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The purpose of this study was to analyze the interobserver reliability and intraobserver repeatability of the China-Japan Friendship Hospital (CJFH) typing classification system for nontraumatic osteonecrosis of the femoral head (ONFH).Image data of 50 hips were randomly selected in 289 patients (433 hips) with ONFH who underwent treatment in the China-Japan Friendship Hospital from 2012 to 2016. Bilateral hip plain radiography, magnetic resonance imaging (MRI), or computerized tomography (CT) were performed in all hips. The assessments were performed by 8 new residents independently, and the repeatability was assessed at 4-week intervals. Evaluation indicators included the size, location, and extent of necrotic lesions. Kappa values were used to determine the reliability and repeatability.According to the CJFH classification system, 2,800 evaluations were performed with an average interobserver Kappa value of 0.711, and 400 assessments were performed with an average intraobserver Kappa value of 0.748. Reliability analysis indicated a higher reliability and repeatability of this classification system. Critical factors affecting the consistency included the accurate selection of the median coronal plane and definitive tri-pillar division of the femoral head.The CJFH classification system is a simple and direct evaluation model for ONFH with substantial inter- and intraobserver reliability.

The composite of zeolitic imidazolate frameworks (ZIF-67) and ordered macroporous carbon (OMC) was successfully synthesized via in situ growth from the OMC matrix. The ZIF67–OMC composite was verified by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), powder X-ray diffraction (XRD) and electrochemical impedance spectroscopy (EIS) and then evaluated as a modified material for electrochemical sensor. Benefitting from the large surface area and enhanced conductivity of the ZIF67–OMC composite, ZIF67–OMC nanocomposite showed superior electrocatalytic performance toward acetaminophen (AP) oxidation. The redox reaction of AP underwent a quasi-reversible redox reaction with higher anodic current at ZIF67–OMC modified electrode compared with the bare glassy carbon electrode (GCE). In optimal condition, the ZIF67–OMC/GCE was stable, reproducible and had a linear range of 0.05–100 μmol·L−1 AP concentration, with the detection limit of 20 nmol·L−1 (signal-to-noise of S/N = 3). In addition, the prepared sensing platform for the detection of AP was evaluated for the compound paracetamol tablets and urine samples.

There has been ample research showing that insomnia is a potential trigger of depression as well as a symptom of depression. These two factors contribute to behavioural problems and are closely related to the plasticity of hippocampal synapses. Although depression and insomnia impair hippocampal synaptic plasticity, the mechanism by which this happens remains a mystery. This study aimed to investigate the pathogenesis of insomnia comorbidity in depression and the regulatory effect of venlafaxine combined with melatonin on hippocampal synaptic plasticity in chronic unpredictable mild stress (CUMS) with sleep deprivation (SD) rats. Thus, rats were subjected to 14 days of chronic mild unpredictable stress, gradually acclimated to sleep deprivation on days 12-14. Followed by 21 consecutive days of sleep deprivation, 18 h per day, with daily gavage of venlafaxine (13.5 mg/kg) + melatonin (72 mg/kg) on days 15-36. Venlafaxine + melatonin treatment improves depression-like behaviour, pentobarbital sodium experimental sleep latency, and sleep duration in CUMS +SD rats. In addition to improving depressive-like behaviors, sleep deprivation also upregulates the expression of caspase-specific cysteine protein 3 (Caspase 3) in the pineal glial cells of chronic mild rats, as well as in hippocampal microglia. Expression of ionic calcium-binding adaptor 1 (iba-1), downregulates the secretion of several synaptic plasticity-related proteins, notably cAMP response element binding protein (CREB), glial cell line-derived neurotrophic factor (GDNF), and the synaptic scaffolding protein Spinophiline (Spinophiline). Hematoxylin-eosin staining showed that the structure of the pineal gland and hippocampus was damaged, and Golgi staining showed that the dendrites and spines in the DG area of the hippocampus were destroyed, vaguely aggregated or even disappeared, and the connection network could not be established. Western blot analysis further revealed a positive correlation between low melatonin levels and reduced Spinophiline protein. Interestingly, venlafaxine + melatonin reversed these events by promoting hippocampal synaptic plasticity by regulating melatonin secretion from the pineal gland. Therefore, it exerted an antidepressant effect in sleep deprivation combined with CUMS model rats. Overall, the results of this study suggest that the pathophysiology of depressive insomnia comorbidity is mediated by impaired pineal melatonin secretion and impaired hippocampal synaptic plasticity. In addition, these responses are associated with melatonin secretion from the pineal gland.

Background: Previous studies have shown that the 5-year survival rates of patients with nasopharyngeal carcinoma (NPC) were still not ideal despite great improvement in NPC treatments. To achieve individualized treatment of NPC, we have been looking for novel models to predict the prognosis of patients with NPC. The objective of this study was to use a novel deep learning network structural model to predict the prognosis of patients with NPC and to compare it with the traditional PET-CT model combining metabolic parameters and clinical factors. Methods: A total of 173 patients were admitted to 2 institutions between July 2014 and April 2020 for the retrospective study; each received a PET-CT scan before treatment. The least absolute shrinkage and selection operator (LASSO) was employed to select some features, including SUVpeak-P, T3, age, stage II, MTV-P, N1, stage III and pathological type, which were associated with overall survival (OS) of patients. We constructed 2 survival prediction models: an improved optimized adaptive multimodal task (a 3D Coordinate Attention Convolutional Autoencoder and an uncertainty-based jointly Optimizing Cox Model, CACA-UOCM for short) and a clinical model. The predictive power of these models was assessed using the Harrell Consistency Index (C index). Overall survival of patients with NPC was compared by Kaplan–Meier and Log-rank tests. Results: The results showed that CACA-UOCM model could estimate OS (C index, 0.779 for training, 0.774 for validation, and 0.819 for testing) and divide patients into low and high mortality risk groups, which were significantly associated with OS ( P Conclusions: The deep learning network model based on 18F-FDG PET/CT can serve as a reliable and powerful predictive tool for NPC and provide therapeutic strategies for individual treatment.

To observe the effect of Yishen Tonglong Decoction (YTD) on the epithelial-mesenchymal transition (EMT) and Ras/ERK signaling pathway in human PCa DU-145 cells and explore its action mechanism.We treated human PCa DU-145 cells with normal plasma (the blank control) or plasma containing 5% (low-dose), 10% (medium-dose) and 15% (high-dose) YTD. After intervention, we examined the proliferation of the DU-145 cells in different groups with CCK-8 and their apoptosis by Annexin V/PI double staining. We detected the cell cycle by PI assay, the invasion and migration of the cells using the Transwell chamber and scratch test, and the expressions of the proteins and genes related to the EMT and Ras/ERK signaling pathways in the cells by Western blot and RT-PCR.Compared with the blank control group, high-, medium- and low-dose YTD significantly inhibited the proliferation of the PCa DU-145 cells, decreased their adherence and growth (P0.05, P0.01), promoted their apoptosis (P0.01), regulated their cell cycles (P0.05, P0.01), and reduced their in vitro invasion and migration abilities (P0.05), all in a dose-dependent manner. The results of Western blot and RT-PCR revealed down-regulated protein and mRNA expressions of N-cadherin, zinc finger transcription factor (Snail), Ras, p-ERK1/2 and ERK1/2, but up-regulated protein and mRNA expressions of E-cadherin in the PCa DU-145 cells treated with YTD (P0.05, P0.01).Yishen Tonglong Decoction can effectively inhibit the proliferation, promote the apoptosis, regulate the cell cycle and suppress the invasion and migration abilities and EMT process of human PCa DU-145 cells. The mechanism of Yishen Tonglong Decoction acting on PCa may be associated with its inhibitory effect on the EMT process and expression of the Ras/ERK signaling pathway in PCa cells./.

Clinical studies have shown that diabetes can present with underlying depression, and a combination of the two can lead to emotional, memory and cognitive disorders, closely associated with hippocampal neuroinflammation. However, the mechanism underlying the development of hippocampal neuroinflammation under the above condition remains elusive. The aims of this study were to explore the pathogenesis of diabetes combined with depression, and the effect of dexamethasone (Dex), a glucocorticoid receptor (GR) agonist, on hippocampal neuroinflammation in diabetic rats with chronic unpredictable mild stress (CUMS). Therefore, rats were intragastrically fed on a high-fat diet (10% cholesterol 10 ml/kg) for 14 days and thereafter injected with 38 mg/kg of streptozotocin on the 15th day to induce diabetes. Dex treatment of the diabetic and CUMS rats ameliorated the depression-associated behavior in the respective rats. Apart from enhanced depressive behavior, diabetes-depressed condition also up-regulated the expression of hippocampus microglia chemokine Ⅰ receptor (CX3CR1) and secretion of several pro-inflammatory factors, in particular, interleukin 1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor - α (TNF-α). Hematoxylin-eosin staining revealed inflammatory damages in the hippocampus. Western blot analysis further revealed repression of GR proteins converse to the nuclear factor kappa-B (NF-κB) proteins, which were up-regulated. Intriguingly, Dex reversed the above events by inhibiting inflammatory reactions in the hippocampus. Consequently, played an antidepressant effect in diabetic and CUMS model rats. Overall, findings of this research suggest that the physiopathology of diabetes with stress cormobity are mediated by inflammatory reactions in the hippocampus. In particular, the responses are associated with regulation of GR/NF-κB signaling pathway.

Background: The purpose of this study is to evaluate the correlation between spinopelvicalignment and the body weight parameters in healthy Chinese adult volunteers. That has not been systematically studied yet. Methods: 100 Chinese healthy adult volunteers (36 males and 64 females) were included in this study, which grouped according to the gender. The obesity parameters, body mass index (BMI), waist circumference (WC), sagittal abdominal diameter (SAD), transverse abdominal diameter (TAD) and RR (the ratio of SAD to TAD) were measured. The sagittal spinopelvic parameters include pelvic incidence (PI), pelvic tilt (PT), pelvic angulation (PA), sacral slope (SS), sacral inclination (SI), lumbar lordosis (LL) and the disc angle of L5/S1. The coronal spinopelvic parameters include the Cobb angle of the major curve of the spine, lumbar scoliosis (LS) and pelvic obliquity (PO). Pearson's correlation analysis was used to determine correlations between obesity index and spinopelvic alignment parameters. Results: The mean BMI and WC of the males and females was 28.7 ± 3.7 kg/m2 vs 26.8 ± 2.3 kg/m2 and 88.39 ± 9 cm vs 82.6 ± 2.7 cm respectively. In the female group, a strong correlation was found between BMI and PI, WC and PT, WC and PI. However, there was no strong correlation between the obesity and spinopelvic alignment parameters in the male group. None of the coronal spinopelvic parameters showed a correlation with the obesity parameters in two groups. The RR showed a positive linear correlation with PA and PT in both groups. Conclusions: Body weight could influence the spinopelvic alignment,especially for females. People with abdominal obesity, the sagittal spinopelvic alignment is likely to change. But there is little effect on the coronal spinopelvic alignment.

Relative humidity (RH) is broadly involved in various areas, including industry, agriculture, medical engineering, as well as environments. Thus, development of a high-performance, low-energy consumption, flexible, and miniaturized RH sensing device is quite essential to meet the modern requirements. However, it is still a grand challenge to endow a RH sensor with all the above strengths. Herein, according to the electrical double layer mechanism, a RH-responsive poly (acrylic acid) is employed as a sensing layer and simultaneously a dielectric layer for fabrication of flexible organic thin-film transistor (OTFT) RH sensors, which could remarkably reduce the driven voltage of the OTFT device to 2 V. The sensitivity of such-designed sensors can be manipulated by tuning the driven voltage. Notably, all the fabricated OTFT sensing devices show reversibly linear response to RH and a fast response of around 4 s. Due to the solution-processing abilities and flexibility of the OTFT device, it can be miniaturized and integrated into multiple functional devices, e.g., soft medical devices.

This study evaluated the outcomes of using porous tantalum rods for the treatment of osteonecrosis of the femoral head (ONFH). We performed core decompression and inserted porous tantalum implants in 149 patients (168 consecutive hips) with ONFH. Hips had large (65), medium (64), or small (39) lesions; 63 lesions were lateral, 68 were central, and 35 were medial. Conversion to total hip arthroplasty (THA) was the end point of this survey. A total of 130 cases (138 hips) were followed. The mean follow-up time was 38.46 ± 5.76 months; 43 hips (31%) were converted to or needed THA. Of the 43 hips requiring THA, 33 had large lesions, including 1 medial, 3 central, and 29 lateral lesions; 9 had medium, lateral lesions, and 1 hip had a small, lateral lesion. Bone grafting was used in 59 hips, with 3 hips failing; 40 of 79 hips without bone grafts failed. The sum distances between the tops of the rods and the lateral lesion boundaries (SDTL, mm) were measured in anteroposterior and lateral radiographs. In the failure and spared groups, the average SDTLs were 7.65 ± 2.759 and 0.83 ± 2.286 mm, respectively. The survival of porous tantalum rods used for treating early-stage ONFH was affected by the size and location of the lesion, whether or not a bone graft was used, as well as the distance between top of the rod and the lateral boundary of the lesion.

Train compartment is very special confined spaces; fire smoke in compartment brings great hazards when fire broke out. It is the main reason which caused people to die or hurt. This paper uses CFD method based on the FDS. It analyzes the main features of fire smoke on the human body injury; simulate smoke flow caused by compartment fire; It computes and analyses the interior fire smoke's diffusion process, the cabin space area of smoke concentration distribution and the temperature distribution and trends, and discusses and analyses the impact of smoke and temperature change in the train personnel in emergency evacuation.

This study is aimed to explore the progression of osteonecrosis of the femoral head (OFNH) in severe acute respiratory syndrome patients 7 years after steroid administration and to analyze factors affecting the prognosis. One-hundred and ninety hips in 117 patients with more than 7 years of follow-up were studied. The prevalence of progression to symptoms and collapse was determined. The total dose of steroid, gender, age, stage, lesion location, volume of necrosis, viable lateral column and bone marrow edema were analyzed and correlated with progression. During the 7 years of follow-up, 66 hips progressed to symptoms, 50 hips collapsed and 10 hips showed complete regression. Fifty-seven hips (86.36 %) caused pain and 32 (64.00 %) collapsed within 3 years of steroid administration. The lesion was relatively larger, and there was relatively less viable lateral column in hips that exhibited symptoms or collapsed. Mechanical failure of the necrotic segment of bone principally occurred within 3 years after the administration of steroids. Larger lesions and less viable lateral column were the main risk factors for progression. Small ONFH lesions seldom collapsed.

Nontraumatic osteonecrosis of the femoral head (non-ONFH) is a disorder that can lead to femoral head collapse and the need for total hip replacement. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularised and nonvascularised bone grafting procedures. We examined the effect of bone-grafting through a window at the femoral head-neck junction known as the “light bulb” approach for the treatment of osteonecrosis of the femoral head with a combination of demineralised bone matrix (DBM) and auto-iliac bone. The study included 110 patients (138 hips; 41 females, 69 males; mean age 32.36 years, range 17–54 years) with stage IIA–IIIA nontraumatic avascular necrosis of the femoral head according to the system of the ARCO (Association Research Circulation Osseous). The bone grafting procedure is called “light bulb” procedure in which the diseased bone was replaced by a bone graft substitute (combination of DBM and auto-iliac bone).The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 25.37 months (range 7–42 months). All data were processed by a statistics analysis including Cox risk model analysis and Kaplan-Meier survival analysis. Pre- and postoperative evaluations showed that the mean Harris hip score increased from 62 to 79. Clinically, 94 of 138 hips (68%) were successful at the latest follow-up, and radiological improvement was noted in 100% of patients in stage IIA, 76.67% of patients in stage IIB and 50.96% of patients in stage IIC and IIIA cases. Excellent and good results according to the Harris score were obtained in 100% of cases in stage IIA, 93.33% in stage IIB and 59.62% in stages IIIA and IIC stage, with a survivorship of 85% in stages IIA and IIB and 60% in stage IIIA and IIC cases. Cox risk model analysis showed that the clinical success rate correlated with both pre-operation stage and the necrotic area of the femoral head. The complications included ectopic ossification, lateral femoral cutaneous nerve lesion and joint infection. This procedure may be effective at avoiding or forestalling the need for total hip replacement in young patients with early to intermediate stages of osteonecrosis of the femoral head. Therefore, it may be the treatment of choice particularly in nontraumatic osteonecrosis of the femoral head of pre-collapse stage with small and middle area (

It is difficult to predict if and when the femoral head will collapse and whether the collapse can be minimized. This study examined the final outcome of early-stage osteonecrosis of the femoral head (ONFH) using magnetic resonance imaging to verify the relationship between preservation of the lateral pillar and collapse of the femoral head. A midcoronal section of the femoral head was divided into 3 pillars (medial, central, and lateral) on a T1-weighted image. According to the site of necrosis on the lateral pillar, the necrosis was divided into 3 types: I, the necrosis occupies the central and medial pillars, and the lateral pillar is preserved; II, the necrosis partially occupies the lateral pillar; and III, the necrosis totally occupies the lateral pillar. One group of 87 patients (127 hips) with Association for Research on Osseous Circulation (ARCO) stage I ONFH underwent nonoperative treatment and were followed for 3 to 8 years (average, 6.2 years). Another group of 42 patients (72 hips) with ARCO stage I ONFH underwent debridement and impacted bone graft and were followed for 5 to 9 years (average, 7.1 years). In both groups, the more preserved the lateral pillar, the less collapse occurred. The authors concluded that whether ONFH progressed to collapse is determined by preservation of the lateral pillar. The lateral pillar is the keystone for maintaining the sphere of the femoral head and its preservation.

OBJECTIVES: This study examined the anticardiolipin antibodies in post-SARS (severe acute respiratory syndrome) osteonecrosis patients to investigate the etiology of post-SARS osteonecrosis, and to eventually provide valuable information for the early diagnosis of nontraumatic osteonecrosis and for the susceptible population screening. METHODS: This study recruited 62 post-SARS osteonecrosis patients and 52 age- and gender-matched healthy controls. Fasting blood samples were collected from all the subjects through cubital veins. Immunoglobulins A, G and M (IgA, G and M) types of anticardiolipin antibodies were examined by enzyme-linked immunosorbent assay. The routine examinations of prothrombin time, thrombin time, prothrombin activity, and international normalized ratio were also performed. RESULTS: There were 21 of 62 post-SARS osteonecrosis patients (33.9%) who showed at least one type of anticardiolipin antibodies. The titers of specific IgA, IgG, and IgM were 11.33 +/- 11.209 APL, 5.127 +/- 5.927 GPL, and 17.821 +/- 10.606 MPL, respectively. There were only 4 of 52 subjects in the control group (7.7%) who showed positive anticardiolipin antibody with titers of IgA at 10.702 +/- 3.126 APL, IgG at 5.184 +/- 4.780 GPL, and IgM at 14.684 +/- 5.516 MPL. There were significant differences between the 2 groups confirmed by t-Test and chi(2) test (P < 0.05), while no significant differences were observed in prothrombin time, thrombin time, prothrombin activity, and international normalized ratio results between the 2 groups. CONCLUSIONS: The incidences of anticardiolipin antibodies were increased in the post-SARS osteonecrosis patients and anticardiolipin antibodies may play a role in the pathogenesis of post-SARS osteonecrosis.

Objective: To evaluate the early and middle‐term results of in situ single screw fixation and subtrochanteric osteotomy of the femur with external fixator for slipped capital femoral epiphysis (SCFE). Methods: From June 1998 to July 2008, 11 patients (seven male [eight hips] and four female [four hips]) of average age 14.3 years (range, 9–18 years) were treated in our hospital. According to the Southwick measurement, seven hips were mildly affected (50°). The average body mass index (BMI) was 31.1 g/m(2) (range, 27–35 g/m(2)). All the mild and moderate cases underwent in situ single screw fixation, and the three severe cases subtrochanteric osteotomy of femur with external fixator. All cases were evaluated both clinically and radiographically at 3 months, 6 months and every year postoperatively. Results: All cases were followed up for 2–12 years (average 5.6 years). The Harris hip score increased from a mean of 74.8 (70 ∼ 85) points preoperatively to 90.6 (70 ∼ 100) points postoperatively. X‐ray films showed epiphyseal closure in the in situ single screw fixation cases, and no further increase in epiphyseal‐shaft angle. Partial reduction of slipped epiphysis with normal joint spaces was observed after subtrochanteric osteotomy of the femur in the external fixator cases. Conclusion: In situ single screw fixation for treating mild and moderate SCFE has a satisfactory clinical outcome, and the advantage of prevention of further slippage. Subtrochanteric osteotomy of the femur with external fixator is suitable for severe SCFE with late deformity; the realignment procedure can correct deformity and postpone or prevent subsequent osteoarthritis.

To detect the cartilage changes of hip joint with osteonecrosis of femoral head (ONFH) in stages II and III and provide evidence for understanding cartilage changes of femoral head of osteonecrosis before collapse.The cartilage changes of ONFH were determined by delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC). According to ARCO classification of ONFH, the samples were divided into three groups: Group A, 11 hips, stageII; Group B, 13 hips, stage III; Group C, 10 hips, normal. All participates underwent the tests by dGEMRIC. And the data of T1Gd were collected and analyzed.The values of T1Gd were 420 ± 60 (Group A), 361 ± 54(Group B) and 538 ± 26 (Group C) respectively. There was a significant difference among three groups. The values of T1Gd in the ONFH patients were lower than their healthy counterparts. The values of TIGd of Group B was 14% lower than those of Group A. And the difference was significant statistically.Cartilage of the femoral head undergoes abnormal metabolic changes before collapse. There is a loss of GAG in the cartilage and it aggravates with the worsening of ONFH.

Synchrotron radiation light is 1 of 4 artificial light sources, the others being electric light, X-ray, and laser. Phase-contrast imaging with hard X-ray has achieved wide application in many scientific fields, such as biomedicine and material science. This article compares the effectiveness of nanohydroxyapatite/collagen (nHAC) and autologous mesenchymal stem cell for the repair of defects in a rabbit model with osteonecrosis of the femoral head under the monitoring of phase-contrast imaging with synchrotron hard X-ray. We established models of bilateral osteonecrosis of the femoral head defect using New Zealand rabbits and divided them into 3 groups. Imaging techniques such as phase-contrast imaging and diffraction enhanced imaging with synchrotron hard X-ray were applied to assess the degradation and repair process of nHAC and mesenchymal stem cell at 4, 8, and 12 weeks postoperatively. We found phase-contrast imaging with synchrotron hard X-ray displayed the reparative process of the bone defect, degradation of nHAC, and osteocyte substitution. There were significant differences in the repair of the bone defect and osteogenesis in groups B and C compared with group A (control). Osteogenesis was more significant in group C. We provided experimental data for the development and application of synchrotron hard X-ray imaging techniques and concluded that phase-contrast microimaging with synchrotron hard X-ray displays the reparative process of bone tissue at a micro-level and plays an important role in the development of tissue engineering.

To analyze retrospectively the formation and histological changes of sclerosis rim in patients with osteonecrosis of the femoral head (ONFH), and to study the relationship between bone morphogenetic proteins (BMP4) and sclerosis rim, so as to acquire experimental and theoretical basis on individualized treatment for ONFH patients.From November 2005 to November 2007, 184 hips of steroid-induced ONFH inpatients were collected. The mean age was (47 ± 7) years, the patients were divided into high (more than 54 years old), middle (40 - 54 years old) and low (less than 40 years old) age groups. Their clinical data were analyzed retrospectively according to gender and age. Parts of the femoral heads were selected for the study, including 18 hips in high age group, 11 hips in low age group and 20 hips in middle age group. Each 10 hips were selected with or without sclerosis rim. The femoral heads were cut along middle coronal plane, their weight-bearing and non-weight-bearing areas were used for the study. The specimens were processed by routine HE staining and picric acid-Sirius red staining and electron microscopy preparation and immunohistochemistry stain. The average optical density of BMP4 protein was calculated by image analysis software.The trabecular of sclerosis rim was thickening and disorder. But its osteocytes were normal and with high secretion. The ratio of sclerosis rim was 71.4% (105/147) in middle age ONFH patients, which was significantly higher than the low age group patients (45.5%, 5/11) and high age group patients (38.5%, 10/26) (P0.01). The optical density of BMP4 in middle age ONFH patients was 0.32 ± 0.14, which was significantly higher than the low age group 0.20 ± 0.17 and high age patients 0.19 ± 0.27 (P0.05). The optical density was 0.16 ± 0.11 in ONFH patients without sclerosis rim, which was significantly lower than with sclerosis rim (0.28 ± 0.13) (P0.01). The time from hip pain to joint replacement in patients with sclerosis rim was (49 ± 11) months, and (15 ± 2) months without sclerosis rim. There was significant difference between the two groups (P0.01).The formation of sclerosis rim is positively related to the expression of BMP4, and high expression of BMP maybe promote the formation of sclerosis rim.

From individual randomized studies, it is not clear whether a closed suction drainage should be used after total knee arthroplasty. Our meta-analysis compares the clinical outcomes of closed suction drainage with nondrainage after total knee arthroplasty in randomized controlled trials reported between January 1966 and May 2010. Fifteen eligible trials involving 1361 knee incisions (686 knees with closed suction drainage and 675 knees without drainage) satisfied the inclusion criteria for our meta-analysis. The result of the meta-analysis indicates that closed suction drainage reduces the incidence of soft tissue ecchymosis and requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference between drainage and nondrainage was observed in the incidence of infection, deep venous thrombosis, or postoperative range of motion.

To understand the curve of thoracolumbar junction in patients with thoracolumbar intervertebral disc herniation and analyze the relation between thoracolumbar intervertebral disc herniation and spinal sagittal curve.The radiographic films of thoracolumbar junction of spine from 27 patients with thoracic disc herniation and 37 healthy persons as control were taken at reclining position. The Cobb angles of sagittal plane of thoracolumbar junction of spine were measured and statistically compared by SPSS (statistics package for social science).The Cobb angles of T10-L2, T10-L12 and T12-L2 in patients with thoracolumbar intervertebral disc herniation were greater than those in healthy controls respectively.The Cobb angles of sagittal plane of thoracolumbar junction of spine in patients with thoracolumbar intervertebral disc herniation are greater than those in healthy controls. The abnormal spinal curve is possibly responsible for thoracolumbar intervertebral disc herniation by abnormal biomechanical action.

To assess the efficacy of UKA versus HTO in the treatment of unicompartmental knee osteoarthritis.Comparative studies of UKA and HTO were retrieved from the domestic and foreign literatures and included for a meta-analysis.Seven eligible randomized controlled trials included 196 UKAs and 219 HTOs. The result of Meta-analysis indicated that the ratio for an excellent outcome was higher in UKA than HTO. The combined OR was 2.43, 95%CI (1.46, 4.05) (P = 0.0006). The risks of revision and complications were lower in UKA than HTO. The combined OR was 0.47 and 0.24 and 95%CI (0.23, 0.97), (0.10, 0.56).UKA reduces the risk of postoperative revision and complications and provides excellent outcomes.

Osteonecrosis of the femoral head (ONFH) is one of the intractable diseases. It is controversial whether the lesion size assessed by magnetic resonance imaging (MRI) can change over time without any operative treatment. In this study, we used MRI to observe the lesion size changes of ONFH induced by corticosteroid administration in severe acute respiratory syndrome (SARS) patients. The study included 51 SARS patients (84 hips) with early-stage ONFH who did not receive any operative treatment and were diagnosed by MRI. All of the patients underwent MRI follow-ups. Each patient was evaluated on the basis of the lesion volume on MRI at every follow-up for further comparisons. At the first MRI scan, the mean lesion volume was 10.12 +/- 8.05 cm(3) (range: 0.39-41.62 cm(3)). At the mid-term follow-up (2.5 years), the mean lesion volume was 7.82 +/- 7.59 cm(3) (range: 0.11-39.65 cm(3)). At the final follow-up (five years), complete regression of the lesion was observed in six hips, and the mean lesion volume was 5.67 +/- 6.58 cm(3) (range: 0.00-31.47 cm(3)). Overall, the lesion volume was reduced by15% in 80 hips, and only four hips with relatively larger lesion volumes showed no apparent reductions. The reduction in lesion size of ONFH observed on MRI is a slow, discontinuous and time-dependent process.

To explore Poloxamer 188, a non-ionic surfactant as a potential tool for early intervention into the chondrocyte damaged by blunt mechanical trauma in vitro.Three groups were control group (n = 6), no treatment group (n = 12) and Poloxamer 188 treatment group (n = 12). Two groups are then loaded to 20 MPa in unconfined compression. At 1 and 24 h the percentages of live and dead cells of superficial zone in compressed and control groups were determined with a cell viability stain.At 1 h post-trauma, specimens of Poloxamer 188 treatment group (76%) had a significantly increased percentage of live cells in the superficial zone versus the no treatment group (55%). In 24 h the percentages of live cells in the superficial zone of the Poloxamer 188 treatment group (57%) were significantly greater than in the no treatment group (38%).Poloxamer 188 surfactant could help restore the integrity of cell membranes in cartilage damaged by blunt mechanical trauma. Models of mechanical cartilage injury in vitro may explain aspect of the interactions between mechanical forces and degradative pathways which lead to osteoarthritis progression.

To detect the blood perfusion of the necrotic area and the femoral head and neck junction in the patients diagnosed as osteonecrosis of femoral head (ONFH) with laser doppler flowmetry (LDF).From 2007 to 2008, 50 patients with ONFH 82 hips were performed core decompression and autologous stem cells transplantation. Group A was for ARCO stage II 46 hips (IIA 6 hips, IIB 22 hips, IIC 18 hips), and Group B was for stage III 36 hips (IIIA 20 hips, IIIB 10 hips, IIIC 6 hips). Blood perfusion of necrotic area and femoral head and neck junction with LDP were detected during the operation. Statistical analysis was made.In Group A, the perfusion volume of necrotic area was (30.2 +/- 3.0) PU, and the perfusion volume of femoral head and neck junction was (103.4 +/- 4.4) PU. In Group B, the perfusion volume of necrotic area was (30.6 +/- 2.8) PU, and the perfusion volume of femoral head and neck junction was (103.4 +/- 3.9) PU. In Group A and Group B, the perfusion volume of necrotic area was lower than that of femoral head and neck junction, and the difference was significant (P0.01).LDF can effectively detect that the perfusion volume of ONFH decreased, which provides a theoretical basis in order to further study the pathogenesis of ONFH. Meanwhile, there is application value of LDF on the study of ONFH.

To investigate the changes of structure and metabolism of the cartilage of femoral head overlying the bone defect in animal model and analyse the possible effect of the necrotic area of the femoral head on the cartilage overlying there.18 adult hybrid dogs was applied for bone defect model of femoral head. Of the femoral heads, the left was applied for bone defect model, the right for shame-operation. 5, 5, and 8 animals were sacrificed respectively 4, 12 and 24 weeks after operation and the femoral heads were received for examinations. The X-rays films were taken just before the animals were sacrificed. After the cartilage specimens were decalcified, dehydrated and embedded, sections 6, u thick were made. They were stained with hematoxylin-eosin, sirius-red and toilude blue. The biochemical assay were performed.12 and 24 weeks after operation of bone defect, cartilage histology and biochemistry demonstrated the signs of articular cartilage pathological changes. The arrangement of chondrocytes were disorder. The number of chondrocytes decreased. The cartilage surface lost its smoothness, and these kinds of changes were more severe in the area next to the bone defect. Fibrosis and vasi formation were found. Tidemark had the changes of discontinuation and veil. Glycosaminoglycans decreased.The bone defect, whose damaged structure strength and decreased blood supply is similar, had effect on the structure and metabolism of the articular cartilage near the bone defect, and suggest osteonecrosis at the stage of pro-collapse may affect the cartilage overlying it.

Our study investigated the location and accuracy of osteonecrotic lesions measured by a computed magnetic resonance imaging (MRI, T1-weighted) and coronal data sets in patients with femoral osteonecrosis (ON). A total of 29 patients (38 hips) with ON at the femoral head, who underwent total hip arthroplasty, were recruited into this study. All patients were subjected to MR imaging acquisition before operation. The MRI (T1-weighted) coronal data sets were transferred to a computer in DICOM format using import and export images software (Mimics). A 3D model of ON of the femoral head was restructured. The volume of both femoral heads and the necrotic lesions was calculated. The risk of collapse in patients with different osteonecrotic volume of the femoral head was evaluated using 3D finite element analysis (FEA). Our measurement results showed that the necrotic lesions were located at the anterolateral and superior portion of the femoral head in the restructured 3D model, which matched well with the anatomical location of the osteonecrotic lesions. Our results also revealed that if the necrotic volume was more than 30% of the entire femoral head, there was also a larger collapsed region. Our study suggested that the 3D ON model at the femoral head can be restructured precisely using computed MRI technique. This will be helpful for orthopedic surgeons to understand the shape and location of the necrotic lesion at the femoral head of patients non-destructively.

To investigate the hematological changes and related gene mutation of post-severe acute respiratory syndrome (SARS) patients with osteonecrosis so as to find the sensitive molecular symbols for early screening of the high risk populations.Fast peripheral venous blood samples were collected from 61 post-SARS patients with osteonecrosis, 25 males and 36 females, aged 30.4 (20 - 60), and 52 sex and age-matched healthy persons as controls. ELISA was used to detect the coagulation and fibrinolysis indicators: activated partial thromboplastin time (APTT), protein C (PC), antithrombin III (AT-III), plasminogen activator inhibitor (PAI), activated protein C resistance (APC-R), plasminogen (PLG), von Willebrand factor (VWF), D-dimer (D-D), and fibrinogen (Fib). Real-time PCR was used to detect the mutation of factor V G1601A (FV Leiden) and prothrombin G20210A.The levels of PC, AT-III, and PLG of the osteonecrosis group were 85% +/- 34%, 84 +/- 29%, and 69 +/- 23%, significantly lower than that of the control group (109% +/- 20%, 104% +/- 14%, and 94% +/- 15% respectively, all P0.01). PAI of the osteonecrosis group was 16 U/ml +/- 14 U/ml, significantly higher than that of the control group (8.0 U/ml +/- 4.3 U/ml, P0.01). The percentage of patients with abnormal indicators was 99.5% (54/61) in the osteonecrosis group, significantly higher than that of the control group (36.5%, 19/52, P0.01). The percentage of patients with 3 or more abnormal indicators was 72.1% (44/61) in the osteonecrosis group, significantly higher than that of the control group (17.3%, 9/52, P0.01). No mutations of F V Leiden and prothrombin G20210A was found in both groups.Trends of hypercoagulation and hypofibrinolysis exist in the post-SARS patients with osteonecrosis. APTT, PC, AT-III, and PLG can be used as sensitive indicator for screening high risk populations of osteonecrosis.

The purpose of this study was to detect changes in coagulation and fibrinolysis of post-severe acute respiratory syndrome (SARS) Chinese patients with osteonecrosis, investigate the aetiology of post-SARS osteonecrosis (ON), and select the sensitive molecular markers for identifying the susceptible population. For this study, blood samples were collected from 88 patients with post-SARS ON and 52 healthy people. Activated partial thromboplastin time (APTT), protein C (PC), antithrombin III (AT–III), plasminogen activator inhibitor (PAI), activated protein C resistance (APC–R), plasminogen (PLG), von Willebrand’s factor(vWF), D–dimer (D–D), fibrinogen (Fib), and homocysteine (HCY) were examined by enzyme-linked immunosorbent assay (ELISA). We noted that blood agents of patients with ON changed obviously. APTT, PC, AT–III, PAI, APC–R, and PLG were significantly different between the two groups. Hypercoagulation and hypofibrinolysis were found in patients with post-SARS ON. Therefore, these examinations can be used to screen a population susceptible to ON. Measurements of APTT, PC, AT–III, PAI, APC–R, and PLG are sensitive blood tests for screening purposes.

To explore the correlation between the dosage of corticosteroid, time of onset and incidence of osteonecrosis (ON) in patients with SARS.From July 2003 to January 2004, general survey carried out for ON in 551 patients with SARS. Five hundred and fifty-one patients except 12 were administrated by corticosteroid from 80 mg to 30 000 mg. The age of patients was (33 +/- 9) years old ranging from 19 to 59 years old. One hundred and thirty-one were male, and four hundred and twenty were female. MRI and X-ray film were taken in all patients including both hips, knees, shoulders, ankles and wrists. CT scan was taken in partial patients. Common classification system were used for staging of hip (ARCO), knee (Lotka) and shoulder (Cruess). Independent test, rank-sum test and multiple factor logistic regression analysis were used for statistical analysis.No osteonecrosis was detected in 12 patients without corticosteroid. Osteonecrosis was detected in 176 patients (32.7 percent) among 539 patients. There were ON of femoral head in 130 cases (210 hips), ON of knee in 98 cases (130 knees), ON of humeral head in 21 cases (36 shoulders), ON of talus and calcaneus in 16 cases (26 ankles), ON of scaphoid and lunate in 11 cases (17 wrists), ON of patella in 3 cases (4 patella), ON of ilium in 1 case and bone infarction (femur, tibia) in 18 cases. One hundred and nineteen cases (195 hips) with ONFH were in stage I (IA 45 hips, IB 77 hips, IC 73 hips). Eleven cases (15 hips) were in stage II. All osteonecrosis of the knee and humoral head was stage I. Thirty-four patients with ON had one joint affected, 45 patients had 2 joints, 93 patients had more than 3 joints. The dosage of corticosteroid was (5842 +/- 4988) mg in ON group and (2719 +/- 2571) mg in non-ON group (P0.0001). The duration of steroid was (38 +/- 17) d in ON group and (27 +/- 15) d in non-ON group (P0.01). The dosage of pulse treatment was (340 +/- 207) mg/d in ON group and (211 +/- 160) mg/d in non-ON group (P0.01). The duration of pulse treatment was (28 +/- 13) d in ON group and (18 +/- 11) d in non-ON group (P0.01). All patients with ON were detected within 6 months from administration.About one-third patients with SARS who were treated with a high dose of corticosteroid occurred osteonecrosis. ON is frequently multiple focuses. The actual time of onset of ON is early of steroid used. MRI is golden standard for early diagnosis of ON. The patients who were treated with a high dose of corticosteroid should be inspected initially by MRI.

To explore the correct localization of the acetabular component, surgical technique and the outcome in total hip arthroplasty (THA) for acetabular dysplasia with secondary osteoarthritis.A retrospective review was undertaken of 44 hips (38 patients) that had had a total hip arthroplasty for acetabular dysplasia with secondary osteoarthritis from September.1989 to April. 2003. 14 were male (one bilateral) and 24 patients were female (5 bilateral). The mean duration of clinical and roentgenographic follow-up was thirty-six months (range, eight to one hundred and sixty-eight months), and the mean age of the patients was fifty-one years (range, twenty-nine to eighty years). Twelve hips were classified as type I; twenty-four as type II; seven as type III; and one as type IV, according to the criteria of Crowe. The horizontal location of the center of the hip (the distance along the interior drop line extending lateral or medial from the inferior point of the teardrop to the perpendicular line dropped from the center of the femoral head) was measured.There were 24 acetabular components that were placed in the centralized position and the other 20 in no deepen placement post-operatively. At the most recent follow-up, the mean Harris hip score was 90.2, 86.3 for the centralized position and the undeepen placement hips respectively, there was a significant difference between these two groups.In order to obtain the stability of acetabular component, deepen acetabular reaming is necessary for the most acetabular dysplasia in THA. In this way the anatomical rotational center can be obtained medially and lowly. The excellent long-term function will be maintained.

To explore the indications, operative technique and clinical results of the transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).Nineteen patients (23 hips) with ONFH underwent TRO from October 1992 to May 2001 were reviewed. There were 14 males and 5 females. The age was ranging from 22 to 43 years old with an average age of 33.4 years old. The etiology were as followed: alcoholism 10 cases (12 hips); steroid 6 cases (7 hips); trauma 2 cases (2 hips); caisson disease 1 case (2 hips). Ficat stage: II 8 cases 8 hips; III 11 cases 15 hips. Harris hip score 46 to 74 with mean score 56 preoperatively. In order to determine the location and extent of osteonecrosis, A-P view and accurate lateral view (the film should be placed parallel to the femoral neck with the hip in precisely 90 degrees and flexion 45 degrees of abduction and neutral rotation) were taken in both hips preoperatively. The surgical technique described by Sugioka were used in all patients.Seventeen patients (19 hips) were followed up ranging from 18 to 11 years with mean 54 months. The Harris hip score was from 55 to 94 with mean 80.5. Fourteen hips score more than 80 and good to excellent rate was 73.2%. Harris score were less than 79 in 5 cases and 4 hips of these 5 hips were revised by total hip arthroplasty. The rotation angle was from 55 degrees to 80 degrees with mean 60 degrees .The circumflex femoral medial artery injury was found in 1 hip; subtrochanteric fracture was found in 2 hips and 1 osteotomy site nonunion occurred.TRO can be used to treat ONFH. The indications include: (1) younger patients (less than 45 years old). (2) Ficat stage II and III with more than one third intact articular surface of the femoral head. The better results could be obtained using posterior rotation and lager rotational angle. The Sugioka osteotomy should be used carefully because of its complicated surgical technique.

To explore the correct localization of the acetabular component, surgical technique and the outcome in total hip arthroplasty (THA) for acetabular dysplasia with secondary osteoarthritis.A retrospective review was undertaken of 39 hips (33 patients) that had been performed a total hip arthroplasty for acetabular dysplasia with secondary osteoanthritis from September 1989 to January 2003. These patients were divided into two groups, 16 patients (20 hips) who were performed by regular THA of Harris method were defined as group A and the other 17 patients (19 hips) by acetabular centralization technique as group B. The hip function was evaluated using Harris hip score before and after operation. The horizontal location of the center of the hip (the distance along the intertear drop line extending lateral or medial from the inferior point of the teardrop to the perpendicular line dropped from the center of the femoral head), abduction angle of the cup, and femoral offset was measured.At the most recent follow-up, the mean Harris hip score was 88.9 +/- 5.8, and 82.3 +/- 8.4 for the anatomical position reconstruction and the lateral displacement hips, respectively (P0.05). The horizontal distance between the teardrop and the hip center was significantly shorter in B group [(37.3 +/- 3.4) mm] than in A group [(46.1 +/- 5.3) mm] (P0.05). Two patients had bone resorption of autograft and malposition of the acetabular component during follow-up, while others had no revision, loosening, or migration of the acetabular component.Accurately confirmed acetabular position, stable acetabular component, and appropriate techniques are important to guarantee the clinical efficacy of THA.

To explore the factors effecting restoring femoral offset and the relation between femoral offset and hip abductor strength during total hip arthroplasty (THA).Ninety-nine THA for 81 patients were performed from March 1998 to January 2002. And follow-up was finished. There were 53 women and 28 men and the average age was 57 years (29 to 80). The right hip had been replaced in 28 cases, the left in 35 cases and the bilateral in 18 cases. The mean duration of clinical and roentgenographic follow-up was 36.8 months (range, 19 approximately 66 months). A posterolateral approach was used in all THA. The femoral offset and the abductor lever arm were measured from each radiograph. The measurement of the hip abduction strength was made for some THA by the Cybex machine. Statistical data analysis was performed by SPSS10.0 software.Femoral offset correlated positively with the length of the abductor lever arm (r = 0.613; P0.001). Simple regression analysis showed that femoral offset was significantly and positively related to the length of femoral neck and neck-shaft angle (r = 0.451, P = 0.001; r = 0.567, P0.001). There was a highly significant and positive correlation between femoral offset (and consequently abductor lever arm) and hip abductor strength (r = 0.500, P = 0.009; r = 0.477, P = 0.014).It is very important to template both sides of hip preoperatively for restoring femoral offset in THA. Femoral component with more anatomical neck-shaft angle will be used with the increase in the femoral neck length.