CircCDR1as Suppresses Bone Microvascular Endothelial Cell Activity and Angiogenesis Through Targeting miR‐135b/ FIH‐1 Axis

ObjectiveThe current study investigated the role of CircCDR1as on angiogenesis of bone microvascular endothelial cells (BMECs) isolated from non‐traumatic ONFH.MethodsForty corticosteroid‐induced ONFH patients received THA were enrolled in our study. Expressions of CircCDR1as, miR‐135b, and FIH‐1 were detected by qRT‐PCR in affected necrosis tissue and non‐affected normal tissue. Bone microvascular endothelial cells (BMEC) were isolated from six patients and treated with 0.1 mg/mL hydrocortisone to establish a GC‐damaged model of BMECs. Circ CDR1as plasmid and miR‐135b mimic were transfected into BMECs. BMEC proliferation was assessed using MTT assays. The migration ability of cells was detected by scratch‐wound assays. Matrigel assay was performed to detect angiogenesis in vitro. Western blot assay was used to detect HIF‐1α, VEGF, and FIH‐1 expressions. FISH, RNA pull down, RIP, and luciferase assay were carried out to determine the interaction of CircCDR1as, miR‐135b, and FIH‐1.ResultsCircCDR1as was upregulated(2.02 ± 0.30 vs. 1.00 ± 0.10,P < 0.001) whereas miR‐135b was downregulated (0.55 ± 0.12 vs. 1.00 ± 0.10,P < 0.001) in affected tissues than in non‐affected tissues. Expression of CircCDR1as and FIH‐1 were negatively associated with miR‐135b in affected tissues (CircCDR1as with miR‐135b: r = −0.506, P < 0.001; FIH‐1 with miR‐135b r = −0.510, P < 0.001). Total blood tubule density was increased when CircCDR1as was silenced compared with NC (P < 0.01 vs. NC). The number of migrated BMECs were significantly increased in CircCDR1as silencing group compared with NC group (P < 0.05 vs. NC). In addition, CircCDR1as plasmids transfection increased the protein expressions of FIH‐1 (P < 0.05 vs. NC) and reduced the HIF‐1α as well as VEGF expression compared with NC group (P < 0.05 vs. NC). FISH, RNA pull down, RIP, and luciferase assay identified that FIH‐1 was a target of miR‐135b and could be modulated by CircCDR1as.ConclusionCircCDR1as decreases angiogenesis and proliferation of BMECs by sponging miR‐135b and upregulate FIH‐1.     

Culture-Expanded Autologous Adipose-Derived Mesenchymal Stem Cell Treatment for Osteonecrosis of the Femoral Head

BackgroudOutcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH.MethodsEighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint.ResultsPreoperatively, the necrotic lesion extent was 63.0% (38.4%–96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2).ConclusionsOur outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.     

Cementless Hemiarthroplasty for Intracapsular Femoral Neck Fractures in the Octa- and Nonagenarians

BackgroudCurrent evidence supports the use of cemented hemiarthroplasty for treatment of intracapsular femoral neck fractures since it is associated with a lower risk of implant-related complications. However, many medical centers employ the cementless technique for the frail elderly population because it is faster and has lower cardiovascular risks and perioperative mortality. This observational study reports the outcomes of cementless bipolar hemiarthroplasty for intracapsular femoral neck fractures in patients aged 80 years and older.MethodsA total of 424 patients (female, 77.1%) with a mean age of 86.9 years were operated for intracapsular femoral neck fractures between January 2009 and December 2017. Of those, 66.7% had an American Society of Anaesthesiologists (ASA) score of 3 or more. All operations were performed with the posterolateral surgical approach and all patients received a cementless stem. Intraoperative and perioperative values and in-hospital outcomes were evaluated, and clinical and radiographical follow-up was done at 40 days, 90 days, and when possible between 5 months and 12 months postoperatively. Multivariate analysis was performed to evaluate if there were factors affecting mortality.ResultsThe mean operative time was 50 minutes. There were no deaths intraoperatively. Intraoperative periprosthetic fractures occurred in 2.1% of the cases with 66.7% of them fixed through cerclage wires intraoperatively. The median length of hospitalization was 11 days (interquartile range, 8.75–15) and 2.4% of patients died while in hospital after surgery. Approximately 91.5% of patients presented with perioperative anemia. Only 1.9% of the complications were related to the implant, 62.5% of which were dislocations. More than 90% of patients were ambulatory either autonomously or with support at each follow-up assessment. Age, male sex, and higher ASA score were related to increased mortality.ConclusionsDespite some limitations, this observational study underlines that a cementless femoral stem of modern design can give good clinical outcomes, thus being an appropriate solution especially for the frail elderly.     

A cost-minimization analysis of measures against metallic dental restorations for head and neck radiotherapy

The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.     

Anatomic study of femoral vein occlusion during simulated hip arthroplasty

Summary An anatomic study was undertaken to establish whether positioning of the leg and surgical approaches for total hip replacement (THR) cause changes in the femoral v. which may contribute to the development of deep vein thrombosis (DVT). The patency of 32 femoral vv. of 18 cadavers was inspected at different levels during simulated THR. Before and after removal of the femoral head through a transgluteal or posterior approach, a wide-angle endoscope was inserted into the femoral v. via the external iliac v. Blood flow was simulated by proximal irrigation with saline through the popliteal v. After removal of the femoral head distinct changes were observed in both approaches. In the transgluteal approach the changes were dependent on the degree of adduction and the body build of the cadaver. Initially, an oval form was seen in a constricted lumen with an increasingly oblique oval deformation and a final facet-like closure, usually at about 5 to 7.5 cm below the inguinal ligament. In total adduction this stenosis occured regardless of build. Using a posterior approach, the necessary internal rotation caused a closure of the vein in 50% of cases. In combination with flexion and adduction there was stenosis in all cadavers regardless of body build. Our results indicate that the duration of the adducted position of the thigh during THR via a transgluteal approach should be minimised, as there is a reduction in blood flow with even minor degrees of adduction. In the posterior approach the stenosis occurs earlier, and is independent of the build of the cadaver.

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Étude anatomique de la sténose de la veine fémorale au cours des arthroplasties totales de hanche

Résumé L'étude anatomique a été réalisée pour établir la relation entre les différentes positions du membre inférieur au cours des arthroplasties totales de hanche et la survenue d'une thrombose veineuse profonde. Cette étude a été réalisée sur 18 cadavres, dont 32 vv. fémorales ont pu être examinées à différents temps de l'arthroplastie totale de hanche, avant et après ablation de la tête fémorale, par voie trans-glutéale ou par voie postérieure. Un endoscope (grand angle) a été introduit dans la v. fémorale par la v. iliaque externe. Le flux sanguin a été simulé par irrigation antérograde avec du sérum salé à travers la v. poplitée. Après l'ablation de la tête fémorale, il a été noté des différences significatives entre la voie d'abord trans-glutéale et la voie d'abord postérieure pour ce qui concerne l'aspect de la lumière de la v. fémorale et le flux sanguin. En ce qui concerne la voie trans-glutéale, ces modifications dépendaient du degré d'adduction et de la corpulence du cadavre. L'aspect de la lumière de la v. fémorale était initialement ovale, puis évoluait progressivement vers la sténose complète qui se situait à peu près entre 5 et 7,5 cm audessous du ligament inguinal. En adduction complète de la cuisse, la sténose se produisait, quelle que soit la corpulence du cadavre. En ce qui concerne la voie d'abord postérieure, la rotation médiale, indispensable à l'accès pour la mise en place de l'élément prothétique fémoral, causait une sténose de la v. fémorale dans 50% des cas. En ce qui concerne la combinaison des mouvements d'adduction et de flexion de la hanche, elle était responsable d'une sténose de la v. fémorale dans tous les cas, et ceci quelle que soit la corpulence du cadavre. Nos résultats indiquent que le durée de la position d'adduction de la cuisse durant l'arthroplastie totale de hanche par voie transglutéale devrait être diminuée car la réduction du flux sanguin dans la v. fémorale survient, même pour des petits degrés d'adduction. Dans la voie d'abord postérieure, la sténose survient plus tôt, elle ne dépend pas de la corpulence du cadavre.

     

Potential of P40 plastination for morphometric hip measurements

Total hip replacement has become one of the most successful surgical operations over the past 25 years. The duration of a total hip prosthesis depends on primary stability, and many studies have tried precisely to evaluate hip joint morphology to obtain excellent contact between bone and prosthetic component. This study performed a morphometric analysis of the human hip joint using, for the first time, the P40 plastination procedure. We cut 42 hip joint compounds into slices 3 mm thick; for exact distance measuring the sections were scanned into the computer. The following mean measurements for hip geometry were obtained: vertical diameter of acetabulum 4.894±0.274 cm, depth of acetabulum 1.643±0.245 cm, femoral head radius 2.268±0.149 cm, femoral neck length 4.3670±0.528 cm, acetabular perimeter 6.711±0.434 cm, vertical diameter of labrum acetabulare 4.759±0.476 cm, depth of labrum acetabulare 2.599±0.395 cm, sum of femoral head and neck lengths 6.759±0.550 cm, hip axis length 11.859±1.007 cm, femoral neck axis length 10.12±0.555 cm, and femoral neck diameter 3.349±0.276 cm. All of these data reveal a significant gender difference. Our aim was to indicate an unconventional and new method of gaining morphometric hip data by using plastination.     

股骨颈骨折不同角度固定的生物力学比较研究

本文通过测量２０个股骨上段标本，Ｘ线片的压力骨小梁系统，按照其骨小梁系统采用低角度固定其股骨颈骨折标本，以临床常用角度固定的股骨颈骨折标本作为对照组，进行静力学测定。股骨上段骨小梁系统与股骨纵轴线所成角度均数为１５４．７±１．９度，骨小梁系统与股骨外侧骨皮质交点到大转子距离均数为７．３±１．０ｃｍ。低角度固定组承载力及最大承载力明显大于对照组（Ｐ＜０．０５），且有更小的旋转移位（Ｐ＜０．０５）。本研究将低角度固定概念量化，对股骨颈骨折内固定的使用有显著的临床指导意义。     

Solar heat load: heat balance during exercise in clothed subjects

Summary Six subjects exercised for 60 min on a cycle ergometer. Their backs were exposed to an artificial sun with a spectral distribution similar to sunlight and an intensity of 724 W m^–2. Each subject took part in four experiments in random order: wearing suits of polyester (insulation value = 0.5 clo), white (WP) or black (BP), or cotton (0.6 clo), white (WC) or black (BC). Measured by partitional calorimetry, the calculated heat losses and gains for the four conditions balanced within less than 10%. The differences between the short-wave radiation gains of subjects in white or black garments were small. This is due to the transparency of the white materials, which allows a larger percentage of the radiation to penetrate the clothing. The surface temperatures of the sun-exposed areas were very high, especially in the black suits. This promotes dry heat loss. Therefore the sweat loss in the black suits and the differences between the black and white clothes became relatively small. The physiological strain in steady-state exercise, as expressed by average heart rates, was 142 (WP), 154 (BP), 151 (WC), and 160 (BC) beats min^–1; the sweat losses were 649 (WP), 666 (BP), 704 (WC), and 808 (BC) g. For both of these measures values for white polyester were significantly less than those for black cotton.     

Humeruskopfresektion als therapie bei oberarmkopftrümmerfrakturen —ergebnisse

Zusammenfassung Proximale Humerusfrakturen gehö-ren zu den häufigen Verletzungen des ä1teren Menschen. Gering dislozierte Brüche können mit gutem Erfolg konservativ behandelt werden. Therapeutische Schwierigkeiten bereiten vor allem dislozierte Mehrfragment- oder Trümmerfrakturen des Oberarmkopfes. Im Zeitraum von 1970–1988 wurde in unserer Klinik in dieser Situation bei 8 Patienten eine Resektion des Humeruskopfes durchgeführt. 6 Patienten konnten bei einer mittleren Beobachtungszeit von 69 Monaten nachuntersucht werden. Alle Patienten wiesen postoperativ eine erhebliche Bewegungseinscänkung im betroffenen Schultergelenk auf. Die durchschnittliche Abduktion betrug 60° (40–80dg), die Anteflexion 60° (40–80°) bei einer mittleren AuBenrotation von 17° (5–30°) und Innenrotation von 48° (5–90°). Eine Patientin war postoperativ schmerzfrei, 2 weitere verspürten nächtliche Schmerzen, während die übrigen 3 Patienten fiber eine unterschiedliche Schmerzsymptomatik klagten. Dennoch waren 5 der 6 Patienten mit dem Operationsergebnis zufrieden, eine Patientin bewertete das Resultat mit gut.

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Resection of the humeral head in cases of head-splitting humeral fractures — results

Summary Proximal humeral fractures are frequent injuries in older patients. Most of these fractures respond satisfactorily to conservative treatment. Problems arise in cases of four-part displacements and in head-splitting fractures with massive defects in the articular surface. Between 1970 to 1988 eight patients were treated in our clinic in this situation by resection of the humeral head. 6 patients could be followed-up for an average of 69 months. Postoperative findings showed a restricted range of motion in all operated shoulders. The average abduction of the arm was 6° (40-80°) and elevation 60° (40–80°). The patients showed a mean external rotation of 17° (5–30°) and an internal rotation of 48° (5–90°). Only one patient was painless, 2 patients had pain during the night, and 3 patients suffered from various pain symptoms. Nevertheless 5 of 6 patients assessed the result as satisfactory and one patient as good.