Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These compli...Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These complications lead to significant morbidity and mortality, in addition to chronic pain and functional impairment. We report the clinical case of bilateral avascular necrosis (AVN) of the femoral head in a kidney transplant recipient. Clinical Case: 53-year-old male with a history of chronic hypertension. He underwent chronic hemodialysis for 12 months and was treated with Entecavir for chronic hepatitis B. The patient received a kidney transplant from a non-related living donor. Induction therapy included Thymoglobulin along with tapered corticosteroids, reaching a dose of 5 mg/day after 3 months, Mycophenolate mofetil (2 g/day), and Tacrolimus adjusted based on residual levels. There was good recovery of renal graft function. After six months, the patient reported bilateral hip pain and functional impairment of both lower limbs. Pelvic X-rays showed signs suggestive of bilateral AVN of the femoral heads. The diagnosis was confirmed by MRI. The patient underwent right hip drilling and total left hip replacement (THR). A right THR was performed a year later. Conclusion: AVN constitutes a frequent cause of morbidity and mortality after RT. The pathophysiology of osteonecrosis remains complex and multifactorial. We emphasize the importance of conducting a thorough assessment of bone health in patients both before and after RT.展开更多
BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been...BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.展开更多
Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whethe...Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whether its therapeutic mechanism is related to the expression of HIF-1α and VEGF (angiogenic factors), BMP2 and Osterix (osteogenic factor), CD31 (type H vascular marker) and MMP13 (bone destruction-related factor). Methods: Twenty-seven healthy male New Zealand white rabbits were divided into a normal group, model group, traditional Chinese medcine (TCM) group (clinical equivalent dose group of YKP), miR-130a inhibitor group and TCM + inhibitor group. The SANFH model was established by combining horse serum with methylprednisolone. After the model is successfully established, TCM group was given 6.44 g/kg·d YKP by gavage, and the miR-130a gene inhibitor group was intraperitoneally injected with 25 mg/kg miR-130a inhibitor, locked nucleic acid (LNA)-anti-miR-130a. TCM + inhibitor group was treated with YKP intragastrically and miR-130a inhibitor intraperitoneally. The rabbits in the normal group and the model group were intragastrically administered with normal saline 10 ml/d. Once a day for 4 weeks. The avascular necrosis was detected by HE staining. The contents of HIF-1α, VEGF, BMP2 and Osterix in rabbit tissues were detected by qRT-PCR kit, and the expression of CD31 and MMP13 was detected by immunofluorescence staining. Results: In the normal group, the surface of the cartilage layer of the femoral head was smooth, the bone trabeculae were intact and densely arranged, the cells of each layer were neatly arranged, the morphology of the bone cells, the chondrocytes and the adipocytes were normal. In the model group, cartilage surfaces of the femoral head showed exfoliative cracks. The bone trabecular structure was loose and incomplete, chondrocytes, osteoblasts and bone marrow cells were significantly reduced, and the number of empty bone traps was significantly increased. In the TCM-treated group, more chondrocytes, thicker cartilage layer, and more regular bone trabeculae were detected as compared to model rabbits. In contrast, the cartilage layer was thinner, the destruction and fracture of bone trabeculae was more serious, chondrocytes and osteocytes were decreased as compared to model group. The expression of HIF-1α, VEGF, BMP2, and Osterix in the model group decreased significantly as compared to the normal group (P Conclusion: YKP can regulate the expression of angiogenic-related factors (VEGF and HIF-α), osteogenic-related factors (BMP2 and Osterix), and H-type vascular marker CD31, resulting in increased expressions of VEGF, HIF-α, BMP2, and Osterix, which promote intra-femoral head revascularization. Meanwhile, YKP decreased the expression of bone-destruction-related factor MMP13, thus enhancing the ability of bone tissue to repair itself. Regulation of these molecules’ expression may be one of the mechanisms of YKP in the treatment of hormonal femoral head necrosis.展开更多
Objective To establish an experimental model of early stage avascular necrosis of the femoral head （ANFH） caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techni...Objective To establish an experimental model of early stage avascular necrosis of the femoral head （ANFH） caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techniques. Methods ANFH was induced by a combination of hypersensitivity vasculitis caused by injection of horse serum and subsequent administration of a high dose of corticosteroid. The pathological changes were detected with digital radiography （DR）, computed tomography （CT）, magnetic resonance imaging （MRI）, ink artery infusion angiography, hematoxylin-eosin staining, and immunohistochemistry. Results The imageological and pathological changes corresponded to the clinical characteristics of early stage ANFH. DR showed bilaterally increased bone density, an unclear epiphyseal line, and blurred texture of cancellous bone. CT showed spot-like low-density imaging of cancellous bone, thinner cortical bone, osteoporosis, and an unclear epiphyseal line. MR! showed bone marrow edema and spot-like high signals in T2-weighted imaging in cancellous bone. Ink artery infusion angiography showed fewer obstructed blood vessels in the femoral head. HE staining of pathological sections showed fewer trabeculae and thin bone, an increased proportion of empty osteocyte lacunae, decreased hematopoiesis, thrombosis, and fat cell hypertrophy. Immunohistochemistry showed attenuated expression of vascular endothelial growth factor in osteoblasts and chondrocytes, and on the inner membrane of blood vessels. Conclusion Experimental rabbit model of early stage ANFH caused by corticosteroid can be successfully established and provide the foundation for developing effective methods to treat early stage ANFH.展开更多
To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression...To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression of vascular endothelial growth factor (VEGF) was detected by RNA dot hybridization and immunohistochemical method The repair of the femoral head was observed by histological method The results showed that the expression of VEGF was detectable in the femoral head treated with VEGF gene Angiogenesis in these femoral heads was more abundant than the control Bone repairing was augmented in the femoral head treated with VEGF gene The results suggest that angiogenesis in bone tissue could be augmented by gene transfection of VEGF and bone repairing would be accelerated accordingly展开更多
The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head （ANFH）. The rabbit model of the ANFH is established. The histopathologic featu...The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head （ANFH）. The rabbit model of the ANFH is established. The histopathologic features are studied successfully. The differences between the steroidinjection group （S.G.） and the controlled group （C.G.） are examined, including the weight of rabbits, the hematological examination and the three-dimensional stnactures. It is found that the plasma levels of cholesterol （CHO）, high-density lipoprotein （HDL） and low-density lipoprotein （LDL） in S.G. are lower than those in C.G. when the triglyceride （TG） increased in the S.G.; but the bone mineral content （BMC） and the structural model index （SMI） of the organ and tissue decreased significantly in S.G. Three-dimensional structures of the femoral head are obtained using micro-computed tomography （CT） scanning and the mechanical model is established to analyze the influences of these structural changes on the mechanical properties of the cancellous bone.展开更多
To investigate the foveal morphological changes and foveal avascular zone（FAZ）area before and after epiretinal membrane（ERM）surgery.Twenty-two eyes with treatmentnaive ERM were included in this retrospective study...To investigate the foveal morphological changes and foveal avascular zone（FAZ）area before and after epiretinal membrane（ERM）surgery.Twenty-two eyes with treatmentnaive ERM were included in this retrospective study.The central foveal thickness（CFT）and FAZ area were measured via swept-source optical coherence tomography（SS-OCT）and OCT angiography pre-and postoperatively.The unaffected fellow eyes were used as controls.The preoperative superficial FAZ area was significantly smaller in patients（0.08±0.04 mm^2）than in controls（0.33±0.09 mm^2;P〈0.001）.The postoperative superficial FAZ（0.12±0.06 mm^2）area was significantly greater than the preoperative area（P〈0.001）.The preoperative superficial FAZ area was strongly negatively correlated with CFT（P〈0.001,rho=-0.763）.ERM induced significant foveal morphological changes and reduction of the superficial FAZ area.Foveal thickness was restored and FAZ area increased postoperatively.However,the process is rather slow and the recovery is incomplete.展开更多
Objective To explore a new method for the therapy of avascular necrosis of the femoral head. Method The recombinant plasmid pCD-rbFGF was mixed with collagen and was implanted in the necrotic femoral head. Expression ...Objective To explore a new method for the therapy of avascular necrosis of the femoral head. Method The recombinant plasmid pCD-rbFGF was mixed with collagen and was implanted in the necrotic femoral head. Expression of basic fibroblast growth factor (bFGF) was examined by RT-PCR and immunohistochemical method. Re-pair of the femoral head was observed by histological and histomorphometric analysis. Result Expression of bFGF was detected in the femoral head transfected with bFGF gene, indicating significant increase of angiogenesis 2 weeks after gene transfection and increased new bone formation 8 weeks after gene transfection on histom-orphometric analysis (P< 0.01). Conclusion Transfection of bFGF gene enhances bone tissue angiogenesis. Repair in osteonecrosis would be accelerated accordingly.展开更多
A multi-scale continuous-discrete model based on the effects of the p27 gene control is built to simulate the avascular tumor growth. At the tissue level, the continuous Eulerian model is adopted to determine the dist...A multi-scale continuous-discrete model based on the effects of the p27 gene control is built to simulate the avascular tumor growth. At the tissue level, the continuous Eulerian model is adopted to determine the distribution of the concentration of oxygen, the extracellular matrix （ECM）, and the matrix-degradative enzyme （MDE）. At the cellular level, the discrete Lagrangien model is adopted to determine the movement, the proliferation, and the death of single tumor cells （TCs）. At the genetic level, whether a cell is committed to mitosis is determined by solving a set of equations modeling the effects of the p27 gene control. The avascular morphological evolution of the solid tumor growth is simulated, including the radius the oxygen distribution over time, and the expression. of the solid tumor, the number of the TCs, inhibiting effect＇ of the up-regulating p27 gene展开更多
BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendi...BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendiceal inflammation,necrosis,and suppuration,which affect the outcome of surgical repair.A De Garengeot hernia is a femoral hernia that contains the appendix.This type of hernia has a low incidence.When a De Garengeot hernia is clinically suspected,emergency surgical treatment should be performed as soon as possible.CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier.Physical examination revealed a 4 cm×2 cm palpable mass in the right groin.The mass was hard and could not be reduced due to tenderness.It did not descend into the scrotum.B-ultrasound revealed an incarcerated hernia.During surgery,the hernia was found to contain the appendix,which exhibited distal avascular necrosis.A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia.Laparoscopic reduction of the incarcerated hernia,appendectomy,and small-incision femoral hernia repair were performed in the emergency department,and cefuroxime was administered as anti-infection therapy for 2 d postoperatively.After treatment,the patient had no abdominal pain or infection and was discharged on postoperative day 4.He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose.Laparoscopy is useful for their diagnosis and treatment.展开更多
·AIM:To describe the morphological characteristics of foveal avascular zone(FAZ)in normal Chinese adults with or without myopia by swept-source optical coherence tomography angiography(SS-OCTA)and analyze the pos...·AIM:To describe the morphological characteristics of foveal avascular zone(FAZ)in normal Chinese adults with or without myopia by swept-source optical coherence tomography angiography(SS-OCTA)and analyze the possible associated factors.·METHODS:Normal Chinese adults with or without myopia aged between 18 and 60 y were recruited into the study.One eye in each individual was randomly selected for scanning using SS-OCTA.FAZ parameters,central retinal thickness(CRT)and central choroidal thickness(CCT)were then analyzed.Correlations between systemic and ocular variables and FAZ parameters were subsequently evaluated.The subgroup analysis based on refractive error was also carried out.·RESULTS:In total,127 eyes out of 127 normal subjects were finally included in the study(mean age29.5±8.22 y,61 males and 66 females).The pattern of FAZ was variable:round configuration in 28 eyes(22%),quadrilateral configuration in 23 eyes(18%),pentagonal configuration in 20 eyes(16%),oval configuration in 15 eyes(12%),triangular configuration in 6 eyes(5%)and irregular configuration in 35 eyes(28%).The mean area of FAZ was0.37±0.12 mm^(2).Females had a larger FAZ(0.41±0.11 mm^(2)vs0.32±0.11 mm^(2))compared with that of males(P<0.01).All myopic individuals showed smaller FAZ area and perimeter compared with that of normal individuals(P<0.01).There was no obvious correlation between age and FAZ.In the univariate regression analysis,both axial length(AL)and refractive error were significantly related to FAZ parameters.However,only CRT showed negative correlation with FAZ in the multivariate regression analysis.·CONCLUSION:The pattern of FAZ configuration in normal Chinese adults with or without myopia is highly variable.Establishing quantitative parameters of FAZ would not only provide details of macular pathophysiology but could possibly contribute as a biomarker in disease staging.展开更多
An accurate segmentation and quantification of the superficial foveal avascular zone(sFAZ)is important to facilitate the diagnosis and treatment of many retinal diseases,such as diabetic retinopathy and retinal vein o...An accurate segmentation and quantification of the superficial foveal avascular zone(sFAZ)is important to facilitate the diagnosis and treatment of many retinal diseases,such as diabetic retinopathy and retinal vein occlusion.We proposed a method based on deep learning for the automatic segmentation and quantification of the sFAZ in optical coherence tomography angiography(OCTA)images with robustness to brightness and contrast(B/C)variations.A dataset of 405 OCTA images from 45 participants was acquired with Zeiss Cirrus HD-OCT 5000 and the ground truth(GT)was manually segmented subsequently.A deep learning network with an encoder–decoder architecture was created to classify each pixel into an sFAZ or non-sFAZ class.Subsequently,we applied largestconnected-region extraction and hole-filling to fine-tune the automatic segmentation results.A maximum mean dice similarity coefficient(DSC)of 0.976±0.011 was obtained when the automatic segmentation results were compared against the GT.The correlation coefficient between the area calculated from the automatic segmentation results and that calculated from the GT was 0.997.In all nine parameter groups with various brightness/contrast,all the DSCs of the proposed method were higher than 0.96.The proposed method achieved better performance in the sFAZ segmentation and quantification compared to two previously reported methods.In conclusion,we proposed and successfully verified an automatic sFAZ segmentation and quantification method based on deep learning with robustness to B/C variations.For clinical applications,this is an important progress in creating an automated segmentation and quantification applicable to clinical analysis.展开更多
BACKGROUND This case study describes an atypical presentation of avascular necrosis(AVN)of the first metatarsal head,which is largely unfounded in the literature.CASE SUMMARY A healthy 24-year-old female initially pre...BACKGROUND This case study describes an atypical presentation of avascular necrosis(AVN)of the first metatarsal head,which is largely unfounded in the literature.CASE SUMMARY A healthy 24-year-old female initially presented with pain at the first metatarsophalangeal joint(MTPJ)and was diagnosed with AVN by physical examination and magnetic resonance imaging.The patient demonstrated atypically poor progress in recovery,despite being in otherwise good health and being of young age,with no history of corticosteroid or alcohol use.The patient also did not have any history or clinical features of autoimmune disease or vasculitis,such as systemic lupus erythematosus.The patient was managed with conservative treatment for 18 mo,which allowed for gradual return of full range of motion of the first MTPJ and subsiding pain,permitting the patient to return to highintensity sports training and full weight-bearing.Throughout her recovery,many differential diagnoses were ruled out through specific investigations leading to further reinforcement of the diagnosis of AVN of the 1st metatarsal head.CONCLUSION Atypical AVN may occur with no predisposing risk factors.Treatment is mainly conservative,with unclear guidelines in literature on management.展开更多
A three-dimensional （3D） mathematical model of tumour growth at the avascular phase and vessel remodelling in host tissues is proposed with emphasis on the study of the interactions of tumour growth and hypoxic micr...A three-dimensional （3D） mathematical model of tumour growth at the avascular phase and vessel remodelling in host tissues is proposed with emphasis on the study of the interactions of tumour growth and hypoxic micro-environment in host tissues. The hybrid based model includes the continuum part, such as the distributions of oxygen and vascular endothelial growth factors （VEGFs）, and the discrete part of tumour cells （TCs） and blood vessel networks. The simulation shows the dynamic process of avascular tumour growth from a fewinitial cells to an equilibrium state with varied vessel networks. After a phase of rapidly increasing numbers of the TCs, more and more host vessels collapse due to the stress caused by the growing tumour. In addition, the consumption of oxygen expands with the enlarged tumour region. The study also discusses the effects of certain factors on tumour growth, including the density and configuration of pre- existing vessel networks and the blood oxygen content. The model enables us to examine the relationship between early tumour growth and hypoxic micro-environment in host tissues, which can be useful for further applications, such as tumour metastasis and the initialization of tumour angiogenesis.展开更多
Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. The most serious complication is avascular necrosis (AVN), which has lasting sequelae. The objective of this study was to...Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. The most serious complication is avascular necrosis (AVN), which has lasting sequelae. The objective of this study was to determine the rate of AVN in stable slips. Method: We reviewed retrospectively all the children treated for SCFE between 2004 and 2008 at Princess Margaret Hospital. Results: Of a total of 67 patients, 51 (76%) were stable slips and 16 (24%) unstable. Avascular necrosis developed in 3 patients with stable slip (5.9%) and in 6 with unstable slip (37.5%). There was no statistically significant association found between AVN and age, weight, slip severity, pin position, number of pins used, experience of the surgeon or side affected. Those with stable presentations can develop AVN2, males are more likely and the possibility of developing AVN increases as the time from presentation to operation increased. Conclusion: AVN can occur in stable slips without joint penetration. This combined with male sex and increased time to operation, increases the risk of AVN.展开更多
Optical coherence tomography-angiography (OCT-A) is a relatively new non-invasive imaging technique which provides three-dimensional visualization of the retinal and choroidal microvasculature. Recently, OCT-A is wide...Optical coherence tomography-angiography (OCT-A) is a relatively new non-invasive imaging technique which provides three-dimensional visualization of the retinal and choroidal microvasculature. Recently, OCT-A is widely used in the diagnosis of age-related macular degeneration (AMD). Purpose: To compare 3 quantitative indexes of foveal avascular zone (FAZ)—area (A), perimeter (Pm), and circularity (C) in patients with early and intermediate nonexudative AMD and healthy subjects using OCT-A. Methods: Eighty-nine patients with nonexudative AMD (n = 89 eyes) were enrolled in the study. They were compared with sex- and age-matched control group of 66 healthy subjects (n = 66 eyes). The patients with nonexudative AMD were divided into 2 subgroups—early AMD (n = 42 eyes) and intermediate AMD (n = 47 eyes). All participants underwent OCT-A (3 × 3 mm scans, Cirrus HD-OCT, Angioplex, Carl Zeiss Meditec, Dublin, CA). Results: There was no statistically significant difference in all 3 assessed indexes between the early AMD subgroup and the control group (A ? P = 0.139;Pm ? P = 0.230;and C ? P = 0.191). There was also no statistically significant difference in all 3 assessed indexes between the intermediate AMD subgroup and the control group (A ? P = 0.106, Pm ? P = 0.124, and C ? P = 0.102, respectively). Conclusions: According to our results from the assessment of FAZ in patients with early and intermediate AMD, we hypothesize that macular perfusion remains fairly unchanged in the nonexudative stages of the disease. OCT-A is a reliable technique for visualizing and quantifying FAZ in patients with nonexudative AMD.展开更多
Objective To evaluate the indications for vascularized iliac bone grafting in the treatment of osteonecrosis of the femoral head and operative results. Methods From October 1993 to August 2000, Twenty-six hips of 18 p...Objective To evaluate the indications for vascularized iliac bone grafting in the treatment of osteonecrosis of the femoral head and operative results. Methods From October 1993 to August 2000, Twenty-six hips of 18 patients with osteonecrosis of the femoral head underwent vascularized iliac bone grafting. Clinical evaluation was made according to Harris Hip Score and ARCO staging system. Results Twenty-three hips of 16 patients were followed up for 31. 5 months (6-74 months) on average. The mean Harris hip score was 76peints (mean 61.7). Thirteen hips (medial 8 hips,central3 hips,lateral 2 hips). were graded 】80 points by Harriship score were. The incidence of radiographic collapse 20% was (medial),40% (central) and 75% (lateral) respectively. Conclusion Vascularized iliac bone grafting is effective for the treatment of osteonecrosis of the femoral head in short and middle term. We recommend this procedure for the patients with ONFH in ARCO stage Ⅰ , stage Ⅱ A, Ⅱ B medial and central, and stage Ⅱ展开更多
Avascular osteonecrosis of the femoral head is increasingly affecting HIV-infected patients. Several factors may contribute to its occurrence, including antiretroviral therapy and its complications. We report a case o...Avascular osteonecrosis of the femoral head is increasingly affecting HIV-infected patients. Several factors may contribute to its occurrence, including antiretroviral therapy and its complications. We report a case of avascular necrosis of the femoral head in a black woman infected with HIV and treated with antiretroviral drugs in Lomé, Togo, for about 13 years at the time of consultation and with therapeutic success. The antiretroviral treatment included a protease inhibitor initiated 3 years before the onset of the symptomatology which was marked by bilateral hip pain. Biochemical tests showed hypercholesterolemia (total and LDL-cholesterol) and a slight increase in triglycerides. Antiretroviral treatment with a protease inhibitor was changed to an integrase inhibitor. The surgical treatment that was indicated could not be performed because of the patient’s lack of financial means.展开更多
文摘Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These complications lead to significant morbidity and mortality, in addition to chronic pain and functional impairment. We report the clinical case of bilateral avascular necrosis (AVN) of the femoral head in a kidney transplant recipient. Clinical Case: 53-year-old male with a history of chronic hypertension. He underwent chronic hemodialysis for 12 months and was treated with Entecavir for chronic hepatitis B. The patient received a kidney transplant from a non-related living donor. Induction therapy included Thymoglobulin along with tapered corticosteroids, reaching a dose of 5 mg/day after 3 months, Mycophenolate mofetil (2 g/day), and Tacrolimus adjusted based on residual levels. There was good recovery of renal graft function. After six months, the patient reported bilateral hip pain and functional impairment of both lower limbs. Pelvic X-rays showed signs suggestive of bilateral AVN of the femoral heads. The diagnosis was confirmed by MRI. The patient underwent right hip drilling and total left hip replacement (THR). A right THR was performed a year later. Conclusion: AVN constitutes a frequent cause of morbidity and mortality after RT. The pathophysiology of osteonecrosis remains complex and multifactorial. We emphasize the importance of conducting a thorough assessment of bone health in patients both before and after RT.
文摘BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.
文摘Objective: To investigate the effect of Yang-warming and Kidney-tonifying Prescription (YKP) on the treatment of steroid-induced avascular necrosis of the femoral head (SANFH) in rabbits. And to further explore whether its therapeutic mechanism is related to the expression of HIF-1α and VEGF (angiogenic factors), BMP2 and Osterix (osteogenic factor), CD31 (type H vascular marker) and MMP13 (bone destruction-related factor). Methods: Twenty-seven healthy male New Zealand white rabbits were divided into a normal group, model group, traditional Chinese medcine (TCM) group (clinical equivalent dose group of YKP), miR-130a inhibitor group and TCM + inhibitor group. The SANFH model was established by combining horse serum with methylprednisolone. After the model is successfully established, TCM group was given 6.44 g/kg·d YKP by gavage, and the miR-130a gene inhibitor group was intraperitoneally injected with 25 mg/kg miR-130a inhibitor, locked nucleic acid (LNA)-anti-miR-130a. TCM + inhibitor group was treated with YKP intragastrically and miR-130a inhibitor intraperitoneally. The rabbits in the normal group and the model group were intragastrically administered with normal saline 10 ml/d. Once a day for 4 weeks. The avascular necrosis was detected by HE staining. The contents of HIF-1α, VEGF, BMP2 and Osterix in rabbit tissues were detected by qRT-PCR kit, and the expression of CD31 and MMP13 was detected by immunofluorescence staining. Results: In the normal group, the surface of the cartilage layer of the femoral head was smooth, the bone trabeculae were intact and densely arranged, the cells of each layer were neatly arranged, the morphology of the bone cells, the chondrocytes and the adipocytes were normal. In the model group, cartilage surfaces of the femoral head showed exfoliative cracks. The bone trabecular structure was loose and incomplete, chondrocytes, osteoblasts and bone marrow cells were significantly reduced, and the number of empty bone traps was significantly increased. In the TCM-treated group, more chondrocytes, thicker cartilage layer, and more regular bone trabeculae were detected as compared to model rabbits. In contrast, the cartilage layer was thinner, the destruction and fracture of bone trabeculae was more serious, chondrocytes and osteocytes were decreased as compared to model group. The expression of HIF-1α, VEGF, BMP2, and Osterix in the model group decreased significantly as compared to the normal group (P Conclusion: YKP can regulate the expression of angiogenic-related factors (VEGF and HIF-α), osteogenic-related factors (BMP2 and Osterix), and H-type vascular marker CD31, resulting in increased expressions of VEGF, HIF-α, BMP2, and Osterix, which promote intra-femoral head revascularization. Meanwhile, YKP decreased the expression of bone-destruction-related factor MMP13, thus enhancing the ability of bone tissue to repair itself. Regulation of these molecules’ expression may be one of the mechanisms of YKP in the treatment of hormonal femoral head necrosis.
基金The National 863 Program (2007AA02Z458)Science and Technology Program of Guangdong Province (2005B34001004)+1 种基金Science and Technology Program of Guangzhou (2005Z3-E0151)Medical Science Research Fund of Guangdong Province (B2005083, B2007107)
文摘Objective To establish an experimental model of early stage avascular necrosis of the femoral head （ANFH） caused by corticosteroid in adult rabbits and to observe the pathological changes with various imaging techniques. Methods ANFH was induced by a combination of hypersensitivity vasculitis caused by injection of horse serum and subsequent administration of a high dose of corticosteroid. The pathological changes were detected with digital radiography （DR）, computed tomography （CT）, magnetic resonance imaging （MRI）, ink artery infusion angiography, hematoxylin-eosin staining, and immunohistochemistry. Results The imageological and pathological changes corresponded to the clinical characteristics of early stage ANFH. DR showed bilaterally increased bone density, an unclear epiphyseal line, and blurred texture of cancellous bone. CT showed spot-like low-density imaging of cancellous bone, thinner cortical bone, osteoporosis, and an unclear epiphyseal line. MR! showed bone marrow edema and spot-like high signals in T2-weighted imaging in cancellous bone. Ink artery infusion angiography showed fewer obstructed blood vessels in the femoral head. HE staining of pathological sections showed fewer trabeculae and thin bone, an increased proportion of empty osteocyte lacunae, decreased hematopoiesis, thrombosis, and fat cell hypertrophy. Immunohistochemistry showed attenuated expression of vascular endothelial growth factor in osteoblasts and chondrocytes, and on the inner membrane of blood vessels. Conclusion Experimental rabbit model of early stage ANFH caused by corticosteroid can be successfully established and provide the foundation for developing effective methods to treat early stage ANFH.
基金ThisprojectwassupportedbyagrantfromNationalNaturalSciencesFoundationofChina (No 30 170 94 5 )
文摘To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression of vascular endothelial growth factor (VEGF) was detected by RNA dot hybridization and immunohistochemical method The repair of the femoral head was observed by histological method The results showed that the expression of VEGF was detectable in the femoral head treated with VEGF gene Angiogenesis in these femoral heads was more abundant than the control Bone repairing was augmented in the femoral head treated with VEGF gene The results suggest that angiogenesis in bone tissue could be augmented by gene transfection of VEGF and bone repairing would be accelerated accordingly
基金supported by the National Natural Science Foundation of China(30470430 and 30400514)
文摘The aim of this study is to investigate microscopic structure and characterize cancellous bone of avascular necrosis of the femoral head （ANFH）. The rabbit model of the ANFH is established. The histopathologic features are studied successfully. The differences between the steroidinjection group （S.G.） and the controlled group （C.G.） are examined, including the weight of rabbits, the hematological examination and the three-dimensional stnactures. It is found that the plasma levels of cholesterol （CHO）, high-density lipoprotein （HDL） and low-density lipoprotein （LDL） in S.G. are lower than those in C.G. when the triglyceride （TG） increased in the S.G.; but the bone mineral content （BMC） and the structural model index （SMI） of the organ and tissue decreased significantly in S.G. Three-dimensional structures of the femoral head are obtained using micro-computed tomography （CT） scanning and the mechanical model is established to analyze the influences of these structural changes on the mechanical properties of the cancellous bone.
文摘To investigate the foveal morphological changes and foveal avascular zone（FAZ）area before and after epiretinal membrane（ERM）surgery.Twenty-two eyes with treatmentnaive ERM were included in this retrospective study.The central foveal thickness（CFT）and FAZ area were measured via swept-source optical coherence tomography（SS-OCT）and OCT angiography pre-and postoperatively.The unaffected fellow eyes were used as controls.The preoperative superficial FAZ area was significantly smaller in patients（0.08±0.04 mm^2）than in controls（0.33±0.09 mm^2;P〈0.001）.The postoperative superficial FAZ（0.12±0.06 mm^2）area was significantly greater than the preoperative area（P〈0.001）.The preoperative superficial FAZ area was strongly negatively correlated with CFT（P〈0.001,rho=-0.763）.ERM induced significant foveal morphological changes and reduction of the superficial FAZ area.Foveal thickness was restored and FAZ area increased postoperatively.However,the process is rather slow and the recovery is incomplete.
基金Supported by the National Natural Sciences Foundation of China(30170945).
文摘Objective To explore a new method for the therapy of avascular necrosis of the femoral head. Method The recombinant plasmid pCD-rbFGF was mixed with collagen and was implanted in the necrotic femoral head. Expression of basic fibroblast growth factor (bFGF) was examined by RT-PCR and immunohistochemical method. Re-pair of the femoral head was observed by histological and histomorphometric analysis. Result Expression of bFGF was detected in the femoral head transfected with bFGF gene, indicating significant increase of angiogenesis 2 weeks after gene transfection and increased new bone formation 8 weeks after gene transfection on histom-orphometric analysis (P< 0.01). Conclusion Transfection of bFGF gene enhances bone tissue angiogenesis. Repair in osteonecrosis would be accelerated accordingly.
基金Project supported by the National Natural Science Foundation of China （Nos. 10372026 and 10772751）
文摘A multi-scale continuous-discrete model based on the effects of the p27 gene control is built to simulate the avascular tumor growth. At the tissue level, the continuous Eulerian model is adopted to determine the distribution of the concentration of oxygen, the extracellular matrix （ECM）, and the matrix-degradative enzyme （MDE）. At the cellular level, the discrete Lagrangien model is adopted to determine the movement, the proliferation, and the death of single tumor cells （TCs）. At the genetic level, whether a cell is committed to mitosis is determined by solving a set of equations modeling the effects of the p27 gene control. The avascular morphological evolution of the solid tumor growth is simulated, including the radius the oxygen distribution over time, and the expression. of the solid tumor, the number of the TCs, inhibiting effect＇ of the up-regulating p27 gene
基金Zhejiang Provincial Medical Science Research Foundation,No.2020ZH053 and No.2021KY1133.
文摘BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendiceal inflammation,necrosis,and suppuration,which affect the outcome of surgical repair.A De Garengeot hernia is a femoral hernia that contains the appendix.This type of hernia has a low incidence.When a De Garengeot hernia is clinically suspected,emergency surgical treatment should be performed as soon as possible.CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier.Physical examination revealed a 4 cm×2 cm palpable mass in the right groin.The mass was hard and could not be reduced due to tenderness.It did not descend into the scrotum.B-ultrasound revealed an incarcerated hernia.During surgery,the hernia was found to contain the appendix,which exhibited distal avascular necrosis.A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia.Laparoscopic reduction of the incarcerated hernia,appendectomy,and small-incision femoral hernia repair were performed in the emergency department,and cefuroxime was administered as anti-infection therapy for 2 d postoperatively.After treatment,the patient had no abdominal pain or infection and was discharged on postoperative day 4.He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose.Laparoscopy is useful for their diagnosis and treatment.
基金Supported by the National Natural Science Foundation of China(No.81970792No.82171040)Medical Science and Technology Project of Health Commission of Henan Province(No.YXKC2020026)。
文摘·AIM:To describe the morphological characteristics of foveal avascular zone(FAZ)in normal Chinese adults with or without myopia by swept-source optical coherence tomography angiography(SS-OCTA)and analyze the possible associated factors.·METHODS:Normal Chinese adults with or without myopia aged between 18 and 60 y were recruited into the study.One eye in each individual was randomly selected for scanning using SS-OCTA.FAZ parameters,central retinal thickness(CRT)and central choroidal thickness(CCT)were then analyzed.Correlations between systemic and ocular variables and FAZ parameters were subsequently evaluated.The subgroup analysis based on refractive error was also carried out.·RESULTS:In total,127 eyes out of 127 normal subjects were finally included in the study(mean age29.5±8.22 y,61 males and 66 females).The pattern of FAZ was variable:round configuration in 28 eyes(22%),quadrilateral configuration in 23 eyes(18%),pentagonal configuration in 20 eyes(16%),oval configuration in 15 eyes(12%),triangular configuration in 6 eyes(5%)and irregular configuration in 35 eyes(28%).The mean area of FAZ was0.37±0.12 mm^(2).Females had a larger FAZ(0.41±0.11 mm^(2)vs0.32±0.11 mm^(2))compared with that of males(P<0.01).All myopic individuals showed smaller FAZ area and perimeter compared with that of normal individuals(P<0.01).There was no obvious correlation between age and FAZ.In the univariate regression analysis,both axial length(AL)and refractive error were significantly related to FAZ parameters.However,only CRT showed negative correlation with FAZ in the multivariate regression analysis.·CONCLUSION:The pattern of FAZ configuration in normal Chinese adults with or without myopia is highly variable.Establishing quantitative parameters of FAZ would not only provide details of macular pathophysiology but could possibly contribute as a biomarker in disease staging.
文摘An accurate segmentation and quantification of the superficial foveal avascular zone(sFAZ)is important to facilitate the diagnosis and treatment of many retinal diseases,such as diabetic retinopathy and retinal vein occlusion.We proposed a method based on deep learning for the automatic segmentation and quantification of the sFAZ in optical coherence tomography angiography(OCTA)images with robustness to brightness and contrast(B/C)variations.A dataset of 405 OCTA images from 45 participants was acquired with Zeiss Cirrus HD-OCT 5000 and the ground truth(GT)was manually segmented subsequently.A deep learning network with an encoder–decoder architecture was created to classify each pixel into an sFAZ or non-sFAZ class.Subsequently,we applied largestconnected-region extraction and hole-filling to fine-tune the automatic segmentation results.A maximum mean dice similarity coefficient(DSC)of 0.976±0.011 was obtained when the automatic segmentation results were compared against the GT.The correlation coefficient between the area calculated from the automatic segmentation results and that calculated from the GT was 0.997.In all nine parameter groups with various brightness/contrast,all the DSCs of the proposed method were higher than 0.96.The proposed method achieved better performance in the sFAZ segmentation and quantification compared to two previously reported methods.In conclusion,we proposed and successfully verified an automatic sFAZ segmentation and quantification method based on deep learning with robustness to B/C variations.For clinical applications,this is an important progress in creating an automated segmentation and quantification applicable to clinical analysis.
文摘BACKGROUND This case study describes an atypical presentation of avascular necrosis(AVN)of the first metatarsal head,which is largely unfounded in the literature.CASE SUMMARY A healthy 24-year-old female initially presented with pain at the first metatarsophalangeal joint(MTPJ)and was diagnosed with AVN by physical examination and magnetic resonance imaging.The patient demonstrated atypically poor progress in recovery,despite being in otherwise good health and being of young age,with no history of corticosteroid or alcohol use.The patient also did not have any history or clinical features of autoimmune disease or vasculitis,such as systemic lupus erythematosus.The patient was managed with conservative treatment for 18 mo,which allowed for gradual return of full range of motion of the first MTPJ and subsiding pain,permitting the patient to return to highintensity sports training and full weight-bearing.Throughout her recovery,many differential diagnoses were ruled out through specific investigations leading to further reinforcement of the diagnosis of AVN of the 1st metatarsal head.CONCLUSION Atypical AVN may occur with no predisposing risk factors.Treatment is mainly conservative,with unclear guidelines in literature on management.
基金supported by the National 973 Basic Research Program of China(No.2013CB733800)the National Natural Science Foundation of China(Nos.11272091 and 11102113)
文摘A three-dimensional （3D） mathematical model of tumour growth at the avascular phase and vessel remodelling in host tissues is proposed with emphasis on the study of the interactions of tumour growth and hypoxic micro-environment in host tissues. The hybrid based model includes the continuum part, such as the distributions of oxygen and vascular endothelial growth factors （VEGFs）, and the discrete part of tumour cells （TCs） and blood vessel networks. The simulation shows the dynamic process of avascular tumour growth from a fewinitial cells to an equilibrium state with varied vessel networks. After a phase of rapidly increasing numbers of the TCs, more and more host vessels collapse due to the stress caused by the growing tumour. In addition, the consumption of oxygen expands with the enlarged tumour region. The study also discusses the effects of certain factors on tumour growth, including the density and configuration of pre- existing vessel networks and the blood oxygen content. The model enables us to examine the relationship between early tumour growth and hypoxic micro-environment in host tissues, which can be useful for further applications, such as tumour metastasis and the initialization of tumour angiogenesis.
文摘Introduction: Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents. The most serious complication is avascular necrosis (AVN), which has lasting sequelae. The objective of this study was to determine the rate of AVN in stable slips. Method: We reviewed retrospectively all the children treated for SCFE between 2004 and 2008 at Princess Margaret Hospital. Results: Of a total of 67 patients, 51 (76%) were stable slips and 16 (24%) unstable. Avascular necrosis developed in 3 patients with stable slip (5.9%) and in 6 with unstable slip (37.5%). There was no statistically significant association found between AVN and age, weight, slip severity, pin position, number of pins used, experience of the surgeon or side affected. Those with stable presentations can develop AVN2, males are more likely and the possibility of developing AVN increases as the time from presentation to operation increased. Conclusion: AVN can occur in stable slips without joint penetration. This combined with male sex and increased time to operation, increases the risk of AVN.
文摘Optical coherence tomography-angiography (OCT-A) is a relatively new non-invasive imaging technique which provides three-dimensional visualization of the retinal and choroidal microvasculature. Recently, OCT-A is widely used in the diagnosis of age-related macular degeneration (AMD). Purpose: To compare 3 quantitative indexes of foveal avascular zone (FAZ)—area (A), perimeter (Pm), and circularity (C) in patients with early and intermediate nonexudative AMD and healthy subjects using OCT-A. Methods: Eighty-nine patients with nonexudative AMD (n = 89 eyes) were enrolled in the study. They were compared with sex- and age-matched control group of 66 healthy subjects (n = 66 eyes). The patients with nonexudative AMD were divided into 2 subgroups—early AMD (n = 42 eyes) and intermediate AMD (n = 47 eyes). All participants underwent OCT-A (3 × 3 mm scans, Cirrus HD-OCT, Angioplex, Carl Zeiss Meditec, Dublin, CA). Results: There was no statistically significant difference in all 3 assessed indexes between the early AMD subgroup and the control group (A ? P = 0.139;Pm ? P = 0.230;and C ? P = 0.191). There was also no statistically significant difference in all 3 assessed indexes between the intermediate AMD subgroup and the control group (A ? P = 0.106, Pm ? P = 0.124, and C ? P = 0.102, respectively). Conclusions: According to our results from the assessment of FAZ in patients with early and intermediate AMD, we hypothesize that macular perfusion remains fairly unchanged in the nonexudative stages of the disease. OCT-A is a reliable technique for visualizing and quantifying FAZ in patients with nonexudative AMD.
文摘Objective To evaluate the indications for vascularized iliac bone grafting in the treatment of osteonecrosis of the femoral head and operative results. Methods From October 1993 to August 2000, Twenty-six hips of 18 patients with osteonecrosis of the femoral head underwent vascularized iliac bone grafting. Clinical evaluation was made according to Harris Hip Score and ARCO staging system. Results Twenty-three hips of 16 patients were followed up for 31. 5 months (6-74 months) on average. The mean Harris hip score was 76peints (mean 61.7). Thirteen hips (medial 8 hips,central3 hips,lateral 2 hips). were graded 】80 points by Harriship score were. The incidence of radiographic collapse 20% was (medial),40% (central) and 75% (lateral) respectively. Conclusion Vascularized iliac bone grafting is effective for the treatment of osteonecrosis of the femoral head in short and middle term. We recommend this procedure for the patients with ONFH in ARCO stage Ⅰ , stage Ⅱ A, Ⅱ B medial and central, and stage Ⅱ
文摘Avascular osteonecrosis of the femoral head is increasingly affecting HIV-infected patients. Several factors may contribute to its occurrence, including antiretroviral therapy and its complications. We report a case of avascular necrosis of the femoral head in a black woman infected with HIV and treated with antiretroviral drugs in Lomé, Togo, for about 13 years at the time of consultation and with therapeutic success. The antiretroviral treatment included a protease inhibitor initiated 3 years before the onset of the symptomatology which was marked by bilateral hip pain. Biochemical tests showed hypercholesterolemia (total and LDL-cholesterol) and a slight increase in triglycerides. Antiretroviral treatment with a protease inhibitor was changed to an integrase inhibitor. The surgical treatment that was indicated could not be performed because of the patient’s lack of financial means.
