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Background This study introduces a novel approach for screening bone alterations in the femoral head and neck (H&N) of prostate cancer (PCa) and rectal cancer (RCa) patients during helical tomotherapy (HT) using megavoltage computed tomography (MVCT) images. The goal is to identify robust radiomic features (RFs) with the highest percentage changes during treatment and examine their correlation with the administered dose. Methods Reproducible RFs were identified through a test-retest analysis using a cheese phantom. This study involved 20 male patients (10 PCa, 10 RCa). The left and right femoral H&N regions were segmented on MVCT images from the initial, middle, and final HT sessions. Absolute RF values and relative percentage changes were analyzed using repeated measures analysis of variance (ANOVA). The Pearson correlation coefficient with Benjamini-Hochberg adjustment (q < 0.05) was used to evaluate the relationship between altered RFs and the dose (Gy). Results The femoral H&N had the highest relative percentage changes (RPCs) for intensity-histogram (IH) and intensity-based (IB) RFs, respectively, with texture-based RFs providing insights into radiotherapy-induced changes. Strong correlations ( r ~ -0.7) were observed between changes in H&N RFs and dose (Gy) in PCa. For RCa, IB features, including the IB_Coefficient_of_Variation ( r  = 0.54) for the neck, and IH RFs, such as IH_Minimum_Histogram_Gradient ( r = -0.51) and IB_Robust_Mean_Absolute_Deviation ( r  = 0.55) for the head, showed significant correlations. Conclusions Among robust RFs, the most highly correlated with dose alterations were IB, IH, and gray-level co-occurrence matrix (GLCM)-based RFs. The RFs at mid- and end-treatment varied with dose fractionation. Percentage changes in robust MVCT features during HT may serve as early markers.

Insufficient femoral head-neck offset is common in femoroacetabular impingement (FAI) and reflected by the alpha angle, a validated measurement for quantifying this anatomic deformity in patients with FAI. We compared the alpha angle determined on magnetic resonance imaging (MRI) oblique axial plane images with the maximal alpha angle value obtained using radial images. The MRIs of 41 subjects with clinically suspected FAI were reviewed and alpha angle measurements were performed on both oblique axial plane images parallel to the long axis of the femoral neck and radial images obtained using the center of the femoral neck as the axis of rotation. The mean oblique axial plane and mean maximal radial alpha angle values were 53.4° and 70.5°, respectively. In 54% of subjects, the alpha angle was less than 55° on the conventional oblique axial plane image but 55° or greater on the radial plane images. Radial images yielded higher alpha angle values than oblique axial images. Patients with clinically suspected FAI may have a substantial contour abnormality that can be underestimated or missed if only oblique axial plane images are reviewed. Radial plane imaging should be considered in the MRI investigation of FAI. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

The choices of the treatments for femoral neck fractures (FNF) remain controversial. The purpose of this study is to evaluate the prognoses of the variable pitch fully threaded headless cannulated screws (HCS) in the fixation of femoral neck fractures and to compare them with those of partially threaded cannulated screws (PCS). Between 1st January 2012 and 31st December 2016, there were 89 patients with the main diagnose of FNF who accepted the treatment of closed reduction cannulated screw fixation in Peking University People’s Hospital. 34 cases of PCS and 23 cases of HCS met the criterion. The characteristics, prognoses and the imaging changes of all cases were described and the differences between the two groups were compared. Statistical analyses were performed using SPSS version 23.0 (SPSS Inc., USA). Mann–Whitney U test, Analysis of Variance and Chi-square test were used. Statistical significance was defined as P value (two sided) less than 0.05. There was no significant difference in the general characteristics, fracture classifications and reduction quality between the two groups. HCS group had a significant lower angle decrease rate (30.4% vs. 58.8%, P  = 0.035), femoral neck shortening rate (26.1% vs. 52.9%, P  = 0.044) and screw back-sliding rate (21.7% vs. 50.0%, P  = 0.032), but a higher screw cut-out rate (21.7% vs. 0.0%, P  = 0.008). In non-displacement fracture subgroup, HCS had significant higher Harris Score (92 vs. 90, P  = 0.048). Compared with PCS, HCS had a lower screw back-sliding rate, femoral shortening rate, angle decrease rate and similar function score, but would result in more screw cut-outs in displaced FNF. As a conclusion, HCS should not be used in displaced FNF due to its higher screw cut-out rate, and its potential advantage in non-displaced FNF needs to be further proved. Further qualified investigations with a larger scale of patients and longer follow-up are needed in the future.

Objectives We examined the association between long-term bisphosphonates use and morphological change in the femur. Methods 140 patients (97.1% female, 70.8 ± 8.7 years) with over 5-year BP use (8.1 ± 2.4 years) were matched 1:1 for age (± 3), same BMD status with patients as a control group. The primary outcome was femoral lateral bowing (FLB). The hip–knee–shaft angle (HKSA) and femoral neck shaft angle (FNSA) were secondary outcomes. Results Compared with the Control group, the femoral lateral bowing and hip–knee–shaft angle (5.9 ± 4.3° vs. 3.7 ± 1.7°; 6.6 ± 2.6° vs. 5.1 ± 1.5°, respectively) were significantly larger, while the femoral neck shaft angle was significantly lower (128.1 ± 3.4° vs. 129.3 ± 2.5°) in the BP group. The correlation analysis shows there is a positive correlation between the BP therapy time and FLB ( r  = 0.2566, P  < 0.01), HKSA ( r  = 0.1353, P  = 0.1325), while negative correlation between the BP therapy time and FNSA ( r  = − 0.1637, P  = 0.0681) without significance, indicating that the longer BP therapy, the larger the lateral bowing of the femur. Conclusions Patients who took bisphosphonates over 5 years have a larger femoral lateral bowing, hip–knee–shaft angle and a smaller femoral neck shaft angle than control patients.

Chronic pediatric inflammatory bowel disease (IBD) leads to lack of bone accrual, bone loss, and increased fractures. Presently there is no cure, and many IBD treatments incur negative side effects. We previously discovered treatment with exogenous irisin resolved inflammatory changes in the colon, gut lymphatics, and bone in a mild IBD rodent model. Here we assess irisin treatment in severe IBD induced via dextran sodium sulfate (DSS). Male Sprague Dawley rats (2-mo-old) were untreated (Con) or given 2% DSS in drinking water. In week two, half of each group (Con + Ir and DSS + Ir) received injections of recombinant irisin (i.p., 2x/wk). After 4 weeks, gut inflammation was associated with declines in bone mineral density and cancellous bone volume. Furthermore, elevated osteocyte TNF-α, interleukin-6, RANKL, OPG, and sclerostin corresponded with higher osteoclast surfaces and lower bone formation rate in DSS animals as well as lower ultimate load. While irisin treatment improved colon inflammation, there were no improvements in bone density or bone mechanical properties; however, irisin elevated bone formation rate, decreased osteoclast surfaces, and reduced osteocyte pro-inflammatory factors. These data highlight the negative impact of chronic gut inflammation on bone as well as the therapeutic potential of irisin as an anti-inflammatory treatment.

Background Low bone mineral density (BMD) and subsequent fractures are a major public health problem in postmenopausal women. The purpose of this study was to use the aggregate data meta-analytic approach to examine the effects of ground (for example, walking) and/or joint reaction (for example, strength training) exercise on femoral neck (FN) and lumbar spine (LS) BMD in postmenopausal women. Methods The a priori inclusion criteria were: (1) randomized controlled trials, (2) exercise intervention ≥ 24 weeks, (3) comparative control group, (4) postmenopausal women, (5) participants not regularly active, i.e., less than 150 minutes of moderate intensity (3.0 to 5.9 metabolic equivalents) weight bearing endurance activity per week, less than 75 minutes of vigorous intensity (> 6.0 metabolic equivalents) weight bearing endurance activity per week, resistance training < 2 times per week, (6) published and unpublished studies in any language since January 1, 1989, (7) BMD data available at the FN and/or LS. Studies were located by searching six electronic databases, cross-referencing, hand searching and expert review. Dual selection of studies and data abstraction were performed. Hedge’s standardized effect size ( g ) was calculated for each FN and LS BMD result and pooled using random-effects models. Z -score alpha values, 95%confidence intervals (CI) and number-needed-to-treat (NNT) were calculated for pooled results. Heterogeneity was examined using Q and I 2 . Mixed-effects ANOVA and simple meta-regression were used to examine changes in FN and LS BMD according to selected categorical and continuous variables. Statistical significance was set at an alpha value ≤0.05 and a trend at >0.05 to ≤ 0.10. Results Small, statistically significant exercise minus control group improvements were found for both FN (28  g’s , 1632 participants, g  = 0.288, 95% CI = 0.102, 0.474, p  = 0.002, Q = 90.5, p  < 0.0001, I 2  = 70.1%, NNT = 6) and LS (28  g’s , 1504 participants, g  = 0.179, 95% CI = −0.003, 0.361, p  = 0.05, Q = 77.7, p  < 0.0001, I 2  = 65.3%, NNT = 6) BMD. Clinically, it was estimated that the overall changes in FN and LS would reduce the 20-year relative risk of osteoporotic fracture at any site by approximately 11% and 10%, respectively. None of the mixed-effects ANOVA analyses were statistically significant. Statistically significant, or a trend for statistically significant, associations were observed for changes in FN and LS BMD and 20 different predictors. Conclusions The overall findings suggest that exercise may result in clinically relevant benefits to FN and LS BMD in postmenopausal women. Several of the observed associations appear worthy of further investigation in well-designed randomized controlled trials.

The purpose of the present study was to reveal the relationship between degenerative changes in the cervical spine, head and neck postures, neck pain, and bone mineral density (BMD) of the total hip, femoral neck, and lumbar spine in post-menopausal females. In total, 116 females (mean age 60.4 ± 7.1 years; age range 50–80 years) were included. Participants were classified into three groups based on the T-score criteria of the total hip, femoral neck, and lumbar spine set by World Health Organization, respectively. The degree of neck pain was assessed using self-administered questionnaire, the Neck Disability Index. Cervical spine degeneration and head and neck postures were identified using the lateral cephalograms. Grading system for cervical degeneration included three categories of the radiographic alterations including disc height loss, osteophyte formation, and diffuse sclerosis. The areal BMD of the total hip, femoral neck, and lumbar spine were determined using dual-energy x-ray absorptiometry. Females with lower BMD exhibited lesser degree of neck pain and forward head posture (FHP) compared to those with normal BMD. Higher BMD seemed to be associated with more notable loss of the disc height at the level of C4-5. More prominent degenerative changes in the cervical spine were associated with higher areal BMD of the hip, femoral neck, and lumbar spine, altered head posture, and development of neck pain.

This study investigated bone regeneration in the femoral neck canal of osteoporotic rats using a novel animal model. A calcium sulphate (CS)/hydroxyapatite (HA) carrier was used to deliver a bisphosphonate, zoledronic acid (ZA), locally, with or without added recombinant human bone morphogenic protein-2 (rhBMP-2). Twenty-eight-week-old ovariectomized Sprague–Dawley rats were used. A 1 mm diameter and 8 mm long defect was created in the femoral neck by drilling from the lateral cortex in the axis of the femoral neck, leaving the surrounding cortex intact. Three treatment groups and one control group were used: (1) CS/HA alone, (2) CS/HA + ZA (10 μg) (3) CS/HA + ZA (10 μg) + rhBMP-2 (4 μg), and (4) empty defect (control). The bone formation was assessed at 4 weeks post surgery using in vivo micro computed tomography (micro-CT). At 8 weeks post surgery, the animals were sacrificed, and both defect and contralateral femurs were subjected to micro-CT, mechanical testing, and histology. Micro-CT results showed that the combination of CS/HA with ZA or ZA + rhBMP-2 increased the bone formation in the defect when compared to the other groups and to the contralateral hips. Evidence of new dense bone formation in CS/HA + ZA and CS/HA + ZA + rhBMP-2 groups was seen histologically. Mechanical testing results showed no differences in the load to fracture between the treatments in either of the treated or contralateral legs. The CS/HA biomaterial can be used as a carrier for ZA and rhBMP-2 to regenerate bone in the femoral neck canal of osteoporotic rats.

Silver coating has demonstrated good antimicrobial activity and low toxicity. Silver-coated megaprostheses have been introduced in oncological musculoskeletal surgery considering the high rate of infection. We conducted a retrospective analysis on 68 cases of primary or metastatic bone tumors, affecting the proximal femur, treated between 2005 and 2016 with wide margins resection and tumor implants reconstruction. All patients were treated by the same surgeon, with antibiotic prophylaxis according to a standard protocol. In 55.9% of patients silver-coated hip hemiarthroplasty was implanted; in the remaining 44.1% uncoated megaprostheses were implanted. Patients were reevaluated recording the complications and focusing the analysis on infective complications. The average follow-up was 46.5 months. No patient has shown any sign of local or general silver toxicity. A SEM analysis was conducted on the 3-silver-coated hip hemiarthroplasty explanted confirming a severe degradation with a small amount of residual silver on the coating surface. Silver-coated hip prostheses have a lower rate of early infection than traditional implants but showed a reduction of antimicrobial activity for silver coating wear. We recommend using silver-coated prosthesis as primary implants for limb salvage surgery, in primary or metastatic bone tumors affecting the proximal femur, considering the absence of signs of toxicity and the lower rate of early infection.

Background Femoroacetabular impingement (FAI) has been recognized as a common cause of hip pain as well as a cause of hip arthritis, yet despite this, little is known about the etiology of the cam morphology or possible risk factors associated with its development. Questions/purposes The purposes of our study were to determine when the cam morphology associated with FAI developed in a cross-sectional cohort study of pediatric patients pre- and postphyseal closure using MRI and whether increased activity level during the period of physeal closure is associated with an increased likelihood that the cam deformity will develop. Methods Alpha angles were measured at the 3 o’clock (anterior head-neck junction) and 1:30 (anterosuperior head-neck junction) positions in both hips with a cam deformity defined as an alpha angle ≥ 50.5° at the 3 o’clock position. Forty-four volunteers (88 hips) were studied: 23 with open physes (12 females, mean age 9.7 years; 11 males, age 11.7 years) and 21 with closed physes (five females, age 15.2 years; 16 males, age 16.2 years). Daily activity level using the validated Habitual Activity Estimation Scale was compared for patients in whom cam morphology did and did not develop. Results None of the 23 (0%) patients prephyseal closure had cam morphology, whereas three of 21 (14%, p = 0.02; all males) postclosure had at least one hip with cam morphology. Daily activity level was higher (p = 0.02) for patients with the cam morphology (7.1 hours versus 2.9 hours). Mean alpha angles at the 3 o’clock head-neck position were 38° (95% confidence interval [CI], 37.2°–39.1°) in the open physes group and 42° (95% CI, 40.16°–43.90°) in the closed physes group; at the 1:30 head-neck position, they were 45° (95% CI, 44.0°–46.4°) in the open physes group and 50° (47.9°–52.3°) in the closed physes group. Conclusions The fact that cam morphology was present exclusively in the closed physeal group strongly supports its development during the period of physeal closure with increased activity level as a possible risk factor. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.