BACKGROUND:The appearance of the crescent sign in femoral head necrosis is a"turning point"in the progression of the disease,and repairing and stabilizing the bone-cartilage interface is particularly important in preventing further progression and collapse of the femoral head.Tissue engineering offers potential advantages in the simultaneous repair and integration of the bone-cartilage interface. OBJECTIVE:To review potentially suitable techniques addressing the subchondral separation in femoral head necrosis. METHODS:Relevant articles from January 1970 to April 2023 were searched in PubMed,Web of Science,and China National Knowledge Infrastructure(CNKI)using English search terms"femoral head necrosis,avascular necrosis of femoral head,osteonecrosis of femoral head"and Chinese search terms"femoral head necrosis,subchondral bone,cartilage,integration of cartilage and subchondral bone".A total of 114 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)Structural defects,ischemic and hypoxic environment,inflammatory factors,and stress concentration may cause subchondral separation in osteonecrosis of the femoral head.Subchondral bone collapse and failure of hip-preserving surgery may be associated.Integration of tissue engineering scaffolds with the bone-cartilage interface is one potential approach for treating subchondral separation in osteonecrosis of the femoral head.(2)Current literature suggests that multiphase scaffolds,gradient scaffolds,and composite materials have shown improvements in promoting cell adhesion,proliferation,and deposition of bone and cartilage matrix.These advancements aid in the integration of scaffolds with the bone-cartilage interface and have implications for the treatment of subchondral separation in osteonecrosis of the femoral head.(3)Surface modifications of scaffolds can enhance interface integration efficiency,but they have their advantages and disadvantages.Scaffolds providing different environments can induce differentiation of mesenchymal stem cells and facilitate integration between different interfaces.(4)Future scaffolds for subchondral separation in osteonecrosis of the femoral head are expected to be composite materials with gradient and differentiated biomimetic structures.Surface modifications and stem cell loading can promote integration between the bone-cartilage interface and scaffolds for therapeutic purposes,but further experimental verification is still needed.Challenges include synchronizing scaffold degradation rate with repair progress and ensuring stability between different interfaces.

OBJECTIVE: To investigate the value of CT-based radiomics and clinical data in predicting the efficacy of non-vascularized bone grafting (NVBG) in hip preservation, and to construct a visual, quantifiable, and effective method for decision-making of hip preservation. METHODS: Between June 2009 and June 2019, 153 patients (182 hips) with osteonecrosis of the femoral head (ONFH) who underwent NVBG for hip preservation were included, and the training and testing sets were divided in a 7∶3 ratio to define hip preservation success or failure according to the 3-year postoperative follow-up. The radiomic features of the region of interest in the CT images were extracted, and the radiomics-scores were calculated by the linear weighting and coefficients of the radiomic features after dimensionality reduction. The clinical predictors were screened using univariate and multivariate Cox regression analysis. The radiomics model, clinical model, and clinical-radiomics (C-R) model were constructed respectively. Their predictive performance for the efficacy of hip preservation was compared in the training and testing sets, with evaluation indexes including area under the curve, C-Index, sensitivity, specificity, and calibration curve, etc. The best model was visualised using nomogram, and its clinical utility was assessed by decision curves. RESULTS: At the 3-year postoperative follow-up, the cumulative survival rate of hip preservation was 70.33%. Continued exposure to risk factors postoperative and Japanese Investigation Committee (JIC) staging were clinical predictors of the efficacy of hip preservation, and 13 radiomic features derived from least absolute shrinkage and selection operator downscaling were used to calculate Rad-scores. The C-R model outperformed both the clinical and radiomics models in predicting the efficacy of hip preservation 1, 2, 3 years postoperative in both the training and testing sets ( P<0.05), with good agreement between the predicted and observed values. A nomogram constructed based on the C-R model showed that patients with lower Rad-scores, no further postoperative exposure to risk factors, and B or C1 types of JIC staging had a higher probability of femoral survival at 1, 2, 3 years postoperatively. The decision curve analysis showed that the C-R model had a higher total net benefit than both the clinical and radiomics models with a single predictor, and it could bring more net benefit to patients within a larger probability threshold. CONCLUSION The prediction model and nomogram constructed by CT-based radiomics combined with clinical data is a visual, quantifiable, and effective method for decision-making of hip preservation, which can predict the efficacy of NVBG before surgery and has a high value of clinical application.
Humans ; Bone Transplantation ; Femur Head/surgery* ; Femur ; Osteonecrosis ; Tomography, X-Ray Computed ; Retrospective Studies

BACKGROUND:At present, finite element analysis technology can set up the model, predict diagnosis, treatment design, as wel as surgical plan, and can be used in the treatment of necrosis of femoral head. OBJECTIVE:To sum and discuss recent progress in clinical and experimental research regarding biomechanical study in osteonecrosis of femoral head by using finite element analysis. METHODS:A computer-based retrieval was performed by the authors (Hong Guo-ju and Zhou Guang-quan) in PubMed, Google, SpringerLink, ChinaNational Knowledge Infrastructure databases for literatures published from January 2010 to December 2015. The key words were“(finite element analysis OR finite element) AND (osteonecrosis OR osteonecrosis of femoral head)”. Inclusive criteria:studies with contents closely related to this paper;original papers with reliable topics and evidence;or papers with clear points and al-round analysis and both studies in vitro and in vivo. RESULTS AND CONCLUSION:A total of 27 studies were included. The articles in the latest five years related to femoral head osteonecrosis and finite element analysis application were concentrated on. We summarized the latest research progress and problems, including the applied research carried out in the femoral head osteonecrosis clinical cases, innovational skil s, so as to point out the direction of future research in the finite element analysis.

Objective To study thyroid function in patients with depression.Methods The average levels of TSH,FT3,FT4 in 5 316 patients with depression were compared with 5 316 healthy controls.The average levels of TSH,FT3,FT4 were compared between male and female patients with depression.The differences of thyroid disease detection rate were compared between elder and group younger group.Results The differences of TSH,FT3,FT4 levels between the depression patients and healthy controls have statistically significant(P＜0.05).The differences of TSH,FT3,FT4 levels between the male depression patients and the female depression patients have statistically significant (P＜ 0.05).The hyperthyroidism prevalence were as follows:6.50 ％ versus 6.10 ％ (P＞0.05),compared between older and younger depression patients.The subclinical hypothyroidism prevalence 24.30 ％ versus 9.40 ％ (P＜0.05),compared between older and younger depression patients.The hypothyroidism prevalence 14.30 ％ versus 2.90％ (P＜0.05),compared between older and younger depression patients.Conclusion Depression is easily caused by low thyroid hormone levels.Women and elder people with hypothyroidism should more prevent depression.Thyroid hormones can be used as routine screening index of depression,but not specific indicators.

OBJECTIVETo explore the effect of arterial infusion with methylene blue during total mesorectal excision (TME) for better preservation of pelvic autonomic nerve on urination function and sexual function in male patients with rectal cancer.

METHODSA total of 68 male rectal cancer patients from Zhejiang Xiaoxing People's Hospital and 44 male rectal cancer patients from Guangdong Zhongshan Chenxinghai Hospital between June 2013 and June 2015 were prospectively enrolled. Patients were randomly divided into the trial group receiving arterial infusion with 8 ml of 1% methylene blue and the control group without artery infusion, with 56 cases in each group. All the patients underwent TME. Intra-operational lymph node removal and postoperative urination and sexual function (erection and ejaculation) were compared between two groups.

RESULTSThe baseline data of the two groups were not significantly different (all P>0.05). As compared to the control group, the trial group had shorter operation time [(3.28±0.63) hours vs. (4.01±0.94) hours, P<0.01], less blood loss[(92.5±36.4) ml vs. (174.1±61.4) ml, P<0.01], and more lymph nodes harvested per patient (15.8±7.6 vs. 11.9±4.3, P<0.01). One year after operation, classI(, II(, III(, IIII( of urination was observed in 33 cases (58.9%), 15 cases (26.8%), 6 cases (10.7%), 2 cases (3.6%) in the trial group, while 24 (42.9%), 15 (26.8%), 12 (21.4%), 5 (8.9%) in the control group, which indicated that trial group was superior to control group(P<0.05). ClassI(, II(, III( of erection was observed in 36 cases (64.3%), 18 cases (32.1%), 2 cases(3.6%) in the trial group, while 25(44.6%), 23(41.1%), 8(14.3%) in the control group, which indicated that trial group was superior to the control group (P<0.05). ClassI(, II(, III( of ejaculation was found in 36 cases (62.5%), 18 cases (32.1%), 3 cases (5.4%) in the trial group, while 24 (42.9%), 22 (39.3%), 10(17.9%) in the control group, which also indicated that trial group was superior to the control group(P<0.05).

CONCLUSIONSIn the treatment of male rectal cancer patients, TME combined with arterial infusion with methylene blue can facilitate the distinction of operation scope, which is beneficial to reduce damages to the pelvic nerve, leading to the protection of urinary function and sexual function. In addition, this procedure can result in shorter operation time, less operational blood loss and more lymph nodes harvested.

Digestive System Surgical Procedures ; Humans ; Infusions, Intra-Arterial ; Lymph Node Excision ; Male ; Methylene Blue ; administration & dosage ; Postoperative Period ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Urination

Objective To investigate the diagnostic threshold value and diagnostic performance of high-sensitivity troponin T (hs-cTnT)for elderly patients with acute myocardial infarction(AMI).Methods 835 emergency department patients with chest pain were recruited in the study,then these patients were divided into elderly group (≥65 years old)and control group(<65 years old).Hs-cTnT concrentrations were compared between the two groups;The difference of hs-cTnT concentrations between AMI pa-tients and non-AMI patients were compared in elderly group and control group respectively;The optimal threshold values of the hs-cTnT for acute myocardial infarction were determined by receiver operating characteristic(ROC)curve.Results The hs-cTnT con-centrations of non-AMI patients in elderly group were 18.4(14.5-32.5)ng/L,which were higher than those of non-AMI patients in control group[3.2(3.0-8.2)ng/L],and the difference were statistically significant(P <0.05);The hs-cTnT concentrations of AMI patients in elderly group were 136.1 (51.6 - 384.1 )ng/L,which were higher than those of AMI patients in group 68.5 (25.6-217.1)ng/L,and the difference were statistically significant(P <0.05).According to the ROC curve,the optimal threshold value for AMI diagnosis in elderly group by using hs-cTnT was 32 ng/L,which was higher than that in control group(14 ng/L). The specificity and the positive predictive value of the optimal threshold value determined by ROC were apparently higher than the 99th percentile(P 99 )in elderly group respectively,the difference were statistically significant(P <0.05).Conclusion The hs-cTnT levels were positively related with age.The optimal threshold value of hs-cTnT for AMI(32 ng/L)was higher than the P 99 (14ng/L)in elderly group.

The model of knee OA (KOA) was established in our laboratory with three-dimensional (3D) reconstruction technique based on the CT data. We then designed the unicompartmental prosthesis matching KOA model with parametric software Pro/e 5. 0. Finally, the models were used to mimic the operation of knee unicompantment replacement and the model of unicompartmental knee athroplasty (UKA) was analyzed using 3D finite element method. The results indicates that the approach for designing the model by 3D parametric is effective and meets the need of automation and efficacy to design unicompartmental prosthesis. The results proves that the model is vivid and precise, and the 3D parameteric modeling method can provide biomechanical research of unicompantment replacement with model foundation and new experimental method. It can be widely utilized in the clinics and research.
Algorithms ; Arthroplasty, Replacement, Knee ; methods ; Computer-Aided Design ; Finite Element Analysis ; Humans ; Imaging, Three-Dimensional ; methods ; Knee Joint ; diagnostic imaging ; surgery ; Knee Prosthesis ; Prosthesis Design ; Tomography, X-Ray Computed

This paper is aimed to acquire high Geometric similar Subject-specific three-dimensional (3D) finite element mesh model of hip joint containing necrotic femoral head according to individual patient's X-ray, CT and MRI by using the image registration and fusion technology. We selected a middle-aged female patient with osteonecrosis of femoral head, obtained the X-ray, CT and MRI images respectively. Then we established 3D solid model separately based on these image data by using Mimics 13. 1 and Pro/E 5.1 software. We confirmed the match points and then proceed the 2D image registration after image projection conversion. Finally we showed the 3D finite element mesh model. A highly geometric similar subject-specific 3D finite element mesh model for osteonecrosis of femoral head has been established, which included normal cortical bone, cancellous bone, articular cartilage and necrotic zone, fractured trabecular bone within the femoral head. The model truly reflects the morphological characteristics and relationship of hip joint with osteonecrosis of femoral head, provides a relatively ideal research platform for further biomechanical analysis and surgical simulation.
Female ; Femur Head Necrosis ; diagnostic imaging ; pathology ; Finite Element Analysis ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Middle Aged ; Models, Anatomic ; Tomography, X-Ray Computed

Objective To explore early endoscopic diagnosis and treatment of the clinical value of biliarypancreatitis. Methods From January 2007 to December 2009 completed 93 cases acute pancreatitis of endoscopic treatment,routining for endoscopic incision nipple,observed remission of symptoms and recurrence after treatment. Results In these cases acute biliarypancreatitis was 62.4% (58/93),occult biliarypancreatitis diagnosed by endoscopy was 27.6% (16/58),remission rate was 93.8% (15/16),no surgical operation and recurrence. Conclusion Occult biliarypancreatitis occupies a certain proportion of acute pancreatitis,also easily missed diagnosis and recurred,endoscopy is currently the most effective method.

Objective To determine the value of ERCP and EST after Billroth gastroenterostomy. Methods ERCP was used in 31 patients after Billroth- Ⅰ gastroenterostomy, 12 of whom received EST. It was in 137 patients after Billroth-Ⅱ gastroenterostomy, of the 34 received EST and 4 EPBD.Results Billroth- Ⅰ gastroenterostomy ERCP was successfully performed in 28 out of the 31 patients and EST in 11 out of the 12 patients. Billroth- Ⅱ gastroenterostomy ERCP was successfully performed in 109 out of the 137 patients and EST in 31 out of the 38 patients. There were no serious complications in patients receiving endoscopic treatments. Concluasion The success rates of ERCP and EST are high in patients with bile duct lithiasis after Billroth-gastroenterostomy. Endoscopic treatment or cholangioduodenostomy has good therapeutic effects.