Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis,Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip. It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.     

股骨头缺血坏死并髂腰肌囊扩张的影像学表现

目的　探讨髂腰肌囊扩张的CT、MRI表现 ,明确其诊断、原因及意义。资料与方法　回顾性分析具有典型影像学表现和 /或经病理或随访证实的 86例 (138髋 )成人股骨头缺血坏死患者的CT和MRI片 ,从中挑选出伴髂腰肌囊扩张者 17例 (18髋 )进行分析。结果　 18髋均为圆形、卵圆形或倒水滴状囊性肿物 ,位于髋关节囊前方 ,髂外或股动静脉后外方和髂腰肌 (腱 )内侧。MR上T1WI呈低信号 ,T2 WI呈高信号 ,T2 WI 脂肪抑制呈明显高信号。CT上为等或略低密度 ,CT值 12～ 4 5HU。 5例增强检查 ,囊壁轻度强化。Ⅱ级关节积液并髂腰肌囊扩张 12髋 ,Ⅲ级关节积液并髂腰肌囊扩张 6髋。Ⅱ级关节积液并髂腰肌囊扩张多于Ⅲ级关节积液 (P <0 .0 0 1)。结论　股骨头坏死并髂腰肌囊扩张见于股骨头缺血坏死中晚期 ,提示临床采取进一步措施     

Complement activation by necrotic cells in normal plasma environment compares to that by late apoptotic cells and involves predominantly IgM

Necrotic cells are generally considered to stimulate inflammation, whereas apoptotic cells should not. However, apoptotic cells have pro-inflammatory properties since they can activate complement. To what extent this activation compares to that by necrotic cells is not known. We compared complement activation by necrotic cells and apoptotic cells in plasma. Jurkat cells were made apoptotic or necrotic by incubation with etoposide or by heat shock, respectively. Cells incubated in recalcified plasma were tested for C3 and C4 fixation and fluid phase generation of complement activation products. Fixation of C3 and C4 to necrotic cells occurred mainly via the classical pathway, independent from the method of necrosis induction and the cell type. Depletion of IgM from plasma almost completely abrogated complement fixation by necrotic cells, which was restored by supplementation with purified IgM. Complement activation by late apoptotic cells was comparable to that by necrotic cells regarding the extent and dependence on IgM. Moreover, incubation of plasma with necrotic or late apoptotic cells led to the generation of comparable amounts of complement activation products. These results indicate that late apoptotic and necrotic cells employ similar complement activation mechanisms in the plasma environment.     

IL1ra、TNFα、US-CRP与多囊卵巢综合征发病的相关性研究

目的探讨血清炎症因子白细胞介素1受体拮抗剂（IL1ra）、肿瘤坏死因子（TNFα）、血超敏C反应蛋白（US-CRP）与多囊卵巢综合征（PCOS）发病的关系。方法采用酶放大化学发光法分别检测30例PCOS无糖尿病患者及30例正常对照组血清卵泡刺激素（FSH）、黄体生成素（LH）和睾酮（T）水平;葡萄糖氧化酶法测定血清空腹血糖（GLU）水平;酶联免疫吸附试验（ELISA）方法血清IL1ra、TNFα水平;用乳胶增强免疫比浊法检测血清US-CRP水平。并用统计学方法分析两实验组中各血清成分水平差异,以及各检测指标之间的相关关系。结果（1）PCOS组LH、T、LH/FSH、IL1ra、TNFα、US-CRP水平明显高于正常组,PCOS组FSH水平低于对照组,差异有显著性（P〈0.05）。（2）PCOS组血清IL1ra、TNFα、US-CRP、T水平与体重指数（BMI）呈正相关（P〈0.05）。（3）PCOS组血清IL1ra、TNFα、US-CRP水平与LH/FSH和睾酮水平呈正相关（P〈0.05）。（4）两组血清IL1ra、US-CRP、TNFα水平存在正相关。结论炎症因子IL1ra、TNFα、US-CRP在多囊卵巢综合征患者血清中明显升高,提示慢性亚临床炎症可能与多囊卵巢综合征发病相关。     

带股方肌蒂骨瓣移位治疗成人股骨头缺血性坏死的疗效及安全性分析

目的　研究分析带股方肌蒂骨瓣移位治疗成人股骨头缺血性坏死的疗效及安全性。 方法　选取2013年1月-2016年1月于我院接受带股方肌蒂骨瓣移植手术的患者96例作为研究对象,参照世界骨循环研究学会分期标准将患者分为Ⅰ期、Ⅱ期、Ⅲ期3个分期,并分别研究对比3个分期疗效及安全性情况。 结果　3个不同分期的患者治疗后Harris评分均要显著高于治疗前,差异有统计学意义（P＜0.05）。随着年龄的增长,愈合速度呈明显的延长趋势,差异有统计学意义（P＜0.05）。随着患者临床分期的加深,患者治疗的优良率呈明显的下降趋势,差异有统计学意义（P＜0.05）。观察不同分期患者并发症情况,结果无明显差异,证明带股方肌蒂骨瓣移植较为安全有效,差异有统计学意义（P＜0.05）。 结论　带股方肌蒂骨瓣移位治疗股骨头缺血性坏死具有十分显著的疗效,患者恢复时间较快,是一种值得肯定的手术方法。     

99Tc-MDP治疗股骨头缺血性坏死临床应用

探讨99Tc-MDP(商品名:云克)治疗股骨头缺血性坏死的机制及临床疗效.用99Tc-MDP治疗经影像学和临床诊断的股骨头缺血性坏死83例,并对治疗前后疼痛、生活能力、关节活动度及行走距离进行评分比较,观察分析临床疗效.统计学分析采用SPSS16.0软件,P<0.05认为有统计学差异.平均随访12个月,各期患者疼痛、生...     

Malignant granular cell tumor: a look into the diagnostic criteria

Fanburg-Smith et al. classified granular cell tumors (GCTs) using six criteria with high Ki-67 and p53 in malignant cases.We aim to refine their classification and reproduce their immunohistochemical findings. We, first, classified our 48 cases according to Fanburg-Smith criteria (37 benign, seven atypical, and four malignant), and performed Ki-67 and p53 on a sample of tumors. Then, we reclassified them into 44 benign and four with uncertain malignant potential (GCT-UMP) using only necrosis and/or mitoses.

(1)

According to Fanburg-Smith criteria: Malignant cases were significantly younger than benign and atypical ones; occurred predominantly in males; were significantly larger in size; and showed a higher Ki-67 expression but an insignificant difference in p53 staining.

(2)

Comparative findings: The four malignant cases according to Fanburg-Smith corresponded to our four cases with UMP. The seven atypical cases and our benign group shared similar means, except for age. None of these atypical cases recurred or metastasized.

Despite its small number, our preliminary study showed similar selectivity of two more reproducible criteria (vs six) in the classification of cases of GCT with potential aggressive behavior, preserving a role for Ki-67 in difficult cases. However, metastases remain the sole definite criterion for malignancy.     

PMA and crystal‐induced neutrophil extracellular trap formation involves RIPK1‐RIPK3‐MLKL signaling

Neutrophil extracellular trap (NET) formation contributes to gout, autoimmune vasculitis, thrombosis, and atherosclerosis. The outside‐in signaling pathway triggering NET formation is unknown. Here, we show that the receptor‐interacting protein kinase (RIPK)‐1‐stabilizers necrostatin‐1 or necrostatin‐1s and the mixed lineage kinase domain‐like (MLKL)‐inhibitor necrosulfonamide prevent monosodium urate (MSU) crystal‐ or PMA‐induced NET formation in human and mouse neutrophils. These compounds do not affect PMA‐ or urate crystal‐induced production of ROS. Moreover, neutrophils of chronic granulomatous disease patients are shown to lack PMA‐induced MLKL phosphorylation. Genetic deficiency of RIPK3 in mice prevents MSU crystal‐induced NET formation in vitro and in vivo. Thus, neutrophil death and NET formation may involve the signaling pathway defining necroptosis downstream of ROS production. These data imply that RIPK1, RIPK3, and MLKL could represent molecular targets in gout or other crystallopathies.     

股骨颈骨折修复后股骨头坏死7个相关因素：199例回顾分析

BACKGROUND: The incidence of femoral head necrosis after internal fixation in femoral neck fracture is at high level, but the risk factors are still under discussion. OBJECTIVE:To retrospectively propose and analyze the relative risk factors of femoral head necrosis after internal fixation with femoral neck fracture in patients younger than 60 years old. METHODS:Data from 199 patients with femoral neck fractures, younger than 60 years, undergoing closed reduction and internal fixation were analyzed retrospectively. Seven factors including age, sex, body mass index, Garden classification, fracture seasons, reduction quality and weight-bearing time after internal fixation were statistically analyzed to evaluate their correlation with femoral head necrosis. RESULTS AND CONCLUSION: The incidence of femoral head necrosis was 13.1% among the 199 cases. Body mass index, Garden classification, fracture seasons, reduction quality were significantly associated with femoral head necrosis. The age, sex and weight-bearing time were in significantly associated with femoral head necrosis. In multivariate logistic regression analysis, Garden classification, reduction quality and fracture seasons (winter versus summer) had overt effects on development of femoral head necrosis. These results suggest that Garden classification and reduction quality make an important effect on the healing of femoral neck fracture. In addition, fracture in winter may be the risk factor of the femoral head necrosis after internal fixation in femoral neck fracture.| 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程