NR), and amputation (AM) groups were compared. The correlation between TTP changes in the ankle area (ΔTTP) and changes in ABI (ΔABI)/changes in TcPO2 (ΔTcPO2) was analyzed.ResultsThere was a significant increase in both TcPO2 and ABI compared with the pre-intervention values (27.75 ± 5.32 vs 40.92 ± 4.62, and 0.35 ± 0.16 vs 0.79 ± 0.15, respectively, all p < 0.01). The post-intervention TTP differences in the knee areas (5.12 ± 2.45 s) and ankle areas (6.93 ± 4.37 s) were significantly faster than pre-intervention TTP differences (7.03 ± 2.57 s and 10.66 ± 4.07 s, respectively, all p < 0.05). The post-operative TTP in the ankle area, post-operative TTP difference in the ankle area, and ΔTTP in the AM group were higher than the values in the CR and PR groups. The ΔTTP demonstrated strong correlation with ΔABI (r = −0.722, p < 0.01) and ΔTcPO2 (r = −0.734, p < 0.01).Conclusions2D perfusion angiography with enhanced visual and quantitative analysis exhibits great potential to evaluate the efficacy of endovascular intervention, and provides a quantitative and sensitive tool to evaluate post-endovascular limb perfusion for ALI patients.

MRI Knee Domain Translation for Unsupervised Segmentation By CycleGAN (data from Osteoarthritis initiative (OAI)).

Accurate quantification of bone and cartilage features is the key to efficient management of knee osteoarthritis (OA). Bone and cartilage tissues can be accurately segmented from magnetic resonance imaging (MRI) data using supervised Deep Learning (DL) methods. DL training is commonly conducted using large datasets with expert-labeled annotations. DL models perform better if distributions of testing data (target domains) are close to those of training data (source domains). However, in practice, data distributions of images from different MRI scanners and sequences are different and DL models need to re-trained on each dataset separately. We propose a domain adaptation (DA) framework using the CycleGAN model for MRI translation that would aid in unsupervised MRI data segmentation. We have validated our pipeline on five scans from the Osteoarthritis Initiative (OAI) dataset. Using this pipeline, we translated TSE Fat Suppressed MRI sequences to pseudo-DESS images. An improved MaskRCNN (IMaskRCNN) instance segmentation network trained on DESS was used to segment cartilage and femoral head regions in TSE Fat Suppressed sequences. Segmentations of the I-MaskRCNN correlated well with approximated manual segmentation obtained from nearest DESS slices (DICE = 0.76) without the need for retraining. We anticipate this technique will aid in automatic unsupervised assessment of knee MRI using commonly acquired MRI sequences and save experts' time that would otherwise be required for manual segmentation.Clinical relevance- This technique paves the way to automatically convert one MRI sequence to its equivalent as if acquired by a different protocol or different magnet, facilitating robust, hardware-independent automated analysis. For example, routine clinically acquired knee MRI could be converted to high-resolution high-contrast images suitable for automated detection of cartilage defects.

Etiology and Pathogenesis of Corticosteroid-Associated Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head (ONFH) is an intractable disease occurring at a relatively young age. The characteristic finding of ONFH – the femoral head collapse with severe hip pain – is observed in many cases, which frequently leads to further joint destruction, requiring surgical treatment. Among the associated factors of ONFH, majority of patients who require high-dose corticosteroid are still challenging due to inevitable therapeutic option regardless of poor prognosis. As a pathological mechanism, ONFH is defined as tissue necrosis in the femoral head region due to occlusion of the nutrient vessels; but the detailed micro-level processes leading to blood flow failure remains unclear. The elucidation of ONFH and the establishment of preventive therapy is desirable for these patients. Here, we discuss the etiology and pathogenesis of corticosteroid-associated ONFH by reviewing current literature.

The effect of calcar femoral neck plating on vascularity of the femoral head and neck.

AimsSurgical treatment of young femoral neck fractures often requires an open approach to achieve an anatomical reduction. The application of a calcar plate has recently been described to aid in femoral neck fracture reduction and to augment fixation. However, application of a plate may potentially compromise the regional vascularity of the femoral head and neck. The purpose of this study was to investigate the effect of calcar femoral neck plating on the vascularity of the femoral head and neck.MethodsA Hueter approach and capsulotomy were performed bilaterally in six cadaveric hips. In the experimental group, a one-third tubular plate was secured to the inferomedial femoral neck at 6:00 on the clockface. The contralateral hip served as a control with surgical approach and capsulotomy without fixation. Pre- and post-contrast MRI was then performed to quantify signal intensity in the femoral head and neck. Qualitative assessment of the terminal arterial branches to the femoral head, specifically the inferior retinacular artery (IRA), was also performed.ResultsQuantitative MRI revealed a mean reduction of 1.8% (SD 3.1%) of arterial contribution in the femoral head and a mean reduction of 7.1% (SD 10.6%) in the femoral neck in the plating group compared to non-plated controls. Based on femoral head quadrant analysis, the largest mean decrease in arterial contribution was in the inferomedial quadrant (4.0%, SD 6.6%). No significant differences were found between control and experimental hips for any femoral neck or femoral head regions. The inferior retinaculum of Weitbrecht (containing the IRA) was directly visualized in six of 12 specimens. Qualitative MRI assessment confirmed IRA integrity in all specimens.ConclusionCalcar femoral neck plating at the 6:00 position on the clockface resulted in minimal decrease in femoral head and neck vascularity, and therefore it may be considered as an adjunct to laterally-based fixation for reduction and fixation of femoral neck fractures, especially in younger patients.Cite this article: Bone Jt Open 2021;2(8):611–617.

Finding alternative sites for intraosseous infusions in newborns

AimIntraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia. MethodsThe cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1–39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system. ResultsIn term newborns, diameter of the cortex of the proximal humeral head is 12.1 ± 1.8 mm, distal end of the femur 11.9 ± 3.4 mm and the proximal tibial bone 12.0 ± 2.4 mm with cross-sectional diameter of 113.5 ± 19.7 mm2, 120.6 ± 28.2 mm2 and 111.6 ± 29.5 mm2, respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds. ConclusionProximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.

Genetic expression differences of 11 beta-hydroxysteroid dehydrogenase in the bone microvascular endothelial cells derived from different regions of the human femoral head

Objective: To investigate the expression levels and activation differences of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) gene in bone microvascular endothelial cells (BMECs) in different regions of human femoral head. Methods: Tissue specimens of femoral heads were obtained from hip arthroplasty carried out in China-Japan Friendship Hospital from January 2017 to June 2018. And the BMECs we isolated, purified, identified and cultured from different regions of the human femoral head: in the subchondral and cancellous bone regions. The BMECs from the two regions were intervened by hydrocortisone with a series of low concentration gradients (0, 0.03, 0.06, 0.10 mg/ml) respectively. The cell phenotype and functional status of BMECs and cell migration were detected by scratch experiments, and the angiogenesis in different regions of the femoral head was observed. The mRNA and protein expression of 11beta-HSD1, 11beta-HSD2 in BMECs were detected by real-time fluorescence quantitative polymerase chain reaction (RT-PCR) and Western-blot method, respectively. Results: With the increase of the concentration of hydrocortisone, the 11beta-HSD1 mRNA and protein expression of BMECs in the subchondral and cancellous bone regions of the femoral head increased significantly, and the 11beta-HSD1 mRNA and protein expression of BMECs in the subchondral bone region was significantly lower than those in cancellous bone region (all P<0.05). The 11beta-HSD2 mRNA and protein expression of BMECs in the cancellous bone region showed a slow decrease first and then increased slightly at 0.10 mg/ml, while the expression in the subchondral bone region was the opposite. The 11beta-HSD2 mRNA and protein expression of BMECs in subchondral bone region was slightly higher than those in cancellous bone region (all P<0.05), but there was no significant statistical difference between the two regions at 0.10 mg/ml (0.123±0.018 vs 0.126±0.021, 0.577±0.231 vs 0.609±0.174, t=1.380, 0.409, both P>0.05). At different times of the 0.06 mg/ml hydrocortisone intervention, there was no significant differences in scratch closure rate, the number of BMECs lumen, the number of buds and the length of tubule branches in different regions of the femoral head (all P>0.05). Conclusion: The 11beta-HSD expression of BMECs in different regions of human femoral head is significantly different. The 11beta-HSD1 is high-expressed, but 11beta-HSD2 is low-expressed in BMECs of the cancellous bone region, and those are opposite in the subchondral bone region, which helps to explain the pathological characteristics and pathogenesis of hormonal osteonecrosis.

Effects of Alpha-Lipoic Acid on TGF-β1 and Urotensin-II Levels in Glucocorticoid-Induced Osteonecrosis in Rats

Background: Osteonecrosis (ON) is a serious health problem, which dramatically reduces the quality of life. Objectives: In the present study on the rat model of glucocorticoids (GCs) -induced ON, we explored the influence of alpha-lipoic acid on serum levels of TGF-β1 and urotensin-II (U-II) and on histological alteration with respect to fatty degeneration and osteocyte necrosis. Methods: A total of 32 male Wistar albino rats were equally assigned to four groups, including control, methylprednisolone acetate (MPA), alpha-lipoic acid (ALA), and MPA with ALA (MP1 + ALA). The animals in MPA group subcutaneously received 15 mg/kg/week during 2 weeks, whereas 100 mg/kg/day ALA was intraperitoneally administered to ALA group during 4 weeks. The MPA + ALA group had both treatments with the same doses. ON was confirmed and graded histologically. Lipid peroxidation and DNA damage levels were immunohistochemically assessed in rats’ bones. Results: After histopathological examinations, ALA injection attenuated oxidative stress levels through reducing both 8-OHdG-and 4-HNE-positive cells in the femoral head region (P < 0.05). The U-II and TGF-β1 protein levels significantly decreased after ALA treatment in MPA injected animals (P < 0.05, P < 0.01, respectively). Moreover, there was a strong correlation between U-II and TGF-β1 protein levels (P = 0.019, r = 0.884). Conclusions: This study is novel with regard to showing the therapeutic effects of ALA on GC-induced ON in rats as well as the strong correlation between the expression levels of U-II and TGF-β1 proteins. In this regard, ALA may be a therapeutic agent in the treatment of ON patients.

Subchondral bone deterioration in femoral heads in patients with osteoarthritis secondary to hip dysplasia: A case-control study.

ObjectivesResidual hip dysplasia is the most common underlying condition leading to secondary osteoarthritis (OA) of the hip. Subchondral bone alterations in OA secondary to hip dysplasia (HD-OA) are poorly investigated. The aim of the present study was to analyse the microarchitecture, bone remodelling and pathological alterations of subchondral bone in femoral heads from patients with HD-OA.MethodsSubchondral bone specimens were extracted from both weight-bearing and non–weight-bearing regions of femoral heads from 20 patients with HD-OA and 20 patients with osteoporotic femoral neck fracture, during hip replacement surgery. Micro-CT and histological examination were performed to assess the microarchitecture and histopathological changes.ResultsThe weight-bearing subchondral bone showed significantly more sclerotic microarchitecture and higher bone remodelling level in HD-OA as compared with osteoporosis. In the non–weight-bearing region, the two diseases shared similar microarchitectural characteristics, but higher bone remodelling level was detected in HD-OA. Distinct regional differences were observed in HD-OA, whereas the two regions exhibited similar characteristics in osteoporosis. In addition, HD-OA displayed more serious pathological alterations, including subchondral bone cyst, metaplastic cartilaginous tissue, bone marrow oedema and fibrous tissue, especially in the weight-bearing region.ConclusionsOsteoarthritic deteriorations of subchondral bone induced by hip dysplasia spread throughout the whole joint, but exhibit region-dependent variations, with the weight-bearing region more seriously affected. Biomechanical stress might exert a pivotal impact on subchondral bone homeostasis in hip dysplasia.The translational potential of this articleThe histomorphometric findings in the project indicate an early intervention for the development of hip dysplasia in clinic.

The role of Gdf5 regulatory regions in development of hip morphology.

Given GDF5 involvement in hip development, and osteoarthritis (OA) and developmental hip dysplasia (DDH) risk, here we sought to assess the role(s) of GDF5 and its regulatory sequence on the development of hip morphology linked to injury risk. The brachypodism (bp) mouse, which harbors a Gdf5 inactivating mutation, was used to survey how Gdf5 loss of function impacts the development of hip morphology. Two transgenic Gdf5 reporter BAC lines were used to assess the spatiotemporal expression of Gdf5 regulatory sequences. Each BAC line was also used to assess the functional roles of upstream and downstream sequence on hip morphology. bp/bp mice had shorter femora with smaller femoral heads and necks as well as larger alpha angles, smaller anterior offsets, and smaller acetabula, compared to bp/+ mice (p<0.04). Regulatory sequences downstream of Gdf5 drove strong prenatal (E17) expression and low postnatal (6 months) expression across regions of femoral head and acetabulum. Conversely, upstream regulatory sequences drove very low expression at E17 and no detectable expression at 6 months. Importantly, downstream, but not upstream Gdf5 regulatory sequences fully restored all the key morphologic features disrupted in bp/bp mice. Hip morphology is profoundly affected by Gdf5 absence, and downstream regulatory sequences mediate its effects by controlling Gdf5 expression during development. This downstream region contains numerous enhancers harboring risk variants related to hip OA, DDH, and dislocation. We posit that subtle alterations to morphology driven by changes in downstream regulatory sequence underlie this locus’ role in hip injury risk.

Cell-based Treatments of Femoral Head Osteonecrosis: A Literature Review

The preferred desire of orthopedic surgeons is to preserve the femoral head in the early stages of femoral head osteonecrosis; however, hip arthroplasty is needed in most cases. The outcomes of traditional surgical treatments alone are not favorable. Thus, femoral head osteonecrosis frequently follows an unpredictable course resulting in significant hip arthritis. Through the years, it has been identified that decreased proliferation capacity and content of bone marrow stem cells (BMSCs) in the femoral head region play a key role in the pathogenesis of osteonecrosis of femoral head (ONFH). In the past two decades, researchers have focused on cell-based therapies for ONFH treatment. The regenerative potential of damaged cartilage and bone tissue with stem cells has become a new treatment approach in the field of orthopedics. Ongoing basic science and clinical studies are progressing toward efficient standard treatment options for this extremely challenging condition. In this article, we reviewed the recently developed methods of cell therapy for these types of musculoskeletal conditions.

Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement.

Background:Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood.Purpose:To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T1ρ and T2) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores.Results:A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m2; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T1ρ and T2 mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery.Conclusion:Femoral cartilage damage, as measured on T1ρ and T2 mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.

Comparative analysis ofapplication value and setup error between two setup methods in proton and carbon ion therapy for prostate cancer

Objective To compare the application values and setup errors between vacuum bag plus body mask and customized alpha cradle duringproton and carbon therapy using Siemens 6D robotic couch in prostate cancer patients. Methods Nineteen patients received vacuum bag plus body mask setup were allocated into the vacuum bag group and19 patients with alpha cradle were assigned into the alpha cradle group. Orthogonal X-ray portals were performed to verify the treatment position before beam delivery in every fraction. The couch correction between the portal and reference DRR through manual image registration was recorded as setup errors in 6 directions including the lateral, supine-inferior, anterior-posterior, yaws, roll and pitch, respectively. Two-tail t-test was used to analyze the setup error data from each direction between two groups. Results In total, 452 and 436 sets of data errors were collected from the vacuum bag and alpha cradle groups. The average setup errors and standard deviation in the vacuum bag and alpha cradle groups in the lateral, supine-inferior, anterior-posterior, yaws, roll and pitch directions were (0.63±0.48) cm vs. (0.33±0.24) cm (P=0.000), (0.40±0.3) cm vs. (0.31±0.25) cm (P=0.000), (0.69±0.61) cm vs. (0.82±0.69) cm (P=0.006), 0.65°±0.47°vs 0.32°±0.25°(P=0.000), 1.05°±0.95°vs 1.16°±0.94°(P=0.100) and 0.67°±0.56°vs 0.40°±0.36°(P=0.000), respectively. The maximum setup errors were detected in the pitch direction for both groups. Conclusions During the proton and carbon therapy using Siemens 6D robotic couch, two setup methods using vacuum bag plus body mask and customized alpha cradle should be selected according to the individual conditions of patients. A customized foot fixer should be utilized to reduce the uncertainty in the femoral head region. Key words: Prostatic neoplasms/proton heavy ion therapy; Radiotherapy planning, computer-assisted; Setup error

Assessment of femoral neck fractures in the elderly with respect to morphology and mineral density.

Femoral neck fractures are among the major orthopaedic problems seen in the elderly and the annual mortality rate is high. The calcium (Ca) and phosphorus (P) ratio can be used as an indicator of osteoporosis. The purpose of this study is to investigate the microarchitectural structure of the fractured regions of femoral head as well as bone mineral density in female and male patients. The bone tissues taken from the fractured regions of 10 male and 9 female patients were examined with a scanning electron microscope. Electron probe microanalyses were carried out to measure mineral ratios. The bone trabeculae in the fractured area were thin and the cavities between trabeculae were seen to have transformed to irregular and broad structures. There were small valleculae reflecting osteoclastic activity. The analysis showed that the Ca/P ratio at the fracture site averaged 2.20/1 in women and 2.16/1 in men. As age increased, the percentage values of Ca and P decreased and the Ca/P ratio increased. Although there is no significant difference between the parameters of male and female patients, it seems that men can be affected by osteoporosis as much as women.

Flaxseed flour (Linum usitatissinum) consumption improves bone quality and decreases the adipocyte area of lactating rats in the post-weaning period

The aim of this work was to evaluate the effects of flaxseed flour in the intake on adiposity and femur structure of the lactating rats during the post-weaning period. After weaning, the lactating rats were divided into control (C, n = 6) and experimental (F, n = 6) groups treated with a diet containing flaxseed flour. Serum hormone and fatty acids composition, morphology of intra-abdominal adipocytes, computed tomography and biomechanical analyses of femur were determined. Food intake, body mass and hormone analysis have shown similar results. The F group showed the following (p < 0.05): lower arachidonic acid (–60%), total polyunsaturated fatty acids (–30%) and retroperitoneal adipocytes (–36%) area. Higher radiodensity of femoral head region (+29%) and higher maximum force (+18%), breaking strength (+18%) and rigidity (+31%). Fatty acid composition of flaxseed flour decreased the area of adipocytes and improved the bone quality, which may be associated with lower serum levels of arachidonic acid levels, during the post-weaning period.

Regional Variations in Trabecular Morphological Features of Femoral Head of Patients with Proximal Femoral Fractures

The regional microstructural variations in femoral head from proximal femoral fracture patients were investigated. Micro-CT scanning was performed on seven femoral heads from proximal femoral fracture patients. Each femoral head was divided into three regions according to the trabecular orientation from the fovea of femoral head to the femoral neck. Eight three-dimensional trabecular cube models were reconstructed from each region. A total of 154 trabecular cubic models were reconstructed because the corresponding areas for 14 cubic models were damaged during the surgeries. Eight trabecular morphological parameters were measured and analyzed, namely, trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), specific bone surface (BS/BV), bone volume fraction (BV/TV), structural model index (SMI), degree of anisotropy (DA), trabecular pattern factor (Tb.Pf), and trabecular number (Tb.N). Bivariate correlation analyses were performed for all morphological parameters. One-way ANOVA tests were performed to analyze the differences of each parameter among three regions. Post-hoc multiple comparisons (Student-Newman-Keuls method) were performed to analyze the morphological difference between two regions. Trabecular bone of proximal femoral fracture patients significantly degenerated in all regions of femoral heads. BV/TV was statistically correlated with Tb.Th, Tb.Sp, BS/BV, Tb.Pf, and Tb.N (p < 0.05). Statistical differences in morphological parameters were observed between regions (p < 0.05). The trabecular strength in the middle regions was significantly higher than that in other regions because of the relationships between morphological parameters and mechanical parameters. Trabeculae in the medial region were more uniform and stable along each direction than those in the lateral region. Most trabeculae in the lateral region only grew along the weight-bearing direction, and those along the other directions degenerated significantly. This study provides detailed trabecular morphological information on fractured femoral heads, as well as references for the prevention of high fracture risk in the elderly.