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Objectives: Bone failure due to avascular necrosis (AVN) is a complex pathological phenomenon. Analysis of molecular changes in the bone matrix may help to shed light on the disease process and guide management. This study aimed to explore changes in bone quality and structural damage caused by sickle cell disease (SCD)- induced AVN using Raman spectroscopy. Methods: A total of 10 necrotic femoral heads were obtained from seven SCD patients who underwent total hip replacements. The femoral heads were cut in half and scanned using Raman spectroscopy in correlation with preoperative magnetic resonance imaging to identify necrotic and healthy control areas. Subsequently, samples were examined to determine changes in bone mineralisation, crystallinity, carbonate content, collagen cross-linking and mineral and collagen fibril orientation. Results: Significant changes were observed in bone mineral content, mineral-to-organic content and collagen fibril orientation in necrotic compared to control areas (P ≤0.050). Conclusion: The necrotic samples displayed severe structural damage and loss of mineral and organic contents. Similar Raman signals have been reported in other metabolic bone diseases such as osteoporosis, thereby potentially supporting the use of medical treatment in AVN to promote bone quality. Keywords: Sickle Cell Disease; Osteonecrosis; Femur Head Necrosis; Bone Mineralization; Bone Density; Bone Remodeling; Extracellular Matrix; Raman Spectroscopy.

Introduction The purpose of this study is to retrospectively evaluate the immediate effect of retrograde intramedullary femoral nail (RIMFN) fixation technique on patient's hemodynamic status as documented by vital signs (blood pressure and pulse) intraoperatively in all patients with femoral shaft fractures with multiple injuries and hemodynamic instability who were treated with RIMFN at our institution on emergency basis as part of damage control orthopaedics. Patients and methods A retrospective review of intra operative vital signs obtained from patient records was completed at a Level 1 trauma center in a university hospital. In all, 11 multiply injured patients with (14) femur fractures with hemodynamic instability were identified. Of those, 3 had bilateral femur fractures. Closed reduction and retrograde femoral nailing without proximal locking was performed to achieve immediate skeletal and haemodynamic stability. Pulse rate and BP measurements were noted for all patients starting from the time patient would enter the operating room till the patient was shifted back to the recovery ward. Results The average cohort age was 28 years (20–36 years). The average Injury Severity Score was 28 (16–50). Statistically significant improvement in pulse rate and blood pressure was noted following femoral fracture fixation with intramedullary nail. No cases of infection or symptomatic fat or pulmonary embolism were encountered. One patient required exchange nailing for non-union and one femur underwent later lengthening. Conclusions Retrograde Intramedullary femoral nail can be an effective alternative to external fixator as damage control device and is associated with immediate improvement in vital signs (pulse and blood pressure) intra operatively., Highlights • Reversal of shock is important determinant of outcome in multiply injured patients. • Retrograde femoral nailing achieves immediate haemodynamic stability. • Retrograde nailing as damage control device has low morbidity and mortality. • Retrograde nailing without proximal locking is rapid, safe, effective procedure.

Folate and vitamin B12 deficiency is associated with depletion of the major intracellular antioxidant glutathione, and oxidative stress is emerging as an etiological mechanism for colon cancer. Azoxymethane (AOM), a potent carcinogen, induces colon cancer in rats by causing pathophysiological changes and oxidative stress. We investigated the synergistic effect of folate and vitamin B12 supplementation against AOM-induced carcinogenesis and oxidative stress in rat colon. Adult male rats were distributed into four groups: 1) Basal diet only; 2) AOM injection (15 mg/kg once per week in weeks 5 and 6); 3) Folate and vitamin B12 supplemented diet; 4) Folate and B12 diet with AOM injection. After 16 weeks, rats were sacrificed, colon tissue dissected, indicators of oxidative stress were measured, and immunohistochemical and ultrastructural changes were evaluated. AOM-injected rats showed oxidative stress, evident by glutathione depletion, oxidation of cellular proteins, and DNA oxidative damage. AOM increased mucosal levels of antiapoptotic and proapoptotic proteins Bcl2 and Bax and caused ultrastructure changes in colonic cell organelles. Folate and vitamin B12 supplementation decreased the level of oxidative stress and ameliorated the cytotoxic effects of AOM. In this in vivo experimental model of colon cancer, folate and vitamin B12 supplementation combats carcinogen-induced oxidative stress.

Oxidative stress plays a pivotal role in the development of diabetes and hyperglycaemia. The protective effects of natural extracts against diabetes are mainly dependent on their antioxidant and hypoglycaemic properties. Broccoli (Brassica oleracea) exerts beneficial health effects in several diseases including diabetes; however, the mechanism has not been elucidated yet. The present study was carried out to evaluate the potential hypoglycaemic and antioxidant properties of aqueous broccoli extracts (BEs) in diabetic rats. Streptozotocin (STZ) drug was used as a diabetogenic agent in a single intraperitoneal injection dose of 50 mg/kg body weight. The blood glucose level for each rat was measured twice a week. After 8 weeks, all animals were fasted overnight and sacrificed; pancreatic tissues were homogenized and used for measuring oxidative DNA damage, biochemical assessment of glutathione (GSH), and total antioxidant capacity (TAC) as well as histopathological examination for pancreatic tissues was examined. Diabetic rats showed significantly higher levels of DNA damage, GSH depletion, and impaired TAC levels in comparison to non-diabetics (P

The interest of researchers, clinicians, and industry in artificial intelligence (AI) continues to grow, especially with recent deep-learning (DL) advances. Recent published reports have shown the utility of DL for bone fracture diagnosis in the radiological examination. It is important for practicing physicians to recognize the current scope of DL as it may impact the clinical practices in the near future. This article will give an insight to the practicing clinician of the current advances in AI fracture diagnosis by reviewing the current literature on this participant. Electronic databases were searched for relevant articles relating to AI applications in bone fracture detection. We included all published work in PubMed, Medline, and Cross-references, which satisfied the inclusion criteria. The search identified 104 references. Of those, 13 articles were eligible for the analysis. AI advancements in fracture imaging applications can be divided into the categories of fracture detection, classification, segmentation, and noninterpretive tasks. Despite the potential work presented in the literature, there are many challenges in the form of clinical translation and its widespread uses. These challenges range from the proof of safety to clearance from the regulatory agencies.

Periprosthetic joint infection (PJI) due to Brucella is uncommon despite relatively high endemicity of human brucellosis and its osteoarticular predilection. We report a case of a 57-year-old woman with bacteraemic brucellosis complicated by Brucella periprosthetic infection of both knee joints occurring a decade after bilateral knee arthroplasty and associated with a negative synovial fluid alpha-defensin test. The patient was successfully treated with anti-Brucella therapy alone and without surgical revision, resulting in clinical and microbiological cure. We propose that Brucella should be considered as a possible cause of prosthetic joint infection in the appropriate clinical and epidemiological settings. A negative synovial fluid alpha-defensin (Synovasure AD test) should not be used as a rule-out test for Brucella PJI. Brucella PJI without radiological loosening may be treated conservatively and solely with antimicrobial therapy.

BACKGROUND: Avascular necrosis (AVN) especially of the femoral head has long been recognized as a morbidity of sickle cell disease (SCD). AVN might be of gradual onset and silent or run a more acute course with severe pain and limping.The clinical presentations and risk factors of this complication among Egyptian and Omani children and young adults with SCD were not fully studied. We aimed to determine the patterns of presentation, risk factors, diagnosis and management of avascular necrosis of the hip in SCD in the 2 centers. PATIENTS AND METHODS : A cross sectional study carried out at the Pediatric Hematology clinics of Ain Shams and Sultan Qaboos University Hospitals. All young SCD patients diagnosed with hip AVN during the period between Jan. 2010-Jan. 2018 were included. Age of 1st presentation with SCD, symptoms or signs of AVN, frequency of VOCs, hospital admissions and transfusion, spleen status, hydroxyurea administration (dose and compliance ), radiological findings (X-ray and MRI using FICAT and Arlet Staging) and serum ferritin were recorded. Therapeutic options included physiotherapy, autologous bone marrow stem cell injection in the affected joint, hip coring, and hip replacement. RESULTS :Sixty-eight children, adolescents and young adults with SCD and AVN; aged 8-22 years of both sexes were recruited from two centers; Egypt; n= 22, and Oman; n= 46. Twenty patients (29.4%) had hemoglobin SS while 48 (70.6%) had Sickle-βThalassemia. Thirty-seven (54%), were males with a median age of 16 years, five out of the 22 Egyptians have in addition to hip AVN, femoral shaft necrosis in one patient and 2 have lumbar vertebra necrosis. According to FICAT and Alert classification of AVN; 22 patients had stage 0, 2 patients had stage I, 13 patients had stage II, 14 had stage III and 17 patients were at stage IV; 64% of patients had stage II and above at diagnosis. Sixty percent of the studied population were on Hydroxyurea; of them 25% were non-compliant. Multivariate regression analysis didn't show a significant risk factor for development of AVN in these patients. Management was different in the 2 centers; Half of the patients in Oman were managed with physiotherapy alone; while only 25% in Egypt. Stem cell injection in the bone marrow of the affected hip was tried in 25% of Omani patients with good success while none in the Egyptian patients. Hip replacement in was performed in a total of 7 patients and Bone marrow transplantation in two. CONCLUSION: Avascular necrosis of the hip is a significant cause of morbidity in SCD in this part of the world. Majority of patients had an advanced disease at diagnosis, which emphasizes the need of early screening to avoid complications of the advanced disease. Injection of bone marrow in the affected hip might be a promising tool to prevent disease progression and improve the symptoms. Disclosures No relevant conflicts of interest to declare.