Background： Nontraumatic osteonecrosis of the femoral head （NONFH） is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, how...Background： Nontraumatic osteonecrosis of the femoral head （NONFH） is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population. Methods： A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging exalnination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein （HDL） and low-density lipoprotein （LDL） levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH. Results： NONFH was diagnosed in 218 subjects （0.725%） and the estimated NONFH cases were 8.12 million among Chinesepeople aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females （1.02% vs. 0.51%, x^2 = 24.997, P 〈 0.001 ）. Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents （0.85% vs. 0.61%,x^2= 5.847, P = 0.016）. Our multivariate regression analysis showed that high blood levels oftriglycerides, total cholesterol, LDL-cholesterol, and non-H DL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head. heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH. Conclusions： Our findings highlight that NONFH is a significantpublic health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk 展开更多
It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1...It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging(MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures(FHSP) and femoral head replacement procedures(FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.展开更多
Osteonecrosis is a phenomenon involving disruption to the vascular supply to the femoral head, resulting in articular surface collapse and eventual osteoarthritis. Although alcoholism, steroid use, and hip trauma rema...Osteonecrosis is a phenomenon involving disruption to the vascular supply to the femoral head, resulting in articular surface collapse and eventual osteoarthritis. Although alcoholism, steroid use, and hip trauma remain the most common causes, several other etiologies for osteonecrosis have been identified. Basic science research utilizing animal models and stem cell applications continue to further elucidate the pathophysiology of osteonecrosis and promise novel treatment options in the future. Clinical studies evaluating modern joint-sparing procedures have demonstrated significant improvements in outcomes, but hip arthroplasty is still the most common procedure performed in these affected younger adults. Further advances in joint-preserving procedures are required and will be widely studied in the coming decade.展开更多
Background Many potential causative factors are related to the initiation and progression of osteonecrosis of the femoral head. The aim of this research was to investigate the etiology and clinical features of osteone...Background Many potential causative factors are related to the initiation and progression of osteonecrosis of the femoral head. The aim of this research was to investigate the etiology and clinical features of osteonecrosis of the femoral head in Chinese patients. Methods From January 1990 to July 2011, 643 cases of osteonecrosis of the femoral head were investigated retrospectively to analyze the potential causative factors, age, gender, latency period, time from the onset of pain to diagnosis, and Association Research Circulation Osseous stage. Results Of 643 cases, 315 cases were bilateral and 328 cases were unilateral, with an average age of （47.55±15.27） years. In the steroid-induced group, the average age at symptom onset was （41.80±15.47） years, and the median duration from taking steroid to the onset of pain was 36 months. The underlying diseases in the steroid-induced osteonecrosis of the femoral head group consisted of autoimmune and other diseases, of which systemic lupus erythematosus was the most common. In the alcohol-induced group, the average age at onset of symptoms was （48.06±11.90） years and the median time of habitual alcohol use was 240 months. In the traumatic group, the average age was （51.43±14.23） years and the median time from trauma to the onset of pain was 20 months. In the idiopathic group, the average age was （50.33±15.88） years. Of the total of 958 hips, 647 were at stage III or IV. The stage at diagnosis was earlier in the steroid-induced group than in the alcohol-induced, traumatic, or idiopathic groups. Conclusions Steroid use is the most common cause for osteonecrosis of the femoral head in this study. The age at diaqnosis, time from the onset of pain to diaqnosis, and staqe were significantly earlier in the steroid-induced .qroup.展开更多
Objective To explore a new method for the therapy of avascular necrosis of the femoral head. Methods The recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head. The...Objective To explore a new method for the therapy of avascular necrosis of the femoral head. Methods 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 examined by RNA dot hybridization and immunohistochemical techniques. Repair of the femoral head was observed by histological and histomorphometric analysis.Results The expression of VEGF was detected in the femoral head transfected with the VEGF gene. The femoral head transfected with the VEGF gene showed a significant increase in angiogenesis 2 and 4 weeks after gene transfection and a significant increase in bone formation 6 and 8 weeks after gene transfection on histomorphometric analysis ( P <0.01).Conclusions Transfection of the VEGF gene enhances bone tissue angiogenesis. Repair of osteonecrosis could be accelerated accordingly,thus providing a potential method for therapy of osteonecrosis.展开更多
Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44...Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages. Results： No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱin 15 hips, stage Ⅲin 14 hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6 hips, stage Ⅱin 13 hips, stage Ⅲin 13 hips, stage Ⅳ in 7 hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 （ 46-89 ）, and improved to 86 （ 70-94 ） postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %. Conclusions ： Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.展开更多
High-efficiency design of a mixed-flow pump has been carried out based on numerical analysis of a three-dimensional viscous flow.For analysis,the Reynolds-averaged Navier-Stokes equations with a shear stress transport...High-efficiency design of a mixed-flow pump has been carried out based on numerical analysis of a three-dimensional viscous flow.For analysis,the Reynolds-averaged Navier-Stokes equations with a shear stress transport turbulence model were discretized by finite-volume approximations.Structured grid system was constructed in the computational domain,which has O-type grids near the blade surfaces and H/J-type grids in other regions.The numerical results were validated with experimental data for the heads and hydraulic efficiencies at different flow coefficients.The hydraulic efficiency at the design flow coefficient was evaluated with variation of the geometric variables,i.e.,the area of the discharge and length of the vane in the diffuser.The result has shown that the hydraulic efficiency of a mixed-flow pump at the design condition is improved by the modification of the geometry.展开更多
Objective To review the recent developments in the mechanisms of glucocorticoids induced osteonecrosis of femoral head （ONFH） and introduce a new theory of ONFH.Data sources Both Chinese- and English-language litera...Objective To review the recent developments in the mechanisms of glucocorticoids induced osteonecrosis of femoral head （ONFH） and introduce a new theory of ONFH.Data sources Both Chinese- and English-language literatures were searched using MEDLINE （1997-2011）,Pubmed （1997-2011 ） and the Index of Chinese-language Literature （1997-2011 ）.Study selection Data from published articles about mechanisms of glucocorticoids induced ONFH in recent domestic and foreign literature were selected.Data extraction Data were mainly extracted from 61 articles which are listed in the reference section of this review.Results Glucocorticoids are steroid hormones secreted by the adrenal cortex that play a pivotal role in the regulation of a variety of developmental,metabolic and immune functions.However,high dose of exogenous glucocorticoids usage is the most common non-traumatic cause of ON FH.Glucocorticoids can affect the metabolisms of osteoblasts,osteoclasts,bone marrow stromal cells and adipocytes which decrease osteoblasts formation but increase adipocytes formation and cause ONFH finally.Conclusions Glucocorticoids affect the differentiation of mesenchymal stem cells,through activating or inhibiting the related transcript regulators of osteogenesis and adipogenesis.At last,the size and volume of mesenchymal stem cells derived adipocytes will increase amazingly,but the osteoblasts will be decreased obviously.In the meantime,the activity of the osteoclasts will be activated.So,these mechanisms work together and lead to ONFH.展开更多
Thinopyrum elongatum （2n = 2x = 14, EE）, a wild relative of wheat, has been suggested as a potentially novel source of resistance to several major wheat diseases including Fusarium Head Blight （FHB）. In this study...Thinopyrum elongatum （2n = 2x = 14, EE）, a wild relative of wheat, has been suggested as a potentially novel source of resistance to several major wheat diseases including Fusarium Head Blight （FHB）. In this study, a series of wheat （cv. Chinese Spring, CS） substitution and ditelosomic lines, including Th. elongatum additions, were assessed for Type II resistance to FHB. Results indicated that the lines containing chromosome 7E of Th. elongatum gave a high level of resistance to FHB, wherein the infection did not spread beyond the inoculated floret. Furthermore, it was determined that the novel resistance gene（s） of 7E was located on the short-ann （7ES） based on sharp difference in FHB resistance between the two 7E ditelosomic lines for each arm. On the other hand, Th. elongatum chromosomes 5E and 6E likely contain gene（s） for susceptibility to FHB because the disease spreads rapidly within the inoculated spikes of these lines. Genomic in situ hybridization （GISH） analysis revealed that the alien chromosomes in the addition and substitution lines were intact, and the lines did not contain discernible genomic aberrations. GISH and multicolor-GISH analyses were further performed on three trans- location lines that also showed high levels of resistance to FHB. Lines TA3499 and TA3695 were shown to contain one pair of wheat-Th. elongatum translocated chromosomes involving fragments of 7D plus a segment of the 7E, while line TA3493 was found to contain one pair of wheat-Th, elongatum translocated chromosomes involving the D- and A-genome chromosomes of wheat. Thus, this study has established that the short-arm of chromosome 7E of Th. elongatum harbors gene（s） highly resistant to the spreading of FHB, and chromatin of 7E introgressed into wheat chromosomes largely retained the resistance, implicating the feasibility of using these lines as novel material for breeding FHB-resistant wheat cultivars.展开更多
Background： Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective...Background： Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods： A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up （WFU） group or telephone follow-up （TFU） group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results： Time consumption in WFU group for each patient （23.36 ± 6.16 min） was significantly shorter than that in TFU group （42.89 ± 7.15 min） （P 〈 0.001 ）; total economic cost in WFU group （RMB 90 Yuan） was much lower than that in TFU group （RMB 196 Yuan）. Lost-to-follow-up rate in the WFU group was 7.02% （4/57） compared with TFU group, 9.80% （5/51 ）, while no significance was observed （95% confidence interval [CI]： 0.176-2.740; P = 0.732）. The overall satisfaction rate in WFU group was 94.34% （50/53） compared with 80.43% （37/46） in TFU group （95% CI： 0.057-0.067; P = 0.034）. Conclusions： The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions.展开更多
Fusarium head blight(FHB) or scab caused by Fusarium graminearum is a major threat to wheat production in China as well as in the world. To combat this disease, multiple efforts have been carried out internationally. ...Fusarium head blight(FHB) or scab caused by Fusarium graminearum is a major threat to wheat production in China as well as in the world. To combat this disease, multiple efforts have been carried out internationally. In this article, we review our long-time effort in identifying the resistance genes and dissecting the resistance mechanisms by both forward and reverse genetics approaches in the last two decades. We present recent progress in resistance QTL identification, candidate functional gene discovery, marker-assisted improvement of FHB resistant varieties, and findings in investigating association of signal molecules, such as Ca^(++),SA, JA, and ET, with FHB response, with the assistance from rapidly growing genomics platforms. The information will be helpful for designing novel and efficient approaches to curb FHB.展开更多
Objective： This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head （ONFH） base...Objective： This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head （ONFH） based on a comprehensive analysis of the clinical literature. Data Sources： For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words： ＆quot;corticosteroid＆quot;, ＆quot;osteonecrosis of the femoral head＆quot;,＆quot;risk factors＆quot;, ＆quot;diagnosis＆quot;, ＆quot;prognosis＆quot;, and ＆quot;treatment＆quot;. Study Selection： Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed. Results： The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living. Conclusions： Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.展开更多
Objective： To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head （ONFH） and review its significance in disease diagnosis and treatment selection. Data Sources： A search for eli...Objective： To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head （ONFH） and review its significance in disease diagnosis and treatment selection. Data Sources： A search for eligible studies was conducted in three electronic databases including PubMed, Cochrane Library, and Embase up to August 10, 2018, using the following keywords： ＂osteonecrosis＂, ＂prognosis＂, and ＂treatment＂. Study Selection： Investigations appraising the clinical signs, symptoms, and imaging manifestations in different stages of ONFH were included. Articles evaluating the prognosis of various joint-preserving procedures were also reviewed. Results： The pericollapse stage refers to a continuous period in the development of ONFH from the occurrence of subchondral fracture to early collapse （〈2 mm）, possessing specific imaging features that mainly consist of bone marrow edema and joint effusion on magnetic resonance imaging （MR1）, crescent signs on X-ray films, and clinical manifestations such as the sudden worsening of hip pain. Accumulating evidence has indicated that these findings may be secondary to the changes after subchondral fractures. Of note. computed tomography provides more information for identifying possible subchondral fractures than does MRI and serves as the most sensitive tool for grading the pericollapse lesion stage. The pericollapse stage may indicate a high possibility of progressive disease but also demonstrates satisfactory long- and medium-term outcomes fbr joint-preserving techniques. In tact, if the articular surface subsides more than 2 mm, total hip arthroplasty is preferable. Conclusions： The pericollapse stage with distinct clinical and imaging characteristics provides a last good opportunity for the use of joint-preserving techniques. It is necessary to separate the pericollapse stage as an independent state in evaluating the natural progression of ONFH and selecting an appropriate treatment regimen.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
文摘Background： Nontraumatic osteonecrosis of the femoral head （NONFH） is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population. Methods： A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging exalnination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein （HDL） and low-density lipoprotein （LDL） levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH. Results： NONFH was diagnosed in 218 subjects （0.725%） and the estimated NONFH cases were 8.12 million among Chinesepeople aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females （1.02% vs. 0.51%, x^2 = 24.997, P 〈 0.001 ）. Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents （0.85% vs. 0.61%,x^2= 5.847, P = 0.016）. Our multivariate regression analysis showed that high blood levels oftriglycerides, total cholesterol, LDL-cholesterol, and non-H DL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head. heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH. Conclusions： Our findings highlight that NONFH is a significantpublic health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk
文摘It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging(MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures(FHSP) and femoral head replacement procedures(FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.
文摘Osteonecrosis is a phenomenon involving disruption to the vascular supply to the femoral head, resulting in articular surface collapse and eventual osteoarthritis. Although alcoholism, steroid use, and hip trauma remain the most common causes, several other etiologies for osteonecrosis have been identified. Basic science research utilizing animal models and stem cell applications continue to further elucidate the pathophysiology of osteonecrosis and promise novel treatment options in the future. Clinical studies evaluating modern joint-sparing procedures have demonstrated significant improvements in outcomes, but hip arthroplasty is still the most common procedure performed in these affected younger adults. Further advances in joint-preserving procedures are required and will be widely studied in the coming decade.
文摘Background Many potential causative factors are related to the initiation and progression of osteonecrosis of the femoral head. The aim of this research was to investigate the etiology and clinical features of osteonecrosis of the femoral head in Chinese patients. Methods From January 1990 to July 2011, 643 cases of osteonecrosis of the femoral head were investigated retrospectively to analyze the potential causative factors, age, gender, latency period, time from the onset of pain to diagnosis, and Association Research Circulation Osseous stage. Results Of 643 cases, 315 cases were bilateral and 328 cases were unilateral, with an average age of （47.55±15.27） years. In the steroid-induced group, the average age at symptom onset was （41.80±15.47） years, and the median duration from taking steroid to the onset of pain was 36 months. The underlying diseases in the steroid-induced osteonecrosis of the femoral head group consisted of autoimmune and other diseases, of which systemic lupus erythematosus was the most common. In the alcohol-induced group, the average age at onset of symptoms was （48.06±11.90） years and the median time of habitual alcohol use was 240 months. In the traumatic group, the average age was （51.43±14.23） years and the median time from trauma to the onset of pain was 20 months. In the idiopathic group, the average age was （50.33±15.88） years. Of the total of 958 hips, 647 were at stage III or IV. The stage at diagnosis was earlier in the steroid-induced group than in the alcohol-induced, traumatic, or idiopathic groups. Conclusions Steroid use is the most common cause for osteonecrosis of the femoral head in this study. The age at diaqnosis, time from the onset of pain to diaqnosis, and staqe were significantly earlier in the steroid-induced .qroup.
基金ThisstudywassupportedbyagrantfromtheNationalNaturalScienceFoundationofChina (No 3 0 170 945 )
文摘Objective To explore a new method for the therapy of avascular necrosis of the femoral head. Methods 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 examined by RNA dot hybridization and immunohistochemical techniques. Repair of the femoral head was observed by histological and histomorphometric analysis.Results The expression of VEGF was detected in the femoral head transfected with the VEGF gene. The femoral head transfected with the VEGF gene showed a significant increase in angiogenesis 2 and 4 weeks after gene transfection and a significant increase in bone formation 6 and 8 weeks after gene transfection on histomorphometric analysis ( P <0.01).Conclusions Transfection of the VEGF gene enhances bone tissue angiogenesis. Repair of osteonecrosis could be accelerated accordingly,thus providing a potential method for therapy of osteonecrosis.
文摘Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages. Results： No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱin 15 hips, stage Ⅲin 14 hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6 hips, stage Ⅱin 13 hips, stage Ⅲin 13 hips, stage Ⅳ in 7 hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 （ 46-89 ）, and improved to 86 （ 70-94 ） postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %. Conclusions ： Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.
基金supported by the Korea Institute of Industrial Technology Evaluation and Planning (ITEP) grant funded by the Ministry of Knowledge Economy (Grant No.10031771)
文摘High-efficiency design of a mixed-flow pump has been carried out based on numerical analysis of a three-dimensional viscous flow.For analysis,the Reynolds-averaged Navier-Stokes equations with a shear stress transport turbulence model were discretized by finite-volume approximations.Structured grid system was constructed in the computational domain,which has O-type grids near the blade surfaces and H/J-type grids in other regions.The numerical results were validated with experimental data for the heads and hydraulic efficiencies at different flow coefficients.The hydraulic efficiency at the design flow coefficient was evaluated with variation of the geometric variables,i.e.,the area of the discharge and length of the vane in the diffuser.The result has shown that the hydraulic efficiency of a mixed-flow pump at the design condition is improved by the modification of the geometry.
文摘Objective To review the recent developments in the mechanisms of glucocorticoids induced osteonecrosis of femoral head （ONFH） and introduce a new theory of ONFH.Data sources Both Chinese- and English-language literatures were searched using MEDLINE （1997-2011）,Pubmed （1997-2011 ） and the Index of Chinese-language Literature （1997-2011 ）.Study selection Data from published articles about mechanisms of glucocorticoids induced ONFH in recent domestic and foreign literature were selected.Data extraction Data were mainly extracted from 61 articles which are listed in the reference section of this review.Results Glucocorticoids are steroid hormones secreted by the adrenal cortex that play a pivotal role in the regulation of a variety of developmental,metabolic and immune functions.However,high dose of exogenous glucocorticoids usage is the most common non-traumatic cause of ON FH.Glucocorticoids can affect the metabolisms of osteoblasts,osteoclasts,bone marrow stromal cells and adipocytes which decrease osteoblasts formation but increase adipocytes formation and cause ONFH finally.Conclusions Glucocorticoids affect the differentiation of mesenchymal stem cells,through activating or inhibiting the related transcript regulators of osteogenesis and adipogenesis.At last,the size and volume of mesenchymal stem cells derived adipocytes will increase amazingly,but the osteoblasts will be decreased obviously.In the meantime,the activity of the osteoclasts will be activated.So,these mechanisms work together and lead to ONFH.
基金supported by the grant of the National High Technology Research and Development Program("863"Program)of China(No.2011AA100101)
文摘Thinopyrum elongatum （2n = 2x = 14, EE）, a wild relative of wheat, has been suggested as a potentially novel source of resistance to several major wheat diseases including Fusarium Head Blight （FHB）. In this study, a series of wheat （cv. Chinese Spring, CS） substitution and ditelosomic lines, including Th. elongatum additions, were assessed for Type II resistance to FHB. Results indicated that the lines containing chromosome 7E of Th. elongatum gave a high level of resistance to FHB, wherein the infection did not spread beyond the inoculated floret. Furthermore, it was determined that the novel resistance gene（s） of 7E was located on the short-ann （7ES） based on sharp difference in FHB resistance between the two 7E ditelosomic lines for each arm. On the other hand, Th. elongatum chromosomes 5E and 6E likely contain gene（s） for susceptibility to FHB because the disease spreads rapidly within the inoculated spikes of these lines. Genomic in situ hybridization （GISH） analysis revealed that the alien chromosomes in the addition and substitution lines were intact, and the lines did not contain discernible genomic aberrations. GISH and multicolor-GISH analyses were further performed on three trans- location lines that also showed high levels of resistance to FHB. Lines TA3499 and TA3695 were shown to contain one pair of wheat-Th. elongatum translocated chromosomes involving fragments of 7D plus a segment of the 7E, while line TA3493 was found to contain one pair of wheat-Th, elongatum translocated chromosomes involving the D- and A-genome chromosomes of wheat. Thus, this study has established that the short-arm of chromosome 7E of Th. elongatum harbors gene（s） highly resistant to the spreading of FHB, and chromatin of 7E introgressed into wheat chromosomes largely retained the resistance, implicating the feasibility of using these lines as novel material for breeding FHB-resistant wheat cultivars.
基金This work was partially supported by a grant from the National Natural Science Foundation of China （No. 81072224）.
文摘Background： Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods： A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up （WFU） group or telephone follow-up （TFU） group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results： Time consumption in WFU group for each patient （23.36 ± 6.16 min） was significantly shorter than that in TFU group （42.89 ± 7.15 min） （P 〈 0.001 ）; total economic cost in WFU group （RMB 90 Yuan） was much lower than that in TFU group （RMB 196 Yuan）. Lost-to-follow-up rate in the WFU group was 7.02% （4/57） compared with TFU group, 9.80% （5/51 ）, while no significance was observed （95% confidence interval [CI]： 0.176-2.740; P = 0.732）. The overall satisfaction rate in WFU group was 94.34% （50/53） compared with 80.43% （37/46） in TFU group （95% CI： 0.057-0.067; P = 0.034）. Conclusions： The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions.
基金supported by National Key Research and Development Program (2016YFD0101802, 2016YFD0101004)National Basic Research Program of China (2004CB117205, 2012CB125902)+5 种基金National Key Technology R&D Program of China (2002AA224161)National Science and Technology Major Project (2009ZX08009-049B, 2012ZX08009003)Jiangsu Collaborative Innovation Initiative for Modern Crop Production,'111' project B08025Natural Science Foundation of Jiangsu Province (BK20131316)Innovation Team Program for Jiangsu Universities (2014)the long-term funding from the National Science Foundation of China (30025030,30430440,30721140555,31030054,30671295)
文摘Fusarium head blight(FHB) or scab caused by Fusarium graminearum is a major threat to wheat production in China as well as in the world. To combat this disease, multiple efforts have been carried out internationally. In this article, we review our long-time effort in identifying the resistance genes and dissecting the resistance mechanisms by both forward and reverse genetics approaches in the last two decades. We present recent progress in resistance QTL identification, candidate functional gene discovery, marker-assisted improvement of FHB resistant varieties, and findings in investigating association of signal molecules, such as Ca^(++),SA, JA, and ET, with FHB response, with the assistance from rapidly growing genomics platforms. The information will be helpful for designing novel and efficient approaches to curb FHB.
基金This study was supported by grants from the National Natura1 Science Foundation of China(No.81372013 and No.81672236)China-Japan Friendship Hospital Youth Science and Technology Excellence Proiect(No.2014-QNYC-A-06).
文摘Objective： This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head （ONFH） based on a comprehensive analysis of the clinical literature. Data Sources： For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words： ＆quot;corticosteroid＆quot;, ＆quot;osteonecrosis of the femoral head＆quot;,＆quot;risk factors＆quot;, ＆quot;diagnosis＆quot;, ＆quot;prognosis＆quot;, and ＆quot;treatment＆quot;. Study Selection： Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed. Results： The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living. Conclusions： Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.
文摘Objective： To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head （ONFH） and review its significance in disease diagnosis and treatment selection. Data Sources： A search for eligible studies was conducted in three electronic databases including PubMed, Cochrane Library, and Embase up to August 10, 2018, using the following keywords： ＂osteonecrosis＂, ＂prognosis＂, and ＂treatment＂. Study Selection： Investigations appraising the clinical signs, symptoms, and imaging manifestations in different stages of ONFH were included. Articles evaluating the prognosis of various joint-preserving procedures were also reviewed. Results： The pericollapse stage refers to a continuous period in the development of ONFH from the occurrence of subchondral fracture to early collapse （〈2 mm）, possessing specific imaging features that mainly consist of bone marrow edema and joint effusion on magnetic resonance imaging （MR1）, crescent signs on X-ray films, and clinical manifestations such as the sudden worsening of hip pain. Accumulating evidence has indicated that these findings may be secondary to the changes after subchondral fractures. Of note. computed tomography provides more information for identifying possible subchondral fractures than does MRI and serves as the most sensitive tool for grading the pericollapse lesion stage. The pericollapse stage may indicate a high possibility of progressive disease but also demonstrates satisfactory long- and medium-term outcomes fbr joint-preserving techniques. In tact, if the articular surface subsides more than 2 mm, total hip arthroplasty is preferable. Conclusions： The pericollapse stage with distinct clinical and imaging characteristics provides a last good opportunity for the use of joint-preserving techniques. It is necessary to separate the pericollapse stage as an independent state in evaluating the natural progression of ONFH and selecting an appropriate treatment regimen.
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.
